Kidney360最新文献

{"title":"The Synergistic Impact of Air Pollution and Residential Neighborhood Segregation on Post-Kidney Transplant Mortality.","authors":"Yiting Li, Gayathri Menon, Jane J Long, Malika Wilson, Byoungjun Kim, Babak J Orandi, Sunjae Bae, Wenbo Wu, George D Thurston, Dorry L Segev, Mara A McAdams-DeMarco","doi":"10.34067/KID.0000000915","DOIUrl":"https://doi.org/10.34067/KID.0000000915","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612193","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":"Correction to: Preservation of Residual Kidney Function in the Management of Patients on Incident Hemodialysis: An Opportunity to Improve Outcomes.","authors":"Jochen G Raimann, Yoshitsugu Obi","doi":"10.34067/KID.0000000913","DOIUrl":"https://doi.org/10.34067/KID.0000000913","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584283","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":"Pain Management in Autosomal Dominant Polycystic Kidney Disease: Clinical Challenges and a Stepwise Algorithmic Approach.","authors":"Abdul Hamid Borghol, Fadi George Munairdjy Debeh, Ahmad Ghanem, Marie Therese Bou Antoun, Vineetha Rangarajan, Jonathan Mina, Mohamed Hassanein, Lyle W Baker, Sahil Gupta, Shennen A Mao, Christy L Hunt, Marie C Hogan, Michael A Mao, Fouad T Chebib","doi":"10.34067/KID.0000000907","DOIUrl":"https://doi.org/10.34067/KID.0000000907","url":null,"abstract":"<p><p>Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic kidney disorder. It is primarily caused by pathogenic variants in the PKD1 or PKD2 genes. This leads to the development of numerous kidney cysts, which can result in kidney enlargement and progression to kidney failure. Pain is a common symptom in ADPKD and can negatively impact quality of life (QOL). This pain is often due to the continuous growth of kidney and liver cysts or associated cystic complications. We present a case of a 29-year-old female with ADPKD who experienced chronic, refractory right-sided flank pain that significantly affected her QOL. Her pain persisted despite taking daily multimodal analgesics and undergoing multiple invasive interventions. She had an unusual asymmetric disease with the right kidney accounting for only 24% of her kidney function. After exhausting all other pain control strategies, she underwent right nephrectomy and partial hepatectomy, which led to substantial improvement in pain and QOL. This review describes the causes, manifestations, and management strategies for abdominal and/or flank pain in ADPKD, including a practical stepwise algorithm to guide clinicians in managing pain and improve QOL of patients with ADPKD. Pain in ADPKD can either be acute or chronic and can lead to significant physical and psychological distress. Effective pain management in ADPKD requires a multidisciplinary approach, incorporating both non-pharmacological and pharmacological interventions such as gabapentin or tolvaptan in select cases. Interventions considered in ADPKD pain control include cyst aspiration with sclerotherapy, celiac plexus blockade, spinal cord stimulation, renal denervation, or nephrectomy.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584286","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":"Multicenter Insights into Peritoneal Dialysis for ADPKD: Role of Cumulative Cystic Organ Volumes in Treatment Complications.","authors":"Fadi George Munairdjy Debeh, Ahmad Ghanem, Vineetha Rangarajan, Abdul Hamid Borghol, Stefan Paul, Bassel AlKhatib, Nay Nader, Marie Therese Bou Antoun, Dana Hanna, Levon Souvalian, Zhuo Li, Adriana Gregory, Timothy Kline, Michael M Mao, Sandhya Manohar, Ivan E Porter, John J Dillon, Andrea Kattah, Sayeed Khalillullah, Lyle W Baker, Christopher L Trautman, LaTonya J Hickson, Fouad T Chebib, Nabeel Aslam","doi":"10.34067/KID.0000000888","DOIUrl":"https://doi.org/10.34067/KID.0000000888","url":null,"abstract":"<p><strong>Background: </strong>Autosomal dominant polycystic kidney disease (ADPKD) is the most prevalent genetic kidney disorder and the fourth leading cause of kidney failure (KF). Peritoneal dialysis (PD). Preferred for its home-based convenience and cost-effectiveness, is often underutilized in ADPKD due to concerns over enlarged kidneys and heightened complications risks.