American Journal of Nephrology最新文献

{"title":"Methods Article for a Study Protocol: Study Design and Baseline Characteristics of the Treatment of Cardiovascular Disease with Low Dose Rivaroxaban in Advanced Chronic Kidney Disease (TRACK) Trial.","authors":"Sunil V Badve, Maha Al Ammari, Craig S Anderson, Laurent Billot, Severine Bompoint, David Collister, An S De Vriese, John W Eikelboom, Adrien Flahault, Amit X Garg, Jeffrey T Ha, Hiddo J L Heerspink, Meg J Jardine, Shilpanjali Jesudason, Vivekanand Jha, Min Jun, Jenny Landrigan, Adrian Liew, Enmoore Lin, Jicheng Lv, Patrick B Mark, Jan Menne, Helen Monaghan, Lily Mushahar, Anushka Patel, Helen Pilmore, Vlado Perkovic, Raja Ramachandran, Patrick Rossignol, Ahmed Shaman, Habib Skhiri, Michael Walsh, David C Wheeler, Muh Geot Wong, Li Zuo, Martin Gallagher","doi":"10.1159/000550796","DOIUrl":"10.1159/000550796","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with advanced stages of chronic kidney disease (CKD) and dialysis-dependent kidney failure are at a greater risk of cardiovascular events and mortality than those with early stages of CKD. There are no completed definitive randomized trials on the safety and efficacy of anticoagulant therapy in this patient population.</p><p><strong>Methods: </strong>Treatment of cardiovascular disease with low-dose Rivaroxaban in Advanced Chronic Kidney disease (TRACK) is a multicenter, randomized, placebo-controlled trial (NCT03969953), designed to enroll 1,886 adult participants with CKD stage 4 or 5 (estimated glomerular filtration rate ≤29 mL/min/1.73 m2) or dialysis-dependent kidney failure and high cardiovascular risk (defined as at least one of the following risk factors; coronary artery disease, nonhemorrhagic non-lacunar stroke, peripheral artery disease [PAD], diabetes mellitus, or age ≥65 years). Participants are randomized to rivaroxaban 2.5 mg twice daily or matching placebo. The primary efficacy outcome is a composite of cardiovascular death, myocardial infarction, stroke, or PAD event. The primary safety outcome is major bleeding, defined as a composite of fatal bleeding, bleeding leading to hospitalization, or symptomatic bleeding in a critical area or organ. From January 2021 to July 2025, 1,458 eligible participants (mean age 63.2 years, 700 [48%] age ≥65 years, 432 [29.6%] women, 715 [49%] dialysis-dependent kidney failure and 743 [51%] CKD stage 4 or 5, 1,125 [77.2%] diabetes mellitus, 674 [46.2%] treated with aspirin at baseline) underwent randomization.</p><p><strong>Conclusion: </strong>TRACK will evaluate the effect of low dose rivaroxaban on major adverse cardiovascular events in participants with CKD stages 4 and 5 and dialysis-dependent kidney failure, and elevated cardiovascular risk.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-11"},"PeriodicalIF":3.2,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146148789","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":"Exercise Training and Progression of Chronic Kidney Disease: The GFR-Exercise (GFR-Ex) Randomized Controlled Feasibility Study.","authors":"Mark David Davies, Juliet Briggs, Abdulfattah Alejmi, Jamie Hugo Macdonald, Sharlene A Greenwood","doi":"10.1159/000549971","DOIUrl":"10.1159/000549971","url":null,"abstract":"<p><strong>Introduction: </strong>The GFR-Ex study assessed the feasibility of a 12-month exercise training program to attenuate the rate of decline in isotope-measured (mGFR) and estimated (eGFR) glomerular filtration rate.</p><p><strong>Methods: </strong>In a multicenter feasibility study, people with stage 3-4 chronic kidney disease (CKD) with declining function were randomized to 12 months exercise training (home-based aerobic and resistance program) or control (usual care). Feasibility was assessed by recruitment and retention rates, intervention adherence, and harms. Differences in mGFR between groups at 12 months and between mGFR and eGFR were calculated. Qualitative interviews were used to explore participant experiences.