Kidney360最新文献

{"title":"Geographic Disparities in Access to CKD Randomized Clinical Trials in the United States.","authors":"Parth Dhamelia, Omar Darwish, Dharmik Jadvani, Hashane K Abeyagunawardene, Lauren Tong, Clare C Brown, John M Arthur, Nishank Jain","doi":"10.34067/KID.0000001375","DOIUrl":"https://doi.org/10.34067/KID.0000001375","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874412","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's Onboarding Challenge May Reflect a Workforce Challenge.","authors":"Juliano Alhaddad, Georges Nakhoul","doi":"10.34067/KID.0000001386","DOIUrl":"10.34067/KID.0000001386","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":"7 9","pages":"1928-1929"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Newly Designed Expedited Allocation Pathways Cannot Be Expected to Rely on Data That Do Not Currently Exist.","authors":"Cameron D Ekanayake, Syed A Husain, Miko E Yu, Joel T Adler, Chetan Sree Muppavarapu, Jesse D Schold, Sumit Mohan","doi":"10.34067/KID.0000001213","DOIUrl":"10.34067/KID.0000001213","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":"2134-2137"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147529730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shaping an Early Nephrology Fellowship Curriculum: Results from the American Society of Nephrology Fellow Survey.","authors":"Ashley M La, Suzanne M Boyle, Kurtis A Pivert, Anna L Zisman, Benjamin S Ko","doi":"10.34067/KID.0000001228","DOIUrl":"10.34067/KID.0000001228","url":null,"abstract":"<p><strong>Key points: </strong>A quarter of Nephrology Fellow Survey respondents reported feeling unprepared to start fellowship. Current fellows desire a focus on nephrology emergencies and executive functioning skills in an early-fellowship curriculum. Optimizing early fundamental nephrology education has potential to positively influence fellows' clinical success.</p><p><strong>Background: </strong>The transition between residency and nephrology fellowship can be difficult for many trainees because of nephrology's inherent complexity and high-intensity nature as well as the lack of standardization in internal medicine training. We aimed to assess self-perceived preparedness of nephrology fellows at the start of fellowship and explore learner preferences for educational methods and content for an early-fellowship curriculum.</p><p><strong>Methods: </strong>Data were collected using an instrument included in the 2025 American Society of Nephrology Fellow Survey.</p><p><strong>Results: </strong>Responses from 339 adult nephrology fellows were included in analysis. Most responding fellows (252 [74%]) reported feeling extremely prepared, very prepared, or moderately prepared when starting nephrology fellowship. Preparedness was associated with completing three or more weeks of nephrology rotations in residency (chi-squared test for independence, P = 0.004). Half of fellows (49%) reported participating in an early-fellowship curriculum before starting clinical rotations. Learner preferences for educational methods used in an early-fellowship curriculum were similar to those most commonly used in contemporary curricula (didactics, shadowing senior fellows, and case simulations), although there was a preference for small-group problem-based learning compared with procedural training. Fellows reported a preference for learning about common inpatient nephrology emergencies (AKI, dialysis prescriptions and complications, and electrolytes and acid/base) and executive functioning skills (workflow/efficiency and discussing dialysis and goals of care with patients) in their ideal early-fellowship curriculum.</p><p><strong>Conclusions: </strong>These results can help inform development of future early-fellowship curricula on the basis of current fellows' experiences and perceived needs to promote successful clinical training.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":"2039-2045"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147988119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Disease Recurrence and Outcomes following Kidney Transplantation for GN: A Prospective Nationwide Cohort Study.","authors":"Matthieu Halfon, Patrick Taffé, Christian Bucher, Fadi Haidar, Uyen Huynh-do, Laila-Yasmin Mani, Thomas Schachtner, Caroline Wehmeier, Jean-Pierre Venetz, Manuel Pascual, Fadi Fakhouri, Dela Golshayan","doi":"10.34067/KID.0000001218","DOIUrl":"10.34067/KID.0000001218","url":null,"abstract":"<p><strong>Key points: </strong>GN is one of the main causes of kidney transplantation. In patients transplanted for GN, the risk of recurrence is approximately 16%. Recurrence significantly worsens the prognostic, tripling and doubling the risk of graft loss and acute rejection, respectively. Despite having more often received immunosuppression before transplantation, patients with GN are not at increased risk of post-transplantation cancers.