Pub Date : 2025-12-12DOI: 10.1016/j.xkme.2025.101206
Christine P. Limonte , Stephanie Aw , Charles E. Alpers , Laura Barisoni , Brooke Berry , Frank C. Brosius , Kirk N. Campbell , Leal C. Herlitz , Zoltan Laszik , Gearoid McMahon , Amy Mottl , Patrick Nachman , Yunbi Nam , Emilio E. Poggio , Parmjeet S. Randhawa , Sylvia E. Rosas , Isaac E. Stillman , Jonathan J. Taliercio , Jose Torrealba , Katherine Tuttle , Joel Henderson
<div><h3>Rationale & Objective</h3><div>The Kidney Precision Medicine Project is obtaining kidney biopsies from people with chronic kidney disease (CKD) and acute kidney injury for comprehensive clinical, histopathological, and molecular characterization. Here, we describe histopathological findings from a subset of kidney biopsies from adults with CKD.</div></div><div><h3>Study Design</h3><div>Descriptive case series of histopathology findings from adjudicated CKD biopsies.</div></div><div><h3>Setting & Participants</h3><div>Kidney Precision Medicine Project enrolled adults with CKD and diabetes (DKD) and/or hypertension (HCKD) with persistent eGFR 30-59 mL/min/1.73 m<sup>2</sup>, urine albumin-creatinine ratio ≥30 mg/g, or urine protein-creatinine ratio ≥150 mg/g. Clinicopathological adjudication by study nephrologists and kidney pathologists was completed as part of a pilot program for 39 participants enrolled 2019-2022. Clinicians completed surveys to assess impacts of biopsies on diagnosis, prognosis, and management.</div></div><div><h3>Exposures</h3><div>This is a descriptive study without defined exposures.</div></div><div><h3>Outcomes</h3><div>Characterization of glomerular, tubulointerstitial, and vascular histopathological features across CKD biopsies.</div></div><div><h3>Analytical Approach</h3><div>Continuous variables were summarized as mean (standard deviation) or median (interquartile range); categorial variables were summarized as count (percentage).</div></div><div><h3>Results</h3><div>Participants’ mean age was 59 years, 59% were female. Mean eGFR was 55 mL/min/1.73 m<sup>2</sup>; median urine albumin-creatinine ratio and urine protein-creatinine ratio were 81 mg/g and 211 mg/g, respectively. Among DKD-enrolled participants (N = 28), 15 (54%) had a primary diagnosis of diabetic nephropathy, 3 (11%) had hypertension-associated nephropathy, 2 (7%) had other glomerular diseases, and 8 (29%) had nonspecific findings. Among HCKD-enrolled participants (N = 11), 5 (46%) had hypertension-associated nephropathy and 6 (55%) had nonspecific findings. A range of glomerular, tubulointerstitial, and vascular findings was observed. 26% of clinicians stated results were different than expected; 77% stated results affected prognostic discussions.</div></div><div><h3>Limitations</h3><div>Small sample size and lack of longitudinal data limit generalizability.</div></div><div><h3>Conclusions</h3><div>Kidney biopsies in people with common causes of CKD demonstrate a broad range of histopathology and may have clinical utility. Unsuspected disease processes and unexpected and nonspecific findings precluding a definitive diagnosis are often present.</div></div><div><h3>Plain-Language Summary</h3><div>Most of our knowledge of diabetes- and hypertension-related kidney disease comes from kidney biopsies performed in people with unusual or severe symptoms, which may not reflect how these diseases usually present. The Kidney Precision Medicine Proje
{"title":"Case Series of Histopathological Findings in Chronic Kidney Disease: Insights From the Kidney Precision Medicine Project","authors":"Christine P. Limonte , Stephanie Aw , Charles E. Alpers , Laura Barisoni , Brooke Berry , Frank C. Brosius , Kirk N. Campbell , Leal C. Herlitz , Zoltan Laszik , Gearoid McMahon , Amy Mottl , Patrick Nachman , Yunbi Nam , Emilio E. Poggio , Parmjeet S. Randhawa , Sylvia E. Rosas , Isaac E. Stillman , Jonathan J. Taliercio , Jose Torrealba , Katherine Tuttle , Joel Henderson","doi":"10.1016/j.xkme.2025.101206","DOIUrl":"10.1016/j.xkme.2025.101206","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>The Kidney Precision Medicine Project is obtaining kidney biopsies from people with chronic kidney disease (CKD) and acute kidney injury for comprehensive clinical, histopathological, and molecular characterization. Here, we describe histopathological findings from a subset of kidney biopsies from adults with CKD.</div></div><div><h3>Study Design</h3><div>Descriptive case series of histopathology findings from adjudicated CKD biopsies.</div></div><div><h3>Setting & Participants</h3><div>Kidney Precision Medicine Project enrolled adults with CKD and diabetes (DKD) and/or hypertension (HCKD) with persistent eGFR 30-59 mL/min/1.73 m<sup>2</sup>, urine albumin-creatinine ratio ≥30 mg/g, or urine protein-creatinine ratio ≥150 mg/g. Clinicopathological adjudication by study nephrologists and kidney pathologists was completed as part of a pilot program for 39 participants enrolled 2019-2022. Clinicians completed surveys to assess impacts of biopsies on diagnosis, prognosis, and management.</div></div><div><h3>Exposures</h3><div>This is a descriptive study without defined exposures.</div></div><div><h3>Outcomes</h3><div>Characterization of glomerular, tubulointerstitial, and vascular histopathological features across CKD biopsies.</div></div><div><h3>Analytical Approach</h3><div>Continuous variables were summarized as mean (standard deviation) or median (interquartile range); categorial variables were summarized as count (percentage).</div></div><div><h3>Results</h3><div>Participants’ mean age was 59 years, 59% were female. Mean eGFR was 55 mL/min/1.73 m<sup>2</sup>; median urine albumin-creatinine ratio and urine protein-creatinine ratio were 81 mg/g and 211 mg/g, respectively. Among DKD-enrolled participants (N = 28), 15 (54%) had a primary diagnosis of diabetic nephropathy, 3 (11%) had hypertension-associated nephropathy, 2 (7%) had other glomerular diseases, and 8 (29%) had nonspecific findings. Among HCKD-enrolled participants (N = 11), 5 (46%) had hypertension-associated nephropathy and 6 (55%) had nonspecific findings. A range of glomerular, tubulointerstitial, and vascular findings was observed. 26% of clinicians stated results were different than expected; 77% stated results affected prognostic discussions.</div></div><div><h3>Limitations</h3><div>Small sample size and lack of longitudinal data limit generalizability.</div></div><div><h3>Conclusions</h3><div>Kidney biopsies in people with common causes of CKD demonstrate a broad range of histopathology and may have clinical utility. Unsuspected disease processes and unexpected and nonspecific findings precluding a definitive diagnosis are often present.</div></div><div><h3>Plain-Language Summary</h3><div>Most of our knowledge of diabetes- and hypertension-related kidney disease comes from kidney biopsies performed in people with unusual or severe symptoms, which may not reflect how these diseases usually present. The Kidney Precision Medicine Proje","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101206"},"PeriodicalIF":3.4,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146022761","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 : 2025-12-11DOI: 10.1016/j.xkme.2025.101199
