Kidney Medicine最新文献

{"title":"Optimizing a Dose Prescription as the First Step of Green Continuous Kidney Replacement Therapy","authors":"Harin Rhee , Taeil Kim , Kyung Sook Jung , Eun Young Ku","doi":"10.1016/j.xkme.2025.101088","DOIUrl":"10.1016/j.xkme.2025.101088","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Continuous kidney replacement therapy (CKRT) requires a large amount of fluid; however, it is often overused in clinical settings, leading to fluid waste. This study aimed to investigate the influence of dose optimization on fluid consumption and dialysis efficacy.</div></div><div><h3>Study Design</h3><div>Single-center prospective study.</div></div><div><h3>Setting & Participants</h3><div>All patients treated with CKRT at Pusan National University Hospital between May 1 and December 31, 2023.</div></div><div><h3>Quality Improvement Activities</h3><div>The CKRT prescription dose was adjusted from the previous 35-25-30 mL/kg/h, targeting delivered doses between 20 and 25 mL/kg/h, as per the Kidney Disease: Improving Global Outcomes recommendations.</div></div><div><h3>Outcomes</h3><div>The primary outcome was the change in total fluid consumption, and the secondary outcome was the differences in the pattern of biochemical parameter changes after 48 hours of CKRT before and after the study (serum urea nitrogen, creatinine, potassium, phosphate, and bicarbonate).</div></div><div><h3>Analytic Approach</h3><div>General linear model for the primary outcome; repeated measures analysis of variance for the secondary outcome.</div></div><div><h3>Results</h3><div>A total of 441 patients were included before (N = 210) and after (N = 231) participating in the study. The median age was 70.0 (61.0-77.5) years; 67.3% were male, and 17.6% had end-stage kidney disease. Before the study, the median prescribed dose for CKRT was 34.1 (33.0-35.4) mL/kg/h, with the median amount of fluid consumption being 53.6 (43.0-63.2) L/person/d. During the study periods, the median delivered dose was reduced to 27.4 mL/kg/h (<em>P</em> < 0.001), and total fluid consumption was reduced by 6.7 (3.7-9.8) L/person/d, with a median reduction in plastic package usage of 1.3 (0.8-1.9) (<em>P</em> < 0.001). The degree of biochemical changes was not significantly different before and after the study.</div></div><div><h3>Limitations</h3><div>The fluid-saving effect may be greater in countries with heavier patients.</div></div><div><h3>Conclusions</h3><div>Efforts to optimize CKRT dosing allowed for a 12.7% reduction in fluid consumption (ie, 6.7 L/person/d), without any additional changes in treatment efficacy.</div></div><div><h3>Plain Language Summary</h3><div>Greening of intensive care is essential; however, it is often challenging in critically ill patients, because the greening process should not compromise patient safety. Continuous kidney replacement therapy is the most common method of dialysis in the intensive care unit, requiring large amounts of fluid. This quality improvement study controlled the delivered dialysis dose by reducing treatment intensity and analyzed its impact on fluid savings and treatment efficacy. Reducing the dose prescription by 3.3 mL/kg/h resulted in savings of approximately 6.7 L of fluid and 1.3 dialys","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 10","pages":"Article 101088"},"PeriodicalIF":3.4,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096980","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":"Galectin-3 Is Associated With Risk of Cardiovascular and Kidney Outcomes in Ambulatory Veterans","authors":"Shreya Banerjee , Pranav S. Garimella , Kimberly N. Hong , Alexander L. Bullen , Lori B. Daniels , Nicholas Wettersten","doi":"10.1016/j.xkme.2025.101089","DOIUrl":"10.1016/j.xkme.2025.101089","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Cardiovascular and kidney disease are highly prevalent comorbid conditions, and each is a risk factor for the other condition. We evaluated whether Galectin-3 (Gal-3), a biomarker of organ fibrosis, is associated with cardiovascular and kidney events in ambulatory Veterans.</div></div><div><h3>Study Design</h3><div>An observational cohort study.</div></div><div><h3>Setting & Participants</h3><div>Ambulatory Veterans presenting for an outpatient echocardiogram at the San Diego Veterans Affairs between 2010 and 2013.</div></div><div><h3>Predictor</h3><div>Blood Gal-3 levels.