American Journal of Nephrology最新文献

{"title":"Outcomes of Dual Kidney Transplantation from Donors with High Pre-Implantation Biopsy Scores.","authors":"Giorgia Comai, Michele Provenzano, Elisa Gessaroli, Valeria Grandinetti, Daniele Vetrano, Angelodaniele Napoletano, Chiara Abenavoli, Claudia Bini, Vania Cuna, Marcello Demetri, Francesca Chiappo, Francesca Leone, Benedetta Fabbrizio, Massimo Del Gaudio, Lorenzo Maroni, Matteo Ravaioli, Gaetano La Manna, Valeria Corradetti","doi":"10.1159/000553292","DOIUrl":"10.1159/000553292","url":null,"abstract":"<p><strong>Introduction: </strong>The persistent shortage of transplantable kidneys has increased reliance on marginal organs, yet kidneys with advanced chronic lesions on pre-implantation biopsy are frequently discarded. Dual kidney transplantation (DKT) may mitigate this risk by increasing nephron mass, but outcomes of allografts with very high histological scores remain poorly defined. We evaluated kidney transplant outcomes according to transplant type and pre-implantation Karpinski score, with particular focus on DKT using kidneys with combined Karpinski score ≥9.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 262 adult deceased-donor kidney transplant recipients undergoing pre-implantation biopsy at a single Italian center between 2014 and 2021. Recipients were stratified into 3 allocation groups: single kidney transplantation with Karpinski score <9 (SKT <9), DKT with combined Karpinski score <9 (DKT <9), and DKT with combined Karpinski score ≥9 (DKT ≥9). Primary outcomes were post-transplant eGFR and proteinuria during follow-up. Secondary outcomes included delayed graft function (DGF), acute rejection, complications, overall graft failure, all-cause mortality, and death-censored graft failure.</p><p><strong>Results: </strong>Among 262 recipients, 142 received SKT <9, 35 received DKT <9, and 85 received DKT ≥9. DKT donors were older and had higher KDPI/KDRI than SKT donors. Despite greater histological chronicity, recipients of DKT ≥9 grafts did not show inferior renal function at longer-term follow-up, with comparable eGFR and proteinuria at 12 and 36 months. Primary non-function, DGF, biopsy-proven acute rejection, and major complications were similar across groups, although post-transplant thrombotic microangiopathy was more frequent in DKT recipients. Kaplan-Meier analyses showed no significant differences in overall graft failure, all-cause mortality, or death-censored graft failure. In multivariable Cox regression, allocation group was not independently associated with overall graft failure.</p><p><strong>Conclusion: </strong>In this real-world allocation cohort, kidneys with combined Karpinski score ≥9 achieved outcomes comparable to lower-score grafts when allocated as DKT. These findings support the use of DKT as a strategy to safely expand the donor pool and suggest that high histological chronicity should not automatically preclude transplantation when integrated with clinical and functional donor assessment.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-12"},"PeriodicalIF":3.8,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148560551","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":"Diagnostic Utility of NT-proBNP in Tracking Cardiovascular Functional and Structural Changes in Advanced CKD and Post-Transplantation.","authors":"Monique Campos, Nolan Groninger, Gayatri Narayanan, Claudia Tomkins, Heather N Burney, Xiaochun Li, Olivia Carlton, Stone Chen, Stephen M S Ting, Daniel Zehnder, Thomas Hiemstra, Kenneth Lim","doi":"10.1159/000552892","DOIUrl":"10.1159/000552892","url":null,"abstract":"<p><strong>Introduction: </strong>NT-proBNP is a critical biomarker in the management of heart failure. However, its role in tracking cardiovascular (CV) function and structure in patients with advanced chronic kidney disease (CKD) and after kidney transplantation remains unclear. Herein, we investigated the association between NT-proBNP with CV function and structure in advanced CKD and longitudinally post-kidney transplantation.