Clinical Journal of the American Society of Nephrology最新文献

{"title":"Impact of a Longitudinal Virtual Education Series on Home Dialysis Education: A Mixed-Methods Evaluation.","authors":"Wendy Wen Qing Ye,Anjali Saxena,Kerry A Leigh,Thomas A Golper,Edward R Gould,Graham Abra,Janice Lea,Joel Glickman,Shimrit Keddem,Colleen Brensinger,Jeffrey Perl,Christopher T Chan,Yuvaram N V Reddy","doi":"10.2215/cjn.0000000813","DOIUrl":"https://doi.org/10.2215/cjn.0000000813","url":null,"abstract":"BACKGROUNDHome dialysis has clinical and economic benefits, yet it remains underutilized in the United States. One barrier is a lack of experience amongst fellows due to inadequate training. To enhance fellow training, the American Society of Nephrology launched the Home Dialysis Virtual Longitudinal Education Program (ASN-HDU) with Home Dialysis University (HDU) in 2023.METHODSWe evaluated the ASN-HDU longitudinal program using mixed-methods. We sampled participants from two groups: (1) fellows who attended both HDU and the ASN virtual program, and (2) fellows who only attended HDU. We sent a post-HDU survey and eight-month follow-up survey to assess quantitative changes in comfort in home dialysis. We interviewed participants from both groups and used a constant comparative method to identify qualitative themes related to home dialysis training.RESULTSAfter attending HDU, 52 participants reported median comfort levels of 7-8 out of 10 for peritoneal dialysis (PD) topics, and 4-5 out of 10 for home hemodialysis topics. In the follow-up survey, only participants of ASN-HDU demonstrated significant improvement in comfort level for all home dialysis topics by 1-2 out of 10 (except volume overload management on PD). Two main themes emerged from 10 qualitative interviews: (1) home dialysis training is sporadic and lacks structure, with subthemes describing challenges with receiving hands-on training, lack of systematic training, and a need for fellows to create their own training pathways, and (2) HDU and ASN-HDU are structured curricula that fill many educational gaps, but not all, with subthemes describing the value of these programs, examples of how fellows apply knowledge gained in clinical practice, and gaps that these curricula cannot directly address.CONCLUSIONSParticipation in ASN-HDU was associated with improved fellow comfort levels in home dialysis. Both HDU and ASN-HDU help address several gaps in home dialysis training in fellowship programs, but trainees may benefit from additional hands-on clinical experience.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"86 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145140373","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":"Correction to: Fall Risk in Maintenance Hemodialysis Patients: A Secondary Analysis of the HOPE Consortium Trial.","authors":"David M Charytan,Alvin H Moss,Manar Shalak,Wenbo Wu,Laura M Dember,Jesse Y Hsu,Natalie Kuzla,Denise Esserman,Sahir Kalim,Paul L Kimmel,Mark B Lockwood,Nobuyuki Miyawaki,Beth Pellegrino,Patrick H Pun,Rudy Qamhiyeh,Jennifer Scherer,Sarah Schrauben,Daniel E Weiner,Rajnish Mehrotra, ","doi":"10.2215/cjn.0000000912","DOIUrl":"https://doi.org/10.2215/cjn.0000000912","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"28 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145127210","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":"Implementation of Established Global Guidelines in the Management of CKD in Patients with Type 2 Diabetes in Asia.","authors":"Rajiv Agarwal,Masaomi Nangaku,Liming Chen,Angela Yee Moon Wang,Motoko Yanagita,Sunita Bavanandan,Bancha Satirapoj,Narayan Prasad,Soo Kun Lim,Apiradee Sriwijitkamol,Elizabeth Angelica Roasa,Boon Wee Teo,Chien-Ning Huang,Chun-Yao Huang,Carol Pollock,Sung Hee Choi,Dibya Singh Shah,Chuanming Hao,Sung Gyun Kim,Uday Jadhav,Mai-Szu Wu,Sydney Cw Tang","doi":"10.2215/cjn.0000000909","DOIUrl":"https://doi.org/10.2215/cjn.0000000909","url":null,"abstract":"Worldwide, chronic kidney disease (CKD) is seen in one in nine adults; type 2 diabetes (T2D) is the most common cause. The population of just two countries in Asia, India and China, constitutes about 35% of the global population and is larger than the population of Africa or the combined populations of Europe and the Americas. CKD Global Outcomes (KDIGO) Clinical Practice Guideline