American Journal of Kidney Diseases最新文献

{"title":"Reframing Risk in CKD: Inflammation at the Center Stage","authors":"Peter Stenvinkel","doi":"10.1053/j.ajkd.2025.04.010","DOIUrl":"10.1053/j.ajkd.2025.04.010","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 2","pages":"Pages 150-151"},"PeriodicalIF":9.4,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144273946","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":"To Stay or to Fold: Biomarkers and the Management of Potentially Hemodynamic Acute Kidney Injury","authors":"Justin M. Belcher","doi":"10.1053/j.ajkd.2025.04.006","DOIUrl":"10.1053/j.ajkd.2025.04.006","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 2","pages":"Pages 143-145"},"PeriodicalIF":9.4,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144273947","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":"Mortality on Hemodiafiltration Compared to High-Flux Hemodialysis: A Brazilian Cohort Study","authors":"Jorge Paulo Strogoff-de-Matos , Maria Eugenia F. Canziani , Ana Beatriz L. Barra","doi":"10.1053/j.ajkd.2025.04.013","DOIUrl":"10.1053/j.ajkd.2025.04.013","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Hemodiafiltration (HDF) has been associated with better survival than high-flux hemodialysis (HD), but these studies were mainly conducted in developed countries. This study examined the mortality risk among Brazilian patients with kidney failure, comparing treatment with HDF to treatment with high-flux HD.</div></div><div><h3>Study Design</h3><div>Observational cohort study.</div></div><div><h3>Setting & Participants</h3><div>All adult patients on maintenance dialysis (high-flux HD and HDF) at 29 dialysis facilities in Brazil between January 1, 2022 and December 31, 2023.</div></div><div><h3>Exposure</h3><div>Treatment with HDF patients versus high-flux HD.</div></div><div><h3>Outcome</h3><div>All-cause mortality and cause-specific mortality attributed to cardiovascular/cerebrovascular and infection-related diseases.</div></div><div><h3>Analytical Approach</h3><div>Multivariable Cox proportional hazards regression in which dialysis modality was considered a time-updated exposure.</div></div><div><h3>Results</h3><div>The study included 8,391 patients: 6,787 receiving only high-flux HD, 2,836 receiving HDF, among whom 1,222 had migrated from high-flux HD to HDF during the follow-up period. The 2-year survival rates in these groups were 81.2% and 77.9%, respectively (<em>P</em> <!--><<!--> <!-->0.001). A significantly lower adjusted death risk was observed among patients receiving HDF versus HD (HR, 0.73 [95% CI, 0.63-0.85]) in a time-updated analysis. HDF treatment was also associated with a reduction in cardiovascular mortality risk but not in infection-related death. In the subgroup analysis, the reduction in mortality risk associated with HDF was consistent across subgroups, with a more pronounced effect observed in patients under the age of 65 (HR, 0.56 [95% CI, 0.42-0.77]) than for those aged 65 or more (HR, 0.82 [95% CI, 0.70-0.96]). In a sensitivity analysis including only HD and HDF as starting therapy and data censored at the time of dialysis modality change, treatment with HDF was associated with a lower death risk (HR 0.73 [95% CI, 0.62-0.85]).</div></div><div><h3>Limitations</h3><div>The retrospective design and a relatively small follow-up period.</div></div><div><h3>Conclusions</h3><div>In this large cohort study conducted in Brazil, patients treated with HDF, compared with those treated with conventional high-flux HD, exhibited a lower risk of all-cause and cardiovascular mortality.</div></div><div><h3>Plain-Language Summary</h3><div>Hemodialysis (HD), after decades of dominance, has been challenged by online hemodiafiltration (HDF) as the new standard of therapy for kidney failure. HDF has been associated with better survival in recent clinical trials. However, data are scanty about its benefits in real-world studies with unselected dialysis populations. In this retrospective cohort study, we compared the mortality risk in patients treated with HDF (n<!--> <!