Kidney Medicine最新文献

{"title":"Remdesivir and Kidney and Cardiovascular Outcomes in COVID-19 Patients With Reduced GFR","authors":"James E. Dinulos BA , Qiyu Wang MD , Sophia Zhao MD, PhD , Duru Cosar BS , Ritu Seethapathy MBBS , Joshua D. Long BA , Ian Strohbehn BA , Meghan E. Sise MD, MS","doi":"10.1016/j.xkme.2024.100835","DOIUrl":"10.1016/j.xkme.2024.100835","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000463/pdfft?md5=fd2a8b278591e2a70a44221d011c4654&pid=1-s2.0-S2590059524000463-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141029856","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":"Concurrent Crystalline Light-Chain Proximal Tubulopathy and Membranous Nephropathy: A Case Report and Literature Review","authors":"Huizi Zhang,&nbsp;Chunyun Zhang,&nbsp;Hua Su","doi":"10.1016/j.xkme.2024.100816","DOIUrl":"10.1016/j.xkme.2024.100816","url":null,"abstract":"<div><p>Light-chain proximal tubulopathy (LCPT) is typically characterized by the intracytoplasmic deposition of light chains within the proximal tubular epithelial cells, which is usually classified into crystalline and noncrystalline subgroups. Membranous nephropathy (MN) is a common glomerular disease characterized by diffused subepithelial electron-dense deposits along the capillary loop accompanied by the effacement and microvillus transformation of the foot process. Here, we report a biopsy-confirmed case of a concurrence of LCPT with crystals (κ light chains restricted) and antigen-undetermined MN in a male patient. The patient presented with low-molecular-weight proteinuria, increased serum creatinine levels, and incomplete Fanconi syndrome. To our knowledge, this is the first report of a concurrence of LCPT and independent MN of unknown target antigens, which may enrich our recognition of monoclonal gammopathy of renal significance with synchronous MN.</p></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S259005952400027X/pdfft?md5=74522a17a26efdef59315401ba1bcb33&pid=1-s2.0-S259005952400027X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140408240","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":"Sparsentan for Focal Segmental Glomerulosclerosis in the DUET Open-Label Extension: Long-term Efficacy and Safety","authors":"Kirk N. Campbell ,&nbsp;Loreto Gesualdo ,&nbsp;Edward Murphy ,&nbsp;Michelle N. Rheault ,&nbsp;Tarak Srivastava ,&nbsp;Vladimir Tesar ,&nbsp;Radko Komers ,&nbsp;Howard Trachtman","doi":"10.1016/j.xkme.2024.100833","DOIUrl":"https://doi.org/10.1016/j.xkme.2024.100833","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><p>Sparsentan is a novel, non-immunosuppressive, single-molecule, dual endothelin angiotensin receptor antagonist (DEARA) examined in the ongoing phase 2 DUET trial for focal segmental glomerulosclerosis (FSGS). In the DUET 8-week double-blind period, sparsentan resulted in greater proteinuria reduction versus irbesartan. We report the long-term efficacy and safety of sparsentan during the open-label extension over more than 4 years.</p></div><div><h3>Study Design</h3><p>Patients were examined from their first sparsentan dose (double-blind period or open-label extension) through 4.6 years.</p></div><div><h3>Setting &amp; Participants</h3><p>Patients with FSGS, excluding secondary FSGS.</p></div><div><h3>Intervention</h3><p>Sparsentan (200, 400, and 800<!--> <!-->mg/d).</p></div><div><h3>Outcomes</h3><p>Urinary protein-creatinine ratio, FSGS partial remission endpoint (urinary protein-creatinine ratio<!--> <!-->≤1.5<!--> <!-->g/g and<!--> <!-->&gt;40% reduction from baseline), estimated glomerular filtration rate, and blood pressure approximately every 12 weeks. Treatment-emergent adverse events by year and cases/100 patient-years.</p></div><div><h3>Results</h3><p>109 patients were enrolled; 108 received<!--> <!-->≥1 sparsentan dose; 103 entered the open-label extension (68 sparsentan, 35 irbesartan during the double-blind period). Sparsentan was ongoing in 45/108 patients (41.7%); median time to treatment discontinuation was 3.9 years (95% CI, 2.6-5.2). Mean percent proteinuria reduction from baseline was sustained through follow-up. Achieving partial remission within 9 months of first sparsentan dose (52.8% of patients) versus not achieving (47.2%) was associated with significantly slower rate of estimated glomerular filtration rate decline over the entire treatment period (−2.70 vs<!