Am. J. Kidney Dis. [JOURNAL]
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200 papers
What's New in Membranous Nephropathy and How to Incorporate New Antigen Discoveries Into Clinical Practice: A Review.
Zand L, Fervenza FC, Sethi S
Am J Kidney Dis · 2026 Jan · PMID 41110629 · Publisher ↗
Membranous nephropathy (MN) is one of the most common causes of nephrotic syndrome in adults and can be seen in association with other diseases, including malignancy, drugs, infections, or autoimmune diseases. Over the l...
Membranous nephropathy (MN) is one of the most common causes of nephrotic syndrome in adults and can be seen in association with other diseases, including malignancy, drugs, infections, or autoimmune diseases. Over the last decade, great progress has been made in understanding the pathogenesis of the disease, resulting from the discovery of several target antigens by use of laser microdissection/mass spectrometry methodology. This technique has proven to be the most sensitive method available and has the advantage of testing for all the target antigens at one time. The discovery of these target antigens has now shifted the classification of MN from primary versus secondary to classification based on the target antigen identified. Each target antigen has its own specific clinical characteristics and known associated diseases. Identification of the target antigen can help further identify the underlying cause for a more targeted approach in looking for associated diseases. Progress has also been made in the treatment of patients with MN, with more standard risk stratification of the patients and a shift in using anti-CD20 drugs as the first line for those with moderate and high risk of progression. Trials are ongoing to further investigate the role of anti-plasma cell, anticomplement, and CAR-T (chimeric antigen receptor T-cell) therapies.
Association of Influenza Vaccination With Acute Kidney Injury: A Prospective Target Trial Emulation Study.
Zhuo L, Zhang B, Huang Y … +4 more , Wen Q, Wang S, Zhan S, Zhao H
Am J Kidney Dis · 2026 Jan · PMID 41110628 · Publisher ↗
RATIONALE & OBJECTIVE: The impact of influenza vaccination on the risk of acute kidney injury (AKI) has not been thoroughly evaluated in large-scale prospective studies. We assessed whether influenza vaccination was asso...
RATIONALE & OBJECTIVE: The impact of influenza vaccination on the risk of acute kidney injury (AKI) has not been thoroughly evaluated in large-scale prospective studies. We assessed whether influenza vaccination was associated with a reduced incidence of AKI among individuals aged 65 years or older. STUDY DESIGN: Target trial emulated with a sequential trial design. SETTING & PARTICIPANTS: Participants aged 65 years or older in the UK Biobank. EXPOSURE: Influenza vaccination compared with no influenza vaccine. OUTCOME: Incident AKI during 1 year after vaccination. Participants were followed from baseline until the diagnosis of AKI, death, loss to follow-up, or for 1 year after entering the study, whichever occurred first. ANALYTICAL APPROACH: Fifty trials were emulated, each with a 1-month enrollment period. These trials began in September 2007 and continued from September to January of the following year until January 2017. Eligible participants could be included in multiple trials until they no longer met the inclusion criteria. Propensity score matching was applied to match vaccine recipients to unvaccinated individuals in a 1:1 ratio to control for confounders, emulating random assignment. A clustered marginal competing risk model that accounts for the within-pair clustering of outcomes was fit to estimate the hazard ratio, along with the 95% confidence interval, characterizing the association between the use of influenza vaccination and incident AKI. RESULTS: Overall, the cohort included 1,408,922 eligible person-trials in the general practice data. After propensity score matching, 97,663 pairs of person-trials were included. During the 1-year follow-up, a total of 598 incident AKI events were observed. In the primary analysis, the incidence of AKI was 36.8 per 10,000 person-years (PYs) in unvaccinated participants and 30.6 per 10,000 PYs in the vaccinated group. After adjusting for potential confounders using propensity score matching, influenza vaccination was associated with a 17% lower AKI risk (HR, 0.83 [95% CI, 0.71-0.98]). The cumulative mortality rates were 62.8 per 10,000 PYs in the unvaccinated group and 47.2 per 10,000 PYs in the vaccinated group, corresponding to an HR of 0.75 (95% CI, 0.66-0.85). These findings remained consistent in subgroup and sensitivity analyses. LIMITATIONS: Potential residual confounding from variations in vaccine formulations and batch; potential selection bias from restricting to participants with linked primary care data in the UK Biobank; and potential outcome misclassification from use of a code-based algorithm to identify AKI. CONCLUSIONS: In this prospective population-based study of older adults within the UK Biobank, influenza vaccination was significantly associated with a lower risk of incident AKI. These findings support use of influenza vaccination in older adults to reduce influenza and its kidney-related complications. PLAIN-LANGUAGE SUMMARY: Influenza infection can damage multiple systems beyond the respiratory system and cause impairment of kidney function. We hypothesized that influenza vaccination may provide a more extensive protective effect beyond respiratory diseases. However, the impact of influenza vaccination on the risk of acute kidney injury (AKI) has not been sufficiently evaluated. This study investigated the association between influenza vaccination and AKI in older adults represented in the UK Biobank, a large prospective cohort. By emulating a targeted randomized clinical trial in this cohort, we found that influenza vaccination may reduce the risk of AKI by 17%. This effect was partially mediated by a reduction in influenza and pneumonia. These findings support the broader implementation of influenza vaccination to reduce both influenza and kidney-related complications in older adult populations.
