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":"10.1053/j.ajkd.2026.02.642","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Denosumab, an osteoporosis medication, may induce hypocalcemia, secondary hyperparathyroidism (SHPT), and hypophosphatemia. We studied these risks compared with zoledronate and whether the risks differ based on underlying kidney function.</div></div><div><h3>Study Design</h3><div>Observational study, new-user design with active comparator.</div></div><div><h3>Setting & Participants</h3><div>Patients aged 50 year or older initiating denosumab (n = 5,085) or zoledronate (n = 3,599) in Stockholm, Sweden (2011-2021).</div></div><div><h3>Exposure</h3><div>Denosumab or zoledronate initiation.</div></div><div><h3>Outcome</h3><div>Hypocalcemia, with secondary outcomes of SHPT and hypophosphatemia assessed within 180 days of dispensing of study medications.</div></div><div><h3>Analytical Approach</h3><div>Cox 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).</div></div><div><h3>Results</h3><div>Twenty-five percent of the study population had eGFR < 60 mL/min/1.73 m<sup>2</sup> (chronic kidney disease [CKD] stage 3a [15%] and 3b [8%]). Compared with 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]), which occurred mainly within the first 2 weeks of treatment. Adverse event rates were greater with lower kidney function and mainly limited to people with eGFR < 60 mL/min/1.73 m<sup>2</sup>. The denosumab-associated absolute risk differences for hypocalcemia (RD, 2.12% versus 0.19%; <em>P</em> for interaction = 0.04) and SHPT (RD, 4.84% versus 0.03%; <em>P</em> for interaction < 0.001) were greater in patients with eGFR < 60 versus ≥60 mL/min/1.73 m<sup>2</sup>. For hypophosphatemia, the RDs were numerically higher, but no multiplicative interaction was observed across lower eGFR strata (<em>P</em> for interaction = 0.1). The results were similar when restricting previous users of oral bisphosphonates, when requiring sustained abnormal laboratory values, and across different testing rate scenarios.</div></div><div><h3>Limitations</h3><div>Residual confounding inherent to observational studies and lack of generalizability to other populations.</div></div><div><h3>Conclusions</h3><div>Compared with zoledronate, denosumab was associated with higher risks of hypocalcemia, 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.</div></div><div><h3>Plain-Language Summary</h3><div>Denosumab is a drug used to prevent fractures, but it can affect ca","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"88 1","pages":"Pages 88-98.e1"},"PeriodicalIF":9.4,"publicationDate":"2026-07-01","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":"Medicaid Expansion and Optimal Starts of Treatment for Incident Kidney Failure","authors":"Nicholas S. Roetker, James B. Wetmore, Jiannong Liu, Haifeng Guo, David T. Gilbertson, Kirsten L. Johansen","doi":"10.1053/j.ajkd.2026.01.007","DOIUrl":"10.1053/j.ajkd.2026.01.007","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Beginning in 2014, some states expanded Medicaid eligibility to include additional low-income adults under the age of 65 years. Examining whether the expansion led to improvements in optimal treatment at the start of kidney failure has been understudied and was the focus of this investigation.</div></div><div><h3>Study Design</h3><div>Observational cohort study.</div></div><div><h3>Setting & Participants</h3><div>Patients aged 26-64 years represented in the US Renal Data System initiating treatment for kidney failure between 2008 and 2019.</div></div><div><h3>Exposure</h3><div>Residence in states that did or did not expand Medicaid in 2014.</div></div><div><h3>Outcome</h3><div>An optimal start of kidney failure treatment was defined as undergoing preemptive kidney transplant, initiating home dialysis, or initiating in-center hemodialysis using an arteriovenous access.</div></div><div><h3>Analytical Approach</h3><div>Interrupted time-series analyses were implemented to evaluate the adjusted association of residence in a Medicaid-expansion state and optimal kidney failure treatment by comparing the trend in optimal kidney failure treatment starts during the preexpansion period versus the postexpansion period.</div></div><div><h3>Results</h3><div>Before Medicaid expansion, the percentage of patients with optimal starts increased similarly in expansion and nonexpansion states. After Medicaid expansion, the percentage with optimal starts continued to increase in expansion states but decreased in nonexpansion states, resulting in a 3.9% (95% CI, 0.5%-7.2%) higher percentage with optimal starts in expansion versus nonexpansion states by 2019 (postexpansion vs preexpansion change in trend, <em>P</em> = 0.02). Most of the change in trend was attributable to a greater increase in use of home dialysis at initiation of kidney failure treatment in expansion versus nonexpansion states (difference of 0.29% per year; 95% CI, 0.08%-0.51%) during the postexpansion period.