Kidney360最新文献

{"title":"Lung Ultrasound Guided Management of Pulmonary Congestion in Hemodialysis: A Multi-center Randomized Controlled Trial.","authors":"Saleh Kaysi, Abdullah Hamad, Abdullah Boulgheraif, Florence Bonkain, Mark Libertalis, Anis Abu Ayyach, Mahmoud Baz, Ibrahim Farah, Rania Ibrahim, Heba Ateya, Mincy Mathew, Frederic Collart, Maria Mesquita, Maxime Taghavi, Mohamad Alkadi, Hassan Al-Malki, Joelle Nortier","doi":"10.34067/KID.0000000873","DOIUrl":"https://doi.org/10.34067/KID.0000000873","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary congestion (PC) is frequent in Hemodialysis (HD) patients and is associated with deleterious prognosis. Lung ultrasound (LUS) accurately quantifies PC; however, many methods exist to evaluate PC using LUS. Here, we validate a simplified LUS-guided protocol for managing PC in HD patients and explore its impact on blood pressure control.</p><p><strong>Methods: </strong>We enrolled 100 HD patients from 6 dialysis units in 3 countries in a multi-center randomized controlled trial. All patients had LUS after their mid-week session on days 1, 15, 30, 45, and 60. LUS was performed using the 8-zone method to obtain a global B-line score (BLS). Doctors and nurses performed LUS at the bedside. Dry weight was adjusted according to the standard of care in the control group, while it was reduced by 500 g if BLS was above five on day 1 and by 500 g further on Day 15 if BLS was still above 5 in the active group. Blood pressure home monitoring (BPHM) was obtained weekly.</p><p><strong>Results: </strong>The mean BLS on day 1 (13 ± 9) decreased to (8 ± 5) on day 60 (P < 0.001) in the active group. In contrast, the control group showed no significant changes in B-line score on day 60 compared to baseline. HBPM on day 60 was similar to the baseline in both groups. Applying this protocol did not increase the intra-dialytic hypotension frequency.</p><p><strong>Conclusions: </strong>This simplified LUS-guided protocol for managing PC was effective and safe in HD patients and could be considered for inclusion in standard care practices. Nurses and advanced caregivers may perform LUS in HD units. LUS-guided management may have a positive impact on blood pressure control.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859304","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":"Association of Volume Status Assessed by Bioimpedance with Blood Pressure in CKD.","authors":"Katherine Scovner Ravi, Enass Elsayed, Brendon L Neuen, Glenn M Chertow, Finnian R Mc Causland","doi":"10.34067/KID.0000000932","DOIUrl":"10.34067/KID.0000000932","url":null,"abstract":"<p><strong>Background: </strong>Hypertension is common among patients with CKD and is a risk factor for cardiovascular events and mortality. Though hypervolemia is a contributor to hypertension, the association of blood pressure with biomarkers of volume among patients with CKD is unclear.</p><p><strong>Methods: </strong>Using data from 5,384 patients in the Chronic Renal Insufficiency Cohort (CRIC), we fit linear regression models to examine the association of vector length (bioimpedance proxy of volume) with systolic and diastolic blood pressure (BP). We employed categorical analyses given evidence of non-linear associations. We also assessed whether the change in vector length at two years from baseline was associated with changes in BP.</p><p><strong>Results: </strong>The mean age was 59 ±11 years; 44% were female; 43% were Black; mean systolic BP and eGFR were 129 ±21 mmHg and 48 ±16 mL/min/1.73m2, respectively. The association of vector length with systolic BP was non-linear; the lowest quartile of vector length (a proxy for hypervolemia) was associated with a 3.2 mmHg (95%CI 1.1, 5.3) higher systolic BP, compared with the third quartile. Compared with the third quartile over two years, the lowest quartile of change in vector length (a proxy for volume expansion) was associated with an increase in systolic BP (3.0 mmHg; 95%CI 1.0, 5.1). Diastolic BP was not associated with vector length.</p><p><strong>Conclusions: </strong>Shorter and shortening vector length were independently associated with higher and increasing systolic BP, respectively. Whether bioimpedance-guided optimization of volume status could improve BP management among patients with CKD requires further investigation.