American Journal of Kidney Diseases最新文献

{"title":"In Reply to “Low-Flow Home Hemodialysis Technologies: The Key to Greener Dialysis?”","authors":"Katherine A. Barraclough PhD , Ben Talbot PhD , Scott McAlister PhD","doi":"10.1053/j.ajkd.2025.10.010","DOIUrl":"10.1053/j.ajkd.2025.10.010","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 284-285"},"PeriodicalIF":8.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688976","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":"Selecting Antihypertensive Medications for Kidney Transplant Recipients: Flying Blind","authors":"Deepthi Malepati, Paul E. Drawz","doi":"10.1053/j.ajkd.2025.09.016","DOIUrl":"10.1053/j.ajkd.2025.09.016","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 272-274"},"PeriodicalIF":8.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688981","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":"Access to Kidney Transplantation in Adults With Severe Obesity: A Population-Based Retrospective Cohort Study","authors":"Natasha Wiebe , Stephanie Thompson , Ashley Spellman , Ngan N. Lam , Marcello Tonelli","doi":"10.1053/j.ajkd.2025.09.013","DOIUrl":"10.1053/j.ajkd.2025.09.013","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>International guidelines do not consider moderate or severe obesity to be a contraindication to kidney transplantation, but clinical practice suggests otherwise. This study evaluated the likelihood of kidney transplantation in patients with moderate or severe obesity and how that likelihood compared with patients with other risk factors.</div></div><div><h3>Study Design</h3><div>Retrospective population-based cohort study.</div></div><div><h3>Setting & Participants</h3><div>96,181 adults with kidney failure, living in Canada between 2000 and 2021.</div></div><div><h3>Exposure</h3><div>Moderate or severe obesity and other risk factors (eg, age groups, diabetes, heart disease).</div></div><div><h3>Outcome</h3><div>Time to transplantation and time to allograft failure or death.</div></div><div><h3>Analytical Approach</h3><div>Parametric survival modeling, adjusting for all risk factors.</div></div><div><h3>Results</h3><div>Over a median follow-up period of 2.5 years, 58.2% of patients died, and 16.3% were transplanted. Participants with severe (body mass index [BMI] ≥ 40 kg/m<sup>2</sup>) or moderate (BMI 35.0-39.9 kg/m<sup>2</sup>) obesity were less likely to be transplanted than the control participants (BMI 18.5-24.9 kg/m<sup>2</sup>) (HR, 0.43 [95% CI, 0.39-0.47] and HR, 0.76 [95% CI, 0.71-0.82], respectively). Of 39 characteristics/categories considered, only participants aged ≥80 years were less likely to receive a transplant than those with severe obesity. Transplant recipients were followed for a median of 5.4 years. After those aged ≥65 years, participants with severe obesity were the most likely to experience allograft failure or death (HR, 1.70 [95% CI, 1.38-2.02] compared with controls). When we considered combinations of key risk factors, young participants with severe or moderate obesity and few comorbidities were at lower risk for allograft failure or death than participants with other common clinical characteristics.</div></div><div><h3>Limitations</h3><div>Residual confounding.</div></div><div><h3>Conclusions</h3><div>Canadian dialysis patients with moderate or severe obesity had a markedly reduced likelihood of receiving a kidney transplant. Although patients with moderate or severe obesity also had a heightened risk of allograft failure or death, the magnitude of the latter was similar to the excess risk associated with other common clinical characteristics. These findings support current practice guidelines and suggest that further work should identify and remove barriers to accessing kidney transplantation among patients with obesity.</div></div><div><h3>Plain-Language Summary</h3><div>International guidelines do not consider moderate or severe obesity (body mass index ≥35 and ≥40 kg/m<sup>2</sup>, respectively) to be a contraindication to kidney transplantation, but clinical practice suggests otherwise. Canadian dialysis patients with moderate or severe obesity had a reduced likel","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 199-210"},"PeriodicalIF":8.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145516264","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":"Thrombotic Microangiopathy During Pregnancy: Role of Soluble Fms-like Tyrosine Kinase-1–Placental Growth Factor Ratios","authors":"Daan P.C. van Doorn ,&nbsp;Salwan Al-Nasiry ,&nbsp;Marc E.A. Spaanderman ,&nbsp;Jan G.M.C. Damoiseaux ,&nbsp;Pieter van Paassen ,&nbsp;Sjoerd A.M.E.G. Timmermans","doi":"10.1053/j.ajkd.2025.09.017","DOIUrl":"10.1053/j.ajkd.2025.09.017","url":null,"abstract":"<div><div>Thrombotic microangiopathies (TMAs) are severe endotheliopathies that can arise in pregnancy and require early recognition. Complement-mediated (C-)TMA should be differentiated from other endotheliopathies of pregnancy because the treatment differs. Here, we report a case of a pregnant woman with acute kidney injury requiring hemodialysis due to C-TMA on the background of a pathogenic <em>C3</em> variant at 28+5 weeks of gestation. The low soluble Fms-like tyrosine kinase-1 to placental growth factor (sFlt1/PlGF) ratio excluded pre-eclampsia. Eculizumab was started, and therapeutic drug monitoring was applied for optimal dosing. Despite prolonged hemodialysis, fetal well-being was preserved, and delivery was safely postponed till 34+3 weeks of gestation, resulting in a healthy neonate. We also separately report on sFlt1/PlGF ratios measured in a cohort of 11 patients with TMA and coexisting pregnancy. Ten of 11 patients (91%) had low sFlt1/PlGF ratios, excluding pre-eclampsia. Thus, successful pregnancy in women with C-TMA can occur, and sFlt1/PlGF ratios may aid in clarifying the diagnosis and appropriate treatment.