Kidney Medicine最新文献

{"title":"Reply: Comment on “Kidney Function and Incident Stroke and Dementia Using an Updated Estimated Glomerular Filtration Rate Equation Without Race: The Multi-Ethnic Study of Atherosclerosis”","authors":"Samuel Moen MPH, James Pankow PhD, Sanaz Sedaghat PhD","doi":"10.1016/j.xkme.2025.101034","DOIUrl":"10.1016/j.xkme.2025.101034","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 6","pages":"Article 101034"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184777","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":"Response to the letter by Ito","authors":"Maxime Ingwiller MD , Thierry Hannedouche MD, PhD","doi":"10.1016/j.xkme.2025.101032","DOIUrl":"10.1016/j.xkme.2025.101032","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 6","pages":"Article 101032"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184776","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":"Comment on “Kidney Function and Incident Stroke and Dementia Using an Updated Estimated Glomerular Filtration Rate Equation Without Race: The Multi-Ethnic Study of Atherosclerosis”","authors":"Paul T. Williams PhD","doi":"10.1016/j.xkme.2025.101033","DOIUrl":"10.1016/j.xkme.2025.101033","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 6","pages":"Article 101033"},"PeriodicalIF":3.2,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144166416","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":"Re: “Kidney Biopsy-Proven Diabetic and Non-Diabetic Kidney Diseases and Outcomes in Patients With Type 2 Diabetes Receiving Dialysis: The REIN Registry” by Ingwiller et al.","authors":"Hiroki Ito MD, PhD","doi":"10.1016/j.xkme.2025.101031","DOIUrl":"10.1016/j.xkme.2025.101031","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 6","pages":"Article 101031"},"PeriodicalIF":3.2,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144166422","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":"Utilization Trends of Dual GIP/GLP-1 Receptor Agonist, Newer Glucose-Lowering Medications, and Anti-Obesity Medications Among Patients With Chronic Kidney Disease With and Without Type 2 Diabetes","authors":"Panupong Hansrivijit , Janinne Ortega-Montiel , Deborah J. Wexler , Elisabetta Patorno , Julie M. Paik","doi":"10.1016/j.xkme.2025.101013","DOIUrl":"10.1016/j.xkme.2025.101013","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Tirzepatide, a dual GIP/GLP-1 receptor agonist, has been approved for type 2 diabetes (T2D) and obesity. However, the real-world utilization of tirzepatide remains unexplored, particularly in patients with chronic kidney disease (CKD), where the prevalence of T2D and obesity is high. This study aimed to describe the utilization trends of tirzepatide, glucose-lowering medications (GLMs), and anti-obesity medications (AOMs) in patients with CKD, with and without T2D.</div></div><div><h3>Study Design</h3><div>A population-based, observational cohort study.</div></div><div><h3>Setting & Participants</h3><div>Patients with CKD, with and without T2D, were identified from a large US health insurance claims database (from January 1, 2022 to September 30, 2023).</div></div><div><h3>Exposures</h3><div>Tirzepatide, other GLMs, and AOMs.</div></div><div><h3>Outcomes</h3><div>Medication utilization trends and patient characteristics. Any users were defined as those with prescription claims, and incident users as those with no previous dispensing within 365 days.</div></div><div><h3>Analytical Approach</h3><div>Longitudinal trends were assessed by 1-month intervals from January 1, 2022 to September 30, 2023.</div></div><div><h3>Results</h3><div>Among 455,047 patients with CKD and T2D, tirzepatide any users increased to 4.8% in September 2023, while incident users rose from 0.8% to 8.6%. Sodium glucose cotransporter-2 inhibitors remained the most initiated GLM. Tirzepatide initiators had higher rates of obesity (32.5%), and morbid obesity (44.1%) when compared with other GLMs. Among 5,978 patients with CKD without diabetes, weekly semaglutide<!--> <!-->≤2<!--> <!-->mg was the most initiated AOM, followed by tirzepatide. Incident users of tirzepatide rose from 0.6% in June 2022 to 23.5% in September 2023. Clinical characteristics were similar between semaglutide<!--> <!-->≤2<!--> <!-->mg versus tirzepatide initiators.</div></div><div><h3>Limitations</h3><div>The study period ended before tirzepatide’s approval for weight management (November 2023).</div></div><div><h3>Conclusions</h3><div>Our study indicates rapidly shifting trends in tirzepatide uptake among patients with CKD both with and without diabetes. The uptake of tirzepatide is expected to increase further. Future studies on the comparative effectiveness and safety of tirzepatide in patients with CKD are warranted.