Pub Date : 2025-11-19DOI: 10.1053/j.ajkd.2025.10.001
Janewit Wongboonsin , Michelle T. McNulty , Matthew G. Sampson
{"title":"Gaining a Genomic Foothold on Unexplained Kidney Failure","authors":"Janewit Wongboonsin , Michelle T. McNulty , Matthew G. Sampson","doi":"10.1053/j.ajkd.2025.10.001","DOIUrl":"10.1053/j.ajkd.2025.10.001","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 6","pages":"Pages 721-723"},"PeriodicalIF":8.2,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145537319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-19DOI: 10.1053/j.ajkd.2025.10.003
Alyssa D. Steitz , Devika Nair
{"title":"Telemedicine in Dialysis: Established Gains Yet Enduring Gaps to Enhance the Quality of Care","authors":"Alyssa D. Steitz , Devika Nair","doi":"10.1053/j.ajkd.2025.10.003","DOIUrl":"10.1053/j.ajkd.2025.10.003","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 6","pages":"Pages 727-729"},"PeriodicalIF":8.2,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145537320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-18DOI: 10.1053/j.ajkd.2025.03.031
Colleen M. Glennon , Sagar U. Nigwekar , Daniela Kroshinsky , J. Kevin Tucker
Skin disorders occur commonly in patients with chronic kidney disease (CKD) and may greatly impact their quality of life. These skin disorders have varying underlying pathophysiologies, but there are a few common mechanisms including the accumulation of uremic solutes, metabolic disturbances, and inflammation. Pruritus in the setting of CKD (CKD-associated pruritus or CKD-aP), acquired perforating disorder (APD), calcinosis cutis, calciphylaxis, cutaneous lupus, and vasculitis are skin disorders often occurring in association with kidney disease and with which clinicians should be familiar. CKD-aP is reported to have a prevalence of 40% among patients receiving dialysis and 20% with earlier stages of CKD. Acquired perforating disorder (APD) is a skin disorder seen commonly in patients with diabetes mellitus and kidney failure that presents typically with crater-shaped nodular eruptions with a central hyperkeratosis. Calcinosis cutis is a skin disorder that occurs when calcium salts deposit into skin and subcutaneous tissues. Calciphylaxis is a rare cutaneous vasculopathy characterized by microvascular calcium deposition and thrombosis leading to tissue ischemia and subsequent skin necrosis. Lupus erythematosus and the vasculitides are systemic disorders with distinct skin manifestations that may offer clues as to the underlying disorder.
{"title":"Skin Disorders in Kidney Disease: Core Curriculum 2026","authors":"Colleen M. Glennon , Sagar U. Nigwekar , Daniela Kroshinsky , J. Kevin Tucker","doi":"10.1053/j.ajkd.2025.03.031","DOIUrl":"10.1053/j.ajkd.2025.03.031","url":null,"abstract":"<div><div>Skin disorders occur commonly in patients with chronic kidney disease (CKD) and may greatly impact their quality of life. These skin disorders have varying underlying pathophysiologies, but there are a few common mechanisms including the accumulation of uremic solutes, metabolic disturbances, and inflammation. Pruritus in the setting of CKD (CKD-associated pruritus or CKD-aP), acquired perforating disorder (APD), calcinosis cutis, calciphylaxis, cutaneous lupus, and vasculitis are skin disorders often occurring in association with kidney disease and with which clinicians should be familiar. CKD-aP is reported to have a prevalence of 40% among patients receiving dialysis and 20% with earlier stages of CKD. Acquired perforating disorder (APD) is a skin disorder seen commonly in patients with diabetes mellitus and kidney failure that presents typically with crater-shaped nodular eruptions with a central hyperkeratosis. Calcinosis cutis is a skin disorder that occurs when calcium salts deposit into skin and subcutaneous tissues. Calciphylaxis is a rare cutaneous vasculopathy characterized by microvascular calcium deposition and thrombosis leading to tissue ischemia and subsequent skin necrosis. Lupus erythematosus and the vasculitides are systemic disorders with distinct skin manifestations that may offer clues as to the underlying disorder.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 102-114"},"PeriodicalIF":8.2,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145538206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-13DOI: 10.1053/j.ajkd.2025.07.020
L. Parker Gregg , Lynnel Goodman , Ella Q. Carroll , S. Susan Hedayati
The detection and management of depression have special considerations in people with kidney disease. Screening should be performed every 6-12 months using a self-reported questionnaire. Clinicians should rule out symptoms from medical conditions such as dialysis inadequacy or hypothyroidism and confirm the presence of sadness or anhedonia. Sertraline has shown limited efficacy and an increased risk for adverse effects such as gastrointestinal symptoms, so cautious, gradual dose titration is warranted. Cognitive behavioral therapy has potential benefit for depressive symptoms in people with kidney disease. Current trials are evaluating behavioral activation therapy. Physical activity has many benefits and likely improves depression.
