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    Peritoneal dialysis in patients with end-stage renal disease, chronic liver disease and ascites: A prospective observational study

    Jul-Sep 2026: 37(3):210-216

    Objectives:

    Patients with chronic liver disease (CLD) complicated by ascites may develop end-stage renal disease (ESRD), making selection of renal replacement therapy challenging. This study described the feasibility and clinical outcomes of peritoneal dialysis (PD) in selected patients with ESRD, CLD, and ascites.

    Patients and Methods:

    This prospective observational study included 51 selected patients with ESRD, CLD, and ascites and 55 patients with ESRD without CLD who underwent PD at a tertiary university hospital in Saudi Arabia. All underwent percutaneous insertion of a three-cuff PD catheter and received automated peritoneal dialysis (APD). Clinical outcomes recorded during observed follow-up are presented descriptively.

    Results:

    Percutaneous catheter insertion was successful in all patients without bowel perforation, catheter migration, or major hemorrhage. Thirteen peritonitis episodes were recorded in the CLD group and 12 in the non-CLD group. The overall peritonitis rate was 0.10 episodes per patient-year; group-specific rates were 0.11 and 0.09 episodes per patient-year, respectively. None required catheter removal. A transient serum albumin decline of at least 0.5 g/dL was recorded in 5 and 4 patients, respectively. Early dialysate leakage occurred in 7/51 and 3/55 patients and was managed by temporary reduction of fill volume. During observed follow-up, 12/51 patients with CLD and 9/55 patients without CLD died.

    Conclusions:

    Peritoneal dialysis was feasible in this selected cohort of patients with ESRD, chronic liver disease, and ascites. The observed adequacy values, complication counts, and crude mortality are reported descriptively. The findings should not be interpreted as establishing safety, effectiveness, equivalence, or superiority.

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    Value of repeat renal biopsy in lupus nephritis: Histological transitions, treatment impact, and predictors of repeat biopsy and active disease

    Jul-Sep 2026: 37(3):204-209

    Background:

    Repeat renal biopsy frequently reveals the changes in the histological pattern in lupus nephritis (LN) which can guide alterations in therapeutic decisions. However, the choice of which patients should undergo such a repetition on clinical ground remains insufficiently defined. We sought to identify independent clinical predictors for repeat biopsy.

    Patients and Methods:

    We retrospectively evaluated 370 patients with biopsy-proven LN. A clinically indicated second renal biopsy was performed in 122 patients (33%) due to acute renal flares, persistent disease activity, or suspected progression. LN classes were classified as nonproliferative (classes I, II, V, and VI) or proliferative (classes III, IV, and mixed). Crude odds ratios (ORs) and multivariable logistic regression models adjusting for baseline age, sex, and LN classification were utilized to identify independent predictors. The treatment regimens were consolidated into broad categories of clinical management subsets to evaluate the changes in therapeutic pathways.

    Results:

    The initial biopsies showed, 30.5% of patients had nonproliferative and 69.5% proliferative LN. Histological transformation occurred in 68% of the repeat biopsies. Mixed LN classes increased significantly in the second biopsy from 7.4% to 22.9% (P < 0.05). Multivariable regression identified longer systemic lupus erythematosus (SLE) disease duration as the sole independent clinical predictor for undergoing a second biopsy (22.2 ± 4.96 vs. 17.2 ± 6.29 years; adjusted OR = 1.15, 95% confidence interval [CI]: 1.06–1.25), indicating that shorter SLE duration corresponds to clinical stability and conservative management without rebiopsy. Baseline proliferative LN independently predicted active disease on repeat biopsy (Adjusted OR = 2.42, 95% CI: 1.09–5.38). Repeat biopsy findings led to immediate therapeutic modification in 82.8% of patients, most commonly therapy intensification in those with active proliferative transformations.

    Conclusions:

    Repeat renal biopsy revealed high rates of histological transitions and directly guided alterations in therapeutic adjustment. A longer SLE duration predicted the need for repeat renal biopsy, and a baseline proliferative LN strongly predicts active disease on re-biopsy. Although long-term survival benefits cannot be inferred from this retrospective cohort, repeat renal biopsy remains an indispensable tool for optimizing individualized immunosuppressive therapy.

