Pub Date : 2025-02-01DOI: 10.1016/j.xkme.2024.100926
Wolfgang C. Winkelmayer , Austin Hu , Pascale Khairallah , Medha Airy , Kevin F. Erickson , Tara I. Chang , Jingbo Niu
<div><h3>Rationale & Objective</h3><div>Atrial fibrillation (AF) is common in patients with kidney failure on hemodialysis (HD), but few patients receive oral anticoagulant (OAC) treatment. Availability of direct-target OACs starting in 2010 may have induced greater OAC initiation, but this has not been systematically studied.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>Using Medicare fee-for-service billing claims (2006-2020), we identified previously OAC-naïve HD patients newly-diagnosed with AF between January 1, 2007, and October 1, 2020.</div></div><div><h3>Exposures</h3><div>Calendar year; race/ethnicity.</div></div><div><h3>Outcomes</h3><div>OAC initiation within 90 days from AF diagnosis (any; specific agent).</div></div><div><h3>Analytical Approach</h3><div>We estimated initiation risk ratios for each calendar year compared with the referent cohort, 2007, using unadjusted and multivariable-adjusted modified Poisson regression. We also determined differences by racial/ethnic group in OAC initiation, as well as any changes in these disparities over time.</div></div><div><h3>Results</h3><div>Among 82,389 HD patients newly-diagnosed with AF, 20,002 (24.3%) initiated new OAC treatment within 90 days: 20.5% in 2007 and 34.1% in 2020. Direct-target OACs accounted for 81.0% of OAC initiations in 2020. Adjusted regression models estimated that OAC initiation remained essentially unchanged between 2007 and 2013, but thereafter increased toward a demographics-adjusted risk ratio of 1.61 (95% CI: 1.50-1.73) in 2020. Compared with non-Hispanic Whites, the rates of OAC initiation were 15% (95% CI, 12%-17%) lower among Black patients, 29% (95% CI, 24%-34%) lower among Asian patients, and 22% (95% CI, 19%-25%) lower among Hispanic patients. These disparities were not found to have differed across time (<em>P</em><sub>interaction</sub> <!-->=<!--> <!-->0.75).</div></div><div><h3>Limitations</h3><div>Lack of clinical detail to firmly establish contraindications to OAC initiation.</div></div><div><h3>Conclusions</h3><div>While rates of OAC initiation among patients on HD with newly-diagnosed AF increased in recent years, predominantly driven by increased use of apixaban, OAC initiation rates remained low, at 34% of patients in 2020. Compared with non-Hispanic White patients, OAC initiation remained consistently lower in patients of other race and ethnic groups.</div></div><div><h3>Plain-Language Summary</h3><div>Use of oral blood thinners (anticoagulants) in patients with kidney failure undergoing hemodialysis who have a common type of heart rhythm disorder (atrial fibrillation) used to be low. We studied whether the availability of a novel class of anticoagulants increased use of this treatment approach in recent years. We were also interested in identifying any differences in anticoagulant use between patients of different racial and ethnic backgrounds. We found that us
{"title":"Oral Anticoagulant Initiation in Patients With Kidney Failure on Hemodialysis Newly Diagnosed With Atrial Fibrillation (2007-2020): An Observational Study of Trends and Disparities","authors":"Wolfgang C. Winkelmayer , Austin Hu , Pascale Khairallah , Medha Airy , Kevin F. Erickson , Tara I. Chang , Jingbo Niu","doi":"10.1016/j.xkme.2024.100926","DOIUrl":"10.1016/j.xkme.2024.100926","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Atrial fibrillation (AF) is common in patients with kidney failure on hemodialysis (HD), but few patients receive oral anticoagulant (OAC) treatment. Availability of direct-target OACs starting in 2010 may have induced greater OAC initiation, but this has not been systematically studied.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>Using Medicare fee-for-service billing claims (2006-2020), we identified previously OAC-naïve HD patients newly-diagnosed with AF between January 1, 2007, and October 1, 2020.</div></div><div><h3>Exposures</h3><div>Calendar year; race/ethnicity.</div></div><div><h3>Outcomes</h3><div>OAC initiation within 90 days from AF diagnosis (any; specific agent).</div></div><div><h3>Analytical Approach</h3><div>We estimated initiation risk ratios for each calendar year compared with the referent cohort, 2007, using unadjusted and multivariable-adjusted modified Poisson regression. We also determined differences by racial/ethnic group in OAC initiation, as well as any changes in these disparities over time.