Kidney360最新文献

{"title":"Transitional Care Units in the United States: A Model for Improving Dialysis Care.","authors":"Louis G Baeseman, Samantha Gunning, Bharathi V Reddy, Rita L McGill, Arlene B Chapman","doi":"10.34067/KID.0000000899","DOIUrl":"https://doi.org/10.34067/KID.0000000899","url":null,"abstract":"<p><p>ESKD incidence rates are increasing, and mortality rates remain high. Fewer than 15% of patients use home dialysis modalities or receive preemptive kidney transplants. To address these shortcomings, executive order 13879 (The Advancing American Kidney Health Initiative) directs the Centers for Medicare and Medicaid Services (CMS) to encourage home dialysis and increase access to kidney transplants. Transitional care dialysis units (TCUs) have the potential to promote these goals by filling the gaps in care. TCUs are outpatient dialysis units for patients initiating dialysis with little or no pre-dialysis care that provides education and facilitate smooth transitions to home or in-center dialysis and expedite referrals to transplant clinics. TCUs offer patient-centered education, enhanced case management, and emotional support. This can improve vascular access outcomes, home dialysis utilization, and transplant referral rates. TCUs potentially address barriers to home dialysis and ideally compensate for inadequate pre-ESKD care. We performed a narrative review of several studies concerning the impact of TCUs on home dialysis utilization and patient outcomes. Eight primary studies from the United States (US), Canada, and the United Kingdom (UK) were reviewed, with about 7,400 patients from several health and payer systems. We focused on TCU programs representing multiple payer systems, variable cohort selection criteria, and manuscripts that addressed CMS quality measures and/or patient centered outcomes. We call attention to the small numbers of TCUs in the US and suggest that expansion of TCU's could benefit patients, particularly those who start dialysis under urgent conditions, which could promote equity within the ESKD population.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310114","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":"Preoperative Dialysis Dose and Postoperative Outcomes in Patients Receiving Maintenance Hemodialysis.","authors":"Vikram Fielding-Singh, Matthew W Vanneman, Arden M Morris, Wolfgang C Winkelmayer, Louise Y Sun, Pavel S Roshanov, Maria Montez-Rath, Glenn M Chertow, Eugene Lin","doi":"10.34067/KID.0000000874","DOIUrl":"https://doi.org/10.34067/KID.0000000874","url":null,"abstract":"<p><strong>Background: </strong>Little is known about preoperative hemodialysis dosing for patients with end-stage kidney disease. We assessed whether changes in preoperative hemodialysis dose (compared to and controlling for baseline dose) are associated with postoperative mortality in patients receiving maintenance hemodialysis.</p><p><strong>Methods: </strong>We identified fee-for-service Medicare beneficiaries receiving hemodialysis for end-stage kidney disease who underwent surgical procedures between January 1, 2011, and November 30, 2020. Follow-up ended December 31, 2020. The primary exposure was preoperative change in Kt/Vurea, defined as the difference between the Kt/Vurea in the hemodialysis session proximal to the procedure and the mean Kt/Vurea for the preceding 180 days. The primary outcome was postoperative 30-day mortality. The relation between preoperative change in Kt/Vurea and the primary outcome was modeled using a Cox proportional hazards regression model, adjusted for mean and standard deviation of Kt/Vurea in the 180 days preceding the procedure, and for other covariates.</p><p><strong>Results: </strong>Among 151,240 procedures (median age, 65 years [25%-75% range, 56-73], 63,437 (41.9%) in women), 31,825 (21.0%) had a preoperative change in Kt/Vurea of <-0.10, 43,790 (29.0%) had a preoperative change of -0.10 to < 0, 45,058 (29.8%) had a preoperative change of 0 to <+0.10, and 30,567 (20.2%) had a preoperative change of ≥+0.10. The median Kt/Vurea for the 180 days prior to the procedure was 1.58 (25th-75th percentiles, 1.45-1.74). In adjusted analysis, compared to patients with a preoperative change in Kt/Vurea of 0 to <+0.10, 30-day mortality was 1.50 (95% CI, 1.32, 1.70) times higher with a preoperative Kt/Vurea change of ≤-0.10 and 1.16 (95% CI, 1.02, 1.31) times higher with a preoperative Kt/Vurea change of -0.10 to < 0. Increases in preoperative Kt/Vurea that were greater than 0.10 were not significantly associated with 30-day mortality.</p><p><strong>Conclusions: </strong>Among Medicare beneficiaries receiving maintenance hemodialysis, preoperative decreases in Kt/Vurea (compared to and controlling for mean Kt/Vurea) were significantly associated with postoperative mortality.