Current Opinion in Nephrology and Hypertension最新文献_第6页

Promises and limits of biopsy-based transcriptomics in kidney transplantation: a clinical utility perspective. 基于活检的转录组学在肾移植中的应用前景和局限性：临床应用前景。

IF 3.1 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-05-01 Epub Date: 2026-03-05 DOI: 10.1097/MNH.0000000000001168

Karolien Wellekens, Tim Debyser, Candice Roufosse, Maarten Naesens

{"title":"Promises and limits of biopsy-based transcriptomics in kidney transplantation: a clinical utility perspective.","authors":"Karolien Wellekens, Tim Debyser, Candice Roufosse, Maarten Naesens","doi":"10.1097/MNH.0000000000001168","DOIUrl":"10.1097/MNH.0000000000001168","url":null,"abstract":"Purpose of review: Biopsy-based transcriptomics have been proposed as a complement to histopathology in the evaluation of kidney allograft rejection by providing standardized, mechanism-oriented insight into intra-graft immune activity. However, diagnostic performance, interpretability, and clinical relevance vary substantially across rejection phenotypes and clinical contexts. This review critically examines the evidence supporting biopsy-based transcriptomics and evaluates where, and whether, it adds value to practice.Recent findings: Large multicenter studies show that biopsy-based transcriptomics achieve robust analytical performance for antibody-mediated rejection. In contrast, for T cell-mediated rejection, intermediate Banff phenotypes, mixed rejection, and molecular activity detected in histologically negative biopsies, transcriptomic signals are more heterogeneous and frequently discordant with histology. Associations with graft outcome and treatment response have been reported but are largely derived from observational cohorts and lack validated, phenotype-specific thresholds. To date, no interventional studies have demonstrated improved patient outcomes through molecularly guided management.Summary: Biopsy-based transcriptomics provides biologically meaningful information but has not yet demonstrated outcome-improving clinical utility. Its value is highly context- dependent and currently best defined for selected scenarios rather than routine use. Prospective interventional studies and consensus-based interpretative frameworks are required to determine how molecular information should inform clinical decision-making in kidney transplantation.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"308-315"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147354136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

New advances in the diagnosis and pathologic spectrum of monoclonal gammopathy of renal significance. 肾脏单克隆γ病诊断及病理谱的新进展。

IF 3.1 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-05-01 Epub Date: 2026-03-26 DOI: 10.1097/MNH.0000000000001171

Lihong Bu, Samih H Nasr

{"title":"New advances in the diagnosis and pathologic spectrum of monoclonal gammopathy of renal significance.","authors":"Lihong Bu, Samih H Nasr","doi":"10.1097/MNH.0000000000001171","DOIUrl":"10.1097/MNH.0000000000001171","url":null,"abstract":"Purpose of review: Monoclonal gammopathy of renal significance (MGRS) refers to clonal plasma cell or B-cell proliferative disorders that cause kidney disease by nephrotoxic monoclonal immunoglobulins but do not meet criteria for hematologic malignancy. This review will discuss recent advances in the diagnosis and pathologic spectrum of MGRS.Recent findings: New noninvasive prediction tools that can calculate the risk of finding MGRS in a kidney biopsy have been developed, and can potentially help in decision-making, particularly when kidney biopsy is contraindicated. A joint working group of nephropathologists and nephrologists from Renal Pathology Society (RPS) and International Kidney and Monoclonal Gammopathy Research Group (KMG) reported a consensus-based terminology and precise definitions for monoclonal gammopathy-associated kidney lesions. Recent studies have broadened the spectrum of MGRS-associated crystalline nephropathies to include lesions of light chain crystalline podocytopathy and crystalglobulin induced nephropathy, and revealed distinct characteristics of the rare immunoglobulin (Ig)M and IgG1 variants of PGNMID from the IgG3 variant. Solid evidence using RACE-RepSeq and immunofluorescence staining with antibodies specific for immunoglobulin light chain variable region subgroups revealed that most cases of PGNMID involve oligoclonal or polyclonal production of nephrotoxic IgG3 rather than representing monoclonal disorders.Summary: Novel MGRS prediction tools, highly sensitive sequencing techniques, new ancillary renal pathology techniques, and the recent RPS/IKMG consensus definitions have the potential to significantly improve MGRS diagnosis.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":"35 3","pages":"294-299"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147510326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Implications of the cystatin C/creatinine discordance. 胱抑素C/肌酐不一致的意义。

IF 3.1 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-05-01 Epub Date: 2026-03-12 DOI: 10.1097/MNH.0000000000001178

