American Journal of Nephrology最新文献

{"title":"Anti-PLA2R IgG4-to-IgG Ratio Helps Predict Remission of PLA2R-Associated Primary Membranous Nephropathy.","authors":"Yuting Liu, Zhenling Deng, Zihan Wang, Shang Gao, Tianyu Zheng, Danxia Zheng, Song Wang, Biao Huang, Yue Wang","doi":"10.1159/000547713","DOIUrl":"10.1159/000547713","url":null,"abstract":"<p><strong>Introduction: </strong>PLA2R-associated primary membranous nephropathy (PMN) was classified as IgG4-associated autoimmune disease, in which anti-PLA2R antibody is predominantly IgG4 subclass. Our objective was to explore the capability of anti-PLA2R IgG4-to-IgG ratio for predicting remission in PLA2R-associated PMN patients.</p><p><strong>Methods: </strong>A total of 143 patients with anti-PLA2R IgG ≥14 RU/mL were biopsy-confirmed as PLA2R-associated PMN. Serum samples collected at the time of renal biopsy were tested for anti-PLA2R IgG and anti-PLA2R IgG4 using time-resolved fluoroimmunoassay. The anti-PLA2R IgG4-to-IgG ratio was calculated as anti-PLA2R IgG4 (ng/mL) divided by anti-PLA2R IgG (RU/mL). Patients were divided into high-ratio and low-ratio groups by cutoff value of 31.5 ng/RU determined by the maximally selected log-rank statistic. The relationship between anti-PLA2R IgG4-to-IgG ratio and remission was analyzed using Cox proportional hazard regression.</p><p><strong>Results: </strong>Compared to the low-ratio group, patients in the high-ratio group were significantly younger (52 [40-60] vs. 58 [51-61] years, p = 0.035), had higher estimated glomerular filtration rate (102 [88-111] vs. 94 [72-100] mL/min/1.73 m2, p = 0.004), and obtained higher 6-month partial remission rates (64.6% vs. 30.0%, p = 0.001) and 1-year complete remission rates (38.3% vs. 7.7%, p = 0.003). The higher remission rates with high ratio remained in both moderate-low-risk and high-risk subgroups categorized according to KDIGO 2021 guidelines. The anti-PLA2R IgG4-to-IgG ratio had a significant positive relation with partial remission (hazard ratio [95% confidence interval] = 2.09 [1.27-3.46], p = 0.004), which also persisted across both risk subgroups. Kaplan-Meier survival curves confirmed the significantly higher possibility of partial remission in the high-ratio group.</p><p><strong>Conclusion: </strong>An elevated anti-PLA2R IgG4-to-IgG ratio may be a supplementary predictor for remission in PLA2R-associated PMN.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"383-394"},"PeriodicalIF":3.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783211","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":"Extended-Release Calcifediol Normalized 1,25-Dihydroxyvitamin D and Prevented Progression of Secondary Hyperparathyroidism in Hemodialysis Patients in a Pilot Randomized Clinical Trial.","authors":"Charles W Bishop, Akhtar Ashfaq, John Choe, Stephen A Strugnell, Laura L Johnson, Keith C Norris, Stuart M Sprague","doi":"10.1159/000546615","DOIUrl":"10.1159/000546615","url":null,"abstract":"<p><p><p>Introduction: Serum concentrations of 25-hydroxyvitamin D (25D) and 1,25-dihydroxyvitamin D (1,25D) decline as chronic kidney disease (CKD) advances, becoming insufficient without effective vitamin D repletion and driving onset of secondary hyperparathyroidism (SHPT). Randomized controlled trials (RCTs) in non-dialysis CKD patients have established that extended-release calcifediol (ERC) effectively raises 25D and 1,25D and reduces elevated intact parathyroid hormone (iPTH) despite the progressive loss of renal cytochrome P450 25D-1α-hydroxylase (CYP27B1), suggesting its potential usefulness in treating SHPT in end-stage kidney disease (ESKD).</p><p><strong>Methods: </strong>This pilot RCT explored the safety and efficacy of oral ERC to raise serum total 25D to ≥50 ng/mL, normalize circulating 1,25D, and reduce elevated iPTH in ESKD patients requiring regular hemodialysis (HD). Forty-four adults from 13 US clinics requiring HD three times per week were washed out from iPTH-lowering therapies and randomized 3:1 to 26 weeks of treatment with ERC (300 µg/HD) or placebo. Participants had a mean age of 56.4 ± 11.6 years, body mass index of 32.7 ± 8.1 kg/m2, 46% were female, 68% black, 30% white, and 24% Hispanic. At randomization, iPTH had to be 300 to <1,200 pg/mL, 25D <50 ng/mL, corrected serum calcium <9.8 mg/dL, and phosphorus <6.5 mg/dL. These parameters were monitored weekly or biweekly and 1,25D quarterly.