Citations

Abstract Purpose Patients presenting for iliopsoas tendinitis consultation after total hip arthroplasty (THA) often describe a prolonged time to diagnosis and subsequent surgical management. The purpose of this study was to quantify time from symptom onset to diagnosis and subsequent arthroscopic iliopsoas fractional lengthening, including number of providers seen. Methods Patients undergoing arthroscopic iliopsoas fractional lengthening after THA were prospectively identified between 2023-2025 at a single institution. Time from symptom onset to iliopsoas tendinitis diagnosis as well as arthroscopic lengthening were determined. Number of providers seen, diagnostic relief from preoperative iliopsoas bursal injections, and postoperative satisfaction after fractional lengthening were also evaluated to better quantify indications and outcomes of arthroscopic intervention in this population. Results A total of 44 hips in 41 patients (23 females and 18 males) were included (mean age: 64.7 ± 10.2, mean BMI: 29.9 ± 5.9 kg/m2). Of note, 7 patients (16%) had undergone revision THA prior to iliopsoas symptom onset. Patients had on average 2.2 ± 2.1 years of symptoms and saw 2.5 ± 1.7 [range: 1-8] providers prior to being diagnosed with iliopsoas tendinitis and referred for consideration of arthroscopic fractional lengthening. Preoperatively, 93% of patients underwent at least 1 iliopsoas bursal corticosteroid injection, with an average of 81.1% symptom relief during the diagnostic (anesthetic) phase. The mean time between THA and iliopsoas fractional lengthening was 4.8 ± 3.4 years, whereas the mean time between initial iliopsoas tendinitis symptoms to fractional lengthening was 3.1 ± 2.5 years. At a mean of 11.3 ± 6.8 months postoperatively, mean surgery satisfaction was 8.1 ± 2.6 on a scale of 1 to 10, with the vast majority of patients (89.5%) stating that they would undergo fractional lengthening again. Conclusion Patients often experience a protracted period of symptoms and see multiple clinicians prior to being diagnosed with iliopsoas tendinitis and undergoing arthroscopic management. In patients refractory to conservative management, arthroscopic fractional lengthening can provide high surgery satisfaction, with most patients stating they would undergo the procedure again. These findings highlight the importance of increased recognition and appropriate referral of patients with iliopsoas tendinitis following THA.

Abstract Purpose Iliopsoas tendinitis following total hip arthroplasty (THA) has been described to result from acetabular component overhang as well as prominent femoral collars. Yet, a portion of patients experience iliopsoas tendinitis in the setting of well-positioned components. The purpose of this study was to assess anatomic factors predisposing to iliopsoas tendinitis after THA. Methods Patients with THAs performed at three academic institutions who subsequently underwent arthroscopic iliopsoas release were retrospectively reviewed from 2015 to 2025 and propensity matched in a 1:3 fashion to a control group of THAs without subsequent iliopsoas release. Controls were matched by age, surgery date, laterality, sex, surgical approach, and implanted femoral component. Patients with iliopsoas tendinitis and subsequent release (THA-IP) were evaluated for anterior acetabular component overhang and femoral collar overhang, when a collar was present. We also evaluated the absolute and relative profile of the lesser trochanter on anteroposterior radiographs, understanding that when less of the lesser trochanter is visualized, the trochanter is anatomically displaced posterolaterally, resulting in a more arduous route from the inner pelvic origin of the iliopsoas to its insertion on the femur. Results Forty-five patients (mean age: 57±11; 71% female; 19 direct anterior, 10 anterolateral, 16 posterior approach) undergoing THA-IP were analyzed and matched to 135 controls. Both groups demonstrated a median cup size of 54 mm and head size of 36 mm. Average time to iliopsoas release after THA was 4 years. Anterior cup overhang of >2 mm was present in 49% of THA-IP patients, with 18% having collared femoral components, and 9% demonstrating collar overhang of >2 mm. Overall, 19 THA-IP patients had <2 mm of cup and collar overhang and 26 patients had >2 mm of overhang. THA-IP patients with <2 mm of cup and collar overhang had significantly greater relative posterolateralization of the lesser trochanter compared to those with overhang of >2 mm (p=0.010) and to controls (p=0.037). Conclusion Visualizing “Less of the Lesser” on anteroposterior hip radiographs and associated posterolateralization of the lesser trochanter may be an anatomic risk factor for iliopsoas tendinitis following THA, even in the presence of satisfactorily positioned components.

