Clinical Journal of the American Society of Nephrology最新文献

{"title":"Vascular Calcification and Chronic Kidney Disease: Challenges, Emerging Targets, and Future Perspectives.","authors":"Lucie Fernandez,Julie Klein","doi":"10.2215/cjn.0000000733","DOIUrl":"https://doi.org/10.2215/cjn.0000000733","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"29 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143846280","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 Clinical Implications of Slope of Glomerular Filtration Rate in Clinical Trials of Chronic Kidney Disease.","authors":"Tom Greene,Willem Collier,Benjamin Haaland,Chong Zhang,Sunil V Badve,Fernando Caravaca-Fontán,Lucia Del Vecchio,Jürgen Floege,Thierry Hannedouche,Enyu Imai,Tazeen H Jafar,Julia B Lewis,Philip K T Li,Francesco Locatelli,Bart D Maes,Brendon L Neuen,Ronald D Perrone,Francesco P Schena,Robert Toto,Christoph Wanner,Mark Woodward,Arjan van Zuilen,Hiddo J L Heerspink,Lesley A Inker,","doi":"10.2215/cjn.0000000662","DOIUrl":"https://doi.org/10.2215/cjn.0000000662","url":null,"abstract":"BACKGROUNDSlope of the glomerular filtration rate (GFR) is considered a validated surrogate endpoint for chronic kidney disease (CKD) trials. However, differing short and long-term treatment effects on GFR slope can create ambiguities concerning the appropriate time period for evaluating slope, in part because current methods cannot separate the distinct contributions of the acute (before three months) and chronic (after three months) slopes for treatment effects on clinical endpoints.METHODSWe estimated treatment effects on the acute and chronic GFR slopes and on the established clinical endpoint (CE) of kidney failure or serum creatinine doubling for 66 randomized treatment comparisons from previous CKD clinical trials. We used a novel Bayesian meta-regression framework to relate treatment effects on the established CE to both the acute and chronic slopes in a single multivariable model to determine the independent contributions of the acute and chronic slopes.RESULTSTreatment effects on both the acute and chronic slopes independently predicted the treatment effect on the established CE with a high median R2 (95% credible interval) of 0.95 (0.79,1.00). For a fixed treatment effect on the chronic slope, each 1 mL/min/1.73m2 greater acute GFR decline for the treatment vs. control increased the HR for the established CE by 11.4% (7.9%, 15.0%), against the treatment. The optimal weights for the acute and chronic slopes were consistent with the three-year total slope defined as the average slope extending from baseline to three years.CONCLUSIONTreatment effects on both the acute and chronic GFR slopes are independent determinants of the effects on the established CE, with variation in acute effects accounting for much of the observed variation in treatment effects on the CE across previous trials. Our results establish that acute effects impact the CE independently of treatment effects on the chronic slope, and support the three-year total slope as the primary slope-based outcome in randomized trials.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"90 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143846302","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":"Multicenter Development and Validation of a Multimodal Deep Learning Model to Predict Moderate to Severe Acute Kidney Injury.","authors":"Jay L Koyner,Jennie Martin,Kyle A Carey,John Caskey,Dana P Edelson,Anoop Mayampurath,Dmitriy Dligach,Majid Afshar,Matthew M Churpek","doi":"10.2215/cjn.0000000695","DOIUrl":"https://doi.org/10.2215/cjn.0000000695","url":null,"abstract":"BACKGROUNDPrior models for the early identification of acute kidney injury (AKI) have utilized structured data (e.g., vital signs and laboratory values). We aimed to develop and validate a deep learning model to predict moderate to severe AKI by combining structured data and information from unstructured notes.METHODSAdults (≥18 years) admitted to the University of Wisconsin (2009-20) and the University of Chicago Medicine (2016-22) were eligible for inclusion. Patients were excluded if they had no documented serum creatinine (SCr), end-stage kidney disease, an admission SCr≥3.0mg/dL, developed ≥Stage 2 AKI before reaching the wards or intensive care unit (ICU), or required dialysis (KRT) within the first 48 hours. Text from unstructured notes was mapped to standardized Concept Unique Identifiers (CUIs) to create predictor variables, and structured data variables were also included. An intermediate fusion deep learning recurrent neural network architecture was used to predict ≥Stage 2 AKI within the next 48 hours. This multimodal model was developed in the first 80% of the data and temporally validated in the next 20%.RESULTSThere were 339,998 admissions in the derivation cohort and 84,581 in the validation cohort, with 12,748 (3%) developing ≥Stage 2 AKI. Patients with ≥Stage 2 AKI were older, more likely to be male, had higher baseline SCr, and were more commonly in the ICU (p<0.001 for all). The multimodal model outperformed a model based only on structured data for all outcomes, with an area under the receiver operating characteristic curve (95% CI) of 0.88(0.88-0.88) for predicting ≥Stage 2 AKI and 0.93(0.93-0.94) for receiving KRT. The area under the precision-recall-curve for ≥Stage 2 AKI was 0.20. Results were similar during external validation.CONCLUSIONSWe developed and validated a multimodal deep learning model using structured and unstructured data that predicts the development of severe AKI across the hospital stay for earlier intervention.