Ian E McCoy

{"title":"Implications of the cystatin C/creatinine discordance.","authors":"Ian E McCoy","doi":"10.1097/MNH.0000000000001178","DOIUrl":"10.1097/MNH.0000000000001178","url":null,"abstract":"Purpose of review: Clinicians may estimate the glomerular filtration rate using serum creatinine (eGFRcr) or cystatin C (eGFRcys). But the difference between these estimates (eGFRdiff) is often large. In addition to presenting a clinical conundrum, eGFRdiff is associated with adverse outcomes. Often, these associations have been attributed to low muscle mass, wherein creatinine production is low, artificially increasing eGFRcr above eGFRcys. Less prominent theories propose the adverse associations may be due to artificial depression of eGFRcys when cystatin C production is increased by obesity or inflammation or when cystatin C clearance is decreased relative to creatinine clearance (shrunken pore syndrome).Recent findings: Recent analyses have revealed our understanding of the determinants and consequences of eGFRdiff remains poor. Models incorporating iothalamate GFR measurements and objective measures of muscle mass, obesity, inflammation, shrunken pore syndrome, have explained only a minority of the variation in eGFRdiff among individuals. Moreover, adjustment for these factors does not extinguish the associations with outcomes.Summary: The pathophysiology underlying the associations between eGFRdiff and adverse outcomes remains poorly understood. Until our understanding improves to allow prediction of whether eGFRcr or eGFRcys is likely to be more accurate in a particular patient, the combined equation estimate should be favored.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"323-328"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

New insights into clinical spectrum of antineutrophil cytoplasmic autoantibody associated disease. 抗中性粒细胞胞浆自身抗体相关疾病临床谱的新认识。

IF 3.1 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-05-01 Epub Date: 2026-02-18 DOI: 10.1097/MNH.0000000000001164

Marco A Alba, J Charles Jennette

{"title":"New insights into clinical spectrum of antineutrophil cytoplasmic autoantibody associated disease.","authors":"Marco A Alba, J Charles Jennette","doi":"10.1097/MNH.0000000000001164","DOIUrl":"10.1097/MNH.0000000000001164","url":null,"abstract":"Purpose of review: Antineutrophil cytoplasmic autoantibody (ANCA) vasculitis is a systemic autoimmune disease characterized by small-vessel inflammation caused by pathogenic autoantibodies directed against myeloperoxidase or proteinase 3. The clinical spectrum of ANCA vasculitis has expanded in recent years. This review summarizes emerging phenotypes and novel disease associations that have increased our understanding of ANCA disease and may be relevant for classification and treatment.Recent findings: ANCA disease exhibits marked clinical heterogeneity in terms of organ involvement and disease severity. Recent studies have further increased phenotypic diversity of ANCA vasculitis by describing less common manifestations, such as involvement of large vessels and interstitial lung disease, characterizing features associated with elderly and ANCA-negative patients, and exploring new cluster associations defined by clinical and serologic features. Novel entities, such as immune checkpoint inhibitor-induced vasculitis and vasculitis associated with monogenic and autoinflammatory conditions, have also been increasingly recognized.Summary: Recognition of less frequent manifestations within major clinicopathological variants of ANCA vasculitis and the identification of new disease associations underscore the diversity of pathogenic mechanisms (e.g., immune, genetic, and environmental) involved in ANCA-associated disease. Future disease phenotyping refinement will likely improve precision medicine and patient care.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"287-293"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146257600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Early changes in kidney function in young adults: what is the significance? 青壮年肾功能的早期变化：有何意义？

IF 3.1 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-05-01 Epub Date: 2026-03-13 DOI: 10.1097/MNH.0000000000001176

Junayd Hussain, Manish M Sood

{"title":"Early changes in kidney function in young adults: what is the significance?","authors":"Junayd Hussain, Manish M Sood","doi":"10.1097/MNH.0000000000001176","DOIUrl":"10.1097/MNH.0000000000001176","url":null,"abstract":"Purpose of review: Early changes in kidney function in young adults - particularly modest declines in estimated glomerular filtration rate (eGFR) and the development of microalbuminuria - are increasingly recognized as predictors of long-term kidney and cardiovascular outcomes. This review summarizes the recent literature to present the clinical relevance of these early changes, highlight emerging insights into underlying mechanisms, and discuss implications for preventive strategies.Recent findings: Even subtle reductions in kidney function in young adults are associated with higher risks of clinically significant adverse outcomes. Advancements in measurement techniques, including the use of novel biomarkers such as cystatin C, have improved early detection of dysfunction in kidney filtration. Risk factors include metabolic, vascular, genetic, and environmental determinants. Evidence suggests early kidney changes are prognostically important and may warrant targeted screening in high-risk populations. Lifestyle interventions and pharmacologic therapies, such as sodium-glucose co-transporter-2 inhibitors, show promise in slowing early progression.Summary: Recognition of early kidney function changes offers a window for intervention to mitigate long-term morbidity. Future research should refine screening thresholds, optimize preventive strategies, and evaluate early interventional therapies to improve outcomes In young adults.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"347-352"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147456220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

