Kidney Medicine最新文献

{"title":"COVID-19 Hospitalization and Mortality Trends Among US Dialysis Patients by Race/Ethnicity and Vaccination Status","authors":"Monica M. Shieu ,&nbsp;Daniel E. Weiner ,&nbsp;Nien Chen Li ,&nbsp;Harold J. Manley ,&nbsp;Antonia Harford ,&nbsp;Caroline M. Hsu ,&nbsp;Dana Miskulin ,&nbsp;Doug Johnson ,&nbsp;Eduardo K. Lacson Jr.","doi":"10.1016/j.xkme.2025.101026","DOIUrl":"10.1016/j.xkme.2025.101026","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><div>The coronavirus disease 2019 (COVID-19) pandemic disproportionately affected vulnerable individuals, including people with kidney disease. We elucidated longitudinal trends in hospitalization and mortality among individuals receiving maintenance dialysis before and during the pandemic and explored how universal vaccine availability affected COVID-19 outcomes by race/ethnicity.</div></div><div><h3>Study Design</h3><div>A retrospective cohort study.</div></div><div><h3>Settings &amp; Participants</h3><div>Adult maintenance dialysis patients between 2018-2023 at a national not-for-profit US provider.</div></div><div><h3>Predictors</h3><div>COVID-19 era (2020-2023), race/ethnicity.</div></div><div><h3>Outcomes</h3><div>COVID-19 vaccination status; hospitalization and death (COVID-related, all-cause).</div></div><div><h3>Analytical Approach</h3><div>Zero-inflated Poisson models and logistic regression models were used to calculate hospitalization and mortality rates, respectively, adjusted for age, sex, race/ethnicity, dialysis vintage, and number of comorbid conditions.</div></div><div><h3>Results</h3><div>Among 41,257 patients receiving maintenance dialysis, all-cause hospitalization dropped abruptly in March/April 2020 and increased thereafter, albeit remaining below prepandemic rates. All-cause mortality exhibited typical seasonal variability during 2018-2019, subsequently increasing with onset of the COVID-19 pandemic in March 2020. Mortality peaked in January 2021 at 228 deaths per 1,000 person-years before declining to 151 deaths per 1,000 person-years in March 2021. Subsequently, mortality transiently increased during the Delta and Omicron variant periods, peaking at 188 and 189 deaths per 1,000 person-years, respectively. Thereafter, all-cause mortality remained below prepandemic levels. After widespread SARS-CoV-2 vaccine availability in 2021 with vaccine provision in dialysis facilities, the COVID-19 mortality rate among all race/ethnicity groups declined significantly (b<!--> <!-->=<!--> <!-->−5.3; <em>P</em> <!-->&lt;<!--> <!-->0.001). There were no statistically significant differences by race/ethnicity in the vaccination status at each year’s end.</div></div><div><h3>Limitations</h3><div>Potential residual confounders and underreporting of COVID-19–related outcomes.</div></div><div><h3>Conclusions</h3><div>All-cause mortality increased sharply in 2020 and early 2021, reflecting COVID-19-related deaths, whereas non–COVID-19 mortality declined during the early phase of the pandemic and subsequently remained below prepandemic levels. After introduction of SARS-CoV-2 vaccines, all-cause mortality declined to below prepandemic levels, likely reflecting the impact of widespread vaccination in the dialysis population.</div></div><div><h3>Plain-Language Summary</h3><div>This study evaluated trends for mortality, hospitalization, and vaccination status, before and during the coronavirus disease 2019 (C","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 7","pages":"Article 101026"},"PeriodicalIF":3.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144329496","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":"Temporal Trends in Acute Kidney Injury in Hospitalizations From 2009-2018 in Alberta: A Retrospective Population-Based Cohort Study","authors":"Anita Dahiya ,&nbsp;Natasha Wiebe ,&nbsp;Tyrone G. Harrison ,&nbsp;Matthew T. James ,&nbsp;Neesh Pannu ,&nbsp;Alberta Kidney Disease Network","doi":"10.1016/j.xkme.2025.101029","DOIUrl":"10.1016/j.xkme.2025.101029","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Studies have reported an increase in acute kidney injury (AKI) incidence; however, they are limited by administrative codes. We aimed to identify trends in AKI incidence, severity, and mortality using Kidney Disease: Improving Global Outcomes (KDIGO)-based definitions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;This is a retrospective, population-based cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Population&lt;/h3&gt;&lt;div&gt;Hospitalized adult patients in Alberta, Canada from 2009-2018.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposures&lt;/h3&gt;&lt;div&gt;AKI episodes were identified using validated KDIGO definitions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;We assessed in-hospital and 90-day all-cause mortality.