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855702","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":"Deep Learning-Based Instance-Level Segmentation of Kidney and Liver Cysts in CT Images of Patients Affected by Polycystic Kidney Disease.","authors":"Adriana V Gregory, Muhammed Khalifa, Jeeho Im, Sumana Ramanathan, Doaa E Elbarougy, Conrad Cruz, Hana Yang, Aleksandar Denic, Andrew D Rule, Fouad T Chebib, Neera K Dahl, Marie C Hogan, Peter C Harris, Vicente E Torres, Bradley J Erickson, Theodora A Potretzke, Timothy L Kline","doi":"10.34067/KID.0000000924","DOIUrl":"https://doi.org/10.34067/KID.0000000924","url":null,"abstract":"<p><strong>Background: </strong>Total kidney and liver volumes are key image-based biomarkers to predict the severity of kidney and liver phenotype in autosomal dominant polycystic kidney disease (ADPKD). However, MRI-based advanced biomarkers like total cyst number (TCN) and cyst parenchyma surface area (CPSA) have been shown to more accurately assess cyst burden and improve the prediction of disease progression. The main aim of this study is to extend the calculation of advanced biomarkers to other imaging modalities; thus, we propose a fully automated model to segment kidney and liver cysts in CT images.</p><p><strong>Methods: </strong>Abdominal CTs of ADPKD patients were gathered retrospectively between 2001-2018. A 3D deep-learning method using the nnU-Net architecture was trained to learn cyst edges-cores and the non-cystic kidney/liver parenchyma. Separate segmentation models were trained for kidney cysts in contrast-enhanced CTs and liver cysts in non-contrast CTs using an active learning approach. Two experienced research fellows manually generated the reference standard segmentation, which were reviewed by an expert radiologist for accuracy.</p><p><strong>Results: </strong>Two-hundred CT scans from 148 patients (mean age, 51.2 ± 14.1 years; 48% male) were utilized for model training (80%) and testing (20%). In the test set, both models showed good agreement with the reference standard segmentations, similar to the agreement between two independent human readers (model vs reader: TCNkidney/liver r=0.96/0.97 and CPSAkidney r=0.98), inter-reader: TCNkidney/liver r=0.96/0.98 and CPSAkidney r=0.99).</p><p><strong>Conclusions: </strong>Our study demonstrates that automated models can segment kidney and liver cysts accurately in CT scans of patients with ADPKD.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855703","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":"Novel Molecular Signatures of Peripheral Regulatory T Cells in Kidney Disease Associated With Type 1 Diabetes.","authors":"Amita Bansal, Soon Wei Wong, Wilson K M Wong, Giles Best, Steven James, Sarah Glastras, Alexia Pena, Cheng Xue Qin, Sih Min Tan, Devy Deliyanti, Darling M Rojas-Canales, Mugdha V Joglekar, Elif I Ekinci","doi":"10.34067/KID.0000000921","DOIUrl":"https://doi.org/10.34067/KID.0000000921","url":null,"abstract":"<p><strong>Background: </strong>Diabetic kidney disease (DKD) is a common complication of type 1 diabetes (T1D). T1D and some kidney disorders are often associated with abnormalities in regulatory T cells (Tregs). However, it is unknown if Treg subsets, and their molecular architecture are altered during the onset and progression of DKD in T1D.</p><p><strong>Methods: </strong>We addressed this critical knowledge gap by characterising changes in Tregs isolated from 31 participants (10 control, 13 with T1D, and 8 T1D with albuminuria) using flow cytometry, RNA-sequencing, and microRNA profiling.</p><p><strong>Results: </strong>We identified that the effector and central memory Tregs were significantly different between groups. Similarly, multiple gene transcripts were also significantly different between groups that also overlapped with other publicly available datasets. Machine-learning based data analyses discovered a set of important microRNAs associated with clinical eGFR values.</p><p><strong>Conclusions: </strong>Importantly, our analyses identified two differentially expressed Treg ligand genes (LRRC4B, TGM2), which interacted with the receptors on kidney cells (PTPRD/F/S, ADGRG1) in silico, providing potential mechanistic insights into the role of Tregs in DKD progression. Together, our work supports the yet unappreciated role of Tregs in DKD and opens new research avenues to further consolidate their causal relationship.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855704","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 Implementation of Urinary NGAL Testing for Diagnosing Acute Kidney Injury in an Academic Tertiary Care Medical Centre.","authors":"Michael Strader, Sharjeel Imran, Abdullah Tariq, Candice Fraser, Ellen Saghie, Bernadine C Louis, Therese Meade, Vladamir Stoyanov, Jean-Maxime Cote, Patrick J Twomey, Patrick T Murray","doi":"10.34067/KID.0000000887","DOIUrl":"https://doi.org/10.34067/KID.0000000887","url":null,"abstract":"<p><strong>Background: </strong>Differentiating functional acute kidney injury (AKI) from structural/intrinsic AKI with tubular injury remains a clinical challenge. Urinary NGAL (uNGAL) has shown promise in distinguishing these conditions. This study evaluated the implementation of uNGAL in a heterogeneous medical cohort at an academic tertiary care center in Ireland over a three-year period.