Pub Date : 2026-02-01Epub Date: 2025-12-15DOI: 10.1016/j.xkme.2025.101221
Mary F. Hannan , Michael J. Fischer , Jesse Hsu , Alana D. Steffen , Feiyi Sun , Kerri L. Cavanaugh , Laura M. Dember , John Farrar , Manisha Jhamb , Paul L. Kimmel , Mark B. Lockwood , Sagar U. Nigwekar , Rebecca Schmidt , Jennifer L. Steel , Mark Unruh , Ardith Z. Doorenbos
<div><h3>Rationale & Objective</h3><div>Fatigue is commonly experienced by adults with kidney failure receiving hemodialysis and those with chronic pain, but factors associated with fatigue are not fully understood. We determined the prevalence of fatigue in a clinical trial cohort of adults receiving maintenance hemodialysis who have chronic pain and identified factors associated with fatigue.</div></div><div><h3>Study Design</h3><div>A cross-sectional study.</div></div><div><h3>Setting & Participants</h3><div>The baseline data from the HOPE Consortium Trial to Reduce Pain and Opioid Use in Hemodialysis (HOPE Trial). Of the 643 participants randomized in the HOPE Trial, 636 had a baseline fatigue assessment and were included in this study.</div></div><div><h3>Exposures</h3><div>Pain, sociodemographic, biological, dialysis-related, medical comorbid condition, psychological, and behavioral factors.</div></div><div><h3>Outcome</h3><div>Fatigue was evaluated with the patient-reported outcomes measurement information system Fatigue SF 6a and defined as a T-score of ≥ 55.</div></div><div><h3>Analytical Approach</h3><div>Logistic regression models.</div></div><div><h3>Results</h3><div>Seventy-three percent of participants reported fatigue (n = 463), mean age was 60.4 (12.5), 289 (45.4%) were female, and 294 (46.2%) were Black/African American. In fully adjusted models, higher pain interference and opioid use in the last 14 days were each associated with higher odds of having fatigue (odds ratio ([OR) ] 1.37; 95% CI, 1.18-1.61; OR 1.80; 95% CI, 1.03-3.21, respectively), as were greater depressive symptoms and sleep disturbance (OR 1.21; 95% CI. 1.13-1.31; OR 1.08 95% CI 1.03-1.12, respectively). Higher physical function was associated with lower odds of having fatigue (OR 0.96 95% CI 0.93-0.99).</div></div><div><h3>Limitations</h3><div>Fatigue assessed at one point in time.</div></div><div><h3>Conclusions</h3><div>In adults receiving maintenance hemodialysis who have chronic pain, pain interference, opioid use, depression, and sleep disturbances are associated with increased odds of fatigue, and greater physical function is associated with lower odds of fatigue. Future work is needed to evaluate longitudinal associations, underlying mechanisms, and identify interventions.</div></div><div><h3>Plain-Language Summary</h3><div>Fatigue is commonly experienced by adults with kidney failure receiving hemodialysis and those with chronic pain, but factors associated with fatigue are not fully understood. Baseline data were examined from adults with kidney failure receiving hemodialysis who have chronic pain in the HOPE Trial. Fatigue was found in 73% of included participants. Higher levels of pain interference, opioid use, depressive symptoms, and sleep disturbances were each associated with higher odds of having fatigue. Higher levels of physical function were associated with lower odds of having fatigue. Future work is needed to evaluate causes of fati
理由和目的接受血液透析的肾功能衰竭和慢性疼痛的成年人通常会感到疲劳，但与疲劳相关的因素尚不完全清楚。我们在一组接受维持性血液透析且患有慢性疼痛的成人临床试验队列中确定了疲劳的患病率，并确定了与疲劳相关的因素。研究设计：横断面研究。背景和参与者：减少血液透析疼痛和阿片类药物使用的HOPE联合试验（HOPE试验）的基线数据。在HOPE试验中随机分配的643名参与者中，有636人进行了基线疲劳评估，并被纳入本研究。暴露：西班牙、社会人口统计学、生物学、透析相关、医学合并症、心理和行为因素。使用患者报告的结果测量信息系统Fatigue SF 6a评估疲劳，并将t评分定义为≥55。分析方法逻辑回归模型。结果73%的参与者报告疲劳（n = 463），平均年龄为60.4(12.5)，女性289(45.4%)，黑人/非裔美国人294（46.2%）。在完全调整后的模型中，在最后14天内，较高的疼痛干扰和阿片类药物使用均与较高的疲劳发生率相关(优势比[OR] 1.37；95% ci, 1.18-1.61；或1.80;95% CI分别为1.03-3.21)，更严重的抑郁症状和睡眠障碍也是如此(OR 1.21; 95% CI。1.13 - -1.31;OR 1.08 （95% CI 1.03-1.12）。较高的身体机能与较低的疲劳发生率相关（OR 0.96 95% CI 0.93-0.99）。限制疲劳评估在一个时间点。结论在接受维持性血液透析的成年人中，慢性疼痛、疼痛干扰、阿片类药物使用、抑郁和睡眠障碍与疲劳发生率增加相关，而身体功能增强与疲劳发生率降低相关。未来的工作需要评估纵向关联，潜在机制，并确定干预措施。接受血液透析的肾功能衰竭成人和慢性疼痛患者通常会感到疲劳，但与疲劳相关的因素尚不完全清楚。基线数据来自HOPE试验中接受血液透析的患有慢性疼痛的肾功能衰竭成人。73%的参与者感到疲劳。高水平的疼痛干扰、阿片类药物的使用、抑郁症状和睡眠障碍都与疲劳的高几率相关。身体机能水平越高，疲劳的几率就越低。未来的工作需要评估疲劳的原因，确定随着时间的推移导致疲劳的因素，并确定这一人群的疲劳干预措施。
{"title":"Risk Factors for Fatigue in Adults Receiving Maintenance Hemodialysis Who Have Chronic Pain: A Secondary Analysis of the HOPE Consortium Trial","authors":"Mary F. Hannan , Michael J. Fischer , Jesse Hsu , Alana D. Steffen , Feiyi Sun , Kerri L. Cavanaugh , Laura M. Dember , John Farrar , Manisha Jhamb , Paul L. Kimmel , Mark B. Lockwood , Sagar U. Nigwekar , Rebecca Schmidt , Jennifer L. Steel , Mark Unruh , Ardith Z. Doorenbos","doi":"10.1016/j.xkme.2025.101221","DOIUrl":"10.1016/j.xkme.2025.101221","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Fatigue is commonly experienced by adults with kidney failure receiving hemodialysis and those with chronic pain, but factors associated with fatigue are not fully understood. We determined the prevalence of fatigue in a clinical trial cohort of adults receiving maintenance hemodialysis who have chronic pain and identified factors associated with fatigue.</div></div><div><h3>Study Design</h3><div>A cross-sectional study.</div></div><div><h3>Setting & Participants</h3><div>The baseline data from the HOPE Consortium Trial to Reduce Pain and Opioid Use in Hemodialysis (HOPE Trial). Of the 643 participants randomized in the HOPE Trial, 636 had a baseline fatigue assessment and were included in this study.</div></div><div><h3>Exposures</h3><div>Pain, sociodemographic, biological, dialysis-related, medical comorbid condition, psychological, and behavioral factors.</div></div><div><h3>Outcome</h3><div>Fatigue was evaluated with the patient-reported outcomes measurement information system Fatigue SF 6a and defined as a T-score of ≥ 55.</div></div><div><h3>Analytical Approach</h3><div>Logistic regression models.</div></div><div><h3>Results</h3><div>Seventy-three percent of participants reported fatigue (n = 463), mean age was 60.4 (12.5), 289 (45.4%) were female, and 294 (46.2%) were Black/African American. In fully adjusted models, higher pain interference and opioid use in the last 14 days were each associated with higher odds of having fatigue (odds ratio ([OR) ] 1.37; 95% CI, 1.18-1.61; OR 1.80; 95% CI, 1.03-3.21, respectively), as were greater depressive symptoms and sleep disturbance (OR 1.21; 95% CI. 1.13-1.31; OR 1.08 95% CI 1.03-1.12, respectively). Higher physical function was associated with lower odds of having fatigue (OR 0.96 95% CI 0.93-0.99).</div></div><div><h3>Limitations</h3><div>Fatigue assessed at one point in time.</div></div><div><h3>Conclusions</h3><div>In adults receiving maintenance hemodialysis who have chronic pain, pain interference, opioid use, depression, and sleep disturbances are associated with increased odds of fatigue, and greater physical function is associated with lower odds of fatigue. Future work is needed to evaluate longitudinal associations, underlying mechanisms, and identify interventions.</div></div><div><h3>Plain-Language Summary</h3><div>Fatigue is commonly experienced by adults with kidney failure receiving hemodialysis and those with chronic pain, but factors associated with fatigue are not fully understood. Baseline data were examined from adults with kidney failure receiving hemodialysis who have chronic pain in the HOPE Trial. Fatigue was found in 73% of included participants. Higher levels of pain interference, opioid use, depressive symptoms, and sleep disturbances were each associated with higher odds of having fatigue. Higher levels of physical function were associated with lower odds of having fatigue. Future work is needed to evaluate causes of fati","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101221"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023298","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 : 2026-02-01Epub Date: 2025-11-07DOI: 10.1016/j.xkme.2025.101175
