Pub Date : 2025-10-25DOI: 10.1016/j.xkme.2025.101159
Rachel Shulman, Wei Yang, Debbie L. Cohen, Peter P. Reese, Jordana B. Cohen
<div><h3>Rationale & Objective</h3><div>The kidney-protective benefits of renin-angiotensin system inhibitors (RASIs; ie, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers) in nonproteinuric chronic kidney disease (CKD) are unclear. We aimed to evaluate kidney outcomes in adults with nonproteinuric CKD treated with RASIs versus other antihypertensive medications.</div></div><div><h3>Study Design</h3><div>Using data from the Chronic Renal Insufficiency Cohort study, a prospective cohort study, we evaluated the association of RASI use with kidney outcomes and survival. Secondary analyses included censoring with drug discontinuation and a time-updated RASI approach (ie, cumulative exposure).</div></div><div><h3>Setting & Participants</h3><div>Individuals with <0.5 g/d of proteinuria (via 24-hour urine collection or spot test) on ≥1 antihypertensive medication. Participants with heart failure were excluded.</div></div><div><h3>Exposure</h3><div>Patient-reported use of RASIs versus non-RASI antihypertensive medication.</div></div><div><h3>Outcomes</h3><div>(1) CKD progression (halving of estimated glomerular filtration rate, dialysis, or transplant) and (2) all-cause mortality.</div></div><div><h3>Analytical Approach</h3><div>Inverse probability of treatment weighting and Cox proportional hazards modeling; marginal structural models.</div></div><div><h3>Results</h3><div>Among the 2,664 participants, the mean age was 62 years, 46% were female, and the mean estimated glomerular filtration rate was 50 mL/min/1.73 m<sup>2</sup>. There were 457 kidney events (29/1,000 person-years) in RASI users versus 129 (23/1,000 person-years) in the comparator. Treatment with RASIs was not associated with CKD progression in the baseline analysis (adjusted hazard ratio [HR], 1.01; 95% CI, 0.81-1.25) and drug discontinuation analysis (adjusted HR, 0.92; 95% CI, 0.68-1.25). The cumulative exposure approach showed a higher risk of CKD progression for low RASI users (<50% of follow-up) versus nonusers but no higher risk of CKD progression among high RASI users (≥50% of follow-up) versus nonusers. RASI users had a lower mortality risk in the drug discontinuation analysis (adjusted HR, 0.64; 95% CI, 0.50-0.82) and a nonsignificantly lower risk among participants receiving treatment with RASIs ≥75% of follow-up versus nonusers.</div></div><div><h3>Limitations</h3><div>Residual confounding cannot be ruled out. Medication use was patient-reported, increasing the potential for misclassification.</div></div><div><h3>Conclusions</h3><div>For people with nonproteinuric CKD, RASIs may not be kidney-protective but may still confer a mortality benefit for hypertension management.</div></div><div><h3>Plain-Language Summary</h3><div>Chronic kidney disease is a leading cause of illness and death. Although the majority of individuals with chronic kidney disease do not have proteinuria, clinical trials have historically excluded nonproteinuric chronic
{"title":"Renin-Angiotensin System Inhibitors in Patients With Nonproteinuric Chronic Kidney Disease and Kidney Outcomes: Findings From the CRIC Study","authors":"Rachel Shulman, Wei Yang, Debbie L. Cohen, Peter P. Reese, Jordana B. Cohen","doi":"10.1016/j.xkme.2025.101159","DOIUrl":"10.1016/j.xkme.2025.101159","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>The kidney-protective benefits of renin-angiotensin system inhibitors (RASIs; ie, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers) in nonproteinuric chronic kidney disease (CKD) are unclear. We aimed to evaluate kidney outcomes in adults with nonproteinuric CKD treated with RASIs versus other antihypertensive medications.</div></div><div><h3>Study Design</h3><div>Using data from the Chronic Renal Insufficiency Cohort study, a prospective cohort study, we evaluated the association of RASI use with kidney outcomes and survival. Secondary analyses included censoring with drug discontinuation and a time-updated RASI approach (ie, cumulative exposure).</div></div><div><h3>Setting & Participants</h3><div>Individuals with <0.5 g/d of proteinuria (via 24-hour urine collection or spot test) on ≥1 antihypertensive medication. Participants with heart failure were excluded.</div></div><div><h3>Exposure</h3><div>Patient-reported use of RASIs versus non-RASI antihypertensive medication.</div></div><div><h3>Outcomes</h3><div>(1) CKD progression (halving of estimated glomerular filtration rate, dialysis, or transplant) and (2) all-cause mortality.</div></div><div><h3>Analytical Approach</h3><div>Inverse probability of treatment weighting and Cox proportional hazards modeling; marginal structural models.