Pub Date : 2026-02-01Epub Date: 2025-12-04DOI: 10.1053/j.ajkd.2025.09.017
Daan P.C. van Doorn , Salwan Al-Nasiry , Marc E.A. Spaanderman , Jan G.M.C. Damoiseaux , Pieter van Paassen , Sjoerd A.M.E.G. Timmermans
Thrombotic microangiopathies (TMAs) are severe endotheliopathies that can arise in pregnancy and require early recognition. Complement-mediated (C-)TMA should be differentiated from other endotheliopathies of pregnancy because the treatment differs. Here, we report a case of a pregnant woman with acute kidney injury requiring hemodialysis due to C-TMA on the background of a pathogenic C3 variant at 28+5 weeks of gestation. The low soluble Fms-like tyrosine kinase-1 to placental growth factor (sFlt1/PlGF) ratio excluded pre-eclampsia. Eculizumab was started, and therapeutic drug monitoring was applied for optimal dosing. Despite prolonged hemodialysis, fetal well-being was preserved, and delivery was safely postponed till 34+3 weeks of gestation, resulting in a healthy neonate. We also separately report on sFlt1/PlGF ratios measured in a cohort of 11 patients with TMA and coexisting pregnancy. Ten of 11 patients (91%) had low sFlt1/PlGF ratios, excluding pre-eclampsia. Thus, successful pregnancy in women with C-TMA can occur, and sFlt1/PlGF ratios may aid in clarifying the diagnosis and appropriate treatment.
{"title":"Thrombotic Microangiopathy During Pregnancy: Role of Soluble Fms-like Tyrosine Kinase-1–Placental Growth Factor Ratios","authors":"Daan P.C. van Doorn , Salwan Al-Nasiry , Marc E.A. Spaanderman , Jan G.M.C. Damoiseaux , Pieter van Paassen , Sjoerd A.M.E.G. Timmermans","doi":"10.1053/j.ajkd.2025.09.017","DOIUrl":"10.1053/j.ajkd.2025.09.017","url":null,"abstract":"<div><div>Thrombotic microangiopathies (TMAs) are severe endotheliopathies that can arise in pregnancy and require early recognition. Complement-mediated (C-)TMA should be differentiated from other endotheliopathies of pregnancy because the treatment differs. Here, we report a case of a pregnant woman with acute kidney injury requiring hemodialysis due to C-TMA on the background of a pathogenic <em>C3</em> variant at 28+5 weeks of gestation. The low soluble Fms-like tyrosine kinase-1 to placental growth factor (sFlt1/PlGF) ratio excluded pre-eclampsia. Eculizumab was started, and therapeutic drug monitoring was applied for optimal dosing. Despite prolonged hemodialysis, fetal well-being was preserved, and delivery was safely postponed till 34+3 weeks of gestation, resulting in a healthy neonate. We also separately report on sFlt1/PlGF ratios measured in a cohort of 11 patients with TMA and coexisting pregnancy. Ten of 11 patients (91%) had low sFlt1/PlGF ratios, excluding pre-eclampsia. Thus, successful pregnancy in women with C-TMA can occur, and sFlt1/PlGF ratios may aid in clarifying the diagnosis and appropriate treatment.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 278-283"},"PeriodicalIF":8.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-19DOI: 10.1053/j.ajkd.2025.10.017
Volker H. Haase M.D. Dr. med., Nadiesda A. Costa M.D. M.P.H., Mark J. Koury M.D.