Léa Pessin , Mary K. Roberts , Avrum Gillespie , Catherine R. Butler , Andrea Corradi , Arinala Randrianasolo , Jonathan Daw
<div><h3>Rationale & Objective</h3><div>There are substantial racial/ethnic disparities in access to kidney replacement therapies (KRT). Although existing work often focuses on discrete treatment outcomes, a holistic depiction of racial/ethnic groups’ differential experiences requires a longitudinal approach.</div></div><div><h3>Study Design</h3><div>A sequence analysis in national registry data.</div></div><div><h3>Setting & Participants</h3><div>Adults aged 18-64 years with incident kidney failure in 2009 in the United States Renal Data System database.</div></div><div><h3>Exposure</h3><div>Race/ethnicity (non-Hispanic Asian American [Asian-NH], non-Hispanic African American or Black [Black-NH], Hispanic, and non-Hispanic White [White-NH]) and age group (18-44 years and 45-64 years).</div></div><div><h3>Outcome</h3><div>Ten-year KRT modality sequences (in-center dialysis, home dialysis, deceased donor kidney transplant [DDKT], living donor kidney transplant, stopped dialysis, and mortality).</div></div><div><h3>Analytical Approach</h3><div>Using sequence analysis, longitudinal KRT modalities were characterized using descriptive statistics and visualized with state distribution plots, stratified by race/ethnicity and age.</div></div><div><h3>Results</h3><div>The study included 50,776 adults with kidney failure (24% 18-44 years old and 76% 45-64 years old; 3.6% Asian-NH, 35.8% Black-NH, 17.7% Hispanic, and 42.9% White-NH). Among those aged 18-44, Hispanic and Asian-NH patients more frequently survived 10 years compared with Black-NH and White-NH patients. Among non-White patients, receipt of DDKT increased in years 4-6. Asian-NH patients had the highest DDKT receipt frequency. Asian-NH and White-NH patients more frequently experienced treatment sequences with 3 or more KRT modalities, and these sequences more commonly included transplant. Among patients initially receiving home dialysis, Asian-NH and White-NH patients more commonly transitioned to transplant compared with Black-NH and Hispanic patients. Compared with patients aged 18-44 years, racial/ethnic differences in KRT treatment sequences were attenuated among those aged 45-64 years.</div></div><div><h3>Limitations</h3><div>Descriptive analyses cannot identify causal mechanisms. Excluding patients missing KRT modality may limit generalizability.</div></div><div><h3>Conclusions</h3><div>Patterns in the KRT modality sequences offer a more nuanced view of racial/ethnic disparities in access to treatments for incident kidney failure.</div></div><div><h3>Plain-Language Summary</h3><div>Although much prior research has investigated racial/ethnic differences in kidney failure treatments, they typically focus on one outcome at a time instead of looking at a patient’s full treatment course. This project uses data from the United States Renal Data System to show patterns in patient history in kidney replacement therapies. Patterns in patient history for kidney replacement therapies are shown
{"title":"Kidney Replacement Therapy Sequences: Racial/Ethnic Disparities in End-Stage Kidney Disease Patients’ 10-Year Treatment Histories","authors":"Léa Pessin , Mary K. Roberts , Avrum Gillespie , Catherine R. Butler , Andrea Corradi , Arinala Randrianasolo , Jonathan Daw","doi":"10.1016/j.xkme.2025.101175","DOIUrl":"10.1016/j.xkme.2025.101175","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>There are substantial racial/ethnic disparities in access to kidney replacement therapies (KRT). Although existing work often focuses on discrete treatment outcomes, a holistic depiction of racial/ethnic groups’ differential experiences requires a longitudinal approach.</div></div><div><h3>Study Design</h3><div>A sequence analysis in national registry data.</div></div><div><h3>Setting & Participants</h3><div>Adults aged 18-64 years with incident kidney failure in 2009 in the United States Renal Data System database.</div></div><div><h3>Exposure</h3><div>Race/ethnicity (non-Hispanic Asian American [Asian-NH], non-Hispanic African American or Black [Black-NH], Hispanic, and non-Hispanic White [White-NH]) and age group (18-44 years and 45-64 years).</div></div><div><h3>Outcome</h3><div>Ten-year KRT modality sequences (in-center dialysis, home dialysis, deceased donor kidney transplant [DDKT], living donor kidney transplant, stopped dialysis, and mortality).</div></div><div><h3>Analytical Approach</h3><div>Using sequence analysis, longitudinal KRT modalities were characterized using descriptive statistics and visualized with state distribution plots, stratified by race/ethnicity and age.</div></div><div><h3>Results</h3><div>The study included 50,776 adults with kidney failure (24% 18-44 years old and 76% 45-64 years old; 3.6% Asian-NH, 35.8% Black-NH, 17.7% Hispanic, and 42.9% White-NH). Among those aged 18-44, Hispanic and Asian-NH patients more frequently survived 10 years compared with Black-NH and White-NH patients. Among non-White patients, receipt of DDKT increased in years 4-6. Asian-NH patients had the highest DDKT receipt frequency. Asian-NH and White-NH patients more frequently experienced treatment sequences with 3 or more KRT modalities, and these sequences more commonly included transplant. Among patients initially receiving home dialysis, Asian-NH and White-NH patients more commonly transitioned to transplant compared with Black-NH and Hispanic patients. Compared with patients aged 18-44 years, racial/ethnic differences in KRT treatment sequences were attenuated among those aged 45-64 years.</div></div><div><h3>Limitations</h3><div>Descriptive analyses cannot identify causal mechanisms. Excluding patients missing KRT modality may limit generalizability.</div></div><div><h3>Conclusions</h3><div>Patterns in the KRT modality sequences offer a more nuanced view of racial/ethnic disparities in access to treatments for incident kidney failure.</div></div><div><h3>Plain-Language Summary</h3><div>Although much prior research has investigated racial/ethnic differences in kidney failure treatments, they typically focus on one outcome at a time instead of looking at a patient’s full treatment course. This project uses data from the United States Renal Data System to show patterns in patient history in kidney replacement therapies. Patterns in patient history for kidney replacement therapies are shown","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101175"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789713","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 : 2026-02-01Epub Date: 2025-12-15DOI: 10.1016/j.xkme.2025.101219
