Kidney Medicine最新文献

{"title":"Erratum Regarding “Protein Biomarkers and Major Cardiovascular Events in Older People With Advanced CKD: The European Quality (EQUAL) Study” (Kid Med. 2023;6(1):100745)","authors":"","doi":"10.1016/j.xkme.2025.101000","DOIUrl":"10.1016/j.xkme.2025.101000","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 5","pages":"Article 101000"},"PeriodicalIF":3.2,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852023","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":"Empowering Young Adults: Reimagining Peritoneal Dialysis Support","authors":"Caroline M. Hsu , Ankur D. Shah","doi":"10.1016/j.xkme.2025.100999","DOIUrl":"10.1016/j.xkme.2025.100999","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 5","pages":"Article 100999"},"PeriodicalIF":3.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859689","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":"Effect of Post-Acute Kidney Injury Use of Renin-Angiotensin Inhibitors on Long-term Mortality and Major Adverse Kidney Events: A 5-year Retrospective Observational Cohort Study","authors":"Byorn W.L. Tan , Bryce W.Q. Tan , K. Akalya , Wei-Zhen Hong , Yi Da , Sanmay Low , Wan-Ying Ng , Horng-Ruey Chua","doi":"10.1016/j.xkme.2025.100996","DOIUrl":"10.1016/j.xkme.2025.100996","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Acute kidney injury (AKI) is common in hospitalized adults and a risk factor for chronic kidney disease and mortality. The effect of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs) post-AKI on mortality and long-term kidney function remains unclear.</div></div><div><h3>Study Design</h3><div>Propensity-weighted retrospective observational cohort study.</div></div><div><h3>Setting & Participants</h3><div>A total of 3,289 patients with AKI admitted to a tertiary care hospital from November 2015-October 2016, with follow-up until September 2020.</div></div><div><h3>Exposures</h3><div>ACEi/ARB use within 180 days post-AKI.</div></div><div><h3>Outcomes</h3><div>All-cause mortality, and major adverse kidney events (MAKE) as defined by composite of renal replacement therapy post-AKI, sustained estimated glomerular filtration rate (eGFR) decline<!--> <!-->>30% from baseline, or eGFR<!--> <!-->≤15<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup>.</div></div><div><h3>Analytical Approach</h3><div>We generated propensity weights for ACEi/ARB use post-AKI, using age, sex, comorbid conditions, prior medication, intensive care unit admission, severe sepsis, and index AKI Kidney Disease: Improving Global Outcomes severity. Cox proportional hazard models were used to test associations of post-AKI ACEi/ARB with mortality, MAKE, and joint models for eGFR slopes.</div></div><div><h3>Results</h3><div>A total of 2,309 (70.2%) participants died or experienced MAKE by end of follow-up. 161 (4.9%) and 406 (12.3%) patients initiated or resumed prior ACEi/ARB use within 180 days post-AKI, respectively. Although the overall cohort had no significant mortality association with post-AKI ACEi/ARB use, a significant association with lower mortality was observed in patients with KDIGO 3 AKI (HR, 0.40; 95% CI, 0.21-0.75; <em>P</em><sub>interaction</sub> <!-->=<!--> <!-->0.003). However, post-AKI ACEi/ARB use was associated with increased MAKE in patients without cardiovascular indications for ACEi/ARB use (HR, 1.52; 95% CI, 1.17-1.98; <em>P</em><sub>interaction</sub> <!-->=<!--> <!-->0.03). Although post-AKI use of ACEi/ARB was associated with acute eGFR decline (initial eGFR change<!--> <!-->−2.3<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup>/year; 95% CI, −3.1 to<!--> <!-->−1.5; <em>P</em> <!--><<!--> <!-->0.001), no association with longer-term eGFR decline was observed.</div></div><div><h3>Limitations</h3><div>Retrospective observational study on heterogeneous AKI cohort without data on ACEi/ARB cumulative exposure.</div></div><div><h3>Conclusions</h3><div>Early ACEi/ARB post-AKI was not associated with better long-term survival or kidney function but was associated with lower mortality in patients with KDIGO 3 AKI.</div></div><div><h3>Plain Language Summary</h3><div>Acute kidney injury (AKI) is common in hospitalized adults and increases the risk of death and kidney failure. Although ang","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 5","pages":"Article 100996"},"PeriodicalIF":3.