The clinical challenges and safety concerns associated with the use of erythropoiesis stimulating agents (ESAs) have provided the rationale for developing novel therapeutic approaches that address the complex pathophysiology of anemia in chronic kidney disease (CKD). Hypoxia-inducible factor-prolyl hydroxylase inhibitors (HIF-PHIs) are a new class of oral agents that effectively increase and maintain hemoglobin levels in patients with CKD. These agents stimulate the endogenous production of erythropoietin and enhance iron metabolism by activating hypoxia-inducible factors. Despite their efficacy, the use of some HIF-PHIs has been limited to patients on maintenance dialysis in some countries, including the United States, due to unresolved cardiovascular safety concerns in patients with CKD not on dialysis. In this review, we examine the mechanisms of action and erythropoietic effects of HIF-PHIs, evaluate undesirable on-target and off-target effects, and address cardiovascular and other safety concerns that have been raised in comparison to ESAs. We discuss how this novel class of oral anemia drugs may impact clinical practice, including their potential use in kidney transplant recipients.
{"title":"Navigating Anemia Therapy in CKD: The Role of Hypoxia-Inducible Factor Activators","authors":"Volker H. Haase M.D. Dr. med., Nadiesda A. Costa M.D. M.P.H., Mark J. Koury M.D.","doi":"10.1053/j.ajkd.2025.10.017","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.10.017","url":null,"abstract":"The clinical challenges and safety concerns associated with the use of erythropoiesis stimulating agents (ESAs) have provided the rationale for developing novel therapeutic approaches that address the complex pathophysiology of anemia in chronic kidney disease (CKD). Hypoxia-inducible factor-prolyl hydroxylase inhibitors (HIF-PHIs) are a new class of oral agents that effectively increase and maintain hemoglobin levels in patients with CKD. These agents stimulate the endogenous production of erythropoietin and enhance iron metabolism by activating hypoxia-inducible factors. Despite their efficacy, the use of some HIF-PHIs has been limited to patients on maintenance dialysis in some countries, including the United States, due to unresolved cardiovascular safety concerns in patients with CKD not on dialysis. In this review, we examine the mechanisms of action and erythropoietic effects of HIF-PHIs, evaluate undesirable on-target and off-target effects, and address cardiovascular and other safety concerns that have been raised in comparison to ESAs. We discuss how this novel class of oral anemia drugs may impact clinical practice, including their potential use in kidney transplant recipients.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146006430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.1053/j.ajkd.2025.11.007
Richard A Hirth,Paula A Guro,Ali Imtiaz,Mary K Oerline,John M Hollingsworth,Vahakn B Shahinian
RATIONALE & OBJECTIVEUnemployment is common among patients receiving maintenance dialysis, and peritoneal dialysis may better facilitate employment and employer-sponsored health insurance than hemodialysis. This study assessed the employment status of dialysis patients and examined the association between dialysis modality and the likelihood of insurance transitions after dialysis initiation, using employer-sponsored health insurance status as a proxy for patient or household employment.STUDY DESIGNNational retrospective cohort study.SETTING & PARTICIPANTSPatients represented in the United States Renal Data System who initiated dialysis between 1/1/2013-12/31/2018 and were followed for between 3 and 30 months. 18,408 in-center hemodialysis and peritoneal dialysis patients employed full-time at the time of dialysis initiation, with employer-sponsored health insurance three months post-dialysis, followed for loss of employer-sponsored health insurance. 104,952 in-center hemodialysis and peritoneal dialysis patients unemployed at the time of dialysis initiation and without employer-sponsored health insurance three months post-dialysis initiation, followed for initiation of employer-sponsored health insurance.EXPOSUREDialysis modality 3 months post-dialysis initiation, categorized as either in-center hemodialysis (IHD) with a hemodialysis fistula, IHD without a fistula, or peritoneal dialysis (PD) OUTCOMES: Employer-sponsored health insurance loss or gain.ANALYTICAL APPROACHCause-specific hazards modeling.RESULTSCompared to patients receiving PD, patients receiving IHD without a fistula (HR, 1.26 [95% CI, 1.18-1.36]) and with a fistula (HR, 1.14 [95% CI, 1.05-1.24]) were more likely to lose employer-sponsored health insurance. Compared to patients receiving PD, patients receiving IHD without a fistula (HR, 0.55 [95% CI, 0.49-0.61]) and with a fistula (HR, 0.59 [95% CI, 0.52-0.67]) were less likely to gain employer-sponsored insurance.LIMITATIONSEmployer-sponsored health insurance may not be a fully accurate proxy for employment status. Potential for residual confounding.CONCLUSIONSPeritoneal dialysis was associated with higher probabilities of maintaining and gaining employer-sponsored health insurance after dialysis initiation, compared to in-center hemodialysis. These findings may inform policies that influence the uptake of peritoneal dialysis, potentially improving rates of employer-sponsored health insurance and employment among dialysis patients or their households.
