Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used as part of multimodal analgesia, but their association with acute kidney injury (AKI) in patients undergoing elective surgery remains uncertain. We conducted a retrospective, propensity score-matched study at a single-center academic hospital (ChiCTR2300076725). The primary outcome was the incidence of AKI, defined by the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria, compared between patients who did and did not receive NSAIDs during surgery. Secondary outcomes included AKI severity staging and prolonged postoperative hospitalization (≥7 days). A total of 11,139 patients were included, with 3,361 in the NSAIDs group and 7,778 in the control group. After propensity score matching (PSM), 3,361 matched pairs were obtained. The incidence of postoperative AKI was comparable between the NSAIDs and control groups after matching (4.2% vs. 4.2%, p > 0.999). The distribution of AKI stages (p = 0.830) and the median duration of postoperative hospital stay were also comparable between the two groups (both 6 days, p = 0.290). Sequentially adjusted logistic regression models consistently showed no significant association between NSAIDs and AKI, AKI staging, or prolonged hospitalization, both before and after PSM. Stratified analyses by NSAID type and dose-response analyses revealed no significant association with AKI. A sensitivity analysis using complete cases without imputation (n = 9,385) yielded consistent results. In conclusion, intraoperative NSAIDs administration was not independently associated with an increased risk of postoperative AKI in patients undergoing major noncardiac surgery.

IgA nephropathy (IgAN) is the most common primary glomerulonephritis, requiring improved diagnostic tools. We analyzed three cohorts (GSE37460, GSE93798, and GSE115857 are internal validation cohorts) using gene set enrichment analysis on 7751 pathways. A machine learning model was developed and externally validated in multi-cohort gene expression data (external validation cohorts are GSE99339, GSE116626, and GSE104948). Additionally, immunohistochemistry was performed to validate the expression of key biomarkers and the presence of functionally active immune cells. We developed and validated a multi-cohort machine learning diagnostic model. The selected two-step glmBoost + Enet [alpha = 0.4] model achieved high concordance in GSE37460 (κ = 0.704, p < 0.001), GSE93798 (κ = 0.486, p < 0.001), and GSE115857 (κ = 1.000, p < 0.001). Applying the same model to the external validation cohorts demonstrated strong diagnostic accuracy with AUCs of 0.938 (GSE99339), 0.871 (GSE116626), and 0.926 (GSE104948); the corresponding Kappa statistics were κ = 0.699 (p < 0.001), 0.443 (p = 0.018), and 0.615 (p = 0.023). Nine genes were identified as significant for the diagnosis of IgAN, and HLA-DRA and VASH1 emerged as robust biomarkers across the cohorts (all p < 0.05). Additionally, immunohistochemistry validation demonstrated a marked increase in HLA-DRA and VASH1 expression in IgAN patients. Immunofluorescence staining indicated a greater presence of CD4 + HLA-DRA+ functionally active/activated CD4+ T cells in IgAN tissues than in controls. This study delivers a reproducible 9-gene machine-learning classifier for precise IgA nephropathy diagnosis and highlights HLA-DRA and VASH1 as promising biomarkers.

Optimal regional citrate anticoagulation (RCA) for hemodialysis (HD) in high-bleeding-risk patients remains undefined. This prospective observational cohort study included 195 high-bleeding-risk patients (481 HD sessions) allocated to three RCA groups: RCA-one (prefilter citrate only, 141 patients/337 sessions), RCA-two (pre- and post-filter citrate, 51 patients/133 sessions), and RCA+saline (prefilter citrate + post-filter saline, 3 patients/11 sessions). Primary outcome: circuit survival time; secondary outcomes: complete dialysis rate, clotting scores, and adverse events. RCA-two had the highest complete dialysis rate (99.7% vs. 97.0% [RCA-one], 97.7% [RCA+saline]; p = .037) and lowest venous expansion chamber serious clotting (score = 3: 5.4% vs. 16.9%, 30.0%; p < .001). Non-severe venous clotting (score < 3) was highest in RCA-two (94.6% vs. 83.1%, 70%; p < .001), with no intergroup differences in dialyzer clotting (score < 3: 96.1% vs. 95.3%, 90%; p = .83). RCA-two had the lowest adverse event rate (1.8% vs. 10.8%, 11.1%; p = .001), including less hypotension (0.9% vs. 7.6%, 2.0%; p = .023) and no muscle cramps. Venous pretreatment calcium in RCA-two decreased at 2 h (p = .03) without serious electrolyte/acid-base imbalances. Circuit survival time did not differ among groups (p > .05). RCA is safe and effective for high-bleeding-risk HD patients. RCA-two (pre- and post-filter citrate) offers advantages in venous anticoagulation and safety but requires confirmation in large randomized trials.