--> <!-->−6.56; <em>P</em> <!-->=<!--> <!-->0.03) and in the first 2 years (−1.69 vs<!--> <!-->−6.46; <em>P</em> <!-->=<!--> <!-->0.03). The most common treatment-emergent adverse events (&gt;9 cases/100 patient-years) were headache, peripheral edema, upper respiratory infection, hyperkalemia, and hypotension. Peripheral edema and hypotension declined from year 1 (13.9% and 15.7% of patients, respectively) to<!--> <!-->≤4% in years<!--> <!-->≥2. There were no cases of heart failure and no patient deaths.</p></div><div><h3>Limitations</h3><p>The open-label extension does not include a comparison group.</p></div><div><h3>Conclusions</h3><p>Long-term sparsentan treatment showed sustained proteinuria reduction and a consistent safety profile.</p></div><div><h3>Plain-Language Summary</h3><p>There is substantial unmet clinical need for safe and effective treatments for focal segmental glomerulosclerosis (FSGS), a kidney lesion with varied causes. Sparsentan is being studied for treatment of FSGS and targets 2 important pathways (endothelin-1 and angiotensin II) that lead to the loss of kidney function. In the 8-week randomized, doubl","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S259005952400044X/pdfft?md5=8ec98911908bcf19a9cbaea2a2968e87&pid=1-s2.0-S259005952400044X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141083992","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":"Urine Biomarkers of Kidney Tubule Health and Risk of Incident CKD in Persons Without Diabetes: The ARIC, MESA, and REGARDS Studies","authors":"Jonathan G. Amatruda ,&nbsp;Ronit Katz ,&nbsp;Casey M. Rebholz ,&nbsp;Mark J. Sarnak ,&nbsp;Orlando M. Gutierrez ,&nbsp;Sarah J. Schrauben ,&nbsp;Jason H. Greenberg ,&nbsp;Josef Coresh ,&nbsp;Mary Cushman ,&nbsp;Sushrut Waikar ,&nbsp;Chirag R. Parikh ,&nbsp;Jeffrey R. Schelling ,&nbsp;Manasi P. Jogalekar ,&nbsp;Joseph V. Bonventre ,&nbsp;Ramachandran S. Vasan ,&nbsp;Paul L. Kimmel ,&nbsp;Joachim H. Ix ,&nbsp;Michael G. Shlipak ,&nbsp;CKD Biomarkers Consortium","doi":"10.1016/j.xkme.2024.100834","DOIUrl":"https://doi.org/10.1016/j.xkme.2024.100834","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><p>Tubulointerstitial damage is a feature of early chronic kidney disease (CKD), but current clinical tests capture it poorly. Urine biomarkers of tubulointerstitial health may identify risk of CKD.</p></div><div><h3>Study Design</h3><p>Prospective cohort (Atherosclerosis Risk in Communities [ARIC]) and case-cohort (Multi-Ethnic Study of Atherosclerosis [MESA] and Reasons for Geographic and Racial Differences in Stroke [REGARDS]).</p></div><div><h3>Setting &amp; Participants</h3><p>Adults with estimated glomerular filtration rate (eGFR) ≥60<!--> <!-->mL/min/1.73<!--> <!-->m² and without diabetes in the ARIC, REGARDS, and MESA studies.</p></div><div><h3>Exposures</h3><p>Baseline urine monocyte chemoattractant protein-1 (MCP-1), alpha-1-microglobulin (α1m), kidney injury molecule-1, epidermal growth factor, and chitinase-3-like protein 1.</p></div><div><h3>Outcome</h3><p>Incident CKD or end-stage kidney disease.</p></div><div><h3>Analytical Approach</h3><p>Multivariable Cox proportional hazards regression for each cohort; meta-analysis of results from all 3 cohorts.</p></div><div><h3>Results</h3><p>872 ARIC participants (444 cases of incident CKD), 636 MESA participants (158 cases), and 924 REGARDS participants (488 cases) were sampled. Across cohorts, mean age ranged from 60<!--> <!-->±<!--> <!-->10 to 63<!--> <!-->±<!--> <!-->8 years, and baseline eGFR ranged from 88<!--> <!-->±<!--> <!-->13 to 91<!--> <!-->±<!--> <!-->14<!--> <!-->mL/min/1.73<!--> <!-->m². In ARIC, higher concentrations of urine MCP-1, α1m, and kidney injury molecule-1 were associated with incident CKD. In MESA, higher concentration of urine MCP-1 and lower concentration of epidermal growth factor were each associated with incident CKD. In REGARDS, none of the biomarkers were associated with incident CKD. In meta-analysis of all 3 cohorts, each 2-fold increase α1m concentration was associated with incident CKD (HR, 1.19; 95% CI, 1.08-1.31).