Highlights from the January 2025 Issue

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 January 2025 issue:

Patient, Parental, and Health Professional Perspectives on Growth in Children With CKD by Justin G. Wu et al. 

From the authors: Children with chronic kidney disease (CKD) are often much shorter than their peers and may experience poorer mental health and quality of life. To understand the specific important issues on how growth impairment affects these children, we collected qualitative data from the Standardized Outcomes in Nephrology–Children and Adolescents (SONG-Kids) initiative and analyzed perspectives on growth from patients, parents, and health professionals. These data revealed impaired psychological health, reduced enjoyment during school and sports, difficulty dealing with medication side effects and growth hormone treatment, and concerns related to tracking health status and kidney transplant outcomes. These findings may inform the psychosocial support needed by children with CKD and their caregivers to address concerns about growth and overall health.

DOI:  10.1053/j.ajkd.2024.06.016

EDITORIAL: Harmonizing the Different Perspectives on Growth Impairment in Pediatric CKD by Melissa S. Zhou et al. [FREE]


Explaining International Trends in Mortality on Hemodialysis Through Changes in Hemodialysis Practices in the Dialysis Outcomes and Practice Patterns Study (DOPPS) by Keith P. McCullough et al. 

From the authors: Case-mix adjusted survival of patients treated with hemodialysis has improved over the last 2 decades in the United States, Japan, and Europe. Some of this improvement can be explained by region-specific changes in 4 dialysis practices, namely increases in the proportions of patients achieving (1) Kt/V≥1.2, (2) serum phosphorus levels<6mg/dL, (3) interdialytic weight gain<5.7% of body weight, and/or (4) use of arteriovenous fistulas as vascular access, with the magnitude varying according to region-specific trends in these practices. These findings suggest that further improvement in these practice measures may be attended by further reductions in mortality among patients treated with maintenance hemodialysis.

DOI:  10.1053/j.ajkd.2024.06.017

EDITORIAL: Improved Survival in Patients Receiving Hemodialysis Through Changes in Practice Patterns: Does This Apply to Your Country? by Anneke Kramer et al. [FREE]


Longitudinal Patterns of Ankle-Brachial Index and Their Association With Progression of CKD in Patients With Type 2 Diabetes and Elevated Body Mass Index by Mengyi Liu et al. 

From the authors: The ankle-brachial index (ABI) has recently become a routine screening parameter for vascular complications in patients with diabetes. In this post hoc analysis of the Look AHEAD (Action for Health in Diabetes) trial including 3,631 participants with type 2 diabetes mellitus and increased body mass index, we examined the longitudinal relationship of average ABI and annual change in ABI with chronic kidney disease progression. We observed that low and high-average ABI, even at clinically normal values, as well as decreases and increases in average annual ABI, were associated with a higher risk of chronic kidney disease progression in patients with type 2 diabetes mellitus and increased body mass index.

DOI: 10.1053/j.ajkd.2024.06.024

EDITORIAL: Three Ankle-Brachial Index Ranges and Incident CKD in Diabetes: A Goldilocks Perspective on the “Just Right” Range by Houry Puzantian et al. [FREE]


Burden of CKD-Associated Pruritus and Adverse Clinical Outcomes in Patients Receiving Dialysis: The Stockholm Creatinine Measurements (SCREAM) Project by Anne-Laure Faucon et al. [OPEN ACCESS]

From the authors: Pruritus is a common but not well-characterized symptom of patients receiving dialysis. We analyzed data from 3,281 patients receiving maintenance hemodialysis or peritoneal dialysis in the region of Stockholm, Sweden. At baseline, 14% of patients had pruritus, and pruritus developed in an additional 19% of patients during their time receiving dialysis. We identified conditions associated with the development of pruritus (eg, older age, female sex, lower serum albumin level, and higher C-reactive protein, serum calcium, and phosphorus levels) and observed that the presence of pruritus was associated with higher risks of sleep disorders, developing anxiety and depression, and being hospitalized for severe infections. No association between pruritus and all-cause mortality was identified.

