Kidney Medicine最新文献

{"title":"Interventions to Improve Life Participation in Kidney Transplant Recipients: A Systematic Review","authors":"Patrizia Natale ,&nbsp;Angela Ju ,&nbsp;Martin Howell ,&nbsp;Germaine Wong ,&nbsp;Armando Teixeira-Pinto ,&nbsp;Anastasia Hughes ,&nbsp;Chandana Guha ,&nbsp;Amanda Sluiter ,&nbsp;Nicole Scholes-Robertson ,&nbsp;Jonathan C. Craig ,&nbsp;Michelle A. Josephson ,&nbsp;Giovanni Strippoli ,&nbsp;Allison Jaure","doi":"10.1016/j.xkme.2025.100980","DOIUrl":"10.1016/j.xkme.2025.100980","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><div>Life participation, defined as the ability to participate in meaningful activities of daily living, is a critically important outcome for kidney transplant recipients. We aimed to evaluate the effectiveness of any interventions on life participation in kidney transplant recipients.</div></div><div><h3>Study Design</h3><div>A systematic review of randomized controlled studies.</div></div><div><h3>Study Populations</h3><div>Adult kidney transplant recipients.</div></div><div><h3>Search Strategy &amp; Sources</h3><div>MEDLINE, Embase, CENTRAL, PsycINFO and CINAHL were searched up to March 2023.</div></div><div><h3>Data Extraction</h3><div>Two authors independently screened titles and abstracts, and extracted data from the included studies using standard data extraction forms.</div></div><div><h3>Analytical Approach</h3><div>We used random-effects models with relative risk for dichotomous outcomes and mean difference for continuous outcomes with 95% confidence intervals (CIs). Confidence in the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.</div></div><div><h3>Results</h3><div>From 14,162 reports, only 33 studies (4,857 participants) were included. The risk of bias was adjudicated as high or unclear for most domains. No studies reported the outcome of life participation specifically. Among 33 studies, mental, physical and social functioning were reported in 5 (15%), 5 (15%), and 11 (33%) studies, respectively.</div></div><div><h3>Limitations</h3><div>A wide range of interventions were included across the studies with a limited follow-up, and we were unable to pool the data and perform meta-analysis for outcomes that were reported in a single study only or in studies reporting no events.</div></div><div><h3>Conclusions</h3><div>The effects of prebiotics, erythropoietin-stimulating agents, immunosuppressive treatments, induction therapy of interleukin-2 receptor antagonist, exercise, nutrition, education, and surgical procedures on life participation-related outcomes were uncertain. Life participation was not reported as a specific outcome in trials in kidney transplant recipients with very limited evidence on interventions for life participation-related outcomes. Trial-based evidence for interventions to improve life participation, a critical outcome for kidney transplant recipients, is needed.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 4","pages":"Article 100980"},"PeriodicalIF":3.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685117","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":"Risk Factor-Based Screening for Early Detection of Chronic Kidney Disease in Primary Care Settings: A Systematic Review","authors":"Ayana Korsa MSc ,&nbsp;Wubshet Tesfaye PhD ,&nbsp;Kamal Sud MD ,&nbsp;Ines Krass PhD ,&nbsp;Ronald L. Castelino PhD","doi":"10.1016/j.xkme.2025.100979","DOIUrl":"10.1016/j.xkme.2025.100979","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Kidney failure can be prevented or delayed if chronic kidney disease (CKD) is detected and treated early. Targeted screening has been shown effective in detecting CKD worldwide, but a recently updated summary of evidence is lacking. We synthesized up-to-date evidence of the effectiveness of risk factor-based screening for the early detection of CKD among adults in primary care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;We retrieved articles from Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Scopus. Relevant gray literature and hand-searching bibliographies of key articles were also performed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Study Populations&lt;/h3&gt;&lt;div&gt;Adult patients (age ≥ 18 years) with at least 1 known CKD risk factor in primary care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Selection Criteria for Studies&lt;/h3&gt;&lt;div&gt;Prospective studies applying CKD screening in adults based on at least 1 CKD risk factor.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Data Extraction&lt;/h3&gt;&lt;div&gt;Data were abstracted from full texts and the risk of bias was assessed using the Joanna Briggs Institute critical appraisal tools.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;No meta-analysis was conducted.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;In total, 24 studies from 11 countries fulfilled the inclusion criteria. Diverse screening tests, CKD definitions, formulas for estimating kidney function, and positive screening test cutoffs were used. Most studies (n = 22) employed estimated glomerular filtration rate (eGFR), albumin-creatinine ratio (ACR) (n = 14), and dipstick urinalysis (n = 9) for screening. The prevalence of reduced kidney function and/or kidney damage was between 2.9% and 56%, and confirmed CKD varied from 4.4% to 17.1%. Increased patient referrals and physician visits, higher patient satisfaction, and some form of patient willingness to pay for the services were reported because of screening.