Pub Date : 2025-10-10DOI: 10.1016/j.xkme.2025.101141
Varsha Swamy , Kaitlin Kelly , Jay L. Koyner , Benjamin A. Derman , Marco Bonilla
Chimeric antigen receptor (CAR) T-cell therapy has emerged as a transformative treatment for multiple hematologic malignancies, including multiple myeloma. However, patients with advanced chronic kidney disease, particularly those who are dialysis-dependent, have generally been excluded from clinical trials, leaving a significant gap in evidence regarding the safety and feasibility of CAR T-cell therapy in these patients. Concerns in this patient population include potential toxicity from lymphodepleting chemotherapy regimens and increased susceptibility to immune-related adverse events such as cytokine release syndrome and neurotoxicity. While limited case reports suggest feasibility in patients with lymphoma and kidney impairment, data on CAR T-cell use in dialysis-dependent patients with multiple myeloma remain scarce. We present a case series of 5 dialysis-dependent patients with relapsed/refractory multiple myeloma who were successfully treated with ciltacabtagene autoleucel. This series highlights the potential for safe and effective administration of CAR T-cell therapy in dialysis-dependent patients, supporting the need for broader inclusion of this population in future studies.
{"title":"Chimeric Antigen Receptor T-Cell Therapy in Dialysis-Dependent Patients With Multiple Myeloma: Insights From a 5-Case Series","authors":"Varsha Swamy , Kaitlin Kelly , Jay L. Koyner , Benjamin A. Derman , Marco Bonilla","doi":"10.1016/j.xkme.2025.101141","DOIUrl":"10.1016/j.xkme.2025.101141","url":null,"abstract":"<div><div>Chimeric antigen receptor (CAR) T-cell therapy has emerged as a transformative treatment for multiple hematologic malignancies, including multiple myeloma. However, patients with advanced chronic kidney disease, particularly those who are dialysis-dependent, have generally been excluded from clinical trials, leaving a significant gap in evidence regarding the safety and feasibility of CAR T-cell therapy in these patients. Concerns in this patient population include potential toxicity from lymphodepleting chemotherapy regimens and increased susceptibility to immune-related adverse events such as cytokine release syndrome and neurotoxicity. While limited case reports suggest feasibility in patients with lymphoma and kidney impairment, data on CAR T-cell use in dialysis-dependent patients with multiple myeloma remain scarce. We present a case series of 5 dialysis-dependent patients with relapsed/refractory multiple myeloma who were successfully treated with ciltacabtagene autoleucel. This series highlights the potential for safe and effective administration of CAR T-cell therapy in dialysis-dependent patients, supporting the need for broader inclusion of this population in future studies.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 12","pages":"Article 101141"},"PeriodicalIF":3.4,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576874","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 : 2025-10-10DOI: 10.1016/j.xkme.2025.101135
Danielle Rosenzweig , Ravi K. Mallavarapu
We reported the unusual presentation of a 62-year-old kidney transplant recipient with acute unilateral eye swelling and fever suggestive of severe orbital cellulitis with features of a space-occupying inflammatory lesion of the orbit. The clinical course deteriorated despite the therapy with broad-spectrum antibiotics alone. The computed tomography scan findings were significant for moderate thickening of the right superior rectus muscle and asymmetric enlargement of the superior ophthalmic vein. These features brought an orbital pseudotumor, or nonspecific orbital inflammation, to the differential diagnoses. With multidisciplinary team management including internal medicine, infectious disease, ophthalmology, and transplant nephrology, the patient’s condition improved with immunosuppressive therapy adjustment, intravenous glucocorticoids followed by a steroid taper, and aggressive antimicrobial therapy. Immunocompromised patients can have atypical and severe presentations of infection with rapid progression. Prompt diagnostic workup and urgent computed tomography scan or magnetic resonance imaging scan of the orbits to assess the extent of inflammation, including abscess formation or intracranial extension, are crucial. Judicious antimicrobial coverage, as well as careful immunosuppression adjustment to ensure the best outcome, is often required.