A Novel Founder PKHD1 Disease Causing Variant in Israeli Bedouins With Autosomal Recessive Polycystic Kidney Disease.
Sayer JA, Pillai J
Am J Kidney Dis · 2025 Dec · PMID 41110000 · Publisher ↗
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Patient and Center Factors in Home Dialysis Therapy Uptake: Analysis of a UK Renal Registry Cohort and a National Dialysis Center Survey.
Potts J, Pearse CM, Lambie M … +8 more , Fotheringham J, Hill H, Coyle D, Damery S, Allen K, Williams I, Davies SJ, Solis-Trapala I
Am J Kidney Dis · 2026 Jan · PMID 41109550 · Publisher ↗
RATIONALE & OBJECTIVE: Variation in home dialysis therapy (HT) use across centers and geography may reflect the interplay between dialysis center services and patient characteristics. We examined direct and indirect asso...
RATIONALE & OBJECTIVE: Variation in home dialysis therapy (HT) use across centers and geography may reflect the interplay between dialysis center services and patient characteristics. We examined direct and indirect associations between these factors and HT uptake in England. STUDY DESIGN: UK Renal Registry (UKRR) cohort linked to a national survey of renal centers. SETTING & PARTICIPANTS: Adults who initiated kidney replacement therapy (KRT) between 2015 and 2019 at 51 English renal centers, totaling 32,400 individuals identified through the UKRR with center practices captured from a 2022 national survey of dialysis centers. EXPOSURE: Patient-level (demographics and clinical characteristics) and center-level (including availability of assisted peritoneal dialysis, quality improvement initiatives, and fostering staff engagement in research) factors. OUTCOME: Use of HT (home hemodialysis or peritoneal dialysis) within 1 year of starting KRT. ANALYTICAL APPROACH: Sequences of regressions, an extension of path analysis, used to examine direct and indirect associations between patient-level and center-level factors and the probability of HT uptake. RESULTS: Both center-level and patient-level factors were significantly associated with the probability of HT uptake. Patients at centers conducting quality improvement projects (odds ratio [OR], 1.94 [95% CI, 1.36-2.76]), offering assisted peritoneal dialysis (OR, 1.89 [95% CI, 1.39-2.57]), fostering staff research engagement (OR, 1.35 [95% CI, 1.03-1.77]), or hosting HT roadshows (OR, 1.22 [95% CI, 1.05-1.41]) had higher odds of HT uptake. Centers with greater stress on staff capacity to deliver HT had lower uptake (OR, 0.60 [95% CI, 0.45-0.81]). Patients on transplant lists at KRT start (OR, 2.55 [95% CI, 2.35-2.77]) or who lived farther from a treatment center (OR, 1.10 [95% CI, 1.08-1.12] per 10 km) had higher odds of HT uptake. Patients living in areas of higher deprivation or members of minoritized ethnic groups had lower HT uptake overall. However, some of these associations may have been indirectly mitigated in centers serving more diverse populations because these centers were more likely to implement practices associated with higher HT uptake. LIMITATIONS: Health care professional-reported and aggregated survey data. CONCLUSIONS: This study identified modifiable center-level factors associated with HT uptake, informing potential opportunities to reduce ethnic and area-level disparities. PLAIN-LANGUAGE SUMMARY: Some patients are less likely to use home dialysis, possibly due to both patient characteristics and how dialysis centers operate. We studied over 32,000 patients who began kidney replacement therapy between 2015 and 2019, linking national patient data with a 2022 survey of English dialysis centers. Using advanced statistical methods, we uncovered direct and indirect links between patient and center factors and home therapy use. Patients were more likely to use home dialysis if their center offered supportive practices like assisted dialysis, staff-led improvement projects, or home dialysis educational roadshows. Notably, centers serving diverse populations were more likely to implement such practices. This study highlights how center practices may contribute to improving and reducing disparities in access to home therapy.
