Kidney360最新文献

{"title":"Patient Perspectives on Their Home Peritoneal Dialysis Experience: A Qualitative Study.","authors":"Caroline M Hsu, Teya Lovell, Keren Ladin, Leah Meyer, Antonia Harford, Darren Schmidt, Klemens Meyer, Michelle M Richardson, Daniel E Weiner","doi":"10.34067/KID.0000001437","DOIUrl":"https://doi.org/10.34067/KID.0000001437","url":null,"abstract":"<p><strong>Background: </strong>The 2019 Advancing American Kidney Health initiative greatly incentivized increased home dialysis. However, peritoneal dialysis (PD) uptake in the United States has increased only modestly, and, although PD is associated with quality-of-life benefits for many patients, individual patient experiences of disease and treatment burden can vary greatly. Gaps remain in understanding the lived experience and impact of PD on patients.</p><p><strong>Methods: </strong>Current and former PD patients (age ≥18 years) who received PD in 2019 or later were recruited between 2022 and 2025. Semi-structured interviews explored experiences along their PD journey, including modality discussions, technical and logistical aspects of home dialysis, and the physical, emotional, and social impacts of treatment. Interviews also addressed challenges encountered during PD and, when applicable, circumstances surrounding PD-to-hemodialysis transfer. Interviews were audio-recorded, transcribed, double-coded, and analyzed using thematic analysis.</p><p><strong>Results: </strong>In interviews with 31 current and former PD patients, three interrelated themes emerged. First, patients' desire for normalcy was grounded in individualized characterizations of freedom and independence. Freedom was defined differently across patients but considered essential regardless of modality, while independence reflected the ability to manage life and health, even when support from others was needed. Normalcy was described as attaining or maintaining an expected lifestyle. Second, PD's technical demands and home-based logistics strongly shaped treatment experiences. Third, patients highly valued relief of kidney failure-related symptoms. These themes often interacted in complex and sometimes conflicting ways.</p><p><strong>Conclusions: </strong>Patients' experiences with PD vary widely. We propose a conceptual model linking patients' feelings of normalcy, freedom, and independence to their PD experiences and specifically to modifiable aspects of PD care, including technical features of therapy, home-based logistics, and availability of support. This model aims to facilitate improved, patient-centered delivery of home dialysis.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preeclampsia and Hypertension Disorders of Pregnancy in Women with Kidney Disease.","authors":"Laura Aponte Becerra, Ursula C Brewster","doi":"10.34067/KID.0000001454","DOIUrl":"https://doi.org/10.34067/KID.0000001454","url":null,"abstract":"<p><p>Hypertensive disorders of pregnancy are a leading cause of maternal and perinatal morbidity and mortality worldwide. Women with CKD are at particularly high risk, with preeclampsia affecting up to 40% of pregnancies. This chapter summarizes the current understanding of hypertensive disorders of pregnancy, with an emphasis on preeclampsia in women with underlying kidney disease. We discuss the epidemiology, pathophysiology, clinical diagnosis, prevention, and management of preeclampsia, highlighting the unique diagnostic and therapeutic challenges posed by preexisting CKD. We review the role of angiogenic biomarkers, including the sFlt1/PlGF ratio which is a ratio of anti/pro angiogenic proteins, in the diagnosis and risk stratification of preeclampsia, current prevention and management strategies, and the importance of post-partum nephrology follow-up.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rituximab-Belimumab Sequential Therapy in Refractory Minimal Change Disease.","authors":"Yifan Li, Yuxin Ai, Jinbo Cheng, Yinghui Huang","doi":"10.34067/KID.0000001449","DOIUrl":"https://doi.org/10.34067/KID.0000001449","url":null,"abstract":"<p><p>Frequent relapses and steroid dependence remain challenging in minimal change disease (MCD). Rituximab depletes B cells, yet post-treatment B-cell Activating Factor (BAFF) elevation may drive disease relapse. Sequential rituximab followed by belimumab (a BAFF inhibitor) has shown benefit in lupus, but its role in MCD is unknown. A 14-year-old male with biopsy-proven MCD and acute kidney injury failed multiple immunosuppressants, including two courses of rituximab (the first induced a 6-month remission, whereas the second failed despite B-cell depletion). After another relapse, he received single-dose rituximab followed by belimumab, achieving complete remission and maintaining relapse-free for 57 months.This case suggests that sequential rituximab-belimumab therapy may offer durable remission in MCD patients who are refractory to conventional immunosuppressive regimens.