Rationale & Objective: Ventricular assist devices (VADs) are used for advanced heart failure, but their impact on kidney function remains unclear. This study evaluated changes in kidney function following VAD implantation, including acute kidney injury (AKI) incidence and need for kidney replacement therapy (KRT). Study Design: A retrospective cohort study analyzing longitudinal kidney function outcomes post-VAD placement. Setting & Participants: Adult patients who underwent durable VAD placement (2009-2019) at a single center were included. Patients were stratified into chronic kidney disease (CKD) (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73m2) and non-CKD (eGFR ≥60 mL/min/1.73m2) groups. Exposures & Predictors: The VAD implantation was the primary intervention, with baseline kidney function modifying its impact on post-VAD kidney function. Outcomes: Primary outcomes were changes in eGFR and creatinine at 3-months and 12-months post-VAD. Secondary outcomes included AKI incidence, KRT requirement, and postdischarge AKI within 1 year. Analytical Approach: Descriptive statistics and comparative analyses, including Wilcoxon rank sum, χ2, and paired t tests, were used to assess differences. Significance was set at P < 0.05. Results: Among 160 patients (82% male and 69% White), patients with CKD were older with a higher prevalence of diabetes, vasodilator use, and inotrope use. At 3 months, kidney function improved in patients with CKD (eGFR +17, P < 0.001) but declined by 12 months (eGFR +7, P = 0.03). The non-CKD group had a smaller improvement at 3 months (eGFR +8, P = 0.004) that was not sustained. AKI requiring KRT occurred in 14%, with 45% in-hospital mortality; and 41% discontinued KRT before discharge. Post-VAD AKI occurred in 21%. Half of the patients underwent heart transplant, which was associated with worsening kidney function at 1-year. Limitations: Single-center design limits generalizability. Conclusions: The VAD placement initially improves kidney function, particularly in CKD patients, but this effect diminishes over time. AKI and KRT use are common, highlighting the need for close kidney monitoring post-VAD. Plain-Language Summary: Ventricular assist devices (VADs) help patients with advanced heart failure by supporting heart function, but their impact on kidney health is not well understood. Because kidney disease is common in heart failure and linked to worse outcomes, we studied how kidney function changes after VAD placement. We compared patients with and without chronic kidney disease and found that kidney function improved in the first 3 months, especially in those with chronic kidney disease. However, this benefit declined over the first year. Some patients developed acute kidney injury requiring dialysis, which significantly increased their risk of death. These findings highlight the importance of closely monitoring kidney health in VAD patients to improve long-term outcomes.

Key PointsThis study demonstrates that peritoneal dialysis is a safe and feasible option for patients with autosomal dominant polycystic kidney disease, even with high cystic organ volumes.Larger organ volumes, including height-adjusted cumulative kidney and liver volume, were not associated with increased peritoneal dialysis-related complications.BackgroundAutosomal dominant polycystic kidney disease (ADPKD) is the most prevalent genetic kidney disorder and the fourth leading cause of kidney failure. Peritoneal dialysis (PD), preferred for its home-based convenience and cost-effectiveness, is often underutilized in ADPKD because of concerns over enlarged kidneys and heightened risk of complications.MethodsThis retrospective cohort study used data from the Mayo Clinic Polycystic Kidney Disease Database to evaluate individuals with ADPKD undergoing PD. We analyzed demographics, clinical parameters, and PD-related parameters. Complications were correlated with kidney and liver volumes derived from pre-kidney failure imaging.ResultsA total of 155 individuals with ADPKD on PD were included, of whom 45.1% were male. The mean age at PD initiation was 54.3 +/- 12.8 years, and the mean body mass index was 28.0 +/- 7.0 kg/m2. The median duration of PD was 24.3 months (interquartile range [IQR], 10.7-43.1), with 21.9% transitioning to hemodialysis. The most common complications were abdominal hernias (30.3%) and peritonitis (23.9%), with a peritonitis rate of 0.11 episodes per patient-year. Imaging analyses performed on a subset of 50 patients showed a median height-adjusted total kidney liver volume of 2731.9 ml/m (IQR, 2102.5-3131.1) and a median height-adjusted total kidney volume of 1303.5 ml/m (IQR, 733.1-1829.4). Kaplan-Meier analysis demonstrated no differences in complications rates on the basis of height-adjusted total kidney liver volume or height-adjusted total kidney volume (above versus below median values) or body mass index categories. Multivariate Cox regression analysis revealed that higher height-adjusted cumulative organ volume was associated with a lower risk of PD-related complications (hazard ratio=0.56, P = 0.026).ConclusionsPD is a safe and feasible treatment option for patients with ADPKD, with no increased risk of PD-related complications associated with larger height-adjusted cumulative organ volumes. Infectious complication rates in this cohort were within International Society of Peritoneal Dialysis guideline thresholds, further supporting the safety of PD in this population.

