American Journal of Kidney Diseases最新文献

{"title":"Long-Term Exposure to Uranium and Arsenic in Community Drinking Water and CKD Risk Among California Women.","authors":"Danielle N Medgyesi,Sumit Mohan,Komal Bangia,Emma S Spielfogel,Maya Spaur,Anirban Basu,Jared A Fisher,Jessica M Madrigal,Arce Domingo-Relloso,Rena R Jones,Mary H Ward,James V Lacey,Tiffany R Sanchez,","doi":"10.1053/j.ajkd.2025.04.008","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.04.008","url":null,"abstract":"RATIONALE & OBJECTIVEMetals/metalloids in drinking water, including uranium and arsenic, may damage kidney function and increase chronic kidney disease (CKD) risk. We evaluated exposure to these contaminants in community water supplies (CWS) and CKD risk in the California Teachers Study.STUDY DESIGNProspective cohort study.SETTING & PARTICIPANTS88,185 women who were California teachers and school administrators enrolled 1995-1996.EXPOSURESTime- and residence- weighted annual average uranium and arsenic concentrations from CWS serving participants' residential addresses from 1995 to 2005.OUTCOME6,185 moderate to end-stage CKD cases from hospitalization records between 2005 and 2018.ANALYTICAL APPROACHHazard ratios (HRs) and 95% confidence intervals (95%CIs) calculated using mixed-effects Cox models, adjusted for age as the time scale, body mass index, smoking status, race/ethnicity, neighborhood socioeconomic status, and Census region as a random effect. Analyses were also stratified by risk factors and comorbidities.RESULTSMost exposures in this population were below the current regulatory limits (uranium=30μg/L and arsenic=10 μg/L), with median (interquartile range; IQR) concentrations of 3.1 (0.9, 5.6) μg/L for uranium and 1.0 (0.6, 1.8) μg/L for arsenic. Uranium exposure was positively associated with CKD risk (continuous log, per IQR; HR=1.11, 95%CI=1.02-1.20). Compared to uranium exposure <2μg/L (World Health Organization 1998 guideline), risk was over 30% greater at 10-<15μg/L (HR=1.33, 95%CI=1.15-1.54) and similar at ≥15μg/L (HR=1.32, 95%CI=1.09-1.58). There was no evidence of a significant association between arsenic and CKD overall (log, per IQR; HR=1.02, 95%CI=0.98-1.07). However, risk from arsenic was greater among younger individuals (≤55 years), and those who developed cardiovascular disease or diabetes.LIMITATIONSIndividual tap water use and consumption; limited generalizability to men and non-White and less affluent populations.CONCLUSIONSUranium below the current regulatory limit from community water may increase CKD risk.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"35 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087503","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":"Volume 1: Chronic Kidney Disease","authors":"","doi":"10.1053/j.ajkd.2025.04.002","DOIUrl":"10.1053/j.ajkd.2025.04.002","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 6","pages":"Pages S1-S187"},"PeriodicalIF":9.4,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143946694","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":"Support Page","authors":"","doi":"10.1053/S0272-6386(25)00830-3","DOIUrl":"10.1053/S0272-6386(25)00830-3","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 6","pages":"Page A5"},"PeriodicalIF":9.4,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143946610","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":"US Renal Data System 2024 Annual Data Report: Epidemiology of Kidney Disease in the United States","authors":"Kirsten L. Johansen ,&nbsp;David T. Gilbertson ,&nbsp;Shuling Li ,&nbsp;Suying Li ,&nbsp;Jiannong Liu ,&nbsp;Nicholas S. Roetker ,&nbsp;Allyson Hart ,&nbsp;Christopher D. Knapp ,&nbsp;Elaine Ku ,&nbsp;Neil R. Powe ,&nbsp;Jon Snyder ,&nbsp;Wendy St. Peter ,&nbsp;Eric D. Weinhandl ,&nbsp;James B. Wetmore","doi":"10.1053/j.ajkd.2025.02.602","DOIUrl":"10.1053/j.ajkd.2025.02.602","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 6","pages":"Pages A8-A11"},"PeriodicalIF":9.4,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143946693","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":"Volume 2: End Stage Renal Disease","authors":"","doi":"10.1053/j.ajkd.2025.04.003","DOIUrl":"10.1053/j.ajkd.2025.04.003","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 6","pages":"Pages S188-S565"},"PeriodicalIF":9.4,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143946695","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":"Complex Etiologies of the Discordance Between Cystatin C- and