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

{"title":"Genetic Insights into Kidney Function and Disease Risk in Type 1 Diabetes.","authors":"Nora Franceschini","doi":"10.2215/CJN.0000001196","DOIUrl":"10.2215/CJN.0000001196","url":null,"abstract":"","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":"1496-1497"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148690739","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":"Comparison of Low eGFR Prevalence and Prediction for Mortality Using 2009 and 2021 CKD Epidemiology Collaboration Equations in Mexican Adults.","authors":"Daniel Ramírez-García, Carlos A Fermín-Martínez, Paulina Sánchez Castro, Brenda Guadalupe Cortez-Flores, Jerónimo Perezalonso Espinosa, Juan Pablo Díaz-Sánchez, Karime Berenice Carrillo-Herrera, Leslie Alitzel Cabrera-Quintana, Jaime Berumen-Campos, Pablo Kuri-Morales, Roberto Tapia-Conyer, Jacqueline A Seiglie, Jesus Alegre-Díaz, Neftali Eduardo Antonio-Villa, Omar Yaxmehen Bello-Chavolla","doi":"10.2215/CJN.0000000933","DOIUrl":"10.2215/CJN.0000000933","url":null,"abstract":"<p><p>Accurate eGFR is essential for identifying and managing CKD. The CKD Epidemiology Collaboration (CKD-EPI) 2021 equation removed the race coefficient from the 2009 version, but its effect in Mexican populations remains unclear. Here, we compared eGFR category prevalence, and predictive performance between the CKD-EPI 2009 and 2021 creatinine-based eGFR equations, as well as the prognostic relevance of reclassification in eGFR categories using the 2021 equation in Mexicans. We evaluated 25,110 adults who were at least aged 20 years from the 2016-2023 cycles of the Mexican National Health and Nutrition Survey to estimate national low eGFR and eGFR category prevalence using both equations. We also assessed 5-year and 10-year risk of all-cause, cardiovascular, and kidney-related mortality in 142,884 adults from the Mexico City Prospective Study using Cox proportional hazards and Fine and Gray regression models. In Mexican National Health and Nutrition Survey 2023, prevalence of eGFR <60 ml/min per 1.73 m 2 was lower with CKD-EPI 2021 (3%; 95% confidence interval [CI], 2% to 4%) compared with the 2009 equation (4%; 95% CI, 2% to 5%). Use of the 2021 equation resulted in upward eGFR reclassification in 7% (95% CI, 4% to 9%) of adults 20 years or older, particularly among older adults and those with hypertension or diabetes, yielding a reduction in 486,532 adults identified with eGFR <60 ml/min per 1.73 m 2 compared with the 2009 equation. In Mexico City Prospective Study, despite both equations showing similar C-statistics, the 2021 equation reclassified 8.3% of participants to higher eGFR categories, and reclassification was associated with lower risk of 5-year and 10-year all-cause, cardiovascular, and kidney-related mortality, particularly for participants reclassified upward from G3a to G5 categories. The CKD-EPI 2021 equation yields lower prevalence of low eGFR but leads to prognostically relevant eGFR category reclassification compared with the 2009 equation. Our findings support the implementation of the 2021 equation for population health monitoring in Mexico without compromising prognostic utility.</p>","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":"1645-1656"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145746473","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 Static Risk: The Clinical Meaning of Trajectories in Cardiovascular-Kidney-Metabolic Health.","authors":"Edgar V Lerma","doi":"10.2215/CJN.0000001194","DOIUrl":"10.2215/CJN.0000001194","url":null,"abstract":"","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":"1493-1495"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148690753","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":"A Target Trial Emulation to Investigate Kidney Protection from Statin Initiation in Adults with Normal Kidney Function.","authors":"Franco W T Cheng, Ivy L Mak, Zoey C T Wong, Jacqueline J Wang, Emily T Y Tse, Sydney C W Tang, Ian C K Wong, Eric Y F Wan","doi":"10.2215/CJN.0000001107","DOIUrl":"10.2215/CJN.0000001107","url":null,"abstract":"<p><strong>Key points: </strong>Statin initiation in adults with normal kidney function lowered risks of mortality and major adverse kidney events. Statins yielded modest yet clinically meaningful absolute risk reductions for mortality and GFR declines. The observed pleiotropic benefits justified using statins for simultaneous cardiovascular risk reduction and kidney protection.