Pub Date : 2025-01-01DOI: 10.1053/j.ajkd.2024.05.013
Anne-Laure Faucon , Catherine M. Clase , Helena Rydell , Milica Uhde , Peter Barany , Marie Evans , Juan-Jesús Carrero
<div><h3>Rationale & Objective</h3><div>Pruritus is a common but not well-characterized complaint of patients receiving maintenance dialysis. This study sought to quantify the burden of pruritus and its associated adverse health outcomes in this population.</div></div><div><h3>Study Design</h3><div>Observational study.</div></div><div><h3>Setting & Participants</h3><div>All patients receiving maintenance dialysis in Stockholm, Sweden, during 2005-2021.</div></div><div><h3>Exposure</h3><div>Clinically recognized pruritus defined using <em>International Classification of Diseases, Tenth Revision</em> codes or a prescription for antipruritus treatments (including UV therapy).</div></div><div><h3>Outcomes</h3><div>All-cause mortality, severe infection–related hospitalizations (composite of endocarditis, peritoneal dialysis–related peritonitis, hemodialysis/peritoneal dialysis–related catheter infection, sepsis due to <em>Staphylococcus</em> spp., or skin infection) and incident diagnoses of anxiety/depression and sleep disorders.</div></div><div><h3>Analytical Approach</h3><div>Multivariable logistic regression and cause-specific hazards models to analyze factors associated with prevalent and new-onset pruritus, respectively. Multivariable cause-specific hazards models with time-varying exposure were used to explore the association of prevalent and new-onset pruritus with adverse health outcomes.</div></div><div><h3>Results</h3><div>Among 3,281 dialysis recipients (median age, 64 years; 66% men; 69% receiving hemodialysis, 77% with incident dialysis), 456 (14%) had pruritus at enrollment. During a median follow-up of 3.3 (IQR, 1.3-9.2) years, 539 (19%) additional patients experienced pruritus. Older age, female sex, a lower serum albumin level, and higher C-reactive protein, serum calcium, and phosphorus levels were independently associated with pruritus. Compared with patients without pruritus, patients with pruritus were at a higher risk of sleep disorders (adjusted HR, 1.96; 95% CI, 1.60-2.39), developing anxiety/depression (adjusted HR, 1.56; 95% CI, 1.23-1.98), and being hospitalized for severe infections (adjusted HR, 1.36; 95% CI, 1.18-1.57), the latter attributed to higher risk of sepsis and peritoneal dialysis–related peritonitis. There was no detectable association between the development of pruritus and all-cause mortality.</div></div><div><h3>Limitations</h3><div>Potential misclassification bias if pruritus is not clinically recognized, lack of information on pruritus intensity/severity, use of diagnostic codes for exposure and outcome diagnoses.</div></div><div><h3>Conclusions</h3><div>At least one third of patients experience pruritus during their first years undergoing dialysis, and pruritus was consistently associated with adverse health outcomes.</div></div><div><h3>Plain-Language Summary</h3><div>Pruritus is a common but not well-characterized symptom of patients receiving dialysis. We analyzed data from 3,281 patients recei
{"title":"Burden of CKD-Associated Pruritus and Adverse Clinical Outcomes in Patients Receiving Dialysis: The Stockholm Creatinine Measurements (SCREAM) Project","authors":"Anne-Laure Faucon , Catherine M. Clase , Helena Rydell , Milica Uhde , Peter Barany , Marie Evans , Juan-Jesús Carrero","doi":"10.1053/j.ajkd.2024.05.013","DOIUrl":"10.1053/j.ajkd.2024.05.013","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Pruritus is a common but not well-characterized complaint of patients receiving maintenance dialysis. This study sought to quantify the burden of pruritus and its associated adverse health outcomes in this population.</div></div><div><h3>Study Design</h3><div>Observational study.</div></div><div><h3>Setting & Participants</h3><div>All patients receiving maintenance dialysis in Stockholm, Sweden, during 2005-2021.</div></div><div><h3>Exposure</h3><div>Clinically recognized pruritus defined using <em>International Classification of Diseases, Tenth Revision</em> codes or a prescription for antipruritus treatments (including UV therapy).</div></div><div><h3>Outcomes</h3><div>All-cause mortality, severe infection–related hospitalizations (composite of endocarditis, peritoneal dialysis–related peritonitis, hemodialysis/peritoneal dialysis–related catheter infection, sepsis due to <em>Staphylococcus</em> spp., or skin infection) and incident diagnoses of anxiety/depression and sleep disorders.