Pub Date : 2024-07-24DOI: 10.1053/j.ajkd.2024.06.005
Lisa K Stamp, Nicola Dalbeth, David B Mount
{"title":"Yet More Reassurance: Treat-to-Target With Allopurinol or Febuxostat is Safe and Effective in Lowering Serum Urate in People With CKD.","authors":"Lisa K Stamp, Nicola Dalbeth, David B Mount","doi":"10.1053/j.ajkd.2024.06.005","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.06.005","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141750873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-23DOI: 10.1053/j.ajkd.2024.05.007
Michael K Sullivan, Jennifer S Lees, Brenda M Rosales, Rachel Cutting, Melanie L Wyld, Mark Woodward, Angela C Webster, Patrick B Mark, Nicole De La Mata
<p><strong>Rationale & objective: </strong>Females have a higher prevalence of chronic kidney disease (CKD) than males but are less likely to be treated with kidney replacement therapy (KRT). We studied the interaction between sex and the association of cardiometabolic risk factors for the decline in kidney function over time.</p><p><strong>Study design: </strong>A population-based cohort study.</p><p><strong>Setting & participants: </strong>1,127,731 adults living in Wales, United Kingdom, within the Secure Anonymised Information Linkage Databank.</p><p><strong>Exposure: </strong>Sex and risk factors including age, estimated glomerular filtration rate (eGFR), cardiometabolic conditions, smoking, and socioeconomic deprivation. These risk factors were defined using primary care records.</p><p><strong>Outcome: </strong>The yearly declines in eGFR and the risk of incident kidney failure defined as long-term KRT and/or sustained eGFR<15mL/min/1.73m<sup>2</sup>.</p><p><strong>Analytical approach: </strong>Linear mixed effects models and Cox proportional hazards analysis.</p><p><strong>Results: </strong>The average decline in eGFR at age≤73 years was equal in males and females. After age 73 years, eGFR decline was faster in males than females, particularly for males with heart failure (males-1.22mL/min/1.73m<sup>2</sup> per year [95% CI, -1.25 to-1.20] vs females-0.87mL/min/1.73m<sup>2</sup> per year [95% CI, -0.89 to-0.85]) and current smokers (males-1.58mL/min/1.73m<sup>2</sup> per year [95% CI, -1.60 to-1.55] vs females-1.27mL/min/1.73m<sup>2</sup> per year [95% CI, -1.29 to-1.25]). Socioeconomic deprivation was one of the most impactful risk factors on eGFR decline among females aged>73 years, whereas cardiometabolic risk factors were more important among males. Older females at baseline were less likely to develop incident kidney failure than older males (P for age<0.001).</p><p><strong>Limitations: </strong>Study of people who were almost exclusively White and who had blood laboratory test data. Reliance on creatinine-based eGFR. Albuminuria and body mass index data were incomplete.</p><p><strong>Conclusions: </strong>The eGFR decline was faster in males than in females, especially in the setting of heart failure and smoking. Socioeconomic deprivation was an important risk factor associated with eGFR decline, particularly for females. further work is required to explore less well-recognized risk factors, but these findings may inform clinical management strategies of CKD overall and within sex-specific groups.</p><p><strong>Plain-language summary: </strong>Kidney function is known to decline at a faster rate among males than females. This study incorporated blood laboratory test results from the routine care of 1.1 million adults living in the United Kingdom and found that the decline in kidney function associated with risk factors varied by sex. Before and at the age of 73 years, the decline in kidney function was similar between males and femal
{"title":"Sex and the Relationship Between Cardiometabolic Risk Factors and Estimated GFR Decline: A Population-Based Cohort Study.","authors":"Michael K Sullivan, Jennifer S Lees, Brenda M Rosales, Rachel Cutting, Melanie L Wyld, Mark Woodward, Angela C Webster, Patrick B Mark, Nicole De La Mata","doi":"10.1053/j.ajkd.2024.05.007","DOIUrl":"10.1053/j.ajkd.2024.05.007","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Females have a higher prevalence of chronic kidney disease (CKD) than males but are less likely to be treated with kidney replacement therapy (KRT). We studied the interaction between sex and the association of cardiometabolic risk factors for the decline in kidney function over time.</p><p><strong>Study design: </strong>A population-based cohort study.</p><p><strong>Setting & participants: </strong>1,127,731 adults living in Wales, United Kingdom, within the Secure Anonymised Information Linkage Databank.