for the Evaluation and Management of CKD recommends the use of foundational therapies such as lifestyle modifications, detection and treatment of hypertension, and pharmacological management to forestall cardiovascular and kidney complications of T2D, including renin-angiotensin system inhibitors, sodium-glucose cotransporter 2 inhibitors, nonsteroidal mineralocorticoid receptor antagonists such as finerenone, and glucagon-like peptide 1 receptor agonists. However, the implementation of these guidelines may be limited by real-world considerations, especially in Asia. This continent represents low-, middle-, and high-income countries and a variety of healthcare systems and policies. In this narrative review, the authors comprising of experts in the management of CKD in T2D in Asia, convened via video conferencing and online survey to discuss the perceived barriers to the implementation of guidelines with a focus on implementing the use of finerenone in CKD in T2D, particularly on the following: (1) the management of hypertension as an important comorbidity of T2D leading to CKD; (2) perceived barriers to screening for CKD in T2D; and (3) use of finerenone in T2D with CKD, including its effects on Asian patients and perceived barriers to implementing the use of finerenone in the region.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"40 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145127212","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 Survey Study to Assess the Diversity and Inclusion in Nephrology Journal Editorial Leadership.","authors":"Jingyao Zhang,Mariya Sesil Varghese,Rhea Gandhi,Alejandra de Jesus Sanchez,Basmh Shamel,Alejandro Valdesuso,Vineet Gupta,Tushar Chopra,Rakesh Malhotra","doi":"10.2215/cjn.0000000803","DOIUrl":"https://doi.org/10.2215/cjn.0000000803","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"24 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145127213","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":"Hypothermic Perfusion Mitigates Extended Cold Ischemia Time in Kidney Transplantation.","authors":"Angelica Perez-Gutierrez,Jessica Cao,Piotr Bachul,Rolf N Barth,John Fung,Rita L McGill","doi":"10.2215/cjn.0000000848","DOIUrl":"https://doi.org/10.2215/cjn.0000000848","url":null,"abstract":"BACKGROUNDExtended cold ischemia time is associated with higher incidences of delayed graft function and graft failure. Kidneys on hypothermic machine perfusion perform better than comparable kidneys in static cold storage (SCS). This study aimed to determine whether hypothermic perfusion was associated with lowering the deleterious effects of extended cold ischemia time.METHODSData from the United Network of Organ Sharing database was examined to identify adult first-time, kidney-only recipients from 2005-2022. Multivariable models for death-censored graft failure, uncensored graft failure, delayed graft function, and patient mortality were constructed, and adjusted for donor, recipient, and transplant factors. Kidneys with ≤12 hours SCS, an accepted standard for optimal transplantation, served as the reference group for each model.RESULTSAmong 120,438 allografts, 63% were in SCS and 37% were preserved with hypothermic perfusion. Death-censored graft failure was higher in a dose-dependent fashion as cold ischemia time increased. Kidneys on hypothermic machine perfusion for ≤24 hours had less death-censored graft failure than reference (≤12 hours in SCS) kidneys. Perfusion for 24-36 hours did not differ from reference. After 36 hours, all kidneys had higher death-censored graft failure, regardless of the storage method. Hypothermic machine perfusion lowered the incidence of delayed graft function at every level of cold ischemia time.CONCLUSIONSHypothermic machine perfusion is an effective strategy for lowering the negative impact of prolonged cold ischemia time, providing transplant teams with greater flexibility to optimize donor and recipient logistics, without compromising long-term graft outcomes.