Kidney Medicine最新文献

{"title":"Sarcopenia in Peritoneal Dialysis: Prevalence, Pathophysiology, and Management Strategies","authors":"Xiaohua Hu ,&nbsp;Bibo Wu ,&nbsp;Yang Yang ,&nbsp;Liming Zhang ,&nbsp;Cheng Xue","doi":"10.1016/j.xkme.2025.100989","DOIUrl":"10.1016/j.xkme.2025.100989","url":null,"abstract":"<div><div>Sarcopenia, defined as the loss of skeletal muscle mass, strength, and function, is a significant complication in patients with chronic kidney disease, particularly those undergoing peritoneal dialysis (PD). This review explores the prevalence, pathophysiology, diagnostic challenges, and management strategies of sarcopenia in the PD population. The multifactorial etiology of sarcopenia in PD, including protein-energy wasting, chronic inflammation, insulin resistance, and hormonal imbalances, underscores the complexity of its management. The prevalence of sarcopenia in patients treated with PD is influenced by age, duration of dialysis, and comorbid conditions, presenting a considerable variation across studies due to differing diagnostic criteria. Diagnostic challenges arise from fluid overload and the PD process, affecting the accuracy of muscle mass measurements. Intervention strategies focusing on nutritional supplementation and physical exercise have shown promise; however, the need for PD-specific diagnostic criteria and treatment protocols remains. This review highlights the critical effect of sarcopenia on functional status and survival in patients treated with PD, emphasizing the importance of addressing this condition to improve patient outcomes. Future directions call for comprehensive, longitudinal studies to better understand sarcopenia’s progression in patients treated with PD and the development of tailored interventions.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 5","pages":"Article 100989"},"PeriodicalIF":3.2,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143785965","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":"Quality of Life in Patients with CKD With Catastrophic Health Care Expenditures: A National Study From Thailand","authors":"Pornpen Sangthawan ,&nbsp;Sarayut L. Geater ,&nbsp;Pinkaew Klyprayong ,&nbsp;Pimwara Tanvejsilp ,&nbsp;Sirirat Anutrakulchai ,&nbsp;Pongsathorn Gojaseni ,&nbsp;Charan Kuhiran ,&nbsp;Pichet Lorvinitnun ,&nbsp;Kajohnsak Noppakun ,&nbsp;Watanyu Parapiboon ,&nbsp;Adisorn Pathumarak ,&nbsp;Supinda Sirilak ,&nbsp;Pleumjit Tankee ,&nbsp;Puntapong Taruangsri ,&nbsp;Piyamitr Sritara ,&nbsp;Nathorn Chaiyakunapruk ,&nbsp;Chagriya Kitiyakara","doi":"10.1016/j.xkme.2025.100987","DOIUrl":"10.1016/j.xkme.2025.100987","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Despite universal health coverage, patients with chronic kidney disease (CKD) in middle-income nations still face financial hardship. Catastrophic health care expenditures (CHEs) serve as a valuable index of patient-derived financial hardship, but few studies have explored the connection of CHE with clinical correlates, especially in patients with CKD. This study aimed to assess the association between CHE and health-related quality of life (HRQoL) in a spectrum of patients with CKD in Thailand.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;A multicenter, nationwide cross-sectional study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Population&lt;/h3&gt;&lt;div&gt;Patients with CKD (stages 3-5 and dialysis) from 11 centers across Thailand.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposures&lt;/h3&gt;&lt;div&gt;Catastrophic health expenditures.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Health-related quality of life.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Data on clinical, socioeconomic status, and out-of-pocket expenses were acquired via interviews. The CHE was defined as health care expenditures of at least 40% of the household’s capacity to pay. The HRQoL was assessed using the EuroQol-5 Dimensions (EQ5DL) questionnaire. Fractional and multivariable logistic regression models were used to determine the CHE’s effect on EQ5DL composite utility scores and each HRQoL dimension.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Of 1,224 patients with CKD, 20% experienced CHE. EuroQol-5 Dimensions utility scores were notably lower in those with CHE (CHE, 0.76 vs No CHE, 0.82, &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.001) after adjustments for confounding factors. Differences between CHE and non-CHE appeared in mobility, self-care, and usual activity, with multivariable analysis showing more severe mobility and activity issues in CHE. (adjusted OR [95% CI] in CHE vs non-CHE: mobility: 1.89 [1.23-2.91], &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.004; usual activity: 1.82 [1.10-3.02], &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.020].&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Cross-sectional design prevents causal inferences.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Despite health coverage, patients with CKD with financial strain experience reduced quality of life, with pronounced effects on mobility and daily activity. Integrating the assessment of patient-derived financial burden is an essential step into CKD care plans in middle-income countries.