Journal of The American Society of Nephrology最新文献

{"title":"Obesity, Underweight, and Accuracy of eGFR Using Cystatin C and Creatinine in a Northern European Population.","authors":"William A Russel, Edouard L Fu, Alessandro Bosi, Aurora Caldinelli, Lesley A Inker, Alex R Chang, Andrew S Levey, Juan J Carrero","doi":"10.1681/ASN.0000000760","DOIUrl":"https://doi.org/10.1681/ASN.0000000760","url":null,"abstract":"<p><strong>Background: </strong>The presence of a low or high body mass index (BMI) in patients may influence the accuracy of estimated glomerular filtration rate (eGFR). This study evaluates the performance of eGFR equations across the range of BMI.</p><p><strong>Methods: </strong>This is an observational study of 4,707 adults (7,503 repeated observations) referred for measured GFR (mGFR) in Stockholm, Sweden. We calculated indexed eGFR (in mL/min/1.73 m2) and non-indexed eGFR (in mL/min) with validated equations that use creatinine (eGFRcr), cystatin C (eGFRcys), or both (eGFRcr-cys). We assessed equation performance against indexed and non-indexed mGFR across categories of BMI with median bias, P30 (the percentage of estimated values within 30% of mGFR), and classification of GFR categories, and modelled the implications of choice of filtration marker and indexing on clinical decisions regarding dose-adjustment or eligibility for treatment.</p><p><strong>Results: </strong>Mean age(SD)was 57(16) years (39% female), and median(IQR) indexed and non-indexed mGFR were 59(39-79) and 65(42-87), respectively. In total, 9% of participants were underweight (BMI <20 kg/m2) and 18% were obese (BMI ≥ 30 kg/m2). For indexed and non-indexed eGFR for all equations, eGFRcr overestimated mGFR at BMI <20 kg/m2 and ≥30 kg/m2, and eGFRcys underestimated mGFR at BMI ≥30 kg/m2. eGFRcr-cys had the least bias, acceptable P30, and highest correct classification throughout the BMI range. In theoretical modelling, using indexed eGFRcr-cys vs. eGFRcr would allow more accurate clinical decisions across all BMI categories. Using non-indexed vs. indexed eGFRcr-cys would lead to further but smaller improvement that was not consistently related to BMI category for these decisions.</p><p><strong>Conclusions: </strong>In a clinical population of northern European individuals referred for GFR measurement, indexed eGFRcr-cys was more accurate than indexed eGFRcr across the BMI spectrum and may improve classification accuracy for treatment decisions. Using non-indexed eGFRcr-cys further improved accuracy for some treatment decisions.</p>","PeriodicalId":17217,"journal":{"name":"Journal of The American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144289482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kidney Parameters with Tirzepatide in Obesity with or without Type 2 Diabetes.","authors":"Hiddo J L Heerspink, Allon N Friedman, Petter Bjornstad, Daniel H van Raalte, David Cherney, Dachuang Cao, Luis-Emilio Garcia-Pérez, Adam Stefanski, Ibrahim Turfanda, Mathijs C Bunck, Imane Benabbad, Ryan Griffin, Carolina Piras de Oliveira","doi":"10.1681/ASN.0000000764","DOIUrl":"https://doi.org/10.1681/ASN.0000000764","url":null,"abstract":"<p><strong>Background: </strong>Tirzepatide, a once-weekly, glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist, showed kidney protective effects in people with type 2 diabetes at high cardiovascular disease risk. In this post hoc analysis of the SURMOUNT-1 and SURMOUNT-2 trials, we assessed the association of tirzepatide use with kidney function parameters in people with overweight/obesity with or without type 2 diabetes.</p><p><strong>Methods: </strong>In SURMOUNT-1, participants with overweight or obesity without type 2 diabetes were randomized to tirzepatide 5 mg, 10 mg, and 15 mg or placebo. In SURMOUNT-2, participants with type 2 diabetes were randomized to tirzepatide 10 mg and 15 mg or placebo. For this analysis, all tirzepatide groups were pooled in each trial. Assessments included change from baseline to week 72 for urine albumin-to-creatinine ratio (UACR) and eGFR. eGFR was assessed using creatinine-based eGFR (Cr-eGFR), cystatin-C-based-eGFR (Cys-C-eGFR), and creatinine-cystatin-C-based eGFR (Cr-Cys-C-eGFR).