Danya Pradeep Kumar,Jacob A Hiss,Kate Young,Robert N Montgomery,Rebecca J Lepping,Aditi Gupta
{"title":"Association of Cognition before and after Kidney Transplantation with Cerebral White Matter Integrity.","authors":"Danya Pradeep Kumar,Jacob A Hiss,Kate Young,Robert N Montgomery,Rebecca J Lepping,Aditi Gupta","doi":"10.2215/cjn.0000000918","DOIUrl":"https://doi.org/10.2215/cjn.0000000918","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"435 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145374042","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}
Simon B Ascher,Ronit Katz,Stein I Hallan,Michelle M Estrella,Rebecca Scherzer,Teresa K Chen,Julio A Lamprea-Montealegre,Kasey Campos,Pranav S Garimella,Alexander L Bullen,Nicholas Wettersten,Alfred K Cheung,Joachim H Ix,Michael G Shlipak
BACKGROUNDAcute kidney injury (AKI) frequently occurs in the ambulatory setting, but few tools are available to distinguish whether an individual's kidney function will subsequently recover.METHODSWe included 652 participants with and without chronic kidney disease in the Systolic Blood Pressure Intervention Trial (SPRINT) who experienced ambulatory acute kidney injury (AKI), defined as a rise in serum creatinine of ≥0.3 mg/dL from baseline that occurred at the 12-month or 24-month study visits. Four plasma biomarkers of kidney tubule health were measured at baseline and when ambulatory AKI was detected: kidney injury molecule-1 (KIM-1), soluble tumor necrosis factor receptor 1 (sTNFR1) and receptor 2 (sTNFR2), and uromodulin (UMOD). Multivariable logistic regression models were used to evaluate biomarker associations with subsequent odds of <50% recovery in eGFR ("non-recovery") at 12-months.RESULTSMean age was 70 ±10 years; eGFR at baseline was 62 ± 25 mL/min/1.73 m2 and there was an eGFR decline of 21.7 ± 12.5 mL/min/1.73 m2 at the time ambulatory AKI was detected. When measured at the time of ambulatory AKI, higher KIM-1 (OR 1.40, 95% CI: 1.14, 1.73) and sTNFR1 (OR 2.07, 95% CI: 1.49, 2.88) and lower UMOD (OR 0.77, 95% CI: 0.63, 0.94) were each associated with eGFR non-recovery in multivariable models that adjusted for eGFR and albuminuria. In models that included all four plasma biomarkers, KIM-1 and sTNFR1 remained jointly associated with eGFR non-recovery.CONCLUSIONAmong hypertensive adults with ambulatory AKI, plasma biomarkers reflecting impaired kidney tubule health measured at the time of ambulatory AKI are associated with subsequent non-recovery in kidney function.
