Pub Date : 2025-12-15DOI: 10.1016/j.ekir.2025.103734
Vincent Linse , Kirsten De Groot , Thorsten Wiech , Ulrich J. Sachs , Bernhard Hellmich , Faeq Husain-Syed
{"title":"Persistent ANCA Positivity in Granulicatella adiacens-associated Endocarditis: Diagnostic Implications of Methodological Variability","authors":"Vincent Linse , Kirsten De Groot , Thorsten Wiech , Ulrich J. Sachs , Bernhard Hellmich , Faeq Husain-Syed","doi":"10.1016/j.ekir.2025.103734","DOIUrl":"10.1016/j.ekir.2025.103734","url":null,"abstract":"","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"11 2","pages":"Article 103734"},"PeriodicalIF":5.7,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145881195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-15DOI: 10.1016/j.ekir.2025.103725
Manjusha Yadla , Priyadarshini John
{"title":"Remote Monitoring of Dialysis: A Successful Model for Low- and Middle-Income Countries","authors":"Manjusha Yadla , Priyadarshini John","doi":"10.1016/j.ekir.2025.103725","DOIUrl":"10.1016/j.ekir.2025.103725","url":null,"abstract":"","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"11 3","pages":"Article 103725"},"PeriodicalIF":5.7,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145915211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-15DOI: 10.1016/j.ekir.2025.103722
Arrti A. Bhasin , Rohan D’Souza , Dini Hui , Nir Melamed , Christopher T. Chan , Michelle A. Hladunewich
Introduction
Tailored hemodialysis prescriptions, including more frequent and intensive regimens, may improve pregnancy outcomes, yet most women are counselled to delay conception until after a successful kidney transplantation.
Methods
We conducted a retrospective cohort study between 2000 and 2023 in Toronto, Ontario, Canada to compare pregnancy outcomes of women receiving intensified hemodialysis versus kidney transplant recipients.
Results
We included 48 pregnancies in 37 women receiving hemodialysis and 96 pregnancies in 60 women conceiving post–kidney transplantation. The 2 patient populations managed by the same multidisciplinary team had similar live birth rates (80% in hemodialysis and 76% in transplant patients; P = 0.68). However, the hemodialysis cohort had a shorter pregnancy duration (36.2 weeks; interquartile range [IQR]: 32.5–37.1 vs. 37.0 weeks; IQR; 35.7–38.0; P = 0.004) and smaller infants at birth (2202 g; IQR: 1600-2750 vs. 2766 g; IQR: 2380–3180; P < 0.001). No difference was observed in the proportion of pregnancies with reported pregnancy-associated complications (67% in hemodialysis and 73% in transplant; P = 0.53), including hypertensive disorders of pregnancy at 33% in the hemodialysis cohort and 47% among transplant recipients (P = 0.18).
Conclusion
With appropriate counselling and management, pregnancy while on hemodialysis may be considered a viable alternative to conceiving post–renal transplant for women without imminent access to a donor.
量身定制的血液透析处方，包括更频繁和强化的治疗方案，可能会改善妊娠结局，但大多数妇女被建议推迟怀孕，直到肾移植成功后。方法：我们于2000年至2023年在加拿大安大略省多伦多进行了一项回顾性队列研究，比较接受强化血液透析的妇女与接受肾移植的妇女的妊娠结局。结果我们纳入了37例接受血液透析的48例妊娠和60例肾移植后妊娠的96例妊娠。同一多学科小组管理的两组患者的活产率相似（血液透析患者为80%，移植患者为76%；P = 0.68）。然而，血液透析组妊娠期较短（36.2周；四分位数间距[IQR]: 32.5-37.1 vs. 37.0周；IQR; 35.7-38.0; P = 0.004），出生时婴儿较小（2202 g; IQR: 1600-2750 vs. 2766 g; IQR: 2380-3180; P < 0.001）。报告妊娠相关并发症的妊娠比例（血液透析组为67%，移植组为73%，P = 0.53）无差异，包括妊娠高血压疾病在血液透析组为33%，移植组为47% （P = 0.18）。结论通过适当的咨询和管理，对于无法立即获得供体的妇女，在血液透析期间怀孕可能被认为是肾移植后怀孕的可行选择。
{"title":"A Comparison of Pregnancy Outcomes in Women Receiving Intensive Hemodialysis Versus Kidney Transplant Recipients","authors":"Arrti A. Bhasin , Rohan D’Souza , Dini Hui , Nir Melamed , Christopher T. Chan , Michelle A. Hladunewich","doi":"10.1016/j.ekir.2025.103722","DOIUrl":"10.1016/j.ekir.2025.103722","url":null,"abstract":"<div><h3>Introduction</h3><div>Tailored hemodialysis prescriptions, including more frequent and intensive regimens, may improve pregnancy outcomes, yet most women are counselled to delay conception until after a successful kidney transplantation.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study between 2000 and 2023 in Toronto, Ontario, Canada to compare pregnancy outcomes of women receiving intensified hemodialysis versus kidney transplant recipients.