American Journal of Kidney Diseases最新文献

{"title":"Understanding Rare Kidney Stone Diseases: A Review.","authors":"Michelle A Baum,Mallory Mandel,Michael Jg Somers","doi":"10.1053/j.ajkd.2025.03.023","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.03.023","url":null,"abstract":"Rare kidney stone diseases typically present with nephrolithiasis or nephrocalcinosis in childhood or adolescence. Affected individuals might face kidney injury and even kidney failure related to associated complications. Screening blood and urine tests recommended for patients with nephrolithiasis/nephrocalcinosis help guide further evaluation, and the increased availability and decreased costs of genetic testing can facilitate the diagnosis of hereditary stone conditions. Genetic testing should be considered when there are clinical clues of an increased likelihood of an inherited condition such as consanguinity, nephrolithiasis in young children, nephrolithiasis in multiple family members, repeated episodes of nephrolithiasis, or kidney failure with nephrolithiasis or nephrocalcinosis. Adult and pediatric nephrologists and urologists should have a basic understanding of monogenic rare kidney stone diseases and their associated diagnoses, treatments, and complications. In many disorders, early detection allows for the initiation of tailored therapies that may alter the natural history of the disease, preserve kidney function, and modify extra renal manifestations.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"8 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087542","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":"Kidney Dysfunction in Heart Failure: Core Curriculum 2025.","authors":"Kevin Bryan Lo,Arun Janakiraman,Janani Rangaswami","doi":"10.1053/j.ajkd.2024.12.006","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.12.006","url":null,"abstract":"The pathophysiology of heart failure (HF) with kidney dysfunction is represented by several maladaptive bidirectional pathways wherein acute or chronic dysfunction of one organ drives acute or chronic dysfunction in the other organ. Suboptimal decongestion, diuretic resistance, and low use rates of guideline-directed medical therapy in individuals with kidney dysfunction and HF contribute to poor cardiovascular and kidney outcomes. Recent developments with the early identification and treatment of diuretic resistance may help mitigate the harmful effects of persistent congestion in individuals with HF. Several classes of guideline-directed medical therapies in HF have been shown to reduce death, hospitalizations for HF, and kidney function decline and improve quality of life. A combination of efficient and personalized strategies to achieve decongestion while optimizing the implementation of evidence-based therapies that modify the trajectory of HF are essential in tandem to reduce adverse outcomes and premature death in this high-risk patient population.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"17 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144083297","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":"Finitude and Transcendence: A Perspective on Treatment Burden From the Perspective of a Doctoral Researcher and a Former Patient on Peritoneal Dialysis.","authors":"Kitty Sze Wing Ko","doi":"10.1053/j.ajkd.2025.02.604","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.02.604","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"1 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065578","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":"Adapting to Artificial Intelligence in Nephrology Practice.","authors":"Chia-Ter Chao","doi":"10.1053/j.ajkd.2025.01.021","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.01.021","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"124 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065577","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":"CKD, Cardiovascular Risk Estimation, and Gaps in Therapy: A Shift to PREVENT.","authors":"Tyrone G Harrison,Matthew T James","doi":"10.1053/j.ajkd.2025.04.004","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.04.004","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"36 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065579","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":"Validation of an Algorithm