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Severe Nonsteroidal Anti-Inflammatory Drug-Associated Acute Kidney Injury in a Patient with CYP2C9*2/*2: Lessons from the Vulture Crisis.","authors":"Katharina Konzett, Clemens Untersulzner, Martin Tiefenthaler, Lukas Harasser, Romuald Bellmann, Martin Windpessl, Andrea Griesmacher, Lorin Loacker, Andreas Kronbichler","doi":"10.34067/KID.0000001431","DOIUrl":"10.34067/KID.0000001431","url":null,"abstract":"<p><p>Nonsteroidal anti-inflammatory drugs (NSAIDs) are a well-recognized cause of AKI, typically occurring in the setting of substantial exposure or predisposing risk factors. We report a case of severe AKI following minimal naproxen exposure in a previously healthy young adult. An 18-year-old man presented with abdominal and flank pain and was found to have KDIGO stage 3 AKI after receiving analgesic treatment for fracture-related pain. The patient had taken two oral 500-mg doses of naproxen seven days before presentation and had received two intravenous 2.5-g doses of metamizole, one on the day before and the other on the day of presentation. Clinical presentation, ultrasonography and magnetic resonance angiography argued against prerenal, postrenal and vascular causes. Suspected interstitial nephritis prompted empiric methylprednisolone therapy. Kidney biopsy revealed acute tubular injury without interstitial nephritis, and corticosteroids were discontinued. Kidney function recovered within two weeks of symptom onset. Given the severity of AKI relative to the reported drug exposure, pharmacogenetic testing was performed and revealed a CYP2C9*2/*2 genotype associated with reduced NSAID metabolism. Although the identified genotype is unlikely to fully account for the severe AKI observed, it may have contributed to the patient's susceptibility to nephrotoxicity. This case highlights pharmacogenetically impaired NSAID metabolism as a potentially underrecognized contributor to AKI and underscores the potential value of pharmacogenetic testing in selected patients without conventional risk factors.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of the Klinrisk CKD Progression Model in the Dapagliflozin and Prevention of Adverse Outcomes in CKD (DAPA-CKD) Population.","authors":"Niels Jongs, Hiddo J L Heerspink, Navdeep Tangri, Pam Gottschal, Thomas W Ferguson, Ryan J Bamforth, Brendon L Neuen","doi":"10.34067/KID.0000001339","DOIUrl":"https://doi.org/10.34067/KID.0000001339","url":null,"abstract":"<p><strong>Background: </strong>Early identification and treatment of high-risk CKD can lower the risk of kidney failure and cardiovascular events. A laboratory-based machine-learning model (Klinrisk) was developed to predict the risk of CKD progression in adults with, or at risk for, CKD. It has shown good accuracy in the general population and in clinical trial populations with diabetic kidney disease, but its performance in non-diabetic CKD is unclear. We evaluated Klinrisk in a clinical trial of the sodium glucose cotransporter 2 inhibitor dapagliflozin in patients with CKD, with and without type 2 diabetes.</p><p><strong>Methods: </strong>We externally validated Klinrisk in the DAPA-CKD trial population for prediction of CKD progression (first occurrence of sustained ≥40% eGFR decline or kidney failure) up to 3 years. Performance was assessed with the area under the receiver operating characteristic curve (AUC), Brier scores and calibration plots, and compared with Kidney Disease Improving Global Outcomes (KDIGO) heat-map categories based on eGFR and urine albumin-to-creatinine ratio. Consistency of the dapagliflozin effect on CKD progression across Klinrisk risk categories was also examined.</p><p><strong>Results: </strong>The analysis included 4,304 DAPA-CKD participants, of whom 578 experienced CKD progression events over a median follow-up of 2.4 years. Klinrisk achieved an AUC of 0.79 (95% CI 0.77-0.81) and a Brier score of 0.10 (95% CI 0.09-0.11). It outperformed KDIGO heat-map categories in subgroups of patients with and without type 2 diabetes, and in those with IgA nephropathy. Dapagliflozin reduced CKD progression compared with placebo, irrespective of baseline risk.