Vikas S Sridhar,Luxcia Kugathasan,Yuliya Lytvyn,Hongyan Liu,Yangqing Deng,Leif Erik Lovblom,Massimo Nardone,Darren A Yuen,Yixiao Chen,Jonathan Hua,Yarden Aronson,Mai Mohsen,S Joseph Kim,Jacob A Udell,Bruce A Perkins,Jasper Stevens,Daan J Touw,Hiddo J L Heerspink,David Z I Cherney,Sunita K S Singh
BACKGROUNDCardiovascular and kidney protective mechanisms with 12 weeks of sodium-glucose cotransporter-2 (SGLT2) inhibitor (dapagliflozin 10 mg daily) were assessed in kidney transplant recipients (KTR) with and without type 2 diabetes (T2D).METHODSThis randomized double-blind, parallel-group, placebo-controlled study enrolled 52 KTR and comprised three sequential physiologic assessments under clamped euglycemia (4-6 mmol/L): baseline, at one week and 12 weeks of treatment. The primary objective was to evaluate blood pressure lowering with dapagliflozin. Secondary outcomes were: iohexol-measured glomerular filtration rate (GFR), natriuresis, body composition, non-invasive cardiac output monitoring, arterial stiffness, heart rate variability, neurohormones, and safety.RESULTSFifty-one KTR completed the study - mean age 53±13 years, 62% with hypertension, 57% with T2D, 50% on renin-angiotensin-aldosterone system (RAAS) inhibitors and mean estimated GFR 68.2±24.4 mL/min/1.73m2. Compared to placebo, dapagliflozin did not lower systolic blood pressure at one or 12 weeks, though it did reduce mean arterial pressure after one week (3.9 mmHg 95% CI -7.5, -0.2). Dapagliflozin led to significant, placebo-adjusted reductions in iohexol-measured GFR from baseline to one week (4.2 ml/min/1.73m2; 95% CI -7.14, -1.24 ml/min/1.73m2) and 12 weeks (-3.49 ml/min/1.73m2; 95% CI -6.33, -0.64). Dapagliflozin significantly increased glucosuria without altering proximal sodium handling or evidence of sympathetic activation. Acute decreases in arterial stiffness (carotid augmentation index -3.5%; 95% CI -6.0, -1.1) were observed in the dapagliflozin group after 12 weeks, though this was not significant compared to placebo. Dapagliflozin was generally safe and well tolerated. No episodes of urinary tract or genitourinary infections were observed in either treatment group throughout the trial.CONCLUSIONDapagliflozin activated expected physiological pathways, though key differences observed in KTR might suggest mechanistic heterogeneity compared to non-transplant populations. Clinical trials evaluating SGLT2 inhibitors in KTR are important to determine whether these mechanistic effects translate to improvements in kidney and cardiovascular outcomes.
研究背景：在伴有和不伴有2型糖尿病（T2D）的肾移植受者（KTR）中，研究人员评估了钠-葡萄糖共转运蛋白-2 （SGLT2）抑制剂（达格列净10mg /天）12周的心血管和肾脏保护机制。方法：这项随机、双盲、平行组、安慰剂对照的研究纳入了52名KTR患者，包括在固定血糖（4-6 mmol/L）下的三个顺序生理评估：基线、治疗1周和治疗12周。主要目的是评估达格列净降低血压的效果。次要结果是：碘己醇测量的肾小球滤过率（GFR）、尿钠、身体成分、无创心输出量监测、动脉僵硬度、心率变异性、神经激素和安全性。结果51名KTR完成了研究，平均年龄53±13岁，62%患有高血压，57%患有T2D， 50%服用肾素-血管紧张素-醛固酮系统（RAAS）抑制剂，平均估计GFR为68.2±24.4 mL/min/1.73m2。与安慰剂相比，达格列净在1周或12周时没有降低收缩压，但在1周后确实降低了平均动脉压（3.9 mmHg, 95% CI -7.5, -0.2）。达格列净导致碘醇测量的GFR从基线到1周（4.2 ml/min/1.73m2; 95% CI -7.14, -1.24 ml/min/1.73m2）和12周（-3.49 ml/min/1.73m2; 95% CI -6.33, -0.64）显著降低。达格列净显著增加血糖，但未改变近端钠处理或交感神经激活的证据。达格列净组在12周后观察到动脉僵硬度的急性下降（颈动脉增强指数-3.5%;95% CI -6.0, -1.1），尽管与安慰剂相比这并不显著。达格列净总体上是安全的，耐受性良好。在整个试验过程中，两组均未观察到尿路或泌尿生殖系统感染的发生。结论：达格列净激活了预期的生理途径，尽管与非移植人群相比，KTR观察到的关键差异可能表明机制异质性。评估SGLT2抑制剂在KTR中的临床试验对于确定这些机制作用是否转化为肾脏和心血管预后的改善非常重要。
