American Journal of Kidney Diseases最新文献

{"title":"Health-Related Quality of Life After Living Kidney Donation: Insights From a Contemporary Meta-Analysis","authors":"Neetika Garg , Carrie Thiessen , Didier A. Mandelbrot","doi":"10.1053/j.ajkd.2025.11.002","DOIUrl":"10.1053/j.ajkd.2025.11.002","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 153-155"},"PeriodicalIF":8.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145786058","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}

{"title":"Health-Related Quality of Life After Living Kidney Donation: A Systematic Review and Meta-Analysis","authors":"Stijn C. van de Laar , Hidde A. de Heus , Emma K. Massey , Liset H.M. Pengel , Robert J. Porte , Frank J.M.F. Dor , Robert C. Minnee","doi":"10.1053/j.ajkd.2025.09.008","DOIUrl":"10.1053/j.ajkd.2025.09.008","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Living donor kidney transplantation is considered the most effective treatment for end-stage kidney disease, but healthy individuals who donate may experience potential threats to their long-term well-being. This meta-analysis assessed the impact of living kidney donation on health-related quality of life (HRQoL) among donors overall and among those at higher risk for negative health impacts.</div></div><div><h3>Study Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Setting & Participants</h3><div>Living donors of kidney allografts included in studies of postdonation HRQoL with predefined inclusion and exclusion criteria. Studies were identified through a comprehensive search of Embase, MEDLINE OvidSP, CENTRAL, Web of Science, PsycINFO, and the top 100 rankings in Google Scholar.</div></div><div><h3>Data Extraction</h3><div>Data were extracted in accordance with PRISMA guidelines, with independent extraction by multiple observers to ensure accuracy.</div></div><div><h3>Analytical Approach</h3><div>Primary outcomes included the 36-item Short-Form Health Survey (SF-36) and its composite mental component summary (MCS) and physical component summary (PCS). These measures were used to compare postdonation HRQoL with predonation levels and to the HRQoL of the general population. Study-level effects were calculated as standardized mean differences for continuous variables. Pooled effects were estimated with a random-effects model using restricted maximum likelihood.</div></div><div><h3>Results</h3><div>The meta-analysis included 73 studies with 14,474 donors. The MCS did not show significant changes at 3, 6, or 12 or more months after donation compared with baseline. However, the PCS was significantly lower at 3 months after donation compared with before donation (standardized mean difference, −0.38 [95% CI, −0.72 to −0.05], <em>P</em> = 0.02), which did not persist at 6 or 12 months. Both PCS and MCS scores were significantly higher in donors than in the general population. Donors’ HRQoL scores were comparable to or better than those of healthy controls, recipients, patients who underwent a nephrectomy, and patients receiving maintenance dialysis.</div></div><div><h3>Limitations</h3><div>Heterogeneity in study populations and outcomes, a limited number of studies for certain comparisons, methodological weaknesses of especially older studies, variability across geographies studied, and unaccounted for temporal changes.</div></div><div><h3>Conclusions</h3><div>Kidney donors reported physical HRQoL to be decreased after living donor nephrectomy, which returned to predonation levels by 6 months. The HRQoL reported by living donors was significantly better than that of the general population and healthy controls. These findings suggest that concerns about postdonation HRQoL need not be a deterrent to potential living kidney donors.</div></div><div><h3>Trial Registration</h3><div>Registe","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 159-181"},"PeriodicalIF":8.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145516257","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}

{"title":"Home Dialysis Utilization in Puerto Rico","authors":"Anthony Barisano , Daeho Kim , Rajnish Mehrotra , Amal N. Trivedi , Maricruz Rivera-Hernandez","doi":"10.1053/j.ajkd.2025.07.017","DOIUrl":"10.1053/j.ajkd.2025.07.017","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 230-233"},"PeriodicalIF":8.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145516258","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}

