American Journal of Kidney Diseases最新文献

{"title":"Trends in Outcomes Among Patients Initiating Peritoneal Dialysis in the United States, 2009-2018","authors":"Christopher Knapp ,&nbsp;Shuling Li ,&nbsp;Chuanyu Kou ,&nbsp;David T. Gilbertson ,&nbsp;James B. Wetmore ,&nbsp;Allyson Hart ,&nbsp;Kirsten L. Johansen","doi":"10.1053/j.ajkd.2025.06.007","DOIUrl":"10.1053/j.ajkd.2025.06.007","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><div>Peritoneal dialysis (PD) use has increased since 2009. We sought to evaluate how historic disparities in outcomes across different demographic groups have changed over time.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting &amp; Participants</h3><div>Patients initiating PD from 2009 to 2018 in the United States represented in the US Renal Data Systems (USRDS).</div></div><div><h3>Exposure</h3><div>Patient age group, race and ethnicity, urban or rural residence, obesity status, and level of neighborhood deprivation.</div></div><div><h3>Outcome</h3><div>Mortality and conversion to in-center hemodialysis (HD) in 1 and 2 years after dialysis initiation.</div></div><div><h3>Analytical Approach</h3><div>The cumulative incidence of events was estimated for each yearly cohort. Temporal trends were evaluated using Cox proportional hazards models (mortality) and Fine-Gray models (conversion to HD).</div></div><div><h3>Results</h3><div>The study included 101,640 incident PD patients, of whom 38.1% were aged<!--> <!-->≥65 years, and 57.5% were White. The overall mortality 1 year after PD initiation decreased from 11.0% in 2009 to 8.4% in 2018, and the hazard decreased by 3% per 2 study years (HR, 0.97 [95% CI, 0.96-0.99]). The probability of conversion to in-center HD 1 year after PD initiation decreased from 17.8% in 2009 to 15.1% in 2018, and the hazard decreased by 2% per 2 study years (HR, 0.98 [95% CI, 0.97-1.00]). Patients over 75 years old did not experience lower conversion to HD over time (HR, 1.02 [95% CI, 0.99-1.05], <em>P</em> for age interaction<!--> <!-->=<!--> <!-->0.02). Overall, the hazard of conversion to HD in the 2 years after PD initiation did not improve. Hazards of mortality and conversion to HD changed similarly, regardless of urban or rural residence, race and ethnicity, obesity, or level of neighborhood deprivation.</div></div><div><h3>Limitations</h3><div>Incomplete data on medical comorbidities.</div></div><div><h3>Conclusions</h3><div>The rate of mortality improved for incident PD patients regardless of patient demographic factors over the period 2009 to 2020. Hazards of conversion to in-center HD improved less and attenuated with longer follow-up.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 4","pages":"Pages 487-498"},"PeriodicalIF":8.2,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612883","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":"Advancing Noninvasive Imaging to Quantify Kidney Fibrosis: Hidden in Plain Sight","authors":"Momen Abbasi,&nbsp;Anand Srivastava","doi":"10.1053/j.ajkd.2025.06.006","DOIUrl":"10.1053/j.ajkd.2025.06.006","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 4","pages":"Pages 560-562"},"PeriodicalIF":8.2,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144603898","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 Sex With All-Cause and Cause-Specific Peritoneal Dialysis Discontinuation","authors":"Dharshana Sabanayagam ,&nbsp;Pedro Lopez ,&nbsp;Farzaneh Boroumand ,&nbsp;Katrina Chau ,&nbsp;Eric H. Au ,&nbsp;Ryan Gately ,&nbsp;K. Shuvo Bakar ,&nbsp;Lin Zhu ,&nbsp;Armando Teixeira-Pinto ,&nbsp;Wai H. Lim ,&nbsp;Germaine Wong","doi":"10.1053/j.ajkd.2025.05.009","DOIUrl":"10.1053/j.ajkd.2025.05.009","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Little is known about the association between sex and specific causes of peritoneal dialysis (PD) discontinuation. This study assessed the association of sex with all-cause and cause-specific PD discontinuation and explored the factors mediating these relationships.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Retrospective cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;All patients with kidney failure who started PD between 2005 and 2019 in Australia.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;Sex.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome&lt;/h3&gt;&lt;div&gt;All-cause (transfer to hemodialysis for&lt;!--&gt; &lt;!--&gt;≥30 days or death) PD discontinuation, PD discontinuation related to inadequate dialysis, and PD discontinuation related to infection.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Adjusted cause-specific proportional hazards regression models were used to assess the association of sex with all-cause and cause-specific PD discontinuation. Counterfactual mediation analysis was conducted to explore potential mediators (sociodemographic status, geographical remoteness, cardiovascular disease, diabetes, history of peritonitis, late referral, smoking status, and body mass index) of these associations. Sensitivity analyses using the Fine and Gray method were implemented to address the competing risks of death, kidney transplantation, and other causes of PD discontinuation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Of 9,748 incident patients, 6,001 experienced PD discontinuation from any cause (2,098 died, 793 were inadequate dialysis related, 1,442 were infection related, and 1,668 were other cause), with a median follow-up of 1.47 years (IQR, 0.67-2.73). Men were more likely to experience PD discontinuation from any cause (HR, 1.09 [95% CI, 1.03-1.14], &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.002) or for inadequate dialysis (HR, 1.71[95% CI, 1.47-1.99], &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.001) but not for infection (HR, 0.95[95% CI, 0.85-1.05], &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.3). The mediation analyses found that 76.9% of the total effect of sex on all-cause PD discontinuation was explained by mediators, including cardiovascular disease, smoking status, and diabetes, whereas less than 10% of the total effect of sex on PD discontinuation from inadequate dialysis was explained by mediators.