Am. J. Kidney Dis. [JOURNAL]
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200 papers
Implications of Acute Kidney Injury Requiring Dialysis Versus End-Stage Kidney Disease Status.
McCoy IE, Lin E
Am J Kidney Dis · 2026 Jun · PMID 41881384 · Full text
More than 20% of patients receiving dialysis at in-center hemodialysis facilities initiate dialysis for acute kidney injury requiring dialysis (AKI-D) rather than end-stage kidney disease (ESKD). The transition from AKI-...
More than 20% of patients receiving dialysis at in-center hemodialysis facilities initiate dialysis for acute kidney injury requiring dialysis (AKI-D) rather than end-stage kidney disease (ESKD). The transition from AKI-D to ESKD status is important to reorient clinical efforts from short-term monitoring for recovery to equally important long-term goals of establishing permanent dialysis access and planning for kidney transplant. The timing of this transition is highly variable and determined by the treating nephrologist. Because of numerous subtle policy differences, the implications of transitioning a patient receiving dialysis for AKI-D to ESKD status can be complex and far-reaching. Here, we aim to describe the financial and nonfinancial implications of the AKI-D-to-ESKD status transition. Clinicians and policymakers alike may be able to improve the care of this vulnerable patient population through a better understanding of these implications. We conclude with policy recommendations to address disincentives to optimal care.
Experiences and Management of People With a Failing Kidney Transplant: Findings From the IN-FAKT Study.
Venter B, Noyes J, Selman LE … +6 more , Exley C, Griffin S, Hancock A, McLaughlin L, Hole B, Bailey PK
Am J Kidney Dis · 2026 Jun · PMID 41881383 · Publisher ↗
RATIONALE & OBJECTIVE: Transplant failure is associated with a morbidity burden, increased mortality, and poor quality of life. We have a limited understanding of how patients prepare for transplant failure, when they do...
RATIONALE & OBJECTIVE: Transplant failure is associated with a morbidity burden, increased mortality, and poor quality of life. We have a limited understanding of how patients prepare for transplant failure, when they do so, and what experiences and priorities are relevant to clinical management decisions when transplants are failing. This study investigated the experiences of living with and managing kidney transplant failure among patients, families and friends, and health care professionals (HCPs). STUDY DESIGN: Qualitative semistructured interview study. SETTING & PARTICIPANTS: Three groups of adults sampled from 3 UK hospitals: (1) people with a failing kidney transplant or one that had failed in the last year; (2) family/friends of group 1; (3) kidney transplant HCPs. ANALYTICAL APPROACH: Inductive analysis based in constructivist grounded theory. RESULTS: We interviewed 41 participants (15 people with failing/failed transplants, 9 family/friends, 17 HCPs). We identified 8 theoretical categories under 3 headings. First, the experience of waiting: (1) a constant threat: anticipation of failure; (2) lack of preparedness; (3) liminality: an indeterminate and in-between state. Second, shaping conversations about failing transplants: (4) navigating uncertainty; (5) responsibility and control; (6) failing to acknowledge failure: the elephant in the room. Third, the focus on the failing transplant: (7) maximizing mileage and missed opportunities; (8) the ripple effect of failure and family suffering. "Duality" emerged as the core category to describe findings that appeared to be in opposition but were experienced or delivered simultaneously. Patients experienced failure as both an inevitability and a surprise, and they felt both responsible for and as having no control over the transplant outcome. HCPs identified a need for parallel planning: simultaneously prolonging transplant survival and planning posttransplant treatment. LIMITATIONS: Adult participants only. CONCLUSIONS: Our study identified targets for improving the experiences of people with transplant failure, related to explicit communication, navigating uncertainty, and parallel planning. PLAIN-LANGUAGE SUMMARY: We interviewed people who were experiencing or had experienced kidney transplant failure, their family and friends, and health care professionals (HCPs) about their experiences of living with and managing this failure. Patients described transplant failure as a constant threat, but they did not feel prepared for it. Patients and their families have many questions including: When will the transplant fail? How will it happen? Why did it fail? HCPs are unable to fully answer these questions, and patients feel responsible for what happens to their transplant. Our research shows that talking about transplant failure is difficult for patients and HCPs and that there are missed opportunities to prepare and support people.
Representation of Adults With CKD in Major Endovascular Stroke Trials.
Lakshman S, Zaharchuk G, Kurella Tamura M
Am J Kidney Dis · 2026 Jun · PMID 41881382 · Full text
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Cancer Incidence in People With Glomerular Disease: A Population-Level Study.