</p><p><strong>Methods: </strong>We assessed 159 stage 5 CKD patients from the Cardiopulmonary Exercise Testing in Renal Failure and After Kidney Transplantation (CAPER) cohort, including kidney transplant recipients (KTRs) and waitlisted controls (NTWCs). All patients underwent cardiopulmonary exercise testing and echocardiography at baseline and 1-year follow-up and were stratified by baseline NT-proBNP quartiles (Q1-Q4).</p><p><strong>Results: </strong>Groups were balanced by sex and race (p > 0.05); however, Q4 patients were older, had lower BMI, and were predominantly on hemodialysis (all p < 0.03). Higher baseline NT-proBNP was associated with lower VO₂Max (gold-standard index of CV functional capacity), reduced peak HR, workload, endurance time, and elevated LVMI (all p < 0.007). Longitudinally, NTWCs demonstrated worsening VO₂Max, workload, peak HR, and endurance time, along with a mean 89% increase in NT-proBNP. In KTRs, VO₂Max, workload, and endurance time improved in parallel with a mean 92% reduction in NT-proBNP after transplantation (all p ≤ 0.02). Changes in logNT-proBNP before and after transplantation were associated with alterations in VO₂Max, peak HR, workload, and elevated LVMI (all p < 0.02).</p><p><strong>Conclusion: </strong>Elevated NT-proBNP reflects impaired CV function and structure in advanced CKD and may serve as a prognostic biomarker for tracking improvements in CV health in patients with advanced CKD and undergoing kidney transplantation.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-15"},"PeriodicalIF":3.8,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468249","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":"Access Type-Specific Vascular Access Creation Timing in Incident Hemodialysis: A Nationwide Cohort Study.","authors":"Jooyeon Yoon, Kyungjun Shon, Hayne Cho Park, Sua Lee, Young-Ki Lee, Hyungseok Lee, Eun Jung Kim, Hoon Suk Park, Min-Ho Kim, Do Hyoung Kim","doi":"10.1159/000553533","DOIUrl":"10.1159/000553533","url":null,"abstract":"<p><strong>Introduction: </strong>The lead time needed for vascular access (VA) creation before hemodialysis (HD) initiation remains unclear. Because arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) differ in expected time to cannulation, the association between VA timing and outcomes may differ by access type.</p><p><strong>Methods: </strong>Using the Korean National Health Insurance Service database, we identified incident HD patients in 2013 who underwent AVF or AVG creation before HD initiation. Patients were classified according to the interval from VA creation to HD initiation: VA0 (<1 month), VA1 (1 to <3 months), VA3 (3 to <6 months), VA6 (6 to <9 months, reference), VA9 (9 to <12 months), and VA12 (12 to ≤24 months). Catheter use, patency loss, and mortality were analyzed separately in AVF and AVG patients using logistic regression, Kaplan-Meier analysis, and Cox models.</p><p><strong>Results: </strong>Among 24,713 patients, 20,894 underwent AVF and 3,819 underwent AVG creation. In AVF patients, compared with VA6, VA0, and VA1 were associated with higher catheter use (odds ratios, 14.03 and 1.85), primary patency loss (hazard ratios [HRs], 2.64 and 1.16), secondary patency loss (HRs, 4.56 and 1.12), and mortality (HRs, 1.67 and 1.25). In AVG patients, adverse associations were mainly observed in VA0, including higher catheter use (odds ratio, 8.45), primary patency loss (HR, 1.97), secondary patency loss (HR, 2.06), and mortality (HR, 1.43). Primary patency loss was also higher in VA1.</p><p><strong>Conclusion: </strong>The association between VA creation timing and outcomes differed between AVF and AVG. For AVF, creation at least 3 months before HD initiation was associated with more favorable outcomes. For AVG, adverse associations for most outcomes were concentrated within 1 month before HD initiation.