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    Divergent practice patterns in lupus nephritis care: A national survey of rheumatologists and nephrologists in Saudi Arabia

    Jul-Sep 2026: 37(3):196-203

    Background:

    Lupus nephritis (LN) carries significant morbidity and mortality and demands coordinated, multidisciplinary care. Given the complexity of diagnosis, immunosuppressive therapy, and long-term renal monitoring, collaboration between rheumatologists and nephrologists is essential.

    Aims:

    This study aimed to investigate specialty-driven similarities and differences in the management of patients with LN in Saudi Arabia.

    Subjects and Methods:

    A cross-sectional, self-reported, electronic survey was distributed to adult rheumatologists and nephrologists practicing in Saudi Arabia, achieving a response rate of 31% (158 of 500 clinicians contacted through national specialty-society distribution lists). The questionnaire assessed demographic characteristics, institutional settings, and LN management practices. Associations between specialty and survey responses were analyzed using Pearson’s Chi-square or Fisher’s exact tests, with statistical significance defined as a two-sided P < 0.05.

    Results:

    A total of 158 clinicians participated, with equal representation of rheumatologists and nephrologists (79 each). Nephrologists were more frequently male (81.0% vs. 60.8%; χ2P = 0.005), whereas rheumatologists were younger and had fewer years of clinical experience (P = 0.005). Marked specialty-based differences were observed in induction strategies. Rheumatologists more frequently administered higher-dose pulse methylprednisolone (1000 mg vs. 500 mg; P = 0.015) and were more likely to prescribe mycophenolate mofetil for Class III/IV ± V LN (88.6% vs. 73.4%). In contrast, nephrologists demonstrated greater reliance on cyclophosphamide-based regimens (26.6% vs. 11.4%; P = 0.015). Significant variation was also evident in supportive care practices. Nephrologists more commonly prescribed Pneumocystis jirovecii pneumonia (PJP) prophylaxis (22.8% vs. 5.1%; P = 0.005), while rheumatologists more frequently implemented gonadal protection during cyclophosphamide therapy (94.6% vs. 74.0%; P = 0.003).

    Conclusion:

    Variation in LN management was observed between rheumatologists and nephrologists in Saudi Arabia, highlighting potential care gaps and areas for standardization. A multidisciplinary approach can lead to more comprehensive, unified care. Future studies are recommended to evaluate quality indicators in the management of LN.

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    Effectiveness of nurse led intervention on kidney transplant recipients at a tertiary care hospital – A randomized controlled trial

    Jul-Sep 2026: 37(3):182-195

    Aim:

    To assess the effectiveness of nurse led intervention on self-care behavior, psychological symptoms, and quality of life among kidney transplant recipients.

    Materials and Methods:

    The study was a prospective, randomized controlled, parallel group, interventional, single-center trial with two arms (registry no: CTRI/2018/12/016630, www.ctri.nic.in). It comprised 120 kidney transplant recipients attending transplant clinic who had completed 3 months after transplantation. They were randomized to receive either standard care (n = 60) or standard care plus nurse led intervention (n = 60). Sociodemographic and clinical data were collected using self-structured questionnaire, self-care behavior was assessed by self-care practice checklist, and Morisky Green Levine Adherence Scale. Psychological symptoms and quality of life were assessed by Depression Anxiety and Stress Scale 21 and WHO-QOL BREF, respectively. Outcome measures were assessed at baseline, 6 months, and 9 months postrandomization.

    Results:

    The mean age of the participants was 40.05 ± 10.91 years in experimental and 39.45 ± 10.09 years in control group. Baseline characteristics in the groups were comparable. Nurse led intervention showed significant difference in the self-care behavior (self-care practice total [F = 28.30, P < 0.001]; adherence to therapy [U = 1436.0, P = 0.03]), psychological symptoms (stress [F = 35.74, P < 0.001], anxiety [F = 46.37, P < 0.001], depression [F = 65.92, P < 0.001]) between the experimental and control groups. No significant differences were seen in QOL except in physical domain.