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854533","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":"Acute Kidney Injury Secondary to Pegylated Liposomal Doxorubicin-Associated Renal-limited Thrombotic Microangiopathy","authors":"Tarek S. Karam ,&nbsp;Mrinalini Sarkar ,&nbsp;Jonathan E. Zuckerman","doi":"10.1016/j.xkme.2025.100998","DOIUrl":"10.1016/j.xkme.2025.100998","url":null,"abstract":"<div><div>The emergence of pegylated liposomal doxorubicin (PLD) as a preferred treatment for various malignancies, because of its reduced cardiotoxicity compared with conventional doxorubicin, has raised significant interest. However, the association between PLD and thrombotic microangiopathy (TMA) remains a concerning and relatively rare complication. Here, we present the case of an 80-year-old man with metastatic Kaposi sarcoma who underwent extended PLD monotherapy, subsequently developing kidney-limited TMA demonstrated on kidney biopsy. This led to acute kidney injury necessitating hemodialysis. The patient’s clinical history, laboratory, and kidney biopsy data supported PLD chemotherapy as the primary etiologic factor for the observed kidney-limited TMA, an insidious condition with poor prognosis. This report highlights the need for vigilance and early kidney biopsy in patients with rising serum creatinine concentrations or worsening proteinuria/hematuria during PLD therapy. Understanding the mechanisms underlying PLD-induced TMA, likely involving reactive oxygen species-mediated endothelial dysfunction and platelet aggregation, remains a crucial area for future research to optimize monitoring and management strategies for this rare yet severe complication associated with PLD therapy.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 5","pages":"Article 100998"},"PeriodicalIF":3.2,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855305","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":"Vascular Access Thrombosis Events in Patients With Dialysis-Dependent CKD Treated With Vadadustat or Darbepoetin Alfa: The INNO2VATE Trial Program","authors":"Wolfgang C. Winkelmayer ,&nbsp;Steven K. Burke ,&nbsp;Glenn M. Chertow ,&nbsp;Kai-Uwe Eckardt ,&nbsp;Wenli Luo ,&nbsp;Todd Minga ,&nbsp;Mark J. Sarnak ,&nbsp;Prabir Roy-Chaudhury","doi":"10.1016/j.xkme.2025.100997","DOIUrl":"10.1016/j.xkme.2025.100997","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;In the global phase 3 INNO&lt;sub&gt;2&lt;/sub&gt;VATE program of patients with dialysis-dependent chronic kidney disease (DD-CKD) and CKD-related anemia (2 trials: patients new to [NCT02865850] and established on maintenance dialysis [NCT02892149]), vadadustat was noninferior to the erythropoiesis-stimulating agent darbepoetin alfa for cardiovascular safety and hemoglobin efficacy. Here, we investigated between-group differences in positively adjudicated vascular access thrombosis (VAT) events.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Phase 3, global, open-label, randomized, active-controlled clinical trials.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;A total of 3,902 patients who initiated dialysis within the past 16 weeks (incident DD-CKD trial; N&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;365) or who had been treated with dialysis for&lt;!--&gt; &lt;!--&gt;&gt;12 weeks (prevalent DD-CKD trial; N = 3,537).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Intervention&lt;/h3&gt;&lt;div&gt;Eligible patients randomized 1:1 to vadadustat or darbepoetin alfa.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Positively adjudicated VAT events.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;In the INNO&lt;sub&gt;2&lt;/sub&gt;VATE program, at baseline, 3,590 (92.0%) randomized patients were receiving hemodialysis: 2,709 (69.4%) via an arteriovenous fistula and 340 (8.7%) via an arteriovenous graft. During 6,468 patient-years (PY) of follow-up, there were 426 positively adjudicated VAT events in 266 individual patients, with 146 randomized to vadadustat and 120 randomized to darbepoetin alfa. Corresponding first VAT rates were 4.79 and 3.86 per 100 PY, respectively (rate difference, 0.94; 95% CI, −0.10 to 1.97; hazard ratio [HR], 1.27; 95% CI, 0.99-1.62). When considering first and recurrent events, VAT rates were 6.58 and 6.59 per 100 PY for the vadadustat and darbepoetin alfa groups, respectively (rate difference, −0.01; 95% CI, −1.26 to 1.24; HR, 1.00; 95% CI, 0.83-1.21).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Trials were not specifically designed to assess VAT rates; uncertain generalizability to nontrial populations.