American Journal of Kidney Diseases最新文献

{"title":"ACGME Accreditation for Transplant Nephrology Training: Clarifying Why This is a Step in the Right Direction.","authors":"Neeraj Singh, Michelle A Josephson, Vineeta Kumar, Roy D Bloom","doi":"10.1053/j.ajkd.2024.11.001","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.11.001","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695187","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":"Three Ankle-Brachial Index Ranges and Incident CKD in Diabetes: A Goldilocks Perspective on the \"Just Right\" Range.","authors":"Houry Puzantian, Raymond R Townsend","doi":"10.1053/j.ajkd.2024.09.003","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.09.003","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680550","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":"ACGME Accreditation for Transplant Nephrology Training: Clarifying Why This is a Step in the Right Direction.","authors":"Neeraj Singh, Michelle A Josephson, Vineeta Kumar, Roy D Bloom","doi":"10.1053/j.ajkd.2024.09.009","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.09.009","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142685767","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":"KDOQI US Commentary on the KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of CKD.","authors":"Sankar D Navaneethan, Nisha Bansal, Kerri L Cavanaugh, Alexander Chang, Susan Crowley, Cynthia Delgado, Michelle M Estrella, Cybele Ghossein, T Alp Ikizler, Holly Koncicki, Wendy St Peter, Katherine R Tuttle, Jeffrey William","doi":"10.1053/j.ajkd.2024.08.003","DOIUrl":"10.1053/j.ajkd.2024.08.003","url":null,"abstract":"<p><p>The Kidney Disease Outcomes Quality Initiative (KDOQI) convened a work group to review the 2024 KDIGO (Kidney Disease: Improving Global Outcomes) guideline for the management of chronic kidney disease (CKD). The KDOQI Work Group reviewed the KDIGO guideline statements and practice points and provided perspective for implementation within the context of clinical practice in the United States. In general, the KDOQI Work Group concurs with several recommendations and practice points proposed by the KDIGO guidelines regarding CKD evaluation, risk assessment, and management options (both lifestyle and medications) for slowing CKD progression, addressing CKD-related complications, and improving cardiovascular outcomes. The KDOQI Work Group acknowledges the growing evidence base to support the use of several novel agents such as sodium/glucose cotransporter 2 inhibitors for several CKD etiologies, and glucagon-like peptide 1 receptor agonists and nonsteroidal mineralocorticoid receptor antagonists for type 2 CKD in setting of diabetes. Further, KDIGO guidelines emphasize the importance of team-based care which was also recognized by the work group as a key factor to address the growing CKD burden. In this commentary, the Work Group has also assessed and discussed various barriers and potential opportunities for implementing the recommendations put forth in the 2024 KDIGO guidelines while the scientific community continues to focus on enhancing early identification of CKD and discovering newer therapies for managing kidney disease.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142646814","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":"Improved Survival in Patients Receiving Hemodialysis Through Changes in Practice Patterns: Does This Apply to Your Country?","authors":"Anneke Kramer, Rianne Boenink, Vianda S Stel","doi":"10.1053/j.ajkd.2024.09.002","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.09.002","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638457","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":"Harmonizing the Different Perspectives on Growth Impairment in Pediatric CKD.","authors":"Melissa S Zhou, Alexander J Wolf, Ken Sutha","doi":"10.1053/j.ajkd.2024.08.004","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.08.004","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638453","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":"Clinicopathologic, Proteomic and Outcome Characteristics of Renal Apolipoprotein C-II Amyloidosis: A Case Series.","authors":"Samih H Nasr, Surendra Dasari, Anthony M Valeri, Jason D Theis, Ann Moyer, Alessia Buglioni, M Barry