{"title":"Plasma Biomarkers of Kidney Tubule Health During Ambulatory AKI and Kidney Function Recovery in SPRINT.","authors":"Simon B Ascher,Ronit Katz,Stein I Hallan,Michelle M Estrella,Rebecca Scherzer,Teresa K Chen,Julio A Lamprea-Montealegre,Kasey Campos,Pranav S Garimella,Alexander L Bullen,Nicholas Wettersten,Alfred K Cheung,Joachim H Ix,Michael G Shlipak","doi":"10.2215/cjn.0000000910","DOIUrl":"https://doi.org/10.2215/cjn.0000000910","url":null,"abstract":"BACKGROUNDAcute kidney injury (AKI) frequently occurs in the ambulatory setting, but few tools are available to distinguish whether an individual's kidney function will subsequently recover.METHODSWe included 652 participants with and without chronic kidney disease in the Systolic Blood Pressure Intervention Trial (SPRINT) who experienced ambulatory acute kidney injury (AKI), defined as a rise in serum creatinine of ≥0.3 mg/dL from baseline that occurred at the 12-month or 24-month study visits. Four plasma biomarkers of kidney tubule health were measured at baseline and when ambulatory AKI was detected: kidney injury molecule-1 (KIM-1), soluble tumor necrosis factor receptor 1 (sTNFR1) and receptor 2 (sTNFR2), and uromodulin (UMOD). Multivariable logistic regression models were used to evaluate biomarker associations with subsequent odds of <50% recovery in eGFR (\"non-recovery\") at 12-months.RESULTSMean age was 70 ±10 years; eGFR at baseline was 62 ± 25 mL/min/1.73 m2 and there was an eGFR decline of 21.7 ± 12.5 mL/min/1.73 m2 at the time ambulatory AKI was detected. When measured at the time of ambulatory AKI, higher KIM-1 (OR 1.40, 95% CI: 1.14, 1.73) and sTNFR1 (OR 2.07, 95% CI: 1.49, 2.88) and lower UMOD (OR 0.77, 95% CI: 0.63, 0.94) were each associated with eGFR non-recovery in multivariable models that adjusted for eGFR and albuminuria. In models that included all four plasma biomarkers, KIM-1 and sTNFR1 remained jointly associated with eGFR non-recovery.CONCLUSIONAmong hypertensive adults with ambulatory AKI, plasma biomarkers reflecting impaired kidney tubule health measured at the time of ambulatory AKI are associated with subsequent non-recovery in kidney function.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"49 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145374132","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}
Pablo Martinez-Amezcua,Alfredo Fuentes-Mercado,Lacey H Etzkorn,Jennifer A Schrack,Erika Elizabet Jaime-Borja,Fernanda Garza-Romero,Rodrigo Gopar-Nieto,Magdalena Madero,Salvador Lopez-Gil
{"title":"Differences in Physical Activity Assessed by Accelerometry Across Hemodialysis Days and Shifts.","authors":"Pablo Martinez-Amezcua,Alfredo Fuentes-Mercado,Lacey H Etzkorn,Jennifer A Schrack,Erika Elizabet Jaime-Borja,Fernanda Garza-Romero,Rodrigo Gopar-Nieto,Magdalena Madero,Salvador Lopez-Gil","doi":"10.2215/cjn.0000000914","DOIUrl":"https://doi.org/10.2215/cjn.0000000914","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"7 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145373949","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":"A Qualitative Study of Nephrologists' Perceptions of Management of Hypertension in Hemodialysis Patients.","authors":"Nisha Bansal,Matthew Rivara,Harini Sarathy,Carlyn Clark,Julie Porter,Claire Wolf,Luisa Rios-Avila,Rose-Ann Thomas,Matthew Caliz,Ernie Ayers,Farshad Palad,Rajnish Mehrotra,Chi-Yuan Hsu,Bryan J Weiner","doi":"10.2215/cjn.0000000885","DOIUrl":"https://doi.org/10.2215/cjn.0000000885","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"54 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145374041","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}
Deepa H Chand,Abubakr Imam,Stephen D Marks,Michael Jg Somers
{"title":"Challenges Facing Contemporary Pediatric Nephrology: A Call to Global Advocacy.","authors":"Deepa H Chand,Abubakr Imam,Stephen D Marks,Michael Jg Somers","doi":"10.2215/cjn.0000000940","DOIUrl":"https://doi.org/10.2215/cjn.0000000940","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"485 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145351647","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}
