Clinical Kidney Journal最新文献

{"title":"Acute kidney injury as a key predictor of cardiovascular events in chronic kidney disease patients: the CKD-REIN study.","authors":"Nans Florens, Estelle Aymes, Victoria Gauthier, Luc Frimat, Maurice Laville, Dimitri Bedo, Thomas Beaudrey, Philippe Amouyel, Nicolas Mansencal, Céline Lange, Sophie Liabeuf, Ziad A Massy, Benedicte Stengel, Natalia Alencar de Pinho, Aghiles Hamroun","doi":"10.1093/ckj/sfae337","DOIUrl":"10.1093/ckj/sfae337","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>Cardiovascular diseases are a leading cause of morbidity and mortality in patients with chronic kidney disease (CKD). Acute kidney injury (AKI) has been increasingly recognized as a potential exacerbating factor for cardiovascular events in these patients. The CKD-REIN study aims to explore the relationship between AKI and the risk of major adverse cardiovascular events (MACE) in a cohort of CKD patients. We hypothesize that AKI is a significant and independent predictor of MACE in patients with CKD, and that the severity of AKI correlates with the risk of subsequent cardiovascular events.</p><p><strong>Methods: </strong>This prospective cohort study included 3033 adult CKD patients from 40 outpatient nephrology clinics in France. Patients were followed for a median of 5.2 years. AKI episodes were identified and staged based on the KDIGO-AKI criteria. Cardiovascular events, including myocardial infarction, stroke, heart failure hospitalization, and cardiovascular death, were systematically recorded. The association between AKI and MACE was analyzed using a multivariable Cox model, adjusting for confounders such as demographic characteristics, medical history, and baseline kidney function.</p><p><strong>Results: </strong>During the follow-up, 530 patients experienced at least one episode of AKI. The cumulative incidence of MACE at 1 year post-AKI was 8.1%. Patients with AKI had a significantly increased risk of MACE, with an adjusted hazard ratio (HR) of 5.78 (<i>P</i> < .001). The risk was consistent across different MACE components and was independent of age, sex, CKD stage, or comorbidities. The risk of MACE was higher for more severe AKI stages and for AKI events requiring hospitalization or associated with incomplete renal recovery.</p><p><strong>Conclusion: </strong>The findings of this study confirm that AKI is a significant independent predictor of MACE in CKD patients, demonstrating a strong severity-response relationship. These results underscore the importance of vigilant cardiovascular monitoring and preventive strategies in CKD patients following AKI episodes. Understanding the mechanisms linking AKI to cardiovascular outcomes is crucial for developing targeted interventions to mitigate these risks.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 12","pages":"sfae337"},"PeriodicalIF":3.9,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11646099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Push toward pre-emptive kidney transplantation - for sure?","authors":"Orsolya Cseprekal, Christian Jacquelinet, Ziad Massy","doi":"10.1093/ckj/sfae335","DOIUrl":"https://doi.org/10.1093/ckj/sfae335","url":null,"abstract":"<p><p>Pre-emptive kidney transplantation (PKT) has long been considered the optimal treatment for patients with end-stage chronic kidney disease (CKD) seeking the most favourable long-term outcomes. However, the significant growth in transplant procedures over recent decades has led to a notable increase in wait-listed patients and a disproportionate demand for donor organs. This situation necessitates a re-evaluation of transplantation timing and the establishment of rational indications from both societal and clinical perspectives. An increasing number of retrospective analyses have challenged the universal benefit of PKT, suggesting that premature indications for living or deceased donor PKT may not always yield superior hard outcomes compared with non-PKT approaches. Conventional predictive models have shown limitations in accurately assessing risks for certain subpopulations, potentially leading to significant disparities among wait-listed patients. To address these challenges, we propose the following considerations. Prediction models should not only optimize the distribution of our limited