In 2017, we established an annual celebration of articles that our editorial team designated as “Editors’ Choice” selections. The editors are delighted to recognize the articles listed below that have been selected to receive the 2023 Editors’ Choice Award. These articles will be freely available at AJKD.org until January 31, 2024. Congratulations to all the authors!

Racial and Ethnic Disparities in Acute Care Utilization Among Patients With Glomerular Disease by Jill R. Krissberg, Michelle M. O’Shaughnessy, Abigail R. Smith, Margaret E. Helmuth, Salem Almaani, Diego H. Aviles, Kaye E. Brathwaite, Yi Cai, Daniel Cattran, Rasheed Gbadegesin, Dorey A. Glenn, Larry A. Greenbaum, Sandra Iragorri, Koyal Jain, Myda Khalid, Jason Kidd, Jeffrey Kopp, Richard Lafayette, Jerome C. Lane, Francesca Lugani, Jordan G. Nestor, Rulan S. Parekh, Kimberly Reidy, David T. Selewski, Christine B. Sethna, C. John Sperati, Katherine Tuttle, Katherine Twombley, Tetyana L. Vasylyeva, Donald J. Weaver, Scott E. Wenderfer, Keisha Gibson, on behalf of the CureGN Consortium (March 2023)

From the authors: Racial and ethnic disparities have been described in many aspects of kidney disease, but little is known about disparities in glomerular disease. This large multinational cohort study of the Cure Glomerulonephropathy Network describes differences in acute care utilization for patients with glomerular disease across racial and ethnic groups and explores potential underlying reasons for any observed differences. We found that Black race was associated with higher rates of acute care utilization, whereas Asian race was associated with lower rates of acute care utilization. These associations may be explained by differences in socioeconomic status and disease severity among these groups. Efforts to improve health equity should consider socioeconomic factors contributing to disease severity or reliance on hospital over ambulatory care.

DOI: 10.1053/j.ajkd.2022.08.010

Efficacy of Potassium Supplementation in Hypokalemic Patients Receiving Peritoneal Dialysis: A Randomized Controlled Trial by Watthikorn Pichitporn, Talerngsak Kanjanabuch, Jeerath Phannajit, Pongpratch Puapatanakul, Piyatida Chuengsaman, WatanyuParapiboon, Worapot Treamtrakanpon, Chanchana Boonyakrai, Saraporn Matayart, Pisut Katavetin, Jeffrey Perl, Kearkiat Praditpornilpa, Somchai Eiam-Ong, Kriang Tungsanga, and David W. Johnson (November 2022)

From the authors: Hypokalemia, which is commonly found in patients on peritoneal dialysis (PD), is associated with poor outcomes. A multicenter, open-label, prospective, randomized controlled trial was conducted with 167 hypokalemic patients receiving PD. It examined whether a protocol-based correction of hypokalemia to maintain a serum potassium concentration of 4-5 mEq/L (85 participants) could improve PD-related outcomes compared with reactive potassium supplementation administered when serum potassium levels fell below 3.5 mEq/L (82 participants). During the median follow-up time of 401 days, the protocol supplementation appeared safe and significantly reduced the risk of peritonitis.

DOI: 10.1053/j.ajkd.2022.03.013

EDITORIAL: Correction of Hypokalemia in Peritoneal Dialysis Patients May Decrease Peritonitis Risk by Beth M. Piraino [FREE]

Longitudinal Relationship Between Anemia and Statural Growth Impairment in Children and Adolescents With Nonglomerular CKD: Findings From the Chronic Kidney Disease in Children (CKiD) Study by Oleh Akchurin, Andrea R. Molino, Michael F. Schneider, Meredith A. Atkinson. Bradley A. Warady. Susan L. Furth (April 2023)

From the authors: Both anemia and short stature are common complications of chronic kidney disease (CKD) in children. In children without CKD, anemia has been shown to impair physical development; however, the relationship between anemia and growth in children with CKD remains unclear. Using data from the Chronic Kidney Disease in Children (CKiD) cohort study, we demonstrated that children with the most common (nonglomerular) origin of CKD and lower hemoglobin values are more likely to grow poorly, independent of their kidney function, sex, and age. These findings are important for the refinement of guidelines for the management of anemia and short stature in children with CKD.

