Pub Date : 2026-02-02DOI: 10.1053/j.ajkd.2025.09.027
Nisha Bansal, Leila R Zelnick, Grace Tabada, Jaejin An, Teresa N Harrison, Ming-Sum Lee, Chengyi Zheng, Ben Lidgard, Daniel E Singer, Elisha Garcia, Alan S Go
{"title":"Association of Recurrent Atrial Fibrillation With Subsequent Kidney Function Decline in Adults Receiving Rhythm Control Therapy.","authors":"Nisha Bansal, Leila R Zelnick, Grace Tabada, Jaejin An, Teresa N Harrison, Ming-Sum Lee, Chengyi Zheng, Ben Lidgard, Daniel E Singer, Elisha Garcia, Alan S Go","doi":"10.1053/j.ajkd.2025.09.027","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.09.027","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146117447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-31DOI: 10.1053/j.ajkd.2025.10.018
Ann Bugeja, Andrew Scarffe, Anubhav Agarwal, Edward G Clark, Kevin Burns, Jessica McDougall, Ariana Noel, Heather Badenoch, Manish Sood, Greg Knoll, Paul Komenda, Kednapa Thavorn
{"title":"An Economic Evaluation of a One-Day Living Kidney Donor Evaluation Process Compared to the Usual Approach.","authors":"Ann Bugeja, Andrew Scarffe, Anubhav Agarwal, Edward G Clark, Kevin Burns, Jessica McDougall, Ariana Noel, Heather Badenoch, Manish Sood, Greg Knoll, Paul Komenda, Kednapa Thavorn","doi":"10.1053/j.ajkd.2025.10.018","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.10.018","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146103403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-21DOI: 10.1053/j.ajkd.2025.10.006
Chia-shi Wang , Rasheed Gbadegesin
The Kidney Disease Outcomes Quality Initiative (KDOQI) convened a work group to review the 2025 KDIGO (Kidney Disease: Improving Global Outcomes) Clinical Practice Guideline for the Management of Nephrotic Syndrome in Children. The KDOQI work group reviewed the KDIGO guideline statements and practice points and provided perspective for implementation within the context of clinical practice in the United States. The updated guidelines reflect contemporary US practice and offer highly relevant guidance that is harmonized with the International Pediatric Nephrology Association’s guidelines published in 2020 and 2022. A focus on close monitoring and characterization of the disease status for children with nephrotic syndrome remains central to treatment and management decisions, noting that the lack of insurance coverage for urine dipsticks in the United States is a significant barrier to optimal disease management. As more treatment options become available to children with nephrotic syndrome, the detailed practice points are a sound tool to help providers engage patients and their families in joint decision making. The clinical utility of the guidelines would be enhanced by inclusion of practice points on the incorporation of genetic testing results into treatment decisions, as well as factors to consider when treating and managing patients at high risk for progression to end-stage kidney disease—those with secondary steroid-resistant nephrotic syndrome and those with the chronic kidney disease high-risk APOL1 genotype. The research needs detailed in the updated guidelines reflect the exciting direction of the practice landscape to provide patient-centered, precision-based care.