</p><p><strong>Results: </strong>A total of 2,260 patients were screened; 74 participants were randomized (mean age [SD]: 56 [14] years; eGFR: 34 [13] mL/min/1.73 m2; 62% male; 61% white); and 34 completed the study (11 exercise; 23 control). The screening eligibility rate was 11%; consent rate was 48%; 12-month retention rate was 43%; and the median (IQR) exercise sessions completed was 69 (63, 72)%. No exercise-related harms were recorded. The mean mGFR at 12 months was 36.1 (exercise) vs. 33.8 (control); eGFR minus mGFR was -1.6 (95% Cl: -2.6, -0.6) mL/min/1.73 m2. Qualitative interviews identified the importance of peer and professional support for patient engagement and a high level of patient commitment being required for the research procedures.</p><p><strong>Conclusion: </strong>In people with progressive CKD, a 12-month exercise training program was safe and feasible. Exercise tended to attenuate GFR decline, and eGFR agreed well with mGFR. Progression to a definitive trial is warranted, provided modifications are made, including providing patient support and selection of eGFR as the primary outcome.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-12"},"PeriodicalIF":3.2,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146123174","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":"Authors' Response to \"Urinary and Plasma KIM-1 in Chronic Kidney Disease: Prognostic Insights and Remaining Questions\".","authors":"Thomas McDonnell, Magnus Söderberg, Maarten W Taal, Nicolas Vuilleumier, Philip A Kalra","doi":"10.1159/000550127","DOIUrl":"10.1159/000550127","url":null,"abstract":"","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-2"},"PeriodicalIF":3.2,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12829995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146040279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparative Analysis of Left Ventricular Myocardial Work in Patients with Diabetic and Non-Diabetic Kidney Disease after Peritoneal Dialysis.","authors":"Minjie Wan, Chunyan Yi, Yan Wang, Yagui Qiu, Jianwen Yu, Jianxiong Lin, Wei Chen, Haiping Mao, Xiao Yang, Fengjuan Yao, Donghong Liu, Qunying Guo, Yanqiu Liu","doi":"10.1159/000550324","DOIUrl":"10.1159/000550324","url":null,"abstract":"<p><strong>Introduction: </strong>Initiation of dialysis encompasses new cardiovascular challenges for patients with end-stage kidney disease (ESKD). The prognostic value of assessment of left ventricular (LV) myocardial function in peritoneal dialysis (PD) patients is still unclear. This study used global LV myocardial work (MW) indices to investigate the change of LV myocardial function undergoing PD within 1 year.</p><p><strong>Methods: </strong>A total of 179 patients with ESKD were enrolled in this prospective study. Among them, 48 patients were diagnosed with diabetic kidney disease (DKD), and 131 patients had non-diabetic kidney disease (NDKD). We evaluated LV myocardial function of patients with ESKD by two-dimensional speckle-tracking echocardiography (2D-STE) with strains and MW indices. Echocardiography and clinical data were evaluated at baseline and 1 year after PD.</p><p><strong>Results: </strong>Compared with the NDKD group, patients with DKD had lower global longitudinal strain (GLS) (14.43 ± 3.52 vs. 16.78 ± 4.78; p = 0.002), global work index (GWI) (1,546.29 ± 496.06 vs. 1,750.51 ± 416.97; p = 0.006), and global constructive work (GCW) (1,955.33 ± 483.86 vs. 2,129.65 ± 459.04; p = 0.028). After PD therapy, the NDKD group showed a significant reduction of GWI (1,616.78 ± 360.18 vs. 1,750.51 ± 416.97; p < 0.001), GCW (1,980.45 ± 385.82 vs. 2,129.65 ± 459.04; p = 0.006), and global wasted work (GWW) (158.00 [102.00, 219.00] vs. 185.00 [141.00, 250.00]; p < 0.001) and an increase of global work efficiency (GWE) (92.00 [89.00, 94.00] vs. 91.00 [88.00, 93.00]; p = 0.008). Compared with the NDKD group, the DKD group had a less decrease of GWW (-14.00 [-69.75, 85.00] vs. -36.00 [-97.00, 21.00]; p = 0.020) and a less increase of GWE (-1.00 [-4.00, 2.00] vs. 1.00 [-2.00, 4.00]; p = 0.006) after PD therapy. After multivariable adjustment, Δresidual GFR (β = -0.165; p = 0.034) and ΔDBP (β = -0.168; p = 0.028) were the significant independent determinants of ΔGWE. ΔDBP was the only significant independent determinant of ΔGWW (β = 0.343; p < 0.001).