</div></div><div><h3>Limitations</h3><div>Potential for unmeasured confounding from state-level factors other than Medicaid expansion.</div></div><div><h3>Conclusions</h3><div>Medicaid expansion was associated with an increasing percentage of patients with incident kidney failure experiencing an optimal start to treatment, driven mostly by an increase in the use of home dialysis. Expanding Medicaid coverage may offer an opportunity to improve treatment for low-income patients initiating kidney replacement therapy.</div></div><div><h3>Plain-Language Summary</h3><div>This study examined whether the expansion of Medicaid eligibility in 2014 led to improvements in the percentage of patients receiving an optimal start to treatment for new-onset kidney failure (ie, kidney transplant before the need to start dialysis, initiation of home dialysis, or initiation of in-center hemodialysis using an arteriovenous access). We compared trends from 2008 to 2019 acr","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"88 1","pages":"Pages 78-87.e1"},"PeriodicalIF":9.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147495193","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":"Prevalence of CKD Among Adults in Africa: A Systematic Review and Meta-Analysis","authors":"Cindy George, Ikechi G. Okpechi, Dipuo D. Motshwari, Suzaan Stoker, Min Jun, Sradha Kotwal, Segun Fatumo, Charles Agyemang, June Fabian, Tandi E. Matsha, Pascal Bovet, Mark Woodward, Andre P. Kengne, CKD-Africa Collaboration","doi":"10.1053/j.ajkd.2026.02.640","DOIUrl":"10.1053/j.ajkd.2026.02.640","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Chronic kidney disease (CKD) is a global public health concern, but its burden in Africa is poorly defined. This study estimated CKD prevalence across the African continent.</div></div><div><h3>Study Design</h3><div>Systematic review and individual participant data meta-analysis.</div></div><div><h3>Setting & Study Population</h3><div>Populations residing in Africa.</div></div><div><h3>Selection Criteria</h3><div>Eligible studies enrolled ≥300 adults, were observational, used community-based designs, and reported CKD prevalence or data necessary to calculate it.</div></div><div><h3>Search Strategy</h3><div>Studies, both published and unpublished, through May 31, 2024, identified through systematic searches of major databases and through networks within the CKD-Africa Collaboration.</div></div><div><h3>Data Extraction</h3><div>Data were systematically extracted and verified by the authors. Extracted information included study and publication details, CKD diagnostic criteria, and participant characteristics.</div></div><div><h3>Analytical Approach</h3><div>Pooled prevalence estimates were calculated using random-effects meta-analysis.</div></div><div><h3>Results</h3><div>Sixty-seven studies, comprising 91,723 participants from 19 countries, were included. High- and moderate-quality studies accounted for 37% and 52%, respectively, and 6% were unpublished. Pooled CKD prevalence (stages 1-5) was 13.7% (95% CI, 11.0-16.4), and 5.1% (95% CI, 4.3-5.8) for stages 3-5. Regional variation was evident (<em>I</em><sup>2</sup> >98%; <em>P</em> < 0.001), with higher prevalence in western Africa compared to southern Africa. Estimates using aggregated data and individual participant data were consistent.</div></div><div><h3>Limitations</h3><div>Variations in the quality of the study data and substantial heterogeneity in prevalence estimates. Lack of assessment of chronic CKD. Reliance on aggregated data for 55% of the sample. Gaps in geographic representation may limit the generalizability of findings.</div></div><div><h3>Conclusions</h3><div>Approximately 14% of African adults had CKD, highlighting its public health burden. The precision of this finding was augmented by the use of individual participant data.</div></div><div><h3>Registration</h3><div>Registered at Prospero with identification number CRD42019143370.</div></div><div><h3>Plain-Language Summary</h3><div>Chronic kidney disease (CKD), a long-term condition in which the kidneys gradually lose their ability to filter waste and fluids from the blood, is an increasing health problem in Africa, but prevalence data have been limited. Previous studies relied on only summaries of studies’ data. This analysis combined individual-level and summary data from multiple African countries to provide a more accurate and precise estimate of CKD prevalence. It found that CKD affects a substantial proportion of adults, with rates varying across regions. These finding","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"88 1","pages":"Pages 44-66.e1"},"PeriodicalIF":9.