{"title":"KDOQI US Commentary on the KDIGO 2025 Clinical Practice Guideline for the Management of Nephrotic Syndrome in Children","authors":"Chia-shi Wang , Rasheed Gbadegesin","doi":"10.1053/j.ajkd.2025.10.006","DOIUrl":"10.1053/j.ajkd.2025.10.006","url":null,"abstract":"<div><div>The Kidney Disease Outcomes Quality Initiative (KDOQI) convened a work group to review the 2025 KDIGO (Kidney Disease: Improving Global Outcomes) Clinical Practice Guideline for the Management of Nephrotic Syndrome in Children. The KDOQI work group reviewed the KDIGO guideline statements and practice points and provided perspective for implementation within the context of clinical practice in the United States. The updated guidelines reflect contemporary US practice and offer highly relevant guidance that is harmonized with the International Pediatric Nephrology Association’s guidelines published in 2020 and 2022. A focus on close monitoring and characterization of the disease status for children with nephrotic syndrome remains central to treatment and management decisions, noting that the lack of insurance coverage for urine dipsticks in the United States is a significant barrier to optimal disease management. As more treatment options become available to children with nephrotic syndrome, the detailed practice points are a sound tool to help providers engage patients and their families in joint decision making. The clinical utility of the guidelines would be enhanced by inclusion of practice points on the incorporation of genetic testing results into treatment decisions, as well as factors to consider when treating and managing patients at high risk for progression to end-stage kidney disease—those with secondary steroid-resistant nephrotic syndrome and those with the chronic kidney disease high-risk <em>APOL1</em> genotype. The research needs detailed in the updated guidelines reflect the exciting direction of the practice landscape to provide patient-centered, precision-based care.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 141-152"},"PeriodicalIF":8.2,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146001700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-21DOI: 10.1053/j.ajkd.2025.09.015
William E. Dennehy , John R. Silkensen , Tracy L. Anderson-Haag , Rebecca Zadroga , Jeffrey H. Wang
{"title":"Severe Hypercalcemia in a Kidney Transplant Recipient: A Quiz","authors":"William E. Dennehy , John R. Silkensen , Tracy L. Anderson-Haag , Rebecca Zadroga , Jeffrey H. Wang","doi":"10.1053/j.ajkd.2025.09.015","DOIUrl":"10.1053/j.ajkd.2025.09.015","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages A10-A14"},"PeriodicalIF":8.2,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146001847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-19DOI: 10.1053/j.ajkd.2025.10.017
Volker H. Haase M.D. Dr. med., Nadiesda A. Costa M.D. M.P.H., Mark J. Koury M.D.
The clinical challenges and safety concerns associated with the use of erythropoiesis stimulating agents (ESAs) have provided the rationale for developing novel therapeutic approaches that address the complex pathophysiology of anemia in chronic kidney disease (CKD). Hypoxia-inducible factor-prolyl hydroxylase inhibitors (HIF-PHIs) are a new class of oral agents that effectively increase and maintain hemoglobin levels in patients with CKD. These agents stimulate the endogenous production of erythropoietin and enhance iron metabolism by activating hypoxia-inducible factors. Despite their efficacy, the use of some HIF-PHIs has been limited to patients on maintenance dialysis in some countries, including the United States, due to unresolved cardiovascular safety concerns in patients with CKD not on dialysis. In this review, we examine the mechanisms of action and erythropoietic effects of HIF-PHIs, evaluate undesirable on-target and off-target effects, and address cardiovascular and other safety concerns that have been raised in comparison to ESAs. We discuss how this novel class of oral anemia drugs may impact clinical practice, including their potential use in kidney transplant recipients.