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-14"},"PeriodicalIF":3.8,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148443909","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":"Prognostic Relevance of Erythropoiesis-Stimulating Agent Dose Requirements in PIVOTAL and Its Implications for the Potential Mechanisms of Intravenous Iron Benefit in Maintenance Haemodialysis Patients.","authors":"Benjamin A Oliveira, Mohamad F Barakat, Iain C Macdougall, Darlington O Okonko","doi":"10.1159/000552970","DOIUrl":"10.1159/000552970","url":null,"abstract":"<p><strong>Introduction: </strong>Decreased erythropoiesis-stimulating agent (ESA) requirements might explain the benefits of high-dose intravenous (IV) iron in PIVOTAL. However, as iron can be beneficial via non-erythropoietic pathways, higher iron doses might relate to better outcomes independently of ESA doses. This post hoc analysis examines whether reductions in ESA exposure were associated with the benefits of IV iron, and whether IV iron doses remained associated with outcomes after accounting for ESA exposure and haemoglobin (Hb) levels in PIVOTAL.</p><p><strong>Methods: </strong>We analysed data from 2,141 participants in the PIVOTAL trial. Primary endpoint was all-cause mortality (ACM) or nonfatal myocardial infarction, nonfatal stroke, or heart failure hospitalization.</p><p><strong>Results: </strong>Baseline median (IQR) ESA dose was 8,000 (5,000, 10,000) IU/week and similar in both treatment arms. Over 24 (10, 33) months, 658 (31%) patients met the primary endpoint, and ACM occurred in 515 (24%) patients. In adjusted Cox models, higher baseline ESA doses (per 10,000 IU/week) were associated with increased risks (primary endpoint: HR: 1.31 [95% confidence interval [CI]: 1.16, 1.49], p < 0.001; ACM: HR: 1.33 [95% CI: 1.15, 1.53], p < 0.001) in reactive patients. Over time, proactive patients had lower ESA (25,980 [17,320, 43,300] vs. 34,640 [25,980, 56,290] IU/month) and higher iron (250 [193, 300] vs. 127 [88, 171] mg/month) doses. In adjusted Cox models with time-varying covariates, higher ESA doses (≥34,640 IU/month) were associated with increased risks (primary endpoint: HR: 1.58 [95% CI: 1.34, 1.86], p < 0.001; ACM: HR: 1.83 [95% CI: 1.51, 2.20], p < 0.001), while higher iron doses (≥200 mg/month) were linked to reduced risks (primary endpoint: HR: 0.78 [95% CI: 0.67, 0.92], p = 0.002; ACM: HR: 0.78 [0.65, 0.93], p = 0.001) in the total population.</p><p><strong>Conclusion: </strong>Lower ESA requirements predicted better outcomes in PIVOTAL, but higher IV iron doses remained associated with better outcomes even after accounting for ESA dose requirements and Hb levels. These findings suggest that some of the benefits of proactive IV iron in PIVOTAL may not be fully mediated by reductions in ESA exposure alone, supporting the possibility of non-erythropoietic mechanisms.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-10"},"PeriodicalIF":3.8,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148434764","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":"Kidney and Cardiovascular Outcomes by Chronic Kidney Disease Stage and Etiology of Chronic Kidney Disease: A Randomly Selected Nationwide Prospective Multicenter Cohort Study in Japan (Reach-J Study).","authors":"Ryoya Tsunoda, Tomohiro Ohigashi, Junichi Hoshino, Yukiko Ito, Kei Nagai, Reiko Okubo, Hirayasu Kai, Chie Saito, Masahide Kondo, Koichi Asahi, Hirokazu Okada, Shoichi Maruyama, Takashi Wada, Ichiei Narita, Naoki Kashihara, Ronald Pisoni, Roberto Pecoits-Filho, Kunihiro Yamagata","doi":"10.1159/000553499","DOIUrl":"10.1159/000553499","url":null,"abstract":"<p><strong>Introduction: </strong>Kidney disease is a global health priority. Accurate identification of primary diseases causing end-stage kidney disease is essential.</p><p><strong>Methods: </strong>We established the REACH-J cohort, a nationwide prospective cohort of patients with advanced chronic kidney disease (CKD) under nephrologist care, using random sampling across 31 institutions. Patients with CKD stages G3b-G5 completed lifestyle and medical surveys; institutions provided medical history data over 5 years of follow-up.