American Journal of Kidney Diseases (Am J Kidney Dis)

Publisher: National Kidney Foundation, Elsevier

Journal description

American Journal of Kidney Diseases not only publishes a broad range of clinical and basic investigations in human renal function but also describes the impact of the advances on clinical practice. Coverage encompasses applied physiology, dialysis/chronic uremia, hypertension, urology, pathology, and transplantation. In addition to peer-reviewed original articles and case reports, the Journal includes regular features such as in-depth reviews of relevant clinical topics; presentation and discussion of renal biopsy teaching cases; discussion and analysis of important recent articles; and forum discussions of ethical, moral, and legal issues related to kidney disease. The Journal's website includes such exclusive features as "Atlas of Renal Pathology," CME exercises, clinical nephrology teaching cases, and web-only case reports.

Current impact factor: 5.90

Impact Factor Rankings

2015 Impact Factor Available summer 2016
2014 Impact Factor 5.9
2013 Impact Factor 5.756
2012 Impact Factor 5.294
2011 Impact Factor 5.434
2010 Impact Factor 5.242
2009 Impact Factor 5.152
2008 Impact Factor 4.822
2007 Impact Factor 3.981
2006 Impact Factor 4.072
2005 Impact Factor 4.412
2004 Impact Factor 4.038
2003 Impact Factor 3.897
2002 Impact Factor 3.688
2001 Impact Factor 3.614
2000 Impact Factor 3.646
1999 Impact Factor 3.501
1998 Impact Factor 3.084
1997 Impact Factor 2.813
1996 Impact Factor 2.759
1995 Impact Factor 2.048
1994 Impact Factor 2.09
1993 Impact Factor 1.964
1992 Impact Factor 1.841

Impact factor over time

Impact factor

Additional details

5-year impact 5.56
Cited half-life 9.10
Immediacy index 1.95
Eigenfactor 0.03
Article influence 1.86
Website American Journal of Kidney Diseases website
Other titles American journal of kidney diseases (Online), American journal of kidney diseases, AJKD
ISSN 1523-6838
OCLC 40756717
Material type Document, Periodical, Internet resource
Document type Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details


  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • Authors pre-print on any website, including arXiv and RePEC
    • Author's post-print on author's personal website immediately
    • Author's post-print on open access repository after an embargo period of between 12 months and 48 months
    • Permitted deposit due to Funding Body, Institutional and Governmental policy or mandate, may be required to comply with embargo periods of 12 months to 48 months
    • Author's post-print may be used to update arXiv and RepEC
    • Publisher's version/PDF cannot be used
    • Must link to publisher version with DOI
    • Author's post-print must be released with a Creative Commons Attribution Non-Commercial No Derivatives License
    • Publisher last reviewed on 03/06/2015
  • Classification
    ​ green