</div></div><div><h3>Outcomes</h3><div>The primary cardiovascular outcome was major adverse cardiac events (MACEs: acute coronary syndrome [ACS], stroke, heart failure [HF] hospitalization, or cardiovascular death). The primary kidney outcome was major adverse kidney events (MAKEs: ≥40% estimated glomerular filtration rate decrease or renal replacement therapy). Secondary outcomes were cardiovascular death, incident HF, ACS, and all-cause mortality.</div></div><div><h3>Analytical Approach</h3><div>Cox proportional hazard models adjusting for cardiovascular and kidney disease risk factors.</div></div><div><h3>Results</h3><div>A total of 882 Veterans with an average age of 66 ± 12 years, 97% were men, average eGFR of 78 ± 20 mL/min/1.73 m<sup>2</sup>, 40% prevalence of coronary artery disease, and 17% prevalence of HF. Higher Gal-3 was associated with a greater risk of MACEs (hazard ratio [HR], 1.54 per 2-fold higher Gal-3; 95% confidence interval [CI], 1.02-2.32; <em>P</em> = 0.04), cardiovascular death (HR, 3.41; 95% CI, 1.75-6.66; <em>P</em> < 0.001), and all-cause mortality (HR, 1.81; 95% CI, 1.41-2.33; <em>P</em> < 0.001), but not incident HF or ACS. Higher Gal-3 was associated with a greater risk of MAKEs (HR, 1.92; 95% CI, 1.20-3.08; <em>P</em> = 0.004). Higher Gal-3 was associated with >350% greater risk of experiencing both MACEs and MAKEs during follow-up (HR, 3.57; 95% CI, 1.63-7.84; <em>P</em> = 0.002).</div></div><div><h3>Limitations</h3><div>Select population of Veterans presenting for an echocardiogram who were primarily older men with multiple comorbid conditions.</div></div><div><h3>Conclusions</h3><div>Gal-3 is associated with risk of cardiovascular and kidney outcomes among ambulatory Veterans.</div></div><div><h3>Plain Language Summary</h3><div>Galectin-3 is a biomarker of organ fibrosis and has been associated with risk of cardiovascular and kidney outcomes individually, but its association with both outcomes is less well described. We assessed whether Galectin-3 was associated with risk of cardiovascular and kidney events in 882 ambulatory Veterans with 13 years of follow-up. We found that Galectin-3 was associated with risk for major adverse cardiac events (acute coronary syndrome, stroke, cardiovascular death, or heart failure hospitalization) and major kidney events (need for renal replacement therap","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 10","pages":"Article 101089"},"PeriodicalIF":3.4,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145119393","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":"Body Composition and Kidney Outcomes: A Cohort Study of Rapid Kidney Function Decline and a Mendelian Randomization Analysis of CKD Incidence","authors":"Kaixin Li MD , Yao Liu MD , Jiaxi Zhao MD , Zhibin Ye MD, PhD","doi":"10.1016/j.xkme.2025.101087","DOIUrl":"10.1016/j.xkme.2025.101087","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Chronic kidney disease (CKD) is a global health issue, potentially arising from rapid kidney function decline (RKFD). Although body composition influences various metabolic disorders, its relationship with kidney outcomes remains unclear. This study aimed to investigate the impact of body composition on RKFD and CKD risk.</div></div><div><h3>Study Design</h3><div>A cohort study assessed the relationship between body composition and RKFD. A 2-sample Mendelian randomization approach investigated genetic evidence linking body composition to CKD risk.</div></div><div><h3>Setting & Participants</h3><div>In total, 229 adults aged 50-70 years with normal kidney function were recruited from Huadong Hospital in Shanghai, China.</div></div><div><h3>Predictors</h3><div>Body composition indicators include fat mass, lean mass, appendicular lean mass index, fat mass index, total and regional body fat percentages, and sarcopenic obesity, defined by high body fat percentages (>27% in men, >38% in women) and low lean mass (appendicular lean mass index <7.26 kg/m<sup>2</sup> in men, <5.45 kg/m<sup>2</sup> in women).</div></div><div><h3>Outcomes</h3><div>The primary outcome was RKFD. The second was genetically predicted CKD risk.</div></div><div><h3>Analytical Approach</h3><div>Cox regression and subgroup analyses assessed observational associations. The Mendelian randomization study used two-sample Mendelian randomization, multivariable, and bidirectional Mendelian randomization.