Pub Date : 2025-12-15DOI: 10.1016/j.xkme.2025.101220
Dipal M. Patel , Aurosikha Panda , Sani Fatima , Mary Ann Stephens , Jessica Gotay-Lehmer , Danielle Santiago , Deidra C. Crews , Kristin A. Riekert
<div><h3>Rationale & Objective</h3><div>People with non-dialysis-dependent chronic kidney disease (NDD-CKD) can experience substantial symptoms related to physical and mental health. Patient-reported outcome measures (PROMs) assess these aspects of health-related quality of life (QOL). Using the Kidney Disease Symptom Survey as an example to guide discussions, we sought to understand perspectives of patients and nephrology physicians about using PROMs in routine NDD-CKD care.</div></div><div><h3>Study Design</h3><div>Individual semi-structured interviews informed by the Theoretical Domains Framework and associated Capability, Opportunity, Motivation model of behavior change.</div></div><div><h3>Setting & Participants</h3><div>Adults with NDD-CKD and nephrology physicians in the Greater Baltimore-Maryland region.</div></div><div><h3>Analytical Approach</h3><div>Hybrid inductive-deductive thematic analysis.</div></div><div><h3>Results</h3><div>We analyzed interview transcripts from 15 nephrology physicians and 21 people with NDD-CKD. Capability to use PROMs was hindered by limited knowledge and skills of nephrology care teams to act on PROM results and manage symptoms. Opportunity to use PROMs was influenced by concerns surrounding environmental resources, including limited accessibility of PROMs to select patient users and limited time available to physicians to review PROMs data. Participants believed that PROMs could guide person-centered care, but motivation to use them was impeded by the uncertain role of nephrology physicians in assessing and managing symptoms and QOL, as well as concerns that PROMs may capture symptoms unrelated to CKD while also lacking sensitivity for key issues relevant to CKD patient care.</div></div><div><h3>Limitations</h3><div>Impact of clinical practice setting (including the availability of multidisciplinary support) and the views of individual PROM domains was not assessed.</div></div><div><h3>Conclusions</h3><div>Patient and clinician participants recognized the importance of symptom and QOL assessment in nephrology care. However, behavior changes required to integrate PROMs into routine CKD care may be limited by barriers related to the capability, opportunity, and motivation of users. These findings can inform the development of programs which support PROM implementation.</div></div><div><h3>Plain-Language Summary</h3><div>People with kidney disease often have symptoms, which worsen quality of life. Patient-reported outcome measures (PROMs) are surveys that patients can complete to share how they are feeling with health care teams. We spoke with people with kidney disease and kidney doctors to explore perspectives on using PROMs in kidney care. Participants agreed that PROMs could help focus care on patient needs. Some were uncertain if kidney doctors should be responsible for managing symptoms, especially because some symptoms might not be caused by kidney disease. Some doctors felt they did not have en
{"title":"Patient and Physician Perspectives on Use of Patient-Reported Outcome Measures in Non-Dialysis-Dependent CKD Care: A Qualitative Study","authors":"Dipal M. Patel , Aurosikha Panda , Sani Fatima , Mary Ann Stephens , Jessica Gotay-Lehmer , Danielle Santiago , Deidra C. Crews , Kristin A. Riekert","doi":"10.1016/j.xkme.2025.101220","DOIUrl":"10.1016/j.xkme.2025.101220","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>People with non-dialysis-dependent chronic kidney disease (NDD-CKD) can experience substantial symptoms related to physical and mental health. Patient-reported outcome measures (PROMs) assess these aspects of health-related quality of life (QOL). Using the Kidney Disease Symptom Survey as an example to guide discussions, we sought to understand perspectives of patients and nephrology physicians about using PROMs in routine NDD-CKD care.</div></div><div><h3>Study Design</h3><div>Individual semi-structured interviews informed by the Theoretical Domains Framework and associated Capability, Opportunity, Motivation model of behavior change.</div></div><div><h3>Setting & Participants</h3><div>Adults with NDD-CKD and nephrology physicians in the Greater Baltimore-Maryland region.</div></div><div><h3>Analytical Approach</h3><div>Hybrid inductive-deductive thematic analysis.</div></div><div><h3>Results</h3><div>We analyzed interview transcripts from 15 nephrology physicians and 21 people with NDD-CKD. Capability to use PROMs was hindered by limited knowledge and skills of nephrology care teams to act on PROM results and manage symptoms. Opportunity to use PROMs was influenced by concerns surrounding environmental resources, including limited accessibility of PROMs to select patient users and limited time available to physicians to review PROMs data. Participants believed that PROMs could guide person-centered care, but motivation to use them was impeded by the uncertain role of nephrology physicians in assessing and managing symptoms and QOL, as well as concerns that PROMs may capture symptoms unrelated to CKD while also lacking sensitivity for key issues relevant to CKD patient care.</div></div><div><h3>Limitations</h3><div>Impact of clinical practice setting (including the availability of multidisciplinary support) and the views of individual PROM domains was not assessed.</div></div><div><h3>Conclusions</h3><div>Patient and clinician participants recognized the importance of symptom and QOL assessment in nephrology care. However, behavior changes required to integrate PROMs into routine CKD care may be limited by barriers related to the capability, opportunity, and motivation of users. These findings can inform the development of programs which support PROM implementation.</div></div><div><h3>Plain-Language Summary</h3><div>People with kidney disease often have symptoms, which worsen quality of life. Patient-reported outcome measures (PROMs) are surveys that patients can complete to share how they are feeling with health care teams. We spoke with people with kidney disease and kidney doctors to explore perspectives on using PROMs in kidney care. Participants agreed that PROMs could help focus care on patient needs. Some were uncertain if kidney doctors should be responsible for managing symptoms, especially because some symptoms might not be caused by kidney disease. Some doctors felt they did not have en","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101220"},"PeriodicalIF":3.4,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023242","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}
<div><h3>Rationale & Objective</h3><div>Growth failure is prevalent in pediatric dialysis patients. Physical growth is limited to a specific period, and missed interventions may cause lifelong growth retardation. We aimed to investigate the association of secondary hyperparathyroidism with short stature and height growth failure.</div></div><div><h3>Study Design</h3><div>Cohort study.</div></div><div><h3>Setting & Participants</h3><div>Patients aged 1-20 years who initiated dialysis and were registered in the nationwide dialysis registry of Japan between 2009 and 2020.</div></div><div><h3>Exposure</h3><div>Intact parathyroid hormone (PTH) levels.</div></div><div><h3>Outcomes</h3><div>Height standard deviation score (SDS), short stature (less than or equal to −2.0 SDS of height), height velocity SDS, and height growth failure (less than or equal to −1.5 SDS of height velocity).</div></div><div><h3>Analytical Approach</h3><div>We examined the association between intact PTH levels and the outcomes in both cross-sectional and longitudinal analyses.</div></div><div><h3>Results</h3><div>Intact PTH, height, and weight were measured in 622 patients. The median dialysis vintage was 10 months, the mean age was 13 years, 59% were boys, 50% were receiving peritoneal dialysis, and the median value of intact PTH was 183 pg/mL. At enrollment, the median height SDS was −1.9 (IQR, −3.3 to −0.6), and 302 patients (49%) had a short stature. The median SDS of height velocity during the first year was −2.4 (IQR, −5.6 to −1.5), and 205 patients (75%) had height growth failure (a decrease in height velocity). Elevated intact PTH levels per doubling were associated with a significant decrease in height velocity (β = −0.26; 95% CI, −0.49 to −0.02) and height growth failure (OR, 1.16; 95% CI, 1.00-1.34). Restricted cubic spline analysis showed a decrease in height velocity with increasing intact PTH levels.