Autosomal dominant polycystic kidney disease (ADPKD) is a multisystem disorder in which progressive renal, and frequently hepatic, enlargement drives a distinctive body-composition phenotype that is often poorly captured by conventional anthropometric measures.Converging evidence shows that a substantial proportion of adults develop protein-energy malnutrition and early sarcopenia, frequently overlooked due to elevated BMI, visceral adiposity and cyst-related abdominal mass. SGA, BIA and imaging-based studies identify intra-abdominal organomegaly as the dominant determinant of nutritional risk and a factor associated with accelerated eGFR decline, independent of baseline renal function, proteinuria and imaging class. Hallmark alterations, extracellular water expansion, reduced phase angle and loss of skeletal muscle mass, reflect a catabolic milieu driven by mass effect, metabolic dysregulation and glycolytic reprogramming of cyst-lining cells. These findings position malnutrition as an independent prognostic determinant in ADPKD and support the early incorporation of structured nutritional assessment and lean-mass-preserving strategies into routine care. Emerging dietary approaches show promise but remain investigational. Critical research gaps include the need for interventional trials and integrated longitudinal studies to define the therapeutic potential of nutritional optimization in modifying the trajectory of the disease.
Autosomal dominant polycystic kidney disease (ADPKD) is a multisystemic disorder in which progressive organomegaly generates a peculiar “body phenotype”: visible abdominal distension, apparent overweight, and, beneath it, early malnutrition and sarcopenia masked by falsely reassuring anthropometric indices. Recent evidence has unveiled this “hidden iceberg”, documenting that approximately 30% of ambulatory patients are at risk of malnutrition regardless of glomerular filtration rate, and that the main predictor is cystic organ volume. This body paradox produces psychological consequences with no equivalent in non-polycystic chronic kidney disease (CKD): altered body image, “double invisibility” of malnutrition, identity dissonance, barriers to physical activity, and a disturbed relationship with food, all within a context already burdened by the genetic load, prognostic uncertainty, and the effects of Tolvaptan. This paper proposes that, among the multiple dimensions of psychological distress in ADPKD, the body and its transformation, from organomegaly to hidden malnutrition, from altered body image to barriers to physical activity, represent the most underrecognized thread and the one that most directly calls for an integrated paradigm in which psychologist and nutritionist collaborate structurally at every stage of the care pathway.
Anemia is one of the most common complications in patients undergoing kidney transplantation, with an estimated prevalence between 30% and 50%, especially in the first six months after transplantation. The pathogenesis of anemia in these patients is multifactorial, related to chronic inflammation, disorders of iron metabolism, myelosuppression from several immunosuppressive drugs, and hormonal and metabolic alterations. The clinical implications of anemia in kidney transplants are significant: it is a negative prognostic factor for patient and transplant survival, significantly affecting cardiovascular risk and quality of life. This review analyzes in detail the pathogenic mechanisms of anemia in the post-transplant context, illustrating their clinical impact and providing an updated overview of currently available therapeutic strategies, with a focus on new molecules belonging to the class of prolyl-hydroxylase inhibitors (HIF-PHi), which are revolutionizing the therapeutic approach to anemia secondary to renal failure.
Kidney stone disease (nephrolithiasis) is a prevalent, recurrent condition often underpinned by modifiable metabolic risk factors such as hypocitraturia, hyperuricosuria, and low urinary pH. Although prevention through dietary and pharmacologic interventions is possible, it remains inconsistently applied in clinical practice. Sodium–glucose co-transporter 2 inhibitors (SGLT2i), originally developed for glycemic control in type 2 diabetes, have shown unexpected effects on renal metabolism and acid-base handling, prompting interest in their potential utility in stone prevention. SGLT2i promotes glycosuria and shift in acid–base balance, which may increase urinary citrate and pH—both protective against stone formation. They also reduce serum uric acid and may exert favorable effects on urinary volume and calcium handling. These mechanisms suggest a growing therapeutic role in selected patients with nephrolithiasis, especially those with comorbid diabetes, chronic kidney disease (CKD), or hypocitraturia. While direct clinical data on stone recurrence under SGLT2i therapy are still limited, mechanistic consistency across preclinical and clinical studies is compelling. SGLT2 inhibitors are thus emerging as a promising pharmacologic strategy for nephrolithiasis prevention, particularly in patients with overlapping metabolic or renal indications. Ongoing mechanistic studies and prospective trials are expected to confirm their role as part of a personalized approach to stone disease management.
Introduction: The growing focus on person-centered medicine calls for reflection on renal replacement therapy modalities that best combine clinical effectiveness with quality of life. This article examines the role of home dialysis, with particular reference to peritoneal dialysis, in light of the main national and international guidelines. Methods: Narrative review of policy documents from major nephrology scientific societies and of the literature on patient involvement in therapeutic decision-making. Results: Guidelines recommend early, comprehensive and balanced information on renal replacement therapy options, emphasizing shared decision-making. Home-based modalities, in appropriately selected patients, provide clinical outcomes comparable to in-center hemodialysis, with potential advantages in terms of autonomy and quality of life. Conclusions: Promoting home dialysis represents a strategic element to strengthen a care model oriented toward personalized medicine, sustainability and patient empowerment.
