Kidney360最新文献

{"title":"An ESKD Patient with Unusual Findings on Abdominal Imaging.","authors":"Remy Fadel, Saud Al Saleh, Megha Salani","doi":"10.34067/KID.0000000756","DOIUrl":"10.34067/KID.0000000756","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":"6 8","pages":"1424-1425"},"PeriodicalIF":3.0,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12407144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959299","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":"Cardiovascular Autonomic Control in Normotensive Patients with Autosomal Dominant Polycystic Kidney Disease.","authors":"Daniel Ribeiro Rocha, Ana Carolina Anauate, Milene Subtil Ormanji, Cássia Marta de Toledo Bergamaschi, Ruy Ribeiro de Campos Júnior, Bruno Moreira Silva, Ita Pfeferman Heilberg","doi":"10.34067/KID.0000000958","DOIUrl":"https://doi.org/10.34067/KID.0000000958","url":null,"abstract":"<p><strong>Background: </strong>Autosomal Dominant Polycystic Kidney Disease (ADPKD) is the most common monogenic kidney disease, leading to progressive renal function loss. Systemic arterial hypertension is a frequent early onset extrarenal manifestation with an incompletely understood pathogenesis. Therefore, this study investigated cardiovascular autonomic control at rest and during physiological sympathetic stimulation, along with humoral and urinary molecules involved in blood pressure (BP) regulation, in young ADPKD patients before hypertension and renal dysfunction onset.</p><p><strong>Methods: </strong>Eighteen normotensive ADPKD patients (11F/7M, 27.7 ± 6.4 years) and 19 age- and sex-matched healthy controls (9F/10M, 25.7 ± 3.8 years) participated in the study. Based on Mayo Clinic imaging criteria, ADPKD patients were classified as rapid or slow progressors. Heart rate variability (HRV), BP variability (BPV), and spontaneous baroreflex sensitivity (BRS) were assessed at rest, with BRS further evaluated during the Valsalva maneuver. Cardiovascular reactivity to sympathoexcitation was examined using the cold pressor test, Stroop test, and static handgrip exercise. Neuropeptide Y, angiotensinogen (AGT), and inflammatory and endothelial function markers were measured in blood, while monocyte chemoattractant protein-1 (MCP-1), AGT, and albumin were analyzed in urine.</p><p><strong>Results: </strong>HRV, BPV, BRS, and cardiovascular reactivity did not differ between patients and controls or between rapid and slow progressors. Serum markers and urinary MCP-1 were also no difference between groups. However, urinary AGT and albumin levels were significantly higher in patients.</p><p><strong>Conclusions: </strong>These findings suggest that cardiovascular autonomic dysregulation, systemic inflammation, and endothelial dysfunction are absent in early-stage ADPKD, whereas intrarenal RAAS is overactivated and potentially plays a key role in triggering hypertension.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959303","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":"Clinical Inertia in Urgent Dialysis Initiation: Understanding and Overcoming Barriers to Change.","authors":"Megha Salani, Thomas Golper","doi":"10.34067/KID.0000000937","DOIUrl":"10.34067/KID.0000000937","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":"6 8","pages":"1262-1264"},"PeriodicalIF":3.0,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12407143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959314","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":"Scaling Peritoneal Dialysis: Center Effects Thresholds in US Facilities.","authors":"Ankur D Shah, Afzal Ariff, Cara J Sammartino, Christina A Raker, Susie L Hu","doi":"10.34067/KID.0000000969","DOIUrl":"https://doi.org/10.34067/KID.0000000969","url":null,"abstract":"<p><strong>Background: </strong>Center effects in peritoneal dialysis (PD) refer to how facility patient volume impacts outcomes, with larger centers typically demonstrating better patient results. Recent U.S. policy changes have promoted PD utilization, but it remains unclear how this growth has affected center-level thresholds associated with improved outcomes. This study aimed to characterize facility-level changes in PD patient volume threshold across the United States.</p><p><strong>Methods: </strong>We conducted a retrospective observational study analyzing PD utilization across U.S. dialysis facilities from 2010-2021 using the CMS Dialysis Facility Compare database. The final analytic cohort included 8,982 unique facilities. We used mixed-effects logistic regression models with random facility effects to examine temporal trends in facilities meeting key PD volume thresholds (>0, >20, and >50 patients), adjusting for region, facility size, and profit status.