</div></div><div><h3>Analytical Approach</h3><div>Multivariable logistic regression and cause-specific hazards models to analyze factors associated with prevalent and new-onset pruritus, respectively. Multivariable cause-specific hazards models with time-varying exposure were used to explore the association of prevalent and new-onset pruritus with adverse health outcomes.</div></div><div><h3>Results</h3><div>Among 3,281 dialysis recipients (median age, 64 years; 66% men; 69% receiving hemodialysis, 77% with incident dialysis), 456 (14%) had pruritus at enrollment. During a median follow-up of 3.3 (IQR, 1.3-9.2) years, 539 (19%) additional patients experienced pruritus. Older age, female sex, a lower serum albumin level, and higher C-reactive protein, serum calcium, and phosphorus levels were independently associated with pruritus. Compared with patients without pruritus, patients with pruritus were at a higher risk of sleep disorders (adjusted HR, 1.96; 95% CI, 1.60-2.39), developing anxiety/depression (adjusted HR, 1.56; 95% CI, 1.23-1.98), and being hospitalized for severe infections (adjusted HR, 1.36; 95% CI, 1.18-1.57), the latter attributed to higher risk of sepsis and peritoneal dialysis–related peritonitis. There was no detectable association between the development of pruritus and all-cause mortality.</div></div><div><h3>Limitations</h3><div>Potential misclassification bias if pruritus is not clinically recognized, lack of information on pruritus intensity/severity, use of diagnostic codes for exposure and outcome diagnoses.</div></div><div><h3>Conclusions</h3><div>At least one third of patients experience pruritus during their first years undergoing dialysis, and pruritus was consistently associated with adverse health outcomes.</div></div><div><h3>Plain-Language Summary</h3><div>Pruritus is a common but not well-characterized symptom of patients receiving dialysis. We analyzed data from 3,281 patients recei","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 1","pages":"Pages 45-54.e1"},"PeriodicalIF":9.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1053/j.ajkd.2024.06.012
Gabriel Cojuc-Konigsberg , Alberto Guijosa , Alberto Moscona-Nissan , Alberto Nordmann-Gomes , Vianca Anabel Canaviri-Flores , Alan Braverman-Poyastro , Regina de la Fuente-Ramírez , Denisse Tinajero-Sánchez , Alejandra de las Fuentes Cepeda , Andrés Noyola-Pérez , Rafael Lozano , Ricardo Correa-Rotter , Juan C. Ramírez-Sandoval
<div><h3>Rationale & Objective</h3><div>Almost 80% of individuals with chronic kidney disease (CKD) reside in low- and middle-income countries (LMICs) and are potentially underrepresented in randomized controlled clinical trials (RCTs). We assessed the global distribution of RCTs comparing pharmacological treatments for CKD over the past 2 decades, as well as the magnitude and evolution of participation by LMICs.</div></div><div><h3>Study Design</h3><div>Systematic review.</div></div><div><h3>Setting & Study Populations</h3><div>RCTs evaluating pharmacological interventions in adults with CKD.</div></div><div><h3>Selection Criteria for Studies</h3><div>RCTs published between 2003-2023 and indexed in MEDLINE.</div></div><div><h3>Data Extraction</h3><div>Each trial was reviewed and extracted independently by 2 investigators with disagreements settled by consensus or a third reviewer.</div></div><div><h3>Analytical Approach</h3><div>RCT participation of World Bank–defined income groups and geographic regions were described, and the representation indices (RI) according to RCT participants and estimated CKD prevalences were calculated. RCTs were also categorized as global, regional, or national in scope.</div></div><div><h3>Results</h3><div>Among 7,760 identified studies, we included 1,366 RCTs conducted in 84 countries with 301,158 participants. National, regional, and global RCTs represented 85.4%, 3.5%, and 11.1% of studies, respectively. LMICs were included in 34.7% of RCTs. No RCTs included participants from low-income countries, and lower-middle-income countries participated in 13.2%. Of participants from RCTs with available information, 25.4% (n<!--> <!-->=<!--> <!-->64,843 of 255,237) were from LMICs. According to the RI, 6 LMICs were overrepresented (>1.25), 7 were adequately represented (0.75-1.25), and 26 were underrepresented (<0.75). Most global CKD RCTs (80.2%) included LMICs; however, LMIC participants constituted only 32.9% of the global trial population. We observed a positive trend in LMIC inclusion over time, rising from 22.9% (n<!--> <!-->=<!--> <!-->71<!--> <!-->of 310) in 2003-2007 to 45.5% (n<!--> <!-->=<!--> <!-->140<!--> <!-->of 308) in 2018-2023.</div></div><div><h3>Limitations</h3><div>The use of an income-group dichotomy, exclusion of nonrandomized studies of intervention, and studies identified in 1 database.</div></div><div><h3>Conclusions</h3><div>Despite an increase in participation over the past 2 decades, individuals with CKD from LMICs remain significantly underrepresented in RCTs. These findings suggest that increased efforts are warranted to increase LMIC representation in pharmacological CKD RCTs.</div></div><div><h3>Plain-Language Summary</h3><div>Chronic kidney disease (CKD) substantially affects people from low- and middle-income countries (LMICs). However, the participation of these countries in randomized controlled trials (RCTs) remains uncertain. To assess the global distribution and represen