</p><p><strong>Results: </strong>In SURMOUNT-1 (N=2539) and SURMOUNT-2 (N=938) median [25th to 75th percentile] baseline UACR was 6.0 [4.0, 11.0] mg/g and 13.0 [6.0, 35.1] mg/g, respectively. UACR estimated difference for tirzepatide vs. placebo, at week 72 was -8.4% (95% confidence interval [CI], -14.7 to -1.6) for SURMOUNT-1 and -31.1% (95% CI, -40.9 to -19.7) for SURMOUNT-2. The UACR change was more pronounced among participants with baseline UACR ≥30 mg/g with placebo-corrected changes from baseline at week 72 of -42.3% (95% CI, -60.8 to -15.0) in SURMOUNT-1 and -55.2% (95% CI, -68.5 to -36.4) in SURMOUNT-2, respectively. In SURMOUNT-1, tirzepatide was associated with increased eGFR based on Cys-C-eGFR or Cr-Cys-C-eGFR estimation equations, with mean differences versus placebo at week 72 of 3.2 ml/min per 1.73 m2 (95% CI, 2.1-4.3) and 1.9 ml/min per 1.73 m2 (95% CI, 0.9 to 2.9), respectively. In SURMOUNT-2 at week 72, increases in both tirzepatide and placebo groups were observed for Cys-C or Cr-Cys-C-eGFR, with no between-group differences.</p><p><strong>Conclusions: </strong>In participants with obesity/overweight with or without type 2 diabetes, tirzepatide was associated with reduced albuminuria without adverse changes in eGFR.</p>","PeriodicalId":17217,"journal":{"name":"Journal of The American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144289481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Quest for a Urea Sorbent: From Frustration, to Failure, to the KidneyX Prize.","authors":"Dr Stephen Richard Ash","doi":"10.1681/ASN.0000000791","DOIUrl":"https://doi.org/10.1681/ASN.0000000791","url":null,"abstract":"","PeriodicalId":17217,"journal":{"name":"Journal of The American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144289483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of Kidney Allograft Rejection Using Urinary Chemokines.","authors":"Valentin Goutaudier, Olivier Aubert, Maud Racapé, Agathe Truchot, Marta Sablik, Marc Raynaud, Éric Vicaut, Olivia Rousseau, Michelle Elias, Gillian Divard, Emmanuelle Papuchon, Richard Danger, Béatrice Charreau, Didier Bouton, Thao Nguyen-Khoa, Christine Randoux-Lebrun, Jean-Luc Taupin, Pierre-Antoine Gourraud, Magali Giral, Moglie Le Quintrec, Emmanuel Morelon, Lionel Couzi, Christophe Legendre, Carmen Lefaucheur, Nassim Kamar, Sophie Brouard, Dany Anglicheau, Alexandre Loupy","doi":"10.1681/ASN.0000000742","DOIUrl":"https://doi.org/10.1681/ASN.0000000742","url":null,"abstract":"<p><strong>Background: </strong>Urinary chemokines CXCL9 and CXCL10 have shown promise for detecting kidney allograft rejection, but the demonstration of their added value beyond standard of care patient monitoring requires further study.</p><p><strong>Methods: </strong>We prospectively enrolled adult patients who underwent kidney transplantation in 7 transplant referral centers between July 2018 and December 2019 (ClinicalTrials.gov, NCT03582436). We quantified urinary CXCL9 and CXCL10 protein levels at the time of kidney allograft biopsies in the first year post-transplantation using an automated immunoassay platform. The primary outcome was allograft rejection defined according to the international Banff 2019 classification.</p><p><strong>Results: </strong>Overall, 733 kidney transplant patients (64% male, 36% female) were included in the main analysis, with 1,549 biopsies paired with a urine sample. The cumulative incidence of rejection was 10%. For detecting allograft rejection, urinary CXCL9 and CXCL10 demonstrated areas under the receiver operating characteristic curve (AUROC) of 0.70 (95% confidence interval [CI], 0.64-0.75) and 0.64 (95% CI, 0.58-0.71), respectively. Adding urinary CXCL9 to a standard of care model improved discrimination for allograft rejection (AUROC 0.75 [percentile bootstrap CI 0.70-0.79] to 0.78 [percentile bootstrap CI 0.73-0.83]), while urinary CXCL10 did not. There was no improvement of overall fit with the addition of urinary CXCL9 (Brier score changed from 0.056 [95% CI, 0.046-0.067] to 0.054 [95% CI, 0.045-0.064]), as this tended to overestimate the risk for allograft rejection. In sensitivity analyses restricting to only acute/active forms of rejection or to a single randomly selected biopsy per patient, urinary chemokines did not show additional value beyond the standard of care. In addition, existing chemokine-based models showed low to moderate performance for the detection of allograft rejection.