Background: The quality of life (QoL) of patients with end-stage kidney disease (ESKD) who undergo dialysis is a reliable predictor of their long-term survival. Hemodialysis is the most common form of kidney replacement therapy for ESKD, followed by peritoneal dialysis. This study aimed to identify the factors affecting QoL in ESKD patients treated with peritoneal dialysis (PD) or hemodialysis (HD) in Riyadh, Saudi Arabia. Methods: A cross-sectional study was conducted between June and July 2021 to assess the QoL of patients with ESKD who underwent peritoneal dialysis and hemodialysis. Patients who had been on dialysis for at least one year were included. The Arabic version of the Quality of Life Index–Dialysis (QLI-D) version III was used to measure the QoL. Results: A total of 210 patients completed the questionnaire. The overall QLI score was 21.73 ± 4.2, with subscales for health and functioning (20.35 ± 5.2), social and economic (20.20 ± 4.8), psychological/spiritual (23.94 ± 4.9), and family (24.95 ± 4.5). The QLI scores for PD and HD patients were 21.80 ± 4.4 and 21.72 ± 4.1, respectively. SOCSUB (p = 0.031) was significantly associated with group and income, whereas QLI (p = 0.003), HFSUB (p = 0.013), SOCSUB (p = 0.002), and PSPSUB (p = 0.003) were significantly correlated with group and years of dialysis. Conclusion: The study found that patients were most satisfied with their family, health and functioning, and social/economic subscales. Income and years of dialysis were found to be predictive factors of QoL. Overall, peritoneal patients in this study demonstrated a better QoL than HD patients.

Few data are available about the rate of short-term remission and its impact on the long-term outcomes of proliferative lupus nephritis in the Middle East. An observational study was carried out involving 96 adult patients with biopsy-proven focal or diffuse proliferative lupus nephritis (PLN) from four different hospitals. Data on induction, remission and long-term outcomes were collected and analyzed. Among the 96 patients with biopsy-proven PLN (median age 27 (IQR: 21,34) years, 85% women and median duration of systemic lupus erythematosus (SLE) prior to diagnosis 27 (IQR: 11, 55) months), 67% developed remission at 6 months (proportion 0.67; 95% CI 0.57, 0.76). Mycophenolate mofetil (MMF) was used in 45/96 (47%), CYC in 41/95 (43%) and other agents in 10/96 (10%). The choice of MMF as induction agent has increased in recent years. Among baseline characteristics, only histologic activity was found to have a significant association with remission, with active lesions more likely to remit than active/chronic and chronic lesions (AOR 6.5, 95% CI 1.44–29.39, p = 0.015). Based on Kaplan–Meier analysis, the 5-year renal survival rate without doubling serum creatinine was 73.8%. Compared to patients with complete remission, lower long-term renal survival rates were observed in patients with no remission (89.7 versus 43%, p = 0.001) and partial remission (89.7 versus 77.6%, p = 0.256). The cumulative rate of doubling serum creatinine, dialysis, relapse and death was 23%, 11%, 10% and 5%, respectively, at 48-month median follow up. Approximately two-thirds of patients with PLN develop remission in response to standard induction therapy. Remission was negatively associated with the presence of chronic changes in renal biopsy. Overall, MMF is the most commonly used agent to induce remission; however, with more severe disease CYC, is used more frequently. PLN is associated with significant long-term renal outcomes including a 26% cumulative rate of doubling of serum creatinine at 5 years. Initial remission predicts this long-term renal survival.

Objective: Lupus nephritis (LN) is a serious manifestation of systemic lupus erythematosus (SLE). Existing data on LN in Saudi Arabia are primarily retrospective and derived from single centers. Therefore, this systematic review presents a unique and comprehensive analysis of the disease characteristics and outcomes of LN in Saudi Arabia. Method: A systematic search of MEDLINE, ScienceDirect, Embase, Cochrane, and PubMed databases was conducted up to April 2024. Eligible articles reporting on LN in Saudi Arabia were included, and disease characteristics and outcomes were analyzed. Results: A total of 36 studies met the inclusion criteria. The prevalence of LN among SLE patients in Saudi Arabia ranged from 19% to 55%, with biopsy-proven LN reported in 11% to 42.7% of cases. Females accounted for 66% to 94.9% of patients, with a mean age at diagnosis between 23.8 and 39.7 years. Hypertension was present in 45.8% to 62.9% of patients, with nephrotic-range proteinuria in 20.7% to 58.5% and mean serum creatinine levels between 60 and 112.68 µmol/L. Class IV LN was the most common histopathological finding, occurring in up to 72% of cases. Complete remission was achieved in up to 81.5% of patients within 12 months, though lower remission rates were observed in those with proliferative LN. End-stage renal disease (ESRD) rates ranged from 5.5% to 30.7%, with proliferative LN, older age, and hypertension being significant predictors of progression to ESRD. Five-year survival rates ranged from 92% to 96%, while 10-year survival reached 95%. Infection and renal failure were the leading causes of mortality. Conclusion: LN is highly prevalent in lupus Saudi patients, with Class IV LN being the most common and associated with poor outcomes. Although survival has improved, many patients still progress to ESRD. Prospective trials are needed to evaluate outcomes in the current era of biological therapies.

