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Complete Remission After Percutaneous Renal Artery Angioplasty for Focal Segmental Glomerulosclerosis due to Takayasu Disease: A Case Report 经皮肾动脉血管成形术治疗高松病引起的局灶节段性肾小球硬化后完全缓解1例。
IF 3.4 Q1 UROLOGY & NEPHROLOGY Pub Date : 2026-03-01 Epub Date: 2026-01-08 DOI: 10.1016/j.xkme.2026.101251
Yusuke Ushio , Shun Manabe , Anna Nakai , Momoko Seki , Shiho Makabe , Shizuka Kobayashi , Yuki Kawaguchi , Hiroshi Kataoka , Naoko Ito , Sekiko Taneda , Kazuho Honda , Junichi Hoshino
Renal artery stenosis is a common complication of Takayasu disease; however, the presence of nephrotic syndrome is rare. Percutaneous transluminal renal angioplasty (PTRA) is performed for renal artery stenosis; however, its efficacy is unclear for renal artery stenosis complicated with nephrotic syndrome. This is a case report of Takayasu disease in an 18-year-old woman with no relevant medical history. Magnetic resonance angiography revealed bilateral renal artery stenosis, and nephrotic syndrome was noted. Focal segmental glomerulosclerosis was diagnosed based on renal biopsy. As atrophy was observed in the right kidney, PTRA was performed for the left renal artery stenosis. Urine protein levels decreased subsequently, leading to remission. Renal artery stenosis may commonly occur due to Takayasu disease; however, the resulting accentuation of the renin-angiotensin-aldosterone cascade and increased intraglomerular pressure may cause focal segmental glomerulosclerosis. PTRA may induce remission if renal dysfunction is mild, and it should be performed as early as possible.
肾动脉狭窄是高须病的常见并发症;然而,肾病综合征的存在是罕见的。肾动脉狭窄行经皮腔内肾血管成形术(PTRA);然而,其对肾动脉狭窄合并肾病综合征的疗效尚不清楚。本文报告一例高须病,患者为18岁女性,无相关病史。磁共振血管造影显示双侧肾动脉狭窄,并发肾病综合征。局灶节段性肾小球硬化是基于肾活检诊断的。右肾萎缩,左肾动脉狭窄行PTRA治疗。随后尿蛋白水平下降,导致缓解。肾动脉狭窄常见于高须病;然而,肾素-血管紧张素-醛固酮级联的加重和肾小球内压力的增加可能导致局灶节段性肾小球硬化。如果肾功能不全,PTRA可引起缓解,应尽早进行。
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引用次数: 0
Uptake of Newly Licensed Influenza Vaccine Formulations Among Patients Receiving Chronic Hemodialysis During the 2010/2011 to 2021/2022 Influenza Seasons 2010/2011年至2021/2022年流感季节接受慢性血液透析患者新许可流感疫苗制剂的摄取
IF 3.4 Q1 UROLOGY & NEPHROLOGY Pub Date : 2026-03-01 Epub Date: 2026-01-06 DOI: 10.1016/j.xkme.2026.101243
John M. Sahrmann MA , J. Bradley Layton PhD , Katelin B. Nickel MPH , John W. Davis MD, PhD , Vikas R. Dharnidharka MD, MPH , David J. Weber MD, MPH , Anne M. Butler PhD
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引用次数: 0
Efficacy of Low-Dose Tolvaptan for Treatment of Profound Hyponatremia in Syndrome of Inappropriate Antidiuresis (SIAD): The EFFLUX-FLUID TRIAL 低剂量托伐普坦治疗重度低钠血症不适当抗利尿综合征(SIAD)的疗效:外排液试验。
IF 3.4 Q1 UROLOGY & NEPHROLOGY Pub Date : 2026-03-01 Epub Date: 2026-01-05 DOI: 10.1016/j.xkme.2025.101239
Narongchai Jaiyen , Sutatip Chinpraditsuk , Pattharawin Pattharanitima , Pichaya Tantiyavarong , Pajaree Krisanapan
<div><h3>Rationale & Objective</h3><div>Although tolvaptan is effective for treating hyponatremia in the syndrome of inappropriate antidiuresis (SIAD), fluid restriction remains the first-line therapy because of safety concerns. This study evaluated whether low-dose tolvaptan is more effective than a combination of fluid restriction, furosemide, and sodium chloride tablets in patients with profound hyponatremia and clinical predictors of fluid restriction failure.</div></div><div><h3>Study Design</h3><div>Single-center, open-label, randomized controlled trial.</div></div><div><h3>Setting & Participants</h3><div>Hospitalized adults with chronic SIAD and serum sodium concentration [Na<sup>+</sup>] ≤125 mmol/L, meeting ≥ 1 predictor of fluid restriction failure (urine osmolality >500 mOsm/kg H<sub>2</sub>O, sum of urine sodium and potassium > [Na<sup>+</sup>], or urine volume <1,500 mL/day). Twenty-nine patients were randomized (13 to tolvaptan, 16 to control).</div></div><div><h3>Exposure(s)</h3><div>Tolvaptan 7.5 mg/day with liberal fluid intake versus fluid restriction (800 mL/day), furosemide (20-40 mg/day), and sodium chloride tablets (3 g/day) for 28 days.</div></div><div><h3>Outcome(s)</h3><div>The primary outcome was change in [Na<sup>+</sup>] from baseline to day 4. Secondary outcomes include change in [Na<sup>+</sup>] through day 28, achievement of [Na<sup>+</sup>] ≥130 mmol/L at day 4, time to correction, and adverse events.</div></div><div><h3>Analytical Approach</h3><div>Intention-to-treat analysis using <em>t</em> tests, Fisher exact test, Kaplan–Meier estimates, and generalized estimating equation models.</div></div><div><h3>Results</h3><div>Mean baseline [Na<sup>+</sup>] was 120 ± 3 mmol/L. By day 4, [Na<sup>+</sup>] increased significantly more with tolvaptan (12.2 ± 3.4 vs 6.3 ± 6.0 mmol/L; <em>P</em> = 0.004), with continued benefit on days 7 and 14. More patients achieved [Na<sup>+</sup>] ≥130 mmol/L at day 4 (77% vs 25%; <em>P</em> = 0.009), with shorter median time to correction (2 vs 14 days; <em>P</em> = 0.02). Hypokalemia was less frequent with tolvaptan (8% vs 44%; <em>P</em> = 0.04). Overcorrection occurred in 3 tolvaptan patients (23%) without clinical sequelae (<em>P</em> = 0.08).</div></div><div><h3>Limitations</h3><div>Small sample size and single-center design.</div></div><div><h3>Conclusions</h3><div>Low-dose tolvaptan effectively and rapidly increases [Na<sup>+</sup>] in SIAD patients with predictors of fluid restriction failure, with acceptable safety under close monitoring.</div></div><div><h3>Plain-Language Summary</h3><div>Hyponatremia, or low blood sodium levels, is a common and potentially serious condition in hospitalized patients. Fluid restriction is the standard first-line treatment, but it is often ineffective in patients with the syndrome of inappropriate antidiuresis (SIAD). This study evaluated whether low-dose tolvaptan could improve outcomes in patients at high risk of fluid restrict
