Kidney Medicine最新文献

{"title":"Concerning the article “False-positive Serum Antiglomerular Basement Membrane Antibody due to Bovine Serum Albumin-containing Surgical Adhesive: A Case Report” by Yoshida et al","authors":"Giulia Zorzi MD","doi":"10.1016/j.xkme.2025.100985","DOIUrl":"10.1016/j.xkme.2025.100985","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 4","pages":"Article 100985"},"PeriodicalIF":3.2,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143528712","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":"Peritoneal Dialysis in Young Adults: A Mixed-Methods Study","authors":"Hannah C. Lyons , Lucy E. Selman , Yoav Ben-Shlomo , Fergus J. Caskey , Carol D. Inward , Alexander Hamilton","doi":"10.1016/j.xkme.2025.100983","DOIUrl":"10.1016/j.xkme.2025.100983","url":null,"abstract":"<div><h3>Background</h3><div>Peritoneal dialysis (PD) preserves kidney function and offers flexibility; however, few young adults have it compared with hemodialysis (HD). This study aimed to understand factors influencing the change from PD to HD.</div></div><div><h3>Study Design</h3><div>This was a sequential explanatory mixed-methods study.</div></div><div><h3>Setting & Participants</h3><div>Quantitative data were collected from 470 participants (50% male participants, 85% White, mean age: 16 years) who received dialysis between 1987 and 2015. Cox proportional hazards analysis was used to examine psychosocial factors associated with transitions from PD to HD. Qualitative data were gathered from 13 young adults (aged 14-29 years) who received dialysis between 2013 and 2015, with retrospective interviews conducted in 2020.</div></div><div><h3>Results</h3><div>25% of participants experienced multiple episodes of PD. Survival rates for PD at 1 and 5 years were 71% and 37%, respectively. Risk factors for transitioning to HD included young adulthood (age: 15-30 years), with higher transition risks in older age groups (age: 15-19 years, HR: 2.41; age: 20-24<!--> <!-->years, HR: 3.39; age: 25-30 years, HR: 3.14; <em>P</em> <!--><<!--> <!-->0.005). Other factors included primary kidney disease type (systemic diseases vs tubulointerstitial diseases). Leading causes for transition were infection (50%), noncompliance (21%), and mechanical issues (18%). Qualitative analysis revealed the key themes around communicating treatment options, life impact, and support structures. Resilience was an additional theme among those who continued PD.</div></div><div><h3>Limitations</h3><div>The study was based on cross-sectional psychosocial data, lacked detailed parental involvement, and may have suffered recall bias.</div></div><div><h3>Conclusions</h3><div>Young adults are at higher risk of transitioning to HD owing to both transplant failure and complications with PD. Challenges of PD have been underestimated, and there is a need to educate young adults well on all dialysis options. Additional support including mental health support, peer support, and support during life changes, such as moving out of their family home, is recommended.</div></div><div><h3>Plain-Language Summary</h3><div>This study aimed to understand why young adults are more likely to switch from peritoneal dialysis (PD) to hemodialysis. Although PD preserves kidney function and offers flexibility, few young adults choose it. We conducted a mixed-methods study with 470 patients aged 0-30 years and interviews with 13 individuals who were receiving dialysis. Our findings showed that young adults (aged 15-30 years) were at higher risk of transitioning to hemodialysis, mainly owing to infections, noncompliance, and mechanical issues. Challenges of PD have been underestimated, and there is a need to educate young adults well on all dialysis options. Additional support including mental health suppo","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 4","pages":"Article 100983"},"PeriodicalIF":3.2,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685116","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":"Body Mass Index in Late Adolescence and Later Life Kidney Outcomes: A Population-Based Cohort Study in Swedish Men","authors":"Monika Vitkauskaitė , Ernesta Mačionienė , Rytis Stankevičius , Marius Miglinas , Joachim H. Ix , Mattias Brunström","doi":"10.1016/j.xkme.2025.100982","DOIUrl":"10.1016/j.xkme.2025.100982","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>The association between body mass index (BMI) and chronic kidney disease (CKD) is well established in middle-aged and older adults. Here, we assess the association of BMI in late adolescence with CKD, kidney failure, and acute kidney injury (AKI) later in life.</div></div><div><h3>Study Design, Setting & Participants</h3><div>Population-based cohort study including data from the Swedish Conscription Database, the National Patient Register, the Cause of Death Register, and Statistics Sweden. Conscripts with no history of diabetes, cardiovascular, kidney, or rheumatic diseases enlisted between 1969 and 1997 were followed until December 31, 2019.