American Journal of Kidney Diseases最新文献

{"title":"Associations of Urine Biomarkers During Ambulatory Acute Kidney Injury With Subsequent Recovery in Kidney Function: Findings From the SPRINT Study.","authors":"Simon B Ascher,Ronit Katz,Michelle M Estrella,Rebecca Scherzer,Teresa K Chen,Pranav S Garimella,Alexander L Bullen,Stein I Hallan,Nicholas Wettersten,Alfred Cheung,Michael G Shlipak,Joachim H Ix","doi":"10.1053/j.ajkd.2025.02.607","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.02.607","url":null,"abstract":"RATIONALE & OBJECTIVESerum creatinine elevations in the ambulatory setting frequently occur during antihypertensive treatment and complicate clinical management, but few tools are available to distinguish whether kidney function will recover in this setting. This study evaluated if urine biomarkers of glomerular and tubular health are associated with subsequent recovery of eGFR after acute kidney injury (AKI) occurred in the ambulatory setting during blood pressure treatment.STUDY DESIGNLongitudinal analysis of clinical trial participants.SETTING & PARTICIPANTS652 participants in the Systolic Blood Pressure Intervention Trial (SPRINT) who developed AKI in the ambulatory setting, defined as a rise in serum creatinine of ≥0.3 mg/dL from baseline detected at the 1-year or 2-year study visits.EXPOSUREEight urine biomarkers measured at baseline and at the study visit when ambulatory AKI was detected.OUTCOME<50% recovery in eGFR (\"non-recovery\") at 12-months.ANALYTICAL APPROACHMultivariable logistic regression models, stratified by randomization arm, to evaluate biomarker associations with the odds of non-recovery in eGFR.RESULTSMean age was 70 ±10 years; eGFR at baseline was 62 ± 25 mL/min/1.73 m2, and eGFR at the time of serum creatinine elevation was 42 ± 12 mL/min/1.73 m2. Among biomarkers measured at the time ambulatory AKI was detected, higher urine albumin (OR per 1-SD higher: 1.72; 95% CI: 1.10, 2.70) and lower epidermal growth factor (OR 0.46; 95% CI: 0.26, 0.79) were associated with non-recovery in the standard BP treatment arm; higher urine α-1 microglobulin (OR 1.45; 1.09, 1.92), lower epidermal growth factor (OR 0.62; 95% CI: 0.46, 0.83) and lower kidney injury molecule-1 (OR 0.75; 95% CI: 0.59, 0.96) were associated with non-recovery of eGFR in the intensive BP treatment arm.LIMITATIONSPersons with diabetes and proteinuria >1 g/d were excluded.CONCLUSIONSAmong adults enrolled in a BP treatment trial who developed ambulatory AKI, urine biomarkers reflecting glomerular injury and tubular dysfunction may help to distinguish whether kidney function will subsequently recover.PLAIN-LANGUAGE SUMMARYElevations in serum creatinine can occur when treating hypertension and complicate clinical management, but there are few tools available to distinguish whether an individual's kidney function will subsequently recover. In this study, we investigated the association of kidney biomarkers measured in the urine with subsequent kidney function among individuals in the outpatient setting who develop a rise in serum creatinine. We found that biomarkers reflecting worse glomerular injury and tubular dysfunction are associated with the risk of an individual's kidney function not recovering. These results suggest that a broader assessment of kidney health when serum creatinine increases in the outpatient setting may help distinguish subsequent trajectories in kidney function.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"7 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143872026","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":"LB-03 Influence of Kidney Function on Apixaban Pharmacokinetics, Pharmacodynamics and Hemorrhage","authors":"","doi":"10.1053/j.ajkd.2025.03.007","DOIUrl":"10.1053/j.ajkd.2025.03.007","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 5","pages":"Pages 668-669"},"PeriodicalIF":9.4,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852108","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":"Severe Mental Illness in CKD: Why it Matters","authors":"S. Susan Hedayati","doi":"10.1053/j.ajkd.2025.03.012","DOIUrl":"10.1053/j.ajkd.2025.03.012","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 5","pages":"Pages 543-544"},"PeriodicalIF":9.4,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852362","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":"Erratum regarding “Lupus Nephritis Patterns and Response to Type I Interferon in Patients With DNASE1L3 Variants: Report of Three Cases” (Am J Kidney Dis. 2024;84(6):791-797)","authors":"","doi":"10.1053/j.ajkd.2025.03.002","DOIUrl":"10.1053/j.ajkd.2025.03.002","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 5","pages":"Page 666"},"PeriodicalIF":9.4,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143851515","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":"LB-05 Long-Term Efficacy and Safety in the Phase 3 Illuminate-B Trial of Lumasiran for Primary Hyperoxaluria Type 1 in Infants and Young