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Generalized linear models with a Gaussian family were used to determine absolute rates of AKI and mortality. Rates of AKI and mortality were adjusted for patient demographics and comorbid conditions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;There were 339,986 hospitalizations with an episode of AKI (12.7%, 2,668,954 hospitalizations) with a median age of 70 years (56, 82) and 152,115 (44.7%) women. AKI rates increased by an unadjusted relative increase of 5.5% (95% confidence interval [CI], 4.2-6.9). When fully adjusted, a relative decrease of 11.2% (95% CI, 9.2-13.2) was seen in rates of AKI. Stage 1 AKI was most common (unadjusted mean rate, 659 per 100,000 person-years [95% CI, 655-662]). In-hospital mortality decreased across all stages of AKI with the greatest decrease noted in stage 3 AKI requiring kidney replacement therapy (unadjusted relative decrease 29.9% [95% CI, 20-38.6]). Similar trends were identified in 90-day mortality.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;The primary strength of this paper is that it involves a large cohort of patients from a diverse population. The use of KDIGO definition of AKI is limited by the reliance on serum creatinine values.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Although rates of AKI appear to be increasing, this seems to be largely driven by patient comorbid condition with the highest rates seen in stage 1 AKI. Furthermore, there was an overall increase in rates of AKI in patients aged younger than 60 and a decrease in the most elderly of patients in both the crude and adjusted data, suggesting potential changes in practice patterns and patient characteristics. Despite this increase, there was an overall decrease in mortality, especially in severe forms of 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 the sudden decrease in kidney function. It is common and reported to be increasing in the literature; however, previous studies are limited by their definitions of AKI. In this study, we looked at changes in the number of AKIs and death rates in hospitalized patients with AKI in Alberta, Canada from 2009-2018. We found that when we accounted for the fact that patients are getting sicker, the rates of AK","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 7","pages":"Article 101029"},"PeriodicalIF":3.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144329679","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":"Kidney Outcomes in Patients With Advanced Heart Failure Treated With Ventricular Assist Devices","authors":"Lyle W. Baker ,&nbsp;Tambi Jarmi ,&nbsp;Michael A. Mao ,&nbsp;Ivan E. Porter ,&nbsp;Christopher L. Trautman ,&nbsp;Parag C. Patel ,&nbsp;Yaohua Ma ,&nbsp;David O. Hodge ,&nbsp;Nabeel Aslam","doi":"10.1016/j.xkme.2025.101027","DOIUrl":"10.1016/j.xkme.2025.101027","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Ventricular assist devices (VADs) are used for advanced heart failure, but their impact on kidney function remains unclear. This study evaluated changes in kidney function following VAD implantation, including acute kidney injury (AKI) incidence and need for kidney replacement therapy (KRT).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;A retrospective cohort study analyzing longitudinal kidney function outcomes post-VAD placement.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Adult patients who underwent durable VAD placement (2009-2019) at a single center were included. Patients were stratified into chronic kidney disease (CKD) (estimated glomerular filtration rate [eGFR]&lt;!--&gt; &lt;!--&gt;&lt;60&lt;!--&gt; &lt;!--&gt;mL/min/1.73m&lt;sup&gt;2&lt;/sup&gt;) and non-CKD (eGFR&lt;!--&gt; &lt;!--&gt;≥60&lt;!--&gt; &lt;!--&gt;mL/min/1.73m&lt;sup&gt;2&lt;/sup&gt;) groups.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposures &amp; Predictors&lt;/h3&gt;&lt;div&gt;The VAD implantation was the primary intervention, with baseline kidney function modifying its impact on post-VAD kidney function.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Primary outcomes were changes in eGFR and creatinine at 3-months and 12-months post-VAD. Secondary outcomes included AKI incidence, KRT requirement, and postdischarge AKI within 1 year.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Descriptive statistics and comparative analyses, including Wilcoxon rank sum, χ&lt;sup&gt;2&lt;/sup&gt;, and paired &lt;em&gt;t&lt;/em&gt; tests, were used to assess differences. Significance was set at &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.05.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among 160 patients (82% male and 69% White), patients with CKD were older with a higher prevalence of diabetes, vasodilator use, and inotrope use. At 3 months, kidney function improved in patients with CKD (eGFR&lt;!--&gt; &lt;!--&gt;+17, &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.001) but declined by 12 months (eGFR&lt;!