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Meta-analysis was not conducted, and the findings might not be generalized to resource-limited settings.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Risk factor-based screening effectively identifies a substantial proportion of people with undiagnosed CKD, but there is still scope for improvement. We recommend future studies have robust designs and multidimensional interventions to establish the effectiveness of targeted CKD screening in primary care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;div&gt;Chronic kidney disease (CKD) is a major public health issue worldwide. Targeted screening programs for high-risk populations (eg, diabetes) are clinically effective and cost-effective in detecting CKD, according to studies. We conducted a systematic review to summarize up-to-date evidence on risk factor-based screening for early detection of CKD in primary care. From the results, it may be inferred that targeted screening effectively detects a significant proportion of previousl","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 4","pages":"Article 100979"},"PeriodicalIF":3.2,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610207","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":"Sleep Patterns, Symptoms, and Mortality in Hemodialysis: A Prospective Cohort Study","authors":"Yoko Narasaki ,&nbsp;Amy S. You ,&nbsp;Ira Kurtz ,&nbsp;Niloofar Nobakht ,&nbsp;Mohammad Kamgar ,&nbsp;Man Kit Michael Siu ,&nbsp;Rebecca S. Ahdoot ,&nbsp;Ramy Hanna ,&nbsp;Sara S. Kalantar ,&nbsp;Jihoon Yoon ,&nbsp;Lisa Le ,&nbsp;Silvina Torres Rivera ,&nbsp;Tracy Nakata ,&nbsp;Ria Arora ,&nbsp;Danh V. Nguyen ,&nbsp;Kamyar Kalantar-Zadeh ,&nbsp;Connie M. Rhee","doi":"10.1016/j.xkme.2025.100976","DOIUrl":"10.1016/j.xkme.2025.100976","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;While sleep disorders are common in patients treated with hemodialysis, the impact of sleep patterns on survival is not well defined. We thus examined the association of specific sleep patterns with mortality in this population.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;An observational cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Population&lt;/h3&gt;&lt;div&gt;In-center hemodialysis patients from the multicenter prospective NIH Malnutrition, Diet, and Racial Disparities in Chronic Kidney Disease (MADRAD) cohort.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;Sleep patterns ascertained using protocolized sleep surveys from March 2014 to June 2019.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Mortality.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Cox proportional hazards models.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among 452 participants, the mean age was 55±14 years, among whom 46% were women and the median follow-up was 3.5 years. In expanded case-mix models, shorter sleep duration (≤ median of observed values) was associated with higher mortality on dialysis and nondialysis days (ref: &gt; median): HRs (95% CIs) 1.59 (1.09-2.31) and 1.51 (1.04-2.19), respectively. Patients who reported high frequencies (often/almost always) of difficulty falling asleep, feeling unrested, fatigue/exhaustion post-dialysis, or fatigue/exhaustion on nondialysis days had higher mortality (ref: never/rarely having these symptoms): HRs (95% CIs) 1.74 (1.17-2.58), 1.69 (1.1-2.5), 2.42 (1.41-4.16), and 1.73 (1.11-2.69), respectively. Moderate to high frequency of sleeping pill use was associated with higher mortality (ref: never/rare use): HRs (95% CIs) 2.07 (1.08, 3.97) and 2.00 (1.22, 3.28) for sometimes and often/almost always using sleeping pills, respectively. Sleeping outside of the primary sleep period (intra-dialytic sleeping and napping) was not associated with worse survival. However, patients reporting frequent apnea or restless legs syndrome had higher mortality.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Potential recall bias, residual confounding, absence of time-varying observations, and limitations in generalizability.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;In a well-characterized prospective multicenter hemodialysis cohort, patients who reported shorter sleep duration, sleeping difficulty or feeling unrested, moderate to frequent sleeping pill consumption, and sleep disorders (apnea and restless legs) had a higher mortality risk.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;div&gt;Patients with kidney failure have a high burden of sleep disorders. However, the relationship between sleeping problems and the health of patients treated with dialysis is not well understood. To address this knowledge gap, we examined the relationship between various types of sleep disturbances and associated symptoms with survival among a diverse cohort of patients treated with hemodialysis from the multicenter prospective NIH Malnutrition, Diet, and","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 4","pages":"Article 100976"},"PeriodicalIF":3.2,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685118","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":"Transferring From Peritoneal Dialysis to Home or In-Center Hemodialysis: A Cohort Study of an Integrated Home Dialysis Model","authors":"Jana Mahmoud BSc ,&nbsp;Louis-Charles Desbiens MD, MSc ,&nbsp;Naoual Elftouh MSc ,&nbsp;Louis-Philippe Laurin MD, MSc ,&nbsp;Annie-Claire Nadeau-Fredette