American Journal of Kidney Diseases最新文献

{"title":"Association of Race and Ethnicity With High Longevity Deceased Donor Kidney Transplantation Under the US Kidney Allocation System.","authors":"Nour W Asfour, Kevin C Zhang, Jessica Lu, Peter P Reese, Milda Saunders, Monica Peek, Molly White, Govind Persad, William F Parker","doi":"10.1053/j.ajkd.2024.02.017","DOIUrl":"10.1053/j.ajkd.2024.02.017","url":null,"abstract":"<p><strong>Rationale & objective: </strong>The US Kidney Allocation System (KAS) prioritizes candidates with a≤20% estimated posttransplant survival (EPTS) to receive high-longevity kidneys defined by a≤20% Kidney Donor Profile Index (KDPI). Use of EPTS in the KAS deprioritizes candidates with older age, diabetes, and longer dialysis durations. We assessed whether this use also disadvantages race and ethnicity minority candidates, who are younger but more likely to have diabetes and longer durations of kidney failure requiring dialysis.</p><p><strong>Study design: </strong>Observational cohort study.</p><p><strong>Setting & participants: </strong>Adult candidates for and recipients of kidney transplantation represented in the Scientific Registry of Transplant Recipients from January 2015 through December 2020.</p><p><strong>Exposure: </strong>Race and ethnicity.</p><p><strong>Outcome: </strong>Age-adjusted assignment to≤20% EPTS, transplantation of a≤20% KDPI kidney, and posttransplant survival in longevity-matched recipients by race and ethnicity.</p><p><strong>Analytic approach: </strong>Multivariable logistic regression, Fine-Gray competing risks survival analysis, and Kaplan-Meier and Cox proportional hazards methods.</p><p><strong>Results: </strong>The cohort included 199,444 candidates (7% Asian, 29% Black, 19% Hispanic or Latino, and 43% White) listed for deceased donor kidney transplantation. Non-White candidates had significantly higher rates of diabetes, longer dialysis duration, and were younger than White candidates. Adjusted for age, Asian, Black, and Hispanic or Latino candidates had significantly lower odds of having a ETPS score of≤20% (odds ratio, 0.86 [95% CI, 0.81-0.91], 0.52 [95% CI, 0.50-0.54], and 0.49 [95% CI, 0.47-0.51]), and were less likely to receive a≤20% KDPI kidney (sub-hazard ratio, 0.70 [0.66-0.75], 0.89 [0.87-0.92], and 0.73 [0.71-0.76]) compared with White candidates. Among recipients with≤20% EPTS scores transplanted with a≤20% KDPI deceased donor kidney, Asian and Hispanic recipients had lower posttransplant mortality (HR, 0.45 [0.27-0.77] and 0.63 [0.47-0.86], respectively) and Black recipients had higher but not statistically significant posttransplant mortality (HR, 1.22 [0.99-1.52]) compared with White recipients.</p><p><strong>Limitations: </strong>Provider reported race and ethnicity data and 5-year post transplant follow-up period.</p><p><strong>Conclusions: </strong>The US kidney allocation system is less likely to identify race and ethnicity minority candidates as having a≤20% EPTS score, which triggers allocation of high-longevity deceased donor kidneys. These findings should inform the Organ Procurement and Transplant Network about how to remedy the race and ethnicity disparities introduced through KAS's current approach of allocating allografts with longer predicted longevity to recipients with longer estimated posttransplant survival.