Kidney360最新文献

{"title":"The Effect of Dialysate Sodium on Endothelial Injury and Microcirculatory Dysfunction.","authors":"Lisa Hur, Yanmin Zhang, Alireza Akbari, Eric K Patterson, Barry G H Janssen, Christopher W McIntyre","doi":"10.34067/KID.0000000949","DOIUrl":"https://doi.org/10.34067/KID.0000000949","url":null,"abstract":"<p><strong>Background: </strong>Hemodialysis (HD) causes injury to the glycocalyx, inducing shedding of syndecan-1. This damage results from hemodynamic stress of HD and injury caused by oncotic shifts in the presence of additional sodium. The aim of this study is to investigate the effects of sodium dialysate concentration on endothelial cell injury and microcirculatory dysfunction during HD. We hypothesize that changes in plasma sodium concentration will result in direct injury to the glycocalyx and reduce microcirculatory perfusion.</p><p><strong>Methods: </strong>Twenty-seven healthy male Wistar Kyoto rats underwent HD: eight were exposed to 140mM sodium dialysate concentration (control), ten were exposed to low sodium dialysate (130mM), and nine were exposed to high sodium dialysate (150mM). Throughout HD, intravital microscopy was used to image the microvasculature perfusion at baseline, during extracorporeal circulation with no dialysate flow (\"Sham\"), at 1 hr into HD, at 2 hrs into HD, and post HD (\"Final\"). Blood samples were collected at the same timepoints corresponding to the intravital microscopy image acquisitions to measure syndecan-1.</p><p><strong>Results: </strong>The findings demonstrate a gradual increase in syndecan-1 concentration in blood plasma and a consistent trend of lower perfusion throughout the duration of the experiment in all experimental groups. Particularly, syndecan-1 concentration in plasma was significantly higher at 2 hrs into HD in the high sodium dialysate group compared to the control and low sodium dialysate group.</p><p><strong>Conclusions: </strong>HD results in direct acute endothelial injury and microcirculatory disturbance. This effect is aggravated by exposure to supraphysiological concentrations of sodium, potentially resulting in sustained injury to the glycocalyx.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225563","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":"Time to Inject Some Contrast into the Nephrotoxicity Debate.","authors":"Nans Florens, Julien Demiselle","doi":"10.34067/KID.0000001019","DOIUrl":"https://doi.org/10.34067/KID.0000001019","url":null,"abstract":"<p><p>Iodinated contrast media have long been feared for causing \"contrast-induced AKI\" (CI-AKI), a concern rooted in early reports with high-osmolar agents. Experimental data suggest potential nephrotoxic mechanisms, yet clinical evidence from older uncontrolled studies was confounded by comorbidities and procedural risks. Contemporary propensity-matched and controlled analyses consistently show that modern low- and iso-osmolar contrast agents (mostly intravenously administered) uncommonly cause true nephrotoxicity, even among high-risk populations such as patients with advanced chronic kidney disease, acute kidney injury, or critical illness. Large randomized trials, including PRESERVE, found no difference in outcomes between sodium bicarbonate and isotonic saline hydration as preventive strategies, nor N-acetylcysteine administration, and highlighted risks like fluid overload. Persistent fear of CI-AKI has fueled \"renalism\": unnecessary avoidance or delay of essential imaging, leading to worse outcomes. Current consensus emphasizes individualized care-avoiding hypovolemia, limiting contrast dose, and withholding nephrotoxins only in severe kidney impairment. A balanced, evidence-based approach should replace outdated caution.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213227","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":"Short Course Immunosuppression to Prevent Transfusion-related Human Leukocyte Antigen Sensitisation in Kidney Transplant Candidates: CON.","authors":"Alessandra Orsillo, Georgina L Irish","doi":"10.34067/KID.0000000827","DOIUrl":"https://doi.org/10.34067/KID.0000000827","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206634","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":"Short Course Immunosuppression to Prevent Transfusion-related Human Leukocyte Antigen Sensitisation in Kidney Transplant Candidates: PRO.","authors":"Samantha Ng","doi":"10.34067/KID.0000000848","DOIUrl":"https://doi.org/10.34067/KID.0000000848","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206705","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":"Short Course Immunosuppression to Prevent Transfusion-related Human Leukocyte Antigen Sensitisation in Kidney Transplant Candidates: Commentary.","authors":"Jennifer Li","doi":"10.34067/KID.0000001008","DOIUrl":"https://doi.org/10.34067/KID.0000001008","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206696","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":"Strategic Innovations to Reduce Disincentives and Increase Living Kidney Donation.","authors":"Amanda Leonberg-Yoo, Robert Redfield, Ty Dunn, James N Fleming, Janny Fonk, Garet Hil, Matthew Cooper","doi":"10.34067/KID.0000001001","DOIUrl":"https://doi.org/10.34067/KID.0000001001","url":null,"abstract":"<p><strong>Background: </strong>While up to 59% of the U.S. population report willingness to donate a kidney, only about 6,000 living kidney donations occur annually. This study described the use and impact of National Kidney Registry (NKR) programs designed to eliminate disincentives to living kidney donation.