Pub Date : 2026-02-02DOI: 10.1053/j.ajkd.2025.09.027
Nisha Bansal, Leila R Zelnick, Grace Tabada, Jaejin An, Teresa N Harrison, Ming-Sum Lee, Chengyi Zheng, Ben Lidgard, Daniel E Singer, Elisha Garcia, Alan S Go
{"title":"Association of Recurrent Atrial Fibrillation With Subsequent Kidney Function Decline in Adults Receiving Rhythm Control Therapy.","authors":"Nisha Bansal, Leila R Zelnick, Grace Tabada, Jaejin An, Teresa N Harrison, Ming-Sum Lee, Chengyi Zheng, Ben Lidgard, Daniel E Singer, Elisha Garcia, Alan S Go","doi":"10.1053/j.ajkd.2025.09.027","DOIUrl":"10.1053/j.ajkd.2025.09.027","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12890429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146117447","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 : 2026-02-01Epub 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":"2026-02-01","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 : 2026-02-01Epub Date: 2026-01-21DOI: 10.1053/j.ajkd.2025.10.006
Chia-shi Wang , Rasheed Gbadegesin
The Kidney Disease Outcomes Quality Initiative (KDOQI) convened a work group to review the 2025 KDIGO (Kidney Disease: Improving Global Outcomes) Clinical Practice Guideline for the Management of Nephrotic Syndrome in Children. The KDOQI work group reviewed the KDIGO guideline statements and practice points and provided perspective for implementation within the context of clinical practice in the United States. The updated guidelines reflect contemporary US practice and offer highly relevant guidance that is harmonized with the International Pediatric Nephrology Association’s guidelines published in 2020 and 2022. A focus on close monitoring and characterization of the disease status for children with nephrotic syndrome remains central to treatment and management decisions, noting that the lack of insurance coverage for urine dipsticks in the United States is a significant barrier to optimal disease management. As more treatment options become available to children with nephrotic syndrome, the detailed practice points are a sound tool to help providers engage patients and their families in joint decision making. The clinical utility of the guidelines would be enhanced by inclusion of practice points on the incorporation of genetic testing results into treatment decisions, as well as factors to consider when treating and managing patients at high risk for progression to end-stage kidney disease—those with secondary steroid-resistant nephrotic syndrome and those with the chronic kidney disease high-risk APOL1 genotype. The research needs detailed in the updated guidelines reflect the exciting direction of the practice landscape to provide patient-centered, precision-based care.
{"title":"KDOQI US Commentary on the KDIGO 2025 Clinical Practice Guideline for the Management of Nephrotic Syndrome in Children","authors":"Chia-shi Wang , Rasheed Gbadegesin","doi":"10.1053/j.ajkd.2025.10.006","DOIUrl":"10.1053/j.ajkd.2025.10.006","url":null,"abstract":"<div><div>The Kidney Disease Outcomes Quality Initiative (KDOQI) convened a work group to review the 2025 KDIGO (Kidney Disease: Improving Global Outcomes) Clinical Practice Guideline for the Management of Nephrotic Syndrome in Children. The KDOQI work group reviewed the KDIGO guideline statements and practice points and provided perspective for implementation within the context of clinical practice in the United States. The updated guidelines reflect contemporary US practice and offer highly relevant guidance that is harmonized with the International Pediatric Nephrology Association’s guidelines published in 2020 and 2022. A focus on close monitoring and characterization of the disease status for children with nephrotic syndrome remains central to treatment and management decisions, noting that the lack of insurance coverage for urine dipsticks in the United States is a significant barrier to optimal disease management. As more treatment options become available to children with nephrotic syndrome, the detailed practice points are a sound tool to help providers engage patients and their families in joint decision making. The clinical utility of the guidelines would be enhanced by inclusion of practice points on the incorporation of genetic testing results into treatment decisions, as well as factors to consider when treating and managing patients at high risk for progression to end-stage kidney disease—those with secondary steroid-resistant nephrotic syndrome and those with the chronic kidney disease high-risk <em>APOL1</em> genotype. The research needs detailed in the updated guidelines reflect the exciting direction of the practice landscape to provide patient-centered, precision-based care.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 141-152"},"PeriodicalIF":8.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146001700","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 : 2026-02-01Epub 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":"2026-02-01","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}