</div></div><div><h3>Limitations</h3><div>Lacked data on recombinant human growth hormone use and limited follow-up periods to evaluate the impact of PTH on long-term growth.</div></div><div><h3>Conclusions</h3><div>Our findings suggest the involvement of secondary hyperparathyroidism in height growth failure in pediatric dialysis patients.</div></div><div><h3>Plain-Language Summary</h3><div>Growth failure is a common problem in children and adolescents receiving dialysis. We investigated the association between parathyroid hormone (PTH) and height growth in children and adolescents receiving dialysis, using data from a Japanese national dialysis survey. Between 2009 and 2020, we enrolled 622 patients receiving dialysis aged 1-20 years and measured PTH, height, and weight. The mean age was 13 years and the median value of intact PTH was 183 pg/mL. At enrollment, 302 (49%) patients had a short stature, and 205 (75%) had height growth failure during the first year. Elevated PTH levels were associated with height growth impairment. This study suggests the importanc
{"title":"Growth Failure Associated With Parathyroid Hormone Levels in Pediatric Dialysis Patients: A Nationwide Cohort Study","authors":"Takahiro Imaizumi , Takuo Kubota , Hirotaka Komaba , Masanori Abe , Norio Hanafusa , Takayuki Hamano , Masafumi Fukagawa","doi":"10.1016/j.xkme.2025.101214","DOIUrl":"10.1016/j.xkme.2025.101214","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Growth failure is prevalent in pediatric dialysis patients. Physical growth is limited to a specific period, and missed interventions may cause lifelong growth retardation. We aimed to investigate the association of secondary hyperparathyroidism with short stature and height growth failure.</div></div><div><h3>Study Design</h3><div>Cohort study.</div></div><div><h3>Setting & Participants</h3><div>Patients aged 1-20 years who initiated dialysis and were registered in the nationwide dialysis registry of Japan between 2009 and 2020.</div></div><div><h3>Exposure</h3><div>Intact parathyroid hormone (PTH) levels.</div></div><div><h3>Outcomes</h3><div>Height standard deviation score (SDS), short stature (less than or equal to −2.0 SDS of height), height velocity SDS, and height growth failure (less than or equal to −1.5 SDS of height velocity).</div></div><div><h3>Analytical Approach</h3><div>We examined the association between intact PTH levels and the outcomes in both cross-sectional and longitudinal analyses.</div></div><div><h3>Results</h3><div>Intact PTH, height, and weight were measured in 622 patients. The median dialysis vintage was 10 months, the mean age was 13 years, 59% were boys, 50% were receiving peritoneal dialysis, and the median value of intact PTH was 183 pg/mL. At enrollment, the median height SDS was −1.9 (IQR, −3.3 to −0.6), and 302 patients (49%) had a short stature. The median SDS of height velocity during the first year was −2.4 (IQR, −5.6 to −1.5), and 205 patients (75%) had height growth failure (a decrease in height velocity). Elevated intact PTH levels per doubling were associated with a significant decrease in height velocity (β = −0.26; 95% CI, −0.49 to −0.02) and height growth failure (OR, 1.16; 95% CI, 1.00-1.34). Restricted cubic spline analysis showed a decrease in height velocity with increasing intact PTH levels.</div></div><div><h3>Limitations</h3><div>Lacked data on recombinant human growth hormone use and limited follow-up periods to evaluate the impact of PTH on long-term growth.</div></div><div><h3>Conclusions</h3><div>Our findings suggest the involvement of secondary hyperparathyroidism in height growth failure in pediatric dialysis patients.</div></div><div><h3>Plain-Language Summary</h3><div>Growth failure is a common problem in children and adolescents receiving dialysis. We investigated the association between parathyroid hormone (PTH) and height growth in children and adolescents receiving dialysis, using data from a Japanese national dialysis survey. Between 2009 and 2020, we enrolled 622 patients receiving dialysis aged 1-20 years and measured PTH, height, and weight. The mean age was 13 years and the median value of intact PTH was 183 pg/mL. At enrollment, 302 (49%) patients had a short stature, and 205 (75%) had height growth failure during the first year. Elevated PTH levels were associated with height growth impairment. This study suggests the importanc","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101214"},"PeriodicalIF":3.4,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-15DOI: 10.1016/j.xkme.2025.101215
Safa Y. Mohammed , Abdulqadir J. Nashwan
Rising global temperatures owing to climate change have direct and harmful effects on kidney health, mainly through heat stress and related acute kidney injury. Despite growing clinical evidence, the nephrology community has yet to incorporate environmental stressors into risk models and guidelines fully. This perspective examines the link between heat stress and kidney injury, identifies vulnerable groups, and discusses long-term effects, including the progression of chronic kidney disease. Drawing on epidemiological data, clinical experience, and real-world observations, we advocate the urgent adoption of preventive measures, enhanced clinical training, and climate-aware policies to address the emerging kidney crisis. In addition, this perspective seeks to increase awareness of the risks associated with rising temperatures worldwide, especially in low-income areas, and the risk of heat-related acute kidney injury and kidney disease. It summarizes the concept of heat stress and its impact on kidney health—particularly among high-risk groups, such as those working indoors and outdoors—and the potential mechanisms by which heat stress affects the kidneys. Factors contributing to heat-related kidney disease include dehydration, heat acclimation, age, and other variables. We also outline prevention strategies to lower this risk.
{"title":"Heat Stress and Kidney Injury: A Growing Concern Amidst Climate Change","authors":"Safa Y. Mohammed , Abdulqadir J. Nashwan","doi":"10.1016/j.xkme.2025.101215","DOIUrl":"10.1016/j.xkme.2025.101215","url":null,"abstract":"<div><div>Rising global temperatures owing to climate change have direct and harmful effects on kidney health, mainly through heat stress and related acute kidney injury. Despite growing clinical evidence, the nephrology community has yet to incorporate environmental stressors into risk models and guidelines fully. This perspective examines the link between heat stress and kidney injury, identifies vulnerable groups, and discusses long-term effects, including the progression of chronic kidney disease. Drawing on epidemiological data, clinical experience, and real-world observations, we advocate the urgent adoption of preventive measures, enhanced clinical training, and climate-aware policies to address the emerging kidney crisis. In addition, this perspective seeks to increase awareness of the risks associated with rising temperatures worldwide, especially in low-income areas, and the risk of heat-related acute kidney injury and kidney disease. It summarizes the concept of heat stress and its impact on kidney health—particularly among high-risk groups, such as those working indoors and outdoors—and the potential mechanisms by which heat stress affects the kidneys. Factors contributing to heat-related kidney disease include dehydration, heat acclimation, age, and other variables. We also outline prevention strategies to lower this risk.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101215"},"PeriodicalIF":3.4,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-13DOI: 10.1016/j.xkme.2025.101216
Rivaldo José Melo Tavares , Mariana Póvoa-Corrêa , Iandy de Souza Mateus Tarricone , Simone Collopy , Roberta Lins Gonçalves , Carlos Alberto da Silva Magliano , Gaudencio Espinosa Lopez
Rationale & Objective
Patients with chronic kidney disease (CKD) often reach a point where their options for hemodialysis access are exhausted, when transhepatic and translumbar access becomes an option. The aim of this study is to compare the prevalence of complications associated with both types of catheters through a systematic review and meta-analysis.
