Clinical Journal of the American Society of Nephrology最新文献

英文中文

Advancing Equitable Kidney Care through Population Health Approaches in Los Angeles County's Safety Net System

IF 9.8 1区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Journal of the American Society of Nephrology

Pub Date : 2024-11-25 DOI: 10.2215/cjn.0000000634

Kamyar Kalantar-Zadeh, Evan A Raff, Chyi-Chyi Chong, Jane K. Yang, Thomas K Le, Lilly M. Barba, Phuong-Chi Pham, Rajiv Dhamija, Arshia Ghaffari, Annika Khine, Nina Patel, Susanne B. Nicholas, John J. Sim, Hal F. Jr Yee, Belinda A. Waltman, Nina J. Park

An abstract is unavailable. This article is available as a PDF only.

引用次数: 0

Community Health Center penetration and kidney care outcomes among low-income, nonelderly adults with kidney failure

IF 9.8 1区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Journal of the American Society of Nephrology

Pub Date : 2024-11-25 DOI: 10.2215/cjn.0000000598

Yoshio N. Hall, Wyatt P. Bensken, Suzanne E. Morrissey, Indhira De La Cruz Alcantara, Mark L. Unruh, David K. Prince

Health Centers (CHCs) for affordable ambulatory care. Methods: We conducted a retrospective cohort study of 139,275 adults aged 18-64 years who were enrolled in Medicaid or uninsured at time of end-stage kidney disease (ESKD) onset during 2016-2020. We examined whether CHC penetration of the state-level low-income population was associated with ESKD incidence, process measures reflective of pre-ESKD care quality, and survival and kidney transplant waitlisting one year after ESKD onset. We obtained population characteristics of the 1,370 Health Resources and Services Administration CHCs and 50 states (and the District of Columbia) for the same period. Results: Mean CHC penetration among low-income residents (percentage of low-income residents who were CHC patients in each state) was 36% (standard deviation, 19%). The Northeast (Census region) had the highest proportion of states with high CHC penetration and the South had the highest proportion of states with low CHC penetration. The prevalence of diabetes mellitus, high blood pressure, and obesity were lower in states with high versus low CHC penetration. There were no significant differences in age- and sex-standardized ESKD incidence according to CHC penetration. In individual-level analyses, higher CHC penetration was significantly associated with a higher likelihood of prolonged nephrology care (adjusted odds ratio [OR]: 1.04 [95% confidence intervals [CI]: 1.03, 1.05]), arteriovenous fistula or graft usage at hemodialysis initiation (OR: 1.11 [95% CI: 1.09, 1.12]), home dialysis usage (OR: 1.04 [95% CI: 1.02, 1.05]), and one-year kidney transplant waitlisting (OR: 1.19 [95% CI: 1.18, 1.21]) and ESKD survival (OR: 1.06 [95% CI: 1.04, 1.07]). Conclusions: Among Medicaid enrollees and uninsured adults with incident kidney failure, higher CHC penetration was associated with a lower prevalence of kidney disease risk factors, and better preparedness for, and higher survival after, ESKD onset. These findings warrant additional study into the role and impact of Community Health Centers in addressing longstanding disparities in kidney health. Copyright © 2024 by the American Society of Nephrology...

