American Journal of Kidney Diseases

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The understanding and management of membranous nephropathy, a common cause of nephrotic syndrome that is more frequently encountered in adults than in children, has rapidly evolved over the past decade. Identification of target antigens has allowed for more precise molecular diagnoses, and the ability to monitor circulating autoantibodies has added a new vantage point in terms of disease monitoring and decisions about immunosuppression. Although immunosuppression with alkylating agents combined with corticosteroids, or with calcineurin inhibitor-based regimens, has been the historical mainstay of treatment, observational and now randomized controlled trials with the B-cell-depleting agent rituximab have moved this agent to the forefront of therapy for primary membranous nephropathy...

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RATIONALE & OBJECTIVE: During the COVID-19 pandemic, patients receiving maintenance dialysis are a highly vulnerable population due to their comorbidities and circumstances that limit physical distancing during treatment. This study sought to characterize the risk factors for and outcomes following COVID-19 infection in this population. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: Maintenance dialysis patients in clinics with at least one patient with a positive test for SARS-CoV-2 from February to June 2020, treated by a mid-size national dialysis provider...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

No abstract text is available yet for this article.

RATIONALE & OBJECTIVE: Optimal blood pressure (BP) control is a major therapeutic strategy in the management of chronic kidney disease (CKD). We studied the association of BP with adverse kidney outcomes within a diverse cohort of Koreans with CKD. STUDY DESIGN: Prospective observational cohort study. SETTING & PARTICIPANTS: 2,044 participants from the KoreaN Cohort Study for Outcomes in patients With CKD (KNOW-CKD). EXPOSURES: Baseline and time-updated systolic BP (SBP) and diastolic BP (DBP)...

RATIONALE AND OBJECTIVE: Chronic kidney disease (CKD) is a global health problem with increasing prevalence. Several sex-specific differences have been reported for disease progression and mortality. Selection and survival bias might have influenced the results of previous cohort studies. Our objective was to investigate sex-specific differences of CKD progression and mortality among patients with CKD not receiving maintenance dialysis. STUDY DESIGN: Observational cohort study...

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No abstract text is available yet for this article.

RATIONALE & OBJECTIVE: There is limited evidence to guide follow-up after acute kidney injury (AKI). Knowledge gaps include which patients to prioritize, at what time point, and for mitigation of which outcomes. In this study, we sought to compare the net-benefit of risk model-based clinical decisions following AKI. STUDY DESIGN: External validation of two risk models of AKI outcomes: 1) the Grampian (UK) - Aberdeen AKI readmissions model and 2) the Alberta (Canada) Kidney Disease risk model of CKD G4-G5)...

RATIONALE AND OBJECTIVE: While COVID-19 infection has been associated with acute kidney injury (AKI), it is unclear whether this association is independent of traditional risk factors such as hypotension, nephrotoxin exposure, and inflammation. We tested the independent association of COVID-19 with AKI. STUDY DESIGN: Multicenter, observational, cohort study. SETTING AND PARTICIPANTS: Patients admitted to one of six hospitals within the Yale-New Haven Health System between 3/10/2020 and 8/31/2020 and tested for SARS-CoV-2 via nasopharyngeal PCR test...

RATIONALE & OBJECTIVE: The national prevalence of dialysis in China has not been well studied. We aimed to estimate the prevalence of patients receiving dialysis and predict the trend using claims data in order to provide evidence for developing prevention strategies. STUDY DESIGN: Cross-sectional study of insurance claims. SETTING & PARTICIPANTS: Medical claims data from Jan 1, 2013 to Dec 31, 2017 were extracted from a large claims database, using a two-stage sampling design to obtain a national sample covered by the urban basic medical insurance, the most predominant insurance program in China...

RATIONALE AND OBJECTIVE: An important component of hemodialysis management involves delivery of complex dietary recommendations. The aim of this study was to determine the feasibility of a mobile phone text message intervention to improve dietary behavior in people on hemodialysis. STUDY DESIGN: Six-month randomized feasibility study. SETTING: and participants: Patients receiving maintenance hemodialysis across two health districts in Sydney, Australia...

RATIONALE AND OBJECTIVE: An arteriovenous fistula (AVF) in the non-dominant arm is the preferred access for hemodialysis (HD) patients. Prior peripheral intravenous (PIV) line placement can lead to vascular injury and limit options for AVF placement, a particular problem for children with the potential need for HD over a lifetime. We instituted an initiative to increase the frequency of PIV placement in the dominant arm for hospitalized pediatric patients with advanced chronic kidney disease (CKD)...

RATIONALE & OBJECTIVES: Comparing kidney disease progression among patients treated with direct oral anticoagulants (DOACs) versus warfarin has not been well studied. We hypothesized that apixaban, compared with warfarin, would be associated with lower risks of progression of chronic kidney disease (CKD) and progression to incident kidney failure in patients with atrial fibrillation (AF). STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: Medicare recipients with stages 3, 4, or 5 CKD and incident AF who received a new prescription for apixaban or warfarin between 2013 and 2017...

RATIONAL & OBJECTIVE: The clearance of protein-bound solutes by the proximal tubules is an innate kidney mechanism for removing putative uremic toxins that could exert cardiovascular toxicity in humans. However, potential associations between impaired kidney clearances of secretory solutes and cardiovascular events among patients with chronic kidney disease (CKD) remains uncertain. STUDY DESIGN: A multicenter, prospective, cohort study. SETTING & PARTICIPANTS: We evaluated 3,407 participants from the Chronic Renal Insufficiency Cohort (CRIC) study...

RATIONALE AND OBJECTIVE: Anti-glomerular basement membrane (GBM) disease is a rapidly progressive glomerulonephritis which, in rare instances, occurs concurrently with other diseases such as ANCA vasculitis. Rarely, it also occurs with membranous nephropathy (MN). We report a series of such patients, characterizing their long-term follow up. STUDY DESIGN: Case series. SETTING AND PARTICIPANTS: 12 patients referred to one medical center between 2001 and 2019 with anti-GBM disease and MN whose clinical characteristics and course were described...

RATIONALE & OBJECTIVE: Previous studies have illustrated the potential superiority of drug-coated balloons (DCBs) in maintaining patency after initial angioplasty for arteriovenous fistula (AVF) dysfunction due to stenosis. Our trial evaluated the efficacy and safety of DCBs for preventing fistula restenosis in Chinese hemodialysis patients. STUDY DESIGN: Multicenter, prospective, randomized, open-label, blinded-endpoint, controlled trial. SETTINGS & PARTICIPANTS: A total of 161 hemodialysis patients with fistula dysfunction from 10 centers in China...