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

{"title":"Associations of Plant- and Animal-Sourced Ultra-Processed Foods and Incident CKD in the Cardiovascular Health Study.","authors":"Courtney M Hill, Alyssa Feinberg, Casey M Rebholz, Rozenn Lemaitre, Amanda M Fretts, Kerri L Wiggins, Nona Sotoodehnia, James S Floyd, Benjamin Lidgard, Nisha Bansal, Bruce M Psaty, Hyunju Kim","doi":"10.2215/CJN.0000001207","DOIUrl":"10.2215/CJN.0000001207","url":null,"abstract":"<p><strong>Background: </strong>Ultra-processed foods (UPFs) are associated with adverse health. Plant foods can be highly processed. It is not clear whether plant- and animal-sourced UPFs are associated chronic kidney disease (CKD) risk.</p><p><strong>Methods: </strong>Data came from the Cardiovascular Health Study, a prospective cohort of 2,661 older adults (≥65 years). The exposure was UPF intake, classified as plant- or animal-sourced in servings/day using the Nova framework from food frequency questionnaires (1989-1990, 1995-1996). The outcome was incident CKD (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2) and absolute eGFR change (up to 18 years). Time-dependent Cox and linear models were used to examine the associations between total, plant-, and animal-sourced UPF, and minimally-processed food (MPF) intake with incident CKD and eGFR change.</p><p><strong>Results: </strong>After a median 6.8 years follow-up and adjusting for demographics and health behaviors, those in the highest tertiles of total and animal-sourced UPF intake had 26% and 37% higher risk of incident CKD compared to the lowest tertile (Hazard Ratio (HR) 1.26; 95% CI 1.08, 1.47; p-trend=0.003 and HR 1.37; 95% CI 1.17, 1.60; p-trend<0.001, respectively). Per standard deviation higher plant-sourced UPF was associated with higher CKD risk (HR 1.07; 95% CI 1.01, 1.13) but not in categorical analyses (p-trend=0.12). Higher total MPF was associated with 20% lower risk of incident CKD (HR 0.80 for tertile 3 vs. 1; 95% CI 0.69, 0.95; p-trend = 0.008). Replacing three servings of total MPF with total UPF (HR 1.02; 95% CI 1.001, 1.03, p=0.04) and plant-sourced MPF with plant-sourced UPF (HR 1.02; 95% CI 1.002, 1.05, p=0.03) was weakly associated with elevated risks of CKD. No associations were observed for eGFR change. Competing risks analyses for mortality attenuated estimates.</p><p><strong>Conclusions: </strong>Total, and animal-sourced UPF were associated with incident CKD and plant-sourced UPF was modestly associated. Health benefits of plant foods may be dampened by ultra-processing, but additional work is needed in younger populations.</p>","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":"148883248","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: We've Been Down this Road Before-Persistent Challenges in Dialysis Modality Survival Analyses.","authors":"Hatem Ali, Tibor Fülöp, Rizwan Hamer","doi":"10.2215/CJN.0000001186","DOIUrl":"https://doi.org/10.2215/CJN.0000001186","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":"148883246","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":"Effects and Safety of Henagliflozin on Cardiac Structure in Patients with Heart Failure with Preserved Ejection Fraction on Dialysis.","authors":"Hao Yan, Wei Wang, Wangshu Wu, Ying Li, Yinghui Qi, Yijun Zhou, Weiming Zhang, Shang Liu, Huihua Pang, Yan Fang, Zhenyuan Li, Zhiqing Qiao, Renhua Lu, Meng Jiang, Wei Fang, Jun Pu, Leyi Gu","doi":"10.2215/CJN.0000001201","DOIUrl":"10.2215/CJN.0000001201","url":null,"abstract":"<p><strong>Key points: </strong>This trial evaluated the effects of henagliflozin on cardiac structure and its safety in patients with heart failure with preserved ejection fraction on dialysis. At week 24, henagliflozin achieved a statistically significant reduction in left ventricular mass index versus placebo (-5.27 g/m 2 ; 95% confidence interval, -10.02 to -0.53 g/m 2 ). Henagliflozin was tolerable in the peritoneal dialysis and hemodialysis settings.