Abstract Introduction Understanding factors that impact outcomes of total hip arthroplasty (THA) can aid clinical decision-making and patient counselling. The purpose of this study was to investigate functional outcomes, complications, and reoperation rates among patients undergoing primary THA after hip arthroscopy (HA-THA) compared to a matched cohort of primary THA patients without prior arthroscopy (THA-only). Methods A retrospective review was performed to identify all patients who underwent primary THA after prior hip arthroscopy from 2009-2022 at a single institution. Patients with a history of revision arthroscopy were excluded. Cases were propensity-matched with primary THA controls in a 1:4 ratio by age at time of THA, sex, body mass index, surgical approach, and year of surgery. At minimum 2-year follow-up, patient-reported outcomes (PROs) including Forgotten Joint Score (FJS), Modified Harris Hip Score (mHHS), Hip Disability and Osteoarthritis Outcome Score Pain (HOOS pain), and Visual Analog Pain Scale (VAS) were analyzed. Results Sixty-three hips in 60 patients (age: 47.3±9.4 years, BMI: 29.8±6.2 kg/m2) were matched to 252 THA-only hips, with patients converting to THA at a mean 3.1 years (range 0.3-10.3) following hip arthroscopy. While both HA-THA and THA patients demonstrated significant (p<0.001) postoperative improvements in PROs, HA-THA patients reported significantly lower postoperative FJS, mHHS, HOOS pain, and VAS pain scores (p<0.001) as compared to THA-only controls. At mean 6.6±3.2 years follow-up, HA-THA patients with preoperative Tönnis grades 2-3 reported significantly increased FJS, mHHS, and HOOS pain compared to those with preoperative Tönnis grades of 0-1 (p≤0.03). Additionally, HA-THA patients with preoperative Tönnis grades 0-1 exhibited worse PROs (p<0.001) as compared to THA-only controls. While there were no differences in complication rates between HA-THA patients and THA-only controls (8% vs. 5%, p=0.49), all-cause reoperation was greater amongst HA-THA patients compared to THA-only (10% vs. 2%, p=0.01). Conclusion While improved compared to preoperatively, patients undergoing THA after prior hip arthroscopy demonstrated inferior outcomes at mid-term follow up as compared to a demographically age-matched cohort without prior arthroscopy. When considering conversion to THA following arthroscopy, clinicians should consider counseling patients regarding improved outcomes in the setting of advanced radiographic osteoarthritis, and potentially increased all-cause reoperation.