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 278-283"},"PeriodicalIF":8.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688975","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":"Environmental Impacts of Kidney Replacement Therapies: A Comparative Lifecycle Assessment","authors":"Saba Saleem ,&nbsp;Caroline Stigant ,&nbsp;Tasleem Rajan ,&nbsp;Kasun Hewage ,&nbsp;Rehan Sadiq ,&nbsp;Andrea J. MacNeill ,&nbsp;Christopher Nguan","doi":"10.1053/j.ajkd.2025.08.010","DOIUrl":"10.1053/j.ajkd.2025.08.010","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Health care delivery is associated with considerable emissions of greenhouse gases and other pollutants. Although the relative health and economic impacts of kidney replacement therapies (KRTs) have been examined, their comparative environmental impacts have been poorly described. This study sought to characterize these impacts, comparing them across types of KRT.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;A comparative lifecycle assessment (LCA).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Data collection implemented at Vancouver General Hospital in Vancouver, British Columbia, Canada.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;Three KRTs: deceased-donor kidney transplant (KT), automated/cycler peritoneal dialysis (PD), or in-center hemodialysis (HD).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome&lt;/h3&gt;&lt;div&gt;Environmental impacts of KRTs over 1 year were evaluated using the World ReCiPe (H) 2016 method.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Lifecycle inventory results were transformed into 3 end-point and 18 midpoint environmental impact categories including climate change, air pollution, human toxicity, and water depletion.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Across the majority of environmental impact categories, including climate change, air pollution, human toxicity, and water depletion, HD had the highest environmental impact and KT the lowest. The climate impact from a patient receiving HD was 74% and 46% more than from patients receiving KT and PD, respectively. Similarly, HD accounted for 65% of total air pollution impacts, 54% of human toxicity, and 44% of water depletion. The highest impact of PD was on water depletion (41%) and metal depletion (81%). KT demonstrated the lowest impact across all categories except terrestrial ecotoxicity. Within each therapy, patient and staff travel and consumables were the largest contributors to greenhouse gas emissions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Pharmaceuticals were excluded from this study because of a lack of publicly available data.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;KT is the most environmentally preferred KRT. PD had fewer environmental impacts than HD. Understanding the relative environmental impacts of KRTs can help inform clinical decision-making in the management of kidney failure.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;The environmental impacts of health care are gaining attention, yet kidney care, and especially kidney replacement therapies (KRTs), have been underexamined. This study was inspired by growing concerns about the environmental consequences of KRTs like hemodialysis, peritoneal dialysis, and transplantation. We used environmental assessment tools to measure emissions and resource use across different KRTs in a clinical setting in Vancouver, Canada. We found that these therapies vary widely in their environmental impacts, with in-center hemodialysis having the greatest negative impact and kidney transpla","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 65-74.e1"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261606","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 “Kidney Cysts in Alport Syndrome: Illustrative Cases, but Misleading Conclusions”","authors":"Thomas Bais MD ,&nbsp;Martijn J. de Groot MD, PhD ,&nbsp;Esther Meijer MD, PhD","doi":"10.1053/j.ajkd.2025.09.007","DOIUrl":"10.1053/j.ajkd.2025.09.007","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Page 135"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145462016","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":"Purpura in a Patient With Nephritic Syndrome: A Quiz","authors":"Telma Pais ,&nbsp;José Oliveira da Costa ,&nbsp;Mafalda Pinho ,&nbsp;Dolores López-Presa ,&nbsp;Sofia Jorge ,&nbsp;José António Lopes ,&nbsp;Joana Gameiro","doi":"10.1053/j.ajkd.2025.09.006","DOIUrl":"10.1053/j.ajkd.2025.09.006","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages A21-A24"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765755","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":"Monoallelic IFT140 Variants Causing Childhood-Onset Autosomal Dominant Polycystic Kidney Disease","authors":"Joshua D. Griffiths ,&nbsp;Grace Ehidiamhen ,&nbsp;Sergio Camilo Lopez-Garcia ,&nbsp;Rachel Hubbard ,&nbsp;Jackie Cook ,&nbsp;Albert C.M. Ong","doi":"10.1053/j.ajkd.2025.08.006","DOIUrl":"10.1053/j.ajkd.2025.08.006","url":null,"abstract":"<div><div><em>IFT140</em> is