{"title":"A Practical Primer on How to Detect and Treat Depression in CKD","authors":"L. Parker Gregg , Lynnel Goodman , Ella Q. Carroll , S. Susan Hedayati","doi":"10.1053/j.ajkd.2025.07.020","DOIUrl":"10.1053/j.ajkd.2025.07.020","url":null,"abstract":"<div><div>The detection and management of depression have special considerations in people with kidney disease. Screening should be performed every 6-12 months using a self-reported questionnaire. Clinicians should rule out symptoms from medical conditions such as dialysis inadequacy or hypothyroidism and confirm the presence of sadness or anhedonia. Sertraline has shown limited efficacy and an increased risk for adverse effects such as gastrointestinal symptoms, so cautious, gradual dose titration is warranted. Cognitive behavioral therapy has potential benefit for depressive symptoms in people with kidney disease. Current trials are evaluating behavioral activation therapy. Physical activity has many benefits and likely improves depression.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 239-245"},"PeriodicalIF":8.2,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145525118","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}
RATIONALE & OBJECTIVEEvidence is limited regarding the associations of non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated fatty liver disease (MAFLD) with the development of nephrolithiasis. This study aimed to assess the associations of NAFLD and MAFLD with the risk of incident nephrolithiasis, using data from two cohort studies conducted in China and UK.STUDY DESIGNProspective cohort study.SETTING & PARTICIPANTS26,490 participants without nephrolithiasis at baseline in the Tianjin Chronic Low-grade Systemic Inflammation and Health Cohort Study (TCLSIH) and 294,577 participants in the UK Biobank.EXPOSURESFatty liver diagnosed by abdominal ultrasonography in the TCLSIH and by the hepatic steatosis index (HSI) in the UK Biobank. NAFLD and MAFLD were defined according to standard clinical criteria in both cohorts.OUTCOMENephrolithiasis was confirmed by ultrasonography in the TCLSIH and identified through ICD-10 and OPCS-4 in the UK Biobank.ANALYTICAL APPROACHCox proportional hazards regression analysis was used to assess the relationship between exposures and incident nephrolithiasis.RESULTSThe TCLSIH and the UK Biobank recorded 806 and 2,743 new cases of nephrolithiasis during a median follow-up of 4 and 12 years, respectively. Participants in both cohorts showed a significantly increased risk of nephrolithiasis in the setting of NAFLD (TCLSIH: HR=1.69, 95% CI 1.46-1.95; UK Biobank: HR=1.66, 95% CI 1.53-1.79) and MAFLD (TCLSIH: HR=1.79, 95% CI 1.55-2.08; UK Biobank: HR=1.54, 95% CI 1.42-1.66) after multivariable adjustments.LIMITATIONSObservational nature limits causal inferences; generalizability limited outside of the cohorts studied; limited diagnostic approaches to detect nephrolithiasis; unavailability of stone composition data.CONCLUSIONSBoth NAFLD and MAFLD are associated with a higher risk of nephrolithiasis. The results suggest that NAFLD/MAFLD and their associated metabolic conditions may represent modifiable risk factors for nephrolithiasis.