</div></div><div><h3>Results</h3><div>Among the 2,664 participants, the mean age was 62 years, 46% were female, and the mean estimated glomerular filtration rate was 50 mL/min/1.73 m<sup>2</sup>. There were 457 kidney events (29/1,000 person-years) in RASI users versus 129 (23/1,000 person-years) in the comparator. Treatment with RASIs was not associated with CKD progression in the baseline analysis (adjusted hazard ratio [HR], 1.01; 95% CI, 0.81-1.25) and drug discontinuation analysis (adjusted HR, 0.92; 95% CI, 0.68-1.25). The cumulative exposure approach showed a higher risk of CKD progression for low RASI users (<50% of follow-up) versus nonusers but no higher risk of CKD progression among high RASI users (≥50% of follow-up) versus nonusers. RASI users had a lower mortality risk in the drug discontinuation analysis (adjusted HR, 0.64; 95% CI, 0.50-0.82) and a nonsignificantly lower risk among participants receiving treatment with RASIs ≥75% of follow-up versus nonusers.</div></div><div><h3>Limitations</h3><div>Residual confounding cannot be ruled out. Medication use was patient-reported, increasing the potential for misclassification.</div></div><div><h3>Conclusions</h3><div>For people with nonproteinuric CKD, RASIs may not be kidney-protective but may still confer a mortality benefit for hypertension management.</div></div><div><h3>Plain-Language Summary</h3><div>Chronic kidney disease is a leading cause of illness and death. Although the majority of individuals with chronic kidney disease do not have proteinuria, clinical trials have historically excluded nonproteinuric chronic ","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 1","pages":"Article 101159"},"PeriodicalIF":3.4,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145786979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-24DOI: 10.1016/j.xkme.2025.101158
Koyal Jain MD, MPH , Javier A. Neyra MD, MSCS , Hitesh H. Shah MD , Ryan Mullane DO , Suzanne M. Boyle MD, MSCE , Kurtis A. Pivert MS , Benjamin S. Ko MD
{"title":"Nephrology Fellows’ Cultural Background and Faculty Alignment: A Research Letter","authors":"Koyal Jain MD, MPH , Javier A. Neyra MD, MSCS , Hitesh H. Shah MD , Ryan Mullane DO , Suzanne M. Boyle MD, MSCE , Kurtis A. Pivert MS , Benjamin S. Ko MD","doi":"10.1016/j.xkme.2025.101158","DOIUrl":"10.1016/j.xkme.2025.101158","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 1","pages":"Article 101158"},"PeriodicalIF":3.4,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145786856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-23DOI: 10.1016/j.xkme.2025.101157
Steven G. Achinger , Juan Carlos Ayus , Ambuj Kumar , Athanasios Tsalatsanis
Rationale & Objective
Allograft failure has been associated with chronic inflammation and poor survival among dialysis patients after allograft failure. Allograft nephrectomy is associated with higher levels of anti-human alloantibodies, making it more difficult to find matching kidney donors; however, the rate of repeat transplantation following allograft nephrectomy is largely unknown.
Study Design
A retrospective, propensity score-matched cohort study.
Setting & Participants
Using the US Renal Data System, we identified adult dialysis patients after a failed kidney transplant between January 1, 1995, and December 31, 2015. A total of 50,217 patients met the inclusion criteria.
Exposure
Kidney allograft nephrectomy
Outcomes
Primary outcome was repeat kidney transplantation.
Analytical Approach
Exposure to nephrectomy was modeled as a time-varying event. We estimated the cumulative incidence of repeat kidney transplant using the competing risk approach. After propensity score matching, 9,696 patients remained in each cohort.
Results
Overall, patients with nephrectomy had higher chances of receiving a second transplant (subdistribution HR, 1.21; 95% CI, 1.15-1.28; P < 0.001). The cumulative incidence of second transplant in the nephrectomy group was 19%, 28%, and 31% at 5, 10, and 20 years, respectively, versus 16%, 24%, and 27% in the comparison group.
Limitations
As a retrospective, registry-based study, cause and effect relationship cannot be established.
Conclusions
Allograft nephrectomy of a failed kidney allograft is associated with a higher likelihood of repeat transplantation and should not be considered contraindicated in dialysis patients who are candidates for repeat transplantation.
Plain-Language Summary
Patients who start dialysis after a failure of kidney transplant have a high risk of dying. Prior studies have shown that removing the failed kidney may help these patients. This procedure is often not performed; however, out of concern that it may be more difficult to match for a repeat kidney transplant if the failed kidney is removed. Our study shows that patients who have a failed kidney transplant removed have a likelihood of repeat transplant. Therefore, removing a failed kidney should not be considered contraindicated in those hoping for a future kidney transplant.
