American Journal of Nephrology最新文献

{"title":"Adjunctive Active Vitamin D Decreases Kidney Function during Treatment of Secondary Hyperparathyroidism with Extended-Release Calcifediol in Non-Dialysis Chronic Kidney Disease in a Randomized Trial.","authors":"Akhtar Ashfaq, John Choe, Stephen A Strugnell, Nilay Patel, Stuart M Sprague, Keith C Norris, Edgar Lerma, P Martin Petkovich, Charles W Bishop, Akhtar Ashfaq","doi":"10.1159/000544086","DOIUrl":"10.1159/000544086","url":null,"abstract":"<p><strong>Introduction: </strong>Sustained 30% reductions of intact parathyroid hormone (iPTH) with extended-release calcifediol (ERC) are associated with slower decline in estimated glomerular filtration rate (eGFR) in non-dialysis chronic kidney disease (ND-CKD) patients with secondary hyperparathyroidism (SHPT). Such iPTH reductions usually require elevation of serum total 25-hydroxyvitamin D (25D) to ≥50 ng/mL, but achieving these reductions can be limited by the ERC dose ceiling (60 μg/day), raising the question of whether adjunctive active vitamin D (adj AVD) might be appropriate to further reduce iPTH.</p><p><strong>Methods: </strong>This randomized controlled trial (RCT) examined whether adj AVD could safely increase iPTH reductions achieved with ERC and further reduce the rate of eGFR decline in 78 ND-CKD adults treated with ERC for 38 weeks. Participants had mean age of 66 years, body mass index of 35 kg/m2, were 41% female, 63% white, 36% black, 19% Hispanic. At ERC initiation, participants had plasma iPTH 85-<500 pg/mL, eGFR 15-<60 mL/min/1.73 m2, serum 25D 10-<30 ng/mL, corrected serum calcium (Ca) 8.4-<9.8 mg/dL, serum phosphorus (P) 2.0-<5.0 mg/dL, and absence of macroalbuminuria (>3 g/g creatinine). At baseline (BL; week 38), participants had plasma iPTH >70 pg/mL and serum Ca <9.8 mg/dL and were randomized 3:1:1:1 to daily ERC (60 μg) for 14 additional weeks with (n = 40) or without (n = 38) adj daily oral calcitriol (0.25 μg), doxercalciferol (0.5 μg), or paricalcitol (1.0 μg). Measurements of eGFR, iPTH, 25D, Ca, P, and fibroblast growth factor 23 (FGF23) were obtained at BL and through end of treatment (EOT).</p><p><strong>Results: </strong>No significant intergroup differences were observed at BL. Mean 25D at BL was 65 ng/mL and rose 14 ng/mL by EOT in both groups (p < 0.001). Mean BL iPTH was 137 pg/mL and fell by a further 35.4% (p < 0.001) with adj AVD therapy versus 2.2% without. Mean Ca, P, and FGF23 increased with adj AVD by 0.40 mg/dL (p < 0.001), 0.27 mg/dL (p < 0.01), and 49.1 pg/mL (155%; p < 0.001), respectively, but remained unchanged with ERC alone. Mean BL eGFR was 25.4 mL/min/1.73 m2 and fell by 11.8% (p < 0.05) with adj AVD versus 3.0% without.</p><p><strong>Conclusion: </strong>Adj AVD at these doses enabled 35% more iPTH reduction in ND-CKD patients with mild to moderate SHPT on long-term ERC treatment but increased mean serum Ca and P by 0.40 and 0.27 mg/dL, respectively, FGF23 by more than 2-fold, and eGFR decline by 4-fold, suggesting that adding AVD to ERC has untoward effects that override the nephrosparing impact of iPTH reductions with ERC treatment alone. Corroboration is warranted with a larger, longer RCT.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"490-499"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482074","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":"IgA Nephropathy and the Risk of Primary Infections: A Swedish Population-Based Cohort Study.","authors":"Johanna Rehnberg, Jonas F Ludvigsson, Louise Emilsson, Johanna Rehnberg","doi":"10.1159/000544753","DOIUrl":"10.1159/000544753","url":null,"abstract":"<p><strong>Introduction: </strong>IgA nephropathy is the most common primary kidney disease in the world and has a highly variable clinical presentation. While studies have indicated a link between glomerular disease and infections, large-scale studies on IgA nephropathy are missing.</p><p><strong>Methods: </strong>In our study, IgA nephropathy was defined as having a kidney biopsy record 1997-2011 in Sweden. Each IgA nephropathy patient was matched with five reference individuals based on age, sex, calendar year, and county of residence. We excluded individuals with earlier organ transplants, HIV, immunodeficiency, or end-stage kidney disease. Linear and Cox regressions, adjusted for age, sex, education, and diabetes, were performed to analyze total infections and antimicrobial treatments in both patients and reference individuals. Sibling analyses were also performed.