Pub Date : 2025-09-19DOI: 10.1053/j.ajkd.2025.08.007
Carly Weaver , Babak J. Orandi , Mara McAdams-DeMarco
{"title":"Exercise Prehabilitation in Kidney Transplant Candidates: Insights From the FRAILMar Trial","authors":"Carly Weaver , Babak J. Orandi , Mara McAdams-DeMarco","doi":"10.1053/j.ajkd.2025.08.007","DOIUrl":"10.1053/j.ajkd.2025.08.007","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 5","pages":"Pages 591-593"},"PeriodicalIF":8.2,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093507","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 : 2025-09-19DOI: 10.1053/j.ajkd.2025.08.008
Trenton M. Haltom , Susie Q. Lew , Wolfgang C. Winkelmayer , Glenn M. Chertow , Allison Jaure , Kevin F. Erickson
Rationale & Objective
During the coronavirus disease 2019 (COVID-19) pandemic, the US government expanded originating telemedicine sites to include outpatient dialysis units. For the first time, nephrology care providers (nephrologists and affiliated advanced practice providers) across the United States could use telemedicine in lieu of face-to-face visits to deliver care for patients receiving in-center hemodialysis. In this study, we describe perspectives and experiences of nephrologists using telemedicine to deliver in-center hemodialysis care.
Study Design
Qualitative research study.
Setting & Participants
Nephrologists in 3 health systems who used telemedicine for in-center hemodialysis during the COVID-19 pandemic.
Analytical Approach
We conducted 16 semistructured telephone interviews. Transcripts were thematically analyzed.
Results
We identified 5 themes and respective subthemes: maintaining safety and quality of care (making up missed appointments, fostering continuity of care, addressing urgent medical issues); maximizing efficiency (reducing nephrologists' travel burden, allowing for flexibility); operational complexities (dependence on facility resources; challenges coordinating with facility staff; modifying visit duration/length); diminished depth of clinical encounters (excess formality, constrained communication, incomplete physical examinations); supporting confidence in telemedicine (complementing in-person care, accounting for patient preferences, requiring reimbursement).
Limitations
The transferability of the findings outside of an urban academic setting is uncertain.
Conclusions
Although nephrologists encountered operational (both technical and personal level) challenges such as communication constraints when using telemedicine for in-center hemodialysis care, they reported improvements in aspects of care quality and enhanced efficiency. These findings inform the potential use of a hybrid in-center hemodialysis care delivery model in which telemedicine supplements in-person visits.
Plain-Language Summary
We describe nephrologists’ perspectives and experiences with delivery of care using telemedicine at dialysis facilities during the COVID-19 pandemic. The nephrologists participating in this study suggested telemedicine is beneficial to maintaining patient safety and quality of care and maximizing physicians’ efficiency. Nephrologists experienced barriers given operational complexities such as technical and personnel support from dialysis facilities. Clinical encounters were also less personal and more formal. Nevertheless, the experiences of participating nephrologists suggest that a hybrid care model with both in-person and telemedicine visits may help maintain high-quality care while increasing the
{"title":"Nephrologist Perspectives on Using Telemedicine During In-Center Hemodialysis: A Qualitative Study","authors":"Trenton M. Haltom , Susie Q. Lew , Wolfgang C. Winkelmayer , Glenn M. Chertow , Allison Jaure , Kevin F. Erickson","doi":"10.1053/j.ajkd.2025.08.008","DOIUrl":"10.1053/j.ajkd.2025.08.008","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>During the coronavirus disease 2019 (COVID-19) pandemic, the US government expanded originating telemedicine sites to include outpatient dialysis units. For the first time, nephrology care providers (nephrologists and affiliated advanced practice providers) across the United States could use telemedicine in lieu of face-to-face visits to deliver care for patients receiving in-center hemodialysis. In this study, we describe perspectives and experiences of nephrologists using telemedicine to deliver in-center hemodialysis care.</div></div><div><h3>Study Design</h3><div>Qualitative research study.</div></div><div><h3>Setting & Participants</h3><div>Nephrologists in 3 health systems who used telemedicine for in-center hemodialysis during the COVID-19 pandemic.</div></div><div><h3>Analytical Approach</h3><div>We conducted 16 semistructured telephone interviews. Transcripts were thematically analyzed.</div></div><div><h3>Results</h3><div>We identified 5 themes and respective subthemes: maintaining safety and quality of care (making up missed appointments, fostering continuity of care, addressing urgent medical issues); maximizing efficiency (reducing nephrologists' travel burden, allowing for flexibility); operational complexities (dependence on facility resources; challenges coordinating with facility staff; modifying visit duration/length); diminished depth of clinical encounters (excess formality, constrained communication, incomplete physical examinations); supporting confidence in telemedicine (complementing in-person care, accounting for patient preferences, requiring reimbursement).