理由与目的关于非酒精性脂肪性肝病（NAFLD）和代谢功能障碍相关脂肪性肝病（MAFLD）与肾结石发生的关联证据有限。本研究旨在评估NAFLD和MAFLD与肾结石发生风险的关系，使用来自中国和英国的两项队列研究的数据。研究设计前瞻性队列研究。背景和参与者：天津慢性低度全身性炎症与健康队列研究（TCLSIH）的26,490名基线时无肾结石的参与者和英国生物银行的294,577名参与者。通过TCLSIH的腹部超声检查和UK Biobank的肝脂肪变性指数（HSI）诊断脂肪肝。在两个队列中，根据标准临床标准定义NAFLD和MAFLD。结果：TCLSIH超声检查证实肾结石，英国生物银行通过ICD-10和OPCS-4诊断肾结石。分析方法采用cox比例风险回归分析来评估暴露与肾结石事件之间的关系。结果TCLSIH和UK Biobank在中位随访4年和12年期间分别记录了806例和2743例肾结石新病例。多变量调整后，两个队列的参与者均显示NAFLD （TCLSIH: HR=1.69, 95% CI 1.46-1.95; UK Biobank: HR=1.66, 95% CI 1.53-1.79）和MAFLD （TCLSIH: HR=1.79, 95% CI 1.55-2.08; UK Biobank: HR=1.54, 95% CI 1.42-1.66）的肾结石风险显著增加。局限性：观察性质限制了因果推论；在研究的队列之外，通用性有限；检测肾结石的有限诊断方法无法获得石材成分数据。结论NAFLD和MAFLD均与肾结石的高风险相关。结果表明，NAFLD/MAFLD及其相关代谢状况可能是肾结石可改变的危险因素。
{"title":"Association of Fatty Liver Disease and the Risk of Nephrolithiasis: Findings From Two Prospective Cohort Studies.","authors":"Song Bai,Xin Yang,Qiuju Sheng,Qing Zhang,Li Liu,Shaomei Sun,Xing Wang,Ming Zhou,Qiyu Jia,Kun Song,Kaijun Niu,Yang Ding,Yang Xia","doi":"10.1053/j.ajkd.2025.09.012","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.09.012","url":null,"abstract":"RATIONALE & OBJECTIVEEvidence is limited regarding the associations of non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated fatty liver disease (MAFLD) with the development of nephrolithiasis. This study aimed to assess the associations of NAFLD and MAFLD with the risk of incident nephrolithiasis, using data from two cohort studies conducted in China and UK.STUDY DESIGNProspective cohort study.SETTING & PARTICIPANTS26,490 participants without nephrolithiasis at baseline in the Tianjin Chronic Low-grade Systemic Inflammation and Health Cohort Study (TCLSIH) and 294,577 participants in the UK Biobank.EXPOSURESFatty liver diagnosed by abdominal ultrasonography in the TCLSIH and by the hepatic steatosis index (HSI) in the UK Biobank. NAFLD and MAFLD were defined according to standard clinical criteria in both cohorts.OUTCOMENephrolithiasis was confirmed by ultrasonography in the TCLSIH and identified through ICD-10 and OPCS-4 in the UK Biobank.ANALYTICAL APPROACHCox proportional hazards regression analysis was used to assess the relationship between exposures and incident nephrolithiasis.RESULTSThe TCLSIH and the UK Biobank recorded 806 and 2,743 new cases of nephrolithiasis during a median follow-up of 4 and 12 years, respectively. Participants in both cohorts showed a significantly increased risk of nephrolithiasis in the setting of NAFLD (TCLSIH: HR=1.69, 95% CI 1.46-1.95; UK Biobank: HR=1.66, 95% CI 1.53-1.79) and MAFLD (TCLSIH: HR=1.79, 95% CI 1.55-2.08; UK Biobank: HR=1.54, 95% CI 1.42-1.66) after multivariable adjustments.LIMITATIONSObservational nature limits causal inferences; generalizability limited outside of the cohorts studied; limited diagnostic approaches to detect nephrolithiasis; unavailability of stone composition data.CONCLUSIONSBoth NAFLD and MAFLD are associated with a higher risk of nephrolithiasis. The results suggest that NAFLD/MAFLD and their associated metabolic conditions may represent modifiable risk factors for nephrolithiasis.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"19 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145516260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-12DOI: 10.1053/j.ajkd.2025.07.019
Jillian S. Caldwell , Eugene Lin