{"title":"Changes in Employment Status After Initiation of Peritoneal and In-center Hemodialysis.","authors":"Richard A Hirth,Paula A Guro,Ali Imtiaz,Mary K Oerline,John M Hollingsworth,Vahakn B Shahinian","doi":"10.1053/j.ajkd.2025.11.007","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.11.007","url":null,"abstract":"RATIONALE & OBJECTIVEUnemployment is common among patients receiving maintenance dialysis, and peritoneal dialysis may better facilitate employment and employer-sponsored health insurance than hemodialysis. This study assessed the employment status of dialysis patients and examined the association between dialysis modality and the likelihood of insurance transitions after dialysis initiation, using employer-sponsored health insurance status as a proxy for patient or household employment.STUDY DESIGNNational retrospective cohort study.SETTING & PARTICIPANTSPatients represented in the United States Renal Data System who initiated dialysis between 1/1/2013-12/31/2018 and were followed for between 3 and 30 months. 18,408 in-center hemodialysis and peritoneal dialysis patients employed full-time at the time of dialysis initiation, with employer-sponsored health insurance three months post-dialysis, followed for loss of employer-sponsored health insurance. 104,952 in-center hemodialysis and peritoneal dialysis patients unemployed at the time of dialysis initiation and without employer-sponsored health insurance three months post-dialysis initiation, followed for initiation of employer-sponsored health insurance.EXPOSUREDialysis modality 3 months post-dialysis initiation, categorized as either in-center hemodialysis (IHD) with a hemodialysis fistula, IHD without a fistula, or peritoneal dialysis (PD) OUTCOMES: Employer-sponsored health insurance loss or gain.ANALYTICAL APPROACHCause-specific hazards modeling.RESULTSCompared to patients receiving PD, patients receiving IHD without a fistula (HR, 1.26 [95% CI, 1.18-1.36]) and with a fistula (HR, 1.14 [95% CI, 1.05-1.24]) were more likely to lose employer-sponsored health insurance. Compared to patients receiving PD, patients receiving IHD without a fistula (HR, 0.55 [95% CI, 0.49-0.61]) and with a fistula (HR, 0.59 [95% CI, 0.52-0.67]) were less likely to gain employer-sponsored insurance.LIMITATIONSEmployer-sponsored health insurance may not be a fully accurate proxy for employment status. Potential for residual confounding.CONCLUSIONSPeritoneal dialysis was associated with higher probabilities of maintaining and gaining employer-sponsored health insurance after dialysis initiation, compared to in-center hemodialysis. These findings may inform policies that influence the uptake of peritoneal dialysis, potentially improving rates of employer-sponsored health insurance and employment among dialysis patients or their households.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"5 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994876","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}
This case report investigates the genetic basis of collagenofibrotic glomerulopathy (CG), a type of collagen type III glomerulopathy. It is a rare kidney disease characterized by collagen III deposition. A 47-year-old man with CG, born to consanguineous parents, underwent whole-exome sequencing. A homozygous truncating variant in STAB2 and a heterozygous variant in STAB1 were identified. Neither of the proteins encoded by STAB2 and STAB1 was expressed in the kidney glomeruli, suggesting a systemic mechanism for CG development. The patient's mother and brother, with homozygous or heterozygous STAB1 and heterozygous STAB2 variants, were unaffected. These observations suggest that the homozygous truncating variant of STAB2 was crucial for CG in our patient. This study provides initial evidence implicating STAB1 and STAB2 in CG pathogenesis. Further studies are needed to confirm the present findings, elucidate the roles of stabilin-1 and stabilin-2 in CG, and investigate their potential for systemic involvement.
