American Journal of Kidney Diseases最新文献

{"title":"Toward Smarter Allocation by Rethinking Kidney Donor Profile Index","authors":"Ajay K. Israni , Jon Miller , 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}

{"title":"Urine Oxalate Excretion and CKD Stage in Patients With Primary Hyperoxaluria Type 1","authors":"Lisa E. Vaughan , Phillip J. Schulte , Felix Knauf , David J. Sas , Dawn S. Milliner , John C. Lieske","doi":"10.1053/j.ajkd.2025.07.013","DOIUrl":"10.1053/j.ajkd.2025.07.013","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 138-140"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145117154","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":"Contraceptive Use and Reproductive Health in Women With CKD: A Qualitative Study of Nephrologists in the United States","authors":"Nedas Semaska , Rachael Nolan , Silvi Shah","doi":"10.1053/j.ajkd.2025.07.007","DOIUrl":"10.1053/j.ajkd.2025.07.007","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Women with chronic kidney disease (CKD) face elevated risks during pregnancy, yet contraceptive use and reproductive health counseling remain low. Nephrologists, who often maintain longitudinal relationships with patients, may be well-positioned to engage in these discussions. This study explored nephrologists’ perspectives on contraception and reproductive health management in women with CKD.</div></div><div><h3>Study Design</h3><div>Qualitative study using semistructured interviews.</div></div><div><h3>Setting & Participants</h3><div>Interviews were conducted with 25 adult general and transplant nephrologists from both academic and private practice settings across the United States.</div></div><div><h3>Analytical Approach</h3><div>Virtual interviews were recorded, transcribed, and analyzed using thematic analysis until thematic saturation was achieved. A grounded theory approach guided coding and identification of key themes related to provider experiences and perspectives.</div></div><div><h3>Results</h3><div>The following 4 themes and their respective subthemes were identified: (1) physician discomfort regarding discussion of contraception and reproductive health (reliance on patient initiation, hesitation with counseling, uncertainty about scope of practice); (2) insufficient training and inadequate guidelines regarding contraception and reproductive health (paucity of formal guidelines, limited exposure, reliance on self-education); (3) lack of interdisciplinary coordination regarding contraceptive use and reproductive health (the patient as an intermediary, fragmentation of care); (4) need for holistic and patient-centered care (comprehensive and sustained approach, shared decision-making).</div></div><div><h3>Limitations</h3><div>Generalizability may be limited due to participants being predominantly early-career academic nephrologists.</div></div><div><h3>Conclusions</h3><div>Key barriers to contraceptive use and management of reproductive health for women with CKD include provider discomfort due to limited exposure and training, lack of clear guidelines, and fragmented care. Despite these challenges, providers recognize the importance of holistic, patient-centered care. These findings highlight the need to improve contraceptive counseling to support appropriate contraceptive use and shared decision making for the reproductive health of patients with kidney disease.</div></div><div><h3>Plain-Language Summary</h3><div>Women with kidney disease can face challenges with fertility, sexual health, and menstruation. Pregnancy is often riskier for these women due to complications such as high blood pressure and preterm birth. Despite these risks, the use of birth control among women with kidney disease remains low. This study looked at the experiences of nephrologists in providing contraception and reproductive health counseling for their female patients. The interviews revealed that many nephrolo","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 7-17.e1"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145083579","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":"Living Kidney Donors’ Residential Neighborhoods: Driver or Barrier of Postdonation Follow-Up?","authors":"Yiting Li , Gayathri Menon , Byoungjun Kim , Mario P. DeMarco , Babak J. Orandi , Sunjae Bae , Wenbo Wu , Allan B. Massie , Macey L. Levan , Jonathan C. Berger , Dorry L. Segev , Mara A. McAdams-DeMarco","doi":"10.1053/j.ajkd.2025.06.020","DOIUrl":"10.1053/j.ajkd.2025.06.020","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 135-138"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093511","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":"Trends in Major Cardiovascular Events and Bleeding Among Patients With Advanced CKD: A Nationwide Swedish Study","authors":"Anne-Laure Faucon , Stefania Lando , Shunsuke Murata , Morgan E. Grams , Edouard L. Fu , Frida Welander , Nazleen F. Khan , G. Brandon Atkins , Irina Barash , Dena R. Ramey , Karin Modig , Marie Evans , Juan-Jesús Carrero","doi":"10.1053/j.ajkd.2025.08.011","DOIUrl":"10.1053/j.ajkd.2025.08.011","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Patients with advanced chronic kidney disease (CKD) have an excess risk of cardiovascular and bleeding events, but trends in the rates of these events have yet to be fully investigated. This study focused on characterizing them in Sweden.