</div></div><div><h3>Plain Language Summary</h3><div>Tirzepatide, a dual GIP/GLP-1 receptor agonist, has been approved for glycemic control and weight management, but its utilization in the real-world settings among patients with chronic kidney disease (CKD) is unknown, where the prevalence of type 2 diabetes and obesity is high. In this study, we examined the utilization trends of tirzepatide, other glucose-lowering medications, and anti-obesity medications (AOMs) from January 1, 2022 to September 30, 2023 using a large US health insurance datab","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 6","pages":"Article 101013"},"PeriodicalIF":3.2,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144116047","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 Primary Care Continuity With Home Dialysis, Transplantation, and Utilization of Medical Services for Patients Starting Hemodialysis","authors":"Cole S. Wyman , Maya Djerboua , Kristin K. Clemens , Ziv Harel , Manish M. Sood , Samuel A. Silver","doi":"10.1016/j.xkme.2025.101015","DOIUrl":"10.1016/j.xkme.2025.101015","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Primary care may help patients starting dialysis with emotional support and access to health care services. It is unknown whether consistently visiting the same primary care physician (PCP) can strengthen patient confidence to select home dialysis, help facilitate medical appointments for transplantation, or increase care access.</div></div><div><h3>Study Design</h3><div>A population-based retrospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>Patients initiating maintenance hemodialysis from 2007 to 2017 in Ontario, Canada.</div></div><div><h3>Exposure</h3><div>High PCP continuity using the usual provider of care index (an established measure of PCP continuity), defined as<!--> <!-->>75% of PCP visits with the same PCP in the 2 years before dialysis initiation.</div></div><div><h3>Outcomes</h3><div>Primary outcomes were time to home dialysis (peritoneal or hemodialysis) and transplantation. Secondary outcomes included specialist visits, cancer screening, influenza vaccination, and measures of diabetes care.</div></div><div><h3>Analytical Approach</h3><div>Propensity scores to match patients with high and low PCP continuity.</div></div><div><h3>Results</h3><div>We identified 9,530 matched pairs. High PCP continuity was not associated with increased home dialysis (14.0 events per 100 person-years vs 14.0 events per 100 person-years; subdistribution hazard ratio 1.00; 95% CI, 0.97-1.04) or transplantation (4.3 events per 100 person-years vs 4.5 events per 100 person-years; subdistribution hazard ratio 0.97; 95% CI, 0.90-1.04). High PCP continuity was associated with greater colon cancer screening (hazard ratio 1.07; 95% CI, 1.01-1.14), influenza vaccination (hazard ratio 1.33; 95% CI, 1.27-1.39), and comprehensive diabetes care (hazard ratio 1.23; 95% CI, 1.14-1.33).</div></div><div><h3>Limitations</h3><div>Residual confounding is possible.</div></div><div><h3>Conclusions</h3><div>High PCP continuity before dialysis initiation was not associated with increased utilization of home dialysis or transplantation but was associated with greater colon cancer screening, influenza vaccination, and comprehensive diabetes care. Additional work is needed to clarify how primary care may best benefit this patient population.</div></div><div><h3>Plain Language Summary</h3><div>Patients transitioning to maintenance hemodialysis require comprehensive health care. We investigated how closer relationships with a primary care physician (PCP) may complement nephrologists in caring for this patient population. We used administrative databases in Ontario, Canada, to conduct a retrospective population-based study, assessing how continuity with one PCP influenced the uptake of home dialysis, kidney transplantation, and patient access to health care services. We found that high PCP continuity before dialysis initiation was not associated with increased transition to home dialysis or kidney transplan","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 6","pages":"Article 101015"},"PeriodicalIF":3.2,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144115993","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":"Patient Activation, Social Support, Physician Trust, and Shared Dialysis Decision-Making: A Cross-Sectional Investigation","authors":"Fahad Saeed , Basil S. Kazi , Musaib Syed , Kevin A. Fiscella , Paul R. Duberstein","doi":"10.1016/j.xkme.2025.101014","DOIUrl":"10.1016/j.xkme.2025.101014","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>People undergoing maintenance dialysis often lack essential information about kidney therapy options. Therefore, nephrologists must involve patients and families in shared decision-making (SDM). In this investigation, we hypothesized that patient activation, social support, and physician trust would be associated with patient-reported SDM.