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;In this secondary analysis of the INNO&lt;sub&gt;2&lt;/sub&gt;VATE program in patients with DD-CKD and CKD-related anemia receiving hemodialysis, first VAT rates were numerically higher among patients treated with vadadustat versus darbepoetin alfa but statistically not different. The rates of first and recurrent VAT events were similar between treatment groups.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;The phase 3 INNO&lt;sub&gt;2&lt;/sub&gt;VATE program studied patients with dialysis-dependent chronic kidney disease (CKD) and CKD-related anemia in 2 trials: one enrolled patients new to dialysis (365 patients) and another studied patients who had been treated with dialysis for at least 3 months (3,537 patients). In terms of cardiovascular safety and ability to treat CKD-related anemia, vadadustat and darbepoetin alfa were not meaningfully different. This analysis al","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 5","pages":"Article 100997"},"PeriodicalIF":3.2,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855200","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":"Effect of a Population Health Management Intervention on Medication Therapy Problems in People With Chronic Kidney Disease: Post Hoc Analysis of the K-CHAMP Cluster-Randomized Trial","authors":"Melanie R. Weltman ,&nbsp;Zhuoheng Han ,&nbsp;Linda-Marie U. Lavenburg ,&nbsp;Alaa A. Alghwiri ,&nbsp;Jonathan G. Yabes ,&nbsp;Thomas D. Nolin ,&nbsp;Manisha Jhamb","doi":"10.1016/j.xkme.2025.100995","DOIUrl":"10.1016/j.xkme.2025.100995","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Medication therapy problems (MTPs) are therapeutic issues related to medications that may cause undesirable events. People with chronic kidney disease (CKD) are at high risk of experiencing MTPs owing to comorbid conditions and medication burden. This study characterizes MTPs in individuals enrolled in the Kidney Coordinated Health Management Partnership trial and evaluates the intervention’s effect on MTPs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Post hoc analysis of a pragmatic, cluster-randomized trial.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Individuals aged 18-85 years with an estimated glomerular filtration rate of&lt;!--&gt; &lt;!--&gt;&lt;60&lt;!--&gt; &lt;!--&gt;mL/min/1.73&lt;!--&gt; &lt;!--&gt;m&lt;sup&gt;2&lt;/sup&gt;, moderate to high risk of CKD progression, and not seeing a nephrologist enrolled from 101 primary care practices (May 2019 to November 2021).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Intervention(s)&lt;/h3&gt;&lt;div&gt;Electronic health record-based multidisciplinary care including nephrology e-consult, pharmacist medication review, and patient education at baseline and every 6 months.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;MTP type and frequency of occurrence were characterized along with associated medication classes. Descriptive statistics of MTPs were conducted, and cumulative probabilities of resolution over time were estimated using the discrete-time survival method.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Baseline medication reviews were completed by telephone (52%) or chart review (48%) in 730 out of 754 (97%) intervention-arm participants (mean age, 74&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;9 years and estimated glomerular filtration rate, 37&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;8&lt;!--&gt; &lt;!--&gt;mL/min/1.73&lt;!--&gt; &lt;!--&gt;m&lt;sup&gt;2&lt;/sup&gt;). Polypharmacy was evident in 63% of participants. At baseline, 78% had MTPs and 79% had medication discrepancies. The most common MTP was indication without drug therapy, associated with sodium-glucose cotransporter-2 (SGLT-2) inhibitors. The average number of MTPs per participant decreased from 2.01 at baseline to 1.28 at 6 months (36% reduction), and 1.15 at 12 months (43% reduction). Based on the discrete-time survival model, an estimated 92% of MTPs were resolved by 12 months.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Medication management was not completed for control-arm participants. No standardized tool was used to assess medication adherence. We relied on electronic health record chart review to identify MTPs in participants who could not be reached by telephone.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;MTPs and medication discrepancies are highly prevalent in nondialysis-dependent CKD. Medication management through multidisciplinary team care can optimize medication therapy in CKD.