</p><p><strong>Background: </strong>Few effective drug treatments exist for patients with heart failure with preserved ejection fraction (HFpEF) on dialysis. The aim of this study was to evaluate the effects of henagliflozin, a sodium-glucose cotransporter 2 inhibitor, on cardiac structure and its safety in such population.</p><p><strong>Methods: </strong>In this multicenter, randomized, double-blind, placebo-controlled trial, patients with HFpEF on dialysis were randomly assigned (1:1) to receive henagliflozin or placebo for 24 weeks. All enrolled participants received conventional therapy. The primary outcome was change in left ventricular mass index (LVMI) from baseline to week 24. The secondary outcomes were changes in the left atrial volume index, E/e', e', and N -terminal pro-brain natriuretic peptide and safety. Efficacy was assessed in the intention-to-treat population. Safety was assessed in the as-treated population. Analysis of covariance was used to assess treatment effects.</p><p><strong>Results: </strong>A total of 112 participants were randomly assigned to the henagliflozin group ( n =56) and placebo group ( n =56). Of these, 60 participants were on hemodialysis and 52 were on peritoneal dialysis. From baseline to week 24, henagliflozin resulted in a greater reduction in least-squares mean (±SEM) change in LVMI than placebo (-3.27±1.71 g/m 2 versus 2.01±1.69 g/m 2 ), with a between-group difference of -5.27 g/m 2 (95% confidence interval [CI], -10.02 to -0.53 g/m 2 ; P = 0.03). In the prespecified subgroup by dialysis modality, the between-group difference in LVMI change from baseline to week 24 was -6.86 g/m 2 (95% CI, -14.02 to 0.29 g/m 2 ) among participants on peritoneal dialysis and -3.91 g/m 2 (95% CI, -10.45 to 2.63 g/m 2 ) among participants on hemodialysis. No between-group differences in secondary outcomes were observed. The incidence of adverse events was similar between the henagliflozin and placebo groups (36% versus 34%).</p><p><strong>Conclusions: </strong>Henagliflozin was associated with a greater reduction in LVMI at week 24 compared with placebo and was tolerable in patients with HFpEF on dialysis. Larger studies are needed to confirm the LVMI-lowering effect of henagliflozin.</p><p><strong>Clinical trial registry name and registration number: </strong>ChiCTR2300073169.</p>","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":"148883295","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":"Randomized Controlled Trial Comparing Lactoferrin+Iron with Iron Alone for Iron Deficiency Anemia in CKD.","authors":"Smita Divyaveer, Kushal Kekan, Madhuri Kashyap, Maninder Kaur, Kanchan Prajapati, Madhumita Premkumar, Deepy Zohmangaihi, Nabhajit Mallik, Deepesh Lad, Ravjit Singh Jassal, Akanksha Sharma, Simran Behl, Amol N Patil, Ashok Kumar, Lekha Rani, Arun Prabhahar, Manish Rathi, Raja Ramachandran, Harbir Singh Kohli","doi":"10.2215/CJN.0000001204","DOIUrl":"10.2215/CJN.0000001204","url":null,"abstract":"<p><strong>Key points: </strong>Lactoferrin+iron significantly improved hemoglobin and iron indices versus iron alone in CKD patients with iron deficiency anemia. Lactoferrin reduced hepcidin and inflammatory markers, suggesting improved iron utilization using anti-inflammatory mechanisms. Three patients with iron deficiency anemia had elevated inflammatory markers, higher among patients with CKD on dialysis than those not on dialysis.</p><p><strong>Background: </strong>Lactoferrin, a multifunctional iron-binding glycoprotein with anti-inflammatory properties, is reported to be effective in anemia in pregnant women and patients with malignancy but has not been tested elaborately in CKD.</p><p><strong>Methods: </strong>In this randomized, open-label trial, 185 patients (intention-to-treat) with iron-deficiency anemia (hemoglobin [Hb] <10 g/dl, transferrin saturation <20%) were enrolled: 90 with patients with CKD not on dialysis (CKD-ND) and 95 with dialysis-dependent CKD (patients with CKD on dialysis [CKD-5D]). Patients were randomized to receive either oral iron (30 mg/d liposomal iron) or oral iron+lactoferrin (100 mg twice daily) for 3 months. The primary outcome was change in Hb. Secondary outcomes included iron indices and inflammatory markers (C-reactive protein, IL-6, erythrocyte sedimentation rate, and hepcidin).