</p><p><strong>Exposure: </strong>Sex and risk factors including age, estimated glomerular filtration rate (eGFR), cardiometabolic conditions, smoking, and socioeconomic deprivation. These risk factors were defined using primary care records.</p><p><strong>Outcome: </strong>The yearly declines in eGFR and the risk of incident kidney failure defined as long-term KRT and/or sustained eGFR<15mL/min/1.73m<sup>2</sup>.</p><p><strong>Analytical approach: </strong>Linear mixed effects models and Cox proportional hazards analysis.</p><p><strong>Results: </strong>The average decline in eGFR at age≤73 years was equal in males and females. After age 73 years, eGFR decline was faster in males than females, particularly for males with heart failure (males-1.22mL/min/1.73m<sup>2</sup> per year [95% CI, -1.25 to-1.20] vs females-0.87mL/min/1.73m<sup>2</sup> per year [95% CI, -0.89 to-0.85]) and current smokers (males-1.58mL/min/1.73m<sup>2</sup> per year [95% CI, -1.60 to-1.55] vs females-1.27mL/min/1.73m<sup>2</sup> per year [95% CI, -1.29 to-1.25]). Socioeconomic deprivation was one of the most impactful risk factors on eGFR decline among females aged>73 years, whereas cardiometabolic risk factors were more important among males. Older females at baseline were less likely to develop incident kidney failure than older males (P for age<0.001).</p><p><strong>Limitations: </strong>Study of people who were almost exclusively White and who had blood laboratory test data. Reliance on creatinine-based eGFR. Albuminuria and body mass index data were incomplete.</p><p><strong>Conclusions: </strong>The eGFR decline was faster in males than in females, especially in the setting of heart failure and smoking. Socioeconomic deprivation was an important risk factor associated with eGFR decline, particularly for females. further work is required to explore less well-recognized risk factors, but these findings may inform clinical management strategies of CKD overall and within sex-specific groups.</p><p><strong>Plain-language summary: </strong>Kidney function is known to decline at a faster rate among males than females. This study incorporated blood laboratory test results from the routine care of 1.1 million adults living in the United Kingdom and found that the decline in kidney function associated with risk factors varied by sex. Before and at the age of 73 years, the decline in kidney function was similar between males and femal","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141756535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-22DOI: 10.1053/j.ajkd.2024.06.003
Charles Ginsberg, Joachim H Ix
{"title":"New Insights into Vitamin D Metabolism in Kidney Disease and Transplant.","authors":"Charles Ginsberg, Joachim H Ix","doi":"10.1053/j.ajkd.2024.06.003","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.06.003","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141750872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-20DOI: 10.1053/j.ajkd.2024.04.009
Resistant hypertension is defined as blood pressure above goal despite confirmed adherence to 3 first-line antihypertensive agents or when blood pressure is controlled with 4 or more medications at maximal or maximally tolerated doses. In addition to meeting these criteria, identifying patients with true resistant hypertension requires both accurate in-office blood pressure measurement as well as excluding white coat effects through out-of-office blood pressure measurements. Patients with resistant hypertension are at higher risk for adverse cardiovascular events and are more likely to have a potentially treatable secondary cause contributing to their hypertension. Effective treatment of resistant hypertension includes ongoing lifestyle modifications and collaboration with patients to detect and address barriers to optimal medication adherence. Pharmacologic treatment should prioritize optimizing first-line, once daily, longer acting medications followed by the stepwise addition of second-, third-, and fourth-line agents as tolerated. Physicians should systematically evaluate for and address any underlying secondary causes. A coordinated, multidisciplinary team approach including clinicians with experience in treating resistant hypertension is essential. New treatment options, including both pharmacologic and device-based therapies, have recently been approved, and more are in the pipeline; their optimal role in the management of resistant hypertension is an area of ongoing research.