{"title":"Efficacy, Mechanisms and Safety of Sodium-Glucose Cotransporter-2 Inhibitors in Kidney Transplant Recipients: A Randomized, Double-Blind, Placebo-Controlled Trial.","authors":"Vikas S Sridhar,Luxcia Kugathasan,Yuliya Lytvyn,Hongyan Liu,Yangqing Deng,Leif Erik Lovblom,Massimo Nardone,Darren A Yuen,Yixiao Chen,Jonathan Hua,Yarden Aronson,Mai Mohsen,S Joseph Kim,Jacob A Udell,Bruce A Perkins,Jasper Stevens,Daan J Touw,Hiddo J L Heerspink,David Z I Cherney,Sunita K S Singh","doi":"10.2215/cjn.0000000951","DOIUrl":"https://doi.org/10.2215/cjn.0000000951","url":null,"abstract":"BACKGROUNDCardiovascular and kidney protective mechanisms with 12 weeks of sodium-glucose cotransporter-2 (SGLT2) inhibitor (dapagliflozin 10 mg daily) were assessed in kidney transplant recipients (KTR) with and without type 2 diabetes (T2D).METHODSThis randomized double-blind, parallel-group, placebo-controlled study enrolled 52 KTR and comprised three sequential physiologic assessments under clamped euglycemia (4-6 mmol/L): baseline, at one week and 12 weeks of treatment. The primary objective was to evaluate blood pressure lowering with dapagliflozin. Secondary outcomes were: iohexol-measured glomerular filtration rate (GFR), natriuresis, body composition, non-invasive cardiac output monitoring, arterial stiffness, heart rate variability, neurohormones, and safety.RESULTSFifty-one KTR completed the study - mean age 53±13 years, 62% with hypertension, 57% with T2D, 50% on renin-angiotensin-aldosterone system (RAAS) inhibitors and mean estimated GFR 68.2±24.4 mL/min/1.73m2. Compared to placebo, dapagliflozin did not lower systolic blood pressure at one or 12 weeks, though it did reduce mean arterial pressure after one week (3.9 mmHg 95% CI -7.5, -0.2). Dapagliflozin led to significant, placebo-adjusted reductions in iohexol-measured GFR from baseline to one week (4.2 ml/min/1.73m2; 95% CI -7.14, -1.24 ml/min/1.73m2) and 12 weeks (-3.49 ml/min/1.73m2; 95% CI -6.33, -0.64). Dapagliflozin significantly increased glucosuria without altering proximal sodium handling or evidence of sympathetic activation. Acute decreases in arterial stiffness (carotid augmentation index -3.5%; 95% CI -6.0, -1.1) were observed in the dapagliflozin group after 12 weeks, though this was not significant compared to placebo. Dapagliflozin was generally safe and well tolerated. No episodes of urinary tract or genitourinary infections were observed in either treatment group throughout the trial.CONCLUSIONDapagliflozin activated expected physiological pathways, though key differences observed in KTR might suggest mechanistic heterogeneity compared to non-transplant populations. Clinical trials evaluating SGLT2 inhibitors in KTR are important to determine whether these mechanistic effects translate to improvements in kidney and cardiovascular outcomes.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"1 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145732822","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}
Rehab Albakr,Dhajanae Sylvertooth,Brian Bieber,Shilpanjali Jesudason,David W Johnson,Hideki Kawanishi,Kosuka Nitta,Yong-Lim Kim,Talerngsak Kanjanabuch,Mihran Naljayan,Roberto Pecoits-Filho,Ronald L Pisoni,Jeffrey Perl,Edwina A Brown
BACKGROUNDSex differences may influence peritoneal dialysis (PD) outcomes for individuals with kidney failure and remain poorly understood. Understanding these differences is important in optimizing dialysis care and addressing disparities in treatment outcomes We sought to explore association of sex with PD outcomes.METHODSData from the international PD Outcomes and Practice Patterns Study (PDOPPS) across eight countries was used to examine sex differences in outcomes, including mortality, transfer to hemodialysis HD, the composite of both, peritonitis risks and kidney transplantation. Cause-specific Cox regression models were used to assess the association between sex and each clinical outcome, adjusting for region, comorbidities, demographic and treatment characteristics.RESULTSOf 26,292 included individuals on PD, 43% were female, ranging from 34% in Japan to 51% in Thailand. Females (compared to males) had lower mortality (rate per 100 patient years [PY100]=10.9 vs.11.3; adjusted hazard ratio {aHR} of mortality 0.92 [95% confidence intervals {CI} 0.86-0.99]), transfer to hemodialysis (PY100=16.3 vs.17.9; aHR=0.87 [95%CI 0.83-0.92]), the