Kidney Outcomes Research Articles

Kidney ANCA-Associated Vasculitides (AAV) Manifestations and Outcomes in a Diverse Pediatric Cohort: A Single-Center Experience

Kidney ANCA-Associated Vasculitides (AAV) Manifestations and Outcomes in a Diverse Pediatric Cohort: A Single-Center Experience

An international, multi-center study evaluated rituximab therapy in childhood steroid-resistant nephrotic syndrome

The efficacy and safety of rituximab in childhood steroid-resistant nephrotic syndrome (SRNS) remains unclear. Therefore, we conducted a retrospective cohort study at 28 pediatric nephrology centers from 19 countries in Asia, Europe, North America and Oceania to evaluate this. Children with SRNS treated with rituximab were analyzed according to the duration of calcineurin inhibitors (CNIs) treatment before rituximab [6 months or more (CNI-resistant) and under 6 months]. Primary outcome was complete/partial remission (CR/PR) as defined by IPNA/KDIGO guidelines. Secondary outcomes included kidney failure and adverse events. Two-hundred-forty-six children (mean age, 6.9 years; 136 boys; 57% focal segmental glomerulosclerosis, FSGS) were followed a median of 32.4 months after rituximab. All patients were in non-remission before rituximab. (146 and 100 children received CNIs for 6 month or more or under 6 months before rituximab, respectively). In patients with CNI-resistant SRNS, the remission rates (CR/PR) at 3-, 6-, 12- and 24-months were 26% (95% confidence interval 19.3-34.1), 35.6% (28.0-44.0), 35.1% (27.2-43.8) and 39.1% (29.2-49.9), respectively. Twenty-five patients were in PR at 12-months, of which 22 had over 50% reduction in proteinuria from baseline. The remission rates among children treated with CNIs under 6 months before rituximab were 42% (32.3-52.3), 52% (41.8-62.0), 54% (44.3-64.5) and 60% (47.6-71.3) at 3-, 6-, 12-, and 24-months. Upon Kaplan-Meier analysis, non-remission and PR at 12-months after rituximab, compared to CR, were associated with significantly worse kidney survival Adverse events occurred in 30.5% and most were mild. Thus, rituximab enhances remission in a subset of children with SRNS, is generally safe and CR following rituximab is associated with favorable kidney outcome.

Frequent Premature Atrial Contractions Are Associated with Increased Mortality Risk and Poor Kidney Outcomes in Patients with CKD

Frequent Premature Atrial Contractions Are Associated with Increased Mortality Risk and Poor Kidney Outcomes in Patients with CKD

The Importance of Kidney Response over Hematologic Response in Predicting Kidney Outcomes in AL Amyloidosis

The Importance of Kidney Response over Hematologic Response in Predicting Kidney Outcomes in AL Amyloidosis

Enlarged Kidney Parenchymal Volume Predicts Poor Kidney Outcomes in Advanced Stage Diabetic Nephropathy

Enlarged Kidney Parenchymal Volume Predicts Poor Kidney Outcomes in Advanced Stage Diabetic Nephropathy

6-Year Prospective Study of Kidney Outcomes after Withdrawal of Concurrent RAAS Blockade in Patients Presenting with New, Progressive, Otherwise Inexplicable AKI

6-Year Prospective Study of Kidney Outcomes after Withdrawal of Concurrent RAAS Blockade in Patients Presenting with New, Progressive, Otherwise Inexplicable AKI

Roxadustat Regulates the NKA/Src/HIF-1/ROS Signaling Pathway to Improve Kidney Outcomes in Mice with Lupus

Roxadustat Regulates the NKA/Src/HIF-1/ROS Signaling Pathway to Improve Kidney Outcomes in Mice with Lupus

Urinary Complements as a Predictor of Kidney Outcomes in Patients with ANCA-Associated Vasculitis

Urinary Complements as a Predictor of Kidney Outcomes in Patients with ANCA-Associated Vasculitis

