American Journal of Kidney Diseases最新文献

{"title":"Explaining International Trends in Mortality on Hemodialysis Through Changes in Hemodialysis Practices in the Dialysis Outcomes and Practice Patterns Study (DOPPS)","authors":"Keith P. McCullough , Hal Morgenstern , Hugh C. Rayner , Friedrich K. Port , Michel Y. Jadoul , Tadao Akizawa , Ronald L. Pisoni , William H. Herman , Bruce M. Robinson","doi":"10.1053/j.ajkd.2024.06.017","DOIUrl":"10.1053/j.ajkd.2024.06.017","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Case-mix adjusted hemodialysis mortality has decreased since 1998. Many factors that influence mortality may have contributed to this trend, and these associations may differ by continental region. We studied changes in hemodialysis facility practices over time and their potential role in mediating changes in patient survival.</div></div><div><h3>Study Design</h3><div>Observational prospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>Adult hemodialysis patients treated in 500 hemodialysis facilities participating in the Dialysis Outcomes and Practice Patterns Study (DOPPS) between 1999 and 2015 in the United States, Japan, and 4 European countries: Germany, Italy, Spain, and the United Kingdom.</div></div><div><h3>Predictors</h3><div>Four practice measures at each facility: the percentages of patients with Kt/V<!--> <!-->≥<!--> <!-->1.2, interdialytic weight gain [IDWG]<!--> <!--><<!--> <!-->5.7%, phosphorus<!--> <!--><<!--> <!-->6<!--> <!-->mg/dL, and using arteriovenous fistulas (AVFs).</div></div><div><h3>Outcome</h3><div>Patient survival.</div></div><div><h3>Analytical Approach</h3><div>Mediation analyses, adjusted for case mix, were conducted using 3-year study phase as the exposure and facility practice measures as potential mediators.</div></div><div><h3>Results</h3><div>In Europe, we observed a 13% improvement in overall case-mix adjusted survival per decade. Trends in facility practice measures, especially Kt/V and phosphorus, explained 10% improvement in case-mix survival per decade, representing 77% (10% explained of 13% improvement) of the observed improvement. In Japan, 73% of the observed 12%/decade improvement in case-mix adjusted survival could be attributed to facility practices, especially Kt/V and IDWG. In the United States, 56% of the observed 47%/decade improvement in case-mix adjusted survival could be attributed to facility practices, especially AVF use and phosphorus control.</div></div><div><h3>Limitations</h3><div>Unmeasured changes in the characteristics of the patient population over this period may confound the observed associations.</div></div><div><h3>Conclusions</h3><div>The improvements in adjusted hemodialysis patient survival in Europe, Japan, and the United States from 1999 to 2015 can be largely explained by improvements in specific facility practices. Future changes in patient survival may be responsive to further evolution in the implementation of common clinical practices.</div></div><div><h3>Plain-Language Summary</h3><div>Case-mix adjusted survival of patients treated with hemodialysis has improved over the last 2 decades in the United States, Japan, and Europe. Some of this improvement can be explained by region-specific changes in 4 dialysis practices, namely increases in the proportions of patients achieving (1) Kt/V<!--> <!-->≥<!--> <!-->1.2, (2) serum phosphorus levels<!--> <!--><<!--> <!-->6<!--> <!-->mg/dL, (3) interd","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 1","pages":"Pages 25-35.e1"},"PeriodicalIF":9.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141911352","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":"Effect of Dual RAAS Blockade and Intensive BP Lowering on Risk of End-Stage Kidney Disease and Death in Autosomal Dominant Polycystic Kidney Disease: Long-term Follow-up of the HALT-PKD Trials","authors":"Elaine Ku MD, MAS , Timothy P. Copeland PhD , Charles E. McCulloch PhD , Kaleab Z. Abebe PhD , Michel Chonchol MD , Ronald D. Perrone MD , Frederic F. Rahbari-Oskoui MD , Alan S.L. Yu MD , Theodore Steinman MD , Arlene Chapman MD , Mark J. Sarnak MD, MS","doi":"10.1053/j.ajkd.2024.06.020","DOIUrl":"10.1053/j.ajkd.2024.06.020","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 1","pages":"Pages 127-130"},"PeriodicalIF":9.