Clinical Journal of the American Society of Nephrology最新文献

{"title":"Proteinuria Trajectory and Disease Progression in Children and Adults with IgA Nephropathy/Vasculitis.","authors":"Dorey A Glenn,Ashley W Carver,Margaret E Helmuth,Abigail R Smith,Richard A Lafayette,Prasanth Ravipati,Andrea L Oliverio,Dana V Rizk,Jan Novak,Francesca Lugani,Sharon M Bartosh,Krzysztof Mucha,Krzysztof Kiryluk,Manish K Saha,Cynthia C Nast,Jean Hou,Laura E Biederman,Nidia Messias,Avi Z Rosenberg,Heather N Reich,Pietro A Canetta,Patrick H Nachman,Carla Nester,Raed Bou-Matar,Shikha Wadhwani,Laura H Mariani,Myda Khalid,","doi":"10.2215/cjn.0000000707","DOIUrl":"https://doi.org/10.2215/cjn.0000000707","url":null,"abstract":"BACKGROUNDIdentifying patients with IgA Nephropathy at risk for disease progression is critical for clinical decision making, risk-based patient counseling, and optimal enrollment of clinical trials.METHODSPatients with IgA Nephropathy (IgAN) and IgA Vasculitis with Nephritis (IgAVN) were enrolled in CureGN, a multi-center observational cohort study. Children and adults were analyzed separately in four cohorts 1) full, 2) incident, 3) prevalent, and 4) histology. Groups were defined using latent class trajectory modeling using proteinuria measurements over two years. Linear mixed models were used to calculate predicted estimated glomerular filtration rate (eGFR) slope. In adults, Cox proportional hazard models were used to model time to kidney failure or 40% eGFR decline as a function of proteinuria trajectory group.RESULTSOf 919 individuals with IgAN/IgAVN enrolled into CureGN, 368 adults and 234 children were included in the analysis. In the full adult cohort, Group 1 had the lowest levels of proteinuria (IQR 0.1-0.4 g/g), while Groups 2 and 3 had intermediate and higher levels of proteinuria (IQR 0.5-1.5 and IQR 1.8-4.1 g/g, respectively). Average predicted time to eGFR less than 15 ml/min/1.73 m2 was >90, 16, and 8 years and >90, 67, 11 years for proteinuria trajectory groups 1, 2, and 3, in the full adult and pediatric cohorts, respectively. In adults, adjusting for age, eGFR at enrollment, immunosuppression exposure, and hypertension, Group 3 membership was associated with 3.13 (95% CI 1.84-5.33), 1.98 (95% CI 0.97-4.06), and 3.36 (95% CI 1.59-7.13) times higher hazard of progressing to a composite outcome compared to Group 2 membership in the full, prevalent and histology cohorts, respectively, but not associated with progression in the incident cohort.CONCLUSIONSProteinuria trajectory is a major predictor of disease progression in patients with IgA nephropathy.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"25 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143818994","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":"Rurality vs. Non-Rurality of Kidney Transplant Patients and the Potential Role of Telemedicine Services.","authors":"Fawaz Al Ammary,Krista L Lentine,Yaara Zisman-Ilani,Helen Hughes,Simeon Adeyemo","doi":"10.2215/cjn.0000000717","DOIUrl":"https://doi.org/10.2215/cjn.0000000717","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"43 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143819377","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":"Sleep-Related Disorders in Patients with Chronic Kidney Disease and Kidney Transplant Recipients.","authors":"Nicolas Vendeville,Istvan Mucsi,Miklos Z Molnar","doi":"10.2215/cjn.0000000728","DOIUrl":"https://doi.org/10.2215/cjn.0000000728","url":null,"abstract":"Sleep disorders such as insomnia, restless legs syndrome (RLS), and sleep apnea are common in patients with chronic kidney disease (CKD). These conditions tend to become more prevalent and more severe as kidney function deteriorates and when a patient reaches end-stage kidney disease (ESKD). The prevalence of insomnia in the general population ranges from 4-29% compared to i) 30-67%, ii) 39-54%, iii) 41-79%, and iv) 9-49% in patients with CKD, on hemodialysis, on peritoneal dialysis (PD), or in kidney transplant recipients (KTRs) respectively. RLS occurs in about 1-15% of the general population compared to i) 5-18%, ii) 24-33%, iii) 23-64%, and iv) 6-8% in patients with CKD, on hemodialysis, on PD, or in KTRs respectively. Obstructive sleep apnea has been reported in i) 40-69%, ii) 25-47%, iii) 9-52%, and iv) 25-30% in patients with CKD, on hemodialysis, on PD, or in KTRs respectively. Fatigue is a complex symptom that has been reported in patients with CKD, ESKD, and in KTRs and can be associated with sleep disorders. Fatigue and sleep disorders have been associated with negative outcomes such as progression of CKD, increased risk of morbidity, mortality, and lower health-related quality of life. In this Review, we highlight non-pharmacologic and pharmacologic options for treatment of these sleep disorders. Specifically, the diagnosis and evaluation, epidemiology, risk factors and associations, outcomes (such as CKD progression, morbidity, and mortality), treatment, and post-transplant outcomes for sleep disorders (insomnia, RLS, sleep apnea) and fatigue will be discussed.