to Identify End-Stage Kidney Disease in Electronic Health Records Data.","authors":"Chenxi Gao,Yunwen Xu,Sneha Mehta,Yingying Sang,Carina Flaherty,Aditya Surapaneni,Krutika Pandit,Alexander R Chang,Jamie Alton Green,Morgan E Grams,Jung-Im Shin","doi":"10.1053/j.ajkd.2025.03.021","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.03.021","url":null,"abstract":"RATIONALE & OBJECTIVESAccurate ascertainment of end-stage kidney disease (ESKD) in electronic health records (EHRs) data is important for much epidemiological research. This study aimed to develop and validate an algorithm using diagnosis and procedure codes to identify patients with ESKD (treated with maintenance dialysis or kidney transplantation) in EHRs data.STUDY DESIGNStudy of diagnostic algorithms.SETTING & PARTICIPANTSThe development cohort included 559,615 patients treated at the Geisinger Health System (January 1996-June 2018). The validation cohort included 767,186 patients treated at New York University Langone Health System (January 2018-December 2020).ALGORITHMS COMPAREDAn algorithm developed using diagnosis and procedure codes compared to a nominal gold standard designation within the United States Renal Data System (USRDS) data. The performance of the algorithm was characterized by sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The dates of incident ESKD between the algorithm and USRDS were compared in a subset of cases.OUTCOMESESKD (maintenance dialysis, prior recipient of a kidney transplant, or kidney transplantation surgery) cases.RESULTSIn Geisinger, we developed the ESKD algorithm that identified 4,766 (0.85%) ESKD cases, while there were 5,155 (0.92%) ESKD cases reported by the USRDS. The sensitivity, specificity, PPV, and NPV of the algorithm were 73.9% (95% CI, 72.7-75.1%), 99.83% (99.82-99.84%), 79.9% (78.9-81.0%), and 99.76% (99.75-99.77%), respectively. When applying the algorithm to New York University Langone Health System data, the sensitivity, specificity, PPV, and NPV were 71.8% (95% CI, 70.7-73.0%), 99.95% (99.95-99.96%), 91.6% (90.8-92.4%), and 99.79 (99.78-99.80%), respectively. The median (interquartile range) difference between dates of incident ESKD (algorithms minus USRDS) were -3 (-21 to 83) days in Geisinger and 0 (-12 to 69) days in New York University Langone Health.LIMITATIONSUse of structured EHRs data only.CONCLUSIONSAlgorithms combining diagnosis and procedure codes show high specificity and modest sensitivity for identifying patients with ESKD, providing a research tool to inform future EHR-based studies.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"58 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087502","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":"Inflammatory and Cardiovascular Events in CKD: The Multi-Ethnic Study of Atherosclerosis.","authors":"Gautam R Shroff,Daniel A Duprez,Evan Manning,Yuni Choi,Holly J Kramer,Alexander R Chang,David R Jacobs","doi":"10.1053/j.ajkd.2025.03.020","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.03.020","url":null,"abstract":"RATIONALE & OBJECTIVEChronic kidney disease (CKD) is associated with a proinflammatory state caused by maladaptive immune response, predisposing to cardiovascular (CVD) and inflammatory/infectious disease outcomes. We sought to examine the association of chronic inflammation-related disease (ChrIRD) as compared to CVD events with worsening kidney function.STUDY DESIGNLongitudinal, observational study over 19 years follow-up.SETTING & PARTICIPANTSParticipants free of CVD were enrolled from the Multi-Ethnic Study of Atherosclerosis (MESA), a multicenter, population-based cohort.EXPOSUREBaseline 5-level CKD categories based on modified KDIGO (Kidney Disease Improving Global Outcomes) groups using estimated glomerular filtration rate (eGFR, mL/min/1.73m2) and UACR (urine albumin-creatinine ratio, mg/g).OUTCOME(S)3 outcomes of interest: time to occurrence of first ChrIRD, time to first CVD, and time to all-cause mortality. ChrIRD encompassed inflammatory or infectious conditions identified using ICD (except kidney codes).ANALYTICAL APPROACHProportional hazards regression analysis RESULTS: 6,705 participants (mean age 62 years, 53% female, 38.5% White, 27.6% Black, 22% Hispanic, 11.9% Chinese) were studied. Among study participants, 70% had no CKD, 17% low-risk CKD (eGFR>60 + UACR<10-29); 7% moderate-risk