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999270","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":"Hyperkalemia in a Patient With Resolving Acute Kidney Injury","authors":"Nicole E. Wyatt , Levan Gakhokidze , Gautam Bhave , Juan Pablo Arroyo","doi":"10.1053/j.ajkd.2024.07.016","DOIUrl":"10.1053/j.ajkd.2024.07.016","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 1","pages":"Pages A23-A26"},"PeriodicalIF":9.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142870977","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":"Peer Support Interventions for People With CKD: A Scoping Review","authors":"Meghan J. Elliott , Tyrone G. Harrison , Shannan Love , Paul E. Ronksley , Nancy Verdin , Dwight Sparkes , Caitrin O’Connor , Kate Manns , Sabrina Jassemi , Brenda R. Hemmelgarn , Maoliosa Donald","doi":"10.1053/j.ajkd.2024.07.007","DOIUrl":"10.1053/j.ajkd.2024.07.007","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Formalized peer support is a promising approach for addressing the emotional and practical needs of people living with chronic kidney disease (CKD). We systematically identified and summarized peer support interventions studied in individuals with CKD with or without kidney replacement therapy (KRT).</div></div><div><h3>Sources of Evidence</h3><div>Search of electronic databases and grey literature sources in March 2023.</div></div><div><h3>Eligibility Criteria</h3><div>Studies of any design were eligible if they reported sufficient detail on peer support interventions and outcomes for adults with CKD with or without KRT and/or their caregivers.</div></div><div><h3>Charting Methods</h3><div>We extracted information on study and intervention characteristics and reported outcomes using established frameworks. We summarized quantitative data descriptively and qualitative data thematically. Our approach observed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews.</div></div><div><h3>Results</h3><div>We included 77 studies describing 56 unique peer support interventions. Most reports were program evaluations (39%) or randomized controlled trials (27%) published after 2013. Two-thirds of interventions focused on in-center hemodialysis or mixed CKD populations, and three quarters were integrated within a kidney care clinic or program. Whereas most peer interactions centered on informational support, few programs offered focused support in areas such as transplant navigation or dialysis modality selection. Only one-third of outcomes were assessed against a comparator group, with results suggesting improvements in psychological health with peer support.</div></div><div><h3>Limitations</h3><div>Heterogeneity of included studies; lack of rigorous program evaluation.</div></div><div><h3>Conclusions</h3><div>This review suggests recent growth in peer support programming with a variety of formats and delivery methods to address the diverse needs of people living with kidney disease. Notable gaps in peer support availability for transplant and home dialysis recipients and the lack of rigorous evaluations present opportunities to expand the reach and impact of peer support in the kidney care context.</div></div><div><h3>Plain-Language Summary</h3><div>Many people with kidney disease struggle with isolation, making decisions about their care, and declines in their mental well-being. Peer support is a way of providing information and emotional support to patients and their loved ones by connecting them with others who have a shared experience of kidney disease. We summarize the features of peer support programs worldwide and the settings in which they have been studied. We searched the medical literature and found 56 unique peer support programs reported in 77 studies. Most studies were from the last 10 years, targeted people receiving hemodialysis, and focused o","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 1","pages":"Pages 78-88.e1"},"PeriodicalIF":9.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999271","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 Blood Mitochondrial DNA Copy Number With Risk of Acute Kidney Injury After Cardiac Surgery","authors":"Vasantha Jotwani MD , Heather Thiessen-Philbrook MMath , Dan E. Arking PhD , Stephanie Y. Yang PhD , Eric McArthur MSc , Amit X. Garg MD, PhD , Ronit Katz DPhil , Gregory J. Tranah PhD , Joachim H. Ix MD, MAS , Steve Cummings MD , Sushrut S. Waikar MD , Mark J. Sarnak MD, MS , Michael G. Shlipak MD, MPH , Samir M. Parikh MD , Chirag R. Parikh MD, PhD","doi":"10.1053/j.ajkd.2024.03.013","DOIUrl":"10.1053/j.ajkd.2024.03.013","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 1","pages":"Pages 130-133"},"PeriodicalIF":9.