American Journal of Kidney Diseases最新文献

{"title":"Evolution of Stakeholder Involvement and Scope of Research Priority-Setting Studies in Kidney Disease: A Systematic Review","authors":"Dale Coghlan,Allison Jaure,Jonathan C. Craig,Shilpanjali Jesudason,Chandana Guha,Germaine Wong,Shingisai Chando,Sally Crowe,Braden Manns,Brenda Hemmelgarn,Wolfgang C. Winkelmayer,Nicole Scholes-Robertson","doi":"10.1053/j.ajkd.2026.06.016","DOIUrl":"https://doi.org/10.1053/j.ajkd.2026.06.016","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"45 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149092373","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":"Barriers to and Facilitators of the Adoption of Peritoneal Dialysis: A Systematic Review of Qualitative Studies","authors":"Ravi Shankar,Anjali Bundele,Amanda Yap,Aaron Goh,Aanya Rao,Joshua Low,See Cheng Yeo","doi":"10.1053/j.ajkd.2026.07.013","DOIUrl":"https://doi.org/10.1053/j.ajkd.2026.07.013","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"1 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088863","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 Between Obesity and Cockcroft-Gault Creatinine Clearance in Patients With Solid Organ Malignancies","authors":"Meghan E. Sise,Verônica T. Costa e Silva,Lea Mantz Cand,Tianqi Ouyang,Fernando Louzada Strufaldi,Florian J. Fintelmann,Emmanuel A. Burdmann,Lesley A. Inker","doi":"10.1053/j.ajkd.2026.06.025","DOIUrl":"https://doi.org/10.1053/j.ajkd.2026.06.025","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"480 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088864","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":"Normoproteic Plant-Dominant Protein Diets, Uremic Toxins, and Gut Microbiota in Patients With Advanced CKD: A Randomized Controlled Trial.","authors":"Ryuta Uwatoko, Yusuke Sakaguchi, Tatsufumi Oka, Yohei Doi, Yuki Kawano, Hikaru Kadono, Shungo Fukuda, Ryohei Yamamoto, Isao Matsui, Masayuki Mizui, Jun-Ya Kaimori, Yoshitaka Isaka","doi":"10.1053/j.ajkd.2026.07.008","DOIUrl":"https://doi.org/10.1053/j.ajkd.2026.07.008","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Plant-dominant protein diets may ameliorate metabolic disturbances associated with CKD, such as uremia and gut microbiota dysbiosis, although interventional evidence remains limited. This trial investigated their effects on uremic toxins and other metabolic disorders in patients with advanced CKD.</p><p><strong>Study design: </strong>Randomized controlled trial.</p><p><strong>Setting & participants: </strong>36 Japanese patients with an eGFR <20 mL/min/1.73m² and serum potassium levels <5.5 mEq/L, who received renin-angiotensin system inhibitors.</p><p><strong>Intervention: </strong>Patients were randomly assigned to receive pre-prepared normoproteic (0.8 g/kg/day) diets in which 70% (plant-protein diet group) or 50% (control group) of total protein was derived from plant sources for 4 weeks.</p><p><strong>Outcomes: </strong>The co-primary outcomes were serum indoxyl sulfate (IS), p-cresyl sulfate (PCS), and trimethylamine N-oxide (TMAO). Secondary outcomes included venous bicarbonate, serum short-chain fatty acids (SCFAs), and 16S rRNA sequencing of fecal microbiota.</p><p><strong>Results: </strong>Thirty-six patients were randomized (18 per group). Their median (interquartile range) eGFR was 13 (10, 17) mL/min/1.73m², and 55% were female. After four weeks, 34 patients (94%) reported good adherence to the study diets. Serum TMAO levels were significantly reduced in the 70% plant-protein diet group compared to the control group (between-group difference [95% confidence interval] -4.6 [-7.2, -2.0] μg/mL; false discovery rate [FDR]-adjusted P=0.003), whereas no significant between-group differences were observed for IS (-0.8 [-2.5, 0.9] μg/mL; FDR-adjusted P=0.5) or PCS (-0.9 [-5.1, 3.4] μg/mL; FDR-adjusted P=0.7). The plant-protein diet increased venous bicarbonate, serum calcium, and serum acetate, while reducing parathyroid hormone. Pro-inflammatory gut microbiota genera decreased, while SCFA-producing genera increased with the plant-protein diet. Changes in serum potassium did not differ significantly between groups.</p><p><strong>Limitations: </strong>Small sample size and short intervention period.</p><p><strong>Conclusion: </strong>A normoproteic 70% plant-protein diet reduced TMAO, favorably modulated gut microbiota, and did not cause an increase in serum potassium in patients with far-advanced CKD.