Am. J. Kidney Dis. [JOURNAL]
Sun
200 papers
Identification of Maintenance Dialysis Recipients in Administrative Health Data: A Systematic Review.
Shaw A, Jarrar F, Quinn RR … +5 more , Harrison TG, Elliott MJ, James MT, Ravani P, Liu P
Am J Kidney Dis · 2026 Jun · PMID 42320579 · Publisher ↗
RATIONALE & OBJECTIVE: Administrative health data are increasingly used to identify individuals receiving maintenance dialysis. We systematically reviewed literature on the accuracy of administrative data in recording di...
RATIONALE & OBJECTIVE: Administrative health data are increasingly used to identify individuals receiving maintenance dialysis. We systematically reviewed literature on the accuracy of administrative data in recording dialysis treatments and the performance of case definitions for identifying recipients of maintenance dialysis. STUDY DESIGN: Systematic review of studies included in MEDLINE and Embase from inception to June 13, 2025. SETTING & STUDY POPULATIONS: Studies of individuals with kidney failure treated with maintenance dialysis. SELECTION CRITERIA FOR STUDIES: Studies either assessed the accuracy of administrative data in recording dialysis treatments or in identifying recipients of maintenance dialysis. DATA EXTRACTION: Two investigators independently screened studies and extracted data. ANALYTICAL APPROACH: Narrative synthesis of study characteristics, data sources, case definitions, and reference standards. Performance metrics included sensitivity, positive predictive value (PPV), and F1-score (range 0-1, the higher the better). RESULTS: Nine studies were included. One study reported high accuracy in documenting initial and 90-day dialysis modalities in claims versus medical records. Eight studies evaluated various case definitions for maintenance dialysis using inpatient data (n=1), outpatient claims (n=2), or both (n=5). Three studies used procedural codes alone, and five used both procedural and diagnostic codes. Two studies included incident cases only. Reference standards were kidney replacement therapy registries or data from kidney care programs in seven studies, and from medical records in one. Median (25 and 75 percentiles) was 85.9% (74.4%-92.9%) for PPV (n=37), 75.8% (63.5%-83.8%) for sensitivity, and 79.5% (70.2%-81.9%) for F1-score (n=18). LIMITATIONS: Findings were based on studies from high-income countries; lack of studies using contemporary data. CONCLUSIONS: Performance of case definitions for identifying maintenance dialysis recipients in administrative data is context-dependent and varies across definitions. Existing definitions may guide the development of updated, locally adapted methods, ideally validated against medical records as the reference standard for future studies. REGISTRATION: Registered at PROSPERO with identification number CRD42024582507. PLAIN-LANGUAGE SUMMARY: Administrative health data, such as hospital records and billing information, are often used to identify individuals receiving long-term dialysis. Different methods have been developed to identify these patients in the data, but it is unclear how accurate these methods are, and a critical assessment of the literature is lacking. We conducted a systematic review to compare the accuracy of these methods. We found that most methods were reasonably accurate, but many were tested using outdated data or were compared against a reference standard, which may not have accurately identified all patients. Our findings inform the development of more reliable methods for accurately identifying dialysis patients in administrative data and for planning healthcare services.
Electronic Phenotype for Detection, Staging, and Subtyping of Acute Kidney Injury.
Shang N, Xu K, Stevens JS … +2 more , Barasch J, Kiryluk K
Am J Kidney Dis · 2026 Jun · PMID 42320578 · Publisher ↗
RATIONALE & OBJECTIVE: Distinguishing between transient and sustained subtypes of acute kidney injury (AKI) among hospitalized patients is valuable for clinical management and risk stratification. The objective of this s...