--&gt; &lt;!--&gt;+7, &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.03). The non-CKD group had a smaller improvement at 3 months (eGFR&lt;!--&gt; &lt;!--&gt;+8, &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.004) that was not sustained. AKI requiring KRT occurred in 14%, with 45% in-hospital mortality; and 41% discontinued KRT before discharge. Post-VAD AKI occurred in 21%. Half of the patients underwent heart transplant, which was associated with worsening kidney function at 1-year.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Single-center design limits generalizability.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;The VAD placement initially improves kidney function, particularly in CKD patients, but this effect diminishes over time. AKI and KRT use are common, highlighting the need for close kidney monitoring post-VAD.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Ventricular assist devices (VADs) help patients with advanced heart failure by supporting heart function, but their impact on kidney health is not well understood. Because kidney disease is common in heart failure and linked to worse outcomes, we studied how kidney function changes after VAD placement","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 7","pages":"Article 101027"},"PeriodicalIF":3.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144329781","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":"Hypomagnesemia With Metformin Use in Diabetes Mellitus: A Case and Narrative Review","authors":"Eric J. Xu,&nbsp;David J.R. Steele,&nbsp;Andrew Z. Fenves","doi":"10.1016/j.xkme.2025.101030","DOIUrl":"10.1016/j.xkme.2025.101030","url":null,"abstract":"<div><div>Hypomagnesemia is defined as a serum magnesium level<!--> <!-->&lt;1.7<!--> <!-->mg/dL, and it can be induced by gastrointestinal losses or renal wasting of magnesium. This is a common electrolyte abnormality in patients with diabetes mellitus. Refractory hypomagnesemia presents a significant challenge in clinical management, because some patients are prone to developing severe, recurrent hypomagnesemia that is refractory to aggressive repletion. In diabetes, insulin resistance in renal tissue inhibits magnesium reabsorption and contributes to the hypomagnesemia observed in these patients. Hypomagnesemia has also been reported with use of metformin and may be because of gastrointestinal wasting and intracellular accumulation. Chronic use of metformin suppresses transient receptor potential cation channel subfamily M member 6 in the kidneys, although it also appears to reduce urinary magnesium excretion. In addition to repletion aadnd using potassium-sparing diuretics, substituting sodium-glucose cotransporter 2 inhibitors for metformin may be helpful in managing refractory hypomagnesemia in patients with diabetes.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 7","pages":"Article 101030"},"PeriodicalIF":3.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144329681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Perceptions of a Population Health Management Program to Improve Kidney Care: Optimizing care in CKD","authors":"Linda-Marie U. Lavenburg ,&nbsp;Susan M. Devaraj ,&nbsp;Ambreen Gul ,&nbsp;Melanie R. Weltman ,&nbsp;Balchandre Neilesh Kenkre ,&nbsp;Flor de Abril Cameron ,&nbsp;Jane O. Schell ,&nbsp;Megan E. Hamm ,&nbsp;Manisha Jhamb","doi":"10.1016/j.xkme.2025.101025","DOIUrl":"10.1016/j.xkme.2025.101025","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;A population health management intervention for a pragmatic cluster randomized control trial (Kidney CHAMP) aimed to improve care and outcomes in patients with chronic kidney disease (CKD) at high-risk of progression to dialysis dependence but not seeing a nephrologist. The Kidney CHAMP intervention provided comanagement support to primary care providers by nephrology electronic-consult, pharmacist-directed medication reconciliation, and nurse-delivered CKD patient education. We sought to learn patient perceptions of Kidney CHAMP intervention and whether the intervention improved their understanding of CKD.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;An ancillary study of Kidney CHAMP using qualitative methods.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Participants were sampled from Kidney CHAMP intervention group using 3 predefined strata (racial/ethnic minorities, low socioeconomic status, and multimorbidities) from May 2021 to February 2022.