Clinical Kidney Journal最新文献

{"title":"Talquetamab-associated hypokalemia.","authors":"Krishna Mohita Kuruvada, Hassane Izzedine, Rimda Wanchoo, Kenar D Jhaveri","doi":"10.1093/ckj/sfag368","DOIUrl":"https://doi.org/10.1093/ckj/sfag368","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"19 10","pages":"sfag368"},"PeriodicalIF":5.3,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13696887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149263648","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":"Efficacy and safety of low-dose telitacicept in IgA nephropathy: a real-world study.","authors":"Chenxi Liu, Juanyong Zhao, Ming Xia, Xinyan Fan, Xunzi Tang, Xiaomiao Hao, Lili Wan, Bin Len, Di Liu, Haiyang Liu, Linshan Zhou, Xia Tan, Hong Liu","doi":"10.1093/ckj/sfag312","DOIUrl":"10.1093/ckj/sfag312","url":null,"abstract":"<p><strong>Background: </strong>Immunoglobulin A nephropathy (IgAN) represents one of the most common causes of primary glomerulonephritis with unmet clinical needs. This study evaluates the efficacy and safety of telitacicept in patients with IgAN.</p><p><strong>Methods: </strong>This real-world study included 38 biopsy-proven IgAN patients with baseline estimated glomerular filtration rate (eGFR) >10 mL/min/1.73 m² and urine protein-to-creatinine ratio (UPCR) >440 mg/g. Nineteen patients received weekly telitacicept 80 mg (telitacicept group), divided into early-start (telitacicept treatment initiated within 6 months after diagnosis) and late-start (>6 months) subgroups. The other 19, diagnosed during the same period but not receiving telitacicept, served as controls. Clinical data were collected over 12 months. Safety was evaluated.</p><p><strong>Results: </strong>Baseline characteristics were comparable between groups. In the telitacicept group, median UPCR was 1715.98 mg/g (interquartile range 1281.63-2892.11) and median eGFR was 45.45 mL/min/1.73 m² (interquartile range 33.86-93.14). Over 12 months, telitacicept 80 mg weekly was associated with a trend toward greater proteinuria reduction (-51.52% versus -33.31%, <i>P</i> = .081) and a favorable change in renal function (+1.77 versus -4.06 mL/min/1.73 m², <i>P</i> = .008). The early-start subgroup showed greater benefits than the late-start subgroup. In an exploratory analysis of patients with eGFR <35 mL/min/1.73 m² (<i>n</i> = 7 each), telitacicept treatment yielded a sustained reduction in UPCR (-48.83% versus +9.68%) and a stable mean annualized eGFR slope (+0.77 versus -8.88 mL/min/1.73 m²) over 12 months. No severe adverse events occurred with telitacicept, versus one in controls.</p><p><strong>Conclusions: </strong>Our study supports the potential efficacy of low-dose telitacicept in reducing proteinuria and stabilizing eGFR in IgAN. Its clinical benefits were more pronounced when initiated early after diagnosis. Furthermore, in IgAN patients with severe renal impairment, telitacicept may yield better outcomes for proteinuria reduction and eGFR preservation than conventional treatment. These advantages position low-dose telitacicept as a potentially effective treatment strategy, though larger prospective studies are warranted.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"19 10","pages":"sfag312"},"PeriodicalIF":5.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13678823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227492","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":"Ten tips for the management of vascular access in hemodialysis patients.","authors":"Uberto Percudani, Marco Delsante, Giordano Pastori, Meilad Shakkour, Enrico Fiaccadori, Andrea Bandera","doi":"10.1093/ckj/sfag366","DOIUrl":"https://doi.org/10.1093/ckj/sfag366","url":null,"abstract":"<p><p>Vascular access management represents one of the central challenges in hemodialysis care, requiring the nephrologist to navigate a complex and dynamic process that begins well before the first dialysis session and continues throughout the patient's entire treatment trajectory. This challenge is further amplified by the growing age and comorbidity burden of the hemodialysis population, and by the recent shift toward high-convection-volume hemodiafiltration, which depends on a reliably functioning access. Drawing on current evidence and clinical experience, this narrative review argues that optimal outcomes depend not on any single intervention, but on a coherent, longitudinal approach integrating timely planning, careful patient selection, surgical precision, and structured follow-up. In this context, the nephrologist plays a pivotal coordinating role, and assuming ownership of this field through continuous training, multidisciplinary engagement, and education of patients and colleagues remains essential to improving outcomes along the entire course of kidney disease.