Han J, Canney M, Zhao Y … +3 more , Atiquzzaman M, Levin A, Barbour SJ
Am J Kidney Dis · 2026 Jun · PMID 41881381 · Publisher ↗
RATIONAL & OBJECTIVE: People with glomerulonephritis (GN) may be at an increased risk of cancer, but existing studies have not accurately clarified the cancer risk in patients with GN. A better understanding of these ris...
RATIONAL & OBJECTIVE: People with glomerulonephritis (GN) may be at an increased risk of cancer, but existing studies have not accurately clarified the cancer risk in patients with GN. A better understanding of these risks may inform cancer screening strategies and identify potentially modifiable risk factors. This study identified risk factors for cancer among Canadian patients with GN. STUDY DESIGN: Retrospective observational cohort study. SETTING & PARTICIPANTS: Adults with diagnosed GN (n = 4,039) identified using a centralized pathology registry in British Columbia, Canada, between 2000 and 2020. EXPOSURE: Known cancer risk factors, including age, sex, ethnicity, smoking, alcohol abuse, obesity, diabetes, dyslipidemia, hypertension, and cardiovascular disease as well as GN-related potential risk factors, including GN disease type, estimated glomerular filtration rate (eGFR), and level of proteinuria. OUTCOME: All-cause cancer, excluding non-melanoma skin cancer. ANALYTICAL APPROACH: Standardized incidence ratios (SIRs) were calculated using an age- and sex-matched general population. The time to the first cancer event was modeled using a cause-specific hazards model, with death considered as a competing event. RESULTS: The mean age of the cohort was 51 years, and 52% of the participants were male. During a median of 7.8 years of follow-up, 384 patients (9.5%) developed de novo cancer. The 20-year cancer risk was 23%, with an incidence rate 30% higher than the general population (SIR, 1.3 [95% CI, 1.2-1.4]). The risk was most pronounced in patients younger than 40, almost 3-fold higher than in the general population (SIR, 2.9 [95% CI, 1.6-4.6]). Significant increases in cancer incidence were observed for lymphoma (SIR, 3.5), kidney (SIR, 2.6), colorectal (SIR, 2.4), and lung cancers (SIR, 1.5). Elevated risk was observed both before and after the onset of end-stage kidney disease. Age, male sex, baseline eGFR, and GN disease type were independently associated with cancer risk. LIMITATIONS: The lack of immunosuppression data. CONCLUSIONS: Patients with GN have a substantially increased risk of cancer compared with the general population, particularly younger patients who are typically excluded from current screening programs. These findings suggest the need to raise awareness of the cancer risk among people with GN and may inform the further development of tailored cancer screening and prevention strategies, especially among younger adults with GN. PLAIN-LANGUAGE SUMMARY: People with glomerulonephritis (GN) are thought to be at an increased risk of cancer, but previous studies had limitations that limited the accuracy of the cancer risk estimates in this population. This study of 4,039 patients with GN found the incidence of cancer to be 30% higher than in the general population. Among patients under 40 years of age, the risk was nearly 3-fold. The types of cancers at increased risk were colorectal, lung, kidney, and lymphoma. These findings highlight the need to raise awareness of cancer risk in patients with GN and may inform further development of targeted screening and prevention strategies, particularly among younger adults.
Association of Autosomal Dominant Polycystic Kidney Disease With Incident Aortic Dissection or Aneurysm.
Nakayama T, Kaneko H, Suzuki Y … +11 more , Okada A, Morita H, Fujiu K, Takeda N, Azegami T, Yokoo T, Takeda N, Node K, Yasunaga H, Nangaku M, Hayashi K
Am J Kidney Dis · 2026 Jun · PMID 41881380 · Publisher ↗
RATIONALE & OBJECTIVE: Autosomal dominant polycystic kidney disease (ADPKD) is characterized by a broad range of extrarenal complications, yet epidemiologic data on its association with aortic dissection (AD) or aortic a...