理由与目的:尽管托伐普坦对不适当抗利尿综合征(SIAD)中的低钠血症有效,但由于安全性考虑,限制液体仍然是一线治疗。本研究评估了在深度低钠血症患者中,低剂量托伐普坦是否比限流、速尿和氯化钠片联合使用更有效,以及限流失败的临床预测指标。研究设计:单中心、开放标签、随机对照试验。环境和参与者:慢性SIAD住院成人,血清钠浓度[Na+]≤125 mmol/L,符合限流失败的≥1个预测因子(尿渗透压>500 mOsm/kg H2O,尿钠和钾> [Na+]之和,或尿量暴露:托伐普坦7.5 mg/天,自由液体摄入vs限流(800 mL/天),速尿(20-40 mg/天),氯化钠片(3 g/天)28天。结果:主要结果是[Na+]从基线到第4天的变化。次要结局包括第28天[Na+]的变化,第4天[Na+]达到≥130 mmol/L,矫正时间和不良事件。分析方法:使用t检验、Fisher精确检验、Kaplan-Meier估计和广义估计方程模型进行意向治疗分析。结果:平均基线[Na+]为120±3 mmol/L。到第4天,托伐普坦组[Na+]明显增加(12.2±3.4 vs 6.3±6.0 mmol/L; P = 0.004),在第7天和第14天继续受益。更多患者在第4天达到[Na+]≥130 mmol/L (77% vs 25%, P = 0.009),中位矫正时间更短(2天vs 14天,P = 0.02)。托伐普坦组低钾血症发生率较低(8% vs 44%; P = 0.04)。3例托伐普坦患者(23%)出现过矫正,无临床后遗症(P = 0.08)。局限性:样本量小,单中心设计。结论:低剂量托伐普坦在SIAD患者中有效且快速地增加[Na+],并在密切监测下具有可接受的安全性。
{"title":"Efficacy of Low-Dose Tolvaptan for Treatment of Profound Hyponatremia in Syndrome of Inappropriate Antidiuresis (SIAD): The EFFLUX-FLUID TRIAL","authors":"Narongchai Jaiyen ,&nbsp;Sutatip Chinpraditsuk ,&nbsp;Pattharawin Pattharanitima ,&nbsp;Pichaya Tantiyavarong ,&nbsp;Pajaree Krisanapan","doi":"10.1016/j.xkme.2025.101239","DOIUrl":"10.1016/j.xkme.2025.101239","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Although tolvaptan is effective for treating hyponatremia in the syndrome of inappropriate antidiuresis (SIAD), fluid restriction remains the first-line therapy because of safety concerns. This study evaluated whether low-dose tolvaptan is more effective than a combination of fluid restriction, furosemide, and sodium chloride tablets in patients with profound hyponatremia and clinical predictors of fluid restriction failure.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Single-center, open-label, randomized controlled trial.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Hospitalized adults with chronic SIAD and serum sodium concentration [Na&lt;sup&gt;+&lt;/sup&gt;] ≤125 mmol/L, meeting ≥ 1 predictor of fluid restriction failure (urine osmolality &gt;500 mOsm/kg H&lt;sub&gt;2&lt;/sub&gt;O, sum of urine sodium and potassium &gt; [Na&lt;sup&gt;+&lt;/sup&gt;], or urine volume &lt;1,500 mL/day). Twenty-nine patients were randomized (13 to tolvaptan, 16 to control).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure(s)&lt;/h3&gt;&lt;div&gt;Tolvaptan 7.5 mg/day with liberal fluid intake versus fluid restriction (800 mL/day), furosemide (20-40 mg/day), and sodium chloride tablets (3 g/day) for 28 days.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome(s)&lt;/h3&gt;&lt;div&gt;The primary outcome was change in [Na&lt;sup&gt;+&lt;/sup&gt;] from baseline to day 4. Secondary outcomes include change in [Na&lt;sup&gt;+&lt;/sup&gt;] through day 28, achievement of [Na&lt;sup&gt;+&lt;/sup&gt;] ≥130 mmol/L at day 4, time to correction, and adverse events.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Intention-to-treat analysis using &lt;em&gt;t&lt;/em&gt; tests, Fisher exact test, Kaplan–Meier estimates, and generalized estimating equation models.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Mean baseline [Na&lt;sup&gt;+&lt;/sup&gt;] was 120 ± 3 mmol/L. By day 4, [Na&lt;sup&gt;+&lt;/sup&gt;] increased significantly more with tolvaptan (12.2 ± 3.4 vs 6.3 ± 6.0 mmol/L; &lt;em&gt;P&lt;/em&gt; = 0.004), with continued benefit on days 7 and 14. More patients achieved [Na&lt;sup&gt;+&lt;/sup&gt;] ≥130 mmol/L at day 4 (77% vs 25%; &lt;em&gt;P&lt;/em&gt; = 0.009), with shorter median time to correction (2 vs 14 days; &lt;em&gt;P&lt;/em&gt; = 0.02). Hypokalemia was less frequent with tolvaptan (8% vs 44%; &lt;em&gt;P&lt;/em&gt; = 0.04). Overcorrection occurred in 3 tolvaptan patients (23%) without clinical sequelae (&lt;em&gt;P&lt;/em&gt; = 0.08).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Small sample size and single-center design.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Low-dose tolvaptan effectively and rapidly increases [Na&lt;sup&gt;+&lt;/sup&gt;] in SIAD patients with predictors of fluid restriction failure, with acceptable safety under close monitoring.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Hyponatremia, or low blood sodium levels, is a common and potentially serious condition in hospitalized patients. Fluid restriction is the standard first-line treatment, but it is often ineffective in patients with the syndrome of inappropriate antidiuresis (SIAD). This study evaluated whether low-dose tolvaptan could improve outcomes in patients at high risk of fluid restrict","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 3","pages":"Article 101239"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165804","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}
引用次数: 0
Determining Physical Function Measures for Estimating VO2Peak in Patients Receiving Hemodialysis 测定血液透析患者身体功能指标估算VO2Peak。
IF 3.4 Q1 UROLOGY & NEPHROLOGY Pub Date : 2026-03-01 Epub Date: 2026-01-05 DOI: 10.1016/j.xkme.2026.101244
Nolan W. Groninger , Monique Campos , Eliott Arroyo , Gayatri Narayanan , Heather N. Burney , Xiaochun Li , Drake E. Dillman , Keith G. Avin , S. Jawad Sher , Sharon L. Karp , Sharon M. Moe , Kenneth Lim