</div></div><div><h3>Main Outcomes & Exposures</h3><div>The study examined the impact of BMI on kidney outcomes. The primary outcome was incident chronic kidney disease. Secondary outcomes were stage 5 chronic kidney disease, end-stage kidney disease, and acute kidney injury.</div></div><div><h3>Analytical Approach</h3><div>Patients were stratified into the quintiles of BMI at conscription, and followed until events, death, or censoring, using Cox proportional hazards model, adjusted for baseline systolic and diastolic blood pressure, proteinuria, and socioeconomic factors.</div></div><div><h3>Results</h3><div>In total, 1,321,481 male participants with a mean age of 18.3 years and a mean BMI of 21.6 kg/m<sup>2</sup> were followed for an average of 35.6 years, generating a total of 47 million person-years of follow-up. During this period, the incidence of CKD-based on diagnosis codes was 5,590, whereas 2,357 subjects were diagnosed with end-stage kidney disease and 8,023 with AKI, respectively. The risk for CKD was increased for the fourth and fifth highest BMI quintile relative to the lowest (adjusted hazard ratio [aHR] 1.23; 95% confidence interval [CI], 1.13-1.35 for BMI 21.9-23.5 kg/m<sup>2</sup>; aHR 2.09; 95% CI, 1.93-2.26 for BMI >23.5 kg/m<sup>2</sup>). Patterns were similar for stage 5 CKD and end-stage kidney disease, whereas the risk for AKI was evident at the third and higher quintiles (aHR 1.14; 95% CI, 1.06-1.23 for BMI 20.7-21.9 kg/m<sup>2</sup>; aHR 1.31; 95% CI, 1.22-1.41 for BMI 21.9-23.5 kg/m<sup>2</sup>; and aHR 1.92; 1.79-2.05 for BMI ≥23.5 kg/m<sup>2</sup>).</div></div><div><h3>Limitations</h3><div>A retrospective observational study of male Swedish adolescents.</div></div><div><h3>Conclusions</h3><div>The findings of this study indicate that, for prevention of kidney disease, the optimal BMI in adolescence with reference to kidney outcomes is likely in the low-normal range.</div></div><div><h3>Plain Language Summary</h3><div>This study investigates the long-term link between body mass index (BMI) during late adolescence and kidney failure and acute kidney injury. It draws from a large, population-based Swedish cohort, tracking over a million young men over decades. The research shows that higher BMI in adolescence is associated with","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 4","pages":"Article 100982"},"PeriodicalIF":3.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143644434","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":"Population-Level Risk Factors for Kidney Outcomes in IgA Nephropathy: The CURE-CKD Registry","authors":"Katherine R. Tuttle , Lindsey M. Kornowske , Cami R. Jones , Kenn B. Daratha , Radica Z. Alicic , Christina L. Reynolds , Joshua J. Neumiller , Mark E. Bensink , Wu Gong , Keith C. Norris , Susanne B. Nicholas , CURE-CKD Consortium","doi":"10.1016/j.xkme.2025.100981","DOIUrl":"10.1016/j.xkme.2025.100981","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Although IgA nephropathy (IgAN) therapies are advancing quickly, therapeutic interventions are hampered by a lack of kidney disease identification and risk assessment. The study aim was to use population-level data from health systems to identify IgAN and assess risks.</div></div><div><h3>Study Design</h3><div>A longitudinal and real-world cohort study.</div></div><div><h3>Setting & Participants</h3><div>Electronic health record data for patients ≥18 years old with IgAN at Providence and University of California Los Angeles health systems during 2016-2022.</div></div><div><h3>Predictors</h3><div>Health insurance and care utilization along with age, gender, race, ethnicity, estimated glomerular filtration rate (eGFR), urine albumin/creatinine ratio (UACR) or urine protein/creatinine ratio (UPCR), diabetes, hypertension, and medications.</div></div><div><h3>Outcomes</h3><div>Time to first major adverse kidney event (MAKE): ≥40% eGFR decline; eGFR <15 mL/min/1.73 m2; administrative codes for kidney failure, dialysis, or transplant; and death.</div></div><div><h3>Analytical Approach</h3><div>Kaplan-Meier survival curves and Cox proportional hazards models.</div></div><div><h3>Results</h3><div>Patients with IgAN (n = 2,571) were 50% (n = 1,277) women and 58 ± 18 (mean ± SD) years old. At baseline, eGFR was 78 ± 27 mL/min/1.73 m<sup>2</sup> (chronic kidney disease epidemiologic 2021 equation); median UACR and UPCR were 166 (interquartile range 25-795) mg/g and 0.7 (0.2-1.8) g/g, respectively, among those with baseline measurements (n = 669). MAKE occurred in 22% of the cohort by 3 years. In Cox proportional hazards models, MAKE was predicted by noncommercial (Medicare or Medicaid) health insurance, hospitalization, more frequent outpatient encounters, lower eGFR, and a higher UACR or UPCR.</div></div><div><h3>Limitations</h3><div>Missingness, miscoding, and retrospective data.