Loryn W Dass, Anna Williams, Jennifer D Varner, Terri Taylor, Holly Hough, Jessica Sperling, Matthew A Sparks, Allison McElvaine, Rasheed Gbadegesin
{"title":"Addressing the Workforce Crisis in Uronephrology: Design and Initial Observations of the Paired Undergraduate Mentorship Program (PUMP).","authors":"Loryn W Dass, Anna Williams, Jennifer D Varner, Terri Taylor, Holly Hough, Jessica Sperling, Matthew A Sparks, Allison McElvaine, Rasheed Gbadegesin","doi":"10.2215/CJN.0000000601","DOIUrl":"https://doi.org/10.2215/CJN.0000000601","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856539","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}
Muhammad Shahzeb Khan, Ahmed Mustafa Rashid, Tariq Shafi, Janani Rangaswami, David Z I Cherney, Javed Butler
{"title":"Residual Risk of Adverse Kidney and Cardiovascular Outcomes in Patients with Chronic Kidney Disease.","authors":"Muhammad Shahzeb Khan, Ahmed Mustafa Rashid, Tariq Shafi, Janani Rangaswami, David Z I Cherney, Javed Butler","doi":"10.2215/CJN.0000000588","DOIUrl":"10.2215/CJN.0000000588","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840058","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}
Steven Menez, Kathleen F Kerr, Si Cheng, David Hu, Heather Thiessen-Philbrook, Dennis G Moledina, Sherry G Mansour, Alan S Go, T Alp Ikizler, James S Kaufman, Paul L Kimmel, Jonathan Himmelfarb, Steven G Coca, Chirag R Parikh
Background: Acute kidney injury (AKI) increases the risk for chronic kidney disease (CKD). We aimed to identify combinations of clinical variables and biomarkers that predict long-term kidney disease risk after AKI.
Methods: We analyzed data from a prospective cohort of 723 hospitalized patients with AKI in the Assessment, Serial Evaluation, and Subsequent Sequelae of AKI (ASSESS-AKI) Study. Using machine learning, we investigated 75 candidate predictors including biomarkers measured at three-month post-discharge follow-up to predict major adverse kidney events (MAKE) within three years, defined as a decline in eGFR ≥40%, development of end-stage kidney disease (ESKD), or death.
Results: The mean age of study participants was 64 ± 13 years, 68% were men, and 79% were of White race. Two hundred and four (28%) patients developed MAKE over 3 years of follow-up. Random forest and LASSO penalized regression models using all 75 predictors yielded area under the receiver-operating characteristic curve (AUC) values of 0.80 (95% CI: 0.69-0.91) and 0.79 (95% CI: 0.68-0.90) respectively. The most consistently selected predictors were albuminuria, soluble tumor necrosis factor receptor 1 (sTNFR1), and diuretic use. A parsimonious model using the top eight predictor variables showed similarly strong discrimination for MAKE (AUC = 0.78; 95% CI: 0.66-0.90). Clinical impact utility analyses demonstrated that the eight-predictor model would have 55% higher efficiency of post-AKI care (number needed to screen/follow-up for a MAKE event decreased from 3.55 to 1.97). For a kidney-specific outcome of eGFR decline or ESKD, a four-predictor model showed strong discrimination (AUC = 0.82; 95% CI: 0.68-0.96).
Conclusion: Combining clinical data and biomarkers can accurately identify high-risk AKI patients, enabling personalized post-AKI care and improved outcomes.
