Pub Date : 2025-01-01DOI: 10.1016/j.xkme.2024.100935
Fouad T. Chebib , Neera Dahl , Xiaolei Zhou , Diana Garbinsky , Jinyi Wang , Sasikiran Nunna , Dorothee Oberdhan , Ancilla W. Fernandes
<div><h3>Rational & Objective</h3><div>Data are limited regarding the long-term efficacy of tolvaptan in adults aged 18-35 years with autosomal dominant polycystic kidney disease (ADPKD) at increased risk of rapid progression. We assessed the effects of tolvaptan within a larger population of younger adults and over longer follow-up than individual clinical trials could provide.</div></div><div><h3>Study Design</h3><div>Pooled database study.</div></div><div><h3>Setting & Study Populations</h3><div>A consolidated clinical study database with ADPKD patients aged 18-35 years.</div></div><div><h3>Selection Criteria for Studies</h3><div>Studies that enrolled patients who received either tolvaptan or standard-of-care treatment not including tolvaptan.</div></div><div><h3>Data Extraction</h3><div>Annual rate of change in estimated glomerular filtration rate (eGFR) and time to kidney failure.</div></div><div><h3>Analytical Approach</h3><div>For individuals participating in multiple studies, their data were longitudinally linked to extend the follow-up period. We matched tolvaptan-treated patients with controls based on age, sex, chronic kidney disease stage, eGFR, and, where possible, Mayo Imaging Classification. We compared eGFR decline between groups using mixed-effects modeling.</div></div><div><h3>Results</h3><div>The matched analysis set encompassed 204 tolvaptan-treated individuals and 204 controls. Median follow-up was 4.6 years for the tolvaptan group and 1.7 years for controls. In the mixed-effects model, the eGFR decline rate (in mL/min/1.73<!--> <!-->m<sup>2</sup>/year) was –2.58 for the tolvaptan cohort and -4.28 for controls. This indicates reduction in the eGFR decline rate by 1.69<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup>/year (95% confidence interval: 0.87-2.52; <em>P</em> <!--><<!--> <!-->0.001) with tolvaptan, a 40% improvement. Extrapolating eGFR over 35 years, tolvaptan could delay kidney failure onset by approximately 11 years.</div></div><div><h3>Limitations</h3><div>Median follow-up was shorter in the control cohort than the tolvaptan cohort. The projection of time to kidney failure assumed a linear model of eGFR decline.</div></div><div><h3>Conclusions</h3><div>This analysis offers insights into the anticipated treatment benefits of tolvaptan for young adults with ADPKD. These findings are crucial for weighing treatment benefits against any associated risks.</div></div><div><h3>Plain-Language Summary</h3><div>Tolvaptan is the only approved treatment for delaying kidney function decline in patients with autosomal dominant polycystic kidney disease (ADPKD) at high risk of rapid progression. Clinical trials have included few patients aged 18-35 years, a group potentially benefiting significantly from early tolvaptan initiation. We pooled clinical study data, matching tolvaptan-treated patients with untreated controls by baseline characteristics. The results showed a statistically significant reduction in kidney functi
{"title":"Tolvaptan and Autosomal Dominant Polycystic Kidney Disease Progression in Individuals Aged 18-35 Years: A Pooled Database Analysis","authors":"Fouad T. Chebib , Neera Dahl , Xiaolei Zhou , Diana Garbinsky , Jinyi Wang , Sasikiran Nunna , Dorothee Oberdhan , Ancilla W. Fernandes","doi":"10.1016/j.xkme.2024.100935","DOIUrl":"10.1016/j.xkme.2024.100935","url":null,"abstract":"<div><h3>Rational & Objective</h3><div>Data are limited regarding the long-term efficacy of tolvaptan in adults aged 18-35 years with autosomal dominant polycystic kidney disease (ADPKD) at increased risk of rapid progression. We assessed the effects of tolvaptan within a larger population of younger adults and over longer follow-up than individual clinical trials could provide.</div></div><div><h3>Study Design</h3><div>Pooled database study.</div></div><div><h3>Setting & Study Populations</h3><div>A consolidated clinical study database with ADPKD patients aged 18-35 years.</div></div><div><h3>Selection Criteria for Studies</h3><div>Studies that enrolled patients who received either tolvaptan or standard-of-care treatment not including tolvaptan.</div></div><div><h3>Data Extraction</h3><div>Annual rate of change in estimated glomerular filtration rate (eGFR) and time to kidney failure.</div></div><div><h3>Analytical Approach</h3><div>For individuals participating in multiple studies, their data were longitudinally linked to extend the follow-up period. We matched tolvaptan-treated patients with controls based on age, sex, chronic kidney disease stage, eGFR, and, where possible, Mayo Imaging Classification. We compared eGFR decline between groups using mixed-effects modeling.</div></div><div><h3>Results</h3><div>The matched analysis set encompassed 204 tolvaptan-treated individuals and 204 controls. Median follow-up was 4.6 years for the tolvaptan group and 1.7 years for controls. In the mixed-effects model, the eGFR decline rate (in mL/min/1.73<!--> <!-->m<sup>2</sup>/year) was –2.58 for the tolvaptan cohort and -4.28 for controls. This indicates reduction in the eGFR decline rate by 1.69<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup>/year (95% confidence interval: 0.87-2.52; <em>P</em> <!--><<!--> <!-->0.001) with tolvaptan, a 40% improvement. Extrapolating eGFR over 35 years, tolvaptan could delay kidney failure onset by approximately 11 years.</div></div><div><h3>Limitations</h3><div>Median follow-up was shorter in the control cohort than the tolvaptan cohort. The projection of time to kidney failure assumed a linear model of eGFR decline.</div></div><div><h3>Conclusions</h3><div>This analysis offers insights into the anticipated treatment benefits of tolvaptan for young adults with ADPKD. These findings are crucial for weighing treatment benefits against any associated risks.</div></div><div><h3>Plain-Language Summary</h3><div>Tolvaptan is the only approved treatment for delaying kidney function decline in patients with autosomal dominant polycystic kidney disease (ADPKD) at high risk of rapid progression. Clinical trials have included few patients aged 18-35 years, a group potentially benefiting significantly from early tolvaptan initiation. We pooled clinical study data, matching tolvaptan-treated patients with untreated controls by baseline characteristics. The results showed a statistically significant reduction in kidney functi","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 1","pages":"Article 100935"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11731472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.xkme.2024.100916
Michael Alexander Aragon , Osama El Shamy , Sijie Zheng , Glenn M. Chertow , Joel Glickman , Eric Weinhandl , Paul Komenda , Stephan Dunning , Frank Liu , Charmaine Lok
Expansion of home hemodialysis (HHD) provides an opportunity to improve clinical outcomes, reduce cost of care, and address the staffing challenges currently faced in caring for patients with kidney failure on replacement therapy. To increase HHD expansion, current practices and barriers to home dialysis must be examined and addressed. One such barrier is vascular access for HHD; although tunneled hemodialysis central venous catheters (CVCs) have been used for decades, physicians still hesitate to send patients home without a mature, functional arteriovenous access. An expert panel of clinicians was convened by Outset Medical, a manufacturer of hemodialysis systems, to review the literature and generate consensus recommendations regarding the use of CVCs for HHD. Consistent with the most recent Kidney Disease Outcomes vascular access guidelines, the end-stage kidney disease life plan should be created via shared decision making for modality choices, with the corresponding dialysis access individualized for the patient, and for whom a CVC may represent the most appropriate vascular access to provide HHD.