Peritoneal dialysis (PD) transforms the peritoneum into a dynamic therapeutic interface, with each exchange offering direct access to molecular and cellular signals from the peritoneal cavity. Among these, extracellular vesicles (EVs) have emerged as stable, information-rich messengers reflecting peritoneal health, inflammation, and fibrosis. The review explores the peritoneum as a living therapeutic interface, summarizing current evidence on EV biology, their molecular cargo, and potential roles in monitoring inflammation, fibrosis, and membrane function. It also discusses existing knowledge gaps, technological advances, and opportunities for translating EV research into clinical practice.

Objective This study investigates the dyadic mechanisms linking social support, coping styles, quality of life (QoL), and caregiver burden among maintenance hemodialysis (MHD) patient-caregiver dyads, with a focus on the mediating role of adaptive coping strategies. Method In a cross-sectional design, 200 patient—caregiver dyads with MHD completed self—report measures of QoL, caregiver burden, coping style and social support. Mediation analysis was performed using actor—partner interdependence model extended to mediation (APIMeM) and the bootstrapping method. Bias-corrected 95% confidence intervals were calculated for the study of direct and indirect effects. Results Significant actor effects were observed: patients’ social support directly associated with improved their QoL (β = 0.224, p = 0.001), while caregivers’ support associated with reduced their burden (β = −0.141, p = 0.001). Adaptive coping mediated 46.2% of patient QoL variance via actor effects (total indirect β = 0.288) and 25.0% of caregiver burden reduction via actor effects (total indirect β = −0.047). Partner effects revealed cross-dyad influences: caregivers’ support associated with enhanced patient QoL (β = 0.239, p = 0.002), and patients’ support associated with reduced caregiver burden (β = −0.475, p = 0.001). Key mediation pathways included caregivers’ support affecting patient QoL via caregivers’ coping (β = 0.050, 95% CI [0.005, 0.103]) and patients’ support affecting caregiver burden via caregivers’ coping (β = −0.164, 95% CI [−0.236, −0.103]). Conclusions Enhancing social support networks and fostering adaptive coping strategies through dyad-centered programs may synergistically alleviate caregiver burden and improve patient QoL.

Objective To investigate the relationships between Subjective Global Assessment (SGA)-determined nutritional status and cardiac index (CI), protein-energy wasting (PEW), prognostic factors, and clinical parameters in peritoneal dialysis patients with end-stage renal disease (ESRD). Methods A total of 80 ESRD patients treated between December 2019 and December 2021 were categorized into well-nourished (n = 36) and malnourished (n = 44) groups based on SGA scoring. Nutritional status, CI, and PEW were assessed. Clinical parameters and prognostic factors, including C-reactive protein (CRP), fetuin-A, and interleukin-6 (IL-6), were measured. Multivariate logistic regression and Spearman’s correlation analyses were employed to identify independent influencing factors and assess variable relationships. Results Significant intergroup differences (p < 0.05) were observed for PEW prevalence, CI, CRP, fetuin-A, IL-6, serum creatinine, and albumin levels. Binary logistic regression identified PEW status, CI, fetuin-A, IL-6, serum creatinine, and albumin levels as independent factors associated with malnutrition. Spearman’s correlation analysis revealed strong positive correlations between SGA scores and PEW prevalence, CI, fetuin-A, IL-6, serum creatinine, and albumin (all p < 0.001). The combined prognostic model demonstrated excellent discriminatory power, with an area under the curve (AUC) of 0.960 (p < 0.05). Conclusion SGA-determined nutritional status significantly influences CI, PEW development, and key clinical biomarkers in ESRD patients. Systematic assessment of these parameters provides valuable prognostic stratification and can guide therapeutic interventions for malnutrition management in this population.