RATIONALE & OBJECTIVE: Distinguishing between transient and sustained subtypes of acute kidney injury (AKI) among hospitalized patients is valuable for clinical management and risk stratification. The objective of this study was to develop and validate a pragmatic electronic phenotype (e-phenotype) for the diagnosis, staging, and subtyping of AKI using electronic health record (EHR) data. STUDY DESIGN: Development of a computable rule-based algorithm to diagnose, stage, and subtype AKI using longitudinal changes of serum creatinine values recorded in an electronic health record. Assessment of the test characteristics of these algorithm-based diagnoses was implemented using a set of patients admitted to the Emergency Department (ED) with or without clinically diagnosed AKI. Validation of AKI diagnoses was implemented in two ways: using a set of patients hospitalized for COVID-19 and using a dataset of patients hospitalized for any cause following an ED visit. These analyses examined the associations of AKI stage and subtype with mortality. SETTING & PARTICIPANTS: Assessment of the test characteristics of the algorithm-based diagnoses: 90 ED visits for AKI and 376 visits without clinical evidence of AKI at Columbia University. Validation in the setting of COVID-19: EHR data from 117,514 instances of COVID-19 infection diagnosed at Columbia University Medical Center throughout the pandemic. Validation in the setting of general hospital admissions: 405,467 general hospital admissions at Beth Israel Medical Center, Boston, MA. TESTS COMPARED: The algorithm-based diagnosis, stage, and subtype of AKI were compared with the clinically adjudicated AKI diagnosis, stage, and subtype. OUTCOMES: AKI detected, staged, and subtyped by an electronic algorithm, and 30-day mortality. RESULTS: The AKI e-phenotype had a positive predictive value of 95.4%, sensitivity of 69.0%, specificity of 99.2%, and overall accuracy of 93.4%. In COVID-19 patients, pre-existing CKD was an independent predictor of AKI. COVID-19-related AKI was associated with mortality in a stage-dependent manner. The subtype of sustained AKI was associated with higher mortality compared to transient AKI within and across all pandemic waves. These results were reproducible in the dataset of patients hospitalized for any condition. LIMITATIONS: Reliance on serum creatinine patterns alone and the inability to incorporate urine output or molecular markers to diagnose and subtype AKI. CONCLUSIONS: The AKI e-phenotype is an accurate, scalable, and generalizable to diverse EHR datasets with reproducible associations with mortality. PLAIN-LANGAGE SUMMARY: Acute kidney injury (AKI) is a common and serious complication in hospitalized patients, but identifying and tracking it accurately in electronic health records is challenging. We developed an algorithm that uses patterns in kidney function test data to detect, classify, and distinguish AKI subtypes. After testing and validating the method, we applied it to two large hospital databases: one including patients hospitalized with COVID-19 and another including hospital admissions for any cause. Our approach reliably identified AKI and its association with poor outcomes. Patients with more severe or sustained AKI were more likely to die. This tool may help researchers study kidney injury more consistently across different healthcare settings.
To Hold or Not to Hold, That is the Question: Sick Day Medication Guidance as Routine Care.
Thavarajah S
Am J Kidney Dis · 2026 Jun · PMID 42320577 · Publisher ↗
With the cardiovascular and kidney protective benefits of medications such as sodium-glucose cotransporter-2 (SGLT2) inhibitors, renin-angiotensin -aldosterone system (RAAS) inhibitors, and mineralocorticoid receptor ant...
With the cardiovascular and kidney protective benefits of medications such as sodium-glucose cotransporter-2 (SGLT2) inhibitors, renin-angiotensin -aldosterone system (RAAS) inhibitors, and mineralocorticoid receptor antagonists (MRAs), there are increased rates of initiation and use of combinations of these agents. The same mechanisms that allow for reduction of glomerular hypertension and blood pressure reduction limit the ability to maintain kidney perfusion in the setting of volume depletion and relative hypotension, and as a result increase the risk of acute kidney injury (AKI) development or severity. Sick day medication guidance that provides recommendations for holding medications in the setting of illness to mitigate the risk of AKI has not been widely adopted by practitioners. Confusion over criteria defining a sick day, lack of clarity as to how long to hold the medications and when to resume, concerns that this information drives patient hesitancy to use the medications, lack of data demonstrating benefit of holding medication, and concerns that patients will lose out on the therapeutic benefits of these agents due to constant interruption have fueled the arguments against regular use of these guidelines. In this Perspective, sick day medication guidance will be shown to be a valuable tool in counseling patients about the use of the medications, reduce the risk of and costs associated with an AKI episode, and ultimately promote more consistent use of these important medications.
Heat Stress and Kidney Injury in Taiwanese Farmers: Associations With Renal Artery Resistance and Urinary Acidification.
Yang HY, Jou HY, Wang YY … +7 more , Chang CJ, Lin CY, Chen WC, Wang YH, Teng PC, Chang HY, Hung CI
Am J Kidney Dis · 2026 Jun · PMID 42320576 · Publisher ↗
RATIONALE & OBJECTIVE: Taiwan has the world's highest burden of end-stage kidney disease, and farmers face elevated risk of chronic kidney disease of non-traditional causes (CKDnt). This study explored mechanisms linking...