</p><p><strong>Results: </strong>From 2010 to 2021, facilities with active PD services rose from 38.4% to 44.6%. The proportion of PD-offering facilities with large programs (>20 patients) increased from 22.9% to 29%, while those with very large programs (>50 patients) nearly doubled from 3.5% to 5.9%. In adjusted analyses, facilities in 2021 had significantly higher odds of maintaining programs with >20 patients (OR 6.08, 95% CI 4.82-7.68) and >50 patients (OR 8.65, 95% CI 5.34-13.99) compared to 2010. Significant regional variation persisted, with Western facilities consistently maintaining larger PD programs than other regions.</p><p><strong>Conclusions: </strong>While the United States has seen meaningful growth in facilities with large PD programs likely to achieve center effects thresholds, opportunities remain to expand PD access more broadly. Current policies have successfully encouraged some facilities to expand PD programs, but additional interventions may be needed to achieve more widespread adoption and address regional disparities.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959301","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":"Managing Dysregulated Vitamin D Metabolism in CKD: Time to Update Conventional Wisdom?","authors":"Charles W Bishop, Akhtar Ashfaq, John Choe, Keith C Norris, Stuart M Sprague","doi":"10.34067/KID.0000000982","DOIUrl":"https://doi.org/10.34067/KID.0000000982","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959326","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":"Clinical Frailty Scale, Surprise Question and One-year Mortality in Older Patients With Advanced CKD.","authors":"Imre Demirhan, Micha Jongejan, Mathijs van Oevelen, Keanu Kiriwenno, Simon P Mooijaart, Marianne C Verhaar, Willem Jan W Bos, Hanneke Joosten, Trijntje T Cnossen, Marjolijn van Buren, Alferso C Abrahams","doi":"10.34067/KID.0000000936","DOIUrl":"https://doi.org/10.34067/KID.0000000936","url":null,"abstract":"<p><strong>Background: </strong>Frailty is common in older patients with advanced chronic kidney disease (CKD) and is associated with mortality. This study investigates whether the Clinical Frailty Scale (CFS) and Surprise Question ('Would you be surprised if this patient died in the next 12 months?', SQ) are associated with one-year mortality and whether combining risk assessments has benefits.</p><p><strong>Methods: </strong>Patients ≥65 years with estimated glomerular filtration rate (eGFR) 20 - 10 mL/min/1.73m2 were included from the ongoing prospective observational cohort study DIALysis or not: Outcomes in older kidney patients with GerIatriC Assessment (DIALOGICA, first inclusion May 13th, 2020). Frailty was screened using the CFS, the SQ was answered using clinical impression ('gestalt'). Patients were classified 'high risk' with CFS-score ≥5 and/or SQ-answer 'no'. Four subgroups were formed: High risk: CFS ≥5 & SQ 'no', High risk: CFS ≥5 only, High risk: SQ 'no' only and Low risk: CFS <5 & SQ 'yes'. Associations with one-year mortality were explored using Kaplan-Meier curves and adjusted Cox proportional hazards models.</p><p><strong>Results: </strong>Overall, 589 patients were included (male sex 70%, mean age 77±6 years, mean eGFR 15±3 mL/min/1.73m2). CFS-score ≥5 was found in 125 patients (21%), 112 patients (19%) had SQ-answer 'no'. Both CFS-score ≥5 (adjusted HR 3.09, 95% CI 1.75;5.54) and SQ-answer 'no' (adjusted HR 1.96, 95% CI 1.09;3.52) were associated with higher mortality risk. Subgroup High risk: CFS ≥5 & SQ 'no' had the highest mortality risk (adjusted HR 3.37, 95% CI 1.65;6.91).</p><p><strong>Conclusions: </strong>Both CFS-score ≥5 and SQ-answer 'no' are associated with higher one-year mortality risk in older patients with advanced CKD. The strongest association with mortality was found by combining both assessments, when both indicate high risk. These findings may help older patients and nephrologists make better informed treatment decisions and initiate timely advance care planning conversations.