Yefei Yu,Bernard G Jaar,Panduranga S Rao,Zeenat Bhat,Hernan Rincon-Choles,Giselle Sosa,Ana C Ricardo,Jonathan Taliercio,Lucy Van Dyke,Jing Chen,Lawrence J Appel,Junichi Ishigami,
BACKGROUNDPeople with chronic kidney disease (CKD) are at high risk of infection, potentially as a result of impaired immune function. Obesity is prevalent in people with CKD and may be a risk factor for developing serious infections.METHODSIn 5,499 participants of the Chronic Renal Insufficiency Cohort (CRIC) Study, we examined the association of measures of obesity and body composition with time to first hospitalization with infection, defined by hospital discharge records with a diagnostic code for major infections. Body mass index was categorized as underweight (<18.5 kg/m2), normal weight (18.5-24.9), overweight (25.0-29.9), and Class I (30.0-34.9); Class II (35.0-39.9); and Class III (≥ 40.0) obesity. Measures of body cell mass (i.e., phase angle) and tissue hydration status (i.e., vector length), assessed with bioelectrical impedance, were grouped into quartiles. We used multivariable Cox models to estimate adjusted hazard ratios (aHRs) of all-cause infection, as well as by infection subtypes.RESULTSDuring follow-up (median, 4.7 years), 2,913 participants had hospitalization with infection. Compared to normal weight, Class III obesity and underweight were both associated with a higher risk of all-cause infection (aHR, 1.35, 95% confidence interval [CI]: 1.16-1.57 and 1.76, 95% CI: 1.06-2.93, respectively). Compared to the highest quartile, the lowest quartiles of phase angle and vector length were significantly associated with a higher risk of all-cause infection, (aHR, 1.39, 95% CI: 1.22-1.57 and 1.17, 95% CI: 1.02-1.33, respectively). When the analysis was separately performed by infection subtypes, the association of obesity was particularly strong for skin and soft tissue infection (aHR, 1.98, 95% CI: 1.54-2.54]), but not for others (e.g., aHR for lower respiratory tract infection, 0.96, 95% CI: 0.77-1.19), whereas underweight and shallow phase angle were broadly associated with the risk of infection across subtypes.CONCLUSIONAmong people with CKD, both obesity and underweight were significantly associated with the risk of infection. The association of obesity with skin infection, relative to other infection subtypes, warrants further investigations.
{"title":"Association of Obesity and Body Composition and Hospitalization Risk with Infection in the CRIC Study.","authors":"Yefei Yu,Bernard G Jaar,Panduranga S Rao,Zeenat Bhat,Hernan Rincon-Choles,Giselle Sosa,Ana C Ricardo,Jonathan Taliercio,Lucy Van Dyke,Jing Chen,Lawrence J Appel,Junichi Ishigami, ","doi":"10.2215/cjn.0000000845","DOIUrl":"https://doi.org/10.2215/cjn.0000000845","url":null,"abstract":"BACKGROUNDPeople with chronic kidney disease (CKD) are at high risk of infection, potentially as a result of impaired immune function. Obesity is prevalent in people with CKD and may be a risk factor for developing serious infections.METHODSIn 5,499 participants of the Chronic Renal Insufficiency Cohort (CRIC) Study, we examined the association of measures of obesity and body composition with time to first hospitalization with infection, defined by hospital discharge records with a diagnostic code for major infections. Body mass index was categorized as underweight (<18.5 kg/m2), normal weight (18.5-24.9), overweight (25.0-29.9), and Class I (30.0-34.9); Class II (35.0-39.9); and Class III (≥ 40.0) obesity. Measures of body cell mass (i.e., phase angle) and tissue hydration status (i.e., vector length), assessed with bioelectrical impedance, were grouped into quartiles. We used multivariable Cox models to estimate adjusted hazard ratios (aHRs) of all-cause infection, as well as by infection subtypes.RESULTSDuring follow-up (median, 4.7 years), 2,913 participants had hospitalization with infection. Compared to normal weight, Class III obesity and underweight were both associated with a higher risk