Kidney Medicine最新文献

{"title":"Subcutaneous Daratumumab in Recurrent Posttransplant Focal Segmental Glomerulosclerosis: A Report of 2 Cases","authors":"Andreja Aleš Rigler,&nbsp;Tanja Belčič Mikič,&nbsp;Matic Bošnjak,&nbsp;Miha Arnol","doi":"10.1016/j.xkme.2026.101473","DOIUrl":"10.1016/j.xkme.2026.101473","url":null,"abstract":"<div><div>Recurrent primary focal segmental glomerulosclerosis (FSGS) after kidney transplantation requires prolonged treatment, often with unsatisfactory results. We report 2 cases of FSGS recurrence that achieved remission with subcutaneous daratumumab and propose novel mechanisms of its action that demonstrate efficacy in this disease. The first patient was a 51-year-old woman who experienced early FSGS recurrence 1 month after transplantation. With regular biweekly plasma exchange, her daily proteinuria was 1-1.5 g, and the estimated glomerular filtration rate was 43 mL/min/1.73 m². Although 2 doses of rituximab depleted CD19/20 B lymphocytes, they were ineffective in reducing proteinuria, leading to the reintroduction of plasma exchange. Based on histological persistence of FSGS at the 1-year surveillance biopsy, subcutaneous daratumumab treatment was initiated, which led to a rapid decrease in proteinuria and disease remission. The second patient was a 25-year-old woman with a second relapse of FSGS 7 years after transplantation, which was immune adsorption dependent as rituximab was ineffective in inducing remission. A kidney biopsy performed 2 years later showed persistence of FSGS as well as chronic active antibody-mediated rejection. Daratumumab treatment was initiated using the chronic active antibody-mediated rejection treatment protocol. With this treatment, daily proteinuria decreased from 6 g to 0.3-0.5 g, and immune adsorption was discontinued. In conclusion, daratumumab shows promise in controlling recurrent FSGS in selected kidney transplant recipients with potential mechanisms beyond plasma and natural killer cells.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 9","pages":"Article 101473"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148855499","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":"New-Onset Heart Failure in Hemodialysis Patients: Association With Access Location and Access Flow in a Nationwide Cohort From Sweden","authors":"Emelie Laveborn,&nbsp;Ellinor Bergdahl,&nbsp;Ulrika Hahn Lundström,&nbsp;Bernd Stegmayr,&nbsp;Michael Ott","doi":"10.1016/j.xkme.2026.101427","DOIUrl":"10.1016/j.xkme.2026.101427","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;There is increasing evidence that arteriovenous fistulas (AVFs) might alter cardiac function. Upper arm AVFs are associated with higher access flow, and their use is increasing. It has been hypothesized that the creation of upper arm AVFs would lead to a higher incidence of heart failure compared with forearm AVFs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Retrospective cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;All patients who received a hemodialysis access between 2013 and 2022 in Sweden. Patients with prevalent heart failure or previous hemodialysis were excluded.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure or Predictor&lt;/h3&gt;&lt;div&gt;Type of hemodialysis access and access flow.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome&lt;/h3&gt;&lt;div&gt;New-onset heart failure.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Cox proportional hazards regression for type of access and restricted cubic splines for access flow. Comorbid conditions were included as covariates in both models.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;In total, 10,170 patients were included. Of those, 6,579 patients with a total of 11,238 accesses remained after excluding patients with prevalent heart failure or prevalent hemodialysis. The risk of new-onset heart failure was comparable between forearm and upper arm AVF (&lt;em&gt;P&lt;/em&gt; = 0.57). Access flow was highest in upper arm AVF (&lt;em&gt;P&lt;/em&gt; &lt; 0.001), but there was a substantial overlap. The risk of heart failure development depending on access flow was nonlinear (&lt;em&gt;P&lt;/em&gt; &lt; 0.001) with increased risk in patients with lowest as well as the highest flow.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Reliance on International Classification of Diseases (ICD)-10 codes is a limitation because of potential underascertainment and misclassification. The findings may not be generalizable to settings where upper arm AVF are used more liberally than in Sweden.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Upper arm AVFs were not associated with the development of heart failure. Comorbid conditions such as ischemic heart disease, heart valve disease, and diabetes as well as age were more important factors for the development of heart failure than access type. The association between access flow and new-onset heart failure is U-shaped.