Kidney Medicine最新文献

{"title":"Patient Activation, Social Support, Physician Trust, and Shared Dialysis Decision-Making: A Cross-Sectional Investigation","authors":"Fahad Saeed , Basil S. Kazi , Musaib Syed , Kevin A. Fiscella , Paul R. Duberstein","doi":"10.1016/j.xkme.2025.101014","DOIUrl":"10.1016/j.xkme.2025.101014","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>People undergoing maintenance dialysis often lack essential information about kidney therapy options. Therefore, nephrologists must involve patients and families in shared decision-making (SDM). In this investigation, we hypothesized that patient activation, social support, and physician trust would be associated with patient-reported SDM.</div></div><div><h3>Study Design</h3><div>A cross-sectional survey.</div></div><div><h3>Methods</h3><div>We surveyed hospitalized individuals receiving maintenance dialysis. Participants completed the 9-item SDM questionnaire (SDM-Q-9) and the Patient Activation Measure-13, the Multidimensional scale of perceived social support, and the Primary Care Assessment Survey Trust Subscale.</div></div><div><h3>Analytic Approach</h3><div>We used descriptive statistics to present demographics. We included patient demographics in multivariable linear regression models predicting SDM scores.</div></div><div><h3>Results</h3><div>Of the 223 respondents, 222 patients completed SDM-Q-9, 54% were<!--> <!-->≥65 years old, with 47% being woman. In addition, 37% self-identified as African American, 48% had an education level at<!--> <!-->≤high school, and 54% reported an annual household income of ≤$20,000. The SDM-Q-9 scores (n<!--> <!-->=<!--> <!-->222) had a mean of 57.49 (SD<!--> <!-->=<!--> <!-->27.07), median 58 (IQR<!--> <!-->=<!--> <!-->38-82), and ranged from 0 to 100. The mean patient activation was 53.5<!--> <!-->±<!--> <!-->16.5 (min 24, max 100), social support 61.2<!--> <!-->±<!--> <!-->24 (min 0, max 100), and physician trust 59.29<!--> <!-->±<!--> <!-->21.6 (min 0, max 100). In separate multivariable linear regression models, higher patient activation (1-point patient activation measure increase per 0.48-unit SDM increase; 95% CI, 0.24-0.73), higher social support (1-point increase per 0.28 SDM increase; 95% CI, 0.11-0.45), and greater physician trust (0.31-point increase per 1-point SDM increase; 95% CI, 0.12-0.49) were significantly associated with greater SDM.</div></div><div><h3>Limitations</h3><div>The study was a cross-sectional investigation.</div></div><div><h3>Conclusions</h3><div>Our findings indicate a significant association between SDM and patient activation, social support, and physician trust. Future research with individuals actively considering kidney therapy options should prospectively explore the relationship between patient activation, social support, physician trust and SDM.</div></div><div><h3>Plain Language Summary</h3><div>There is limited literature on the association between patient activation, social support, and physician trust with patient-reported shared dialysis decision-making. Therefore, we examined this association in a convenience sample of 222 people receiving maintenance dialysis. We found that patient activation, social support, and physician trust were independently associated with shared dialysis decision-making. Future prospective","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 6","pages":"Article 101014"},"PeriodicalIF":3.2,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144115934","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":"Time Trends and Causes of Infection-Related Mortality Among Patients Starting Dialysis in Finland: A Nationwide Cohort Study","authors":"Susanna Kinnunen , Ilkka Helanterä , Auni Juutilainen , Wisam Bitar , Jaakko Helve , Patrik Finne","doi":"10.1016/j.xkme.2025.101012","DOIUrl":"10.1016/j.xkme.2025.101012","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Previously, we reported a decrease in infection-related mortality in kidney transplant recipients. Regarding patients treated with dialysis, it is unclear whether infection-related mortality is decreasing. Therefore, we investigated current time trends and specific causes of infection-related mortality over 2 decades in a large cohort of patients treated with dialysis.</div></div><div><h3>Study Design</h3><div>A nationwide cohort study.</div></div><div><h3>Setting & Participants</h3><div>Patients starting kidney replacement therapy were identified through the Finnish Registry for Kidney Diseases. Follow-up continued until death of any cause, kidney transplantation, moving abroad, recovery of kidney function, loss of follow-up, or end of study.</div></div><div><h3>Exposure</h3><div>Long-term kidney replacement therapy.</div></div><div><h3>Outcome</h3><div>Death due to infection.