-->=<!--> <!-->2,826) t","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 3","pages":"Pages 335-342.e1"},"PeriodicalIF":8.2,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144273945","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":"Systemic Inflammation and the Risks of Adverse Kidney Outcomes in Adults With Atherosclerotic Cardiovascular Disease","authors":"Faizan Mazhar ,&nbsp;Edouard L. Fu ,&nbsp;Anne-Laure Faucon ,&nbsp;Paul Hjemdahl ,&nbsp;Jimmi Mathisen ,&nbsp;Iram Faqir Muhammad ,&nbsp;Oscar Plunde ,&nbsp;Vlado Perkovic ,&nbsp;Katherine R. Tuttle ,&nbsp;Juan-Jesus Carrero","doi":"10.1053/j.ajkd.2025.04.011","DOIUrl":"10.1053/j.ajkd.2025.04.011","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><div>Inflammasome activation is involved in the pathogenesis of atherosclerotic cardiovascular disease (ASCVD) and chronic kidney disease (CKD). This study investigated whether systemic inflammation, measured by C-reactive protein (CRP), is associated with adverse kidney outcomes in adults with ASCVD.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting &amp; Participants</h3><div>83,928 adults with ASCVD in Stockholm, Sweden, who underwent routine CRP testing between 2007 and 2021.</div></div><div><h3>Exposure(s)</h3><div>CRP was defined as the geometric mean of serum CRP levels within a 3-month ascertainment window, excluding CRP values potentially associated with an acute inflammatory process.</div></div><div><h3>Outcome(s)</h3><div>Acute kidney injury (AKI; based on diagnosis code or Kidney Disease: Improving Global Outcomes [KDIGO] serum creatinine criteria) and a composite kidney outcome defined as a sustained<!--> <!-->&gt;30% decrease in estimated glomerular filtration rate or kidney failure.</div></div><div><h3>Analytical Approach</h3><div>Cause-specific Cox proportional hazards regression.</div></div><div><h3>Results</h3><div>54% of the cohort was male, with a mean age of 71 years, and 59% of participants had systemic inflammation (CRP<!--> <!-->≥2<!--> <!-->mg/L). During a median follow-up of 6.4 years (IQR, 3.1-9.8 years), 8,371 kidney events, 10,757 AKI events, and 24,954 deaths were recorded. Compared with CRP<!--> <!-->&lt;1<!--> <!-->mg/L, higher CRP categories were associated with increased risks of both outcomes. Compared with a CRP of<!--> <!-->≤1<!--> <!-->mg/L, the adjusted HRs for the composite kidney outcome were 1.16 (95% CI, 1.09-1.23) for CRP<!--> <!-->&gt;1-3<!--> <!-->mg/L, 1.24 (1.17-1.32) for CRP<!--> <!-->&gt;3-10<!--> <!-->mg/L, and 1.35 (1.25-1.46) for CRP<!--> <!-->&gt;10-20<!--> <!-->mg/L. For AKI, the HRs were 1.18 (1.12-1.25), 1.34 (1.27-1.42), and 1.37 (1.28-1.47), respectively.</div></div><div><h3>Limitations</h3><div>Unmeasured confounding inherent to observational studies.</div></div><div><h3>Conclusions</h3><div>In this large cohort of adults with ASCVD, increased CRP levels were associated with higher risks of adverse kidney outcomes.</div></div><div><h3>Plain-Language Summary</h3><div>Inconsistent evidence exists regarding the association between the circulating blood marker of inflammation C-reactive protein (CRP) and kidney outcomes. We conducted an observational study in more than 83,000 adults with atherosclerotic cardiovascular disease undergoing routine care. The study showed that CRP levels were higher in participants with lower levels of kidney function and that CRP was associated with more rapid declines in kidney function over time as well as a greater risk of acute kidney injury.