</p><p><strong>Plain-language summary: </strong>The US Kidney All","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140846888","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":"Difference Between Estimated GFR Based on Cystatin C Versus Creatinine and Incident Atrial Fibrillation: A New Instrument on the Horizon to Improve Risk Assessment in This High-Risk Population?","authors":"Veronica T. Costa e Silva ,&nbsp;Ogechi M. Adingwupu ,&nbsp;Lesley A. Inker","doi":"10.1053/j.ajkd.2024.03.009","DOIUrl":"10.1053/j.ajkd.2024.03.009","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":13.2,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0272638624006863/pdfft?md5=0630d224addac1dd1bd2aafa8a2d1e94&pid=1-s2.0-S0272638624006863-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140848282","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":"Erythrocytosis and CKD: A Review.","authors":"Mabel Aoun, Michel Jadoul, Hans-Joachim Anders","doi":"10.1053/j.ajkd.2024.02.015","DOIUrl":"10.1053/j.ajkd.2024.02.015","url":null,"abstract":"<p><p>Erythrocytosis or polycythemia is defined as an increase in red blood cell concentration above the age- and sex-specific normal levels. Unlike anemia, which is very common in patients with chronic kidney disease (CKD), erythrocytosis is less frequent but requires specific understanding by health care professionals in order to provide the best care. Erythrocytosis, especially when undiagnosed and untreated, can lead to serious thrombotic events and higher mortality. Classic causes of erythrocytosis associated with CKD include cystic kidney diseases, kidney or other erythropoietin-secreting neoplasms, high-altitude renal syndrome, overdosage of erythropoietin-stimulating agents, androgen therapy, heavy smoking, chronic lung disease, obstructive sleep apnea, IgA nephropathy, post-kidney transplant erythrocytosis, renal artery stenosis, and congenital etiologies. After ruling out the common acquired causes of erythrocytosis and/or in the presence of suggestive parameters, primary erythrocytosis or polycythemia vera (PV) should be considered, and patients should be screened for JAK2V617F somatic mutation. The newest entity inducing erythrocytosis is linked to the use of sodium/glucose cotransporter 2 (SGLT2) inhibitors that hypothetically activate hypoxia-inducible factor 2α (HIF-2α) and in some cases unmask PV. This Review focuses on the pathogenesis, renal manifestations and management of PV, the pathophysiology of erythrocytosis induced by SGLT2 inhibitors and the relevance of timely JAK2 mutation screening in these patients.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":13.2,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140847337","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 Energetics and Cyst Burden in Autosomal Dominant Polycystic Kidney Disease: A Pilot Study","authors":"","doi":"10.1053/j.ajkd.2024.02.016","DOIUrl":"10.1053/j.ajkd.2024.02.016","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><p>In this pilot study, we hypothesized that autosomal dominant polycystic kidney disease (ADPKD) is characterized by impaired kidney oxidative metabolism that associates with kidney size and cyst burden.</p></div><div><h3>Study Design</h3><p>Cross-sectional study.</p></div><div><h3>Setting &amp; Participants</h3><p>Twenty adults with ADPKD (age, 31<!--> <!-->±<!--> <span>6 years; 65% women; body mass index [BMI], 26.8 [22.7-30.4] kg/m</span>²<span>; estimated glomerular filtration rate [eGFR, 2021 CKD-EPI creatinine], 103</span> <!-->±<!--> <!-->18<!--> <!-->mL/min/1.73<!--> <!-->m²; height-adjusted total kidney volume [HTKV], 731<!--> <!-->±<!--> <!-->370<!--> <!-->mL/m; Mayo classifications 1B [5%], 1C [42%], 1D [21%], and 1E [32%]) and 11 controls in normal weight category (NWC) (age, 25<!--> <!-->±<!--> <!-->3 years; 45% women; BMI, 22.5 [21.7-24.2] kg/m2; eGFR, 113<!--> <!-->±<!--> <!-->15<!--> <!-->mL/min/1.73<!--> <!-->m²; HTKV, 159<!--> <!-->±<!--> <!-->31<!--> <!-->mL/m) at the University of Colorado Anschutz Medical Campus.</p></div><div><h3>Predictors</h3><p>ADPKD status (yes/no) and severity (Mayo classifications).</p></div><div><h3>Outcome</h3><p>HTKV and cyst burden by magnetic resonance imaging, kidney oxidative metabolism, and perfusion by ¹¹<span>C-acetate positron emission tomography/computed tomography, insulin sensitivity by hyperinsulinemic-euglycemic clamps (presented as ratio of M-value of steady state insulin concentration [M/I]).