Clinical Journal of the American Society of Nephrology最新文献

{"title":"Urinary Response to Consuming Plant-Based Meat Alternatives in Persons with Normal Kidney Function: The SWAP-MEAT Pilot Trial","authors":"Catherine P. Ward, Matthew J. Landry, Kristen M. Cunanan, Kalani L. Raphael, Christopher C. Dant, Christopher D. Gardner, Alan C. Pao","doi":"10.2215/cjn.0000000000000532","DOIUrl":"https://doi.org/10.2215/cjn.0000000000000532","url":null,"abstract":"nefits as eating whole vegetables. We hypothesized that eating plant-meat when compared with animal meat decreases dietary acid load but increases dietary phosphorus and nitrogen. Methods: SWAP-MEAT was a randomized eight-week, crossover trial (NCT03718988) of participants consuming >2 servings/day of either plant-meat or animal meat for each eight-week phase. We measured urine sulfate, ammonium, pH, phosphorus, urea nitrogen, citrate, and creatinine concentrations, and serum creatinine and bicarbonate concentrations from stored participant samples from each phase. Results: At a single site, we enrolled 36 generally healthy participants (mean±SD age 50.2 ± 13.8 years, 67% women, and 69% White). Eating the plant-meat diet vs. eating the animal meat diet was associated with lower mean concentration of urine sulfate (-6.7 mEq/L; 95% CI -11.0, -2.4), urine ammonium (-4.2 mmol/L; 95% CI -8.2, -0.1), urine phosphorus (-9.0 mg/dL; 95% CI -17.5, -0.5), and urine urea nitrogen (-124.8 mg/dL; 95% CI -226.9, -22.6). Eating plant-meat compared with eating animal meat was associated with higher mean urine pH (+0.3 units; 95% CI 0.2, 0.5) and mean urine citrate/creatinine ratio (+111.65; 95% CI 52.69-170.60). After participants consumed a plant-meat diet compared with when they consumed an animal meat diet, mean serum creatinine concentration was lower (-0.07 mg/dL, 95% CI -0.10, -0.04), whereas mean serum bicarbonate concentration was not different. Conclusions: Eating plant-based meat products, compared with eating animal meat, was associated with lower urinary excretion of sulfate, ammonium, phosphorus, and urea nitrogen and higher urinary excretion of citrate. Our findings provide rationale for examining whether plant-based meat will benefit patients with kidney disease. Copyright © 2024 by the American Society of Nephrology...","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":null,"pages":null},"PeriodicalIF":9.8,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100614","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 Between Residential Segregation and Access to Kidney Transplantation - Evidence from a Multi-State Cohort Study.","authors":"Jasmine Berry, Aubriana Perez, Mengyu Di, Chengcheng Hu, Stephen O Pastan, Rachel E Patzer, Jessica L Harding","doi":"10.2215/CJN.0000000000000565","DOIUrl":"https://doi.org/10.2215/CJN.0000000000000565","url":null,"abstract":"<p><strong>Background: </strong>Individuals currently living in neighborhoods historically influenced by racial segregation have reduced access to healthcare. Whether this is true for individuals with end-stage kidney disease (ESKD) seeking transplant is unknown.</p><p><strong>Methods: </strong>We identified Black or White adults (n = 42,401; 18-80 years) with ESKD initiating kidney replacement therapy (KRT) in three US States (Georgia, North Carolina, South Carolina) between January 2015 and December 2019, with follow-up through 2020, from the United States Renal Data System (USRDS). Residential segregation was defined using the racial Index of Concentration at the Extremes and classified into tertiles (predominantly Black, mixed, or predominantly White neighborhoods). Primary outcomes were referral within 12-months of KRT initiation (among patients initiating KRT) and evaluation within six-months of referral (among all referred patients), determined via linkage of USRDS to the Early-Steps to Transplant Access Registry. Secondary outcomes included waitlisting (among evaluated patients), and living or deceased donor transplant (among waitlisted patients). The association between residential segregation and each outcome was assessed using multivariable Cox models with robust sandwich variance estimators.</p><p><strong>Results: </strong>In models adjusted for clinical factors, individuals living in predominantly Black or mixed (vs. predominantly White) neighborhoods were 8% (adjusted hazard ratio (aHR) 0.92 [0.88 - 0.96]) and 5% (aHR: 0.95 [0.91 - 0.99]) less likely to be referred for a kidney transplant, 18% (aHR: 0.82 [0.76 - 0.90]) and 9% (aHR: 0.91 [0.84 - 0.98]) less likely to be waitlisted among those who started evaluation, and 54% (aHR: 0.46 [0.36 - 0.58]) and 24% (aHR: 0.76 [0.63 - 0.93]) less likely to receive a living donor kidney transplant among those who were waitlisted, respectively. For other transplant steps, associations were non-significant.