Kidney International Reports最新文献

{"title":"Steroid Avoidance With Low-Dose Tacrolimus is Safe and Effective in the Long-Term for Kidney Transplant Recipients","authors":"Jana Ekberg ,&nbsp;Anna-Elisabeth Aagaard Enevoldsen ,&nbsp;Carin Wallquist ,&nbsp;Karin Skov ,&nbsp;Bente Jespersen ,&nbsp;Per Lindnér ,&nbsp;Seema Baid-Agrawal","doi":"10.1016/j.ekir.2025.06.016","DOIUrl":"10.1016/j.ekir.2025.06.016","url":null,"abstract":"<div><h3>Introduction</h3><div>In our previous multicenter, open-label, randomized controlled trial (RCT), the SAILOR study, we reported good feasibility, safety, and efficacy of steroid avoidance (SA) at 2 years in immunologically low-risk kidney transplant recipients. A total of 222 participants were randomized to either antithymocyte globulin (ATG) induction + low-dose tacrolimus + mycophenolate mofetil (MMF) or basiliximab induction + low-dose tacrolimus + MMF + prednisolone. Long-term results are needed to confirm the extended safety and efficacy of the SA protocol beyond the short- to medium-term follow-up seen in current reports using low-dose tacrolimus.</div></div><div><h3>Methods</h3><div>In the SAILOR follow-up observational study, we collected clinical data of 215 participants of the original SAILOR trial at 1, 2, 5 years, and at the last follow-up.</div></div><div><h3>Results</h3><div>The mean follow-up time postrandomization was 7.3 years. Death-censored graft survival (91.8 vs. 93.1%, <em>P</em> = 0.88), patient survival (88 vs. 93%, <em>P</em> = 0.32), cumulative incidence of biopsy-proven rejection (19.8% vs. 16.3%, <em>P</em> = 0.6), and kidney function (estimated glomerular filtration rate [eGFR]: 50.8 vs. 54 ml/min per 1.73 m², <em>P</em> = 0.27) were similar in the 2 arms. Cumulative incidence of posttransplantation diabetes mellitus in per-protocol population was significantly lower in the steroid-avoidance arm. Serious infections requiring hospitalization, and malignancies did not differ significantly. Two-thirds of participants in the SA arm remained on the steroid-free protocol at the end of follow-up.</div></div><div><h3>Conclusion</h3><div>SA proved to be safe and effective in patients with low immunological risk for up to 7 years following kidney transplantation. Our findings provide robust evidence supporting SA strategy with low-dose tacrolimus without compromising outcomes even at the extended 7-years follow up.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"10 9","pages":"Pages 3102-3112"},"PeriodicalIF":5.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Protective Effects of SGLT-2 Inhibitors Against Postoperative Acute Kidney Injury in Type 2 Diabetes","authors":"Seung Min Song ,&nbsp;Minji Kim ,&nbsp;Minyoung Jang ,&nbsp;Minhyung Kim ,&nbsp;Kyungho Lee ,&nbsp;Junseok Jeon ,&nbsp;Sang-Man Jin ,&nbsp;Hye Ryoun Jang ,&nbsp;Wooseong Huh ,&nbsp;Jung Eun Lee","doi":"10.1016/j.ekir.2025.06.036","DOIUrl":"10.1016/j.ekir.2025.06.036","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite concerns about the potential of sodium-glucose cotransporter-2 inhibitors (SGLT-2i) to cause acute kidney injury (AKI), recent studies have shown that patients with diabetes on long-term SGLT-2i have lower rates of AKI-related hospitalizations and dialysis. We aimed to assess the real-world preventive effects of SGLT-2i on the risk of postoperative AKI.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study on patients with diabetes who underwent a major surgery at a tertiary hospital in Korea from 2013 to 2023 (<em>n</em> = 5527). We compared patients receiving SGLT-2i with those receiving dipeptidyl peptidase-4 inhibitors (DPP-4i) before surgery to evaluate the development of AKI within 7 days after surgery. A 1:3 propensity score matching was performed to adjust for 10 potential confounders.