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 3","pages":"Pages 314-323.e1"},"PeriodicalIF":8.2,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245733","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":"Transplant Staff Awareness of Gender Disparities and the Evaluation of Women for Kidney Transplantation","authors":"Annika Gompers MPhil ,&nbsp;Jade Buford MPH ,&nbsp;Rachel E. Patzer PhD, MPH ,&nbsp;Stephen O. Pastan MD ,&nbsp;Ana Rossi MD, MPH ,&nbsp;Jessica L. Harding PhD","doi":"10.1053/j.ajkd.2025.03.027","DOIUrl":"10.1053/j.ajkd.2025.03.027","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 4","pages":"Pages 575-578"},"PeriodicalIF":8.2,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245734","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":"Role of Chimeric Antigen Receptor–Expressing Cell Therapy in Immune-Mediated Kidney Diseases: A Review","authors":"Jiawen Peng ,&nbsp;Yuemiao Zhang ,&nbsp;Jingyu Wang ,&nbsp;Hong Zhang ,&nbsp;Georg Schett","doi":"10.1053/j.ajkd.2025.04.012","DOIUrl":"10.1053/j.ajkd.2025.04.012","url":null,"abstract":"<div><div>Immune-mediated kidney diseases are characterized by an adaptive immune response directed against various self-antigens. B cells, as progenitors of autoantibody-producing plasma cells and as antigen-presenting cells, play a crucial role in the pathogenesis of these diseases. Despite significant advancements in B-cell-targeting therapies, relapses are common among patients. Evidence of insufficient B-cell depletion by monoclonal antibodies such as rituximab, and the inability to deplete plasma cells, suggests that a more robust and complete B-cell depletion may be necessary for immune-mediated kidney diseases. Chimeric antigen receptor (CAR)-expressing cell therapy has emerged as a promising option. In this approach, immune cells like T cells are genetically engineered to recognize specific markers on B cells. By leveraging T cells’ natural ability to infiltrate tissues and their high-affinity target binding, this method enables a deeper clearance of B cells than is usually observed with B-cell-depleting monoclonal antibodies. This review explores the potential of using B-cell-depleting CAR-expressing cell therapy in the treatment of immune-mediated kidney diseases.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 3","pages":"Pages 360-371"},"PeriodicalIF":8.2,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245732","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 Volume Overload With Kidney Function Outcomes Among Patients With Acute Decompensated Heart Failure","authors":"Amanda I. Moises ,&nbsp;Hocine Tighiouart ,&nbsp;Jeffrey M. Testani ,&nbsp;Marcelle Tuttle ,&nbsp;Run Banlengchit ,&nbsp;Tatsufumi Oka ,&nbsp;Ki Jung Lee ,&nbsp;Katie Ferguson ,&nbsp;Hannah Sarnak ,&nbsp;Callum Harding ,&nbsp;Michael S. Kiernan ,&nbsp;Mark J. Sarnak ,&nbsp;Wendy McCallum","doi":"10.1053/j.ajkd.2025.03.026","DOIUrl":"10.1053/j.ajkd.2025.03.026","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Reduced kidney function, as evaluated by estimated glomerular filtration rate (eGFR), is a powerful risk factor for adverse outcomes among patients with acute decompensated heart failure (ADHF). However, evidence that volume overload is a risk factor for declines in eGFR has been inconsistent. This study examined this association among adults with ADHF.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Retrospective observational study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Adult patients admitted to a quaternary referral hospital for a primary diagnosis of ADHF requiring right heart catheterization between 2015 and 2021.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;Initial central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP), and change in CVP and PCWP.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome&lt;/h3&gt;&lt;div&gt;The eGFR when CVP and/or PCWP monitoring began, in-hospital eGFR slope, and initiation of dialysis through March 2022.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Restricted cubic splines and linear mixed models to examine the association of CVP and PCWP with baseline eGFR and in-hospital eGFR slope. Cox proportional hazard regression models were used to examine the association of CVP, PCWP, and changes in CVP and PCWP with initiation of dialysis. Sensitivity analyses were performed treating death as a competing risk.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among 753 patients, higher CVP and PCWP were significantly associated with lower eGFR (β, −5.01 [95% CI, −6.68 to&lt;!--&gt; &lt;!