Pub Date : 2026-03-05DOI: 10.1053/j.ajkd.2025.09.029
Colin Reily,Jan Novak,Dana V Rizk
In IgA nephropathy (IgAN), elevated levels of the circulating autoantigen, galactose-deficient IgA1, are critical to disease pathogenesis. Abnormal B-cell glycosylation pathways produce the autoantigen that, upon recognition by autoantibodies, forms immune complexes. Genetic as well as in vitro, in vivo, and human immunologic studies identified APRIL (a proliferation-inducing ligand) and BAFF (B-cell activating factor) as key cytokines controlling B-cell development and differentiation of antibody-secreting cells. Targeting APRIL with or without BAFF is emerging as a viable strategy for the treatment of IgAN and nascent data from global clinical trials are showing very promising results.
{"title":"The Roles of A Proliferation-Inducing Ligand (APRIL) and B-Cell Activating Factor (BAFF) in IgA Nephropathy.","authors":"Colin Reily,Jan Novak,Dana V Rizk","doi":"10.1053/j.ajkd.2025.09.029","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.09.029","url":null,"abstract":"In IgA nephropathy (IgAN), elevated levels of the circulating autoantigen, galactose-deficient IgA1, are critical to disease pathogenesis. Abnormal B-cell glycosylation pathways produce the autoantigen that, upon recognition by autoantibodies, forms immune complexes. Genetic as well as in vitro, in vivo, and human immunologic studies identified APRIL (a proliferation-inducing ligand) and BAFF (B-cell activating factor) as key cytokines controlling B-cell development and differentiation of antibody-secreting cells. Targeting APRIL with or without BAFF is emerging as a viable strategy for the treatment of IgAN and nascent data from global clinical trials are showing very promising results.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"32 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147371027","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 : 2026-03-04DOI: 10.1053/j.ajkd.2025.10.022
Amy K Mottl,Deirdre L Sawinski,Petter Bjornstad
Despite the abundance of new therapies designed to delay or prevent kidney and cardiovascular events in people with type 2 diabetes (T2D), there remains a stark gap in the evidence supporting their efficacy and safety for other types of diabetes. Individuals without T2D are frequently excluded from clinical trials based on the assumptions that their event risk, pathogenesis, and potential for adverse events differ significantly. It is anticipated that treatments will eventually be expanded to include this population, yet the uptake of new therapies even with clear evidence is often disappointingly low. In this perspective, we critically examine the characteristics of diabetes types other than T2D and evaluate the available evidence for novel therapies in these underrepresented populations. Future small trials of surrogate endpoints and real-world studies, including individuals without T2D, will be essential to understand and utilize recent advancements in treatments for preventing kidney failure and cardiovascular events and death.
{"title":"Kidney and Cardiovascular Protection in Diabetes: Beyond Diabetes Typology.","authors":"Amy K Mottl,Deirdre L Sawinski,Petter Bjornstad","doi":"10.1053/j.ajkd.2025.10.022","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.10.022","url":null,"abstract":"Despite the abundance of new therapies designed to delay or prevent kidney and cardiovascular events in people with type 2 diabetes (T2D), there remains a stark gap in the evidence supporting their efficacy and safety for other types of diabetes. Individuals without T2D are frequently excluded from clinical trials based on the assumptions that their event risk, pathogenesis, and potential for adverse events differ significantly. It is anticipated that treatments will eventually be expanded to include this population, yet the uptake of new therapies even with clear evidence is often disappointingly low. In this perspective, we critically examine the characteristics of diabetes types other than T2D and evaluate the available evidence for novel therapies in these underrepresented populations. Future small trials of surrogate endpoints and real-world studies, including individuals without T2D, will be essential to understand and utilize recent advancements in treatments for preventing kidney failure and cardiovascular events and death.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"225 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147368244","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}