</p><p><strong>Conclusion: </strong>After 1 year of PD treatment, patients with NDKD showed improved LV myocardial function. However, the benefit for DKD patients was relatively limited, reflected in a smaller increase in GWE and a smaller reduction in GWW.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-13"},"PeriodicalIF":3.2,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984245","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":"Efficacy and Safety of Finerenone in Patients with Idiopathic Membranous Nephropathy: A Multicentre, Prospective-Retrospective Real-World Study.","authors":"Jia-Yi Li, Yu-Lin Zhu, Jian-Peng Zhang, Jia-Mei Lu, Xiao-Yong Yu, Jing E, Yang Wei, Dan-Na Ma, Akhmedova Nilufar Sharipovna, Jason Choo, Chieh Suai Tan, Min Qi, Yan Li, Xiao-Tao Ma, Zhe Kang, Zhao Chen, Xiang-Hui Chen, Rong-Guo Fu","doi":"10.1159/000550311","DOIUrl":"10.1159/000550311","url":null,"abstract":"<p><strong>Introduction: </strong>The efficacy and safety of finerenone in patients with idiopathic membranous nephropathy (IMN) remain unclear, especially given the need for additional supportive therapeutic options.</p><p><strong>Methods: </strong>This prospective-retrospective, multicentre, observational real-world study evaluated the efficacy and safety of finerenone in IMN patients with proteinuria ≥1 g/24 h. The primary outcome was the percentage change in proteinuria from baseline to 6 months with finerenone treatment. Secondary outcomes included the stratified reduction in proteinuria, and changes in estimated glomerular filtration rate (eGFR), serum albumin (ALB), and total cholesterol (TCHO). Safety assessment focused on serum potassium. Data were primarily analysed using linear mixed-effects models.</p><p><strong>Results: </strong>Among 112 IMN patients treated with finerenone, 79 were ultimately analysed. All of them received tolerated doses of ACEIs or ARBs, and 53.2% (42/79) were treated with immunosuppressive therapy. The median baseline proteinuria was 3,212.5 mg/24 h (IQR 1,977.0-7,113.6). After 6 months of finerenone treatment, the geometric mean reduction in proteinuria was -58.5% (95% CI: -67.7 to -46.6; p < 0.001). The reduction was significantly greater in patients receiving immunosuppressive therapy than supportive treatment (-67.1% vs. -45.3%, p = 0.023). eGFR showed an initial decline but subsequently stabilized (-1.3 mL/min/1.73 m2, p = 0.226). Significant improvements were observed in ALB (4.6 g/L, p < 0.001) and TCHO (-0.8 mmol/L, p = 0.003). Although hyperkalaemia (>5 mmol/L) occurring in 5.1% of participants (4/79), no cases exceeded 5.5 mmol/L.</p><p><strong>Conclusion: </strong>In combination with ACEIs or ARBs, finerenone appeared to reduce proteinuria in IMN patients with or without immunosuppressive therapy. Serum potassium did not exceed 5.5 mmol/L in any cases.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-11"},"PeriodicalIF":3.2,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145965014","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":"Effect of Sodium Zirconium Cyclosilicate Approval on the Management of Acute Hyperkalemia in Japan: Interrupted Time Series Analysis.","authors":"Hiroki Shimada, Kayoko Mizuno, Koji Kawakami","doi":"10.1159/000550435","DOIUrl":"10.1159/000550435","url":null,"abstract":"<p><strong>Introduction: </strong>The impact of the new potassium binder sodium zirconium cyclosilicate (SZC) on the real-world management of acute hyperkalemia remains unknown. The aim of this study was to evaluate changes in treatment strategies and clinical outcomes for acute hyperkalemia following the approval of SZC in Japan.