Clinical Journal of the American Society of Nephrology最新文献

{"title":"Sex and Gender in Science, Medicine, and Nephrology: Where Are We and Why Does It Matter?","authors":"Farah Wehbe, Adeera Levin","doi":"10.2215/cjn.0000000677","DOIUrl":"https://doi.org/10.2215/cjn.0000000677","url":null,"abstract":"An abstract is unavailable. This article is available as a PDF only.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"50 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143192027","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 Gap: Assessing Nephrology Transition Practices in Pediatric and Adult Medical Centers","authors":"Andrew Vissing, Priya S Verghese, Angelina Dixon, Cybele Ghossein","doi":"10.2215/cjn.0000000639","DOIUrl":"https://doi.org/10.2215/cjn.0000000639","url":null,"abstract":"cols in academic medical centers, however, is currently unknown. Methods: General nephrology and transplant nephrology programs were surveyed at both pediatric and adult medical centers to explore the current state of nephrology transition practices. Programs without transition clinics were asked to identify obstacles preventing the establishment of a transition clinic. Results: Overall, there were 488 programs targeted for survey distribution. There were 188 survey responses with an overall response rate of 39%. Only 20% of programs had a transition clinic and 32% of programs reported neither having an established transition clinic nor a transition protocol. Adult programs were more likely to lack an established transition clinic or protocol compared to pediatric programs (42% vs 20%, P = 0.001). Of partnered pediatric and adult programs that both responded to the survey, 51% were discordant in their transition practices. For the 150 programs without a transition clinic, there were 119 comments regarding obstacles to the establishment of such a clinic. Resource and financial obstacles were mentioned the most frequently (50% of comments). Adult programs were more likely to mention no perceived need or obstacles compared to pediatric programs (17% vs 4%, P = 0.04). Conclusions: Despite guidelines recommending pediatric to adult transition programs for young adults with kidney disease, transition clinics remain uncommon. While there are many cited barriers to the establishment of a nephrology transition clinic, our study highlights the lack of coordination and cooperation between adult and pediatric centers which may stem from a lack of perceived need or interest from adult nephrology programs. Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Nephrology...","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"136 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143192025","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 Kinetics of Cystatin C and Serum Creatinine in AKI.","authors":"Levi Hooper, Michael Heung, Michael Kenes, Kathleen A Stringer, Bruce A Mueller, Manjunath P Pai","doi":"10.2215/CJN.0000000654","DOIUrl":"10.2215/CJN.0000000654","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071169","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 Urinary PGE2 with Plasma Potassium in Patients with CKD and the General Population.","authors":"Frank Geurts, Martin Gritter, Dominique M Bovée, Rosa D Wouda, Liffert Vogt, Layal Chaker, Robert A Fenton, Ewout J Hoorn","doi":"10.2215/CJN.0000000653","DOIUrl":"10.2215/CJN.0000000653","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071165","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":"Health Equity and Artificial Intelligence in Nephrology.","authors":"Adam Engel Hercz,Susanne B Nicholas,Alex A T Bui,Keith C Norris","doi":"10.2215/cjn.0000000673","DOIUrl":"https://doi.org/10.2215/cjn.0000000673","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"28 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056899","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":"Performance of Creatinine and Cystatin-Based Equations on Estimating Measured Glomerular Filtration Rate in People with Hematological and Solid Cancers.","authors":"Silvia M Titan,John C Lieske,Jeffrey W Meeusen,Stacy Thorson,Yi Lin,Grzegorz S Nowakowski,Jason N Barreto,Erin F Barreto,Kathryn J Ruddy,Nelson Leung,Andrew D Rule,Sandra M Herrmann","doi":"10.2215/cjn.0000000616","DOIUrl":"https://doi.org/10.2215/cjn.0000000616","url":null,"abstract":"BACKGROUNDGlomerular filtration rate (GFR) assessment is important in clinical practice, with implications for diagnosis, prognostication, and drug dosing. People with cancer are at risk of imprecision in GFR estimation. This cross-sectional study evaluated the performance of various creatinine and cystatin C-based equations in comparison to measured GFR (mGFR) in people with cancer.METHODSWe retrieved data for all adult patients who had mGFR by urinary iothalamate clearance between 2011 and 2023 at Mayo Clinic and use of an electronic health record diagnosis code for cancer within two years prior to mGFR. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), European Kidney Function Consortium (EKFC), and Cockcroft-Gault (CG) equations were computed, along with performance metrics (bias, precision, and root mean square error, RMSE). Confidence intervals were generated by bootstrapping and analysis were stratified by solid and hematological cancer.RESULTSFrom all adults with cancer and mGFR, 1145 had both creatinine and cystatin C available within seven days of mGFR. Among all equations, the creatinine- cystatin C CKDEPI equation provided the best performance, with small bias (median 3.0, 95%CI 2.3-3.8) and higher precision (RMSE 14.5) compared to creatinine-only or cystatin-only equations (RMSE varying from 16.6 to 20), and this was also true in solid and hematological cancers. The creatinine-cystatin EKFC equation had a similar performance to CKDEPI, CG showed worst precision (30% of people with errors above 30%), and cystatin C CKDEPI equation was the most biased, prone to underestimation of mGFR.CONCLUSIONSIn our cohort of patients with mGFR and cancer, the CKDEPI creatinine-cystatin C equation performed best for GFR assessment, and this was true for both solid and hematological cancers. Our findings give support for the preferential use of creatinine and cystatin C-based equations instead of creatinine-only or cystatin C-only equations in people with cancer.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"39 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056898","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":"Impact of Race on Transplantation in Autosomal Dominant Polycystic Kidney Disease.","authors":"Sambhavi Krishnamoorthy,Niveditha Girimaji Satishchandra,Arlene Chapman,Rita McGill","doi":"10.2215/cjn.0000000626","DOIUrl":"https://doi.org/10.2215/cjn.0000000626","url":null,"abstract":"BACKGROUNDAutosomal dominant polycystic kidney disease (ADPKD) is the most common genetic cause of end-stage kidney disease (ESKD) and occurs without racial predilection. In general, non-White ESKD patients have less access to transplantation, especially living donor transplantation. We examined long-term outcomes of ADPKD-ESKD patients by self-reported race, with attention to the trajectory of Estimated Post-Transplant Survival (EPTS) scores over time.METHODSUnited Network for Organ Sharing Standard Transplant Analysis and Research files were used to identify 32,611 ADPKD transplant recipients between 1/2000-12/2022. EPTS scores were calculated from the date of waitlisting until transplantation occurred. Cumulative incidences of living and deceased transplantation were calculated and plotted. Cox models were made for graft failure and death, and a sub-distribution hazards model for graft failure accounted for death as a competing outcome, with adjustment for patient, donor, and transplant factors.RESULTSCompared to White ADPKD patients, all other groups had more dialysis years, more delayed graft function, and fewer living and pre-emptive transplants; mean EPTS scores were lower in African American (AA) and Hispanic patients at each timepoint on the waitlist. However, EPTS scores at the time of transplant was less likely to be <20% in AA and Hispanic patients, due to longer waiting time. AA patients had a significantly higher risk of graft failure with death as competing risk compared to White patients. Asian and Hispanic patients had similar graft survivals but better patient survival compared to White patients.CONCLUSIONSWaitlist experience, allograft quality, and post-transplant outcomes of patients with ADPKD are influenced by patient race.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"7 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056906","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":"Assessing Current Nephrology Fellows' Perceptions of Future Earnings as Attending Physicians.","authors":"Rasha Raslan, Kurtis A Pivert, Jefferson L Triozzi, Suzanne M Boyle","doi":"10.2215/CJN.0000000645","DOIUrl":"10.2215/CJN.0000000645","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029798","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":"New Index Demonstrates Association between Social Vulnerability, Environmental Burden, and Kidney Failure Risk among Individuals with Glomerular Disease.","authors":"Loryn W Dass,Abigail R Smith,Jill Krissberg,Chia-Shi Wang,Bruce M Robinson,Rasheed A Gbadegesin,Gaurav