Kidney Medicine最新文献

{"title":"Association of Plasma KIM-1, TNFR-1, and TNFR-2 With Cardiovascular Outcomes and All-Cause Mortality in Individuals With Chronic Kidney Disease: An Ancillary Analysis of SPRINT","authors":"Nicholas Wettersten , Ronit Katz , Simon B. Ascher , Rebecca Scherzer , Alexander L. Bullen , Teresa K. Chen , Kasey Campos , Pranav S. Garimella , Michelle M. Estrella , Michael G. Shlipak , Joachim H. Ix","doi":"10.1016/j.xkme.2025.101024","DOIUrl":"10.1016/j.xkme.2025.101024","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Among individuals with chronic kidney disease (CKD), higher blood levels of kidney injury molecule-1 (KIM-1) and soluble tumor necrosis factor receptors (TNFR-1 and TNFR-2) have been associated with greater risk of CKD progression. Their associations with risk of cardiovascular disease (CVD) and all-cause mortality in individuals with CKD remain uncertain.</div></div><div><h3>Study Design</h3><div>An observational cohort study.</div></div><div><h3>Setting & Participants</h3><div>Systolic Blood Pressure Intervention Trial participants with hypertension and CKD (eGFR<!--> <!--><60<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup>) but without diabetes.</div></div><div><h3>Predictors</h3><div>Plasma KIM-1, TNFR-1, and TNFR-2.</div></div><div><h3>Outcomes</h3><div>A composite CVD outcome (acute coronary syndrome/myocardial infarction, stroke, heart failure, and CVD death) and all-cause mortality.</div></div><div><h3>Analytic Approach</h3><div>Cox proportional hazards models, adjusting for CVD risk factors, eGFR, and urine albumin-to-creatinine ratio.</div></div><div><h3>Results</h3><div>Total of 2,350 participants with a mean age of 73<!--> <!-->±<!--> <!-->9 years, eGFR of 46<!--> <!-->±<!--> <!-->10<!--> <!-->mL/min/1.73m<sup>2</sup> and 25% prevalence of CVD. Over more than 3 years follow-up, 293 CVD events (12%) and 160 deaths (7%) occurred. Higher KIM-1, TNFR-1, and TNFR-2 were associated with higher risk of the composite CVD outcome after adjusting for CVD risk factors, but associations were no longer significant after adjusting for eGFR and urine albumin-to-creatinine ratio (KIM-1: HR<!--> <!-->=<!--> <!-->1.13, 95% CI, 0.99-1.30; TNFR-1: HR<!--> <!-->=<!--> <!-->1.03, 95% CI, 0.72-1.46; TNFR-2: HR<!--> <!-->=<!--> <!-->0.98, 95% CI, 0.76-1.26). In contrast, in fully adjusted models, higher plasma KIM-1 and TNFR-1, but not TNFR-2, were associated with higher risk of all-cause mortality (KIM-1: HR<!--> <!-->=<!--> <!-->1.23, 95% CI, 1.01-1.49; TNFR-1: HR<!--> <!-->=<!--> <!-->2.09, 95% CI, 1.14-3.83; TNFR-2: HR<!--> <!-->=<!--> <!-->1.19, 95% CI, 0.85-1.66).</div></div><div><h3>Limitations</h3><div>No individuals with diabetes or stroke.</div></div><div><h3>Conclusions</h3><div>In individuals with hypertension and nondiabetic CKD, associations of higher plasma KIM-1, TNFR-1, and TNFR-2 concentrations with CVD events were not independent of eGFR and albuminuria, whereas higher levels of plasma KIM-1 and TNFR-1 were independently associated with greater risk of all-cause mortality.</div></div><div><h3>Plain-Language Summary</h3><div>Blood levels of kidney injury molecule-1 (KIM-1) and soluble tumor necrosis factor receptors (TNFR-1 and TNFR-2) have been associated with progression of kidney disease. We evaluated if these biomarkers were associated with risk of cardiovascular events and all-cause mortality in individuals without diabetes with hypertension and chronic kidney disease from the Systolic B","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 7","pages":"Article 101024"},"PeriodicalIF":3.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144571339","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 Outcome Measures in CKD-Associated Pruritus: A Systematic Review.","authors":"Linyu Bai, Jia Shi, Xiaogang Du","doi":"10.1016/j.xkme.2025.101055","DOIUrl":"https://doi.org/10.1016/j.xkme.2025.101055","url":null,"abstract":"<p><p>Chronic kidney disease-associated pruritus (CKD-aP) is a common and burdensome dermatologic condition in which patients can experience various symptoms. This study aimed to summarize and describe the patient-reported outcomes (PROs) and patient-reported outcome measures (PROMs) used in CKD-aP studies over the past 5 years. A total of 99 studies were identified, which included 5 different PROs and 40 different PROMs. The most frequently evaluated PRO was pruritus (n = 99), followed by health-related quality of life (HRQoL) (n = 31), sleep disturbances (n = 12), psychiatric symptoms (n = 7), and other skin symptoms (n = 5). Among the 40 different PROMs, 19 were generic, 18 were skin-specific, and 3 were CKD-specific. The most commonly used PROMs in the PROs of pruritus, HRQoL, sleeping, and psychiatric symptoms were the visual analog scale (n = 47), dermatological life quality index (n = 8), Pittsburgh sleep quality index (n = 7), and Beck depression inventory (n = 3), respectively. The PROs and PROMs are common and effective tools for evaluating CKD-aP, but more high-quality studies and guidelines are needed to reach a clear consensus on their application.