Kidney Medicine最新文献

{"title":"Patient-Reported Outcome Measures in CKD-Associated Pruritus: A Systematic Review.","authors":"Linyu Bai, Jia Shi, Xiaogang Du","doi":"10.1016/j.xkme.2025.101055","DOIUrl":"10.1016/j.xkme.2025.101055","url":null,"abstract":"<p><p>Chronic kidney disease-associated pruritus (CKD-aP) is a common and burdensome dermatologic condition in which patients can experience various symptoms. This study aimed to summarize and describe the patient-reported outcomes (PROs) and patient-reported outcome measures (PROMs) used in CKD-aP studies over the past 5 years. A total of 99 studies were identified, which included 5 different PROs and 40 different PROMs. The most frequently evaluated PRO was pruritus (n = 99), followed by health-related quality of life (HRQoL) (n = 31), sleep disturbances (n = 12), psychiatric symptoms (n = 7), and other skin symptoms (n = 5). Among the 40 different PROMs, 19 were generic, 18 were skin-specific, and 3 were CKD-specific. The most commonly used PROMs in the PROs of pruritus, HRQoL, sleeping, and psychiatric symptoms were the visual analog scale (n = 47), dermatological life quality index (n = 8), Pittsburgh sleep quality index (n = 7), and Beck depression inventory (n = 3), respectively. The PROs and PROMs are common and effective tools for evaluating CKD-aP, but more high-quality studies and guidelines are needed to reach a clear consensus on their application.</p>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 8","pages":"101055"},"PeriodicalIF":3.4,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12311519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760444","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":"Assessing Caregiver Burden in Kidney Failure: A Systematic Review of Measurement Properties of Instruments","authors":"Ravi Shankar ,&nbsp;Eunice Wei Xin Lee ,&nbsp;Nan Luo ,&nbsp;Priyanka Khatri ,&nbsp;Leanne Leong ,&nbsp;Amartya Mukhopadhyay ,&nbsp;Horng-Ruey Chua ,&nbsp;Wei-Zhen Hong","doi":"10.1016/j.xkme.2025.101054","DOIUrl":"10.1016/j.xkme.2025.101054","url":null,"abstract":"<div><div>Caregiver burden in end-stage kidney disease requires assessment using validated instruments. This systematic review evaluated measurement properties of caregiver burden instruments in end-stage kidney disease using Consensus-Based Standards for the Selection of Health Measurement Instruments methodology. We searched 8 databases (PubMed, CINAHL, Embase, Web of Science, MEDLINE, Cochrane Library, Scopus, and PsycINFO) for studies evaluating measurement properties of caregiver burden instruments in caregivers of patients with kidney failure. The Consensus-Based Standards for the Selection of Health Measurement Instruments Risk of Bias checklist assessed methodological quality, and Grading of Recommendations Assessment, Development and Evaluation approach evaluated evidence quality. Twenty-four studies evaluating 21 distinct caregiver burden instruments were included. The Zarit Burden Interview, Caregiver Burden Scale, and Beck Depression Inventory were most frequently evaluated. Only a few instruments had high-quality evidence of sufficient content validity, internal consistency, test-retest reliability, and construct validity. Cross-cultural validity was assessed for only 9 instruments, with most rated as indeterminate owing to methodological limitations. No studies evaluated responsiveness to change over time. Quality of evidence was low to very low for most measurement properties, highlighting significant gaps in validation research. The Zarit Burden Interview, Caregiver Burden Scale, and Beck Depression Inventory show promising validity and reliability but require further testing. Rigorously conducted validation studies, involvement of caregivers of patients with kidney failure in content validation, and cross-cultural adaptations are priorities for optimizing burden assessment in this unique population.