donor resources, but should also illuminate foreseeable risks associated with a potentially 'unsuccessful' PKT. Therefore, this article seeks to underscore the necessity for further discourse on the smouldering concept of when and for whom living or deceased donor PKT should be considered. Is it universally beneficial, or should the clinical paradigm be re-evaluated? In the endeavour to attain superior post-PKT survival outcomes compared with non-PKT or conservative treatment, it seems critical to acknowledge that other treatments may provide more favourable results for certain individuals. This introduces the intricate task of effectively navigating the complexities associated with 'too early' or 'unsuccessful' PKT.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 12","pages":"sfae335"},"PeriodicalIF":3.9,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11653007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SUrvey of renal Biopsy registry database and Anticancer dRUg therapy in Japan (SUBARU-J study).","authors":"Takashige Kuwabara, Yoshikazu Miyasato, Tomoko Kanki, Teruhiko Mizumoto, Takeshi Matsubara, Naoki Sawa, Hitoshi Sugiyama, Shoichi Maruyama, Hiroshi Sato, Tatsuo Tsukamoto, Tomohiro Murata, Mariko Miyazaki, Toshiyuki Imasawa, Masashi Mukoyama, Naoka Murakami, Kenar D Jhaveri, Motoko Yanagita","doi":"10.1093/ckj/sfae327","DOIUrl":"10.1093/ckj/sfae327","url":null,"abstract":"<p><strong>Background: </strong>Kidney complications associated with anticancer drug therapy have greatly increased recently. We aimed to investigate the real-world clinical outcomes of anticancer drug therapy-associated renal complications in Japan using the national kidney biopsy database, Japan Renal Biopsy Registry (J-RBR).</p><p><strong>Methods: </strong>From 2018 to 2021, 449 cases from 49 facilities identified as 'drug-induced' histopathology in the J-RBR were screened, of which a total of 135 were confirmed as anticancer drug-related cases and included in the analysis. Overall survival rates were estimated using the Kaplan-Meier method and compared by logrank test. The Cox regression model was used to evaluate the association between variables and deaths.</p><p><strong>Results: </strong>The most common primary sites of malignancies were the lung (33.3%), followed by gastrointestinal (16.3%) and gynaecological (11.1%) cancers. Tubulointerstitial nephritis (TIN; 47.4%) and thrombotic microangiopathy (TMA; 35.6%) were the most frequent diagnoses. All immunoglobulin A nephropathy, minimal change disease and crescentic glomerulonephritis (CrGN) cases were immune checkpoint inhibitor related. All CrGN cases were anti-neutrophil cytoplasmic antibody negative. Antibiotics were most frequently used concomitantly with anticancer drugs in TMA cases among subgroups (TMA versus others: 62.5 versus 27.5%; <i>P</i> < .001). Among TMA cases, the serum lactate dehydrogenase level tended to be higher in cytotoxic agent-associated TMA (CTx-TMA) than in other TMAs, but was not significant between groups (415.5 versus 219.0 U/l; <i>P</i> = .06). Overall survival was worse in CTx-TMA than in other TMAs (<i>P</i> = .007). The Cox model demonstrated proton pump inhibitor (PPI) use (hazard ratio 2.49, <i>P</i> = .001) as a significant prognostic factor, as well as the presence of metastasis and serum albumin level.</p><p><strong>Conclusions: </strong>Our registry analysis highlighted various presentations of biopsy-proven kidney complications associated with anticancer drug therapy. Clinicians should be aware of worse outcomes associated with CTx-TMA and the prognostic role of PPI use.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 12","pages":"sfae327"},"PeriodicalIF":3.9,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11630032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ERA Registry Figure of the month Heterogeneity of kidney replacement therapy incidence across Europe.","authors":"Vianda S Stel, Alberto Ortiz, Anneke Kramer","doi":"10.1093/ckj/sfae306","DOIUrl":"https://doi.org/10.1093/ckj/sfae306","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 11","pages":"sfae306"},"PeriodicalIF":3.9,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11600136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction.","authors":"","doi":"10.1093/ckj/sfae344","DOIUrl":"https://doi.org/10.1093/ckj/sfae344","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1093/ckj/sfae199.][This corrects the article DOI: 10.1093/ckj/sfae236.].