<div><h3>Rationale & Objective</h3><div>Cardiopulmonary exercise testing is the gold standard for evaluating cardiovascular functional capacity, as assessed by oxygen uptake at peak exercise (VO<sub>2</sub>Peak). Traditional physical function tests have been proposed as predictive of VO<sub>2</sub>Peak, although their associations remain inconclusive in individuals with kidney failure. This study aimed to assess whether comprehensive physical function metrics are associated with VO<sub>2</sub>Peak in patients receiving hemodialysis.</div></div><div><h3>Study Design</h3><div>Cross-sectional analysis from the “Effects of Long Interdialytic Intervals on Cardiovascular Functional Capacity (ECON)” study.</div></div><div><h3>Setting & Participants</h3><div>Thirty patients with kidney failure receiving maintenance thrice-weekly hemodialysis.</div></div><div><h3>Predictors</h3><div>Physical function tests.</div></div><div><h3>Outcomes</h3><div>VO<sub>2</sub>Peak (mL·min<sup>−1</sup>·kg<sup>−1</sup>) measured by cardiopulmonary exercise testing, with participants dichotomized into Low (n=14) and High (n=16) VO<sub>2</sub>Peak groups.</div></div><div><h3>Analytical Approach</h3><div>Group comparisons for demographics and physical function measures were performed. Multivariable linear regression was used to assess associations.</div></div><div><h3>Results</h3><div>The Low and High groups were well matched by age, sex, and race (all <em>P</em> ≥ 0.05). However, body mass index (32.7 ± 6.7 kg/m<sup>2</sup> vs 26.9 ± 6.5 kg/m<sup>2</sup>; <em>P</em> = 0.02) and fat mass composition (41.8 ± 7.3% vs 28.9 ± 12.0%; <em>P</em> = 0.002) were significantly higher in the Low group. The Short Form-36-Physical Function Scale total score, standing static balance test score, number of sit-to-stands in 30 seconds (30sec-STS), total Short Physical Performance Battery score, Patient-Reported Outcomes Measurement Information System physical function computerized adaptive testing, Patient-Reported Outcomes Measurement Information System physical mobility computerized adaptive testing, handgrip strength, and 6-minute walk test were all significantly associated with VO<sub>2</sub>Peak (all <em>P</em> < 0.05). However, after adjusting for age, sex, and fat mass composition, only 30sec-STS was significantly associated with VO<sub>2</sub>Peak (<em>P</em> = 0.04).</div></div><div><h3>Limitations</h3><div>The study’s small sample size and cross-sectional design limit statistical power and causal inference.</div></div><div><h3>Conclusions</h3><div>Metrics of basic physical function demonstrate limited association with VO<sub>2</sub>Peak in patients on hemodialysis, except for the 30sec-STS test.</div></div><div><h3>Plain-Language Summary</h3><div>People with kidney failure often have serious heart and muscle problems that limit their ability to exercise. This study tested how simple physical function tests relate to cardiovascular fitness, measured by oxygen use during exer
原理与目的:心肺运动试验是评价心血管功能的金标准,通过峰值运动时的摄氧量(VO2Peak)来评估。传统的身体功能测试已被提出作为VO2Peak的预测指标,尽管它们在肾衰竭患者中的相关性仍不确定。本研究旨在评估接受血液透析患者的综合身体功能指标是否与VO2Peak相关。研究设计:“长透析间隔时间对心血管功能(ECON)的影响”研究的横断面分析。环境与参与者:30例肾衰竭患者接受维持性血液透析,每周3次。预测指标:身体机能测试。结果:通过心肺运动试验测量VO2Peak (mL·min-1·kg-1),参与者分为低(n=14)和高(n=16) VO2Peak组。分析方法:进行人口统计学和身体功能测量的组间比较。多变量线性回归用于评估相关性。结果:低组和高组在年龄、性别、种族上匹配良好(P均≥0.05)。然而,体重指数(32.7±6.7 kg/m2 vs 26.9±6.5 kg/m2, P = 0.02)和脂肪质量组成(41.8±7.3% vs 28.9±12.0%,P = 0.002)在低组显著更高。短表36-身体功能量表总分、站立静态平衡测试分数、30秒内坐转站次数、短表身体功能电池总分、患者报告结果测量信息系统身体功能计算机化适应测试、患者报告结果测量信息系统身体活动能力计算机化适应测试、握力、6分钟步行试验与VO2Peak均有显著相关(P < 0.05)。然而,在调整了年龄、性别和脂肪质量组成后,只有30sec-STS与VO2Peak显著相关(P = 0.04)。局限性:研究的小样本量和横断面设计限制了统计能力和因果推断。结论:除30sec-STS测试外,血液透析患者的基本身体功能指标与VO2Peak的相关性有限。
{"title":"Determining Physical Function Measures for Estimating VO2Peak in Patients Receiving Hemodialysis","authors":"Nolan W. Groninger ,&nbsp;Monique Campos ,&nbsp;Eliott Arroyo ,&nbsp;Gayatri Narayanan ,&nbsp;Heather N. Burney ,&nbsp;Xiaochun Li ,&nbsp;Drake E. Dillman ,&nbsp;Keith G. Avin ,&nbsp;S. Jawad Sher ,&nbsp;Sharon L. Karp ,&nbsp;Sharon M. Moe ,&nbsp;Kenneth Lim","doi":"10.1016/j.xkme.2026.101244","DOIUrl":"10.1016/j.xkme.2026.101244","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Cardiopulmonary exercise testing is the gold standard for evaluating cardiovascular functional capacity, as assessed by oxygen uptake at peak exercise (VO&lt;sub&gt;2&lt;/sub&gt;Peak). Traditional physical function tests have been proposed as predictive of VO&lt;sub&gt;2&lt;/sub&gt;Peak, although their associations remain inconclusive in individuals with kidney failure. This study aimed to assess whether comprehensive physical function metrics are associated with VO&lt;sub&gt;2&lt;/sub&gt;Peak in patients receiving hemodialysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Cross-sectional analysis from the “Effects of Long Interdialytic Intervals on Cardiovascular Functional Capacity (ECON)” study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Thirty patients with kidney failure receiving maintenance thrice-weekly hemodialysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Predictors&lt;/h3&gt;&lt;div&gt;Physical function tests.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;VO&lt;sub&gt;2&lt;/sub&gt;Peak (mL·min&lt;sup&gt;−1&lt;/sup&gt;·kg&lt;sup&gt;−1&lt;/sup&gt;) measured by cardiopulmonary exercise testing, with participants dichotomized into Low (n=14) and High (n=16) VO&lt;sub&gt;2&lt;/sub&gt;Peak groups.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Group comparisons for demographics and physical function measures were performed. Multivariable linear regression was used to assess associations.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The Low and High groups were well matched by age, sex, and race (all &lt;em&gt;P&lt;/em&gt; ≥ 0.05). However, body mass index (32.7 ± 6.7 kg/m&lt;sup&gt;2&lt;/sup&gt; vs 26.9 ± 6.5 kg/m&lt;sup&gt;2&lt;/sup&gt;; &lt;em&gt;P&lt;/em&gt; = 0.02) and fat mass composition (41.8 ± 7.3% vs 28.9 ± 12.0%; &lt;em&gt;P&lt;/em&gt; = 0.002) were significantly higher in the Low group. The Short Form-36-Physical Function Scale total score, standing static balance test score, number of sit-to-stands in 30 seconds (30sec-STS), total Short Physical Performance Battery score, Patient-Reported Outcomes Measurement Information System physical function computerized adaptive testing, Patient-Reported Outcomes Measurement Information System physical mobility computerized adaptive testing, handgrip strength, and 6-minute walk test were all significantly associated with VO&lt;sub&gt;2&lt;/sub&gt;Peak (all &lt;em&gt;P&lt;/em&gt; &lt; 0.05). However, after adjusting for age, sex, and fat mass composition, only 30sec-STS was significantly associated with VO&lt;sub&gt;2&lt;/sub&gt;Peak (&lt;em&gt;P&lt;/em&gt; = 0.04).