Kidney Medicine最新文献

{"title":"Malignancy-Associated Hypercalcemia and Kidney Disease: Facts, Controversies, and Management","authors":"Swetha R. Kanduri ,&nbsp;Pooja Amarapurkar ,&nbsp;Mohamed Hassanein ,&nbsp;Sabine Karam ,&nbsp;Juan Carlos Q. Velez ,&nbsp;Kenar D. Jhaveri","doi":"10.1016/j.xkme.2025.101218","DOIUrl":"10.1016/j.xkme.2025.101218","url":null,"abstract":"<div><div>Hypercalcemia can affect multiple organ systems and, depending on its severity, presents with a wide range of clinical manifestations. Severe hypercalcemia may lead to serious complications such as confusion and encephalopathy. Malignancy-associated hypercalcemia (MAH) occurs in up to 10%-30% of patients with cancer, with a higher incidence in those with advanced disease, and is associated with a poor prognosis. Several mechanisms have been proposed to explain MAH, the most prominent being humoral hypercalcemia of malignancy and osteolytic hypercalcemia. Although less common, recent advances have identified additional mechanisms of MAH, including novel cancer medications such as immune checkpoint inhibitors and prolonged immobilization. While various treatment modalities are available for managing hypercalcemia, dosing of antihypercalcemic medications in patients with kidney dysfunction remains challenging. This comprehensive review illustrates the mechanisms of MAH, discusses relevant investigations, and focuses on management strategies tailored to the severity of hypercalcemia in patients with cancer. Additionally, we address the dose adjustments for antihypercalcemic agents in patients with reduced glomerular filtration rate and explore potential areas for developing targeted therapies to better address MAH.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101218"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023167","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":"Translumbar and Transhepatic Catheters for Hemodialysis in Chronic Kidney Disease: A Systematic Review and Meta-Analysis","authors":"Rivaldo José Melo Tavares ,&nbsp;Mariana Póvoa-Corrêa ,&nbsp;Iandy de Souza Mateus Tarricone ,&nbsp;Simone Collopy ,&nbsp;Roberta Lins Gonçalves ,&nbsp;Carlos Alberto da Silva Magliano ,&nbsp;Gaudencio Espinosa Lopez","doi":"10.1016/j.xkme.2025.101216","DOIUrl":"10.1016/j.xkme.2025.101216","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><div>Patients with chronic kidney disease (CKD) often reach a point where their options for hemodialysis access are exhausted, when transhepatic and translumbar access becomes an option. The aim of this study is to compare the prevalence of complications associated with both types of catheters through a systematic review and meta-analysis.</div></div><div><h3>Study Design</h3><div>Literature-based systematic review and meta-analysis were accomplished in 2021/2022. Studies were obtained from 11 registries, including Medline/PubMed, Embase, and Scopus.</div></div><div><h3>Setting &amp; Study Populations</h3><div>Included studies involved patients with CKD in access exhaustion who underwent translumbar or transhepatic catheter placement.</div></div><div><h3>Selection Criteria for Studies</h3><div>Eligible designs included clinical trials, quasi-experimental studies, observational studies, and case series; case reports were excluded.</div></div><div><h3>Data Extraction</h3><div>Two independent researchers used a tailored sheet to extract data from the studies.</div></div><div><h3>Analytical Approach</h3><div>A fixed-effect model for proportions was used to assess complications across 18 observational studies involving 649 catheters.</div></div><div><h3>Results</h3><div>Compared to the translumbar group, the transhepatic group showed significantly higher proportions per 100 catheter-days of irreversible infections (0.085 [95% CI, 0.051-0.118] vs 0.015 [95% CI, 0.007-0.023]; <em>P</em> &lt; 0.001) and irreversible dysfunction (0.259 [95% CI, 0.205-0.313] vs 0.071 [95% CI, 0.054-0.089]; <em>P</em> &lt; 0.001). Total infections (<em>P</em> &lt; 0.001), thrombosis (<em>P</em> &lt; 0.001), and catheter displacement (<em>P</em> &lt; 0.001) were also significantly more frequent in the transhepatic group.</div></div><div><h3>Limitations</h3><div>The main challenge was the variability in study designs and the lack of randomized clinical trials, which was expected given the nature of the intervention.</div></div><div><h3>Conclusions</h3><div>Translumbar access in CKD is associated with fewer complications; however, transhepatic access remains a viable option as a bridge to definitive access or transplantation.