Kidney Medicine最新文献

{"title":"Erratum to Impact of Prior Kidney Transplantation on Symptom Burden and Health-Related Quality of Life in Incident Dialysis Patients (Kid Med. 2026;8(6):101357)","authors":"Tessa S. Schoot, Thomas S. van Lieshout, Alferso C. Abrahams, Esmee Driehuis, Angèle P.M. Kerckhoffs, Luuk B. Hilbrands, Friedo W. Dekker, Brigit C. van Jaarsveld, Anna A. Bonenkamp, DOMESTICO study group","doi":"10.1016/j.xkme.2026.101420","DOIUrl":"10.1016/j.xkme.2026.101420","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 7","pages":"Article 101420"},"PeriodicalIF":4.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13329698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Ambient Temperature on Intradialytic Hypotension in Hemodialysis Patients: A Retrospective Cohort Study","authors":"Yapeng He, Yan Qian, Qiuting Xu, Xiaohua Sheng, Nina Zhang","doi":"10.1016/j.xkme.2026.101413","DOIUrl":"10.1016/j.xkme.2026.101413","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>This study aimed to investigate the effect of ambient temperature on intradialytic hypotension (IDH) in hemodialysis (HD) patients.</div></div><div><h3>Study Design</h3><div>A single-center retrospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>Patients receiving HD at the HD center at Shanghai Sixth People’s Hospital between January 1, 2022, and May 31, 2025.</div></div><div><h3>Predictors</h3><div>Ambient temperature and demographics (age, sex, dry weight, predialysis systolic blood pressure (SBP), interdialytic weight gain, HD shifts, modalities, dialysate calcium concentration, and ultrafiltration rate) were primary and secondary predictors.</div></div><div><h3>Outcome</h3><div>The primary outcome of this study was IDH.</div></div><div><h3>Analytical Approach</h3><div>Pearson χ<sup>2</sup> tests for categorical variables and <em>t</em> test for continuous variables. Logistic regression was used to analyze IDH risk per temperature bin relative to the highest.</div></div><div><h3>Results</h3><div>We collected 946,703 blood pressure records from 149,273 HD sessions. IDH occurred in 5,073 sessions, accounting for a prevalence of 3.4%. Compared with sessions at an ambient temperature of 33.5-35.5 °C, HD patients had a 2-fold higher risk of IDH when the ambient temperature was less than or equal to -0.5 °C. Furthermore, each 2 °C decrease in ambient temperature was associated with a 4.4% increase in IDH risk. Sensitivity analyses indicated that 21.5 °C as the temperature threshold shows the risk difference under the Nadir90/100 definition. The 3-way interaction indicated that patients with predialysis SBP ≥ 140 mm Hg and UFR ≤ 500 mL in spring and summer have the lowest intradialytic IDH risk. In addition, the analysis identified age, sex, HD shifts, predialysis SBP, interdialytic weight gain, dialysate calcium concentration, ultrafiltration rate, and season as independent risk factors for IDH.</div></div><div><h3>Limitations</h3><div>A single-center, retrospective, and observational study design, not considering indoor temperature, inconsistent threshold analysis results, and ambiguity risk factors.</div></div><div><h3>Conclusions</h3><div>Lower ambient temperatures significantly increase the risk of IDH occurrence. Clinical staff should integrate ambient temperature, patient characteristics, and HD parameters into risk assessments to enhance early prevention, monitoring, and intervention of IDH.</div></div><div><h3>Plain-Language Summary</h3><div>This large-sample retrospective observational study collected intradialytic blood pressure data from adult patients at a single hemodialysis center in Shanghai over 3.5 years, aiming to characterize the association between ambient temperature and intradialytic hypotension (IDH) risk. IDH is a prevalent intradialytic complication, significantly affecting dialysis adequacy and patient safety. Its pathogenesis is multifactorial, with e","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 7","pages":"Article 101413"},"PeriodicalIF":4.