Neighborhood Disadvantage As a Clinical Variable For Kidney Care, With Maya Clark Cutaia, PhD, RN

Considering neighborhood disadvantage as a clinical variable may be a useful strategy for supporting populations with reduced socioeconomic status in their kidney health, especially 

Lifelong exposure to adverse conditions within disadvantaged neighborhoods has been associated with an increased risk for kidney disease, along with accelerated progression. Despite this population’s adverse clinical outcomes, including progression to end-stage kidney disease, many needs remain unmet.

“In kidney disease, it looks like individuals who have higher exposure to environmental stressors,” said Maya Clark Cutaia, PhD, RN, the inaugural Evelyn Lauder Associate Dean for Nurse Practitioner Programs and Professor at the Hunter-Bellevue School of Nursing at Hunter College, in an interview with 

 “That may be things like pollution and heat, which we're seeing a lot nowadays, when, you know, focusing on climate work, fewer safe spaces so there's an inability to exercise, there's less reliability for access to healthy food and transportation, and then there's just a litany of other barriers that make it difficult for patients to get to primary care or nephrology care, and so it increases their risk, and therefore can accelerate their progression.”

Patients with kidney failure living in disadvantaged neighborhoods face barriers to care. Recent research has reported an association with neighborhood disadvantage and access to waitlisting and kidney transplantation. Furthermore, other evidence stated for > 1 in 10 of the most disadvantaged communities (11.7%) lacked a dialysis facility within a 30-minute drive compared with roughly 1 in 40 of the least disadvantaged communities (2.3%).

Even before patients reach ESKD, there may be missed opportunities for identifying CKD in its earlier stages and to intervene sooner, an aspect especially heightened in this patient population because of the aforementioned barriers to care.

“When we think about neighborhood disadvantage, it does mean there are differences in screening and CKD development or acknowledgement, diagnosis and management, suggesting that there are missed opportunities happening way downstream. It's a difficult conundrum because we're often seeing them being diagnosed at a point when complications already exist, and so our window for intervention is smaller.”

Surachman A. Neighborhood Deprivation, Financial Hardship, and Decrements in Kidney Function Across a Decade. 

https://doi.org/10.1093/geroni/igaf122.4413

Li Y, Menon G, Kim B, et al. Residential Neighborhood Disadvantage and Access to Kidney Transplantation. 

https://doi.org/10.1001/jamanetworkopen.2025.49679

Eisenbeisz ME, Chertow GM. Diminished Access to Dialysis in Disadvantaged Communities—Driving Toward More Equitable Care. 

. Published online February 23, 2026. doi:

https://doi.org/10.1001/jamainternmed.2025.8037

Videos

Should clinicians consider neighborhood disadvantage the same way they measure proteinuria and GFR for kidney health?

On March 16, Eli Lilly and Company released 

 from the phase 3 ADorable-1 study regarding lebrikizumab (Ebglyss) and its success in treating those with moderate to severe atopic dermatitis, including infants and children as young as 6 months.

These data suggest both of the ADorable-1 study’s co-primary endpoints were met while using this interleukin (IL)-13–targeting monoclonal antibody, currently 

-approved for moderate to severe atopic dermatitis in adults and adolescents.

 Lilly has also indicated its intention to submit the data to US and international regulators for a label expansion in younger pediatric patients.

Amy Paller, MD, chair of the department of dermatology at Northwestern University and an investigator in the study, spoke with 

 following the release of these findings. The following is a Q&A discussion with Paller about the biggest highlights:

What would you say stood out most among these findings from ADorable-1 as an investigator on this trial?

 The biggest takeaway is that we've been living with one advanced systemic only, for such a long time now, yet we have such a large part of our population, the pediatric population under 12, who have moderate to severe atopic dermatitis. They are just not responding well enough to topicals, or parents are putting on so much steroid that I'm sure that it's having some adverse effects over time. Not to mention the burden of disease and spending so much time.

