Clinical Journal of the American Society of Nephrology最新文献

{"title":"High-Diversity Plant-Based Diets in CKD: Key Considerations from a Patient's Perspective.","authors":"Edson Arakaki","doi":"10.2215/CJN.0000000712","DOIUrl":"https://doi.org/10.2215/CJN.0000000712","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804709","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 Association of Fibrate Use with Kidney Outcomes and Mortality.","authors":"Rina Takahashi, Jenny Shen, Diana Tran, Ibrahim Elali, Tiane Dai, Anuja Shah, Ramnath Dukkipati, Adnan Ismail, Keiichi Sumida, Fridtjof Thomas, Connie M Rhee, Csaba P Kovesdy, Kamyar Kalantar-Zadeh","doi":"10.2215/CJN.0000000683","DOIUrl":"https://doi.org/10.2215/CJN.0000000683","url":null,"abstract":"<p><strong>Background: </strong>Fibrate use can result in an acute increase in serum creatinine, making assessing kidney outcomes associated with fibrates difficult in studies with short follow-up times. Additionally, there is limited research on certain kidney outcomes and mixed results of past studies. The aim of this study is to examine the association of fibrate use with incident chronic kidney disease (CKD), end-stage kidney disease (ESKD), and mortality in a large national cohort of United States (US) Veterans.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted to examine the association of de novo prescription of fibrate medications with incident CKD, ESKD, and mortality over up to 14 years of follow-up. Patients (n=688,382) were selected from the national Veterans Administration (VA) research database. Associations were examined in Cox proportional hazard models and Fine-Gray model adjusted for demographics, major comorbidities, laboratory measurements, including baseline estimated glomerular filtration rate (eGFR), albuminuria, and medications.</p><p><strong>Results: </strong>We identified 58,773 incident new fibrate users. The overall mean (standard deviation [SD]) age was 59 (13) years, with 7% female, 18% Black, and 7% Hispanic. Fibrate users were more likely to be male, White, current smokers, and had higher frequencies of comorbidities. In the fully adjusted model, fibrate use (versus non-use) was associated with a lower risk of death (Hazard ratio [HR]: 0.91, 95% confidential interval [CI]: 0.89-0.93) and ESKD (0.80, 0.71-0.92) but with a higher risk of incident CKD (1.21, 1.19-1.24).</p><p><strong>Conclusions: </strong>In this large national cohort of US Veterans with long follow-up time, fibrate use was associated with a higher risk of incident CKD but a lower risk of ESKD and mortality. Further studies are needed to corroborate the potential benefits of fibrate on kidney function and survival.</p>","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796802","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":"Efficacy and Safety of SGLT-2 Inhibitors in Patients With and Without Advanced CKD: A Systematic Review and Meta-Analysis.","authors":"Elias John Elenjickal, Christoforos K Travlos, Judy Luu, Serge Lemay, Rita S Suri, Thomas A Mavrakanas","doi":"10.2215/CJN.0000000693","DOIUrl":"https://doi.org/10.2215/CJN.0000000693","url":null,"abstract":"<p><strong>Background: </strong>The efficacy and safety of sodium-glucose co-transporter-2 (SGLT-2) inhibitors in patients with advanced chronic kidney disease (CKD), defined as an estimated glomerular filtration rate (eGFR) <30 ml/min/1.73m2, has not been adequately studied.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis of phase 3 randomized controlled trials (RCTs) of SGLT-2 inhibitors in adults. We searched the MEDLINE and Embase databases from inception to April 2024. The primary outcomes were a composite kidney (worsening kidney function, kidney failure, kidney or cardiovascular death) and cardiovascular (cardiovascular death or hospitalization for heart failure) outcome. Secondary outcomes included other reported cardiovascular and kidney outcomes, eGFR slopes, mechanistic and safety outcomes. The relative risks (RR) were estimated using a random effects model. Interaction effects were estimated for treatment effect modification by baseline eGFR (<30 and ≥30 ml/min/1.73m2).