Kidney Medicine最新文献

{"title":"Why Not Transplant Nephrology? A Survey of US Nephrology Fellows","authors":"Abhinaya Sridhar ,&nbsp;Kurtis Pivert ,&nbsp;Dinushika Mohottige ,&nbsp;Kirk N. Campbell ,&nbsp;Samira S. Farouk","doi":"10.1016/j.xkme.2025.101003","DOIUrl":"10.1016/j.xkme.2025.101003","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><div>The current transplant nephrology workforce may be inadequate to care for the growing population of kidney transplant recipients, particularly as the United States aims to increase kidney transplantation rates. Although transplant nephrology fellowship programs experience similar challenges as general nephrology programs in filling positions, few studies have explored nephrology fellows’ perspectives on transplant careers. We aimed to describe nephrology fellows’ interest in transplant nephrology careers, training experiences, and potential factors influencing transplant nephrology career interests.</div></div><div><h3>Study Design</h3><div>A cross-sectional survey-based study was conducted among US nephrology fellows.</div></div><div><h3>Setting &amp; Participants</h3><div>An electronic survey was distributed in 2024 to 962 current adult, pediatric, and adult and pediatric nephrology fellows in training via the American Society of Nephrology.</div></div><div><h3>Exposure</h3><div>Prior transplant experiences.</div></div><div><h3>Outcome</h3><div>Responses to survey items.</div></div><div><h3>Analytical Approach</h3><div>Descriptive statistics and a χ² test for independence evaluating relationship between respondents’ transplant rotation experiences and their likelihood of pursuing transplant nephrology.</div></div><div><h3>Results</h3><div>The survey response rate was 45%. 23% (90/393) were somewhat/highly likely to pursue transplant nephrology fellowship. Those less likely to pursue transplant nephrology cited additional training time (66%), inadequate compensation (37%), lifestyle/work-life balance (34%), job availability (23%), and focus on immunology (23%). Free-text responses mentioned challenges with the surgical team as a deterrent. Transplant experiences were similar between those who were likely and those who were not likely to pursue transplant. Of those likely to pursue transplant (n<!--> <!-->=<!--> <!-->90), 19% (17/90) indicated that the introduction of a hypothetical transplant nephrology certification examination would make them not likely to pursue a transplant nephrology career.</div></div><div><h3>Limitations</h3><div>Nonresponse bias.</div></div><div><h3>Conclusions</h3><div>This first survey to assess nephrology fellows’ interest in transplant nephrology careers identified several potential barriers to the lack of interest in transplant nephrology that may serve as areas for intervention in the future.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 6","pages":"Article 101003"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144116044","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":"Primary Care Physicians’ Perspective on SGLT2 Inhibitors for Chronic Kidney Disease","authors":"Sky Wei Chee Koh FCFP ,&nbsp;Ming Yi Lai MBBChir ,&nbsp;Choon Kit Leong FCFP ,&nbsp;Joelle Lam DIP ,&nbsp;Han Shi Jocelyn Chew PhD ,&nbsp;Clara Lee Ying Ngoh FAMS","doi":"10.1016/j.xkme.2025.101002","DOIUrl":"10.1016/j.xkme.2025.101002","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 6","pages":"Article 101002"},"PeriodicalIF":3.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144115997","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":"Hemoadsorption as a Supportive Strategy for Severe Toxicity Associated With Chimeric Antigen Receptor T-Cell Therapy: A Case Series","authors":"Pasquale Esposito ,&nbsp;Massimiliano Gambella ,&nbsp;Elisa Russo ,&nbsp;Anna Maria Raiola ,&nbsp;Elena Beltrametti ,&nbsp;Novella Conti ,&nbsp;Elisa Porcile ,&nbsp;Stefania Bianzina ,&nbsp;Monica Centanaro ,&nbsp;Francesca Viazzi ,&nbsp;Emanuele Angelucci","doi":"10.1016/j.xkme.2025.101001","DOIUrl":"10.1016/j.xkme.2025.101001","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;To describe the use and effects of extracorporeal blood purification with hemoadsorption in managing severe complications after treatment with chimeric antigen receptor T-cells (CAR-T).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Retrospective analysis of a case series.