Clinical Journal of the American Society of Nephrology最新文献

{"title":"Frailty in Adults with Chronic Kidney Disease and Validation of the Kidney Failure Risk Equation in Frailty Sub-Groups.","authors":"Heather Walker,Juan-Jesus Carrero,Michael K Sullivan,Ryan Field,Jennifer S Lees,Peter Hanlon,Anne-Laure Faucon,Edouard L Fu,Giorgi Beridze,Bhautesh Dinesh Jani,Katie Gallacher,Patrick B Mark","doi":"10.2215/cjn.0000000739","DOIUrl":"https://doi.org/10.2215/cjn.0000000739","url":null,"abstract":"BACKGROUND AND HYPOTHESISFrailty is common amongst adults with chronic kidney disease (CKD) and its presence can influence clinical outcomes such as advancing CKD and mortality. Clinical guidelines recommend the use of the Kidney Failure Risk Equation (KFRE) to guide management of CKD.Our aim was to validate KFRE by frailty status and assess whether model performance could be improved by using cystatin based estimated glomerular filtration rate (eGFR) equations and to assess the impact of accounting for competing mortality risk.METHODSWe studied adults from the prospective research cohort UK Biobank with CKD G3-5 (eGFR <60mL/min/1.73m2) by any of the three CKD-EPI consortium eGFR equations: eGFR creatinine (eGFRcr), eGFR cystatin (eGFRcys) and eGFR creatinine-cystatin (eGFRcr-cys)). Frailty was assessed by a modified frailty phenotype and two cumulative deficit frailty indices. Kidney failure was defined as long-term dialysis or kidney transplantation. Model assessment included discrimination, calibration and overall fit at two- and five-years.RESULTSThe prevalence of frailty by one or more measures was 35% (N=8,533). Those classed as frail had a higher discrepancy between eGFRcys and eGFRcr compared to the non-frail group (-15.8 vs -6.9 ml/min/1.73m2). Discrimination of KFRE was good (area under receiver operating characteristic curve ≥0.88 across all frailty sub-groups and eGFR equations). Kidney failure at five years was under-estimated in individuals with frailty (observed/expected (O/E) ratio 1.70; 95% CI 1.55-1.85). Calibration-in-the-large improved when eGFRcr was replaced by eGFRcys (five-years O/E ratio 1.20; 95%CI 1.05-1.35). Overestimation of kidney failure risk in analyses that do not account for competing mortality risk compared to those that do, was most apparent in the frailty group and the higher KFRE predicted risk groups.CONCLUSIONKFRE under-estimates kidney failure risk for individuals with CKD and frailty. Risk prediction improved for those with frailty when cystatin-based eGFR equations are utilized and when analyses account for competing risk of mortality. These factors should be considered when KFRE calculation is used in clinical practice in individuals with frailty.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"71 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114256","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 Kidney Disease Screening and Awareness Program (KDSAP): Transforming Community Outreach and Inspiring Interest in Nephrology.","authors":"Kavya M Shah,Jacqueline Lee,Benjamin J Lee,Ming-Yan Jiang,Li-Li Hsiao","doi":"10.2215/cjn.0000000727","DOIUrl":"https://doi.org/10.2215/cjn.0000000727","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"38 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114258","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 Florence Working Group: An Initiative for a Collaborative Effort to Improve the Classification and Scoring Systems in ANCA-Glomerulonephritis.","authors":"Silke R Brix,Annelies Berden,Giacomo Emmi,Lauren Floyd,J Charles Jennette,Andreas Kronbichler,Irmgard Neumann,Martina Uzzo,Augusto Vaglio,Maria Wester Trejo,Thorsten Wiech,David Jayne,Ingeborg Bajema","doi":"10.2215/cjn.0000000758","DOIUrl":"https://doi.org/10.2215/cjn.0000000758","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"33 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114257","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":"A Home Hemodialysis Objective Structured Clinical Examination (OSCE) for Formative Assessment of Nephrology Fellows.","authors":"Jason A Jones,Trevor W Tobin,Maria C Bermudez,Gregory L Braden,Evan Fisher,Nupur Gupta,Daniel Landry,Christopher LeBrun,Robert Nee,Bret Pasiuk,Christina M Yuan","doi":"10.2215/cjn.0000000740","DOIUrl":"https://doi.org/10.2215/cjn.0000000740","url":null,"abstract":"BACKGROUNDThe Accreditation Council for Graduate Medical Education requires graduating nephrology fellows demonstrate competence in home hemodialysis (HHD). Because