</p><p><strong>Results: </strong>Mean (±SE) serum total 25D rose with ERC treatment from 24.1 ± 1.7 ng/mL at baseline (BL) to steady-state levels of 157.7 ± 10.4 (p < 0.001) after 12 weeks, with all individual levels exceeding 50 ng/mL but varying inversely with body weight. Serum 25D levels declined with placebo treatment from 36.0 ± 5.3 to 30.6 ± 5.5 ng/mL. Mean 1,25D rose from 9.4 ± 1.2 to 50.7 ± 7.8 pg/mL (p < 0.001) with ERC and concentrations surpassed 19.9 pg/mL (lower limit of normal) in 93% of participants. Mean iPTH increased 19.8 ± 10.6% from BL with placebo (497.6 ± 69.2 to 593.1 ± 95.1 pg/mL) but decreased 1.7 ± 4.7% (p < 0.05) with ERC (530.4 ± 29.4 to 529.6 ± 43.7 pg/mL). A strong correlation was observed with ERC treatment between serum 1,25D and 25D (R2 = 0.8248; p < 0.001) indicating that, on average, 1,25D normalized as 25D reached ≥50 ng/mL. Increases in mean serum calcium or phosphorus, episodes of hypercalcemia, or treatment-emergent adverse events were not observed with ERC treatment.</p><p><strong>Conclusion: </strong>ERC safely raised serum total 25D, normalized low serum 1,25D, and stabilized elevated plasma iPTH in this pilot placebo-controlled RCT involving ESKD patients requiring regular HD. The observed increases in 1,25D indicated that ERC restored adequate endogenous vitamin D hormone production via substrate-driven conversion to calcitriol in extrarenal tissues expressing CYP27B1, thereby preventing further SHPT progression. </p>.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"109-119"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12193742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224007","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":"Intradialytic Cognitive and Aerobic Exercise Training to Preserve Cognitive Function: IMPCT, a Multi-Dialysis Center 2 × 2 Factorial Block-Randomized Controlled Trial.","authors":"Nidhi Ghildayal, Yi Liu, Jingyao Hong, Yiting Li, Xiaomeng Chen, Marlís González Fernández, Michelle C Carlson, Derek M Fine, Lawrence J Appel, Marie Diener-West, David M Charytan, Aarti Mathur, Dorry L Segev, Mara McAdams-DeMarco","doi":"10.1159/000546296","DOIUrl":"10.1159/000546296","url":null,"abstract":"<p><p><p>Introduction: Patients with end-stage kidney disease develop cognitive impairment due to comorbidities and dialysis dependence. Among community-dwelling older adults, cognitive (CT) and exercise training (ET) are promising interventions to preserve cognition; these interventions may be tailored for adults undergoing in-center hemodialysis.</p><p><strong>Methods: </strong>Adult (≥18 years) English-speaking patients undergoing hemodialysis (within 3 months to 3 years of initiation) were enrolled in a 2 × 2 factorial randomized controlled trial: Interventions Made to Preserve Cognitive Function Trial (IMPCT). Participants (n = 121) were block-randomized (September, 2018-February, 2023) into 4 arms: control (SC) (n = 26), intradialytic web-based CT (n = 31), ET using foot peddler (n = 29), and combined CT+ET (n = 35). Participants underwent assessments at baseline and 3 months for executive function, global cognitive function, clinical outcomes, and patient-centered outcomes. We estimated 3-month executive function change (primary outcome) and secondary outcomes using linear regression.</p><p><strong>Results: </strong>There were no differences in 3-month executive function change by arm. Participants exhibited improvement in 3-month global cognitive function in CT+ET arm (Montreal Cognitive Assessment score difference = 2.1, 95% CI: 0.4-3.9), and self-reported 3-month improvement in perceived health change (score difference = 0.8, 95% CI: 0.2-1.4) in ET arm.