{"title":"Vascular Access for Home Hemodialysis: A Perspective on Tunneled Central Venous Catheters at Home","authors":"Michael Alexander Aragon , Osama El Shamy , Sijie Zheng , Glenn M. Chertow , Joel Glickman , Eric Weinhandl , Paul Komenda , Stephan Dunning , Frank Liu , Charmaine Lok","doi":"10.1016/j.xkme.2024.100916","DOIUrl":"10.1016/j.xkme.2024.100916","url":null,"abstract":"<div><div>Expansion of home hemodialysis (HHD) provides an opportunity to improve clinical outcomes, reduce cost of care, and address the staffing challenges currently faced in caring for patients with kidney failure on replacement therapy. To increase HHD expansion, current practices and barriers to home dialysis must be examined and addressed. One such barrier is vascular access for HHD; although tunneled hemodialysis central venous catheters (CVCs) have been used for decades, physicians still hesitate to send patients home without a mature, functional arteriovenous access. An expert panel of clinicians was convened by Outset Medical, a manufacturer of hemodialysis systems, to review the literature and generate consensus recommendations regarding the use of CVCs for HHD. Consistent with the most recent Kidney Disease Outcomes vascular access guidelines, the end-stage kidney disease life plan should be created via shared decision making for modality choices, with the corresponding dialysis access individualized for the patient, and for whom a CVC may represent the most appropriate vascular access to provide HHD.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 1","pages":"Article 100916"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11721530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.xkme.2024.100934
Megan Urbanski , Emma Blythe , Alicia Hamblin , Alexis A. Bender , Courtney Hoge , Clarica Douglas-Ajayi , Fran Rickenbach , Jessica Joseph , Kelli Collins Damron , Jennifer Craft Morgan , Bernard Jaar , Laura Plantinga
<div><h3>Rationale & Objective</h3><div>Dialysis patient care technicians (PCTs) provide essential, frontline care for patients receiving in-center hemodialysis. We qualitatively explored perceptions of the PCT job role, responsibilities, and training among current PCTs, non-PCT dialysis staff, and patients receiving hemodialysis.</div></div><div><h3>Study Design</h3><div>Focus group study.</div></div><div><h3>Setting & Participants</h3><div>Discussions were conducted in March–May 2023 among US PCTs, non-PCT staff, and patients.</div></div><div><h3>Analytical Approach</h3><div>Thematic analysis was conducted using inductive and deductive strategies.</div></div><div><h3>Results</h3><div>Seven focus groups (N = 36 participants) were conducted (3 with PCTs [n = 19], 2 with non-PCT staff [n = 6], and 2 with patients [n = 11]). Eight themes emerged: (1) value of PCT role is not reflected in job or organizational policies and structures; (2) PCTs play a flexible and often ill-defined role in dialysis clinics; (3) despite being in a position with high risk of burnout, PCTs find ways to persevere and provide high-quality care; (4) PCTs are often perceived as “helpers” or ancillary rather than an integral part of the dialysis care team; (5) PCT job training and qualifications are not standardized and often not commensurate with job expectations and responsibilities; (6) PCT-patient relationships are deeply valued, but boundaries can be fluid and become blurred because of the frequency and nature of dialysis care; (7) dialysis patients and staff are vulnerable to multilevel workplace safety issues; and (8) PCT-staff dynamics have a strong impact on employee morale, clinic efficiency, and patient satisfaction.</div></div><div><h3>Limitations</h3><div>Non-English-speaking participants and physicians were excluded, limiting diversity in perspectives.</div></div><div><h3>Conclusions</h3><div>PCTs play a multifaceted role in dialysis care that is highly valued among patients and staff but not always reflected in actual tasks performed by PCTs, training received by PCTs, or the respect afforded to PCTs. Our findings are actionable and can inform future intervention-based work aimed at improving the PCT role in US hemodialysis care.</div></div><div><h3>Plain-Language Summary</h3><div>In the United States, patient care technicians (PCTs) spend the most chair-side time with patients receiving hemodialysis, but little is known about the role of patient care technicians (PCTs) in dialysis care. We conducted 7 focus groups with US PCTs, other dialysis staff, and patients receiving hemodialysis. Discussions showed that the PCT role is highly valued among dialysis staff and patients, but this is often poorly reflected in organizational structures. PCTs also often work outside of their scope and training. Additionally, PCTs and patients form strong bonds, but these relationships are sometimes viewed as problematic. Results highlight the complex, valuable role PCT
{"title":"“The Heart of the Center”: Exploring the Role of the Patient Care Technician in US Dialysis Care","authors":"Megan Urbanski , Emma Blythe , Alicia Hamblin , Alexis A. Bender , Courtney Hoge , Clarica Douglas-Ajayi , Fran Rickenbach , Jessica Joseph , Kelli Collins Damron , Jennifer Craft Morgan , Bernard Jaar , Laura Plantinga","doi":"10.1016/j.xkme.2024.100934","DOIUrl":"10.1016/j.xkme.2024.100934","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Dialysis patient care technicians (PCTs) provide essential, frontline care for patients receiving in-center hemodialysis. We qualitatively explored perceptions of the PCT job role, responsibilities, and training among current PCTs, non-PCT dialysis staff, and patients receiving hemodialysis.</div></div><div><h3>Study Design</h3><div>Focus group study.