</div></div><div><h3>Limitations</h3><div>The transferability of the findings outside of an urban academic setting is uncertain.</div></div><div><h3>Conclusions</h3><div>Although nephrologists encountered operational (both technical and personal level) challenges such as communication constraints when using telemedicine for in-center hemodialysis care, they reported improvements in aspects of care quality and enhanced efficiency. These findings inform the potential use of a hybrid in-center hemodialysis care delivery model in which telemedicine supplements in-person visits.</div></div><div><h3>Plain-Language Summary</h3><div>We describe nephrologists’ perspectives and experiences with delivery of care using telemedicine at dialysis facilities during the COVID-19 pandemic. The nephrologists participating in this study suggested telemedicine is beneficial to maintaining patient safety and quality of care and maximizing physicians’ efficiency. Nephrologists experienced barriers given operational complexities such as technical and personnel support from dialysis facilities. Clinical encounters were also less personal and more formal. Nevertheless, the experiences of participating nephrologists suggest that a hybrid care model with both in-person and telemedicine visits may help maintain high-quality care while increasing the","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 6","pages":"Pages 762-771.e1"},"PeriodicalIF":8.2,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111672","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 : 2025-09-19DOI: 10.1053/j.ajkd.2025.07.011
Emmanuel A. Burdmann, Lucia C. Andrade
The tropics, a large and heavily inhabited area, are characterized by deep contrasts in sociopolitical, economic, and social development, which are reflected in the epidemiology of diseases. Common noncommunicable chronic diseases, such as diabetes and hypertension, coexist with acute infectious tropical diseases. Global warming, immigration, tourism, and commercial travel have helped spread tropical diseases to temperate zones by facilitating the spread of vectors, the infection of animal reservoirs, and the introduction of contaminated individuals into nonendemic areas. Infectious tropical diseases are currently a significant global public health concern worldwide. Their timely diagnosis and adequate treatment might be a considerable challenge to health workers from nontropical areas because most share very similar initial clinical presentations. It is essential that health care teams worldwide can recognize and treat a broad spectrum of tropical diseases. Several of these infectious tropical diseases can affect the kidneys, acutely or chronically. In this review, we explore and discuss the epidemiology, pathophysiological mechanisms, and clinical aspects of the most relevant infectious tropical diseases that can be associated with acute kidney injury. Such diseases include, but are not limited to, dengue, yellow fever, chikungunya, malaria, leptospirosis, and scrub typhus.
{"title":"Infectious Tropical Diseases That Acutely Affect the Kidneys: What Physicians and Health Care Workers in Nonendemic Countries Should Know","authors":"Emmanuel A. Burdmann, Lucia C. Andrade","doi":"10.1053/j.ajkd.2025.07.011","DOIUrl":"10.1053/j.ajkd.2025.07.011","url":null,"abstract":"<div><div>The tropics, a large and heavily inhabited area, are characterized by deep contrasts in sociopolitical, economic, and social development, which are reflected in the epidemiology of diseases. Common noncommunicable chronic diseases, such as diabetes and hypertension, coexist with acute infectious tropical diseases. Global warming, immigration, tourism, and commercial travel have helped spread tropical diseases to temperate zones by facilitating the spread of vectors, the infection of animal reservoirs, and the introduction of contaminated individuals into nonendemic areas. Infectious tropical diseases are currently a significant global public health concern worldwide. Their timely diagnosis and adequate treatment might be a considerable challenge to health workers from nontropical areas because most share very similar initial clinical presentations. It is essential that health care teams worldwide can recognize and treat a broad spectrum of tropical diseases. Several of these infectious tropical diseases can affect the kidneys, acutely or chronically. In this review, we explore and discuss the epidemiology, pathophysiological mechanisms, and clinical aspects of the most relevant infectious tropical diseases that can be associated with acute kidney injury. Such diseases include, but are not limited to, dengue, yellow fever, chikungunya, malaria, leptospirosis, and scrub typhus.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 6","pages":"Pages 814-827"},"PeriodicalIF":8.2,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103422","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 : 2025-09-18DOI: 10.1053/j.ajkd.2025.06.020
