Kidney Medicine最新文献

{"title":"The Uptake of Influenza, Pneumococcal, Shingles, and COVID-19 Vaccines Among US Adults With and Without Kidney Disease: Findings From the Behavioral Risk Factor Surveillance System 2018-2022","authors":"Ekua Yeboah , Wei Lin , Junichi Ishigami","doi":"10.1016/j.xkme.2025.101074","DOIUrl":"10.1016/j.xkme.2025.101074","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Persons with kidney disease are at risk of infections such as influenza, pneumonia, shingles, and coronavirus-2019 (COVID-19), which can be prevented by vaccination. However, comparative uptake across these vaccines in people with and without kidney disease has not been well described.</div></div><div><h3>Study Design</h3><div>A cross-sectional analysis.</div></div><div><h3>Setting & Participants</h3><div>Vaccine-eligible adults in the Behavioral Risk Factor Surveillance System (BRFSS) 2018-2022.</div></div><div><h3>Exposures</h3><div>Self-reported status of kidney disease.</div></div><div><h3>Outcomes</h3><div>The uptake of the influenza (past 12 months), pneumococcal (lifetime), shingles (lifetime), and COVID-19 (at least one dose) vaccines.</div></div><div><h3>Analytical Approach</h3><div>Multivariable logistic regressions to compare the odds of vaccine uptake between those with and without kidney disease. The results were pooled to show the overall uptake from 2018 to 2022, except for the COVID-19 vaccine, for which data were only available for 2022.</div></div><div><h3>Results</h3><div>In the pooled sample of BRFSS 2018-2022, 4.0% had kidney disease. In people with kidney disease, the highest uptake was observed for COVID-19 (87.0%), followed by pneumococcal (63.6%), influenza (59.6%), and shingles (37.1%) vaccines. These numbers were higher compared with those without kidney disease (78.4% for COVID-19, 52.9% for pneumococcal, 41.8% for influenza, and 31.1% for shingles vaccines), but the differences varied by vaccine type. In multivariable logistic models, the largest odds ratio in uptake of those with versus without kidney disease was observed for pneumococcal vaccine (aOR, 1.58 [95%CI, 1.48-1.69]), followed by COVID-19 (1.50 [1.18-1.89]), influenza (1.35 [1.28-1.43]), and shingles (1.03 [0.91-1.17]) vaccines. These findings were consistent across age and race/ethnicity groups, with lower uptakes generally in younger (vs older) and non-Hispanic African American and Hispanic (vs non-Hispanic White) participants.</div></div><div><h3>Limitations</h3><div>Possible misclassification of kidney disease status due to self-report.</div></div><div><h3>Conclusions</h3><div>Vaccine uptakes in people with kidney disease varied by vaccine type and remained suboptimal, particularly for shingles vaccine. Efforts are needed to increase vaccine uptake and ensure all recommended vaccines are offered to people with kidney disease.</div></div><div><h3>Plain-Language Summary</h3><div>People with kidney disease are more likely to get sick from infections such as the flu, pneumonia, shingles, and coronavirus-2019, but vaccines can help prevent these illnesses. This study looked at how many adults with and without kidney disease got these vaccines from 2018 to 2022 using Behavioral Risk Factor Surveillance System data. People with kidney disease were more likely to get vaccinated, especially for coronavirus-2019 (87","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 10","pages":"Article 101074"},"PeriodicalIF":3.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096937","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":"Severe Clinical Phenotype in Alport Syndrome Due to 2 COL4A4 Exon-Skipping Events","authors":"Jerica Pleško ,&nbsp;Nika Kojc ,&nbsp;Špela Kert ,&nbsp;Sara Petrin ,&nbsp;Alenka Matjašič ,&nbsp;Anamarija Meglič ,&nbsp;Andrej Zupan","doi":"10.1016/j.xkme.2025.101077","DOIUrl":"10.1016/j.xkme.2025.101077","url":null,"abstract":"<div><div>Alport syndrome (AS) is a genetically heterogeneous disorder caused by mutations in <em>COL4A3</em>, <em>COL4A4</em>, or <em>COL4A5</em>, leading to progressive kidney dysfunction. Although genetic screening has advanced, many cases remain undiagnosed due to deep intronic splice-site variants. We report a male patient diagnosed with autosomal recessive AS, characterized by