Clinical journal of the American Society of Nephrology : CJASN最新文献

{"title":"Beyond the Binary: A Holistic Perspective on Gender-Affirming Hormone Therapy and Measures of Kidney Health.","authors":"Badal S B Pattar, Sofia B Ahmed","doi":"10.2215/CJN.0000001227","DOIUrl":"10.2215/CJN.0000001227","url":null,"abstract":"","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":"1672-1674"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular Risk Assessment Tools in CKD.","authors":"Carmine Zoccali, Vianda S Stel, Francesca Mallamaci, Giovanni Tripepi, Mehmet Kanbay, Michel Jadoul, Kitty J Jager","doi":"10.2215/CJN.0000001025","DOIUrl":"10.2215/CJN.0000001025","url":null,"abstract":"<p><p>Cardiovascular (CV) risk calculators estimate the likelihood of CV events by integrating factors such as age, sex, BP, lipids, smoking, and diabetes. Commonly used tools in the general population include the Framingham Risk Score, Systematic Coronary Risk Evaluation, atherosclerotic cardiovascular disease Pooled Cohort Equations, and QResearch Cardiovascular Risk Algorithm (QRISK), the latter being regularly updated using large-scale UK health records and including a wider range of variables such as CKD. CKD is a strong, independent risk factor for CV disease, but most standard models omit kidney function and CKD-specific factors ( e.g ., inflammation, vascular calcification, and mineral metabolism disorders). Consequently, they often underestimate CV risk in CKD, particularly in advanced stages and among dialysis patients, where competing risks ( e.g ., non-CV death) further complicate risk estimation. To overcome these limitations, enhanced and CKD-specific models have been developed. Systematic Coronary Risk Evaluation Add-ons incorporate eGFR and albuminuria to refine prediction in CKD. QRISK includes CKD as a variable. The CKD Prognosis Consortium and Predicting Risk of Cardiovascular Disease EVENTs models are tailored to CKD populations and leverage large, diverse datasets to improve discrimination and calibration. Reflecting this evidence, the 2024 Kidney Disease Improving Global Outcomes guidelines recommend QRISK, CKD Prognosis Consortium, and Predicting Risk of Cardiovascular Disease EVENTs for CV risk prediction in CKD. Artificial intelligence and machine learning approaches may further enhance risk prediction by exploiting complex clinical and laboratory data, but they require external validation, transparency, and assessment of clinical utility before broad implementation. CV risk calculators should support, not replace, clinical judgment and must be embedded within individualized, multifactorial management strategies. This narrative review summarizes the main characteristics, strengths, and limitations of currently available CV risk tools for CKD, focusing on those endorsed by major international guidelines and used in routine practice. We adopt a global perspective, while acknowledging that most evidence derives from high-income settings, which limits generalizability.</p>","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":"1826-1835"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146152090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of the Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) Equations in a CKD Population: A Nationwide Veterans Analysis.","authors":"Nikitha Murthy, Alyssa Sanchez, Janani Rangaswami, Sadiya S Khan, Roy O Mathew","doi":"10.2215/CJN.0000001129","DOIUrl":"10.2215/CJN.0000001129","url":null,"abstract":"<p><strong>Key points: </strong>The Predicting Risk of Cardiovascular Disease EVENTs equations optimize risk prediction in the modern era of increasing cardiovascular kidney metabolic disease prevalence. Risk prediction is most helpful to intensify therapy in those with less advanced kidney disease. In those with advanced kidney disease, risk indices provide little utility beyond biomarkers alone such as eGFR and albuminuria.</p><p><strong>Background: </strong>Cardiovascular kidney metabolic syndrome is a growing public health problem and leading cause of cardiovascular mortality. We evaluated model performance of the American Heart Association Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) equations in a large single health system population in patients with CKD and across strata of kidney function and compared findings where applicable to those of the pooled cohort equations (PCE).</p><p><strong>Methods: </strong>Veterans with eGFR measurements were divided into three groups: eGFR ≥60, eGFR 30-59, and eGFR 15-29. We assessed the base PREVENT equations for total cardiovascular disease (CVD), atherosclerotic CVD (ASCVD), and heart failure as well as add-on equations using albuminuria. Accuracy of equations was assessed with c-index as a measure of discrimination and calibration curve slopes as a measure of calibration.