Pub Date : 2025-11-01DOI: 10.1016/j.xkme.2025.101167
Yiting Li , Gayathri Menon , Jane J. Long , Malika Wilson , Byoungjun Kim , Mario P. DeMarco , Babak J. Orandi , Sunjae Bae , Wenbo Wu , Yijing Feng , Terry Gordon , George D. Thurston , Dorry L. Segev , Mara A. McAdams-DeMarco
<div><h3>Rationale & Objective</h3><div>Fine particulate matter (PM<sub>2.5</sub>) is associated with increased mortality and disproportionately affects minoritized patients with kidney failure, particularly Black patients. Among patients with kidney failure, we tested whether neighborhood characteristics (racial and ethnic segregation, socioeconomic deprivation, and built environment) modified the association between PM<sub>2.5</sub> exposure and mortality, overall and by race and ethnicity.</div></div><div><h3>Study Design</h3><div>Cohort study (2003-2019).</div></div><div><h3>Setting & Participants</h3><div>National registry for patients with kidney failure.</div></div><div><h3>Exposures</h3><div>Annualized PM<sub>2.5</sub> concentrations (high, > 9 μg/m<sup>3</sup>), segregation scores (Theil’s H method), deprivation scores (American Community Survey), and built environment factors (medically underserved areas [MUA] and urbanicity) by patients’ residential ZIP code at dialysis initiation.</div></div><div><h3>Outcome</h3><div>All-cause mortality.</div></div><div><h3>Analytical Approach</h3><div>We used multivariable Cox regression with shared state-level frailty to quantify whether neighborhood factors modify the association between PM<sub>2.5</sub> and mortality, overall and stratified by race and ethnicity.</div></div><div><h3>Results</h3><div>High PM<sub>2.5</sub> (vs low) was differentially associated with mortality among patients with kidney failure residing in neighborhoods characterized by high segregation (adjusted hazard ratio [aHR], 1.17; 95% confidence interval [CI], 1.15-1.19; <em>P</em><sub>interaction high vs low</sub> < 0.001), high deprivation (aHR, 1.17; 95% CI, 1.15-1.19; <em>P</em><sub>interaction high vs low</sub> < 0.001), MUA (aHR, 1.15; 95% CI, 1.13-1.16; <em>P</em><sub>interaction</sub> = 0.005), and high-density urban (HDU) areas (aHR, 1.14; 95% CI, 1.12-1.15; <em>P</em><sub>interaction</sub> < 0.001). These differential associations were most prominent among Black patients ([high segregation: aHR, 1.25; 95% CI, 1.21-1.29; <em>P</em><sub>interaction high vs low</sub> = 0.006], [high deprivation: aHR, 1.26; 95% CI, 1.22-1.30; <em>P</em><sub>interaction high vs low</sub> < 0.001], [MUA: aHR, 1.22; 95% CI, 1.19-1.26; <em>P</em><sub>interaction</sub> = 0.02], [HDU areas: aHR, 1.23; 95% CI, 1.20-1.26; <em>P</em><sub>interaction</sub> < 0.001])</div></div><div><h3>Limitations</h3><div>Outdoor PM<sub>2.5</sub> may not reflect individual-level exposures.</div></div><div><h3>Conclusions</h3><div>High levels of PM<sub>2.5</sub> were associated with increased mortality risk among patients with kidney failure residing in neighborhoods characterized by high segregation, high deprivation, MUAs, and HDU areas, particularly among Black patients. Nephrologists should consider closer monitoring of patients, particularly those from minoritized groups who reside in these high-risk neighborhoods, to help mitigate
{"title":"Neighborhood Factors, Air Pollution, and Mortality Among Kidney Failure Patients: Exploring Differences by Race and Ethnicity","authors":"Yiting Li , Gayathri Menon , Jane J. Long , Malika Wilson , Byoungjun Kim , Mario P. DeMarco , Babak J. Orandi , Sunjae Bae , Wenbo Wu , Yijing Feng , Terry Gordon , George D. Thurston , Dorry L. Segev , Mara A. McAdams-DeMarco","doi":"10.1016/j.xkme.2025.101167","DOIUrl":"10.1016/j.xkme.2025.101167","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Fine particulate matter (PM<sub>2.5</sub>) is associated with increased mortality and disproportionately affects minoritized patients with kidney failure, particularly Black patients. Among patients with kidney failure, we tested whether neighborhood characteristics (racial and ethnic segregation, socioeconomic deprivation, and built environment) modified the association between PM<sub>2.5</sub> exposure and mortality, overall and by race and ethnicity.</div></div><div><h3>Study Design</h3><div>Cohort study (2003-2019).</div></div><div><h3>Setting & Participants</h3><div>National registry for patients with kidney failure.</div></div><div><h3>Exposures</h3><div>Annualized PM<sub>2.5</sub> concentrations (high, > 9 μg/m<sup>3</sup>), segregation scores (Theil’s H method), deprivation scores (American Community Survey), and built environment factors (medically underserved areas [MUA] and urbanicity) by patients’ residential ZIP code at dialysis initiation.</div></div><div><h3>Outcome</h3><div>All-cause mortality.</div></div><div><h3>Analytical Approach</h3><div>We used multivariable Cox regression with shared state-level frailty to quantify whether neighborhood factors modify the association between PM<sub>2.5</sub> and mortality, overall and stratified by race and ethnicity.