</p><p><strong>Results: </strong>In the intention-to-treat analysis, lactoferrin+iron resulted in significantly greater improvements in Hb and iron parameters than iron alone in both patients with CKD-ND and those with CKD-5D. Mean Hb increased by 1.95±1.19 versus 1.33±0.86 g/dl in patients with CKD-ND and by 1.73±0.96 versus 1.11±0.93 g/dl in patients with CKD-5D receiving lactoferrin+iron and iron alone, respectively. Improvements in iron indices were also greater with add-on lactoferrin treatment. Mean difference in hepcidin levels were -20.24±15.99 versus -16.03±40.65 ng/dl in patients with CKD-ND and -15.29±8.73 versus -20.99±20.16 ng/dl in patients with CKD-5D treated with lactoferrin+iron and iron alone, respectively.</p><p><strong>Conclusions: </strong>Among patients with CKD-associated anemia, adjunctive lactoferrin therapy improved Hb and iron parameters compared with oral iron alone in both non-dialysis-dependent and dialysis-dependent patients. Lactoferrin was also associated with modest improvements in inflammatory status, although effects on individual inflammatory markers were inconsistent. These findings suggest that lactoferrin may be a useful adjunct to oral iron therapy for the management of anemia in CKD, especially in resource-limited settings.</p><p><strong>Clinical trial registry name and registration number: </strong>Clinical Trials Registry of India, CTRI/2020/04/024746.</p>","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":"148883283","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":"Five Years on Hemodialysis: A Patient Perspective on Muscle Cramps and Quality of Life.","authors":"Michel Baujard","doi":"10.2215/CJN.0000001182","DOIUrl":"10.2215/CJN.0000001182","url":null,"abstract":"","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":"1491-1492"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148690762","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":"Why Am I on Dialysis? Gaps in Rural CKD Care in Central California.","authors":"Marimar Contreras Nieves, Aya Aziz, Angelina Powers, Esteban Banda, Stefan Jaskulak, Melissa Cerezo, Itzel Ramirez, Xue Yu, Mackenzie Moreno, Diana Jimenez, Irima Ajang, Pablo Garcia, Hemant Dhingra, Gopal G Krishna, Mitchell R Lunn, Manjula Kurella Tamura, Maria Montez-Rath, Juan Rodriguez, Tom Yang, Shuchi Anand","doi":"10.2215/CJN.0000000965","DOIUrl":"10.2215/CJN.0000000965","url":null,"abstract":"","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":"1660-1663"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12879835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145770481","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":"Intradialytic Myocardial Stunning in Hemodialysis-Dependent ESKD.","authors":"David M Charytan, James B Wetmore, Charles A Herzog","doi":"10.2215/CJN.0000001236","DOIUrl":"10.2215/CJN.0000001236","url":null,"abstract":"<p><p>People with hemodialysis-dependent kidney failure have a high incidence of cardiovascular morbidity and mortality, the etiologies of which remain incompletely understood. Recent work has suggested that the hemodialysis procedure itself induces transient episodes of myocardial contractile dysfunction, a phenomenon known as intradialytic myocardial stunning (IDMS). IDMS likely results in repetitive injury to the heart and, as such, may be an underappreciated risk factor which at least partly underlies the high rate of cardiovascular events in this population. However, many important questions about IDMS remain. In this article, we review the evidence base on IDMS. First, we provide a proposed working definition of this entity, placing it within the historical context of other syndromes of transient myocardial contractile abnormalities such as those caused by ischemia or by neurogenic (stress) cardiomyopathy. We then outline the seminal evidence supporting the hypothesis that IDMS is a specific form of Takotsubo (stress) cardiomyopathy. We next discuss the epidemiology of IDMS, including incidence, risk factors, sequelae, and potential contributions to the development of cardiovascular disease in people receiving maintenance hemodialysis. Finally, we focus on the frontiers of IDMS research by identifying avenues of future study, including potential mechanisms which can be investigated using novel techniques, and identify gaps in the current understanding of IDMS which provide a roadmap for future studies.