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;People with chronic kidney disease (CKD) are at risk of experiencing medication therapy problems (MTPs), which are issues related to medications that may cause undesirable events. In this study, we chara","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 5","pages":"Article 100995"},"PeriodicalIF":3.2,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855199","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":"Genetic Testing in Biopsy-Confirmed Kidney Disease","authors":"Insa M. Schmidt MD, MPH ,&nbsp;Ashish Verma MBBS ,&nbsp;Sophie E. Claudel MD ,&nbsp;Ragnar Palsson MD ,&nbsp;Anand Srivastava MD, MPH ,&nbsp;Isaac E. Stillman MD ,&nbsp;Laurence H. Beck Jr. MD, PhD ,&nbsp;Sushrut S. Waikar MD, MPH","doi":"10.1016/j.xkme.2025.100994","DOIUrl":"10.1016/j.xkme.2025.100994","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 5","pages":"Article 100994"},"PeriodicalIF":3.2,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852022","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":"Evaluation of Light Chain Removal Rates in Blood Purification Therapy for Light Chain Cast Nephropathy","authors":"Hisashi Kamido ,&nbsp;Shigekazu Kurihara ,&nbsp;Yuki Oba ,&nbsp;Kaito Hirota ,&nbsp;Kansei Suzuki ,&nbsp;Masayuki Yamanouchi ,&nbsp;Tatsuya Suwabe ,&nbsp;Kei Kono ,&nbsp;Kenichi Ohashi ,&nbsp;Yoshifumi Ubara ,&nbsp;Naoki Sawa","doi":"10.1016/j.xkme.2025.100993","DOIUrl":"10.1016/j.xkme.2025.100993","url":null,"abstract":"<div><div>Acute kidney injury is a crucial prognostic factor for multiple myeloma. The most common cause is light chain cast nephropathy. The primary pathology of light chain-induced acute kidney injury involves obstruction of distal tubules due to the interaction of free light chains (FLCs) with Tamm-Horsfall protein produced there. Based on this pathology, chemotherapy is used to suppress the production of FLCs. Recently, combined blood purification therapies to remove existing FLCs have been used. However, the extent to which FLCs are removed by blood purification therapy remains unclear. We investigated the dialysis removal rates under various conditions and found that hemodialysis achieved 16% removal, plasma exchange 75%, and online hemodiafiltration varied from 20% to 31%. Although online hemodiafiltration is less effective than plasma exchange, it is a viable option that does not require albumin infusions or lead to infections. Despite hematologic remission, renal recovery was limited by a high number of casts, severe interstitial fibrosis and tubular atrophy, and the delay in treatment initiation.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 5","pages":"Article 100993"},"PeriodicalIF":3.2,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852026","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":"CKD Knowledge and CKD Report Card Use During a Nephrology Encounter: A Randomized Trial","authors":"Jillian Bowman ,&nbsp;Christina Zhou ,&nbsp;Lindsay Zasadzinski ,&nbsp;Mengqi Zhu ,&nbsp;Milda R. Saunders","doi":"10.1016/j.xkme.2025.100991","DOIUrl":"10.1016/j.xkme.2025.100991","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><div>Higher chronic kidney disease (CKD) knowledge and health literacy (HL) are associated with improved CKD outcomes. We sought to determine if the CKD Report Card intervention increased CKD knowledge in patients regardless of HL level.</div></div><div><h3>Study Design</h3><div>A block-randomized trial by clinic session.</div></div><div><h3>Setting &amp; Participants</h3><div>Patients with CKD 3 or above in an urban academic nephrology clinic.</div></div><div><h3>Intervention</h3><div>The intervention group received the CKD Report Card, a 2-sided information sheet, before the clinic visit.</div></div><div><h3>Outcomes</h3><div>Kidney Knowledge Survey pre–post-visit score change.</div></div><div><h3>Results</h3><div>Of 91 participants, the average age was 66.2 years, 64.8% identified as African American, 41.8% were male, and 11.0% had inadequate HL. The control group’s (n<!--> <!-->=<!--> <!-->53) mean pre-visit knowledge score was 55.8% with a post–pre-score change of 0.9 (95% confidence intervals [CI], −1.3 to 3.2). The intervention group’s (n<!--> <!-->=<!--> <!-->38) mean pre-visit score was 60.2% with a score change of 19.2 (95% CI, 15.2-23.3). The difference in score change between the control group and intervention group was<!--> <!-->−18.4 (95% CI, −22.6 to<!--> <!-->−14.1). In addition, there was no significant difference in knowledge gained by adequate and inadequate HL for the control group (<em>P</em> <!-->=<!--> <!-->0.6) or the intervention group (<em>P</em> <!-->=<!--> <!