Malgorzata Kasztan,Guolian Kang,Davide Botta,David M Pollock,Sara Rashkin,Rima Zahr,Jeffrey Lebensburger
{"title":"Increased Endothelin-1 and High-Risk APOL1 Variants Contribute to Albuminuria in Pediatric and Young Adults with Sickle Cell Anemia.","authors":"Malgorzata Kasztan,Guolian Kang,Davide Botta,David M Pollock,Sara Rashkin,Rima Zahr,Jeffrey Lebensburger","doi":"10.2215/cjn.0000000993","DOIUrl":"https://doi.org/10.2215/cjn.0000000993","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"74 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146088894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Manjula Kurella Tamura,Jonathan Sosnov,Cynthia Delgado,John W Morrison,Sankar D Navaneethan,Mai T Nguyen,Paul M Palevsky,Diane Rybacki,James Sall,Amy R Schwartz,Sunil P Verma,Maura A Watson,Jesse Wickham,Linda Fried
{"title":"Principles Supporting Chronic Kidney Disease Management in Primary Care: 2025 Veterans Affairs/Department of Defense Clinical Practice Guidelines.","authors":"Manjula Kurella Tamura,Jonathan Sosnov,Cynthia Delgado,John W Morrison,Sankar D Navaneethan,Mai T Nguyen,Paul M Palevsky,Diane Rybacki,James Sall,Amy R Schwartz,Sunil P Verma,Maura A Watson,Jesse Wickham,Linda Fried","doi":"10.2215/cjn.0000001018","DOIUrl":"https://doi.org/10.2215/cjn.0000001018","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"43 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146088893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heart failure and chronic kidney disease (CKD) often co-exist. Heart failure with preserved ejection fraction (HFpEF) contributes to significant morbidity and mortality among patients with CKD. Among patients with CKD, along with traditional risk factors for heart failure, numerous CKD-specific pathophysiological pathways contribute to the heightened risk of HFpEF development. However, the heterogeneity of HFpEF presents numerous challenges for diagnosis, treatment, and prevention, which has led to various phenotyping approaches. Phenotyping HFpEF may allow for better HFpEF characterization for targeted management and development of risk stratification strategies for prevention. In this Kidney Cross-Talk article, we discuss the epidemiology of HFpEF in CKD, pathways of HFpEF development in CKD, and highlight the impact of CKD in HFpEF phenotyping. Additionally, we propose a potential risk-based prevention algorithm for heart failure among patients with CKD.
{"title":"The Intersection of Heart Failure with Preserved Ejection Fraction and Chronic Kidney Disease.","authors":"Vaishnavi Krishnan,Sadiya S Khan,Rupal Mehta","doi":"10.2215/cjn.0000001013","DOIUrl":"https://doi.org/10.2215/cjn.0000001013","url":null,"abstract":"Heart failure and chronic kidney disease (CKD) often co-exist. Heart failure with preserved ejection fraction (HFpEF) contributes to significant morbidity and mortality among patients with CKD. Among patients with CKD, along with traditional risk factors for heart failure, numerous CKD-specific pathophysiological pathways contribute to the heightened risk of HFpEF development. However, the heterogeneity of HFpEF presents numerous challenges for diagnosis, treatment, and prevention, which has led to various phenotyping approaches. Phenotyping HFpEF may allow for better HFpEF characterization for targeted management and development of risk stratification strategies for prevention. In this Kidney Cross-Talk article, we discuss the epidemiology of HFpEF in CKD, pathways of HFpEF development in CKD, and highlight the impact of CKD in HFpEF phenotyping. Additionally, we propose a potential risk-based prevention algorithm for heart failure among patients with CKD.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"145 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146056515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Devika Nair,Ilana Mittleman,Juliana Magro,Benjamin Catanese,Mary F Hannan,Melissa D Hladek,Jingyao Hong,Nan-Su Huang,Matthew H Taylor,Karthik K Tennankore,Dawn F Wolfgram,Rasheeda K Hall,Mara McAdams-DeMarco,