</div></div><div><h3>Results</h3><div>High PM<sub>2.5</sub> (vs low) was differentially associated with mortality among patients with kidney failure residing in neighborhoods characterized by high segregation (adjusted hazard ratio [aHR], 1.17; 95% confidence interval [CI], 1.15-1.19; <em>P</em><sub>interaction high vs low</sub> < 0.001), high deprivation (aHR, 1.17; 95% CI, 1.15-1.19; <em>P</em><sub>interaction high vs low</sub> < 0.001), MUA (aHR, 1.15; 95% CI, 1.13-1.16; <em>P</em><sub>interaction</sub> = 0.005), and high-density urban (HDU) areas (aHR, 1.14; 95% CI, 1.12-1.15; <em>P</em><sub>interaction</sub> < 0.001). These differential associations were most prominent among Black patients ([high segregation: aHR, 1.25; 95% CI, 1.21-1.29; <em>P</em><sub>interaction high vs low</sub> = 0.006], [high deprivation: aHR, 1.26; 95% CI, 1.22-1.30; <em>P</em><sub>interaction high vs low</sub> < 0.001], [MUA: aHR, 1.22; 95% CI, 1.19-1.26; <em>P</em><sub>interaction</sub> = 0.02], [HDU areas: aHR, 1.23; 95% CI, 1.20-1.26; <em>P</em><sub>interaction</sub> < 0.001])</div></div><div><h3>Limitations</h3><div>Outdoor PM<sub>2.5</sub> may not reflect individual-level exposures.</div></div><div><h3>Conclusions</h3><div>High levels of PM<sub>2.5</sub> were associated with increased mortality risk among patients with kidney failure residing in neighborhoods characterized by high segregation, high deprivation, MUAs, and HDU areas, particularly among Black patients. Nephrologists should consider closer monitoring of patients, particularly those from minoritized groups who reside in these high-risk neighborhoods, to help mitigate ","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 1","pages":"Article 101167"},"PeriodicalIF":3.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.xkme.2025.101099
Rui She , Stanton P. Newman , Augustine Kang , Jason C.J. Choo , Erik Khoo , Mooppil Nandakumar , Konstadina Griva
<div><h3>Rationale & Objective</h3><div>Individuals with comorbid diabetes and kidney failure have poor clinical prognosis, often aggravated by psychological distress. Identifying individuals most at risk is crucial to improving service provision. This study aimed to identify psychosocial profiles in patients with diabetes and kidney failure, model their prognostic effects on hospitalization and mortality, and explore underlying mechanisms linking psychosocial health to clinical outcomes.</div></div><div><h3>Study Design</h3><div>Prospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>A total of 221 participants with coexisting diabetes and kidney failure (median age: 59 years, 60.6% men) receiving hemodialysis were recruited from the National Kidney Foundation Singapore’s dialysis centers.</div></div><div><h3>Exposures</h3><div>Depression, anxiety, loneliness, and hopelessness alongside self-care indicators were measured using validated self-reported scales.</div></div><div><h3>Outcomes</h3><div>All-cause hospitalization and mortality were ascertained from medical records.</div></div><div><h3>Analytical Approach</h3><div>Latent profile analysis was used to identify psychosocial profiles. Associations of sociodemographic, clinical factors and psychosocial profiles with clinical endpoints were modeled with Negative binomial and Cox regressions (mean = 21.8 months). Casual mediation analyses modeled self-care as mediator.</div></div><div><h3>Results</h3><div>Three psychosocial profiles emerged: resilient (37.6%; all below cutoffs), overwhelmed (30.3%; above cutoffs), and lonely (32.1%; above cutoff for loneliness only). The lonely group was more socioeconomically disadvantaged relative to the resilient group. The lonely and overwhelmed groups had increased hospitalization rates and more hospitalization days than the resilient group (incident risk ratio [IRR] range, 1.50-1.82; <em>P</em> < 0.05). No association with mortality was found. Better diabetes self-care and nutrition quality-of-life also predicted hospitalization (IRR range, 0.94-0.97; <em>P</em> < 0.05) and mortality (hazard ratio [HR] = 0.93 and 0.96). Mediation analysis indicated that diabetes self-care activities accounted for 18% of the associations between the lonely profile and hospitalization days.</div></div><div><h3>Limitations</h3><div>Geographic generalizability of participants and sample size.</div></div><div><h3>Conclusions</h3><div>Interconnected psychosocial burdens significantly affect disease management and hospitalization risk in patients with diabetes and kidney failure. Integrating psychosocial screening and interventions into clinical practice, particularly addressing loneliness and not just depression and anxiety, may be crucial.</div></div><div><h3>Plain Language Summary</h3><div>Patients with coexisting diabetes and kidney failure often struggle with emotional distress and complex treatments. Although depression and anxiety receiv
{"title":"Prognostication of Mental Health Risk Clusters on Hospitalization and Mortality in Patients With Coexisting Diabetes and Kidney Failure: The Hidden Burden of Loneliness","authors":"Rui She , Stanton P. Newman , Augustine Kang , Jason C.J. Choo , Erik Khoo , Mooppil Nandakumar , Konstadina Griva","doi":"10.1016/j.xkme.2025.101099","DOIUrl":"10.1016/j.xkme.2025.101099","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Individuals with comorbid diabetes and kidney failure have poor clinical prognosis, often aggravated by psychological distress. Identifying individuals most at risk is crucial to improving service provision. This study aimed to identify psychosocial profiles in patients with diabetes and kidney failure, model their prognostic effects on hospitalization and mortality, and explore underlying mechanisms linking psychosocial health to clinical outcomes.</div></div><div><h3>Study Design</h3><div>Prospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>A total of 221 participants with coexisting diabetes and kidney failure (median age: 59 years, 60.6% men) receiving hemodialysis were recruited from the National Kidney Foundation Singapore’s dialysis centers.