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;The study’s small sample size and cross-sectional design limit statistical power and causal inference.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Metrics of basic physical function demonstrate limited association with VO&lt;sub&gt;2&lt;/sub&gt;Peak in patients on hemodialysis, except for the 30sec-STS test.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;People with kidney failure often have serious heart and muscle problems that limit their ability to exercise. This study tested how simple physical function tests relate to cardiovascular fitness, measured by oxygen use during exer","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 3","pages":"Article 101244"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165782","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}
引用次数: 0
The Impact of Tenapanor on Serum Phosphate in Adult Dialysis Patients: A Narrative Review 泰纳帕诺对成人透析患者血清磷酸盐的影响:一项叙述性综述
IF 3.4 Q1 UROLOGY & NEPHROLOGY Pub Date : 2026-03-01 Epub Date: 2026-01-03 DOI: 10.1016/j.xkme.2025.101237
Malki Waldman, Stephani Johnson, Melanie Newkirk, Corey Hawes, Laura Byham-Gray
Managing hyperphosphatemia remains a challenging feat in the dialysis population. In 2023, tenapanor, a sodium hydrogen exchanger inhibitor, was approved in the United States for treating hyperphosphatemia in adults with chronic kidney disease receiving dialysis. This narrative review evaluated the recent literature on tenapanor, its effects on serum phosphate, and the achievement of target serum phosphate reference ranges in individuals undergoing peritoneal and hemodialysis. In addition to efficacy, this review examined the prevalence of drug-induced diarrhea. Twelve articles met the inclusion criteria. Results indicate clinical and statistical differences in the mean change in serum phosphate and a greater tendency to achieve serum phosphate target reference ranges among individuals receiving dialysis who take tenapanor compared with those who do not. These findings support using tenapanor independently or in conjunction with phosphate binders to treat hyperphosphatemia. However, drug-induced diarrhea may lead to discontinuation of tenapanor therapy. Future research should focus on nutrition counseling to mitigate drug-induced diarrhea and extend tenapanor tolerance in individuals receiving dialysis.
在透析人群中,管理高磷血症仍然是一项具有挑战性的壮举。2023年,tenapanor(一种氢交换钠抑制剂)在美国被批准用于治疗接受透析的成人慢性肾病患者的高磷血症。这篇叙述性综述评估了最近关于tenapanor的文献,它对血清磷酸盐的影响,以及在接受腹膜透析和血液透析的个体中实现的目标血清磷酸盐参考范围。除了疗效外,本综述还调查了药物性腹泻的患病率。12篇文章符合纳入标准。结果表明,在接受透析的个体中,服用tenapanor的患者与不服用tenapanor的患者相比,血清磷酸盐的平均变化有临床和统计学上的差异,并且更倾向于达到血清磷酸盐目标参考范围。这些发现支持单独使用tenapanor或与磷酸盐结合剂联合使用来治疗高磷血症。然而,药物性腹泻可能导致tenapanor治疗停止。未来的研究应侧重于营养咨询,以减轻药物引起的腹泻,并扩大接受透析的个体的tenapanor耐受性。
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引用次数: 0
Causal Effect of Kidney Function on Lipid Metabolism: An Integrated Population-Scale Observational Analysis and Mendelian Randomization Study 肾功能对脂质代谢的因果影响:一项综合人群规模观察分析和孟德尔随机化研究。
IF 3.4 Q1 UROLOGY & NEPHROLOGY Pub Date : 2026-03-01 Epub Date: 2026-01-05 DOI: 10.1016/j.xkme.2026.101245
Minsang Kim , Jung Hun Koh , Seong Geun Kim , Soojin Lee , Yaerim Kim , Jeong Min Cho , Semin Cho , Kwangsoo Kim , Yong Chul Kim , Seung Seok Han , Hajeong Lee , Jung Pyo Lee , Kwon Wook Joo , Chun Soo Lim , Yon Su Kim , Dong Ki Kim , Sehoon Park
<div><h3>Rationale & Objective</h3><div>Additional investigations into the causal effects of kidney function on various metabolites, particularly lipoprotein lipids in detailed subfractions of lipoprotein particles, in the general population are warranted.</div></div><div><h3>Study Design</h3><div>Integrated cross-sectional observational and Mendelian randomization (MR) analyses.</div></div><div><h3>Setting & Participants</h3><div>We included 157,541 participants aged 40-69 years from the UK Biobank study, a population-scale prospective cohort. Genetic instruments for estimated glomerular filtration rate (eGFR) were developed from the Chronic Kidney Disease Genetics genome-wide association study meta-analysis results, which comprised 567,460 individuals of European ancestry.</div></div><div><h3>Exposure</h3><div>eGFR for observational analysis and genetically predicted eGFR for MR analysis.</div></div><div><h3>Outcomes</h3><div>Each of the 178 metabolites from recently updated metabolomics data, including detailed lipoprotein components within 14 subclasses of lipoprotein particles.</div></div><div><h3>Analytical Approach</h3><div>Observational analysis was performed using multivariate linear regression adjusted for various clinicodemographic characteristics. A 2-sample MR analysis was performed using the random-effects inverse-variance weighted method as the main MR method.</div></div><div><h3>Results</h3><div>In the integrated results of the observational and MR analyses, 25 metabolites were causally associated with eGFR. A lower eGFR causally decreased lipoprotein components of high-density lipoprotein and several of its subclasses, particularly medium-sized high-density lipoprotein. Conversely, a lower eGFR causally increased triglyceride levels in smaller-sized very low–density lipoprotein and intermediate-density lipoprotein, as well as increased lipoprotein particle concentrations and total lipids in small very low–density lipoprotein. Additionally, a lower eGFR causally increased the ratio of monounsaturated fatty acids to total fatty acids and that of apolipoprotein B to apolipoprotein A-1.</div></div><div><h3>Limitations</h3><div>Possibility of false-negative findings when integrating observational and MR analyses.</div></div><div><h3>Conclusions</h3><div>Decreased kidney function causally aggravates lipoprotein lipid profiles; therefore, clinicians should closely monitor the lipid profiles of individuals with impaired kidney function.</div></div><div><h3>Plain-Language Summary</h3><div>The kidney plays an essential role in body metabolism and interacts with metabolic risk factors that can lead to adverse clinical outcomes. We aimed to identify how declining kidney function affects various metabolites, including lipids within detailed subclasses of lipoproteins, by integrating observational and Mendelian randomization analyses. We used a large, published genetic dataset and a database including 157,541 participants in the United