BACKGROUNDFrailty is a multi-system syndrome of decreased physiologic reserve with high prevalence, early incidence, and prognostic significance in kidney disease. Apart from the Physical Frailty Phenotype (PFP), less is known regarding psychometric properties of other instruments. We critically appraise the validity and reliability of frailty instruments across the kidney disease continuum, acknowledge limitations, and highlight knowledge gaps.METHODSFollowing PRISMA-ScR guidelines, we searched PubMed, EMBASE, Cochrane, CINAHL, Web of Science, ClinicalTrials.gov, and PsycInfo from website inception through 9/2024. Eligible studies applied a validated frailty instrument apart from the PFP to a kidney disease population.RESULTSWe identified 136 articles after screening 4,048 initial results. The most commonly cited instruments were the Clinical Frailty Scale (CFS; N=56), FRAIL Scale (N=30), and Edmonton Frail Scale (N=16). Most studies included adults receiving hemodialysis (N=85) and with chronic kidney disease (N=39). Median age ranges were 53-83 years. Most frailty instruments demonstrated predictive validity for mortality and hospitalizations. Concurrent validity was most frequently demonstrated between frailty and older age, female sex, greater comorbidities, and lower albumin. Seven studies reported reliability. While some instruments were feasible (CFS, FRAIL scale), their measurement could result in higher frailty prevalence compared to the PFP. Existing instruments do not capture the full spectrum of psychosocial and physiologic domains of frailty.CONCLUSIONSThe CFS demonstrates the strongest validity, apart from the PFP, although its use may result in higher measured frailty prevalence. Further research should test the feasibility of screening for frailty in clinical practice; the psychometric properties (i.e., responsiveness) of frailty instruments in younger adults, those with acute kidney injury, kidney transplant recipients, and those receiving conservative kidney management; and whether adding psychosocial and/or physiological markers improves frailty measurement validity. Addressing these gaps will facilitate wider frailty measurement in kidney disease research and aid adoption into practice.
背景：虚弱是一种多系统的生理储备下降综合征，在肾脏疾病中具有高患病率、早期发病率和预后意义。除了身体虚弱表型（PFP），对其他工具的心理测量特性知之甚少。我们批判性地评估整个肾脏疾病连续体的衰弱仪器的有效性和可靠性，承认局限性，并强调知识差距。方法：按照PRISMA-ScR指南，我们检索了PubMed， EMBASE, Cochrane， CINAHL, Web of Science, ClinicalTrials.gov和PsycInfo从网站建立到2024年9月。符合条件的研究应用了除PFP之外的一种经过验证的衰弱仪器来检测肾脏疾病人群。结果在筛选4048个初步结果后，我们确定了136篇文章。最常被引用的工具是临床虚弱量表（CFS； N=56）、虚弱量表（N=30）和埃德蒙顿虚弱量表（N=16）。大多数研究包括接受血液透析的成人（N=85）和患有慢性肾病的成人（N=39）。年龄中位数为53-83岁。大多数虚弱指标显示对死亡率和住院率的预测有效性。同时效度最常在虚弱和老年、女性、更大的合并症和较低的白蛋白之间表现出来。七项研究报告了可靠性。虽然一些工具是可行的（CFS，虚弱量表），但与PFP相比，它们的测量结果可能导致更高的虚弱患病率。现有的手段并没有涵盖脆弱的社会心理和生理领域的全部范围。结论除了PFP外，CFS表现出最强的有效性，尽管它的使用可能导致更高的测量虚弱患病率。进一步的研究应在临床实践中检验虚弱筛查的可行性；在年轻人、急性肾损伤患者、肾移植患者和接受保守肾治疗的患者中，虚弱量表的心理测量特性（即反应性）；以及添加社会心理和/或生理标记是否能提高脆弱性测量的有效性。解决这些差距将促进肾脏疾病研究中更广泛的脆弱性测量，并有助于将其应用于实践。
