Clinical Journal of the American Society of Nephrology最新文献

{"title":"Empowering the Next Generation of Nephrologists: Trainee Opportunities in GlomCon's Educational Ecosystem.","authors":"Nasim Wiegley,Vinay Srinivasan,Harish Seethapathy,Sayna Norouzi,Kate Robson,Paolo So,Edgar Lerma,Ali Poyan Mehr","doi":"10.2215/cjn.0000000891","DOIUrl":"https://doi.org/10.2215/cjn.0000000891","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"99 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145311329","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":"Association between Serum Glycerol-3-Phosphate and Fibroblast Growth Factor-23 in Nondiabetic Patients on Hemodialysis.","authors":"Scott M Wilson,Shari Zaslow,Stephen M Sozio,Bernard G Jaar,Farzana Perwad,Cassiane Robinson-Cohen,Michelle M Estrella,Aline Martin,Rulan S Parekh,Wei Chen","doi":"10.2215/cjn.0000000871","DOIUrl":"https://doi.org/10.2215/cjn.0000000871","url":null,"abstract":"BACKGROUNDFibroblast growth factor-23 (FGF23) is a key regulator of mineral metabolism that is independently associated with mortality in patients with end-stage kidney disease (ESKD). Glycerol-3-phosphate (G3P), a byproduct of glycolysis that can be derived from injured kidneys, stimulates FGF23 production. We aimed to determine if serum G3P is associated with FGF23 levels in patients with ESKD and identify potential molecular pathways that mediate their relationship.METHODSWe conducted a cross-sectional study of 99 non-diabetic patients with ESKD on hemodialysis. We utilized linear regression to examine the association between G3P terciles and log-transformed C-terminal FGF23 levels, adjusting for demographics, coronary artery disease, serum calcium, phosphorus, and parathyroid hormone. Mann-Whitney U tests compared 247 serum metabolite levels between the first and third FGF23 terciles; significant metabolites (p<0.01) were selected for pathway enrichment analyses. Top pathway scores were used in mediation analyses.RESULTSThe median age of participants was 54 years (Interquartile Range (IQR): 44-63), 38% were women, 71% self-identified as Black, and 27% had coronary artery disease. Median FGF23 level was 777 (IQR 222-1,310) RU/mL. In adjusted analyses, compared with participants with the lowest G3P tercile, those with the highest G3P tercile had a 95% higher FGF23 level (95% Confidence Interval (CI): 6%, 260%, p=0.004). Of the 27 metabolites significantly associated with FGF23 levels, pathway enrichment analysis identified the pentose phosphate pathway as the top hit (impact score=0.33, false discovery rate-adjusted p-value= 0.01). The pentose phosphate pathway mediated the relationship between G3P and FGF23, resulting in a 62% change in the β coefficient.CONCLUSIONIn nondiabetic patients with ESKD on hemodialysis, serum G3P positively correlated with serum C-terminal FGF23, and this relationship was mediated by the pentose phosphate pathway. Exploring the pentose phosphate pathway could yield critical mechanistic insights into the regulation of FGF23, enhancing our understanding of its broader biological functions.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"45 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145311327","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":"National Prevalence, Regional Distribution, and Risk Factors for Chronic Kidney Disease in Taiwan.","authors":"Min-De Ang,Chia-Yun Cheng,Wan-Chuan Tsai,Ping-Hsiu Tsai,Le-Yin Hsu,Mei-Ju Ko,Kuo-Liong Chien,Kuan-Yu Hung,Hon-Yen Wu","doi":"10.2215/cjn.0000000892","DOIUrl":"https://doi.org/10.2215/cjn.0000000892","url":null,"abstract":"Taiwan has exhibited one of the highest incidence and prevalence rates of dialysis globally, yet updated national data on chronic kidney disease (CKD) has been lacking for nearly two decades. We estimated the national CKD prevalence, identified associated risk factors, and evaluated CKD of undetermined etiology (CKDu) in Taiwan. In this cross-sectional study, we analyzed data from 4,298 adults age ≥20 years who participated in the 2017-2020 Nutrition and Health Survey in Taiwan, a nationally representative survey employing stratified, three-stage, clustered sampling across 20 administrative divisions. CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2 