American Journal of Kidney Diseases最新文献

{"title":"Longitudinal Patterns of Ankle-Brachial Index and Their Association With Progression of CKD in Patients With Type 2 Diabetes and Elevated Body Mass Index","authors":"Mengyi Liu, Yanjun Zhang, Yuanyuan Zhang, Panpan He, Chun Zhou, Ziliang Ye, Sisi Yang, Xiaoqin Gan, Fan Fan Hou, Xianhui Qin","doi":"10.1053/j.ajkd.2024.06.024","DOIUrl":"10.1053/j.ajkd.2024.06.024","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Ankle-brachial index (ABI) is used to screen for vascular complications in the setting of diabetes. This study sought to examine the relationship of longitudinal ABI data and chronic kidney disease (CKD) progression in patients with type 2 diabetes mellitus (T2DM) and increased body mass index.</div></div><div><h3>Study Design</h3><div>A post hoc analysis of the Look AHEAD (Action for Health in Diabetes) trial.</div></div><div><h3>Setting & Participants</h3><div>This study included 3,631 participants in the Look AHEAD trial with a baseline estimated glomerular filtration rate<!--> <!-->>60<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup>.</div></div><div><h3>Exposures</h3><div>Average ABI and average annual change in ABI were calculated based on annual ABI measurements during the first 4 years of the study.</div></div><div><h3>Outcome</h3><div>CKD progression, defined as kidney failure requiring maintenance dialysis or the occurrence of an estimated glomerular filtration rate<!--> <!--><60<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup> with a decrease of<!--> <!-->≥30% versus baseline at a follow-up visit.</div></div><div><h3>Analytical Approach</h3><div>Restricted cubic spline and Cox proportional hazards models were fit to estimate associations and to explore nonlinearity.</div></div><div><h3>Results</h3><div>During a median follow-up of 10.1 years, CKD progression developed in 1,051 participants. There was a reversed J-shaped relationship of CKD progression with average ABI (ABI<!--> <!--><1.17: HR per 1-SD decrement, 1.23; 95% CI, 1.06-1.42; ABI<!--> <!-->≥1.17: HR per 1-SD increment, 1.10; 95% CI, 1.00-1.22) and average annual change in ABI (change in ABI less than<!--> <!-->−0.007: HR per 1-SD decrement, 1.37; 95% CI, 1.12-1.66; change in ABI of at least<!--> <!-->−0.007: HR per 1-SD increment, 1.13; 95% CI, 1.03-1.24).</div></div><div><h3>Limitations</h3><div>Observational study, potential unmeasured confounding.</div></div><div><h3>Conclusions</h3><div>Low and high-average ABI, even at clinically normal values, as well as decreasing and increasing average annual ABI, were associated with a higher risk of CKD progression in patients with T2DM and increased body mass index. Monitoring ABI and its changes over time may facilitate CKD risk stratification in patients with T2DM.</div></div><div><h3>Plain-Language Summary</h3><div>The ankle-brachial index (ABI) has recently become a routine screening parameter for vascular complications in patients with diabetes. In this post hoc analysis of the Look AHEAD (Action for Health in Diabetes) trial including 3,631 participants with type 2 diabetes mellitus and increased body mass index, we examined the longitudinal relationship of average ABI and annual change in ABI with chronic kidney disease progression. We observed that low and high-average ABI, even at clinically normal values, as well as decreases and increases in average annual ABI, were ass","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 1","pages":"Pages 36-44.e1"},"PeriodicalIF":9.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142363950","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":"Homozygosity for a Rare FASTKD2 Variant Resulting in an Adult Onset Autosomal Recessive Mitochondrial Podocytopathy","authors":"Francisco Pereira Gonçalves ,&nbsp;Isabel Tavares ,&nbsp;Roberto Silva ,&nbsp;Ana Teresa Nunes ,&nbsp;Luciano Pereira ,&nbsp;Andreia Campos ,&nbsp;Joel Pinto ,&nbsp;Ana Lopes ,&nbsp;Marta Simões ,&nbsp;Manuela Grazina ,&nbsp;Agnes B. Fogo ,&nbsp;João Paulo Oliveira","doi":"10.1053/j.ajkd.2024.05.018","DOIUrl":"10.1053/j.ajkd.2024.05.018","url":null,"abstract":"<div><div>Mitochondrial cytopathies can have kidney involvement in up to half of cases. Their diagnosis is challenging due to phenotypic variability, lack of noninvasive tests to assess mitochondrial dysfunction, and genetic heterogeneity. We report on a young adult male with hypertrophic cardiomyopathy (HCM) and chronic kidney disease (CKD) with subnephrotic proteinuria who presented to the emergency department with kidney failure and hypervolemia requiring dialysis. A kidney biopsy showed focal segmental and global glomerulosclerosis, extensive foot process effacement, and abnormal mitochondria in podocytes and tubular epithelial cells; the genetic workup identified a rare <em>FASTKD2</em> exon 2 variant, c.29G&gt;C p.