Nephrology

EKFC vs CKD-EPI for KDIGO 2024 eGFR implementation across the lifespan

In >30,000 individuals aged 2–99 years, switching from CKD-EPI to EKFC changed CKD staging in a minority but clinically relevant subset. About 3.2% moved from stage II to III and 0.4% from stage III to IV when EKFC replaced CKD-EPI for staging. Against 4144 measured GFRs, EKFC had the lowest bias and highest P30 in adults, particularly outperforming CKD-EPI in ages 18–25 years. CKD-EPI substantially overestimated GFR in young adults, whereas all equations performed similarly in those older than 70 years. Overall, EKFC offered a continuous, age-spanning equation with better accuracy, supporting its use for KDIGO 2024 implementation and CKD classification. 1

Nationwide AKI e-alerts at a 50% creatinine-rise threshold showed no outcome benefit

In a Welsh population of 3.1 million adults, AKI e-alerts triggered in 5.8% of hospital and 2.0% of community encounters. Regression discontinuity analysis found no significant changes in mortality or hospital admission/readmission around the 50% creatinine-rise alert threshold. Alerts modestly increased AKI coding in hospitals but had minimal effect on primary care coding after discharge. Only small improvements were seen in proteinuria and blood pressure monitoring, with no signal of harm or benefit on hard outcomes. Findings were consistent across passive and interruptive alert types, suggesting alerts alone are insufficient without effective response pathways. 2

Rituximab monotherapy underperforms cyclophosphamide-based regimens in crescentic ANCA-GN

Among 304 patients with biopsy-proven ANCA-GN (median eGFR 20 ml/min per 1.73 m2), induction used cyclophosphamide, rituximab, or rituximab–cyclophosphamide. Overall, half recovered kidney function and about one-fifth developed kidney failure over a median 42-month follow-up. In the crescentic class, rituximab monotherapy was associated with lower odds of 6-month eGFR recovery versus cyclophosphamide and versus rituximab–cyclophosphamide. Rituximab monotherapy also showed a higher hazard of kidney failure in crescentic disease compared with cyclophosphamide-based regimens. No meaningful regimen differences were seen in other Berden classes, suggesting regimen choice is particularly critical in crescentic ANCA-GN. 3

Non-HDL and remnant cholesterol better predict ASCVD risk than LDL-C in CKD

In 27,978 CKD patients followed for a median 13.8 years, higher LDL-C, non-HDL-C, and remnant cholesterol each associated with increased ASCVD risk. Non-HDL-C and remnant cholesterol associations with ASCVD were more consistent across CKD subgroups than LDL-C. Patients with elevated non-HDL-C or remnant cholesterol but normal LDL-C still had significantly higher ASCVD risk than those with concordantly low lipids. These discordant profiles indicate that LDL-C alone can underestimate residual ASCVD risk in CKD. Non-HDL-C and remnant cholesterol may therefore be preferable markers for risk stratification and treatment targeting in CKD. 4