Pub Date : 2026-03-01Epub Date: 2026-02-19DOI: 10.1053/j.ajkd.2026.01.001
Janaina A.M. Ramalho , Maria Julia C.L.N. Araujo , Rosa M.A. Moysés
{"title":"Post-Transplant Bone Loss: How Muscles, Parathormone, and Steroids Come Into Play","authors":"Janaina A.M. Ramalho , Maria Julia C.L.N. Araujo , Rosa M.A. Moysés","doi":"10.1053/j.ajkd.2026.01.001","DOIUrl":"10.1053/j.ajkd.2026.01.001","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 3","pages":"Pages 287-291"},"PeriodicalIF":8.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146776039","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: 2025-10-14DOI: 10.1053/j.ajkd.2025.09.004
Dha Woon Im , Jiyun Jung , Miso Ha , Yon Su Kim , Kwon Wook Joo , Kook-Hwan Oh , Dong Ki Kim , Hajeong Lee , Seung Seok Han , Eunjeong Kang , Sehoon Park , Sung Joon Shin , Jangwook Lee , Jeongin Song , Yun Kyu Oh , Hayne Cho Park , Curie Ahn , Kyu-Beck Lee , Yeong Hoon Kim , Seungyeup Han , Yong Chul Kim
<div><h3>Rationale & Objective</h3><div>Low muscle mass is a risk factor for chronic kidney disease. In this study, we examined the relationship between muscle mass and mortality, as well as end-stage kidney disease (ESKD), in patients with autosomal-dominant polycystic kidney disease (ADPKD).</div></div><div><h3>Study Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>1,443 patients with ADPKD from eight tertiary-care hospitals in South Korea between 2006 and 2020.</div></div><div><h3>Exposures</h3><div>Computed tomography images were obtained at the third lumbar vertebra to measure the skeletal muscle area (SMA) using an artificial intelligence system. SMA indexed for the square of height (height<sup>2</sup>) was classified as low-attenuation muscle area (LAMA) or normal-attenuation muscle area (NAMA) based on muscle quality.</div></div><div><h3>Outcomes</h3><div>All-cause mortality and ESKD.</div></div><div><h3>Analytical Approach</h3><div>Cox proportional hazards regression, adjusted for sex, age, creatinine, glucose, and height-adjusted total kidney volume, was used to investigate the associations of muscle indices with all-cause mortality and ESKD. Subgroup analyses were conducted based on body mass index categories: low or normal (<25 kg/m<sup>2</sup>) and overweight or obese (≥25 kg/m<sup>2</sup>).</div></div><div><h3>Results</h3><div>The study population included more than half female patients, and the mean estimated glomerular filtration rate was 68.4 mL/min/1.73 m<sup>2</sup>. Mean follow-up was 5.14 years. Greater SMA/height<sup>2</sup> and NAMA/height<sup>2</sup> ratios were associated with a lower risk of mortality (HRs, 0.58 [95% CI, 0.39-0.88] and 0.55 [0.39-0.79], respectively). Greater NAMA/height<sup>2</sup> ratio was associated with a 26% lower ESKD incidence (HR, 0.74; 95% CI, 0.59-0.92), but a greater LAMA/height<sup>2</sup> ratio was associated with a higher ESKD incidence (HR 1.18, 95% CI 1.01-1.37). A higher NAMA/LAMA ratio was associated with a lower ESKD incidence (HR, 0.74; 95% CI, 0.60-0.92). Greater muscle mass was associated with a lower risk of mortality among overweight individuals and a lower risk of ESKD in underweight individuals.</div></div><div><h3>Limitations</h3><div>Lack of details about muscle strength and performance.</div></div><div><h3>Conclusions</h3><div>Among individuals with ADPKD, greater and higher-quality muscle mass were associated with lower risks of mortality and progression of chronic kidney disease to ESKD.</div></div><div><h3>Plain-Language Summary</h3><div>Low muscle mass is a known health concern, and we aimed to study its impact specifically in patients with autosomal-dominant polycystic kidney disease (ADPKD). We investigated how muscle mass relates to patient survival and progression to end-stage kidney disease. Using computed tomography scans performed on more than 1,400 patients with ADPKD, we measured the amount and quality of