<div><h3>Rationale & Objective</h3><div>Living kidney donors (LKDs) perceive gaps in care along their donation journeys, such as poor coordination and communication between providers. Better integration of their primary care providers (PCPs) in their donation journey can help address these gaps. We captured the perspectives of Canadian PCPs to understand the challenges they perceive when caring for LKDs and their recommendations to address them.</div></div><div><h3>Study Design</h3><div>Qualitative descriptive design.</div></div><div><h3>Setting & Participants</h3><div>Semistructured in-depth interviews with 19 family physicians conducted until data saturation.</div></div><div><h3>Analytical Approach</h3><div>Thematic analysis.</div></div><div><h3>Results</h3><div>Participants highlighted several challenges with the current living kidney donation processes: (1) limited scope of LKD care in primary practice; (2) poor clarity surrounding roles and responsibilities before donation (perceived as a facilitator) and after donation (perceived as low-barrier and high-access resource, and providing soft psychosocial support); (3) variable understanding of the living kidney donation process; and 4) lack of support and resources (patient accessibility to primary care, communication challenges between providers, poor health record transmission, limited availability of mental health services, limited financial support for patients and providers). The participants had 3 key recommendations: (1) support PCPs with pragmatic approaches and on-demand resources; (2) empower LKDs to be active participants in their care; and (3) implement strategies to address LKD care provision deficiencies (primary care accessibility, developing a collaborative care model, improving communication between all stakeholders, dedicated and prolonged psychosocial support, and governmental prioritization).</div></div><div><h3>Limitations</h3><div>About half the sample had limited experience with LKD care; inability to recruit some PCPs such as nurse practitioners.</div></div><div><h3>Conclusions</h3><div>As co-providers of patient care during the predonation phase and the primary drivers of care in the postdonation period, PCPs are positioned to deliver high-quality care to LKDs, contribute to long-term data collection, and potentially improve LKD outcomes. This study outlines challenges PCPs perceive and possible approaches to address them.</div></div><div><h3>Plain-Language Summary</h3><div>Living kidney donors (LKDs) have reported gaps in their care, such as poor communication and a lack of coordination between doctors. Because family physicians play a key role in supporting donors before and after surgery, we interviewed 19 Canadian family doctors to hear their perspectives. Participants reported challenges such as unclear roles, limited scope of seeing LKDs in their practices, poor communication with transplant centers, and a lack of mental health and financial services. The