</div></div><div><h3>Setting & Participants</h3><div>Discussions were conducted in March–May 2023 among US PCTs, non-PCT staff, and patients.</div></div><div><h3>Analytical Approach</h3><div>Thematic analysis was conducted using inductive and deductive strategies.</div></div><div><h3>Results</h3><div>Seven focus groups (N = 36 participants) were conducted (3 with PCTs [n = 19], 2 with non-PCT staff [n = 6], and 2 with patients [n = 11]). Eight themes emerged: (1) value of PCT role is not reflected in job or organizational policies and structures; (2) PCTs play a flexible and often ill-defined role in dialysis clinics; (3) despite being in a position with high risk of burnout, PCTs find ways to persevere and provide high-quality care; (4) PCTs are often perceived as “helpers” or ancillary rather than an integral part of the dialysis care team; (5) PCT job training and qualifications are not standardized and often not commensurate with job expectations and responsibilities; (6) PCT-patient relationships are deeply valued, but boundaries can be fluid and become blurred because of the frequency and nature of dialysis care; (7) dialysis patients and staff are vulnerable to multilevel workplace safety issues; and (8) PCT-staff dynamics have a strong impact on employee morale, clinic efficiency, and patient satisfaction.</div></div><div><h3>Limitations</h3><div>Non-English-speaking participants and physicians were excluded, limiting diversity in perspectives.</div></div><div><h3>Conclusions</h3><div>PCTs play a multifaceted role in dialysis care that is highly valued among patients and staff but not always reflected in actual tasks performed by PCTs, training received by PCTs, or the respect afforded to PCTs. Our findings are actionable and can inform future intervention-based work aimed at improving the PCT role in US hemodialysis care.</div></div><div><h3>Plain-Language Summary</h3><div>In the United States, patient care technicians (PCTs) spend the most chair-side time with patients receiving hemodialysis, but little is known about the role of patient care technicians (PCTs) in dialysis care. We conducted 7 focus groups with US PCTs, other dialysis staff, and patients receiving hemodialysis. Discussions showed that the PCT role is highly valued among dialysis staff and patients, but this is often poorly reflected in organizational structures. PCTs also often work outside of their scope and training. Additionally, PCTs and patients form strong bonds, but these relationships are sometimes viewed as problematic. Results highlight the complex, valuable role PCT","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 1","pages":"Article 100934"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.xkme.2024.100936
Yu Lin , Tongyue Shi , Guilan Kong
<div><h3>Rationale & Objective</h3><div>Accurate estimation of in-hospital outcomes for patients with acute kidney injury (AKI) is crucial for aiding physicians in making optimal clinical decisions. We aimed to review prediction models constructed by machine learning methods for predicting AKI prognosis using administrative databases.</div></div><div><h3>Study Design</h3><div>A systematic review following PRISMA guidelines.</div></div><div><h3>Setting & Study Populations</h3><div>Adult patients diagnosed with AKI who are admitted to either hospitals or intensive care units.</div></div><div><h3>Search Strategy & Sources</h3><div>We searched PubMed, Embase, Web of Science, Scopus, and Cumulative Index to Nursing and Allied Health for studies published between January 1, 2014 and February 29, 2024. Eligible studies employed machine learning models to predict in-hospital outcomes of AKI based on administrative databases.</div></div><div><h3>Data Extraction</h3><div>Extracted data included prediction outcomes and population, prediction models with performance, feature selection methods, and predictive features.</div></div><div><h3>Analytical Approach</h3><div>The included studies were qualitatively synthesized with assessments of quality and bias. We calculated the pooled model discrimination of different AKI prognoses using random-effects models.</div></div><div><h3>Results</h3><div>Of 3,029 studies, 27 studies were eligible for qualitative review. In-hospital outcomes for patients with AKI included acute kidney disease, chronic kidney disease, renal function recovery or kidney failure, and mortality. Compared with models predicting the mortality of patients with AKI during hospitalization, the prediction performance of models on kidney function recovery was less accurate. Meta-analysis showed that machine learning methods outperformed traditional approaches in mortality prediction (area under the receiver operating characteristic curve, 0.831; 95% CI, 0.799-0.859 vs 0.772; 95% CI, 0.744-0.797). The overlapping predictive features for in-hospital mortality identified from<!--> <!-->≥6 studies were age, serum creatinine level, serum urea nitrogen level, anion gap, and white blood cell count. Similarly, age, serum creatinine level, AKI stage, estimated glomerular filtration rate, and comorbid conditions were the common predictive features for kidney function recovery.</div></div><div><h3>Limitations</h3><div>Many studies developed prediction models within specific hospital settings without broad validation, restricting their generalizability and clinical application.</div></div><div><h3>Conclusions</h3><div>Machine learning models outperformed traditional approaches in predicting mortality for patients with AKI, although they are less accurate in predicting kidney function recovery. Overall, these models demonstrate significant potential to help physicians improve clinical decision making and patient outcomes.</div></div><div><h3>Registrati