of all-cause infection (aHR, 1.35, 95% confidence interval [CI]: 1.16-1.57 and 1.76, 95% CI: 1.06-2.93, respectively). Compared to the highest quartile, the lowest quartiles of phase angle and vector length were significantly associated with a higher risk of all-cause infection, (aHR, 1.39, 95% CI: 1.22-1.57 and 1.17, 95% CI: 1.02-1.33, respectively). When the analysis was separately performed by infection subtypes, the association of obesity was particularly strong for skin and soft tissue infection (aHR, 1.98, 95% CI: 1.54-2.54]), but not for others (e.g., aHR for lower respiratory tract infection, 0.96, 95% CI: 0.77-1.19), whereas underweight and shallow phase angle were broadly associated with the risk of infection across subtypes.CONCLUSIONAmong people with CKD, both obesity and underweight were significantly associated with the risk of infection. The association of obesity with skin infection, relative to other infection subtypes, warrants further investigations.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"119 5 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145351646","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}
Nasim Wiegley,Vinay Srinivasan,Harish Seethapathy,Sayna Norouzi,Kate Robson,Paolo So,Edgar Lerma,Ali Poyan Mehr
{"title":"Empowering the Next Generation of Nephrologists: Trainee Opportunities in GlomCon's Educational Ecosystem.","authors":"Nasim Wiegley,Vinay Srinivasan,Harish Seethapathy,Sayna Norouzi,Kate Robson,Paolo So,Edgar Lerma,Ali Poyan Mehr","doi":"10.2215/cjn.0000000891","DOIUrl":"https://doi.org/10.2215/cjn.0000000891","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"99 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145311329","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}
Scott M Wilson,Shari Zaslow,Stephen M Sozio,Bernard G Jaar,Farzana Perwad,Cassiane Robinson-Cohen,Michelle M Estrella,Aline Martin,Rulan S Parekh,Wei Chen
BACKGROUNDFibroblast growth factor-23 (FGF23) is a key regulator of mineral metabolism that is independently associated with mortality in patients with end-stage kidney disease (ESKD). Glycerol-3-phosphate (G3P), a byproduct of glycolysis that can be derived from injured kidneys, stimulates FGF23 production. We aimed to determine if serum G3P is associated with FGF23 levels in patients with ESKD and identify potential molecular pathways that mediate their relationship.METHODSWe conducted a cross-sectional study of 99 non-diabetic patients with ESKD on hemodialysis. We utilized linear regression to examine the association between G3P terciles and log-transformed C-terminal FGF23 levels, adjusting for demographics, coronary artery disease, serum calcium, phosphorus, and parathyroid hormone. Mann-Whitney U tests compared 247 serum metabolite levels between the first and third FGF23 terciles; significant metabolites (p<0.01) were selected for pathway enrichment analyses. Top pathway scores were used in mediation analyses.RESULTSThe median age of participants was 54 years (Interquartile Range (IQR): 44-63), 38% were women, 71% self-identified as Black, and 27% had coronary artery disease. Median FGF23 level was 777 (IQR 222-1,310) RU/mL. In adjusted analyses, compared with participants with the lowest G3P tercile, those with the highest G3P tercile had a 95% higher FGF23 level (95% Confidence Interval (CI): 6%, 260%, p=0.004). Of the 27 metabolites significantly associated with FGF23 levels, pathway enrichment analysis identified the pentose phosphate pathway as the top hit (impact score=0.33, false discovery rate-adjusted p-value= 0.01). The pentose phosphate pathway mediated the relationship between G3P and FGF23, resulting in a 62% change in the β coefficient.CONCLUSIONIn nondiabetic patients with ESKD on hemodialysis, serum G3P positively correlated with serum C-terminal FGF23, and this relationship was mediated by the pentose phosphate pathway. Exploring the pentose phosphate pathway could yield critical mechanistic insights into the regulation of FGF23, enhancing our understanding of its broader biological functions.
