American Journal of Kidney Diseases最新文献

{"title":"KDOQI US Commentary on the KDIGO 2025 Clinical Practice Guideline for the Management of Immunoglobulin A Nephropathy (IgAN) and Immunoglobulin A Vasculitis (IgAV).","authors":"Isabelle Ayoub, Gaia Coppock, Shikha Wadhwani, Timothy Yau","doi":"10.1053/j.ajkd.2026.02.639","DOIUrl":"https://doi.org/10.1053/j.ajkd.2026.02.639","url":null,"abstract":"<p><p>The Kidney Disease Outcomes Quality Initiative (KDOQI) convened a work group to review the 2025 KDIGO (Kidney Disease: Improving Global Outcomes) Clinical Practice Guideline for the Management of Immunoglobulin A Nephropathy (IgAN) and Immunoglobulin A Vasculitis (IgAV). The KDOQI work group reviewed the KDIGO guideline statements and practice points and provided perspective for implementation within the context of clinical practice in the United States. Our understanding of the pathophysiology of IgAN has led to several treatment options that are new to this clinical practice guideline. With many ongoing studies on agents with novel therapeutic mechanisms of action, the KDOQI work group acknowledges the challenges in selecting the appropriate disease modifying agents for such a heterogenous disease. In this commentary, the work group addresses the importance of risk stratification of IgAN while emphasizing the novel therapeutic options that are now available to prevent disease progression.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832267","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":"KDOQI US Commentary on the KDIGO 2026 Clinical Practice Guideline for the Management of Anemia in CKD.","authors":"Diana I Jalal, Nisha Bansal, Monique E Cho, Steven Fishbane, Orlando M Gutierrez, Csaba P Kovesdy, Abhijit Kshirsagar, Bruce Spinowitz, Jay Wish","doi":"10.1053/j.ajkd.2026.03.036","DOIUrl":"https://doi.org/10.1053/j.ajkd.2026.03.036","url":null,"abstract":"<p><p>The prevalence of anemia is high in people with chronic kidney disease (CKD) and increases as the disease advances. The Kidney Disease Outcomes Quality Initiative (KDOQI) convened a work group to review the Kidney Disease: Improving Global Outcomes (KDIGO) 2026 clinical practice guideline for the management of anemia in CKD. The previous KDIGO anemia guideline was published in 2012; in 2019 and 2021 KDIGO convened conferences addressing controversies in iron management and hypoxia-inducible factor-prolyl hydroxylase inhibitor (HIF-PHI) use, respectively. The KDOQI work group provides perspective for implementation of the KDIGO 2026 anemia guideline within the context of clinical practice in the United States. The KDOQI work group agrees with most of the KDIGO recommendations, particularly the proactive use of intravenous (IV) iron in hemodialysis patients and the preference for erythropoiesis stimulating agents (ESAs) over HIF-PHIs for first-line anemia therapy, due to greater familiarity with safety of the former. Specific issues regarding recommendations and practice points for providers in the United States include higher serum ferritin targets and mean levels among people receiving hemodialysis than in the rest of the world; the availability of a single HIF-PHI product with approval only for patients receiving dialysis for ≥3 months; and payment barriers that may drive the choice of therapeutic agents. Additional commentary is provided on topics including IV iron therapy in people receiving hemodialysis and an iron-based phosphate binder, the incidence and significance of hypophosphatemia among people with CKD not on dialysis but receiving IV iron therapy, the physiologic importance of iron repletion in people with CKD and iron deficiency without anemia, possible therapeutic benefits of HIF-PHIs compared with ESAs, and assessing risk versus harm of red blood cell transfusions.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832316","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":"Purpura and Anasarca in a Kidney-Transplanted Recipient: A Quiz.","authors":"Mathias Stevanin,Camillo Ribi,Thomas Brahier,Oriol Manuel,Manuel Pascual,Matthieu Halfon","doi":"10.1053/j.ajkd.2025.10.025","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.10.025","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"35 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147754538","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":"Burden and Outcomes Associated With Heart Failure Hospitalizations Among Patients Treated With Dialysis.","authors":"Mahlet Assefa,Leila R Zelnick,Bryan Kestenbaum,Karen S De Wolski,Nisha Bansal","doi":"10.1053/j.ajkd.2026.01.016","DOIUrl":"https://doi.org/10.1053/j.ajkd.2026.01.016","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"31 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147735300","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":"Prevalence Of CKD Among Adults in Africa: A Systematic Review and Meta-Analysis.","authors":"Cindy George, Ikechi G Okpechi, Dipuo D Motshwari, Suzaan Stoker, Min Jun, Sradha Kotwal, Segun Fatumo, Charles Agyemang, June Fabian, Tandi E Matsha, Pascal Bovet, Mark Woodward, Andre P Kengne","doi":"10.1053/j.ajkd.2026.02.640","DOIUrl":"https://doi.org/10.1053/j.ajkd.2026.02.640","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Chronic kidney disease (CKD) is a global public health concern, but its burden in Africa is poorly defined. This study aimed to estimate CKD prevalence across the African continent.