理由与目的低肌肉质量是慢性肾脏疾病的危险因素。在这项研究中，我们研究了常染色体显性多囊肾病（ADPKD）患者的肌肉质量与死亡率以及终末期肾病（ESKD）之间的关系。研究设计回顾性队列研究。环境与参与者：2006年至2020年间，韩国8家三级医院的1443例ADPKD患者。在第三腰椎处获取计算机断层图像，使用人工智能系统测量骨骼肌面积（SMA）。SMA根据肌肉质量分为低衰减肌区（LAMA）和正常衰减肌区（NAMA）。结果：全因死亡率和ESKD。分析方法：采用cox比例风险回归，校正性别、年龄、肌酐、血糖和身高调整后的总肾体积，研究肌肉指标与全因死亡率和ESKD的关系。根据体重指数分类进行亚组分析：低或正常（<25 kg/m2）和超重或肥胖（≥25 kg/m2）。结果研究人群中女性患者占一半以上，肾小球滤过率平均估计为68.4 ml/min/1.73m2。平均随访5.14年。较高的SMA/height2和NAMA/height2与较低的死亡风险相关（hr分别为0.58 （95% CI 0.39-0.88）和0.55 (95% CI, 0.39-0.79)）。较高的NAMA/height2与ESKD发生率降低26%相关(0.74(0.59,0.92)，但较高的LAMA/height2与较低的ESKD发生率相关（HR 1.18, 95% CI 1.01-1.37）。较高的NAMA/LAMA比值与较低的ESKD发生率相关（HR 0.74, 95% CI 0.60-0.92）。在超重人群中，更大的肌肉质量与更低的死亡风险相关，在体重不足人群中，更低的ESKD风险相关。限制：缺乏肌肉力量和表现的细节。结论：在ADPKD患者中，更大和更高质量的肌肉质量与较低的死亡率和CKD向ESKD进展的风险相关。
{"title":"Associations of Skeletal Muscle Mass and Body Mass Index With Clinical Outcomes in Autosomal-Dominant Polycystic Kidney Disease: An Observational Study","authors":"Dha Woon Im , Jiyun Jung , Miso Ha , Yon Su Kim , Kwon Wook Joo , Kook-Hwan Oh , Dong Ki Kim , Hajeong Lee , Seung Seok Han , Eunjeong Kang , Sehoon Park , Sung Joon Shin , Jangwook Lee , Jeongin Song , Yun Kyu Oh , Hayne Cho Park , Curie Ahn , Kyu-Beck Lee , Yeong Hoon Kim , Seungyeup Han , Yong Chul Kim","doi":"10.1053/j.ajkd.2025.09.004","DOIUrl":"10.1053/j.ajkd.2025.09.004","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Low muscle mass is a risk factor for chronic kidney disease. In this study, we examined the relationship between muscle mass and mortality, as well as end-stage kidney disease (ESKD), in patients with autosomal-dominant polycystic kidney disease (ADPKD).</div></div><div><h3>Study Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>1,443 patients with ADPKD from eight tertiary-care hospitals in South Korea between 2006 and 2020.</div></div><div><h3>Exposures</h3><div>Computed tomography images were obtained at the third lumbar vertebra to measure the skeletal muscle area (SMA) using an artificial intelligence system. SMA indexed for the square of height (height<sup>2</sup>) was classified as low-attenuation muscle area (LAMA) or normal-attenuation muscle area (NAMA) based on muscle quality.</div></div><div><h3>Outcomes</h3><div>All-cause mortality and ESKD.</div></div><div><h3>Analytical Approach</h3><div>Cox proportional hazards regression, adjusted for sex, age, creatinine, glucose, and height-adjusted total kidney volume, was used to investigate the associations of muscle indices with all-cause mortality and ESKD. Subgroup analyses were conducted based on body mass index categories: low or normal (<25 kg/m<sup>2</sup>) and overweight or obese (≥25 kg/m<sup>2</sup>).</div></div><div><h3>Results</h3><div>The study population included more than half female patients, and the mean estimated glomerular filtration rate was 68.4 mL/min/1.73 m<sup>2</sup>. Mean follow-up was 5.14 years. Greater SMA/height<sup>2</sup> and NAMA/height<sup>2</sup> ratios were associated with a lower risk of mortality (HRs, 0.58 [95% CI, 0.39-0.88] and 0.55 [0.39-0.79], respectively). Greater NAMA/height<sup>2</sup> ratio was associated with a 26% lower ESKD incidence (HR, 0.74; 95% CI, 0.59-0.92), but a greater LAMA/height<sup>2</sup> ratio was associated with a higher ESKD incidence (HR 1.18, 95% CI 1.01-1.37). A higher NAMA/LAMA ratio was associated with a lower ESKD incidence (HR, 0.74; 95% CI, 0.60-0.92). Greater muscle mass was associated with a lower risk of mortality among overweight individuals and a lower risk of ESKD in underweight individuals.</div></div><div><h3>Limitations</h3><div>Lack of details about muscle strength and performance.</div></div><div><h3>Conclusions</h3><div>Among individuals with ADPKD, greater and higher-quality muscle mass were associated with lower risks of mortality and progression of chronic kidney disease to ESKD.</div></div><div><h3>Plain-Language Summary</h3><div>Low muscle mass is a known health concern, and we aimed to study its impact specifically in patients with autosomal-dominant polycystic kidney disease (ADPKD). We investigated how muscle mass relates to patient survival and progression to end-stage kidney disease. Using computed tomography scans performed on more than 1,400 patients with ADPKD, we measured the amount and quality of","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 3","pages":"Pages 334-344"},"PeriodicalIF":8.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145305649","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.2025.08.016
Niraj B. Desai , Casey Gashti , William L. Whittier