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101216"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023169","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":"ReNU Syndrome due to a de novo RNU4-2 Variant as a Novel Genetic Cause of Proteinuria","authors":"William Morello ,&nbsp;Greta Armaroli ,&nbsp;Donatella Milani ,&nbsp;Anita Sofia Bellotti ,&nbsp;Paola Castelli ,&nbsp;Elena Cicchetti ,&nbsp;Alessandro Del Gobbo ,&nbsp;Alessandra De Franco ,&nbsp;Giovanni Montini","doi":"10.1016/j.xkme.2025.101202","DOIUrl":"10.1016/j.xkme.2025.101202","url":null,"abstract":"<div><div>Proteinuria has been linked to several genetic disorders, providing valuable insights into its pathophysiology. ReNU syndrome, a recently described condition caused by heterozygous variants in the <em>RNU4-2</em> gene, is characterized by intellectual disability, microcephaly, and multisystemic features. Kidney involvement has been reported exclusively as anatomical abnormalities.</div><div>Here, we presented a girl with isolated proteinuria and ReNU syndrome. Her prenatal history was notable for a small head circumference and reduced brain hemispheres. She was referred to our clinic at 3 months of age for isolated proteinuria. Physical examination revealed microsomia, strabismus, and dysmorphic features. Kidney ultrasound was unremarkable, and edema was never observed. A kidney biopsy showed minimal change disease with slight podocyte effacement. Treatment with prednisone was ineffective, and antiproteinuric agents were started. At her last follow-up, at age 16 years, nephrotic-range proteinuria persists with normal kidney function. Genetic testing before 2024 yielded no diagnosis, but whole-genome sequencing analysis later identified a de novo variant in the <em>RNU4-2</em> gene (n.64_65insT), confirming ReNU syndrome.</div><div>This case is the first documented report of isolated, persistent proteinuria in ReNU syndrome. We recommend testing for <em>RNU4-2</em> variants in patients with unexplained proteinuria and syndromic features and suggest regular monitoring for proteinuria in individuals with ReNU syndrome.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101202"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023172","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":"Chinese Herb-Induced Type II Crescentic Glomerulonephritis: A Case Report of Four Patients","authors":"Yujia Wang ,&nbsp;Kaiqi Huang ,&nbsp;Caiming Chen ,&nbsp;Keng Ye ,&nbsp;Kunmei Lai ,&nbsp;Xuan Tao ,&nbsp;Hong Chen ,&nbsp;Yanfang Xu","doi":"10.1016/j.xkme.2025.101228","DOIUrl":"10.1016/j.xkme.2025.101228","url":null,"abstract":"<div><div>Drug-induced type II crescentic glomerulonephritis is an uncommon but severe renal syndrome, rarely linked to pharmaceutical agents, with no established association to Chinese herbal medicines to date. In this case report, we described 4 patients who developed biopsy-confirmed type II crescentic glomerulonephritis within 1-4 weeks following exposure to Chinese herbal products. Key histopathologic findings included crescent formation in ≥50% of glomeruli and immunofluorescence demonstrating granular mesangial deposits of immunoglobulin G and C3, accompanied by prominent acute tubulointerstitial injury. Clinically, 75% of cases presented with macroscopic hematuria, reflecting severe glomerular capillary damage. The therapeutic regimen comprised intravenous methylprednisolone, cyclophosphamide, and plasma exchange. Persistent hematuria and a longer duration of drug exposure were associated with slower and incomplete renal recovery during follow-up. Our case report suggested that Chinese herbal medicine may be a potential environmental trigger for crescentic glomerulonephritis and highlight the value of clinical inquiry into herbal product use in cases of rapidly progressive glomerulonephritis. Further toxicovigilance and compound-specific risk assessments are urgently needed.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101228"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023174","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":"An Extremely Low-Birth-Weight Infant With Bone Fragility Due to Fanconi Syndrome","authors":"Rei Yoshida,&nbsp;Miku Hosokawa,&nbsp;Toshiko Ukawa,&nbsp;Chisa Tsurisawa,&nbsp;Yoshiya Hisaeda,&nbsp;Shusuke Amagata,&nbsp;Tomohiro Takeda,&nbsp;Atsushi Nakao","doi":"10.1016/j.xkme.2025.101227","DOIUrl":"10.1016/j.xkme.2025.101227","url":null,"abstract":"<div><div>Fanconi syndrome is a generalized dysfunction of the renal proximal tubule, leading to growth failure and rickets during childhood. There are few reports of this syndrome in neonates, especially in extremely low-birth-weight infants. We present a case of an extremely low-birth-weight Asian girl with bone fragility because of Fanconi syndrome without underlying diseases. She was born at 29 weeks of gestation and weighed 418 g (–5.2SD). Based on blood and urine analyses, she was diagnosed with Fanconi syndrome. Metabolic acidosis was easily corrected with bicarbonate supplementation. However, the control of the rickets was very difficult, with multiple bone fractures observed despite supplementation of calcium, phosphorus, and vitamin D. Her renal tubular function finally improved at 6 months of age, and oral supplementation of bicarbonate, calcium, and phosphorus was discontinued before discharge. The genetic test for inherited causes of Fanconi syndrome showed no abnormalities. Hypoperfusion during the fetal period was assumed to be one of the causes of Fanconi syndrome in this case.