</p><p><strong>Study design: </strong>Systematic review and individual participant data meta-analysis.</p><p><strong>Setting & study population: </strong>Populations residing in Africa.</p><p><strong>Selection criteria: </strong>Eligible studies enrolled ≥300 adults, were observational, used community-based designs, and reported CKD prevalence or data necessary to calculate it.</p><p><strong>Search strategy: </strong>Studies, both published and unpublished, through May 31, 2024, identified through systematic searches of major databases and through networks within the CKD-Africa Collaboration.</p><p><strong>Data extraction: </strong>Data were systematically extracted and verified by the authors. Extracted information included study and publication details, CKD diagnostic criteria and participant characteristics.</p><p><strong>Analytical approach: </strong>Pooled prevalence estimates were calculated using random-effects meta-analysis.</p><p><strong>Results: </strong>Sixty-seven studies, comprising 91,723 participants from 19 countries, were included. High- and moderate-quality studies accounted for 37% and 52%, respectively, and 6% were unpublished. Pooled CKD prevalence (stages 1-5) was 13.7% (95% confidence interval [CI], 11.0-16.4), and 5.1% (95% CI, 4.3-5.8) for stages 3-5. Regional variation was evident (I² >98%; p<0.001), with higher prevalence in Western Africa compared to Southern Africa. Estimates using aggregated data (AD) and individual participant data (IPD) were consistent.</p><p><strong>Limitations: </strong>Variations in the quality of the study data and substantial heterogeneity in prevalence estimates. Lack of assessment of chronic CKD. Reliance on AD for 55% of the sample. Gaps in geographic representation may limit the generalizability of findings.</p><p><strong>Conclusions: </strong>Approximately 14% of African adults had CKD, highlighting its public health burden. The precision of this finding was augmented by the use of IPD.</p><p><strong>Plain-language summary: </strong>Chronic kidney disease (CKD), a long-term condition in which the kidneys gradually lose their ability to filter waste and fluids from the blood, is an increasing health problem in Africa, but prevalence data have been limited. Previous studies relied on only summaries of studies' data. This analysis combined individual-level and summary data from multiple African countries to provide a more accurate and precise estimate of CKD prevalence. It found that CKD affects a substantial proportion of adults, with rates varying across regions. These findings highlight the potential value of early detection given the availability of effective clinical strategies to manage CKD.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809683","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":"Transitioning from CKD to Kidney Failure: A Mixed Methods Study of Patient Perspectives.","authors":"Megan Urbanski,Laura A Siminoff,Amy Waterman,Crystal A Gadegbeku,Levent Dumenci,Kimberly Jacob Arriola,Laura C Plantinga,Heather Gardiner","doi":"10.1053/j.ajkd.2026.02.644","DOIUrl":"https://doi.org/10.1053/j.ajkd.2026.02.644","url":null,"abstract":"RATIONALE & OBJECTIVEThe transition from chronic kidney disease (CKD) to kidney failure (KF) is life-changing. We explored the KF transition and dialysis start experiences of patients with varying degrees of prior nephrology care and preparation.STUDY DESIGNConvergent parallel mixed methods study using surveys and interviews.SETTING & PARTICIPANTSData were collected from December 2018 to January 2020 among adults in metropolitan Philadelphia who had recently transitioned from CKD to KF and started dialysis.ANALYTICAL APPROACHParticipants were categorized as either having had 1) some prior nephrology care and placement of an arteriovenous or peritoneal dialysis access, 2) minimal nephrology care (prior nephrology care, but no placement of a dialysis access), or 3) no prior nephrology care or placement of an access. Applied thematic analysis guided the qualitative analysis, and quantitative data were fully described.RESULTSKF transition was tumultuous for all participants (N=47), regardless of preparation (some prior care, n=23 [48.9%]; minimal prior