Na’amah Razon , Yi Zhang , Bethney Bonilla-Herrera , Lorien S. Dalrymple , Amanda K. Stennett , Baback Roshanravan , Daniel Tancredi , Joshua J. Fenton
<div><h3>Rationale & Objective</h3><div>Transportation insecurity is a social risk factor of particular importance to individuals with end-stage kidney disease (ESKD), as most individuals need to travel multiple times a week to dialysis treatment. Advancing home modalities for individuals with ESKD experiencing transportation insecurity may be beneficial by reducing travel burden and improving access.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>Individuals with ESKD treated with in-center hemodialysis (HD) at a large, national dialysis organization.</div></div><div><h3>Exposures</h3><div>The main transportation mode to HD is categorized into private transportation (individuals who drive themselves or have a family member/friend drive) or those who lack private transportation (Medicaid non-emergency medical transportation, paratransit, public transportation, private pay non-emergency medical transportation, and other).</div></div><div><h3>Outcomes</h3><div>Transition to home dialysis is defined as an individual who has completed at least 1 training treatment for home therapies or at least 1 dialysis treatment at home.</div></div><div><h3>Analytic Approach</h3><div>Log-binomial multivariate regression models to estimate adjusted incidence rate ratios of home dialysis transition by transportation mode.</div></div><div><h3>Results</h3><div>Individuals who lacked private transportation were significantly less likely to transition to home dialysis compared with those who drove themselves or had a family member/friend drive them to HD. Adjusted incidence rate ratios for home dialysis transition were 47%-58% lower in nonprivate transportation groups compared with those with private transportation, ranging from 0.42 in individuals relying on Medicaid transportation benefits (95% confidence interval, 0.35-0.50; <em>P</em> < 0.001) to 0.53 (95% confidence interval, 0.41-0.67; <em>P</em> < 0.001) among paratransit users.</div></div><div><h3>Limitations</h3><div>Single transportation assessment, exclusion of individuals already on home dialysis, and absence of caregiver data.</div></div><div><h3>Conclusions</h3><div>Individuals with ESKD receiving in-center HD who lack private transportation may have reduced access to home dialysis, even though this group may benefit from home modalities. Better identifying transportation barriers and targeting home modalities for those with transportation insecurity may reduce the adverse consequences of missed dialysis related to transportation barriers and be an additional opportunity to increase home dialysis uptake.</div></div><div><h3>Plain-Language Summary</h3><div>Transportation is a key barrier for many individuals receiving in-center dialysis care. Nonetheless, the majority of individuals in the United States receive their dialysis treatment at an in-center facility. In a study of patients with end-stage kidney disease treate
{"title":"Association Between Transportation and Home Dialysis Transition: Retrospective Cohort Study","authors":"Na’amah Razon , Yi Zhang , Bethney Bonilla-Herrera , Lorien S. Dalrymple , Amanda K. Stennett , Baback Roshanravan , Daniel Tancredi , Joshua J. Fenton","doi":"10.1016/j.xkme.2025.101199","DOIUrl":"10.1016/j.xkme.2025.101199","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Transportation insecurity is a social risk factor of particular importance to individuals with end-stage kidney disease (ESKD), as most individuals need to travel multiple times a week to dialysis treatment. Advancing home modalities for individuals with ESKD experiencing transportation insecurity may be beneficial by reducing travel burden and improving access.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>Individuals with ESKD treated with in-center hemodialysis (HD) at a large, national dialysis organization.</div></div><div><h3>Exposures</h3><div>The main transportation mode to HD is categorized into private transportation (individuals who drive themselves or have a family member/friend drive) or those who lack private transportation (Medicaid non-emergency medical transportation, paratransit, public transportation, private pay non-emergency medical transportation, and other).</div></div><div><h3>Outcomes</h3><div>Transition to home dialysis is defined as an individual who has completed at least 1 training treatment for home therapies or at least 1 dialysis treatment at home.</div></div><div><h3>Analytic Approach</h3><div>Log-binomial multivariate regression models to estimate adjusted incidence rate ratios of home dialysis transition by transportation mode.</div></div><div><h3>Results</h3><div>Individuals who lacked private transportation were significantly less likely to transition to home dialysis compared with those who drove themselves or had a family member/friend drive them to HD. Adjusted incidence rate ratios for home dialysis transition were 47%-58% lower in nonprivate transportation groups compared with those with private transportation, ranging from 0.42 in individuals relying on Medicaid transportation benefits (95% confidence interval, 0.35-0.50; <em>P</em> < 0.001) to 0.53 (95% confidence interval, 0.41-0.67; <em>P</em> < 0.001) among paratransit users.</div></div><div><h3>Limitations</h3><div>Single transportation assessment, exclusion of individuals already on home dialysis, and absence of caregiver data.