American Journal of Kidney Diseases最新文献

{"title":"Erratum regarding “Correlation of renal interstitial fibrosis, sinus fat volume, parenchymal volume with aging, hypertension and diabetes” (Am J Kidney Dis. 2024;83(4S2):S152)","authors":"","doi":"10.1053/j.ajkd.2024.10.001","DOIUrl":"10.1053/j.ajkd.2024.10.001","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"84 6","pages":"Page 803"},"PeriodicalIF":9.4,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142700632","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":"ACGME Accreditation for Transplant Nephrology Training: Clarifying Why This Is a Step in the Right Direction.","authors":"Neeraj Singh, Michelle A Josephson, Vineeta Kumar, Roy D Bloom","doi":"10.1053/j.ajkd.2024.09.009","DOIUrl":"10.1053/j.ajkd.2024.09.009","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142685767","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":"Clinicopathologic, Proteomic and Outcome Characteristics of Renal Apolipoprotein C-II Amyloidosis: A Case Series.","authors":"Samih H Nasr, Surendra Dasari, Anthony M Valeri, Jason D Theis, Ann Moyer, Alessia Buglioni, M Barry Stokes, Linda Hasadsri, Julie A Vrana, Samar M Said, Satoru Kudose, Neeraja Kambham, Mei Lin Bissonnette, Lihong Bu, Renu Gupta, Attaya Suvannasankha, Suzanne Martin, Xu Zeng, Renuka Sothinathan, Adil Jadoon, Tewabe Kebede, Srimathi Manickaratnam, Jordan L Rosenstock, Glen S Markowitz, Sanjeev Sethi, Nelson Leung, Ellen D McPhail","doi":"10.1053/j.ajkd.2024.09.007","DOIUrl":"10.1053/j.ajkd.2024.09.007","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Amyloidosis derived from apolipoprotein C-II (AApoCII) is a recently discovered, rare form of amyloidosis. Data on clinical presentations and natural history are very limited. This study defines the clinicopathologic, proteomic, and outcome characteristics of renal AApoCII.</p><p><strong>Study design: </strong>Case series.</p><p><strong>Setting & participants: </strong>Twenty-five renal AApoCII cases were identified from the Mayo Clinic Tissue Proteomics Laboratory archives from January 2008 through January 2024.</p><p><strong>Findings: </strong>All patients were White, 19 were≥65 years old at diagnosis, and 18 were female. Seven had a family history of chronic kidney disease (CKD). Patients presented with proteinuria (median 3.3g/day) and reduced kidney function (n=16; median creatinine, 1.6mg/dL). No patients had clinical evidence of other organ involvement by amyloidosis or features of monogenic hypertriglyceridemia. Histologically, amyloid deposits were often weakly positive for Congo red and involved glomeruli in all cases (with a nodular pattern in 22), whereas extraglomerular involvement was less common and generally mild. Proteomic analysis revealed abundant spectra for Apo C-II and for all 3 amyloid signature proteins (apolipoprotein E, apolipoprotein A-IV, and serum amyloid P) in all cases and detected an Apo C-II variant in 14 (K19T [p.Lys41Thr] in 12 and E47V [p.Glu69Val] in 2). Among 22 patients with follow-up information available, there were 12 end-stage kidney disease (ESKD) events and 2 deaths without ESKD during an average follow-up period of 75.5±12.5 (SE) months.</p><p><strong>Limitations: </strong>Retrospective design, small sample size, APOC2 gene sequencing performed in a smaller subset.</p><p><strong>Conclusions: </strong>AApoCII mostly affects the kidney and manifests in the elderly with proteinuria and CKD. A minority of these patients had a family history of kidney disease. Kidney failure occurred in about half, whereas overall survival was more favorable.</p><p><strong>Plain-language summary: </strong>Amyloidosis derived from apolipoprotein C-II (AApoCII) is very rare, and data on clinicopathologic and outcome characteristics are scant. This study of 25 patients with AApoCII diagnosed by mass spectrometry at the Mayo Clinic Tissue Proteomics Laboratory revealed that most patients were elderly White females who presented with proteinuria and reduced kidney function, without involvement of other organs. A family history of kidney disease was often lacking. Pathologically, most cases exhibited nodular glomerular involvement. Proteomic analysis revealed abundant protein spectra for Apo C-II and amyloid signature proteins, and identified an Apo C-II variant in over half of cases (most commonly the p.Lys41Thr variant). The cumulative incidence of kidney failure was over 50% at 5 years follow-up. Only 4 deaths occurred over an average follow-up period of 76 months.