Pub Date : 2026-02-01Epub Date: 2025-11-12DOI: 10.1053/j.ajkd.2025.07.017
Anthony Barisano , Daeho Kim , Rajnish Mehrotra , Amal N. Trivedi , Maricruz Rivera-Hernandez
{"title":"Home Dialysis Utilization in Puerto Rico","authors":"Anthony Barisano , Daeho Kim , Rajnish Mehrotra , Amal N. Trivedi , Maricruz Rivera-Hernandez","doi":"10.1053/j.ajkd.2025.07.017","DOIUrl":"10.1053/j.ajkd.2025.07.017","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 230-233"},"PeriodicalIF":8.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145516258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-13DOI: 10.1053/j.ajkd.2025.09.014
Laura Aponte Becerra, Sherry G. Mansour
Exercise triggers complex effects on kidney physiology that vary with intensity, duration, and environmental conditions. While moderate physical activity improves cardiovascular and renal outcomes, intense or prolonged exertion, particularly in endurance sports, can lead to acute kidney injury. Adaptations in kidney physiology during exercise include reduced plasma flow, altered glomerular filtration, and hormone-mediated fluid retention. These changes are protective but may become maladaptive with dehydration, heat stress, or excessive fluid intake. High-intensity exercise increases oxidative stress and proteinuria, while ultramarathon participation may cause transient creatinine elevation from muscle breakdown, complicating acute kidney injury diagnosis. Prevention strategies include individualized hydration plans, electrolyte replacement, and avoidance of nonsteroidal anti-inflammatory drugs. In special populations, such as children with chronic kidney disease or patients receiving dialysis, structured exercise enhances quality of life and physical function when implemented safely. Clinicians must balance the benefits of exercise with kidney-related risks, promote safe training practices, and recognize early signs of exertional complications to optimize renal and overall health in physically active individuals. This core curriculum reviews the physiology of exercise on kidney function and provides evidence-based strategies for patient counseling and risk reduction.
{"title":"Exercise and Kidney Health: Core Curriculum 2026","authors":"Laura Aponte Becerra, Sherry G. Mansour","doi":"10.1053/j.ajkd.2025.09.014","DOIUrl":"10.1053/j.ajkd.2025.09.014","url":null,"abstract":"<div><div>Exercise triggers complex effects on kidney physiology that vary with intensity, duration, and environmental conditions. While moderate physical activity improves cardiovascular and renal outcomes, intense or prolonged exertion, particularly in endurance sports, can lead to acute kidney injury. Adaptations in kidney physiology during exercise include reduced plasma flow, altered glomerular filtration, and hormone-mediated fluid retention. These changes are protective but may become maladaptive with dehydration, heat stress, or excessive fluid intake. High-intensity exercise increases oxidative stress and proteinuria, while ultramarathon participation may cause transient creatinine elevation from muscle breakdown, complicating acute kidney injury diagnosis. Prevention strategies include individualized hydration plans, electrolyte replacement, and avoidance of nonsteroidal anti-inflammatory drugs. In special populations, such as children with chronic kidney disease or patients receiving dialysis, structured exercise enhances quality of life and physical function when implemented safely. Clinicians must balance the benefits of exercise with kidney-related risks, promote safe training practices, and recognize early signs of exertional complications to optimize renal and overall health in physically active individuals. This core curriculum reviews the physiology of exercise on kidney function and provides evidence-based strategies for patient counseling and risk reduction.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 246-259"},"PeriodicalIF":8.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145732820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-19DOI: 10.1053/j.ajkd.2025.07.021
Robert Sanchez MPS
{"title":"Why This Research Matters","authors":"Robert Sanchez MPS","doi":"10.1053/j.ajkd.2025.07.021","DOIUrl":"10.1053/j.ajkd.2025.07.021","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages A8-A9"},"PeriodicalIF":8.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145792907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-12DOI: 10.1053/j.ajkd.2025.09.009
Michael J. Fischer , Jesse Y. Hsu , Joanna Walsh , Kerri L. Cavanaugh , David M. Charytan , Susan T. Crowley , Daniel Cukor , Laura M. Dember , Ardith Z. Doorenbos , Denise Esserman , Manisha Jhamb , Kirsten L. Johansen , Francis J. Keefe , Paul L. Kimmel , Mark B. Lockwood , Rajnish Mehrotra , Benjamin J. Morasco , Sagar Nigwekar , Patrick Pun , Rudy Qamhiyeh , Sahir Kalim