</p><p><strong>Methods: </strong>This was a retrospective cohort analysis utilizing administrative data records from the NKR, a national database capturing information on potential living kidney donors at 103 transplant centers across the continental US. Descriptive statistics were used to summarize donor characteristics, program participation, and outcome measures. An interrupted time series was used to analyze changes in registration conversion rates before and after program implementation.</p><p><strong>Results: </strong>Following the implementation of Donor Connect, the registration conversion rate increased from 8.4% immediately preceding implementation to 18.4% by the end of follow-up. At the time of intervention, a statistically significant 8% increase in registration conversion rate was observed (p<0.001), with an additional 0.3% increase per quarter thereafter (p=0.017). Remote donors were significantly more likely to live > 150 miles from the recipient's transplant center (84% vs 21%); the Remote Donor Program reduced travel burden by 597 [205,1196] miles. Referral conversion rates were significantly higher for donors living within 50 miles (8.3%) compared to those 51-150 miles (6.5%, p<0.001) and >150 miles (5.3%, p<0.003), corresponding to an increased donation odds of 1.31 and 1.62, respectively). Fifty-one percent of donors received cost reimbursement through the Donor Shield program. Donors who participated were more racially diverse and were more likely to reside further from the transplant center.</p><p><strong>Conclusions: </strong>This analysis indicates that the outcomes from NKR's programs support the efficacy of disincentive-targeted innovations as a way to increase donation rates by supporting donors and streamlining the donation process. These innovations represent a modern, donor-centered approach to living kidney donation. By addressing known barriers, these programs have the potential to expand the donor pool, improve the efficiency in donor evaluation, and improve the overall donor experience.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206664","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 Association between Neighborhood Socioeconomic Status and Posttransplant Cancer Outcomes among Kidney Transplant Recipients in the United States.","authors":"Yue-Harn Ng, Shyfuddin Ahmed, Nathan Pan, Jun Tao, Bessie Young, Qianlai Luo, Ruth M Pfeiffer, Christopher Blosser, Eric A Engels","doi":"10.34067/KID.0000000979","DOIUrl":"https://doi.org/10.34067/KID.0000000979","url":null,"abstract":"<p><strong>Background: </strong>Cancer is a leading cause of death among kidney transplant recipients (KTRs) and may disproportionately affect disadvantaged individuals. We assessed the association between neighborhood socioeconomic status and cancer outcomes among KTRs in the US.</p><p><strong>Methods: </strong>We evaluated first-time KTRs through a linkage between US transplant and cancer registries (2000-2019). The Yost index, which incorporates neighborhood measurements of income, educational level, housing, and employment, was categorized into quintiles, with the lowest quintile (Q1) corresponding to the most disadvantaged neighborhood. We used Poisson regression to compare the association of Yost quintiles with cancer incidence overall and with seven common cancer types (colorectum, lung, female breast, prostate, kidney, melanoma, and non-Hodgkin lymphoma) as well as to compare the Yost index with cancer stage at diagnosis. Cox regression was used to evaluate cancer-specific mortality.</p><p><strong>Results: </strong>We included 168,028 KTRs. Overall cancer incidence was 12.3 per 1,000 person-years (n=11,146 cases) with no overall difference across Yost quintiles (p-trend=0.893). However, KTRs from the most disadvantaged neighborhoods had higher lung cancer incidence (adjusted incidence rate ratio [IRR] 1.44, 95% confidence interval [95%CI] 1.19-1.73, Q1 vs. Q5; p-trend=0.001) and lower prostate cancer incidence (IRR 0.76, 95%CI 0.63-0.92, Q1 vs. Q5; p-trend=0.022). KTRs in more disadvantaged areas who were diagnosed with melanoma were more likely to present with regional or distant stage cancer (p-trend=0.022). After a cancer diagnosis, cancer-specific mortality was higher among KTRs in lower Yost quintiles (adjusted hazard ratio 1.18, 95%CI 1.05-1.32 for Q1 vs. Q5; p-trend=0.004), although trends were not significant for individual cancer types.</p><p><strong>Conclusions: </strong>KTRs from disadvantaged neighborhoods have increased lung cancer risk and reduced prostate cancer risk, and are more likely to present with advanced-stage melanoma. After a cancer diagnosis, KTRs from disadvantaged neighborhoods are also more likely to die from their cancer. These results point to important disparities among KTRs in cancer screening and treatment.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206632","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":"Spatial Mass Spectrometry-Based Proteomic Analysis of Normal-Appearing Glomeruli from Young and Old Adults.","authors":"Kiran K Mangalaparthi, Gunveen S Sachdeva, Afsana Ansari Shaik, Shilpa Venkataraman, Aidan F Mullan, Ganesh P Pujari, Benjamin J Madden, Muhammad Sohaib Asghar, Vidit Sharma, Mariam P Alexander, Nicholas B Larson, Aleksandar Denic, Akhilesh Pandey, Andrew D Rule","doi":"10.34067/KID.0000000986","DOIUrl":"https://doi.org/10.34067/KID.0000000986","url":null,"abstract":"<p><strong>Background: </strong>Kidney aging is characterized by a loss of glomeruli, predominately in the superficial cortex, with a resultant decline in glomerular filtration rate and an increased risk of various kidney-related diseases. The early molecular alterations in glomeruli associated with the aging process are not well studied.