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;We conducted semistructured televideo or telephone interviews that were transcribed and then inductively coded by 2 data analysts until thematic saturation was reached. Conventional content and thematic analyses were performed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;In 45 patient interviews (mean age 75&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;8 years, 44% women, 9% non-White race, and 59% low socioeconomic status), we identified 4 themes. First, patients expressed support for CKD comanagement by the primary care providers (PCPs) and nephrology team. Second, education sessions had variable effect on improving patients’understanding of CKD and its health implications. Third, patients’ self-efficacy and understanding of CKD management varied and was influenced by their understanding of its health implications. Fourth, patients appreciated education sessions and wanted more frequent sessions and actionable individualized guidance.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Low representation of non-White individuals, recall bias, and lack of validated measures for health literacy, patient knowledge, and activation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Patients with CKD who are managed by their PCP were supportive of remote comanagement by a nephrologist. Patients perceive some aspects of CKD health education to be beneficial; however, more effective approaches to communicating risk of CKD development and progression are needed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;In this ancillary qualitative study, we aimed to learn patient perspectives on a population health management approach to kidney disease comanagement between primary care providers and a multidisciplinary nephrology team. Patient interviewees were supportive of communication between primary care providers and the nephrology specialists, and most appreciated nurse-provided education sessions. However, despite exposure to the same standardized kidney e","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 7","pages":"Article 101025"},"PeriodicalIF":3.2,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144290956","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":"Atrial Fibrillation Is Associated With Increased In-Hospital and 1-Year Mortality in Patients Receiving Hemodialysis With ST Elevation Myocardial Infarction: A Retrospective Cohort Study","authors":"Simonetta Genovesi ,&nbsp;Giuseppe Regolisti ,&nbsp;Alice Bonomi ,&nbsp;Olivia Leoni ,&nbsp;Arianna Galotta ,&nbsp;Giancarlo Marenzi","doi":"10.1016/j.xkme.2025.101023","DOIUrl":"10.1016/j.xkme.2025.101023","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Atrial fibrillation (AF) is highly prevalent among patients receiving maintenance hemodialysis (HD) and patients with ST elevation myocardial infarction (STEMI). We investigated the association of AF with in-hospital mortality, 1-year mortality, and 1-year readmission for acute myocardial infarction (AMI) in HD patients admitted with STEMI.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Retrospective cohort study based on a large administrative database.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;138,939 patients admitted with STEMI from 2003-2018, of whom 1,185 (8.5%)receiving HD, followed from the date of admission until death, migration, or 1 year after discharge.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposures&lt;/h3&gt;&lt;div&gt;STEMI (&lt;em&gt;International Classification of Diseases, Ninth Revision, Clinical Modification&lt;/em&gt; [ICD-9-CM] 410.x) as the primary discharge diagnosis, maintenance HD (ICD-9-CM 39.95; 54.98; V560; V563.1; V563.2), and AF (ICD-9-CM 427.31).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;In-hospital all-cause mortality (primary outcome), 1-year all-cause mortality, and 1-year readmission for AMI (secondary outcomes).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Multivariable logistic regression and multivariable Cox regression.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;One hundred and ninety-five out of 1,185 (16.5%) patients had AF at admission or developed AF during hospitalization. After adjusting for possible confounders, AF versus sinus rhythm was associated with higher in-hospital mortality (odds ratio [OR]&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;1.57; 95% confidence interval [CI], 1.11-2.22). AF was associated with higher 1-year mortality (hazard ratio [HR]&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;1.45; 95% CI, 1.18-1.76), whereas it was not associated with higher 1-year readmission for AMI (HR&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;1.05; 95% CI, 0.72-1.53). Less than 20% of patients with AF discharged alive were prescribed oral anticoagulant therapy. In this subgroup, oral anticoagulant therapy was associated with lower 1-year mortality (HR&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.46; 95% CI, 0.24-0.89).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Potential bias due to incorrect or incomplete coding, retrospective design, incidence of thromboembolic events after discharge, and cause of 1-year mortality unknown.