low patient numbers may lead to training gaps, clinical experience may be enhanced using simulation. We designed and preliminarily validated a formative objective structured clinical examination (OSCE) assessing clinical care of an uncomplicated patient initiating HHD, using a unified model of construct validity.METHODSThe OSCE was developed by a nephrology fellow and five faculty (three practicing HHD). The nine-member test committee (five in HHD practice; one HHD care partner) assessed test item difficulty/relevance and determined passing scores. The final test consisted of 27 items (31 possible points); seven were evidence-based/standard-of-care questions (9.5 possible points). Passing score was 20 out of 31 points (65%). Median relevance for all items was \"important\" or \"essential\". Content validity index was 0.84. On preliminary validation by 11 board-certified volunteers (four practicing HHD), overall mean±SD score was 27.5±2 (100% passing); kappa=0.83 [95% confidence interval (CI) 0.67-0.99]. Validator evidence-based question score was 9.0 ± 0.6 .RESULTSThirty-eight fellows (nine programs, 21 first-year; 17 second-year) were tested. Seventy one percent passed (Cronbach's alpha=0.70). Fellows' mean±SD scores were lower than validators: 21.5±4.0 vs. 27.5±2, p<0.001, as were their scores on evidence-based questions: 7.4±1.4 vs. 9.0±0.6, p<0.001. Eighty-eight percent of evidence-based/standard-of-care questions were answered correctly by validators vs. 62% by fellows; p <0.001. Forty-two percent of fellows were able to name four potential benefits and two risks associated with HHD; 79% recognized that the primary risk of buttonhole cannulation was infection. Seventy-four percent correctly identified minimum single pool Kt/V for thrice-weekly hemodialysis, and 29% knew the minimum standard weekly Kt/V target. Eighty-eight percent of fellows surveyed (22 out of 25) agreed/strongly agreed that the OSCE was useful in self-assessing proficiency.CONCLUSIONSThe OSCE may be used as a formative assessment of fellow proficiency in prescribing HHD.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"5 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114259","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":"Sodium-Glucose Cotransporter-2 Inhibitor Therapy and Longitudinal Changes in Kidney Function among Veterans with Autosomal Dominant Polycystic Kidney Disease.","authors":"Meghana Eswarappa,Erin Madden,Michael G Shlipak,Xiangqin Cui,Michal Mrug,Michelle M Estrella,Meyeon Park","doi":"10.2215/cjn.0000000725","DOIUrl":"https://doi.org/10.2215/cjn.0000000725","url":null,"abstract":"BACKGROUNDSodium-glucose cotransporter-2 inhibitors (SGLT2i) are a pillar of kidney disease therapy, but their efficacy remains unknown in Autosomal Dominant Polycystic Kidney Disease (ADPKD). We evaluated effects of SGLT2i on kidney function in ADPKD.METHODSThis retrospective cohort study within the Veterans Health Administration included adults with an ADPKD diagnosis code who initiated SGLT2i between January 2017 and May 2023. Repeated measures models were used to evaluate eGFR slope before and after SGLT2i initiation. Among patients with ADPKD and type 2 diabetes mellitus (T2DM), a target trial emulation was used to compare the effects of SGLT2i versus dipeptidyl peptidase-4 inhibition (DPP4i) on eGFR slope.RESULTSAmong 348 eligible patients with ADPKD who started an SGLT2i, 93% were male, mean ± standard deviation age was 68 ± 11, and median eGFR was 53 (interquartile range: 16-127) ml/min/1.73m2. In adjusted analyses, the pre-initiation eGFR slope was -0.79 (95% confidence interval: -1.26, -0.33) ml/min/1.73m2 per-90-days. The eGFR slope steepened to -2.78 (-4.04, -1.53) ml/min/1.73m2 during the first three months post-initiation, and then stabilized to -0.07 (-0.72, 0.58) ml/min/1.73m2 during months 3-to-12 post-initiation. The target trial emulation compared 217 SGLT2i-users with 198 DPP4i-users. In adjusted analyses, eGFR declined -4.03 (-6.45, -1.60) mL/min/1.73m2 per-90-days faster in SGLT2i- versus DPP4i-users during the first three months post-initiation; however, during the subsequent 3-to-12 months, the slope was more stable in SGLT2i- than DPP4i-initiators, with a difference of 1.29 (0.16, 2.41) mL/min/1.73m2 per-90-days.CONCLUSIONSIn older patients with mild ADPKD and a high prevalence of diabetes and cardiovascular disease who initiated an SGLT2i, there was an initial three-month decline in eGFR followed by stabilization during the remainder of the year-long follow-up. Compared with DPP4i use, SGLT2i use was associated with a slower eGFR decline between 3-to-12 months post-initiation in patients with concurrent T2DM. These findings suggest that SGLT2is are potentially beneficial in older individuals with ADPKD in whom comorbid disease may play a greater role in kidney function decline, but further studies are required.