American Journal of Kidney Diseases最新文献

{"title":"Assessing Deceased-Donor Kidneys Through Posttransplant Survival Prediction Algorithms","authors":"Vishnu S. Potluri ,&nbsp;Jeremy Rubin ,&nbsp;Jarcy Zee ,&nbsp;Sarah J. Ratcliffe ,&nbsp;Michael O. Harhay ,&nbsp;Peter L. Abt ,&nbsp;Emily A. Vail ,&nbsp;Chirag R. Parikh ,&nbsp;Roy D. Bloom ,&nbsp;Alessandro Gasparini ,&nbsp;Michael Crowther ,&nbsp;David S. Goldberg ,&nbsp;Peter P. Reese","doi":"10.1053/j.ajkd.2025.07.016","DOIUrl":"10.1053/j.ajkd.2025.07.016","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><div>The Kidney Donor Risk Index (KDRI) is widely used to rank the quality of deceased-donor kidneys and is integrated into the U.S. kidney allograft allocation system. However, the KDRI has modest predictive accuracy for allograft survival, and recent revisions to the KDRI, which removed donor race and hepatitis C virus status, also revealed model calibration problems. This study aimed to evaluate novel approaches for predicting posttransplant allograft survival.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study using Organ Procurement and Transplantation Network data from May 1, 2007, through December 31, 2021.</div></div><div><h3>Predictors</h3><div>(1) Donor demographic and clinical variables (established predictors); (2) longitudinal laboratory data from the donor’s terminal hospitalization, such as serum creatinine (new predictors); and (3) recipient clinical variables (new predictors).</div></div><div><h3>Setting &amp; Participants</h3><div>75,867 adult kidney recipients at U.S. centers.</div></div><div><h3>Outcomes</h3><div>The primary outcome was time to all-cause allograft failure over 3 years. A secondary outcome was delayed graft function, defined as dialysis in the first week after the transplant.</div></div><div><h3>Analytical Approach</h3><div>We implemented and compared machine-learning statistical models versus traditional modeling approaches (ie, proportional hazards for the primary outcome and logistic regression of the secondary outcome) that incorporated various combinations of predictors. The performance metrics used to assess discrimination were the integrated (time-dependent) area under the curve (AUC) for allograft survival and the AUC for delayed graft function. To assess calibration, we calculated Brier scores and visually compared the predicted outcomes with the observed ones. Predictive performance was assessed in a 20% testing data split.</div></div><div><h3>Results</h3><div>Neither machine-learning models nor the addition of longitudinal laboratory data from the donor hospitalization to traditional models improved discrimination. For the primary outcome, the final model (named the Kidney Allograft Survival Index) used a proportional hazards modeling approach. Adding recipient variables improved model discrimination (integrated AUC, 0.68) and achieved excellent calibration for the overall cohort and subgroups. The final model for delayed allograft function used logistic regression, included recipient variables, and had an AUC of 0.75 with acceptable calibration.</div></div><div><h3>Limitations</h3><div>No external validation.</div></div><div><h3>Conclusions</h3><div>Improving the discrimination and calibration of kidney allograft survival prediction models is achievable by including recipient characteristics. These enhanced models have potential to improve the system of kidney allocation.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 18-30"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357748","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}

{"title":"Urine Oxalate Excretion and CKD Stage in Patients With Primary Hyperoxaluria Type 1","authors":"Lisa E. Vaughan ,&nbsp;Phillip J. Schulte ,&nbsp;Felix Knauf ,&nbsp;David J. Sas ,&nbsp;Dawn S. Milliner ,&nbsp;John C. Lieske","doi":"10.1053/j.ajkd.2025.07.013","DOIUrl":"10.1053/j.ajkd.2025.07.013","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 138-140"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145117154","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}