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Hemodialysis requires access to the bloodstream, most often through an arteriovenous fistula. Fistulas created in the upper arm are increasingly used and usually have higher blood flow than those created in the forearm. This has raised concerns that they might cause heart failure. We studied all patients in Sweden who received a hemodialysis access between 2013 and 2022 and did not have heart failure beforehand. We found no increased risk of heart failure with upper arm fistulas. Patients with very low or very high blood flow had the highest risk. Development of heart failure was mainly related to the presence of heart and vascular disease ","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 8","pages":"Article 101427"},"PeriodicalIF":4.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13416664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148620586","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":"Associations Between the Vitamin D Levels and Urinary Albumin-Creatinine Ratio in Adults With Hypertension","authors":"Youxue Zhang,&nbsp;Xuexun Chen,&nbsp;Xiangming Wang,&nbsp;Min Guo,&nbsp;Shujuan Qiu","doi":"10.1016/j.xkme.2026.101445","DOIUrl":"10.1016/j.xkme.2026.101445","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Hypertension is a major risk factor for cardiovascular and kidney diseases. Although an elevated urinary albumin-creatinine ratio (UACR)—even within the normal range—predicts increased cardiovascular risk, and vitamin D level is associated with UACR in general populations, this relationship remains unclear in individuals with hypertension.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;This study employed a cross-sectional design using data from the National Health and Nutrition Examination Survey (NHANES, 1999-2018).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;The study involved a cohort of 37,554 individuals, comprising 19,802 patients with hypertension and 17,752 nonhypertensive individuals from the United States, with a mean age of 46.7 ± 16.8 years.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;Serum vitamin D levels.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome&lt;/h3&gt;&lt;div&gt;UACR.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Survey-weighted multivariable regression models were applied to assess the relationship between vitamin D level and log&lt;sub&gt;2&lt;/sub&gt;-transformed UACR. Restricted cubic splines, subgroup analyses, and sensitivity analyses were conducted to examine the nature and robustness of the association.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;In patients with hypertension, the inverse association between vitamin D level and UACR was more pronounced than in nonhypertensive individuals (&lt;em&gt;P&lt;/em&gt; for interaction = 0.03). Vitamin D deficiency was associated with 17.3% higher geometric mean UACR (β = 0.23) than insufficiency, whereas sufficient levels showed no significant difference (&lt;em&gt;P&lt;/em&gt; = 0.51). A threshold effect was identified at approximately 60 nmol/L, with levels below this point showing a significant negative correlation (β = −0.14, equivalent to a 9.3% reduction in UACR, &lt;em&gt;P&lt;/em&gt; &lt; 0.001). These consistent findings were corroborated by subgroup and sensitivity analyses.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;The observational design precludes causal inferences, and residual confounding may persist despite adjustments. Generalizability may be limited, because data were derived from a single US cohort, and both vitamin D level and UACR relied on single measurements.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;There is an L-shaped inverse association between serum vitamin D levels and UACR among US adults with hypertension.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;High blood pressure increases the risk of kidney damage, often signaled by protein in the urine. Vitamin D level is linked to this marker in the general population, but its role in hypertension is unclear. We analyzed 20 years of national health data. In adults with hypertension, lower vitamin D concentration was consistently linked to higher urine protein—a pattern stronger than in those without hypertension. This relationship was not linear; it only became evident when vitamin D dropped below a certain level. Our findings su","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 8","pages":"Article 101445"},"PeriodicalIF":4.