Kidney360最新文献

{"title":"Postnatal Steroid Exposure in Extremely Low Gestational Age Newborns and Kidney Function at 24 Months Corrected Age.","authors":"Meredith P Schuh, Russel Griffin, Cara Slagle, David Selewski, Danielle E Soranno, Megan J Turner, Jennifer Varner, David Askenazi, Shina Menon, Katja M Gist","doi":"10.34067/KID.0000000824","DOIUrl":"https://doi.org/10.34067/KID.0000000824","url":null,"abstract":"<p><strong>Background: </strong>Preterm birth is associated with low nephron endowment, with an increased risk of chronic kidney disease (CKD) later in life. Almost all pregnant women at risk for preterm delivery are given antenatal corticosteroids (ANS) to accelerate lung maturity in preterm neonates. Similar to ANS, postnatal corticosteroids are also given to improve lung function, but the impact on kidney function is unknown. The objective of this study was to determine if duration and timing of postnatal corticosteroids in preterm infants influences kidney function at 24 months corrected age.</p><p><strong>Methods: </strong>A secondary analysis of the PENUT trial (neonates <28 weeks' gestation) was performed and included surviving participants with serum creatinine measured at 22-26 months corrected gestational age (cGA). Exposure included the presence, type, start date, and duration of postnatal steroids (duration and start date based on postmenstrual age (PMA)). The primary outcome was reduced estimated GFR (GFR <90 ml/min/1.73 m2 at the 24-month CGA timepoint). Outcomes were adjusted for perinatal/neonatal exposures, and neonatal outcomes were compared.</p><p><strong>Results: </strong>Out of 838 surviving infants, 397 (47%) were exposed to any postnatal steroid. Dexamethasone was the most common exposure (n = 238, median start date at day of life (DOL) 27, median duration of 8 days), followed by hydrocortisone (n = 232, median start DOL 13, median duration 17 days). 348 infants were evaluated at 22-26-month follow-up, 61 of whom had reduced GFR. Hydrocortisone duration of 1-7 days had 2.8 (95% CI = 1.06-7.62) times increased odds of reduced GFR at 24 months corrected age. Although overall steroid exposure was not associated with GFR at follow-up, initiation of dexamethasone at ≤25 weeks PMA was associated with 9.39 (95% CI = 1.61-54.71) increased odds of reduced GFR compared to those given dexamethasone at ≥29 weeks.</p><p><strong>Conclusions: </strong>Although observational, this study supports an association between postnatal steroid timing, duration, and reduced GFR. Further studies are warranted to better understand this association to protect long-term kidney health.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002650","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":"Hurricane Helene's Impact on Peritoneal Dialysis Supply Chain: A Case Study in Healthcare System Vulnerability.","authors":"Osama El Shamy, Ankur D Shah","doi":"10.34067/KID.0000000822","DOIUrl":"https://doi.org/10.34067/KID.0000000822","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027270","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":"Dialysis Management and Funding in Saudi Arabia.","authors":"Ayman Karkar, Besher Al-Attar","doi":"10.34067/KID.0000000819","DOIUrl":"10.34067/KID.0000000819","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":"1034-1036"},"PeriodicalIF":3.2,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017522","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":"Real-World Tolvaptan Use in Autosomal Dominant Polycystic Kidney Disease: Insights from Two US Medical Centers.","authors":"Vinamratha Rao, Shahed Ammar, Abrar Alshorman, Michelle Fravel, Kerri A McGreal, Franz T Winklhofer, Lama Noureddine, Diana I Jalal, Alan S L Yu, Reem A Mustafa","doi":"10.34067/KID.0000000816","DOIUrl":"https://doi.org/10.34067/KID.0000000816","url":null,"abstract":"<p><strong>Background: </strong>Autosomal Dominant Polycystic Kidney Disease (ADPKD) is the most prevalent genetic kidney disease leading to kidney failure. Tolvaptan, a Vasopressin V2 receptor antagonist, is the only medication approved by the United States Food and Drug Administration (FDA) for slowing kidney growth in individuals with rapidly progressive ADPKD, but its long-term tolerability and effective implementation has yet to be studied, particularly in real-world clinical settings within the US.