American Journal of Nephrology最新文献

{"title":"Relationship Between Podocyte Injury and Renal Outcomes in Patients with Acute Kidney Injury: A Report From a Retrospective Study in China.","authors":"Shun Wu, Mengling Guo, Yudan Wang, Yilun Zhou, Liyuan Zhang, Yun Zhou, Yuanyuan Xing, Dong Sun, Xueqing Hu, Zhenmin Ruan, John Cijiang He, Hongqi Ren","doi":"10.1159/000543789","DOIUrl":"https://doi.org/10.1159/000543789","url":null,"abstract":"<p><strong>Introduction: </strong>Podocyte injury has been proven to be a major cause for poor renal outcomes after acute kidney injury (AKI). However, clinical trial data are still limited. This study aimed to explore the clinical correlations between podocyte injury and renal outcomes in hospitalized AKI patients.</p><p><strong>Method: </strong>This retrospective study analyzed data on 52 AKI patients who were histologically diagnosed with acute tubular necrosis (ATN) or acute interstitial nephritis (AIN) from six centers throughout China between January 2012 and June 2023. Patients were classified into two groups based on the degree of foot process fusion: ≤50% (mild podocyte injury group), and ＞50% (severe podocyte injury group). The outcomes were post-AKI new-onset proteinuria and incident CKD.</p><p><strong>Results: </strong>Among 52 AKI patients (14 male; median age, 49 [30, 56] years), 28 (53.8%) had mild podocyte injury, 24 (46.2%) had severe podocyte injury. After 12-month follow-up, 16(57.1%) had post-AKI proteinuria, and 5(17.9%) had post-AKI incident CKD in mild podocyte injury group. 20 (83.3%) had post-AKI new-onset proteinuria, and 14 (58.3%) had post-AKI incident CKD in severe podocyte injury group. Patients with more severe foot process fusion exhibited significantly higher incidences of post-AKI new-onset proteinuria (83.3% vs. 57.1%, P = 0.041) and incident CKD (58.3% vs. 17.9%, P = 0.003) at 12 months following AKI. The degree of foot process fusion (95%CI 1.013～3.88, P=0.048) and proteinuria at 3 months (95%CI 1.309～5.443, P=0.015) were identified as independent risk factors for post-AKI new-onset proteinuria at 12 months. The degree of foot process fusion (95%CI 1.026～14.196, P=0.048), and the presence of partial renal pathological features, including tubular atrophy (95%CI 1.012～5.958, P=0.030), interstitial inflammation (95%CI 1.005～6.846, P=0.039), interstitial fibrosis (95%CI 1.110～6.075, P=0.043) were independent risk factors for post-AKI incident CKD at 12month. Kaplan-Meier analysis shows severe podocyte injury group had worst renal survival, including post-AKI new-onset proteinuria (P=0.0066) and incident CKD (P=0.0455).</p><p><strong>Conclusion: </strong>The degree of podocyte injury is an independent risk factor for post-AKI new-onset proteinuria and incident CKD in patients, and patients with more severe podocyte injury exhibit a higher incidence of post-AKI new-onset proteinuria and incident CKD.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-19"},"PeriodicalIF":4.3,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association of Niacin Use with Kidney Outcomes and Mortality.","authors":"Rina Takahashi, Thuy-Anh Bui, Ibrahim Elali, Diana Tran, Keiichi Sumida, Fridtjof Thomas, Ramanath Dukkipati, Anuja Shah, Connie M Rhee, Csaba P Kovesdy, Kamyar Kalantar-Zadeh","doi":"10.1159/000543098","DOIUrl":"10.1159/000543098","url":null,"abstract":"<p><strong>Introduction: </strong>Niacin is a non-statin lipid-lowering therapy that has been shown to lower triglycerides and improve other risk factors for renal outcomes. Despite these favorable data, the effect of niacin on long-term kidney outcomes remains unclear. The aim of this study was to examine the associations of niacin therapies with incident chronic kidney disease (CKD), end-stage renal disease (ESRD), and death in patients with estimated glomerular filtration rate (eGFR) of at least 60 mL/min/1.73 m2.</p><p><strong>Methods: </strong>In a nationwide historic cohort of 1,139,630 United States (US) veterans with normal baseline eGFR, we examined the association of de novo prescription of niacin with incident CKD (defined as eGFR <60 mL/min/1.73 m2 on two occasions, separated by ≥90 days), ESRD (defined as the initiation of kidney replacement therapy), and death. Associations were examined in Cox proportional hazards models adjusted for demographics, major comorbidities, laboratory measurements, and medications. Prescription time-distribution matching was used to control for survival bias.</p><p><strong>Results: </strong>We identified 133,450 new users of niacin. Overall, patients (n = 1,139,630) had a mean (standard deviation) age of 60 (13) years, with 6% female, 78% white, 16% black, and 6% Hispanic. Niacin users were more likely to be male, white, current, or former smokers, with higher frequencies of comorbidities and statin use. Niacin use (vs. nonuse) was associated with a higher risk of CKD (HR: 1.08, 95% confidence interval:1.07-1.10) but a lower risk of ESRD (0.82, 0.76-0.88) and death (0.90, 0.89-0.91).