American Journal of Kidney Diseases最新文献

{"title":"Long-Term Exposure to Uranium and Arsenic in Community Drinking Water and CKD Risk Among California Women","authors":"Danielle N. Medgyesi , Sumit Mohan , Komal Bangia , Emma S. Spielfogel , Maya Spaur , Anirban Basu , Jared A. Fisher , Jessica M. Madrigal , Arce Domingo-Relloso , Rena R. Jones , Mary H. Ward , James V. Lacey Jr. , Tiffany R. Sanchez , California Teachers Study Investigators","doi":"10.1053/j.ajkd.2025.04.008","DOIUrl":"10.1053/j.ajkd.2025.04.008","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Metals/metalloids in drinking water, including uranium and arsenic, may damage kidney function and increase chronic kidney disease (CKD) risk. We evaluated exposure to these contaminants in community water supplies (CWS) and CKD risk in the California Teachers Study.</div></div><div><h3>Study Design</h3><div>Prospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>88,185 women who were California teachers and school administrators enrolled 1995-1996.</div></div><div><h3>Exposure</h3><div>Time- and residence-weighted annual average uranium and arsenic concentrations from CWS serving participants’ residential addresses from 1995 to 2005.</div></div><div><h3>Outcome</h3><div>6,185 moderate to end-stage CKD cases from hospitalization records between 2005 and 2018.</div></div><div><h3>Analytical Approach</h3><div>Hazard ratios and 95% confidence intervals calculated using mixed-effects Cox models, adjusted for age as the time scale, body mass index, smoking status, race and ethnicity, neighborhood socioeconomic status, and census region as a random effect. Analyses were also stratified by risk factors and comorbidities.</div></div><div><h3>Results</h3><div>Most exposures in this population were below the current regulatory limits (uranium: 30<!--> <!-->μg/L; arsenic: 10<!--> <!-->μg/L), with median concentrations of 3.1<!--> <!-->μg/L (IQR, 0.9-5.6<!--> <!-->μg/L) for uranium and 1.0<!--> <!-->μg/L (IQR, 0.6-1.8<!--> <!-->μg/L) for arsenic. Uranium exposure was positively associated with CKD risk (continuous log, per IQR; HR, 1.11 [95% CI, 1.02-1.20]). Compared with uranium exposure<!--> <!--><<!--> <!-->2<!--> <!-->μg/L (World Health Organization 1998 guideline), the risk was over 30% greater at 10 to<!--> <!--><15<!--> <!-->μg/L (HR, 1.33 [95% CI, 1.15-1.54]) and similar at<!--> <!-->≥15<!--> <!-->μg/L (HR, 1.32 [95% CI, 1.09-1.58]). There was no evidence of a significant association between arsenic and CKD overall (log, per IQR; HR, 1.02 [95% CI, 0.98-1.07]). However, the risk from arsenic was greater among younger individuals (≤55 years) and those who developed cardiovascular disease or diabetes.</div></div><div><h3>Limitations</h3><div>Individual tap water use and consumption; limited generalizability to men and non-White and less affluent populations.</div></div><div><h3>Conclusions</h3><div>Uranium below the current regulatory limit from community water may increase CKD risk.</div></div><div><h3>Plain-Language Summary</h3><div>Metals, including uranium and arsenic, can damage kidney function and may increase chronic kidney disease (CKD) risk. These contaminants are often present in groundwater and are regulated in US community water supplies. In a cohort of California women, we examined long-term uranium and arsenic exposure from households using community water. Higher uranium concentrations were associated with CKD. Those exposed to 10-15<!--> <!-->μg/L (or one-third t","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 2","pages":"Pages 222-235.e1"},"PeriodicalIF":9.4,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087503","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":"Volume 1: Chronic Kidney Disease","authors":"","doi":"10.1053/j.ajkd.2025.04.002","DOIUrl":"10.1053/j.ajkd.2025.04.002","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 6","pages":"Pages S1-S187"},"PeriodicalIF":9.4,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143946694","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":"Support Page","authors":"","doi":"10.1053/S0272-6386(25)00830-3","DOIUrl":"10.1053/S0272-6386(25)00830-3","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 6","pages":"Page