RATIONALE & OBJECTIVE: Autosomal dominant polycystic kidney disease (ADPKD) is characterized by a broad range of extrarenal complications, yet epidemiologic data on its association with aortic dissection (AD) or aortic aneurysm (AA) remain limited. In the present study, we assessed whether ADPKD is associated with an increased risk of developing these aortic conditions. STUDY DESIGN: Observational cohort study. SETTING & PARTICIPANTS: 2,568,283 individuals without a history of AD or AA, enrolled between April 2014 and August 2023 in a nationwide Japanese epidemiological database provided by DeSC Healthcare of Tokyo, Japan. EXPOSURE: Presence of ADPKD based on the International Classification of Diseases, Tenth Revision codes. OUTCOME: Incidence of AD or AA. ANALYTICAL APPROACH: Cause-specific hazards models were used to estimate associations (hazard ratios), adjusting for potential confounders. RESULTS: The median age was 68 years (IQR, 61-77), and 1,123,131 individuals (44%) were male. ADPKD was diagnosed in 1,102 individuals (0.04%) within the cohort. During a median follow-up of 1,043 days (IQR: 556-1,600), there were 15,019 occurrences of AD or AA. Multivariable cause-specific hazards models demonstrated that individuals with ADPKD had a significantly increased risk of developing these aortic diseases (HR, 1.76 [95% CI, 1.13-2.73]). When analyzed separately, the HRs were 2.53 (95% CI, 1.13-5.66) for AD and 1.56 (95% CI, 0.94-2.60) for AA. The association of ADPKD with incident AD or AA was more pronounced in individuals with body mass index (BMI) ≥ 25 kg/m than in those with BMI < 25 kg/m. LIMITATIONS: Potential residual confounding, possible detection bias, and lack of data on ADPKD-causing genetic variant. CONCLUSIONS: Our analysis of a large-scale epidemiological dataset indicated an elevated risk of AD or AA occurrence in individuals with ADPKD. These findings may inform the clinical management of this condition. PLAIN-LANGUAGE SUMMARY: Autosomal dominant polycystic kidney disease (ADPKD) is a common inherited condition that can impair kidney function and affect other organs. Previous studies have suggested that aortic dissection (AD) or aortic aneurysm (AA) may be among its complications, but the evidence has remained inconclusive. We used a nationwide dataset of more than 2.5 million individuals to examine whether individuals with ADPKD are at increased risk of developing AD or AA. Our analyses showed a significant association between ADPKD and these serious aortic disorders. These findings highlight the importance of multidisciplinary efforts to promote prevention, timely recognition, and early intervention for AD or AA in individuals with ADPKD.
Association of the Timing of Acute Declines in Kidney Function in Acute Heart Failure With Cardiovascular and Kidney Outcomes.
McCallum W, Tighiouart H, Tuttle M … +10 more , Oka T, Testani JM, Udelson JE, Bautista I, Lala A, Costanzo MR, O'Connor CM, Fiuzat M, Konstam MA, Sarnak MJ
Am J Kidney Dis · 2026 Jun · PMID 41881379 · Publisher ↗
RATIONALE & OBJECTIVE: Inconsistencies in the association of acute declines in kidney function with longer-term cardiovascular (CV) and kidney outcomes in patients with acute heart failure (AHF) may be due to different a...
RATIONALE & OBJECTIVE: Inconsistencies in the association of acute declines in kidney function with longer-term cardiovascular (CV) and kidney outcomes in patients with acute heart failure (AHF) may be due to different approaches to assessing the timing of the decline. This study examined the influence of the timing of acute kidney function decline among patients with AHF on the associations of these declines with mortality, CV outcomes, and long-term kidney function. STUDY DESIGN: Observational analysis of clinical trial data. SETTING & PARTICIPANTS: Participants in the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan (EVEREST) trial hospitalized for AHF. EXPOSURE: Kidney function decline (defined by creatinine increase by ≥0.3 mg/dL, creatinine increase by >50%, and percentage of creatinine change) at 3 different time points (3, 7, and 14 days after randomization). OUTCOME: Mortality, a composite of CV mortality or heart failure (HF) hospitalization, incident estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m, and a >40% eGFR decline. ANALYTICAL APPROACH: Analytical Approach: Multivariable cause-specific proportional hazards regression models. RESULTS: Among 3,931 patients over a median follow-up of 9.9 months, acute kidney function decline at 3 days was not associated with mortality (HR, 0.98 [95% CI, 0.88-1.09] per 30% creatinine increase) or with the composite outcome of CV mortality and HF hospitalization (HR, 0.96 [95% CI, 0.89-1.05]). By contrast, acute kidney function decline at 7 days after randomization was associated with a higher risk of mortality (HR, 1.19 [95% CI, 1.10-1.30] per 30% creatinine increase) and the composite outcome (HR, 1.10 [95% CI, 1.03-1.18]). Acute kidney function decline at 14 days after randomization also was associated with a higher risk of mortality (HR, 1.27 [95% CI, 1.16-1.38] per 30% creatinine increase) and the composite outcome (HR, 1.15 [95% CI, 1.08-1.23]). Acute kidney function declines at 3, 7, and 14 days after randomization were all associated with significantly higher risk of incident eGFR < 30 mL/min/1.73 m and >40% eGFR decline. LIMITATIONS: Limited generalizability from the study of clinical trial participants. CONCLUSIONS: Among patients hospitalized for AHF, incorporating the timing of acute kidney function declines may inform prognostic assessment of CV end points. Acute declines in kidney function at all studied time points were associated with worse longer term kidney function. PLAIN-LANGUAGE SUMMARY: Acute declines in kidney function are frequently encountered among patients admitted for acute heart failure. Using data from the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan (EVEREST) trial, we evaluated whether the timing of an acute decline in kidney function may inform the relationship of those declines with the risk of death and other adverse cardiovascular outcomes. We found that early declines in kidney function 3 days after randomization were not associated with death or cardiovascular outcomes. However, declines occurring at 14 days and as early as 7 days were associated with higher risks. Declines at any of these times were associated with worse kidney function over time.
