Pub Date : 2024-06-06DOI: 10.1053/j.ajkd.2024.04.007
<div><h3>Rationale & Objective</h3><div>Developing strategies to improve home dialysis use requires a comprehensive understanding of barriers. We sought to identify the most important barriers to home dialysis use from the perspective of patients, care partners, and providers.</div></div><div><h3>Study Design</h3><div>This is a convergent parallel mixed-methods study.</div></div><div><h3>Setting & Participants</h3><div>We convened a 7-member advisory board of patients, care partners, and providers who collectively developed lists of major patient/care partner-perceived barriers and provider-perceived barriers to home dialysis. We used these lists to develop a survey that was distributed to patients, care partners, and providers—through the American Association of Kidney Patients and the National Kidney Foundation. The surveys asked participants to (1) rank their top 3 major barriers (quantitative) and (2) describe barriers to home dialysis (qualitative).</div></div><div><h3>Analytical Approach</h3><div>We compiled a list of the top 3 patient/care partner-perceived and top 3 provider-perceived barriers (quantitative). We also conducted a directed content analysis of open-ended survey responses (qualitative).</div></div><div><h3>Results</h3><div>There were 522 complete responses (233 providers; 289 patients/care partners). The top 3 patient/care partner-perceived barriers were fear of performing home dialysis; lack of space; and the need for home-based support. The top 3 provider-perceived barriers were poor patient education; limited mechanisms for home-based support staff, mental health, and education; and lack of experienced staff. We identified 9 themes through qualitative analysis: limited education; financial disincentives; limited resources; high burden of care; built environment/structure of care delivery that favors in-center hemodialysis; fear and isolation; perceptions of inequities in access to home dialysis; provider perspectives about patients; and patient/provider resiliency.</div></div><div><h3>Limitations</h3><div>This was an online survey that is subject to nonresponse bias.</div></div><div><h3>Conclusions</h3><div>The top 3 barriers to home dialysis for patient/care partners and providers incompletely overlap, suggesting the need for diverse strategies that simultaneously address patient-perceived barriers at home and provider-perceived barriers in the clinic.</div></div><div><h3>Plain-Language Summary</h3><div>There are many barriers to home dialysis use in the United States. However, we know little about which barriers are the most important to patients and clinicians. This makes it challenging to develop strategies to increase home dialysis use. In this study, we surveyed patients, care partners, and clinicians across the country to identify the most important barriers to home dialysis, namely (1) patients/care partners identified fear of home dialysis, lack of space, and lack of home-based support; and (2) clinicians
{"title":"Identifying Major Barriers to Home Dialysis (The IM-HOME Study): Findings From a National Survey of Patients, Care Partners, and Providers","authors":"","doi":"10.1053/j.ajkd.2024.04.007","DOIUrl":"10.1053/j.ajkd.2024.04.007","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Developing strategies to improve home dialysis use requires a comprehensive understanding of barriers. We sought to identify the most important barriers to home dialysis use from the perspective of patients, care partners, and providers.</div></div><div><h3>Study Design</h3><div>This is a convergent parallel mixed-methods study.</div></div><div><h3>Setting & Participants</h3><div>We convened a 7-member advisory board of patients, care partners, and providers who collectively developed lists of major patient/care partner-perceived barriers and provider-perceived barriers to home dialysis. We used these lists to develop a survey that was distributed to patients, care partners, and providers—through the American Association of Kidney Patients and the National Kidney Foundation. The surveys asked participants to (1) rank their top 3 major barriers (quantitative) and (2) describe barriers to home dialysis (qualitative).</div></div><div><h3>Analytical Approach</h3><div>We compiled a list of the top 3 patient/care partner-perceived and top 3 provider-perceived barriers (quantitative). We also conducted a directed content analysis of open-ended survey responses (qualitative).</div></div><div><h3>Results</h3><div>There were 522 complete responses (233 providers; 289 patients/care partners). The top 3 patient/care partner-perceived barriers were fear of performing home dialysis; lack of space; and the need for home-based support. The top 3 provider-perceived barriers were poor patient education; limited mechanisms for home-based support staff, mental health, and education; and lack of experienced staff. We identified 9 themes through qualitative analysis: limited education; financial disincentives; limited resources; high burden of care; built environment/structure of care delivery that favors in-center hemodialysis; fear and isolation; perceptions of inequities in access to home dialysis; provider perspectives about patients; and patient/provider resiliency.