</p><p><strong>Methods: </strong>We combined laser capture microdissection and mass spectrometry-based unbiased proteomic analysis of non-sclerosed, non-ischemic glomeruli in the superficial cortex from young and old adults who underwent a radical nephrectomy for a tumor to understand the age-related molecular changes in glomeruli. 24 young and 30 old adults were used for the discovery dataset and the significant differentially expressed proteins were further validated using an independent set comprising 6 young and 8 old adults.</p><p><strong>Results: </strong>Kidneys from older adults had lower eGFR, less kidney parenchyma on CT imaging, and more glomerulosclerosis and arteriosclerosis on histology. Quantitative proteomic analysis of non-sclerosed, non-ischemic glomeruli identified increased expression of TIMP3, GPC6, SNCG, APOA4 and NT5E in old adults that were further validated in an independent set. Pathway analysis indicated that proteins with increased expression in old adults were enriched in mitochondrial translational processes, aerobic respiration, and TCA cycle, whereas proteins with decreased expression in old adults were enriched in mRNA splicing, mRNA processing, and nonsense mediated decay. Further, Spearman correlation of validated differentially expressed proteins did not show any significant correlation with the kidney pathology independent of age group.</p><p><strong>Conclusions: </strong>Overall, this study identified proteins that are specifically associated with the aging process in otherwise normal-appearing glomeruli.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206648","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":"Commemorating the National Institute of Diabetes and Digestive and Kidney Diseases' Advances in Kidney Health: 75 Years of Discovery and Impact.","authors":"Connie M Rhee, Michael Allon, Rajnish Mehrotra","doi":"10.34067/KID.0000001005","DOIUrl":"https://doi.org/10.34067/KID.0000001005","url":null,"abstract":"<p><p>This year commemorates the 75th anniversary of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), one of the 27 institutes and centers of the National Institutes of Health. A core mission of the NIDDK has been the advancement and support of biomedical research across a diverse spectrum of disciplines, including endocrine and metabolic diseases, digestive and nutritional disorders, obesity, urologic and benign hematologic conditions, and, notably, kidney diseases, which has been a major focus of the institute's strategic priorities. Through the years, the NIDDK has heavily invested in biomedical infrastructure, foundational studies, and cross-cutting basic science, clinical investigation, epidemiology, and health services research, which have fundamentally shaped the detection, management, and prevention of kidney diseases worldwide. Furthermore, the NIDDK has had a longstanding commitment to promoting workforce development, advancing equal access to kidney health care, and forging collaborative partnerships with academic centers, federal agencies, professional societies, patient advocacy organizations, community groups, and industry stakeholders toward the shared goal of improving kidney disease outcomes. In this review published across the three American Society of Nephrology journals, we celebrate the landmark achievements and profound effect of the NIDDK in improving the health and well-being of people living with kidney diseases.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145200039","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":"Re-evaluating TIPS Candidacy for Patients with Kidney Disease.","authors":"Megan M Griffin, Cary H Paine, Sarah F Sanghavi","doi":"10.34067/KID.0000001011","DOIUrl":"https://doi.org/10.34067/KID.0000001011","url":null,"abstract":"<p><p>Patients with cirrhosis of the liver are at risk for kidney dysfunction due to portal hypertension-induced splanchnic vasodilation, which results in a decrease in effective arterial blood volume. This can lead to hepatorenal syndrome, which may manifest clinically as ascites that is refractory to diuretics, a rise in creatinine, and hyponatremia. Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure that shunts blood directly from the portal vein to the hepatic vein, bypassing the high-pressure system of the cirrhotic liver. Among patients with diuretic-resistant ascites, TIPS decreases recurrence of ascites and improves kidney function. However, since less blood is passing through the hepatic sinusoids, post-procedure risks of TIPS, including worsening hepatic encephalopathy and liver ischemia, increase with the severity of liver disease. The model for end-stage liver disease (MELD) score quantifies this risk using the INR, bilirubin, and serum creatinine as variables, and has been used to exclude high-risk patients from TIPS. The flaw in this method is that although serum creatinine can indicate worse hepatic function, it is a parameter of this composite score that may improve with TIPS. This review discusses the physiologic changes that occur after TIPS and recommends an individualized approach to TIPS selection in patients with kidney disease.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149643","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}