Trends in Major Cardiovascular Events and Bleeding Among Patients With Advanced CKD: A Nationwide Swedish Study.
Faucon AL, Lando S, Murata S … +10 more , Grams ME, Fu EL, Welander F, Khan NF, Atkins GB, Barash I, Ramey DR, Modig K, Evans M, Carrero JJ
Am J Kidney Dis · 2026 Jan · PMID 41109549 · Publisher ↗
RATIONALE & OBJECTIVE: 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...
RATIONALE & OBJECTIVE: 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. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: All patients with advanced CKD enrolled by nephrologists in a nationwide Swedish Renal Registry between 2011 and 2021. EXPOSURE: 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). OUTCOME: Major adverse cardiovascular events (MACE), arterial and venous thromboembolic events, major and non-major clinically-relevant bleeding. ANALYTICAL APPROACH: 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. RESULTS: 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, P = 0.03). The increase in non-major bleeding rates was greater in women than in men (P = 0.02). LIMITATIONS: Outcomes based on diagnostic codes; unknown generalizability to other countries. CONCLUSIONS: 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. PLAIN-LANGUAGE SUMMARY: 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 rates of both types of events. The decline in these events over time was larger than that observed in the general population. These findings document improvements in cardiovascular and bleeding risks for patients with advanced CKD, but their continued occurrence at a rate greater than in the general population indicates the need for additional strategies to further reduce the burden of these health conditions.
Physician as Patient.
Fang C
Am J Kidney Dis · 2025 Dec · PMID 41108313 · Publisher ↗
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Associations of Skeletal Muscle Mass and Body Mass Index With Clinical Outcomes in Autosomal-Dominant Polycystic Kidney Disease: An Observational Study.
Im DW, Jung J, Ha M … +21 more , Kim YS, Joo KW, Oh KH, Kim DK, Lee H, Han SS, Kang E, Park S, Shin SJ, Lee J, Song J, Oh YK, Park HC, Ahn C, Lee KB, Kim YH, Han S, Kim Y, Bae EH, Park JY, Kim YC
Am J Kidney Dis · 2026 Mar · PMID 41101718 · Publisher ↗
RATIONALE & OBJECTIVE: Low muscle mass is a risk factor for chronic kidney disease. In this study, we examined the relationship between muscle mass and mortality, as well as end-stage kidney disease (ESKD), in patients w...