Medicare Advantage (MA) enrollment among patients receiving dialysis has surged following the passage of the 21st Century Cures Act, which lifted prior restrictions on enrollment. As MA becomes the plurality payer for dialysis, understanding its implications for patients, providers, and policymakers is critical. MA offers out-of-pocket spending caps and additional services not covered under fee-for-service (FFS) Medicare. Some plans also prioritize care coordination, which may improve patient outcomes. However, concerns remain regarding limited provider networks, prior authorization barriers, and disparities in access to medications and transplants. The increasing shift to MA also challenges value-based care models, as most quality measures and payment models for patients receiving dialysis are limited to FFS Medicare. Although research examining the benefits and downsides of MA is paramount, a comparison of MA versus FFS Medicare is complicated by selection bias and incomplete or inaccessible data. To ensure that increasing enrollment into MA has not harmed patients, policymakers must enhance data fidelity and transparency, strengthen regulatory oversight, and align financial incentives across populations to safeguard access to high-quality care for patients receiving dialysis.
{"title":"What is Medicare Advantage and Why is it the Most Important Contemporary Policy Affecting Kidney Disease?","authors":"Jillian S. Caldwell , Eugene Lin","doi":"10.1053/j.ajkd.2025.07.019","DOIUrl":"10.1053/j.ajkd.2025.07.019","url":null,"abstract":"<div><div>Medicare Advantage (MA) enrollment among patients receiving dialysis has surged following the passage of the 21st Century Cures Act, which lifted prior restrictions on enrollment. As MA becomes the plurality payer for dialysis, understanding its implications for patients, providers, and policymakers is critical. MA offers out-of-pocket spending caps and additional services not covered under fee-for-service (FFS) Medicare. Some plans also prioritize care coordination, which may improve patient outcomes. However, concerns remain regarding limited provider networks, prior authorization barriers, and disparities in access to medications and transplants. The increasing shift to MA also challenges value-based care models, as most quality measures and payment models for patients receiving dialysis are limited to FFS Medicare. Although research examining the benefits and downsides of MA is paramount, a comparison of MA versus FFS Medicare is complicated by selection bias and incomplete or inaccessible data. To ensure that increasing enrollment into MA has not harmed patients, policymakers must enhance data fidelity and transparency, strengthen regulatory oversight, and align financial incentives across populations to safeguard access to high-quality care for patients receiving dialysis.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 260-269"},"PeriodicalIF":8.2,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145516259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-12DOI: 10.1053/j.ajkd.2025.09.010
Kevin Yau , Joel G. Ray , Nivethika Jeyakumar , Bin Luo , Sheikh Abdullah , Stephanie N. Dixon , Sara Wing , Kristin K. Clemens , Fabio Castrillon-Ramirez , Jacob A. Udell , Alejandro Meraz-Munoz , Ann Young , Ziv Harel , Jeffrey Perl , Lawrence A. Leiter , Amit X. Garg , David Z.I. Cherney , Ron Wald