</p>","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148877190","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":"Evaluation of the Association between Age, Sex, and d -Amino Acid-Based Estimation of GFR.","authors":"Shota Fukae, Shinsuke Sakai, Ryo Tanaka, Ayumu Taniguchi, Masataka Kawamura, Shihoko Kimura-Ohba, Shigeaki Nakazawa, Masaru Horio, Shiro Takahara, Ryoichi Imamura, Muneharu Yamada, Takashi Oda, Osamu Konno, Hitoshi Iwamoto, Yoshitaka Isaka, Masayuki Mizui, Norio Nonomura, Yoichi Kakuta, Tomonori Kimura","doi":"10.2215/CJN.0000001108","DOIUrl":"10.2215/CJN.0000001108","url":null,"abstract":"<p><strong>Key points: </strong>Blood d -serine and d -asparagine reflect GFR, reportedly with stable kinetics minimally influenced by age and tubular transport. d -Amino acid-based eGFR minimizes age and sex biases, a distinct advantage over conventional models. d -Amino acid-based eGFR holds broad clinical potential across all ages and populations.</p><p><strong>Background: </strong>eGFR is challenging because of its dependence on age and body composition, especially in pediatric and elderly populations. Recently, d -serine and d -asparagine, rare amino acid enantiomers, have been identified as GFR biomarkers characterized by their ideal kidney clearance and minimal impacts of body size. We investigated the impact of age and sex on GFR estimation using these d -amino acids.</p><p><strong>Methods: </strong>We analyzed data from a cross-sectional observational cohort: 366 adult Japanese living kidney transplant donors and recipients. Using a dataset of 244 patients, we developed GFR estimation formulae on the basis of blood levels of d -serine and d -asparagine using linear regression analyses and validated the formulas' performance in 122 patients.</p><p><strong>Results: </strong>The d -amino acid - based equation was established as 60.4× d -Ser -0.450 × d -Asn -0.304 ×0.916 (if female), in which age did not significantly improve model performance and the impact of sex was minor. The performance of the established equations was equivalent to that of creatinine-based equations: bias (absolute difference), 9.1 (8.0-11.2); precision (interquartile range of bias), 11.1 (8.8-14.2); and accuracy (ratios of 30% different from measured GFR [P 30 ]), 0.82 (0.73-0.89).</p><p><strong>Conclusions: </strong>d -Amino acid-based estimation of GFR exhibits minimal empirical association with age and sex, offering a distinct advantage over models dependent on these demographic variables. This stability may support its broad clinical utility as a reliable diagnostic tool across all age groups and diverse populations.</p>","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":"1545-1553"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148214052","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":"Interpreting the CFH-CFHR Signal in IgA Nephropathy: Caution before Therapeutic Prioritization.","authors":"Honglin Pu","doi":"10.2215/CJN.0000001096","DOIUrl":"10.2215/CJN.0000001096","url":null,"abstract":"","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":"1666"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166843","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":"Charting the Course of Recurrent C3 Glomerulopathy and Immune Complex-Mediated Membranoproliferative GN in Kidney Transplant Recipients.","authors":"Edwin K S Wong","doi":"10.2215/CJN.0000001192","DOIUrl":"10.2215/CJN.0000001192","url":null,"abstract":"","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":"1498-1500"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148690738","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}