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285062","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":"Multi-Omics Reveal Antioxidant Effects of Bardoxolone Methyl in the TSUBAKI Study.","authors":"Kentaro Yoshioka, Hiroto Kaneko, Waka Haruyama, Tetsuro Tomiyama, Atsuko Takami, Kohei Yamasaki, Tetsuya Kitayama","doi":"10.34067/KID.0000000853","DOIUrl":"https://doi.org/10.34067/KID.0000000853","url":null,"abstract":"<p><strong>Background: </strong>Nuclear factor erythroid 2-related factor 2 (Nrf2) is crucial for defense against oxidative stress. In the Phase 2 TSUBAKI study, bardoxolone methyl, an Nrf2 activator, was shown to increase the glomerular filtration rate (GFR) in patients with diabetic kidney disease (DKD). Though non-clinical reports suggest that bardoxolone methyl acts mainly through Nrf2-mediated antioxidant response activation, this has not been proven in clinical settings. The present study assessed its effects using plasma and urine from the TSUBAKI study.</p><p><strong>Methods: </strong>Patients received either bardoxolone methyl or placebo daily for 16 weeks. Urine and plasma samples were collected at baseline, after 16 weeks of dosing, and 4 weeks post-dosing and were cryopreserved for an analysis. A total of 45 patients in the bardoxolone methyl group and 52 in the placebo group were subjected to proteomic and metabolic analyses. Proteomic profiling was conducted using the SOMAscan assay, while metabolomics analyses were performed by Human Metabolome Technologies, Inc.</p><p><strong>Results: </strong>Plasma proteomics revealed that two oxidative stress related pathways have been significantly changed by bardoxolone methyl treatment. Among these two pathways, antioxidative proteins and proteins that enhance the antioxidative process were significantly increased. Some of these increased proteins were known to be Nrf2 target proteins. Similarly, urine proteomics revealed that four pathways were changed, and antioxidative proteins that are the target proteins of Nrf2 were increased. Furthermore, seven metabolites that potentiate the antioxidative effect were significantly increased in urine.</p><p><strong>Conclusions: </strong>This study demonstrated the first evidence in humans that bardoxolone methyl activates an antioxidant response.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275272","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":"Hemodiafiltration Should Be the Primary In-Center Kidney Replacement Modality in End Stage Kidney Disease: CON.","authors":"Khounish Sharma, Eugene Lin","doi":"10.34067/KID.0000000783","DOIUrl":"https://doi.org/10.34067/KID.0000000783","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275270","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":"Global Perspective on Kidney Transplantation in Egypt.","authors":"Youssef M K Farag, Enass Elsayed","doi":"10.34067/KID.0000000891","DOIUrl":"https://doi.org/10.34067/KID.0000000891","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275170","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":"Hemodiafiltration Should Be the Primary In-Center Kidney Replacement Modality in End Stage Kidney Disease: Commentary.","authors":"Thomas A Golper","doi":"10.34067/KID.0000000847","DOIUrl":"https://doi.org/10.34067/KID.0000000847","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275171","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":"Hemodiafiltration Should Be the Primary In-Center Kidney Replacement Modality in End Stage Kidney Disease: PRO.","authors":"Bernard J M Canaud","doi":"10.34067/KID.0000000614","DOIUrl":"https://doi.org/10.34067/KID.0000000614","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275271","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":"Neutrophils Expression of Decay Accelerating Factor (DAF), a Key Complement Regulator, Has No Impact on Acute Kidney Injury.","authors":"Barbara Franchin, Paolo Cravedi","doi":"10.34067/KID.0000000890","DOIUrl":"https://doi.org/10.34067/KID.0000000890","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266576","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":"Leveraging Acoustic Analysis to Detect Arteriovenous Fistula Complications.","authors":"Sofia Poloni, Carmela Giuseppina Condemi, Tobia Peracchi, Anna Caroli, Andrea Remuzzi, Michela Bozzetto","doi":"10.34067/KID.0000000840","DOIUrl":"https://doi.org/10.34067/KID.0000000840","url":null,"abstract":"<p><strong>Background: </strong>Vascular access failure often makes hemodialysis treatment inefficient or impossible. This study investigates the potential of using recordings and acoustic analysis of arteriovenous fistula (AVF) sounds to i) distinguish between AVFs suitable for routine cannulation and those that are unsuitable and ii) detect possible complications in functional AVFs early.