The fact that we now have a second one that, hopefully, will move forward for FDA clearance is really thrilling to us as pediatric dermatologists. We've been waiting for this for a long time. We don't have any options other than what we've had for decades: methotrexate and cyclosporine. These are the options for kids who don't respond well to dupilumab or have an issue with it.

ADorable-1 enrolled patients as young as 6 months, a population where we have very few approved targeted options. How meaningful are these topline results to you as an investigator, and what does a 63% EASI-75 response rate tell us about the potential role of selective IL-13 inhibition in this age group?

 What it tells us is probably going to be on par with the type of changes that we've seen with dupilumab, and that's great. You know, we've all now had some experience with those who are 12 and above. We know that they're very different, these approaches, and we can't take a response to one and just apply it to the other. They're quite different, and again, it gives us an option. But it tells us that it's an option that looks to be pretty promising, and the majority, that is two-thirds of children within as short a period of 16 weeks, will have a tremendously meaningful improvement in their disease.

The trial used weight-based dosing alongside background topical corticosteroids. Can you walk us through the rationale for that design, and how confident are you that the efficacy signal here reflects lebrikizumab's contribution specifically, rather than the combination with topical therapy?

This has also been done with these other pediatric trials, including with dupilumab. It's just really not considered ethical in children to not provide some modicum of relief. Of course, these are children in whom the topicals weren't enough anyway, so putting them on a topical steroid on both arms is really an ethical move to try to assuage some of the pain, itch, and terrible aspects of this disease. That's where that comes from. The weight-based dosing, of course, reflects the fact that this is pediatrics.

We can't just give them adult doses, but it is tiered. So, the smallest children in the study would be getting something like the two loading doses, and then going to 125 every 4 weeks. Whereas the older children in the study would be, depending on where they were, if they were 40 kilograms and above, on the standard 250 milligram for 0, 2 weeks, and then every 2 weeks after that. If they were in the next tiered group, that is under 40, but I think it was over 15 milligrams, they would be getting the 250 after that, 2 weeks on an every-4-week basis.

Atopic dermatitis in infants and toddlers carries a significant burden not just for the patient but for the whole family. Beyond the clinical endpoints, what did you observe in terms of the real-world impact on patients and caregivers throughout the trial?

I don't know that that data is out there in the public domain yet, but I will just say, from my own experience, when you get something that works great, you get a lot of smiles on everybody's face. This is a disease that has a terrible burden, not just for the young children, but for the entire family. The parents don't sleep. When the kids don't sleep, the parents spend more time at the doctors and out of work. Kids are homesick, and it's a tremendous burden for, not just the parents but, of course, the entire family. Being able, in a relatively short period of time in this study, to turn around the burden of this disease really helps the physical and emotional burden for the entire family.

With Lilly planning regulatory submissions based on these data, what would a label expansion down to 6 months mean for how pediatric dermatologists approach treatment sequencing?

As I mentioned, it gives us options. I think we're very used to using dupilumab. I don't think that's going to go away, but I think that we now have an option for one or the other. There is going to potentially be a difference. We'll see what the FDA does. I really don't know, but the cutoff for going every 2-week-dosing with dupilumab was set at 30 milligrams. You get that 200-milligram every 2 weeks. Here, it's set at 40. So that means under 40, they'd be every 4 weeks based on the FDA. I don't know if that'll make a difference, but it gives a certain group of kids more of an on-label every 4 weeks.

For dupilumab, I often use it every 4 weeks for the kids in that group. That's 30 and above. This is just because that's the on-label for Europe, and it works just fine. The answer to your question is that we have options now for these kids of this age. We can have first-line dupilumab, we can have first line lebrikizumab. We certainly have options if they don't do well with whatever our first choice is.

What remaining questions would you most like answered in the next phase of research for lebrikizumab in this younger patient population?

I think it's always important to see a larger group beyond what's in the study. We want to see what the real-world experience is with first-line lebrikizumab, with changing from dupilumab to lebrikizumab. We certainly didn't see much in terms of any kind of adverse events during this trial, no new signals, and nothing of concern. But we'll keep an eye on whether there seems to be any difference with instance of ocular surface disease, although it's so low with dupilumab as well in this young population.