</p><p><strong>Results: </strong>A total of 10 RCTs were included (total of 4800 patients with eGFR <30 ml/min/1.73m2). Participants were randomized to receive either placebo or an SGLT-2 inhibitor. Use of SGLT-2 inhibitors was associated with a lower incidence of the primary composite kidney outcome in patients with eGFR <30 ml/min/1.73m2 [RR 0.79, 95% confidence interval (CI) 0.70-0.89] and ≥30 ml/min/1.73m2 (RR 0.71, 95% CI 0.64-0.79). The incidence of the primary cardiovascular outcome was numerically lower in the SGLT-2 inhibitor arm in patients with eGFR <30 ml/min/1.73m2 (RR 0.88, 95% CI 0.71-1.10). In patients with eGFR ≥30 ml/min/1.73m2, SGLT-2 inhibitor use was associated with a lower incidence of the composite cardiovascular outcome (RR 0.77, 95% CI 0.71-0.83). However, there was no interaction between advanced CKD status and the effect of SGLT-2 inhibitors on any of the primary or secondary outcomes. The incidence of adverse events was similar in both arms.</p><p><strong>Conclusion: </strong>SGLT-2 inhibitors retain their kidney and cardiovascular protective effect in patients with advanced CKD, with no added safety concerns.</p>","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732787","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":"Dietary Phosphorus and Metabolic Health in CKD and ESKD.","authors":"Adamasco Cupisti, Domenico Giannese, Mario Cozzolino, Vincenzo Panichi, Claudia D'Alessandro, Maurizio Gallieni","doi":"10.2215/CJN.0000000715","DOIUrl":"https://doi.org/10.2215/CJN.0000000715","url":null,"abstract":"<p><p>The contribution of dietary phosphorus in the pathogenesis of chronic kidney disease associated mineral bone disease (CKD-MBD) and the management of phosphorus intake in CKD patients are essential to slow down disease progression and improve patient outcomes. In patients with CKD, and most likely in the general population, phosphorus retention and overload can affect four critical aspects of the cardiovascular system: increased arterial blood pressure, vascular and valvular calcification and left ventricular hypertrophy. All of these factors contribute to increased cardiovascular risk and mortality. Intestinal absorption of phosphorus from a mixed diet is approximately 60-70% of the dietary phosphorus content, with lower rates for organic phosphorus from plant sources and higher rates for inorganic phosphorus from processed foods containing additives. The widespread use of phosphate additives in processed foods and the high consumption of animal protein in the Western diet have led to a steady increase in phosphate consumption in recent decades. Although it is unclear whether this high phosphorus intake has adverse effects in people with normal kidney function, several studies have found that increased dietary phosphorus contributes to the progression of CKD and cardiovascular damage. High phosphorus intake may be detrimental, but there is no clear evidence that it should be avoided in the general population. On the contrary, kidney function impairment is the setting in which modulation of phosphorus intake is justified and easy to implement by restricting/reducing protein intake. However, it is quite difficult to implement phosphorus restriction in dialysis patients because of the conflicting recommendation of high protein intake. Educational approaches, together with solid motivation and adherence by patients and caregivers, are needed to achieve the goal of successful dietary phosphate management in CKD patients.</p>","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665140","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":"Innovating Kidney Care in Patients with Cancer: The Development of an Inpatient Onconephrology Service.","authors":"Raad B Chowdhury, Jessica L Ortega, Sophia L Wells, Marta Pirovano, Raphael Kim, Carolina S Lima, Mohit Madken, Sheikh B Khalid, Rania El Fekih, Firasat M Alikhan, Alexa C Peterkin, Gearoid M McMahon, David B Mount, Joseph V Bonventre, Shruti Gupta","doi":"10.2215/CJN.0000000714","DOIUrl":"https://doi.org/10.2215/CJN.0000000714","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665141","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":"High-Diversity Plant-Based Diet and Gut Microbiome, Plasma Metabolome, and Symptoms in Adults with CKD.","authors":"Jordan Stanford, Anita Stefoska-Needham, Xiaotao Jiang, Brett McWhinney, Hicham I Cheikh Hassan, Emad El-Omar, Karen Charlton, Kelly Lambert","doi":"10.2215/CJN.0000000682","DOIUrl":"https://doi.org/10.2215/CJN.0000000682","url":null,"abstract":"<p><strong>Background: </strong>Research suggests that eating a plant-dominant dietary pattern is beneficial to people with chronic kidney disease (CKD). The aim was to investigate how increasing the diversity of plant food intake would impact metabolomic, microbiome and clinical parameters in people with CKD.