Pub Date : 2025-10-20DOI: 10.1053/j.ajkd.2025.08.005
Alvin H. Moss , Christine M. Corbett , Dale E. Lupu
{"title":"Supportive Care for Patients Receiving Maintenance Hemodialysis: Why Nephrologists Should Care and What They Can Do","authors":"Alvin H. Moss , Christine M. Corbett , Dale E. Lupu","doi":"10.1053/j.ajkd.2025.08.005","DOIUrl":"10.1053/j.ajkd.2025.08.005","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 5","pages":"Pages 579-581"},"PeriodicalIF":8.2,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145320635","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 : 2025-10-20DOI: 10.1053/j.ajkd.2025.09.002
Benjamin Catanese , Semra Ozdemir , Rasheeda K. Hall
{"title":"Choices Matter: Expanding the Quality of Shared Decision-Making for Older Adults With Advanced CKD","authors":"Benjamin Catanese , Semra Ozdemir , Rasheeda K. Hall","doi":"10.1053/j.ajkd.2025.09.002","DOIUrl":"10.1053/j.ajkd.2025.09.002","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 5","pages":"Pages 588-590"},"PeriodicalIF":8.2,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145320640","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 : 2025-10-20DOI: 10.1053/j.ajkd.2025.09.003
Pascale Khairallah , Elizabeth C. Lorenz , Puneet Sood
{"title":"Rethinking Transplant Care Through a Sex- and Gender-Based Lens","authors":"Pascale Khairallah , Elizabeth C. Lorenz , Puneet Sood","doi":"10.1053/j.ajkd.2025.09.003","DOIUrl":"10.1053/j.ajkd.2025.09.003","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 5","pages":"Pages 582-584"},"PeriodicalIF":8.2,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145320638","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 : 2025-10-17DOI: 10.1053/j.ajkd.2025.09.005
Lin Zhuo , Baixue Zhang , Yi Huang , Qiaorui Wen , Shengfeng Wang , Siyan Zhan , Houyu Zhao
<div><h3>Rationale & Objective</h3><div>The impact of influenza vaccination on the risk of acute kidney injury (AKI) has not been thoroughly evaluated in large-scale prospective studies. We assessed whether influenza vaccination was associated with a reduced incidence of AKI among individuals aged 65 years or older.</div></div><div><h3>Study Design</h3><div>Target trial emulated with a sequential trial design.</div></div><div><h3>Setting & Participants</h3><div>Participants aged 65 years or older in the UK Biobank.</div></div><div><h3>Exposure</h3><div>Influenza vaccination compared with no influenza vaccine.</div></div><div><h3>Outcome</h3><div>Incident AKI during 1 year after vaccination. Participants were followed from baseline until the diagnosis of AKI, death, loss to follow-up, or for 1 year after entering the study, whichever occurred first.</div></div><div><h3>Analytical Approach</h3><div>Fifty trials were emulated, each with a 1-month enrollment period. These trials began in September 2007 and continued from September to January of the following year until January 2017. Eligible participants could be included in multiple trials until they no longer met the inclusion criteria. Propensity score matching was applied to match vaccine recipients to unvaccinated individuals in a 1:1 ratio to control for confounders, emulating random assignment. A clustered marginal competing risk model that accounts for the within-pair clustering of outcomes was fit to estimate the hazard ratio, along with the 95% confidence interval, characterizing the association between the use of influenza vaccination and incident AKI.</div></div><div><h3>Results</h3><div>Overall, the cohort included 1,408,922 eligible person-trials in the general practice data. After propensity score matching, 97,663 pairs of person-trials were included. During the 1-year follow-up, a total of 598 incident AKI events were observed. In the primary analysis, the incidence of AKI was 36.8 per 10,000 person-years (PYs) in unvaccinated participants and 30.6 per 10,000 PYs in the vaccinated group. After adjusting for potential confounders using propensity score matching, influenza vaccination was associated with a 17% lower AKI risk (HR, 0.83 [95% CI, 0.71-0.98]). The cumulative mortality rates were 62.8 per 10,000 PYs in the unvaccinated group and 47.2 per 10,000 PYs in the vaccinated group, corresponding to an HR of 0.75 (95% CI, 0.66-0.85). These findings remained consistent in subgroup and sensitivity analyses.</div></div><div><h3>Limitations</h3><div>Potential residual confounding from variations in vaccine formulations and batch; potential selection bias from restricting to participants with linked primary care data in the UK Biobank; and potential outcome misclassification from use of a code-based algorithm to identify AKI.</div></div><div><h3>Conclusions</h3><div>In this prospective population-based study of older adults within the UK Biobank, influenza vaccination was significa