</div></div><div><h3>Results</h3><div>Among 82,389 HD patients newly-diagnosed with AF, 20,002 (24.3%) initiated new OAC treatment within 90 days: 20.5% in 2007 and 34.1% in 2020. Direct-target OACs accounted for 81.0% of OAC initiations in 2020. Adjusted regression models estimated that OAC initiation remained essentially unchanged between 2007 and 2013, but thereafter increased toward a demographics-adjusted risk ratio of 1.61 (95% CI: 1.50-1.73) in 2020. Compared with non-Hispanic Whites, the rates of OAC initiation were 15% (95% CI, 12%-17%) lower among Black patients, 29% (95% CI, 24%-34%) lower among Asian patients, and 22% (95% CI, 19%-25%) lower among Hispanic patients. These disparities were not found to have differed across time (<em>P</em><sub>interaction</sub> <!-->=<!--> <!-->0.75).</div></div><div><h3>Limitations</h3><div>Lack of clinical detail to firmly establish contraindications to OAC initiation.</div></div><div><h3>Conclusions</h3><div>While rates of OAC initiation among patients on HD with newly-diagnosed AF increased in recent years, predominantly driven by increased use of apixaban, OAC initiation rates remained low, at 34% of patients in 2020. Compared with non-Hispanic White patients, OAC initiation remained consistently lower in patients of other race and ethnic groups.</div></div><div><h3>Plain-Language Summary</h3><div>Use of oral blood thinners (anticoagulants) in patients with kidney failure undergoing hemodialysis who have a common type of heart rhythm disorder (atrial fibrillation) used to be low. We studied whether the availability of a novel class of anticoagulants increased use of this treatment approach in recent years. We were also interested in identifying any differences in anticoagulant use between patients of different racial and ethnic backgrounds. We found that us","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 2","pages":"Article 100926"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11750526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.xkme.2024.100941
Steven G. Achinger , Juan Carlos Ayus , Ambuj Kumar , Athanasios Tsalatsanis
Rationale & Objective
There are likely over 42 million patients with hypertension taking thiazides in the United States and many more worldwide. Hyponatremia is a common complication of thiazide therapy. It is not currently known if thiazide-associated hyponatremia is also associated with increased mortality. The objective of this study was to determine if outpatients who start thiazide diuretic treatment and develop early hyponatremia are at increased risk of mortality when compared with those who do not develop hyponatremia after starting a thiazide.
Study Design
A retrospective cohort study.
Setting & Participants
This study used data from the TriNetX federated health research network comprising deidentified electronic medical records of ∼93 million patients from 76 health care organizations located primarily in the United States. The study population was adult patients 40-90 years old, with essential hypertension and who started on a thiazide diuretic between January 1, 2010, and December 31, 2021. The patients were then subdivided into a hyponatremia cohort and a control cohort. 22,057 patients met the inclusion criteria for the hyponatremia cohort, and 234,466 patients met the inclusion criteria for the control cohort. After propensity score matching, 22,052 remained in both cohorts. The primary outcome is one-year mortality.
Exposure
The hyponatremia cohort developed early hyponatremia defined as a serum sodium ≤ 135 mmol/L within 6 months after initiation of thiazide versus a control that had a serum sodium 136-144 mmol/L after initiation of thiazide.
Outcomes
Primary outcome is mortality. Secondary outcomes include development of sepsis, pneumonia, urinary tract infection, cellulitis, myocardial infarction, stroke, congestive heart failure, ataxia, fall, and hip fracture.
Analytical Approach
The design is a retrospective cohort study, propensity score matched.
Results
Patients in the hyponatremia cohort had a higher hazard of mortality than patients in control, HR 1.96 (95% CI, 1.72-2.28; P < 0.001). In addition, patients in the hyponatremia cohort had higher hazard of developing sepsis, pneumonia, urinary tract infection, cellulitis, myocardial infarction, stroke, congestive heart failure, ataxia, and hip fracture.
Limitations
The study had a retrospective design.
Conclusions
Patients who develop early hyponatremia (serum sodium ≤ 135 mmol/L) following initiation of a thiazide diuretic have a higher risk of mortality when compared with those who do not develop hyponatremia after initiation of a thiazide diuretic.
