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}
Pub Date : 2025-11-19DOI: 10.1053/j.ajkd.2025.10.003
Alyssa D. Steitz , Devika Nair
{"title":"Telemedicine in Dialysis: Established Gains Yet Enduring Gaps to Enhance the Quality of Care","authors":"Alyssa D. Steitz , Devika Nair","doi":"10.1053/j.ajkd.2025.10.003","DOIUrl":"10.1053/j.ajkd.2025.10.003","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 6","pages":"Pages 727-729"},"PeriodicalIF":8.2,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145537320","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 : 2025-11-18DOI: 10.1053/j.ajkd.2025.03.031
Colleen M. Glennon , Sagar U. Nigwekar , Daniela Kroshinsky , J. Kevin Tucker
Skin disorders occur commonly in patients with chronic kidney disease (CKD) and may greatly impact their quality of life. These skin disorders have varying underlying pathophysiologies, but there are a few common mechanisms including the accumulation of uremic solutes, metabolic disturbances, and inflammation. Pruritus in the setting of CKD (CKD-associated pruritus or CKD-aP), acquired perforating disorder (APD), calcinosis cutis, calciphylaxis, cutaneous lupus, and vasculitis are skin disorders often occurring in association with kidney disease and with which clinicians should be familiar. CKD-aP is reported to have a prevalence of 40% among patients receiving dialysis and 20% with earlier stages of CKD. Acquired perforating disorder (APD) is a skin disorder seen commonly in patients with diabetes mellitus and kidney failure that presents typically with crater-shaped nodular eruptions with a central hyperkeratosis. Calcinosis cutis is a skin disorder that occurs when calcium salts deposit into skin and subcutaneous tissues. Calciphylaxis is a rare cutaneous vasculopathy characterized by microvascular calcium deposition and thrombosis leading to tissue ischemia and subsequent skin necrosis. Lupus erythematosus and the vasculitides are systemic disorders with distinct skin manifestations that may offer clues as to the underlying disorder.
{"title":"Skin Disorders in Kidney Disease: Core Curriculum 2026","authors":"Colleen M. Glennon , Sagar U. Nigwekar , Daniela Kroshinsky , J. Kevin Tucker","doi":"10.1053/j.ajkd.2025.03.031","DOIUrl":"10.1053/j.ajkd.2025.03.031","url":null,"abstract":"<div><div>Skin disorders occur commonly in patients with chronic kidney disease (CKD) and may greatly impact their quality of life. These skin disorders have varying underlying pathophysiologies, but there are a few common mechanisms including the accumulation of uremic solutes, metabolic disturbances, and inflammation. Pruritus in the setting of CKD (CKD-associated pruritus or CKD-aP), acquired perforating disorder (APD), calcinosis cutis, calciphylaxis, cutaneous lupus, and vasculitis are skin disorders often occurring in association with kidney disease and with which clinicians should be familiar. CKD-aP is reported to have a prevalence of 40% among patients receiving dialysis and 20% with earlier stages of CKD. Acquired perforating disorder (APD) is a skin disorder seen commonly in patients with diabetes mellitus and kidney failure that presents typically with crater-shaped nodular eruptions with a central hyperkeratosis. Calcinosis cutis is a skin disorder that occurs when calcium salts deposit into skin and subcutaneous tissues. Calciphylaxis is a rare cutaneous vasculopathy characterized by microvascular calcium deposition and thrombosis leading to tissue ischemia and subsequent skin necrosis. Lupus erythematosus and the vasculitides are systemic disorders with distinct skin manifestations that may offer clues as to the underlying disorder.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 102-114"},"PeriodicalIF":8.2,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145538206","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 : 2025-11-13DOI: 10.1053/j.ajkd.2025.07.020
L. Parker Gregg , Lynnel Goodman , Ella Q. Carroll , S. Susan Hedayati
The detection and management of depression have special considerations in people with kidney disease. Screening should be performed every 6-12 months using a self-reported questionnaire. Clinicians should rule out symptoms from medical conditions such as dialysis inadequacy or hypothyroidism and confirm the presence of sadness or anhedonia. Sertraline has shown limited efficacy and an increased risk for adverse effects such as gastrointestinal symptoms, so cautious, gradual dose titration is warranted. Cognitive behavioral therapy has potential benefit for depressive symptoms in people with kidney disease. Current trials are evaluating behavioral activation therapy. Physical activity has many benefits and likely improves depression.
