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Chronic Kidney Disease: Clinical Challenges and Management
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Chronic Kidney Disease: Clinical Challenges and Management

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nephrology & Urology".

Deadline for manuscript submissions: 30 September 2025 | Viewed by 4253

Special Issue Editors

Dr. Shuzo Kobayashi

E-Mail Website
Guest Editor
Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
Interests: vascular biology; cardiovascular disease; hemodialysis; kidney disease; regenerative medicine
Special Issues, Collections and Topics in MDPI journals
Dr. Takayasu Ohtake

E-Mail Website
Guest Editor
Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
Interests: kidney disease; regenerative medicine; hemodialysis; vascular biology; cardiovascular disease
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Chronic kidney disease (CKD) is a devastating disease which progresses to end-stage renal disease (ESRD) and has a large impact on prognosis in CKD patients via concomitant atherosclerotic cardiovascular diseases, malnutrition, inflammation, malignancy, etc. Previous large clinical trials have shown that drugs, including angiotensin converting enzyme inhibitors (ACEi), angiotensin type Ⅱ receptor blockers (ARBs), SGLT2 inhibitors, and mineral corticoid receptor antagonists (MRAs), retard the progression of CKD. However, the results are still not optimal, leading to an increase in dialysis patients worldwide. Although interventional treatment could retard the progression of CKD, improvement in kidney function (reverse kidney dysfunction), as the final goal, has not been fully achieved. Regenerative cell therapies or exosome therapies using several cell sources are emerging as new potential strategies. However, there are still challenges for human CKD.

Based on the abovementioned background, we introduce this Special Issue, entitled “Chronic Kidney Disease: Clinical Challenges and Management”, in the Journal of Clinical Medicine. As Guest Editors of this Special Issue, we invite submissions focused on treatment approaches (even if challenging and/or small clinical trials), observational research, and trials conducted by specialists in the fields of nursing, nutrition, rehabilitation, pharmacies, and multidisciplinary team approaches for CKD and comorbid diseases.

Dr. Shuzo Kobayashi
Dr. Takayasu Ohtake
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • chronic kidney disease
  • clinical trial
  • end-stage renal disease
  • kidney dysfunction
  • management
  • challenge

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (5 papers)

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Research

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17 pages, 988 KiB  
Article
Exploring the Associations Between Inflammatory Biomarkers, Survival, and Cardiovascular Events in Hemodialysis Patients and the Interrelationship with Nutritional Parameters—The Experience of a Single Transylvanian Dialysis Center
by Crina Claudia Rusu, Ina Kacso, Diana Moldovan, Alina Potra, Dacian Tirinescu, Maria Ticala, Yuriy Maslyennikov, Alexandra Urs and Cosmina Ioana Bondor
J. Clin. Med. 2025, 14(4), 1139; https://doi.org/10.3390/jcm14041139 - 10 Feb 2025
Viewed by 449
Abstract
Background/Objectives: In hemodialysis (HD), inflammatory biomarkers are discussed as prognostic markers for survival and cardiovascular events (CVEs). The results of the studies are not uniform and there are particularities related to population groups and comorbidities. In addition, it is known that inflammation determines [...] Read more.
Background/Objectives: In hemodialysis (HD), inflammatory biomarkers are discussed as prognostic markers for survival and cardiovascular events (CVEs). The results of the studies are not uniform and there are particularities related to population groups and comorbidities. In addition, it is known that inflammation determines protein malnutrition and less about the effect of adipose tissue on inflammation in HD. This study investigates the relationship between inflammatory molecules and nutritional biomarkers, and CVE and survival in HD patients. Methods: We included, in an observational, longitudinal study, 65 patients with chronic HD (53 without diabetes and 22 smokers), with a mean age of 60.1 ± 12.4 years. High-sensitivity C-reactive protein (hs-CRP), interleukin 1 beta, tumor necrosis factor alpha (TNF-alpha), interleukin 6, soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK), soluble CD163 (sCD163), and fibroblast growth factor 21 were determined. We recorded survival and cardiovascular events for 60 months. Univariate and multivariate analyses were performed. Results: Hs-CRP was significantly associated with survival (p = 0.014) in the total group. In smokers and former smokers, TNF-α lower than 368.34 pg/mL was associated with better survival. In multivariate analysis, hs-CRP was correlated with adipose tissue biomarkers (p = 0.006), and sCD163 was correlated with total and LDL cholesterol (p = 0.002). In addition, in univariate analysis, sTWEAK was correlated with serum albumin (p = 0.026, r = −0.30). In conclusion, in HD patients, hs-CRP was significantly associated with survival, and low TNF-alpha values in smokers and former smokers were linked to better survival. Hs-CRP was also correlated with adipose tissue biomarkers, CD163 was correlated with total and LDL cholesterol, and albumin was inversely associated with sTWEAK. The relation between inflammatory molecules and adipose tissue biomarkers was less identified in HD patients until now. Full article
(This article belongs to the Special Issue Chronic Kidney Disease: Clinical Challenges and Management)
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Figure 1