</p><p><strong>Conclusions: </strong>In a large national cohort of US veterans with normal kidney function, niacin use was associated with a lower risk of ESRD and death but with a higher risk of incident CKD, which is potentially explained by acute effects on eGFR. Further studies are needed to corroborate the potential benefits of niacin on kidney function and survival.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-11"},"PeriodicalIF":4.3,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between serum zinc levels and trabecular bone scores among patients undergoing chronic hemodialysis.","authors":"Mayuko Hori, Hiroshi Takahashi, Chika Kondo, Asami Takeda, Kunio Morozumi, Shoichi Maruyama","doi":"10.1159/000543756","DOIUrl":"https://doi.org/10.1159/000543756","url":null,"abstract":"<p><strong>Introduction: </strong>Zinc, an essential trace element, plays an important role in various cellular processes, and zinc deficiency is common in patients undergoing hemodialysis. Zinc has been shown to stimulate osteoblastic bone formation and mineralization and inhibit osteoclastic bone resorption. Although osteoporosis is highly prevalent among patients undergoing hemodialysis, the utility of areal bone mineral density (aBMD) measured using dual-energy X-ray absorptiometry (DXA) is limited because DXA cannot reveal bone microarchitectural alterations. The trabecular bone score (TBS) extracted from DXA images is a new texture measurement used to assess the bone microarchitecture. However, whether zinc status is associated with TBS in patients undergoing hemodialysis remains unclear. Therefore, we investigated the association between serum zinc levels and osteoporosis parameters (aBMD and TBS) in patients undergoing chronic hemodialysis.</p><p><strong>Methods: </strong>This cross-sectional study included 316 outpatients undergoing hemodialysis at the Masuko Memorial Hospital in Japan. Serum zinc levels were measured, and aBMD and TBS were assessed using DXA.</p><p><strong>Results: </strong>In total, 139 (41.0%) patients had zinc deficiency, defined as serum zinc levels < 60 µg/dL. In multivariate linear regression analyses, high serum zinc levels were associated with high TBS (β = 0.146, P = 0.004) but not aBMD values (total hip aBMD: β = -0.0200, P = 0.63; lumbar spine aBMD: β = 0.0478, P = 0.34). In multiple logistic regression analysis, zinc deficiency was associated with degraded bone microarchitecture according to the TBS (odds ratio, 2.27; 95% confidence interval, 1.22-4.22; P = 0.009). No association was found between the serum zinc status and aBMD thresholds for osteoporosis.</p><p><strong>Conclusion: </strong>These results suggest that zinc plays a protective role in bone metabolism by inhibiting chronic kidney disease-induced changes in the bone microarchitecture.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-13"},"PeriodicalIF":4.3,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Significant Dry Weight Reduction after Transition from Peritoneal Dialysis to Hemodialysis.","authors":"Yen-Ting Lin, Ming-Tsun Tsai, Tzen-Wen Chen, Chih-Ching Lin, Szu-Yuan Li","doi":"10.1159/000543598","DOIUrl":"10.1159/000543598","url":null,"abstract":"<p><strong>Introduction: </strong>Dry weight management in dialysis patients is crucial but often subjective, primarily based on symptoms. Due to continuous fluid removal in peritoneal dialysis (PD) and intermittent ultrafiltration in hemodialysis (HD), symptom-based assessments may be biased, leading to varying results. Surprisingly, no direct comparison of dry weight changes between PD and HD has been conducted. This study aimed to evaluate the impact of transitioning from PD to HD on body weight and related clinical parameters.</p><p><strong>Methods: </strong>This retrospective cohort study included 127 stable PD patients who transitioned to HD. Changes in body weight, echocardiographic parameters, albumin, and hemoglobin levels were analyzed over a 1-year period post-transition.</p><p><strong>Results: </strong>The mean patient age was 57.1 ± 15.5 years, with an average PD vintage of 5.8 ± 4.9 years. Most patients had hypertension. After transitioning to HD, body weight decreased significantly, with a reduction of -2.8 kg at 1 month, -5.3 kg at 3 months, and -7.5 kg 1 year post-transition. Echocardiographic parameters showed no significant changes. However, serum albumin and hemoglobin levels increased slightly but significantly after the transition, and the number of antihypertensive medications was also reduced.