Pub Date : 2025-11-07DOI: 10.1016/j.xkme.2025.101179
Hoimonty Mazumder , Easter Protiva Gain , Monir Hossain Shimul , Faizah Farah , Naznin Alam , Xichen Mou , Fawaz Mzayek , Chunrong Jia , Matthew P. Smeltzer , Hongmei Zhang , Howard H. Chang , Robert Lowell Davis , Joshua S. Fu , Csaba P. Kovesdy , M. Mahbub Hossain , Abu Mohd Naser
<div><h3>Rationale & Objectives</h3><div>Extreme ambient temperatures have been associated with a higher risk of acute and chronic health outcomes, including cardiovascular, respiratory, infectious, and kidney diseases. However, there is a lack of synthesized comprehensive evidence regarding the association of ambient temperature and renal colic in existing literature.</div></div><div><h3>Study Design</h3><div>Systematic review and meta-analysis of epidemiological studies.</div></div><div><h3>Setting & Population</h3><div>Population of any geographic areas regardless of their age, sex/gender, ethnicity, or any other population characteristics.</div></div><div><h3>Selection Criteria for Studies</h3><div>We conducted literature searches in PubMed, Scopus, CINAHL complete, Web of Sciences, and additional sources until June 4, 2024, following the Population-Exposure-Comparator-Outcome (PECO) framework.</div></div><div><h3>Exposure</h3><div>Daily ambient temperature.</div></div><div><h3>Outcomes</h3><div>Confirmed cases of renal colic, including its underlying causes, such as kidney stone/nephrolithiasis or urolithiasis, urinary tract infection, and pyelonephritis, etc.</div></div><div><h3>Data Extraction</h3><div>Two investigators performed data extraction to ensure data consistency and quality.</div></div><div><h3>Analytical Approach</h3><div>Random-effects meta-analyses using the DerSimonian and Laird method.</div></div><div><h3>Results</h3><div>Of 982 initially retrieved articles, we included 26 articles in the systematic review, of which 23 were eligible for the heat effect meta-analysis and 7 were included in the cold effect meta-analysis. Despite high heterogeneity, the result showed a 2.4% higher risk of renal colic for 1°C higher daily ambient temperature (Cohen’s d, 0.013 [95% CI, 0.010-0.015]; RR, 1.024 [95% CI, 1.020-1.028]; <em>I</em><sup><em>2</em></sup>, 99.7%, <em>P</em> <0.001). For a 1 °C lower daily ambient temperature, the risk of renal colic was 1.5% (Cohen’s d, 0.008 [95% CI: –0.000 to 0.016]; RR, 1.015 [95% CI, 1.000-1.029]; <em>I</em><sup><em>2</em></sup>, 73.2%; <em>P</em> > 0.05), although not statistically significant.</div></div><div><h3>Limitations</h3><div>Limitations of this systematic review include high heterogeneity and publication bias.</div></div><div><h3>Conclusions</h3><div>Elevated daily ambient temperature is associated with the risk of renal colic, suggesting an adverse effect of high ambient temperature on kidney function.</div></div><div><h3>Registration</h3><div>PROSPERO registration number: CRD420245555</div></div><div><h3>Plain-language Summary</h3><div>Ambient temperature is a risk factor for acute kidney injury and chronic kidney disease but evidence on its role in renal colic has not been explored. We conducted a meta-analysis including 26 studies to evaluate the heat and cold effect of ambient temperature on renal colic risk. We found that high ambient temperature increases the risk of re
{"title":"Ambient Temperature and Risk of Renal Colic: A Systematic Review and Meta-analysis","authors":"Hoimonty Mazumder , Easter Protiva Gain , Monir Hossain Shimul , Faizah Farah , Naznin Alam , Xichen Mou , Fawaz Mzayek , Chunrong Jia , Matthew P. Smeltzer , Hongmei Zhang , Howard H. Chang , Robert Lowell Davis , Joshua S. Fu , Csaba P. Kovesdy , M. Mahbub Hossain , Abu Mohd Naser","doi":"10.1016/j.xkme.2025.101179","DOIUrl":"10.1016/j.xkme.2025.101179","url":null,"abstract":"<div><h3>Rationale & Objectives</h3><div>Extreme ambient temperatures have been associated with a higher risk of acute and chronic health outcomes, including cardiovascular, respiratory, infectious, and kidney diseases. However, there is a lack of synthesized comprehensive evidence regarding the association of ambient temperature and renal colic in existing literature.</div></div><div><h3>Study Design</h3><div>Systematic review and meta-analysis of epidemiological studies.</div></div><div><h3>Setting & Population</h3><div>Population of any geographic areas regardless of their age, sex/gender, ethnicity, or any other population characteristics.</div></div><div><h3>Selection Criteria for Studies</h3><div>We conducted literature searches in PubMed, Scopus, CINAHL complete, Web of Sciences, and additional sources until June 4, 2024, following the Population-Exposure-Comparator-Outcome (PECO) framework.</div></div><div><h3>Exposure</h3><div>Daily ambient temperature.</div></div><div><h3>Outcomes</h3><div>Confirmed cases of renal colic, including its underlying causes, such as kidney stone/nephrolithiasis or urolithiasis, urinary tract infection, and pyelonephritis, etc.</div></div><div><h3>Data Extraction</h3><div>Two investigators performed data extraction to ensure data consistency and quality.</div></div><div><h3>Analytical Approach</h3><div>Random-effects meta-analyses using the DerSimonian and Laird method.</div></div><div><h3>Results</h3><div>Of 982 initially retrieved articles, we included 26 articles in the systematic review, of which 23 were eligible for the heat effect meta-analysis and 7 were included in the cold effect meta-analysis. Despite high heterogeneity, the result showed a 2.4% higher risk of renal colic for 1°C higher daily ambient temperature (Cohen’s d, 0.013 [95% CI, 0.010-0.015]; RR, 1.024 [95% CI, 1.020-1.028]; <em>I</em><sup><em>2</em></sup>, 99.7%, <em>P</em> <0.001). For a 1 °C lower daily ambient temperature, the risk of renal colic was 1.5% (Cohen’s d, 0.008 [95% CI: –0.000 to 0.016]; RR, 1.015 [95% CI, 1.000-1.029]; <em>I</em><sup><em>2</em></sup>, 73.2%; <em>P</em> > 0.05), although not statistically significant.</div></div><div><h3>Limitations</h3><div>Limitations of this systematic review include high heterogeneity and publication bias.</div></div><div><h3>Conclusions</h3><div>Elevated daily ambient temperature is associated with the risk of renal colic, suggesting an adverse effect of high ambient temperature on kidney function.</div></div><div><h3>Registration</h3><div>PROSPERO registration number: CRD420245555</div></div><div><h3>Plain-language Summary</h3><div>Ambient temperature is a risk factor for acute kidney injury and chronic kidney disease but evidence on its role in renal colic has not been explored. We conducted a meta-analysis including 26 studies to evaluate the heat and cold effect of ambient temperature on renal colic risk. We found that high ambient temperature increases the risk of re","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 1","pages":"Article 101179"},"PeriodicalIF":3.4,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787288","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 : 2025-11-06DOI: 10.1016/j.xkme.2025.101176