or an urine albumin-to-creatinine ratio ≥30 mg/g. Data on demographics, comorbidities, lifestyle factors, and socioeconomic status were collected to identify risk factors associated with CKD. The primary outcome was the national prevalence of CKD. Secondary outcomes included regional CKD prevalence, major risk factors associated with CKD, and characteristics of CKDu. The national CKD prevalence was 10.0%, affecting 1.91 million adults. Prevalence rates for CKD stages 1, 2, 3a, 3b, 4, and 5 were 0.7%, 2.1%, 4.6%, 1.9%, 0.6%, and 0.05%, respectively. CKD prevalence was higher in men (11.9%) than in women (8.1%) and varied regionally, with the highest rate in eastern Taiwan (13.9%), followed by the central (11.5%), southern (11.1%), and northern (8.0%) regions. CKD was independently associated with male sex, older age, diabetes, hypertension, hypertriglyceridemia, gout/hyperuricemia, lower socioeconomic status, and physical inactivity. Only 8% of the CKD patients were aware of their kidney condition, and CKDu accounted for approximately one-eighth of the CKD population. In conclusion, CKD affects approximately 10% of Taiwanese adults, with marked geographic disparities and low awareness. These findings underscore the need for targeted interventions addressing modifiable risk factors and enhanced screening to improve CKD detection and prevention.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"1 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145311328","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":"Challenging Clinical Practice Guideline Definitions in Childhood Nephrotic Syndrome.","authors":"Cal H Robinson,Nowrin Aman,Tonny H M Banh,Josefina Brooke,Vaneet Dhillon,Mackenzie Garner,Christoph Licht,Ashlene McKay,Rachel Pearl,Seetha Radhakrishnan,Keisha Rasool,Nithiakishna Selvathesan,Chia Wei Teoh,Jovanka Vasilevska-Ristovska,Rulan S Parekh","doi":"10.2215/cjn.0000000842","DOIUrl":"https://doi.org/10.2215/cjn.0000000842","url":null,"abstract":"BACKGROUNDIn childhood nephrotic syndrome, definitions of immunosuppression response, frequent relapses (FRNS), and long-term remission are conflicting and based on limited evidence. Our goal was to define treatment response, FRNS, and long-term remission based on associated disease outcomes.METHODSWe included children (six months-18 years) diagnosed with nephrotic syndrome between 1993-2023 in combined Canadian cohorts. We evaluated different definitions of 1) immunosuppressive treatment response, 2) FRNS, including Kidney Disease Improving Global Outcomes (KDIGO) 2021 and International Pediatric Nephrology Association (IPNA) 2023 criteria, and 3) long-term remission. Outcomes were time-to-chronic kidney disease (CKD), relapse count throughout follow-up, and time-to-relapse, analyzed by Cox proportional hazards and negative binomial regression.RESULTSWe included 1114 children with nephrotic syndrome (median 3.8-years at diagnosis, 63% male, median 4.7-year follow-up). Of these, 1054 (95%) were steroid-sensitive, 60 (5%) were steroid-resistant (SRNS), and 73% with SRNS achieved complete remission with steroid-sparing immunosuppression. No child with treatment-responsive SRNS developed CKD. Within one-year of diagnosis, 281 steroid-sensitive children (27%) were classified with FRNS by KDIGO and 383 (36%) by IPNA criteria. Children with FRNS by IPNA criteria (vs. KDIGO) had a similar number of relapses (adjusted rate ratio 0.95, 95% confidence interval [CI] 0.81-1.12) and CKD risk (2% each) but less often received steroid-sparing immunosuppression (hazard ratio 0.42, 95% CI 0.32-0.56). Ninety-eight percent of relapses occur within three-years of the initial diagnosis or last relapse event.CONCLUSIONSChildren with SRNS that achieve remission have a similar CKD risk as steroid-sensitive children. Children with FRNS by IPNA 2023 and KDIGO 2021 criteria experience similar rates of relapse and CKD. This supports defining treatment resistance by response to any immunosuppressive medication, implementation of the IPNA FRNS criteria, and use of three-year relapse-free survival as a surrogate for long-term remission.