Kidney Medicine最新文献

{"title":"Patient Perceptions of a Population Health Management Program to Improve Kidney Care: Optimizing care in CKD","authors":"Linda-Marie U. Lavenburg , Susan M. Devaraj , Ambreen Gul , Melanie R. Weltman , Balchandre Neilesh Kenkre , Flor de Abril Cameron , Jane O. Schell , Megan E. Hamm , Manisha Jhamb","doi":"10.1016/j.xkme.2025.101025","DOIUrl":"10.1016/j.xkme.2025.101025","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>A population health management intervention for a pragmatic cluster randomized control trial (Kidney CHAMP) aimed to improve care and outcomes in patients with chronic kidney disease (CKD) at high-risk of progression to dialysis dependence but not seeing a nephrologist. The Kidney CHAMP intervention provided comanagement support to primary care providers by nephrology electronic-consult, pharmacist-directed medication reconciliation, and nurse-delivered CKD patient education. We sought to learn patient perceptions of Kidney CHAMP intervention and whether the intervention improved their understanding of CKD.</div></div><div><h3>Study Design</h3><div>An ancillary study of Kidney CHAMP using qualitative methods.</div></div><div><h3>Setting & Participants</h3><div>Participants were sampled from Kidney CHAMP intervention group using 3 predefined strata (racial/ethnic minorities, low socioeconomic status, and multimorbidities) from May 2021 to February 2022.</div></div><div><h3>Analytical Approach</h3><div>We conducted semistructured televideo or telephone interviews that were transcribed and then inductively coded by 2 data analysts until thematic saturation was reached. Conventional content and thematic analyses were performed.</div></div><div><h3>Results</h3><div>In 45 patient interviews (mean age 75<!--> <!-->±<!--> <!-->8 years, 44% women, 9% non-White race, and 59% low socioeconomic status), we identified 4 themes. First, patients expressed support for CKD comanagement by the primary care providers (PCPs) and nephrology team. Second, education sessions had variable effect on improving patients’understanding of CKD and its health implications. Third, patients’ self-efficacy and understanding of CKD management varied and was influenced by their understanding of its health implications. Fourth, patients appreciated education sessions and wanted more frequent sessions and actionable individualized guidance.</div></div><div><h3>Limitations</h3><div>Low representation of non-White individuals, recall bias, and lack of validated measures for health literacy, patient knowledge, and activation.</div></div><div><h3>Conclusions</h3><div>Patients with CKD who are managed by their PCP were supportive of remote comanagement by a nephrologist. Patients perceive some aspects of CKD health education to be beneficial; however, more effective approaches to communicating risk of CKD development and progression are needed.</div></div><div><h3>Plain-Language Summary</h3><div>In this ancillary qualitative study, we aimed to learn patient perspectives on a population health management approach to kidney disease comanagement between primary care providers and a multidisciplinary nephrology team. Patient interviewees were supportive of communication between primary care providers and the nephrology specialists, and most appreciated nurse-provided education sessions. However, despite exposure to the same standardized kidney e","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 7","pages":"Article 101025"},"PeriodicalIF":3.2,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144290956","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":"Atrial Fibrillation Is Associated With Increased In-Hospital and 1-Year Mortality in Patients Receiving Hemodialysis With ST Elevation Myocardial Infarction: A Retrospective Cohort Study","authors":"Simonetta Genovesi , Giuseppe Regolisti , Alice Bonomi , Olivia Leoni , Arianna Galotta , Giancarlo Marenzi","doi":"10.1016/j.xkme.2025.101023","DOIUrl":"10.1016/j.xkme.2025.101023","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Atrial fibrillation (AF) is highly prevalent among patients receiving maintenance hemodialysis (HD) and patients with ST elevation myocardial infarction (STEMI). We investigated the association of AF with in-hospital mortality, 1-year mortality, and 1-year readmission for acute myocardial infarction (AMI) in HD patients admitted with STEMI.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study based on a large administrative database.</div></div><div><h3>Setting & Participants</h3><div>138,939 patients admitted with STEMI from 2003-2018, of whom 1,185 (8.5%)receiving HD, followed from the date of admission until death, migration, or 1 year after discharge.