</div></div><div><h3>Results</h3><div>RKFD occurred in 9.9% of participants. Lower appendicular lean mass index and the presence of sarcopenic obesity were associated with higher RKFD risk. In overweight participants and those with baseline estimated glomerular filtration rate >90 mL/min/1.73 m<sup>2</sup>, the negative association between appendicular lean mass index and RKFD remained significant. Mendelian randomization analysis revealed that genetically predicted legs and whole-body fat percentages increased CKD risk, whereas appendicular muscle mass was negatively associated with CKD.</div></div><div><h3>Limitations</h3><div>Differences between the outcomes require further validation. Some sample overlap in the Mendelian randomization analysis may introduce bias.</div></div><div><h3>Conclusions</h3><div>Lower appendicular lean mass index and sarcopenic obesity were associated with RKFD. Higher leg and whole-body fat percentages and lower appendicular muscle mass significantly contribute to CKD risk, highlighting the importance of body composition in kidney health.</div></div><div><h3>Plain Language Summary</h3><div>Body composition, such as fat and muscle mass and percentage, may play a role in kidney outcomes. In this study, we followed a group of middle-aged to old adults with normal kidney function to see how body composition affects how quickly kidney function declines over time. We further explore whether genetically p","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 10","pages":"Article 101087"},"PeriodicalIF":3.4,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145118798","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":"Development of a Predictive Tool for Maintenance Dialysis Initiation: A Retrospective Cohort Analysis of 589,284 Participants From the Shizuoka Kokuho Database Study","authors":"Yuri Oshiro , Tatsunori Satoh , Emi Ohata , Eiji Nakatani , Hideaki Kaneda , Akira Sugawara","doi":"10.1016/j.xkme.2025.101084","DOIUrl":"10.1016/j.xkme.2025.101084","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Maintenance dialysis initiation is rare in early-stage chronic kidney disease (CKD), making accurate risk stratification difficult. We sought to build a simple prediction score based on routine health checkup data.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>Adults (≥40 years) attending government-mandated health checkups in Shizuoka Prefecture, Japan, 2012-2020 (N = 589,284).</div></div><div><h3>Predictors</h3><div>Baseline demographics, vital signs, laboratory indices, medication use, and lifestyle factors routinely recorded at health checks.</div></div><div><h3>Outcomes</h3><div>Time from first health checkup to initiation of maintenance dialysis, ascertained from procedure codes; death treated as a competing risk.</div></div><div><h3>Analytical Approach</h3><div>Two-thirds of participants were randomly assigned to a training cohort (n = 392,856; events = 335) and one-third to a test cohort (n = 196,428; events = 179). Cause-specific Cox models generated hazard ratios that were converted to integer scores (maximum 31). Discrimination was evaluated with Harrell’s c-index and calibration with performed with cumulative incidence curves.</div></div><div><h3>Results</h3><div>During a median follow-up of 5.9 years, 514 participants (0.09%) initiated dialysis. Independent predictors included male sex, body mass index <18.5 kg/m<sup>2</sup>, higher systolic blood pressure, hemoglobin A1c ≥8 %, lower estimated glomerular filtration rate, proteinuria, aspartate aminotransferase ≥50 IU/L, use of antihypertensive or antidiabetic drugs, and habitual smoking. The score showed excellent discrimination in both training (c-index, 0.916; 95% confidence interval [CI], 0.898-0.934) and test (c-index, 0.916; 95% CI, 0.889-0.943) cohorts. High-risk individuals (score ≥16; 0.3% of the cohort) had a 5-year dialysis incidence of 4.6%, yet 95% remained dialysis-free, underscoring the challenge of predicting this rare outcome.</div></div><div><h3>Limitations</h3><div>CKD onset predated cohort entry, prescription data were not analyzed for causal effects, and external validation is pending.</div></div><div><h3>Conclusions</h3><div>Our model, leveraging routine health checkup data, accurately identifies persons at elevated risk for future dialysis despite low event rates.