Pub Date : 2026-01-01Epub Date: 2025-10-16DOI: 10.1053/j.ajkd.2025.08.012
Jessica Potts , Camille M. Pearse , Mark Lambie , James Fotheringham , Harry Hill , David Coyle , Sarah Damery , Kerry Allen , Iestyn Williams , Simon J. Davies , Ivonne Solis-Trapala
<div><h3>Rationale & Objective</h3><div>Variation in home dialysis therapy (HT) use across centers and geography may reflect the interplay between dialysis center services and patient characteristics. We examined direct and indirect associations between these factors and HT uptake in England.</div></div><div><h3>Study Design</h3><div>UK Renal Registry (UKRR) cohort linked to a national survey of renal centers.</div></div><div><h3>Setting & Participants</h3><div>Adults who initiated kidney replacement therapy (KRT) between 2015 and 2019 at 51 English renal centers, totaling 32,400 individuals identified through the UKRR with center practices captured from a 2022 national survey of dialysis centers.</div></div><div><h3>Exposure</h3><div>Patient-level (demographics and clinical characteristics) and center-level (including availability of assisted peritoneal dialysis, quality improvement initiatives, and fostering staff engagement in research) factors.</div></div><div><h3>Outcome</h3><div>Use of HT (home hemodialysis or peritoneal dialysis) within 1 year of starting KRT.</div></div><div><h3>Analytical Approach</h3><div>Sequences of regressions, an extension of path analysis, used to examine direct and indirect associations between patient-level and center-level factors and the probability of HT uptake.</div></div><div><h3>Results</h3><div>Both center-level and patient-level factors were significantly associated with the probability of HT uptake. Patients at centers conducting quality improvement projects (odds ratio [OR], 1.94 [95% CI, 1.36-2.76]), offering assisted peritoneal dialysis (OR, 1.89 [95% CI, 1.39-2.57]), fostering staff research engagement (OR, 1.35 [95% CI, 1.03-1.77]), or hosting HT roadshows (OR, 1.22 [95% CI, 1.05-1.41]) had higher odds of HT uptake. Centers with greater stress on staff capacity to deliver HT had lower uptake (OR, 0.60 [95% CI, 0.45-0.81]). Patients on transplant lists at KRT start (OR, 2.55 [95% CI, 2.35-2.77]) or who lived farther from a treatment center (OR, 1.10 [95% CI, 1.08-1.12] per 10 km) had higher odds of HT uptake. Patients living in areas of higher deprivation or members of minoritized ethnic groups had lower HT uptake overall. However, some of these associations may have been indirectly mitigated in centers serving more diverse populations because these centers were more likely to implement practices associated with higher HT uptake.</div></div><div><h3>Limitations</h3><div>Health care professional–reported and aggregated survey data.</div></div><div><h3>Conclusions</h3><div>This study identified modifiable center-level factors associated with HT uptake, informing potential opportunities to reduce ethnic and area-level disparities.</div></div><div><h3>Plain-Language Summary</h3><div>Some patients are less likely to use home dialysis, possibly due to both patient characteristics and how dialysis centers operate. We studied over 32,000 patients who began kidney replacement therapy between 2015 and
{"title":"Patient and Center Factors in Home Dialysis Therapy Uptake: Analysis of a UK Renal Registry Cohort and a National Dialysis Center Survey","authors":"Jessica Potts , Camille M. Pearse , Mark Lambie , James Fotheringham , Harry Hill , David Coyle , Sarah Damery , Kerry Allen , Iestyn Williams , Simon J. Davies , Ivonne Solis-Trapala","doi":"10.1053/j.ajkd.2025.08.012","DOIUrl":"10.1053/j.ajkd.2025.08.012","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Variation in home dialysis therapy (HT) use across centers and geography may reflect the interplay between dialysis center services and patient characteristics. We examined direct and indirect associations between these factors and HT uptake in England.</div></div><div><h3>Study Design</h3><div>UK Renal Registry (UKRR) cohort linked to a national survey of renal centers.</div></div><div><h3>Setting & Participants</h3><div>Adults who initiated kidney replacement therapy (KRT) between 2015 and 2019 at 51 English renal centers, totaling 32,400 individuals identified through the UKRR with center practices captured from a 2022 national survey of dialysis centers.</div></div><div><h3>Exposure</h3><div>Patient-level (demographics and clinical characteristics) and center-level (including availability of assisted peritoneal dialysis, quality improvement initiatives, and fostering staff engagement in research) factors.