{"title":"Collagenofibrotic Glomerulopathy Associated With Homozygous STAB2 and Heterozygous STAB1 Variants: A Case Report.","authors":"Satoko Yamamoto,Jun-Ya Kaimori,Daisuke Motooka,Hirofumi Taniguchi,Ghahei Lee,Masataka Inoue,Tomoka Imanaka,Seiichi Yasuda,Kenji Nishimura,Nobuyuki Kajiwara,Yuki Kawano,Yohei Doi,Tatsufumi Oka,Yusuke Sakaguchi,Yoshitaka Isaka","doi":"10.1053/j.ajkd.2025.10.016","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.10.016","url":null,"abstract":"This case report investigates the genetic basis of collagenofibrotic glomerulopathy (CG), a type of collagen type III glomerulopathy. It is a rare kidney disease characterized by collagen III deposition. A 47-year-old man with CG, born to consanguineous parents, underwent whole-exome sequencing. A homozygous truncating variant in STAB2 and a heterozygous variant in STAB1 were identified. Neither of the proteins encoded by STAB2 and STAB1 was expressed in the kidney glomeruli, suggesting a systemic mechanism for CG development. The patient's mother and brother, with homozygous or heterozygous STAB1 and heterozygous STAB2 variants, were unaffected. These observations suggest that the homozygous truncating variant of STAB2 was crucial for CG in our patient. This study provides initial evidence implicating STAB1 and STAB2 in CG pathogenesis. Further studies are needed to confirm the present findings, elucidate the roles of stabilin-1 and stabilin-2 in CG, and investigate their potential for systemic involvement.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"22 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-15DOI: 10.1053/j.ajkd.2025.11.008
Wei Lin,Alexander R Chang,Deidra C Crews,Tanjala S Purnell,Lawrence J Appel,Junichi Ishigami,
RATIONALE & OBJECTIVEKidney disease is often clustered within families, including Black families, and could be due in part to shared adverse social determinants of health (SDoH) and/or genetic factors. We hypothesize that the association between family history of kidney failure and chronic kidney disease (CKD) progression is largely attenuated when adjusting for adverse SDoH and apolipoprotein L1 (APOL1) risk allele.STUDY DESIGNLongitudinal observational study.SETTING & PARTICIPANTS5,623 participants from Chronic Renal Insufficiency Cohort (CRIC) Study.EXPOSURESelf-reported family history of kidney failure defined as a first-degree relative treated for kidney failure with dialysis or transplantation.OUTCOMECKD progression defined as incident end-stage kidney disease or 50% decline in estimated glomerular filtration rate (eGFR) from baseline.ANALYTICAL APPROACHLogistic regression models were fitted to estimate adjusted odds ratios (aORs) of the outcome of family history of kidney failure according to the main exposures of race-ethnicity/APOL1 risk allele status and SDoH. Next, Cox proportional hazards models were fitted to assess the association of family history of kidney failure with the outcome of CKD progression.RESULTSAmong all participants (mean (SD) age 59.6±10.7 years; 44% female; 43% Black race), 948 (17%) reported a family history of kidney failure. Compared to White participants, Black participants were more likely to report a family history of kidney failure regardless of APOL1 status (aOR =2.25 (95% CI: 1.74-2.91) for 0 or 1 risk allele; and aOR=3.46 (95% CI: 2.39-5.02) for 2 risk alleles). Adverse SDoH, such as lower income and lower educational attainment, were positively associated with family history of kidney failure in unadjusted analyses, but not in multivariable models. In prospective analysis, family history of kidney failure was significantly associated with an increased risk of CKD progression in both crude (HR, 1.33, 95% CI: 1.19-1.49) and multivariable models adjusting for demographics, APOL1 risk allele status, SDoH, and clinical factors (HR, 1.16, 95% CI: 1.02-1.33).LIMITATIONSPossible residual confounding.CONCLUSIONAmong people with CKD, Black race was significantly associated with a family history of kidney failure, even in those without the high risk APOL1 allele status. After adjusting for SDoH and APOL1 status, the family history of kidney failure remained associated with the risk of CKD progression. These findings highlight the importance of collecting information on family history and the need for further efforts to understand the reasons for familial aggregation of CKD.
