American Journal of Kidney Diseases最新文献

{"title":"Obesity Management in End-Stage Kidney Disease: Pathways to Improve Kidney Transplant Access.","authors":"Pooja Budhiraja,Babak J Orandi","doi":"10.1053/j.ajkd.2025.11.019","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.11.019","url":null,"abstract":"Obesity is highly prevalent among patients with end-stage kidney disease (ESKD) and remains a major barrier to kidney transplantation, the optimal kidney replacement therapy for improving survival and quality of life. Weight loss strategies tailored to the ESKD population are urgently needed to expand access. This review examines the role of lifestyle interventions, pharmacotherapy, and bariatric surgery in supporting transplant candidacy. While lifestyle modification is foundational, its effectiveness in ESKD is limited by metabolic, physical, and psychosocial barriers. Pharmacologic agents, particularly glucagon-like peptide-1 receptor agonists, offer promising weight loss and metabolic benefits, though access and safety data in ESKD remain limited. Bariatric surgery, increasingly performed in this population, provides durable weight loss, especially for patients requiring ≥20% reduction in weight to meet transplant body mass index criterion. We also highlight systemic barriers, including payer policies, program-level variability, and disparities in access, that shape patient outcomes. An integrated approach combining clinical strategies with supportive policies is essential to reduce inequities and expand timely access to kidney transplantation for patients with ESKD and obesity.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"16 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147536494","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":"A Survey of Home Dialysis Competency, Exposure & Barriers Among Nephrology Fellows in the United States.","authors":"Osama El Shamy,Matthew A Sparks,Ankur D Shah,Maria Bermudez,Megha Salani,Graham Abra,Lauren Stern,Ashté Collins,Vikram Aggarwal,Matthew B Rivara,Jenny I Shen,Jeffrey S Berns","doi":"10.1053/j.ajkd.2025.12.006","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.12.006","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"61 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147524589","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":"Remote Ischemic Preconditioning: Is This Star Still Rising?","authors":"John A Kellum,Dana Y Fuhrman,Oladipupo Olafiranye,Alexander Zarbock","doi":"10.1053/j.ajkd.2025.09.031","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.09.031","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"58 1 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147524588","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":"National All-Cause Mortality Trends Among Adults With and Without CKD in the United States, 1999-2019.","authors":"Daesung Choi, Fang Xu, Ibrahim Zaganjor, Stephen Onufrak, Sola Han, Meda E Pavkov","doi":"10.1053/j.ajkd.2026.01.010","DOIUrl":"10.1053/j.ajkd.2026.01.010","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Chronic kidney disease (CKD) is one of the most highly prevalent chronic conditions in the United States and associated with a high risk of premature death, particularly from cardiovascular disease. However, contemporary national trends in all-cause mortality among adults with CKD in the United States remain unclear. This study examined trends in all-cause mortality among US adults with CKD from 1999 to 2019.</p><p><strong>Study design: </strong>Observational cohort study.</p><p><strong>Setting & participants: </strong>Adults aged ≥20 years who participated in the 1999-2016 National Health and Nutrition Examination Survey (NHANES), with mortality follow-up through December 2019.</p><p><strong>Exposure: </strong>CKD defined by an estimated glomerular filtration rate < 60 mL/min/1.73 m² or a urinary albumin-creatinine ratio ≥ 30 mg/g.</p><p><strong>Outcome: </strong>All-cause mortality.</p><p><strong>Analytical approach: </strong>Age-standardized all-cause mortality rates were estimated for 3 survey periods: 1999-2004, 2005-2010, and 2011-2016. Average percent change (APC) in age-standardized mortality and adjusted relative risk (RR) of CKD-associated mortality for each survey period were estimated.</p><p><strong>Results: </strong>Age-standardized mortality rate was 23.0 deaths/1,000 person-years (95% CI, 19.8-26.2) among adults with CKD surveyed 1999-2004 and 21.8 deaths/1,000 person-years (95% CI, 18.8-24.9) for those surveyed 2011-2016 (APC, -0.4% [95% CI, -1.4 to 0.5]). In contrast to men whose mortality declined (APC, -3.0 [95% CI, -3.5 to -2.6]), mortality rates increased among women with CKD (APC, 2.3 [95% CI, 1.7-3.0]). Adjusted RRs for CKD-associated mortality remained approximately 2-fold higher compared with adults without CKD across all time periods.</p><p><strong>Limitations: </strong>The cross-sectional design of NHANES precludes analysis of CKD progression or incident CKD during follow-up.</p><p><strong>Conclusions: </strong>All-cause mortality remained stable among adults with CKD and was about 2 times higher than for those without CKD. However, increasing mortality trends in specific demographic subpopulations may indicate the need for focused public health strategies and further research to address and reduce mortality disparities.