Pub Date : 2026-02-01Epub Date: 2025-12-19DOI: 10.1053/j.ajkd.2025.11.003
James O. Burton DM, MBChB , Katherine L. Hull MBChB
{"title":"Chronic Pain in Hemodialysis: Beyond the Biochemical Paradigm","authors":"James O. Burton DM, MBChB , Katherine L. Hull MBChB","doi":"10.1053/j.ajkd.2025.11.003","DOIUrl":"10.1053/j.ajkd.2025.11.003","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 156-158"},"PeriodicalIF":8.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145786361","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 : 2026-02-01Epub 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":"2026-02-01","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}
Pub Date : 2026-02-01Epub Date: 2025-11-12DOI: 10.1053/j.ajkd.2025.09.010
Kevin Yau , Joel G. Ray , Nivethika Jeyakumar , Bin Luo , Sheikh Abdullah , Stephanie N. Dixon , Sara Wing , Kristin K. Clemens , Fabio Castrillon-Ramirez , Jacob A. Udell , Alejandro Meraz-Munoz , Ann Young , Ziv Harel , Jeffrey Perl , Lawrence A. Leiter , Amit X. Garg , David Z.I. Cherney , Ron Wald
<div><h3>Rationale & Objective</h3><div>There are limited real-world data describing the cardiovascular benefits of glucagon-like peptide-1 receptor agonists (GLP1-RAs) across the spectrum of chronic kidney disease (CKD) severity. This study evaluated the association of GLP1-RAs with major adverse cardiovascular events (MACE) in comparison with dipeptidyl peptidase-4 (DPP-4) inhibitors in the setting of CKD.</div></div><div><h3>Study Design</h3><div>Retrospective observational cohort study.</div></div><div><h3>Setting & Participants</h3><div>24,576 new users of GLP1-RA and 44,367 new users of DPP-4 inhibitors with estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73 m<sup>2</sup> in Ontario, Canada.</div></div><div><h3>Exposure</h3><div>New use of GLP1-RAs versus DPP-4 inhibitors.</div></div><div><h3>Outcome</h3><div>The primary outcome was MACE, comprising nonfatal myocardial infarction, unstable angina, nonfatal ischemic stroke or transient ischemic attack, coronary revascularization, and cardiovascular death. Secondary outcomes included individual components of the composite outcome, hospitalization or emergency department visits for congestive heart failure, peripheral vascular disease revascularization, lower limb amputation, and all-cause mortality.</div></div><div><h3>Analytical Approach</h3><div>Inverse probability of treatment weighting using propensity scores was used to minimize confounding. Multivariable Fine-Gray subdistribution hazard models stratified by eGFR subgroup were fit to evaluate the primary outcome.</div></div><div><h3>Findings</h3><div>Mean age of study participants was 69 years, 50% were female, 92% had type 2 diabetes mellitus, 40% were taking a sodium/glucose cotransporter 2 (SGLT2) inhibitor, and 41% had CKD stages 3-5. MACE occurred among 1,296 (31.6 per 1,000 person-years) GLP1-RA users versus 1,374 (36.5 per 1,000 person-years) DPP-4 inhibitor users (subdistribution hazard ratio [SHR], 0.88 [95% CI, 0.80-0.97]). The lower rate of MACE among GLP1-RA users was largely related to a lower rate of cardiovascular death (SHR, 0.72 [95% CI, 0.62-0.85]). In subgroup analyses, there was no effect modification between the association of GLP1-RA initiation and lower rates of MACE by CKD stages, degree of albuminuria, or concomitant use of SGLT2 inhibitors.</div></div><div><h3>Limitations</h3><div>Retrospective design. A substantial amount of missing information on albuminuria.</div></div><div><h3>Conclusions</h3><div>In a population-based study of individuals across the spectrum of kidney disease, GLP1-RA initiation was associated with a lower rate of MACE than initiation of DPP-4 inhibitors.</div></div><div><h3>Plain-Language Summary</h3><div>A class of medications called glucagon-like peptide-1 receptor agonists (GLP1-RA) is now used for the treatment of diabetes. This study explored the association of GLP1-RA administration with cardiac health in people with kidney disease compared with another common cl
