American Journal of Kidney Diseases最新文献

{"title":"Trends in Outcomes Among Patient Initiating Peritoneal Dialysis in the United States, 2009-2018.","authors":"Christopher Knapp,Shuling Li,Chuanyu Kou,David T Gilbertson,James B Wetmore,Allyson Hart,Kirsten L Johansen","doi":"10.1053/j.ajkd.2025.06.007","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.06.007","url":null,"abstract":"RATIONALE & OBJECTIVEPeritoneal dialysis (PD) use has increased since 2009. We sought to evaluate how historic disparities in outcomes across different demographic groups have changed over time.STUDY DESIGNRetrospective cohort study.SETTING & PARTICIPANTSPatients initiating PD from 2009 to 2018 in the US represented in the US Renal Data Systems (USRDS).EXPOSURESPatient age group, race/ethnicity, urban or rural residence, obesity status, and level of neighborhood deprivation.OUTCOMESMortality and conversion to in-center hemodialysis (HD) in one and two years following dialysis initiation.ANALYTICAL APPROACHThe cumulative incidence of events was estimated for each yearly cohort. Temporal trends were evaluated using Cox proportional hazards models (mortality) and Fine-Gray models (conversion to HD).RESULTSThe study included 101,640 incident PD patients, of whom 38.1% were aged ≥65 years, and 57.5% were White. The overall mortality one year after PD initiation decreased from 11.0% in 2009 to 8.4% in 2018, and the hazard decreased by 3% per two study years(hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.96-0.99). The probability of conversion to in-center HD one year after PD initiation decreased from 17.8% in 2009 to 15.1% in 2018, and the hazard decreased by 2% per two study years (HR 0.98, 95% CI, 0.97-1.00). Patients over 75 did not experience lower conversion to HD over time (HR 1.02, 95% CI 0.99-1.05, p for age interaction= 0.02). Overall, the hazard of conversion to HD in the two years following PD initiation did not improve. Hazards of mortality and conversion to HD changed similarly, regardless of urban or rural residence, race/ethnicity, obesity, or level of neighborhood deprivation.LIMITATIONSIncomplete data on medical comorbidities.CONCLUSIONSThe rate of mortality improved for incident PD patients regardless of patient demographic factors over the period 2009 to 2020. Hazards of conversion to in-center HD improved less and attenuated with longer follow-up.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"26 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612883","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":"Advancing Non-Invasive Imaging to Quantify Kidney Fibrosis: Hidden in Plain Sight.","authors":"Momen Abbasi,Anand Srivastava","doi":"10.1053/j.ajkd.2025.06.006","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.06.006","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"14 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144603898","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 Sex With All-Cause and Cause-Specific Peritoneal Dialysis Discontinuation.","authors":"Dharshana Sabanayagam,Pedro Lopez,Farzaneh Boroumand,Katrina Chau,Eric H Au,Ryan Gately,K Shuvo Bakar,Lin Zhu,Armando Teixeira-Pinto,Wai H Lim,Germaine Wong","doi":"10.1053/j.ajkd.2025.05.009","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.05.009","url":null,"abstract":"RATIONALE & OBJECTIVELittle is known about the association between sex and specific causes of peritoneal dialysis (PD) discontinuation. This study sought to assess the association of sex with all-cause and cause-specific PD discontinuation and explore the factors mediating these relationships.STUDY DESIGNRetrospective cohort study.SETTING & PARTICIPANTSAll patients with kidney failure who started PD between 2005-2019 in Australia.EXPOSURESex.OUTCOMESAll-cause (transfer to hemodialysis for ≥30 days or death) PD discontinuation, PD discontinuation related to inadequate dialysis, and PD discontinuation related to infection.ANALYTICAL APPROACHAdjusted cause-specific proportional hazards regression models were used to assess the association of sex with all-cause and cause-specific PD discontinuation. Counterfactual mediation analysis was conducted to explore potential mediators (sociodemographic status, geographical remoteness, cardiovascular disease, diabetes, history of peritonitis, late referral, smoking status, and BMI) of these associations. Sensitivity analyses using the Fine and Gray method were implemented to address the competing risks of death, kidney transplantation, and other causes of PD discontinuation.RESULTS6001 out of 9748 incident patients experienced PD-discontinuation from any cause (2098 died, 793 inadequate dialysis-related, 1442 infection-related, 1668 other cause), with