{"title":"Navigating Anemia Therapy in CKD: The Role of Hypoxia-Inducible Factor Activators","authors":"Volker H. Haase M.D. Dr. med., Nadiesda A. Costa M.D. M.P.H., Mark J. Koury M.D.","doi":"10.1053/j.ajkd.2025.10.017","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.10.017","url":null,"abstract":"The clinical challenges and safety concerns associated with the use of erythropoiesis stimulating agents (ESAs) have provided the rationale for developing novel therapeutic approaches that address the complex pathophysiology of anemia in chronic kidney disease (CKD). Hypoxia-inducible factor-prolyl hydroxylase inhibitors (HIF-PHIs) are a new class of oral agents that effectively increase and maintain hemoglobin levels in patients with CKD. These agents stimulate the endogenous production of erythropoietin and enhance iron metabolism by activating hypoxia-inducible factors. Despite their efficacy, the use of some HIF-PHIs has been limited to patients on maintenance dialysis in some countries, including the United States, due to unresolved cardiovascular safety concerns in patients with CKD not on dialysis. In this review, we examine the mechanisms of action and erythropoietic effects of HIF-PHIs, evaluate undesirable on-target and off-target effects, and address cardiovascular and other safety concerns that have been raised in comparison to ESAs. We discuss how this novel class of oral anemia drugs may impact clinical practice, including their potential use in kidney transplant recipients.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146006430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.1053/j.ajkd.2025.11.007
Richard A Hirth,Paula A Guro,Ali Imtiaz,Mary K Oerline,John M Hollingsworth,Vahakn B Shahinian
RATIONALE & OBJECTIVEUnemployment is common among patients receiving maintenance dialysis, and peritoneal dialysis may better facilitate employment and employer-sponsored health insurance than hemodialysis. This study assessed the employment status of dialysis patients and examined the association between dialysis modality and the likelihood of insurance transitions after dialysis initiation, using employer-sponsored health insurance status as a proxy for patient or household employment.STUDY DESIGNNational retrospective cohort study.SETTING & PARTICIPANTSPatients represented in the United States Renal Data System who initiated dialysis between 1/1/2013-12/31/2018 and were followed for between 3 and 30 months. 18,408 in-center hemodialysis and peritoneal dialysis patients employed full-time at the time of dialysis initiation, with employer-sponsored health insurance three months post-dialysis, followed for loss of employer-sponsored health insurance. 104,952 in-center hemodialysis and peritoneal dialysis patients unemployed at the time of dialysis initiation and without employer-sponsored health insurance three months post-dialysis initiation, followed for initiation of employer-sponsored health insurance.EXPOSUREDialysis modality 3 months post-dialysis initiation, categorized as either in-center hemodialysis (IHD) with a hemodialysis fistula, IHD without a fistula, or peritoneal dialysis (PD) OUTCOMES: Employer-sponsored health insurance loss or gain.ANALYTICAL APPROACHCause-specific hazards modeling.RESULTSCompared to patients receiving PD, patients receiving IHD without a fistula (HR, 1.26 [95% CI, 1.18-1.36]) and with a fistula (HR, 1.14 [95% CI, 1.05-1.24]) were more likely to lose employer-sponsored health insurance. Compared to patients receiving PD, patients receiving IHD without a fistula (HR, 0.55 [95% CI, 0.49-0.61]) and with a fistula (HR, 0.59 [95% CI, 0.52-0.67]) were less likely to gain employer-sponsored insurance.LIMITATIONSEmployer-sponsored health insurance may not be a fully accurate proxy for employment status. Potential for residual confounding.CONCLUSIONSPeritoneal dialysis was associated with higher probabilities of maintaining and gaining employer-sponsored health insurance after dialysis initiation, compared to in-center hemodialysis. These findings may inform policies that influence the uptake of peritoneal dialysis, potentially improving rates of employer-sponsored health insurance and employment among dialysis patients or their households.
{"title":"Changes in Employment Status After Initiation of Peritoneal and In-center Hemodialysis.","authors":"Richard A Hirth,Paula A Guro,Ali Imtiaz,Mary K Oerline,John M Hollingsworth,Vahakn B Shahinian","doi":"10.1053/j.ajkd.2025.11.007","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.11.007","url":null,"abstract":"RATIONALE & OBJECTIVEUnemployment is common among patients receiving maintenance dialysis, and peritoneal dialysis may better facilitate employment and employer-sponsored health insurance than hemodialysis. This study assessed the employment status of dialysis patients and examined the association between dialysis modality and the likelihood of insurance transitions after dialysis initiation, using employer-sponsored health insurance status as a proxy for patient or household employment.STUDY DESIGNNational retrospective cohort study.SETTING & PARTICIPANTSPatients represented in the United States Renal Data System who initiated dialysis between 1/1/2013-12/31/2018 and were followed for between 3 and 30 months. 