</div></div><div><h3>Outcome</h3><div>Use of HT (home hemodialysis or peritoneal dialysis) within 1 year of starting KRT.</div></div><div><h3>Analytical Approach</h3><div>Sequences of regressions, an extension of path analysis, used to examine direct and indirect associations between patient-level and center-level factors and the probability of HT uptake.</div></div><div><h3>Results</h3><div>Both center-level and patient-level factors were significantly associated with the probability of HT uptake. Patients at centers conducting quality improvement projects (odds ratio [OR], 1.94 [95% CI, 1.36-2.76]), offering assisted peritoneal dialysis (OR, 1.89 [95% CI, 1.39-2.57]), fostering staff research engagement (OR, 1.35 [95% CI, 1.03-1.77]), or hosting HT roadshows (OR, 1.22 [95% CI, 1.05-1.41]) had higher odds of HT uptake. Centers with greater stress on staff capacity to deliver HT had lower uptake (OR, 0.60 [95% CI, 0.45-0.81]). Patients on transplant lists at KRT start (OR, 2.55 [95% CI, 2.35-2.77]) or who lived farther from a treatment center (OR, 1.10 [95% CI, 1.08-1.12] per 10 km) had higher odds of HT uptake. Patients living in areas of higher deprivation or members of minoritized ethnic groups had lower HT uptake overall. However, some of these associations may have been indirectly mitigated in centers serving more diverse populations because these centers were more likely to implement practices associated with higher HT uptake.</div></div><div><h3>Limitations</h3><div>Health care professional–reported and aggregated survey data.</div></div><div><h3>Conclusions</h3><div>This study identified modifiable center-level factors associated with HT uptake, informing potential opportunities to reduce ethnic and area-level disparities.</div></div><div><h3>Plain-Language Summary</h3><div>Some patients are less likely to use home dialysis, possibly due to both patient characteristics and how dialysis centers operate. We studied over 32,000 patients who began kidney replacement therapy between 2015 and ","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 53-64.e1"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314603","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 : 2026-01-01Epub Date: 2025-11-20DOI: 10.1053/j.ajkd.2025.10.007
Ryann Sohaney , Andrea L. Oliverio
{"title":"Breaking Down Barriers to Reproductive Health Care in CKD","authors":"Ryann Sohaney , Andrea L. Oliverio","doi":"10.1053/j.ajkd.2025.10.007","DOIUrl":"10.1053/j.ajkd.2025.10.007","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 1-3"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145559044","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 : 2026-01-01Epub Date: 2025-10-08DOI: 10.1053/j.ajkd.2025.07.014
Thalia Porteny , Kristen Kennefick , Hillary Matos , Kelli Collins Damron , Daniel E. Weiner , Sean Kalloo , Keren Ladin
Rationale & Objective
Latino adults aged 65 years and older comprise the fastest growing minoritized group in the United States and experience a disproportionate burden of kidney failure. Decision aids improve decisional quality and goal-concordant care among older patients with chronic kidney disease (CKD). However, decision aids for kidney replacement therapy have yet to be adapted for the older Latino adult population with advanced CKD. This study assessed the acceptability, accessibility and adaptions needed to facilitate use of a Spanish version of the Decision-Aid for Renal Therapy (DART-S) for older Latino adults with advanced CKD.
Study Design
Qualitative study applying the Cultural Targeting and Tailoring of Shared Decision-Making Technology Framework in focus groups and structured interviews. Suggested adaptations were grouped into recommendations and analyzed qualitatively.
Setting & Participants
Five focus groups (N = 17) and interviews (N = 15) with Spanish-speaking patients and care partners were conducted.
Analytical Approach
Thematic analysis.
Results
Among patient participants, 55% were male, and the mean age was 68 ± 9 years. Overall, the participants found DART-S to be acceptable and accessible. Thematic analysis revealed the importance of incorporating lived experiences, including patient and family testimonials, to illustrate the mental health impact of CKD, self-care strategies, and home dialysis adaptations. Some found the delivery of prognostic information distressing, highlighting the need for more sensitive communication. The tailoring recommendations included information about financial barriers, nutrition, and lifestyle. Participants preferred that DART-S be disseminated via kidney clinicians upon CKD diagnosis and recommended leveraging social media for broader reach.
