Kidney Medicine最新文献

{"title":"Chimeric Antigen Receptor (CAR) T-Cell Therapy Use in Patients with Multiple Myeloma and Kidney Failure on Maintenance Hemodialysis: A Report of 2 Cases","authors":"Wai Lun Will Pak ,&nbsp;Natalie A. Brumwell ,&nbsp;Charlene C. Kabel ,&nbsp;Victoria Gutgarts ,&nbsp;Insara Jaffer Sathick ,&nbsp;Sham Mailankody ,&nbsp;Alexander M. Lesokhin ,&nbsp;Heather J. Landau ,&nbsp;Aisha Shaikh","doi":"10.1016/j.xkme.2024.100856","DOIUrl":"10.1016/j.xkme.2024.100856","url":null,"abstract":"<div><p>Chimeric antigen receptor (CAR) T-cell therapy against B-cell maturation antigen is a new treatment modality for relapsed or refractory multiple myeloma (MM). Patients with kidney failure and MM were excluded from the pivotal CAR T-cell therapy clinical trials: KaRMMa (idecabtagene vicleucel) and CARTITUDE (ciltacabtagene autocleucel). The safety and efficacy of CAR T-cell therapy in patients with relapsed or refractory MM and kidney failure are limited to a few case reports using idecabtagene vicleucel. Here, we report the first 2 cases of ciltacabtagene autoleucel use in patients with kidney failure on maintenance hemodialysis and relapsed or refractory MM. Both patients achieved a hematologic response following ciltacabtagene autoleucel administration without serious adverse events. These findings suggest that ciltacabtagene autoleucel may be safe and effective in patients with relapsed or refractory MM and kidney failure. In this report, we review the available literature regarding the use of CAR T-cell therapy in patients with MM and kidney failure. We also discuss the modification of the lymphodepletion regimen in the kidney failure setting.</p></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000670/pdfft?md5=c328862153c55c26af4d73907a956882&pid=1-s2.0-S2590059524000670-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141403513","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":"Primary Cilia Elongation in Early-Onset Polycystic Kidney Disease with 2 Hypomorphic PKD1 Alleles: A Case Report","authors":"Yohei Taniguchi ,&nbsp;Kenichiro Miura ,&nbsp;Yoko Shira ,&nbsp;Takuya Fujimaru ,&nbsp;Eisei Sohara ,&nbsp;Yutaka Yamaguchi ,&nbsp;Motoshi Hattori","doi":"10.1016/j.xkme.2024.100857","DOIUrl":"10.1016/j.xkme.2024.100857","url":null,"abstract":"<div><p>Recent studies have described several children with very early-onset polycystic kidney disease (PKD) that mimicked autosomal recessive polycystic kidney disease because of 2 hypomorphic <em>PKD1</em> gene variants. However, no reports have described pathological changes in the primary cilia in these cases. We analyzed the primary cilia in the kidney tubules of an early elementary school child who had very early-onset PKD and a history of large, echogenic kidneys in utero. There was no family history of autosomal dominant PKD. The patient developed kidney failure and received a living-donor kidney transplant from his father. Genetic analysis revealed compound heterozygous variants in the <em>PKD1</em> gene: c.3876C&gt;A (p. Phe1292Leu) and c.5957C&gt;T (p. Thr1986Met). These variants were likely pathogenic based on in silico analysis. The absence of kidney cysts in the parents suggested that these variants were hypomorphic alleles. Pathological examination of the patient’s excised kidney showed prominent dilatation of the proximal and distal tubules. Immunofluorescence staining for α-tubulin showed pronounced elongation of the primary cilia. These findings suggest that the hypomorphic <em>PKD1</em> variants expressed in this patient with very early-onset PKD were pathogenic.