{"title":"Unusual Presentation of Orbital Cellulitis as an Inflammatory Pseudotumor in a Kidney Transplant Recipient","authors":"Danielle Rosenzweig , Ravi K. Mallavarapu","doi":"10.1016/j.xkme.2025.101135","DOIUrl":"10.1016/j.xkme.2025.101135","url":null,"abstract":"<div><div>We reported the unusual presentation of a 62-year-old kidney transplant recipient with acute unilateral eye swelling and fever suggestive of severe orbital cellulitis with features of a space-occupying inflammatory lesion of the orbit. The clinical course deteriorated despite the therapy with broad-spectrum antibiotics alone. The computed tomography scan findings were significant for moderate thickening of the right superior rectus muscle and asymmetric enlargement of the superior ophthalmic vein. These features brought an orbital pseudotumor, or nonspecific orbital inflammation, to the differential diagnoses. With multidisciplinary team management including internal medicine, infectious disease, ophthalmology, and transplant nephrology, the patient’s condition improved with immunosuppressive therapy adjustment, intravenous glucocorticoids followed by a steroid taper, and aggressive antimicrobial therapy. Immunocompromised patients can have atypical and severe presentations of infection with rapid progression. Prompt diagnostic workup and urgent computed tomography scan or magnetic resonance imaging scan of the orbits to assess the extent of inflammation, including abscess formation or intracranial extension, are crucial. Judicious antimicrobial coverage, as well as careful immunosuppression adjustment to ensure the best outcome, is often required.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 12","pages":"Article 101135"},"PeriodicalIF":3.4,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576903","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 : 2025-10-10DOI: 10.1016/j.xkme.2025.101134
Jarrin D. Penny , Dariuz Gozdzik , Tanya Tamasi , Justin Dorie , Kathy Koyle , Zabrina Bailey Lozon , Rosemary Cesario , Gihad Nesrallah , Christopher W. McIntyre
<div><h3>Rationale & Objectives</h3><div>Current hemodialysis (HD), using conventional high-flux dialyzers, is handicapped by clearance limitations, contributing to poor health-related quality of life (HRQoL) and symptom burden. Recent international consensus guideline-setting efforts have prioritized the identification and management of symptoms and subjective experience, while acknowledging the lack of appropriate tools available to fully appreciate and continuously monitor symptoms.</div></div><div><h3>Study Design</h3><div>Multicenter interventional trial.</div></div><div><h3>Setting & Participants</h3><div>Forty-seven patients undergoing established, conventional, thrice weekly HD in 2 centers in Ontario, Canada.</div></div><div><h3>Interventions</h3><div>Fifteen-month study with the following 5 phases: (1) 1 month observation (high-flux HD), (2) 3 months expanded hemodialysis (HDx); (3) 2 months wash-out (high-flux HD), (4) 6 months HDx, (5) 3 months wash-out (high-flux HD). HRQoL and symptom burden were evaluated using a dynamic patient-reported outcome measurement (PROM) tool throughout the study.</div></div><div><h3>Outcomes</h3><div>This study aimed to use a dynamic PROM to interrogate patient experience and confirm HRQoL and symptom benefit of expanded hemodialysis (HDx) using a medium cutoff dialyzer. The durability of the effects of treatment and variability of symptom measures were analyzed, with the aim to further establish causality through withdrawal and reintroduction of therapy.</div></div><div><h3>Results</h3><div>HDx therapy improved HRQoL (19% from baseline) and a variety of symptoms including general wellbeing (23%), energy (33%), sleep quality (33%), pruritus (30%), pain (19%), restless leg syndrome (15%), mood (12%), appetite (9%), breathlessness (9%), and HD recovery (26%). Response was more pronounced in those with poorer HRQoL and higher symptom burden. Improvements were durable over time with less symptom variability. Improvement diminished with return to high-flux HD. Drivers of poor HRQoL were largely general wellbeing, energy, sleep quality, pruritus, and bodily pain.