Study Design
Literature-based systematic review and meta-analysis were accomplished in 2021/2022. Studies were obtained from 11 registries, including Medline/PubMed, Embase, and Scopus.
Setting & Study Populations
Included studies involved patients with CKD in access exhaustion who underwent translumbar or transhepatic catheter placement.
Selection Criteria for Studies
Eligible designs included clinical trials, quasi-experimental studies, observational studies, and case series; case reports were excluded.
Data Extraction
Two independent researchers used a tailored sheet to extract data from the studies.
Analytical Approach
A fixed-effect model for proportions was used to assess complications across 18 observational studies involving 649 catheters.
Results
Compared to the translumbar group, the transhepatic group showed significantly higher proportions per 100 catheter-days of irreversible infections (0.085 [95% CI, 0.051-0.118] vs 0.015 [95% CI, 0.007-0.023]; P < 0.001) and irreversible dysfunction (0.259 [95% CI, 0.205-0.313] vs 0.071 [95% CI, 0.054-0.089]; P < 0.001). Total infections (P < 0.001), thrombosis (P < 0.001), and catheter displacement (P < 0.001) were also significantly more frequent in the transhepatic group.
Limitations
The main challenge was the variability in study designs and the lack of randomized clinical trials, which was expected given the nature of the intervention.
Conclusions
Translumbar access in CKD is associated with fewer complications; however, transhepatic access remains a viable option as a bridge to definitive access or transplantation.
基本原理和目的慢性肾脏疾病（CKD）患者经常达到他们的血液透析途径选择用尽的地步，当经肝和经腰椎途径成为一种选择。本研究的目的是通过系统回顾和荟萃分析来比较两种导管相关并发症的发生率。研究设计基于文献的系统评价和荟萃分析于2021/2022年完成。研究从11个注册中心获得，包括Medline/PubMed、Embase和Scopus。背景和研究人群纳入的研究涉及经腰椎或经肝置管的CKD通路衰竭患者。研究选择标准：符合条件的设计包括临床试验、准实验研究、观察性研究和病例系列；病例报告被排除在外。数据提取两名独立研究人员使用定制的表格从研究中提取数据。采用比例固定效应模型对涉及649根导管的18项观察性研究的并发症进行评估。结果与经腰椎组相比，经肝组每100个导管日发生不可逆感染（0.085 [95% CI, 0.051-0.118] vs 0.015 [95% CI, 0.007-0.023]; P < 0.001）和不可逆功能障碍（0.259 [95% CI, 0.205-0.313] vs 0.071 [95% CI, 0.054-0.089]; P < 0.001）的比例显著高于经肝组。总感染（P < 0.001）、血栓形成（P < 0.001）和导管移位（P < 0.001）在经肝组也明显更频繁。主要的挑战是研究设计的可变性和缺乏随机临床试验，考虑到干预的性质，这是意料之中的。结论CKD患者经腰椎通路并发症较少；然而，经肝进入仍然是一个可行的选择，作为最终进入或移植的桥梁。
{"title":"Translumbar and Transhepatic Catheters for Hemodialysis in Chronic Kidney Disease: A Systematic Review and Meta-Analysis","authors":"Rivaldo José Melo Tavares , Mariana Póvoa-Corrêa , Iandy de Souza Mateus Tarricone , Simone Collopy , Roberta Lins Gonçalves , Carlos Alberto da Silva Magliano , Gaudencio Espinosa Lopez","doi":"10.1016/j.xkme.2025.101216","DOIUrl":"10.1016/j.xkme.2025.101216","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Patients with chronic kidney disease (CKD) often reach a point where their options for hemodialysis access are exhausted, when transhepatic and translumbar access becomes an option. The aim of this study is to compare the prevalence of complications associated with both types of catheters through a systematic review and meta-analysis.</div></div><div><h3>Study Design</h3><div>Literature-based systematic review and meta-analysis were accomplished in 2021/2022. Studies were obtained from 11 registries, including Medline/PubMed, Embase, and Scopus.</div></div><div><h3>Setting & Study Populations</h3><div>Included studies involved patients with CKD in access exhaustion who underwent translumbar or transhepatic catheter placement.</div></div><div><h3>Selection Criteria for Studies</h3><div>Eligible designs included clinical trials, quasi-experimental studies, observational studies, and case series; case reports were excluded.</div></div><div><h3>Data Extraction</h3><div>Two independent researchers used a tailored sheet to extract data from the studies.</div></div><div><h3>Analytical Approach</h3><div>A fixed-effect model for proportions was used to assess complications across 18 observational studies involving 649 catheters.</div></div><div><h3>Results</h3><div>Compared to the translumbar group, the transhepatic group showed significantly higher proportions per 100 catheter-days of irreversible infections (0.085 [95% CI, 0.051-0.118] vs 0.015 [95% CI, 0.007-0.023]; <em>P</em> < 0.001) and irreversible dysfunction (0.259 [95% CI, 0.205-0.313] vs 0.071 [95% CI, 0.054-0.089]; <em>P</em> < 0.001). Total infections (<em>P</em> < 0.001), thrombosis (<em>P</em> < 0.001), and catheter displacement (<em>P</em> < 0.001) were also significantly more frequent in the transhepatic group.</div></div><div><h3>Limitations</h3><div>The main challenge was the variability in study designs and the lack of randomized clinical trials, which was expected given the nature of the intervention.</div></div><div><h3>Conclusions</h3><div>Translumbar access in CKD is associated with fewer complications; however, transhepatic access remains a viable option as a bridge to definitive access or transplantation.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101216"},"PeriodicalIF":3.4,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-13DOI: 10.1016/j.xkme.2025.101209
Giulia Isabella Pintea , Annette Aldous , Christine M. Corbett , Elizabeth Anderson , Laurie Posey , Kimberly Wallace , Kelly Shipley , Joshua J. Mannix , Matthew Ryan , Dale E. Lupu , Alvin H. Moss
<div><h3>Rationale & Objective</h3><div>Shared decision making (SDM) is the preferred model for medical decision making, but implementation in kidney failure treatment decisions remains suboptimal. We educated nephrology clinicians to engage in comprehensive SDM with empathetic communication.</div></div><div><h3>Study Design</h3><div>Single-arm educational intervention with pre-post evaluation.</div></div><div><h3>Setting & Participants</h3><div>Three virtual educational sessions for 80 nephrology clinicians from 14 nephrology practices in the Expanding and Promoting Alternative Care and Knowledge in Decision-Making (ExPAND) clinical trial.</div></div><div><h3>Quality Improvement Activities</h3><div>We educated nephrology clinicians to operationalize SDM, including presentation of active medical care without dialysis, using the Ask-Tell-Ask approach and empathetic communication.</div></div><div><h3>Outcomes</h3><div>Participants rated their pre- and postsession confidence in achieving the learning objectives and provided qualitative feedback.</div></div><div><h3>Analytical Approach</h3><div>We used the Wilcoxon signed-rank paired test and obtained effect sizes (Cohen’s r) to compare pre-post ratings.</div></div><div><h3>Results</h3><div>On a 7-point scale, median postsession confidence ratings increased 1 to 2 points from presession ratings for all learning objectives. The effect sizes (Cohen’s r) for the increase were large for 12 of the 13 objectives. The 2 objectives showing the greatest improvement were using the 9 elements of SDM (2.00; 95% CI, 1.50-3.00; <em>P</em> < 0.001, r = 0.84) and delivering kidney disease education with a balanced presentation of all the options including active medical care without dialysis (2.00; 95% CI, 1.50-3.00; <em>P</em> < 0.001, r = 0.75). The qualitative feedback supported the quantitative results.