{"title":"Family Physicians’ Perspectives on Providing Living Kidney Donor Care","authors":"Chloe Wong-Mersereau , Saly El Wazze , Kathleen Gaudio , Katya Loban , Shaifali Sandal","doi":"10.1053/j.ajkd.2025.09.018","DOIUrl":"10.1053/j.ajkd.2025.09.018","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Living kidney donors (LKDs) perceive gaps in care along their donation journeys, such as poor coordination and communication between providers. Better integration of their primary care providers (PCPs) in their donation journey can help address these gaps. We captured the perspectives of Canadian PCPs to understand the challenges they perceive when caring for LKDs and their recommendations to address them.</div></div><div><h3>Study Design</h3><div>Qualitative descriptive design.</div></div><div><h3>Setting & Participants</h3><div>Semistructured in-depth interviews with 19 family physicians conducted until data saturation.</div></div><div><h3>Analytical Approach</h3><div>Thematic analysis.</div></div><div><h3>Results</h3><div>Participants highlighted several challenges with the current living kidney donation processes: (1) limited scope of LKD care in primary practice; (2) poor clarity surrounding roles and responsibilities before donation (perceived as a facilitator) and after donation (perceived as low-barrier and high-access resource, and providing soft psychosocial support); (3) variable understanding of the living kidney donation process; and 4) lack of support and resources (patient accessibility to primary care, communication challenges between providers, poor health record transmission, limited availability of mental health services, limited financial support for patients and providers). The participants had 3 key recommendations: (1) support PCPs with pragmatic approaches and on-demand resources; (2) empower LKDs to be active participants in their care; and (3) implement strategies to address LKD care provision deficiencies (primary care accessibility, developing a collaborative care model, improving communication between all stakeholders, dedicated and prolonged psychosocial support, and governmental prioritization).</div></div><div><h3>Limitations</h3><div>About half the sample had limited experience with LKD care; inability to recruit some PCPs such as nurse practitioners.</div></div><div><h3>Conclusions</h3><div>As co-providers of patient care during the predonation phase and the primary drivers of care in the postdonation period, PCPs are positioned to deliver high-quality care to LKDs, contribute to long-term data collection, and potentially improve LKD outcomes. This study outlines challenges PCPs perceive and possible approaches to address them.</div></div><div><h3>Plain-Language Summary</h3><div>Living kidney donors (LKDs) have reported gaps in their care, such as poor communication and a lack of coordination between doctors. Because family physicians play a key role in supporting donors before and after surgery, we interviewed 19 Canadian family doctors to hear their perspectives. Participants reported challenges such as unclear roles, limited scope of seeing LKDs in their practices, poor communication with transplant centers, and a lack of mental health and financial services. The","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 3","pages":"Pages 376-387.e1"},"PeriodicalIF":8.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145696694","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 : 2026-03-01Epub Date: 2025-11-12DOI: 10.1053/j.ajkd.2025.09.012
Song Bai , Xin Yang , Qiuju Sheng , Qing Zhang , Li Liu , Shaomei Sun , Xing Wang , Ming Zhou , Qiyu Jia , Kun Song , Kaijun Niu , Yang Ding , Yang Xia
<div><h3>Rationale & Objective</h3><div>Evidence is limited regarding the associations of nonalcoholic fatty liver disease (NAFLD) and metabolic dysfunction–associated fatty liver disease (MAFLD) with the development of nephrolithiasis. This study assessed the associations of NAFLD and MAFLD with the risk of incident nephrolithiasis using data from 2 cohort studies conducted in the People’s Republic of China and the United Kingdom.</div></div><div><h3>Study Design</h3><div>Prospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>26,490 participants without nephrolithiasis at baseline in the Tianjin Chronic Low-grade Systemic Inflammation and Health Cohort Study (TCLSIH) and 294,577 participants in the UK Biobank.</div></div><div><h3>Exposure</h3><div>Fatty liver diagnosed by abdominal ultrasonography in the TCLSIH and by the Hepatic Steatosis Index in the UK Biobank. NAFLD and MAFLD were defined according to standard clinical criteria in both cohorts.