I think we're also going to be looking at the long term. One of the big questions: We talk now about the potential that dupilumab, which we know is on-label for asthma, and we know it is helpful for a variety of allergic and new mediated disorders. [The question is] whether there is going to be a role in reducing the development of other atopic diseases, in addition to reducing the severity of those diseases while on the drug; we just don't know how much of that is.

Specifically, the fact that the IL-4 receptor inhibitor of dopamine also inhibits IL-4 signaling directly…We may not get that with the IL-13-specific targeting. I think that will be an interesting question to look at further, looking at the development or the occurrence of these other allergic disorders with IL-13. That's going to be something. Then obviously, other questions that we have as well, are why vaccines? Is there any concern with giving a live vaccine? Theoretically, there would not be, but obviously that remains to be answered with real data. I think those are the 2 big questions that are out there.

The quotes used in this interview were edited for the purposes of clarity.

Disclosures for Paller include the following: AbbVie, AnaptysBio, Eli Lilly, Galderma, Incyte, Janssen, LEO Pharma, Novartis, Regeneron Pharmaceuticals, Inc., Sanofi – investigator; AbbVie, Amgen, Asana, Dermavant, Dermira, Eli Lilly, Forte, Galderma, LEO Pharma, Matrisys Bioscience, Menlo Therapeutics, MorphoSys/Galapagos, Novartis, Pfizer, Regeneron Pharmaceuticals. Inc., Sanofi – consultant.

Campbell P. Phase 3 Trial Supports Lebrikizumab in Pediatric Atopic Dermatitis. HCPLive. March 16, 2026. Accessed March 17, 2026. 

https://www.hcplive.com/view/phase-3-trial-supports-lebrikizumab-in-pediatric-atopic-dermatitis

Eli Lilly and Company. Lilly’s EBGLYSS (lebrikizumab-lbkz) is the first and only selective IL-13 inhibitor to deliver positive Phase 3 outcomes in patients aged six months to 18 years with moderate-to-severe atopic dermatitis | Eli Lilly and Company. Eli Lilly and Company. Published March 16, 2026. Accessed March 17, 2026. 

https://investor.lilly.com/news-releases/news-release-details/lillys-ebglyss-lebrikizumab-lbkz-first-and-only-selective-il-13

Articles

Phase 3 ADorable-1 topline data support lebrikizumab, a selective IL‑13 monoclonal antibody, in moderate-to-severe atopic dermatitis for patients aged 6 months to 18 years, meeting both co-primary endpoints and achieving ~63% EASI‑75 at 16 weeks with background topical corticosteroids. Weight-tiered dosing aligned with pediatric pharmacology and mirrored ethical trial norms for symptom control. A potential label expansion would add a second advanced systemic option for younger children, enabling alternative first-line sequencing and switch strategies beyond dupilumab and legacy immunosuppressants.

Following the release of new results from the phase 3 ADorable-1 trial on lebrikizumab in pediatric patients, Amy Paller, MD, speaks in a new Q&A interview.

Significance of ADorable-1 Data on Lebrikizumab in Children with Atopic Dermatitis, With Amy Paller, MD

AHA/ACC Dyslipidemia Guidelines Reinstate LDL-C Goals, With Viet Le, DMSc, PA-C

On March 13, 2026, the American College of Cardiology (ACC) and American Heart Association (AHA) released an updated clinical guideline for the management of 

, replacing the 2018 Guideline on the Management of Blood Cholesterol.

Among the most major changes in these guidelines is the shift from percent reduction of LDL-C back to specific, targeted goals. The 2018 version encouraged the use of percent LDL-C reductions as a method of monitoring lipid levels and guiding lipid-lowering therapy (LLT) across the board. Additionally, secondary prevention now includes LDL-C goals as well, with recommendations shifting for LDL-C ≥190 mg/dL and familial hypercholesterolemia (FH).