</div></div><div><h3>Conclusions</h3><div>Substantial loss of kidney function, kidney failure, and death were common events over a short period of time in patients with IgAN. Within health system populations, noncommercial health insurance and greater care utilization augmented risk prediction and could help to identify those who may benefit from closer monitoring and implementation of therapeutic interventions.</div></div><div><h3>Plain Language Summary</h3><div>IgA nephropathy therapies have advanced quickly. However, therapeutic interventions are hampered by lack of disease identification and risk assessment. We identified patients with IgA nephropathy at 2 United States health systems and assessed predictors of risk for major adverse kidney events (major adverse kidney event [MAKE]—substantial loss of kidney function, kidney failure, or death). More than one in 5 patients experienced MAKE by 3 years. In addition to demographic and clinical predictors, MAKE was predicted by noncommercial health insurance, hospitalization, and m","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 4","pages":"Article 100981"},"PeriodicalIF":3.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685115","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":"Interventions to Improve Life Participation in Kidney Transplant Recipients: A Systematic Review","authors":"Patrizia Natale ,&nbsp;Angela Ju ,&nbsp;Martin Howell ,&nbsp;Germaine Wong ,&nbsp;Armando Teixeira-Pinto ,&nbsp;Anastasia Hughes ,&nbsp;Chandana Guha ,&nbsp;Amanda Sluiter ,&nbsp;Nicole Scholes-Robertson ,&nbsp;Jonathan C. Craig ,&nbsp;Michelle A. Josephson ,&nbsp;Giovanni Strippoli ,&nbsp;Allison Jaure","doi":"10.1016/j.xkme.2025.100980","DOIUrl":"10.1016/j.xkme.2025.100980","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><div>Life participation, defined as the ability to participate in meaningful activities of daily living, is a critically important outcome for kidney transplant recipients. We aimed to evaluate the effectiveness of any interventions on life participation in kidney transplant recipients.</div></div><div><h3>Study Design</h3><div>A systematic review of randomized controlled studies.</div></div><div><h3>Study Populations</h3><div>Adult kidney transplant recipients.</div></div><div><h3>Search Strategy &amp; Sources</h3><div>MEDLINE, Embase, CENTRAL, PsycINFO and CINAHL were searched up to March 2023.</div></div><div><h3>Data Extraction</h3><div>Two authors independently screened titles and abstracts, and extracted data from the included studies using standard data extraction forms.</div></div><div><h3>Analytical Approach</h3><div>We used random-effects models with relative risk for dichotomous outcomes and mean difference for continuous outcomes with 95% confidence intervals (CIs). Confidence in the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.</div></div><div><h3>Results</h3><div>From 14,162 reports, only 33 studies (4,857 participants) were included. The risk of bias was adjudicated as high or unclear for most domains. No studies reported the outcome of life participation specifically. Among 33 studies, mental, physical and social functioning were reported in 5 (15%), 5 (15%), and 11 (33%) studies, respectively.</div></div><div><h3>Limitations</h3><div>A wide range of interventions were included across the studies with a limited follow-up, and we were unable to pool the data and perform meta-analysis for outcomes that were reported in a single study only or in studies reporting no events.</div></div><div><h3>Conclusions</h3><div>The effects of prebiotics, erythropoietin-stimulating agents, immunosuppressive treatments, induction therapy of interleukin-2 receptor antagonist, exercise, nutrition, education, and surgical procedures on life participation-related outcomes were uncertain. Life participation was not reported as a specific outcome in trials in kidney transplant recipients with very limited evidence on interventions for life participation-related outcomes. Trial-based evidence for interventions to improve life participation, a critical outcome for kidney transplant recipients, is needed.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 4","pages":"Article 100980"},"PeriodicalIF":3.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685117","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":"Risk Factor-Based Screening for Early Detection of Chronic Kidney Disease in Primary Care Settings: A Systematic Review","authors":"Ayana Korsa MSc ,&nbsp;Wubshet Tesfaye PhD ,&nbsp;Kamal Sud MD ,&nbsp;Ines Krass PhD ,&nbsp;Ronald L. Castelino PhD","doi":"10.1016/j.xkme.2025.100979","DOIUrl":"10.1016/j.xkme.2025.100979","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Kidney failure can be prevented or delayed if chronic kidney disease (CKD) is detected and treated early. Targeted screening has been shown effective in detecting CKD worldwide, but a recently updated summary of evidence is lacking. We synthesized up-to-date evidence of the effectiveness of risk factor-based screening for the early detection of CKD among adults in primary care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;We retrieved articles from Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Scopus. Relevant gray literature and hand-searching bibliographies of key articles were also performed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Study Populations&lt;/h3&gt;&lt;div&gt;Adult patients (age ≥ 18 years) with at least 1 known CKD risk factor in primary care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Selection Criteria for Studies&lt;/h3&gt;&lt;div&gt;Prospective studies applying CKD screening in adults based on at least 1 CKD risk factor.