背景：急性肾损伤（AKI）会增加慢性肾脏疾病（CKD）的风险。我们的目的是找出能预测 AKI 后长期肾病风险的临床变量和生物标志物组合：我们分析了 "AKI 的评估、序列评价和后续后果（ASSESS-AKI）研究 "中 723 名 AKI 住院患者的前瞻性队列数据。我们利用机器学习研究了 75 个候选预测因子，包括出院后三个月随访时测量的生物标志物，以预测三年内的主要不良肾脏事件（MAKE），即 eGFR 下降≥40%、发展为终末期肾病（ESKD）或死亡：研究参与者的平均年龄为 64 ± 13 岁，68% 为男性，79% 为白种人。214名患者（28%）在3年的随访中发展为MAKE。使用所有 75 个预测因子的随机森林和 LASSO 惩罚回归模型得出的接受者工作特征曲线下面积 (AUC) 值分别为 0.80（95% CI：0.69-0.91）和 0.79（95% CI：0.68-0.90）。白蛋白尿、可溶性肿瘤坏死因子受体 1 (sTNFR1) 和使用利尿剂是最一致的预测因子。使用前 8 个预测变量的简化模型显示，MAKE 的分辨力同样很强（AUC = 0.78；95% CI：0.66-0.90）。临床影响效用分析表明，八项预测变量模型可将 AKI 后护理效率提高 55%（筛查/随访 MAKE 事件所需次数从 3.55 降至 1.97）。对于肾脏特异性结果 eGFR 下降或 ESKD，四预测模型显示出很强的区分度（AUC = 0.82；95% CI：0.68-0.96）：结论：结合临床数据和生物标志物可以准确识别高危 AKI 患者，从而实现个性化的 AKI 后护理并改善预后。
{"title":"Biomarker Panels for Predicting Progression of Kidney Disease in Acute Kidney Injury Survivors.","authors":"Steven Menez, Kathleen F Kerr, Si Cheng, David Hu, Heather Thiessen-Philbrook, Dennis G Moledina, Sherry G Mansour, Alan S Go, T Alp Ikizler, James S Kaufman, Paul L Kimmel, Jonathan Himmelfarb, Steven G Coca, Chirag R Parikh","doi":"10.2215/CJN.0000000622","DOIUrl":"https://doi.org/10.2215/CJN.0000000622","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) increases the risk for chronic kidney disease (CKD). We aimed to identify combinations of clinical variables and biomarkers that predict long-term kidney disease risk after AKI.</p><p><strong>Methods: </strong>We analyzed data from a prospective cohort of 723 hospitalized patients with AKI in the Assessment, Serial Evaluation, and Subsequent Sequelae of AKI (ASSESS-AKI) Study. Using machine learning, we investigated 75 candidate predictors including biomarkers measured at three-month post-discharge follow-up to predict major adverse kidney events (MAKE) within three years, defined as a decline in eGFR ≥40%, development of end-stage kidney disease (ESKD), or death.</p><p><strong>Results: </strong>The mean age of study participants was 64 ± 13 years, 68% were men, and 79% were of White race. Two hundred and four (28%) patients developed MAKE over 3 years of follow-up. Random forest and LASSO penalized regression models using all 75 predictors yielded area under the receiver-operating characteristic curve (AUC) values of 0.80 (95% CI: 0.69-0.91) and 0.79 (95% CI: 0.68-0.90) respectively. The most consistently selected predictors were albuminuria, soluble tumor necrosis factor receptor 1 (sTNFR1), and diuretic use. A parsimonious model using the top eight predictor variables showed similarly strong discrimination for MAKE (AUC = 0.78; 95% CI: 0.66-0.90). Clinical impact utility analyses demonstrated that the eight-predictor model would have 55% higher efficiency of post-AKI care (number needed to screen/follow-up for a MAKE event decreased from 3.55 to 1.97). For a kidney-specific outcome of eGFR decline or ESKD, a four-predictor model showed strong discrimination (AUC = 0.82; 95% CI: 0.68-0.96).</p><p><strong>Conclusion: </strong>Combining clinical data and biomarkers can accurately identify high-risk AKI patients, enabling personalized post-AKI care and improved outcomes.</p>","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820076","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}
Rachel E Patzer, Jade Buford, Megan Urbanski, Laura McPherson, Sudeshna Paul, Mengyu Di, Jessica L Harding, Goni Katz-Greenberg, Ana Rossi, Prince Mohan Anand, Amber Reeves-Daniel, Heather Jones, Laura Mulloy, Stephen O Pastan
{"title":"Reducing Disparities in Access to Kidney Transplantation Regional Study: A Randomized Trial in the Southeastern United States.","authors":"Rachel E Patzer, Jade Buford, Megan Urbanski, Laura McPherson, Sudeshna Paul, Mengyu Di, Jessica L Harding, Goni Katz-Greenberg, Ana Rossi, Prince Mohan Anand, Amber Reeves-Daniel, Heather Jones, Laura Mulloy, Stephen O Pastan","doi":"10.2215/CJN.0000000586","DOIUrl":"10.2215/CJN.0000000586","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820079","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}
Sarah A van Eeghen, Natalie J Nokoff, Taryn G Vosters, Maartina J P Oosterom-Eijmael, David Z I Cherney, Irene G M van Valkengoed, Ye Ji Choi, Laura Pyle, Petter Bjornstad, Martin den Heijer, Daniël H van Raalte
Sexual dimorphism plays an important role in the pathogenesis and progression of CKD. Men with CKD often exhibit faster kidney function decline, leading to higher rates of kidney failure and mortality compared with women. Studies suggest that sex hormones may influence this apparent dimorphism, although the mechanisms underlying these influences remain poorly understood. In this review, we first summarize recent findings on sex differences in the prevalence and progression of CKD. Subsequently, we will focus on ( 1 ) the role of sex hormones in these sex differences, ( 2 ) kidney structural and hemodynamic differences between men and women, ( 3 ) the influence of sex hormones on pathophysiological processes leading to kidney disease, including glomerular hyperfiltration and key pathways involved in kidney inflammation and fibrosis, and finally, focus on the consequences of the underrepresentation of women in clinical trials. Understanding these sex differences is critical for advancing precision medicine and improving outcomes for both men and women with CKD.