</p><p><strong>Conclusion: </strong>Clinicians may encourage CT+ET for hemodialysis patients to improve short-term global cognitive function and perceived health. The long-term benefits of these interventions warrant further study. </p>.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-13"},"PeriodicalIF":3.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12173432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061934","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":"Preeclampsia and Onset of Renal Disorders in the Long-Term Period following Pregnancy.","authors":"Nathalie Auger, Sam Amar, Gilles Paradis, Aimina Ayoub, Antoine Lewin, Amanda Maniraho, Brian J Potter","doi":"10.1159/000547538","DOIUrl":"10.1159/000547538","url":null,"abstract":"<p><p><p>Introduction: Preeclampsia is associated with acute renal complications during pregnancy, but the risk of renal sequelae later in life is unclear. We determined if preeclampsia was associated with chronic renal complications in the long-term period following pregnancy.</p><p><strong>Methods: </strong>We conducted a longitudinal cohort study of 1,431,156 pregnant women in QC, Canada with 25,598,024 person-years of follow-up between 1989 and 2023. The main exposure measure was preeclampsia, and outcomes included hospitalization for vascular and nonvascular renal complications up to 34 years after pregnancy. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between preeclampsia and subsequent kidney complications using Cox regression models adjusted for patient characteristics.</p><p><strong>Results: </strong>Patients with preeclampsia had a higher hospitalization rate for renal complications than patients without preeclampsia (29.4 vs. 19.5 per 10,000 person-years). Preeclampsia was associated with 1.45 times the risk of hospitalization for renal disease during follow-up (95% CI 1.40-1.50). Risks were particularly elevated for renal vascular disease (HR 3.74, 95% CI 3.21-4.37), diabetic kidney disease (HR 3.71, 95% CI 3.18-4.32), and glomerulopathy (HR 3.44, 95% CI 2.92-4.05). Associations were also present with obstructive uropathy (HR 1.44, 95% CI 1.30-1.58). Severe forms of preeclampsia, including early onset preeclampsia (HR 1.90, 95% CI 1.72-2.10) and superimposed preeclampsia (HR 2.52, 95% CI 2.22-2.85), were strongly associated with subsequent renal morbidity.</p><p><strong>Conclusion: </strong>Preeclampsia, especially severe preeclampsia, is associated with the long-term risk of renal disease. Patients with preeclampsia may benefit from nephrological follow-up in the long-term period after pregnancy. </p>.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"352-360"},"PeriodicalIF":3.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681807","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":"Impact of Preexisting Intracranial Aneurysm on Incidence and Risk of de novo Aneurysm Formation in Autosomal Dominant Polycystic Kidney Disease: An Observational Study.","authors":"Satoshi Miyamoto, Shuhei Egashira, Jun Isozaki, Daiichiro Ishigami, Akinari Sekine, Naoki Sawa, Tatsuya Suwabe, Yoshifumi Ubara, Takehiko Wada, Wataro Tsuruta","doi":"10.1159/000548190","DOIUrl":"10.1159/000548190","url":null,"abstract":"<p><strong>Introduction: </strong>Autosomal dominant polycystic kidney disease (ADPKD) has an elevated prevalence of intracranial aneurysms compared to the general population. However, the risk of de novo aneurysm formation in these patients remains unclear, leading to a lack of consensus regarding whom and when to follow. Although the data from the general population tend to be referred, this assumption needs caution because patients with ADPKD have different characteristics, such as location tendency, aneurysm size at rupture, and gene mutation. Here, we investigate the incidence of de novo aneurysm in ADPKD patients to examine whether patients without intracranial aneurysms on initial imaging need frequent follow-up.