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"19 10","pages":"sfag366"},"PeriodicalIF":5.3,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13688669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149263600","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":"Single-sample iohexol-measured vs estimated GFR: improving risk prediction?","authors":"Nejc Piko, Sergio Luis Lima, Esteban Porrini","doi":"10.1093/ckj/sfag365","DOIUrl":"https://doi.org/10.1093/ckj/sfag365","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"19 10","pages":"sfag365"},"PeriodicalIF":5.3,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13688673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149263626","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":"A critical appraisal of guidelines and recommendations for the management of ANCA-associated vasculitis.","authors":"Vanja Ivković, Sejin Park, Lauren Floyd, Yoon Seo Kwon, Annette Bruchfeld, Andreas Kronbichler, Jae Il Shin","doi":"10.1093/ckj/sfag317","DOIUrl":"10.1093/ckj/sfag317","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to appraise 11 currently available guidelines for ANCA-associated vasculitis (AAV), identify potential gaps, and provide recommendations for improvement.</p><p><strong>Methods: </strong>The guidelines were appraised using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument consisting of 23 appraisal criteria/items across six domains (D). Four reviewers independently appraised guidelines and scaled domain scores were calculated.</p><p><strong>Results: </strong>The average score of all guidelines was 4.5 ± 0.8 out of 7.0. Agreement between the reviewers was excellent. British Society for Rheumatology 2025 guidelines scored highest (5.8/7.0), being the only guideline unanimously recommended for use. In 'D1/Scope and purpose', all guidelines achieved high scores. In 'D2/Stakeholder involvement', major gaps were identified in the inclusion of the views and preferences of the target population (2c), with few guidelines including patient representatives, addressing patient participation, or considering patient views. In 'D3/Rigour of development', all but two guidelines received high scores. Implementation of the procedure for updating the guidelines (3 h) and for external review (3 g) was addressed poorly. In 'D4/Clarity of presentation', all guidelines except one received a high score. 'D5/Applicability' had the lowest scores due to gaps in the criteria for monitoring/auditing guideline implementation (5d), resource/cost implications (5c), lack of advice/tools for implementation (5a), and inadequate addressing of facilitators/barriers in guideline application (5a). 'D6/Editorial independence' was addressed well.</p><p><strong>Conclusions: </strong>Several aspects of AAV guidelines could be improved, including the inclusion of patient views and preferences, the processes for translating guidelines into clinical practice, and clearer criteria for monitoring guideline implementation and uptake.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"19 10","pages":"sfag317"},"PeriodicalIF":5.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13684405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149236931","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":"Creatinine increases have consistent and differential prognostic impact across kidney function.","authors":"Philip Vestergaard Munch, Simon Sawhney, Uffe Heide-Jørgensen, Simon Kok Jensen, Samira Bell, David Yeung, Zhi Tan, Tim Scale, Matthew Thomas James, Christian Fynbo Christiansen","doi":"10.1093/ckj/sfag319","DOIUrl":"https://doi.org/10.1093/ckj/sfag319","url":null,"abstract":"<p><strong>Background: </strong>Within the current criteria for acute kidney injury (AKI), it remains debated whether small absolute creatinine increases are associated with higher mortality in patients with low baseline estimated glomerular filtration rates (eGFRs), and whether these changes carry prognostic value comparable to relative increases. We therefore examined the prognostic impact of rapid creatinine increases across baseline eGFRs in patients undergoing major elective surgery.</p><p><strong>Methods: </strong>We pooled data on patients undergoing major elective surgery from Canada, Denmark, Scotland, and Wales. This clinical setting was chosen because creatinine levels in this group are routinely monitored both before and after an acute stress event, regardless of clinical status. We ascertained the highest relative creatinine increase within 7 days and the highest absolute creatinine increase within 2 days during the first 7 days after surgery. We used logistic regressions with splines and interaction terms to construct heatmaps depicting age-, sex-, year-, and surgery type-standardized 90-day mortality according to creatinine increases across baseline eGFRs.</p><p><strong>Results: </strong>There were 311 975 surgical procedures performed in 279 554 patients, with 11 568 deaths. Compared to no change in creatinine, a 0.3 mg/dl (26.5 µmol/l) absolute increase was associated with a consistent 2.2-3.3 percentage point increase in mortality for eGFR between 15 and 90 ml/min/1.73 m². However, while the excess mortality associated with a 0.3 mg/dl and a 50% creatinine increase was similar at baseline eGFR of 90 ml/min/1.73 m², the excess mortality of a 50% creatinine increase was substantially greater among those with baseline eGFRs <30 ml/min/1.73 m².</p><p><strong>Conclusions: </strong>A small absolute creatinine increase of 0.3 mg/dl is associated with a consistent increase in mortality across baseline eGFRs, indicating its relevance as a component of the AKI criteria. However, the higher excess mortality associated with a 50% increase at low eGFRs should be emphasized in future guidelines to improve clinical discussions.