</p><p><strong>Results: </strong>The linear regression analysis revealed a significant association between IgA nephropathy and the overall frequency of infections compared to the general population (β = 0.44; 95% CI: 0.35-0.53) and siblings (β = 0.36; 95% CI: 0.23-0.49). Similarly, antimicrobial prescriptions, especially antibiotics, were more common in IgA nephropathy compared to the general population and to siblings. Cox regression showed an elevated risk of any infection (adjusted hazard ratio [aHR] = 2.00; 95% CI: 1.84-2.18) and sepsis (aHR = 3.18; 95% CI: 2.17-4.65) corresponding to one extra case of sepsis per 63 patients followed for 10 years. The strongest associations were seen for urinary tract infections; ear, nose, and throat infections; and musculoskeletal and gastrointestinal infections.</p><p><strong>Conclusion: </strong>Conclusively, our study demonstrates an increased prevalence of infections and antibiotic prescriptions in IgA nephropathy patients. The increased risk of sepsis warrants clinical awareness and prevention.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"445-456"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555535","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":"Edema and Outcome in Patients with Nephrotic-Range Albuminuria and Hypoalbuminemia: A Danish Multicenter Cohort Study.","authors":"Sarah Kelddal, Bawer Jalal Tofig, Anne-Mette Hvas, Erik Lerkevang Grove, Christian Fynbo Christiansen, Henrik Birn, Sarah Kelddal","doi":"10.1159/000544759","DOIUrl":"10.1159/000544759","url":null,"abstract":"<p><strong>Introduction: </strong>Nephrotic syndrome (NS) is characterized by proteinuria, hypoalbuminemia, and edema, though not all patients present with edema. This study investigates edema prevalence and its association with venous thromboembolism, kidney failure, and mortality in patients with nephrotic-range albuminuria and hypoalbuminemia.</p><p><strong>Methods: </strong>We conducted a Danish multicenter cohort study, including patients with plasma albumin <30 g/L and nephrotic-range albuminuria in the Central Denmark Region (2012-2022). Patients were identified using the laboratory information system and followed until death, lost to follow-up, or end of study. Data on demographics, comorbidities, biochemical markers, medical treatment, renal pathology, edema venous thromboembolism, bleeding, kidney failure, and death were collected.</p><p><strong>Results: </strong>Among 1,219 patients, 758 (62%) had edema at diagnosis. Patients with edema had higher urine albumin-creatinine ratio (4,245 mg/g [3,046-6,079] vs. 3,546 mg/g [2,691-5,125]) or higher 24-h urine albumin excretion rate (4,559 mg/day [3,146-6,591] vs. 3,546 mg/day [2,828-5,578]) and lower plasma albumin (26 g/L [22-28] vs. 28 g/L [26-29]) than those without edema. Venous thromboembolism occurred in 54 (4%) patients, with an incidence rate of 15 (95% CI, 11-21) per 1,000 person-years in patients with edema versus 10 (95% CI, 10-17) in patients without edema. Edema was also associated with faster kidney failure progression (edema: 188 days (IQR, 28-581), non-edema 364 days (IQR, 116-920), and higher 1-year all-cause mortality (edema: 19%; non-edema: 16%).</p><p><strong>Conclusion: </strong>Edema affects approximately 60% of patients with nephrotic-range albuminuria and hypoalbuminemia, associated with increased risk of venous thromboembolism, faster kidney failure progression, and higher 1-year all-cause mortality, highlighting its prognostic information in NS.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"510-519"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143565703","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 Clinical Impact of Urinalysis Screened by Automated Microscopy Compared to Reference Manual Analysis.","authors":"Priscila Aparecida Correa Freitas, Yasmini Dandara Silva da Silva, José Antonio Tesser Poloni, Francisco José Veríssimo Veronese, Luiz Felipe Santos Goncalves","doi":"10.1159/000541561","DOIUrl":"10.1159/000541561","url":null,"abstract":"<p><strong>Introduction: </strong>Clinical laboratories have replaced conventional manual urine microscopy with automated urinalysis; however, concerns persist regarding its validity in detecting specific elements of urinary sediment crucial for evaluating kidney diseases. This study aimed to assess the accuracy of urinary sediment analysis performed by a large hospital laboratory compared to a standardized microscopic review, focusing on patients both with and without kidney disease.