{"title":"Contraceptive Use and Reproductive Health in Women With CKD: A Qualitative Study of Nephrologists in the United States","authors":"Nedas Semaska ,&nbsp;Rachael Nolan ,&nbsp;Silvi Shah","doi":"10.1053/j.ajkd.2025.07.007","DOIUrl":"10.1053/j.ajkd.2025.07.007","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Women with chronic kidney disease (CKD) face elevated risks during pregnancy, yet contraceptive use and reproductive health counseling remain low. Nephrologists, who often maintain longitudinal relationships with patients, may be well-positioned to engage in these discussions. This study explored nephrologists’ perspectives on contraception and reproductive health management in women with CKD.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Qualitative study using semistructured interviews.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Interviews were conducted with 25 adult general and transplant nephrologists from both academic and private practice settings across the United States.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Virtual interviews were recorded, transcribed, and analyzed using thematic analysis until thematic saturation was achieved. A grounded theory approach guided coding and identification of key themes related to provider experiences and perspectives.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The following 4 themes and their respective subthemes were identified: (1) physician discomfort regarding discussion of contraception and reproductive health (reliance on patient initiation, hesitation with counseling, uncertainty about scope of practice); (2) insufficient training and inadequate guidelines regarding contraception and reproductive health (paucity of formal guidelines, limited exposure, reliance on self-education); (3) lack of interdisciplinary coordination regarding contraceptive use and reproductive health (the patient as an intermediary, fragmentation of care); (4) need for holistic and patient-centered care (comprehensive and sustained approach, shared decision-making).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Generalizability may be limited due to participants being predominantly early-career academic nephrologists.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Key barriers to contraceptive use and management of reproductive health for women with CKD include provider discomfort due to limited exposure and training, lack of clear guidelines, and fragmented care. Despite these challenges, providers recognize the importance of holistic, patient-centered care. These findings highlight the need to improve contraceptive counseling to support appropriate contraceptive use and shared decision making for the reproductive health of patients with kidney disease.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Women with kidney disease can face challenges with fertility, sexual health, and menstruation. Pregnancy is often riskier for these women due to complications such as high blood pressure and preterm birth. Despite these risks, the use of birth control among women with kidney disease remains low. This study looked at the experiences of nephrologists in providing contraception and reproductive health counseling for their female patients. The interviews revealed that many nephrolo","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 7-17.e1"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145083579","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}

{"title":"Living Kidney Donors’ Residential Neighborhoods: Driver or Barrier of Postdonation Follow-Up?","authors":"Yiting Li ,&nbsp;Gayathri Menon ,&nbsp;Byoungjun Kim ,&nbsp;Mario P. DeMarco ,&nbsp;Babak J. Orandi ,&nbsp;Sunjae Bae ,&nbsp;Wenbo Wu ,&nbsp;Allan B. Massie ,&nbsp;Macey L. Levan ,&nbsp;Jonathan C. Berger ,&nbsp;Dorry L. Segev ,&nbsp;Mara A. McAdams-DeMarco","doi":"10.1053/j.ajkd.2025.06.020","DOIUrl":"10.1053/j.ajkd.2025.06.020","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 135-138"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093511","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}

{"title":"Trends in Major Cardiovascular Events and Bleeding Among Patients With Advanced CKD: A Nationwide Swedish Study","authors":"Anne-Laure Faucon ,&nbsp;Stefania Lando ,&nbsp;Shunsuke Murata ,&nbsp;Morgan E. Grams ,&nbsp;Edouard L. Fu ,&nbsp;Frida Welander ,&nbsp;Nazleen F. Khan ,&nbsp;G. Brandon Atkins ,&nbsp;Irina Barash ,&nbsp;Dena R. Ramey ,&nbsp;Karin Modig ,&nbsp;Marie Evans ,&nbsp;Juan-Jesús Carrero","doi":"10.1053/j.ajkd.2025.08.011","DOIUrl":"10.1053/j.ajkd.2025.08.011","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Patients with advanced chronic kidney disease (CKD) have an excess risk of cardiovascular and bleeding events, but trends in the rates of these events have yet to be fully investigated. This study focused on characterizing them in Sweden.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Retrospective cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;All patients with advanced CKD enrolled by nephrologists in a nationwide Swedish Renal Registry between 2011 and 2021.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;Stage G4 CKD (N = 25,591), nondialysis stage G5 CKD (ND-CKD, N = 13,968), supported by hemodialysis (N = 10,635), or supported by peritoneal dialysis (N = 4,511).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome&lt;/h3&gt;&lt;div&gt;Major adverse cardiovascular events (MACE), arterial and venous thromboembolic events, major and non-major clinically-relevant bleeding.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Patients were followed until an outcome event, death, or progression to a more severe CKD-stage/change of dialysis modality. Poisson models to estimate unadjusted incidence rates and standardized incidence rate ratios were computed using indirect standardization based on the observed rates in the age- and sex- matched general population.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The rates of all study outcomes were greater with more severe stages of CKD; by 2021, the rates of these outcomes were 1.4 to 13.6 times higher than in the general population. Between 2011 and 2021, patients with advanced CKD experienced important reductions in the rates of MACE and arterial and venous thromboembolic events (as much as 39%, 28%, and 57%, respectively), with larger declines than those observed for the general population. Major bleeding rates also decreased (up to 12%), but non-major bleeding markedly increased, especially in ND-CKD (from 42% to 69%). The decreases in MACE as well as arterial and venous events were comparable for men and women (except for a greater reduction in arterial events in men than in women, &lt;em&gt;P&lt;/em&gt; = 0.03). The increase in non-major bleeding rates was greater in women than in men (&lt;em&gt;P&lt;/em&gt; = 0.02).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Outcomes based on diagnostic codes; unknown generalizability to other countries.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Although there have been important reductions in the rates of cardiovascular events and major bleeding events in patients with advanced CKD, the event rates remain substantially higher than in the general population, indicating a need for additional strategies to minimize these risks.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;We explored rates and trends of cardiovascular and bleeding events in Swedish patients with advanced CKD between 2011 and 2021. Cardiovascular and bleeding events were 1.5 to 11.1 times more common in patients with CKD than in the general population. However, over time there has been a significant reduction in the","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 31-43.e1"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward Smarter Allocation by Rethinking Kidney Donor Profile Index","authors":"Ajay K. Israni ,&nbsp;Jon Miller ,&nbsp;Syed F. Hassan","doi":"10.1053/j.ajkd.2025.11.001","DOIUrl":"10.1053/j.ajkd.2025.11.001","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 4-6"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765734","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}

