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

{"title":"Validation of Urinary C-C Motif Chemokine Ligand 14 for Persistent Severe AKI Using Clinical Adjudication.","authors":"J Patrick Kampf, Ali Al-Khafaji, Swati Arora, Anahat Dhillon, Michael Heung, Kianoush Kashani, Marcos G Lopez, James Szalados, Ashita Tolwani, Richard G Wunderink, John A Kellum, Fei Zheng, Sophie Grosz, Ludovic Brossault, June Coronella, Lydia Octave, Sandrine Michel-Busseret, Julia de la Salle, Chloé Geller, Jay L Koyner","doi":"10.2215/CJN.0000001212","DOIUrl":"https://doi.org/10.2215/CJN.0000001212","url":null,"abstract":"<p><strong>Background: </strong>Urinary C-C motif chemokine ligand 14 (CCL14) has been demonstrated to prognosticate persistent severe acute kidney injury (PS-AKI) in patients with established AKI. We sought to validate the performance of CCL14 among intensive care unit (ICU) patients, at previously established cutoffs of 1.3 and 13 ng/mL.</p><p><strong>Methods: </strong>The Diamond Study was a multi-center prospective observational study of ICU patients with KDIGO Stage 2 or 3 AKI within the last 36 hours. Urine was collected at enrollment for CCL14 measurement. The primary study endpoint was the development of PS-AKI (Stage 3, lasting for ≥72 hours) as determined by a clinical adjudication committee consisting of three nephrologists with expertise in AKI.</p><p><strong>Results: </strong>We enrolled 476 patients with CCL14 measurements and 151 (32%) were adjudicated to have PS-AKI. At enrollment, PS-AKI patients had higher APACHE III scores and more Stage 3 AKI (p<0.002 for both). Ninety-five (20%) patients received kidney replacement therapy (KRT), 98 (21%) died, and 155 (33%) received KRT and/or died within 30 days. The area under the receiver operating characteristic curve (95% CI) for CCL14's prediction of PS-AKI was 0.70 (0.65-0.76). The sensitivity at the 1.3 ng/mL cutoff was 78.1% (70.9%-84.0%), while the specificity was 49.8% (44.4%-55.3%). For every 1 ng/mL increase in CCL14, there was a 6% higher rate of KRT initiation; with values above 13 ng/mL having a hazard ratio (95%CI) of 5.70 (3.22-10.11) for need for KRT and 3.50 (2.19-5.60) for need for KRT or death relative to values ≤1.3 ng/mL (p<0.001 for all).</p><p><strong>Conclusions: </strong>In ICU patients with Stage 2 or 3 AKI, urinary CCL14 is associated with a higher risk of PS-AKI, including KRT initiation and death. Future efforts to treat AKI could be enriched using CCL14 to target those at high risk for PS-AKI.</p>","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984146","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":"Glucagon-Like Peptide-1 Receptor Agonists in CKD: A Case-Based Discussion of Translating Evidence into Practice.","authors":"Dianne S Cheung","doi":"10.2215/CJN.0000001252","DOIUrl":"10.2215/CJN.0000001252","url":null,"abstract":"","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983832","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":"Navigating the Emotional Landscape of Kidney Allograft Failure: Patient and Provider Perspectives.","authors":"Preethi Yerram, Marc Brazie, Dawn P Edwards, Andrew Howard, Daniel Landry, Precious McCowan, Ramin Sam, Renata Sledge, Mary Baliker","doi":"10.2215/CJN.0000001250","DOIUrl":"10.2215/CJN.0000001250","url":null,"abstract":"","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148973014","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":"Atherosclerotic Cardiovascular Disease in CKD: Contemporary Insights into Pathogenesis, Diagnosis, and Management.","authors":"Simon Correa, Jonathan W Cuningham, Finnian R Mc Causland","doi":"10.2215/CJN.0000001199","DOIUrl":"https://doi.org/10.2215/CJN.0000001199","url":null,"abstract":"<p><p>Patients with chronic kidney disease (CKD) have a disproportionate burden of cardiovascular disease, and the majority die from cardiovascular causes before ever reaching kidney failure. Atherosclerotic cardiovascular disease (ASCVD), which includes coronary artery disease, cerebrovascular disease, and peripheral arterial disease, develops in CKD through the convergence of traditional risk factors and a distinct group of CKD-related, non-traditional mechanisms, including mineral and bone disorder with vascular calcification, chronic inflammation and oxidative stress, uremic toxicity, and an atherogenic dyslipidemia. Cardiovascular and kidney disease interact in a bidirectional manner in which each accelerates the other. Reflecting this unique pathophysiology, the burden of ASCVD rises steeply as kidney function declines, reaching a several-fold higher risk of myocardial infarction, stroke, and peripheral arterial disease at the lowest eGFR and highest albuminuria. Nonetheless, ASCVD in CKD remains under-recognized