</p></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000682/pdfft?md5=14d7d49a642fea3dbe22d4e7cc242fb0&pid=1-s2.0-S2590059524000682-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141411040","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":"Improving Kidney Health Knowledge for Acute Kidney Injury Survivors: A Multidisciplinary AKI Survivor Program","authors":"Heather P. May PharmD, MSc ,&nbsp;Joseph R. Herges PharmD ,&nbsp;Brenda K. Anderson RN ,&nbsp;Kianoush B. Kashani MD ,&nbsp;Andrea G. Kattah MD ,&nbsp;Kristin C. Cole MS ,&nbsp;Rozalina G. McCoy MD, MS ,&nbsp;Laurie A. Meade RN ,&nbsp;Andrew D. Rule MD ,&nbsp;Diana J. Schreier PharmD, MBA ,&nbsp;Angeliki G. Tinaglia RRT, LRT ,&nbsp;Erin F. Barreto PharmD, MSc ,&nbsp;ACT Study Group","doi":"10.1016/j.xkme.2024.100854","DOIUrl":"10.1016/j.xkme.2024.100854","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000657/pdfft?md5=3cdca11e5cfb420f5c2058fde74b3054&pid=1-s2.0-S2590059524000657-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141414139","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":"Ravulizumab in Atypical Hemolytic Uremic Syndrome: An Analysis of 2-Year Efficacy and Safety Outcomes in 2 Phase 3 Trials","authors":"Bradley P. Dixon ,&nbsp;David Kavanagh ,&nbsp;Alvaro Domingo Madrid Aris ,&nbsp;Brigitte Adams ,&nbsp;Hee Gyung Kang ,&nbsp;Edward Wang ,&nbsp;Katherine Garlo ,&nbsp;Masayo Ogawa ,&nbsp;Praveen Amancha ,&nbsp;Sourish Chakravarty ,&nbsp;Nils Heyne ,&nbsp;Seong Heon Kim ,&nbsp;Spero Cataland ,&nbsp;Sung-Soo Yoon ,&nbsp;Yoshitaka Miyakawa ,&nbsp;Yosu Luque ,&nbsp;Melissa Muff-Luett ,&nbsp;Kazuki Tanaka ,&nbsp;Larry A. Greenbaum","doi":"10.1016/j.xkme.2024.100855","DOIUrl":"10.1016/j.xkme.2024.100855","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><p>Atypical hemolytic uremic syndrome (aHUS) is a rare form of thrombotic microangiopathy (TMA) caused by complement dysregulation. Ravulizumab is a C5i approved for the treatment of aHUS. This analysis assessed long-term outcomes of ravulizumab in adults and pediatric patients with aHUS.</p></div><div><h3>Study Design</h3><p>This analysis reports 2-year data from 2 phase 3, single-arm studies.</p></div><div><h3>Setting &amp; Participants</h3><p>One study included C5i-naïve adults (NCT02949128), and the other included 2 cohorts of pediatric patients (C5i-naïve and those who switched to ravulizumab from eculizumab [pediatric switch patients]; NCT03131219).</p></div><div><h3>Exposure</h3><p>Patients received intravenous ravulizumab every 4-8 weeks, with the dose depending on body weight.</p></div><div><h3>Outcomes</h3><p>The primary endpoint in the studies of C5i-naïve patients was complete TMA response, which consisted of platelet count normalization, lactate dehydrogenase normalization, and<!--> <!-->≥25% improvement in serum creatinine concentrations from baseline, at 2 consecutive assessments<!--> <!-->≥4 weeks apart.</p></div><div><h3>Analytical Approach</h3><p>All analyses used descriptive statistics. No formal statistical comparisons were performed.</p></div><div><h3>Results</h3><p>In total, 86 and 92 patients were included in efficacy and safety analyses, respectively. Complete TMA response rates over 2 years were 61% and 90% in C5i-naïve adults and pediatric patients, respectively. The median increase in estimated glomerular filtration rate from baseline was maintained over 2 years in C5i-naïve adults (35<!--> <!-->mL/min/1.73<!--> <!-->m²) and pediatric patients (82.5<!--> <!-->mL/min/1.73<!--> <!-->m²). Most adverse events and serious adverse events occurred during the first 26 weeks. No meningococcal infections were reported. Improvement in the Functional Assessment of Chronic Illness Therapy – Fatigue score achieved by 26 weeks was maintained over 2 years.</p></div><div><h3>Limitations</h3><p>Limitations were the small sample of pediatric switch patients and limited availability of genetic data.</p></div><div><h3>Conclusions</h3><p>Long-term treatment with ravulizumab is well tolerated and associated with improved hematologic and renal parameters and quality of life in adults and pediatric patients with aHUS.