{"title":"Association of Influenza Vaccination With Acute Kidney Injury: A Prospective Target Trial Emulation Study","authors":"Lin Zhuo , Baixue Zhang , Yi Huang , Qiaorui Wen , Shengfeng Wang , Siyan Zhan , Houyu Zhao","doi":"10.1053/j.ajkd.2025.09.005","DOIUrl":"10.1053/j.ajkd.2025.09.005","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>The impact of influenza vaccination on the risk of acute kidney injury (AKI) has not been thoroughly evaluated in large-scale prospective studies. We assessed whether influenza vaccination was associated with a reduced incidence of AKI among individuals aged 65 years or older.</div></div><div><h3>Study Design</h3><div>Target trial emulated with a sequential trial design.</div></div><div><h3>Setting & Participants</h3><div>Participants aged 65 years or older in the UK Biobank.</div></div><div><h3>Exposure</h3><div>Influenza vaccination compared with no influenza vaccine.</div></div><div><h3>Outcome</h3><div>Incident AKI during 1 year after vaccination. Participants were followed from baseline until the diagnosis of AKI, death, loss to follow-up, or for 1 year after entering the study, whichever occurred first.</div></div><div><h3>Analytical Approach</h3><div>Fifty trials were emulated, each with a 1-month enrollment period. These trials began in September 2007 and continued from September to January of the following year until January 2017. Eligible participants could be included in multiple trials until they no longer met the inclusion criteria. Propensity score matching was applied to match vaccine recipients to unvaccinated individuals in a 1:1 ratio to control for confounders, emulating random assignment. A clustered marginal competing risk model that accounts for the within-pair clustering of outcomes was fit to estimate the hazard ratio, along with the 95% confidence interval, characterizing the association between the use of influenza vaccination and incident AKI.</div></div><div><h3>Results</h3><div>Overall, the cohort included 1,408,922 eligible person-trials in the general practice data. After propensity score matching, 97,663 pairs of person-trials were included. During the 1-year follow-up, a total of 598 incident AKI events were observed. In the primary analysis, the incidence of AKI was 36.8 per 10,000 person-years (PYs) in unvaccinated participants and 30.6 per 10,000 PYs in the vaccinated group. After adjusting for potential confounders using propensity score matching, influenza vaccination was associated with a 17% lower AKI risk (HR, 0.83 [95% CI, 0.71-0.98]). The cumulative mortality rates were 62.8 per 10,000 PYs in the unvaccinated group and 47.2 per 10,000 PYs in the vaccinated group, corresponding to an HR of 0.75 (95% CI, 0.66-0.85). These findings remained consistent in subgroup and sensitivity analyses.</div></div><div><h3>Limitations</h3><div>Potential residual confounding from variations in vaccine formulations and batch; potential selection bias from restricting to participants with linked primary care data in the UK Biobank; and potential outcome misclassification from use of a code-based algorithm to identify AKI.</div></div><div><h3>Conclusions</h3><div>In this prospective population-based study of older adults within the UK Biobank, influenza vaccination was significa","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 75-86.e1"},"PeriodicalIF":8.2,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145319219","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 : 2025-10-17DOI: 10.1053/j.ajkd.2025.08.013
Ladan Zand , Fernando C. Fervenza , Sanjeev Sethi
Membranous nephropathy (MN) is one of the most common causes of nephrotic syndrome in adults and can be seen in association with other diseases, including malignancy, drugs, infections, or autoimmune diseases. Over the last decade, great progress has been made in understanding the pathogenesis of the disease, resulting from the discovery of several target antigens by use of laser microdissection/mass spectrometry methodology. This technique has proven to be the most sensitive method available and has the advantage of testing for all the target antigens at one time. The discovery of these target antigens has now shifted the classification of MN from primary versus secondary to classification based on the target antigen identified. Each target antigen has its own specific clinical characteristics and known associated diseases. Identification of the target antigen can help further identify the underlying cause for a more targeted approach in looking for associated diseases. Progress has also been made in the treatment of patients with MN, with more standard risk stratification of the patients and a shift in using anti-CD20 drugs as the first line for those with moderate and high risk of progression. Trials are ongoing to further investigate the role of anti-plasma cell, anticomplement, and CAR-T (chimeric antigen receptor T-cell) therapies.