Shan Ma , Yanqing Hu , Yuanting Zhu , Shuaiye Liu , Yang Wu MD
<div><h3>Rationale & Objective</h3><div>Chronic kidney disease (CKD) is associated with a high risk of cardiovascular events. However, the role of diastolic blood pressure variability (DBPV) in predicting these outcomes, particularly in comparison to systolic blood pressure variability (SBPV), remains unclear. This study aimed to assess the prognostic value of DBPV in patients with CKD.</div></div><div><h3>Study Design</h3><div>A retrospective cohort study was conducted.</div></div><div><h3>Setting & Participants</h3><div>A total of 1,245 adults diagnosed with CKD (stages G3a, G3b, and G4-5) from the Seventh Affiliated Hospital of Sun Yat—sen University from 2019 to 2023 were included in the study.</div></div><div><h3>Exposures</h3><div>DBPV parameters, including 24-hour DBP standard deviation (SD), coefficient of variation, and nocturnal decline rate, were measured using 24-hour ambulatory blood pressure monitoring.</div></div><div><h3>Outcomes</h3><div>The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular death and heart failure hospitalization.</div></div><div><h3>Analytical Approach</h3><div>Cox proportional hazards models were used to analyze the associations, adjusting for multiple confounding factors, such as SBP, SBPV, and traditional cardiovascular risk factors. Interaction analyses were performed by CKD stage. The incremental predictive value of DBPV was evaluated using integrated discrimination improvement and net reclassification improvement.</div></div><div><h3>Results</h3><div>During a median follow-up of 3.2 years, higher 24-hour DBP SD was independently associated with an increased risk of all-cause mortality (hazard ratio [HR], 1.08; 95% CI, 1.03-1.13; <em>P</em> = 0.002) and cardiovascular death (HR 1.11; 95% CI, 1.05-1.18; <em>P</em> < 0.001). A nondipping DBP pattern was associated with an increased risk of heart failure hospitalization (HR 1.42; 95% CI, 1.07-1.89; <em>P</em> = 0.02). These associations were more pronounced in patients with stage G4-5 CKD (eg, for all-cause mortality: HR 1.15; 95% CI, 1.08-1.23; <em>P</em> < 0.001). DBPV provided incremental prognostic value beyond SBPV (for cardiovascular death, integrated discrimination improvement = 0.023; <em>P</em> = 0.004).</div></div><div><h3>Limitations</h3><div>The study had a single-center design, lacked non-CKD and stage 1-2 CKD controls, and did not have longitudinal DBPV data.</div></div><div><h3>Conclusions</h3><div>DBPV independently predicts adverse cardiovascular outcomes in patients with CKD, with stronger associations in advanced stages. It adds incremental value to SBPV in predicting cardiovascular events in this high-risk population.</div></div><div><h3>Plain-Language Summary</h3><div>Chronic kidney disease (CKD) often leads to serious heart problems. However, we don't know much about how changes in diastolic blood pressure (the lower number in blood pressure readings) affect these risks. We studied over 1,20
理由和目的慢性肾脏疾病（CKD）与心血管事件的高风险相关。然而，舒张压变异性（DBPV）在预测这些结果中的作用，特别是与收缩压变异性（SBPV）相比，仍不清楚。本研究旨在评估DBPV在CKD患者中的预后价值。研究设计进行回顾性队列研究。研究对象2019年至2023年中山大学第七附属医院确诊为CKD （G3a、G3b和G4-5期）的1245名成人纳入研究。使用24小时动态血压监测测量dbpv参数，包括24小时DBP标准差（SD）、变异系数和夜间下降率。主要结果为全因死亡率。次要结局包括心血管死亡和心力衰竭住院。分析方法：采用cox比例风险模型分析相关性，调整多种混杂因素，如收缩压、SBPV和传统心血管危险因素。相互作用分析按CKD分期进行。采用综合判别改进和净重分类改进评价DBPV的增量预测值。结果在中位随访3.2年期间，较高的24小时DBP SD与全因死亡风险增加（风险比[HR]， 1.08; 95% CI, 1.03-1.13; P = 0.002）和心血管死亡风险增加（风险比[HR]， 1.11; 95% CI, 1.05-1.18; P < 0.001）独立相关。舒张压不下降与心力衰竭住院风险增加相关（HR 1.42; 95% CI, 1.07-1.89; P = 0.02）。这些关联在G4-5期CKD患者中更为明显（例如，全因死亡率：HR 1.15; 95% CI, 1.08-1.23; P < 0.001）。DBPV提供了比SBPV更大的预后价值（对于心血管死亡，综合判别改善= 0.023;P = 0.004）。该研究为单中心设计，缺乏非CKD和1-2期CKD对照，也没有纵向DBPV数据。结论dbpv独立预测CKD患者的不良心血管结局，在晚期有更强的相关性。它增加了SBPV在预测高危人群心血管事件中的增量价值。慢性肾脏疾病（CKD）经常导致严重的心脏问题。然而，我们对舒张压（血压读数中较低的数字）的变化如何影响这些风险知之甚少。我们研究了1200多名CKD患者，并使用24小时血压监测仪跟踪他们的舒张压波动（DBPV）。我们发现，高DBPV与更高的死亡、心脏相关死亡或因心力衰竭需要住院治疗的几率有关，尤其是在晚期CKD患者中。重要的是，这些波动给我们提供了比收缩压变化（上限）更多的风险信息。这意味着检查DBPV可以帮助医生更好地确定哪些CKD患者风险最高，需要额外的护理。
{"title":"Diastolic Blood Pressure Variability Predicts Cardiovascular Outcomes in CKD, Especially in Advanced Stages","authors":"Shan Ma , Yanqing Hu , Yuanting Zhu , Shuaiye Liu , Yang Wu MD","doi":"10.1016/j.xkme.2025.101219","DOIUrl":"10.1016/j.xkme.2025.101219","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Chronic kidney disease (CKD) is associated with a high risk of cardiovascular events. However, the role of diastolic blood pressure variability (DBPV) in predicting these outcomes, particularly in comparison to systolic blood pressure variability (SBPV), remains unclear. This study aimed to assess the prognostic value of DBPV in patients with CKD.</div></div><div><h3>Study Design</h3><div>A retrospective cohort study was conducted.</div></div><div><h3>Setting & Participants</h3><div>A total of 1,245 adults diagnosed with CKD (stages G3a, G3b, and G4-5) from the Seventh Affiliated Hospital of Sun Yat—sen University from 2019 to 2023 were included in the study.</div></div><div><h3>Exposures</h3><div>DBPV parameters, including 24-hour DBP standard deviation (SD), coefficient of variation, and nocturnal decline rate, were measured using 24-hour ambulatory blood pressure monitoring.</div></div><div><h3>Outcomes</h3><div>The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular death and heart failure hospitalization.</div></div><div><h3>Analytical Approach</h3><div>Cox proportional hazards models were used to analyze the associations, adjusting for multiple confounding factors, such as SBP, SBPV, and traditional cardiovascular risk factors. Interaction analyses were performed by CKD stage. The incremental predictive value of DBPV was evaluated using integrated discrimination improvement and net reclassification improvement.</div></div><div><h3>Results</h3><div>During a median follow-up of 3.2 years, higher 24-hour DBP SD was independently associated with an increased risk of all-cause mortality (hazard ratio [HR], 1.08; 95% CI, 1.03-1.13; <em>P</em> = 0.002) and cardiovascular death (HR 1.11; 95% CI, 1.05-1.18; <em>P</em> < 0.001). A nondipping DBP pattern was associated with an increased risk of heart failure hospitalization (HR 1.42; 95% CI, 1.07-1.89; <em>P</em> = 0.02). These associations were more pronounced in patients with stage G4-5 CKD (eg, for all-cause mortality: HR 1.15; 95% CI, 1.08-1.23; <em>P</em> < 0.001). DBPV provided incremental prognostic value beyond SBPV (for cardiovascular death, integrated discrimination improvement = 0.023; <em>P</em> = 0.004).</div></div><div><h3>Limitations</h3><div>The study had a single-center design, lacked non-CKD and stage 1-2 CKD controls, and did not have longitudinal DBPV data.</div></div><div><h3>Conclusions</h3><div>DBPV independently predicts adverse cardiovascular outcomes in patients with CKD, with stronger associations in advanced stages. It adds incremental value to SBPV in predicting cardiovascular events in this high-risk population.</div></div><div><h3>Plain-Language Summary</h3><div>Chronic kidney disease (CKD) often leads to serious heart problems. However, we don't know much about how changes in diastolic blood pressure (the lower number in blood pressure readings) affect these risks. We studied over 1,20","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101219"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023164","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 : 2026-02-01Epub Date: 2025-12-16DOI: 10.1016/j.xkme.2025.101222