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Residual and unmeasured confounders, such as biological differences, behavioral patterns, hospitalizations, frailty, and severity of comorbidities.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Men were more likely than women to experience PD discontinuation from any cause and from inadequate dialysis. This relationship was mediated by multiple morbidities for PD discontinuation from any cause but not for PD discontinuation for inadequate dialysis. These findings may inform future studies evaluating biological and sociodemographic factors that may contribute to these observed sex differences.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 4","pages":"Pages 475-486.e1"},"PeriodicalIF":8.2,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144603976","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":"Safe Patient Care in CKD: Core Curriculum 2025","authors":"Prasheen Shah ,&nbsp;Hassan Mahmoud ,&nbsp;Grant Oakley ,&nbsp;Mark G. Parker","doi":"10.1053/j.ajkd.2025.03.022","DOIUrl":"10.1053/j.ajkd.2025.03.022","url":null,"abstract":"<div><div>Quality and safety in health care have garnered scrutiny in recent decades. Complete prevention of unintended harm remains elusive. Patients with chronic kidney disease are at risk for adverse events because of the complexity of this illness and the impact of declining kidney function on choices for diagnostic studies and therapies. Nephrologists must be knowledgeable about patient safety principles and methods for evaluating harm or near harm events and be prepared to learn from investigations to make improvements. Medication safety is particularly challenging in the context of progressive kidney disease, and safety has increased in scope due to the broader choices of therapeutics for such conditions as diabetic nephropathy and anemia of chronic kidney disease. Radiologic imaging and procedural safety are also influenced by impairment of kidney function. Technological applications for patient safety are evolving and hold promise for mitigating human error and engaging patients as partners in care. In this Core Curriculum, we address essential nephrologist competency for maintaining patient safety in chronic kidney disease.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 2","pages":"Pages 245-256"},"PeriodicalIF":9.4,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574714","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":"Gout Management in Patients With CKD: A Review","authors":"Rochella A. Ostrowski","doi":"10.1053/j.ajkd.2025.04.020","DOIUrl":"10.1053/j.ajkd.2025.04.020","url":null,"abstract":"<div><div>The management of gout in patients with chronic kidney disease (CKD) can be challenging due to multiple factors. These include limitations on the type or doses of medications used. Although limitations or exclusions of some treatment options are warranted, others that are traditionally followed, such as the doses used for urate-lowering therapies such as allopurinol or febuxostat, may lead to undertreatment of gout. In this review, guidelines from consensus groups are discussed with a focus on management of gout in patients with CKD and appropriate dose adjustments beyond traditional kidney-dosed limits. Studies in the literature with regard to risk factors for allopurinol hypersensitivity syndrome are reviewed, including HLAB∗5801 allele testing. Additionally, current evidence that allows providers to optimize both the effectiveness and safety of gout management in the setting of CKD, such as the “start-low-go-low” approach, are reviewed as well as considerations for kidney transplant recipients. Although there is a potential role of sodium/glucose cotransporter 2 inhibitors in lowering serum urate, it is limited in CKD. Finally, the use of immunomodulators to improve outcomes for pegloticase, a pegylated form of uricase, shows promise for increasing the utility of pegloticase in cases where it is warranted.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 4","pages":"Pages 516-524"},"PeriodicalIF":8.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558796","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":"Incidence and Adverse Outcomes of Acute Kidney Disease: A Systematic Review and Meta-Analysis","authors":"Changyuan Yang ,&nbsp;Marcello Tonelli ,&nbsp;Matthew T. James ,&nbsp;Zhi Tan ,&nbsp;Wisanne M. Bakker ,&nbsp;Ron T. Gansevoort ,&nbsp;Priya Vart","doi":"10.1053/j.ajkd.2025.05.008","DOIUrl":"10.1053/j.ajkd.2025.05.008","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Estimates of the incidence of acute kidney disease (AKD) and its associated adverse outcomes are inconsistent, which may be due in part to differences in prior studies’ definitions of AKD. This study sought to summarize these reports and identify study-level characteristics, including the definition of AKD, that may explain the observed heterogeneity.