RATIONALE & OBJECTIVE: Taiwan has the world's highest burden of end-stage kidney disease, and farmers face elevated risk of chronic kidney disease of non-traditional causes (CKDnt). This study explored mechanisms linking heat stress to acute kidney injury (AKI) among agricultural workers. STUDY DESIGN: Pre-post study with repeated measures. SETTING & PARTICIPANTS: 119 agricultural workers in Taiwan (2023-2024). EXPOSURE: Occupational heat stress characterized by the physiological strain index (PSI). OUTCOME: Pre- and post-work shift serum creatinine; urine biomarkers, including monocyte chemotactic protein-1 (MCP-1), N-acetyl-beta-D-glucosaminidase (NAG), and 8-hydroxy-2-deoxyguoanosine (8-OHdG); and the renal artery resistance index (RI). AKI was defined as a rise in post-shift serum creatinine of ≥0.3 mg/dL. ANALYTICAL APPROACH: Difference-in-differences (DiD) analysis to evaluate biomarker changes by AKI status. RESULTS: AKI occurred in 24 participants (20.2%) and was associated with higher peak core temperature and lower post-shift urinary pH (both P = 0.02). Higher PSI was associated with greater declines in eGFR (β = -1.27, P = 0.01). After a single workday under heat stress, the AKI group showed significant increases in urinary NAG/SG (P = 0.008), MCP-1/SG (P = 0.002), and RI (P = 0.03). DiD analysis demonstrated a significantly higher increase in urine NAG (P = 0.04) and MCP-1 (P = 0.001) in the AKI group. Urine acidification was significantly associated with increases in MCP-1/SG (P < 0.001). LIMITATIONS: No information on the persistence of kidney dysfunction after acute declines in post-work kidney function. CONCLUSIONS: Heat stress was associated with acute kidney injury accompanied by elevated core temperature, inflammation, urine acidification, and renal ischemia, suggesting potential mechanisms underlying heat-related acute declines in kidney function. PLAIN-LANGUAGE SUMMARY: Outdoor workers face increasing risks to their kidney health as global temperatures continue to rise. In this study, agricultural workers were followed during a typical summer workday to examine how heat stress affected their kidneys. Before and after work, we measured their physical strain, renal artery resistance, kidney function, and several blood and urine biomarkers. We found that heat exposure was associated with impaired kidney function, with urinary acidification, and with inflammation. These results underscore the need for stronger protection, monitoring, and education for people working in hot environments as extreme heat events become more frequent.
Meaningful Engagement of Patients in Research.
McCowan P, Joseph T, Picataggio CB … +6 more , Bailey L, Chandi S, Singh A, Surati S, Dember LM, Flythe JE
Am J Kidney Dis · 2026 Jun · PMID 42320575 · Publisher ↗
Engaging patients as research partners is increasingly recognized as essential to producing relevant, credible, and impactful research. Evidence suggests that meaningful patient engagement aligns research with patient ne...
Engaging patients as research partners is increasingly recognized as essential to producing relevant, credible, and impactful research. Evidence suggests that meaningful patient engagement aligns research with patient needs and priorities, improves feasibility and acceptability of interventions, enhances recruitment and retention of participants, and promotes uptake of study findings. However, there are persistent challenges, including tokenistic involvement, poorly defined roles, limited scope of influence, and insufficient engagement across all research phases. Published frameworks and evidence-based best practices highlight mutual respect, equity, trust, empowerment, and shared ownership as central to ensuring that patient contributions are substantive and integrated in all research phases. Strategies such as capacity-building through training, co-developing communication plans, demonstrating flexibility, providing fair compensation, and assessing the quality of the engagement support meaningful engagement. In this perspective, we share the insights of patients and researchers working together on an ongoing multicenter, pragmatic clinical trial, review key principles of patient engagement in research, provide examples of engagement from our trial, and offer practical guidance for supporting meaningful partnership between patients and researchers.
Pig Kidney Xenotransplantation: Immune Insights From a Landmark Human Case.
Tang Z, Lakkis FG
Am J Kidney Dis · 2026 Jun · PMID 42315008 · Publisher ↗
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Enrollment Barriers and Demographic Trends in Hemodialysis Access Clinical Trials.
Kotturu NRK, Montano DL, Appah-Sampong A … +8 more , Holden-Wingate C, Ruan M, Kernodle A, Swerdlow NJ, Selim OK, Hentschel DM, Ozaki CK, Hussain MA
Am J Kidney Dis · 2026 Jun · PMID 42302980 · Publisher ↗
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Comparison of Specific Glucagon-Like Peptide-1 Receptor Agonists on Kidney Outcomes Among Patients With Type 2 Diabetes.
Neumiller JJ, Deng Y, Swarna KS … +9 more , Polley EC, Herrin J, Galindo RJ, Umpierrez GE, Ross JS, Mickelson MM, Dryden K, Tuttle KR, McCoy RG
Am J Kidney Dis · 2026 Jun · PMID 42302979 · Publisher ↗
RATIONALE & OBJECTIVE: Glucagon-like peptide-1 (GLP-1) receptor agonist treatment is associated with lower risk for incident chronic kidney disease (CKD) and death relative to treatment with a dipeptidyl peptidase-4 inhi...