Systemic lupus erythematosus (SLE) is a chronic, multiorgan autoimmune disease, with lupus nephritis (LN) affecting up to 60% of patients. Early diagnosis and treatment are critical for preserving kidney function. Advances in understanding the immunopathogenesis of LN are driving the development of personalized treatment strategies that hold promise for transforming disease management through interventions targeting distinct immunologic and histopathologic features. In this review, we discuss current and emerging therapies for proliferative and membranous LN with a focus on strategies targeting underlying mechanisms of disease in LN. Glucocorticoids with cytotoxic agents or mycophenolate mofetil (MMF) remain the standard of care, but newer therapies targeting B cells (eg, belimumab and obinutuzumab) and T cells (eg, voclosporin) have proven efficacy as add-on treatments. Novel therapies such as complement and cytokine inhibitors are being evaluated in preclinical and clinical trials. Although maintenance therapy with MMF remains the standard, the distinction between sequential induction and maintenance therapy has become increasingly blurred, and new strategies to reduce long-term disease and pharmacologic toxicity to improve remission and relapse rates are emerging.
{"title":"“A Change Is Gonna Come” to Treatment of Lupus Nephritis: A Review","authors":"Niraj B. Desai , Casey Gashti , William L. Whittier","doi":"10.1053/j.ajkd.2025.08.016","DOIUrl":"10.1053/j.ajkd.2025.08.016","url":null,"abstract":"<div><div>Systemic lupus erythematosus (SLE) is a chronic, multiorgan autoimmune disease, with lupus nephritis (LN) affecting up to 60% of patients. Early diagnosis and treatment are critical for preserving kidney function. Advances in understanding the immunopathogenesis of LN are driving the development of personalized treatment strategies that hold promise for transforming disease management through interventions targeting distinct immunologic and histopathologic features. In this review, we discuss current and emerging therapies for proliferative and membranous LN with a focus on strategies targeting underlying mechanisms of disease in LN. Glucocorticoids with cytotoxic agents or mycophenolate mofetil (MMF) remain the standard of care, but newer therapies targeting B cells (eg, belimumab and obinutuzumab) and T cells (eg, voclosporin) have proven efficacy as add-on treatments. Novel therapies such as complement and cytokine inhibitors are being evaluated in preclinical and clinical trials. Although maintenance therapy with MMF remains the standard, the distinction between sequential induction and maintenance therapy has become increasingly blurred, and new strategies to reduce long-term disease and pharmacologic toxicity to improve remission and relapse rates are emerging.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 3","pages":"Pages 422-432"},"PeriodicalIF":8.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145516263","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: 2025-11-13DOI: 10.1053/j.ajkd.2025.09.011
Ao Zhang , Anita van Zwieten , Anastasia Hughes , Siah Kim , Kelly Lambert , Luca G. Torrisi , Allison Jaure , Chandana Guha
<div><h3>Rationale & Objective</h3><div>Children with chronic kidney disease (CKD) and their families encounter many difficulties adjusting to diet and fluid restrictions, which can reduce adherence to dietary recommendations. This study describes the perspectives and experiences of children with CKD and their caregivers regarding dietary intake.</div></div><div><h3>Study Design</h3><div>Systematic review and thematic synthesis of qualitative studies.</div></div><div><h3>Setting & Participants</h3><div>Children and adolescents with any stage of CKD and their caregivers.</div></div><div><h3>Selection Criteria for Studies</h3><div>MEDLINE, Embase, PsycINFO, and CINAHL were searched from inception to July 2024. These databases were chosen because they cover biomedical, clinical, and qualitative research relevant to pediatric CKD and nutrition.</div></div><div><h3>Data Extraction</h3><div>All text from the results/conclusion of the primary studies.</div></div><div><h3>Analytical Approach</h3><div>Thematic synthesis.