DOI: 10.1053/j.ajkd.2024.05.013


Representation of Low- and Middle-Income Countries in CKD Drug Trials: A Systematic Review by Gabriel Cojuc-Konigsberg et al.

From the authors: Chronic kidney disease (CKD) substantially affects people from low- and middle-income countries (LMICs). However, the participation of these countries in randomized controlled trials (RCTs) remains uncertain. To assess the global distribution and representation of these countries in kidney disease research, we reviewed 1,366 CKD drug RCTs published from 2003-2023, conducted in 84 countries involving more than 300,000 participants. LMICs were included in approximately a third of these studies, with their participants making up approximately one-quarter of the total; lower-middle-income countries were poorly represented, and low-income countries were absent. LMICs constituted a third of participants in multinational RCTs. Most LMICs were underrepresented relative to the prevalence of CKD. We observed an increasing inclusion of LMICs, particularly in the last decade. Nonetheless, individuals with CKD from LMICs remain underrepresented in drug RCTs, suggesting that increased efforts are warranted to include representation of these populations in these studies.

DOI:  10.1053/j.ajkd.2024.06.012


Progression of Coronary Artery Calcification and Risk of Clinical Events in CKD: The Chronic Renal Insufficiency Cohort Study by Ling Tian et al. [OPEN ACCESS]

From the authors: Prior research has shown that coronary artery calcification (CAC) is a marker of higher risk of heart disease and death. Less is known about how changes in CAC over time might affect risk, particularly among patients with kidney disease. In this study, participants with chronic kidney disease who developed CAC or had worsening CAC over time showed higher rates of heart attack, stroke, and death than those who did not develop CAC. These findings support the need for further research on longitudinal changes in CAC as a possible aid to establishing prognosis among patients with kidney disease and to inform treatment.

DOI:  10.1053/j.ajkd.2024.06.018


Peer Support Interventions for People With CKD: A Scoping Review by Meghan J. Elliott et al.

From the authors: Many people with kidney disease struggle with isolation, making decisions about their care, and declines in their mental well-being. Peer support is a way of providing information and emotional support to patients and their loved ones by connecting them with others who have a shared experience of kidney disease. We summarize the features of peer support programs worldwide and the settings in which they have been studied. We searched the medical literature and found 56 unique peer support programs reported in 77 studies. Most studies were from the last 10 years, targeted people receiving hemodialysis, and focused on sharing information about kidney disease. Studies summarized in this review revealed notable gaps in peer support availability for transplant and home dialysis recipients. Many studies found improvements in people’s mental health, quality of life, and confidence in managing their health after initiation of peer support. These findings suggest there are unrealized opportunities to expand the reach and impact of peer support in the care of patients with kidney disease.

DOI: 10.1053/j.ajkd.2024.07.007


Core Curriculum in the January 2025 issue:

Laboratory Anomalies in the Basic Metabolic Panel: Core Curriculum 2025 by Layana T. Takieddine et al 

In this Core Curriculum, the authors examine several instances where an understanding of preanalytical, analytical, and postanalytical variation is essential for detecting anomalies and providing proper patient care.

DOI: 10.1053/j.ajkd.2024.06.019


On the Cover:

Feline chronic kidney disease is estimated to affect up to 80% of older cats, with symptoms such as weight loss, anorexia, and polyuria. While itching can occur, it is more commonly associated with fleas, allergies, or skin infections in cats e possibly afflicting the cat featured on this month’s cover. Pruritus, or severe itching, impairs the quality of life in patients with advanced chronic kidney disease. In this issue, Faucon et al. report associations of pruritis with older age, higher serum phosphate, and reduced serum albumin in a Swedish cohort of patients receiving maintenance dialysis.

The photograph “Itch” by Stig Nygaard is released on Flickr under the CC BY 2.0 deed license. Special thanks to Editorial Intern Jillian Caldwell for curating the cover image and drafting the cover blurb for this issue.


2024 EDITORS’ CHOICE

The editors are delighted to recognize these articles that have been selected to receive the 2024 AJKD Editors’ Choice Award (all articles are freely available until February 1, 2025).