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Hematological department and intensive care unit from a single institution. Patients with hematological cancer who underwent CAR-T therapy between 2021 and 2023, developed severe toxicity, and were treated with hemoadsorption based on clinical indications.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Of 48 patients, extracorporeal blood purification was prescribed to 4 (8.3%): 3 with diffuse large B-cell lymphoma and 1 with mantle cell lymphoma. These patients experienced rapid increases in serum interleukin-6 and ferritin levels after CAR-T infusion, which progressed to severe cytokine release syndrome with hemodynamic instability and multiple-organ toxicity. Despite corticosteroid and anakinra rescue therapy after tocilizumab failure, extracorporeal blood purification with hemoadsorption was initiated at a mean of 5.2&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;1.7 days following CAR-T infusion due to rapid clinical deterioration. The treatment was performed using continuous venovenous hemodiafiltration with an AN69ST hemofilter and a CytoSorb cartridge. One patient died 1&lt;!--&gt; &lt;!--&gt;day after the initiation of blood purification because of concomitant cardiomyopathy progressing to multiple-organ failure. In the 3 surviving patients, interleukin-6 levels significantly decreased (from&lt;!--&gt; &lt;!--&gt;−18% to&lt;!--&gt; &lt;!--&gt;−95%), cytokine release syndrome resolved, and vasoactive support was reduced. Treatment-related complications were not observed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Small sample size, retrospective design, and lack of a predefined hemoadsorption therapy protocol.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;A strategy based on hemoadsorption was safe and effective in mitigating inflammation and improving hemodynamics in patients with hematological cancer treated with CAR-T therapy who developed early severe toxicity.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;div&gt;Chimeric antigen receptor T-cell (CAR-T) therapy may improve remission rates and survival in hematological cancers but can lead to severe side effects, including cytokine release syndrome (CRS). CRS is characterized by systemic inflammation and multiorgan toxicity and is often associated with poor outcomes. Although pharmacological treatments are available, some cases remain refractory. In this study, we share our experience with hemoadsorption as a supportive therapy for severe CRS in CAR-T recipients. Of the 4 patients treated, 3 experienced CRS resolution with reduced inflammation and improved hemodynamic stability, without treatment-related complications. These findings highlight hemoadsorption as a promising adjunctive therapy to pharm","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 6","pages":"Article 101001"},"PeriodicalIF":3.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144115954","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":"Erratum Regarding “Protein Biomarkers and Major Cardiovascular Events in Older People With Advanced CKD: The European Quality (EQUAL) Study” (Kid Med. 2023;6(1):100745)","authors":"","doi":"10.1016/j.xkme.2025.101000","DOIUrl":"10.1016/j.xkme.2025.101000","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 5","pages":"Article 101000"},"PeriodicalIF":3.2,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852023","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":"Empowering Young Adults: Reimagining Peritoneal Dialysis Support","authors":"Caroline M. Hsu ,&nbsp;Ankur D. Shah","doi":"10.1016/j.xkme.2025.100999","DOIUrl":"10.1016/j.xkme.2025.100999","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 5","pages":"Article 100999"},"PeriodicalIF":3.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859689","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":"Effect of Post-Acute Kidney Injury Use of Renin-Angiotensin Inhibitors on Long-term Mortality and Major Adverse Kidney Events: A 5-year Retrospective Observational Cohort Study","authors":"Byorn W.L. Tan ,&nbsp;Bryce W.Q. Tan ,&nbsp;K. Akalya ,&nbsp;Wei-Zhen Hong ,&nbsp;Yi Da ,&nbsp;Sanmay Low ,&nbsp;Wan-Ying Ng ,&nbsp;Horng-Ruey Chua","doi":"10.1016/j.xkme.2025.100996","DOIUrl":"10.1016/j.xkme.2025.100996","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Acute kidney injury (AKI) is common in hospitalized adults and a risk factor for chronic kidney disease and mortality. The effect of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs) post-AKI on mortality and long-term kidney function remains unclear.