</div></div><div><h3>Results</h3><div>We included 48 pregnancies in 37 women receiving hemodialysis and 96 pregnancies in 60 women conceiving post–kidney transplantation. The 2 patient populations managed by the same multidisciplinary team had similar live birth rates (80% in hemodialysis and 76% in transplant patients; <em>P</em> = 0.68). However, the hemodialysis cohort had a shorter pregnancy duration (36.2 weeks; interquartile range [IQR]: 32.5–37.1 vs. 37.0 weeks; IQR; 35.7–38.0; <em>P</em> = 0.004) and smaller infants at birth (2202 g; IQR: 1600-2750 vs. 2766 g; IQR: 2380–3180; <em>P</em> < 0.001). No difference was observed in the proportion of pregnancies with reported pregnancy-associated complications (67% in hemodialysis and 73% in transplant; <em>P</em> = 0.53), including hypertensive disorders of pregnancy at 33% in the hemodialysis cohort and 47% among transplant recipients (<em>P</em> = 0.18).</div></div><div><h3>Conclusion</h3><div>With appropriate counselling and management, pregnancy while on hemodialysis may be considered a viable alternative to conceiving post–renal transplant for women without imminent access to a donor.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"11 3","pages":"Article 103722"},"PeriodicalIF":5.7,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-15DOI: 10.1016/j.ekir.2025.103733
Natacha Rodrigues , Chintan V. Shah
{"title":"Pseudo–Acute Kidney Injury With Tyrosine Kinase Inhibitors: Utility of the Creatinine–to–Cystatin C Ratio","authors":"Natacha Rodrigues , Chintan V. Shah","doi":"10.1016/j.ekir.2025.103733","DOIUrl":"10.1016/j.ekir.2025.103733","url":null,"abstract":"","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"11 3","pages":"Article 103733"},"PeriodicalIF":5.7,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145920951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-13DOI: 10.1016/j.ekir.2025.103724
Atlas Khan
{"title":"Genetic Prediction of Kidney Function: Why Measured GFR Matters","authors":"Atlas Khan","doi":"10.1016/j.ekir.2025.103724","DOIUrl":"10.1016/j.ekir.2025.103724","url":null,"abstract":"","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"11 2","pages":"Article 103724"},"PeriodicalIF":5.7,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-12DOI: 10.1016/j.ekir.2025.103718
Sabrine Chaara , Paul A. Rootjes , Miquéla I.Y. Bergtop , Muriel P.C. Grooteman , Peiyun Liu , Menso J. Nubé , Gertrude Wijngaarden , Camiel L.M. de Roij van Zuijdewijn
Introduction
Although intradialytic hypotension (IDH) is a frequent complication of hemodialysis (HD), a consensus definition is lacking. Adverse symptoms and/or interventions are a prerequisite in guidelines; however, a threshold-based blood pressure (BP) definition appeared most strongly associated with mortality. In this study, we evaluated the association of IDH with both real-time symptoms and physical intradialytic patient-reported outcome measures (PID-PROMs) in prevalent HD and hemodiafiltration (HDF) patients.
Methods
This is a secondary analysis of the HOLLANT study, a randomized cross-over trial comparing 4 dialysis modalities (i.e., standard HD, cool high-flux HD, low-volume HDF, and high-volume HDF), each applied for 2 weeks in 40 patients. In each second treatment week, BP was measured every 15 minutes and when symptoms occurred. Symptoms were documented real-time and PID-PROMs were collected after each modality. Considering that symptoms occurred independent of dialysis mode, data from all treatment modalities were pooled. IDH was threshold-defined (systolic BP [SBP] < 90 or < 100 mm Hg, dependent on predialysis SBP). The incidence of symptomatic IDH (sIDH) and asymptomatic IDH (aIDH) was assessed, with sIDH defined by concurrent symptoms. When real-time symptoms arose, attribution to IDH was appraised according to the threshold, National Kidney Disease Outcomes Quality Initiative, and the European Best Practice Guideline definitions. Differences in PID-PROMs were analyzed in tertiles of IDH occurrence.