“I love coming back to goals,” Viet Le, DMSc, PA-C, associate professor of research and preventive cardiology PA at Intermountain Health and ACC editor in chief, told 

 in an exclusive interview. “It was a little nebulous to just throw out percent reduction of LDL cholesterol, so I think it’s helpful for patients and for clinicians alike to be able to see goals of where we’re going.”

Percent LDL-C reductions were widely considered vague, given their subjectivity between patients. Now, although the guidelines retain percentage reduction in LDL-C as a priority for individuals, with goals for percent reduction dependent on the level of 

atherosclerotic cardiovascular disease (ASCVD

) risk, LDL-C and non-HDL-C treatment goals are once again forming the backbone of LLT guidance.

Specific goals are largely determined by PREVENT risk tier. Those at borderline risk – between 3 and <5% - have a goal LDL-C of <100 mg/dL and a goal non-HDL-C of <130 mg/dL. Patients at intermediate risk, or from 5 to <10%, have a goal LDL-C of <100 mg/dL. Those at high risk - ≥10% - have a goal LDL-C of <70 mg/dL and non-HDL-C of <100 mg/dL and should be given ezetimibe if the goal is not met on a maximum statin.

Secondary prevention markers will also incorporate LDL-C goals – patients at very high risk, or with ≥2 major ASCVD events or 1 event and ≥2 high-risk features have a goal LDL-C of <55 mg/dL and non-HDL-C <85 mg/dL and should have ezetimibe added to max statin. Patients not at very high risk, however, have an LDL-C goal of <70 mg/dL and non-HDL-C of <100 mg/dL. Additionally, based on data from CLEAR OUTCOMES, bempedoic acid and inclisiran are now formally positioned as add-on options for very high-risk patients who cannot reach goal.

Finally, patients with severe hypercholesterolemia or FH have received recommendations as well. Patients with ASCVD have an LDL-C goal <55 mg/dL and should receive ezetimibe, while those without ASCVD but with heterozygous HF (HeFH) have a goal LDL-C <70 mg/dL with ezetimibe, PCSK9 inhibitors, and/or bempedoic acid added to max statin. Additionally, standard risk calculators like PREVENT and PCE explicitly not recommended for HeFH – the authors cite their tendency to underestimate risk. Instead, panel-based genetic testing should be used for FH.

“This is important,” Le said. “These are individuals with 1 event and 2 or more major risk factors, or 2 or more major events. They’re very high risk. And the guidelines make this clear. Most of our patients end up in the very high risk category if they have any events. Typically, they have 2 or more risk factors with them. So, less than 55 mg/dL should really be the clarion call and the goal that we think about for most of these individuals.”

Editors’ Note: Le reports disclosures with Janssen, Pfizer, Novartis, Idorsia, Amarin, and Lexicon.

Blumenthal RS, Morris PB, Gaudino M, et al. 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APHA/ASPC/NLA/PCNA guideline on the management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. Published online March 13, 2026. 

Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APHA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139(25). 

Le discusses the AHA/ACC clinical guidelines for the management of dyslipidemia, highlighting the return of LDL-C target goals for ASCVD prevention.

Barriers to Using SLIT, With Désirée Larenas-Linnemann, MD

2026 American Academy of Allergy, Asthma & Immunology

, from Hospital Médica Sur, shared persistent real‑world barriers to broader adoption of 

 in the United States. Although SLIT can offer a home‑based alternative to injections, financial and practical hurdles continue to limit its uptake.

“It’s only one allergen that you can give in a tablet,” Larenas-Linnemann said. “If you want to do 2 allergens, you have to give 2 tablets, which doubles the cost. Most tablets are not covered by insurance.”

She further emphasized the complexity of prescribing tablets for allergic asthma, as not all formulations have FDA approval for this indication. However, since many patients also have concomitant allergic rhinitis, clinicians often navigate this off-label use.

