Kidney Medicine最新文献

{"title":"Glomerular and Nephron Size and Kidney Disease Outcomes: A Comparison of Manual Versus Deep Learning Methods in Kidney Pathology","authors":"Jaidip M. Jagtap PhD, MS , Andrew R. Janowczyk PhD, MS , Yijiang Chen PhD , Afsana A. Shaik MBBS , Aidan F. Mullan MA , Bradley J. Erickson MD, PhD , Vidit Sharma MD , Timothy L. Kline PhD, MS , Laura Barisoni MD , Aleksandar Denic MD, PhD , Andrew D. Rule MD","doi":"10.1016/j.xkme.2024.100939","DOIUrl":"10.1016/j.xkme.2024.100939","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 1","pages":"Article 100939"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11728938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979082","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":"Spinal Cord Compression as the First Presentation of Primary Hyperoxaluria in a Patient With Kidney Failure: A Case Report and Literature Review","authors":"Marwa Kliea ,&nbsp;Mohammad Alsultan ,&nbsp;Safaa Qatleesh ,&nbsp;Yousef Haroun ,&nbsp;Osama Abdul Aziz ,&nbsp;Kassem Basha","doi":"10.1016/j.xkme.2024.100932","DOIUrl":"10.1016/j.xkme.2024.100932","url":null,"abstract":"<div><div>A 50-year-old woman with kidney failure complained of back pain and an inability to walk. The medical history included hypothyroidism, nephrolithiasis, and resistant anemia aligned with several transfusions. The examination showed hepatosplenomegaly, lower limb weakness, absence of reflexes, and lack of sensations with a sensory level T6. Laboratory results showed hypercalcemia with suppression of parathyroid hormone levels. Magnetic resonance imaging showed vertebral fractures and mass-like lesions that compressed the spine at T4, T9, L4, and L5. Vertebral and bone marrow biopsies showed calcium oxalate (CaOx) depositions. Here, we reported a rare case of primary hyperoxaluria (PH) in a patient with kidney failure who presented with spinal cord compression caused by vertebral fractures and mass-like lesions. We summarized a literature review of PH patients with spinal cord compression, which showed only 3 cases. The multiorgan CaOx infiltration in this patient also caused resistant anemia, hepatosplenomegaly, extensive bone lesions, hypoparathyroidism, hypothyroidism, and hypercalcemia. The overdiagnosis of renal osteodystrophy and the negative family history could delay the diagnosis of PH in patients with kidney failure. Thus, clinicians should always consider PH in the differential diagnosis of kidney failure patients with stone events given that the early diagnosis of PH could be lifesaving.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 1","pages":"Article 100932"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932297","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":"Development of a Novel Intraperitoneal Icodextrin/Dextrose Solution for Enhanced Sodium Removal","authors":"Jennifer L. Asher ,&nbsp;Juan B. Ivey-Miranda ,&nbsp;Christopher Maulion ,&nbsp;Zachary L. Cox ,&nbsp;Julian A. Borges-Vela ,&nbsp;Genaro H. Mendoza-Zavala ,&nbsp;Jose A. Cigarroa-Lopez ,&nbsp;Rogelio I. Silva-Rueda ,&nbsp;Cristina Revilla-Monsalve ,&nbsp;Julieta Moreno-Villagomez ,&nbsp;Daniela Ramos-Mastache ,&nbsp;Oliver Goedje ,&nbsp;Ian Crosbie ,&nbsp;Christopher McIntyre ,&nbsp;Fredrick Finkelstein ,&nbsp;Jeffrey M. Turner ,&nbsp;Jeffrey M. Testani ,&nbsp;Veena S. Rao","doi":"10.1016/j.xkme.2024.100938","DOIUrl":"10.1016/j.xkme.2024.100938","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Peritoneal dialysis (PD) solutions provide both clearance of uremic toxins and sodium and water. An intraperitoneal (IP) solution of icodextrin and glucose designed without the requirement for uremic toxin clearance could provide substantially greater sodium and water removal than PD solutions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;We examined varying concentrations of icodextrin and dextrose IP solutions in rats. We evaluated a 30% icodextrin and 10% dextrose IP solution in animals and humans.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;Small and large animal models, and humans (N&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;10) with kidney failure.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;30% icodextrin and 10% dextrose IP solution.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;We evaluated ultrafiltration (UF), sodium removal, and peritoneal health in animals. We evaluated safety, tolerability, and efficacy in humans.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;In rats, increasing concentrations of icodextrin and dextrose IP solutions, up to 30% icodextrin and 10% dextrose, produced progressively greater UF (&lt;em&gt;P&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.001). In sheep treated with 30% icodextrin and 10% dextrose, the mean UF was ∼3.5-fold greater (1.77&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;0.22&lt;!--&gt; &lt;!--&gt;L vs 0.47&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;0.34&lt;!--&gt; &lt;!