RATIONALE & OBJECTIVE: Low muscle mass is a risk factor for chronic kidney disease. In this study, we examined the relationship between muscle mass and mortality, as well as end-stage kidney disease (ESKD), in patients with autosomal-dominant polycystic kidney disease (ADPKD). STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: 1,443 patients with ADPKD from eight tertiary-care hospitals in South Korea between 2006 and 2020. EXPOSURES: Computed tomography images were obtained at the third lumbar vertebra to measure the skeletal muscle area (SMA) using an artificial intelligence system. SMA indexed for the square of height (height) was classified as low-attenuation muscle area (LAMA) or normal-attenuation muscle area (NAMA) based on muscle quality. OUTCOMES: All-cause mortality and ESKD. ANALYTICAL APPROACH: Cox proportional hazards regression, adjusted for sex, age, creatinine, glucose, and height-adjusted total kidney volume, was used to investigate the associations of muscle indices with all-cause mortality and ESKD. Subgroup analyses were conducted based on body mass index categories: low or normal (<25 kg/m) and overweight or obese (≥25 kg/m). RESULTS: The study population included more than half female patients, and the mean estimated glomerular filtration rate was 68.4 mL/min/1.73 m. Mean follow-up was 5.14 years. Greater SMA/height and NAMA/height ratios were associated with a lower risk of mortality (HRs, 0.58 [95% CI, 0.39-0.88] and 0.55 [0.39-0.79], respectively). Greater NAMA/height ratio was associated with a 26% lower ESKD incidence (HR, 0.74; 95% CI, 0.59-0.92), but a greater LAMA/height ratio was associated with a higher ESKD incidence (HR 1.18, 95% CI 1.01-1.37). A higher NAMA/LAMA ratio was associated with a lower ESKD incidence (HR, 0.74; 95% CI, 0.60-0.92). Greater muscle mass was associated with a lower risk of mortality among overweight individuals and a lower risk of ESKD in underweight individuals. LIMITATIONS: Lack of details about muscle strength and performance. CONCLUSIONS: Among individuals with ADPKD, greater and higher-quality muscle mass were associated with lower risks of mortality and progression of chronic kidney disease to ESKD. PLAIN-LANGUAGE SUMMARY: Low muscle mass is a known health concern, and we aimed to study its impact specifically in patients with autosomal-dominant polycystic kidney disease (ADPKD). We investigated how muscle mass relates to patient survival and progression to end-stage kidney disease. Using computed tomography scans performed on more than 1,400 patients with ADPKD, we measured the amount and quality of their muscle. We discovered that patients with more muscle, especially higher-quality muscle, had a significantly lower risk of death and were less likely to develop end-stage kidney disease. Conversely, lower-quality muscle was associated with an increased risk of death. These findings suggest that maintaining good muscle mass may improve outcomes for patients with ADPKD. These data can inform future strategies for improving outcomes in people with ADPKD.
Revisiting New Data on the Mortality Benefit of Rapid Correction of Hyponatremia: Déjà Vu All Over Again.
Sterns RH, Rondon-Berrios H
Am J Kidney Dis · 2026 Jan · PMID 41093163 · Publisher ↗
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 corr...
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.
Clarifying Dialysis Modality Classification in Algorithm-Based ESKD Identification.
Palamuthusingam D
Am J Kidney Dis · 2025 Dec · PMID 41093162 · Publisher ↗
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In Reply to "Clarifying Dialysis Modality Classification in Algorithm-Based ESKD Identification".
Gao C, Shin JI
Am J Kidney Dis · 2025 Dec · PMID 41093161 · Publisher ↗
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Management of Chronic Hyponatremia in the Outpatient Setting.
Savelberg ABMC, Hoorn EJ, Refardt JC
Am J Kidney Dis · 2026 Jan · PMID 41093160 · Publisher ↗
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 sig...
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.
Environmental Impacts of Kidney Replacement Therapies: A Comparative Lifecycle Assessment.
Saleem S, Stigant C, Rajan T … +4 more , Hewage K, Sadiq R, MacNeill AJ, Nguan C
Am J Kidney Dis · 2026 Jan · PMID 41076003 · Publisher ↗
RATIONALE & OBJECTIVE: Health care delivery is associated with considerable emissions of greenhouse gases and other pollutants. Although the relative health and economic impacts of kidney replacement therapies (KRTs) hav...