</div></div><div><h3>Conclusions</h3><div>Individuals with ESKD receiving in-center HD who lack private transportation may have reduced access to home dialysis, even though this group may benefit from home modalities. Better identifying transportation barriers and targeting home modalities for those with transportation insecurity may reduce the adverse consequences of missed dialysis related to transportation barriers and be an additional opportunity to increase home dialysis uptake.</div></div><div><h3>Plain-Language Summary</h3><div>Transportation is a key barrier for many individuals receiving in-center dialysis care. Nonetheless, the majority of individuals in the United States receive their dialysis treatment at an in-center facility. In a study of patients with end-stage kidney disease treate","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101199"},"PeriodicalIF":3.4,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023299","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 : 2025-12-11DOI: 10.1016/j.xkme.2025.101200
Liselotte F.S. Langenhuijsen , Daniëlle C.L. Derksen , Jet Milders , Sabine F.B. van der Horst , Merel van Diepen , Serge A. Trines , Paul L. den Exter , Frederikus A. Klok , Joris I. Rotmans , Ype de Jong
<div><h3>Rationale & Objective</h3><div>Patients with atrial fibrillation (AF) and chronic kidney disease (CKD) are at high risk for ischemic stroke (IS) and bleeding. The applicability of prediction models in this population remains debated. This study aimed to (1) identify external validations of CHA<sub>2</sub>DS<sub>2</sub>-VASc, CHADS<sub>2</sub>, HAS-BLED, and HEMORR<sub>2</sub>HAGES model scores in patients with AF undergoing dialysis or with CKD, (2) provide pooled estimates, and (3) assess their risk of bias (ROB).</div></div><div><h3>Study Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Setting & Participants</h3><div>We searched Web of Science, PubMed, MEDLINE, Embase, Emcare, PMC, Cochrane Library, and Academic Search Premier for studies externally validating IS and bleeding prediction models in patients with AF undergoing dialysis or with CKD.</div></div><div><h3>Exposures</h3><div>AF and CKD or dialysis.</div></div><div><h3>Outcomes</h3><div>IS and bleeding.</div></div><div><h3>Analytical Approach</h3><div>Eligible studies were reviewed, discrimination was pooled using random-effects meta-analysis, calibration was calculated and plotted, and the ROB score was assessed using the prediction model ROB assessment tool.</div></div><div><h3>Results</h3><div>The CHA<sub>2</sub>DS<sub>2</sub>-VASc score was validated in 35 studies, the CHADS<sub>2</sub> and HAS-BLED scores in 19 each, and the HEMORR<sub>2</sub>HAGES score in 1. Among 627,199 patients, 28,493 (4.5%) experienced IS and 25,695 (4.1%) bleeding. Only 12 studies presented c-statistic scores. In patients with AF and CKD, the CHADS<sub>2</sub> model score showed nominally better discrimination predicting IS (pooled c-statistic score of 0.70) than the CHA<sub>2</sub>DS<sub>2</sub>-VASc model score (0.64). In patients with AF undergoing dialysis, the CHA<sub>2</sub>DS<sub>2</sub>-VASc and CHADS<sub>2</sub> model scores showed similar discrimination predicting IS (both 0.70), and the HAS-BLED and HEMORR<sub>2</sub>HAGES model scores showed similar c-statistic scores predicting bleeding (0.55 and 0.56, respectively). Calibration was good in the most relevant high-risk group.</div></div><div><h3>Limitations</h3><div>All studies were at high ROB scores, contained within- and between-study heterogeneity, and often merged scoring categories or populations, limiting comparability.</div></div><div><h3>Conclusions</h3><div>Although modest, the discrimination of prediction models in patients with AF undergoing dialysis or with CKD is similar to patients with AF without CKD. Despite the described limitations, these models can be used in clinical practice for patients with CKD and patients undergoing dialysis.</div></div><div><h3>Plain-Language Summary</h3><div>Patients with both atrial fibrillation (AF) and chronic kidney disease (CKD) or patients undergoing dialysis face a higher risk of stroke and therapy-related bleeding. To estimate these risks, prediction m
理由和目的房颤（AF）和慢性肾脏疾病（CKD）患者发生缺血性卒中（IS）和出血的风险较高。预测模型在这一人群中的适用性仍存在争议。本研究旨在(1)确定房颤透析或CKD患者CHA2DS2-VASc、CHADS2、ha - bled和HEMORR2HAGES模型评分的外部验证，(2)提供汇总估计，(3)评估其偏倚风险（ROB）。研究设计：系统回顾和荟萃分析。背景和参与者我们检索了Web of Science、PubMed、MEDLINE、Embase、Emcare、PMC、Cochrane Library和Academic Search Premier，以获取外部验证AF接受透析或CKD患者的IS和出血预测模型的研究。暴露于af和CKD或透析。结果和出血。分析方法回顾符合条件的研究，使用随机效应荟萃分析合并歧视，计算和绘制校准，使用预测模型ROB评估工具评估ROB评分。结果35项研究验证了CHA2DS2-VASc评分，19项研究验证了CHADS2和HAS-BLED评分，1项研究验证了HEMORR2HAGES评分。在627,199例患者中，28,493例（4.5%）发生IS， 25,695例（4.1%）出血。只有12项研究给出了c统计分数。在AF和CKD患者中，CHADS2模型评分（合并c统计评分为0.70）比CHA2DS2-VASc模型评分（0.64）在预测IS方面具有更好的区分性。在房事透析患者中，CHA2DS2-VASc和CHADS2模型评分预测IS具有相似的判别性（均为0.70），HAS-BLED和HEMORR2HAGES模型评分预测出血具有相似的c统计评分（分别为0.55和0.56）。在最相关的高危人群中，校正效果良好。局限性：所有的研究都有较高的ROB评分，包含研究内部和研究之间的异质性，并且经常合并评分类别或人群，限制了可比性。结论房颤透析患者或合并CKD患者的预测模型与无CKD的房颤患者的预测模型差别不大。尽管存在上述局限性，但这些模型可用于CKD患者和透析患者的临床实践。合并心房颤动（AF）和慢性肾脏疾病（CKD）的患者或接受透析的患者面临更高的中风和治疗相关出血的风险。为了估计这些风险，可以使用预测模型，但它们在这一人群中的预测价值尚不清楚。本研究回顾并分析了现有的4种房颤透析或CKD患者常用的卒中和出血预测模型。我们发现，尽管这些模型表现出适度的歧视，但它们的表现与无CKD或接受透析的AF患者相似。因此，尽管纳入的研究存在弱点，但我们相信这些工具可以用于CKD患者和接受透析的患者，以帮助指导治疗决策。•本研究确定了35个验证CHA2DS2-VASc评分的研究，21个验证CHADS2评分的研究，22个验证HAS-BLED评分的研究，1个验证HEMORR2HAGES评分的研究，反映了指南的认可。•在合并慢性肾脏疾病（CKD）的房颤（AF）患者中，CHADS2评分在名义上比CHA2DS2-VASc评分具有更好的区分能力。•在接受透析的患者中，CHA2DS2-VASc、CHADS2、HAS-BLED和HEMORR2HAGES评分表现相似。•CHA2DS2-VASc和HAS-BLED评分在最相关的高危人群中显示出良好的校准。•在所有研究中都发现了高偏倚风险（ROB），特别是在结果和分析领域。•这些模型在接受透析的房颤患者或CKD患者中的鉴别能力与肾功能正常的房颤患者的鉴别能力相当。•校准在低风险组中较差，但在更相关的高风险组中显示出更好的一致性。•这些预测模型研究的ROB较高。这意味着什么？现在应该改变什么？•与更广泛的房颤指南一致，传统的卒中和出血预测模型也可以应用于CKD患者和接受透析的患者。•纳入研究的高ROB分数和纳入人群的异质性突出表明需要对该人群的预测模型进行更严格的验证。