(Ser10Thr), in homozygosity; and functional mitochondrial assays in cultured skin fibroblasts showed reduction in FASTKD2 protein expression and moderate combined impairment in mitochondrial respiratory chain (MRC) assembly and function. This is the first report of a FASTKD2-associated cardiorenal mitochondrial cytopathy, characterized by young adult-onset proteinuric CKD and dilated HCM, in the absence of the severe neurologic manifestations described in patients with biallelic <em>FASTKD2</em> variants. We hypothesize that the increased production of reactive oxygen species associated with moderate MRC impairment could result in a smoldering podocytopathy with progressive proteinuric CKD, without overt tubulopathy or encephalomyopathy—which might be, instead, pathogenically related to adenosine triphosphate deficiency.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 1","pages":"Pages 119-123"},"PeriodicalIF":9.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141878212","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 Serum Afamin Concentrations With Kidney Failure in Patients With CKD: Findings From the German CKD Cohort Study.","authors":"Barbara Kollerits, Fruzsina Kotsis, Markus P Schneider, Ulla T Schultheiss, Hansi Weissensteiner, Sebastian Schönherr, Lukas Forer, Heike Meiselbach, Christoph Wanner, Kai-Uwe Eckardt, Hans Dieplinger, Florian Kronenberg","doi":"10.1053/j.ajkd.2024.11.004","DOIUrl":"10.1053/j.ajkd.2024.11.004","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Afamin is a vitamin E-binding glycoprotein primarily expressed in the liver and kidney. This study investigated whether serum afamin concentrations are associated with kidney function and incident kidney failure.</p><p><strong>Study design: </strong>Prospective cohort study with 6.5 years follow-up.</p><p><strong>Setting & participants: </strong>5,041 White patients enrolled in the German Chronic Kidney Disease (GCKD) study with measured afamin concentrations and either an estimated glomerular filtration rate (eGFR) of 30-60mL/min/1.73m² or an eGFR>60mL/min/1.73m² with a urinary albumin-creatinine ratio (UACR) of≥300mg/g at study entry.</p><p><strong>Exposure: </strong>Serum afamin concentrations (mg/L).</p><p><strong>Outcome: </strong>Incident kidney failure (initiation of kidney replacement therapy or kidney-related death).</p><p><strong>Analytical approach: </strong>Generalized linear regression and quantile regression models fit to investigate the association of afamin concentrations with eGFR and UACR. Adjusted Cox regression analysis to examine the association of afamin concentrations with incident kidney failure.</p><p><strong>Results: </strong>The mean±SD afamin concentration at study entry was 73.2±17.6mg/L. Higher afamin concentrations were associated with better kidney function with a 2.60mL/min/1.73m² higher eGFR (95% CI, 2.30-2.89) and a 5.97mg/g lower UACR (95% CI, 3.04-8.90) for each 10mg/L higher level of afamin concentration in adjusted analysis. During the follow-up period, each 10mg/L higher level of afamin concentration was associated with a 14% lower risk of kidney failure (HR, 0.86 [95%CI, 0.81-0.92], P<0.001).</p><p><strong>Limitations: </strong>Residual confounding, and potential limited generalizability to non-White populations and people with mild stages of chronic kidney disease (CKD) or no CKD.</p><p><strong>Conclusions: </strong>Higher serum afamin concentrations appear to be associated with a higher eGFR, less albuminuria, and a lower risk for future kidney failure in patients with CKD.