</div></div><div><h3>Results</h3><div>Before matching, the mean age was 67.5 years, with males comprising 66.3% of the cohort. In the matched cohort, the incidence of postoperative AKI was 11.9% in patients on SGLT-2i and 15.1% in those on DPP-4i (<em>P</em> = 0.026). In a multivariable logistic regression analysis adjusted for various risk factors, the use of SGLT-2i was associated with a 31% reduction in the risk of postoperative AKI (odds ratio [OR]: 0.699; 95% confidence interval [CI]: 0.528–0.918; <em>P</em> = 0.011). Subgroup analyses demonstrated a significant protective effect of SGLT-2i in high-risk populations, particularly in patients with heart failure undergoing cardiovascular surgery, where the incidence of AKI increased to 54%, in which SGLT-2i reduced the risk of AKI by up to 57% (OR: 0.431; 95% CI: 0.205–0.889; <em>P</em> = 0.024). However, the SGLT-2i group experienced a higher incidence of mild diabetic ketoacidosis (DKA) than the DPP-4i group (0.8% vs. 0%; <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>The use of SGLT-2i was independently associated with a lower risk of postoperative AKI than the use of DPP-4i in patients with type 2 diabetes, particularly in high-risk groups such as those with heart failure undergoing cardiovascular surgery. These findings suggest that SGLT-2i may have a role in perioperative AKI prevention in patients with diabetes, although careful monitoring for DKA is advised.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"10 9","pages":"Pages 3181-3191"},"PeriodicalIF":5.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemodiafiltration Attenuates NETosis Compared With High-Flux Hemodialysis in End-Stage Kidney Disease Patients","authors":"Lital Remez-Gabay ,&nbsp;Olga Vdovich ,&nbsp;Faten Y. Andrawes Barbara ,&nbsp;George Jiries ,&nbsp;Etty Kruzel-Davila","doi":"10.1016/j.ekir.2025.06.002","DOIUrl":"10.1016/j.ekir.2025.06.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients with chronic kidney disease (CKD) and diabetes mellitus face a heightened risk of cardiovascular complications and infections, potentially exacerbated by dysregulated NETosis. Given the superior survival rates observed with hemodiafiltration (HDF) over high-flux hemodialysis (HD; HFHD) and the documented NETosis dysregulation in HD and in patients with diabetes mellitus, this study aimed to investigate the impact of dialysis modality on NETosis activity in patients on HD, stratified by diabetes status.</div></div><div><h3>Methods</h3><div>A total of 20 patients on HD (10 with diabetes, 10 without diabetes) undergoing HDF treatment were recruited. Blood samples were collected before and after HDF. After transition to HFHD treatment, blood samples were taken again after 1 and 3 weeks of HDFD treatment. Neutrophils were isolated, stimulated with phorbol-12-myristate-13-acetate, and stained for the following NETosis markers: peptidyl arginine deiminase 4 (PAD4), neutrophil elastase (NE), myeloperoxidase (MPO), histone H3, and double-stranded DNA (dsDNA). Data were acquired using a flow cytometer. In addition, serum levels of citrullinated histone H3 (citH3), MPO, and NE were measured using enzyme-linked immunosorbent assay.</div></div><div><h3>Results</h3><div>Our results demonstrate a significant increase in NETosis activation and markers after HFHD treatment compared with HDF treatment. NETosis markers significantly increased in serum after 3 weeks of HFHD treatment. In addition, significantly lower NETosis markers were observed in patients with diabetes than in patients without diabetes.</div></div><div><h3>Conclusion</h3><div>The increase in NETosis markers after 3 weeks of HFHD compared with HDF highlights the role of HDF in mitigating dysregulated NETosis. Further research is needed to explore differences in NETosis profiles across patient populations and assess their clinical implications based on dialysis modality.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"10 9","pages":"Pages 3070-3080"},"PeriodicalIF":5.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethical Considerations for Research in CKD of Unknown Etiology: Reflections From an Ethics Panel at the Fourth International Workshop on CKD of Unknown Etiology","authors":"Nathan H. Raines ,&nbsp;Marta Avellan ,&nbsp;Jesica Candanedo ,&nbsp;Berta Sam ,&nbsp;Madeleine K. Scammell ,&nbsp;Catharina Wesseling ,&nbsp;Julia Wijkstrom ,&nbsp;Vidhya Venugopal ,&nbsp;Marvin González-Quiroz ,&nbsp;Peter Rohloff","doi":"10.1016/j.ekir.2025.06.053","DOIUrl":"10.1016/j.ekir.2025.06.053","url":null,"abstract":"<div><div>Chronic kidney disease (CKD) of unknown etiology (CKDu) is a form of tubulointerstitial kidney disease predominantly affecting impoverished