Pub Date : 2025-02-13DOI: 10.1053/j.ajkd.2025.01.006
Anukul Ghimire, Christoph Wanner, Marcello Tonelli
{"title":"Closing CKD Treatment Gaps: Why Practice Guidelines and Better Drug Coverage Are Not Enough.","authors":"Anukul Ghimire, Christoph Wanner, Marcello Tonelli","doi":"10.1053/j.ajkd.2025.01.006","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.01.006","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405389","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 : 2025-02-13DOI: 10.1053/j.ajkd.2025.01.002
Pablo Antonio Ureña Torres, Ana P N Pimentel, Martine Cohen-Solal
{"title":"Osteoporotic Fractures After Kidney Transplantation.","authors":"Pablo Antonio Ureña Torres, Ana P N Pimentel, Martine Cohen-Solal","doi":"10.1053/j.ajkd.2025.01.002","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.01.002","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405391","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 : 2025-02-09DOI: 10.1053/j.ajkd.2024.11.017
George Vasquez-Rios, Rachel Shulman, Megan Urbanski, Emmanuel A Adomako, Michael L Granda
After an enriching year in the editorial internship program at the American Journal of Kidney Diseases (AJKD), we reflect on the valuable lessons that we learned throughout the year. Engaging in the editorial and medical publishing process, we gained experience in critical appraisal and the role of scholarship in the nephrology community. In this Perspective, each editorial intern highlights five manuscripts published in AJKD between August 2023 and June 2024, offering commentary on specific aspects that, in our perspective, hold particularly high clinical or research significance.
{"title":"One Year at AJKD: A Perspective From the 2023- 2024 Editorial Interns.","authors":"George Vasquez-Rios, Rachel Shulman, Megan Urbanski, Emmanuel A Adomako, Michael L Granda","doi":"10.1053/j.ajkd.2024.11.017","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.11.017","url":null,"abstract":"<p><p>After an enriching year in the editorial internship program at the American Journal of Kidney Diseases (AJKD), we reflect on the valuable lessons that we learned throughout the year. Engaging in the editorial and medical publishing process, we gained experience in critical appraisal and the role of scholarship in the nephrology community. In this Perspective, each editorial intern highlights five manuscripts published in AJKD between August 2023 and June 2024, offering commentary on specific aspects that, in our perspective, hold particularly high clinical or research significance.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397757","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 : 2025-02-04DOI: 10.1053/j.ajkd.2024.10.015
Fokko P Wieringa, Swathi Suran, Henning Søndergaard, Stephen Ash, Cian Cummins, Ashesh Ray Chaudhury, Tugrul Irmak, Karin Gerritsen, Jeroen Vollenbroek
Worldwide, the number of people needing lifesaving kidney replacement therapy (KRT) steadily grows, but about two thirds of them lack access to KRT and thus die. Access to KRT depends on economic, social, infrastructural, ecological, and political factors. Current KRTs include kidney transplantation, peritoneal dialysis (PD) and hemodialysis (HD). Xenotransplantation recently is opening promising new perspectives but needs improvement. Unfortunately, not all patients are suitable for transplantation. PD and HD will remain important KRTs, but they are expensive and strongly depend on infrastructure, with little fundamental changes since the 1980s. The KRT field might learn from the African mobile phone revolution that beat infrastructural limitations, lowered costs, and increased access. We provide a non-exhaustive overview of promising ways to increase the mobility of technology-based KRTs by dialysate regeneration, chip-based nanoporous filters, bioreactor-enabling technologies and using the gut as a "third kidney". In 2018, the Kidney Health Initiative published a Roadmap for innovative KRTs composed by leading innovators, but the pace of innovation is slower than targeted. Ambitious political statements about realizing this roadmap can only succeed if the granted funding matches the targeted time scale. Patient-centered international coopetition (the act of cooperation between competing entities) seems to offer the quickest pathway to success.