</div></div><div><h3>Analytical Approach</h3><div>Incidence rates, incidence rate ratios, and adjusted Cox regression hazard ratios for infection-related deaths were calculated by sub-cohorts consisting of patients whose kidney replacement therapy was started either 2000-2004, 2005-2009, 2010-2014, or 2015-2019. As sensitivity analyses, we studied infection-related mortality within 1 year of dialysis initiation and performed competing risk analysis.</div></div><div><h3>Results</h3><div>A total of 9,671 adult patients started long-term dialysis from 2000 to 2019. Infection-related deaths declined from 47 to 23 deaths per 1,000 person-years over the four 5-year intervals from 2000-2004 to 2015-2019. The hazard ratio of a Cox model including identified risk factors was 0.49 (95% CI, 0.39-0.62) for patients who started dialysis in 2015-2019 compared with those who started in 2000-2004. The most common specific causes of infection-related deaths were septicemia (38%), pulmonary infection (36%), and peritonitis (8%), whereas opportunistic infections rarely caused death.</div></div><div><h3>Limitations</h3><div>Death certificates may have low sensitivity for infectious diseases. Only one cause of death is available. Categories of infectious deaths may overlap.</div></div><div><h3>Conclusions</h3><div>Risk of dying due to infections has halved since the beginning of the millennium despite aging among patients treated with dialysis. The reason for this development requires further studies.</div></div><div><h3>Plain Language Summary</h3><div>Patients treated with dialysis experience a very significantly increased risk of dying from infection compared to the general population. This study evaluated current time trends and specific causes of infectious disease mortality in patients treated with dialysis in Finland from 2000 to 2019 based on data from the national registry with complete coverage of the dialysis cohort. The risk of death from infection in maintenance dialysis in Finland has dropped by half since the 2000s, despite the aging","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 6","pages":"Article 101012"},"PeriodicalIF":3.2,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124959","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":"Variations in Creatinine Generation Among Patients With Glomerular Disease: Evidence From the NEPTUNE and CureGN Studies","authors":"Shalini S. Ramachandra , Melody Chiang , Michael Arbit , Dorey A. Glenn , Laura H. Mariani , Jarcy Zee","doi":"10.1016/j.xkme.2025.101010","DOIUrl":"10.1016/j.xkme.2025.101010","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Estimation of glomerular filtration rate (GFR) assumes that creatinine generation (crG) is relatively stable. This study identified factors associated with crG variability and its impact on serum creatinine changes (<span><math><mrow><mo>Δ</mo></mrow></math></span> Scr) among patients with glomerular disease.</div></div><div><h3>Study Design</h3><div>An observational cohort study.</div></div><div><h3>Setting & Participants</h3><div>Nephrotic Syndrome Study Network and Cure Glomerulonephropathy adult and pediatric participants with at least one crG measurement.</div></div><div><h3>Predictors</h3><div>Potential predictors of crG levels included age, sex, disease diagnosis, weight status, estimated GFR (eGFR), urine protein, steroid use, and nonsteroid immunosuppressant use. crG change (<span><math><mrow><mo>Δ</mo></mrow></math></span> crG) was then used as an exposure to assess impacts on <span><math><mrow><mo>Δ</mo></mrow></math></span> Scr.</div></div><div><h3>Outcomes</h3><div>crG levels and <span><math><mrow><mo>Δ</mo></mrow></math></span> Scr.</div></div><div><h3>Analytical Approach</h3><div>The intraclass correlation coefficient illustrated crG variability within individuals. Multivariable linear mixed models identified factors associated with crG levels. Among those with 2+<!--> <!-->crG measurements, multivariable linear mixed models estimated the association between <span><math><mrow><mo>Δ</mo></mrow></math></span> crG and <span><math><mrow><mo>Δ</mo></mrow></math></span> Scr.</div></div><div><h3>Results</h3><div>Among 4,626 crG measurements from 1,081 participants, there was only moderate correlation between measurements within individuals (intraclass correlation coefficient<!--> <!-->=<!--> <!-->0.517, 95% CI, 0.482-0.548) overall. For pediatric participants, factors significantly associated with crG included age, sex, weight status, and urine protein. Among adults, significant factors were age, sex, disease diagnosis, weight status, eGFR, steroid use, and nonsteroid immunosuppressant use.</div></div><div><h3>Limitations</h3><div>The 24-hour urine collections may have collection error, measured GFR was unavailable, and edema status was unavailable.