Nephrology Dialysis Transplantation最新文献

{"title":"Early identification of CKD in patients with solitary functioning kidney.","authors":"Luigi Cirillo, Tommaso Mazzierli, Alessandra Bettiol, Andrea La Tessa, Marco Moscato, Samantha Innocenti, Elisa Buti, Carmela Errichiello, Marco Materassi, Catia Olianti, Lorenzo Masieri, Francesca Becherucci","doi":"10.1093/ndt/gfaf063","DOIUrl":"https://doi.org/10.1093/ndt/gfaf063","url":null,"abstract":"","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Meta-analysis of Graft Survival, Patient Survival, and Delayed Graft Function in First-Time and Repeat Kidney Transplants.","authors":"Mehmet Kanbay, Sama Mahmoud Abdel-Rahman, Crischentian Brinza, Lasin Ozbek, Elif Yayci, Ozgur Aktas, Candan Genc, Mustafa Guldan, Ezgi N Alper, Alexandru Burlacu, Andreea Covic, Adrian Covic","doi":"10.1093/ndt/gfaf066","DOIUrl":"https://doi.org/10.1093/ndt/gfaf066","url":null,"abstract":"<p><strong>Background: </strong>Previous evidence showed that while first-time kidney transplants typically yield better outcomes, repeat and subsequent transplants were associated with increased risks of graft failure and adverse patient outcomes, yet conflicting findings exist. The aim of this meta-analysis is to compare graft survival and delayed graft function (DGF) outcomes in first-time kidney transplants (KT), repeat kidney transplants (regrafts), and subsequent KT.</p><p><strong>Methods: </strong>Relevant studies were identified through comprehensive searches in PubMed, Web of Science, Cochrane Library, MEDLINE (Ovid) and Scopus until 8 October 2024. Primary outcomes include graft survival, and DGF compared to repeat, and subsequent kidney transplants.</p><p><strong>Results: </strong>The meta-analysis included a total of 16 studies. Analysis on long-term graft survival revealed that patients who underwent a first KT had significantly better graft survival compared to those who received a second transplant (86.7% vs. 77.6%; OR 1.40, 95% CI 1.14-1.71, p = 0.001). At 5 years post-transplant, first KT recipients continued to demonstrate superior graft survival (OR 1.41, 95% CI 1.13-1.77, p = 0.003), although this difference diminished by 10 years, with no significant disparity observed (OR 1.26, 95% CI 0.88-1.81, p = 0.20). Graft survival at 5 years was also significantly higher in second KT recipients compared to those undergoing a third transplant (OR 2.66, 95% CI 1.86-3.80, p < 0.00001). Patient survival outcomes were largely comparable between first and second KT groups, with no statistically significant differences in overall survival (OR 1.25, 95% CI 0.87-1.81, p = 0.23). At specific time points, the 5-year survival rate showed a borderline non-significant trend favoring first KT recipients (OR 1.63, 95% CI 0.97-2.73, p = 0.06), while the 10-year survival rate showed no difference (OR 0.94, 95% CI 0.67-1.32, p = 0.71). Survival rates between second and subsequent retransplants (e.g., third or fourth KT) showed no significant variation, including at 5 years (p = 0.37 and p = 0.90, respectively). DGF rates did not differ significantly between first and second KT recipients (p = 0.11).</p><p><strong>Conclusion: </strong>These findings underscore the superior graft survival associated with first and second kidney transplants compared to subsequent retransplants, particularly in the early post-transplant period, while highlighting the lack of significant differences in overall patient survival across groups; however, variability in outcomes due to study heterogeneity and patient-specific factors warrants cautious interpretation and tailored clinical approaches.