</p><p><strong>Methods: </strong>This retrospective cohort study utilized data from the Mayo Clinic PKD Database to evaluate individuals with ADPKD undergoing PD. We analyzed demographics, clinical parameters, and PD-related parameters. Complications were correlated with kidney and liver volumes derived from pre-KF imaging.</p><p><strong>Results: </strong>A total of 155 individuals with ADPKD on PD were included, of whom 45.1% were male. The mean age at PD initiation was 54.3 ± 12.8 years and the mean BMI was 28.0 ± 7.0 Kg/m2. The median duration of PD was 24.3 months (IQR, 10.7-43.1), with 21.9% transitioning to hemodialysis. The most common complications were abdominal hernias (30.3%) and peritonitis (23.9%), with a peritonitis rate of 0.11 episodes per patient-year. Imaging analyses was performed on a subset of 50 patients, showed a median height-adjusted total kidney liver volume (htTKLV) of 2731.9 mL/m (IQR, 2102.5-3131.1) and a median height-adjusted total kidney volume (htTKV) of 1303.5 mL/m (IQR, 733.1-1829.4). Kaplan-Meier analysis demonstrated no differences in complications rates based on htTKLV or htTKV (above vs. below median values) or BMI categories. Multivariate Cox regression analysis revealed that higher height-adjusted cumulative organ volume was associated with a lower risk of PD-related complications (hazard ratio = 0.56, p = 0.026).</p><p><strong>Conclusions: </strong>Peritoneal dialysis (PD) is a safe and feasible treatment option for ADPKD patients, with no increased risk of PD-related complications associated with larger height-adjusted cumulative organ volumes. Infectious complication rates in this cohort were within ISPD guideline thresholds further supporting the safety of PD in this population.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584285","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":"Long-term Outcomes of COVID-19 in Patients Receiving Maintenance Dialysis: A Propensity Score Matched Population-Based Cohort Study.","authors":"Kevin Yau, Sarah E Bota, Eric McArthur, Kyla L Naylor, Hiten Naik, Sara Wing, Peter G Blake, Michelle A Hladunewich, Adeera Levin, Matthew J Oliver","doi":"10.34067/KID.0000000866","DOIUrl":"https://doi.org/10.34067/KID.0000000866","url":null,"abstract":"<p><strong>Background: </strong>There is concern regarding the long-term impact of COVID-19 on the maintenance dialysis population. This study describes the long-term morbidity and mortality of COVID-19 among patients receiving maintenance dialysis in comparison to uninfected controls.</p><p><strong>Methods: </strong>We conducted a population-based cohort study of patients receiving maintenance dialysis in Ontario, Canada, between March 14, 2020, and December 1, 2021 (pre-Omicron), with follow-up until March 31, 2023. We accounted for confounding using propensity-scores to match each patient with COVID-19 to four uninfected controls. The primary outcome was all-cause mortality, while secondary outcomes included subsequent COVID-19 infection, COVID-19 associated death, composite of cardiovascular (CV)-related death or hospitalization, all-cause hospitalization, and admission to long-term care, or complex continuing care.</p><p><strong>Results: </strong>Our matched cohort included 3,340 maintenance dialysis patients: 668 with COVID-19 and 2,672 controls. Over a median of 1.8 years of follow-up, the rate of long-term all-cause mortality for 90-day COVID-19 survivors was 11.9 deaths per 100 person-years which did not differ from 13.9 deaths per 100 person-years in those without COVID-19 infection; hazard ratio (HR) 0.86, (95% CI 0.72 to 1.03). Similarly, no significant difference was observed on a composite outcome of cardiovascular death or hospitalization, all-cause hospitalization, long-term care or complex continuing care placement. Prior COVID-19 infection was associated with a reduced risk of subsequent COVID-19 infection (HR 0.75; 95% CI 0.63 to 0.88). Subsequent COVID-19 infection was associated with a higher rate of death (HR 1.68; 95% CI 1.42 to 1.98).