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101227"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023175","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":"Caveolin-1 as a Marker of Endothelial Damage in Primary Antiphospholipid Syndrome Nephropathy","authors":"Savino Sciascia ,&nbsp;Massimo Radin ,&nbsp;Irene Cecchi ,&nbsp;Alice Barinotti ,&nbsp;Francesco Trevisani ,&nbsp;Roberta Fenoglio ,&nbsp;Emanuele De Simone ,&nbsp;Dario Roccatello ,&nbsp;Paola Cassoni ,&nbsp;Antonella Barreca","doi":"10.1016/j.xkme.2025.101223","DOIUrl":"10.1016/j.xkme.2025.101223","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Thrombotic microangiopathy (TMA) as seen in antiphospholipid syndrome nephropathy (APSN) is associated with poor kidney outcomes. Caveolin-1 (Cav-1) has emerged as a potential marker of endothelial damage and microvascular injury.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;This retrospective study investigates the diagnostic potential value of Cav-1 immunohistochemistry in APSN-related TMA.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Patients were retrieved from the Piedmont and Aosta Valley Rare Disease Registry, from which a total of 771 APS cases had been recorded.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;Only case with biopsy-proven renal involvement were included.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Cases were classified into three histopathological clusters: TMA (APSN-TMA), hyperplastic vasculopathy, and subendothelial edema. Immunohistochemical staining for Cav-1 was performed and graded based on expression in peritubular and glomerular capillaries.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Clinical and laboratory data, including antiphospholipid antibody profiles, were correlated with Cav-1 expression.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Out of 771 patients with APS, a total of 11 patients with primary APS and renal involvement were retrieved (1.43%). APSN-TMA was identified in 7 (63.3%) cases, hyperplastic vasculopathy in 2 (18.1%), and subendothelial edema in 2 (18.1%). Cav-1 expression was significantly higher in APSN-TMA cases in both glomerular (&lt;em&gt;P&lt;/em&gt; &lt; 0.001) and peritubular (&lt;em&gt;P&lt;/em&gt; &lt; 0.05) capillaries compared with other clusters, with 5 of 7 APSN-TMA cases exhibiting diffuse (grade III) staining. Triple antiphospholipid antibody positive testing was more prevalent in APSN-TMA cases, reinforcing their distinct pathophysiological profile.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;The small sample size warrants validation in larger cohorts, and Cav-1 expression, although associated with APSN, might not be disease-specific.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;APSN-TMA is a rare manifestation of a rare disease. Cav-1 is strongly associated with APSN-TMA and may serve as a novel marker for its diagnosis and stratification. Given the poor renal prognosis of APSN-TMA, identifying affected patients is crucial for optimizing management strategies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Antiphospholipid syndrome (APS) is an autoimmune condition that can cause blood clots in many organs, including the kidneys. In some patients, a type of severe small-vessel injury called thrombotic microangiopathy develops, leading to poor kidney outcomes. Diagnosing this form of kidney damage can be challenging. In our study, we examined kidney tissue from people with APS using a special stain for a protein called Caveolin-1, which is found in damaged blood vessel cells. We found that high Caveolin-1 levels were strongly linked to the most aggressive form of APS-rel","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101223"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023239","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":"Real-World Effectiveness of Ravulizumab Among C5 Inhibitor-Naive Patients With Atypical Hemolytic Uremic Syndrome: A Physician Panel-Based Chart Review (aHUS IMPACT Study)","authors":"Ramy Magdy Hanna ,&nbsp;Shruti Chaturvedi ,&nbsp;Moh-Lim Ong ,&nbsp;Arpita Nag ,&nbsp;Rui Song ,&nbsp;Lynn Huynh ,&nbsp;Jordan A. Burdeau ,&nbsp;Mei Sheng Duh ,&nbsp;Yan Wang","doi":"10.1016/j.xkme.2025.101198","DOIUrl":"10.1016/j.xkme.2025.101198","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Atypical hemolytic uremic syndrome (aHUS) is a rare form of thrombotic microangiopathy (TMA) caused by complement dysregulation. Ravulizumab, a complement C5 inhibitor (C5i), is approved for aHUS; however, published evidence in a real-world setting is limited.