</div></div><div><h3>Exposures</h3><div>Depression, anxiety, loneliness, and hopelessness alongside self-care indicators were measured using validated self-reported scales.</div></div><div><h3>Outcomes</h3><div>All-cause hospitalization and mortality were ascertained from medical records.</div></div><div><h3>Analytical Approach</h3><div>Latent profile analysis was used to identify psychosocial profiles. Associations of sociodemographic, clinical factors and psychosocial profiles with clinical endpoints were modeled with Negative binomial and Cox regressions (mean = 21.8 months). Casual mediation analyses modeled self-care as mediator.</div></div><div><h3>Results</h3><div>Three psychosocial profiles emerged: resilient (37.6%; all below cutoffs), overwhelmed (30.3%; above cutoffs), and lonely (32.1%; above cutoff for loneliness only). The lonely group was more socioeconomically disadvantaged relative to the resilient group. The lonely and overwhelmed groups had increased hospitalization rates and more hospitalization days than the resilient group (incident risk ratio [IRR] range, 1.50-1.82; <em>P</em> < 0.05). No association with mortality was found. Better diabetes self-care and nutrition quality-of-life also predicted hospitalization (IRR range, 0.94-0.97; <em>P</em> < 0.05) and mortality (hazard ratio [HR] = 0.93 and 0.96). Mediation analysis indicated that diabetes self-care activities accounted for 18% of the associations between the lonely profile and hospitalization days.</div></div><div><h3>Limitations</h3><div>Geographic generalizability of participants and sample size.</div></div><div><h3>Conclusions</h3><div>Interconnected psychosocial burdens significantly affect disease management and hospitalization risk in patients with diabetes and kidney failure. Integrating psychosocial screening and interventions into clinical practice, particularly addressing loneliness and not just depression and anxiety, may be crucial.</div></div><div><h3>Plain Language Summary</h3><div>Patients with coexisting diabetes and kidney failure often struggle with emotional distress and complex treatments. Although depression and anxiety receiv","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 11","pages":"Article 101099"},"PeriodicalIF":3.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145417098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.xkme.2025.101106
Noémie Laurier , Taylor Stoesz , Andrea Quaiattini , Caitlin Gilpin , Romina Pace , Laura Horowitz , Rita S. Suri , Shaifali Sandal , Emilie Trinh
The burden of kidney disease among Indigenous peoples in Canada is disproportionately higher than the rest of the population. We aimed to synthesize the existing knowledge on the clinical outcomes among Indigenous peoples treated with dialysis in Canada. We searched MEDLINE, Embase, CINAHL, Scopus, Web of Science Core Collection, and the Bibliography of Indigenous Peoples of North America, supplemented by a gray literature review. The following inclusion criteria were used: (1) studies assessing dialysis patients, (2) including Canadian Indigenous patients, and (3) relating to incidence, mortality, treatment complications, access to care, and/or quality of life. Forty-four studies, conducted across multiple Canadian provinces, were included. Fifteen studies highlighted the higher prevalence of diabetic and nondiabetic kidney failure among Indigenous Canadians compared with non-Indigenous Canadians. Indigenous patients experienced more frequent dialysis-related infections and cardiovascular complications, increased hospitalization rates, lower rates of arteriovenous fistula creation, lower use of home dialysis, reduced access to health care services, and decreased quality of life because of relocation for dialysis. Few studies explored the underlying causes of the observed inequities. Our findings underscore the need to better understand the contributing factors to develop culturally appropriate interventions, codesigned with Indigenous communities, that promote equitable care for Indigenous patients receiving dialysis.
加拿大土著人民的肾脏疾病负担比其他人口高得不成比例。我们的目的是综合现有的关于加拿大土著人接受透析治疗的临床结果的知识。我们检索了MEDLINE、Embase、CINAHL、Scopus、Web of Science核心馆藏和北美土著人民参考书目，并辅以灰色文献综述。采用以下纳入标准：(1)评估透析患者的研究，(2)包括加拿大土著患者，(3)与发病率、死亡率、治疗并发症、获得护理和/或生活质量有关的研究。包括在加拿大多个省份进行的44项研究。15项研究强调，与非土著加拿大人相比，土著加拿大人患糖尿病和非糖尿病性肾衰竭的患病率更高。土著病人经历了更频繁的与透析有关的感染和心血管并发症，住院率增加，动静脉瘘管形成率降低，家庭透析使用率降低，获得保健服务的机会减少，以及由于搬迁透析而降低的生活质量。很少有研究探讨观察到的不平等的根本原因。我们的研究结果强调需要更好地了解影响因素，以制定文化上适当的干预措施，与土著社区共同设计，促进对接受透析的土著患者的公平护理。
{"title":"Examining Inequities in Clinical Outcomes for Indigenous Patients Treated With Dialysis in Canada: A Scoping Review","authors":"Noémie Laurier , Taylor Stoesz , Andrea Quaiattini , Caitlin Gilpin , Romina Pace , Laura Horowitz , Rita S. Suri , Shaifali Sandal , Emilie Trinh","doi":"10.1016/j.xkme.2025.101106","DOIUrl":"10.1016/j.xkme.2025.101106","url":null,"abstract":"<div><div>The burden of kidney disease among Indigenous peoples in Canada is disproportionately higher than the rest of the population. We aimed to synthesize the existing knowledge on the clinical outcomes among Indigenous peoples treated with dialysis in Canada. We searched MEDLINE, Embase, CINAHL, Scopus, Web of Science Core Collection, and the Bibliography of Indigenous Peoples of North America, supplemented by a gray literature review. The following inclusion criteria were used: (1) studies assessing dialysis patients, (2) including Canadian Indigenous patients, and (3) relating to