care, n=13 [27.7%]; no prior care, n=11 [23.4%]). Dialysis start occurred along a spectrum of urgency with most (n=44; 93.6%) initiating dialysis in a hospital, and nearly all (n=46; 97.9%) were treated with in-center hemodialysis. Four additional themes emerged: (1) participants were unprepared to receive the KF diagnosis because they were unaware of the urgency of their medical situation; (2) the KF diagnosis communication environment was chaotic, but effective provider communication helped; (3) the first dialysis treatment was marked by intense apprehension and fear; and (4) participants prioritized making sense of their sudden new reality.LIMITATIONSLimited geographic representation and the exclusion of non-English-speaking participants.CONCLUSIONSIrrespective of prior preparation, participants experienced apprehension and fear during the transition from CKD to KF. Successfully addressing modifiable health system-level factors that affect this critical care transition and directly address the patient experience is needed to improve care and outcomes.PLAIN-LANGUAGE SUMMARYThe progression from chronic kidney disease to kidney failure and dialysis is a challenging time for patients. We sought to understand the experiences of patients - those who had received prior kidney disease care, and those who had not - during this transition to kidney failure and dialysis treatment. We interviewed and surveyed 47 patients in metropolitan Philadelphia within 5 months of their dialysis initiation to understand and compare their experiences. Nearly all participants described this transition as traumatic and chaotic, even those with prior kidney disease care. This study underscores the need for patient-centered, health-system level programs that equip patients with the knowledge, resources, and support necessary to cope with this major life change and ultimately improve patient outcomes.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"1 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147735535","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 Ertugliflozin on Kidney Outcomes in People After and Without an Interval Cardiovascular Event: Observations From the VERTIS CV Trial.","authors":"Ayodele Odutayo,Francesco Cosentino,Richard E Pratley,Christopher P Cannon,Chih-Chin Liu,Robert Frederich,Urszula Masiukiewicz,Nilo B Cater,Ira Gantz,David Z I Cherney, ","doi":"10.1053/j.ajkd.2026.01.017","DOIUrl":"https://doi.org/10.1053/j.ajkd.2026.01.017","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"55 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147735536","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":"Allocation of Kidney Allografts From Donors With Kidney Donor Profile Index <35% and the Impact of Kidney Donor Profile Index Revisions on Access to Transplantation for Children.","authors":"Elizabeth M Sonnenberg,Sandra Amaral,Siqi Zhang,Jeremy Rubin,Matthew H Levine,Vishnu S Potluri","doi":"10.1053/j.ajkd.2026.02.643","DOIUrl":"https://doi.org/10.1053/j.ajkd.2026.02.643","url":null,"abstract":"RATIONALE & OBJECTIVEChildren in the US receive priority for kidneys with a kidney donor profile index (KDPI) &lt;35%, although their priority falls below that of certain adult recipients. Recently, the KDPI was revised to include 8 donor characteristics instead of 10. We sought to: 1) describe the allocation of these high-quality kidneys and 2) compare characteristics of donors with a KDPI &lt;35% using the original KDPI (KDPI-10) versus the revised KDPI (KDPI-8) calculation.STUDY DESIGNRetrospective cohort study.SETTINGS & PARTICIPANTS60,587 deceased donors and their kidney recipients in the Organ Procurement and Transplantation Network registry between January 1, 2018 and December 31, 2023.EXPOSUREKDPI calculated using KDPI-10 and KDPI-8 (without race and hepatitis C virus [HCV]).OUTCOMESThe primary outcome was the utilization of kidneys with a KDPI &lt;35% overall. Secondary outcome was the utilization of kidneys from \"ideal pediatric-quality donors\" who were defined as having a KDPI &lt;35%, diagnosed with brain death, were aged &lt;35 years, had a creatinine ≤1.5 mg/dL, and had no infectious risk, diabetes, or hypertension. Additionally, we assessed the changes in characteristics of KDPI&lt;35% donors following revision to the KDPI.ANALYTICAL APPROACHDescriptive statistics.RESULTSDuring the study period, 23.4% KDPI-10 &lt;35% and 34.3% of ideal pediatric-quality, KDPI-10 &lt;35% kidneys were transplanted into adults in allocation categories that receive more priority than children. Nearly three-quarters of these adults were multiorgan recipients. Compared to the KDPI-10 calculation, donors with a KDPI &lt;35% using the KDPI-8 calculation were more often Black (15.3% vs 9.9%), HCV-seropositive (11.1% vs 3.6%), and less frequently donated after