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638450","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 Kidney Allograft Failure Among First-Time Transplant Recipients in the United States.","authors":"Pascale Khairallah, Elizabeth C Lorenz, Amy Waterman, Nidhi Aggarwal, Akshta Pai, Wolfgang C Winkelmayer, Jingbo Niu","doi":"10.1053/j.ajkd.2024.09.005","DOIUrl":"10.1053/j.ajkd.2024.09.005","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale & objective: &lt;/strong&gt;The management and outcomes of kidney transplant recipients have evolved over the past 3 decades. This study of US patients whose first kidney allograft failed examined long-term trends in subsequent waitlisting, retransplantation, and all-cause mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting & participants: &lt;/strong&gt;Patients recorded in the US Renal Data System (USRDS) whose first kidney allograft failed between 1990 and 2019.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;The 5-year period in which the allograft failure occurred: 1990-1994, 1995-1999, 2000-2004, 2005-2009, 2010-2014, or 2015-2019.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome: &lt;/strong&gt;(1) Waitlisting for retransplantation, (2) retransplantation, and (3) all-cause mortality following first allograft failure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Analytical approach: &lt;/strong&gt;Competing risk survival analyses with the approach described by Fine and Gray used for the outcomes of waitlisting and retransplantation, and Cox proportional hazards models used for the outcome of all-cause mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The absolute number of patients whose allograft failed and who started dialysis increased from 3,197 in 1990 to 5,821 in 2019. Compared with 1990-1994, the rate of waitlisting for a second transplant increased with each subsequent 5-year period, peaking between 2005 and 2009 before decreasing again subsequently. The rate of retransplantation following allograft failure decreased by 9%, 14%, 18%, 7%, and 11% in the sequential 5-year eras; and the mortality rate was 25% lower in 2015-2019 (HR, 0.75 [95% CI, 0.72-0.77]) compared with 1990-1994. Women had a reduced rate of waitlisting (HR, 0.93 [95% CI, 0.91-0.95]) and lower rate of retransplantation (HR, 0.93 [95% CI, 0.91-0.95]) compared with men. Compared with White patients, African American and Hispanic patients had significantly lower rates of waitlisting, retransplantation, and mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Retrospective data that lacks granular clinical information.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;During the past 3 decades, among patients whose first kidney allograft failed and subsequently initiated dialysis, the rates of waitlisting for retransplantation increased while the rates of retransplantation and mortality decreased. Disparities based on race, ethnicity, and sex in waitlisting and retransplantation were observed and warrant further investigation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain-language summary: &lt;/strong&gt;Kidney allograft failure constitutes the fourth most common cause of dialysis initiation in the United States, and it accounts for 4% to 10% of yearly new dialysis starts globally. Little is known about the trends in the outcomes of patients whose kidney allograft failed. We studied US patients whose first kidney allograft failed between 1990 and 2019 to understand trends in waitlisting for retransplantation, retransplantation, and all-cause mortality after ","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142611770","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":"From Calculations to Care: The Impact of Changes in Kidney Function Estimation on a Patient's Experience of Care.","authors":"Kristine Marie Guevarra Almonte, Gregory D Mumford, Pipier Smith-Mumford, David Lee, Martha Pavlakis, Melanie Hoenig, Aditya S Pawar","doi":"10.1053/j.ajkd.2024.07.009","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.07.009","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142611756","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":"Vadadustat Three Times Weekly in Patients With Anemia Due to Dialysis-Dependent CKD.","authors":"Hakan R Toka, Marializa Bernardo, Steven K Burke, Wenli Luo, Roberto Manllo-Karim, Irfan Ullah, Zhihui Yang, Zhiqun Zhang, James Tumlin","doi":"10.1053/j.ajkd.2024.09.006","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.09.006","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) may offer an alternative erythropoiesis-stimulating agents (ESA) for the treatment of anemia in the setting of CKD. To investigate the efficacy and safety of conversion from long-acting erythropoiesis-stimulating agent (ESA) methoxy polyethylene glycol-epoetin beta (MPG-EPO) to the oral hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI) vadadustat 3-times-weekly versus maintenance on MPG-EPO.</p><p><strong>Study design: </strong>Phase 3b, open-label, noninferiority trial.</p><p><strong>Setting & participants: </strong>Multicenter study in United States; 456 patients adults with anemia and dialysis-dependent chronic kidney disease.