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"37 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145089812","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":"Impact of Simultaneous Initiation of Finerenone and Empagliflozin on Urinary Albumin-to-Creatinine Ratio in Asia: Pre-Specified Analysis of CONFIDENCE.","authors":"Rajiv Agarwal,Jennifer B Green,Hiddo J L Heerspink,Johannes F E Mann,Janet B McGill,Amy Mottl,Takeshi Osonoi,Atanu Pal,Peter Rossing,Julio Rosenstock,Muthiah Vaduganathan,Li Li,Na Li,Charlie Scott,Pravin Manjrekar,Satoshi Yamashita,Masaomi Nangaku","doi":"10.2215/cjn.0000000865","DOIUrl":"https://doi.org/10.2215/cjn.0000000865","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"71 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145077735","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":"Dietary Inflammatory Potential and Chronic Kidney Disease Risk: Exploring the Mediation Effects of Circulating Proteins.","authors":"Hee Byung Koh,Hyo Jeong Kim,Hyung Woo Kim,Young Su Joo,Seung Hyeok Han,Tae-Hyun Yoo,Shin-Wook Kang,Jung Tak Park","doi":"10.2215/cjn.0000000847","DOIUrl":"https://doi.org/10.2215/cjn.0000000847","url":null,"abstract":"BACKGROUNDWhile the association between diet-induced inflammation and the risk of cardiovascular disease or cancer has been previously reported, its contribution to chronic kidney disease (CKD) and the underlying biological mechanisms remain unclear. This study aimed to elucidate the mechanistic role of the Dietary Inflammatory Index (DII) in CKD through multi-omics-based mediation analyses and to provide clinically relevant insight.METHODSThis study included 158,722 United Kingdom (UK) Biobank participants without underlying CKD (median age 57 years; 53% female). The DII was assessed via a 24-hour dietary recall and categorized into quartiles. Incident CKD was identified using International Classification of Diseases (ICD)-10 and Office of Population Censuses and Surveys Classification of Interventions and Procedures (OPCS)-4 codes. In a sub-cohort with creatinine follow-up, CKD was also defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. Mediation analyses using proteomics and metabolomics data were conducted to explore potential mechanisms linking diet-induced inflammation to CKD. Individual food item analyses were performed to identify their association with CKD via diet-induced inflammation.RESULTSDuring a median of 11.2 years of follow-up, CKD occurred in 4,382 patients. Cox regression revealed that the adjusted hazard ratios for incident CKD were higher in a stepwise fashion across higher DII quartiles (adjusted hazard ratio [aHR] and 95% confidence interval [CI]: Q2, 1.08 [0.99-1.18]; Q3, 1.15 [1.05-1.26]; Q4, 1.17 [1.06-1.29]) relative to Q1 (P-for-trend <0.001). Similar results were observed with eGFR-defined CKD. Proteomics-based mediation analysis identified death receptor and tumor necrosis factor (TNF) receptor-related proteins as mediators linking diet-induced inflammation to CKD. Metabolomics analysis highlighted omega-3 fatty acids, especially docosahexaenoic acid, as protective mediators. Oily fish intake was inversely associated with CKD risk, while sugar-rich and high-fat dairy consumption showed positive associations, partly through inflammatory pathways.CONCLUSIONSThe association between the DII and incident CKD risk may be partly mediated by alterations in circulating protein profiles involving TNF receptor superfamily-related pathways and plasma omega-3 fatty acids. Dietary counseling aimed at lowering the consumption of sugar-rich and high-fat dairy products may be beneficial.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"79 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145083578","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":"Plasma Proteomic Profile of Dietary Potassium and Incident Chronic Kidney Disease.","authors":"Jiaqi Yang,Lauren Bernard,Jingsha Chen,Valerie K Sullivan,Bing Yu,Eugene P Rhee,Paul A Welling,Casey M Rebholz","doi":"10.2215/cjn.0000000864","DOIUrl":"https://doi.org/10.2215/cjn.0000000864","url":null,"abstract":"BACKGROUNDThere is a need for objective biomarkers of dietary potassium. The mechanisms through which dietary potassium influences kidney health are incompletely understood.METHODSAtherosclerosis Risk in Communities study participants at visit 3 (1993-1995) with dietary and proteomics data were randomly divided into discovery (N=6,814) and replication (N=3,380) sets. We examined associations between dietary potassium and 4,955 aptamers using multivariable linear regression, adjusting for sociodemographic factors, health behaviors, and