MD, MSc","doi":"10.1016/j.xkme.2025.100977","DOIUrl":"10.1016/j.xkme.2025.100977","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 4","pages":"Article 100977"},"PeriodicalIF":3.2,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519517","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":"Clinical Decision-Making About Immunosuppressive Treatment in Focal Segmental Glomerulosclerosis","authors":"Brooke Blazius ,&nbsp;Jonathan P. Troost ,&nbsp;Jeffrey B. Kopp ,&nbsp;Rulan S. Parekh ,&nbsp;Brenda Gillespie ,&nbsp;Isabelle Ayoub ,&nbsp;Mahmoud Kallash ,&nbsp;Rasheed Gbadegesin ,&nbsp;Pietro A. Canetta ,&nbsp;Tarak Srivastava ,&nbsp;Tracy E. Hunley ,&nbsp;Katherine E. Twombley ,&nbsp;Yonatan A. Peleg ,&nbsp;Larry A. Greenbaum ,&nbsp;Aftab S. Chishti ,&nbsp;Carla M. Nester ,&nbsp;Amy K. Mottl ,&nbsp;Susan L. Hogan ,&nbsp;Virginie Royal ,&nbsp;Vivette D. D’Agati ,&nbsp;Jason M. Kidd","doi":"10.1016/j.xkme.2025.100975","DOIUrl":"10.1016/j.xkme.2025.100975","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Focal segmental glomerulosclerosis (FSGS) is a heterogeneous disorder with a high risk of progression to kidney failure. There are no approved therapies for FSGS, and futility of treatment is poorly defined. The Cure Glomerulonephropathy (CureGN) study offers the opportunity to describe the characteristics of participants who started immunosuppressive therapy (IST), never received IST, or in whom this treatment was discontinued.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;An observational cohort.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Settings &amp; Participants&lt;/h3&gt;&lt;div&gt;Participants enrolled in CureGN with FSGS and surveyed nephrologists.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;The clinical and laboratory data from participants with FSGS who were enrolled in the CureGN observational cohort were reviewed to define features associated with withholding initial IST or terminating ongoing IST. Nephrologists were surveyed about what factors would influence their decision to prescribe or withdraw IST in patients with FSGS.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;(1) Identify factors associated with IST initiation and discontinuation in individuals with FSGS; and (2) Identify clinical and laboratory features nephrologists consider when they recommend against the use of IST at diagnosis (initiation of care) and during the course of disease.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Based on quantitative findings from the CureGN cohort and survey responses from practicing nephrologists, a low estimated glomerular filtration rate at presentation, significant glomerulosclerosis, and interstitial fibrosis and tubular atrophy on kidney biopsy make initiation of IST less likely.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Heterogeneous nature of the cohort and an inability to divide the patients into KDIGO subgroups of FSGS. Rationale for decision to stop or defer treatment was not available. More surveys were completed by pediatric providers, and the majority were completed by academic practitioners.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;The factors that impact decisions about IST initiation and discontinuation were consistent among pediatric and internal medicine nephrologists, namely advanced scarring and lower estimated glomerular filtration rate. We suggest that this information should be incorporated into patient management guidelines and clinical trial design.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;div&gt;Patients with focal segmental glomerulosclerosis (FSGS) are at high risk for progression to kidney failure and there are no approved therapies. This study from the CureGN consortium described clinical situations in which immunosuppressive therapy (IST) was started, not started, or discontinued in participants with FSGS. Furthermore, we surveyed nephrologists to better understand factors that influence the management of patients with FSGS. Participants in the CureGN cohort with a lower estimated glomerular filtration rate and ad","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 4","pages":"Article 100975"},"PeriodicalIF":3.2,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143679022","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":"Disentangling Dialysis Facility and Transplant Center Factors on Evaluation Start Following Referral for Kidney Transplantation: A Regional Study in the United States","authors":"Laura McPherson ,&nbsp;Laura C. Plantinga ,&nbsp;Penelope P. Howards ,&nbsp;Michael Kramer ,&nbsp;Rachel E. Patzer","doi":"10.1016/j.xkme.2025.100974","DOIUrl":"10.1016/j.xkme.2025.100974","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Little is known about the relative importance of dialysis facilities and transplant centers on variability in starting an evaluation among patients referred for kidney transplant. The primary objective of this study was to leverage cross-classified multilevel modeling to simultaneously examine the contextual effects of dialysis facilities and transplant centers on variation in the start of the transplant evaluation process.&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;Dialysis patients referred for kidney transplant to transplant centers across the Southeast, Northeast, New York, or Ohio River Valley US regions from January 1, 2012, to December 31, 2020, were identified from the United States Renal Data System and the Early Steps to Transplant Access Registry and followed through June 30, 2021. A total of N=25,488 referred patients were nested with 1,720 dialysis facilities and 26 transplant centers.