</p><p><strong>Conclusions: </strong>In DAPA-CKD, Klinrisk accurately predicted CKD progression and outperformed KDIGO-based risk stratification in patients with and without type 2 diabetes. Eight of the 22 model inputs were unavailable and supplied from the development model rather than measured. Dapagliflozin reduced CKD progression across the full spectrum of predicted risk compared with placebo.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Pain in Autosomal Dominant Polycystic Kidney Disease and the Long-Term Effects of Increasing Water Intake.","authors":"Sumedh Jayanti, James Elhindi, Gopala Rangan","doi":"10.34067/KID.0000001324","DOIUrl":"https://doi.org/10.34067/KID.0000001324","url":null,"abstract":"<p><strong>Background: </strong>Chronic pain is a debilitating consequence of ADPKD, and the longitudinal progression of pain has not been well-defined. Previous studies suggested that increased water intake may reduce ADPKD-related pain.</p><p><strong>Methods: </strong>This was a post-hoc analysis of the PREVENT-ADPKD trial, where pain characteristics were assessed biannually using the HALT-PKD pain questionnaire. This 3-year trial allocated 184 participants to either increased water intake to reduce urine osmolality to ≤270 mosmol/kg (n=92) or to continue usual water intake (n=92).</p><p><strong>Results: </strong>At baseline, two-thirds (66%) and one-third (33-38%) of participants experienced back and abdominal pain respectively. By multivariable analyses, baseline back and abdominal pain were associated with a higher eGFR (75-90ml/min/1.73m2). Participants allocated to the usual water intake group experienced no progression in back or abdominal pain over three years. In the increased water intake group, back pain was transiently reduced by 33% between 12-18 months (p=0.04), but this improvement was not sustained over three years (p=0.21). Increased water intake had no impact on the progression of abdominal pain. By multivariable analyses (age, sex, Mayo class, eGFR) of pain progression, participants with lower eGFR (30-45ml/min/1.73m2) were more likely to experience an increase in abdominal pain over three years (p=0.03). Participants allocated to the increased water intake group had reduced analgesia use (16% vs 31%, p<0.001).</p><p><strong>Conclusions: </strong>Chronic back and abdominal pain were common and associated with higher eGFR at baseline, while abdominal pain progression was more frequent among participants with lower eGFR. Increased water intake was associated with reduced analgesic use, however, as pain outcomes were not the primary endpoint of the parent trial, these findings should be considered exploratory.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nephrology Consultation Patterns and Clinical Outcomes in Hospitalized Patients with Heart Failure.","authors":"Sebastián Morales-Cancio, Jorge Marie-Rosado, Fabian Ramirez-Rivera, Robert Ferrer-Macias, Myrna Millan-Ortiz, Ángel Ramos-Gil, Luis Colón-Gonzalez, Ángel Rivera-Santos, Miguel Echevarria-Quintana, Félix Perez-Ramos","doi":"10.34067/KID.0000001397","DOIUrl":"https://doi.org/10.34067/KID.0000001397","url":null,"abstract":"<p><strong>Background: </strong>Kidney dysfunction frequently complicates heart failure hospitalization and is associated with adverse outcomes, complicating inpatient management. However, nephrology consultation practices in hospitalized patients with heart failure remain incompletely characterized.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of adults hospitalized with a primary diagnosis of heart failure at a tertiary care center in Puerto Rico between January 1, 2021, and December 31, 2023. Nephrology consultation patterns, including timing, were evaluated. Outcomes included in-hospital mortality, length of stay, and 90-day readmission. Descriptive and exploratory analyses were performed.