</p><p><strong>Methods: </strong>This retrospective cohort study examined adults with ADPKD treated with tolvaptan at the University of Kansas Medical Center and the University of Iowa Hospitals & Clinics from May 2018 to April 2023. Data on demographics, clinical characteristics, tolvaptan dosage, and treatment duration were collected from electronic health records for an average follow-up duration of 28.2 months (Interquartile Range/IQR: 8.5 months- 47.1 months). The study focused on examining tolvaptan dosage trends, treatment discontinuation reasons, and the impact of aquaretic side effects on dosage and adherence.</p><p><strong>Results: </strong>Out of 134 patients, 27% stopped tolvaptan during the observational period, with 10.4% of the cohort withdrawing from treatment due to intolerance of aquaretic side effects. Most patients maintained a lower tolvaptan dosage (≤ 45/15 mg) than in clinical trials, with two-thirds of individuals who underwent dosage adjustment undergoing net decrease in dosage. Adverse effects significantly influenced and dosage decisions, presenting a potential early barrier for adherence, particularly in female patients.</p><p><strong>Conclusions: </strong>The study highlights real-world challenges in the use of tolvaptan for ADPKD, particularly in terms of side effects leading to high discontinuation rates and dosage adjustments. These findings underscore the need for standardized and improved management strategies to enhance tolerability and adherence, offering insights for future research and practice in the treatment of ADPKD with tolvaptan.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029760","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 Pathologic Actions of Phosphate in CKD.","authors":"Abul Fajol, Christian Faul","doi":"10.34067/KID.0000000820","DOIUrl":"10.34067/KID.0000000820","url":null,"abstract":"<p><p>CKD is associated with high serum levels of phosphate (also called hyperphosphatemia), which is a main driver of soft tissue calcifications and potentially other pathologic changes that are associated with CKD. However, it remains unclear in what form and through which mechanisms and targets elevated phosphate can damage cells and tissues. Rises in serum phosphate levels are accompanied by changes in the endocrine regulators of phosphate metabolism and result in the formation of calcium-phosphate crystals, and all three events can have pathologic actions on various tissues. Furthermore, tissues can accumulate phosphate from the circulation, and cells can generate free phosphate in their environment independently from circulating phosphate, which both result in local elevations of phosphate that could also contribute to tissue damage. It is important to better understand the various scenarios underlying the pathologic actions of hyperphosphatemia, as some of them suggest that measuring extracellular serum phosphate, which is the gold standard to estimate overall phosphate status of the body, is not sufficient to do so. Understanding the pathologic actions of phosphate on a conceptual level should not only help to design more efficient detection tools for phosphate but also to identify phosphate-induced pathomechanisms which could provide us with novel drug targets to tackle phosphate-driven pathologies in CKD. Here, we discuss the different concepts and scenarios that could underlie the widespread pathologic actions of hyperphosphatemia in CKD.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":"1040-1049"},"PeriodicalIF":3.2,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989400","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":"Medical Therapy versus Bariatric Surgery in Kidney Transplant Candidates.","authors":"Beata Bzoma, Anum Iqbal, Tayyab S Diwan, Aleksandra Kukla","doi":"10.34067/KID.0000000813","DOIUrl":"10.34067/KID.0000000813","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":"1037-1039"},"PeriodicalIF":3.2,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024145","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":"Safety and