Creatinine-Based Estimated GFR and Its Adverse Associations: Findings From the CRIC Study.","authors":"Ian E McCoy, Jingrong Yang, Alan S Go, Hernan Rincon-Choles, Jonathan Taliercio, Sylvia E Rosas, Mark Unruh, Vallabh Shah, Debbie L Cohen, Jiang He, Jing Chen, James Sondheimer, Afshin Parsa, Wei Yang, Panduranga S Rao, Chi-Yuan Hsu","doi":"10.1053/j.ajkd.2025.03.018","DOIUrl":"10.1053/j.ajkd.2025.03.018","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale & objective: &lt;/strong&gt;The difference between glomerular filtration rate (GFR) estimated by cystatin C and creatinine (eGFR&lt;sub&gt;diff&lt;/sub&gt;, defined as eGFR&lt;sub&gt;cys&lt;/sub&gt;-eGFR&lt;sub&gt;cr&lt;/sub&gt;) has been repeatedly associated with adverse outcomes, often ascribed to low muscle mass. However, it is unclear to what extent putative determinants of eGFR&lt;sub&gt;diff&lt;/sub&gt;, such as low muscle mass, explain associations between eGFR&lt;sub&gt;diff&lt;/sub&gt; and the outcomes of death and heart failure. Determinants of eGFR&lt;sub&gt;diff&lt;/sub&gt; have not been investigated to assess their impacts on eGFR&lt;sub&gt;cys&lt;/sub&gt;, eGFR&lt;sub&gt;cr&lt;/sub&gt;, and ultimately eGFR&lt;sub&gt;diff&lt;/sub&gt; in a dataset with measured GFR.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Prospective cohort study for outcomes of eGFR&lt;sub&gt;diff&lt;/sub&gt; and cross-sectional study for determinants of eGFR&lt;sub&gt;diff&lt;/sub&gt;.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting & participants: &lt;/strong&gt;1,290 adult participants in the Chronic Renal Insufficiency Cohort (CRIC) Study with directly measured iothalamate GFR, 24-hour urine creatinine collections, and plasma measurements of larger molecules such as β&lt;sub&gt;2&lt;/sub&gt;-microglobulin.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Baseline eGFR&lt;sub&gt;diff&lt;/sub&gt; (eGFR&lt;sub&gt;cys&lt;/sub&gt;-eGFR&lt;sub&gt;cr&lt;/sub&gt;) for prospective analysis; putative eGFR&lt;sub&gt;diff&lt;/sub&gt; determinants for cross-sectional analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome: &lt;/strong&gt;Time to all-cause death, heart failure hospitalization for prospective analyses, and eGFR for cross-sectional analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Analytical approach: &lt;/strong&gt;Cox proportional hazards regression for prospective analysis and linear regression for cross-sectional analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among adults with CKD, a more positive eGFR&lt;sub&gt;diff&lt;/sub&gt; was associated with decreased risk of death (adjusted HR, 0.80 [95% CI, 0.74-0.88]) and heart failure hospitalization (adjusted HR 0.83 [95% CI, 0.73-94]). Neither association was substantially changed by adjustment for putative determinants of eGFR&lt;sub&gt;diff&lt;/sub&gt;. Estimated GFR&lt;sub&gt;diff&lt;/sub&gt; was weakly correlated with markers of muscle mass, middle molecule clearance, and other putative determinants of eGFR&lt;sub&gt;diff&lt;/sub&gt; (eg, obesity, inflammation). Only 36% of the variance in eGFR&lt;sub&gt;diff&lt;/sub&gt; was explained by these factors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Imprecision in measurements such as 24-hour urine collections.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The associations of eGFR&lt;sub&gt;diff&lt;/sub&gt; with adverse outcomes were unchanged by adjustment for markers of putative determinants such as muscle mass. Examined putative determinants of eGFR&lt;sub&gt;diff&lt;/sub&gt; accounted for a minority of the variance in eGFR&lt;sub&gt;diff&lt;/sub&gt;.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain-language summary: &lt;/strong&gt;The difference between estimated glomerular filtration rates (eGFR&lt;sub&gt;diff&lt;/sub&gt;) using serum creatinine and cystatin C (eGFR&lt;sub&gt;cys&lt;/sub&gt;-eGFR&lt;sub&gt;cr&lt;/sub&gt;) has been repeatedly associated with adverse outcomes, including death and heart failure. The biological me","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075356","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":"Fenofibrate-Induced Osmotic Nephropathy: A Novel Mechanism of Acute Kidney Injury.","authors":"Raymond Lin,Seethalakshmi Viswanathan,Nikki L Wong","doi":"10.1053/j.ajkd.2025.03.019","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.03.019","url":null,"abstract":"Fibrates are a commonly utilized medication in the management of dyslipidaemia and cardiovascular risk. These agents have a