</div></div><div><h3>Study Design</h3><div>A cross-sectional survey.</div></div><div><h3>Methods</h3><div>We surveyed hospitalized individuals receiving maintenance dialysis. Participants completed the 9-item SDM questionnaire (SDM-Q-9) and the Patient Activation Measure-13, the Multidimensional scale of perceived social support, and the Primary Care Assessment Survey Trust Subscale.</div></div><div><h3>Analytic Approach</h3><div>We used descriptive statistics to present demographics. We included patient demographics in multivariable linear regression models predicting SDM scores.</div></div><div><h3>Results</h3><div>Of the 223 respondents, 222 patients completed SDM-Q-9, 54% were<!--> <!-->≥65 years old, with 47% being woman. In addition, 37% self-identified as African American, 48% had an education level at<!--> <!-->≤high school, and 54% reported an annual household income of ≤$20,000. The SDM-Q-9 scores (n<!--> <!-->=<!--> <!-->222) had a mean of 57.49 (SD<!--> <!-->=<!--> <!-->27.07), median 58 (IQR<!--> <!-->=<!--> <!-->38-82), and ranged from 0 to 100. The mean patient activation was 53.5<!--> <!-->±<!--> <!-->16.5 (min 24, max 100), social support 61.2<!--> <!-->±<!--> <!-->24 (min 0, max 100), and physician trust 59.29<!--> <!-->±<!--> <!-->21.6 (min 0, max 100). In separate multivariable linear regression models, higher patient activation (1-point patient activation measure increase per 0.48-unit SDM increase; 95% CI, 0.24-0.73), higher social support (1-point increase per 0.28 SDM increase; 95% CI, 0.11-0.45), and greater physician trust (0.31-point increase per 1-point SDM increase; 95% CI, 0.12-0.49) were significantly associated with greater SDM.</div></div><div><h3>Limitations</h3><div>The study was a cross-sectional investigation.</div></div><div><h3>Conclusions</h3><div>Our findings indicate a significant association between SDM and patient activation, social support, and physician trust. Future research with individuals actively considering kidney therapy options should prospectively explore the relationship between patient activation, social support, physician trust and SDM.</div></div><div><h3>Plain Language Summary</h3><div>There is limited literature on the association between patient activation, social support, and physician trust with patient-reported shared dialysis decision-making. Therefore, we examined this association in a convenience sample of 222 people receiving maintenance dialysis. We found that patient activation, social support, and physician trust were independently associated with shared dialysis decision-making. Future prospective","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 6","pages":"Article 101014"},"PeriodicalIF":3.2,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144115934","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":"Time Trends and Causes of Infection-Related Mortality Among Patients Starting Dialysis in Finland: A Nationwide Cohort Study","authors":"Susanna Kinnunen , Ilkka Helanterä , Auni Juutilainen , Wisam Bitar , Jaakko Helve , Patrik Finne","doi":"10.1016/j.xkme.2025.101012","DOIUrl":"10.1016/j.xkme.2025.101012","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Previously, we reported a decrease in infection-related mortality in kidney transplant recipients. Regarding patients treated with dialysis, it is unclear whether infection-related mortality is decreasing. Therefore, we investigated current time trends and specific causes of infection-related mortality over 2 decades in a large cohort of patients treated with dialysis.</div></div><div><h3>Study Design</h3><div>A nationwide cohort study.</div></div><div><h3>Setting & Participants</h3><div>Patients starting kidney replacement therapy were identified through the Finnish Registry for Kidney Diseases. Follow-up continued until death of any cause, kidney transplantation, moving abroad, recovery of kidney function, loss of follow-up, or end of study.</div></div><div><h3>Exposure</h3><div>Long-term kidney replacement therapy.</div></div><div><h3>Outcome</h3><div>Death due to infection.