</div></div><div><h3>Exposures</h3><div>STEMI (<em>International Classification of Diseases, Ninth Revision, Clinical Modification</em> [ICD-9-CM] 410.x) as the primary discharge diagnosis, maintenance HD (ICD-9-CM 39.95; 54.98; V560; V563.1; V563.2), and AF (ICD-9-CM 427.31).</div></div><div><h3>Outcomes</h3><div>In-hospital all-cause mortality (primary outcome), 1-year all-cause mortality, and 1-year readmission for AMI (secondary outcomes).</div></div><div><h3>Analytical Approach</h3><div>Multivariable logistic regression and multivariable Cox regression.</div></div><div><h3>Results</h3><div>One hundred and ninety-five out of 1,185 (16.5%) patients had AF at admission or developed AF during hospitalization. After adjusting for possible confounders, AF versus sinus rhythm was associated with higher in-hospital mortality (odds ratio [OR]<!--> <!-->=<!--> <!-->1.57; 95% confidence interval [CI], 1.11-2.22). AF was associated with higher 1-year mortality (hazard ratio [HR]<!--> <!-->=<!--> <!-->1.45; 95% CI, 1.18-1.76), whereas it was not associated with higher 1-year readmission for AMI (HR<!--> <!-->=<!--> <!-->1.05; 95% CI, 0.72-1.53). Less than 20% of patients with AF discharged alive were prescribed oral anticoagulant therapy. In this subgroup, oral anticoagulant therapy was associated with lower 1-year mortality (HR<!--> <!-->=<!--> <!-->0.46; 95% CI, 0.24-0.89).</div></div><div><h3>Limitations</h3><div>Potential bias due to incorrect or incomplete coding, retrospective design, incidence of thromboembolic events after discharge, and cause of 1-year mortality unknown.</div></div><div><h3>Conclusions</h3><div>AF is highly prevalent and associated with adverse short- and long-term outcomes in HD patients admitted with STEMI.</div></div><div><h3>Plain-Language Summary</h3><div>Atrial fibrillation (AF) is common both in patients with kidney failure receiving hemodialysis (HD) and in those with acute myocardial infarction. We investigated retrospectively the impact of AF on 1,185 patients receiving HD admitted for ST elevation myocardial infarction (STEMI). We examined the incidence of in-hospital mortality, 1-year mortality, and 1-year readmission for acute myocardial infarction in patients with AF compared with patients without AF. ","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 7","pages":"Article 101023"},"PeriodicalIF":3.2,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144329780","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":"Effectiveness of Allopurinol on Uric Acid and Pediatric Chronic Kidney Disease Severity in the Chronic Kidney Disease in Children Study","authors":"Derek K. Ng ,&nbsp;Matthew B. Matheson ,&nbsp;George J. Schwartz ,&nbsp;Katherine E. Kurgansky ,&nbsp;Bradley A. Warady ,&nbsp;Susan L. Furth ,&nbsp;CKiD Study Investigators","doi":"10.1016/j.xkme.2025.101021","DOIUrl":"10.1016/j.xkme.2025.101021","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><div>Clinical trials have shown that serum uric acid reduction does not slow chronic kidney disease (CKD) progression in adults, but it is uncertain whether these findings apply to children.</div></div><div><h3>Study Design</h3><div>An observational cohort study.</div></div><div><h3>Setting &amp; Population</h3><div>The Chronic Kidney Disease in Children cohort with participants who initiated allopurinol with a comparison group matched on age, sex, uric acid, CKD diagnosis, estimated glomerular filtration rate (eGFR), and proteinuria.</div></div><div><h3>Exposure</h3><div>Allopurinol initiation.</div></div><div><h3>Outcomes</h3><div>Uric acid, eGFR, and proteinuria before and after initiation, and longitudinal changes over time.</div></div><div><h3>Analytical Approach</h3><div>Allopurinol initiators were matched to noninitiators at a 1:3 ratio. Nonparametric tests compared levels before and after initiation and within-person changes. Linear mixed effects models characterized baseline and longitudinal differences between treatment groups.</div></div><div><h3>Results</h3><div>A total of 27 participants initiated allopurinol, and these were matched to 81 participants who did not initiate allopurinol. Allopurinol was associated with a 15.9% lower serum uric acid (95% CI, −21.1% to<!--> <!-->−10.4%) relative to the matched comparison group (<em>P</em> <!-->&lt;<!--> <!-->0.001) after initiation. There were no significant differences in eGFR or proteinuria over time by group.</div></div><div><h3>Limitations</h3><div>Observational study designed for comparative effectiveness and relatively small sample size; effectiveness of allopurinol initiated at lower levels of uric acid could not be estimated.</div></div><div><h3>Conclusions</h3><div>Allopurinol was effective at significantly lowering serum uric acid in children with CKD but was not associated with CKD progression measured by longitudinal eGFR and proteinuria.