Figure 1
<p>Comparative survival curves between subjects with hs-CRP less than 0.3 mg/dL and those with hs-CRP greater than or equal to 0.3 mg/dL.</p> Full article ">Figure 2
<p>Comparative values of sTWEAK between subjects with diabetes mellitus and without.</p> Full article ">Figure 3
<p>Comparative survival curves between subjects with TNF-α less than 368.34 pg/mL and those with TNF-α higher or equal to 368.34 pg/mL.</p> Full article ">
11 pages, 554 KiB  
Article
Asymmetric Dimethylarginine (ADMA) as a Novel Risk Factor for Progression of Coronary Artery Calcification in Patients with Chronic Kidney Disease
by Shuzo Kobayashi, Takayasu Ohtake, Yasuhiro Mochida, Kunihiro Ishioka, Machiko Oka, Kyoko Maesato, Hidekazu Moriya and Sumi Hidaka
J. Clin. Med. 2025, 14(4), 1051; https://doi.org/10.3390/jcm14041051 - 7 Feb 2025
Viewed by 374
Abstract
Background: Vascular calcification (VC) is a characteristic feature of atherosclerosis in patients with chronic kidney disease (CKD), and coronary artery calcification (CAC) significantly impacts future cardiovascular events and mortality. Although factors associated with CAC are well reported, only a few studies have evaluated [...] Read more.
Background: Vascular calcification (VC) is a characteristic feature of atherosclerosis in patients with chronic kidney disease (CKD), and coronary artery calcification (CAC) significantly impacts future cardiovascular events and mortality. Although factors associated with CAC are well reported, only a few studies have evaluated the factors associated with the progression of CAC in pre-dialysis patients with CKD. Methods: We quantitatively evaluated CAC progression using the CAC score (CACS) measured using 16-row multi-detector computed tomography and assessed associated factors in 74 patients with CKD. Results: The median annual increase in CACS was 23.7 (IQR 2.0–73.0). CAC progression was associated with serum phosphate and plasma asymmetric dimethylarginine (ADMA) levels, an endogenous inhibitor of nitric-oxide synthase and a marker of endothelial dysfunction and atherosclerosis, in univariate analysis. Multivariate analysis revealed that ADMA is an independent risk factor for CAC progression in patients with CKD. The annual change in CACS was significantly different between patients with ADMA values <0.51 and those with ADMA values >0.51 (p < 0.05). Elevated ADMA levels were also significantly associated with estimated glomerular filtration rate (eGFR) decline in the univariate analysis. Conclusions: ADMA is a novel risk factor for CAC progression in patients with CKD. Vascular endothelial cell dysfunction, represented by elevated ADMA levels, may contribute to the progression of vascular calcification in patients with pre-dialysis CKD. Full article
(This article belongs to the Special Issue Chronic Kidney Disease: Clinical Challenges and Management)
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Figure 1