A5"},"PeriodicalIF":9.4,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143946610","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":"US Renal Data System 2024 Annual Data Report: Epidemiology of Kidney Disease in the United States","authors":"Kirsten L. Johansen , David T. Gilbertson , Shuling Li , Suying Li , Jiannong Liu , Nicholas S. Roetker , Allyson Hart , Christopher D. Knapp , Elaine Ku , Neil R. Powe , Jon Snyder , Wendy St. Peter , Eric D. Weinhandl , James B. Wetmore","doi":"10.1053/j.ajkd.2025.02.602","DOIUrl":"10.1053/j.ajkd.2025.02.602","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 6","pages":"Pages A8-A11"},"PeriodicalIF":9.4,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143946693","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":"Volume 2: End Stage Renal Disease","authors":"","doi":"10.1053/j.ajkd.2025.04.003","DOIUrl":"10.1053/j.ajkd.2025.04.003","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 6","pages":"Pages S188-S565"},"PeriodicalIF":9.4,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143946695","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":"Complex Etiologies of the Discordance Between Cystatin C– and Creatinine-Based Estimated GFR and Its Adverse Associations: Findings From the CRIC Study","authors":"Ian E. McCoy , Jingrong Yang , Alan S. Go , Hernan Rincon-Choles , Jonathan Taliercio , Sylvia E. Rosas , Mark Unruh , Vallabh Shah , Debbie L. Cohen , Jiang He , Jing Chen , James Sondheimer , Afshin Parsa , Wei Yang , Panduranga S. Rao , Chi-yuan Hsu","doi":"10.1053/j.ajkd.2025.03.018","DOIUrl":"10.1053/j.ajkd.2025.03.018","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>The difference between glomerular filtration rate (GFR) estimated by cystatin C and creatinine (eGFR<sub>diff</sub>, defined as eGFR<sub>cys</sub> <!-->−<!--> <!-->eGFR<sub>cr</sub>) has been repeatedly associated with adverse outcomes, often ascribed to low muscle mass. However, it is unclear to what extent putative determinants of eGFR<sub>diff</sub>, such as low muscle mass, explain associations between eGFR<sub>diff</sub> and the outcomes of death and heart failure. Determinants of eGFR<sub>diff</sub> have not been investigated to assess their impacts on eGFR<sub>cys</sub>, eGFR<sub>cr</sub>, and ultimately eGFR<sub>diff</sub> in a dataset with measured GFR.</div></div><div><h3>Study Design</h3><div>Prospective cohort study for outcomes of eGFR<sub>diff</sub> and cross-sectional study for determinants of eGFR<sub>diff</sub>.</div></div><div><h3>Setting & Participants</h3><div>1,290 adult participants in the Chronic Renal Insufficiency Cohort (CRIC) Study with directly measured iothalamate GFR, 24-hour urine creatinine collections, and plasma measurements of larger molecules such as β<sub>2</sub>-microglobulin.</div></div><div><h3>Exposure</h3><div>Baseline eGFR<sub>diff</sub> (eGFR<sub>cys</sub> <!-->−<!--> <!-->eGFR<sub>cr</sub>) for prospective analysis; putative eGFR<sub>diff</sub> determinants for cross-sectional analyses.</div></div><div><h3>Outcome</h3><div>Time to all-cause death, heart failure hospitalization for prospective analyses, and eGFR for cross-sectional analyses.</div></div><div><h3>Analytical Approach</h3><div>Cox proportional hazards regression for prospective analysis and linear regression for cross-sectional analyses.</div></div><div><h3>Results</h3><div>Among adults with CKD, a more positive eGFR<sub>diff</sub> was associated with decreased risk of death (adjusted HR, 0.80 [95% CI, 0.74-0.88]) and heart failure hospitalization (adjusted HR 0.83 [95% CI, 0.73-94]). Neither association was substantially changed by adjustment for putative determinants of eGFR<sub>diff</sub>. Estimated GFR<sub>diff</sub> was weakly correlated with markers of muscle mass, middle molecule clearance, and other putative determinants of eGFR<sub>diff</sub> (eg, obesity, inflammation). Only 36% of the variance in eGFR<sub>diff</sub> was explained by these factors.</div></div><div><h3>Limitations</h3><div>Imprecision in measurements such as 24-hour urine collections.</div></div><div><h3>Conclusions</h3><div>The associations of eGFR<sub>diff</sub> with adverse outcomes were unchanged by adjustment for markers of putative determinants such as muscle mass. Examined putative determinants of eGFR<sub>diff</sub> accounted for a minority of the variance in eGFR<sub>diff</sub>.