American Journal of Nephrology最新文献

{"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":"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":"168-179"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","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":"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}

{"title":"Assessing Rural Veterans' Experiences with a Tele-Nephrology Program in the Veterans Health Administration.","authors":"Kristin M Mattocks, Lorrie Walker, Aimee Kroll-Desrosiers, Susan Crowley, David T Moore, Ramon Bonegio","doi":"10.1159/000546917","DOIUrl":"10.1159/000546917","url":null,"abstract":"<p><strong>Introduction: </strong>Rural-living veterans with chronic kidney disease and refractory hypertension have a higher mortality rate and are hospitalized more frequently than veterans living in urban or suburban areas. They also face particularly unique challenges in accessing nephrology specialty care. Previous studies suggest virtual nephrology care can be used to increase access to care for veterans. The purpose of this study was to examine veteran's perceptions and experiences with a veteran administration (VA) virtual nephrology program.</p><p><strong>Methods: </strong>We conducted semi-structured interviews with forty-four veterans at five rural VA medical centers who were receiving virtual nephrology care (\"tele-nephrology\").</p><p><strong>Results: </strong>Four major themes arose that represent the veterans' perceptions and experiences with VA virtual nephrology care: (1) tele-nephrology provides timely access to care for veterans living in rural areas, (2) clinical partnerships between primary care and tele-nephrology are key to veterans' health, (3) veterans' technology fears were assuaged with virtual nephrology care, and (4) improvements to care include more direct access to virtual nephrologists.</p><p><strong>Conclusion: </strong>This evaluation represents an important step forward in how the VA can enhance virtual nephrology care to better meet the needs of rural veterans receiving care at facilities without VA specialty providers. Prior to the Choice and MISSION Acts, veterans were often required to drive long distances to the closest VA specialty provider. However, since the COVID-19 pandemic, the VA has been shifting care from the community to the VA via virtual care. Further research should examine veterans' experiences with different modalities of nephrology care as well as experiences of demographically and geographically diverse veterans.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"272-279"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315724","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":"Nephrology Provider Perceptions about Recommending Influenza and COVID-19 Vaccines: A Nationwide Survey.","authors":"Guangchen Zou, Lawrence Appel, Deidra C Crews, David Dowdy, Kunihiro Matsushita, Kristin A Riekert, Bernard G Jaar, Junichi Ishigami","doi":"10.1159/000544935","DOIUrl":"10.1159/000544935","url":null,"abstract":"<p><strong>Introduction: </strong>Vaccination rates for influenza and COVID-19 remain low among people with chronic kidney disease (CKD). Nephrology care offers an opportunity to boost vaccination rates. Understanding provider perceptions can be key to developing effective intervention programs.</p><p><strong>Methods: </strong>We conducted a nationwide survey among nephrology care providers. In a questionnaire, we assessed the providers' agreement with potential barriers to recommending influenza and COVID-19 vaccines and perceptions of selected vaccination programs on their acceptability, appropriateness, and feasibility.</p><p><strong>Results: </strong>Between February and June 2023, 312 providers responded to the survey. Most providers agreed that there is sufficient evidence for influenza vaccines (270/311, 86.8%) and that vaccines reduce the risk of serious complications of influenza (277/310, 89.4%). However, 40/312 (12.8%) felt that recommending influenza vaccines is less important than other issues they must address. By profession, more physicians agreed with the evidence (112/123 or 91.1% vs. 39/49 or 79.5% for NPs and 83/101 or 82.2% for RNs, p = 0.007) than nurse practitioners (NPs) or nurses (RNs). The most perceived barrier was lack of self-efficacy: 95/311 (30.5%) felt that many patients will not get vaccinated even if they recommend it. Similar responses were seen for COVID-19 vaccines. Regarding vaccination programs, 209/235 (88.9%), 197/224 (87.9%), and 183/222 (82.4%) providers considered provider reminders acceptable, appropriate, and feasible. 209/239 (87.4%), 198/226 (87.6%), and 187/224 (83.5%) did so for standing orders. Onsite/walk-in vaccinations were viewed as acceptable by 192/242 (79.3%) but less feasible (137/222 or 61.7%). Fewer than 33% of providers perceived patient incentives as acceptable, appropriate, or feasible.</p><p><strong>Conclusions: </strong>Most nephrology care providers believe that influenza and COVID-19 vaccinations offer evidence-based benefits, with slightly higher belief among physicians compared to NPs or RNs. However, important barriers to vaccination remain. Standing orders, provider reminders, and onsite/walk-in vaccination are favorably perceived by providers.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"96-108"},"PeriodicalIF":3.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12354274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144140965","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":"Association between the Frailty and Cardiovascular Disease Risk in Populations with Cardiovascular-Kidney-Metabolic Syndrome Stages 0-3: A Prospective Cohort Study.","authors":"Xunliang Li, Wenman Zhao, Li Zhao, Tongxin Sun, Fuhai Zhu, Deguang Wang","doi":"10.1159/000548772","DOIUrl":"10.1159/000548772","url":null,"abstract":"<p><strong>Introduction: </strong>Previous studies found that frailty was an important risk factor for cardiovascular disease (CVD). However, the relationship between frailty and CVD risk across different cardiovascular-kidney-metabolic (CKM) syndrome stages remains poorly understood. This study investigated the association between frailty and incident CVD in populations with CKM syndrome stages 0-3.</p><p><strong>Methods: </strong>We analyzed 6,049 middle-aged and older adults without pre-existing CVD data from the China Health and Retirement Longitudinal Study (2011-2020). Participants were categorized into CKM syndrome stages 0-3 based on the American Heart Association's criteria. Frailty was assessed using the frailty index (FI) and classified as robust, pre-frail, or frail. Cox proportional hazard models examined the association between frailty and incident CVD.</p><p><strong>Results: </strong>During a median follow-up of 7.5 years, 1,441 participants developed CVD. Compared to robust individuals, pre-frail and frail participants had multivariable-adjusted hazard ratios of 1.58 and 2.13 for incident CVD, respectively. Each standard deviation increase in FI was associated with a 28% higher risk of incident CVD. A dose-response relationship was observed between FI and CVD risk, with no significant nonlinearity was detected. These associations remained consistent across all CKM syndrome stages, although significant effect modifications were observed by age, gender, and hypertension status. Sensitivity analyses yielded consistent results.</p><p><strong>Conclusions: </strong>Frailty is independently associated with increased CVD risk across the spectrum of CKM syndrome stages, with a clear dose-response relationship.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"629-641"},"PeriodicalIF":3.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145243601","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":"Bridging the Evidence-to-Practice Gap in Hypertension: Why Innovation Is Not Always Implementation?","authors":"Mehmet Kanbay, Francesca Mallamaci, Carmine Zoccali","doi":"10.1159/000551867","DOIUrl":"10.1159/000551867","url":null,"abstract":"","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"541-546"},"PeriodicalIF":3.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148293133","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}