composite of both (PY100=27.2 vs.29.0; aHR=0.89 [95% CI 0.85-0.93]) and time to first observed peritonitis (PY100=17.5 vs.18.7; aHR=0.90 [95% CI 0.84-0.95]), while transplant hazards were similar (PY100=4.0 vs.4.0; aHR=0.97 [95% CI 0.87-1.08]). In subgroup and additional analyses, sex differences in outcomes were particularly apparent in South Korea (SK), with a median time on PD of 6.4 years for females and 4.9 years for males, with SK females having lower hemodialysis transfer and transplant rates. Across all countries, diabetes substantially attenuated the lower risks of death and hemodialysis transfer in females. Females had significantly lower risks of gram-positive peritonitis (aHR=0.73 [95% CI 0.65-0.82]).CONCLUSIONSCompared to males, females receiving PD have lower likelihoods of mortality, hemodialysis transfer and peritonitis. Better understanding of these findings will help inform sex-specific strategies for managing PD while enhancing personalized care approaches in this patient population.
{"title":"Sex-Specific Outcomes in The Peritoneal Dialysis Outcomes and Practice Patterns Study.","authors":"Rehab Albakr,Dhajanae Sylvertooth,Brian Bieber,Shilpanjali Jesudason,David W Johnson,Hideki Kawanishi,Kosuka Nitta,Yong-Lim Kim,Talerngsak Kanjanabuch,Mihran Naljayan,Roberto Pecoits-Filho,Ronald L Pisoni,Jeffrey Perl,Edwina A Brown","doi":"10.2215/cjn.0000000937","DOIUrl":"https://doi.org/10.2215/cjn.0000000937","url":null,"abstract":"BACKGROUNDSex differences may influence peritoneal dialysis (PD) outcomes for individuals with kidney failure and remain poorly understood. Understanding these differences is important in optimizing dialysis care and addressing disparities in treatment outcomes We sought to explore association of sex with PD outcomes.METHODSData from the international PD Outcomes and Practice Patterns Study (PDOPPS) across eight countries was used to examine sex differences in outcomes, including mortality, transfer to hemodialysis HD, the composite of both, peritonitis risks and kidney transplantation. Cause-specific Cox regression models were used to assess the association between sex and each clinical outcome, adjusting for region, comorbidities, demographic and treatment characteristics.RESULTSOf 26,292 included individuals on PD, 43% were female, ranging from 34% in Japan to 51% in Thailand. Females (compared to males) had lower mortality (rate per 100 patient years [PY100]=10.9 vs.11.3; adjusted hazard ratio {aHR} of mortality 0.92 [95% confidence intervals {CI} 0.86-0.99]), transfer to hemodialysis (PY100=16.3 vs.17.9; aHR=0.87 [95%CI 0.83-0.92]), the composite of both (PY100=27.2 vs.29.0; aHR=0.89 [95% CI 0.85-0.93]) and time to first observed peritonitis (PY100=17.5 vs.18.7; aHR=0.90 [95% CI 0.84-0.95]), while transplant hazards were similar (PY100=4.0 vs.4.0; aHR=0.97 [95% CI 0.87-1.08]). In subgroup and additional analyses, sex differences in outcomes were particularly apparent in South Korea (SK), with a median time on PD of 6.4 years for females and 4.9 years for males, with SK females having lower hemodialysis transfer and transplant rates. Across all countries, diabetes substantially attenuated the lower risks of death and hemodialysis transfer in females. Females had significantly lower risks of gram-positive peritonitis (aHR=0.73 [95% CI 0.65-0.82]).CONCLUSIONSCompared to males, females receiving PD have lower likelihoods of mortality, hemodialysis transfer and peritonitis. Better understanding of these findings will help inform sex-specific strategies for managing PD while enhancing personalized care approaches in this patient population.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"19 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145717464","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}