理由与目的:在普通人群中,需要进一步研究肾功能对各种代谢物的因果关系,特别是脂蛋白颗粒中详细亚组分的脂蛋白脂。研究设计:综合横断面观察和孟德尔随机化(MR)分析。环境和参与者:我们从英国生物银行研究中纳入了157541名年龄在40-69岁之间的参与者,这是一个人口规模的前瞻性队列。估计肾小球滤过率(eGFR)的遗传工具是根据慢性肾病遗传学全基因组关联研究荟萃分析结果开发的,该研究包括567,460名欧洲血统的个体。暴露:eGFR用于观察分析,基因预测eGFR用于MR分析。结果:来自最近更新的代谢组学数据的178种代谢物中的每一种,包括脂蛋白颗粒14个亚类中的详细脂蛋白成分。分析方法:观察性分析采用多变量线性回归调整各种临床人口学特征。采用随机效应反方差加权法作为主要MR方法进行2样本MR分析。结果:在观察和MR分析的综合结果中,25种代谢物与eGFR有因果关系。较低的eGFR导致高密度脂蛋白及其几个亚类的脂蛋白成分减少,特别是中等大小的高密度脂蛋白。相反,较低的eGFR会导致小尺寸极低密度脂蛋白和中密度脂蛋白中甘油三酯水平的升高,以及小尺寸极低密度脂蛋白中脂蛋白颗粒浓度和总脂质的升高。此外,较低的eGFR导致单不饱和脂肪酸与总脂肪酸的比例以及载脂蛋白B与载脂蛋白a -1的比例升高。局限性:在整合观察和MR分析时存在假阴性结果的可能性。结论:肾功能下降导致脂蛋白脂谱恶化;因此,临床医生应密切监测肾功能受损个体的脂质谱。
{"title":"Causal Effect of Kidney Function on Lipid Metabolism: An Integrated Population-Scale Observational Analysis and Mendelian Randomization Study","authors":"Minsang Kim ,&nbsp;Jung Hun Koh ,&nbsp;Seong Geun Kim ,&nbsp;Soojin Lee ,&nbsp;Yaerim Kim ,&nbsp;Jeong Min Cho ,&nbsp;Semin Cho ,&nbsp;Kwangsoo Kim ,&nbsp;Yong Chul Kim ,&nbsp;Seung Seok Han ,&nbsp;Hajeong Lee ,&nbsp;Jung Pyo Lee ,&nbsp;Kwon Wook Joo ,&nbsp;Chun Soo Lim ,&nbsp;Yon Su Kim ,&nbsp;Dong Ki Kim ,&nbsp;Sehoon Park","doi":"10.1016/j.xkme.2026.101245","DOIUrl":"10.1016/j.xkme.2026.101245","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Additional investigations into the causal effects of kidney function on various metabolites, particularly lipoprotein lipids in detailed subfractions of lipoprotein particles, in the general population are warranted.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Integrated cross-sectional observational and Mendelian randomization (MR) analyses.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;We included 157,541 participants aged 40-69 years from the UK Biobank study, a population-scale prospective cohort. Genetic instruments for estimated glomerular filtration rate (eGFR) were developed from the Chronic Kidney Disease Genetics genome-wide association study meta-analysis results, which comprised 567,460 individuals of European ancestry.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;eGFR for observational analysis and genetically predicted eGFR for MR analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Each of the 178 metabolites from recently updated metabolomics data, including detailed lipoprotein components within 14 subclasses of lipoprotein particles.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Observational analysis was performed using multivariate linear regression adjusted for various clinicodemographic characteristics. A 2-sample MR analysis was performed using the random-effects inverse-variance weighted method as the main MR method.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;In the integrated results of the observational and MR analyses, 25 metabolites were causally associated with eGFR. A lower eGFR causally decreased lipoprotein components of high-density lipoprotein and several of its subclasses, particularly medium-sized high-density lipoprotein. Conversely, a lower eGFR causally increased triglyceride levels in smaller-sized very low–density lipoprotein and intermediate-density lipoprotein, as well as increased lipoprotein particle concentrations and total lipids in small very low–density lipoprotein. Additionally, a lower eGFR causally increased the ratio of monounsaturated fatty acids to total fatty acids and that of apolipoprotein B to apolipoprotein A-1.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Possibility of false-negative findings when integrating observational and MR analyses.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Decreased kidney function causally aggravates lipoprotein lipid profiles; therefore, clinicians should closely monitor the lipid profiles of individuals with impaired kidney function.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;The kidney plays an essential role in body metabolism and interacts with metabolic risk factors that can lead to adverse clinical outcomes. We aimed to identify how declining kidney function affects various metabolites, including lipids within detailed subclasses of lipoproteins, by integrating observational and Mendelian randomization analyses. We used a large, published genetic dataset and a database including 157,541 participants in the United","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 3","pages":"Article 101245"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326645","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}
引用次数: 0
Multinational Real-World Practice Patterns in the Use of Antithrombotic Therapy Among Patients on Hemodialysis and Peritoneal Dialysis 血液透析和腹膜透析患者使用抗血栓治疗的跨国现实世界实践模式。
IF 3.4 Q1 UROLOGY & NEPHROLOGY Pub Date : 2026-03-01 Epub Date: 2025-12-12 DOI: 10.1016/j.xkme.2025.101211
Murilo Guedes , Calvin Andrews , Junhui Zhao , G. Brandon Atkins , Irina Barash , Lori D. Bash , Catelyn R. Coyle , Xuehua Ke , Dena R. Ramey , David W. Johnson , Pablo Ureña-Torres , Pietro Manuel Ferraro , Mohammed Al Ghonaim , Marc P. Bonaca , Roberto Pecoits-Filho , Angelo Karaboyas