</span></p></div><div><h3>Analytical Approach</h3><p>For categorical variables, χ²/Fisher’s exact tests, and for continuous variables <em>t</em> tests/Mann-Whitney <em>U</em> tests. Pearson correlation was used to estimate the relationships between variables.</p></div><div><h3>Results</h3><p>Compared with NWC individuals, the participants with ADPKD exhibited lower mean<!--> <!-->±<!--> <!-->SD M/I ratio (0.586<!--> <!-->±<!--> <!-->0.205 vs 0.424<!--> <!-->±<!--> <!-->0.171 [mg/kg lean/min]/(μIU/mL), <em>P</em> <em>=</em> <!-->0.04), lower median cortical perfusion (1.93 [IQR, 1.80-2.09] vs 0.68 [IQR, 0.47-1.04] mL/min/g, <em>P</em> <!-->&lt;<!--> <!-->0.001) and lower median total kidney oxidative metabolism (0.17 [IQR, 0.16-0.19] vs. 0.14 [IQR, 0.12-0.15] min⁻¹, <em>P</em> <!-->=<!--> <!-->0.001) in voxel-wise models excluding cysts. HTKV correlated inversely with cortical perfusion (<em>r</em>: −0.83, <em>P</em> &lt; 0.001), total kidney oxidative metabolism (<em>r</em>: −0.61, <em>P</em> <!-->&lt;<!--> <!-->0.001) and M/I (<em>r</em>: −0.41, <em>P</em> = 0.03).</p></div><div><h3>Limitations</h3><p>Small sample size and cross-sectional design.</p></div><div><h3>Conclusions</h3><p>Adults with ADPKD and preserved kidney function exhibited impaired renal perfusion<span> and kidney oxidative metabolism across a wide range of cysts and kidney enlargements.</span></p></div><div><h3>Funding</h3><","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140848872","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":"Reducing Infections in Outpatient Hemodialysis: The Impact of Human Factors","authors":"Jeffrey I. Silberzweig","doi":"10.1053/j.ajkd.2024.02.002","DOIUrl":"10.1053/j.ajkd.2024.02.002","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":13.2,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S027263862400667X/pdfft?md5=956b1cd40ccf3a3d2202df488958cc39&pid=1-s2.0-S027263862400667X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140854524","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":"The Impact of Kidney Transplantation on a Breadth of Cognitive Measures","authors":"Nidhi Ghildayal ,&nbsp;Dorry L. Segev ,&nbsp;Mara McAdams-DeMarco","doi":"10.1053/j.ajkd.2024.03.008","DOIUrl":"10.1053/j.ajkd.2024.03.008","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":13.2,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0272638624006826/pdfft?md5=f5ce772e7a511e805a7e685e0a065973&pid=1-s2.0-S0272638624006826-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140859566","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":"Unraveling Barriers in Access to Living Donor Kidney Transplantation for South Asian Canadian Populations","authors":"Amy D. Waterman,&nbsp;LaShara A. Davis,&nbsp;Solaf Al Awadhi","doi":"10.1053/j.ajkd.2024.01.519","DOIUrl":"10.1053/j.ajkd.2024.01.519","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":13.2,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0272638624006280/pdfft?md5=1e6fa57f5836a6f7102d8f955f6b8646&pid=1-s2.0-S0272638624006280-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140854525","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":"Visceral Adiposity and Progression of ADPKD: A Cohort Study of Patients From the TEMPO 3:4 Trial","authors":"","doi":"10.1053/j.ajkd.2024.02.014","DOIUrl":"10.1053/j.ajkd.2024.02.014","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><p>Body mass index<span> (BMI) is an independent predictor of kidney disease progression<span> in individuals with autosomal dominant polycystic kidney<span> disease (ADPKD). Adipocytes do not simply act as a fat reservoir but are active endocrine organs. We hypothesized that greater visceral abdominal adiposity<span> would associate with more rapid kidney growth<span> in ADPKD and influence the efficacy of tolvaptan.