American Journal of Kidney Diseases最新文献

{"title":"In Reply to “Serum Sodium in Peritoneal Dialysis: Beyond Mortality to Mechanistic Insights”","authors":"Isaac Teitelbaum MD, FACP , Brian Bieber MPH, MS , Jeffrey Perl MD","doi":"10.1053/j.ajkd.2025.06.001","DOIUrl":"10.1053/j.ajkd.2025.06.001","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 3","pages":"Pages 414-416"},"PeriodicalIF":8.2,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487971","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":"How to Leverage Implementation Science to Achieve Equity in Nephrology Care Delivery","authors":"Yuvaram N.V. Reddy ,&nbsp;Laura Ellen Ashcraft ,&nbsp;Mallika L. Mendu","doi":"10.1053/j.ajkd.2025.03.029","DOIUrl":"10.1053/j.ajkd.2025.03.029","url":null,"abstract":"<div><div>There are several evidence-based practices within nephrology that have the potential to meaningfully improve patient outcomes and mitigate disparities. However, these practices are inconsistently implemented in routine care, contributing to low-quality care, persistent health disparities, and high health care costs. To address these care gaps quickly, nephrology would benefit from leveraging implementation science: a multidisciplinary field that seeks to close the gap between evidence and practice by examining the optimal approach to help individuals, groups, organizations, and communities implement evidence-based interventions in real-world settings. This Perspective is designed to provide an overview of the field of implementation science and summarize how to apply implementation science in nephrology to address health disparities. To illustrate how to leverage implementation science for health equity, we also showcase 2 case examples focused on (1) addressing disparities in the use of sodium/glucose cotransporter 2 inhibitors to slow the progression of chronic kidney disease, and (2) increasing equitable access to home dialysis for people with kidney failure.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 4","pages":"Pages 550-559"},"PeriodicalIF":8.2,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144335587","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":"Peripheral Neuropathy Presenting With Hypereosinophilia: A Quiz","authors":"Rex K. Siu ,&nbsp;Alexandra C. Hardy ,&nbsp;Faaiq N. Aslam ,&nbsp;Induja R. Nimma ,&nbsp;Sehreen Mumtaz ,&nbsp;Sam T. Albadri ,&nbsp;Nancy Dawson ,&nbsp;Lyle W. Baker","doi":"10.1053/j.ajkd.2025.01.017","DOIUrl":"10.1053/j.ajkd.2025.01.017","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 1","pages":"Pages A13-A16"},"PeriodicalIF":9.4,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320893","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":"Primary Care Use and Clinical Outcomes Among Patients Initiating Hemodialysis","authors":"Dustin Le ,&nbsp;Rohanit Singh ,&nbsp;Byoungjun Kim ,&nbsp;Raquel C. Greer ,&nbsp;Morgan E. Grams ,&nbsp;Bernard G. Jaar","doi":"10.1053/j.ajkd.2025.04.017","DOIUrl":"10.1053/j.ajkd.2025.04.017","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;The association between primary care use within 90 days after hemodialysis (HD) initiation and health outcomes is unclear, so evaluating these associations may have implications for population health management. This study examined the association of primary care use after in-center HD initiation and clinical outcomes.&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;United States Renal Data System registry of incident patients with end-stage kidney disease linked with Medicare claims data between January 2012 and December 2020.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;Primary care use was defined as&lt;!--&gt; &lt;!--&gt;≥1 outpatient visit to a provider with the specialty of family, general, geriatric, or internal medicine within 90 days of HD initiation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome&lt;/h3&gt;&lt;div&gt;The primary study outcome was all-cause mortality, and secondary outcomes were cardiovascular mortality, infectious disease mortality, index hospitalization, emergency department/urgent care, kidney transplantation, intensive care unit care, and a subsequent primary care visit.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Inverse probability of treatment weighting to balance patients with primary care use with those without primary care use before fitting an unadjusted Cox proportional hazards regression model and cause-specific hazards models when competing risks were treated as censoring events.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;We identified 58,011 (51%) and 56,653 (49%) Medicare beneficiaries (average age 71, 70% White, and 53% men) with and without primary care use within 90 days after HD initiation, respectively. There were 58,982 deaths during a median (interquartile interval) follow-up of 1.79 (0.69-3.38) years. The hazard ratio for all-cause mortality was 0.91 (95% CI, 0.89-0.92), and there were similar reductions in cardiovascular death (HR, 0.94 [95% CI, 0.91-0.96]), infectious disease death (HR, 0.87 [95% CI, 0.81-0.94]), and index hospitalization (HR, 0.98 [95% CI, 0.97-1.00], &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.03). There was no difference in the next emergency department/urgent care visit (HR, 1.00 [95% CI, 0.99-1.02]), but there was an increase in receiving subsequent primary care (HR, 3.72 [95% CI, 3.65-3.79]).