-->0.6). In the fully adjusted multivariable model, the HL ×<!--> <!-->group interaction term was not significant (β = −6.1; <em>P</em> <!-->=<!--> <!-->0.4). Pre-visit score (β = −0.2; <em>P</em> <!-->&lt;<!--> <!-->0.01) and intervention group (β<!--> <!-->=<!--> <!-->19.0; <em>P</em> <!-->&lt;<!--> <!-->0.001) were significant.</div></div><div><h3>Limitations</h3><div>Limited generalizability because the study took place at 1 academic medical center and there were only a small proportion of patients with inadequate HL.</div></div><div><h3>Conclusions</h3><div>The CKD Report Card is a low-touch, low-cost intervention that improved CKD knowledge for all patients in our urban nephrology clinic regardless of HL level.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 5","pages":"Article 100991"},"PeriodicalIF":3.2,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855197","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":"Commercial Health Insurance and Quality of Care in US Dialysis Facilities","authors":"Anshul Bhatnagar ,&nbsp;Allison C. Reaves ,&nbsp;Daniel E. Weiner ,&nbsp;Kevin F. Erickson","doi":"10.1016/j.xkme.2025.100992","DOIUrl":"10.1016/j.xkme.2025.100992","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Commercial health insurance typically reimburses at a higher rate for dialysis than Medicare. A recent ruling by the US Supreme Court could result in many commercially insured patients who receive dialysis forgoing their private health insurance and shifting to Medicare as the primary payer. Our objective was to determine whether differences in commercial payers as a proportion of payer mix affect the quality of care at dialysis facilities.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Cross-sectional study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Population&lt;/h3&gt;&lt;div&gt;We examined US patients receiving dialysis from US Dialysis Facility Reports and the Dialysis Facility Compare websites in 2019.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposures&lt;/h3&gt;&lt;div&gt;Percentage of prevalent dialysis patients with commercial health insurance.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Seven key dialysis facility quality metrics included in Dialysis Facility Compare star ratings.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Multivariable linear regression models adjusted for observed confounders.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among 7,194 US dialysis facilities, an average of 4.4% of prevalent dialysis patients had commercial insurance. Each 10% absolute increase in the percentage of dialysis patients in a facility with commercial insurance was associated with an adjusted 8.3% (3.0%-13.6%) lower standardized mortality ratio. Commercial health insurance was not significantly associated with the remaining quality metrics examined, including standardized fistula rate, long-term catheter rate, standardized hospitalization ratio, standardized transfusion ratio, dialysis adequacy, and In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems patient experience score.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;The potential for unobserved confounders including social risk factors limits the ability to make causal inferences.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions and Relevance&lt;/h3&gt;&lt;div&gt;Dialysis facilities with a higher percentage of patients with commercial health insurance had better performance in standardized mortality ratio. If this association reflects a causal connection, then increased shifting of coverage from commercial health insurance to Medicare could adversely affect the quality of care at dialysis facilities.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;div&gt;A recent US Supreme Court decision may lead US patients receiving dialysis to shift from commercial health insurance to Medicare. Our objective was to determine whether differences in commercial payers as a proportion of dialysis facility payer mix affect the quality of care at dialysis facilities. In an analysis of dialysis facility quality ratings from 2019, more commercial insurance was associated with better performance in standardized mortality ratio but not with other key dialysis facility quality measures. This finding suggests that the shifting of coverage from c","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 5","pages":"Article 100992"},"PeriodicalIF":3.2,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855198","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}