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 9","pages":"Article 101054"},"PeriodicalIF":3.4,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144821952","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":"Obinutuzumab, an Anti-CD20, in Refractory Adult Autoimmune Podocytopathies: Report of 2 Cases","authors":"Thomas Loeffler ,&nbsp;Adrien Flahault ,&nbsp;Asma Alla ,&nbsp;Luc Frimat ,&nbsp;Raphaël Kormann","doi":"10.1016/j.xkme.2025.101057","DOIUrl":"10.1016/j.xkme.2025.101057","url":null,"abstract":"<div><div>Autoimmune podocytopathies can represent a therapeutic challenge in the case of frequently relapsing nephrotic syndrome leading to steroid dependence or steroid resistance. Rituximab is an effective treatment option, but allergic reactions or resistance to treatment are frequent. The first case describes a 32-year-old man with corticosteroid-dependent nephrotic syndrome since childhood. After multiple relapses and treatments with cyclosporine, mycophenolate mofetil, and rituximab, a third rituximab treatment led to life-threatening laryngospasm, contraindicating its further use. A treatment with obinutuzumab sustained remission, without additional immunosuppressive treatment, still maintained after 36 months of follow-up. The second case involves a 42-year-old man with nephrotic syndrome, kidney failure, and severe hypertension. A first biopsy showed minimal change disease, whereas a second biopsy found focal segmental glomerulosclerosis lesions. Despite treatments with corticosteroids, cyclosporine, and rituximab, he required hemodialysis. A few years later, he received his first kidney transplant. A relapse was diagnosed at day 3 posttransplantation. Obinutuzumab treatment led to significant improvement in kidney function and sustained remission of the nephrotic syndrome, without relapse 2 years after this treatment. Obinutuzumab could therefore provide a safe and effective alternative to these patients with allergic reactions or resistance to rituximab.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 9","pages":"Article 101057"},"PeriodicalIF":3.4,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886477","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":"Pretransplant Serum Creatinine in Peritoneal Dialysis Patients Predicts Graft Outcomes","authors":"Faisal Jarrar ,&nbsp;Karthik K. Tennankore ,&nbsp;Ngan N. Lam ,&nbsp;David A. Clark ,&nbsp;Bryce A. Kiberd ,&nbsp;Amanda J. Vinson","doi":"10.1016/j.xkme.2025.101056","DOIUrl":"10.1016/j.xkme.2025.101056","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><div>Although peritoneal dialysis (PD) as a pretransplant dialysis modality is associated with favorable outcomes after kidney transplant, it is unknown if pretransplant serum creatinine (Scr) level is associated with subsequent graft outcomes in candidates managed with PD. Our objective was to examine the association between Scr at the time of transplant and short-term and long-term outcomes posttransplant.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting &amp; Participants</h3><div>A total of 20,166 adult (≥18 years of age) patients who were receiving PD at the time of a first living or deceased donor kidney transplant in the United States between 2000 and 2017, identified using the Scientific Registry of Transplant Recipients database.</div></div><div><h3>Exposures</h3><div>Primary exposure was final Scr level before transplant, categorized as<!--> <!-->&lt;5, 5-8, 8-12, and<!--> <!-->&gt;12<!--> <!-->mg/dL. Sensitivity analyses for patient subgroups included recipient age (≥50 vs<!--> <!-->&lt;50 years) and dialysis vintage (≥3 vs<!--> <!-->&lt;3 years) at transplant.</div></div><div><h3>Outcomes</h3><div>The primary outcome was death-censored graft loss (DCGL). Secondary outcomes included all-cause graft loss and delayed graft function (DGF).</div></div><div><h3>Results</h3><div>Pretransplant Scr was significantly associated with DCGL (adjusted HR, 1.17; 95% CI, 1.02-1.34 for Scr<!--> <!-->&gt;12<!--> <!-->mg/dL [reference<!--> <!-->&lt;5<!--> <!-->mg/dL]) and DGF (adjusted OR, 2.71; 95% CI, 2.26-3.26 for Scr<!--> <!-->&gt;12<!--> <!-->mg/dL [reference<!--> <!-->&lt;5<!--> <!-->mg/dL]). There was no association with all-cause graft loss. The risk of DCGL and DGF associated with high pretransplant Scr was higher for those who were older (≥50 years) and those with longer dialysis vintage (≥3 years).</div></div><div><h3>Limitations</h3><div>No access to potential predictors of pretransplant Scr including residual kidney function, dialysis adequacy and adherence; exact timing of Scr values pretransplant was unknown.