Results
In 20.1% of 458 treatments, 222 IDH episodes were observed (0.48/session). The majority occurred toward the end of dialysis and 98% was asymptomatic. Real-time reported symptoms (n = 24) were noted in 5.2% of the sessions. Although half were BP-related (n = 13/24), just 4 fulfilled the threshold criteria. Associations between IDH and PID-PROMs were largely absent.
Conclusion
aIDH exceeds sIDH by far. Therefore, symptom-based definitions severely underestimate aIDH incidence. Both real-time occurring symptoms and PID-PROMs are only occasionally associated with IDH.
{"title":"Intradialytic Hypotensive Episodes are Only Occasionally Associated With Adverse Symptoms","authors":"Sabrine Chaara , Paul A. Rootjes , Miquéla I.Y. Bergtop , Muriel P.C. Grooteman , Peiyun Liu , Menso J. Nubé , Gertrude Wijngaarden , Camiel L.M. de Roij van Zuijdewijn","doi":"10.1016/j.ekir.2025.103718","DOIUrl":"10.1016/j.ekir.2025.103718","url":null,"abstract":"<div><h3>Introduction</h3><div>Although intradialytic hypotension (IDH) is a frequent complication of hemodialysis (HD), a consensus definition is lacking. Adverse symptoms and/or interventions are a prerequisite in guidelines; however, a threshold-based blood pressure (BP) definition appeared most strongly associated with mortality. In this study, we evaluated the association of IDH with both real-time symptoms and physical intradialytic patient-reported outcome measures (PID-PROMs) in prevalent HD and hemodiafiltration (HDF) patients.</div></div><div><h3>Methods</h3><div>This is a secondary analysis of the HOLLANT study, a randomized cross-over trial comparing 4 dialysis modalities (i.e., standard HD, cool high-flux HD, low-volume HDF, and high-volume HDF), each applied for 2 weeks in 40 patients. In each second treatment week, BP was measured every 15 minutes and when symptoms occurred. Symptoms were documented real-time and PID-PROMs were collected after each modality. Considering that symptoms occurred independent of dialysis mode, data from all treatment modalities were pooled. IDH was threshold-defined (systolic BP [SBP] < 90 or < 100 mm Hg, dependent on predialysis SBP). The incidence of symptomatic IDH (sIDH) and asymptomatic IDH (aIDH) was assessed, with sIDH defined by concurrent symptoms. When real-time symptoms arose, attribution to IDH was appraised according to the threshold, National Kidney Disease Outcomes Quality Initiative, and the European Best Practice Guideline definitions. Differences in PID-PROMs were analyzed in tertiles of IDH occurrence.</div></div><div><h3>Results</h3><div>In 20.1% of 458 treatments, 222 IDH episodes were observed (0.48/session). The majority occurred toward the end of dialysis and 98% was asymptomatic. Real-time reported symptoms (<em>n</em> = 24) were noted in 5.2% of the sessions. Although half were BP-related (<em>n</em> = 13/24), just 4 fulfilled the threshold criteria. Associations between IDH and PID-PROMs were largely absent.</div></div><div><h3>Conclusion</h3><div>aIDH exceeds sIDH by far. Therefore, symptom-based definitions severely underestimate aIDH incidence. Both real-time occurring symptoms and PID-PROMs are only occasionally associated with IDH.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"11 3","pages":"Article 103718"},"PeriodicalIF":5.7,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146180891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-12DOI: 10.1016/j.ekir.2025.103719
Els Van de Perre , Florine V. Janssens , Dieter De Clerck , Wilfried Cools , Peter Janssens , Mandelina Allamani , Tom Robberechts , Freya Van Hulle , Lissa Pipeleers , Karlien François , Dominique Bazin , Christian Tielemans , Michel Daudon , Emmanuel Letavernier , Karl M. Wissing
Introduction
There is limited real-world data on the effectiveness of combined prophylactic measures to prevent recurrent kidney stone formation.
Methods
This single-center retrospective study evaluated the effect of combined, patient-tailored prophylaxis on metabolic risk factors, urinary crystallization risk indices, and renal colic and urological intervention rates in a real-life clinical setting.