CKD (eGFR ≥60 + UACR 30-299), 4.6% high-risk CKD (eGFR 30-59 + UACR <30 or eGFR 45-59 + UACR 30-299 or eGFR ≥60 and UACR ≥300), 0.8% very high-risk (more advanced combinations of eGFR/UACR). Over 19-years follow-up, unadjusted incidence density (events/1000-person-years) of ChrIRD, CVD events were (respectively): 18, 11.9 for no CKD, 26.3, 18.4 low-risk, 39.7, 29.6 moderate-risk, 60.1, 35.4 high-risk CKD and 128.7, 56.6 very high-risk categories. After demographic adjustment, respective HRs (95% CI) for ChrIRD and CVD events were 1.23 (1.10-1.39), 1.35 (1.17-1.55) for low-risk, generally increasing to 3.87 (2.75-5.44), 2.84 (1.85-4.36) for very high-risk CKD categories.LIMITATIONSUnmeasured confounders and selection bias.CONCLUSIONSChrIRD increased in a graded fashion with worsening CKD risk categories, starting with UACR > 10 mg/g.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"126 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087541","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":"Long-Term Exposure to Uranium and Arsenic in Community Drinking Water and CKD Risk Among California Women.","authors":"Danielle N Medgyesi,Sumit Mohan,Komal Bangia,Emma S Spielfogel,Maya Spaur,Anirban Basu,Jared A Fisher,Jessica M Madrigal,Arce Domingo-Relloso,Rena R Jones,Mary H Ward,James V Lacey,Tiffany R Sanchez,","doi":"10.1053/j.ajkd.2025.04.008","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.04.008","url":null,"abstract":"RATIONALE & OBJECTIVEMetals/metalloids in drinking water, including uranium and arsenic, may damage kidney function and increase chronic kidney disease (CKD) risk. We evaluated exposure to these contaminants in community water supplies (CWS) and CKD risk in the California Teachers Study.STUDY DESIGNProspective cohort study.SETTING & PARTICIPANTS88,185 women who were California teachers and school administrators enrolled 1995-1996.EXPOSURESTime- and residence- weighted annual average uranium and arsenic concentrations from CWS serving participants' residential addresses from 1995 to 2005.OUTCOME6,185 moderate to end-stage CKD cases from hospitalization records between 2005 and 2018.ANALYTICAL APPROACHHazard ratios (HRs) and 95% confidence intervals (95%CIs) calculated using mixed-effects Cox models, adjusted for age as the time scale, body mass index, smoking status, race/ethnicity, neighborhood socioeconomic status, and Census region as a random effect. Analyses were also stratified by risk factors and comorbidities.RESULTSMost exposures in this population were below the current regulatory limits (uranium=30μg/L and arsenic=10 μg/L), with median (interquartile range; IQR) concentrations of 3.1 (0.9, 5.6) μg/L for uranium and 1.0 (0.6, 1.8) μg/L for arsenic. Uranium exposure was positively associated with CKD risk (continuous log, per IQR; HR=1.11, 95%CI=1.02-1.20). Compared to uranium exposure <2μg/L (World Health Organization 1998 guideline), risk was over 30% greater at 10-<15μg/L (HR=1.33, 95%CI=1.15-1.54) and similar at ≥15μg/L (HR=1.32, 95%CI=1.09-1.58). There was no evidence of a significant association between arsenic and CKD overall (log, per IQR; HR=1.02, 95%CI=0.98-1.07). However, risk from arsenic was greater among younger individuals (≤55 years), and those who developed cardiovascular disease or diabetes.LIMITATIONSIndividual tap water use and consumption; limited generalizability to men and non-White and less affluent populations.CONCLUSIONSUranium below the current regulatory limit from community water may increase CKD risk.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"35 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087503","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":"Volume 1: Chronic Kidney Disease","authors":"","doi":"10.1053/j.ajkd.2025.04.002","DOIUrl":"10.1053/j.ajkd.2025.04.002","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 6","pages":"Pages S1-S187"},"PeriodicalIF":9.4,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143946694","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":"Support Page","authors":"","doi":"10.1053/S0272-6386(25)00830-3","DOIUrl":"10.1053/S0272-6386(25)00830-3","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 6","pages":"Page A5"},"PeriodicalIF":9.4,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143946610","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}