Yiting Li , Gayathri Menon , Byoungjun Kim , Mario P. DeMarco , Babak J. Orandi , Sunjae Bae , Wenbo Wu , Allan B. Massie , Macey L. Levan , Jonathan C. Berger , Dorry L. Segev , Mara A. McAdams-DeMarco
{"title":"Living Kidney Donors’ Residential Neighborhoods: Driver or Barrier of Postdonation Follow-Up?","authors":"Yiting Li , Gayathri Menon , Byoungjun Kim , Mario P. DeMarco , Babak J. Orandi , Sunjae Bae , Wenbo Wu , Allan B. Massie , Macey L. Levan , Jonathan C. Berger , Dorry L. Segev , Mara A. McAdams-DeMarco","doi":"10.1053/j.ajkd.2025.06.020","DOIUrl":"10.1053/j.ajkd.2025.06.020","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 135-138"},"PeriodicalIF":8.2,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093511","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 : 2025-09-18DOI: 10.1053/j.ajkd.2025.06.021
Lihong Bu , Jae H. Lee , Michael M. Quigley , Reza Elahimehr , Jason D. Theis , Robert L. Perrizo , Surendra Dasari , Timothy J. Garrett , Samih H. Nasr
Lecithin cholesterol acyltransferase (LCAT) deficiency, inherited or acquired, is characterized by markedly low plasma high-density lipoprotein (HDL) cholesterol levels and increased unesterified cholesterol. We report a case of an elderly patient with persistently very low HDL and proteinuria. Serum cholesteryl esters were markedly low, and kidney biopsy revealed diffuse global glomerular lipid deposition, classic for LCAT deficiency, whereas genetic testing for variants associated with LCAT deficiency was negative. Kidney biopsy also showed concomitant monoclonal (IgG3κ) membranous nephropathy (MN). Proteomic analysis of glomeruli detected spectra for LCAT and serum amyloid P (SAP), suggesting that LCAT could be a target antigen in monoclonal MN with SAP enrichment and associated LCAT deficiency. Furthermore, lipidomic analysis revealed an accumulation of phosphatidylcholines and sphingomyelin and a decrease in ceramides. The patient was treated with daratumumab, and at 22 months follow-up his proteinuria was decreased while HDL level remained low.
{"title":"IgG3κ Monoclonal Membranous Nephropathy Associated With Acquired Lecithin Cholesterol Acyltransferase Deficiency","authors":"Lihong Bu , Jae H. Lee , Michael M. Quigley , Reza Elahimehr , Jason D. Theis , Robert L. Perrizo , Surendra Dasari , Timothy J. Garrett , Samih H. Nasr","doi":"10.1053/j.ajkd.2025.06.021","DOIUrl":"10.1053/j.ajkd.2025.06.021","url":null,"abstract":"<div><div>Lecithin cholesterol acyltransferase (LCAT) deficiency, inherited or acquired, is characterized by markedly low plasma high-density lipoprotein (HDL) cholesterol levels and increased unesterified cholesterol. We report a case of an elderly patient with persistently very low HDL and proteinuria. Serum cholesteryl esters were markedly low, and kidney biopsy revealed diffuse global glomerular lipid deposition, classic for LCAT deficiency, whereas genetic testing for variants associated with LCAT deficiency was negative. Kidney biopsy also showed concomitant monoclonal (IgG3κ) membranous nephropathy (MN). Proteomic analysis of glomeruli detected spectra for LCAT and serum amyloid P (SAP), suggesting that LCAT could be a target antigen in monoclonal MN with SAP enrichment and associated LCAT deficiency. Furthermore, lipidomic analysis revealed an accumulation of phosphatidylcholines and sphingomyelin and a decrease in ceramides. The patient was treated with daratumumab, and at 22 months follow-up his proteinuria was decreased while HDL level remained low.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 6","pages":"Pages 854-859"},"PeriodicalIF":8.2,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093514","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 : 2025-09-17DOI: 10.1053/j.ajkd.2025.08.006
Joshua D. Griffiths , Grace Ehidiamhen , Sergio Camilo Lopez-Garcia , Rachel Hubbard , Jackie Cook , Albert C.M. Ong
IFT140 is a component of the intraflagellar transport-complex A involved in retrograde ciliary trafficking of proteins into primary cilia. Monoallelic IFT140 variants have been identified as an important cause of adult-onset autosomal dominant polycystic kidney disease (ADPKD), accounting for ∼2% of prevalent cases. Patients with ADPKD-IFT140 usually present in later life with small numbers of large cysts and rarely develop kidney failure. Here, we report 3 genetically resolved cases of ADPKD-IFT140 diagnosed in childhood or infancy from 3 unrelated pedigrees with ages at presentation ranging from in utero to 14 years. Each pedigree had a different familial IFT140 variant, with no evidence of a second ADPKD gene variant on whole genome sequencing. All 3 children had normal kidney function and normal blood pressure, although 1 child presented initially with a high cyst burden in utero and had impaired function on a DMSA scan. Despite the negative family history, cascade screening of first-degree relatives revealed previously undiagnosed ADPKD with features typical of adult-onset ADPKD-IFT140. Our findings highlight the need to consider IFT140 as a potential cause of childhood early-onset ADPKD and expand the phenotypic spectrum of ADPKD-IFT140.
