Clinical Journal of the American Society of Nephrology最新文献

{"title":"GLP-1 Receptor Agonist Outcomes, Safety, and BMI Change in a National Cohort of Dialysis Patients.","authors":"Babak J Orandi,Yusi Chen,Yiting Li,David Charyton,Krista L Lentine,Brian P Lee,Nicole Ali,Mario P DeMarco,Michael A Weintraub,Sunjae Bae,Bonnie E Lonze,Christine J Ren-Fielding,Holly Lofton,Akash Gujral,Dorry L Segev,Mara McAdams-DeMarco","doi":"10.2215/cjn.0000000750","DOIUrl":"https://doi.org/10.2215/cjn.0000000750","url":null,"abstract":"BACKGROUNDOf the 808,000 US dialysis patients, 60% have diabetes and are eligible for glucagon-like peptide-1 (GLP-1) receptor agonists. Safety and outcomes in this population is unknown. We sought to examine GLP-1 receptor agonist real-world safety, efficacy, and weight loss in people with diabetes on dialysis.METHODSIn this observational national cohort study (2013-2021), we identified adults with type 2 diabetes on dialysis. The exposure of interest was GLP-1 receptor agonist use. Body mass index (BMI) change after dialysis initiation was quantified among patients with two measurements (N=6,474). Extended Cox models with inverse probability of treatment weights (censoring for kidney transplant waitlisting) were used to quantify all-cause mortality associated with GLP-1 receptor agonists. Specific safety outcomes (acute pancreatitis, biliary complications, medullary thyroid cancer, diabetic retinopathy) were assessed.RESULTSThe study included 151,649 incident dialysis patients with type 2 diabetes. Mean BMI and weight change among GLP-1 receptor agonist users were greater than that among non-users (-1.47 versus -0.61 kg/m2; -4.03 versus -1.47 kg; P<0.001 for both). The mortality incidence rate was lower among GLP-1 receptor agonist users (219.0 versus 279.5 cases/1,000 person-years; P<0.001). GLP-1 receptor agonist use was associated with a 23% lower risk of mortality (adjusted hazard ratio [aHR]: 0.77, 95% confidence interval [CI]:0.70-0.85; P<0.001); results were consistent among initiates with BMI≥30 kg/m2. GLP-1 receptor agonist use was associated with a 66% higher chance of waitlisting (aHR=1.66, 95%CI:1.28-2.13; P<0.001). There was an increased association with diabetic retinopathy (aHR=1.32, 95%CI:1.12-1.56; P=0.001), but not with any other safety outcomes. Inferences were consistent across multiple sensitivity analyses.CONCLUSIONSGLP-1 receptor agonist use in patients with type 2 diabetes on dialysis was associated with weight loss, reduced mortality risk, and increased likelihood of kidney transplant waitlisting. These real-world data are the strongest evidence to date supporting GLP-1 receptor agonist use in this population.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"623 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311374","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":"Culinary Medicine for Chronic Kidney Disease.","authors":"Rebecca Schlueter,Joanne Cooke,Karen L Isaacson,Brandon G Calhoun","doi":"10.2215/cjn.0000000785","DOIUrl":"https://doi.org/10.2215/cjn.0000000785","url":null,"abstract":"Culinary medicine is an emerging, evidence-based discipline that integrates medical and nutritional care with practical culinary strategies to mitigate the risk and progression of chronic kidney disease (CKD). Culinary Medicine, which falls under the broader movement of \"Food is Medicine\", supports culturally relevant, person-centered health care goals. It addresses strategies to overcome the health risks of the standard American diet, high in animal protein, salt, sugar, and ultra-processed foods. Recent guidelines, including the Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guidelines for Nutrition in CKD 2020 and Kidney Disease Improving Global Outcomes (KDIGO) 2024 Clinical Practice Guideline for Evaluation and Management of CKD (40), recommend adoption of plant-rich eating patterns, based on the large body of evidence highlighting benefits such as reduced net acid production, lower body weight, and improved blood pressure. Transition to a kidney-friendly eating pattern is often hindered by barriers, like time, budget, and culinary skill. This innovative field uses food as a preventive and therapeutic tool to overcome barriers to the actionable food choices needed for better health. This article aims to: (1) underscore the role of culinary medicine in lifestyle intervention to improve CKD outcomes; and (2) explore practical implementation of Culinary Medicine in CKD management to optimize patient well-being. While direct, large-scale clinical trials specifically on culinary medicine in CKD are still emerging, the synergy of nutritional evidence and experiential strategies points to its promise as a preventive and therapeutic tool for improving CKD outcomes. Increasing awareness of the existence and effectiveness of culinary medicine within the nephrology community can foster meaningful discussions about impactful lifestyle changes that influence patient outcomes.