Wathanavasin, Wannasit

ABSTRACT Background Uremic toxins are a growing area of research in nephrology, with significant implications in the progression and treatment of chronic kidney disease (CKD) and the management of end‐stage kidney disease (ESKD). This bibliometric analysis aims to evaluate the global research trends, key contributors, and the impact of publications in the field of uremic toxins from 1991 to 2024. Methods The data were retrieved from the Science Citation Index Expanded (SCI‐EXPANDED) database. The study analyzed 2210 articles using various bibliometric indicators, including total publications ( TP ), average number of citations per publication ( CPP 2024 ), and the Y ‐index for author contributions. Publication trends were examined across countries, institutions, and authors. The analysis included document types, languages, Web of Science categories, and journals. Results The study revealed a steady increase in uremic toxin research publications. Japan, the USA, and China remained the most productive countries, with Japan maintaining the highest output, while Belgium achieved the highest citation impact. Citations of uremic toxin‐related research peaked 2 years following publication and plateaued after approximately 6 years. The research foci evolved, with CKD, ESKD, indoxyl sulfate, protein‐bound solutes, and gut microbiota gaining prominence. Studies on oxidative stress, inflammation, metabolomics, and advanced adsorption‐based toxin removal strategies increased markedly. International collaboration and interdisciplinary integration across nephrology, microbiology, and biochemistry correlated with higher citation performance and research visibility. Conclusion This bibliometric study provides an in‐depth analysis of uremic toxin research trends, identifies major contributors, and suggests future research priorities. The findings can inform future research directions, guide funding allocation, and strengthen global collaborative efforts towards improved management of toxin‐related kidney disease.

Key Points Both sodium zirconium cyclosilicate and patiromer effectively lower serum potassium and provide clinical benefits. Sodium zirconium cyclosilicate is associated with higher risk of edema. Patiromer is associated with the increased risk of constipation and hypokalemia. Background Sodium zirconium cyclosilicate (SZC) and patiromer have recently been approved for the treatment of hyperkalemia. However, their efficacy in lowering serum potassium according to the phase of intervention, safety profile, and impact clinical outcomes remains to be fully defined. This study aims to assess their efficacy and tolerability in the management of hyperkalemia. Methods A comprehensive search of PubMed, Scopus, and Cochrane Central Register of Controlled Trials was conducted up to June 6, 2025. Eligible studies included randomized controlled trials reporting the effects of SZC and patiromer on laboratory parameters, clinical outcomes, and safety profiles. Meta-analyses were synthesized using a random-effects model, with results presented as weighted mean differences (WMD) or relative risks (RR), along with 95% confidence intervals (CI). Results Nineteen randomized controlled trials involving 3627 patients (1911 on SZC; 1716 on patiromer) were analyzed. During the initial 48–72 hours, only SZC significantly reduced serum potassium levels (WMD, −0.45 mEq/L; 95% CI, –0.61 to –0.29). At the end of treatment, both agents effectively lowered serum potassium (SZC: WMD, –0.50 mEq/L; 95% CI, –0.63 to –0.38; patiromer: WMD, –0.36 mEq/L; 95% CI, –0.51 to –0.21). SZC significantly normalized serum potassium and reduced hyperkalemia incidence, while patiromer enabled renin-angiotensin-aldosterone system inhibitor optimization by supporting target dosing and reducing discontinuation due to hyperkalemia. However, SZC was associated with a higher incidence of edema (RR, 2.92; 95% CI, 1.08 to 7.90) and patiromer with increased rates of constipation (RR, 2.96; 95% CI, 1.21 to 7.22) and hypokalemia (RR, 1.46; 95% CI, 1.05 to 2.03). Conclusions Both SZC and patiromer effectively lower serum potassium and provide clinical benefits, with distinct safety considerations. Therapy selection should be guided by treatment goals and the patient's individual risk profile.