RATIONALE & OBJECTIVE: Health care delivery is associated with considerable emissions of greenhouse gases and other pollutants. Although the relative health and economic impacts of kidney replacement therapies (KRTs) have been examined, their comparative environmental impacts have been poorly described. This study sought to characterize these impacts, comparing them across types of KRT. STUDY DESIGN: A comparative lifecycle assessment (LCA). SETTING & PARTICIPANTS: Data collection implemented at Vancouver General Hospital in Vancouver, British Columbia, Canada. EXPOSURE: Three KRTs: deceased-donor kidney transplant (KT), automated/cycler peritoneal dialysis (PD), or in-center hemodialysis (HD). OUTCOME: Environmental impacts of KRTs over 1 year were evaluated using the World ReCiPe (H) 2016 method. ANALYTICAL APPROACH: Lifecycle inventory results were transformed into 3 end-point and 18 midpoint environmental impact categories including climate change, air pollution, human toxicity, and water depletion. RESULTS: Across the majority of environmental impact categories, including climate change, air pollution, human toxicity, and water depletion, HD had the highest environmental impact and KT the lowest. The climate impact from a patient receiving HD was 74% and 46% more than from patients receiving KT and PD, respectively. Similarly, HD accounted for 65% of total air pollution impacts, 54% of human toxicity, and 44% of water depletion. The highest impact of PD was on water depletion (41%) and metal depletion (81%). KT demonstrated the lowest impact across all categories except terrestrial ecotoxicity. Within each therapy, patient and staff travel and consumables were the largest contributors to greenhouse gas emissions. LIMITATIONS: Pharmaceuticals were excluded from this study because of a lack of publicly available data. CONCLUSIONS: KT is the most environmentally preferred KRT. PD had fewer environmental impacts than HD. Understanding the relative environmental impacts of KRTs can help inform clinical decision-making in the management of kidney failure. PLAIN-LANGUAGE SUMMARY: The environmental impacts of health care are gaining attention, yet kidney care, and especially kidney replacement therapies (KRTs), have been underexamined. This study was inspired by growing concerns about the environmental consequences of KRTs like hemodialysis, peritoneal dialysis, and transplantation. We used environmental assessment tools to measure emissions and resource use across different KRTs in a clinical setting in Vancouver, Canada. We found that these therapies vary widely in their environmental impacts, with in-center hemodialysis having the greatest negative impact and kidney transplant the least impact. This study also explored the sources of these impacts and can inform health systems and health care policymakers regarding opportunities for more environmentally informed practices in kidney care.
Identifying Adaptation Needs of a Decision Aid for Older Latino Adults With Advanced CKD: A Qualitative Study.
Porteny T, Kennefick K, Matos H … +4 more , Damron KC, Weiner DE, Kalloo S, Ladin K
Am J Kidney Dis · 2026 Jan · PMID 41067689 · Publisher ↗
RATIONALE & OBJECTIVE: Latino adults aged 65 years and older comprise the fastest growing minoritized group in the United States and experience a disproportionate burden of kidney failure. Decision aids improve decisiona...
RATIONALE & OBJECTIVE: Latino adults aged 65 years and older comprise the fastest growing minoritized group in the United States and experience a disproportionate burden of kidney failure. Decision aids improve decisional quality and goal-concordant care among older patients with chronic kidney disease (CKD). However, decision aids for kidney replacement therapy have yet to be adapted for the older Latino adult population with advanced CKD. This study assessed the acceptability, accessibility and adaptions needed to facilitate use of a Spanish version of the Decision-Aid for Renal Therapy (DART-S) for older Latino adults with advanced CKD. STUDY DESIGN: Qualitative study applying the Cultural Targeting and Tailoring of Shared Decision-Making Technology Framework in focus groups and structured interviews. Suggested adaptations were grouped into recommendations and analyzed qualitatively. SETTING & PARTICIPANTS: Five focus groups (N = 17) and interviews (N = 15) with Spanish-speaking patients and care partners were conducted. ANALYTICAL APPROACH: Thematic analysis. RESULTS: Among patient participants, 55% were male, and the mean age was 68 ± 9 years. Overall, the participants found DART-S to be acceptable and accessible. Thematic analysis revealed the importance of incorporating lived experiences, including patient and family testimonials, to illustrate the mental health impact of CKD, self-care strategies, and home dialysis adaptations. Some found the delivery of prognostic information distressing, highlighting the need for more sensitive communication. The tailoring recommendations included information about financial barriers, nutrition, and lifestyle. Participants preferred that DART-S be disseminated via kidney clinicians upon CKD diagnosis and recommended leveraging social media for broader reach. LIMITATIONS: Findings are not generalizable beyond the Latino subgroups in this study. Legal status was not ascertained. CONCLUSIONS: Targeting and tailoring decision aids is a necessary step in providing goal-concordant and person-centered care for older Latino adults with advanced CKD. Future research should examine the comparative efficacy of DART-S in increasing knowledge and decisional quality among Latino patients.