Anna M Morenz,David K Prince,Jordan Nichols,Andrew Snyder,James Perkins,Omri Ganzarski,Zakariya Hussein,Bessie A Young,Yue-Harn Ng
BACKGROUND AND OBJECTIVESNeighborhood socioeconomic disadvantage may impact kidney transplant (KT) access and reasons for waitlist denial. We assessed (1) the association between Area Deprivation Index (ADI) and time-to-KT waitlisting and (2) whether evaluation outcomes differ by ADI quartile.DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTSWe conducted a retrospective cohort study of 4,896 adults who were referred for KT evaluation from 1/2015 -12/2021 at the University of Washington, using data collected from the electronic medical record. We used Cox proportional hazards models to evaluate the association of ADI quartile and time to KT waitlisting, adjusting for individual medical and social variables. Multinomial logistic regression was used to assess if KT evaluation outcomes (including waitlist denial reason) differed across ADI quartiles.RESULTSAmong the 3,638 patients who initiated evaluation, 1,381 (38%) were waitlisted. Residents in ADI quartile 4 (Q4) (most disadvantaged) required longer time and were 27% less likely to be waitlisted than residents in Q1 (least disadvantaged) in the adjusted analysis (adjusted odds ratio (aOR) 0.73, 95% confidence interval (CI) 0.62-0.87). Residents in Q4 were more likely to be denied for medical reasons (aOR 2.83, 95% CI 2.03-3.95), non-medical reasons (aOR 2.56, 95% CI 1.80-3.64), or for higher body mass index (BMI) (aOR 2.47, 95% CI 1.40-4.36) than residents in Q1.CONCLUSIONSResidents in disadvantaged neighborhood required longer time and had lower likelihood of KT waitlisting, with variable reasons for denial (medical, psychosocial, and BMI), suggesting a need for individualized interventions to improve KT access. Further work, including qualitative methods, may better specify barriers and inform future interventions to address this disparity.
背景和目的社区社会经济劣势可能影响肾移植（KT）的获取和拒绝候补名单的原因。我们评估了(1)区域剥夺指数（ADI）与等待排队时间之间的关系，(2)评估结果是否因ADI四分位数而不同。设计、环境、参与者和测量我们进行了一项回顾性队列研究，从2015年1月至2021年12月在华盛顿大学转介进行KT评估的4,896名成年人，使用从电子病历收集的数据。我们使用Cox比例风险模型来评估ADI四分位数与KT候补时间的关系，并对个人医疗和社会变量进行了调整。使用多项逻辑回归来评估KT评估结果（包括候补名单拒绝原因）在ADI四分位数之间是否存在差异。结果在3638例启动评估的患者中，有1381例（38%）进入了等待名单。在调整分析中，ADI四分位数4 (Q4)（最弱势）的居民需要更长的时间，比第一季度（最弱势）的居民等待名单的可能性低27%（调整优势比（aOR） 0.73, 95%置信区间（CI） 0.62-0.87）。与第一季度相比，第四季度的居民更有可能因医疗原因（aOR 2.83, 95% CI 2.03-3.95）、非医疗原因（aOR 2.56, 95% CI 1.80-3.64）或较高的身体质量指数（BMI） （aOR 2.47, 95% CI 1.40-4.36）而被拒绝。结论弱势社区的居民需要更长的时间和更低的可能性等待KT，拒绝的原因多种多样（医学、社会心理和BMI），表明需要个性化的干预措施来改善KT的获取。进一步的工作，包括定性方法，可能会更好地明确障碍，并为未来的干预措施提供信息，以解决这一差距。
{"title":"Association between Area Deprivation Index, Kidney Transplant Waitlisting, and Reasons for Denial.","authors":"Anna M Morenz,David K Prince,Jordan Nichols,Andrew Snyder,James Perkins,Omri Ganzarski,Zakariya Hussein,Bessie A Young,Yue-Harn Ng","doi":"10.2215/cjn.0000000939","DOIUrl":"https://doi.org/10.2215/cjn.0000000939","url":null,"abstract":"BACKGROUND AND OBJECTIVESNeighborhood socioeconomic disadvantage may impact kidney transplant (KT) access and reasons for waitlist denial. We assessed (1) the association between Area Deprivation Index (ADI) and time-to-KT waitlisting and (2) whether evaluation outcomes differ by ADI quartile.DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTSWe conducted a retrospective cohort study of 4,896 adults who were referred for KT evaluation from 1/2015 -12/2021 at the University of Washington, using data collected from the electronic medical record. We used Cox proportional hazards models to evaluate the association of ADI quartile and time to KT waitlisting, adjusting for individual medical and social variables. Multinomial logistic regression was used to assess if KT evaluation outcomes (including waitlist denial reason) differed across ADI quartiles.RESULTSAmong the 3,638 patients who initiated evaluation, 1,381 (38%) were waitlisted. Residents in ADI quartile 