</p></div><div><h3>Limitations</h3><p>Observational design susceptible to confounding; competing risks during long follow-up period; meta-analysis limited to 3 cohorts.</p></div><div><h3>Conclusions</h3><p>In 3 combined cohorts of adults without prevalent CKD or diabetes, higher urine α1m concentration was independently associated with incident CKD. 4 biomarkers were associated with incident CKD in at least 1 of the cohorts when analyzed individually. Kidney tubule health markers might inform CKD risk independent of eGFR and albuminuria.</p></div><div><h3>Plain-Language Summary</h3><p>This study analyzed 3 cohorts (ARIC, MESA, and REGARDS) of adults without diabetes or prevalent chronic kidney disease (CKD) to determine the associations of 5 urinary biomarkers of kidney tubulointerstitial health with incident CKD, independent of traditional measures of kidney health. Meta-analysis of results from all 3 cohorts suggested that higher baseline levels of urine alpha-1-microglobulin were ","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000451/pdfft?md5=9677af2a2936700dedd06ff7f9bd6d04&pid=1-s2.0-S2590059524000451-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141077780","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":"Proneurotensin/Neuromedin N and Risk of Incident CKD and Other Kidney Outcomes in Community-Living Individuals: The REGARDS Study","authors":"Alexander L. Bullen ,&nbsp;Alma Fregoso-Leyva ,&nbsp;Ronit Katz ,&nbsp;Dorothy Leann Long ,&nbsp;Katharine L. Cheung ,&nbsp;Suzanne E. Judd ,&nbsp;Orlando M. Gutierrez ,&nbsp;Joachim H. Ix ,&nbsp;Mary Cushman ,&nbsp;Dena E. Rifkin","doi":"10.1016/j.xkme.2024.100831","DOIUrl":"10.1016/j.xkme.2024.100831","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><p>Plasma proneurotensin/neuromedin N (pro-NT/NMN) is a precursor of neurotensin, a tridecapeptide linked with type 2 diabetes mellitus and other comorbid conditions associated with kidney disease. Whether pro-NT/NMN is directly associated with incident chronic kidney disease (CKD), and whether that association differs by race, is uncertain. We evaluated whether pro-NT/NMN levels were associated with increased risk of kidney outcomes.</p></div><div><h3>Study Design</h3><p>Prospective cohort.</p></div><div><h3>Setting &amp; Participants</h3><p>Participants in Biomarker Mediators of Racial Disparities in Risk Factors, a nested cohort from the REasons for Geographic And Racial Differences in Stroke study, with available stored serum and urine samples from baseline and second visits for biomarker measurement.</p></div><div><h3>Exposure</h3><p>Baseline log-transformed pro-NT/NMN.</p></div><div><h3>Outcomes</h3><p>Incident CKD, progressive estimated glomerular filtration rate (eGFR) decline, incident albuminuria, and incident kidney failure within median follow-up time of 9.4 years.</p></div><div><h3>Analytical Approach</h3><p>Logistic regression.</p></div><div><h3>Results</h3><p>Among 3,914 participants, the mean<!--> <!-->±<!--> <!-->SD age was 64<!--> <!-->±<!--> <!-->8 (SD) years, 48% were women, and 51% were Black. Median baseline eGFR was 90 (IQR, 77-102) mL/min/1.73<!--> <!-->m². Each SD higher of pro-NT/NMN was associated with 9% higher odds of progressive eGFR decline (OR, 1.09; 95% CI, 1.00-1.20). There was no association observed with incident CKD (OR, 1.10; 95% CI, 0.96-1.27), incident albuminuria (OR, 1.08; 95% CI, 0.96-1.22), or incident kidney failure (OR, 1.10; 95% CI, 0.83-1.46). There were no differences in results by race or sex.</p></div><div><h3>Limitations</h3><p>Single measurement of pro-NT/NMN and limited generalizability.</p></div><div><h3>Conclusions</h3><p>Higher pro-NT/NMN was associated with progressive eGFR decline but no other manifestations of kidney disease incidence.</p></div><div><h3>Plain-Language Summary</h3><p>Neurotensin is a peptide secreted by the small intestine in response to a meal. Higher levels of neurotensin and its stable precursor, proneurotensin/neuromedin N (pro-NT/NMN), have been associated with cardiovascular disease and type 2 diabetes mellitus, important risk factors for the development of kidney disease. Whether pro-NT/NMN is directly associated with kidney outcomes has been less studied and has been done so in largely homogenous cohorts of White participants. Using the REasons for Geographic And Racial Differences in Stroke study, we followed Black and White participants and evaluated the risk of developing kidney outcomes. We found that elevated levels of pro-NT/NMN were associated with kidney function decline. Pro-NT/NMN may help individuals who may benefit from closer monitoring of kidney function.