{"title":"Community Health Center penetration and kidney care outcomes among low-income, nonelderly adults with kidney failure","authors":"Yoshio N. Hall, Wyatt P. Bensken, Suzanne E. Morrissey, Indhira De La Cruz Alcantara, Mark L. Unruh, David K. Prince","doi":"10.2215/cjn.0000000598","DOIUrl":"https://doi.org/10.2215/cjn.0000000598","url":null,"abstract":" Health Centers (CHCs) for affordable ambulatory care. Methods: We conducted a retrospective cohort study of 139,275 adults aged 18-64 years who were enrolled in Medicaid or uninsured at time of end-stage kidney disease (ESKD) onset during 2016-2020. We examined whether CHC penetration of the state-level low-income population was associated with ESKD incidence, process measures reflective of pre-ESKD care quality, and survival and kidney transplant waitlisting one year after ESKD onset. We obtained population characteristics of the 1,370 Health Resources and Services Administration CHCs and 50 states (and the District of Columbia) for the same period. Results: Mean CHC penetration among low-income residents (percentage of low-income residents who were CHC patients in each state) was 36% (standard deviation, 19%). The Northeast (Census region) had the highest proportion of states with high CHC penetration and the South had the highest proportion of states with low CHC penetration. The prevalence of diabetes mellitus, high blood pressure, and obesity were lower in states with high versus low CHC penetration. There were no significant differences in age- and sex-standardized ESKD incidence according to CHC penetration. In individual-level analyses, higher CHC penetration was significantly associated with a higher likelihood of prolonged nephrology care (adjusted odds ratio [OR]: 1.04 [95% confidence intervals [CI]: 1.03, 1.05]), arteriovenous fistula or graft usage at hemodialysis initiation (OR: 1.11 [95% CI: 1.09, 1.12]), home dialysis usage (OR: 1.04 [95% CI: 1.02, 1.05]), and one-year kidney transplant waitlisting (OR: 1.19 [95% CI: 1.18, 1.21]) and ESKD survival (OR: 1.06 [95% CI: 1.04, 1.07]). Conclusions: Among Medicaid enrollees and uninsured adults with incident kidney failure, higher CHC penetration was associated with a lower prevalence of kidney disease risk factors, and better preparedness for, and higher survival after, ESKD onset. These findings warrant additional study into the role and impact of Community Health Centers in addressing longstanding disparities in kidney health. Copyright © 2024 by the American Society of Nephrology...","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"17 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752849","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}

引用次数: 0

The Trojan Horse of Kidney Transplantation Returns: A Review and Call for Financial Neutrality

IF 9.8 1区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Journal of the American Society of Nephrology

Pub Date : 2024-11-22 DOI: 10.2215/cjn.0000000633

Gabriel M. Danovitch

ebate over payments to donors is discussed with particular emphasis on the national and international ramifications of such payments, the impact on normative “altruistic” donation, and the nature of the relationship between the doctor and the patient in the donor work up process. A way forward is proposed through the promotion of “Financial Neutrality” and expanded efforts to prevent chronic kidney disease. Publications in both the lay and academic press suggest that the problem of long waiting lists for deceased donor kidney transplants could be solved if only the National Organ Transplant Act (NOTA) were changed to permit various forms of financial incentives to kidney donors. The history of the debate over payments to donors is discussed with particular emphasis on the national and international ramifications of such payments, the impact on normative “altruistic” donation, and the nature of the relationship between the doctor and the patient in the donor work up process. A way forward is proposed through the promotion of “Financial Neutrality” and expanded efforts to prevent chronic kidney disease. Copyright © 2024 by the American Society of Nephrology...

{"title":"The Trojan Horse of Kidney Transplantation Returns: A Review and Call for Financial Neutrality","authors":"Gabriel M. Danovitch","doi":"10.2215/cjn.0000000633","DOIUrl":"https://doi.org/10.2215/cjn.0000000633","url":null,"abstract":"ebate over payments to donors is discussed with particular emphasis on the national and international ramifications of such payments, the impact on normative “altruistic” donation, and the nature of the relationship between the doctor and the patient in the donor work up process. A way forward is proposed through the promotion of “Financial Neutrality” and expanded efforts to prevent chronic kidney disease. Publications in both the lay and academic press suggest that the problem of long waiting lists for deceased donor kidney transplants could be solved if only the National Organ Transplant Act (NOTA) were changed to permit various forms of financial incentives to kidney donors. The history of the debate over payments to donors is discussed with particular emphasis on the national and international ramifications of such payments, the impact on normative “altruistic” donation, and the nature of the relationship between the doctor and the patient in the donor work up process. A way forward is proposed through the promotion of “Financial Neutrality” and expanded efforts to prevent chronic kidney disease. Copyright © 2024 by the American Society of Nephrology...","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"23 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752850","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}