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>All patients with advanced CKD enrolled by nephrologists in a nationwide Swedish Renal Registry between 2011 and 2021.</div></div><div><h3>Exposure</h3><div>Stage G4 CKD (N = 25,591), nondialysis stage G5 CKD (ND-CKD, N = 13,968), supported by hemodialysis (N = 10,635), or supported by peritoneal dialysis (N = 4,511).</div></div><div><h3>Outcome</h3><div>Major adverse cardiovascular events (MACE), arterial and venous thromboembolic events, major and non-major clinically-relevant bleeding.</div></div><div><h3>Analytical Approach</h3><div>Patients were followed until an outcome event, death, or progression to a more severe CKD-stage/change of dialysis modality. Poisson models to estimate unadjusted incidence rates and standardized incidence rate ratios were computed using indirect standardization based on the observed rates in the age- and sex- matched general population.</div></div><div><h3>Results</h3><div>The rates of all study outcomes were greater with more severe stages of CKD; by 2021, the rates of these outcomes were 1.4 to 13.6 times higher than in the general population. Between 2011 and 2021, patients with advanced CKD experienced important reductions in the rates of MACE and arterial and venous thromboembolic events (as much as 39%, 28%, and 57%, respectively), with larger declines than those observed for the general population. Major bleeding rates also decreased (up to 12%), but non-major bleeding markedly increased, especially in ND-CKD (from 42% to 69%). The decreases in MACE as well as arterial and venous events were comparable for men and women (except for a greater reduction in arterial events in men than in women, <em>P</em> = 0.03). The increase in non-major bleeding rates was greater in women than in men (<em>P</em> = 0.02).</div></div><div><h3>Limitations</h3><div>Outcomes based on diagnostic codes; unknown generalizability to other countries.</div></div><div><h3>Conclusions</h3><div>Although there have been important reductions in the rates of cardiovascular events and major bleeding events in patients with advanced CKD, the event rates remain substantially higher than in the general population, indicating a need for additional strategies to minimize these risks.</div></div><div><h3>Plain-Language Summary</h3><div>We explored rates and trends of cardiovascular and bleeding events in Swedish patients with advanced CKD between 2011 and 2021. Cardiovascular and bleeding events were 1.5 to 11.1 times more common in patients with CKD than in the general population. However, over time there has been a significant reduction in the","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 31-43.e1"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314622","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":"Interpreting Metabolomics and Proteomics in Kidney Disease: A Practical Guide","authors":"Insa M. Schmidt , Eugene P. Rhee","doi":"10.1053/j.ajkd.2025.08.014","DOIUrl":"10.1053/j.ajkd.2025.08.014","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 129-133"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145450596","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":"Kidney Cysts in Alport Syndrome: Illustrative Cases, but Misleading Conclusions","authors":"Thomas Robert MD , Laure Raymond , Laurent Mesnard","doi":"10.1053/j.ajkd.2025.08.015","DOIUrl":"10.1053/j.ajkd.2025.08.015","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 134-135"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145462013","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":"Management of Chronic Hyponatremia in the Outpatient Setting","authors":"Angelique B.M.C. Savelberg ,&nbsp;Ewout J. Hoorn ,&nbsp;Julie C. Refardt","doi":"10.1053/j.ajkd.2025.06.024","DOIUrl":"10.1053/j.ajkd.2025.06.024","url":null,"abstract":"<div><div>The diagnostic evaluation and management of chronic hyponatremia in outpatients can be challenging for several reasons. First, chronic hyponatremia is often mild, leading to uncertainty about whether it is clinically significant and warrants further diagnostic evaluation and treatment. Second, if the initial diagnostic workup does not identify a clear cause, it becomes uncertain how much further investigation is required. Third, when no clear cause is found or the underlying condition cannot be treated, physicians may struggle to choose the most appropriate treatment approach. This review offers practical guidance to navigate these challenges in managing chronic hyponatremia in the outpatient setting.