<div><h3>Rationale & Objective</h3><div>There are limited real-world data describing the cardiovascular benefits of glucagon-like peptide-1 receptor agonists (GLP1-RAs) across the spectrum of chronic kidney disease (CKD) severity. This study evaluated the association of GLP1-RAs with major adverse cardiovascular events (MACE) in comparison with dipeptidyl peptidase-4 (DPP-4) inhibitors in the setting of CKD.</div></div><div><h3>Study Design</h3><div>Retrospective observational cohort study.</div></div><div><h3>Setting & Participants</h3><div>24,576 new users of GLP1-RA and 44,367 new users of DPP-4 inhibitors with estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73 m<sup>2</sup> in Ontario, Canada.</div></div><div><h3>Exposure</h3><div>New use of GLP1-RAs versus DPP-4 inhibitors.</div></div><div><h3>Outcome</h3><div>The primary outcome was MACE, comprising nonfatal myocardial infarction, unstable angina, nonfatal ischemic stroke or transient ischemic attack, coronary revascularization, and cardiovascular death. Secondary outcomes included individual components of the composite outcome, hospitalization or emergency department visits for congestive heart failure, peripheral vascular disease revascularization, lower limb amputation, and all-cause mortality.</div></div><div><h3>Analytical Approach</h3><div>Inverse probability of treatment weighting using propensity scores was used to minimize confounding. Multivariable Fine-Gray subdistribution hazard models stratified by eGFR subgroup were fit to evaluate the primary outcome.</div></div><div><h3>Findings</h3><div>Mean age of study participants was 69 years, 50% were female, 92% had type 2 diabetes mellitus, 40% were taking a sodium/glucose cotransporter 2 (SGLT2) inhibitor, and 41% had CKD stages 3-5. MACE occurred among 1,296 (31.6 per 1,000 person-years) GLP1-RA users versus 1,374 (36.5 per 1,000 person-years) DPP-4 inhibitor users (subdistribution hazard ratio [SHR], 0.88 [95% CI, 0.80-0.97]). The lower rate of MACE among GLP1-RA users was largely related to a lower rate of cardiovascular death (SHR, 0.72 [95% CI, 0.62-0.85]). In subgroup analyses, there was no effect modification between the association of GLP1-RA initiation and lower rates of MACE by CKD stages, degree of albuminuria, or concomitant use of SGLT2 inhibitors.</div></div><div><h3>Limitations</h3><div>Retrospective design. A substantial amount of missing information on albuminuria.</div></div><div><h3>Conclusions</h3><div>In a population-based study of individuals across the spectrum of kidney disease, GLP1-RA initiation was associated with a lower rate of MACE than initiation of DPP-4 inhibitors.</div></div><div><h3>Plain-Language Summary</h3><div>A class of medications called glucagon-like peptide-1 receptor agonists (GLP1-RA) is now used for the treatment of diabetes. This study explored the association of GLP1-RA administration with cardiac health in people with kidney disease compared with another common cl
{"title":"Glucagon-like Peptide-1 Receptor Agonists and Risk of Major Adverse Cardiovascular Events in Patients With CKD","authors":"Kevin Yau , Joel G. Ray , Nivethika Jeyakumar , Bin Luo , Sheikh Abdullah , Stephanie N. Dixon , Sara Wing , Kristin K. Clemens , Fabio Castrillon-Ramirez , Jacob A. Udell , Alejandro Meraz-Munoz , Ann Young , Ziv Harel , Jeffrey Perl , Lawrence A. Leiter , Amit X. Garg , David Z.I. Cherney , Ron Wald","doi":"10.1053/j.ajkd.2025.09.010","DOIUrl":"10.1053/j.ajkd.2025.09.010","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>There are limited real-world data describing the cardiovascular benefits of glucagon-like peptide-1 receptor agonists (GLP1-RAs) across the spectrum of chronic kidney disease (CKD) severity. This study evaluated the association of GLP1-RAs with major adverse cardiovascular events (MACE) in comparison with dipeptidyl peptidase-4 (DPP-4) inhibitors in the setting of CKD.