Urine Oxalate Excretion and CKD Stage in Patients With Primary Hyperoxaluria Type 1.
Vaughan LE, Schulte PJ, Knauf F … +3 more , Sas DJ, Milliner DS, Lieske JC
Am J Kidney Dis · 2026 Jan · PMID 40983145 · Full text
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A 16-Year-Old With a Hypertension Emergency: A Quiz.
Churilla T, Baker JB, Chang A … +1 more , Finer G
Am J Kidney Dis · 2025 Oct · PMID 40976636 · Publisher ↗
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Infectious Tropical Diseases That Acutely Affect the Kidneys: What Physicians and Health Care Workers in Nonendemic Countries Should Know.
Burdmann EA, Andrade LC
Am J Kidney Dis · 2025 Dec · PMID 40976334 · Publisher ↗
The tropics, a large and heavily inhabited area, are characterized by deep contrasts in sociopolitical, economic, and social development, which are reflected in the epidemiology of diseases. Common noncommunicable chroni...
The tropics, a large and heavily inhabited area, are characterized by deep contrasts in sociopolitical, economic, and social development, which are reflected in the epidemiology of diseases. Common noncommunicable chronic diseases, such as diabetes and hypertension, coexist with acute infectious tropical diseases. Global warming, immigration, tourism, and commercial travel have helped spread tropical diseases to temperate zones by facilitating the spread of vectors, the infection of animal reservoirs, and the introduction of contaminated individuals into nonendemic areas. Infectious tropical diseases are currently a significant global public health concern worldwide. Their timely diagnosis and adequate treatment might be a considerable challenge to health workers from nontropical areas because most share very similar initial clinical presentations. It is essential that health care teams worldwide can recognize and treat a broad spectrum of tropical diseases. Several of these infectious tropical diseases can affect the kidneys, acutely or chronically. In this review, we explore and discuss the epidemiology, pathophysiological mechanisms, and clinical aspects of the most relevant infectious tropical diseases that can be associated with acute kidney injury. Such diseases include, but are not limited to, dengue, yellow fever, chikungunya, malaria, leptospirosis, and scrub typhus.
Pharmaceutical Practice Considerations Regarding Adoption of the Race-Free Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2021 Equations.
Tarzi R, McKenzie J, Reid M … +9 more , Goodison S, Oyee J, Hiemstra TF, Zamek-Gliszczynski MJ, Muoneke M, Obert LA, Nwokolo N, Young B, Richards A
Am J Kidney Dis · 2025 Dec · PMID 40976333 · Publisher ↗
The race-free Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2021 estimated glomerular filtration rate-creatinine (eGFR) equation is being adopted in the United States. Elsewhere there is debate regarding it...
The race-free Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2021 estimated glomerular filtration rate-creatinine (eGFR) equation is being adopted in the United States. Elsewhere there is debate regarding its validation and adoption. Absence of a perfect solution and a lack of alignment present challenges when considering global clinical trials. While acknowledging these challenges, GSK decided to adopt the CKD-EPI 2021 eGFR equation for new adult trials to support health equity and delivery benefits from standardized data management. The eGFR obtained using the CKD-EPI 2021 equation versus CKD-EPI 2009 equation is moderately lower in US Black individuals and moderately higher in non-Black individuals. Analyses before adoption suggested no major impact for study safety or efficacy evaluations although racial/ethnic representation may need to be examined in trials with an eGFR ≥ 60 mL/min/1.73 m inclusion criterion because enrollment of eligible Black participants could be reduced. Sensitivity analyses using 2009 and 2021 equations may be necessary to understand any effect size with population change, especially where there are kidney end points or relevant safety concerns. GSK plans to monitor the impact of adopting the CKD-EPI 2021 eGFR equation on adverse event reporting across studies and pharmacovigilance outcomes and to monitor the evolution of regulatory guidance for eGFR equation implementation.
Effectiveness of Bivalent mRNA COVID-19 Vaccine Among Adults With Kidney Failure Receiving Dialysis: A Cohort Study From the Centers for Medicare and Medicaid Services.