</div></div><div><h3>Conclusions</h3><div>crG was highly dynamic within individuals over time and varied with glomerular disease activity and treatments. The impact of <span><math><mrow><mo>Δ</mo></mrow></math></span> crG on <span><math><mrow><mo>Δ</mo></mrow></math></span> Scr —and subsequently on estimation of kidney function—is potentially large. Accounting for these changes or development of alternative kidney function measures are needed among glomerular disease patients.</div></div><div><h3>Plain Language Summary</h3><div>Creatinine generation is often assumed to be stable when using creatinine to estimate kidney function and track kidney function over time, but it can vary with chronic disease. This study showed high variability in creatini","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 6","pages":"Article 101010"},"PeriodicalIF":3.2,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144116045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-Reported Symptoms Compared With Nephrologist Documentation During Outpatient Visits: A Retrospective Patient-Reported Outcome Measures Study","authors":"Kendra E. Wulczyn , Annie Liu , James P. Lash , Mallika L. Mendu , Sahir Kalim","doi":"10.1016/j.xkme.2025.101011","DOIUrl":"10.1016/j.xkme.2025.101011","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Communication of symptom presence between patients and nephrologists is a key step toward management of the symptom burden faced by many patients with chronic kidney disease (CKD), but whether symptoms are being routinely discussed during ambulatory non-dialysis nephrology encounters is uncertain. This study compared patient reports of 11 CKD-related symptoms with nephrologists’ documentation of symptom presence in the concomitant visit note.</div></div><div><h3>Study Design</h3><div>A retrospective analysis of patient-reported outcome measures and nephrologist documentation in the electronic health record (EHR).</div></div><div><h3>Setting & Study Populations</h3><div>Adults treated at 2 ambulatory nephrology practices within a single tertiary academic center in the United States from 2015 to 2020.</div></div><div><h3>Data Extraction</h3><div>Patients reported symptoms using the Kidney Disease Quality of Life Short Form (KDQOL-SF) instrument before clinic visits. Symptoms were identified in the EHR-based note by natural language processing with subsequent manual identification of the context.</div></div><div><h3>Analytical Approach</h3><div>Sensitivity and specificity of nephrologist documentation for symptoms were calculated using KDQOL responses as the reference standard and stratified by numerous patient, nephrologist, and encounter characteristics.</div></div><div><h3>Results</h3><div>Over 4 years, 1,534 patients completed 2,118 KDQOL surveys before visits with 45 nephrologists. Average sensitivity of nephrologist documentation for symptoms was 16% (and<!--> <!--><40% for each individual symptom), with an average specificity of 98%. Sensitivity of documentation for symptoms was higher when the patient was female, had an estimated glomerular filtration rate of<!--> <!--><30<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup>, or had a history of cardiovascular disease. The documentation sensitivity of nephrologists was higher if they were female or were in practice for<!--> <!-->≤7 years as compared with<!--> <!-->>25 years.</div></div><div><h3>Limitations</h3><div>Nephrologist documentation in the EHR may not accurately represent what was discussed during a visit.</div></div><div><h3>Conclusions</h3><div>Accuracy of nephrologist documentation for the presence of CKD-related symptoms in the EHR is low. Although recognizing that symptoms may have been assessed but not documented, the low proportion of clinic notes correctly identifying patient symptoms in this study suggests an opportunity for tools to streamline and standardize symptom assessment in this patient population.</div></div><div><h3>Plain Language Summary</h3><div>This study aimed to characterize how accurate the documentation of nephrologists is when it comes to patient-reported symptoms commonly associated with chronic kidney disease. Patients completed an electronic questionnaire regarding their symptoms before visits at 2 gener","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 6","pages":"Article 101011"},"PeriodicalIF":3.2,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144116046","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 and Urine Metabolites Associated With Nondiabetic Chronic Kidney Disease: The HELIUS Study","authors":"Charlotte M. Mosterd , Barbara J.H. Verhaar , Bert-Jan H. van den Born , Max Nieuwdorp , Daniel H. van Raalte","doi":"10.1016/j.xkme.2025.101009","DOIUrl":"10.1016/j.xkme.2025.101009","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>We aimed to find predictive plasma and urine metabolites for nondiabetic chronic kidney disease (CKD), and to validate these biomarkers in a diabetic kidney disease (DKD) population, using data of the population-based multiethnic Healthy Life in an Urban Setting study.