</div></div><div><h3>Limitations</h3><div>Relatively small cohort (because of pandemic restrictions) and unblinded design (partially overcome with wash-out and reintroduction).</div></div><div><h3>Conclusions</h3><div>Use of a dynamic PROM effectively evaluated HRQoL, symptom burden, and response to treatment in HD patients. Use of HDx therapy improved clinically meaningful outcomes with durable effect and was associated with less variability in important symptom domains than conventional high-flux HD.</div></div><div><h3>Plain Language Summary</h3><div>People undergoing hemodialysis (HD) often experience poor quality of life and extreme symptoms. This study examined whether expanded hemodialysis (HDx)—a newer therapy using a specialized filter—could improve symptoms and wellbeing. Over 15 months, 47 patients in Ontario, Canada, switched betwee
{"title":"Impact of Expanded Hemodialysis on Subjective Experience Using Dynamic Patient-Reported Outcome Measurement Tool","authors":"Jarrin D. Penny , Dariuz Gozdzik , Tanya Tamasi , Justin Dorie , Kathy Koyle , Zabrina Bailey Lozon , Rosemary Cesario , Gihad Nesrallah , Christopher W. McIntyre","doi":"10.1016/j.xkme.2025.101134","DOIUrl":"10.1016/j.xkme.2025.101134","url":null,"abstract":"<div><h3>Rationale & Objectives</h3><div>Current hemodialysis (HD), using conventional high-flux dialyzers, is handicapped by clearance limitations, contributing to poor health-related quality of life (HRQoL) and symptom burden. Recent international consensus guideline-setting efforts have prioritized the identification and management of symptoms and subjective experience, while acknowledging the lack of appropriate tools available to fully appreciate and continuously monitor symptoms.</div></div><div><h3>Study Design</h3><div>Multicenter interventional trial.</div></div><div><h3>Setting & Participants</h3><div>Forty-seven patients undergoing established, conventional, thrice weekly HD in 2 centers in Ontario, Canada.</div></div><div><h3>Interventions</h3><div>Fifteen-month study with the following 5 phases: (1) 1 month observation (high-flux HD), (2) 3 months expanded hemodialysis (HDx); (3) 2 months wash-out (high-flux HD), (4) 6 months HDx, (5) 3 months wash-out (high-flux HD). HRQoL and symptom burden were evaluated using a dynamic patient-reported outcome measurement (PROM) tool throughout the study.</div></div><div><h3>Outcomes</h3><div>This study aimed to use a dynamic PROM to interrogate patient experience and confirm HRQoL and symptom benefit of expanded hemodialysis (HDx) using a medium cutoff dialyzer. The durability of the effects of treatment and variability of symptom measures were analyzed, with the aim to further establish causality through withdrawal and reintroduction of therapy.</div></div><div><h3>Results</h3><div>HDx therapy improved HRQoL (19% from baseline) and a variety of symptoms including general wellbeing (23%), energy (33%), sleep quality (33%), pruritus (30%), pain (19%), restless leg syndrome (15%), mood (12%), appetite (9%), breathlessness (9%), and HD recovery (26%). Response was more pronounced in those with poorer HRQoL and higher symptom burden. Improvements were durable over time with less symptom variability. Improvement diminished with return to high-flux HD. Drivers of poor HRQoL were largely general wellbeing, energy, sleep quality, pruritus, and bodily pain.</div></div><div><h3>Limitations</h3><div>Relatively small cohort (because of pandemic restrictions) and unblinded design (partially overcome with wash-out and reintroduction).</div></div><div><h3>Conclusions</h3><div>Use of a dynamic PROM effectively evaluated HRQoL, symptom burden, and response to treatment in HD patients. Use of HDx therapy improved clinically meaningful outcomes with durable effect and was associated with less variability in important symptom domains than conventional high-flux HD.</div></div><div><h3>Plain Language Summary</h3><div>People undergoing hemodialysis (HD) often experience poor quality of life and extreme symptoms. This study examined whether expanded hemodialysis (HDx)—a newer therapy using a specialized filter—could improve symptoms and wellbeing. Over 15 months, 47 patients in Ontario, Canada, switched betwee","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 12","pages":"Article 101134"},"PeriodicalIF":3.4,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576871","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 : 2025-10-10DOI: 10.1016/j.xkme.2025.101140