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;AF is highly prevalent and associated with adverse short- and long-term outcomes in HD patients admitted with STEMI.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Atrial fibrillation (AF) is common both in patients with kidney failure receiving hemodialysis (HD) and in those with acute myocardial infarction. We investigated retrospectively the impact of AF on 1,185 patients receiving HD admitted for ST elevation myocardial infarction (STEMI). We examined the incidence of in-hospital mortality, 1-year mortality, and 1-year readmission for acute myocardial infarction in patients with AF compared with patients without AF. ","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 7","pages":"Article 101023"},"PeriodicalIF":3.2,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144329780","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":"Effectiveness of Allopurinol on Uric Acid and Pediatric Chronic Kidney Disease Severity in the Chronic Kidney Disease in Children Study","authors":"Derek K. Ng ,&nbsp;Matthew B. Matheson ,&nbsp;George J. Schwartz ,&nbsp;Katherine E. Kurgansky ,&nbsp;Bradley A. Warady ,&nbsp;Susan L. Furth ,&nbsp;CKiD Study Investigators","doi":"10.1016/j.xkme.2025.101021","DOIUrl":"10.1016/j.xkme.2025.101021","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><div>Clinical trials have shown that serum uric acid reduction does not slow chronic kidney disease (CKD) progression in adults, but it is uncertain whether these findings apply to children.</div></div><div><h3>Study Design</h3><div>An observational cohort study.</div></div><div><h3>Setting &amp; Population</h3><div>The Chronic Kidney Disease in Children cohort with participants who initiated allopurinol with a comparison group matched on age, sex, uric acid, CKD diagnosis, estimated glomerular filtration rate (eGFR), and proteinuria.</div></div><div><h3>Exposure</h3><div>Allopurinol initiation.</div></div><div><h3>Outcomes</h3><div>Uric acid, eGFR, and proteinuria before and after initiation, and longitudinal changes over time.</div></div><div><h3>Analytical Approach</h3><div>Allopurinol initiators were matched to noninitiators at a 1:3 ratio. Nonparametric tests compared levels before and after initiation and within-person changes. Linear mixed effects models characterized baseline and longitudinal differences between treatment groups.</div></div><div><h3>Results</h3><div>A total of 27 participants initiated allopurinol, and these were matched to 81 participants who did not initiate allopurinol. Allopurinol was associated with a 15.9% lower serum uric acid (95% CI, −21.1% to<!--> <!-->−10.4%) relative to the matched comparison group (<em>P</em> <!-->&lt;<!--> <!-->0.001) after initiation. There were no significant differences in eGFR or proteinuria over time by group.</div></div><div><h3>Limitations</h3><div>Observational study designed for comparative effectiveness and relatively small sample size; effectiveness of allopurinol initiated at lower levels of uric acid could not be estimated.</div></div><div><h3>Conclusions</h3><div>Allopurinol was effective at significantly lowering serum uric acid in children with CKD but was not associated with CKD progression measured by longitudinal eGFR and proteinuria.</div></div><div><h3>Plain-Language Summary</h3><div>Uric acid is a blood biomarker that is strongly associated with the severity of chronic kidney disease in adults and children. Clinical trials in adults have shown that medications like allopurinol, which reduce uric acid, do not slow progression of kidney disease. This has not been evaluated in children because this disease is rare and trials in this special population are difficult. Using observational data and matching methods in a longitudinal cohort of children with kidney diseases, we evaluated whether allopurinol lowered uric acid and slowed disease progression. Allopurinol significantly and substantially reduced uric acid levels but did not slow in kidney disease progression over about 5 years. These findings were congruent with the hypothesis that higher uric acid is a consequence rather than a cause of kidney disease progression.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 7","pages":"Article 101021"},"PeriodicalIF":3.2,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144330495","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":"Posterior Reversible Encephalopathy Syndrome in Chronic Kidney Disease: Incidence, Outcomes, and Risk Factors in a National Cohort","authors":"Mingyue He ,&nbsp;Avrum Gillespie","doi":"10.1016/j.xkme.2025.101022","DOIUrl":"10.1016/j.xkme.2025.101022","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Posterior reversible encephalopathy syndrome (PRES) is an acute neurological condition that, if untreated, can result in severe complications, such as intracerebral hemorrhage. Patients with chronic kidney disease (CKD) are at an increased risk of developing PRES; however, it is unclear whether this risk is primarily driven by comorbid conditions or if renal dysfunction itself is an independent risk factor. This study aimed to evaluate the incidence, outcomes, and resource utilization of PRES across CKD stages compared with patients without kidney disease.