hematuria, proteinuria, and chronic kidney disease progression. Initial kidney biopsy at age 10 revealed glomerular basement membrane thinning and focal segmental glomerulosclerosis, whereas targeted deoxyribonucleic acid sequencing failed to detect pathogenic variants. Over 15 years, kidney function declined, and a second biopsy showed severe glomerular basement membrane abnormalities with multilamellated structures. Whole-transcriptome sequencing revealed 2 events of exon skipping, specifically at exons 27 and 38 of the <em>COL4A4</em> gene, which were verified by exon-specific PCR and Sanger sequencing. Intronic regions analysis revealed 2 heterozygous variants positioned 78 bp downstream of exon 27 and 8 bp upstream of exon 38, though their role in aberrant splicing remains uncertain. Immunofluorescence analysis confirmed disrupted α3α4α5(IV) heterotrimer assembly. This is the first documented case of dual exon-skipping events in <em>COL4A4</em>, highlighting their contribution to disease severity. Our findings emphasize the need for ribonucleic acid–based diagnostics and raise questions about potential benefit of exon-skipping therapy in autosomal recessive AS.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 10","pages":"Article 101077"},"PeriodicalIF":3.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096940","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":"Desensitization With Imlifidase: Overcoming Immunological Barriers in Kidney Transplantation","authors":"Paul José Hernández-Velasco ,&nbsp;Eduardo Gutiérrez Martínez ,&nbsp;Natalia Polanco Fernández ,&nbsp;Maria Esther González Monte ,&nbsp;Celia González-García ,&nbsp;Esther Mancebo Sierra ,&nbsp;Amado Andrés Belmonte","doi":"10.1016/j.xkme.2025.101076","DOIUrl":"10.1016/j.xkme.2025.101076","url":null,"abstract":"<div><div>Highly sensitized patients without compatible living donors face prolonged waiting times for a transplant. Prioritization and desensitization strategies often prove insufficient because of logistical challenges, extended treatments, and increased infection risk. The new drug imlifidase offers an opportunity for these patients by rapidly removing IgG antibodies, enabling desensitization when a donor is available. However, real-word experience remains limited. Here, we present the first case in Spain, outside of a clinical trial, in which imlifidase desensitization allowing a kidney transplant in a woman with a calculated panel reactive antibody &gt;99.99%, requiring a second kidney transplant after 13 years on dialysis. After anti-human leukocyte antigen antibodies delisting (&lt;20,000 mean fluorescence intensity [MFI], responders to dilution and noncomplement fixing), she received a deceased-donor kidney against whom she had 6 donor-specific antibodies (DSAs; ranging from 3,049 to 12,001 MFI; targeting human leukocyte antigen class I and II) and a positive flow cytometry crossmatch—all becoming negative after treatment with imlifidase. Early post-transplant DSA rebound was managed with conventional desensitization and anti-C5 blockade. Short-term outcomes were encouraging, with stable kidney function and significant DSA reduction at 9 months. This case highlights the potential of imlifidase in highly sensitized patients; however, long-term studies remain essential to optimize monitoring and concomitant desensitization protocols.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 10","pages":"Article 101076"},"PeriodicalIF":3.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096941","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 and Evaluation of a Culturally Targeted Apolipoprotein L1 Counseling Training Program for Transplant Clinicians: A Pilot Study","authors":"Elisa J. Gordon ,&nbsp;Jessica Gacki-Smith ,&nbsp;Dahlya Manning ,&nbsp;Catherine Wicklund ,&nbsp;Debra Duquette ,&nbsp;Clyde W. Yancy ,&nbsp;Lutfiyya N. Muhammad ,&nbsp;Siyuan Dong ,&nbsp;John Friedewald ,&nbsp;Alexander Gilbert ,&nbsp;Matthew Cooper ,&nbsp;Justin D. Smith ,&nbsp;Aneesha Shetty ,&nbsp;Akansha Agrawal","doi":"10.1016/j.xkme.2025.101075","DOIUrl":"10.1016/j.xkme.2025.101075","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><div><em>Apolipoprotein L1</em> (<em>APOL1</em>) genetic testing is increasingly used to evaluate potential living kidney donors (pLDs) of African ancestry. Transplant clinicians may benefit from improving knowledge and skills in delivering <em>APOL1</em> counseling. This multisite study developed and evaluated the effectiveness of a culturally targeted Counseling Training Program on <em>APOL1</em> and Living Donation (“Training Program”) to train transplant clinicians on <em>APOL1</em> biology, genetics, and genetic counseling.