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13416665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148620591","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":"Association of Serum Chloride Concentration With All-Cause and Cardiovascular Mortality in Patients Undergoing Peritoneal Dialysis: The Fukuoka Peritoneal Dialysis Registry","authors":"Tomoya Hamashoji,&nbsp;Shoji Tsuneyoshi,&nbsp;Kazuhiro Okamura,&nbsp;Shunsuke Yamada,&nbsp;Kazuhiko Tsuruya,&nbsp;Toshiaki Nakano,&nbsp;Tetsuro Ago","doi":"10.1016/j.xkme.2026.101441","DOIUrl":"10.1016/j.xkme.2026.101441","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Low serum chloride concentration is linked to mortality in chronic kidney disease and hemodialysis, but evidence in peritoneal dialysis (PD) has largely come from incident cohorts. We evaluated whether serum chloride concentration at registry enrollment is independently associated with all-cause and cardiovascular mortality among maintenance PD patients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Multicenter retrospective cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;The Fukuoka Peritoneal Dialysis Registry (F-PDR) enrolled PD patients from 20 centers in Japan (2011-2020). Enrollment in this cohort study was not restricted to the time of PD initiation. After excluding patients with PD duration &lt;90 days at F-PDR enrollment, 1,049 maintenance PD patients were analyzed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;Serum chloride concentration at registry enrollment, categorized into tertiles (T1 &lt;96, T2 96-99, and T3 &gt;99 mmol/L).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;All-cause mortality (primary) and cardiovascular mortality (secondary).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Cox proportional hazards models estimated HR and 95% CI with multivariable adjustment including serum sodium and other prespecified covariates. Missing covariates were handled with multiple imputation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Over a median follow-up of 731 days, 179 patients (17.1%) died, including 59 (5.6%) from cardiovascular causes. In the fully adjusted model, compared with T3 (&gt;99 mmol/L), T1 (&lt;96 mmol/L) was associated with higher risks of all-cause mortality (HR, 2.59; 95% CI, 1.55-4.34) and cardiovascular mortality (HR, 3.33; 95% CI, 1.28-8.66).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Observational design with potential residual confounding. Serum chloride and covariates were measured only at registry enrollment. Serum bicarbonate was unavailable. Generalizability may be limited.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;In maintenance PD patients, lower serum chloride concentration was independently associated with increased all-cause and cardiovascular mortality risks, suggesting serum chloride may be a useful marker for risk assessment.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Chloride is a common blood electrolyte, but it has received less attention than sodium in kidney research. Recent studies suggest that low serum chloride may be linked to worse outcomes in people with kidney disease, but this has not been well studied in patients continuing peritoneal dialysis. In this study, we used data from a multicenter dialysis registry in Japan to examine whether serum chloride is related to survival in patients continuing peritoneal dialysis. We found that patients with lower serum chloride had a higher risk of death, including from cardiovascular causes. These results suggest that serum chloride may be a simple and widely available marker that could help identify","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 8","pages":"Article 101441"},"PeriodicalIF":4.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13420716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630897","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":"Efficacy Trial of a Mobile Application for Fluid Intake Management in Patients Receiving Chronic Hemodialysis Therapy","authors":"Michael Rocco,&nbsp;Marion Rigaud,&nbsp;Carole Ertel,&nbsp;Greg Russell,&nbsp;Juliane Zemdegs,&nbsp;Mariacristina Vecchio","doi":"10.1016/j.xkme.2026.101443","DOIUrl":"10.1016/j.xkme.2026.101443","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Increased interdialytic weight gain (IDWG) is associated with increased morbidity and mortality in patients receiving chronic hemodialysis. We evaluated the efficacy of a smartphone-based application (app) designed to support reductions in interdialytic fluid intake.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Pre–post intervention study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Adult patients receiving chronic hemodialysis with mean IDWG &gt;3.5% over a 3-month period were recruited from outpatient hemodialysis units in central North Carolina, United States.