Clinical Kidney Journal最新文献

{"title":"Predicting prognosis in ANCA-associated vasculitis with kidney involvement.","authors":"Christian Maalouli, Selda Aydin, Alix Collard, Jean-Francois Cambier, Agnes Dejardin, Benoit Georges, Gaelle Gillerot, Benedicte Vanderperren, Ann-Karolien Vandooren, Michel Jadoul, Johann Morelle, Nathalie Demoulin","doi":"10.1093/ckj/sfaf268","DOIUrl":"10.1093/ckj/sfaf268","url":null,"abstract":"<p><strong>Background: </strong>The ANCA Renal Risk Score was updated in 2023 to the ANCA Kidney Risk Score (AKRiS) to improve clinicopathological prognostication in patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and kidney involvement. Our study aimed to assess whether incorporating recently identified predictors of kidney survival in AAV could further refine the prognostic accuracy of AKRiS in our multicentric cohort.</p><p><strong>Methods: </strong>We retrospectively reviewed all incident AAV with kidney biopsy from 2005 to 2020. Cox regression analysis examined factors [AKRiS, dialysis within 4 weeks, urine protein-creatinine ratio (UPCR) and hematuria at baseline, C3 deposits, renal arteritis on biopsy, estimated glomerular filtration rate (eGFR), UPCR and hematuria after induction] associated with kidney failure. These factors in combination with AKRiS were analyzed using the area under the receiver operating characteristic curve (AUROC) for prediction of kidney failure.</p><p><strong>Results: </strong>The cohort included 115 patients (age 64 years, 55% male, 57% myeloperoxidase-ANCA, baseline creatinine 3.6 mg/dL, eGFR 16 mL/min/1.73 m²), with 34 (30%) dialysed within 4 weeks. During a median 6.4-year follow-up, 39 (34%) patients progressed to kidney failure, and 13 (11%) died. Cox analysis identified AKRiS, dialysis within 4 weeks, C3 deposits, renal arteritis on biopsy, lower eGFR after induction and higher UPCR after induction as unadjusted risk factors for kidney failure. After adjusting for AKRiS, dialysis within 4 weeks [hazard ratio (HR) 6.20 (95% confidence interval 2.76 to 13.95), <i>P</i> ≤ .001], eGFR after induction [HR 0.94 (0.89 to 0.99), <i>P </i>= .03] and UPCR after induction [HR 1.62 (1.02 to 2.58), <i>P </i>= .04] remained significantly associated with kidney outcome. The AUROC for kidney failure prediction was 0.77 for AKRiS, increasing to 0.82, 0.80 and 0.79 when adding dialysis within 4 weeks, eGFR and UPCR after induction, respectively.</p><p><strong>Conclusion: </strong>Dialysis within 4 weeks, eGFR after induction and UPCR after induction are able to predict long-term kidney outcome in AAV patients. Adjusting AKRiS for these variables modestly enhances its predictive power. We propose using them as placeholder endpoints for kidney failure in future studies.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 9","pages":"sfaf268"},"PeriodicalIF":4.6,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12451443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130177","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":"Social deprivation as a key driver of spatial disparities in end-stage kidney disease incidence.","authors":"Aghiles Hamroun, Amadou Tidiane Niang, Florent Occelli, Camille Frévent, Martin Paumelle, Clémence Béchade, Florian Bayer, Marta Blangiardo, Philippe Amouyel, Luc Dauchet, François Glowacki, Cécile Couchoud, Michaël Génin","doi":"10.1093/ckj/sfaf266","DOIUrl":"10.1093/ckj/sfaf266","url":null,"abstract":"<p><strong>Background: </strong>Despite France's universal healthcare system, significant geographic disparities in the incidence of end-stage kidney disease (ESKD) persist. We hypothesized that social deprivation is a major driver of these spatial variations, independent of healthcare access and clinical risk factors, and that its contribution is stable over time.</p><p><strong>Methods: </strong>We conducted an ecological study including 102 226 incident ESKD cases across 34 830 municipalities in metropolitan France from 2012 to 2021, using data from the national REIN (Renal Epidemiology and Information Network) registry. A Bayesian hierarchical spatiotemporal model was used to estimate the association between ESKD incidence and ecological-level covariates: social deprivation [measured by the French European Deprivation Index (EDI)], diabetes prevalence, dialysis center accessibility and long-term exposure to PM_2.5 (fine particulate matter, ≤2.5 µm in diameter). We estimated the population-attributable fraction of ESKD incidence for each factor under various counterfactual scenarios.