{"title":"Evaluation and Management of Resistant Hypertension: Core Curriculum 2024","authors":"","doi":"10.1053/j.ajkd.2024.04.009","DOIUrl":"10.1053/j.ajkd.2024.04.009","url":null,"abstract":"<div><p>Resistant hypertension is defined as blood pressure above goal despite confirmed adherence to 3 first-line antihypertensive agents or when blood pressure is controlled with 4 or more medications at maximal or maximally tolerated doses. In addition to meeting these criteria, identifying patients with true resistant hypertension requires both accurate in-office blood pressure measurement as well as excluding white coat effects through out-of-office blood pressure measurements. Patients with resistant hypertension are at higher risk for adverse cardiovascular events and are more likely to have a potentially treatable secondary cause contributing to their hypertension. Effective treatment of resistant hypertension includes ongoing lifestyle modifications and collaboration with patients to detect and address barriers to optimal medication adherence. Pharmacologic treatment should prioritize optimizing first-line, once daily, longer acting medications followed by the stepwise addition of second-, third-, and fourth-line agents as tolerated. Physicians should systematically evaluate for and address any underlying secondary causes. A coordinated, multidisciplinary team approach including clinicians with experience in treating resistant hypertension is essential. New treatment options, including both pharmacologic and device-based therapies, have recently been approved, and more are in the pipeline; their optimal role in the management of resistant hypertension is an area of ongoing research.</p></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0272638624007935/pdfft?md5=20bb34f3c168434ee3e8f3e3462314a6&pid=1-s2.0-S0272638624007935-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-19DOI: 10.1053/j.ajkd.2024.05.012
Jesse C Ikeme, Rebecca Scherzer, Pranav S Garimella, Stein I Hallan, Ronit Katz, Michelle M Estrella, Joachim H Ix, Michael G Shlipak
{"title":"The Association of Plasma and Urine Uromodulin With Cardiovascular Disease in Persons With Hypertension and CKD.","authors":"Jesse C Ikeme, Rebecca Scherzer, Pranav S Garimella, Stein I Hallan, Ronit Katz, Michelle M Estrella, Joachim H Ix, Michael G Shlipak","doi":"10.1053/j.ajkd.2024.05.012","DOIUrl":"10.1053/j.ajkd.2024.05.012","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-19DOI: 10.1053/j.ajkd.2024.05.009
Samira S Farouk, Anshul Bhalla, Meera Harhay, Laila Lakhani, Luis Sanchez Russo, Scott Sanoff, Manpreet Samra, Matthew A Sparks, Niralee Patel, Fasika Tedla, Anju Yadav, Roslyn B Mannon
{"title":"More Exams, More Problems: Do We Really Need a New Accreditation System for Transplant Nephrology?","authors":"Samira S Farouk, Anshul Bhalla, Meera Harhay, Laila Lakhani, Luis Sanchez Russo, Scott Sanoff, Manpreet Samra, Matthew A Sparks, Niralee Patel, Fasika Tedla, Anju Yadav, Roslyn B Mannon","doi":"10.1053/j.ajkd.2024.05.009","DOIUrl":"10.1053/j.ajkd.2024.05.009","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-19DOI: 10.1053/j.ajkd.2024.05.005
{"title":"Visceral Abdominal Adiposity and Autosomal Dominant Polycystic Kidney Disease Progression: One More Step Toward Identifying Useful Biomarkers and Characterizing the Disease Metabolic Links","authors":"","doi":"10.1053/j.ajkd.2024.05.005","DOIUrl":"10.1053/j.ajkd.2024.05.005","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0272638624008412/pdfft?md5=1a25a4393ec9a0ce70ae8ee2a11bc019&pid=1-s2.0-S0272638624008412-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-19DOI: 10.1053/j.ajkd.2024.05.008
Rachel Shulman, Wei Yang, Debbie L Cohen, Peter P Reese, Jordana B Cohen
