Clinical Kidney Journal最新文献

{"title":"Effect of healthy lifestyle on renal dysfunction risk: interactions with genetic risk.","authors":"Masato Takase, Naoki Nakaya, Mana Kogure, Rieko Hatanaka, Kumi Nakaya, Ippei Chiba, Sayuri Tokioka, Kotaro Nochioka, Tomohiro Nakamura, Naho Tsuchiya, Takumi Hirata, Ikumi Kanno, Akira Narita, Taku Obara, Mami Ishikuro, Hisashi Ohseto, Ippei Takahashi, Akira Uruno, Tomoko Kobayashi, Eiichi N Kodama, Yohei Hamanaka, Masatsugu Orui, Soichi Ogishima, Satoshi Nagaie, Nobuo Fuse, Junichi Sugawara, Shinichi Kuriyama, Koichi Matsuda, Yoko Izumi, Kengo Kinoshita, Gen Tamiya, Atsushi Hozawa, Masayuki Yamamoto","doi":"10.1093/ckj/sfaf275","DOIUrl":"10.1093/ckj/sfaf275","url":null,"abstract":"<p><strong>Background: </strong>Whether adherence to a healthy lifestyle can mitigate genetic risk for renal dysfunction remains unclear.</p><p><strong>Methods: </strong>This prospective cohort study included 12 680 adults aged ≥20 years, free from chronic kidney disease at baseline, enrolled in the Tohoku Medical Megabank Community-based Cohort study. A healthy lifestyle score-based on normal weight, never smoking, never drinking, regular physical activity, and a low urinary sodium-to-potassium ratio-classified participants into ideal, intermediate, or poor lifestyle groups. A polygenic risk score (PRS) was constructed using estimated glomerular filtration rate (eGFR) data from a previous multi-ancestry genome-wide association meta-analysis. The primary outcome was renal dysfunction, defined as eGFR <60.0 ml/min/1.73 m².</p><p><strong>Results: </strong>Among the 12 680 adults, 123 participants (0.9%) developed renal dysfunction during a mean follow-up of 4.4 ± 0.8 years. Poor lifestyle was consistently associated with higher risk of renal dysfunction across most PRS categories. Participants with intermediate genetic risk had elevated risk only when also exhibiting an intermediate lifestyle. Formal testing for effect modification by PRS provided modest evidence that the association between high genetic risk and increased risk of renal dysfunction was stronger among individuals with an intermediate lifestyle. Although the addition of the PRS to the model included the C-statistic, this improvement was not statistically significant.</p><p><strong>Conclusions: </strong>Maintaining a healthy lifestyle is associated with lower risk of renal dysfunction, regardless of genetic risk. Combining PRSs with lifestyle information may enhance risk stratification, although further studies are needed to improve predictive accuracy.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 10","pages":"sfaf275"},"PeriodicalIF":4.6,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12538286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145343893","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":"Practical adjustment of blood hemoglobin for anemia treatment in maintenance hemodialysis.","authors":"Masayuki Tanemoto","doi":"10.1093/ckj/sfaf274","DOIUrl":"10.1093/ckj/sfaf274","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 10","pages":"sfaf274"},"PeriodicalIF":4.6,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12491996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231428","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 novel CT-based radiomics approach for kidney function evaluation in ADPKD: a pilot study.","authors":"Luca Calvaruso, Pierluigi Fulignati, Luigi Larosa, Huong Elena Tran, Claudio Votta, Carla Cipri, Luigi Natale, Viola D'Ambrosio, Giulia Condello, Pietro Manuel Ferraro, Francesco Pesce, Luca Boldrini, Giuseppe Grandaliano","doi":"10.1093/ckj/sfaf264","DOIUrl":"10.1093/ckj/sfaf264","url":null,"abstract":"<p><strong>Background: </strong>Management of autosomal dominant polycystic kidney disease (ADPKD) might take advantage of the use of new tools to predict risk of progression towards end-stage kidney disease (ESKD). The aim of this study is to explore the potential of radiomic features obtained from computed tomography (CT) scans for the prediction of kidney function decline over time of ADPKD patients.</p><p><strong>Methods: </strong>We retrospectively selected a cohort of 58 ADPKD patients who routinely underwent CT scan for total kidney volume (TKV) assessment from February 2020 to March 2021. An expert radiologist generated a region-of-interest segmentation for cystic kidneys from which we extracted 217 radiomic features. In a subgroup of 51 patients with at least three serum creatinine measurements, on the basis of estimated glomerular filtration rate we identified 26 rapid progressors to ESKD (>3 mL/min/1.73 m²/year), and we developed a radiomic model to discriminate rapid from non-rapid progressors. Area under the curve (AUC) of the receiver operating characteristic (ROC) and sensitivity were employed to evaluate models' performance.