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;div&gt;Patients with chronic kidney disease (CKD) often face substantial out-of-pocket payments for their care. This study aimed to understand how catastrophic health care expenditures (CHE) affect CKD patients' quality of life. CHE occurs when medical costs overwhelm a household's finances. We conducted a nationwide study in Thailand to examine how CHE affects patients with CKD’s well-being, focusing on mobility, daily activities, and emotional health. By analyzing data from patients across different stages of CKD, we fou","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 5","pages":"Article 100987"},"PeriodicalIF":3.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792712","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":"Resistance-Based Muscle Therapy, Frailty, and Muscle Biopsy Findings in Kidney Transplant Candidates: A Clinical Trial","authors":"Stephen T. Bartlett ,&nbsp;Ilaria Santi ,&nbsp;Greg Hachaj ,&nbsp;Kenneth R. Wilund ,&nbsp;Ivo Tzvetanov ,&nbsp;Mario Spaggiari ,&nbsp;Jorge Almario ,&nbsp;Pierpaolo Di Cocco ,&nbsp;Francesco Bianco ,&nbsp;Zahraa Hajjiri ,&nbsp;Lorenzo Gallon ,&nbsp;Ajay Rana ,&nbsp;Sandeep Kumar ,&nbsp;Enrico Benedetti ,&nbsp;Robert W. Motl","doi":"10.1016/j.xkme.2025.100978","DOIUrl":"10.1016/j.xkme.2025.100978","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Frailty is associated with increased morbidity and mortality in kidney transplant recipients. We hypothesized that frailty may be attributable to diminished muscle function associated with muscle morphologic changes. This trial in kidney transplant candidates tested the reversibility of frailty by specifically targeting the affected major muscle groups.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Randomized clinical trial.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Kidney transplant candidates.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;Supervised, resistance-based muscle therapy program delivered for 1 hour, 2 times per week for 1 year.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Baseline, 6-month, and 12-month Short Physical Performance Battery, gait speed, grip strength, sit-to-stand in 30&lt;!--&gt; &lt;!--&gt;s, 36-item Short Form Survey, Patient-Reported Outcomes Measurement Information System-29, and muscle biopsy light and electron microscopy and immunohistochemistry.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytic Approach&lt;/h3&gt;&lt;div&gt;Paired 2-tailed &lt;em&gt;t&lt;/em&gt; test, 1-way repeated measures analysis of variance.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Twenty-nine participants (mean age, 55 years; female, 55%; African American, 65%) were analyzed: 23 intervention and 6 control. Exercise intervention participants had significant improvements in Short Physical Performance Battery, baseline 5.2 (95% CI, 3.6-6.7) versus 6 months, 6.9 (95% CI, 5.2-8.5; &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.001) and 12 months, 7.2 (95% CI, 5.6-8.8; &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.001); baseline hand grip, 14.3&lt;!--&gt; &lt;!--&gt;kg (95% CI, 10.3-18.4) versus 6 months, 16.9&lt;!--&gt; &lt;!--&gt;kg (95% CI, 13.1-20.8; &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.05) and 12 months, 17.4&lt;!--&gt; &lt;!--&gt;kg (95% CI, 13.9-21.0; &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.05); and baseline sit-to-stand in 30&lt;!--&gt; &lt;!--&gt;s, 8.0 (95% CI, 3.8-12.2) versus 6 months, 12.7 (95% CI, 8.2-17.1; &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.001) and 12 months, 16.2 (95% CI, 10.7-21.7; &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.001). The exercise group 12-month muscle fiber diameter increased by 18.6&lt;!--&gt; &lt;!--&gt;μm (95% CI, 8.4-28.5; &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.003). Expression of immunohistology markers of muscle atrophy decreased significantly. The mean difference in immunohistology score of mitochondrial oxidative function improved for cytochrome c oxidase complex IV, 1.00 (95% CI, 0.71-1.29; P&lt;!--&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.001) and ATP5I increased by 0.74 (95% CI, 0.49-0.99; &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.001). Increased mitochondrial count did not achieve statistical significance (&lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.096). Controls showed no improvement in either physical performance or histology.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Significant under-enrollment in the control group required a paired &lt;em&gt;t&lt;/em&gt; test analysis of experimental participants.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;One year of muscle rehabilitation therapy resulted in","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 4","pages":"Article 100978"},"PeriodicalIF":3.