Thomas Fairhead, Sophie Seager, Jennifer Whitehead, Sean Fenwick
Mesonephric-like adenocarcinoma (MLA) of the ovary is an exceptionally rare malignancy, and antiglomerular basement membrane (anti-GBM) disease has not previously been described in this setting. We report a 63-year-old woman with FIGO (Fédération Internationale de Gynécologie et d’Obstétrique) stage IIIA1(i) ovarian MLA who underwent complete cytoreduction followed by 6 cycles of carboplatin-paclitaxel. Four months after chemotherapy, she developed fatigue, hematuria, and rapidly progressive kidney failure; serology revealed high-titer anti-GBM antibodies. Despite urgent plasma exchange, high-dose corticosteroids, cyclophosphamide, rituximab, and maintenance hemodialysis, renal recovery was minimal. The close temporal sequence raises, but does not establish, a possible link between MLA, its cytotoxic treatment, and the emergence of anti-GBM autoimmunity, perhaps through chemotherapy-mediated alteration or exposure of glomerular antigens. Although causality remains speculative and additional cases are required for confirmation, our observation suggests that autoimmune vasculitides should remain within the differential diagnosis of otherwise unexplained fulminant kidney injury in patients with rare gynecological malignancies.
卵巢中肾样腺癌（MLA）是一种非常罕见的恶性肿瘤，抗肾小球基底膜（anti-GBM）疾病在此背景下尚未被报道。我们报告了一名63岁的女性，患有FIGO (fsamdsamacration Internationale de gyynacimcolgie et d’obstsamtrique) IIIA1(i)期卵巢MLA，她接受了完全的细胞减少，随后接受了6个周期的卡铂-紫杉醇治疗。化疗后4个月，患者出现疲劳、血尿和快速进行性肾衰竭；血清学显示高滴度抗gbm抗体。尽管紧急血浆置换、大剂量皮质类固醇、环磷酰胺、利妥昔单抗和维持性血液透析，肾脏恢复甚微。密切的时间序列提出，但没有建立MLA，其细胞毒性治疗和抗gbm自身免疫出现之间的可能联系，可能通过化疗介导的改变或肾小球抗原暴露。尽管因果关系仍然是推测性的，需要更多的病例来证实，我们的观察表明，自身免疫性血管增生应该仍然是罕见妇科恶性肿瘤患者其他原因不明的暴发性肾损伤的鉴别诊断。
{"title":"Anti-GBM Disease Following Ovarian Mesonephric-Like Adenocarcinoma: A Unique Insight Into Paraneoplastic Autoimmunity","authors":"Thomas Fairhead, Sophie Seager, Jennifer Whitehead, Sean Fenwick","doi":"10.1016/j.xkme.2025.101140","DOIUrl":"10.1016/j.xkme.2025.101140","url":null,"abstract":"<div><div>Mesonephric-like adenocarcinoma (MLA) of the ovary is an exceptionally rare malignancy, and antiglomerular basement membrane (anti-GBM) disease has not previously been described in this setting. We report a 63-year-old woman with FIGO (Fédération Internationale de Gynécologie et d’Obstétrique) stage IIIA1(i) ovarian MLA who underwent complete cytoreduction followed by 6 cycles of carboplatin-paclitaxel. Four months after chemotherapy, she developed fatigue, hematuria, and rapidly progressive kidney failure; serology revealed high-titer anti-GBM antibodies. Despite urgent plasma exchange, high-dose corticosteroids, cyclophosphamide, rituximab, and maintenance hemodialysis, renal recovery was minimal. The close temporal sequence raises, but does not establish, a possible link between MLA, its cytotoxic treatment, and the emergence of anti-GBM autoimmunity, perhaps through chemotherapy-mediated alteration or exposure of glomerular antigens. Although causality remains speculative and additional cases are required for confirmation, our observation suggests that autoimmune vasculitides should remain within the differential diagnosis of otherwise unexplained fulminant kidney injury in patients with rare gynecological malignancies.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 12","pages":"Article 101140"},"PeriodicalIF":3.4,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576873","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}