</p><p><strong>Results: </strong>The most statistically significant radiomic feature (<i>F_cm.corr</i>) (<i>P</i>-value = .04) associated with rapid progression showed an AUC (95% confidence interval) of 0.78 (0.65-0.90) and a sensitivity of 0.92 (0.78-0.98). On the contrary, the logistic regression model based on the height-adjusted TKV (ht-TKV) presented a lower AUC (95% confidence interval) of 0.65 (0.49-0.80), with a sensitivity 0.62 (0.42-0.78).</p><p><strong>Conclusions: </strong>We developed a model based on the radiomic feature <i>F_cm.corr</i> that was able to discriminate rapid progressors. Further validation studies on larger and external cohort are warranted to corroborate our findings and to confirm the role of radiomics in ADPKD management.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 9","pages":"sfaf264"},"PeriodicalIF":4.6,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12455199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136293","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":"Dapagliflozin use in tolvaptan-treated patients with ADPKD: exploring renal outcomes in a retrospective study.","authors":"Ryunosuke Nakajima, Shun Minatoguchi, Ryosuke Umeda, Shigehisa Koide, Midori Hasegawa, Hiroki Hayashi, Naotake Tsuboi","doi":"10.1093/ckj/sfaf269","DOIUrl":"10.1093/ckj/sfaf269","url":null,"abstract":"<p><strong>Background: </strong>Despite the widespread use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in the management of chronic kidney disease, their role in autosomal dominant polycystic kidney disease (ADPKD) remains unclear.</p><p><strong>Methods: </strong>This observational study evaluated the efficacy of the SGLT2i dapagliflozin in patients with ADPKD receiving tolvaptan. The primary outcome was the chronic estimated glomerular filtration rate (eGFR) slope, modeled using a multivariable linear mixed-effect model; a within-group analysis was also performed using an interrupted time series approach.</p><p><strong>Results: </strong>A total of 48 patients receiving tolvaptan were analyzed (24 patients in the control group vs 24 patients in the dapagliflozin group). The mean follow-up duration was 649 ± 363 days across all patients. The chronic eGFR slope was -2.30 [95% confidence interval (CI) -3.47, -1.13] in the control group and -1.72 (95% CI -3.48, -0.03) mL/min/1.73 m² per year in the dapagliflozin group (<i>P</i> = .595). In within-group analysis using an interrupted time series approach, the chronic eGFR slope changed from -2.34 (95% CI -3.39, -1.30) to -1.14 (95% CI -2.68, 0.40) mL/min/1.73 m² per year following dapagliflozin initiation (<i>P</i> = .191). No serious adverse events were observed during the follow-up period.</p><p><strong>Conclusions: </strong>Although no statistically significant differences were observed, both between- and within-group analyses showed a numerically slower decline in eGFR with dapagliflozin. Importantly, no evidence of harm was observed. These findings may contribute to ongoing discussions regarding the potential role of SGLT2i in ADPKD.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 9","pages":"sfaf269"},"PeriodicalIF":4.6,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12461144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184780","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":"Three decades of CKD due to diabetes mellitus type 2 in China, with projections of disease burden from 2022 to 2036: a systematic analysis for the Global Burden of Disease Study 2021.","authors":"Yujun He, Xiaoyi Wang, Yachao Wu, Lu Li, Minhui Liu, Ru Chen, Jiujie He, Wei Mai, Xiaojun Li","doi":"10.1093/ckj/sfaf265","DOIUrl":"10.1093/ckj/sfaf265","url":null,"abstract":"<p><strong>Background: </strong>A comprehensive assessment of disease burden is critical for optimizing management strategies for chronic kidney disease (CKD) due to type 2 diabetes (T2DM) in China. This study analyzes 30-year trends (1990-2021) in T2DM-related CKD burden, epidemiological characteristics, 15-year projections and dietary risk factors in China.</p><p><strong>Methods: </strong>Data from the Global Burden of Disease Study (GBD) were used to examine prevalence, incidence, deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs) and years of life lost (YLLs) stratified by age, sex and year. Analytical methods included joinpoint regression to identify trend changes, age-period-cohort modeling to disentangle demographic effects, decomposition analysis to assess drivers (aging, population growth, epidemiological shifts), autoregressive integrated moving average (ARIMA) forecasting for 2022-36 projections and dietary risk factor analysis focusing on seven modifiable dietary factors.