Limitations
Findings are not generalizable beyond the Latino subgroups in this study. Legal status was not ascertained.
Conclusions
Targeting and tailoring decision aids is a necessary step in providing goal-concordant and person-centered care for older Latino adults with advanced CKD. Future research should examine the comparative efficacy of DART-S in increasing knowledge and decisional quality among Latino patients.
理由与目的65岁及以上的非裔成年人构成了美国增长最快的少数群体，他们承受着不成比例的肾衰竭负担。决策辅助提高老年慢性肾病患者的决策质量和目标一致性护理。然而，肾脏替代疗法的辅助决策尚未适用于老年拉丁裔成年晚期CKD患者。本研究的目的是评估西班牙语版本的Decision-Aid for Renal Therapy （DART-S）对老年拉丁裔晚期CKD患者的可接受性、可及性和适应性。研究设计：在焦点小组和结构化访谈中应用共享决策技术框架的文化目标和裁剪的定性研究。建议的适应被归类为建议并进行定性分析。环境和参与者进行了5个焦点小组（N=17）和对讲西班牙语的患者和护理伙伴的访谈（N=15）。分析方法：主题分析。结果患者中55%为男性，平均年龄为68±9岁。总体而言，参与者认为DART-S是可接受和可访问的。专题分析揭示了纳入生活经验的重要性，包括患者和家属的证词，以说明慢性肾病的心理健康影响，自我护理策略和家庭透析适应。一些人发现传递预后信息令人苦恼，强调需要更敏感的沟通。量身定制的建议包括有关经济障碍、营养和生活方式的信息。参与者更倾向于在CKD诊断时通过肾脏临床医生传播DART-S，并建议利用社交媒体进行更广泛的传播。局限性：本研究的发现不能推广到拉丁裔亚组之外。法律地位尚未确定。结论有针对性和量身定制的决策辅助是为拉丁裔老年晚期CKD患者提供目标一致和以人为本的护理的必要步骤。未来的研究应该检验DART-S在增加拉丁裔患者的知识和决策质量方面的比较功效。
{"title":"Identifying Adaptation Needs of a Decision Aid for Older Latino Adults With Advanced CKD: A Qualitative Study","authors":"Thalia Porteny , Kristen Kennefick , Hillary Matos , Kelli Collins Damron , Daniel E. Weiner , Sean Kalloo , Keren Ladin","doi":"10.1053/j.ajkd.2025.07.014","DOIUrl":"10.1053/j.ajkd.2025.07.014","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Latino adults aged 65 years and older comprise the fastest growing minoritized group in the United States and experience a disproportionate burden of kidney failure. Decision aids improve decisional quality and goal-concordant care among older patients with chronic kidney disease (CKD). However, decision aids for kidney replacement therapy have yet to be adapted for the older Latino adult population with advanced CKD. This study assessed the acceptability, accessibility and adaptions needed to facilitate use of a Spanish version of the Decision-Aid for Renal Therapy (DART-S) for older Latino adults with advanced CKD.</div></div><div><h3>Study Design</h3><div>Qualitative study applying the Cultural Targeting and Tailoring of Shared Decision-Making Technology Framework in focus groups and structured interviews. Suggested adaptations were grouped into recommendations and analyzed qualitatively.</div></div><div><h3>Setting & Participants</h3><div>Five focus groups (N = 17) and interviews (N = 15) with Spanish-speaking patients and care partners were conducted.</div></div><div><h3>Analytical Approach</h3><div>Thematic analysis.</div></div><div><h3>Results</h3><div>Among patient participants, 55% were male, and the mean age was 68 ± 9 years. Overall, the participants found DART-S to be acceptable and accessible. Thematic analysis revealed the importance of incorporating lived experiences, including patient and family testimonials, to illustrate the mental health impact of CKD, self-care strategies, and home dialysis adaptations. Some found the delivery of prognostic information distressing, highlighting the need for more sensitive communication. The tailoring recommendations included information about financial barriers, nutrition, and lifestyle. Participants preferred that DART-S be disseminated via kidney clinicians upon CKD diagnosis and recommended leveraging social media for broader reach.</div></div><div><h3>Limitations</h3><div>Findings are not generalizable beyond the Latino subgroups in this study. Legal status was not ascertained.</div></div><div><h3>Conclusions</h3><div>Targeting and tailoring decision aids is a necessary step in providing goal-concordant and person-centered care for older Latino adults with advanced CKD. Future research should examine the comparative efficacy of DART-S in increasing knowledge and decisional quality among Latino patients.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 44-52"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254486","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 : 2026-01-01Epub Date: 2025-10-17DOI: 10.1053/j.ajkd.2025.08.013
Ladan Zand , Fernando C. Fervenza , Sanjeev Sethi