Results
Four hundred ninety patients with nephrolithiasis (NL) with a median follow-up of 12.8 months were evaluated. After the introduction of prophylaxis, the main metabolic risk factors, namely urinary volume, oxalate, calcium, and citrate excretion improved significantly in patients presenting the specific risk factor at baseline (+ 653 ml/24 h for urinary volume, − 10.9 mg/24 h for oxaluria, − 2.35 mmol/24 h for calciuria, and + 901 μmol/24 h for citraturia; all P < 0.001). Relative urinary calcium oxalate supersaturation and Tiselius risk index improved significantly in the total population (− 1.68 and − 0.33, respectively; both P < 0.001). Renal colic and urological intervention rates improved significantly (from 0.82 to 0.21 /1000 d at risk, P < 0.001 for renal colic rate; and from 0.31 to 0.21 /1000 d at risk, P < 0.001 for urological intervention rate). A score expressing overall control of the 4 main metabolic risk factors was significantly associated with a reduction of renal colic rate during follow-up.
Conclusion
Combined, patient-tailored prophylaxis in kidney stone formers significantly improves metabolic risk factors and urinary crystallization risk indices, resulting in a significant reduction of renal colic and urological intervention rates.
{"title":"Tailored Kidney Stone Prevention Improves Metabolic Risk Factors and Reduces Renal Colic Rate","authors":"Els Van de Perre , Florine V. Janssens , Dieter De Clerck , Wilfried Cools , Peter Janssens , Mandelina Allamani , Tom Robberechts , Freya Van Hulle , Lissa Pipeleers , Karlien François , Dominique Bazin , Christian Tielemans , Michel Daudon , Emmanuel Letavernier , Karl M. Wissing","doi":"10.1016/j.ekir.2025.103719","DOIUrl":"10.1016/j.ekir.2025.103719","url":null,"abstract":"<div><h3>Introduction</h3><div>There is limited real-world data on the effectiveness of combined prophylactic measures to prevent recurrent kidney stone formation.</div></div><div><h3>Methods</h3><div>This single-center retrospective study evaluated the effect of combined, patient-tailored prophylaxis on metabolic risk factors, urinary crystallization risk indices, and renal colic and urological intervention rates in a real-life clinical setting.</div></div><div><h3>Results</h3><div>Four hundred ninety patients with nephrolithiasis (NL) with a median follow-up of 12.8 months were evaluated. After the introduction of prophylaxis, the main metabolic risk factors, namely urinary volume, oxalate, calcium, and citrate excretion improved significantly in patients presenting the specific risk factor at baseline (+ 653 ml/24 h for urinary volume, − 10.9 mg/24 h for oxaluria, − 2.35 mmol/24 h for calciuria, and + 901 μmol/24 h for citraturia; all <em>P</em> < 0.001). Relative urinary calcium oxalate supersaturation and Tiselius risk index improved significantly in the total population (− 1.68 and − 0.33, respectively; both <em>P</em> < 0.001). Renal colic and urological intervention rates improved significantly (from 0.82 to 0.21 /1000 d at risk, <em>P</em> < 0.001 for renal colic rate; and from 0.31 to 0.21 /1000 d at risk, <em>P</em> < 0.001 for urological intervention rate). A score expressing overall control of the 4 main metabolic risk factors was significantly associated with a reduction of renal colic rate during follow-up.</div></div><div><h3>Conclusion</h3><div>Combined, patient-tailored prophylaxis in kidney stone formers significantly improves metabolic risk factors and urinary crystallization risk indices, resulting in a significant reduction of renal colic and urological intervention rates.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"11 3","pages":"Article 103719"},"PeriodicalIF":5.7,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-12DOI: 10.1016/j.ekir.2025.103721
Jade Buford , Mengyu Di , Jessica L. Harding , Kelsey Drewry , Catherine Kelty , Adam Wilk , Anne Huml , Ana P. Rossi , Sumit Mohan , Bruce E. Gelb , Bhavna Chopra , Daniel Glicklich , Prince Mohan Anand , Matthew Handmacher , Laura Mulloy , Wasim A. Dar , Amber Reeves-Daniel , Enver Akalin , Kenneth J. McPartland , Stephen O. Pastan , Rachel E. Patzer
Introduction
Pretransplant access varies, but whether pretransplant steps vary regionally across dialysis facilities remains unclear.