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Patients had pre-existing Medicare coverage before dialysis initiation, limiting generalizability.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Primary care use within 90 days of HD initiation was low at 51% but was associated with lower mortality and hospitalization. Further studies are needed to assess the mechanisms and barriers of primary care use in this vulnerable population.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Primary care is associated with improved health outcomes for the general population, but whether this also applies to patients on dialysis is unclear. We used the","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 4","pages":"Pages 437-447.e1"},"PeriodicalIF":8.2,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144335555","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":"Patients’ Perspectives on Living With Primary Membranous Nephropathy: A Semi-Structured Interview Study","authors":"Edmund Y.M. Chung ,&nbsp;Simon A. Carter ,&nbsp;Allison Jaure ,&nbsp;Martin Howell ,&nbsp;Bhadran Bose ,&nbsp;Meg Jardine ,&nbsp;Lukas Kairaitis ,&nbsp;Karen Keung ,&nbsp;Hugh J. McCarthy ,&nbsp;Nicole Scholes-Robertson ,&nbsp;Amanda Sluiter ,&nbsp;Germaine Wong ,&nbsp;Stephen I. Alexander","doi":"10.1053/j.ajkd.2025.03.028","DOIUrl":"10.1053/j.ajkd.2025.03.028","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Membranous nephropathy (MN) is characterized by a relapsing remitting course with a third of patients developing kidney failure if untreated. Little is known about the experiences patients have when living with MN. This study described those experiences to inform choices of clinical care and guide future research.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Semistructured interview study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;20 adult participants with primary MN from 5 hospitals in Australia.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Transcripts of interviews were analyzed thematically.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The participants had a mean age of 63 years, were mostly men (85%) and White (65%), and had chronic kidney disease stages 1 to 2 (45%) or stages 3 to 5 (35%), were receiving dialysis (10%), or had received a kidney transplant (10%). Five themes were identified: impeding life participation (with subthemes of invisibility of exhaustion, debilitated by swelling, restricted activity from treatment); strained relationships (fractured family life and friendships, the guilt of burdening others, guilt of losing a transplant from recurrent disease); overwhelmed by treatment decision making (disempowered by inadequate information, disorientated by an unfamiliar disease, trusting and deferring to health professionals); disappointed with treatment (confronting unexpected treatment harms, frustration and fear of catastrophic complications, demoralized by the incurability of disease, resigned to accept treatment toxicity); and uncertain future and health (unable to plan ahead, insecurity from lack of tangible treatment benefit).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;English-speaking participants only.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Participants with MN face the burden of living with a chronic relapsing disease and associated fatigue, swelling, and substantial treatment harms with the risk of kidney failure that impact life participation and relationships. Awareness and management of these burdens and psychological support may inform care and improve outcomes among patients living with MN.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Primary membranous nephropathy (MN) is an autoimmune kidney disease that often progresses to kidney failure, necessitating treatments that suppress the immune system. By recording the experiences of people living with primary MN, this study expands the understanding of how to best care for these patients and manage their treatment regimens. This study implemented semistructured interviews of 20 adults with MN to understand their lived experiences with this disease. They described being burdened by disease symptoms (fatigue and swelling) and the decisions regarding treatments and associated harms that limit their daily activities and relationships. The relapsing nature of MN and risk of progressing to kidney failure also caused","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 3","pages":"Pages 343-352.e1"},"PeriodicalIF":8.2,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144335589","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":"In