Hemodiafiltration (HDF) is increasingly used because of its enhanced theoretical clearance of diverse uremic toxins, particularly middle molecules and inflammatory cytokines, relative to conventional hemodialysis (HD), yet evidence on its biochemical benefits remains conflicting. Therefore, this meta-analysis was performed to evaluate the effects of HDF versus HD on uremic toxins, inflammation, anemia, and nutritional parameters. A systematic literature search was conducted using PubMed, Scopus, and the Cochrane Central Register of Controlled Trials to identify relevant studies. Only randomized controlled trials (RCTs) were included. Random-effects meta-analyses were performed to evaluate changes in the prespecified outcomes. Twenty-four RCTs involving 6072 dialysis patients were included. Compared with conventional HD, HDF was associated with significant reductions in serum phosphorus (weighted mean difference [WMD] −0.28 mg/dL; 95% CI −0.44 to −0.12) and β2-microglobulin (WMD −4.84 mg/dL; 95% CI −6.13 to −3.54). HDF also significantly reduced serum urea and C-reactive protein (CRP) levels, along with weekly erythropoietin requirements. Serum albumin levels were slightly but significantly lower in the HDF group than in the conventional HD group (WMD –0.06 g/dL; 95% CI −0.10 to −0.01); however, the clinical significance of such a difference remains uncertain. Higher convective volumes were identified as a key determinant of greater reductions in β2-microglobulin and CRP. Compared with conventional HD, HDF demonstrated superior reductions in several surrogate endpoints, including serum phosphorus, urea, β2-microglobulin, CRP, and weekly erythropoietin requirements. Reduced need for phosphate binders and anemia management may lower treatment-related costs.

Background/Objectives: The study aimed to investigate whether malnutrition influences the obesity paradox and to explore the relationship between obesity with/without malnutrition and in-hospital outcomes among hospitalized ESKD patients. Methods: The study used the National Inpatient Sample database from 2016 to 2021. Hospitalized ESKD patients were included and categorized into three groups: non-obese, obese without malnutrition, and obese with malnutrition. The association between obesity with/without malnutrition and in-hospital outcomes, compared to non-obese patients, were analyzed. Results: Of 674,367 hospitalized ESKD patients included, 125,978 (18.7%) had obesity. Obese ESKD patients without malnutrition were associated with a decreased risk of mortality (odd ratio [OR] 0.87, 95% CI 0.84–0.91), whereas obese patients with malnutrition were associated with an increased risk of mortality (OR 2.08, 95% CI 1.90–2.27), compared to non-obese patients. Furthermore, obesity, with or without malnutrition, was linked to higher infection-related complications and resource utilization, especially when malnutrition was present. Conclusions: Our findings show that obesity is significantly associated with lower in-hospital mortality among ESKD patients without malnutrition. However, when malnutrition coexists, this survival advantage is reversed, underscoring the importance of detecting malnutrition in obese ESKD patients.

Background Sex-based differences may influence the clinical management, complication risks, and healthcare resource utilization of hospitalized end-stage kidney disease (ESKD) patients undergoing peritoneal dialysis (PD). Understanding these disparities is essential for optimizing patient care and informing healthcare policy. Methods This study was conducted using the National Inpatient Sample to identify hospitalized adult ESKD patients receiving PD from the year 2003 to 2018. The outcomes included 1) PD-related outcomes, defined as a composite of peritonitis, mechanical complications, catheter removal or revision, and adequacy issues, 2) non-PD-related outcomes, defined as a composite of sepsis, cardiac arrest, and need for mechanical ventilation 3) transfer to hemodialysis, and 4) in-hospital mortality. The associations between sex and in-hospital outcomes were analyzed using multivariable logistic regression and were adjusted for demographic factors, comorbidities, primary diagnoses, admission types, and hospital characteristics. Discharge weights were applied to generate nationally representative estimates. Results Of 97,036 hospitalized ESKD patients receiving PD analyzed, 48,906 (50.4%) were females. In adjusted analyses, there were no overall sex differences in PD-related outcomes, non-PD-related outcomes, or in-hospital mortality. However, age- and comorbidity-based variations were observed in PD-related outcomes. Female sex was associated with lower odds of transfer to hemodialysis, particularly among younger patients and those without heart failure or peripheral vascular disease. Notably, sex differences in in-hospital mortality were observed only among patients with elective admissions. Conclusion There were sex-based disparities in the outcomes and healthcare utilization of hospitalized ESKD patients receiving PD. These findings underscore the need for sex-specific, individualized strategies to improve PD care and inform clinical and policy decisions.