目的：同种异体移植失败与慢性炎症和低生存率有关。同种异体移植肾切除术与较高水平的抗人类同种异体抗体相关，使得寻找匹配的肾脏供体更加困难；然而，同种异体肾切除术后的重复移植率在很大程度上是未知的。研究设计：回顾性、倾向评分匹配的队列研究。使用美国肾脏数据系统，我们确定了1995年1月1日至2015年12月31日期间肾移植失败后的成人透析患者。共有50,217例患者符合纳入标准。结果：主要结局是重复肾移植。分析方法暴露于肾切除术被建模为一个时变事件。我们使用竞争风险法估计重复肾移植的累积发生率。倾向评分匹配后，每个队列中仍有9696名患者。结果总体而言，行肾切除术的患者接受第二次移植的机会更高（亚分布HR， 1.21; 95% CI, 1.15-1.28; P < 0.001）。在5年、10年和20年，肾切除术组第二次移植的累计发生率分别为19%、28%和31%，而对照组为16%、24%和27%。局限性：作为一项回顾性的、基于登记的研究，不能建立因果关系。结论同种异体肾移植失败的肾切除术与重复移植的可能性较高相关，不应将其视为重复移植候选透析患者的禁忌症。肾移植失败后开始透析的患者有很高的死亡风险。先前的研究表明，切除衰竭的肾脏可能对这些患者有所帮助。这个程序通常不执行；然而，考虑到如果切除了衰竭的肾脏，可能会更难匹配重复的肾脏移植。我们的研究表明，肾移植手术失败的患者有可能再次移植。因此，对于那些希望将来进行肾脏移植的人来说，切除衰竭的肾脏不应该被认为是禁忌。
{"title":"Repeat Transplantation Rate of Patients Receiving Dialysis After Allograft Nephrectomy","authors":"Steven G. Achinger , Juan Carlos Ayus , Ambuj Kumar , Athanasios Tsalatsanis","doi":"10.1016/j.xkme.2025.101157","DOIUrl":"10.1016/j.xkme.2025.101157","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Allograft failure has been associated with chronic inflammation and poor survival among dialysis patients after allograft failure. Allograft nephrectomy is associated with higher levels of anti-human alloantibodies, making it more difficult to find matching kidney donors; however, the rate of repeat transplantation following allograft nephrectomy is largely unknown.</div></div><div><h3>Study Design</h3><div>A retrospective, propensity score-matched cohort study.</div></div><div><h3>Setting & Participants</h3><div>Using the US Renal Data System, we identified adult dialysis patients after a failed kidney transplant between January 1, 1995, and December 31, 2015. A total of 50,217 patients met the inclusion criteria.</div></div><div><h3>Exposure</h3><div>Kidney allograft nephrectomy</div></div><div><h3>Outcomes</h3><div>Primary outcome was repeat kidney transplantation.</div></div><div><h3>Analytical Approach</h3><div>Exposure to nephrectomy was modeled as a time-varying event. We estimated the cumulative incidence of repeat kidney transplant using the competing risk approach. After propensity score matching, 9,696 patients remained in each cohort.</div></div><div><h3>Results</h3><div>Overall, patients with nephrectomy had higher chances of receiving a second transplant (subdistribution HR, 1.21; 95% CI, 1.15-1.28; <em>P</em> < 0.001). The cumulative incidence of second transplant in the nephrectomy group was 19%, 28%, and 31% at 5, 10, and 20 years, respectively, versus 16%, 24%, and 27% in the comparison group.</div></div><div><h3>Limitations</h3><div>As a retrospective, registry-based study, cause and effect relationship cannot be established.</div></div><div><h3>Conclusions</h3><div>Allograft nephrectomy of a failed kidney allograft is associated with a higher likelihood of repeat transplantation and should not be considered contraindicated in dialysis patients who are candidates for repeat transplantation.</div></div><div><h3>Plain-Language Summary</h3><div>Patients who start dialysis after a failure of kidney transplant have a high risk of dying. Prior studies have shown that removing the failed kidney may help these patients. This procedure is often not performed; however, out of concern that it may be more difficult to match for a repeat kidney transplant if the failed kidney is removed. Our study shows that patients who have a failed kidney transplant removed have a likelihood of repeat transplant. Therefore, removing a failed kidney should not be considered contraindicated in those hoping for a future kidney transplant.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 1","pages":"Article 101157"},"PeriodicalIF":3.4,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Currently, Immunoglobulin G4 (IgG4)–related disease is treated with glucocorticoids alone or in combination with other immunosuppressants. Although the initial response rate is substantial, the remission rate is suboptimal, and the recurrence rate following rituximab therapy remains high. Here, we report the first patient with IgG4-related tubulointerstitial nephritis who was treated with obinutuzumab after relapse, providing additional insights for future treatment strategies. This case demonstrates that the obinutuzumab induction and maintenance regimen in patients with IgG4-related tubulointerstitial nephritis can maintain prolonged B-cell depletion, rapidly and persistently reduce inflammation and serum IgG4 levels, and reverse functional impairment in some affected organs.