</p><p><strong>Conclusions: </strong>Individuals receiving maintenance dialysis who survived their initial COVID-19 infection did not have an increased long-term risk of death, all-cause hospitalization, or cardiovascular disease compared to those without COVID-19. Subsequent COVID-19 infection during follow-up, however, was associated with increased mortality.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584284","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":"The Impact of Sex on KRT in Acute Kidney Injury: A Secondary Analysis of the STARRT-AKI Trial.","authors":"Emily J See, Ary Serpa Neto, Zahraa Habeeb, Rinaldo Bellomo, Ron Wald, Sean M Bagshaw","doi":"10.34067/KID.0000000850","DOIUrl":"https://doi.org/10.34067/KID.0000000850","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study is to evaluate whether sex modifies the initiation, prescription, or outcome of KRT, or the relationship between KRT initiation strategy and patient outcomes.</p><p><strong>Methods: </strong>We performed a secondary analysis of STARRT-AKI, a multinational randomized controlled trial comparing accelerated-initiation and standard-initiation of RRT in critically ill adults with acute kidney injury. The primary outcome was all-cause mortality at 90 days. Secondary and tertiary outcomes included renal recovery, mortality in the intensive care unit (ICU) or hospital, and resource utilization. We used logistic and linear regression analyses and interaction testing to explore the effect of KRT initiation strategy on outcomes according to sex.</p><p><strong>Results: </strong>A total of 2,926 participants from STARRT-AKI were included in this secondary analysis, of whom 937 were female (32%). Females had a lower pre-morbid serum creatinine level and were more likely to be admitted with a medical diagnosis, especially sepsis, compared to males. KRT was initiated with equal frequency in males and females, although females received a higher KRT dose and ultrafiltration intensity. There was no difference in 90-day mortality between sexes, even after covariate adjustment, nor in the number of days alive and free of ventilation, ICU, or hospital. Sex did not modify the association between KRT initiation strategy and survival, KRT dependence, or resource utilization.</p><p><strong>Conclusions: </strong>In this secondary analysis of the STARRT-AKI trial, KRT initiation and outcome did not differ by sex. An accelerated strategy of KRT initiation did not confer better outcomes to either females or males.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540722","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":"Impact of CKD/Kidney Failure on Angiodysplasia-Related Gastrointestinal Bleeding: Incidence, Outcomes, and Readmission Risk in a National Cohort.","authors":"Mingyue He, Ankur D Shah, Yichen Wang, Avrum Gillespie","doi":"10.34067/KID.0000000901","DOIUrl":"https://doi.org/10.34067/KID.0000000901","url":null,"abstract":"<p><strong>Background: </strong>Angiodysplasia-related gastrointestinal bleeding (AGIB) is an increasingly recognized cause of hospitalization, particularly among patients with chronic kidney disease (CKD). While AGIB has been linked to kidney failure (KF), its burden across CKD stages remains unclear. This study aimed to evaluate AGIB incidence, outcomes, and readmissions across CKD stages using the largest inpatient and readmission databases in the United States.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the 2022 National Inpatient Sample (NIS) and Nationwide Readmissions Database (NRD). Adult patients hospitalized with AGIB were identified and stratified into five groups: non-CKD (NCKD), early CKD (ECKD, stage 3), advanced CKD (ACKD, stages 4-5 not on dialysis), kidney failure (KF, end-stage kidney disease requiring chronic dialysis) and others. The primary outcome was AGIB hospitalization incidence. Secondary outcomes included in-hospital mortality, disease severity, treatment interventions, healthcare utilization, and 30-day readmission. Multivariable regression models were used to identify independent risk.