</p><p><strong>Funding: </strong>Grants from government (Osaka Kidney Foundation and Japan Society for the Promotion of Science) and not-for-profit (Osaka Heart Club) sources.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015143","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":"Carbamylation as a Novel Marker of Coronary Artery Calcification in People With CKD: Findings from a Phenome-Wide Association Study in CRIC.","authors":"Aya Awwad, Pranav Garimella, Eugene P Rhee, Joachim Janowski, S Ananth Karumanchi, Sagar Nigwekar, Andrew S Allegretti, Anders H Berg, James P Lash, Alba Gutiérrez-Sacristán, Mengyao Tang, Sahir Kalim","doi":"10.1053/j.ajkd.2026.06.014","DOIUrl":"10.1053/j.ajkd.2026.06.014","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Protein carbamylation, a urea-driven post-translational protein modification that increases in chronic kidney disease (CKD), affects diverse mechanisms relevant to the excess morbidity and mortality observed in this population. Given urea's ubiquitous presence in the body, we hypothesized that carbamylation would associate with a broad range of clinical phenotypes, specifically cardiovascular diseases.</p><p><strong>Study design: </strong>Observational cohort study.</p><p><strong>Settings & participants: </strong>3,111 participants from the Chronic Renal Insufficiency Cohort (CRIC).</p><p><strong>Exposure: </strong>Carbamylation burden assessed by carbamylated albumin (C-Alb).</p><p><strong>Outcome: </strong>Clinical phenotypes, and coronary artery calcification (CAC) prevalence, severity, and progression.</p><p><strong>Analytical approach: </strong>A phenome-wide association study (PheWAS) evaluated associations between C-Alb and clinical phenotypes. Post-PheWAS analyses examined the association of carbamylation with CAC measured by Agatston and total volume scores.</p><p><strong>Results: </strong>Across 212 phenotypes, multivariable adjusted comparisons identified 47 significant associations between C-Alb and clinical phenotypes after accounting for multiple testing. Blood urea nitrogen showed one of the greatest associations. Among the most significant continuous phenotypes correlated with C-Alb, those within the coronary calcification category exhibited the greatest magnitude of association prompting additional analysis. 1,046 participants had CAC assessments (median age 60 years, 46% female, median eGFR 43) with CAC present in 65% and the highest C-Alb quartile showing the greatest prevalence. Cross-sectional analysis revealed that each SD increase in log-transformed C-Alb associated with 41% greater CAC severity. Longitudinally, among 269 participants with baseline CAC zero, 55 developed incident CAC, while among 389 with baseline CAC > 0, 147 showed ≥50-unit annual CAC progression. C-Alb associated with progressive CAC in multivariable models adjusting for traditional risk factors.</p><p><strong>Limitations: </strong>Observational design, residual confounding, and limited power for incident CAC analyses.</p><p><strong>Conclusions: </strong>Among patients with CKD, our findings showcase a wide range of phenotypic associations with carbamylation, particularly cardiovascular phenotypes. Carbamylation may be an independent risk factor for CAC, suggesting its potential as a therapeutic target to mitigate cardiovascular risk in CKD populations.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of Sodium/Glucose Cotransporter 2 Inhibitors in Patients With Type 2 Diabetes and CKD.","authors":"Janinne Ortega-Montiel, Wajd Alkabbani, Georg Hahn, Jun Liu, Caroline F Byrne, Deborah J Wexler, Elisabetta Patorno, Julie M Paik","doi":"10.1053/j.ajkd.2026.06.013","DOIUrl":"https://doi.org/10.1053/j.ajkd.2026.06.013","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Patients with chronic kidney disease (CKD) are often underrepresented in clinical trials evaluating the safety profile of newer medication classes for type 2 diabetes (T2D). Given the high burden of comorbidities and polypharmacy in this population, further safety research is needed. This study aimed to detect potential adverse events associated with sodium/glucose cotransporter 2 (SGLT2) inhibitors in patients with T2D and CKD, using a tree-based scan statistic approach.</p><p><strong>Study design: </strong>New-user active comparator cohort study.</p><p><strong>Setting & participants: </strong>Medicare Fee-for-service data (October 2016 - December 2020) and the Merative MarketScan commercial claims database (October 2016 - December 2022) used to identify patients aged ≥65 years (Medicare) or ≥18 years (MarketScan) with T2D and CKD (Stages III-IV).