{"title":"Exercise and Kidney Health: Core Curriculum 2026","authors":"Laura Aponte Becerra,&nbsp;Sherry G. Mansour","doi":"10.1053/j.ajkd.2025.09.014","DOIUrl":"10.1053/j.ajkd.2025.09.014","url":null,"abstract":"<div><div>Exercise triggers complex effects on kidney physiology that vary with intensity, duration, and environmental conditions. While moderate physical activity improves cardiovascular and renal outcomes, intense or prolonged exertion, particularly in endurance sports, can lead to acute kidney injury. Adaptations in kidney physiology during exercise include reduced plasma flow, altered glomerular filtration, and hormone-mediated fluid retention. These changes are protective but may become maladaptive with dehydration, heat stress, or excessive fluid intake. High-intensity exercise increases oxidative stress and proteinuria, while ultramarathon participation may cause transient creatinine elevation from muscle breakdown, complicating acute kidney injury diagnosis. Prevention strategies include individualized hydration plans, electrolyte replacement, and avoidance of nonsteroidal anti-inflammatory drugs. In special populations, such as children with chronic kidney disease or patients receiving dialysis, structured exercise enhances quality of life and physical function when implemented safely. Clinicians must balance the benefits of exercise with kidney-related risks, promote safe training practices, and recognize early signs of exertional complications to optimize renal and overall health in physically active individuals. This core curriculum reviews the physiology of exercise on kidney function and provides evidence-based strategies for patient counseling and risk reduction.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 246-259"},"PeriodicalIF":8.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145732820","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}

{"title":"Why This Research Matters","authors":"Robert Sanchez MPS","doi":"10.1053/j.ajkd.2025.07.021","DOIUrl":"10.1053/j.ajkd.2025.07.021","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages A8-A9"},"PeriodicalIF":8.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145792907","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}

{"title":"Chronic Pain Locations, Characteristics, and Associations With Other Symptoms in Adults Receiving Maintenance Hemodialysis: Findings From the HOPE Consortium Trial","authors":"Michael J. Fischer ,&nbsp;Jesse Y. Hsu ,&nbsp;Joanna Walsh ,&nbsp;Kerri L. Cavanaugh ,&nbsp;David M. Charytan ,&nbsp;Susan T. Crowley ,&nbsp;Daniel Cukor ,&nbsp;Laura M. Dember ,&nbsp;Ardith Z. Doorenbos ,&nbsp;Denise Esserman ,&nbsp;Manisha Jhamb ,&nbsp;Kirsten L. Johansen ,&nbsp;Francis J. Keefe ,&nbsp;Paul L. Kimmel ,&nbsp;Mark B. Lockwood ,&nbsp;Rajnish Mehrotra ,&nbsp;Benjamin J. Morasco ,&nbsp;Sagar Nigwekar ,&nbsp;Patrick Pun ,&nbsp;Rudy Qamhiyeh ,&nbsp;Sahir Kalim","doi":"10.1053/j.ajkd.2025.09.009","DOIUrl":"10.1053/j.ajkd.2025.09.009","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Adults receiving maintenance hemodialysis (HD) frequently report pain, yet detailed descriptions of pain in this population are lacking. This study examines pain locations, characteristics, and associations with other symptoms in adults receiving HD.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Cross-sectional analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Adults with moderate to severe chronic pain receiving maintenance HD enrolled in the multicenter HOPE Consortium Trial from 2021 to 2023.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;Sociodemographic, pain treatment, dialysis, medical comorbidity, and psychological and behavioral characteristics. Other patient-reported symptoms.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome&lt;/h3&gt;&lt;div&gt;Pain interference and severity as assessed by the Brief Pain Inventory (BPI) Interference and Severity subscales (range, 0-10).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Multivariable regression with least absolute shrinkage and selection operator (LASSO) to examine associations between participant characteristics and pain interference/severity, and Spearman’s correlation to examine relationships between other symptoms and pain interference/severity at baseline.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among 643 participants, the median BPI interference was 6.6 (IQR, 5.1-7.9) and severity was 6.0 (IQR, 4.5-7.5). Among the participants, 84% of participants reported pain &gt;1 year, and 75% had daily pain; 89% and 66% of participants endorsed musculoskeletal and neuropathic pain, respectively. Of 32 body regions, the median number of painful regions was 8 (IQR, 4-14). Common regions in females were lower back (72%), knees (64%), legs (60%), and upper back (59%), and a similar pattern existed for males. In LASSO analyses, cardiovascular disease and depression were associated with significantly higher pain interference whereas White race (reference, Black race) and non-Hispanic ethnicity were associated with significantly lower pain interference. Similar findings were noted for pain severity. Pain catastrophizing and symptoms of fatigue, depression, and anxiety were moderately correlated with pain interference (&lt;em&gt;r&lt;/em&gt; &gt; 0.4).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Neither relationship directionality nor causality can be inferred.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Among adults treated with HD who have chronic pain, pain locations were numerous and diverse, with substantial musculoskeletal and neuropathic characteristics. Factors associated with pain interference were predominantly sociodemographic and psychological rather than those related to comorbid diseases and dialysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Adults receiving maintenance hemodialysis (HD) frequently experience chronic pain, but it remains poorly understood. We examined pain locations, characteristics, and relationships with other symptoms among 643 adults with moderate to severe chron","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 182-198.e1"},"PeriodicalIF":8.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145516261","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}