Kelcie K. Darpel , Julie A. Wright-Nunes , Sarah T. Hawley , Michelle A. Hladunewich , Claire Z. Kalpakjian , Corey Powell , Andrea L. Oliverio
<div><h3>Rationale & Objective</h3><div>Female reproductive health is affected by kidney disease but is often not addressed in nephrology care. Our objective was to better understand patient education needs on this topic to facilitate reproductive health education and care in chronic kidney disease (CKD).</div></div><div><h3>Study Design</h3><div>A cross-sectional online survey.</div></div><div><h3>Setting & Participants</h3><div>Female assigned sex at birth, aged 18-45 years, within the United States, fluent in English, with CKD recruited from national kidney organizations, research consortiums, and an academic medical center.</div></div><div><h3>Outcomes</h3><div>Reproductive health knowledge satisfaction, education needs, and communication preferences and barriers.</div></div><div><h3>Exposures</h3><div>Gravidity, pregnancy planning, CKD stage, disease etiology, health literacy, and demographics.</div></div><div><h3>Analytic Approach</h3><div>Univariate and multivariable logistic regression were used to examine associations between patient characteristics, knowledge satisfaction, and education needs. Descriptive statistics were used to assess communication preferences and barriers.</div></div><div><h3>Results</h3><div>Two hundred and nine surveys were completed. In total, 77% of participants self-identified as White, 11% Black, 4% Asian, and 11% Hispanic. A total of 23% had limited health literacy. Individuals planning a pregnancy in the future had lower knowledge satisfaction in univariate analysis. After multivariable analysis, only health literacy was significantly associated with knowledge satisfaction (<em>β</em>, −0.5; 95% CI, −0.9 to −0.02; <em>P</em> = 0.04). Understanding the impact of CKD on fetal development and menstruation, and kidney function changes after pregnancy were topics ranked as high priority by patients. Most wanted a nephrologist’s recommendation about birth control (76%; n = 159/209) and pregnancy timing (77%; n = 161/209).</div></div><div><h3>Limitations</h3><div>The limitations include convenience sampling and generalizability because of the online delivery of the survey and overrepresentation of higher socioeconomic groups.</div></div><div><h3>Conclusions</h3><div>This study provides priority topics to include in pregnancy planning during CKD care. Patients want advice from their nephrologists. More tools are needed to support reproductive health education for people with CKD, starting by addressing the need for those with limited health literacy.</div></div><div><h3>Plain-language Summary</h3><div>Chronic kidney disease (CKD) presents reproductive health challenges that can affect both the mother and fetus. Our study surveyed 209 women with CKD to assess their current reproductive health knowledge satisfaction, educational needs, and communication preferences and barriers. Results revealed that women are not satisfied with their knowledge about the effects of CKD on reproductive health, especially for thos
{"title":"Reproductive Health Knowledge and Educational Priorities in Chronic Kidney Disease: A Cross-Sectional Survey of People With CKD","authors":"Kelcie K. Darpel , Julie A. Wright-Nunes , Sarah T. Hawley , Michelle A. Hladunewich , Claire Z. Kalpakjian , Corey Powell , Andrea L. Oliverio","doi":"10.1016/j.xkme.2025.101222","DOIUrl":"10.1016/j.xkme.2025.101222","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Female reproductive health is affected by kidney disease but is often not addressed in nephrology care. Our objective was to better understand patient education needs on this topic to facilitate reproductive health education and care in chronic kidney disease (CKD).</div></div><div><h3>Study Design</h3><div>A cross-sectional online survey.</div></div><div><h3>Setting & Participants</h3><div>Female assigned sex at birth, aged 18-45 years, within the United States, fluent in English, with CKD recruited from national kidney organizations, research consortiums, and an academic medical center.</div></div><div><h3>Outcomes</h3><div>Reproductive health knowledge satisfaction, education needs, and communication preferences and barriers.</div></div><div><h3>Exposures</h3><div>Gravidity, pregnancy planning, CKD stage, disease etiology, health literacy, and demographics.</div></div><div><h3>Analytic Approach</h3><div>Univariate and multivariable logistic regression were used to examine associations between patient characteristics, knowledge satisfaction, and education needs. Descriptive statistics were used to assess communication preferences and barriers.</div></div><div><h3>Results</h3><div>Two hundred and nine surveys were completed. In total, 77% of participants self-identified as White, 11% Black, 4% Asian, and 11% Hispanic. A total of 23% had limited health literacy. Individuals planning a pregnancy in the future had lower knowledge satisfaction in univariate analysis. After multivariable analysis, only health literacy was significantly associated with knowledge satisfaction (<em>β</em>, −0.5; 95% CI, −0.9 to −0.02; <em>P</em> = 0.04). Understanding the impact of CKD on fetal development and menstruation, and kidney function changes after pregnancy were topics ranked as high priority by patients. Most wanted a nephrologist’s recommendation about birth control (76%; n = 159/209) and pregnancy timing (77%; n = 161/209).</div></div><div><h3>Limitations</h3><div>The limitations include convenience sampling and generalizability because of the online delivery of the survey and overrepresentation of higher socioeconomic groups.</div></div><div><h3>Conclusions</h3><div>This study provides priority topics to include in pregnancy planning during CKD care. Patients want advice from their nephrologists. More tools are needed to support reproductive health education for people with CKD, starting by addressing the need for those with limited health literacy.</div></div><div><h3>Plain-language Summary</h3><div>Chronic kidney disease (CKD) presents reproductive health challenges that can affect both the mother and fetus. Our study surveyed 209 women with CKD to assess their current reproductive health knowledge satisfaction, educational needs, and communication preferences and barriers. Results revealed that women are not satisfied with their knowledge about the effects of CKD on reproductive health, especially for thos","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101222"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023240","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 : 2026-02-01Epub Date: 2025-12-15DOI: 10.1016/j.xkme.2025.101220