Reply to “Clarification on Existing Opportunities for POCUS Certifications for Nephrologists”","authors":"Abhilash Koratala MD ,&nbsp;Amir Kazory MD","doi":"10.1053/j.ajkd.2025.04.016","DOIUrl":"10.1053/j.ajkd.2025.04.016","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 3","pages":"Pages 413-414"},"PeriodicalIF":8.2,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319817","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":"TSC2/PKD1 Contiguous Gene Deletion Syndrome: A Case Series","authors":"Eduardo de Oliveira Valle ,&nbsp;Mateus Coelho Guerreiro ,&nbsp;Jose Otto Reusing Junior ,&nbsp;Elieser Hitoshi Watanabe ,&nbsp;Luiz Fernando Onuchic","doi":"10.1053/j.ajkd.2025.05.004","DOIUrl":"10.1053/j.ajkd.2025.05.004","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><div><em>TSC2/PKD1</em> contiguous gene deletion syndrome (CGS) has been associated with a more severe kidney phenotype than observed in autosomal dominant polycystic kidney disease (ADPKD), displaying childhood onset and progression to end-stage kidney disease (ESKD) within the first 3 decades of life. Because recent case reports have suggested a more variable clinical course, we characterized a series of patients with CGS.</div></div><div><h3>Study Design</h3><div>Case series.</div></div><div><h3>Setting &amp; Participants</h3><div>Eleven patients and a clinically unaffected individual from two CGS pedigrees.</div></div><div><h3>Findings</h3><div>The pedigree patients presented with widely variable kidney survival, with 2 reaching the fourth decade of life without ESKD even in the absence of mosaicism. The median age of individuals who developed ESKD was 22.5 (IQR, 20-25) years, whereas the median age among those who did not develop ESKD was 25.5 (IQR, 25-35) years.</div></div><div><h3>Limitations</h3><div>Retrospective study, limited number of patients with complete clinical data. Possible incomplete evaluation of tuberous sclerosis complex (TSC) clinical features.</div></div><div><h3>Conclusions</h3><div>Patients with CGS have a variable clinical course and may reach ESKD later than previously reported, even in the absence of mosaicism. Some patients with CGS may have a kidney phenotype similar to severe ADPKD. Other patients with CGS may have TSC manifestations associated with severe progression of cystic kidney disease but not as fast as previously expected for CGS.</div></div><div><h3>Plain-Language Summary</h3><div>The <em>TSC2</em>/<em>PKD1</em> contiguous gene deletion syndrome (CGS) includes features of tuberous sclerosis complex (TSC) and autosomal dominant polycystic kidney disease (ADPKD). It has been associated with fast progression to end-stage kidney disease (ESKD) in children and young adults, but more recent data suggest a more variable clinical course. This case series, including 12 CGS-affected individuals, brings key information to the characterization of this disorder’s clinical spectrum and natural history. This case series revealed a widely variable kidney prognosis even among patients with the same deletion, with the age of ESKD onset in milder cases overlapping with severe cases of ADPKD. CGS should, therefore, be considered in patients diagnosed with severe ADPKD who are apparently not presenting TSC manifestations as well as in patients diagnosed with TSC with severe progression of cystic kidney disease.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 3","pages":"Pages 353-359.e1"},"PeriodicalIF":8.2,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144335588","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":"Why Do Creatinine- and Cystatin C–Based Estimated GFR Values Often Differ?","authors":"Antoine Créon ,&nbsp;Andrew S. Levey ,&nbsp;Juan J. Carrero","doi":"10.1053/j.ajkd.2025.05.002","DOIUrl":"10.1053/j.ajkd.2025.05.002","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 2","pages":"Pages 152-154"},"PeriodicalIF":9.4,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295799","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":"Clarification on Existing Opportunities for POCUS Certifications for Nephrologists","authors":"Daniel W. Ross MD, MPH ,&nbsp;Andrew A. Moses MD ,&nbsp;Adina S. Voiculescu MD ,&nbsp;Vandana Dua Niyyar MD","doi":"10.1053/j.ajkd.2025.04.015","DOIUrl":"10.1053/j.ajkd.2025.04.015","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 3","pages":"Page 413"},"PeriodicalIF":8.2,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319816","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":"Financial Nephrotoxicity: Prevention Is Better Than Cure","authors":"Simon Sawhney ,&nbsp;Nicole Scholes-Robertson","doi":"10.1053/j.ajkd.2025.05.001","DOIUrl":"10.1053/j.ajkd.2025.05.001","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 2","pages":"Pages 146-149"},"PeriodicalIF":9.4,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281957","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}