</p><p><strong>Intervention: </strong>Participants were randomized 1:1:1 either to vadadustat (starting dose: 600 mg thrice weekly), vadadustat (starting dose: 900 mg thrice weekly), or MPG-EPO, for up to 52 treatment weeks and 4 safety follow-up weeks after the end of treatment or early termination.</p><p><strong>Outcomes: </strong>Primary and secondary efficacy endpoints were the mean change in hemoglobin from baseline during primary (weeks 20-26) and secondary (weeks 46-52) evaluation periods, respectively. Noninferiority was specified as a lower bound of the 95% CI above -0.75 g/dL for the difference in mean change in hemoglobin from baseline. Other efficacy endpoints were the proportion of participants with hemoglobin levels within the target range and the proportions of participants requiring ESA or red blood cell transfusion rescue for anemia during the evaluation periods. Transfusion rates were low and occurred at similar rates across treatment groups (2.7% and 4.0% in the combined vadadustat and MPG-EPO groups, respectively). Primary safety endpoints were any treatment-emergent and serious adverse events (AEs).</p><p><strong>Results: </strong>After combining the vadadustat groups (600 mg and 900 mg thrice weekly, n=304), vadadustat was noninferior to MPG-EPO (n=152) for both primary (least squares mean treatment difference, -0.33; 95% CI, -0.53 to -0.13) and secondary efficacy endpoints (-0.33; -0.56 to -0.09). Mean hemoglobin concentrations were stable for all groups, except for an initial slight decline in the vadadustat 600 mg group, which stabilized by week 12. ESA rescue for anemia was more frequent in the MPG-EPO group (primary evaluation period, 27.7%; secondary evaluation period, 16.2%) than in the combined vadadustat (14.2%; 7.3%) groups. The incidences of any treatment-emergent and serious treatment-emergent AEs were similar across treatment groups.</p><p><strong>Limitations: </strong>Potential errors in attribution of AEs as drug related.</p><p><strong>Conclusions: </strong>Three-times-weekly vadadustat was noninferior to MPG-EPO on their effect on hemoglobin levels without detectable differences in AEs.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142611782","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":"Exploring the Causal Relationship Between Kidney Function and Cancer Risk: Insights and Limitations of Mendelian Randomization","authors":"Sehoon Park ,&nbsp;Jeong Min Cho ,&nbsp;Dong Ki Kim","doi":"10.1053/j.ajkd.2024.07.004","DOIUrl":"10.1053/j.ajkd.2024.07.004","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"84 6","pages":"Pages 670-671"},"PeriodicalIF":9.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543060","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":"Proteinuria as an End Point in Clinical Trials of Focal Segmental Glomerulosclerosis.","authors":"Laura H Mariani, Howard Trachtman, Aliza Thompson, Barbara S Gillespie, Michelle Denburg, Ulysses Diva, Duvuru Geetha, Peter J Greasley, Michelle A Hladunewich, Robert B Huizinga, Jula K Inrig, Radko Komers, Louis-Philippe Laurin, Dustin J Little, Patrick H Nachman, Kimberly A Smith, Liron Walsh, Keisha L Gibson","doi":"10.1053/j.ajkd.2024.08.011","DOIUrl":"10.1053/j.ajkd.2024.08.011","url":null,"abstract":"<p><p>Focal segmental glomerulosclerosis (FSGS) is a characteristic histopathological lesion that is indicative of underlying glomerular dysfunction. It is not a single disease entity but rather a heterogeneous disorder that is an important cause of nephrotic syndrome and kidney failure in children and adults. The aim of this Kidney Health Initiative project was to evaluate potential end points for clinical trials in FSGS. Our focus is on the data supporting proteinuria as a surrogate end point. Available data support the use of complete remission of proteinuria in patients with heavy proteinuria as a surrogate end point for progression to kidney failure. Substantial treatment effects on proteinuria that are short of a complete remission may also predict the effect of a treatment on progression to kidney failure, but further work is needed to determine how such an end point should be defined. Fortunately, efforts are underway to bring together patient-level data from randomized controlled trials, observational studies, and registries to address this issue.