</p><p><strong>Exposures: </strong>New use of SGLT2 inhibitors or glucagon-like peptide-1 receptor agonists (GLP-1RA).</p><p><strong>Outcomes: </strong>ICD-10 coded adverse outcome events, in outpatient, inpatient, or emergency department settings.</p><p><strong>Analytic approach: </strong>After 1:1 propensity-score matching, a hierarchical data-mining surveillance method using ICD-10 outcomes, a tree-based scan statistic, to identify signals for incident adverse events.</p><p><strong>Results: </strong>We identified 22,328 matched pairs in Medicare (mean age, 74 years; 45% female) and 8,918 matched pairs in MarketScan (mean age, 65 years; 42% female). In both cohorts, based on outpatient diagnosis codes, SGLT2 inhibitor initiation showed safety signals for genital infections in both females and males (p < 0.001). However, the tree-based scan statistic did not detect any safety signals based on inpatient/ED diagnosis codes.</p><p><strong>Limitations: </strong>Residual confounding, potential misclassification, and limited power.</p><p><strong>Conclusions: </strong>In two large real-world cohorts of patients with T2D and CKD, the tree-based scan statistic identified previously known adverse events, but no new safety signals associated with SGLT2 inhibitor use compared with GLP-1RA use.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015220","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":"Mental Health, Neurodegenerative, and Cardiovascular Health of Korean Kidney Transplant Recipients in Single-Person Households.","authors":"Junseok Jeon, Yebin Park, Minji Kim, Kyungho Lee, Jung Eun Lee, Wooseong Huh, Kyungdo Han, Hye Ryoun Jang","doi":"10.1053/j.ajkd.2026.06.012","DOIUrl":"https://doi.org/10.1053/j.ajkd.2026.06.012","url":null,"abstract":"<p><strong>Rationale & objective: </strong>The prevalence of single-person households is increasing globally. However, the health of kidney transplant recipients (KTRs) who live alone is underexplored. This study investigated the mental health, neurodegenerative, and cardiovascular health outcomes of KTRs living in single-person households.</p><p><strong>Study design: </strong>Nationwide retrospective observational cohort study.</p><p><strong>Setting & participants: </strong>9,134 KTRs who participated in a national health screening program from 2009 to 2017 and were represented in the Korean National Health Insurance Service (NHIS) data. Sub-cohorts ranging in size from 3,790 to 7,452 KTRs were constructed for each outcome.</p><p><strong>Exposure: </strong>Living in single-person household.</p><p><strong>Outcomes: </strong>Composite mental health outcome (depression, anxiety, or insomnia), dementia, Parkinson disease, allograft failure, all-cause mortality, and cardiovascular disease (CVD).</p><p><strong>Analytical approach: </strong>Multivariable Cox proportional hazards models.</p><p><strong>Results: </strong>KTRs in single-person households accounted for 10.0% of the study population, and were more likely to belong to the lowest quintile (52.1% vs 18.8%) and less likely to belong to the highest quintile of income (9.5% vs 30.9%; P <0.001). Over a median follow-up of 6 years, living in a single-person household was associated with a higher risk of the composite mental health outcome (adjusted HR, 1.28; 95% confidence interval [CI], 1.02-1.60), with depression showing the strongest individual association (aHR, 1.42; 95% CI, 1.04-1.94). Single-person households were also associated with a higher risk of dementia (aHR, 1.68; 95% CI, 1.05-2.70), and Parkinson disease (aHR, 4.40; 95% CI, 1.48-13.09), as well as a higher risk of CVD (aHR, 1.40; 95% CI, 1.00-1.96), particularly myocardial infarction (MI) (aHR, 1.80; 95% CI, 1.16-2.80). All-cause mortality and allograft failure rates were comparable between the two groups.</p><p><strong>Limitations: </strong>Retrospective study design, incompleteness of the NHIS database, and potential inaccuracies in the definition of \"single-person households\".</p><p><strong>Conclusions: </strong>KTRs in single-person households have a higher risk of mental health disorders, dementia, Parkinson disease, and MI after kidney transplantation. These findings highlight the need to incorporate comprehensive psychosocial assessments and targeted support into post-transplant care, particularly for socially isolated KTRs.