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Data Extraction&lt;/h3&gt;&lt;div&gt;Data were abstracted from full texts and the risk of bias was assessed using the Joanna Briggs Institute critical appraisal tools.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;No meta-analysis was conducted.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;In total, 24 studies from 11 countries fulfilled the inclusion criteria. Diverse screening tests, CKD definitions, formulas for estimating kidney function, and positive screening test cutoffs were used. Most studies (n = 22) employed estimated glomerular filtration rate (eGFR), albumin-creatinine ratio (ACR) (n = 14), and dipstick urinalysis (n = 9) for screening. The prevalence of reduced kidney function and/or kidney damage was between 2.9% and 56%, and confirmed CKD varied from 4.4% to 17.1%. Increased patient referrals and physician visits, higher patient satisfaction, and some form of patient willingness to pay for the services were reported because of screening.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Meta-analysis was not conducted, and the findings might not be generalized to resource-limited settings.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Risk factor-based screening effectively identifies a substantial proportion of people with undiagnosed CKD, but there is still scope for improvement. We recommend future studies have robust designs and multidimensional interventions to establish the effectiveness of targeted CKD screening in primary care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;div&gt;Chronic kidney disease (CKD) is a major public health issue worldwide. Targeted screening programs for high-risk populations (eg, diabetes) are clinically effective and cost-effective in detecting CKD, according to studies. We conducted a systematic review to summarize up-to-date evidence on risk factor-based screening for early detection of CKD in primary care. From the results, it may be inferred that targeted screening effectively detects a significant proportion of previousl","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 4","pages":"Article 100979"},"PeriodicalIF":3.2,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610207","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":"Sleep Patterns, Symptoms, and Mortality in Hemodialysis: A Prospective Cohort Study","authors":"Yoko Narasaki ,&nbsp;Amy S. You ,&nbsp;Ira Kurtz ,&nbsp;Niloofar Nobakht ,&nbsp;Mohammad Kamgar ,&nbsp;Man Kit Michael Siu ,&nbsp;Rebecca S. Ahdoot ,&nbsp;Ramy Hanna ,&nbsp;Sara S. Kalantar ,&nbsp;Jihoon Yoon ,&nbsp;Lisa Le ,&nbsp;Silvina Torres Rivera ,&nbsp;Tracy Nakata ,&nbsp;Ria Arora ,&nbsp;Danh V. Nguyen ,&nbsp;Kamyar Kalantar-Zadeh ,&nbsp;Connie M. Rhee","doi":"10.1016/j.xkme.2025.100976","DOIUrl":"10.1016/j.xkme.2025.100976","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;While sleep disorders are common in patients treated with hemodialysis, the impact of sleep patterns on survival is not well defined. We thus examined the association of specific sleep patterns with mortality in this population.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;An observational cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Population&lt;/h3&gt;&lt;div&gt;In-center hemodialysis patients from the multicenter prospective NIH Malnutrition, Diet, and Racial Disparities in Chronic Kidney Disease (MADRAD) cohort.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;Sleep patterns ascertained using protocolized sleep surveys from March 2014 to June 2019.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Mortality.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Cox proportional hazards models.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among 452 participants, the mean age was 55±14 years, among whom 46% were women and the median follow-up was 3.5 years. In expanded case-mix models, shorter sleep duration (≤ median of observed values) was associated with higher mortality on dialysis and nondialysis days (ref: &gt; median): HRs (95% CIs) 1.59 (1.09-2.31) and 1.51 (1.04-2.19), respectively. Patients who reported high frequencies (often/almost always) of difficulty falling asleep, feeling unrested, fatigue/exhaustion post-dialysis, or fatigue/exhaustion on nondialysis days had higher mortality (ref: never/rarely having these symptoms): HRs (95% CIs) 1.74 (1.17-2.58), 1.69 (1.1-2.5), 2.42 (1.41-4.16), and 1.73 (1.11-2.69), respectively. Moderate to high frequency of sleeping pill use was associated with higher mortality (ref: never/rare use): HRs (95% CIs) 2.07 (1.08, 3.97) and 2.00 (1.22, 3.28) for sometimes and often/almost always using sleeping pills, respectively. Sleeping outside of the primary sleep period (intra-dialytic sleeping and napping) was not associated with worse survival. However, patients reporting frequent apnea or restless legs syndrome had higher mortality.