</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 11","pages":"sfae344"},"PeriodicalIF":3.9,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does <i>de novo</i> malignancy heighten the risk of rejection in kidney transplant recipients?","authors":"Erol Demir, Mevlut Tamer Dincer, Cebrail Karaca, Cansu Erel, Latif Karahan, Aslihan Pekmezci, Sinan Trabulus, Nurhan Seyahi, Aydin Turkmen","doi":"10.1093/ckj/sfae349","DOIUrl":"10.1093/ckj/sfae349","url":null,"abstract":"<p><strong>Background: </strong>Malignancies are the third leading cause of death among kidney transplant recipients. These patients face increased mortality and challenges such as allograft loss and rejection, which may arise from surgical complications, changes in immunosuppressive therapy or the use of chemotherapeutics. This study aims to examine the risk of allograft rejection and loss in kidney transplant recipients diagnosed with <i>de novo</i> malignancies.</p><p><strong>Methods: </strong>This retrospective case-control study included adult kidney transplant patients from 1986 to 2020 who developed <i>de novo</i> malignancies. Each patient with a malignancy was matched with a control without malignancy using the nearest neighbor matching method. The outcomes measured were biopsy-confirmed allograft rejection, death-censored allograft loss and overall mortality after the diagnosis of malignancy in the malignancy group and at any point in the control group.</p><p><strong>Results: </strong>Of 2750 records reviewed, 267 patients (9.7%) had biopsy-confirmed malignancies, with a median age of 60 years and 66.3% men. The median follow-up was 218 months. Kaplan-Meier analysis showed that the allograft rejection rates were lower in the malignancy group compared with the control group (26 vs 60, <i>P </i>< .001). Overall mortality was higher in the malignancy group, although this difference was not statistically significant (104 vs 73, <i>P </i>= .25). Death-censored allograft loss was similar between groups (22 vs 32, <i>P </i>= .49). Chemotherapy and older recipient age were associated with reduced allograft rejection risk, as indicated by multivariable regression analysis.</p><p><strong>Conclusions: </strong>In kidney transplant recipients with <i>de novo</i> malignancies, death with a functioning graft remains significant. However, allograft loss rates do not increase compared with those without malignancies, and rejection risk is reduced, especially in older and chemotherapy-treated patients. These findings suggest that managing immunosuppression reduction in this population may be appropriate, but further research is needed to determine optimal care strategies.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 12","pages":"sfae349"},"PeriodicalIF":3.9,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11646098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between plasma osteopontin, sex, and 2-year global and cardiorenal outcomes in older outpatients screened for CKD: a secondary analysis of the SCOPE study.","authors":"Luca Soraci, Johan Ärnlöv, Axel C Carlsson, Tobias Rudholm Feldreich, Anders Larsson, Regina Roller-Wirnsberger, Gerhard Wirnsberger, Francesco Mattace-Raso, Lisanne Tap, Francesc Formiga, Rafael Moreno-González, Bartlomiej Soltysik, Joanna Kostka, Rada Artzi-Medvedik, Itshak Melzer, Christian Weingart, Cornel Sieber, Serena Marcozzi, Lucia Muglia, Fabrizia Lattanzio","doi":"10.1093/ckj/sfae336","DOIUrl":"10.1093/ckj/sfae336","url":null,"abstract":"<p><strong>Background: </strong>Plasma osteopontin (pOPN) is a promising aging-related biomarker among individuals with and without kidney disease. The interaction between sex, pOPN levels, and global and cardiorenal outcomes among older individuals was not previously evaluated.</p><p><strong>Methods: </strong>In this study we investigated the association of pOPN with 24-month global mortality, major cardiovascular events (MACEs), MACEs + cardiovascular (CV) mortality, and renal decline among older individuals; we also evaluated whether sex modified observed associations. pOPN levels were measured in a cohort of 2013 outpatients (908 men and 1105 women) aged 75 years or more enrolled in the context of a multicenter prospective cohort study in Europe. Multivariable linear regression, Cox and Fine Gray models, and linear mixed regression models were fitted to evaluate whether sex modified the associations between biomarkers and study outcomes.