a median follow-up of 1.47 years (IQR 0.67-2.73). Males were more likely to experience PD discontinuation from any cause (HR 95% CI) (1.09, 1.03-1.14, p=0.002) and inadequate dialysis (1.71, 1.47-1.99, p<0.001), but not from infection (0.95, 0.85-1.05, p=0.3). The mediation analyses found that 76.9% of the total effect of sex on all-cause PD discontinuation was explained by mediators, including cardiovascular disease, smoking status, and diabetes, whereas less than 10% of the total effect of sex on PD discontinuation from inadequate dialysis was explained by mediators.LIMITATIONSResidual and unmeasured confounders, such as biological differences, behavioral patterns, hospitalizations, frailty, and severity of comorbidities.CONCLUSIONMales were more likely than females to experience PD discontinuation from any cause and from inadequate dialysis. This relationship was mediated by multiple morbidities for PD discontinuation from any cause but not for PD discontinuation from inadequate dialysis. These findings may inform future studies evaluating biological and sociodemographic factors that may contribute to these observed sex differences.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"109 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144603976","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":"Gout Management in Patients With CKD.","authors":"Rochella A Ostrowski","doi":"10.1053/j.ajkd.2025.04.020","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.04.020","url":null,"abstract":"<p><p>The management of gout in patients with chronic kidney disease can be challenging due to multiple factors. These include limitations on the type or doses of medications used. While limitations or exclusions of some treatment options are warranted, others that are traditionally followed, such as the doses used for urate lowering therapies like allopurinol or febuxostat, may lead to undertreatment of gout. In this review, guidelines from consensus groups are discussed with a focus on management of gout in patients with chronic kidney disease and appropriate dose adjustments beyond traditional kidney-dosed limits. Studies in the literature with regard to risk factors for allopurinol hypersensitivity syndrome are reviewed, including HLAB*5801 allele testing. Additionally, current evidence that allows providers to optimize both the effectiveness and safety of gout management in the setting of chronic kidney disease, such as the \"start-low-go-low\" approach are reviewed, as well as considerations for kidney transplant recipients. While there is a potential role of sodium/glucose cotransporter 2 inhibitors in lowering serum urate, it is limited in chronic kidney disease. Lastly, the use of immunomodulators to improve outcomes for pegloticase, a pegylated form of uricase, show promise for increasing the utility of pegloticase in cases where it is warranted.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558796","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":"Incidence and Adverse Outcomes of Acute Kidney Disease: A Systematic Review and Meta-Analysis.","authors":"Changyuan Yang, Marcello Tonelli, Matthew T James, Zhi Tan, Wisanne M Bakker, Ron T Gansevoort, Priya Vart","doi":"10.1053/j.ajkd.2025.05.008","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.05.008","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Estimates of the incidence of acute kidney disease (AKD) and its associated adverse outcomes are inconsistent, which may be due, in part, to differences in prior studies' definitions of AKD. This study sought to summarize these reports and identify study-level characteristics, including the definition of AKD, that may explain the observed heterogeneity.</p><p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Setting & study populations: </strong>Adults aged ≥18 years and not receiving maintenance kidney replacement therapy.</p><p><strong>Selection criteria for studies: </strong>Observational studies that assessed the incidence of AKD and its association with adverse outcomes.</p><p><strong>Data extraction: </strong>Two reviewers independently extracted data and assessed study quality.