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685173","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":"Effectiveness of Tolvaptan for Autosomal Dominant Polycystic Kidney Disease in US Clinical Practice With Comparison to Historical Control Data","authors":"Ronald D. Perrone ,&nbsp;Diana Garbinsky ,&nbsp;Sasikiran Nunna ,&nbsp;Hema K. Gandhi ,&nbsp;Ancilla W. Fernandes ,&nbsp;Gabriela Burgos ,&nbsp;Abisola Olopoenia ,&nbsp;Marc DeCongelio ,&nbsp;Martine C. Maculaitis ,&nbsp;Xiaolei Zhou","doi":"10.1016/j.xkme.2025.100988","DOIUrl":"10.1016/j.xkme.2025.100988","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Data from clinical practice are needed to characterize the effectiveness of pharmacotherapy outside the controlled setting of clinical trials but lack an untreated placebo group for comparison. To assess the effectiveness of tolvaptan for autosomal dominant polycystic kidney disease (ADPKD) in nephrology practice, we performed a chart review of US patients and compared it with a historical matched control cohort.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Patient data from charts were provided by US nephrologists who participated in an online survey. Historical control data for patients with ADPKD not treated with tolvaptan were extracted from a database of ADPKD clinical studies (Consortium for Radiologic Imaging Studies of Polycystic Kidney Disease, HALT Progression of Polycystic Kidney Disease, and OVERTURE).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Nephrologist respondents (n&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;57) provided baseline data and up to 4 years of follow-up on estimated glomerular filtration rate (eGFR) for tolvaptan-treated adults (n&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;149). Historical ADPKD-affected controls were adults in Mayo imaging risk classes 1C–1E (ie, at increased risk of rapid progression, consistent with the tolvaptan indication).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;Cases had to receive tolvaptan continuously for&lt;!--&gt; &lt;!--&gt;≥2 years. Historical controls received nontolvaptan standard of care, including various antihypertensive regimens.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome&lt;/h3&gt;&lt;div&gt;Annual rate of eGFR change.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Cases and controls were matched on baseline clinical characteristics (matched set A: age, sex, and chronic kidney disease stage [110 matched pairs]; matched set B: age, sex, and eGFR [98 matched pairs]) and compared using a mixed model.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The annual rate of eGFR decline was slower in tolvaptan-treated patients versus historical controls, by 1.40&lt;!--&gt; &lt;!--&gt;mL/min/1.73&lt;!--&gt; &lt;!--&gt;m&lt;sup&gt;2&lt;/sup&gt; (95% CI, 0.05-2.74; &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.04) in set A. Set B demonstrated a similar trend: 1.18&lt;!--&gt; &lt;!--&gt;mL/min/1.73&lt;!--&gt; &lt;!--&gt;m&lt;sup&gt;2&lt;/sup&gt; per year (95% CI, −0.22 to 2.58; &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.10).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Risk of bias from convenience sampling and potential residual confounding after case/historical control matching.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Tolvaptan was associated with slower eGFR decline in routine clinical practice, consistent with the results of controlled trials.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;div&gt;Randomized, controlled trials are the gold standard for evaluating pharmacotherapy, but evidence collected under routine clinical conditions can answer questions about drug effectiveness, safety, and value that are particularly relevant to everyday medical practice. Trial data have demonstrated that tolvaptan slows kidney function decline ","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 5","pages":"Article 100988"},"PeriodicalIF":3.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143760647","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":"Insights Into Health-Related Quality of Life of Kidney Transplant Recipients: A Narrative Review of Associated Factors","authors":"Tim J. Knobbe ,&nbsp;Daan Kremer ,&nbsp;Ute Bültmann ,&nbsp;Coby Annema ,&nbsp;Gerjan Navis ,&nbsp;Stefan P. Berger ,&nbsp;Stephan J.L. Bakker ,&nbsp;Yvette Meuleman","doi":"10.1016/j.xkme.2025.100986","DOIUrl":"10.1016/j.xkme.2025.100986","url":null,"abstract":"<div><div>Life expectancy and graft survival continue to improve after transplantation. However, improved posttransplant clinical outcomes do not necessarily translate into improved health-related quality of life (HRQoL). Therefore, there is an increased focus on HRQoL in kidney transplant recipients (KTRs). The HRQoL of KTRs is worse than that of the general population, but interventions that improve HRQoL in KTRs are scarce, and health care professionals in nephrology care do not routinely address HRQoL. To improve HRQoL, it is essential to understand which factors play a role in HRQoL and to pinpoint areas for intervention. This narrative review maps the concept of HRQoL within the KTR population and provides a comprehensive overview of factors associated with posttransplant HRQoL. The results are structured using an easy-to-understand conceptual model of HRQoL, which is instrumental for understanding how HRQoL is constituted of many clinical and nonclinical factors. We conclude that symptom burden among KTRs is high, which is likely a key driver of the limited HRQoL in this population. Moreover, myriad other clinical and nonclinical factors are associated with HRQoL, but the majority of the evidence is observational.