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13279291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concurrent Mantle Cell Lymphoma and Paraneoplastic Membranous Nephropathy","authors":"Daoyuan Lv,&nbsp;Ping Sun,&nbsp;Yuanyuan Li,&nbsp;Tingting Liu,&nbsp;Fan Ye,&nbsp;Yafen Yu,&nbsp;Tiekun Li,&nbsp;Aining Liu","doi":"10.1016/j.xkme.2026.101372","DOIUrl":"10.1016/j.xkme.2026.101372","url":null,"abstract":"<div><div>We report a rare case of synchronous stage IV mantle cell lymphoma (MCL) and paraneoplastic membranous nephropathy (MN) in a 48-year-old man. The patient presented with a nasopharyngeal mass; biopsy confirmed cyclin D1-positive MCL harboring the <em>CCND1::IGH</em> rearrangement, along with nephrotic syndrome. Kidney biopsy revealed MN with IgG1/IgG3-dominant glomerular deposits but was negative for PLA2R, THSD7A, and NELL-1 antigens in both renal and tumor tissues, with corresponding serum antibodies undetectable. After lymphoma-directed therapy alone (R-CHOP/R-DHAP induction, autologous hematopoietic stem cell transplantation consolidation, and extended rituximab maintenance), both conditions achieved sustained remission. Complete remission was confirmed per the Lugano 2014 criteria, and nephrotic syndrome resolved, with proteinuria decreasing from 7.38 to 0.29 g/24 hours and serum albumin improving from 26.2 to 35.5 g/L with preserved kidney function. Both MCL and MN remained in remission for &gt;2 years. This case highlights MCL-associated MN as a PLA2R/THSD7A/NELL-1 triple-negative entity where antineoplastic therapy alone induces renal remission, demonstrating both the paraneoplastic mechanism and the feasibility of intensive lymphoma treatment, including transplantation without renal compromise.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 7","pages":"Article 101372"},"PeriodicalIF":4.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13312128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148352500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Scoping Review of Toolkits Addressing Ethical Issues in Health Registry and Clinical Research Enrollment Among African Americans With CKD","authors":"Henry Asante Antwi,&nbsp;Adaeze Aroh,&nbsp;Deidra C. Crews,&nbsp;Rodney Elliot,&nbsp;Nicole Huillca,&nbsp;C. Daniel Mullins,&nbsp;Mehar Sandhu,&nbsp;Abdou Simon Senghor","doi":"10.1016/j.xkme.2026.101403","DOIUrl":"10.1016/j.xkme.2026.101403","url":null,"abstract":"<div><div>Chronic kidney disease (CKD) disproportionately affects African Americans, yet they remain underrepresented in health registries and clinical research enrollment. This scoping review maps and describes existing toolkits designed to address the ethical challenges that contribute to this disparity. We conducted a scoping review following the Joanna Briggs Institute methodology. We systematically searched Ovid MEDLINE, EMBASE, Scopus, and Cochrane Central for English-language studies (2000-2024) describing tools, strategies, or frameworks to improve the ethical recruitment and retention of African American patients in CKD health registries and clinical research. Of 149 records screened, 14 US-based studies met inclusion criteria. We identified several toolkit strategies: community engagement and educational materials (eg, for APOL1 testing), educational programs (eg, for living donor transplantation), participant experience surveys, virtual recruitment tools, and enhanced genetic testing panels. Although these toolkits aimed to mitigate challenges like mistrust and complex informed consent, significant gaps in design, evaluation, and scalability were identified. Most toolkits were not rigorously evaluated for effectiveness, were often context-specific (eg, limited to transplantation), and rarely addressed structural drivers of inequity. Few provided scalable, culturally tailored solutions for the digital divide or offered sustainable models for community partnership. Although several promising toolkits exist to address ethical challenges in CKD research with African Americans, they remain nascent. Future work must focus on developing rigorously evaluated, scalable, and codeveloped toolkits that move beyond describing barriers to providing actionable, ethical solutions for inclusive registry enrollment and research participation.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 7","pages":"Article 101403"},"PeriodicalIF":4.