Abstract Purpose To investigate clinical outcomes, including patient reported outcome measures (PROMs), subjective anterior groin pain and hip flexion strength, and reoperation rates following arthroscopic iliopsoas fractional lengthening after total hip arthroplasty (THA). Methods Patients who were indicated for arthroscopic iliopsoas fractional lengthening after ipsilateral THA were prospectively identified between 2023-2025 at a single institution. Pre- and post-operative PROMs, including Visual Analog Scale (VAS), Tegner activity scale, Single Assessment Numeric Evaluation (SANE), and subjective anterior groin pain and hip flexion strength were analyzed. Reoperations at final follow-up were also evaluated. Results A total of 44 hips in 41 patients (23 females and 18 males) were included (mean age: 64.7 ± 10.2, mean BMI: 29.9 ± 5.9 kg/m2). Fifty-five percent of patients underwent surgery on their right hip. The mean postoperative follow-up timeframe was 10.0 ± 7.1 months. There was a significant improvement in postoperative PROMs compared to pre-operative levels for VAS at rest (1.3 ± 1.9 vs. 2.9 ± 2.2), VAS with use (3.1 ± 3.8 vs. 8.0 ± 1.6), Tegner activity scale (2.9 ± 1.3 vs. 2.1 ± 1.1), and SANE (74.0 ± 20.3 vs. 47.9 ± 23.4) (p<0.001 for all). Over 90% of patients reported feeling much better or slightly better regarding their anterior groin pain at 2-weeks post-operatively (93%), 6 weeks post-operatively (90%), 3 months post-operatively (93%), and at final follow-up (91%). Regarding hip flexion strength, 73% reported feeling much better or slightly better at 2-weeks post-operatively, 95% at 6-weeks post-operatively, 85% at 3 months post-operatively, and 61% at final follow-up. Only 2 patients (5%) reported feeling much weaker at final follow-up. Two of 44 hips (5%) underwent reoperation at final follow-up. One patient underwent a 2-stage revision THA at 5 months postoperatively due to infection, while 1 patient underwent an open iliopsoas release with acetabular screw removal and liner exchange. Overall, the mean surgery satisfaction was 8.1 ± 2.6 on a scale of 1-10. Conclusion Patients who underwent arthroscopic iliopsoas fractional lengthening following THA demonstrated satisfactory postoperative outcomes, with over 90% reporting durably improved anterior groin pain and nearly two-thirds reporting increased hip flexor strength throughout follow-up.

Summary Central obesity is a risk factor for esophageal adenocarcinoma (EAC) independent of acid reflux. However, about a quarter of patients with Barrett’s esophagus (BE) and EAC have a normal body mass index (BMI). One hypothesis is that chronic systemic inflammation is as critical to the cancer pathway than the BMI alone. Therefore, we hypothesized that lean patients with BE/EAC would have a high prevalence of metabolic diseases. We aimed to compare metabolic diseases among lean patients with BE/EAC and overweight/obese BE/EAC and lean control without BE/EAC. We performed a propensity score–matched case–control study including patients with BE/EAC and a control group without BE/EAC from the Rochester Epidemiology Project (REP). The groups were compared using chi-square χ 2 and Student t-test as appropriate. Adjusted logistic regression models were used to compare the association with metabolic diseases. We included a total of 2504 patients (631 EAC, 621 BE, and 1252 controls). A quarter of patients (24.6%) with BE/EAC were lean. When compared to controls without BE/EAC, lean patients with BE were more likely to have diabetes (32.2% vs. 11.2%, P < 0.001) and hyperlipidemia (76.2% vs. 53%, P < 0.001). When comparing lean EAC patients to controls without BE/EAC, lean patients had a higher association with smoking (73.3% vs. 58.6%, P: 0.002) and diabetes (18.7% vs. 11.2%, P: 0.03). When compared to overweight/obese BE patients, lean BE were less likely to have NASH (7.7% vs. 20.3%, P: 0.001), diabetes (32.3% vs. 42.1%, P: 0.03), hyperlipidemia (77.2% vs. 87%, P: 0.003), and metabolic syndrome (24% vs. 54%, P < 0.001). Similarly, when compared to overweight/obese patients with EAC, lean EAC patients were less likely to have NASH (0% vs. 15.5%, P < 0.001), diabetes (18.7% vs. 34.1%, P < 0.001), hyperlipidemia (37.3% vs. 51.8%, P: 0.002), hypertension (37.3% vs. 55.3%, P < 0.001), and metabolic syndrome (8% vs. 37.6%, P < 0.001). A quarter of patients with BE/EAC are lean. Although lean BE/EAC patients have a more favorable metabolic profile compared to overweight/obese BE/EAC patients, diabetes and smoking are more common among lean patients with EAC compared to lean controls. The higher association with smoking and diabetes among lean EAC challenges traditional risk factor paradigms, suggesting a significant role for insulin resistance and chronic inflammation in EAC pathogenesis, especially in patients without typical risk factors. BMI-determined obesity may need to be supplemented with inflammatory metabolic diseases to improve assessment of BE/EAC risk in lean patients.