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Retrospective, longitudinal, physician panel-based chart review.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Population&lt;/h3&gt;&lt;div&gt;C5i-naive adults with aHUS in the United States treated with ravulizumab. Physicians randomly selected 1-5 patients who had ≥6 months of follow-up after ravulizumab initiation; patients who died within 6 months of initiation were eligible.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure(s) or Predictor(s)&lt;/h3&gt;&lt;div&gt;Ravulizumab.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;The clinical outcomes evaluated included hematologic and renal outcomes, complete TMA response (a composite hematolgic/renal endpoint), and dialysis use.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Descriptive statistics, Kaplan-Meier estimators, and generalized linear models.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Overall, 79 C5i-naive adults with aHUS (enrolled by 31 physicians) initiated ravulizumab and were included in the study. Statistically significant improvements from baseline occurred as early as day 4 (lactate dehydrogenase and percent change in serum creatinine; both &lt;em&gt;P&lt;/em&gt; &lt; 0.001) and day 8 (platelet count; &lt;em&gt;P&lt;/em&gt; &lt; 0.001). The proportions of patients with normalization of platelet counts and lactate dehydrogenase levels, and ≥25% improvement in serum creatinine levels, were 14 out of 67 (21%), 12 out of 58 (21%), and 10 out of 65 (15%) at day 4, and 40 out of 48 (83%), 35 out of 38 (92%), and 42 out of 48 (88%) at 12 months after ravulizumab initiation, respectively. Complete TMA response rates were 60% and 68% within 6 and 12 months after ravulizumab initiation, respectively, and the median (interquartile range) time to complete TMA response was 3.1 (1.0-14.0) months. Of the 20 patients who received any dialysis at baseline, 14 (70.0%) did not have dialysis during follow-up.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;The study design relies on available medical record data and has potential responder bias.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;This study supports the immediate and sustained benefits of initiating ravulizumab in patients with aHUS as seen by the early response and continued improvement in clinical outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;This study evaluates the use of a treatment called ravulizumab for atypical hemolytic uremic syndrome (aHUS), a rare disease that causes clots in small blood vessels and can lead to kidney failure. Researchers reviewed the medical records of 79 adults with aHUS in the United States who were treated with ravulizumab and had never used similar treatments before. Significant improvements in laboratory measures including lactate dehydrogenase and se","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101198"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023245","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":"Systematic Review and Meta-analysis of the Predictive Performance of Stroke and Bleeding Prediction Models in Atrial Fibrillation Patients With Kidney Disease","authors":"Liselotte F.S. Langenhuijsen ,&nbsp;Daniëlle C.L. Derksen ,&nbsp;Jet Milders ,&nbsp;Sabine F.B. van der Horst ,&nbsp;Merel van Diepen ,&nbsp;Serge A. Trines ,&nbsp;Paul L. den Exter ,&nbsp;Frederikus A. Klok ,&nbsp;Joris I. Rotmans ,&nbsp;Ype de Jong","doi":"10.1016/j.xkme.2025.101200","DOIUrl":"10.1016/j.xkme.2025.101200","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Patients with atrial fibrillation (AF) and chronic kidney disease (CKD) are at high risk for ischemic stroke (IS) and bleeding. The applicability of prediction models in this population remains debated. This study aimed to (1) identify external validations of CHA&lt;sub&gt;2&lt;/sub&gt;DS&lt;sub&gt;2&lt;/sub&gt;-VASc, CHADS&lt;sub&gt;2&lt;/sub&gt;, HAS-BLED, and HEMORR&lt;sub&gt;2&lt;/sub&gt;HAGES model scores in patients with AF undergoing dialysis or with CKD, (2) provide pooled estimates, and (3) assess their risk of bias (ROB).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Systematic review and meta-analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;We searched Web of Science, PubMed, MEDLINE, Embase, Emcare, PMC, Cochrane Library, and Academic Search Premier for studies externally validating IS and bleeding prediction models in patients with AF undergoing dialysis or with CKD.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposures&lt;/h3&gt;&lt;div&gt;AF and CKD or dialysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;IS and bleeding.