{"title":"Systematic Review and Meta-analysis of the Predictive Performance of Stroke and Bleeding Prediction Models in Atrial Fibrillation Patients With Kidney Disease","authors":"Liselotte F.S. Langenhuijsen , Daniëlle C.L. Derksen , Jet Milders , Sabine F.B. van der Horst , Merel van Diepen , Serge A. Trines , Paul L. den Exter , Frederikus A. Klok , Joris I. Rotmans , Ype de Jong","doi":"10.1016/j.xkme.2025.101200","DOIUrl":"10.1016/j.xkme.2025.101200","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Patients with atrial fibrillation (AF) and chronic kidney disease (CKD) are at high risk for ischemic stroke (IS) and bleeding. The applicability of prediction models in this population remains debated. This study aimed to (1) identify external validations of CHA<sub>2</sub>DS<sub>2</sub>-VASc, CHADS<sub>2</sub>, HAS-BLED, and HEMORR<sub>2</sub>HAGES model scores in patients with AF undergoing dialysis or with CKD, (2) provide pooled estimates, and (3) assess their risk of bias (ROB).</div></div><div><h3>Study Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Setting & Participants</h3><div>We searched Web of Science, PubMed, MEDLINE, Embase, Emcare, PMC, Cochrane Library, and Academic Search Premier for studies externally validating IS and bleeding prediction models in patients with AF undergoing dialysis or with CKD.</div></div><div><h3>Exposures</h3><div>AF and CKD or dialysis.</div></div><div><h3>Outcomes</h3><div>IS and bleeding.</div></div><div><h3>Analytical Approach</h3><div>Eligible studies were reviewed, discrimination was pooled using random-effects meta-analysis, calibration was calculated and plotted, and the ROB score was assessed using the prediction model ROB assessment tool.</div></div><div><h3>Results</h3><div>The CHA<sub>2</sub>DS<sub>2</sub>-VASc score was validated in 35 studies, the CHADS<sub>2</sub> and HAS-BLED scores in 19 each, and the HEMORR<sub>2</sub>HAGES score in 1. Among 627,199 patients, 28,493 (4.5%) experienced IS and 25,695 (4.1%) bleeding. Only 12 studies presented c-statistic scores. In patients with AF and CKD, the CHADS<sub>2</sub> model score showed nominally better discrimination predicting IS (pooled c-statistic score of 0.70) than the CHA<sub>2</sub>DS<sub>2</sub>-VASc model score (0.64). In patients with AF undergoing dialysis, the CHA<sub>2</sub>DS<sub>2</sub>-VASc and CHADS<sub>2</sub> model scores showed similar discrimination predicting IS (both 0.70), and the HAS-BLED and HEMORR<sub>2</sub>HAGES model scores showed similar c-statistic scores predicting bleeding (0.55 and 0.56, respectively). Calibration was good in the most relevant high-risk group.</div></div><div><h3>Limitations</h3><div>All studies were at high ROB scores, contained within- and between-study heterogeneity, and often merged scoring categories or populations, limiting comparability.</div></div><div><h3>Conclusions</h3><div>Although modest, the discrimination of prediction models in patients with AF undergoing dialysis or with CKD is similar to patients with AF without CKD. Despite the described limitations, these models can be used in clinical practice for patients with CKD and patients undergoing dialysis.</div></div><div><h3>Plain-Language Summary</h3><div>Patients with both atrial fibrillation (AF) and chronic kidney disease (CKD) or patients undergoing dialysis face a higher risk of stroke and therapy-related bleeding. To estimate these risks, prediction m","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101200"},"PeriodicalIF":3.4,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023247","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 : 2025-12-11DOI: 10.1016/j.xkme.2025.101201
Dong-Hyuk Cho , Jun Gyo Gwon , Jimi Choi , Cheol Woong Jung , Tai Yeon Koo , Se Won Oh , Sang-Kyung Jo , Kyo Won Lee , Kyu Ha Huh , Han Ro , Seung-Yeup Han , Jang-Hee Cho , Sik Lee , Jaeseok Yang , Seong-Mi Park , Myung-Gyu Kim
<div><h3>Rationale & Objective</h3><div>Kidney transplantation (KT) alleviates the hemodynamic burden in chronic kidney disease on dialysis. However, cardiovascular disease remains the leading cause of death after KT. This study evaluated the metabolic and hemodynamic burden and its impact on myocardial remodeling and clinical outcomes after KT.</div></div><div><h3>Study Design</h3><div>Multicenter observational prospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>600 patients who underwent echocardiography before and 3 years after KT from 8 university hospitals in Korea.</div></div><div><h3>Predictors</h3><div>Changes in metabolic parameters (glycosylated hemoglobin [HbA<sub>1C</sub>] and triglyceride [TG] levels) and hemodynamic parameters (hemoglobin [Hb] and systolic blood pressure [SBP]) from baseline to 3 years after KT.</div></div><div><h3>Outcomes</h3><div>Primary outcome was major adverse cardiovascular events (MACE). Secondary outcomes included left ventricular geometry changes.</div></div><div><h3>Analytical Approach</h3><div>Cox proportional hazards models were used to assess the association between echocardiographic changes and MACE.</div></div><div><h3>Results</h3><div>TG and HbA<sub>1c</sub> levels increased 3 years after KT; however, Hb levels and SBP improved (<em>P</em> < 0.05). Left ventricular end-diastolic dimension also improved for 3 years (<em>P</em> < 0.05). Nevertheless, the relative wall thickness (RWT) increased from 0.39 ± 0.07-0.41 ± 0.07. Changes in hemodynamic parameters (Hb level and SBP) were associated with a change in the left ventricular end-diastolic dimension, whereas changes in metabolic parameters (HbA<sub>1c</sub> and TG levels) were associated with a change in RWT (<em>P</em> < 0.05). During the 5-year follow-up, 30 MACE occurred, and an increase in RWT independently predicted MACE occurrence (hazard ratio, 2.20; 95% confidence interval, 1.21-3.99; <em>P</em> < 0.01).</div></div><div><h3>Limitations</h3><div>Only patients with baseline and follow-up echocardiography were included, potentially introducing selection bias.</div></div><div><h3>Conclusions</h3><div>Hemodynamic improvements are associated with decreased left ventricular size; better metabolic control is associated with greater wall thickness improvement. RWT increases predicted MACE. Optimizing metabolic control to promote balanced left ventricular improvement could enhance cardiovascular outcomes in patients receiving KTs.</div></div><div><h3>Plain-Language Summary</h3><div>Patients receiving a kidney transplant often develop cardiovascular complications despite successful transplantation. To examine how cardiac structure changes posttransplant and their impact on future cardiovascular risk, we analyzed 600 patients in the prospective multicenter cohort, performing echocardiography before and 3 years after transplant. Overall, cardiac structure improved following transplantation, but some developed