</div></div><div><h3>Results</h3><div>We included 70 studies involving 1,941 participants from 21 countries. We identified 5 themes: (1) frustrated by unpalatable food (unfulfilled by unappetizing meals, uninterested in food due to altered perception of taste, loss of control over food choices), (2) deprived by restrictions (breaking rules out of desperation, constant craving for forbidden food, limiting life participation, parental distress and relational strain from enforcing dietary restrictions), (3) compounding the burden of caregiving and clinical management (overwhelmed by food preparation and dietary demands, financial cost of adhering to special dietary needs), (4) agency in dietary decision making (strengthening nutritional literacy, autonomy in decision making about diet, regaining dietary freedom after transplant), and (5) controlling diet for health (motivated to stay well, instilling coping strategies for dietary adherence).</div></div><div><h3>Limitations</h3><div>Several included studies did not specify patients’ CKD stages.</div></div><div><h3>Conclusions</h3><div>Children with CKD face dietary challenges leading to frustration, cravings, and occasional dietary nonadherence. These restrictions impact social interactions and daily routines. Strategies that improve nutrition literacy may enhance self-efficacy and social connectedness and facilitate better adherence to dietary recommendations.</div></div><div><h3>Plain-Language Summary</h3><div>Children with chronic kidney disease (CKD) face significant challenges in following dietary and fluid restrictions, which often affect their daily lives and social interactions. This study examines how children with CKD and their caregivers feel about these restrictions. We reviewed 70 studies to gather the perspectives of patients and caregivers on their dietary experiences. We found that many children felt frustrated by bland foods, and their caregivers often struggled with e
{"title":"Patient and Caregiver Perspectives on Diet and Nutrition for Children With CKD: A Systematic Review of Qualitative Studies","authors":"Ao Zhang , Anita van Zwieten , Anastasia Hughes , Siah Kim , Kelly Lambert , Luca G. Torrisi , Allison Jaure , Chandana Guha","doi":"10.1053/j.ajkd.2025.09.011","DOIUrl":"10.1053/j.ajkd.2025.09.011","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Children with chronic kidney disease (CKD) and their families encounter many difficulties adjusting to diet and fluid restrictions, which can reduce adherence to dietary recommendations. This study describes the perspectives and experiences of children with CKD and their caregivers regarding dietary intake.</div></div><div><h3>Study Design</h3><div>Systematic review and thematic synthesis of qualitative studies.</div></div><div><h3>Setting & Participants</h3><div>Children and adolescents with any stage of CKD and their caregivers.</div></div><div><h3>Selection Criteria for Studies</h3><div>MEDLINE, Embase, PsycINFO, and CINAHL were searched from inception to July 2024. These databases were chosen because they cover biomedical, clinical, and qualitative research relevant to pediatric CKD and nutrition.</div></div><div><h3>Data Extraction</h3><div>All text from the results/conclusion of the primary studies.</div></div><div><h3>Analytical Approach</h3><div>Thematic synthesis.</div></div><div><h3>Results</h3><div>We included 70 studies involving 1,941 participants from 21 countries. We identified 5 themes: (1) frustrated by unpalatable food (unfulfilled by unappetizing meals, uninterested in food due to altered perception of taste, loss of control over food choices), (2) deprived by restrictions (breaking rules out of desperation, constant craving for forbidden food, limiting life participation, parental distress and relational strain from enforcing dietary restrictions), (3) compounding the burden of caregiving and clinical management (overwhelmed by food preparation and dietary demands, financial cost of adhering to special dietary needs), (4) agency in dietary decision making (strengthening nutritional literacy, autonomy in decision making about diet, regaining dietary freedom after transplant), and (5) controlling diet for health (motivated to stay well, instilling coping strategies for dietary adherence).