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Propensity-weighted retrospective observational cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;A total of 3,289 patients with AKI admitted to a tertiary care hospital from November 2015-October 2016, with follow-up until September 2020.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposures&lt;/h3&gt;&lt;div&gt;ACEi/ARB use within 180 days post-AKI.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;All-cause mortality, and major adverse kidney events (MAKE) as defined by composite of renal replacement therapy post-AKI, sustained estimated glomerular filtration rate (eGFR) decline&lt;!--&gt; &lt;!--&gt;&gt;30% from baseline, or eGFR&lt;!--&gt; &lt;!--&gt;≤15&lt;!--&gt; &lt;!--&gt;mL/min/1.73&lt;!--&gt; &lt;!--&gt;m&lt;sup&gt;2&lt;/sup&gt;.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;We generated propensity weights for ACEi/ARB use post-AKI, using age, sex, comorbid conditions, prior medication, intensive care unit admission, severe sepsis, and index AKI Kidney Disease: Improving Global Outcomes severity. Cox proportional hazard models were used to test associations of post-AKI ACEi/ARB with mortality, MAKE, and joint models for eGFR slopes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 2,309 (70.2%) participants died or experienced MAKE by end of follow-up. 161 (4.9%) and 406 (12.3%) patients initiated or resumed prior ACEi/ARB use within 180 days post-AKI, respectively. Although the overall cohort had no significant mortality association with post-AKI ACEi/ARB use, a significant association with lower mortality was observed in patients with KDIGO 3 AKI (HR, 0.40; 95% CI, 0.21-0.75; &lt;em&gt;P&lt;/em&gt;&lt;sub&gt;interaction&lt;/sub&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.003). However, post-AKI ACEi/ARB use was associated with increased MAKE in patients without cardiovascular indications for ACEi/ARB use (HR, 1.52; 95% CI, 1.17-1.98; &lt;em&gt;P&lt;/em&gt;&lt;sub&gt;interaction&lt;/sub&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.03). Although post-AKI use of ACEi/ARB was associated with acute eGFR decline (initial eGFR change&lt;!--&gt; &lt;!--&gt;−2.3&lt;!--&gt; &lt;!--&gt;mL/min/1.73&lt;!--&gt; &lt;!--&gt;m&lt;sup&gt;2&lt;/sup&gt;/year; 95% CI, −3.1 to&lt;!--&gt; &lt;!--&gt;−1.5; &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.001), no association with longer-term eGFR decline was observed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Retrospective observational study on heterogeneous AKI cohort without data on ACEi/ARB cumulative exposure.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Early ACEi/ARB post-AKI was not associated with better long-term survival or kidney function but was associated with lower mortality in patients with KDIGO 3 AKI.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;div&gt;Acute kidney injury (AKI) is common in hospitalized adults and increases the risk of death and kidney failure. Although ang","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 5","pages":"Article 100996"},"PeriodicalIF":3.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854533","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 Injury Secondary to Pegylated Liposomal Doxorubicin-Associated Renal-limited Thrombotic Microangiopathy","authors":"Tarek S. Karam ,&nbsp;Mrinalini Sarkar ,&nbsp;Jonathan E. Zuckerman","doi":"10.1016/j.xkme.2025.100998","DOIUrl":"10.1016/j.xkme.2025.100998","url":null,"abstract":"<div><div>The emergence of pegylated liposomal doxorubicin (PLD) as a preferred treatment for various malignancies, because of its reduced cardiotoxicity compared with conventional doxorubicin, has raised significant interest. However, the association between PLD and thrombotic microangiopathy (TMA) remains a concerning and relatively rare complication. Here, we present the case of an 80-year-old man with metastatic Kaposi sarcoma who underwent extended PLD monotherapy, subsequently developing kidney-limited TMA demonstrated on kidney biopsy. This led to acute kidney injury necessitating hemodialysis. The patient’s clinical history, laboratory, and kidney biopsy data supported PLD chemotherapy as the primary etiologic factor for the observed kidney-limited TMA, an insidious condition with poor prognosis. This report highlights the need for vigilance and early kidney biopsy in patients with rising serum creatinine concentrations or worsening proteinuria/hematuria during PLD therapy. Understanding the mechanisms underlying PLD-induced TMA, likely involving reactive oxygen species-mediated endothelial dysfunction and platelet aggregation, remains a crucial area for future research to optimize monitoring and management strategies for this rare yet severe complication associated with PLD therapy.