</div></div><div><h3>Study Design</h3><div>A prospective, nonrandomized pretest/posttest clinical trial.</div></div><div><h3>Setting &amp; Participants</h3><div>Transplant nephrologists, surgeons, nurses, advanced practice providers, and general nephrologists at 6 kidney transplant centers.</div></div><div><h3>Intervention</h3><div>The training program included 8 prerecorded videos about <em>APOL1</em> and living kidney donation, counseling skills, cultural sensitivity, and shared decision making.</div></div><div><h3>Outcomes</h3><div>Knowledge and self-efficacy in genetic counseling, knowledge of genetic variation, use of race in clinical decision making, and beliefs about the relationship between genetics and race, as assessed via validated surveys.</div></div><div><h3>Analytic Approach</h3><div>Paired tests of pre–post scores from validated surveys.</div></div><div><h3>Results</h3><div>In total, 35 clinicians participated; 21 were female, and 34 had no formal genetics training. Training program exposure was significantly associated with an increase in knowledge of genetic variation: pre, 3.31 (1.41); post, 3.91 (1.27), <em>P</em> <!-->=<!--> <!-->0.04. Participants reported increased confidence post-training in their ability to know when the <em>APOL1</em> genetic test is indicated (<em>P</em> <!-->=<!--> <!-->0.001), interpret <em>APOL1</em> test results (<em>P</em> &lt; 0.001), and communicate about <em>APOL1</em> in a culturally sensitive manner (<em>P</em> &lt; 0.001). There was a nonsignificant decrease in beliefs about relationships between genetics and race from pretest to posttest (biologic domain: pre, 9.63 (3.06); post, 9.06 (2.76), <em>P</em> <!-->=<!--> <!-->0.32; clinical domain, pre, 11.03 (2.22); post, 10.57 (2.63), <em>P</em> <!-->=<!--> <!-->0.36).</div></div><div><h3>Limitations</h3><div>Small sample size and nonrandomized design.</div></div><div><h3>Conclusions</h3><div>Our findings suggest the training program can increase transplant clinicians’ competence in counseling pLDs about <em>APOL1</em> genetic testing. Training program dissemination may facilitate integration of <em>APOL1</em> testing and counseling into pLD evaluation nationally.</div></div><div><h3>Plain Language Summary</h3><div>Although genetic testing is increasingly used to evaluate potential living kidney donors (pLDs), transplant clinicians may benefit from improving their delivery of <em>Apoli","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 10","pages":"Article 101075"},"PeriodicalIF":3.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933813","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 Center-level Practices Across US Transplant Centers Are Associated With Time to Relisting and Retransplantation in Patients With Graft Failure","authors":"Elaine Ku ,&nbsp;Deborah B. Adey ,&nbsp;Isabelle Lopez ,&nbsp;Brian K. Lee ,&nbsp;Feng Lin ,&nbsp;Adrian M. Whelan ,&nbsp;Charles E. McCulloch ,&nbsp;Matthew R. Weir ,&nbsp;Ling-Xin Chen ,&nbsp;Patrick Ahearn ,&nbsp;John Gill ,&nbsp;Sang Joseph Kim ,&nbsp;Kirsten L. Johansen","doi":"10.1016/j.xkme.2025.101072","DOIUrl":"10.1016/j.xkme.2025.101072","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><div>There is known variability in the management of kidney transplant recipients facing graft failure. We hypothesized that variations in the timing of care transitions, immunosuppression weaning, and re-evaluation processes would be associated with differential access to retransplantation and relisting.</div></div><div><h3>Study Design</h3><div>An observational study.</div></div><div><h3>Setting &amp; Participants</h3><div>Survey directed at medical directors of US transplant centers.</div></div><div><h3>Exposures</h3><div>Transplant center-reported practices.</div></div><div><h3>Outcomes</h3><div>Time to retransplantation (and secondarily, relisting) after graft failure.