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Intervention&lt;/h3&gt;&lt;div&gt;Participants were trained to use a smartphone-based app that allowed recording fluid intake and incorporated behavioral support features (eg, goal setting, prompts, feedback). The patients were asked to use the app daily during the 8-week active phase of the trial.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;The primary study outcome was the change in mean IDWG from baseline (before app usage) to the 8-week active phase. Secondary outcomes included app safety and usage. IDWG was also assessed during a 6-month passive phase to monitor for possible long-term behavioral changes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Twenty-three patients completed the 8-week active phase and provided app data. Compared with baseline, mean IDWG for the 3-day interdialytic interval decreased by −0.52 ± 0.24 lb (&lt;em&gt;P&lt;/em&gt; = 0.032) during the active phase and −0.86 ± 0.96 lb (&lt;em&gt;P&lt;/em&gt; &lt; 0.01) during the passive phase. No safety concerns (defined as &gt;50% increase in IDWG) were observed. During the active phase, app was used on ≥80% of the days by 65% of participants and daily by 26% of participants. Reductions in IDWG were sustained during the passive phase. Correlations between app-recorded fluid intake and IDWG were weak and not statistically significant.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;This uncontrolled pre–post study was subject to selection bias toward more technologically literate and adherent participants, did not meet recruitment targets, and lacked urine output data.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Use of a smartphone-based app designed to support fluid intake restriction is feasible and associated with sustained reductions in IDWG among patients receiving chronic hemodialysis, without safety concerns.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Excessive weight gains between hemodialysis sessions increase the risk of hospitalization and death. We developed a smartphone app that allows patients to record their fluid intake on a daily basis. The app also provides practical tips to help limit fluid intake and grants digital rewards when goals are met. We found that, on average, patients gained less weight between dialysis sessions while using the app compared with the period before they used it. These results suggest that smartphones apps that combine fluid intake tracking with behavi","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 8","pages":"Article 101443"},"PeriodicalIF":4.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13396856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148584580","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":"The Downstream Economic Impact of Transplant Nephrologists: A Single-Center Analysis","authors":"Deirdre Sawinski MD,&nbsp;Will Simmons MPH,&nbsp;Sri Lekha Tummalapalli MD, MBA, MAS,&nbsp;John J. Friedewald MD","doi":"10.1016/j.xkme.2026.101442","DOIUrl":"10.1016/j.xkme.2026.101442","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 8","pages":"Article 101442"},"PeriodicalIF":4.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148634601","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":"Association of Cystatin C- and Creatinine-Based Estimated Glomerular Filtration Rate With Adverse Outcomes in Heart Failure With Preserved Ejection Fraction","authors":"Bethany Roehm,&nbsp;Xiaoyue Zhang,&nbsp;Jie Yang,&nbsp;John Haley,&nbsp;Justin L. Grodin,&nbsp;S. Susan Hedayati","doi":"10.1016/j.xkme.2026.101435","DOIUrl":"10.1016/j.xkme.2026.101435","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale and Objective&lt;/h3&gt;&lt;div&gt;Cystatin C-based versus creatinine-based measures of estimated glomerular filtration rate (eGFR) are more predictive of worse outcomes in people with heart failure with reduced ejection fraction (HFrEF). It is unknown if cystatin C-based measures may also yield more accurate prognoses in heart failure with preserved ejection fraction (HFpEF).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;A longitudinal analysis of people with HFpEF.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;214 participants from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial with available serum at baseline and 12 months in the National Heart, Lung, and Blood Institute’s Biologic Specimen and Data Repository Information Coordinating Center.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposures&lt;/h3&gt;&lt;div&gt;Baseline, time-varying, or change over 12 months in eGFRcr, eGFRcys, and eGFRcr-cys&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Composite of aborted cardiac arrest, heart failure hospitalization, or cardiovascular death.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Fine-Gray and joint models.