{"title":"Frailty in Focus - A Scoping Review of Frailty Instruments on from the Kidney Disease Aging Research Collaborative.","authors":"Devika Nair,Ilana Mittleman,Juliana Magro,Benjamin Catanese,Mary F Hannan,Melissa D Hladek,Jingyao Hong,Nan-Su Huang,Matthew H Taylor,Karthik K Tennankore,Dawn F Wolfgram,Rasheeda K Hall,Mara McAdams-DeMarco, ","doi":"10.2215/cjn.0000000998","DOIUrl":"https://doi.org/10.2215/cjn.0000000998","url":null,"abstract":"BACKGROUNDFrailty is a multi-system syndrome of decreased physiologic reserve with high prevalence, early incidence, and prognostic significance in kidney disease. Apart from the Physical Frailty Phenotype (PFP), less is known regarding psychometric properties of other instruments. We critically appraise the validity and reliability of frailty instruments across the kidney disease continuum, acknowledge limitations, and highlight knowledge gaps.METHODSFollowing PRISMA-ScR guidelines, we searched PubMed, EMBASE, Cochrane, CINAHL, Web of Science, ClinicalTrials.gov, and PsycInfo from website inception through 9/2024. Eligible studies applied a validated frailty instrument apart from the PFP to a kidney disease population.RESULTSWe identified 136 articles after screening 4,048 initial results. The most commonly cited instruments were the Clinical Frailty Scale (CFS; N=56), FRAIL Scale (N=30), and Edmonton Frail Scale (N=16). Most studies included adults receiving hemodialysis (N=85) and with chronic kidney disease (N=39). Median age ranges were 53-83 years. Most frailty instruments demonstrated predictive validity for mortality and hospitalizations. Concurrent validity was most frequently demonstrated between frailty and older age, female sex, greater comorbidities, and lower albumin. Seven studies reported reliability. While some instruments were feasible (CFS, FRAIL scale), their measurement could result in higher frailty prevalence compared to the PFP. Existing instruments do not capture the full spectrum of psychosocial and physiologic domains of frailty.CONCLUSIONSThe CFS demonstrates the strongest validity, apart from the PFP, although its use may result in higher measured frailty prevalence. Further research should test the feasibility of screening for frailty in clinical practice; the psychometric properties (i.e., responsiveness) of frailty instruments in younger adults, those with acute kidney injury, kidney transplant recipients, and those receiving conservative kidney management; and whether adding psychosocial and/or physiological markers improves frailty measurement validity. Addressing these gaps will facilitate wider frailty measurement in kidney disease research and aid adoption into practice.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"39 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nastassia Liaukouskaya,Felicitas E Hengel,Anne Mühlig,Nicola M Tomas,Tobias B Huber
The etiology of primary podocytopathies including childhood nephrotic syndrome, minimal change disease, primary focal segmental glomerulosclerosis as well as recurrent focal segmental glomerulosclerosis had long remained elusive. The development of robust anti-nephrin autoantibody detection methods, the identification of these antibodies in idiopathic nephrotic syndrome, and the demonstration of their causal role in podocytopathy have led to a paradigm shift in our understanding of these diseases, offering new insights into pathophysiology and promising improved diagnostic, prognostic, and therapeutic approaches. Prognostication and risk stratification based on anti-nephrin antibody detection as well as personalized therapeutic strategies including therapies targeting antibody-producing B cells or even antigen-specific depletion of autoreactive B cells could markedly improve treatment outcomes and patient quality of life in the future. In this review, we explore the prevalence of anti-nephrin antibodies in various glomerular diseases, current treatment options for primary podocytopathies, and how the emerging evidence of anti-nephrin antibody-mediated podocytopathy could influence future treatment approaches for affected patients.