{"title":"Monoallelic IFT140 Variants Causing Childhood-Onset Autosomal Dominant Polycystic Kidney Disease","authors":"Joshua D. Griffiths , Grace Ehidiamhen , Sergio Camilo Lopez-Garcia , Rachel Hubbard , Jackie Cook , Albert C.M. Ong","doi":"10.1053/j.ajkd.2025.08.006","DOIUrl":"10.1053/j.ajkd.2025.08.006","url":null,"abstract":"<div><div><em>IFT140</em> is a component of the intraflagellar transport-complex A involved in retrograde ciliary trafficking of proteins into primary cilia. Monoallelic <em>IFT140</em> variants have been identified as an important cause of adult-onset autosomal dominant polycystic kidney disease (ADPKD), accounting for ∼2% of prevalent cases. Patients with ADPKD-<em>IFT140</em> usually present in later life with small numbers of large cysts and rarely develop kidney failure. Here, we report 3 genetically resolved cases of ADPKD-<em>IFT140</em> diagnosed in childhood or infancy from 3 unrelated pedigrees with ages at presentation ranging from in utero to 14 years. Each pedigree had a different familial <em>IFT140</em> variant, with no evidence of a second ADPKD gene variant on whole genome sequencing. All 3 children had normal kidney function and normal blood pressure, although 1 child presented initially with a high cyst burden in utero and had impaired function on a DMSA scan. Despite the negative family history, cascade screening of first-degree relatives revealed previously undiagnosed ADPKD with features typical of adult-onset ADPKD-<em>IFT140</em>. Our findings highlight the need to consider <em>IFT140</em> as a potential cause of childhood early-onset ADPKD and expand the phenotypic spectrum of ADPKD-<em>IFT140</em>.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 124-128"},"PeriodicalIF":8.2,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145089840","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 : 2025-09-17DOI: 10.1053/j.ajkd.2025.07.008
Guangchen Zou , Bernard G. Jaar , James P. Lash , Jing Chen , Jeanne B. Charleston , Arksarapuk Jittirat , Dipal M. Patel , Julia Brown , Jiang He , Denise Cornish-Zirker , Hernan Rincon-Choles , Lawrence J. Appel , Deidra C. Crews , Kristin A. Riekert , David W. Dowdy , Kunihiro Matsushita , Junichi Ishigami
<div><h3>Rationale & Objective</h3><div>Vaccine uptake among individuals with chronic kidney disease (CKD) is suboptimal. Understanding the perceptions associated with vaccine hesitancy can help inform programs aimed at addressing these concerns.</div></div><div><h3>Study Design</h3><div>Cross-sectional survey.</div></div><div><h3>Setting & Participants</h3><div>A subset of participants from the Chronic Renal Insufficiency Cohort (CRIC) Study, recruited from 3 study sites.</div></div><div><h3>Exposure</h3><div>Participants’ perceptions about influenza and COVID-19 infection risks, benefits and harms of vaccines, vaccine skepticism, access barriers, and cues to action, according to the Health Belief Model.</div></div><div><h3>Outcome</h3><div>Influenza and COVID-19 vaccine hesitancy, defined as being uncertain about or not planning to receive a future dose of these vaccines.</div></div><div><h3>Analytical Approach</h3><div>Responses were measured on a 5-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree). Linear regression models were used to analyze differences in mean Likert scale scores between participants with and without vaccine hesitancy.</div></div><div><h3>Results</h3><div>Between July 2022 and June 2023, 278 CRIC participants completed the survey, of whom 47 (16.9%) and 46 (16.8%) had influenza and COVID-19 vaccine hesitancy, respectively. Linear regression models identified key perceptions associated with vaccine hesitancy, including perceived harms of the vaccines (eg, the vaccine causes influenza; ΔMean Likert scale, 1.25 [95% CI, 0.96-1.55]) and vaccine skepticism (eg, benefits of the influenza vaccine are exaggerated, 0.96 [95% CI, 0.65-1.26]). Perceived benefits were negatively associated with vaccine hesitancy (eg, influenza vaccines prevent serious illness, −0.93 [−1.23 to −0.62]). More than 40% perceived that they were not at risk of influenza, but this perception was not associated with vaccine hesitancy (0.02 [−0.35 to 0.40]). These findings were overall consistent for COVID-19, although vaccine skepticism was more prevalent and more strongly associated with vaccine hesitancy.</div></div><div><h3>Limitations</h3><div>The study population consisted of individuals with CKD who were enrolled in a cohort study and voluntarily responded to the survey.</div></div><div><h3>Conclusions</h3><div>Among individuals with CKD, perceptions of vaccine harms and vaccine skepticism were significant factors contributing to vaccine hesitancy. Improved dissemination of accurate vaccine information through tailored patient education initiatives may enhance vaccination uptake in this population.</div></div><div><h3>Plain-Language Summary</h3><div>People with chronic kidney disease (CKD) are at higher risk for infections, but some are hesitant to get vaccines. This study surveyed 278 CKD patients to understand why some avoid flu and COVID-19 vaccines. The study found about 17% were hesitant ab