{"title":"Representation of Low- and Middle-Income Countries in CKD Drug Trials: A Systematic Review","authors":"Gabriel Cojuc-Konigsberg , Alberto Guijosa , Alberto Moscona-Nissan , Alberto Nordmann-Gomes , Vianca Anabel Canaviri-Flores , Alan Braverman-Poyastro , Regina de la Fuente-Ramírez , Denisse Tinajero-Sánchez , Alejandra de las Fuentes Cepeda , Andrés Noyola-Pérez , Rafael Lozano , Ricardo Correa-Rotter , Juan C. Ramírez-Sandoval","doi":"10.1053/j.ajkd.2024.06.012","DOIUrl":"10.1053/j.ajkd.2024.06.012","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Almost 80% of individuals with chronic kidney disease (CKD) reside in low- and middle-income countries (LMICs) and are potentially underrepresented in randomized controlled clinical trials (RCTs). We assessed the global distribution of RCTs comparing pharmacological treatments for CKD over the past 2 decades, as well as the magnitude and evolution of participation by LMICs.</div></div><div><h3>Study Design</h3><div>Systematic review.</div></div><div><h3>Setting & Study Populations</h3><div>RCTs evaluating pharmacological interventions in adults with CKD.</div></div><div><h3>Selection Criteria for Studies</h3><div>RCTs published between 2003-2023 and indexed in MEDLINE.</div></div><div><h3>Data Extraction</h3><div>Each trial was reviewed and extracted independently by 2 investigators with disagreements settled by consensus or a third reviewer.</div></div><div><h3>Analytical Approach</h3><div>RCT participation of World Bank–defined income groups and geographic regions were described, and the representation indices (RI) according to RCT participants and estimated CKD prevalences were calculated. RCTs were also categorized as global, regional, or national in scope.</div></div><div><h3>Results</h3><div>Among 7,760 identified studies, we included 1,366 RCTs conducted in 84 countries with 301,158 participants. National, regional, and global RCTs represented 85.4%, 3.5%, and 11.1% of studies, respectively. LMICs were included in 34.7% of RCTs. No RCTs included participants from low-income countries, and lower-middle-income countries participated in 13.2%. Of participants from RCTs with available information, 25.4% (n<!--> <!-->=<!--> <!-->64,843 of 255,237) were from LMICs. According to the RI, 6 LMICs were overrepresented (>1.25), 7 were adequately represented (0.75-1.25), and 26 were underrepresented (<0.75). Most global CKD RCTs (80.2%) included LMICs; however, LMIC participants constituted only 32.9% of the global trial population. We observed a positive trend in LMIC inclusion over time, rising from 22.9% (n<!--> <!-->=<!--> <!-->71<!--> <!-->of 310) in 2003-2007 to 45.5% (n<!--> <!-->=<!--> <!-->140<!--> <!-->of 308) in 2018-2023.</div></div><div><h3>Limitations</h3><div>The use of an income-group dichotomy, exclusion of nonrandomized studies of intervention, and studies identified in 1 database.</div></div><div><h3>Conclusions</h3><div>Despite an increase in participation over the past 2 decades, individuals with CKD from LMICs remain significantly underrepresented in RCTs. These findings suggest that increased efforts are warranted to increase LMIC representation in pharmacological CKD RCTs.</div></div><div><h3>Plain-Language Summary</h3><div>Chronic kidney disease (CKD) substantially affects people from low- and middle-income countries (LMICs). However, the participation of these countries in randomized controlled trials (RCTs) remains uncertain. To assess the global distribution and represen","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 1","pages":"Pages 55-66.e1"},"PeriodicalIF":9.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905564","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 : 2025-01-01DOI: 10.1053/j.ajkd.2024.08.004
Melissa S. Zhou, Alexander J. Wolf, Ken Sutha
{"title":"Harmonizing the Different Perspectives on Growth Impairment in Pediatric CKD","authors":"Melissa S. Zhou, Alexander J. Wolf, Ken Sutha","doi":"10.1053/j.ajkd.2024.08.004","DOIUrl":"10.1053/j.ajkd.2024.08.004","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 1","pages":"Pages 5-7"},"PeriodicalIF":9.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638453","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 : 2025-01-01DOI: 10.1053/j.ajkd.2024.05.006