{"title":"Thiazide-Associated Hyponatremia and Mortality Risk: A Cohort Study","authors":"Steven G. Achinger , Juan Carlos Ayus , Ambuj Kumar , Athanasios Tsalatsanis","doi":"10.1016/j.xkme.2024.100941","DOIUrl":"10.1016/j.xkme.2024.100941","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>There are likely over 42 million patients with hypertension taking thiazides in the United States and many more worldwide. Hyponatremia is a common complication of thiazide therapy. It is not currently known if thiazide-associated hyponatremia is also associated with increased mortality. The objective of this study was to determine if outpatients who start thiazide diuretic treatment and develop early hyponatremia are at increased risk of mortality when compared with those who do not develop hyponatremia after starting a thiazide.</div></div><div><h3>Study Design</h3><div>A retrospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>This study used data from the TriNetX federated health research network comprising deidentified electronic medical records of ∼93 million patients from 76 health care organizations located primarily in the United States. The study population was adult patients 40-90 years old, with essential hypertension and who started on a thiazide diuretic between January 1, 2010, and December 31, 2021. The patients were then subdivided into a hyponatremia cohort and a control cohort. 22,057 patients met the inclusion criteria for the hyponatremia cohort, and 234,466 patients met the inclusion criteria for the control cohort. After propensity score matching, 22,052 remained in both cohorts. The primary outcome is one-year mortality.</div></div><div><h3>Exposure</h3><div>The hyponatremia cohort developed early hyponatremia defined as a serum sodium<!--> <!-->≤<!--> <!-->135<!--> <!-->mmol/L within 6 months after initiation of thiazide versus a control that had a serum sodium 136-144<!--> <!-->mmol/L after initiation of thiazide.</div></div><div><h3>Outcomes</h3><div>Primary outcome is mortality. Secondary outcomes include development of sepsis, pneumonia, urinary tract infection, cellulitis, myocardial infarction, stroke, congestive heart failure, ataxia, fall, and hip fracture.</div></div><div><h3>Analytical Approach</h3><div>The design is a retrospective cohort study, propensity score matched.</div></div><div><h3>Results</h3><div>Patients in the hyponatremia cohort had a higher hazard of mortality than patients in control, HR 1.96 (95% CI, 1.72-2.28; <em>P</em> <!--><<!--> <!-->0.001). In addition, patients in the hyponatremia cohort had higher hazard of developing sepsis, pneumonia, urinary tract infection, cellulitis, myocardial infarction, stroke, congestive heart failure, ataxia, and hip fracture.</div></div><div><h3>Limitations</h3><div>The study had a retrospective design.</div></div><div><h3>Conclusions</h3><div>Patients who develop early hyponatremia (serum sodium<!--> <!-->≤<!--> <!-->135<!--> <!-->mmol/L) following initiation of a thiazide diuretic have a higher risk of mortality when compared with those who do not develop hyponatremia after initiation of a thiazide diuretic.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 2","pages":"Article 100941"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.xkme.2024.100947
Qiong Chen , Xuan Liu , Juan Wang , Man Yang , Qiu-ling Fan
Pure red cell aplasia (PRCA) is a rare complication of erythropoietin (EPO) therapy, characterized by a severe deficiency in red blood cell production. There is no guideline on the treatment for PRCA because there have been too few cases to perform prospective cohort studies. The main treatments for PRCA include immediate cessation of EPO, restrictive transfusion, and immunosuppressive therapies. A 35-year-old male patient with type 1 diabetic nephropathy was diagnosed with PRCA. Enarodustat and roxadustat were administered successively after discontinuation of EPO, but anemia did not improve, and the patient was maintained with weekly blood transfusions. Subsequently, the EPO-mimetic peptide pegmolesatide was administered, and the patient’s hemoglobin started to increase after 1 week and increased from 50 g/L to 92 g/L over approximately 3 months. Based on these findings, we speculate that pegmolesatide can provide a safe, effective, and convenient therapeutic strategy for PRCA in Chinese patients with chronic kidney disease.