An update on the epidemiology of chronic kidney disease of uncertain etiology. 病因不明的慢性肾脏病流行病学进展。

IF 3.1 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-05-01 Epub Date: 2026-03-17 DOI: 10.1097/MNH.0000000000001177

Sophie E Claudel, Sushrut S Waikar, Madeleine K Scammell

{"title":"An update on the epidemiology of chronic kidney disease of uncertain etiology.","authors":"Sophie E Claudel, Sushrut S Waikar, Madeleine K Scammell","doi":"10.1097/MNH.0000000000001177","DOIUrl":"10.1097/MNH.0000000000001177","url":null,"abstract":"Purpose of review: Chronic kidney disease of uncertain etiology (CKDu) has devastating impacts on individuals and communities in affected regions, but it remains an ill-defined diagnosis of exclusion despite decades of environmental and epidemiologic research. The purpose of this review is to synthesize recent literature describing the global burden of disease and potential causal factors.Recent findings: A large, international prevalence study quantitatively identified Uddanam, India, Northwest Nicaragua, and Anuradhapura, Sri Lanka as prominent CKDu hotspots. Stronger evidence for the role of heat stress in exacerbating kidney function decline among individuals with CKDu now includes validated measurements of core body temperature. Additionally, recent studies use urine metabolomics to support environmental exposure evaluation and generate hypotheses for future pathway analysis. While longitudinal studies remain infrequent, three key longitudinal studies provide greater insight into trajectories of kidney function decline in CKDu.Summary: The cause(s) of CKDu remain uncertain, but greater integration of genetic, translational, biopsy, and longitudinal epidemiologic data hold promise for elucidating mechanistic pathways. Increased standardization of kidney biopsy protocols, epidemiologic definitions, and population surveillance methodologies would strengthen ongoing efforts to identify, treat, and prevent CKDu.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"353-359"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147473020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The podocyte slit-diaphragm: target of anti-nephrin antibodies. 足细胞裂膜：抗肾素抗体的靶点。

IF 3.1 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-05-01 Epub Date: 2026-02-23 DOI: 10.1097/MNH.0000000000001167

Laurence H Beck, David J Salant

{"title":"The podocyte slit-diaphragm: target of anti-nephrin antibodies.","authors":"Laurence H Beck, David J Salant","doi":"10.1097/MNH.0000000000001167","DOIUrl":"10.1097/MNH.0000000000001167","url":null,"abstract":"Purpose of review: This review is prompted by substantial new information on the composition and structure of the podocyte slit-diaphragm and the identification of anti-nephrin antibodies in patients with acquired diseases of the glomerular podocyte, including steroid-sensitive nephrotic syndrome of childhood, minimal change disease and some cases of primary focal and segmental glomerulosclerosis (FSGS).Recent findings: New methodologies including multi-epitope affinity purification, high resolution proteomics and cryo-electron tomography reveal that the slit-diaphragm consists of a multi-layered fishnet-like structure made up by nephrin and neph1 homodimers as well as several co-assembled proteins with signaling properties. Insights from clinical studies and experimental models support the concept that pathogenic antibodies engaging the extracellular domain of nephrin disrupt the integrity of the slit-diaphragm and signal changes to the podocyte cytoskeleton that lead to foot process effacement and proteinuria.Summary: These findings raise several questions to be answered experimentally, including the nephrin epitopes targeted by the antibodies and the way in which they alter the slit-diaphragm and podocyte architecture and induce nephrin endocytosis. They also highlight the need for a reliable and widely available assay for anti-nephrin antibodies, which would have diagnostic and therapeutic impact on diagnosis, prognosis and therapy.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"279-286"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Stopping renin-angiotensin-aldosterone system inhibitors in kidney disease. 肾病患者停用肾素-血管紧张素-醛固酮系统抑制剂。

IF 3.1 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-05-01 Epub Date: 2026-03-13 DOI: 10.1097/MNH.0000000000001173