incidence, mortality, treatment complications, access to care, and/or quality of life. Forty-four studies, conducted across multiple Canadian provinces, were included. Fifteen studies highlighted the higher prevalence of diabetic and nondiabetic kidney failure among Indigenous Canadians compared with non-Indigenous Canadians. Indigenous patients experienced more frequent dialysis-related infections and cardiovascular complications, increased hospitalization rates, lower rates of arteriovenous fistula creation, lower use of home dialysis, reduced access to health care services, and decreased quality of life because of relocation for dialysis. Few studies explored the underlying causes of the observed inequities. Our findings underscore the need to better understand the contributing factors to develop culturally appropriate interventions, codesigned with Indigenous communities, that promote equitable care for Indigenous patients receiving dialysis.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 11","pages":"Article 101106"},"PeriodicalIF":3.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145417099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.xkme.2025.101155
Monica M. Shieu PhD, MS , Daniel E. Weiner MD, MS , Nien Chen Li PhD, MPH, MA , Eduardo K. Lacson Jr. MD, MPH
{"title":"Reply to Comment on “COVID-19 Hospitalization and Mortality Trends Among US Dialysis Patients by Race/Ethnicity and Vaccination Status”","authors":"Monica M. Shieu PhD, MS , Daniel E. Weiner MD, MS , Nien Chen Li PhD, MPH, MA , Eduardo K. Lacson Jr. MD, MPH","doi":"10.1016/j.xkme.2025.101155","DOIUrl":"10.1016/j.xkme.2025.101155","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 11","pages":"Article 101155"},"PeriodicalIF":3.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145417101","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 : 2025-10-31DOI: 10.1016/j.xkme.2025.101168
Niels L. Riemersma , Tim J. Knobbe , Daan Kremer , Svea Nolte , Ute Bültmann , Coby Annema , Naser B.N. Shehab , Michele F. Eisenga , Stefan P. Berger , Stephan J.L. Bakker , TransplantLines Investigators, C. Annema , S.J.L. Bakker , S.P. Berger , H. Blokzijl , F.A.J.A. Bodewes , M.T. de Boer , Damman , M.H. de Borst , A. Diepstra , R.K. Weersma
<div><h3>Rationale & Objective</h3><div>A multitude of symptoms may contribute to low health-related quality of life (HRQoL) in kidney transplant recipients (KTR). We aimed to identify the most occurring and distressing symptoms, to explore potential determinants of symptom burden, and to examine associations with patient-reported outcomes in KTR.</div></div><div><h3>Study Design</h3><div>A cross-sectional retrospective patient-reported outcome measures study.</div></div><div><h3>Setting & Participants</h3><div>Stable KTR ≥1 year after transplantation participating in the TransplantLines Biobank and Cohort Studies.</div></div><div><h3>Predictors</h3><div>Clinical variables, including sex, age, and time after transplantation.</div></div><div><h3>Outcomes</h3><div>Symptom occurrence/distress/burden, medication adherence, symptoms of depression/anxiety, societal participation, and HRQoL.</div></div><div><h3>Analytical Approach</h3><div>Symptoms were evaluated using ridit analyses. A burden score was calculated to explore determinants of symptom burden and its associations with other patient-reported outcomes.</div></div><div><h3>Results</h3><div>We included 936 KTR (38.8% female; mean ± SD age, 55.6 ± 13.0 years) at a median [IQR] of 2.0 [1.0-9.0] years after transplantation. Based on ridit scores, most occurring symptoms were tiredness [0.724], bruises [0.718], and lack of energy [0.688]; most distressful symptoms were menstrual problems [0.679], impotence [0.654], and joint pain [0.611]. Worse nutritional status (<em>P</em> < 0.001), being female (<em>P</em> < 0.001), cyclosporine use (<em>P</em> = 0.005), and proton pomp inhibitor use (<em>P</em> < 0.001) were associated with higher symptom burden. Higher symptom burden was associated with medication nonadherence, symptoms of depression and anxiety, lower societal participation, and lower physical and mental HRQoL (st.β = –0.53, 95% CI –0.59 to –0.47, <em>P</em> <0.001 and st.β=-0.53, 95% CI –0.60 to –0.46, <em>P</em> < 0.001, respectively).</div></div><div><h3>Limitations</h3><div>No causality can be established because of the cross-sectional design.</div></div><div><h3>Conclusions</h3><div>The most occurring symptoms were tiredness, bruises, and lack of energy, and the most distressing symptoms were menstrual problems, impotence, and joint pain. The strongest determinants of symptom burden were female sex, malnutrition, cyclosporine use, and proton pump inhibitor use. The associations of symptom burden with patient-related outcomes underline the importance of addressing symptom status after transplant.</div></div><div><h3>Plain-language Summary</h3><div>Symptom burden of immunosuppressive medication may cause lower health-related quality of life (HRQoL) in kidney transplant recipients (KTR). Therefore, we aimed to assess (1) symptom occurrence and distress, (2) determinants of symptom burden, and (3) associations of symptom burden with HRQoL and other patient-reported out