Hyeran Park , Ji-Yun Song , Hae-Young Lopilly Park , Byung Ha Chung , Hanbi Lee
Fluctuations in intraocular pressure (IOP) during hemodialysis (HD) have been a challenging and troublesome issue, particularly in patients with impaired aqueous humor outflow. In this report, we present a case of a 72-year-old man receiving HD with a history of glaucoma who experienced worsening of IOP fluctuations during HD and subsequently achieved IOP stabilization after transitioning to peritoneal dialysis (PD). Despite medical management and surgical interventions, his IOP remained uncontrolled, and visual disturbances persisted. After the unsuccessful treatment, we considered PD as an alternative therapy owing to its theoretical potential to stabilize osmotic disequilibrium during HD. As a result, conversion to PD resulted in stabilization of IOP within normal ranges. However, the pre-existing visual damage remained irreversible. This report represents the first attempt to address IOP fluctuations by transitioning from HD to PD, offering an option for IOP regulation in patients receiving HD. Moreover, it underscores the need for early and proactive adjustments in dialysis treatment to preserve vision and quality of life.
{"title":"Peritoneal Dialysis Conversion as a Salvage Therapy for Refractory Intraocular Pressure Fluctuations During Hemodialysis in a Patient With End-Stage Kidney Disease","authors":"Hyeran Park , Ji-Yun Song , Hae-Young Lopilly Park , Byung Ha Chung , Hanbi Lee","doi":"10.1016/j.xkme.2025.101176","DOIUrl":"10.1016/j.xkme.2025.101176","url":null,"abstract":"<div><div>Fluctuations in intraocular pressure (IOP) during hemodialysis (HD) have been a challenging and troublesome issue, particularly in patients with impaired aqueous humor outflow. In this report, we present a case of a 72-year-old man receiving HD with a history of glaucoma who experienced worsening of IOP fluctuations during HD and subsequently achieved IOP stabilization after transitioning to peritoneal dialysis (PD). Despite medical management and surgical interventions, his IOP remained uncontrolled, and visual disturbances persisted. After the unsuccessful treatment, we considered PD as an alternative therapy owing to its theoretical potential to stabilize osmotic disequilibrium during HD. As a result, conversion to PD resulted in stabilization of IOP within normal ranges. However, the pre-existing visual damage remained irreversible. This report represents the first attempt to address IOP fluctuations by transitioning from HD to PD, offering an option for IOP regulation in patients receiving HD. Moreover, it underscores the need for early and proactive adjustments in dialysis treatment to preserve vision and quality of life.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 1","pages":"Article 101176"},"PeriodicalIF":3.4,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787333","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 : 2025-11-06DOI: 10.1016/j.xkme.2025.101177
Yuvaram N.V. Reddy MBBS, MPH , Sri Lekha Tummalapalli MD, MBA, MAS , Vishnu S. Potluri MD, MPH , Adam Mussell MA , Joel T. Adler MD, MPH , Amol S. Navathe MD, PhD
{"title":"Transplantation in Mandatory Kidney Payment Models: Understanding the Potential Influence of the ESRD Treatment Choices Model on the Increasing Organ Transplant Access Model","authors":"Yuvaram N.V. Reddy MBBS, MPH , Sri Lekha Tummalapalli MD, MBA, MAS , Vishnu S. Potluri MD, MPH , Adam Mussell MA , Joel T. Adler MD, MPH , Amol S. Navathe MD, PhD","doi":"10.1016/j.xkme.2025.101177","DOIUrl":"10.1016/j.xkme.2025.101177","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 1","pages":"Article 101177"},"PeriodicalIF":3.4,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787334","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 : 2025-11-06DOI: 10.1016/j.xkme.2025.101180
Christie Rampersad
Accurate prediction of kidney allograft failure is key to guiding posttransplant care and stratifying trial participants. The iBox model estimates death-censored graft failure risk at 3, 5, and 7 years posttransplant using demographic, functional, immunologic, and histologic variables. It has been externally validated and to our knowledge, is the first transplant risk score to receive regulatory qualification as a surrogate trial endpoint.
This narrative review critically appraises iBox using the Kirschner and Guyatt framework for clinical indices and Steyerberg’s framework for predictive models. iBox demonstrates strong sensibility, excellent discrimination (C-index ∼0.81), good calibration, and robust performance across known subgroups. Criterion and construct validity are strong, although several aspects warrant further exploration to support broader implementation. Item reduction and model selection methods were not fully detailed, and key inputs such as biopsy findings and donor-specific antibody levels may vary in availability or be subject to measurement challenges. Some predictors reflect late-stage pathology, which may limit opportunities for early intervention. Formal evaluation of reliability, responsiveness, and interpretability—particularly for longitudinal score changes—remains an important area for future research.
By systematically assessing iBox’s measurement properties, this review supported its thoughtful implementation and highlighted future research priorities as iBox is integrated into posttransplant care and trial design.