</p><p><strong>Background: </strong>Evidence on the kidney-protective effects of statins in individuals with normal kidney function is mixed, with some trials suggesting benefits and others raising concerns about AKI. This study evaluates the effect of statin initiation on kidney function in adults with normal kidney function.</p><p><strong>Methods: </strong>Sequential target trial emulation on the basis of electronic health records in the Hong Kong Hospital Authority were conducted. Patients aged 18 year or older with normal kidney function (eGFR ≥60 ml/min per 1.73 m 2 ) who met the indication for statin therapy ( i.e ., LDL-cholesterol ≥100 mg/dl without cardiovascular disease or ≥70 mg/dl with cardiovascular diseases) in Hong Kong between January 2008 and December 2017 were included. Statin initiators and noninitiators were matched using 1:1 propensity score matching. Hazard ratio (HR) and 10-year absolute risk reduction (ARR) of outcomes, including impaired kidney function (eGFR <15 and <60 ml/min per 1.73 m 2 ), kidney function deterioration (≥30% and ≥50% eGFR decline), and all-cause mortality, were estimated using weighted pooled logistic regression on intention-to-treat approach.</p><p><strong>Results: </strong>Among 449,595 statin initiators and 449,595 matched noninitiators, statin use was associated with a lower risk of eGFR <15 ml/min per 1.73 m 2 (HR, 0.92 [0.90 to 0.95]; ARR, -0.33% [-0.42% to -0.24%]), eGFR <60 ml/min per 1.73 m 2 (HR, 0.97 [0.96 to 0.98]; ARR, -0.98% [-1.12% to -0.84%]), ≥30% eGFR decline (HR, 0.94 [0.93 to 0.95]; ARR, -1.81% [-2.00% to -1.60%]), ≥50% eGFR decline (HR, 0.90 [0.88 to 0.91]; ARR, -0.98% [-1.11% to -0.85%]), and all-cause mortality (HR [95% confidence interval], 0.90 [0.89 to 0.91]; ARR [95% confidence interval], -1.63% [-1.76% to -1.49%]).</p><p><strong>Conclusions: </strong>Statin initiation in adults with normal kidney function was associated with modestly lower all-cause mortality and kidney function impairment, supporting a potential kidney protective benefit of statins without increasing the risks of adverse kidney outcomes.</p>","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":"1511-1520"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148268001","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":"Stage-Specific Progression of Cardiovascular-Kidney-Metabolic Health and Mortality in a Nationwide Cohort of East Asian Adults.","authors":"Sehoon Park, Min Woo Kang, Jinsun Lee, Jaeik Oh, Minsang Kim, Jung Hun Koh, Jin Kyung Kwon, Jeong Min Cho, Seong Geun Kim, Hyuk Huh, Sehyun Jung, Semin Cho, Soojin Lee, Eunjeong Kang, Yaerim Kim, Kwon Wook Joo, Kyungdo Han, Dong Ki Kim","doi":"10.2215/CJN.0000001104","DOIUrl":"10.2215/CJN.0000001104","url":null,"abstract":"<p><strong>Key points: </strong>Four-year worsening of cardiovascular-kidney-metabolic stage was independently associated with higher all-cause mortality, showing a stepwise risk gradient in 2.81 million adults. Early worsening of cardiovascular-kidney-metabolic health was associated with higher mortality, whereas stage improvement lowered the risk, highlighting the value of monitoring changes. The association between cardiovascular-kidney-metabolic progression and mortality was stronger in older adults, highlighting prevention targets.</p><p><strong>Background: </strong>Cardiovascular-kidney-metabolic (CKM) syndrome represents the progressive interplay among metabolic dysfunction, kidney impairment, and cardiovascular disease, ultimately contributing to higher mortality. We investigated how changes across CKM stages correlate with subsequent all-cause mortality in a nationwide population-based cohort.</p><p><strong>Methods: </strong>We analyzed data from 2,812,170 adults aged ≥20 years who underwent two general health screenings 4 years apart through the Korean National Health Insurance Service, with CKM stages classified according to clinical criteria reflecting progressive metabolic, kidney, and cardiovascular risk. Stage-specific CKM stage change (improve, sustain, or progress) and its association with all-cause mortality were evaluated using multivariable Cox regression analysis, adjusted for clinicodemographic variables.