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"1 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144066802","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":"Progress Toward a Better Predictor of Remission in Anti-Phospholipase A2 Receptor-Associated Membranous Nephropathy.","authors":"Patrick H Nachman","doi":"10.2215/cjn.0000000737","DOIUrl":"https://doi.org/10.2215/cjn.0000000737","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"53 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065581","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":"Video-Assisted Electronic Consent versus Standard Consent for Percutaneous Kidney Biopsy.","authors":"Thelma Barber","doi":"10.2215/cjn.0000000736","DOIUrl":"https://doi.org/10.2215/cjn.0000000736","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"13 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982451","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 Approach Hematuria and Proteinuria: Can We Prevent the Same Mistake from Happening Twice?","authors":"Timothy T. Yau","doi":"10.2215/cjn.0000000752","DOIUrl":"https://doi.org/10.2215/cjn.0000000752","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":"14 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144097584","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":"Effects of Lowering Dietary Phosphorus Additive Intake on Mineral Metabolism in Adults with and without Chronic Kidney Disease.","authors":"Muhammad Bilal Khan,Mercedes R Carnethon,Tamara Isakova,Myles Wolf,Orlando M Gutiérrez","doi":"10.2215/cjn.0000000730","DOIUrl":"https://doi.org/10.2215/cjn.0000000730","url":null,"abstract":"BACKGROUNDExcess phosphorus additive intake leads to alterations in phosphorus metabolism that are linked to cardiovascular and kidney disease. The effects of lowering phosphorus additive intake in adults with and without chronic kidney disease (CKD) are unclear.METHODSWe conducted a feeding study in 39 adults without and 11 adults with CKD. Participants were fed a phosphorus additive-enhanced diet for two weeks followed by a low additive diet for six weeks. Both diets were identical except for phosphorus additive content. Blood and urine samples were collected at regular intervals with analyses comparing follow-up measures of mineral metabolism markers to baseline values.RESULTSThe mean (SD) age of the non-CKD group was 34(12) years, among whom 51% were male, 36% were of Black race, and mean (SD) eGFR was 106(16) ml/min/1.73m2. The mean (SD) age of the CKD group was 72(6) years, among whom 36% were male, 82% were of Black race, and mean (SD) eGFR was 35(13) ml/min/1.73m2. After consuming the additive-enhanced diet for two weeks, consuming the low additive diet for six weeks decreased 24-hour urine phosphorus excretion by ∼30% in both groups. In the non-CKD group, the effect of the low additive diet on circulating fibroblast growth factor 23 (FGF23) concentrations differed by race (Pinteraction=0.03)-FGF23 decreased by 22% from baseline in White adults (P<0.001) but not in Black adults (P=0.08). In the CKD group, FGF23 decreased 25% after six weeks of the low additive diet (P<0.001) with no difference by race. Intact parathyroid hormone (PTH) concentrations decreased 20% in CKD participants and did not change in the non-CKD participants.CONCLUSIONSix weeks of a low phosphorus additive diet decreased FGF23 and PTH in adults with moderate CKD. Lowering phosphorus additive intake lowered FGF23 in White adults without CKD but had no effect in Black adults without CKD.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"96 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945506","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":"Tangled Threads: Unravelling a Case from Kidney Allograft Loss to Re-Transplantation","authors":"Christie Rampersad, Ian W. Gibson, James Shaw, Julie Ho","doi":"10.2215/cjn.0000000748","DOIUrl":"https://doi.org/10.2215/cjn.0000000748","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":"25 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143933566","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}