</div></div><div><h3>Analytical Approach</h3><div>Adjusted proportional hazards models with clustering by transplant center.</div></div><div><h3>Results</h3><div>Of the 178 surveyed centers, 77 unique transplant centers (43%) responded. Respondents reported significant variability in the timing of transition of patients back to general nephrologists (ranging from within 1 year of transplantation to never), weaning of immunosuppression with graft failure, and approach to assessments of frailty and adherence during the evaluation for relisting. Transplant centers that transitioned patients back to general nephrologists<!--> <!-->&gt;3 to<!--> <!-->&lt;5 years after transplant had lower likelihood of retransplantation (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.73-0.88) and relisting (HR, 0.80; 95% CI, 0.75-0.85) compared with centers that transitioned patients earlier (between 1-3 years of transplantation). Transplant centers that did not oversee weaning of immunosuppression after graft failure had patients with a lower likelihood of retransplantation (HR, 0.89; 95% CI, 0.79-0.99) and relisting (HR, 0.88; 95% CI, 0.82-0.95) compared with centers that oversaw this weaning. Withdrawal of immunosuppression 12-24 months after return to dialysis was associated with a higher likelihood of retransplantation (HR, 1.28; 95% CI, 1.14-1.43) and relisting (HR, 1.15; 95% CI, 1.06-1.26) compared with withdrawal of immunosuppression within 6 months of graft failure.</div></div><div><h3>Limitations</h3><div>Observational nature of data and potential for residual confounding.</div></div><div><h3>Conclusions</h3><div>There is significant variation in the management of patients with graft failure across US transplant centers during the transition of care, and this variation was associated with differential access of patients to retransplantation and relisting.</div></div><div><h3>Plain-Language Summary</h3><div>Transplant centers vary in how they approach the management of transplant recipients with low kidney function facing graft failure. In this study, we surveyed transplant centers about their practices when working with patients with impending graft failure and linked these practices to access of patients to relisting and retransplantation u","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 9","pages":"Article 101072"},"PeriodicalIF":3.4,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144895406","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":"Membranous Lupus Nephropathy Clinical Characteristics, Treatment Response, and Renal Prognosis: A Retrospective Cohort Study","authors":"Matthew Baker MD,&nbsp;Catherine Larned MD,&nbsp;Robert Nee MD,&nbsp;Sarah Gordon MD,&nbsp;Stephen Olson MD","doi":"10.1016/j.xkme.2025.101073","DOIUrl":"10.1016/j.xkme.2025.101073","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 9","pages":"Article 101073"},"PeriodicalIF":3.4,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144888667","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":"Microscopic Tubulovenous Communications in Nonneoplastic Kidneys: A Single-Center Case Series and Review of the Literature","authors":"Cullen M. Lilley,&nbsp;Jonathan E. Zuckerman","doi":"10.1016/j.xkme.2025.101071","DOIUrl":"10.1016/j.xkme.2025.101071","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Pathological connection between the kidney tubules and veins is known as a microscopic tubulovenous communication we refer to as a tubulovenous fistula (TVF). This finding has been reported in a few small case reports, but no systematic examination of cases across various clinical settings detailing their histologic spectrum and associated clinical/pathologic findings has been performed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Case series and literature review.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Nonneoplastic kidney pathology reports from an academic medical center (February 1, 1990, to February 1, 2024) were queried for mention of TVF. In total, 30,537 nonneoplastic kidney reports were queried, and 22 cases of TVF were identified.