Paid Employment and Ability to Work Among People Receiving Dialysis: A Systematic Review of Qualitative Studies.
Zhang A, Martin A, Manera K … +11 more , Guha C, Howell M, Natale P, Scholes-Robertson N, Sabanayagam D, Levin A, Winkelmayer W, Erickson KF, Wong G, Jaure A, van Zwieten A
Am J Kidney Dis · 2026 Jun · PMID 41866019 · Publisher ↗
RATIONALE & OBJECTIVE: People receiving dialysis have reduced workforce participation, which can affect mental well-being and exacerbate the financial burden of dialysis. This study describes the experiences and perspect...
RATIONALE & OBJECTIVE: People receiving dialysis have reduced workforce participation, which can affect mental well-being and exacerbate the financial burden of dialysis. This study describes the experiences and perspectives of people receiving dialysis on employment and their ability to work. STUDY DESIGN: Systematic review and thematic synthesis of qualitative studies. SETTING & STUDY POPULATIONS: Adults aged 16 years and over receiving dialysis. SEARCH STRATEGY & SOURCES: MEDLINE, Embase, and PsycINFO were searched to May 2025 for qualitative and mixed-methods studies that reported the perspectives of people receiving dialysis on employment or ability to work. DATA EXTRACTION: Text from results and conclusions of studies. ANALYTICAL APPROACH: Thematic synthesis. RESULTS: The analysis included 37 studies involving 1,374 participants from 17 countries/regions. Six themes were identified: impinging on capacity to work (lacking physical endurance and energy, battling with cognitive symptoms, grueling treatment schedule), narrowed vocational opportunities and financial insecurity (unfulfilled dreams and worry about job prospects, struggling to stay afloat financially), discrimination and stigma (overlooked by potential employers, being pushed out of jobs or fired, delaying or avoiding disclosure of dialysis), conducive workplace environments (empathy and support from managers and colleagues, occupational adjustments), managing dialysis around work (choosing a suitable dialysis type to support work, careful time management and scheduling), and fostering esteem, enjoyment, and social connection. LIMITATIONS: Only English-language articles were included. CONCLUSIONS: Among people receiving dialysis, the symptom and treatment burdens, lack of workplace accommodations, and discrimination all compromised sustained employment. Conversely, supportive workplaces that implemented tailored occupational adjustments enabled work participation, thereby boosting psychosocial well-being. Workplace advocacy and flexible work arrangements, symptom management, and aligning dialysis modality choices and timing with work demands may help to improve participation and work ability among people on dialysis. TRIAL REGISTRATION: Registered at PROSPERO with identification number CRD42023424482. PLAIN-LANGUAGE SUMMARY: Many people receiving dialysis want to work, but maintaining paid employment can be challenging. Work is important not only for income but also for identity and social connection. We reviewed 37 studies to examine how people on dialysis experience work. People described that fatigue and the time demands of dialysis often limited their ability to work. Many also faced discrimination, job loss, or a lack of understanding from employers. However, supportive workplaces, flexible hours, and choosing dialysis options that accommodate work schedules helped people to remain employed. These findings show that better workplace support, flexible work arrangements, and health care that considers employment needs may help people on dialysis remain employed and support their well-being.
Dialysis Facility Closures in the US From 2018 to 2024: A Serial Cross-Sectional Study.