</div></div><div><h3>Outcome</h3><div>Nephrolithiasis was confirmed by ultrasonography in the TCLSIH and identified through ICD-10 and OPCS-4 in the UK Biobank.</div></div><div><h3>Analytical Approach</h3><div>Cox proportional hazards regression analysis was used to assess the relationship between exposures and incident nephrolithiasis.</div></div><div><h3>Results</h3><div>The TCLSIH and the UK Biobank recorded 806 and 2,743 new cases of nephrolithiasis during a median follow-up period of 4 and 12 years, respectively. Participants in both cohorts showed a significantly increased risk of nephrolithiasis in the setting of NAFLD (TCLSIH: HR, 1.69 [95% CI, 1.46-1.95]; UK Biobank: HR, 1.66 [95% CI, 1.53-1.79]) and MAFLD (TCLSIH: HR, 1.79 [95% CI, 1.55-2.08]; UK Biobank: HR, 1.54 [95% CI, 1.42-1.66]) after multivariable adjustments.</div></div><div><h3>Limitations</h3><div>Observational nature limits causal inferences; generalizability limited outside of the cohorts studied; limited diagnostic approaches to detect nephrolithiasis; unavailability of stone composition data.</div></div><div><h3>Conclusions</h3><div>Both NAFLD and MAFLD are associated with a higher risk of nephrolithiasis. The results suggest that NAFLD/MAFLD and their associated metabolic conditions may represent modifiable risk factors for nephrolithiasis.</div></div><div><h3>Plain-Language Summary</h3><div>Evidence on the association between nonalcoholic fatty liver disease (NAFLD) or metabolic dysfunction–associated fatty liver disease (MAFLD) and the risk of nephrolithiasis remains limited. In this study, we assessed whether NAFLD or MAFLD were associated with an increased risk of developing nephrolithiasis by analyzing data from 2 large prospective cohorts in the People’s Republic of China and the United Kingdom. Our findings demonstrated that individuals with NAFLD or MAFLD had a significantly higher risk of incident nephrolithiasis later in life. This increased risk remained consistent across different age
理由与目的关于非酒精性脂肪性肝病（NAFLD）和代谢功能障碍相关脂肪性肝病（MAFLD）与肾结石发生的关联证据有限。本研究旨在评估NAFLD和MAFLD与肾结石发生风险的关系，使用来自中国和英国的两项队列研究的数据。研究设计前瞻性队列研究。背景和参与者：天津慢性低度全身性炎症与健康队列研究（TCLSIH）的26,490名基线时无肾结石的参与者和英国生物银行的294,577名参与者。通过TCLSIH的腹部超声检查和UK Biobank的肝脂肪变性指数（HSI）诊断脂肪肝。在两个队列中，根据标准临床标准定义NAFLD和MAFLD。结果：TCLSIH超声检查证实肾结石，英国生物银行通过ICD-10和OPCS-4诊断肾结石。分析方法采用cox比例风险回归分析来评估暴露与肾结石事件之间的关系。结果TCLSIH和UK Biobank在中位随访4年和12年期间分别记录了806例和2743例肾结石新病例。多变量调整后，两个队列的参与者均显示NAFLD （TCLSIH: HR=1.69, 95% CI 1.46-1.95; UK Biobank: HR=1.66, 95% CI 1.53-1.79）和MAFLD （TCLSIH: HR=1.79, 95% CI 1.55-2.08; UK Biobank: HR=1.54, 95% CI 1.42-1.66）的肾结石风险显著增加。局限性：观察性质限制了因果推论；在研究的队列之外，通用性有限；检测肾结石的有限诊断方法无法获得石材成分数据。结论NAFLD和MAFLD均与肾结石的高风险相关。结果表明，NAFLD/MAFLD及其相关代谢状况可能是肾结石可改变的危险因素。
{"title":"Association of Fatty Liver Disease and the Risk of Nephrolithiasis: Findings From Two Prospective Cohort Studies","authors":"Song Bai , Xin Yang , Qiuju Sheng , Qing Zhang , Li Liu , Shaomei Sun , Xing Wang , Ming Zhou , Qiyu Jia , Kun Song , Kaijun Niu , Yang Ding , Yang Xia","doi":"10.1053/j.ajkd.2025.09.012","DOIUrl":"10.1053/j.ajkd.2025.09.012","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Evidence is limited regarding the associations of nonalcoholic fatty liver disease (NAFLD) and metabolic dysfunction–associated fatty liver disease (MAFLD) with the development of nephrolithiasis. This study assessed the associations of NAFLD and MAFLD with the risk of incident nephrolithiasis using data from 2 cohort studies conducted in the People’s Republic of China and the United Kingdom.</div></div><div><h3>Study Design</h3><div>Prospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>26,490 participants without nephrolithiasis at baseline in the Tianjin Chronic Low-grade Systemic Inflammation and Health Cohort Study (TCLSIH) and 294,577 participants in the UK Biobank.</div></div><div><h3>Exposure</h3><div>Fatty liver diagnosed by abdominal ultrasonography in the TCLSIH and by the Hepatic Steatosis Index in the UK Biobank. NAFLD and MAFLD were defined according to standard clinical criteria in both cohorts.