--&gt;−3.35] and −2.84 [95% CI, −4.55 to −1.13] mL/min/1.73m&lt;sup&gt;2&lt;/sup&gt; per 1 SD higher CVP and PCWP, respectively) and lower in-hospital eGFR slope (β, −1.13 [95% CI, −1.57 to&lt;!--&gt; &lt;!--&gt;−0.69] and&lt;!--&gt; &lt;!--&gt;−0.59 [95% CI, −1.02 to&lt;!--&gt; &lt;!--&gt;−0.15] mL/min/1.73&lt;!--&gt; &lt;!--&gt;m&lt;sup&gt;2&lt;/sup&gt;/week per 1 SD higher). Over a median of 33 (IQR, 13-58) months, 62 patients (8.2%) required dialysis, and 264 patients (35.1%) died. Higher CVP and PCWP were associated with increased risk for dialysis: the adjusted HR per 1 SD higher CVP was 1.49 (95% CI, 1.17-1.90) and PCWP 1.30 (95% CI, 1.04-1.62). The associations remained consistent when treating death before dialysis as a competing risk. Change in CVP and PCWP were not associated with concomitantly assessed eGFR or risk of dialysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Observational design.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Volume overload was associated with lower baseline kidney function, greater declines in eGFR, and increased risk of starting dialysis. Changes in the degree of volume overload were not associated with concomitantly assessed changes in eGFR or the risk of dialysis over follow-up.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Studies evaluating volume overload as a risk factor for kidney function decline have been inconsistent. This study included adult patients admitted to the hospital with acute heart failure (2015-2021) who required invasive monitori","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 3","pages":"Pages 324-334.e1"},"PeriodicalIF":8.2,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245729","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 Between the Ideal Cardiovascular Health Score and Cardiovascular-Kidney Outcomes in Young Adults","authors":"Hyeok-Hee Lee ,&nbsp;Jong Hyun Jhee ,&nbsp;Eun-Jin Kim ,&nbsp;Dasom Son ,&nbsp;Hyeon Chang Kim ,&nbsp;Donald M. Lloyd-Jones ,&nbsp;Hokyou Lee","doi":"10.1053/j.ajkd.2025.03.024","DOIUrl":"10.1053/j.ajkd.2025.03.024","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;The linkage between cardiovascular disease (CVD) and kidney disease and the importance of promoting cardiovascular health (CVH) to prevent them are increasingly recognized. This study investigated the associations of ideal CVH and its longitudinal change with cardiovascular-kidney outcomes in young adults.&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;From nationwide health screening data, we identified adults aged 20-39 years without prior CVD or kidney disease who underwent baseline health examinations in 2009-2010 (N = 3,836,626).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;Using a modified American Heart Association Life’s Simple 7 construct excluding dietary data, the participants were categorized according to the number of ideal CVH components they met. Participants who underwent follow-up health examinations between 2011 and 2014 (N&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;2,728,675) were additionally categorized by the combination of baseline and follow-up CVH scores.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome&lt;/h3&gt;&lt;div&gt;A composite of cardiovascular or kidney event. Cardiovascular events included myocardial infarction, ischemic stroke, heart failure, and death from CVD. Kidney events included incident chronic kidney disease, kidney replacement therapy, and death from kidney disease.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Cause-specific proportional hazards model.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;During a median follow-up of 12.1 years, 134,317 composite cardiovascular or kidney events occurred. Multivariable-adjusted risk of the event decreased stepwise with higher CVH scores (for a CVH score of 6 vs 0: HR, 0.32 [95% CI, 0.30-0.34]). An increase in CVH score from baseline (2009-2010) to follow-up (2011-2014) examination was associated with lower risk of the event (HR, 0.86 [95% CI, 0.86-0.87] per&lt;!--&gt; &lt;!