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;A retrospective study using the Nationwide Inpatient Sample Database.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Adult patients nonelectively admitted with PRES from 2016 to 2019.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposures&lt;/h3&gt;&lt;div&gt;Different stages of CKD versus no kidney disease&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;All-cause in-hospital mortality, Incidence of PRES hospitalizations, in-hospital morbidity (intracerebral hemorrhage, ischemic stroke, brain herniation, and status epilepticus), and health care resource utilization (length of hospital stay and total hospitalization charges)&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Multivariate logistic and linear regression analyses were conducted using survey design methods.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The cohort included 12,605 patients, representing 0.014% of all admissions. PRES incidence increased from 0.013% in 2016 to 0.015% in 2019 (&lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.01) and demonstrated a dose-response relationship with CKD stage progression. Key risk factors for PRES included female sex, White race, hypertension, metastatic cancer, solid organ transplantation, rheumatologic disorders, substance use disorders, carotid artery stenosis, migraines, and cerebral atherosclerosis. Kidney failure (KF) was strongly associated with in-hospital mortality (aOR 5.12, 95% CI, 2.09-12.53, &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.001). The length of stay, total hospitalization charge, and rates of neurological complications were similar between CKD/KF and patients without kidney disease.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;The use of administrative data limits access to detailed clinical information. Residual confounding factors remain possible.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;This is the largest study to date on PRES in CKD populations. CKD is strongly associated with PRES, with a dose-response relationship, and KF is an independent risk factor for in-hospital mortality, emphasizing the need for heightened clinical vigilance in this population.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Posterior Reversible Encephalopathy Syndrome (PRES) is a serious brain condition that can cause seizures, confusion, and even death if not recognized and treated in time. However, it is often overlooked because its symptoms can be vague. While PRES is commonly","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 7","pages":"Article 101022"},"PeriodicalIF":3.2,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144330392","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":"C3 Glomerulonephritis Associated With Unusual IgG4 Antifactor H in IgG4-related Disease","authors":"Paul Dalmas ,&nbsp;Mickael Bobot ,&nbsp;Noémie Jourde-Chiche ,&nbsp;Julie Bruno ,&nbsp;Stéphane Burtey ,&nbsp;Laurent Daniel ,&nbsp;Carine El-Sissy ,&nbsp;Véronique Fremeaux-Bacchi ,&nbsp;Antonio Jorquera ,&nbsp;Vincent Javaugue ,&nbsp;Nicolas Schleinitz ,&nbsp;Mikael Ebbo","doi":"10.1016/j.xkme.2025.101019","DOIUrl":"10.1016/j.xkme.2025.101019","url":null,"abstract":"<div><div>C3 glomerulonephritis (C3GN) is characterized by glomerular aggression mediated by deregulation of the alternative complement pathway. C3GN can be inherited or consequent to acquired autoantibodies, notably against factor H. We report the case of a patient with systemic active IgG4-related disease who presented for acute kidney injury with glomerular proteinuria and hypocomplementemia related to C3GN associated with IgG4-related interstitial nephritis on kidney biopsy. Factor H was low, and antifactor H IgG autoantibody was detected. Detection of other acquired or genetic complement alternative pathway disorders returned negative. After initial failure of oral corticoids and intravenous rituximab, the patient was successfully treated by intravenous cyclophosphamide followed by maintenance therapy with rituximab. Antifactor H autoantibody isotypes were IgG1 and IgG3, mainly as all antifactor H in positive controls but also IgG4, which is unusual. This suggests a link in this case between the oligoclonal expansion of plasma cells in IgG4-related disease and the production of antifactor H antibodies, especially of IgG4 isotype.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 7","pages":"Article 101019"},"PeriodicalIF":3.2,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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