American Journal of Kidney Diseases最新文献

{"title":"Risks of Hypocalcemia and Other Bone Mineral Disorders for Denosumab Versus Zoledronate Across the Spectrum of Kidney Function: A Target Trial Emulation.","authors":"Ruowei Xiao,Anne-Laure Faucon,Na He,Muhammad K Javaid,Dongze Ji,Yang Xu,Juan-Jesus Carrero","doi":"10.1053/j.ajkd.2026.02.642","DOIUrl":"https://doi.org/10.1053/j.ajkd.2026.02.642","url":null,"abstract":"RATIONALE & OBJECTIVEDenosumab, an osteoporosis medication, may induce hypocalcemia, secondary hyperparathyroidism (sHPT), and hypophosphatemia. We aimed to study these risks compared to zoledronate and if the risks differ based on underlying kidney function.STUDY DESIGNObservational study, new-user design with active comparator.SETTING & PARTICIPANTSPatients aged 50 year or older initiating denosumab (n=5,085) or zoledronate (n=3,599) in Stockholm, Sweden (2011-2021).EXPOSURESDenosumab or zoledronate initiation.OUTCOMESPrimary outcome: hypocalcemia.SECONDARY OUTCOMESsHPT and hypophosphatemia assessed within 180 days of dispensing of study medications.ANALYTICAL APPROACHCox regression to estimate hazard ratios (HRs), Aalen-Johansen estimators to compute absolute risks (ARs) and risk differences (RDs), and splines to explore effect modification by baseline estimated glomerular filtration rate (eGFR).RESULTSTwenty five percent of the study population had eGFR <60 mL/min/1.73 m2 (chronic kidney disease [CKD] stage 3a [15%] and 3b [8%]). Compared to zoledronate, denosumab initiation was associated with higher rates of hypocalcemia (HR 2.10 [95% CI, 1.28-4.33]; RD 0.72% [95% CI, 0.26-1.18]), sHPT (HR 2.85 [95% CI, 1.94-5.48]; RD 1.33% [95% CI, 0.91-1.85]), and hypophosphatemia (HR 1.96 [95% CI, 1.30-3.38]; RD 0.85% [95% CI, 0.33-1.38]), occurring mainly within the first two weeks of treatment. Adverse event rates were greater with lower kidney function, mainly limited to people with eGFR <60 mL/min/1.73m2: Denosumab-associated absolute risk differences for hypocalcemia (RD 2.12% vs. 0.19%; P for interaction =0.04) and sHPT (RD 4.84% vs. 0.03%; P for interaction <0.001) were greater in patients with eGFR <60 vs. ≥60 mL/min/1.73 m2. For hypophosphatemia, risk differences were numerically higher, but no multiplicative interaction was observed across lower eGFR strata (P for interaction =0.1). Results were similar when restricting previous users of oral bisphosphonates, when requiring sustained abnormal laboratory values and across different testing rate scenarios.LIMITATIONSResidual confounding inherent to observational studies and lack of generalizability to other populations.CONCLUSIONSCompared with zoledronate, denosumab was associated with higher risks of hypocalcemia and sHPT, and hypophosphatemia, particularly among users with moderate-to-advanced CKD, highlighting the need for careful monitoring of these parameters, especially immediately after treatment initiation.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"65 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147726230","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":"Apixaban Initiation in Hemodialysis Patients With Newly Diagnosed Atrial Fibrillation.","authors":"Youyi Lu,Jiaming Li,Yupeng Cui","doi":"10.1053/j.ajkd.2025.12.009","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.12.009","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"131 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655684","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":"Unmasking the Survival Benefit: Vascular Fragility and Selection Bias in Dialysis Anticoagulation.","authors":"Baodong Wang,Jiayuan Huang,Zhiyun Chen","doi":"10.1053/j.ajkd.2025.12.008","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.12.008","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"21 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655682","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: \"Unmasking the Survival Benefit: Vascular Fragility and Selection Bias in Dialysis Anticoagulation\" and \"Apixaban Initiation in Hemodialysis Patients With Newly Diagnosed Atrial Fibrillation\".","authors":"Wolfgang C Winkelmayer,Tara I Chang","doi":"10.1053/j.ajkd.2026.03.035","DOIUrl":"https://doi.org/10.1053/j.ajkd.2026.03.035","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"129 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655685","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":"Sodium/Glucose Cotransporter 2 Inhibitors and Renal Oxygenation: Rethinking the Role of Uromodulin","authors":"Emilio Venturelli MD, Elisa Russo MD, Francesca Viazzi MD","doi":"10.1053/j.ajkd.2026.01.013","DOIUrl":"https://doi.org/10.1053/j.ajkd.2026.01.013","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"19 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147587339","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 Transplant Outcomes in Coatomer Protein Complex Subunit Alpha (COPA) Syndrome: Report of Five Patients.","authors":"Clément Triaille, Kevin Côté, Jérôme Coulombe, Maité Daroux, Clémence David, Marie-Louise Frémond, Elie Haddad, Naseer Khan, Victor Kokta, Anne-Laure Lapeyraque, Céline Lebas, María Luisa Matoses Ruipérez, Berta López Montesinos, Héloise Reumaux, Tiphanie P Vogel, Marie-Paule Morin, Véronique Phan","doi":"10.1053/j.ajkd.2025.12.007","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.12.007","url":null,"abstract":"<p><p>COPA (coatomer protein complex subunit α) syndrome is a rare inborn error of immunity associated with constitutive activation of type I interferon signaling. Organ inflammation and damage (i.e. lungs, kidneys, joints) usually develops early in life. Kidney involvement occurs in a subset of COPA syndrome patients, with the potential for rapid progression to kidney failure. Through an international collaboration, we identified COPA syndrome patients who developed kidney failure and underwent a kidney transplantation. The aim of the present report was to describe (i) the kidney involvement at presentation, (ii) the immunosuppressive strategies used before and after transplant, (iii) the kidney graft outcomes, and (iv) the evolution of the underlying COPA disease after transplantation. Five COPA syndrome patients were included. Kidney failure manifested at young age (range: 5 - 40 years). Kidney involvement was heterogenous between patients (ANCA-associated vasculitis-like disease, lupus or immune-complex mediated glomerulonephritis or overlapping phenotypes), and all had advanced histological damage at clinical presentation. Pulmonary disease of variable severity was also present in all patients. Kidney disease responded poorly to multiple lines of immunosuppression justifying kidney transplantation between the ages of 7.5 and 42 years. After a follow-up of 10 months-12 years, we report favorable graft outcomes in all patients (CKD stage 2-3b) but one patient developed polyomavirus infection (skin, kidney graft), and another died of progressive lung disease.