</p><p><strong>Methods: </strong>This is a retrospective cohort study conducted in two ADPKD referral centers in Japan. Consecutive samples of 2,117 adult patients with ADPKD from April 2003 to October 2024 were eligible. Of these, 850 patients without baseline brain imaging and 555 patients without follow-up brain imaging were excluded, leaving 712 patients included in this study. Patients were divided into two groups according to the presence of intracranial aneurysms on the initial image. The primary outcome was the incidence of de novo aneurysm formation during follow-up. Kaplan-Meier analysis and Cox proportional hazards models were used to estimate risks, adjusting for age, sex, hypertension, smoking history, and family history of subarachnoid hemorrhage or aneurysm.</p><p><strong>Results: </strong>Of 712 patients, 181 had intracranial aneurysms on initial imaging (screening-positive) and 531 had none (screening-negative). The median age was 54 years (interquartile range, 45-62 years), and 398 (55.8%) were women. Over 4,580 person-years of follow-up, the overall incidence of de novo aneurysm formation was higher in the screening-positive group (1.2 per 100 person-years) than in the screening-negative group (0.26 per 100 person-years) (hazard ratio, 3.81; 95% confidence interval, 1.50-9.67, p = 0.005).</p><p><strong>Conclusion: </strong>ADPKD patients without preexisting aneurysms on initial imaging are at relatively low risk of developing de novo aneurysms. Our findings help determine the adequate follow-up timing and its target in patients with ADPKD. However, caution is warranted in generalizing these results because the study population had a higher median age and more advanced kidney disease.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"468-475"},"PeriodicalIF":3.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145038920","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":"Vitamin D in Chronic Kidney Disease: Familiar Treatment, Unresolved Questions.","authors":"Alireza Zomorodian, Khashayar Sakhaee","doi":"10.1159/000547690","DOIUrl":"10.1159/000547690","url":null,"abstract":"","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"405-408"},"PeriodicalIF":3.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783212","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":"Fluid Volume Estimation by Bioimpedance: Methodological Caveats and Clinical Interpretation.","authors":"Sebastian Mussnig, Daniel Schneditz, David Francis Keane, Christopher W McIntyre, Manfred Hecking","doi":"10.1159/000549268","DOIUrl":"10.1159/000549268","url":null,"abstract":"<p><p><p>Background: Fluid monitoring is critical for patients on maintenance hemodialysis. Bioimpedance enables estimation of fluid volumes from measures of electrical tissue properties. However, empirical equations are needed to approximate key variables, especially in wrist-to-ankle bioimpedance measurements, introducing potential errors. Summary: Here, we provide a technical overview of electrical impedance, derivation of fluid volumes from different bioimpedance methods and electrode setups, as well as sources of error including the assumption of constant resistivity, constant body temperature, and vendor-specific equations to derive fluid overload. We summarize the validity of bioimpedance methods in hemodialysis and conclude that irrespective of error sources reported above, segmental bioimpedance, where limbs and the trunk are measured separately, may be more accurate compared to the convenient wrist-to-ankle measurement. We argue that insufficient correction for variable body shape in wrist-to-ankle measurements jeopardizes this methodology, reporting here our analyses by means of theory and data simulation, where we found that conventional wrist-to-ankle bioimpedance underestimated extracellular fluid volume with increasing body fat percentage. The error could be reduced by using subject-specific body shape correction based on high-resolution 3D models. Finally, we attempt to provide guidance for identifying and mitigating common issues of wrist-to-ankle bioimpedance. Key Messages: While more convenient than segmental measurements, wrist-to-ankle bioimpedance may underestimate fluid volumes in obesity when body shape is not properly accounted for. Novel techniques, including smartphone-based 3D scans of the body, could potentially facilitate individualizing body shape correction to improve fluid volume estimates. </p>.