<div><h3>Rationale & Objective</h3><div>Adults receiving maintenance hemodialysis (HD) frequently report pain, yet detailed descriptions of pain in this population are lacking. This study examines pain locations, characteristics, and associations with other symptoms in adults receiving HD.</div></div><div><h3>Study Design</h3><div>Cross-sectional analysis.</div></div><div><h3>Setting & Participants</h3><div>Adults with moderate to severe chronic pain receiving maintenance HD enrolled in the multicenter HOPE Consortium Trial from 2021 to 2023.</div></div><div><h3>Exposure</h3><div>Sociodemographic, pain treatment, dialysis, medical comorbidity, and psychological and behavioral characteristics. Other patient-reported symptoms.</div></div><div><h3>Outcome</h3><div>Pain interference and severity as assessed by the Brief Pain Inventory (BPI) Interference and Severity subscales (range, 0-10).</div></div><div><h3>Analytical Approach</h3><div>Multivariable regression with least absolute shrinkage and selection operator (LASSO) to examine associations between participant characteristics and pain interference/severity, and Spearman’s correlation to examine relationships between other symptoms and pain interference/severity at baseline.</div></div><div><h3>Results</h3><div>Among 643 participants, the median BPI interference was 6.6 (IQR, 5.1-7.9) and severity was 6.0 (IQR, 4.5-7.5). Among the participants, 84% of participants reported pain >1 year, and 75% had daily pain; 89% and 66% of participants endorsed musculoskeletal and neuropathic pain, respectively. Of 32 body regions, the median number of painful regions was 8 (IQR, 4-14). Common regions in females were lower back (72%), knees (64%), legs (60%), and upper back (59%), and a similar pattern existed for males. In LASSO analyses, cardiovascular disease and depression were associated with significantly higher pain interference whereas White race (reference, Black race) and non-Hispanic ethnicity were associated with significantly lower pain interference. Similar findings were noted for pain severity. Pain catastrophizing and symptoms of fatigue, depression, and anxiety were moderately correlated with pain interference (<em>r</em> > 0.4).</div></div><div><h3>Limitations</h3><div>Neither relationship directionality nor causality can be inferred.</div></div><div><h3>Conclusions</h3><div>Among adults treated with HD who have chronic pain, pain locations were numerous and diverse, with substantial musculoskeletal and neuropathic characteristics. Factors associated with pain interference were predominantly sociodemographic and psychological rather than those related to comorbid diseases and dialysis.</div></div><div><h3>Plain-Language Summary</h3><div>Adults receiving maintenance hemodialysis (HD) frequently experience chronic pain, but it remains poorly understood. We examined pain locations, characteristics, and relationships with other symptoms among 643 adults with moderate to severe chron
{"title":"Chronic Pain Locations, Characteristics, and Associations With Other Symptoms in Adults Receiving Maintenance Hemodialysis: Findings From the HOPE Consortium Trial","authors":"Michael J. Fischer , Jesse Y. Hsu , Joanna Walsh , Kerri L. Cavanaugh , David M. Charytan , Susan T. Crowley , Daniel Cukor , Laura M. Dember , Ardith Z. Doorenbos , Denise Esserman , Manisha Jhamb , Kirsten L. Johansen , Francis J. Keefe , Paul L. Kimmel , Mark B. Lockwood , Rajnish Mehrotra , Benjamin J. Morasco , Sagar Nigwekar , Patrick Pun , Rudy Qamhiyeh , Sahir Kalim","doi":"10.1053/j.ajkd.2025.09.009","DOIUrl":"10.1053/j.ajkd.2025.09.009","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Adults receiving maintenance hemodialysis (HD) frequently report pain, yet detailed descriptions of pain in this population are lacking. This study examines pain locations, characteristics, and associations with other symptoms in adults receiving HD.</div></div><div><h3>Study Design</h3><div>Cross-sectional analysis.</div></div><div><h3>Setting & Participants</h3><div>Adults with moderate to severe chronic pain receiving maintenance HD enrolled in the multicenter HOPE Consortium Trial from 2021 to 2023.</div></div><div><h3>Exposure</h3><div>Sociodemographic, pain treatment, dialysis, medical comorbidity, and psychological and behavioral characteristics. Other patient-reported symptoms.</div></div><div><h3>Outcome</h3><div>Pain interference and severity as assessed by the Brief Pain Inventory (BPI) Interference and Severity subscales (range, 0-10).</div></div><div><h3>Analytical Approach</h3><div>Multivariable regression with least absolute shrinkage and selection operator (LASSO) to examine associations between participant characteristics and pain interference/severity, and Spearman’s correlation to examine relationships between other symptoms and pain interference/severity at baseline.