理由与目的：准确估计急性肾损伤（AKI）患者的住院结果对于帮助医生做出最佳临床决策至关重要。我们的目的是回顾机器学习方法构建的预测模型，用于使用管理数据库预测AKI预后。研究设计：遵循PRISMA指南进行系统评价。设置和研究人群：被诊断为AKI的成年患者，他们被医院或重症监护病房收治。检索策略和来源：我们检索了PubMed， Embase, Web of Science， Scopus和Cumulative Index to Nursing and Allied Health，检索了2014年1月1日至2024年2月29日之间发表的研究。符合条件的研究采用机器学习模型基于管理数据库预测AKI的住院结果。数据提取：提取的数据包括预测结果和总体、具有性能的预测模型、特征选择方法和预测特征。分析方法：纳入的研究通过质量和偏倚评估进行定性综合。我们使用随机效应模型计算了不同AKI预后的混合模型判别。结果：3029项研究中，27项研究符合定性评价。AKI患者的住院结局包括急性肾病、慢性肾病、肾功能恢复或肾功能衰竭以及死亡率。与预测AKI患者住院期间死亡率的模型相比，模型对肾功能恢复的预测性能较差。meta分析显示，机器学习方法在死亡率预测方面优于传统方法(受试者工作特征曲线下面积，0.831；95% CI, 0.799-0.859 vs 0.772；95% ci, 0.744-0.797)。从≥6项研究中确定的住院死亡率的重叠预测特征是年龄、血清肌酐水平、血清尿素氮水平、阴离子间隙和白细胞计数。同样，年龄、血清肌酐水平、AKI分期、估计肾小球滤过率和合并症是肾功能恢复的常见预测特征。局限性：许多研究在特定的医院环境中建立了预测模型，但没有得到广泛的验证，限制了它们的推广和临床应用。结论：机器学习模型在预测AKI患者死亡率方面优于传统方法，尽管它们在预测肾功能恢复方面不太准确。总的来说，这些模型显示出帮助医生改善临床决策和患者预后的巨大潜力。注册:CRD42024535965。
{"title":"Acute Kidney Injury Prognosis Prediction Using Machine Learning Methods: A Systematic Review","authors":"Yu Lin , Tongyue Shi , Guilan Kong","doi":"10.1016/j.xkme.2024.100936","DOIUrl":"10.1016/j.xkme.2024.100936","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Accurate estimation of in-hospital outcomes for patients with acute kidney injury (AKI) is crucial for aiding physicians in making optimal clinical decisions. We aimed to review prediction models constructed by machine learning methods for predicting AKI prognosis using administrative databases.</div></div><div><h3>Study Design</h3><div>A systematic review following PRISMA guidelines.</div></div><div><h3>Setting & Study Populations</h3><div>Adult patients diagnosed with AKI who are admitted to either hospitals or intensive care units.</div></div><div><h3>Search Strategy & Sources</h3><div>We searched PubMed, Embase, Web of Science, Scopus, and Cumulative Index to Nursing and Allied Health for studies published between January 1, 2014 and February 29, 2024. Eligible studies employed machine learning models to predict in-hospital outcomes of AKI based on administrative databases.</div></div><div><h3>Data Extraction</h3><div>Extracted data included prediction outcomes and population, prediction models with performance, feature selection methods, and predictive features.</div></div><div><h3>Analytical Approach</h3><div>The included studies were qualitatively synthesized with assessments of quality and bias. We calculated the pooled model discrimination of different AKI prognoses using random-effects models.</div></div><div><h3>Results</h3><div>Of 3,029 studies, 27 studies were eligible for qualitative review. In-hospital outcomes for patients with AKI included acute kidney disease, chronic kidney disease, renal function recovery or kidney failure, and mortality. Compared with models predicting the mortality of patients with AKI during hospitalization, the prediction performance of models on kidney function recovery was less accurate. Meta-analysis showed that machine learning methods outperformed traditional approaches in mortality prediction (area under the receiver operating characteristic curve, 0.831; 95% CI, 0.799-0.859 vs 0.772; 95% CI, 0.744-0.797). The overlapping predictive features for in-hospital mortality identified from<!--> <!-->≥6 studies were age, serum creatinine level, serum urea nitrogen level, anion gap, and white blood cell count. Similarly, age, serum creatinine level, AKI stage, estimated glomerular filtration rate, and comorbid conditions were the common predictive features for kidney function recovery.</div></div><div><h3>Limitations</h3><div>Many studies developed prediction models within specific hospital settings without broad validation, restricting their generalizability and clinical application.</div></div><div><h3>Conclusions</h3><div>Machine learning models outperformed traditional approaches in predicting mortality for patients with AKI, although they are less accurate in predicting kidney function recovery. Overall, these models demonstrate significant potential to help physicians improve clinical decision making and patient outcomes.</div></div><div><h3>Registrati","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 1","pages":"Article 100936"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>Rational & Objective</h3><div>Majority of people with end-stage kidney disease (ESKD) are sedentary, which increases risk for decreased quality and quantity of life. Development of exercise programs with characteristics that address individual preferences may increase interest in participating and completing exercise programs. We evaluated which exercise intervention characteristics affect exercise program recruitment, adherence, and completion in people with ESKD receiving dialysis.</div></div><div><h3>Study Design</h3><div>Scoping review of randomized controlled trials (RCTs) with searching of Medline, Embase, Cochrane, and CINAHL databases through May 12, 2023.</div></div><div><h3>Setting & Study Populations</h3><div>Adults with ESKD receiving dialysis.</div></div><div><h3>Selection Criteria</h3><div>RCTs with exercise interventions of<!--> <!-->≥12 weeks that included more than 10 people with ESKD receiving dialysis in each study arm.</div></div><div><h3>Data Extraction</h3><div>One individual extracted data and the second author checked for accuracy.</div></div><div><h3>Analytical Approach</h3><div>Data were synthesized qualitatively. Associations between intervention characteristics and recruitment, retention and adherence rates were assessed through one-way analysis of variance tests. Risk of bias was assessed using the Cochrane Risk of Bias 1.0 tool.</div></div><div><h3>Results</h3><div>Of 7,396 studies identified, 55 studies with 3,269 trial participants were included. The majority of participants were male (63.2%) and treated with hemodialysis (89.1%). Mean age was 56<!--> <!-->±<!--> <!