</div></div><div><h3>Plain Language Summary</h3><div>Many early kidney problems go unnoticed until dialysis is suddenly required. We wondered whether the routine health-check data already collected each year in Japan could warn clinicians sooner. We followed a very large group of adults who had regular checkups, recording simple measures such as weight, blood pressure, blood sugar, urinary protein, kidney filtering rate, smoking status, and common prescriptions. Using these items, we built an easy point score that sorts people into low, moderate, or high risk of needing dialysis","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 10","pages":"Article 101084"},"PeriodicalIF":3.4,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096979","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":"Avacopan in Double-Positive Vasculitis...Why Not Consider It?: A Case Report","authors":"Shehab Sayed ,&nbsp;Patricia Torres ,&nbsp;Patricia Purón ,&nbsp;Marina Alonso ,&nbsp;Eduardo Gutierrez ,&nbsp;Ángel M. Sevillano ,&nbsp;Enrique Morales","doi":"10.1016/j.xkme.2025.101083","DOIUrl":"10.1016/j.xkme.2025.101083","url":null,"abstract":"<div><div>Rapidly progressive glomerulonephritis (RPGN) secondary to antineutrophil cytoplasmic antibody-associated vasculitis and antiglomerular basement membrane disease has a poor prognosis, influenced by the dual positivity of both antibodies. Despite the use of aggressive immunosuppressive treatments, the outlook remains bleak, with a high percentage of patients progressing to advanced chronic kidney disease or requiring renal replacement therapy. We present the case of a 72-year-old patient with RPGN associated with vasculitis and double positivity, confirmed by immunological testing and renal histology. The patient was initially treated with a combination of glucocorticoid pulses, rituximab, cyclophosphamide, and plasmapheresis. Shortly thereafter, however, she experienced a relapse, which led to the addition of avacopan to the treatment regimen, with progressive improvement in clinical status and kidney function. This case highlights the importance of considering aggressive therapeutic strategies in antiglomerular basement membrane disease, including avacopan as part of immunosuppressive therapy to prevent progression to advanced chronic kidney disease.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 10","pages":"Article 101083"},"PeriodicalIF":3.4,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145118795","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":"Renal Papillary Necrosis Complicating Immune Checkpoint Inhibitor Therapy","authors":"James Alstott ,&nbsp;Eliza Harrold ,&nbsp;Myron Pozniak ,&nbsp;Amaka Achufusi","doi":"10.1016/j.xkme.2025.101082","DOIUrl":"10.1016/j.xkme.2025.101082","url":null,"abstract":"<div><div>Renal papillary necrosis (RPN) is a particular form of renal injury characterized by necrosis of the renal papilla identified through imaging and histological investigation. RPN generally occurs in the setting of urinary obstruction, urinary infection, sickle cell disease, diabetes mellitus, or nonsteroidal anti-inflammatory drug use. We present a case of RPN in a patient on immune checkpoint inhibitor (ICI) therapy who developed immunotherapy-induced severe colitis followed by obstructive acute kidney injury (AKI). The patient lacked other risk factors for RPN. Initial imaging with computed tomography of the abdomen and pelvis without contrast showed bilateral perinephric edema, mild bilateral hydroureteronephrosis, and high attenuation material at bilateral ureterovescular junctions. Supportive care with isotonic fluids led to passage of tissue in urine and AKI recovery. Contrast-enhanced computed tomography performed 3 weeks after AKI hospitalization revealed multiple pyramids with a bullseye enhancement pattern consistent with prior RPN. Although ICIs have well-recognized nephrotoxicity, this case is the first to describe RPN in the setting of an ICI immune-related adverse event.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 10","pages":"Article 101082"},"PeriodicalIF":3.4,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096944","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":"Navigating Health Care in Crises: Health Literacy and Treatment Adherence Among Hemodialysis Patients in Lebanon","authors":"Myriam Boueri,&nbsp;Mohamad Abdelkhalik ,&nbsp;Fatima Al Maaz ,&nbsp;Houssein Chehade,&nbsp;Carmel Bouclaous","doi":"10.1016/j.xkme.2025.101081","DOIUrl":"10.1016/j.xkme.2025.101081","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Chronic kidney disease is projected to become the fifth most prevalent chronic condition globally by 2040, with a current prevalence of 10%-15%. This study aimed to assess treatment adherence in relation to health literacy (HL) and digital healthy diet literacy (DDL) levels of patients receiving hemodialysis in Lebanon.