</p><p><strong>Conclusion: </strong>Individuals with ESKD living in historically and currently marginalized communities in the Southeast US have reduced access to important steps along the transplant care continuum.</p>","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":null,"pages":null},"PeriodicalIF":8.5,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074482","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":"Cystatin C and Kidney Function Recovery in Patients Requiring Continuous Kidney Replacement Therapy for Acute Kidney Injury.","authors":"Sarah M Haeger, Kayo Okamura, Amy S Li, Zhibin He, Bryan D Park, Isadore M Budnick, North Foulon, Matthew Kennis, Rachel Blaine, Makoto Miyazaki, Ruth Campbell, Diana I Jalal, James F Colbert, John T Brinton, Benjamin R Griffin, Sarah Faubel","doi":"10.2215/CJN.0000000000000531","DOIUrl":"https://doi.org/10.2215/CJN.0000000000000531","url":null,"abstract":"<p><strong>Background: </strong>Plasma cystatin C is a reliable marker to estimate kidney function; however, it is unknown whether this remains true in patients receiving continuous kidney replacement therapy (CKRT). Herein, we tested the hypothesis that lower concentrations of plasma cystatin C during the first three days of CKRT would predict kidney function recovery.</p><p><strong>Methods: </strong>We performed a retrospective observational study of 72 patients from a 126-patient, single-center CKRT study. We studied two a priori defined cohorts of patients without advanced CKD who had acute kidney injury requiring CKRT (AKI-CKRT): 1) with early kidney function recovery defined as liberation from KRT within seven days of CKRT initiation versus 2) with delayed kidney function recovery defined as receipt of KRT for >21 days or death while on KRT. Subsequent analysis included patients with advanced CKD and intermediate kidney function recovery (liberation between 8 and 21 days). Cystatin C was then measured on stored plasma, urine, and dialysis effluent collected prior to CKRT initiation and on days 1, 2, and 3 of CKRT.</p><p><strong>Results: </strong>Plasma cystatin C was significantly lower in patients with early kidney function recovery in comparison to patients with delayed kidney function recovery on days 1 (1.79 vs. 2.39mg/L), 2 (1.91 vs. 2.38mg/L) and 3 (2.04 vs. 2.67mg/L) of CKRT. Sieving coefficient and CKRT clearance of cystatin C were similar for patients with early and delayed kidney function recovery. The lowest plasma cystatin C concentration on days 1-3 of CKRT predicted early kidney function recovery with an area under the receiver operating curve of 0.77 (P = 0.002), positive likelihood ratio of 5.60 for plasma cystatin C <1.30mg/L, and negative likelihood ratio of 0.17 for plasma cystatin C ≥1.88mg/L.</p><p><strong>Conclusion: </strong>Lower plasma cystatin C concentrations during the first three days of CKRT are associated with early kidney function recovery.</p>","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":null,"pages":null},"PeriodicalIF":8.5,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019464","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 kidney function with SGLT2 inhibitor discontinuation among United States Veterans.","authors":"Jesse Ikeme, Erin Madden, Julio A Lamprea-Montealegre, Chi D Chu, Michael G Shlipak, Ian E McCoy, Michelle M Estrella","doi":"10.2215/CJN.0000000000000536","DOIUrl":"https://doi.org/10.2215/CJN.0000000000000536","url":null,"abstract":"<p><strong>Background: </strong>The impact of sodium-glucose co-transporter-2 inhibitors (SGLT2i) on cardiovascular disease and chronic kidney disease (CKD) may be limited if discontinued in persons with CKD. We sought to determine whether CKD at SGLT2i initiation was associated with subsequent discontinuation.</p><p><strong>Methods: </strong>This cohort study used electronic health record data of patients who initiated SGLT2i in the Veterans Health Administration from January 2017 through December 2021. The primary exposure was eGFR category at the time of SGLT2i initiation. The risk of SGLT2i discontinuation, defined by a provider order or expiration of an SGLT2i prescription without resumption in the following 180 days, was estimated using proportional hazards models with inverse probability weights for censoring due to death. Analyses were stratified by year of SGLT2i initiation.