American Journal of Kidney Diseases最新文献

{"title":"Why This Research Matters","authors":"Robert Sanchez MPS","doi":"10.1053/j.ajkd.2025.07.021","DOIUrl":"10.1053/j.ajkd.2025.07.021","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages A8-A9"},"PeriodicalIF":8.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145792907","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":"Chronic Pain Locations, Characteristics, and Associations With Other Symptoms in Adults Receiving Maintenance Hemodialysis: Findings From the HOPE Consortium Trial","authors":"Michael J. Fischer , Jesse Y. Hsu , Joanna Walsh , Kerri L. Cavanaugh , David M. Charytan , Susan T. Crowley , Daniel Cukor , Laura M. Dember , Ardith Z. Doorenbos , Denise Esserman , Manisha Jhamb , Kirsten L. Johansen , Francis J. Keefe , Paul L. Kimmel , Mark B. Lockwood , Rajnish Mehrotra , Benjamin J. Morasco , Sagar Nigwekar , Patrick Pun , Rudy Qamhiyeh , Sahir Kalim","doi":"10.1053/j.ajkd.2025.09.009","DOIUrl":"10.1053/j.ajkd.2025.09.009","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Adults receiving maintenance hemodialysis (HD) frequently report pain, yet detailed descriptions of pain in this population are lacking. This study examines pain locations, characteristics, and associations with other symptoms in adults receiving HD.</div></div><div><h3>Study Design</h3><div>Cross-sectional analysis.</div></div><div><h3>Setting & Participants</h3><div>Adults with moderate to severe chronic pain receiving maintenance HD enrolled in the multicenter HOPE Consortium Trial from 2021 to 2023.</div></div><div><h3>Exposure</h3><div>Sociodemographic, pain treatment, dialysis, medical comorbidity, and psychological and behavioral characteristics. Other patient-reported symptoms.</div></div><div><h3>Outcome</h3><div>Pain interference and severity as assessed by the Brief Pain Inventory (BPI) Interference and Severity subscales (range, 0-10).</div></div><div><h3>Analytical Approach</h3><div>Multivariable regression with least absolute shrinkage and selection operator (LASSO) to examine associations between participant characteristics and pain interference/severity, and Spearman’s correlation to examine relationships between other symptoms and pain interference/severity at baseline.</div></div><div><h3>Results</h3><div>Among 643 participants, the median BPI interference was 6.6 (IQR, 5.1-7.9) and severity was 6.0 (IQR, 4.5-7.5). Among the participants, 84% of participants reported pain >1 year, and 75% had daily pain; 89% and 66% of participants endorsed musculoskeletal and neuropathic pain, respectively. Of 32 body regions, the median number of painful regions was 8 (IQR, 4-14). Common regions in females were lower back (72%), knees (64%), legs (60%), and upper back (59%), and a similar pattern existed for males. In LASSO analyses, cardiovascular disease and depression were associated with significantly higher pain interference whereas White race (reference, Black race) and non-Hispanic ethnicity were associated with significantly lower pain interference. Similar findings were noted for pain severity. Pain catastrophizing and symptoms of fatigue, depression, and anxiety were moderately correlated with pain interference (<em>r</em> > 0.4).</div></div><div><h3>Limitations</h3><div>Neither relationship directionality nor causality can be inferred.</div></div><div><h3>Conclusions</h3><div>Among adults treated with HD who have chronic pain, pain locations were numerous and diverse, with substantial musculoskeletal and neuropathic characteristics. Factors associated with pain interference were predominantly sociodemographic and psychological rather than those related to comorbid diseases and dialysis.</div></div><div><h3>Plain-Language Summary</h3><div>Adults receiving maintenance hemodialysis (HD) frequently experience chronic pain, but it remains poorly understood. We examined pain locations, characteristics, and relationships with other symptoms among 643 adults with moderate to severe chron","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 182-198.e1"},"PeriodicalIF":8.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145516261","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":"Are Mother Glomeruli in Good or Bad Company?","authors":"Georgina Gyarmati","doi":"10.1053/j.ajkd.2025.10.008","DOIUrl":"10.1053/j.ajkd.2025.10.008","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 275-277"},"PeriodicalIF":8.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644985","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":"In Reply to “Low-Flow Home Hemodialysis Technologies: The Key to Greener Dialysis?”","authors":"Katherine A. Barraclough PhD , Ben Talbot PhD , Scott McAlister PhD","doi":"10.1053/j.ajkd.2025.10.010","DOIUrl":"10.1053/j.ajkd.2025.10.010","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 284-285"},"PeriodicalIF":8.