Figure 1
<p>Study protocol. Seventy-four patients were included in this study. CACS was evaluated twice with a median interval of 22.0 months (IQR 20.0–25.0).</p> Full article ">Figure 2
<p>Stratified association between ADMA and CACS progression. CAC progression was significantly different according to the stratified ADMA value. Higher ADMA was significantly associated with higher annual change in CACS compared with those in lower ADMA. * <span class="html-italic">p</span> &lt; 0.05.</p> Full article ">
10 pages, 197 KiB  
Article
Public Unawareness of Renal Function: A Questionnaire Survey at a Health Promotion Seminar
by Yukinori Aimiya, Sho Hasegawa, Mikio Sakakibara, Midori Hasegawa, Naotake Tsuboi, Naoki Nakagawa and Shigeki Yamada
J. Clin. Med. 2025, 14(3), 664; https://doi.org/10.3390/jcm14030664 - 21 Jan 2025
Viewed by 327
Abstract
Background: Progression of chronic kidney disease (CKD) increases the risk of complications such as cardiovascular disease; however, knowledge regarding renal function in the general population is low. We aimed to determine factors necessitating CKD education in the general population. Methods: Participants for a [...] Read more.
Background: Progression of chronic kidney disease (CKD) increases the risk of complications such as cardiovascular disease; however, knowledge regarding renal function in the general population is low. We aimed to determine factors necessitating CKD education in the general population. Methods: Participants for a health promotion seminar were recruited via the Sugiura Memorial Foundation website and Sugi Pharmacy stores. Those who agreed to participate in the seminar were included in the questionnaire survey after a health seminar. Results: Out of 1548 participants, 1050 answered all questionnaire items, resulting in a valid response rate of 67.83%. Multivariable analysis revealed that sex (OR = 0.611), pharmacy consultations (OR = 0.661), receiving a blood test within 1 year (OR = 0.268), awareness of blood pressure (OR = 0.038), and knowledge of blood glucose level (OR = 0.099) were factors for unawareness of renal function. Conclusions: This study suggests that female individuals unaware of their blood pressure or glucose levels, those who have not had a blood test within 1 year, and those who have not sought health consultations need education on renal function. Full article
(This article belongs to the Special Issue Chronic Kidney Disease: Clinical Challenges and Management)
11 pages, 1153 KiB  
Article
The Association Between the Perception of Exercise Benefits and Barriers and Exercise Self-Efficacy During the Induction Phase of Dialysis in Patients with End-Stage Kidney Disease: A Cross-Sectional Study
by Yuma Hirano, Tomoyuki Fujikura, Tomoya Yamaguchi, Akihiko Kato, Kenichi Kono, Naro Ohashi, Hideo Yasuda and Katsuya Yamauchi
J. Clin. Med. 2024, 13(21), 6332; https://doi.org/10.3390/jcm13216332 - 23 Oct 2024
Viewed by 932
Abstract
Background/Objectives: The physical function of patients with chronic kidney disease gradually declines as kidney function deteriorates, and this decline becomes more pronounced after the initiation of dialysis. Encouraging the development of exercise habits from the initiation phase of dialysis is crucial. Increased exercise [...] Read more.
Background/Objectives: The physical function of patients with chronic kidney disease gradually declines as kidney function deteriorates, and this decline becomes more pronounced after the initiation of dialysis. Encouraging the development of exercise habits from the initiation phase of dialysis is crucial. Increased exercise self-efficacy is essential for establishing these habits. However, the related factors at this stage are unclear. This study hypothesized that perceptions of exercise benefits and barriers are related to exercise self-efficacy and aimed to investigate this association. Methods: This single-center, cross-sectional study included 72 patients and assessed the stages of exercise behavior change, perceptions of exercise benefits and barriers, and exercise self-efficacy. Multiple regression analysis was used to examine the association between exercise self-efficacy and perceptions of the benefits and barriers of exercise. Results: Perceptions of exercise benefits were still significantly associated with self-efficacy for exercise after adjustment for age, gender, history of cardiovascular disease, diabetic kidney disease, living alone, employment, and physical function (β = 0.474, p < 0.001). Similarly, perceptions of exercise barriers were also significantly associated with self-efficacy for exercise (β = −0.410, p = 0.001). A subgroup analysis that only examined participants without exercise habits revealed a similar association. Conclusions: Perceptions of exercise benefits and barriers may be associated with exercise self-efficacy in patients with end-stage kidney disease during the initiation phase of dialysis. As patients are temporarily hospitalized during this phase, it provides an opportunity for intervention. Exercise education and supportive environments during hospitalization may enhance perceptions of exercise benefits, reduce perceptions of exercise barriers, and improve exercise self-efficacy. Full article
(This article belongs to the Special Issue Chronic Kidney Disease: Clinical Challenges and Management)
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Figure 1

Figure 1
<p>The selection of participants for analysis. Of the 90 participants included in the study period, 18 were excluded, and 72 were ultimately included in the analysis.</p> Full article ">Figure 2
<p>Distribution of stages of exercise behavior change in all participants. No exercise habits (precontemplation, contemplation, and preparation) accounted for approximately 80% of all respondents.</p> Full article ">Figure 3
<p>The distribution of perceptions of exercise benefits and perceptions of exercise barriers sub-items among all participants. Perceptions of exercise benefits had the highest scores for physical benefit, and perceptions of exercise barriers had the highest scores for lack of motivation.</p> Full article ">

