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Introduction: Real-world data from patients with chronic kidney disease (CKD) are limited, particularly regarding clinical management, treatment patterns and health-related quality of life (HRQoL) in the context of new therapies and updated standard of care guidelines., Methods: DISCOVER CKD is an observational cohort study enrolling adult patients with CKD, defined by an International Classification of Diseases, 10th Revision code, or with two estimated glomerular filtration rate measures < 75 ml/min/1.73 m 2 recorded 91-730 days apart. We describe the demographics, baseline characteristics and patient-reported outcomes of patients enrolled in the prospective phase., Results: Of 1052 patients (mean age 62.5 years; 36.9% female) enrolled from the USA, UK, Spain, Italy, Sweden and Japan, 727 (69.1%) had stage 2-3b CKD and 325 (30.9%) had stage 4-5 CKD. Overall, 72.4%, 43.0% and 37.5% of patients had histories of hypertension, diabetes and hyperlipidaemia, respectively. In total, 58.7% and 14.0% were receiving renin-angiotensin-aldosterone system inhibitors (RAASi) and sodium-glucose co-transporter 2 inhibitors (SGLT2i), respectively. Compared with patients with stage 2-3b CKD, patients with stage 4-5 CKD reported numerically greater symptom burden across all 11 symptoms measured, numerically worse HRQoL across all eight categories measured using the 36-item Short Form (SF-36) questionnaire, and numerically greater impairment at work across all four categories measured using the Work Productivity and Activity Impairment chronic kidney disease (WPAI-CKD) questionnaire. Compared with patients with stage 2-3b CKD, a higher proportion of patients with stage 4-5 CKD had anaemia, hyperkalaemia and oedema (49.8% vs. 16.9%, 21.8% vs. 8.4% and 17.5% vs. 9.5%, respectively)., Conclusions: These contemporary real-world data from six countries highlight the substantial symptom, medication and psychosocial burden associated with CKD, and continued gaps in treatment. Graphical abstract available for this article., Trial Registration: ClinicalTrials.gov identifier, NCT04034992., Competing Interests: Declarations. Conflict of Interest: Carol Pollock reports advisory board membership for AstraZeneca, Boehringer Ingelheim, Eli Lilly and Vifor Pharma; and speaker fees for AstraZeneca, Janssen-Cilag, Novartis, Otsuka and Vifor Pharma. Juan-Jesus Carrero reports institutional grants from Astellas, AstraZeneca and Vifor Pharma; speaker fees from AstraZeneca, Abbott and Nutricia; and consultancy for AstraZeneca and Bayer. Eiichiro Kanda is a consultant for AstraZeneca. Richard Ofori-Aseno, Hungta Chen, Juan Jose Garcia Sanchez and Surendra Pentakota are employees of and hold or may hold stock in AstraZeneca. Roberto Pecoits-Filho is an employee of Arbor Research Collaborative for Health, which receives global support for the ongoing Dialysis Outcomes and Practice Patterns Study Programs (provided without restriction on publications by a variety of funders; for details see https://www.dopps.org/AboutUs/Support.aspx ). Roberto Pecoits-Filho also reports: research grants from Fresenius Medical Care; nonfinancial support from Akebia, AstraZeneca, Bayer, Boehringer Ingelheim, Novo Nordisk and FibroGen; personal fees from Travere Therapeutics; and consulting fees from George Clinical outside the submitted work. Steven Fishbane reports research support and consulting fees from AstraZeneca; and research support from Akebia Inc., MegaPro Biomedical Co., Ltd., Ardelyx, Corvidia Therapeutics, Inc. and Cara Therapeutics. Carolyn S. P. Lam is supported by a Clinician Scientist Award from the National Medical Research Council of Singapore; has received research support from NovoNordisk and Roche Diagnostics; has served as a consultant or is on the advisory board/steering committee/executive committee for Alleviant Medical, Allysta Pharma, Amgen, AnaCardio AB, Applied Therapeutics, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, CardioRenal, Cytokinetics, Darma Inc., EchoNous Inc., Eli Lilly, Impulse Dynamics, Intellia Therapeutics, Ionis Pharmaceutical, Inc., Janssen Research & Development LLC, Medscape/WebMD Global LLC, Merck, Novartis, NovoNordisk, Prosciento Inc., Quidel Corporation, Radcliffe Group Ltd., Recardio Inc., ReCor Medical, Roche Diagnostics, Sanofi, Siemens Healthcare Diagnostics and Us2.ai; and serves as co-founder and non-executive director of Us2.ai. Naoki Kashihara is a consultant for AstraZeneca, Boehringer Ingelheim, and Kyowa Hakko Kirin; and receives honoraria from Kyowa Hakko Kirin and Daiichi Sankyo. David C. Wheeler reports personal fees and nonfinancial support from AstraZeneca; and personal fees from Astellas, Bayer, Boehringer Ingelheim, GSK, Janssen, Mundipharma, Napp, Reata Pharmaceuticals, Tricida and Vifor Fresenius. Ethical Approval: This study was performed in accordance with ethical principles consistent with the Declaration of Helsinki, International Conference on Harmonisation, Good Clinical Practice, and the applicable legislation on noninterventional studies and observational studies. The study received central (approval numbers, Italy: 711/19; UK, REC No. 19/YH/0357; Sweden, DNR 2019–05355; Spain 2021/342; and USA, Pro00036594) and local (Japan) institutional review board ethics approval. The names of the central ethics committees that approved the study are Italy: Comitato Etico Indipendente Istituto Clinico Humanitas; Spain: Ethics Committee for Research with Drugs of Galicia; Sweden: Swedish Ethical Review Authority; UK: Health Research Authority; and USA: Advarra. A full list of study sites and their respective ethics committees is provided in Supplementary Table S1. All patients provided written informed consent., (© 2025. The Author(s).)