{"title":"Association between Serum Glycerol-3-Phosphate and Fibroblast Growth Factor-23 in Nondiabetic Patients on Hemodialysis.","authors":"Scott M Wilson,Shari Zaslow,Stephen M Sozio,Bernard G Jaar,Farzana Perwad,Cassiane Robinson-Cohen,Michelle M Estrella,Aline Martin,Rulan S Parekh,Wei Chen","doi":"10.2215/cjn.0000000871","DOIUrl":"https://doi.org/10.2215/cjn.0000000871","url":null,"abstract":"BACKGROUNDFibroblast growth factor-23 (FGF23) is a key regulator of mineral metabolism that is independently associated with mortality in patients with end-stage kidney disease (ESKD). Glycerol-3-phosphate (G3P), a byproduct of glycolysis that can be derived from injured kidneys, stimulates FGF23 production. We aimed to determine if serum G3P is associated with FGF23 levels in patients with ESKD and identify potential molecular pathways that mediate their relationship.METHODSWe conducted a cross-sectional study of 99 non-diabetic patients with ESKD on hemodialysis. We utilized linear regression to examine the association between G3P terciles and log-transformed C-terminal FGF23 levels, adjusting for demographics, coronary artery disease, serum calcium, phosphorus, and parathyroid hormone. Mann-Whitney U tests compared 247 serum metabolite levels between the first and third FGF23 terciles; significant metabolites (p<0.01) were selected for pathway enrichment analyses. Top pathway scores were used in mediation analyses.RESULTSThe median age of participants was 54 years (Interquartile Range (IQR): 44-63), 38% were women, 71% self-identified as Black, and 27% had coronary artery disease. Median FGF23 level was 777 (IQR 222-1,310) RU/mL. In adjusted analyses, compared with participants with the lowest G3P tercile, those with the highest G3P tercile had a 95% higher FGF23 level (95% Confidence Interval (CI): 6%, 260%, p=0.004). Of the 27 metabolites significantly associated with FGF23 levels, pathway enrichment analysis identified the pentose phosphate pathway as the top hit (impact score=0.33, false discovery rate-adjusted p-value= 0.01). The pentose phosphate pathway mediated the relationship between G3P and FGF23, resulting in a 62% change in the β coefficient.CONCLUSIONIn nondiabetic patients with ESKD on hemodialysis, serum G3P positively correlated with serum C-terminal FGF23, and this relationship was mediated by the pentose phosphate pathway. Exploring the pentose phosphate pathway could yield critical mechanistic insights into the regulation of FGF23, enhancing our understanding of its broader biological functions.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"45 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145311327","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}
Taiwan has exhibited one of the highest incidence and prevalence rates of dialysis globally, yet updated national data on chronic kidney disease (CKD) has been lacking for nearly two decades. We estimated the national CKD prevalence, identified associated risk factors, and evaluated CKD of undetermined etiology (CKDu) in Taiwan. In this cross-sectional study, we analyzed data from 4,298 adults age ≥20 years who participated in the 2017-2020 Nutrition and Health Survey in Taiwan, a nationally representative survey employing stratified, three-stage, clustered sampling across 20 administrative divisions. CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2 or an urine albumin-to-creatinine ratio ≥30 mg/g. Data on demographics, comorbidities, lifestyle factors, and socioeconomic status were collected to identify risk factors associated with CKD. The primary outcome was the national prevalence of CKD. Secondary outcomes included regional CKD prevalence, major risk factors associated with CKD, and characteristics of CKDu. The national CKD prevalence was 10.0%, affecting 1.91 million adults. Prevalence rates for CKD stages 1, 2, 3a, 3b, 4, and 5 were 0.7%, 2.1%, 4.6%, 1.9%, 0.6%, and 0.05%, respectively. CKD prevalence was higher in men (11.9%) than in women (8.1%) and varied regionally, with the highest rate in eastern Taiwan (13.9%), followed by the central (11.5%), southern (11.1%), and northern (8.0%) regions. CKD was independently associated with male sex, older age, diabetes, hypertension, hypertriglyceridemia, gout/hyperuricemia, lower socioeconomic status, and physical inactivity. Only 8% of the CKD patients were aware of their kidney condition, and CKDu accounted for approximately one-eighth of the CKD population. In conclusion, CKD affects approximately 10% of Taiwanese adults, with marked geographic disparities and low awareness. These findings underscore the need for targeted interventions addressing modifiable risk factors and enhanced screening to improve CKD detection and prevention.
