Half of CKD patients are non-dippers, and non-dipping tracks death and progression

The edition in brief

A meta-analysis of 63 mostly retrospective studies (54,515 people) found 53% of patients with chronic kidney disease were non-dippers, whose blood pressure falls less than 10% at night, and people without CKD were less likely to be (RR 0.69). Among patients with CKD, dipping was associated with lower mortality (RR 0.60), fewer cardiovascular events (RR 0.63) and slower progression (RR 0.64), with high heterogeneity. A Chinese study of an automated chemiluminescence assay for anti-nephrin antibodies in 121 children with minimal change disease or FSGS found it agreed substantially with the research reference method and detected antibodies more often (41% vs 28%); positivity was linked to heavier proteinuria and, during remission, to relapse within three months. In 1,052 people with congenital kidney and urinary tract anomalies in the UK 100,000 Genomes Project, whole-genome sequencing found a monogenic cause in only 4.9%, more often with family history, consanguinity or extra-renal features. A meta-analysis of 15 studies found AI models classified membranous nephropathy, IgA nephropathy and minimal change disease from biopsy images with high accuracy, but head-to-head evidence against pathologists was sparse. The pearl: CKD staging needs albuminuria as well as eGFR.