</p><p><strong>Results: </strong>From 1990 to 2021, T2DM-related CKD burden showed a consistent upward trend. In 2021, prevalence reached 20.91 million cases [age-standardized rate (ASR) 1053.92/100 000], a 75.87% increase from 1990. Incidence and mortality rose by 177.64% and 147.26%, respectively, with 354 000 new cases and 108 000 deaths. Males exhibited higher ASRs than females across all outcomes, and the 70-94 years age group bore the highest burden. Aging was the primary driver of burden growth. Projections (2022-36) indicate declining age-standardized prevalence but rising trends in incidence, mortality, DALYs and YLLs, with stable YLDs. Key dietary risks included high red-meat consumption and low intake of whole grains and fruits.</p><p><strong>Conclusions: </strong>While age-standardized rates for some outcomes may decline, absolute burdens of T2DM-related CKD in China are increasing, driven by population aging. Strengthening healthcare systems, enhancing risk factor screening (e.g. dietary interventions) and improving diabetes management are imperative for prevention and control.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 10","pages":"sfaf265"},"PeriodicalIF":4.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257498","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":"Age at disease onset and risk of chronic kidney disease in patients with heterozygous disease-causing variants in <i>COL4A3</i> and <i>COL4A4</i>.","authors":"Ningning Hu, Lei Sun, Xuantong Dai, Ziyi Zhao, Xi Zhang, Jia Rao, Xujie Zhou, Yi Fang, Yiqin Shi, Shi Jin, Xialian Xu, Jiawei Yu, Qi Bian, Ying Fan, Jia Chen, Ning Yang, Lirong Lin, Zhangzhe Peng, Guangyi Liu, Bixia Zheng, Yu Sun, Mingzhu Zhao, Xin Sun, Hong Xu, Wenyan Huang, Gengru Jiang, Fujun Lin","doi":"10.1093/ckj/sfaf272","DOIUrl":"10.1093/ckj/sfaf272","url":null,"abstract":"<p><strong>Background: </strong>A key goal in managing patients with heterozygous disease-causing <i>COL4A3</i> and <i>COL4A4</i> (<i>COL4A3/4</i>) variants, affecting individuals spanning a broad age range, is to slow the development of chronic kidney disease (CKD). Whether age of onset is associated with the risk of CKD has not been investigated.</p><p><strong>Methods: </strong>In 294 patients (118 males) with heterozygous disease-causing <i>COL4A3/4</i> variants in the Shanghai Registry of Alport Syndrome, we made the comparison of risk of CKD between those showing disease onset before 18 years old (early onset) or from 18 years and older (late onset). CKD were defined as onset of persistent albuminuria (albumin-to-creatinine ratio ≥30 mg/g) or CKD G2 (estimated glomerular filtration rate <90 ml/min/1.73 m²).</p><p><strong>Results: </strong>147 (50.0%) of patients had initial presentation of symptoms of kidney diseases when they were <18 years old [median age at onset, 5.0 years (IQR, 3.0-8.0 years)], and in the remainder when they were older [median age at onset, 30.0 years (IQR, 26.0-38.0 years)]. During a median follow-up of 3.0 years (IQR, 0-10.3 years), earlier disease onset showed significant associations with higher risk of albuminuria [hazard ratio (HR) 7.08, 95% confidence intervals (CI) 4.59-10.93] and CKD G2 (HR 3.49, 95%CI 1.57-7.75). Risk of albuminuria increased by 64%, and risk of CKD G2 increased by 34%, per 5-year step toward younger age at disease onset.</p><p><strong>Conclusions: </strong>Earlier onset of disease may predict higher risk of CKD in patients with heterozygous disease-causing <i>COL4A3/4</i> variants. This association, if verified in large prospective studies, may help stratify patients by risk of worse prognosis, which can guide their management and preemptive nephroprotective treatment.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 10","pages":"sfaf272"},"PeriodicalIF":4.6,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12498093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145243811","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 interstitial edema as the central pathophysiological mechanism of NSAKI: a call for reappraisal.","authors":"Osamu Uemura","doi":"10.1093/ckj/sfaf271","DOIUrl":"10.1093/ckj/sfaf271","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 9","pages":"sfaf271"},"PeriodicalIF":4.6,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12461143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184733","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":"Drivers of hospital costs in ANCA-associated vasculitis patients with long-term follow-up-a real-world cost analysis.","authors":"Jolijn R van Leeuwen, Frouzan H Soltani, Wilbert B van den Hout, Ton J Rabelink, Y K Onno Teng","doi":"10.1093/ckj/sfaf267","DOIUrl":"10.1093/ckj/sfaf267","url":null,"abstract":"<p><strong>Background: </strong>Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a potentially life-threatening, systemic autoimmune disease with a high risk for relapse and treatment-related toxicity, making AAV a high-costs illness. This study aimed to identify clinical insights for clinicians on considering this costs burden.