</span></span></span></span></span></p></div><div><h3>Study Design</h3><p>A retrospective cohort study.</p></div><div><h3>Setting &amp; Participants</h3><p>1,053 patients enrolled in the TEMPO 3:4 tolvaptan<span> trial with ADPKD and at high risk of rapid disease progression.</span></p></div><div><h3>Predictor</h3><p>Estimates of visceral adiposity extracted from coronal plane magnetic resonance imaging (MRI) scans using deep learning.</p></div><div><h3>Outcome</h3><p><span>Annual change in total kidney volume (TKV) and effect of tolvaptan on </span>kidney growth.</p></div><div><h3>Analytical Approach</h3><p>Multinomial logistic regression and linear mixed models.</p></div><div><h3>Results</h3><p>In fully adjusted models, the highest tertile of visceral adiposity was associated with greater odds of annual change in TKV of<!--> <!-->≥7% versus<!--> <!-->&lt;5% (odds ratio [OR], 4.78 [95% CI, 3.03-7.47]). The association was stronger in women than men (interaction <em>P</em> <!-->&lt;<!--> <span>0.01). In linear mixed models with an outcome of percent change in TKV per year, tolvaptan efficacy (% change in TKV) was reduced with higher visceral adiposity (3-way interaction of treatment ∗ time ∗ visceral adiposity, </span><em>P</em> <!-->=<!--> <!-->0.002). Visceral adiposity significantly improved classification performance of predicting rapid annual percent change in TKV for individuals with a normal BMI (DeLong’s test <em>z</em> score: −2.03; <em>P</em> <!-->=<!--> <span>0.04). Greater visceral adiposity was not associated with estimated glomerular filtration rate (eGFR) slope in the overall cohort; however, visceral adiposity was associated with more rapid decline in eGFR slope (below the median) in women (fully adjusted OR, 1.06 [95% CI, 1.01-1.11] per 10 unit increase in visceral adiposity) but not men (OR, 0.98 [95% CI, 0.95-1.02]).</span></p></div><div><h3>Limitations</h3><p>Retrospective; rapid progressors; computational demand of deep learning.</p></div><div><h3>Conclusions</h3><p>Visceral adiposity that can be quantified by MRI in the coronal plane using a deep learning segmentation model independently associates with more rapid kidney growth and improves classification of rapid progression in individuals with a normal BMI. Tolvaptan efficacy decreases with increasing visceral adiposity.</p></div><div><h3>Plain-Language Summary</h3><p><span>We analyzed images from a previous study with the drug tolvaptan conducted in patients with autosomal dominant polycystic kidney disease (ADPKD) to me","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140859567","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 “‘Atypical’ Anti-GBM Disease: Just Atypical, or Not Anti-GBM Disease at All?”","authors":"Bertrand Chauveau MD ,&nbsp;Jean-Baptiste Gibier MD, PhD ,&nbsp;Marion Rabant MD, PhD","doi":"10.1053/j.ajkd.2024.03.011","DOIUrl":"10.1053/j.ajkd.2024.03.011","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":13.2,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0272638624006954/pdfft?md5=6e6e06a919bf301d497ddb90e449cce3&pid=1-s2.0-S0272638624006954-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140642114","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":"“Atypical” Anti-GBM Disease: Just Atypical, or Not Anti-GBM Disease at All?","authors":"Vanja Ivković MD, PhD ,&nbsp;Andreas Kronbichler MD, PhD ,&nbsp;Tiffany N. Caza MD, PhD","doi":"10.1053/j.ajkd.2024.02.011","DOIUrl":"10.1053/j.ajkd.2024.02.011","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":13.2,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0272638624006942/pdfft?md5=25dda9cf292245b51857681cbe50378b&pid=1-s2.0-S0272638624006942-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140819570","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}