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Starting an evaluation for kidney transplant at a transplant center within 6 months of referral.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;A series of multilevel models were performed to estimate the variability in starting an evaluation for kidney transplant within 6 months of referral. The between-dialysis facility and/or transplant center variation in starting an evaluation was quantified using the median OR.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among 25,488 dialysis patients referred for kidney transplantation, 51% of patients started an evaluation at a transplant center within 6 months of referral. In multilevel models, the median OR between transplant centers was higher (indicating higher unexplained variability) than the dialysis facility median OR, regardless of measured patient, dialysis facility, and transplant center characteristics.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Early transplant access data was limited to 20 of 48 transplant centers across these 4 regions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;When taking dialysis facilities and transplant centers into account, variation in starting an evaluation for kidney transplant appeared at both the dialysis facility and transplant center-level but was more apparent among transplant centers.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Kidney transplantation is a life-saving treatment, but not all dialysis patients referred for transplant take the next step of starting their evaluation at a transplant center. Our study sought to understand the relative influence of dialysis facilities and transplant centers in starting an evaluation for kidney transplantation. When taking both dialysis facilities and transplant centers into account, we observed variation in starting an evaluation for kidney transplantation appeared at both the dialysis facility and transplant center-level but characteristics specific to transpla","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 4","pages":"Article 100974"},"PeriodicalIF":3.2,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143563498","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":"Mineralocorticoid Receptor Antagonist Use Among Patients With Chronic Kidney Disease Who Transitioned to Dialysis","authors":"Eric M. Tong MD ,&nbsp;Hui Zhou PhD ,&nbsp;Katherine Pak MS ,&nbsp;Cheng-Wei Huang MD ,&nbsp;Benjamin I. Broder MD, PhD ,&nbsp;John J. Sim MD","doi":"10.1016/j.xkme.2025.100973","DOIUrl":"10.1016/j.xkme.2025.100973","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 4","pages":"Article 100973"},"PeriodicalIF":3.2,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519516","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":"Preliminary Testing of the Discussion of Patient Life Goals Patient-Reported Outcome Measure for Dialysis Facilities","authors":"Claudia Dahlerus ,&nbsp;Noelle E. Carlozzi ,&nbsp;Katrina Price ,&nbsp;Jennifer A. Miner ,&nbsp;Richard A. Hirth ,&nbsp;Garrett Gremel ,&nbsp;Peisong Han ,&nbsp;Wei Zhang ,&nbsp;Jennifer Sardone ,&nbsp;Jesse Roach ,&nbsp;Wilfred Agbenyikey ,&nbsp;Stephanie L. Clark ,&nbsp;Golden Horton ,&nbsp;Alexander Yaldo ,&nbsp;Joseph M. Messana","doi":"10.1016/j.xkme.2025.100972","DOIUrl":"10.1016/j.xkme.2025.100972","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objectives&lt;/h3&gt;&lt;div&gt;To test a new patient-reported outcome measure that assesses end-stage kidney disease (ESKD) maintenance dialysis patients’ experience with life goals discussions with their dialysis facility care team.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Observational cross-sectional study. Survey data collected via REDCap, paper form or telephone in a convenience sample of patients with ESKD receiving maintenance dialysis in the United States.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Settings &amp; Participants&lt;/h3&gt;&lt;div&gt;People aged 18 years or older with ESKD receiving maintenance hemodialysis or peritoneal dialysis in US dialysis facilities between the June and December 2020 study period.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposures&lt;/h3&gt;&lt;div&gt;Testing of 6 items providing the core quality assessment and 1 item measuring whether 1 or more members of the treatment team discussed life goals with the patient.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Preliminary reliability and validity of the Discussion of Patient Life Goals survey (D-PaLS).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytic Approach&lt;/h3&gt;&lt;div&gt;Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and item response theory methods, including the graded response model (GRM) and differential item functioning (DIF).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Of 517 participants, 479 completed the survey via REDCap; 38 completed the survey via paper or telephone. EFA and CFA supported the unidimensionality of the 6 core items. GRM overall and item fit analyses and DIF analyses supported retention of all core items. Preliminary reliability data indicated very good internal consistency (Cronbach’s alpha&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.84). Known-groups validity was supported whereby individuals receiving home dialysis had more positive responses, than those receiving in-center hemodialysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Study participants were not fully representative of the US ESKD dialysis population.