Effectiveness of Apixaban versus Warfarin by Kidney Function in Atrial Fibrillation: A Binational Population-Based Study.","authors":"Dickson Lam, Anish Scaria, Jason Andrade, Sunil V Badve, Peter Birks, Sarah E Bota, Anna Campain, Ognjenka Djurdjev, Amit X Garg, Ziv Harel, Brenda Hemmelgarn, Carinna Hockham, Matthew T James, Meg J Jardine, Adeera Levin, Eric McArthur, Pietro Ravani, Selena Shao, Manish M Sood, Zhi Tan, Navdeep Tangri, Reid Whitlock, Martin Gallagher, Min Jun, Jeffrey T Ha","doi":"10.34067/KID.0000000809","DOIUrl":"https://doi.org/10.34067/KID.0000000809","url":null,"abstract":"<p><strong>Background: </strong>Evidence to guide use of apixaban in people with atrial fibrillation (AF) and chronic kidney disease (CKD) in routine clinical practice has been limited. We assessed comparative safety (major bleeding) and effectiveness (ischemic stroke and death) of apixaban versus warfarin in patients with AF across the spectrum of non-dialysis-dependent CKD using large, routinely collected data.</p><p><strong>Methods: </strong>We combined findings from 5 retrospective cohorts (2013-2018) across Australia and Canada. Adults with AF, new dispensation of apixaban or warfarin, and a recorded eGFR grouped as ≥60, 45-59, 30-44 and <30mL/min/1.73m2 were included. Patients on dialysis or kidney transplant recipients were excluded. We assessed outcomes within one year of initiating either therapy: (1) composite of all-cause death, ischemic stroke or transient ischemic attack and (2) first hospitalization for major bleeding (intracranial, gastrointestinal or other). Cox models estimated hazard ratios (HRs; 95% confidence intervals [CIs]) for outcomes across eGFR categories, after 1:1 matching using propensity scores. We summarized center-level data using random effects meta-analysis.</p><p><strong>Results: </strong>Among 38,598 matched apixaban and warfarin users, there were 4130 (10.7%) ischemic and 697 (1.8%) bleeding events within one year. Apixaban was associated with lower or similar risk for the ischemic outcome compared with warfarin in all eGFR categories (pooled HRs [95% CI]: 0.78 [0.64-0.94]), 0.77 [0.62-0.97], 0.82 [0.68-0.98] and 0.99 [0.68-1.45] for eGFR >60, 45-59, 30-44 and <30mL/min/1.73m2 respectively). Apixaban was associated with lower or similar risk of bleeding across the range of kidney function (pooled HRs: 0.55 [0.43-0.69], 0.73 [0.52-1.02], 0.55 [0.31-0.97], 0.68 [0.47-0.99], respectively). There was no significant heterogeneity across jurisdictions or eGFR categories.</p><p><strong>Conclusions: </strong>In adults with AF and non-dialysis-dependent CKD, apixaban compared with warfarin was associated with lower or similar risk of ischemic and bleeding outcomes. Our results suggest apixaban offers a favorable risk-benefit ratio in patients with AF independent of kidney function.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000382","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":"Predicting Postoperative Cardiac Events and Mortality for People with Kidney Failure Having Non-Cardiac Surgery: An External Validation Study.","authors":"Gurpreet S Pabla, Navdeep Tangri, Reid H Whitlock, Thomas Ferguson, Tyrone G Harrison","doi":"10.34067/KID.0000000811","DOIUrl":"https://doi.org/10.34067/KID.0000000811","url":null,"abstract":"<p><strong>Background: </strong>Patients with kidney failure undergoing non-cardiac surgery are at high risk of adverse cardiac events and mortality, however existing perioperative risk prediction tools for these outcomes are not valid in these patients. Recently, three models were developed from a kidney failure cohort in Alberta, Canada. In this study, we evaluated these Alberta models in a kidney failure cohort that had surgery in Manitoba, Canada.