</div></div><div><h3>Conclusions</h3><div>To our knowledge, this is the first study to explore the association between pretransplant Scr level in PD patients and graft outcomes after kidney transplantation. The reason for this increased risk is unclear but may reflect reduced residual kidney function, among other factors.</div></div><div><h3>Plain-Language Summary</h3><div>Kidney transplantation is a life-saving procedure and is associated with improved survival for people living with kidney failure. However, kidney transplants may fail during the lifetime of transplant recipients. Identifying treatable factors that contribute to kidney transplant failure before transplantation is important. Many of these factors relate to dialysis before transplantation. Therefore, our study examined whether creatinine level before transplantation in peritoneal di","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 9","pages":"Article 101056"},"PeriodicalIF":3.4,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817048","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":"The Case of the Terribly Treatable Tumors! A Case Report","authors":"Nisha Jose ,&nbsp;Manish Lalwani ,&nbsp;Goldwin H ,&nbsp;Rijo Issac ,&nbsp;Elanthenral Sigamani ,&nbsp;Abimanesh S ,&nbsp;Jeethu Joseph Eapen ,&nbsp;Santosh Varughese","doi":"10.1016/j.xkme.2025.101058","DOIUrl":"10.1016/j.xkme.2025.101058","url":null,"abstract":"<div><div>Genitourinary tuberculosis manifests several years after infection with tuberculosis. It presents with fever, pyuria, weight loss, and loss of appetite. Urine cultures are typically sterile. Within the urinary system it presents with fibrosis and stricture formation. The renal manifestation involves granulomatous interstitial nephritis with or without chronic kidney disease. Renal pseudotumors are a very infrequent manifestation of tuberculosis, which can lead to unnecessary nephrectomies. This case report describes a patient with this odd manifestation of tuberculosis.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 9","pages":"Article 101058"},"PeriodicalIF":3.4,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886501","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":"Acute Kidney Failure in Limited Scleroderma Reveals Anti-GBM--Associated Kidney Disease","authors":"Keya Panchal ,&nbsp;Julian Peng ,&nbsp;Hameed Ahmad ,&nbsp;Jignesh Shah","doi":"10.1016/j.xkme.2025.101053","DOIUrl":"10.1016/j.xkme.2025.101053","url":null,"abstract":"<div><div>Although scleroderma renal crisis (SRC) is the most common form of kidney injury in patients with scleroderma, consideration of other autoimmune conditions is warranted in patients with atypical presentation. A 27-year-old woman with a history of limited scleroderma presented to the hospital with 1 month of uremic symptoms and oliguria. Initial laboratory tests revealed significantly elevated serum urea nitrogen and creatinine levels, suggesting kidney failure. Suspicion for SRC was low, and kidney biopsy was performed to evaluate further. Histopathology revealed severe diffuse crescentic glomerulonephritis involving almost all glomeruli. Immunofluorescence revealed a diffuse linear reaction for immunoglobulin G along capillary loop basement membranes, consistent with antiglomerular basement membrane (GBM) disease. Further work-up revealed a positive antineutrophil cytoplasmic antibody panel for antimyeloperoxidase antibodies. Anti-GBM levels were also elevated. Treatment for anti-GBM disease was not warranted in our patient as the severity of kidney injury histopathology suggested unlikely kidney recovery. She was initiated on outpatient dialysis, and discussion regarding kidney transplant was initiated. There is a rare association between scleroderma and anti-GBM disease. Anti-GBM disease should be considered in scleroderma patients presenting with acute kidney failure with atypical features for SRC, especially if they have a history of antineutrophil cytoplasmic antibody positivity.