Membranous nephropathy (MN) is one of the most common causes of nephrotic syndrome in adults and can be seen in association with other diseases, including malignancy, drugs, infections, or autoimmune diseases. Over the last decade, great progress has been made in understanding the pathogenesis of the disease, resulting from the discovery of several target antigens by use of laser microdissection/mass spectrometry methodology. This technique has proven to be the most sensitive method available and has the advantage of testing for all the target antigens at one time. The discovery of these target antigens has now shifted the classification of MN from primary versus secondary to classification based on the target antigen identified. Each target antigen has its own specific clinical characteristics and known associated diseases. Identification of the target antigen can help further identify the underlying cause for a more targeted approach in looking for associated diseases. Progress has also been made in the treatment of patients with MN, with more standard risk stratification of the patients and a shift in using anti-CD20 drugs as the first line for those with moderate and high risk of progression. Trials are ongoing to further investigate the role of anti-plasma cell, anticomplement, and CAR-T (chimeric antigen receptor T-cell) therapies.
{"title":"What’s New in Membranous Nephropathy and How to Incorporate New Antigen Discoveries Into Clinical Practice: A Review","authors":"Ladan Zand , Fernando C. Fervenza , Sanjeev Sethi","doi":"10.1053/j.ajkd.2025.08.013","DOIUrl":"10.1053/j.ajkd.2025.08.013","url":null,"abstract":"<div><div>Membranous nephropathy (MN) is one of the most common causes of nephrotic syndrome in adults and can be seen in association with other diseases, including malignancy, drugs, infections, or autoimmune diseases. Over the last decade, great progress has been made in understanding the pathogenesis of the disease, resulting from the discovery of several target antigens by use of laser microdissection/mass spectrometry methodology. This technique has proven to be the most sensitive method available and has the advantage of testing for all the target antigens at one time. The discovery of these target antigens has now shifted the classification of MN from primary versus secondary to classification based on the target antigen identified. Each target antigen has its own specific clinical characteristics and known associated diseases. Identification of the target antigen can help further identify the underlying cause for a more targeted approach in looking for associated diseases. Progress has also been made in the treatment of patients with MN, with more standard risk stratification of the patients and a shift in using anti-CD20 drugs as the first line for those with moderate and high risk of progression. Trials are ongoing to further investigate the role of anti-plasma cell, anticomplement, and CAR-T (chimeric antigen receptor T-cell) therapies.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 93-101"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145319221","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 : 2025-12-24DOI: 10.1053/j.ajkd.2025.11.005
Sumit Mohan,Kundan Jana,Miko E Yu
{"title":"Expanding Our Understanding of Genetic Variations That Impact Post-Transplant Outcomes.","authors":"Sumit Mohan,Kundan Jana,Miko E Yu","doi":"10.1053/j.ajkd.2025.11.005","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.11.005","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"1 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835983","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 : 2025-12-20DOI: 10.1053/j.ajkd.2025.10.013
Howard Trachtman,Sean Eddy,Matthias Kretzler
Focal segmental glomerulosclerosis (FSGS) is not a single disease. Instead, it is a histopathological entity that is the manifestation of a wide range of clinical insults that injure the podocyte, a key structural element in the glomerular filtration barrier. The current classification of FSGS includes four subtypes - primary immune-mediated, genetic, secondary, and undetermined cause. Based on this scheme, patients are treated empirically with a combination of non-specific renoprotective drugs and immunosuppressive agents in an effort to reduce proteinuria and preserve kidney function. However, there are no FDA-approved medications for FSGS. Moreover, current therapy is successful in achieving disease remission in less than a quarter of patients and all of the available options are associated with significant side effects that limit their use in practice. Ongoing research using a full array of muti-omics analytical tools including genomic, transcriptomic, proteomic and metabolomic assessment suggest that patients with FSGS can be characterized mechanistically by the primary process(es) initiating and promoting disease progression. This work is summarized in this review and raises the potential to individualize therapy for each patient with FSGS. This would usher in the potential for precision medicine to be applied in the treatment of those affected by this rare but serious glomerular disease.