RATIONALE & OBJECTIVE: Glucagon-like peptide-1 (GLP-1) receptor agonist treatment is associated with lower risk for incident chronic kidney disease (CKD) and death relative to treatment with a dipeptidyl peptidase-4 inhibitor or sulfonylurea. This study examined within class effects of GLP-1 receptor agonists on kidney outcomes in type 2 diabetes (T2D) and moderate cardiovascular risk. STUDY DESIGN: Retrospective observational study using the target trial emulation framework. SETTING & PARTICIPANTS: This study used claims data from OptumLabs® Data Warehouse and 100% sample of Medicare fee-for-service claims. Participants were adults ≥21 years of age, at moderate cardiovascular risk, who filled a new prescription for a GLP-1 receptor agonists between January 1, 2019 and December 31, 2021. EXPOSURE: GLP-1 receptor agonists dulaglutide, exenatide, liraglutide, or semaglutide. OUTCOMES: A primary kidney composite outcome inclusive of incident diagnosis codes for CKD stages 3-4 and kidney failure (inclusive of CKD stage 5 and kidney replacement therapy). A secondary kidney composite outcome included the elements of the primary composite outcome plus death from any cause. Components of the kidney composite outcomes were also evaluated independently. ANALYTICAL APPROACH: Random treatment assignment was emulated using inverse probability of treatment weighting (IPTW) with propensity scores estimated using the SuperLearner ensemble method. Primary analyses were time-to-event models under the intention-to-treat framework using cause-specific IPTW Cox proportional hazards models. RESULTS: There was no difference among dulaglutide, exenatide, liraglutide, and semaglutide with respect to the primary outcome. When compared to dulaglutide and exenatide, semaglutide was associated with a reduced risk for the secondary kidney composite outcome by 8% (HR 0.92 [95% CI, 0.87-0.97]) and 12% (HR:0.88; 95% CI: 0.79-0.99), respectively. Compared to dulaglutide, semaglutide was also associated with reduced risk of death (HR 0.81 [95% CI, 0.70-0.93]). LIMITATIONS: Potential for residual confounding, lack of HbA1c and weight data, and uncertainty about the indication for GLP-1 receptor agonist prescriptions. CONCLUSIONS: No differences were observed among different GLP-1 receptor agonists for the primary outcome, but semaglutide initiation was associated with a lower risk of the secondary kidney composite outcome and of death. PLAIN-LANGUAGE SUMMARY: Chronic kidney disease (CKD) is a common complication of diabetes that increases the risk for poor health outcomes. Glucagon-like peptide-1 (GLP-1) receptor agonists were found to improve kidney outcomes in people with type 2 diabetes (T2D) and moderate cardiovascular risk when compared to dipeptidyl peptidase-4 inhibitors and sulfonylureas. While there has been no head-to-head comparison of individual GLP-1 receptor agonists, randomized controlled trials suggest that there may be variation among members of this drug class on kidney disease outcomes. In this study, we tested whether there were differences in kidney outcomes when comparing individual GLP-1 receptor agonist medications. We found that semaglutide compared favorably to other drugs in the class and may represent the preferred GLP-1 receptor agonist for delaying or preventing CKD in this population.
Complement-Mediated Postpartum Atypical Hemolytic Uremic Syndrome With Collapsing Focal Segmental Glomerulosclerosis Associated With a Novel CFHR5 Copy Number Variant.
Piras R, Martinatto C, Bresin E … +14 more , Alberti M, Mele C, Breno M, Valoti E, Gastoldi S, Aiello S, Carrara C, Basile F, La Manna G, Comai G, Baraldi O, Benigni A, Remuzzi G, Noris M
Am J Kidney Dis · 2026 May · PMID 42217727 · Publisher ↗
Thrombotic microangiopathies (TMAs) that occur during pregnancy or the postpartum period-including preeclampsia/HELLP syndrome (hemolysis, elevated liver enzymes, low platelets), thrombotic thrombocytopenic purpura, and...
Thrombotic microangiopathies (TMAs) that occur during pregnancy or the postpartum period-including preeclampsia/HELLP syndrome (hemolysis, elevated liver enzymes, low platelets), thrombotic thrombocytopenic purpura, and atypical hemolytic uremic syndrome (aHUS)-present a diagnostic challenge owing to their overlapping clinical features. We report a case of a 21-year-old primigravida of African origin who developed HELLP syndrome followed by postpartum aHUS. The clinical course was marked by thrombocytopenia, hemolytic anemia, acute kidney injury, and massive proteinuria. Kidney biopsy revealed TMA with collapsing focal segmental glomerulosclerosis (FSGS), suggesting concomitant podocyte injury. Genetic analysis identified a novel heterozygous deletion in CFHR5, resulting in a shorter-than-normal FHR5 protein, as revealed by Western blot, consistent with the predicted product of the deleted gene. Functional assays using endothelial cells demonstrated abnormal C5b-9 formation, indicating complement dysregulation. The patient achieved clinical recovery with mild residual proteinuria after plasma infusion and supportive therapy. This case highlights a potential pathogenic role of aberrant FHR5 proteins in postpartum aHUS and suggests a link between complement-mediated endothelial dysfunction and podocyte injury in TMA with collapsing FSGS. Complement genetic and functional testing should be considered in postpartum TMA, even in the absence of overt complement consumption, to guide diagnosis, prognosis, and treatment.
