Pub 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":"2025-11-12","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 : 2025-11-12DOI: 10.1053/j.ajkd.2025.09.008
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
<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
理由与目的活体肾脏移植（LDKT）被认为是治疗终末期肾脏疾病最有效的方法，但健康的捐赠者可能会对他们的长期健康造成潜在的威胁。本荟萃分析旨在评估活体肾脏捐赠（LDK）对供体总体和具有较高负面健康影响风险者健康相关生活质量（HRQoL）的影响。研究设计：系统评价和荟萃分析。环境与研究人群同种异体肾移植活体供者被纳入捐献后HRQoL的研究，具有预定义的纳入和排除标准。通过Embase、MEDLINE OvidSP、CENTRAL、Web of Science、PsycINFO和b谷歌Scholar排名前100的综合搜索来确定研究。数据提取按照PRISMA指南提取数据，由多个观测者独立提取以确保准确性。主要结果包括SF-36及其综合心理成分总结（MCS）和生理成分总结（PCS）。这些指标用于比较捐献后与捐献前的HRQoL水平以及与一般人群的HRQoL水平。研究水平效应以连续变量的标准化平均差异计算。用限制最大似然的随机效应模型估计合并效应。结果荟萃分析包括73项研究，14474名供体。与基线相比，捐献后3、6、12个月或更长时间的MCS确实显示出显著的变化。然而，与捐献前相比，捐献后3个月的PCS显著降低（SMD为-0.38;95% CI: -0.72至-0.05,p = 0.02），这种情况在6或12个月时不会持续。献血者的PCS和MCS评分明显高于一般人群。供者的HRQoL评分与健康对照者、受者、接受肾切除术的患者和接受维护性透析的患者相当或更好。局限性：研究人群和结果的异质性，某些比较的研究数量有限，特别是旧研究的方法学弱点，研究的地理差异，以及未解释的时间变化。结论肾供者报告活体肾切除术后HRQoL下降，6个月后恢复到捐献前水平。活体献血者报告的HRQoL明显优于普通人群和健康对照组。这些发现表明，对捐赠后HRQoL的担忧不必成为潜在活体肾脏捐赠者的威慑。
{"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":"2025-11-12","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}
Pub Date : 2025-11-12DOI: 10.1053/j.ajkd.2025.07.017
Anthony Barisano , Daeho Kim , Rajnish Mehrotra , Amal N. Trivedi , Maricruz Rivera-Hernandez
{"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":"2025-11-12","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}
Pub 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, multi-organ 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 which 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 (e.g., belimumab, obinutuzumab) and T cells (e.g., voclosporin) have proven efficacy as add-on treatments. Novel therapies such as complement and cytokine inhibitors are being evaluated in preclinical and clinical trials. While maintenance therapy with MMF remains the standard, the distinction between sequential induction and maintenance therapy has 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":"https://doi.org/10.1053/j.ajkd.2025.08.016","url":null,"abstract":"Systemic Lupus Erythematosus (SLE) is a chronic, multi-organ 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 which 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 (e.g., belimumab, obinutuzumab) and T cells (e.g., voclosporin) have proven efficacy as add-on treatments. Novel therapies such as complement and cytokine inhibitors are being evaluated in preclinical and clinical trials. While maintenance therapy with MMF remains the standard, the distinction between sequential induction and maintenance therapy has increasingly blurred, and new strategies to reduce long term disease and pharmacologic toxicity to improve remission and relapse rates are emerging.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"170 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-11-12","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 : 2025-11-12DOI: 10.1053/j.ajkd.2025.09.009
Michael J. Fischer , Jesse Y. Hsu , Joanna Walsh , Kerri L. Cavanaugh , David M. Charytan , Susan T. Crowley , Daniel Cukor , Laura M. Dember , Ardith Z. Doorenbos , Denise Esserman , Manisha Jhamb , Kirsten L. Johansen , Francis J. Keefe , Paul L. Kimmel , Mark B. Lockwood , Rajnish Mehrotra , Benjamin J. Morasco , Sagar Nigwekar , Patrick Pun , Rudy Qamhiyeh , Sahir Kalim