Patients undergoing hemodialysis frequently experience significant emotional distress, including anxiety and depressive symptoms. Music therapy has emerged as a promising nonpharmacological intervention to alleviate these psychological burdens. This study explored the effects of 2 distinct music listening protocols—Therapeutic Music Listening and algorithmic music listening—on anxiety, stress, and physiological parameters in a female patient with end-stage kidney disease in comorbid condition with a major depression and anxiety symptoms. Over a two-week period, the patient participated in 6 Therapeutic Music Listening sessions (3 per week), each lasting 20 minutes during the initiation phase of hemodialysis. Following a washout period, algorithmic music listening was introduced. Anxiety and stress were assessed pre- and postsession using the State-Trait Anxiety Inventory (Y1) and Distress Thermometer, while physiological parameters (blood pressure, heart rate, respiratory rate) were recorded simultaneously. The results indicated a reduction in anxiety after each session, with a more pronounced effect observed during algorithmic music listening. No significant changes were noted in physiological parameters. The patient reported a high level of subjective enjoyment of the experience, suggesting potential psychological benefits. These findings highlight the need for randomized controlled trials incorporating objective biomarkers to validate the therapeutic role of music listening in hemodialysis patients.
{"title":"Conventional and Algorithmic Music Listening During Hemodialysis: A Case Report","authors":"Alfredo Raglio , Giuseppe Sileno , Federica Boschetti , Federica Liuzzo , Marta Arazzi , Filippo Sangregorio , Ciro Esposito , Alessia Cardella , Paola Gabanelli , Paola Baiardi , Marina Rita Manera","doi":"10.1016/j.xkme.2025.101142","DOIUrl":"10.1016/j.xkme.2025.101142","url":null,"abstract":"<div><div>Patients undergoing hemodialysis frequently experience significant emotional distress, including anxiety and depressive symptoms. Music therapy has emerged as a promising nonpharmacological intervention to alleviate these psychological burdens. This study explored the effects of 2 distinct music listening protocols—Therapeutic Music Listening and algorithmic music listening—on anxiety, stress, and physiological parameters in a female patient with end-stage kidney disease in comorbid condition with a major depression and anxiety symptoms. Over a two-week period, the patient participated in 6 Therapeutic Music Listening sessions (3 per week), each lasting 20 minutes during the initiation phase of hemodialysis. Following a washout period, algorithmic music listening was introduced. Anxiety and stress were assessed pre- and postsession using the State-Trait Anxiety Inventory (Y1) and Distress Thermometer, while physiological parameters (blood pressure, heart rate, respiratory rate) were recorded simultaneously. The results indicated a reduction in anxiety after each session, with a more pronounced effect observed during algorithmic music listening. No significant changes were noted in physiological parameters. The patient reported a high level of subjective enjoyment of the experience, suggesting potential psychological benefits. These findings highlight the need for randomized controlled trials incorporating objective biomarkers to validate the therapeutic role of music listening in hemodialysis patients.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 12","pages":"Article 101142"},"PeriodicalIF":3.4,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576867","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 : 2025-10-01DOI: 10.1016/j.xkme.2025.101131
Akira Takahashi , Daisuke Kiyozawa , Takamasa Miyauchi , James Mirocha , Yi Mi Kevin Ren , Toshiki Doi , Hae Yoon Grace Choung , Mercury Y. Lin , Jean Hou , Takao Masaki , Yoshinao Oda , Mark Haas , Cynthia C. Nast , Michifumi Yamashita
<div><h3>Rationale & Objective</h3><div>Kidney biopsy is vital to diagnose and manage medical kidney diseases. However, not many large-scale studies for medical kidney disease have been reported worldwide. We describe 30-year temporal and demographic trends in biopsy-proven glomerular and nonglomerular diseases in the Southwestern United States.</div></div><div><h3>Study Design</h3><div>Retrospective single-center cohort study.</div></div><div><h3>Setting & Participants</h3><div>Native kidney biopsy cases referred to the Renal Pathology Service at Cedars-Sinai Medical Center between 1993 and 2022.</div></div><div><h3>Predictors</h3><div>Biopsy era (1993-2002, 2003-2012, and 2013-2022) and demographics (age, sex, and race) were primary and secondary predictors.