PURPOSE:This study aimed to assess whether kidney stone burden and risk factors at the time of kidney donor evaluation were associated with a symptomatic stone event post-donor evaluation. METHODS:We identified adults evaluated at Mayo Clinic (two sites) (2000-2011) for living kidney donation and had either a personal history or radiological evidence of kidney stone disease. We analyzed demographics, stone risk factors, stone number/size, and the committee's donation decision and reasons. A follow-up survey (2022-2023) assessed post-evaluation symptomatic kidney stones and related morbidity. RESULTS:Among 412 potential donors with kidney stone disease, 258 donated, 75 did not donate due to kidney stones, and 79 did not donate for other reasons. Multivariable analysis showed that candidates not donating due to stones had higher body mass index (BMI), prior symptomatic kidney stones, multiple stones on imaging, bilateral kidney stones, and diameter of largest stone ≥3 mm. Of 147 who completed the survey, 26 (18%) had a symptomatic kidney stone post-donor evaluation. Younger age (p = 0.031) and multiple stones on imaging (p = 0.02) were significant predictors of post-evaluation symptomatic stones regardless of donation status (p = 0.41). CONCLUSIONS:Stone burden on imaging and prior symptomatic stone events were associated with not donating. Younger age and stone burden on imaging were the primary risk factors for a symptomatic kidney stone event after donor evaluation.

Kidney stones (nephrolithiasis/urolithiasis) are a clinically significant yet underrecognized complication of autosomal dominant polycystic kidney disease (ADPKD), with reported prevalence ranging from 3% to 59% due to differences in diagnostic criteria and study design. Patients with ADPKD are predisposed to uric acid and calcium oxalate stones, driven by metabolic abnormalities, such as low urine pH, hypocitraturia, hyperuricosuria, as well as structural factors including cyst-induced distortion of the collecting system and impaired urinary drainage. These anatomical changes complicate both diagnosis and intervention, posing challenges, such as reduced stone-free rates, longer operative times, increased need for repeat procedures, and higher complication risk. While non-contrast computed tomography (CT) remains the diagnostic gold standard, low-dose CT is preferred to minimize cumulative radiation exposure. Management generally aligns with that of the broader population and includes aggressive hydration, correction of metabolic derangements, dietary modification, and individualized urologic intervention. Tolvaptan, a vasopressin V2 receptor antagonist, may have additional benefit by increasing urine volume, reducing supersaturation, and potentially mitigating stone risk. This review integrates nephrology, urology, and imaging perspectives to summarize the current understanding of nephrolithiasis in ADPKD, including its pathophysiology, clinical manifestations, diagnostic challenges, and management. We propose an ADPKD-specific diagnostic and management algorithm to optimize prevention, evaluation, and treatment of stone disease in this complex population.