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glucocorticoids-induced remission followed by rituximab as maintenance therapy for podocytopathy with minimal change lesions in adults.","authors":"Ling Wang, Chen Yan, Shihui Hou, Xinghong Liu, Fei Xiao, Huanzi Dai","doi":"10.1093/ndt/gfaf050","DOIUrl":"https://doi.org/10.1093/ndt/gfaf050","url":null,"abstract":"","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IdeZ protease does not prevent convertase stabilization by C3 nephritic factors in C3 glomerulopathy.","authors":"Kes H Stevens, Laura M Baas, Nicole C A J van de Kar, Lambertus P W J van den Heuvel, Marloes A H M Michels","doi":"10.1093/ndt/gfaf065","DOIUrl":"https://doi.org/10.1093/ndt/gfaf065","url":null,"abstract":"","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maintaining kidney health in aging societies: a JSN and ERA call to action.","authors":"Alberto Ortiz, Anneke Kramer, Ivan Rychlík, Masaomi Nangaku, Motoko Yanagita, Kitty J Jager, Fergus J Caskey, Vianda S Stel, Naoki Kashihara, Takahiro Kuragano, Yusuke Suzuki, Yoshiaki Takemoto, Hideki Yokoi, Giuseppe Palladino, Danilo Fliser, Roser Torra, Christoph Wanner","doi":"10.1093/ndt/gfaf068","DOIUrl":"https://doi.org/10.1093/ndt/gfaf068","url":null,"abstract":"<p><p>Chronic kidney disease (CKD) is the fastest growing cause of death, expected to become the fifth global cause of death and the third in some countries with long life expectancy, such as Japan and Spain by 2050. This reflects societal aging, as advancing kidney age is the main risk factor for CKD. The forecasted 140% increase in death rate from CKD by 2050 is reduced to 33% when adjusted for age. The increasing mortality burden is paralleled by higher personal, healthcare, socioeconomic, and environmental burdens and need for kidney replacement therapy to treat kidney failure. To some extent, the higher CKD burden represents the price of success in prolonging longevity by decreasing other causes of death. Now is the time to act to minimize the negative impact of CKD on aging societies through primary prevention and early diagnosis and treatment of CKD. Action aimed at maintaining kidney health and delaying kidney aging will contribute to healthy aging as the kidneys have gerosuppressor functions. CKD has the highest negative impact on body aging among chronic non-communicable diseases. This should be part of a move towards novel holistic approaches to healthy longevity represented by concepts such as cardiovascular-kidney-metabolic health, geromedicine, gerosuppressors, and organ rejuvenation. We discuss a conceptual framework for the present and future of kidney aging and kidney health in the elderly, emphasizing opportunities for intervention that underlie the Japanese Society of Nephrology (JSN) and European Renal Association (ERA) call to action on Achieving Kidney Health in Aging/Aged Societies.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SGLT2 inhibition for patients with ADPKD - closing the evidence gap.","authors":"Roman-Ulrich Müller, Dominique Guerrot, Michel Chonchol, Roland Schmitt, Kiyotaka Uchiyama, Ron T Gansevoort, Emilie Cornec-Le Gall","doi":"10.1093/ndt/gfaf061","DOIUrl":"https://doi.org/10.1093/ndt/gfaf061","url":null,"abstract":"<p><p>Inhibitors of the sodium-glucose cotransporter 2 (SGLT2i) were originally developed to treat diabetes mellitus but have shown important renoprotective benefits independently from blood glucose levels. SGLT2i have thus become an important addition to the therapeutic armamentarium to treat patients with chronic kidney disease. However, specific patient populations were excluded from the pivotal trials, for instance patients with very low eGFR, patients on dialysis, kidney transplant recipients and patients with autosomal dominant polycystic kidney disease (ADPKD), the most common genetic kidney disorder. Considering the lack of potent treatment modalities in ADPKD, the use of SGLT2i in this patient population would be of major interest. However, the combination of inconclusive results from preclinical models with the lack of clinical efficacy data and potential disease-specific safety concerns currently exclude patients with ADPKD from this promising therapeutic opportunity. This results in an urgent need for adequately powered clinical trials examining SGLT2i in ADPKD. This review summarizes the current knowledge on SGLT2i in this specific patient population and outlines running and upcoming clinical trial programs in different geographic regions aiming to make SGLT2i accessible to patients with ADPKD.