DOI: 10.1053/j.ajkd.2022.09.019

Shared Decision Making Among Older Adults With Advanced CKD by Rebecca Frazier, Sarah Levine, Thalia Porteny, Hocine Tighiouart, John B. Wong, Tamara Isakova, Susan Koch-Weser, Elisa J. Gordon, Daniel E. Weiner, and Keren Ladin (November 2022) [Open Access]

Distribution of 9-item Shared Decision Making Questionnaire item scores. Figure 2 from Frazier et al, AJKD (CC BY-NC-ND 4.0).

From the authors: Older adults with advanced kidney disease face difficult treatment decisions. Dialysis offers uncertain survival benefits but has significant quality of life implications. Shared decision making (SDM) may help patients choose treatment options that best align with their goals and values. We performed a cross-sectional analysis among older adults with advanced kidney disease to examine SDM in nephrology clinics using the 9-item Shared Decision Making Questionnaire. We found that SDM was suboptimal, with a mean questionnaire score of 52 (possible scores of 0-100). Being “well informed” and “very well informed” about kidney treatment options, having higher decisional certainty, and attendance at a kidney treatment options class were associated with greater SDM. Our research highlights the need to improve SDM for older adults facing dialysis decisions.

DOI: 10.1053/j.ajkd.2022.02.017

Referral and Evaluation for Kidney Transplantation Following Implementation of the 2014 National Kidney Allocation System by Rachel E. Patzer, Mengyu Di, Rebecca Zhang, Laura McPherson, Derek A. DuBay, Matthew Ellis, Joshua Wolf, Heather Jones, Carlos Zayas, Laura Mulloy, Amber Reeves-Daniel, Sumit Mohan, Aubriana C. Perez, Amal Trivedi, Stephen O. Pastan, on behalf of the Southeastern Kidney Transplant Coalition (December 2022)

Adjusted hazard ratios (95% CI) of the impact of the new kidney allocation system (KAS) policy compared to pre-KAS population on referral, evaluation, and waitlisting among incident patients (circle) and prevalent patients (triangle) with kidney failure 2012-2016, with at least 12 months on dialysis (2013-2016) with follow-up through 2017 in Georgia, North Carolina, and South Carolina. Figure 2 from Patzer et al, AJKD © National Kidney Foundation.

Our study sought to examine whether this decrease in waitlisting was driven by lower rates of referral, evaluation, or waitlisting in the southeastern United States, the only region with systematic data collection on early transplant steps that would facilitate this analysis. The results from this region suggest that among the incident population that started the evaluation process, KAS led to a decline in overall waitlisting. Although many have hypothesized that these declines in waitlisting may have been the result of the removal of the loss of allocation time that results from delayed referral in KAS, our results suggest that the lower rates of waitlisting among the incident population after KAS are not explained by lower rates of referral or evaluation among incident patients but rather lower waitlisting among evaluated patients at transplant centers. Among the prevalent population, the group most likely to benefit from the allocation time changes in KAS, we observed higher rates of waitlisting among those who were referred and started the evaluation but no significant impact of KAS on referral and evaluation start. These results emphasize the importance of understanding how policy changes can lead to health system and provider-level behavior changes among both dialysis facilities and transplant centers.

DOI: 10.1053/j.ajkd.2022.01.423

EDITORIAL: Advancing Transplant Equity by Closing the Gaps in Policy, Practice, and Research by Tanjala S. Purnell [FREE]

~2023 NKF MISSION AWARD~

“Recognizing research published in AJKD that has great promise to enhance the lives of those affected by kidney disease”

Patient and Clinician Perspectives on Shared Decision Making in Vascular Access Selection: A Qualitative Study (January 2023)

by Meghan J. Elliott, Pietro Ravani, Robert R. Quinn, Matthew J. Oliver, Shannan Love, Jennifer MacRae, Swapnil Hiremath, Sarah Friesen, Matthew T. James, and Kathryn M. King-Shier

Findings suggest that earlier, or upstream, decisions about kidney replacement therapies influence how and when vascular access decisions are made. Repeated vascular access discussions that are integrated with other higher-level decisions are needed to promote vascular access shared decision making and preparedness.

DOI: 10.1053/j.ajkd.2022.05.016