American Journal of Kidney Diseases最新文献

{"title":"Impact of the Type of Dialysate Acid Concentrate Container on the Environmental Footprint of Hemodialysis Centers.","authors":"Rodrigo Martínez Cadenas,Julia Audije-Gil,María Dolores Arenas,Natalia Martín Vaquero,Jesús Portillo,James Larkin,Abass Fehintola,Alberto Ortiz,Brett Duane","doi":"10.1053/j.ajkd.2025.06.009","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.06.009","url":null,"abstract":"RATIONALE & OBJECTIVEHemodialysis is the most common form of kidney replacement therapy and has a significant environmental footprint, raising sustainability concerns as demand increases. This study aimed at assessing the environmental impact of one aspect of the hemodialysis procedure, the type of container used for holding the acid concentrate that is used to prepare dialysate.STUDY DESIGNA retrospective cross-sectional life cycle assessment (LCA) of acid concentrate containers used in hemodialysis was conducted.SETTING & PARTICIPANTSFifteen hemodialysis centers in three Spanish regions participated, representing approximately 5% of the national hemodialysis population.EXPOSUREFour acid concentrate container types from two manufacturers were assessed: canisters (3.9 L), flexible bags (4.2 L), and centralized storage tanks (300 L and 600 L).OUTCOMESThe primary outcome was the environmental impact of each container, measured by carbon footprint (CO2eq in kg) and 16 additional environmental impact categories.ANALYTICAL APPROACHLCA was performed using OpenLCA software and Ecoinvent v3.10 database, considering the full life cycle of the containers, including production, transport, and waste disposal.RESULTSThe 3.9 L canister had a carbon footprint 1.63-fold higher than the 4.2 L flexible bag and 2.63-fold higher than storage tanks (p<0.001). The main contributors to the carbon footprint were container production and waste disposal, particularly plastic usage and canister production and disposal. Storage tanks had the lowest carbon footprint (p<0.001), with no difference between 300 L and 600 L storage tanks. There were also significant differences in the environmental impact of different containers across 16 impact categories, with the largest differences observed for freshwater ecotoxicity, non-renewable energy use, and freshwater eutrophication.LIMITATIONSAssumptions regarding transport and disposal processes may introduce some variability. Additionally, financial costs were not assessed, which could influence container selection.CONCLUSIONThe choice of dialysate acid concentrate container is associated with a differential environmental impact. Thus, this study has identified a key potential approach to decrease the environmental impact of KRT.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"149 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144748018","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":"Reframing Acute Kidney Disease: Two Coins or Two Sides?","authors":"Christopher H. Grant ,&nbsp;Simon Sawhney ,&nbsp;Samira Bell","doi":"10.1053/j.ajkd.2025.07.002","DOIUrl":"10.1053/j.ajkd.2025.07.002","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 4","pages":"Pages 426-428"},"PeriodicalIF":8.2,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144720247","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":"Sex and Mortality Risk in Patients Following Failure of a Kidney Transplant.","authors":"Samantha Carija, Armando Teixeira-Pinto, Farzaneh Boroumand, Ryan Gately, Helen Pilmore, Charmaine Lok, Esther Ooi, Germaine Wong, Wai H Lim","doi":"10.1053/j.ajkd.2025.05.012","DOIUrl":"10.1053/j.ajkd.2025.05.012","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Female patients treated with dialysis experience poorer health outcomes compared with male patients, but few studies have examined sex differences in all-cause and cause-specific death after return to dialysis after failure of a kidney allograft. This study examined the association between sex and mortality after kidney allograft loss.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Setting & participants: </strong>Patients in Australia and New Zealand represented in the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), who returned to dialysis after loss of their first kidney allograft between 2000 and 2020.</p><p><strong>Exposure: </strong>Sex.</p><p><strong>Outcome: </strong>All-cause and cause-specific mortality on dialysis through 2020.