{"title":"Recurrent IgG4-related Tubulointerstitial Nephritis Successfully Treated With Obinutuzumab: A Case Report and Literature Review","authors":"Shu-Hua Zhu , Du-Qun Chen , Ming-Chao Zhang, Zhe Li, Zhen Cheng","doi":"10.1016/j.xkme.2025.101156","DOIUrl":"10.1016/j.xkme.2025.101156","url":null,"abstract":"<div><div>Currently, Immunoglobulin G4 (IgG4)–related disease is treated with glucocorticoids alone or in combination with other immunosuppressants. Although the initial response rate is substantial, the remission rate is suboptimal, and the recurrence rate following rituximab therapy remains high. Here, we report the first patient with IgG4-related tubulointerstitial nephritis who was treated with obinutuzumab after relapse, providing additional insights for future treatment strategies. This case demonstrates that the obinutuzumab induction and maintenance regimen in patients with IgG4-related tubulointerstitial nephritis can maintain prolonged B-cell depletion, rapidly and persistently reduce inflammation and serum IgG4 levels, and reverse functional impairment in some affected organs.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 1","pages":"Article 101156"},"PeriodicalIF":3.4,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-21DOI: 10.1016/j.xkme.2025.101153
Amelia Chien-Wei Chao , Jack Kit-Chung Ng , Sam Lik-Fung Lau , Winston Wing-Shing Fung , Gordon Chan-Kau Chan , Phyllis Mei-Shan Cheng , Wing-Fai Pang , Kai-Ming Chow , Philip Kam-Tao Li , Cheuk-Chun Szeto
<div><h3>Rational & Objectives</h3><div>Peritonitis is a serious complication of peritoneal dialysis (PD). Current treatment guidelines are directed toward patients receiving continuous ambulatory PD (CAPD), whereas the optimal treatment for those receiving automated PD (APD) is less clear. In this study, we compared the bacteriology and treatment outcomes of peritonitis episodes between patients receiving APD and CAPD and, for peritonitis episodes in patients receiving APD, we studied the difference in clinical outcomes between intermittent and continuous dosing of intraperitoneal antibiotics.</div></div><div><h3>Study Design</h3><div>Single-center, retrospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>One hundred and seventy-six APD peritonitis episodes from 2007 to 2021 were compared to 352 CAPD episodes, matched for age, sex, and diabetes status.</div></div><div><h3>Exposures</h3><div>Mode of PD; intermittent versus continuous dosing of intraperitoneal antibiotics.</div></div><div><h3>Outcomes</h3><div>Primary outcome was the rate of complete cure.</div></div><div><h3>Analytical Approach</h3><div>Groups were compared by χ<sup>2</sup> test, Mann-Whitney <em>U</em> test, <em>t</em> test, or Fisher exact test.</div></div><div><h3>Results</h3><div>The APD group had higher complete cure rates than the CAPD group (88% vs 81%, <em>P</em> = 0.033), but primary response rates were similar. Patients receiving nocturnal intermittent peritoneal dialysis had significantly higher primary response rates (91% vs 80%, <em>P</em> = 0.03) and complete cure rates (95% vs 79%, <em>P</em> < 0.001) than those receiving continuous cyclic peritoneal dialysis. Within the APD group, patients treated with intermittent dosing of intraperitoneal antibiotics demonstrated significantly better primary response rates (91% vs 69%, <em>P</em> < 0.001) and complete cure rates (93% vs 74%, <em>P</em> <0.001) than those converted to CAPD for a continuous regimen.</div></div><div><h3>Limitations</h3><div>Retrospective study; small subgroup size.</div></div><div><h3>Conclusions</h3><div>Peritonitis episodes in patients receiving APD had better treatment outcomes than those receiving CAPD. In the APD group, treatment with intermittent dosing of intraperitoneal antibiotics had better primary response rate and complete cure rate than those treated with continuous regimens.</div></div><div><h3>Plain Language Summary</h3><div>Peritoneal dialysis (PD)–associated peritonitis is a serious and devastating complication in patients undergoing PD. Few studies have investigated the favorable mode of administering intraperitoneal antibiotics in those receiving automated PD (APD). This study investigated the bacteriology and clinical outcomes of peritonitis episodes in patients receiving APD and continuous ambulatory PD (CAPD) and compared the treatment response between intermittent and continuous dosing of intraperitoneal antibiotics. We found that patie
