American Journal of Kidney Diseases最新文献

{"title":"Patient and Center Factors in Home Dialysis Therapy Uptake: Analysis of a UK Renal Registry Cohort and a National Dialysis Center Survey.","authors":"Jessica Potts,Camille M Pearse,Mark Lambie,James Fotheringham,Harry Hill,David Coyle,Sarah Damery,Kerry Allen,Iestyn Williams,Simon J Davies,Ivonne Solis-Trapala","doi":"10.1053/j.ajkd.2025.08.012","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.08.012","url":null,"abstract":"RATIONALE & OBJECTIVEVariation in home dialysis therapy (HT) use across centers and geography may reflect the interplay between dialysis center services and patient characteristics. We examined direct and indirect associations between these factors and HT uptake in England.STUDY DESIGNUK Renal Registry (UKRR) cohort linked to a national survey of renal centers.SETTING & PARTICIPANTSAdults who initiated kidney replacement therapy (KRT) between 2015 and 2019 at 51 English renal centers, totalling 32,400 individuals identified through the UKRR, with center practices captured from a 2022 national survey of dialysis centers.EXPOSURESPatient- (demographics and clinical characteristics) and center-level (including availability of assisted peritoneal dialysis, quality improvement initiatives, and fostering staff engagement in research) factors.OUTCOMESUse of HT (home haemodialysis or peritoneal dialysis) within one year of starting KRT.ANALYTICAL APPROACHSequences of regressions, an extension of path analysis, used to examine direct and indirect associations between patient- and center-level factors and the probability of HT uptake.RESULTSBoth center- and patient-level factors were significantly associated with the probability of HT uptake. Patients at centers conducting quality improvement projects, (OR [95% CI]) 1.94, [1.36-2.76]), offering assisted PD (1.89, [1.39-2.57]), fostering staff research engagement (1.35, [1.03-1.77]) or hosting HT roadshows (1.22, [1.05-1.41]) had higher odds of HT uptake. Centers with greater stress on staff capacity to deliver HT had lower uptake (0.60, [0.45-0.81]). Patients on transplant lists at KRT start (2.55, [2.35-2.77]) or who lived farther from a treatment center (1.10, [1.08-1.12] per 10km) had higher odds of HT uptake. Patients living in areas of higher deprivation or members of minority ethnic groups had lower HT uptake overall. However, some of these associations may have been indirectly mitigated in centers serving more diverse populations, as these centers were more likely to implement practices associated with higher HT uptake.LIMITATIONSHealthcare professional-reported and aggregated survey data.CONCLUSIONSThis study identified modifiable center-level factors associated with HT uptake, informing potential opportunities to reduce ethnic and area-level disparities.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"102 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314603","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":"Associations of Skeletal Muscle Mass and Body Mass Index With Clinical Outcomes in Autosomal Dominant Polycystic Kidney Disease: An Observational Study.","authors":"Dha Woon Im,Jiyun Jung,Miso Ha,Yon Su Kim,Kwon Wook Joo,Kook-Hwan Oh,Dong Ki Kim,Hajeong Lee,Seung Seok Han,Eunjeong Kang,Sehoon Park,Sung Joon Shin,Jangwook Lee,Jeongin Song,Yun Kyu Oh,Hayne Cho Park,Curie Ahn,Kyu-Beck Lee,Yeong Hoon Kim,Seungyeup Han,Yaerim Kim,Eun Hui Bae,Jae Yoon Park,Yong Chul Kim","doi":"10.1053/j.ajkd.2025.09.004","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.09.004","url":null,"abstract":"RATIONALE & OBJECTIVELow muscle mass is a risk factor for chronic kidney disease. In this study, we examined the relationship between muscle mass and mortality, as well as end-stage kidney disease (ESKD), in patients with autosomal dominant polycystic kidney disease (ADPKD).STUDY DESIGNRetrospective cohort study.SETTING & PARTICIPANTS1,443 patients with ADPKD from eight tertiary-care hospitals in Korea between 2006 and 2020.EXPOSURESComputed tomography images were obtained at the third lumbar vertebra to measure the skeletal muscle area (SMA) using an artificial intelligence system. SMA indexed for w a height2 s classified as low-attenuation muscle area (LAMA) or normal-attenuation muscle area (NAMA) based on muscle quality.OUTCOMESAll-cause mortality and ESKD.ANALYTICAL APPROACHCox proportional hazards regression, adjusted for sex, age, creatinine, glucose, and height-adjusted total kidney volume, was used to investigate the associations of muscle indices with all-cause mortality and ESKD. Subgroup analyses were conducted based on body mass index categories: low or normal (<25 kg/m2) and overweight or obese (≥25 kg/m2).RESULTSThe study population included more than half female patients, and the mean estimated glomerular filtration rate was 68.4 ml/min/1.73m2. Mean follow-up was 5.14 years. Greater SMA/height2 and NAMA/height2 were associated with a lower risk of mortality (HRs 0.58 (95% CI 0.39-0.88) and 0.55 (95% CI, 0.39-0.79), respectively). Greater NAMA/height2 was associated with a 26% lower ESKD incidence (0.74 (0.59,0.92), but a greater LAMA/height2 was associated with a lower ESKD incidence (HR 1.18, 95% CI 1.01-1.37). A higher NAMA/LAMA ratio was associated with a lower ESKD incidence (HR 0.74, 95% CI 0.60-0.92). Greater muscle mass was associated with a lower risk of mortality among overweight individuals and a lower risk of ESKD in underweight individuals.LIMITATIONSLack of details about muscle strength and performance.CONCLUSIONSAmong individuals with ADPKD, greater and higher-quality muscle mass were associated with lower risk of mortality and progression of CKD to ESKD.