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688976","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":"Selecting Antihypertensive Medications for Kidney Transplant Recipients: Flying Blind","authors":"Deepthi Malepati, Paul E. Drawz","doi":"10.1053/j.ajkd.2025.09.016","DOIUrl":"10.1053/j.ajkd.2025.09.016","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 272-274"},"PeriodicalIF":8.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688981","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":"Access to Kidney Transplantation in Adults With Severe Obesity: A Population-Based Retrospective Cohort Study","authors":"Natasha Wiebe , Stephanie Thompson , Ashley Spellman , Ngan N. Lam , Marcello Tonelli","doi":"10.1053/j.ajkd.2025.09.013","DOIUrl":"10.1053/j.ajkd.2025.09.013","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>International guidelines do not consider moderate or severe obesity to be a contraindication to kidney transplantation, but clinical practice suggests otherwise. This study evaluated the likelihood of kidney transplantation in patients with moderate or severe obesity and how that likelihood compared with patients with other risk factors.</div></div><div><h3>Study Design</h3><div>Retrospective population-based cohort study.</div></div><div><h3>Setting & Participants</h3><div>96,181 adults with kidney failure, living in Canada between 2000 and 2021.</div></div><div><h3>Exposure</h3><div>Moderate or severe obesity and other risk factors (eg, age groups, diabetes, heart disease).</div></div><div><h3>Outcome</h3><div>Time to transplantation and time to allograft failure or death.</div></div><div><h3>Analytical Approach</h3><div>Parametric survival modeling, adjusting for all risk factors.</div></div><div><h3>Results</h3><div>Over a median follow-up period of 2.5 years, 58.2% of patients died, and 16.3% were transplanted. Participants with severe (body mass index [BMI] ≥ 40 kg/m<sup>2</sup>) or moderate (BMI 35.0-39.9 kg/m<sup>2</sup>) obesity were less likely to be transplanted than the control participants (BMI 18.5-24.9 kg/m<sup>2</sup>) (HR, 0.43 [95% CI, 0.39-0.47] and HR, 0.76 [95% CI, 0.71-0.82], respectively). Of 39 characteristics/categories considered, only participants aged ≥80 years were less likely to receive a transplant than those with severe obesity. Transplant recipients were followed for a median of 5.4 years. After those aged ≥65 years, participants with severe obesity were the most likely to experience allograft failure or death (HR, 1.70 [95% CI, 1.38-2.02] compared with controls). When we considered combinations of key risk factors, young participants with severe or moderate obesity and few comorbidities were at lower risk for allograft failure or death than participants with other common clinical characteristics.</div></div><div><h3>Limitations</h3><div>Residual confounding.</div></div><div><h3>Conclusions</h3><div>Canadian dialysis patients with moderate or severe obesity had a markedly reduced likelihood of receiving a kidney transplant. Although patients with moderate or severe obesity also had a heightened risk of allograft failure or death, the magnitude of the latter was similar to the excess risk associated with other common clinical characteristics. These findings support current practice guidelines and suggest that further work should identify and remove barriers to accessing kidney transplantation among patients with obesity.</div></div><div><h3>Plain-Language Summary</h3><div>International guidelines do not consider moderate or severe obesity (body mass index ≥35 and ≥40 kg/m<sup>2</sup>, respectively) to be a contraindication to kidney transplantation, but clinical practice suggests otherwise. Canadian dialysis patients with moderate or severe obesity had a reduced likel","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 199-210"},"PeriodicalIF":8.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145516264","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":"Thrombotic Microangiopathy During Pregnancy: Role of Soluble Fms-like Tyrosine Kinase-1–Placental Growth Factor Ratios","authors":"Daan P.C. van Doorn ,&nbsp;Salwan Al-Nasiry ,&nbsp;Marc E.A. Spaanderman ,&nbsp;Jan G.M.C. Damoiseaux ,&nbsp;Pieter van Paassen ,&nbsp;Sjoerd A.M.E.G. Timmermans","doi":"10.1053/j.ajkd.2025.09.017","DOIUrl":"10.1053/j.ajkd.2025.09.017","url":null,"abstract":"<div><div>Thrombotic microangiopathies (TMAs) are severe endotheliopathies that can arise in pregnancy and require early recognition. Complement-mediated (C-)TMA should be differentiated from other endotheliopathies of pregnancy because the treatment differs. Here, we report a case of a pregnant woman with acute kidney injury requiring hemodialysis due to C-TMA on the background of a pathogenic <em>C3</em> variant at 28+5 weeks of gestation. The low soluble Fms-like tyrosine kinase-1 to placental growth factor (sFlt1/PlGF) ratio excluded pre-eclampsia. Eculizumab was started, and therapeutic drug monitoring was applied for optimal dosing. Despite prolonged hemodialysis, fetal well-being was preserved, and delivery was safely postponed till 34+3 weeks of gestation, resulting in a healthy neonate. We also separately report on sFlt1/PlGF ratios measured in a cohort of 11 patients with TMA and coexisting pregnancy. Ten of 11 patients (91%) had low sFlt1/PlGF ratios, excluding pre-eclampsia. Thus, successful pregnancy in women with C-TMA can occur, and sFlt1/PlGF ratios may aid in clarifying the diagnosis and appropriate treatment.