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809683","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":"Complement 3 Glomerulopathy (C3G) in Native and Posttransplant Kidneys: A Review","authors":"Manuel Praga,&nbsp;Richard J. Smith,&nbsp;Andrew S. Bomback","doi":"10.1053/j.ajkd.2025.11.021","DOIUrl":"10.1053/j.ajkd.2025.11.021","url":null,"abstract":"<div><div>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 variants and/or acquired autoantibodies. These systemic drivers can affect 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 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.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"88 1","pages":"Pages 127-141"},"PeriodicalIF":9.4,"publicationDate":"2026-07-01","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transitioning From CKD to Kidney Failure: A Mixed-Methods Study of Patient Perspectives","authors":"Megan Urbanski,&nbsp;Laura A. Siminoff,&nbsp;Amy Waterman,&nbsp;Crystal A. Gadegbeku,&nbsp;Levent Dumenci,&nbsp;Kimberly Jacob Arriola,&nbsp;Laura C. Plantinga,&nbsp;Heather Gardiner","doi":"10.1053/j.ajkd.2026.02.644","DOIUrl":"10.1053/j.ajkd.2026.02.644","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;The transition from chronic kidney disease (CKD) to kidney failure (KF) is life-changing. We explored the KF transition and dialysis start experiences of patients with varying degrees of prior nephrology care and preparation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Convergent parallel mixed-methods study using surveys and interviews.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Data were collected from December 2018 to January 2020 among adults in metropolitan Philadelphia who had recently transitioned from CKD to KF and started dialysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Participants were categorized as having had (1) some prior nephrology care and placement of an arteriovenous or peritoneal dialysis access, (2) minimal nephrology care (prior nephrology care, but no placement of a dialysis access), or (3) no prior nephrology care or placement of an access. Applied thematic analysis guided the qualitative analysis, and quantitative data were fully described.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;KF transition was tumultuous for all participants (N = 47) regardless of preparation (some prior care, n = 23 [48.9%]; minimal prior care, n = 13 [27.7%]; no prior care, n = 11 [23.4%]). Dialysis start occurred along a spectrum of urgency, with most (n = 44; 93.6%) initiating dialysis in a hospital, and nearly all (n = 46; 97.9%) were treated with in-center hemodialysis. Four additional themes emerged: (1) participants were unprepared to receive the KF diagnosis because they were unaware of the urgency of their medical situation; (2) the KF diagnosis communication environment was chaotic, but effective provider communication helped; (3) the first dialysis treatment was marked by intense apprehension and fear; and (4) participants prioritized making sense of their sudden new reality.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Limited geographic representation and the exclusion of non–English-speaking participants.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Irrespective of prior preparation, participants experienced apprehension and fear during the transition from CKD to KF. Successfully addressing modifiable health system–level factors that affect this critical care transition and directly address the patient experience is needed to improve care and outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;The progression from chronic kidney disease to kidney failure and dialysis is a challenging time for patients. We sought to understand the experiences of patients—those who had received prior kidney disease care and those who had not—during this transition to kidney failure and dialysis treatment. We interviewed and surveyed 47 patients in metropolitan Philadelphia within 5 months of their dialysis initiation to understand and compare their experiences. Nearly all participants described this transition as traumatic and chaotic, even those who had received prior kidney disease care. Th","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"88 1","pages":"Pages 67-77.e1"},"PeriodicalIF":9.