{"title":"Perceptions About Influenza and COVID-19 Vaccines Among People With CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study","authors":"Guangchen Zou , Bernard G. Jaar , James P. Lash , Jing Chen , Jeanne B. Charleston , Arksarapuk Jittirat , Dipal M. Patel , Julia Brown , Jiang He , Denise Cornish-Zirker , Hernan Rincon-Choles , Lawrence J. Appel , Deidra C. Crews , Kristin A. Riekert , David W. Dowdy , Kunihiro Matsushita , Junichi Ishigami","doi":"10.1053/j.ajkd.2025.07.008","DOIUrl":"10.1053/j.ajkd.2025.07.008","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Vaccine uptake among individuals with chronic kidney disease (CKD) is suboptimal. Understanding the perceptions associated with vaccine hesitancy can help inform programs aimed at addressing these concerns.</div></div><div><h3>Study Design</h3><div>Cross-sectional survey.</div></div><div><h3>Setting & Participants</h3><div>A subset of participants from the Chronic Renal Insufficiency Cohort (CRIC) Study, recruited from 3 study sites.</div></div><div><h3>Exposure</h3><div>Participants’ perceptions about influenza and COVID-19 infection risks, benefits and harms of vaccines, vaccine skepticism, access barriers, and cues to action, according to the Health Belief Model.</div></div><div><h3>Outcome</h3><div>Influenza and COVID-19 vaccine hesitancy, defined as being uncertain about or not planning to receive a future dose of these vaccines.</div></div><div><h3>Analytical Approach</h3><div>Responses were measured on a 5-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree). Linear regression models were used to analyze differences in mean Likert scale scores between participants with and without vaccine hesitancy.</div></div><div><h3>Results</h3><div>Between July 2022 and June 2023, 278 CRIC participants completed the survey, of whom 47 (16.9%) and 46 (16.8%) had influenza and COVID-19 vaccine hesitancy, respectively. Linear regression models identified key perceptions associated with vaccine hesitancy, including perceived harms of the vaccines (eg, the vaccine causes influenza; ΔMean Likert scale, 1.25 [95% CI, 0.96-1.55]) and vaccine skepticism (eg, benefits of the influenza vaccine are exaggerated, 0.96 [95% CI, 0.65-1.26]). Perceived benefits were negatively associated with vaccine hesitancy (eg, influenza vaccines prevent serious illness, −0.93 [−1.23 to −0.62]). More than 40% perceived that they were not at risk of influenza, but this perception was not associated with vaccine hesitancy (0.02 [−0.35 to 0.40]). These findings were overall consistent for COVID-19, although vaccine skepticism was more prevalent and more strongly associated with vaccine hesitancy.</div></div><div><h3>Limitations</h3><div>The study population consisted of individuals with CKD who were enrolled in a cohort study and voluntarily responded to the survey.</div></div><div><h3>Conclusions</h3><div>Among individuals with CKD, perceptions of vaccine harms and vaccine skepticism were significant factors contributing to vaccine hesitancy. Improved dissemination of accurate vaccine information through tailored patient education initiatives may enhance vaccination uptake in this population.</div></div><div><h3>Plain-Language Summary</h3><div>People with chronic kidney disease (CKD) are at higher risk for infections, but some are hesitant to get vaccines. This study surveyed 278 CKD patients to understand why some avoid flu and COVID-19 vaccines. The study found about 17% were hesitant ab","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 6","pages":"Pages 751-761.e1"},"PeriodicalIF":8.2,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145089813","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 : 2025-09-16DOI: 10.1053/j.ajkd.2025.06.019
Kristen L. Nowak, Michel Chonchol
Chronic systemic inflammation, triggered by innate immune system activation, is a key driver of both chronic kidney disease and associated atherosclerosis and cardiovascular disease. Directly targeting inflammatory pathways has emerged over the past 15 years as a novel approach under active investigation to reduce atherosclerotic cardiovascular disease risk in patients with chronic kidney disease and to slow kidney disease progression. Recent and ongoing clinical trials in patients with kidney disease include targeting interleukin-1 and the interleukin-1 receptor, interleukin-6 and the interleukin-6 receptor, the NLRP3 inflammasome, nuclear factor erythroid 2-related factor 2, and senolytics. As we await results of ongoing phase 3 clinical trials, numerous challenges and considerations remain for both research and clinical implementation of anticytokine therapies.