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the RWD database, a nationwide electronic medical record and claims database in Japan, including adult patients who were hospitalized with hyperkalemia (serum potassium ≥5.5 mmol/L) between April 2015 and December 2024. Using an interrupted time-series analysis, we evaluated changes in outcomes following SZC approval in April 2020. The post-approval period was stratified to distinguish the effects of the coronavirus disease 2019 (COVID-19) pandemic. The primary outcome was the monthly proportion of patients receiving renal replacement therapy (RRT). Secondary outcomes included in-hospital mortality, intensive care unit (ICU) admission, and maintenance hemodialysis initiation.</p><p><strong>Results: </strong>Overall, 38,540 hospitalizations were included. While no significant immediate change in RRT use occurred upon SZC approval, a significant decreasing trend was subsequently observed (slope change, -0.7% per month; 95% confidence interval [CI], -1.2 to -0.1%). This downward trend in RRT use was highly pronounced after the COVID-19 pandemic ended. A significant decreasing trend in ICU admissions was observed in the post-pandemic period (slope change, -4.2% per month; 95% CI, -6.6 to -1.7%). Trends of in-hospital mortality and maintenance hemodialysis initiation did not significantly change.</p><p><strong>Conclusions: </strong>Following SZC approval, a decreasing trend in the use of RRT for acute hyperkalemia was observed, along with a post-pandemic decrease in ICU admissions. These trends were not accompanied by an observable increase in in-hospital mortality or initiation of maintenance hemodialysis.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-12"},"PeriodicalIF":3.2,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12900531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145948382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility Study of Empagliflozin in Patients with Autosomal Dominant Polycystic Kidney Disease: Design and Baseline Characteristics.","authors":"Stephen L Seliger, Wei Wang, Terry Watnick, Diana George, Charalett Diggs, Miranda West, Kristen Nowak, Anna Ostrow, Zhiying You, Berenice Gitomer, Michel Chonchol","doi":"10.1159/000549447","DOIUrl":"10.1159/000549447","url":null,"abstract":"<p><strong>Introduction: </strong>Sodium-glucose cotransporter 2 inhibitors (SGLT2is) have been shown to slow progressive loss of kidney function in both diabetic and nondiabetic proteinuric kidney diseases. Despite the benefits of SGLT2i in patients with chronic kidney disease, the potential benefits of SGLT2i in autosomal dominant polycystic kidney disease (ADPKD) have not been assessed.</p><p><strong>Methods: </strong>This is a randomized, placebo-controlled trial with empagliflozin (Jardiance®) with a 1-year duration and 2 participating centers, including the University of Colorado Anschutz Medical Campus and the University of Maryland Medical Center. Fifty nondiabetic ADPKD patients aged 18-55 years and estimated glomerular filtration rate of 30-90 mL/min/1.73 m2 are randomized in 1:1 ratio to receive 10 mg/day empagliflozin or a matching placebo. After 1 month, the dose is increased to 25 mg/day empagliflozin/placebo in all patients tolerating the lower dose. Results (Outcomes): The primary outcomes are safety and tolerability of empagliflozin, the latter determined by the percentage of patients tolerating the 25 mg dose of study drug/placebo at the end of the 12-month period. Safety is assessed by the frequency of all adverse events (AEs) and of specific AEs, including acute kidney injury, compared to placebo. Secondary outcomes include changes in total kidney volume, kidney function, aortic stiffness, copeptin level, urinary kidney injury molecule-1, and PKD-specific Health-Related Quality of Life questionnaire.