Clinical Journal of the American Society of Nephrology最新文献

{"title":"Finerenone and Clinical Outcomes in Chronic Kidney Disease and Type 2 Diabetes by Frailty Index: FIDELITY Post Hoc Analysis.","authors":"Peter Rossing,Andreas L Birkenfeld,Paola Fioretto,Janet B McGill,Stefan D Anker,Bertram Pitt,Katja Rohwedder,Andrea Scalise,Charlie Scott,Gerasimos Filippatos,","doi":"10.2215/cjn.0000000700","DOIUrl":"https://doi.org/10.2215/cjn.0000000700","url":null,"abstract":"INTRODUCTIONFrailty is associated with a higher risk of adverse outcomes. It is believed that people with a higher frailty index may be less tolerant to new treatments, often leading to inappropriate prescribing. This post hoc analysis of FIDELITY, a prespecified, pooled analysis of the FIDELIO-DKD and FIGARO-DKD phase 3 clinical trials, investigated the efficacy and safety of finerenone versus placebo according to baseline frailty index.METHODSBetween September 2015 and October 2018, 12,990 people with chronic kidney disease (CKD) and type 2 diabetes (T2D) receiving the maximum tolerated dose of a renin-angiotensin system inhibitor were randomized to receive finerenone 10 or 20 mg once daily or placebo. Baseline frailty index was calculated using the Rockwood cumulative deficit approach including 30 clinical characteristics. Primary efficacy outcomes included a kidney (kidney failure, sustained decrease of ≥57% in estimated glomerular filtration rate [eGFR], or kidney-related death) and a cardiovascular (CV) composite outcome (CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure). Changes in urine albumin-to-creatinine ratio (UACR) and eGFR were measured across the study period.RESULTSOverall, kidney and CV event rates increased with increasing frailty. Finerenone reduced the risk of primary kidney and CV composite outcomes irrespective of baseline frailty (P interaction=0.93 and 0.35, respectively). Compared with placebo, finerenone also demonstrated significant reductions in UACR across all frailty subgroups (P<0.01 for all visits) and significant attenuation of eGFR decline from baseline to month 48 in the three most frail quartiles (>Q1 to ≤Q2, P=0.001; >Q2 to ≤Q3, P<0.001; >Q3, P<0.001, respectively). The incidence of serious adverse events and hyperkalemia increased with increasing frailty in both treatment arms.CONCLUSIONFinerenone reduced the risk of CV and kidney events in people with CKD and T2D versus placebo irrespective of baseline frailty status.REGISTRATIONFIDELIO-DKD (NCT02540993) and FIGARO-DKD (NCT02545049).","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"6 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143903104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intermuscular Adipose Tissue in Chronic Kidney Disease: A Window into Muscle Quality and Health?","authors":"Mert Demirci,R Gulsah Dilaver,Baback Roshanravan,T Alp Ikizler,Jorge L Gamboa","doi":"10.2215/cjn.0000000745","DOIUrl":"https://doi.org/10.2215/cjn.0000000745","url":null,"abstract":"Patients with chronic kidney disease (CKD) often experience loss of muscle mass, altered muscle function, and low physical functionality, all of which contribute to increased mortality and morbidity. Mitochondrial dysfunction emerges early in the progression of CKD and may play a central role in physical dysfunction. Factors such as uremia, systemic inflammation, oxidative stress, and inappropriate activation of the renin-angiotensin-aldosterone system may play are role on mitochondrial dysfunction. On the other hand, the accumulation of ectopic adipose tissue in skeletal muscle, also known as intermuscular adipose tissue (IMAT), is a newly recognized factor in muscle function and physical performance. IMAT is a marker of muscle quality, adversely affecting local muscle function, and is associated with insulin resistance and systemic inflammation, conditions commonly observed in CKD. Nevertheless, the exact composition of IMAT and its relationship with mitochondria and muscle energetics in CKD is not fully understood. Evaluating the relationship between IMAT accumulation and mitochondrial dysfunction in CKD may unveil potential interventions to improve physical function and the quality of life of patients with CKD.