4 (Q4) (most disadvantaged) required longer time and were 27% less likely to be waitlisted than residents in Q1 (least disadvantaged) in the adjusted analysis (adjusted odds ratio (aOR) 0.73, 95% confidence interval (CI) 0.62-0.87). Residents in Q4 were more likely to be denied for medical reasons (aOR 2.83, 95% CI 2.03-3.95), non-medical reasons (aOR 2.56, 95% CI 1.80-3.64), or for higher body mass index (BMI) (aOR 2.47, 95% CI 1.40-4.36) than residents in Q1.CONCLUSIONSResidents in disadvantaged neighborhood required longer time and had lower likelihood of KT waitlisting, with variable reasons for denial (medical, psychosocial, and BMI), suggesting a need for individualized interventions to improve KT access. Further work, including qualitative methods, may better specify barriers and inform future interventions to address this disparity.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"28 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680606","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":"Blood Pressure Beyond the Dialysis Chair.","authors":"Daniel Gallego","doi":"10.2215/cjn.0000000957","DOIUrl":"https://doi.org/10.2215/cjn.0000000957","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"1 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680594","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":"Boosting CONFIDENCE in Combination Therapy for Diabetic Kidney Disease in Asia.","authors":"Mengyao Tang,Sahir Kalim","doi":"10.2215/cjn.0000000959","DOIUrl":"https://doi.org/10.2215/cjn.0000000959","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"1 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680598","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":"\"See You in the Morning?\"-Can Hypothermic Machine Perfusion Allow Longer Ischemic Times without Compromising Transplant Outcomes?","authors":"Dylan R Barnett,Michael G Collins","doi":"10.2215/cjn.0000000960","DOIUrl":"https://doi.org/10.2215/cjn.0000000960","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"69 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680595","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}
Autosomal dominant polycystic kidney disease (ADPKD) is the most prevalent genetic kidney disorder and is characterized by the progressive growth of multiple kidney cysts, leading to kidney failure in most patients. The management of ADPKD, which up to a decade ago was limited to supportive measures to preserve kidney function and prevent complications, has evolved with the regulatory approval of disease-modifying agents. This review provided an overview of the current status and future perspectives of treatment for ADPKD. At present, the only drugs approved to slow disease progression are the vasopressin V2-receptor antagonist tolvaptan and, in Italy, the somatostatin analogue octreotide long-acting release for the subset of patients with stage 4 chronic kidney disease. However, various therapeutic strategies are under clinical investigation. These include not only repurposed pharmacological agents, namely sodium-glucose cotransporter-2 inhibitors, metformin, and glucagon-like peptide-1 receptor agonists, but also innovative therapies, as it is the case for a monoclonal antibody against pregnancy-associated plasma protein-A, microRNA-17 inhibitors, and the polycystin-1 correcting agent VX-407. Dietary interventions, such as caloric restriction and ketogenic diets, are being tested in clinical trials as well, and could complement pharmacotherapy to slow disease progression. Moreover, the rapid advancements in the field of gene therapy for ADPKD suggest that this approach, though as yet only explored at experimental level, could be translated into clinical practice in future to correct the underlying genetic defect, and potentially reverse disease pathogenesis, thereby improving patient outcomes.
