Sepsis-associated acute kidney injury (SA-AKI) has no specific treatment. Labile iron and iron-dependent lipid peroxidation (ferroptosis) have been implicated in tubular injury in experimental models. MEX-CD1 is a high-molecular-weight chelating polymer designed to be added to dialysate to extract labile iron extracorporeally. This pilot study assessed the feasibility and tolerance of dialysis-based iron removal in a large-animal model of SA-AKI. Three anesthetized pigs of both sexes (43–57 kg) received autologous fecal peritonitis. After an observation period (planned 12 h, shortened in two animals because of hemodynamic instability), resuscitation (antibiotics, fluids, norepinephrine targeting a mean arterial pressure > 60 mmHg) was started together with a 24-h continuous veno-venous hemodialysis session using a MEX-CD1-containing dialysate at a deliberately low effluent dose (≈4 mL/kg/h) chosen to maximize contact time between blood and chelator. Hemodynamics, urine output, serum creatinine and urea, iron parameters (transferrin saturation, hepcidin), dialysate metals (Fe, Cu, Zn, Mn, Al) and renal histology (PAS with Jablonski scoring, Perls, TUNEL, GPX4 immunostaining) were assessed. No control group was included; results are descriptive (median [range]). All animals developed vasopressor-dependent septic shock, transient oliguria (onset 4–7 h after peritonitis), KDIGO stage 1–2 AKI on the creatinine criterion at the start of resuscitation (T12), and acute tubular necrosis on histology (Jablonski score 2–3), and survived to T48. The planned 24-h session was delivered in all animals; circuit dysfunction occurred in the two animals that received the lowest initial heparin doses, and heparin requirements far exceeded the planned regimen. MEX-CD1 extracted 158, 236 and 712 µg of iron into the effluent, and effluent iron concentration remained detectable throughout the 24-h session. Transferrin saturation was very low at baseline (<12
Serum albumin and systolic blood pressure (SBP) are strong predictors of adverse outcomes in hemodialysis patients, yet clinical interpretation often relies on static measurements rather than longitudinal patterns. Functional data analysis enables characterization of dynamic biomarker trajectories and identification of patient phenotypes that may better capture underlying nutritional, inflammatory, and hemodynamic states. Here, we applied data-driven clustering methods to map albumin and SBP trajectories and to identify phenotypes associated with higher mortality risk. We analyzed 38,863 adults who initiated hemodialysis in Fresenius Kidney Care North America clinics between 2010 and 2014 and had ≥ 9 months of albumin and SBP measurements during the first year. Monthly averages were modeled as functional data. Unsupervised clustering using K-means and functional principal component analysis (FPCA) identified albumin and SBP trajectory phenotypes. Cox proportional hazards models assessed the association between trajectory clusters and all-cause mortality after the first year, adjusting for demographics, diabetes, catheter use, interdialytic weight gain, erythropoietin dose, hemoglobin, and neutrophil-to-lymphocyte ratio. K-means clustering identified three albumin phenotypes (low, medium, high), and FPCA identified three trajectories (high, rising, falling). Low or declining albumin was consistently associated with the highest mortality risk. Compared to the high-albumin group, low-albumin patients had a 2.63-fold higher adjusted mortality risk (95
Cardiac surgery–associated acute kidney injury (CSA-AKI) is a frequent and serious complication of coronary artery bypass grafting (CABG), yet contemporary data from Southeast Asia are sparse and established preoperative risk scores have not been externally validated in this region. The KARMA (AKI Risk and outcomes in cARdiac surgery in MAlaysia) Study was a 5-year retrospective cohort study of adults undergoing CABG at a tertiary Malaysian centre (January 2021–December 2025). CSA-AKI was defined and staged using KDIGO 2012 criteria. Multivariable logistic regression was used to identify variables associated with Acute Kidney Injury (AKI), severe AKI, and in-hospital mortality; the severe AKI and mortality models were exploratory given limited event numbers. Four preoperative risk scores (Mehta, Cleveland Clinic, Simplified Renal Index [SRI], and Leicester) were evaluated for prediction of severe AKI and continuous renal replacement therapy (CRRT) requirement using ROC analysis. A prespecified descriptive subgroup analysis examined outcomes by CRRT initiation timing (≤ 24 h vs. > 24 h from AKI diagnosis) in the small subgroup of patients requiring dialysis; this analysis was substantially underpowered (n = 24; 6 early vs. 18 late) and is presented as hypothesis-generating only. Among 551 CABG patients (mean age 62.3 years, 82.4
Chronic kidney disease (CKD) represents a major public health challenge worldwide and is associated with substantial morbidity, mortality, and healthcare costs. Despite the availability of evidence-based recommendations for CKD management, significant international variability exists in their implementation and monitoring. Cyprus historically reported among the highest incidences of kidney replacement therapy (KRT) in Europe, but lacked guidelines adapted to the local context as well as a structured CKD quality-of-care monitoring framework. This manuscript describes the development and implementation of guideline-based CKD clinical quality indicators within the Cyprus General Health System (GeSY), following the contextualization of the National Institute for Health and Care Excellence (NICE) guideline NG203, and evaluates changes in quality-of-care during the first year of implementation. Through a structured adaptation process, which included a series of meetings, followed by public consultation, relevant and feasible quality indicators were contextualized and integrated into the GeSY information system. Six indicators were evaluated comparing indicator outputs between a baseline 12-month period before the introduction of the contextualized guideline (01 November 2023–31 October 2024) with a post-introduction reporting 12-month period (01 November 2024–31 October 2025). Four indicators improved following guideline introduction with significant increases observed in annual urine albumin-to-creatinine ratio testing in CKD, renal function monitoring among chronic nonsteroidal anti-inflammatory drugs users, confirmation of CKD diagnosis using repeated estimated Glomerular Filtration Rate (eGFR) testing, and combined eGFR and albuminuria assessment at diagnosis. Indicators related to pharmacological management remained largely unchanged across the two study periods. Introduction of guideline-based CKD quality indicators within the Cyprus health system was associated with measurable improvements during the first year of monitoring. These findings suggest that structured adaptation of international guidance combined with routine quality of care monitoring may support improvements in CKD care in healthcare systems with limited prior experience in quality-of-care monitoring.