</p><p><strong>Methods: </strong>Urine samples were randomly selected from routine laboratory specimens at a university hospital. Laboratory analysis was performed using LabUmat 2 and Urised 3 PRO equipment (Abbott Diagnostics). In the automated analysis for sediment examination, technicians have the option to reclassify urinary sediment elements as necessary and, if warranted, conduct manual microscopic evaluations to validate findings. The laboratory's analysis was compared with a \"reference\" analysis, which was double-blinded and conducted by two experienced technicians using bright-field and phase-contrast microscopy.</p><p><strong>Results: </strong>503 samples were selected, with 52.3% originating from nephrology outpatient clinic patients. Overall agreement between the laboratory results and the reference analysis was 42.1%. The sensitivity (SN) of the laboratory examination for detecting pathological casts, lipiduria, and renal tubular epithelial cells was low (<50%), while specificity (SP) was high (>98%). However, for hyaline casts (SN: 50.4%; SP: 80.9%) and dysmorphic red blood cells (SN: 62.3%; SP: 96.2%), accuracy was intermediate. Performance was better for hematuria (SN: 86.1%; SP: 82.3%; intraclass correlation coefficient [ICC]: 0.703; R: 0.828) and leukocyturia (SN: 84.9%; SP: 95.1%; ICC: 0.807; R: 0.861). In patients with kidney disease (N = 248) and in samples manually reviewed by the laboratory (N = 115), accuracy for each urinary element was comparable to the overall sample findings. However, when assessing the ability to identify elements suggestive of nephropathy, only samples manually reviewed by the laboratory showed statistically similar results to those obtained by the reference analysis (p = 0.503, McNemar's test).</p><p><strong>Conclusion: </strong>Employing automated urinalysis seems to be accurate for detecting hematuria and leukocyturia, as well as for screening patients without kidney diseases. However, clinical laboratories attending complex patients should employ personalized strategies to help decide when to perform manual review, thus avoiding misleading urinalysis results.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"178-186"},"PeriodicalIF":4.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142455858","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":"Five-Year Time Profiles of Clearances of Different Uremic Solutes in Incident Peritoneal Dialysis Patients.","authors":"Ji Ji, Min Lu, Shulan Guo, Bo Xiang, Weiwei Wu, Yang Li, Xiaoyan Jiao, Jun Ji, Xiaoqiang Ding, Xiaofang Yu, Xiaofang Yu","doi":"10.1159/000543622","DOIUrl":"10.1159/000543622","url":null,"abstract":"<p><strong>Introduction: </strong>Different uremic solutes have varying degrees of clearances owing to different chemical properties and the pathological and physiological changes in the kidneys and peritoneum.</p><p><strong>Methods: </strong>The 5-year time profiles of renal, peritoneal, and total clearances of creatinine, urea nitrogen (UN), uric acid (UA), trimethylamine <sc>n</sc>-oxide (TMAO), phosphate, beta-2-microglobulin (β2-MG), interleukin-6 (IL-6), indoxyl sulfate (IS), and p-cresol sulfate (PCS) were investigated in 64 peritoneal dialysis (PD) patients. The patients were divided into an early start and a late start group according to baseline estimated glomerular filtration rate to investigate the effect of dialysis initiation timing on uremic solutes clearances. Patients were also divided into incremental peritoneal dialysis (IPD) and full-dose PD groups to investigate the impact of PD strategy on uremic solutes clearances.</p><p><strong>Results: </strong>Peritoneal clearances of creatinine, UN, UA, and phosphate increased over time, while the peritoneal clearance of IL-6 showed a downward trend. The peritoneal clearances of TMAO, β2-MG, IS, and PCS did not change significantly. Patients in early start group showed a lower level of variation and a higher average of renal clearances. IPD patients had a higher level of total clearances of uremic solutes than full-dose PD patients in the first 3 years after PD initiation.</p><p><strong>Conclusion: </strong>In a long-term follow-up period, the peritoneal clearance of water-soluble small solutes increased over time, but that of protein-bound toxins and middle molecules did not. Initiating PD when residual kidney function remains at a relatively high level and performing IPD may better improve the efficiency of PD and help preserve the renal clearances of uremic solutes.