Payne AB, Novosad S, Sung HM … +11 more , Zhang Y, Wiegand R, Gomez Victor CS, Wallace M, Gomes DJ, Najdowski M, Lufkin B, Chillarige Y, Lacson E, Dalrymple LS, Link-Gelles R
Am J Kidney Dis · 2025 Dec · PMID 40976332 · Publisher ↗
RATIONAL & OBJECTIVE: Patients with kidney failure treated with maintenance dialysis have an increased risk of severe disease due to SARS-CoV-2 infection, the virus that causes COVID-19. Previous studies have shown that...
RATIONAL & OBJECTIVE: Patients with kidney failure treated with maintenance dialysis have an increased risk of severe disease due to SARS-CoV-2 infection, the virus that causes COVID-19. Previous studies have shown that COVID-19 vaccination is effective against severe COVID-19 illness in the general population. However, less is known about populations at greater risk for severe disease. This investigation examined the real-world effectiveness of bivalent messenger RNA (mRNA) COVID-19 vaccination against clinical outcomes among patients treated with maintenance dialysis. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: Medicare Fee-for-Service (FFS) claims data for beneficiaries aged ≥18 years with kidney failure receiving maintenance dialysis between September 4, 2022, and April 1, 2023. EXPOSURE: Bivalent mRNA COVID-19 vaccination compared with receipt of original monovalent COVID-19 doses alone. OUTCOME: Medically attended COVID-19, which was defined as the occurrence of a COVID-19-associated outpatient encounter, COVID-19-associated hospitalization, critical COVID-19 illness, or COVID-19-associated death, overall as well as each COVID-19-associated outcome individually. ANALYTICAL APPROACH: Relative vaccine effectiveness against COVID-19-associated outcomes was calculated as 1 - adjusted hazard ratio, with the adjusted hazard ratio comparing rates of outcomes by vaccination status estimated using a weighted Cox regression model. RESULTS: Compared with receipt of original monovalent COVID-19 vaccine doses, the relative estimated effectiveness of a bivalent mRNA COVID-19 vaccine dose was 41% (95% CI, 37%-46%) against medically attended COVID-19, 49% (95% CI, 43%-54%) against COVID-19-associated hospitalization, 53% (95% CI, 44%-61%) against critical COVID-19 illness, and 54% (95% CI, 42%-63%) against COVID-19-associated death among adults with kidney failure treated with maintenance dialysis without additional immunocompromising conditions. Estimated vaccine effectiveness against medically attended COVID-19 was 50% (95% CI, 44%-55%) 7-59 days after bivalent vaccination and 33% (95% CI, 26%-39%) 60-206 days after bivalent vaccination. LIMITATIONS: Potential misclassification bias, residual confounding, and generalizability concerns may exist. CONCLUSIONS: These findings suggest a bivalent mRNA COVID-19 vaccine dose provided protection against COVID-19 disease among previously vaccinated persons with kidney failure receiving maintenance dialysis, but the estimated effectiveness waned over time. PLAIN-LANGUAGE SUMMARY: People with kidney failure treated with maintenance dialysis are at increased risk of severe COVID-19. The role of COVID-19 vaccination in this population is not well characterized. Between September 4, 2022, and April 1, 2023, the relative effectiveness of a bivalent mRNA COVID-19 vaccine dose compared with receipt of original monovalent COVID-19 vaccine doses alone among adults aged ≥18 years with kidney failure treated with maintenance dialysis but without additional immunocompromising conditions was 41% (95% CI, 37%-46%) against medically attended COVID-19, with the estimated effectiveness being similar for severe outcomes like COVID-19-associated hospitalization and COVID-19-associated death. COVD-19 vaccine effectiveness among these adults waned with more time since vaccination.
Nephrologist Perspectives on Using Telemedicine During In-Center Hemodialysis: A Qualitative Study.
Haltom TM, Lew SQ, Winkelmayer WC … +3 more , Chertow GM, Jaure A, Erickson KF
Am J Kidney Dis · 2025 Dec · PMID 40976331 · Publisher ↗
RATIONALE & OBJECTIVE: During the coronavirus disease 2019 (COVID-19) pandemic, the US government expanded originating telemedicine sites to include outpatient dialysis units. For the first time, nephrology care provider...