{"title":"Unboxing iBox: A Critical Appraisal of Its Measurement Properties for Predicting Kidney Allograft Failure","authors":"Christie Rampersad","doi":"10.1016/j.xkme.2025.101180","DOIUrl":"10.1016/j.xkme.2025.101180","url":null,"abstract":"<div><div>Accurate prediction of kidney allograft failure is key to guiding posttransplant care and stratifying trial participants. The iBox model estimates death-censored graft failure risk at 3, 5, and 7 years posttransplant using demographic, functional, immunologic, and histologic variables. It has been externally validated and to our knowledge, is the first transplant risk score to receive regulatory qualification as a surrogate trial endpoint.</div><div>This narrative review critically appraises iBox using the Kirschner and Guyatt framework for clinical indices and Steyerberg’s framework for predictive models. iBox demonstrates strong sensibility, excellent discrimination (C-index ∼0.81), good calibration, and robust performance across known subgroups. Criterion and construct validity are strong, although several aspects warrant further exploration to support broader implementation. Item reduction and model selection methods were not fully detailed, and key inputs such as biopsy findings and donor-specific antibody levels may vary in availability or be subject to measurement challenges. Some predictors reflect late-stage pathology, which may limit opportunities for early intervention. Formal evaluation of reliability, responsiveness, and interpretability—particularly for longitudinal score changes—remains an important area for future research.</div><div>By systematically assessing iBox’s measurement properties, this review supported its thoughtful implementation and highlighted future research priorities as iBox is integrated into posttransplant care and trial design.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 1","pages":"Article 101180"},"PeriodicalIF":3.4,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787276","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 : 2025-11-06DOI: 10.1016/j.xkme.2025.101178
Heather P. May , Caroline B. Ledet , Joan M. Griffin , Joseph R. Herges , Kianoush B. Kashani , Andrea G. Kattah , Rozalina G. McCoy , Angeliki G. Tinaglia , Andrew D. Rule , Erin F. Barreto , ACT Study
<div><h3>Rationale & Objective</h3><div>Acute kidney injury (AKI) survivors are at risk for not receiving necessary follow-up medical care after discharge. This study assessed feasibility and acceptability of a multidisciplinary AKI survivor care delivery model (AKI in care transitions, ACT).</div></div><div><h3>Study Design</h3><div>Embedded convergent mixed methods study within a randomized trial.</div></div><div><h3>Setting & Participants</h3><div>The trial was conducted at a single academic medical center. Included individuals had stage 3 AKI during a hospitalization and were discharged to home and not on dialysis or were health care staff delivering ACT’s components.</div></div><div><h3>Analytical Approach</h3><div>Descriptive analysis of surveys and themes from qualitative interviews was integrated using embedding.</div></div><div><h3>Results</h3><div>Surveys were completed by 19 patients and 10 health care staff. Ten patients and 13 health care staff were interviewed. More than 80% of health care staff agreed ACT was feasible and acceptable, and 95% of patients would recommend ACT to others. The multidisciplinary approach, including pharmacists and nurses, and numerous kidney health touchpoints throughout care transitions were met with enthusiasm. Smooth integration of workflows and care elements with existing practices promoted acceptability. Developing efficient workflows to facilitate timely hospital discharge remains a priority. The diffuse and heterogenous nature of AKI and deprioritization of kidney health, relative to other disease states, represent challenges for ACT and similar programs.</div></div><div><h3>Limitations</h3><div>Data was collected from willing trial participants within a well-resourced health care system. Health systems’ specific needs should be evaluated when generalizing results.</div></div><div><h3>Conclusions</h3><div>The unique needs of patients and health care contexts call for flexible solutions to bridge the post-AKI care gap. The ACT intervention was designed with a small footprint to address previously identified patient priorities, leverage principles of minimally disruptive medicine, and engage the multidisciplinary health care team to minimize sole reliance on specialist resources. This mixed methods data indicates feasibility and broad acceptability and engagement with the approach.</div></div><div><h3>Plain-Language Summary</h3><div>This study evaluated a new program (acute kidney injury in care transitions) to improve care for acute kidney injury survivors after hospital discharge. The program used a multidisciplinary team (primary care providers, nurses, and pharmacists) to provide multiple points of contact focused on kidney health. Surveys and interviews with patients and staff showed high feasibility and acceptability (over 80% of staff and 95% of patients approved). Key benefits included a multidisciplinary approach and convenient integration into existing workflows. Challenges included
理由和目的急性肾损伤（AKI）幸存者在出院后没有得到必要的后续医疗护理的风险较大。本研究评估了多学科AKI幸存者护理交付模型（AKI in care transitions， ACT）的可行性和可接受性。研究设计：随机试验中的融合混合方法研究。背景和参与者本试验在单一的学术医疗中心进行。纳入住院期间患有3期AKI的个人，出院回家，没有透析，或者是提供ACT成分的卫生保健人员。分析方法采用嵌入法对调查和定性访谈的主题进行描述性分析。结果对19名患者和10名医护人员进行了问卷调查。访谈了10名患者和13名保健工作人员。80%以上的医护人员认为ACT是可行和可接受的，95%的患者会向他人推荐ACT。多学科的方法，包括药剂师和护士，以及许多肾脏健康接触点在整个护理过渡受到了热烈的欢迎。工作流和护理元素与现有实践的顺利集成提高了可接受性。制定有效的工作流程以促进及时出院仍然是一个优先事项。相对于其他疾病状态，AKI的弥漫性和异质性以及肾脏健康的不优先性对ACT和类似项目构成了挑战。数据是从资源充足的卫生保健系统中自愿的试验参与者中收集的。在推广结果时，应评估卫生系统的具体需求。结论患者的独特需求和卫生保健环境需要灵活的解决方案来弥合aki后的护理差距。ACT干预措施的设计占地面积小，以解决先前确定的患者优先事项，利用最小破坏性医学原则，并让多学科卫生保健团队参与，以最大限度地减少对专科资源的单独依赖。这种混合的方法数据表明可行性和广泛的可接受性和参与的方法。本研究评估了一个新的项目（急性肾损伤护理过渡），以改善急性肾损伤幸存者出院后的护理。该项目使用了一个多学科团队（初级保健提供者、护士和药剂师）来提供关注肾脏健康的多个接触点。对患者和工作人员的调查和访谈显示出较高的可行性和可接受性（超过80%的工作人员和95%的患者认可）。主要的好处包括多学科方法和方便地集成到现有的工作流程中。挑战包括急性肾损伤的不同性质，以及与其他疾病相比，肾脏健康往往受到的重视程度较低。研究表明，急性肾损伤在护理过渡是一个有前途的模式，但其适应不同的卫生保健环境需要进一步研究。