</div></div><div><h3>Limitations</h3><div>Several included studies did not specify patients’ CKD stages.</div></div><div><h3>Conclusions</h3><div>Children with CKD face dietary challenges leading to frustration, cravings, and occasional dietary nonadherence. These restrictions impact social interactions and daily routines. Strategies that improve nutrition literacy may enhance self-efficacy and social connectedness and facilitate better adherence to dietary recommendations.</div></div><div><h3>Plain-Language Summary</h3><div>Children with chronic kidney disease (CKD) face significant challenges in following dietary and fluid restrictions, which often affect their daily lives and social interactions. This study examines how children with CKD and their caregivers feel about these restrictions. We reviewed 70 studies to gather the perspectives of patients and caregivers on their dietary experiences. We found that many children felt frustrated by bland foods, and their caregivers often struggled with e","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 3","pages":"Pages 345-363.e1"},"PeriodicalIF":8.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145516266","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: 2025-12-06DOI: 10.1053/j.ajkd.2025.09.019
Waleed Zafar , Yirui Hu , Lauren Brubaker , Nathaniel Harshaw , Jamie Green , Alexander R. Chang
<div><h3>Rationale & Objective</h3><div>Early detection of albuminuria can enable administration of therapeutic interventions that improve clinical outcomes in patients at elevated risk for chronic kidney disease (CKD). We investigated the impact of smartphone-enabled home urinary albumin-creatinine ratio (UACR) testing on albuminuria screening and clinical management of these patients.</div></div><div><h3>Study Design</h3><div>Nonrandomized clinical trial.</div></div><div><h3>Setting & Participants</h3><div>Active intervention group comprised 3,998 randomly selected adults (50% with hypertension but no diabetes; 50% with diabetes) receiving primary care at a large, regional health system compared with 3,998 propensity score–matched controls who were receiving usual care.</div></div><div><h3>Interventions</h3><div>Minuteful Kidney, a smartphone-enabled home UACR test kit cleared by the US Food and Drug Administration.</div></div><div><h3>Outcome</h3><div>The primary outcome was completion of UACR testing (either laboratory-based or home testing) within 100 days of program start.</div></div><div><h3>Analytical Approach</h3><div>Covariate balance between matched groups was evaluated using the standardized mean difference (SMD). Outcomes were compared between the 2 matched groups using McNemar’s test.</div></div><div><h3>Results</h3><div>Overall, completion of any UACR test was higher in the intervention program than in the control group for the hypertension subgroup (53% vs 13%) and the diabetes subgroup (53% vs 30%). Greater UACR testing with Minuteful Kidney was consistent across age, sex, race, and ethnicity subgroups, though lower in nonusers of the patient portal. The Minuteful Kidney UACR results were abnormal (≥30 mg/g) in 38% (330 of 872) in the hypertension subgroup and in 45% (306 of 682) in the diabetes subgroup. Among the Minuteful Kidney–tested individuals, those with abnormal UACR were more likely to have follow-up primary care and nephrology visits and new prescriptions of renin-angiotensin-aldosterone system inhibitors than those with normal UACR.</div></div><div><h3>Limitations</h3><div>Despite random assignment to intervention, this was not a randomized study; intervention was limited to 1 large rural health system; use of glucagon-like peptide-1 receptor agonists in CKD was not assessed.</div></div><div><h3>Conclusions</h3><div>A convenient smartphone-enabled home albuminuria test is effective in increasing albuminuria screening among high-risk individuals.</div></div><div><h3>Plain Language Summary</h3><div>This study evaluated whether a smartphone-enabled home albuminuria test could improve chronic kidney disease (CKD) screening among adults with hypertension or diabetes. We found that home testing increased albuminuria test completion 2.5-fold in the intervention group compared with the control group (53% vs 21%). The impact was larger in the hypertension-only subgroup (53% vs 13%) than in the diabetes subgroup (53% vs