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147508584","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 Autosomal Dominant Polycystic Kidney Disease With Incident Aortic Dissection or Aneurysm.","authors":"Takashin Nakayama, Hidehiro Kaneko, Yuta Suzuki, Akira Okada, Hiroyuki Morita, Katsuhito Fujiu, Norifumi Takeda, Tatsuhiko Azegami, Takashi Yokoo, Norihiko Takeda, Koichi Node, Hideo Yasunaga, Masaomi Nangaku, Kaori Hayashi","doi":"10.1053/j.ajkd.2025.12.004","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.12.004","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Autosomal dominant polycystic kidney disease (ADPKD) is characterized by a broad range of extrarenal complications, yet epidemiologic data on its association with aortic dissection (AD) or aortic aneurysm (AA) remain limited. In the present study, we assessed whether ADPKD is associated with an increased risk of developing these aortic conditions.</p><p><strong>Study design: </strong>Observational cohort study.</p><p><strong>Setting & participants: </strong>2,568,283 individuals without a history of AD or AA, enrolled between April 2014 and August 2023 in a nationwide Japanese epidemiological database provided by DeSC Healthcare (Tokyo, Japan).</p><p><strong>Exposure: </strong>Presence of ADPKD based on the International Classification of Diseases, 10th Revision codes.</p><p><strong>Outcome: </strong>Incidence of AD or AA.</p><p><strong>Analytical approach: </strong>Cause-specific hazards models were used to estimate associations (HRs), adjusting for potential confounders.</p><p><strong>Results: </strong>The median age was 68 years (interquartile range [IQR]: 61-77), and 1,123,131 individuals (44%) were male. ADPKD was diagnosed in 1,102 individuals (0.04%) within the cohort. During a median follow-up of 1,043 days (IQR: 556-1,600), there were 15,019 occurrences of AD or AA. Multivariable cause-specific hazards models demonstrated that individuals with ADPKD had a significantly increased risk of developing these aortic diseases (HR 1.76; 95% confidence interval [CI], 1.13-2.73). When analyzed separately, the HRs were 2.53 (95% CI, 1.13-5.66) for AD and 1.56 (95% CI, 0.94-2.60) for AA. The association of ADPKD with incident AD or AA was more pronounced in individuals with body mass index (BMI) ≥ 25 kg/m² than in those with BMI < 25 kg/m².</p><p><strong>Limitations: </strong>Potential residual confounding, possible detection bias, and lack of data on ADPKD-causing genetic mutation.</p><p><strong>Conclusions: </strong>Our analysis of a large-scale epidemiological dataset indicated an elevated risk of AD or AA occurrence in individuals with ADPKD. These findings may inform the clinical management of this condition.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147508589","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":"Implications of AKI-D Versus ESKD Status.","authors":"Ian E McCoy, Eugene Lin","doi":"10.1053/j.ajkd.2025.11.015","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.11.015","url":null,"abstract":"<p><p>More than 20% of patients receiving dialysis at in-center hemodialysis facilities initiate dialysis for acute kidney injury requiring dialysis (AKI-D) rather than end-stage kidney disease (ESKD). The transition from AKI-D to ESKD status is important to reorient clinical efforts from short-term monitoring for recovery to equally important long-term goals of establishing permanent dialysis access and planning for kidney transplant. The timing of this transition is highly variable and determined by the treating nephrologist. Due to numerous subtle policy differences, the implications of transitioning a patient receiving dialysis for AKI-D to ESKD status can be complex and far-reaching. Here, we aim to describe both the financial and non-financial implications of the AKI-D to ESKD status transition. Clinicians and policy makers alike may be able to improve the care of this vulnerable patient population through a better understanding of these implications. We conclude with policy recommendations to address disincentives to optimal care.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147508609","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":"Cancer Incidence in People With Glomerular Disease: A Population-Level Study.","authors":"Jialin Han, Mark Canney, Yinshan Zhao, Mohammad Atiquzzaman, Adeera Levin, Sean J Barbour","doi":"10.1053/j.ajkd.2025.11.014","DOIUrl":"10.1053/j.ajkd.2025.11.014","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rational & objective: &lt;/strong&gt;People with glomerulonephritis (GN) may be at an increased risk of cancer, but existing studies have not accurately clarified the cancer risk in patients with GN. A better understanding of these risks may inform cancer screening strategies and identify potentially modifiable risk factors. This study identified risk factors for cancer among Canadian patients with GN.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective observational cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting & participants: &lt;/strong&gt;Adults with diagnosed GN (n = 4,039) identified using a centralized pathology registry in British Columbia, Canada, between 2000 and 2020.