</p><p><strong>Results: </strong>Among 2,249 patients (mean age, 69.1 ± 12.6 years), primary CKD etiologies were diabetic kidney disease (DKD; 24.5%), nephrosclerosis (NSc; 24.4%), polycystic kidney disease (PKD; 5.8%), and others (45.3%). Event rates (per 100 person-years) were 3.0 for all-cause mortality, 2.0 for pre-kidney replacement therapy (KRT) death, and 8.4 for KRT initiation. Among patients at stage G3b at enrollment, the primary disease most frequently associated with KRT initiation was diabetes. However, among patients at stage G4 or G5 at enrollment, the condition most frequently associated with KRT initiation was PKD. NSc had the lowest KRT initiation rate. Mortality was highest in stage G3b DKD, followed by NSc. Kaplan-Meier analysis showed early KRT initiation in DKD, later surpassed by PKD. Across etiologies, higher proteinuria predicted poorer renal outcomes, whereas cardiovascular and mortality rates did not differ by proteinuria stage.</p><p><strong>Conclusions: </strong>Although DKD is the leading cause of end-stage kidney disease worldwide, PKD most commonly leads to dialysis in patients with CKD stages 4-5 under the nephrologist's control. In contrast, non-proteinuric NSc conferred a very low risk of end-stage kidney disease, even in advanced CKD (G3b-G5).</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-15"},"PeriodicalIF":3.8,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148417983","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":"Effects of Sodium Glucose Transporters 2 Inhibitors on Body Mass Index and Systolic Blood Pressure in Kidney Transplant Recipients with or without Diabetes Mellitus: A Multicenter Propensity Score-Matched Analysis.","authors":"Daniela Picciotto, Giorgia Comai, Elisabetta Bussalino, Michele Provenzano, Elvina Lecini, Denise Cignesi, Miriam Di Nunzio, Valeria Corradetti, Valeria Grandinetti, Giuseppe Cianciolo, Federica Bui, Maria Teresa Gandolfo, Angelica Parodi, Rodolfo Russo, Vincenzo Cantaluppi, Gaetano La Manna, Francesca Viazzi","doi":"10.1159/000552079","DOIUrl":"10.1159/000552079","url":null,"abstract":"<p><strong>Introduction: </strong>Sodium glucose transporters inhibitors 2 (SGLT2is) have represented one of the most relevant revolutions in the field of nephrology in recent years, but strong evidence regarding their use in kidney transplant recipients (KTRs) is still lacking. We therefore performed a multicenter retrospective analysis, in order to evaluate the impact of SGLT2i in KTR with and without diabetes.</p><p><strong>Methods: </strong>All consecutive adult KTRs followed at the three participating outpatient Nephrology Clinics between 2015 and December 2023 who were prescribed an SGLT2i were identified and constituted the pool of treated subjects. KTRs who were not prescribed SGLT2i during the same time frame served as the source population for the control group. After performing propensity score matching, patients on SGLT2i (n = 88) and matched controls (n = 88) were selected. Longitudinal changes in body mass index (BMI), blood pressure (BP), and kidney parameters were assessed.</p><p><strong>Results: </strong>The SGLT2i group showed a mean difference in BMI decrease of 0.81 and 1.17 Kg/m2 at 6 months and 12 months, respectively (p < 0.02), compared to controls. Similarly, systolic blood pressure (SBP) was significantly lower in KTR on SGLT2i at 12 months (mean difference -5.83 mm Hg, p = 0.042). No changes over time were observed for the other analyzed variables, including eGFR and 24-h proteinuria. None of the patients developed genital infections or euglycemic ketoacidosis. Urinary tract infections were the most common side effect (12.4%) and did not occur significantly more frequently among SGLT2i users.</p><p><strong>Conclusion: </strong>SGLT2is have a favorable effect on SBP and BMI in KTR. Results concerning nephroprotection and safety are promising but have to be confirmed in the long term.