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140849962","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":"Glucagon-like Peptide-1 Receptor Agonists: New Evidence of Kidney and Cardiovascular Protection From the FLOW and SELECT Trials","authors":"Maarten W. Taal , Nicholas M. Selby","doi":"10.1053/j.ajkd.2024.08.002","DOIUrl":"10.1053/j.ajkd.2024.08.002","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 1","pages":"Pages 115-118"},"PeriodicalIF":9.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339111","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":"Aiming for a Patient-Centered Organ Procurement and Transplantation Network","authors":"Sylvia E. Rosas , Morgan Reid","doi":"10.1053/j.ajkd.2024.09.004","DOIUrl":"10.1053/j.ajkd.2024.09.004","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 1","pages":"Pages 1-4"},"PeriodicalIF":9.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142563733","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":"Burden of CKD-Associated Pruritus and Adverse Clinical Outcomes in Patients Receiving Dialysis: The Stockholm Creatinine Measurements (SCREAM) Project","authors":"Anne-Laure Faucon , Catherine M. Clase , Helena Rydell , Milica Uhde , Peter Barany , Marie Evans , Juan-Jesús Carrero","doi":"10.1053/j.ajkd.2024.05.013","DOIUrl":"10.1053/j.ajkd.2024.05.013","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Pruritus is a common but not well-characterized complaint of patients receiving maintenance dialysis. This study sought to quantify the burden of pruritus and its associated adverse health outcomes in this population.</div></div><div><h3>Study Design</h3><div>Observational study.</div></div><div><h3>Setting & Participants</h3><div>All patients receiving maintenance dialysis in Stockholm, Sweden, during 2005-2021.</div></div><div><h3>Exposure</h3><div>Clinically recognized pruritus defined using <em>International Classification of Diseases, Tenth Revision</em> codes or a prescription for antipruritus treatments (including UV therapy).</div></div><div><h3>Outcomes</h3><div>All-cause mortality, severe infection–related hospitalizations (composite of endocarditis, peritoneal dialysis–related peritonitis, hemodialysis/peritoneal dialysis–related catheter infection, sepsis due to <em>Staphylococcus</em> spp., or skin infection) and incident diagnoses of anxiety/depression and sleep disorders.</div></div><div><h3>Analytical Approach</h3><div>Multivariable logistic regression and cause-specific hazards models to analyze factors associated with prevalent and new-onset pruritus, respectively. Multivariable cause-specific hazards models with time-varying exposure were used to explore the association of prevalent and new-onset pruritus with adverse health outcomes.</div></div><div><h3>Results</h3><div>Among 3,281 dialysis recipients (median age, 64 years; 66% men; 69% receiving hemodialysis, 77% with incident dialysis), 456 (14%) had pruritus at enrollment. During a median follow-up of 3.3 (IQR, 1.3-9.2) years, 539 (19%) additional patients experienced pruritus. Older age, female sex, a lower serum albumin level, and higher C-reactive protein, serum calcium, and phosphorus levels were independently associated with pruritus. Compared with patients without pruritus, patients with pruritus were at a higher risk of sleep disorders (adjusted HR, 1.96; 95% CI, 1.60-2.39), developing anxiety/depression (adjusted HR, 1.56; 95% CI, 1.23-1.98), and being hospitalized for severe infections (adjusted HR, 1.36; 95% CI, 1.18-1.57), the latter attributed to higher risk of sepsis and peritoneal dialysis–related peritonitis. There was no detectable association between the development of pruritus and all-cause mortality.</div></div><div><h3>Limitations</h3><div>Potential misclassification bias if pruritus is not clinically recognized, lack of information on pruritus intensity/severity, use of diagnostic codes for exposure and outcome diagnoses.</div></div><div><h3>Conclusions</h3><div>At least one third of patients experience pruritus during their first years undergoing dialysis, and pruritus was consistently associated with adverse health outcomes.