</p><p><strong>Results: </strong>During the 4-year exposure assessment period, 674,465 adults (24%) experienced CKM stage progress, 1,802,489 (64%) sustained their CKM stage, and 335,216 (12%) improved. Over a subsequent 6.4-year follow-up, CKM stage progress was significantly associated with a higher risk of all-cause mortality (adjusted hazard ratio [HR], 1.38 [1.36 to 1.41]), whereas CKM stage improvement was associated with a lower risk (adjusted HR, 0.93 [0.90 to 0.95]). Notably, even early-stage progression (from stage 0 to stage 1) was linked to a higher mortality risk (adjusted HR, 1.08 [1.01 to 1.15]), with a stepwise higher risk observed with progression to more advanced follow-up CKM stages. The association between CKM stage progress and mortality was more pronounced in older adults.</p><p><strong>Conclusions: </strong>Worsening of CKM stage is associated with higher all-cause mortality from early to advanced stages, whereas CKM stage improvement is associated with lower mortality risk. These findings provide epidemiologic real-world evidence supporting the importance of monitoring and intervening on CKM progression across its full spectrum to lower long-term mortality risk.</p>","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":"1531-1544"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240923","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":"Systolic Blood Pressure Variability and Risk of Ischemic Stroke in Patients Receiving Hemodialysis.","authors":"Mu-Yang Hsieh, Li-Kai Tsai, Ru-Yin Hsu, Meng-Kan Chen, Chung-Wei Yang, Shao-Yuan Chuang, Ting-Ju Lai, Hao-Ming Cheng, Chih-Cheng Wu","doi":"10.2215/CJN.0000001210","DOIUrl":"https://doi.org/10.2215/CJN.0000001210","url":null,"abstract":"<p><strong>Background and objectives: </strong>Blood pressure variability (BPV) has been recognized as a cardiovascular risk factor beyond mean blood pressure, but its role in ischemic stroke among patients receiving hemodialysis remains incompletely defined, particularly across stroke subtypes. We evaluated the association between visit-to-visit BPV and incident ischemic stroke in a multicenter hemodialysis cohort.</p><p><strong>Design, setting, participants, measurements: </strong>In this prospective cohort study, 1,136 patients undergoing maintenance hemodialysis were enrolled from 12 centers. Pre-dialysis blood pressure measurements were collected over a standardized 12-week baseline period (approximately 36 readings per patient). BPV was quantified using the coefficient of variation (CV) and analyzed per 10% greater CV and by tertiles. The primary outcome was incident ischemic stroke, including large artery atherosclerosis (LAA) and small vessel occlusion (SVO). Fine-Gray competing risk models were used to estimate subdistribution hazard ratios (sHRs), adjusting for demographics, blood pressure, comorbidities, medication, and dialysis-related factors.</p><p><strong>Results: </strong>During a median follow-up of 54 months, 144 patients developed ischemic stroke. Higher systolic BPV was independently associated with greater stroke risk (sHR per 10% greater CV, 1.74; 95% confidence interval [CI], 1.10-2.76, P=0.02) in the clinically adjusted model, with consistent findings in extended analyses. In subtype-specific analyses, systolic BPV was significantly associated with LAA and showed a directionally consistent but attenuated association with SVO after extended adjustment. In contrast, diastolic BPV showed weaker associations that were not statistically significant after multivariable adjustment.</p><p><strong>Conclusions: </strong>Higher systolic BPV was independently associated with ischemic stroke in patients receiving hemodialysis, with the most consistent subtype-specific association observed for large artery atherosclerosis. These findings suggest that systolic BPV may serve as a clinically accessible marker of cerebrovascular risk beyond mean blood pressure 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":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868639","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":"We've Been down This Road before: Persistent Challenges in Dialysis Modality Survival Analyses.","authors":"Jeffrey Perl, Joanne M