</p></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000426/pdfft?md5=7ad0c198c6834e8031d4d4ea5f9aeb6e&pid=1-s2.0-S2590059524000426-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140775618","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":"Cystatin C Use for CKD Detection in the Veterans Health Administration System: A Qualitative Study of Barriers and Facilitators","authors":"Julio A. Lamprea-Montealegre ,&nbsp;Abigail Shapiro ,&nbsp;Natalie A.B. Bontrager ,&nbsp;Dena E. Rifkin ,&nbsp;Simerjot K. Jassal ,&nbsp;Lucile Parker Gregg ,&nbsp;Sankar D. Navaneethan ,&nbsp;Krista Navarra ,&nbsp;Michael G. Shlipak ,&nbsp;Michelle M. Estrella ,&nbsp;Virginia Wang","doi":"10.1016/j.xkme.2024.100830","DOIUrl":"10.1016/j.xkme.2024.100830","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><p>The measurement of cystatin C has been recommended to enhance chronic kidney disease (CKD) detection and risk stratification in clinical practice. This study gathered insights into the perceptions and experiences of clinical staff regarding the use of cystatin C in CKD detection within the Veterans Health Administration (VHA) system.</p></div><div><h3>Study Design</h3><p>A qualitative approach was employed to explore barriers and facilitators of clinical staff regarding the use of cystatin C in CKD detection within the VHA system. The Organizational Theory of Implementation Effectiveness informed the development of a semistructured interview guide.</p></div><div><h3>Setting &amp; Participants</h3><p>Health care providers, nurses, and clinical pharmacists from the VHA systems in San Francisco, San Diego, and Houston were interviewed between October 2021 and May 2022.</p></div><div><h3>Exposures</h3><p>Participants' experiences with cystatin C testing.</p></div><div><h3>Outcomes</h3><p>Perceived barriers and facilitators to cystatin C testing.</p></div><div><h3>Analytical Approach</h3><p>Participant responses from individual interviews were analyzed by a multidisciplinary team using rapid qualitative analysis methods.</p></div><div><h3>Results</h3><p>Fourteen in-depth interviews were conducted across the 3 VHA systems. Ten of 11 providers worked in primary care. Five key barriers to using cystatin C for CKD detection were identified. These included lack of patient awareness of CKD testing, lack of provider awareness about cystatin C, knowledge barriers about cystatin C testing, unclear roles and ownership of CKD detection, and lack of clinic support to enhance CKD detection. Suggested interventions to overcome these barriers included educational and training programs, improved clinic workflows, and electronic health record aids to support CKD detection and use of cystatin C.</p></div><div><h3>Limitations</h3><p>The results may not be generalizable to other health care systems outside the VHA.</p></div><div><h3>Conclusions</h3><p>The findings indicate a need for targeted interventions such as educational and training programs, improved clinical workflows, and electronic health record aids to address barriers limiting the use of cystatin C in clinical practice for enhanced CKD detection.</p></div><div><h3>Plain-Language Summary</h3><p>This study assessed how clinical staff at the Veterans Health Administration (VHA) feel about using a test called cystatin C to help detect chronic kidney disease (CKD) earlier and more accurately. The research team spoke to healthcare providers, nurses, and clinical pharmacists in San Francisco, San Diego, and Houston between October 2021 and May 2022. We conducted 14 detailed interviews to understand the challenges and opportunities in using cystatin C for CKD detection. We found that participants often lacked awareness of CKD and the benefits of testing with cystatin C. There","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000414/pdfft?md5=f62bce0ebf263264571fdc25971176cc&pid=1-s2.0-S2590059524000414-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140766276","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":"Hemodiafiltration