The entire April 2025 issue is FREE until the end of the month to celebrate NKF Spring Clinicals Meeting!

Editor’s Note: We asked authors of Original Investigations to provide short plain-language summaries that would briefly summarize what inspired their study, the basic approach taken, what was learned, and why it matters. We hope our readers will find this valuable in helping them keep up with the latest research in the field of nephrology.

Highlights from the April 2025 issue:

Clinical Significance of Incident Osteoporotic Fractures After Kidney Transplantation: A National Korean Cohort Study by Yunyoung Jang et al. [FREE]

Kidney allograft recipients have a lower rate of incident OF compared with dialysis patients, but when OF occurs it is associated with a higher rate of death and allograft loss.

DOI: 10.1053/j.ajkd.2024.09.014

EDITORIAL: Osteoporotic Fractures After Kidney Transplantation by Pablo Antonio Ureña Torres, Ana P.N. Pimentel, Martine Cohen-Solal. [FREE]

Use of Statins for Primary Prevention Among Individuals With CKD in the United States: A Cross-Sectional, Time-Trend Analysis by Oshozimhede E. Iyalomhe et al. [FREE]

From the authors: Chronic kidney disease (CKD) affects many Americans, increasing their heart disease risk. Statins effectively reduce this risk in individuals with CKD but are underused. Our study examined statin use in individuals with CKD before and after the release of the 2013 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommending statin use for selected adults with CKD. It also examined factors influencing usage patterns. Using years of US National Health and Nutrition Examination Survey data, we found that while statin use doubled over the study period, fewer than half of eligible individuals with CKD received statins for primary prevention. Statin use was more common among those with health insurance, high blood pressure, or diabetes. This underuse highlights potential opportunities for improved risk monitoring and preventive use of statin therapy for individuals with CKD.

DOI: 10.1053/j.ajkd.2024.11.003

EDITORIAL: Closing CKD Treatment Gaps: Why Practice Guidelines and Better Drug Coverage Are Not Enough by Anukul Ghimire et al. [FREE]

AJKDBlog COMMENTARY: Statin Use in Chronic Kidney Disease: An Interview by Oshozimhede E. Iyalomhe [FREE]

Association of Serum Afamin Concentrations With Kidney Failure in Patients With CKD: Findings From the German CKD Cohort Study by Barbara Kollerits et al. 

Higher serum afamin concentrations appear to be associated with a higher eGFR, less albuminuria, and a lower risk for future kidney failure in patients with CKD.

DOI: 10.1053/j.ajkd.2024.11.004

AJKDBlog COMMENTARY: Afamin and Kidney Health: In the Pursuit of a Better Biomarker for CKD Progression by Somaya Zahran [FREE]

Treatment Effect Heterogeneity in Acute Kidney Injury Incidence Following Intravenous Antihypertensive Administration for Severe Blood Pressure Elevation During Hospitalization by Lama Ghazi et al. [OPEN ACCESS]

From the authors: Patients who develop severe blood pressure elevation during hospitalization are commonly treated with intravenous antihypertensives; however, this could lead to acute kidney injury (AKI). We wanted to assess whether this is consistent across all patients, using a new statistical approach that predicts what would happen if patients who were treated had not been treated and those who were not treated had been. We found that most patients will develop AKI, and only a small subset of patients might not. This exploratory study can help inform future studies on the treatment of hypertension that develops during hospitalization.

DOI: 10.1053/j.ajkd.2024.09.011

Vadadustat Three Times Weekly in Patients With Anemia Due to Dialysis-Dependent CKD by Hakan R. Toka et al. [OPEN ACCESS]

Vadadustat, taken 3 times a week, was noninferior to methoxy polyethylene glycol-epoetin-ß (MPG-EPO) in treating anemia. Vadadustat is an oral drug used to treat anemia in people with chronic kidney disease. This study enrolled participants undergoing dialysis for kidney failure and compared the efficacy and safety of continuing to receive MPG-EPO, a long-acting injectable anemia treatment, or switching to vadadustat, taken by mouth 3 times per week for 1 year. Vadadustat was noninferior to MPG-EPO in maintaining hemoglobin levels. Hemoglobin levels remained stable across all groups, except for a slight decrease in the lower-dose vadadustat group, which stabilized with dose titration by week 12. The occurrence of new or serious side effects was similar across treatment groups.

DOI: 10.1053/j.ajkd.2024.09.006 

AJKDBlog COMMENTARY: Addressing Anemia in CKD and ESRD: Will Hypoxia-Inducible Factor Stabilization Eliminate the Need for Erythropoietin Stimulating Agents?  by Diana Mahbod [FREE]

Clinical Spectrum and Prognosis of Atypical Autosomal Dominant Polycystic Kidney Disease Caused by Monoallelic Pathogenic Variants of IFT₁₄₀ by Nikola Zagorec et al. 