{"title":"Family History of Kidney Failure, APOL-1 Risk Variants, Social Determinants of Health, and Risk of CKD Progression: Findings From the CRIC Study.","authors":"Wei Lin,Alexander R Chang,Deidra C Crews,Tanjala S Purnell,Lawrence J Appel,Junichi Ishigami, ","doi":"10.1053/j.ajkd.2025.11.008","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.11.008","url":null,"abstract":"RATIONALE & OBJECTIVEKidney disease is often clustered within families, including Black families, and could be due in part to shared adverse social determinants of health (SDoH) and/or genetic factors. We hypothesize that the association between family history of kidney failure and chronic kidney disease (CKD) progression is largely attenuated when adjusting for adverse SDoH and apolipoprotein L1 (APOL1) risk allele.STUDY DESIGNLongitudinal observational study.SETTING & PARTICIPANTS5,623 participants from Chronic Renal Insufficiency Cohort (CRIC) Study.EXPOSURESelf-reported family history of kidney failure defined as a first-degree relative treated for kidney failure with dialysis or transplantation.OUTCOMECKD progression defined as incident end-stage kidney disease or 50% decline in estimated glomerular filtration rate (eGFR) from baseline.ANALYTICAL APPROACHLogistic regression models were fitted to estimate adjusted odds ratios (aORs) of the outcome of family history of kidney failure according to the main exposures of race-ethnicity/APOL1 risk allele status and SDoH. Next, Cox proportional hazards models were fitted to assess the association of family history of kidney failure with the outcome of CKD progression.RESULTSAmong all participants (mean (SD) age 59.6±10.7 years; 44% female; 43% Black race), 948 (17%) reported a family history of kidney failure. Compared to White participants, Black participants were more likely to report a family history of kidney failure regardless of APOL1 status (aOR =2.25 (95% CI: 1.74-2.91) for 0 or 1 risk allele; and aOR=3.46 (95% CI: 2.39-5.02) for 2 risk alleles). Adverse SDoH, such as lower income and lower educational attainment, were positively associated with family history of kidney failure in unadjusted analyses, but not in multivariable models. In prospective analysis, family history of kidney failure was significantly associated with an increased risk of CKD progression in both crude (HR, 1.33, 95% CI: 1.19-1.49) and multivariable models adjusting for demographics, APOL1 risk allele status, SDoH, and clinical factors (HR, 1.16, 95% CI: 1.02-1.33).LIMITATIONSPossible residual confounding.CONCLUSIONAmong people with CKD, Black race was significantly associated with a family history of kidney failure, even in those without the high risk APOL1 allele status. After adjusting for SDoH and APOL1 status, the family history of kidney failure remained associated with the risk of CKD progression. These findings highlight the importance of collecting information on family history and the need for further efforts to understand the reasons for familial aggregation of CKD.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"83 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145993040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-14DOI: 10.1053/j.ajkd.2025.09.026
Wendy Wen Qing Ye,Joanne M Bargman,Jeffrey Perl
Since its introduction in 1985, Kt/V urea has played a pivotal role as a marker of "dialysis adequacy". Over the decades, multiple clinical practice guidelines have adopted and subsequently relaxed Kt/V targets, which were then transformed into quality metrics in various healthcare systems, including the United States. In this perspective, we explore the historical origins of Kt/V, focusing on its adaptation to peritoneal dialysis (PD). We critically examine literature linking Kt/V to patient outcomes and explore the limitations of Kt/V-including reliance on urea removal alone as a surrogate for the clearance of all uremic toxins, the flawed assumption of equivalence between residual kidney and dialytic urea clearances, and the challenges in estimating the volume of distribution of urea. We propose alternative quality metrics that may better reflect meaningful patient outcomes such as preserving residual kidney function, optimizing nutrition and volume status, minimizing dialysis-related infections, and maintaining quality of life. Ultimately, we call for a shift away from Kt/V-centric quality frameworks and the concept of "adequate" dialysis, advocating instead for a more holistic model of high-quality, person-centered dialysis care; a model in which kidney care practitioners are empowered to provide high quality PD care without the constraints of Kt/V.