{"title":"National Prevalence, Regional Distribution, and Risk Factors for Chronic Kidney Disease in Taiwan.","authors":"Min-De Ang,Chia-Yun Cheng,Wan-Chuan Tsai,Ping-Hsiu Tsai,Le-Yin Hsu,Mei-Ju Ko,Kuo-Liong Chien,Kuan-Yu Hung,Hon-Yen Wu","doi":"10.2215/cjn.0000000892","DOIUrl":"https://doi.org/10.2215/cjn.0000000892","url":null,"abstract":"Taiwan has exhibited one of the highest incidence and prevalence rates of dialysis globally, yet updated national data on chronic kidney disease (CKD) has been lacking for nearly two decades. We estimated the national CKD prevalence, identified associated risk factors, and evaluated CKD of undetermined etiology (CKDu) in Taiwan. In this cross-sectional study, we analyzed data from 4,298 adults age ≥20 years who participated in the 2017-2020 Nutrition and Health Survey in Taiwan, a nationally representative survey employing stratified, three-stage, clustered sampling across 20 administrative divisions. CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2 or an urine albumin-to-creatinine ratio ≥30 mg/g. Data on demographics, comorbidities, lifestyle factors, and socioeconomic status were collected to identify risk factors associated with CKD. The primary outcome was the national prevalence of CKD. Secondary outcomes included regional CKD prevalence, major risk factors associated with CKD, and characteristics of CKDu. The national CKD prevalence was 10.0%, affecting 1.91 million adults. Prevalence rates for CKD stages 1, 2, 3a, 3b, 4, and 5 were 0.7%, 2.1%, 4.6%, 1.9%, 0.6%, and 0.05%, respectively. CKD prevalence was higher in men (11.9%) than in women (8.1%) and varied regionally, with the highest rate in eastern Taiwan (13.9%), followed by the central (11.5%), southern (11.1%), and northern (8.0%) regions. CKD was independently associated with male sex, older age, diabetes, hypertension, hypertriglyceridemia, gout/hyperuricemia, lower socioeconomic status, and physical inactivity. Only 8% of the CKD patients were aware of their kidney condition, and CKDu accounted for approximately one-eighth of the CKD population. In conclusion, CKD affects approximately 10% of Taiwanese adults, with marked geographic disparities and low awareness. These findings underscore the need for targeted interventions addressing modifiable risk factors and enhanced screening to improve CKD detection and prevention.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"1 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145311328","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}
Cal H Robinson,Nowrin Aman,Tonny H M Banh,Josefina Brooke,Vaneet Dhillon,Mackenzie Garner,Christoph Licht,Ashlene McKay,Rachel Pearl,Seetha Radhakrishnan,Keisha Rasool,Nithiakishna Selvathesan,Chia Wei Teoh,Jovanka Vasilevska-Ristovska,Rulan S Parekh
BACKGROUNDIn childhood nephrotic syndrome, definitions of immunosuppression response, frequent relapses (FRNS), and long-term remission are conflicting and based on limited evidence. Our goal was to define treatment response, FRNS, and long-term remission based on associated disease outcomes.METHODSWe included children (six months-18 years) diagnosed with nephrotic syndrome between 1993-2023 in combined Canadian cohorts. We evaluated different definitions of 1) immunosuppressive treatment response, 2) FRNS, including Kidney Disease Improving Global Outcomes (KDIGO) 2021 and International Pediatric Nephrology Association (IPNA) 2023 criteria, and 3) long-term remission. Outcomes were time-to-chronic kidney disease (CKD), relapse count throughout follow-up, and time-to-relapse, analyzed by Cox proportional hazards and negative binomial regression.RESULTSWe included 1114 children with nephrotic syndrome (median 3.8-years at diagnosis, 63% male, median 4.7-year follow-up). Of these, 1054 (95%) were steroid-sensitive, 60 (5%) were steroid-resistant (SRNS), and 73% with SRNS achieved complete remission with steroid-sparing immunosuppression. No child with treatment-responsive SRNS developed CKD. Within one-year of diagnosis, 281 steroid-sensitive children (27%) were classified with FRNS by KDIGO and 383 (36%) by IPNA criteria. Children with FRNS by IPNA criteria (vs. KDIGO) had a similar number of relapses (adjusted rate ratio 0.95, 95% confidence interval [CI] 0.81-1.12) and CKD risk (2% each) but less often received steroid-sparing immunosuppression (hazard ratio 0.42, 95% CI 0.32-0.56). Ninety-eight percent of relapses occur within three-years of the initial diagnosis or last relapse event.CONCLUSIONSChildren with SRNS that achieve remission have a similar CKD risk as steroid-sensitive children. Children with FRNS by IPNA 2023 and KDIGO 2021 criteria experience similar rates of relapse and CKD. This supports defining treatment resistance by response to any immunosuppressive medication, implementation of the IPNA FRNS criteria, and use of three-year relapse-free survival as a surrogate for long-term remission.