Hematuria Remission and Prognosis in IgA Nephropathy: A Post Hoc Analysis of the TESTING Randomized Clinical Trial.
Wu J, Kim D, Guo L … +9 more , Wang J, Yang H, Chen P, Li J, Monaghan H, Wong MG, Perkovic V, Lv J, Zhang H
Am J Kidney Dis · 2026 May · PMID 42214605 · Publisher ↗
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Racial and Ethnic Disprities in Living Donor Kidney Transplantation in California: 2010-2024.
Al Ammary F, Adeyemo S, Lincoln KD … +6 more , Ku E, Adey DB, Lau WL, Rhee CM, Kalantar-Zadeh K, Flores GM
Am J Kidney Dis · 2026 May · PMID 42208926 · Publisher ↗
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Clinical and Social Risk Factors for 30-Day Readmissions in Children With Kidney Disease.
Villegas L, Xiao R, Cervantes L … +2 more , Furth SL, Modi Z
Am J Kidney Dis · 2026 May · PMID 42176877 · Publisher ↗
RATIONALE & OBJECTIVE: Hospital readmissions represent a significant burden for children with chronic kidney disease (CKD), however, the epidemiology and drivers of readmission remain poorly understood. We evaluated 30-d...
RATIONALE & OBJECTIVE: Hospital readmissions represent a significant burden for children with chronic kidney disease (CKD), however, the epidemiology and drivers of readmission remain poorly understood. We evaluated 30-day all-cause readmission rates among U.S. pediatric patients with kidney disease and examined associations with clinical and social factors. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: Children ≤18 years old with a diagnosis of CKD discharged from 49 tertiary care centers participating in the Pediatric Health Information System between January 1, 2016, and June 30, 2021. PREDICTOR: Primary or comorbid CKD identified using ICD-10 diagnostic codes. OUTCOMES: All-cause 30-day hospital readmission. ANALYTICAL APPROACH: Multivariable logistic regression adjusting for demographic, clinical, and social factors. RESULTS: Among 48,228 pediatric patients with CKD (median age 5.8 years, IQR 1.0-12.5; 46.7% female; 50.2% non-Hispanic White), 6,172 (12.8%) were readmitted within 30 days. Among children with kidney failure, 22.3% experienced readmission. In adjusted analyses, higher readmission risk was associated with glomerular CKD etiology (OR 1.34 [95% CI, 1.23-1.46]), complex chronic disease (OR 6.13 [95% CI, 4.53-8.29]), increasing illness severity by APR-DRG (OR 2.10 [95% CI, 1.84-2.40]), longer length of stay (OR 1.50 [95% CI, 1.39-1.63]), and mental health comorbidity (OR 1.16 [95% CI, 1.03-1.30]). CKD-related index admissions were associated with lower odds of readmission (OR 0.85 [95% CI, 0.80-0.92]). Urban residence was independently associated with readmission (OR 1.18 [95% CI, 1.08-1.29]), whereas insurance type, neighborhood income, and Child Opportunity Index were not. LIMITATIONS: Laboratory data were not available. CONCLUSION: Approximately 1 in 8 children with CKD and 1 in 5 with kidney failure were readmitted within 30 days. Readmission risk was driven primarily by clinical complexity, illness severity, and mental health comorbidity. These findings inform integrated transitional care strategies and targeted interventions addressing medical and behavioral health needs to reduce preventable hospital utilization in pediatric CKD.
Temporal Trends in the Complexity of Nephrology Inpatients: A Population-Based Cohort Study.
Ghimire A, Wiebe N, Hemmelgarn BR … +2 more , Manns BJ, Tonelli M
Am J Kidney Dis · 2026 May · PMID 42176876 · Publisher ↗
RATIONALE & OBJECTIVE: Patients seen by nephrologists are highly complex, and clinical experience suggests this complexity has increased over time. This study compared temporal trends in the complexity profiles of inpati...