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"47 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145296209","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":"Association of Myosteatosis and of Graft Loss after Kidney Transplantation: An International Observational Study.","authors":"Marcel Zorgdrager,Yi Liu,Jingyao Hong,Nidhi Ghildayal,Tim D A Swaab,Stephan J L Bakker,Alain R Viddeleer,Babak J Orandi,Omid Shafaat,Clifford R Weiss,Dorry Segev,Mara McAdams-DeMarco,Robert A Pol","doi":"10.2215/cjn.0000000862","DOIUrl":"https://doi.org/10.2215/cjn.0000000862","url":null,"abstract":"BACKGROUNDSarcopenia and myosteatosis are indicators of abnormal body composition (BC). Computed tomography (CT) imaging has proven to be an accurate modality for BC quantification in kidney transplantation (KT). We tested whether pre-KT CT-based BC was associated with both all-cause graft loss (ACGL) and mortality among adult recipients from two centers (Johns Hopkins Hospital [JHH] and University Medical Center Groningen [UMCG]).METHODSPatients who underwent a KT between 2003 and 2020 were followed for a median (interquartile range) follow-up of 6.4 (4.6-8.5) years at JHH and 6.3 (5.1-7.5) years at UMCG. Cox proportional hazard models were used to estimate the associations of BC with ACGL/ mortality. Fine and Gray regression analysis was performed to assess the association between BC and death-censored graft loss. Prior to KT, 49% of recipients had sarcopenia and 66% had myosteatosis.RESULTSIn total 608 patients were included from JHH (N= 294) and UMCG (N=314). Sarcopenia was not associated with post-KT outcomes. Myosteatosis was associated with a higher risk of ACGL (adjusted hazard ratio 1.78, 95%CI:1.08 - 2.93) and mortality (adjusted hazard ratio 2.35, 95%CI: 1.27 - 4.33) at JHH, but showed no significant association at UMCG after adjusting for confounders. Myosteatosis did not show a significant association with death-censored graft loss at both centers.CONCLUSIONMyosteatosis ascertained from existing CT scans could help identify recipients at higher risk for ACGL who may benefit most from prehabilitation.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"11 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145296208","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 Importance of the Patient Perspective and Real-World Experience in Home Dialysis Training.","authors":"Pesh Patel","doi":"10.2215/cjn.0000000903","DOIUrl":"https://doi.org/10.2215/cjn.0000000903","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"1 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145288243","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":"Sepsis-Related Hospitalization and Mortality in Patients with Chronic Kidney Disease.","authors":"Ninad Khandekar,Shung Chiu,Lauren Tong,Deepa Raghavan,Nishank Jain","doi":"10.2215/cjn.0000000861","DOIUrl":"https://doi.org/10.2215/cjn.0000000861","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"12 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145283521","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":"Bridging the \"Employment Gap\" for Dialysis Patients: From Association to Action.","authors":"Karthik Tennankore,Annie-Claire Nadeau-Fredette","doi":"10.2215/cjn.0000000907","DOIUrl":"https://doi.org/10.2215/cjn.0000000907","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"43 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145283693","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 Nocturnal Home Hemodialysis - an under-prescribed but essential home dialysis modality in the United States.","authors":"Frank Liu,Graham Abra,Nupur Gupta,Brigitte Schiller,Matthew B Rivara","doi":"10.2215/cjn.0000000927","DOIUrl":"https://doi.org/10.2215/cjn.0000000927","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"28 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261211","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":"Is Assisted Home Dialysis Feasible In the US? Addressing Legislative and Regulatory Levers.","authors":"Yuvaram N V Reddy,Suzanne Watnick,Nupur Gupta","doi":"10.2215/cjn.0000000925","DOIUrl":"https://doi.org/10.2215/cjn.0000000925","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"72 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261451","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}