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Systematic review and meta-analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Study Populations&lt;/h3&gt;&lt;div&gt;Adults aged&lt;!--&gt; &lt;!--&gt;≥18 years and not receiving maintenance kidney replacement therapy.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Selection Criteria for Studies&lt;/h3&gt;&lt;div&gt;Observational studies that assessed the incidence of AKD and its association with adverse outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Data Extraction&lt;/h3&gt;&lt;div&gt;Two reviewers independently extracted data and assessed study quality.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;AKD definitions were classified as (1) Acute Disease Quality Initiative (ADQI) or ADQI-equivalent or (2) KDIGO (Kidney Disease: Improving Global Outcomes) or KDIGO-equivalent. A random-effects meta-analysis was used to calculate pooled estimates of incidence and the relationship between AKD and outcomes (mortality, kidney failure, onset of chronic kidney disease) summarized by ORs and 95% CIs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among 1,883 identified studies, 59, involving nearly 6 million participants, met the inclusion criteria. Most studies were classified as being of good quality per the Newcastle-Ottawa scale (n&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;44). The pooled incidence of AKD was higher when defined by ADQI/ADQI-equivalent criteria compared with KDIGO/KDIGO-equivalent criteria (26.6% [95% CI, 20.3-34.9%] vs 11.1% [95% CI, 7.6-16.3%]; &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.001). The pooled OR of all-cause mortality associated with AKD was similar whether defined with KDIGO/KDIGO-equivalent or ADQI/ADQI-equivalent criteria (3.8 [95% CI, 2.2-6.7] vs 3.0 [95% CI, 2.1-4.4]; &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.5). After accounting for baseline acute kidney injury status, the incidence of AKD and its association with all-cause mortality were similar for the 2 definitions. The incidences of AKD were 13.6% and 11.1%, and the ORs for all-cause mortality were not different (4.2 [95% CI, 2.0-8.7] vs 3.8 [95% CI, 2.2-6.7]; &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.8) using the ADQI/ADQI-equivalent and KDIGO/KDIGO-equivalent definitions, respectively. Similar results were observed for the association between AKD and the development of chronic kidney disease, but the association between AKD and kidney failure was stronger in studies that used the KDIGO/KDIGO-equivalent definition.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Heterogeneity persisted across most of the examined subgroups.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Estimates for AKD incidence and AKD-associated risk for clinical outcomes vary by the definition used for AKD. These findings inform","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 4","pages":"Pages 448-464"},"PeriodicalIF":8.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558797","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":"Effectiveness of Inpatient Rehabilitation for Older Adults Soon After Dialysis Initiation to Improve Health Outcomes.","authors":"Ismay Van Loon,Shepherd Kajawo,Eric McArthur,Danielle M Nash,Lima F Rodrigues,Stephanie N Dixon,Amit X Garg,Jamie L Fleet,Blayne Welk,S Vanita Jassal","doi":"10.1053/j.ajkd.2025.06.003","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.06.003","url":null,"abstract":"RATIONALE & OBJECTIVEMultiple studies have shown that older adults' initiation of dialysis is associated with functional decline often within months of starting treatment. This functional impairment has been associated with a 2- to 4-fold higher risk of mortality and morbidity. This study sought to assess if rehabilitation within the first few months after starting dialysis may improve physical function and reduce the rates of hospitalization and mortality.STUDY DESIGNRetrospective matched cohort study.SETTING & PARTICIPANTSIndividuals in Ontario, Canada, aged ≥66 years initiating maintenance dialysis whose healthcare data were recorded by ICES, which captures administrative health data for the population of Ontario.EXPOSUREInpatient rehabilitation care within 6 months of starting dialysis.OUTCOMESChange in the Functional Independence Measure (FIM®) score during the rehabilitation hospitalization among those receiving rehabilitation. Counts of hospital days, rates of admission to hospitals and long-term care facilities, and mortality over one year following the index date for comparisons of those who received rehabilitation to those who did not.ANALYTICAL APPROACHPatients receiving rehabilitation and three times as many not receiving rehabilitation were matched using a propensity score logistic regression model. Outcomes among those who did and did not receive rehabilitation were compared using Cox proportional hazards models and the Cochran-Mantel-Haenszel test for binary outcomes.RESULTSAmong those undergoing rehabilitation, FIM® scores improved from 76±17 at admission, to 98±19 by discharge (p<0.0001). 