{"title":"EPO-Mimetic Peptide Pegmolesatide Therapy for Pure Red Cell Aplasia in a Patient with Non-dialysis-dependent Type 1 Diabetic Nephropathy: A Case Report","authors":"Qiong Chen , Xuan Liu , Juan Wang , Man Yang , Qiu-ling Fan","doi":"10.1016/j.xkme.2024.100947","DOIUrl":"10.1016/j.xkme.2024.100947","url":null,"abstract":"<div><div>Pure red cell aplasia (PRCA) is a rare complication of erythropoietin (EPO) therapy, characterized by a severe deficiency in red blood cell production. There is no guideline on the treatment for PRCA because there have been too few cases to perform prospective cohort studies. The main treatments for PRCA include immediate cessation of EPO, restrictive transfusion, and immunosuppressive therapies. A 35-year-old male patient with type 1 diabetic nephropathy was diagnosed with PRCA. Enarodustat and roxadustat were administered successively after discontinuation of EPO, but anemia did not improve, and the patient was maintained with weekly blood transfusions. Subsequently, the EPO-mimetic peptide pegmolesatide was administered, and the patient’s hemoglobin started to increase after 1 week and increased from 50<!--> <!-->g/L to 92<!--> <!-->g/L over approximately 3 months. Based on these findings, we speculate that pegmolesatide can provide a safe, effective, and convenient therapeutic strategy for PRCA in Chinese patients with chronic kidney disease.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 2","pages":"Article 100947"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>Rationale & Objective</h3><div>Chronic kidney disease (CKD) in patients with diabetes does not always equate to diabetic kidney disease (DKD). This study aims to delineate and compare the clinical characteristics, survival rates, and access to kidney transplantation among patients with type 2 diabetes commencing dialysis, who were classified by kidney biopsy as having either DKD or non-diabetic kidney disease (non-DKD).</div></div><div><h3>Study Design</h3><div>We used the comprehensive French Renal Epidemiology and Information Network registry to analyze baseline clinical characteristics at dialysis inception and outcomes defined as death and access to kidney transplantation.</div></div><div><h3>Outcomes & Analytical Approach</h3><div>We employed a multivariate Cox proportional hazards model and the Fine-Gray competing risk model to assess the probabilities of mortality and transplantation.</div></div><div><h3>Settings & Participants</h3><div>Adults in the Renal Epidemiology and Information Network registry in France with a diagnosis of type 2 diabetes who initiated kidney replacement therapy from January 2009 to December 2015 and had a previous native kidney biopsy.</div></div><div><h3>Results</h3><div>We analyzed data from 2,869 patients with diabetes, 45% of whom had a biopsy-confirmed diagnosis of DKD. Among these patients, half presented additional histopathological findings indicative of nephroangiosclerosis and focal segmental glomerulosclerosis. The clinical profiles of patients with DKD and non-DKD were largely comparable. There were no significant differences in dialysis survival rates or kidney transplantation access between the groups, even after adjusting for confounding variables and considering competing risks. At the 6-year mark, the mortality rate was 60.3% (95% CI: 55.5-64.5) for the DKD group and 60.3% (95% CI: 55.9-64.3) for the non-DKD group. Multivariable Cox analysis revealed no significant difference in mortality risk between the DKD and non-DKD groups.</div></div><div><h3>Limitations</h3><div>The study limitations include potential residual confounders, lack of predialysis data, kidney biopsies possibly outdated, nonrandom biopsy indications, and survival bias because of analysis at dialysis inception.</div></div><div><h3>Conclusions</h3><div>In patients with diabetes initiating dialysis, clinical characteristics and outcomes following dialysis initiation were similar in biopsy-proven DKD versus non-DKD. Our results suggest that the diabetic milieu has a more significant impact on outcomes in patients with diabetes treated with dialysis than the underlying pathological kidney diagnosis.</div></div><div><h3>Plain Language Summary</h3><div>This study explored whether chronic kidney diseases in patients with diabetes are always caused by diabetes or if other conditions might be responsible. By examining medical records from the nationwide French registry, researchers compared patients with diabetic kidn