</p><p><strong>Methods: </strong>The cohort included adults from Manitoba, Canada (≥ 18 years) with pre-existing kidney failure (estimated glomerular filtration rate < 15 mL/min/1.73m2 or receiving maintenance dialysis) undergoing non-cardiac surgeries between 2007-2019. The primary outcome was a composite of acute myocardial infarction, cardiac arrest, ventricular arrhythmia, and all-cause mortality within 30 days. The three models included an increasing number of variables: demographics and surgical characteristics (model 1), comorbidities (model 2), and preoperative albumin and hemoglobin (model 3). Model performance was evaluated using Area Under the Receiver Operating Characteristic Curve (AUC-ROC), calibration, and Brier score on Manitoba data. This was evaluated by applying Alberta model coefficients for all three models to predict outcomes on Manitoba data, and also by re-estimating the Alberta model predictor coefficients using logistic regression on Manitoba data.</p><p><strong>Results: </strong>We identified 12,082 surgeries performed in 4,175 participants; 569 outcomes were observed (4.7%). All three models performed well with both approaches, with AUC-ROC ranging from 0.821 (model 1) to 0.874 (model 3) using the models with Alberta coefficients. Calibration slopes were 1.32, 1.40, and 1.24 for models 1, 2, and 3, respectively. Upon refitting, AUC-ROC ranged from 0.830 (model 1) to 0.861 (model 3). Calibration slopes approximated 1 across all the re-estimated models. Brier scores remained < 0.1 across all original and re-estimated models.</p><p><strong>Conclusions: </strong>Our external validation study confirmed that the kidney failure specific postoperative outcome models developed in Alberta, Canada, performed well in a geographically distinct Canadian population. Future research should explore the performance of these models in different settings and evaluate their clinical impact with prospective implementation.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006665","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":"Socioeconomic Disparities in Preemptive Kidney Transplant Rates in Children.","authors":"Sarah Kizilbash, Chung-Ii Wi, Madison Roy, Warren T McKinney, Sandra Amaral, Samy Riad, Young Juhn","doi":"10.34067/KID.0000000802","DOIUrl":"https://doi.org/10.34067/KID.0000000802","url":null,"abstract":"<p><strong>Background: </strong>Preemptive kidney transplantation in children is associated with better patient and graft survival compared to transplants following dialysis. However, preemptive kidney transplantation rates in children remain low. This study aimed to evaluate the effect of socioeconomic status (SES) on preemptive transplantation in children.</p><p><strong>Methods: </strong>Our study included 173 Minnesota-resident pediatric kidney transplant recipients (<18 years) transplanted at the University of Minnesota from 2010-2020. Using the HOUSES index, a validated, individual SES measure based on housing units categorized into quartiles (Q1: lower SES; Q2-Q4: higher SES), we applied mixed-effects multivariable logistic models to examine the effects of HOUSES on preemptive kidney transplants and pretransplant dialysis duration.</p><p><strong>Results: </strong>Of 173 pediatric kidney transplant recipients, 46 (26.6%) received a preemptive transplant, and of 109 recipients with dialysis duration data, 39 (35.8%) received dialysis for >1 year. After adjusting for age at kidney failure, sex, donor type, insurance type, and underlying cause of kidney failure, we observed significantly lower odds of preemptive transplantation among Q1 recipients compared to Q2-4 recipients (Adjusted odds ratio [aOR]: 0.31; 95% CI: 0.11, 0.90; p=0.03).</p><p><strong>Conclusions: </strong>Using the HOUSES index, we found significant socioeconomic disparities in preemptive kidney transplantation rates among children.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795767","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":"Ameliorative Effect of an Anti-MicroRNA-21 Oligonucleotide on Animal and Human Models of Cystic Kidney Disease.","authors":"Yuhei Noda, Noritoshi Kato, Fuminori Sato, Yuji Suzuki, Shoma Tsubota, Hiroki Kitai, Shintaro Komatsu, Akihito Tanaka, Yuka Sato, Kayaho Maeda, Kazuhiro Furuhashi, Takuji Ishimoto, Tomoki Kosugi, Tamio Yamaguchi, Shizuko Nagao, Yukiko Kamiya, Kenji Kadomatsu, Hiroyuki Asanuma, Shoichi Maruyama","doi":"10.34067/KID.0000000771","DOIUrl":"10.34067/KID.0000000771","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":"900-913"},"PeriodicalIF":3.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780394","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}