</div></div><div><h3>Plain-Language Summary</h3><div>The difference between estimated glomerular filtration rates (eGFR<sub>diff</sub>) using serum creatinine and cystatin C (eGFR<sub>cys</sub> <!-->−<!--> <!-->eGFR<sub>cr</sub>) has b","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 2","pages":"Pages 192-201"},"PeriodicalIF":9.4,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075356","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":"Fenofibrate-Induced Osmotic Nephropathy: A Novel Mechanism of Acute Kidney Injury","authors":"Raymond Lin ,&nbsp;Seethalakshmi Viswanathan ,&nbsp;Nikki L. Wong","doi":"10.1053/j.ajkd.2025.03.019","DOIUrl":"10.1053/j.ajkd.2025.03.019","url":null,"abstract":"<div><div><span><span><span>Fibrates<span> are a commonly used medication in the management of dyslipidemia and cardiovascular risk. These agents have a well-documented association with reversible elevations in serum creatinine and in some instances </span></span>acute kidney injury<span><span>. The mechanism underlying the renal effects of fibrates are currently not well understood. We describe a case of acute kidney injury<span> in a patient who was administered an unadjusted dose of fenofibrate in the setting of </span></span>severe renal impairment<span><span>. Kidney biopsy demonstrated extensive isometric </span>vacuolization<span> within tubular epithelial cells consistent with osmotic-type injury. Fenofibrate in this case was the likely causative agent based on the temporal relationship of drug administration and acute kidney injury. The acute kidney injury also recovered over a timeframe consistent with the known half-life of the </span></span></span></span>drug metabolite. There were no other drugs, extreme instances of </span>hyperglycemia<span>, or intravenous (IV) agents administered to account for the biopsy findings. This case demonstrates a potential novel mechanism of fenofibrate-associated acute kidney injury with osmotic nephropathy<span>. We review the current understanding of the effects of fenofibrate on the kidney and possible pathogenesis of osmotic nephropathy.</span></span></div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 3","pages":"Pages 404-407"},"PeriodicalIF":8.2,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982535","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":"Finding Barriers for the Implementation of Advanced Care Planning in Patients Receiving Dialysis","authors":"Marie Evans ,&nbsp;Jenny Lindberg ,&nbsp;Johan Sundelöf","doi":"10.1053/j.ajkd.2025.03.013","DOIUrl":"10.1053/j.ajkd.2025.03.013","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 6","pages":"Pages 671-673"},"PeriodicalIF":9.4,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143893286","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":"Comparative Effectiveness of Glucagon-Like Peptide-1 Receptor Agonists and Sodium/Glucose Cotransporter 2 Inhibitors in Preventing Chronic Kidney Failure and Mortality in Patients With Type 2 Diabetes and CKD","authors":"Yen-Chieh Lee ,&nbsp;Li-Chiu Wu ,&nbsp;Vin-Cent Wu ,&nbsp;Chia-Hsuin Chang","doi":"10.1053/j.ajkd.2025.03.016","DOIUrl":"10.1053/j.ajkd.2025.03.016","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium/glucose cotransporter 2 (SGLT2) inhibitors improve cardiovascular, kidney, and survival outcomes in patients with type 2 diabetes; however, the comparative effectiveness of these drugs in a real-world setting remains unclear.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Retrospective cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;&lt;span&gt;79,047 patients with type 2 diabetes and an estimated glomerular filtration rate&lt;/span&gt; &lt;!--&gt;&lt;60&lt;!--&gt; &lt;!--&gt;mL/min/1.73&lt;!--&gt; &lt;!--&gt;m&lt;sup&gt;2&lt;/sup&gt; in the Taiwan National Health Insurance Research Database between 2016 and 2021.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;Treatment with GLP-1RAs or SGLT2 inhibitors.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome&lt;/h3&gt;&lt;div&gt;Initiation of kidney replacement therapy (KRT) and all-cause mortality.