</p><p><strong>Results: </strong>Overall c-index was 0.651 for PREVENT-CVD, 0.633 for PREVENT-ASCVD, and 0.673 for PREVENT-heart failure. Discrimination of PREVENT-ASCVD was modestly greater than that of PCE (0.633 versus 0.629, respectively). For all three base PREVENT equations, discrimination declined with advancing kidney disease. Overall calibration slopes for the PREVENT equations ranged from 0.78 to 1.27. PREVENT-ASCVD had superior calibration compared to PCE with a calibration slope of 1.27 and 0.53, respectively. In those with urine albumin to creatinine ratio (UACR) measurements, discrimination of UACR add-on equations improved from base equations in those with less advanced kidney disease (c-index 0.624 for PREVENT-CVD UACR versus 0.607 for PREVENT-CVD base equation in those with eGFR ≥60, and c-index 0.586 for PREVENT-CVD UACR versus 0.563 for PREVENT-CVD base equation in those with eGFR 30-59). This trend was similar for the PREVENT-ASCVD and PREVENT-heart failure UACR add-on equations.</p><p><strong>Conclusions: </strong>In a CKD population, the PREVENT equations perform best in those less advanced stages of CKD and cardiovascular kidney metabolic, presenting an opportunity to apply disease-preventing and disease-modifying therapeutics in a timely manner.</p>","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":"1744-1752"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148623756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the Numbers: A Three-Time Kidney Transplant Recipient's Perspective on Barriers to Re-Transplantation.","authors":"Kimberly Brown Marsh","doi":"10.2215/CJN.0000001228","DOIUrl":"10.2215/CJN.0000001228","url":null,"abstract":"","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":"1667-1668"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Gender-Affirming Hormone Treatment on Kidney Function Trajectories in Transgender and Gender-Diverse Veterans.","authors":"Nicholas Jackson, Neda Buljubasic, Kamyar Kalantar-Zadeh, Hill L Wolfe, Joel Neugarten, Leila Hashemi","doi":"10.2215/CJN.0000001131","DOIUrl":"10.2215/CJN.0000001131","url":null,"abstract":"<p><strong>Key points: </strong>Administration of testosterone was associated with decline in the slope of eGFR in transgender veterans. Administration of testosterone was associated with increase in creatinine in first 12 months of hormone initiation in transgender veterans. Administration of estrogen was associated with stability of eGFR slope in transgender veterans.</p><p><strong>Background: </strong>The impact of hormone therapy (HT) on kidney function in transgender and gender-diverse (TGD) individuals remains poorly understood, and this lack of data poses challenges in caring for TGD individuals with kidney disease. The aim of this study was to compare serum creatinine levels and eGFR slope, a critical marker of kidney function, in transgender women (TW) and transgender men (TM) relative to cisgender (non-TGD) controls.</p><p><strong>Methods: </strong>We conducted a longitudinal cohort study of veterans using Veterans Health Administration care from January 2006 to December 2019. Serum creatinine and eGFR were assessed using algorithms based on affirmed gender and sex assigned at birth. Within-group changes over time were assessed using generalized linear mixed-effect models with random intercept and time modeled as a categorical variable. Two-way fixed-effects models were used to assess changes in eGFR slopes relative to HT initiation compared with cisgender controls.</p><p><strong>Results: </strong>The analytic dataset included 6616 veterans of whom 262 were receiving HT (214 [3%] TW and 48 [0.72%] TM) and 6354 were cisgender not receiving HT (1988 [30%] cisgender women and 4366 [66%] cisgender men). Serum creatinine was higher as early as 3 months after HT initiation in TM veterans with stabilization by 12 months, whereas TW veterans did not demonstrate any significant change in their serum creatinine. eGFR was significantly lower in TM veterans after HT initiation, whereas it remained stable in TW veterans.</p><p><strong>Conclusions: </strong>Our findings suggest that HT is associated with divergent effects on kidney function. These findings suggest the need for individualized kidney monitoring and potentially refined eGFR calculations for TGD populations.</p>","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":"1710-1718"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148274429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impaired Cardiopulmonary Fitness in Youth with CKD: A Call for Intervention.","authors":"James T Nugent","doi":"10.2215/CJN.0000001193","DOIUrl":"10.2215/CJN.0000001193","url":null,"abstract":"","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":"1675-1677"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular and Kidney Outcomes following Sodium-Glucose Cotransporter 2 Inhibitor Initiation in CKD: A Swedish Nationwide Cohort Study.","authors":"Joakim Österman, Ehab Al-Sodany, Peter Hemmingsson, Ida Haugen Löfman, Peter Barany, Marie Evans","doi":"10.2215/CJN.0000001160","DOIUrl":"10.2215/CJN.0000001160","url":null,"abstract":"<p><strong>Key points: </strong>In nationwide nephrology-referred CKD, sodium-glucose cotransporter 2 inhibitor use was associated with lower cardiovascular event and KRT risk. Associations with cardiovascular events and KRT were consistent in advanced CKD, a group underrepresented in trials. Findings supported the applicability of trial results to a broad nephrology-referred CKD population.