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 9","pages":"Article 101053"},"PeriodicalIF":3.4,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817047","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":"RECOVID: Retrospective Observational Study of Renal Outcomes and Long-Term Mortality in Patients With COVID-19-Associated AKI, A Comparison Between Vaccinated and Unvaccinated Patients","authors":"Niloofar Nobakht ,&nbsp;Charley Jang ,&nbsp;Tristan Grogan ,&nbsp;Peter Fahim ,&nbsp;Ira Kurtz ,&nbsp;Joanna Schaenman ,&nbsp;James Wilson ,&nbsp;Mohammad Kamgar ,&nbsp;RECOVID Investigators","doi":"10.1016/j.xkme.2025.101020","DOIUrl":"10.1016/j.xkme.2025.101020","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><div>Acute kidney injury (AKI) is a common complication in patients with Coronavirus disease-2019 (COVID-19) infections, with rates as high as 32% to 46%, and it has been associated with poor outcomes. However, the long-term renal and survival outcomes among hospitalized patients with COVID-19 and AKI are not fully understood.</div></div><div><h3>Study Design</h3><div>A single-center cohort study.</div></div><div><h3>Setting &amp; Participants</h3><div>Total of 972 adult patients admitted with COVID-19 infection and AKI at a single large urban academic medical center from March 1, 2022, to March 30, 2022. Among these, 411 (42.3%) did not receive a dose of a US FDA-approved COVID-19 vaccine, and 467 (48.0%) had completed the primary vaccine series.</div></div><div><h3>Exposure</h3><div>Patients admitted with COVID-19 infection and AKI were analyzed using vaccination status as the exposure. Additional exposures included demographics, comorbid conditions, and need for continuous renal replacement therapy (CRRT) during hospitalization.</div></div><div><h3>Outcome</h3><div>The primary outcome was in-hospital mortality. Secondary outcomes included long-term mortality, length of hospital stay, and the need for renal replacement therapy (RRT) at discharge.</div></div><div><h3>Analytical Approach</h3><div>The vaccinated and unvaccinated cohorts were characterized using descriptive analyses. The cohorts were analyzed using the Kaplan-Meier method and groups were compared using the log-rank test. Multivariable cox, logistic, and linear regression models were used for mortality, RRT status at discharge, and length of stay, respectively.</div></div><div><h3>Results</h3><div>Among 3,527 hospitalized patients with a COVID-19 infection, AKI occurred in 972 patients. Of the 972 patients with AKI, 411 (42.3%) did not receive a dose of a US FDA-approved COVID-19 vaccine and 467 (48.0%) had completed the primary vaccine series. Unvaccinated patients had a higher rate of requiring CRRT during their hospitalization compared with vaccinated patients (15.8% vs 10.9%, <em>P</em> <!-->=<!--> <!-->0.03). The CRRT during hospitalization was significantly associated with in-hospital death (adjusted HR 2.82; 95% CI, 1.88-4.25) and long-term follow-up death (adjusted HR 2.44; 95% CI, 1.73-3.42). Unvaccinated patients also had a 2.56 (95% CI, 1.52-4.30) times higher odds of being discharged on RRT when compared with those who were vaccinated. In an adjusted multivariable analysis, those who were unvaccinated had both significantly increased in-hospital mortality (adjusted HR 5.54; 95% CI, 3.36-9.13) and long-term follow-up mortality (adjusted HR 4.78; 95% CI, 3.39-6.73) when compared with those who were vaccinated.</div></div><div><h3>Limitations</h3><div>There was a lack of data on the ventilation status and other indicators of infection severity in patients in intensive care unit who received CRRT. In addition, data on booster COVID-19 v","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 7","pages":"Article 101020"},"PeriodicalIF":3.2,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321804","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 U-Shaped Relationship Between Blood Manganese Levels and Anemia in Patients With CKD: A Cross-Sectional Analysis from National Health and Nutrition Examination Survey 2015 to 2018.","authors":"Chunjie Jiang, Junlin Yi, Jiahui Lai, Luona Wen, Xiaoshi Zhong, Rongshao Tan, Yun Liu","doi":"10.1016/j.xkme.2025.101050","DOIUrl":"10.1016/j.xkme.2025.101050","url":null,"abstract":"<p><strong>Rationale & objective: </strong>A complex relationship exists between blood manganese (Mn) and hemoglobin concentrations in patients with chronic kidney disease (CKD), with associations observed in patients not treated with dialysis and those on maintenance hemodialysis. This study aimed to elucidate this relationship using a large sample of adult patients with CKD from the National Health and Nutrition Examination Survey (NHANES) database.