</p><p><strong>Results: </strong>Social deprivation was strongly associated with ESKD incidence [relative risk per 1 standard deviation increase in EDI: 1.10 (95% credible interval 1.09-1.11)] and explained 34.7% of its spatial variability. The association was only partially mediated by diabetes prevalence [mediation proportion: 15.3% (95% confidence interval 12.5-18.2)]. The model incorporating all covariates explained 49.9% of the observed spatial heterogeneity. The effect of social deprivation remained consistent over time. Reducing deprivation in the most disadvantaged areas to the levels of the 5th, 25th and 50th percentiles of less deprived areas could have prevented an estimated 23 092, 17 450 and 13 601 ESKD cases, respectively, over the study period.</p><p><strong>Conclusions: </strong>Social deprivation is the leading ecological determinant of spatial disparities in ESKD incidence in France, with limited mediation by clinical factors and persistent effects despite universal healthcare. These findings underscore the need to address social determinants of health and to adapt kidney care delivery models to better reach socioeconomically disadvantaged populations.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 9","pages":"sfaf266"},"PeriodicalIF":4.6,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12451440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130198","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":"Anemia and iron deficiency in post-kidney transplantation: an unsolved challenge.","authors":"Jose Portolés, Rainer Oberbauer, Michele F Eisenga, Aleix Cases, Jolanta Małyszko, Gabriel Choukroun, Marta Crespo, Kai-Uwe Eckardt, Roberto Minutolo","doi":"10.1093/ckj/sfaf252","DOIUrl":"10.1093/ckj/sfaf252","url":null,"abstract":"<p><p>Anemia and iron deficiency (ID) are common and significant complications in kidney transplant recipients (KTRs) that can affect their health-related quality of life (HRQoL) and outcomes. Current anemia guidelines equate the post-transplant situation with the anemia associated with chronic kidney disease (CKD) in non-transplanted persons, not acknowledging relevant differences ranging from pathophysiology to clinical manifestation. Nephrologists caring for these patients tend to pay less attention to post-transplant anemia (PTA) and ID than in non-transplanted persons with CKD. In this narrative review we summarize the available evidence about PTA and ID and their specifics in KTRs, including associations with patient and graft survival and poorer HRQoL. The prevalence of anemia is higher in KTRs than in non-transplanted patients with CKD for a given level of glomerular filtration rate (GFR) due to kidney transplant (KT)-specific pathophysiological factors. ID should be detected and corrected in KTRs using oral or intravenous (IV) iron. Some IV iron formulations are associated with an increased risk of hypophosphatemia a typical complication in KTRs. Current guidelines suggest the same hemoglobin targets for erythropoiesis stimulating agent therapy in transplanted and non-transplanted patients, despite the fact that a higher hemoglobin target has been associated with a slower estimated GFR decline in KT. There are insufficient data to recommend the widespread use of hypoxia-inducible factor-prolyl-hydroxylase inhibitors in PTA. Red blood cell transfusions should be avoided to minimize alosensitization. We call for increased awareness and targeted trials on anemia and ID in KTRs, accounting for the diverse and specific profiles of these patients.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 9","pages":"sfaf252"},"PeriodicalIF":4.6,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12415517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029002","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":"Empagliflozin and fluid balance: results from the SiRENA project.","authors":"Steffen Flindt Nielsen, Camilla Lundgreen Duus, Niels Henrik Buus, Jesper Nørgaard Bech, Frank Holden Mose","doi":"10.1093/ckj/sfaf262","DOIUrl":"10.1093/ckj/sfaf262","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose co-transporter 2 inhibitors (SGLT2is) exert cardiorenal benefits in type 2 diabetes (T2D) and chronic kidney disease (CKD), possibly mediated by natriuresis and changes in fluid balance. We examined the effects of empagliflozin on fluid and electrolyte balance.