{"title":"Bridging the \"Employment Gap\" for Dialysis Patients: From Association to Action.","authors":"Karthik Tennankore,Annie-Claire Nadeau-Fredette","doi":"10.2215/cjn.0000000907","DOIUrl":"https://doi.org/10.2215/cjn.0000000907","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"43 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145283693","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}
Frank Liu,Graham Abra,Nupur Gupta,Brigitte Schiller,Matthew B Rivara
{"title":"How I Treat Nocturnal Home Hemodialysis - an under-prescribed but essential home dialysis modality in the United States.","authors":"Frank Liu,Graham Abra,Nupur Gupta,Brigitte Schiller,Matthew B Rivara","doi":"10.2215/cjn.0000000927","DOIUrl":"https://doi.org/10.2215/cjn.0000000927","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"28 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261211","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":"Is Assisted Home Dialysis Feasible In the US? Addressing Legislative and Regulatory Levers.","authors":"Yuvaram N V Reddy,Suzanne Watnick,Nupur Gupta","doi":"10.2215/cjn.0000000925","DOIUrl":"https://doi.org/10.2215/cjn.0000000925","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"72 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261451","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}
Andrzej S Krolewski,Jani K Haukka,Zaipul I Md Dom,Viktor R Curovic,Chunyi Wu,Mario Luca Morieri,Katsuhito Ihara,Sok Cin Tye,Hiroki Kobayashi,Youngshin Keum,Sathishkumar Baskaran,Stefan Mutter,Simone Theilade,Eiichiro Satake,Narges Rashidi,Valma Harjutsalo,Tarunveer S Ahluwalia,Monika A Niewczas,Fergus Fleming,Marlon Pragnell,Robert G Nelson,Joseph V Bonventre,Per-Henrik Groop,Peter Rossing,Niina Sandholm,Andrzej Galecki,Alessandro Doria
BACKGROUNDTo facilitate personalized treatment of diabetic kidney disease (DKD), we developed the Joslin Kidney Panel (JKP) of 21 circulating proteins associated with progression to end-stage kidney disease (ESKD). Prognostic models using baseline concentrations of JKP proteins in circulation and clinical markers were then developed to stratify individuals according to ESKD risk and according to response to fenofibrate, a potential reno-protective drug.METHODSThe custom-made Joslin OLINK multipurpose proteomics platform was used to quantify JKP proteins. Association between baseline serum/plasma concentrations of these proteins and kidney outcomes was examined in five independent study groups.RESULTSIn Type 1 diabetes individuals from Joslin (N=59), FinnDiane (N=389), and Steno (N=283), all JKP proteins were good discriminators of ESKD risk during 10-year follow-up. Baseline concentrations of KIM-1 and WFDC2 performed the best, matching or outperforming the clinical markers. An optimal model to discriminate ESKD risk that included three clinical markers and eight JKP proteins (KIM1, TNF-R2, TNF-R3, TNF-R19L, PVRL4, WFDC2, DLL1, SYND1), was developed using the FinnDiane cohort (C-index 0.868, SE±0.019) and validated in the Steno cohort (C-index 0.913, SE±0.104) and in Type 2 diabetes Joslin study (C-index 0.807, SE±0.036). In each of these studies the optimal model performed better than models based solely on three clinical markers. In a subgroup of 450 individuals with Type 2 diabetes from the ACCORD-Lipid trial, high levels of three JKP proteins (EFNA4, DLL1, IL-1RT1) predicted amelioration of fast kidney function decline during four years of follow-up in those treated with fenofibrate compared to placebo.CONCLUSIONQuantification of circulating JKP proteins using the Joslin OLINK platform discriminates ESKD risk in individuals with diabetes and their response to reno-protective drugs. Use of this multi-purpose precision medicine tool should facilitate studies on the etiology of DKD and enable the development of effective personalized treatment protocols for individuals with DKD.