</div></div><div><h3>Limitations</h3><div>This was an online survey that is subject to nonresponse bias.</div></div><div><h3>Conclusions</h3><div>The top 3 barriers to home dialysis for patient/care partners and providers incompletely overlap, suggesting the need for diverse strategies that simultaneously address patient-perceived barriers at home and provider-perceived barriers in the clinic.</div></div><div><h3>Plain-Language Summary</h3><div>There are many barriers to home dialysis use in the United States. However, we know little about which barriers are the most important to patients and clinicians. This makes it challenging to develop strategies to increase home dialysis use. In this study, we surveyed patients, care partners, and clinicians across the country to identify the most important barriers to home dialysis, namely (1) patients/care partners identified fear of home dialysis, lack of space, and lack of home-based support; and (2) clinicians ","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141293007","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 : 2024-06-01DOI: 10.1053/j.ajkd.2024.03.015
{"title":"Going From Point A to Point B: Changes in the Mobility of Older Persons With CKD","authors":"","doi":"10.1053/j.ajkd.2024.03.015","DOIUrl":"10.1053/j.ajkd.2024.03.015","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0272638624007418/pdfft?md5=9255d521334a61bf4964e7cfec5fd9f8&pid=1-s2.0-S0272638624007418-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141199250","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 : 2024-05-29DOI: 10.1053/j.ajkd.2024.03.027
Andreia Curto, Tiago Assis Pereira, Ana Carina Ferreira
{"title":"The Use of Ultrasound in Peritoneal Dialysis Setting.","authors":"Andreia Curto, Tiago Assis Pereira, Ana Carina Ferreira","doi":"10.1053/j.ajkd.2024.03.027","DOIUrl":"10.1053/j.ajkd.2024.03.027","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141183350","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 : 2024-05-29DOI: 10.1053/j.ajkd.2024.04.006
Vandana Dua Niyyar
{"title":"In Reply to \"The Use of Ultrasound in Peritoneal Dialysis Setting\".","authors":"Vandana Dua Niyyar","doi":"10.1053/j.ajkd.2024.04.006","DOIUrl":"10.1053/j.ajkd.2024.04.006","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141183347","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 : 2024-05-28DOI: 10.1053/j.ajkd.2024.03.028
<div><h3>Rationale & Objective</h3><div>Biomarkers that enable better identification of persons with chronic kidney disease (CKD) who are at higher risk for disease progression and adverse events are needed. This study sought to identify urine and plasma metabolites associated with progression of kidney disease.</div></div><div><h3>Study Design</h3><div>Prospective metabolome-wide association study.</div></div><div><h3>Setting & Participants</h3><div>Persons with CKD enrolled in the GCKD (German CKD) study with metabolite measurements, with external validation within the ARIC (Atherosclerosis Risk in Communities) Study.</div></div><div><h3>Exposures</h3><div>1,513 urine and 1,416 plasma metabolites (Metabolon Inc) measured at study entry using untargeted mass spectrometry.</div></div><div><h3>Outcomes</h3><div>Main end points were kidney failure (KF) and a composite kidney end point (CKE) of KF, estimated glomerular filtration rate<!--> <!--><15<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup>, or a 40% decrease in estimated glomerular filtration rate. Death from any cause was a secondary end point. After a median of 6.5 years of follow-up, 500 persons had experienced KF, 1,083 had experienced the CKE, and 680 had died.</div></div><div><h3>Analytical Approach</h3><div>Time-to-event analyses using multivariable proportional hazard regression models in a discovery–replication design with external validation.</div></div><div><h3>Results</h3><div>5,088 GCKD study participants were included in analyses of urine metabolites, and 5,144 were included in analyses of plasma metabolites. Among 182 unique metabolites, 30 were significantly associated with KF, 49 with the CKE, and 163 with death. The strongest association with KF was observed for plasma hydroxyasparagine (HR, 1.95; 95% CI, 1.68-2.25). An unnamed metabolite measured in plasma and urine was significantly associated with KF, the CKE, and death. External validation of the identified associations of metabolites with KF or the CKE revealed directional consistency for 88% of observed associations. Selected associations of 18 metabolites with study outcomes have not been previously reported.</div></div><div><h3>Limitations</h3><div>Use of observational data and semiquantitative metabolite measurements at a single time point.</div></div><div><h3>Conclusions</h3><div>The observed associations between metabolites and KF, the CKE, or death in persons with CKD confirmed previously reported findings and also revealed several associations not previously described. These findings warrant confirmatory research in other study cohorts.</div></div><div><h3>Plain-Language Summary</h3><div>Incomplete understanding of the variability of chronic kidney disease (CKD) progression motivated the search for new biomarkers that would help identify people at increased risk. We explored metabolites in plasma and urine for their association with unfavorable kidney outcomes or death in persons with CKD. Metabolomic an