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Median follow-up was (IQR) 3.09 (2.07-4.44) years. All 3 baseline eGFR measures were independently associated with the risk of the composite endpoint, after adjustment for race, diabetes mellitus, and body mass index: HR (95% CI) per 5mL/min/1.73m&lt;sup&gt;2&lt;/sup&gt; lower eGFR: eGFRcr, 1.16 (1.04-1.28); eGFRcys, 1.20 (1.08-1.34); eGFRcr-cys, 1.19 (1.08-1.32). After adjusting for NT-proBNP and age, no baseline eGFR measure was statistically significantly associated with the composite endpoint. Only a relative decline in eGFRcr-cys from baseline to 12 months was associated with the composite endpoint in fully adjusted models: eGFRcr-cys, HR 1.31 (1.02-1.67); per 10% eGFR decrease). Lower eGFR at any timepoint, using all 3 measures, was associated with the composite endpoint in fully-adjusted models.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;small number of events, possible survival bias&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;A decline in eGFRcr-cys from baseline to 12 months is associated with adverse cardiovascular outcomes in people with HFpEF. Measures of eGFR that incorporate only cystatin C may not be of greater prognostic value in people with HFpEF than measures that also incorporate serum creatinine.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Cystatin C-based measures of kidney function have been more predictive of adverse outcomes in people with heart failure with reduced ejection fraction (HFrEF), but their prognostic utility in heart failure with preserved ejection fraction (HFpEF) is unclear. In a longitudinal analysis of 214 participants from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial, a HFpEF population, we found that a relative decline in eGFRcr-cys from baseline to 12 months was associated with adverse cardiovascular ","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 8","pages":"Article 101435"},"PeriodicalIF":4.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13396861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148584636","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":"Trajectories of Serum Total Carbon Dioxide and the Risk of Cardiorenal Outcomes in Chronic Kidney Disease: Results From the KNOW-CKD Study","authors":"Semin Cho,&nbsp;Wookyung Chung,&nbsp;Young Youl Hyun,&nbsp;Jong Cheol Jeong,&nbsp;Seung Hyeok Han,&nbsp;Sue Kyung Park,&nbsp;Kook-Hwan Oh,&nbsp;Ji Yong Jung","doi":"10.1016/j.xkme.2026.101425","DOIUrl":"10.1016/j.xkme.2026.101425","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><div>Serum bicarbonate concentrations vary over time in chronic kidney disease (CKD), but most studies have focused on baseline values rather than longitudinal trajectories. We aimed to determine the association between long-term patterns of serum total carbon dioxide (tCO₂) and adverse renal and cardiovascular outcomes.</div></div><div><h3>Study Design</h3><div>Longitudinal cohort study.</div></div><div><h3>Setting &amp; Participants</h3><div>Patients with CKD enrolled in a prospective cohort with repeated tCO₂ measurements.</div></div><div><h3>Exposure</h3><div>tCO₂ trajectories identified using group-based trajectory modeling: Low, Intermediate, High, and Improving.</div></div><div><h3>Outcome</h3><div>Renal composite outcome and major cardiovascular events.</div></div><div><h3>Analytical Approach</h3><div>Cox proportional hazards models adjusted for demographic, clinical, and laboratory covariates.</div></div><div><h3>Results</h3><div>Compared with the Intermediate group, the Low trajectory group had higher risk of renal events (HR, 2.08; 95% CI, 1.25-3.46). The High trajectory group showed a trend toward lower renal risk (HR, 0.57; 95% CI, 0.31-1.03), with time-dependent protective effects during prolonged follow-up. The Improving group showed no significant differences in renal or cardiovascular risk but demonstrated a numerically lower incidence of the renal endpoint. Cardiovascular outcomes did not differ across trajectories.</div></div><div><h3>Limitations</h3><div>Observational design and potential residual confounding.</div></div><div><h3>Conclusions</h3><div>Persistent low tCO₂ was associated with increased renal risk, whereas high levels conferred delayed protection. The Improving group showed intermediate risk. Longitudinal monitoring of tCO₂ may help guide individualized bicarbonate therapy in CKD.</div></div><div><h3>Plain-Language Summary</h3><div>The kidneys help maintain the body’s acid–base balance. As kidney function declines, blood total carbon dioxide (tCO₂), a surrogate for bicarbonate, may decrease and contribute to kidney damage. In this study, we followed people with chronic kidney disease over time and examined longitudinal patterns of blood tCO₂ rather than relying on a single measurement. We found that patients with persistently low tCO₂ levels had a higher risk of chronic kidney disease progression, whereas those with consistently higher levels had better outcomes. Importantly, patients whose tCO₂ levels improved during follow-up showed intermediate risk, suggesting that recovery of acid–base status may be clinically meaningful. Monitoring changes in tCO₂ over time may help identify patients at higher risk and guide kidney-protective care.