1287 of 1567 (82%) patients admitted for rehabilitation within 6 months of dialysis were matched to 3861 patients who did not receive rehabilitation. Patients undergoing rehabilitation had similar 1-year mortality rates to the matched comparison population (27% vs. 25%, p=0.45), but higher hospitalization rates and length-of-stay. Six percent of patients in both groups were admitted to a long-term care facility within the 1-year follow-up (P=0.65).LIMITATIONSPotential for residual confounding due to the use of administrative data.CONCLUSIONSThese data suggest that patients may benefit physically from rehabilitation around the time of starting dialysis. Hospitalization was slightly higher in those undergoing rehab, however unlike previously published data on those with low baseline functional status, mortality was similar across both groups.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"48 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144547805","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 Silent Struggle of Facing Kidney Failure as a Child","authors":"Luca G. Torrisi BPsych","doi":"10.1053/j.ajkd.2025.03.030","DOIUrl":"10.1053/j.ajkd.2025.03.030","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 4","pages":"Pages A10-A11"},"PeriodicalIF":8.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144547806","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":"Carbon Emissions From Different Dialysis Modalities: A Life Cycle Assessment","authors":"Katherine A. Barraclough ,&nbsp;Ben Talbot ,&nbsp;John Knight ,&nbsp;Susan Blair ,&nbsp;Forbes McGain ,&nbsp;Rosemary Masterson ,&nbsp;Richard Knight ,&nbsp;Craig Nelson ,&nbsp;Stephen McDonald ,&nbsp;Scott McAlister","doi":"10.1053/j.ajkd.2025.04.019","DOIUrl":"10.1053/j.ajkd.2025.04.019","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><div>As the health impacts of climate change intensify, the health care sector faces growing pressure to minimize its carbon footprint. Achieving this goal requires understanding of the carbon impact of widely used medical treatments. This study evaluated and compared the carbon footprints of in-center hemodialysis, home hemodialysis, automated peritoneal dialysis (APD), and continuous ambulatory peritoneal dialysis (CAPD).</div></div><div><h3>Study Design</h3><div>Comparative life cycle assessment.</div></div><div><h3>Setting &amp; Participants</h3><div>In-center hemodialysis, home-based hemodialysis, CAPD, and APD treatments provided by the Royal Melbourne Hospital Kidney Care Service, Melbourne, Victoria, Australia.</div></div><div><h3>Outcome</h3><div>Carbon emissions in kilograms of carbon dioxide equivalents (kg CO₂e) from the annual provision of dialysis to a single patient.</div></div><div><h3>Analytical Approach</h3><div>Attributional process-based comparative life cycle assessment methodology was used to identify the sources and extent of carbon emissions for all dialysis modalities.</div></div><div><h3>Results</h3><div>In-center hemodialysis had the highest annual per patient carbon impact, at 4,814<!--> <!-->kg CO2e. In comparison, emissions from home hemodialysis were 41% lower (2,938<!--> <!-->kg CO2e), APD 29% lower (3,339<!--> <!-->kg CO2e), and CAPD 59% lower (1,969<!--> <!-->kg CO2e). Across all 4 modalities, consumables were the largest source of emissions. For in-center hemodialysis, patient travel was the main factor contributing to its higher carbon footprint compared with home-based dialysis options.</div></div><div><h3>Limitations</h3><div>Single dialysis provider in an urban setting.</div></div><div><h3>Conclusions</h3><div>In-center hemodialysis has a substantially higher carbon footprint than all home dialysis options, informing the choice of home dialysis when feasible and appropriate for individual patients.</div></div><div><h3>Plain-Language Summary</h3><div>As climate change intensifies, there is growing pressure on health care systems to reduce their greenhouse gas emissions. To do this effectively, it is important to understand the carbon footprint of different treatment options and identify key areas where emissions are highest. This study compared greenhouse gas emissions from 4 types of dialysis: hemodialysis performed in a health care facility (in-center hemodialysis), home hemodialysis, automated peritoneal dialysis (APD), and continuous ambulatory peritoneal dialysis (CAPD). We found that in-center hemodialysis had the highest carbon footprint, primarily due to the impact of patient travel. Among the home therapies, APD was responsible for higher emissions than home hemodialysis while CAPD had the lowest carbon footprint. Across all treatment types, consumables were the largest source of carbon emissions.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 4","pages":"Pages 465-474.e1"},"PeriodicalIF":8.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144547789","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":"Serum Sodium in Peritoneal Dialysis: Beyond Mortality to Mechanistic Insights","authors":"Zhengyang Zhu MS,&nbsp;Kejun Ren MD","doi":"10.1053/j.ajkd.2025.04.018","DOIUrl":"10.1053/j.ajkd.2025.04.018","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 3","pages":"Page 414"},"PeriodicalIF":8.2,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487972","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}