Background & AimChronic kidney disease (CKD) affects over 800 million individuals worldwide and has no cure. However, multiple preclinical studies in CKD animal models show therapeutic potential of mesenchymal stem/stromal cells (MSC). We aimed to investigate MSC safety in a phase I clinical trial and further examined therapy response in individuals with CKD.Methods, Results & Conclusion: MethodsAllogeneic vertebral bone marrow-derived MSC (®Ossium Health) were intravenously administered via peripheral vein (arm) to CKD participants assigned to one of two dose arms: Arm 1 (n=7) 100 x 10^6 MSCs at Days 0 and 84 and Arm 2 (n=7) 200 x 10^6 MSC at Day 0 only. Study subjects underwent testing at baseline through 6 months (interim review). Kidney function was evaluated by CKD-EPI creatinine equation (estimated glomerular filtration rate; eGFR). Clinical enzyme-linked immunosorbent assay measured serum inflammatory cytokine tumor necrosis factor (TNF)-α. Unpaired t-test was used to compare the means of two independent groups.ResultsCKD subjects (n=14) were enrolled with mean age 60.4±11.6 years, 28.6% females, 71.4% white, 36% diabetes mellitus, and baseline eGFR 30.9±7.6 mL/min/1.73m2. No infusion-related or treatment-related serious adverse events were identified. Kidney function remained stable following infusions and over study follow-up, Figure (Left). At 6 months, kidney function was similar to baseline (eGFR 32.1 vs. 30.9 mL/min/1.73m2) with mean eGFR change of 1.2±4.7 mL/min/1.73m2 (all subjects). No difference in 6-month eGFR change was found between dose arm groups (eGFR 1.0±6.5 [Arm 1] vs. 1.4±2.4 [Arm 2], p=0.9). However, proinflammatory marker, TNF-α, had a sustained trend towards lower levels at 3 and 6 months in dose Arm 1 (vs. Arm 2, p=0.09), Figure (Right).ConclusionAllogeneic bone marrow-derived MSC infusions appear safe and tolerable in CKD participants over short-term follow-up. Interim 6-month studies suggest stable to improved kidney function and a repeat of split-dose MSC administration may yield lower systemic inflammation. Additional, larger-scale and placebo-controlled studies are necessary to examine safety and efficacy of this promising therapeutic.

Ornithine transcarbamylase deficiency (OTCD) is a rare, X linked disorder that can manifest in late adulthood in heterozygous females as severe hyperammonaemia following environmental stressors. We present a case of hyperammonaemic encephalopathy that was triggered by glucocorticoid administration in an adult woman with heterozygous OTCD with clinical response to haemodialysis, ammonia scavengers and a high-calorie, low-protein diet.

Introduction:Molecular adsorbent recirculating system (MARS) is an extracorporeal system combining conventional veno-venous hemodiafiltration and adsorption to provide rescue support in fulminant hepatic failure. Acute kidney injury (AKI) is common in patients with hepatic failure warranting continuous kidney replacement therapy (CKRT). Our primary aim was to characterize a cohort of patients who received MARS therapy and examine kidney events given the current paucity of available data. Methods:Patients initiating MARS in a tertiary care setting from January 2014 through December 2020 were assessed for treatment indications, transplantation, CKRT, kidney recovery, and death. Data was collected using the REDCAP software. Results:A total of 49 patients (67% female; 75% White) received MARS therapy with 29 patients (59%) requiring concomitant CKRT. Hepatic encephalopathy (HE) was the most common indication for MARS initiation (55%). In-hospital mortality was 41% (12/29) among patients who received CKRT versus 10% (2/20) among those not requiring CKRT (relative risk [RR] 4.15, 95% confidence interval [CI] 1.04 to 16.52, P = 0.044); this persisted following adjustment for prespecified patient characteristics (all RR ≥ 3.76, all P ≤ 0.060). One-year mortality post-MARS initiation was high overall but highest among the CKRT group (59% [17/29] vs. 25% [5/20] unadjusted RR 2.92, 95% CI 1.08 to 7.94, P = 0.035). Liver transplant after MARS occurred in 41% of patients (20/49). After CKRT, 39% of patients (9/29) recovered kidney function prior to hospital discharge. Conclusions:Patients requiring MARS frequently have AKI warranting the use of concomitant CKRT, which is associated with a high rate of in-hospital and 1-year mortality.