{"title":"Implementing the Acute Kidney Injury in Care Transitions (ACT) Program: Results From a Mixed Methods Feasibility Study","authors":"Heather P. May , Caroline B. Ledet , Joan M. Griffin , Joseph R. Herges , Kianoush B. Kashani , Andrea G. Kattah , Rozalina G. McCoy , Angeliki G. Tinaglia , Andrew D. Rule , Erin F. Barreto , ACT Study","doi":"10.1016/j.xkme.2025.101178","DOIUrl":"10.1016/j.xkme.2025.101178","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Acute kidney injury (AKI) survivors are at risk for not receiving necessary follow-up medical care after discharge. This study assessed feasibility and acceptability of a multidisciplinary AKI survivor care delivery model (AKI in care transitions, ACT).</div></div><div><h3>Study Design</h3><div>Embedded convergent mixed methods study within a randomized trial.</div></div><div><h3>Setting & Participants</h3><div>The trial was conducted at a single academic medical center. Included individuals had stage 3 AKI during a hospitalization and were discharged to home and not on dialysis or were health care staff delivering ACT’s components.</div></div><div><h3>Analytical Approach</h3><div>Descriptive analysis of surveys and themes from qualitative interviews was integrated using embedding.</div></div><div><h3>Results</h3><div>Surveys were completed by 19 patients and 10 health care staff. Ten patients and 13 health care staff were interviewed. More than 80% of health care staff agreed ACT was feasible and acceptable, and 95% of patients would recommend ACT to others. The multidisciplinary approach, including pharmacists and nurses, and numerous kidney health touchpoints throughout care transitions were met with enthusiasm. Smooth integration of workflows and care elements with existing practices promoted acceptability. Developing efficient workflows to facilitate timely hospital discharge remains a priority. The diffuse and heterogenous nature of AKI and deprioritization of kidney health, relative to other disease states, represent challenges for ACT and similar programs.</div></div><div><h3>Limitations</h3><div>Data was collected from willing trial participants within a well-resourced health care system. Health systems’ specific needs should be evaluated when generalizing results.</div></div><div><h3>Conclusions</h3><div>The unique needs of patients and health care contexts call for flexible solutions to bridge the post-AKI care gap. The ACT intervention was designed with a small footprint to address previously identified patient priorities, leverage principles of minimally disruptive medicine, and engage the multidisciplinary health care team to minimize sole reliance on specialist resources. This mixed methods data indicates feasibility and broad acceptability and engagement with the approach.</div></div><div><h3>Plain-Language Summary</h3><div>This study evaluated a new program (acute kidney injury in care transitions) to improve care for acute kidney injury survivors after hospital discharge. The program used a multidisciplinary team (primary care providers, nurses, and pharmacists) to provide multiple points of contact focused on kidney health. Surveys and interviews with patients and staff showed high feasibility and acceptability (over 80% of staff and 95% of patients approved). Key benefits included a multidisciplinary approach and convenient integration into existing workflows. Challenges included","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 1","pages":"Article 101178"},"PeriodicalIF":3.4,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787331","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 : 2025-11-04DOI: 10.1016/j.xkme.2025.101165
Junaid A. Wali , Yaseen A. Jamal , Mustafa Al-Kawaaz , Graham Rodwell , Megan L. Troxell
Rationale & Objective
Acute kidney injury and hemolysis are rare side effects of rifampin that are sometimes linked with drug re-exposure. We studied this association in a contemporary patient cohort to comprehensively correlate the clinical, laboratory, and biopsy findings.
Study Design
Adult patients who underwent kidney biopsy for acute kidney injury while on rifampin during an 11-year period (2012-2023) were identified. Electronic medical records and biopsy pathology were correlated.
Setting & Participants
Eighteen patients (50% men, ages 43-81) were prescribed rifampin for active pulmonary tuberculosis (7), latent tuberculosis (3), Mycobacterium avium complex infection (4), septic arthritis (3), and Bartonella endocarditis (1). Nine patients had prior rifampin exposure.
Results
Patients most commonly presented with gastrointestinal and ‘flu-like’ symptoms, 1 day to 1 month after rifampin (re-)exposure. Creatinine at biopsy was 2.2-26.1 mg/dL. Importantly, 15 patients had evidence of hemolysis. All biopsies demonstrated acute tubular injury, yet inflammation (acute interstitial nephritis) was variable. Eleven had pigmented casts, 9 with hemoglobin and 2 with myoglobin. Thus, we highlight acute tubular necrosis with hemoglobin casts as a major finding in rifampin kidney injury. Management included supportive care, steroids, and discontinuation of rifampin. Eleven patients required hemodialysis. Fifteen patients had complete renal remission.
Limitations
Retrospective case series without uniformly available clinical and laboratory data.
Conclusions
Hemolytic anemia, hemoglobin cast nephropathy, and acute kidney injury are rare but serious complications of rifampin. Clinicians and patients should be aware of this side effect, and interrupted use of rifampin therapy should be avoided.
Plain-language Summary
Rifampin (also known as rifampicin; brand name Rifadin) is an important antibiotic medication in treating infection, particularly tuberculosis. Rifampin can very rarely cause serious side effects, especially in patients who have taken rifampin previously. We identified 18 patients with kidney injury and kidney biopsy shortly after rifampin (re-)exposure and found that 15 had hemolysis (destruction of red blood cells), most with systemic illness. We found evidence of hemolysis-related casts causing kidney injury in 9 kidney biopsies. Patients and clinicians should be very cautious with rifampin re-exposure, and patients should seek medical attention for malaise, flu-like symptoms, fever, chills, nausea, vomiting, diarrhea, jaundice, decreased urine output, and dark urine.