and undertreated, owing partly to atypical clinical presentations, conventional risk-prediction tools that underestimate risk, and to the exclusion of patients with advanced CKD from most landmark cardiovascular trials. In this review, which focuses primarily on coronary artery disease in non-dialysis-dependent CKD, we examine the epidemiology and key pathogenic mechanisms of ASCVD in this setting; and appraise diagnostic and risk-prediction approaches together with their limitations, including contemporary CKD-adapted risk equations, cardiac biomarkers, and non-invasive imaging. We also summarize the current evidence for management, spanning lipid-lowering, antiplatelet, and blood-pressure therapies, newer cardiometabolic agents (including SGLT2 inhibitors, GLP-1 receptor agonists, and non-steroidal mineralocorticoid receptor antagonists), coronary revascularization, and lifestyle modification. Throughout, we highlight where high-quality, CKD-specific evidence is lacking, and we outline priority research gaps and emerging therapies directed at CKD-relevant pathways, such as inflammation. Recognizing and aggressively modifying cardiovascular risk in CKD, across both traditional and CKD-specific pathways, represents a substantial, and currently underrealized, opportunity to reduce morbidity and mortality in this high-risk population.</p>","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148972977","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":"Authors' Reply: Evaluating PREVENT for Cardio-Kidney Outcomes in CKD.","authors":"Byounghwi Ko, Jong Hyun Jhee, Tae-Hyun Yoo","doi":"10.2215/CJN.0000001176","DOIUrl":"https://doi.org/10.2215/CJN.0000001176","url":null,"abstract":"","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914951","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":"The Cardiovascular-Kidney-Metabolic Paradox: Enhanced Prediction or Persistent Heterogeneity?","authors":"Amir Kazory, Abhilash Koratala","doi":"10.2215/CJN.0000001150","DOIUrl":"https://doi.org/10.2215/CJN.0000001150","url":null,"abstract":"","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914995","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":"Authors' Reply: Interpreting Neutral Trial Results of Far-Infrared Radiation for Arteriovenous Fistula Patency.","authors":"Kristine Lindhard, Henrik Post Hansen, Boye L Jensen, Ditte Hansen","doi":"10.2215/CJN.0000001178","DOIUrl":"https://doi.org/10.2215/CJN.0000001178","url":null,"abstract":"","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914984","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":"Predictive Value of Urine Tubular Biomarkers on Kidney Outcomes: Observations from EMPA-KIDNEY.","authors":"Greco B Malijan, William G Herrington, Parminder K Judge, Rebecca J Sardell, Daniel Chapman, Michael Hill, Stewart Moffat, Doreen Zhu, Alfred K Cheung, Dominik Steubl, Martin J Landray, Christoph Wanner, Colin Baigent, Richard Haynes, Joachim H Ix, Natalie Staplin, Michael G Shlipak","doi":"10.2215/CJN.0000001203","DOIUrl":"10.2215/CJN.0000001203","url":null,"abstract":"<p><strong>Key points: </strong>The kidney failure risk equation showed excellent discrimination for treated kidney failure outcome in patients with CKD. In a wide range of causes of CKD, urine tubular biomarkers improved prediction of kidney disease progression beyond established clinical risk models. EGF, kidney injury molecule-1, and monocyte chemoattractant protein-1 added the most prognostic value.</p><p><strong>Background: </strong>Urine tubular biomarkers have previously been associated with chronic kidney disease (CKD) progression independently of eGFR and albuminuria. We evaluated whether nine urine tubular biomarkers could improve prediction of kidney failure beyond serum creatinine and urine albumin‑creatinine ratio among adults with CKD.</p><p><strong>Methods: </strong>Among 5100 participants in Study of Heart and Kidney Protection With Empagliflozin, a randomized trial that assessed the effects of empagliflozin 10 mg versus matching placebo among patients with CKD at risk of progression, nine urine creatinine-indexed tubular biomarkers were measured, including α -1 microglobulin, dickkopf-3, EGF, interleukin-18, kidney injury molecule-1 (KIM-1), monocyte chemoattractant protein-1 (MCP-1), neutrophil gelatinase-associated lipocalin, uromodulin, and human cartilage glycoprotein-40. Outcomes were kidney disease progression (treated kidney failure, renal death, or sustained ≥40% eGFR decline) and treated kidney failure (maintenance dialysis or kidney transplant). Relative to models based on the linear predictor of the kidney failure risk equation (KFRE), improvements in discrimination were estimated with further addition of the nine tubular biomarkers using absolute difference in Uno C-index.