well-documented association with reversible elevations in serum creatinine and in some instances acute kidney injury. The mechanism underlying the renal effects of fibrates are currently not well-understood. We describe a case of acute kidney injury in a patient who was administered an unadjusted dose of fenofibrate in the setting of severe renal impairment. Kidney biopsy demonstrated extensive isometric vacuolization within tubular epithelial cells consistent with osmotic-type injury. Fenofibrate in this case was the likely causative agent based on the temporal relationship of drug administration and acute kidney injury. The acute kidney injury also recovered over a timeframe consistent with the known half-life of the drug metabolite. There were no other drugs, extremes instances of hyperglycaemia, or intravenous agents administered to account for the biopsy findings. This case demonstrates a potential novel mechanism of fenofibrate-associated acute kidney injury with osmotic nephropathy. We review the current understanding of the effects of fenofibrate on the kidney and possible pathogenesis of osmotic nephropathy.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"40 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982535","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":"Finding Barriers for the Implementation of Advanced Care Planning in Patients Receiving Dialysis","authors":"Marie Evans ,&nbsp;Jenny Lindberg ,&nbsp;Johan Sundelöf","doi":"10.1053/j.ajkd.2025.03.013","DOIUrl":"10.1053/j.ajkd.2025.03.013","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 6","pages":"Pages 671-673"},"PeriodicalIF":9.4,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143893286","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":"Comparative Effectiveness of Glucagon-Like Peptide-1 Receptor Agonists and Sodium/Glucose Cotransporter 2 Inhibitors in Preventing Chronic Kidney Failure and Mortality in Patients With Type 2 Diabetes and CKD","authors":"Yen-Chieh Lee MD PhD, Li-Chiu Wu MS, Vin-Cent Wu MD PhD, Chia-Hsuin Chang MD ScD","doi":"10.1053/j.ajkd.2025.03.016","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.03.016","url":null,"abstract":"Both glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium/glucose cotransporter 2 (SGLT2) inhibitors improve cardiovascular, kidney, and survival outcomes in patients with type 2 diabetes; however, the comparative effectiveness of these drugs in a real-world setting remains unclear.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"35 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143901638","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":"The Delivery of Kidney Care in Rural or Sparsely Populated Settings.","authors":"Sireesha Koppula,Krishna Patel,Mark Unruh","doi":"10.1053/j.ajkd.2025.03.017","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.03.017","url":null,"abstract":"Social determinants of health and limited access to medical care contribute to underdiagnosis and late presentation of chronic kidney disease (CKD). Rural areas face unique challenges in providing optimal care for patients with CKD due to poverty, limited healthcare access, and geographical barriers. This review will address the challenges of caring for rural patients with CKD and discuss potential strategies to increase healthcare equity. Furthermore, we will examine rural disparities in patients with CKD, patients with kidney failure on in-center or home dialysis, and patients with kidney transplants, highlighting the need for targeted interventions to address these disparities. Addressing the challenges faced by rural patients with CKD requires a multifaceted approach, including improving access to healthcare services, implementing telemedicine and telemonitoring technologies, enhancing the knowledge of primary care physicians around CKD, improving care coordination, and increasing preventive measures. We must create a kidney health model combining early detection, prevention, and disease surveillance to decrease disease progression. Healthcare policies should also incentivize and support the expansion of the rural healthcare workforce. Targeted interventions aimed at reducing rural disparities for patients with CKD and those using in-center hemodialysis, home dialysis, or transplantation are crucial to ensure equitable care.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"75 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143902938","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}