{"title":"Rifampin-induced Acute Kidney Injury Is Associated With Hemolysis and Drug Re-exposure","authors":"Junaid A. Wali , Yaseen A. Jamal , Mustafa Al-Kawaaz , Graham Rodwell , Megan L. Troxell","doi":"10.1016/j.xkme.2025.101165","DOIUrl":"10.1016/j.xkme.2025.101165","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Acute kidney injury and hemolysis are rare side effects of rifampin that are sometimes linked with drug re-exposure. We studied this association in a contemporary patient cohort to comprehensively correlate the clinical, laboratory, and biopsy findings.</div></div><div><h3>Study Design</h3><div>Adult patients who underwent kidney biopsy for acute kidney injury while on rifampin during an 11-year period (2012-2023) were identified. Electronic medical records and biopsy pathology were correlated.</div></div><div><h3>Setting & Participants</h3><div>Eighteen patients (50% men, ages 43-81) were prescribed rifampin for active pulmonary tuberculosis (7), latent tuberculosis (3), <em>Mycobacterium avium</em> complex infection (4), septic arthritis (3), and <em>Bartonella</em> endocarditis (1). Nine patients had prior rifampin exposure.</div></div><div><h3>Results</h3><div>Patients most commonly presented with gastrointestinal and ‘flu-like’ symptoms, 1 day to 1 month after rifampin (re-)exposure. Creatinine at biopsy was 2.2-26.1 mg/dL. Importantly, 15 patients had evidence of hemolysis. All biopsies demonstrated acute tubular injury, yet inflammation (acute interstitial nephritis) was variable. Eleven had pigmented casts, 9 with hemoglobin and 2 with myoglobin. Thus, we highlight acute tubular necrosis with hemoglobin casts as a major finding in rifampin kidney injury. Management included supportive care, steroids, and discontinuation of rifampin. Eleven patients required hemodialysis. Fifteen patients had complete renal remission.</div></div><div><h3>Limitations</h3><div>Retrospective case series without uniformly available clinical and laboratory data.</div></div><div><h3>Conclusions</h3><div>Hemolytic anemia, hemoglobin cast nephropathy, and acute kidney injury are rare but serious complications of rifampin. Clinicians and patients should be aware of this side effect, and interrupted use of rifampin therapy should be avoided.</div></div><div><h3>Plain-language Summary</h3><div>Rifampin (also known as rifampicin; brand name Rifadin) is an important antibiotic medication in treating infection, particularly tuberculosis. Rifampin can very rarely cause serious side effects, especially in patients who have taken rifampin previously. We identified 18 patients with kidney injury and kidney biopsy shortly after rifampin (re-)exposure and found that 15 had hemolysis (destruction of red blood cells), most with systemic illness. We found evidence of hemolysis-related casts causing kidney injury in 9 kidney biopsies. Patients and clinicians should be very cautious with rifampin re-exposure, and patients should seek medical attention for malaise, flu-like symptoms, fever, chills, nausea, vomiting, diarrhea, jaundice, decreased urine output, and dark urine.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 1","pages":"Article 101165"},"PeriodicalIF":3.4,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787287","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 : 2025-11-04DOI: 10.1016/j.xkme.2025.101173
Hyunji Kim , Mary Nguyen , Page Salenger , Amanda Tran , Shelly Seidel , Daniel E. Weiner , Klemens B. Meyer , Caroline M. Hsu
Despite often offering a better quality of life than in-center hemodialysis, peritoneal dialysis (PD) at home can be challenging for many. From May 2021 to October 2024, we offered PD assistance at 2 home dialysis clinics in Dialysis Clinic, Inc, a mid-size national dialysis provider. Eligible patients could be incident to or established on PD, with anticipated need for either permanent or temporary assistance. Over 3 years, 6 patients received assisted PD. Three established PD patients needed assistance when their care partners were unavailable. Three other patients required assistance to initiate PD. Assistance duration ranged from 1 day to 5 months. Three patients ultimately transitioned to PD independence, and 3 transferred to in-center hemodialysis. Our greatest challenge was hiring assistants for unpredictable work with odd hours, and we eventually hired 2 postbaccalaureate students preparing for medical careers. Our successes, minimal missed treatments, and a high rate of PD continuation are a testament to their dedication. Assisted PD programs would benefit from economies of scale by being embedded in the health care system. As interest in assisted PD grows, we advocate for sharing of programs’ successes and challenges so that we may together learn how to enable assisted PD in the US.
{"title":"Assisted Peritoneal Dialysis: A Feasibility and Quality Improvement Project","authors":"Hyunji Kim , Mary Nguyen , Page Salenger , Amanda Tran , Shelly Seidel , Daniel E. Weiner , Klemens B. Meyer , Caroline M. Hsu","doi":"10.1016/j.xkme.2025.101173","DOIUrl":"10.1016/j.xkme.2025.101173","url":null,"abstract":"<div><div>Despite often offering a better quality of life than in-center hemodialysis, peritoneal dialysis (PD) at home can be challenging for many. From May 2021 to October 2024, we offered PD assistance at 2 home dialysis clinics in Dialysis Clinic, Inc, a mid-size national dialysis provider. Eligible patients could be incident to or established on PD, with anticipated need for either permanent or temporary assistance. Over 3 years, 6 patients received assisted PD. Three established PD patients needed assistance when their care partners were unavailable. Three other patients required assistance to initiate PD. Assistance duration ranged from 1 day to 5 months. Three patients ultimately transitioned to PD independence, and 3 transferred to in-center hemodialysis. Our greatest challenge was hiring assistants for unpredictable work with odd hours, and we eventually hired 2 postbaccalaureate students preparing for medical careers. Our successes, minimal missed treatments, and a high rate of PD continuation are a testament to their dedication. Assisted PD programs would benefit from economies of scale by being embedded in the health care system. As interest in assisted PD grows, we advocate for sharing of programs’ successes and challenges so that we may together learn how to enable assisted PD in the US.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 1","pages":"Article 101173"},"PeriodicalIF":3.4,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787200","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 : 2025-11-04DOI: 10.1016/j.xkme.2025.101172
Antonio Ulpiano Trillig , Samuel Rotman , Patricia Mehier , Alain Rossier , Gérard Vogel
Acute kidney injury following sucrose-free intravenous immunoglobulins (IVIG) is rare. We report the case of a 67-year-old male who developed a sudden anuric acute kidney injury at day 4 of L-proline stabilized sucrose-free IVIG for a Guillain-Barré Syndrome. The IVIG treatment was halted. The patient did not require renal replacement therapy after an adequate response to diuretics. Amoxicillin was the sole other potential nephrotoxic. The kidney biopsy showed typical features of osmotic nephropathy (ON). Although a certain degree of kidney hypoxia due to dysautonomia and variations of blood pressure might have occurred, histological findings were not compatible with an ischemic acute tubular necrosis. There was no glomerular and vascular involvement. Immunofluorescence of tubular cells cytoplasm was negative, ruling out antibody deposition. The patient had a complete renal recovery after 2 weeks. We hypothesize that proline itself acted as a reabsorbed toxic solute and accumulated in the lysosomes, leading to ON. In this case report we discuss the proline proximal tubular transport, involving pinocytosis in case of high concentration in the filtrate, and potential mechanisms involved in the development of ON.