{"title":"THE NEED FOR NOVEL THERAPEUTIC DIRECTIONS IN AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE PATIENT CARE.","authors":"Monica Cortinovis,Norberto Perico,Giuseppe Remuzzi","doi":"10.2215/cjn.0000000975","DOIUrl":"https://doi.org/10.2215/cjn.0000000975","url":null,"abstract":"Autosomal dominant polycystic kidney disease (ADPKD) is the most prevalent genetic kidney disorder and is characterized by the progressive growth of multiple kidney cysts, leading to kidney failure in most patients. The management of ADPKD, which up to a decade ago was limited to supportive measures to preserve kidney function and prevent complications, has evolved with the regulatory approval of disease-modifying agents. This review provided an overview of the current status and future perspectives of treatment for ADPKD. At present, the only drugs approved to slow disease progression are the vasopressin V2-receptor antagonist tolvaptan and, in Italy, the somatostatin analogue octreotide long-acting release for the subset of patients with stage 4 chronic kidney disease. However, various therapeutic strategies are under clinical investigation. These include not only repurposed pharmacological agents, namely sodium-glucose cotransporter-2 inhibitors, metformin, and glucagon-like peptide-1 receptor agonists, but also innovative therapies, as it is the case for a monoclonal antibody against pregnancy-associated plasma protein-A, microRNA-17 inhibitors, and the polycystin-1 correcting agent VX-407. Dietary interventions, such as caloric restriction and ketogenic diets, are being tested in clinical trials as well, and could complement pharmacotherapy to slow disease progression. Moreover, the rapid advancements in the field of gene therapy for ADPKD suggest that this approach, though as yet only explored at experimental level, could be translated into clinical practice in future to correct the underlying genetic defect, and potentially reverse disease pathogenesis, thereby improving patient outcomes.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"1 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680601","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}
Jeffrey Perl,Isaac Teitelbaum,Bradley A Warady,Alicia Neu,Suzanne Watnick,Dinesh Chatoth,Joel Glickman,Kristina Bryant,Margaret Bushey,Meghan Finn,Allison Taylor,Cathie Wahlin,Laurie Wolf,Kerry A Leigh,Joseph Kessler,Edward Gould
For some patients, peritoneal dialysis (PD) has several advantages over center-based hemodialysis (HD). PD-related infections such as peritonitis, and PD catheter exit-site and tunnel infections are a significant source of morbidity. Peritonitis leads to increased mortality, and it is the leading cause of transfer off PD. Infection prevention practices may vary widely across dialysis centers, resulting in significant differences in infection rates. To address these issues and improve patient outcomes, the American Society of Nephrology (ASN) facilitated the development of core interventions aimed at reducing PD-related infections across United States (U.S.)dialysis facilities. The core interventions focus on six key strategies: (1) regular surveillance and feedback on infection rates, (2) standardized staff training and competency assessments, (3) standardized patient and care partner/giver education, (4) routine infection prevention assessments, (5) antimicrobial prophylaxis for PD catheter exit sites, and (6) prophylactic antimicrobials for certain procedures and events. These strategies, based on evidence and international guidelines, emphasize consistency in implementation and monitoring at the facility level. The workgroup followed an iterative process, incorporating expert review and feedback to inform and refine these interventions. Effective implementation requires coordinated efforts among dialysis teams, patients, and support networks, with ongoing evaluation through surveillance and quality improvement initiatives. While the interventions are grounded in current evidence, further research is necessary to refine practices and address emerging challenges. The goal is to reduce infection risks, improve quality of life for patients on PD, and support national efforts to expand home dialysis use.
{"title":"Core Interventions for the Prevention of Peritoneal Dialysis Related Infections.","authors":"Jeffrey Perl,Isaac Teitelbaum,Bradley A Warady,Alicia Neu,Suzanne Watnick,Dinesh Chatoth,Joel Glickman,Kristina Bryant,Margaret Bushey,Meghan Finn,Allison Taylor,Cathie Wahlin,Laurie Wolf,Kerry A Leigh,Joseph Kessler,Edward Gould","doi":"10.2215/cjn.0000000976","DOIUrl":"https://doi.org/10.2215/cjn.0000000976","url":null,"abstract":"For some patients, peritoneal dialysis (PD) has several advantages over center-based hemodialysis (HD). PD-related infections such as peritonitis, and PD catheter exit-site and tunnel infections are a significant source of morbidity. Peritonitis leads to increased mortality, and it is the leading cause of transfer off PD. Infection prevention practices may vary widely across dialysis centers, resulting in significant differences in infection rates. To address these issues and improve patient outcomes, the American Society of Nephrology (ASN) facilitated the development of core interventions aimed at reducing PD-related infections across United States (U.S.)dialysis facilities. The core interventions focus on six key strategies: (1) regular surveillance and feedback on infection rates, (2) standardized staff training and competency assessments, (3) standardized patient and care partner/giver education, (4) routine infection prevention assessments, (5) antimicrobial prophylaxis for PD catheter exit sites, and (6) prophylactic antimicrobials for certain procedures and events. These strategies, based on evidence and international guidelines, emphasize consistency in implementation and monitoring at the facility level. The workgroup followed an iterative process, incorporating expert review and feedback to inform and refine these interventions. Effective implementation requires coordinated efforts among dialysis teams, patients, and support networks, with ongoing evaluation through surveillance and quality improvement initiatives. While the interventions are grounded in current evidence, further research is necessary to refine practices and address emerging challenges. The goal is to reduce infection risks, improve quality of life for patients on PD, and support national efforts to expand home dialysis use.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"28 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680593","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}