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytic Approach&lt;/h3&gt;&lt;div&gt;Propensity score matching&lt;span&gt; was performed to balance baseline characteristics between the groups. Cox proportional hazards models were used to estimate HRs and 95% CIs for each outcome using an intention-to-treat approach.&lt;/span&gt;&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;14,182 (7,091 initiating GLP-1RAs and 7,091 initiating SGLT2 inhibitors) individuals among the original cohort of 79,047 were included in the propensity score–matched analysis. With a median follow-up duration of 2.5 years, people initiating GLP-1RAs had a higher risk of requiring KRT than those initiating SGLT2 inhibitors (HR, 1.39; 95% CI, 1.19-1.63). Although tests of interaction did not have statistically significant findings, stratified analyses suggested possibly greater differences between the 2 drugs among patients with an estimated glomerular filtration rate&lt;!--&gt; &lt;!--&gt;&lt;45&lt;!--&gt; &lt;!--&gt;mL/min/1.73&lt;!--&gt; &lt;!--&gt;m&lt;sup&gt;2&lt;/sup&gt; or a urine albumin-creatinine ratio&lt;!--&gt; &lt;!--&gt;&gt;300&lt;!--&gt; &lt;!--&gt;mg/g. Overall mortality did not differ between treatment groups.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Nonrandomized treatment selection.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Patients receiving SGLT2 inhibitors exhibited lower rates of progression to KRT than those receiving GLP-1RAs. These findings may inform the choice of these therapies in the setting of chronic kidney disease and type 2 diabetes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;&lt;span&gt;Chronic kidney disease is a major complication of type 2 diabetes that often leads to kidney failure and increased mortality. This study aimed to compare the effectiveness of 2 drug classes, glucagon-like peptide-1 receptor agonists and sodium/glucose cotransporter 2 inhibitors, in preventing kidney failure and death in patients with type 2 diabetes and &lt;/span&gt;chronic kidney disease. Using a nationwide health database in Taiwan, we applied rigorous statistical methods to balance differences between treatment groups and analyze outcomes. Our findings demonstrated that sodium/glucose cotransporter 2 inhibitors might be mo","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 3","pages":"Pages 301-313.e1"},"PeriodicalIF":8.2,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143901638","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 Delivery of Kidney Care in Rural or Sparsely Populated Settings","authors":"Sireesha Koppula ,&nbsp;Krishna Patel ,&nbsp;Mark Unruh","doi":"10.1053/j.ajkd.2025.03.017","DOIUrl":"10.1053/j.ajkd.2025.03.017","url":null,"abstract":"<div><div>Social determinants of health and limited access to medical care contribute to underdiagnosis and late presentation of chronic kidney disease (CKD). Rural areas face unique challenges in providing optimal care for patients with CKD due to poverty, limited health care access, and geographical barriers. This review addresses the challenges of caring for rural patients with CKD and discuss potential strategies to increase health care equity. Furthermore, we examine rural disparities in patients with CKD, patients with kidney failure on in-center or home dialysis, and patients with kidney transplants, highlighting the need for targeted interventions to address these disparities. Addressing the challenges faced by rural patients with CKD requires a multifaceted approach, including improving access to health care services, implementing telemedicine and telemonitoring technologies, enhancing the knowledge of primary care physicians around CKD, improving care coordination, and increasing preventive measures. We must create a kidney health model combining early detection, prevention, and disease surveillance to decrease disease progression. Health care policies should also incentivize and support the expansion of the rural health care workforce. Targeted interventions aimed at reducing rural disparities for patients with CKD and those using in-center hemodialysis, home dialysis, or transplantation are crucial to ensure equitable care.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 4","pages":"Pages 543-549"},"PeriodicalIF":8.2,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143902938","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}