Dipal M. Patel , Aurosikha Panda , Sani Fatima , Mary Ann Stephens , Jessica Gotay-Lehmer , Danielle Santiago , Deidra C. Crews , Kristin A. Riekert
<div><h3>Rationale & Objective</h3><div>People with non-dialysis-dependent chronic kidney disease (NDD-CKD) can experience substantial symptoms related to physical and mental health. Patient-reported outcome measures (PROMs) assess these aspects of health-related quality of life (QOL). Using the Kidney Disease Symptom Survey as an example to guide discussions, we sought to understand perspectives of patients and nephrology physicians about using PROMs in routine NDD-CKD care.</div></div><div><h3>Study Design</h3><div>Individual semi-structured interviews informed by the Theoretical Domains Framework and associated Capability, Opportunity, Motivation model of behavior change.</div></div><div><h3>Setting & Participants</h3><div>Adults with NDD-CKD and nephrology physicians in the Greater Baltimore-Maryland region.</div></div><div><h3>Analytical Approach</h3><div>Hybrid inductive-deductive thematic analysis.</div></div><div><h3>Results</h3><div>We analyzed interview transcripts from 15 nephrology physicians and 21 people with NDD-CKD. Capability to use PROMs was hindered by limited knowledge and skills of nephrology care teams to act on PROM results and manage symptoms. Opportunity to use PROMs was influenced by concerns surrounding environmental resources, including limited accessibility of PROMs to select patient users and limited time available to physicians to review PROMs data. Participants believed that PROMs could guide person-centered care, but motivation to use them was impeded by the uncertain role of nephrology physicians in assessing and managing symptoms and QOL, as well as concerns that PROMs may capture symptoms unrelated to CKD while also lacking sensitivity for key issues relevant to CKD patient care.</div></div><div><h3>Limitations</h3><div>Impact of clinical practice setting (including the availability of multidisciplinary support) and the views of individual PROM domains was not assessed.</div></div><div><h3>Conclusions</h3><div>Patient and clinician participants recognized the importance of symptom and QOL assessment in nephrology care. However, behavior changes required to integrate PROMs into routine CKD care may be limited by barriers related to the capability, opportunity, and motivation of users. These findings can inform the development of programs which support PROM implementation.</div></div><div><h3>Plain-Language Summary</h3><div>People with kidney disease often have symptoms, which worsen quality of life. Patient-reported outcome measures (PROMs) are surveys that patients can complete to share how they are feeling with health care teams. We spoke with people with kidney disease and kidney doctors to explore perspectives on using PROMs in kidney care. Participants agreed that PROMs could help focus care on patient needs. Some were uncertain if kidney doctors should be responsible for managing symptoms, especially because some symptoms might not be caused by kidney disease. Some doctors felt they did not have en
{"title":"Patient and Physician Perspectives on Use of Patient-Reported Outcome Measures in Non-Dialysis-Dependent CKD Care: A Qualitative Study","authors":"Dipal M. Patel , Aurosikha Panda , Sani Fatima , Mary Ann Stephens , Jessica Gotay-Lehmer , Danielle Santiago , Deidra C. Crews , Kristin A. Riekert","doi":"10.1016/j.xkme.2025.101220","DOIUrl":"10.1016/j.xkme.2025.101220","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>People with non-dialysis-dependent chronic kidney disease (NDD-CKD) can experience substantial symptoms related to physical and mental health. Patient-reported outcome measures (PROMs) assess these aspects of health-related quality of life (QOL). Using the Kidney Disease Symptom Survey as an example to guide discussions, we sought to understand perspectives of patients and nephrology physicians about using PROMs in routine NDD-CKD care.</div></div><div><h3>Study Design</h3><div>Individual semi-structured interviews informed by the Theoretical Domains Framework and associated Capability, Opportunity, Motivation model of behavior change.</div></div><div><h3>Setting & Participants</h3><div>Adults with NDD-CKD and nephrology physicians in the Greater Baltimore-Maryland region.</div></div><div><h3>Analytical Approach</h3><div>Hybrid inductive-deductive thematic analysis.</div></div><div><h3>Results</h3><div>We analyzed interview transcripts from 15 nephrology physicians and 21 people with NDD-CKD. Capability to use PROMs was hindered by limited knowledge and skills of nephrology care teams to act on PROM results and manage symptoms. Opportunity to use PROMs was influenced by concerns surrounding environmental resources, including limited accessibility of PROMs to select patient users and limited time available to physicians to review PROMs data. Participants believed that PROMs could guide person-centered care, but motivation to use them was impeded by the uncertain role of nephrology physicians in assessing and managing symptoms and QOL, as well as concerns that PROMs may capture symptoms unrelated to CKD while also lacking sensitivity for key issues relevant to CKD patient care.</div></div><div><h3>Limitations</h3><div>Impact of clinical practice setting (including the availability of multidisciplinary support) and the views of individual PROM domains was not assessed.</div></div><div><h3>Conclusions</h3><div>Patient and clinician participants recognized the importance of symptom and QOL assessment in nephrology care. However, behavior changes required to integrate PROMs into routine CKD care may be limited by barriers related to the capability, opportunity, and motivation of users. These findings can inform the development of programs which support PROM implementation.</div></div><div><h3>Plain-Language Summary</h3><div>People with kidney disease often have symptoms, which worsen quality of life. Patient-reported outcome measures (PROMs) are surveys that patients can complete to share how they are feeling with health care teams. We spoke with people with kidney disease and kidney doctors to explore perspectives on using PROMs in kidney care. Participants agreed that PROMs could help focus care on patient needs. Some were uncertain if kidney doctors should be responsible for managing symptoms, especially because some symptoms might not be caused by kidney disease. Some doctors felt they did not have en","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101220"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-13DOI: 10.1016/j.xkme.2025.101213
Darren Green , John G.F. Cleland , Hannah O’Keeffe , Rajkumar Chinnadurai , Edward Lake , Constantina Chrysochou , Philip A. Kalra