Cheol Ho Park,Yujoon Kim,Chaeeun Kim,Chaehyung Kim,Sowon Kim,Kangwon Lee,Tae-Hyun Yoo
BACKGROUNDHyperkalemia is a common electrolyte imbalance leading to an increased risk of serious cardiac dysrhythmias and mortality in patients undergoing hemodialysis. A convenient point-of-care testing (POCT) of potassium levels is considered to improve patient outcomes. However, POCT for potassium level using capillary blood with satisfactory performance is not available.METHODSWe tested the performance of disposable test strips for potassium level using various concentrations of potassium solutions with or without interfering electrolytes in an experimental setting. Subsequently, we examined the agreement between potassium levels measured by disposable test strips and those measured by central laboratory equipment using various types of blood samples, including capillary blood obtained by finger prick, in 40 patients undergoing maintenance hemodialysis. In the analysis, Passing-Bablok regression and Bland-Altman analysis were employed.RESULTSPotassium concentrations measured by disposable test strips showed a high degree of agreement with potassium levels achieved using inductively coupled plasma atomic emission spectroscopy. The coefficient of variations for disposable test strips were less than 5% across potassium concentrations ranging from 2 to 9 mM. Furthermore, potassium levels measured by disposable strips from capillary blood demonstrated a high degree of agreement with potassium levels obtained by central laboratory equipment using serum, showing the slope achieved from Passing-Bablok regression was 1.04 (95% CI, 0.97 to 1.12). Additional analysis with various blood samples also showed similar results.CONCLUSIONPOCT for potassium level using the disposable test strip could be employed for self-monitoring of blood potassium levels in clinical practice.
{"title":"Clinical Evaluation of a Disposable Test Strip for Potassium Level Measurement in Patients Treated with Maintenance Hemodialysis.","authors":"Cheol Ho Park,Yujoon Kim,Chaeeun Kim,Chaehyung Kim,Sowon Kim,Kangwon Lee,Tae-Hyun Yoo","doi":"10.2215/cjn.0000000934","DOIUrl":"https://doi.org/10.2215/cjn.0000000934","url":null,"abstract":"BACKGROUNDHyperkalemia is a common electrolyte imbalance leading to an increased risk of serious cardiac dysrhythmias and mortality in patients undergoing hemodialysis. A convenient point-of-care testing (POCT) of potassium levels is considered to improve patient outcomes. However, POCT for potassium level using capillary blood with satisfactory performance is not available.METHODSWe tested the performance of disposable test strips for potassium level using various concentrations of potassium solutions with or without interfering electrolytes in an experimental setting. Subsequently, we examined the agreement between potassium levels measured by disposable test strips and those measured by central laboratory equipment using various types of blood samples, including capillary blood obtained by finger prick, in 40 patients undergoing maintenance hemodialysis. In the analysis, Passing-Bablok regression and Bland-Altman analysis were employed.RESULTSPotassium concentrations measured by disposable test strips showed a high degree of agreement with potassium levels achieved using inductively coupled plasma atomic emission spectroscopy. The coefficient of variations for disposable test strips were less than 5% across potassium concentrations ranging from 2 to 9 mM. Furthermore, potassium levels measured by disposable strips from capillary blood demonstrated a high degree of agreement with potassium levels obtained by central laboratory equipment using serum, showing the slope achieved from Passing-Bablok regression was 1.04 (95% CI, 0.97 to 1.12). Additional analysis with various blood samples also showed similar results.CONCLUSIONPOCT for potassium level using the disposable test strip could be employed for self-monitoring of blood potassium levels in clinical practice.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"5 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680597","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}
Conflicts severely disrupt care for patients with kidney failure, often limiting access to dialysis. In these challenging settings, conservative kidney management (CKM) emerges as a compassionate alternative focused on quality of life and symptom relief. This study explores how conflict conditions shape nephrologists' perceptions and implementation of CKM across the Middle East and North Africa (MENA) region. A web-based survey was distributed across 17 Arabic-speaking MENA countries over three months in 2022. Responses were divided into two groups according to the country's conflict status. Of the 334 nephrologist respondents, 66 were practicing in conflict zones and 268 in non-conflict zones. Conflict-zone respondents were more likely to work part-time and less likely to be female. Dialysis in conflict zones was more likely funded by charitable sources (OR 4.22, 95% CI 1.36-13.07). Compared to non-conflict zones, nephrologists in conflict areas reported significantly less access to palliative care (OR 3.36, 95% CI 1.3-8.68) and cited lack of CKM training and limited access to CKM programs as barriers to its implementation (OR 2.59, 95% CI 1.24-5.38 and OR 3.42, 95% CI 1.59-7.35, respectively). While overall awareness of CKM was similar, those in conflict zones expressed greater moral and religious discomfort with withholding dialysis. These findings underscore important ethical, operational, and access-related disparities in CKM delivery in conflict zones in the MENA region. Addressing these gaps through supportive ethical policies focusing on procedural and distributive justice, increased nephrologists' awareness and training, and enhanced efforts to strengthen palliative care services are essential tools for establishing CKM as a viable and ethical approach for patients in conflict-affected regions.