Publications in this journal

  • Wael F Hussein · Rohini Arramreddy · Sumi J Sun · Sheila Doss-McQuitty · Brigitte Schiller
    American Journal of Kidney Diseases 10/2015; DOI:10.1053/j.ajkd.2015.08.024
  • American Journal of Kidney Diseases 09/2015; DOI:10.1053/j.ajkd.2015.07.029
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    ABSTRACT: A 12-year-old boy was hospitalized for hemolytic anemia, thrombocytopenia, acute kidney injury, and generalized seizures. The childhood onset, severely decreased kidney function, absence of prodromal diarrhea, negative test results for Shiga-like toxin-producing Escherichia coli, elevated plasma levels of the terminal complement complex sC5b-9, and ex vivo testing in endothelial cells showing serum-induced complement activation were all consistent with a diagnosis of complement-mediated atypical hemolytic uremic syndrome. Before plasma ADAMTS13 (von Willebrand factor protease) activity results were available, the patient was treated with the anti-C5 monoclonal antibody eculizumab, and treatment was followed by prompt disease remission. However, results of ADAMT13 activity level tests and gene screening revealed a severe deficiency associated with 2 heterozygous mutations in the ADAMTS13 gene, fully consistent with a diagnosis of congenital thrombotic thrombocytopenic purpura. Screening for atypical hemolytic uremic syndrome-associated genes failed to show a mutation and an assay for plasma anti-factor H antibodies gave negative results both before and after eculizumab treatment initiation. The patient's clinical evolution suggests that complement activation plays a role in the pathogenesis of thrombotic thrombocytopenic purpura and provides unexpected new insights into the treatment of this life-threatening disease.
    American Journal of Kidney Diseases 09/2015; DOI:10.1053/j.ajkd.2015.06.032
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    ABSTRACT: Background: The disease spectrum of crescentic glomerulonephritis (GN) has been described in only a few previous studies, and detailed epidemiologic data from China are unavailable to date. Study design: Case series. Setting & participants: 528 patients with biopsy-proven crescentic GN in 2003 to 2013 from a single center. Predictor: Crescentic GN was classified into 3 types according to immunofluorescence findings: type I was defined as linear deposition of immunoglobulins along the glomerular basement membrane; type II, as glomerular deposition of immune complex; and type III, as pauci-immune deposition. Outcomes: Demographic, clinical, and serologic characteristics. Results: Of 528 cases identified, 208 (39.4%) were men, with a mean age of 37.6±16.4 (SD) years at kidney biopsy. 61 (11.6%) patients had type I crescentic GN, 331 (62.7%) had type II (lupus nephritis, 34.3%; immunoglobulin A [IgA] nephropathy, 17.4%), and 136 (25.8%) had type III. Proportions of patients with acute kidney injury (AKI), acute kidney diseases and disorders without AKI, and chronic kidney disease were 86.9%, 0%, and 13.1% for type I; 42.0%, 19.6%, and 38.4% for type II; and 84.6%, 2.9%, and 12.5% for type III crescentic GN, respectively. Serum antineutrophil cytoplasmic antibodies were detected in 11 (18.0%) patients with type I, 15 (4.5%) with type II, and 117 (86.0%) with type III. Anti-glomerular basement membrane antibodies were found in 60 (98.4%) patients with type I, 3 (0.9%) with type II, and 5 (3.7%) with type III. 5-year cumulative renal survival rates for patients with types I, II, and III were 17.6%, 70.1%, and 44.3%, respectively. Limitations: Retrospective study, single-center experience. Conclusions: Lupus nephritis may be the most common type of crescentic GN in China, followed by pauci-immune crescentic GN and IgA nephropathy. Almost half the patients presented with AKI, whereas 28.8% of cases showed chronic kidney disease. Clinical manifestations and outcomes varied according to crescentic GN type. The distinction between subtypes based on immunofluorescence and serologic findings has important implications for therapy and outcome.
    American Journal of Kidney Diseases 09/2015; DOI:10.1053/j.ajkd.2015.07.034
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    ABSTRACT: Background: Peritoneal dialysis (PD) solutions with reduced sodium content may have advantages for hypertensive patients; however, they have lower osmolarity and solvent drag, so the achieved Kt/Vurea may be lower. Furthermore, the increased transperitoneal membrane sodium gradient can influence sodium balance with consequences for blood pressure (BP) control. Study design: Prospective, randomized, double-blind clinical trial to prove the noninferiority of total weekly Kt/Vurea with low-sodium versus standard-sodium PD solution, with the lower confidence limit above the clinically accepted difference of -0.5. Setting & participants: Hypertensive patients (≥1 antihypertensive drug, including diuretics, or office systolic BP≥130mmHg) on continuous ambulatory PD therapy from 17 sites. Intervention: 108 patients were randomly assigned (1:1) to 6-month treatments with either low-sodium (125mmol/L of sodium; 1.5%, 2.3%, or 4.25% glucose; osmolarity, 338-491mOsm/L) or