</div></div><div><h3>Results</h3><div>Among 643 participants, the median BPI interference was 6.6 (IQR, 5.1-7.9) and severity was 6.0 (IQR, 4.5-7.5). Among the participants, 84% of participants reported pain >1 year, and 75% had daily pain; 89% and 66% of participants endorsed musculoskeletal and neuropathic pain, respectively. Of 32 body regions, the median number of painful regions was 8 (IQR, 4-14). Common regions in females were lower back (72%), knees (64%), legs (60%), and upper back (59%), and a similar pattern existed for males. In LASSO analyses, cardiovascular disease and depression were associated with significantly higher pain interference whereas White race (reference, Black race) and non-Hispanic ethnicity were associated with significantly lower pain interference. Similar findings were noted for pain severity. Pain catastrophizing and symptoms of fatigue, depression, and anxiety were moderately correlated with pain interference (<em>r</em> > 0.4).</div></div><div><h3>Limitations</h3><div>Neither relationship directionality nor causality can be inferred.</div></div><div><h3>Conclusions</h3><div>Among adults treated with HD who have chronic pain, pain locations were numerous and diverse, with substantial musculoskeletal and neuropathic characteristics. Factors associated with pain interference were predominantly sociodemographic and psychological rather than those related to comorbid diseases and dialysis.</div></div><div><h3>Plain-Language Summary</h3><div>Adults receiving maintenance hemodialysis (HD) frequently experience chronic pain, but it remains poorly understood. We examined pain locations, characteristics, and relationships with other symptoms among 643 adults with moderate to severe chron","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 182-198.e1"},"PeriodicalIF":8.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145516261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-29DOI: 10.1053/j.ajkd.2025.10.008
Georgina Gyarmati
{"title":"Are Mother Glomeruli in Good or Bad Company?","authors":"Georgina Gyarmati","doi":"10.1053/j.ajkd.2025.10.008","DOIUrl":"10.1053/j.ajkd.2025.10.008","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 275-277"},"PeriodicalIF":8.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-05DOI: 10.1053/j.ajkd.2025.10.010
Katherine A. Barraclough PhD , Ben Talbot PhD , Scott McAlister PhD
{"title":"In Reply to “Low-Flow Home Hemodialysis Technologies: The Key to Greener Dialysis?”","authors":"Katherine A. Barraclough PhD , Ben Talbot PhD , Scott McAlister PhD","doi":"10.1053/j.ajkd.2025.10.010","DOIUrl":"10.1053/j.ajkd.2025.10.010","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 284-285"},"PeriodicalIF":8.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-12DOI: 10.1053/j.ajkd.2025.09.013
Natasha Wiebe , Stephanie Thompson , Ashley Spellman , Ngan N. Lam , Marcello Tonelli
<div><h3>Rationale & Objective</h3><div>International guidelines do not consider moderate or severe obesity to be a contraindication to kidney transplantation, but clinical practice suggests otherwise. This study evaluated the likelihood of kidney transplantation in patients with moderate or severe obesity and how that likelihood compared with patients with other risk factors.</div></div><div><h3>Study Design</h3><div>Retrospective population-based cohort study.</div></div><div><h3>Setting & Participants</h3><div>96,181 adults with kidney failure, living in Canada between 2000 and 2021.</div></div><div><h3>Exposure</h3><div>Moderate or severe obesity and other risk factors (eg, age groups, diabetes, heart disease).</div></div><div><h3>Outcome</h3><div>Time to transplantation and time to allograft failure or death.</div></div><div><h3>Analytical Approach</h3><div>Parametric survival modeling, adjusting for all risk factors.</div></div><div><h3>Results</h3><div>Over a median follow-up period of 2.5 years, 58.2% of patients died, and 16.3% were transplanted. Participants with severe (body mass index [BMI] ≥ 40 kg/m<sup>2</sup>) or moderate (BMI 35.0-39.9 kg/m<sup>2</sup>) obesity were less likely to be transplanted than the control participants (BMI 18.5-24.9 kg/m<sup>2</sup>) (HR, 0.43 [95% CI, 0.39-0.47] and HR, 0.76 [95% CI, 0.71-0.82], respectively). Of 39 characteristics/categories considered, only participants aged ≥80 years were less likely to receive a transplant than those with severe obesity. Transplant recipients were followed for a median of 5.4 years. After those aged ≥65 years, participants with severe obesity were the most likely to experience allograft failure or death (HR, 1.70 [95% CI, 1.38-2.02] compared with controls). When we considered combinations of key risk factors, young participants with severe or moderate obesity and few comorbidities were at lower risk for allograft failure or death than participants with other common clinical characteristics.