{"title":"Impact of Smartphone-Enabled Home Urinary Albumin-Creatinine Ratio Testing on Albuminuria Screening and Management","authors":"Waleed Zafar , Yirui Hu , Lauren Brubaker , Nathaniel Harshaw , Jamie Green , Alexander R. Chang","doi":"10.1053/j.ajkd.2025.09.019","DOIUrl":"10.1053/j.ajkd.2025.09.019","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Early detection of albuminuria can enable administration of therapeutic interventions that improve clinical outcomes in patients at elevated risk for chronic kidney disease (CKD). We investigated the impact of smartphone-enabled home urinary albumin-creatinine ratio (UACR) testing on albuminuria screening and clinical management of these patients.</div></div><div><h3>Study Design</h3><div>Nonrandomized clinical trial.</div></div><div><h3>Setting & Participants</h3><div>Active intervention group comprised 3,998 randomly selected adults (50% with hypertension but no diabetes; 50% with diabetes) receiving primary care at a large, regional health system compared with 3,998 propensity score–matched controls who were receiving usual care.</div></div><div><h3>Interventions</h3><div>Minuteful Kidney, a smartphone-enabled home UACR test kit cleared by the US Food and Drug Administration.</div></div><div><h3>Outcome</h3><div>The primary outcome was completion of UACR testing (either laboratory-based or home testing) within 100 days of program start.</div></div><div><h3>Analytical Approach</h3><div>Covariate balance between matched groups was evaluated using the standardized mean difference (SMD). Outcomes were compared between the 2 matched groups using McNemar’s test.</div></div><div><h3>Results</h3><div>Overall, completion of any UACR test was higher in the intervention program than in the control group for the hypertension subgroup (53% vs 13%) and the diabetes subgroup (53% vs 30%). Greater UACR testing with Minuteful Kidney was consistent across age, sex, race, and ethnicity subgroups, though lower in nonusers of the patient portal. The Minuteful Kidney UACR results were abnormal (≥30 mg/g) in 38% (330 of 872) in the hypertension subgroup and in 45% (306 of 682) in the diabetes subgroup. Among the Minuteful Kidney–tested individuals, those with abnormal UACR were more likely to have follow-up primary care and nephrology visits and new prescriptions of renin-angiotensin-aldosterone system inhibitors than those with normal UACR.</div></div><div><h3>Limitations</h3><div>Despite random assignment to intervention, this was not a randomized study; intervention was limited to 1 large rural health system; use of glucagon-like peptide-1 receptor agonists in CKD was not assessed.</div></div><div><h3>Conclusions</h3><div>A convenient smartphone-enabled home albuminuria test is effective in increasing albuminuria screening among high-risk individuals.</div></div><div><h3>Plain Language Summary</h3><div>This study evaluated whether a smartphone-enabled home albuminuria test could improve chronic kidney disease (CKD) screening among adults with hypertension or diabetes. We found that home testing increased albuminuria test completion 2.5-fold in the intervention group compared with the control group (53% vs 21%). The impact was larger in the hypertension-only subgroup (53% vs 13%) than in the diabetes subgroup (53% vs","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 3","pages":"Pages 324-333.e1"},"PeriodicalIF":8.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697285","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: 2025-12-23DOI: 10.1053/j.ajkd.2025.11.004
Michelle M. Estrella
{"title":"Sex Hormones and Effects on Kidney Health: Piecing Together the Science","authors":"Michelle M. Estrella","doi":"10.1053/j.ajkd.2025.11.004","DOIUrl":"10.1053/j.ajkd.2025.11.004","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 3","pages":"Pages 443-446"},"PeriodicalIF":8.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145830320","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.2025.09.024