    Conclusion:

    Nurse led intervention with follow-up improved self-care behavior and reduced psychological symptoms among kidney transplant recipients.

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    Causes and clinical outcomes of pregnancy-related acute kidney injury: A single-center tertiary hospital study in Abu Dhabi, United Arab Emirates

    Jul-Sep 2026: 37(3):176-181

    Background:

    Pregnancy-related acute kidney injury (prAKI) remains a serious complication associated with maternal and fetal morbidity, with significant regional variation. Data from the Middle east are limited. This study aimed to investigate the causes and outcomes of prAKI in a tertiary hospital in Abu Dhabi.

    Methods:

    We conducted a retrospective cohort study of pregnant women with prAKI at Corniche Hospital, Abu Dhabi, between 2019 and 2023. AKI was defined according to the Kidney Disease Improving Global Outcomes criteria as any of the following ≥1.5-fold increase in serum creatinine from the baseline within 7 days or ≥0.3 mg/dl (≥26.5 μmol/L) increase from the baseline within 48 h. Baseline serum creatinine was defined as the most recent creatinine value within 1 year prior to the index pregnancy. In cases where baseline creatinine was not available, the lowest serum creatinine value recorded after recovery was used as a surrogate baseline. Complete renal recovery is the return to baseline serum creatinine, and partial recovery if the creatinine did not return to baseline.

    Results:

    A total of 167 patients had prAKI over a 5-year study period. The most common cause of prAKI was preeclampsia, accounting for 65 cases (39%), followed by infection, 30 cases (18%) of the cases. The majority of cases were classified as mild acute kidney injury (AKI) (75.5%), while moderate and severe AKI accounted for 16% and 8%, respectively. Maternal outcomes were generally favorable, with a low mortality rate (0.6%). Complete renal recovery was observed in 148 patients (88.6%), eight patients progressed to chronic kidney disease, while follow-up serum creatinine was not done in 11 patients (6.6%). Only two patients required transient renal replacement therapy. prAKI was recognized and documented by the obstetric team in 60% of the cases.

    Conclusion:

    In this cohort, prAKI was predominantly mild and associated with favorable maternal outcomes, likely reflecting early detection and management in a tertiary care hospital. However, under-recognition of prAKI remains a concern. Multidisciplinary collaboration between obstetric and nephrology teams is key for prevention, early recognition, and management of AKI.

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    Baseline and longitudinal determinants of survival in end-stage renal disease: A joint longitudinal–survival analysis

    Saudi Journal of Kidney Diseases and Transplantation. October 14, 2026

    Introduction:

    Evidence remains limited regarding how repeated biomarker measurements influence survival in individuals with end-stage renal disease (ESRD). This study examined the prognostic role of both baseline biomarker levels and their longitudinal patterns in ESRD patients.

    Materials and Methods:

    This retrospective cohort included maintenance hemodialysis patients from Shahid Ayatollah Ashrafi Esfahani Hospital, Tehran, Iran, with at least 3 months of dialysis history. Cox regression assessed baseline predictors, while a joint longitudinal–survival model evaluated repeated albumin, hemoglobin, Kt/V, and urea reduction ratio (URR) measurements in relation to survival.

    Results:

    Overall, 330 ESRD patients were analyzed, with a mean age of 55.63 ± 15.57 years. In the joint model, each one-unit increase in the estimated current value of albumin, hemoglobin, Kt/V, and URR was linked to a lower risk of mortality over follow-up, with hazard ratios of 0.996 (P = 0.009), 0.999 (P = 0.015), 0.994 (P = 0.039), and 0.988 (P = 0.043), respectively. In Cox regression, higher white blood cell count increased mortality risk (Hazard ratio [HR]: 1.09, P = 0.025), whereas higher baseline log-ferritin, hemoglobin, and URR reduced risk, with HRs of 0.83 (P = 0.042), 0.85 (P < 0.001), and 0.13 (P = 0.035), respectively.

