Clinical Kidney Journal最新文献

{"title":"Associations between initial dialysis access types and death from dialysis withdrawal in incident patients with kidney failure.","authors":"Jenny H C Chen, David W Johnson, Matthew A Roberts, Mark A Brown, Frank Brennan, Germaine Wong, Hicham Cheikh Hassan, Wing-Chi G Yeung, Alice Kennard, Christopher E Davies, Neil Boudville, Charmaine E Lok, Wai H Lim","doi":"10.1093/ckj/sfaf024","DOIUrl":"10.1093/ckj/sfaf024","url":null,"abstract":"<p><strong>Background: </strong>Patients receiving haemodialysis via a central venous catheter (HD-CVC) have been shown to have an increased risk of all-cause mortality. It is unclear whether death from dialysis withdrawal is associated with the high mortality risk observed in patients initiated on HD-CVC.</p><p><strong>Methods: </strong>Using the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, we examined the association between initial dialysis access [HD-CVC, haemodialysis via arteriovenous fistula (HD-AVF), and peritoneal dialysis (PD) via PD catheter (PD-PDC)] and death from dialysis withdrawal in adult patients starting dialysis in Australia between 2005 and 2022, analysed by time-stratified adjusted Cox regression with propensity score-matched cohorts.</p><p><strong>Results: </strong>Of 47 412 incident patients followed for a median of 2.65 years (interquartile range 1.19-4.87), 8170 (17%) died from dialysis withdrawal. Compared with patients initiated on HD-AVF, patients initiated on HD-CVC were more likely to experience death from dialysis withdrawal in the first 3 years after dialysis initiation, but not after 3 years [adjusted hazard ratios 2.43 (95% confidence interval 1.95-3.02), 2.06 (1.67-2.53), 1.57 (1.40-1.76), and 1.06 (0.97-1.15) for 0-6 months, >6-12 months, >1-3 years, and >3 years after dialysis initiation, respectively]. Comparison between patients initiated on HD-CVD and PD-PDC showed similar estimates. No difference in withdrawal risk was observed between patients initiated on HD-AVF and PD-PDC.</p><p><strong>Conclusions: </strong>Patients initiated on HD-CVC were twice as likely to experience early death from dialysis withdrawal compared with patients who had initiated dialysis with HD-AVF or PD-PDC. The increased risks diminished over time and were not observed after 3 years on dialysis.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf024"},"PeriodicalIF":3.9,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566044","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":"COVID-19 among kidney transplant recipients: evaluating risk factors during the initial phase of the pandemic.","authors":"Alexandra Nowak, Aurora Caldinelli, Mårten Segelmark, Helena Rydell, Angelica Artborg, Rino Bellocco, Maria Stendahl, Bengt Lindholm, Julia Wijkström, Marie Evans","doi":"10.1093/ckj/sfaf030","DOIUrl":"10.1093/ckj/sfaf030","url":null,"abstract":"<p><strong>Background: </strong>Current knowledge about risk factors for severe COVID-19 among kidney transplant recipients stem from meta-analyses of small or regional studies.</p><p><strong>Methods: </strong>All kidney transplant recipients in Sweden as of 1 January 2020 (<i>n</i> = 5824) were followed during the first 2 years of the pandemic. Data from the Swedish Renal Registry and linked health care registries were analyzed by multivariable adjusted logistic regression to identify risk factors for severe COVID-19, defined as hospitalization or death due to COVID-19.</p><p><strong>Results: </strong>Male sex increased the risk of severe COVID-19. While many comorbidities were associated with increased risk, their significance diminished after adjustment for other factors. Kidney transplant recipients of working age, 49-58 years adjusted odds ratio (aOR) 2.32 (95% CI 1.53-3.51) and 59-68 years aOR (1.92; 1.26-2.91) had the highest risk compared to the youngest age group (18-38 years). Compared to recently (<1 year) transplanted patients, those transplanted >5 years ago had a lower risk of severe COVID-19 (aOR 0.52; 0.36-0.75 for 6-10 years; aOR 0.57; 0.41-0.79 for >10 years). Longer pre-transplant dialysis vintage (aOR_1-year 1.04; 1.01-1.06) and deceased donor kidneys (aOR 1.41; 1.09-1.84) increased the risk. Immunosuppression with mycophenolate mofetil (aOR 1.47, 95% CI 1.08-1.99) and proton pump inhibitor use (aOR 1.58, 95% CI 1.24-2.01) were strongly associated with severe COVID-19.</p><p><strong>Conclusions: </strong>While kidney transplant recipients share risk factors with the general population, working age groups were at the highest risk, unlike in the general population. These findings emphasize the need for targeted prevention and treatment strategies for kidney transplant recipients in future pandemics.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf030"},"PeriodicalIF":3.9,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572297","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":"Women in academic nephrology: have we bridged the gender gap?","authors":"Rose Mary Attieh, Karima Wehbe, Wafaa Khaled, Darshil Jhaveri, Hay Me Me, Salman Bhutta, Kiran Munir, Kenar D Jhaveri","doi":"10.1093/ckj/sfaf019","DOIUrl":"10.1093/ckj/sfaf019","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf019"},"PeriodicalIF":3.