Varkila MRJ, Montez-Rath M, Yu X … +7 more , Subramanian N, Owens DK, Brady B, Block GA, Parsonnet J, Chertow GM, Anand S
Am J Kidney Dis · 2026 Jun · PMID 41866018 · Publisher ↗
RATIONALE & OBJECTIVE: Between 2006 and 2016, the number of US dialysis facilities experienced steady annual growth. Recent data suggest a reversal in this trend. We examined trends in US dialysis facility closures and a...
RATIONALE & OBJECTIVE: Between 2006 and 2016, the number of US dialysis facilities experienced steady annual growth. Recent data suggest a reversal in this trend. We examined trends in US dialysis facility closures and associated facility- and neighborhood-level characteristics. STUDY DESIGN: Serial cross-sectional study of dialysis facilities from 2018 through 2024. SETTING & PARTICIPANTS: Dialysis facilities in the United States. EXPOSURE: Calendar year; census region; census tract social vulnerability index; rural or urban area designation; racial and ethnic composition; COVID-19 mortality; dialysis facility payor mix, size, and profit status. OUTCOME: Number of dialysis facility closures; temporal change in number of facilities by census tract. ANALYTICAL APPROACH: Dialysis facilities listed in the Provider of Services data from Centers for Medicare & Medicaid Services were used to determine openings and closures by quarter. Geocoded dialysis facility data were linked to the American Community Survey, rural urban commuting area codes, and the United States Renal Data System to describe associated facility- and neighborhood-level characteristics of closed facilities, and of census tracts without any remaining dialysis facilities. RESULTS: We identified 8,343 unique dialysis facilities across 7,222 census tracts from 2018 through 2024. Annual opening-to-closure ratios were 8.9 (2018: 401 openings, 45 closures), 2.7 (2019: 293 openings, 105 closures), 4.3 (2020: 218 openings, 51 closures), 1.5 (2021: 171 openings, 111 closures), 0.6 (2022: 123 openings, 210 closures), 0.5 (2023: 94 openings, 207 closures), and 0.8 (2024: 56 openings,74 closures). Closures exceeded openings between the fourth quarter of 2021 and the first quarter of 2024 (n = 500; 62.2% of all closures during study period). Closed facilities were smaller than the facilities that remained open (median size 58 [IQR, 34-96] for closed vs 112 [IQR, 66-165] for open facilities). Closures were observed more frequently in rural versus urban areas (11.2% vs 9.3%, respectively) and among facilities located in the Midwest versus the West (10.8% vs 7.7%, respectively). Closed facilities had a modestly higher proportion of patients eligible for both Medicaid and Medicare-dual eligibility, a marker of economic disadvantage-than the facilities that remained open (mean proportion of census dual eligible 36.1% vs 34.6%). LIMITATIONS: Lack of data on patient outcomes. CONCLUSIONS: Nationwide, an increasing number of US dialysis facilities closed between 2018 and 2024, with smaller facilities and rural and Midwest communities disproportionately affected. The patient-level implications of this trend require further study. PLAIN-LANGUAGE SUMMARY: Until recently, the number of dialysis facilities in the United States was increasing, but this trend may have reversed in 2022. This study assessed whether dialysis facility closures were relatively more common in rural or socially vulnerable areas. It found a drastic increase in numbers of closures and a decrease in number of openings across the United States starting in late 2021, with closures disproportionately affecting smaller facilities, rural areas, and the Midwest. Closures may reflect a change in demand for dialysis, but because prior data have indicated dialysis facility closures disrupt patient care, this trend and its effect on persons with complex medical needs requires attention by nephrologists and policymakers.
Medicaid Expansion and Optimal Starts of Treatment for Incident Kidney Failure.
Roetker NS, Wetmore JB, Liu J … +3 more , Guo H, Gilbertson DT, Johansen KL
Am J Kidney Dis · 2026 Jul · PMID 41866017 · Full text
RATIONALE & OBJECTIVE: Beginning in 2014, some states expanded Medicaid eligibility to include additional low-income adults under the age of 65 years. Examining whether the expansion led to improvements in optimal treatm...