Background & Objectives: Data on the efficacy and adverse effects of finerenone in patients with nondiabetic chronic kidney disease (CKD) are limited, particularly regarding ethnic diversity. This study aimed to evaluate the outcomes of finerenone in patients with nondiabetic CKD previously treated with standard therapies and investigate associated adverse effects, including hyperkalemia and hypotension. Methods: This is a retrospective exploratory study. It is a single-center study including patients with nondiabetic CKD who visited King Fahad Medical City in Riyadh, Saudi Arabia. The primary exposure was finerenone treatment, assessing its effects on albuminuria, kidney function, and blood pressure (BP), following prior use of renin–angiotensin–aldosterone system and sodium–glucose transport protein 2 inhibitors. The measured outcomes were the urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR). The UACR (primary endpoint) was calculated as the mean of two morning spot urine samples collected consecutively 1 day apart. During each 4-week treatment period, secondary endpoints included changes in UACR, as determined by a 24 h urine sample, BP, and eGFR. The Wilcoxon signed-rank test was used to compare changes in continuous variables before and after therapy initiation. Statistical significance was set at p < 0.05. Results: This study included 16 patients with nondiabetic CKD (median age, 38.5 years [range, 35–50 years]; 56.3% male). The baseline eGFR was 66 mL/min/1.73 m² (47–82.5), with a UACR of 90.0 mg/g (58.8–132.5). No hyperkalemia was observed (potassium level, 4 mmol/L [3.8–4.4]). However, significant reductions in systolic and diastolic BPs were observed. Albuminuria improved significantly: the UACR decreased from 90.0 to 39.3 mg/g (p = 0.04). No adverse events, including hyperkalemia or hypotension, were reported. Conclusions: Finerenone showed promise in reducing albuminuria and blood pressure among patients with nondiabetic chronic kidney disease, with no significant adverse effects reported. These findings suggest potential benefits for this patient population, warranting further investigation.

Contrast medium-induced nephropathy (CIN) is a leading cause of acquired acute kidney injury and has been associated with prolonged hospitalization and adverse clinical outcomes. This study aimed to determine if omega 3 fatty acids reduce the risk of CIN in patients with chronic kidney disease undergoing coronary angiography. A total of 130 consecutive patients undergoing coronary angiography were randomly assigned to one of two groups as follows: 67 patients were assigned to the N-acetylcysteine (NAC; 1200 mg) and 63 patients were assigned to the omega 3 fatty acid (4 g). Both drugs were administered orally twice per day one day before and on the day of contrast administration. Of the 130 patients enrolled in this study, 10 (7.7%) experienced an increase of at least 0.5 mg/dL (44 μmol/L) in serum creatinine levels 48 h after administration of the contrast agent including 5 of the 67 patients in the NAC group (7.5%) and 5 of the 63 patients in the omega 3 fatty acids group (7.9%; P = 0.919). There were no significant differences in the need for renal replacement therapy (3.0% vs. 9.5%, P = 0.121) or in the mortality rate (3.0% vs. 6.3%, P = 0.361) between the two groups. Short-term prophylactic omega 3 fatty acid treatment with hydration does not reduce the risk of CIN in patients with chronic kidney disease undergoing coronary angiography.

Background: Crescent formation is a marker of severe kidney injury in lupus nephritis (LN), but data from Saudi Arabia are scarce. We studied how crescents affect clinical features, pathology, and outcomes in Saudi patients. Methods: We reviewed 100 adults with biopsy‐proven LN (2003–2024), classifying them by the presence and type of crescents (cellular, fibrocellular, fibrous). Crescent burden was calculated as the percentage of glomeruli involved; ≥ 7.39% was considered high. The composite renal outcome included estimated glomerular filtration rate (eGFR) < 20 mL/min/1.73 m ² , ≥ 20% decline in eGFR, doubling of serum creatinine, or dialysis or transplant. Outcomes were analyzed using Kaplan–Meier curves and multivariable Cox regression. Results: Out of 100 patients with LN, 41 (41%) had crescents. Those with crescents had lower eGFR (71.41 ± 43.92 vs. 100.12 ± 45.63 mL/min/1.73 m ² , p = 0.002), lower albumin (25.51 ± 6.17 vs. 29.81 ± 7.56 g/L, p = 0.004), and higher activity scores (7.93 ± 3.05 vs. 2.27 ± 2.33, p < 0.001) than non‐crescent patients; chronicity scores were similar. Kaplan–Meier curves suggested that patients with high crescent burden (≥ 7.39%) had worse event‐free survival, but crescent burden was not an independent predictor. Instead, older age, higher baseline creatinine, elevated CRP, and fibrous crescents were linked to worse outcomes. Treatment response did not differ by crescent burden ( p = 0.294). Conclusion: Crescents indicate more active disease and worse kidney function at diagnosis. While a high crescent burden may signal poorer short‐term outcomes, long‐term prognosis depends more on other clinical and pathological factors. Assessing both clinical presentation and biopsy findings is important for managing LN.