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Known cancer risk factors, including age, sex, ethnicity, smoking, alcohol abuse, obesity, diabetes, dyslipidemia, hypertension, and cardiovascular disease as well as GN-related potential risk factors, including GN disease type, estimated glomerular filtration rate (eGFR), and level of proteinuria.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome: &lt;/strong&gt;All-cause cancer, excluding non-melanoma skin cancer.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Analytical approach: &lt;/strong&gt;Standardized incidence ratios (SIRs) were calculated using an age- and sex-matched general population. The time to the first cancer event was modeled using a cause-specific hazards model, with death considered as a competing event.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The mean age of the cohort was 51 years, and 52% of the participants were male. During a median of 7.8 years of follow-up, 384 patients (9.5%) developed de novo cancer. The 20-year cancer risk was 23%, with an incidence rate 30% higher than the general population (SIR, 1.3 [95% CI, 1.2-1.4]). The risk was most pronounced in patients younger than 40, almost 3-fold higher than in the general population (SIR, 2.9 [95% CI, 1.6-4.6]). Significant increases in cancer incidence were observed for lymphoma (SIR, 3.5), kidney (SIR, 2.6), colorectal (SIR, 2.4), and lung cancers (SIR, 1.5). Elevated risk was observed both before and after the onset of end-stage kidney disease. Age, male sex, baseline eGFR, and GN disease type were independently associated with cancer risk.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The lack of immunosuppression data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Patients with GN have a substantially increased risk of cancer compared with the general population, particularly younger patients who are typically excluded from current screening programs. These findings suggest the need to raise awareness of the cancer risk among people with GN and may inform the further development of tailored cancer screening and prevention strategies, especially among younger adults with GN.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain-language summary: &lt;/strong&gt;People with glomerulonephritis (GN) are thought to be at an increased risk of cancer, but previous studies had limitations that limited the accuracy of the cancer risk estimates in this population. This study of 4,039 patients with GN found the inciden","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147508632","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":"Representation of Adults With CKD in Major Endovascular Stroke Trials.","authors":"Sneha Lakshman, Greg Zaharchuk, Manjula Kurella Tamura","doi":"10.1053/j.ajkd.2025.10.024","DOIUrl":"10.1053/j.ajkd.2025.10.024","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13035339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147508664","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":"Experiences and Management of People With a Failing Kidney Transplant: Findings From the IN-FAKT Study.","authors":"Bonnie Venter, Jane Noyes, Lucy E Selman, Catherine Exley, Siân Griffin, Alan Hancock, Leah McLaughlin, Barnaby Hole, Pippa K Bailey","doi":"10.1053/j.ajkd.2026.01.009","DOIUrl":"10.1053/j.ajkd.2026.01.009","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale & objective: &lt;/strong&gt;Transplant failure is associated with a morbidity burden, increased mortality, and poor quality of life. We have a limited understanding of how patients prepare for transplant failure, when they do so, and what experiences and priorities are relevant to clinical management decisions when transplants are failing. This study investigated the experiences of living with and managing kidney transplant failure among patients, families and friends, and health care professionals (HCPs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Qualitative semistructured interview study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting & participants: &lt;/strong&gt;Three groups of adults sampled from 3 UK hospitals: (1) people with a failing kidney transplant or one that had failed in the last year; (2) family/friends of group 1; (3) kidney transplant HCPs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Analytical approach: &lt;/strong&gt;Inductive analysis based in constructivist grounded theory.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We interviewed 41 participants (15 people with failing/failed transplants, 9 family/friends, 17 HCPs). We identified 8 theoretical categories under 3 headings. First, the experience of waiting: (1) a constant threat: anticipation of failure; (2) lack of preparedness; (3) liminality: an indeterminate and in-between state. Second, shaping conversations about failing transplants: (4) navigating uncertainty; (5) responsibility and control; (6) failing to acknowledge failure: the elephant in the room. Third, the focus on the failing transplant: (7) maximizing mileage and missed opportunities; (8) the ripple effect of failure and family suffering. \"Duality\" emerged as the core category to describe findings that appeared to be in opposition but were experienced or delivered simultaneously. Patients experienced failure as both an inevitability and a surprise, and they felt both responsible for and as having no control over the transplant outcome. HCPs identified a need for parallel planning: simultaneously prolonging transplant survival and planning posttransplant treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Adult participants only.