RATIONALE & OBJECTIVE: Beginning in 2014, some states expanded Medicaid eligibility to include additional low-income adults under the age of 65 years. Examining whether the expansion led to improvements in optimal treatment at the start of kidney failure has been understudied and was the focus of this investigation. STUDY DESIGN: Observational cohort study. SETTING & PARTICIPANTS: Patients aged 26-64 years represented in the US Renal Data System initiating treatment for kidney failure between 2008 and 2019. EXPOSURE: Residence in states that did or did not expand Medicaid in 2014. OUTCOME: An optimal start of kidney failure treatment was defined as undergoing preemptive kidney transplant, initiating home dialysis, or initiating in-center hemodialysis using an arteriovenous access. ANALYTICAL APPROACH: Interrupted time-series analyses were implemented to evaluate the adjusted association of residence in a Medicaid-expansion state and optimal kidney failure treatment by comparing the trend in optimal kidney failure treatment starts during the preexpansion period versus the postexpansion period. RESULTS: Before Medicaid expansion, the percentage of patients with optimal starts increased similarly in expansion and nonexpansion states. After Medicaid expansion, the percentage with optimal starts continued to increase in expansion states but decreased in nonexpansion states, resulting in a 3.9% (95% CI, 0.5%-7.2%) higher percentage with optimal starts in expansion versus nonexpansion states by 2019 (postexpansion vs preexpansion change in trend, P = 0.02). Most of the change in trend was attributable to a greater increase in use of home dialysis at initiation of kidney failure treatment in expansion versus nonexpansion states (difference of 0.29% per year; 95% CI, 0.08%-0.51%) during the postexpansion period. LIMITATIONS: Potential for unmeasured confounding from state-level factors other than Medicaid expansion. CONCLUSIONS: Medicaid expansion was associated with an increasing percentage of patients with incident kidney failure experiencing an optimal start to treatment, driven mostly by an increase in the use of home dialysis. Expanding Medicaid coverage may offer an opportunity to improve treatment for low-income patients initiating kidney replacement therapy. PLAIN-LANGUAGE SUMMARY: This study examined whether the expansion of Medicaid eligibility in 2014 led to improvements in the percentage of patients receiving an optimal start to treatment for new-onset kidney failure (ie, kidney transplant before the need to start dialysis, initiation of home dialysis, or initiation of in-center hemodialysis using an arteriovenous access). We compared trends from 2008 to 2019 across US states that expanded Medicaid and those that did not. Before 2014, both groups showed a similar upward trend in optimal starts. However, after Medicaid expansion, states that expanded Medicaid continued to experience an increase in optimal starts whereas states that did not expand showed a decrease over time. Much of the difference was explained by a larger increase in the use of home dialysis in states that expanded access to Medicaid. Our findings suggest that expanding Medicaid may lead to better initial treatment for kidney failure.
Is There a Role for Pentoxifylline in Diabetic Kidney Disease? A Mini Review.
Leehey DJ, Agarwal R
Am J Kidney Dis · 2026 Jun · PMID 41866016 · Publisher ↗
For many years, the only specific pharmacologic intervention to decrease end-stage kidney disease in diabetic kidney disease was renin-angiotensin-aldosterone system blockade. Recently, sodium/glucose cotransporter 2 inh...
For many years, the only specific pharmacologic intervention to decrease end-stage kidney disease in diabetic kidney disease was renin-angiotensin-aldosterone system blockade. Recently, sodium/glucose cotransporter 2 inhibitors, nonsteroidal mineralocorticoid antagonists, and glucagon-like peptide 1 receptor agonists have been introduced. However, there remains a need for new therapies. The nonspecific phosphodiesterase inhibitor pentoxifylline (PTX) has been shown to have antiproteinuric and anti-inflammatory effects, and small randomized clinical trials and meta-analyses indicate that PTX may have therapeutic benefits in diabetic kidney disease. A large multicenter randomized clinical trial to determine whether PTX decreases time to end-stage kidney disease or death is being conducted.
A Young Man With Nephrotic Syndrome and Facial Rash: A Quiz.
Sushmitha KG, Rajakumar I, Lamech TM … +3 more , Kumar JS, Kurien AA, Jayaprakash V
Am J Kidney Dis · 2026 Apr · PMID 41864661 · Publisher ↗
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The Beam in Our House.
Deele M
Am J Kidney Dis · 2026 Apr · PMID 41864660 · Publisher ↗
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Beyond the Individual: Toward a Family-Centered Understanding of Dialysis Caregiving.
Finderup J, Deele M, Agerskov H … +1 more , Bonner A
Am J Kidney Dis · 2026 Apr · PMID 41864659 · Publisher ↗
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Guidance on Care for Autosomal Dominant Polycystic Kidney Disease: A Patient Perspective.
Dickerson B, Fennel R, Maxwell C … +2 more , Revere C, Damron KC
Am J Kidney Dis · 2026 Apr · PMID 41864658 · Publisher ↗
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KDOQI US Commentary on the KDIGO 2025 Clinical Practice Guideline for the Evaluation, Management, and Treatment of Autosomal Dominant Polycystic Kidney Disease (ADPKD).