</p><p><strong>Methods: </strong>Employing a randomized, double-blind, placebo-controlled crossover design, we conducted three identical trials examining patients with T2D with and without CKD and non-diabetic CKD, respectively. A total of 49 participants were randomized to 4 weeks of empagliflozin 10 mg/day or matching placebo and crossed over to the opposite treatment after a wash-out. We measured body composition, 24-h ambulatory blood pressure (BP) and several markers of fluid and electrolyte balance.</p><p><strong>Results: </strong>In the combined cohort, empagliflozin reduced extracellular body water by 0.29 l [95% confidence interval (CI) -0.54 to -0.03, <i>P</i> = .03] and tended towards reducing overhydration [-0.23 l (95% CI -0.51-0.05), <i>P</i> = .10]. Change in overhydration was correlated to changes in BP (<i>R</i> = 0.38, <i>P</i> = .008). Sodium excretion and urine volume was unchanged, but copeptin, a surrogate of antidiuretic hormone (ADH), increased by 30% (<i>P</i> > .0001), aquaporin-2 excretion increased by 8% (<i>P</i> = .04) and free water clearance decreased (<i>P</i> = .0001). Renin levels increased (<i>P</i> = .02) with non-significant increases in aldosterone (<i>P</i> = .05) and epithelial sodium channel excretion (<i>P</i> = .08).</p><p><strong>Conclusion: </strong>SGLT2i could exert diuretic effects that, although compensated for by increased ADH and renin-angiotensin-aldosterone system activity, causes lasting changes in fluid balance.</p><p><strong>Trial registration: </strong>EU Clinical Trials Register 2019-004303-12, 2019-004447-80 and 2019-004467-50.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 9","pages":"sfaf262"},"PeriodicalIF":4.6,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12455196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136262","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":"Kidney Failure Risk Equation performance according to the etiology of chronic kidney disease in the CKD-CAREMEAU cohort.","authors":"Julien Prouvot, Pedram Ahmadpoor, Edouard Clemmer, Florian Garo, Emilie Pambrun, Sylvain Cariou, Pascal Reboul, Ziyad Messikh, Olivier Moranne","doi":"10.1093/ckj/sfaf258","DOIUrl":"10.1093/ckj/sfaf258","url":null,"abstract":"<p><strong>Background: </strong>The Kidney Failure Risk Equation (KFRE) is a prognostic score for predicting kidney replacement therapy (KRT) at 5 years in patients with chronic kidney disease (CKD). Some studies show that the score performs poorly for certain etiologies of CKD but not all have been evaluated. The aim of this study was to evaluate the performance of the KFRE score according to the etiology of the CKD.</p><p><strong>Methods: </strong>The CKD-CAREMEAU cohort, which included all patients who consulted a nephrologist for CKD between 2008 and 2017, was used. Patients were monitored for 5 years and the observed event was KRT, completed by the French REIN registry (Reseau Epidemiologique et Information en Néphrologie). Performance was evaluated by calibration (individual approach) and discrimination (populational approach), using observed vs predicted risk curves and the area under curve, respectively, according to each etiology.</p><p><strong>Results: </strong>A total of 3191 patients were included in the study, median age 71 (interquartile range 61-80) years, 1921 (60%) of whom were men, and the median estimated glomerular filtration rate was 41 (28-80) mL/min/1.73 m². The main etiologies of CKD were vascular; 1164 patients (37%), diabetic; 667 (21%), glomerular; 512 (16%), tubulointerstitial; 459 (14%), polycystic; 121 (4%) and unclassified; and 268(8%). Discrimination was satisfactory for all etiologies, but calibration was unsatisfactory for polycystic, tubulointerstitial and unclassified (multiple or unknown) etiologies, without correlation with age.