{"title":"A New Hope for Treating Podocytopathies - Emerging Role of Anti-Nephrin Antibody.","authors":"Nastassia Liaukouskaya,Felicitas E Hengel,Anne Mühlig,Nicola M Tomas,Tobias B Huber","doi":"10.2215/cjn.0000001008","DOIUrl":"https://doi.org/10.2215/cjn.0000001008","url":null,"abstract":"The etiology of primary podocytopathies including childhood nephrotic syndrome, minimal change disease, primary focal segmental glomerulosclerosis as well as recurrent focal segmental glomerulosclerosis had long remained elusive. The development of robust anti-nephrin autoantibody detection methods, the identification of these antibodies in idiopathic nephrotic syndrome, and the demonstration of their causal role in podocytopathy have led to a paradigm shift in our understanding of these diseases, offering new insights into pathophysiology and promising improved diagnostic, prognostic, and therapeutic approaches. Prognostication and risk stratification based on anti-nephrin antibody detection as well as personalized therapeutic strategies including therapies targeting antibody-producing B cells or even antigen-specific depletion of autoreactive B cells could markedly improve treatment outcomes and patient quality of life in the future. In this review, we explore the prevalence of anti-nephrin antibodies in various glomerular diseases, current treatment options for primary podocytopathies, and how the emerging evidence of anti-nephrin antibody-mediated podocytopathy could influence future treatment approaches for affected patients.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"95 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jair Munoz Mendoza,Matthew R Weir,Stefan D Anker,Gerasimos Filippatos,Peter Rossing,Christiane Ahlers,Meike Brinker,Samuel T Fatoba,Andrea Horvat-Broecker,Katja Rohwedder,Alessia Fornoni,
BACKGROUNDFinerenone significantly reduced the risk of cardiovascular and kidney outcomes in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) in FIDELITY, a prespecified pooled analysis of two phase 3 trials. This post hoc FIDELITY analysis examined the efficacy and safety of finerenone in patients with CKD, T2D, and a history of nephrectomy.METHODSPatients in FIDELITY were randomized to receive finerenone or placebo and were on optimized renin-angiotensin system inhibition. We identified nephrectomy status using patients' medical history and assessed CKD progression in patients by nephrectomy status at baseline by modeling change in urine albumin-to-creatinine ratio (UACR) from baseline to months 4-24. Safety outcomes included treatment-emergent adverse events (TEAEs) and incident hyperkalemia.RESULTSOf 12,990 patients, 108 had a history of nephrectomy at baseline; 101/108 had radical nephrectomy, 55 received finerenone, and 53 received placebo. Baseline mean estimated glomerular filtration rates were numerically lower in patients with a history of nephrectomy (48 ± 17 mL/min/1.73 m2) than in patients without (58 ± 22 mL/min/1.73 m2). For patients with a history of nephrectomy, those who received finerenone had a greater UACR reduction at 4 months versus those who received placebo (least-squares mean ratio to baseline, 0.65 versus 1.09; least-squares mean treatment ratio, 0.60; 95% CI, 0.48-0.76; P<0.001). This reduction was maintained for two years. TEAEs were similar in patients with and without a history of nephrectomy. Among patients with a history of nephrectomy, treatment-emergent hyperkalemia occurred in 7% and 6% of finerenone and placebo groups, respectively.CONCLUSIONSFinerenone reduced albuminuria compared with placebo and demonstrated a safety profile consistent with the overall FIDELITY population in patients with and without a history of nephrectomy at baseline. Finerenone may delay CKD progression and associated morbidity in patients with CKD and T2D, irrespective of nephrectomy status.
{"title":"Finerenone in People with Chronic Kidney Disease, Type 2 Diabetes, and History of Nephrectomy.","authors":"Jair Munoz Mendoza,Matthew R Weir,Stefan D Anker,Gerasimos Filippatos,Peter Rossing,Christiane Ahlers,Meike Brinker,Samuel T Fatoba,Andrea Horvat-Broecker,Katja Rohwedder,Alessia Fornoni, ","doi":"10.2215/cjn.0000000932","DOIUrl":"https://doi.org/10.2215/cjn.0000000932","url":null,"abstract":"BACKGROUNDFinerenone significantly reduced the risk of cardiovascular and kidney outcomes in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) in FIDELITY, a prespecified pooled analysis of two phase 3 trials. This post hoc FIDELITY analysis examined the efficacy and safety of finerenone in patients with CKD, T2D, and a history of nephrectomy.METHODSPatients in FIDELITY were randomized to receive finerenone or placebo and were on optimized renin-angiotensin system inhibition. We identified nephrectomy status using patients' medical history and assessed CKD progression in patients by nephrectomy status at baseline by modeling change in urine albumin-to-creatinine ratio (UACR) from baseline to months 4-24. Safety outcomes included treatment-emergent adverse events (TEAEs) and incident hyperkalemia.RESULTSOf 12,990 patients, 108 had a history of nephrectomy at baseline; 101/108 had radical nephrectomy, 55 received finerenone, and 53 received placebo. Baseline mean estimated glomerular filtration rates were numerically lower in patients with a history of nephrectomy (48 ± 17 mL/min/1.73 m2) than in patients without (58 ± 22 mL/min/1.73 m2). For patients with a history of nephrectomy, those who received finerenone had a greater UACR reduction at 4 months versus those who received placebo (least-squares mean ratio to baseline, 0.65 versus 1.09; least-squares mean treatment ratio, 0.60; 95% CI, 0.48-0.76; P<0.001). This reduction was maintained for two years. TEAEs were similar in patients with and without a history of nephrectomy. Among patients with a history of nephrectomy, treatment-emergent hyperkalemia occurred in 7% and 6% of finerenone and placebo groups, respectively.CONCLUSIONSFinerenone reduced albuminuria compared with placebo and demonstrated a safety profile consistent with the overall FIDELITY population in patients with and without a history of nephrectomy at baseline. Finerenone may delay CKD progression and associated morbidity in patients with CKD and T2D, irrespective of nephrectomy status.