Dahl NK, August P, Besse W … +15 more , Chebib FT, Chonchol M, Cowley BD, Goral S, Guay-Woodford LM, Gulati A, Hogan MC, Lakhia R, Miskulin D, Nowak KL, Rahbari-Oskoui F, Park M, Seliger S, Yu A, Watnick T
Am J Kidney Dis · 2026 Apr · PMID 41864657 · Publisher ↗
The Kidney Disease Outcomes Quality Initiative (KDOQI) convened a work group to review the 2025 KDIGO (Kidney Disease: Improving Global Outcomes) clinical practice guideline for the evaluation, management, and treatment...
The Kidney Disease Outcomes Quality Initiative (KDOQI) convened a work group to review the 2025 KDIGO (Kidney Disease: Improving Global Outcomes) clinical practice guideline for the evaluation, management, and treatment of autosomal dominant polycystic kidney disease (ADPKD). The KDOQI work group reviewed the KDIGO guideline statements and practice points and provided perspective for implementation within the context of clinical practice in the United States. In general, the KDOQI work group concurs with several recommendations and practice points proposed by the KDIGO guidelines regarding the diagnosis, kidney manifestations of ADPKD, chronic kidney disease management and progression, and therapies to delay the progression of disease, along with management of extrarenal manifestations. The KDOQI work group acknowledges the growing evidence base to support a change in the nomenclature for ADPKD. In this commentary, the work group has also assessed and discussed various barriers and potential opportunities for implementing the recommendations put forth in the 2025 KDIGO guidelines while the scientific community continues to focus on prospective high-quality evidence to support specific recommendations for this systemic condition.
Splice Variant of Uromodulin Protects Against Acute Kidney Injury.
Werion A, Nikolaou K, Devuyst O
Am J Kidney Dis · 2026 May · PMID 41839288 · Publisher ↗
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The Roles of A Proliferation-Inducing Ligand (APRIL) and B-Cell Activating Factor (BAFF) in IgA Nephropathy.
Reily C, Novak J, Rizk DV
Am J Kidney Dis · 2026 May · PMID 41794353 · Full text
In IgA nephropathy (IgAN), elevated levels of the circulating autoantigen galactose-deficient IgA1 are critical to disease pathogenesis. Abnormal B-cell glycosylation pathways produce the autoantigen that, on recognition...
In IgA nephropathy (IgAN), elevated levels of the circulating autoantigen galactose-deficient IgA1 are critical to disease pathogenesis. Abnormal B-cell glycosylation pathways produce the autoantigen that, on recognition by autoantibodies, forms immune complexes. Genetic as well as in vitro, in vivo, and human immunologic studies have identified APRIL (a proliferation-inducing ligand) and BAFF (B-cell activating factor) as key cytokines controlling B-cell development and the differentiation of antibody-secreting cells. Targeting APRIL with or without BAFF is emerging as a viable strategy for the treatment of IgAN and nascent data from global clinical trials are showing very promising results.
Kidney and Cardiovascular Protection in Diabetes: Beyond Diabetes Typology.
Mottl AK, Sawinski DL, Bjornstad P
Am J Kidney Dis · 2026 May · PMID 41791642 · Publisher ↗
Despite the abundance of new therapies designed to delay or prevent kidney and cardiovascular events in people with type 2 diabetes mellitus (T2DM), a stark gap remains in the evidence supporting their efficacy and safet...
Despite the abundance of new therapies designed to delay or prevent kidney and cardiovascular events in people with type 2 diabetes mellitus (T2DM), a stark gap remains in the evidence supporting their efficacy and safety for other types of diabetes. Individuals without T2DM are frequently excluded from clinical trials based on the assumptions that their event risk, pathogenesis, and potential for adverse events differ significantly. It is anticipated that treatments will eventually be expanded to include this population, yet the uptake of new therapies even with clear evidence is often disappointingly low. In this perspective, we critically examine the characteristics of diabetes types other than T2DM and evaluate the available evidence for novel therapies in these underrepresented populations. Future small trials of surrogate end points and real-world studies, including individuals without T2DM, will be essential to understand and use recent advancements in treatments for preventing kidney failure and cardiovascular events and death.
Hypophosphatemia During Kidney Replacement Therapy and Ventilator-Free Days: A Post Hoc Analysis of the STARRT-AKI Trial.