<div><h3>Rationale & Objective</h3><div>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.</div></div><div><h3>Study Design</h3><div>Cross-sectional analysis.</div></div><div><h3>Setting & Participants</h3><div>Adults with moderate to severe chronic pain receiving maintenance HD enrolled in the multicenter HOPE Consortium Trial from 2021 to 2023.</div></div><div><h3>Exposure</h3><div>Sociodemographic, pain treatment, dialysis, medical comorbidity, and psychological and behavioral characteristics. Other patient-reported symptoms.</div></div><div><h3>Outcome</h3><div>Pain interference and severity as assessed by the Brief Pain Inventory (BPI) Interference and Severity subscales (range, 0-10).</div></div><div><h3>Analytical Approach</h3><div>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.</div></div><div><h3>Results</h3><div>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 >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 (<em>r</em> > 0.4).</div></div><div><h3>Limitations</h3><div>Neither relationship directionality nor causality can be inferred.</div></div><div><h3>Conclusions</h3><div>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.</div></div><div><h3>Plain-Language Summary</h3><div>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
{"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 , Jesse Y. Hsu , Joanna Walsh , Kerri L. Cavanaugh , David M. Charytan , Susan T. Crowley , Daniel Cukor , Laura M. Dember , Ardith Z. Doorenbos , Denise Esserman , Manisha Jhamb , Kirsten L. Johansen , Francis J. Keefe , Paul L. Kimmel , Mark B. Lockwood , Rajnish Mehrotra , Benjamin J. Morasco , Sagar Nigwekar , Patrick Pun , Rudy Qamhiyeh , Sahir Kalim","doi":"10.1053/j.ajkd.2025.09.009","DOIUrl":"10.1053/j.ajkd.2025.09.009","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>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.</div></div><div><h3>Study Design</h3><div>Cross-sectional analysis.</div></div><div><h3>Setting & Participants</h3><div>Adults with moderate to severe chronic pain receiving maintenance HD enrolled in the multicenter HOPE Consortium Trial from 2021 to 2023.</div></div><div><h3>Exposure</h3><div>Sociodemographic, pain treatment, dialysis, medical comorbidity, and psychological and behavioral characteristics. Other patient-reported symptoms.</div></div><div><h3>Outcome</h3><div>Pain interference and severity as assessed by the Brief Pain Inventory (BPI) Interference and Severity subscales (range, 0-10).</div></div><div><h3>Analytical Approach</h3><div>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.</div></div><div><h3>Results</h3><div>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 >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 (<em>r</em> > 0.4).</div></div><div><h3>Limitations</h3><div>Neither relationship directionality nor causality can be inferred.</div></div><div><h3>Conclusions</h3><div>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.</div></div><div><h3>Plain-Language Summary</h3><div>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":"2025-11-12","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}
Pub Date : 2025-11-12DOI: 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
RATIONALE & OBJECTIVEChildren 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 aimed to describe the perspectives and experiences of children with CKD and their caregivers regarding dietary intake.STUDY DESIGNSystematic review and thematic synthesis of qualitative studies SETTING & STUDY POPULATIONS: Children and adolescents with any stage of CKD and their caregivers SELECTION CRITERIA FOR STUDIES: MEDLINE, Embase, PsycINFO and CINAHL were searched from inception to July 2024.DATA EXTRACTIONAll text from the results/conclusion of the primary studies.ANALYTICAL APPROACHThematic synthesis.RESULTSWe included 70 studies involving 1941 participants from 21 countries. We identified five themes, 1) frustrated by unpalatable food (unfulfilled by unappetizing meals, disinterested 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 post-transplant), and 5) controlling diet for health (motivated to stay well, instilling coping strategies for dietary adherence).LIMITATIONSSeveral included studies did not specify patients' CKD stages.CONCLUSIONSChildren with CKD face dietary challenges leading to frustration, cravings, and occasional dietary non-adherence. 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.