--&gt;+1 CVH score change). Moreover, the risk was lower in participants who maintained high CVH scores at both baseline and follow-up examinations than in those who newly achieved a high CVH score at follow-up examination (HR, 0.87 [95% CI, 0.86-0.87] per&lt;!--&gt; &lt;!--&gt;+1 baseline CVH score).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Diet data were not included in CVH score.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;In young adults, achieving and maintaining high CVH was associated with reduced risk of cardiovascular-kidney outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Cardiovascular disease (CVD) and kidney disease are closely connected, influencing each other from an early age. We explored whether achieving and maintaining good cardiovascular health (CVH) in young adulthood was associated with the prevention of future CVD and kidney disease. Our findings showed that young adults with better CVH had a lower risk of developing these conditions later in life. Improving CVH over time led to reduced risk, and maintaining good CVH from the ","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 4","pages":"Pages 499-509"},"PeriodicalIF":8.2,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245728","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":"Challenges of Vaccine-Induced Thrombotic Thrombocytopenia–Related Kidney Transplantation: Venous Graft Thrombosis in a Pediatric Recipient","authors":"Marvin Droste ,&nbsp;Leonie Kubitza ,&nbsp;Jan Wesche ,&nbsp;Stefanie Jeruschke ,&nbsp;Michael Berger ,&nbsp;Moritz Kaths ,&nbsp;Hideo A. Baba ,&nbsp;Andreas Greinacher ,&nbsp;Lars Pape ,&nbsp;Thomas Thiele ,&nbsp;Anja K. Büscher","doi":"10.1053/j.ajkd.2025.03.025","DOIUrl":"10.1053/j.ajkd.2025.03.025","url":null,"abstract":"<div><div>During the COVID-19 pandemic, adenoviral vaccines drew attention owing to a potential life-threatening coagulation disorder, the vaccine-induced immune thrombotic thrombocytopenia (VITT). Patients deceased of VITT have been accepted as organ donors despite safety concerns regarding the transmission of VITT to recipients. The outcome of adult kidney graft recipients was reported favorable in most cases; however, (thrombotic) complications were observed more frequently. We present 2 pediatric recipients of kidney grafts from VITT-deceased patients. Both donors (38 and 34 years old, male, body mass index each 23<!--> <!-->kg/m²) experienced VITT-related symptoms 22 and 12 days after first dose of Vaxzevria and Vaccine Janssen, respectively. Neither had a prior history of other prothrombotic conditions (eg, history of smoking, arterial hypertension, or prior thrombosis). The graft function was excellent for up to 36 months in the recipient in case 1 (14-year-old girl, hemodialysis, kidney failure caused by methylmalonic acidemia). However, the recipient in case 2 (4-year-old boy, peritoneal dialysis, kidney failure caused by abnormal urethral valves) experienced immediate and recurrent renal vein thrombosis. Histopathology of the explanted organ revealed extended platelet-enriched thrombus formation. VITT-causing antibodies against platelet factor 4 were detected in the organ perfusate of both allografts during cold storage, with significantly higher concentrations in the latter patient. Our findings emphasize the need for careful evaluation of donor organs from VITT-deceased patients, especially in high-risk patients, such as young children.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 3","pages":"Pages 408-412"},"PeriodicalIF":8.2,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245730","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":"Native American Ancestry and Susceptibility to Mesoamerican Nephropathy","authors":"Yuka Sato ,&nbsp;Joseph Yracheta ,&nbsp;Carlos Roncal ,&nbsp;Amy Li ,&nbsp;Richard J. Johnson","doi":"10.1053/j.ajkd.2025.05.003","DOIUrl":"10.1053/j.ajkd.2025.05.003","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 3","pages":"Pages 400-403"},"PeriodicalIF":8.2,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245731","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}