--&gt;L; &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.005) and the mean sodium removal was ∼4-fold greater (7.07&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;0.72&lt;!--&gt; &lt;!--&gt;g vs 1.78&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;1.27&lt;!--&gt; &lt;!--&gt;g; &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.003) compared with commercially available 7.5% icodextrin PD solution. Long-term exposure of mice (30 days) and sheep (30-45 days) to a 30% icodextrin and 10% dextrose IP solution resulted in no significant structural tissue changes compared with the control 4.25% commercially available PD solution. In humans, a 24-hour dwell of a 30% icodextrin and 10% dextrose IP solution resulted in median net UF of 2,498&lt;!--&gt; &lt;!--&gt;mL (IQR, 2,249-2,768), and median sodium removal of 387&lt;!--&gt; &lt;!--&gt;mmol (IQR, 372-434&lt;!--&gt; &lt;!--&gt;mmol). No serious adverse events occurred.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;The long-term safety with chronic therapy and the efficacy in patients without kidney failure were not established and require future studies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;A 30% icodextrin and 10% dextrose IP solution provides more efficient UF and sodium removal than traditional PD solutions. The promising inhuman safety and efficacy results warrant future investigation as a sodium removal therapy in patients with edematous disorders such as heart failure.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Clinical Trial Registration&lt;/h3&gt;&lt;div&gt;NCT05780086.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Summary&lt;/h3&gt;&lt;div&gt;We aimed to design a novel intraperitoneal solution designed for optimal sodium and water removal. A sodium-free 30% icodextrin and 10% dextrose intraperitoneal solution was evaluated in animal models and humans to determine the safety and efficacy. A 30% i","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 1","pages":"Article 100938"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11714391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950822","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":"Artificial Intelligence in Nephrology: Clinical Applications and Challenges","authors":"Prabhat Singh ,&nbsp;Lokesh Goyal ,&nbsp;Deobrat C. Mallick ,&nbsp;Salim R. Surani ,&nbsp;Nayanjyoti Kaushik ,&nbsp;Deepak Chandramohan ,&nbsp;Prathap K. Simhadri","doi":"10.1016/j.xkme.2024.100927","DOIUrl":"10.1016/j.xkme.2024.100927","url":null,"abstract":"<div><div>Artificial intelligence (AI) is increasingly used in many medical specialties. However, nephrology has lagged in adopting and incorporating machine learning techniques. Nephrology is well positioned to capitalize on the benefits of AI. The abundance of structured clinical data, combined with the mathematical nature of this specialty, makes it an attractive option for AI applications. AI can also play a significant role in addressing health inequities, especially in organ transplantation. It has also been used to detect rare diseases such as Fabry disease early. This review article aims to increase awareness on the basic concepts in machine learning and discuss AI applications in nephrology. It also addresses the challenges in integrating AI into clinical practice and the need for creating an AI-competent nephrology workforce. Even though AI will not replace nephrologists, those who are able to incorporate AI into their practice effectively will undoubtedly provide better care to their patients. The integration of AI technology is no longer just an option but a necessity for staying ahead in the field of nephrology. Finally, AI can contribute as a force multiplier in transitioning to a value-based care model.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 1","pages":"Article 100927"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11719832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971536","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":"Intracapillary Monoclonal IgM Deposition Concomitant With Cold Agglutinin Disease","authors":"Silvia M. Titan ,&nbsp;Sandra Herrmann ,&nbsp;Nelson Leung ,&nbsp;Pingchuan Zhang ,&nbsp;Stephen Ansell","doi":"10.1016/j.xkme.2024.100964","DOIUrl":"10.1016/j.xkme.2024.100964","url":null,"abstract":"<div><div>Monoclonal gammopathy of renal significance (MGRS) comprises a spectrum of kidney manifestations distinguished by its clinical and pathological presentations. This article reports a case of a female on her 60s who was referred to Nephrology for evaluation of worsening kidney function, hematuria, and proteinuria. Her medical history was notable for marginal zone lymphoma along with immunoglobulin M (IgM)-kappa cold agglutinin disease diagnosed 3 years before the current presentation, which had been treated with rituximab. A kidney biopsy was performed and revealed IgM-kappa monoclonal protein-associated nephropathy with predominantly intracapillary monoclonal IgM deposition injury pattern, a rare form of MGRS, reported for the first time in association with cold agglutinin disease.