</p><p><strong>Methods: </strong>A retrospective audit was conducted from 2020-2023. Standard clinical data around the time of AKI and uNGAL request were recorded. Blinded case adjudication of the differential diagnosis of AKI cause using the standard clinical information (but not urine NGAL results) was performed by two expert Nephrologists. Analysis of uNGAL focused on the accuracy in differentiating adjudicated (Intra-renal) AKI from Non-intrinsic AKI (Pre-renal & Post-renal).</p><p><strong>Results: </strong>A total of 323 uNGAL tests were performed, with 292 AKI cases adjudicated. Intrinsic AKI cases had significantly higher uNGAL and uNGAL/Cr levels than non-intrinsic cases (p < 0.001), including after excluding UTI cases. uNGAL (AUC 0.71; 95% CI: 0.65-0.77) and uNGAL/Cr (AUC 0.73; 95% CI: 0.67-0.79) showed moderate discriminative performance. uNGAL (threshold 150 ng/ml) had high sensitivity (0.87) and negative predictive value (0.82). uNGAL/Cr was similar at the 288 ng/mg threshold. Discriminative performance improved for uNGAL and uNGAL/Cr, but not for serum creatinine, fractional excretion of sodium (FENa), or serum urea, after excluding UTI cases. Both uNGAL (aOR 2.05; 95% CI: 1.59-2.71) and uNGAL/Cr (aOR 2.07; 95% CI: 1.64-2.68) were independently associated with intrinsic AKI. Adding these biomarkers to a logistic regression model significantly improved discrimination performance (AUC 0.79; 95% CI: 0.76-0.84; p = 0.0116).</p><p><strong>Conclusions: </strong>The use of uNGAL improved the discriminative accuracy of differential diagnosis of AKI in clinical practice by differentiating intrinsic AKI from non-intrinsic. Specificity was low at the manufacturer's recommended threshold (150ng/ml), but the sensitivity and NPV were high in all analyses. These findings support the clinical utility of uNGAL at the 150ng/ml threshold as a \"rule-out\" test for intrinsic AKI, thereby helping to direct management toward functional (pre-renal) or obstructive (post-renal) causes when uNGAL is negative.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847305","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":"Renal Denervation: A New Era in the Management of Resistant Hypertension.","authors":"Sidrah Abid, Swati Mehta, Fnu Munazzah, Neil Yager, Shoaib Baloch, Krishnakumar Hongalgi","doi":"10.34067/KID.0000000961","DOIUrl":"10.34067/KID.0000000961","url":null,"abstract":"<p><p>Hypertension is one of the leading causes of mortality related to cardiovascular disease. Since the advent of modern medicine, a multitude of efforts have been made to achieve better blood pressure control. However, despite a wide range of monitoring protocols and medication therapies, only 23% of patients with hypertension achieve blood pressure control. 1 Renal Denervation (RDN) has emerged as an adjunctive therapy to medications and lifestyle modification for blood pressure control. Two methods of RDN were approved by the U.S. Department of Food and Drug Administration in 2023: Radiofrequency Ablation (RFA) and an ultrasound-based method. RFA employs heat-generating electrodes placed on the renal artery via a catheter and delivers heat through alternating current. 2 Ultrasound-based technique uses ultrasonic heating to create a ring of ablative energy that interrupts renal nerve signaling. Over the last two decades, well-conducted randomized sham control trials and registry analysis have proven RDN to be an effective and safe treatment option for resistant hypertension with promising results. RDN also becomes appealing in chronic kidney disease (CKD) patients who have an underlying sympathetic overactivity. 3 This article aims to provide a comprehensive review of RDN, including current evidence and its implications in routine clinician practice.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847306","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 Utility of Urine Microscopy Score for Early Detection and Prediction of Acute Kidney Injury in At-Risk Patients.","authors":"Rolando Claure-Del Granado, Diego Torrico-Moreira, Jingyao Zhang, Jacqueline Breunig, Basmh Shamel, Vineet Gupta, Tushar Chopra, Subhasis Dasgupta, Rakesh Malhotra","doi":"10.34067/KID.0000000911","DOIUrl":"https://doi.org/10.34067/KID.0000000911","url":null,"abstract":"<p><strong>Background: </strong>AKI is a global health concern associated with high morbidity and mortality. Early diagnosis and treatment of subclinical AKI are critical for mitigating adverse outcomes. Here, we evaluated whether the urine microscopy score (UMS), a simple and cost-effective method for detecting structural kidney injury, could serve as a substitute biomarker within the AKI Risk Assessment Model (ARA-F4) to identify subclinical AKI and predict clinical AKI development.