</div></div><div><h3>Plain-Language Summary</h3><div>Uric acid is a blood biomarker that is strongly associated with the severity of chronic kidney disease in adults and children. Clinical trials in adults have shown that medications like allopurinol, which reduce uric acid, do not slow progression of kidney disease. This has not been evaluated in children because this disease is rare and trials in this special population are difficult. Using observational data and matching methods in a longitudinal cohort of children with kidney diseases, we evaluated whether allopurinol lowered uric acid and slowed disease progression. Allopurinol significantly and substantially reduced uric acid levels but did not slow in kidney disease progression over about 5 years. These findings were congruent with the hypothesis that higher uric acid is a consequence rather than a cause of kidney disease progression.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 7","pages":"Article 101021"},"PeriodicalIF":3.2,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144330495","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":"Posterior Reversible Encephalopathy Syndrome in Chronic Kidney Disease: Incidence, Outcomes, and Risk Factors in a National Cohort","authors":"Mingyue He ,&nbsp;Avrum Gillespie","doi":"10.1016/j.xkme.2025.101022","DOIUrl":"10.1016/j.xkme.2025.101022","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Posterior reversible encephalopathy syndrome (PRES) is an acute neurological condition that, if untreated, can result in severe complications, such as intracerebral hemorrhage. Patients with chronic kidney disease (CKD) are at an increased risk of developing PRES; however, it is unclear whether this risk is primarily driven by comorbid conditions or if renal dysfunction itself is an independent risk factor. This study aimed to evaluate the incidence, outcomes, and resource utilization of PRES across CKD stages compared with patients without kidney disease.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;A retrospective study using the Nationwide Inpatient Sample Database.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Adult patients nonelectively admitted with PRES from 2016 to 2019.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposures&lt;/h3&gt;&lt;div&gt;Different stages of CKD versus no kidney disease&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;All-cause in-hospital mortality, Incidence of PRES hospitalizations, in-hospital morbidity (intracerebral hemorrhage, ischemic stroke, brain herniation, and status epilepticus), and health care resource utilization (length of hospital stay and total hospitalization charges)&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Multivariate logistic and linear regression analyses were conducted using survey design methods.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The cohort included 12,605 patients, representing 0.014% of all admissions. PRES incidence increased from 0.013% in 2016 to 0.015% in 2019 (&lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.01) and demonstrated a dose-response relationship with CKD stage progression. Key risk factors for PRES included female sex, White race, hypertension, metastatic cancer, solid organ transplantation, rheumatologic disorders, substance use disorders, carotid artery stenosis, migraines, and cerebral atherosclerosis. Kidney failure (KF) was strongly associated with in-hospital mortality (aOR 5.12, 95% CI, 2.09-12.53, &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.001). The length of stay, total hospitalization charge, and rates of neurological complications were similar between CKD/KF and patients without kidney disease.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;The use of administrative data limits access to detailed clinical information. Residual confounding factors remain possible.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;This is the largest study to date on PRES in CKD populations. CKD is strongly associated with PRES, with a dose-response relationship, and KF is an independent risk factor for in-hospital mortality, emphasizing the need for heightened clinical vigilance in this population.