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Eligible studies were reviewed, discrimination was pooled using random-effects meta-analysis, calibration was calculated and plotted, and the ROB score was assessed using the prediction model ROB assessment tool.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The CHA&lt;sub&gt;2&lt;/sub&gt;DS&lt;sub&gt;2&lt;/sub&gt;-VASc score was validated in 35 studies, the CHADS&lt;sub&gt;2&lt;/sub&gt; and HAS-BLED scores in 19 each, and the HEMORR&lt;sub&gt;2&lt;/sub&gt;HAGES score in 1. Among 627,199 patients, 28,493 (4.5%) experienced IS and 25,695 (4.1%) bleeding. Only 12 studies presented c-statistic scores. In patients with AF and CKD, the CHADS&lt;sub&gt;2&lt;/sub&gt; model score showed nominally better discrimination predicting IS (pooled c-statistic score of 0.70) than the CHA&lt;sub&gt;2&lt;/sub&gt;DS&lt;sub&gt;2&lt;/sub&gt;-VASc model score (0.64). In patients with AF undergoing dialysis, the CHA&lt;sub&gt;2&lt;/sub&gt;DS&lt;sub&gt;2&lt;/sub&gt;-VASc and CHADS&lt;sub&gt;2&lt;/sub&gt; model scores showed similar discrimination predicting IS (both 0.70), and the HAS-BLED and HEMORR&lt;sub&gt;2&lt;/sub&gt;HAGES model scores showed similar c-statistic scores predicting bleeding (0.55 and 0.56, respectively). Calibration was good in the most relevant high-risk group.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;All studies were at high ROB scores, contained within- and between-study heterogeneity, and often merged scoring categories or populations, limiting comparability.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Although modest, the discrimination of prediction models in patients with AF undergoing dialysis or with CKD is similar to patients with AF without CKD. Despite the described limitations, these models can be used in clinical practice for patients with CKD and patients undergoing dialysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Patients with both atrial fibrillation (AF) and chronic kidney disease (CKD) or patients undergoing dialysis face a higher risk of stroke and therapy-related bleeding. To estimate these risks, prediction m","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101200"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023247","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":"Home Dialysis Transitions in Canada During the COVID-19 Pandemic: An Interrupted Time Series Analysis","authors":"Davide Verrelli ,&nbsp;Reid Whitlock ,&nbsp;Thomas Ferguson ,&nbsp;Claudio Rigatto ,&nbsp;Nathan Nickel ,&nbsp;Karthik Tennankore ,&nbsp;Oksana Harasemiw ,&nbsp;Ranveer Brar ,&nbsp;Clara Bohm","doi":"10.1016/j.xkme.2025.101207","DOIUrl":"10.1016/j.xkme.2025.101207","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;During the coronavirus disease 2019 (COVID-19) pandemic, nephrology societies recommended transition from facility-based hemodialysis to home dialysis to minimize risks associated with COVID-19 infection. We compared transition rates from facility-based hemodialysis to home dialysis and rates and reasons for transfers from home dialysis to facility-based hemodialysis before and during the pandemic in Canada.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Interrupted time-series analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Population&lt;/h3&gt;&lt;div&gt;Using administrative data from the Canadian Organ Replacement Register, our cohort included 31,596 and 22,607 adults with any time receiving hemodialysis during the prepandemic and pandemic study periods, respectively.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;Early pandemic (April 1, 2020-September 30, 2021) versus prepandemic (January 1, 2016-December 31, 2019).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Monthly rates of transitions between facility-based hemodialysis and home dialysis as well as reasons for transfer from home to facility.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Segmented linear regression and analysis of covariance.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;During the early pandemic, transitions to home dialysis increased by 0.60 per 10,000 patients/month (95% CI, 0.08 to 1.11; &lt;em&gt;P&lt;/em&gt; = 0.03), beyond the nonsignificant monthly prepandemic trend of 0.02 per 10,000 (95% CI, –0.10 to 0.13; &lt;em&gt;P&lt;/em&gt; = 0.80). Monthly transfers from home dialysis to facility-based hemodialysis per 10,000 home dialysis patients also increased during the pandemic (6.91; 95% CI, 3.42 to 10.40; &lt;em&gt;P&lt;/em&gt; &lt; 0.001) versus the prepandemic period (–1.78; 95% CI, –4.31 to0.75; &lt;em&gt;P&lt;/em&gt; = 0.20). The rate of increase in home-to-facility transfers during the pandemic was not significantly different than facility-to-home transfers (−0.10 transfers/month; 95% CI, –1.51 to 1.31; &lt;em&gt;P&lt;/em&gt; = 0.89). More transfers to facility occurred for geographic/resource-related reasons during the pandemic versus prepandemic (5.8% vs 2.7%; &lt;em&gt;P&lt;/em&gt; &lt; 0.0001).