Background: Interstitial lung disease (ILD) involves numerous chronic pulmonary conditions that damage the lung parenchyma and alveolar interstitium. ILD has overlapping clinical and radiological features with other commonly seen cardiac and respiratory conditions. If not identified and treated in a timely manner, it may lead to irreversible fibrosis and a poor prognosis in the patient. The current diagnostic methods are either invasive or reliant on imaging or specialist interpretation, which can lead to diagnostic delay, increased radiation exposure, and healthcare costs. Lung crackles, often under-recognized as a non-specific feature of ILD, may serve as an important diagnostic clue in identifying not only the early stages of ILD but also its subtypes. This review explores the potential of analyzing the lung sounds in ILD through AI-based auscultation. Objective: To provide a comprehensive analysis of the pathophysiological stages of lung injury in ILD, the specific acoustic features, and the location associated with each ILD subtype and to evaluate the current state-of-the-art non-AI and AI methodologies that are used to diagnose ILD. This review aims to analyze the limitations associated with the current modalities and to envision AI-integrated auscultation as a powerful, cost-effective, non-invasive, radiation-free screening tool for early detection of ILD and its subtypes. Content Overview: The review begins with a detailed analysis of the lung sound pathophysiology, exploring the two-stage mechanism of alveolar epithelial injury and fibrosis formation. Existing hypotheses explaining the mechanism behind crackle production and the role of structural anatomy and surface tension in the generation of pathological lung sounds are examined. A tabulated summary of common ILD subtypes is provided, including their inciting events, pathogenesis, anatomical auscultation locations, and prognostic implications. Current diagnostic modalities for ILD, both non-AI and AI-based, are summarized along with their limitations, emphasizing the need for improved diagnostic tools. Discussion: Existing studies suggest that AI-based auscultation can match or exceed the current modalities in its sensitivity and specificity for detecting ILD-related crackles. Clinicians can identify the specific sound pattern and then correlate it with the ILD subtype and understand the prognosis in real time, thereby providing timely intervention to the patient. Additionally, AI-based auscultation can be used in resource-limited settings and can potentially reduce dependence on pulmonology expertise and radiation-based imaging for monitoring the condition. Conclusions: This literature review highlights the clinical potential of AI-based auscultation for early and accurate diagnoses of ILD. Understanding the associated pathological sounds, biomarkers, and genetic mutations linked to different subtypes opens avenues for future development of non-invasive diagnostic panels for ILD in clinical practice.

Abstract Introduction: Isocitrate dehydrogenase (IDH) mutations are observed in ~20% of patients with acute myeloid leukemia (AML). In the U.S., ivosidenib (ivo) is approved with or without azacitidine (aza) in the frontline (FL) and as monotherapy in relapsed/refractory (R/R) IDH1-mutated (mut) AML. Olutasidenib (oluta) is approved as monotherapy for R/R IDH1-mut AML. Enasidenib (ena) is approved as monotherapy for R/R IDH2-mut AML. This study describes real-world IDH inhibitor (IDHi) administration patterns and evaluates their outcomes in on-label settings. Methods: A retrospective review of patients with IDH1/2-mut AML who received ivosidenib, olutasidenib, or enasidenib was conducted at 12 academic institutions in the U.S. Best response at any time during treatment, including complete response (CR) and complete response with partial hematologic recovery (CRh), were graded using European Leukemia Net (ELN) 2022 criteria. Results: A total of 387 patients with IDH1- and IDH2-mut AML were treated with an IDHi in the FL or R/R setting. Median follow-up was 9.6 months (range, 0.03-90.7). Demographics include 79% White, 14% Black, 3% Asian, and 4% other/unknown race; 5% were Hispanic ethnicity; 46% were female; the median age was 70 years (range, 28-95). 