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"19 10","pages":"sfag319"},"PeriodicalIF":5.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179671","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":"Exploring the suboptimal use of home-based kidney replacement therapies through the lens of structural injustice.","authors":"Wim Van Biesen, Sigrid Sterckx, Ann-Lorraine Clause, Simon Davies","doi":"10.1093/ckj/sfag361","DOIUrl":"https://doi.org/10.1093/ckj/sfag361","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"19 10","pages":"sfag361"},"PeriodicalIF":5.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13696890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149263634","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":"New potassium binders: we need them-we do not need them.","authors":"Luca De Nicola, Marie Evans, Juergen Floege, Carmine Zoccali","doi":"10.1093/ckj/sfag360","DOIUrl":"10.1093/ckj/sfag360","url":null,"abstract":"<p><p>New potassium binders may facilitate contemporary chronic kidney disease care by controlling hyperkalemia and thereby facilitating the continued use of kidney- and cardioprotective therapies, particularly renin-angiotensin-aldosterone system inhibitors. The opposing view is that sodium polystyrene sulfonate remains effective, familiar, inexpensive, and often well tolerated, while direct comparative evidence has not yet shown clinically meaningful superiority of newer binders. This debate weighs clinical utility, comparative efficacy, safety, and cost, concluding that new binders are valuable options but that their routine replacement of established low-dose sodium polystyrene sulfonate and the need for potassium binders beyond optimized diuretic therapy, acidosis control, diet, etc. requires stronger comparative evidence.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"19 10","pages":"sfag360"},"PeriodicalIF":5.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215056","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":"Blood pressure variability associates with mortality risk of patients with ANCA-associated vasculitis.","authors":"Elisabetta Bussalino, Elisa Russo, Lucia Maccio, Marta Donati, Federica Mescia, Marta Calatroni, Martina Tedesco, Gabriella Moroni, Federico Alberici, Francesca Viazzi, Pasquale Esposito","doi":"10.1093/ckj/sfag356","DOIUrl":"10.1093/ckj/sfag356","url":null,"abstract":"<p><strong>Objectives: </strong>Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) is associated with increased cardiovascular risk, related to persistent inflammation and endothelial dysfunction. Long-term systolic blood pressure variability (SBPV), reflecting vascular damage, may predict outcomes better than mean blood pressure (BP). We investigated the impact of BP control and visit-to-visit BP variability (VVV), on all-cause mortality in AAV patients during maintenance therapy.</p><p><strong>Methods: </strong>We retrospectively studied 95 AAV patients followed at three Italian nephrology centers. SBPV was defined as the standard deviation of ≥4 systolic BP measurements within 12 months from the first SBPV assessment. Patients were stratified by SBPV tertiles. The primary outcome was all-cause mortality.</p><p><strong>Results: </strong>Over a median follow-up of 78 months, 14 patients (14.7%) died. Deceased patients were older and had higher pulse pressure (PP) and VVV. Hypertension prevalence increased across SBPV tertiles (35%, 62%, 69%; <i>P</i> = .02). Mortality rose from 6% in the lowest to 34.5% in the highest SBPV tertile (Fisher's exact, <i>P</i> = .001). Time-averaged systolic BP was not associated with mortality. Conversely, each 5-mmHg increase in SBPV was associated with a two-fold higher risk of death [hazard ratio (HR) 2.03, 95% confidence interval (CI) 1.29-3.20; <i>P</i> = .002]. SBPV remained significantly associated with outcome after full multi-variable adjustment, including age, sex, myeloperoxidase positivity, estimated glomerular filtration rate, PP, and proteinuria (adjusted HR 8.06 per 1 mmHg, 95% CI 1.42-45.54; <i>P</i> = .02).</p><p><strong>Conclusion: </strong>In AAV patients, increased VVV was associated with all-cause mortality outperforming mean systolic BP. Further research is needed to confirm the impact of variable blood pressure on patient outcomes in AAV.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"19 10","pages":"sfag356"},"PeriodicalIF":5.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13678739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227551","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":"Anti-PLA2R positivity does not exclude malignancy in membranous nephropathy: lessons from the course after tumor treatment.","authors":"Saide Elif Güllülü Boz, Abdülmecit Yıldız","doi":"10.1093/ckj/sfag357","DOIUrl":"10.1093/ckj/sfag357","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"19 10","pages":"sfag357"},"PeriodicalIF":5.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13678737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227563","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}