</p><p><strong>Conclusion: </strong>The transition from PD to HD results in significant reductions in body weight. These findings underscore the often-overlooked issue of fluid overload in PD patients and its potential impact on patient outcomes.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-9"},"PeriodicalIF":4.3,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Superiority of European Kidney Function Consortium Cystatin C-Based Formula for Risk Stratification of All-Cause and Cardiovascular Deaths in US Adults.","authors":"Zixiang Ye, Haixu Wang, Enmin Xie, Zeming Zhou, Kefei Dou","doi":"10.1159/000542912","DOIUrl":"https://doi.org/10.1159/000542912","url":null,"abstract":"<p><strong>Introduction: </strong>We intended to compare the predictive value for all-cause and cardiovascular deaths between estimated glomerular filtration rate (eGFR) derived from the European Kidney Function Consortium (EKFC) cystatin C-based formula, the EKFC creatinine-based formula, and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) cystatin C- or creatinine-based formulas.</p><p><strong>Methods: </strong>Overall, 4,132 participants from the National Health and Nutrition Examination Survey between 1999 and 2002 were included, and death information was obtained through the National Death Index. To compare predictive accuracy between EKFC eGFRcys (EKFC cystatin C-based formula), CKD-EPI eGFRcys (CKD-EPI cystatin C-based formula), EKFC eGFRcr (EKFC creatinine-based formula), and CKD-EPI eGFRcr (CKD-EPI creatinine-based formula), we conducted time-dependent receiver operator characteristic (ROC) curves and reclassification analysis.</p><p><strong>Results: </strong>During a median follow-up of 17.4 years, a total of 1,987 all-cause and 530 cardiovascular deaths were confirmed. Restricted cubic splines analyses showed that reduced EKFC eGFRcys was linearly related to higher risks of all-cause and cardiovascular deaths (p for nonlinearity > 0.05). Time-dependent ROC curves suggested that EKFC eGFRcys exhibited higher predictive ability than CKD-EPI eGFRcys, EKFC eGFRcr, and CKD-EPI eGFRcr at 5-year and 10-year follow-ups. For 10-year all-cause deaths, EKFC eGFRcys yielded significant improvement over CKD-EPI eGFRcr (integrated discrimination improvement [IDI], 9.4%; net reclassification improvement [NRI], 39.7%). Similar improvement was observed in 10-year cardiovascular deaths when comparing EKFC eGFRcys to CKD-EPI eGFRcr (IDI, 6.7%; NRI, 45.1%).</p><p><strong>Conclusion: </strong>The EKFC eGFRcys outperformed CKD-EPI eGFRcys, EKFC eGFRcr, and CKD-EPI eGFRcr in predicting all-cause and cardiovascular deaths, providing the possibility to utilize EKFC eGFRcys in the stratification of death risk among the general US population.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-12"},"PeriodicalIF":4.3,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Pilot, Single-Blinded, Randomized Crossover Trial of Cramp Reduction with Angiotensin II in Maintenance Patients on Hemodialysis (the CRAMP-HD Study).","authors":"Atthaphong Phongphithakchai, Rinaldo Bellomo, Peter Mount, Cindy-Anne T Bach, Greta Gurry, Wendy Liu, Akinori Maeda, Nuttapol Pattamin, Yukiko Hikasa, Sofia Spano, Anis Chaba, Glenn Eastwood, Mink Chawla, Arthur J Atkinson, James Wilkie, Emily J See","doi":"10.1159/000543280","DOIUrl":"10.1159/000543280","url":null,"abstract":"<p><strong>Introduction: </strong>Angiotensin II may reduce muscle ischemia during intermittent hemodialysis (IHD) and thereby decrease the incidence and/or intensity of intradialytic muscle cramps. We aimed to test whether angiotensin II infusion during IHD is safe, feasible, and effective in the attenuation of muscle cramps.</p><p><strong>Methods: </strong>We performed a pilot, single-blinded, randomized crossover trial of patients receiving IHD who frequently experience intradialytic muscle cramps. Patients were randomly allocated to receive either intravenous angiotensin II or placebo for the duration of their first dialysis session of the week. They crossed over to the alternate arm each week for 4 weeks. The primary outcome was safety. Secondary outcomes included cramp-related symptoms, hemodynamic parameters, dialysis prescription alterations, and biomarkers.</p><p><strong>Results: </strong>We studied 24 sessions in 6 patients. Intradialytic hypertension (systolic blood pressure >180 mm Hg) occurred more often with angiotensin II than with placebo (4/12 sessions, 33% vs. 2/12 sessions, 17% sessions, p = 0.64). There were no other adverse events. Compared with placebo, muscle cramps were less frequent (4/12 sessions, 33% vs. 11/12 sessions, 92% sessions, p = 0.009) and of lower intensity with angiotensin II (median Brief Pain Inventory score 1.4 vs. 5.3; p < 0.001; maximal Brief Pain Inventory score 1.2 vs. 6.0; p < 0.001). Fluid bolus administration for cramps was less common during angiotensin II infusion than placebo (0/12 sessions, 0% vs. 5/12 sessions, 42% sessions, p = 0.037).