{"title":"Kidney Biopsy-Proven Diabetic and Non-Diabetic Kidney Diseases and Outcomes in Patients With Type 2 Diabetes Receiving Dialysis: The REIN Registry","authors":"Maxime Ingwiller , Arnaud Delautre , Jean-Michel Tivollier , Stephane Edet , Nans Florens , Cécile Couchoud , Thierry Hannedouche , REIN registry","doi":"10.1016/j.xkme.2024.100944","DOIUrl":"10.1016/j.xkme.2024.100944","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Chronic kidney disease (CKD) in patients with diabetes does not always equate to diabetic kidney disease (DKD). This study aims to delineate and compare the clinical characteristics, survival rates, and access to kidney transplantation among patients with type 2 diabetes commencing dialysis, who were classified by kidney biopsy as having either DKD or non-diabetic kidney disease (non-DKD).</div></div><div><h3>Study Design</h3><div>We used the comprehensive French Renal Epidemiology and Information Network registry to analyze baseline clinical characteristics at dialysis inception and outcomes defined as death and access to kidney transplantation.</div></div><div><h3>Outcomes & Analytical Approach</h3><div>We employed a multivariate Cox proportional hazards model and the Fine-Gray competing risk model to assess the probabilities of mortality and transplantation.</div></div><div><h3>Settings & Participants</h3><div>Adults in the Renal Epidemiology and Information Network registry in France with a diagnosis of type 2 diabetes who initiated kidney replacement therapy from January 2009 to December 2015 and had a previous native kidney biopsy.</div></div><div><h3>Results</h3><div>We analyzed data from 2,869 patients with diabetes, 45% of whom had a biopsy-confirmed diagnosis of DKD. Among these patients, half presented additional histopathological findings indicative of nephroangiosclerosis and focal segmental glomerulosclerosis. The clinical profiles of patients with DKD and non-DKD were largely comparable. There were no significant differences in dialysis survival rates or kidney transplantation access between the groups, even after adjusting for confounding variables and considering competing risks. At the 6-year mark, the mortality rate was 60.3% (95% CI: 55.5-64.5) for the DKD group and 60.3% (95% CI: 55.9-64.3) for the non-DKD group. Multivariable Cox analysis revealed no significant difference in mortality risk between the DKD and non-DKD groups.</div></div><div><h3>Limitations</h3><div>The study limitations include potential residual confounders, lack of predialysis data, kidney biopsies possibly outdated, nonrandom biopsy indications, and survival bias because of analysis at dialysis inception.</div></div><div><h3>Conclusions</h3><div>In patients with diabetes initiating dialysis, clinical characteristics and outcomes following dialysis initiation were similar in biopsy-proven DKD versus non-DKD. Our results suggest that the diabetic milieu has a more significant impact on outcomes in patients with diabetes treated with dialysis than the underlying pathological kidney diagnosis.</div></div><div><h3>Plain Language Summary</h3><div>This study explored whether chronic kidney diseases in patients with diabetes are always caused by diabetes or if other conditions might be responsible. By examining medical records from the nationwide French registry, researchers compared patients with diabetic kidn","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 2","pages":"Article 100944"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.xkme.2024.100945
Zewei Chen , Shangxi Fu , Jun Wu , Xiaoling Luo , Zhiguo Mao , Dechao Xu , Xiang Gao
Despite treatment with immunosuppressive or clone-targeted chemotherapy, patients with proliferative glomerulonephritis with monoclonal immunoglobulin deposit (PGNMID) frequently progress into end-stage kidney failure, and early recurrence of PGNMID after kidney transplantation is common. The standard management of PGNMID has been unclear, currently based on data from small cohorts, which requires a need for additional therapeutic regimens in this disease. A human IgG monoclonal antibody that targets CD38 (daratumumab) was recently identified as a potential therapeutic option for treating PGNMID. To date, rare data on the application of daratumumab in patients with PGNMID after kidney transplantation have been reported. Herein, we first described a unique patient with recurrent PGNMID in kidney allograft who was treated with daratumumab after not responding to bortezomib-based regimens. Daratumumab was shown to successfully reduce proteinuria with stabilizing kidney function and was well-tolerated in this patient, which supports that daratumumab appears to be a viable option for treatment-resistant PGNMID.