</p><p><strong>Results: </strong>In total, 2013 older participants with a median age of 79 years, 54.9% of whom women, were included in the study; increased pOPN levels were associated with all-cause mortality specifically among women [reduced fully adjusted model resulting from backward selection, hazard ratio, 95% confidence interval (CI): 1.84, 1.20-2.89]. Addition of pOPN to models containing age, eGFR, and albumin-to-creatinine ratio (ACR) improved the time-dependent area under the curve (AUC) at 6, 12, and 24 months, among women only. No significant association was found between the biomarker levels, MACE, and MACE + CV mortality. Conversely, increased baseline pOPN was associated with eGFR decline in all patients (-0.45, 95%CI: -0.68 to -0.22 ml/min/1.73 m² year) but with slightly steeper declines in women compared to men (-0.57, -0.99 to -0.15 vs -0.47, -0.88 to -0.07).</p><p><strong>Conclusions: </strong>pOPN levels were significantly lower in women than in men but associated with all-cause mortality in women only; increase in serum pOPN was associated with eGFR decline over time in all patients, but with stronger associations among women. Assessment of pOPN may help identifying older female participants at risk of poor outcomes.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 12","pages":"sfae336"},"PeriodicalIF":3.9,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11631127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive value of residual active histologic lesions on renal flare in lupus nephritis patients with clinical remission.","authors":"Jinhua Hou, Dandan Liang, Songxia Quan, Zhangsuo Liu, Zhihong Liu","doi":"10.1093/ckj/sfae350","DOIUrl":"https://doi.org/10.1093/ckj/sfae350","url":null,"abstract":"<p><strong>Background: </strong>Renal flare in lupus nephritis (LN) is a crucial contributing factor to poor kidney outcomes. This study aimed at evaluating the predictive value of residual active histologic lesions on renal flare in proliferative LN patients with clinical remission.</p><p><strong>Methods: </strong>We retrospectively enrolled LN patients with class III/IV ± V (biopsy 1) who had undergone a protocol repeat biopsy (biopsy 2) at 7.3 (IQR: 6.5, 8.4) months after induction therapy with clinical remission and experienced renal flare within 3 years or had been followed up for at least 3 years without renal flare after biopsy 2 with maintenance therapy from two kidney units in China.</p><p><strong>Results: </strong>A total of 114 eligible patients were included, 28 (24.6%) of whom developed a renal flare. Activity index (AI) at biopsy 2 was significantly associated with LN flare (<i>P </i>< .0001). If AI > 1, the OR for LN flare was 23.1 (95%CI, 5.1-103.8, <i>P </i>< .001). For patients with partial clinical remission compared with those with complete clinical remission, the OR for LN flare was 3.0 (95%CI: 1.1-8.3, <i>P </i>= .029). Multivariate analysis showed that anti-dsDNA positivity, presence of cellular/fibrocellular crescent, and endocapillary hypercellularity at biopsy 2 were independent risk factors for LN flare. When residual active histologic lesions were added to clinical variables, the area under the curve of the prediction model for LN flare significantly increased and the misclassification rate significantly decreased.</p><p><strong>Conclusions: </strong>Renal flare in LN patients with clinical remission is strongly associated with the residual active histologic lesions.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 12","pages":"sfae350"},"PeriodicalIF":3.9,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11650015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of incentivising dialysis facilities on peripheral arterial disease care in patients undergoing haemodialysis: a claims-based cohort study.","authors":"Yasunori Suzuki, Masao Iwagami, Sayuri Shimizu, Atsushi Goto","doi":"10.1093/ckj/sfae342","DOIUrl":"https://doi.org/10.1093/ckj/sfae342","url":null,"abstract":"<p><strong>Background: </strong>Peripheral arterial disease (PAD) occurs frequently in patients undergoing dialysis, but early intervention for PAD may not be fully implemented. We evaluated the effects of financially incentivising dialysis facilities that provided early detection and management of PAD on outcomes of PAD care.