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959286","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":"Health and Wellness Coaching to Reduce Care Burden in ADPKD: A Mixed-Methods Pilot Study of BeWell360-PKD Dyadic Model.","authors":"Abd Moain Abu Dabrh, Abdul Hamid Borghol, Bassel Alkhatib, Stefan Paul, Zhuo Li, Wendi M Lehman, Michael A Mao, LaTonya Hickson, Fouad T Chebib","doi":"10.34067/KID.0000000950","DOIUrl":"10.34067/KID.0000000950","url":null,"abstract":"<p><strong>Background: </strong>Autosomal Dominant Polycystic Kidney Disease (ADPKD) imposes substantial care burden on patients and their informal caregivers (CGs), often contributing to nonadherence and impaired quality of life. Existing care models insufficiently address the behavioral and psychosocial dimensions of this burden. To evaluate the feasibility and impact of BeWell360-PKD , a person-centered intervention integrating Health and Wellness Coaching (HWC) and capacity-workload support into ADPKD care, on care burden, adherence, self-efficacy, activation, and resilience.</p><p><strong>Methods: </strong>In this six-month, single-arm, mixed-methods pilot study, seven patient-CG dyads were enrolled from tertiary-care PKD clinic. Board-certified HWCs delivered individualized coaching within routine nephrology care, emphasizing capacity-building, goal setting, and care enactment support. Primary outcomes included changes in treatment burden (Treatment Burden Questionnaire [TBQ], ADPKD Impact Scale [ADPKD-IS]) and CG burden (Burden Scale for Family Caregivers [BSFC-s]). Secondary outcomes included patient activation and resilience, and CG self-efficacy. Semi-structured interviews explored participant experiences.</p><p><strong>Results: </strong>Patients experienced reduced treatment burden (TBQ mean change -9.3) and modest, domain-specific improvements in physical and fatigue-related ADPKD symptom burden. CG self-efficacy improved (+2.4), while CG burden increased (+14.8), and patient activation declined (-6.6). Qualitative themes reflected disease burden, emotional adaptation, and the perceived value of coaching in promoting behavior change and relational support.</p><p><strong>Conclusions: </strong>BeWell360-PKD was feasible to implement and demonstrated early signals of benefit in reducing patient burden and improving CG self-efficacy. Increased caregiver burden and declining activation highlight the complexity of dyadic adaptation in ADPKD and the need for larger, controlled studies to refine and tailor coaching interventions.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959308","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":"Protein Intake in Hemodialysis Patients Should Be Higher Than 1.2 g/kg/day: Commentary.","authors":"Joel D Kopple","doi":"10.34067/KID.0000000968","DOIUrl":"10.34067/KID.0000000968","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144883121","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":"Protein Intake in Hemodialysis Patients Should Be Higher Than 1.2 g/kg/day: CON.","authors":"Bersan Ozcan, T Alp Ikizler","doi":"10.34067/KID.0000000892","DOIUrl":"10.34067/KID.0000000892","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144883122","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":"BK Nephropathy in the Modern Era: What Have We Learned?","authors":"David Wojciechowski, Camille Nelson Kotton","doi":"10.34067/KID.0000000967","DOIUrl":"10.34067/KID.0000000967","url":null,"abstract":"<p><p>BK polyomavirus (BKPyV) remains a significant cause of graft dysfunction and failure in kidney transplant recipients, with DNAemia affecting up to 30% and nephropathy contributing to approximately 7% of graft losses. This review synthesizes current understanding of BKPyV pathogenesis, risk factors, and management strategies. Screening protocols and immunosuppression reduction remain the cornerstone of care, though emerging therapies-including monoclonal antibodies and virus-specific T-cell therapies-offer promise. The role of mTOR inhibitors and other agents is critically evaluated, with recent trials challenging their efficacy. Unique transplant-related factors, such as ureteral stent use and the kidney's role as a viral reservoir, may explain the predominance of BKPyV in renal transplantation. The review highlights the need for improved serologic and cellular immunity assays, targeted antiviral therapies, and individualized approaches to retransplantation. Continued research is essential to reduce the burden of BKPyV-associated nephropathy and improve long-term kidney transplant outcomes.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144883120","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}