</p><p><strong>Background: </strong>Sodium-glucose cotransporter 2 inhibitors (SGLT2 inhibitors) reduce cardiovascular (CV) and kidney events in randomized trials, yet evidence on their effectiveness in routine nephrology practice remains limited. We examined CV and kidney outcomes associated with SGLT2 inhibitor initiation in adults with CKD receiving specialist nephrology care.</p><p><strong>Methods: </strong>In this nationwide cohort study, we included adults with CKD receiving specialist nephrology care, identified through the Swedish Renal Registry between January 1, 2016, and December 31, 2023. Participants had baseline data on eGFR, urine albumin-to-creatinine ratio, and hemoglobin; those with prior KRT were excluded. Follow-up continued until December 31, 2024. SGLT2 inhibitor use was identified through national pharmacy records and analyzed according to an intention-to-treat approach. Outcomes were major adverse cardiovascular events (MACE), initiation of KRT, all-cause mortality, and a composite of heart failure hospitalization or CV death. Associations were estimated using inverse probability-weighted marginal structural models to address time-dependent confounding.</p><p><strong>Results: </strong>Among 32,856 participants (median age 73 years [interquartile range, 63-79]; 36% women; mean eGFR 29.3±16.8 ml/min per 1.73 m 2 ), 1493 (4.5%) were prevalent SGLT2 inhibitor users at baseline and 3491 (10.6%) initiated treatment during follow-up (4984 ever-exposed, 15.2%). SGLT2 inhibitor use was associated with a lower risk of MACE (odds ratio 0.80, 95% confidence interval, 0.71 to 0.91) and KRT (0.67, 0.52 to 0.85). No associations were observed for all-cause mortality (0.95, 0.79 to 1.15) or the composite heart failure outcome (0.87, 0.65 to 1.16), although a lower risk was observed in the incident-user analysis (0.61, 0.38 to 0.98). Associations were generally consistent across prespecified subgroups.</p><p><strong>Conclusions: </strong>In adults with CKD managed in specialist nephrology care, SGLT2 inhibitor use was associated with a lower risk of MACE and KRT, extending randomized trial evidence to a broad, real-world CKD population.</p>","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":"1733-1743"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liberation from Continuous KRT in Children: Where Do the Wins Come from?","authors":"Edoardo La Porta, Pasquale Esposito","doi":"10.2215/CJN.0000001229","DOIUrl":"10.2215/CJN.0000001229","url":null,"abstract":"","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":"1669-1671"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"On The Record: A Nephrologist's Guide to Navigating News Media Conversations.","authors":"Pranav Garimella, Joseph A Vassalotti","doi":"10.2215/CJN.0000001262","DOIUrl":"https://doi.org/10.2215/CJN.0000001262","url":null,"abstract":"","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrated Risk Prediction of Kidney Failure: Clinical and Multi-Omic Approaches.","authors":"Alana C Jones, Atlas Khan, Amit Patki, Vinodh Srinivasasainagendra, Nicole D Armstrong, Hemant K Tiwari, Bertha A Hidalgo, Nita A Limdi, Donna K Arnett, Devin M Absher, Krzysztof Kiryluk, Brittney Davis, Stephen S Rich, Jerome I Rotter, Josyf Mychaleckyj, Holly J Kramer, Yongmei Liu, Marguerite R Irvin","doi":"10.2215/CJN.0000001217","DOIUrl":"https://doi.org/10.2215/CJN.0000001217","url":null,"abstract":"<p><strong>Background: </strong>Kidney failure affects approximately 800,000 adults in the United States, and African Americans carry a disproportionate burden of disease. Robust algorithms for clinical risk prediction, such as the Kidney Failure Risk Equation (KFRE), have previously been validated, whereas the clinical utility of polygenic (PRS) and methylation risk scores (MRS), have not been as well characterized.1.</p><p><strong>Methods: </strong>In this study, we evaluated the capacity of PRS and MRS for CKD to predict multiple clinical endpoints, including incident kidney failure and decline in kidney function. Leveraging genomic, epigenomic, and clinical data from African American participants of the Hypertension Genetic Epidemiology Network (HyperGEN), Multi-Ethnic Study of Atherosclerosis (MESA), and Electronic Medical Records and Genomics (eMERGE) Network, we evaluated the performance of these risk scores in comparison to and in conjunction with the widely validated KFRE.</p><p><strong>Results: </strong>In HyperGEN, a higher PRS was associated with a higher risk of kidney failure. Similarly, the MRS was associated with incident kidney failure in both HyperGEN and MESA. Neither PRS nor MRS were associated with the rate of decline in kidney function in eMERGE or MESA. The KFRE outperformed both PRS and MRS as a single predictor. However, multi-score models suggested a synergistic effect of PRS and MRS to the predictive accuracy of the KFRE, with the greatest risk of kidney failure among individuals in high-risk strata of KFRE, PRS, and MRS.</p><p><strong>Conclusions: </strong>Results from this exploratory analysis suggest that, while PRS and MRS may not be superior to clinical algorithms, inclusion of '-omics' information may improve disease risk prediction. Future studies should seek to increase sample size to better evaluate these risk models and improve their capacity.</p>","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}