Nephrology

Nine-protein APOL1 plasma score strongly predicts CKD progression in high-risk African-ancestry adults

Among 851 African-ancestry adults with APOL1 high-risk genotypes and eGFR ≥60, a nine-protein plasma APOL1 Proteomic Risk Score (APRS) was derived. APRS predicted ≥40% eGFR decline, kidney failure, or death with a tAUC of 86.5%, outperforming the Kidney Failure Risk Equation at 66.1%. Ten-year event rates were 62.5% in the highest APRS quintile versus 3.3% in the lowest, demonstrating striking risk separation. External validation in Atherosclerosis Risk in Communities and UK Biobank showed consistent accuracy (tAUC 82–85%) across demographic and clinical subgroups. 1

Dapagliflozin shows no short-term cardiovascular surrogate benefit in maintenance dialysis (DARE-ESKD-2)

In this 24-week open-label randomized trial, 80 adults on chronic dialysis received dapagliflozin 10 mg daily or standard care. Adjusted NT-proBNP change did not differ significantly, with an intergroup difference of -155 pg/mL (P = 0.065) after baseline adjustment. Kansas City Cardiomyopathy Questionnaire scores, 6-minute walk distance, and echocardiographic parameters were also similar between groups. Adverse event rates did not differ, indicating short-term safety in this setting. 2

Suboptimal dialysis initiation markedly reduces downstream transplant referral and evaluation

This Southeast US cohort included 49,057 adults initiating dialysis, categorized as highly, moderately, minimally, or non-optimal pre-dialysis care. Compared with highly optimal starters, moderately, minimally, and non-optimal starters were 28%, 31%, and 57% less likely to be referred for transplant. Patients with non-optimal starts were also 37% less likely to begin transplant evaluation after referral than highly optimal starters. More than half of adults initiated dialysis in minimal or non-optimal ways, with correspondingly reduced transplant access. 3

Heat above 25°C incrementally increases AKI risk, especially severe AKI and in very elderly patients

Among 947,342 AKI alerts in England, temperatures above 25°C were associated with increased AKI risk in a nationwide case-crossover analysis. Each 1°C rise above 25°C increased AKI odds by 3.8% (OR 1.038; 95% CI 1.036–1.040), with highest odds for stage 3 AKI. Risks were higher in males and approximately doubled in those aged ≥85 years versus ages 45–64. Heat-related AKI risk was particularly elevated among admissions with delirium or respiratory diseases. 4