standard-sodium (134mmol/L of sodium; 1.5%, 2.3%, or 4.25% glucose; osmolarity, 356-509mOsm/L) PD solution. Outcomes: Primary end point: weekly total Kt/Vurea; secondary outcomes: BP control, safety, and tolerability. Measurements: Total Kt/Vurea was determined from 24-hour dialysate and urine collection; BP, by office measurement. Results: Total Kt/Vurea after 12 weeks was 2.53±0.89 in the low-sodium group (n=40) and 2.97±1.58 in the control group (n=42). The noninferiority of total Kt/Vurea could not be confirmed. There was no difference for peritoneal Kt/Vurea (1.70±0.38 with low sodium, 1.77±0.44 with standard sodium), but there was a difference in renal Kt/Vurea (0.83±0.80 with low sodium, 1.20±1.54 with standard sodium). Mean daily sodium removal with dialysate at week 12 was 1.188g higher in the low-sodium group (P<0.001). BP changed marginally with standard-sodium solution, but decreased with low-sodium PD solution, resulting in less antihypertensive medication. Limitations: Broader variability of study population than anticipated, particularly regarding residual kidney function. Conclusions: The noninferiority of the low-sodium PD solution for total Kt/Vurea could not be proved; however, it showed beneficial clinical effects on sodium removal and BP.
    American Journal of Kidney Diseases 09/2015; DOI:10.1053/j.ajkd.2015.07.031
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    ABSTRACT: Background: The interaction between baseline kidney function and the performance of biomarkers of acute kidney injury (AKI) on the development of AKI is unclear. Study design: Post hoc analysis of prospective cohort study. Setting & participants: The 1,219 TRIBE-AKI Consortium adult cardiac surgery cohort participants. Predictor: Unadjusted postoperative urinary biomarkers of AKI measured within 6 hours of surgery. Outcome: AKI was defined as AKI Network stage 1 (any AKI) or higher, as well as a doubling of serum creatinine level from the preoperative value or the need for post-operative dialysis (severe AKI). Measurements: Stratified analyses by preoperative estimated glomerular filtration rate (eGFR) ≤ 60 versus > 60mL/min/1.73m(2). Results: 180 (42%) patients with preoperative eGFRs≤60mL/min/1.73m(2) developed clinical AKI compared with 246 (31%) of those with eGFRs>60mL/min/1.73m(2) (P<0.001). For log2-transformed biomarker concentrations, there was a significant interaction between any AKI and baseline eGFR for interleukin 18 (P=0.007) and borderline significance for liver-type fatty acid binding protein (P=0.06). For all biomarkers, the adjusted relative risk (RR) point estimates for the risk for any AKI were higher in those with elevated baseline eGFRs compared with those with eGFRs≤60mL/min/1.73m(2). However, the difference in magnitude of these risks was low (adjusted RRs were 1.04 [95% CI, 0.99-1.09] and 1.11 [95% CI, 1.07-1.15] for those with preoperative eGFRs≤60mL/min/1.73m(2) and those with higher eGFRs, respectively). Although no biomarker displayed an interaction for baseline eGFR and severe AKI, log2-transformed interleukin 18 and kidney injury molecule 1 had significant adjusted RRs for severe AKI in those with and without baseline eGFRs≤60mL/min/1.73m(2). Limitations: Limited numbers of patients with severe AKI and post-operative dialysis. Conclusions: The association between early postoperative AKI urinary biomarkers and AKI is modified by preoperative eGFR. The degree of this modification and its impact on the biomarker-AKI association is small across biomarkers. Our findings suggest that distinct biomarker cutoffs for those with and without a preoperative eGFR≤60mL/min/1.73m(2) is not necessary.
    American Journal of Kidney Diseases 09/2015; DOI:10.1053/j.ajkd.2015.07.027
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    ABSTRACT: Background: Despite different pharmacologic properties, little is known about the comparative safety of sodium ferric gluconate versus iron sucrose in hemodialysis patients. Study design: Retrospective cohort study using the clinical database of a large dialysis provider (2004-2005) merged with administrative data from the US Renal Data System. Setting & participants: 66,207 patients with Medicare coverage who received center-based hemodialysis. Predictors: Iron formulation use assessed during repeated 1-month exposure periods (n=278,357). Outcomes: All-cause mortality, infection-related hospitalizations and mortality, and cardiovascular-related hospitalizations and mortality occurring during a 3-month follow-up period. Measurements: For all outcomes, we estimated 90-day risk differences between the formulations using propensity score weighting of Kaplan-Meier functions, which controlled for a wide range of demographic, clinical, and laboratory variables. Risk differences were also estimated within various clinically important subgroups. Results: Ferric gluconate was administered in 11.4%; iron sucrose, in 48.9%; and no iron in 39.7% of the periods. Risks for most study outcomes did not differ between ferric gluconate and iron sucrose; however, among patients with a hemodialysis catheter, use of ferric gluconate was associated with a slightly decreased risk for both infection-related death (risk difference, -0.3%; 95% CI, -0.5% to 0.0%) and infection-related hospitalization (risk difference, -1.5%; 95% CI, -2.3% to -0.6%). Bolus dosing was associated with an increase in infection-related events among both ferric gluconate and iron sucrose users. Limitations: Residual confounding and outcome measurement error. Conclusions: Overall, the 2 iron formulations studied exhibited similar safety profiles; however, ferric gluconate was associated with a slightly decreased risk for infection-related outcomes compared to iron sucrose among patients with a hemodialysis catheter. These associations should be explored further using other data or study designs.