<p><strong>Rationale & objective: </strong>The clinical trajectory of normoalbuminuric chronic kidney disease (CKD), particularly in the absence of diabetes, has not yet been well-studied. This study evaluated the association of kidney and cardiovascular outcomes with levels of albuminuria in a cohort of patients with nondiabetic CKD.</p><p><strong>Study design: </strong>Prospective cohort study.</p><p><strong>Setting & participants: </strong>1,463 adults with nondiabetic CKD without known glomerulonephritis and diagnosed with hypertensive nephrosclerosis or unknown cause of CKD participating in the Chronic Renal Insufficiency Cohort (CRIC) Study.</p><p><strong>Exposure: </strong>Albuminuria stage at study entry.</p><p><strong>Outcome: </strong>Primary outcome: Composite kidney (halving of estimated glomerular filtration rate [eGFR], kidney transplantation, or dialysis), Secondary outcomes: (1) eGFR slope, (2) composite cardiovascular disease events (hospitalization for heart failure, myocardial infarction, stroke, or all-cause death), (3) all-cause death.</p><p><strong>Analytical approach: </strong>Linear mixed effects and Cox proportional hazards regression analyses.</p><p><strong>Results: </strong>Lower levels of albuminuria were associated with female sex and older age. For the primary outcome, compared with normoalbuminuria, those with moderate and severe albuminuria had higher rates of kidney outcomes (adjusted hazard ratio [AHR], 3.3 [95% CI, 2.4-4.6], and AHR, 8.6 [95% CI, 6.0-12.0], respectively) and cardiovascular outcomes (AHR, 1.5 [95% CI, 1.2-1.9], and AHR, 1.5 [95% CI, 1.1-2.0], respectively). Those with normoalbuminuria (<30μg/mg; n=863) had a slower decline in eGFR (-0.46mL/min/1.73m<sup>2</sup> per year) compared with those with moderate (30-300μg/mg, n=372; 1.41mL/min/1.73m<sup>2</sup> per year) or severe albuminuria (>300μg/mg, n=274; 2.63mL/min/1.73m<sup>2</sup> per year). In adjusted analyses, kidney outcomes occurred, on average, sooner among those with moderate (8.6 years) and severe (7.3 years) albuminuria compared with those with normoalbuminuria (9.3 years) whereas the average times to cardiovascular outcomes were similar across albuminuria groups (8.2, 8.1, and 8.6 years, respectively).</p><p><strong>Limitations: </strong>Self-report of CKD etiology without confirmatory kidney biopsies; residual confounding.</p><p><strong>Conclusions: </strong>Participants with normoalbuminuric nondiabetic CKD experienced substantially slower CKD progression but only modestly lower cardiovascular risk than those with high levels of albuminuria. These findings inform the design of future studies investigating interventions among individuals with lower levels of albuminuria.</p><p><strong>Plain-language summary: </strong>Diabetes and hypertension are the leading causes of chronic kidney disease (CKD). Urine albumin levels are associated with cardiovascular and kidney disease outcomes among individuals with CKD. However, previous studies o
理由和目标：对于正常白蛋白尿型慢性肾脏病（CKD）的临床轨迹，尤其是在无糖尿病的情况下，尚未进行深入研究。本研究评估了非糖尿病慢性肾脏病患者队列中肾脏和心血管预后与白蛋白尿水平的关系：前瞻性队列研究：参加慢性肾功能不全队列（CRIC）研究的1,463名非糖尿病慢性肾功能不全成人患者，无已知肾小球肾炎，被诊断为高血压肾硬化症或慢性肾功能不全原因不明：研究开始时的白蛋白尿分期：主要结果次要结局：(1) eGFR斜率；(2) 复合心血管疾病事件（因心力衰竭、心肌梗死、中风或全因死亡住院）；(3) 全因死亡：分析方法：线性混合效应和考克斯比例危险回归分析：结果：白蛋白尿水平较低与女性和年龄较大有关。就主要结果而言，与正常白蛋白尿相比，中度和重度白蛋白尿患者的肾脏结果（调整后危险比[aHR]3.3，95% CI 2.4-4.6；aHR 8.6，95% CI 6.0-12.0）和心血管结果（aHR 1.5，95% CI 1.2-1.9；aHR 1.5，95% CI 1.1-2.0）发生率较高。正常白蛋白尿患者（300 毫克/毫克，N=274；2.63 毫升/分钟/1.73 平方米/年）。在调整分析中，与正常白蛋白尿患者（9.3年）相比，中度（8.6年）和重度（7.3年）白蛋白尿患者出现肾脏疾病结果的平均时间更早，而各组白蛋白尿患者出现心血管疾病结果的平均时间相似（分别为8.2年、8.1年和8.6年）：局限性：CKD病因自我报告，未进行肾活检确诊。结论：正常白蛋白尿型非糖尿病慢性肾脏病患者的慢性肾脏病进展速度大大减缓，但心血管风险仅略低于白蛋白尿水平高的患者。这些发现为今后设计针对白蛋白尿水平较低人群的干预研究提供了参考。