</p><p><strong>Conclusions: </strong>Predictive performance of the KFRE score at 5 years varies according to the etiology of CKD, without impact on discrimination, but with a significant impact on calibration, and poor performance for polycystic, tubulointerstitial and multiple/unknown etiologies. These limitations should be known in order to develop new prognostic tools.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 9","pages":"sfaf258"},"PeriodicalIF":4.6,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12415514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029034","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":"Identification of early predictors of clinical remission in primary membranous nephropathy: a <i>post hoc</i> analysis of the STARMEN trial.","authors":"Jorge E Rojas-Rivera, Fernando Caravaca-Fontán, Anne-Els van de Logt, Angel Sevillano, Amir Shabaka, Ana Ávila, Cristina Rabasco, Virginia Cabello, Alberto Ortiz, Luis F Quintana, Marian Goicoechea, Montserrat Diaz, Pierre Ronco, Jack Wetzels, Gema Fernández-Juárez, Manuel Praga","doi":"10.1093/ckj/sfaf256","DOIUrl":"10.1093/ckj/sfaf256","url":null,"abstract":"<p><strong>Background: </strong>Patients with primary membranous nephropathy may progress to advanced chronic kidney disease despite immunosuppressive therapy (IST). Prediction of treatment response based on early and combined assessment of several standard clinical markers could improve risk stratification for progression, allowing timely individualization of treatment, which can optimize clinical outcomes and safety.</p><p><strong>Methods: </strong>In this <i>post hoc</i> exploratory analysis of the STARMEN trial, we evaluated if combined baseline data, and IST-induced early changes in standard clinical markers predicted clinical remission at 2 years. The 2-year primary outcome was complete (CR) or partial remission (PR). The secondary outcome was CR. Additionally, we described kidney function outcomes. Standard clinical markers were incorporated into statistical modeling by logistic regression. Predictive performance was assessed by receiver operating characteristic curve analysis.</p><p><strong>Results: </strong>The best multivariate model excluding immunosuppression to predict complete or PR at 2 years, included 3-month 24-h proteinuria, serum creatinine and immunological response [area under the curve (AUC) 0.87, 95% confidence interval (CI) 0.76-0.94, efficiency 87%]. For CR at 2 years, the best model included the same clinical markers at 6 months, but predictive performance was lower (AUC 0.74, 95% CI 0.62-0.85, efficiency 70%).</p><p><strong>Conclusions: </strong>In the STARMEN cohort, a multivariable model that included 24-h proteinuria, serum creatinine and immunological response status at 3 months after initiation of IST predicted clinical remission at 2 years with significantly better predictive performance than baseline data or each clinical marker assessed separately.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 9","pages":"sfaf256"},"PeriodicalIF":4.6,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12399971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991715","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":"Effect of dialysate bicarbonate on calciprotein particle crystallization time (T50) in hemodialysis patients-the D-Bic study.","authors":"Jennifer Machacek, Peter S Neufeld, Andreas Pasch, Martina Gaggl, Maria C Haller, Edward R Smith, Daniel Cejka","doi":"10.1093/ckj/sfaf263","DOIUrl":"10.1093/ckj/sfaf263","url":null,"abstract":"<p><strong>Background: </strong>Short calciprotein crystallization time (low T50) is directly associated with an increased risk of cardiovascular events and mortality. Here, we investigated whether increases in dialysate bicarbonate concentrations increase T50 times in dialysis patients.</p><p><strong>Methods: </strong>In a prospective, single-center, single-arm, interventional trial in hemodialysis patients (<i>N</i> = 29), dialysate bicarbonate was decreased from baseline settings to 27 mmol/L (D-Bic 27) followed by an increase to 37 mmol/L (D-Bic 37), over the course of 6 weeks. The primary endpoint was the change in T50 time between the D-Bic 27 and D-Bic 37 phases. Measurements of endogenous calciprotein monomers (CPM), primary (CPP-1) and secondary (CPP-2) calciprotein particles were pre-specified secondary outcomes.