Introduction: Home hemodialysis (HHD) began in the 1960s; it has largely moved to the dialysis centers in recent decades, particularly across Europe. HHD patients account for <2% of the dialysis patient population. Training programs aimed at addressing the benefits, enablers and obstacles of home hemodialysis may therefore be relevant when considering this modality of renal replacement therapy (RRT). The aim was to conduct a scoping review of studies about training in HHD patients. Methods: Using Arksey and O’Malley’s framework, three databases were searched on CINAHL, PubMed and Scopus. The search included studies published in English from August 2013 to August 2023. Results: Five studies met the scoping review criteria (two observational, two qualitative and one narrative review). Three education themes were identified: technique and management of the dialysis machine, self-cannulation of arterio-venous fistulas and safety. Conclusion: The educational fields described represent a systematic approach to foster the growing use of home hemodialysis, but to date, further research is needed to investigate the feasibility and effects of educational training to understand if they meet the educational needs of patients. Finally, in Europe, there are obstacles to the implementation of home hemodialysis concerning health costs, logistics, but above all, the lack of specialized and dedicated medical and nursing staff.
In contemporary nephrology and dialysis care, oriented toward developing care more closely connected to the person’s resources, needs, beliefs, and opinions, it is important to adopt a comprehensive, systemic approach useful for advancing care in nephrology and dialysis from a personalized, patient-oriented perspective: health psychology. Health psychology aims to promote an integrated understanding of health and illness and to facilitate the integration of biomedical and psychological knowledge through research, education, and professional activities in nephrology and dialysis care. It considers not only integrated aspects of disease state, types of thoughts, emotions, and behaviors, but also factors related to social, cultural, gender, and socioeconomic inequalities. Another systemic variable is health and well-being in the workplace as an element influencing a person’s psychosomatic balance. In a vision of care based on the biopsychosocial and systemic model, health psychology connects, in a circular way with feedback dynamics, modern lifestyles with people’s mental health, where stress-management processes are central in the genesis and disruption of mind–body balance. Health psychology also regards the health and psychological well-being of healthcare providers as determinants strongly influencing the quality of care. It brings elements for reflection, comparison, and design in nephrology and dialysis care, integrating psychological, physical, technological, and social components. By considering these dimensions, health psychology strengthens patient-centered practice and offers a systemic perspective that supports both patients and providers. It provides tools to understand complex interactions, guide interventions, and promote holistic care that addresses biological, psychological, and social factors in modern nephrology and dialysis settings.
Introduction: Transportation insecurity is a problem for people fighting against chronic diseases, and the organization of transportation for in-center hemodialysis (HD) is a complex challenge and long travel times to dialysis centers have been associated with increased mortality risk and poorer health-related quality of life. Methods: We carried out a cross-sectional survey with the aim of identifying and understanding the transportation options available to in-center HD patients and to describe their experiences from their perspective. Results: We investigated 132 out of 166 patients treated with HD in the province of Ferrara (mean age 68.6 ± 13.9 years, 65% males). An investigation was performed by using a questionnaire. The average distance from residence to the dialysis center was 20 ± 14.7 km. 48.5% of users used their own vehicle, while 41.7% used an ambulance. A minority of the population used social services vehicles. The average travel time was 29 ± 15 minutes, and when the vehicle was not personal, it was shared with 2.6 passengers in 85% of cases. Transportation fee was reimbursed in 48.5% of cases. Users were dissatisfied or very dissatisfied in 7.5-15.1% of cases. Duration of the journey was the main determinant of patients’ satisfaction, independently of age, gender, and receiving financial support for transportation. Conclusion: Although the majority of investigated subjects were satisfied with their transportation arrangements, the burden of traveling to HD is an issue, and its organization should consider economic resources and patients’ needs. A validated instrument is needed to understand this complex phenomenon, which is not a logistic item.
Introduction: Patients undergoing hemodialysis can show anxiety, depression, poor sleep and a reduction in the quality of life. Non-pharmacological interventions could be used to combine with conventional treatments to improve these outcomes. Guided imagery is a mind-body technique that uses mental images to promote relaxation and well-being. This is the first international research protocol that studies the effects of guided imagery in hemodialysis patients on various subjective and objective outcomes. Methods: The aim is to evaluate the impact of guided imagery on the level of anxiety, depression, sleep, quality of life, systolic blood pressure, diastolic blood pressure, heart rate and respiratory rate. The study design is a randomized controlled trial, prospective, with two parallel groups (guided imagery vs standard care), with 1:1 balanced allocation, pre-posttest, in a calculated sample of 30 patients diagnosed with chronic kidney disease (CKD) undergoing hemodialysis. The intervention requires that each patient be treated with guided imagery for 30 minutes, three times a week, for 4 weeks. Expected results. The research hypotheses on the results are that the guided imagery, compared to the control group, reduces anxiety levels, reduces depression levels, improves sleep, improves quality of life, improves systolic blood pressure, improves diastolic blood pressure, improves heart rate and improves respiratory rate. Conclusion: If the effects show a statistically significant efficacy, guided imagery could be used during the daily care of hemodialysis patients.