{"title":"What’s New in Membranous Nephropathy and How to Incorporate New Antigen Discoveries Into Clinical Practice: A Review","authors":"Ladan Zand , Fernando C. Fervenza , Sanjeev Sethi","doi":"10.1053/j.ajkd.2025.08.013","DOIUrl":"10.1053/j.ajkd.2025.08.013","url":null,"abstract":"<div><div>Membranous nephropathy (MN) is one of the most common causes of nephrotic syndrome in adults and can be seen in association with other diseases, including malignancy, drugs, infections, or autoimmune diseases. Over the last decade, great progress has been made in understanding the pathogenesis of the disease, resulting from the discovery of several target antigens by use of laser microdissection/mass spectrometry methodology. This technique has proven to be the most sensitive method available and has the advantage of testing for all the target antigens at one time. The discovery of these target antigens has now shifted the classification of MN from primary versus secondary to classification based on the target antigen identified. Each target antigen has its own specific clinical characteristics and known associated diseases. Identification of the target antigen can help further identify the underlying cause for a more targeted approach in looking for associated diseases. Progress has also been made in the treatment of patients with MN, with more standard risk stratification of the patients and a shift in using anti-CD20 drugs as the first line for those with moderate and high risk of progression. Trials are ongoing to further investigate the role of anti-plasma cell, anticomplement, and CAR-T (chimeric antigen receptor T-cell) therapies.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 93-101"},"PeriodicalIF":8.2,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145319221","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 : 2025-10-16DOI: 10.1053/j.ajkd.2025.08.011
Anne-Laure Faucon , Stefania Lando , Shunsuke Murata , Morgan E. Grams , Edouard L. Fu , Frida Welander , Nazleen F. Khan , G. Brandon Atkins , Irina Barash , Dena R. Ramey , Karin Modig , Marie Evans , Juan-Jesús Carrero
<div><h3>Rationale & Objective</h3><div>Patients with advanced chronic kidney disease (CKD) have an excess risk of cardiovascular and bleeding events, but trends in the rates of these events have yet to be fully investigated. This study focused on characterizing them in Sweden.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>All patients with advanced CKD enrolled by nephrologists in a nationwide Swedish Renal Registry between 2011 and 2021.</div></div><div><h3>Exposure</h3><div>Stage G4 CKD (N = 25,591), nondialysis stage G5 CKD (ND-CKD, N = 13,968), supported by hemodialysis (N = 10,635), or supported by peritoneal dialysis (N = 4,511).</div></div><div><h3>Outcome</h3><div>Major adverse cardiovascular events (MACE), arterial and venous thromboembolic events, major and non-major clinically-relevant bleeding.</div></div><div><h3>Analytical Approach</h3><div>Patients were followed until an outcome event, death, or progression to a more severe CKD-stage/change of dialysis modality. Poisson models to estimate unadjusted incidence rates and standardized incidence rate ratios were computed using indirect standardization based on the observed rates in the age- and sex- matched general population.</div></div><div><h3>Results</h3><div>The rates of all study outcomes were greater with more severe stages of CKD; by 2021, the rates of these outcomes were 1.4 to 13.6 times higher than in the general population. Between 2011 and 2021, patients with advanced CKD experienced important reductions in the rates of MACE and arterial and venous thromboembolic events (as much as 39%, 28%, and 57%, respectively), with larger declines than those observed for the general population. Major bleeding rates also decreased (up to 12%), but non-major bleeding markedly increased, especially in ND-CKD (from 42% to 69%). The decreases in MACE as well as arterial and venous events were comparable for men and women (except for a greater reduction in arterial events in men than in women, <em>P</em> = 0.03). The increase in non-major bleeding rates was greater in women than in men (<em>P</em> = 0.02).</div></div><div><h3>Limitations</h3><div>Outcomes based on diagnostic codes; unknown generalizability to other countries.</div></div><div><h3>Conclusions</h3><div>Although there have been important reductions in the rates of cardiovascular events and major bleeding events in patients with advanced CKD, the event rates remain substantially higher than in the general population, indicating a need for additional strategies to minimize these risks.</div></div><div><h3>Plain-Language Summary</h3><div>We explored rates and trends of cardiovascular and bleeding events in Swedish patients with advanced CKD between 2011 and 2021. Cardiovascular and bleeding events were 1.5 to 11.1 times more common in patients with CKD than in the general population. However, over time there has been a significant reduction in the