</p><p><strong>Methods: </strong>This study was a cross-over, randomized controlled trial involving 25 Australian adults diagnosed with stage 3-4 CKD. Participants were randomly allocated to follow two diets for 6 weeks each, separated by a minimum 4-week washout period: a high-diversity plant-based diet (HDPD, ≥30 unique plant foods weekly) and a low-diversity plant-based diet (LDPD, ≤15 unique plant foods weekly), alongside a usual kidney diet prescription. Data collection was completed at four timepoints (beginning and end of each intervention period). Primary outcome included a change in uremic toxins (indoxyl sulfate and p-Cresyl sulfate) concentrations. Secondary and exploratory outcomes included diet quality and nutritional status, fecal microbiome composition and diversity, plasma metabolome, symptom burden, quality of life scores, blood pressure, biochemical and anthropometric measures.</p><p><strong>Results: </strong>Plasma and urinary uremic toxin levels did not consistently decrease across the cohort; however, significant reductions were observed in responders to the HDPD, particularly those with poorer kidney function and higher baseline uremic toxin levels. Neither diet caused electrolyte imbalances. The HDPD significantly improved diet quality, reduced potential renal acid load by an average of 47% from baseline, with an estimated marginal mean reduction of 9.96 (95% CI: -16.28 to -3.64), and compared to the LDPD, decreased total symptom burden, including constipation (95% CI: -4.11 to -0.54 and -0.91 to -0.22, respectively). It also shifted the gut microbiome toward increased production of beneficial metabolites like butyrate/isobutyrate. In contrast, the LDPD reduced microbial diversity and decreased the abundance of 27 species and 33 functional genes.</p><p><strong>Conclusions: </strong>This study demonstrated the safety and clinically relevant therapeutic benefits of aiming to incorporate 30 or more unique plant foods weekly in the diet of individuals with moderate CKD. It was observed that individuals with more advanced kidney disease and higher levels of uremic toxins may derive the greatest benefit from adopting a HDPD.</p><p><strong>Trial registration: </strong>ACTRN12619000442101.</p>","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651748","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":"Prescribing Physical Activity and Exercise for People with Chronic Kidney Disease: A Practical Guide by the Global Renal Exercise Network.","authors":"Thomas J Wilkinson, Brett Tarca, Courtney J Lightfoot, João L Viana, Kenneth R Wilund, Heitor S Ribeiro, Sharlene Greenwood, Giorgos K Sakkas, Brandon M Kistler","doi":"10.2215/CJN.0000000708","DOIUrl":"https://doi.org/10.2215/CJN.0000000708","url":null,"abstract":"<p><p>Physical activity (PA) and exercise are fundamental to optimising and maintaining health. The evidence on the benefits of PA and exercise in people with chronic kidney disease (CKD) is well-established. Yet patients remain inactive, partly driven by a lack of knowledge and confidence from the healthcare providers (HCPs) involved in their management. A potential key element in improving PA in CKD includes better provisions around education, tools, and training resources amongst nephrology healthcare providers on PA recommendations, counselling, prescription, and referral to appropriate professionals for assessment, implementation, and monitoring. Much like other pharmacological therapies, an effective prescription should be prescribed at the correct dose, strength, and frequency to the individual, titrated (and progressed) to optimize adherence and safety, and reviewed regularly to ensure maximum effectiveness. Aside from a formal prescription of exercise, many people would benefit from modest improvements in daily PA, and an emphasis on reducing sedentary behaviour is likely to confer beneficial effects on outcomes. The purpose of this article is to outline the key components of successful PA and exercise prescriptions, including understanding the barriers and facilitators individuals may have, taking a PA history, and how to tailor exercise 'dose' to each patient with the ultimate goal of increasing accessibility of PA for all people living with CKD. To do this, we will use worked examples to demonstrate what an exercise prescription may consist of across each of the major CKD stages.