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13312113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148352421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Tonsillectomy for Dual Remission of Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Adenitis Syndrome and Immunoglobulin A Nephropathy: A Case Report","authors":"Daishi Hirano,&nbsp;Kensuke Joh,&nbsp;Shiko Honma,&nbsp;Ryoko Sakaguchi,&nbsp;Aya Saito,&nbsp;Yuna Hiwatari,&nbsp;Shiho Yoshizawa,&nbsp;Yosuke Shoji,&nbsp;Haruhide Sakaguchi,&nbsp;Chisato Umeda,&nbsp;Saori Miwa,&nbsp;Akira Ito","doi":"10.1016/j.xkme.2026.101377","DOIUrl":"10.1016/j.xkme.2026.101377","url":null,"abstract":"<div><div>Despite sharing tonsillar immune dysregulation as a common pathogenic mechanism, concurrent presentation of periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome with immunoglobulin A (IgA) nephropathy (IgAN) remains exceptionally rare, with only 1 previous case reported in the literature receiving multidrug immunosuppressive therapy before tonsillectomy. In this study, we report the first pediatric case in which both conditions achieved sustained remission following early tonsillectomy without additional immunosuppression. A 6-year-old boy with a 3-year history of PFAPA developed gross hematuria coinciding with febrile episodes. Kidney biopsy confirmed IgAN. Owing to the poor response to cimetidine and significant disruption to schooling, palatine tonsillectomy was performed at 7 years. Following surgery, PFAPA episodes completely resolved, and hematuria ceased. Repeat kidney biopsy at 11 months postoperatively showed marked histological improvement, with resolution of mesangial hypercellularity and reduced endocapillary proliferation. This case provides the first pediatric case demonstrating that early tonsillectomy alone can effectively treat coexisting PFAPA and IgAN without the need for additional immunosuppressive therapy. The simultaneous clinical and histological remission supports a shared pathogenic mechanism involving tonsillar immune dysfunction and highlights tonsillectomy as a potentially curative intervention for select patients with concurrent tonsil-driven diseases.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 7","pages":"Article 101377"},"PeriodicalIF":4.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13293688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparable Efficacy of Medium Cut-Off Dialysis Plus HA130 Hemoadsorption and Postfilter Hemodiafiltration in Removing Protein-Bound Uremic Toxins","authors":"Gonzalo Ramírez-Guerrero,&nbsp;Cristian Pedreros-Rosales,&nbsp;María José Cáceres,&nbsp;Katherine Saravia,&nbsp;Alejandra Urizar,&nbsp;Armando Rojas,&nbsp;Thiago Reis,&nbsp;Hans Müller-Ortiz,&nbsp;Claudio Ronco","doi":"10.1016/j.xkme.2026.101389","DOIUrl":"10.1016/j.xkme.2026.101389","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Protein-bound uremic toxins, including indoxyl sulfate and &lt;em&gt;p&lt;/em&gt;-cresyl sulfate, are poorly removed by conventional dialysis and contribute to cardiovascular, inflammatory, and neurological complications in end-stage kidney disease. Although postfilter hemodiafiltration enhances middle molecule clearance, its availability is limited. We evaluated whether combining medium cut-off dialysis with HA130 hemoadsorption achieves protein-bound uremic toxin removal comparable with that of optimized postfilter hemodiafiltration.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Prospective, single-center, parallel-group, single-session comparative study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Twenty anuric adult patients undergoing maintenance hemodialysis treated at a tertiary dialysis center were allocated to medium cut-off dialysis with hemoadsorption (n = 10) or postfilter hemodiafiltration (n = 10).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;Expanded hemodialysis using a medium cut-off membrane combined with HA130 hemoadsorption versus postfilter hemodiafiltration.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Corrected reduction ratios of protein-bound uremic toxins (indoxyl sulfate, &lt;em&gt;p&lt;/em&gt;-cresyl sulfate, carboxymethyllysine, and protein carbonyls) and middle molecules (β&lt;sub&gt;2&lt;/sub&gt;-microglobulin, free light chains, prolactin, parathyroid hormone, soluble receptor for advanced glycation end-products).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Predialysis and postdialysis plasma concentrations were measured, and corrected reduction ratios were calculated after adjusting for hemoconcentration. Between-group comparisons were performed using nonparametric tests.