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"602-613"},"PeriodicalIF":3.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12700587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145457320","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":"Intensive versus Less-Intensive Blood Pressure Control in Chronic Kidney Disease: A Systematic Review and Meta-Analysis of Clinical Trials.","authors":"Parisa Fallahtafti, Davood Semirani-Nezhad, Saba Maleki, Sahar Zafarmandi, Parham Dastjerdi, Soheil Rahmati, Khatere Roozbehi, Farhad Shaker, Mehra Fekri, Michael Nanna, Jishanth Mattumpuram, Kaveh Hosseini, Hamidreza Soleimani","doi":"10.1159/000547812","DOIUrl":"10.1159/000547812","url":null,"abstract":"<p><strong>Introduction: </strong>High blood pressure accelerates chronic kidney disease (CKD) progression, but the optimal intensity of blood pressure control in this population remains unclear. We aimed to determine whether intensive blood pressure control, compared to less-intensive control, improves clinical outcomes in individuals with CKD.</p><p><strong>Methods: </strong>A comprehensive search of PubMed, Embase, Scopus, and the Cochrane Library was conducted through December 2024. Randomized controlled trials comparing intensive versus standard blood pressure targets in patients with CKD stage 3 or higher were included. Eligible studies reported all-cause mortality and at least one cardiovascular or renal outcome. Risk of bias was assessed using the Cochrane Risk of Bias tool. A random-effects model was used to pool risk ratios (RRs) with 95% confidence intervals (CIs). Subgroup analyses were performed based on the baseline systolic blood pressure, inclusion of diabetic patients versus exclusion, and baseline glomerular filtration rate (GFR).</p><p><strong>Results: </strong>Eleven randomized controlled trials with 8,740 participants were included. Intensive blood pressure control did not significantly reduce all-cause mortality (6.4% vs. 6.9%; RR, 0.91 [95% CI 0.73-1.13]; p = 0.32), cardiovascular mortality (RR, 0.89 [95% CI 0.69-1.15]; p = 0.3), major adverse cardiovascular events (RR, 0.91 [95% CI 0.69-1.20]; p = 0.27), decline in kidney function (RR, 0.86 [95% CI 0.59-1.25]; p = 0.34), or progression to end-stage kidney disease (RR, 1.00 [95% CI 0.81-1.23]; p = 0.99).</p><p><strong>Conclusions: </strong>Intensive BP control did not improve overall mortality or renal outcomes in CKD patients. Further large, long-term studies are warranted.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"426-440"},"PeriodicalIF":3.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793267","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":"Global Burden of Cardiovascular Disease Attributable to Kidney Dysfunction, 1990-2021: A Comprehensive Analysis of Trends and Forecasts to 2050.","authors":"Jiahao Huang, Qi He, Shirui Sun, Zepeng Li, Bingxuan Zheng, Zhenting Zhao, Yingcong Guo, Jingyue Qin, Chenguang Ding, Mei Yang","doi":"10.1159/000549108","DOIUrl":"10.1159/000549108","url":null,"abstract":"<p><strong>Introduction: </strong>Kidney dysfunction (KD) is a major metabolic risk factor for cardiovascular disease (CVD) and has been playing an increasingly significant role in the global burden of disease. However, there is still a lack of comprehensive, long-term, and systematic research assessing the global burden of CVD attributable to KD.</p><p><strong>Methods: </strong>Using data from the Global Burden of Disease (GBD) 2021 database, we extracted burden indicators related to KD-associated CVD, including the number of deaths, disability-adjusted life years (DALYs), years of life lost (YLLs), years lived with disability (YLDs), and their corresponding age-standardized rates, and evaluated annual trends using estimated annual percentage change. We performed decomposition analysis to identify three main drivers of burden changes-population, aging, and epidemiological change; and applied an autoregressive integrated moving average model to project future trends from 2022 to 2050.