Bargman","doi":"10.2215/CJN.0000001175","DOIUrl":"https://doi.org/10.2215/CJN.0000001175","url":null,"abstract":"","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868669","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":"Microbiome Science and the Kidney-Vascular Axis: Plenty of Mechanisms, Little Medicine.","authors":"Carmine Zoccali, Griet Glorieux, Francesca Mallamaci, Raymond Vanholder","doi":"10.2215/CJN.0000001234","DOIUrl":"10.2215/CJN.0000001234","url":null,"abstract":"","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842623","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":"Cancer Risk after Immunosuppressive Therapy in Glomerular Diseases.","authors":"Marco Bonilla, Joana Gameiro, Kenar D Jhaveri","doi":"10.2215/CJN.0000001235","DOIUrl":"10.2215/CJN.0000001235","url":null,"abstract":"","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842693","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":"Proteinuria and Kidney Function Trajectories in Patients with Advanced CKD: Insights from Chronic Renal Insufficiency Cohort and Korean Cohort Study for Outcome in Patients with CKD Studies.","authors":"Cheol Ho Park, Hyun Jun Hong, Hyung Woo Kim, Jung Tak Park, Tae Ik Chang, Tae-Hyun Yoo, Sue K Park, Jung Soon Kim, Kyu-Beck Lee, Jong Cheol Jeong, Kook-Hwan Oh, Amanda H Anderson, Wei Yang, Jordana B Cohen, Mahboob Rahman, Shin-Wook Kang, Seung Hyeok Han","doi":"10.2215/CJN.0000001206","DOIUrl":"10.2215/CJN.0000001206","url":null,"abstract":"<p><strong>Key points: </strong>Higher urine protein-to-creatinine ratios were strongly associated with a rapid decline in kidney function in patients with CKD stages G3b-G4. The stronger association observed with time-updated urine protein-to-creatinine ratio suggests that sustained lower urine protein-to-creatinine ratio was associated with lower risk of CKD progression. In advanced CKD, patients with lower proteinuria levels exhibited slower kidney function decline and longer time to eGFR threshold for kidney failure.</p><p><strong>Background: </strong>Although urine protein-to-creatinine ratio (UPCR) is more commonly used than urine albumin-to-creatinine ratio in routine care, and particularly in low-resource settings, its association with kidney function decline and projected time to reach a kidney failure eGFR threshold in advanced CKD remains underexplored.</p><p><strong>Methods: </strong>We analyzed 2727 participants with eGFR 15-45 ml/min per 1.73 m 2 without KRT from the Chronic Renal Insufficiency Cohort study and the Korean Cohort Study for Outcome in Patients with CKD (KNOW-CKD). The main exposures were baseline and time-updated UPCR. The primary outcome was CKD progression defined as 50% or more decline in eGFR from baseline measurement or the initiation of KRT. The secondary outcome was eGFR slope (ml/min per 1.73 m 2 per year), whereas the exploratory outcome was projected time to reach the eGFR threshold of 10 ml/min per 1.73 m 2 for kidney failure.</p><p><strong>Results: </strong>During 17,069 person-years of follow-up (median 4.9 years), the primary outcome occurred in 1474 participants (54%). Compared with UPCR <0.5 g/gCr, hazard ratios (95% confidence intervals [CIs]) for UPCR categories of 0.5-1.0, 1.0-3.0, and ≥3.0 g/gCr were 2.08 (1.76 to 2.45), 3.05 (2.64 to 3.52), and 6.32 (5.24 to 7.61), respectively. This association was stronger in analysis with time-updated UPCR, with the corresponding hazard ratios (95% CIs) of 2.58 (2.13 to 3.12), 5.61 (4.76 to 6.62), and 12.88 (10.58 to 15.67), respectively. In secondary analyses, the eGFR slopes for the respective categories were -0.87 (-0.98 to -0.77), -2.32 (-2.56 to -2.07), -3.41 (-3.63 to -3.19), and -5.45 (-5.93 to -4.97) ml/min per 1.73 m 2 per year. In addition, projected time to eGFR threshold for kidney failure (95% CIs) was lower progressively with increasing proteinuria categories, estimated at 28.7 (25.6 to 32.6), 10.3 (9.3 to 11.5), 6.4 (6.0 to 6.8), and 3.8 (3.5 to 4.2) years, respectively.</p><p><strong>Conclusions: </strong>Higher UPCRs were strongly associated with accelerated CKD progression and shorter projected time to reach the eGFR threshold for kidney failure, underscoring the prognostic significance of proteinuria in patients with advanced CKD.</p>","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842741","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}