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-10"},"PeriodicalIF":3.8,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148417914","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":"Comment on \"Lower Risk of Acute Kidney Injury in Hospitalized Patients Treated with Sodium-Glucose Cotransporter 2 Inhibitors: A Retrospective Matched Cohort Study\".","authors":"Linsong Gao, Keda Lu","doi":"10.1159/000553490","DOIUrl":"10.1159/000553490","url":null,"abstract":"","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-3"},"PeriodicalIF":3.8,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410152","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":"Safety and Effectiveness of Apixaban versus Warfarin in Peritoneal Dialysis Patients with Newly Diagnosed Nonvalvular Atrial Fibrillation.","authors":"Mingyue He, Kevin F Erickson, Hania Kassem, Maria E Montez-Rath, Tara I Chang, Wolfgang C Winkelmayer, Jingbo Niu","doi":"10.1159/000553428","DOIUrl":"10.1159/000553428","url":null,"abstract":"<p><strong>Introduction: </strong>Apixaban reduces thromboembolic events, bleeding, and mortality compared with warfarin in patients with nonvalvular atrial fibrillation (NVAF). However, evidence in patients with kidney failure (KF) receiving peritoneal dialysis (PD) is limited. We evaluated the safety and effectiveness of apixaban versus warfarin in this population.</p><p><strong>Methods: </strong>Using the US Renal Data System, we identified Medicare beneficiaries on PD with newly diagnosed NVAF (2014-2019) who had no prior oral anticoagulation (OAC) use. We included patients initiating apixaban or warfarin within 30 days after NVAF diagnosis. After propensity matching, we estimated the hazard ratios for thromboembolic events, bleeding events, and mortality using Cox models accounting for competing risks, where applicable, and using both intent-to-treat and as-treated (AT) approaches.</p><p><strong>Results: </strong>Among 6,571 OAC-naive PD patients with newly diagnosed NVAF, 334 initiated apixaban and 717 initiated warfarin within 30 days. After 1:1 propensity matching, all observed characteristics of 330 apixaban and 330 warfarin users were balanced. The median CHA₂DS₂-VASc score was 4 (IQR 3-5). In intent-to-treat analyses, hazards of ischemic stroke (hazard ratio [HR] = 0.92; 95% CI: 0.42-2.01) and the composite of other thromboembolic outcomes with cardiovascular death (HR = 0.90; 95% CI: 0.66-1.22) did not differ between groups. The hazards of clinically important bleeding (HR = 0.81; 95% CI: 0.62-1.07), major bleeding, intracranial hemorrhage, and all-cause mortality also did not differ between groups. Findings were consistent in AT analyses.</p><p><strong>Conclusion: </strong>Among PD patients with newly diagnosed NVAF, we observed no statistically significant differences between apixaban and warfarin for effectiveness or bleeding outcomes. Given the challenges of warfarin management in KF, apixaban may represent a more practical option when anticoagulation is pursued.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-13"},"PeriodicalIF":3.8,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13474193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403273","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":"Context-Dependent Prognostic Significance of Total Iron-Binding Capacity by Nutritional and Inflammatory Status in Hemodialysis.","authors":"Masahiro Eriguchi, Shunichiro Orihara, Yoshihiro Onishi, Masaru Matsui, Keisuke Okamoto, Ken-Ichi Samejima, Kazuhiko Tsuruya","doi":"10.1159/000553442","DOIUrl":"10.1159/000553442","url":null,"abstract":"<p><strong>Introduction: </strong>Total iron-binding capacity (TIBC) is widely used in anemia management among dialysis patients. While low TIBC reflects malnutrition and inflammation, elevated TIBC indicates iron deficiency and has been linked to adverse outcomes, including thrombotic events. We examined the prognostic value of TIBC in hemodialysis (HD) patients.</p><p><strong>Methods: </strong>We analyzed data from Phases 4-7 of the Japanese Dialysis Outcomes and Practice Patterns Study (J-DOPPS). Patients were categorized into TIBC quintiles and stratified by serum albumin (<3.8 vs. ≥3.8 g/dL) or C-reactive protein (CRP; <0.1 vs. ≥0.1 mg/dL). Outcomes included all-cause mortality, cardiovascular events, and thrombotic events. Cox models estimated hazard ratios (HRs), and nonlinear associations were assessed using multivariable fractional polynomials.