Children","authors":"","doi":"10.1053/j.ajkd.2025.03.009","DOIUrl":"10.1053/j.ajkd.2025.03.009","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 5","pages":"Page 669"},"PeriodicalIF":9.4,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852110","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":"LB-01 Chlorthalidone Compared to Hydrochlorothiazide for the Prevention of Kidney Stones: A Secondary Analysis of the Diuretic Comparison Project","authors":"","doi":"10.1053/j.ajkd.2025.03.005","DOIUrl":"10.1053/j.ajkd.2025.03.005","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 5","pages":"Page 668"},"PeriodicalIF":9.4,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143851517","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 Between Serum Sodium, Peritoneal Dialysis-Associated Peritonitis, and Mortality in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS).","authors":"Isaac Teitelbaum,Junhui Zhao,Charlotte Tu,Brian Bieber,Simon Davies,David W Johnson,Hideki Kawanishi,Yong-Lim Kim,Talerngsak Kanjanabuch,Ronald L Pisoni,Jeffrey Perl","doi":"10.1053/j.ajkd.2025.02.605","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.02.605","url":null,"abstract":"RATIONALE & OBJECTIVEThe clinical consequences of hyponatremia among patients receiving peritoneal dialysis (PD) are poorly understood. This study sought to evaluate the association of variations in serum sodium with peritoneal dialysis-associated peritonitis and death.STUDY DESIGNMulticenter observational cohort study.SETTINGS & PARTICIPANTS23,707 participants in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) in 8 countries between 2014 and 2022 with a serum sodium available at study enrollment.PREDICTORSerum sodium categories (categories: <135, 135-137, 138-139, 140-141, >142 mEq/L) at study enrollment.OUTCOMESTime to first peritonitis episode and all-cause mortality.ANALYTICAL APPROACHCause-specific hazards models adjusted for demographic, comorbidity, and treatment characteristics. Secondary analyses using average serum sodium levels over time and evaluation of modification of the association between serum sodium and study outcomes by use of icodextrin, as well as patient characteristics and peritoneal dialysis (PD) modality.RESULTSCompared to a serum sodium of 140 - 141 mEq/L (n=5065), those with a sodium of <135 mEq/L (n=3601) had longer dialysis vintage and were more likely to have diabetes and use icodextrin. Across serum sodium categories, there were no differences in the adjusted peritonitis risks. Compared to individuals with a sodium of 140-141 mEq/L, those with a sodium of <135 mEq/L (adjusted hazard ratio [AHR] 1.45, 95% CI 1.29-1.63), a sodium of 135-137 mEq/L (AHR 1.26, 95% CI 1.13-1.42) and a sodium ≥142 mEq/L (AHR 1.16, 95% CI 1.03-1.30) were all associated with higher mortality. Associations between serum sodium and mortality were similar across all patient characteristic and PD modality subgroups. Peritonitis risk was not detectably different across serum sodium categories regardless of treatment with icodextrin.LIMITATIONSLack of standardization/validation of serum sodium measures across sites; icodextrin use was limited to a subset of patients.CONCLUSIONSVariations in serum sodium were associated with death but not peritonitis risk. Future studies are needed to understand the mechanisms underpinning these associations and whether modification of serum sodium would improve outcomes among those receiving PD.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"26 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143827125","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":"Safety and Effectiveness of Nirmatrelvir-Ritonavir in Patients With Advanced Kidney Dysfunction and COVID-19.","authors":"Marimar Contreras Nieves,Shuchi Anand,I-Chun Thomas,Pascal Geldsetzer,Enrica Fung,Manjula Kurella Tamura,Maria E Montez-Rath","doi":"10.1053/j.ajkd.2025.02.603","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.02.603","url":null,"abstract":"RATIONALE & OBJECTIVENirmatrelvir-ritonavir prevents COVID-19 hospitalization among high-risk adults, but safety concerns limit its use in advanced kidney dysfunction. This study examined safety and effectiveness outcomes from its off-label use in patients with advanced kidney dysfunction.STUDY DESIGNRetrospective matched cohort study.SETTING & PARTICIPANTSPatients with estimated glomerular filtration rate (eGFR) 15-30 mL/min/1.73m2 and COVID-19 between January 2022 and January 2023 cared for in Veterans Health Administration facilities.EXPOSURESTreatment with nirmatrelvir-ritonavir, no treatment with nirmatrelvir-ritonavir or molnupiravir, or treatment with molnupiravir.OUTCOMESIncidence of cardiac events, stroke, acute kidney injury, liver injury, hypertension, and infection-related death, respiratory failure, pneumonia, severe infection, and hospitalization within 30-60 days of diagnosis with COVID-19.ANALYTICAL APPROACHLogistic regression for propensity matching, standardized