agricultural communities in the global tropics, with major hotspots identified in Mesoamerica and South Asia. From February 14 to 16, 2024, the Consortium for the Epidemic of Nephropathy in Central America and Mexico (CENCAM) hosted the Fourth International Workshop on CKDu in Antigua, Guatemala. The workshop hosted &gt; 100 experts of CKDu from Central America and around the world. For the first time, a panel discussion was dedicated to the ethical challenges of conducting CKDu research and interventions in low-resource communities affected by the disease. Epidemiologists, nephrologists, and scientists with expertise in community-based research and bioethics on the panel identified several key ethical considerations, primarily centered on researcher interactions with affected communities or other CKDu stakeholders. These included aligning research priorities, study designs, consent procedures, and the return of results with the needs and concerns of CKDu-affected communities; fostering equitable North-South collaboration in CKDu research; and ensuring that research findings are translated into meaningful actions to help mitigate the disease’s impact, even as scientific understanding remains incomplete. The panel emphasized that affected communities, local health care systems, regional governments, and international researchers are all critical stakeholders in CKDu research. Ongoing discussion is essential to ensure that ethical considerations remain centered in response to emerging challenges and insights related to CKDu.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"10 9","pages":"Pages 2937-2942"},"PeriodicalIF":5.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Salt and Volume Homeostasis in Patients Receiving Hemodialysis: Novel Considerations for Future Clinical Trials","authors":"Gerren Hobby ,&nbsp;Benjamin Lazarus","doi":"10.1016/j.ekir.2025.07.026","DOIUrl":"10.1016/j.ekir.2025.07.026","url":null,"abstract":"","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"10 9","pages":"Pages 2912-2913"},"PeriodicalIF":5.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Peritoneal Interleukin-6 in Predicting Patient Survival on Peritoneal Dialysis","authors":"Emma H. Elphick ,&nbsp;Vasileios Zavvos ,&nbsp;John Belcher ,&nbsp;Nicholas Topley ,&nbsp;James A. Chess ,&nbsp;Clifford J. Holmes ,&nbsp;Simon J. Davies ,&nbsp;Donald Fraser ,&nbsp;Mark Lambie","doi":"10.1016/j.ekir.2025.06.049","DOIUrl":"10.1016/j.ekir.2025.06.049","url":null,"abstract":"<div><h3>Introduction</h3><div>Systemic inflammation predicts cardiovascular events and mortality in patients on peritoneal dialysis (PD). Peritoneal inflammation potentially causes adverse outcomes by increasing peritoneal solute transfer rates (PSTRs); however, the extent to which it contributes to systemic inflammation is uncertain. We sought to quantify the longitudinal interrelationship between peritoneal and systemic inflammation, to understand whether peritoneal or systemic inflammation should be targeted to reduce mortality.</div></div><div><h3>Methods</h3><div>We used patients recruited to the GLOBAL Fluid Study (GFS) within 90 days of starting PD, with ≥ 3 longitudinal paired dialysate and plasma samples. These were assayed for dialysate and plasma interleukin (IL)-6 levels by electrochemiluminescence (Meso-Scale Discovery, Gaithersburg, MD). Linear mixed models and univariate or bivariate joint longitudinal survival modelling were used.</div></div><div><h3>Results</h3><div>Two hundred seventeen patients with 1273 measurements were included. Dialysate IL-6 levels increased with time (1.14 pg/ml/yr on PD, 95% confidence interval [CI]: 1.10–1.19), with an associated increase in PSTR (<em>P</em> = 0.001). Plasma IL-6 levels increased over time (1.07 pg/ml/yr on PD, 95% CI: 1.04–1.10), with an associated increase in dialysate IL-6 (<em>P</em> &lt; 0.001) and reduction in residual kidney function (<em>P</em> = 0.01). Dialysate IL-6 levels estimated at any given time point weakly predicted mortality area under the curve (AUC: 0.57) and did not improve the prediction of mortality by plasma IL-6 (combined dialysate/plasma IL-6 AUC: 0.79, plasma IL-6 only AUC 0.81).