目的腹膜炎是腹膜透析（PD）的严重并发症。目前的治疗指南是针对接受持续动态PD （CAPD）的患者，而接受自动PD （APD）的患者的最佳治疗方法尚不清楚。在本研究中，我们比较了APD和CAPD患者腹膜炎发作的细菌学和治疗结果，对于APD患者腹膜炎发作，我们研究了间歇给药和连续给药腹膜抗生素在临床结果上的差异。研究设计：单中心、回顾性队列研究。背景和参与者将2007年至2021年期间176例APD腹膜炎发作与352例CAPD发作进行比较，这些发作与年龄、性别和糖尿病状况相匹配。曝光模式；间歇与连续给药的腹腔内抗生素。主要观察指标为完全治愈率。分析方法组间比较采用χ2检验、Mann-Whitney U检验、t检验或Fisher精确检验。结果APD组的完全治愈率高于CAPD组（88% vs 81%, P = 0.033），但初次有效率相似。接受夜间间歇腹膜透析的患者原发性缓解率（91% vs 80%, P = 0.03）和完全治愈率（95% vs 79%, P < 0.001）明显高于接受连续循环腹膜透析的患者。在APD组中，间歇给药的腹腔内抗生素治疗的患者显示出明显更好的原发性缓解率（91%对69%，P <0.001）和完全治愈率（93%对74%，P <0.001），比那些转换为连续治疗的CAPD组。LimitationsRetrospective研究;小的子组大小。结论APD组腹膜炎发作的治疗效果优于CAPD组。在APD组中，间歇给药的腹腔内抗生素治疗比连续给药的治疗有更好的初次缓解率和完全治愈率。腹膜透析（PD）相关性腹膜炎是腹膜透析（PD）患者中一种严重且毁灭性的并发症。很少有研究调查了在接受自动PD （APD）的患者中给予腹腔内抗生素的有利模式。本研究探讨了APD和持续动态PD （CAPD）患者腹膜炎发作的细菌学和临床结局，并比较了间歇和连续给药的腹膜内抗生素的治疗效果。我们发现，接受APD的患者腹膜炎发作的完全治愈率高于接受CAPD的患者，接受夜间间歇腹膜透析的患者腹膜炎发作的完全治愈率高于连续循环腹膜透析。此外，间歇给药腹腔注射抗生素的患者比连续给药的患者有更好的初次缓解率、更好的完全治愈率和更短的住院时间。我们的研究结果表明，不建议将接受APD的患者转换为持续腹腔内抗生素治疗腹膜炎发作的CAPD。
{"title":"Outcome of Peritonitis in Automated Peritoneal Dialysis: A Cohort Study","authors":"Amelia Chien-Wei Chao , Jack Kit-Chung Ng , Sam Lik-Fung Lau , Winston Wing-Shing Fung , Gordon Chan-Kau Chan , Phyllis Mei-Shan Cheng , Wing-Fai Pang , Kai-Ming Chow , Philip Kam-Tao Li , Cheuk-Chun Szeto","doi":"10.1016/j.xkme.2025.101153","DOIUrl":"10.1016/j.xkme.2025.101153","url":null,"abstract":"<div><h3>Rational & Objectives</h3><div>Peritonitis is a serious complication of peritoneal dialysis (PD). Current treatment guidelines are directed toward patients receiving continuous ambulatory PD (CAPD), whereas the optimal treatment for those receiving automated PD (APD) is less clear. In this study, we compared the bacteriology and treatment outcomes of peritonitis episodes between patients receiving APD and CAPD and, for peritonitis episodes in patients receiving APD, we studied the difference in clinical outcomes between intermittent and continuous dosing of intraperitoneal antibiotics.</div></div><div><h3>Study Design</h3><div>Single-center, retrospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>One hundred and seventy-six APD peritonitis episodes from 2007 to 2021 were compared to 352 CAPD episodes, matched for age, sex, and diabetes status.</div></div><div><h3>Exposures</h3><div>Mode of PD; intermittent versus continuous dosing of intraperitoneal antibiotics.</div></div><div><h3>Outcomes</h3><div>Primary outcome was the rate of complete cure.</div></div><div><h3>Analytical Approach</h3><div>Groups were compared by χ<sup>2</sup> test, Mann-Whitney <em>U</em> test, <em>t</em> test, or Fisher exact test.</div></div><div><h3>Results</h3><div>The APD group had higher complete cure rates than the CAPD group (88% vs 81%, <em>P</em> = 0.033), but primary response rates were similar. Patients receiving nocturnal intermittent peritoneal dialysis had significantly higher primary response rates (91% vs 80%, <em>P</em> = 0.03) and complete cure rates (95% vs 79%, <em>P</em> < 0.001) than those receiving continuous cyclic peritoneal dialysis. Within the APD group, patients treated with intermittent dosing of intraperitoneal antibiotics demonstrated significantly better primary response rates (91% vs 69%, <em>P</em> < 0.001) and complete cure rates (93% vs 74%, <em>P</em> <0.001) than those converted to CAPD for a continuous regimen.</div></div><div><h3>Limitations</h3><div>Retrospective study; small subgroup size.</div></div><div><h3>Conclusions</h3><div>Peritonitis episodes in patients receiving APD had better treatment outcomes than those receiving CAPD. In the APD group, treatment with intermittent dosing of intraperitoneal antibiotics had better primary response rate and complete cure rate than those treated with continuous regimens.</div></div><div><h3>Plain Language Summary</h3><div>Peritoneal dialysis (PD)–associated peritonitis is a serious and devastating complication in patients undergoing PD. Few studies have investigated the favorable mode of administering intraperitoneal antibiotics in those receiving automated PD (APD). This study investigated the bacteriology and clinical outcomes of peritonitis episodes in patients receiving APD and continuous ambulatory PD (CAPD) and compared the treatment response between intermittent and continuous dosing of intraperitoneal antibiotics. We found that patie","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 1","pages":"Article 101153"},"PeriodicalIF":3.4,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-17DOI: 10.1016/j.xkme.2025.101152
Hannah Tait , Katrina Blazek , Mia E. Abdy , Ivy W. Jiang , Giovanni F.M. Strippoli , Jonathan C. Craig , David J. Tunnicliffe
<div><h3>Rationale & Objective</h3><div>The rigor of randomized controlled trials (RCTs) is essential for evaluating treatment efficacy, but their validity depends on methodological rigor. In nephrology, a field historically underrepresented in RCTs, concerns about trial quality are particularly important. This study evaluates time trends in the conduct and reporting of nephrology RCTs to assess improvements in methodological quality.</div></div><div><h3>Study Design</h3><div>This meta-research study analyzed systematic reviews of kidney disease interventions from the Cochrane Database of Systematic Reviews.</div></div><div><h3>Setting & Participants</h3><div>We included all RCTs and quasi-RCTs of from Cochrane reviews with 7 Cochrane risk of bias domains.