</p><p><strong>Results: </strong>A total of 991 hospitalizations were analyzed. Mean age was 73 years, and 42% were female. Chronic kidney disease was present in 27% of patients, and acute kidney injury in 16%. Nephrology consultation occurred in 38% of hospitalizations, including 76% of patients with acute kidney injury and 73% with chronic kidney disease. Consultation rates were higher with increasing baseline serum creatinine, reaching 97% in patients with creatinine ≥3.0 mg/dL. Length of stay differed significantly across consultation groups (5.6, 8.3, and 12.2 days; P < 0.001). In-hospital mortality was 9%. Unadjusted mortality was higher among consulted patients (OR, 3.74; 95% CI, 2.48-5.90; P < 0.001). Exploratory adjusted analyses incorporating measured kidney-related variables were consistent with substantial confounding and should be interpreted cautiously because key measures of illness severity were unavailable. Ninety-day readmission occurred in 40% of hospitalizations and did not differ by consultation status.</p><p><strong>Conclusions: </strong>Nephrology consultation occurred in fewer than half of hospitalizations and was more common in patients with advanced kidney dysfunction; however, a significant proportion of patients with acute kidney injury or chronic kidney disease did not receive consultation. These findings highlight variability in nephrology consultation practices and referral patterns in hospitalized patients with heart failure and kidney dysfunction.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proton Pump Inhibitors and Risk of Hyponatremia.","authors":"Issa Issa, Jakob Skov, Henrik Falhammar, Jonatan D Lindh, Buster Mannheimer","doi":"10.34067/KID.0000001412","DOIUrl":"https://doi.org/10.34067/KID.0000001412","url":null,"abstract":"<p><strong>Background: </strong>Proton pump inhibitors (PPIs) have been linked to hyponatremia, but evidence based on laboratory-confirmed sodium measurements remains limited.</p><p><strong>Methods: </strong>We conducted a retrospective population-based cohort study using the Stockholm Sodium Cohort, linking laboratory sodium measurements with nationwide health registers. To reduce confounding by indication, adults initiating treatment with PPIs were compared to adults initiating treatment with histamine-2 receptor antagonists. Outcomes were defined using serum sodium concentrations. Inverse probability of treatment weighting (IPTW) based on propensity scores was used to balance baseline covariates between groups. IPTW-weighted Cox proportional hazards models estimated hazard ratios (HRs) for profound hyponatremia (<125 mmol/L) within 90 days. Secondary analyses examined thresholds of Na<130 and <135 mmol/L.</p><p><strong>Results: </strong>A total of 492,994 individuals were included (451,676 using PPIs, 41,318 using histamine-2 receptor antagonists). During follow-up, 1,104 PPI users and 27 histamine-2 receptor antagonists users developed profound hyponatremia. After IPTW, PPI use was associated with higher risk of profound hyponatremia (HR 2.57; 95% CI 1.74-3.81). Hyponatremia defined as Na<130 mmol/L occurred in 2,088 PPI users and 76 histamine-2 receptor antagonists' users (HR 1.72; 95% CI 1.36-2.18). Na<135 mmol/L developed in 11,226 PPI users and 615 histamine-2 receptor antagonists' users (HR 1.43; 95% CI 1.31-1.56). Events clustered early after treatment initiation. The IPTW-weighted 90-day absolute risk of profound hyponatremia was 0.24% among PPI initiators and 0.09% among histamine-2 receptor antagonists' initiators (number needed to harm, 680).</p><p><strong>Conclusions: </strong>PPI-treatment was associated with a higher risk of hyponatremia compared to treatment with histamine-2 receptor antagonists. This supports a strong independent association between use of PPIs and profound hyponatremia.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social Support and Clinical Outcomes Among Older Adult Men and Women in the Chronic Renal Insufficiency Cohort.","authors":"Flor Alvarado, Siyi Geng, Eleanor Rivera, Robert S Hoover, Hua He, Jing Chen, Milda R Saunders, Vallabh O Shah, Bernard G Jaar, Ana C Ricardo, Mark L Unruh, James Lash, Hernan Rincon-Choles, James H Sondheimer, Paul E Drawz, Amanda H Anderson, Deidra C Crews, Jiang He, Katherine T Mills","doi":"10.34067/KID.0000001383","DOIUrl":"https://doi.org/10.34067/KID.0000001383","url":null,"abstract":"<p><strong>Background: </strong>Social support is an important psychosocial determinant of health, but its association with clinical outcomes among older adults with non-dialysis-dependent CKD remains incompletely characterized. We examined associations between social support and clinical outcomes among older adults with CKD and evaluated whether these associations differed by sex.