</div></div><div><h3>Conclusion</h3><div>Although rising dialysate IL-6 levels may contribute to rising PSTR and increasing systemic inflammation independently of declining kidney function over time, it is plasma IL-6 that confers mortality risk. This suggests future antiinflammatory interventions to improve patient survival should target systemic rather than peritoneal inflammation.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"10 9","pages":"Pages 3164-3173"},"PeriodicalIF":5.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Laparoscopic Donor Nephrectomy Like Riding a Bike?","authors":"Soo Youn Yi ,&nbsp;Lloyd E. Ratner","doi":"10.1016/j.ekir.2025.07.040","DOIUrl":"10.1016/j.ekir.2025.07.040","url":null,"abstract":"","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"10 9","pages":"Pages 2917-2918"},"PeriodicalIF":5.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum to “Point-of-Care Testing and Integrated Digital Health Technology for CKD Screening in High-Risk Populations of India” [Kidney International Reports Volume 10, Issue 7, July 2025, Pages 2128-2139]","authors":"Rama Krishna Chinta ,&nbsp;Venkateswar Shri ,&nbsp;Bogdan Milojkovic ,&nbsp;Dennis Begos ,&nbsp;Shyamala Kemisetti ,&nbsp;Naresh Kumar Chintagunti ,&nbsp;Boris Bikbov ,&nbsp;FOCUS-CKD (Frontline Optimization and Comprehensive Upgradation of Services in Chronic Kidney Disease) Project","doi":"10.1016/j.ekir.2025.07.001","DOIUrl":"10.1016/j.ekir.2025.07.001","url":null,"abstract":"","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"10 9","pages":"Page 3296"},"PeriodicalIF":5.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acceptance of High Kidney Donor Profile Index Kidneys Among Consented Candidates","authors":"Miko Yu ,&nbsp;Lindsey M. Maclay ,&nbsp;Riya Lahiri ,&nbsp;Syed Ali Husain ,&nbsp;Jesse D. Schold ,&nbsp;Sumit Mohan","doi":"10.1016/j.ekir.2025.06.025","DOIUrl":"10.1016/j.ekir.2025.06.025","url":null,"abstract":"<div><h3>Introduction</h3><div>The Kidney Donor Profile Index (KDPI) is a percentile score based on the relative risk of allograft failure for deceased donor kidneys, where higher scores indicate shorter estimated allograft longevity. The Organ Procurement and Transplantation Network policy requires patients to proactively opt-in via written consent to receive offers for “high-KDPI” (&gt; 85%) kidneys before being considered for organs in this category.</div></div><div><h3>Methods</h3><div>This retrospective cohort study examined United States (US) candidates and recipients from 2012 to 2022 to determine if consent for less-than-ideal organs impacted organ allocation, efficiency, and utilization.</div></div><div><h3>Results</h3><div>Among 138,242 deceased donor transplants, 7031 (5%) were from KDPI of 80% to 85% kidneys, 4847 (4%) from KDPI of 86% to 90% kidneys, and 6089 (4%) from KDPI &gt; 90%. Among transplants with KDPI of 86% to 90% kidneys, representing the best quality among high-KDPI organs, 10% of recipients in 2014 were top-ranked candidates compared with 5% in 2015 and 4% in 2022. The number of declined offers for KDPI of 86% to 90% kidneys increased following implementation of the Kidney Allocation System (11 [interquartile range, IQR: 2–52] in 2014 versus 21.5 [IQR: 6–109] in 2015 vs. 52 [IQR: 12–323] in 2022).</div></div><div><h3>Conclusion</h3><div>These findings demonstrate changes in the centers’ willingness to accept high KDPI kidneys on behalf of their patients after the introduction of the KDPI label and other changes in allocation policy and regulatory oversight in the system.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"10 9","pages":"Pages 3094-3101"},"PeriodicalIF":5.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laser Microdissection and Mass Spectrometry Reveals Diverse Membranous Nephropathy Antigens","authors":"António Inácio ,&nbsp;Patrícia Domingues ,&nbsp;Ana Piedade ,&nbsp;Beatriz Mendes ,&nbsp;Francisca Fonseca ,&nbsp;Julie Vrana ,&nbsp;Jason Theis ,&nbsp;Samih Nasr ,&nbsp;Benjamin Madden ,&nbsp;Karina Soto ,&nbsp;Fernando C. Fervenza ,&nbsp;Sanjeev Sethi","doi":"10.1016/j.ekir.2025.06.035","DOIUrl":"10.1016/j.ekir.2025.06.035","url":null,"abstract":"","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"10 9","pages":"Pages 3276-3279"},"PeriodicalIF":5.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}