引用次数: 0

Obstacles and Opportunities for Albuminuria Testing On the Basis of the Perspective of Primary Care: A Qualitative Study. 基于基层医疗机构视角的白蛋白尿检测障碍与机遇：定性研究。

IF 8.5 1区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Journal of the American Society of Nephrology

Pub Date : 2024-11-21 DOI: 10.2215/CJN.0000000620

Agnès Oude Engberink, Julie Marc, Elodie Renk, Philippe Serayet, Gérard Bourrel, Olivier Moranne

引用次数: 0

Treating Metabolic Acidosis for CKD Progression? Need for Higher Quality Data 治疗代谢性酸中毒以防止 CKD 进展？需要更高质量的数据

IF 9.8 1区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Journal of the American Society of Nephrology

Pub Date : 2024-11-20 DOI: 10.2215/cjn.0000000632

Stella Kilduff, Denver D. Brown, Michal L. Melamed

An abstract is unavailable. This article is available as a PDF only.

无摘要。本文仅以 PDF 格式提供。

引用次数: 0

Risk of Major Adverse Cardiovascular Events in Home Dialysis Compared to In-Center Hemodialysis 家庭透析与中心血液透析相比发生主要不良心血管事件的风险

IF 9.8 1区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Journal of the American Society of Nephrology

Pub Date : 2024-11-19 DOI: 10.2215/cjn.0000000579

Wisam Bitar, Jaakko Helve, Mikko Haapio, Virpi Rauta, Eero Honkanen, Patrik Finne

d continuous ambulatory peritoneal dialysis (CAPD), automated peritoneal dialysis (APD) and home hemodialysis (HD) with in-center HD patients. Methods: We included 968 patients who entered dialysis in the Helsinki-Uusimaa healthcare district in Finland from 2004 to 2017, of whom 162 were on CAPD, 229 on APD, 145 on home HD and 432 on in-center HD at day 90 from the start of dialysis. MACE was defined as acute myocardial infarction, stroke, or death due to cardiovascular disease. The cumulative incidence of the first MACE was calculated. Cox regression was used to compare risk of MACE between dialysis modalities with adjustment for potential confounding factors. Results: Of all 968 patients, 195 (20%) experienced a MACE during the entire follow-up and 62 (6%) during the first year of follow-up. The cumulative incidence of first MACE was similar in in-center HD and CAPD patients and higher than that in APD and home HD patients. After adjustment for possible confounders, the hazard ratio (HR) of MACE was 1.22 [95% confidence intervals (CI) 0.73–2.05] for CAPD, 0.86 [95% CI 0.47–1.57] for APD and 0.67 [95% CI 0.30–1.50] for home HD compared to in-center HD. Unexpectedly, compared to in-center HD, PD associated with lower risk of MACE among females (HR 0.37, 95% CI 0.14–0.99) and higher risk among males (HR 1.80, 95% CI 1.11–2.92). Conclusions: In this cohort, the risk of MACE was comparable across in-center and home dialysis modalities. However, the result differed between males and females, which requires further research. Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Nephrology...