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"55 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
MicroRNAs (miRs), small non-coding RNAs that regulate gene expression post-transcriptionally, have been shown to vary in their expression throughout chronic kidney disease (CKD) stages, dialysis modality, alterations in LV hypertrophy (LVH), vascular tone, and inflammation. In addition, fluctuations in miR expression have been reported with various hemodialysis regimens, though whether these alterations contribute mechanistically to the observed clinical effects remains unresolved. The relative stability of miRs in biological fluids offers an opportunity for the identification of biomarkers for disease monitoring and assessing for therapeutic intervention. We will review the current understanding of miR regulation within the context of dialysis, to better define the molecular impact of conventional and intensive hemodialysis and guide the development of targeted strategies to mitigate CKD-related complications.
{"title":"The Role of MicroRNA Regulation on Clinical Outcomes in Kidney Disease.","authors":"Carmine A Alberga,Filio Billia,Christopher T Chan","doi":"10.2215/cjn.0000001002","DOIUrl":"https://doi.org/10.2215/cjn.0000001002","url":null,"abstract":"MicroRNAs (miRs), small non-coding RNAs that regulate gene expression post-transcriptionally, have been shown to vary in their expression throughout chronic kidney disease (CKD) stages, dialysis modality, alterations in LV hypertrophy (LVH), vascular tone, and inflammation. In addition, fluctuations in miR expression have been reported with various hemodialysis regimens, though whether these alterations contribute mechanistically to the observed clinical effects remains unresolved. The relative stability of miRs in biological fluids offers an opportunity for the identification of biomarkers for disease monitoring and assessing for therapeutic intervention. We will review the current understanding of miR regulation within the context of dialysis, to better define the molecular impact of conventional and intensive hemodialysis and guide the development of targeted strategies to mitigate CKD-related complications.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"51 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145956218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Medication Dosing in Online Hemodiafiltration: Clinical Considerations.","authors":"Stefano Stuard,Dinesh Chatoth,Kyle Tonnies,Chance Mysayphonh,Michael Anger","doi":"10.2215/cjn.0000001001","DOIUrl":"https://doi.org/10.2215/cjn.0000001001","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"14 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145956057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUNDEndothelin receptor antagonists (ERAs) are considered a potential effective treatment to reduce proteinuria and protect kidney function for patients with chronic kidney disease (CKD); however, they may cause fluid retention. We conducted this meta-analysis to quantify the efficacy and safety of ERAs in CKD.METHODSWe searched Cochrane Library, Ovid Medline, and Ovid Embase for randomized controlled trials up to January 2025. Continuous and dichotomous data were reported as standardized mean differences (SMDs) with 95% confidence intervals (CIs) and risk ratios (RRs) with 95% Cis, respectively.RESULTSFourteen trials enrolling 6,412 patients were included. Compared to the control group, ERAs decreased the risk of end-stage kidney disease (ESKD) [RR=0.76, 95%CI (0.61, 0.96)], reduced the urine protein-to-creatinine ratio (UPCR) [SMD=-0.56, 95%CI (-0.78, -0.35)] and urine albumin-to-creatinine ratio (UACR) [SMD=-0.64, 95%CI (-0.75, -0.53)], achieved more frequent complete proteinuria remission [RR=2.61, 95%CI (1.84, 3.71)] and partial proteinuria remission [RR=1.51, 95%CI (1.32, 1.73)], slowed the decline of estimated glomerular filtration rate (eGFR) in the subgroup with a follow-up duration of at least one year [SMD=0.18, 95%CI (0.04, 0.32)], improved the chronic eGFR slope [SMD=0.15, 95%CI (0.01, 0.30)], and decreased systolic blood pressure [SMD=-0.53, 95%CI (-0.76, -0.30)] and diastolic blood pressure [SMD=-0.78, 95%CI (-1.18, -0.38)]. Although the risk was increased in B-type natriuretic peptide (BNP) [SMD=0.08, 95%CI (0.01, 0.16)] and body weight [SMD=0.15, 95%CI (0.01, 0.29)], ERAs did not increase the incidence of edema, fluid retention, or heart failure. The risk of hypotension was higher with ERAs compared to the control group [RR=1.92, 95%CI (1.36, 2.70)].CONCLUSIONThese findings suggest that ERAs may reduce proteinuria, prevent kidney disease progression, and lower blood pressure in individuals with CKD.