</div></div><div><h3>Plain-Language Summary</h3><div>Pruritus is a common but not well-characterized symptom of patients receiving dialysis. We analyzed data from 3,281 patients recei","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 1","pages":"Pages 45-54.e1"},"PeriodicalIF":9.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787040","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":"Representation of Low- and Middle-Income Countries in CKD Drug Trials: A Systematic Review","authors":"Gabriel Cojuc-Konigsberg , Alberto Guijosa , Alberto Moscona-Nissan , Alberto Nordmann-Gomes , Vianca Anabel Canaviri-Flores , Alan Braverman-Poyastro , Regina de la Fuente-Ramírez , Denisse Tinajero-Sánchez , Alejandra de las Fuentes Cepeda , Andrés Noyola-Pérez , Rafael Lozano , Ricardo Correa-Rotter , Juan C. Ramírez-Sandoval","doi":"10.1053/j.ajkd.2024.06.012","DOIUrl":"10.1053/j.ajkd.2024.06.012","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Almost 80% of individuals with chronic kidney disease (CKD) reside in low- and middle-income countries (LMICs) and are potentially underrepresented in randomized controlled clinical trials (RCTs). We assessed the global distribution of RCTs comparing pharmacological treatments for CKD over the past 2 decades, as well as the magnitude and evolution of participation by LMICs.</div></div><div><h3>Study Design</h3><div>Systematic review.</div></div><div><h3>Setting & Study Populations</h3><div>RCTs evaluating pharmacological interventions in adults with CKD.</div></div><div><h3>Selection Criteria for Studies</h3><div>RCTs published between 2003-2023 and indexed in MEDLINE.</div></div><div><h3>Data Extraction</h3><div>Each trial was reviewed and extracted independently by 2 investigators with disagreements settled by consensus or a third reviewer.</div></div><div><h3>Analytical Approach</h3><div>RCT participation of World Bank–defined income groups and geographic regions were described, and the representation indices (RI) according to RCT participants and estimated CKD prevalences were calculated. RCTs were also categorized as global, regional, or national in scope.</div></div><div><h3>Results</h3><div>Among 7,760 identified studies, we included 1,366 RCTs conducted in 84 countries with 301,158 participants. National, regional, and global RCTs represented 85.4%, 3.5%, and 11.1% of studies, respectively. LMICs were included in 34.7% of RCTs. No RCTs included participants from low-income countries, and lower-middle-income countries participated in 13.2%. Of participants from RCTs with available information, 25.4% (n<!--> <!-->=<!--> <!-->64,843 of 255,237) were from LMICs. According to the RI, 6 LMICs were overrepresented (>1.25), 7 were adequately represented (0.75-1.25), and 26 were underrepresented (<0.75). Most global CKD RCTs (80.2%) included LMICs; however, LMIC participants constituted only 32.9% of the global trial population. We observed a positive trend in LMIC inclusion over time, rising from 22.9% (n<!--> <!-->=<!--> <!-->71<!--> <!-->of 310) in 2003-2007 to 45.5% (n<!--> <!-->=<!--> <!-->140<!--> <!-->of 308) in 2018-2023.</div></div><div><h3>Limitations</h3><div>The use of an income-group dichotomy, exclusion of nonrandomized studies of intervention, and studies identified in 1 database.</div></div><div><h3>Conclusions</h3><div>Despite an increase in participation over the past 2 decades, individuals with CKD from LMICs remain significantly underrepresented in RCTs. These findings suggest that increased efforts are warranted to increase LMIC representation in pharmacological CKD RCTs.</div></div><div><h3>Plain-Language Summary</h3><div>Chronic kidney disease (CKD) substantially affects people from low- and middle-income countries (LMICs). However, the participation of these countries in randomized controlled trials (RCTs) remains uncertain. To assess the global distribution and represen","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 1","pages":"Pages 55-66.e1"},"PeriodicalIF":9.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905564","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":"10.1053/j.ajkd.2024.08.004","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 1","pages":"Pages 5-7"},"PeriodicalIF":9.4,"publicationDate":"2025-01-01","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}