Kassidy Thomas, Rayna Levitt RD
{"title":"The Hidden Consequences of Kidney Disease on Body Image","authors":"Kassidy Thomas, Rayna Levitt RD","doi":"10.1053/j.ajkd.2024.05.006","DOIUrl":"10.1053/j.ajkd.2024.05.006","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 1","pages":"Pages A21-A22"},"PeriodicalIF":9.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142436020","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 : 2025-01-01DOI: 10.1053/j.ajkd.2024.06.024
Mengyi Liu, Yanjun Zhang, Yuanyuan Zhang, Panpan He, Chun Zhou, Ziliang Ye, Sisi Yang, Xiaoqin Gan, Fan Fan Hou, Xianhui Qin
<div><h3>Rationale & Objective</h3><div>Ankle-brachial index (ABI) is used to screen for vascular complications in the setting of diabetes. This study sought to examine the relationship of longitudinal ABI data and chronic kidney disease (CKD) progression in patients with type 2 diabetes mellitus (T2DM) and increased body mass index.</div></div><div><h3>Study Design</h3><div>A post hoc analysis of the Look AHEAD (Action for Health in Diabetes) trial.</div></div><div><h3>Setting & Participants</h3><div>This study included 3,631 participants in the Look AHEAD trial with a baseline estimated glomerular filtration rate<!--> <!-->>60<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup>.</div></div><div><h3>Exposures</h3><div>Average ABI and average annual change in ABI were calculated based on annual ABI measurements during the first 4 years of the study.</div></div><div><h3>Outcome</h3><div>CKD progression, defined as kidney failure requiring maintenance dialysis or the occurrence of an estimated glomerular filtration rate<!--> <!--><60<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup> with a decrease of<!--> <!-->≥30% versus baseline at a follow-up visit.</div></div><div><h3>Analytical Approach</h3><div>Restricted cubic spline and Cox proportional hazards models were fit to estimate associations and to explore nonlinearity.</div></div><div><h3>Results</h3><div>During a median follow-up of 10.1 years, CKD progression developed in 1,051 participants. There was a reversed J-shaped relationship of CKD progression with average ABI (ABI<!--> <!--><1.17: HR per 1-SD decrement, 1.23; 95% CI, 1.06-1.42; ABI<!--> <!-->≥1.17: HR per 1-SD increment, 1.10; 95% CI, 1.00-1.22) and average annual change in ABI (change in ABI less than<!--> <!-->−0.007: HR per 1-SD decrement, 1.37; 95% CI, 1.12-1.66; change in ABI of at least<!--> <!-->−0.007: HR per 1-SD increment, 1.13; 95% CI, 1.03-1.24).</div></div><div><h3>Limitations</h3><div>Observational study, potential unmeasured confounding.</div></div><div><h3>Conclusions</h3><div>Low and high-average ABI, even at clinically normal values, as well as decreasing and increasing average annual ABI, were associated with a higher risk of CKD progression in patients with T2DM and increased body mass index. Monitoring ABI and its changes over time may facilitate CKD risk stratification in patients with T2DM.</div></div><div><h3>Plain-Language Summary</h3><div>The ankle-brachial index (ABI) has recently become a routine screening parameter for vascular complications in patients with diabetes. In this post hoc analysis of the Look AHEAD (Action for Health in Diabetes) trial including 3,631 participants with type 2 diabetes mellitus and increased body mass index, we examined the longitudinal relationship of average ABI and annual change in ABI with chronic kidney disease progression. We observed that low and high-average ABI, even at clinically normal values, as well as decreases and increases in average annual ABI, were ass
原理和目的：踝肱指数（ABI）用于筛查糖尿病患者的血管并发症。本研究旨在探讨纵向 ABI 数据与 2 型糖尿病（T2D）和体重指数（BMI）升高患者的慢性肾病（CKD）进展之间的关系：Look AHEAD试验的事后分析：这项研究包括 Look AHEAD 试验中基线肾小球滤过率 (eGFR) >60 ml/min/1.73 m2 的 3,631 名参与者：平均 ABI 和平均 ABI 年变化是根据研究前 4 年的年度 ABI 测量值计算得出的：CKD进展，定义为需要维持性透析的肾衰竭或随访时eGFR2相对于首次eGFR测量值下降≥30%：分析方法：采用限制性立方样条和考克斯比例危险模型来估计相关性并探讨非线性：在10.1年的中位随访期间，有1051名参与者出现了CKD进展。CKD进展与平均ABI呈反向J形关系（当ABI为限制性指标时）：局限性：观察性研究，可能存在未测量的混杂因素：即使在临床正常值下，平均 ABI 值过低和过高，以及年平均 ABI 值下降和上升，都与 T2D 和体重指数升高患者的 CKD 进展风险较高有关。监测 ABI 及其随时间的变化有助于对 T2D 患者进行 CKD 风险分层。