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;In total, 72.7% of TVF cases were from native kidney biopsies. Median patient age was 66 (range, 25-84) with a male predominance (68.2%). Clinically, 82.4% had microscopic hematuria, and 17.6% had gross hematuria. TVFs were usually singular and involved arcuate size veins. Microscopically, 95.5% of cases had acute tubular injury, and 73.3% had at least focal pathologic intratubular casts/calcium crystals. In total, 56.3% of native cases had interstitial nephritis. Of the transplant cases (n&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;6), 66.7% exhibited rejection.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Laboratory data, clinical follow-up, and original slides were not available in all cases examined. Although rare in our repository, TVFs are likely an under-reported finding. In addition, the focality of TVFs could play a role in their limited rate of detection.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;This is the largest case series exploring the clinical and histologic features associated with TVFs in the kidney. Our findings support the assertion that TVFs are associated with hematuria without glomerulonephritis and occur in the setting of significant tubular injury, intratubular casts/crystals, and obstructive phenomena likely because of disruption of tubular basement membranes adjacent to veins.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;div&gt;Our study explores a rare feature found in medical kidney biopsies called tubulovenous communications, in which small blood vessels connect with kidney tubules. These communications can sometimes be overlooked or not recognized because of their rarity. We reviewed a series of biopsies to identify and describe these communications and their associated findings in the kidney. By looking at these biopsies, we learned that these communications are more common when there is background kidney inflammation. Our findings highlight the importance of recognizing tubulovenous communications, which could potentially explain blood in the urine in patients with kidney inflammation but no damage to the glomerulus. Our findings also suggest that inflammation may be a mechanistic explanation for the formatio","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 9","pages":"Article 101071"},"PeriodicalIF":3.4,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886475","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 Between Cancer and Incident Acute Kidney Injury Among Medicare Fee-for-Service Population","authors":"Yoshihisa Miyamoto,&nbsp;Linda J. Andes,&nbsp;Alain K. Koyama,&nbsp;Fang Xu,&nbsp;Meda E. Pavkov","doi":"10.1016/j.xkme.2025.101069","DOIUrl":"10.1016/j.xkme.2025.101069","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><div>Acute kidney injury (AKI) is a frequent complication of cancer due to multiple factors. Our aim was to assess contemporary associations between various cancers and incident AKI among Medicare beneficiaries.</div></div><div><h3>Study Design</h3><div>A retrospective observational study.</div></div><div><h3>Setting &amp; Participants</h3><div>Medicare fee-for-service beneficiaries aged<!--> <!-->≥66 years.</div></div><div><h3>Exposure</h3><div>New cancer diagnosis.</div></div><div><h3>Outcomes</h3><div>Incidence of AKI.</div></div><div><h3>Analytical Approach</h3><div>Follow-up started at cancer diagnosis or on December 31, 2014, for controls and ended at the date of AKI, death, cancer in the control group, or at 5 years, whichever occurred first. Overall and site-specific associations between cancer and AKI were assessed by cause-specific Cox models and Fine-Gray competing risk models, adjusting for age, sex, race and ethnicity, and comorbid conditions.</div></div><div><h3>Results</h3><div>We identified 482,016 beneficiaries with newly diagnosed cancer and the same number of matched controls. The median follow-up time was 4.1 years (interquartile range [IQR], 1.0-5.0 years) and 4.8 (IQR, 1.7-5.0 years), respectively, for cancer cases and controls. The highest 5-year risk of AKI was observed in cancer of the renal pelvis and ureter 32.8% (95% confidence interval [CI], 30.7%-34.8%); multiple myeloma 32.6% (95% CI, 31.7%-33.4%); and kidney cancer 28.9% (95% CI, 28.2%-29.5%). The multivariable-adjusted subdistribution hazard ratio for AKI was significantly higher for multiple myeloma compared with controls and was significantly lower for cancers with high mortality, such as pancreatic, lung and bronchial, liver, gallbladder and biliary, or stomach cancer.