Pub Date : 2025-12-04DOI: 10.1053/j.ajkd.2025.07.022
Patrizia Natale , Suetonia C. Green , Jonathan C. Craig , Giovanni F.M. Strippoli
{"title":"Blood Pressure–Lowering Agents for Kidney Transplant Recipients: Editorial Summary of a Cochrane Review","authors":"Patrizia Natale , Suetonia C. Green , Jonathan C. Craig , Giovanni F.M. Strippoli","doi":"10.1053/j.ajkd.2025.07.022","DOIUrl":"10.1053/j.ajkd.2025.07.022","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 270-272"},"PeriodicalIF":8.2,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688972","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 : 2025-12-04DOI: 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
RATIONALE & OBJECTIVEAtrial fibrillation (AF) is common among patients with kidney failure on hemodialysis (KFHD). We studied the outcomes of apixaban initiation, compared with no initiation of any oral anticoagulation (OAC), among patients with KFHD and newly-diagnosed AF.STUDY DESIGNRetrospective cohort study.SETTING & PARTICIPANTSMedicare-insured patients with KFHD, with newly-diagnosed AF, and without recent OAC use (2014-2019).EXPOSUREInitiation of apixaban treatment versus no OAC initiation within 30 days of an AF diagnosis.OUTCOMESThromboembolic and bleeding events and death within 365 days of follow-up.ANALYTICAL APPROACHPropensity-matched comparison of new apixaban users and OAC non-users implemented using Cox proportional hazards models while accounting for competing risks.RESULTSWithin 30 days of the new diagnosis of AF among 63,300 previously OAC-naïve patients, 4010 initiated apixaban and 59,290 did not initiate any OAC within 30 days. After propensity matching, 3985 apixaban users were well-matched to 3985 OAC non-users on all measured characteristics. Median CHA2DS2-VASc, a multidimensional stroke risk score, was 4 (IQR: 3-5). Apixaban was initiated a median 5 (IQR: 2-12) days after AF and used for a median 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.LIMITATIONSPotential for residual confounding from unobserved characteristics or informative censoring unaccounted for by competing risk models.CONCLUSIONSAmong patients with KFHD, initiation of apixaban soon after newly-diagnosed AF, compared to no anticoagulation, was associated with lower risks of ischemic stroke, a composite thromboembolic endpoint, and all-cause mortality, but higher rates of clinically meaningful bleeding.
{"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":"https://doi.org/10.1053/j.ajkd.2025.10.009","url":null,"abstract":"RATIONALE & OBJECTIVEAtrial fibrillation (AF) is common among patients with kidney failure on hemodialysis (KFHD). We studied the outcomes of apixaban initiation, compared with no initiation of any oral anticoagulation (OAC), among patients with KFHD and newly-diagnosed AF.STUDY DESIGNRetrospective cohort study.SETTING & PARTICIPANTSMedicare-insured patients with KFHD, with newly-diagnosed AF, and without recent OAC use (2014-2019).EXPOSUREInitiation of apixaban treatment versus no OAC initiation within 30 days of an AF diagnosis.OUTCOMESThromboembolic and bleeding events and death within 365 days of follow-up.ANALYTICAL APPROACHPropensity-matched comparison of new apixaban users and OAC non-users implemented using Cox proportional hazards models while accounting for competing risks.RESULTSWithin 30 days of the new diagnosis of AF among 63,300 previously OAC-naïve patients, 4010 initiated apixaban and 59,290 did not initiate any OAC within 30 days. After propensity matching, 3985 apixaban users were well-matched to 3985 OAC non-users on all measured characteristics. Median CHA2DS2-VASc, a multidimensional stroke risk score, was 4 (IQR: 3-5). Apixaban was initiated a median 5 (IQR: 2-12) days after AF and used for a median 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.LIMITATIONSPotential for residual confounding from unobserved characteristics or informative censoring unaccounted for by competing risk models.CONCLUSIONSAmong patients with KFHD, initiation of apixaban soon after newly-diagnosed AF, compared to no anticoagulation, was associated with lower risks of ischemic stroke, a composite thromboembolic endpoint, and all-cause mortality, but higher rates of clinically meaningful bleeding.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"1 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-12-04","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}
Pub Date : 2025-12-04DOI: 10.1053/j.ajkd.2025.09.017
Daan P.C. van Doorn , Salwan Al-Nasiry , Marc E.A. Spaanderman , Jan G.M.C. Damoiseaux , Pieter van Paassen , Sjoerd A.M.E.G. Timmermans
Thrombotic microangiopathies (TMAs) are severe endotheliopathies that can arise in pregnancy and require early recognition. Complement-mediated (C-)TMA should be differentiated from other endotheliopathies of pregnancy because the treatment differs. Here, we report a case of a pregnant woman with acute kidney injury requiring hemodialysis due to C-TMA on the background of a pathogenic C3 variant at 28+5 weeks of gestation. The low soluble Fms-like tyrosine kinase-1 to placental growth factor (sFlt1/PlGF) ratio excluded pre-eclampsia. Eculizumab was started, and therapeutic drug monitoring was applied for optimal dosing. Despite prolonged hemodialysis, fetal well-being was preserved, and delivery was safely postponed till 34+3 weeks of gestation, resulting in a healthy neonate. We also separately report on sFlt1/PlGF ratios measured in a cohort of 11 patients with TMA and coexisting pregnancy. Ten of 11 patients (91%) had low sFlt1/PlGF ratios, excluding pre-eclampsia. Thus, successful pregnancy in women with C-TMA can occur, and sFlt1/PlGF ratios may aid in clarifying the diagnosis and appropriate treatment.