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 278-283"},"PeriodicalIF":8.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688975","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":"Environmental Impacts of Kidney Replacement Therapies: A Comparative Lifecycle Assessment","authors":"Saba Saleem ,&nbsp;Caroline Stigant ,&nbsp;Tasleem Rajan ,&nbsp;Kasun Hewage ,&nbsp;Rehan Sadiq ,&nbsp;Andrea J. MacNeill ,&nbsp;Christopher Nguan","doi":"10.1053/j.ajkd.2025.08.010","DOIUrl":"10.1053/j.ajkd.2025.08.010","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Health care delivery is associated with considerable emissions of greenhouse gases and other pollutants. Although the relative health and economic impacts of kidney replacement therapies (KRTs) have been examined, their comparative environmental impacts have been poorly described. This study sought to characterize these impacts, comparing them across types of KRT.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;A comparative lifecycle assessment (LCA).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Data collection implemented at Vancouver General Hospital in Vancouver, British Columbia, Canada.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;Three KRTs: deceased-donor kidney transplant (KT), automated/cycler peritoneal dialysis (PD), or in-center hemodialysis (HD).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome&lt;/h3&gt;&lt;div&gt;Environmental impacts of KRTs over 1 year were evaluated using the World ReCiPe (H) 2016 method.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Lifecycle inventory results were transformed into 3 end-point and 18 midpoint environmental impact categories including climate change, air pollution, human toxicity, and water depletion.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Across the majority of environmental impact categories, including climate change, air pollution, human toxicity, and water depletion, HD had the highest environmental impact and KT the lowest. The climate impact from a patient receiving HD was 74% and 46% more than from patients receiving KT and PD, respectively. Similarly, HD accounted for 65% of total air pollution impacts, 54% of human toxicity, and 44% of water depletion. The highest impact of PD was on water depletion (41%) and metal depletion (81%). KT demonstrated the lowest impact across all categories except terrestrial ecotoxicity. Within each therapy, patient and staff travel and consumables were the largest contributors to greenhouse gas emissions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Pharmaceuticals were excluded from this study because of a lack of publicly available data.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;KT is the most environmentally preferred KRT. PD had fewer environmental impacts than HD. Understanding the relative environmental impacts of KRTs can help inform clinical decision-making in the management of kidney failure.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;The environmental impacts of health care are gaining attention, yet kidney care, and especially kidney replacement therapies (KRTs), have been underexamined. This study was inspired by growing concerns about the environmental consequences of KRTs like hemodialysis, peritoneal dialysis, and transplantation. We used environmental assessment tools to measure emissions and resource use across different KRTs in a clinical setting in Vancouver, Canada. We found that these therapies vary widely in their environmental impacts, with in-center hemodialysis having the greatest negative impact and kidney transpla","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 65-74.e1"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261606","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":"In Reply to “Kidney Cysts in Alport Syndrome: Illustrative Cases, but Misleading Conclusions”","authors":"Thomas Bais MD ,&nbsp;Martijn J. de Groot MD, PhD ,&nbsp;Esther Meijer MD, PhD","doi":"10.1053/j.ajkd.2025.09.007","DOIUrl":"10.1053/j.ajkd.2025.09.007","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Page 135"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145462016","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 in a Patient With Nephritic Syndrome: A Quiz","authors":"Telma Pais ,&nbsp;José Oliveira da Costa ,&nbsp;Mafalda Pinho ,&nbsp;Dolores López-Presa ,&nbsp;Sofia Jorge ,&nbsp;José António Lopes ,&nbsp;Joana Gameiro","doi":"10.1053/j.ajkd.2025.09.006","DOIUrl":"10.1053/j.ajkd.2025.09.006","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages A21-A24"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765755","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}