理由和目的多种症状可能导致肾移植受者（KTR）健康相关生活质量（HRQoL）降低。我们的目的是确定最常见和最令人痛苦的症状，探索症状负担的潜在决定因素，并检查与KTR患者报告的结果的关联。研究设计：横断面回顾性患者报告的结果测量研究。受试者：移植后稳定KTR≥1年，参加TransplantLines生物库和队列研究。预测指标临床变量，包括性别、年龄和移植后时间。结果：症状发生/痛苦/负担、药物依从性、抑郁/焦虑症状、社会参与和HRQoL。分析方法：使用ridit分析对症状进行评估。计算负担评分以探讨症状负担的决定因素及其与其他患者报告结果的关联。结果纳入936例KTR患者（38.8%为女性，平均±SD年龄55.6±13.0岁），移植后中位[IQR]为2.0[1.0-9.0]年。根据ridit评分，最常见的症状是疲劳[0.724]、瘀伤[0.718]和精力不足[0.688]；最痛苦的症状是月经问题[0.679]、阳痿[0.654]和关节痛[0.611]。较差的营养状况（P < 0.001）、女性（P < 0.001）、使用环孢素（P = 0.005）和使用质子泵抑制剂（P < 0.001）与较高的症状负担相关。较高的症状负担与药物不依从、抑郁和焦虑症状、较低的社会参与度以及较低的身心HRQoL相关（st.β =-0.53, 95% CI -0.59至-0.47,P <0.001, st.β=-0.53, 95% CI -0.60至-0.46,P <0.001）。限制：由于横断面设计，不能建立因果关系。结论以疲劳、瘀伤、乏力为主要症状，以月经不调、阳痿、关节痛为主要症状。症状负担的最强决定因素是女性、营养不良、环孢素的使用和质子泵抑制剂的使用。症状负担与患者相关结果的关联强调了处理移植后症状状态的重要性。免疫抑制药物的症状负担可能导致肾移植受者（KTR）健康相关生活质量（HRQoL）降低。因此，我们的目的是评估(1)症状的发生和困扰，(2)症状负担的决定因素，以及(3)症状负担与HRQoL和其他患者报告的结局的关联。在936 KTR中，最常见的症状是疲劳、瘀伤和缺乏能量，最令人痛苦的症状是月经问题、阳痿和关节疼痛。女性、营养不良、使用环孢素和质子泵抑制剂是高症状负担的决定因素。此外，较高的症状负担与更多的药物依从性、更多的焦虑/抑郁症状、较低的社会参与以及较低的身心HRQoL相关。这些发现可能有助于改善以病人为中心的医疗保健。
{"title":"Symptom Burden and Patient-Reported Outcomes in Kidney Transplant Recipients: Results From the TransplantLines Biobank and Cohort Studies","authors":"Niels L. Riemersma , Tim J. Knobbe , Daan Kremer , Svea Nolte , Ute Bültmann , Coby Annema , Naser B.N. Shehab , Michele F. Eisenga , Stefan P. Berger , Stephan J.L. Bakker , TransplantLines Investigators, C. Annema , S.J.L. Bakker , S.P. Berger , H. Blokzijl , F.A.J.A. Bodewes , M.T. de Boer , Damman , M.H. de Borst , A. Diepstra , R.K. Weersma","doi":"10.1016/j.xkme.2025.101168","DOIUrl":"10.1016/j.xkme.2025.101168","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>A multitude of symptoms may contribute to low health-related quality of life (HRQoL) in kidney transplant recipients (KTR). We aimed to identify the most occurring and distressing symptoms, to explore potential determinants of symptom burden, and to examine associations with patient-reported outcomes in KTR.</div></div><div><h3>Study Design</h3><div>A cross-sectional retrospective patient-reported outcome measures study.</div></div><div><h3>Setting & Participants</h3><div>Stable KTR ≥1 year after transplantation participating in the TransplantLines Biobank and Cohort Studies.</div></div><div><h3>Predictors</h3><div>Clinical variables, including sex, age, and time after transplantation.</div></div><div><h3>Outcomes</h3><div>Symptom occurrence/distress/burden, medication adherence, symptoms of depression/anxiety, societal participation, and HRQoL.</div></div><div><h3>Analytical Approach</h3><div>Symptoms were evaluated using ridit analyses. A burden score was calculated to explore determinants of symptom burden and its associations with other patient-reported outcomes.</div></div><div><h3>Results</h3><div>We included 936 KTR (38.8% female; mean ± SD age, 55.6 ± 13.0 years) at a median [IQR] of 2.0 [1.0-9.0] years after transplantation. Based on ridit scores, most occurring symptoms were tiredness [0.724], bruises [0.718], and lack of energy [0.688]; most distressful symptoms were menstrual problems [0.679], impotence [0.654], and joint pain [0.611]. Worse nutritional status (<em>P</em> < 0.001), being female (<em>P</em> < 0.001), cyclosporine use (<em>P</em> = 0.005), and proton pomp inhibitor use (<em>P</em> < 0.001) were associated with higher symptom burden. Higher symptom burden was associated with medication nonadherence, symptoms of depression and anxiety, lower societal participation, and lower physical and mental HRQoL (st.β = –0.53, 95% CI –0.59 to –0.47, <em>P</em> <0.001 and st.β=-0.53, 95% CI –0.60 to –0.46, <em>P</em> < 0.001, respectively).</div></div><div><h3>Limitations</h3><div>No causality can be established because of the cross-sectional design.</div></div><div><h3>Conclusions</h3><div>The most occurring symptoms were tiredness, bruises, and lack of energy, and the most distressing symptoms were menstrual problems, impotence, and joint pain. The strongest determinants of symptom burden were female sex, malnutrition, cyclosporine use, and proton pump inhibitor use. The associations of symptom burden with patient-related outcomes underline the importance of addressing symptom status after transplant.</div></div><div><h3>Plain-language Summary</h3><div>Symptom burden of immunosuppressive medication may cause lower health-related quality of life (HRQoL) in kidney transplant recipients (KTR). Therefore, we aimed to assess (1) symptom occurrence and distress, (2) determinants of symptom burden, and (3) associations of symptom burden with HRQoL and other patient-reported out","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 1","pages":"Article 101168"},"PeriodicalIF":3.4,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787279","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 : 2025-10-30DOI: 10.1016/j.xkme.2025.101163
Danielle S. Kroll MD , Kyle J. Woodward BS , Miko E. Yu MPH , Sumit Mohan MD , Syed Ali Husain MD
{"title":"Association Between Primary Language and Evaluation Completion Among Kidney Transplant Candidates","authors":"Danielle S. Kroll MD , Kyle J. Woodward BS , Miko E. Yu MPH , Sumit Mohan MD , Syed Ali Husain MD","doi":"10.1016/j.xkme.2025.101163","DOIUrl":"10.1016/j.xkme.2025.101163","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 1","pages":"Article 101163"},"PeriodicalIF":3.4,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145786939","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 : 2025-10-30DOI: 10.1016/j.xkme.2025.101164
Ainhoa Indurain , Markus Karlsson , Anders Fernström , Fredrik Uhlin , Jennifer Linge , Mikael Petersson , Olof Dahlqvist Leinhard , Mårten Segelmark