{"title":"Trends in Major Cardiovascular Events and Bleeding Among Patients With Advanced CKD: A Nationwide Swedish Study","authors":"Anne-Laure Faucon , Stefania Lando , Shunsuke Murata , Morgan E. Grams , Edouard L. Fu , Frida Welander , Nazleen F. Khan , G. Brandon Atkins , Irina Barash , Dena R. Ramey , Karin Modig , Marie Evans , Juan-Jesús Carrero","doi":"10.1053/j.ajkd.2025.08.011","DOIUrl":"10.1053/j.ajkd.2025.08.011","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Patients with advanced chronic kidney disease (CKD) have an excess risk of cardiovascular and bleeding events, but trends in the rates of these events have yet to be fully investigated. This study focused on characterizing them in Sweden.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>All patients with advanced CKD enrolled by nephrologists in a nationwide Swedish Renal Registry between 2011 and 2021.</div></div><div><h3>Exposure</h3><div>Stage G4 CKD (N = 25,591), nondialysis stage G5 CKD (ND-CKD, N = 13,968), supported by hemodialysis (N = 10,635), or supported by peritoneal dialysis (N = 4,511).</div></div><div><h3>Outcome</h3><div>Major adverse cardiovascular events (MACE), arterial and venous thromboembolic events, major and non-major clinically-relevant bleeding.</div></div><div><h3>Analytical Approach</h3><div>Patients were followed until an outcome event, death, or progression to a more severe CKD-stage/change of dialysis modality. Poisson models to estimate unadjusted incidence rates and standardized incidence rate ratios were computed using indirect standardization based on the observed rates in the age- and sex- matched general population.</div></div><div><h3>Results</h3><div>The rates of all study outcomes were greater with more severe stages of CKD; by 2021, the rates of these outcomes were 1.4 to 13.6 times higher than in the general population. Between 2011 and 2021, patients with advanced CKD experienced important reductions in the rates of MACE and arterial and venous thromboembolic events (as much as 39%, 28%, and 57%, respectively), with larger declines than those observed for the general population. Major bleeding rates also decreased (up to 12%), but non-major bleeding markedly increased, especially in ND-CKD (from 42% to 69%). The decreases in MACE as well as arterial and venous events were comparable for men and women (except for a greater reduction in arterial events in men than in women, <em>P</em> = 0.03). The increase in non-major bleeding rates was greater in women than in men (<em>P</em> = 0.02).</div></div><div><h3>Limitations</h3><div>Outcomes based on diagnostic codes; unknown generalizability to other countries.</div></div><div><h3>Conclusions</h3><div>Although there have been important reductions in the rates of cardiovascular events and major bleeding events in patients with advanced CKD, the event rates remain substantially higher than in the general population, indicating a need for additional strategies to minimize these risks.</div></div><div><h3>Plain-Language Summary</h3><div>We explored rates and trends of cardiovascular and bleeding events in Swedish patients with advanced CKD between 2011 and 2021. Cardiovascular and bleeding events were 1.5 to 11.1 times more common in patients with CKD than in the general population. However, over time there has been a significant reduction in the","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 31-43.e1"},"PeriodicalIF":8.2,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314622","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 : 2025-10-16DOI: 10.1053/j.ajkd.2025.08.012
Jessica Potts , Camille M. Pearse , Mark Lambie , James Fotheringham , Harry Hill , David Coyle , Sarah Damery , Kerry Allen , Iestyn Williams , Simon J. Davies , Ivonne Solis-Trapala
<div><h3>Rationale & Objective</h3><div>Variation in home dialysis therapy (HT) use across centers and geography may reflect the interplay between dialysis center services and patient characteristics. We examined direct and indirect associations between these factors and HT uptake in England.</div></div><div><h3>Study Design</h3><div>UK Renal Registry (UKRR) cohort linked to a national survey of renal centers.</div></div><div><h3>Setting & Participants</h3><div>Adults who initiated kidney replacement therapy (KRT) between 2015 and 2019 at 51 English renal centers, totaling 32,400 individuals identified through the UKRR with center practices captured from a 2022 national survey of dialysis centers.</div></div><div><h3>Exposure</h3><div>Patient-level (demographics and clinical characteristics) and center-level (including availability of assisted peritoneal dialysis, quality improvement initiatives, and fostering staff engagement in research) factors.</div></div><div><h3>Outcome</h3><div>Use of HT (home hemodialysis or peritoneal dialysis) within 1 year of starting KRT.</div></div><div><h3>Analytical Approach</h3><div>Sequences of regressions, an extension of path analysis, used to examine direct and indirect associations between patient-level and center-level factors and the probability of HT uptake.