circulatory death (12.7% vs 20.3%). The proportion of KDPI &lt;35% donors who are ideal pediatric-quality was similar (32.7% KDPI-10 vs 33.5% KDPI-8).LIMITATIONSExtrapolation of KDPI-8 donor characteristics using an historical cohort.CONCLUSIONSMany ideal pediatric-quality kidneys are allocated to adults, primarily multiorgan transplant recipients. We anticipate no meaningful change in the proportion of ideal pediatric-quality kidneys prioritized for children using the revised KDPI-8 calculation.PLAIN-LANGUAGE SUMMARYChildren with end-stage kidney disease are intended to have priority for kidneys from the best quality kidney donors. However, their priority may fall below adult candidates who need multiple organs or are highly sensitized. Only about one-third of donors prioritized for children are \"ideal pediatric-quality\", meaning they come from young donors with minimal risk of kidney dysfunction. About one-third of these top-quality kidneys are transplanted into adults with more priority than children, most often transplanted into recipients receiving more than one organ transplant. Recently, the risk index used to determine which kidneys are prioritized for children was revised by excluding donor race and donor infection with he","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"20 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147735301","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":"Trends in Pregnancy After Kidney Transplantation in the United States.","authors":"Chenxi Gao,Gayathri Menon,Malika Wilson,Yiting Li,Sunjae Bae,Byoungjun Kim,Babak J Orandi,Allan B Massie,Mario P DeMarco,Aprajita Mattoo,Lauren M Kucirka,Dorry L Segev,Mara A McAdams-DeMarco","doi":"10.1053/j.ajkd.2026.01.015","DOIUrl":"https://doi.org/10.1053/j.ajkd.2026.01.015","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"26 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147733789","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":"Cystatin C and Creatinine-Based Estimated GFR and Disease Activity Biomarkers in Rheumatoid Arthritis.","authors":"Sho Fukui,Lesley A Inker,Leah M Santacroce,Jon T Giles,Katherine P Liao,Joan M Bathon,Daniel H Solomon","doi":"10.1053/j.ajkd.2026.01.014","DOIUrl":"https://doi.org/10.1053/j.ajkd.2026.01.014","url":null,"abstract":"RATIONALE & OBJECTIVECreatinine-based estimated glomerular filtration rate (eGFRcr) and cystatin C-based eGFR (eGFRcys) may be inaccurate for patients with rheumatoid arthritis (RA) due to sarcopenia and inflammation. This study characterized changes in eGFRcys and eGFRcr following two RA treatment regimens and their association with RA disease activity biomarkers.STUDY DESIGNSecondary observational analysis of randomized controlled trial of tumor necrosis factor (TNF) inhibitor plus methotrexate (MTX) vs. triple therapy (MTX, sulfasalazine, and hydroxychloroquine).SETTING & PARTICIPANTSPatients with active RA enrolled at multiple US institutions into an immunomodulatory treatment trial.EXPOSURESRA disease activity biomarkers.OUTCOMESEGFRcys and eGFRcr at baseline and weeks 6, 18, and 24.ANALYTICAL APPROACHEGFRcys and eGFRcr at baseline and during the follow-up were described in the overall cohort and by treatment arm. Adjusted mixed-effects linear models to estimate the associations of RA activity biomarkers with eGFR.RESULTS157 eligible trial participants (median age 58 years, 75% female) were included. At baseline, mean eGFRcys was lower than eGFRcr (63.3 vs. 84.2; difference -20.9 mL/min/1.73m2 [95% confidence interval [CI], -24.7 to -17.0]). Over 24 weeks, neither eGFRcys nor eGFRcr changed overall (1.74 mL/min/1.73m2 [95% CI, -0.77 to 4.24] and -0.28 mL/min/1.73m2 [95% CI, -3.71 to 3.15], respectively). Multiple disease activity biomarkers, including vascular cell adhesion protein 1 (VCAM-1), interleukin 6 (IL-6), tumor necrosis factor receptor I (TNF-RI), leptin, and resistin, were inversely associated with eGFRcys and/or eGFRcr at baseline in adjusted models. During follow-up, only TNF-RI change was inversely associated with eGFRcys change (-2.91 mL/min/1.73m2 [95% CI: -4.48 to -1.33]) in adjusted models, whereas no biomarker change was significantly related to eGFRcr change.LIMITATIONSNo measured GFR, a relatively short follow-up period, and potential false discovery because of the large number of associations examined.CONCLUSIONSAmong patients with actively treated RA, eGFRcys is consistently lower than eGFRcr. Neither eGFRcys nor eGFRcr demonstrated a change following RA treatments, despite reductions in the disease activity biomarker TNF-RI. Further studies incorporating directly measured GFR are warranted.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"24 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147733783","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}