</p><p><strong>Methods: </strong>This retrospective cohort study identified patients aged 18-74 years who received maintenance haemodialysis between April 2016 and March 2021 from the JMDC Claims Database. The (time-dependent) exposure was claim for incentives for early detection and management of PAD. The outcomes were PAD screening tests (process indicator) and infections, revascularisation procedures, and amputations in the lower extremities (outcome indicators). We used Poisson regression models with generalised estimation equations for the number of screening tests and Cox proportional hazards models for the first incidence of the outcome indicator.</p><p><strong>Results: </strong>Overall, 5850 patients on haemodialysis were identified: 5183 and 667 with and without claims for the incentive, respectively; the numbers of screening tests were 9070 and 776, respectively (adjusted ratio of the frequency, 1.89 [95% confidence interval 1.70-2.10]). Among patients with and without claims for the incentive, infections occurred in 479 and 109 (adjusted hazard ratio [HR], 0.99 [0.80-1.23]), revascularisations were performed in 192 and 29 (adjusted HR, 1.11 [0.75-1.66]), and amputations were conducted in 72 and 9 patients, respectively (adjusted HR, 1.35 [0.66-2.75]).</p><p><strong>Conclusion: </strong>The financial incentive for early detection and management of PAD was associated with a higher frequency of PAD screening tests, but not with improved outcome indicators.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 12","pages":"sfae342"},"PeriodicalIF":3.9,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11653004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of arteriovenous fistula formation on trajectory of kidney function decline: a target trial emulation.","authors":"Luis Loureiro Harrison, Edouard L Fu, Peter C Thomson, Jamie P Traynor, Patrick B Mark, Sokratis Stoumpos","doi":"10.1093/ckj/sfae345","DOIUrl":"https://doi.org/10.1093/ckj/sfae345","url":null,"abstract":"<p><strong>Background: </strong>Prior nonrandomized studies have suggested nephroprotective effects of arteriovenous fistula (AVF) formation, but these are plausibly susceptible to immortal time and selection biases.</p><p><strong>Methods: </strong>We studied patients attending nephrology clinics in the West of Scotland during 2010-22 with an estimated glomerular filtration rate (eGFR) ≤15 mL/min/1.73 m² and no prior AVF. Using target trial emulation and a sequential trial design, we simulated a hypothetical trial that would randomize patients to either undergo AVF formation immediately or not to undergo AVF formation. The primary outcome was the difference in eGFR slope for the first 6 months of follow-up, estimated using a mixed-effects model. The secondary outcomes were 5-year absolute risks of dialysis and death, estimated using the Aalen-Johansen and Kaplan-Meier estimators respectively.</p><p><strong>Results: </strong>A total of 1364 unique patients (mean age 51.1 years, 55.7% male) contributed 3125 person-trials, with 561 in the AVF and 2564 in the no AVF group. Mean eGFR was 12.6 mL/min/1.73 m² and the median number of eGFR measurements per person-trial was 7 (interquartile range 4-12). Slope of eGFR decline did not differ significantly between the AVF and no AVF groups (between-group difference -0.67 mL/min/1.73 m²/year, 95% CI -1.43, 0.10). The 5-year absolute risk of dialysis was 87% (95% CI 84, 91) in the AVF group and 75% (95% CI 73, 77) in the no AVF group, and the 5-year survival probability was 77% (95% CI 70, 83) in the AVF group and 67% (95% CI 64, 69) in the no AVF group.</p><p><strong>Conclusions: </strong>In this study of patients with advanced chronic kidney disease, there was no evidence of a nephroprotective effect of AVF formation.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 12","pages":"sfae345"},"PeriodicalIF":3.9,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11647593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}