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 3","pages":"Article 100964"},"PeriodicalIF":3.2,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143131169","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":"Acute Kidney Injury, Mild Cognitive Impairment, and Dementia: A Cohort Study of Patients from SPRINT","authors":"Kristen L. Nowak,&nbsp;Anna Ostrow,&nbsp;Ester S. Oh,&nbsp;Zhiying You,&nbsp;Michel Chonchol","doi":"10.1016/j.xkme.2024.100962","DOIUrl":"10.1016/j.xkme.2024.100962","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><div>It is well accepted that acute cognitive dysfunction and delirium can occur with severe acute kidney injury (AKI). Recent evidence has indicated AKI can contribute to incident dementia years later. However, these observations were limited by lack of adjudication in most of these studies and greater severity of AKI.</div></div><div><h3>Study Design</h3><div>A retrospective cohort study.</div></div><div><h3>Setting &amp; Participants</h3><div>8,148 older adults at high cardiovascular risk enrolled in the Systolic Blood Pressure Intervention Trial (SPRINT).</div></div><div><h3>Predictor</h3><div>Adjudicated AKI as a time-varying predictor.</div></div><div><h3>Outcomes</h3><div>Incident mild cognitive impairment (MCI), probable dementia, and their composite.</div></div><div><h3>Analytical Approach</h3><div>Cox proportional hazard models.</div></div><div><h3>Results</h3><div>Participants were 68<!--> <!-->±<!--> <!-->9 years, 65% male, 28% with prevalent chronic kidney disease), with a median (interquartile range) follow-up time for the composite of 4.0 (2.1-5.4) and 4.6 (3.6-5.9) years in the AKI and non-AKI groups, respectively. The incidence rate of MCI, probable dementia, and their composite was higher in participants who experienced an AKI event (n<!--> <!-->=<!--> <!-->270). In the fully adjusted model, AKI was positively associated with probable dementia (hazard ratio, 1.72; 95% CI, 1.07-2.75) and the composite outcome (1.43 [1.01-2.04]).</div></div><div><h3>Limitations</h3><div>AKI before baseline was not captured; retrospective and associative.</div></div><div><h3>Conclusions</h3><div>Adjudicated AKI, which was largely mild and reversible, was independently associated with increased risk of probable dementia and the composite of probable dementia and MCI in older adults at high cardiovascular risk.</div></div><div><h3>Plain Language Summary</h3><div>It is well accepted that acute cognitive dysfunction and delirium can occur with severe acute kidney injury (AKI), and recent evidence has indicated that AKI can contribute to new onset of dementia years later. We examined whether having an AKI increased risk of adverse cognitive outcomes among 8,148 older adults at high cardiovascular risk enrolled who participated in the Systolic Blood Pressure Intervention Trial. AKI, although generally mild and reversible, independently associated with increased risk of probable dementia and a combined endpoint of probable dementia and mild cognitive impairment. These results suggest that cognitive function should be monitored following AKI in this patient population.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 3","pages":"Article 100962"},"PeriodicalIF":3.2,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143131174","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":"Sodium–Glucose Cotransporter-2 Inhibitors and Prevention of Adverse Kidney Outcomes in Type 2 Diabetes: A Clinical Multiethnic Asian Cohort","authors":"Liang Feng ,&nbsp;Zhong Hong Liew ,&nbsp;Yong Mong Bee ,&nbsp;Tazeen H. Jafar","doi":"10.1016/j.xkme.2024.100963","DOIUrl":"10.1016/j.xkme.2024.100963","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Studies of sodium-glucose cotransporter-2 (SGLT2) inhibitors assessing kidney outcomes among Asians with type 2 diabetes in a clinical setting are limited. We assessed the association of SGLT2 inhibitors with kidney and safety outcomes in a diverse multiethnic Asian population with type 2 diabetes in a clinical setting.&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;Patients with type 2 diabetes from multi-institutional SingHealth Diabetes Registry in Singapore.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;Initiators of SGLT2 inhibitors between 2014 to 2018 with a median follow-up duration of 25.6 months (interquartile range, 17.9-31.4).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Composite kidney outcome (≥40% estimated glomerular filtration rate [eGFR] decline or incident kidney failure with replacement therapy [KFRT]), its components, rate of eGFR change, amputation, and acute kidney injury (AKI).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Propensity scores for SGLT2 inhibitors initiation were developed, with 1:1 matching with initiators of other antidiabetic drugs. Cox proportional hazards and linear mixed effect models were employed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;After matching, there were 4,254 patients newly initiated on either SGLT-2 inhibitors or other glucose-lowering drugs (2,127 in each group). The mean age was 63.4 (SD 9.2) years, with 48.6% women. In total, 67.8% of participants were Chinese, 11.9% Indian, 15.6% Malay, and 4.7% others. Initiating SGLT2 inhibitors was associated with lower risks of composite kidney outcome (hazard ratio [HR], 0.39; 95% CI, 0.31-0.48) and&lt;!