</div></div><div><h3>Analytical Approach</h3><div>Incidence rates, incidence rate ratios, and adjusted Cox regression hazard ratios for infection-related deaths were calculated by sub-cohorts consisting of patients whose kidney replacement therapy was started either 2000-2004, 2005-2009, 2010-2014, or 2015-2019. As sensitivity analyses, we studied infection-related mortality within 1 year of dialysis initiation and performed competing risk analysis.</div></div><div><h3>Results</h3><div>A total of 9,671 adult patients started long-term dialysis from 2000 to 2019. Infection-related deaths declined from 47 to 23 deaths per 1,000 person-years over the four 5-year intervals from 2000-2004 to 2015-2019. The hazard ratio of a Cox model including identified risk factors was 0.49 (95% CI, 0.39-0.62) for patients who started dialysis in 2015-2019 compared with those who started in 2000-2004. The most common specific causes of infection-related deaths were septicemia (38%), pulmonary infection (36%), and peritonitis (8%), whereas opportunistic infections rarely caused death.</div></div><div><h3>Limitations</h3><div>Death certificates may have low sensitivity for infectious diseases. Only one cause of death is available. Categories of infectious deaths may overlap.</div></div><div><h3>Conclusions</h3><div>Risk of dying due to infections has halved since the beginning of the millennium despite aging among patients treated with dialysis. The reason for this development requires further studies.</div></div><div><h3>Plain Language Summary</h3><div>Patients treated with dialysis experience a very significantly increased risk of dying from infection compared to the general population. This study evaluated current time trends and specific causes of infectious disease mortality in patients treated with dialysis in Finland from 2000 to 2019 based on data from the national registry with complete coverage of the dialysis cohort. The risk of death from infection in maintenance dialysis in Finland has dropped by half since the 2000s, despite the aging","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 6","pages":"Article 101012"},"PeriodicalIF":3.2,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124959","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":"Variations in Creatinine Generation Among Patients With Glomerular Disease: Evidence From the NEPTUNE and CureGN Studies","authors":"Shalini S. Ramachandra , Melody Chiang , Michael Arbit , Dorey A. Glenn , Laura H. Mariani , Jarcy Zee","doi":"10.1016/j.xkme.2025.101010","DOIUrl":"10.1016/j.xkme.2025.101010","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Estimation of glomerular filtration rate (GFR) assumes that creatinine generation (crG) is relatively stable. This study identified factors associated with crG variability and its impact on serum creatinine changes (<span><math><mrow><mo>Δ</mo></mrow></math></span> Scr) among patients with glomerular disease.</div></div><div><h3>Study Design</h3><div>An observational cohort study.</div></div><div><h3>Setting & Participants</h3><div>Nephrotic Syndrome Study Network and Cure Glomerulonephropathy adult and pediatric participants with at least one crG measurement.</div></div><div><h3>Predictors</h3><div>Potential predictors of crG levels included age, sex, disease diagnosis, weight status, estimated GFR (eGFR), urine protein, steroid use, and nonsteroid immunosuppressant use. crG change (<span><math><mrow><mo>Δ</mo></mrow></math></span> crG) was then used as an exposure to assess impacts on <span><math><mrow><mo>Δ</mo></mrow></math></span> Scr.</div></div><div><h3>Outcomes</h3><div>crG levels and <span><math><mrow><mo>Δ</mo></mrow></math></span> Scr.</div></div><div><h3>Analytical Approach</h3><div>The intraclass correlation coefficient illustrated crG variability within individuals. Multivariable linear mixed models identified factors associated with crG levels. Among those with 2+<!--> <!-->crG measurements, multivariable linear mixed models estimated the association between <span><math><mrow><mo>Δ</mo></mrow></math></span> crG and <span><math><mrow><mo>Δ</mo></mrow></math></span> Scr.</div></div><div><h3>Results</h3><div>Among 4,626 crG measurements from 1,081 participants, there was only moderate correlation between measurements within individuals (intraclass correlation coefficient<!--> <!-->=<!--> <!-->0.517, 95% CI, 0.482-0.548) overall. For pediatric participants, factors significantly associated with crG included age, sex, weight status, and urine protein. Among adults, significant factors were age, sex, disease diagnosis, weight status, eGFR, steroid use, and nonsteroid immunosuppressant use.