-->11.5 years. Average recruitment, retention and adherence rates were 77.4%, 81.2%, and 76.0%, respectively. Only 27% of studies reported adherence rates. No significant associations were found between intervention characteristics (ie, exercise type, duration, frequency, setting, and supervision) and recruitment, adherence, and retention rates.</div></div><div><h3>Limitations</h3><div>Data were limited by small sample size, suboptimal risk of bias, selective recruiting methods, and variability in definitions of adherence rates.</div></div><div><h3>Conclusion</h3><div>Average recruitment, retention, and adherence rates in exercise interventions for patients receiving dialysis were high although less than 1 in 4 studies reported adherence rates. These results call for standardized reporting of recruitment, retention, and adherence rates in exercise interventions.</div></div><div><h3>Plain-Language Summary</h3><div>Regular exercise for people with end-stage kidney disease (ESKD) can improve their quality of life. We sought to determine if there were certain characteristics of an exercise program such as exercise type, frequency, program length, and setting that were associated with enhanced recruitment, retention, and adherence to the program. From the 55 identified studies, average recruitment, retention, and adherence rates in exercise i
理性与客观：大多数终末期肾病（ESKD）患者久坐不动，这增加了生活质量和数量下降的风险。针对个人喜好的锻炼计划的发展可能会增加参与和完成锻炼计划的兴趣。我们评估了哪些运动干预特征会影响接受透析的ESKD患者的运动计划招募、依从性和完成情况。研究设计：检索Medline、Embase、Cochrane和CINAHL数据库，纳入2023年5月12日的随机对照试验（RCTs）。环境和研究人群：接受透析的成人ESKD患者。选择标准：运动干预≥12周的随机对照试验，每个研究组包括10名以上接受透析治疗的ESKD患者。数据提取：一个人提取数据，第二作者检查准确性。分析方法：定性综合资料。通过单向方差分析检验评估干预特征与招募、保留和依从率之间的关系。使用Cochrane Risk of bias 1.0工具评估偏倚风险。结果：在7396项研究中，纳入了55项研究，3269名试验参与者。大多数参与者为男性（63.2%），接受血液透析治疗（89.1%）。平均年龄56±11.5岁。平均入职率、留任率和依从率分别为77.4%、81.2%和76.0%。只有27%的研究报告了依从率。干预特征（即运动类型、持续时间、频率、设置和监督）与招募、坚持和保留率之间没有发现显著关联。局限性：数据受到样本量小、次优偏倚风险、选择性招募方法和依从率定义的可变性的限制。结论：透析患者运动干预的平均招募率、保留率和坚持率很高，尽管只有不到1 / 4的研究报告了坚持率。这些结果要求对运动干预的招募、保留和依从率进行标准化报告。
{"title":"Factors Influencing Recruitment, Retention, and Adherence Rates in Exercise Interventions in ESKD: A Scoping Review","authors":"Malvika Agarwal , Jamie Alexiuk , Clara Bohm , Lindsey Sikora , Deborah Zimmerman","doi":"10.1016/j.xkme.2024.100933","DOIUrl":"10.1016/j.xkme.2024.100933","url":null,"abstract":"<div><h3>Rational & Objective</h3><div>Majority of people with end-stage kidney disease (ESKD) are sedentary, which increases risk for decreased quality and quantity of life. Development of exercise programs with characteristics that address individual preferences may increase interest in participating and completing exercise programs. We evaluated which exercise intervention characteristics affect exercise program recruitment, adherence, and completion in people with ESKD receiving dialysis.</div></div><div><h3>Study Design</h3><div>Scoping review of randomized controlled trials (RCTs) with searching of Medline, Embase, Cochrane, and CINAHL databases through May 12, 2023.</div></div><div><h3>Setting & Study Populations</h3><div>Adults with ESKD receiving dialysis.</div></div><div><h3>Selection Criteria</h3><div>RCTs with exercise interventions of<!--> <!-->≥12 weeks that included more than 10 people with ESKD receiving dialysis in each study arm.</div></div><div><h3>Data Extraction</h3><div>One individual extracted data and the second author checked for accuracy.</div></div><div><h3>Analytical Approach</h3><div>Data were synthesized qualitatively. Associations between intervention characteristics and recruitment, retention and adherence rates were assessed through one-way analysis of variance tests. Risk of bias was assessed using the Cochrane Risk of Bias 1.0 tool.</div></div><div><h3>Results</h3><div>Of 7,396 studies identified, 55 studies with 3,269 trial participants were included. The majority of participants were male (63.2%) and treated with hemodialysis (89.1%). Mean age was 56<!--> <!-->±<!--> <!-->11.5 years. Average recruitment, retention and adherence rates were 77.4%, 81.2%, and 76.0%, respectively. Only 27% of studies reported adherence rates. No significant associations were found between intervention characteristics (ie, exercise type, duration, frequency, setting, and supervision) and recruitment, adherence, and retention rates.</div></div><div><h3>Limitations</h3><div>Data were limited by small sample size, suboptimal risk of bias, selective recruiting methods, and variability in definitions of adherence rates.</div></div><div><h3>Conclusion</h3><div>Average recruitment, retention, and adherence rates in exercise interventions for patients receiving dialysis were high although less than 1 in 4 studies reported adherence rates. These results call for standardized reporting of recruitment, retention, and adherence rates in exercise interventions.</div></div><div><h3>Plain-Language Summary</h3><div>Regular exercise for people with end-stage kidney disease (ESKD) can improve their quality of life. We sought to determine if there were certain characteristics of an exercise program such as exercise type, frequency, program length, and setting that were associated with enhanced recruitment, retention, and adherence to the program. From the 55 identified studies, average recruitment, retention, and adherence rates in exercise i","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 1","pages":"Article 100933"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.xkme.2024.100939
Jaidip M. Jagtap PhD, MS , Andrew R. Janowczyk PhD, MS , Yijiang Chen PhD , Afsana A. Shaik MBBS , Aidan F. Mullan MA , Bradley J. Erickson MD, PhD , Vidit Sharma MD , Timothy L. Kline PhD, MS , Laura Barisoni MD , Aleksandar Denic MD, PhD , Andrew D. Rule MD