</div></div><div><h3>Predictors</h3><div>We used the year 2001 as a cut-point to evaluate the impact of increased awareness of trial methodology following the revised the Consolidated Standards of Reporting Trials (CONSORT) statement.</div></div><div><h3>Outcomes</h3><div>The primary outcome was the change in risk of bias domains over time.</div></div><div><h3>Analytical Approach</h3><div>Piecewise linear regression assessed change in bias domains before and after 2001.</div></div><div><h3>Results</h3><div>From 153 Cochrane reviews, 3083 trials were identified. High bias was most common in detection bias (47%) and least in sequence generation (3%). Between 2001 and 2019, there were increases in low bias across selection bias (1.6% per year; <em>P</em> < 0.001), allocation concealment (1.2% per year; <em>P</em> = 0.016), and selective outcome reporting (1.2% per year; <em>P</em> < 0.05). No change was observed for performance and detection bias domains; however, unclear bias in blinding of outcome assessors decreased (1.2% per year; <em>P</em> < 0.05).</div></div><div><h3>Limitations</h3><div>Findings are based on Cochrane reviews, which may limit generalizability. Bias assessment has evolved, potentially affecting findings over time, and our analyses was unadjusted and did not incorporate potential confounding variables.</div></div><div><h3>Conclusions</h3><div>The conduct of clinical trials in nephrology has improved modestly largely because of better reporting. Ongoing efforts are needed to enhance trial design and ensure RCTs in nephrology are trustworthy and useful to clinical decision makers.</div></div><div><h3>Plain-language Summary</h3><div>Randomized controlled trials are the gold standard for testing treatments, but their quality can vary. In kidney research, randomized controlled trials have often been limited and poorly reported. Our study looked at over 3,000 kidney-related trials from Cochrane reviews to see if they had improved over time. We found that while some aspects of trial design and reporting have gotten better, mostly after 2001. However, many trials still lack clear or strong methods. The improvements were mostly attributed to better reporting, not neces
{"title":"Marginal Improvements in Risk of Bias of Nephrology Randomized Controlled Trials Over Time: A Meta-research Study of Cochrane Reviews of Randomized Controlled Trials","authors":"Hannah Tait , Katrina Blazek , Mia E. Abdy , Ivy W. Jiang , Giovanni F.M. Strippoli , Jonathan C. Craig , David J. Tunnicliffe","doi":"10.1016/j.xkme.2025.101152","DOIUrl":"10.1016/j.xkme.2025.101152","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>The rigor of randomized controlled trials (RCTs) is essential for evaluating treatment efficacy, but their validity depends on methodological rigor. In nephrology, a field historically underrepresented in RCTs, concerns about trial quality are particularly important. This study evaluates time trends in the conduct and reporting of nephrology RCTs to assess improvements in methodological quality.</div></div><div><h3>Study Design</h3><div>This meta-research study analyzed systematic reviews of kidney disease interventions from the Cochrane Database of Systematic Reviews.</div></div><div><h3>Setting & Participants</h3><div>We included all RCTs and quasi-RCTs of from Cochrane reviews with 7 Cochrane risk of bias domains.</div></div><div><h3>Predictors</h3><div>We used the year 2001 as a cut-point to evaluate the impact of increased awareness of trial methodology following the revised the Consolidated Standards of Reporting Trials (CONSORT) statement.</div></div><div><h3>Outcomes</h3><div>The primary outcome was the change in risk of bias domains over time.</div></div><div><h3>Analytical Approach</h3><div>Piecewise linear regression assessed change in bias domains before and after 2001.</div></div><div><h3>Results</h3><div>From 153 Cochrane reviews, 3083 trials were identified. High bias was most common in detection bias (47%) and least in sequence generation (3%). Between 2001 and 2019, there were increases in low bias across selection bias (1.6% per year; <em>P</em> < 0.001), allocation concealment (1.2% per year; <em>P</em> = 0.016), and selective outcome reporting (1.2% per year; <em>P</em> < 0.05). No change was observed for performance and detection bias domains; however, unclear bias in blinding of outcome assessors decreased (1.2% per year; <em>P</em> < 0.05).</div></div><div><h3>Limitations</h3><div>Findings are based on Cochrane reviews, which may limit generalizability. Bias assessment has evolved, potentially affecting findings over time, and our analyses was unadjusted and did not incorporate potential confounding variables.</div></div><div><h3>Conclusions</h3><div>The conduct of clinical trials in nephrology has improved modestly largely because of better reporting. Ongoing efforts are needed to enhance trial design and ensure RCTs in nephrology are trustworthy and useful to clinical decision makers.