mean differences for assessment of covariate balance, and conditional logistic regression for estimation of relative risk ratios comparing exposures for each outcome.RESULTSAmong 4,020 patients with eGFR 15-30 mL/min/1.73m2 and COVID-19, 117 (2.9%) were treated with nirmatrelvir-ritonavir (mean age 75.6 [SD 12.2] years and eGFR 24.9 [SD 4.0] mL/min/1.73m2). Compared with no treatment with either nirmatrelvir-ritonavir or molnupiravir, treatment with nirmatrelvir-ritonavir was not detectably associated with different risks of cardiovascular events (e.g., heart failure (RR 1.0 [95% CI, 0.7-1.2]), liver injury (RR 1.2 [95% CI, 0.7-1.7]), or acute kidney injury (RR 1.0 [95% CI, 0.8-1.2]), but was associated with a lower risk of acute respiratory failure (RR 0.5 [95% CI, 0.2-0.7]) and pneumonia (RR 0.6 [95% CI, 0.3-0.8]). Compared with treatment with molnupiravir, treatment with nirmatrelvir-ritonavir was not detectably associated with different risks of cardiovascular events, acute respiratory failure, or pneumonia, but was associated with a higher risk of acute kidney injury. Sensitivity analyses among patients with eGFR 15-35 ml/min/1.73m2 yielded similar findings.LIMITATIONSRetrospective analysis, predominantly men in the study cohort.CONCLUSIONSNirmatrelvir-ritonavir use in the setting of advanced kidney dysfunction was associated with a reduced risk of acute respiratory failure and pneumonia, and no detectable differences in non-respiratory adverse outcomes compared with no treatment with either nirmatrelvir-ritonavir or molnupiravir.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"34 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143819294","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":"Pediatric Nephrology Practice in the US: Survey of Pediatric Nephrology Division Directors.","authors":"Priya S Verghese, Amy Bobrowski, Caitlin Carter, Vikas R Dharnidharka, Jyothsna Gattineni, Julie E Goodwin, David B Kershaw, Teri J Mauch, Raoul Nelson, Mihail Subtirelu, Joseph Flynn, Daniel Feig","doi":"10.1053/j.ajkd.2025.01.025","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.01.025","url":null,"abstract":"<p><strong>Rationale & objectives: </strong>Addressing the growing demand for pediatric nephrology care is challenging because of increasing limitations in the size of this workforce. The objective of this study was to characterize the state of pediatric nephrology practices across the US to inform possible strategies to address this shortfall.</p><p><strong>Study design: </strong>Cross-sectional survey.</p><p><strong>Setting & participants: </strong>The American Society of Pediatric Nephrology (ASPN) interest group comprised of 92 pediatric nephrology division leaders of pediatric nephrology programs.</p><p><strong>Exposures: </strong>Practice size defined by number of full-time equivalent (FTE) pediatric nephrologists.</p><p><strong>Outcomes: </strong>The scope of inpatient and outpatient services related to dialysis and extracorporeal treatment, kidney transplantation, procedures (kidney biopsy, ultrasound, ambulatory blood pressure monitoring), faculty roles, and funding for programmatic activities.</p><p><strong>Analytical approach: </strong>Descriptive and comparative statistics, including Chi-Squared test, Fisher's Exact test, Student's t-Test, two proportion Z-test, with significance defined as p-value < 0.05 was performed using GraphPad Prism (version 8.0.0, 131) and SAS Enterprise guide 7.1.</p><p><strong>Results: </strong>Large programs had more outreach capacity, ancillary staffing, independent transplant programs, diverse kidney replacement options, and on-site outpatient dialysis units. Smaller programs had fewer ambulatory patients and fewer inpatients per FTE pediatric nephrologists. Medium-sized programs had the highest inpatient and ambulatory volume per FTE pediatric nephrologists. The administrative support for transplant/dialysis/fellowship programs was often limited.</p><p><strong>Limitations: </strong>Granularity of data was limited. Assessment of trends was not implemented nor were changes in faculty appointment type.</p><p><strong>Conclusions: </strong>Pediatric nephrologists in medium-sized programs had the highest volume of clinical work and administrative support for transplant/dialysis/fellowship programs was often insufficient in many programs. These findings may inform strategies to support pediatric nephrology programs and enhance the care they provide.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794448","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":"Renal Denervation in Loin Pain Hematuria Syndrome: A Pilot Randomized Controlled Trial.","authors":"Bhanu Prasad, Aarti Garg, Aditi Sharma, Francisco Garcia, Kunal Goyal, Mohammed Nayeemuddin","doi":"10.1053/j.ajkd.2025.01.024","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.01.024","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794450","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}