</p></div><div><h3>Plain-Language Summary</h3><p>This research tested a drug called ravulizumab for the treatment of atypical hemolytic uremic syndrome (aHUS). aHUS is a rare disease that causes clots in tiny blood vessels. This can damage the kidneys and other organs. We analyzed data from 2 clinical trials in which children and adults with aHUS received ravulizumab through a tube placed in a vein (intravenous line). They received ravulizumab every 4-8 weeks depending on their weight. We found that treating patients for 2 years with ravulizumab was associated with improv","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000669/pdfft?md5=3685fbcbb30362b271ff65bc6088216b&pid=1-s2.0-S2590059524000669-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141403922","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":"Glucocorticoid Minimization in Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis: An International Survey of Clinicians","authors":"","doi":"10.1016/j.xkme.2024.100858","DOIUrl":"10.1016/j.xkme.2024.100858","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><p>Research in anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) has focused on reducing treatment toxicities, notably through reduction of exposure to glucocorticoids. Glucocorticoid-sparing therapies such as avacopan are not widely available in many countries, and patients are exposed to high glucocorticoid doses. There is little data concerning what clinicians should accept as the lowest glucocorticoid dosing that can be used in induction therapy for AAV.</p></div><div><h3>Study Design</h3><p>International, online survey.</p></div><div><h3>Setting &amp; Participants</h3><p>Clinicians in various countries with experience in managing vasculitis.</p></div><div><h3>Exposure and Outcomes</h3><p>Survey questions to gauge interest and preferences in studying an induction of remission regimen for severe AAV using only 2 or 4 weeks of glucocorticoids without avacopan. Data collected included general opinions about standard of care for induction agents, glucocorticoids, and avacopan. Respondents were presented with 3 candidate trial designs, 2 of which proposed a combination of cyclophosphamide and rituximab induction.</p></div><div><h3>Analytical Approach</h3><p>Using a 10-point Likert scale, respondents ranked each candidate trial on its usefulness in demonstrating whether a minimal glucocorticoid regimen would be safe and effective and their willingness to randomize into the trial.</p></div><div><h3>Results</h3><p>There were 210 respondents to the survey. The candidate trials were rated moderate-to-high for usefulness to demonstrate safety and efficacy (scores 6-7/10), and moderate (scores 5-6/10) for willingness to randomize. Four-week glucocorticoid duration was preferred to 2 weeks, and combination cyclophosphamide-rituximab with 4-week glucocorticoids was the most preferred design. Forty-two percent of respondents felt avacopan had to be incorporated into a minimal GC trial design to want to recruit patients.</p></div><div><h3>Limitations</h3><p>Representativeness of survey sample and generalizability of findings.</p></div><div><h3>Conclusions</h3><p>Combination cyclophosphamide-rituximab may be the ideal way of studying minimal glucocorticoid use in severe AAV. Given its increasing uptake, incorporating avacopan into a potential trial design is important.</p></div><div><h3>Plain Language Summary</h3><p>Research in anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) has focused on using less glucocorticoids to limit side effects. New drugs that drastically limit glucocorticoid use are not available in many countries. Studies are needed to find other ways of reducing glucocorticoid exposure to treat AAV, but it is unclear how best to achieve this. We administered a survey to doctors with experience in treating AAV and had them grade different combinations of widely available treatments with 2 or 4 weeks of glucocorticoids. We found that a combination of 2 doses cyclophosphamide wit","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000694/pdfft?md5=e19ec3ad4c9c95254407c6a861890590&pid=1-s2.0-S2590059524000694-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141405849","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":"SGLT2 Inhibitor Use in Chronic Kidney Disease: Supporting Cardiovascular, Kidney, and Metabolic Health","authors":"Magdalena Madero ,&nbsp;Glenn M. Chertow ,&nbsp;Patrick B. Mark","doi":"10.1016/j.xkme.2024.100851","DOIUrl":"10.1016/j.xkme.2024.100851","url":null,"abstract":"<div><p>Originally developed for use in type 2 diabetes mellitus (T2DM), sodium–glucose co-transporter-2 (SGLT2) inhibitors demonstrated diverse cardiovascular- and kidney-protective effects in large outcome trials. Their subsequent