{"title":"Free to Be in Peritoneal Dialysis: Without Kt/V?","authors":"Wendy Wen Qing Ye,Joanne M Bargman,Jeffrey Perl","doi":"10.1053/j.ajkd.2025.09.026","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.09.026","url":null,"abstract":"Since its introduction in 1985, Kt/V urea has played a pivotal role as a marker of \"dialysis adequacy\". Over the decades, multiple clinical practice guidelines have adopted and subsequently relaxed Kt/V targets, which were then transformed into quality metrics in various healthcare systems, including the United States. In this perspective, we explore the historical origins of Kt/V, focusing on its adaptation to peritoneal dialysis (PD). We critically examine literature linking Kt/V to patient outcomes and explore the limitations of Kt/V-including reliance on urea removal alone as a surrogate for the clearance of all uremic toxins, the flawed assumption of equivalence between residual kidney and dialytic urea clearances, and the challenges in estimating the volume of distribution of urea. We propose alternative quality metrics that may better reflect meaningful patient outcomes such as preserving residual kidney function, optimizing nutrition and volume status, minimizing dialysis-related infections, and maintaining quality of life. Ultimately, we call for a shift away from Kt/V-centric quality frameworks and the concept of \"adequate\" dialysis, advocating instead for a more holistic model of high-quality, person-centered dialysis care; a model in which kidney care practitioners are empowered to provide high quality PD care without the constraints of Kt/V.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"38 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-10-10DOI: 10.1053/j.ajkd.2025.08.010
Saba Saleem , Caroline Stigant , Tasleem Rajan , Kasun Hewage , Rehan Sadiq , Andrea J. MacNeill , Christopher Nguan
<div><h3>Rationale & Objective</h3><div>Health care delivery is associated with considerable emissions of greenhouse gases and other pollutants. Although the relative health and economic impacts of kidney replacement therapies (KRTs) have been examined, their comparative environmental impacts have been poorly described. This study sought to characterize these impacts, comparing them across types of KRT.</div></div><div><h3>Study Design</h3><div>A comparative lifecycle assessment (LCA).</div></div><div><h3>Setting & Participants</h3><div>Data collection implemented at Vancouver General Hospital in Vancouver, British Columbia, Canada.</div></div><div><h3>Exposure</h3><div>Three KRTs: deceased-donor kidney transplant (KT), automated/cycler peritoneal dialysis (PD), or in-center hemodialysis (HD).</div></div><div><h3>Outcome</h3><div>Environmental impacts of KRTs over 1 year were evaluated using the World ReCiPe (H) 2016 method.</div></div><div><h3>Analytical Approach</h3><div>Lifecycle inventory results were transformed into 3 end-point and 18 midpoint environmental impact categories including climate change, air pollution, human toxicity, and water depletion.</div></div><div><h3>Results</h3><div>Across the majority of environmental impact categories, including climate change, air pollution, human toxicity, and water depletion, HD had the highest environmental impact and KT the lowest. The climate impact from a patient receiving HD was 74% and 46% more than from patients receiving KT and PD, respectively. Similarly, HD accounted for 65% of total air pollution impacts, 54% of human toxicity, and 44% of water depletion. The highest impact of PD was on water depletion (41%) and metal depletion (81%). KT demonstrated the lowest impact across all categories except terrestrial ecotoxicity. Within each therapy, patient and staff travel and consumables were the largest contributors to greenhouse gas emissions.</div></div><div><h3>Limitations</h3><div>Pharmaceuticals were excluded from this study because of a lack of publicly available data.</div></div><div><h3>Conclusions</h3><div>KT is the most environmentally preferred KRT. PD had fewer environmental impacts than HD. Understanding the relative environmental impacts of KRTs can help inform clinical decision-making in the management of kidney failure.