</p><p><strong>Conclusion: </strong>Angiotensin II increased blood pressure and heart rate but not cardiac output or levels of troponin, creatine kinase, or renin. Angiotensin II infusion during IHD appears safe and effective at reducing intradialytic muscle cramps. These observations justify further investigation in larger controlled studies.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-12"},"PeriodicalIF":4.3,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing Predictors of Acute and Chronic Thrombotic Microangiopathy in Native and Allograft Biopsies.","authors":"Anam Tariq, Dominic Raj, Azka Tariq, Lois Arend, Mohamed G Atta","doi":"10.1159/000542025","DOIUrl":"10.1159/000542025","url":null,"abstract":"<p><strong>Introduction: </strong>Thrombotic microangiopathies (TMAs) represent distinct pathological and clinical entities with known chronicity and recurrence. Kidney biopsy is the gold standard to diagnose TMA in patients with renal manifestations, but the prognostic significance of acute or chronic phase of the disease has not been well studied. We examined the clinical characteristics, management, and predictors of acute versus chronic TMA among native and transplants.</p><p><strong>Methods: </strong>Observational, cross-sectional study of a 22-year period at Johns Hopkins Hospital. Prevalence of acute versus chronic TMA was based on specific histology identified on native and allograft kidney biopsies. Predictors of acute and chronic TMA were assessed using simple linear regression and odds ratios.</p><p><strong>Results: </strong>Among 127 patients, 29 (23%) had chronic TMA and 98 (77%) had acute TMA, with 60% female and 43 ± 18 years of age. Chronic TMA was significantly associated with a history of lupus or hemolytic uremic syndrome (HUS) and the use of clopidogrel or mammalian target of rapamycin inhibitors (mTORi). Specifically, chronic TMA was significantly associated with use of mTORi in native kidneys. The odds of chronic TMA compared to acute TMA were lower for each race (Caucasians, 76%; blacks, 38%; Hispanics and Asians, 22%).</p><p><strong>Conclusions: </strong>A kidney biopsy may not necessarily be needed to determine the presence of chronic TMA since certain predictors, as those demonstrated by our study (use of mTORi and history of lupus or HUS), independently predicted higher odds of developing chronic TMA and its sequelae conditions.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-9"},"PeriodicalIF":4.3,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of Causes of Chronic Kidney Disease with Disease Progression and Mortality: Insights from the Fukuoka Kidney Disease Registry Study.","authors":"Hiromasa Kitamura, Shigeru Tanaka, Hiroto Hiyamuta, Kazuhiko Tsuruya, Takanari Kitazono, Toshiaki Nakano","doi":"10.1159/000543201","DOIUrl":"10.1159/000543201","url":null,"abstract":"<p><strong>Introduction: </strong>The Kidney Disease: Improving Global Outcomes guidelines recognize the importance of causes of chronic kidney disease (CKD), glomerular filtration rate, and albuminuria as predictors of kidney outcome and prognosis. However, compared with biopsy-proven causes, there has been limited research regarding the relationship between clinically diagnosed causes of CKD and patient prognosis.</p><p><strong>Methods: </strong>We examined 3,119 patients with non-dialysis-dependent CKD who participated in the Fukuoka Kidney disease Registry Study, a multicenter prospective cohort study. Patients were divided into six groups: IgA nephropathy, chronic glomerulonephritis (non-biopsy-proven), diabetic nephropathy, hypertensive nephrosclerosis, chronic interstitial nephritis, and polycystic kidney disease. The primary outcomes included a composite kidney outcome, defined as a 1.5-fold increase in serum creatinine and/or the development of end-stage kidney disease, and all-cause mortality. The risks of these outcomes were estimated using a Fine-Gray proportional subdistribution hazards model. Patients with IgA nephropathy, the most prevalent primary glomerulonephritis, served as the reference group.</p><p><strong>Results: </strong>During the median follow-up period of 5 years, 1,221 patients developed the composite kidney outcome, and 346 patients died. Compared with IgA nephropathy, the multivariable-adjusted subdistribution hazard ratios (sHRs) for the composite kidney outcome were significantly higher in diabetic nephropathy (sHR 1.45) and polycystic kidney disease (sHR 2.07) groups, whereas the chronic interstitial nephritis group had a significantly lower risk (sHR 0.71). The risk of all-cause mortality was significantly higher in the hypertensive nephrosclerosis group (sHR 1.90).