{"title":"Joslin Kidney Panel of Circulating Proteins: A Tool for ESKD Risk Discrimination and Individualized Diabetic Kidney Disease Treatment.","authors":"Andrzej S Krolewski,Jani K Haukka,Zaipul I Md Dom,Viktor R Curovic,Chunyi Wu,Mario Luca Morieri,Katsuhito Ihara,Sok Cin Tye,Hiroki Kobayashi,Youngshin Keum,Sathishkumar Baskaran,Stefan Mutter,Simone Theilade,Eiichiro Satake,Narges Rashidi,Valma Harjutsalo,Tarunveer S Ahluwalia,Monika A Niewczas,Fergus Fleming,Marlon Pragnell,Robert G Nelson,Joseph V Bonventre,Per-Henrik Groop,Peter Rossing,Niina Sandholm,Andrzej Galecki,Alessandro Doria","doi":"10.2215/cjn.0000000863","DOIUrl":"https://doi.org/10.2215/cjn.0000000863","url":null,"abstract":"BACKGROUNDTo facilitate personalized treatment of diabetic kidney disease (DKD), we developed the Joslin Kidney Panel (JKP) of 21 circulating proteins associated with progression to end-stage kidney disease (ESKD). Prognostic models using baseline concentrations of JKP proteins in circulation and clinical markers were then developed to stratify individuals according to ESKD risk and according to response to fenofibrate, a potential reno-protective drug.METHODSThe custom-made Joslin OLINK multipurpose proteomics platform was used to quantify JKP proteins. Association between baseline serum/plasma concentrations of these proteins and kidney outcomes was examined in five independent study groups.RESULTSIn Type 1 diabetes individuals from Joslin (N=59), FinnDiane (N=389), and Steno (N=283), all JKP proteins were good discriminators of ESKD risk during 10-year follow-up. Baseline concentrations of KIM-1 and WFDC2 performed the best, matching or outperforming the clinical markers. An optimal model to discriminate ESKD risk that included three clinical markers and eight JKP proteins (KIM1, TNF-R2, TNF-R3, TNF-R19L, PVRL4, WFDC2, DLL1, SYND1), was developed using the FinnDiane cohort (C-index 0.868, SE±0.019) and validated in the Steno cohort (C-index 0.913, SE±0.104) and in Type 2 diabetes Joslin study (C-index 0.807, SE±0.036). In each of these studies the optimal model performed better than models based solely on three clinical markers. In a subgroup of 450 individuals with Type 2 diabetes from the ACCORD-Lipid trial, high levels of three JKP proteins (EFNA4, DLL1, IL-1RT1) predicted amelioration of fast kidney function decline during four years of follow-up in those treated with fenofibrate compared to placebo.CONCLUSIONQuantification of circulating JKP proteins using the Joslin OLINK platform discriminates ESKD risk in individuals with diabetes and their response to reno-protective drugs. Use of this multi-purpose precision medicine tool should facilitate studies on the etiology of DKD and enable the development of effective personalized treatment protocols for individuals with DKD.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"115 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261444","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":"Spatial Atlas Creation at the Single Cell Level: Unveiling the Human Kidney Metaverse.","authors":"Pierre C Dagher,Michael T Eadon,Tarek M El-Achkar","doi":"10.2215/cjn.0000000924","DOIUrl":"https://doi.org/10.2215/cjn.0000000924","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"25 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254493","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":"Untangling the Web of Dietary Micronutrient Intake and the Metabolome in Children with CKD.","authors":"Denver D Brown,Kristen Sgambat,Marva Moxey-Mims","doi":"10.2215/cjn.0000000908","DOIUrl":"https://doi.org/10.2215/cjn.0000000908","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"18 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254483","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":"TESTING for the Best Biomarker in IgA Nephropathy.","authors":"Richard A Lafayette","doi":"10.2215/cjn.0000000904","DOIUrl":"https://doi.org/10.2215/cjn.0000000904","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"32 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246911","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}
Jose Perez,Jingbo Niu,Elliot Baerman,Wolfgang C Winkelmayer,Kerri L Cavanaugh,Monique R Pappadis,Kevin F Erickson
{"title":"Association between Access to Alternatives to Daytime In-Center Hemodialysis and Employment among Patients with Kidney Failure.","authors":"Jose Perez,Jingbo Niu,Elliot Baerman,Wolfgang C Winkelmayer,Kerri L Cavanaugh,Monique R Pappadis,Kevin F Erickson","doi":"10.2215/cjn.0000000819","DOIUrl":"https://doi.org/10.2215/cjn.0000000819","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"30 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145247113","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}