</div></div><div><h3>Plain-Language Summary</h3><div>The environmental impacts of health care are gaining attention, yet kidney care, and especially kidney replacement therapies (KRTs), have been underexamined. This study was inspired by growing concerns about the environmental consequences of KRTs like hemodialysis, peritoneal dialysis, and transplantation. We used environmental assessment tools to measure emissions and resource use across different KRTs in a clinical setting in Vancouver, Canada. We found that these therapies vary widely in their environmental impacts, with in-center hemodialysis having the greatest negative impact and kidney transpla
{"title":"Environmental Impacts of Kidney Replacement Therapies: A Comparative Lifecycle Assessment","authors":"Saba Saleem , Caroline Stigant , Tasleem Rajan , Kasun Hewage , Rehan Sadiq , Andrea J. MacNeill , Christopher Nguan","doi":"10.1053/j.ajkd.2025.08.010","DOIUrl":"10.1053/j.ajkd.2025.08.010","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Health care delivery is associated with considerable emissions of greenhouse gases and other pollutants. Although the relative health and economic impacts of kidney replacement therapies (KRTs) have been examined, their comparative environmental impacts have been poorly described. This study sought to characterize these impacts, comparing them across types of KRT.</div></div><div><h3>Study Design</h3><div>A comparative lifecycle assessment (LCA).</div></div><div><h3>Setting & Participants</h3><div>Data collection implemented at Vancouver General Hospital in Vancouver, British Columbia, Canada.</div></div><div><h3>Exposure</h3><div>Three KRTs: deceased-donor kidney transplant (KT), automated/cycler peritoneal dialysis (PD), or in-center hemodialysis (HD).</div></div><div><h3>Outcome</h3><div>Environmental impacts of KRTs over 1 year were evaluated using the World ReCiPe (H) 2016 method.</div></div><div><h3>Analytical Approach</h3><div>Lifecycle inventory results were transformed into 3 end-point and 18 midpoint environmental impact categories including climate change, air pollution, human toxicity, and water depletion.</div></div><div><h3>Results</h3><div>Across the majority of environmental impact categories, including climate change, air pollution, human toxicity, and water depletion, HD had the highest environmental impact and KT the lowest. The climate impact from a patient receiving HD was 74% and 46% more than from patients receiving KT and PD, respectively. Similarly, HD accounted for 65% of total air pollution impacts, 54% of human toxicity, and 44% of water depletion. The highest impact of PD was on water depletion (41%) and metal depletion (81%). KT demonstrated the lowest impact across all categories except terrestrial ecotoxicity. Within each therapy, patient and staff travel and consumables were the largest contributors to greenhouse gas emissions.</div></div><div><h3>Limitations</h3><div>Pharmaceuticals were excluded from this study because of a lack of publicly available data.</div></div><div><h3>Conclusions</h3><div>KT is the most environmentally preferred KRT. PD had fewer environmental impacts than HD. Understanding the relative environmental impacts of KRTs can help inform clinical decision-making in the management of kidney failure.</div></div><div><h3>Plain-Language Summary</h3><div>The environmental impacts of health care are gaining attention, yet kidney care, and especially kidney replacement therapies (KRTs), have been underexamined. This study was inspired by growing concerns about the environmental consequences of KRTs like hemodialysis, peritoneal dialysis, and transplantation. We used environmental assessment tools to measure emissions and resource use across different KRTs in a clinical setting in Vancouver, Canada. We found that these therapies vary widely in their environmental impacts, with in-center hemodialysis having the greatest negative impact and kidney transpla","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 65-74.e1"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub 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":"2026-01-01","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}