</div></div><div><h3>Limitations</h3><div>Participant perceptions may not be generalizable to all nephrology clinicians. We did not measure whether improvements were retained over time or applied in practice.</div></div><div><h3>Conclusions</h3><div>The increase in clinician confidence suggests that our explicit instruction on how to conduct comprehensive SDM with empathetic communication may represent a breakthrough in improving the quality of SDM in the care of older patients with chronic kidney disease and kidney failure.</div></div><div><h3>Plain-Language Summary</h3><div>Shared decision making, in which patients and clinicians agree on treatment based on patient preferences, is often poorly done in nephrology. We taught practicing nephrology clinicians how to use the Ask-Tell-Ask approach to have more complete and empathetic conversations with patients and discuss all kidney failure treatment options, including active medical care without dialysis, along with their benefits and risks in an unbiased, balanced way. After training, participants felt more confident in conducting shared decision maki
目的共享决策（SDM）是医疗决策的首选模型，但在肾衰竭治疗决策中的实施仍不理想。我们教育肾脏病临床医生通过共情沟通进行全面的SDM。研究设计：单臂教育干预及前后评价。背景和参与者：在扩展和促进决策中的替代治疗和知识（ExPAND）临床试验中，来自14个肾内科实践的80名肾内科临床医生参加了三次虚拟教育会议。质量改进活动我们教育肾脏病临床医生实施SDM，包括采用“问-说-问”方法和移情沟通，在没有透析的情况下提供积极的医疗护理。结果：参与者评估了他们在学习前和学习后对实现学习目标的信心，并提供了定性反馈。分析方法我们使用Wilcoxon符号秩配对检验并获得效应量（Cohen’s r）来比较前后评分。结果在7分制量表中，所有学习目标的学习后信心评分中位数比压力评分提高了1到2分。在13个目标中，有12个目标的效应量（Cohen’s r）很大。显示改善最大的两个目标是使用SDM的9个要素（2.00;95% CI, 1.50-3.00; P < 0.001, r = 0.84）和提供肾脏疾病教育，并平衡地展示所有选择，包括非透析的积极医疗护理（2.00;95% CI, 1.50-3.00; P < 0.001, r = 0.75）。定性反馈支持定量结果。局限性参与者的感知可能不能推广到所有的肾脏病临床医生。我们没有衡量改进是否随时间保留或在实践中应用。结论临床医师信心的增加，提示我们明确指导如何通过共情沟通进行全面的SDM，可能是提高老年慢性肾病肾衰竭患者SDM护理质量的一个突破。共同决策，即患者和临床医生根据患者的偏好就治疗方案达成一致，在肾脏病学中往往做得很差。我们教授执业肾脏病临床医生如何使用Ask-Tell-Ask方法与患者进行更完整、更有同理心的对话，并以公正、平衡的方式讨论所有肾衰竭治疗方案，包括非透析的积极医疗护理，以及它们的益处和风险。培训后，参与者对共同决策更有信心。我们的研究结果表明，教授进行这些对话的具体方法可能会显著改善患者和医生共同做出决定的方式。我们的结果很有希望。如果通过测量患者对谈话的看法的研究得到证实，我们共同决策的方法可能会带来更好、更个性化的患者护理。
{"title":"An Initiative to Improve Nephrology Clinician Confidence in Shared Decision Making","authors":"Giulia Isabella Pintea , Annette Aldous , Christine M. Corbett , Elizabeth Anderson , Laurie Posey , Kimberly Wallace , Kelly Shipley , Joshua J. Mannix , Matthew Ryan , Dale E. Lupu , Alvin H. Moss","doi":"10.1016/j.xkme.2025.101209","DOIUrl":"10.1016/j.xkme.2025.101209","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Shared decision making (SDM) is the preferred model for medical decision making, but implementation in kidney failure treatment decisions remains suboptimal. We educated nephrology clinicians to engage in comprehensive SDM with empathetic communication.</div></div><div><h3>Study Design</h3><div>Single-arm educational intervention with pre-post evaluation.</div></div><div><h3>Setting & Participants</h3><div>Three virtual educational sessions for 80 nephrology clinicians from 14 nephrology practices in the Expanding and Promoting Alternative Care and Knowledge in Decision-Making (ExPAND) clinical trial.</div></div><div><h3>Quality Improvement Activities</h3><div>We educated nephrology clinicians to operationalize SDM, including presentation of active medical care without dialysis, using the Ask-Tell-Ask approach and empathetic communication.</div></div><div><h3>Outcomes</h3><div>Participants rated their pre- and postsession confidence in achieving the learning objectives and provided qualitative feedback.</div></div><div><h3>Analytical Approach</h3><div>We used the Wilcoxon signed-rank paired test and obtained effect sizes (Cohen’s r) to compare pre-post ratings.</div></div><div><h3>Results</h3><div>On a 7-point scale, median postsession confidence ratings increased 1 to 2 points from presession ratings for all learning objectives. The effect sizes (Cohen’s r) for the increase were large for 12 of the 13 objectives. The 2 objectives showing the greatest improvement were using the 9 elements of SDM (2.00; 95% CI, 1.50-3.00; <em>P</em> < 0.001, r = 0.84) and delivering kidney disease education with a balanced presentation of all the options including active medical care without dialysis (2.00; 95% CI, 1.50-3.00; <em>P</em> < 0.001, r = 0.75). The qualitative feedback supported the quantitative results.</div></div><div><h3>Limitations</h3><div>Participant perceptions may not be generalizable to all nephrology clinicians. We did not measure whether improvements were retained over time or applied in practice.</div></div><div><h3>Conclusions</h3><div>The increase in clinician confidence suggests that our explicit instruction on how to conduct comprehensive SDM with empathetic communication may represent a breakthrough in improving the quality of SDM in the care of older patients with chronic kidney disease and kidney failure.</div></div><div><h3>Plain-Language Summary</h3><div>Shared decision making, in which patients and clinicians agree on treatment based on patient preferences, is often poorly done in nephrology. We taught practicing nephrology clinicians how to use the Ask-Tell-Ask approach to have more complete and empathetic conversations with patients and discuss all kidney failure treatment options, including active medical care without dialysis, along with their benefits and risks in an unbiased, balanced way. After training, participants felt more confident in conducting shared decision maki","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101209"},"PeriodicalIF":3.4,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-13DOI: 10.1016/j.xkme.2025.101213
Darren Green , John G.F. Cleland , Hannah O’Keeffe , Rajkumar Chinnadurai , Edward Lake , Constantina Chrysochou , Philip A. Kalra