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 87-92"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145296211","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":"Revisiting New Data on the Mortality Benefit of Rapid Correction of Hyponatremia: Déjà Vu All Over Again","authors":"Richard H. Sterns ,&nbsp;Helbert Rondon-Berrios","doi":"10.1053/j.ajkd.2025.07.015","DOIUrl":"10.1053/j.ajkd.2025.07.015","url":null,"abstract":"<div><div>Studies in the 1980s linking rapid correction of severe, chronic hyponatremia to the osmotic demyelination syndrome (ODS) led to a major controversy that eventually gave way to consensus guidelines. Efforts to limit correction to ≤8 mmol/L per day in patients at high risk of developing ODS became common practice. Recent studies have questioned these guidelines, suggesting that ODS is rare and that slow correction may increase mortality. In this review, we revisit the history of the controversy and find that these claims have persisted for 4 decades. Older studies supporting faster correction are flawed by referral bias while newer studies are limited by confounding as comorbidities influence rates of both mortality and hyponatremia correction. Although both old and new studies emphasize the rarity of magnetic resonance imaging–documented ODS after rapid correction, they were not conducted in hyponatremic patients who were at risk for ODS. Old studies reporting hyponatremic deaths due to cerebral edema overestimate its true incidence, and new studies reporting an association of mortality and slow rates of sodium correction do not document cerebral edema as a common contributor to death. Further research is required to better define the incidence of both ODS and cerebral edema in patients at risk for these complications. Until then, we conclude that the risks of rapid correction—including irreversible neurological damage—necessitate caution. Clinicians should continue to prioritize slow, controlled sodium correction to protect high-risk patients from harm.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 115-123"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145296210","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 Influenza Vaccination With Acute Kidney Injury: A Prospective Target Trial Emulation Study","authors":"Lin Zhuo ,&nbsp;Baixue Zhang ,&nbsp;Yi Huang ,&nbsp;Qiaorui Wen ,&nbsp;Shengfeng Wang ,&nbsp;Siyan Zhan ,&nbsp;Houyu Zhao","doi":"10.1053/j.ajkd.2025.09.005","DOIUrl":"10.1053/j.ajkd.2025.09.005","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;The impact of influenza vaccination on the risk of acute kidney injury (AKI) has not been thoroughly evaluated in large-scale prospective studies. We assessed whether influenza vaccination was associated with a reduced incidence of AKI among individuals aged 65 years or older.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Target trial emulated with a sequential trial design.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Participants aged 65 years or older in the UK Biobank.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;Influenza vaccination compared with no influenza vaccine.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome&lt;/h3&gt;&lt;div&gt;Incident AKI during 1 year after vaccination. Participants were followed from baseline until the diagnosis of AKI, death, loss to follow-up, or for 1 year after entering the study, whichever occurred first.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Fifty trials were emulated, each with a 1-month enrollment period. These trials began in September 2007 and continued from September to January of the following year until January 2017. Eligible participants could be included in multiple trials until they no longer met the inclusion criteria. Propensity score matching was applied to match vaccine recipients to unvaccinated individuals in a 1:1 ratio to control for confounders, emulating random assignment. A clustered marginal competing risk model that accounts for the within-pair clustering of outcomes was fit to estimate the hazard ratio, along with the 95% confidence interval, characterizing the association between the use of influenza vaccination and incident AKI.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Overall, the cohort included 1,408,922 eligible person-trials in the general practice data. After propensity score matching, 97,663 pairs of person-trials were included. During the 1-year follow-up, a total of 598 incident AKI events were observed. In the primary analysis, the incidence of AKI was 36.8 per 10,000 person-years (PYs) in unvaccinated participants and 30.6 per 10,000 PYs in the vaccinated group. After adjusting for potential confounders using propensity score matching, influenza vaccination was associated with a 17% lower AKI risk (HR, 0.83 [95% CI, 0.71-0.98]). The cumulative mortality rates were 62.8 per 10,000 PYs in the unvaccinated group and 47.2 per 10,000 PYs in the vaccinated group, corresponding to an HR of 0.75 (95% CI, 0.66-0.85). These findings remained consistent in subgroup and sensitivity analyses.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Potential residual confounding from variations in vaccine formulations and batch; potential selection bias from restricting to participants with linked primary care data in the UK Biobank; and potential outcome misclassification from use of a code-based algorithm to identify AKI.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;In this prospective population-based study of older adults within the UK Biobank, influenza vaccination was significa","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 75-86.e1"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145319219","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}