Pub Date : 2026-01-01Epub Date: 2025-12-18DOI: 10.1053/j.ajkd.2025.09.006
Telma Pais , José Oliveira da Costa , Mafalda Pinho , Dolores López-Presa , Sofia Jorge , José António Lopes , Joana Gameiro
{"title":"Purpura in a Patient With Nephritic Syndrome: A Quiz","authors":"Telma Pais , José Oliveira da Costa , Mafalda Pinho , Dolores López-Presa , Sofia Jorge , José António Lopes , Joana Gameiro","doi":"10.1053/j.ajkd.2025.09.006","DOIUrl":"10.1053/j.ajkd.2025.09.006","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages A21-A24"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-09-17DOI: 10.1053/j.ajkd.2025.08.006
Joshua D. Griffiths , Grace Ehidiamhen , Sergio Camilo Lopez-Garcia , Rachel Hubbard , Jackie Cook , Albert C.M. Ong
IFT140 is a component of the intraflagellar transport-complex A involved in retrograde ciliary trafficking of proteins into primary cilia. Monoallelic IFT140 variants have been identified as an important cause of adult-onset autosomal dominant polycystic kidney disease (ADPKD), accounting for ∼2% of prevalent cases. Patients with ADPKD-IFT140 usually present in later life with small numbers of large cysts and rarely develop kidney failure. Here, we report 3 genetically resolved cases of ADPKD-IFT140 diagnosed in childhood or infancy from 3 unrelated pedigrees with ages at presentation ranging from in utero to 14 years. Each pedigree had a different familial IFT140 variant, with no evidence of a second ADPKD gene variant on whole genome sequencing. All 3 children had normal kidney function and normal blood pressure, although 1 child presented initially with a high cyst burden in utero and had impaired function on a DMSA scan. Despite the negative family history, cascade screening of first-degree relatives revealed previously undiagnosed ADPKD with features typical of adult-onset ADPKD-IFT140. Our findings highlight the need to consider IFT140 as a potential cause of childhood early-onset ADPKD and expand the phenotypic spectrum of ADPKD-IFT140.
{"title":"Monoallelic IFT140 Variants Causing Childhood-Onset Autosomal Dominant Polycystic Kidney Disease","authors":"Joshua D. Griffiths , Grace Ehidiamhen , Sergio Camilo Lopez-Garcia , Rachel Hubbard , Jackie Cook , Albert C.M. Ong","doi":"10.1053/j.ajkd.2025.08.006","DOIUrl":"10.1053/j.ajkd.2025.08.006","url":null,"abstract":"<div><div><em>IFT140</em> is a component of the intraflagellar transport-complex A involved in retrograde ciliary trafficking of proteins into primary cilia. Monoallelic <em>IFT140</em> variants have been identified as an important cause of adult-onset autosomal dominant polycystic kidney disease (ADPKD), accounting for ∼2% of prevalent cases. Patients with ADPKD-<em>IFT140</em> usually present in later life with small numbers of large cysts and rarely develop kidney failure. Here, we report 3 genetically resolved cases of ADPKD-<em>IFT140</em> diagnosed in childhood or infancy from 3 unrelated pedigrees with ages at presentation ranging from in utero to 14 years. Each pedigree had a different familial <em>IFT140</em> variant, with no evidence of a second ADPKD gene variant on whole genome sequencing. All 3 children had normal kidney function and normal blood pressure, although 1 child presented initially with a high cyst burden in utero and had impaired function on a DMSA scan. Despite the negative family history, cascade screening of first-degree relatives revealed previously undiagnosed ADPKD with features typical of adult-onset ADPKD-<em>IFT140</em>. Our findings highlight the need to consider <em>IFT140</em> as a potential cause of childhood early-onset ADPKD and expand the phenotypic spectrum of ADPKD-<em>IFT140</em>.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 124-128"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145089840","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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