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardio-Kidney Outcomes for Combined versus Monotherapy with Finerenone or SGLT2 Inhibitors in Patients with CKD.","authors":"Min-Hsiang Chuang, Hsien-Yi Wang, Wei-Chih Kan, Chih-Chiang Chien, Ming-Yan Jiang, Yun-Ting Huang, Vin-Cent Wu, Jui-Yi Chen","doi":"10.1093/ndt/gfaf064","DOIUrl":"https://doi.org/10.1093/ndt/gfaf064","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and finerenone each improve kidney and cardiovascular outcomes in patients with chronic kidney disease (CKD). This study compares the association between combined therapy versus monotherapy with SGLT2i or finerenone and the kidney, cardiovascular, and mortality outcomes in CKD patients.</p><p><strong>Methods: </strong>This retrospective cohort study included adults ≥18 years with CKD between July 9, 2021, and November 30, 2023 from multiple centers in the United States, utilizing the TriNetX database. Exposures included treatment with finerenone, SGLT2i, or a combination of both. The primary outcome was major adverse kidney events (MAKE). Secondary outcomes included all-cause mortality, major adverse cardiac events (MACE), and end stage renal disease (ESRD).</p><p><strong>Results: </strong>853 patients were included in the combined group [mean (±SD) age, 66.7±11.4 years; 34.9% female), 942 in the finerenone group (mean age, 68.2±11.4 years; 45.8% female), and 45,948 in the SGLT2i group (mean age, 70.2±11.8 years; 41.4% female). After matching, the combined group had less MAKE compared to finerenone monotherapy [adjusted hazard ratio (aHR)=0.20; 95% CI, 0.09-0.45] or SGLT2i monotherapy (aHR=0.44; 95% CI, 0.22-0.89). The hazards of all-cause mortality and ESRD were also lower in the combined group compared to either finerenone or SGLT2i alone, while hazard of MACE was similar between the combined and monotherapy groups. The combined group had higher risk of hyperkalemia compared to SGLT2i monotherapy (aHR=1.36; 95% CI, 1.08-1.71).</p><p><strong>Conclusion: </strong>Combined therapy with finerenone and SGLT2i is associated with less MAKE and all-cause mortality in CKD patients compared to monotherapy. However, the risk of hyperkalemia with finerenone warrants caution.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genotype and X-chromosome inactivation are associated with disease severity in females with X-linked Alport syndrome.","authors":"Ryota Suzuki, Nana Sakakibara, Sae Murakami, Yuta Ichikawa, Hideaki Kitakado, Chika Ueda, Yu Tanaka, Eri Okada, Atsushi Kondo, Yuya Aoto, Shinya Ishiko, Shingo Ishimori, China Nagano, Tomohiko Yamamura, Tomoko Horinouchi, Takayuki Okamoto, Kandai Nozu","doi":"10.1093/ndt/gfae182","DOIUrl":"10.1093/ndt/gfae182","url":null,"abstract":"<p><strong>Background: </strong>Male patients with X-linked Alport syndrome (XLAS) generally develop end-stage kidney disease in early or middle adulthood and show distinct genotype-phenotype correlations. However, female patients show various phenotypes ranging from asymptomatic to severe with no genotype-phenotype correlations. The factors affecting the severity of XLAS in female patients are unclear. Since X-chromosome inactivation (XCI) affects the severity of certain female X-linked diseases, we investigated whether genotype and XCI were associated with XLAS severity in female patients in a large Japanese cohort.</p><p><strong>Methods: </strong>Among 139 female patients with genetically diagnosed XLAS at our institution, we conducted XCI analysis on peripheral blood leucocytes using the human androgen receptor assay method and analysed two cohorts. In 74 adult female patients we evaluated the correlation between kidney function [creatinine estimated glomerular filtration rate (Cr-eGFR) optimized for Japanese individuals] and genotype/XCI using multivariable linear regression analysis and in 65 paediatric female patients we evaluated the correlation between kidney function (Cr-eGFR optimized for Japanese individuals) and genotype/XCI using multivariable linear regression analysis. We also investigated the correlation between the development of proteinuria (urine protein:creatinine ratio above normal for the patient's age) and genotype/XCI using multivariable Cox proportional hazards analysis.