<div><h3>Rationale & Objective</h3><div>Trials failed to show that angioplasty and stenting of atherosclerotic renovascular disease (ARVD) conferred benefit when used as first-line therapy. However, some patients might benefit from kidney revascularization depending on their clinical phenotype and severity of renal artery stenosis (RAS). We investigated this hypothesis further.</div></div><div><h3>Study Design</h3><div>Data from the Angioplasty and Stenting for Renal Artery Lesions (ASTRAL) randomized trial and Salford ARVD observational study were included in a single analysis.</div></div><div><h3>Setting & Participants</h3><div>Patients were grouped based on RAS severity (≥70%) and whether unilateral or bilateral, with the bilateral group including RAS in a single functioning kidney. High-risk clinical phenotypes included advanced chronic kidney disease (CKD) (estimated glomerular filtration rate < 30 mL/min/1.73 m<sup>2</sup>), rapid CKD progression (creatinine increase >100 μmol/l or >20% per year), refractory systolic hypertension (≥150 mm Hg on ≥3 agents), and heart failure (chronic or decompensated).</div></div><div><h3>Exposures</h3><div>Medical therapy alone versus medial therapy and kidney revascularization.</div></div><div><h3>Outcome</h3><div>Composite of end stage CKD, cardiovascular events, or all-cause mortality.</div></div><div><h3>Analytical Approach</h3><div>Cox proportional hazard model adjusted for age, self-reported gender, and estimated glomerular filtration rate. Analysis of all patients and selected subgroups.</div></div><div><h3>Results</h3><div>In total, 1,644 patients (806 ASTRAL and 838 Salford). Median (IQR) age 72 (66-77) years. For bilateral severe RAS (≥70%) the HR for the composite outcome for revascularization compared with medical therapy was 0.70 (0.50-0.99), <em>P</em> = 0.048. The clinical phenotype where benefit appeared to be greatest in the presence of bilateral severe disease was people with rapidly progressive kidney disease with a HR of 0.39 (0.22-0.71]). In the absence of bilateral severe RAS, there was no benefit to revascularization for any clinical phenotype.</div></div><div><h3>Limitations</h3><div>The analyses included observational data.</div></div><div><h3>Conclusions</h3><div>The presence of bilateral severe RAS may be the best predictor of benefit for kidney revascularization.</div></div><div><h3>Plain-language Summary</h3><div>Previous clinical trials have indicated that undertaking procedures to restore blood flow to narrowed arteries in the kidneys should not be used routinely in patients with this condition (renal artery stenosis). This study looked at whether the procedure would benefit some patients, namely those with high-risk features. It used data from more than 1,000 patients, some of whom had the procedure and some who did not. It found that people with severe narrowing in both kidneys, particularly those who also had heart failure, had better long-term outcomes if
{"title":"Patient Selection for Revascularization of Atherosclerotic Renal Artery Stenosis: Comparing the Importance of Stenosis Severity and Clinical Phenotype","authors":"Darren Green , John G.F. Cleland , Hannah O’Keeffe , Rajkumar Chinnadurai , Edward Lake , Constantina Chrysochou , Philip A. Kalra","doi":"10.1016/j.xkme.2025.101213","DOIUrl":"10.1016/j.xkme.2025.101213","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Trials failed to show that angioplasty and stenting of atherosclerotic renovascular disease (ARVD) conferred benefit when used as first-line therapy. However, some patients might benefit from kidney revascularization depending on their clinical phenotype and severity of renal artery stenosis (RAS). We investigated this hypothesis further.</div></div><div><h3>Study Design</h3><div>Data from the Angioplasty and Stenting for Renal Artery Lesions (ASTRAL) randomized trial and Salford ARVD observational study were included in a single analysis.</div></div><div><h3>Setting & Participants</h3><div>Patients were grouped based on RAS severity (≥70%) and whether unilateral or bilateral, with the bilateral group including RAS in a single functioning kidney. High-risk clinical phenotypes included advanced chronic kidney disease (CKD) (estimated glomerular filtration rate < 30 mL/min/1.73 m<sup>2</sup>), rapid CKD progression (creatinine increase >100 μmol/l or >20% per year), refractory systolic hypertension (≥150 mm Hg on ≥3 agents), and heart failure (chronic or decompensated).</div></div><div><h3>Exposures</h3><div>Medical therapy alone versus medial therapy and kidney revascularization.</div></div><div><h3>Outcome</h3><div>Composite of end stage CKD, cardiovascular events, or all-cause mortality.</div></div><div><h3>Analytical Approach</h3><div>Cox proportional hazard model adjusted for age, self-reported gender, and estimated glomerular filtration rate. Analysis of all patients and selected subgroups.</div></div><div><h3>Results</h3><div>In total, 1,644 patients (806 ASTRAL and 838 Salford). Median (IQR) age 72 (66-77) years. For bilateral severe RAS (≥70%) the HR for the composite outcome for revascularization compared with medical therapy was 0.70 (0.50-0.99), <em>P</em> = 0.048. The clinical phenotype where benefit appeared to be greatest in the presence of bilateral severe disease was people with rapidly progressive kidney disease with a HR of 0.39 (0.22-0.71]). In the absence of bilateral severe RAS, there was no benefit to revascularization for any clinical phenotype.</div></div><div><h3>Limitations</h3><div>The analyses included observational data.</div></div><div><h3>Conclusions</h3><div>The presence of bilateral severe RAS may be the best predictor of benefit for kidney revascularization.</div></div><div><h3>Plain-language Summary</h3><div>Previous clinical trials have indicated that undertaking procedures to restore blood flow to narrowed arteries in the kidneys should not be used routinely in patients with this condition (renal artery stenosis). This study looked at whether the procedure would benefit some patients, namely those with high-risk features. It used data from more than 1,000 patients, some of whom had the procedure and some who did not. It found that people with severe narrowing in both kidneys, particularly those who also had heart failure, had better long-term outcomes if ","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101213"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-17DOI: 10.1016/j.xkme.2025.101187
Octavio Rene García Flores , Mayra Eugenia Avilés Ramírez , Jose Carlos Gasca Aldama , Marco Vidals Sánchez , María Virgilia Soto Abraham , Martha Arisbeth Villanueva Pérez , Magdalena Madero , Enzo Vásquez Jiménez
In patients with mechanical ventilation or critically ill patients there are various mechanisms for kidney function impairment, ranging from systemic disease to intrinsic kidney etiology. Kidney biopsy is the study of choice for the diagnosis, treatment decision and prognosis of kidney disease. Ten critically ill patients on mechanical ventilation underwent kidney biopsy using 2 kidney biopsy techniques: the standard technique (prone position) in 5 patients and the lateral position (left lateral decubitus position) in 5 patients. Most of our patients had a kidney histological diagnosis secondary to autoimmune disease that required induction treatment. Despite the risk factors for complications, only one patient received a transfusion of packed red blood cells. The prone group had the highest number of deaths due to the severity of the patient’s disease and unrelated to the procedure. Kidney biopsy in patients with mechanical ventilation is a high-risk procedure that should be performed on selected patients who can benefit from a histological diagnosis.