{"title":"Longitudinal Changes in Left Ventricular Geometry After Kidney Transplantation and Their Implications on Cardiovascular Risk","authors":"Dong-Hyuk Cho , Jun Gyo Gwon , Jimi Choi , Cheol Woong Jung , Tai Yeon Koo , Se Won Oh , Sang-Kyung Jo , Kyo Won Lee , Kyu Ha Huh , Han Ro , Seung-Yeup Han , Jang-Hee Cho , Sik Lee , Jaeseok Yang , Seong-Mi Park , Myung-Gyu Kim","doi":"10.1016/j.xkme.2025.101201","DOIUrl":"10.1016/j.xkme.2025.101201","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Kidney transplantation (KT) alleviates the hemodynamic burden in chronic kidney disease on dialysis. However, cardiovascular disease remains the leading cause of death after KT. This study evaluated the metabolic and hemodynamic burden and its impact on myocardial remodeling and clinical outcomes after KT.</div></div><div><h3>Study Design</h3><div>Multicenter observational prospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>600 patients who underwent echocardiography before and 3 years after KT from 8 university hospitals in Korea.</div></div><div><h3>Predictors</h3><div>Changes in metabolic parameters (glycosylated hemoglobin [HbA<sub>1C</sub>] and triglyceride [TG] levels) and hemodynamic parameters (hemoglobin [Hb] and systolic blood pressure [SBP]) from baseline to 3 years after KT.</div></div><div><h3>Outcomes</h3><div>Primary outcome was major adverse cardiovascular events (MACE). Secondary outcomes included left ventricular geometry changes.</div></div><div><h3>Analytical Approach</h3><div>Cox proportional hazards models were used to assess the association between echocardiographic changes and MACE.</div></div><div><h3>Results</h3><div>TG and HbA<sub>1c</sub> levels increased 3 years after KT; however, Hb levels and SBP improved (<em>P</em> < 0.05). Left ventricular end-diastolic dimension also improved for 3 years (<em>P</em> < 0.05). Nevertheless, the relative wall thickness (RWT) increased from 0.39 ± 0.07-0.41 ± 0.07. Changes in hemodynamic parameters (Hb level and SBP) were associated with a change in the left ventricular end-diastolic dimension, whereas changes in metabolic parameters (HbA<sub>1c</sub> and TG levels) were associated with a change in RWT (<em>P</em> < 0.05). During the 5-year follow-up, 30 MACE occurred, and an increase in RWT independently predicted MACE occurrence (hazard ratio, 2.20; 95% confidence interval, 1.21-3.99; <em>P</em> < 0.01).</div></div><div><h3>Limitations</h3><div>Only patients with baseline and follow-up echocardiography were included, potentially introducing selection bias.</div></div><div><h3>Conclusions</h3><div>Hemodynamic improvements are associated with decreased left ventricular size; better metabolic control is associated with greater wall thickness improvement. RWT increases predicted MACE. Optimizing metabolic control to promote balanced left ventricular improvement could enhance cardiovascular outcomes in patients receiving KTs.</div></div><div><h3>Plain-Language Summary</h3><div>Patients receiving a kidney transplant often develop cardiovascular complications despite successful transplantation. To examine how cardiac structure changes posttransplant and their impact on future cardiovascular risk, we analyzed 600 patients in the prospective multicenter cohort, performing echocardiography before and 3 years after transplant. Overall, cardiac structure improved following transplantation, but some developed","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101201"},"PeriodicalIF":3.4,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023244","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 : 2025-12-11DOI: 10.1016/j.xkme.2025.101203
Claudia Dahlerus , Noelle E. Carlozzi , Richard A. Hirth , Katrina Price , Jennifer Sardone , Jennifer A. Miner , Jonathan H. Segal , Joel Andress , Jesse Roach , Elena Balovlenkov , Stephanie Clark , Joseph M. Messana
Rationale & Objectives
To report on the qualitative study supporting concept elicitation and item development for a new survey assessing discussion of patient life goals (D-PaLS) for people with kidney failure (KF) on maintenance dialysis.
Study Design
Three-stage qualitative data collection using a semi-structured group discussion format with an expert panel (stage 1); 2 focus groups (stage 2); and cognitive debriefing interviews (stage 3).
Setting & Participants
All participants were recruited nationally in the United States to obtain a diverse convenience sample of KF patients with maintenance dialysis experience, nephrologists, and dialysis clinic staff.
Analytic Approach
Qualitative analysis of major themes to support life goals concept elicitation and survey item development and revision.
Results
There was strong consensus for the development of a patient life goals patient-reported outcome measure to support the alignment of patient life goals with treatment planning. Themes from stage 1 included “quality gap—life goals discussions are not happening,” “how life goals inform treatment planning,” and “starting the life goals conversation.” In stages 2 and 3, focus group feedback related to item interpretability; mix of item type; limiting survey burden; and preserving patient anonymity. The final survey contained 8 items (6 core items and 2 check-list items).
Limitations
People that volunteered for participation may reflect self-selection.
Conclusions
The new D-PaLS is a brief survey that was based on extensive input from patient and clinical provider stakeholders that supported elicitation of the measure concept and item development. The D-PaLS has the potential to support shared decision-making in treatment planning for people with KF. Stakeholder support is necessary throughout patient-reported outcome measure measure development to ensure content is meaningful and captures experiences and outcomes that are important to the patients.
Plain-language Summary
The discussion of patient life goals survey was developed based on conversations we had in 2017 with people with kidney failure and kidney doctors who felt it was important that discussing patient life goals should be happening as part of kidney replacement treatment planning. After the 2017 meeting, we developed initial survey questions that were reviewed by 2 focus groups, which provided feedback. Next, we conducted cognitive debriefing interviews to make sure survey questions were clear and easy to understand. The survey will fill a need for more patient-reported outcome measures for people being treated for kidney failure.