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 5","pages":"Article 100998"},"PeriodicalIF":3.2,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855305","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":"Vascular Access Thrombosis Events in Patients With Dialysis-Dependent CKD Treated With Vadadustat or Darbepoetin Alfa: The INNO2VATE Trial Program","authors":"Wolfgang C. Winkelmayer ,&nbsp;Steven K. Burke ,&nbsp;Glenn M. Chertow ,&nbsp;Kai-Uwe Eckardt ,&nbsp;Wenli Luo ,&nbsp;Todd Minga ,&nbsp;Mark J. Sarnak ,&nbsp;Prabir Roy-Chaudhury","doi":"10.1016/j.xkme.2025.100997","DOIUrl":"10.1016/j.xkme.2025.100997","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;In the global phase 3 INNO&lt;sub&gt;2&lt;/sub&gt;VATE program of patients with dialysis-dependent chronic kidney disease (DD-CKD) and CKD-related anemia (2 trials: patients new to [NCT02865850] and established on maintenance dialysis [NCT02892149]), vadadustat was noninferior to the erythropoiesis-stimulating agent darbepoetin alfa for cardiovascular safety and hemoglobin efficacy. Here, we investigated between-group differences in positively adjudicated vascular access thrombosis (VAT) events.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Phase 3, global, open-label, randomized, active-controlled clinical trials.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;A total of 3,902 patients who initiated dialysis within the past 16 weeks (incident DD-CKD trial; N&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;365) or who had been treated with dialysis for&lt;!--&gt; &lt;!--&gt;&gt;12 weeks (prevalent DD-CKD trial; N = 3,537).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Intervention&lt;/h3&gt;&lt;div&gt;Eligible patients randomized 1:1 to vadadustat or darbepoetin alfa.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Positively adjudicated VAT events.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;In the INNO&lt;sub&gt;2&lt;/sub&gt;VATE program, at baseline, 3,590 (92.0%) randomized patients were receiving hemodialysis: 2,709 (69.4%) via an arteriovenous fistula and 340 (8.7%) via an arteriovenous graft. During 6,468 patient-years (PY) of follow-up, there were 426 positively adjudicated VAT events in 266 individual patients, with 146 randomized to vadadustat and 120 randomized to darbepoetin alfa. Corresponding first VAT rates were 4.79 and 3.86 per 100 PY, respectively (rate difference, 0.94; 95% CI, −0.10 to 1.97; hazard ratio [HR], 1.27; 95% CI, 0.99-1.62). When considering first and recurrent events, VAT rates were 6.58 and 6.59 per 100 PY for the vadadustat and darbepoetin alfa groups, respectively (rate difference, −0.01; 95% CI, −1.26 to 1.24; HR, 1.00; 95% CI, 0.83-1.21).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Trials were not specifically designed to assess VAT rates; uncertain generalizability to nontrial populations.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;In this secondary analysis of the INNO&lt;sub&gt;2&lt;/sub&gt;VATE program in patients with DD-CKD and CKD-related anemia receiving hemodialysis, first VAT rates were numerically higher among patients treated with vadadustat versus darbepoetin alfa but statistically not different. The rates of first and recurrent VAT events were similar between treatment groups.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;The phase 3 INNO&lt;sub&gt;2&lt;/sub&gt;VATE program studied patients with dialysis-dependent chronic kidney disease (CKD) and CKD-related anemia in 2 trials: one enrolled patients new to dialysis (365 patients) and another studied patients who had been treated with dialysis for at least 3 months (3,537 patients). In terms of cardiovascular safety and ability to treat CKD-related anemia, vadadustat and darbepoetin alfa were not meaningfully different. This analysis al","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 5","pages":"Article 100997"},"PeriodicalIF":3.2,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855200","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":"Effect of a Population