70% had an Eastern Cooperative Oncology Group (ECOG) performance status of 0-1, 26% had secondary AML, and 10% had therapy-related AML. Per the ELN 2024 less-Intensive risk classification, 58% were favorable risk, 29% intermediate, 7% adverse, and 6% unknown. Overall, 209 of 387 patients (54%) received IDHi regimens on-label. In FL IDH1-mut AML (n=45), 11 received ivo monotherapy, 25 aza/ivo, and 9 used off-label combinations: 3 hypomethylating agent (HMA) + venetoclax (ven) + ivo, 5 decitabine/ivo, 1 intensive chemotherapy (IC)/ivo. Among R/R IDH1-mut AML (n=109), 47 received ivo monotherapy, 7 oluta monotherapy, and 55 off-label (31 HMA/ivo, 16 HMA/ven/ivo, 3 IC/ivo, and 5 other). 44 received off-label ena for FL treatment of IDH2-mut AML (25 ena monotherapy, 9 HMA/ena, 8 HMA/ven/ena, and 2 IC/ena). In R/R IDH2-mut AML (n=189), 119 patients received ena monotherapy and 70 received off-label combinations (25 HMA/ena, 30 HMA/ven/ena, 7 IC/ena, 6 ena/gilteritinib, and 2 other). In on-label treatment of FL IDH1-mut AML, one of four patients with response assessment of FL ivo monotherapy had a CR/CRh. Of 19 patients with response assessment on FL aza/ivo, 13 patients (68.4%) had a CR as best response (95% CI, 46.0-84.6%). Median OS was 14.9 mo (95% CI, 4.17-NR) for ivo monotherapy (n=11) and 31.9 mo (95% CI, 9.1-NR) for aza/ivo (n=25), with 0 and 2 patients receiving allogeneic stem cell transplant (allo-SCT), respectively. In R/R IDH1-mut AML, the rate of CR/CRh was 35.5% (95% CI, 21.1-53.1) for on-label ivo monotherapy. All 4 patients with response assessment for on-label oluta monotherapy had a CR. Median OS was 14.0 mo (95% CI, 10.1-22.4) for ivo monotherapy and NR for oluta monotherapy (95% CI, 10.1-NR), with 10 and 0 receiving allo-SCT, respectively. The CR/CRh rate for ivo was 38.1% (8 of 21 assessed; 95% CI, 20.8-59.1) in age < 70, and 30.0% (3 of 10 assessed; 95% CI, 10.8-60.3) in age ≥ 70. Median OS was 15.2 mo (95% CI 9.3-NR) in age < 70 (n=27) and 10.4 mo (95% CI 8.0-18) in age ≥ 70 (n=20). In R/R IDH2-mut AML, the rate of CR/CRh for on-label ena monotherapy was 38.2% (95% CI, 27.6-50.1). Median OS was 12.1 mo (95% CI, 8.2-16.6), with 5 having received allo-SCT. In demographic subgroups for ena monotherapy, 52 non-Hispanic White (NHW) patients with response assessment had a CR/CRh rate of 42.3% (95% CI, 0.30-0.56). Only 1 of 13 non-Hispanic Black (NHB) patients with response assessment had a CRh (7.7%; 95% CI, 1.4-33.0) as best response, with none attaining CR. Median OS was 13.7 mo (95% CI 10.3-26.3) in NHW (n=82), 11.2 mo (95% CI, 6.1-NR) in NHB (n=18), and 69.1 mo (95% CI, 52.6-NR) in Hispanic patients (n=8). The CR/CRh rate was 48.6% (17 of 35 assessed; 95% CI, 33.0-64.4) for age < 70, and 27.3% (9 of 33 assessed; 95% CI, 15.1-44.2) for age ≥ 70. Median OS was 12.0 mo (95% CI, 9.9-22.1) in age < 70 (n=48) and 5.8 mo (95% CI, 4.1-8.7) in age ≥ 70 (n=69). Conclusion: Practice patterns for IDH inhibitors in AML vary considerably, with high amounts of off-label use. Response rates for ivosidenib and enasidenib in the real-world setting are comparable to those of clinical trials. Descriptive analyses of demographic subgroups highlight areas in need of further research.

