American Journal of Kidney Diseases最新文献

{"title":"Aiming for a Patient-Centered Organ Procurement and Transplantation Network.","authors":"Sylvia E Rosas, Morgan Reid","doi":"10.1053/j.ajkd.2024.09.004","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.09.004","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142563733","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":"Exploring the Causal Relationship Between Kidney Function and Cancer Risk: Insights and Limitations of Mendelian Randomization.","authors":"Sehoon Park, Jeong Min Cho, Dong Ki Kim","doi":"10.1053/j.ajkd.2024.07.004","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.07.004","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543060","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":"Proteinuria as an Endpoint in Clinical Trials of Focal Segmental Glomerulosclerosis.","authors":"Laura H Mariani, Howard Trachtman, Aliza Thompson, Barbara S Gillespie, Michelle Denburg, Ulysses Diva, Duvuru Geetha, Peter J Greasley, Michelle A Hladunewich, Robert B Huizinga, Jula K Inrig, Radko Komers, Louis-Philippe Laurin, Dustin J Little, Patrick H Nachman, Kimberly A Smith, Liron Walsh, Keisha L Gibson","doi":"10.1053/j.ajkd.2024.08.011","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.08.011","url":null,"abstract":"<p><p>Focal Segmental Glomerulosclerosis (FSGS) is a characteristic histopathological lesion that is indicative of underlying glomerular dysfunction. It is not a single disease entity but rather a heterogeneous disorder that is an important cause of nephrotic syndrome and kidney failure in children and adults. The aim of this Kidney Health Initiative project was to evaluate potential endpoints for clinical trials in FSGS. This paper focuses on the data supporting proteinuria as a surrogate endpoint. Available data support the use of complete remission of proteinuria in patients with heavy proteinuria as a surrogate endpoint for progression to kidney failure. While substantial treatment effects on proteinuria that are short of a complete remission may also predict the effect of a treatment on progression to kidney failure, further work is needed to determine how such an endpoint should be defined. Fortunately, efforts are underway to bring together patient-level data from randomized controlled trials, observational studies, and registries to address this issue.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142492822","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":"Sex, Acute Kidney Injury, and Age: A Prospective Cohort Study.","authors":"Ladan Golestaneh,Abby Basalely,Andreas Linkermann,Tarek M El-Achkar,Ryung S Kim,Joel Neugarten","doi":"10.1053/j.ajkd.2024.10.003","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.10.003","url":null,"abstract":"RATIONALE & OBJECTIVEAnimal models of kidney disease suggest a protective role for female sex hormones but in humans, some authorities assert that female sex is a risk factor for acute kidney injury (AKI). To better understand the risk of AKI, we studied the strength of association between sex and AKI incidence in hormonally distinct age groups across the life span.STUDY DESIGNProspective cohort study.SETTINGS & PARTICIPANTSAll patients hospitalized in the Montefiore Health System between 10/15/2015 and 1/1/2019, excluding those with kidney failure or obstetrics diagnoses.EXPOSUREMale versus female sex.OUTCOMESAcute kidney injury (AKI) occurring during hospitalization based on KDIGO definitions.ANALYTICAL APPROACHGeneralized Estimating Equation logistic regression adjusted for comorbidities, socio-demographic factors, and severity of illness. Analyses were stratified into 3 age categories, 6 months to ≤16 years, age >16 years - <55 years, and age ≥55 years.RESULTSA total of 132,667 individuals were hospitalized a total of 235,629 times. The mean age was 55.2 (SD 23.8) years. The counts (%) of hospitalizations for women were 129,912 (55%). Hospitalization counts (%) among Black and Hispanic patients were 71,834 (30.5%) and 24,199 (10.3%), respectively. AKI occurred in 53,926 (22.9%) hospitalizations. In adjusted models, there was a significant interaction between age and sex (p<0.001). Boys and men had higher risk of AKI across all age groups, an association more pronounced in the age group >16 years to <55 years in which the OR for men was 1.7 (95% CI, 1.6-1.8). This age-based pattern remained consistent across prespecified types of hospitalizations. In a sensitivity analysis, women older than 55 years who received prescriptions for estrogen had lower odds of AKI than those without prescriptions.LIMITATIONSResidual confounding.CONCLUSIONThe greatest relative risk of AKI for males occurred during ages >16 to <55 years. The lower risk among post-menopausal women receiving supplemental estrogen supports a protective role for female sex hormones.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":13.2,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142490427","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":"Intensive Home Blood Pressure Lowering in Patients with Advanced CKD.","authors":"Elaine Ku, Timothy P Copeland, Charles E McCulloch, Divya Seth, Christopher A Carlos, Kerry Cho, Anna Malkina, Lowell J Lo, Raymond K Hsu","doi":"10.1053/j.ajkd.2024.08.010","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.08.010","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Optimal blood pressure (BP) targets in advanced CKD are controversial. More intensive BP lowering in the setting of advanced CKD is thought to be associated with risk of acute kidney injury, hyperkalemia, and ESKD. We aimed to conduct a pilot trial of intensive BP control to determine if lower SBP targets can be safely achieved for patients with CKD through titration of BP medications using in-home measured BP.