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 5","pages":"Article 100986"},"PeriodicalIF":3.2,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143642795","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":"Concerning the article “False-positive Serum Antiglomerular Basement Membrane Antibody due to Bovine Serum Albumin-containing Surgical Adhesive: A Case Report” by Yoshida et al","authors":"Giulia Zorzi MD","doi":"10.1016/j.xkme.2025.100985","DOIUrl":"10.1016/j.xkme.2025.100985","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 4","pages":"Article 100985"},"PeriodicalIF":3.2,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143528712","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":"Peritoneal Dialysis in Young Adults: A Mixed-Methods Study","authors":"Hannah C. Lyons ,&nbsp;Lucy E. Selman ,&nbsp;Yoav Ben-Shlomo ,&nbsp;Fergus J. Caskey ,&nbsp;Carol D. Inward ,&nbsp;Alexander Hamilton","doi":"10.1016/j.xkme.2025.100983","DOIUrl":"10.1016/j.xkme.2025.100983","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Peritoneal dialysis (PD) preserves kidney function and offers flexibility; however, few young adults have it compared with hemodialysis (HD). This study aimed to understand factors influencing the change from PD to HD.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;This was a sequential explanatory mixed-methods study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Quantitative data were collected from 470 participants (50% male participants, 85% White, mean age: 16 years) who received dialysis between 1987 and 2015. Cox proportional hazards analysis was used to examine psychosocial factors associated with transitions from PD to HD. Qualitative data were gathered from 13 young adults (aged 14-29 years) who received dialysis between 2013 and 2015, with retrospective interviews conducted in 2020.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;25% of participants experienced multiple episodes of PD. Survival rates for PD at 1 and 5 years were 71% and 37%, respectively. Risk factors for transitioning to HD included young adulthood (age: 15-30 years), with higher transition risks in older age groups (age: 15-19 years, HR: 2.41; age: 20-24&lt;!--&gt; &lt;!--&gt;years, HR: 3.39; age: 25-30 years, HR: 3.14; &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.005). Other factors included primary kidney disease type (systemic diseases vs tubulointerstitial diseases). Leading causes for transition were infection (50%), noncompliance (21%), and mechanical issues (18%). Qualitative analysis revealed the key themes around communicating treatment options, life impact, and support structures. Resilience was an additional theme among those who continued PD.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;The study was based on cross-sectional psychosocial data, lacked detailed parental involvement, and may have suffered recall bias.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Young adults are at higher risk of transitioning to HD owing to both transplant failure and complications with PD. Challenges of PD have been underestimated, and there is a need to educate young adults well on all dialysis options. Additional support including mental health support, peer support, and support during life changes, such as moving out of their family home, is recommended.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;This study aimed to understand why young adults are more likely to switch from peritoneal dialysis (PD) to hemodialysis. Although PD preserves kidney function and offers flexibility, few young adults choose it. We conducted a mixed-methods study with 470 patients aged 0-30 years and interviews with 13 individuals who were receiving dialysis. Our findings showed that young adults (aged 15-30 years) were at higher risk of transitioning to hemodialysis, mainly owing to infections, noncompliance, and mechanical issues. Challenges of PD have been underestimated, and there is a need to educate young adults well on all dialysis options. Additional support including mental health suppo","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 4","pages":"Article 100983"},"PeriodicalIF":3.2,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685116","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":"Body Mass Index in Late Adolescence and Later Life Kidney Outcomes: A Population-Based Cohort Study in Swedish Men","authors":"Monika Vitkauskaitė ,&nbsp;Ernesta Mačionienė ,&nbsp;Rytis Stankevičius ,&nbsp;Marius Miglinas ,&nbsp;Joachim H. Ix ,&nbsp;Mattias Brunström","doi":"10.1016/j.xkme.2025.100982","DOIUrl":"10.1016/j.xkme.2025.100982","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;The association between body mass index (BMI) and chronic kidney disease (CKD) is well established in middle-aged and older adults. Here, we assess the association of BMI in late adolescence with CKD, kidney failure, and acute kidney injury (AKI) later in life.