{"title":"Longitudinal Patterns of Ankle-Brachial Index and Their Association With Progression of CKD in Patients With Type 2 Diabetes and Elevated Body Mass Index","authors":"Mengyi Liu, Yanjun Zhang, Yuanyuan Zhang, Panpan He, Chun Zhou, Ziliang Ye, Sisi Yang, Xiaoqin Gan, Fan Fan Hou, Xianhui Qin","doi":"10.1053/j.ajkd.2024.06.024","DOIUrl":"10.1053/j.ajkd.2024.06.024","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Ankle-brachial index (ABI) is used to screen for vascular complications in the setting of diabetes. This study sought to examine the relationship of longitudinal ABI data and chronic kidney disease (CKD) progression in patients with type 2 diabetes mellitus (T2DM) and increased body mass index.</div></div><div><h3>Study Design</h3><div>A post hoc analysis of the Look AHEAD (Action for Health in Diabetes) trial.</div></div><div><h3>Setting & Participants</h3><div>This study included 3,631 participants in the Look AHEAD trial with a baseline estimated glomerular filtration rate<!--> <!-->>60<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup>.</div></div><div><h3>Exposures</h3><div>Average ABI and average annual change in ABI were calculated based on annual ABI measurements during the first 4 years of the study.</div></div><div><h3>Outcome</h3><div>CKD progression, defined as kidney failure requiring maintenance dialysis or the occurrence of an estimated glomerular filtration rate<!--> <!--><60<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup> with a decrease of<!--> <!-->≥30% versus baseline at a follow-up visit.</div></div><div><h3>Analytical Approach</h3><div>Restricted cubic spline and Cox proportional hazards models were fit to estimate associations and to explore nonlinearity.</div></div><div><h3>Results</h3><div>During a median follow-up of 10.1 years, CKD progression developed in 1,051 participants. There was a reversed J-shaped relationship of CKD progression with average ABI (ABI<!--> <!--><1.17: HR per 1-SD decrement, 1.23; 95% CI, 1.06-1.42; ABI<!--> <!-->≥1.17: HR per 1-SD increment, 1.10; 95% CI, 1.00-1.22) and average annual change in ABI (change in ABI less than<!--> <!-->−0.007: HR per 1-SD decrement, 1.37; 95% CI, 1.12-1.66; change in ABI of at least<!--> <!-->−0.007: HR per 1-SD increment, 1.13; 95% CI, 1.03-1.24).</div></div><div><h3>Limitations</h3><div>Observational study, potential unmeasured confounding.</div></div><div><h3>Conclusions</h3><div>Low and high-average ABI, even at clinically normal values, as well as decreasing and increasing average annual ABI, were associated with a higher risk of CKD progression in patients with T2DM and increased body mass index. Monitoring ABI and its changes over time may facilitate CKD risk stratification in patients with T2DM.</div></div><div><h3>Plain-Language Summary</h3><div>The ankle-brachial index (ABI) has recently become a routine screening parameter for vascular complications in patients with diabetes. In this post hoc analysis of the Look AHEAD (Action for Health in Diabetes) trial including 3,631 participants with type 2 diabetes mellitus and increased body mass index, we examined the longitudinal relationship of average ABI and annual change in ABI with chronic kidney disease progression. We observed that low and high-average ABI, even at clinically normal values, as well as decreases and increases in average annual ABI, were ass","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 1","pages":"Pages 36-44.e1"},"PeriodicalIF":9.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142363950","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 : 2025-01-01DOI: 10.1053/j.ajkd.2024.05.018
Francisco Pereira Gonçalves , Isabel Tavares , Roberto Silva , Ana Teresa Nunes , Luciano Pereira , Andreia Campos , Joel Pinto , Ana Lopes , Marta Simões , Manuela Grazina , Agnes B. Fogo , João Paulo Oliveira
Mitochondrial cytopathies can have kidney involvement in up to half of cases. Their diagnosis is challenging due to phenotypic variability, lack of noninvasive tests to assess mitochondrial dysfunction, and genetic heterogeneity. We report on a young adult male with hypertrophic cardiomyopathy (HCM) and chronic kidney disease (CKD) with subnephrotic proteinuria who presented to the emergency department with kidney failure and hypervolemia requiring dialysis. A kidney biopsy showed focal segmental and global glomerulosclerosis, extensive foot process effacement, and abnormal mitochondria in podocytes and tubular epithelial cells; the genetic workup identified a rare FASTKD2 exon 2 variant, c.29G>C p.(Ser10Thr), in homozygosity; and functional mitochondrial assays in cultured skin fibroblasts showed reduction in FASTKD2 protein expression and moderate combined impairment in mitochondrial respiratory chain (MRC) assembly and function. This is the first report of a FASTKD2-associated cardiorenal mitochondrial cytopathy, characterized by young adult-onset proteinuric CKD and dilated HCM, in the absence of the severe neurologic manifestations described in patients with biallelic FASTKD2 variants. We hypothesize that the increased production of reactive oxygen species associated with moderate MRC impairment could result in a smoldering podocytopathy with progressive proteinuric CKD, without overt tubulopathy or encephalomyopathy—which might be, instead, pathogenically related to adenosine triphosphate deficiency.