<div><h3>Rationale & Objective</h3><div>Trials failed to show that angioplasty and stenting of atherosclerotic renovascular disease (ARVD) conferred benefit when used as first-line therapy. However, some patients might benefit from kidney revascularization depending on their clinical phenotype and severity of renal artery stenosis (RAS). We investigated this hypothesis further.</div></div><div><h3>Study Design</h3><div>Data from the Angioplasty and Stenting for Renal Artery Lesions (ASTRAL) randomized trial and Salford ARVD observational study were included in a single analysis.</div></div><div><h3>Setting & Participants</h3><div>Patients were grouped based on RAS severity (≥70%) and whether unilateral or bilateral, with the bilateral group including RAS in a single functioning kidney. High-risk clinical phenotypes included advanced chronic kidney disease (CKD) (estimated glomerular filtration rate < 30 mL/min/1.73 m<sup>2</sup>), rapid CKD progression (creatinine increase >100 μmol/l or >20% per year), refractory systolic hypertension (≥150 mm Hg on ≥3 agents), and heart failure (chronic or decompensated).</div></div><div><h3>Exposures</h3><div>Medical therapy alone versus medial therapy and kidney revascularization.</div></div><div><h3>Outcome</h3><div>Composite of end stage CKD, cardiovascular events, or all-cause mortality.</div></div><div><h3>Analytical Approach</h3><div>Cox proportional hazard model adjusted for age, self-reported gender, and estimated glomerular filtration rate. Analysis of all patients and selected subgroups.</div></div><div><h3>Results</h3><div>In total, 1,644 patients (806 ASTRAL and 838 Salford). Median (IQR) age 72 (66-77) years. For bilateral severe RAS (≥70%) the HR for the composite outcome for revascularization compared with medical therapy was 0.70 (0.50-0.99), <em>P</em> = 0.048. The clinical phenotype where benefit appeared to be greatest in the presence of bilateral severe disease was people with rapidly progressive kidney disease with a HR of 0.39 (0.22-0.71]). In the absence of bilateral severe RAS, there was no benefit to revascularization for any clinical phenotype.</div></div><div><h3>Limitations</h3><div>The analyses included observational data.</div></div><div><h3>Conclusions</h3><div>The presence of bilateral severe RAS may be the best predictor of benefit for kidney revascularization.</div></div><div><h3>Plain-language Summary</h3><div>Previous clinical trials have indicated that undertaking procedures to restore blood flow to narrowed arteries in the kidneys should not be used routinely in patients with this condition (renal artery stenosis). This study looked at whether the procedure would benefit some patients, namely those with high-risk features. It used data from more than 1,000 patients, some of whom had the procedure and some who did not. It found that people with severe narrowing in both kidneys, particularly those who also had heart failure, had better long-term outcomes if
{"title":"Patient Selection for Revascularization of Atherosclerotic Renal Artery Stenosis: Comparing the Importance of Stenosis Severity and Clinical Phenotype","authors":"Darren Green , John G.F. Cleland , Hannah O’Keeffe , Rajkumar Chinnadurai , Edward Lake , Constantina Chrysochou , Philip A. Kalra","doi":"10.1016/j.xkme.2025.101213","DOIUrl":"10.1016/j.xkme.2025.101213","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Trials failed to show that angioplasty and stenting of atherosclerotic renovascular disease (ARVD) conferred benefit when used as first-line therapy. However, some patients might benefit from kidney revascularization depending on their clinical phenotype and severity of renal artery stenosis (RAS). We investigated this hypothesis further.</div></div><div><h3>Study Design</h3><div>Data from the Angioplasty and Stenting for Renal Artery Lesions (ASTRAL) randomized trial and Salford ARVD observational study were included in a single analysis.</div></div><div><h3>Setting & Participants</h3><div>Patients were grouped based on RAS severity (≥70%) and whether unilateral or bilateral, with the bilateral group including RAS in a single functioning kidney. High-risk clinical phenotypes included advanced chronic kidney disease (CKD) (estimated glomerular filtration rate < 30 mL/min/1.73 m<sup>2</sup>), rapid CKD progression (creatinine increase >100 μmol/l or >20% per year), refractory systolic hypertension (≥150 mm Hg on ≥3 agents), and heart failure (chronic or decompensated).</div></div><div><h3>Exposures</h3><div>Medical therapy alone versus medial therapy and kidney revascularization.</div></div><div><h3>Outcome</h3><div>Composite of end stage CKD, cardiovascular events, or all-cause mortality.</div></div><div><h3>Analytical Approach</h3><div>Cox proportional hazard model adjusted for age, self-reported gender, and estimated glomerular filtration rate. Analysis of all patients and selected subgroups.</div></div><div><h3>Results</h3><div>In total, 1,644 patients (806 ASTRAL and 838 Salford). Median (IQR) age 72 (66-77) years. For bilateral severe RAS (≥70%) the HR for the composite outcome for revascularization compared with medical therapy was 0.70 (0.50-0.99), <em>P</em> = 0.048. The clinical phenotype where benefit appeared to be greatest in the presence of bilateral severe disease was people with rapidly progressive kidney disease with a HR of 0.39 (0.22-0.71]). In the absence of bilateral severe RAS, there was no benefit to revascularization for any clinical phenotype.</div></div><div><h3>Limitations</h3><div>The analyses included observational data.</div></div><div><h3>Conclusions</h3><div>The presence of bilateral severe RAS may be the best predictor of benefit for kidney revascularization.</div></div><div><h3>Plain-language Summary</h3><div>Previous clinical trials have indicated that undertaking procedures to restore blood flow to narrowed arteries in the kidneys should not be used routinely in patients with this condition (renal artery stenosis). This study looked at whether the procedure would benefit some patients, namely those with high-risk features. It used data from more than 1,000 patients, some of whom had the procedure and some who did not. It found that people with severe narrowing in both kidneys, particularly those who also had heart failure, had better long-term outcomes if ","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101213"},"PeriodicalIF":3.4,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-12DOI: 10.1016/j.xkme.2025.101212
Jeong-Hoon Lim , Youn-Sik Oh , Man-Hoon Han , You Hyun Jeon , Hee-Yeon Jung , Ji-Young Choi , Jang-Hee Cho , Sun-Hee Park , Chan-Duck Kim , Yong-Lim Kim , Yong-Jin Kim
Proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) is a rare form of monoclonal gammopathy of renal significance (MGRS). The natural history and optimal treatment are poorly defined, particularly when circulating monoclonal proteins or hematologic clones are undetectable. We report a 57-year-old woman with biopsy-confirmed PGNMID who underwent 3 sequential kidney biopsies. The initial biopsy showed a classic membranoproliferative pattern with monotypic IgG-kappa deposits, whereas bone marrow examination showed no clonal plasma cell or B-cell proliferation. Despite corticosteroid-based immunosuppression, proteinuria persisted, and histology worsened on the second biopsy. Rituximab was administered 10 months after diagnosis; a third biopsy 3 months later showed resolution of immune deposits and glomerular proliferation. At 8 months post-rituximab, the patient remained in clinical remission with stable kidney function. This case underscores the value of sequential kidney biopsies to monitor disease activity and treatment response in PGNMID. Rituximab can induce clinical and histologic remission, even when circulating monoclonal proteins are undetectable.