</p><p><strong>Conclusions: </strong>The outcomes of this pilot trial will provide important data regarding the safety and tolerability of empagliflozin in patients with ADPKD. Preliminary insight into the potential kidney and vascular benefits of SGLT2i will aid the design of future large-scale efficacy studies.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-11"},"PeriodicalIF":3.2,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12854092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145931791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anti-Phospholipase A2 Receptor Antibody Trajectories for Predicting Prognosis in Patients with Phospholipase A2 Receptor-Associated Membranous Nephropathy.","authors":"Siwen Gong, Dacheng Chen, Feng Xu, Zhe Li, Aijuan Li, Zhihong Liu, Mengyao Zeng","doi":"10.1159/000550352","DOIUrl":"10.1159/000550352","url":null,"abstract":"<p><strong>Introduction: </strong>Phospholipase A2 receptor (PLA2R) is the major autoantigen in membranous nephropathy (MN); however, the trajectories of anti-PLA2R antibodies and their prognostic implications remain unclear.</p><p><strong>Methods: </strong>In this retrospective cohort study, we analyzed 1,528 patients with PLA2R-associated MN (2011-2022), each with at least three serial measurements of anti-PLA2R antibody levels. Group-based trajectory modeling was applied to identify distinct longitudinal patterns of antibody change. Associations between antibody trajectories and clinical outcomes were assessed using multivariable Cox proportional hazards and logistic regression models, complemented by Kaplan-Meier analysis.</p><p><strong>Results: </strong>Four distinct serum anti-PLA2R antibody trajectories were identified: rising (5.3%), low-stable (74.8%), declining (14.9%), and high-stable (5.0%). The low-stable group had the lowest rates of renal function decline (15.3%), clinical non-remission (18.8%), and relapse (31.6%). Compared to this group, the risks of renal function decline were significantly higher in the rising (adjusted hazard ratio [aHR] = 3.69; 95% confidence interval [CI]: 2.57-5.30), declining (aHR = 1.66; 95% CI: 1.24-2.21), and high-stable (aHR = 4.18; 95% CI: 2.91-6.00) groups. Similarly, the rates of clinical remission were significantly lower (aHR = 0.38 for rising; aHR = 0.61 for declining; aHR = 0.28 for high-stable), while the odds of relapse were higher (adjusted odds ratio 3.13, 2.35, and 3.17, respectively) in these three groups. These associations remained consistent across sex and age subgroups.</p><p><strong>Conclusion: </strong>Serum anti-PLA2R antibody trajectories represent a robust prognosis biomarker in MN, useful for risk stratification and clinical decision-making. Patients with high-stable or rising antibody trajectories require heightened clinical attention due to significantly increased risks of renal function decline, clinical non-remission, and relapse.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-11"},"PeriodicalIF":3.2,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145916569","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":"Comparative Performance of Novel and Standard Urinary Kidney Biomarkers for Prediction of Persistent Severe Acute Kidney Injury and Long-Term Major Adverse Kidney Events.","authors":"Michael Strader, Stephen Duff, Jean-Maxime Côte, Lynn Redahan, Marie Galligan, Blaithin A McMahon, Brian Marsh, Alistair Nichol, Patrick T Murray","doi":"10.1159/000550218","DOIUrl":"10.1159/000550218","url":null,"abstract":"<p><strong>Introduction: </strong>Acute kidney injury (AKI) is common complication in the critically ill. Standard functional biomarkers are limited at predicting persistent severe AKI (PS-AKI) and long-term outcomes. This study evaluated the diagnostic and prognostic performance of a panel of urinary biomarkers (novel and standard) for predicting PS-AKI and major adverse kidney events (MAKEs).