RATIONALE & OBJECTIVE: During the coronavirus disease 2019 (COVID-19) pandemic, the US government expanded originating telemedicine sites to include outpatient dialysis units. For the first time, nephrology care providers (nephrologists and affiliated advanced practice providers) across the United States could use telemedicine in lieu of face-to-face visits to deliver care for patients receiving in-center hemodialysis. In this study, we describe perspectives and experiences of nephrologists using telemedicine to deliver in-center hemodialysis care. STUDY DESIGN: Qualitative research study. SETTING & PARTICIPANTS: Nephrologists in 3 health systems who used telemedicine for in-center hemodialysis during the COVID-19 pandemic. ANALYTICAL APPROACH: We conducted 16 semistructured telephone interviews. Transcripts were thematically analyzed. RESULTS: We identified 5 themes and respective subthemes: maintaining safety and quality of care (making up missed appointments, fostering continuity of care, addressing urgent medical issues); maximizing efficiency (reducing nephrologists' travel burden, allowing for flexibility); operational complexities (dependence on facility resources; challenges coordinating with facility staff; modifying visit duration/length); diminished depth of clinical encounters (excess formality, constrained communication, incomplete physical examinations); supporting confidence in telemedicine (complementing in-person care, accounting for patient preferences, requiring reimbursement). LIMITATIONS: The transferability of the findings outside of an urban academic setting is uncertain. CONCLUSIONS: Although nephrologists encountered operational (both technical and personal level) challenges such as communication constraints when using telemedicine for in-center hemodialysis care, they reported improvements in aspects of care quality and enhanced efficiency. These findings inform the potential use of a hybrid in-center hemodialysis care delivery model in which telemedicine supplements in-person visits. PLAIN-LANGUAGE SUMMARY: We describe nephrologists' perspectives and experiences with delivery of care using telemedicine at dialysis facilities during the COVID-19 pandemic. The nephrologists participating in this study suggested telemedicine is beneficial to maintaining patient safety and quality of care and maximizing physicians' efficiency. Nephrologists experienced barriers given operational complexities such as technical and personnel support from dialysis facilities. Clinical encounters were also less personal and more formal. Nevertheless, the experiences of participating nephrologists suggest that a hybrid care model with both in-person and telemedicine visits may help maintain high-quality care while increasing the efficiency of delivering clinical care. These findings inform the potential use of a hybrid in-center hemodialysis care delivery model.
IgG3κ Monoclonal Membranous Nephropathy Associated With Acquired Lecithin Cholesterol Acyltransferase Deficiency.
Bu L, Lee JH, Quigley MM … +6 more , Elahimehr R, Theis JD, Perrizo RL, Dasari S, Garrett TJ, Nasr SH
Am J Kidney Dis · 2025 Dec · PMID 40975265 · Publisher ↗
Lecithin cholesterol acyltransferase (LCAT) deficiency, inherited or acquired, is characterized by markedly low plasma high-density lipoprotein (HDL) cholesterol levels and increased unesterified cholesterol. We report a...
Lecithin cholesterol acyltransferase (LCAT) deficiency, inherited or acquired, is characterized by markedly low plasma high-density lipoprotein (HDL) cholesterol levels and increased unesterified cholesterol. We report a case of an elderly patient with persistently very low HDL and proteinuria. Serum cholesteryl esters were markedly low, and kidney biopsy revealed diffuse global glomerular lipid deposition, classic for LCAT deficiency, whereas genetic testing for variants associated with LCAT deficiency was negative. Kidney biopsy also showed concomitant monoclonal (IgG3κ) membranous nephropathy (MN). Proteomic analysis of glomeruli detected spectra for LCAT and serum amyloid P (SAP), suggesting that LCAT could be a target antigen in monoclonal MN with SAP enrichment and associated LCAT deficiency. Furthermore, lipidomic analysis revealed an accumulation of phosphatidylcholines and sphingomyelin and a decrease in ceramides. The patient was treated with daratumumab, and at 22 months follow-up his proteinuria was decreased while HDL level remained low.
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