{"title":"Unraveling Sex Differences in Kidney Health and CKD: A Review of the Effect of Sex Hormones.","authors":"Sarah A van Eeghen, Natalie J Nokoff, Taryn G Vosters, Maartina J P Oosterom-Eijmael, David Z I Cherney, Irene G M van Valkengoed, Ye Ji Choi, Laura Pyle, Petter Bjornstad, Martin den Heijer, Daniël H van Raalte","doi":"10.2215/CJN.0000000642","DOIUrl":"10.2215/CJN.0000000642","url":null,"abstract":"<p><p>Sexual dimorphism plays an important role in the pathogenesis and progression of CKD. Men with CKD often exhibit faster kidney function decline, leading to higher rates of kidney failure and mortality compared with women. Studies suggest that sex hormones may influence this apparent dimorphism, although the mechanisms underlying these influences remain poorly understood. In this review, we first summarize recent findings on sex differences in the prevalence and progression of CKD. Subsequently, we will focus on ( 1 ) the role of sex hormones in these sex differences, ( 2 ) kidney structural and hemodynamic differences between men and women, ( 3 ) the influence of sex hormones on pathophysiological processes leading to kidney disease, including glomerular hyperfiltration and key pathways involved in kidney inflammation and fibrosis, and finally, focus on the consequences of the underrepresentation of women in clinical trials. Understanding these sex differences is critical for advancing precision medicine and improving outcomes for both men and women with CKD.</p>","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820083","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}
Mercedes A Munis, Qiaoling Chen, T Matthew Hill, Min Zhuo, Asher D Schachter, Simran K Bhandari, Aviv Hever, Teresa N Harrison, Ancilla W Fernandes, John J Sim
{"title":"Incidence and Proportion of Primary Focal Segmental Glomerulosclerosis (FSGS) among a Racially and Ethnically Diverse Adult Patient Population between 2010 and 2021.","authors":"Mercedes A Munis, Qiaoling Chen, T Matthew Hill, Min Zhuo, Asher D Schachter, Simran K Bhandari, Aviv Hever, Teresa N Harrison, Ancilla W Fernandes, John J Sim","doi":"10.2215/CJN.0000000590","DOIUrl":"10.2215/CJN.0000000590","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407172","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}
Todd A. Miano, Christina H.W. Brotman, Marc H. Scheetz, Michael G. S. Shashaty
An abstract is unavailable. This article is available as a PDF only.
{"title":"Impact of pseudo-nephrotoxicity on apparent acute kidney injury incidence and severity: a simulation study.","authors":"Todd A. Miano, Christina H.W. Brotman, Marc H. Scheetz, Michael G. S. Shashaty","doi":"10.2215/cjn.0000000623","DOIUrl":"https://doi.org/10.2215/cjn.0000000623","url":null,"abstract":"An abstract is unavailable. This article is available as a PDF only.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"9 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776398","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}
Pub Date : 2024-12-01Epub Date: 2024-11-01DOI: 10.2215/CJN.0000000612
Deepa Jayaram, Ladan Golestaneh
{"title":"Cancer Screening among Patients with Kidney Failure Requiring Hemodialysis: Where We Are and Where We Are Going.","authors":"Deepa Jayaram, Ladan Golestaneh","doi":"10.2215/CJN.0000000612","DOIUrl":"10.2215/CJN.0000000612","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":" ","pages":"1521-1523"},"PeriodicalIF":8.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Dis-impede the Achievement of Euvolemia in Kidney Failure.","authors":"Sagar U Nigwekar, Michael J Cima","doi":"10.2215/CJN.0000000615","DOIUrl":"10.2215/CJN.0000000615","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"19 12","pages":"1518-1520"},"PeriodicalIF":8.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.2215/CJN.0000000000000556
Anitha Ramu, Rosalba Santana de Roberts, Nang San Hti Lar Seng, Gopisree Peringeth, Hana Rajevac, James M Pullman, Meryl Waldman, Ladan Golestaneh, Belinda Jim
{"title":"The Role of Repeat Kidney Biopsies in Lupus Nephritis in a Largely Black and Hispanic Population.","authors":"Anitha Ramu, Rosalba Santana de Roberts, Nang San Hti Lar Seng, Gopisree Peringeth, Hana Rajevac, James M Pullman, Meryl Waldman, Ladan Golestaneh, Belinda Jim","doi":"10.2215/CJN.0000000000000556","DOIUrl":"10.2215/CJN.0000000000000556","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":" ","pages":"1643-1645"},"PeriodicalIF":8.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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