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566059","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":"Development and validation of a measure to assess patient experience of needling of arteriovenous fistulas or grafts for haemodialysis access: the NPREM.","authors":"Currie Moore, Amanda Busby, Rebecca Flanagan, Helen Ellis-Caird, Faizan Awan, Tarsem Paul, Catherine Fielding, Kieran McCafferty, Sabine N van der Veer, Ken Farrington, David Wellsted","doi":"10.1093/ckj/sfaf029","DOIUrl":"10.1093/ckj/sfaf029","url":null,"abstract":"<p><strong>Background: </strong>Needling is a key step in haemodialysis. Research suggests that needling experience is sub-optimal; however, no validated measure exists to inform improvements. We addressed this by developing the Needling Patient Reported Experience Measure (NPREM).</p><p><strong>Methods: </strong>We used mixed methods and co-production. All participants were adults with working fistulas/grafts from eight UK kidney centres. Phase 1 involved developing concepts and items: in interviews (<i>n</i> = 41), we explored patients' needling experience and identified key aspects of needling using thematic analysis. This informed the 98-item NPREM(v0.1). Phase 2 was piloting the measure: cognitive interviews (<i>n</i> = 16) assessed face validity. Items were amended or removed, yielding a 48-item NPREM(v0.2). A pilot survey (<i>n</i> = 183) examined initial psychometric properties. NPREM(v0.2) showed good internal consistency (Cronbach's alpha = 0.95). Review of analyses resulted in a 35-item NPREM(v0.3). Phase 3 involved evaluating the measure's dimensionality, validity and reliability: patients (<i>n</i> = 468) completed the NPREM(v0.3), Vascular Access Quality of Life (VASQoL), EuroQol 5-Dimension-5-Level (EQ-5D-5L) and Patient Activation Measure (PAM), with a sub-set completing a follow-up NPREM (<i>n</i> = 99). Items were evaluated with 28 items retained in the NPREM(v1.0). Confirmatory factor analysis confirmed a unidimensional model fit (comparative fit index = 0.899). Validity of the NPREM(v1.0) was good [convergent: VASQoL (<i>r </i>= 0.60) and overall experience (<i>r </i>= 0.79); divergent: EQ-5D (<i>r </i>= -0.31), EQ-5D visul analogue scale (<i>r </i>= 0.24) and PAM (<i>r </i>= 0.17)]. Test-retest scores were strongly correlated (<i>r </i>= 0.88), demonstrating high reliability. Known-groups validity was demonstrated between centre scores [range 5.21 (standard deviation 1.20) to 5.94 (0.75)].</p><p><strong>Conclusion: </strong>The NPREM measures patient experience of needling for haemodialysis. It offers kidney services a means of assessing needling experience, informing patient-focused clinical and service improvements.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf029"},"PeriodicalIF":3.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11928787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691287","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":"Automated dialysate sodium control system: a word of caution regarding potassium.","authors":"Maxime Ingwiller","doi":"10.1093/ckj/sfaf018","DOIUrl":"10.1093/ckj/sfaf018","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf018"},"PeriodicalIF":3.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596420","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":"International validation of a pre-transplant risk assessment tool for graft survival in pediatric kidney transplant recipients.","authors":"Loes Oomen, Liesbeth L de Wall, Burkhard Tönshoff, Kai Krupka, Jerome Harambat, Julien Hogan, Cécile Couchoud, Emilie Savoye, Huib de Jong, Elisabeth A M Cornelissen, Antonia H M Bouts, Mandy G Keijzer-Veen, Wout F J Feitz, Charlotte M H H T Bootsma-Robroeks","doi":"10.1093/ckj/sfaf031","DOIUrl":"10.1093/ckj/sfaf031","url":null,"abstract":"<p><strong>Background: </strong>A pre-transplant prediction model using commonly available factors is valuable for optimizing donor selection, communication, and counseling for pediatric kidney transplant (PKT) recipients. This study aims to externally validate a Dutch PKT prediction model and assess its international applicability.</p><p><strong>Materials and methods: </strong>Data from the Dutch-, CERTAIN-, and CRISTAL registries, covering PKT from 2005 to 2021, were used. The Dutch prediction model was externally validated in a German and French cohort and then adapted to these specific countries. An international prediction model was also developed using all available data. Models were based on 80% derivation cohorts and internally validated using areas under the receiver operating characteristic curve (ROC-AUC) and calibration plots.</p><p><strong>Results: </strong>Of 3266 transplantations, 2475 (273 Dutch, 356 German, 1622 French, and 224 other) were used for analysis. Cohorts differed significantly in baseline characteristics and outcomes. Internal validation of the Dutch model showed ROC-AUC of 0.77 and 0.75 at 10 and 15 years. External validation in German and French cohorts yielded 10-year ROC-AUC of 0.63 and 0.60, respectively.Internal validation of the international prediction model showed AUC of 0.61 and 0.60 at 10 and 15 years with poor calibration, indicating inferior performance. The adapted national models showed better internal validation performance, with 10-year ROC-AUC of 0.77, 0.76, and 0.73 in Dutch, French, and German cohorts, respectively.