</p><p><strong>Methods: </strong>A total of 154 AVF sounds were recorded and classified into functioning and non-functioning groups. Functioning AVFs were further categorized as optimally patent or as having complications like stenosis or aneurysm, based on ultrasound. After audio pre-processing, the high-low peak ratio (HLPR) and its natural logarithm (ln(HLPR)) were calculated using peak amplitudes in low and high-frequency ranges (100-250 Hz and 500-700 Hz respectively).</p><p><strong>Results: </strong>The results revealed significant differences in acoustic metrics between functioning and non-functioning AVFs. Non-functioning AVFs exhibited higher frequency sounds, higher HLPR and ln(HLPR), and reduced amplitude in the low frequency range. In functioning AVFs, the presence of stenosis produced distinct acoustic patterns with higher frequencies and lower amplitude in the low-frequency range, while aneurysms exhibited prominent high frequencies but did not significantly affect acoustic metrics compared to sound recordings from optimally patent AVFs. Optimally patent AVFs had the highest amplitude in low frequency and the lowest high-frequency presence, exhibiting statistically significant differences compared to stenotic and non-functioning AVFs. Additionally, exploratory ROC analysis suggests a potential threshold in ln(HLPR) for identifying AVF function impairment, with good sensitivity and specificity.</p><p><strong>Conclusions: </strong>This study highlights the transformative potential of AVF sound analysis as a tool for identifying AVF complications and failure. By using the unique acoustic characteristics of AVFs, clinicians can improve their surveillance strategies, providing patients with timely interventions and better outcomes.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266575","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":"DNA Methylation and 28-Year Incidence of Kidney Disease in Type 1 Diabetes.","authors":"Rachel G Miller, Josyf C Mychaleckyj, Suna Onengut-Gumuscu, Trevor J Orchard, Tina Costacou","doi":"10.34067/KID.0000000881","DOIUrl":"https://doi.org/10.34067/KID.0000000881","url":null,"abstract":"<p><strong>Background: </strong>Prior epigenome-wide association studies (EWAS) of DNA methylation (DNAm) and diabetic kidney disease (DKD) in type 1 diabetes (T1D) focused on advanced disease. We hypothesized DNAm is a biomarker of earlier manifestations of DKD, microalbuminuria (MA) and overt nephropathy (ON), independent of traditional risk factors in T1D. We thus performed separate EWAS of 28-year MA and ON in the Pittsburgh Epidemiology of Diabetes Complications (EDC) T1D cohort.</p><p><strong>Methods: </strong>We analyzed baseline whole blood DNAm (total n=405 participants; 683,597 CpGs) and time-to-event in EDC participants free of each respective complication at baseline (n=224 eligible for MA analysis, n=306 eligible for ON analysis). We also identified differentially methylated regions (DMRs), assessed associations between DKD-associated CpGs and established clinical risk factors, and performed in silico functional analyses. In secondary analyses, we performed EWAS of ESKD in participants with existing DKD at baseline (ON or estimated glomerular filtration rate (eGFR) 15-59 ml/min/1.73m2, n=99) for comparison to prior studies.</p><p><strong>Results: </strong>DNAm at cg06568490 (HDAC11) and cg13618568 (CRELD2) was associated with MA incidence (False Discovery Rate [FDR]<0.05). Associations between both CpGs and MA remained similar after risk factor adjustment. We also identified 48 significant DMRs (Šidák value<0.05) for MA. For ON, no individual CpGs had FDR<0.05, but there were 35 significant DMRs. Pathways in Signal Transduction were the most significantly enriched for both endpoints. In EWAS of ESKD, no CpGs were significant in minimally adjusted models, while cg09867934 (ETFDH) was significantly associated with ESKD after adjusting for clinical risk factors (FDR=0.002), but there was little overlap with previously published studies of DNAm and ESKD in T1D.</p><p><strong>Conclusions: </strong>Epigenetic modification of loci including HDAC11, which has been associated with kidney fibrosis, and CRELD2, which is involved in angiogenesis, may contribute to early kidney damage in T1D, thus warranting further study as potential biomarkers of future risk.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258377","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}