</p><p><strong>Results: </strong>From 1990 to 2021, the global absolute numbers of deaths, DALYs, YLLs, and YLDs caused by KD-related CVD increased, while the corresponding age-standardized rates generally declined. Males exhibited a higher disease burden compared to females, and the elderly population, particularly those aged 75-84 years, represented the primary burden group. Middle-SDI countries experienced the highest burden, while inequality remained pronounced in low-SDI countries. Decomposition analysis revealed that, however, the increase in burden was primarily driven by population and aging, epidemiological change showed improvement. Forecasting results indicated that by 2050, the total number of cases will continue to rise, age-standardized rates will keep declining, but the YLD among females is expected to increase.</p><p><strong>Conclusion: </strong>The burden of CVD attributable to KD is expected to continue rising in the future, characterized by increasing absolute numbers and declining age-standardized rates. This trend suggests that stratified prevention strategies may be needed across countries with varying SDI levels, with particular attention to older populations and integrated heart-kidney disease management to reduce the global burden of the disease.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"131-150"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145501578","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":"Longitudinal Impacts of Bariatric Surgery on eGFR in CKD Patients.","authors":"Siddharth S Madapoosi, Lindsey M Kornowske, Kenn B Daratha, Christina L Reynolds, Cami R Jones, Katherine R Tuttle, Laura H Mariani","doi":"10.1159/000547339","DOIUrl":"10.1159/000547339","url":null,"abstract":"<p><strong>Introduction: </strong>Obesity is associated with chronic kidney disease (CKD) incidence and progression. We examined whether bariatric surgery is associated with change in eGFR trajectory among patients with and without CKD.</p><p><strong>Methods: </strong>Patients who underwent bariatric surgery at two health systems were identified using ICD-9/ICD-10 and CPT codes. Linear mixed models were fit on estimated glomerular filtration rate (eGFR) trajectory pre- and post-surgery among patients with or without CKD. Models were adjusted for age, sex, race, ethnicity, body mass index, hypertension, diabetes, follow-up duration, and type of bariatric surgery. Post-surgery, eGFR trajectory among patients with CKD was also compared following 1:2 propensity score matching to (1) patients without CKD who underwent surgery and (2) patients with CKD who did not undergo surgery.</p><p><strong>Results: </strong>Patients with CKD (n = 139) at Michigan Medicine had a slower annual rate of eGFR decline post-surgery compared to patients without CKD (n = 278) (1.54 [-2.26, -0.81] vs. 3.15 [-3.41, -2.87] mL/min/1.73 m2; p < 0.001), despite adjusting for degree of weight loss. Among patients with CKD, surgery was associated with a slower annual rate of eGFR decline (-0.20 [-0.83, 0.43] post-surgery vs. -1.11 [-1.37, -0.85] mL/min/1.73 m2 for non-surgery patients; p < 0.001). In an external validation study of patients with CKD in the Providence health system, bariatric surgery predicted an average increase in annualized eGFR slope by 1.19 [0.12, 2.25] mL/min/1.73 m2 (p = 0.03).</p><p><strong>Conclusion: </strong>Bariatric surgery is associated with less eGFR decline and may have weight-independent effects on preserving kidney function among persons living with obesity and CKD.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"305-315"},"PeriodicalIF":3.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706019","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}