Purpose of Review The purpose of this article is to critically appraise and summarize recent literature addressing racial and ethnic disparities in cardiovascular disease among adults with chronic kidney disease. Recent Findings Despite advances in medical care, individuals with chronic kidney disease continue to bear a high burden of clinical and subclinical cardiovascular disease. Multiple racial and ethnic factors influence cardiovascular disease pathophysiology, burden, and clinical outcomes therein contributing to increased morbidity and mortality among racial and ethnic minority populations with chronic kidney disease. Summary Racial differences in the prevalence of left ventricular hypertrophy, endothelial dysfunction, vascular calcification, and inflammation are observed in chronic kidney disease and contribute to increased morbidity and mortality. This review describes key pathophysiologic processes in addition to biologic and sociodemographic risk factors that impact observed cardiovascular disparities in racial and ethnic minority populations with chronic kidney disease. The review highlights factors impacting the relationship between chronic kidney disease and cardiovascular risk including diabetes, dyslipidemia, apolipoprotein L1 gene variants, dialysis, and kidney transplantation as well as drivers of racial and ethnic disparities including structural racism.

Health care leaders must be innovative to meet the demands of patient access and cost efficiency, all while never compromising patient safety or experience. A clear understanding of the care team model with optimal utilization of all team members is paramount to success. This article discusses 5 nurse practitioner and physician assistant (collectively called advanced practice providers) care team models that regularly occur in health care organizations across the country. Examples of each practice model, a discussion on when each model would be appropriate, as well as data on patient experience and financial return of investment of each model are provided.

Health care leaders must be innovative to meet the demands of patient access and cost efficiency, all while never compromising patient safety or experience. A clear understanding of the care team model with optimal utilization of all team members is paramount to success. This article discusses 5 nurse practitioner and physician assistant (collectively called advanced practice providers) care team models that regularly occur in health care organizations across the country. Examples of each practice model, a discussion on when each model would be appropriate, as well as data on patient experience and financial return of investment of each model are provided.

In an outpatient health care practice, it can be challenging to convert patient demand into completed appointments, even for high-priority patients. One of the barriers to higher conversion rates is excessive appointment lag time, which can lead to nonattendance or cancellation for other reasons. In this article, we develop a mechanism for reducing appointment lag time for priority patient populations. We report on a pilot program with 12 practices, split into pilot and control groups, and involving 11001 patients requesting new appointments. The results of the pilot show that statistically significant improvements to conversion rates can be achieved.

Abstract Background Calcium oxalate stones are the most common cause of nephrolithiasis in the United States. Smaller studies of <15 patients investigating ezetimibe, a selective cholesterol absorption inhibitor, have suggested increased urine oxalate levels with use of the drug. We attempt to better define this relationship of ezetimibe on urinary oxalate using a larger patient sample analysing multiple urine collections on and off treatment. Materials and Methods We retrospectively reviewed all consecutive patients from 01/2018 through 04/2019 evaluated for nephrolithiasis with use of ezetimibe documented in their medical record at Mayo Clinic Florida. Primary outcomes included increase in urinary oxalate with use of ezetimibe and reduction in urinary oxalate with discontinuation of medication. Results Of 57 reviewed patients, 30 (53%) met inclusion criteria yielding 117 24‐h urine measurements either on ezetimibe (72 measurements) or off ezetimibe (41 measurements). The mean urinary oxalate level off ezetimibe was 39.86 mg versus 40.45 mg with ezetimibe. After adjusting for age and sex, the estimated difference was 1.239 mg (95% CI, −4.856 to 7.335 mg; p = 0.93). A subset of six patients with urinary oxalate values both on and off ezetimibe showed a difference in 24‐h urinary oxalate levels ranged from −16.40 to 14.95 mg (mean difference = 0.93 mg; median difference = 3.84 mg). Conclusion Use of ezetimibe does not provide clear evidence of a difference in urinary oxalate levels.

Edwardsiella tarda (E. tarda) is a gram-negative, facultatively anaerobic bacillus that is associated with gastroenteritis and a host of other extra-intestinal manifestations in humans. However, its impact on the kidneys is unclear. Most literature that has explored this association involves fish, marine life in which E. tarda inhabits. We report a rare case of a 72-year-old female who presented with an acute kidney injury (AKI) associated with newfound minimal change disease, subacute interstitial nephritis, and a severe E. tarda infection. Her clinical course resolved with antibiotics and glucocorticoids.