Clinical Journal of the American Society of Nephrology : CJASN

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Background Patients with stage 4 chronic kidney disease (CKD) and type 2 diabetes have limited treatment options to reduce their persistent cardiovascular and kidney risk. In FIDELITY, a prespecified pooled analysis of FIDELIO-DKD and FIGARO-DKD, finerenone improved heart-kidney outcomes in participants with CKD and type 2 diabetes. Methods This FIDELITY subgroup analysis investigated the effects of finerenone in participants with stage 4 CKD (estimated glomerular filtration rate [eGFR] <30 ml/min/1.73 m2)...

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BACKGROUND: We hypothesized that the association of ultrafiltration rate with mortality in hemodialysis patients was differentially affected by weight and sex, and sought to derive a sex and weight indexed ultrafiltration rate measure that captures the differential effects of these parameters on the association of ultrafiltration rate with mortality. METHODS: Data were analyzed from the U.S. Fresenius Kidney Care (FKC) database for 1 year following patient entry into a FKC dialysis unit (baseline) and over 2 years of follow-up for patients receiving thrice weekly in-center hemodialysis...

BACKGROUND: Eculizumab is a monoclonal antibody for the treatment of atypical hemolytic uremic syndrome (aHUS). Kidney damage, a common condition in patients with aHUS may result in proteinuria. As proteinuria may impact the pharmacokinetics of therapeutic proteins like eculizumab, the aim of our study was to investigate the effect of proteinuria on eculizumab pharmacokinetics. METHODS: This study was an ancillary study of a previously performed pharmacokinetic-pharmacodynamic study of eculizumab in aHUS...

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METHODS: We undertook realist synthesis to develop a model of these context-mechanism-outcome interactions. We included references from two existing systematic reviews and from database searches. Six reviewers produced a long-list of study context-mechanism-outcome configurations based on review of individual studies. During group sessions, these were synthesized to produce an integrated model of intervention mechanisms, how they act and interact to deliver desired outcomes, and in which contexts these mechanisms work...

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The American Society of Nephrology (ASN) Task Force on the Future of Nephrology was established in April 2022 in response to requests from the American Board of Internal Medicine (ABIM) and the Accreditation Council for Graduate Medical Education (ACGME) regarding training requirements in nephrology. Given recent changes in kidney care, ASN also charged the task force with reconsidering all aspects of the specialty's future to ensure that nephrologists are prepared to provide high-quality care for people with kidney diseases...

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BACKGROUND: Limited information exists regarding the safety of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in patients with chronic kidney disease (CKD) treated in routine care. We evaluated the safety of SGLT2i in patients with CKD and type 2 diabetes treated in US routine practice. METHODS: Using claims data from 2 large U.S. commercial and Medicare databases (April 2013-December 2021), we included 96,128 adults with CKD stages 3-4 and type 2 diabetes who newly filled prescriptions for SGLT2i vs...

BACKGROUND: Height-adjusted total kidney volume (htTKV) measured by imaging defined as Mayo Imaging Class (MIC) is a validated prognostic measure for autosomal dominant polycystic kidney disease (ADPKD) in adults to predict and stratify disease progression. However, no stratification tool is currently available in pediatric ADPKD. Since magnetic resonance imaging and computed tomography in children are difficult, we propose a novel 3D ultrasound based pediatric Leuven Imaging Classification (LIC) to complement the MIC...

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BACKGROUND: Statins are the third most prescribed drug class in kidney transplant recipients as cardiovascular diseases is the leading cause of death in this population. However, statins' safety profile remains unclear in kidney transplant recipients who are uniquely burdened by concomitant immunosuppression and comorbidities. We conducted a national study to characterize the association of statin use with adverse events in kidney transplant recipients. METHODS: We studied adult (≥18) single-organ kidney transplant recipients in 2006-2016 with Medicare as primary payer (n=57,699)...

BACKGROUND: As free open access medical education use increases, it is important to characterize how and why learners are using this educational material in nephrology. We describe the frequency, purpose, and type of free open access medical education usage across US nephrology fellows. METHODS: In this cross-sectional survey, items were emailed to all US adult and pediatric nephrology fellows via the American Society of Nephrology (ASN) Fellow Survey in May 2022...

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BACKGROUND: Individuals with chronic kidney disease (CKD) are at an increased risk for cardiovascular morbidity and mortality. Acidosis is positively correlated with CKD progression and elevated systolic blood pressure. Sodium bicarbonate is an efficacious treatment for acidosis, although this may also increase systolic blood pressure. In this systematic review and meta-analysis, we summarize the evidence evaluating systolic blood pressure and antihypertensive medication change (which may indicate systolic blood pressure change) in response to sodium bicarbonate therapy in CKD patients...