冲突严重扰乱了对肾衰竭患者的护理，往往限制了透析的获得。在这些具有挑战性的环境中，保守肾脏管理（CKM）作为一种关注生活质量和症状缓解的富有同情心的替代方案出现。本研究探讨了冲突条件如何影响肾病学家对中东和北非（MENA）地区CKM的看法和实施。2022年，一项基于网络的调查在17个讲阿拉伯语的中东和北非国家进行了为期三个月的分发。根据该国的冲突状况，回答被分为两组。在334名接受调查的肾病专家中，66名在冲突地区执业，268名在非冲突地区执业。冲突地区的受访者更有可能从事兼职工作，女性的可能性更小。冲突地区的透析更有可能由慈善机构资助（OR 4.22, 95% CI 1.36-13.07）。与非冲突地区相比，冲突地区的肾病学家获得姑息治疗的机会明显更少（OR 3.36, 95% CI 1.3-8.68），并将CKM培训的缺乏和CKM项目的有限获取列为实施的障碍（OR 2.59, 95% CI 1.24-5.38和OR 3.42, 95% CI 1.59-7.35）。虽然对CKM的总体认识是相似的，但冲突地区的人对停止透析表现出更大的道德和宗教不适。这些研究结果强调了中东和北非地区冲突地区在提供CKM方面存在的重要的道德、操作和可及性差异。通过注重程序和分配公正的支持性伦理政策、提高肾病学家的意识和培训以及加强姑息治疗服务来解决这些差距，是为受冲突影响地区的患者建立CKM作为一种可行和合乎道德的方法的重要工具。
{"title":"Conservative Kidney Management in the Middle East and North Africa: A Comparative Study of Conflict and Non-Conflict Settings.","authors":"Akram Al-Makki,David Gunderman,Valerie Luyckx,Taha Hatab,Imed Helal,Mayssaa Hoteit,Rana Yamout,Ala Ali,Abdulhafid Shebani,Najib AbuOsba,Mohamed H Sayegh,Krishna Allam,Sahar Koubar","doi":"10.2215/cjn.0000000900","DOIUrl":"https://doi.org/10.2215/cjn.0000000900","url":null,"abstract":"Conflicts severely disrupt care for patients with kidney failure, often limiting access to dialysis. In these challenging settings, conservative kidney management (CKM) emerges as a compassionate alternative focused on quality of life and symptom relief. This study explores how conflict conditions shape nephrologists' perceptions and implementation of CKM across the Middle East and North Africa (MENA) region. A web-based survey was distributed across 17 Arabic-speaking MENA countries over three months in 2022. Responses were divided into two groups according to the country's conflict status. Of the 334 nephrologist respondents, 66 were practicing in conflict zones and 268 in non-conflict zones. Conflict-zone respondents were more likely to work part-time and less likely to be female. Dialysis in conflict zones was more likely funded by charitable sources (OR 4.22, 95% CI 1.36-13.07). Compared to non-conflict zones, nephrologists in conflict areas reported significantly less access to palliative care (OR 3.36, 95% CI 1.3-8.68) and cited lack of CKM training and limited access to CKM programs as barriers to its implementation (OR 2.59, 95% CI 1.24-5.38 and OR 3.42, 95% CI 1.59-7.35, respectively). While overall awareness of CKM was similar, those in conflict zones expressed greater moral and religious discomfort with withholding dialysis. These findings underscore important ethical, operational, and access-related disparities in CKM delivery in conflict zones in the MENA region. Addressing these gaps through supportive ethical policies focusing on procedural and distributive justice, increased nephrologists' awareness and training, and enhanced efforts to strengthen palliative care services are essential tools for establishing CKM as a viable and ethical approach for patients in conflict-affected regions.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"36 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680596","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：