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147735535","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 “The Association of Class I and II Human Leukocyte Antigen Serotypes With End-Stage Kidney Disease Due to Membranoproliferative Glomerulonephritis and Dense Deposit Disease” (Am J Kidney Dis. 2024;83(1):79-89)","authors":"","doi":"10.1053/j.ajkd.2026.04.002","DOIUrl":"10.1053/j.ajkd.2026.04.002","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"88 1","pages":"Pages 177-178"},"PeriodicalIF":9.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283075","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":"CKD in Africa: A Call to Urgent, Coordinated Action","authors":"Robert Kalyesubula,&nbsp;Aminu Bello,&nbsp;Marcello Tonelli","doi":"10.1053/j.ajkd.2026.05.001","DOIUrl":"10.1053/j.ajkd.2026.05.001","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"88 1","pages":"Pages 38-40"},"PeriodicalIF":9.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148282997","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":"Diagnostic Challenges of Acute Kidney Injury in a Patient With High-Risk Multiple Myeloma: A Quiz","authors":"Emmanuel Garrastegui Mercado,&nbsp;Sarwat Gilani,&nbsp;Tareq Nassar,&nbsp;Swetha R. Kanduri","doi":"10.1053/j.ajkd.2025.11.020","DOIUrl":"10.1053/j.ajkd.2025.11.020","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"88 1","pages":"Pages A11-A14"},"PeriodicalIF":9.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283036","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":"Association of Ertugliflozin on Kidney Outcomes in People After and Without an Interval Cardiovascular Event: Observations From the VERTIS CV Trial","authors":"Ayodele Odutayo,&nbsp;Francesco Cosentino,&nbsp;Richard E. Pratley,&nbsp;Christopher P. Cannon,&nbsp;Chih-Chin Liu,&nbsp;Robert Frederich,&nbsp;Urszula Masiukiewicz,&nbsp;Nilo B. Cater,&nbsp;Ira Gantz,&nbsp;David Z.I. Cherney,&nbsp;VERTIS CV Investigators","doi":"10.1053/j.ajkd.2026.01.017","DOIUrl":"10.1053/j.ajkd.2026.01.017","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"88 1","pages":"Pages 118-121"},"PeriodicalIF":9.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147735536","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":"KDOQI US Commentary on the KDIGO 2026 Clinical Practice Guideline for the Management of Anemia in CKD","authors":"Diana I. Jalal,&nbsp;Nisha Bansal,&nbsp;Monique E. Cho,&nbsp;Steven Fishbane,&nbsp;Orlando M. Gutierrez,&nbsp;Csaba P. Kovesdy,&nbsp;Abhijit Kshirsagar,&nbsp;Bruce Spinowitz,&nbsp;Jay Wish","doi":"10.1053/j.ajkd.2026.03.036","DOIUrl":"10.1053/j.ajkd.2026.03.036","url":null,"abstract":"<div><div>The prevalence of anemia is high in people with chronic kidney disease (CKD) and increases as the disease advances. The Kidney Disease Outcomes Quality Initiative (KDOQI) convened a work group to review the Kidney Disease: Improving Global Outcomes (KDIGO) 2026 clinical practice guideline for the management of anemia in CKD. The previous KDIGO anemia guideline was published in 2012; in 2019 and 2021 KDIGO convened conferences addressing controversies in iron management and hypoxia-inducible factor-prolyl hydroxylase inhibitor (HIF-PHI) use, respectively. The KDOQI work group provides perspective for implementation of the KDIGO 2026 anemia guideline within the context of clinical practice in the United States. The KDOQI work group agrees with most of the KDIGO recommendations, particularly the proactive use of intravenous (IV) iron in hemodialysis patients and the preference for erythropoiesis stimulating agents (ESAs) over HIF-PHIs for first-line anemia therapy, due to greater familiarity with safety of the former. Specific issues regarding recommendations and practice points for providers in the United States include higher serum ferritin targets and mean levels among people receiving hemodialysis than in the rest of the world; the availability of a single HIF-PHI product with approval only for patients receiving dialysis for ≥3 months; and payment barriers that may drive the choice of therapeutic agents. Additional commentary is provided on topics including IV iron therapy in people receiving hemodialysis and an iron-based phosphate binder, the incidence and significance of hypophosphatemia among people with CKD not on dialysis but receiving IV iron therapy, the physiologic importance of iron repletion in people with CKD and iron deficiency without anemia, possible therapeutic benefits of HIF-PHIs compared with ESAs, and assessing risk versus harm of red blood cell transfusions.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"88 1","pages":"Pages 1-17"},"PeriodicalIF":9.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832316","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}