{"title":"Current and Future Therapeutics for Focal Segmental Glomerular Sclerosis in the Era of Precision Medicine: A Review.","authors":"Howard Trachtman,Sean Eddy,Matthias Kretzler","doi":"10.1053/j.ajkd.2025.10.013","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.10.013","url":null,"abstract":"Focal segmental glomerulosclerosis (FSGS) is not a single disease. Instead, it is a histopathological entity that is the manifestation of a wide range of clinical insults that injure the podocyte, a key structural element in the glomerular filtration barrier. The current classification of FSGS includes four subtypes - primary immune-mediated, genetic, secondary, and undetermined cause. Based on this scheme, patients are treated empirically with a combination of non-specific renoprotective drugs and immunosuppressive agents in an effort to reduce proteinuria and preserve kidney function. However, there are no FDA-approved medications for FSGS. Moreover, current therapy is successful in achieving disease remission in less than a quarter of patients and all of the available options are associated with significant side effects that limit their use in practice. Ongoing research using a full array of muti-omics analytical tools including genomic, transcriptomic, proteomic and metabolomic assessment suggest that patients with FSGS can be characterized mechanistically by the primary process(es) initiating and promoting disease progression. This work is summarized in this review and raises the potential to individualize therapy for each patient with FSGS. This would usher in the potential for precision medicine to be applied in the treatment of those affected by this rare but serious glomerular disease.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"29 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145807587","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 : 2025-12-11DOI: 10.1053/j.ajkd.2025.09.022
Doreen Zhu,Parminder K Judge,Susan T Francis,Zhaojing Che,Jennifer J Rayner,Charlotte Buchanan,Kaitlin J Mayne,Will Stevens,Torsten Bley,Nitin Bhandary,Catherine Byrne,Vladimir Cejka,Daniel Chapman,Eleanor F Cox,Tanaji Dasgupta,Greco B Malijan,Rosemary Nicholas,Paul Phelan,Eleanor Smith,Elizabeth M Tunnicliffe,Nicholas Wooding,Masaomi Nangaku,David Z I Cherney,Nicholas M Selby,Maarten Taal,Dominik Steubl,Cristiane Aoqui,Christoph Wanner,Jonathan R Emberson,Martin J Landray,Colin Baigent,Natalie Staplin,William G Herrington,Richard Haynes,
{"title":"Effects of Empagliflozin on Kidney and Cardiac Magnetic Resonance Imaging Measures in Patients With CKD: An EMPA-KIDNEY Mechanistic Substudy.","authors":"Doreen Zhu,Parminder K Judge,Susan T Francis,Zhaojing Che,Jennifer J Rayner,Charlotte Buchanan,Kaitlin J Mayne,Will Stevens,Torsten Bley,Nitin Bhandary,Catherine Byrne,Vladimir Cejka,Daniel Chapman,Eleanor F Cox,Tanaji Dasgupta,Greco B Malijan,Rosemary Nicholas,Paul Phelan,Eleanor Smith,Elizabeth M Tunnicliffe,Nicholas Wooding,Masaomi Nangaku,David Z I Cherney,Nicholas M Selby,Maarten Taal,Dominik Steubl,Cristiane Aoqui,Christoph Wanner,Jonathan R Emberson,Martin J Landray,Colin Baigent,Natalie Staplin,William G Herrington,Richard Haynes, ","doi":"10.1053/j.ajkd.2025.09.022","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.09.022","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"3 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145746701","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}
RATIONALE & OBJECTIVESedentary behavior is common among hemodialysis patients although large-scale data on physical activity (PA) objectively measured by accelerometers are scarce. We aimed to 1) compare PA levels between hemodialysis patients and community-dwelling adults, 2) estimate annual PA changes, and 3) determine associations between PA levels and mortality in hemodialysis patients.STUDY DESIGNProspective cohort study.SETTING & PARTICIPANTS1,030 Japanese hemodialysis patients were enrolled for PA measurements between June 2019 and July 2020, and followed for three years. PA data in community-dwelling adults were obtained from the Dazaifu-City Survey in Japan.EXPOSURELight-intensity PA, moderate-intensity PA, vigorous-intensity PA, and steps measured by triaxial accelerometers after enrollment and one year later, defined based on 10-second epoch-averaged metabolic equivalents (METs) of 1.6-2.9, 3.0-5.9, and ≥6.0, respectively.OUTCOMEAll-cause death.ANALYTICAL APPROACHCox proportional hazards models with least absolute shrinkage and selection operator (LASSO).RESULTSThe median (interquartile range) light-intensity PA, moderate-intensity PA, vigorous-intensity PA, and steps were 192 (128-263) min/day, 70 (26-169) min/week, 0 (0-0) min/week, and 1,832 (680-3,822)/day, respectively. Age- and sex-adjusted geometric means of light-intensity PA, moderate-to-vigorous intensity PA, and steps were 42%, 77%, and 73% lower among hemodialysis patients than community-dwelling adults. The least-squares mean annual changes in light-intensity PA, moderate-intensity PA, and steps were -12.4 min/day, -10.7 min/week, and -215 steps/day, respectively. The lowest hazard was observed at 216-262 min/day for light-intensity PA, 239-291 min/week for moderate-intensity PA, and 4,294-6,045/day for steps. LASSO identified light-intensity PA on non-dialysis days as the parameter most strongly associated with survival. The lowest mortality risk was observed at about 300 min/day of light-intensity PA on non-dialysis days, compared to about 200 min/day on dialysis days.LIMITATIONObservational study design precludes causal inference.CONCLUSIONLight-intensity PA on non-dialysis days, even for short durations, was associated with better survival in hemodialysis patients.
{"title":"Accelerometry-Derived Physical Activity Levels and Mortality in Hemodialysis Patients: A Prospective Cohort Study.","authors":"Atsuko Hiraoka,Yusuke Sakaguchi,Hikaru Kadono,Takayuki Kawaoka,Tatsufumi Oka,Yohei Doi,Yuki Kawano,Hiro Kishimoto,Takafumi Saito,Ryohei Yamamoto,Isao Matsui,Masayuki Mizui,Jun-Ya Kaimori,Yoshitaka Isaka","doi":"10.1053/j.ajkd.2025.10.011","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.10.011","url":null,"abstract":"RATIONALE & OBJECTIVESedentary behavior is common among hemodialysis patients although large-scale data on physical activity (PA) objectively measured by accelerometers are scarce. We aimed to 1) compare PA levels between hemodialysis patients and community-dwelling adults, 2) estimate annual PA changes, and 3) determine associations between PA levels and mortality in hemodialysis patients.STUDY DESIGNProspective cohort study.SETTING & PARTICIPANTS1,030 Japanese hemodialysis patients were enrolled for PA measurements between June 2019 and July 2020, and followed for three years. PA data in community-dwelling adults were obtained from the Dazaifu-City Survey in Japan.EXPOSURELight-intensity PA, moderate-intensity PA, vigorous-intensity PA, and steps measured by triaxial accelerometers after enrollment and one year later, defined based on 10-second epoch-averaged metabolic equivalents (METs) of 1.6-2.9, 3.0-5.9, and ≥6.0, respectively.OUTCOMEAll-cause death.ANALYTICAL APPROACHCox proportional hazards models with least absolute shrinkage and selection operator (LASSO).RESULTSThe median (interquartile range) light-intensity PA, moderate-intensity PA, vigorous-intensity PA, and steps were 192 (128-263) min/day, 70 (26-169) min/week, 0 (0-0) min/week, and 1,832 (680-3,822)/day, respectively. Age- and sex-adjusted geometric means of light-intensity PA, moderate-to-vigorous intensity PA, and steps were 42%, 77%, and 73% lower among hemodialysis patients than community-dwelling adults. The least-squares mean annual changes in light-intensity PA, moderate-intensity PA, and steps were -12.4 min/day, -10.7 min/week, and -215 steps/day, respectively. The lowest hazard was observed at 216-262 min/day for light-intensity PA, 239-291 min/week for moderate-intensity PA, and 4,294-6,045/day for steps. LASSO identified light-intensity PA on non-dialysis days as the parameter most strongly associated with survival. The lowest mortality risk was observed at about 300 min/day of light-intensity PA on non-dialysis days, compared to about 200 min/day on dialysis days.LIMITATIONObservational study design precludes causal inference.CONCLUSIONLight-intensity PA on non-dialysis days, even for short durations, was associated with better survival in hemodialysis patients.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"38 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145717571","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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