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Posterior Reversible Encephalopathy Syndrome (PRES) is a serious brain condition that can cause seizures, confusion, and even death if not recognized and treated in time. However, it is often overlooked because its symptoms can be vague. While PRES is commonly","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 7","pages":"Article 101022"},"PeriodicalIF":3.2,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144330392","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":"C3 Glomerulonephritis Associated With Unusual IgG4 Antifactor H in IgG4-related Disease","authors":"Paul Dalmas ,&nbsp;Mickael Bobot ,&nbsp;Noémie Jourde-Chiche ,&nbsp;Julie Bruno ,&nbsp;Stéphane Burtey ,&nbsp;Laurent Daniel ,&nbsp;Carine El-Sissy ,&nbsp;Véronique Fremeaux-Bacchi ,&nbsp;Antonio Jorquera ,&nbsp;Vincent Javaugue ,&nbsp;Nicolas Schleinitz ,&nbsp;Mikael Ebbo","doi":"10.1016/j.xkme.2025.101019","DOIUrl":"10.1016/j.xkme.2025.101019","url":null,"abstract":"<div><div>C3 glomerulonephritis (C3GN) is characterized by glomerular aggression mediated by deregulation of the alternative complement pathway. C3GN can be inherited or consequent to acquired autoantibodies, notably against factor H. We report the case of a patient with systemic active IgG4-related disease who presented for acute kidney injury with glomerular proteinuria and hypocomplementemia related to C3GN associated with IgG4-related interstitial nephritis on kidney biopsy. Factor H was low, and antifactor H IgG autoantibody was detected. Detection of other acquired or genetic complement alternative pathway disorders returned negative. After initial failure of oral corticoids and intravenous rituximab, the patient was successfully treated by intravenous cyclophosphamide followed by maintenance therapy with rituximab. Antifactor H autoantibody isotypes were IgG1 and IgG3, mainly as all antifactor H in positive controls but also IgG4, which is unusual. This suggests a link in this case between the oligoclonal expansion of plasma cells in IgG4-related disease and the production of antifactor H antibodies, especially of IgG4 isotype.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 7","pages":"Article 101019"},"PeriodicalIF":3.2,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223359","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":"Predicting Hospitalization and Related Outcomes in Advanced Chronic Kidney Disease: A Systematic Review, External Validation, and Development Study","authors":"Roemer J. Janse ,&nbsp;Jet Milders ,&nbsp;Joris I. Rotmans ,&nbsp;Fergus J. Caskey ,&nbsp;Marie Evans ,&nbsp;Claudia Torino ,&nbsp;Maciej Szymczak ,&nbsp;Christiane Drechsler ,&nbsp;Christoph Wanner ,&nbsp;Maria Pippias ,&nbsp;Antonio Vilasi ,&nbsp;Vianda S. Stel ,&nbsp;Nicholas C. Chesnaye ,&nbsp;Kitty J. Jager ,&nbsp;Friedo W. Dekker ,&nbsp;Merel van Diepen","doi":"10.1016/j.xkme.2025.101016","DOIUrl":"10.1016/j.xkme.2025.101016","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Hospitalization is common in patients with advanced chronic kidney disease (CKD). Predicting hospitalization and related outcomes would be beneficial for hospitals and patients. Therefore, we aimed to (1) give an overview of current prediction models for hospitalization, length of stay, and readmission in patients with advanced CKD; (2) externally validate these models; and (3) develop a new model if no valid models were identified.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Systematic review, development, and external validation study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;We were interested in prediction models of hospitalization, length of stay, or readmission for patients with advanced CKD. Our available development and validation data consisted of hemodialysis, peritoneal dialysis, and advanced CKD patients not receiving dialysis from a Dutch dialysis and European advanced CKD cohort.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Selection Criteria for Studies&lt;/h3&gt;&lt;div&gt;We systematically searched PubMed. Studies had to intentionally develop, validate, or update a prediction model in adults with CKD.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;We used the PROBAST for risk of bias assessment. Identified models were externally validated on model discrimination (C-statistic) and calibration (calibration plot, slope, and calibration-in-the-large). We developed a Fine-Gray model for hospitalization within 1 year in patients initiating hemodialysis, accounting for the competing risk of death.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;We identified 45 models in 8 studies. The majority were of low quality with a high risk of bias. Due to underreporting and population-specific predictors, we could only validate 3 models. These were poorly calibrated and had poor discrimination. Using multiple modeling strategies, an adequate new model could not be developed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;The outcome hospitalization might be too heterogeneous, and we did not have all relevant predictors available.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Hospitalizations are important but difficult to predict for patients with advanced CKD. An improved prediction model should be developed, for example, using a more specific outcome (eg, cardiovascular hospitalizations) and more predictors (eg, patient-reported outcome measures).