</div></div><div><h3>Limitations</h3><div>Potential misclassification from using International Classification of Diseases codes to identify cancer and AKI, residual confounding from unmeasured variables, lack of information on cancer stage and histology, and not accounting for cancer treatment including medication.</div></div><div><h3>Conclusions</h3><div>Risks of AKI vary across cancer types. Multiple myeloma had the highest significant risk of AKI compared with controls.</div></div><div><h3>Plain-Language Summary</h3><div>Acute kidney injury (AKI) is a common complication in patients with cancer due to tumor growth, treatments, and other health conditions. This study analyzed the association between cancer types and AKI risk among Medicare beneficiaries aged 66 years or older with new cancer diagnoses in 2014. Cancers of the renal pelvis/ureter (32.8%), multiple myeloma (32.6%), and kidney cancer (28.9%) had the highest 5-year AKI risks. Multiple myeloma showed a significantly higher AKI risk compared with controls after adjustment for comorbid conditions. These findings highlight variations in AKI risk across cancer types.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 9","pages":"Article 101069"},"PeriodicalIF":3.4,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886506","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":"Comparison of the 2021 and 2012 CKD-EPI eGFR Equations With the 2009 CKD-EPI eGFR Equation in a Chinese Population","authors":"Yifeng Shen ,&nbsp;Junhua Cui ,&nbsp;Rong Yang ,&nbsp;Wenqi Shao ,&nbsp;Jing Yang ,&nbsp;Beili Wang ,&nbsp;Baishen Pan ,&nbsp;Jing Zhu ,&nbsp;Wei Guo","doi":"10.1016/j.xkme.2025.101068","DOIUrl":"10.1016/j.xkme.2025.101068","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><div>The 2024 KDIGO guideline recommends the use of the 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. We used the most widely applied 2009 CKD-EPI estimated glomerular filtration rate based on creatinine (eGFRcr) equation as a reference to compare the other 4 CKD-EPI eGFR equations in a large clinical population in China.</div></div><div><h3>Study Design</h3><div>A cross-sectional analysis.</div></div><div><h3>Setting &amp; Participants</h3><div>Individuals with clinical encounters at Zhongshan Hospital, Fudan University, from July 1, 2017, to July 1, 2023, who had both creatinine (cr) and cystatin C (cys) tested.</div></div><div><h3>Exposures</h3><div>Serum cr and serum cys.</div></div><div><h3>Outcomes</h3><div>This study compared the clinical effects of the 2012 CKD-EPI eGFR cr-cys and eGFRcys, 2021 CKD-EPI eGFRcr and eGFRcr-cys according to the 2009 CKD-EPI eGFRcr in a large clinical population in China.</div></div><div><h3>Analytical Approach</h3><div>The eGFR results were statistically evaluated according to sex, age, serum cys, and serum cr levels, and CKD stage.</div></div><div><h3>Results</h3><div>The 2009 CKD-EPI eGFRcr had the overall result with a median of 74.9<!--> <!-->mL/min/1.73m². The median of 2012 CKD-EPI eGFRcys and eGFRcr-cys were 67.6 and 72.2<!--> <!-->mL/min/1.73m², respectively. The median of 2021 CKD-EPI eGFRcr and eGFRcr-cys were 79.5 and 75.0<!--> <!-->mL/min/1.73<!--> <!-->m², respectively. Compared with the 2009 CKD-EPI eGFRcr equation, the 2012 CKD-EPI eGFRcys equation had the greatest disagreement. The P₃₀ and P₁₀ were 84.2% and 39.5%, respectively. The extent of reclassification was 28.8% of participants had CKD stage worsening and 9.3% of participants had CKD stage improvement. The smallest difference with the 2009 CKD-EPI eGFRcr was observed in the 2021 CKD-EPI eGFRcr. The P₃₀ was 100.0% and P₁₀ was 99.5%. The extent of reclassification was 14.3% of participants had CKD stage improvement. The differences were similar between 2012 and 2021 CKD-EPI eGFRcr-cys equations when compared with the 2009 CKD-EPI eGFRcr equation.</div></div><div><h3>Limitations</h3><div>Lack of measured GFR.</div></div><div><h3>Conclusions</h3><div>The 2021 and the 2009 CKD-EPI eGFRcr results appeared to have the best comparability, whereas the results of the 2012 CKD-EPI eGFRcys and the 2009 CKD-EPI eGFRcr showed the most obvious difference. The differences between eGFR equations should be considered when judging the CKD stage of patients.