{"title":"Glomerular and Nephron Size and Kidney Disease Outcomes: A Comparison of Manual Versus Deep Learning Methods in Kidney Pathology","authors":"Jaidip M. Jagtap PhD, MS , Andrew R. Janowczyk PhD, MS , Yijiang Chen PhD , Afsana A. Shaik MBBS , Aidan F. Mullan MA , Bradley J. Erickson MD, PhD , Vidit Sharma MD , Timothy L. Kline PhD, MS , Laura Barisoni MD , Aleksandar Denic MD, PhD , Andrew D. Rule MD","doi":"10.1016/j.xkme.2024.100939","DOIUrl":"10.1016/j.xkme.2024.100939","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 1","pages":"Article 100939"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11728938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.xkme.2024.100932
Marwa Kliea , Mohammad Alsultan , Safaa Qatleesh , Yousef Haroun , Osama Abdul Aziz , Kassem Basha
A 50-year-old woman with kidney failure complained of back pain and an inability to walk. The medical history included hypothyroidism, nephrolithiasis, and resistant anemia aligned with several transfusions. The examination showed hepatosplenomegaly, lower limb weakness, absence of reflexes, and lack of sensations with a sensory level T6. Laboratory results showed hypercalcemia with suppression of parathyroid hormone levels. Magnetic resonance imaging showed vertebral fractures and mass-like lesions that compressed the spine at T4, T9, L4, and L5. Vertebral and bone marrow biopsies showed calcium oxalate (CaOx) depositions. Here, we reported a rare case of primary hyperoxaluria (PH) in a patient with kidney failure who presented with spinal cord compression caused by vertebral fractures and mass-like lesions. We summarized a literature review of PH patients with spinal cord compression, which showed only 3 cases. The multiorgan CaOx infiltration in this patient also caused resistant anemia, hepatosplenomegaly, extensive bone lesions, hypoparathyroidism, hypothyroidism, and hypercalcemia. The overdiagnosis of renal osteodystrophy and the negative family history could delay the diagnosis of PH in patients with kidney failure. Thus, clinicians should always consider PH in the differential diagnosis of kidney failure patients with stone events given that the early diagnosis of PH could be lifesaving.
{"title":"Spinal Cord Compression as the First Presentation of Primary Hyperoxaluria in a Patient With Kidney Failure: A Case Report and Literature Review","authors":"Marwa Kliea , Mohammad Alsultan , Safaa Qatleesh , Yousef Haroun , Osama Abdul Aziz , Kassem Basha","doi":"10.1016/j.xkme.2024.100932","DOIUrl":"10.1016/j.xkme.2024.100932","url":null,"abstract":"<div><div>A 50-year-old woman with kidney failure complained of back pain and an inability to walk. The medical history included hypothyroidism, nephrolithiasis, and resistant anemia aligned with several transfusions. The examination showed hepatosplenomegaly, lower limb weakness, absence of reflexes, and lack of sensations with a sensory level T6. Laboratory results showed hypercalcemia with suppression of parathyroid hormone levels. Magnetic resonance imaging showed vertebral fractures and mass-like lesions that compressed the spine at T4, T9, L4, and L5. Vertebral and bone marrow biopsies showed calcium oxalate (CaOx) depositions. Here, we reported a rare case of primary hyperoxaluria (PH) in a patient with kidney failure who presented with spinal cord compression caused by vertebral fractures and mass-like lesions. We summarized a literature review of PH patients with spinal cord compression, which showed only 3 cases. The multiorgan CaOx infiltration in this patient also caused resistant anemia, hepatosplenomegaly, extensive bone lesions, hypoparathyroidism, hypothyroidism, and hypercalcemia. The overdiagnosis of renal osteodystrophy and the negative family history could delay the diagnosis of PH in patients with kidney failure. Thus, clinicians should always consider PH in the differential diagnosis of kidney failure patients with stone events given that the early diagnosis of PH could be lifesaving.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 1","pages":"Article 100932"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.xkme.2024.100938
Jennifer L. Asher , Juan B. Ivey-Miranda , Christopher Maulion , Zachary L. Cox , Julian A. Borges-Vela , Genaro H. Mendoza-Zavala , Jose A. Cigarroa-Lopez , Rogelio I. Silva-Rueda , Cristina Revilla-Monsalve , Julieta Moreno-Villagomez , Daniela Ramos-Mastache , Oliver Goedje , Ian Crosbie , Christopher McIntyre , Fredrick Finkelstein , Jeffrey M. Turner , Jeffrey M. Testani , Veena S. Rao
<div><h3>Rationale & Objective</h3><div>Peritoneal dialysis (PD) solutions provide both clearance of uremic toxins and sodium and water. An intraperitoneal (IP) solution of icodextrin and glucose designed without the requirement for uremic toxin clearance could provide substantially greater sodium and water removal than PD solutions.</div></div><div><h3>Study Design</h3><div>We examined varying concentrations of icodextrin and dextrose IP solutions in rats. We evaluated a 30% icodextrin and 10% dextrose IP solution in animals and humans.</div></div><div><h3>Participants</h3><div>Small and large animal models, and humans (N<!--> <!-->=<!--> <!-->10) with kidney failure.</div></div><div><h3>Exposure</h3><div>30% icodextrin and 10% dextrose IP solution.</div></div><div><h3>Outcomes</h3><div>We evaluated ultrafiltration (UF), sodium removal, and peritoneal health in animals. We evaluated safety, tolerability, and efficacy in humans.</div></div><div><h3>Results</h3><div>In rats, increasing concentrations of icodextrin and dextrose IP solutions, up to 30% icodextrin and 10% dextrose, produced progressively greater UF (<em>P</em> <!--><<!--> <!-->0.001). In sheep treated with 30% icodextrin and 10% dextrose, the mean UF was ∼3.5-fold greater (1.77<!--> <!-->±<!--> <!-->0.22<!--> <!-->L vs 0.47<!--> <!-->±<!--> <!-->0.34<!--> <!-->L; <em>P</em> <!-->=<!--> <!-->0.005) and the mean sodium removal was ∼4-fold greater (7.07<!--> <!-->±<!--> <!