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"36 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143818987","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 Randomized Controlled Trial of Video-Assisted Electronic Consent Versus Standard Consent for Percutaneous Kidney Biopsy.","authors":"Pedro H Franca Gois,Vera Y Miao,Rebecca B Saunderson,Marina Wainstein,Julia Jefferis,Rebecca Hudson,Shaun Chandler,Kylie-Ann Mallitt,Martin Wolley,Belinda Elford,Ann Bonner,Helen G Healy","doi":"10.2215/cjn.0000000702","DOIUrl":"https://doi.org/10.2215/cjn.0000000702","url":null,"abstract":"BACKGROUNDInformed consent is crucial in healthcare, as it respects and honors patient autonomy. However, the process of consenting a patient to a procedure or intervention is often unstandardized, leading to gaps in comprehension, which in turn affects decision-making. This study aimed to assess the patient-reported benefits of video-assisted electronic consent (eConsent) compared with the usual consent practices for percutaneous kidney biopsies (PKB).METHODSIn this single-center, open-label, randomized controlled trial, consecutive patients undergoing PKB between July 2021 and January 2024 were randomized (1:1) to either video-assisted eConsent (intervention) or usual practice of consent (control). The intervention group accessed an eight-minute explanatory animation on an online platform covering the procedure, its risks, and pre- and post-biopsy care before providing digital consent. The control group was consented to by clinicians in the usual manner and signed a paper form. The primary outcome was questionnaire-based patient comprehension, with secondary outcomes including patient-reported experience, anxiety, and satisfaction with the consent process.RESULTSOf 178 eligible patients, 120 were enrolled (60 in each group), with a median age of 52 (IQR 34-65) years, 56% were female, and 59% had less than 12 years of education. Comprehension scores were significantly higher in the eConsent group, with participants answering on average three more questions correctly out of nine compared to the control group (p<0.001). Comprehension did not differ significantly by sex or education level, but younger patients scored higher. The eConsent group also had better comprehension of pre- and post-PKB care. No significant differences were observed in patient-reported experience, anxiety, or satisfaction between groups.CONCLUSIONSVideo-assisted eConsent improves patient comprehension of PKB compared to usual consent practice without affecting patient experience, anxiety, or satisfaction.TRIAL REGISTRATIONAustralian New Zealand Clinical Trials Registry (ACTRN12621000768897).","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"31 9 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143818984","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":"10.2215/CJN.0000000683","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":" ","pages":"779-787"},"PeriodicalIF":8.5,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12160953/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Heat Exposure and Medical Utilization among the Chronic Kidney Disease Population","authors":"Jeff Romine, Daniel Cullen, Eugene Galperin, Hakon Mattson, Joseph A. Vassalotti, Katelyn Tang, Aliza Gordon","doi":"10.2215/cjn.0000000699","DOIUrl":"https://doi.org/10.2215/cjn.0000000699","url":null,"abstract":"\u0000We investigated the relationship between temperature and healthcare utilization among patients with chronic kidney disease (CKD). We utilized panel regression models with individual and year fixed effects to evaluate how exposure to different levels of temperature (measured by heat index) was associated with changes in weekly healthcare utilization from October 1, 2015, to March 31, 2023. Data were derived from medical claims data, Parameter-Elevation Regressions on Independent Slopes Model (PRISM) climate data, and the Census block group of each individual. The study population was comprised of 916,886 individuals with commercial or Medicare insurance who had been diagnosed with CKD stage G3, G4, or G5. CKD was defined using diagnosis codes in medical claims and estimated glomerular filtration rate (eGFR) laboratory results. Exposure was the number of days in a week with a daily heat index in ten-degree Fahrenheit bins. Results: We found that exposure to a higher heat index bin, 90-100F compared to 60-70F, was associated with an increase in weekly