</p><p><strong>Results: </strong>Among the 222,772 patients initiating an SGLT2i during the study period, median age was 68 (IQR: 60-73) years, 95% were male, and median (IQR) eGFR was 73 (58, 89) mL/min/1.73m2. Median follow-up was 1.6 years; 32% experienced SGLT2i discontinuation. Cumulative risk of discontinuation at one year was 21% to 27% across calendar years; approximately 41% of these discontinuations occurred within the first three months. There was a graded association between lower baseline eGFR and greater risk of discontinuation; this association attenuated across calendar years. Those initiating an SGLT2i in 2017 with baseline eGFR of 45-59 and 30-44 had 1.34- (95%CI: 1.21-1.49) and 2.04-fold (95%CI: 1.58-2.63) risks of discontinuation, respectively, compared to those with eGFR ≥60 ml/min/1.73m2. These hazard ratios reduced to 1.05 (95%CI: 1.02-1.10) and 1.20 (95%CI: 1.14-1.26), respectively, in those initiated in 2021.</p><p><strong>Conclusions: </strong>A substantial proportion of patients experience SGLT2i discontinuation within a year of initiation. Persons with lower eGFR had higher discontinuation rates; however, this trend attenuated over time. Additional studies identifying determining factors of discontinuation are needed to fully realize the benefits of SGLT2i.</p>","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":null,"pages":null},"PeriodicalIF":8.5,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019463","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":"Large discordance between creatinine-based and cystatin C-based estimated glomerular filtration rates is associated with falls, hospitalizations, and death in older adults.","authors":"Nurit Katz-Agranov, Meghan L Rieu-Werden, Ayush Thacker, Jacquelyn M Lykken, Meghan E Sise, Sachin J Shah","doi":"10.2215/CJN.0000000000000523","DOIUrl":"https://doi.org/10.2215/CJN.0000000000000523","url":null,"abstract":"<p><strong>Background: </strong>Estimated glomerular filtration rate (eGFR) calculated using creatinine and cystatin C often differ in older adults. We hypothesized that older adults with cystatin-based eGFR (eGFRcys) values significantly lower than creatinine-based eGFR (eGFRcr) values may have higher risk for aging-related adverse outcomes, independent of kidney function.</p><p><strong>Methods: </strong>We conducted a longitudinal cohort study of adults ≥65 years old from the Health and Retirement Study, a cohort of older American adults, to determine the relationship between eGFR discordance and aging-related adverse outcomes. We calculated eGFRcr and eGFRcys using baseline creatinine and cystatin C measurements. A large eGFR discordance was defined as eGFRcys >30% lower than eGFRcr. We assessed four aging-related adverse outcomes over a two-year follow-up: falls, hip fractures, hospitalizations, and death. We fit separate multivariable regression models to determine the association between having a large eGFR discordance and each outcome adjusting for confounders including kidney function.</p><p><strong>Results: </strong>Of 5574 older adults, 1683 (30%) had a large eGFR discordance. Those with a large eGFR discordance were more likely to be older, female, and White. The prevalence of a large eGFR discordance increased with age, from 20% among those 65-69 years to 44% among those 80 years and older. Over a two-year follow-up, there were 305 deaths (5.5%), 2013 falls (39.2%), 69 hip fractures (1.3%), and 1649 hospitalizations (32.2%). In adjusted analyses, large eGFR discordance was associated with a higher hazard ratio for death (HR 1.43, 95% CI 1.12-1.82) and significantly higher odds of falls (odds ratio [OR] 1.32, 95% CI 1.16-1.51) and hospitalizations (OR 1.32, 95% CI 1.15-1.51). A large eGFR discordance was not associated with hip fractures.</p><p><strong>Conclusion: </strong>In a large, nationally representative cohort of older adults, prevalence of eGFR discordance increased with age and was associated with higher risk of falls, hospitalization, and death, independent of kidney function.