approval as a treatment for chronic kidney disease (CKD) marked a pivotal shift in the landscape of CKD management. Further to this, the approval of dapagliflozin and empagliflozin for use in patients with CKD with and without T2DM afforded new treatment opportunities for this population. SGLT2 inhibitors provide an effective treatment for CKD with a favorable safety profile. However, their uptake has been slow, especially among patients without T2DM, owing perhaps to a lack of certainty and familiarity among health care professionals. As the landscape of CKD management continues to evolve, health care professionals should remain knowledgeable about these changes, and implement new guideline recommendations promptly to avoid therapeutic inertia. SGLT2 inhibitors are recommended for patients with CKD with or without T2DM and are foundational agents to support cardiovascular, kidney, and metabolic health. In this review, we provide evidence-based answers to questions that may be asked in the clinic regarding the use of SGLT2 inhibitors to treat CKD.</p></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000621/pdfft?md5=0ee161fd897a66153850b1f67cefccdc&pid=1-s2.0-S2590059524000621-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141415295","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":"Matrix Metalloproteinase-2 and CKD Progression: The Chronic Renal Insufficiency Cohort (CRIC) Study","authors":"","doi":"10.1016/j.xkme.2024.100850","DOIUrl":"10.1016/j.xkme.2024.100850","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><p>Matrix metalloproteinase 2 (MMP-2) plays an important role in the development of fibrosis, the final common pathway of chronic kidney disease (CKD). This study aimed to assess the relationship between repeated measures of MMP-2 and CKD progression in a large, diverse prospective cohort.</p></div><div><h3>Study Design</h3><p>In a prospective cohort of Chronic Renal Insufficiency Cohort (CRIC) participants (N<!--> <!-->=<!--> <!-->3,827), MMP-2 was measured at baseline. In a case-cohort design, MMP-2 was additionally measured at year 2 in a randomly selected subcohort and cases of estimated glomerular filtration rate (eGFR) halving or kidney replacement therapy (KRT) (N = 1,439).</p></div><div><h3>Setting &amp; Participants</h3><p>CRIC is a multicenter prospective cohort of adults with CKD.</p></div><div><h3>Exposure</h3><p>MMP-2 measured in plasma at baseline and at year 2.</p></div><div><h3>Outcomes</h3><p>A composite kidney endpoint (KRT/eGFR halving)</p></div><div><h3>Analytical Approach</h3><p>Weighted Cox proportional hazards models for case-cohort participants.</p></div><div><h3>Results</h3><p>Participants were followed for a median of 4.6 years from year 2 and 6.9 years from the baseline. Persistently elevated MMP-2 (≥300<!--> <!-->ng/mL at both baseline and year 2) increased the hazard of the composite kidney endpoint (HR, 1.61; 95% CI, 1.07-2.42; <em>P</em> <!-->=<!--> <!-->0.09) after adjusting for covariates. The relationship of persistently elevated MMP-2 was modified by levels of inflammation, with a 2.6 times higher rate of the composite kidney endpoint in those with high-sensitivity C-reactive protein<!--> <!-->&lt;<!--> <!-->2.5<!--> <!-->g/dL at study entry. Heterogeneity of effect was found with proteinuria, with a baseline MMP-2 level of<!--> <!-->≥300<!--> <!-->ng/mL associated with an increased risk of the composite kidney endpoint (HR, 1.30; 95% CI, 1.09-1.54) only with proteinuria<!--> <!-->≥<!--> <!-->442<!--> <!-->mg/g.</p></div><div><h3>Limitations</h3><p>The observational study design limits causal interpretation.</p></div><div><h3>Conclusions</h3><p>Elevated MMP-2 is associated with CKD progression, particularly among those with low inflammation and those with proteinuria. Future investigations are warranted to confirm the reduction in risk of CKD progression among these subgroups of patients with CKD.