Joanna Q. Hudson , Alex R. Chang , Amanda J. Condon Martinez , Rebecca Maxson , Calvin J. Meaney , Wendy L. St. Peter
Comprehensive medication management (CMM) is the standard of care that ensures that medications are individually assessed to determine that each medication is appropriate, effective for the medical condition, safe given the patient’s comorbidities and other medications, and able to be taken by the patient as intended. CMM helps improve all aspects of health care quality and is essential for individuals with chronic kidney disease. It specifically addresses the complexity of medication regimens in patients with multiple comorbid conditions that often lead to medication therapy problems. The provision of CMM is best optimized with a multidisciplinary team that includes a pharmacist. The importance of interprofessional and multidisciplinary practice in the care of individuals with kidney disease has been emphasized by nephrology organizations and within chronic kidney disease–related guidelines. The shift toward pay for performance and value-based care models within nephrology has created more opportunities for pharmacist integration into care teams. Other health care providers should view the inclusion of pharmacists in the kidney care team as a valuable opportunity to enhance patient support, reduce work-related stress, and improve outcomes through collaborative teamwork. The Advancing Kidney Health through Optimal Medication Management initiative supports the involvement of pharmacists across practices and health care systems to ensure the successful implementation of CMM for individuals with kidney disease.
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Pub Date : 2026-03-01Epub Date: 2025-12-04DOI: 10.1053/j.ajkd.2025.10.009
Wolfgang C. Winkelmayer , Kevin F. Erickson , Pascale Khairallah , Mingyue He , Maria E. Montez-Rath , Tara I. Chang , Jingbo Niu
<div><h3>Rationale & Objective</h3><div>Atrial fibrillation (AF) is common among patients with kidney failure treated with hemodialysis. We studied the outcomes of apixaban initiation compared with no initiation of any oral anticoagulation among patients with hemodialysis-treated kidney failure and newly diagnosed AF.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>Medicare-insured patients with hemodialysis-treated kidney failure with newly diagnosed AF and without recent oral anticoagulant (OAC) use (2014-2019).</div></div><div><h3>Exposure</h3><div>Initiation of apixaban treatment versus no OAC initiation within 30 days of an AF diagnosis.</div></div><div><h3>Outcomes</h3><div>Thromboembolic and bleeding events and death within 365 days of follow-up.</div></div><div><h3>Analytical Approach</h3><div>Propensity-matched comparison of new apixaban users and OAC nonusers implemented using Cox proportional hazards models while accounting for competing risks.</div></div><div><h3>Results</h3><div>Within 30 days of the new diagnosis of AF among 63,300 previously OAC-naïve patients, 4,010 initiated apixaban and 59,290 did not initiate any OAC. After propensity matching, 3,985 apixaban users were well matched to 3,985 OAC nonusers on all measured characteristics. Median CHA<sub>2</sub>DS<sub>2</sub>-VASc, a multidimensional stroke risk score, was 4 (interquartile range [IQR], 3-5). Apixaban was initiated a median of 5 (IQR, 2-12) days after AF and used for a median of 59 (IQR, 37-135) days. In intention-to-treat analyses, rates of ischemic stroke were 25% lower (HR, 0.75; 95% CI, 0.57–0.97) and those of a composite outcome of thromboembolic events and cardiovascular death were 24% lower (HR, 0.76; 95% CI, 0.70-0.83) among apixaban users. Conversely, apixaban users had a 55% higher rate of hemorrhagic stroke (HR, 1.55; 95% CI, 1.03-2.33) and a 29% increased rate of clinically important bleeding (HR, 1.29; 95% CI, 1.14-1.45). The HR for all-cause mortality was 0.61 (95% CI, 0.56-0.67). Results from as-treated analyses were qualitatively consistent with intent-to-treat analyses but generally larger in magnitude.</div></div><div><h3>Limitations</h3><div>Potential for residual confounding from unobserved characteristics or informative censoring unaccounted for by competing risk models.