--&gt; &lt;!--&gt;≥40% reduction in eGFR from baseline (HR, 0.38; 95% CI, 0.31-0.48). SGLT2 inhibitor initiation was also associated with a slower eGFR decline among the intention-to-treat population (n&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;1,888, difference in slope: 2.67&lt;!--&gt; &lt;!--&gt;mL/min per 1.73&lt;!--&gt; &lt;!--&gt;m&lt;sup&gt;2&lt;/sup&gt; per year; 95% CI, 1.90-3.43). No significant association with amputation was found, though SGLT2 inhibitors were associated with reduced AKI risk.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Potential informed presence bias and residual and unmeasured confounding.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;SGLT2 inhibitors significantly benefit kidney outcomes in multiethnic Asians with type 2 diabetes, highlighting their role in preventing kidney complications.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;div&gt;Real-world evidence on the kidney benefits of sodium-glucose cotransporter-2 (SGLT2) inhibitors among Asians with type 2 diabetes is limited. This study examined the effects of SGLT2 inhibitors on kidney and safety outcomes in a diverse group with type 2 diabetes in Singapore. Data from 2,127 patients initiating SGLT2 inhibitors were matched 1:1 with other glucose-lowering drugs users using propensity scores. Over a median follow-up of 25.6 months,","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 3","pages":"Article 100963"},"PeriodicalIF":3.2,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143479743","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":"Kidney Function and Incident Stroke and Dementia Using an Updated Estimated Glomerular Filtration Rate Equation Without Race: The Multi-Ethnic Study of Atherosclerosis","authors":"Samuel R. Moen ,&nbsp;Jeffrey R. Misialek ,&nbsp;Timothy M. Hughes ,&nbsp;Craig W. Johnson ,&nbsp;Mark J. Sarnak ,&nbsp;Sarah N. Forrester ,&nbsp;W.T. Longstreth Jr. ,&nbsp;Mercedes R. Carnethon ,&nbsp;James S. Pankow ,&nbsp;Sanaz Sedaghat","doi":"10.1016/j.xkme.2024.100961","DOIUrl":"10.1016/j.xkme.2024.100961","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Equations for estimated glomerular filtration rate (eGFR) have previously included a coefficient for African American race. We evaluated and compared risk of incident stroke and dementia between old and new equations of eGFR for African American and non-African American participants.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Prospective observational study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Baseline values were collected from 6,814 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort between 2000 and 2002. Participants were followed up until 2018. The analytic sample consisted of 6,646 participants (mean [SD] age 62 [10] years; 53% female; 39% White, 27% African American, 12% Chinese American, and 22% Hispanic/Latino).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;eGFR equation from 2021 based on serum creatinine and cystatin C levels without race.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome&lt;/h3&gt;&lt;div&gt;Incident stroke and dementia.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Cox proportional regression adjusting for demographic, lifestyle, and clinical variables was performed to estimate associations between different eGFR measures and risk of incident stroke and dementia.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;During a median follow-up period of 17 years, 349 (5.3%) participants experienced an incident stroke event, and 574 (8.6%) participants experienced incident dementia. In the fully adjusted model, overall participants with eGFR&lt;!--&gt; &lt;!--&gt;&lt;60 compared with those&lt;!--&gt; &lt;!--&gt;&gt;90&lt;!--&gt; &lt;!--&gt;mL/min/1.73&lt;!--&gt; &lt;!--&gt;m&lt;sup&gt;2&lt;/sup&gt; were at significantly increased risk of dementia (HR, 95% CI: 1.73, 1.21-2.45). A lower eGFR was not significantly associated with incident stroke (1.30, 0.75-2.24). African American participants tended to be reclassified to a lower group of eGFR in the new equations, whereas non-African American participants were reclassified to a higher group of eGFR. When comparing older versus newer equations of eGFR in African American and non-African American participants in association with incident stroke and dementia, differences were minimal.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Incident dementia was ascertained through International Classification of Diseases (Ninth and Tenth Revisions) codes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Our findings illustrate participants with 2021 eGFR&lt;!--&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;60 compared with those with eGFR&lt;!--&gt; &lt;!--&gt;&gt;&lt;!--&gt; &lt;!