</p><p><strong>Analytical approach: </strong>Flexible parametric survival models that integrated restricted cubic splines to examine the association between sex and mortality after kidney allograft loss. Models included sex by follow-up time interaction to examine whether these associations change over time. Follow-up was censored at the time of repeat transplantation.</p><p><strong>Results: </strong>Of 4,135 patients who lost their first kidney allografts, 1,576 were female (38%). During a median follow-up of 2.7 (IQR, 1.1-5.4) years, 1,476 patients (36%) died on dialysis. Cardiovascular disease (CVD) and dialysis withdrawal were the most common causes of death. Compared with female patients, male patients were less likely to die early after allograft loss, with adjusted HR at 1 year after allograft loss for all-cause mortality of 0.84 (95% CI, 0.70-0.99). The reduced risk of death was attributed to infection and dialysis withdrawal, with adjusted HRs at 1 year after allograft loss of 0.58 (95% CI, 0.35-0.96) and 0.68 (95% CI, 0.47-0.99), respectively. However, we did not observe any significant sex-based differences in all-cause or cause-specific mortality beyond 1 year after allograft loss.</p><p><strong>Limitations: </strong>Observational study, residual and unmeasured confounding factors.</p><p><strong>Conclusions: </strong>After kidney allograft loss, female patients experienced a higher initial mortality risk compared with male patients, attributed to early deaths from infection and dialysis withdrawal.</p><p><strong>Plain-language summary: </strong>Sex and gender are known to impact the risk of health outcomes in dialysis patients. In this study, we examined the relationship between sex differences and mortality after the failure of a kidney transplant that necessitated a return to maintenance dialysis. The study examined registry data from 4,135 patients in Australia and New Zealand who returned to dialysis after their first kidney transplant failed between 2000 and 2020. Compared with female patients, male patients were less likely to die early after allograft loss. The reduced risk of death was attributed t","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717246","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":"Acute Flank Pain in a Young Man: A Quiz","authors":"Raju Swathy ,&nbsp;Vellathussery Chakkalakkombil Sunitha ,&nbsp;P.S. Priyamvada","doi":"10.1053/j.ajkd.2025.04.009","DOIUrl":"10.1053/j.ajkd.2025.04.009","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 2","pages":"Pages A11-A13"},"PeriodicalIF":9.4,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144671009","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":"Inflammation: A Key Driver in the Progression of CKD","authors":"Peter Stenvinkel","doi":"10.1053/j.ajkd.2025.06.002","DOIUrl":"10.1053/j.ajkd.2025.06.002","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 3","pages":"Pages 296-297"},"PeriodicalIF":8.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652664","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":"Tenapanor: An Update on Evidence of Effectiveness and Guidance on Practical Use","authors":"Ian Da Silva Lugo,&nbsp;Jaime Uribarri","doi":"10.1053/j.ajkd.2025.06.008","DOIUrl":"10.1053/j.ajkd.2025.06.008","url":null,"abstract":"<div><div>Hyperphosphatemia remains a major challenge in managing patients with kidney failure and is associated with significant morbidity and mortality. Traditional approaches such as dietary phosphate restriction, oral phosphate binders, and dialysis modifications, even if combined, often provide insufficient control of serum phosphate levels. Tenapanor, a novel therapy that targets intestinal phosphate absorption, has shown promise in reducing serum phosphate as monotherapy and in combination with binders, even though gastrointestinal side effects may occur. Here, we review the available information about the clinical use of tenapanor, including its safety profile, and provide some clinical suggestions for its practical use.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 4","pages":"Pages 510-515"},"PeriodicalIF":8.