与中心内血液透析（HD）患者进行连续非卧床腹膜透析（CAPD）、自动腹膜透析（APD）和家庭血液透析（HD）。方法：我们纳入了2004年至2017年期间在芬兰赫尔辛基-乌西马医疗保健区进行透析的968名患者，其中162人在开始透析后的第90天进行了CAPD透析，229人进行了APD透析，145人进行了家庭血液透析，432人进行了中心内血液透析。MACE定义为急性心肌梗死、中风或心血管疾病导致的死亡。计算首次 MACE 的累积发生率。在对潜在混杂因素进行调整后，采用 Cox 回归比较不同透析方式的 MACE 风险。结果：在所有968名患者中，195人（20%）在整个随访期间发生过MACE，62人（6%）在随访第一年发生过MACE。中心内 HD 和 CAPD 患者首次 MACE 的累积发生率相似，但高于 APD 和家庭 HD 患者。对可能的混杂因素进行调整后，与中心内 HD 相比，CAPD 的 MACE 危险比 (HR) 为 1.22 [95% 置信区间 (CI) 0.73-2.05]，APD 为 0.86 [95% CI 0.47-1.57]，家庭 HD 为 0.67 [95% CI 0.30-1.50]。意外的是，与中心内 HD 相比，PD 与女性 MACE 风险较低（HR 0.37，95% CI 0.14-0.99）和男性 MACE 风险较高（HR 1.80，95% CI 1.11-2.92）相关。结论在该队列中，中心内透析和家庭透析的MACE风险相当。但是，男性和女性的结果有所不同，这需要进一步研究。版权所有 © 2024 作者。由 Wolters Kluwer Health, Inc. 代表美国肾脏病学会出版...

{"title":"Risk of Major Adverse Cardiovascular Events in Home Dialysis Compared to In-Center Hemodialysis","authors":"Wisam Bitar, Jaakko Helve, Mikko Haapio, Virpi Rauta, Eero Honkanen, Patrik Finne","doi":"10.2215/cjn.0000000579","DOIUrl":"https://doi.org/10.2215/cjn.0000000579","url":null,"abstract":"d continuous ambulatory peritoneal dialysis (CAPD), automated peritoneal dialysis (APD) and home hemodialysis (HD) with in-center HD patients. Methods: We included 968 patients who entered dialysis in the Helsinki-Uusimaa healthcare district in Finland from 2004 to 2017, of whom 162 were on CAPD, 229 on APD, 145 on home HD and 432 on in-center HD at day 90 from the start of dialysis. MACE was defined as acute myocardial infarction, stroke, or death due to cardiovascular disease. The cumulative incidence of the first MACE was calculated. Cox regression was used to compare risk of MACE between dialysis modalities with adjustment for potential confounding factors. Results: Of all 968 patients, 195 (20%) experienced a MACE during the entire follow-up and 62 (6%) during the first year of follow-up. The cumulative incidence of first MACE was similar in in-center HD and CAPD patients and higher than that in APD and home HD patients. After adjustment for possible confounders, the hazard ratio (HR) of MACE was 1.22 [95% confidence intervals (CI) 0.73–2.05] for CAPD, 0.86 [95% CI 0.47–1.57] for APD and 0.67 [95% CI 0.30–1.50] for home HD compared to in-center HD. Unexpectedly, compared to in-center HD, PD associated with lower risk of MACE among females (HR 0.37, 95% CI 0.14–0.99) and higher risk among males (HR 1.80, 95% CI 1.11–2.92). Conclusions: In this cohort, the risk of MACE was comparable across in-center and home dialysis modalities. However, the result differed between males and females, which requires further research. Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Nephrology...","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"19 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142679170","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}

引用次数: 0

Fracture in Association with Anticoagulant Therapy in Patients with Chronic Kidney Disease and Atrial Fibrillation 慢性肾病和心房颤动患者骨折与抗凝疗法的关系

IF 9.8 1区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Journal of the American Society of Nephrology