John J Sim,Mercedes A Munis,Benjamin Lewing,Qiaoling Chen,Matthew Hill,Min Zhuo,Ancilla W Fernandes,Asher D Schachter
BACKGROUNDFocal segmental glomerulosclerosis (FSGS) has a variable response to immunosuppressive therapy (IS) and high relapse rates. Lack of Food and Drug Administration-approved therapies underscore the need for real-world evidence to better understand treatment patterns and outcomes. This study aimed to evaluate treatment response, relapse patterns, and kidney outcomes among patients with primary FSGS.METHODSA retrospective cohort study was performed within 14 medical centers of an integrated health system. Patients (≥18 years) with biopsy-confirmed primary FSGS treated with IS between 2010 and 2021 were included. Treatment response, assessed at up to eight months, was categorized as complete remission (CR): urine protein-to-creatinine ratio (UPCR) <0.3g/g; partial remission (PR): UPCR decline >50% from baseline and between 0.3-3.5g/g; and, no remission (NR). Relapse was defined as loss of remission within two years. Outcomes, including end-stage kidney disease (ESKD; treatment with dialysis or transplant) and mortality, were analyzed using Fine-Gray subdistribution hazard ratio (sHR) models.RESULTSAmong 228 patients treated with IS, 55% achieved remission (12% CR, 43% PR), with relapse rates of 63% and 75% by two years. Median follow-up was 4 years (interquartile range 2.0, 7.6), during which 88 (39%) progressed to ESKD. A total of 62 (27%) patients died, with 33 (15%) deaths occurring before reaching ESKD. Non-responders had a higher risk of ESKD compared to responders (sHR: 2.22; 95% CI: 1.41, 3.49). Baseline estimated glomerular filtration rate (eGFR) <30 mL/min/1.73m2 was strongly associated with risk of ESKD (sHR for eGFR of <30 vs 60+: 4.74, 95% CI: 2.24, 10.05; p<0.001), while baseline proteinuria (UPCR >3.5 g/g) was not significant. Asian/Pacific Islander patients exhibited the highest ESKD risk among racial/ethnic groups (sHR: 2.03; 95% CI:1.07, 3.84).CONCLUSIONSApproximately half of FSGS patients achieved remission with IS, but relapse rates were high, and nearly 40% progressed to ESKD. Non-responders and low baseline eGFR had the highest risk. These findings underscore the need for novel therapies to achieve durable disease control, lower relapse rates, and improve outcomes in FSGS.
{"title":"Treatment Response Rates and Kidney Outcomes among Adults with Primary Focal Segmental Glomerulosclerosis.","authors":"John J Sim,Mercedes A Munis,Benjamin Lewing,Qiaoling Chen,Matthew Hill,Min Zhuo,Ancilla W Fernandes,Asher D Schachter","doi":"10.2215/cjn.0000000898","DOIUrl":"https://doi.org/10.2215/cjn.0000000898","url":null,"abstract":"BACKGROUNDFocal segmental glomerulosclerosis (FSGS) has a variable response to immunosuppressive therapy (IS) and high relapse rates. Lack of Food and Drug Administration-approved therapies underscore the need for real-world evidence to better understand treatment patterns and outcomes. This study aimed to evaluate treatment response, relapse patterns, and kidney outcomes among patients with primary FSGS.METHODSA retrospective cohort study was performed within 14 medical centers of an integrated health system. Patients (≥18 years) with biopsy-confirmed primary FSGS treated with IS between 2010 and 2021 were included. Treatment response, assessed at up to eight months, was categorized as complete remission (CR): urine protein-to-creatinine ratio (UPCR) <0.3g/g; partial remission (PR): UPCR decline >50% from baseline and between 0.3-3.5g/g; and, no remission (NR). Relapse was defined as loss of remission within two years. Outcomes, including end-stage kidney disease (ESKD; treatment with dialysis or transplant) and mortality, were analyzed using Fine-Gray subdistribution hazard ratio (sHR) models.RESULTSAmong 228 patients treated with IS, 55% achieved remission (12% CR, 43% PR), with relapse rates of 63% and 75% by two years. Median follow-up was 4 years (interquartile range 2.0, 7.6), during which 88 (39%) progressed to ESKD. A total of 62 (27%) patients died, with 33 (15%) deaths occurring before reaching ESKD. Non-responders had a higher risk of ESKD compared to responders (sHR: 2.22; 95% CI: 1.41, 3.49). Baseline estimated glomerular filtration rate (eGFR) <30 mL/min/1.73m2 was strongly associated with risk of ESKD (sHR for eGFR of <30 vs 60+: 4.74, 95% CI: 2.24, 10.05; p<0.001), while baseline proteinuria (UPCR >3.5 g/g) was not significant. Asian/Pacific Islander patients exhibited the highest ESKD risk among racial/ethnic groups (sHR: 2.03; 95% CI:1.07, 3.84).CONCLUSIONSApproximately half of FSGS patients achieved remission with IS, but relapse rates were high, and nearly 40% progressed to ESKD. Non-responders and low baseline eGFR had the highest risk. These findings underscore the need for novel therapies to achieve durable disease control, lower relapse rates, and improve outcomes in FSGS.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"80 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240891","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}