-->0.72<!--> <!-->g vs 1.78<!--> <!-->±<!--> <!-->1.27<!--> <!-->g; <em>P</em> <!-->=<!--> <!-->0.003) compared with commercially available 7.5% icodextrin PD solution. Long-term exposure of mice (30 days) and sheep (30-45 days) to a 30% icodextrin and 10% dextrose IP solution resulted in no significant structural tissue changes compared with the control 4.25% commercially available PD solution. In humans, a 24-hour dwell of a 30% icodextrin and 10% dextrose IP solution resulted in median net UF of 2,498<!--> <!-->mL (IQR, 2,249-2,768), and median sodium removal of 387<!--> <!-->mmol (IQR, 372-434<!--> <!-->mmol). No serious adverse events occurred.</div></div><div><h3>Limitations</h3><div>The long-term safety with chronic therapy and the efficacy in patients without kidney failure were not established and require future studies.</div></div><div><h3>Conclusions</h3><div>A 30% icodextrin and 10% dextrose IP solution provides more efficient UF and sodium removal than traditional PD solutions. The promising inhuman safety and efficacy results warrant future investigation as a sodium removal therapy in patients with edematous disorders such as heart failure.</div></div><div><h3>Clinical Trial Registration</h3><div>NCT05780086.</div></div><div><h3>Summary</h3><div>We aimed to design a novel intraperitoneal solution designed for optimal sodium and water removal. A sodium-free 30% icodextrin and 10% dextrose intraperitoneal solution was evaluated in animal models and humans to determine the safety and efficacy. A 30% i
理由与目的：腹膜透析（PD）溶液既能清除尿毒症毒素，又能清除钠和水。一种不需要清除尿毒症毒素的卵黄糊精和葡萄糖腹腔内（IP）溶液可以提供比PD溶液更大的钠和水去除效果。研究设计：我们在大鼠体内检测了不同浓度的乙醇糊精和葡萄糖IP溶液。我们在动物和人类中评估了30%的碘糊精和10%的葡萄糖IP溶液。参与者：小型和大型动物模型，以及肾衰竭患者（N = 10）。暴露：30%的乙醇糊精和10%的葡萄糖IP溶液。结果：我们评估了动物的超滤（UF）、钠去除和腹膜健康。我们评估了该药物在人体中的安全性、耐受性和有效性。结果：在大鼠中，增加浓度的icodextrin和葡萄糖IP溶液，高达30%的icodextrin和10%的葡萄糖，产生逐渐增加的UF (P P = 0.005)，平均钠去除率增加约4倍(7.07±0.72 g vs 1.78±1.27 g；P = 0.003)，与市售的7.5% icodextrin PD溶液相比。小鼠（30天）和绵羊（30-45天）长期暴露于30%的碘糊精和10%的葡萄糖IP溶液中，与对照组4.25%的市售PD溶液相比，没有明显的组织结构变化。在人类中，30%的糊精和10%的葡萄糖IP溶液在24小时内停留导致净UF的中位数为2498 mL (IQR, 2249 - 2768)，去除钠的中位数为387 mmol （IQR, 372-434 mmol）。未发生严重不良事件。局限性：慢性治疗的长期安全性和无肾衰竭患者的疗效尚未确定，需要进一步研究。结论：30%的碘糊精和10%的葡萄糖IP溶液比传统的PD溶液更有效地去除UF和钠。有希望的非人道的安全性和有效性结果值得未来的研究，作为一种钠去除治疗患者的水肿疾病，如心力衰竭。临床试验注册：NCT05780086。摘要：我们的目的是设计一种新的腹腔内溶液，以达到最佳的钠和水去除效果。在动物模型和人体中对不含钠的30%糊精和10%葡萄糖腹腔注射溶液进行了评估，以确定其安全性和有效性。30%的乙醇糊精和10%的葡萄糖溶液比传统的腹膜透析溶液更有效地去除钠和水。有希望的非人道的安全性和有效性结果值得未来的研究，作为一种钠去除治疗患者的水肿疾病，如心力衰竭。
{"title":"Development of a Novel Intraperitoneal Icodextrin/Dextrose Solution for Enhanced Sodium Removal","authors":"Jennifer L. Asher , Juan B. Ivey-Miranda , Christopher Maulion , Zachary L. Cox , Julian A. Borges-Vela , Genaro H. Mendoza-Zavala , Jose A. Cigarroa-Lopez , Rogelio I. Silva-Rueda , Cristina Revilla-Monsalve , Julieta Moreno-Villagomez , Daniela Ramos-Mastache , Oliver Goedje , Ian Crosbie , Christopher McIntyre , Fredrick Finkelstein , Jeffrey M. Turner , Jeffrey M. Testani , Veena S. Rao","doi":"10.1016/j.xkme.2024.100938","DOIUrl":"10.1016/j.xkme.2024.100938","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Peritoneal dialysis (PD) solutions provide both clearance of uremic toxins and sodium and water. An intraperitoneal (IP) solution of icodextrin and glucose designed without the requirement for uremic toxin clearance could provide substantially greater sodium and water removal than PD solutions.</div></div><div><h3>Study Design</h3><div>We examined varying concentrations of icodextrin and dextrose IP solutions in rats. We evaluated a 30% icodextrin and 10% dextrose IP solution in animals and humans.</div></div><div><h3>Participants</h3><div>Small and large animal models, and humans (N<!--> <!-->=<!--> <!-->10) with kidney failure.</div></div><div><h3>Exposure</h3><div>30% icodextrin and 10% dextrose IP solution.</div></div><div><h3>Outcomes</h3><div>We evaluated ultrafiltration (UF), sodium removal, and peritoneal health in animals. We evaluated safety, tolerability, and efficacy in humans.</div></div><div><h3>Results</h3><div>In rats, increasing concentrations of icodextrin and dextrose IP solutions, up to 30% icodextrin and 10% dextrose, produced progressively greater UF (<em>P</em> <!--><<!--> <!-->0.001). In sheep treated with 30% icodextrin and 10% dextrose, the mean UF was ∼3.5-fold greater (1.77<!--> <!-->±<!--> <!-->0.22<!--> <!-->L vs 0.47<!--> <!-->±<!--> <!-->0.34<!--> <!-->L; <em>P</em> <!-->=<!--> <!-->0.005) and the mean sodium removal was ∼4-fold greater (7.07<!--> <!-->±<!--> <!-->0.72<!--> <!-->g vs 1.78<!--> <!-->±<!--> <!-->1.27<!--> <!-->g; <em>P</em> <!-->=<!--> <!-->0.003) compared with commercially available 7.5% icodextrin PD solution. Long-term exposure of mice (30 days) and sheep (30-45 days) to a 30% icodextrin and 10% dextrose IP solution resulted in no significant structural tissue changes compared with the control 4.25% commercially available PD solution. In humans, a 24-hour dwell of a 30% icodextrin and 10% dextrose IP solution resulted in median net UF of 2,498<!--> <!-->mL (IQR, 2,249-2,768), and median sodium removal of 387<!--> <!-->mmol (IQR, 372-434<!--> <!-->mmol). No serious adverse events occurred.</div></div><div><h3>Limitations</h3><div>The long-term safety with chronic therapy and the efficacy in patients without kidney failure were not established and require future studies.</div></div><div><h3>Conclusions</h3><div>A 30% icodextrin and 10% dextrose IP solution provides more efficient UF and sodium removal than traditional PD solutions. The promising inhuman safety and efficacy results warrant future investigation as a sodium removal therapy in patients with edematous disorders such as heart failure.</div></div><div><h3>Clinical Trial Registration</h3><div>NCT05780086.</div></div><div><h3>Summary</h3><div>We aimed to design a novel intraperitoneal solution designed for optimal sodium and water removal. A sodium-free 30% icodextrin and 10% dextrose intraperitoneal solution was evaluated in animal models and humans to determine the safety and efficacy. A 30% i","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 1","pages":"Article 100938"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11714391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.xkme.2024.100927