<div><h3>Rationale & Objective</h3><div>Patients with kidney failure requiring maintenance dialysis have a high risk of cardiovascular events warranting antithrombotic therapies, including oral anticoagulant (OAC) or antiplatelet therapy (APT). However, chronic use of antithrombotic therapy can increase the bleeding risk in patients receiving dialysis. However, little is known about medication use patterns and risk of bleeding events in real-world clinical practice.</div></div><div><h3>Study Design</h3><div>Retrospective analysis of data from 2 prospective cohort studies.</div></div><div><h3>Setting & Participants</h3><div>We included 27,612 patients from the Dialysis Outcomes and Practice Patterns Study (DOPPS) and 5,289 patients from the Peritoneal DOPPS (PDOPPS), international cohorts of hemodialysis (HD) and peritoneal dialysis (PD) patients.</div></div><div><h3>Exposures</h3><div>Patient demographics and comorbid conditions; OAC and APT use.</div></div><div><h3>Outcomes</h3><div>OAC and APT use; a bleeding composite outcome including a hospitalization or death because of a major bleeding event.</div></div><div><h3>Analytical Approach</h3><div>Descriptive analyses to explore OAC and APT utilization and crude rates of the bleeding composite outcome and Kaplan–Meier analyses to estimate medication discontinuation.</div></div><div><h3>Results</h3><div>Baseline OAC and APT use was 9% and 10% in HD patients and 4% and 7% in PD patients, respectively. Patients prescribed antithrombotic drugs were older and more likely to have a history of cardiovascular disease. After 36 months, the Kaplan–Meier estimated proportions of baseline users who remained on therapy were 57% for OAC and 53% for APT. The composite bleeding rates per 100 patient-years among patients with baseline OAC use versus baseline APT use versus neither were 8.6, 5.6, and 4.1 in HD patients and 12.0, 6.1, and 3.9 in PD patients, respectively.</div></div><div><h3>Limitations</h3><div>Potential for event misclassification; no over-the-counter medication data; rates unadjusted.</div></div><div><h3>Conclusions</h3><div>Antithrombotic drugs are infrequently prescribed and often discontinued in patients receiving HD or PD. With major bleeding event rates high among antithrombotic users, new strategies are needed to optimize the risks and benefits of antithrombotic agents in the dialysis setting.</div></div><div><h3>Plain-language Summary</h3><div>Patients on dialysis face a difficult balance: they are at high risk for blood clots but also prone to serious bleeding. We examined real-world data from over 30,000 patients across multiple countries to understand how often blood thinners are used and what outcomes follow. We found that these medications are prescribed infrequently and often discontinued. Importantly, patients who received them experienced more major bleeding events. These findings highlight the urgent need for safer, more tailored approaches to managing clotting risks in d
理由和目的:需要维持性透析的肾衰竭患者有心血管事件的高风险,需要抗血栓治疗,包括口服抗凝剂(OAC)或抗血小板治疗(APT)。然而,长期使用抗血栓治疗会增加透析患者出血的风险。然而,在现实世界的临床实践中,对药物使用模式和出血事件的风险知之甚少。研究设计:回顾性分析2项前瞻性队列研究的数据。环境和参与者:我们纳入了来自透析结果和实践模式研究(DOPPS)的27,612名患者和来自腹膜透析(PDOPPS)、国际血液透析(HD)和腹膜透析(PD)患者队列的5,289名患者。暴露:患者人口统计和合并症;OAC和APT的使用。结果:OAC和APT的使用;出血复合结局,包括因大出血事件住院或死亡。分析方法:描述性分析探讨OAC和APT的使用情况和出血综合结局的粗率,Kaplan-Meier分析评估停药情况。结果:HD患者基线OAC和APT使用率分别为9%和10%,PD患者基线OAC和APT使用率分别为4%和7%。服用抗血栓药物的患者年龄较大,且更有可能有心血管疾病史。36个月后,Kaplan-Meier估计基线使用OAC的患者比例为57%,APT为53%。在基线使用OAC的患者与基线使用APT的患者相比,每100患者年的复合出血率在HD患者中分别为8.6、5.6和4.1,在PD患者中分别为12.0、6.1和3.9。局限性:事件错误分类的可能性;无非处方药数据;未经调整的利率。结论:HD或PD患者很少开抗血栓药物处方,而且经常停药。由于抗血栓使用者的大出血事件发生率很高,因此需要新的策略来优化透析环境中抗血栓药物的风险和益处。
{"title":"Multinational Real-World Practice Patterns in the Use of Antithrombotic Therapy Among Patients on Hemodialysis and Peritoneal Dialysis","authors":"Murilo Guedes ,&nbsp;Calvin Andrews ,&nbsp;Junhui Zhao ,&nbsp;G. Brandon Atkins ,&nbsp;Irina Barash ,&nbsp;Lori D. Bash ,&nbsp;Catelyn R. Coyle ,&nbsp;Xuehua Ke ,&nbsp;Dena R. Ramey ,&nbsp;David W. Johnson ,&nbsp;Pablo Ureña-Torres ,&nbsp;Pietro Manuel Ferraro ,&nbsp;Mohammed Al Ghonaim ,&nbsp;Marc P. Bonaca ,&nbsp;Roberto Pecoits-Filho ,&nbsp;Angelo Karaboyas","doi":"10.1016/j.xkme.2025.101211","DOIUrl":"10.1016/j.xkme.2025.101211","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Patients with kidney failure requiring maintenance dialysis have a high risk of cardiovascular events warranting antithrombotic therapies, including oral anticoagulant (OAC) or antiplatelet therapy (APT). However, chronic use of antithrombotic therapy can increase the bleeding risk in patients receiving dialysis. However, little is known about medication use patterns and risk of bleeding events in real-world clinical practice.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Retrospective analysis of data from 2 prospective cohort studies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;We included 27,612 patients from the Dialysis Outcomes and Practice Patterns Study (DOPPS) and 5,289 patients from the Peritoneal DOPPS (PDOPPS), international cohorts of hemodialysis (HD) and peritoneal dialysis (PD) patients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposures&lt;/h3&gt;&lt;div&gt;Patient demographics and comorbid conditions; OAC and APT use.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;OAC and APT use; a bleeding composite outcome including a hospitalization or death because of a major bleeding event.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Descriptive analyses to explore OAC and APT utilization and crude rates of the bleeding composite outcome and Kaplan–Meier analyses to estimate medication discontinuation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Baseline OAC and APT use was 9% and 10% in HD patients and 4% and 7% in PD patients, respectively. Patients prescribed antithrombotic drugs were older and more likely to have a history of cardiovascular disease. After 36 months, the Kaplan–Meier estimated proportions of baseline users who remained on therapy were 57% for OAC and 53% for APT. The composite bleeding rates per 100 patient-years among patients with baseline OAC use versus baseline APT use versus neither were 8.6, 5.6, and 4.1 in HD patients and 12.0, 6.1, and 3.9 in PD patients, respectively.