</div></div><div><h3>Outcome</h3><div>Nephrolithiasis was confirmed by ultrasonography in the TCLSIH and identified through ICD-10 and OPCS-4 in the UK Biobank.</div></div><div><h3>Analytical Approach</h3><div>Cox proportional hazards regression analysis was used to assess the relationship between exposures and incident nephrolithiasis.</div></div><div><h3>Results</h3><div>The TCLSIH and the UK Biobank recorded 806 and 2,743 new cases of nephrolithiasis during a median follow-up period of 4 and 12 years, respectively. Participants in both cohorts showed a significantly increased risk of nephrolithiasis in the setting of NAFLD (TCLSIH: HR, 1.69 [95% CI, 1.46-1.95]; UK Biobank: HR, 1.66 [95% CI, 1.53-1.79]) and MAFLD (TCLSIH: HR, 1.79 [95% CI, 1.55-2.08]; UK Biobank: HR, 1.54 [95% CI, 1.42-1.66]) after multivariable adjustments.</div></div><div><h3>Limitations</h3><div>Observational nature limits causal inferences; generalizability limited outside of the cohorts studied; limited diagnostic approaches to detect nephrolithiasis; unavailability of stone composition data.</div></div><div><h3>Conclusions</h3><div>Both NAFLD and MAFLD are associated with a higher risk of nephrolithiasis. The results suggest that NAFLD/MAFLD and their associated metabolic conditions may represent modifiable risk factors for nephrolithiasis.</div></div><div><h3>Plain-Language Summary</h3><div>Evidence on the association between nonalcoholic fatty liver disease (NAFLD) or metabolic dysfunction–associated fatty liver disease (MAFLD) and the risk of nephrolithiasis remains limited. In this study, we assessed whether NAFLD or MAFLD were associated with an increased risk of developing nephrolithiasis by analyzing data from 2 large prospective cohorts in the People’s Republic of China and the United Kingdom. Our findings demonstrated that individuals with NAFLD or MAFLD had a significantly higher risk of incident nephrolithiasis later in life. This increased risk remained consistent across different age ","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 3","pages":"Pages 364-375.e1"},"PeriodicalIF":8.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145516260","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 : 2026-03-01Epub Date: 2025-12-11DOI: 10.1053/j.ajkd.2025.08.019
Carolyn T. Thorpe , Ryan P. Hickson , Xinhua Zhao , Sherrie L. Aspinall , Vimal K. Derebail , Binxin Cao , Alexa Ehlert , Joshua M. Thorpe , Ronald J. Falk , Susan L. Hogan
{"title":"Antimicrobial Prophylaxis in US Medicare Beneficiaries Receiving Immunosuppressants for Antineutrophil Cytoplasmic Antibody–Associated Vasculitis","authors":"Carolyn T. Thorpe , Ryan P. Hickson , Xinhua Zhao , Sherrie L. Aspinall , Vimal K. Derebail , Binxin Cao , Alexa Ehlert , Joshua M. Thorpe , Ronald J. Falk , Susan L. Hogan","doi":"10.1053/j.ajkd.2025.08.019","DOIUrl":"10.1053/j.ajkd.2025.08.019","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 3","pages":"Pages 393-396"},"PeriodicalIF":8.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145746719","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 : 2026-03-01Epub Date: 2025-12-19DOI: 10.1053/j.ajkd.2025.07.023
Jia Wei Teh , Sinead Stoneman , Michelle M. O’Shaughnessy
IgA nephropathy (IgAN) is the most common immune-mediated glomerular disease worldwide. Advanced understanding of the role of complement in IgAN pathogenesis has motivated the development of complement inhibition as a therapeutic strategy. Iptacopan, a complement factor B inhibitor, is the first approved complement inhibitor for IgAN. Several other complement inhibitors are being studied in phase 2/3 clinical trials. How best to integrate complement inhibition into the evolving treatment paradigm for IgAN remains a challenge. This review provides an overview of the role of complement in the pathogenesis and progression of IgAN and summarizes current and emerging complement-targeted IgAN therapies.