Stokes, Linda Hasadsri, Julie A Vrana, Samar M Said, Satoru Kudose, Neeraja Kambham, Mei Lin Bissonnette, Lihong Bu, Renu Gupta, Attaya Suvannasankha, Suzanne Martin, Xu Zeng, Renuka Sothinathan, Adil Jadoon, Tewabe Kebede, Srimathi Manickaratnam, Jordan L Rosenstock, Glen S Markowitz, Sanjeev Sethi, Nelson Leung, Ellen D McPhail","doi":"10.1053/j.ajkd.2024.09.007","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.09.007","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Amyloidosis derived from apolipoprotein C-II (AApoCII) is a recently discovered, rare form of amyloidosis. Data on clinical presentations and natural history are very limited. This study defines the clinicopathologic, proteomic and outcome characteristics of renal AApoCII.</p><p><strong>Study design: </strong>Case series.</p><p><strong>Setting & participants: </strong>Twenty-five renal AApoCII cases were identified from the Mayo Clinic Tissue Proteomics Laboratory archives from January 2008 through January 2024.</p><p><strong>Findings: </strong>All patients were White, 19 were ≥65 years old at diagnosis, and 18 were female. Seven had a family history of CKD. Patients presented with proteinuria (median 3.3 g/day) and reduced kidney function (n=16, median creatinine 1.6 mg/dl). No patient had clinical evidence of other organ involvement by amyloidosis or features of monogenic hypertriglyceridemia. Histologically, amyloid deposits were often weakly positive for Congo red and involved glomeruli in all cases (with a nodular pattern in 22), whereas extraglomerular involvement was less common and generally mild. Proteomic analysis revealed abundant spectra for Apo C-II and for all 3 amyloid signature proteins (Apo E, Apo A-IV and SAP) in all cases, and detected an Apo C-II variant in 14 (K19T [p.Lys41Thr] in 12 and E47V [p.Glu69Val] in 2). Among 22 patients with follow-up available, there were 12 ESKD events and 2 deaths without ESKD during an average (SE) follow up of 75.5 (12.5) months.</p><p><strong>Limitations: </strong>Retrospective design, small sample size, APOC2 gene sequencing performed in a smaller subset.</p><p><strong>Conclusions: </strong>AApoCII mostly affects the kidney, and manifests in the elderly with proteinuria and CKD. A minority of these patients had a family history of kidney disease. Kidney failure occurred in about half, whereas overall survival was more favorable.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638450","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":"Trends in Kidney Allograft Failure Among First-Time Transplant Recipients in the United States.","authors":"Pascale Khairallah, Elizabeth C Lorenz, Amy Waterman, Nidhi Aggarwal, Akshta Pai, Wolfgang C Winkelmayer, Jingbo Niu","doi":"10.1053/j.ajkd.2024.09.005","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.09.005","url":null,"abstract":"<p><strong>Rationale & objective: </strong>The management and outcomes of kidney transplant recipients have evolved over the past three decades. This study of U.S patients whose first kidney allograft failed sought to understand long-term trends in subsequent waitlisting, re-transplantation, and all-cause mortality.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Setting & participants: </strong>Patients recorded in the United States Renal Data System (USRDS) whose first kidney allograft failed between 1990 and 2019.</p><p><strong>Exposure: </strong>The 5-year period in which the allograft failure occurred: 1990-1994, 1995-1999, 2000-2004, 2005-2009, 2010-2014, or 2015-2019.</p><p><strong>Outcomes: </strong>1) Waitlisting for re-transplantation, 2) re-transplantation, and 3) all-cause mortality following first allograft failure.</p><p><strong>Analytical approach: </strong>Competing risk survival analyses using the approach described by Fine and Gray were used for the outcomes of waitlisting and re-transplantation. Cox proportional hazards models were used for the outcome of all-cause mortality.