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Our study identified targets for improving the experiences of people with transplant failure, related to explicit communication, navigating uncertainty, and parallel planning.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain-language summary: &lt;/strong&gt;We interviewed people who were experiencing or had experienced kidney transplant failure, their family and friends, and health care professionals (HCPs) about their experiences of living with and managing this failure. Patients described transplant failure as a constant threat, but they did not feel prepared for it. Patients and their families have many questions including: When will the transplant fail? How will it happen? Why did it fail? HCPs are unable to fully answer these questions, and patients feel responsible for what happens to their transplant. Our research shows that talking about transplan","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147508606","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 the Timing of Acute Declines in Kidney Function in Acute Heart Failure With Cardiovascular and Kidney Outcomes.","authors":"Wendy McCallum, Hocine Tighiouart, Marcelle Tuttle, Tatsufumi Oka, Jeffrey M Testani, James E Udelson, Isabel Bautista, Anuradha Lala, Maria Rosa Costanzo, Christopher M O'Connor, Mona Fiuzat, Marvin A Konstam, Mark J Sarnak","doi":"10.1053/j.ajkd.2025.12.005","DOIUrl":"10.1053/j.ajkd.2025.12.005","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale & objective: &lt;/strong&gt;Inconsistencies in the association of acute declines in kidney function with longer-term cardiovascular (CV) and kidney outcomes in patients with acute heart failure (AHF) may be due to different approaches to assessing the timing of the decline. This study examined the influence of the timing of acute kidney function decline among patients with AHF on the associations of these declines with mortality, CV outcomes, and long-term kidney function.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Observational analysis of clinical trial data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting & participants: &lt;/strong&gt;Participants in the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan (EVEREST) trial hospitalized for AHF.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Kidney function decline (defined by creatinine increase by ≥0.3 mg/dL, creatinine increase by &gt;50%, and percentage of creatinine change) at 3 different time points (3, 7, and 14 days after randomization).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome: &lt;/strong&gt;Mortality, a composite of CV mortality or heart failure (HF) hospitalization, incident estimated glomerular filtration rate (eGFR) &lt; 30 mL/min/1.73 m&lt;sup&gt;2&lt;/sup&gt;, and a &gt;40% eGFR decline.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Analytical approach: &lt;/strong&gt;Analytical Approach: Multivariable cause-specific proportional hazards regression models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 3,931 patients over a median follow-up of 9.9 months, acute kidney function decline at 3 days was not associated with mortality (HR, 0.98 [95% CI, 0.88-1.09] per 30% creatinine increase) or with the composite outcome of CV mortality and HF hospitalization (HR, 0.96 [95% CI, 0.89-1.05]). By contrast, acute kidney function decline at 7 days after randomization was associated with a higher risk of mortality (HR, 1.19 [95% CI, 1.10-1.30] per 30% creatinine increase) and the composite outcome (HR, 1.10 [95% CI, 1.03-1.18]). Acute kidney function decline at 14 days after randomization also was associated with a higher risk of mortality (HR, 1.27 [95% CI, 1.16-1.38] per 30% creatinine increase) and the composite outcome (HR, 1.15 [95% CI, 1.08-1.23]). Acute kidney function declines at 3, 7, and 14 days after randomization were all associated with significantly higher risk of incident eGFR &lt; 30 mL/min/1.73 m&lt;sup&gt;2&lt;/sup&gt; and &gt;40% eGFR decline.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Limited generalizability from the study of clinical trial participants.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Among patients hospitalized for AHF, incorporating the timing of acute kidney function declines may inform prognostic assessment of CV end points. Acute declines in kidney function at all studied time points were associated with longer-term kidney function.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain-language summary: &lt;/strong&gt;Acute declines in kidney function are frequently encountered among patients admitted for acute heart failure. Using data from the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvapta","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147508655","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}