{"title":"Daratumumab for Bortezomib-Refractory Proliferative Glomerulonephritis With Monoclonal Immunoglobulin Deposits in Kidney Allograft: A Case Report","authors":"Zewei Chen , Shangxi Fu , Jun Wu , Xiaoling Luo , Zhiguo Mao , Dechao Xu , Xiang Gao","doi":"10.1016/j.xkme.2024.100945","DOIUrl":"10.1016/j.xkme.2024.100945","url":null,"abstract":"<div><div>Despite treatment with immunosuppressive or clone-targeted chemotherapy, patients with proliferative glomerulonephritis with monoclonal immunoglobulin deposit (PGNMID) frequently progress into end-stage kidney failure, and early recurrence of PGNMID after kidney transplantation is common. The standard management of PGNMID has been unclear, currently based on data from small cohorts, which requires a need for additional therapeutic regimens in this disease. A human IgG monoclonal antibody that targets CD38 (daratumumab) was recently identified as a potential therapeutic option for treating PGNMID. To date, rare data on the application of daratumumab in patients with PGNMID after kidney transplantation have been reported. Herein, we first described a unique patient with recurrent PGNMID in kidney allograft who was treated with daratumumab after not responding to bortezomib-based regimens. Daratumumab was shown to successfully reduce proteinuria with stabilizing kidney function and was well-tolerated in this patient, which supports that daratumumab appears to be a viable option for treatment-resistant PGNMID.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 2","pages":"Article 100945"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.xkme.2024.100949
Caitlin K. Monaghan PhD , Joanna Willetts MS , Hao Han MS , Sheetal Chaudhuri PhD , Linda H. Ficociello DSc , Michael A. Kraus MD , Harold E. Giles MD , Len Usvyat PhD , Joseph Turk MBA
{"title":"Home Dialysis Prediction Using Artificial Intelligence","authors":"Caitlin K. Monaghan PhD , Joanna Willetts MS , Hao Han MS , Sheetal Chaudhuri PhD , Linda H. Ficociello DSc , Michael A. Kraus MD , Harold E. Giles MD , Len Usvyat PhD , Joseph Turk MBA","doi":"10.1016/j.xkme.2024.100949","DOIUrl":"10.1016/j.xkme.2024.100949","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 2","pages":"Article 100949"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143178071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.xkme.2024.100942
Pien Rawee MSc , Daan Kremer MD, PhD , Ilja M. Nolte PhD , Mark R. Hanudel MD, MS , Daan J. Touw PharmD, PhD , Martin H. De Borst MD, PhD , Stephan J.L. Bakker MD, PhD , Michele F. Eisenga MD, PhD
{"title":"Iron Deficiency, Cadmium Levels, and Kidney Transplant Outcomes in Prevalent Kidney Transplant Recipients","authors":"Pien Rawee MSc , Daan Kremer MD, PhD , Ilja M. Nolte PhD , Mark R. Hanudel MD, MS , Daan J. Touw PharmD, PhD , Martin H. De Borst MD, PhD , Stephan J.L. Bakker MD, PhD , Michele F. Eisenga MD, PhD","doi":"10.1016/j.xkme.2024.100942","DOIUrl":"10.1016/j.xkme.2024.100942","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 2","pages":"Article 100942"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11761878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>Rationale & Objective</h3><div>Management of asymptomatic bacteriuria in kidney transplant recipients remains uncertain. Our main objective was to evaluate whether patient- or episode-related factors could help identify episodes of asymptomatic bacteriuria associated with a higher risk of being followed by a symptomatic urinary tract infection.</div></div><div><h3>Study Design</h3><div>A single-center, retrospective cohort study.</div></div><div><h3>Settings & Participants</h3><div>Consecutive patients who received a kidney transplantation between January 1, 2008, and April 26, 2016, and experienced<!--> <!-->≥1 episode of asymptomatic bacteriuria during the first 3 years posttransplantation.</div></div><div><h3>Exposure</h3><div>Recipient age, sex, diabetes, donor type, retransplant, urological abnormalities, thymoglobulin for induction, time since transplant, presence of ureteral stent, prior acute rejection, leukocyturia, hematuria, urinary nitrites, bacterial strain, prior urinary tract infection, resistance to antibiotics, antibiotic treatment.</div></div><div><h3>Outcomes</h3><div>The primary outcome was the occurrence of symptomatic urinary tract infection. The secondary outcome was antibiotic treatment of asymptomatic bacteriuria.</div></div><div><h3>Analytical Approach</h3><div>A Cox regression survival analysis model accounting for recurrent events and a logistic regression model.