</div></div><div><h3>Conclusions</h3><div>Among patients with hemodialysis-treated kidney failure, compared with no anticoagulation, initiation of apixaban soon after newly diagnosed AF was associated with lower risks of ischemic stroke, a composite thromboembolic end point, and all-cause mortality but higher rates of clinically meaningful bleeding.</div></div><div><h3>Plain-Language Summary</h3><div>In this study of existing data of patients with kidney failure receiving dialysis who were newly diagnosed with atrial fibrillation, the most common heart rhythm disorder, we found that initiating a ne
{"title":"Effectiveness and Safety of Apixaban Initiation Following Newly-Diagnosed Atrial Fibrillation in Patients With Kidney Failure on Hemodialysis","authors":"Wolfgang C. Winkelmayer , Kevin F. Erickson , Pascale Khairallah , Mingyue He , Maria E. Montez-Rath , Tara I. Chang , Jingbo Niu","doi":"10.1053/j.ajkd.2025.10.009","DOIUrl":"10.1053/j.ajkd.2025.10.009","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Atrial fibrillation (AF) is common among patients with kidney failure treated with hemodialysis. We studied the outcomes of apixaban initiation compared with no initiation of any oral anticoagulation among patients with hemodialysis-treated kidney failure and newly diagnosed AF.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>Medicare-insured patients with hemodialysis-treated kidney failure with newly diagnosed AF and without recent oral anticoagulant (OAC) use (2014-2019).</div></div><div><h3>Exposure</h3><div>Initiation of apixaban treatment versus no OAC initiation within 30 days of an AF diagnosis.</div></div><div><h3>Outcomes</h3><div>Thromboembolic and bleeding events and death within 365 days of follow-up.</div></div><div><h3>Analytical Approach</h3><div>Propensity-matched comparison of new apixaban users and OAC nonusers implemented using Cox proportional hazards models while accounting for competing risks.</div></div><div><h3>Results</h3><div>Within 30 days of the new diagnosis of AF among 63,300 previously OAC-naïve patients, 4,010 initiated apixaban and 59,290 did not initiate any OAC. After propensity matching, 3,985 apixaban users were well matched to 3,985 OAC nonusers on all measured characteristics. Median CHA<sub>2</sub>DS<sub>2</sub>-VASc, a multidimensional stroke risk score, was 4 (interquartile range [IQR], 3-5). Apixaban was initiated a median of 5 (IQR, 2-12) days after AF and used for a median of 59 (IQR, 37-135) days. In intention-to-treat analyses, rates of ischemic stroke were 25% lower (HR, 0.75; 95% CI, 0.57–0.97) and those of a composite outcome of thromboembolic events and cardiovascular death were 24% lower (HR, 0.76; 95% CI, 0.70-0.83) among apixaban users. Conversely, apixaban users had a 55% higher rate of hemorrhagic stroke (HR, 1.55; 95% CI, 1.03-2.33) and a 29% increased rate of clinically important bleeding (HR, 1.29; 95% CI, 1.14-1.45). The HR for all-cause mortality was 0.61 (95% CI, 0.56-0.67). Results from as-treated analyses were qualitatively consistent with intent-to-treat analyses but generally larger in magnitude.</div></div><div><h3>Limitations</h3><div>Potential for residual confounding from unobserved characteristics or informative censoring unaccounted for by competing risk models.</div></div><div><h3>Conclusions</h3><div>Among patients with hemodialysis-treated kidney failure, compared with no anticoagulation, initiation of apixaban soon after newly diagnosed AF was associated with lower risks of ischemic stroke, a composite thromboembolic end point, and all-cause mortality but higher rates of clinically meaningful bleeding.</div></div><div><h3>Plain-Language Summary</h3><div>In this study of existing data of patients with kidney failure receiving dialysis who were newly diagnosed with atrial fibrillation, the most common heart rhythm disorder, we found that initiating a ne","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 3","pages":"Pages 313-323"},"PeriodicalIF":8.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688977","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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