{"title":"Challenging Clinical Practice Guideline Definitions in Childhood Nephrotic Syndrome.","authors":"Cal H Robinson,Nowrin Aman,Tonny H M Banh,Josefina Brooke,Vaneet Dhillon,Mackenzie Garner,Christoph Licht,Ashlene McKay,Rachel Pearl,Seetha Radhakrishnan,Keisha Rasool,Nithiakishna Selvathesan,Chia Wei Teoh,Jovanka Vasilevska-Ristovska,Rulan S Parekh","doi":"10.2215/cjn.0000000842","DOIUrl":"https://doi.org/10.2215/cjn.0000000842","url":null,"abstract":"BACKGROUNDIn childhood nephrotic syndrome, definitions of immunosuppression response, frequent relapses (FRNS), and long-term remission are conflicting and based on limited evidence. Our goal was to define treatment response, FRNS, and long-term remission based on associated disease outcomes.METHODSWe included children (six months-18 years) diagnosed with nephrotic syndrome between 1993-2023 in combined Canadian cohorts. We evaluated different definitions of 1) immunosuppressive treatment response, 2) FRNS, including Kidney Disease Improving Global Outcomes (KDIGO) 2021 and International Pediatric Nephrology Association (IPNA) 2023 criteria, and 3) long-term remission. Outcomes were time-to-chronic kidney disease (CKD), relapse count throughout follow-up, and time-to-relapse, analyzed by Cox proportional hazards and negative binomial regression.RESULTSWe included 1114 children with nephrotic syndrome (median 3.8-years at diagnosis, 63% male, median 4.7-year follow-up). Of these, 1054 (95%) were steroid-sensitive, 60 (5%) were steroid-resistant (SRNS), and 73% with SRNS achieved complete remission with steroid-sparing immunosuppression. No child with treatment-responsive SRNS developed CKD. Within one-year of diagnosis, 281 steroid-sensitive children (27%) were classified with FRNS by KDIGO and 383 (36%) by IPNA criteria. Children with FRNS by IPNA criteria (vs. KDIGO) had a similar number of relapses (adjusted rate ratio 0.95, 95% confidence interval [CI] 0.81-1.12) and CKD risk (2% each) but less often received steroid-sparing immunosuppression (hazard ratio 0.42, 95% CI 0.32-0.56). Ninety-eight percent of relapses occur within three-years of the initial diagnosis or last relapse event.CONCLUSIONSChildren with SRNS that achieve remission have a similar CKD risk as steroid-sensitive children. Children with FRNS by IPNA 2023 and KDIGO 2021 criteria experience similar rates of relapse and CKD. This supports defining treatment resistance by response to any immunosuppressive medication, implementation of the IPNA FRNS criteria, and use of three-year relapse-free survival as a surrogate for long-term remission.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"47 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145296209","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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