{"title":"Rituximab-Induced Remission in Proliferative Glomerulonephritis With Monoclonal Immunoglobulin G Deposits: A Case Report With Serial Kidney Biopsies","authors":"Jeong-Hoon Lim , Youn-Sik Oh , Man-Hoon Han , You Hyun Jeon , Hee-Yeon Jung , Ji-Young Choi , Jang-Hee Cho , Sun-Hee Park , Chan-Duck Kim , Yong-Lim Kim , Yong-Jin Kim","doi":"10.1016/j.xkme.2025.101212","DOIUrl":"10.1016/j.xkme.2025.101212","url":null,"abstract":"<div><div>Proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) is a rare form of monoclonal gammopathy of renal significance (MGRS). The natural history and optimal treatment are poorly defined, particularly when circulating monoclonal proteins or hematologic clones are undetectable. We report a 57-year-old woman with biopsy-confirmed PGNMID who underwent 3 sequential kidney biopsies. The initial biopsy showed a classic membranoproliferative pattern with monotypic IgG-kappa deposits, whereas bone marrow examination showed no clonal plasma cell or B-cell proliferation. Despite corticosteroid-based immunosuppression, proteinuria persisted, and histology worsened on the second biopsy. Rituximab was administered 10 months after diagnosis; a third biopsy 3 months later showed resolution of immune deposits and glomerular proliferation. At 8 months post-rituximab, the patient remained in clinical remission with stable kidney function. This case underscores the value of sequential kidney biopsies to monitor disease activity and treatment response in PGNMID. Rituximab can induce clinical and histologic remission, even when circulating monoclonal proteins are undetectable.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101212"},"PeriodicalIF":3.4,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978510","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}
<div><h3>Rationale & Objective</h3><div>During the coronavirus disease 2019 (COVID-19) pandemic, nephrology societies recommended transition from facility-based hemodialysis to home dialysis to minimize risks associated with COVID-19 infection. We compared transition rates from facility-based hemodialysis to home dialysis and rates and reasons for transfers from home dialysis to facility-based hemodialysis before and during the pandemic in Canada.</div></div><div><h3>Study Design</h3><div>Interrupted time-series analysis.</div></div><div><h3>Setting & Population</h3><div>Using administrative data from the Canadian Organ Replacement Register, our cohort included 31,596 and 22,607 adults with any time receiving hemodialysis during the prepandemic and pandemic study periods, respectively.</div></div><div><h3>Exposure</h3><div>Early pandemic (April 1, 2020-September 30, 2021) versus prepandemic (January 1, 2016-December 31, 2019).</div></div><div><h3>Outcomes</h3><div>Monthly rates of transitions between facility-based hemodialysis and home dialysis as well as reasons for transfer from home to facility.</div></div><div><h3>Analytical Approach</h3><div>Segmented linear regression and analysis of covariance.</div></div><div><h3>Results</h3><div>During the early pandemic, transitions to home dialysis increased by 0.60 per 10,000 patients/month (95% CI, 0.08 to 1.11; <em>P</em> = 0.03), beyond the nonsignificant monthly prepandemic trend of 0.02 per 10,000 (95% CI, –0.10 to 0.13; <em>P</em> = 0.80). Monthly transfers from home dialysis to facility-based hemodialysis per 10,000 home dialysis patients also increased during the pandemic (6.91; 95% CI, 3.42 to 10.40; <em>P</em> < 0.001) versus the prepandemic period (–1.78; 95% CI, –4.31 to0.75; <em>P</em> = 0.20). The rate of increase in home-to-facility transfers during the pandemic was not significantly different than facility-to-home transfers (−0.10 transfers/month; 95% CI, –1.51 to 1.31; <em>P</em> = 0.89). More transfers to facility occurred for geographic/resource-related reasons during the pandemic versus prepandemic (5.8% vs 2.7%; <em>P</em> < 0.0001).</div></div><div><h3>Limitations</h3><div>Inability to analyze change in trends by province and ecological bias.</div></div><div><h3>Conclusions</h3><div>Transitions from facility-based hemodialysis to home dialysis increased, suggesting kidney care programs in Canada implemented recommendations intended to decrease COVID-19-related risks in this population. Reasons for the observed increase in transfers from home to facility during the pandemic are unclear.</div></div><div><h3>Plain-Language Summary</h3><div>During the coronavirus disease 2019 (COVID-19) pandemic, individuals with kidney failure receiving dialysis faced high rates of COVID-19 transmission and severe infection. As a preventive measure, kidney care societies advised increased use of home dialysis. To assess the impact of this directive, we tracked monthly transitions from
{"title":"Home Dialysis Transitions in Canada During the COVID-19 Pandemic: An Interrupted Time Series Analysis","authors":"Davide Verrelli , Reid Whitlock , Thomas Ferguson , Claudio Rigatto , Nathan Nickel , Karthik Tennankore , Oksana Harasemiw , Ranveer Brar , Clara Bohm","doi":"10.1016/j.xkme.2025.101207","DOIUrl":"10.1016/j.xkme.2025.101207","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>During the coronavirus disease 2019 (COVID-19) pandemic, nephrology societies recommended transition from facility-based hemodialysis to home dialysis to minimize risks associated with COVID-19 infection. We compared transition rates from facility-based hemodialysis to home dialysis and rates and reasons for transfers from home dialysis to facility-based hemodialysis before and during the pandemic in Canada.</div></div><div><h3>Study Design</h3><div>Interrupted time-series analysis.</div></div><div><h3>Setting & Population</h3><div>Using administrative data from the Canadian Organ Replacement Register, our cohort included 31,596 and 22,607 adults with any time receiving hemodialysis during the prepandemic and pandemic study periods, respectively.</div></div><div><h3>Exposure</h3><div>Early pandemic (April 1, 2020-September 30, 2021) versus prepandemic (January 1, 2016-December 31, 2019).</div></div><div><h3>Outcomes</h3><div>Monthly rates of transitions between facility-based hemodialysis and home dialysis as well as reasons for transfer from home to facility.</div></div><div><h3>Analytical Approach</h3><div>Segmented linear regression and analysis of covariance.</div></div><div><h3>Results</h3><div>During the early pandemic, transitions to home dialysis increased by 0.60 per 10,000 patients/month (95% CI, 0.08 to 1.11; <em>P</em> = 0.03), beyond the nonsignificant monthly prepandemic trend of 0.02 per 10,000 (95% CI, –0.10 to 0.13; <em>P</em> = 0.80). Monthly transfers from home dialysis to facility-based hemodialysis per 10,000 home dialysis patients also increased during the pandemic (6.91; 95% CI, 3.42 to 10.40; <em>P</em> < 0.001) versus the prepandemic period (–1.78; 95% CI, –4.31 to0.75; <em>P</em> = 0.20). The rate of increase in home-to-facility transfers during the pandemic was not significantly different than facility-to-home transfers (−0.10 transfers/month; 95% CI, –1.51 to 1.31; <em>P</em> = 0.89). More transfers to facility occurred for geographic/resource-related reasons during the pandemic versus prepandemic (5.8% vs 2.7%; <em>P</em> < 0.0001).</div></div><div><h3>Limitations</h3><div>Inability to analyze change in trends by province and ecological bias.</div></div><div><h3>Conclusions</h3><div>Transitions from facility-based hemodialysis to home dialysis increased, suggesting kidney care programs in Canada implemented recommendations intended to decrease COVID-19-related risks in this population. Reasons for the observed increase in transfers from home to facility during the pandemic are unclear.</div></div><div><h3>Plain-Language Summary</h3><div>During the coronavirus disease 2019 (COVID-19) pandemic, individuals with kidney failure receiving dialysis faced high rates of COVID-19 transmission and severe infection. As a preventive measure, kidney care societies advised increased use of home dialysis. To assess the impact of this directive, we tracked monthly transitions from","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101207"},"PeriodicalIF":3.4,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-12DOI: 10.1016/j.xkme.2025.101210
Hiroki Nishiwaki , Chisato Miyakoshi , Jun Miyashita , Yoshihiro Onishi , Noriaki Kurita , Hirotaka Komaba , Ken Sakai
Rationale & Objective
Advance care planning (ACP) is crucial in end-of-life care. Data on ACP discussion among patients with end-stage kidney disease are limited. One study has suggested that depressive symptoms increase ACP discussion.
Study Design
This study aimed to analyze the association between depression and ACP discussion in patients undergoing hemodialysis.
Setting & Population
This used data from the Japan Dialysis Outcomes and Practice Patterns Study.
Predictor
Both cross-sectional and longitudinal associations between depressive symptoms and ACP discussion were examined.