</p>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 8","pages":"101055"},"PeriodicalIF":3.4,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12311519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760444","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":"RECOVID: Retrospective Observational Study of Renal Outcomes and Long-Term Mortality in Patients With COVID-19-Associated AKI, A Comparison Between Vaccinated and Unvaccinated Patients","authors":"Niloofar Nobakht ,&nbsp;Charley Jang ,&nbsp;Tristan Grogan ,&nbsp;Peter Fahim ,&nbsp;Ira Kurtz ,&nbsp;Joanna Schaenman ,&nbsp;James Wilson ,&nbsp;Mohammad Kamgar ,&nbsp;RECOVID Investigators","doi":"10.1016/j.xkme.2025.101020","DOIUrl":"10.1016/j.xkme.2025.101020","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Acute kidney injury (AKI) is a common complication in patients with Coronavirus disease-2019 (COVID-19) infections, with rates as high as 32% to 46%, and it has been associated with poor outcomes. However, the long-term renal and survival outcomes among hospitalized patients with COVID-19 and AKI are not fully understood.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;A 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;Total of 972 adult patients admitted with COVID-19 infection and AKI at a single large urban academic medical center from March 1, 2022, to March 30, 2022. Among these, 411 (42.3%) did not receive a dose of a US FDA-approved COVID-19 vaccine, and 467 (48.0%) had completed the primary vaccine series.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;Patients admitted with COVID-19 infection and AKI were analyzed using vaccination status as the exposure. Additional exposures included demographics, comorbid conditions, and need for continuous renal replacement therapy (CRRT) during hospitalization.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome&lt;/h3&gt;&lt;div&gt;The primary outcome was in-hospital mortality. Secondary outcomes included long-term mortality, length of hospital stay, and the need for renal replacement therapy (RRT) at discharge.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;The vaccinated and unvaccinated cohorts were characterized using descriptive analyses. The cohorts were analyzed using the Kaplan-Meier method and groups were compared using the log-rank test. Multivariable cox, logistic, and linear regression models were used for mortality, RRT status at discharge, and length of stay, respectively.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among 3,527 hospitalized patients with a COVID-19 infection, AKI occurred in 972 patients. Of the 972 patients with AKI, 411 (42.3%) did not receive a dose of a US FDA-approved COVID-19 vaccine and 467 (48.0%) had completed the primary vaccine series. Unvaccinated patients had a higher rate of requiring CRRT during their hospitalization compared with vaccinated patients (15.8% vs 10.9%, &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.03). The CRRT during hospitalization was significantly associated with in-hospital death (adjusted HR 2.82; 95% CI, 1.88-4.25) and long-term follow-up death (adjusted HR 2.44; 95% CI, 1.73-3.42). Unvaccinated patients also had a 2.56 (95% CI, 1.52-4.30) times higher odds of being discharged on RRT when compared with those who were vaccinated. In an adjusted multivariable analysis, those who were unvaccinated had both significantly increased in-hospital mortality (adjusted HR 5.54; 95% CI, 3.36-9.13) and long-term follow-up mortality (adjusted HR 4.78; 95% CI, 3.39-6.73) when compared with those who were vaccinated.