{"title":"Osmotic Nephropathy Induced by L-Proline Stabilized Sucrose-free Intravenous Immunoglobulins: A Case Report","authors":"Antonio Ulpiano Trillig , Samuel Rotman , Patricia Mehier , Alain Rossier , Gérard Vogel","doi":"10.1016/j.xkme.2025.101172","DOIUrl":"10.1016/j.xkme.2025.101172","url":null,"abstract":"<div><div>Acute kidney injury following sucrose-free intravenous immunoglobulins (IVIG) is rare. We report the case of a 67-year-old male who developed a sudden anuric acute kidney injury at day 4 of L-proline stabilized sucrose-free IVIG for a Guillain-Barré Syndrome. The IVIG treatment was halted. The patient did not require renal replacement therapy after an adequate response to diuretics. Amoxicillin was the sole other potential nephrotoxic. The kidney biopsy showed typical features of osmotic nephropathy (ON). Although a certain degree of kidney hypoxia due to dysautonomia and variations of blood pressure might have occurred, histological findings were not compatible with an ischemic acute tubular necrosis. There was no glomerular and vascular involvement. Immunofluorescence of tubular cells cytoplasm was negative, ruling out antibody deposition. The patient had a complete renal recovery after 2 weeks. We hypothesize that proline itself acted as a reabsorbed toxic solute and accumulated in the lysosomes, leading to ON. In this case report we discuss the proline proximal tubular transport, involving pinocytosis in case of high concentration in the filtrate, and potential mechanisms involved in the development of ON.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 1","pages":"Article 101172"},"PeriodicalIF":3.4,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787201","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>Bioelectrical impedance spectroscopy (BIS) is a valuable tool for assessing body composition in patients on peritoneal dialysis (PD), as body composition can significantly change during long-term PD treatment. We aimed to clarify the relationship between time-dependent changes in the extracellular-to-intracellular water ratio (EIR) and all-cause mortality in patients undergoing long-term PD.</div></div><div><h3>Study Design</h3><div>A single-center, retrospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>This study enrolled adult PD patients who underwent body composition measurements from our bioelectrical impedance spectroscopy-aided fluid management program from May 1, 2012, to April 30, 2023. Patients were followed up until death, withdrawal from PD, or the end of the study.</div></div><div><h3>Exposure</h3><div>EIR and its covariates.</div></div><div><h3>Outcomes</h3><div>All-cause mortality.</div></div><div><h3>Analytical Approach</h3><div>Time-dependent Cox proportional hazards, restricted cubic splines, and propensity score matching analyzed risk factors and mortality.</div></div><div><h3>Results</h3><div>Among the 468 PD patients, the median follow-up period was 2.0 (interquartile range [IQR] 0.6-4.3) years. Three distinct temporal EIR trajectories are found after grouping baseline EIR (bEIR) into quartiles (<em>P</em><sub><em>interaction</em></sub> < 0.001). Additionally, the optimal cutoff value of bEIR for predicting survival was 0.87. A high bEIR (≥0.87) was associated with a greater risk of mortality than a low bEIR (<0.87, crude hazard ratio, 6.095; <em>P</em> < 0.001). The multivariable time-dependent Cox model showed that the risk of mortality increased by nearly 50% for every 0.1 increase in the EIR (<em>P</em> < 0.001), without significant nonlinearity (<em>P</em> = 0.07). After propensity score matching, the EIR remained an important predictor of the risk of mortality.</div></div><div><h3>Limitations</h3><div>The study had a retrospective design.</div></div><div><h3>Conclusions</h3><div>The EIR, regarded as either a time-independent or time-dependent variable, is a crucial predictor of mortality in PD patients under regular monitoring of fluid status. Our results also suggest that an EIR of ≥0.87 would be a useful target for predicting the long-term mortality of PD patients in clinical practice.</div></div><div><h3>Plain-language Summary</h3><div>Fluid overload-induced cardiovascular disease has long been one of the leading causes of mortality in dialysis patients. In this study, we used time-dependent Cox proportional hazards regression analysis and found that the extracellular-to-intracellular water ratio (EIR), as measured by bioelectrical impedance spectroscopy, can predict the mortality risk in peritoneal dialysis patients. Over the course of dialysis, the bEIR quartile groups exhibited 3 distinct trajectories. Except for the fourth bEIR q
{"title":"Time-Dependent Changes in Extracellular-to-Intracellular Water Ratios and Risk of All-Cause Mortality in Peritoneal Dialysis Patients: A Single-Center Retrospective Cohort Study","authors":"Huan-Nung Chao , Yi-Liang Tsai , Jhih-Wen Hsu , Ya-Chi Chan , Pei-Ni Chen , Chia-Lin Wu","doi":"10.1016/j.xkme.2025.101171","DOIUrl":"10.1016/j.xkme.2025.101171","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Bioelectrical impedance spectroscopy (BIS) is a valuable tool for assessing body composition in patients on peritoneal dialysis (PD), as body composition can significantly change during long-term PD treatment. We aimed to clarify the relationship between time-dependent changes in the extracellular-to-intracellular water ratio (EIR) and all-cause mortality in patients undergoing long-term PD.