Prabhat Singh , Lokesh Goyal , Deobrat C. Mallick , Salim R. Surani , Nayanjyoti Kaushik , Deepak Chandramohan , Prathap K. Simhadri
Artificial intelligence (AI) is increasingly used in many medical specialties. However, nephrology has lagged in adopting and incorporating machine learning techniques. Nephrology is well positioned to capitalize on the benefits of AI. The abundance of structured clinical data, combined with the mathematical nature of this specialty, makes it an attractive option for AI applications. AI can also play a significant role in addressing health inequities, especially in organ transplantation. It has also been used to detect rare diseases such as Fabry disease early. This review article aims to increase awareness on the basic concepts in machine learning and discuss AI applications in nephrology. It also addresses the challenges in integrating AI into clinical practice and the need for creating an AI-competent nephrology workforce. Even though AI will not replace nephrologists, those who are able to incorporate AI into their practice effectively will undoubtedly provide better care to their patients. The integration of AI technology is no longer just an option but a necessity for staying ahead in the field of nephrology. Finally, AI can contribute as a force multiplier in transitioning to a value-based care model.
{"title":"Artificial Intelligence in Nephrology: Clinical Applications and Challenges","authors":"Prabhat Singh , Lokesh Goyal , Deobrat C. Mallick , Salim R. Surani , Nayanjyoti Kaushik , Deepak Chandramohan , Prathap K. Simhadri","doi":"10.1016/j.xkme.2024.100927","DOIUrl":"10.1016/j.xkme.2024.100927","url":null,"abstract":"<div><div>Artificial intelligence (AI) is increasingly used in many medical specialties. However, nephrology has lagged in adopting and incorporating machine learning techniques. Nephrology is well positioned to capitalize on the benefits of AI. The abundance of structured clinical data, combined with the mathematical nature of this specialty, makes it an attractive option for AI applications. AI can also play a significant role in addressing health inequities, especially in organ transplantation. It has also been used to detect rare diseases such as Fabry disease early. This review article aims to increase awareness on the basic concepts in machine learning and discuss AI applications in nephrology. It also addresses the challenges in integrating AI into clinical practice and the need for creating an AI-competent nephrology workforce. Even though AI will not replace nephrologists, those who are able to incorporate AI into their practice effectively will undoubtedly provide better care to their patients. The integration of AI technology is no longer just an option but a necessity for staying ahead in the field of nephrology. Finally, AI can contribute as a force multiplier in transitioning to a value-based care model.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 1","pages":"Article 100927"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11719832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-31DOI: 10.1016/j.xkme.2024.100964
Silvia M. Titan , Sandra Herrmann , Nelson Leung , Pingchuan Zhang , Stephen Ansell
Monoclonal gammopathy of renal significance (MGRS) comprises a spectrum of kidney manifestations distinguished by its clinical and pathological presentations. This article reports a case of a female on her 60s who was referred to Nephrology for evaluation of worsening kidney function, hematuria, and proteinuria. Her medical history was notable for marginal zone lymphoma along with immunoglobulin M (IgM)-kappa cold agglutinin disease diagnosed 3 years before the current presentation, which had been treated with rituximab. A kidney biopsy was performed and revealed IgM-kappa monoclonal protein-associated nephropathy with predominantly intracapillary monoclonal IgM deposition injury pattern, a rare form of MGRS, reported for the first time in association with cold agglutinin disease.
{"title":"Intracapillary Monoclonal IgM Deposition Concomitant With Cold Agglutinin Disease","authors":"Silvia M. Titan , Sandra Herrmann , Nelson Leung , Pingchuan Zhang , Stephen Ansell","doi":"10.1016/j.xkme.2024.100964","DOIUrl":"10.1016/j.xkme.2024.100964","url":null,"abstract":"<div><div>Monoclonal gammopathy of renal significance (MGRS) comprises a spectrum of kidney manifestations distinguished by its clinical and pathological presentations. This article reports a case of a female on her 60s who was referred to Nephrology for evaluation of worsening kidney function, hematuria, and proteinuria. Her medical history was notable for marginal zone lymphoma along with immunoglobulin M (IgM)-kappa cold agglutinin disease diagnosed 3 years before the current presentation, which had been treated with rituximab. A kidney biopsy was performed and revealed IgM-kappa monoclonal protein-associated nephropathy with predominantly intracapillary monoclonal IgM deposition injury pattern, a rare form of MGRS, reported for the first time in association with cold agglutinin disease.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 3","pages":"Article 100964"},"PeriodicalIF":3.2,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143131169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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：