</div></div><div><h3>Outcomes</h3><div>Relative frequencies (percentages) of 35 widely recognized glomerular/ nonglomerular disease categories are primary outcome.</div></div><div><h3>Analytical Approach</h3><div>Non-numerical and numerical variables were compared using χ<sup>2</sup> test and analysis of variance, followed by Tukey–Kramer post hoc tests.</div></div><div><h3>Results</h3><div>In total, 57,613 patients were identified, with a mean age 51.0 (± 19.2) years, 52.2% men, 53.8% White, 19.5% Latino, 11.0% Black, 10.2% Asian, and 5.5% other race. Glomerular disease relative frequency was always higher than nonglomerular disease frequency. Among the glomerular diseases, the relative frequency of diabetic glomerulosclerosis in our cohort was constantly and rapidly increasing, whereas those of other glomerular disease categories were decreasing except for antineutrophil cytoplasmic antibody/pauci-immune glomerulonephritis. However, the decline in the relative frequency of glomerular diseases was much less apparent when diabetic glomerulosclerosis was removed. Among the nonglomerular diseases, acute tubular necrosis was increasing in frequency. These temporal trends were largely preserved in all demographic subgroups, although there were several cross-sectional differences of glomerular disease frequencies within each demographic subgroup.</div></div><div><h3>Limitation</h3><div>Retrospective and observational study design, no patient/kidney outcomes, some missing patients’ data, and possible misclassification of disease categorization.</div></div><div><h3>Conclusions</h3><div>To our best knowledge, we provided the largest and latest medical kidney biopsy data, which may provide valuable insights to predict the relative likelihood of a disease diagnosis in a daily medical practice.</div></div><div><h3>Plain-Language Summary</h3><div>This is a large-scale medical kidney biopsy study describing 30-year temporal and demographic trends in glomerular and nonglomerular diseases in the Southwestern United States. Glomerulus is a crucial component to filter blood to generate urine. Glomerular disease consistently dominated nonglomerular disease in frequency. Among the glomerular diseases,
{"title":"Temporal and Demographic Trends in Biopsy-Proven Kidney Disease Diagnoses in the Southwestern United States, 1993-2022","authors":"Akira Takahashi , Daisuke Kiyozawa , Takamasa Miyauchi , James Mirocha , Yi Mi Kevin Ren , Toshiki Doi , Hae Yoon Grace Choung , Mercury Y. Lin , Jean Hou , Takao Masaki , Yoshinao Oda , Mark Haas , Cynthia C. Nast , Michifumi Yamashita","doi":"10.1016/j.xkme.2025.101131","DOIUrl":"10.1016/j.xkme.2025.101131","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Kidney biopsy is vital to diagnose and manage medical kidney diseases. However, not many large-scale studies for medical kidney disease have been reported worldwide. We describe 30-year temporal and demographic trends in biopsy-proven glomerular and nonglomerular diseases in the Southwestern United States.</div></div><div><h3>Study Design</h3><div>Retrospective single-center cohort study.</div></div><div><h3>Setting & Participants</h3><div>Native kidney biopsy cases referred to the Renal Pathology Service at Cedars-Sinai Medical Center between 1993 and 2022.</div></div><div><h3>Predictors</h3><div>Biopsy era (1993-2002, 2003-2012, and 2013-2022) and demographics (age, sex, and race) were primary and secondary predictors.</div></div><div><h3>Outcomes</h3><div>Relative frequencies (percentages) of 35 widely recognized glomerular/ nonglomerular disease categories are primary outcome.</div></div><div><h3>Analytical Approach</h3><div>Non-numerical and numerical variables were compared using χ<sup>2</sup> test and analysis of variance, followed by Tukey–Kramer post hoc tests.