Kidney Medicine最新文献

{"title":"C3 Glomerulonephritis Associated With Unusual IgG4 Antifactor H in IgG4-related Disease","authors":"Paul Dalmas ,&nbsp;Mickael Bobot ,&nbsp;Noémie Jourde-Chiche ,&nbsp;Julie Bruno ,&nbsp;Stéphane Burtey ,&nbsp;Laurent Daniel ,&nbsp;Carine El-Sissy ,&nbsp;Véronique Fremeaux-Bacchi ,&nbsp;Antonio Jorquera ,&nbsp;Vincent Javaugue ,&nbsp;Nicolas Schleinitz ,&nbsp;Mikael Ebbo","doi":"10.1016/j.xkme.2025.101019","DOIUrl":"10.1016/j.xkme.2025.101019","url":null,"abstract":"<div><div>C3 glomerulonephritis (C3GN) is characterized by glomerular aggression mediated by deregulation of the alternative complement pathway. C3GN can be inherited or consequent to acquired autoantibodies, notably against factor H. We report the case of a patient with systemic active IgG4-related disease who presented for acute kidney injury with glomerular proteinuria and hypocomplementemia related to C3GN associated with IgG4-related interstitial nephritis on kidney biopsy. Factor H was low, and antifactor H IgG autoantibody was detected. Detection of other acquired or genetic complement alternative pathway disorders returned negative. After initial failure of oral corticoids and intravenous rituximab, the patient was successfully treated by intravenous cyclophosphamide followed by maintenance therapy with rituximab. Antifactor H autoantibody isotypes were IgG1 and IgG3, mainly as all antifactor H in positive controls but also IgG4, which is unusual. This suggests a link in this case between the oligoclonal expansion of plasma cells in IgG4-related disease and the production of antifactor H antibodies, especially of IgG4 isotype.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 7","pages":"Article 101019"},"PeriodicalIF":3.2,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Hospitalization and Related Outcomes in Advanced Chronic Kidney Disease: A Systematic Review, External Validation, and Development Study","authors":"Roemer J. Janse ,&nbsp;Jet Milders ,&nbsp;Joris I. Rotmans ,&nbsp;Fergus J. Caskey ,&nbsp;Marie Evans ,&nbsp;Claudia Torino ,&nbsp;Maciej Szymczak ,&nbsp;Christiane Drechsler ,&nbsp;Christoph Wanner ,&nbsp;Maria Pippias ,&nbsp;Antonio Vilasi ,&nbsp;Vianda S. Stel ,&nbsp;Nicholas C. Chesnaye ,&nbsp;Kitty J. Jager ,&nbsp;Friedo W. Dekker ,&nbsp;Merel van Diepen","doi":"10.1016/j.xkme.2025.101016","DOIUrl":"10.1016/j.xkme.2025.101016","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Hospitalization is common in patients with advanced chronic kidney disease (CKD). Predicting hospitalization and related outcomes would be beneficial for hospitals and patients. Therefore, we aimed to (1) give an overview of current prediction models for hospitalization, length of stay, and readmission in patients with advanced CKD; (2) externally validate these models; and (3) develop a new model if no valid models were identified.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Systematic review, development, and external validation study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;We were interested in prediction models of hospitalization, length of stay, or readmission for patients with advanced CKD. Our available development and validation data consisted of hemodialysis, peritoneal dialysis, and advanced CKD patients not receiving dialysis from a Dutch dialysis and European advanced CKD cohort.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Selection Criteria for Studies&lt;/h3&gt;&lt;div&gt;We systematically searched PubMed. Studies had to intentionally develop, validate, or update a prediction model in adults with CKD.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;We used the PROBAST for risk of bias assessment. Identified models were externally validated on model discrimination (C-statistic) and calibration (calibration plot, slope, and calibration-in-the-large). We developed a Fine-Gray model for hospitalization within 1 year in patients initiating hemodialysis, accounting for the competing risk of death.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;We identified 45 models in 8 studies. The majority were of low quality with a high risk of bias. Due to underreporting and population-specific predictors, we could only validate 3 models. These were poorly calibrated and had poor discrimination. Using multiple modeling strategies, an adequate new model could not be developed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;The outcome hospitalization might be too heterogeneous, and we did not have all relevant predictors available.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Hospitalizations are important but difficult to predict for patients with advanced CKD. An improved prediction model should be developed, for example, using a more specific outcome (eg, cardiovascular hospitalizations) and more predictors (eg, patient-reported outcome measures).