{"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":"https://doi.org/10.1053/j.ajkd.2025.09.011","url":null,"abstract":"RATIONALE & OBJECTIVEChildren 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 aimed to describe the perspectives and experiences of children with CKD and their caregivers regarding dietary intake.STUDY DESIGNSystematic review and thematic synthesis of qualitative studies SETTING & STUDY POPULATIONS: Children and adolescents with any stage of CKD and their caregivers SELECTION CRITERIA FOR STUDIES: MEDLINE, Embase, PsycINFO and CINAHL were searched from inception to July 2024.DATA EXTRACTIONAll text from the results/conclusion of the primary studies.ANALYTICAL APPROACHThematic synthesis.RESULTSWe included 70 studies involving 1941 participants from 21 countries. We identified five themes, 1) frustrated by unpalatable food (unfulfilled by unappetizing meals, disinterested 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 post-transplant), and 5) controlling diet for health (motivated to stay well, instilling coping strategies for dietary adherence).LIMITATIONSSeveral included studies did not specify patients' CKD stages.CONCLUSIONSChildren with CKD face dietary challenges leading to frustration, cravings, and occasional dietary non-adherence. 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.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"373 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-11-12","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 : 2025-11-12DOI: 10.1053/j.ajkd.2025.09.013
Natasha Wiebe , Stephanie Thompson , Ashley Spellman , Ngan N. Lam , Marcello Tonelli
<div><h3>Rationale & Objective</h3><div>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.</div></div><div><h3>Study Design</h3><div>Retrospective population-based cohort study.</div></div><div><h3>Setting & Participants</h3><div>96,181 adults with kidney failure, living in Canada between 2000 and 2021.</div></div><div><h3>Exposure</h3><div>Moderate or severe obesity and other risk factors (eg, age groups, diabetes, heart disease).</div></div><div><h3>Outcome</h3><div>Time to transplantation and time to allograft failure or death.</div></div><div><h3>Analytical Approach</h3><div>Parametric survival modeling, adjusting for all risk factors.</div></div><div><h3>Results</h3><div>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<sup>2</sup>) or moderate (BMI 35.0-39.9 kg/m<sup>2</sup>) obesity were less likely to be transplanted than the control participants (BMI 18.5-24.9 kg/m<sup>2</sup>) (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.</div></div><div><h3>Limitations</h3><div>Residual confounding.</div></div><div><h3>Conclusions</h3><div>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.</div></div><div><h3>Plain-Language Summary</h3><div>International guidelines do not consider moderate or severe obesity (body mass index ≥35 and ≥40 kg/m<sup>2</sup>, 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
{"title":"Access to Kidney Transplantation in Adults With Severe Obesity: A Population-Based Retrospective Cohort Study","authors":"Natasha Wiebe , Stephanie Thompson , Ashley Spellman , Ngan N. Lam , Marcello Tonelli","doi":"10.1053/j.ajkd.2025.09.013","DOIUrl":"10.1053/j.ajkd.2025.09.013","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>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.</div></div><div><h3>Study Design</h3><div>Retrospective population-based cohort study.</div></div><div><h3>Setting & Participants</h3><div>96,181 adults with kidney failure, living in Canada between 2000 and 2021.</div></div><div><h3>Exposure</h3><div>Moderate or severe obesity and other risk factors (eg, age groups, diabetes, heart disease).</div></div><div><h3>Outcome</h3><div>Time to transplantation and time to allograft failure or death.</div></div><div><h3>Analytical Approach</h3><div>Parametric survival modeling, adjusting for all risk factors.</div></div><div><h3>Results</h3><div>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<sup>2</sup>) or moderate (BMI 35.0-39.9 kg/m<sup>2</sup>) obesity were less likely to be transplanted than the control participants (BMI 18.5-24.9 kg/m<sup>2</sup>) (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.</div></div><div><h3>Limitations</h3><div>Residual confounding.</div></div><div><h3>Conclusions</h3><div>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.</div></div><div><h3>Plain-Language Summary</h3><div>International guidelines do not consider moderate or severe obesity (body mass index ≥35 and ≥40 kg/m<sup>2</sup>, 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":"2025-11-12","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}
Pub Date : 2025-11-06DOI: 10.1053/j.ajkd.2025.10.005
Susan L Ziolkowski,Jin Long,Thomas L Nickolas,Shaun Bender,Simin Goral,Babette S Zemel,Chamith S Rajapakse,Thomas Dienemann,Mary B Leonard
RATIONALE & OBJECTIVEKidney transplantation ameliorates the underlying abnormalities contributing to skeletal fragility in CKD, but fracture rates increase following transplantation. This study sought to assess the impact of changes in body composition and mineral metabolism on bone mineral density (BMD) and structure following kidney KTxp.STUDY DESIGN24-month prospective cohort study.SETTING & PARTICIPANTS60 incident KTxp recipients and 361 healthy controls, ages 20-60 years.OUTCOMESTibia volumetric BMD (vBMD) and cortical dimensions measured using peripheral quantitative computerized tomography (pQCT), and areal BMD (aBMD) and appendicular lean mass index (ALMI) and fat mass index (FMI) measured using Dual-energy X-ray absorptiometry (DXA).ANALYTICAL APPROACHOutcomes were converted to sex-specific Z-scores for age and compared to 361 controls. Quasi-least squares regression models identified correlates of change.RESULTSAt baseline, ALMI, trabecular and cortical vBMD, cortical thickness, and total hip, femoral neck, and ultradistal radius aBMD were lower in KTxp vs. controls (p≤0.003). Over the first 6 months post-KTxp, ALMI, FMI, and body mass index (BMI) increased (p<0.001), while tibia trabecular vBMD and lumbar spine aBMD declined (p≤0.005). Cortical vBMD increased from 6 months onward (p<0.001) in association with declining PTH levels (p=0.004). Cortical thickness declined between 6 and 24 months (p=0.002) due to loss of endocortical bone. Total hip and femoral neck aBMD remained stable for 6 months, then improved through 24 months (p≤0.02). Ultra-distal radius aBMD declined throughout (p≤0.003). Higher BMI and ALMI were associated with gains in hip and spine aBMD and trabecular vBMD (all p≤0.02). Corticosteroid dose was negatively associated with changes in spine and hip aBMD and cortical and trabecular vBMD (all p≤0.02). Higher bone turnover markers and loss of cortical vBMD and thickness was associated with increases in serum calcium concentrations (p≤0.03).LIMITATIONSNot generalizable to older KTxp recipients.CONCLUSIONSSkeletal deficits in KTxp recipients largely stabilize or improve beyond 6 months, with the exception of progressive cortical thinning. Strategies are needed to preserve cortical bone prior to and following KTxp. Gains in BMI and ALMI may improve bone health in the weight-bearing skeleton following KTxp.