    Conclusions:

    The current study showed that longitudinal changes in markers such as albumin, hemoglobin, Kt/V, and URR may be important predictors of survival in patients with ESRD. Evaluation of baseline marker levels, along with longitudinal changes, nutritional status, age, and body mass index, may be important for determining survival among patients with ESRD.

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    Renoprotective Effects of AdipoRon in Preclinical Models of Renal Injury: A Systematic Review and Meta-Analysis

    Saudi Journal of Kidney Diseases and Transplantation. September 01, 2026

    Background:

    AdipoRon has shown promising metabolic and anti-inflammatory effects by activating the AMPK and PPARα pathways. However, its renal effects have not been systematically assessed. This study aimed to evaluate the efficacy of AdipoRon in mitigating renal injury based on preclinical evidence.

    Methods:

    A comprehensive systematic literature search was conducted in accordance with the PRISMA 2020 guidelines. We searched PubMed, Embase, Web of Science, Scopus, and Cochrane Central for publications up to December 2025. The SYstematic Review Centre for Laboratory animal Experimentation (SYRCLE) tool was used to evaluate the risk of bias of the included studies. Quantitative synthesis was performed using RevMan 5.4.1, employing standardized mean differences (SMDs) with 95% confidence intervals (CIs) under random-effects models. Heterogeneity was assessed using the I2 statistic.

    Results:

    Eight studies met the inclusion criteria for qualitative synthesis, and four provided extractable data for meta-analysis. AdipoRon significantly reduced albuminuria (SMD = –2.64, 95% CI –3.41 to –1.87, p < 0.001) and triglyceride levels (SMD = –1.65, 95% CI –2.28 to –1.01, p < 0.001) with negligible heterogeneity. Mechanistic analyses indicated that AdipoRon attenuated oxidative stress, inflammation, apoptosis, and fibrosis by activating the AMPK and PPARα signalling pathways.

    Conclusions:

    AdipoRon demonstrated consistent nephroprotective effects in preclinical models, primarily through metabolic and anti-inflammatory modulation. Despite heterogeneity in some outcomes, findings support its potential as a candidate for renal protection. Further standardized and translational studies are needed to confirm these effects in clinical settings.

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    Nephrotic range proteinuria in adults: Clinicopathological experience from a single institute in rural North India

    Saudi Journal of Kidney Diseases and Transplantation. September 01, 2026

    Background:

    The western literature is increasingly reporting focal segmental glomerulosclerosis overtaking membranous nephropathy as the leading cause of nephrotic range proteinuria in adults. However, data from a socioeconomically and geographically diverse nation like India are limited and does not entirely align with Western observations. We undertook this study to evaluate the spectrum of glomerular diseases presenting as nephrotic range proteinuria in adults, and to establish its clinico-pathological correlation.

    Methods:

    Ninety patients presenting with adult-onset nephrotic range proteinuria, who underwent USG-guided percutaneous renal biopsy, were evaluated clinically and histopathologically over 4 years in a tertiary care centre in north India.

    Results:

    The majority (28.9%) of patients were in 18-28 years age group (mean age, 39.36 years), with a 1.7:1 male-to-female ratio. The most common presenting complaint was generalised body swelling/pedal oedema (94.4%). Podocytopathy, including non-proliferative glomerulopathy suggestive of minimal change disease (26.6%) and focal segmental glomerulosclerosis (15.6%) combined, constituted the largest category (42.2%) of glomerular diseases manifesting as nephrotic range proteinuria in adult patients. Membranous nephropathy accounted for 23.33% of cases. The other etiologies included 13 (14.4%) cases of IgA nephropathy, 6 (6.6%) cases each of diabetic nephropathy and immune complex-mediated membranoproliferative glomerulonephritis, 4 (4.4%) cases of AA-type amyloidosis, and 2 (2.2%) cases of lupus nephritis.

    Conclusion:

    Our study reinforces that the etiologic spectrum of adult-onset nephrotic range proteinuria in India did not entirely mirror Western trends. Podocytopathies represented the largest category, emphasising the ongoing epidemiologic transition in glomerular diseases, advocating a need for continued regional surveillance and multicenter data integration.

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