</p><p><strong>Methods: </strong>A prospective cohort study was conducted, enrolling hospitalized adult patients (non-ICU) at moderate to high risk of AKI according to ARA-F4 model. At admission, urine microscopy was performed, and patients with UMS ≥2 without concurrent serum creatinine elevation were classified as subclinical AKI (AKI-1S); those with UMS = 1 were classified as non-AKI. The primary outcomes was development of clinical AKI within 48 hours, the need for kidney replacement therapy (KRT), and mortality. The discriminative ability of the UMS for predicting AKI was assessed using the area under the receiver operating characteristic curve (AUC).</p><p><strong>Results: </strong>A total of 103 patients were included in the study, with 39 (37.9%) classified as AKI-1S and 64 (62.1%) as non-AKI at admission. Among the AKI-1S group, 89.7% developed clinical AKI within 48 hours compared to 10.9% of non-AKI patients (p<0.05). The AKI-1S group had a significant higher requirement for KRT (10.3% vs. 1.6%, p<0.05) and increased mortality rate (43.6% vs. 14.1%, p<0.05). The UMS demonstrated good predictive performance for AKI development, with an AUC of 0.84 (95% CI: 0.75-0.92). The sensitivity and specificity of the UMS were 74.5% and 92.9%, respectively.</p><p><strong>Conclusions: </strong>The UMS can be used in the ARA-F4 model to identify patients with subclinical AKI and predict the subsequent development of clinical AKI. Early recognition of subclinical AKI using the UMS can facilitate timely interventions and may reduce the burden of AKI in low- and middle-income countries.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847307","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":"Kidney Stone Events and ESKD Incidence in Patients with Enteric Hyperoxaluria from Diverse Enteric Etiologies.","authors":"Ryan Tatton, Stephen O'Neill, Deondre Jordan, Lisa E Vaughan, John C Lieske, Mira T Keddis","doi":"10.34067/KID.0000000908","DOIUrl":"https://doi.org/10.34067/KID.0000000908","url":null,"abstract":"<p><strong>Background: </strong>Enteric Hyperoxaluria (EH) is a risk factor for calcium oxalate nephrolithiasis and kidney disease. The study compares patient characteristics and urine metabolic profiles at the time of EH diagnosis and kidney stones and end stage kidney disease (ESKD) events during follow-up in a cohort with diverse causes of EH.</p><p><strong>Methods: </strong>Adult patients with newly documented elevated urinary oxalate excretion (UOX) >40 mg/24hr between 1/1/2010 to 10/31/2023 and a known enteric diagnosis including inflammatory bowel disease, Exocrine Pancreatic Insufficiency (EPI), Celiac disease, Structural Intestinal Malabsorption (SIM), or Malabsorptive Bariatric surgery (Bariatric) were identified. Event rates and cumulative incidence of kidney stones and ESKD were assessed.</p><p><strong>Results: </strong>Among 814 identified patients, the most common enteric etiology was Bariatric (n=524, 64%). Patients with ulcerative colitis had the highest prevalence of kidney stones at EH diagnosis (93.6%) compared to other enteric etiologies (p=0.002). Patients with SIM had the highest urinary oxalate, lower urinary citrate, and volume, compared to other enteric etiologies (p<0.05). Calcium oxalate supersaturation was similar among the enteric groups (p=0.67). Median stone event rate for the overall cohort was 0.70 stone events/year during a mean (SD) follow-up of 5.0 (3.9) years. The SIM and EPI groups experienced the highest stone events (median (IQR) 1.24 (0.28, 2.40) and 1.20 (0.41, 1.99) events/year, respectively) while the Bariatric group had the lowest event rates (median (IQR) 0.45 (0.00, 1.66 events/year)) (p<0.001). The SIM group had the highest ESKD incidence (17.8% 5 years post-diagnosis; log-rank test p<0.001).</p><p><strong>Conclusions: </strong>We describe a large EH cohort from diverse enteric etiologies. Significant heterogeneity exists in patient characteristics, urine metabolic risk factors and adverse kidney outcomes. Patients with SIM and EPI experienced the highest kidney stone events and patients with SIM had the highest ESKD incidence. This study highlights the urgent need for more granular information regarding the natural history and risk factors for kidney complications for EH patients to support interventional trials to improve outcomes.