{"title":"The Future of Technology-Based Kidney Replacement Therapies: An Update on Portable, Wearable and Implantable Artificial Kidneys.","authors":"Fokko P Wieringa, Swathi Suran, Henning Søndergaard, Stephen Ash, Cian Cummins, Ashesh Ray Chaudhury, Tugrul Irmak, Karin Gerritsen, Jeroen Vollenbroek","doi":"10.1053/j.ajkd.2024.10.015","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.10.015","url":null,"abstract":"<p><p>Worldwide, the number of people needing lifesaving kidney replacement therapy (KRT) steadily grows, but about two thirds of them lack access to KRT and thus die. Access to KRT depends on economic, social, infrastructural, ecological, and political factors. Current KRTs include kidney transplantation, peritoneal dialysis (PD) and hemodialysis (HD). Xenotransplantation recently is opening promising new perspectives but needs improvement. Unfortunately, not all patients are suitable for transplantation. PD and HD will remain important KRTs, but they are expensive and strongly depend on infrastructure, with little fundamental changes since the 1980s. The KRT field might learn from the African mobile phone revolution that beat infrastructural limitations, lowered costs, and increased access. We provide a non-exhaustive overview of promising ways to increase the mobility of technology-based KRTs by dialysate regeneration, chip-based nanoporous filters, bioreactor-enabling technologies and using the gut as a \"third kidney\". In 2018, the Kidney Health Initiative published a Roadmap for innovative KRTs composed by leading innovators, but the pace of innovation is slower than targeted. Ambitious political statements about realizing this roadmap can only succeed if the granted funding matches the targeted time scale. Patient-centered international coopetition (the act of cooperation between competing entities) seems to offer the quickest pathway to success.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363195","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 : 2025-02-01DOI: 10.1053/j.ajkd.2024.06.015
Thalia Porteny , Kristen Kennefick , Mary Lynch , Angie M. Velasquez , Kelli Collins Damron , Sylvia Rosas , Jennifer Allen , Daniel E. Weiner , Sean Kalloo , Katherine Rizzolo , Keren Ladin
Older Latino adults (aged 65+ years) comprise the fastest growing minoritized group among the older population in the United States and experience a disproportionate burden of kidney failure as well as disparities in kidney care compared with non-Hispanic White individuals. Despite significant need and barriers uniquely faced by this population, few educational resources or decision aids are available to meet the language and cultural needs of Latino patients. Decision aids are designed to improve knowledge and empower individuals to engage in shared decision making and have been shown to improve decisional quality and goal-concordant care among older patients with chronic kidney disease (CKD). In this commentary, we examine the barriers faced by older Latino people with CKD who must make dialysis initiation decisions. We conclude that there is a need for culturally concordant decision aids tailored for older Latino patients with CKD to overcome barriers in access to care and improve patient-centered care for older Latino CKD patients.
{"title":"The Need for Culturally Tailored CKD Education in Older Latino Patients and Their Families","authors":"Thalia Porteny , Kristen Kennefick , Mary Lynch , Angie M. Velasquez , Kelli Collins Damron , Sylvia Rosas , Jennifer Allen , Daniel E. Weiner , Sean Kalloo , Katherine Rizzolo , Keren Ladin","doi":"10.1053/j.ajkd.2024.06.015","DOIUrl":"10.1053/j.ajkd.2024.06.015","url":null,"abstract":"<div><div>Older Latino adults (aged 65+<!--> <!-->years) comprise the fastest growing minoritized group among the older population in the United States and experience a disproportionate burden of kidney failure as well as disparities in kidney care compared with non-Hispanic White individuals. Despite significant need and barriers uniquely faced by this population, few educational resources or decision aids are available to meet the language and cultural needs of Latino patients. Decision aids are designed to improve knowledge and empower individuals to engage in shared decision making and have been shown to improve decisional quality and goal-concordant care among older patients with chronic kidney disease (CKD). In this commentary, we examine the barriers faced by older Latino people with CKD who must make dialysis initiation decisions. We conclude that there is a need for culturally concordant decision aids tailored for older Latino patients with CKD to overcome barriers in access to care and improve patient-centered care for older Latino CKD patients.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 2","pages":"Pages 253-261"},"PeriodicalIF":9.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141911354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1053/j.ajkd.2024.10.002
