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Highlights From The March 2024 Issue – Renal.PlatoHealth.ai

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 March 2024 issue:

Comparative Safety and Effectiveness of Warfarin or Rivaroxaban Versus Apixaban in Patients With Advanced CKD and Atrial Fibrillation: Nationwide US Cohort Study by Edouard L. Fu et al

From the authors: Different anticoagulants have been shown to reduce the risk of stroke in patients with atrial fibrillation, such as warfarin and direct oral anticoagulants like apixaban and rivaroxaban. Unfortunately, the large-scale randomized trials that compared direct anticoagulants versus warfarin excluded patients with advanced chronic kidney disease. Therefore, the comparative safety and effectiveness of warfarin, apixaban, and rivaroxaban are uncertain in this population. In this study, we used administrative claims data from the United States to answer this question. We found that warfarin and rivaroxaban were associated with increased risks of major bleeding compared with apixaban. There were few stroke events, with no major differences among the 3 drugs in the risk of stroke. In conclusion, this study suggests that apixaban has a better safety profile than warfarin and rivaroxaban.

DOI: 10.1053/j.ajkd.2023.08.017

EDITORIAL: Anticoagulation for Atrial Fibrillation in Advanced CKD: Can Observational Studies Provide the Answer? by Daniel E. Weiner et al [FREE]


Association of Implantation Biopsy Findings in Living Donor Kidneys With Donor and Recipient Outcomes by Brendan R. Emmons et al 

From the authors:  Kidney biopsies are the gold standard test to identify the presence or absence of kidney disease. However, kidneys donated by healthy living donors—who are extensively screened for any evidence of kidney disease before donation—occasionally show findings that might be considered “abnormal,” including the presence of scarring in the kidney or findings suggestive of a primary kidney disease. We studied the frequency of abnormal kidney biopsy findings among living donors at our center. We found that about 14% of kidneys had chronic abnormalities and 1% had findings suggesting possible glomerular kidney disease, but the presence of abnormal biopsy findings was not associated with worse outcomes for the donors or their recipients.

DOI: 10.1053/j.ajkd.2023.08.022

EDITORIAL: Implantation Biopsy in Living-Donor Kidney Transplantation: Expectations, Utility, and Limitations by Junji Yamauchi et al [FREE]


Advance Care Planning and Palliative Care Consultation in Kidney Transplantation by Marlena C. Fisher et al [OPEN ACCESS]

From the authors:  Kidney transplant (KT) candidates and recipients are at elevated risk of morbidity and mortality. They may benefit from completing a document or conversation with their palliative care provider that outlines their future health care wishes, known as advance care planning (ACP), which is a component of palliative care consultation (PCC). We wanted to determine how many KT candidates and recipients have engaged in ACP or PCC and identify potential racial disparities. We found that 21.4% of candidates and 34.9% of recipients engaged in ACP. After adjustment, Black recipients had a 29% lower likelihood of engaging in ACP. We found that 4.2% of KT candidates and 5.1% of KT recipients engaged in PCC, with no racial disparities found in PCC.

DOI: 10.1053/j.ajkd.2023.07.018


Kidney Transplantation in Patients With AA Amyloidosis: Outcomes in a French Multicenter Cohort by Chloë Schwarz et al [OPEN ACCESS]

From the authors: AA amyloidosis is a severe and rare disease. Kidney involvement is frequent and leads to end-stage kidney disease. Because of the involvement of other organs, these patients are often frail, which has raised concerns about their suitability for kidney transplantation. We reviewed all patients with AA amyloidosis nephropathy who underwent kidney transplantation in France in the recent era (2008-2018) and found that the outcomes after kidney transplantation were favorable, with 85.5% of patients still alive 5 years after transplantation, a survival rate that is comparable to the outcomes of patients receiving a transplant for other forms of kidney diseases. Recurrence of amyloidosis in the transplanted kidney was infrequent (5.8%). These data support the practice of kidney transplantation for patients with AA amyloidosis who experience kidney failure.

DOI: 10.1053/j.ajkd.2023.07.020


Ofatumumab in Rituximab-Resistant and Rituximab-Intolerant Patients With Primary Membranous Nephropathy: A Case Series by Manuel Alfredo Podestà et al [OPEN ACCESS]

From the authors: Primary membranous nephropathy (MN) is one of the most frequent causes of nephrotic syndrome (NS) in adults. In this case series, we explored the efficacy of ofatumumab, a fully human second-generation anti-CD20 antibody, in 17 patients with MN and NS who were intolerant or unresponsive to rituximab. All 7 rituximab-intolerant patients exhibited complete or partial clinical remission, compared with only 3 of the 10 rituximab-resistant patients. Autoantibody levels decreased in all patients with phospholipase A2 receptor–related disease. Ofatumumab achieved a significant reduction in urinary protein and immunoglobulin G excretion while increasing serum albumin and immunoglobulin G levels. Ofatumumab may be a promising option for patients with MN who are rituximab-intolerant. Further investigations are warranted to validate these preliminary findings.

DOI: 10.1053/j.ajkd.2023.08.010


Kidney Function, Albuminuria, and Risk of Incident Atrial Fibrillation: A Systematic Review and Meta-Analysis by Jeffrey T. Ha et al [FREE]

From the authors: Irregular heartbeat, or atrial fibrillation (AF), is the commonest abnormal heart rhythm. AF occurs commonly in people with chronic kidney disease (CKD), and CKD is also common in people with AF. However, CKD in not widely recognized as a risk factor for new-onset or incident AF. In this research, we combined data on more than 28 million participants in 38 studies to determine whether CKD itself increases the chances of incident AF. We found that both commonly used markers of kidney disease (estimated glomerular filtration rate and albuminuria, ie, protein in the urine) were independently associated with a greater risk of incident AF. This finding suggests that CKD should be recognized as an independent risk factor for incident AF.

DOI: 10.1053/j.ajkd.2023.07.023


Core Curriculum from the March 2024 issue:

Kidney Dysfunction in the Setting of Liver Failure: Core Curriculum 2024 by Swetha R. Kanduri and Juan Carlos Q. Velez

This installment of AJKD’s Core Curriculum in Nephrology explores the underpinnings of how cirrhosis, ALF, acute cholestasis, and post–liver transplantation can be associated with various forms of acute, subacute, or chronic kidney diseases. We navigate through the recommended therapies for each condition, including supportive care, pharmacological interventions, kidney replacement therapy, and organ transplantation. Finally, key acid-base and electrolyte disorders associated with hepatobiliary disease are also summarized.

DOI: 10.1053/j.ajkd.2023.08.013


On the Cover:

On March 14, 2024, the 19th annual World Kidney Day (WKD) highlights the global burden of kidney disease. This year’s theme, “Advancing equitable access to care and optimal medication practice,” calls attention to the need for all members of the medical community to address the barriers individuals living with kidney disease face including lack of CKD awareness, shortages of kidney specialists, and high treatment costs that contribute to profound inequities in the quality of kidney disease diagnosis and care. Further information on the 2024 WKD campaign is available at http://www.WorldKidneyDay.org.

Image adapted from the WKD 2023 campaign image, © World Kidney Day 2006-2024.