</p>","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":null,"pages":null},"PeriodicalIF":8.5,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989436","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 Intake of Whole Grains with Health Outcomes in the Chronic Renal Insufficiency Cohort Study.","authors":"Dillon Winkelman, Julie Smith-Gagen, Casey M Rebholz, Orlando M Gutierrez, David E St-Jules","doi":"10.2215/CJN.0000000000000538","DOIUrl":"https://doi.org/10.2215/CJN.0000000000000538","url":null,"abstract":"<p><strong>Background: </strong>Patients with chronic kidney disease (CKD) are encouraged to choose refined grains instead of whole grains as part of the low-phosphorus diet for managing chronic kidney disease-mineral and bone disorders (CKD-MBD). However, there is no direct evidence indicating that limiting whole grains has a beneficial impact on CKD outcomes.</p><p><strong>Methods: </strong>This study analyzed Chronic Renal Insufficiency Cohort data in two ways, namely cross-sectional examination of CKD-MBD biomarkers and prospective examination of health outcomes. A total of 4,067 (cross-sectional) and 4,331 (prospective) participants were included. The primary exposure was reported intake of whole grains (analyzed as servings/day, servings/1,000kcal, and refined grain servings/whole grain servings). CKD-MBD biomarkers included serum phosphorus, fibroblast growth factor-23, parathyroid hormone, calcitriol, and calcium. Outcomes included cardiovascular events, kidney failure, and all-cause mortality.</p><p><strong>Results: </strong>In adjusted models, reported intake of whole grains was associated with higher phosphorus intake and serum phosphorus when assessed crudely (serving/day), but not when analyzed in relation to energy. Higher intake of refined grain relative to whole grains was associated (all models) with higher risk of kidney failure (Model 4: 1.01, 95% CI 1.00 to 1.02; P=0.01, all-cause mortality (Model 4: 1.01, 95% CI 1.00 to 1.01; P=0.01), and cardiovasulcar disease except for the fully adjusted model. Higher dietary density was associated with lower mortality in models adjusted for demographic and clinical factors including kidney function, but not in the fully adjusted model that futher adjusted for dietary factors.</p><p><strong>Conclusion: </strong>Intake of whole grains was not associated with CKD-MBD biomarkers. Intake of whole grains in relation to refined grains was associated with lower risk of cardiovascular disease, kidney failure, and mortality. The results of this study put into question the long-standing practice of restricting whole grains in patients with chronic kidney disease.</p>","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":null,"pages":null},"PeriodicalIF":8.5,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983813","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":"Transforming Dialysis Access Together (TDAT): a Multi-Disciplinary, Cross Cutting, Patient Centered Initiative.","authors":"Vandana Dua Niyyar, Gerald A Beathard, Gordon McLennan, Matthew A Sparks, Kristina Bryant, Cynthia Delgado, Nichole Jefferson, Joseph Kessler, Kerry Leigh, Susan Stark, Prabir Roy-Chaudhury","doi":"10.2215/CJN.0000000000000569","DOIUrl":"https://doi.org/10.2215/CJN.0000000000000569","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":null,"pages":null},"PeriodicalIF":8.5,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983814","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":"Automated Dialysis Anemia Management: Role of the Treating Nephrologist.","authors":"Steven Fishbane, Hitesh H Shah","doi":"10.2215/CJN.0000000000000541","DOIUrl":"https://doi.org/10.2215/CJN.0000000000000541","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":null,"pages":null},"PeriodicalIF":8.5,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141977117","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":"Biopsy-Based Transcriptomics May Be Precisely What Is Needed in Post-Kidney Transplant Care","authors":"David M. White","doi":"10.2215/cjn.0000000000000539","DOIUrl":"https://doi.org/10.2215/cjn.0000000000000539","url":null,"abstract":"An abstract is unavailable.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":null,"pages":null},"PeriodicalIF":9.8,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141992000","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":"Definition of Oliguria in the Intensive Care Unit: How Do You Do It?","authors":"Chloe G Braun, Javier A Neyra","doi":"10.2215/CJN.0000000000000545","DOIUrl":"https://doi.org/10.2215/CJN.0000000000000545","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":null,"pages":null},"PeriodicalIF":8.5,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141910155","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}