</p><p><strong>Analytical approach: </strong>AKD definitions were classified as: 1) Acute Disease Quality Initiative (ADQI) or ADQI-equivalent or 2) KDIGO/KDIGO-equivalent. Random effects meta-analysis was used to calculate pooled estimates of incidence and the relationship between AKD and outcomes([mortality, kidney failure, onset of chronic kidney disease [CKD]) summarized by odds ratios (ORs) and 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Among 1,883 identified studies, 59, involving nearly 6 million participants, met inclusion criteria. Most studies were classified as having good quality per the New-Castle Ottawa scale (n=44). The pooled incidence of AKD was higher when defined by ADQI/ADQI-equivalent compared with KDIGO/KDIGO-equivalent criteria (26.6% [95% CI, 20.3-34.9%] vs. 11.1% [95% CI, 7.6-16.3%], p for difference <0.001). The pooled odds ratio of all-cause mortality associated with AKD was similar whether defined with KDIGO/KDIGO equivalent or ADQI/ADQI-equivalent criteria (3.8 [95% CI, 2.2-6.7] vs. 3.0 [95% CI, 2.1-4.4], p =0.5). After accounting for the baseline AKI status, both the incidence of AKD and its association with all-cause mortality were similar for the two definitions. The incidence of AKD was 13.6% and 11.1%, and the ORs for all-cause mortality were not different (4.2 [95% CI, 2.0-8.7] vs. 3.8 [95% CI, 2.2-6.7], p =0.8) using the ADQI/ADQI-equivalent and KDIGO/KDIGO-equivalent definitions, respectively. Similar results were observed for the association between AKD and development of CKD, but the association between AKD and kidney failure was stronger in studies using the KDIGO/KDIGO-equivalent definition.</p><p><strong>Limitations: </strong>Heterogeneity persisted across most of the examined subgroups.</p><p><strong>Conclusions: </strong>Estimates for AKD incidence and AKD-associated risk for clinical outcomes vary by the definition used for AKD. These findings inform the assessment of the incidence and consequences of AKD in research and clinical settings.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558797","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":"Effectiveness of Inpatient Rehabilitation for Older Adults Soon After Dialysis Initiation to Improve Health Outcomes.","authors":"Ismay Van Loon,Shepherd Kajawo,Eric McArthur,Danielle M Nash,Lima F Rodrigues,Stephanie N Dixon,Amit X Garg,Jamie L Fleet,Blayne Welk,S Vanita Jassal","doi":"10.1053/j.ajkd.2025.06.003","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.06.003","url":null,"abstract":"RATIONALE & OBJECTIVEMultiple studies have shown that older adults' initiation of dialysis is associated with functional decline often within months of starting treatment. This functional impairment has been associated with a 2- to 4-fold higher risk of mortality and morbidity. This study sought to assess if rehabilitation within the first few months after starting dialysis may improve physical function and reduce the rates of hospitalization and mortality.STUDY DESIGNRetrospective matched cohort study.SETTING & PARTICIPANTSIndividuals in Ontario, Canada, aged ≥66 years initiating maintenance dialysis whose healthcare data were recorded by ICES, which captures administrative health data for the population of Ontario.EXPOSUREInpatient rehabilitation care within 6 months of starting dialysis.OUTCOMESChange in the Functional Independence Measure (FIM®) score during the rehabilitation hospitalization among those receiving rehabilitation. Counts of hospital days, rates of admission to hospitals and long-term care facilities, and mortality over one year following the index date for comparisons of those who received rehabilitation to those who did not.ANALYTICAL APPROACHPatients receiving rehabilitation and three times as many not receiving rehabilitation were matched using a propensity score logistic regression model. Outcomes among those who did and did not receive rehabilitation were compared using Cox proportional hazards models and the Cochran-Mantel-Haenszel test for binary outcomes.RESULTSAmong those undergoing rehabilitation, FIM® scores improved from 76±17 at admission, to 98±19 by discharge (p<0.0001). 1287 of 1567 (82%) patients admitted for rehabilitation within 6 months of dialysis were matched to 3861 patients who did not receive rehabilitation. Patients undergoing rehabilitation had similar 1-year mortality rates to the matched comparison population (27% vs. 25%, p=0.45), but higher hospitalization rates and length-of-stay. Six percent of patients in both groups were admitted to a long-term care facility within the 1-year follow-up (P=0.65).LIMITATIONSPotential for residual confounding due to the use of administrative data.CONCLUSIONSThese data suggest that patients may benefit physically from rehabilitation around the time of starting dialysis. Hospitalization was slightly higher in those undergoing rehab, however unlike previously published data on those with low baseline functional status, mortality was similar across both groups.