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"104 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145305649","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 \"Clarifying Dialysis Modality Classification in Algorithm-Based ESKD Identification\".","authors":"Chenxi Gao,Jung-Im Shin","doi":"10.1053/j.ajkd.2025.08.009","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.08.009","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"106 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145296238","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":"Revisiting New Data on the Mortality Benefit of Rapid Correction of Hyponatremia: Déjà vu All Over Again.","authors":"Richard H Sterns,Helbert Rondon-Berrios","doi":"10.1053/j.ajkd.2025.07.015","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.07.015","url":null,"abstract":"Studies in the 1980s linking rapid correction of severe, chronic hyponatremia to the osmotic demyelination syndrome (ODS) led to a major controversy that eventually gave way to consensus guidelines. Efforts to limit correction to ≤8 mmol/L per day in patients at high risk of developing ODS became common practice. Recent studies have questioned these guidelines, suggesting that ODS is rare and that slow correction may increase mortality. In this review, we revisit the history of the controversy and find that these claims have persisted for four decades. Older studies supporting faster correction are flawed by referral bias while newer studies are limited by confounding as comorbidities influence rates of both mortality and hyponatremia correction. While both old and new studies emphasize the rarity of MRI-documented ODS after rapid correction, they were not conducted in hyponatremic patients who were at risk for ODS. Old studies reporting hyponatremic deaths due to cerebral edema overestimate its true incidence and new studies reporting an association of mortality and slow rates of sodium correction do not document cerebral edema as a common contributor to death. Further research is required to better define the incidence of both ODS and cerebral edema in patients at risk for these complications. Until then, we conclude that the risks of rapid correction-including irreversible neurological damage-necessitate caution. Clinicians should continue to prioritize slow, controlled sodium correction to protect high-risk patients from harm.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"55 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145296210","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":"Management of Chronic Hyponatremia in the Outpatient Setting.","authors":"Angelique B M C Savelberg,Ewout J Hoorn,Julie C Refardt","doi":"10.1053/j.ajkd.2025.06.024","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.06.024","url":null,"abstract":"The diagnostic evaluation and management of chronic hyponatremia in outpatients can be challenging for several reasons. First, chronic hyponatremia is often mild, leading to uncertainty about whether it is clinically significant and warrants further diagnostic evaluation and treatment. Second, if the initial diagnostic workup does not identify a clear cause, it becomes uncertain how much further investigation is required. Third, when no clear cause is found or the underlying condition cannot be treated, physicians may struggle to choose the most appropriate treatment approach. This review offers practical guidance to navigate these challenges in managing chronic hyponatremia in the outpatient setting.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"104 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145296211","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":"Clarifying Dialysis Modality Classification in Algorithm-Based ESKD Identification.","authors":"Dharmenaan Palamuthusingam","doi":"10.1053/j.ajkd.2025.06.023","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.06.023","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"130 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145296212","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,Caroline Stigant,Tasleem Rajan,Kasun Hewage,Rehan Sadiq,Andrea J MacNeill,Christopher Nguan","doi":"10.1053/j.ajkd.2025.08.010","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.08.010","url":null,"abstract":"RATIONALE & OBJECTIVEHealthcare delivery is associated with considerable greenhouse gas (GHG) and other pollutant emissions. 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 across types of KRT.STUDY DESIGNA comparative lifecycle assessment (LCA).SETTING & PARTICIPANTSData collection implemented at Vancouver General Hospital in Vancouver, British Columbia.EXPOSUREThree KRTs: deceased donor kidney transplant (KT), automated/cycler peritoneal dialysis (PD), or in-center hemodialysis (HD) OUTCOME: Environmental impacts of KRTs over one year were evaluated using the World ReCiPe (H) 2016 method.ANALYTICAL APPROACHLifecycle inventory results were transformed into three endpoints and 18 midpoint environmental impact categories including climate change, air pollution, human toxicity, and water depletion RESULTS: 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 GHG emissions.LIMITATIONSPharmaceuticals were excluded from this study due to a lack of publicly available data.CONCLUSIONKT 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.