</div></div><div><h3>Study Design</h3><div>A single-center, retrospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>This study enrolled adult PD patients who underwent body composition measurements from our bioelectrical impedance spectroscopy-aided fluid management program from May 1, 2012, to April 30, 2023. Patients were followed up until death, withdrawal from PD, or the end of the study.</div></div><div><h3>Exposure</h3><div>EIR and its covariates.</div></div><div><h3>Outcomes</h3><div>All-cause mortality.</div></div><div><h3>Analytical Approach</h3><div>Time-dependent Cox proportional hazards, restricted cubic splines, and propensity score matching analyzed risk factors and mortality.</div></div><div><h3>Results</h3><div>Among the 468 PD patients, the median follow-up period was 2.0 (interquartile range [IQR] 0.6-4.3) years. Three distinct temporal EIR trajectories are found after grouping baseline EIR (bEIR) into quartiles (<em>P</em><sub><em>interaction</em></sub> < 0.001). Additionally, the optimal cutoff value of bEIR for predicting survival was 0.87. A high bEIR (≥0.87) was associated with a greater risk of mortality than a low bEIR (<0.87, crude hazard ratio, 6.095; <em>P</em> < 0.001). The multivariable time-dependent Cox model showed that the risk of mortality increased by nearly 50% for every 0.1 increase in the EIR (<em>P</em> < 0.001), without significant nonlinearity (<em>P</em> = 0.07). After propensity score matching, the EIR remained an important predictor of the risk of mortality.</div></div><div><h3>Limitations</h3><div>The study had a retrospective design.</div></div><div><h3>Conclusions</h3><div>The EIR, regarded as either a time-independent or time-dependent variable, is a crucial predictor of mortality in PD patients under regular monitoring of fluid status. Our results also suggest that an EIR of ≥0.87 would be a useful target for predicting the long-term mortality of PD patients in clinical practice.</div></div><div><h3>Plain-language Summary</h3><div>Fluid overload-induced cardiovascular disease has long been one of the leading causes of mortality in dialysis patients. In this study, we used time-dependent Cox proportional hazards regression analysis and found that the extracellular-to-intracellular water ratio (EIR), as measured by bioelectrical impedance spectroscopy, can predict the mortality risk in peritoneal dialysis patients. Over the course of dialysis, the bEIR quartile groups exhibited 3 distinct trajectories. Except for the fourth bEIR q","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 1","pages":"Article 101171"},"PeriodicalIF":3.4,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787199","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 : 2025-11-03DOI: 10.1016/j.xkme.2025.101169
Jiahui Wang , Xin Lei , Junni Wang, Wanyun Nie, Xiaohan Huang, Huanhuan Zhu, Liangliang Chen, Nan Shi, Yaomin Wang, Lan Lan, Pingping Ren, Jianghua Chen, Fei Han
<div><h3>Rationale & Objective</h3><div>Intravenous cyclophosphamide (CTX) or rituximab (RTX) combined with glucocorticoids are first-line therapies for antineutrophil cytoplasmic antibody–associated vasculitis (AAV). We aimed to compare the efficacy of CTX plus RTX and CTX alone, in combination with glucocorticoids, for AAV patients with kidney injury.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>76 newly diagnosed AAV patients with kidney involvement, divided into glucocorticoids plus CTX group (control group, n = 36) and glucocorticoids plus CTX and RTX group (combination group, n = 40).</div></div><div><h3>Exposure</h3><div>CTX plus RTX or CTX alone, in combination with glucocorticoids.</div></div><div><h3>Outcomes</h3><div>Kidney failure, remission, death, combined events endpoint of kidney failure and/or death, relapse, and adverse events.</div></div><div><h3>Analytical Approach</h3><div>Unpaired <em>t</em> test, Mann-Whitney <em>U</em> test, Pearson χ<sup>2</sup> test or Fisher exact test, and Kaplan-Meier method with log-rank test.</div></div><div><h3>Results</h3><div>The median follow-up period was 29.7 (20.4-37.4) months. The remission rate was significantly higher in the combination group than in the control group at 6 months (85.0% vs 52.8%, <em>P</em> = 0.002). However, there were no significant differences in the remission rates at 12 months and at the final follow-up, as well as kidney failure, death, relapse, or improvement of renal function during follow-up between groups. The cumulative dose of glucocorticoids in the combination group was 2.5 (2.0-3.3) g at 6 months and 3.7 (2.6-4.8) g at the final follow-up, significantly lower than those in the control group (<em>P</em> < 0.001 and <em>P</em> < 0.001, respectively). In the subgroup of 45 patients with an estimated glomerular filtration rate of >15 mL/min/1.73 m<sup>2</sup> at admission, 7 of 21 patients in the control group and 1 of 24 patients in the combination group progressed to kidney failure (33.3% vs 4.2%, <em>P</em> = 0.02).</div></div><div><h3>Limitations</h3><div>Primarily Chinese, retrospective data.</div></div><div><h3>Conclusions</h3><div>The combination of glucocorticoids, CTX, and RTX is better in achieving early disease remission and reducing the dose of glucocorticoids for AAV patients.</div></div><div><h3>Plain-language Summary</h3><div>Several case series have reported the combined use of cyclophosphamide (CTX) and rituximab (RTX) in antineutrophil cytoplasmic antibody–associated vasculitis (AAV), which may decrease the cumulative dose of glucocorticoids. However, no study has compared the combined therapy of RTX and CTX with conventional therapy. In this study, we retrospectively analyzed 76 patients with new-onset AAV involving kidneys, who were treated with either a combination of glucocorticoids with CTX and RTX (combination therapy) or glucocorticoids with CTX.