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"48 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144547805","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":"The Silent Struggle of Facing Kidney Failure as a Child.","authors":"Luca G Torrisi","doi":"10.1053/j.ajkd.2025.03.030","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.03.030","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"25 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144547806","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":"Carbon Emissions From Different Dialysis Modalities: A Life Cycle Assessment.","authors":"Katherine A Barraclough,Ben Talbot,John Knight,Susan Blair,Forbes McGain,Rosemary Masterson,Richard Knight,Craig Nelson,Stephen McDonald,Scott McAlister","doi":"10.1053/j.ajkd.2025.04.019","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.04.019","url":null,"abstract":"RATIONALE & OBJECTIVEAs the health impacts of climate change intensify, the healthcare sector faces growing pressure to minimize its carbon footprint. Achieving this goal requires understanding of the carbon impact of widely used medical treatments. This study aimed to evaluate and compare the carbon footprints of in-center hemodialysis, home hemodialysis, automated peritoneal dialysis (APD), and continuous ambulatory peritoneal dialysis (CAPD).STUDY DESIGNComparative life cycle assessment.SETTING & PARTICIPANTSIn-center hemodialysis, home-based hemodialysis, CAPD, and APD treatments provided by the Royal Melbourne Hospital Kidney Care Service, Melbourne, Victoria, Australia.OUTCOMECarbon emissions in kilograms of carbon dioxide equivalents (kg CO2e) from the annual provision of dialysis to a single patient.ANALYTICAL APPROACHAttributional process-based comparative life cycle assessment methodology was used to identify the sources and extent of carbon emissions for all dialysis modalities.RESULTSIn-center hemodialysis had the highest annual per patient carbon impact, at 4,814 kg CO2e. In comparison, emissions from home hemodialysis were 41% lower (2,938 kg CO2e), APD 29% lower (3,339 kg CO2e), and CAPD 59% lower (1,969 kg CO2e). Across all four modalities, consumables were the largest source of emissions. For in-center hemodialysis, patient travel was the main factor contributing to its higher carbon footprint compared to home-based dialysis options.LIMITATIONSSingle dialysis provider in an urban setting.CONCLUSIONSIn-center hemodialysis has a substantially higher carbon footprint than all home dialysis options, informing the choice of home dialysis when feasible and appropriate for individual patients.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"3 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144547789","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":"How to Leverage Implementation Science to Achieve Equity in Nephrology Care Delivery","authors":"Yuvaram N.V. Reddy MBBS MPH, Laura Ellen Ashcraft PhD MSW, Mallika L. Mendu MD MBA","doi":"10.1053/j.ajkd.2025.03.029","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.03.029","url":null,"abstract":"There are several evidence-based practices within nephrology that have the potential to meaningfully improve patient outcomes and mitigate disparities. However, these practices are inconsistently implemented in routine care, contributing to low-quality care, persistent health disparities, and high healthcare costs. To address these care gaps quickly, nephrology would benefit from leveraging implementation science: a multidisciplinary field that seeks to close the gap between evidence and practice by examining the optimal approach to help individuals, groups, organizations, and communities implement evidence-based interventions in real-world settings. This Perspective is designed to provide an overview of the field of implementation science and summarize how to apply implementation science in nephrology to address health disparities. To illustrate how to leverage implementation science for health equity, we also showcase two case examples focused on 1) addressing disparities in the use of sodium/glucose cotransporter-2 inhibitors (SGLT2 inhibitors) to slow the progression of chronic kidney disease, and 2) increasing equitable access to home dialysis for people with kidney failure.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"5 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144335587","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":"Peripheral Neuropathy Presenting With Hypereosinophilia: A Quiz","authors":"Rex K. Siu ,&nbsp;Alexandra C. Hardy ,&nbsp;Faaiq N. Aslam ,&nbsp;Induja R. Nimma ,&nbsp;Sehreen Mumtaz ,&nbsp;Sam T. Albadri ,&nbsp;Nancy Dawson ,&nbsp;Lyle W. Baker","doi":"10.1053/j.ajkd.2025.01.017","DOIUrl":"10.1053/j.ajkd.2025.01.017","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 1","pages":"Pages A13-A16"},"PeriodicalIF":9.4,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320893","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}