versus Hemodialysis in End-Stage Kidney Disease: A Systematic Review and Meta-Analysis","authors":"Maria Gabriela Motta Guimarães ,&nbsp;Fernanda Pinheiro Martin Tapioca ,&nbsp;Naiara Rodrigues dos Santos ,&nbsp;Fernanda Pitta do Carmo Tourinho Ferreira ,&nbsp;Luiz Carlos Santana Passos ,&nbsp;Paulo Novis Rocha","doi":"10.1016/j.xkme.2024.100829","DOIUrl":"10.1016/j.xkme.2024.100829","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><p>The use of hemodiafiltration (HDF) as a kidney replacement therapy (KRT) in patients with end-stage kidney disease (ESKD) has sparked a debate regarding its advantages over conventional hemodialysis (HD). The present study aims to shed light on this controversy by comparing mortality rates and cause-specific deaths between ESKD patients receiving HDF and those undergoing HD.</p></div><div><h3>Study Design</h3><p>Systematic review and meta-analysis of randomized controlled trials (RCTs). The search was conducted using PubMed, EMBASE, and Cochrane Central on July 1, 2023.</p></div><div><h3>Setting &amp; Participants</h3><p>Adult patients with ESKD on regular KRT.</p></div><div><h3>Exposure</h3><p>Studies with participants undergoing HDF.</p></div><div><h3>Outcomes</h3><p>Primary outcomes were all-cause mortality, cardiovascular (CV) mortality, deaths related to infections, and kidney transplant. We also evaluated the endpoints for deaths related to malignancy, myocardial infarction, stroke, arrhythmias, and sudden death.</p></div><div><h3>Analytical Approach</h3><p>We included RCTs evaluating HDF versus HD. Crossover trials and studies with overlapping populations were excluded. Two authors independently extracted the data following predefined search criteria and quality assessment. The risk of bias was assessed with Cochrane’s RoB2 tool.</p></div><div><h3>Results</h3><p>We included 5 RCTs with 4,143 patients, of which 2,078 (50.1%) underwent HDF, whereas 2,065 (49.8%) were receiving HD. Overall, HDF was associated with a lower risk of all-cause mortality (risk ratio [RR], 0.81; 95% confidence interval [CI], 0.73-0.91; <em>P</em> <!-->&lt;<!--> <!-->0.001; I² <!-->=<!--> <!-->7%) and a lower risk of CV-related deaths (RR, 0.75; 95% CI, 0.61-0.92; <em>P</em> <!-->=<!--> <!-->0.007; I² <!-->=<!--> <!-->0%). The incidence of infection-related deaths was also significantly different between therapies (RR, 0.69; 95% CI, 0.50-0.95; <em>P</em> <!-->=<!--> <!-->0.02; I² <!-->=<!--> <!-->26%).</p></div><div><h3>Limitations</h3><p>In individual studies, the HDF groups achieved varying levels of convection volume.</p></div><div><h3>Conclusions</h3><p>Compared with those undergoing HD, patients receiving HDF experienced a reduction in all-cause mortality, CV mortality, and infection-related mortality. These results provide compelling evidence supporting the use of HDF as a beneficial intervention in ESKD patients undergoing KRT.</p></div><div><h3>Registration</h3><p>Registered at PROSPERO: CRD42023438362.</p></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000402/pdfft?md5=e3c3711e7e84ef736a4090316fd2ad24&pid=1-s2.0-S2590059524000402-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140763663","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":"Complementary and Alternative Medicine Use and Glomerular Disease: A Contemporary Case Series","authors":"Prem Kumar Devaraju ,&nbsp;Jayalakshmi Seshadri ,&nbsp;Chelvamalai Muthukumaran Balasubramanian ,&nbsp;Anila Abraham Kurien ,&nbsp;Guhan Senthilkumaran ,&nbsp;Vaishanavi Devi Rajarathinam ,&nbsp;Vijayakumar Stanlybai Jibia ,&nbsp;Vinoj Murugesan ,&nbsp;Tanuj Moses Lamech ,&nbsp;Dineshkumar Thanigachalam ,&nbsp;Sakthirajan Ramanathan ,&nbsp;Sheik Sulthan Alavudeen ,&nbsp;Shivakumar Dakshinamoorthy ,&nbsp;Seenivasan Mookaiah ,&nbsp;Natarajan Gopalakrishnan","doi":"10.1016/j.xkme.2024.100827","DOIUrl":"https://doi.org/10.1016/j.xkme.2024.100827","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><p>Complementary and alternative medicine (CAM) intake is widely prevalent in many parts of India. Heavy metals are known ingredients in some of these formulations. We studied the spectrum of glomerular diseases in patients using CAM.</p></div><div><h3>Study Design</h3><p>Case series.