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"12 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311373","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":"Abnormal Cardiovascular Functional Responses After the Long Interdialytic Interval: A Quasi-Experimental Crossover Study","authors":"Eliott Arroyo, Nolan W. Groninger, Drake E. Dillman, Heather N. Burney, Xiaochun Li, Yang Li, Gayatri Narayanan, Andrew R. Coggan, S. Jawad Sher, Sharon L. Karp, Sharon M. Moe, Kenneth Lim","doi":"10.2215/cjn.0000000749","DOIUrl":"https://doi.org/10.2215/cjn.0000000749","url":null,"abstract":"ctional response patterns, as assessed by cardiopulmonary exercise testing (CPET), following the short- and long- interdialytic intervals. Methods: We conducted an exploratory single center, quasi-experimental two-arm study involving crossover of treatment sequences in patients on conventional thrice-weekly maintenance HD. All patients underwent CPET, bioelectrical impedance spectroscopy, and physical function testing on three study visits: Post-HD, and Pre-HD at the end of a two-day and the three-day interdialytic intervals. Results: Thirty-one patients (N=19 men, mean [SD] age 55 (12) years, median [IQR] dialysis vintage 56 [24, 96] months) completed all study visits. Interdialytic weight gain and total body fluid were greater following three-day compared with two-day (P <0.001). Ventilation/carbon dioxide production (VE/VCO2) slope, a non-invasive index of exercise pulmonary vascular resistance and right ventricular (RV) dysfunction, was significantly elevated at three-day (31.2 (4.8) L VE/L VCO2; P=0.002) compared with two-day (29.5 (3.9) L VE/L VCO2). No significant differences between interdialytic intervals were observed for peak oxygen uptake (VO2Peak) or VO2 at the anaerobic threshold. Change (Δ) in VE/VCO2 slope (ΔVE/VCO2) from two-day to three-day was correlated with Δbody weight (r=0.36, P=0.04) and left ventricular mass index (r=0.44, P=0.02). Conclusions: The long interdialytic interval is associated with abnormal exercise-derived ventilatory and hemodynamic responses, including ventilation-perfusion mismatch and potentially RV dysfunction and RV–pulmonary artery uncoupling during exercise as suggested by elevated VE/VCO2 slope. Copyright © 2025 by the American Society of Nephrology...","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"47 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144252603","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 Emerging Nephrology Physician Workforce in the United States: Defining an Impending Shortfall","authors":"Jason Silvestre, Megan Meyers, Natalie Freidin","doi":"10.2215/cjn.0000000716","DOIUrl":"https://doi.org/10.2215/cjn.0000000716","url":null,"abstract":"ded match data for this retrospective study of US nephrology fellowship applicants (2009-2024). Annual trends were analyzed with linear regression. Results: The annual number of nephrology fellowship programs (142 to 180, 26.8% higher, P<0.001) and training positions (367 to 488, 33.0% higher, P<0.001) were higher over the study period. In contrast, the annual number of applicants were lower (578 to 362, 37.4% lower, P<0.001). The annual applicant-to-training position ratio was lower (1.6 to 0.7, P<0.001) while the annual match rate was higher (60.2% to 89.4%, P=0.004). The annual rate of unmatched training positions were higher (5.2% to 34.2%, P<0.001) and the percentage of applicants that matched at their first-choice ranked fellowship were higher (37.2% to 60.4%, P=0.02). The annual representation of US allopathic graduates were lower (37.9% to 25.5%, P=0.05 while the annual representation of US osteopathic graduates were higher (4.9% to 16.5%, P<0.001). The annual representation of international medical graduates remained similar (57.2% to 57.9%, P=0.15). Conclusions: The annual number of training positions in nephrology have been higher without commensurate growth in the number of applicants. The rate of unmatched training positions is becoming higher with potential deleterious consequences to future US nephrologist workforce adequacy. Accelerated efforts are needed to emphasize the attractiveness of the specialty and stimulate interest among applicants. Surveillance of future nephrology match outcomes is warranted. Copyright © 2025 by the American Society of Nephrology...","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"27 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144252604","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 Protein Intake Recommendations for Patients with Non-Dialysis Dependent CKD: What Should Healthcare Providers Do?","authors":"Csaba P Kovesdy, Giuliano Brunori, Denis Fouque, Allon N Friedman, Giacomo Garibotto, T Alp Ikizler, Kamyar Kalantar-Zadeh, Brandon M Kistler, Laetitia Koppe, Joel D Kopple, Martin K Kuhlmann, Kelly Lambert, Robert H Mak, Linda W Moore, Angela Yee-Moon Wang, S Russ Price","doi":"10.2215/CJN.0000000772","DOIUrl":"https://doi.org/10.2215/CJN.0000000772","url":null,"abstract":"<p><p>Protein intake is crucial to maintain human health, and an adequate quantity and quality of dietary protein intake (DPI) is particularly important in patients with chronic kidney disease (CKD). Both an insufficient amount of DPI (i.e., <0.6 g/kg body weight/day) and an excess amount of DPI (i.e., >1.3 g/kg body weight/day) pose potential health hazards in patients with CKD stages 3-5. Therefore, to optimize patient outcomes, healthcare providers should be familiar with the effects of both inadequate and excessive DPI in this population. The Kidney Disease Outcome Quality Initiative (KDOQI guidelines on DPI are rooted in detailed analyses of available scientific evidence and provide detailed recommendations regarding different dietary interventions strategies to achieve optimal quantity and quality of DPI. The more recent Kidney Disease Improving Global Outcomes (KDIGO) guidelines on CKD management have a substantially broader scope and include a relatively brief section on diet, recommending a DPI of 0.8 g/kg BW/day, emphasizing the need to avoid a DPI of >1.3 g/kg BW/day. Besides aiming for a DPI of ∼0.6-0.8 g/kg body weight/day in patients with CKD stages 3-5, successful practical implementation of dietary interventions requires an individualized approach which considers patient characteristics, such as socio-cultural norms, habitual dietary habits, and nutrition literacy as well as systemic factors such as feasibility and availability of interventions.</p>","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188436","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":"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}