</p><p><strong>Methods: </strong>We analyzed data from the Chronic Renal Insufficiency Cohort Study among participants aged 65 years and older who completed the Lubben Social Network Scale-6 between 2013 and 2018. Low social support was defined as a score <12. Participants were followed until death, withdrawal, or October 2024. Multivariable-adjusted negative binomial regression and Cox proportional hazards models were used to examine associations between social support and hospitalization, all-cause mortality, and CKD progression (≥50% decline in estimated glomerular filtration rate or kidney failure). Effect modification by sex, age, and race and ethnicity was evaluated.</p><p><strong>Results: </strong>Among 2,616 participants (mean age, 71±5 years; 43% women), 23% had low social support. Higher social support was associated with lower mortality risk (hazard ratio, 0.83; 95% confidence interval (CI), 0.71-0.98). This association was significant among women, Hispanic participants, and adults aged ≥70 years. Higher social support was not associated with hospitalization risk in the overall cohort (incidence rate ratio, 0.92; 95% CI, 0.82-1.03) but was associated with lower hospitalization risk among women and older adults, with significant effect modification by sex (P-interaction=0.01). Support from friends, but not family, was associated with lower mortality risk. Social support was not associated with CKD progression.</p><p><strong>Conclusions: </strong>Among older adults with non-dialysis-dependent CKD, higher social support was associated with lower mortality risk, while lower hospitalization risk was observed among women and older adults aged ≥70 years, with stronger protective associations observed among women.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Etelcalcetide Therapy for Secondary Hyperparathyroidism in Hemodialysis Patients with Inadequate Cinacalcet Response or Intolerance: Prospective Observational Study.","authors":"Abdullah Hamad, Amani Zidan, Tarek A Ghonimi, Tarek Fouda, Rania Ibrahim, Anees Jamil, Safiya Habib, Hany Ezzat, Shaza Yousif Elsonosi, Mohamad M Alkadi, Ahmed Awaisu, Hassan A Al-Malki","doi":"10.34067/KID.0000001416","DOIUrl":"https://doi.org/10.34067/KID.0000001416","url":null,"abstract":"<p><strong>Background: </strong>Cinacalcet is widely used for secondary hyperparathyroidism in hemodialysis (HD) patients. However, inadequate biochemical response, gastrointestinal intolerance, and pill burden may limit its use. Intravenous etelcalcetide offers an alternative in such cases. We aimed to provide real-world evidence on the effectiveness of etelcalcetide in reducing parathyroid hormone (PTH) levels and to assess the time to full response in HD patients with inadequate cinacalcet response or intolerance.</p><p><strong>Methods: </strong>A prospective observational study was conducted among HD patients transitioned from cinacalcet to etelcalcetide because of inadequate response or intolerance. The primary outcome was change in serum PTH from baseline to three months. Secondary outcomes included time to full biochemical response (PTH 150-600 ng/mL), hypocalcemia calcium ≤2.0 mmol/L), and time to first hypocalcemia. Changes in PTH from baseline to three months were assessed using the Wilcoxon signed-rank test. Time-to-event outcomes were analyzed using Kaplan-Meier and multivariable Cox regression.</p><p><strong>Results: </strong>A total of 146 patients (age 52± 16 years) were included. At three months, etelcalcetide reduced median (IQR) PTH from 936 (738-1257) pg/mL to 585 (394-962) pg/mL, p < 0.001. At the final assessment, 57% of patients achieved the target PTH range, with a median response time of 3 months. Higher baseline PTH was associated with a lower hazard of achieving full biochemical response (aHR = 0.88 per 100pg/mL increase, 95% CI: 0.83-0.93, p < 0.001). Hypocalcemia occurred in 71% of patients, with a median of 5 months. Higher baseline calcium (aHR 0.81 per 0.1-mmol/L increase, 95% CI 0.71-0.92, p = 0.002) and older age (aHR 0.97 per 1-year increase, 95% CI 0.96-0.99, p < 0.001) were associated with a lower hazard of hypocalcemia.</p><p><strong>Conclusions: </strong>Etelcalcetide use was associated with a significant PTH reduction and may provide a useful therapeutic option for HD patients with inadequate cinacalcet response or intolerance. However, hypocalcemia was common, underscoring the need for close monitoring and timely adjustment of etelcalcetide and concomitant therapies.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}