{"title":"Cardiovascular and Kidney Outcomes of Non-Diabetic CKD by Albuminuria Severity: Findings From the CRIC Study.","authors":"Rachel Shulman, Wei Yang, Debbie L Cohen, Peter P Reese, Jordana B Cohen","doi":"10.1053/j.ajkd.2024.05.008","DOIUrl":"10.1053/j.ajkd.2024.05.008","url":null,"abstract":"<p><strong>Rationale & objective: </strong>The clinical trajectory of normoalbuminuric chronic kidney disease (CKD), particularly in the absence of diabetes, has not yet been well-studied. This study evaluated the association of kidney and cardiovascular outcomes with levels of albuminuria in a cohort of patients with nondiabetic CKD.</p><p><strong>Study design: </strong>Prospective cohort study.</p><p><strong>Setting & participants: </strong>1,463 adults with nondiabetic CKD without known glomerulonephritis and diagnosed with hypertensive nephrosclerosis or unknown cause of CKD participating in the Chronic Renal Insufficiency Cohort (CRIC) Study.</p><p><strong>Exposure: </strong>Albuminuria stage at study entry.</p><p><strong>Outcome: </strong>Primary outcome: Composite kidney (halving of estimated glomerular filtration rate [eGFR], kidney transplantation, or dialysis), Secondary outcomes: (1) eGFR slope, (2) composite cardiovascular disease events (hospitalization for heart failure, myocardial infarction, stroke, or all-cause death), (3) all-cause death.</p><p><strong>Analytical approach: </strong>Linear mixed effects and Cox proportional hazards regression analyses.</p><p><strong>Results: </strong>Lower levels of albuminuria were associated with female sex and older age. For the primary outcome, compared with normoalbuminuria, those with moderate and severe albuminuria had higher rates of kidney outcomes (adjusted hazard ratio [AHR], 3.3 [95% CI, 2.4-4.6], and AHR, 8.6 [95% CI, 6.0-12.0], respectively) and cardiovascular outcomes (AHR, 1.5 [95% CI, 1.2-1.9], and AHR, 1.5 [95% CI, 1.1-2.0], respectively). Those with normoalbuminuria (<30μg/mg; n=863) had a slower decline in eGFR (-0.46mL/min/1.73m<sup>2</sup> per year) compared with those with moderate (30-300μg/mg, n=372; 1.41mL/min/1.73m<sup>2</sup> per year) or severe albuminuria (>300μg/mg, n=274; 2.63mL/min/1.73m<sup>2</sup> per year). In adjusted analyses, kidney outcomes occurred, on average, sooner among those with moderate (8.6 years) and severe (7.3 years) albuminuria compared with those with normoalbuminuria (9.3 years) whereas the average times to cardiovascular outcomes were similar across albuminuria groups (8.2, 8.1, and 8.6 years, respectively).</p><p><strong>Limitations: </strong>Self-report of CKD etiology without confirmatory kidney biopsies; residual confounding.</p><p><strong>Conclusions: </strong>Participants with normoalbuminuric nondiabetic CKD experienced substantially slower CKD progression but only modestly lower cardiovascular risk than those with high levels of albuminuria. These findings inform the design of future studies investigating interventions among individuals with lower levels of albuminuria.</p><p><strong>Plain-language summary: </strong>Diabetes and hypertension are the leading causes of chronic kidney disease (CKD). Urine albumin levels are associated with cardiovascular and kidney disease outcomes among individuals with CKD. However, previous studies o","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-19DOI: 10.1053/j.ajkd.2024.05.010
Nora Franceschini, David L Feldman, Jonathan S Berg, Whitney Besse, Alexander R Chang, Neera K Dahl, Rasheed Gbadegesin, Martin R Pollak, Hila Milo Rasouly, Richard J H Smith, Cheryl A Winkler, Ali Gharavi