</p><p><strong>Results: </strong>The absolute number of patients whose allograft failed and started dialysis increased from 3,197 in 1990 to 5,821 in 2019. Compared to 1990-1994, the rate of waitlisting for a second transplant increased with each subsequent 5-year period, peaking between 2005-2009 before decreasing again subsequently. The rate of re-transplantation following allograft failure decreased by 9%, 14%, 18%, 7%, and 11% in the sequential 5-year eras; and the mortality rate was 25% lower in 2015-2019 (HR=0.75, 95% CI, 0.72-0.77) compared to 1990-1994. Women had a reduced rate of waitlisting (HR 0.93, 95% CI 0.91-0.95) and lower rate of re-transplantation (HR 0.93, 95% CI 0.91, 0.95) compared to men. Compared to White patients, African-American and Hispanic patients had significantly lower rates of waitlisting, re-transplantation, and mortality.</p><p><strong>Limitations: </strong>Retrospective data that lacks granular clinical information.</p><p><strong>Conclusions: </strong>During the past three decades, among patients whose first kidney allograft failed and subsequently initiated dialysis, the rates of waitlisting for re-transplantation increased while the rates of re-transplantation and mortality decreased. Race-, ethnicity-, and sex-based disparities in waitlisting and re-transplantation were observed and warrant further investigation.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142611770","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":"From Calculations to Care: The Impact of Changes in Kidney Function Estimation on a Patient's Experience of Care.","authors":"Kristine Marie Guevarra Almonte, Gregory D Mumford, Pipier Smith-Mumford, David Lee, Martha Pavlakis, Melanie Hoenig, Aditya S Pawar","doi":"10.1053/j.ajkd.2024.07.009","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.07.009","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142611756","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":"Stopping Versus Continuing Metformin in Patients With Advanced CKD: A Nationwide Scottish Target Trial Emulation Study.","authors":"Emilie J Lambourg, Edouard L Fu, Stuart McGurnaghan, Bryan R Conway, Neeraj Dhaun, Christopher H Grant, Ewan R Pearson, Patrick B Mark, John Petrie, Helen Colhoun, Samira Bell","doi":"10.1053/j.ajkd.2024.08.012","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.08.012","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Current guidance recommends against the use of metformin in people with advanced kidney impairment despite a lack of supporting evidence. The aim of this observational study was to compare outcomes of patients with type 2 diabetes who continued versus stopped metformin after developing stage 4 chronic kidney disease (CKD) (eGFR <30 ml/min/1.73m²).</p><p><strong>Study design: </strong>Nationwide observational cohort study.</p><p><strong>Setting & participants: </strong>All adults with type 2 diabetes and incident stage 4 CKD in Scotland who were treated with metformin between January 2010 and April 2019.</p><p><strong>Exposure: </strong>Stopping versus continuing metformin within six months following incident stage 4 CKD.</p><p><strong>Outcomes: </strong>Primary outcome was all-cause mortality. Secondary outcomes included major adverse cardiovascular events (MACE).</p><p><strong>Analytical approach: </strong>Target trial emulation with clone-censor-weight design and marginal structural models fit for sensitivity analyses.</p><p><strong>Results: </strong>In a population of 371,742 Scottish residents with a diagnosis of type 2 diabetes before 30^th April 2019, 4,278 were identified as prevalent metformin users with incident CKD stage 4. Within six months of developing CKD stage IV, 1,713 (40.1%) individuals discontinued metformin. Compared with continuing metformin, stopping metformin was associated with a lower 3-year survival (63.7%, 95% CI 60.9 to 66.6 versus 70.5%, 95% CI 68.0 to 73.0; HR=1.26, 95% CI 1.10 to 1.44), while the incidence of MACE was similar between both strategies (HR=1.05, 95% CI 0.88 to 1.26). Marginal structural models confirmed the higher risk of all-cause mortality and similar risk of MACE in patients who stopped versus continued metformin (all-cause mortality: HR=1.34, 95% CI 1.08 to 1.67; MACE: HR=1.04, 95% CI 0.81 to 1.33).</p><p><strong>Limitations: </strong>Residual confounding.</p><p><strong>Conclusions: </strong>The continued use of metformin may be appropriate when eGFR falls below 30 ml/min/1.73m². Randomized controlled trials are needed to confirm these findings.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142611763","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}