18,408 in-center hemodialysis and peritoneal dialysis patients employed full-time at the time of dialysis initiation, with employer-sponsored health insurance three months post-dialysis, followed for loss of employer-sponsored health insurance. 104,952 in-center hemodialysis and peritoneal dialysis patients unemployed at the time of dialysis initiation and without employer-sponsored health insurance three months post-dialysis initiation, followed for initiation of employer-sponsored health insurance.EXPOSUREDialysis modality 3 months post-dialysis initiation, categorized as either in-center hemodialysis (IHD) with a hemodialysis fistula, IHD without a fistula, or peritoneal dialysis (PD) OUTCOMES: Employer-sponsored health insurance loss or gain.ANALYTICAL APPROACHCause-specific hazards modeling.RESULTSCompared to patients receiving PD, patients receiving IHD without a fistula (HR, 1.26 [95% CI, 1.18-1.36]) and with a fistula (HR, 1.14 [95% CI, 1.05-1.24]) were more likely to lose employer-sponsored health insurance. Compared to patients receiving PD, patients receiving IHD without a fistula (HR, 0.55 [95% CI, 0.49-0.61]) and with a fistula (HR, 0.59 [95% CI, 0.52-0.67]) were less likely to gain employer-sponsored insurance.LIMITATIONSEmployer-sponsored health insurance may not be a fully accurate proxy for employment status. Potential for residual confounding.CONCLUSIONSPeritoneal dialysis was associated with higher probabilities of maintaining and gaining employer-sponsored health insurance after dialysis initiation, compared to in-center hemodialysis. These findings may inform policies that influence the uptake of peritoneal dialysis, potentially improving rates of employer-sponsored health insurance and employment among dialysis patients or their households.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"5 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994876","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}
This case report investigates the genetic basis of collagenofibrotic glomerulopathy (CG), a type of collagen type III glomerulopathy. It is a rare kidney disease characterized by collagen III deposition. A 47-year-old man with CG, born to consanguineous parents, underwent whole-exome sequencing. A homozygous truncating variant in STAB2 and a heterozygous variant in STAB1 were identified. Neither of the proteins encoded by STAB2 and STAB1 was expressed in the kidney glomeruli, suggesting a systemic mechanism for CG development. The patient's mother and brother, with homozygous or heterozygous STAB1 and heterozygous STAB2 variants, were unaffected. These observations suggest that the homozygous truncating variant of STAB2 was crucial for CG in our patient. This study provides initial evidence implicating STAB1 and STAB2 in CG pathogenesis. Further studies are needed to confirm the present findings, elucidate the roles of stabilin-1 and stabilin-2 in CG, and investigate their potential for systemic involvement.
{"title":"Collagenofibrotic Glomerulopathy Associated With Homozygous STAB2 and Heterozygous STAB1 Variants: A Case Report.","authors":"Satoko Yamamoto,Jun-Ya Kaimori,Daisuke Motooka,Hirofumi Taniguchi,Ghahei Lee,Masataka Inoue,Tomoka Imanaka,Seiichi Yasuda,Kenji Nishimura,Nobuyuki Kajiwara,Yuki Kawano,Yohei Doi,Tatsufumi Oka,Yusuke Sakaguchi,Yoshitaka Isaka","doi":"10.1053/j.ajkd.2025.10.016","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.10.016","url":null,"abstract":"This case report investigates the genetic basis of collagenofibrotic glomerulopathy (CG), a type of collagen type III glomerulopathy. It is a rare kidney disease characterized by collagen III deposition. A 47-year-old man with CG, born to consanguineous parents, underwent whole-exome sequencing. A homozygous truncating variant in STAB2 and a heterozygous variant in STAB1 were identified. Neither of the proteins encoded by STAB2 and STAB1 was expressed in the kidney glomeruli, suggesting a systemic mechanism for CG development. The patient's mother and brother, with homozygous or heterozygous STAB1 and heterozygous STAB2 variants, were unaffected. These observations suggest that the homozygous truncating variant of STAB2 was crucial for CG in our patient. This study provides initial evidence implicating STAB1 and STAB2 in CG pathogenesis. Further studies are needed to confirm the present findings, elucidate the roles of stabilin-1 and stabilin-2 in CG, and investigate their potential for systemic involvement.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"22 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-15DOI: 10.1053/j.ajkd.2025.11.008