</div></div><div><h3>Plain-language Summary</h3><div>Randomized controlled trials are the gold standard for testing treatments, but their quality can vary. In kidney research, randomized controlled trials have often been limited and poorly reported. Our study looked at over 3,000 kidney-related trials from Cochrane reviews to see if they had improved over time. We found that while some aspects of trial design and reporting have gotten better, mostly after 2001. However, many trials still lack clear or strong methods. The improvements were mostly attributed to better reporting, not neces","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 1","pages":"Article 101152"},"PeriodicalIF":3.4,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-16DOI: 10.1016/j.xkme.2025.101151
Maria Camila Bermudez , Ankur D. Shah , Osama El Shamy
The comprehensive kidney care contracting program defines Optimal End Stage Renal Disease Starts as new patients with end-stage kidney disease who receive a preemptive kidney transplant, home dialysis, or initiating in-center hemodialysis using an arteriovenous access. These optimal starts are not possible without optimal patient education. Because policy changes make treatment options become available regardless of diagnosis (acute or chronic kidney injury) and setting, education must similarly evolve to be both site-independent and diagnosis-independent. In this piece, we explore gaps in the delivery of kidney failure modality education across the outpatient nephrology clinics, and dialysis units, and inpatient setting. We highlight both national and international models in each that have proven successful, the important role of both urgent-start peritoneal dialysis and transitional care units, and provide a roadmap for the successful implementation of an inpatient kidney failure educational program to help combat the reality of the high incidence of in-center hemodialysis among crash-start patients.
{"title":"Optimal Education: Paving the Way for True Optimal Start Dialysis","authors":"Maria Camila Bermudez , Ankur D. Shah , Osama El Shamy","doi":"10.1016/j.xkme.2025.101151","DOIUrl":"10.1016/j.xkme.2025.101151","url":null,"abstract":"<div><div>The comprehensive kidney care contracting program defines Optimal End Stage Renal Disease Starts as new patients with end-stage kidney disease who receive a preemptive kidney transplant, home dialysis, or initiating in-center hemodialysis using an arteriovenous access. These optimal starts are not possible without optimal patient education. Because policy changes make treatment options become available regardless of diagnosis (acute or chronic kidney injury) and setting, education must similarly evolve to be both site-independent and diagnosis-independent. In this piece, we explore gaps in the delivery of kidney failure modality education across the outpatient nephrology clinics, and dialysis units, and inpatient setting. We highlight both national and international models in each that have proven successful, the important role of both urgent-start peritoneal dialysis and transitional care units, and provide a roadmap for the successful implementation of an inpatient kidney failure educational program to help combat the reality of the high incidence of in-center hemodialysis among crash-start patients.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 12","pages":"Article 101151"},"PeriodicalIF":3.4,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-15DOI: 10.1016/j.xkme.2025.101149
Kywe Kywe Soe , Dinesh Selvarajah
Diabetic kidney disease (DKD) is the leading cause of chronic kidney disease and kidney failure worldwide, with one-third of patients with diabetes developing kidney disease over the course of their lifetime. With no cure for DKD, its management is mainly conservative. Despite advancement in treatments, the rate of DKD progression to kidney failure is unpredictable, varying from months to years in different individuals. Therefore, researchers have been extensively investigating novel risk factors and biomarkers associated with advancement of DKD. One such emerging factor is cardiac autonomic neuropathy (CAN), which is widespread among diabetic population. It has become imperative to assess whether a causal relationship exists between CAN and DKD. This literature review aims to (1) summarize current evidence for the correlation between DKD and CAN in type 1 and type 2 diabetes mellitus, and (2) outline hypotheses for a possible causal relationship between CAN and DKD. The review covers 28 studies (of which 10 in type 1 diabetes) over the last 3 decades, including well-designed cohort and case-control analytic studies that have clearly demonstrated an association between CAN and the progression of DKD by using kidney parameters such as estimated glomerular filtration rate and urinary albuminuria.