Xingxing S. Cheng
{"title":"Short-term Pains for Long-term Gains? In Search of More Solutions to Inequities in Kidney Transplantation","authors":"Xingxing S. Cheng","doi":"10.1053/j.ajkd.2024.10.002","DOIUrl":"10.1053/j.ajkd.2024.10.002","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 2","pages":"Pages 182-183"},"PeriodicalIF":9.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799024","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 : 2025-02-01DOI: 10.1053/j.ajkd.2024.07.013
Rasheeda K. Hall , Sarah Morton-Oswald , Jonathan Wilson , Devika Nair , Cathleen Colón-Emeric , Jane Pendergast , Carl Pieper , Julia J. Scialla
<div><h3>Rationale & Objective</h3><div>Prescribing psychoactive medications for patients with kidney disease is common, but for patients receiving dialysis some medications may be inappropriate. We evaluated the association of coprescribing gabapentinoids and other psychoactive potentially inappropriate medications (PPIMs) (eg, sedatives or opioids) with altered mental status (AMS) and falls and whether the associations are modified by frailty.</div></div><div><h3>Study Design</h3><div>Observational cohort study.</div></div><div><h3>Setting & Participants</h3><div>Adults receiving dialysis represented in the US Renal Data System who had an active gabapentinoid prescription and no other PPIM prescriptions in the prior 6 months.</div></div><div><h3>Exposure</h3><div>PPIM coprescribing, or the presence of overlapping prescriptions of a gabapentinoid and<!--> <!-->≥1 additional PPIM.</div></div><div><h3>Outcome</h3><div>Acute care visits for AMS and injurious falls.</div></div><div><h3>Analytical Approach</h3><div>Prentice-Williams-Petersen Gap Time models estimated the association between PPIM coprescribing and each outcome, adjusting for demographics, comorbidities, and frailty, as assessed by a validated frailty index (FI). Each model tested for interaction between PPIM coprescribing and frailty.</div></div><div><h3>Results</h3><div>Overall, PPIM coprescribing was associated with increased hazard of AMS (HR, 1.66 [95% CI, 1.44-1.92]) and falls (HR, 1.55 [95% CI, 1.36-1.77]). Frailty significantly modified the effect of PPIM coprescribing on the hazard of AMS (interaction <em>P</em> <!-->=<!--> <!-->0.01) but not falls. Among individuals with low frailty (FI<!--> <!-->=<!--> <!-->0.15), the HR for AMS with PPIM coprescribing was 2.14 (95% CI, 1.69-2.71); for individuals with severe frailty (FI<!--> <!-->=<!--> <!-->0.34), the hazard ratio for AMS with PPIM coprescribing was 1.64 (95% CI, 1.42-1.89). Individuals with PPIM coprescribing and severe frailty (FI<!--> <!-->=<!--> <!-->0.34) had the highest hazard of AMS (HR, 3.22 [95% CI, 2.55-4.06]) and falls (HR, 2.77 [95% CI, 2.27-3.38]) compared with nonfrail individuals without PPIM coprescribing.</div></div><div><h3>Limitations</h3><div>Outcome ascertainment bias; residual confounding.</div></div><div><h3>Conclusions</h3><div>Compared with gabapentinoid prescriptions alone, PPIM coprescribing was associated with an increased risk of AMS and falls. Clinicians should consider these risks when coprescribing PPIMs to patients receiving dialysis.</div></div><div><h3>Plain-Language Summary</h3><div>Among people on dialysis, gabapentinoids may lead to confusion and falls. Often they are prescribed with other sedatives drugs or opioids, which can increase these risks. This study of adults with kidney failure receiving maintenance dialysis in the United States found that those who were prescribed both gabapentinoids and other psychoactive drugs were more likely to have confusion and falls compared
{"title":"Association of Coprescribing of Gabapentinoid and Other Psychoactive Medications With Altered Mental Status and Falls in Adults Receiving Dialysis","authors":"Rasheeda K. Hall , Sarah Morton-Oswald , Jonathan Wilson , Devika Nair , Cathleen Colón-Emeric , Jane Pendergast , Carl Pieper , Julia J. Scialla","doi":"10.1053/j.ajkd.2024.07.013","DOIUrl":"10.1053/j.ajkd.2024.07.013","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Prescribing psychoactive medications for patients with kidney disease is common, but for patients receiving dialysis some medications may be inappropriate. We evaluated the association of coprescribing gabapentinoids and other psychoactive potentially inappropriate medications (PPIMs) (eg, sedatives or opioids) with altered mental status (AMS) and falls and whether the associations are modified by frailty.</div></div><div><h3>Study Design</h3><div>Observational cohort study.</div></div><div><h3>Setting & Participants</h3><div>Adults receiving dialysis represented in the US Renal Data System who had an active gabapentinoid prescription and no other PPIM prescriptions in the prior 6 months.