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Potential for event misclassification; no over-the-counter medication data; rates unadjusted.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Antithrombotic drugs are infrequently prescribed and often discontinued in patients receiving HD or PD. With major bleeding event rates high among antithrombotic users, new strategies are needed to optimize the risks and benefits of antithrombotic agents in the dialysis setting.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-language Summary&lt;/h3&gt;&lt;div&gt;Patients on dialysis face a difficult balance: they are at high risk for blood clots but also prone to serious bleeding. We examined real-world data from over 30,000 patients across multiple countries to understand how often blood thinners are used and what outcomes follow. We found that these medications are prescribed infrequently and often discontinued. Importantly, patients who received them experienced more major bleeding events. These findings highlight the urgent need for safer, more tailored approaches to managing clotting risks in d","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 3","pages":"Article 101211"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165864","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}
引用次数: 0
A Large Deletion With a Large Impact: Homozygous 5,600 bp Deletion of the GALNT3 Gene Causing Hyperphosphatemic Tumoral Calcinosis 影响巨大的大缺失:GALNT3基因纯合子5600 bp缺失导致高磷血症性肿瘤钙沉着症。
IF 3.4 Q1 UROLOGY & NEPHROLOGY Pub Date : 2026-03-01 Epub Date: 2026-01-06 DOI: 10.1016/j.xkme.2026.101241
Julia Maria Portmann , Katharina Martini , Angela Bahr , Alexander Ritter , Carsten A. Wagner , Harald Seeger
Hyperphosphatemic familial tumoral calcinosis (HTC) is a rare disease caused by autosomal recessive loss of function variants in the genes encoding fibroblast growth factor 23 (FGF-23), Klotho, or GalNAc-T3. This results in reduced phosphate excretion in the renal proximal tubule, leading to hyperphosphatemia. The clinical manifestations of HTC are mainly periarticular calcifications accompanied by pain and disability, inflammation, and dental problems. Inactive forms or reduced levels of FGF-23 or resistance to the FGF-23/Klotho complex are the main pathophysiologic characteristics underlying this disease. Treatment options to reduce blood phosphate levels have only been studied in case reports and small cohorts, with positive effects from phosphate binders, acetazolamide, anti-inflammatory drugs, probenecid, nicotinamide, and sodium thiosulfate. In this report, we present the case of a 50-year-old woman with a large (at least 5,600 base pair) deletion in the gene encoding for GalNAc-T3 (GALNT3) who experienced bone pain during childhood and calcifications of her lower limbs at least since her mid-thirties. Intragenic GALNT3 copy number variants have, to our knowledge, not yet been described as a cause of HTC.
高磷血症家族性肿瘤钙化症(HTC)是一种罕见的疾病,由编码成纤维细胞生长因子23 (FGF-23)、Klotho或GalNAc-T3基因的常染色体隐性功能变异缺失引起。这导致肾近端小管中磷酸盐排泄减少,导致高磷血症。HTC的临床表现主要是关节周围钙化,伴有疼痛和残疾、炎症和牙齿问题。FGF-23的失活形式或水平降低或对FGF-23/Klotho复合物的抗性是该疾病的主要病理生理特征。降低血磷酸盐水平的治疗方案仅在病例报告和小队列中进行了研究,磷酸盐结合剂、乙酰唑胺、抗炎药、丙戊酸、烟酰胺和硫代硫酸钠具有积极作用。在本报告中,我们报告了一名50岁女性的病例,GalNAc-T3 (GALNT3)编码基因存在大量缺失(至少5600个碱基对),她在童年时期经历过骨痛,至少从35岁左右开始出现下肢钙化。据我们所知,基因内GALNT3拷贝数变异尚未被描述为HTC的原因。
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引用次数: 0
Patient Perceptions of Artificial Intelligence-Generated Kidney Transplant Information: Comparing ChatGPT With the National Kidney Foundation 患者对人工智能生成的肾移植信息的感知:比较ChatGPT与国家肾脏基金会。
IF 3.4 Q1 UROLOGY & NEPHROLOGY Pub Date : 2026-03-01 Epub Date: 2026-01-08 DOI: 10.1016/j.xkme.2026.101247
Hwarang Stephen Han , Jihye Lee
<div><h3>Rationale & Objective</h3><div>Generative artificial intelligence (AI) may help patients better understand the complexities of kidney transplantation. However, little is known about how individuals with chronic kidney disease (CKD) perceive AI-generated health information. This study assessed patient perceptions of AI-generated responses to common kidney transplant queries compared to those from a trusted health resource.</div></div><div><h3>Study Design</h3><div>A cross-sectional online survey.</div></div><div><h3>Setting & Participants</h3><div>A total of 216 adults with CKD, including kidney transplant recipients, residing in the United States participated in the study.</div></div><div><h3>Exposures</h3><div>Participants compared kidney transplant-related query responses generated by ChatGPT (GPT-4o), a widely used generative AI tool, with those provided by the National Kidney Foundation (NKF).</div></div><div><h3>Outcomes</h3><div>Participant perceptions across several domains: overall preference, perceived information quality, empathy, and learning outcomes.</div></div><div><h3>Analytical Approach</h3><div>Participants reviewed paired responses from both ChatGPT and NKF, presented without source attribution. Results were analyzed using mixed-effect models.</div></div><div><h3>Results</h3><div>Participants preferred ChatGPT-generated responses over NKF’s in 81.3% of comparisons (P < 0.001). ChatGPT responses were rated significantly higher than NKF’s in terms of information quality, empathy, and perceived learning outcomes (all <em>P</em> < 0.001).</div></div><div><h3>Limitations</h3><div>The web-based survey may not fully represent the diverse populations served by transplant centers. Limited prompts were used, which may not capture the full range of transplant scenarios. We were also unable to determine which specific features influenced participant preferences.