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913683","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":"Use of Statins for Primary Prevention Among Individuals with CKD in the United States: A Cross-Sectional, Time-Trend Analysis.","authors":"Oshozimhede E Iyalomhe, Amarasinghe Arachchige Don Nalin Samandika Saparamadu, G Caleb Alexander","doi":"10.1053/j.ajkd.2024.11.003","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.11.003","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Chronic kidney disease (CKD) populations face an elevated risk of cardiovascular disease (CVD), yet many remain undertreated with statins for primary prevention of CVD despite meeting eligibility criteria. We examined trends in statin use for primary prevention among individuals with CKD before and after the release of the 2013 Kidney Disease: Improving Global Outcomes (KDIGO) guideline recommending statin use for lipid management in selected adults with CKD.</p><p><strong>Study design: </strong>Cross-sectional time-trend analysis.</p><p><strong>Settings & participants: </strong>The 2001-2020 National Health and Nutrition Examination Survey (NHANES) data permitted identification of individuals eligible for statin therapy per the 2013 KDIGO guidelines based on: (1) age ≥50 without self-reported CVD; (2) CKD, defined as estimated glomerular filtration rate <60 mL/min/1.73 m² or albumin-to-creatinine ratio ≥30 mg/g; and (3) no dialysis in the previous 12 months.</p><p><strong>Outcome: </strong>Statin use.</p><p><strong>Analytical approach: </strong>Poisson regression to estimate prevalence ratios (PR) comparing the periods before and after KDIGO guideline release and after accounting for NHANES' complex survey design and sampling weights.</p><p><strong>Results: </strong>Among eligible individuals, statin use approximately doubled from 18.6% in 2001-2002 to 36.1% in 2007-2008, increased modestly to 40.1% in 2013-2014, then subsequently plateaued. Multivariable analyses controlling for sociodemographic and clinical characteristics and secular trends demonstrated statin use for primary prevention was higher among the insured (PR 2.48, CI 1.66-3.69), those with hypertension (PR 1.49, CI 1.28-1.74), and those with diabetes (PR 1.71, CI 1.52-1.92). Statin use was more common with lower eGFR (p = 0.009) and higher BMI (p = 0.003) but did not differ by sex, race, or ethnicity.</p><p><strong>Limitations: </strong>Statin use and CVD were self-reported, and our data did not capture statin intolerance nor patient-provider decision-making information.</p><p><strong>Conclusions: </strong>Statin use for primary prevention in CKD substantially increased before the 2013 release of KDIGO guidelines and subsequently plateaued. Use was higher among the insured, and those with hypertension or diabetes.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913684","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":"Hurried Conversation.","authors":"Aditya S Pawar","doi":"10.1053/j.ajkd.2024.08.013","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.08.013","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142891352","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":"Disorders of Volume: Core Curriculum 2025.","authors":"Nayan Arora,Sarah F Sanghavi","doi":"10.1053/j.ajkd.2024.09.008","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.09.008","url":null,"abstract":"Historically, the paradigm for all maladies was associated with an imbalance of the 4 humors: blood, black bile, yellow bile, and phlegm. Although our understanding of disease has evolved significantly since the time of Hippocrates, a similar cornerstone of inpatient and ambulatory care involves understanding and correcting imbalances of volume. The kidneys are the principal organs controlling extracellular volume, capable of both sensing and altering salt retention through multiple redundant pathways, including the sympathetic nervous system and the renin-angiotensin-aldosterone system. Various disease states including sepsis, heart failure, and liver cirrhosis can dramatically alter the movement of volume across body compartments, leading to pathologic responses. Greater understanding of the role of the endothelial glycocalyx, the harms of volume overload among critically ill patients, and the impact of venous congestion on kidney function has challenged the traditional paradigms of volume management. Because both hypovolemia and hypervolemia are symptomatic conditions associated with adverse outcomes, managing volume is an essential skill for the nephrologist. In this Core Curriculum, we review the physiology of volume disorders and management strategies through a series of clinical cases.