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Hospitalizations often occur in patients with advanced chronic kidney disease. By predicting hospitalization and related outcomes, patients can better prepare for the future and cope with their disease. Therefore, we searched existing literature for existing methods to predict hospitalizations and related outcomes. Although many algorithms exist, they are often not available for use or are not reliable. We then developed our own algorithm to predict hospitalization in the coming year. However, it also did not predict reliably. In this study, we summ","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 7","pages":"Article 101016"},"PeriodicalIF":3.2,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144329680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plasma-negative, Renal-limited Cryofibrinogen-associated Glomerulonephritis: A Unique Case Report","authors":"Jarrad A. Hopkins ,&nbsp;Ann Nguyen-Hoang ,&nbsp;John Brealey ,&nbsp;Pravin Hissaria ,&nbsp;Jola Kapojos","doi":"10.1016/j.xkme.2025.101017","DOIUrl":"10.1016/j.xkme.2025.101017","url":null,"abstract":"<div><div>Cryofibrinogen-associated glomerulonephritis is characterized by membranoproliferative glomerulonephritis without immunoglobulin deposition and unique ultrastructural features. This case report presents a 63-year-old man with renal-limited cryofibrinogen-associated glomerulonephritis, with negative plasma cryofibrinogen levels. His medical history included metallic aortic valve replacement and long-term anticoagulation therapy. Clinical examination revealed no cutaneous manifestations or thrombotic events. Initial laboratory investigations showed severe kidney dysfunction, but negative results for plasma cryofibrinogen, serum cryoglobulin, and a comprehensive autoimmune, infective, and malignancy panel. Kidney biopsy revealed mesangiocapillary glomerulonephritis with focal vasculitis and significant interstitial fibrosis, and electron microscopy identified double-walled microtubules consistent with cryofibrinogen. Our patient was managed without immunosuppressive therapy due to significant kidney scarring and absence of extra-renal manifestations. To our knowledge, this case describes the first report of cryofibrinogen-associated glomerulonephritis in the absence of detectable cryofibrinogen in serum, with diagnosis relying on ultrastructural findings. Differential diagnoses such as immunotactoid glomerulonephritis were considered but ruled out based on morphological characteristics. This case adds to the limited literature on renal-limited cryofibrinogen and emphasizes the necessity for thorough investigation including electron microscopy assessment of kidney biopsies to ascertain the diagnosis.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 7","pages":"Article 101017"},"PeriodicalIF":3.2,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144212438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deoxycholic Acid and Cognitive Impairment and Decline in the Chronic Renal Insufficiency Cohort (CRIC)","authors":"Parisa Mortaji ,&nbsp;Xuan Cai ,&nbsp;Ester Oh ,&nbsp;Rebecca Frazier ,&nbsp;Anand Srivastava ,&nbsp;Michael Fischer ,&nbsp;Ana Ricardo ,&nbsp;Jiang He ,&nbsp;Katherine Mills ,&nbsp;Katherine Wolfrum ,&nbsp;Amanda Anderson ,&nbsp;Harold I. Feldman ,&nbsp;Makoto Miyazaki ,&nbsp;Michel Chonchol ,&nbsp;Manjula Kurella Tamura ,&nbsp;Kristen Nowak ,&nbsp;Tamara Isakova ,&nbsp;Anna Jovanovich","doi":"10.1016/j.xkme.2025.101018","DOIUrl":"10.1016/j.xkme.2025.101018","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Cognitive impairment is common in chronic kidney disease (CKD). The secondary bile acid, deoxycholic acid (DCA), is associated with cognitive impairment and Alzheimer’s dementia among older adults without CKD. Whether DCA is associated with cognitive impairment and decline in CKD is unknown.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Cross-sectional and longitudinal multivariable-adjusted regression analyses.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;2,836 CRIC Study participants; 699 CRIC Cognitive (COG) Study participants.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;Fasting serum DCA levels measured at visit 5 (ie, baseline).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Modified Mini-Mental State Examination (3MS) in the main CRIC cohort and domain-specific cognitive tests in the CRIC COG cohort: Trail Making Test Parts A and B, Category Fluency, Buschke Selective Reminding, and Boston Naming. Cognitive impairment was defined as test score&lt;!--&gt; &lt;!--&gt;&gt;1 standard deviation worse than the mean test score.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Mean age 59&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;10 years, 45% female, and 39% Black. In the overall cohort, in cross-sectional analyses, there was no association between DCA and cognitive impairment by 3MS in after adjustment for demographics and clinical factors (prevalence ratio doubling DCA, 1.00; 95% CI, 0.95-1.06; n&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;2,836). In longitudinal analyses, DCA was associated with decline (mean annual percent change in 3MS per doubling DCA, −0.13; 95% CI, −0.28 to&lt;!--&gt; &lt;!