{"title":"Associations of Urine and Plasma Metabolites With Kidney Failure and Death in a Chronic Kidney Disease Cohort","authors":"","doi":"10.1053/j.ajkd.2024.03.028","DOIUrl":"10.1053/j.ajkd.2024.03.028","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Biomarkers that enable better identification of persons with chronic kidney disease (CKD) who are at higher risk for disease progression and adverse events are needed. This study sought to identify urine and plasma metabolites associated with progression of kidney disease.</div></div><div><h3>Study Design</h3><div>Prospective metabolome-wide association study.</div></div><div><h3>Setting & Participants</h3><div>Persons with CKD enrolled in the GCKD (German CKD) study with metabolite measurements, with external validation within the ARIC (Atherosclerosis Risk in Communities) Study.</div></div><div><h3>Exposures</h3><div>1,513 urine and 1,416 plasma metabolites (Metabolon Inc) measured at study entry using untargeted mass spectrometry.</div></div><div><h3>Outcomes</h3><div>Main end points were kidney failure (KF) and a composite kidney end point (CKE) of KF, estimated glomerular filtration rate<!--> <!--><15<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup>, or a 40% decrease in estimated glomerular filtration rate. Death from any cause was a secondary end point. After a median of 6.5 years of follow-up, 500 persons had experienced KF, 1,083 had experienced the CKE, and 680 had died.</div></div><div><h3>Analytical Approach</h3><div>Time-to-event analyses using multivariable proportional hazard regression models in a discovery–replication design with external validation.</div></div><div><h3>Results</h3><div>5,088 GCKD study participants were included in analyses of urine metabolites, and 5,144 were included in analyses of plasma metabolites. Among 182 unique metabolites, 30 were significantly associated with KF, 49 with the CKE, and 163 with death. The strongest association with KF was observed for plasma hydroxyasparagine (HR, 1.95; 95% CI, 1.68-2.25). An unnamed metabolite measured in plasma and urine was significantly associated with KF, the CKE, and death. External validation of the identified associations of metabolites with KF or the CKE revealed directional consistency for 88% of observed associations. Selected associations of 18 metabolites with study outcomes have not been previously reported.</div></div><div><h3>Limitations</h3><div>Use of observational data and semiquantitative metabolite measurements at a single time point.</div></div><div><h3>Conclusions</h3><div>The observed associations between metabolites and KF, the CKE, or death in persons with CKD confirmed previously reported findings and also revealed several associations not previously described. These findings warrant confirmatory research in other study cohorts.</div></div><div><h3>Plain-Language Summary</h3><div>Incomplete understanding of the variability of chronic kidney disease (CKD) progression motivated the search for new biomarkers that would help identify people at increased risk. We explored metabolites in plasma and urine for their association with unfavorable kidney outcomes or death in persons with CKD. Metabolomic an","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141178657","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 : 2024-05-27DOI: 10.1053/j.ajkd.2024.03.026
Patient and caregiver involvement can enhance the uptake and impact of research, but the involvement of patients and caregivers who are underserved and marginalized is often limited. A better understanding of how to make involvement in research more broadly accessible, supportive, and inclusive for patients with chronic kidney disease (CKD) and caregivers is needed. We conducted a national workshop involving patients, caregivers, clinicians, and researchers from across Australia to identify strategies to increase the diversity of patients and caregivers involved in CKD research. Six themes were identified. Building trust and a sense of safety was considered pivotal to establishing meaningful relationships to support knowledge exchange. Establishing community and connectedness was expected to generate a sense of belonging to motivate involvement. Balancing stakeholder goals, expectations, and responsibilities involved demonstrating commitment and transparency by researchers. Providing adequate resources and support included strategies to minimize the burden of involvement for patients and caregivers. Making research accessible and relatable was about nurturing patient and caregiver interest by appealing to intrinsic motivators. Adapting to patient and caregiver needs and preferences required tailoring the approach for individuals and the target community. Strategies and actions to support these themes may support more diverse and equitable involvement of patients and caregivers in research in CKD.