Neyra JA, Thompson Bastin M, Ghamarian E … +4 more , Firenzuoli F, Takeuchi T, Bagshaw SM, Wald R
Am J Kidney Dis · 2026 May · PMID 41763519 · Publisher ↗
RATIONALE & OBJECTIVE: Critically ill patients receiving kidney replacement therapy (KRT), especially continuous KRT (CKRT), have a high risk of hypophosphatemia due to extracorporeal losses, which may contribute to musc...
RATIONALE & OBJECTIVE: Critically ill patients receiving kidney replacement therapy (KRT), especially continuous KRT (CKRT), have a high risk of hypophosphatemia due to extracorporeal losses, which may contribute to muscle weakness and prolonged respiratory failure. This study evaluated the relationship between incident hypophosphatemia and respiratory function in these patients. STUDY DESIGN: Post hoc observational study of STARRT-AKI Trial participants. SETTING & PARTICIPANTS: Eligible trial participants (1) received CKRT >24 hours or intermittent hemodialysis (IHD) or sustained low-efficiency dialysis (SLED) for >1 session, (2) had a serum phosphate level ≥ 0.5 mmol/L on the day of KRT initiation, and (3) had ≥1 serum phosphate measurement during KRT. EXPOSURE: Hypophosphatemia (<0.7 mmol/L) and severe hypophosphatemia (<0.5 mmol/L) during KRT. OUTCOME: Primary outcome was ventilator-free days (VFD) at 28 days of follow-up. Secondary outcomes included mortality and KRT dependence at 90 days. ANALYTICAL APPROACH: A truncated hurdle model was fit to describe clinical characteristics associated with hypophosphatemia. Adjusted analyses of VFD used an inverse probability weighted zero-inflated negative binomial model and a win-ratio analysis. Secondary outcomes were assessed with logistic regression. RESULTS: Of 1,942 trial participants, 634 patients (32.6%) developed hypophosphatemia, and 192 patients (9.9%) developed severe hypophosphatemia. Clinical factors independently associated with incident hypophosphatemia during KRT were female sex, lower body weight, lower serum phosphate levels at KRT initiation, CKRT as the initial KRT modality, and randomization to accelerated KRT initiation. Incident hypophosphatemia and severe hypophosphatemia were associated with fewer VFD at 28 days (β, 0.91 [95% CI, 0.87-0.95] and β, 0.87 [95% CI, 0.82-0.93], respectively; P < 0.001 for both). By win-ratio for any random pair of patients, those with incident hypophosphatemia and severe hypophosphatemia had a 27% and 25% lower likelihood of combined 28-day survival and fewer days on the ventilator, respectively. There was no association between hypophosphatemia and 90-day mortality or KRT dependence. LIMITATIONS: Selection bias and unmeasured confounding. CONCLUSIONS: Incident hypophosphatemia during KRT was independently associated with fewer VFD at 28 days.
Vaccinations to Prevent Infections in Adult Individuals With CKD and After Kidney Transplantation: A Review.
Girndt M
Am J Kidney Dis · 2026 Jun · PMID 41759616 · Publisher ↗
Patients with chronic kidney disease (CKD), especially those undergoing dialysis, are at high risk of infections that lead to hospitalizations, morbidity, and mortality. Influenza, pneumococcal pneumonia, and respiratory...
Patients with chronic kidney disease (CKD), especially those undergoing dialysis, are at high risk of infections that lead to hospitalizations, morbidity, and mortality. Influenza, pneumococcal pneumonia, and respiratory syncytial virus infections account for a significant proportion of typical infectious complications and are preventable by vaccination. The immune system is weakened in CKD, reducing vaccination efficacy. Additionally, some patients with CKD receive immunosuppressive medications. The reduced seroreactivity to various vaccines must be considered when selecting vaccines, vaccine doses, and schedules for patients with CKD. Vaccinations are generally safe in CKD and should be widely used in accordance with public health recommendations to reduce morbidity. Immunosuppression after kidney transplant further impairs vaccination responses. Nevertheless, vaccinations can still be effective and provide protection in a relevant number of patients. Patients who have received transplants should generally not receive live vaccines because of the risk of vaccine-induced complications. Vaccination is usually recommended 6 months after transplant, when immunosuppression is less intense than in the early months. This approach may conflict with seasonal vaccinations, which are often omitted. Data show that at least the influenza vaccination can be administered as early as 4 weeks after transplant without additional risk. In all patients with CKD or posttransplant status, omitting recommended vaccinations is a missed opportunity to prevent relevant infectious complications.
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