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147615519","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":"Complement 3 Glomerulopathy (C3G) in Native and Posttransplant Kidneys: Pathophysiology, Prognosis, and Treatment.","authors":"Manuel Praga,Richard J Smith,Andrew S Bomback","doi":"10.1053/j.ajkd.2025.11.021","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.11.021","url":null,"abstract":"Complement 3 glomerulopathy (C3G) is a rare, complement-mediated kidney disease characterized by overactivation of the alternative pathway (AP). C3G encompasses 2 subtypes-dense deposit disease and C3 glomerulonephritis-both of which lead to C3 deposition in the glomeruli, progressive kidney dysfunction, and, ultimately, kidney failure. The pathophysiology of C3G and the underlying complement AP overactivation are often driven by genetic mutations and/or acquired autoantibodies. These systemic drivers can affect both native and transplanted kidneys; thus, C3G is associated with a high risk of recurrence in allografts. Recurrence of C3G in posttransplant kidneys has a particularly poor prognosis and leads to a high rate of graft loss. Therapeutic strategies for both native and posttransplant recurrent C3G that are largely supportive have shown limited benefit in improving kidney survival, as have therapies targeting the terminal complement cascade, downstream of pathogenic AP overactivation. In contrast, emerging therapies that target AP overactivation are showing promise for more effective disease modification. In light of the evolving treatment landscape, this review provides an update on the current state of knowledge regarding the pathophysiology, prognosis, and treatment options for native and posttransplant recurrent C3G.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"99 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147585511","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 Threats to Kidney Health: A Clinician's Guide to Modern Exposures.","authors":"Anna Strasma,Nishad Jayasundara,Shuchi Anand","doi":"10.1053/j.ajkd.2025.11.017","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.11.017","url":null,"abstract":"Individuals are increasingly exposed to a diverse array of chemicals through the environment, consumer products, and occupational settings. These exposures, often involving substances with unknown or emerging implications for human health, may pose significant kidney health risks, since many are processed by the kidneys and excreted in the urine. Kidneys are particularly vulnerable to injury from inorganic chemicals, such as lead, cadmium, and mercury, which originate from geogenic sources, but whose exposures are multiplied by anthropogenic activities. Emerging data detail possible kidney risks from chemicals derived entirely from anthropogenic activities as well: e.g., from per- and polyfluoroalkyl substances (PFASs), melamine, and agrochemicals. Chronic kidney disease (CKD) resulting from these environmental exposures is likely underdiagnosed in clinical practice. This review describes the sources of exposure, systemic effects, and potential nephrotoxicity of implicated chemicals, aiming to increase the recognition of environmental exposures as contributors to unexplained new kidney disease. A thorough exposure history and specialized laboratory evaluation may be used for diagnosis in high-risk individuals. Increased clinical awareness and dedicated research efforts are essential to understand and mitigate environmental nephrotoxic exposures and protect kidney health.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"34 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147585512","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":"Treatment Preferences Among Older People With Advanced CKD.","authors":"Barnaby Hole","doi":"10.1053/j.ajkd.2025.11.016","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.11.016","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"1 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147536496","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":"Beyond Diffusion: Clinical Perspectives on Online Hemodiafiltration and Medium Cut-Off Dialyzers.","authors":"Karin Bergling,Peter J Blankestijn","doi":"10.1053/j.ajkd.2025.11.018","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.11.018","url":null,"abstract":"Online hemodiafiltration (OL-HDF) and medium cut-off (MCO) dialyzers augment diffusion-based hemodialysis (HD) with convective clearance to enhance removal of middle molecules. In large-scale randomized trials, OL-HDF appears to reduce all-cause, cardiovascular, and infection related mortality compared to high-flux HD, particularly when convection volumes exceed 23 L per session. Data suggests a graded effect; higher achieved convection volumes are associated with greater benefit, and advantages are observed across analysed subgroups. Evidence also indicates better preservation of patient-reported quality of life compared to high-flux HD. Large-scale observational registry data, while subject to inherent limitations, support beneficial outcomes and generalizability to routine clinical practice. MCO membranes enhance middle-molecule clearance on conventional hemodialysis machines via enlarged pore size and internal-filtration-back filtration. However, long-term clinical data remain limited, and the convective component is not externally measured or prescribed. This perspective distils mechanistic and clinical insights on both OL-HDF and MCO HD and evaluates published evidence, including solute clearance studies, mortality outcomes and patient-reported quality-of-life data. We outline actionable prescription strategies and opportunities for individualized treatment optimization. Our goal is to provide clinicians with a concise roadmap to personalize and integrate convection-enhancing therapies in everyday practice.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"63 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147536495","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}