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Corrected reduction ratios for key protein-bound uremic toxins were similar between medium cut-off dialysis with hemoadsorption and hemodiafiltration. Indoxyl sulfate corrected reduction ratios were 28.0% (IQR, 21.6-41.7) with medium cut-off dialysis with hemoadsorption and 26.0% (IQR, 22.5-37.9) with hemodiafiltration, while &lt;em&gt;p&lt;/em&gt;-cresyl sulfate corrected reduction ratios were 31.8% (IQR, 23.9-37.4) versus 36.5% (IQR, 23.9-39.7), respectively (all &lt;em&gt;P&lt;/em&gt; &gt; 0.05). Carboxymethyllysine and protein carbonyl removal did not differ between modalities. In contrast, hemodiafiltration achieved higher corrected reduction ratios for conventional middle molecules, including β&lt;sub&gt;2&lt;/sub&gt;-microglobulin and free light chains. Reduction of soluble receptor for advanced glycation end-products was modest and comparable across treatments.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Small sample size, single-session design, and reliance on plasma reduction ratios without direct dialysate mass measurements.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;In this exploratory study, medium cut-off dialysis with hemoadsorption achieved protein-bound uremic toxin removal similar to that of optimized postfilter hemodiafiltra","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 7","pages":"Article 101389"},"PeriodicalIF":4.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13312152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148352438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kidney health for all: caring for people, protecting the planet","authors":"Raymond Vanholder,&nbsp;Dina Abdellatif,&nbsp;Augusto Cesar Soares Dos Santos Jr.,&nbsp;Ricardo Correa-Rotter,&nbsp;Natarajan Gopalakrishnan,&nbsp;Bill Wang,&nbsp;Stefanos Roumeliotis,&nbsp;Alessandro Balducci,&nbsp;Ágnes Haris,&nbsp;Manjusha Yadla,&nbsp;Li-Li Hsiao","doi":"10.1016/j.xkme.2026.101382","DOIUrl":"10.1016/j.xkme.2026.101382","url":null,"abstract":"<div><div>The current kidney care model—focused on late-stage disease and in-center hemodialysis—is unsustainable, because of costs, environmental burden, poor outcomes, and reduced quality of life. The 78th World Health Assembly’s recognition of kidney disease as a serious health threat presents a critical opportunity to reshape kidney care. Aligned with this, the 2026 World Kidney Day theme, “Kidney Health for All: Caring for People, Protecting the Planet,” calls for a systematic change. A sustainable model must prioritize early detection and prevention, reducing the need for kidney replacement therapy. Transplantation and home dialysis benefit people with kidney failure, environment, and society. Dialysis itself must become more ecofriendly without compromising care quality, recognizing that planetary perturbations in turn affect kidney health. Conservative care should also be considered, particularly for elderly and frail patients, if the quality-of-life benefits outweigh the perspectives offered by dialysis. Achieving this shift requires coordinated action across all stakeholders; education and engagement of the public, policy makers, and health professionals to raise awareness about the threat of kidney disease; and an urgent move toward patient-centered care.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 7","pages":"Article 101382"},"PeriodicalIF":4.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13312082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148352525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"B-Cell Depletion in Glomerular Diseases: Not Always as Safe as We May Think","authors":"Decimo Silvio Chiarenza ,&nbsp;Enrico E. Verrina ,&nbsp;Carolina Bigatti ,&nbsp;Gianluca Caridi ,&nbsp;Agnese Spennacchio ,&nbsp;Xhuliana Kajana ,&nbsp;Massimiliano De Bortoli ,&nbsp;Paolo Cravedi ,&nbsp;Andrea Angeletti","doi":"10.1016/j.xkme.2026.101268","DOIUrl":"10.1016/j.xkme.2026.101268","url":null,"abstract":"<div><div>B-cell depletion with the chimeric anti-CD20 monoclonal antibody rituximab has revolutionized the treatment of glomerular diseases. Obinutuzumab, a type II glycoengineered anti-CD20 humanized monoclonal antibody, is increasingly being employed as an alternative to rituximab in the management of difficult-to-treat cases, due to deeper and more persistent B-cell depletion. However, its safety profile, especially in pediatric and young adults with glomerular diseases, remains to be fully elucidated.