{"title":"Interpreting Metabolomics and Proteomics in Kidney Disease: A Practical Guide","authors":"Insa M. Schmidt ,&nbsp;Eugene P. Rhee","doi":"10.1053/j.ajkd.2025.08.014","DOIUrl":"10.1053/j.ajkd.2025.08.014","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 129-133"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145450596","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}

{"title":"Kidney Cysts in Alport Syndrome: Illustrative Cases, but Misleading Conclusions","authors":"Thomas Robert MD ,&nbsp;Laure Raymond ,&nbsp;Laurent Mesnard","doi":"10.1053/j.ajkd.2025.08.015","DOIUrl":"10.1053/j.ajkd.2025.08.015","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 134-135"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145462013","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}

{"title":"Management of Chronic Hyponatremia in the Outpatient Setting","authors":"Angelique B.M.C. Savelberg ,&nbsp;Ewout J. Hoorn ,&nbsp;Julie C. Refardt","doi":"10.1053/j.ajkd.2025.06.024","DOIUrl":"10.1053/j.ajkd.2025.06.024","url":null,"abstract":"<div><div>The diagnostic evaluation and management of chronic hyponatremia in outpatients can be challenging for several reasons. First, chronic hyponatremia is often mild, leading to uncertainty about whether it is clinically significant and warrants further diagnostic evaluation and treatment. Second, if the initial diagnostic workup does not identify a clear cause, it becomes uncertain how much further investigation is required. Third, when no clear cause is found or the underlying condition cannot be treated, physicians may struggle to choose the most appropriate treatment approach. This review offers practical guidance to navigate these challenges in managing chronic hyponatremia in the outpatient setting.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 87-92"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145296211","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}

{"title":"Revisiting New Data on the Mortality Benefit of Rapid Correction of Hyponatremia: Déjà Vu All Over Again","authors":"Richard H. Sterns ,&nbsp;Helbert Rondon-Berrios","doi":"10.1053/j.ajkd.2025.07.015","DOIUrl":"10.1053/j.ajkd.2025.07.015","url":null,"abstract":"<div><div>Studies in the 1980s linking rapid correction of severe, chronic hyponatremia to the osmotic demyelination syndrome (ODS) led to a major controversy that eventually gave way to consensus guidelines. Efforts to limit correction to ≤8 mmol/L per day in patients at high risk of developing ODS became common practice. Recent studies have questioned these guidelines, suggesting that ODS is rare and that slow correction may increase mortality. In this review, we revisit the history of the controversy and find that these claims have persisted for 4 decades. Older studies supporting faster correction are flawed by referral bias while newer studies are limited by confounding as comorbidities influence rates of both mortality and hyponatremia correction. Although both old and new studies emphasize the rarity of magnetic resonance imaging–documented ODS after rapid correction, they were not conducted in hyponatremic patients who were at risk for ODS. Old studies reporting hyponatremic deaths due to cerebral edema overestimate its true incidence, and new studies reporting an association of mortality and slow rates of sodium correction do not document cerebral edema as a common contributor to death. Further research is required to better define the incidence of both ODS and cerebral edema in patients at risk for these complications. Until then, we conclude that the risks of rapid correction—including irreversible neurological damage—necessitate caution. Clinicians should continue to prioritize slow, controlled sodium correction to protect high-risk patients from harm.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"87 1","pages":"Pages 115-123"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145296210","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}