Wei Lin,Alexander R Chang,Deidra C Crews,Tanjala S Purnell,Lawrence J Appel,Junichi Ishigami,
RATIONALE & OBJECTIVEKidney disease is often clustered within families, including Black families, and could be due in part to shared adverse social determinants of health (SDoH) and/or genetic factors. We hypothesize that the association between family history of kidney failure and chronic kidney disease (CKD) progression is largely attenuated when adjusting for adverse SDoH and apolipoprotein L1 (APOL1) risk allele.STUDY DESIGNLongitudinal observational study.SETTING & PARTICIPANTS5,623 participants from Chronic Renal Insufficiency Cohort (CRIC) Study.EXPOSURESelf-reported family history of kidney failure defined as a first-degree relative treated for kidney failure with dialysis or transplantation.OUTCOMECKD progression defined as incident end-stage kidney disease or 50% decline in estimated glomerular filtration rate (eGFR) from baseline.ANALYTICAL APPROACHLogistic regression models were fitted to estimate adjusted odds ratios (aORs) of the outcome of family history of kidney failure according to the main exposures of race-ethnicity/APOL1 risk allele status and SDoH. Next, Cox proportional hazards models were fitted to assess the association of family history of kidney failure with the outcome of CKD progression.RESULTSAmong all participants (mean (SD) age 59.6±10.7 years; 44% female; 43% Black race), 948 (17%) reported a family history of kidney failure. Compared to White participants, Black participants were more likely to report a family history of kidney failure regardless of APOL1 status (aOR =2.25 (95% CI: 1.74-2.91) for 0 or 1 risk allele; and aOR=3.46 (95% CI: 2.39-5.02) for 2 risk alleles). Adverse SDoH, such as lower income and lower educational attainment, were positively associated with family history of kidney failure in unadjusted analyses, but not in multivariable models. In prospective analysis, family history of kidney failure was significantly associated with an increased risk of CKD progression in both crude (HR, 1.33, 95% CI: 1.19-1.49) and multivariable models adjusting for demographics, APOL1 risk allele status, SDoH, and clinical factors (HR, 1.16, 95% CI: 1.02-1.33).LIMITATIONSPossible residual confounding.CONCLUSIONAmong people with CKD, Black race was significantly associated with a family history of kidney failure, even in those without the high risk APOL1 allele status. After adjusting for SDoH and APOL1 status, the family history of kidney failure remained associated with the risk of CKD progression. These findings highlight the importance of collecting information on family history and the need for further efforts to understand the reasons for familial aggregation of CKD.
{"title":"Family History of Kidney Failure, APOL-1 Risk Variants, Social Determinants of Health, and Risk of CKD Progression: Findings From the CRIC Study.","authors":"Wei Lin,Alexander R Chang,Deidra C Crews,Tanjala S Purnell,Lawrence J Appel,Junichi Ishigami, ","doi":"10.1053/j.ajkd.2025.11.008","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.11.008","url":null,"abstract":"RATIONALE & OBJECTIVEKidney disease is often clustered within families, including Black families, and could be due in part to shared adverse social determinants of health (SDoH) and/or genetic factors. We hypothesize that the association between family history of kidney failure and chronic kidney disease (CKD) progression is largely attenuated when adjusting for adverse SDoH and apolipoprotein L1 (APOL1) risk allele.STUDY DESIGNLongitudinal observational study.SETTING & PARTICIPANTS5,623 participants from Chronic Renal Insufficiency Cohort (CRIC) Study.EXPOSURESelf-reported family history of kidney failure defined as a first-degree relative treated for kidney failure with dialysis or transplantation.OUTCOMECKD progression defined as incident end-stage kidney disease or 50% decline in estimated glomerular filtration rate (eGFR) from baseline.ANALYTICAL APPROACHLogistic regression models were fitted to estimate adjusted odds ratios (aORs) of the outcome of family history of kidney failure according to the main exposures of race-ethnicity/APOL1 risk allele status and SDoH. Next, Cox proportional hazards models were fitted to assess the association of family history of kidney failure with the outcome of CKD progression.RESULTSAmong all participants (mean (SD) age 59.6±10.7 years; 44% female; 43% Black race), 948 (17%) reported a family history of kidney failure. Compared to White participants, Black participants were more likely to report a