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;There was a lack of data on the ventilation status and other indicators of infection severity in patients in intensive care unit who received CRRT. In addition, data on booster COVID-19 v","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 7","pages":"Article 101020"},"PeriodicalIF":3.2,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321804","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":"A U-Shaped Relationship Between Blood Manganese Levels and Anemia in Patients With CKD: A Cross-Sectional Analysis from National Health and Nutrition Examination Survey 2015 to 2018.","authors":"Chunjie Jiang, Junlin Yi, Jiahui Lai, Luona Wen, Xiaoshi Zhong, Rongshao Tan, Yun Liu","doi":"10.1016/j.xkme.2025.101050","DOIUrl":"10.1016/j.xkme.2025.101050","url":null,"abstract":"<p><strong>Rationale & objective: </strong>A complex relationship exists between blood manganese (Mn) and hemoglobin concentrations in patients with chronic kidney disease (CKD), with associations observed in patients not treated with dialysis and those on maintenance hemodialysis. This study aimed to elucidate this relationship using a large sample of adult patients with CKD from the National Health and Nutrition Examination Survey (NHANES) database.</p><p><strong>Study design: </strong>This was a across-sectional study.</p><p><strong>Setting & study populations: </strong>We included data of 1,016 adult patients with CKD from the NHANES database between 2015 and 2018.</p><p><strong>Exposure: </strong>We included participants with CKD who were aged ≥18 years, not pregnant, and had available data on hemoglobin, Mn levels, and other relevant covariates.</p><p><strong>Outcomes: </strong>Hemoglobin and blood Mn levels in patients with CKD.</p><p><strong>Analytical approach: </strong>Whole-blood Mn concentrations were analyzed using quadrupole inductively coupled plasma mass spectrometry. The statistical analyses included univariate and multivariate linear and binary logistic regression models, along with generalized additive models and smooth curve fitting to explore nonlinearity, which was further examined using a 2-piece-wise linear regression model.</p><p><strong>Results: </strong>After adjusting for age; sex; race/ethnicity; body mass index; smoking status; and levels of albumin, creatinine, ferritin, and transferrin receptor, a nonlinear (U-shaped) association was observed between Mn levels and anemia risk (<i>P</i> < 0.001 for nonlinearity). Specifically, lower Mn levels (<194.2 nmol/L) were negatively associated with anemia (OR, 0.984; 95% CI, 0.979-0.990; <i>P</i> < 0.001), whereas higher Mn levels (>194.2 μmol/L) showed a positive association (OR, 1.006; 95% CI, 1.001-1.011; <i>P</i> = 0.021).</p><p><strong>Limitations: </strong>Even with multivariate model analysis, we failed to establish a causal relationship between Mn levels and anemia in patients with CKD.</p><p><strong>Conclusions: </strong>These findings suggest that Mn may have a dual role in the pathophysiology of anemia in patients with CKD.</p>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 8","pages":"101050"},"PeriodicalIF":3.4,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12304937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753712","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":"Effects of Podocyte Foot Process Effacement on Kidney Prognosis and Response to Immunosuppressive Therapy in IgA Nephropathy.","authors":"Yingman Guo, Yali Ren, Sufang Shi, Suxia Wang, Xujie Zhou, Lijun Liu, Jicheng Lv, Li Zhu, Hong Zhang","doi":"10.1016/j.xkme.2025.101049","DOIUrl":"10.1016/j.xkme.2025.101049","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Recent studies have proposed that podocyte lesions within segmental glomerulosclerosis (S1) lesions are associated with kidney prognosis in immunoglobulin A nephropathy (IgAN). However, there is a lack of research exploring the effect of podocyte lesions through electron microscopy, which is currently regarded as the best power tool for evaluating podocyte injury, on kidney prognosis and response to immunosuppressive therapy (IST).</p><p><strong>Study design: </strong>An observational cohort study.</p><p><strong>Setting & participants: </strong>Total of 976 patients with IgAN and at least 12 months of follow-up at Peking University First Hospital.</p><p><strong>Exposure: </strong>Different foot process effacement (FPE) severity evaluated by electron microscopy: mild: <50%, moderate: 50%-74%, and severe: ≥75%.</p><p><strong>Outcome: </strong>A composite kidney outcome of a 50% reduction in the estimated glomerular filtration rate or end-stage kidney disease.