From the authors: Monoallelic pathogenic variants in IFT₁₄₀ have been linked to a spectrum of kidney disease clinically similar to autosomal dominant polycystic kidney disease (ADPKD). This article describes a case series of 75 individuals with ADPKD-IFT₁₄₀. Affected individuals typically presented with an atypical imaging pattern, had fewer but larger kidney cysts compared with classic ADPKD, and rarely developed liver cysts. Although the kidney prognosis appeared better than in classic ADPKD, 56.3% of individuals over 60 years of age had stage 3 or more severe CKD. Individuals with ADPKD-IFT₁₄₀ variants are likely to develop kidney cyst patterns atypical of ADPKD. Their kidney prognosis appears favorable.

DOI:  10.1053/j.ajkd.2024.10.009

Determinants of Caregiver Burden Among Spouses of Patients With Kidney Failure: A Qualitative Study by Esmee Driehuis et al. [OPEN ACCESS]

From the authors: Spousal caregivers are crucial for supporting patients with kidney failure, but they often experience significant stress and challenges. This study explored factors that contribute to spousal caregiver burden and ways to alleviate it. We interviewed 15 spousal caregivers of patients with kidney failure. We found that providing care for patients with kidney failure is complex, burdensome, and has a major impact on caregivers’ lives. We identify factors that contribute to caregiver burden but also factors that may ease this burden. This study underlines the need for acknowledgement of spousal caregivers in 4 areas, namely (1) personal and relational, (2) social environment, (3) health care, and (4) work and legislation.

DOI: 10.1053/j.ajkd.2024.11.005

AJKDBlog COMMENTARY: Unseen, Unheard: The Silent Strain on Dialysis Caregivers by Madhumitha Rajagopal [FREE]

Review in the April 2025 issue:

Treatment of Autosomal-Dominant Polycystic Kidney Disease by Sara S. Jdiaa et al. [OPEN ACCESS]

Autosomal-dominant polycystic kidney disease (ADPKD) is a chronic systemic disease that affects all races and ethnicities. It is the fourth leading cause of end-stage kidney disease, and it has a heterogenous phenotype ranging from mild to severe disease. Identifying patients with ADPKD who are at risk of rapid progression can guide therapeutic decisions. Several tools to predict disease severity are available, based on features such as total kidney volume assessed with magnetic resonance imaging, PKD genotype, estimated glomerular filtration rate (eGFR) trajectory, and the occurrence of hypertension and urologic complications early in life. During the past decade, more evidence has emerged regarding optimal ADPKD management. The HALT PKD (Halt Progression of Polycystic Kidney Disease) trial supported intensive blood pressure control in patients younger than 50 years of age with preserved kidney function. A healthy lifestyle, including maintaining a healthy weight, salt restriction, and smoking cessation, is likely to be beneficial. Tolvaptan, the only disease-modifying agent for patients with ADPKD at risk of rapid progression, is gaining wider use, but is still limited by its side effects. This is an exciting time for the ADPKD community because multiple promising interventions are in the pipeline and being investigated.

DOI: 10.1053/j.ajkd.2024.08.008

AJKDBlog COMMENTARY: Treatment of Autosomal Dominant Polycystic Kidney Disease (ADPKD): An Interview  by Sara Jdiaa and Reem Mustafa [FREE]

On the Cover:

In a Few Words is a recurring AJKD feature through which we give voice to the diverse stories that characterize kidney disease. Physicians and other health professionals, patients, and family members are encouraged to submit nonfiction essays, poems, or original art that convey how kidney disease has impacted their lives. This month’s cover features an illustration depicting the stress experienced by family members of a person with kidney disease. Submitted by 6th grade artist Samvruth Sreevatsava Kanduri, this scene captures the emotional and physical toll faced by the author’s family during her grandfather’s kidney failure journey. It highlights the often unseen burden carried by caregivers as they navigate the challenges of supporting their loved ones through advanced illness and frequent complex medical care demands.

Special thanks to Editorial Intern Somaya Zahran for curating the cover image and drafting the cover blurb for this issue.

“The stress and agony experienced by family members of a person with kidney disease” by Samvruth Sreevatsava Kanduri. Reproduced with permission

SPECIAL COLLECTION: World Kidney Day

In celebration of World Kidney Day, this special collection highlights kidney disease research from around the world (all articles are freely available until April 20, 2025).