Dave,Keisha L Gibson","doi":"10.2215/cjn.0000000638","DOIUrl":"https://doi.org/10.2215/cjn.0000000638","url":null,"abstract":"BACKGROUNDThe Centers for Disease Control and Prevention (CDC) Environmental Justice Index Social-Environmental Ranking (EJI-SER) combines a Social Vulnerability Module (SV) with an Environmental Burden Module (EB) to characterize cumulative environmental and social burden at the census tract level. This analysis evaluates the association between EJI-SER and kidney outcomes in glomerular disease (GD) patients.METHODSCure Glomerulopathy (CureGN) is an observational cohort study of adults and children with biopsy-proven GD. EJI-SER is a percentile ranking by census tract, with a higher score indicating a more severe burden. Associations between EJI-SER and its components with kidney failure (initiation of kidney replacement therapy, transplant, or two estimated glomerular filtration rates [eGFRs] <15ml/min/1.73m2) and longitudinal eGFR were tested using multivariable Cox regression and linear mixed models, respectively, adjusted for demographics, histologic diagnosis, eGFR and urine protein to creatinine ratio at enrollment, and time from biopsy to enrollment.RESULTSAmong 1,149 participants with census tract data, the median (IQR) follow-up was 5.4 (3.0-7.0) years, the median (IQR) age at biopsy was 24 (10-48), and self-identified racial distribution was 5% Asian, 18% Black, and 70% White. Median (IQR) EJI-SER was 0.49 (0.26-0.75). EJI-SER scores in the lowest two quartiles were associated with a lower hazard of kidney failure compared to the highest quartile (adjusted HR [95% CI] 0.62 [0.36-1.08] and 0.43 [0.25-0.76] for EJI-SER 0-25% and >25-50% vs. >75%, respectively) and higher eGFR at enrolllment (adjusted mean 90.1 vs. 87.1 ml/min/1.73m2 for 0-25% vs. >75%, p=0.08).CONCLUSIONAs captured by EJI-SER, higher environmental and social burdens are associated with lower eGFR and a higher risk of kidney failure in the CureGN cohort. This first use of the EJI-SER in GD demonstrates the need for additional investigation into social drivers of disparities in GD and policies and resources that address these structural inequities.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"56 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988793","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":"Non-Indexed vs. Body Surface Area Indexed Measured Glomerular Filtration Rate Determinations as a Criterion of Living Donor Acceptance.","authors":"Abraham J Matar,Erika S Helgeson,Jesse C Seegmiller,Karthik Ramanathan,Erik B Finger,Raja Kandaswamy,Timothy L Pruett,Matthew Wright,Jessica Fisher,Rasha El-Rifai,Richard Spong,Arthur J Matas,Vanessa Humphreville","doi":"10.2215/cjn.0000000606","DOIUrl":"https://doi.org/10.2215/cjn.0000000606","url":null,"abstract":"INTRODUCTIONWhen GFR is measured (mGFR) using iohexol plasma clearance, results are reported both as a \"non-indexed\" (mL/min) and \"body-surface area (BSA) indexed\" to 1.73 m2. When these two values differ, there is no consensus as to which is preferable to use to determine suitability for living kidney donation (LKD). We sought to compare the difference between non-indexed and BSA indexed mGFR in LKDs and the association with postdonation estimated GFR (eGFR).METHODSBetween 1/1/2007-1/1/2023, 627 adult LKDs at the University of Minnesota had predonation mGFR by iohexol plasma clearance and a minimum six-month follow-up. LKD acceptance was based on a non-indexed mGFR ≥80 ml/min (age <60) or ≥75 ml/min (age ≥60). Primary outcomes included eGFR at one-year postdonation and sustained eGFR <45 mL/min/1.73m2.RESULTSAmong 627 LKDs, 561 (90%) had both a non-indexed and BSA indexed mGFR above the age-based threshold (concordant), while 66 (11%) had non-indexed measurements above and BSA indexed below (discordant). Compared to concordant LKDs, discordant LKDs were older (median: 54.1 years vs. 42.8 years, p <0.001) and had higher body mass indices (28.0 vs. 26.1, p <0.001). At one-year postdonation, mean eGFR was higher among concordant LKDs, although the difference in relative change from pre-donation eGFR measurements was similar. During a median follow up of 2.3 years, six out of 66 (9%) discordant LKDs experienced sustained eGFR <45 mL/min/1.73m2 compared to five out of 561 (0.9%) concordant LKDs (hazard ratio: 10.7, 95% confidence intervals: 3.21 to 35.6).CONCLUSIONDiscordant LKDs had lower eGFR measurements postdonation and experienced a higher risk for eGFR <45 mL/min/1.73m2.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"15 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988792","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}