{"title":"Corticosteroid, Parathyroid Hormone, and Body Composition Associations With Bone Density and Structure Following Kidney Transplantation.","authors":"Susan L Ziolkowski,Jin Long,Thomas L Nickolas,Shaun Bender,Simin Goral,Babette S Zemel,Chamith S Rajapakse,Thomas Dienemann,Mary B Leonard","doi":"10.1053/j.ajkd.2025.10.005","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.10.005","url":null,"abstract":"RATIONALE & OBJECTIVEKidney transplantation ameliorates the underlying abnormalities contributing to skeletal fragility in CKD, but fracture rates increase following transplantation. This study sought to assess the impact of changes in body composition and mineral metabolism on bone mineral density (BMD) and structure following kidney KTxp.STUDY DESIGN24-month prospective cohort study.SETTING & PARTICIPANTS60 incident KTxp recipients and 361 healthy controls, ages 20-60 years.OUTCOMESTibia volumetric BMD (vBMD) and cortical dimensions measured using peripheral quantitative computerized tomography (pQCT), and areal BMD (aBMD) and appendicular lean mass index (ALMI) and fat mass index (FMI) measured using Dual-energy X-ray absorptiometry (DXA).ANALYTICAL APPROACHOutcomes were converted to sex-specific Z-scores for age and compared to 361 controls. Quasi-least squares regression models identified correlates of change.RESULTSAt baseline, ALMI, trabecular and cortical vBMD, cortical thickness, and total hip, femoral neck, and ultradistal radius aBMD were lower in KTxp vs. controls (p≤0.003). Over the first 6 months post-KTxp, ALMI, FMI, and body mass index (BMI) increased (p<0.001), while tibia trabecular vBMD and lumbar spine aBMD declined (p≤0.005). Cortical vBMD increased from 6 months onward (p<0.001) in association with declining PTH levels (p=0.004). Cortical thickness declined between 6 and 24 months (p=0.002) due to loss of endocortical bone. Total hip and femoral neck aBMD remained stable for 6 months, then improved through 24 months (p≤0.02). Ultra-distal radius aBMD declined throughout (p≤0.003). Higher BMI and ALMI were associated with gains in hip and spine aBMD and trabecular vBMD (all p≤0.02). Corticosteroid dose was negatively associated with changes in spine and hip aBMD and cortical and trabecular vBMD (all p≤0.02). Higher bone turnover markers and loss of cortical vBMD and thickness was associated with increases in serum calcium concentrations (p≤0.03).LIMITATIONSNot generalizable to older KTxp recipients.CONCLUSIONSSkeletal deficits in KTxp recipients largely stabilize or improve beyond 6 months, with the exception of progressive cortical thinning. Strategies are needed to preserve cortical bone prior to and following KTxp. Gains in BMI and ALMI may improve bone health in the weight-bearing skeleton following KTxp.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"5 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472770","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 : 2025-11-05DOI: 10.1053/j.ajkd.2025.09.007
Thomas Bais MD , Martijn J. de Groot MD, PhD , Esther Meijer MD, PhD
{"title":"In Reply to “Kidney Cysts in Alport Syndrome: Illustrative Cases, but Misleading Conclusions”","authors":"Thomas Bais MD , Martijn J. de Groot MD, PhD , Esther Meijer MD, PhD","doi":"10.1053/j.ajkd.2025.09.007","DOIUrl":"10.1053/j.ajkd.2025.09.007","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Page 135"},"PeriodicalIF":8.2,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145462016","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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