Pub Date : 2024-11-19 DOI: 10.2215/cjn.0000000578

Nazleen F. Khan, Seoyoung C. Kim, Su Been Lee, Katsiaryna Bykov, Julie M. Paik

. Methods: We conducted a new user, active comparator cohort study in a United States-based commercial claims database spanning 2013 through 2020 to quantify the comparative risk of fracture associated with select DOACs (apixaban or rivaroxaban) versus warfarin. Individuals were required to have International Classification of Diseases diagnosis codes for CKD (stages 3-5) and atrial fibrillation during the 365-day baseline period before anticoagulant initiation. Primary analyses quantified non-vertebral fracture risk between patients initiating DOACs and warfarin using a 1:1 propensity score-matched design. Cox proportional hazards regression was used to obtain hazard ratios (HRs) and 95% confidence intervals (CIs) of non-vertebral fracture. Secondary analyses evaluated risks of hip fracture and all-cause mortality. Results: The 1:1 propensity score-matched population included 14,370 DOAC initiators and 14,370 warfarin initiators. The mean age at anticoagulant initiation was 77 years, and 45% were female. The HR for non-vertebral fracture comparing DOACs to warfarin was 1.12 (95% CI 0.95, 1.32), and the corresponding incidence rate difference (IRD) per 1,000 person-years was 3.55 (95% CI -1.67, 8.76). The HR and IRD comparing DOACs to warfarin were 0.98 (95% CI 0.68, 1.41) and -0.13 (95% CI, -2.52, 2.25), respectively for hip fracture and 0.91 (95% CI 0.85, 0.98) and -17.23 (95% CI, -29.49, -4.96), respectively for all-cause mortality. Conclusions: In patients with CKD and atrial fibrillation, we did not observe a difference in the rates of fracture between DOAC and warfarin initiators. DOAC use relative to warfarin was associated with a lower risk of all-cause mortality. Copyright © 2024 by the American Society of Nephrology...

.方法：我们在一个基于美国的商业索赔数据库中开展了一项新用户、主动比较队列研究，研究时间跨度为 2013 年至 2020 年，目的是量化选定 DOAC（阿哌沙班或利伐沙班）与华法林的骨折比较风险。在开始使用抗凝药物前的 365 天基线期间，患者必须具有国际疾病分类诊断代码，即 CKD（3-5 期）和心房颤动。主要分析采用 1:1 倾向评分匹配设计，量化了开始使用 DOAC 和华法林的患者之间的非椎体骨折风险。采用 Cox 比例危险回归法得出非椎体骨折的危险比 (HR) 和 95% 置信区间 (CI)。二次分析评估了髋部骨折和全因死亡率的风险。结果：1:1 倾向评分匹配人群包括 14,370 名 DOAC 启动者和 14,370 名华法林启动者。开始使用抗凝剂时的平均年龄为 77 岁，45% 为女性。DOAC 与华法林相比，非椎体骨折的 HR 为 1.12（95% CI 0.95，1.32），相应的每千人年发病率差异 (IRD) 为 3.55（95% CI -1.67，8.76）。DOAC 与华法林相比，髋部骨折的 HR 和 IRD 分别为 0.98 (95% CI 0.68, 1.41) 和 -0.13 (95% CI, -2.52, 2.25)，全因死亡率的 HR 和 IRD 分别为 0.91 (95% CI 0.85, 0.98) 和 -17.23 (95% CI, -29.49, -4.96)。结论在患有慢性肾脏病和心房颤动的患者中，我们没有观察到 DOAC 和华法林启动者的骨折发生率存在差异。与华法林相比，使用 DOAC 与较低的全因死亡风险相关。美国肾脏病学会版权所有 © 2024...