</p><p><strong>Results: </strong>Among 5,604 HD patients, 622 deaths occurred during a median follow-up of 2.0 years. In crude analyses, mortality decreased across increasing TIBC quintiles only in patients with high CRP or low albumin but not in those with low CRP or high albumin. After multivariable adjustment, mortality risk was elevated in the highest TIBC quintile, particularly in patients with high CRP (aHR 1.89, 95% CI 1.21-2.97) and low albumin (aHR 1.29, 95% CI 0.87-1.92), whereas no significant increase was observed in those with low CRP or high albumin. Fractional polynomial models showed increased mortality risk at very high-TIBC levels, limited to patients with hypoalbuminemia or inflammation. Similar patterns were observed for cardiovascular and thrombotic events.</p><p><strong>Conclusion: </strong>Elevated TIBC was associated with poor outcomes in HD patients with malnutrition or inflammation, underscoring its context-dependent prognostic value.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-12"},"PeriodicalIF":3.8,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403185","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":"Metabolic Syndrome and Risk of Atrial Fibrillation in Chronic Kidney Disease.","authors":"Katherine Scovner Ravi, Finnian R Mc Causland","doi":"10.1159/000553385","DOIUrl":"10.1159/000553385","url":null,"abstract":"<p><strong>Introduction: </strong>Metabolic syndrome is a potent risk factor for adverse cardiovascular outcomes including atrial fibrillation (AF). Although metabolic syndrome is common among patients with chronic kidney disease (CKD), its association with AF remains unclear.</p><p><strong>Methods: </strong>We analyzed 4,641 participants in the Chronic Renal Insufficiency Cohort (CRIC) without baseline AF. Cox regression models evaluated the association of a metabolic syndrome score (Adult Treatment Panel III criteria), its components (hypertension, diabetes, waist circumference, elevated triglycerides, low HDL), and markers of visceral adiposity (waist-to-height ratio and fat mass index) with time to hospitalization with AF. The main model adjusted for demographics, stroke, lifestyle factors (smoking, alcohol use), and whether participants had ever been seen by a nephrologist (as a marker of healthcare utilization). An exploratory model additionally adjusted for laboratory parameters (eGFR, proteinuria, hemoglobin, albumin, and electrolytes), other cardiovascular comorbidities, and medications.</p><p><strong>Results: </strong>The mean age of the participants was 59 ± 11 years, and 44% were female and 42% were black. Over a mean follow-up of 9.3 years, 616 (13%) were hospitalized with AF. Higher metabolic syndrome score was associated with hospitalization with AF (adjusted hazard ratio (aHR) per unit 1.16; 95% CI 1.08, 1.24). Elevated waist circumference and hypertension were the most consistently associated individual components, remaining independently associated with hospitalization with AF across all models including with concomitant adjustment for the remaining metabolic syndrome components (aHR 1.29; 95% CI 1.05, 1.60 and aHR 1.61; 95% CI 1.09, 2.39, respectively). The waist-to-height ratio and fat mass index were also associated with hospitalization with AF in the main adjusted model (aHR per 0.1 unit, 1.23; 95% CI, 1.14, 1.34 and aHR per 5 kg/m2, 1.22; 95% CI, 1.12, 1.34, respectively).</p><p><strong>Conclusion: </strong>Among adults with CKD and no prior AF, hypertension and anthropometric markers of visceral adiposity are independently associated with a higher risk of hospitalization with AF. Future studies should explore mechanisms linking body composition to arrhythmia in CKD and whether reducing visceral adiposity could mitigate this risk.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-12"},"PeriodicalIF":3.8,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13383851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148374303","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}