Background/Objectives: Malnutrition is a prevalent yet under-recognized condition in patients with advanced chronic kidney disease (CKD), contributing to increased morbidity, mortality, and healthcare burden. The aim of this study is to determine the prevalence and trends of malnutrition and investigate the impact of malnutrition on in-hospital outcomes, treatments, and resource utilization in hospitalized patients with advanced CKD. Methods: This study utilized the National Inpatient Sample (NIS) database to identify hospitalized patients with advanced CKD from 2016 to 2021. This study investigated temporal trends in the prevalence and in-hospital mortality across different degrees of malnutrition in advanced CKD patients. Multivariable regression models were used to assess the association between malnutrition and in-hospital outcomes. Results: Out of 1,244,415 advanced CKD patients, 67,587 (5.4%) had mild to moderate malnutrition, and 63,785 (5.1%) had severe malnutrition. Malnourished patients exhibited significantly higher in-hospital mortality, with adjusted odds ratios of 1.70 (95% confidence interval (CI), 1.64–1.75) for mild to moderate cases and 2.67 (95% CI, 2.60–2.75) for severe cases. Severely malnourished patients were associated with longer mean hospital stay by 7.0 days and higher hospitalization costs by $97,767 compared with non-malnourished patients. The prevalence of severe malnutrition showed a significant uptrend from 4.2% in 2016 to 5.5% in 2021 (p for trend < 0.001). Conclusions: Malnutrition in advanced CKD is an increasingly prevalent condition linked to worsened in-hospital outcomes and heightened healthcare resource utilization. The rising trend of severe malnutrition underscores the need for early nutritional screening and the need for future interventional studies to mitigate adverse clinical outcomes in this high-risk population.

Background/Objectives: With the growing population of kidney transplant recipients (KTRs) in intensive care units (ICUs), understanding their prognostic outcomes is critical. As conflicting findings exist, we aim to systematically evaluate and meta-analyze ICU outcomes in kidney transplant recipients compared to non-recipients. Methods: We conducted a comprehensive search of the PubMed, Embase, and Cochrane databases, from inception through 23 December 2024, to identify relevant studies comparing the outcomes of KTRs and non-transplant ICU patients. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for dichotomous outcomes, and weighted mean differences (WMDs) were calculated for continuous outcomes. The risk of bias was assessed using the ROBINS-I V2 tool. The study protocol was registered in the International Prospective Register of Systematic Reviews (CRD42024595104). Results: Seven studies, including 12,062 patients, were analyzed. Demographics, including age and sex, were comparable across groups. No statistically significant associations were found for overall mortality (OR: 1.82, 95% CI: 0.79 to 4.16), ICU mortality (OR: 1.06, 95% CI: 0.45 to 2.48), or 28/30-day mortality (OR: 2.06, 95% CI: 0.30 to 14.10) in KTRs, though there was a trend suggesting a potential increase in the odds of overall mortality. KTRs tended to have longer ICU stays (WMD: +1.96 days, 95% CI: 0.81–3.11) and higher Sequential Organ Failure Assessment (SOFA) scores (WMD: +0.79, 95% CI: −0.78–2.36), but these findings did not reach statistical significance. One study reported higher 1-year and 5-year mortality for KTRs. Sensitivity analyses revealed one influential study. Begg’s test for overall mortality suggested non-significant publication bias (p = 1.0). Conclusions: KTRs in ICUs are at significantly higher risk for long-term mortality, emphasizing the need for tailored critical care strategies and long-term management. Future research should focus on standardizing methodologies, reducing heterogeneity, and addressing gaps in data to improve evidence-based care for this vulnerable population.