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Potential recall bias, residual confounding, absence of time-varying observations, and limitations in generalizability.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;In a well-characterized prospective multicenter hemodialysis cohort, patients who reported shorter sleep duration, sleeping difficulty or feeling unrested, moderate to frequent sleeping pill consumption, and sleep disorders (apnea and restless legs) had a higher mortality risk.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;div&gt;Patients with kidney failure have a high burden of sleep disorders. However, the relationship between sleeping problems and the health of patients treated with dialysis is not well understood. To address this knowledge gap, we examined the relationship between various types of sleep disturbances and associated symptoms with survival among a diverse cohort of patients treated with hemodialysis from the multicenter prospective NIH Malnutrition, Diet, and","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 4","pages":"Article 100976"},"PeriodicalIF":3.2,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685118","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":"Transferring From Peritoneal Dialysis to Home or In-Center Hemodialysis: A Cohort Study of an Integrated Home Dialysis Model","authors":"Jana Mahmoud BSc ,&nbsp;Louis-Charles Desbiens MD, MSc ,&nbsp;Naoual Elftouh MSc ,&nbsp;Louis-Philippe Laurin MD, MSc ,&nbsp;Annie-Claire Nadeau-Fredette MD, MSc","doi":"10.1016/j.xkme.2025.100977","DOIUrl":"10.1016/j.xkme.2025.100977","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 4","pages":"Article 100977"},"PeriodicalIF":3.2,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519517","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":"Clinical Decision-Making About Immunosuppressive Treatment in Focal Segmental Glomerulosclerosis","authors":"Brooke Blazius ,&nbsp;Jonathan P. Troost ,&nbsp;Jeffrey B. Kopp ,&nbsp;Rulan S. Parekh ,&nbsp;Brenda Gillespie ,&nbsp;Isabelle Ayoub ,&nbsp;Mahmoud Kallash ,&nbsp;Rasheed Gbadegesin ,&nbsp;Pietro A. Canetta ,&nbsp;Tarak Srivastava ,&nbsp;Tracy E. Hunley ,&nbsp;Katherine E. Twombley ,&nbsp;Yonatan A. Peleg ,&nbsp;Larry A. Greenbaum ,&nbsp;Aftab S. Chishti ,&nbsp;Carla M. Nester ,&nbsp;Amy K. Mottl ,&nbsp;Susan L. Hogan ,&nbsp;Virginie Royal ,&nbsp;Vivette D. D’Agati ,&nbsp;Jason M. Kidd","doi":"10.1016/j.xkme.2025.100975","DOIUrl":"10.1016/j.xkme.2025.100975","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Focal segmental glomerulosclerosis (FSGS) is a heterogeneous disorder with a high risk of progression to kidney failure. There are no approved therapies for FSGS, and futility of treatment is poorly defined. The Cure Glomerulonephropathy (CureGN) study offers the opportunity to describe the characteristics of participants who started immunosuppressive therapy (IST), never received IST, or in whom this treatment was discontinued.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;An observational cohort.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Settings &amp; Participants&lt;/h3&gt;&lt;div&gt;Participants enrolled in CureGN with FSGS and surveyed nephrologists.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;The clinical and laboratory data from participants with FSGS who were enrolled in the CureGN observational cohort were reviewed to define features associated with withholding initial IST or terminating ongoing IST. Nephrologists were surveyed about what factors would influence their decision to prescribe or withdraw IST in patients with FSGS.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;(1) Identify factors associated with IST initiation and discontinuation in individuals with FSGS; and (2) Identify clinical and laboratory features nephrologists consider when they recommend against the use of IST at diagnosis (initiation of care) and during the course of disease.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Based on quantitative findings from the CureGN cohort and survey responses from practicing nephrologists, a low estimated glomerular filtration rate at presentation, significant glomerulosclerosis, and interstitial fibrosis and tubular atrophy on kidney biopsy make initiation of IST less likely.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Heterogeneous nature of the cohort and an inability to divide the patients into KDIGO subgroups of FSGS. Rationale for decision to stop or defer treatment was not available. More surveys were completed by pediatric providers, and the majority were completed by academic practitioners.