Outcomes
Depressive symptoms were defined as a score of ≥10 points on the 10-item Center for Epidemiologic Studies Depression scale. ACP discussion was defined as discussing ACP with health care providers and family members.
Analytical Approach
Generalized estimating equations and generalized linear models based on Poisson distribution and log-link function were used to estimate prevalence (PR) and incidence proportion ratios (IPRs) using robust standard errors, respectively.
Results
Data in 2016 and 2017 included 2,443 patients for the cross-sectional analysis and 870 for the longitudinal analysis. ACP discussion was 26% in 2016 and 28% in 2017, with depressive symptoms rates of 45% and 47%, respectively. The cross-sectional analysis indicated a positive association between depressive symptoms and ACP discussion (adjusted PR, 1.20; 95% confidence interval (CI), 1.05-1.37). Depressive symptoms were not significantly associated with ACP discussion in longitudinal analyses (adjusted IPR, 1.10; 95% CI 0.80-1.51).
Limitations
Sample size, unadjusted confounding, and generalizability across cultural backgrounds.
Conclusions
Our study showed an association between depressive symptoms and ACP in the cross-sectional analysis, but not longitudinally.
Plain-Language Summary
Thinking ahead about medical decisions is vital for people receiving dialysis, yet we know little about how often these conversations happen or what drives them. We analyzed national survey data from Japanese dialysis centers to see whether feelings of depression encourage or discourage patients from talking with their families and care teams about future care. We compared patients at one point in time and again 1 year later. At baseline, those reporting depressive feelings were more likely to have had these planning talks, but this link did not hold over the following year. Our work suggests that recognizing emotional distress may open a useful doorway to end-of-life discussions and better patient-centered care for dialysis patients and their supportive networks today.
理由和目的预先护理计划（ACP）在临终关怀中至关重要。终末期肾病患者ACP讨论的数据有限。一项研究表明，抑郁症状增加了ACP的讨论。研究设计本研究旨在分析血液透析患者抑郁与ACP讨论的关系。本研究使用的数据来自日本透析结果和实践模式研究。预测者抑郁症状与ACP讨论的横断面和纵向关联均被检验。抑郁症状定义为在流行病学研究中心抑郁量表的10项评分中得分≥10分。ACP讨论定义为与卫生保健提供者和家庭成员讨论ACP。基于泊松分布和log-link函数的广义估计方程和广义线性模型分别使用鲁棒标准误差估计患病率（PR）和发病率比（ipr）。结果2016年和2017年的数据包括2443例患者进行横断面分析，870例进行纵向分析。2016年和2017年ACP讨论率分别为26%和28%，抑郁症状率分别为45%和47%。横断面分析显示抑郁症状与ACP讨论呈正相关（校正PR， 1.20； 95%可信区间（CI）， 1.05-1.37）。在纵向分析中，抑郁症状与ACP讨论无显著相关（校正IPR， 1.10; 95% CI 0.80-1.51）。局限性：样本量、未调整的混杂因素和跨文化背景的普遍性。结论在横断面分析中，sour研究显示抑郁症状与ACP之间存在关联，但在纵向分析中没有关联。对于接受透析治疗的人来说，提前考虑医疗决定是至关重要的，但我们对这些对话发生的频率或驱动因素知之甚少。我们分析了日本透析中心的全国调查数据，看看抑郁的感觉是鼓励还是阻止患者与家人和护理团队谈论未来的护理。我们在一个时间点和一年后再次比较患者。在基线上，那些报告抑郁情绪的人更有可能进行这些计划谈话，但这种联系在接下来的一年里就不成立了。我们的工作表明，认识到情绪困扰可能为今天的透析患者及其支持网络打开了一扇有用的大门，可以进行临终讨论，并提供更好的以患者为中心的护理。
{"title":"Depression and Advance Care Planning Among Japanese Patients Undergoing Hemodialysis: Japanese Dialysis Outcomes and Practice Pattern Study (J-DOPPS)","authors":"Hiroki Nishiwaki , Chisato Miyakoshi , Jun Miyashita , Yoshihiro Onishi , Noriaki Kurita , Hirotaka Komaba , Ken Sakai","doi":"10.1016/j.xkme.2025.101210","DOIUrl":"10.1016/j.xkme.2025.101210","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Advance care planning (ACP) is crucial in end-of-life care. Data on ACP discussion among patients with end-stage kidney disease are limited. One study has suggested that depressive symptoms increase ACP discussion.</div></div><div><h3>Study Design</h3><div>This study aimed to analyze the association between depression and ACP discussion in patients undergoing hemodialysis.</div></div><div><h3>Setting & Population</h3><div>This used data from the Japan Dialysis Outcomes and Practice Patterns Study.</div></div><div><h3>Predictor</h3><div>Both cross-sectional and longitudinal associations between depressive symptoms and ACP discussion were examined.</div></div><div><h3>Outcomes</h3><div>Depressive symptoms were defined as a score of ≥10 points on the 10-item Center for Epidemiologic Studies Depression scale. ACP discussion was defined as discussing ACP with health care providers and family members.</div></div><div><h3>Analytical Approach</h3><div>Generalized estimating equations and generalized linear models based on Poisson distribution and log-link function were used to estimate prevalence (PR) and incidence proportion ratios (IPRs) using robust standard errors, respectively.</div></div><div><h3>Results</h3><div>Data in 2016 and 2017 included 2,443 patients for the cross-sectional analysis and 870 for the longitudinal analysis. ACP discussion was 26% in 2016 and 28% in 2017, with depressive symptoms rates of 45% and 47%, respectively. The cross-sectional analysis indicated a positive association between depressive symptoms and ACP discussion (adjusted PR, 1.20; 95% confidence interval (CI), 1.05-1.37). Depressive symptoms were not significantly associated with ACP discussion in longitudinal analyses (adjusted IPR, 1.10; 95% CI 0.80-1.51).</div></div><div><h3>Limitations</h3><div>Sample size, unadjusted confounding, and generalizability across cultural backgrounds.</div></div><div><h3>Conclusions</h3><div>Our study showed an association between depressive symptoms and ACP in the cross-sectional analysis, but not longitudinally.</div></div><div><h3>Plain-Language Summary</h3><div>Thinking ahead about medical decisions is vital for people receiving dialysis, yet we know little about how often these conversations happen or what drives them. We analyzed national survey data from Japanese dialysis centers to see whether feelings of depression encourage or discourage patients from talking with their families and care teams about future care. We compared patients at one point in time and again 1 year later. At baseline, those reporting depressive feelings were more likely to have had these planning talks, but this link did not hold over the following year. Our work suggests that recognizing emotional distress may open a useful doorway to end-of-life discussions and better patient-centered care for dialysis patients and their supportive networks today.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101210"},"PeriodicalIF":3.4,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023243","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}