</p><p><strong>Results: </strong>In 2022, 46,670 adults were hospitalized with AGIB (0.17% of all admissions). CKD/KF was an independent risk factor for AGIB hospitalization, with risk increasing progressively with worsening kidney function (aOR: 1.34 1.42 1.50 [ECKD], 1.72 1.89 2.07 [ACKD], 2.32 2.51 2.72 [KF]; all p < 0.001). The overall in-hospital mortality rate was 1.04%, higher among CKD patients. KF was independently associated with higher mortality (aOR: 1.06 1.87 3.27), lower rates of endoscopic evaluation (aOR: 0.43 0.53 0.65), and longer hospital stays. Endoscopy was associated with lower mortality (aOR: 0.32 0.54 0.92). The 30-day all-cause readmission rate was 22.3%, with recurrent AGIB as the leading cause. Readmission risk increased progressively with CKD stage.</p><p><strong>Conclusions: </strong>CKD progression is strongly associated with increased risk of AGIB hospitalization and readmission. KF and lack of endoscopic evaluation were independent mortality risk factors. These findings highlight the need for proactive management strategies in this high-risk population.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512116","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":"Associations of Proteinuria Trajectories with Kidney Failure and Death in Individuals with CKD.","authors":"Avi G Aronov, Ashish Verma, Ana C Ricardo, Tanika N Kelly, Sushrut S Waikar, James P Lash, Anand Srivastava","doi":"10.34067/KID.0000000849","DOIUrl":"https://doi.org/10.34067/KID.0000000849","url":null,"abstract":"<p><strong>Background: </strong>Despite repeating proteinuria measurements multiple times during the clinical course of a patient with CKD, clinicians may overlook the significance of temporal patterns of proteinuria. In addition, it is unclear whether proteinuria trajectories identify sub-populations with varying risks of adverse clinical outcomes.</p><p><strong>Methods: </strong>We used group-based trajectory modeling to identify proteinuria trajectories based on annual urine protein-to-creatinine ratio (UPCR) measurements in 3209 participants of the Chronic Renal Insufficiency Cohort Study who were alive and did not reach end-stage kidney disease (ESKD) within 3 years of study entry. Multivariable-adjusted Cox proportional hazards models tested the associations of UPCR trajectories with ESKD and death in those who survived beyond the 3rd annual visit.</p><p><strong>Results: </strong>Trajectory analyses identified 4 discrete groups based on annual UPCR measurements: low-slowly rising (n=1528), high-slowly rising (n=1363), regressing (n=114), and rapidly rising (n=204). Compared to the low-slowly rising proteinuria trajectory group, participants in the other proteinuria trajectory groups had lower socioeconomic status, a greater prevalence of comorbid conditions, and lower eGFR. During a median follow-up of 8.6 years, 547 participants progressed to ESKD, and 836 participants died. Compared to the low-slowly rising group, all proteinuria trajectory groups were associated with higher risks of subsequent ESKD, but only the high-slowly rising group was associated with a higher risk of death.</p><p><strong>Conclusions: </strong>Trajectories of repeated proteinuria measurements identify subgroups of patients with CKD that have increased risks of ESKD and death independent of known risk factors.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144506068","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":"Medication Mindfulness: Implementation and Evaluation of a Single-Site, 6-month Deprescribing Intervention for Patients on Hemodialysis.","authors":"Noah Zlotnik, Angelina Abbaticchio, Madeline Theodorlis, Michelle S Cross, Abhijat Kitchlu, Jo-Anne Wilson, Anna R Gagliardi, Marisa Battistella","doi":"10.34067/KID.0000000884","DOIUrl":"https://doi.org/10.34067/KID.0000000884","url":null,"abstract":"<p><strong>Background: </strong>Patients on hemodialysis (HD) are at increased risk for polypharmacy-related adverse events (AEs). Deprescribing may optimize medication use and mitigate the harmful effects of polypharmacy, but its application in patients on HD remains understudied. The overall aim of this study is to implement and evaluate the effectiveness and safety of a deprescribing intervention utilizing a deprescribing toolkit in multiple HD units across Canada. This preliminary study aims to demonstrate the efficacy and safety of the intervention within one HD unit in Toronto, Canada.