<div><h3>Rational & Objective</h3><div>Sarcopenia is linked to increased morbidity and mortality in chronic kidney disease (CKD), but its definition and assessment vary considerably across studies. This study evaluated the technical feasibility of magnetic resonance imaging (MRI)–based assessment of adverse muscle composition (AMC)—defined as low muscle volume and high fat infiltration—and its associations with comorbidity, functional performance, and risk for coronary heart disease (CHD) in CKD.</div></div><div><h3>Study Design</h3><div>This is a cross-sectional and prospective study.</div></div><div><h3>Settings & Participants</h3><div>Participants included 11 patients from a single-center hemodialysis (HD) cohort and 903 individuals with CKD from the UK Biobank, along with matched controls without CKD. For each participant, a personalized muscle volume z-score (sex-specific and body size–specific) was calculated and combined with muscle fat infiltration for AMC evaluation.</div></div><div><h3>Predictor(s)</h3><div>Adverse muscle composition.</div></div><div><h3>Outcomes</h3><div>Comorbidity index, functional performance (handgrip strength, walking pace, stair climbing, and falls), and new CHD events.</div></div><div><h3>Analytical Approach</h3><div>In the HD cohort, Spearman rank correlations and Cox proportional-hazards model were used. In the UK Biobank cohort, linear/logistic regression models and Cox proportional-hazards model were used.</div></div><div><h3>Results</h3><div>AMC was present in 45% of the HD cohort and associated with higher comorbidity index. In the UK Biobank, AMC prevalence was greater in CKD versus no CKD (32% vs 25%, <em>P</em> < 0.001). Participants with AMC had worse functional performance (<em>P</em> < 0.001), higher comorbidity index (<em>P</em> < 0.001), and 2-fold increased CHD incidence (<em>P</em> = 0.01).</div></div><div><h3>Limitations</h3><div>Blood samples defining CKD were taken 7-9 years before MRI, and self-reported data on walking pace, falls, stair climbing, and type 2 diabetes.</div></div><div><h3>Conclusions</h3><div>The AMC, assessed by MRI, is a prevalent muscle composition phenotype in CKD and is associated with high prevalence of comorbidity, poor function, and increased risk for CHD.</div></div><div><h3>Plain-language Summary</h3><div>Sarcopenia is a common and clinically significant complication in chronic kidney disease (CKD), but its definition and assessment remain variable. This study investigated the use of magnetic resonance imaging to identify adverse muscle composition—defined by low muscle volume and increased fat infiltration within muscle tissue. Using data from a hemodialysis cohort and the UK Biobank, we found that adverse muscle composition is more common in individuals with CKD and is significantly associated with increased comorbidity, poor physical performance, and a 2-fold higher risk of new coronary heart disease events. These findings suggest that magnetic re
目的肌少症与慢性肾脏疾病（CKD）发病率和死亡率增加有关，但其定义和评估在不同研究中差异很大。本研究评估了基于磁共振成像（MRI）评估不良肌肉成分（AMC）的技术可行性——定义为低肌肉体积和高脂肪浸润——及其与CKD合并症、功能表现和冠心病（CHD）风险的关系。研究设计：这是一项横断面前瞻性研究。参与者包括来自单一中心血液透析（HD）队列的11名患者和来自UK Biobank的903名CKD患者，以及匹配的非CKD对照组。对于每个参与者，计算个性化的肌肉体积z分数（性别特异性和体型特异性），并结合肌肉脂肪浸润进行AMC评估。不利的肌肉组成。合并症指数、功能表现（握力、步行速度、爬楼梯和跌倒）和新的冠心病事件。分析方法：在HD队列中，采用Spearman秩相关和Cox比例风险模型。在UK Biobank队列中，使用线性/逻辑回归模型和Cox比例风险模型。结果45%的HD患者存在samc，并伴有较高的合并症指数。在UK Biobank中，CKD患者的AMC患病率高于非CKD患者（32% vs 25%, P < 0.001）。AMC患者的功能表现较差（P < 0.001），合并症指数较高（P < 0.001），冠心病发病率增加2倍（P = 0.01）。限定CKD的血液样本在MRI前7-9年采集，并自我报告步行速度、跌倒、爬楼梯和2型糖尿病的数据。通过MRI评估的AMC是CKD中普遍存在的肌肉成分表型，并且与合并症的高患病率、功能差和冠心病风险增加相关。肌少症是慢性肾脏疾病（CKD）中一种常见且具有临床意义的并发症，但其定义和评估仍存在差异。本研究探讨了使用磁共振成像来识别不良肌肉成分-由肌肉体积低和肌肉组织内脂肪浸润增加定义。使用来自血液透析队列和UK Biobank的数据，我们发现不良肌肉组成在CKD患者中更常见，并且与合并症增加、身体表现不佳和新冠状动脉心脏病事件风险增加2倍显著相关。这些发现表明，基于磁共振成像的肌肉评估可能有助于更早、更准确地识别高风险CKD患者。
{"title":"Adverse Muscle Composition Is an Early Feature of Chronic Kidney Disease and Associates With Poor Function and Comorbidities","authors":"Ainhoa Indurain , Markus Karlsson , Anders Fernström , Fredrik Uhlin , Jennifer Linge , Mikael Petersson , Olof Dahlqvist Leinhard , Mårten Segelmark","doi":"10.1016/j.xkme.2025.101164","DOIUrl":"10.1016/j.xkme.2025.101164","url":null,"abstract":"<div><h3>Rational & Objective</h3><div>Sarcopenia is linked to increased morbidity and mortality in chronic kidney disease (CKD), but its definition and assessment vary considerably across studies. This study evaluated the technical feasibility of magnetic resonance imaging (MRI)–based assessment of adverse muscle composition (AMC)—defined as low muscle volume and high fat infiltration—and its associations with comorbidity, functional performance, and risk for coronary heart disease (CHD) in CKD.</div></div><div><h3>Study Design</h3><div>This is a cross-sectional and prospective study.</div></div><div><h3>Settings & Participants</h3><div>Participants included 11 patients from a single-center hemodialysis (HD) cohort and 903 individuals with CKD from the UK Biobank, along with matched controls without CKD. For each participant, a personalized muscle volume z-score (sex-specific and body size–specific) was calculated and combined with muscle fat infiltration for AMC evaluation.</div></div><div><h3>Predictor(s)</h3><div>Adverse muscle composition.</div></div><div><h3>Outcomes</h3><div>Comorbidity index, functional performance (handgrip strength, walking pace, stair climbing, and falls), and new CHD events.</div></div><div><h3>Analytical Approach</h3><div>In the HD cohort, Spearman rank correlations and Cox proportional-hazards model were used. In the UK Biobank cohort, linear/logistic regression models and Cox proportional-hazards model were used.