Methods
We identified 62,467 adults (aged 18–80 years) referred from 2471 dialysis facilities and 27,171 initiating transplant evaluation from 2188 facilities in New England, New York, Southeast, and Ohio River Valley within the Early Steps to Transplant Access Registry (E-STAR) (January 1, 2015–December 31, 2023), linked with US Renal Data System (USRDS) and the Scientific Registry of Transplant Recipients data, followed-up through March 2, 2024. We examined dialysis facility–level proportions of evaluation start within 6 months of referral and waitlisting within 1 year of evaluation start. Descriptive statistics using analysis of variance and chi-square tests summarized outcome distributions and baseline characteristics within tertiles of outcome proportions, overall and by region.
Results
Evaluation start within 6 months across 2471 facilities varied from 0% to 100%; median within-facility proportion was 50% (interquartile range: 33.3%–64.3%), ranging from 33.3% (18.2%–50%) in the Ohio River Valley to 66.7% (50%–76.7%) in New York. Waitlisting within 1 year of evaluation start varied from 0% to 100% across 2188 facilities; median within-facility proportion was 41.2% (26.0%–60%), lowest in the Southeast (31.9% [20%–43.8%]) and similar across other regions (50%). Facilities in the lowest tertile of evaluation start proportions (< 39.13%) more often treated patients from high-poverty neighborhoods (36.8% vs. 29.2%) and were for-profit (82.4% vs. 73.5%) than the highest tertile (> 58.33%). These characteristics varied by region. Facility-level clustering explained 12.2% (95% confidence interval [CI]: 10.5%–13.5%) of variation in evaluation and 8.2% (6.7%–9.2%) in waitlisting.
Conclusion
Substantial regional variation in pretransplant access across dialysis facilities reinforces the need for region-specific strategies to improve access.
{"title":"Regional Variation in Early Kidney Transplant Access Across Dialysis Facilities in 4 US Regions","authors":"Jade Buford , Mengyu Di , Jessica L. Harding , Kelsey Drewry , Catherine Kelty , Adam Wilk , Anne Huml , Ana P. Rossi , Sumit Mohan , Bruce E. Gelb , Bhavna Chopra , Daniel Glicklich , Prince Mohan Anand , Matthew Handmacher , Laura Mulloy , Wasim A. Dar , Amber Reeves-Daniel , Enver Akalin , Kenneth J. McPartland , Stephen O. Pastan , Rachel E. Patzer","doi":"10.1016/j.ekir.2025.103721","DOIUrl":"10.1016/j.ekir.2025.103721","url":null,"abstract":"<div><h3>Introduction</h3><div>Pretransplant access varies, but whether pretransplant steps vary regionally across dialysis facilities remains unclear.</div></div><div><h3>Methods</h3><div>We identified 62,467 adults (aged 18–80 years) referred from 2471 dialysis facilities and 27,171 initiating transplant evaluation from 2188 facilities in New England, New York, Southeast, and Ohio River Valley within the Early Steps to Transplant Access Registry (E-STAR) (January 1, 2015–December 31, 2023), linked with US Renal Data System (USRDS) and the Scientific Registry of Transplant Recipients data, followed-up through March 2, 2024. We examined dialysis facility–level proportions of evaluation start within 6 months of referral and waitlisting within 1 year of evaluation start. Descriptive statistics using analysis of variance and chi-square tests summarized outcome distributions and baseline characteristics within tertiles of outcome proportions, overall and by region.</div></div><div><h3>Results</h3><div>Evaluation start within 6 months across 2471 facilities varied from 0% to 100%; median within-facility proportion was 50% (interquartile range: 33.3%–64.3%), ranging from 33.3% (18.2%–50%) in the Ohio River Valley to 66.7% (50%–76.7%) in New York. Waitlisting within 1 year of evaluation start varied from 0% to 100% across 2188 facilities; median within-facility proportion was 41.2% (26.0%–60%), lowest in the Southeast (31.9% [20%–43.8%]) and similar across other regions (50%). Facilities in the lowest tertile of evaluation start proportions (< 39.13%) more often treated patients from high-poverty neighborhoods (36.8% vs. 29.2%) and were for-profit (82.4% vs. 73.5%) than the highest tertile (> 58.33%). These characteristics varied by region. Facility-level clustering explained 12.2% (95% confidence interval [CI]: 10.5%–13.5%) of variation in evaluation and 8.2% (6.7%–9.2%) in waitlisting.</div></div><div><h3>Conclusion</h3><div>Substantial regional variation in pretransplant access across dialysis facilities reinforces the need for region-specific strategies to improve access.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"11 3","pages":"Article 103721"},"PeriodicalIF":5.7,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-12DOI: 10.1016/j.ekir.2025.103720
Catherine E. Kelty , Kelsey M. Drewry , Jade Buford , Mengyu Di , Megan Urbanski , Adam S. Wilk , Stephen O. Pastan , Amy Waterman , Rachel E. Patzer
Introduction
For patients receiving dialysis, education from dialysis staff is vital to make informed treatment decisions. Effective education practices are predicated on dialysis staff being well-informed about the kidney transplant process. We assessed dialysis staff knowledge of the transplant process and described staff and facility characteristics associated with knowledge.