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"36 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143897461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decoding Natural Language Processing and Large Language Models in Kidney Health.","authors":"Hailey Yetman,Lili Chan","doi":"10.2215/cjn.0000000746","DOIUrl":"https://doi.org/10.2215/cjn.0000000746","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"10 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143897463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Cardiovascular-Kidney-Metabolic Health Framework: Implications for Nephrology.","authors":"Janani Rangaswami,Michael G Shlipak,Roy O Mathew,Chiadi E Ndumele","doi":"10.2215/cjn.0000000744","DOIUrl":"https://doi.org/10.2215/cjn.0000000744","url":null,"abstract":"Metabolic risk factors, chronic kidney disease, and cardiovascular disease are highly prevalent, frequently co-exist, and adversely impact lifespan and health span globally. The American Heart Association (AHA) recently defined Cardiovascular-Kidney-Metabolic (CKM) syndrome to highlight the interconnectedness between these conditions, across biological and socio-ecological domains. The CKM health initiative of the AHA seeks to improve cardiovascular and kidney health at a population level by providing a holistic approach to the management of individuals with CKM syndrome, emphasizing CKM health across the lifespan with priority for primordial/primary prevention, improving short and long-term cardiovascular risk prediction, and presenting an implementation framework for multidisciplinary health care models across diverse healthcare settings. Chronic kidney disease is a key risk factor, mediator, and therapeutic target to reduce cardiovascular disease burden, and is represented across all aspects of the AHA CKM health framework. This review article highlights the major take-aways for nephrologists from the AHA CKM health initiative. It outlines the areas where nephrologists can impact the delivery of holistic CKM care as part of the multidisciplinary team. Finally, it describes a potential future role for nephrology to guide and implement screening and early interventions for kidney disease, to move the needle towards kidney health at a population level.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"30 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Concept, Usefulness, and Limitations of the Urine Anion Gap","authors":"Daniel Batlle, Ahmed Ismail, Bilal Mohammed, Robert Rosa.","doi":"10.2215/cjn.0000000742","DOIUrl":"https://doi.org/10.2215/cjn.0000000742","url":null,"abstract":"An abstract is unavailable. This article is available as a PDF only.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"22 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143878085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How I Treat Polycystic Kidney Disease in Pregnancy.","authors":"Niloofar Nobakht,Sherry Dadgar,Mohammad Kamgar,Ehsan Nobakht","doi":"10.2215/cjn.0000000741","DOIUrl":"https://doi.org/10.2215/cjn.0000000741","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"26 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143872025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Hypothesis for the 'Obesity Paradox' in End Stage Kidney Disease (ESKD) Subjects on Dialysis.","authors":"Christopher Baker,Biff F Palmer,Deborah J Clegg","doi":"10.2215/cjn.0000000734","DOIUrl":"https://doi.org/10.2215/cjn.0000000734","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"32 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143861989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling the Causal Relationship Between Thyroid and Kidney Function: A Multivariable Mendelian Randomization.","authors":"Hsiao-Mei Tsao,Yu-Hsuan Joni Shao,Yi-Cheng Chang,Yu-Hsiang Chou,Vin-Cent Wu,Shuei-Liong Lin,Yung-Ming Chen,Tai-Shuan Lai","doi":"10.2215/cjn.0000000722","DOIUrl":"https://doi.org/10.2215/cjn.0000000722","url":null,"abstract":"BACKGROUNDRecent studies suggest an association between thyroid dysfunction and kidney function, but the causal relationship remains uncertain. The complex interactions between thyroid-stimulating hormone (TSH), free thyroxine (fT4), and thyroid peroxidase antibodies (TPOAb) complicate the assessment of this link. This study employed multivariable Mendelian randomization (MVMR) to elucidate the causal relationship between thyroid dysfunction and kidney function in East Asian and European populations.METHODSWe conducted a cross-sectional study and MVMR analysis using data from 17,733 participants in the Taiwan Biobank. Thyroid function was assessed by measuring TSH, fT4 and TPOAb levels, with hypothyroidism classified as subclinical or overt. The primary outcome was creatinine-based estimated glomerular filtration rate (eGFR), calculated using the Chronic Kidney Disease-EPIdemiology Collaboration equation. Observational analyses were adjusted for age, sex, body mass index, and metabolic and cardiovascular factors. MVMR analyses used genetic variants associated with TSH, fT4, and TPOAb levels to assess their causal effects on eGFR. Data from the ThyroidOmics and CKDGen Consortium were used to replicate findings in European populations.RESULTSBoth TSH and fT4 levels were inversely associated with eGFR, and hypothyroidism was correlated with lower eGFR. Conversely, TPOAb was positively associated with eGFR. Mendelian randomization analyses, using 26 genetic variants for TSH, four for fT4, and eight for TPOAb confirmed a causal relationship between TSH and eGFR. Significant causal effects of TSH were observed across various MVMR methods (P values from <0.001 to 0.01), whereas fT4 and TPOAb showed no significant causal effects (both P >0.05). These findings were consistent in European populations.CONCLUSIONSThe study found that elevated TSH levels are causally associated with reduced kidney function, highlighting the potential importance of thyroid function in kidney health. These findings suggest that thyroid dysfunction should be considered in managing patients with chronic kidney disease.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"43 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143862019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemodialysis Central Venous Catheter Use and Infections Before and After the COVID-19 Pandemic: Data from a National Dialysis Provider.","authors":"Monica M Shieu,Daniel E Weiner,Nien Chen Li,Harold J Manley,Antonia Harford,Caroline M Hsu,Dana Miskulin,Doug Johnson,Eduardo K Lacson","doi":"10.2215/cjn.0000000679","DOIUrl":"https://doi.org/10.2215/cjn.0000000679","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"49 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143851060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Green, Sustainable Nephrology: State of the Art Needs for Education and Implementation.","authors":"Giorgina Barbara Piccoli,Mariana Murea,Mohamed Ben Hmida,Nathan Berman-Parks,Carole Bonnet,Claudia D'Alessandro,Drasko Pavlovic,Elena Rho,Faissal Tarrass,Carla Maria Avesani,Massimo Torreggiani","doi":"10.2215/cjn.0000000731","DOIUrl":"https://doi.org/10.2215/cjn.0000000731","url":null,"abstract":"Green nephrology, also often called sustainable nephrology, has become a field of interest in our discipline in recent years. While several reviews have been published, comparatively few original papers have appeared, witnessing interest but also lack of original data. Greater awareness of the impact nephrology has on the planet, including, but not limited to its carbon footprint, is needed to promote education and research on these issues. Increasing awareness entails increasing knowledge at various levels and it is for this reason that we are presenting this review focusing on educational activities that have been and could further be undertaken to spread knowledge of these topics. We start from a description of the various approaches to green nephrology: technical, mainly focused on dialysis, clinical, encompassing medical and non-medical treatments in all chronic kidney disease (CKD) phases, and comprehensive, embedding kidney care in the society. We further summarize what is known and the fundamental needs and problems we presently face in reducing dialysis carbon-print, optimizing the pathways of care, avoiding futility in clinical work and research, implementing lifestyle interventions and education. We further acknowledge the lack of data on lifecycle of items and procedures, including commonly used drugs, and identify research needs at various levels. We finally discuss some examples of educational programs on green nephrology that are already available at various levels, from medical schools (an educational game), to medical meetings (healthy eating, reduction of plastic and paper waste), and daily clinical practice, in which teaching passes also through examples (personalizing dialysis, adapting schedules to each patient). Finally, we identify some barriers educational approaches may offers ways to overcome, to promote effective, targeted interventions that will make us advance on the road to reduce nephrology's carbon footprint.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"9 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143846388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}