</div><div>Herein, we report 3 patients who developed severe hematologic toxicity after obinutuzumab infusion. Two patients with steroid-dependent nephrotic syndrome developed severe neutropenia (grade 4) at 4-6 weeks after obinutuzumab administration. Both cases were complicated by infections requiring antibiotic therapy, and 1 patient also required granulocyte colony-stimulating factor support. The third child, affected by membranous nephropathy, developed persistent normocytic anemia, necessitating chronic treatment with erythropoiesis-stimulating agents.</div><div>Cytopenia has been described in patients receiving obinutuzumab for the treatment of hematologic malignancies and in subjects with rheumatological conditions. In these conditions, obinutuzumab is often associated with other immune-targeting compounds. Herein, we show that such complication can occur also individuals with glomerular diseases receiving obinutuzumab as the sole treatment. This element should carefully considered when evaluating this treatment, especially for young patients.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 3","pages":"Article 101268"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165835","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":"Gender-related and Age-related Disparities in Prevalence of the Cardiovascular-Kidney-Metabolic Syndrome Among US Adults From 1999-2020: An Analysis of the NHANES Survey","authors":"Zhejia Tian ,&nbsp;Samira Soltani ,&nbsp;Johann Bauersachs ,&nbsp;Kai M. Schmidt-Ott ,&nbsp;Anette Melk ,&nbsp;Bernhard M.W. Schmidt","doi":"10.1016/j.xkme.2025.101234","DOIUrl":"10.1016/j.xkme.2025.101234","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objectives&lt;/h3&gt;&lt;div&gt;The cardiovascular-kidney-metabolic (CKM) syndrome is defined as the intricate interplay among metabolic risks, chronic kidney disease (CKD) and the cardiovascular system. The deteriorating CKM syndrome contributes to untimely morbidity and mortality. We aim to characterize gender- and age-related disparities in the prevalence of CKM syndrome over the last 2 decades.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;A cross-sectional population-based survey.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;A total of 32,848 US adults participating in the NHANES survey from 1999 to 2020.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposures&lt;/h3&gt;&lt;div&gt;Gender, age (18-44, 45-64, and ≥65), and period (1999-2002, 2003-3008, 2009-2014, and 2015-2020).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Prevalence of CKM stages.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical approach&lt;/h3&gt;&lt;div&gt;Sample weights and Taylor series linearization method were applied to estimate prevalence and standard errors representative of the noninstitutionalized US adult population. For trend analysis across cycles, survey-weighted logistic regression was employed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Young women aged &lt; 45 years were classified more often, but with decreasing prevalence, in stages without CKM defining factors (22.7% of women vs 13.5% of men) and more often in stages with cardiovascular organ damage (13.4% of women vs 6.5% of men). Elderly women were increasingly classified in stages with cardiovascular organ damage over the last 20 years, reaching the same prevalence as men in the most recent period (25.3 % [95% CI, 20.0 %-30.6 %] of women vs 30.5 [95% CI, 25.7-35.3%] of men aged &gt; 65 years).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;NHANES data allow for assessing CKM stages with cardiovascular organ damage mainly based on self-reporting during interviews.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;We demonstrate an increasing proportion of women in advanced CKM stages over the last 20 years. Whereas the overrepresentation of younger women in the low-risk stages almost disappeared, elderly women in the last period showed almost the same risk of being in stages with cardiovascular organ damage as elderly men. Our analysis highlights an urgent need of preventive measures especially tailored to women.