{"title":"Conceptual Development Informing the Kidney Failure Patient Life Goals Survey","authors":"Claudia Dahlerus , Noelle E. Carlozzi , Richard A. Hirth , Katrina Price , Jennifer Sardone , Jennifer A. Miner , Jonathan H. Segal , Joel Andress , Jesse Roach , Elena Balovlenkov , Stephanie Clark , Joseph M. Messana","doi":"10.1016/j.xkme.2025.101203","DOIUrl":"10.1016/j.xkme.2025.101203","url":null,"abstract":"<div><h3>Rationale & Objectives</h3><div>To report on the qualitative study supporting concept elicitation and item development for a new survey assessing discussion of patient life goals (D-PaLS) for people with kidney failure (KF) on maintenance dialysis.</div></div><div><h3>Study Design</h3><div>Three-stage qualitative data collection using a semi-structured group discussion format with an expert panel (stage 1); 2 focus groups (stage 2); and cognitive debriefing interviews (stage 3).</div></div><div><h3>Setting & Participants</h3><div>All participants were recruited nationally in the United States to obtain a diverse convenience sample of KF patients with maintenance dialysis experience, nephrologists, and dialysis clinic staff.</div></div><div><h3>Analytic Approach</h3><div>Qualitative analysis of major themes to support life goals concept elicitation and survey item development and revision.</div></div><div><h3>Results</h3><div>There was strong consensus for the development of a patient life goals patient-reported outcome measure to support the alignment of patient life goals with treatment planning. Themes from stage 1 included “quality gap—life goals discussions are not happening,” “how life goals inform treatment planning,” and “starting the life goals conversation.” In stages 2 and 3, focus group feedback related to item interpretability; mix of item type; limiting survey burden; and preserving patient anonymity. The final survey contained 8 items (6 core items and 2 check-list items).</div></div><div><h3>Limitations</h3><div>People that volunteered for participation may reflect self-selection.</div></div><div><h3>Conclusions</h3><div>The new D-PaLS is a brief survey that was based on extensive input from patient and clinical provider stakeholders that supported elicitation of the measure concept and item development. The D-PaLS has the potential to support shared decision-making in treatment planning for people with KF. Stakeholder support is necessary throughout patient-reported outcome measure measure development to ensure content is meaningful and captures experiences and outcomes that are important to the patients.</div></div><div><h3>Plain-language Summary</h3><div>The discussion of patient life goals survey was developed based on conversations we had in 2017 with people with kidney failure and kidney doctors who felt it was important that discussing patient life goals should be happening as part of kidney replacement treatment planning. After the 2017 meeting, we developed initial survey questions that were reviewed by 2 focus groups, which provided feedback. Next, we conducted cognitive debriefing interviews to make sure survey questions were clear and easy to understand. The survey will fill a need for more patient-reported outcome measures for people being treated for kidney failure.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101203"},"PeriodicalIF":3.4,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023246","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 : 2025-12-10DOI: 10.1016/j.xkme.2025.101202
William Morello , Greta Armaroli , Donatella Milani , Anita Sofia Bellotti , Paola Castelli , Elena Cicchetti , Alessandro Del Gobbo , Alessandra De Franco , Giovanni Montini
Proteinuria has been linked to several genetic disorders, providing valuable insights into its pathophysiology. ReNU syndrome, a recently described condition caused by heterozygous variants in the RNU4-2 gene, is characterized by intellectual disability, microcephaly, and multisystemic features. Kidney involvement has been reported exclusively as anatomical abnormalities.
Here, we presented a girl with isolated proteinuria and ReNU syndrome. Her prenatal history was notable for a small head circumference and reduced brain hemispheres. She was referred to our clinic at 3 months of age for isolated proteinuria. Physical examination revealed microsomia, strabismus, and dysmorphic features. Kidney ultrasound was unremarkable, and edema was never observed. A kidney biopsy showed minimal change disease with slight podocyte effacement. Treatment with prednisone was ineffective, and antiproteinuric agents were started. At her last follow-up, at age 16 years, nephrotic-range proteinuria persists with normal kidney function. Genetic testing before 2024 yielded no diagnosis, but whole-genome sequencing analysis later identified a de novo variant in the RNU4-2 gene (n.64_65insT), confirming ReNU syndrome.
This case is the first documented report of isolated, persistent proteinuria in ReNU syndrome. We recommend testing for RNU4-2 variants in patients with unexplained proteinuria and syndromic features and suggest regular monitoring for proteinuria in individuals with ReNU syndrome.
{"title":"ReNU Syndrome due to a de novo RNU4-2 Variant as a Novel Genetic Cause of Proteinuria","authors":"William Morello , Greta Armaroli , Donatella Milani , Anita Sofia Bellotti , Paola Castelli , Elena Cicchetti , Alessandro Del Gobbo , Alessandra De Franco , Giovanni Montini","doi":"10.1016/j.xkme.2025.101202","DOIUrl":"10.1016/j.xkme.2025.101202","url":null,"abstract":"<div><div>Proteinuria has been linked to several genetic disorders, providing valuable insights into its pathophysiology. ReNU syndrome, a recently described condition caused by heterozygous variants in the <em>RNU4-2</em> gene, is characterized by intellectual disability, microcephaly, and multisystemic features. Kidney involvement has been reported exclusively as anatomical abnormalities.</div><div>Here, we presented a girl with isolated proteinuria and ReNU syndrome. Her prenatal history was notable for a small head circumference and reduced brain hemispheres. She was referred to our clinic at 3 months of age for isolated proteinuria. Physical examination revealed microsomia, strabismus, and dysmorphic features. Kidney ultrasound was unremarkable, and edema was never observed. A kidney biopsy showed minimal change disease with slight podocyte effacement. Treatment with prednisone was ineffective, and antiproteinuric agents were started. At her last follow-up, at age 16 years, nephrotic-range proteinuria persists with normal kidney function. Genetic testing before 2024 yielded no diagnosis, but whole-genome sequencing analysis later identified a de novo variant in the <em>RNU4-2</em> gene (n.64_65insT), confirming ReNU syndrome.</div><div>This case is the first documented report of isolated, persistent proteinuria in ReNU syndrome. We recommend testing for <em>RNU4-2</em> variants in patients with unexplained proteinuria and syndromic features and suggest regular monitoring for proteinuria in individuals with ReNU syndrome.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101202"},"PeriodicalIF":3.4,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023172","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 : 2025-12-09DOI: 10.1016/j.xkme.2025.101204