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"60 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143841044","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":"Exploring Unconscious Bias at International Kidney Conference: A Retrospective Analysis.","authors":"Chaitanya Vankireddy,Joseph Wahba,Jacob Stein,Sandeep Aggarwal","doi":"10.2215/cjn.0000000696","DOIUrl":"https://doi.org/10.2215/cjn.0000000696","url":null,"abstract":"BACKGROUNDThe impact of unconscious biases on academic interactions has gained increasing attention across several disciplines, including the field of medicine. We explored the possible manifestation of these biases by analyzing presenters' introductions by moderators at the American Society of Nephrology (ASN) Kidney Week Conferences.METHODSWe analyzed 1534 archived sessions from ASN Kidney Weeks 2019, 2021, and 2023. Moderator and speaker gender, academic rank, session type, and presence of formal titles in introductions were documented. Multivariable logistic regression was conducted to evaluate the relationship between these characteristics and the frequency of formal title usage by moderators.RESULTSFemale moderators used formal titles more frequently than their male counterparts across all years (estimate 0.60, Standard Error (SE) = 0.18, p <0.05). Title usage was higher in 2021 (virtual format) compared to in 2019 and 2023 (est. 0.76, SE = 0.25, p <0.001). However, there was a significant increase from 2019 to 2023 (est. 0.74, SE = 0.24, p <0.001). With respect to rank interactions, full Professors introducing Associate Professors (est. 0.82, SE = 0.35, p <0.05) and vice versa (est. 0.62, SE = 0.40, p <0.05) both had higher probabilities of formal title usage. On the other hand, Assistant Professors introducing other Assistant Professors showed a lower likelihood of using a full title (est. -0.83, SE = 0.35, p <0.05). Basic science sessions exhibited the lowest rates across all years (p <0.001).CONCLUSIONOur findings suggest that unconscious bias may exist in peer-to-peer interactions in nephrology academic circles. Further investigation is warranted to explore the interplay of additional variables such as geographic and cultural characteristics to more clearly understand the extent of this issue and develop interventions that mitigate bias and promote equity in academic settings.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"74 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143841050","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 Gut Microbiome and the Gut-Liver-Kidney Axis in Metabolic-Associated Steatotic Liver Disease and Chronic Kidney Disease.","authors":"Cyrielle Caussy,Jennifer Rieusset,Laetitia Koppe","doi":"10.2215/cjn.0000000732","DOIUrl":"https://doi.org/10.2215/cjn.0000000732","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"1 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143836514","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":"Predicting Remission in Anti-PLA2R Antibody-Associated Membranous Nephropathy: A Secondary Analysis of the GEMRITUX, MENTOR and STARMEN Trials.","authors":"Sean J Barbour,Pierre Ronco,Manuel Praga,Fernando C Fervenza,Dilshani Induruwage,Bingyue Zhu,Hanna Debiec,Gema Fernández-Juárez,Fernando Caravaca-Fontán,Daniel C Cattran,","doi":"10.2215/cjn.0000000694","DOIUrl":"https://doi.org/10.2215/cjn.0000000694","url":null,"abstract":"BACKGROUNDIn patients with anti-phospholipase A2 receptor (PLA2R) antibody associated membranous nephropathy, there is currently no accepted method to predict an individual's probability of remission after treatment with immunosuppression or supportive therapy using changes in antibody levels and clinical variables during the first 3-6 months of therapy.METHODSUsing a cohort of 187 patients from the GEMRITUX, MENTOR and STARMEN clinical trials with antibody levels at baseline ≥14 RU/ml, we derived logistic regression models to predict proteinuria remission at 12 months that can be used at baseline or after three or six months of treatment. Treatment exposures in the trials included supportive therapy, rituximab, calcineurin inhibitors and cyclophosphamide. Predictors in the models included male sex, and baseline and changes in serum albumin, proteinuria, and antibody levels, with or without changes in eGFR.RESULTSProteinuria remission at 12 months was achieved in 107 patients. Compared to the model at baseline, the three- and six-month models had better model fit with lower Akaike Information Criterion (186/158 vs 225) and higher R2 (52.7%/62.4% vs 25.8%), better discrimination with higher C-statistic (0.87 and 0.91 vs 0.75, P<0.001), and better calibration with lower integrated calibration index (0.89%/2.22% vs 2.51%). The three- and six-month models had no consistent difference in prediction performance and decision curve analysis demonstrated similar net benefit for treatment decisions based on either model up to a threshold probability of 31%. Prediction performance was similar after internal validation using optimism correction. Prediction performance was maintained within subgroups of different treatment regimens, including supportive therapy, rituximab, calcineurin inhibitors and cyclophosphamide.CONCLUSIONSEither the three- or six-month models can be used in patients with anti-PLA2R antibody associated membranous nephropathy after three or six months of treatment with a variety of immunosuppression or supportive therapy to predict remission status at 12 months.