</p><p><strong>Results: </strong>Twenty-four patients completed the study per protocol. T50 time increased significantly from 246 ± 77 to 282 ± 81 min from the D-Bic 27 to the D-Bic 37 phase (<i>P</i> < .0001). The hydrodynamic radius (size) of secondary calciprotein particles generated in the T50 test (CPP-2_Rh) did not differ significantly between study phases (251 ± 75 vs 240 ± 78 nm, <i>P</i> = .27). Comparing the D-Bic 27 with the D-Bic 37 phase, CPM (16.8 × 10³ vs 16.2 × 10³ AU/µL, <i>P</i> = .9) and CPP-1 (4.6 × 105 vs 4.5 × 10⁵ counts/mL, <i>P</i> = .7) did not change significantly, but there was a significant decrease in CPP-2 levels (5.9 × 10⁴ vs 3.2 × 10⁴ counts/mL, <i>P</i> < .0003). Intradialytically, T50 increased, CPM and CPP-1 decreased, while CPP-2 remained stable.</p><p><strong>Conclusions: </strong>Raising dialysate bicarbonate resulted in a significant increase in T50 time and a reduction of CPP-2 levels.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 9","pages":"sfaf263"},"PeriodicalIF":4.6,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039279","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":"The impact of metabolic dysfunction-associated steatotic liver disease (MASH) on the high risk of cardiovascular disease in CKD: interconnections and management.","authors":"Francesc Moncho, Salvador Benlloch, Jose Luis Górriz","doi":"10.1093/ckj/sfaf260","DOIUrl":"10.1093/ckj/sfaf260","url":null,"abstract":"<p><p>Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as a major contributor to systemic metabolic dysfunction and is increasingly recognized as a risk enhancer for both cardiovascular disease (CVD) and chronic kidney disease (CKD). This review explores the complex interconnections between MASLD, CVD, and CKD, with emphasis on shared pathophysiological mechanisms and the clinical implications for risk assessment and management. We describe the crosstalk among the liver, heart, and kidneys, focusing on insulin resistance, chronic inflammation, and progressive fibrosis as key mediators. The severity of liver fibrosis in MASLD is independently associated with both cardiovascular and renal outcomes. Conventional cardiovascular risk scores may underestimate risk in MASLD-CKD populations, highlighting the need for integrated approaches that include hepatic, renal, and metabolic profiling. We also review current non-invasive diagnostic tools, including fibrosis scores and cardiovascular biomarkers, as well as emerging genetic and epigenetic markers that may enhance risk stratification. The therapeutic landscape is evolving, with promising results from lifestyle interventions and pharmacological agents such as GLP-1 receptor agonists, SGLT2 inhibitors, and novel antifibrotic compounds. We also propose a practical algorithm for the screening and risk stratification of MASLD in CKD patients, incorporating non-invasive fibrosis assessment and cardiometabolic risk evaluation. This stepwise approach supports early detection and personalized management, particularly in patients with CKD or type 2 diabetes. In conclusion, MASLD significantly amplifies cardiovascular and renal risk. Early, multidisciplinary intervention is essential to improve long-term outcomes in this high-risk population.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 9","pages":"sfaf260"},"PeriodicalIF":4.6,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12415520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029044","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":"Telitacicept versus mycophenolate mofetil in IgA nephropathy: a real-world comparative study of efficacy, renal outcomes and safety.","authors":"Yangyang He, Shasha Chen, Kaixiang Liu, Xintong Wu, Min Yu, Wei Wang, Kun Peng, Li Wang, Guisen Li, Xisheng Xie, Wei Qin, Xiang Zhong","doi":"10.1093/ckj/sfaf261","DOIUrl":"10.1093/ckj/sfaf261","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the efficacy and safety of telitacicept versus mycophenolate mofetil (MMF) in high-risk progressive immunoglobulin A nephropathy (IgAN).</p><p><strong>Methods: </strong>This retrospective, multicentre cohort study included patients with high-risk progressive IgAN who received telitacicept or MMF therapy, both combined with low-dose steroids. Clinical data were collected from treatment initiation to 12 months.