</div></div><div><h3>Limitations</h3><div>Residual confounding.</div></div><div><h3>Conclusions</h3><div>Canadian dialysis patients with moderate or severe obesity had a markedly reduced likelihood of receiving a kidney transplant. Although patients with moderate or severe obesity also had a heightened risk of allograft failure or death, the magnitude of the latter was similar to the excess risk associated with other common clinical characteristics. These findings support current practice guidelines and suggest that further work should identify and remove barriers to accessing kidney transplantation among patients with obesity.</div></div><div><h3>Plain-Language Summary</h3><div>International guidelines do not consider moderate or severe obesity (body mass index ≥35 and ≥40 kg/m<sup>2</sup>, respectively) to be a contraindication to kidney transplantation, but clinical practice suggests otherwise. Canadian dialysis patients with moderate or severe obesity had a reduced likel
{"title":"Access to Kidney Transplantation in Adults With Severe Obesity: A Population-Based Retrospective Cohort Study","authors":"Natasha Wiebe , Stephanie Thompson , Ashley Spellman , Ngan N. Lam , Marcello Tonelli","doi":"10.1053/j.ajkd.2025.09.013","DOIUrl":"10.1053/j.ajkd.2025.09.013","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>International guidelines do not consider moderate or severe obesity to be a contraindication to kidney transplantation, but clinical practice suggests otherwise. This study evaluated the likelihood of kidney transplantation in patients with moderate or severe obesity and how that likelihood compared with patients with other risk factors.</div></div><div><h3>Study Design</h3><div>Retrospective population-based cohort study.</div></div><div><h3>Setting & Participants</h3><div>96,181 adults with kidney failure, living in Canada between 2000 and 2021.</div></div><div><h3>Exposure</h3><div>Moderate or severe obesity and other risk factors (eg, age groups, diabetes, heart disease).</div></div><div><h3>Outcome</h3><div>Time to transplantation and time to allograft failure or death.</div></div><div><h3>Analytical Approach</h3><div>Parametric survival modeling, adjusting for all risk factors.</div></div><div><h3>Results</h3><div>Over a median follow-up period of 2.5 years, 58.2% of patients died, and 16.3% were transplanted. Participants with severe (body mass index [BMI] ≥ 40 kg/m<sup>2</sup>) or moderate (BMI 35.0-39.9 kg/m<sup>2</sup>) obesity were less likely to be transplanted than the control participants (BMI 18.5-24.9 kg/m<sup>2</sup>) (HR, 0.43 [95% CI, 0.39-0.47] and HR, 0.76 [95% CI, 0.71-0.82], respectively). Of 39 characteristics/categories considered, only participants aged ≥80 years were less likely to receive a transplant than those with severe obesity. Transplant recipients were followed for a median of 5.4 years. After those aged ≥65 years, participants with severe obesity were the most likely to experience allograft failure or death (HR, 1.70 [95% CI, 1.38-2.02] compared with controls). When we considered combinations of key risk factors, young participants with severe or moderate obesity and few comorbidities were at lower risk for allograft failure or death than participants with other common clinical characteristics.</div></div><div><h3>Limitations</h3><div>Residual confounding.</div></div><div><h3>Conclusions</h3><div>Canadian dialysis patients with moderate or severe obesity had a markedly reduced likelihood of receiving a kidney transplant. Although patients with moderate or severe obesity also had a heightened risk of allograft failure or death, the magnitude of the latter was similar to the excess risk associated with other common clinical characteristics. These findings support current practice guidelines and suggest that further work should identify and remove barriers to accessing kidney transplantation among patients with obesity.</div></div><div><h3>Plain-Language Summary</h3><div>International guidelines do not consider moderate or severe obesity (body mass index ≥35 and ≥40 kg/m<sup>2</sup>, respectively) to be a contraindication to kidney transplantation, but clinical practice suggests otherwise. Canadian dialysis patients with moderate or severe obesity had a reduced likel","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 199-210"},"PeriodicalIF":8.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145516264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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}
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