</p><p><strong>Study design: </strong>Non-blinded randomized controlled trial.</p><p><strong>Settings & participants: </strong>108 patients with advanced CKD (eGFR ≤30 mL/min/1.73 m²) and hypertension.</p><p><strong>Interventions: </strong>Participants were randomized either to a target home SBP goal of <120 mmHg (N=66) or a less intensive SBP goal (N=42). Antihypertensive medications were titrated to achieve the target home SBP range in the first 4 months of the study and maintained until the end of the study. Home BP was measured using a wireless Bluetooth-enabled monitor that transmitted readings to providers in real-time.</p><p><strong>Outcomes: </strong>The primary efficacy outcome was the difference in achieved clinic SBP between the two study arms from months 4-12. Safety outcomes included hyperkalemia, a composite outcome of falls or syncope, and onset of need for dialysis or kidney transplantation.</p><p><strong>Results: </strong>The mean clinic SBP at month 12 was 124.7 mmHg in the intensive SBP group vs. 138.2 mmHg in the less intensive SBP group. Averaged over months 4-12, the achieved mean clinic SBP in the intensive SBP arm was 11.7 mmHg (95% CI 7.5 to 16 mmHg, p<0.001) lower than the mean SBP achieved in the less intensive SBP arm. Primary safety outcomes were not statistically significantly different between the two arms (all p>0.05).</p><p><strong>Limitations: </strong>Small sample size which may limit our ability to detect clinically significant differences in rates of adverse outcomes; single-center design.</p><p><strong>Conclusions: </strong>A clinic SBP goal of <120 mmHg is feasible to achieve with the help of real-time home BP monitoring and appears to be safe in this study population with advanced CKD. Larger trials to determine optimal BP targets in advanced CKD and the risks and benefits associated with more intensive BP control are warranted.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142455777","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":"Intensive Home Blood Pressure Lowering in Patients with Advanced CKD.","authors":"Elaine Ku,Timothy P Copeland,Charles E McCulloch,Divya Seth,Christopher A Carlos,Kerry Cho,Anna Malkina,Lowell J Lo,Raymond K Hsu","doi":"10.1053/j.ajkd.2024.08.010","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.08.010","url":null,"abstract":"RATIONALE & OBJECTIVEOptimal blood pressure (BP) targets in advanced CKD are controversial. More intensive BP lowering in the setting of advanced CKD is thought to be associated with risk of acute kidney injury, hyperkalemia, and ESKD. We aimed to conduct a pilot trial of intensive BP control to determine if lower SBP targets can be safely achieved for patients with CKD through titration of BP medications using in-home measured BP.STUDY DESIGNNon-blinded randomized controlled trial.SETTINGS & PARTICIPANTS108 patients with advanced CKD (eGFR ≤30 mL/min/1.73 m2) and hypertension.INTERVENTIONSParticipants were randomized either to a target home SBP goal of <120 mmHg (N=66) or a less intensive SBP goal (N=42). Antihypertensive medications were titrated to achieve the target home SBP range in the first 4 months of the study and maintained until the end of the study. Home BP was measured using a wireless Bluetooth-enabled monitor that transmitted readings to providers in real-time.OUTCOMESThe primary efficacy outcome was the difference in achieved clinic SBP between the two study arms from months 4-12. Safety outcomes included hyperkalemia, a composite outcome of falls or syncope, and onset of need for dialysis or kidney transplantation.RESULTSThe mean clinic SBP at month 12 was 124.7 mmHg in the intensive SBP group vs. 138.2 mmHg in the less intensive SBP group. Averaged over months 4-12, the achieved mean clinic SBP in the intensive SBP arm was 11.7 mmHg (95% CI 7.5 to 16 mmHg, p<0.001) lower than the mean SBP achieved in the less intensive SBP arm. Primary safety outcomes were not statistically significantly different between the two arms (all p>0.05).LIMITATIONSSmall sample size which may limit our ability to detect clinically significant differences in rates of adverse outcomes; single-center design.CONCLUSIONSA clinic SBP goal of <120 mmHg is feasible to achieve with the help of real-time home BP monitoring and appears to be safe in this study population with advanced CKD. Larger trials to determine optimal BP targets in advanced CKD and the risks and benefits associated with more intensive BP control are warranted.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":13.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142486321","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":"Three Cases of Red Yeast Rice-Containing Supplement-Induced Acute Kidney Injury and Fanconi Syndrome.","authors":"Ayako Chikasue,Kensei Taguchi,Ryuji Iwatani,Koki Kimura,Seiya Okuda,Noriko Uesugi,Kei Fukami","doi":"10.1053/j.ajkd.2024.08.007","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.08.007","url":null,"abstract":"Japan has recently faced a public health crisis owing to \"Beni Koji Choleste Help,\" a product marketed as a dietary supplement. It is made from red yeast rice and has cholesterol-lowering effects. Following the identification of the first case of acute kidney injury (AKI) caused by the product, 76 possibly related deaths and 492 hospitalizations have been reported in Japan. We herein demonstrate three cases of AKI with renal tubular acidosis and Fanconi syndrome following consumption of the product for 2 weeks to 7 months. Kidney biopsy revealed diffuse tubular injury, tubular cell flattening, loss of brush border, sparse debris, and cast formation containing periodic acid-Schiff- and silver stain-positive fluffy material in the tubular lumens with interstitial cell infiltration, together with mild fibrosis. Electron microscopy revealed fluffy materials in the tubular lumen surrounded by necrotic tubular cell debris and intracellular contents. Discontinuation of the supplement and the treatment with prednisolone improved kidney function and Fanconi syndrome. Longitudinal monitoring and surveys are required to detect and prevent the progression to chronic kidney disease in people who have consumed \"Beni Koji Choleste Help.