{"title":"Glucagon-like Peptide-1 Receptor Agonists and Risk of Major Adverse Cardiovascular Events in Patients With CKD","authors":"Kevin Yau , Joel G. Ray , Nivethika Jeyakumar , Bin Luo , Sheikh Abdullah , Stephanie N. Dixon , Sara Wing , Kristin K. Clemens , Fabio Castrillon-Ramirez , Jacob A. Udell , Alejandro Meraz-Munoz , Ann Young , Ziv Harel , Jeffrey Perl , Lawrence A. Leiter , Amit X. Garg , David Z.I. Cherney , Ron Wald","doi":"10.1053/j.ajkd.2025.09.010","DOIUrl":"10.1053/j.ajkd.2025.09.010","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>There are limited real-world data describing the cardiovascular benefits of glucagon-like peptide-1 receptor agonists (GLP1-RAs) across the spectrum of chronic kidney disease (CKD) severity. This study evaluated the association of GLP1-RAs with major adverse cardiovascular events (MACE) in comparison with dipeptidyl peptidase-4 (DPP-4) inhibitors in the setting of CKD.</div></div><div><h3>Study Design</h3><div>Retrospective observational cohort study.</div></div><div><h3>Setting & Participants</h3><div>24,576 new users of GLP1-RA and 44,367 new users of DPP-4 inhibitors with estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73 m<sup>2</sup> in Ontario, Canada.</div></div><div><h3>Exposure</h3><div>New use of GLP1-RAs versus DPP-4 inhibitors.</div></div><div><h3>Outcome</h3><div>The primary outcome was MACE, comprising nonfatal myocardial infarction, unstable angina, nonfatal ischemic stroke or transient ischemic attack, coronary revascularization, and cardiovascular death. Secondary outcomes included individual components of the composite outcome, hospitalization or emergency department visits for congestive heart failure, peripheral vascular disease revascularization, lower limb amputation, and all-cause mortality.</div></div><div><h3>Analytical Approach</h3><div>Inverse probability of treatment weighting using propensity scores was used to minimize confounding. Multivariable Fine-Gray subdistribution hazard models stratified by eGFR subgroup were fit to evaluate the primary outcome.</div></div><div><h3>Findings</h3><div>Mean age of study participants was 69 years, 50% were female, 92% had type 2 diabetes mellitus, 40% were taking a sodium/glucose cotransporter 2 (SGLT2) inhibitor, and 41% had CKD stages 3-5. MACE occurred among 1,296 (31.6 per 1,000 person-years) GLP1-RA users versus 1,374 (36.5 per 1,000 person-years) DPP-4 inhibitor users (subdistribution hazard ratio [SHR], 0.88 [95% CI, 0.80-0.97]). The lower rate of MACE among GLP1-RA users was largely related to a lower rate of cardiovascular death (SHR, 0.72 [95% CI, 0.62-0.85]). In subgroup analyses, there was no effect modification between the association of GLP1-RA initiation and lower rates of MACE by CKD stages, degree of albuminuria, or concomitant use of SGLT2 inhibitors.</div></div><div><h3>Limitations</h3><div>Retrospective design. A substantial amount of missing information on albuminuria.</div></div><div><h3>Conclusions</h3><div>In a population-based study of individuals across the spectrum of kidney disease, GLP1-RA initiation was associated with a lower rate of MACE than initiation of DPP-4 inhibitors.</div></div><div><h3>Plain-Language Summary</h3><div>A class of medications called glucagon-like peptide-1 receptor agonists (GLP1-RA) is now used for the treatment of diabetes. This study explored the association of GLP1-RA administration with cardiac health in people with kidney disease compared with another common cl","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 211-229.e1"},"PeriodicalIF":8.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145516256","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 : 2026-02-01Epub Date: 2026-01-21DOI: 10.1053/j.ajkd.2025.09.015
William E. Dennehy , John R. Silkensen , Tracy L. Anderson-Haag , Rebecca Zadroga , Jeffrey H. Wang
{"title":"Severe Hypercalcemia in a Kidney Transplant Recipient: A Quiz","authors":"William E. Dennehy , John R. Silkensen , Tracy L. Anderson-Haag , Rebecca Zadroga , Jeffrey H. Wang","doi":"10.1053/j.ajkd.2025.09.015","DOIUrl":"10.1053/j.ajkd.2025.09.015","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages A10-A14"},"PeriodicalIF":8.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146001847","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号