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144664781","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":"Kidney Cysts in Autosomal Dominant Polycystic Kidney Disease and Alport Syndrome: Two Familial Cases Illustrating Diagnostic Challenges","authors":"Thomas Bais ,&nbsp;Charlotte C.E.T. Pape ,&nbsp;Loes Elferink ,&nbsp;Karin G.F. Gerritsen ,&nbsp;Tineke Kraaij ,&nbsp;Ron T. Gansevoort ,&nbsp;Martijn J. de Groot ,&nbsp;Esther Meijer","doi":"10.1053/j.ajkd.2025.04.022","DOIUrl":"10.1053/j.ajkd.2025.04.022","url":null,"abstract":"<div><div>Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disorder and leads to the formation of kidney cysts, kidney enlargement, and kidney failure. We present a male patient initially misdiagnosed with ADPKD, partly based on his family history, who was later diagnosed with digenic Alport syndrome caused by pathogenic variants in <em>COL4A4</em> and <em>COL4A5</em>. Digenic Alport syndrome was subsequently diagnosed in 3 of his sisters, one of whom had previously been diagnosed with ADPKD, due to a de novo heterozygous pathogenic variant in <em>PKD1</em>. She had experienced an unusual clinical course for a patient with ADPKD, with remarkably rapid kidney function decline, persistent microscopic hematuria, and overt proteinuria. Through these cases, we aim to highlight alternative genetic causes of kidney cysts beyond ADPKD, describe how the phenotypical features in these cases were not fully explained by their known genotypes (leading to alternative or additional genetic diagnoses), and illustrate the importance of accurate genetic diagnoses for cascade screening.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 4","pages":"Pages 570-574"},"PeriodicalIF":8.2,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144664234","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":"Kidney Protective Effects of Glucagon-Like Peptide-1 Receptor Agonists Versus Sodium/Glucose Cotransporter 2 Inhibitors in Persons With Diabetes and CKD: Implications for Personalized Medicine","authors":"Maarten W. Taal ,&nbsp;Mohamed Tarek Eldehni ,&nbsp;Nicholas M. Selby","doi":"10.1053/j.ajkd.2025.05.005","DOIUrl":"10.1053/j.ajkd.2025.05.005","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 3","pages":"Pages 293-295"},"PeriodicalIF":8.2,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144645886","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":"Body Weight Normalization: A Missing Piece in Protein Intake Studies for CKD","authors":"Matteo Brambilla Pisoni MSc,&nbsp;Marco Simonini MD,&nbsp;Giuseppe Vezzoli MD","doi":"10.1053/j.ajkd.2025.05.011","DOIUrl":"10.1053/j.ajkd.2025.05.011","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 4","pages":"Page 575"},"PeriodicalIF":8.2,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652666","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":"Immunofluorescence and Electron Microscopy in Genetically Engineered Pig-to-Human Kidney Xenotransplantation: A Case Report","authors":"Huma Fatima ,&nbsp;Isam-Eldin Eltoum ,&nbsp;Vineeta Kumar ,&nbsp;Douglas J. Anderson ,&nbsp;Jayme E. Locke","doi":"10.1053/j.ajkd.2025.04.021","DOIUrl":"10.1053/j.ajkd.2025.04.021","url":null,"abstract":"<div><div>Genetically engineered (GE) porcine kidney xenografts have been used recently in pig-to-human brain-dead decedent xenotransplantation. However, immunofluorescence (IF) and electron microscopy (EM) findings of xenografts have not been fully described. Here we report novel IF and EM features of GE pigs with 10 genetic modifications (10GE) xenografts with clinical correlation in 3 cases of pig-to-human brain-dead decedent xenotransplantation, performed at our institution. Preimplant biopsies unexpectedly demonstrated clinically silent mesangial immune complex deposits in all 3 xenografts, indicating porcine donor–related process. In addition, EM showed intact podocyte foot processes in the absence of endothelial cell injury, and thin glomerular basement membrane relative to adult human glomeruli in the absence of hematuria in donor pigs, likely reflecting normal porcine anatomy. In a third decedent with nephrotic-range proteinuria, foot process effacement did not correlate with the severity of proteinuria. We believe that these findings in 10GE porcine kidney xenografts may serve as a reference for normal xenograft morphology, contribute to establish xenograft rejection criteria, and support genuine need for phase I clinical trials to fully understand the long-term clinical implications of these findings.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 4","pages":"Pages 563-569"},"PeriodicalIF":8.2,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652665","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}