</p><p><strong>Conclusions: </strong>The Dutch PKT prediction tool requires country-specific adaptations for use in other countries, given the diversity of clinical practice across Europe. A country-specific model is preferable to an international model in the current landscape.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf031"},"PeriodicalIF":3.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572292","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":"Breaking barriers: giving HOPE to people living with HIV and end-stage renal disease.","authors":"Matthias Diebold, Adnan Sharif","doi":"10.1093/ckj/sfaf027","DOIUrl":"10.1093/ckj/sfaf027","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 2","pages":"sfaf027"},"PeriodicalIF":3.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11848131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491198","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":"Life beyond antibodies: quality of life after desensitization in kidney transplantation.","authors":"Patrice Zoehinga, Thomas Jouve, Eloi Chevallier, Paolo Malvezzi, Lionel Rostaing, Johan Noble","doi":"10.1093/ckj/sfae411","DOIUrl":"10.1093/ckj/sfae411","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfae411"},"PeriodicalIF":3.9,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691308","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":"Acquired drivers of C3 glomerulopathy.","authors":"Seth J Welsh, Yuzhou Zhang, Richard J H Smith","doi":"10.1093/ckj/sfaf022","DOIUrl":"10.1093/ckj/sfaf022","url":null,"abstract":"<p><p>C3 glomerulopathy (C3G) is a group of heterogeneous ultrarare kidney diseases characterized by dysregulated activation of the complement alternative pathway (AP) leading to excessive C3 cleavage. Diagnosis relies on kidney biopsy showing predominant C3 deposition in the glomerular basement membrane, with electron microscopy differentiating between dense deposit disease (DDD) and C3 glomerulonephritis (C3GN). The main drivers of AP dysregulation in C3G are acquired rather than genetic and consist primarily of autoantibodies called nephritic factors (C3Nefs, C4Nefs and C5Nefs) that bind to and stabilize complement convertases, causing complement overactivation. Current therapies are largely supportive, and existing complement-targeting treatments, such as eculizumab, demonstrate limited efficacy. Challenges in studying C3G include variability in autoantibody detection and a lack of standardized assays, which complicates clinical interpretation. Comprehensive assessment involving autoantibody panels, complement biomarkers, functional assays and genetic testing provides a more complete understanding of disease dynamics; however, key knowledge gaps remain regarding Nef origins, mechanisms and their pathogenic role. In this review we discuss acquired drivers of C3G with an emphasis on C3Nefs and C5Nefs and suggest areas of interest that might benefit from future research.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf022"},"PeriodicalIF":3.9,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572283","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 type of vascular access on clinical outcomes in peritoneal dialysis patients transitioning to haemodialysis: an ANZDATA study.","authors":"Hicham I Cheikh Hassan, Karumathil Murali, Jenny H C Chen, Judy Mullan","doi":"10.1093/ckj/sfaf025","DOIUrl":"10.1093/ckj/sfaf025","url":null,"abstract":"<p><strong>Background: </strong>Type of vascular access used for haemodialysis is associated with long-term outcomes. However, the effect of access on haemodialysis transfer for peritoneal dialysis (PD) patients has not been fully explored.</p><p><strong>Methods: </strong>A retrospective cohort study was performed in incident adult PD patients from the Australian and New Zealand Dialysis and Transplant (ANZDATA) Registry who transferred to haemodialysis between 2004 and 2022. Associations between vascular access on transfer [central venous catheter (CVC) or arterio-venous access (AVA)] and clinical outcomes (all-cause mortality, cause-specific mortality, kidney transplantation and return to PD) were compared using Cox proportional hazards analysis and competing risk models.</p><p><strong>Results: </strong>Of 6824 patients, 65% used a CVC on transfer and 35% an AVA. Variability of access type at transfer between centres was high (range 13%-98% for CVC). AVA transfer was associated with a longer PD vintage (1.6 versus 1.2 years, <i>P </i>< .001) and inadequate PD as a cause of transfer (29% versus 15%, <i>P </i>< .001). All-cause mortality was lower for AVA transfer compared with a CVC [hazard ratio (HR) 0.71, 95% confidence interval (CI) 0.66-0.77]. The risk was lowest for infection-related mortality (HR 0.59, 95% CI 0.45-0.77) Kidney transplantation was more likely in AVA transfer compared with a CVC (HR 1.18, 95% CI 1.05-1.33), but return to PD was less likely (HR 0.67, 95% CI 0.59-0.71). Results remained consistent in the competing risk analysis.</p><p><strong>Conclusions: </strong>Patients who transferred with an AVA, compared with a CVC, showed better survival and kidney transplantation rates, but were less likely to return to PD.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf025"},"PeriodicalIF":3.9,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572217","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}