Abstract BACKGROUND Hereditary hemorrhagic telangiectasia (HHT) is the second most common inherited bleeding disorder (IBD) worldwide, afflicting 1 in 5,000 people. HHT is likely the most morbid IBD of women. Severe, recurrent epistaxis, gastrointestinal (GI) bleeding, and solid organ arteriovenous malformations (AVMs) cause major clinical and psychosocial morbidity and reduced survival. In recognition of the serious morbidity of HHT as an IBD, in 2022 the U.S. Congress allocated funding to create CHORUS, the Comprehensive HHT Outcomes Registry of the United States (NCT06259292). Herein, we present the initial report from CHORUS. METHODS CHORUS is a prospective, multicenter, U.S. longitudinal registry enrolling unselected patients with HHT, collecting over 2400 data elements. Data were collected by trained research coordinators at enrollment and follow-up visits via the medical record and direct participant interviews. RESULTS Patients. 600 patients with genetically- or Curacao criteria-confirmed HHT were enrolled from November 2023 to April 2025 at 15 U.S. HHT Centers of Excellence. Median (range) age was 53 (0-88) years, and the cohort was 60% female. Despite most patients developing typical HHT disease manifestations by age 13, most HHT diagnoses (63%) were made during mid-to-late adulthood. Mucosal Bleeding. 568 patients (95%) developed recurrent spontaneous epistaxis, with 339 (60%) developing recurrent epistaxis prior to age 13; 43% had at least one nasal surgery/procedure and 22% had at least one medical therapy (e.g., antifibrinolytic or antiangiogenic) for epistaxis. 180 (30%) had a known diagnosis of chronic GI bleeding. Among post-menarche females, 124 (34%) had been diagnosed with heavy menstrual bleeding. 247 (41%) reported other clinically significant mucocutaneous oral or skin bleeding. 454 (76%) had developed moderate-to-severe HHT-associated mucocutaneous bleeding, defined as an Epistaxis Severity Score >4, bleeding requiring targeted pharmaceutical or surgical intervention, IV iron, and/or red cell transfusion. This includes 334 (56%) with moderate-to-severe HHT-associated epistaxis. CNS and Pulmonary Hemorrhage. 16 patients (3%) suffered one or more intracranial hemorrhages (ICH), with 10 (63%) suffering a first ICH by age 25. 13 (2%) suffered one or more pulmonary hemorrhages. Iron Deficiency and Anemia. 408 patients (68%) had been diagnosed with anemia (351, 59%) or iron deficiency (381, 64%). Of those, 247 (61%) and 150 (37%) required IV iron and RBC transfusion, respectively. Solid Organ AVMs. Brain, pulmonary, and liver AVMs were diagnosed in 81 (15%), 268 (45%), and 128 patients (21%), respectively. Just 30 with brain AVMs (37%) had these diagnosed by age 25. 3 patients (2%) had undergone liver transplantation. Thrombosis. Venous and arterial thromboembolism occurred in 44 (7%) and 38 patients (6%), respectively, including 34 (6%) with ischemic stroke (94% of whom had pulmonary AVMs). Other Serious HHT Complications. These included heart failure in 41 patients (7%), pulmonary hypertension in 44 (7%), chronic liver disease in 17 (2.8%), epilepsy in 24 (4%), severe bacterial/deep-seated tissue infection in 35 (6%), and brain abscess in 15 (3%). 205 (34%) developed migraine. Notably, serious CNS manifestations of HHT (brain AVM, ischemic stroke, intracranial hemorrhage, and/or epilepsy) occurred in 128 (21%). 241 (40%) required emergency room visits and/or hospital admissions specifically to manage HHT complications. CONCLUSIONS This first-of-its-kind HHT registry reliably describes for the first time the incidence and severity of numerous HHT complications. Most patients develop moderate-to-severe recurrent epistaxis and/or chronic GI bleeding as well as iron deficiency anemia (usually requiring IV iron and/or RBC transfusion). Heavy menstrual bleeding, thromboembolism, severe cardiopulmonary complications, and serious CNS complications are all substantially more common in HHT than previously thought. Notably, ICH occurred in 3% of patients, which approximates the ICH incidence of hemophilia in the pre-factor prophylaxis era and is ~2-fold and ~9-fold higher than in hemophilia A treated with modern factor prophylaxis (1.6%) and modern non-factor prophylactic agents (0.3%), respectively, per the ATHN registry. This 3% number may be an underestimation given the known high ICH mortality rate, pervasive delay in HHT diagnosis, and the fact that survival post-ICH is necessary to enroll in CHORUS.