{"title":"Targeting Inflammation in CKD","authors":"Kristen L. Nowak, Michel Chonchol","doi":"10.1053/j.ajkd.2025.06.019","DOIUrl":"10.1053/j.ajkd.2025.06.019","url":null,"abstract":"<div><div>Chronic systemic inflammation, triggered by innate immune system activation, is a key driver of both chronic kidney disease and associated atherosclerosis and cardiovascular disease. Directly targeting inflammatory pathways has emerged over the past 15 years as a novel approach under active investigation to reduce atherosclerotic cardiovascular disease risk in patients with chronic kidney disease and to slow kidney disease progression. Recent and ongoing clinical trials in patients with kidney disease include targeting interleukin-1 and the interleukin-1 receptor, interleukin-6 and the interleukin-6 receptor, the NLRP3 inflammasome, nuclear factor erythroid 2-related factor 2, and senolytics. As we await results of ongoing phase 3 clinical trials, numerous challenges and considerations remain for both research and clinical implementation of anticytokine therapies.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 6","pages":"Pages 803-813"},"PeriodicalIF":8.2,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085006","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 : 2025-09-16DOI: 10.1053/j.ajkd.2025.07.007
Nedas Semaska , Rachael Nolan , Silvi Shah
<div><h3>Rationale & Objective</h3><div>Women with chronic kidney disease (CKD) face elevated risks during pregnancy, yet contraceptive use and reproductive health counseling remain low. Nephrologists, who often maintain longitudinal relationships with patients, may be well-positioned to engage in these discussions. This study explored nephrologists’ perspectives on contraception and reproductive health management in women with CKD.</div></div><div><h3>Study Design</h3><div>Qualitative study using semistructured interviews.</div></div><div><h3>Setting & Participants</h3><div>Interviews were conducted with 25 adult general and transplant nephrologists from both academic and private practice settings across the United States.</div></div><div><h3>Analytical Approach</h3><div>Virtual interviews were recorded, transcribed, and analyzed using thematic analysis until thematic saturation was achieved. A grounded theory approach guided coding and identification of key themes related to provider experiences and perspectives.</div></div><div><h3>Results</h3><div>The following 4 themes and their respective subthemes were identified: (1) physician discomfort regarding discussion of contraception and reproductive health (reliance on patient initiation, hesitation with counseling, uncertainty about scope of practice); (2) insufficient training and inadequate guidelines regarding contraception and reproductive health (paucity of formal guidelines, limited exposure, reliance on self-education); (3) lack of interdisciplinary coordination regarding contraceptive use and reproductive health (the patient as an intermediary, fragmentation of care); (4) need for holistic and patient-centered care (comprehensive and sustained approach, shared decision-making).</div></div><div><h3>Limitations</h3><div>Generalizability may be limited due to participants being predominantly early-career academic nephrologists.</div></div><div><h3>Conclusions</h3><div>Key barriers to contraceptive use and management of reproductive health for women with CKD include provider discomfort due to limited exposure and training, lack of clear guidelines, and fragmented care. Despite these challenges, providers recognize the importance of holistic, patient-centered care. These findings highlight the need to improve contraceptive counseling to support appropriate contraceptive use and shared decision making for the reproductive health of patients with kidney disease.</div></div><div><h3>Plain-Language Summary</h3><div>Women with kidney disease can face challenges with fertility, sexual health, and menstruation. Pregnancy is often riskier for these women due to complications such as high blood pressure and preterm birth. Despite these risks, the use of birth control among women with kidney disease remains low. This study looked at the experiences of nephrologists in providing contraception and reproductive health counseling for their female patients. The interviews revealed that many nephrolo