</p><p><strong>Conclusion: </strong>The causes of CKD were associated with risks of the composite kidney outcome and all-cause mortality, highlighting their clinical relevance in predicting prognosis. These findings suggest that different causes of CKD have distinct impacts on patient outcomes, emphasizing the importance of tailoring management strategies according to the underlying causes.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-11"},"PeriodicalIF":4.3,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune Checkpoint Inhibitor-Related Acute Kidney Injury: Management and Challenges.","authors":"Nada Youssef, Ala Abudayyeh","doi":"10.1159/000543323","DOIUrl":"10.1159/000543323","url":null,"abstract":"<p><strong>Background: </strong>Immune checkpoint inhibitors (ICIs) have been increasingly used over the past decade for treatment of several cancer types. Despite the excellent cancer response they provide, their use has been associated with serious immune-related adverse events affecting multiple systems including the kidney. Currently, limited data are available to guide treatment of acute kidney injury secondary to ICI use (ICI-AKI) due to tubulointerstitial nephritis or glomerulonephritis. Another huge obstacle is the safety of resuming ICI following an episode of ICI-AKI.</p><p><strong>Summary: </strong>Acute tubulointerstitial nephritis (ATIN) is the most common pathology associated with ICI-AKI, followed by other less common forms of glomerulonephritis. Management of this disorder is very challenging. Corticosteroids therapy remains the mainstay treatment for patients with ICI-ATIN. Use of other immunosuppressants for ICI-ATIN and recurrent ICI-ATIN has been also described in the literature. In patients with ICI-related glomerulonephritis, the use of rituximab is the more common approach reported in the literature. Regarding the safety to resume ICI following an episode of ICI-AKI, this decision should be made following a multidisciplinary approach on a case-by-case basis.</p><p><strong>Key messages: </strong>Limited evidence is available to guide management in patients with ICI-AKI. More prospective studies are needed in the future to better guide treatment of cancer patients with ICI-AKI.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-12"},"PeriodicalIF":4.3,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex Differences in the Risk of Bladder Cancer among Kidney Transplant Recipients and Patients with Kidney Failure Receiving Hemodialysis: A Nationwide Cohort Study.","authors":"Hoon Yu, Sung Jin Kim, Yoonjong Bae, Mina Kim, Chan-Young Jung","doi":"10.1159/000543298","DOIUrl":"10.1159/000543298","url":null,"abstract":"<p><strong>Introduction: </strong>Although both patients with kidney failure (KF) receiving hemodialysis (HD) and kidney transplantation (KT) recipients (KTRs) have a high risk of bladder cancer, how this risk changes in the transition from dialysis to KT is unknown. In this study, we aimed to investigate the risk of bladder cancer in KTRs and patients on HD.</p><p><strong>Methods: </strong>This was a nationwide longitudinal cohort study of 66,547 participants from the National Health Insurance Service cohort who started HD for patients with KF or who received KT from 2002 to 2020. The primary outcome was the diagnosis of bladder cancer, which was defined as the composite of diagnostic codes and either hospitalization or ≥2 outpatient visits for bladder cancer.</p><p><strong>Results: </strong>During mean follow-ups of 4.2 and 7.9 years in the HD and KT groups, respectively, the incidence rates of bladder cancer were 1.1/1,000 and 0.3/1,000 person-years, respectively. In the time-dependent multivariable Cox models, compared to patients on HD, the adjusted hazard ratio (aHR) for bladder cancer among KTRs was 0.36 (95% confidence interval [CI], 0.21-0.60; p < 0.001). Among men, this aHR was 0.29 (95% CI, 0.15-0.55; p < 0.001); however, no statistically significant association between the kidney replacement therapy modality and the risk of bladder cancer was observed among women. Landmark analysis performed to avoid immortal time bias by redefining time zero as a specific landmark time (2 and 5 years after HD initiation or KT) revealed similar results.</p><p><strong>Conclusion: </strong>The risk of bladder cancer was significantly lower among KTRs than that among patients receiving HD, particularly among men.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-9"},"PeriodicalIF":4.3,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}