</p><p><strong>Study design: </strong>This was a across-sectional study.</p><p><strong>Setting & study populations: </strong>We included data of 1,016 adult patients with CKD from the NHANES database between 2015 and 2018.</p><p><strong>Exposure: </strong>We included participants with CKD who were aged ≥18 years, not pregnant, and had available data on hemoglobin, Mn levels, and other relevant covariates.</p><p><strong>Outcomes: </strong>Hemoglobin and blood Mn levels in patients with CKD.</p><p><strong>Analytical approach: </strong>Whole-blood Mn concentrations were analyzed using quadrupole inductively coupled plasma mass spectrometry. The statistical analyses included univariate and multivariate linear and binary logistic regression models, along with generalized additive models and smooth curve fitting to explore nonlinearity, which was further examined using a 2-piece-wise linear regression model.</p><p><strong>Results: </strong>After adjusting for age; sex; race/ethnicity; body mass index; smoking status; and levels of albumin, creatinine, ferritin, and transferrin receptor, a nonlinear (U-shaped) association was observed between Mn levels and anemia risk (<i>P</i> < 0.001 for nonlinearity). Specifically, lower Mn levels (<194.2 nmol/L) were negatively associated with anemia (OR, 0.984; 95% CI, 0.979-0.990; <i>P</i> < 0.001), whereas higher Mn levels (>194.2 μmol/L) showed a positive association (OR, 1.006; 95% CI, 1.001-1.011; <i>P</i> = 0.021).</p><p><strong>Limitations: </strong>Even with multivariate model analysis, we failed to establish a causal relationship between Mn levels and anemia in patients with CKD.</p><p><strong>Conclusions: </strong>These findings suggest that Mn may have a dual role in the pathophysiology of anemia in patients with CKD.</p>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 8","pages":"101050"},"PeriodicalIF":3.4,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12304937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753712","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":"Effects of Podocyte Foot Process Effacement on Kidney Prognosis and Response to Immunosuppressive Therapy in IgA Nephropathy.","authors":"Yingman Guo, Yali Ren, Sufang Shi, Suxia Wang, Xujie Zhou, Lijun Liu, Jicheng Lv, Li Zhu, Hong Zhang","doi":"10.1016/j.xkme.2025.101049","DOIUrl":"10.1016/j.xkme.2025.101049","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Recent studies have proposed that podocyte lesions within segmental glomerulosclerosis (S1) lesions are associated with kidney prognosis in immunoglobulin A nephropathy (IgAN). However, there is a lack of research exploring the effect of podocyte lesions through electron microscopy, which is currently regarded as the best power tool for evaluating podocyte injury, on kidney prognosis and response to immunosuppressive therapy (IST).</p><p><strong>Study design: </strong>An observational cohort study.</p><p><strong>Setting & participants: </strong>Total of 976 patients with IgAN and at least 12 months of follow-up at Peking University First Hospital.</p><p><strong>Exposure: </strong>Different foot process effacement (FPE) severity evaluated by electron microscopy: mild: <50%, moderate: 50%-74%, and severe: ≥75%.</p><p><strong>Outcome: </strong>A composite kidney outcome of a 50% reduction in the estimated glomerular filtration rate or end-stage kidney disease.</p><p><strong>Analytical approach: </strong>Cox proportional hazard models.</p><p><strong>Results: </strong>Moderate and severe FPE were independent risk factors for kidney outcome in overall cohort (severe: HR, 1.85; 95% CI, 1.22-2.80; <i>P</i> = 0.004; moderate: HR, 1.62; 95% CI, 1.00-2.62; <i>P</i> = 0.048; <i>P</i>-trend = 0.002). Patients with moderate FPE had a significantly increased risk of worse kidney outcome among those without IST (HR, 3.04; 95% CI, 1.52-6.09; <i>P</i> = 0.002), with risk being significantly reduced in those with IST (HR, 1.06; 95% CI, 0.51-2.23; <i>P</i> = 0.87). However, severe FPE was an independent risk factor for kidney prognosis in patients with IgAN regardless of receiving IST (without IST: HR, 2.13; 95% CI, 0.97-6.09; <i>P</i> = 0.06; with IST: HR, 1.80, 95% CI, 1.08-2.98; <i>P</i> = 0.02). The reclassification ability of the model was significantly improved with 1.7% of integrated discrimination improvements (95% CI, 0.1%-5.2%) and 0.37 of continuous net reclassification improvement (95% CI, 0.14-0.62) when integrating FPE into the International IgAN Prediction Tool.