</div></div><div><h3>Results</h3><div>Both center-level and patient-level factors were significantly associated with the probability of HT uptake. Patients at centers conducting quality improvement projects (odds ratio [OR], 1.94 [95% CI, 1.36-2.76]), offering assisted peritoneal dialysis (OR, 1.89 [95% CI, 1.39-2.57]), fostering staff research engagement (OR, 1.35 [95% CI, 1.03-1.77]), or hosting HT roadshows (OR, 1.22 [95% CI, 1.05-1.41]) had higher odds of HT uptake. Centers with greater stress on staff capacity to deliver HT had lower uptake (OR, 0.60 [95% CI, 0.45-0.81]). Patients on transplant lists at KRT start (OR, 2.55 [95% CI, 2.35-2.77]) or who lived farther from a treatment center (OR, 1.10 [95% CI, 1.08-1.12] per 10 km) had higher odds of HT uptake. Patients living in areas of higher deprivation or members of minoritized ethnic groups had lower HT uptake overall. However, some of these associations may have been indirectly mitigated in centers serving more diverse populations because these centers were more likely to implement practices associated with higher HT uptake.</div></div><div><h3>Limitations</h3><div>Health care professional–reported and aggregated survey data.</div></div><div><h3>Conclusions</h3><div>This study identified modifiable center-level factors associated with HT uptake, informing potential opportunities to reduce ethnic and area-level disparities.</div></div><div><h3>Plain-Language Summary</h3><div>Some patients are less likely to use home dialysis, possibly due to both patient characteristics and how dialysis centers operate. We studied over 32,000 patients who began kidney replacement therapy between 2015 and
{"title":"Patient and Center Factors in Home Dialysis Therapy Uptake: Analysis of a UK Renal Registry Cohort and a National Dialysis Center Survey","authors":"Jessica Potts , Camille M. Pearse , Mark Lambie , James Fotheringham , Harry Hill , David Coyle , Sarah Damery , Kerry Allen , Iestyn Williams , Simon J. Davies , Ivonne Solis-Trapala","doi":"10.1053/j.ajkd.2025.08.012","DOIUrl":"10.1053/j.ajkd.2025.08.012","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Variation in home dialysis therapy (HT) use across centers and geography may reflect the interplay between dialysis center services and patient characteristics. We examined direct and indirect associations between these factors and HT uptake in England.</div></div><div><h3>Study Design</h3><div>UK Renal Registry (UKRR) cohort linked to a national survey of renal centers.</div></div><div><h3>Setting & Participants</h3><div>Adults who initiated kidney replacement therapy (KRT) between 2015 and 2019 at 51 English renal centers, totaling 32,400 individuals identified through the UKRR with center practices captured from a 2022 national survey of dialysis centers.</div></div><div><h3>Exposure</h3><div>Patient-level (demographics and clinical characteristics) and center-level (including availability of assisted peritoneal dialysis, quality improvement initiatives, and fostering staff engagement in research) factors.</div></div><div><h3>Outcome</h3><div>Use of HT (home hemodialysis or peritoneal dialysis) within 1 year of starting KRT.</div></div><div><h3>Analytical Approach</h3><div>Sequences of regressions, an extension of path analysis, used to examine direct and indirect associations between patient-level and center-level factors and the probability of HT uptake.</div></div><div><h3>Results</h3><div>Both center-level and patient-level factors were significantly associated with the probability of HT uptake. Patients at centers conducting quality improvement projects (odds ratio [OR], 1.94 [95% CI, 1.36-2.76]), offering assisted peritoneal dialysis (OR, 1.89 [95% CI, 1.39-2.57]), fostering staff research engagement (OR, 1.35 [95% CI, 1.03-1.77]), or hosting HT roadshows (OR, 1.22 [95% CI, 1.05-1.41]) had higher odds of HT uptake. Centers with greater stress on staff capacity to deliver HT had lower uptake (OR, 0.60 [95% CI, 0.45-0.81]). Patients on transplant lists at KRT start (OR, 2.55 [95% CI, 2.35-2.77]) or who lived farther from a treatment center (OR, 1.10 [95% CI, 1.08-1.12] per 10 km) had higher odds of HT uptake. Patients living in areas of higher deprivation or members of minoritized ethnic groups had lower HT uptake overall. However, some of these associations may have been indirectly mitigated in centers serving more diverse populations because these centers were more likely to implement practices associated with higher HT uptake.</div></div><div><h3>Limitations</h3><div>Health care professional–reported and aggregated survey data.</div></div><div><h3>Conclusions</h3><div>This study identified modifiable center-level factors associated with HT uptake, informing potential opportunities to reduce ethnic and area-level disparities.</div></div><div><h3>Plain-Language Summary</h3><div>Some patients are less likely to use home dialysis, possibly due to both patient characteristics and how dialysis centers operate. We studied over 32,000 patients who began kidney replacement therapy between 2015 and ","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 53-64.e1"},"PeriodicalIF":8.2,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314603","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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