To compare the clinicopathological features, treatment response, and renal outcomes of patients with IgA nephropathy (IgAN) with κ-dominant, κ–λ co-deposition, or λ-dominant light-chain deposition. This retrospective, single-centre cohort study included 105 patients with primary IgAN who underwent their first native-kidney biopsy. Twenty-one patients with κ-dominant deposition were matched to 42 patients with κ–λ co-deposition and 42 patients with λ-dominant deposition based on age, sex, 24-hour urinary protein excretion, and baseline serum creatinine. The final matching ratio was 1:2:2. The primary renal endpoint was a sustained ≥30% increase in serum creatinine from baseline. During a median follow-up of 25 months (IQR, 18–36), 21 patients reached the renal endpoint. Time to treatment response did not differ significantly among the three groups (log-rank p = 0.0707). However, renal progression-free survival differed significantly among the light-chain deposition groups (log-rank p = 0.0046). After adjustment for sex, age, 24-hour urinary protein excretion, and baseline eGFR, a higher κ deposition ratio remained associated with a lower hazard of renal progression (HR [per 1-percentage-point increase] 0.96; 95% CI: 0.94–0.99; p = 0.011). A higher κ light-chain deposition ratio was associated with a lower risk of renal progression in IgAN. κ predominance may be a pathological marker of a distinct and possibly less aggressive immune-complex deposition pattern.
Backgrounds Large‑scale multicenter data on vascular access among Chinese incident hemodialysis (HD) patients are limited. We explored temporal trends of initial vascular access and its relationship with all‑cause mortality.Methods This retrospective cohort study was conducted using the China Renal Data System, enrolling incident HD patients from January 2000 to April 2024. Vascular access trends and distribution at HD initiation were analyzed.Results 16,717 patients were enrolled (mean age 55.62 ± 10.93 years; 61.54% male; mean follow‑up 64.41 months). At HD initiation, 29.17% of patients used arteriovenous fistula/graft (AVF/AVG), while 70.83% used central venous catheter (CVC), comprising 60.78% with a maturing AVF/AVG and 10.06% with CVC alone. AVF/AVG use increased from 26.24% in 2015 to 35.77% in 2024, while CVC-only use decreased from 16.16% to 8.27%. Mortality rates per 100 person-years were 4.15 (95% confidence interval [CI] 3.93 – 4.38), 7.24 (95% CI 7.00 – 7.49), and 15.08 (95% CI 14.07 – 16.15) in the AVF/AVG, CVC with maturing AVF/AVG, and CVC-only groups, respectively. In the adjusted Cox model, patients using CVC with a maturing AVF/AVG or CVC alone exhibited 36% and 91% higher all-cause mortality risks, respectively, compared with those using AVF/AVG.Conclusions Over the 25-year period, initial vascular access among Chinese incident HD patients gradually shifted from CVC to AVF/AVG, reflecting ongoing and considerable improvements in vascular access practice in China. CVC use at HD initiation was associated with higher all-cause mortality compared with AVF/AVG. These findings support early AVF/AVG creation in end-stage kidney disease patients to avoid CVC use at HD initiation.
Objective To analyze the possible etiology and evaluate the technical and clinical outcomes of using bare metal stents for the treatment of central venous stenosis (CVS) in the lower extremity with ipsilateral hemodialysis access.Methods A single-center retrospective analysis of a small case series was conducted in hemodialysis patients with lower extremity arteriovenous grafts (AVG) who were treated with bare metal stents (BMS) for symptomatic iliac vein stenosis between April 2016 and June 2021. Patients’ demographic data, technical details, adverse events, clinical outcomes, and imaging data were recorded.Results The study cohort comprised seven females and four males, with a mean age of 58.8 ± 13.4 years. Preoperative lower limb venography was performed in nine patients scheduled for AVG creation. With the exception of one case demonstrating left iliac vein compression, the iliac veins were patent in all other patients. Symptoms of lower limb swelling developed at a mean interval of 9.40 ± 5.83 months (range: 3–20 months) following AVG placement. Eight cases had a concomitant history of temporary ipsilateral femoral vein catheterization. Lesion characteristics included nine stenotic lesions and two occlusive lesions. All patients were treated with SMART Control stents (Cordis Corp, USA). The technical success rate was 100%, and symptomatic relief was achieved in all cases. Over a mean follow-up period of 47.8 ± 31.7 months (range: 10–123 months), the target lesion primary patency was 100% (one-side confidence interval [CI] = 0.74,1).Conclusions Using BMS is a safe and effective method to treat iliac vein stenosis with ipsilateral AVG.