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144821951","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":"Proceedings of the UAB CRRT Academy (2023-2024): Managing De-Escalation of Acute RRT and Optimizing Drug Dosing During RRT Transitions.","authors":"William Beaubien-Souligny, Melissa Thompson Bastin, J Pedro Teixeira, Jorge Cerda, Michael J Connor, Amanda Dijanic Zeidman, Pranav S Garimella, Luis Juncos, Arnaldo Lopez-Ruiz, Ravindra Mehta, Thiago Reis, Lilia Rizo-Topete, Samuel A Silver, J Ricardo Da Silva, Rajesh Speer, Anitha Vijayan, Catherine Wells, Keith Wille, Lenar Yessayan, Ashita Tolwani, Javier A Neyra","doi":"10.34067/KID.0000000951","DOIUrl":"https://doi.org/10.34067/KID.0000000951","url":null,"abstract":"<p><p>In this second installment of the proceedings of the University of Alabama at Birmingham Continuous Renal Replacement Therapy (CRRT) Academy, we focus on the topic of transitions of care in acute RRT. Though we have accumulated data from thousands of critically ill patients with acute kidney injury (AKI) randomized to different strategies for RRT initiation, no trial data exist to guide de-escalation of RRT in the intensive care unit. However, for survivors of severe AKI whose kidney function does not recovery rapidly enough to allow for liberation directly from CRRT, successful de-escalation of care requires the transition from CRRT to intermittent RRT modalities. These transition periods must be carefully navigated since they can be a source of complications, such as failure to transition or intra-dialytic hypotension, which are in turn associated with an increased risk of mortality and reduced odds of kidney recovery. In this review, we focus on the critical factors to consider during de-escalation of RRT care, with a focus on modality transition, the role of volume status in guiding the approach to de-escalation of RRT, and the vital importance of careful dosing of drugs, especially antimicrobial agents, during this transitional period.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804289","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":"Urinary Sodium and Potassium Excretion and the Risk of Cardiovascular Events in CKD.","authors":"Cass G G Sunga, Leila R Zelnick, Nisha Bansal","doi":"10.34067/KID.0000000943","DOIUrl":"https://doi.org/10.34067/KID.0000000943","url":null,"abstract":"<p><strong>Background: </strong>Kidney disease is a known, independent driver of cardiovascular disease. While dietary sodium and potassium intake, approximated via urinary excretion, are known cardiac risk factors in the general population, their role for prevention in persons with kidney disease is unclear. Thus, we studied the relationship between the ratio of urinary sodium-to-potassium excretion and incident cardiovascular disease in individuals with chronic kidney disease.</p><p><strong>Methods: </strong>We included 2,342 adults with chronic kidney disease enrolled in the Chronic Renal Insufficiency Cohort free of cardiovascular disease on study entry. Urinary sodium and potassium were measured via 24-hour urine collection at the baseline visit. Primary study outcomes included atrial fibrillation [AF], heart failure (overall, reduced ejection fraction [HFrEF] and preserved ejection fraction [HFpEF]), and myocardial infarction [MI]. Incidence rates (with 95% confidence intervals) were calculated per 1000 person-years. Nested models were created using Cox regression and adjusted for sociodemographic data (age, sex and race/ethnicity), lifestyle habits (body mass index and cigarette smoking), medication use, medical comorbidities and renal characteristics.</p><p><strong>Results: </strong>Among the study population, mean (SD) age was 56 (11) years and mean estimated glomerular filtrate rate was 51 (20) mL/min/1.73 m2. The highest quartile (versus lowest quartile) of urinary sodium-to-potassium ratio was associated with a 1.4-fold increased risk of overall HF (HR 1.44, CI 95% 1.05-1.98), 1.9-fold increased risk of HFrEF (HR 1.90, CI 95% 1.08-3.36) and 1.5-fold increased risk of AF (HR 1.48, CI 95% 1.03-2.13) after adjustment for the covariates above. We did not find an association with incident MI (HR 1.14, CI 95% 0.78-1.68) and HFpEF (HR 1.18, CI 95% 0.75-1.87).</p><p><strong>Conclusions: </strong>A higher ratio of urinary sodium-to-potassium excretion was associated with incident AF and HF (particularly HFrEF), but not MI, in persons with chronic kidney disease. Dietary sodium and potassium represent possible modifiable risk factors for cardiovascular disease prevention in individuals with kidney disease.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804355","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}