Medical education increasingly incorporates digital technologies; however, many tools remain passive and text-based. Vibe Coding is a clinician-led design framework that embeds expert reasoning and the cognitive ‘feel’ of clinical decision-making into interactive educational tools. This study demonstrates its application in nephrology training through the rapid development of open-source, AI-assisted, web-based applications. We conducted a proof-of-concept development study using a structured, physician-led, AI-assisted process combining (1) deconstruction of clinical algorithms, (2) natural-language-to-code generation with modern large language models, and (3) iterative refinement of user interfaces. The target audience included nephrology trainees and educators, with source content derived from peer-reviewed educational literature. Four open-source, web-based applications were developed: (1) Kidney Stone Navigator for 24-hour urine analysis interpretation, (2) NephroFlow CKRT Clinical Copilot for dose and anticoagulation management, (3) Renal Tubular Acidosis Diagnostic Assistant for algorithmic diagnosis, and (4) Interactive Guide to Disorders of Volume for dynamic visualization of pathophysiology. Each tool mirrored expert reasoning, integrated automated calculations, and was publicly released on GitHub with live deployment for global educational use. Clinician-led, AI-assisted development enables the translation of static educational materials into interactive, open-access tools. The Vibe Coding framework demonstrates a scalable, reproducible model for innovation in medical education and supports transparent digital scholarship in nephrology.

Recombinant human erythropoietin (rhEPO) fused with human immunoglobulin G (IgG) Fc fragment (rhEPO-Fc) is a novel erythropoiesis-stimulating agent designed to extend plasma half-life and enhance biological activity. However, data on the efficacy and safety of rhEPO-Fc in hemodialysis patients with chronic kidney disease (CKD)-related anemia remain limited. This phase 3 trial enrolled patients from 45 Chinese hospitals. Participants were randomized (2:1) to receive either rhEPO-Fc or rhEPO (Chinese hamster ovary cell-derived) for 28 weeks. The rhEPO-Fc responders were eligible for a 24-week extension period. The primary endpoint was the least square mean (LSM) change in hemoglobin (Hb) levels from baseline between weeks 21 and 28. Among 356 rhEPO-Fc and 178 rhEPO recipients, patients receiving rhEPO-Fc demonstrated non-inferiority Hb maintenance compared with rhEPO. The inter-group LSM differences in the full analysis set and per-protocol set were 3.96 g/L (95% CI: 3.02–4.89; p < 0.001) and 2.27 g/L (95% CI: 0.60–3.95; p = 0.008), respectively. Adverse drug reaction rates were comparable (rhEPO-Fc: 39.2% vs. rhEPO: 40.2%). Dose adjustments due to treatment-emergent adverse events were significantly lower with rhEPO-Fc (0.0% vs. 2.2%; p < 0.05). Deaths unrelated to the study drugs occurred in two rhEPO-Fc and four rhEPO patients. These findings indicated that rhEPO-Fc effectively maintained Hb levels in patients with CKD anemia undergoing hemodialysis, showing comparable efficacy to rhEPO with reduced dosing frequency and a similar safety profile.

Diabetic kidney disease (DKD) is a common complication, affecting approximately 40% of patients with diabetes and imposing substantial health and economic burdens worldwide. As DKD prevalence rises, existing treatments remain limited in efficacy, necessitating innovative therapeutic strategies. Soluble guanylate cyclase (sGC) modulators, including activators and stimulators, have emerged as promising treatments by enhancing cyclic guanosine monophosphate production, thereby exerting vasodilatory, anti-inflammatory, and anti-fibrotic effects. Preclinical studies have demonstrated their efficacy in improving renal function and reducing proteinuria in DKD models. Notably, clinical trials involving sGC activators, such as avenicguat, suggest potential benefits in managing DKD, particularly in combination with renin-angiotensin-aldosterone system inhibitors. While initial findings indicate renal protection and good tolerability, further large-scale studies are needed to confirm long-term efficacy and safety. The development of sGC modulators offers hope for improving DKD outcomes and reducing its global healthcare burden.