{"title":"Meta-Analysis of Randomized Controlled Trials Assessing the Efficacy and Safety of Endothelin Receptor Antagonists in Chronic Kidney Disease.","authors":"Yunqi Shi,Nan Ye,Guoqin Wang,Hong Cheng","doi":"10.2215/cjn.0000000928","DOIUrl":"https://doi.org/10.2215/cjn.0000000928","url":null,"abstract":"BACKGROUNDEndothelin receptor antagonists (ERAs) are considered a potential effective treatment to reduce proteinuria and protect kidney function for patients with chronic kidney disease (CKD); however, they may cause fluid retention. We conducted this meta-analysis to quantify the efficacy and safety of ERAs in CKD.METHODSWe searched Cochrane Library, Ovid Medline, and Ovid Embase for randomized controlled trials up to January 2025. Continuous and dichotomous data were reported as standardized mean differences (SMDs) with 95% confidence intervals (CIs) and risk ratios (RRs) with 95% Cis, respectively.RESULTSFourteen trials enrolling 6,412 patients were included. Compared to the control group, ERAs decreased the risk of end-stage kidney disease (ESKD) [RR=0.76, 95%CI (0.61, 0.96)], reduced the urine protein-to-creatinine ratio (UPCR) [SMD=-0.56, 95%CI (-0.78, -0.35)] and urine albumin-to-creatinine ratio (UACR) [SMD=-0.64, 95%CI (-0.75, -0.53)], achieved more frequent complete proteinuria remission [RR=2.61, 95%CI (1.84, 3.71)] and partial proteinuria remission [RR=1.51, 95%CI (1.32, 1.73)], slowed the decline of estimated glomerular filtration rate (eGFR) in the subgroup with a follow-up duration of at least one year [SMD=0.18, 95%CI (0.04, 0.32)], improved the chronic eGFR slope [SMD=0.15, 95%CI (0.01, 0.30)], and decreased systolic blood pressure [SMD=-0.53, 95%CI (-0.76, -0.30)] and diastolic blood pressure [SMD=-0.78, 95%CI (-1.18, -0.38)]. Although the risk was increased in B-type natriuretic peptide (BNP) [SMD=0.08, 95%CI (0.01, 0.16)] and body weight [SMD=0.15, 95%CI (0.01, 0.29)], ERAs did not increase the incidence of edema, fluid retention, or heart failure. The risk of hypotension was higher with ERAs compared to the control group [RR=1.92, 95%CI (1.36, 2.70)].CONCLUSIONThese findings suggest that ERAs may reduce proteinuria, prevent kidney disease progression, and lower blood pressure in individuals with CKD.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"39 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145956058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Beyond the Data: An Asian Patient's Perspective on the \"Asian Paradox\" in Kidney Disease.","authors":"Bill Wang","doi":"10.2215/cjn.0000000984","DOIUrl":"https://doi.org/10.2215/cjn.0000000984","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"9 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145956059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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