RATIONALE & OBJECTIVE: Patients seen by nephrologists are highly complex, and clinical experience suggests this complexity has increased over time. This study compared temporal trends in the complexity profiles of inpatients seen by nephrologists to those seen by other physicians. STUDY DESIGN: Retrospective-cohort study. SETTING & PARTICIPANTS: Adult inpatients hospitalized between 2011 and 2020 in Alberta, Canada. EXPOSURES: (1) Physician groups involved during hospitalization and (2) calendar time. OUTCOMES: Ten markers of complexity were evaluated prior to hospital admission, and two outcomes (death and placement in long-term care) were assessed following hospitalization. ANALYTICAL APPROACH: Generalized linear models to estimate absolute changes over the study period. RESULTS: Between 2011 and 2020, there were 1,621,630 hospital admissions among 971,051 patients. The number of nephrology inpatients seen annually rose by 44%, an increase larger than observed with other specialties (95% CI, 28.9-59.8). The percentage of inpatients seen by nephrologists in 2020 with complexity markers related to the number of specialty caregivers, number of physician caregivers, number of prescriptions, emergency department visits, and number of drug reactions increased by 6.1% (95% CI, 5.0-7.1), 6.0% (95% CI, 4.9-7.1) 1.9% (95% CI, 1.0-2.8), 1.5% (95% CI, 0.9-2.1), and 1.2% (95% CI, 0.4-2.0), respectively. The percentage of inpatients with frailty seen by nephrologists and with low primary-care attachment increased by 5.1% (95% CI, 4.2-6.0) and 3.5% (95% CI, 2.4-4.6), respectively. Except for frailty and number of prescriptions, the magnitude of the increases in these markers was larger for nephrology inpatients than for those cared for by other physicians. Secular changes in complexity were largely due to increases in characteristics other than age. Risks of death or placement in long-term care within 1 year of discharge decreased to a greater extent for inpatients cared for by nephrologists than among those cared for by other physicians. LIMITATIONS: Various markers of patient complexity were not evaluated. CONCLUSIONS: Volume and complexity of inpatients cared for by nephrologists have increased over time, a trend not explained by the increasing age of the population. However, the risks of death or need for long-term care fell more among patients cared for by nephrologists.
Obesity in CKD: Core Curriculum 2026.
Kramer HJ, Lavenburg LM, Navaneethan SD
Am J Kidney Dis · 2026 Jul · PMID 42175979 · Publisher ↗
Obesity is a chronic disease the requires lifelong care. The prevalence of obesity has surpassed diabetes and hypertension and is now the most common risk factor for chronic kidney disease (CKD) and its progression. Exce...
Obesity is a chronic disease the requires lifelong care. The prevalence of obesity has surpassed diabetes and hypertension and is now the most common risk factor for chronic kidney disease (CKD) and its progression. Excess weight not only increases CKD risk but also heightens the risk for heart failure, sleep apnea, steatotic liver disease, osteoarthritis, and a myriad of other chronic conditions. The interplay between obesity, kidney, cardiovascular, and metabolic health has been termed the cardiovascular-kidney-metabolic syndrome. However, obesity is not just a driver of cardiovascular events because it also increases the risk of multiple types of cancers, osteoarthritis, and inhibited physical functioning. Among patients with kidney failure, obesity poses challenges to dialysis treatments, precludes access to transplantation, and contributes to frailty. Helping patients safely achieve and maintain weight loss could have cascading positive effects on kidney health and overall well-being. Medical and surgical therapies now provide clinicians with opportunities to treat obesity, but such treatments need to be coupled with team-based approaches. In this Core Curriculum, we provide a review of the diagnosis of obesity and its surrounding controversies, and we outline steps for obesity management in the setting of CKD.
Transplantation and Mortality as Competing Outcomes Among Patients on Dialysis With Newly Diagnosed Cancer: A Longitudinal Cohort Study.
Gately R, Engels EA, Sabanayagam D … +5 more , Teixeira-Pinto A, Campbell S, Hawley C, Lim W, Wong G
Am J Kidney Dis · 2026 May · PMID 42173347 · Publisher ↗
RATIONALE & OBJECTIVE: A cancer diagnosis for patients receiving dialysis is associated with complex risks that may influence survival and access to transplantation. This study's aim was to characterize the probability a...
