Pub Date : 2025-12-18DOI: 10.1053/j.ajkd.2025.11.001
Ajay K. Israni , Jon Miller , Syed F. Hassan
{"title":"Toward Smarter Allocation by Rethinking Kidney Donor Profile Index","authors":"Ajay K. Israni , Jon Miller , Syed F. Hassan","doi":"10.1053/j.ajkd.2025.11.001","DOIUrl":"10.1053/j.ajkd.2025.11.001","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 4-6"},"PeriodicalIF":8.2,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765734","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 : 2025-12-13DOI: 10.1053/j.ajkd.2025.09.014
Laura Aponte Becerra, Sherry G. Mansour
Exercise triggers complex effects on kidney physiology that vary with intensity, duration, and environmental conditions. While moderate physical activity improves cardiovascular and renal outcomes, intense or prolonged exertion, particularly in endurance sports, can lead to acute kidney injury. Adaptations in kidney physiology during exercise include reduced plasma flow, altered glomerular filtration, and hormone-mediated fluid retention. These changes are protective but may become maladaptive with dehydration, heat stress, or excessive fluid intake. High-intensity exercise increases oxidative stress and proteinuria, while ultramarathon participation may cause transient creatinine elevation from muscle breakdown, complicating acute kidney injury diagnosis. Prevention strategies include individualized hydration plans, electrolyte replacement, and avoidance of nonsteroidal anti-inflammatory drugs. In special populations, such as children with chronic kidney disease or patients receiving dialysis, structured exercise enhances quality of life and physical function when implemented safely. Clinicians must balance the benefits of exercise with kidney-related risks, promote safe training practices, and recognize early signs of exertional complications to optimize renal and overall health in physically active individuals. This core curriculum reviews the physiology of exercise on kidney function and provides evidence-based strategies for patient counseling and risk reduction.
{"title":"Exercise and Kidney Health: Core Curriculum 2026","authors":"Laura Aponte Becerra, Sherry G. Mansour","doi":"10.1053/j.ajkd.2025.09.014","DOIUrl":"10.1053/j.ajkd.2025.09.014","url":null,"abstract":"<div><div>Exercise triggers complex effects on kidney physiology that vary with intensity, duration, and environmental conditions. While moderate physical activity improves cardiovascular and renal outcomes, intense or prolonged exertion, particularly in endurance sports, can lead to acute kidney injury. Adaptations in kidney physiology during exercise include reduced plasma flow, altered glomerular filtration, and hormone-mediated fluid retention. These changes are protective but may become maladaptive with dehydration, heat stress, or excessive fluid intake. High-intensity exercise increases oxidative stress and proteinuria, while ultramarathon participation may cause transient creatinine elevation from muscle breakdown, complicating acute kidney injury diagnosis. Prevention strategies include individualized hydration plans, electrolyte replacement, and avoidance of nonsteroidal anti-inflammatory drugs. In special populations, such as children with chronic kidney disease or patients receiving dialysis, structured exercise enhances quality of life and physical function when implemented safely. Clinicians must balance the benefits of exercise with kidney-related risks, promote safe training practices, and recognize early signs of exertional complications to optimize renal and overall health in physically active individuals. This core curriculum reviews the physiology of exercise on kidney function and provides evidence-based strategies for patient counseling and risk reduction.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 246-259"},"PeriodicalIF":8.2,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145732820","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.2025.08.019
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 Anti-Neutrophil 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":"https://doi.org/10.1053/j.ajkd.2025.08.019","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"12 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-12-11","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 : 2025-12-11DOI: 10.1053/j.ajkd.2025.08.018
Angelina Abbaticchio,Madeline Theodorlis,Noah Zlotnik,Michelle S Cross,Setayesh Yazdani,Abhijat Kitchlu,Jo-Anne Wilson,Anna R Gagliardi,Marisa Battistella