{"title":"Complement Inhibition in Immunoglobulin A Nephropathy: A Mini-Review","authors":"Jia Wei Teh , Sinead Stoneman , Michelle M. O’Shaughnessy","doi":"10.1053/j.ajkd.2025.07.023","DOIUrl":"10.1053/j.ajkd.2025.07.023","url":null,"abstract":"<div><div>IgA nephropathy (IgAN) is the most common immune-mediated glomerular disease worldwide. Advanced understanding of the role of complement in IgAN pathogenesis has motivated the development of complement inhibition as a therapeutic strategy. Iptacopan, a complement factor B inhibitor, is the first approved complement inhibitor for IgAN. Several other complement inhibitors are being studied in phase 2/3 clinical trials. How best to integrate complement inhibition into the evolving treatment paradigm for IgAN remains a challenge. This review provides an overview of the role of complement in the pathogenesis and progression of IgAN and summarizes current and emerging complement-targeted IgAN therapies.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 3","pages":"Pages 412-421"},"PeriodicalIF":8.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145801332","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 : 2026-03-01Epub Date: 2025-12-22DOI: 10.1053/j.ajkd.2025.10.014
Susan F. Massengill , Kenneth A. Andreoni , Keith A. Bellovich , Cheryl Courtlandt , Vimal K. Derebail , David L. Feldman , Gia J. Oh , John W. Sleasman , Kristina A. Bryant
People with chronic kidney disease (CKD) are particularly vulnerable to vaccine-preventable infections. Therefore, the National Kidney Foundation organized a multidisciplinary working group, including people with CKD and family care partners, to develop recommendations to improve vaccination rates, vaccination effectiveness, and health care for the CKD population. A modified Delphi process was used to achieve consensus on the recommendations. Recommendations on vaccination in CKD patients were organized into these categories: (1) patient preferences; (2) assessing the vaccination status of patients with CKD; (3) assessing vaccine response in patients with CKD; (4) vaccination of immunocompromised patients; (5) vaccination in posttransplant patients; (6) vaccinations in patients with CKD before international travel; (7) vaccination of household contacts of patients with CKD; (8) assessing vaccine efficacy and safety in clinical trials with patients with CKD; (9) training and resources for health care teams; (10) training of health care teams for discussions with patients; (11) role of technology in promoting and improving vaccination; and (12) advocacy and policy considerations for promoting and improving vaccination rates. The working group’s recommendations should improve communication between patients and health care clinicians, inclusion of people with CKD in vaccine trials, and use of existing clinical guidelines as well as generate educational resources and training materials for CKD patients of all ages and health care professionals.
{"title":"Improving Vaccination in People With CKD: Report From a National Kidney Foundation Working Group","authors":"Susan F. Massengill , Kenneth A. Andreoni , Keith A. Bellovich , Cheryl Courtlandt , Vimal K. Derebail , David L. Feldman , Gia J. Oh , John W. Sleasman , Kristina A. Bryant","doi":"10.1053/j.ajkd.2025.10.014","DOIUrl":"10.1053/j.ajkd.2025.10.014","url":null,"abstract":"<div><div>People with chronic kidney disease (CKD) are particularly vulnerable to vaccine-preventable infections. Therefore, the National Kidney Foundation organized a multidisciplinary working group, including people with CKD and family care partners, to develop recommendations to improve vaccination rates, vaccination effectiveness, and health care for the CKD population. A modified Delphi process was used to achieve consensus on the recommendations. Recommendations on vaccination in CKD patients were organized into these categories: (1) patient preferences; (2) assessing the vaccination status of patients with CKD; (3) assessing vaccine response in patients with CKD; (4) vaccination of immunocompromised patients; (5) vaccination in posttransplant patients; (6) vaccinations in patients with CKD before international travel; (7) vaccination of household contacts of patients with CKD; (8) assessing vaccine efficacy and safety in clinical trials with patients with CKD; (9) training and resources for health care teams; (10) training of health care teams for discussions with patients; (11) role of technology in promoting and improving vaccination; and (12) advocacy and policy considerations for promoting and improving vaccination rates. The working group’s recommendations should improve communication between patients and health care clinicians, inclusion of people with CKD in vaccine trials, and use of existing clinical guidelines as well as generate educational resources and training materials for CKD patients of all ages and health care professionals.