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"31 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142887679","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":"Clinical Spectrum and Prognosis of Atypical Autosomal Dominant Polycystic Kidney Disease Caused by Monoallelic Pathogenic Variants of IFT140.","authors":"Nikola Zagorec, Alizée Calamel, Margaux Delaporte, Eric Olinger, Sarah Orr, John A Sayer, Vignesh-Guru Pillay, Anne Sophie Denommé-Pichon, Frederic Tran Mau-Them, Sophie Nambot, Laurence Faivre, Elisabet Ars, Roser Torra, Albert Cm Ong, Olivier Devuyst, Noberto Perico, Aurore Michel Després, Hugo Lemoine, Jonathan de Fallois, Romain Brousse, Aurélie Hummel, Bertrand Knebelmann, Nathalie Maisonneuve, Jan Halbritter, Yannick Le Meur, Marie-Pierre Audrézet, Emilie Cornec-Le Gall","doi":"10.1053/j.ajkd.2024.10.009","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.10.009","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Monoallelic predicted Loss-of-Function (pLoF) variants in IFT140 have recently been associated with an autosomal dominant polycystic kidney disease (ADPKD)-like phenotype. This study sought to enhance the characterization of this phenotype.</p><p><strong>Study design: </strong>Case series.</p><p><strong>Setting & participants: </strong>Seventy-five among 2797 European individuals with ADPKD-like phenotypes who underwent genetic testing that revealed pLoF IFT140-variants.</p><p><strong>Findings: </strong>The 75 individuals (median age 56 years, 53.3% females) were from 61 families and were found to have 41 different monoallelic pLoF IFT140-variants. The majority of individuals presented with large, exophytic kidney cysts (median [range] total kidney volume 688 ml [201-4139]), and 90.2% were classified using the Mayo Imaging Classification as Mayo Class 2A. Arterial hypertension was present in 50.7% of the individuals (median [range] age at diagnosis 59 years [29-73]). Only one patient developed kidney failure (at age 69 years). A significant difference in age-adjusted eGFR between male and female patients was observed (P<0.001). 56.3% of the individuals over the age of 60 years had an eGFR less than 60ml/min/1.73m². The estimated genetic prevalence of monoallelic pLoF IFT140 variants was 19.76 (95%CI=18.8-20.7) and 27.89 (95%CI=23.8-31.9) per 10,000 in the Genome Aggregation Database and the 100,000 Genomes Project (100kG), respectively. CyKD (ICD-10 Q61) was associated with pLoF IFT140 variants (P=2.9x10^-9, OR=5.6 (3.3-9.2)) only in 100kG.</p><p><strong>Study limitations: </strong>Retrospective study; younger patients and patients with milder forms of IFT140-related CyKD may not be diagnosed.</p><p><strong>Conclusions: </strong>Individuals with monoallelic IFT140 pLoF variants are likely to develop kidney cysts atypical of classical ADPKD and generally have a favorable kidney prognosis.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142891227","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":"Echoes of a Silent Storm.","authors":"Priti Meena","doi":"10.1053/j.ajkd.2024.09.010","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.09.010","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142891351","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":"Glucocorticoid Exposure and Infection in Children and Adults With Glomerular Disease: Findings From the Cure Glomerulonephropathy Study.","authors":"Dorey A Glenn, Calvin Andrews, Qian Liu, Jarcy Zee, Sarah Mansfield, Abigail Smith, Michelle M O'Shaughnessy, Andrew Bomback, Keisha Gibson, Larry A Greenbaum, Ronald J Falk, Susan L Hogan, Amy Mottl, Michelle R Denburg","doi":"10.1053/j.ajkd.2024.10.008","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.10.008","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142870973","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 New Cardiovascular-Kidney-Metabolic (CKM) Syndrome: An Opportunity for CKD Detection and Treatment in Primary Care.","authors":"Sara-Megumi Rumrill, Michael G Shlipak","doi":"10.1053/j.ajkd.2024.09.016","DOIUrl":"10.1053/j.ajkd.2024.09.016","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142870976","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}