{"title":"Kidney Biopsy in Patients With Mechanical Ventilation: A Report of Ten Cases","authors":"Octavio Rene García Flores , Mayra Eugenia Avilés Ramírez , Jose Carlos Gasca Aldama , Marco Vidals Sánchez , María Virgilia Soto Abraham , Martha Arisbeth Villanueva Pérez , Magdalena Madero , Enzo Vásquez Jiménez","doi":"10.1016/j.xkme.2025.101187","DOIUrl":"10.1016/j.xkme.2025.101187","url":null,"abstract":"<div><div>In patients with mechanical ventilation or critically ill patients there are various mechanisms for kidney function impairment, ranging from systemic disease to intrinsic kidney etiology. Kidney biopsy is the study of choice for the diagnosis, treatment decision and prognosis of kidney disease. Ten critically ill patients on mechanical ventilation underwent kidney biopsy using 2 kidney biopsy techniques: the standard technique (prone position) in 5 patients and the lateral position (left lateral decubitus position) in 5 patients. Most of our patients had a kidney histological diagnosis secondary to autoimmune disease that required induction treatment. Despite the risk factors for complications, only one patient received a transfusion of packed red blood cells. The prone group had the highest number of deaths due to the severity of the patient’s disease and unrelated to the procedure. Kidney biopsy in patients with mechanical ventilation is a high-risk procedure that should be performed on selected patients who can benefit from a histological diagnosis.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101187"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>Rationale & Objective</h3><div>Growth failure is prevalent in pediatric dialysis patients. Physical growth is limited to a specific period, and missed interventions may cause lifelong growth retardation. We aimed to investigate the association of secondary hyperparathyroidism with short stature and height growth failure.</div></div><div><h3>Study Design</h3><div>Cohort study.</div></div><div><h3>Setting & Participants</h3><div>Patients aged 1-20 years who initiated dialysis and were registered in the nationwide dialysis registry of Japan between 2009 and 2020.</div></div><div><h3>Exposure</h3><div>Intact parathyroid hormone (PTH) levels.</div></div><div><h3>Outcomes</h3><div>Height standard deviation score (SDS), short stature (less than or equal to −2.0 SDS of height), height velocity SDS, and height growth failure (less than or equal to −1.5 SDS of height velocity).</div></div><div><h3>Analytical Approach</h3><div>We examined the association between intact PTH levels and the outcomes in both cross-sectional and longitudinal analyses.</div></div><div><h3>Results</h3><div>Intact PTH, height, and weight were measured in 622 patients. The median dialysis vintage was 10 months, the mean age was 13 years, 59% were boys, 50% were receiving peritoneal dialysis, and the median value of intact PTH was 183 pg/mL. At enrollment, the median height SDS was −1.9 (IQR, −3.3 to −0.6), and 302 patients (49%) had a short stature. The median SDS of height velocity during the first year was −2.4 (IQR, −5.6 to −1.5), and 205 patients (75%) had height growth failure (a decrease in height velocity). Elevated intact PTH levels per doubling were associated with a significant decrease in height velocity (β = −0.26; 95% CI, −0.49 to −0.02) and height growth failure (OR, 1.16; 95% CI, 1.00-1.34). Restricted cubic spline analysis showed a decrease in height velocity with increasing intact PTH levels.</div></div><div><h3>Limitations</h3><div>Lacked data on recombinant human growth hormone use and limited follow-up periods to evaluate the impact of PTH on long-term growth.</div></div><div><h3>Conclusions</h3><div>Our findings suggest the involvement of secondary hyperparathyroidism in height growth failure in pediatric dialysis patients.</div></div><div><h3>Plain-Language Summary</h3><div>Growth failure is a common problem in children and adolescents receiving dialysis. We investigated the association between parathyroid hormone (PTH) and height growth in children and adolescents receiving dialysis, using data from a Japanese national dialysis survey. Between 2009 and 2020, we enrolled 622 patients receiving dialysis aged 1-20 years and measured PTH, height, and weight. The mean age was 13 years and the median value of intact PTH was 183 pg/mL. At enrollment, 302 (49%) patients had a short stature, and 205 (75%) had height growth failure during the first year. Elevated PTH levels were associated with height growth impairment. This study suggests the importanc
{"title":"Growth Failure Associated With Parathyroid Hormone Levels in Pediatric Dialysis Patients: A Nationwide Cohort Study","authors":"Takahiro Imaizumi , Takuo Kubota , Hirotaka Komaba , Masanori Abe , Norio Hanafusa , Takayuki Hamano , Masafumi Fukagawa","doi":"10.1016/j.xkme.2025.101214","DOIUrl":"10.1016/j.xkme.2025.101214","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Growth failure is prevalent in pediatric dialysis patients. Physical growth is limited to a specific period, and missed interventions may cause lifelong growth retardation. We aimed to investigate the association of secondary hyperparathyroidism with short stature and height growth failure.</div></div><div><h3>Study Design</h3><div>Cohort study.</div></div><div><h3>Setting & Participants</h3><div>Patients aged 1-20 years who initiated dialysis and were registered in the nationwide dialysis registry of Japan between 2009 and 2020.</div></div><div><h3>Exposure</h3><div>Intact parathyroid hormone (PTH) levels.</div></div><div><h3>Outcomes</h3><div>Height standard deviation score (SDS), short stature (less than or equal to −2.0 SDS of height), height velocity SDS, and height growth failure (less than or equal to −1.5 SDS of height velocity).</div></div><div><h3>Analytical Approach</h3><div>We examined the association between intact PTH levels and the outcomes in both cross-sectional and longitudinal analyses.</div></div><div><h3>Results</h3><div>Intact PTH, height, and weight were measured in 622 patients. The median dialysis vintage was 10 months, the mean age was 13 years, 59% were boys, 50% were receiving peritoneal dialysis, and the median value of intact PTH was 183 pg/mL. At enrollment, the median height SDS was −1.9 (IQR, −3.3 to −0.6), and 302 patients (49%) had a short stature. The median SDS of height velocity during the first year was −2.4 (IQR, −5.6 to −1.5), and 205 patients (75%) had height growth failure (a decrease in height velocity). Elevated intact PTH levels per doubling were associated with a significant decrease in height velocity (β = −0.26; 95% CI, −0.49 to −0.02) and height growth failure (OR, 1.16; 95% CI, 1.00-1.34). Restricted cubic spline analysis showed a decrease in height velocity with increasing intact PTH levels.</div></div><div><h3>Limitations</h3><div>Lacked data on recombinant human growth hormone use and limited follow-up periods to evaluate the impact of PTH on long-term growth.</div></div><div><h3>Conclusions</h3><div>Our findings suggest the involvement of secondary hyperparathyroidism in height growth failure in pediatric dialysis patients.</div></div><div><h3>Plain-Language Summary</h3><div>Growth failure is a common problem in children and adolescents receiving dialysis. We investigated the association between parathyroid hormone (PTH) and height growth in children and adolescents receiving dialysis, using data from a Japanese national dialysis survey. Between 2009 and 2020, we enrolled 622 patients receiving dialysis aged 1-20 years and measured PTH, height, and weight. The mean age was 13 years and the median value of intact PTH was 183 pg/mL. At enrollment, 302 (49%) patients had a short stature, and 205 (75%) had height growth failure during the first year. Elevated PTH levels were associated with height growth impairment. This study suggests the importanc","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101214"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub 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":"2026-02-01","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}