{"title":"Improving Diverse and Equitable Involvement of Patients and Caregivers in Research in CKD: Report of a Better Evidence and Translation–Chronic Kidney Disease (BEAT-CKD) Workshop","authors":"","doi":"10.1053/j.ajkd.2024.03.026","DOIUrl":"10.1053/j.ajkd.2024.03.026","url":null,"abstract":"<div><div>Patient and caregiver involvement can enhance the uptake and impact of research, but the involvement of patients and caregivers who are underserved and marginalized is often limited. A better understanding of how to make involvement in research more broadly accessible, supportive, and inclusive for patients with chronic kidney disease (CKD) and caregivers is needed. We conducted a national workshop involving patients, caregivers, clinicians, and researchers from across Australia to identify strategies to increase the diversity of patients and caregivers involved in CKD research. Six themes were identified. <em>Building trust and a sense of safety</em> was considered pivotal to establishing meaningful relationships to support knowledge exchange. <em>Establishing community and connectedness</em> was expected to generate a sense of belonging to motivate involvement. <em>Balancing stakeholder goals, expectations, and responsibilities</em> involved demonstrating commitment and transparency by researchers. <em>Providing adequate resources and support</em> included strategies to minimize the burden of involvement for patients and caregivers. <em>Making research accessible and relatable</em> was about nurturing patient and caregiver interest by appealing to intrinsic motivators. <em>Adapting to patient and caregiver needs and preferences</em> required tailoring the approach for individuals and the target community. Strategies and actions to support these themes may support more diverse and equitable involvement of patients and caregivers in research in CKD.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141174155","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 : 2024-05-23DOI: 10.1053/j.ajkd.2024.03.025
<div><h3>Rationale & Objective</h3><div>Kidneys are vital for vitamin D<span><span> metabolism, and disruptions in both production and catabolism occur in chronic kidney disease. Although </span>vitamin D<span><span> activation occurs in numerous tissues, the kidneys are the most relevant source of circulating active vitamin D. This study investigates extrarenal vitamin D activation and the impact of kidney transplantation on </span>vitamin D metabolism in patients who are anephric.</span></span></div></div><div><h3>Study Design</h3><div>Case series.</div></div><div><h3>Setting & Participants</h3><div><span>Adult patients with previous bilateral nephrectomy (anephric) not receiving active vitamin D therapy evaluated at the time of (N</span> <!-->=<!--> <!-->38) and 1 year after (n<!--> <!-->=<!--> <!-->25) kidney transplantation.</div></div><div><h3>Analytical Approach</h3><div><span><span>Chromatography with tandem mass spectrometry was used to measure vitamin D metabolites. Activity of </span>CYP24A1 [24,25(OH)</span><sub>2</sub>D/25(OH)D] and CYP27B1 [1α,25(OH)<sub>2</sub>D/25(OH)D] is expressed as metabolic ratios. Differences between time points were evaluated by paired <em>t</em>-test or Wilcoxon matched-pairs signed-rank test.</div></div><div><h3>Results</h3><div>At time of transplantation, 1α,25(OH)<sub>2</sub>D was detectable in all patients (4-36<!--> <!-->pg/mL). There was a linear relationship between 25(OH)D and 1α,25(OH)<sub>2</sub>D levels (r<!--> <em>=</em> <!-->0.58, P<!--> <!--><<!--> <!-->0.001), with 25(OH)D explaining 34% of the variation in 1α,25(OH)<sub>2</sub>D levels. There were no associations between 1α,25(OH)<sub>2</sub><span><span>D and biointact parathyroid hormone (PTH) or </span>fibroblast growth factor 23 (FGF-23). One year after transplantation, 1α,25(OH)</span><sub>2</sub>D levels recovered (+205%), and CYP27B1 activity increased (+352%). Measures of vitamin D catabolism, 24,25(OH)<sub>2</sub><span>D and CYP24A1 activity increased 3- to 5-fold. Also, at 12 months after transplantation, 1α,25(OH)</span><sub>2</sub>D was positively correlated with PTH (ρ<!