</div></div><div><h3>Study Design</h3><div>Retrospective observational cohort study.</div></div><div><h3>Setting & Participants</h3><div>24,576 new users of GLP1-RA and 44,367 new users of DPP-4 inhibitors with estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73 m<sup>2</sup> in Ontario, Canada.</div></div><div><h3>Exposure</h3><div>New use of GLP1-RAs versus DPP-4 inhibitors.</div></div><div><h3>Outcome</h3><div>The primary outcome was MACE, comprising nonfatal myocardial infarction, unstable angina, nonfatal ischemic stroke or transient ischemic attack, coronary revascularization, and cardiovascular death. Secondary outcomes included individual components of the composite outcome, hospitalization or emergency department visits for congestive heart failure, peripheral vascular disease revascularization, lower limb amputation, and all-cause mortality.</div></div><div><h3>Analytical Approach</h3><div>Inverse probability of treatment weighting using propensity scores was used to minimize confounding. Multivariable Fine-Gray subdistribution hazard models stratified by eGFR subgroup were fit to evaluate the primary outcome.</div></div><div><h3>Findings</h3><div>Mean age of study participants was 69 years, 50% were female, 92% had type 2 diabetes mellitus, 40% were taking a sodium/glucose cotransporter 2 (SGLT2) inhibitor, and 41% had CKD stages 3-5. MACE occurred among 1,296 (31.6 per 1,000 person-years) GLP1-RA users versus 1,374 (36.5 per 1,000 person-years) DPP-4 inhibitor users (subdistribution hazard ratio [SHR], 0.88 [95% CI, 0.80-0.97]). The lower rate of MACE among GLP1-RA users was largely related to a lower rate of cardiovascular death (SHR, 0.72 [95% CI, 0.62-0.85]). In subgroup analyses, there was no effect modification between the association of GLP1-RA initiation and lower rates of MACE by CKD stages, degree of albuminuria, or concomitant use of SGLT2 inhibitors.</div></div><div><h3>Limitations</h3><div>Retrospective design. A substantial amount of missing information on albuminuria.</div></div><div><h3>Conclusions</h3><div>In a population-based study of individuals across the spectrum of kidney disease, GLP1-RA initiation was associated with a lower rate of MACE than initiation of DPP-4 inhibitors.</div></div><div><h3>Plain-Language Summary</h3><div>A class of medications called glucagon-like peptide-1 receptor agonists (GLP1-RA) is now used for the treatment of diabetes. This study explored the association of GLP1-RA administration with cardiac health in people with kidney disease compared with another common cl","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 2","pages":"Pages 211-229.e1"},"PeriodicalIF":8.2,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145516256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-12DOI: 10.1053/j.ajkd.2025.09.008
Stijn C. van de Laar , Hidde A. de Heus , Emma K. Massey , Liset H.M. Pengel , Robert J. Porte , Frank J.M.F. Dor , Robert C. Minnee