</div></div><div><h3>Exposure</h3><div>PPIM coprescribing, or the presence of overlapping prescriptions of a gabapentinoid and<!--> <!-->≥1 additional PPIM.</div></div><div><h3>Outcome</h3><div>Acute care visits for AMS and injurious falls.</div></div><div><h3>Analytical Approach</h3><div>Prentice-Williams-Petersen Gap Time models estimated the association between PPIM coprescribing and each outcome, adjusting for demographics, comorbidities, and frailty, as assessed by a validated frailty index (FI). Each model tested for interaction between PPIM coprescribing and frailty.</div></div><div><h3>Results</h3><div>Overall, PPIM coprescribing was associated with increased hazard of AMS (HR, 1.66 [95% CI, 1.44-1.92]) and falls (HR, 1.55 [95% CI, 1.36-1.77]). Frailty significantly modified the effect of PPIM coprescribing on the hazard of AMS (interaction <em>P</em> <!-->=<!--> <!-->0.01) but not falls. Among individuals with low frailty (FI<!--> <!-->=<!--> <!-->0.15), the HR for AMS with PPIM coprescribing was 2.14 (95% CI, 1.69-2.71); for individuals with severe frailty (FI<!--> <!-->=<!--> <!-->0.34), the hazard ratio for AMS with PPIM coprescribing was 1.64 (95% CI, 1.42-1.89). Individuals with PPIM coprescribing and severe frailty (FI<!--> <!-->=<!--> <!-->0.34) had the highest hazard of AMS (HR, 3.22 [95% CI, 2.55-4.06]) and falls (HR, 2.77 [95% CI, 2.27-3.38]) compared with nonfrail individuals without PPIM coprescribing.</div></div><div><h3>Limitations</h3><div>Outcome ascertainment bias; residual confounding.</div></div><div><h3>Conclusions</h3><div>Compared with gabapentinoid prescriptions alone, PPIM coprescribing was associated with an increased risk of AMS and falls. Clinicians should consider these risks when coprescribing PPIMs to patients receiving dialysis.</div></div><div><h3>Plain-Language Summary</h3><div>Among people on dialysis, gabapentinoids may lead to confusion and falls. Often they are prescribed with other sedatives drugs or opioids, which can increase these risks. This study of adults with kidney failure receiving maintenance dialysis in the United States found that those who were prescribed both gabapentinoids and other psychoactive drugs were more likely to have confusion and falls compared ","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 2","pages":"Pages 215-225.e1"},"PeriodicalIF":9.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378985","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 : 2025-02-01DOI: 10.1053/j.ajkd.2024.07.014
David C. Cron , Arnold E. Kuk , Layla Parast , S. Ali Husain , Kristen L. King , Miko Yu , Sumit Mohan , Joel T. Adler
<div><h3>Rationale & Objective</h3><div>The kidney allocation system (KAS250), using circle-based distribution, attempts to address geographic disparities through broader sharing of deceased-donor kidney allografts. This study evaluated the association between KAS250 and likelihood of deceased-donor kidney transplantation (DDKT) among wait-listed candidates, and whether the policy has differentially affected centers with shorter versus longer waiting time.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>160,941 candidates waitlisted at 176 transplant centers between March 2017 and March 2024.</div></div><div><h3>Exposure</h3><div>KAS250 allocation policy.</div></div><div><h3>Outcome</h3><div>Rate of DDKT.</div></div><div><h3>Analytical Approach</h3><div>Multivariable Cox regression, modeling KAS250 as a time-dependent variable.</div></div><div><h3>Results</h3><div>KAS250 was not independently associated with likelihood of DDKT overall (HR, 1.01 vs pre-KAS250 [95% CI, 0.97-1.04]). KAS250’s association with likelihood of DDKT varied across centers from HR, 0.18 (DDKT less likely after KAS250), to HR, 17.12 (DDKT more likely) and varied even among neighboring centers. KAS250 was associated with decreased DDKT at 25.6% and increased DDKT at 18.2% of centers. Centers with previously <em>long</em> median waiting times (57+<!--> <!-->months) experienced <em>increased</em> likelihood of DDKT after KAS250 (HR, 1.20 [95% CI, 1.15-1.26]) whereas centers with previously <em>short</em> median waiting times (6-24 months; HR, 0.88 [95% CI, 0.84-0.92]) experienced <em>decreased</em> likelihood of DDKT.</div></div><div><h3>Limitations</h3><div>Retrospective study of allocation policy changes, confounded by multiple changes over the study time frame.</div></div><div><h3>Conclusions</h3><div>Association between KAS250 and DDKT varied across centers. For 1 in 4 centers, DDKT was less likely after KAS250 relative to pre-KAS250 trends. Candidates at centers with previously long waiting times experienced an increased likelihood of DDKT after KAS250. Thus, broader distribution of kidneys may be associated with improved equity in access to DDKT, but additional strategies may be needed to minimize disparities between centers.</div></div><div><h3>Plain-Language Summary</h3><div>This study examines how a recent policy change, KAS250, aimed at broadening the geographic sharing of deceased-donor kidneys, has impacted likelihood of kidney transplantation in the United States. Historically, kidney allocation occurred within local geographic boundaries, leading to unequal rates of transplantation across regions. KAS250, implemented in March 2021, replaced this system with a broader allocation radius of 250 miles around the donor hospital. Using national registry data, the study found that while there was no overall significant increase in the likelihood of transplantation nationally under KAS250, t