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;A multicenter, cross-sectional study was conducted during 2021-2023.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;It included patients in 18 dialysis centers based on nonprobability sampling. Patients were eligible if they were aged 18+ years and Arabic speakers. Severe illness, dementia, and confusion were exclusion criteria.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure(s)&lt;/h3&gt;&lt;div&gt;Sociodemographic factors (marital status, education, governorate, employment, financial means, and fear of coronavirus disease 2019 [COVID-19]) were assessed as predictors of adherence and HL.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;The primary outcomes were HL scores (Health Literacy Scale- Short Form 12), DDL scores (Digital Healthy Diet Literacy Scale), and adherence to treatment scores (treatment adherence questionnaire).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Bivariate analysis identified associations between patient characteristics and scores on scales. Simple linear regression was used to evaluate the relationship between scores and independent variables.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Participants (N = 699, 64.5% male patients) showed below-average HL levels (18.96 ± 11.79) and DDL (15.95 ± 14.58), and moderate adherence behavior (995.82 ± 178.99). Single patients and those with higher educational and employment statuses had higher levels of HL. Regional disparities were observed. Individuals who did not experience financial difficulty in covering their treatment cost, and those who had less fear from COVID-19, showed higher DDL scores. Single individuals displayed lower treatment adherence.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;This study is limited by its cross-sectional design, and by contextual factors that affected patient attendance and researcher access to hemodialysis centers, along with overrepresentation of private facilities.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;There is a need for educational programs and targeted interventions to enhance health literacy and adherence in this patient population, especially among those with lower education, financial instability, and higher fear of COVID-19.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;The study sought to determine whether patients receiving hemodialysis in Lebanon have sufficient health literacy, in other words, a capacity to obtain, read, and understand health information in such a way to make informed health decisions and follow treatment instructions. The study found that the majority of patients receiving hemodialysis had difficulties adhering to their treatment. Those wi","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 10","pages":"Article 101081"},"PeriodicalIF":3.4,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145118799","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":"Monitoring, Control, and Clinical Outcomes Associated With Chronic Kidney Disease-Mineral Bone Disorder: A Population-Based Cohort Study in Ontario, Canada","authors":"Akshay Varghese ,&nbsp;Yuguang Kang ,&nbsp;Andrea Cowan ,&nbsp;Rachel Holden ,&nbsp;Ron Wald ,&nbsp;Kristin K. Clemens","doi":"10.1016/j.xkme.2025.101080","DOIUrl":"10.1016/j.xkme.2025.101080","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Chronic kidney disease-mineral and bone disorder (CKD-MBD) affects bone and cardiovascular health. We examined the monitoring, control, and outcomes associated with CKD-MBD.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Observational cohort study using ICES administrative data.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&amp; Participants&lt;/h3&gt;&lt;div&gt;Adults aged 40 years and older from Ontario, Canada, with at least 2 outpatient estimated glomerular filtration rate values or receiving dialysis between January 2017 and March 2020.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;CKD stage based on the estimated glomerular filtration rate.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Albumin-corrected serum calcium, phosphate, alkaline phosphatase, parathyroid hormone, and 25 hydroxyvitamin D testing and control at 365 days, and the percentage of patients monitored and controlled per guidelines. We also examined the association between laboratory values, fragility fracture, and major adverse cardiovascular events (MACE) in CKD stage 4, 5 and dialysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Descriptive statistics were used for primary and secondary outcomes. For exploratory outcomes, we examined the cumulative incidence and incidence rate of fragility fracture and MACE based on laboratory values, and adjusted analyses using multivariable Cox proportional hazards models.