    American Journal of Kidney Diseases 09/2015; DOI:10.1053/j.ajkd.2015.07.026
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    ABSTRACT: A 63-year-old man with HIV (human immunodeficiency virus) infection and end-stage renal disease, treated with lanthanum carbonate phosphate binder for 4 years, presented with anemia and an upper gastrointestinal bleed. Upper endoscopy revealed a nodular hyperplastic epithelium, with an endoscopic ultrasound confirming hyperechoic material within the nodules. Light microscopy showed collections of histiocytes and multinucleated giant cells containing brown granular cytoplasmic material and extracellular crystalline material, a finding confirmed by electron microscopy. Similar pathologic findings associated with lanthanum exposure have been described recently. In our patient, lanthanum carbonate treatment was withdrawn and gastrointestinal bleeding has since ceased. The patient was exposed to a high amount of lanthanum over a long period, which may explain his adverse reaction. However, other contributing factors, such as competing medications or comorbid conditions, also may have increased his sensitivity to the drug.
    American Journal of Kidney Diseases 09/2015; DOI:10.1053/j.ajkd.2015.07.033
  • American Journal of Kidney Diseases 09/2015; DOI:10.1053/j.ajkd.2015.08.018
  • American Journal of Kidney Diseases 09/2015; DOI:10.1053/j.ajkd.2015.06.031
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    ABSTRACT: Normocytic normochromic anemia is a common complication in chronic kidney disease and is associated with many adverse clinical consequences. Erythropoiesis-stimulating agents (ESAs) and adjuvant iron therapy represent the primary treatment for anemia in chronic kidney disease. The introduction of ESAs into clinical practice was a success story, mediating an increase in hemoglobin concentrations without the risk for recurrent blood transfusions and improving quality of life substantially. However, recombinant ESAs are still expensive and require a parenteral route of administration. Moreover, concern has arisen following randomized clinical trials showing that higher hemoglobin targets and/or high ESA doses may cause significant harm. This, together with changes in ESA reimbursement policy in some countries, has resulted in a significant reduction in ESA prescribing and the hemoglobin level targeted during therapy. Several attempts are being made to develop new drugs with improved characteristics and/or easier manufacturing processes compared with currently available ESAs, including new treatment approaches that may indirectly improve erythropoiesis. We give an update on the new investigational strategies for increasing erythropoiesis, examining in depth their characteristics and possible advantages in the clinical setting and the caveats to be aware of at the present stage of development.
    American Journal of Kidney Diseases 09/2015; DOI:10.1053/j.ajkd.2015.06.030
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    ABSTRACT: Background: Kidney transplantation offers better outcomes compared to dialysis, but requires patients to adhere to an ongoing and complex self-management regimen. Medication nonadherence remains a leading cause of transplant loss, and inadequate self-management undermines transplantation and other health outcomes. We aimed to describe kidney transplant recipients' motivations, challenges, and attitudes toward self-management. Study design: Systematic review and thematic synthesis of qualitative studies. Setting & population: Kidney transplant recipients. Search strategy & sources: MEDLINE, EMBASE, PsycINFO, and CINAHL were searched to October 2014. Analytical approach: Thematic synthesis. Results: 50 studies involving 1,238 recipients aged 18 to 82 years across 19 countries were included. We identified 5 themes: empowerment through autonomy (achieving mastery, tracking against tangible targets, developing bodily intuition, routinizing and problem solving, and adaptive coping), prevailing fear of consequences (inescapable rejection anxiety, aversion to dialysis, minimizing future morbidity, trivialization and denial, and defining acceptable risks), burdensome treatment and responsibilities (frustrating ambiguities, inadvertent forgetfulness, intrusive side effects, reversing ingrained behaviors, and financial hardship), overmedicalizing life (dominating focus, evading patienthood, and succumbing to burnout), and social accountability and motivation (demonstrating gratitude toward medical team, indebtedness to donor, and peer learning). Limitations: Non-English articles were excluded. Conclusions: Self-efficacy and social accountability are motivators for self-management, although adherence can be mentally and physically taxing. Multicomponent interventions incorporating personalized care planning, education, psychosocial support, decision aids, and self-monitoring tools may foster self-management capacity and improve transplantation outcomes.