Long-Term Kidney Outcome of Lupus Nephritis by Renal Response Status

IntroductionLimited evidence exists that clinical trial treatment response criteria predict long-term outcomes in Asian patients with lupus nephritis (LN). MethodsThis retrospective analysis of prospectively collected data from the Hong Kong Queen Mary Hospital Cohort categorized adults with biopsy-proven LN (Class III, IV, V, or mixed [III±V, IV±V]) after standard treatment for 2 years (2Y) post biopsy and immunosuppression induction according to modified primary efficacy renal response (mPERR: estimated glomerular filtration rate [eGFR] ≥60 ml/min/1.73 m2 or ≤20% below biopsy value AND urine protein:creatinine ratio [uPCR] ≤0.7) and modified complete renal response (mCRR; eGFR ≥90 ml/min/1.73 m2 or ≤10% below biopsy value AND uPCR ≤0.5). Associations between 2Y mPERR/mCRR status and long-term kidney survival and mild chronic kidney disease (CKD) or worse (Stage ≥3) were assessed. ResultsOf the 176 Chinese patients, 64.2% achieved mPERR and 43.8% achieved mCRR at 2Y post biopsy. After mean follow-up of 15.3 years, significantly higher proportions of mPERR and mCRR responders versus non-responders achieved long-term kidney survival (mPERR: 85.8% vs 71.4%; p=0.029; mCRR: 92.2% vs 71.7%; p<0.001). mPERR and mCRR achievement was associated with adjusted risk reductions for kidney non-survival of 60% (p=0.034) and 86% (p<0.001), respectively. Adjusted risk for mild CKD or worse (Stage ≥3) was 82% (p=0.013) and 87% (p=0.012) lower for mPERR and mCRR responders, respectively, versus non-responders. ConclusionsIn Chinese patients with LN, mPERR and mCRR at 2Y post biopsy predict superior long-term kidney outcomes and lower CKD progression risk.

Semaglutide Reduced Risks of Major Kidney Outcomes Irrespective of CKD Severity in the FLOW Trial

Semaglutide Reduced Risks of Major Kidney Outcomes Irrespective of CKD Severity in the FLOW Trial

Serum C-reactive Protein and Risk of Major Kidney Outcomes in Adults with Atherosclerotic Cardiovascular Disease Managed in Routine Care

Serum C-reactive Protein and Risk of Major Kidney Outcomes in Adults with Atherosclerotic Cardiovascular Disease Managed in Routine Care

Glucocorticoid Monotherapy as Induction Therapy for Class 1/2 Lupus Nephritis Is Associated with Higher Renal Relapse and Poorer Kidney Outcomes

Glucocorticoid Monotherapy as Induction Therapy for Class 1/2 Lupus Nephritis Is Associated with Higher Renal Relapse and Poorer Kidney Outcomes

Long-Term Kidney Outcomes in ANCA-Associated Vasculitis in a Mexican Hispanic Cohort

Long-Term Kidney Outcomes in ANCA-Associated Vasculitis in a Mexican Hispanic Cohort

Long-Term Kidney Outcomes in Children and Adolescents with Hypertension

Long-Term Kidney Outcomes in Children and Adolescents with Hypertension

Long-Term Kidney Outcomes in Pediatric Renal Vein Thrombosis

Long-Term Kidney Outcomes in Pediatric Renal Vein Thrombosis

Trace Element Intake and Major Adverse Kidney Outcomes in Critically Ill Patients with Severe Sepsis

Trace Element Intake and Major Adverse Kidney Outcomes in Critically Ill Patients with Severe Sepsis

Cardiac and kidney outcomes after sacubitril-valsartan therapy: recovery of cardiac function relative to kidney function decline.

Sacubitril-valsartan reduces the risk of cardiovascular mortality among patients with heart failure with reduced ejection fraction (HFrEF). However, its long-term protective effects on cardiac function with concurrent acute kidney injury (AKI) remain unclear. This study investigated the recovery of cardiac function relative to kidney function decline. A total of 512 patients with HFrEF who started sacubitril-valsartan or valsartan treatment were enrolled in cohort 1. Additionally, patients who experienced AKI and underwent follow-up transthoracic echocardiography were enrolled in cohort 2. In cohort 1, short- and long-term kidney outcomes were analyzed. For cohort 2, changes in cardiac function in relation to changes in kidney function after drug initiation were analyzed. The mean age of the patients was 68.3 ± 15.1 years, and 57.4% of the patients were male. AKI occurred in 15.9% of the sacubitril-valsartan group and 12.5% of the valsartan group. After AKI, 78.4% of patients in the sacubitril-valsartan group and 71.4% of those in the valsartan group underwent recovery. Furthermore, cardiovascular outcomes in patients who developed AKI after drug initiation were analyzed in cohort 2. The sacubitril-valsartan group showed a greater improvement in cardiac function compared with the valsartan group (12.4% ± 15.4% vs. 1.4% ± 5.7%, p = 0.046). The ratio of deltas of cardiac and kidney function in the sacubitril-valsartan and valsartan groups were -1.76 ± 2.58 and -0.20 ± 0.58, respectively (p = 0.03). Patients with HFrEF treated with sacubitril-valsartan exhibited significant improvements in cardiovascular outcomes despite AKI.