</div></div><div><h3>Study Design</h3><div>Cross-sectional metabolome study.</div></div><div><h3>Setting & Participants</h3><div>From the Healthy Life in an Urban Setting population-based cohort, we included 124 participants with nondiabetic CKD, 45 with DKD and 200 healthy controls.</div></div><div><h3>Predictors</h3><div>Plasma and urine metabolites were measured using ultra-high-performance liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) with an untargeted approach.</div></div><div><h3>Outcomes</h3><div>(Nondiabetic) CKD.</div></div><div><h3>Analytical Approach</h3><div>We used machine learning models to predict nondiabetic CKD from metabolite profiles and used logistic regression models with adjustment for potential confounders to verify our results in the best predicting metabolites. In addition, we assessed the associations between the best predicting metabolites and DKD.</div></div><div><h3>Results</h3><div>Urine metabolites were more predictive of nondiabetic kidney disease than plasma metabolites. In plasma, the best predicting metabolites for nondiabetic CKD included many amino acids, including N-acetylated amino acids, histidine, and indolepropionate. In urine, the highest-ranked metabolites were predominantly lipids, including sphingomyelins and phosphatidylcholines. There was limited overlap among the top-ranked metabolites in predicting nondiabetic CKD between plasma and urine. Almost all associations with nondiabetic CKD could be translated to DKD. No interactions were observed with ethnicity.</div></div><div><h3>Limitations</h3><div>The cross-sectional design limits causal inference.</div></div><div><h3>Conclusions</h3><div>Our analyses revealed that urine metabolites were strongly associated with CKD than plasma metabolites in this multiethnic population. The finding that specific associations of plasma and urine metabolites could be translated to subjects with DKD suggests a shared pathophysiological background.</div></div><div><h3>Plain Language Summary</h3><div>Chronic kidney disease (CKD) has a rising incidence, yet its underlying causes are not fully understood. Using the multiethnic Healthy Life in an Urban Setting study, we explored which molecules in blood and urine (metabolites) are different in patients with CKD with albuminuria and preserved estimated glomerular filtration rate. Urine metabolites, particularly lipids like sphingomyelins, were more strongly associated with CKD than plasma metabolites, which included amino acids such as histidine and indolepropionate. These findings were also applicable to patients with diabetic kidney disease, suggesting shared disease mechanisms. Our stu","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 7","pages":"Article 101009"},"PeriodicalIF":3.2,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144329693","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":"Unusual Central Venous Catheter Position in Hemodialysis: Anatomical Considerations","authors":"Hiroki Ito , Takuo Hirose , Takefumi Mori","doi":"10.1016/j.xkme.2025.101006","DOIUrl":"10.1016/j.xkme.2025.101006","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 6","pages":"Article 101006"},"PeriodicalIF":3.2,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144115996","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":"Dual Occurrence of DNAJB-9 Positive Fibrillary Glomerulonephritis and Diffuse Lupus Nephritis: A Unique Overlap Glomerulopathy","authors":"Jonathan E. Zuckerman ,&nbsp;Tom Yang","doi":"10.1016/j.xkme.2025.101008","DOIUrl":"10.1016/j.xkme.2025.101008","url":null,"abstract":"<div><div>Cases of lupus nephritis (LN) with substructured deposits detected by electron microscopy are not uncommon in nephropathology practice. Rare cases of LN have been reported to show fibril formation similar to the type found in fibrillary glomerulonephritis (FGN). It is uncertain if fibril formation in such cases represents a unique manifestation of LN or LN with a superimposed FGN. FGN is a rare disease with unknown pathogenesis and a poor prognosis. Diagnosis of FGN has required the demonstration, by electron microscopy, of haphazardly arranged fibrils measuring 10 to 30<!--> <!