\"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":13.2,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451443","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":"Treatment of Autosomal Dominant Polycystic Kidney Disease.","authors":"Sara S Jdiaa,Reem A Mustafa,Alan S L Yu","doi":"10.1053/j.ajkd.2024.08.008","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.08.008","url":null,"abstract":"Autosomal dominant polycystic kidney disease (ADPKD) is a chronic systemic disease that affects all races and ethnicities. It is the fourth leading cause of end-stage kidney disease, and it has a heterogenous phenotype ranging from mild to severe disease. Identifying patients with ADPKD who are at risk of rapid progression can guide therapeutic decisions. Several tools to predict disease severity are available, based on features such as total kidney volume from magnetic resonance imaging, PKD genotype, eGFR trajectory, and the occurrence of hypertension and urologic complications early in life. Over the past decade, more evidence has emerged regarding optimal ADPKD management. The HALT PKD trial supported intensive blood pressure control in patients younger than 50 years of age with preserved kidney function. A healthy lifestyle, including maintaining a healthy weight, salt restriction and smoking cessation, is likely to be beneficial. Tolvaptan, the only disease-modifying agent for ADPKD patients that are at risk of rapid progression, is gaining wider use, but is still limited by its side-effects. This is an exciting time for the ADPKD community as multiple promising interventions are in the pipeline and being investigated.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":13.2,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451444","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":"Biomarkers of Rejection in Kidney Transplantation.","authors":"Scott G Westphal,Roslyn B Mannon","doi":"10.1053/j.ajkd.2024.07.018","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.07.018","url":null,"abstract":"Alloimmune injury is a major cause of long-term kidney allograft failure whether due to functionally stable (subclinical) or overt clinical rejection. These episodes may be mediated by immune cells (cellular rejection) or alloantibody (antibody-mediated rejection). Early recognition of immune injury is needed for timely appropriate intervention to maintain graft functional viability. However, the conventional measure of kidney function (i.e., serum creatinine) is insufficient for immune monitoring due to limited sensitivity and specificity for rejection. As a result, there is need for biomarkers that more sensitively detect the immune response to the kidney allograft. Recently, several biomarkers have been clinically implemented into the care of kidney transplant recipients. These biomarkers attempt to achieve multiple goals including (1) more sensitive detection of clinical and subclinical rejection, (2) predicting impending rejection, (3) monitoring for the adequacy of treatment response, and (4) facilitating personalized immunosuppression. In this review, we summarize the findings to date in commercially available biomarkers, along with biomarkers approaching clinical implementation. While we discuss the analytical and clinical validity of these biomarkers, we identify the challenges and limitations to widespread biomarker use, including the need for biomarker-guided prospective studies to establish evidence of clinical utility of these new assays.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":13.2,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449332","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":"Laboratory Anomalies in the Basic Metabolic Panel: Core Curriculum 2025.","authors":"Layana T Takieddine,Joe M El-Khoury","doi":"10.1053/j.ajkd.2024.06.019","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.06.019","url":null,"abstract":"Laboratory testing plays an integral part in medical decision making. However, laboratory results can sometimes vary significantly, leading to anomalous outcomes that are not consistent with the clinical picture. These anomalies can occur even in the best of laboratories simply because the total testing process includes elements that are not totally under the laboratory's control. For example, variations in patient preparation and sample collection procedures, as can happen at physician offices or patients receiving intravenous fluids, are major contributors to these anomalies. Therefore, physicians must remain aware of the causes of these anomalies so they can consider them when interpreting laboratory results and help implement solutions to mitigate them at their respective institutions. This Core Curriculum examines several instances where an understanding of preanalytical, analytical, and postanalytical variation is essential for detecting anomalies and providing proper patient care.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":13.2,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142436112","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}