{"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":"2026-02-01","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}

{"title":"In Reply to “Low-Flow Home Hemodialysis Technologies: The Key to Greener Dialysis?”","authors":"Katherine A. Barraclough PhD ,&nbsp;Ben Talbot PhD ,&nbsp;Scott McAlister PhD","doi":"10.1053/j.ajkd.2025.10.010","DOIUrl":"10.1053/j.ajkd.2025.10.010","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 284-285"},"PeriodicalIF":8.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688976","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}

{"title":"Selecting Antihypertensive Medications for Kidney Transplant Recipients: Flying Blind","authors":"Deepthi Malepati,&nbsp;Paul E. Drawz","doi":"10.1053/j.ajkd.2025.09.016","DOIUrl":"10.1053/j.ajkd.2025.09.016","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 272-274"},"PeriodicalIF":8.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688981","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}

{"title":"Access to Kidney Transplantation in Adults With Severe Obesity: A Population-Based Retrospective Cohort Study","authors":"Natasha Wiebe ,&nbsp;Stephanie Thompson ,&nbsp;Ashley Spellman ,&nbsp;Ngan N. Lam ,&nbsp;Marcello Tonelli","doi":"10.1053/j.ajkd.2025.09.013","DOIUrl":"10.1053/j.ajkd.2025.09.013","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;International guidelines do not consider moderate or severe obesity to be a contraindication to kidney transplantation, but clinical practice suggests otherwise. This study evaluated the likelihood of kidney transplantation in patients with moderate or severe obesity and how that likelihood compared with patients with other risk factors.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Retrospective population-based cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;96,181 adults with kidney failure, living in Canada between 2000 and 2021.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;Moderate or severe obesity and other risk factors (eg, age groups, diabetes, heart disease).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome&lt;/h3&gt;&lt;div&gt;Time to transplantation and time to allograft failure or death.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Parametric survival modeling, adjusting for all risk factors.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Over a median follow-up period of 2.5 years, 58.2% of patients died, and 16.3% were transplanted. Participants with severe (body mass index [BMI] ≥ 40 kg/m&lt;sup&gt;2&lt;/sup&gt;) or moderate (BMI 35.0-39.9 kg/m&lt;sup&gt;2&lt;/sup&gt;) obesity were less likely to be transplanted than the control participants (BMI 18.5-24.9 kg/m&lt;sup&gt;2&lt;/sup&gt;) (HR, 0.43 [95% CI, 0.39-0.47] and HR, 0.76 [95% CI, 0.71-0.82], respectively). Of 39 characteristics/categories considered, only participants aged ≥80 years were less likely to receive a transplant than those with severe obesity. Transplant recipients were followed for a median of 5.4 years. After those aged ≥65 years, participants with severe obesity were the most likely to experience allograft failure or death (HR, 1.70 [95% CI, 1.38-2.02] compared with controls). When we considered combinations of key risk factors, young participants with severe or moderate obesity and few comorbidities were at lower risk for allograft failure or death than participants with other common clinical characteristics.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Residual confounding.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Canadian dialysis patients with moderate or severe obesity had a markedly reduced likelihood of receiving a kidney transplant. Although patients with moderate or severe obesity also had a heightened risk of allograft failure or death, the magnitude of the latter was similar to the excess risk associated with other common clinical characteristics. These findings support current practice guidelines and suggest that further work should identify and remove barriers to accessing kidney transplantation among patients with obesity.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;International guidelines do not consider moderate or severe obesity (body mass index ≥35 and ≥40 kg/m&lt;sup&gt;2&lt;/sup&gt;, respectively) to be a contraindication to kidney transplantation, but clinical practice suggests otherwise. Canadian dialysis patients with moderate or severe obesity had a reduced likel","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 199-210"},"PeriodicalIF":8.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145516264","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}