{"title":"Contraceptive Use and Reproductive Health in Women With CKD: A Qualitative Study of Nephrologists in the United States","authors":"Nedas Semaska , Rachael Nolan , Silvi Shah","doi":"10.1053/j.ajkd.2025.07.007","DOIUrl":"10.1053/j.ajkd.2025.07.007","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Women with chronic kidney disease (CKD) face elevated risks during pregnancy, yet contraceptive use and reproductive health counseling remain low. Nephrologists, who often maintain longitudinal relationships with patients, may be well-positioned to engage in these discussions. This study explored nephrologists’ perspectives on contraception and reproductive health management in women with CKD.</div></div><div><h3>Study Design</h3><div>Qualitative study using semistructured interviews.</div></div><div><h3>Setting & Participants</h3><div>Interviews were conducted with 25 adult general and transplant nephrologists from both academic and private practice settings across the United States.</div></div><div><h3>Analytical Approach</h3><div>Virtual interviews were recorded, transcribed, and analyzed using thematic analysis until thematic saturation was achieved. A grounded theory approach guided coding and identification of key themes related to provider experiences and perspectives.</div></div><div><h3>Results</h3><div>The following 4 themes and their respective subthemes were identified: (1) physician discomfort regarding discussion of contraception and reproductive health (reliance on patient initiation, hesitation with counseling, uncertainty about scope of practice); (2) insufficient training and inadequate guidelines regarding contraception and reproductive health (paucity of formal guidelines, limited exposure, reliance on self-education); (3) lack of interdisciplinary coordination regarding contraceptive use and reproductive health (the patient as an intermediary, fragmentation of care); (4) need for holistic and patient-centered care (comprehensive and sustained approach, shared decision-making).</div></div><div><h3>Limitations</h3><div>Generalizability may be limited due to participants being predominantly early-career academic nephrologists.</div></div><div><h3>Conclusions</h3><div>Key barriers to contraceptive use and management of reproductive health for women with CKD include provider discomfort due to limited exposure and training, lack of clear guidelines, and fragmented care. Despite these challenges, providers recognize the importance of holistic, patient-centered care. These findings highlight the need to improve contraceptive counseling to support appropriate contraceptive use and shared decision making for the reproductive health of patients with kidney disease.</div></div><div><h3>Plain-Language Summary</h3><div>Women with kidney disease can face challenges with fertility, sexual health, and menstruation. Pregnancy is often riskier for these women due to complications such as high blood pressure and preterm birth. Despite these risks, the use of birth control among women with kidney disease remains low. This study looked at the experiences of nephrologists in providing contraception and reproductive health counseling for their female patients. The interviews revealed that many nephrolo","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 7-17.e1"},"PeriodicalIF":8.2,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145083579","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 : 2025-09-16DOI: 10.1053/j.ajkd.2025.07.005
Omid Sadeghi-Alavijeh , Melanie M.Y. Chan , Konstantinos Tzoumkas , Gabriel T. Doctor , Daniel P. Gale
<div><h3>Rationale & Objective</h3><div>Unexplained kidney failure (uKF) affects 15% of individuals needing kidney replacement therapy. The lack of a clear diagnosis creates uncertainty about recurrence, familial risk, and trial eligibility. This study sought to identify genetic variants underlying uKF.</div></div><div><h3>Study Design</h3><div>Genomic analyses conducted using whole-genome sequencing (WGS) were reviewed by a multidisciplinary team that identified candidate pathogenic variants. A case-control study was implemented for single and structural variants to perform gene-based and polygenic risk score (PRS) association testing.</div></div><div><h3>Setting & Participants</h3><div>The study recruited 218 patients with uKF onset before age 50 years from the United Kingdom’s 100,000 Genomes Project. Association analysis was performed in 180 uKF cases that remained unsolved after clinical analysis and constituted the nonmonogenic uKF cohort. 26,373 control subjects were derived from the unaffected relatives of nonrenal probands.</div></div><div><h3>Exposures</h3><div>Candidate variants in 537 genes were assessed at a structural and single-variant level in the 218 recruited patients, as were high-risk <em>APOL1</em> genotypes and PRSs for chronic kidney disease and various glomerular diseases.</div></div><div><h3>Outcomes</h3><div>The primary outcomes were establishing a genetic diagnosis and the associations between genetic findings, age, family history, and ancestry.</div></div><div><h3>Analytical Approach</h3><div>Candidate variants were reviewed for pathogenicity. Gene-based and structural variant analyses and high-risk <em>APOL1</em> genotype assessments were performed. PRSs and post hoc HLA associations were also investigated.</div></div><div><h3>Results</h3><div>Monogenic diagnoses were made in 38 of 218 patients (17%) using WGS via the clinical arm of the 100,000 Genomes Project. Median uKF onset was at the age of 36 years. Diagnoses were less frequent in patients aged ≥36 years, irrespective of family history. Three older patients without a family history had pathogenic variants in type IV collagen genes. Among individuals with recent African ancestry, high-risk <em>APOL1</em> genotypes were significantly more common in those with uKF (52% vs 8.4% in those without uKF; <em>P</em> < 0.001). An increased steroid-sensitive nephrotic syndrome PRS was observed in those with high-risk <em>APOL1</em> genotypes and uKF, partly due to differences at <em>HLA-DQB1∗03:19</em>.</div></div><div><h3>Limitations</h3><div>Potential limitations include the small sizes of subgroups and use of short-read WGS.</div></div><div><h3>Conclusions</h3><div>WGS yielded a monogenic diagnosis in 17% of patients with uKF, with no additional solved cases arising from the case-control analysis. These findings underscore <em>APOL1</em>’s role in those with recent African ancestry and suggest a genetic architecture distinct from common chronic kidney disease