</p><p><strong>Methods: </strong>We conducted a detailed, retrospective, single-centre, activity-based cost-analysis and identified clinical variables associated with increased costs. We analysed real-world costs incurred by the hospital between January 2018 and December 2019, omitting the outpatient pharmacy expenditures. Our cohort included both incident and prevalent AAV patients with at least 6 months of follow-up since diagnosis, indicating survival beyond initial diagnosis.</p><p><strong>Results: </strong>For 180 AAV patients with a median follow-up of 1.8 years the average hospital costs incurred amounted to €9887 per patient year, with inpatient care being the primary cost driver (32%). Merely 15% of costs were attributable to patients experiencing relapse (<i>N</i> = 14/180, 8%). More importantly, 71% of costs were attributable to patients experiencing infections (<i>N</i> = 77/180, 43%). Likewise, 60% of costs were attributable to patients with multi-comorbidity (<i>N</i> = 65/180, 36%). Infections and multi-comorbidity were both strongly associated with corticosteroid (CS) use. Regression and sensitivity analyses suggest that a reduction of infections, comorbidities and maintenance treatment with CS will reduce hospital costs.</p><p><strong>Conclusion: </strong>This real-world cost analysis demonstrates that the burden of infections and comorbidities, both related to CS use, is higher than that of relapses on hospital costs in AAV patients. Thus, this study implicates clinicians considering hospital costs should focus on reducing CS and achieving CS-free remission to prevent infections and comorbidities.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 9","pages":"sfaf267"},"PeriodicalIF":4.6,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112074","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":"Prospective evaluation of CAR-T cell therapy-related proteinuria and kidney dysfunction.","authors":"Francesc Moncho-Francés, Rafael Hernani, Isabel Juan-García, Ana Benzaquén, Miguel Ángel Solís-Salguero, Ariadna Pérez-Martínez, Juan F Navarro-González, Jose Luis Piñana, Juan Carlos Hernández-Boluda, Maria José Terol Casterá, Carlos Solano, Jose L Górriz, Isidro Torregrosa","doi":"10.1093/ckj/sfaf270","DOIUrl":"10.1093/ckj/sfaf270","url":null,"abstract":"<p><strong>Background: </strong>The nephrotoxicity of chimeric antigen receptor T-cell (CAR-T) therapy has been reported, yet data on urinary abnormalities remain limited. This study aimed to characterize proteinuria, acute kidney injury (AKI), and associated electrolyte disorders in patients treated with CAR-T therapy.</p><p><strong>Methods: </strong>A prospective analysis was conducted on 63 patients treated with CAR-T therapy between June 2020 and December 2023. Blood tests were collected daily during hospitalization and a first morning urine void was collected on day of infusion (D0), +7 (D7), and +14 (D14).</p><p><strong>Results: </strong>During the study period, 12 patients (19%) developed AKI. The median urine protein-to-creatinine ratio (uPCR) increased significantly from 0.17 g/g on D0 to 0.39 g/g on D7, returning to baseline levels at D14. Proteinuria >0.5 g/g was detected in 37% of patients at D7. Patients with AKI before D7 had higher proteinuria than patients without AKI or AKI after D7. Proteinuria was associated with higher levels of lactate dehydrogenase (LDH), interleukin-6 levels and cytokine release syndrome (CRS) grade [Formula: see text]3. Patients with higher proteinuria had more progression of hematological disease and increased mortality in the first year. Furthermore, 60 patients (95%) experienced at least one electrolyte disorder, hypophosphatemia being the most frequent. Higher proteinuria was associated with lower levels of phosphorus, potassium, and sodium.</p><p><strong>Conclusions: </strong>CAR-T therapy is associated with transient renal adverse effects, including proteinuria, AKI, and electrolyte disorders. Systemic inflammation-mediated tubular injury contributed to these adverse effects. These findings enhance our understanding of CAR-T therapy nephrotoxicity. Proteinuria levels at D0 may be associated with disease progression and mortality within the first year.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 10","pages":"sfaf270"},"PeriodicalIF":4.6,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12498094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145243777","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":"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}