</p><p><strong>Results: </strong>Over a median 3.5 years of follow-up, 1191 participants experienced kidney disease progression and 461 experienced treated kidney failure. KFRE demonstrated excellent discrimination for treated kidney failure (C-index 0.858 [0.840-0.874]) and moderate discrimination for kidney disease progression (0.724 [0.705-0.743]). Addition of three biomarkers (MCP-1, KIM-1, and EGF) most strongly associated with CKD outcomes yielded some further improvement in predicting kidney failure (absolute difference 0.014 [0.009-0.024]) and kidney disease progression (0.038 [0.026-0.053]). Prediction of kidney outcomes was only slightly improved when further expanding from three to all nine tubular biomarkers.</p><p><strong>Conclusion: </strong>In a wide range of causes of CKD, adding three urine tubular biomarkers (MCP-1, KIM-1, and EGF) to KFRE improves estimates of risk of CKD progression.</p><p><strong>Clinical trial registry name and registration number: </strong>NCT03594110 .</p>","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890150","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":"A Randomized Pilot Trial of a Nephrologist Communication Tool for Discussing Conservative Management.","authors":"Susan P Y Wong, Olivia Gaughran, David K Prince, Jane Schell, Daniel Y Lam, Dawn Bates, Grady Paden, Erin K Kross","doi":"10.2215/CJN.0000001213","DOIUrl":"10.2215/CJN.0000001213","url":null,"abstract":"<p><strong>Key points: </strong>Conservative kidney management is infrequently presented to patients as a treatment option for kidney failure. Conservative Kidney Management Jumpstart Tool is a communication tool that helps nephrologists discuss patients' values and care options. The tool improved discussions about values and conservative management with patients.</p><p><strong>Background: </strong>It is difficult for patients to make informed decisions about kidney failure unless they know all their treatment options. Conservative management is an important option infrequently presented alongside other kidney failure treatments by nephrologists.</p><p><strong>Methods: </strong>We conducted a randomized pilot trial testing the feasibility and acceptability of a communication tool, called the Conservative Kidney Management Jumpstart Tool, in assisting nephrologists with discussing conservative management with their patients. We recruited patients aged 75 years or older with stage 4 or 5 CKD in the greater Seattle area between April 2023 and May 2025. Patients were randomized in 1:1 fashion to either their nephrologists receiving the tool to use with them at their next clinic visit (intervention) or usual care (control). Our primary outcome and feasibility measure was patient-reported discussion of conservative management during the clinic visit. Our secondary outcome and acceptability measure was change in patients' satisfaction with their nephrologist's serious illness communication skills (using the Quality of Communication Scale, with higher scores indicating higher quality) before and after the visit. We performed an intent-to-treat analysis of the primary end point using a chi-squared test. We used paired-samples t tests to assess within-patient changes in the secondary end point.</p><p><strong>Results: </strong>We randomized 74 patients (age 80±1, 19% women, 69% White) to either the control ( n =37) or intervention ( n =37) group. Patients whose nephrologists received the tool were more likely to discuss conservative management during their clinic visit (60% versus 19%, P = 0.001) than patients in the control group. Patients whose nephrologists received the tool rated their nephrologist's communication skills at 7.5±2.1 before the visit and 9.0±1.7 after the visit ( P < 0.001) as compared with 7.8±1.9 and 7.9±1.8 ( P = 0.54), respectively, among patients in the control group.</p><p><strong>Conclusions: </strong>The tool was feasible and acceptable to patients, promoting patient-nephrologist discussion of conservative management and improving patients' satisfaction with their nephrologist's communication skills.</p><p><strong>Clinical trial registry name and registration number: </strong>ClinicalTrials.gov ID: NCT05753020 .</p>","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890165","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":"Interpreting Neutral Trial Results of Far-Infrared Radiation for Arteriovenous Fistula Patency.","authors":"Cheng-Chien Lai, Fan-Yu Chen, Chin-Te Tseng, Chih-Ching Lin","doi":"10.2215/CJN.0000001171","DOIUrl":"https://doi.org/10.2215/CJN.0000001171","url":null,"abstract":"","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148883263","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}