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design, Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Population-based cohort study including data from the Swedish Conscription Database, the National Patient Register, the Cause of Death Register, and Statistics Sweden. Conscripts with no history of diabetes, cardiovascular, kidney, or rheumatic diseases enlisted between 1969 and 1997 were followed until December 31, 2019.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcomes &amp; Exposures&lt;/h3&gt;&lt;div&gt;The study examined the impact of BMI on kidney outcomes. The primary outcome was incident chronic kidney disease. Secondary outcomes were stage 5 chronic kidney disease, end-stage kidney disease, and acute kidney injury.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Patients were stratified into the quintiles of BMI at conscription, and followed until events, death, or censoring, using Cox proportional hazards model, adjusted for baseline systolic and diastolic blood pressure, proteinuria, and socioeconomic factors.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;In total, 1,321,481 male participants with a mean age of 18.3 years and a mean BMI of 21.6 kg/m&lt;sup&gt;2&lt;/sup&gt; were followed for an average of 35.6 years, generating a total of 47 million person-years of follow-up. During this period, the incidence of CKD-based on diagnosis codes was 5,590, whereas 2,357 subjects were diagnosed with end-stage kidney disease and 8,023 with AKI, respectively. The risk for CKD was increased for the fourth and fifth highest BMI quintile relative to the lowest (adjusted hazard ratio [aHR] 1.23; 95% confidence interval [CI], 1.13-1.35 for BMI 21.9-23.5 kg/m&lt;sup&gt;2&lt;/sup&gt;; aHR 2.09; 95% CI, 1.93-2.26 for BMI &gt;23.5 kg/m&lt;sup&gt;2&lt;/sup&gt;). Patterns were similar for stage 5 CKD and end-stage kidney disease, whereas the risk for AKI was evident at the third and higher quintiles (aHR 1.14; 95% CI, 1.06-1.23 for BMI 20.7-21.9 kg/m&lt;sup&gt;2&lt;/sup&gt;; aHR 1.31; 95% CI, 1.22-1.41 for BMI 21.9-23.5 kg/m&lt;sup&gt;2&lt;/sup&gt;; and aHR 1.92; 1.79-2.05 for BMI ≥23.5 kg/m&lt;sup&gt;2&lt;/sup&gt;).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;A retrospective observational study of male Swedish adolescents.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;The findings of this study indicate that, for prevention of kidney disease, the optimal BMI in adolescence with reference to kidney outcomes is likely in the low-normal range.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;div&gt;This study investigates the long-term link between body mass index (BMI) during late adolescence and kidney failure and acute kidney injury. It draws from a large, population-based Swedish cohort, tracking over a million young men over decades. The research shows that higher BMI in adolescence is associated with","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 4","pages":"Article 100982"},"PeriodicalIF":3.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143644434","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":"Population-Level Risk Factors for Kidney Outcomes in IgA Nephropathy: The CURE-CKD Registry","authors":"Katherine R. Tuttle ,&nbsp;Lindsey M. Kornowske ,&nbsp;Cami R. Jones ,&nbsp;Kenn B. Daratha ,&nbsp;Radica Z. Alicic ,&nbsp;Christina L. Reynolds ,&nbsp;Joshua J. Neumiller ,&nbsp;Mark E. Bensink ,&nbsp;Wu Gong ,&nbsp;Keith C. Norris ,&nbsp;Susanne B. Nicholas ,&nbsp;CURE-CKD Consortium","doi":"10.1016/j.xkme.2025.100981","DOIUrl":"10.1016/j.xkme.2025.100981","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Although IgA nephropathy (IgAN) therapies are advancing quickly, therapeutic interventions are hampered by a lack of kidney disease identification and risk assessment. The study aim was to use population-level data from health systems to identify IgAN and assess risks.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;A longitudinal and real-world cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Electronic health record data for patients ≥18 years old with IgAN at Providence and University of California Los Angeles health systems during 2016-2022.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Predictors&lt;/h3&gt;&lt;div&gt;Health insurance and care utilization along with age, gender, race, ethnicity, estimated glomerular filtration rate (eGFR), urine albumin/creatinine ratio (UACR) or urine protein/creatinine ratio (UPCR), diabetes, hypertension, and medications.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Time to first major adverse kidney event (MAKE): ≥40% eGFR decline; eGFR &lt;15 mL/min/1.73 m2; administrative codes for kidney failure, dialysis, or transplant; and death.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Kaplan-Meier survival curves and Cox proportional hazards models.