--> <!-->=<!--> <!-->0.603, <em>P</em> <!-->=<!--> <!-->0.04) but not with levels of 25(OH)D or FGF-23.</div></div><div><h3>Limitations</h3><div>Retrospective, observational study design with a small cohort size.</div></div><div><h3>Conclusions</h3><div>Low-normal levels of 1α,25(OH)<sub>2</sub>D was demonstrated in anephric patients, indicating production outside the kidneys. This extrarenal CYP27B1 activity may be more substrate driven than hormonally regulated. Kidney transplantation seems to restore kidney CYP27B1 and CYP24A1 activity, as evaluated by vitamin D metabolic ratios, resulting in both increased vitamin D production and catabolism. These findings may have implications for vitamin D supplementation strategies in the setting of kidney failure and transplantation.</div></div><div><h3>Plain-Language Summary</h3><div>Vitamin D activation occu
肾脏对维生素 D 的代谢至关重要，慢性肾脏病会导致维生素 D 的生成和分解紊乱。虽然维生素 D 的活化发生在许多组织中，但肾脏是循环活性维生素 D 的最相关来源。本研究调查了肾外维生素 D 的活化以及肾移植对无肾患者维生素 D 代谢的影响。分析方法采用串联质谱色谱法测量维生素 D 代谢物。CYP24A1[24,25(OH)2D/25(OH)D]和CYP27B1[1α,25(OH)2D/25(OH)D]的活性以代谢比率表示。时间点之间的差异通过配对 t 检验或 Wilcoxon 配对符号秩检验进行评估。结果所有患者在移植时均可检测到 1α，25（OH）2D（4-36 pg/mL）。25(OH)D 与 1α、25(OH)2D 水平之间存在线性关系（r = 0.58，P < 0.001），25(OH)D 可解释 34% 的 1α、25(OH)2D 水平变化。1α，25（OH）2D与生物接触甲状旁腺激素（PTH）或成纤维细胞生长因子23（FGF-23）之间没有关联。移植一年后，1α,25(OH)2D水平恢复（+205%），CYP27B1活性增加（+352%）。维生素 D 分解代谢、24,25(OH)2D 和 CYP24A1 活性增加了 3 至 5 倍。此外，在移植后 12 个月，1α,25(OH)2D 与 PTH 呈正相关（ρ = 0.603，P = 0.04），但与 25(OH)D 或 FGF-23 的水平无关。这种肾外 CYP27B1 活性可能更多地由底物驱动，而非激素调节。根据维生素 D 代谢比率评估，肾移植似乎能恢复肾脏 CYP27B1 和 CYP24A1 的活性，从而增加维生素 D 的产生和分解。这些发现可能会对肾衰竭和移植背景下的维生素 D 补充策略产生影响。本研究通过测量 38 名无肾脏患者体内的维生素 D 代谢物，研究了肾脏以外的维生素 D 激活情况。所有患者都能检测到活性维生素 D，这表明维生素 D 是在肾脏之外产生的。活性维生素 D 水平与前体维生素 D 水平之间存在密切关系，但与矿物质代谢激素没有关系，这表明维生素 D 的产生更多取决于底物而非激素调节。肾移植一年后，活性维生素D水平增加了2倍，分解产物增加了3倍，这表明激素的产生和降解在肾移植后会恢复。这些发现对今后研究肾衰竭患者补充维生素D具有重要意义。
{"title":"Vitamin D Metabolites Before and After Kidney Transplantation in Patients Who Are Anephric","authors":"","doi":"10.1053/j.ajkd.2024.03.025","DOIUrl":"10.1053/j.ajkd.2024.03.025","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Kidneys are vital for vitamin D<span><span> metabolism, and disruptions in both production and catabolism occur in chronic kidney disease. Although </span>vitamin D<span><span> activation occurs in numerous tissues, the kidneys are the most relevant source of circulating active vitamin D. This study investigates extrarenal vitamin D activation and the impact of kidney transplantation on </span>vitamin D metabolism in patients who are anephric.</span></span></div></div><div><h3>Study Design</h3><div>Case series.</div></div><div><h3>Setting & Participants</h3><div><span>Adult patients with previous bilateral nephrectomy (anephric) not receiving active vitamin D therapy evaluated at the time of (N</span> <!-->=<!--> <!-->38) and 1 year after (n<!--> <!-->=<!--> <!-->25) kidney transplantation.</div></div><div><h3>Analytical Approach</h3><div><span><span>Chromatography with tandem mass spectrometry was used to measure vitamin D metabolites. Activity of </span>CYP24A1 [24,25(OH)</span><sub>2</sub>D/25(OH)D] and CYP27B1 [1α,25(OH)<sub>2</sub>D/25(OH)D] is expressed as metabolic ratios. Differences between time points were evaluated by paired <em>t</em>-test or Wilcoxon matched-pairs signed-rank test.</div></div><div><h3>Results</h3><div>At time of transplantation, 1α,25(OH)<sub>2</sub>D was detectable in all patients (4-36<!--> <!-->pg/mL). There was a linear relationship between 25(OH)D and 1α,25(OH)<sub>2</sub>D levels (r<!--> <em>=</em> <!-->0.58, P<!--> <!--><<!--> <!-->0.001), with 25(OH)D explaining 34% of the variation in 1α,25(OH)<sub>2</sub>D levels. There were no associations between 1α,25(OH)<sub>2</sub><span><span>D and biointact parathyroid hormone (PTH) or </span>fibroblast growth factor 23 (FGF-23). One year after transplantation, 1α,25(OH)</span><sub>2</sub>D levels recovered (+205%), and CYP27B1 activity increased (+352%). Measures of vitamin D catabolism, 24,25(OH)<sub>2</sub><span>D and CYP24A1 activity increased 3- to 5-fold. Also, at 12 months after transplantation, 1α,25(OH)</span><sub>2</sub>D was positively correlated with PTH (ρ<!