-->nm in thickness in the mesangium or along the glomerular basement membranes. DnaJ homolog subfamily B member 9 (DNAJB-9) immunohistochemical staining is a recently discovered sensitive and specific marker for FGN and is now considered essentially pathognomonic for FGN. No cases of bone fide LN with concurrent DNJAB-9 positive FGN have been reported. Here, we report on one such overlap glomerulopathy showing well developed features of LN (full house immunofluorescence staining, strong C1q staining, extraglomerular deposits, tubuloreticular inclusions) with concurrent fibrillar deposits with strong DNAJB-9 positivity highly consistent with FGN.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 6","pages":"Article 101008"},"PeriodicalIF":3.2,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144115995","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":"Nonpharmacologic and Nonsurgical Weight Management Interventions for Patients With Advanced CKD: A Scoping Review of the Medical Literature","authors":"Kamel Omer ,&nbsp;Kristin K. Clemens ,&nbsp;Yunxu Zhu ,&nbsp;Heather LaPier ,&nbsp;Louise Moist ,&nbsp;Jaclyn Ernst ,&nbsp;Sonja M. Reichert ,&nbsp;Alla Iansavichene ,&nbsp;Michael Chiu ,&nbsp;OK TRANSPLANT Investigators","doi":"10.1016/j.xkme.2025.101004","DOIUrl":"10.1016/j.xkme.2025.101004","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><div>Obesity is associated with morbidity and mortality in people with chronic kidney disease (CKD). Identifying safe and effective nonpharmacologic and nonsurgical interventions to achieve a healthier body weight is essential.</div></div><div><h3>Study Design</h3><div>Scoping review of observational studies and randomized control trials.</div></div><div><h3>Setting &amp; Study Populations</h3><div>Adults aged<!--> <!-->≥18 years with a body mass index (BMI) ≥30<!--> <!-->kg/m² and advanced CKD (category G3-G5D).</div></div><div><h3>Selection Criteria for Studies</h3><div>Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews (PRISMA-ScR), we systematically searched 2 electronic databases (MEDLINE and Embase) for studies that examined the effect of nonpharmacologic and nonsurgical interventions for weight loss between January 2010-July 2024. Outcomes included weight loss and BMI. We also examined adherence, whether participants were involved in the design of the study, and adverse events.</div></div><div><h3>Data Extraction</h3><div>Two reviewers screened relevant citations and extracted study characteristics and outcomes. Discrepancies were resolved by a third reviewer.</div></div><div><h3>Analytical Approach</h3><div>Study data were summarized descriptively following guidance from the PRISMA-ScR.</div></div><div><h3>Results</h3><div>Of the 2,453 citations, 17 met inclusion criteria (9 randomized controlled trials, 2 nonrandomized trials, 5 prospective cohort studies, and 1 retrospective cohort study) and included a total of 960 participants. Interventions included exercise programs, dietary therapy, and/or cognitive behavioral therapy with follow-up ranging from 3-12 months. It appeared that dietary intervention that promoted significant caloric restriction over the short term led to the most weight loss (average, 7<!--> <!-->kg). Interventions with monitored coaching appeared helpful. No adverse events were reported. None of the studies involved participants as partners.</div></div><div><h3>Limitations</h3><div>Not all studies included participants’ estimated glomerular filtration rate or BMI category, and we may have included some without severe CKD or BMI<!--> <!-->≥30<!--> <!-->kg/m².</div></div><div><h3>Conclusions</h3><div>Programs encouraging very low-energy diets along with monitored coaching, may result in modest short-term weight loss. Patient views on these programs and their longer term success remain unclear.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 6","pages":"Article 101004"},"PeriodicalIF":3.2,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144115994","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 Case of Acute Kidney Injury During Eltrombopag Use Successfully Treated With Plasma Exchange in Addition to Antithrombotic Therapy","authors":"Noriko Ueno ,&nbsp;Yasuo Kusunoki ,&nbsp;Toru Kida ,&nbsp;Shun Oda ,&nbsp;Akane Yamano ,&nbsp;Fumi Nakayama ,&nbsp;Shungo Fukuda ,&nbsp;Natsuko Ikeda ,&nbsp;Tomoko Namba-Hamano ,&nbsp;Masato Homma ,&nbsp;Masanobu Takeji","doi":"10.1016/j.xkme.2025.101007","DOIUrl":"10.1016/j.xkme.2025.101007","url":null,"abstract":"<div><div>Eltrombopag (EPAG), a thrombopoietin receptor agonist, has emerged as a valuable option for the treatment of immune thrombocytopenic purpura. However, its use has raised concerns regarding thrombotic complications. Herein, we present a case involving a 60-year-old woman with immune thrombocytopenic purpura and underlying antiphospholipid antibody syndrome who developed abdominal pain and acute kidney injury shortly after initiating EPAG therapy. Kidney histopathology revealed thrombi in the afferent glomerular arterioles, suggesting a link between EPAG and thrombotic events. Despite EPAG discontinuation, the patient’s kidney function deteriorated, necessitating hemodialysis. As an additional treatment, plasma exchange (PE) was performed to remove EPAG. High-performance liquid chromatography analysis showed a reduction in the EPAG concentration after PE, indicating partial removal. The patient’s kidney function gradually improved, and hemodialysis was successfully discontinued. The findings from this case suggest that thrombotic complications should be considered when administering EPAG to patients with antiphospholipid antibody syndrome. PE may be a useful treatment option if thrombosis is induced by EPAG.