Claudio Ronco,Francisco Maduell,Kamyar Kalantar-Zadeh,Magdalena Madero,Thiago Reis
Replacement of kidney function by dialysis maintains the lives of millions of patients. Clinical results however are still unsatisfactory with mortality rates and complications well above the matched control population. This has led to a continuous quest for more effective dialysis techniques and new biomaterials. In the 1980s, the production of synthetic membranes with higher water permeability (i.e., high-flux) leveraged the development of techniques such as hemodiafiltration (HDF) with improved solute removal thanks to combination of diffusion and convection. Efficacy trials have demonstrated the superiority of HDF over high-flux hemodialysis in terms of solute removal, hemodynamic tolerance, and survival. Consequently, the technique gained traction in Europe and Asia. In these trials, a minimum target convection volume (i.e., fluid replaced) of 23 L per session adjusted to body surface area (i.e., 23 L multiplied by ratio of individual body surface area normalized by 1.73 m2), was required to maximize the benefit of the therapy. In general, the replacement fluid is delivered in the post-filter site and to attain this target of 23 L adjusted to body surface area, blood flows must be ≥350 mL/min, requiring 14-15 Gauge needles or ≥14 French catheters to avoid excessive hemoconcentration and circuit pressure issues. In its early days, the replacement solution was provided with sterile bags (offline), making the therapy costly and cumbersome. Online (OL), that is, real-time preparation of ultrapure fluid for replacement has become the key to reduce cost and complexity, while making the technique (OL-HDF) safe and convenient. In the USA however, existing regulations and concerns about safety, prevented approval for clinical use. In 2025, OL-HDF has received approval by the Food and Drug Administration in the USA, and this opens new options and perspectives in the management of people living with kidney failure.
{"title":"The Role of Online Hemodiafiltration in Contemporary Kidney Care.","authors":"Claudio Ronco,Francisco Maduell,Kamyar Kalantar-Zadeh,Magdalena Madero,Thiago Reis","doi":"10.2215/cjn.0000000920","DOIUrl":"https://doi.org/10.2215/cjn.0000000920","url":null,"abstract":"Replacement of kidney function by dialysis maintains the lives of millions of patients. Clinical results however are still unsatisfactory with mortality rates and complications well above the matched control population. This has led to a continuous quest for more effective dialysis techniques and new biomaterials. In the 1980s, the production of synthetic membranes with higher water permeability (i.e., high-flux) leveraged the development of techniques such as hemodiafiltration (HDF) with improved solute removal thanks to combination of diffusion and convection. Efficacy trials have demonstrated the superiority of HDF over high-flux hemodialysis in terms of solute removal, hemodynamic tolerance, and survival. Consequently, the technique gained traction in Europe and Asia. In these trials, a minimum target convection volume (i.e., fluid replaced) of 23 L per session adjusted to body surface area (i.e., 23 L multiplied by ratio of individual body surface area normalized by 1.73 m2), was required to maximize the benefit of the therapy. In general, the replacement fluid is delivered in the post-filter site and to attain this target of 23 L adjusted to body surface area, blood flows must be ≥350 mL/min, requiring 14-15 Gauge needles or ≥14 French catheters to avoid excessive hemoconcentration and circuit pressure issues. In its early days, the replacement solution was provided with sterile bags (offline), making the therapy costly and cumbersome. Online (OL), that is, real-time preparation of ultrapure fluid for replacement has become the key to reduce cost and complexity, while making the technique (OL-HDF) safe and convenient. In the USA however, existing regulations and concerns about safety, prevented approval for clinical use. In 2025, OL-HDF has received approval by the Food and Drug Administration in the USA, and this opens new options and perspectives in the management of people living with kidney failure.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"98 3 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145235863","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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