目的：静脉注射环磷酰胺（CTX）或利妥昔单抗（RTX）联合糖皮质激素是抗中性粒细胞细胞质抗体相关血管炎（AAV）的一线治疗方法。我们的目的是比较CTX加RTX和单独CTX联合糖皮质激素治疗AAV肾损伤患者的疗效。研究设计回顾性队列研究。新诊断的AAV累及肾脏患者76例，分为糖皮质激素+ CTX组（对照组，n = 36）和糖皮质激素+ CTX + RTX组（联合组，n = 40）。暴露rectx加RTX或单独CTX，联合糖皮质激素。结果：肾功能衰竭、缓解、死亡、合并事件（肾功能衰竭和/或死亡）、复发和不良事件。分析方法：非配对t检验、Mann-Whitney U检验、Pearson χ2检验或Fisher精确检验、Kaplan-Meier法加log-rank检验。结果中位随访时间为29.7（20.4 ~ 37.4）个月。6个月时，联合治疗组的缓解率明显高于对照组（85.0% vs 52.8%, P = 0.002）。然而，在12个月和最后随访时的缓解率，以及随访期间肾功能衰竭、死亡、复发或肾功能改善方面，两组之间没有显著差异。联合组患者6个月时糖皮质激素累积剂量为2.5 (2.0-3.3)g，末次随访时为3.7 (2.6-4.8)g，均显著低于对照组（P <； 0.001和P <； 0.001）。在入院时肾小球滤过率估计为15 mL/min/1.73 m2的45例患者亚组中，对照组21例患者中有7例进展为肾衰竭，联合治疗组24例患者中有1例进展为肾衰竭（33.3% vs 4.2%, P = 0.02）。局限性：主要是中国的回顾性数据。结论糖皮质激素联合CTX和RTX治疗AAV患者在早期疾病缓解和减少糖皮质激素剂量方面效果较好。几个病例系列报道了联合使用环磷酰胺（CTX）和利妥昔单抗（RTX）治疗抗中性粒细胞细胞质抗体相关血管炎（AAV），这可能会降低糖皮质激素的累积剂量。然而，没有研究将RTX和CTX联合治疗与常规治疗进行比较。在这项研究中，我们回顾性分析了76例新发累及肾脏的AAV患者，这些患者接受糖皮质激素联合CTX和RTX（联合治疗）或糖皮质激素联合CTX治疗。在这项回顾性队列研究中，联合治疗在诱导AAV患者早期缓解和减少糖皮质激素剂量方面更有效。此外，它降低了AAV患者肾衰竭的发生率，入院时肾小球滤过率估计为15 mL/min/1.73 m2。
{"title":"Cyclophosphamide Plus Rituximab Versus Cyclophosphamide in Antineutrophil Cytoplasmic Antibody–associated Vasculitis With Kidney Involvement: A Retrospective Cohort Study in China","authors":"Jiahui Wang , Xin Lei , Junni Wang, Wanyun Nie, Xiaohan Huang, Huanhuan Zhu, Liangliang Chen, Nan Shi, Yaomin Wang, Lan Lan, Pingping Ren, Jianghua Chen, Fei Han","doi":"10.1016/j.xkme.2025.101169","DOIUrl":"10.1016/j.xkme.2025.101169","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Intravenous cyclophosphamide (CTX) or rituximab (RTX) combined with glucocorticoids are first-line therapies for antineutrophil cytoplasmic antibody–associated vasculitis (AAV). We aimed to compare the efficacy of CTX plus RTX and CTX alone, in combination with glucocorticoids, for AAV patients with kidney injury.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>76 newly diagnosed AAV patients with kidney involvement, divided into glucocorticoids plus CTX group (control group, n = 36) and glucocorticoids plus CTX and RTX group (combination group, n = 40).</div></div><div><h3>Exposure</h3><div>CTX plus RTX or CTX alone, in combination with glucocorticoids.</div></div><div><h3>Outcomes</h3><div>Kidney failure, remission, death, combined events endpoint of kidney failure and/or death, relapse, and adverse events.</div></div><div><h3>Analytical Approach</h3><div>Unpaired <em>t</em> test, Mann-Whitney <em>U</em> test, Pearson χ<sup>2</sup> test or Fisher exact test, and Kaplan-Meier method with log-rank test.</div></div><div><h3>Results</h3><div>The median follow-up period was 29.7 (20.4-37.4) months. The remission rate was significantly higher in the combination group than in the control group at 6 months (85.0% vs 52.8%, <em>P</em> = 0.002). However, there were no significant differences in the remission rates at 12 months and at the final follow-up, as well as kidney failure, death, relapse, or improvement of renal function during follow-up between groups. The cumulative dose of glucocorticoids in the combination group was 2.5 (2.0-3.3) g at 6 months and 3.7 (2.6-4.8) g at the final follow-up, significantly lower than those in the control group (<em>P</em> < 0.001 and <em>P</em> < 0.001, respectively). In the subgroup of 45 patients with an estimated glomerular filtration rate of >15 mL/min/1.73 m<sup>2</sup> at admission, 7 of 21 patients in the control group and 1 of 24 patients in the combination group progressed to kidney failure (33.3% vs 4.2%, <em>P</em> = 0.02).</div></div><div><h3>Limitations</h3><div>Primarily Chinese, retrospective data.</div></div><div><h3>Conclusions</h3><div>The combination of glucocorticoids, CTX, and RTX is better in achieving early disease remission and reducing the dose of glucocorticoids for AAV patients.</div></div><div><h3>Plain-language Summary</h3><div>Several case series have reported the combined use of cyclophosphamide (CTX) and rituximab (RTX) in antineutrophil cytoplasmic antibody–associated vasculitis (AAV), which may decrease the cumulative dose of glucocorticoids. However, no study has compared the combined therapy of RTX and CTX with conventional therapy. In this study, we retrospectively analyzed 76 patients with new-onset AAV involving kidneys, who were treated with either a combination of glucocorticoids with CTX and RTX (combination therapy) or glucocorticoids with CTX.","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 1","pages":"Article 101169"},"PeriodicalIF":3.4,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787347","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}
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