</p></div><div><h3>Setting &amp; Participants</h3><p>Patients with proteinuria or unexplained acute kidney injury, who underwent a kidney biopsy between May 2021 and September 2022, and who provided a history of recent CAM intake were included in the study. For patients enrolled prospectively, blood and urine samples were analyzed using mass spectrometry for the presence of mercury, lead, arsenic and cadmium. The CAM formulation, when available, was analyzed using inductively coupled plasma-optical emission spectroscopy.</p></div><div><h3>Results</h3><p>Twenty-eight patients were enrolled in the study, with a median duration of CAM intake of 4 months (interquartile range, 2-6 months). Heavy metal screening was performed in 17 patients, of whom 15 had elevated urine mercury levels, 10 had elevated blood mercury levels, and 1 had elevated blood and urine arsenic levels. Of the 6 CAM formulations that were analyzed, all had high levels of mercury. Kidney biopsy findings were membranous nephropathy (n<!--> <!-->=<!--> <!-->19), minimal change disease (n<!--> <!-->=<!--> <!-->8), and mesangial proliferative glomerulonephritis (n<!--> <!-->=<!--> <!-->1). Of the 19 patients with membranous nephropathy, 14 were associated with neural epidermal growth factor-like protein 1 (NELL-1). With conservative management alone, 17 patients achieved complete remission.</p></div><div><h3>Limitations</h3><p>Not all patients underwent blood and urine mercury testing, and only 6 patients provided the CAM samples for analysis. Furthermore, occupational and residential exposure to mercury could not be excluded.</p></div><div><h3>Conclusions</h3><p>The most common kidney pathology noted in our study was membranous nephropathy, which was predominantly associated with neural epidermal growth factor-like protein 1. A significant proportion of the patients recovered completely after withdrawal of the offending agent and initiation of renin-angiotensin system blockade.</p></div><div><h3>Plain Language Summary</h3><p>Complementary and alternative medicine (CAM) intake is widely prevalent in many parts of India, and heavy metals are known ingredients in some of these formulations. We describe the clinical spectrum of kidney disease, among patients who had recently ingested CAM. All patients underwent a kidney biopsy, and the most common finding was an entity called “NELL-1-associated membranous nephropathy,” which is known to be associated with heavy metal toxicity and CAM intake. Of 17 patients screened for such heavy metals, 15 had greater-than-permissible levels of mercury. Furthermore, 6 patients provided the CAM formulations that they had consumed for anal","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000384/pdfft?md5=bae3d83b99a9605c9c8068d2e6b34e8b&pid=1-s2.0-S2590059524000384-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141068721","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":"A Review of Focal Segmental Glomerulosclerosis Classification With a Focus on Genetic Associations","authors":"Marco Bonilla ,&nbsp;Orhan Efe ,&nbsp;Haresh Selvaskandan ,&nbsp;Edgar V. Lerma ,&nbsp;Nasim Wiegley","doi":"10.1016/j.xkme.2024.100826","DOIUrl":"10.1016/j.xkme.2024.100826","url":null,"abstract":"<div><p>Focal segmental glomerulosclerosis (FSGS) defines a distinct histologic pattern observed in kidney tissue that is linked to several distinct underlying causes, all converging on the common factor of podocyte injury. It presents a considerable challenge in terms of classification because of its varied underlying causes and the limited correlation between histopathology and clinical outcomes. Critically, precise nomenclature is key to describe and delineate the pathogenesis, subsequently guiding the selection of suitable and precision therapies. A proposed pathomechanism-based approach has been suggested for FSGS classification. This approach differentiates among primary, secondary, genetic, and undetermined causes, aiming to provide clarity. Genetic FSGS from monogenic mutations can emerge during childhood or adulthood, and it is advisable to conduct genetic testing in cases in which there is a family history of chronic kidney disease, nephrotic syndrome, or resistance to treatment. Genome-wide association studies have identified several genetic risk variants, such as those in apolipoprotein L1 (<em>APOL1</em>), that play a role in the development of FSGS. Currently, no specific treatments have been approved to treat genetic FSGS; however, interventions targeting underlying cofactor deficiencies have shown potential in some cases. Furthermore, encouraging results have emerged from a phase 2 trial investigating inaxaplin, a novel small molecule APOL1 channel inhibitor, in <em>APOL1</em>-associated FSGS.