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;There were 2,580,781 people included, of whom, 303,884 had CKD (stage 3A or higher). Monitoring and control of CKD-MBD was suboptimal across the CKD spectrum. Even in maintenance dialysis, the proportion who met laboratory monitoring targets was low (5.1% had all tests measured over 365 days). The most commonly controlled laboratory value was alkaline phosphatase (55.6% were at target across the CKD spectrum). In exploratory analysis, a small protective effect of a higher calcium and phosphate level on fragility fracture was observed, with a parathyroid hormone level of 20-80 pmol/L appearing optimal for bone health in dialysis. There appeared to be a small statistically significant association between higher levels of alkaline phosphatase and phosphate with MACE in dialysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Results are only generalizable to adults with laboratory tests reported within the Ontario Laboratory Information System. Exploratory analyses were limited by events.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;There are gaps in the monitoring and control of CKD-MBD in Ontario, even in groups in which evidence to support management is highest. Focused studies on whether the control of CKD-MBD improves patient-important outcomes remain important.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Calcium, phosphate, parathyroid hormone, and vitamin D are important for to kidney health. We examined how often these tests are being measured in people with kidney disease and how well they are being controlled in the real world. W","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 10","pages":"Article 101080"},"PeriodicalIF":3.4,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145155481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Staphylococcus Dominant Nasal Microbiota in Hemodialysis Patients","authors":"Sylvia Wu MD ,&nbsp;Nicholas Tedrow MD ,&nbsp;Abhinav Bhalla MBBS ,&nbsp;Alex Devito BS ,&nbsp;Sheavonnie Wright MS ,&nbsp;Friederike Selbach MD ,&nbsp;Darshana M. Dadhania MD ,&nbsp;Carol Li BS ,&nbsp;Vesh Srivatana MD ,&nbsp;Jeffrey Silberzweig MD ,&nbsp;John Richard Lee MD","doi":"10.1016/j.xkme.2025.101079","DOIUrl":"10.1016/j.xkme.2025.101079","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 10","pages":"Article 101079"},"PeriodicalIF":3.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096945","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":"IgA Nephropathy: An Overview of the Clinical Trials","authors":"Zohreh Gholizadeh Ghozloujeh ,&nbsp;Haresh Selvaskandan ,&nbsp;Nasim Wiegley ,&nbsp;Edgar Lerma ,&nbsp;Jorge Gaytan ,&nbsp;Alejandro Garcia-Rivera ,&nbsp;Amir Abdipour ,&nbsp;Sayna Norouzi","doi":"10.1016/j.xkme.2025.101078","DOIUrl":"10.1016/j.xkme.2025.101078","url":null,"abstract":"<div><div>IgA nephropathy (IgAN) is characterized by the deposition of poorly-<em>O</em>-galactosylated IgA1 (also referred to as galactose-deficient IgA1 or gd-IgA1) containing immune complexes in the glomerular mesangium. This triggers a variable degree of glomerular inflammation that leads to progressive kidney damage and often kidney failure. The acceptance of proteinuria reduction as a reasonably likely surrogate end point for treatment effects on progression to kidney failure has led to many clinical trials evaluating novel and repurposed therapies for IgAN. New treatments leverage different aspects of IgAN pathophysiology, including the modulation of mucosal immunity, mechanisms of B-cell activation, and complement activity. The approval of the first treatments evaluated specifically for IgAN (including delayed-release budesonide, sparsentan, atrasentan, and iptacopan) represent meaningful advancements in the management landscape, and promisingly, many more treatments seem poised to arrive. This review compiles a list of current active trials for IgAN and highlights the necessity for ongoing research to optimize therapeutic strategies to further improve outcomes for those living with IgAN.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 10","pages":"Article 101078"},"PeriodicalIF":3.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096938","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}