{"title":"A Practical Primer on How to Detect and Treat Depression in CKD","authors":"L. Parker Gregg , Lynnel Goodman , Ella Q. Carroll , S. Susan Hedayati","doi":"10.1053/j.ajkd.2025.07.020","DOIUrl":"10.1053/j.ajkd.2025.07.020","url":null,"abstract":"<div><div>The detection and management of depression have special considerations in people with kidney disease. Screening should be performed every 6-12 months using a self-reported questionnaire. Clinicians should rule out symptoms from medical conditions such as dialysis inadequacy or hypothyroidism and confirm the presence of sadness or anhedonia. Sertraline has shown limited efficacy and an increased risk for adverse effects such as gastrointestinal symptoms, so cautious, gradual dose titration is warranted. Cognitive behavioral therapy has potential benefit for depressive symptoms in people with kidney disease. Current trials are evaluating behavioral activation therapy. Physical activity has many benefits and likely improves depression.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 239-245"},"PeriodicalIF":8.2,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145525118","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 & OBJECTIVEEvidence is limited regarding the associations of non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated fatty liver disease (MAFLD) with the development of nephrolithiasis. This study aimed to assess the associations of NAFLD and MAFLD with the risk of incident nephrolithiasis, using data from two cohort studies conducted in China and UK.STUDY DESIGNProspective cohort study.SETTING & PARTICIPANTS26,490 participants without nephrolithiasis at baseline in the Tianjin Chronic Low-grade Systemic Inflammation and Health Cohort Study (TCLSIH) and 294,577 participants in the UK Biobank.EXPOSURESFatty liver diagnosed by abdominal ultrasonography in the TCLSIH and by the hepatic steatosis index (HSI) in the UK Biobank. NAFLD and MAFLD were defined according to standard clinical criteria in both cohorts.OUTCOMENephrolithiasis was confirmed by ultrasonography in the TCLSIH and identified through ICD-10 and OPCS-4 in the UK Biobank.ANALYTICAL APPROACHCox proportional hazards regression analysis was used to assess the relationship between exposures and incident nephrolithiasis.RESULTSThe TCLSIH and the UK Biobank recorded 806 and 2,743 new cases of nephrolithiasis during a median follow-up of 4 and 12 years, respectively. Participants in both cohorts showed a significantly increased risk of nephrolithiasis in the setting of NAFLD (TCLSIH: HR=1.69, 95% CI 1.46-1.95; UK Biobank: HR=1.66, 95% CI 1.53-1.79) and MAFLD (TCLSIH: HR=1.79, 95% CI 1.55-2.08; UK Biobank: HR=1.54, 95% CI 1.42-1.66) after multivariable adjustments.LIMITATIONSObservational nature limits causal inferences; generalizability limited outside of the cohorts studied; limited diagnostic approaches to detect nephrolithiasis; unavailability of stone composition data.CONCLUSIONSBoth NAFLD and MAFLD are associated with a higher risk of nephrolithiasis. The results suggest that NAFLD/MAFLD and their associated metabolic conditions may represent modifiable risk factors for nephrolithiasis.
理由与目的关于非酒精性脂肪性肝病（NAFLD）和代谢功能障碍相关脂肪性肝病（MAFLD）与肾结石发生的关联证据有限。本研究旨在评估NAFLD和MAFLD与肾结石发生风险的关系，使用来自中国和英国的两项队列研究的数据。研究设计前瞻性队列研究。背景和参与者：天津慢性低度全身性炎症与健康队列研究（TCLSIH）的26,490名基线时无肾结石的参与者和英国生物银行的294,577名参与者。通过TCLSIH的腹部超声检查和UK Biobank的肝脂肪变性指数（HSI）诊断脂肪肝。在两个队列中，根据标准临床标准定义NAFLD和MAFLD。结果：TCLSIH超声检查证实肾结石，英国生物银行通过ICD-10和OPCS-4诊断肾结石。分析方法采用cox比例风险回归分析来评估暴露与肾结石事件之间的关系。结果TCLSIH和UK Biobank在中位随访4年和12年期间分别记录了806例和2743例肾结石新病例。多变量调整后，两个队列的参与者均显示NAFLD （TCLSIH: HR=1.69, 95% CI 1.46-1.95; UK Biobank: HR=1.66, 95% CI 1.53-1.79）和MAFLD （TCLSIH: HR=1.79, 95% CI 1.55-2.08; UK Biobank: HR=1.54, 95% CI 1.42-1.66）的肾结石风险显著增加。局限性：观察性质限制了因果推论；在研究的队列之外，通用性有限；检测肾结石的有限诊断方法无法获得石材成分数据。结论NAFLD和MAFLD均与肾结石的高风险相关。结果表明，NAFLD/MAFLD及其相关代谢状况可能是肾结石可改变的危险因素。
{"title":"Association of Fatty Liver Disease and the Risk of Nephrolithiasis: Findings From Two Prospective Cohort Studies.","authors":"Song Bai,Xin Yang,Qiuju Sheng,Qing Zhang,Li Liu,Shaomei Sun,Xing Wang,Ming Zhou,Qiyu Jia,Kun Song,Kaijun Niu,Yang Ding,Yang Xia","doi":"10.1053/j.ajkd.2025.09.012","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.09.012","url":null,"abstract":"RATIONALE & OBJECTIVEEvidence is limited regarding the associations of non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated fatty liver disease (MAFLD) with the development of nephrolithiasis. This study aimed to assess the associations of NAFLD and MAFLD with the risk of incident nephrolithiasis, using data from two cohort studies conducted in China and UK.STUDY DESIGNProspective cohort study.SETTING & PARTICIPANTS26,490 participants without nephrolithiasis at baseline in the Tianjin Chronic Low-grade Systemic Inflammation