<div><h3>Rationale & Objective</h3><div>Roxadustat effectively improves renal anemia, but its impact on residual kidney function (RKF) preservation in continuous ambulatory peritoneal dialysis (CAPD) patients is unclear. Our objective was to evaluate the impact of roxadustat on RKF decline in prevalent CAPD patients, with particular emphasis on identifying sex-specific differential outcomes.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>This study included 360 CAPD patients treated with either roxadustat (n=144) or erythropoiesis-stimulating agents (ESAs) (n=216) at our center between January 2021 and June 2024.</div></div><div><h3>Exposure</h3><div>CAPD patients diagnosed with renal anemia were treated with roxadustat or ESAs to achieve target hemoglobin levels.</div></div><div><h3>Outcomes</h3><div>The primary endpoint was the decline in RKF during the 18-month follow-up period, measured by the average of 24-hour urinary urea and creatinine clearances adjusted for the body surface area (mL/min/1.73 m<sup>2</sup>). Secondary endpoints included changes in hemoglobin levels and lipid profiles, as well as the incidence of peritonitis.</div></div><div><h3>Analytical Approach</h3><div>Propensity scores methods, including 1:1 propensity score matching with replacement and inverse probability of treatment weighting.</div></div><div><h3>Results</h3><div>Overall, neither propensity score matching nor inverse probability of treatment weighting models showed significant difference in RKF preservation between the roxadustat and ESA groups. However, in male patients, roxadustat was associated with a slower decline in RKF compared with ESAs (Δ–0.8 vs Δ–1.4 mL/min/1.73 m<sup>2</sup>; <em>P</em> = 0.04) at 18 months. Additionally, hemoglobin levels were comparable between groups. The roxadustat group exhibited lower triglycerides and low-density lipoprotein level than the ESA group. No significant difference in peritonitis incidence was observed between the 2 groups.</div></div><div><h3>Limitations</h3><div>The overall baseline RKF of our PD patients was exceptionally low.</div></div><div><h3>Conclusions</h3><div>Roxadustat delays RKF decline in male CAPD patients while providing comparable anemia control and favorable lipid profile effects as ESAs. These sex-specific outcomes suggest underlying biological mechanisms, highlighting the need for larger, targeted studies to further elucidate the potential benefits of roxadustat in this population.</div></div><div><h3>Plain-Language Summary</h3><div>Roxadustat demonstrates comparable efficacy to erythropoiesis-stimulating agents in managing anemia in chronic kidney disease (CKD). Although renal anemia in peritoneal dialysis patients is associated with accelerated residual kidney function decline, its potential renoprotective effects remain unclear. In this single-center retrospective cohort study, we found that roxadustat delays res
目的呋沙司他可有效改善肾性贫血，但其对持续动态腹膜透析（CAPD）患者残余肾功能（RKF）保存的影响尚不清楚。我们的目的是评估罗沙司他对常见CAPD患者RKF下降的影响，特别强调识别性别特异性差异结果。研究设计回顾性队列研究。本研究纳入了2021年1月至2024年6月期间在本中心接受罗沙司他（n=144）或促红细胞生成剂（esa） （n=216）治疗的360例CAPD患者。诊断为肾性贫血的慢性阻塞性肺疾病患者接受罗沙司他或esa治疗以达到目标血红蛋白水平。主要终点是在18个月的随访期间RKF的下降，通过根据体表面积（mL/min/1.73 m2）调整24小时尿尿素和肌酐清除率的平均值来测量。次要终点包括血红蛋白水平和脂质谱的变化，以及腹膜炎的发生率。分析方法倾向评分方法，包括1:1的倾向评分匹配替代和逆概率处理加权。结果总体而言，倾向评分匹配和治疗加权模型的逆概率均未显示罗沙他特组和欧空局组在RKF保存方面存在显著差异。然而，在男性患者中，与esa相比，罗沙司他与18个月时RKF下降较慢相关（Δ-0.8 vs Δ-1.4 mL/min/1.73 m2; P = 0.04）。此外，两组之间的血红蛋白水平具有可比性。罗沙司他组甘油三酯和低密度脂蛋白水平低于ESA组。两组患者腹膜炎发生率无显著差异。局限性：PD患者的总体基线RKF异常低。结论罗沙司他延缓了男性CAPD患者RKF的下降，同时提供了与esa相当的贫血控制和有利的脂质分析效果。这些性别特异性的结果提示潜在的生物学机制，强调需要更大的、有针对性的研究来进一步阐明罗沙他在这一人群中的潜在益处。罗沙他在治疗慢性肾病（CKD）患者贫血方面的疗效与促红细胞生成剂相当。尽管腹膜透析患者肾性贫血与残留肾功能加速下降有关，但其潜在的肾保护作用尚不清楚。在这项单中心回顾性队列研究中，我们发现罗沙司他可以延缓男性连续门诊腹膜透析患者的残余肾功能下降，而不影响贫血的改善，并显示出良好的脂质调节作用。这些发现为优化腹膜透析患者的个体化治疗策略提供了见解。
{"title":"Sex-Specific Impact of Roxadustat on Residual Kidney Function in Peritoneal Dialysis Patients: A Propensity Score-Weighted Analysis","authors":"Simin Jiang , Guanji Zhang , Yiping Xu, Yi Li, Guanglan Li, Hongyu Li, Yuchu Liu, Siyuan Li, Jianxiong Lin, Qunying Guo, Xiao Yang, Wei Chen, Haiping Mao, Yating Wang","doi":"10.1016/j.xkme.2025.101208","DOIUrl":"10.1016/j.xkme.2025.101208","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Roxadustat effectively improves renal anemia, but its impact on residual kidney function (RKF) preservation in continuous ambulatory peritoneal dialysis (CAPD) patients is unclear. Our objective was to evaluate the impact of roxadustat on RKF decline in prevalent CAPD patients, with particular emphasis on identifying sex-specific differential outcomes.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>This study included 360 CAPD patients treated with either roxadustat (n=144) or erythropoiesis-stimulating agents (ESAs) (n=216) at our center between January 2021 and June 2024.</div></div><div><h3>Exposure</h3><div>CAPD patients diagnosed with renal anemia were treated with roxadustat or ESAs to achieve target hemoglobin levels.</div></div><div><h3>Outcomes</h3><div>The primary endpoint was the decline in RKF during the 18-month follow-up period, measured by the average of 24-hour urinary urea and creatinine clearances adjusted for the body surface area (mL/min/1.73 m<sup>2</sup>). Secondary endpoints included changes in hemoglobin levels and lipid profiles, as well as the incidence of peritonitis.</div></div><div><h3>Analytical Approach</h3><div>Propensity scores methods, including 1:1 propensity score matching with replacement and inverse probability of treatment weighting.</div></div><div><h3>Results</h3><div>Overall, neither propensity score matching nor inverse probability of treatment weighting models showed significant difference in RKF preservation between the roxadustat and ESA groups. However, in male patients, roxadustat was associated with a slower decline in RKF compared with ESAs (Δ–0.8 vs Δ–1.4 mL/min/1.73 m<sup>2</sup>; <em>P</em> = 0.04) at 18 months. Additionally, hemoglobin levels were comparable between groups. The roxadustat group exhibited lower triglycerides and low-density lipoprotein level than the ESA group. No significant difference in peritonitis incidence was observed between the 2 groups.</div></div><div><h3>Limitations</h3><div>The overall baseline RKF of our PD patients was exceptionally low.</div></div><div><h3>Conclusions</h3><div>Roxadustat delays RKF decline in male CAPD patients while providing comparable anemia control and favorable lipid profile effects as ESAs. These sex-specific outcomes suggest underlying biological mechanisms, highlighting the need for larger, targeted studies to further elucidate the potential benefits of roxadustat in this population.</div></div><div><h3>Plain-Language Summary</h3><div>Roxadustat demonstrates comparable efficacy to erythropoiesis-stimulating agents in managing anemia in chronic kidney disease (CKD). Although renal anemia in peritoneal dialysis patients is associated with accelerated residual kidney function decline, its potential renoprotective effects remain unclear. In this single-center retrospective cohort study, we found that roxadustat delays res","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101208"},"PeriodicalIF":3.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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