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Patients with IgAN (n = 2,571) were 50% (n = 1,277) women and 58 ± 18 (mean ± SD) years old. At baseline, eGFR was 78 ± 27 mL/min/1.73 m&lt;sup&gt;2&lt;/sup&gt; (chronic kidney disease epidemiologic 2021 equation); median UACR and UPCR were 166 (interquartile range 25-795) mg/g and 0.7 (0.2-1.8) g/g, respectively, among those with baseline measurements (n = 669). MAKE occurred in 22% of the cohort by 3 years. In Cox proportional hazards models, MAKE was predicted by noncommercial (Medicare or Medicaid) health insurance, hospitalization, more frequent outpatient encounters, lower eGFR, and a higher UACR or UPCR.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Missingness, miscoding, and retrospective data.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Substantial loss of kidney function, kidney failure, and death were common events over a short period of time in patients with IgAN. Within health system populations, noncommercial health insurance and greater care utilization augmented risk prediction and could help to identify those who may benefit from closer monitoring and implementation of therapeutic interventions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;div&gt;IgA nephropathy therapies have advanced quickly. However, therapeutic interventions are hampered by lack of disease identification and risk assessment. We identified patients with IgA nephropathy at 2 United States health systems and assessed predictors of risk for major adverse kidney events (major adverse kidney event [MAKE]—substantial loss of kidney function, kidney failure, or death). More than one in 5 patients experienced MAKE by 3 years. In addition to demographic and clinical predictors, MAKE was predicted by noncommercial health insurance, hospitalization, and m","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 4","pages":"Article 100981"},"PeriodicalIF":3.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685115","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":"Interventions to Improve Life Participation in Kidney Transplant Recipients: A Systematic Review","authors":"Patrizia Natale ,&nbsp;Angela Ju ,&nbsp;Martin Howell ,&nbsp;Germaine Wong ,&nbsp;Armando Teixeira-Pinto ,&nbsp;Anastasia Hughes ,&nbsp;Chandana Guha ,&nbsp;Amanda Sluiter ,&nbsp;Nicole Scholes-Robertson ,&nbsp;Jonathan C. Craig ,&nbsp;Michelle A. Josephson ,&nbsp;Giovanni Strippoli ,&nbsp;Allison Jaure","doi":"10.1016/j.xkme.2025.100980","DOIUrl":"10.1016/j.xkme.2025.100980","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><div>Life participation, defined as the ability to participate in meaningful activities of daily living, is a critically important outcome for kidney transplant recipients. We aimed to evaluate the effectiveness of any interventions on life participation in kidney transplant recipients.</div></div><div><h3>Study Design</h3><div>A systematic review of randomized controlled studies.</div></div><div><h3>Study Populations</h3><div>Adult kidney transplant recipients.</div></div><div><h3>Search Strategy &amp; Sources</h3><div>MEDLINE, Embase, CENTRAL, PsycINFO and CINAHL were searched up to March 2023.</div></div><div><h3>Data Extraction</h3><div>Two authors independently screened titles and abstracts, and extracted data from the included studies using standard data extraction forms.</div></div><div><h3>Analytical Approach</h3><div>We used random-effects models with relative risk for dichotomous outcomes and mean difference for continuous outcomes with 95% confidence intervals (CIs). Confidence in the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.</div></div><div><h3>Results</h3><div>From 14,162 reports, only 33 studies (4,857 participants) were included. The risk of bias was adjudicated as high or unclear for most domains. No studies reported the outcome of life participation specifically. Among 33 studies, mental, physical and social functioning were reported in 5 (15%), 5 (15%), and 11 (33%) studies, respectively.</div></div><div><h3>Limitations</h3><div>A wide range of interventions were included across the studies with a limited follow-up, and we were unable to pool the data and perform meta-analysis for outcomes that were reported in a single study only or in studies reporting no events.</div></div><div><h3>Conclusions</h3><div>The effects of prebiotics, erythropoietin-stimulating agents, immunosuppressive treatments, induction therapy of interleukin-2 receptor antagonist, exercise, nutrition, education, and surgical procedures on life participation-related outcomes were uncertain. Life participation was not reported as a specific outcome in trials in kidney transplant recipients with very limited evidence on interventions for life participation-related outcomes. Trial-based evidence for interventions to improve life participation, a critical outcome for kidney transplant recipients, is needed.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 4","pages":"Article 100980"},"PeriodicalIF":3.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685117","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}