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;The factors that impact decisions about IST initiation and discontinuation were consistent among pediatric and internal medicine nephrologists, namely advanced scarring and lower estimated glomerular filtration rate. We suggest that this information should be incorporated into patient management guidelines and clinical trial design.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;div&gt;Patients with focal segmental glomerulosclerosis (FSGS) are at high risk for progression to kidney failure and there are no approved therapies. This study from the CureGN consortium described clinical situations in which immunosuppressive therapy (IST) was started, not started, or discontinued in participants with FSGS. Furthermore, we surveyed nephrologists to better understand factors that influence the management of patients with FSGS. Participants in the CureGN cohort with a lower estimated glomerular filtration rate and ad","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 4","pages":"Article 100975"},"PeriodicalIF":3.2,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143679022","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":"Disentangling Dialysis Facility and Transplant Center Factors on Evaluation Start Following Referral for Kidney Transplantation: A Regional Study in the United States","authors":"Laura McPherson ,&nbsp;Laura C. Plantinga ,&nbsp;Penelope P. Howards ,&nbsp;Michael Kramer ,&nbsp;Rachel E. Patzer","doi":"10.1016/j.xkme.2025.100974","DOIUrl":"10.1016/j.xkme.2025.100974","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Little is known about the relative importance of dialysis facilities and transplant centers on variability in starting an evaluation among patients referred for kidney transplant. The primary objective of this study was to leverage cross-classified multilevel modeling to simultaneously examine the contextual effects of dialysis facilities and transplant centers on variation in the start of the transplant evaluation process.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Retrospective cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Dialysis patients referred for kidney transplant to transplant centers across the Southeast, Northeast, New York, or Ohio River Valley US regions from January 1, 2012, to December 31, 2020, were identified from the United States Renal Data System and the Early Steps to Transplant Access Registry and followed through June 30, 2021. A total of N=25,488 referred patients were nested with 1,720 dialysis facilities and 26 transplant centers.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Starting an evaluation for kidney transplant at a transplant center within 6 months of referral.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;A series of multilevel models were performed to estimate the variability in starting an evaluation for kidney transplant within 6 months of referral. The between-dialysis facility and/or transplant center variation in starting an evaluation was quantified using the median OR.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among 25,488 dialysis patients referred for kidney transplantation, 51% of patients started an evaluation at a transplant center within 6 months of referral. In multilevel models, the median OR between transplant centers was higher (indicating higher unexplained variability) than the dialysis facility median OR, regardless of measured patient, dialysis facility, and transplant center characteristics.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Early transplant access data was limited to 20 of 48 transplant centers across these 4 regions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;When taking dialysis facilities and transplant centers into account, variation in starting an evaluation for kidney transplant appeared at both the dialysis facility and transplant center-level but was more apparent among transplant centers.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Kidney transplantation is a life-saving treatment, but not all dialysis patients referred for transplant take the next step of starting their evaluation at a transplant center. Our study sought to understand the relative influence of dialysis facilities and transplant centers in starting an evaluation for kidney transplantation. When taking both dialysis facilities and transplant centers into account, we observed variation in starting an evaluation for kidney transplantation appeared at both the dialysis facility and transplant center-level but characteristics specific to transpla","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 4","pages":"Article 100974"},"PeriodicalIF":3.2,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143563498","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}