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-language Summary&lt;/h3&gt;&lt;div&gt;Cardiovascular-kidney-metabolic (CKM) syndrome describes the combined impact of heart, kidney, and metabolic health on overall well-being. We examined its prevalence among US adult population and explored differences between women and men across different age groups, using data from over 32,000 adults collected from 1999 to 2020. The results showed that younger women under 45 years were previously more likely to be in the low-risk group; however, this advantage has declined over the past 20 years. Among older adults (over 65 years), women had a comparable risk to men for organ damage associated with cardiovascular-kid","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 3","pages":"Article 101234"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081234","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":"Open-label Randomized Controlled Trial of Controlled-release Formulation Budesonide in Indian Proteinuric IgA Nephropathy Patients","authors":"Pradeep Das,&nbsp;Arpita Ray Chaudhury,&nbsp;Saugat Dasgupta,&nbsp;Koushik Bhattacharya,&nbsp;Atanu Pal,&nbsp;Dipankar Sircar,&nbsp;Debabrata Sen","doi":"10.1016/j.xkme.2025.101166","DOIUrl":"10.1016/j.xkme.2025.101166","url":null,"abstract":"<div><h3>Introduction</h3><div>IgA nephropathy (IgAN) in India is reported to have an onset at a younger age with faster progression to kidney failure requiring replacement therapy, where safe immunosuppression may improve the outcome. The gut-renal connection and multihit pathogenesis of IgAN targeted by an oral targeted-release formulation of budesonide available in the Western world showed that the molecule is safe and effective. In this study, we aimed to assess the safety and efficacy of oral controlled-release budesonide preparation in Indian patients with IgAN.</div></div><div><h3>Methods</h3><div>We report a single-center open-label randomized controlled trial conducted in a tertiary care hospital in Eastern India, where adult patients with biopsy-proven IgAN with proteinuria &gt; 1 g and estimated glomerular filtration rate (eGFR) &gt; 45 mL/min/1.73 m² were included after they had completed a run-in phase of 6 months with a maximized dose of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker. 53 patients were randomized to the control (26, only therapy angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, standard-of-care [SOC]) and intervention arms (27, 18 mg budesonide daily on top of SOC). The primary outcome was efficacy evaluation in terms of change in proteinuria and eGFR in the intervention arm; secondary outcomes mainly included treatment-emergent adverse events.</div></div><div><h3>Results</h3><div>All baseline parameters, including blood pressure, glycemic status, 24-hour urine protein levels, and eGFR, were comparable in both arms. At the end of 9 months, the mean 24-hour proteinuria was lower (<em>P</em>-value &lt; 0.001) and the mean eGFR was significantly better (<em>P</em>-value &lt; 0.001) in the intervention arm receiving budesonide plus SOC than in the control arm receiving only SOC. The total incidence of treatment-emergent adverse events was similar across both groups.</div></div><div><h3>Conclusions</h3><div>Controlled-release budesonide may be considered an effective and safe disease-specific therapy in Indian patients with IgAN.</div></div><div><h3>Plain-Language Summary</h3><div>The need for safe, effective and cost-friendly immunosuppression for IgA nephropathy in India had inspired this randomized controlled study in a subset of IgAN patients with eGFR &gt;45 ml/min and proteinuria&gt; 1 gm/day, where the intervention arm received 18 mg of controlled released budesonide on top of SOC that includes maximised ACEI /ARB and the other arm received SOC only. Controlled released budesonide was safe and well tolerated and satisfied the need for significant proteinuria reduction and eGFR improvement, the two important surrogate markers of long term outcome in IgA nephropathy. It may be considered as safe cost-friendly alternative of TRF budesonide formulation, proved effective in similar clinical scenario of Western world.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 3","pages":"Article 101166"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326640","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}