--&gt;−0.02) but not with incident impairment (n&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;2,836; follow-up of 8.6&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;3.9 years). Among CRIC COG Study participants, in cross-sectional analyses, DCA was associated with cognitive impairment based on Category Fluency (prevalence ratio per doubling DCA, 1.14; 95% CI, 1.02-1.27) but not with other specific-domain cognitive tests (n&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;698-699). In CRIC COG longitudinal analyses, DCA was not associated with decline or incident cognitive impairment (n&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;538-574).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;No adjustment for inflammation, no stool DCA, 3MS may lack specificity.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Among individuals with CKD stages 2-4, higher DCA levels were independently associated with prevalent cognitive impairment in Category Fluency. The association between DCA and progressive cognitive impairment assessed by 3MS was small and likely not clinically significant.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Cognitive impairment is common in chronic kidney disease (CKD). Deoxycholic acid (DCA) is a secondary bile acid that is associated with cognitive impairment in older adults without CKD, but its association with cognitive impairment and decline in patients with CKD is unknown. We examined whether DCA was associated with baseline or later cognitive impairment among 2,836 participants from","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 7","pages":"Article 101018"},"PeriodicalIF":3.2,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization Trends of Dual GIP/GLP-1 Receptor Agonist, Newer Glucose-Lowering Medications, and Anti-Obesity Medications Among Patients With Chronic Kidney Disease With and Without Type 2 Diabetes","authors":"Panupong Hansrivijit ,&nbsp;Janinne Ortega-Montiel ,&nbsp;Deborah J. Wexler ,&nbsp;Elisabetta Patorno ,&nbsp;Julie M. Paik","doi":"10.1016/j.xkme.2025.101013","DOIUrl":"10.1016/j.xkme.2025.101013","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Tirzepatide, a dual GIP/GLP-1 receptor agonist, has been approved for type 2 diabetes (T2D) and obesity. However, the real-world utilization of tirzepatide remains unexplored, particularly in patients with chronic kidney disease (CKD), where the prevalence of T2D and obesity is high. This study aimed to describe the utilization trends of tirzepatide, glucose-lowering medications (GLMs), and anti-obesity medications (AOMs) in patients with CKD, with and without T2D.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;A population-based, observational cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Patients with CKD, with and without T2D, were identified from a large US health insurance claims database (from January 1, 2022 to September 30, 2023).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposures&lt;/h3&gt;&lt;div&gt;Tirzepatide, other GLMs, and AOMs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Medication utilization trends and patient characteristics. Any users were defined as those with prescription claims, and incident users as those with no previous dispensing within 365 days.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Longitudinal trends were assessed by 1-month intervals from January 1, 2022 to September 30, 2023.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among 455,047 patients with CKD and T2D, tirzepatide any users increased to 4.8% in September 2023, while incident users rose from 0.8% to 8.6%. Sodium glucose cotransporter-2 inhibitors remained the most initiated GLM. Tirzepatide initiators had higher rates of obesity (32.5%), and morbid obesity (44.1%) when compared with other GLMs. Among 5,978 patients with CKD without diabetes, weekly semaglutide&lt;!--&gt; &lt;!--&gt;≤2&lt;!--&gt; &lt;!--&gt;mg was the most initiated AOM, followed by tirzepatide. Incident users of tirzepatide rose from 0.6% in June 2022 to 23.5% in September 2023. Clinical characteristics were similar between semaglutide&lt;!--&gt; &lt;!--&gt;≤2&lt;!--&gt; &lt;!--&gt;mg versus tirzepatide initiators.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;The study period ended before tirzepatide’s approval for weight management (November 2023).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Our study indicates rapidly shifting trends in tirzepatide uptake among patients with CKD both with and without diabetes. The uptake of tirzepatide is expected to increase further. Future studies on the comparative effectiveness and safety of tirzepatide in patients with CKD are warranted.