{"title":"Thrombotic Microangiopathy During Pregnancy: Role of Soluble Fms-like Tyrosine Kinase-1–Placental Growth Factor Ratios","authors":"Daan P.C. van Doorn , Salwan Al-Nasiry , Marc E.A. Spaanderman , Jan G.M.C. Damoiseaux , Pieter van Paassen , Sjoerd A.M.E.G. Timmermans","doi":"10.1053/j.ajkd.2025.09.017","DOIUrl":"10.1053/j.ajkd.2025.09.017","url":null,"abstract":"<div><div>Thrombotic microangiopathies (TMAs) are severe endotheliopathies that can arise in pregnancy and require early recognition. Complement-mediated (C-)TMA should be differentiated from other endotheliopathies of pregnancy because the treatment differs. Here, we report a case of a pregnant woman with acute kidney injury requiring hemodialysis due to C-TMA on the background of a pathogenic <em>C3</em> variant at 28+5 weeks of gestation. The low soluble Fms-like tyrosine kinase-1 to placental growth factor (sFlt1/PlGF) ratio excluded pre-eclampsia. Eculizumab was started, and therapeutic drug monitoring was applied for optimal dosing. Despite prolonged hemodialysis, fetal well-being was preserved, and delivery was safely postponed till 34+3 weeks of gestation, resulting in a healthy neonate. We also separately report on sFlt1/PlGF ratios measured in a cohort of 11 patients with TMA and coexisting pregnancy. Ten of 11 patients (91%) had low sFlt1/PlGF ratios, excluding pre-eclampsia. Thus, successful pregnancy in women with C-TMA can occur, and sFlt1/PlGF ratios may aid in clarifying the diagnosis and appropriate treatment.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 278-283"},"PeriodicalIF":8.2,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688975","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 : 2025-11-29DOI: 10.1053/j.ajkd.2025.10.008
Georgina Gyarmati
{"title":"Are Mother Glomeruli in Good or Bad Company?","authors":"Georgina Gyarmati","doi":"10.1053/j.ajkd.2025.10.008","DOIUrl":"10.1053/j.ajkd.2025.10.008","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 275-277"},"PeriodicalIF":8.2,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644985","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 : 2025-11-20DOI: 10.1053/j.ajkd.2025.10.007
Ryann Sohaney , Andrea L. Oliverio
{"title":"Breaking Down Barriers to Reproductive Health Care in CKD","authors":"Ryann Sohaney , Andrea L. Oliverio","doi":"10.1053/j.ajkd.2025.10.007","DOIUrl":"10.1053/j.ajkd.2025.10.007","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 1-3"},"PeriodicalIF":8.2,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145559044","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 : 2025-11-19DOI: 10.1053/j.ajkd.2025.07.009
Christina Lauren Tamargo , Derek Michael Fine , Bangchen Wang , Samir C. Gautam
{"title":"Kidney Disease With Cutaneous Clues: A Quiz","authors":"Christina Lauren Tamargo , Derek Michael Fine , Bangchen Wang , Samir C. Gautam","doi":"10.1053/j.ajkd.2025.07.009","DOIUrl":"10.1053/j.ajkd.2025.07.009","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 6","pages":"Pages A11-A16"},"PeriodicalIF":8.2,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145536892","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 : 2025-11-19DOI: 10.1053/j.ajkd.2025.10.001
Janewit Wongboonsin , Michelle T. McNulty , Matthew G. Sampson
{"title":"Gaining a Genomic Foothold on Unexplained Kidney Failure","authors":"Janewit Wongboonsin , Michelle T. McNulty , Matthew G. Sampson","doi":"10.1053/j.ajkd.2025.10.001","DOIUrl":"10.1053/j.ajkd.2025.10.001","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 6","pages":"Pages 721-723"},"PeriodicalIF":8.2,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145537319","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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