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 8","pages":"Article 101425"},"PeriodicalIF":4.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13416662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148619909","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":"Survival of Older Adults Choosing Dialysis or Conservative Kidney Management, Stratified by Suitability for Dialysis","authors":"Micha Jongejan,&nbsp;Marjolijn van Buren,&nbsp;Wouter R. Verberne,&nbsp;Gurbey Ocak,&nbsp;Willem Jan W. Bos","doi":"10.1016/j.xkme.2026.101430","DOIUrl":"10.1016/j.xkme.2026.101430","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Previous studies indicate survival benefit for dialysis over conservative kidney management (CKM), which attenuates in patients ≥80 years or with high comorbidity. Most studies did not differentiate dialysis suitability among those choosing CKM, potentially biasing outcomes. We aimed to describe survival outcomes in patients choosing dialysis, patients suitable for dialysis who chose CKM, and patients less suitable for dialysis who chose CKM.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study design&lt;/h3&gt;&lt;div&gt;Single-center cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;We included patients aged ≥65 years with a documented treatment decision for dialysis or CKM between 2017 and 2024.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;Chosen treatment (dialysis or CKM). Patients choosing CKM were classified as suitable or less suitable for dialysis, based on the treating nephrologist’s.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome&lt;/h3&gt;&lt;div&gt;The primary outcome was all-cause mortality.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Descriptive, using Kaplan–Meier estimates and Cox proportional hazard models without adjustment for confounding.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Median survival from treatment decision was 53 (dialysis), 32 (CKM, suitable for dialysis), and 18 months (CKM, less suitable for dialysis), with unadjusted hazard ratios of 2.11 (CKM, suitable for dialysis vs dialysis; 95% CI 1.59-2.80) and 3.23 (less suitable for dialysis vs dialysis; 95% CI 2.47-4.23). Among patients aged ≥80 years, hazard ratios were 1.89 (0.99-1.74) for CKM suitable for dialysis versus dialysis and 2.35 (1.31-4.64) for CKM less suitable for dialysis versus dialysis. Thirteen percent of patients who initially chose dialysis switched to CKM, whereas 1% transitioned from CKM to dialysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Subjectivity in dialysis suitability assessment.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;In this cohort of older patients with kidney failure, survival outcomes in patients choosing CKM suitable for dialysis were longer than previously reported. These findings highlight the importance of distinguishing dialysis suitability when evaluating survival outcomes in CKM and dialysis. This supports more individualized shared decision making in older adults with advanced kidney disease.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Older adults with advanced kidney disease often face a difficult decision whether to choose dialysis or conservative kidney management (CKM). Earlier studies did not clarify whether patients opting for CKM were medically eligible for dialysis, making results less applicable for people who face a genuine choice between treatments. This study described survival outcomes in people aged 65 years and older. People who chose dialysis lived about 53 months after making their treatment decision, people who chose CKM and were considered suitable for dialysis lived about 32 months, and people who chose CK","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 8","pages":"Article 101430"},"PeriodicalIF":4.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13416626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148620719","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":"Defining Complete Remission in Nephrotic Syndrome: One Size May Not Fit All","authors":"Nobuo Tsuboi,&nbsp;Takaya Sasaki","doi":"10.1016/j.xkme.2026.101438","DOIUrl":"10.1016/j.xkme.2026.101438","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 8","pages":"Article 101438"},"PeriodicalIF":4.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13393661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148579178","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}