{"title":"Associations Among Circle-Based Kidney Allocation, Center Waiting Time, and Likelihood of Deceased-Donor Kidney Transplantation","authors":"David C. Cron , Arnold E. Kuk , Layla Parast , S. Ali Husain , Kristen L. King , Miko Yu , Sumit Mohan , Joel T. Adler","doi":"10.1053/j.ajkd.2024.07.014","DOIUrl":"10.1053/j.ajkd.2024.07.014","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>The kidney allocation system (KAS250), using circle-based distribution, attempts to address geographic disparities through broader sharing of deceased-donor kidney allografts. This study evaluated the association between KAS250 and likelihood of deceased-donor kidney transplantation (DDKT) among wait-listed candidates, and whether the policy has differentially affected centers with shorter versus longer waiting time.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>160,941 candidates waitlisted at 176 transplant centers between March 2017 and March 2024.</div></div><div><h3>Exposure</h3><div>KAS250 allocation policy.</div></div><div><h3>Outcome</h3><div>Rate of DDKT.</div></div><div><h3>Analytical Approach</h3><div>Multivariable Cox regression, modeling KAS250 as a time-dependent variable.</div></div><div><h3>Results</h3><div>KAS250 was not independently associated with likelihood of DDKT overall (HR, 1.01 vs pre-KAS250 [95% CI, 0.97-1.04]). KAS250’s association with likelihood of DDKT varied across centers from HR, 0.18 (DDKT less likely after KAS250), to HR, 17.12 (DDKT more likely) and varied even among neighboring centers. KAS250 was associated with decreased DDKT at 25.6% and increased DDKT at 18.2% of centers. Centers with previously <em>long</em> median waiting times (57+<!--> <!-->months) experienced <em>increased</em> likelihood of DDKT after KAS250 (HR, 1.20 [95% CI, 1.15-1.26]) whereas centers with previously <em>short</em> median waiting times (6-24 months; HR, 0.88 [95% CI, 0.84-0.92]) experienced <em>decreased</em> likelihood of DDKT.</div></div><div><h3>Limitations</h3><div>Retrospective study of allocation policy changes, confounded by multiple changes over the study time frame.</div></div><div><h3>Conclusions</h3><div>Association between KAS250 and DDKT varied across centers. For 1 in 4 centers, DDKT was less likely after KAS250 relative to pre-KAS250 trends. Candidates at centers with previously long waiting times experienced an increased likelihood of DDKT after KAS250. Thus, broader distribution of kidneys may be associated with improved equity in access to DDKT, but additional strategies may be needed to minimize disparities between centers.</div></div><div><h3>Plain-Language Summary</h3><div>This study examines how a recent policy change, KAS250, aimed at broadening the geographic sharing of deceased-donor kidneys, has impacted likelihood of kidney transplantation in the United States. Historically, kidney allocation occurred within local geographic boundaries, leading to unequal rates of transplantation across regions. KAS250, implemented in March 2021, replaced this system with a broader allocation radius of 250 miles around the donor hospital. Using national registry data, the study found that while there was no overall significant increase in the likelihood of transplantation nationally under KAS250, t","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 2","pages":"Pages 187-195"},"PeriodicalIF":9.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142374970","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 : 2025-02-01DOI: 10.1053/j.ajkd.2024.07.017
Melandrea L. Worsley , Jingbo Niu , Kevin F. Erickson , Neal R. Barshes , Wolfgang C. Winkelmayer , L. Parker Gregg
Rationale & Objective
Race and ethnicity differences exist in the type of arteriovenous access (AVA, including fistulas and grafts) used at hemodialysis (HD) initiation. The preferred anatomic location for the creation of an initial HD AVA is typically in the forearm We evaluated race and ethnicity differences in the use of an AVA in the forearm location at HD initiation.
Study Design
Retrospective cohort study.
Setting & Participants
Using records from DaVita Kidney Care linked to the US Renal Data System (USRDS), we evaluated patients aged ≥16 years who initiated in-center HD with an AVA between 2006 and 2019.