</div></div><div><h3>Results</h3><div>In total, 57,613 patients were identified, with a mean age 51.0 (± 19.2) years, 52.2% men, 53.8% White, 19.5% Latino, 11.0% Black, 10.2% Asian, and 5.5% other race. Glomerular disease relative frequency was always higher than nonglomerular disease frequency. Among the glomerular diseases, the relative frequency of diabetic glomerulosclerosis in our cohort was constantly and rapidly increasing, whereas those of other glomerular disease categories were decreasing except for antineutrophil cytoplasmic antibody/pauci-immune glomerulonephritis. However, the decline in the relative frequency of glomerular diseases was much less apparent when diabetic glomerulosclerosis was removed. Among the nonglomerular diseases, acute tubular necrosis was increasing in frequency. These temporal trends were largely preserved in all demographic subgroups, although there were several cross-sectional differences of glomerular disease frequencies within each demographic subgroup.</div></div><div><h3>Limitation</h3><div>Retrospective and observational study design, no patient/kidney outcomes, some missing patients’ data, and possible misclassification of disease categorization.</div></div><div><h3>Conclusions</h3><div>To our best knowledge, we provided the largest and latest medical kidney biopsy data, which may provide valuable insights to predict the relative likelihood of a disease diagnosis in a daily medical practice.</div></div><div><h3>Plain-Language Summary</h3><div>This is a large-scale medical kidney biopsy study describing 30-year temporal and demographic trends in glomerular and nonglomerular diseases in the Southwestern United States. Glomerulus is a crucial component to filter blood to generate urine. Glomerular disease consistently dominated nonglomerular disease in frequency. Among the glomerular diseases, ","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 12","pages":"Article 101131"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526929","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 : 2025-09-30DOI: 10.1016/j.xkme.2025.101130
Cramer J. Kallem , Megan E. Hamm , Flor Cameron , Kerri L. Cavanaugh , Nwamaka D. Eneanya , Hailey W. Bulls , Caroline Wilkie , Karlyn A. Edwards , Donna M. Olejniczak , Jane M. Liebschutz , Manisha Jhamb
<div><h3>Rationale & Objective</h3><div>Treating pain with analgesic medications in patients with kidney failure receiving dialysis is often complicated owing to altered pharmacokinetics, affecting efficacy and safety of medications. Buprenorphine, a partial opioid agonist without these limitations, has potential value in pain treatment in kidney failure. The aim of this qualitative study was to identify barriers and facilitators to overcoming stigma for implementation of buprenorphine as a pain treatment in patients treated with dialysis.</div></div><div><h3>Study Design</h3><div>Thematic analysis of interview data.</div></div><div><h3>Setting & Participants</h3><div>We used snowball sampling to enroll physicians with expertise in pain management and kidney failure, and other key partners.</div></div><div><h3>Exposures</h3><div>Participants completed semistructured interviews. Topics covered included facilitators and barriers to pain management and buprenorphine prescription for patients with kidney failure.</div></div><div><h3>Outcomes</h3><div>Qualitative themes.</div></div><div><h3>Analytical Approach</h3><div>Interviews were transcribed and coded using the MAXQDA software (VERBI Software). We performed a thematic analysis to determine the most salient themes.</div></div><div><h3>Results</h3><div>Of the 26 participants, 17 were physicians with expertise in nephrology, addiction psychiatry, palliative care, internal medicine, and physical medicine and rehabilitation. The other 9 participants included representatives from payors, retail pharmacy, and dialysis organizations. We identified the following 5 themes: (1) lack of knowledge about buprenorphine, (2) pervasiveness of pain- and buprenorphine-related stigma, (3) perception of pain management as beyond nephrologists’ scope of practice, (4) sociostructural barriers to pain management, and (5) suggestions to overcome the barriers.</div></div><div><h3>Limitations</h3><div>Our sample had limited racial and ethnic diversity and may not represent the perspectives of key partners working within different health systems or geographic locations.</div></div><div><h3>Conclusions</h3><div>Significant barriers to effective pain management and access to buprenorphine exist for patients with kidney failure at multiple levels (ie, patient, provider, organization, and systems levels). Therefore, multilevel interventions that include components that target patient stigma, clinician education, and increase collaboration among key partners are needed.</div></div><div><h3>Plain-Language Summary</h3><div>Buprenorphine has potential value and safety in pain treatment in kidney failure. The aim of this qualitative study was to identify barriers and facilitators to overcoming stigma for implementation of buprenorphine as a pain treatment in patients treated with dialysis. We interviewed 26 participants with expertise in pain management and kidney failure, which revealed the following themes: (1) lack of kno