{"title":"Homozygosity for a Rare FASTKD2 Variant Resulting in an Adult Onset Autosomal Recessive Mitochondrial Podocytopathy","authors":"Francisco Pereira Gonçalves , Isabel Tavares , Roberto Silva , Ana Teresa Nunes , Luciano Pereira , Andreia Campos , Joel Pinto , Ana Lopes , Marta Simões , Manuela Grazina , Agnes B. Fogo , João Paulo Oliveira","doi":"10.1053/j.ajkd.2024.05.018","DOIUrl":"10.1053/j.ajkd.2024.05.018","url":null,"abstract":"<div><div>Mitochondrial cytopathies can have kidney involvement in up to half of cases. Their diagnosis is challenging due to phenotypic variability, lack of noninvasive tests to assess mitochondrial dysfunction, and genetic heterogeneity. We report on a young adult male with hypertrophic cardiomyopathy (HCM) and chronic kidney disease (CKD) with subnephrotic proteinuria who presented to the emergency department with kidney failure and hypervolemia requiring dialysis. A kidney biopsy showed focal segmental and global glomerulosclerosis, extensive foot process effacement, and abnormal mitochondria in podocytes and tubular epithelial cells; the genetic workup identified a rare <em>FASTKD2</em> exon 2 variant, c.29G>C p.(Ser10Thr), in homozygosity; and functional mitochondrial assays in cultured skin fibroblasts showed reduction in FASTKD2 protein expression and moderate combined impairment in mitochondrial respiratory chain (MRC) assembly and function. This is the first report of a FASTKD2-associated cardiorenal mitochondrial cytopathy, characterized by young adult-onset proteinuric CKD and dilated HCM, in the absence of the severe neurologic manifestations described in patients with biallelic <em>FASTKD2</em> variants. We hypothesize that the increased production of reactive oxygen species associated with moderate MRC impairment could result in a smoldering podocytopathy with progressive proteinuric CKD, without overt tubulopathy or encephalomyopathy—which might be, instead, pathogenically related to adenosine triphosphate deficiency.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 1","pages":"Pages 119-123"},"PeriodicalIF":9.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141878212","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 : 2024-12-31DOI: 10.1053/j.ajkd.2024.11.003
Oshozimhede E Iyalomhe, Amarasinghe Arachchige Don Nalin Samandika Saparamadu, G Caleb Alexander
<p><strong>Rationale & objective: </strong>Chronic kidney disease (CKD) populations face an elevated risk of cardiovascular disease (CVD), yet many remain undertreated with statins for primary prevention of CVD despite meeting eligibility criteria. We examined trends in statin use for primary prevention among individuals with CKD before and after the release of the 2013 Kidney Disease: Improving Global Outcomes (KDIGO) guideline recommending statin use for lipid management in selected adults with CKD.</p><p><strong>Study design: </strong>Cross-sectional time-trend analysis.</p><p><strong>Setting & participants: </strong>The 2001-2020 National Health and Nutrition Examination Survey (NHANES) data permitted identification of individuals eligible for statin therapy per the 2013 KDIGO guidelines based on (1) age≥50 without self-reported CVD; (2) CKD, defined as estimated glomerular filtration rate (eGFR)<60mL/min/1.73m<sup>2</sup> or albumin-creatinine ratio≥30mg/g; and (3) no dialysis in the previous 12 months.</p><p><strong>Outcome: </strong>Statin use.</p><p><strong>Analytical approach: </strong>Poisson regression to estimate prevalence ratios (PR) comparing the periods before and after KDIGO guideline release and after accounting for NHANES's complex survey design and sampling weights.</p><p><strong>Results: </strong>Among eligible individuals, statin use approximately doubled from 18.6% in 2001-2002 to 36.1% in 2007-2008, increased modestly to 40.1% in 2013-2014, then subsequently plateaued. Multivariable analyses controlling for sociodemographic and clinical characteristics and secular trends demonstrated statin use for primary prevention was higher among the insured (PR, 2.48 [95% CI 1.66-3.69]), those with hypertension (PR, 1.49 [95% CI 1.28-1.74]), and those with diabetes (PR, 1.71 [95% CI 1.52-1.92]). Statin use was more common with lower eGFR (P=0.009) and higher body mass index (P=0.003) but did not differ by sex, race, or ethnicity.</p><p><strong>Limitations: </strong>Statin use and CVD were self-reported, and our data did not capture statin intolerance nor patient-provider decision making information.</p><p><strong>Conclusions: </strong>Statin use for primary prevention in CKD substantially increased before the 2013 release of KDIGO guidelines and subsequently plateaued. Use was higher among the insured and those with hypertension or diabetes.