</p><p><strong>Methods: </strong>This single-center study included patients on HD for at least three months who were taking at least one of nine study medication classes. Clinicians applied deprescribing algorithms to determine if deprescribing was recommended. Clinicians and patients could decline the algorithm's recommendation. Primary outcomes include the number of patients successfully deprescribed by discontinuing or reducing the dose of their medication over 6 months, and clinically significant AEs. Secondary outcomes include clinician and patient acceptance of algorithm recommendations, and clinical monitoring.</p><p><strong>Results: </strong>Ninety-eight patients were taking an average of 13.47 (+4.01) medications, with an average of 2.32 (+1.00) being study medications. The algorithms recommended 40 patients to deprescribe 49 study medications. Clinicians agreed to 39 (80%) recommendations, and patients agreed to 28 of those 39 (72%). Twenty patients successfully deprescribed 23 medications (82%), while 5 patients failed and restarted 5 medications (18%) at their baseline dose. Clinical monitoring and spontaneous reporting revealed no AEs considered related to the intervention.</p><p><strong>Conclusions: </strong>Approximately 1 in 5 eligible patients successfully deprescribed a medication with minimal clinical detriment. While the deprescribing algorithms are valuable in guiding clinical decision-making, final decisions rest with clinicians, constituting a careful synthesis of potential benefits, risks, and goals of care for each individual patient. Future research will analyze deprescribing outcomes at additional HD units in Canada.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144506070","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":"Higher Urinary Iron Levels are Associated with Kidney Dysfunction, Tubular Damage, and Increased Mortality in Kidney Transplant Recipients.","authors":"Daan Kremer, Pien Rawee, Tim J Knobbe, Joanna Sophia J Vinke, Kai Lüersen, David E Leaf, Dorine W Swinkels, Martin H de Borst, Gerald Rimbach, Stephan J L Bakker, Michele F Eisenga","doi":"10.34067/KID.0000000878","DOIUrl":"https://doi.org/10.34067/KID.0000000878","url":null,"abstract":"<p><strong>Background: </strong>Increased urinary iron can result from (i) increased delivery of iron to the kidneys, (ii) increased glomerular passage of iron, and/or (iii) decreased tubular reuptake. Currently, the relevance of urinary iron levels is unknown. We investigated urinary iron with different pathways and clinical outcomes in kidney transplant recipients (KTRs).</p><p><strong>Methods: </strong>We measured urinary iron in samples from the prospective TransplantLines Food & Nutrition Biobank and Cohort study. Multivariable linear and Cox regression models were applied.</p><p><strong>Results: </strong>We included 693 stable KTRs (age 53±13 years, 43% female, estimated glomerular filtration rate [eGFR] 52±20 ml/min/1.73m2). Higher urinary iron was associated with lower eGFR and higher kidney damage markers, including albuminuria, 24h urinary liver-type fatty acid-binding protein excretion, urinary endothelial growth factor to creatinine ratio, and plasma neutrophil-gelatinase associated lipocalin (all P<0.001). In contrast, urinary iron was not associated with systemic iron status, but was increased with oral iron supplementation. During a follow-up of 5.3 years, 83 KTRs experienced graft failure, and 150 died. Prospectively, higher urinary iron was associated with graft failure, but the association was decreased after adjustment for proteinuria. In contrast, urinary iron was independently associated with increased mortality risk (HR per doubling: 1.29; 95% CI: 1.08-1.56).</p><p><strong>Conclusions: </strong>Higher urinary iron levels are associated with worse kidney function, more proteinuria, increased tubular damage markers and higher mortality. Oral iron supplementation seems to be an important determinant of urinary iron levels. These findings raise the possibility that urinary iron acts as a tubulotoxic agent and mechanistic studies are warranted.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144506069","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}