</p><p><strong>Background: </strong>Patients who receive transplants after kidney failure due to GN (GN-KTx) constitute a significant portion of recipients and may face unique challenges post-transplantation, related to the risk of GN recurrence and a higher global burden of immunosuppression.</p><p><strong>Methods: </strong>We analyzed patient and graft outcomes, including the risk of graft loss in relation to recurrence in GN-KTx, compared with patients transplanted for other causes, using data from the prospective nationwide Swiss Transplant Cohort Study.</p><p><strong>Results: </strong>Among 2631 included patients, 701 were GN-KTx, with IgA nephropathy being the most common GN subtype. GN-KTx recipients were younger and more likely to receive living donor organs. During a mean follow-up period of 5.3 years (interquartile range, 2.3-8.2), the 5-year cumulative incidence of graft loss was similar across groups, with GN-KTx at 6%. Notably, GN-KTx had a similar incidence of acute rejection as other groups. Recurrence occurred in 16% of GN-KTx within a mean time of 1.7 years (interquartile range, 0.28-2). Patients with recurrence faced a three-fold higher risk of graft loss. Furthermore, disease recurrence was associated with a two-fold higher risk of acute rejection compared with nonrecurrent GN-KTx. Interestingly, regarding cancer risks, GN-KTx patients had the lowest incidence of skin cancer and no higher risk of nonskin cancers, despite greater exposure to immunosuppression compared with other kidney transplant recipients.</p><p><strong>Conclusions: </strong>These real-life setting contemporary multicenter data highlight the importance of post-transplant monitoring for GN recurrence, given the strong association with poor graft outcomes and higher rejection rates. This is important in the context of current development of targeted therapies for GN in native kidneys that could be transposed to transplanted kidneys.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":"2102-2113"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147930467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Relevance of Calcium Measures: QT-Based Comparison of Ionized, Total, and Albumin-Corrected Calcium.","authors":"Hiroaki Miyauchi, Tatsuhiko Azegami, Takashin Nakayama, Kaori Hayashi","doi":"10.34067/KID.0000001236","DOIUrl":"10.34067/KID.0000001236","url":null,"abstract":"<p><strong>Key points: </strong>Ionized calcium showed the strongest associations with the QT interval, whereas total and corrected calcium showed weaker associations. Calcium measures that correlated better with ionized calcium did not necessarily perform better for QT-based outcomes. These findings reinforced ionized calcium as the most clinically valid reference and supported outcome-based calcium assessment.</p><p><strong>Background: </strong>Ionized calcium (iCa) is the physiologically active fraction of circulating calcium, whereas total calcium (tCa) and albumin-corrected calcium (cCa) remain widely used. Despite growing concerns over the accuracy of correction formulas, most evaluations rely on concordance with iCa rather than meaningful physiologic outcomes. We compared iCa, tCa, and cCa and assessed their clinical validity using ventricular repolarization-reflected by the QT interval-as a physiologic end point.</p><p><strong>Methods: </strong>This single-center cross-sectional observational study included adults who visited our outpatient department with simultaneous measurements of iCa, tCa, electrolytes, albumin, and electrocardiography. iCa, tCa, and seven albumin-correction formulas were examined. Associations with the QT interval were evaluated using linear regression and restricted cubic splines; logistic regression assessed corrected QT prolongation. Sensitivity analyses included alternative QT-correction methods and analyses in hypoalbuminemia.</p><p><strong>Results: </strong>Among 647 participants (median age 68 years; 54% male), common comorbidities included hypertension (33%), diabetes (18%), and cardiac disease (11%). Correlations between iCa and other calcium measures varied widely. In fully adjusted analyses, iCa demonstrated the strongest association with QT interval (standardized β =-0.22; 95% confidence interval, -0.29 to -0.14). tCa and all cCa exhibited substantially weaker associations. Although some tCa and cCa demonstrated relatively higher correlation with iCa, they exhibited weaker associations with QT. In hypoalbuminemia (albumin <3.0 g/dl, n =118), agreement with iCa declined for all cCa, and associations with QT were attenuated; only iCa (standardized β =-0.25; 95% confidence interval, -0.44 to -0.06) and limited formulas (notably Payne) retained modest associations.