</p><p><strong>Plain-language summary: </strong>Chronic kidney disease (CKD) affects many Americans, increasing their heart disease risk. Statins effectively reduce this risk in individuals with CKD but are underused. Our study examined statin use in individuals with CKD before and after the release of the 2013 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommending statin use for selected adults with CKD. It also examined factors influencing usage patterns. Using years of US National Health and Nutrition Examination Survey data, we found that while statin use doubled over the stu
{"title":"Use of Statins for Primary Prevention Among Individuals With CKD in the United States: A Cross-Sectional, Time-Trend Analysis.","authors":"Oshozimhede E Iyalomhe, Amarasinghe Arachchige Don Nalin Samandika Saparamadu, G Caleb Alexander","doi":"10.1053/j.ajkd.2024.11.003","DOIUrl":"10.1053/j.ajkd.2024.11.003","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Chronic kidney disease (CKD) populations face an elevated risk of cardiovascular disease (CVD), yet many remain undertreated with statins for primary prevention of CVD despite meeting eligibility criteria. We examined trends in statin use for primary prevention among individuals with CKD before and after the release of the 2013 Kidney Disease: Improving Global Outcomes (KDIGO) guideline recommending statin use for lipid management in selected adults with CKD.</p><p><strong>Study design: </strong>Cross-sectional time-trend analysis.</p><p><strong>Setting & participants: </strong>The 2001-2020 National Health and Nutrition Examination Survey (NHANES) data permitted identification of individuals eligible for statin therapy per the 2013 KDIGO guidelines based on (1) age≥50 without self-reported CVD; (2) CKD, defined as estimated glomerular filtration rate (eGFR)<60mL/min/1.73m<sup>2</sup> or albumin-creatinine ratio≥30mg/g; and (3) no dialysis in the previous 12 months.</p><p><strong>Outcome: </strong>Statin use.</p><p><strong>Analytical approach: </strong>Poisson regression to estimate prevalence ratios (PR) comparing the periods before and after KDIGO guideline release and after accounting for NHANES's complex survey design and sampling weights.</p><p><strong>Results: </strong>Among eligible individuals, statin use approximately doubled from 18.6% in 2001-2002 to 36.1% in 2007-2008, increased modestly to 40.1% in 2013-2014, then subsequently plateaued. Multivariable analyses controlling for sociodemographic and clinical characteristics and secular trends demonstrated statin use for primary prevention was higher among the insured (PR, 2.48 [95% CI 1.66-3.69]), those with hypertension (PR, 1.49 [95% CI 1.28-1.74]), and those with diabetes (PR, 1.71 [95% CI 1.52-1.92]). Statin use was more common with lower eGFR (P=0.009) and higher body mass index (P=0.003) but did not differ by sex, race, or ethnicity.</p><p><strong>Limitations: </strong>Statin use and CVD were self-reported, and our data did not capture statin intolerance nor patient-provider decision making information.</p><p><strong>Conclusions: </strong>Statin use for primary prevention in CKD substantially increased before the 2013 release of KDIGO guidelines and subsequently plateaued. Use was higher among the insured and those with hypertension or diabetes.</p><p><strong>Plain-language summary: </strong>Chronic kidney disease (CKD) affects many Americans, increasing their heart disease risk. Statins effectively reduce this risk in individuals with CKD but are underused. Our study examined statin use in individuals with CKD before and after the release of the 2013 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommending statin use for selected adults with CKD. It also examined factors influencing usage patterns. Using years of US National Health and Nutrition Examination Survey data, we found that while statin use doubled over the stu","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913684","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 : 2024-12-31DOI: 10.1053/j.ajkd.2024.11.004
Barbara Kollerits, Fruzsina Kotsis, Markus P Schneider, Ulla T Schultheiss, Hansi Weissensteiner, Sebastian Schönherr, Lukas Forer, Heike Meiselbach, Christoph Wanner, Kai-Uwe Eckardt, Hans Dieplinger, Florian Kronenberg
Rationale & objective: Afamin is a vitamin E-binding glycoprotein primarily expressed in the liver and kidney. This study investigated whether serum afamin concentrations are associated with kidney function and incident kidney failure.