{"title":"Identifying Barriers and Facilitators to Pain Management With Buprenorphine for Patients With Kidney Failure: A Thematic Analysis of Interviews With Key Partners","authors":"Cramer J. Kallem , Megan E. Hamm , Flor Cameron , Kerri L. Cavanaugh , Nwamaka D. Eneanya , Hailey W. Bulls , Caroline Wilkie , Karlyn A. Edwards , Donna M. Olejniczak , Jane M. Liebschutz , Manisha Jhamb","doi":"10.1016/j.xkme.2025.101130","DOIUrl":"10.1016/j.xkme.2025.101130","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Treating pain with analgesic medications in patients with kidney failure receiving dialysis is often complicated owing to altered pharmacokinetics, affecting efficacy and safety of medications. Buprenorphine, a partial opioid agonist without these limitations, has potential value in pain treatment in kidney failure. The aim of this qualitative study was to identify barriers and facilitators to overcoming stigma for implementation of buprenorphine as a pain treatment in patients treated with dialysis.</div></div><div><h3>Study Design</h3><div>Thematic analysis of interview data.</div></div><div><h3>Setting & Participants</h3><div>We used snowball sampling to enroll physicians with expertise in pain management and kidney failure, and other key partners.</div></div><div><h3>Exposures</h3><div>Participants completed semistructured interviews. Topics covered included facilitators and barriers to pain management and buprenorphine prescription for patients with kidney failure.</div></div><div><h3>Outcomes</h3><div>Qualitative themes.</div></div><div><h3>Analytical Approach</h3><div>Interviews were transcribed and coded using the MAXQDA software (VERBI Software). We performed a thematic analysis to determine the most salient themes.</div></div><div><h3>Results</h3><div>Of the 26 participants, 17 were physicians with expertise in nephrology, addiction psychiatry, palliative care, internal medicine, and physical medicine and rehabilitation. The other 9 participants included representatives from payors, retail pharmacy, and dialysis organizations. We identified the following 5 themes: (1) lack of knowledge about buprenorphine, (2) pervasiveness of pain- and buprenorphine-related stigma, (3) perception of pain management as beyond nephrologists’ scope of practice, (4) sociostructural barriers to pain management, and (5) suggestions to overcome the barriers.</div></div><div><h3>Limitations</h3><div>Our sample had limited racial and ethnic diversity and may not represent the perspectives of key partners working within different health systems or geographic locations.</div></div><div><h3>Conclusions</h3><div>Significant barriers to effective pain management and access to buprenorphine exist for patients with kidney failure at multiple levels (ie, patient, provider, organization, and systems levels). Therefore, multilevel interventions that include components that target patient stigma, clinician education, and increase collaboration among key partners are needed.</div></div><div><h3>Plain-Language Summary</h3><div>Buprenorphine has potential value and safety in pain treatment in kidney failure. The aim of this qualitative study was to identify barriers and facilitators to overcoming stigma for implementation of buprenorphine as a pain treatment in patients treated with dialysis. We interviewed 26 participants with expertise in pain management and kidney failure, which revealed the following themes: (1) lack of kno","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 12","pages":"Article 101130"},"PeriodicalIF":3.4,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526602","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号