</div></div><div><h3>Conclusions</h3><div>Generative AI platforms like ChatGPT may present information in ways that resonate with patients, potentially enhancing their education and engagement. However, as these tools are still in the early stages of integration into everyday life, their use should be guided by careful human oversight.</div></div><div><h3>Plain-language Summary</h3><div>This study examined how adults with chronic kidney disease, including transplant recipients, engage with generative artificial intelligence (AI) to learn about kidney transplantation. Participants reviewed answers to common transplant queries from both ChatGPT, a popular AI tool, and the National Kidney Foundation, a trusted educational source, without knowing which source provided each answer. Participants preferred AI-generated responses in 81.3% of cases and rated ChatGPT higher than National Kidney Foundation in information quality, empathy, and perceived learning. These findings suggest that generative AI has the potential to present information in ways that resonate with p
理由与目的:生成式人工智能(AI)可以帮助患者更好地理解肾移植的复杂性。然而,对于慢性肾脏疾病(CKD)患者如何感知人工智能生成的健康信息,人们知之甚少。本研究评估了患者对人工智能对常见肾脏移植问题的反应的看法,并将其与可信赖的卫生资源进行了比较。研究设计:横断面在线调查。环境和参与者:共有216名居住在美国的成人CKD患者参与了这项研究,其中包括肾移植受者。暴露:参与者将ChatGPT (gpt - 40)生成的肾脏移植相关查询响应与国家肾脏基金会(NKF)提供的查询响应进行了比较。ChatGPT是一种广泛使用的生成式人工智能工具。结果:参与者对几个领域的看法:总体偏好、感知信息质量、同理心和学习成果。分析方法:参与者回顾了ChatGPT和NKF的配对回答,没有给出来源归因。结果采用混合效应模型进行分析。结果:在81.3%的比较中,参与者更喜欢chatgpt产生的反应而不是NKF (P < 0.001)。在信息质量、共情和感知学习结果方面,ChatGPT反应的评分显著高于NKF(均P < 0.001)。局限性:基于网络的调查可能不能完全代表移植中心服务的不同人群。使用了有限的提示,这可能无法捕获移植场景的全部范围。我们也无法确定哪些特定的特征会影响参与者的偏好。结论:像ChatGPT这样的生成式人工智能平台可能会以与患者产生共鸣的方式呈现信息,潜在地提高他们的教育和参与度。然而,由于这些工具仍处于融入日常生活的早期阶段,它们的使用应该在人类仔细监督的指导下进行。
{"title":"Patient Perceptions of Artificial Intelligence-Generated Kidney Transplant Information: Comparing ChatGPT With the National Kidney Foundation","authors":"Hwarang Stephen Han ,&nbsp;Jihye Lee","doi":"10.1016/j.xkme.2026.101247","DOIUrl":"10.1016/j.xkme.2026.101247","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Generative artificial intelligence (AI) may help patients better understand the complexities of kidney transplantation. However, little is known about how individuals with chronic kidney disease (CKD) perceive AI-generated health information. This study assessed patient perceptions of AI-generated responses to common kidney transplant queries compared to those from a trusted health resource.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;A cross-sectional online survey.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;A total of 216 adults with CKD, including kidney transplant recipients, residing in the United States participated in the study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposures&lt;/h3&gt;&lt;div&gt;Participants compared kidney transplant-related query responses generated by ChatGPT (GPT-4o), a widely used generative AI tool, with those provided by the National Kidney Foundation (NKF).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Participant perceptions across several domains: overall preference, perceived information quality, empathy, and learning outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Participants reviewed paired responses from both ChatGPT and NKF, presented without source attribution. Results were analyzed using mixed-effect models.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Participants preferred ChatGPT-generated responses over NKF’s in 81.3% of comparisons (P &lt; 0.001). ChatGPT responses were rated significantly higher than NKF’s in terms of information quality, empathy, and perceived learning outcomes (all &lt;em&gt;P&lt;/em&gt; &lt; 0.001).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;The web-based survey may not fully represent the diverse populations served by transplant centers. Limited prompts were used, which may not capture the full range of transplant scenarios. We were also unable to determine which specific features influenced participant preferences.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Generative AI platforms like ChatGPT may present information in ways that resonate with patients, potentially enhancing their education and engagement. However, as these tools are still in the early stages of integration into everyday life, their use should be guided by careful human oversight.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-language Summary&lt;/h3&gt;&lt;div&gt;This study examined how adults with chronic kidney disease, including transplant recipients, engage with generative artificial intelligence (AI) to learn about kidney transplantation. Participants reviewed answers to common transplant queries from both ChatGPT, a popular AI tool, and the National Kidney Foundation, a trusted educational source, without knowing which source provided each answer. Participants preferred AI-generated responses in 81.3% of cases and rated ChatGPT higher than National Kidney Foundation in information quality, empathy, and perceived learning. These findings suggest that generative AI has the potential to present information in ways that resonate with p","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 3","pages":"Article 101247"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147325680","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}
引用次数: 0
Stratifying Hepatic Fat in Hemodialysis: The Role of Phenotype and Anemia Therapy 肝脂肪分层在血液透析中的作用:表型和贫血治疗。
IF 3.4 Q1 UROLOGY & NEPHROLOGY Pub Date : 2026-03-01 Epub Date: 2026-02-14 DOI: 10.1016/j.xkme.2026.101306
Hiroki Ito MD, PhD, Takefumi Mori MD, PhD
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引用次数: 0
期刊
Kidney Medicine
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