emergency department utilization (0.55%; 95% CI: 0.42%-0.68%; p<0.001), with larger percent increases for ED visits with a heat-related primary diagnosis code (2.07%; 95% CI: 1.63%-2.51%; p<0.001) or a kidney-related primary diagnosis code (1.37%; 95% CI: 0.56%-2.17%; p <0.001). ED visits with a primary diagnosis code related to kidney disease were associated with a larger impact among those least likely to have access to air conditioning (2.48%; 95% CI: 0.84%-4.13%; p<0.01). Smaller, statistically significant results were observed comparing heat indexes of 80-90F to 60-70F. Conclusions: Exposure to heat indexes above 90 degrees was associated with greater weekly ED utilization and ED utilization with heat- or kidney-related primary diagnosis codes. Copyright © 2025 by the American Society of Nephrology...","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"40 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143824960","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":"Randomized Controlled Trial of Walking Training with and Without Blood Flow Restriction in Patients Treated with Maintenance Hemodialysis","authors":"Huagang Hu, Xiaomei Jiang, Ying Huang, Ying Zeng, Qinjuan Xu, Chanchan Wu, Pui Hing Chau, Edmond Pui Hang Choi","doi":"10.2215/cjn.0000000701","DOIUrl":"https://doi.org/10.2215/cjn.0000000701","url":null,"abstract":"nd walking training (WT) versus usual care controls on walking capacity among hemodialysis patients. Methods Patients treated with maintenance hemodialysis were recruited from two dialysis units in Suzhou, China between February to June 2024, and were randomly allocated into three groups using block randomization. The control group received usual care. The WT group received eight weeks of low-to-moderate intensity walking intervention. The WT-BFR group received the same intervention as the WT group, with the addition of 40% to 50% limb occlusion pressure applied during walking sessions. Walking capacity (primary outcome), physical function, health-related quality of life, anxiety, and depression were assessed at baseline, eight weeks, and 16 weeks. Results Fifty-seven eligible patients with a mean age of 54 years (Standard Deviation=10) were recruited. They were randomly allocated equally into the control group (N=19), WT-BFR group (N=19), and WT group (N=19). From baseline to eight weeks, the improvements in walking capacity were greater in the WT-BFR (mean differences and 95% confidence interval: 48.48, 28.81 to 68.16 meters) and WT (31.70, 9.29 to 54.11 meters) groups compared to the control group. At 16 weeks, the WT-BFR group also demonstrated a greater improvement in walking capacity than the WT group (34.63, 8.90 to 60.36 meters). Similarly, the WT-BFR and WT groups showed greater improvements in physical function and disease-specific domains of health-related quality of life, compared to the control group. Conclusions After an eight-week intervention, both WT-BFR and WT improved walking capacity, physical function, and health-related quality of life in maintenance hemodialysis patients. However, the prolonged benefits of WT-BFR in the hemodialysis population require further investigation. Copyright © 2025 by the American Society of Nephrology...","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"183 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143824964","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":"Targeting the Optimal Antibody Strategy for a Noninvasive Diagnosis of Phospholipase A2 Receptor–Associated Membranous Nephropathy: Is Serology Alone Sufficient?","authors":"Shane A. Bobart, Fernando C. Fervenza","doi":"10.2215/cjn.0000000710","DOIUrl":"https://doi.org/10.2215/cjn.0000000710","url":null,"abstract":"An abstract is unavailable.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"112 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143824961","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":"Trends in Timing of Preemptive Kidney Transplantation and Association with Allograft and Survival Outcomes in Children.","authors":"Erica Winnicki, Timothy P Copeland, Ashley Kim, Eva M Glenn Lecea, Charles E McCulloch, Elaine Ku","doi":"10.2215/CJN.0000000643","DOIUrl":"10.2215/CJN.0000000643","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":" ","pages":"573-581"},"PeriodicalIF":8.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IgG4-Related Kidney Disease.","authors":"Niloufar Ebrahimi, Vince Ha, William Whittier, Orhan Efe, Andreas Kronbichler, Hae Yoon Grace Choung, Arvind Singh, Amir Abdipour, Sayna Norouzi","doi":"10.2215/CJN.0000000684","DOIUrl":"10.2215/CJN.0000000684","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":" ","pages":"588-590"},"PeriodicalIF":8.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}