</p><p><strong>Analytical approach: </strong>Cox proportional hazard models.</p><p><strong>Results: </strong>Moderate and severe FPE were independent risk factors for kidney outcome in overall cohort (severe: HR, 1.85; 95% CI, 1.22-2.80; <i>P</i> = 0.004; moderate: HR, 1.62; 95% CI, 1.00-2.62; <i>P</i> = 0.048; <i>P</i>-trend = 0.002). Patients with moderate FPE had a significantly increased risk of worse kidney outcome among those without IST (HR, 3.04; 95% CI, 1.52-6.09; <i>P</i> = 0.002), with risk being significantly reduced in those with IST (HR, 1.06; 95% CI, 0.51-2.23; <i>P</i> = 0.87). However, severe FPE was an independent risk factor for kidney prognosis in patients with IgAN regardless of receiving IST (without IST: HR, 2.13; 95% CI, 0.97-6.09; <i>P</i> = 0.06; with IST: HR, 1.80, 95% CI, 1.08-2.98; <i>P</i> = 0.02). The reclassification ability of the model was significantly improved with 1.7% of integrated discrimination improvements (95% CI, 0.1%-5.2%) and 0.37 of continuous net reclassification improvement (95% CI, 0.14-0.62) when integrating FPE into the International IgAN Prediction Tool.</p><p><strong>Limitations: </strong>A single-center observational study, selection bias, and unmeasured confounders.</p><p><strong>Conclusions: </strong>Moderate and severe FPE were independent risk factors affecting kidney prognosis in patients with IgAN. Podocyte injury evaluated by electron microscopy had important clinical value in IgA nephropathy.</p>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 8","pages":"101049"},"PeriodicalIF":3.4,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12309955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753717","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":"Gender-affirming Hormone Therapy and Changes in Kidney Function in Adults: A Retrospective Population-based Study.","authors":"Silvia J Leon, Thomas W Ferguson, Reid Whitlock, Clara Bohm, Paul Komenda, Claudio Rigatto, Navdeep Tangri, Nathalie Saad, Ted Jablonski, Kathleen Moncrieff, Sofia B Ahmed, Raymond Fung, Tehmina Ahmad, Ron Wald, Bikrampal Sidhu, Christine White, Rachel Bond, Louis Bondaz, Annie-Claire Nadeau-Fredette, Irena Druce, Gregory L Hundemer, Laci Williams, Karthik Tennankore, Marshall Dahl, Adeera Levin, Anna Rogers, Adam Burgess, Emily Christie, David Collister","doi":"10.1016/j.xkme.2025.101051","DOIUrl":"10.1016/j.xkme.2025.101051","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Gender-affirming hormone therapy (GAHT) modifies lean body mass and body fat but its impact on kidney function is uncertain. We sought to evaluate the association of GAHT with kidney function and clinical outcomes.</p><p><strong>Study design: </strong>A retrospective observational cohort study using linked health administrative databases.</p><p><strong>Setting & participants: </strong>Transgender and gender diverse (TGD) adults in Manitoba, Canada from January 1, 2007, to March 31, 2018.</p><p><strong>Exposure: </strong>GAHT or no GAHT prescriptions.</p><p><strong>Outcomes: </strong>The primary outcome was the change in serum creatinine levels. Secondary outcomes included the change in urine albumin-to-creatinine ratio, incident acute kidney injury, chronic kidney disease, and hypertension.</p><p><strong>Analytical approach: </strong>Outcomes were assessed for up to 2 years. Participants were censored at 3 months post-GAHT prescription if it was not refilled. Outcomes between TGD adults treated with and without GAHT (stratified by sex assigned at birth) were compared using multivariable linear regression and Cox proportional hazards models.</p><p><strong>Results: </strong>We identified 396 TGD adults assigned female at birth (AFAB) (277 receiving GAHT) and 322 TGD adults assigned male at birth (AMAB) (240 receiving GAHT) with longitudinal kidney function measurements. In AFAB persons treated with GAHT compared with no GAHT, serum creatinine levels increased from baseline at 18 months (+7.0 μmol/L, 95% CI, 0.5-14) and 21 months (+10.7 μmol/L, 95% CI, 3-18) but not at any other time point including 24 months. There were no differences in changes in creatinine in AMAB persons treated with GAHT compared with no GAHT. AFAB and AMAB persons initiating GAHT had no significant increased risks of incident chronic kidney disease or hypertension.</p><p><strong>Limitations: </strong>Limited sample size, missing data, and residual confounding.