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Preliminary analyses indicate the D-PaLS has excellent psychometric properties. The measure provides 2 important quality metrics: facilities’ level of engagement talking with patients about their life goals and the percentage of patients reporting who on the treatment team talks with them about their life goals. Additional work is needed to establish comprehensive reliability and validity to support the clinical utility of this measure in patient care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;div&gt;The Discussion of Patient Life Goals survey (Item S1) was developed based on conversations we had with people with kidney failure and kidney doctors who felt it was important that discussing patient life goals should be part of kidney replacement treatment planning. To make sure this patient survey accurately assesses patient-reported experience with dialysis facility care, we carried out a series of statistical tests. Our testing results showed that the survey meet","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 4","pages":"Article 100972"},"PeriodicalIF":3.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143528630","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":"An Unusual Immediate Posttransplant Eruption","authors":"Ravi K. Mallavarapu,&nbsp;Akhil Vemuri","doi":"10.1016/j.xkme.2025.100969","DOIUrl":"10.1016/j.xkme.2025.100969","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 2","pages":"Article 100969"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143178063","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":"Oral Anticoagulant Initiation in Patients With Kidney Failure on Hemodialysis Newly Diagnosed With Atrial Fibrillation (2007-2020): An Observational Study of Trends and Disparities","authors":"Wolfgang C. Winkelmayer ,&nbsp;Austin Hu ,&nbsp;Pascale Khairallah ,&nbsp;Medha Airy ,&nbsp;Kevin F. Erickson ,&nbsp;Tara I. Chang ,&nbsp;Jingbo Niu","doi":"10.1016/j.xkme.2024.100926","DOIUrl":"10.1016/j.xkme.2024.100926","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Atrial fibrillation (AF) is common in patients with kidney failure on hemodialysis (HD), but few patients receive oral anticoagulant (OAC) treatment. Availability of direct-target OACs starting in 2010 may have induced greater OAC initiation, but this has not been systematically studied.&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;Using Medicare fee-for-service billing claims (2006-2020), we identified previously OAC-naïve HD patients newly-diagnosed with AF between January 1, 2007, and October 1, 2020.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposures&lt;/h3&gt;&lt;div&gt;Calendar year; race/ethnicity.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;OAC initiation within 90 days from AF diagnosis (any; specific agent).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;We estimated initiation risk ratios for each calendar year compared with the referent cohort, 2007, using unadjusted and multivariable-adjusted modified Poisson regression. We also determined differences by racial/ethnic group in OAC initiation, as well as any changes in these disparities over time.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among 82,389 HD patients newly-diagnosed with AF, 20,002 (24.3%) initiated new OAC treatment within 90 days: 20.5% in 2007 and 34.1% in 2020. Direct-target OACs accounted for 81.0% of OAC initiations in 2020. Adjusted regression models estimated that OAC initiation remained essentially unchanged between 2007 and 2013, but thereafter increased toward a demographics-adjusted risk ratio of 1.61 (95% CI: 1.50-1.73) in 2020. Compared with non-Hispanic Whites, the rates of OAC initiation were 15% (95% CI, 12%-17%) lower among Black patients, 29% (95% CI, 24%-34%) lower among Asian patients, and 22% (95% CI, 19%-25%) lower among Hispanic patients. These disparities were not found to have differed across time (&lt;em&gt;P&lt;/em&gt;&lt;sub&gt;interaction&lt;/sub&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.75).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Lack of clinical detail to firmly establish contraindications to OAC initiation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;While rates of OAC initiation among patients on HD with newly-diagnosed AF increased in recent years, predominantly driven by increased use of apixaban, OAC initiation rates remained low, at 34% of patients in 2020. Compared with non-Hispanic White patients, OAC initiation remained consistently lower in patients of other race and ethnic groups.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Use of oral blood thinners (anticoagulants) in patients with kidney failure undergoing hemodialysis who have a common type of heart rhythm disorder (atrial fibrillation) used to be low. We studied whether the availability of a novel class of anticoagulants increased use of this treatment approach in recent years. We were also interested in identifying any differences in anticoagulant use between patients of different racial and ethnic backgrounds. We found that us","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 2","pages":"Article 100926"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11750526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023857","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}