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Hospitalizations often occur in patients with advanced chronic kidney disease. By predicting hospitalization and related outcomes, patients can better prepare for the future and cope with their disease. Therefore, we searched existing literature for existing methods to predict hospitalizations and related outcomes. Although many algorithms exist, they are often not available for use or are not reliable. We then developed our own algorithm to predict hospitalization in the coming year. However, it also did not predict reliably. In this study, we summ","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 7","pages":"Article 101016"},"PeriodicalIF":3.2,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144329680","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":"Plasma-negative, Renal-limited Cryofibrinogen-associated Glomerulonephritis: A Unique Case Report","authors":"Jarrad A. Hopkins ,&nbsp;Ann Nguyen-Hoang ,&nbsp;John Brealey ,&nbsp;Pravin Hissaria ,&nbsp;Jola Kapojos","doi":"10.1016/j.xkme.2025.101017","DOIUrl":"10.1016/j.xkme.2025.101017","url":null,"abstract":"<div><div>Cryofibrinogen-associated glomerulonephritis is characterized by membranoproliferative glomerulonephritis without immunoglobulin deposition and unique ultrastructural features. This case report presents a 63-year-old man with renal-limited cryofibrinogen-associated glomerulonephritis, with negative plasma cryofibrinogen levels. His medical history included metallic aortic valve replacement and long-term anticoagulation therapy. Clinical examination revealed no cutaneous manifestations or thrombotic events. Initial laboratory investigations showed severe kidney dysfunction, but negative results for plasma cryofibrinogen, serum cryoglobulin, and a comprehensive autoimmune, infective, and malignancy panel. Kidney biopsy revealed mesangiocapillary glomerulonephritis with focal vasculitis and significant interstitial fibrosis, and electron microscopy identified double-walled microtubules consistent with cryofibrinogen. Our patient was managed without immunosuppressive therapy due to significant kidney scarring and absence of extra-renal manifestations. To our knowledge, this case describes the first report of cryofibrinogen-associated glomerulonephritis in the absence of detectable cryofibrinogen in serum, with diagnosis relying on ultrastructural findings. Differential diagnoses such as immunotactoid glomerulonephritis were considered but ruled out based on morphological characteristics. This case adds to the limited literature on renal-limited cryofibrinogen and emphasizes the necessity for thorough investigation including electron microscopy assessment of kidney biopsies to ascertain the diagnosis.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 7","pages":"Article 101017"},"PeriodicalIF":3.2,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144212438","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":"Deoxycholic Acid and Cognitive Impairment and Decline in the Chronic Renal Insufficiency Cohort (CRIC)","authors":"Parisa Mortaji ,&nbsp;Xuan Cai ,&nbsp;Ester Oh ,&nbsp;Rebecca Frazier ,&nbsp;Anand Srivastava ,&nbsp;Michael Fischer ,&nbsp;Ana Ricardo ,&nbsp;Jiang He ,&nbsp;Katherine Mills ,&nbsp;Katherine Wolfrum ,&nbsp;Amanda Anderson ,&nbsp;Harold I. Feldman ,&nbsp;Makoto Miyazaki ,&nbsp;Michel Chonchol ,&nbsp;Manjula Kurella Tamura ,&nbsp;Kristen Nowak ,&nbsp;Tamara Isakova ,&nbsp;Anna Jovanovich","doi":"10.1016/j.xkme.2025.101018","DOIUrl":"10.1016/j.xkme.2025.101018","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Cognitive impairment is common in chronic kidney disease (CKD). The secondary bile acid, deoxycholic acid (DCA), is associated with cognitive impairment and Alzheimer’s dementia among older adults without CKD. Whether DCA is associated with cognitive impairment and decline in CKD is unknown.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Cross-sectional and longitudinal multivariable-adjusted regression analyses.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;2,836 CRIC Study participants; 699 CRIC Cognitive (COG) Study participants.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;Fasting serum DCA levels measured at visit 5 (ie, baseline).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Modified Mini-Mental State Examination (3MS) in the main CRIC cohort and domain-specific cognitive tests in the CRIC COG cohort: Trail Making Test Parts A and B, Category Fluency, Buschke Selective Reminding, and Boston Naming. Cognitive impairment was defined as test score&lt;!--&gt; &lt;!--&gt;&gt;1 standard deviation worse than the mean test score.