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 6","pages":"Article 101007"},"PeriodicalIF":3.2,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144116043","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":"Functional Performance Decline Outperforms Sarcopenia and Its Components in Predicting New-Onset Chronic Kidney Disease: A Nationwide Multicenter Study","authors":"Liangyu Yin,&nbsp;Furong Li,&nbsp;Tangli Xiao,&nbsp;Jun Zhang,&nbsp;Yan Li,&nbsp;Jicong Luo,&nbsp;Jinghong Zhao,&nbsp;Jiachuan Xiong","doi":"10.1016/j.xkme.2025.101005","DOIUrl":"10.1016/j.xkme.2025.101005","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;This study aimed to investigate the associations of functional performance, sarcopenia, and components of sarcopenia with the onset of chronic kidney disease (CKD), while also determining the optimal predictive factor.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This observational multicenter study included 8,647 community-dwelling adults. Activities of daily living (ADL) scale, physical performance, and sarcopenia were assessed at baseline, and participants were followed to track CKD incidents. The discriminatory performance and cutoffs of ADL and other indices for predicting CKD onset were evaluated. Multivariable-adjusted logistic regression models were employed to analyze the association of ADL with CKD occurrence.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;There were 4,681 women and 3,966 men (median age&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;57.0 years). Over a 7-year follow-up, 940 CKD incidents occurred. Optimal thresholds for left handgrip strength, right handgrip strength, the 5-time chair stand test, appendicular skeletal muscle index, and ADL to predict CKD onset were established at 35.2&lt;!--&gt; &lt;!--&gt;kg, 30.9&lt;!--&gt; &lt;!--&gt;kg, 10.4 seconds, 7.3&lt;!--&gt; &lt;!--&gt;kg/m,&lt;sup&gt;2&lt;/sup&gt; and 1 for men; and 16.1&lt;!--&gt; &lt;!--&gt;kg, 30.9&lt;!--&gt; &lt;!--&gt;kg, 12.8 seconds, 6.3&lt;!--&gt; &lt;!--&gt;kg/m,&lt;sup&gt;2&lt;/sup&gt; and 1 for women, respectively. Among all factors investigated, the ADL score was optimal to predict CKD onset in both men (area under the curve&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.546; 95% CI, 0.528-0.564) and women (area under the curve&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.559; 95% CI, 0.538-0.581). Functional performance decline (ADL score&lt;!--&gt; &lt;!--&gt;≥1) demonstrated an independent and dose-dependent association with CKD (OR&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;1.841; 95% CI, 1.446-2.329; &lt;em&gt;P&lt;/em&gt; for trend&lt;!--&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.001).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;The use of an anthropometric equation to estimate skeletal muscle mass may not be as precise as other methods. Additionally, the observational nature of the study and reliance on self-reported CKD data may lead to potential confounding, misclassification, and reverse causality, requiring further validation through studies with laboratory-confirmed CKD events and larger, more diverse populations.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;The ADL score indicated that functional performance is superior to sarcopenia and its components in predicting the onset of CKD in middle-aged and older Chinese adults. These findings may facilitate the prevention and management of CKD.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;This study looked at how physical function, sarcopenia (loss of muscle mass and strength), and related factors might predict the development of chronic kidney disease (CKD). This study followed over 8,600 adults for 7 years and found that declines in daily functioning—measured by an activities of daily living score—were linked to an increased risk of CKD. Among several factors studied, the activities of daily living sco","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 6","pages":"Article 101005"},"PeriodicalIF":3.2,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144125078","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}