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Inability to analyze change in trends by province and ecological bias.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Transitions from facility-based hemodialysis to home dialysis increased, suggesting kidney care programs in Canada implemented recommendations intended to decrease COVID-19-related risks in this population. Reasons for the observed increase in transfers from home to facility during the pandemic are unclear.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;During the coronavirus disease 2019 (COVID-19) pandemic, individuals with kidney failure receiving dialysis faced high rates of COVID-19 transmission and severe infection. As a preventive measure, kidney care societies advised increased use of home dialysis. To assess the impact of this directive, we tracked monthly transitions from","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101207"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023248","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":"Fluid Management Based on Bioimpedance, Blood Volume, and Patient Reports: A Quality Improvement Project in Maintenance Hemodialysis","authors":"Sebastian Mussnig ,&nbsp;Luis Naar ,&nbsp;Simon Krenn ,&nbsp;Florian Brosch ,&nbsp;Daniel Schneditz ,&nbsp;Joachim Beige ,&nbsp;Manfred Hecking","doi":"10.1016/j.xkme.2025.101217","DOIUrl":"10.1016/j.xkme.2025.101217","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Fluid management in hemodialysis aims to remove excess fluid while avoiding symptoms of fluid depletion. This study evaluated the impact of determining euvolemic body mass by bioimpedance spectroscopy, and absolute blood volume (ABV), on clinical practice and patient-reported outcome measures (PROMs) at a bioimpedance/ABV-naïve dialysis center.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Fourteen week quality improvement project with 3 Assessment phases separated by 2 Adjustment phases.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Total of 127 patients at a single dialysis center.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Quality Improvement Activities&lt;/h3&gt;&lt;div&gt;Bioimpedance-spectroscopy-derived fluid overload (FO), ABV, and PROMs were longitudinally recorded. Physicians received data from each Assessment phase to inform treatment decisions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Fluid overload, ABV, PROMs, and agreement between perceived fluid status and FO.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytic Approach&lt;/h3&gt;&lt;div&gt;Generalized linear mixed-effects models analyzed changes over time and associations between FO, ABV, and PROMs. Agreement between perceived fluid status and FO was evaluated with linearly weighted Cohen’s κ.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;With each Assessment phase, pre-dialysis FO, systolic and diastolic blood pressure decreased overall (−0.12 L, &lt;em&gt;P&lt;/em&gt; = 0.006; −1.43 mm Hg, &lt;em&gt;P&lt;/em&gt; = 0.003; −0.83 mm Hg, &lt;em&gt;P&lt;/em&gt; &lt; 0.001), with a stronger reduction in baseline fluid overloaded (FO relative to extracellular fluid &gt;15%) patients (−0.25 L, &lt;em&gt;P&lt;/em&gt; &lt; 0.001; −1.84 mm Hg, &lt;em&gt;P&lt;/em&gt; = 0.011; −1.18 mm Hg, &lt;em&gt;P&lt;/em&gt; = 0.01). The difference between post-dialysis and euvolemic body mass decreased in fluid overloaded patients (−0.19 kg, &lt;em&gt;P&lt;/em&gt; = 0.006). Odds of longer recovery time increased (1.43, &lt;em&gt;P&lt;/em&gt; = 0.017), but no significant changes in intradialytic complications or hypotension occurred, and FO and ABV were not associated with any PROM (including recovery time) overall and separately in fluid overloaded patients. Agreement between perceived and bioimpedance-spectroscopy-derived FO was poor (κ: 0.007-0.037 for patients, 0.022-0.018 for nurses).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;During the introduction of bioimpedance- and ABV-guided fluid management at a hemodialysis center, fluid status improved without significant changes in intradialytic morbid events. The lack of agreement between perceived fluid status and bioimpedance-spectroscopy-derived FO reflects the daily clinical struggle when negotiating fluid management based on objective measures.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-language Summary&lt;/h3&gt;&lt;div&gt;Hemodialysis allows to remove excess fluid in patients with impaired kidney function who produce little-to-no urine. Closely monitoring fluid status is necessary to minimize both fluid depletion and fluid overload. This study investigated the combination of objective and subjective mo","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101217"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023297","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}