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015160","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":"Self-Reported Versus Performance-Based Measures of Physical Function and Mortality Among Patients With Kidney Failure: A Cohort Analysis of the CONVINCE Trial.","authors":"Audrey Yuki Brinker, Felix H Fischer, Giovanni F M Strippoli, Krister Cromm, Peter J Blankestijn, Michiel L Bots, Claudia Barth, Bernard Canaud, Andrew Davenport, Kathrin I Fischer, Jörgen Hegbrant, Marietta Török, Robin W M Vernooij, Mark Woodward, Matthias Rose, Gregor Liegl","doi":"10.1053/j.ajkd.2026.06.011","DOIUrl":"https://doi.org/10.1053/j.ajkd.2026.06.011","url":null,"abstract":"<p><strong>Rationale & objective: </strong>While physical function (PF) measures obtained through patient-reported outcomes (PRO) are simpler to obtain than performance-based outcomes (PerfO), their relative prognostic value remains unclear. This study compared the associations of these measures with all-cause mortality in patients with kidney failure enrolled in the CONVINCE trial.</p><p><strong>Study design: </strong>Observational multicenter cohort study.</p><p><strong>Setting & participants: </strong>Adult patients with kidney failure undergoing high-dose hemodiafiltration or high-flux hemodialysis enrolled in the CONVINCE trial between November 2018 and April 2021.</p><p><strong>Predictors: </strong>Baseline PF scores derived from (1) PRO: the 4-item PROMIS-PF short form (PROMIS-PF4a), (2) PerfO: the Physical Performance Test (PPT), and (3) composite PF scores integrating both assessment types. The different PF metrics were standardized to permit comparisons on a common scale.</p><p><strong>Outcome: </strong>All-cause mortality over a median follow-up of 30 months.</p><p><strong>Analytical approach: </strong>Unadjusted and multivariable Cox proportional hazards regression models fitted for each PF predictor. Model discrimination was evaluated using Harrell's C-index and time-dependent AUCs. Restricted cubic splines assessed risk across the PF continuum. Kaplan-Meier curves were stratified according to predefined PROMIS-PF score cut points.</p><p><strong>Results: </strong>Of 1,360 included patients (37.1% women, mean age 62.4 years), 266 (19.6%) died during follow-up. All three PF measures demonstrated statistically significant and comparable associations with mortality in both unadjusted and adjusted analyses. Adjusted hazard ratios (HRs) per 1-point increase in PF score were 0.96 (95% CI, 0.95-0.98) for PROMIS-PF4a, 0.95 (95% CI, 0.94-0.97) for PPT, and 0.96 (95% CI, 0.94-0.97) for the composite score. Discriminative ability was modest but similar across measures (adjusted C-index ≈ 0.71). Across all assessment types, severe PF impairment (T-score<30), was associated with substantially higher mortality risk.</p><p><strong>Limitations: </strong>Observational cohort analysis of a trial population; generalizability is limited to trial participants and to the examined PF tools.</p><p><strong>Conclusions: </strong>Physical function was strongly and independently associated with mortality in kidney failure. The patient-reported PROMIS-PF4a and the performance-based PPT demonstrated comparable associations with mortality. These findings support use of the brief PROMIS-PF instrument as a practical alternative to performance-based assessments for routine monitoring of PF in dialysis care.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015135","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":"Application of a Kidney Hierarchical Composite Endpoints in Trials of CKD Progression: Report of a Scientific Workshop Sponsored by the National Kidney Foundation","authors":"Lesley A. Inker,Tom Greene,Glenn M. Chertow,Kelli Collins Damron,Julie F. Furberg,Samvel B. Gasparyan,Craig Gordon,Hrefna Guðmundsdóttir,Hiddo J.L. Heerspink,Niels Jongs,Dustin J. Little,Cari Maxwell,Precious McCowan,Amy K. Mottl,Patrick Schloemer,Edward Siew,Duane Sunwold,David Vock,Kerry Willis,Leila R. Zelnick,Ian H. de Boer","doi":"10.1053/j.ajkd.2026.06.017","DOIUrl":"https://doi.org/10.1053/j.ajkd.2026.06.017","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"154 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149020244","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":"Blood Leak Alarms With Hydroxocobalamin Administration","authors":"Ranim Razzouk,Ahmed Zaky Fadel,Garvin Hoo Sang,Charmaine E. Lok,Tushar Malavade","doi":"10.1053/j.ajkd.2026.05.026","DOIUrl":"https://doi.org/10.1053/j.ajkd.2026.05.026","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"5 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149049028","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}