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"24 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-10-09","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":"Identifying Adaptation Needs of a Decision Aid for Older Latino Adults With Advanced CKD: A Qualitative Study.","authors":"Thalia Porteny,Kristen Kennefick,Hillary Matos,Kelli Collins Damron,Daniel E Weiner,Sean Kalloo,Keren Ladin","doi":"10.1053/j.ajkd.2025.07.014","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.07.014","url":null,"abstract":"RATIONALE & OBJECTIVELatino adults 65 years and older comprise the fastest growing minoritized group in the US and experience a disproportionate burden of kidney failure. Decision aids improve decisional quality and goal-concordant care among older patients with chronic kidney disease (CKD). However, decision aids for kidney replacement therapy have yet to be adapted for the older Latino adult population with advanced CKD. The objective of this study was to assess the acceptability, accessibility and adaptions needed to facilitate use of a Spanish version of the Decision-Aid for Renal Therapy (DART-S) for older Latino adults with advanced CKD.STUDY DESIGNQualitative study applying the Cultural Targeting and Tailoring of Shared Decision-Making Technology Framework in focus group and structured interviews. Suggested adaptations were grouped into recommendations and analyzed qualitatively.SETTING & PARTICIPANTSFive focus groups (N=17) and interviews (N=15) with Spanish-speaking patients and care partners were conducted.ANALYTICAL APPROACHThematic analysis.RESULTSAmong patient participants, 55% were male and mean age was 68±9 years. Overall, participants found DART-S to be acceptable and accessible. Thematic analysis revealed the importance of incorporating lived experiences, including patient and family testimonials, to illustrate the mental health impact of CKD, self-care strategies, and home dialysis adaptations. Some found the delivery of prognostic information distressing, highlighting the need for more sensitive communication. Tailoring recommendations included information about financial barriers, nutrition, and lifestyle. Participants preferred that DART-S be disseminated via kidney clinicians upon CKD diagnosis and recommended leveraging social media for broader reach.LIMITATIONSFindings are not generalizable beyond the Latino subgroups in this study. Legal status was not ascertained.CONCLUSIONSTargeting and tailoring decision-aids is a necessary step in providing goal-concordant and person-centered care for older Latino adults with advanced CKD. Future research should examine the comparative efficacy of DART-S in increasing knowledge and decisional-quality among Latino patients.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254486","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":"Urine Oxalate Excretion and CKD Stage in Patients With Primary Hyperoxaluria Type 1.","authors":"Lisa Vaughan,Phillip J Schulte,Felix Knauf,David J Sas,Dawn Milliner,John C Lieske","doi":"10.1053/j.ajkd.2025.07.013","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.07.013","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"2 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145117154","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":"Pharmaceutical Practice Considerations Regarding Adoption of the Race-Free Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2021 Equations.","authors":"Ruth Tarzi,Jennifer McKenzie,Michel Reid,Sophia Goodison,James Oyee,Thomas F Hiemstra,Maciej J Zamek-Gliszczynski,Mary Muoneke,Leslie A Obert,Nneka Nwokolo,Benjamin Young,Anna Richards","doi":"10.1053/j.ajkd.2025.06.022","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.06.022","url":null,"abstract":"The race-free Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2021 estimated glomerular filtration rate-creatinine (eGFRcr) equation is being adopted in the US. Elsewhere there is debate regarding its validation and adoption. Absence of a perfect solution and a lack of alignment present challenges when considering global clinical trials. Whilst acknowledging these challenges, GSK decided to adopt the CKD-EPI 2021 eGFRcr equation for new adult trials to support health equity and delivery benefits from standardized data management. The eGFRcr obtained using the CKD-EPI 2021 equation versus CKD-EPI 2009 equation is moderately lower in US Black individuals and moderately higher in non-Black individuals. Analyses before adoption suggested no major impact for study safety or efficacy evaluations although racial/ethnic representation may need to be examined in trials with an eGFR ≥60 mL/min/1.73m2 inclusion criterion, since enrollment of eligible Black participants could be reduced. Sensitivity analyses using 2009 and 2021 equations may be necessary to understand any effect size with population change, especially where there are kidney endpoints or relevant safety concerns. GSK plans to monitor the impact of adopting the CKD-EPI 2021 eGFRcr equation on adverse event reporting across studies and pharmacovigilance outcomes, and to monitor the evolution of regulatory guidance for eGFR equation implementation.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"22 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103421","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}