</p><p><strong>Results: </strong>A total of 104 patients were included, with 56 receiving MMF and 48 receiving telitacicept. The average age was 36.9 ± 11.8 years. Baseline characteristics were well balanced between groups, except for serum albumin, uric acid and tubular pathology based on the Oxford classification, which showed significant differences. At 12 months, telitacicept plus low-dose steroids demonstrated superior proteinuria reduction (-62.5% versus -52.9%, <i>P</i> = .041) and stabilized renal function (4.1% improvement in estimated glomerular filtration rate versus 5.3% decline with MMF, <i>P</i> = .085). Telitacicept plus low-dose steroids achieved higher complete remission rates (33.3% versus 16.1%; <i>P</i> = .04) and significantly lower non-response rates (29.2% versus 48.2%, <i>P</i> = .048) compared with MMF plus low-dose steroids. Cumulative remission rates (complete + partial) favoured telitacicept at all time points, with the largest difference at 12 months. Notably, telitacicept required substantially lower cumulative glucocorticoid doses (<i>P</i> < .001) and exhibited a superior safety profile, with significantly fewer adverse events (22.9% versus 42.9%, <i>P</i> = .032) and no serious complications reported. Multivariable analysis indicated telitacicept was associated with a higher likelihood of achieving 12-month complete remission [adjusted hazard ratio 6 (95% confidence interval 1.41-25.62).</p><p><strong>Conclusions: </strong>Telitacicept may offer better efficacy compared with MMF for proteinuria reduction in high-risk IgAN patients, while reducing combined glucocorticoid requirements and demonstrating a more favourable safety profile. These advantages position it as a promising therapeutic option, warranting further randomized validation.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 9","pages":"sfaf261"},"PeriodicalIF":4.6,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12415519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029080","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":"But how green is it actually? Calculating the environmental footprint of kidney care environmental optimizations within haemodialysis.","authors":"Brett Duane, James Larkin, Marialuisa Caiazzo, Marta Arenas, Anita Griffin, Juilia Audije-Gil, Frances Mortimer, Harriet Attwell, Aycan Yasar, Rodrigo Martínez-Cadenas, Marta Arias-Guillén, Miguel Gomez, Abass Fehintola, Ingeborg Steinbach, Alberto Ortiz","doi":"10.1093/ckj/sfaf220","DOIUrl":"10.1093/ckj/sfaf220","url":null,"abstract":"<p><strong>Background: </strong>Environmental optimizations in kidney care have been analysed as part of the European Union co-funded KitNewCare project.</p><p><strong>Methods: </strong>Life Cycle Assessments (LCA) using Ecoinvent database and OpenLCA software quantified optimizing resource use (e.g. dialysis machines, reducing flow rates, incremental dialysis), energy-saving measures (e.g. solar energy, efficient lighting) and travel reduction (e.g. home dialysis, telemedicine). Efforts in waste management involve transitioning clinical waste to domestic waste streams, recycling and pyrolysis. Water-saving practices include reclaiming water for non-potable uses and efficient treatment systems.</p><p><strong>Results: </strong>LCA quantified these interventions, revealing significant environmental particularly in reducing travel and resource use. Travel optimizations yielded the most significant CO₂ equivalent savings, while incremental dialysis also conserved water and reduced greenhouse gas emissions.</p><p><strong>Conclusion: </strong>The study underlines the importance of prioritizing impactful interventions to minimize the environmental footprint of chronic kidney disease care while maintaining clinical efficacy. Challenges include adapting strategies to local contexts, ensuring economic feasibility and integrating renewable energy sources based on regional energy mixes.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 9","pages":"sfaf220"},"PeriodicalIF":4.6,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198229","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}