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Mean age 59&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;10 years, 45% female, and 39% Black. In the overall cohort, in cross-sectional analyses, there was no association between DCA and cognitive impairment by 3MS in after adjustment for demographics and clinical factors (prevalence ratio doubling DCA, 1.00; 95% CI, 0.95-1.06; n&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;2,836). In longitudinal analyses, DCA was associated with decline (mean annual percent change in 3MS per doubling DCA, −0.13; 95% CI, −0.28 to&lt;!--&gt; &lt;!--&gt;−0.02) but not with incident impairment (n&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;2,836; follow-up of 8.6&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;3.9 years). Among CRIC COG Study participants, in cross-sectional analyses, DCA was associated with cognitive impairment based on Category Fluency (prevalence ratio per doubling DCA, 1.14; 95% CI, 1.02-1.27) but not with other specific-domain cognitive tests (n&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;698-699). In CRIC COG longitudinal analyses, DCA was not associated with decline or incident cognitive impairment (n&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;538-574).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;No adjustment for inflammation, no stool DCA, 3MS may lack specificity.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Among individuals with CKD stages 2-4, higher DCA levels were independently associated with prevalent cognitive impairment in Category Fluency. The association between DCA and progressive cognitive impairment assessed by 3MS was small and likely not clinically significant.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Cognitive impairment is common in chronic kidney disease (CKD). Deoxycholic acid (DCA) is a secondary bile acid that is associated with cognitive impairment in older adults without CKD, but its association with cognitive impairment and decline in patients with CKD is unknown. We examined whether DCA was associated with baseline or later cognitive impairment among 2,836 participants from","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 7","pages":"Article 101018"},"PeriodicalIF":3.2,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336013","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":"Utilization Trends of Dual GIP/GLP-1 Receptor Agonist, Newer Glucose-Lowering Medications, and Anti-Obesity Medications Among Patients With Chronic Kidney Disease With and Without Type 2 Diabetes","authors":"Panupong Hansrivijit ,&nbsp;Janinne Ortega-Montiel ,&nbsp;Deborah J. Wexler ,&nbsp;Elisabetta Patorno ,&nbsp;Julie M. Paik","doi":"10.1016/j.xkme.2025.101013","DOIUrl":"10.1016/j.xkme.2025.101013","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Tirzepatide, a dual GIP/GLP-1 receptor agonist, has been approved for type 2 diabetes (T2D) and obesity. However, the real-world utilization of tirzepatide remains unexplored, particularly in patients with chronic kidney disease (CKD), where the prevalence of T2D and obesity is high. This study aimed to describe the utilization trends of tirzepatide, glucose-lowering medications (GLMs), and anti-obesity medications (AOMs) in patients with CKD, with and without T2D.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;A population-based, observational 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 CKD, with and without T2D, were identified from a large US health insurance claims database (from January 1, 2022 to September 30, 2023).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposures&lt;/h3&gt;&lt;div&gt;Tirzepatide, other GLMs, and AOMs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Medication utilization trends and patient characteristics. Any users were defined as those with prescription claims, and incident users as those with no previous dispensing within 365 days.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Longitudinal trends were assessed by 1-month intervals from January 1, 2022 to September 30, 2023.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among 455,047 patients with CKD and T2D, tirzepatide any users increased to 4.8% in September 2023, while incident users rose from 0.8% to 8.6%. Sodium glucose cotransporter-2 inhibitors remained the most initiated GLM. Tirzepatide initiators had higher rates of obesity (32.5%), and morbid obesity (44.1%) when compared with other GLMs. Among 5,978 patients with CKD without diabetes, weekly semaglutide&lt;!--&gt; &lt;!--&gt;≤2&lt;!--&gt; &lt;!--&gt;mg was the most initiated AOM, followed by tirzepatide. Incident users of tirzepatide rose from 0.6% in June 2022 to 23.5% in September 2023. Clinical characteristics were similar between semaglutide&lt;!--&gt; &lt;!--&gt;≤2&lt;!--&gt; &lt;!--&gt;mg versus tirzepatide initiators.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;The study period ended before tirzepatide’s approval for weight management (November 2023).