</p><p><strong>Results: </strong>In adult female patients, the XCI pattern was significantly associated with Cr-eGFR (regression coefficient estimate -0.53, P = .004), whereas genotype was not (P = .892). In paediatric female patients, both genotype and XCI pattern were significant independent risk factors for the development of proteinuria {hazard ratio [HR] 3.702 [95% confidence interval (CI) 1.681-8.150], P = .001 and HR 1.043 [95% CI 1.061-1.070], P = .001, respectively}, whereas both genotype and XCI pattern were not associated with Cr-eGFR (P = .20 and P = .67, respectively).</p><p><strong>Conclusion: </strong>Genotype and XCI are factors associated with severity in females with XLAS.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"688-695"},"PeriodicalIF":4.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early steroid withdrawal and kidney transplant outcomes in first-transplant and retransplant recipients.","authors":"Sunjae Bae, Yusi Chen, Shaifali Sandal, Krista L Lentine, Mark Schnitzler, Dorry L Segev, Mara A McAdams DeMarco","doi":"10.1093/ndt/gfae218","DOIUrl":"10.1093/ndt/gfae218","url":null,"abstract":"<p><strong>Background: </strong>Early steroid withdrawal (ESW) is often preferred over conventional steroid maintenance (CSM) therapy for kidney transplant recipients with low immunological risks because it may minimize immunosuppression-related adverse events while achieving similar transplant outcomes. However, the risk-benefit balance of ESW could be less favorable in retransplant recipients given their unique immunological risk profile. We hypothesized that the association of ESW with transplant outcomes would differ between first-transplant and retransplant recipients.</p><p><strong>Methods: </strong>To assess whether the impact of ESW differs between first and retransplant recipients, we studied 210 086 adult deceased-donor kidney transplant recipients using the Scientific Registry of Transplant Recipients. Recipients who discontinued maintenance steroids before discharge from transplant admission were classified with ESW; all others were classified with CSM. We quantified the association of ESW (vs CSM) with acute rejection, death-censored graft failure and death, addressing retransplant as an effect modifier, using logistic/Cox regression with inverse probability weights to control for confounders.</p><p><strong>Results: </strong>In our cohort, 26 248 (12%) were retransplant recipients. ESW was used in 30% of first-transplant and 20% of retransplant recipients. Among first-transplant recipients, ESW was associated with no significant difference in acute rejection {adjusted odds ratio (aOR) = 1.04 [95% confidence interval (CI) = 1.00-1.09]}, slightly higher hazard of graft failure [hazard ratio (HR) = 1.09 (95% CI = 1.05-1.12)] and slightly lower mortality [HR = 0.93 (95% CI = 0.91-0.95)] compared with CSM. Nonetheless, among retransplant recipients, ESW was associated with notably higher risk of acute rejection [OR = 1.42 (95% CI = 1.29-1.57); interaction P < .001] and graft failure [HR = 1.24 (95% CI = 1.14-1.34); interaction P = .003], and similar mortality [HR = 1.01 (95% CI = 0.94-1.08); interaction P = .04].</p><p><strong>Conclusions: </strong>In retransplant recipients, the negative impacts of ESW on transplant outcomes appear to be non-negligible. A more conservatively tailored approach to ESW might be necessary for retransplant recipients.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"662-670"},"PeriodicalIF":4.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11960740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142350764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hydroxychloroquine for all patients with lupus nephritis?: no.","authors":"Fernando Caravaca-Fontán, Federico Yandian, Fernando C Fervenza","doi":"10.1093/ndt/gfae254","DOIUrl":"10.1093/ndt/gfae254","url":null,"abstract":"","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"607-609"},"PeriodicalIF":4.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}