Summary Barrett’s esophagus (BE) is the only recognized precursor to esophageal adenocarcinoma, but progression risk is highly heterogeneous. While most patients with nondysplastic BE have an annual cancer risk less than 0.5%, a subset with dysplasia or adverse molecular profiles carries markedly higher risk. This variability necessitates precision risk stratification to optimize surveillance and intervention. We review the evolution of BE risk stratification from historical consensus frameworks to contemporary clinical, histologic, and molecular models. Key clinical predictors, validated scoring systems, and recent advances in biomarker-based and imaging-driven surveillance are summarized, with emphasis on their validation and clinical applicability. Established clinical risk factors—age, male sex, smoking, segment length, and dysplasia—remain central to risk prediction. Biomarker assays, including p53 immunohistochemistry, tissue systems pathology and methylation-based assays may provide risk stratification beyond histology. Advances in endoscopic imaging, wide-area transepithelial sampling, and non-endoscopic capsule-based collection platforms could transform surveillance into a risk-adapted paradigm. The management of BE is shifting from a one-size-fits-all surveillance model toward personalized, biomarker-guided care. Integration of clinical, histologic, and molecular data—underpinned by artificial intelligence and real-world validation—promises to refine surveillance, reduce overtreatment, and improve early cancer detection in Barrett’s esophagus.

Objective To assess the impact of renal replacement therapy in people with lupus nephritis (LN)–associated end‐stage kidney disease (ESKD) and support the development of the 2024 American College of Rheumatology LN treatment guidelines. Methods We conducted a systematic literature review and meta‐analysis to address three Population, Intervention, Comparison, and Outcome (PICO) questions related to renal replacement therapy for ESKD due to LN, including comparisons of kidney transplant versus dialysis, hemodialysis versus peritoneal dialysis, and preemptive kidney transplant versus no preemptive kidney transplant. Outcomes of interest included mortality, cardiovascular (CV) events, infections, lupus flares, disease‐related damage, graft failure, and quality of life. We conducted a meta‐analysis and analyzed hazard ratios for time‐to‐event analyses and risk ratios for dichotomous outcomes, as well as absolute risk estimates. Results Sixteen comparative observational studies addressed at least one of the three PICO questions. Kidney transplant was found to reduce the risks of all‐cause mortality, CV mortality, infection‐related mortality, and CV events compared with dialysis (high certainty). Dialysis modality (peritoneal vs hemodialysis) was not associated with mortality (high certainty) or with other outcomes of infection, CV complications, and systemic lupus erythematosus flares (low certainty). Preemptive kidney transplant was associated with lower risks of graft failure and mortality (low certainty). Conclusion This systematic review identified improved outcomes with kidney transplant versus dialysis for people with LN‐associated ESKD and potential benefits of preemptive kidney transplant. This evidence supports the use of kidney transplant as a preferred renal replacement therapy for people with LN‐ESKD.