{"title":"Fracture in Association with Anticoagulant Therapy in Patients with Chronic Kidney Disease and Atrial Fibrillation","authors":"Nazleen F. Khan, Seoyoung C. Kim, Su Been Lee, Katsiaryna Bykov, Julie M. Paik","doi":"10.2215/cjn.0000000578","DOIUrl":"https://doi.org/10.2215/cjn.0000000578","url":null,"abstract":". Methods: We conducted a new user, active comparator cohort study in a United States-based commercial claims database spanning 2013 through 2020 to quantify the comparative risk of fracture associated with select DOACs (apixaban or rivaroxaban) versus warfarin. Individuals were required to have International Classification of Diseases diagnosis codes for CKD (stages 3-5) and atrial fibrillation during the 365-day baseline period before anticoagulant initiation. Primary analyses quantified non-vertebral fracture risk between patients initiating DOACs and warfarin using a 1:1 propensity score-matched design. Cox proportional hazards regression was used to obtain hazard ratios (HRs) and 95% confidence intervals (CIs) of non-vertebral fracture. Secondary analyses evaluated risks of hip fracture and all-cause mortality. Results: The 1:1 propensity score-matched population included 14,370 DOAC initiators and 14,370 warfarin initiators. The mean age at anticoagulant initiation was 77 years, and 45% were female. The HR for non-vertebral fracture comparing DOACs to warfarin was 1.12 (95% CI 0.95, 1.32), and the corresponding incidence rate difference (IRD) per 1,000 person-years was 3.55 (95% CI -1.67, 8.76). The HR and IRD comparing DOACs to warfarin were 0.98 (95% CI 0.68, 1.41) and -0.13 (95% CI, -2.52, 2.25), respectively for hip fracture and 0.91 (95% CI 0.85, 0.98) and -17.23 (95% CI, -29.49, -4.96), respectively for all-cause mortality. Conclusions: In patients with CKD and atrial fibrillation, we did not observe a difference in the rates of fracture between DOAC and warfarin initiators. DOAC use relative to warfarin was associated with a lower risk of all-cause mortality. Copyright © 2024 by the American Society of Nephrology...","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"14 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142679177","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}

引用次数: 0

Peritoneal Dialysis Modality Choice: Not an Automated Decision 腹膜透析方式的选择：非自动决定

IF 9.8 1区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Journal of the American Society of Nephrology

Pub Date : 2024-11-18 DOI: 10.2215/cjn.0000000627

Adrian McGrath, Jeffrey Perl, Edwina A Brown

An abstract is unavailable. This article is available as a PDF only.

无摘要。本文仅以 PDF 格式提供。

引用次数: 0

Use of Aspirin and Initial Cardiovascular and Bleeding Risk in Patients with Chronic Kidney Disease 阿司匹林的使用与慢性肾病患者最初的心血管和出血风险

IF 9.8 1区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Journal of the American Society of Nephrology

Pub Date : 2024-11-14 DOI: 10.2215/cjn.0000000619

Jae Young Kim, Hyunsun Lim, Cheol Ho Park, Hyung Woo Kim, Tae Ik Chang, Seung Hyeok Han

d the first cardiovascular and bleeding events using Korean nationwide cohort data. Methods: Among individuals aged 40–79 years with an estimated glomerular filtration rate between 15 and 59 mL/min/1.73 m2 who underwent routine health examinations between 2011 and 2016, 15,861 individuals who were newly prescribed aspirin at a dose of 100 mg/day were matched with 79,305 aspirin non-users by propensity score matching. The primary efficacy outcome was a composite of nonfatal atherosclerotic CVD or cardiovascular death. The primary safety outcome was hospitalization due to intracranial or gastrointestinal bleeding. Results: During a mean follow-up of 6.9±2.9 years, the incidence rates for the primary efficacy outcome in aspirin users and non-users were 8.0 and 9.0 per 1,000 person-years, respectively. Aspirin therapy initiation was not associated with the primary efficacy outcome (hazard ratio [HR], 0.93; 95% confidence intervals [CI], 0.86-1.04). However, the primary safety outcome of major bleeding was more frequent in aspirin users than in non-users (6.7 versus 4.7 per 1,000 person-years). The HR for this outcome in aspirin users versus non-users was 1.45 (95% CI, 1.32-1.59). Conclusions: No association was observed between aspirin use and the risk of nonfatal atherosclerotic CVD or cardiovascular death in patients with CKD stages G3 and G4 without prior CVD. Aspirin use was associated with higher risk of major bleeding. Copyright © 2024 by the American Society of Nephrology...