</p></div><div><h3>Plain Language Summary</h3><p>Matrix metalloproteinase 2 (MMP-2) is a matrix-degrading protease involved in fibrosis and elevated in chronic kidney disease (CKD). Longitudinal patterns of MMP-2 have not previously been assessed as a predictor of CKD progression in a large prospective cohort. Here, we found that a higher baseline level and an increasing or persistently elevated 2-year pattern of MMP-2 were associated with CKD progression, independent of all covariates except proteinuria. The association of baseline MMP-2 with CKD progression differed by level of p","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S259005952400061X/pdfft?md5=e92d4051238a597ef72f52d56f762295&pid=1-s2.0-S259005952400061X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141396647","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":"Informed Dialysis Modality Selection Among Veterans With Advanced CKD: A Community-Level Needs Assessment","authors":"Gajapathiraju Chamarthi ,&nbsp;Tatiana Orozco ,&nbsp;Jennifer Hale-Gallardo ,&nbsp;Shobha Subhash ,&nbsp;Popy Shell ,&nbsp;Kailyn Pearce ,&nbsp;Huanguang Jia ,&nbsp;Ashutosh M. Shukla","doi":"10.1016/j.xkme.2024.100832","DOIUrl":"https://doi.org/10.1016/j.xkme.2024.100832","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><p>The Advancing Americans Kidney Health Executive order has directed substantial increases in home dialysis use for incident kidney replacement therapy (KRT). Clinical guidelines recommend patients’ self-selection of KRT modality through a shared decision-making process, which, at the minimum, requires predialysis nephrology care and KRT-directed comprehensive prekidney failure patient education (CoPE). The current state of these essential services among Americans with advanced (stages 4 and 5) chronic kidney disease (CKD) and their informed preferences for home dialysis are unknown.</p></div><div><h3>Study Design</h3><p>We conducted a community-based, cross-sectional, observational cohort study across a large regional Veteran Healthcare System from October 1, 2020, to September 30, 2021.</p></div><div><h3>Setting &amp; Participants</h3><p>Of the 928 Veterans with advanced CKD, 287 (30.9%) were invited for needs assessment evaluations. Of the 218 (76% of invited cohort) responding, 178 (81.6%) were receiving nephrology care, with approximately half of those (43.6%) receiving such care from non-Veterans Affairs providers.</p></div><div><h3>Outcomes</h3><p>The study was targeted to assess the prevalent state of ongoing nephrology care and KRT-directed pre-kidney failure education among Veterans with advanced CKD. The secondary outcome included evaluation of dialysis decision-making state among Veterans with advanced CKD.</p></div><div><h3>Analytical Approach</h3><p>Veterans with advanced CKD with 2 sustained estimated glomerular filtration rates<!--> <!-->&lt;30<!--> <!-->mL/min/1.73<!--> <!-->m² were identified through an electronic database query, and a randomly selected cohort was invited for their current state of and outstanding needs for predialysis nephrology care and CoPE, essential for informed KRT selection.</p></div><div><h3>Results</h3><p>Basic awareness of kidney disease was high (92.2%) among Veterans with advanced CKD, although only 38.5% were aware of the severity of their CKD. KRT-directed education during clinical care was reported by 46.8% of Veterans, of which 21.1% reported having received targeted CoPE classes. Three-quarters (74.3%) of Veterans expressed interest in receiving CoPE services. Overall, awareness of CKD and its severity and receipt of KRT-directed education were significantly higher among Veterans with nephrology care than among those without. Of the 61 Veterans providing their KRT preferences, overall decision making was poor, with three-quarters (73.8%) of the cohort unable to choose any KRT modality, irrespective of ongoing nephrology care. Only 8 (13%) felt confident choosing home KRT modalities.</p></div><div><h3>Limitations</h3><p>The study results are primarily applicable to the Veterans with advanced CKD. Furthermore, a limited numbers of respondents provided data on their KRT decision-making state, prohibiting broad generalizations.