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 3","pages":"Pages 402-411"},"PeriodicalIF":8.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145823890","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 : 2026-03-01Epub Date: 2026-02-19DOI: 10.1053/j.ajkd.2026.01.004
An S. De Vriese
{"title":"Anticoagulation Decisions in Patients With Kidney Failure Requiring Hemodialysis: Caught Between a Clot and a Hard Place","authors":"An S. De Vriese","doi":"10.1053/j.ajkd.2026.01.004","DOIUrl":"10.1053/j.ajkd.2026.01.004","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 3","pages":"Pages 292-294"},"PeriodicalIF":8.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146776031","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 : 2026-03-01Epub Date: 2025-11-06DOI: 10.1053/j.ajkd.2025.10.005
Susan L. Ziolkowski , Jin Long , Thomas L. Nickolas , Shaun Bender , Simin Goral , Babette S. Zemel , Chamith S. Rajapakse , Thomas Dienemann , Mary B. Leonard
<div><h3>Rationale & Objective</h3><div>Kidney transplant (KT) ameliorates the underlying abnormalities contributing to skeletal fragility in chronic kidney disease, but fracture rates increase after transplant. This study sought to assess the impact of changes in body composition and mineral metabolism on bone mineral density (BMD) and structure following kidney KT.</div></div><div><h3>Study Design</h3><div>24-month prospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>60 incident KT recipients and 361 healthy controls aged 20-60 years.</div></div><div><h3>Outcomes</h3><div>Tibia volumetric BMD (vBMD) and cortical dimensions measured using peripheral quantitative computed tomography and areal BMD (aBMD), appendicular lean mass index (ALMI), and fat mass index measured using dual-energy X-ray absorptiometry.</div></div><div><h3>Analytical Approach</h3><div>Analytical Approach: Outcomes were converted to sex-specific <em>z</em> scores for age and compared with those in 361 controls. Quasi–least-squares regression models identified correlates of change.</div></div><div><h3>Results</h3><div>At baseline, ALMI, trabecular and cortical vBMD, cortical thickness, and total hip, femoral neck, and ultradistal radius aBMD were lower in KT recipients versus controls (<em>P</em> ≤ 0.003). During the first 6 months after KT, ALMI, fat mass index, and body mass index (BMI) increased (<em>P</em> < 0.001), whereas tibia trabecular vBMD and lumbar spine aBMD decreased (<em>P</em> ≤ 0.005). Cortical vBMD increased from 6 months onward (<em>P</em> < 0.001) in association with decreasing parathyroid hormone levels (<em>P</em> = 0.004). Cortical thickness decreased between 6 and 24 months (<em>P</em> = 0.002) because of a loss of endocortical bone. Total hip and femoral neck aBMD remained stable for 6 months, then improved through 24 months (<em>P</em> ≤ 0.02). Ultradistal radius aBMD decreased throughout the study (<em>P</em> ≤ 0.003). Higher BMI and ALMI were associated with gains in hip and spine aBMD and trabecular vBMD (all <em>P</em> ≤ 0.02). Corticosteroid dose was negatively associated with changes in spine and hip aBMD and cortical and trabecular vBMD (all <em>P</em> ≤ 0.02). Higher bone turnover marker levels and loss of cortical vBMD and thickness were associated with increases in serum calcium concentrations (<em>P</em> ≤ 0.03).</div></div><div><h3>Limitations</h3><div>Not generalizable to older KT recipients.</div></div><div><h3>Conclusions</h3><div>Skeletal deficits in KT recipients largely stabilize or improve beyond 6 months, with the exception of progressive cortical thinning. Strategies are needed to preserve cortical bone before and after KT. Gains in BMI and ALMI may improve bone health in the weight-bearing skeleton following KT.</div></div><div><h3>Plain-Language Summary</h3><div>We enrolled 60 adults at the time of kidney transplant (KT) and compared measures of bone and muscle mass versus those in 361 healt
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