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"433-444"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497969","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":"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, Chih-Ching Lin","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":"412-420"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","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":"Association between Noninvasive Liver Biomarkers and Graft Outcomes in Kidney Transplantation Recipients.","authors":"Jaeyun Lee, Chung Hee Baek, Soon Bae Kim, Chan-Young Jung","doi":"10.1159/000542914","DOIUrl":"10.1159/000542914","url":null,"abstract":"<p><strong>Introduction: </strong>Although studies have suggested that metabolic risk profiles are prognostic factors in kidney transplantation recipients (KTRs), the prognostic value of fatty liver, a known surrogate of metabolic risk, in KTRs remains to be elucidated. The objective of this study was to investigate the association between noninvasive liver biomarkers used to assess hepatic steatotic and fibrotic burdens and graft outcomes in KTRs.</p><p><strong>Methods: </strong>A total of 3,092 patients who underwent deceased or living donor kidney transplantation (KT) between January 2000 and December 2022 were enrolled. Postoperative hepatic fibrotic burdens of KTRs were assessed using the fibrosis-4 (FIB-4) score and the non-alcoholic fatty liver disease fibrosis score (NFS). The primary outcome was a composite of 50% estimated glomerular filtration rate (eGFR) decline and graft failure. Secondary outcomes included individual outcomes of 50% eGFR decline, graft failure, and acute rejection.</p><p><strong>Results: </strong>For the primary outcome, during a mean follow-up of 6.0 years, the composite outcome occurred in 519 (16.8%) participants. When stratified into three groups according to FIB-4 score categories, the highest score group (FIB-4 ≥2.67) had a 2.05-fold (95% confidence interval [CI], 1.44-2.91; p < 0.001) higher risk of the composite outcome compared to the lowest score group (FIB-4 <1.30). Furthermore, the highest score group showed higher risk of the secondary outcomes, with hazard ratios (95% CI) of 1.75 (1.16-2.66), 1.62 (1.06-2.46), and 2.23 (1.43-3.46) for 50% eGFR decline, acute rejection, and graft failure, respectively. Similar findings were observed for NFS.</p><p><strong>Conclusions: </strong>Higher hepatic fibrotic burdens were associated with unfavorable graft outcomes in KTRs.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"247-257"},"PeriodicalIF":4.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942485","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":"Impairment of Renal Function in Hermansky-Pudlak Syndrome.","authors":"Tadafumi Yokoyama, Kevin J O'Brien, Tesiya M Franklin, Ben Long G Zuo, Mei Xing G Zuo, Melissa A Merideth, Wendy J Introne, Bernadette R Gochuico","doi":"10.1159/000541835","DOIUrl":"10.1159/000541835","url":null,"abstract":"<p><strong>Introduction: </strong>Hermansky-Pudlak syndrome (HPS) is a rare autosomal recessive disorder characterized by defective biogenesis of lysosome-related organelles. The genetic types of HPS are associated with a spectrum of multisystemic clinical manifestations. Phenotypic features of HPS type 1 (HPS-1) or HPS-4, which are associated with defects in biogenesis of lysosome-related organelles complex-3 (BLOC-3), are generally more severe than those of HPS-3, HPS-5, or HPS-6, which are associated with defects in BLOC-2. A paucity of information is available about renal impairment in HPS. The objective of this study is to expand the understanding of kidney disease in HPS.</p><p><strong>Methods: </strong>Medical records and clinical data of patients with HPS evaluated at the National Institutes of Health Clinical Center from 1995 to 2020 were retrospectively reviewed. For patients with more than one visit, the most recent renal function and urinalysis tests were analyzed. Estimated glomerular filtration rate (eGFR) was calculated using standard equations (i.e., Chronic Kidney Disease Epidemiology Collaboration, Modification of Diet in Renal Disease). Kidney tissue sections from 5 patients with HPS-1 and 1 patient with HPS-6 were examined.