</p></div><div><h3>Con","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000438/pdfft?md5=ebdec942b1d918b8cb2bff9821376eb7&pid=1-s2.0-S2590059524000438-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141243340","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":"The Pursuit of New Treatments for Focal Segmental Glomerulosclerosis: Harmonizing Innovation With the DUET Study of Sparsentan","authors":"Aparajita Mishra,&nbsp;Ai Itoku,&nbsp;Kimberly Reidy,&nbsp;Frederick Kaskel","doi":"10.1016/j.xkme.2024.100844","DOIUrl":"10.1016/j.xkme.2024.100844","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000554/pdfft?md5=6bb6a5cf739bfb0ebc9b035668842cef&pid=1-s2.0-S2590059524000554-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141130261","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":"Patient Perspectives on Using Telemedicine During In-Center Hemodialysis: A Qualitative Study","authors":"Trenton M. Haltom ,&nbsp;Susie Q. Lew ,&nbsp;Wolfgang C. Winkelmayer ,&nbsp;Glenn M. Chertow ,&nbsp;Allison Jaure ,&nbsp;Kevin F. Erickson","doi":"10.1016/j.xkme.2024.100848","DOIUrl":"10.1016/j.xkme.2024.100848","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><p>In the wake of the coronavirus disease 2019 (COVID-19) pandemic, the United States federal government expanded originating telemedicine sites to include outpatient dialysis units. For the first time, nephrology practitioners across the United States could replace face-to-face visits with telemedicine for patients receiving in-center hemodialysis. This study describes patients’ perspectives on the use of telemedicine during in-center hemodialysis.</p></div><div><h3>Study Design</h3><p>A qualitative study.</p></div><div><h3>Setting &amp; Participants</h3><p>Thirty-two patients from underserved populations (older, less educated, unemployed, persons of color) receiving in-center hemodialysis who used telemedicine with their nephrologist during the COVID-19 pandemic.</p></div><div><h3>Analytical Approach</h3><p>Telephone semistructured interviews were conducted in English or Spanish. Transcripts were thematically analyzed.</p></div><div><h3>Results</h3><p>We identified 6 themes with subthemes: adapting to telemedicine (gaining familiarity and confidence, overcoming and resolving technical difficulties, and relying on staff for communication); ensuring availability of the physician (enabling an immediate response to urgent medical needs, providing peace of mind, addressing patient needs adequately, and enhanced attention and contact from physicians); safeguarding against infection (limiting COVID-19 exposures and decreasing use); straining communication and physical interactions (loss of personalized touch, limited physical examination, and unable to reapproach physicians about forgotten issues); maintaining privacy (enhancing privacy and projecting voice enables others to hear); and supporting confidence in telemedicine (requiring established rapport with physicians, clinical stabilty of health, and ability to have in-person visits when necessary).</p></div><div><h3>Limitations</h3><p>Interviews were conducted later in the pandemic when some nephrology care providers were using telemedicine infrequently.</p></div><div><h3>Conclusions</h3><p>Patients receiving in-center hemodialysis adapted to telemedicine visits by their nephrologists in the context of the COVID-19 pandemic and observed its benefits. However, further considerations regarding communication, privacy, and physical assessments are necessary. Integrating telemedicine into future in-center hemodialysis care using a hybrid approach could potentially build trust, optimize communication, and augment care.</p></div><div><h3>Plain-Language Summary</h3><p>This study describes patients’ perspectives on the use of telemedicine while receiving in-center hemodialysis during the coronavirus disease 2019 (COVID-19) pandemic. Data are derived from semistructured interviews with thirty-two patients from underserved populations (older, less educated, unemployed, persons of color). We identified 6 major themes including adapting to telemedicine, ensuring availabili","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000591/pdfft?md5=a161a97b18cb55c54ea28c2abe723fe2&pid=1-s2.0-S2590059524000591-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141137576","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}