Other

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21 pages, 2882 KiB  
Perspective
Hemoincompatibility in Hemodialysis-Related Therapies and Their Health Economic Perspectives
by Carsten Hornig, Sudhir K. Bowry, Fatih Kircelli, Dana Kendzia, Christian Apel and Bernard Canaud
J. Clin. Med. 2024, 13(20), 6165; https://doi.org/10.3390/jcm13206165 - 16 Oct 2024
Viewed by 1266
Abstract
Hemobiologic reactions associated with the hemoincompatibility of extracorporeal circuit material are an undesirable and inevitable consequence of all blood-contacting medical devices, typically considered only from a clinical perspective. In hemodialysis (HD), the blood of patients undergoes repetitive (at least thrice weekly for 4 [...] Read more.
Hemobiologic reactions associated with the hemoincompatibility of extracorporeal circuit material are an undesirable and inevitable consequence of all blood-contacting medical devices, typically considered only from a clinical perspective. In hemodialysis (HD), the blood of patients undergoes repetitive (at least thrice weekly for 4 h and lifelong) exposure to different polymeric materials that activate plasmatic pathways and blood cells. There is a general agreement that hemoincompatibility reactions, although unavoidable during extracorporeal therapies, are unphysiological contributors to non-hemodynamic dialysis-induced systemic stress and need to be curtailed. Strategies to lessen the periodic and direct effects of blood interacting with artificial surfaces to stimulate numerous biological pathways have focused mainly on the development of ‘more passive’ materials to decrease intradialytic morbidity. The indirect implications of this phenomenon, such as its impact on the overall delivery of care, have not been considered in detail. In this article, we explore, for the first time, the potential clinical and economic consequences of hemoincompatibility from a value-based healthcare (VBHC) perspective. As the fundamental tenet of VBHC is achieving the best clinical outcomes at the lowest cost, we examine the equation from the individual perspectives of the three key stakeholders of the dialysis care delivery processes: the patient, the provider, and the payer. For the patient, sub-optimal therapy caused by hemoincompatibility results in poor quality of life and various dialysis-associated conditions involving cost-impacting adjustments to lifestyles. For the provider, the decrease in income is attributed to factors such as an increase in workload and use of resources, dissatisfaction of the patient from the services provided, loss of reimbursement and direct revenue, or an increase in doctor–nurse turnover due to the complexity of managing care (nephrology encounters a chronic workforce shortage). The payer and healthcare system incur additional costs, e.g., increased hospitalization rates, including intensive care unit admissions, and increased medications and diagnostics to counteract adverse events and complications. Thus, hemoincompatibility reactions may be relevant from a socioeconomic perspective and may need to be addressed beyond just its clinical relevance to streamline the delivery of HD in terms of payability, future sustainability, and societal repercussions. Strategies to mitigate the economic impact and address the cost-effectiveness of the hemoincompatibility of extracorporeal kidney replacement therapy are proposed to conclude this comprehensive approach. Full article
(This article belongs to the Special Issue Chronic Kidney Disease: Clinical Challenges and Management)
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Figure 1

Figure 1
<p>Hemoincompatibility reactions induced by membrane contact and dialysis fluid contaminants result in the activation of various protein cascades and cells, leading to mediator release, reactions, and organ damage; ROS, reactive oxygen species; NETosis, Neutrophil Extracellular Trap Formation; MPO, myeloperoxidase; C3a, C5a, SC5b-9, Complement fractions; NFkB, Nuclear Factor-kappa B; NO, Nitric Oxide; ET1, Endothelin 1.</p> Full article ">Figure 2
<p>(<b>A</b>) Clinical outcomes and health implications of acute or subacute hemoincompatibility reactions induced by hemodialysis. (<b>B</b>) Clinical outcomes and health implications of chronic or delayed complications of hemoincompatibility reactions induced by hemodialysis.</p> Full article ">Figure 2 Cont.
<p>(<b>A</b>) Clinical outcomes and health implications of acute or subacute hemoincompatibility reactions induced by hemodialysis. (<b>B</b>) Clinical outcomes and health implications of chronic or delayed complications of hemoincompatibility reactions induced by hemodialysis.</p> Full article ">Figure 3
<p>Economic burden of bioincompatibility reactions associated with chronic hemodialysis.</p> Full article ">Figure 4
<p>The cost-effectiveness plane for addressing hemodialysis-related hemoincompatibility reactions. Compared to a poorly hemocompatible HD system with high efficiency (red point in the middle), an enhanced hemocompatible HD system with high efficiency such as HDF (blue points) would result in better outcomes at lower or equivalent costs.</p> Full article ">Figure 5
<p>Proposed strategies to mitigate risk associated with bioincompatibility reactions associated with chronic hemodialysis.</p> Full article ">
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