--&gt;90&lt;!--&gt; &lt;!--&gt;mL/min/1.73&lt;!--&gt; &lt;!--&gt;m&lt;sup&gt;2&lt;/sup&gt; have higher risk of dementia in both African American and non-African American participants, but not of stroke.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;div&gt;Existing research has established that declined kidney function is associated with stroke and dementia. Kidney function is commonly estimated using inputs of blood proteins alongside demographic inputs of age, sex at birth, and race. Inclusion of race to estimate kidney function has gained","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 3","pages":"Article 100961"},"PeriodicalIF":3.2,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143268329","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":"Sepsis-Associated Acute Kidney Disease Incidence, Trajectory, and Outcomes","authors":"Hsiu-Yin Chiang ,&nbsp;Chih-Chia Liang ,&nbsp;Ya-Luan Hsiao ,&nbsp;Uyen-Minh Le ,&nbsp;Yi-Ching Chang ,&nbsp;Pei-Shan Chen ,&nbsp;David Ray Chang ,&nbsp;I-Wen Ting ,&nbsp;Hung-Chieh Yeh ,&nbsp;Chin-Chi Kuo","doi":"10.1016/j.xkme.2024.100959","DOIUrl":"10.1016/j.xkme.2024.100959","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Systematic evaluation of the prognosis from sepsis-associated acute kidney disease (SA-AKD) using real-world data is limited. This study aimed to use data algorithms on the electronic health records to trace the SA-AKD trajectory from acute kidney injury (AKI) to chronic kidney disease (CKD).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;A retrospective cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Adult inpatients with first sepsis episode surviving 90 days after AKD in a quaternary referral medical center.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;We defined SA-AKD as having sustained ≥1.5-fold increased serum creatinine levels or initiating kidney replacement therapy after the SA-AKI, and we classified SA-AKD into recovery, relapse, and persistent SA-AKD subgroups.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;All-cause mortality, kidney replacement therapy (KRT), &lt;em&gt;de novo&lt;/em&gt; nondialysis dependent CKD (CKD-ND), and late-recovery AKD during 1-year follow-up.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;A multivariable Cox proportional hazards models.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Of 24,038 eligible inpatients with sepsis, 42.2% had SA-AKI, and 17.6% progressed to SA-AKD (43.6% recovery, 8.3% relapse, 32.2% persistent, and 15.9% unclassified). Compared with the recovery subgroup, the 1-year mortality risk for the relapse, persistent, and unclassified SA-AKD subgroups were 1.57 (adjusted hazard ratios [aHRs]; 95% CI, 1.22-2.01), 1.36 (1.13-1.63), and 0.65 (0.48-0.89), respectively. Risks of KRT initiation were 3.27 (2.14-4.98), 6.01 (4.41-8.19), and 0.98 (0.55-1.74), respectively, and corresponding aHRs for &lt;em&gt;de novo&lt;/em&gt; CKD-ND were 3.84 (2.82-5.22), 3.35 (2.61-4.29), and 0.48 (0.30-0.77), respectively. Patients with relapse SA-AKD had a higher likelihood of late recovery (aHR, 3.62; 95% CI, 2.52-5.21) than the persistent SA-AKD.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Selection bias and information bias could be present because of limiting population to sepsis survivors and because of no standardized follow-up protocol for kidney function.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;SA-AKD without recovery is associated with increased and long-term risks of KRT initiation, mortality, and increased risk of &lt;em&gt;de novo&lt;/em&gt; CKD-ND for patients initially free of CKD. Further studies are warranted for managing AKI to AKD to CKD in real-world settings.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;div&gt;Systematic evaluation of the prognosis for sepsis-associated acute kidney injury (AKI) and sepsis-associated acute kidney disease (AKD) using real-world data remain limited. We applied standard definitions of sepsis and AKI/AKD and comprehensively profiled the AKI-AKD-chronic kidney disease (CKD) trajectory among sepsis survivors in a large, longitudinal hospital-based cohort. Our study showed that sepsis-associated AKD without recovery is associated with elevated and long-term risks","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 3","pages":"Article 100959"},"PeriodicalIF":3.2,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143131167","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":"High-Frequency Vessel Wall Vibrations Associate With Stenosis Formation and Arteriovenous Fistula Failure","authors":"Luca Soliveri MS ,&nbsp;Sofia Poloni MS ,&nbsp;Paolo Brambilla MD ,&nbsp;Anna Caroli PhD ,&nbsp;Andrea Remuzzi EngD ,&nbsp;Michela Bozzetto PhD ,&nbsp;Kristian Valen-Sendstad PhD","doi":"10.1016/j.xkme.2024.100957","DOIUrl":"10.1016/j.xkme.2024.100957","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 3","pages":"Article 100957"},"PeriodicalIF":3.2,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143349145","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}