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"26 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143836513","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":"Gadolinium and Kidney Disease: Should We Still Be Cautious?","authors":"Ihab M Wahba","doi":"10.2215/cjn.0000000729","DOIUrl":"https://doi.org/10.2215/cjn.0000000729","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"183 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143824823","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":"Nurse-Assisted Peritoneal Dialysis: A Pilot Feasibility Program.","authors":"Neelam Bhalla,Lerisa D Villaflor,Sijie Zheng","doi":"10.2215/cjn.0000000689","DOIUrl":"https://doi.org/10.2215/cjn.0000000689","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"183 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143824776","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":"Risk of Urinary Tract Infections with SGLT-2 Inhibitors in Subpopulations with Abnormal Genitourinary Pathology.","authors":"Jing Xu,Anna Sun,Yuedi Yang,Yi Shi,Jing Su,Michael T Eadon,Pengyue Zhang","doi":"10.2215/cjn.0000000687","DOIUrl":"https://doi.org/10.2215/cjn.0000000687","url":null,"abstract":"BACKGROUNDWhile sodium-glucose transport protein-2 inhibitors (SGLT2i) possess multiple beneficial effects, the drugs are associated with genitourinary infections. We sought to define the precise relationship between SGLT2i exposure, types of urinary tract infections (UTI), and clinical risk factors.METHODSWe used an incident user design with active comparator analysis to derive SGLT2i and glucagon-like peptide-1 receptor agonist (GLP1ra) user cohorts from US nationwide insurance claim data. We used both covariate-adjusted Cox models and Cox models with inverse probability of treatment weighting to investigate the risk of non-candida UTI and candida UTI following drug exposure. We compared the risk between SGLT2i and GLP1ra exposure in the general population and subpopulations with genitourinary abnormalities.RESULTSGLT2i exposure compared with GLP1ra exposure was associated with a greater risk of candida UTI (all hazard ratios [HRs] ≥2.42 and all P-values <0.001), but a lower risk of non-candida UTI (all HRs ≤0.91 and all P-values <0.001). Prior genitourinary abnormalities such as prior UTI, prior genital infection, genitourinary malignancy, indwelling foley, or other genitourinary pathology were associated with greater risk of non-candida and/or candida UTI (all adjusted HRs ≥1.26 and all P-values ≤0.002). However, no difference in comparative risk of SGLT2i to GLP1ra exposure for non-candida UTI was observed in these subpopulations. In contrast, an additive effect between SGLT2i exposure and several genitourinary abnormalities was observed for candida UTI (all adjusted HRs ≥2.37 and all P-values <0.001).CONCLUSIONSSGLT2i exposure was associated with greater risk of candida UTI, but not non-candida UTI. SGLT2i to GLP1ra comparative risk of non-candida UTI did not differ in individuals with abnormal genitourinary pathology compared to those without.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"38 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143824815","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":"Decision Readiness and Determinants of Kidney Replacement Therapy among Veterans with Advanced Chronic Kidney Disease.","authors":"Kailyn E Pearce,Yi Guo,Shobha Subhash,Darin Ftouni,Brian Visconti,Anuradha Wadhwa,Adhish Agarwal,Huanguang Jia,Ashutosh M Shukla","doi":"10.2215/cjn.0000000713","DOIUrl":"https://doi.org/10.2215/cjn.0000000713","url":null,"abstract":"INTRODUCTIONKidney disease stakeholders recommend a system-wide increase in home dialysis use. Kidney replacement therapy (KRT) decision readiness is associated with higher selection and use of home dialysis; however, KRT decision-making is complex, and factors informing KRT decision readiness in patients with advanced chronic kidney disease (CKD) are unclear.METHODSUsing the baseline data of the Trial to Evaluate and Assess the effects of Comprehensive KRT-directed patient education on Home dialysis use among VETerans (TEACH-VET), we conducted a cross-sectional analysis to evaluate prevalent KRT decision readiness, defined as ability to choose any KRT modality among US Veterans with advanced CKD. We also evaluated Veterans' ability to achieve high-quality informed KRT decisions (more than 60% decisional confidence on a scale ranging from 1 to 100%) and selection of home dialysis as secondary outcomes. Univariate and multivariable logistic regression were used to test associations between patient-level variables and outcomes.RESULTSOf the 468 enrollees with a complete baseline dataset, 282 (60%) could not pick any KRT modality; the rest were split between high (20%) vs. low-quality (20%) decisions and home (21%) vs. in-center (19%) dialysis. Younger age, higher CKD stage, history of receiving prior KRT-directed education, rural habitation, and objective disease knowledge were positively associated with KRT decision readiness. Only objective disease knowledge was associated with KRT decision readiness after adjustments, with participants in the highest tertile of CKD-specific knowledge having two-fold (OR: 2.31, 95%CI: 1.18, 4.55) and KRT-specific knowledge having five-fold (OR: 5.16, 95%CI: 2.63, 10.32) higher odds of selecting their KRT. Item-level analysis showed that difficult, specifically KRT knowledge-related, items had a high discriminatory capacity to predict KRT decision readiness.CONCLUSIONVeterans with advanced CKD are ill-prepared for KRT decision-making. While social determinants of health have a potential role in identifying high-risk populations, objective kidney failure and KRT-specific knowledge have a dominant impact on KRT decision readiness.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"6 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143824781","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}