RATIONALE & OBJECTIVE: A cancer diagnosis for patients receiving dialysis is associated with complex risks that may influence survival and access to transplantation. This study's aim was to characterize the probability and timing of cancer-related death, non-cancer death, and transplantation among patients diagnosed with incident cancer after dialysis initiation. STUDY DESIGN: Longitudinal cohort study. SETTING & PARTICIPANTS: 3,052 patients receiving dialysis in Australia and New Zealand, 2000-2021, identified in the Australia and New Zealand Dialysis and Transplant Registry who were diagnosed with cancer after starting dialysis. EXPOSURE: Cancer, categorized by type and stage. OUTCOME: Transplantation, as well as cancer-related death and non-cancer death, for the five most common cancer types. ANALYTICAL APPROACH: Parametric mixture competing risk models to estimate event probabilities and timing, stratified by age and cancer stage. RESULTS: Among 3,052 dialysis patients with incident cancer followed for a median of 1.3 years after diagnosis, 1,245 died from cancer, 1,127 died from other causes, and 204 received a transplant. The most common cancers were lung (n=396), colorectal (n=323), prostate (n=269), liver (n=249), and kidney (n=242). For localized/regional prostate, kidney, and colorectal cancers, the probability of cancer-related death ranged from 0.09 to 0.32, while the probability of non-cancer death was higher, ranging from 0.32 to 0.73. In contrast, cancer-related death predominated in the setting of metastatic disease, with a median time to death of 0.1 years for lung and liver cancers. Among patients aged under 70 with localized or regional prostate cancer, the probability of transplantation was 0.60 (95% CI, 0.48-0.71), which exceeded that of cancer-related death, 0.09 (95% CI, 0.06-0.12), and non-cancer death, 0.32 (95% CI, 0.23-0.41). Analogous probabilities for kidney cancer were 0.52 (95% CI, 0.43-0.60), 0.12 (95% CI, 0.09-0.16), and 0.36 (95% CI, 0.29-0.43). Among those under 70 years with localized/regional prostate, kidney, or colorectal cancers, the risk of cancer-related death fell below that of non-cancer death within 1 year of diagnosis. LIMITATIONS: Data on cancer staging were incomplete, residual confounding, and potential outcome misclassification. CONCLUSIONS: Among patients receiving dialysis who are diagnosed with localized or regional cancer, the risk of cancer-related death is low and may be exceeded by non-cancer mortality within 1 year of the cancer diagnosis. These findings support consideration of earlier transplantation for some patients with cancer and highlight the need for individualized approaches to defining transplant eligibility.
Deceased Donor Kidney Transplantation Versus Continued Dialysis Among Patients Aged 75 Years or Older: A Target Trial Emulation.
Leeaphorn N, Attieh RM, Oshel KM … +6 more , Mai ML, Prendergast M, Wadei HM, Garcia Valencia OA, Cheungpasitporn W, Jarmi T
Am J Kidney Dis · 2026 May · PMID 42173346 · Publisher ↗
RATIONALE & OBJECTIVE: The survival benefit of deceased donor kidney transplantation (DDKT) versus continued dialysis among patients aged ≥75 years remains uncertain due to a lack of randomized trials and limitations of...
RATIONALE & OBJECTIVE: The survival benefit of deceased donor kidney transplantation (DDKT) versus continued dialysis among patients aged ≥75 years remains uncertain due to a lack of randomized trials and limitations of observational study. This study estimated the causal effect of DDKT on survival using a target trial emulation. STUDY DESIGN: Target trial emulation with sequential trials framework. SETTING & PARTICIPANTS: Transplant-eligible adults ≥75 years who initiated dialysis and were listed in the Organ Procurement and Transplantation Network registry (2015-2023) for kidney-only transplantation. EXPOSURE: DDKT versus remaining on dialysis. OUTCOME: Restricted mean survival time (RMST) at 3 and 5 years. ANALYTICAL APPROACH: The stacked dataset from all auxiliary trials analyzed using weighted Cox proportional hazards regression. Inverse probability of treatment and censoring weights incorporated to address confounding and immortal time bias. RESULTS: Among 2,670 patients (mean age 76.8 years, 70.7% male, 49% diabetic), 1,012 (37.9%) received DDKT. The framework generated 511 auxiliary trials with 505,438 person-trial observations. DDKT recipients experienced early mortality risk (hazard ratio 2.29 [95% CI, 1.50-3.49] for days 0-90) transitioning to survival benefit beyond 1 year (HR 0.34 [95% CI, 0.26-0.45] after 3 years). At 3 years, the break-even point, survival was equivalent between groups (RMST difference 2.0 days, P=0.9). By 5 years, DDKT conferred 111-day survival advantage (95% CI, 65.6-156.4, P<0.001). Patients without diabetes experienced numerically greater benefit than patients with diabetics (133.6 vs 81.2 days; P-interaction=0.3), as did those who received ≥2 years dialysis versus <2 years (156.1 vs 107.9 days; P-interaction=0.3). LIMITATIONS: Unmeasured confounding, generalizability limited to waitlisted patients, most covariates measured at listing rather than updated over time, lack of data on quality of life, symptom burden, or patient-reported outcomes. CONCLUSIONS: DDKT confers a survival benefit to waitlisted patients ≥75 years, though benefit emerges only after 3 years providing a critical benchmark for patient counseling. The modest 5-year advantage for DDKT should be weighed against earlier elevated risks of mortality. These findings support individualized decision-making and highlight dialysis as a reasonable alternative to DDKT.