Study design: Prospective cohort study with 6.5 years follow-up.
Setting & participants: 5,041 White patients enrolled in the German Chronic Kidney Disease (GCKD) study with measured afamin concentrations and either an estimated glomerular filtration rate (eGFR) of 30-60mL/min/1.73m2 or an eGFR>60mL/min/1.73m2 with a urinary albumin-creatinine ratio (UACR) of≥300mg/g at study entry.
Exposure: Serum afamin concentrations (mg/L).
Outcome: Incident kidney failure (initiation of kidney replacement therapy or kidney-related death).
Analytical approach: Generalized linear regression and quantile regression models fit to investigate the association of afamin concentrations with eGFR and UACR. Adjusted Cox regression analysis to examine the association of afamin concentrations with incident kidney failure.
Results: The mean±SD afamin concentration at study entry was 73.2±17.6mg/L. Higher afamin concentrations were associated with better kidney function with a 2.60mL/min/1.73m2 higher eGFR (95% CI, 2.30-2.89) and a 5.97mg/g lower UACR (95% CI, 3.04-8.90) for each 10mg/L higher level of afamin concentration in adjusted analysis. During the follow-up period, each 10mg/L higher level of afamin concentration was associated with a 14% lower risk of kidney failure (HR, 0.86 [95%CI, 0.81-0.92], P<0.001).
Limitations: Residual confounding, and potential limited generalizability to non-White populations and people with mild stages of chronic kidney disease (CKD) or no CKD.
Conclusions: Higher serum afamin concentrations appear to be associated with a higher eGFR, less albuminuria, and a lower risk for future kidney failure in patients with CKD.
{"title":"Association of Serum Afamin Concentrations With Kidney Failure in Patients With CKD: Findings From the German CKD Cohort Study.","authors":"Barbara Kollerits, Fruzsina Kotsis, Markus P Schneider, Ulla T Schultheiss, Hansi Weissensteiner, Sebastian Schönherr, Lukas Forer, Heike Meiselbach, Christoph Wanner, Kai-Uwe Eckardt, Hans Dieplinger, Florian Kronenberg","doi":"10.1053/j.ajkd.2024.11.004","DOIUrl":"10.1053/j.ajkd.2024.11.004","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Afamin is a vitamin E-binding glycoprotein primarily expressed in the liver and kidney. This study investigated whether serum afamin concentrations are associated with kidney function and incident kidney failure.</p><p><strong>Study design: </strong>Prospective cohort study with 6.5 years follow-up.</p><p><strong>Setting & participants: </strong>5,041 White patients enrolled in the German Chronic Kidney Disease (GCKD) study with measured afamin concentrations and either an estimated glomerular filtration rate (eGFR) of 30-60mL/min/1.73m<sup>2</sup> or an eGFR>60mL/min/1.73m<sup>2</sup> with a urinary albumin-creatinine ratio (UACR) of≥300mg/g at study entry.</p><p><strong>Exposure: </strong>Serum afamin concentrations (mg/L).</p><p><strong>Outcome: </strong>Incident kidney failure (initiation of kidney replacement therapy or kidney-related death).</p><p><strong>Analytical approach: </strong>Generalized linear regression and quantile regression models fit to investigate the association of afamin concentrations with eGFR and UACR. Adjusted Cox regression analysis to examine the association of afamin concentrations with incident kidney failure.</p><p><strong>Results: </strong>The mean±SD afamin concentration at study entry was 73.2±17.6mg/L. Higher afamin concentrations were associated with better kidney function with a 2.60mL/min/1.73m<sup>2</sup> higher eGFR (95% CI, 2.30-2.89) and a 5.97mg/g lower UACR (95% CI, 3.04-8.90) for each 10mg/L higher level of afamin concentration in adjusted analysis. During the follow-up period, each 10mg/L higher level of afamin concentration was associated with a 14% lower risk of kidney failure (HR, 0.86 [95%CI, 0.81-0.92], P<0.001).</p><p><strong>Limitations: </strong>Residual confounding, and potential limited generalizability to non-White populations and people with mild stages of chronic kidney disease (CKD) or no CKD.</p><p><strong>Conclusions: </strong>Higher serum afamin concentrations appear to be associated with a higher eGFR, less albuminuria, and a lower risk for future kidney failure in patients with CKD.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913683","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 : 2024-12-26DOI: 10.1053/j.ajkd.2024.08.013
Aditya S Pawar
{"title":"Hurried Conversation.","authors":"Aditya S Pawar","doi":"10.1053/j.ajkd.2024.08.013","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.08.013","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142891352","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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