</p>","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631023","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":"Autonomic Nervous System Dysregulation and Bone Health in Patients with CKD: Potential for Intervention.","authors":"Carmine Zoccali, Marc G Vervloet, Pieter Evenepoel, Ziad Massy, Mario Cozzolino, Francesca Mallamaci, Eleanor D Lederer, Jorge Cannata Andia, Tilman B Drueke","doi":"10.2215/CJN.0000000709","DOIUrl":"10.2215/CJN.0000000709","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631018","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":"Interdisciplinary Care for Geriatric Syndromes in CKD: A Qualitative Study.","authors":"Aishwarya Subash, Maya Levinson, Kemberlee Bonnet, Rasheeda K Hall, Fahad Saeed, Christine K Liu, Totini S Chatterjee, Amanda S Mixon, Edward R Gould, Sara N Horst, Ebele M Umeukeje, Rachel A Burdick, Warren D Taylor, Kerri L Cavanaugh, David G Schlundt, Devika Nair","doi":"10.2215/CJN.0000000658","DOIUrl":"10.2215/CJN.0000000658","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631021","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":"Efficacy and Safety of Phosphate-Lowering Agents for Adult Patients with Chronic Kidney Disease Requiring Dialysis: A Network Meta-Analysis.","authors":"Masatoshi Nishimoto, Takeshi Hasegawa, Miho Murashima, Hisashi Noma, Hiroki Nishiwaki, Shunsuke Yamada, Aya Mizukami, Hirotaka Saito, Hiroshi Kimura, Masatomo Taniguchi, Takayuki Hamano, Masafumi Fukagawa","doi":"10.2215/CJN.0000000665","DOIUrl":"https://doi.org/10.2215/CJN.0000000665","url":null,"abstract":"<p><strong>Background: </strong>It is necessary to update the evidence of each phosphate-lowering agent on dialysis patients.</p><p><strong>Methods: </strong>From the CENTRAL, MEDLINE, EMBASE, and ClinicalTrial.gov databases, randomized controlled trials (RCTs) using oral phosphate-lowering agents on adult patients requiring maintenance dialysis were extracted. The treatment period was required for eight or more weeks, and the risk of bias was assessed according to the Cochrane Collaboration method. The outcomes were all-cause mortality, cardiovascular mortality, gastrointestinal (GI) events, fracture, coronary artery calcium score (CACS), serum calcium, phosphate, intact parathyroid hormone (iPTH), and bicarbonate levels. A network meta-analyses using multivariate random-effects models were performed for assessing the comparative effectiveness. The ranking of the phosphate-lowering agents was assessed using a surface under the cumulative ranking curve (SUCRA).</p><p><strong>Results: </strong>A total of 70 RCTs involving 15,551 participants were included. Eleven phosphate-lowering agents including calcium-based agents, sevelamer, bixalomer, lanthanum, sucroferric oxyhydroxide, ferric citrate, tenapanor, magnesium, nicotinamide, aluminum, and sucralfate were assessed. Sevelamer was significantly associated with lower all-cause mortality compared with calcium-based agents [risk ratio (95% Confidence Interval {CI}): 0.59 (0.37-0.94)], and sucroferric oxyhydroxide and tenapanor were estimated to rank high in terms of lowering all-cause mortality based on the SUCRA. The risk of GI events was the highest with nicotinamide, followed by sucroferric oxyhydroxide. Compared with calcium-based agents, CACS were significantly lower among those on lanthanum and sucroferric oxyhydroxide [standardized mean difference (95% CI): -0.26 (-0.52 to -0.01) and -0.50 (-0.95 to -0.06), respectively]. Serum calcium levels were higher and serum iPTH levels were lower in patients treated with calcium-based agents. Except for sevelamer, serum bicarbonate levels for all other agents were higher compared with placebo.</p><p><strong>Conclusions: </strong>Compared with calcium-based agents, sevelamer was associated with lower all-cause mortality, and sucroferric oxyhydroxide and lanthanum were associated with slower progression of CACS. Potential benefits and harms should be considered when selecting phosphate-lowering agents (PROSPERO: CRD42022328388).</p>","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631020","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}