</p><p><strong>Conclusions: </strong>Urinary CXCL9 demonstrated limited clinical utility, while urinary CXCL10 provided no additional value beyond standard of care monitoring for detecting allograft rejection within the first year after kidney transplantation.</p>","PeriodicalId":17217,"journal":{"name":"Journal of The American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Galectic Control of Ferroptosis?","authors":"Florian Gembardt, Claudia Meyer, Andreas Linkermann","doi":"10.1681/ASN.0000000759","DOIUrl":"10.1681/ASN.0000000759","url":null,"abstract":"","PeriodicalId":17217,"journal":{"name":"Journal of The American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral Blood Flow and Cognition in CKD: A Physiological Paradox.","authors":"Aditi Gupta, Swati R Levendovszky","doi":"10.1681/ASN.0000000784","DOIUrl":"https://doi.org/10.1681/ASN.0000000784","url":null,"abstract":"","PeriodicalId":17217,"journal":{"name":"Journal of The American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telemedicine for Hemodialysis Care Delivery: Value Added?","authors":"Kevin X Shi, Delphine S Tuot","doi":"10.1681/ASN.0000000755","DOIUrl":"10.1681/ASN.0000000755","url":null,"abstract":"","PeriodicalId":17217,"journal":{"name":"Journal of The American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Data to Advance Glomerular Disease Care.","authors":"Natasha S Freeman, Andrew S Bomback","doi":"10.1681/ASN.0000000758","DOIUrl":"10.1681/ASN.0000000758","url":null,"abstract":"","PeriodicalId":17217,"journal":{"name":"Journal of The American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exercise and Kidney Function in Care of Older Adults.","authors":"Sharlene A Greenwood, Jamie H Macdonald","doi":"10.1681/ASN.0000000753","DOIUrl":"10.1681/ASN.0000000753","url":null,"abstract":"","PeriodicalId":17217,"journal":{"name":"Journal of The American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeting B Cells and Plasma Cells in Glomerular Disease.","authors":"Syeda Behjat Ahmad, J Ashley Jefferson","doi":"10.1681/ASN.0000000772","DOIUrl":"https://doi.org/10.1681/ASN.0000000772","url":null,"abstract":"<p><strong>Abstract: </strong>Loss of tolerance and the production of self-reactive autoantibodies by the humoral immune system are central to the pathogenesis of many glomerular diseases. These antibodies are produced by plasmablasts and plasma cells, the end-products of B cell lineage development within the bone marrow and secondary lymphoid tissues. In addition to antibody production, B cells also present antigen to T cells and produce pro-inflammatory cytokines. Non-targeted immunosuppression has shown efficacy in glomerular disease, but is associated with multiple side effects, and there remains a high proportion of patients with resistant disease. In this manuscript, we will review the biology of antibody secreting cells, and focus on therapeutics that specifically target B cells and plasma cells. We will review B cell depletion strategies, including anti-CD20 monoclonal antibodies, BAFF and APRIL inhibition and B cell receptor inhibition highlighting their role in different glomerular diseases and outline reasons for therapeutic resistance. We will also review plasma cell directed therapies including proteasome inhibition and anti-CD38 therapies, and discuss novel treatments including CAR-T therapy and bispecific T cell engagers.</p>","PeriodicalId":17217,"journal":{"name":"Journal of The American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}