Health Management Intervention on Medication Therapy Problems in People With Chronic Kidney Disease: Post Hoc Analysis of the K-CHAMP Cluster-Randomized Trial","authors":"Melanie R. Weltman ,&nbsp;Zhuoheng Han ,&nbsp;Linda-Marie U. Lavenburg ,&nbsp;Alaa A. Alghwiri ,&nbsp;Jonathan G. Yabes ,&nbsp;Thomas D. Nolin ,&nbsp;Manisha Jhamb","doi":"10.1016/j.xkme.2025.100995","DOIUrl":"10.1016/j.xkme.2025.100995","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Medication therapy problems (MTPs) are therapeutic issues related to medications that may cause undesirable events. People with chronic kidney disease (CKD) are at high risk of experiencing MTPs owing to comorbid conditions and medication burden. This study characterizes MTPs in individuals enrolled in the Kidney Coordinated Health Management Partnership trial and evaluates the intervention’s effect on MTPs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Post hoc analysis of a pragmatic, cluster-randomized trial.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Individuals aged 18-85 years with an estimated glomerular filtration rate of&lt;!--&gt; &lt;!--&gt;&lt;60&lt;!--&gt; &lt;!--&gt;mL/min/1.73&lt;!--&gt; &lt;!--&gt;m&lt;sup&gt;2&lt;/sup&gt;, moderate to high risk of CKD progression, and not seeing a nephrologist enrolled from 101 primary care practices (May 2019 to November 2021).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Intervention(s)&lt;/h3&gt;&lt;div&gt;Electronic health record-based multidisciplinary care including nephrology e-consult, pharmacist medication review, and patient education at baseline and every 6 months.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;MTP type and frequency of occurrence were characterized along with associated medication classes. Descriptive statistics of MTPs were conducted, and cumulative probabilities of resolution over time were estimated using the discrete-time survival method.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Baseline medication reviews were completed by telephone (52%) or chart review (48%) in 730 out of 754 (97%) intervention-arm participants (mean age, 74&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;9 years and estimated glomerular filtration rate, 37&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;8&lt;!--&gt; &lt;!--&gt;mL/min/1.73&lt;!--&gt; &lt;!--&gt;m&lt;sup&gt;2&lt;/sup&gt;). Polypharmacy was evident in 63% of participants. At baseline, 78% had MTPs and 79% had medication discrepancies. The most common MTP was indication without drug therapy, associated with sodium-glucose cotransporter-2 (SGLT-2) inhibitors. The average number of MTPs per participant decreased from 2.01 at baseline to 1.28 at 6 months (36% reduction), and 1.15 at 12 months (43% reduction). Based on the discrete-time survival model, an estimated 92% of MTPs were resolved by 12 months.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Medication management was not completed for control-arm participants. No standardized tool was used to assess medication adherence. We relied on electronic health record chart review to identify MTPs in participants who could not be reached by telephone.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;MTPs and medication discrepancies are highly prevalent in nondialysis-dependent CKD. Medication management through multidisciplinary team care can optimize medication therapy in CKD.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;People with chronic kidney disease (CKD) are at risk of experiencing medication therapy problems (MTPs), which are issues related to medications that may cause undesirable events. In this study, we chara","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 5","pages":"Article 100995"},"PeriodicalIF":3.2,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855199","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":"Genetic Testing in Biopsy-Confirmed Kidney Disease","authors":"Insa M. Schmidt MD, MPH ,&nbsp;Ashish Verma MBBS ,&nbsp;Sophie E. Claudel MD ,&nbsp;Ragnar Palsson MD ,&nbsp;Anand Srivastava MD, MPH ,&nbsp;Isaac E. Stillman MD ,&nbsp;Laurence H. Beck Jr. MD, PhD ,&nbsp;Sushrut S. Waikar MD, MPH","doi":"10.1016/j.xkme.2025.100994","DOIUrl":"10.1016/j.xkme.2025.100994","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 5","pages":"Article 100994"},"PeriodicalIF":3.2,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852022","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}