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142492822","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":"Sex, Acute Kidney Injury, and Age: A Prospective Cohort Study.","authors":"Ladan Golestaneh,Abby Basalely,Andreas Linkermann,Tarek M El-Achkar,Ryung S Kim,Joel Neugarten","doi":"10.1053/j.ajkd.2024.10.003","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.10.003","url":null,"abstract":"RATIONALE & OBJECTIVEAnimal models of kidney disease suggest a protective role for female sex hormones but in humans, some authorities assert that female sex is a risk factor for acute kidney injury (AKI). To better understand the risk of AKI, we studied the strength of association between sex and AKI incidence in hormonally distinct age groups across the life span.STUDY DESIGNProspective cohort study.SETTINGS & PARTICIPANTSAll patients hospitalized in the Montefiore Health System between 10/15/2015 and 1/1/2019, excluding those with kidney failure or obstetrics diagnoses.EXPOSUREMale versus female sex.OUTCOMESAcute kidney injury (AKI) occurring during hospitalization based on KDIGO definitions.ANALYTICAL APPROACHGeneralized Estimating Equation logistic regression adjusted for comorbidities, socio-demographic factors, and severity of illness. Analyses were stratified into 3 age categories, 6 months to ≤16 years, age >16 years - <55 years, and age ≥55 years.RESULTSA total of 132,667 individuals were hospitalized a total of 235,629 times. The mean age was 55.2 (SD 23.8) years. The counts (%) of hospitalizations for women were 129,912 (55%). Hospitalization counts (%) among Black and Hispanic patients were 71,834 (30.5%) and 24,199 (10.3%), respectively. AKI occurred in 53,926 (22.9%) hospitalizations. In adjusted models, there was a significant interaction between age and sex (p<0.001). Boys and men had higher risk of AKI across all age groups, an association more pronounced in the age group >16 years to <55 years in which the OR for men was 1.7 (95% CI, 1.6-1.8). This age-based pattern remained consistent across prespecified types of hospitalizations. In a sensitivity analysis, women older than 55 years who received prescriptions for estrogen had lower odds of AKI than those without prescriptions.LIMITATIONSResidual confounding.CONCLUSIONThe greatest relative risk of AKI for males occurred during ages >16 to <55 years. The lower risk among post-menopausal women receiving supplemental estrogen supports a protective role for female sex hormones.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"60 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142490427","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":"Intensive Home Blood Pressure Lowering in Patients with Advanced CKD.","authors":"Elaine Ku, Timothy P Copeland, Charles E McCulloch, Divya Seth, Christopher A Carlos, Kerry Cho, Anna Malkina, Lowell J Lo, Raymond K Hsu","doi":"10.1053/j.ajkd.2024.08.010","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.08.010","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Optimal blood pressure (BP) targets in advanced CKD are controversial. More intensive BP lowering in the setting of advanced CKD is thought to be associated with risk of acute kidney injury, hyperkalemia, and ESKD. We aimed to conduct a pilot trial of intensive BP control to determine if lower SBP targets can be safely achieved for patients with CKD through titration of BP medications using in-home measured BP.</p><p><strong>Study design: </strong>Non-blinded randomized controlled trial.</p><p><strong>Settings & participants: </strong>108 patients with advanced CKD (eGFR ≤30 mL/min/1.73 m²) and hypertension.</p><p><strong>Interventions: </strong>Participants were randomized either to a target home SBP goal of <120 mmHg (N=66) or a less intensive SBP goal (N=42). Antihypertensive medications were titrated to achieve the target home SBP range in the first 4 months of the study and maintained until the end of the study. Home BP was measured using a wireless Bluetooth-enabled monitor that transmitted readings to providers in real-time.</p><p><strong>Outcomes: </strong>The primary efficacy outcome was the difference in achieved clinic SBP between the two study arms from months 4-12. Safety outcomes included hyperkalemia, a composite outcome of falls or syncope, and onset of need for dialysis or kidney transplantation.</p><p><strong>Results: </strong>The mean clinic SBP at month 12 was 124.7 mmHg in the intensive SBP group vs. 138.2 mmHg in the less intensive SBP group. Averaged over months 4-12, the achieved mean clinic SBP in the intensive SBP arm was 11.7 mmHg (95% CI 7.5 to 16 mmHg, p<0.001) lower than the mean SBP achieved in the less intensive SBP arm. Primary safety outcomes were not statistically significantly different between the two arms (all p>0.05).</p><p><strong>Limitations: </strong>Small sample size which may limit our ability to detect clinically significant differences in rates of adverse outcomes; single-center design.</p><p><strong>Conclusions: </strong>A clinic SBP goal of <120 mmHg is feasible to achieve with the help of real-time home BP monitoring and appears to be safe in this study population with advanced CKD. Larger trials to determine optimal BP targets in advanced CKD and the risks and benefits associated with more intensive BP control are warranted.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142455777","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}