First interim results from FINE-REAL: a prospective, non-interventional, phase 4 study providing insights into the use and safety of finerenone in a routine clinical setting.

Finerenone, a selective non-steroidal mineralocorticoid receptor antagonist, improves kidney and cardiovascular outcomes in patients with chronic kidney disease (CKD) associated with type 2 diabetes (T2D). The FINE-REAL study (NCT05348733) aims to evaluate the characteristics and treatment patterns of participants treated with finerenone in clinical practice. FINE-REAL is a prospective, single-arm, non-interventional study of patients initiated on finerenone as part of their routine care in accordance with country-approved labels. The study, initiated in June 2022, is expected to be completed by January 2028. The cutoff for this pre-specified interim analysis was June 13, 2023. Participants were recruited across nephrology, endocrinology, cardiology, and primary care settings. Of 556 participants enrolled in the study by the cut-off date, 504 were included in this analysis (median follow-up duration of 7months [finerenone treatment initiation to last recorded observation]). At baseline, 76.1% of participants were in the high or very high (KDIGO) CKD risk categories. Angiotensin converting enzyme inhibitors/angiotensin receptor blockers and sodium-glucose cotransporter 2 inhibitors were prescribed to 71.8% and 46.6% of participants, respectively. Based on prescribing information, 87.9% and 12.1% of participants initiated finerenone at doses of 10 and 20mg, respectively. Finerenone treatment was uninterrupted in 92.3% of participants after 7months' median follow-up. Treatment-emergent adverse events occurred in 110 (21.8%) participants. Hyperkalemia occurred in 25 (5.0%) participants, with no cases leading to death, dialysis, or hospitalization. At this interim analysis, finerenone was initiated in patients with CKD and T2D across various clinical practices participating in the study. Treatment discontinuation and hyperkalemia occurred infrequently.

An innocent bystander or a predisposing culprit? Kidney injury following pediatric liver transplantation.

Survival after pediatric liver transplantation has increased dramatically over the years, revealing extra-hepatic complications including impaired kidney function. We conducted a large single-center retrospective study to evaluate kidney outcomes after pediatric liver transplantation. From electronic charts of 121 children who underwent liver transplantation during 2007-2020, we collected pre- and post-transplant data. We investigated the presence of post-transplant permanent kidney injury, including proteinuria, hypertension, and decreased estimated glomerular filtration rate (eGFR). We excluded children who died, underwent liver-kidney transplantation, or had less than 1year of follow-up. During a median follow-up of 5.1 (interquartile range 2.9-7.3) years, eGFR decreased, mostly in the first year post-transplant. In addition, 41% of the children presented with acute kidney injury. At their last follow-up, 35% showed permanent kidney injury (hypertension 13%, proteinuria 36%, and eGFR < 90mL/min per 1.73m2 7%). Kidney ultrasounds were abnormal for 44% of the children at the last visit, compared to 11% before transplant (p < 0.001). In multivariate analysis, abnormal kidney ultrasound before transplant (odds ratio = 4.53, 95% CI 1.1-18.7) and liver disease with potential risk of primary kidney involvement (odds ratio = 4.77, 95% CI 1.58-14.4) were predictors for hypertension or decreased eGFR at the last follow-up. The high prevalence of kidney injury after pediatric liver transplantation and the pretransplant predictors for kidney injury highlight the importance of a thorough kidney pretransplant evaluation and follow-up.

Response to Comment on Zu et al. Association of Body Weight Time in Target Range With the Risk of Kidney Outcomes in Patients With Overweight/Obesity and Type 2 Diabetes Mellitus. Diabetes Care 2024;47:371–378

Response to Comment on Zu et al. Association of Body Weight Time in Target Range With the Risk of Kidney Outcomes in Patients With Overweight/Obesity and Type 2 Diabetes Mellitus. Diabetes Care 2024;47:371–378