{"title":"Cardiac Autonomic Neuropathy and Its Impact on Progression of Diabetic Kidney Disease in Type 1 and Type 2 Diabetes","authors":"Kywe Kywe Soe , Dinesh Selvarajah","doi":"10.1016/j.xkme.2025.101149","DOIUrl":"10.1016/j.xkme.2025.101149","url":null,"abstract":"<div><div>Diabetic kidney disease (DKD) is the leading cause of chronic kidney disease and kidney failure worldwide, with one-third of patients with diabetes developing kidney disease over the course of their lifetime. With no cure for DKD, its management is mainly conservative. Despite advancement in treatments, the rate of DKD progression to kidney failure is unpredictable, varying from months to years in different individuals. Therefore, researchers have been extensively investigating novel risk factors and biomarkers associated with advancement of DKD. One such emerging factor is cardiac autonomic neuropathy (CAN), which is widespread among diabetic population. It has become imperative to assess whether a causal relationship exists between CAN and DKD. This literature review aims to (1) summarize current evidence for the correlation between DKD and CAN in type 1 and type 2 diabetes mellitus, and (2) outline hypotheses for a possible causal relationship between CAN and DKD. The review covers 28 studies (of which 10 in type 1 diabetes) over the last 3 decades, including well-designed cohort and case-control analytic studies that have clearly demonstrated an association between CAN and the progression of DKD by using kidney parameters such as estimated glomerular filtration rate and urinary albuminuria.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 12","pages":"Article 101149"},"PeriodicalIF":3.4,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-15DOI: 10.1016/j.xkme.2025.101150
Ellie Kelepouris , Connie M. Rhee
Chronic kidney disease-associated pruritus (CKD-aP) has been shown to have a negative impact on many aspects of patients’ health-related quality of life, as well as clinical outcomes. Despite this, CKD-aP is often underrecognized and underdiagnosed. There are a variety of patient-reported outcome tools that can be used to measure the severity of pruritus symptoms more effectively than conventional medical assessments, as well as capture information on the impact of pruritus on patients’ health-related quality of life. However, these instruments are not often used, leading to the failed identification of unpleasant symptoms, underappreciation of symptom burden, and missed opportunities for treatment. In this perspective, we combine the opinions of key clinicians and stakeholders to emphasize the need for timely and efficient CKD-aP diagnosis and treatment and to show a clear need for a paradigm shift toward a symptom-focused approach to chronic kidney disease and CKD-aP management, as well as providing practical advice on how to implement this in the clinical setting.
{"title":"CKD-Associated Pruritus: A Patient-Centered Approach to Reduce Symptom Burden","authors":"Ellie Kelepouris , Connie M. Rhee","doi":"10.1016/j.xkme.2025.101150","DOIUrl":"10.1016/j.xkme.2025.101150","url":null,"abstract":"<div><div>Chronic kidney disease-associated pruritus (CKD-aP) has been shown to have a negative impact on many aspects of patients’ health-related quality of life, as well as clinical outcomes. Despite this, CKD-aP is often underrecognized and underdiagnosed. There are a variety of patient-reported outcome tools that can be used to measure the severity of pruritus symptoms more effectively than conventional medical assessments, as well as capture information on the impact of pruritus on patients’ health-related quality of life. However, these instruments are not often used, leading to the failed identification of unpleasant symptoms, underappreciation of symptom burden, and missed opportunities for treatment. In this perspective, we combine the opinions of key clinicians and stakeholders to emphasize the need for timely and efficient CKD-aP diagnosis and treatment and to show a clear need for a paradigm shift toward a symptom-focused approach to chronic kidney disease and CKD-aP management, as well as providing practical advice on how to implement this in the clinical setting.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 12","pages":"Article 101150"},"PeriodicalIF":3.4,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：