Introduction: Chronic kidney disease (CKD) can have a profound impact on patients' lives. However, multinational data on patients' lived experience with CKD are scarce., Methods: Individuals from the prospective cohort of DISCOVER CKD (NCT04034992), an observational cohort study, were recruited to participate in one-to-one telephone interviews to explore their lived experience with CKD. A target of 100 participant interviews was planned across four countries (Japan, Spain, the UK, and the USA). These qualitative interviews, lasting ∼60-90 min, were conducted in the local language by trained interviewers with specific experience in CKD, between January and June 2023. Transcribed interviews were translated into English for coding and analysis. Data were coded using qualitative research software., Results: Of the 105 participants interviewed, 103 were included in the final analysis. The average time since CKD diagnosis was 9.5 years, and at least half (50.5%) of participants had CKD stage 3A or 3B. CKD diagnosis was an emotional experience, driven by worry (n = 29/103; 28.2%) and shock (n = 26/103; 25.2%), and participants often reported feeling inadequately informed. Additional information was frequently sought, either online or via other healthcare providers. The proportion of participants reporting no impacts of CKD on their lives was highest in those with CKD stage 1 and 2 (64.3%). Conversely, every participant in the CKD stage 5 on dialysis group reported some impact of CKD on their lives. Across all participants, the most reported impacts were anxiety or depression (37.9%) or ability to sleep (37.9%). The frequency of the reported impacts appeared to increase with disease severity, with the highest rates observed in the dialysis group. In that group, the most frequently reported impact was on the ability to work (80.0%)., Conclusion: Findings from this multinational qualitative study suggest that patients may experience symptoms and signs of disease prior to diagnosis; however, these are often nonspecific and may not be directly associated with CKD. Once diagnosed, the burden of CKD can have a diverse, negative impact on various aspects of patients' lives. This highlights the need for early identification of at-risk individuals, and the importance of early CKD diagnosis and management with guideline-directed therapies to either prevent further deterioration of CKD or slow its progression, thus reducing symptom burden and improving quality of life., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Background: For hemodialysis (HD) patients, many risk factors for death are associated with each other intricately. However, they are often considered separately in clinical settings. We evaluated the maintenance HD patients' risk of death within one year from multiple risk factors simultaneously considering their interrelationships using a novel index (survival index, SI) for HD patients in the United States developed using data from the Dialysis Outcomes and Practice Patterns Study (DOPPS)., Methods: We analyzed data from 3899 and 3765 patients to develop and validate SI, respectively. To predict death within one year, candidate models were developed using logistic regression models. The final model was determined by comparing the accuracy among the models for the prediction of deaths., Results: The model included age; body mass index; serum creatinine, albumin, total cholesterol and phosphorus levels; history of cardiovascular diseases; and arteriovenous fistula use. SI showed a higher accuracy in predicting death (c-statistic, 0.739) than geriatric nutritional risk index (0.647) and serum albumin level (0.637). The probability of death predicted on the basis of SI matched the observed number of deaths. Cox proportional hazard models for time-dependent SI showed that patients with low SI had a higher risk of death than patients with high SI [reference, Group 4 (26.1≤SI)]; Group 1 (SI<12.7), adjusted hazard ratio, 7.97 (95% CI, 5.02, 12.65); Group 2 (12.7≤SI<19.0), 3.18 (95% CI, 1.96, 5.16); Group 3 (19.0≤SI<26.1), 2.20 (95% CI, 1.33, 3.66)., Conclusion: Results of this study suggest that the simultaneous evaluation of multiple risk factors can more accurately assess patients' prognosis and identify patients at an increased risk of death than single factors.