estimated glomerular filtration rate, with a false discovery rate of 0.05. Then, we tested the prospective associations between potassium-related proteins and incident chronic kidney disease (CKD).RESULTSDietary potassium was significantly associated with 147 proteins in discovery, of which 85 (33 positive, 52 negative) replicated. Of 85 replicated proteins, 30 were selected by elastic net and improved prediction of high dietary potassium individually and collectively. Over a median follow-up of 21 years, 1,698 CKD cases developed. A score derived from 30 elastic net-selected dietary potassium-related proteins was associated with 7% lower risk of CKD (95% CI, 0.88-0.98, P=0.01). Of 85 potassium-related proteins from replication, 10 were associated with incident CKD. Specifically, pigment epithelium-derived factor and follistatin-related protein 3 were inversely associated with potassium and linked to 57% and 55% higher risk of CKD, respectively. Positively associated with potassium, TOM1-like protein 1 and serine/threonine-protein kinase pim-1 were associated with 28% and 26% lower risk of CKD, respectively. A score of 6 proteins mediated the association between potassium and CKD risk was associated with 13% lower risk of CKD (95% CI, 0.83-0.92, P=8.09×10-7).CONCLUSIONProteins associated with dietary potassium and incident CKD represented biological pathways including iron metabolism, mitochondrial function, fibrosis, and immune-inflammatory responses, which help explain the impact of potassium intake on CKD.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"56 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145083471","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":"Advancing Genetic Risk Assessment in Living Kidney Donation: A Comprehensive Approach to Patient Education and Counseling.","authors":"Jasmine M Akhtar,Carolyn N Sidoti,Kadiatou Diallo,Max C Downey,Samantha B Klitenic,Darren E Stewart,Karen B Vanterpool,Tamar Schiff,Jon J Snyder,Nicole M Ali,Allan B Massie,Dorry L Segev,Macey L Levan","doi":"10.2215/cjn.0000000901","DOIUrl":"https://doi.org/10.2215/cjn.0000000901","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"3 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071683","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":"Uncovering Chronic Disease Disparities Within Compacts of Free Association Migrant Populations in Hawaii.","authors":"Sylvia T Nguyen,Kiara L T Arakawa-Taum,Christie Izutsu,Bryan Brown","doi":"10.2215/cjn.0000000840","DOIUrl":"https://doi.org/10.2215/cjn.0000000840","url":null,"abstract":"Historical events including United States (US) neocolonial administration and thermonuclear weapon testing within their homelands left many Compacts of Free Association (COFA) citizens, including those of Chuukese, Marshallese, Pohnpeian, Yapese, and Kosraean descent with poor health and educational outcomes that led to their migration to Hawai'i. A case-control study was conducted to quantify relative prevalence and severity of chronic diseases among COFA-affiliated patients compared to age- and sex-matched controls. Inclusion was based on a \"Preferred Language\" labeled as a COFA-affiliated language in the electronic health record. Cases and controls had received primary care at The Queen Emma Clinics, a hospital-embedded, mission-based clinic in Honolulu between January 1, 2018 through August 10, 2023. In comparison to the age- and sex-matched control group (N=1076), patients with COFA-affiliated preferred languages (N=353) had prevalence rates of diabetes mellitus two-fold higher (54% vs. 28%), chronic kidney disease 1.8-fold greater (24% vs. 14%), and history of stroke two-fold greater (13% vs. 7%) (all p<0.001). Prevalence of uncontrolled diabetes in the studied population was more than three-fold higher (16% vs 5%), and kidney failure 3.9-fold higher than that of the control group (10% vs. 3%). COFA-affiliated clinic patients had lower engagement with medical services on various indicators. COFA migrants in the US present to primary care with uniquely prevalent and advanced chronic diseases, especially type 2 diabetes mellitus and chronic kidney disease.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"50 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071660","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}