<div><h3>Rationale & Objective</h3><div>Living donor kidney transplantation is considered the most effective treatment for end-stage kidney disease, but healthy individuals who donate may experience potential threats to their long-term well-being. This meta-analysis assessed the impact of living kidney donation on health-related quality of life (HRQoL) among donors overall and among those at higher risk for negative health impacts.</div></div><div><h3>Study Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Setting & Participants</h3><div>Living donors of kidney allografts included in studies of postdonation HRQoL with predefined inclusion and exclusion criteria. Studies were identified through a comprehensive search of Embase, MEDLINE OvidSP, CENTRAL, Web of Science, PsycINFO, and the top 100 rankings in Google Scholar.</div></div><div><h3>Data Extraction</h3><div>Data were extracted in accordance with PRISMA guidelines, with independent extraction by multiple observers to ensure accuracy.</div></div><div><h3>Analytical Approach</h3><div>Primary outcomes included the 36-item Short-Form Health Survey (SF-36) and its composite mental component summary (MCS) and physical component summary (PCS). These measures were used to compare postdonation HRQoL with predonation levels and to the HRQoL of the general population. Study-level effects were calculated as standardized mean differences for continuous variables. Pooled effects were estimated with a random-effects model using restricted maximum likelihood.</div></div><div><h3>Results</h3><div>The meta-analysis included 73 studies with 14,474 donors. The MCS did not show significant changes at 3, 6, or 12 or more months after donation compared with baseline. However, the PCS was significantly lower at 3 months after donation compared with before donation (standardized mean difference, −0.38 [95% CI, −0.72 to −0.05], <em>P</em> = 0.02), which did not persist at 6 or 12 months. Both PCS and MCS scores were significantly higher in donors than in the general population. Donors’ HRQoL scores were comparable to or better than those of healthy controls, recipients, patients who underwent a nephrectomy, and patients receiving maintenance dialysis.</div></div><div><h3>Limitations</h3><div>Heterogeneity in study populations and outcomes, a limited number of studies for certain comparisons, methodological weaknesses of especially older studies, variability across geographies studied, and unaccounted for temporal changes.</div></div><div><h3>Conclusions</h3><div>Kidney donors reported physical HRQoL to be decreased after living donor nephrectomy, which returned to predonation levels by 6 months. The HRQoL reported by living donors was significantly better than that of the general population and healthy controls. These findings suggest that concerns about postdonation HRQoL need not be a deterrent to potential living kidney donors.</div></div><div><h3>Trial Registration</h3><div>Registe
理由与目的活体肾脏移植（LDKT）被认为是治疗终末期肾脏疾病最有效的方法，但健康的捐赠者可能会对他们的长期健康造成潜在的威胁。本荟萃分析旨在评估活体肾脏捐赠（LDK）对供体总体和具有较高负面健康影响风险者健康相关生活质量（HRQoL）的影响。研究设计：系统评价和荟萃分析。环境与研究人群同种异体肾移植活体供者被纳入捐献后HRQoL的研究，具有预定义的纳入和排除标准。通过Embase、MEDLINE OvidSP、CENTRAL、Web of Science、PsycINFO和b谷歌Scholar排名前100的综合搜索来确定研究。数据提取按照PRISMA指南提取数据，由多个观测者独立提取以确保准确性。主要结果包括SF-36及其综合心理成分总结（MCS）和生理成分总结（PCS）。这些指标用于比较捐献后与捐献前的HRQoL水平以及与一般人群的HRQoL水平。研究水平效应以连续变量的标准化平均差异计算。用限制最大似然的随机效应模型估计合并效应。结果荟萃分析包括73项研究，14474名供体。与基线相比，捐献后3、6、12个月或更长时间的MCS确实显示出显著的变化。然而，与捐献前相比，捐献后3个月的PCS显著降低（SMD为-0.38;95% CI: -0.72至-0.05,p = 0.02），这种情况在6或12个月时不会持续。献血者的PCS和MCS评分明显高于一般人群。供者的HRQoL评分与健康对照者、受者、接受肾切除术的患者和接受维护性透析的患者相当或更好。局限性：研究人群和结果的异质性，某些比较的研究数量有限，特别是旧研究的方法学弱点，研究的地理差异，以及未解释的时间变化。结论肾供者报告活体肾切除术后HRQoL下降，6个月后恢复到捐献前水平。活体献血者报告的HRQoL明显优于普通人群和健康对照组。这些发现表明，对捐赠后HRQoL的担忧不必成为潜在活体肾脏捐赠者的威慑。
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Pub Date : 2025-11-12DOI: 10.1053/j.ajkd.2025.07.017
Anthony Barisano , Daeho Kim , Rajnish Mehrotra , Amal N. Trivedi , Maricruz Rivera-Hernandez
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