</p><p><strong>Conclusions: </strong>iCa is the physiologically and clinically valid measure of calcium status consistently demonstrating the strongest associations with ventricular repolarization. By contrast, tCa and cCa demonstrate substantially reduced clinical relevance and numerical concordance with iCa does not reflect clinical validity. These findings support outcome-based validation of calcium measure and reinforce the importance of direct iCa measurement.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":"1998-2007"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148031889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities in Telemedicine Utilization among Kidney Transplant Candidates and Recipients.","authors":"Jae-Hyung Chang, Alexander Moon, Kundan R Jana, Adarsh Ramakrishnan, Jennifer J van Bever, Demetra S Tsapepas, Sumit Mohan, Syed Ali Husain","doi":"10.34067/KID.0000001308","DOIUrl":"10.34067/KID.0000001308","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":"2128-2130"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148422132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical Role of Dysregulated Autophagy in Pathophysiology of Podocytopathy.","authors":"Claudio Ponticelli, Gabriella Moroni, Marta Calatroni, Rachel Njeim, Alessia Fornoni","doi":"10.34067/KID.0000001152","DOIUrl":"10.34067/KID.0000001152","url":null,"abstract":"<p><p>Podocytopathies are glomerular disorders characterized by podocyte injury, typically resulting in marked proteinuria. Podocytes are highly specialized, terminally differentiated epithelial cells essential for maintaining the structural and functional integrity of the glomerular filtration barrier. Owing to constant exposure to injurious stimuli, podocytes may undergo dedifferentiation, hypertrophy, apoptosis, or necrosis. Autophagy is a key cytoprotective mechanism that enables cells to degrade and recycle damaged or unnecessary components through a multistep process involving induction, autophagosome formation, fusion with lysosomes, and degradation. Under physiologic conditions, podocytes exhibit high basal levels of autophagy, which are essential for clearing aberrant cytoplasmic elements, including inflammasomes. Both experimental and clinical studies have demonstrated that dysregulated autophagy is a common feature in various podocytopathies, including minimal change disease, FSGS, membranous nephropathy, diabetic nephropathy, and lupus nephritis. Restoration of autophagic activity through natural or pharmacologic inducers-such as mechanistic target of rapamycin inhibitors, metformin, or mineralocorticoid receptor antagonists-has been associated with reduced proteinuria and improved podocyte function. Despite strong preclinical evidence, clinical trials investigating autophagy-targeting therapies in podocytopathies remain limited and often lack long-term follow-up. Moreover, the clinical use of some promising agents is constrained by significant adverse effects, underscoring the need for safer, more targeted therapeutic strategies.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":"2149-2159"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drug-Induced Thrombotic Microangiopathy in Patients with Cancer : A Clinicopathologic Series.","authors":"Wai Lun Will Pak, Nadia Al Haddad, Andrea Knezevic, Steven Salvatore, Surya Seshan, Ilya Glezerman, Edgar A Jaimes, Insara Jaffer Sathick","doi":"10.34067/KID.0000001249","DOIUrl":"10.34067/KID.0000001249","url":null,"abstract":"<p><strong>Key points: </strong>Gemcitabine, bevacizumab, and doxorubicin were the most common drugs implicated in drug-induced thrombotic microangiopathy in cancer. Cessation of the offending drug was the mainstay of management. The median overall survival was 2.1 years, and the median kidney failure‑free survival was 1.8 years after biopsy-confirmed diagnosis.</p><p><strong>Background: </strong>Drug-induced thrombotic microangiopathy (TMA) is a major sequela of cancer therapies. The diagnosis of drug-induced TMA is often presumptive, making accurate clinical characterization difficult.</p><p><strong>Methods: </strong>We retrospectively reviewed clinical presentation and outcomes of 53 patients with biopsy-proven renal TMA due to cancer therapies in a cancer center between 2001 and 2023.