family history of kidney failure regardless of APOL1 status (aOR =2.25 (95% CI: 1.74-2.91) for 0 or 1 risk allele; and aOR=3.46 (95% CI: 2.39-5.02) for 2 risk alleles). Adverse SDoH, such as lower income and lower educational attainment, were positively associated with family history of kidney failure in unadjusted analyses, but not in multivariable models. In prospective analysis, family history of kidney failure was significantly associated with an increased risk of CKD progression in both crude (HR, 1.33, 95% CI: 1.19-1.49) and multivariable models adjusting for demographics, APOL1 risk allele status, SDoH, and clinical factors (HR, 1.16, 95% CI: 1.02-1.33).LIMITATIONSPossible residual confounding.CONCLUSIONAmong people with CKD, Black race was significantly associated with a family history of kidney failure, even in those without the high risk APOL1 allele status. After adjusting for SDoH and APOL1 status, the family history of kidney failure remained associated with the risk of CKD progression. These findings highlight the importance of collecting information on family history and the need for further efforts to understand the reasons for familial aggregation of CKD.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"83 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145993040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-14DOI: 10.1053/j.ajkd.2025.09.026
Wendy Wen Qing Ye,Joanne M Bargman,Jeffrey Perl
Since its introduction in 1985, Kt/V urea has played a pivotal role as a marker of "dialysis adequacy". Over the decades, multiple clinical practice guidelines have adopted and subsequently relaxed Kt/V targets, which were then transformed into quality metrics in various healthcare systems, including the United States. In this perspective, we explore the historical origins of Kt/V, focusing on its adaptation to peritoneal dialysis (PD). We critically examine literature linking Kt/V to patient outcomes and explore the limitations of Kt/V-including reliance on urea removal alone as a surrogate for the clearance of all uremic toxins, the flawed assumption of equivalence between residual kidney and dialytic urea clearances, and the challenges in estimating the volume of distribution of urea. We propose alternative quality metrics that may better reflect meaningful patient outcomes such as preserving residual kidney function, optimizing nutrition and volume status, minimizing dialysis-related infections, and maintaining quality of life. Ultimately, we call for a shift away from Kt/V-centric quality frameworks and the concept of "adequate" dialysis, advocating instead for a more holistic model of high-quality, person-centered dialysis care; a model in which kidney care practitioners are empowered to provide high quality PD care without the constraints of Kt/V.
{"title":"Free to Be in Peritoneal Dialysis: Without Kt/V?","authors":"Wendy Wen Qing Ye,Joanne M Bargman,Jeffrey Perl","doi":"10.1053/j.ajkd.2025.09.026","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.09.026","url":null,"abstract":"Since its introduction in 1985, Kt/V urea has played a pivotal role as a marker of \"dialysis adequacy\". Over the decades, multiple clinical practice guidelines have adopted and subsequently relaxed Kt/V targets, which were then transformed into quality metrics in various healthcare systems, including the United States. In this perspective, we explore the historical origins of Kt/V, focusing on its adaptation to peritoneal dialysis (PD). We critically examine literature linking Kt/V to patient outcomes and explore the limitations of Kt/V-including reliance on urea removal alone as a surrogate for the clearance of all uremic toxins, the flawed assumption of equivalence between residual kidney and dialytic urea clearances, and the challenges in estimating the volume of distribution of urea. We propose alternative quality metrics that may better reflect meaningful patient outcomes such as preserving residual kidney function, optimizing nutrition and volume status, minimizing dialysis-related infections, and maintaining quality of life. Ultimately, we call for a shift away from Kt/V-centric quality frameworks and the concept of \"adequate\" dialysis, advocating instead for a more holistic model of high-quality, person-centered dialysis care; a model in which kidney care practitioners are empowered to provide high quality PD care without the constraints of Kt/V.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"38 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986567","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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