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;div&gt;Tirzepatide, a dual GIP/GLP-1 receptor agonist, has been approved for glycemic control and weight management, but its utilization in the real-world settings among patients with chronic kidney disease (CKD) is unknown, where the prevalence of type 2 diabetes and obesity is high. In this study, we examined the utilization trends of tirzepatide, other glucose-lowering medications, and anti-obesity medications (AOMs) from January 1, 2022 to September 30, 2023 using a large US health insurance datab","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 6","pages":"Article 101013"},"PeriodicalIF":3.2,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144116047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Primary Care Continuity With Home Dialysis, Transplantation, and Utilization of Medical Services for Patients Starting Hemodialysis","authors":"Cole S. Wyman ,&nbsp;Maya Djerboua ,&nbsp;Kristin K. Clemens ,&nbsp;Ziv Harel ,&nbsp;Manish M. Sood ,&nbsp;Samuel A. Silver","doi":"10.1016/j.xkme.2025.101015","DOIUrl":"10.1016/j.xkme.2025.101015","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Primary care may help patients starting dialysis with emotional support and access to health care services. It is unknown whether consistently visiting the same primary care physician (PCP) can strengthen patient confidence to select home dialysis, help facilitate medical appointments for transplantation, or increase care access.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;A population-based retrospective cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Patients initiating maintenance hemodialysis from 2007 to 2017 in Ontario, Canada.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;High PCP continuity using the usual provider of care index (an established measure of PCP continuity), defined as&lt;!--&gt; &lt;!--&gt;&gt;75% of PCP visits with the same PCP in the 2 years before dialysis initiation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Primary outcomes were time to home dialysis (peritoneal or hemodialysis) and transplantation. Secondary outcomes included specialist visits, cancer screening, influenza vaccination, and measures of diabetes care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Propensity scores to match patients with high and low PCP continuity.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;We identified 9,530 matched pairs. High PCP continuity was not associated with increased home dialysis (14.0 events per 100 person-years vs 14.0 events per 100 person-years; subdistribution hazard ratio 1.00; 95% CI, 0.97-1.04) or transplantation (4.3 events per 100 person-years vs 4.5 events per 100 person-years; subdistribution hazard ratio 0.97; 95% CI, 0.90-1.04). High PCP continuity was associated with greater colon cancer screening (hazard ratio 1.07; 95% CI, 1.01-1.14), influenza vaccination (hazard ratio 1.33; 95% CI, 1.27-1.39), and comprehensive diabetes care (hazard ratio 1.23; 95% CI, 1.14-1.33).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Residual confounding is possible.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;High PCP continuity before dialysis initiation was not associated with increased utilization of home dialysis or transplantation but was associated with greater colon cancer screening, influenza vaccination, and comprehensive diabetes care. Additional work is needed to clarify how primary care may best benefit this patient population.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;div&gt;Patients transitioning to maintenance hemodialysis require comprehensive health care. We investigated how closer relationships with a primary care physician (PCP) may complement nephrologists in caring for this patient population. We used administrative databases in Ontario, Canada, to conduct a retrospective population-based study, assessing how continuity with one PCP influenced the uptake of home dialysis, kidney transplantation, and patient access to health care services. We found that high PCP continuity before dialysis initiation was not associated with increased transition to home dialysis or kidney transplan","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 6","pages":"Article 101015"},"PeriodicalIF":3.2,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144115993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Activation, Social Support, Physician Trust, and Shared Dialysis Decision-Making: A Cross-Sectional Investigation","authors":"Fahad Saeed ,&nbsp;Basil S. Kazi ,&nbsp;Musaib Syed ,&nbsp;Kevin A. Fiscella ,&nbsp;Paul R. Duberstein","doi":"10.1016/j.xkme.2025.101014","DOIUrl":"10.1016/j.xkme.2025.101014","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;A cross-sectional survey.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytic Approach&lt;/h3&gt;&lt;div&gt;We used descriptive statistics to present demographics. We included patient demographics in multivariable linear regression models predicting SDM scores.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Of the 223 respondents, 222 patients completed SDM-Q-9, 54% were&lt;!--&gt; &lt;!--&gt;≥65 years old, with 47% being woman. In addition, 37% self-identified as African American, 48% had an education level at&lt;!--&gt; &lt;!