</p><p><strong>Conclusions: </strong>GAHT is associated with an increase in serum creatinine levels in AFAB persons. Additional research is needed to further evaluate the effect of GAHT on kidney function.</p>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 8","pages":"101051"},"PeriodicalIF":3.4,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12309945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753719","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":"Dietary Oxalate Nephropathy Due to Pureed Feeds.","authors":"Rajavee A Panchal, Heather Rytting, Amirtha V Chinnadurai, Larry A Greenbaum","doi":"10.1016/j.xkme.2025.101048","DOIUrl":"10.1016/j.xkme.2025.101048","url":null,"abstract":"<p><p>An 8-year-old boy with a 5q14.3 deletion presented with an elevated serum creatinine level of 1.8 mg/dL. A kidney biopsy demonstrated tubular injury and extensive oxalate crystals. His serum and urinary oxalate levels were elevated, but genetic testing for primary hyperoxaluria was negative. The patient depended on pureed foods for nutrition, and his mother consistently used a large amount of spinach and nuts when preparing his blenderized feeds. Hence, his dietary intake of oxalate was extremely high. After dietary modification, his serum and urinary oxalate levels decreased, but his serum creatinine levels had increased to 2.1 mg/dL. Unfortunately, the reported outcome of secondary oxalate nephropathy is poor, with no patients having a full recovery and the majority developing kidney failure. Children on pureed foods are at risk of hyperoxaluria if there is a chronic high intake of foods with elevated oxalate content, and caregivers may not realize that healthy foods such as spinach and nuts are high in oxalate. Nutritional counseling of children on pureed foods should include screening for excessive oxalate intake, especially if there is a decrease in kidney function or kidney stones.</p>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 8","pages":"101048"},"PeriodicalIF":3.4,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12304925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753716","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 Efficacy and Safety of Technology-Guided Dry Weight Adjustment Among Dialysis Patients: A Meta-analysis of Randomized Controlled Trials.","authors":"Wannasit Wathanavasin, Charat Thongprayoon, Paul W Davis, Wisit Cheungpasitporn","doi":"10.1016/j.xkme.2025.101052","DOIUrl":"10.1016/j.xkme.2025.101052","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Recently, various instrumental techniques adjunct to standard clinical evaluation have been used to improve fluid balance and guide dry weight adjustments in dialysis populations. We aimed to explore the efficacy and safety of using technology-guided dry weight adjustment among dialysis patients.</p><p><strong>Study design: </strong>Systematic review and meta-analysis of randomized controlled trials (RCTs). The search was conducted in PubMed, Scopus, and Cochrane Central Register of Controlled Trials for relevant RCTs published until April 28, 2024.</p><p><strong>Setting & participants: </strong>Adult patients with kidney failure with replacement therapy.</p><p><strong>Exposure: </strong>Studies with patients receiving technology-guided dry weight adjustments.</p><p><strong>Outcomes: </strong>Studies were selected if they reported at least 1 outcome of interest (eg, mortality, cardiovascular [CV] events, hospitalization, intradialytic hypotension, hypovolemic events, cardiac arrhythmia, or vascular access problems).</p><p><strong>Analytical approach: </strong>Random-effects meta-analyses were conducted, with risk of bias within studies assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials.</p><p><strong>Results: </strong>A total of 21 RCTs involving 4,239 dialysis patients were analyzed. The meta-analysis revealed that the incorporating technology-guided dry weight adjustment not only was associated with a significant 21% reduction in CV events (relative risk, 0.79; 95% confidence interval [CI], 0.71-0.88) but also resulted in a significant 9% increase in muscle cramps (rate ratio, 1.09; 95% CI, 1.02-1.16). In a subgroup analysis, using bioelectrical impedance analysis was associated with a significant reduction in mortality (relative risk, 0.67; 95% CI, 0.51-0.89). In addition, the intervention led to a significant reduction in pulse wave velocity (mean difference, -2.43 m/s; 95% CI, -4.64 to -0.21).