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Our study indicates rapidly shifting trends in tirzepatide uptake among patients with CKD both with and without diabetes. The uptake of tirzepatide is expected to increase further. Future studies on the comparative effectiveness and safety of tirzepatide in patients with CKD are warranted.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;div&gt;Tirzepatide, a dual GIP/GLP-1 receptor agonist, has been approved for glycemic control and weight management, but its utilization in the real-world settings among patients with chronic kidney disease (CKD) is unknown, where the prevalence of type 2 diabetes and obesity is high. In this study, we examined the utilization trends of tirzepatide, other glucose-lowering medications, and anti-obesity medications (AOMs) from January 1, 2022 to September 30, 2023 using a large US health insurance datab","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 6","pages":"Article 101013"},"PeriodicalIF":3.2,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144116047","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":"Association of Primary Care Continuity With Home Dialysis, Transplantation, and Utilization of Medical Services for Patients Starting Hemodialysis","authors":"Cole S. Wyman ,&nbsp;Maya Djerboua ,&nbsp;Kristin K. Clemens ,&nbsp;Ziv Harel ,&nbsp;Manish M. Sood ,&nbsp;Samuel A. Silver","doi":"10.1016/j.xkme.2025.101015","DOIUrl":"10.1016/j.xkme.2025.101015","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Primary care may help patients starting dialysis with emotional support and access to health care services. It is unknown whether consistently visiting the same primary care physician (PCP) can strengthen patient confidence to select home dialysis, help facilitate medical appointments for transplantation, or increase care access.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;A population-based 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 initiating maintenance hemodialysis from 2007 to 2017 in Ontario, Canada.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;High PCP continuity using the usual provider of care index (an established measure of PCP continuity), defined as&lt;!--&gt; &lt;!--&gt;&gt;75% of PCP visits with the same PCP in the 2 years before dialysis initiation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Primary outcomes were time to home dialysis (peritoneal or hemodialysis) and transplantation. Secondary outcomes included specialist visits, cancer screening, influenza vaccination, and measures of diabetes care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Propensity scores to match patients with high and low PCP continuity.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;We identified 9,530 matched pairs. High PCP continuity was not associated with increased home dialysis (14.0 events per 100 person-years vs 14.0 events per 100 person-years; subdistribution hazard ratio 1.00; 95% CI, 0.97-1.04) or transplantation (4.3 events per 100 person-years vs 4.5 events per 100 person-years; subdistribution hazard ratio 0.97; 95% CI, 0.90-1.04). High PCP continuity was associated with greater colon cancer screening (hazard ratio 1.07; 95% CI, 1.01-1.14), influenza vaccination (hazard ratio 1.33; 95% CI, 1.27-1.39), and comprehensive diabetes care (hazard ratio 1.23; 95% CI, 1.14-1.33).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Residual confounding is possible.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;High PCP continuity before dialysis initiation was not associated with increased utilization of home dialysis or transplantation but was associated with greater colon cancer screening, influenza vaccination, and comprehensive diabetes care. Additional work is needed to clarify how primary care may best benefit this patient population.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;div&gt;Patients transitioning to maintenance hemodialysis require comprehensive health care. We investigated how closer relationships with a primary care physician (PCP) may complement nephrologists in caring for this patient population. We used administrative databases in Ontario, Canada, to conduct a retrospective population-based study, assessing how continuity with one PCP influenced the uptake of home dialysis, kidney transplantation, and patient access to health care services. We found that high PCP continuity before dialysis initiation was not associated with increased transition to home dialysis or kidney transplan","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 6","pages":"Article 101015"},"PeriodicalIF":3.2,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144115993","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}