</p></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000372/pdfft?md5=94cd3108604d30cd53491d9615f30ee9&pid=1-s2.0-S2590059524000372-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140784394","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":"APOL1 Kidney Risk Variants and Long-Term Kidney Function in Healthy Middle-Aged Black Individuals: The Atherosclerosis Risk in Communities (ARIC) Study","authors":"Mona D. Doshi ,&nbsp;Lihua Li ,&nbsp;Abhijit S. Naik ,&nbsp;Christie P. Thomas","doi":"10.1016/j.xkme.2024.100828","DOIUrl":"10.1016/j.xkme.2024.100828","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><p>The effect of apolipoprotein L1(<em>APOL1)</em> genotype on future risk of kidney disease among middle-aged individuals with good kidney function is not well established.</p></div><div><h3>Study Design</h3><p>Longitudinal cohort study.</p></div><div><h3>Setting &amp; Participants</h3><p>In total, 5,886 healthy individuals (45-64 years old) enrolled in the Atherosclerosis Risk in Communities study with creatinine-based estimated glomerular filtration rate<!--> <!-->≥<!--> <!-->80<!--> <!-->mL/min who would be suitable kidney donors.</p></div><div><h3>Exposures</h3><p>Race and <em>APOL1</em> genotype.</p></div><div><h3>Outcomes</h3><p>Creatinine- and cystatin C-based estimated glomerular filtration rate (eGFRcr-cys) using the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) 2021 equation, urinary albumin-creatinine ratio (UACR), proportion with chronic kidney disease (CKD) 3a or worse, end-stage kidney disease (ESKD), and death.</p></div><div><h3>Analytical Approach</h3><p>Participants grouped based on race and <em>APOL1</em> genotype. Compared eGFRcr-cys and UACR across groups. Multinomial logistic regression models were used compare odds of CKD. Kaplan–Meier survival curves were created to compare rates of ESKD and death at last follow-up.</p></div><div><h3>Results</h3><p>There were 5,075 Whites (86%), 701 Blacks carrying the low-risk <em>APOL1</em> genotype (12%), and 110 Blacks carrying the high-risk A<em>POL1</em> genotype (2%). The mean age at baseline was 53<!--> <!-->±<!--> <!-->6 years. At 10 years, White participants had lower eGFRcr-cys than low-risk and high-risk groups (89<!--> <!-->±<!--> <!-->16 vs 91<!--> <!-->±<!--> <!-->16 and 92<!--> <!-->±<!--> <!-->15<!--> <!-->mL/min/1.73<!--> <!-->m², respectively; <em>P</em> <!-->&lt;<!--> <!-->0.001). At 25 years, White participants continued to have lower eGFRcr-cys than the low-risk group (70<!--> <!-->±<!--> <!-->18 vs 72<!--> <!-->±<!--> <!-->19<!--> <!-->mL/min/1.73<!--> <!-->m²; <em>P</em> <!-->&lt;<!--> <!-->0.001) but not compared with the high-risk <em>APOL1</em> genotype (67±23<!--> <!-->mL/min/1.73<!--> <!-->m²). There was no difference in UACR among groups at 10 and 25 years (<em>P</em> <!-->=<!--> <!-->0.87 and 0.91, respectively). The odds of developing CKD stage 3a or worse were not different between low-risk and high-risk <em>APOL1</em> group in both unadjusted and adjusted models (<em>P</em> <!-->=<!--> <!-->0.26 and <em>P</em> <!-->=<!--> <!-->0.39, respectively). At last follow-up,<!--> <!-->&lt;5% developed ESKD, and 45% of individuals either died or reached ESKD with no difference in outcomes between the groups.</p></div><div><h3>Limitations</h3><p>Low ascertainment because of death and long follow-up.</p></div><div><h3>Conclusions</h3><p>Among middle-aged individuals, <em>APOL1</em> genotype does not appear to be a major driver of future risk of kidney disease.</p></div><div><h3>Plain","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000396/pdfft?md5=03c5acaccdbaa3b7d1081f33c667e315&pid=1-s2.0-S2590059524000396-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140794290","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}