</p><p><strong>Methods: </strong>This was an exploratory post hoc analysis of the prospective Dublin Acute Biomarker Group Evaluation (DAMAGE) multicentred prospective observational cohort study. ICU AKI (KDIGO stages 1-3) patients were included. Sixteen urinary biomarkers were measured on the day of AKI diagnosis. The primary endpoint was PS-AKI (stage 2/3 AKI ≥48 h). Discrimination was assessed using AUC and logistic regression models, and reclassification metrics (IDI, cfNRI). Secondary endpoints included MAKE90 and MAKE365. Tertile trends for CCL14 also evaluated.</p><p><strong>Results: </strong>Among 186 patients with AKI, 80 (43.0%) developed PS-AKI. Albumin (uAlb; AUC = 0.82; 95% CI: 0.76-0.88), albumin/creatinine ratio (uAlb/Cr; AUC = 0.79; 95% CI: 0.72-0.85), urine output (AUC = 0.81; 95% CI: 0.74-0.87), and serum creatinine (AUC = 0.77; 95% CI: 0.70-0.84) demonstrated the highest discrimination. In logistic regression analysis adjusted for a clinical model, IL-18 showed the strongest association with PS-AKI (aOR = 3.09; 95% CI: 1.92-5.30), while uAlb, uAlb/Cr, cystatin C, CCL14, and MCP-1 were also significantly associated. CCL14 and uAlb tertiles showed a significant stepwise increase in PS-AKI. uAlb was the strongest discriminator for MAKE90 (AUC = 0.70; 95% CI: 0.57-0.83). Pi-GST was negatively associated with MAKE365 (aOR = 0.44; 95% CI: 0.21-0.81).</p><p><strong>Conclusion: </strong>Urine output, uAlb, and uAlb/Cr outperformed several novel biomarkers and demonstrated strong discrimination for PS-AKI. CCL14 showed moderate discrimination and was associated with early adverse outcomes. These findings support integrating standard and novel biomarkers to personalise AKI management.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-14"},"PeriodicalIF":3.2,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145905427","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":"Additive Obinutuzumab Achieves High Remission Rates in Rituximab-Refractory Membranous Nephropathy.","authors":"Huixian Li, Li Jin, Xinfang Xie, Jiping Sun, Dan Niu, Jie Feng, Guiqing Xu, Xiaotian Zhang, Abdulrahman Majeed S Khalaf, Wanhong Lu","doi":"10.1159/000545995","DOIUrl":"10.1159/000545995","url":null,"abstract":"<p><p><p>Introduction: Rituximab has become the first-line therapy for patients with membranous nephropathy (MN). However, approximately 30-40% of patients with MN do not respond to rituximab. We presented our single-center experience of treating rituximab-refractory MN with obinutuzumab which is a humanized and glycoengineered type II anti-CD20 monoclonal antibody.</p><p><strong>Methods: </strong>Seventeen patients with rituximab-refractory phospholipase A₂ receptor (PLA₂R)-associated MN who received obinutuzumab at the First Affiliated Hospital of Xi'an Jiaotong University were included in this case series study. Clinical and laboratory parameters were evaluated at presentation, before and after obinutuzumab administration.</p><p><strong>Results: </strong>Of all patients with an average age of 49.7 ± 13.7 years, 11 (64.7%) patients were men. The median disease duration was 12 (12, 42) months. At presentation, the proteinuria and serum albumin levels were 7.51 ± 3.55 g/day and 22.1 ± 3.6 g/L, respectively. The mean estimated glomerular filtration rate level was 103.5 ± 12.9 mL/min/1.73 m2, and the patients had a baseline anti-PLA₂R level of 183.2 ± 92.9 RU/mL. At obinutuzumab administration, proteinuria and albumin levels were still consistent with nephrotic syndrome. After a median follow-up of 12.6 ± 5.0 months, complete remission was achieved in 9 (52.9%) and partial remission was achieved in 6 (41.2%) cases. Of the patients who achieved remission, the median remission time was 4.4 (4.0, 6.0) months. At 6 months, 12 (70.6%) patients achieved remission and 11 of 12 patients with available PLA₂R measurements reached immunological remission.</p><p><strong>Conclusion: </strong>Obinutuzumab may represent an attractive alternative therapy in rituximab-refractory patients. Larger prospective studies are needed to validate these findings. </p>.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"21-29"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}