Eva Glenn Lecea, Krystle Frazier, Elaine Ku

{"title":"Stopping renin-angiotensin-aldosterone system inhibitors in kidney disease.","authors":"Eva Glenn Lecea, Krystle Frazier, Elaine Ku","doi":"10.1097/MNH.0000000000001173","DOIUrl":"10.1097/MNH.0000000000001173","url":null,"abstract":"Purpose: The KDIGO guidelines recommend the use of renin-angiotensin system inhibitors (RASi) in chronic kidney disease (CKD) given their kidney and cardiovascular benefits. Despite this recommendation, real-word data suggest low rates of the use of these medications, and RASi are frequently discontinued. The objective of this review is to summarize the outcomes associated with the discontinuation of RASi in individuals with CKD, hyperkalemia, and acute kidney injury (AKI).Recent findings: Trial-grade data suggest that there is no benefit to the discontinuation of RASi in patients with low eGFR on kidney or mortality outcomes. Observational and trial-grade data suggests similar outcomes for the continuation of RASi during the perioperative period as compared to discontinuation of RASi. Observational data also suggest that reinitiation of RASi after AKI and hyperkalemia is associated with improved survival and reduces the risk of progression of kidney disease.Summary: This review highlights outcomes following the discontinuation of RASi, which is generally associated with worse outcomes across the spectrum of CKD, hyperkalemia, and AKI.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"329-336"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147456261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Managing hypertension and cardiovascular risk in resource-limited settings. 在资源有限的环境中管理高血压和心血管风险。

IF 3.1 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-05-01 Epub Date: 2026-01-19 DOI: 10.1097/MNH.0000000000001161

Rajeev Gupta

{"title":"Managing hypertension and cardiovascular risk in resource-limited settings.","authors":"Rajeev Gupta","doi":"10.1097/MNH.0000000000001161","DOIUrl":"10.1097/MNH.0000000000001161","url":null,"abstract":"Purpose of review: Hypertension management is a gateway for cardiovascular risk reduction. The status of hypertension treatment and control is low in resource-limited lower income countries and similar settings in middle-income and high-income countries. Implementation of strategies for prevention and management of hypertension can lead to a substantial increase in its control and decline in associated cardiovascular mortality and disease burden.Recent findings: Population-wide and clinical interventions that can be deployed in resource-limited settings globally to improve hypertension control have been summarized in the WHO's Global Report on Hypertension (2025). Focusing on social determinants (poverty, hunger, literacy, clean energy, economic growth, inequalities, sustainable cities, and climate action) can lead to primordial prevention, and risk factor control (such as salt reduction, physical activity, pollution, obesity, and a healthy diet) for primary prevention. Guidelines emphasize simplified medical treatment with algorithm-based single-pill combinations. Specific strategies that focus on nonphysician health worker-led interventions to promote identification and adherence to treatment in low-resource settings ae important. Technology-based interventions for the identification of hypertension and promotion of adherence need more studies.Summary: Primordial and primary prevention of hypertension, combined with interventions that support clinical management and promote adherence to therapies, are important for resource-limited settings to reduce cardiovascular risk.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"373-386"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146003040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Reimagining kidney value-based care: leveraging data science for dynamic, clinician-level risk prediction. 重新构想基于肾脏价值的护理：利用数据科学进行动态的临床水平的风险预测。

IF 3.1 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-05-01 Epub Date: 2026-01-29 DOI: 10.1097/MNH.0000000000001162

Derek J Baughman, Paul Nagy, Chirag R Parikh

{"title":"Reimagining kidney value-based care: leveraging data science for dynamic, clinician-level risk prediction.","authors":"Derek J Baughman, Paul Nagy, Chirag R Parikh","doi":"10.1097/MNH.0000000000001162","DOIUrl":"10.1097/MNH.0000000000001162","url":null,"abstract":"Purpose of review: Chronic kidney disease (CKD) remains one of the costliest conditions in healthcare, yet value-based payment (VBP) reforms have produced limited improvements in cost or quality. Existing renal payment models rely on annual benchmarks that fail to reflect the longitudinal reality of CKD care. This precludes the possibility of observing a dose-response relationship in clinician-level interventions, effectively invisible in current VBP structures.Recent findings: Advances in clinical informatics and predictive modeling demonstrate the feasibility of sub-annual, patient-level risk estimation for CKD outcomes and costs. Standardized electronic health record and claims data enable longitudinal, clinician-level analysis. This can transform retrospective, aggregate VBP into dynamic forecasting systems reflecting real-world care delivery. Short-horizon prediction reveals temporal, dose-response relationships between guideline-aligned interventions and downstream events that remain obscured by annualized VBP frameworks.Summary: CKD is a clinically and economically compelling testbed for next-generation VBP design. Patient-level modeling with sub-annual risk prediction is the next step in modernizing payment frameworks to align incentives. Future VBP policy should shift models beyond static, annual metrics toward EHR-native, temporally precise evaluation frameworks that reward meaningful preventive care for patients, clinicians, and payers.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"360-366"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13177297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146104213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0