Seasonality, Hospitalization, and Initiation of Home Dialysis: A Retrospective Cohort Study.
Awad S, Thacker J, Lung KI … +1 more , Lin E
Am J Kidney Dis · 2026 May · PMID 42173345 · Publisher ↗
RATIONALE & OBJECTIVE: Patients often initiate dialysis for end-stage kidney disease (ESKD) as inpatients, which may steer patients away from home dialysis. Because hospitalizations are often seasonal, this study examine...
RATIONALE & OBJECTIVE: Patients often initiate dialysis for end-stage kidney disease (ESKD) as inpatients, which may steer patients away from home dialysis. Because hospitalizations are often seasonal, this study examined whether inpatient initiation may contribute to the seasonality of home dialysis use. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: US adults with fee-for-service Medicare insurance who initiated dialysis between January 1, 2007, and November 30, 2020. EXPOSURE: Season of the year defined by equinoxes and solstices, and inpatient dialysis initiation as a mediator (hospital discharge within 2 weeks of the first outpatient dialysis treatment). OUTCOME: Home dialysis use at dialysis initiation and at 3, 6, and 12 months after dialysis initiation. Time to first home dialysis use. ANALYTICAL APPROACH: Multivariable logistic and cause-specific hazard models to examine whether dialysis initiation as an inpatient mediated seasonal differences in home dialysis use. RESULTS: Among 548,530 adults, the mean age of the population was 71.0, 44% were female, 3% were Asian, 22% were Black, 73% were White, and 2% were other race or ethnicity. Compared with dialysis initiation in summer, initiation in winter was more likely to occur in the inpatient setting (odds ratio [OR], 1.13 [95% CI, 1.11-1.15]). Initiation in winter (vs summer) also had a lower odds of initiating dialysis in the home setting (OR, 0.89 [95% CI, 0.86-0.91]), a lower odds of receiving home dialysis 12 months after dialysis initiation (OR, 0.95 [95% CI, 0.92-0.97]), and a lower rate of home dialysis use over the follow-up period (HR, 0.94 [95% CI, 0.92-0.96]). Mediation analysis demonstrated that initiation of dialysis in the inpatient setting explained 40% of the total association between season and home dialysis use at initiation of dialysis, 77% of the association between season and home dialysis use 12 months after dialysis initiation, and 55% of the association between season and the overall rate of home dialysis use. LIMITATIONS: Residual confounding from unobserved variables; results limited to patients with fee-for-service Medicare insurance; and analysis of data from before the COVID-19 pandemic. CONCLUSIONS: Patients initiating dialysis in the winter were less likely to use home dialysis. Initiation of dialysis in the inpatient setting partially mediated these findings and may impede efforts to promote the use of home dialysis. PLAIN-LANGUAGE SUMMARY: Home dialysis is underused in the United States despite having outcomes similar to in-center hemodialysis and, in many circumstances, being associated with a higher quality of life. Research studies have broadly shown seasonal effects on health care utilization. This study showed that patients starting dialysis in the winter were less likely to initiate home dialysis than during other seasons, and these differences in home dialysis use persisted throughout the first year of dialysis. When examining potential mechanisms for these differences, this study found that dialysis initiation during the winter was more likely to occur in the hospital, which, in turn, was associated with lower use of home dialysis. Initiation of dialysis during a hospitalization appears to be a factor that may impede efforts to promote the use of home dialysis.
Closing the Gap? Recent Trends in Racial Differences in Blood Pressure Control in the United States.
Hardy ST, Jaeger BC, Muntner P
Am J Kidney Dis · 2026 May · PMID 42173344 · Publisher ↗
Despite the availability of multiple classes of effective antihypertensive medication, most US adults with hypertension have uncontrolled blood pressure (BP), defined by the 2025 American Heart Association/American Colle...
Despite the availability of multiple classes of effective antihypertensive medication, most US adults with hypertension have uncontrolled blood pressure (BP), defined by the 2025 American Heart Association/American College of Cardiology BP guideline as systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg. Disparities have been documented in the United States for several decades, with a higher percentage of US Black versus US White adults having uncontrolled BP. In this article, we review data on the prevalence of uncontrolled BP among racial and ethnic groups in the United States and approaches to achieving BP equity.
Between the Lines.
Venkatesh A
Am J Kidney Dis · 2026 Jun · PMID 42167835 · Publisher ↗
Abstract loading — click title to view on PubMed.
The Role of Altered Mineral Metabolism in Kidney Stone Disease: Is Vitamin D the Key?
Lederer ED, Maalouf NM
Am J Kidney Dis · 2026 Jun · PMID 42167834 · Publisher ↗
Abstract loading — click title to view on PubMed.
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