<div><h3>Rationale & Objective</h3><div>Roxadustat effectively improves renal anemia, but its impact on residual kidney function (RKF) preservation in continuous ambulatory peritoneal dialysis (CAPD) patients is unclear. Our objective was to evaluate the impact of roxadustat on RKF decline in prevalent CAPD patients, with particular emphasis on identifying sex-specific differential outcomes.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>This study included 360 CAPD patients treated with either roxadustat (n=144) or erythropoiesis-stimulating agents (ESAs) (n=216) at our center between January 2021 and June 2024.</div></div><div><h3>Exposure</h3><div>CAPD patients diagnosed with renal anemia were treated with roxadustat or ESAs to achieve target hemoglobin levels.</div></div><div><h3>Outcomes</h3><div>The primary endpoint was the decline in RKF during the 18-month follow-up period, measured by the average of 24-hour urinary urea and creatinine clearances adjusted for the body surface area (mL/min/1.73 m<sup>2</sup>). Secondary endpoints included changes in hemoglobin levels and lipid profiles, as well as the incidence of peritonitis.</div></div><div><h3>Analytical Approach</h3><div>Propensity scores methods, including 1:1 propensity score matching with replacement and inverse probability of treatment weighting.</div></div><div><h3>Results</h3><div>Overall, neither propensity score matching nor inverse probability of treatment weighting models showed significant difference in RKF preservation between the roxadustat and ESA groups. However, in male patients, roxadustat was associated with a slower decline in RKF compared with ESAs (Δ–0.8 vs Δ–1.4 mL/min/1.73 m<sup>2</sup>; <em>P</em> = 0.04) at 18 months. Additionally, hemoglobin levels were comparable between groups. The roxadustat group exhibited lower triglycerides and low-density lipoprotein level than the ESA group. No significant difference in peritonitis incidence was observed between the 2 groups.</div></div><div><h3>Limitations</h3><div>The overall baseline RKF of our PD patients was exceptionally low.</div></div><div><h3>Conclusions</h3><div>Roxadustat delays RKF decline in male CAPD patients while providing comparable anemia control and favorable lipid profile effects as ESAs. These sex-specific outcomes suggest underlying biological mechanisms, highlighting the need for larger, targeted studies to further elucidate the potential benefits of roxadustat in this population.</div></div><div><h3>Plain-Language Summary</h3><div>Roxadustat demonstrates comparable efficacy to erythropoiesis-stimulating agents in managing anemia in chronic kidney disease (CKD). Although renal anemia in peritoneal dialysis patients is associated with accelerated residual kidney function decline, its potential renoprotective effects remain unclear. In this single-center retrospective cohort study, we found that roxadustat delays res
目的呋沙司他可有效改善肾性贫血，但其对持续动态腹膜透析（CAPD）患者残余肾功能（RKF）保存的影响尚不清楚。我们的目的是评估罗沙司他对常见CAPD患者RKF下降的影响，特别强调识别性别特异性差异结果。研究设计回顾性队列研究。本研究纳入了2021年1月至2024年6月期间在本中心接受罗沙司他（n=144）或促红细胞生成剂（esa） （n=216）治疗的360例CAPD患者。诊断为肾性贫血的慢性阻塞性肺疾病患者接受罗沙司他或esa治疗以达到目标血红蛋白水平。主要终点是在18个月的随访期间RKF的下降，通过根据体表面积（mL/min/1.73 m2）调整24小时尿尿素和肌酐清除率的平均值来测量。次要终点包括血红蛋白水平和脂质谱的变化，以及腹膜炎的发生率。分析方法倾向评分方法，包括1:1的倾向评分匹配替代和逆概率处理加权。结果总体而言，倾向评分匹配和治疗加权模型的逆概率均未显示罗沙他特组和欧空局组在RKF保存方面存在显著差异。然而，在男性患者中，与esa相比，罗沙司他与18个月时RKF下降较慢相关（Δ-0.8 vs Δ-1.4 mL/min/1.73 m2; P = 0.04）。此外，两组之间的血红蛋白水平具有可比性。罗沙司他组甘油三酯和低密度脂蛋白水平低于ESA组。两组患者腹膜炎发生率无显著差异。局限性：PD患者的总体基线RKF异常低。结论罗沙司他延缓了男性CAPD患者RKF的下降，同时提供了与esa相当的贫血控制和有利的脂质分析效果。这些性别特异性的结果提示潜在的生物学机制，强调需要更大的、有针对性的研究来进一步阐明罗沙他在这一人群中的潜在益处。罗沙他在治疗慢性肾病（CKD）患者贫血方面的疗效与促红细胞生成剂相当。尽管腹膜透析患者肾性贫血与残留肾功能加速下降有关，但其潜在的肾保护作用尚不清楚。在这项单中心回顾性队列研究中，我们发现罗沙司他可以延缓男性连续门诊腹膜透析患者的残余肾功能下降，而不影响贫血的改善，并显示出良好的脂质调节作用。这些发现为优化腹膜透析患者的个体化治疗策略提供了见解。
{"title":"Sex-Specific Impact of Roxadustat on Residual Kidney Function in Peritoneal Dialysis Patients: A Propensity Score-Weighted Analysis","authors":"Simin Jiang , Guanji Zhang , Yiping Xu, Yi Li, Guanglan Li, Hongyu Li, Yuchu Liu, Siyuan Li, Jianxiong Lin, Qunying Guo, Xiao Yang, Wei Chen, Haiping Mao, Yating Wang","doi":"10.1016/j.xkme.2025.101208","DOIUrl":"10.1016/j.xkme.2025.101208","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Roxadustat effectively improves renal anemia, but its impact on residual kidney function (RKF) preservation in continuous ambulatory peritoneal dialysis (CAPD) patients is unclear. Our objective was to evaluate the impact of roxadustat on RKF decline in prevalent CAPD patients, with particular emphasis on identifying sex-specific differential outcomes.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>This study included 360 CAPD patients treated with either roxadustat (n=144) or erythropoiesis-stimulating agents (ESAs) (n=216) at our center between January 2021 and June 2024.</div></div><div><h3>Exposure</h3><div>CAPD patients diagnosed with renal anemia were treated with roxadustat or ESAs to achieve target hemoglobin levels.</div></div><div><h3>Outcomes</h3><div>The primary endpoint was the decline in RKF during the 18-month follow-up period, measured by the average of 24-hour urinary urea and creatinine clearances adjusted for the body surface area (mL/min/1.73 m<sup>2</sup>). Secondary endpoints included changes in hemoglobin levels and lipid profiles, as well as the incidence of peritonitis.</div></div><div><h3>Analytical Approach</h3><div>Propensity scores methods, including 1:1 propensity score matching with replacement and inverse probability of treatment weighting.</div></div><div><h3>Results</h3><div>Overall, neither propensity score matching nor inverse probability of treatment weighting models showed significant difference in RKF preservation between the roxadustat and ESA groups. However, in male patients, roxadustat was associated with a slower decline in RKF compared with ESAs (Δ–0.8 vs Δ–1.4 mL/min/1.73 m<sup>2</sup>; <em>P</em> = 0.04) at 18 months. Additionally, hemoglobin levels were comparable between groups. The roxadustat group exhibited lower triglycerides and low-density lipoprotein level than the ESA group. No significant difference in peritonitis incidence was observed between the 2 groups.</div></div><div><h3>Limitations</h3><div>The overall baseline RKF of our PD patients was exceptionally low.</div></div><div><h3>Conclusions</h3><div>Roxadustat delays RKF decline in male CAPD patients while providing comparable anemia control and favorable lipid profile effects as ESAs. These sex-specific outcomes suggest underlying biological mechanisms, highlighting the need for larger, targeted studies to further elucidate the potential benefits of roxadustat in this population.</div></div><div><h3>Plain-Language Summary</h3><div>Roxadustat demonstrates comparable efficacy to erythropoiesis-stimulating agents in managing anemia in chronic kidney disease (CKD). Although renal anemia in peritoneal dialysis patients is associated with accelerated residual kidney function decline, its potential renoprotective effects remain unclear. In this single-center retrospective cohort study, we found that roxadustat delays res","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101208"},"PeriodicalIF":3.4,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：