About 37 million people in the United States have chronic kidney disease, a disease that encompasses diseases of multiple causes. About 10% or more of kidney diseases in adults and about 70% of selected chronic kidney diseases in children are expected to be explained by genetic causes. Despite the advances in genetic testing and an increasing understanding of the genetic bases of certain kidney diseases, genetic testing in nephrology lags behind other medical fields. More understanding of the benefits and logistics of genetic testing is needed to advance the implementation of genetic testing in chronic kidney diseases. Accordingly, the National Kidney Foundation convened a Working Group of experts with diverse expertise in genetics, nephrology, and allied fields to develop recommendations for genetic testing for monogenic disorders and to identify genetic risk factors for oligogenic and polygenic causes of kidney diseases. Algorithms for clinical decision making on genetic testing and a road map for advancing genetic testing in kidney diseases were generated. An important aspect of this initiative was the use of a modified Delphi process to reach group consensus on the recommendations. The recommendations and resources described herein provide support to nephrologists and allied health professionals to advance the use of genetic testing for diagnosis and screening of kidney diseases.
{"title":"Advancing Genetic Testing in Kidney Diseases: Report From a National Kidney Foundation Working Group.","authors":"Nora Franceschini, David L Feldman, Jonathan S Berg, Whitney Besse, Alexander R Chang, Neera K Dahl, Rasheed Gbadegesin, Martin R Pollak, Hila Milo Rasouly, Richard J H Smith, Cheryl A Winkler, Ali Gharavi","doi":"10.1053/j.ajkd.2024.05.010","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.05.010","url":null,"abstract":"<p><p>About 37 million people in the United States have chronic kidney disease, a disease that encompasses diseases of multiple causes. About 10% or more of kidney diseases in adults and about 70% of selected chronic kidney diseases in children are expected to be explained by genetic causes. Despite the advances in genetic testing and an increasing understanding of the genetic bases of certain kidney diseases, genetic testing in nephrology lags behind other medical fields. More understanding of the benefits and logistics of genetic testing is needed to advance the implementation of genetic testing in chronic kidney diseases. Accordingly, the National Kidney Foundation convened a Working Group of experts with diverse expertise in genetics, nephrology, and allied fields to develop recommendations for genetic testing for monogenic disorders and to identify genetic risk factors for oligogenic and polygenic causes of kidney diseases. Algorithms for clinical decision making on genetic testing and a road map for advancing genetic testing in kidney diseases were generated. An important aspect of this initiative was the use of a modified Delphi process to reach group consensus on the recommendations. The recommendations and resources described herein provide support to nephrologists and allied health professionals to advance the use of genetic testing for diagnosis and screening of kidney diseases.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-17DOI: 10.1053/j.ajkd.2024.06.004
{"title":"The Impact of Obesity on Glomerular Diseases Remains to be Determined","authors":"","doi":"10.1053/j.ajkd.2024.06.004","DOIUrl":"10.1053/j.ajkd.2024.06.004","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0272638624008424/pdfft?md5=c6bd296b2dc76816268a052dcb34977b&pid=1-s2.0-S0272638624008424-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141632395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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