Objectives Central venous stenosis and occlusion are major causes of arteriovenous fistula (AVF) dysfunction in hemodialysis patients. This study aimed to evaluate the feasibility, safety, radiation exposure, and anatomical findings of bilateral peripheral CT venography for central venous assessment in patients with dysfunctional AVFs.Methods This single-center retrospective cohort study included 46 consecutive hemodialysis patients with dysfunctional AVFs who underwent bilateral peripheral CT venography between August 2023 and June 2025. Technical success, procedure-related adverse events, radiation dose parameters, central venous lesion characteristics, and agreement with available comparative imaging modalities were analyzed. Comparative imaging findings from puncture-based angiography and/or duplex ultrasonography were assessed descriptively.Results All 46 examinations were technically successful (100%), with a mean procedure duration of 4 minutes (range, 3–5 minutes). Minor adverse events included one patient of contrast extravasation (2.2%) and 3 of mild allergic reactions (6.5%); no severe procedure-related complications were documented. The mean CTDIvol and DLP were 11.87 mGy and 784.15 mGy·cm, respectively. Central venous abnormalities were identified in 44 patients (95.7%), including stenosis in 31 (67.4%), occlusion in 11 (23.9%), and aneurysmal changes in 2 (4.3%). Comparative imaging was available in 38 patients, and CT venography showed agreement with available findings in 37 cases (97.4%). This agreement was interpreted as descriptive concordance rather than formal diagnostic accuracy.Conclusions Bilateral peripheral CT venography demonstrated high technical feasibility, acceptable safety, and effective visualization of central venous abnormalities in hemodialysis patients with dysfunctional AVFs. Further prospective studies are needed to validate its diagnostic performance and clinical impact.Advances in knowledge This technique enables efficient, noninvasive assessment of central venous pathology with minimal risk, supporting its potential as a practical alternative to conventional imaging in hemodialysis patients.
Maternal chronic kidney disease (CKD) is associated with adverse pregnancy outcomes, but its relationship with long-term offspring kidney health remains uncertain. This retrospective maternal-child cohort study examined whether maternal CKD or reduced kidney function before or during pregnancy was associated with a composite kidney outcome in offspring. Live births in the Taiwan Mother and Child Health cohort from 2007 to 2017 were followed through 2018. In the primary cohort, maternal kidney disease was defined as claims-based CKD meeting chronicity criteria before or during pregnancy; the maternal eGFR subcohort additionally included eGFR-defined reduced kidney function. The primary outcome comprised ICD-defined CKD, reduced eGFR <60 mL/min/1.73 m2 or ≥30% eGFR decline at age ≥2 years, or kidney replacement therapy. Laboratory components were interpreted as reduced kidney function rather than definitive CKD unless diagnostic chronicity was documented. Models adjusted for maternal, pregnancy, offspring, and perinatal covariates. Among 79,036 children, 4,687 (5.9%) met the composite kidney outcome. Maternal kidney disease was associated with modestly higher odds of the composite outcome (aOR, 1.29; 95% CI, 1.00–1.66) and offspring all-cause mortality (aOR, 1.88; 95% CI, 1.15–3.09). Analyses of individual components of the composite outcome, sex-stratified subgroups, and trimester-specific exposure windows were exploratory, imprecise, and not adjusted for multiplicity. Maternal CKD or reduced kidney function may identify dyads who warrant long-term kidney surveillance, although causal pathways require confirmation.