--> <!-->=<!--> <!-->0.603, <em>P</em> <!-->=<!--> <!-->0.04) but not with levels of 25(OH)D or FGF-23.</div></div><div><h3>Limitations</h3><div>Retrospective, observational study design with a small cohort size.</div></div><div><h3>Conclusions</h3><div>Low-normal levels of 1α,25(OH)<sub>2</sub>D was demonstrated in anephric patients, indicating production outside the kidneys. This extrarenal CYP27B1 activity may be more substrate driven than hormonally regulated. Kidney transplantation seems to restore kidney CYP27B1 and CYP24A1 activity, as evaluated by vitamin D metabolic ratios, resulting in both increased vitamin D production and catabolism. These findings may have implications for vitamin D supplementation strategies in the setting of kidney failure and transplantation.</div></div><div><h3>Plain-Language Summary</h3><div>Vitamin D activation occu","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141131377","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 : 2024-05-22DOI: 10.1053/j.ajkd.2024.03.024
<div><h3>Rationale & Objective</h3><div>Established therapeutic interventions effectively mitigate the risk and progression of chronic kidney disease (CKD). Countries and regions have a compelling need for organizational structures that enable early identification of people with CKD who can benefit from these proven interventions. We report the current global status of CKD detection programs.</div></div><div><h3>Study Design</h3><div>A multinational cross-sectional survey.</div></div><div><h3>Setting & Participants</h3><div>Stakeholders, including nephrologist leaders, policymakers, and patient advocates from 167 countries, participating in the International Society of Nephrology (ISN) survey from June to September 2022.</div></div><div><h3>Outcome</h3><div>Structures for the detection and monitoring of CKD, including CKD surveillance systems in the form of registries, community-based detection programs, case-finding practices, and availability of measurement tools for risk identification.</div></div><div><h3>Analytical Approach</h3><div>Descriptive statistics.</div></div><div><h3>Results</h3><div>Of all participating countries, 19% (n<!--> <!-->=<!--> <!-->31) reported CKD registries, and 25% (n<!--> <!-->=<!--> <!-->40) reported implementing CKD detection programs as part of their national policies. There were variations in CKD detection program, with 50% (n<!--> <!-->=<!--> <!-->20) using a reactive approach (managing cases as identified) and 50% (n<!--> <!-->=<!--> <!-->20) actively pursuing case-finding in at-risk populations. Routine case-finding for CKD in high-risk populations was widespread, particularly for diabetes (n<!--> <!-->=<!--> <!-->152; 91%) and hypertension (n<!--> <!-->=<!--> <!-->148; 89%). Access to diagnostic tools, estimated glomerular filtration rate (eGFR), and urine albumin-creatinine ratio (UACR) was limited, especially in low-income (LICs) and lower-middle-income (LMICs) countries, at primary (eGFR: LICs 22%, LMICs 39%, UACR: LICs 28%, LMICs 39%) and secondary/tertiary health care levels (eGFR: LICs 39%, LMICs 73%, UACR: LICs 44%, LMICs 70%), potentially hindering CKD detection.</div></div><div><h3>Limitations</h3><div>A lack of detailed data prevented an in-depth analysis.</div></div><div><h3>Conclusions</h3><div>This comprehensive survey highlights a global heterogeneity in the organization and structures (surveillance systems and detection programs and tools) for early identification of CKD. Ongoing efforts should be geared toward bridging such disparities to optimally prevent the onset and progression of CKD and its complications.</div></div><div><h3>Plain-Language Summary</h3><div>Early detection and management of chronic kidney disease (CKD) is crucial to prevent progression to kidney failure. A multinational survey across 167 countries revealed disparities in CKD detection programs. Only 19% reported CKD registries, and 25% implemented detection programs as part of their national policy. Half used a re