a component of the intraflagellar transport-complex A involved in retrograde ciliary trafficking of proteins into primary cilia. Monoallelic <em>IFT140</em> variants have been identified as an important cause of adult-onset autosomal dominant polycystic kidney disease (ADPKD), accounting for ∼2% of prevalent cases. Patients with ADPKD-<em>IFT140</em> usually present in later life with small numbers of large cysts and rarely develop kidney failure. Here, we report 3 genetically resolved cases of ADPKD-<em>IFT140</em> diagnosed in childhood or infancy from 3 unrelated pedigrees with ages at presentation ranging from in utero to 14 years. Each pedigree had a different familial <em>IFT140</em> variant, with no evidence of a second ADPKD gene variant on whole genome sequencing. All 3 children had normal kidney function and normal blood pressure, although 1 child presented initially with a high cyst burden in utero and had impaired function on a DMSA scan. Despite the negative family history, cascade screening of first-degree relatives revealed previously undiagnosed ADPKD with features typical of adult-onset ADPKD-<em>IFT140</em>. Our findings highlight the need to consider <em>IFT140</em> as a potential cause of childhood early-onset ADPKD and expand the phenotypic spectrum of ADPKD-<em>IFT140</em>.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 124-128"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145089840","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":"Assessing Deceased-Donor Kidneys Through Posttransplant Survival Prediction Algorithms","authors":"Vishnu S. Potluri ,&nbsp;Jeremy Rubin ,&nbsp;Jarcy Zee ,&nbsp;Sarah J. Ratcliffe ,&nbsp;Michael O. Harhay ,&nbsp;Peter L. Abt ,&nbsp;Emily A. Vail ,&nbsp;Chirag R. Parikh ,&nbsp;Roy D. Bloom ,&nbsp;Alessandro Gasparini ,&nbsp;Michael Crowther ,&nbsp;David S. Goldberg ,&nbsp;Peter P. Reese","doi":"10.1053/j.ajkd.2025.07.016","DOIUrl":"10.1053/j.ajkd.2025.07.016","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><div>The Kidney Donor Risk Index (KDRI) is widely used to rank the quality of deceased-donor kidneys and is integrated into the U.S. kidney allograft allocation system. However, the KDRI has modest predictive accuracy for allograft survival, and recent revisions to the KDRI, which removed donor race and hepatitis C virus status, also revealed model calibration problems. This study aimed to evaluate novel approaches for predicting posttransplant allograft survival.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study using Organ Procurement and Transplantation Network data from May 1, 2007, through December 31, 2021.</div></div><div><h3>Predictors</h3><div>(1) Donor demographic and clinical variables (established predictors); (2) longitudinal laboratory data from the donor’s terminal hospitalization, such as serum creatinine (new predictors); and (3) recipient clinical variables (new predictors).</div></div><div><h3>Setting &amp; Participants</h3><div>75,867 adult kidney recipients at U.S. centers.</div></div><div><h3>Outcomes</h3><div>The primary outcome was time to all-cause allograft failure over 3 years. A secondary outcome was delayed graft function, defined as dialysis in the first week after the transplant.</div></div><div><h3>Analytical Approach</h3><div>We implemented and compared machine-learning statistical models versus traditional modeling approaches (ie, proportional hazards for the primary outcome and logistic regression of the secondary outcome) that incorporated various combinations of predictors. The performance metrics used to assess discrimination were the integrated (time-dependent) area under the curve (AUC) for allograft survival and the AUC for delayed graft function. To assess calibration, we calculated Brier scores and visually compared the predicted outcomes with the observed ones. Predictive performance was assessed in a 20% testing data split.</div></div><div><h3>Results</h3><div>Neither machine-learning models nor the addition of longitudinal laboratory data from the donor hospitalization to traditional models improved discrimination. For the primary outcome, the final model (named the Kidney Allograft Survival Index) used a proportional hazards modeling approach. Adding recipient variables improved model discrimination (integrated AUC, 0.68) and achieved excellent calibration for the overall cohort and subgroups. The final model for delayed allograft function used logistic regression, included recipient variables, and had an AUC of 0.75 with acceptable calibration.</div></div><div><h3>Limitations</h3><div>No external validation.</div></div><div><h3>Conclusions</h3><div>Improving the discrimination and calibration of kidney allograft survival prediction models is achievable by including recipient characteristics. These enhanced models have potential to improve the system of kidney allocation.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 18-30"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357748","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":"Toward Smarter Allocation by Rethinking Kidney Donor Profile Index","authors":"Ajay K. Israni ,&nbsp;Jon Miller ,&nbsp;Syed F. Hassan","doi":"10.1053/j.ajkd.2025.11.001","DOIUrl":"10.1053/j.ajkd.2025.11.001","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 4-6"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765734","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}