Predictor
Race and ethnicity, categorized as non-Hispanic White, non-Hispanic Black, Hispanic, or Other.
Outcome
Forearm versus upper arm AVA location.
Analytical Approach
Multivariable modified Poisson regression to estimate adjusted trends in AVA location over time and race and ethnicity differences in AVA location. Nested models helped assess the relative confounding by groups of variables on estimates of race and ethnicity differences.
Results
Among 70,147 patients (51.7% White, 28.8% Black, 12.6% Hispanic, 6.9% Other), White patients were older and more likely to have peripheral vascular disease but less likely to have diabetes compared with the other groups. The proportion initiating HD using a forearm AVA decreased from 49% in 2006 to 29% in 2019 and by 3.6% (95% CI, 3.3%-3.9%) annually, with no difference in this trend among groups (race and ethnicity by calendar year interaction P = 0.32). Black patients were 13% (95% CI, 10%-15%) less likely and Hispanic patients were 5% (95% CI, 1%-9%) less likely than White patients to initiate HD with a forearm AVA.
Limitations
Findings may not apply to home HD.
Conclusions
Use of a forearm AVA for HD initiation has declined and racial differences have persisted, with Black and Hispanic patients being less likely than White patients to have an AVA in the forearm location. Research toward understanding the causes and consequences of these trends and disparities is warranted.
{"title":"Forearm Versus Upper Arm Location of Arteriovenous Access Used at Hemodialysis Initiation: Temporal Trends and Racial Disparities","authors":"Melandrea L. Worsley , Jingbo Niu , Kevin F. Erickson , Neal R. Barshes , Wolfgang C. Winkelmayer , L. Parker Gregg","doi":"10.1053/j.ajkd.2024.07.017","DOIUrl":"10.1053/j.ajkd.2024.07.017","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Race and ethnicity differences exist in the type of arteriovenous access (AVA, including fistulas and grafts) used at hemodialysis (HD) initiation. The preferred anatomic location for the creation of an initial HD AVA is typically in the forearm We evaluated race and ethnicity differences in the use of an AVA in the forearm location at HD initiation.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>Using records from DaVita Kidney Care linked to the US Renal Data System (USRDS), we evaluated patients aged<!--> <!-->≥16 years who initiated in-center HD with an AVA between 2006 and 2019.</div></div><div><h3>Predictor</h3><div>Race and ethnicity, categorized as non-Hispanic White, non-Hispanic Black, Hispanic, or Other.</div></div><div><h3>Outcome</h3><div>Forearm versus upper arm AVA location.</div></div><div><h3>Analytical Approach</h3><div>Multivariable modified Poisson regression to estimate adjusted trends in AVA location over time and race and ethnicity differences in AVA location. Nested models helped assess the relative confounding by groups of variables on estimates of race and ethnicity differences.</div></div><div><h3>Results</h3><div>Among 70,147 patients (51.7% White, 28.8% Black, 12.6% Hispanic, 6.9% Other), White patients were older and more likely to have peripheral vascular disease but less likely to have diabetes compared with the other groups. The proportion initiating HD using a forearm AVA decreased from 49% in 2006 to 29% in 2019 and by 3.6% (95% CI, 3.3%-3.9%) annually, with no difference in this trend among groups (race and ethnicity by calendar year interaction <em>P</em> <!-->=<!--> <!-->0.32). Black patients were 13% (95% CI, 10%-15%) less likely and Hispanic patients were 5% (95% CI, 1%-9%) less likely than White patients to initiate HD with a forearm AVA.</div></div><div><h3>Limitations</h3><div>Findings may not apply to home HD.</div></div><div><h3>Conclusions</h3><div>Use of a forearm AVA for HD initiation has declined and racial differences have persisted, with Black and Hispanic patients being less likely than White patients to have an AVA in the forearm location. Research toward understanding the causes and consequences of these trends and disparities is warranted.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 2","pages":"Pages 226-235.e1"},"PeriodicalIF":9.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142436111","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 : 2025-02-01DOI: 10.1053/j.ajkd.2024.10.004
Jung-Im Shin , Antoine Créon , Juan-Jesus Carrero
{"title":"Metformin in People With Diabetes and Advanced CKD: Should We Dare?","authors":"Jung-Im Shin , Antoine Créon , Juan-Jesus Carrero","doi":"10.1053/j.ajkd.2024.10.004","DOIUrl":"10.1053/j.ajkd.2024.10.004","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 2","pages":"Pages 184-186"},"PeriodicalIF":9.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142811841","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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