</p><p><strong>Results: </strong>Median age at presentation was 64 (44-81) years, and our cohort was 72% (38/53) female. Most common malignancies treated were pancreatic (19%), breast (17%), ovarian (15%), and lung (15%) cancers. Forty-one patients (77%) presented with AKI, of which nine patients (17%) required dialysis. Most common implicated drugs were gemcitabine (51%); bevacizumab (25%); doxorubicin (15%); and various tyrosine kinase inhibitors (19%), including EGF receptor blocker erlotinib (4%). Cessation of the offending drug was the mainstay of management in 51 patients (96%); other treatment strategies included steroids (15%) and eculizumab (8%). After a median follow-up of 4 years (1.1-7.1), median overall survival was 2.1 years and median kidney failure‑free survival was 1.8 years. Among patients with AKI, 16 patients (39%) had kidney recovery within a year. One of nine patients requiring dialysis was weaned off within a year. Older age, lower GFR at presentation, and thrombocytopenia were associated with worse kidney prognosis. Chronic TMA was noted upon kidney biopsy in most of the patients (85%). Pathologic findings associated with worse kidney outcome were the presence of microvascular thrombi and endothelial swelling.</p><p><strong>Conclusions: </strong>Although limited by its retrospective nature, our study suggests that doxorubicin and erlotinib are underrecognized causes of drug-induced TMA. Many patients' biopsies had chronic changes in glomeruli, arterioles, and small arteries, indicating that mild, ongoing endothelial injury is present before the development of overt TMA. Clinical vigilance with early cessation of the offending drug may help kidney recovery.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":"2046-2055"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Kidney Tubular Secretory Clearance with Cognitive Function among Adults with CKD in the Systolic Blood Pressure Intervention Trial.","authors":"Lindsay M Miller, Simon B Ascher, Rebecca Scherzer, Pranav S Garimella, O Alison Potok, María J Marquine, Nicholas M Pajewski, Alex Bullen, Kalani L Raphael, Michael G Shlipak, Joachim H Ix","doi":"10.34067/KID.0000001334","DOIUrl":"https://doi.org/10.34067/KID.0000001334","url":null,"abstract":"<p><strong>Background: </strong>Persons with CKD are disproportionally affected with cognitive impairment, yet the pathophysiology linking the two conditions is unclear. Because kidney tubule secretion is essential for clearance of medications, uremic toxins, and metabolites, we hypothesized that worse tubular secretion would be associated with reduced cognitive function in CKD.</p><p><strong>Methods: </strong>The Systolic Blood Pressure Intervention Trial tested a systolic blood pressure target <120 mmHg vs. <140 mmHg in hypertensive individuals at high cardiovascular risk. In paired blood and urine specimens from 1,937 participants with eGFR <60 ml/min/1.73m2, we measured 10 endogenous tubule-secreted metabolites and calculated a urine/plasma ratio for each, then averaged these to generate a summary secretion score. We used unadjusted and multivariable-adjusted linear regression and mixed models to evaluate cross-sectional and longitudinal associations of the secretion score with the Montreal Cognitive Assessment, Digit Symbol Coding, and Logical Memory immediate and delayed tests-measured at baseline and months 24 and 48 of follow-up. Multivariable Cox regression evaluated associations with incident probable dementia and mild cognitive impairment, adjudicated by prespecified criteria.</p><p><strong>Results: </strong>Mean age was 73 ± 9 years, 41% were women, mean eGFR was 48.2 ± 11.4 ml/min/1.73m2, median albuminuria was 14.8 [7.1-48.6] mg/g. Lower secretion score was associated with a 0.06 higher adjusted logical memory delayed score (95% CI: 0.02, 0.11) but not with other cognitive tests at baseline or longitudinal cognitive decline. After a median 4.1 years of follow-up, 118 developed probable dementia and 187 developed mild cognitive impairment. Each 1-SD lower secretion score was associated with lower risk of probable dementia (HR 0.78, 95% CI: 0.63, 0.98) but not mild cognitive impairment.</p><p><strong>Conclusions: </strong>Among Systolic Blood Pressure Intervention Trial participants with CKD, lower estimated tubular secretion was not associated with worse cognition at baseline or during longitudinal follow-up.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874337","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}