Eric P. Cohen MD , Bernard Canaud MD
{"title":"Regarding “The Efficacy and Safety of Technology-Guided Dry Weight Adjustment Among Dialysis Patients: A Meta-Analysis of Randomized Controlled Trials” by Wathanavasin et al","authors":"Eric P. Cohen MD , Bernard Canaud MD","doi":"10.1016/j.xkme.2025.101204","DOIUrl":"10.1016/j.xkme.2025.101204","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 1","pages":"Article 101204"},"PeriodicalIF":3.4,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787274","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 : 2025-12-09DOI: 10.1016/j.xkme.2025.101198
Ramy Magdy Hanna , Shruti Chaturvedi , Moh-Lim Ong , Arpita Nag , Rui Song , Lynn Huynh , Jordan A. Burdeau , Mei Sheng Duh , Yan Wang
<div><h3>Rationale & Objective</h3><div>Atypical hemolytic uremic syndrome (aHUS) is a rare form of thrombotic microangiopathy (TMA) caused by complement dysregulation. Ravulizumab, a complement C5 inhibitor (C5i), is approved for aHUS; however, published evidence in a real-world setting is limited.</div></div><div><h3>Study Design</h3><div>Retrospective, longitudinal, physician panel-based chart review.</div></div><div><h3>Setting & Population</h3><div>C5i-naive adults with aHUS in the United States treated with ravulizumab. Physicians randomly selected 1-5 patients who had ≥6 months of follow-up after ravulizumab initiation; patients who died within 6 months of initiation were eligible.</div></div><div><h3>Exposure(s) or Predictor(s)</h3><div>Ravulizumab.</div></div><div><h3>Outcomes</h3><div>The clinical outcomes evaluated included hematologic and renal outcomes, complete TMA response (a composite hematolgic/renal endpoint), and dialysis use.</div></div><div><h3>Analytical Approach</h3><div>Descriptive statistics, Kaplan-Meier estimators, and generalized linear models.</div></div><div><h3>Results</h3><div>Overall, 79 C5i-naive adults with aHUS (enrolled by 31 physicians) initiated ravulizumab and were included in the study. Statistically significant improvements from baseline occurred as early as day 4 (lactate dehydrogenase and percent change in serum creatinine; both <em>P</em> < 0.001) and day 8 (platelet count; <em>P</em> < 0.001). The proportions of patients with normalization of platelet counts and lactate dehydrogenase levels, and ≥25% improvement in serum creatinine levels, were 14 out of 67 (21%), 12 out of 58 (21%), and 10 out of 65 (15%) at day 4, and 40 out of 48 (83%), 35 out of 38 (92%), and 42 out of 48 (88%) at 12 months after ravulizumab initiation, respectively. Complete TMA response rates were 60% and 68% within 6 and 12 months after ravulizumab initiation, respectively, and the median (interquartile range) time to complete TMA response was 3.1 (1.0-14.0) months. Of the 20 patients who received any dialysis at baseline, 14 (70.0%) did not have dialysis during follow-up.</div></div><div><h3>Limitations</h3><div>The study design relies on available medical record data and has potential responder bias.</div></div><div><h3>Conclusions</h3><div>This study supports the immediate and sustained benefits of initiating ravulizumab in patients with aHUS as seen by the early response and continued improvement in clinical outcomes.</div></div><div><h3>Plain-Language Summary</h3><div>This study evaluates the use of a treatment called ravulizumab for atypical hemolytic uremic syndrome (aHUS), a rare disease that causes clots in small blood vessels and can lead to kidney failure. Researchers reviewed the medical records of 79 adults with aHUS in the United States who were treated with ravulizumab and had never used similar treatments before. Significant improvements in laboratory measures including lactate dehydrogenase and se
{"title":"Real-World Effectiveness of Ravulizumab Among C5 Inhibitor-Naive Patients With Atypical Hemolytic Uremic Syndrome: A Physician Panel-Based Chart Review (aHUS IMPACT Study)","authors":"Ramy Magdy Hanna , Shruti Chaturvedi , Moh-Lim Ong , Arpita Nag , Rui Song , Lynn Huynh , Jordan A. Burdeau , Mei Sheng Duh , Yan Wang","doi":"10.1016/j.xkme.2025.101198","DOIUrl":"10.1016/j.xkme.2025.101198","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Atypical hemolytic uremic syndrome (aHUS) is a rare form of thrombotic microangiopathy (TMA) caused by complement dysregulation. Ravulizumab, a complement C5 inhibitor (C5i), is approved for aHUS; however, published evidence in a real-world setting is limited.</div></div><div><h3>Study Design</h3><div>Retrospective, longitudinal, physician panel-based chart review.</div></div><div><h3>Setting & Population</h3><div>C5i-naive adults with aHUS in the United States treated with ravulizumab. Physicians randomly selected 1-5 patients who had ≥6 months of follow-up after ravulizumab initiation; patients who died within 6 months of initiation were eligible.</div></div><div><h3>Exposure(s) or Predictor(s)</h3><div>Ravulizumab.</div></div><div><h3>Outcomes</h3><div>The clinical outcomes evaluated included hematologic and renal outcomes, complete TMA response (a composite hematolgic/renal endpoint), and dialysis use.</div></div><div><h3>Analytical Approach</h3><div>Descriptive statistics, Kaplan-Meier estimators, and generalized linear models.</div></div><div><h3>Results</h3><div>Overall, 79 C5i-naive adults with aHUS (enrolled by 31 physicians) initiated ravulizumab and were included in the study. Statistically significant improvements from baseline occurred as early as day 4 (lactate dehydrogenase and percent change in serum creatinine; both <em>P</em> < 0.001) and day 8 (platelet count; <em>P</em> < 0.001). The proportions of patients with normalization of platelet counts and lactate dehydrogenase levels, and ≥25% improvement in serum creatinine levels, were 14 out of 67 (21%), 12 out of 58 (21%), and 10 out of 65 (15%) at day 4, and 40 out of 48 (83%), 35 out of 38 (92%), and 42 out of 48 (88%) at 12 months after ravulizumab initiation, respectively. Complete TMA response rates were 60% and 68% within 6 and 12 months after ravulizumab initiation, respectively, and the median (interquartile range) time to complete TMA response was 3.1 (1.0-14.0) months. Of the 20 patients who received any dialysis at baseline, 14 (70.0%) did not have dialysis during follow-up.</div></div><div><h3>Limitations</h3><div>The study design relies on available medical record data and has potential responder bias.</div></div><div><h3>Conclusions</h3><div>This study supports the immediate and sustained benefits of initiating ravulizumab in patients with aHUS as seen by the early response and continued improvement in clinical outcomes.</div></div><div><h3>Plain-Language Summary</h3><div>This study evaluates the use of a treatment called ravulizumab for atypical hemolytic uremic syndrome (aHUS), a rare disease that causes clots in small blood vessels and can lead to kidney failure. Researchers reviewed the medical records of 79 adults with aHUS in the United States who were treated with ravulizumab and had never used similar treatments before. Significant improvements in laboratory measures including lactate dehydrogenase and se","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101198"},"PeriodicalIF":3.4,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023245","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}