</div></div><div><h3>Results</h3><div>AMC was present in 45% of the HD cohort and associated with higher comorbidity index. In the UK Biobank, AMC prevalence was greater in CKD versus no CKD (32% vs 25%, <em>P</em> < 0.001). Participants with AMC had worse functional performance (<em>P</em> < 0.001), higher comorbidity index (<em>P</em> < 0.001), and 2-fold increased CHD incidence (<em>P</em> = 0.01).</div></div><div><h3>Limitations</h3><div>Blood samples defining CKD were taken 7-9 years before MRI, and self-reported data on walking pace, falls, stair climbing, and type 2 diabetes.</div></div><div><h3>Conclusions</h3><div>The AMC, assessed by MRI, is a prevalent muscle composition phenotype in CKD and is associated with high prevalence of comorbidity, poor function, and increased risk for CHD.</div></div><div><h3>Plain-language Summary</h3><div>Sarcopenia is a common and clinically significant complication in chronic kidney disease (CKD), but its definition and assessment remain variable. This study investigated the use of magnetic resonance imaging to identify adverse muscle composition—defined by low muscle volume and increased fat infiltration within muscle tissue. Using data from a hemodialysis cohort and the UK Biobank, we found that adverse muscle composition is more common in individuals with CKD and is significantly associated with increased comorbidity, poor physical performance, and a 2-fold higher risk of new coronary heart disease events. These findings suggest that magnetic re","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 1","pages":"Article 101164"},"PeriodicalIF":3.4,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787275","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 : 2025-10-29DOI: 10.1016/j.xkme.2025.101162
Kunal Malhotra , Tejas Desai , Linda H. Ficociello , Hans-Juergen Arens , Rachel A. Lasky , Michael S. Anger
<div><h3>Rationale & Objective</h3><div>Chronic kidney disease–associated pruritus is commonly related to reduced health-related quality of life, decreased adherence to dialysis, and increased mortality, yet it remains underrecognized and underdiagnosed. We conducted an analysis to characterize the relationship between pruritus and a recognized symptom cluster among hemodialysis patients.</div></div><div><h3>Study Design</h3><div>This retrospective study of adults receiving hemodialysis in a large US dialysis organization analyzed pruritus and the individual symptoms of sleep disturbance, depression, pain, anxiety, and low energy/fatigue. Data from the Kidney Disease Quality of Life 36-Item Short Form Survey (KDQOL-36) and the Patient Health Questionnaire-2 were extracted from electronic medical records.</div></div><div><h3>Results</h3><div>Of the 243,168 adults receiving hemodialysis during the study period who completed a KDQOL-36, 47,477 reported at least moderate bother from pruritus. An additional randomly sampled 33,833 adults not reporting at least moderate pruritus were also included. The KDQOL-36 ratings for each symptom (sleep disturbance, depression, pain, anxiety, and low energy/fatigue) exhibited a significantly (<em>P</em> < 0.001) greater burden with increased pruritus severity. Similar results were observed for KDQOL-36 summary scores. Extreme pruritus was associated with greater than 5-fold and 3-fold increased risk of depressive symptoms and sleep disturbance, respectively. Pruritus was also independently associated with Patient Health Questionnaire-2–defined depressive symptoms. The association of pruritus with co-occurring symptoms was demonstrated across all serum phosphorus concentration subgroups. Patients reporting higher degrees of bother from pruritus were significantly more likely to miss multiple hemodialysis sessions or have shortened treatment sessions.</div></div><div><h3>Limitations</h3><div>The cross-sectional nature of the study limits exploration of temporal relationships between the symptoms.</div></div><div><h3>Conclusions</h3><div>Among hemodialysis patients, pruritus is commonly reported and associated with reduced health-related quality of life. It should be considered alongside the following symptoms commonly observed: sleep disturbance, depression, pain, anxiety, and low energy/fatigue. The presence of one symptom should prompt further investigation, allowing for appropriate diagnosis and management.</div></div><div><h3>Plain-language Summary</h3><div>This study of adults receiving hemodialysis examined the relationship between pruritus and the individual symptoms of sleep disturbance, depression, pain, anxiety, and low energy/fatigue. Data from the Kidney Disease Quality of Life 36-Item Short Form Survey and the Patient Health Questionnaire-2 were extracted from electronic medical records. The analysis found that the presence of at least moderate patient-reported pruritus was independently associa