</div></div><div><h3>Results</h3><div>From a cohort of 508 patients, we included 597 episodes of asymptomatic bacteriuria detected in 119 outpatients. Antibiotics were prescribed in 26% of these episodes. Overall, 56 (9%) of episodes were followed by a symptomatic urinary tract infection. Pretransplant diabetes (hazard ratio [HR], 4.28; 95% confidence intervals [CI], 2.40-7.61), leukocyturia or hematuria (HR, 2.24; 95% CI, 1.27-3.96), and the presence of a ureteral stent (HR, 3.40; 95% CI, 1.33-8.70) were associated with development of a clinical urinary tract infection in patients with asymptomatic bacteriuria.</div></div><div><h3>Limitations</h3><div>The small number of events limits complete multivariable adjustment. It also prevents us from drawing a definite conclusion about the importance of a number of independent variables as risk factors for the outcome.</div></div><div><h3>Conclusions</h3><div>The benefit of treating episodes of asymptomatic bacteriuria with high-risk characteristics should be investigated in future trials.</div></div><div><h3>Plain Language Summary</h3><div>Urine infections are very frequent in patients who have received a kidney transplant. Bacteria are sometimes found in the urine of patients who report no symptoms. This is called asymptomatic bacteriuria. Asymptomatic bacteriuria is a risk factor for having an overt symptomatic urine infection, but previous small studies did not show any benefit of treatment. However, this may be different if only patients with asymptomatic bacteriuria at high risk of developing a
{"title":"Clinical Urinary Tract Infections in Kidney Transplant Recipients With Initially Asymptomatic Bacteriuria: A Single-Center Retrospective Cohort Study","authors":"Samar Medani , Marc Dorais , Aurélie Poulin , Alexandre Tavares-Brum , Habib Mawad , Alain Duclos , Azemi Barama , Héloïse Cardinal","doi":"10.1016/j.xkme.2024.100946","DOIUrl":"10.1016/j.xkme.2024.100946","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Management of asymptomatic bacteriuria in kidney transplant recipients remains uncertain. Our main objective was to evaluate whether patient- or episode-related factors could help identify episodes of asymptomatic bacteriuria associated with a higher risk of being followed by a symptomatic urinary tract infection.</div></div><div><h3>Study Design</h3><div>A single-center, retrospective cohort study.</div></div><div><h3>Settings & Participants</h3><div>Consecutive patients who received a kidney transplantation between January 1, 2008, and April 26, 2016, and experienced<!--> <!-->≥1 episode of asymptomatic bacteriuria during the first 3 years posttransplantation.</div></div><div><h3>Exposure</h3><div>Recipient age, sex, diabetes, donor type, retransplant, urological abnormalities, thymoglobulin for induction, time since transplant, presence of ureteral stent, prior acute rejection, leukocyturia, hematuria, urinary nitrites, bacterial strain, prior urinary tract infection, resistance to antibiotics, antibiotic treatment.</div></div><div><h3>Outcomes</h3><div>The primary outcome was the occurrence of symptomatic urinary tract infection. The secondary outcome was antibiotic treatment of asymptomatic bacteriuria.</div></div><div><h3>Analytical Approach</h3><div>A Cox regression survival analysis model accounting for recurrent events and a logistic regression model.</div></div><div><h3>Results</h3><div>From a cohort of 508 patients, we included 597 episodes of asymptomatic bacteriuria detected in 119 outpatients. Antibiotics were prescribed in 26% of these episodes. Overall, 56 (9%) of episodes were followed by a symptomatic urinary tract infection. Pretransplant diabetes (hazard ratio [HR], 4.28; 95% confidence intervals [CI], 2.40-7.61), leukocyturia or hematuria (HR, 2.24; 95% CI, 1.27-3.96), and the presence of a ureteral stent (HR, 3.40; 95% CI, 1.33-8.70) were associated with development of a clinical urinary tract infection in patients with asymptomatic bacteriuria.</div></div><div><h3>Limitations</h3><div>The small number of events limits complete multivariable adjustment. It also prevents us from drawing a definite conclusion about the importance of a number of independent variables as risk factors for the outcome.</div></div><div><h3>Conclusions</h3><div>The benefit of treating episodes of asymptomatic bacteriuria with high-risk characteristics should be investigated in future trials.</div></div><div><h3>Plain Language Summary</h3><div>Urine infections are very frequent in patients who have received a kidney transplant. Bacteria are sometimes found in the urine of patients who report no symptoms. This is called asymptomatic bacteriuria. Asymptomatic bacteriuria is a risk factor for having an overt symptomatic urine infection, but previous small studies did not show any benefit of treatment. However, this may be different if only patients with asymptomatic bacteriuria at high risk of developing a","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 2","pages":"Article 100946"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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