</div></div><div><h3>Limitations</h3><div>The 24-hour urine collections may have collection error, measured GFR was unavailable, and edema status was unavailable.</div></div><div><h3>Conclusions</h3><div>crG was highly dynamic within individuals over time and varied with glomerular disease activity and treatments. The impact of <span><math><mrow><mo>Δ</mo></mrow></math></span> crG on <span><math><mrow><mo>Δ</mo></mrow></math></span> Scr —and subsequently on estimation of kidney function—is potentially large. Accounting for these changes or development of alternative kidney function measures are needed among glomerular disease patients.</div></div><div><h3>Plain Language Summary</h3><div>Creatinine generation is often assumed to be stable when using creatinine to estimate kidney function and track kidney function over time, but it can vary with chronic disease. This study showed high variability in creatini","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 6","pages":"Article 101010"},"PeriodicalIF":3.2,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144116045","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":"Patient-Reported Symptoms Compared With Nephrologist Documentation During Outpatient Visits: A Retrospective Patient-Reported Outcome Measures Study","authors":"Kendra E. Wulczyn , Annie Liu , James P. Lash , Mallika L. Mendu , Sahir Kalim","doi":"10.1016/j.xkme.2025.101011","DOIUrl":"10.1016/j.xkme.2025.101011","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Communication of symptom presence between patients and nephrologists is a key step toward management of the symptom burden faced by many patients with chronic kidney disease (CKD), but whether symptoms are being routinely discussed during ambulatory non-dialysis nephrology encounters is uncertain. This study compared patient reports of 11 CKD-related symptoms with nephrologists’ documentation of symptom presence in the concomitant visit note.</div></div><div><h3>Study Design</h3><div>A retrospective analysis of patient-reported outcome measures and nephrologist documentation in the electronic health record (EHR).</div></div><div><h3>Setting & Study Populations</h3><div>Adults treated at 2 ambulatory nephrology practices within a single tertiary academic center in the United States from 2015 to 2020.</div></div><div><h3>Data Extraction</h3><div>Patients reported symptoms using the Kidney Disease Quality of Life Short Form (KDQOL-SF) instrument before clinic visits. Symptoms were identified in the EHR-based note by natural language processing with subsequent manual identification of the context.</div></div><div><h3>Analytical Approach</h3><div>Sensitivity and specificity of nephrologist documentation for symptoms were calculated using KDQOL responses as the reference standard and stratified by numerous patient, nephrologist, and encounter characteristics.</div></div><div><h3>Results</h3><div>Over 4 years, 1,534 patients completed 2,118 KDQOL surveys before visits with 45 nephrologists. Average sensitivity of nephrologist documentation for symptoms was 16% (and<!--> <!--><40% for each individual symptom), with an average specificity of 98%. Sensitivity of documentation for symptoms was higher when the patient was female, had an estimated glomerular filtration rate of<!--> <!--><30<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup>, or had a history of cardiovascular disease. The documentation sensitivity of nephrologists was higher if they were female or were in practice for<!--> <!-->≤7 years as compared with<!--> <!-->>25 years.</div></div><div><h3>Limitations</h3><div>Nephrologist documentation in the EHR may not accurately represent what was discussed during a visit.</div></div><div><h3>Conclusions</h3><div>Accuracy of nephrologist documentation for the presence of CKD-related symptoms in the EHR is low. Although recognizing that symptoms may have been assessed but not documented, the low proportion of clinic notes correctly identifying patient symptoms in this study suggests an opportunity for tools to streamline and standardize symptom assessment in this patient population.</div></div><div><h3>Plain Language Summary</h3><div>This study aimed to characterize how accurate the documentation of nephrologists is when it comes to patient-reported symptoms commonly associated with chronic kidney disease. Patients completed an electronic questionnaire regarding their symptoms before visits at 2 gener","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 6","pages":"Article 101011"},"PeriodicalIF":3.2,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144116046","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}