</p><p><strong>Results: </strong>Records from 205 adults and 52 children with HPS were reviewed. Calculated eGFR of adult patients with different HPS types differed significantly, and calculated eGFR of pediatric and adult patients with BLOC-3 disorders was significantly lower than that of patients with BLOC-2 disorders. Linear regression analysis showed that renal function progressively decreases with age in patients with BLOC-3 or BLOC-2 disorders, but the rate of decline was more rapid in patients with BLOC-3 disorders compared to patients with BLOC-2 disorders. In adult patients with HPS-1, glucosuria was found in 4%, proteinuria in 12%, hematuria in 15%, high levels of urinary β2MG in 24%, and elevated urinary albumin to creatinine ratios in 9%. Histological examination of kidney tissue showed accumulation of intracellular deposits of ceroid lipofuscin in proximal renal tubular epithelial cells in patients with HPS-1. There was no evidence of fibrosis, and glomeruli, distal renal tubular epithelial cells, and interstitial regions appeared histologically normal.</p><p><strong>Conclusion: </strong>Mild impairment of renal function is a feature of HPS. Kidneys of patients with HPS-1 contain proximal renal tubular intracellular deposits and no histologic evidence of fibrosis. Consistent with other manifestations of HPS, the phenotype of renal impairment is relatively more pronounced in patients with BLOC-3 disorders than in patients with BLOC-2 disorders. Strategies to avoid nephrotoxicity or renal tubular injury and to protect renal function should be considered for patients with HPS irrespective of age.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"25-34"},"PeriodicalIF":4.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387298","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":"Systemic Factors Contributing to Gender Differences in Living Kidney Donation: A Systematic Review and Meta-Synthesis Using the Social-Ecological Model Lens.","authors":"Katya Loban, Chloe Wong-Mersereau, Jewy Cates Ferrer, Lindsay Hales, Antoine Przybylak-Brouillard, Marcelo Cantarovich, Vivek B Kute, Anil K Bhalla, Rosemary Morgan, Shaifali Sandal","doi":"10.1159/000541890","DOIUrl":"10.1159/000541890","url":null,"abstract":"<p><strong>Introduction: </strong>The field of living kidney donation is profoundly gendered contributing to a predominance of women, mothers, and wives as living kidney donors (LKDs). Individual factors have traditionally been emphasized, and there is a limited appreciation of relational, community, and sociocultural influences in decision-making. We aimed to comprehensively capture existing evidence to examine the relative importance of these factors.</p><p><strong>Methods: </strong>This was a systematic review of existing literature that has explored the motivation of different genders to become LKDs. Of the 3,188 records screened, 16 studies from 13 counties were included. Data were synthesized thematically using the Social-Ecological Model lens.</p><p><strong>Results: </strong>At the individual level, themes related to intrinsic motivation; thoughtful deliberation; and attitudes, fears, and beliefs; however, evidence demonstrating differences between men and women was minimal. Greater variation between genders emerged along the relational (coercion from family/network, relationship with the intended recipient, self-sacrifice within the family unit, and stability/acceptance within family); community (economic value and geographic proximity to recipient); and sociocultural (gendered societal roles, social norms and beliefs, social privilege, and legislation and policy) dimensions. The relative importance of each factor varied by context; cultural components were inferred in each study, and economic considerations seemed to transcend the gender divide.</p><p><strong>Conclusions: </strong>A complex interplay of factors at relational, community, and sociocultural levels influences gender roles, relations, and norms and manifests as gender disparities in living kidney donation. Our findings suggest that to address gender disparities in living donation, dismantling of deep-rooted systemic contributors to gender inequities is needed.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"94-110"},"PeriodicalIF":4.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387300","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 Interplay of Nonalcoholic Fatty Liver Disease and Chronic Kidney Disease: A Call for Integrated Management.","authors":"Carmine Zoccali, Francesca Mallamaci","doi":"10.1159/000541889","DOIUrl":"10.1159/000541889","url":null,"abstract":"","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"243-246"},"PeriodicalIF":4.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581446","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}