利用韩国全国范围内的队列数据，分析首次心血管和出血事件的发生率。方法：在 2011 年至 2016 年期间接受常规健康检查的 40-79 岁、估计肾小球滤过率在 15 至 59 mL/min/1.73 m2 之间的人群中，15861 名新处方阿司匹林剂量为 100 mg/天的患者与 79305 名未使用阿司匹林的患者通过倾向得分匹配进行了配对。主要疗效结果是非致死性动脉粥样硬化性心血管疾病或心血管死亡的复合结果。主要安全性结果是因颅内出血或消化道出血而住院。研究结果在平均 6.9±2.9 年的随访期间，阿司匹林使用者和非使用者的主要疗效发生率分别为每千人年 8.0 例和 9.0 例。阿司匹林治疗的开始与主要疗效结果无关（危险比 [HR]，0.93；95% 置信区间 [CI]，0.86-1.04）。然而，阿司匹林使用者比非使用者更容易出现大出血这一主要安全性结果（每千人年6.7例对4.7例）。使用阿司匹林的患者与未使用阿司匹林的患者相比，这一结果的HR值为1.45（95% CI，1.32-1.59）。结论在未患过心血管疾病的 G3 和 G4 期慢性肾脏病患者中，未观察到使用阿司匹林与非致死性动脉粥样硬化性心血管疾病或心血管死亡风险之间存在关联。使用阿司匹林与较高的大出血风险有关。美国肾脏病学会版权所有© 2024...

{"title":"Use of Aspirin and Initial Cardiovascular and Bleeding Risk in Patients with Chronic Kidney Disease","authors":"Jae Young Kim, Hyunsun Lim, Cheol Ho Park, Hyung Woo Kim, Tae Ik Chang, Seung Hyeok Han","doi":"10.2215/cjn.0000000619","DOIUrl":"https://doi.org/10.2215/cjn.0000000619","url":null,"abstract":"d the first cardiovascular and bleeding events using Korean nationwide cohort data. Methods: Among individuals aged 40–79 years with an estimated glomerular filtration rate between 15 and 59 mL/min/1.73 m2 who underwent routine health examinations between 2011 and 2016, 15,861 individuals who were newly prescribed aspirin at a dose of 100 mg/day were matched with 79,305 aspirin non-users by propensity score matching. The primary efficacy outcome was a composite of nonfatal atherosclerotic CVD or cardiovascular death. The primary safety outcome was hospitalization due to intracranial or gastrointestinal bleeding. Results: During a mean follow-up of 6.9±2.9 years, the incidence rates for the primary efficacy outcome in aspirin users and non-users were 8.0 and 9.0 per 1,000 person-years, respectively. Aspirin therapy initiation was not associated with the primary efficacy outcome (hazard ratio [HR], 0.93; 95% confidence intervals [CI], 0.86-1.04). However, the primary safety outcome of major bleeding was more frequent in aspirin users than in non-users (6.7 versus 4.7 per 1,000 person-years). The HR for this outcome in aspirin users versus non-users was 1.45 (95% CI, 1.32-1.59). Conclusions: No association was observed between aspirin use and the risk of nonfatal atherosclerotic CVD or cardiovascular death in patients with CKD stages G3 and G4 without prior CVD. Aspirin use was associated with higher risk of major bleeding. Copyright © 2024 by the American Society of Nephrology...","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"7 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142679174","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}

引用次数: 0

Bisphosphonate Use after Kidney Transplantation Is Associated with Lower Fracture Risk. 肾移植后使用双膦酸盐可降低骨折风险

IF 8.5 1区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Journal of the American Society of Nephrology

Pub Date : 2024-11-05 DOI: 10.2215/CJN.0000000591

Joseph M Kahwaji, Su-Jau Yang, John J Sim, Chong Young Parke, Roland L Lee

引用次数: 0

首页上一页

下一页尾页

类型

全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

数据库

全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

Clinical Journal of the American Society of Nephrology

全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.

﹀