</div></div><div><h3>Plain-Language Summary</h3><div>Glomerular filtration rate (GFR) is an important criterion for the assessment of kidney function. Because GFR measurement is expensive, time-consuming, and invasive, estimated GFR is widely used for kidney function assessment. However, there are significant discrepancies between the results of different eGFR ","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 9","pages":"Article 101068"},"PeriodicalIF":3.4,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144888666","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 Dialysis Medical Director Rotation for Nephrology Fellows: A Single Center’s 10-Year Experience","authors":"Harshil A. Fichadiya ,&nbsp;Jing Miao ,&nbsp;James R. Gregoire","doi":"10.1016/j.xkme.2025.101070","DOIUrl":"10.1016/j.xkme.2025.101070","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Many nephrology fellows will eventually become dialysis unit medical directors, yet few receive formal training on the responsibilities of this position. This study reports on our 10-year experience conducting a dedicated medical director rotation for nephrology fellows.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;An observational longitudinal study of a month-long medical director rotation designed to prepare nephrology fellows for leadership roles in dialysis facilities.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;From 2014 to 2023, 36 nephrology fellows at the Mayo Clinic in Rochester, MN completed the rotation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Quality Improvement Activities&lt;/h3&gt;&lt;div&gt;Fellows were surveyed before and immediately after the rotation. Postgraduation surveys assessed the rotation’s effect on the fellows’ clinical practice.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;The study evaluated how well the rotation improved fellows’ understanding of the medical director role, its influence on their clinical practice, and the importance of incorporating this training into fellowship programs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytic Approach&lt;/h3&gt;&lt;div&gt;Quantitative and qualitative survey responses from fellows before and after the rotation and postgraduation were analyzed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Before the rotation, only 5% of fellows had a strong understanding of the medical director’s role, increasing to 100% after completion. None felt well prepared for the role before rotation, whereas 81% reported feeling well prepared afterward. Among graduated fellows, nearly half served as a dialysis facility medical director, 70% found the rotation valuable to their practice, and 30% found it somewhat valuable. Additionally, 85% considered it very important to include a medical director rotation in fellowship training.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Single-center study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;A structured medical director rotation within a general nephrology fellowship effectively prepares fellows for leadership roles in dialysis facilities and could serve as a model for other institutions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;div&gt;The increasing prevalence of patients with kidney failure has expanded the role of dialysis facility medical directors, yet many nephrology fellows receive little formal training for this leadership position. To address this gap, our fellowship program introduced a dedicated medical director rotation in 2014. We surveyed current and graduated fellows to assess the rotation’s effect. Results showed that participation significantly improved fellows’ understanding and preparedness for the role. Graduates found the rotation highly beneficial, though they identified areas for improvement, such as financial management training. Our study highlights the importance of a structured medical director education in nephrology fellowships, demonstrating that such","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 9","pages":"Article 101070"},"PeriodicalIF":3.4,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886507","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}