Methods
A 17-item adaptation of the Knowledge Assessment of Renal Transplantation (KART) instrument was used to assess dialysis staff knowledge of the kidney transplantation process. Surveys were emailed to 2000 dialysis centers across 4 US regions (August 2021–August 2022). Associations between staff and facility characteristics and correct response scores were assessed using analysis of variance and by ordinal regression for score quartiles.
Results
Of the 630 responses assessed (among 33.5% response rate), respondents were mostly female (91.4%), social workers (81.1%), and worked at chain-owned facilities (86.2%). The average correct response score was 11.8 (69%). Correct responses for individual items ranged from 9.4% to 95.9%. In the adjusted regressions, the odds of scoring highly was reduced for non–social workers (vs. social workers; adjusted odds ratio [aOR]: 0.39; 95% confidence interval [CI]: 0.25–0.63), time working in role (vs. 8–10 years; < 1 year aOR: 0.11 [95% CI: 0.04–0.25], 1–3 years aOR: 0.21 [95% CI: 0.10–0.43], 4–7 years aOR: 0.38 [95% CI: 0.19–0.78], > 10 years aOR: 0.42 [95% CI: 0.21–0.85]), and region (vs. Southeast; New York aOR: 0.52 [95% CI: 0.29–0.94]).
Conclusion
The adapted-KART assessment revealed significant gaps and variation in dialysis staff knowledge of transplantation processes. Interventions to improve staff training and reduce gaps in staff knowledge are needed to ensure appropriate patient education regarding kidney transplantation for patients receiving dialysis.
{"title":"Gaps in Dialysis Staff Knowledge of the Kidney Transplantation Process","authors":"Catherine E. Kelty , Kelsey M. Drewry , Jade Buford , Mengyu Di , Megan Urbanski , Adam S. Wilk , Stephen O. Pastan , Amy Waterman , Rachel E. Patzer","doi":"10.1016/j.ekir.2025.103720","DOIUrl":"10.1016/j.ekir.2025.103720","url":null,"abstract":"<div><h3>Introduction</h3><div>For patients receiving dialysis, education from dialysis staff is vital to make informed treatment decisions. Effective education practices are predicated on dialysis staff being well-informed about the kidney transplant process. We assessed dialysis staff knowledge of the transplant process and described staff and facility characteristics associated with knowledge.</div></div><div><h3>Methods</h3><div>A 17-item adaptation of the Knowledge Assessment of Renal Transplantation (KART) instrument was used to assess dialysis staff knowledge of the kidney transplantation process. Surveys were emailed to 2000 dialysis centers across 4 US regions (August 2021–August 2022). Associations between staff and facility characteristics and correct response scores were assessed using analysis of variance and by ordinal regression for score quartiles.</div></div><div><h3>Results</h3><div>Of the 630 responses assessed (among 33.5% response rate), respondents were mostly female (91.4%), social workers (81.1%), and worked at chain-owned facilities (86.2%). The average correct response score was 11.8 (69%). Correct responses for individual items ranged from 9.4% to 95.9%. In the adjusted regressions, the odds of scoring highly was reduced for non–social workers (vs. social workers; adjusted odds ratio [aOR]: 0.39; 95% confidence interval [CI]: 0.25–0.63), time working in role (vs. 8–10 years; < 1 year aOR: 0.11 [95% CI: 0.04–0.25], 1–3 years aOR: 0.21 [95% CI: 0.10–0.43], 4–7 years aOR: 0.38 [95% CI: 0.19–0.78], > 10 years aOR: 0.42 [95% CI: 0.21–0.85]), and region (vs. Southeast; New York aOR: 0.52 [95% CI: 0.29–0.94]).</div></div><div><h3>Conclusion</h3><div>The adapted-KART assessment revealed significant gaps and variation in dialysis staff knowledge of transplantation processes. Interventions to improve staff training and reduce gaps in staff knowledge are needed to ensure appropriate patient education regarding kidney transplantation for patients receiving dialysis.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"11 3","pages":"Article 103720"},"PeriodicalIF":5.7,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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