</p><p><strong>Limitations: </strong>Large number of studies with some concerns or a high risk of bias.</p><p><strong>Conclusions: </strong>Technology-guided strategies for dry weight adjustment significantly reduce CV events and may lower all-cause mortality in dialysis patients. These benefits are particularly evident with bioelectrical impedance analysis--guided interventions. Nonetheless, clinicians should be aware of a modestly increased risk of muscle cramps.</p>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 8","pages":"101052"},"PeriodicalIF":3.4,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12309956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753725","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":"Markers of Kidney Tubule Secretion and Future Risk of Sepsis-Associated Acute Kidney Injury Among REGARDS Participants.","authors":"Alexander L Bullen, Ashutosh Tamhane, Dena E Rifkin, Pranav S Garimella, Simon B Ascher, Michael G Shlipak, Edward D Siew, Byron C Jaeger, Joseph V Bonventre, Felipe A Guerrero, Jesse Seegmiller, Henry E Wang, Orlando M Gutierrez, Joachim H Ix","doi":"10.1016/j.xkme.2025.101044","DOIUrl":"10.1016/j.xkme.2025.101044","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 8","pages":"101044"},"PeriodicalIF":3.4,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12305563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753720","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":"Socioeconomic Status and Chronic Kidney Disease Among Black and White Adults: An Analysis of 2017-2020 NHANES.","authors":"Benjamin Grobman, Ruth-Alma Turkson-Ocran, Mingyu Zhang, Stephen P Juraschek","doi":"10.1016/j.xkme.2025.101045","DOIUrl":"10.1016/j.xkme.2025.101045","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Chronic kidney disease (CKD) disproportionately affects Black adults and those with lower socioeconomic status in the United States. The aim of this study was to examine the associations between socioeconomic status and CKD, albuminuria/stage 1-2 CKD, and stage 3-5 CKD, and to assess differences between Black and White adults.</p><p><strong>Study design: </strong>We used data from the 2017-2020 National Health and Nutrition Examination Survey. CKD was defined as an estimated glomerular filtration rate of <60 mL/min/1.73 m² based on the race-free CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation (stage 3-5 CKD) and/or a urinary albumin-creatinine ratio of >30 mg/g (albuminuria/stage 1-2 CKD).</p><p><strong>Setting & participants: </strong>Respondents to the 2017-2020 National Health and Nutrition Examination Survey with Black or White race.</p><p><strong>Exposure: </strong>Measures of socioeconomic status (income to poverty ratio, insurance status, education, employment status, and health care access).</p><p><strong>Analytical approach: </strong>We examined the relationship between measures of socioeconomic status and CKD, albuminuria/stage 1-2 CKD, and stage 3-5 CKD using survey-weighted Poisson regressions controlling for age, sex, and medical comorbid conditions.</p><p><strong>Results: </strong>The weighted sample (<i>N</i> = 182,622,525) was 52.2% women and 15.5% Black, with a mean age of 49.1 years. The prevalence of CKD was 15.6% in the overall sample, 20.9% among Black adults, and 14.7% among White adults. Higher income, higher education levels, and having health insurance were associated with a lower prevalence of CKD in the overall sample and among White adults, but not among Black adults. This pattern was consistent for those with albuminuria/stage 1-2 CKD, but not for those with stage 3-5 CKD.</p><p><strong>Limitations: </strong>This study is limited by its cross-sectional design. In addition, data were based on single measurements and thus may be less precise in estimating the prevalence of chronic disease.</p><p><strong>Conclusions: </strong>Higher socioeconomic status was inversely associated with albuminuria/stage 1-2 CKD and CKD among White but not Black adults. Future work should investigate the mechanisms by which albuminuria/stage 1-2 CKD remains independent of socioeconomic status among Black adults.</p>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 8","pages":"101045"},"PeriodicalIF":3.4,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12309949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753723","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}