{"title":"Association of Chronic Kidney Disease–Associated Pruritus With the Sleep Disturbance, Depression, Pain, Anxiety, and Low Energy/Fatigue Symptom Cluster: A Retrospective Cohort Study","authors":"Kunal Malhotra , Tejas Desai , Linda H. Ficociello , Hans-Juergen Arens , Rachel A. Lasky , Michael S. Anger","doi":"10.1016/j.xkme.2025.101162","DOIUrl":"10.1016/j.xkme.2025.101162","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Chronic kidney disease–associated pruritus is commonly related to reduced health-related quality of life, decreased adherence to dialysis, and increased mortality, yet it remains underrecognized and underdiagnosed. We conducted an analysis to characterize the relationship between pruritus and a recognized symptom cluster among hemodialysis patients.</div></div><div><h3>Study Design</h3><div>This retrospective study of adults receiving hemodialysis in a large US dialysis organization analyzed pruritus and the individual symptoms of sleep disturbance, depression, pain, anxiety, and low energy/fatigue. Data from the Kidney Disease Quality of Life 36-Item Short Form Survey (KDQOL-36) and the Patient Health Questionnaire-2 were extracted from electronic medical records.</div></div><div><h3>Results</h3><div>Of the 243,168 adults receiving hemodialysis during the study period who completed a KDQOL-36, 47,477 reported at least moderate bother from pruritus. An additional randomly sampled 33,833 adults not reporting at least moderate pruritus were also included. The KDQOL-36 ratings for each symptom (sleep disturbance, depression, pain, anxiety, and low energy/fatigue) exhibited a significantly (<em>P</em> < 0.001) greater burden with increased pruritus severity. Similar results were observed for KDQOL-36 summary scores. Extreme pruritus was associated with greater than 5-fold and 3-fold increased risk of depressive symptoms and sleep disturbance, respectively. Pruritus was also independently associated with Patient Health Questionnaire-2–defined depressive symptoms. The association of pruritus with co-occurring symptoms was demonstrated across all serum phosphorus concentration subgroups. Patients reporting higher degrees of bother from pruritus were significantly more likely to miss multiple hemodialysis sessions or have shortened treatment sessions.</div></div><div><h3>Limitations</h3><div>The cross-sectional nature of the study limits exploration of temporal relationships between the symptoms.</div></div><div><h3>Conclusions</h3><div>Among hemodialysis patients, pruritus is commonly reported and associated with reduced health-related quality of life. It should be considered alongside the following symptoms commonly observed: sleep disturbance, depression, pain, anxiety, and low energy/fatigue. The presence of one symptom should prompt further investigation, allowing for appropriate diagnosis and management.</div></div><div><h3>Plain-language Summary</h3><div>This study of adults receiving hemodialysis examined the relationship between pruritus and the individual symptoms of sleep disturbance, depression, pain, anxiety, and low energy/fatigue. Data from the Kidney Disease Quality of Life 36-Item Short Form Survey and the Patient Health Questionnaire-2 were extracted from electronic medical records. The analysis found that the presence of at least moderate patient-reported pruritus was independently associa","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 1","pages":"Article 101162"},"PeriodicalIF":3.4,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787346","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 : 2025-10-29DOI: 10.1016/j.xkme.2025.101161
Samuel Ford , Ian Coombes , Julian Williams , Claire Bertenshaw , Adam La Caze
Insulin-dextrose therapy is widely used to manage hyperkalemia but carries a significant risk of iatrogenic hypoglycemia. Glucose alone may reduce serum potassium by stimulating endogenous insulin release, potentially offering an insulin sparing alternative. This scoping review examined studies evaluating the effect of oral or intravenous glucose, without concurrent insulin, on serum or plasma potassium in adults. Nonhuman studies, nonpeer-reviewed sources, and studies where diabetes status could not be determined were excluded. Of 1,105 records screened, 30 met inclusion criteria. Most studies were small and conducted before 2,000, involving healthy individuals and patients with various conditions. A narrative synthesis was performed, with findings categorized by diabetes status and intervention type. Potassium responses varied: in nondiabetic individuals, glucose-only therapy generally lowered potassium, often to a clinically meaningful extent. In contrast, potassium often rose in insulin-dependent individuals. Methodological limitations were common, including small sample sizes, inconsistent statistical reporting, lack of control groups, and limited inclusion of hyperkalemic patients. Although glucose-only therapy may be effective in nondiabetic populations, evidence in people with diabetes is inconsistent and the evidence base is limited. Further rigorous, controlled studies are needed to clarify the role of glucose-only therapy in hyperkalemia management and its impact on hypoglycemia risk.
Plain-language Summary
Hyperkalemia, a condition where there is too much potassium in the blood, is often treated with insulin and glucose. But insulin can cause low blood sugar (hypoglycemia), which can be harmful. This review examined whether using glucose alone—without insulin—could lower potassium safely. We found that in people without diabetes, glucose-only therapy often lowered potassium. But in people with diabetes, the results were mixed and, in some cases, potassium levels increased. Most studies included in this review were small and had design limitations, highlighting the need for further research.
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Pub Date : 2025-10-28DOI: 10.1016/j.xkme.2025.101160
Alexander Kula MD, MHS , David K. Prince PhD , Joseph T. Flynn MD, MS , Susan L. Furth MD, PhD , Bradley Warady MD , Tamara Isakova MD, MMSc , Derek Ng PhD , Jeese Seegmiller PhD , Rob Christenson PhD , Nisha Bansal MD, MAS , CKiD study investigators
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