and Health Cohort Study (TCLSIH) and 294,577 participants in the UK Biobank.EXPOSURESFatty liver diagnosed by abdominal ultrasonography in the TCLSIH and by the hepatic steatosis index (HSI) in the UK Biobank. NAFLD and MAFLD were defined according to standard clinical criteria in both cohorts.OUTCOMENephrolithiasis was confirmed by ultrasonography in the TCLSIH and identified through ICD-10 and OPCS-4 in the UK Biobank.ANALYTICAL APPROACHCox proportional hazards regression analysis was used to assess the relationship between exposures and incident nephrolithiasis.RESULTSThe TCLSIH and the UK Biobank recorded 806 and 2,743 new cases of nephrolithiasis during a median follow-up of 4 and 12 years, respectively. Participants in both cohorts showed a significantly increased risk of nephrolithiasis in the setting of NAFLD (TCLSIH: HR=1.69, 95% CI 1.46-1.95; UK Biobank: HR=1.66, 95% CI 1.53-1.79) and MAFLD (TCLSIH: HR=1.79, 95% CI 1.55-2.08; UK Biobank: HR=1.54, 95% CI 1.42-1.66) after multivariable adjustments.LIMITATIONSObservational nature limits causal inferences; generalizability limited outside of the cohorts studied; limited diagnostic approaches to detect nephrolithiasis; unavailability of stone composition data.CONCLUSIONSBoth NAFLD and MAFLD are associated with a higher risk of nephrolithiasis. The results suggest that NAFLD/MAFLD and their associated metabolic conditions may represent modifiable risk factors for nephrolithiasis.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"19 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145516260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-12DOI: 10.1053/j.ajkd.2025.07.019
Jillian S. Caldwell , Eugene Lin
Medicare Advantage (MA) enrollment among patients receiving dialysis has surged following the passage of the 21st Century Cures Act, which lifted prior restrictions on enrollment. As MA becomes the plurality payer for dialysis, understanding its implications for patients, providers, and policymakers is critical. MA offers out-of-pocket spending caps and additional services not covered under fee-for-service (FFS) Medicare. Some plans also prioritize care coordination, which may improve patient outcomes. However, concerns remain regarding limited provider networks, prior authorization barriers, and disparities in access to medications and transplants. The increasing shift to MA also challenges value-based care models, as most quality measures and payment models for patients receiving dialysis are limited to FFS Medicare. Although research examining the benefits and downsides of MA is paramount, a comparison of MA versus FFS Medicare is complicated by selection bias and incomplete or inaccessible data. To ensure that increasing enrollment into MA has not harmed patients, policymakers must enhance data fidelity and transparency, strengthen regulatory oversight, and align financial incentives across populations to safeguard access to high-quality care for patients receiving dialysis.
{"title":"What is Medicare Advantage and Why is it the Most Important Contemporary Policy Affecting Kidney Disease?","authors":"Jillian S. Caldwell , Eugene Lin","doi":"10.1053/j.ajkd.2025.07.019","DOIUrl":"10.1053/j.ajkd.2025.07.019","url":null,"abstract":"<div><div>Medicare Advantage (MA) enrollment among patients receiving dialysis has surged following the passage of the 21st Century Cures Act, which lifted prior restrictions on enrollment. As MA becomes the plurality payer for dialysis, understanding its implications for patients, providers, and policymakers is critical. MA offers out-of-pocket spending caps and additional services not covered under fee-for-service (FFS) Medicare. Some plans also prioritize care coordination, which may improve patient outcomes. However, concerns remain regarding limited provider networks, prior authorization barriers, and disparities in access to medications and transplants. The increasing shift to MA also challenges value-based care models, as most quality measures and payment models for patients receiving dialysis are limited to FFS Medicare. Although research examining the benefits and downsides of MA is paramount, a comparison of MA versus FFS Medicare is complicated by selection bias and incomplete or inaccessible data. To ensure that increasing enrollment into MA has not harmed patients, policymakers must enhance data fidelity and transparency, strengthen regulatory oversight, and align financial incentives across populations to safeguard access to high-quality care for patients receiving dialysis.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 260-269"},"PeriodicalIF":8.2,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145516259","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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