{"title":"Perspectives on Deprescribing Medications Among Patients Receiving Hemodialysis: A Qualitative Study.","authors":"Angelina Abbaticchio,Madeline Theodorlis,Noah Zlotnik,Michelle S Cross,Setayesh Yazdani,Abhijat Kitchlu,Jo-Anne Wilson,Anna R Gagliardi,Marisa Battistella","doi":"10.1053/j.ajkd.2025.08.018","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.08.018","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"44 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145746698","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.2025.09.023
Kevin Wang,Zoe Bamber,Lonnie Pyne,Arrti A Bhasin,Michael Walsh,Rathika Krishnasamy,Glenn M Chertow,Roberto Pecoits-Filho,Scott Klarenbach,Stephanie Thompson,David Collister
{"title":"Representation of Older Patients Receiving Maintenance Dialysis in Randomized Controlled Trials: A Meta-Epidemiologic Study.","authors":"Kevin Wang,Zoe Bamber,Lonnie Pyne,Arrti A Bhasin,Michael Walsh,Rathika Krishnasamy,Glenn M Chertow,Roberto Pecoits-Filho,Scott Klarenbach,Stephanie Thompson,David Collister","doi":"10.1053/j.ajkd.2025.09.023","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.09.023","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"256 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145746700","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}
Pub Date : 2025-12-06DOI: 10.1053/j.ajkd.2025.09.020
Antoine Créon MD, Anne-Laure Faucon MD PhD, Aurora Caldinelli Ms, Jung-Im Shin MD PhD, Morgan E. Grams MD PhD, Arvid Sjölander PhD, Edouard L. Fu PhD, Juan-Jesus Carrero PharmD PhD
Albuminuria is a predictor of adverse health outcomes. Early detection enables timely clinical management, yet little is known about how clinicians respond to newly detected albuminuria in routine practice. This study sought to characterize clinical care processes for patients with newly detected albuminuria.
{"title":"Care Processes and Clinical Responses to Newly Detected Albuminuria: The Stockholm Creatinine Measurements (SCREAM) Project","authors":"Antoine Créon MD, Anne-Laure Faucon MD PhD, Aurora Caldinelli Ms, Jung-Im Shin MD PhD, Morgan E. Grams MD PhD, Arvid Sjölander PhD, Edouard L. Fu PhD, Juan-Jesus Carrero PharmD PhD","doi":"10.1053/j.ajkd.2025.09.020","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.09.020","url":null,"abstract":"Albuminuria is a predictor of adverse health outcomes. Early detection enables timely clinical management, yet little is known about how clinicians respond to newly detected albuminuria in routine practice. This study sought to characterize clinical care processes for patients with newly detected albuminuria.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"4 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697286","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 : 2025-12-06DOI: 10.1053/j.ajkd.2025.09.021
Manuel Laslandes MD, Marine Lorent PhD, Benoit Brilland MD PhD, Hugoline Boulay MD, Léonard Golbin MD, Christelle Barbet MD, Jimmy Grellier MD, Amaury Dujardin MD, David Larmet MD, Angelo Testa MD, Pierre Pfirmann MD, Antoine Thierry MD PhD, Simon Ville MD PhD, Jacques Dantal MD PhD, Christophe Masset MD PhD
Rituximab effectively limits the number of relapses in childhood idiopathic nephrotic syndromes (INS) and reduces exposure to corticosteroids and other immunosuppressants. However, few data are available on the risk of relapse after an initial dose of rituximab or the benefit of a maintenance therapy in adults with INS.
{"title":"Response to Rituximab as a Maintenance Therapy in Adult Idiopathic Nephrotic Syndrome: A French Multicenter Cohort Study","authors":"Manuel Laslandes MD, Marine Lorent PhD, Benoit Brilland MD PhD, Hugoline Boulay MD, Léonard Golbin MD, Christelle Barbet MD, Jimmy Grellier MD, Amaury Dujardin MD, David Larmet MD, Angelo Testa MD, Pierre Pfirmann MD, Antoine Thierry MD PhD, Simon Ville MD PhD, Jacques Dantal MD PhD, Christophe Masset MD PhD","doi":"10.1053/j.ajkd.2025.09.021","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.09.021","url":null,"abstract":"Rituximab effectively limits the number of relapses in childhood idiopathic nephrotic syndromes (INS) and reduces exposure to corticosteroids and other immunosuppressants. However, few data are available on the risk of relapse after an initial dose of rituximab or the benefit of a maintenance therapy in adults with INS.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"7 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697284","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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