--&gt;≤high school, and 54% reported an annual household income of ≤$20,000. The SDM-Q-9 scores (n&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;222) had a mean of 57.49 (SD&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;27.07), median 58 (IQR&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;38-82), and ranged from 0 to 100. The mean patient activation was 53.5&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;16.5 (min 24, max 100), social support 61.2&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;24 (min 0, max 100), and physician trust 59.29&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;The study was a cross-sectional investigation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;div&gt;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 ,&nbsp;Ilkka Helanterä ,&nbsp;Auni Juutilainen ,&nbsp;Wisam Bitar ,&nbsp;Jaakko Helve ,&nbsp;Patrik Finne","doi":"10.1016/j.xkme.2025.101012","DOIUrl":"10.1016/j.xkme.2025.101012","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;A nationwide cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;Long-term kidney replacement therapy.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome&lt;/h3&gt;&lt;div&gt;Death due to infection.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Death certificates may have low sensitivity for infectious diseases. Only one cause of death is available. Categories of infectious deaths may overlap.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;div&gt;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 ,&nbsp;Melody Chiang ,&nbsp;Michael Arbit ,&nbsp;Dorey A. Glenn ,&nbsp;Laura H. Mariani ,&nbsp;Jarcy Zee","doi":"10.1016/j.xkme.2025.101010","DOIUrl":"10.1016/j.xkme.2025.101010","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;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 (&lt;span&gt;&lt;math&gt;&lt;mrow&gt;&lt;mo&gt;Δ&lt;/mo&gt;&lt;/mrow&gt;&lt;/math&gt;&lt;/span&gt; Scr) among patients with glomerular disease.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;An observational cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Nephrotic Syndrome Study Network and Cure Glomerulonephropathy adult and pediatric participants with at least one crG measurement.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Predictors&lt;/h3&gt;&lt;div&gt;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 (&lt;span&gt;&lt;math&gt;&lt;mrow&gt;&lt;mo&gt;Δ&lt;/mo&gt;&lt;/mrow&gt;&lt;/math&gt;&lt;/span&gt; crG) was then used as an exposure to assess impacts on &lt;span&gt;&lt;math&gt;&lt;mrow&gt;&lt;mo&gt;Δ&lt;/mo&gt;&lt;/mrow&gt;&lt;/math&gt;&lt;/span&gt; Scr.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;crG levels and &lt;span&gt;&lt;math&gt;&lt;mrow&gt;&lt;mo&gt;Δ&lt;/mo&gt;&lt;/mrow&gt;&lt;/math&gt;&lt;/span&gt; Scr.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;The intraclass correlation coefficient illustrated crG variability within individuals. Multivariable linear mixed models identified factors associated with crG levels. Among those with 2+&lt;!--&gt; &lt;!--&gt;crG measurements, multivariable linear mixed models estimated the association between &lt;span&gt;&lt;math&gt;&lt;mrow&gt;&lt;mo&gt;Δ&lt;/mo&gt;&lt;/mrow&gt;&lt;/math&gt;&lt;/span&gt; crG and &lt;span&gt;&lt;math&gt;&lt;mrow&gt;&lt;mo&gt;Δ&lt;/mo&gt;&lt;/mrow&gt;&lt;/math&gt;&lt;/span&gt; Scr.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among 4,626 crG measurements from 1,081 participants, there was only moderate correlation between measurements within individuals (intraclass correlation coefficient&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;The 24-hour urine collections may have collection error, measured GFR was unavailable, and edema status was unavailable.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;crG was highly dynamic within individuals over time and varied with glomerular disease activity and treatments. The impact of &lt;span&gt;&lt;math&gt;&lt;mrow&gt;&lt;mo&gt;Δ&lt;/mo&gt;&lt;/mrow&gt;&lt;/math&gt;&lt;/span&gt; crG on &lt;span&gt;&lt;math&gt;&lt;mrow&gt;&lt;mo&gt;Δ&lt;/mo&gt;&lt;/mrow&gt;&lt;/math&gt;&lt;/span&gt; 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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;div&gt;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 ,&nbsp;Annie Liu ,&nbsp;James P. Lash ,&nbsp;Mallika L. Mendu ,&nbsp;Sahir Kalim","doi":"10.1016/j.xkme.2025.101011","DOIUrl":"10.1016/j.xkme.2025.101011","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;A retrospective analysis of patient-reported outcome measures and nephrologist documentation in the electronic health record (EHR).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Study Populations&lt;/h3&gt;&lt;div&gt;Adults treated at 2 ambulatory nephrology practices within a single tertiary academic center in the United States from 2015 to 2020.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Data Extraction&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;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&lt;!--&gt; &lt;!--&gt;&lt;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&lt;!--&gt; &lt;!--&gt;&lt;30&lt;!--&gt; &lt;!--&gt;mL/min/1.73&lt;!--&gt; &lt;!--&gt;m&lt;sup&gt;2&lt;/sup&gt;, or had a history of cardiovascular disease. The documentation sensitivity of nephrologists was higher if they were female or were in practice for&lt;!--&gt; &lt;!--&gt;≤7 years as compared with&lt;!--&gt; &lt;!--&gt;&gt;25 years.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Nephrologist documentation in the EHR may not accurately represent what was discussed during a visit.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;div&gt;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}