{"title":"Organization and Structures for Detection and Monitoring of CKD Across World Countries and Regions: Observational Data From a Global Survey","authors":"","doi":"10.1053/j.ajkd.2024.03.024","DOIUrl":"10.1053/j.ajkd.2024.03.024","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Established therapeutic interventions effectively mitigate the risk and progression of chronic kidney disease (CKD). Countries and regions have a compelling need for organizational structures that enable early identification of people with CKD who can benefit from these proven interventions. We report the current global status of CKD detection programs.</div></div><div><h3>Study Design</h3><div>A multinational cross-sectional survey.</div></div><div><h3>Setting & Participants</h3><div>Stakeholders, including nephrologist leaders, policymakers, and patient advocates from 167 countries, participating in the International Society of Nephrology (ISN) survey from June to September 2022.</div></div><div><h3>Outcome</h3><div>Structures for the detection and monitoring of CKD, including CKD surveillance systems in the form of registries, community-based detection programs, case-finding practices, and availability of measurement tools for risk identification.</div></div><div><h3>Analytical Approach</h3><div>Descriptive statistics.</div></div><div><h3>Results</h3><div>Of all participating countries, 19% (n<!--> <!-->=<!--> <!-->31) reported CKD registries, and 25% (n<!--> <!-->=<!--> <!-->40) reported implementing CKD detection programs as part of their national policies. There were variations in CKD detection program, with 50% (n<!--> <!-->=<!--> <!-->20) using a reactive approach (managing cases as identified) and 50% (n<!--> <!-->=<!--> <!-->20) actively pursuing case-finding in at-risk populations. Routine case-finding for CKD in high-risk populations was widespread, particularly for diabetes (n<!--> <!-->=<!--> <!-->152; 91%) and hypertension (n<!--> <!-->=<!--> <!-->148; 89%). Access to diagnostic tools, estimated glomerular filtration rate (eGFR), and urine albumin-creatinine ratio (UACR) was limited, especially in low-income (LICs) and lower-middle-income (LMICs) countries, at primary (eGFR: LICs 22%, LMICs 39%, UACR: LICs 28%, LMICs 39%) and secondary/tertiary health care levels (eGFR: LICs 39%, LMICs 73%, UACR: LICs 44%, LMICs 70%), potentially hindering CKD detection.</div></div><div><h3>Limitations</h3><div>A lack of detailed data prevented an in-depth analysis.</div></div><div><h3>Conclusions</h3><div>This comprehensive survey highlights a global heterogeneity in the organization and structures (surveillance systems and detection programs and tools) for early identification of CKD. Ongoing efforts should be geared toward bridging such disparities to optimally prevent the onset and progression of CKD and its complications.</div></div><div><h3>Plain-Language Summary</h3><div>Early detection and management of chronic kidney disease (CKD) is crucial to prevent progression to kidney failure. A multinational survey across 167 countries revealed disparities in CKD detection programs. Only 19% reported CKD registries, and 25% implemented detection programs as part of their national policy. Half used a re","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141092272","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 : 2024-05-21DOI: 10.1053/j.ajkd.2024.04.003
{"title":"Erratum regarding “A New Panel-Estimated GFR, Including β2-Microglobulin and β-Trace Protein and Not Including Race, Developed in a Diverse Population” (Am J Kidney Dis. 2021;77(5):673-683)","authors":"","doi":"10.1053/j.ajkd.2024.04.003","DOIUrl":"10.1053/j.ajkd.2024.04.003","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":13.2,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0272638624006899/pdfft?md5=9f11ddaacb8455323a83e6b08ceb73e9&pid=1-s2.0-S0272638624006899-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141086497","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}
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