{"title":"Response to the Letter to the Editor Regarding “The Efficacy and Safety of Technology-Guided Dry Weight Adjustment Among Dialysis Patients: A Meta-Analysis of Randomized Controlled Trials”","authors":"Wannasit Wathanavasin MD, MSc , Charat Thongprayoon MD , Wisit Cheungpasitporn MD","doi":"10.1016/j.xkme.2025.101205","DOIUrl":"10.1016/j.xkme.2025.101205","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 1","pages":"Article 101205"},"PeriodicalIF":3.4,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787272","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 : 2025-12-06DOI: 10.1016/j.xkme.2025.101197
Ilia Beberashvili , Hamza Abu Marsa , Keren Doenyas-Barak , Ilya Maslakov , Shai Efrati
<div><h3>Rationale & Objective</h3><div>Gout frequently complicates chronic kidney disease (CKD), yet the incidence and specific risk factors for gout in patients with CKD and asymptomatic hyperuricemia remain unclear. We aimed to determine gout incidence and risk factors in nondialysis patients with CKD and asymptomatic hyperuricemia.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>Analysis of 771 ambulatory nondialysis patients with CKD (stages 3-5) with asymptomatic hyperuricemia (serum urate level, ≥7.0 mg/dL), without prior gout, followed from 2010 to 2023 at a single center.</div></div><div><h3>Predictors</h3><div>Multiple clinical and laboratory factors were evaluated, including demographics, comorbidities, medications, and biochemical markers.</div></div><div><h3>Outcomes</h3><div>Incident gout diagnosis confirmed by rheumatology specialists.</div></div><div><h3>Analytical Approach</h3><div>Cox proportional hazards models and receiver operating characteristic curve analyses. A composite weighted index was derived from regression-based predictors.</div></div><div><h3>Results</h3><div>Over a median follow-up of 47 months, gout developed in 140 (18.2%) patients (incidence rate, 41.9 cases per 1,000 person-years). Independent predictors of gout included younger age (per year; hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.96-0.99), higher serum urate (per 1 mg/dL; HR, 1.29; 95% CI, 1.14-1.46), lower serum creatinine levels (per 1 mg/dL; HR, 0.81; 95% CI, 0.65-0.99), and diuretic use (HR, 1.86; 95% CI, 1.00-3.45). Higher composite weighted index (per 1 unit; HR, 2.19; 95% CI, 1.70-2.83) was associated with increased gout risk.</div></div><div><h3>Limitations</h3><div>Single-center, retrospective study design limits generalizability and causal inference.</div></div><div><h3>Conclusions</h3><div>Incident gout is common among patients with CKD and asymptomatic hyperuricemia. Younger age, elevated serum urate levels, lower creatinine levels, and diuretic use significantly predict gout onset. Identifying high-risk patients using these predictors could guide preventive therapeutic decisions.</div></div><div><h3>Plain-Language Summary</h3><div>People with chronic kidney disease often have high levels of uric acid in their blood, but not all of them develop gout. We wanted to understand which patients are more likely to develop gout so that preventive steps could be considered. We studied a large group of patients with chronic kidney disease who had high uric acid levels but no history of gout. We found that younger age, higher uric acid levels, use of diuretics, and earlier stages of kidney disease were linked to a higher chance of developing gout. We combined these factors into a weighted risk index to help identify high-risk patients. Identifying high-risk patients may help guide future treatment strategies aimed at preventing gout and improving quality of l
{"title":"The Incidence and Risk Factors of Gout in Non-dialysis Chronic Kidney Disease Patients With Asymptomatic Hyperuricemia","authors":"Ilia Beberashvili , Hamza Abu Marsa , Keren Doenyas-Barak , Ilya Maslakov , Shai Efrati","doi":"10.1016/j.xkme.2025.101197","DOIUrl":"10.1016/j.xkme.2025.101197","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Gout frequently complicates chronic kidney disease (CKD), yet the incidence and specific risk factors for gout in patients with CKD and asymptomatic hyperuricemia remain unclear. We aimed to determine gout incidence and risk factors in nondialysis patients with CKD and asymptomatic hyperuricemia.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>Analysis of 771 ambulatory nondialysis patients with CKD (stages 3-5) with asymptomatic hyperuricemia (serum urate level, ≥7.0 mg/dL), without prior gout, followed from 2010 to 2023 at a single center.</div></div><div><h3>Predictors</h3><div>Multiple clinical and laboratory factors were evaluated, including demographics, comorbidities, medications, and biochemical markers.</div></div><div><h3>Outcomes</h3><div>Incident gout diagnosis confirmed by rheumatology specialists.</div></div><div><h3>Analytical Approach</h3><div>Cox proportional hazards models and receiver operating characteristic curve analyses. A composite weighted index was derived from regression-based predictors.</div></div><div><h3>Results</h3><div>Over a median follow-up of 47 months, gout developed in 140 (18.2%) patients (incidence rate, 41.9 cases per 1,000 person-years). Independent predictors of gout included younger age (per year; hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.96-0.99), higher serum urate (per 1 mg/dL; HR, 1.29; 95% CI, 1.14-1.46), lower serum creatinine levels (per 1 mg/dL; HR, 0.81; 95% CI, 0.65-0.99), and diuretic use (HR, 1.86; 95% CI, 1.00-3.45). Higher composite weighted index (per 1 unit; HR, 2.19; 95% CI, 1.70-2.83) was associated with increased gout risk.</div></div><div><h3>Limitations</h3><div>Single-center, retrospective study design limits generalizability and causal inference.</div></div><div><h3>Conclusions</h3><div>Incident gout is common among patients with CKD and asymptomatic hyperuricemia. Younger age, elevated serum urate levels, lower creatinine levels, and diuretic use significantly predict gout onset. Identifying high-risk patients using these predictors could guide preventive therapeutic decisions.</div></div><div><h3>Plain-Language Summary</h3><div>People with chronic kidney disease often have high levels of uric acid in their blood, but not all of them develop gout. We wanted to understand which patients are more likely to develop gout so that preventive steps could be considered. We studied a large group of patients with chronic kidney disease who had high uric acid levels but no history of gout. We found that younger age, higher uric acid levels, use of diuretics, and earlier stages of kidney disease were linked to a higher chance of developing gout. We combined these factors into a weighted risk index to help identify high-risk patients. Identifying high-risk patients may help guide future treatment strategies aimed at preventing gout and improving quality of l","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101197"},"PeriodicalIF":3.4,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978512","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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