</p><p><strong>Limitations: </strong>A single-center observational study, selection bias, and unmeasured confounders.</p><p><strong>Conclusions: </strong>Moderate and severe FPE were independent risk factors affecting kidney prognosis in patients with IgAN. Podocyte injury evaluated by electron microscopy had important clinical value in IgA nephropathy.</p>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 8","pages":"101049"},"PeriodicalIF":3.4,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12309955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753717","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":"Gender-affirming Hormone Therapy and Changes in Kidney Function in Adults: A Retrospective Population-based Study.","authors":"Silvia J Leon, Thomas W Ferguson, Reid Whitlock, Clara Bohm, Paul Komenda, Claudio Rigatto, Navdeep Tangri, Nathalie Saad, Ted Jablonski, Kathleen Moncrieff, Sofia B Ahmed, Raymond Fung, Tehmina Ahmad, Ron Wald, Bikrampal Sidhu, Christine White, Rachel Bond, Louis Bondaz, Annie-Claire Nadeau-Fredette, Irena Druce, Gregory L Hundemer, Laci Williams, Karthik Tennankore, Marshall Dahl, Adeera Levin, Anna Rogers, Adam Burgess, Emily Christie, David Collister","doi":"10.1016/j.xkme.2025.101051","DOIUrl":"10.1016/j.xkme.2025.101051","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Gender-affirming hormone therapy (GAHT) modifies lean body mass and body fat but its impact on kidney function is uncertain. We sought to evaluate the association of GAHT with kidney function and clinical outcomes.</p><p><strong>Study design: </strong>A retrospective observational cohort study using linked health administrative databases.</p><p><strong>Setting & participants: </strong>Transgender and gender diverse (TGD) adults in Manitoba, Canada from January 1, 2007, to March 31, 2018.</p><p><strong>Exposure: </strong>GAHT or no GAHT prescriptions.</p><p><strong>Outcomes: </strong>The primary outcome was the change in serum creatinine levels. Secondary outcomes included the change in urine albumin-to-creatinine ratio, incident acute kidney injury, chronic kidney disease, and hypertension.</p><p><strong>Analytical approach: </strong>Outcomes were assessed for up to 2 years. Participants were censored at 3 months post-GAHT prescription if it was not refilled. Outcomes between TGD adults treated with and without GAHT (stratified by sex assigned at birth) were compared using multivariable linear regression and Cox proportional hazards models.</p><p><strong>Results: </strong>We identified 396 TGD adults assigned female at birth (AFAB) (277 receiving GAHT) and 322 TGD adults assigned male at birth (AMAB) (240 receiving GAHT) with longitudinal kidney function measurements. In AFAB persons treated with GAHT compared with no GAHT, serum creatinine levels increased from baseline at 18 months (+7.0 μmol/L, 95% CI, 0.5-14) and 21 months (+10.7 μmol/L, 95% CI, 3-18) but not at any other time point including 24 months. There were no differences in changes in creatinine in AMAB persons treated with GAHT compared with no GAHT. AFAB and AMAB persons initiating GAHT had no significant increased risks of incident chronic kidney disease or hypertension.</p><p><strong>Limitations: </strong>Limited sample size, missing data, and residual confounding.</p><p><strong>Conclusions: </strong>GAHT is associated with an increase in serum creatinine levels in AFAB persons. Additional research is needed to further evaluate the effect of GAHT on kidney function.</p>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 8","pages":"101051"},"PeriodicalIF":3.4,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12309945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753719","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}