原因与目的不明原因肾衰竭（uKF）影响了15%需要肾脏替代治疗的个体。缺乏明确的诊断造成了复发、家族风险和试验资格的不确定性。这项研究试图确定uKF的遗传变异。研究设计基因组分析使用全基因组测序（WGS）进行，由一个多学科小组审查，确定候选致病变异。对单基因和结构变异进行病例对照研究，进行基于基因和多基因的风险评分关联检测。背景和参与者：该研究从英国10万人基因组计划中招募了218名50岁之前患有uKF的患者。对临床分析未解决的180例uKF患者进行关联分析，组成非单基因uKF队列（NM-uKF）。26,373例对照来自非肾先证者的未受影响亲属。在218名招募的患者中，537个基因的候选变异在结构和单变异水平上进行了评估，这些基因是慢性肾脏疾病和各种肾小球肾炎的高风险APOL1基因型和多基因风险评分。主要结果是建立遗传诊断以及遗传结果、年龄、家族史和祖先之间的关联。分析方法对候选变异进行致病性审查。进行基因分析和结构变异分析以及APOL1高危基因型评估。多基因风险评分和事后HLA关联也被调查。结果218例患者中有38例（17%）使用WGS通过100,000基因组计划的临床分支进行了单基因诊断。uKF发病中位数为36年。无论家族史如何，36岁及以上的患者诊断较少。3例无家族史的老年患者有IV型胶原蛋白基因的致病变异。在最近非洲血统的个体中，高危APOL1基因型在uKF患者中更为常见（52% vs. 8.4%， P<0.001）。APOL1高危基因型和uKF患者的类固醇敏感肾病综合征（SSNS）多基因风险评分升高，部分原因是HLA-DQB1*03:19的差异。局限性潜在的局限性包括子组规模小和使用短读WGS。结论：在17%的uKF患者中，swgs产生了单基因诊断，病例对照分析中没有出现额外的解决病例。这些发现强调了APOL1在最近非洲血统人群中的作用，并提示了一种不同于常见慢性肾脏疾病的遗传结构。
{"title":"Quantifying APOL1, Human Leukocyte Antigen, and Other Genetic Contributions to Unexplained Kidney Failure","authors":"Omid Sadeghi-Alavijeh , Melanie M.Y. Chan , Konstantinos Tzoumkas , Gabriel T. Doctor , Daniel P. Gale","doi":"10.1053/j.ajkd.2025.07.005","DOIUrl":"10.1053/j.ajkd.2025.07.005","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Unexplained kidney failure (uKF) affects 15% of individuals needing kidney replacement therapy. The lack of a clear diagnosis creates uncertainty about recurrence, familial risk, and trial eligibility. This study sought to identify genetic variants underlying uKF.</div></div><div><h3>Study Design</h3><div>Genomic analyses conducted using whole-genome sequencing (WGS) were reviewed by a multidisciplinary team that identified candidate pathogenic variants. A case-control study was implemented for single and structural variants to perform gene-based and polygenic risk score (PRS) association testing.</div></div><div><h3>Setting & Participants</h3><div>The study recruited 218 patients with uKF onset before age 50 years from the United Kingdom’s 100,000 Genomes Project. Association analysis was performed in 180 uKF cases that remained unsolved after clinical analysis and constituted the nonmonogenic uKF cohort. 26,373 control subjects were derived from the unaffected relatives of nonrenal probands.</div></div><div><h3>Exposures</h3><div>Candidate variants in 537 genes were assessed at a structural and single-variant level in the 218 recruited patients, as were high-risk <em>APOL1</em> genotypes and PRSs for chronic kidney disease and various glomerular diseases.</div></div><div><h3>Outcomes</h3><div>The primary outcomes were establishing a genetic diagnosis and the associations between genetic findings, age, family history, and ancestry.</div></div><div><h3>Analytical Approach</h3><div>Candidate variants were reviewed for pathogenicity. Gene-based and structural variant analyses and high-risk <em>APOL1</em> genotype assessments were performed. PRSs and post hoc HLA associations were also investigated.</div></div><div><h3>Results</h3><div>Monogenic diagnoses were made in 38 of 218 patients (17%) using WGS via the clinical arm of the 100,000 Genomes Project. Median uKF onset was at the age of 36 years. Diagnoses were less frequent in patients aged ≥36 years, irrespective of family history. Three older patients without a family history had pathogenic variants in type IV collagen genes. Among individuals with recent African ancestry, high-risk <em>APOL1</em> genotypes were significantly more common in those with uKF (52% vs 8.4% in those without uKF; <em>P</em> < 0.001). An increased steroid-sensitive nephrotic syndrome PRS was observed in those with high-risk <em>APOL1</em> genotypes and uKF, partly due to differences at <em>HLA-DQB1∗03:19</em>.</div></div><div><h3>Limitations</h3><div>Potential limitations include the small sizes of subgroups and use of short-read WGS.</div></div><div><h3>Conclusions</h3><div>WGS yielded a monogenic diagnosis in 17% of patients with uKF, with no additional solved cases arising from the case-control analysis. These findings underscore <em>APOL1</em>’s role in those with recent African ancestry and suggest a genetic architecture distinct from common chronic kidney disease","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 6","pages":"Pages 740-750.e1"},"PeriodicalIF":8.2,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145083580","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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