    American Journal of Kidney Diseases 09/2015; DOI:10.1053/j.ajkd.2015.07.030
  • American Journal of Kidney Diseases 09/2015; DOI:10.1053/j.ajkd.2015.07.028
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    ABSTRACT: Background: β-Trace protein (BTP) and β2-microglobulin (B2M) are novel glomerular filtration markers that have stronger associations with adverse outcomes than creatinine. Comparisons of BTP and B2M to creatinine and cystatin C are limited by the absence of rigorously developed glomerular filtration rate (GFR) estimating equations for the novel markers. Study design: Study of diagnostic test accuracy. Setting & participants: Pooled database of 3 populations with chronic kidney disease (CKD) with mean measured GFR of 48mL/min/1.73m(2) (N=3,551; MDRD [Modification of Diet in Renal Disease] Study, AASK [African American Study of Kidney Disease and Hypertension], and CRIC [Chronic Renal Insufficiency Cohort] Study). Index tests: GFR estimated using creatinine, cystatin C, BTP, or B2M level. Reference test: GFR measured as the urinary clearance of iothalamate. Results: For BTP and B2M, coefficients for age, sex, and race were smaller than for creatinine and were similar or smaller than for cystatin C. For B2M, coefficients for sex, age, and race were smaller than for creatinine and were similar (age and race) or smaller (sex) than for cystatin C. The final equations with BTP (BTP, age, and sex) or B2M (B2M alone) were less accurate than either the CKD-EPI (CKD Epidemiology Collaboration) creatinine or cystatin C equations. The combined BTP-B2M equation (BTP and B2M alone) had similar accuracy to the CKD-EPI creatinine or cystatin C equation. The average of the BTP-B2M equation and the CKD-EPI creatinine-cystatin C equation was not more accurate than the CKD-EPI creatinine-cystatin C equation. Limitations: No external validation population, study population was restricted to CKD, few participants older than 65 years, or nonblack nonwhite race. Conclusions: BTP and B2M are less influenced by age, sex, and race than creatinine and less influenced by race than cystatin C, but provide less accurate GFR estimates than the CKD-EPI creatinine and cystatin C equations. The CKD-EPI BTP and B2M equation provides a methodological advance for their study as filtration markers and in their associations with risk and adverse outcomes, but further study is required before clinical use.
    American Journal of Kidney Diseases 09/2015; DOI:10.1053/j.ajkd.2015.07.025
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    ABSTRACT: High serum phosphorus levels are associated with cardiovascular morbidity and mortality in kidney disease. Although serum phosphorus levels possibly influence on mortality in individuals without kidney disease, this is uncertain because of the variable sex- and age-based distribution of serum phosphorus levels. Observational cohort study. Clinical and biochemical data were collected from 138,735 adults undergoing routine health checkups in 3 tertiary hospitals. Individuals with estimated glomerular filtration rates < 60mL/min/1.73m(2) and urine dipstick albumin ≥ 1+ were excluded. Sex-specific quartiles of serum phosphorus and sex. All-cause mortality. The study included 92,756 individuals. Generally, women showed higher serum phosphorus levels than men. In women, serum phosphorus levels increased with age until 60 years old, then decreased with age. Men with higher serum phosphorus levels were younger and less likely to have hypertension, whereas women with higher serum phosphorus levels were older and more likely to have diabetes and hypertension. During a median follow-up of 75 months, 1,646 participants died. In the overall population, higher serum phosphorus levels were an independent predictor for all-cause mortality after adjustment (adjusted HR for the highest vs lowest quartile, 1.34; 95% CI, 1.15-1.56; P<0.001). We observed that this increased risk was present in men but not in women (adjusted HR of 1.43 [95% CI, 1.22-1.68] vs 1.01 [95% CI, 0.76-1.33]), but interaction by sex was not significant (P=0.8). A single phosphorus measurement and low power to test for interactions by sex and age. We demonstrated that higher serum phosphorus levels influenced all-cause mortality in individuals with normal kidney function. Our findings suggest that the association may differ by sex, but future studies with adequate power to test for effect modification are needed to confirm our findings. Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
    American Journal of Kidney Diseases 09/2015; DOI:10.1053/j.ajkd.2015.06.027
  • American Journal of Kidney Diseases 09/2015; 66(3):A17-9. DOI:10.1053/j.ajkd.2015.06.006