Adherence is another critical factor. Larenas-Linnemann described wide variability among patients, observing that while some strictly follow daily dosing, others stretch vials beyond recommended intervals, undermining therapeutic effectiveness.

“If you really want to have good effects, you need to have your monthly dose,” she said. “You need to have your daily dose, ideally, with the tablets.”

Emerging research on multi-allergen SLIT, particularly in liquid form, may expand treatment options, though evidence remains limited. Larenas-Linnemann said it could be possible to use 2 tablets for multi-allergen therapy, but evidence is scarce. European guidelines suggest a 30-minute interval, but this is based on a single study, and the effect of administering 2 tablets simultaneously remains unknown.

“It's a recommendation without solid evidence behind it,” Larenas-Linnemann said.

When it comes to multi‑allergen SLIT, Larenas‑Linnemann emphasized careful patient selection. Typical combinations might include grass pollen, tree pollen, cat dander, and house dust mite. Clinicians must ensure the patient is clinically reactive to these allergens, as positive skin tests alone do not always reflect current symptomatic allergy. For example, patients may test positive for mold exposure they encountered years ago but no longer experience symptoms in their current environment, making immunotherapy unnecessary for that allergen.

Evidence for multi‑allergen liquid SLIT remains limited but promising. Studies combining 2 allergens, such as house dust mite and grass pollen, have demonstrated efficacy over 1 to 2 years. Trials mixing 3 or 4 allergens show weaker but still observable responses, and even studies attempting 10-allergen combinations suggest a signal of benefit when focusing on relevant allergens. Larenas‑Linnemann noted that statistical significance may be limited by small sample sizes.

In her practice, she limits multi‑allergen therapy to no more than four allergens, using liquid formulations with high concentrations

to maximize the potential therapeutic effect. The goal is to deliver the strongest possible dose for each relevant allergen, balancing efficacy with safety.

Larenas-Linnemann has no relevant disclosures.

Larenas-Linnemann, D. What Should You Know About SLIT in 2026? Session presented at the American Academy of Allergy, Asthma, & Immunology (AAAAI) in Philadelphia on February 28, 2026.

High costs, limited insurance coverage, and adherence challenges remain key barriers to broader SLIT use in the US, Larenas-Linnemann says in an interview at AAAAI 2026.

Kidney Disease: Improving Global Outcomes (KDIGO)

2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (CKD)

, one of the most widely used global resources for CKD evaluation and management.

The update will focus on Chapter 3, “Delaying CKD progression and managing its complications,” with particular emphasis on medical management using newer therapies in light of the evolving therapeutic landscape.

At the time the 2024 guideline was published, recommendations for therapies such as ACE inhibitors, ARBs, SGLT2 inhibitors, GLP-1 receptor agonists, and nonsteroidal MRAs were based on the best available evidence, primarily in patients with diabetes or significant albuminuria, where most trial data were available. The guidance used a cautious, stepwise approach to balance potential benefits with safety considerations, including hyperkalemia and changes in kidney function. 

Since then, emerging trial data have demonstrated broader kidney and cardiovascular benefits of these therapies, including in people without diabetes, prompting KDIGO to initiate a focused update to ensure recommendations reflect the most current evidence.

“Since the publication of the 2024 KDIGO CKD Guideline, new data continue to emerge that have important implications for how we slow CKD progression and manage complications,” said Adeera Levin, MD, co-chair of the 2024 guidelines. “This focused update will ensure that KDIGO recommendations reflect the latest evidence and continue to support healthcare professionals caring for people living with CKD.”

These data include several therapies, which have been changing CKD management, including sodium-glucose cotransporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 (GLP-1)-based therapies, and nonsteroidal mineralocorticoid receptor antagonists (nsMRAs) in people with CKD without diabetes.

The update will follow the rigorous KDIGO guideline development methodology, including systematic evidence review and multidisciplinary expert input. Updated systematic evidence reviews will inform the decision to update existing recommendations and practice points. Levin is on board for the new update process, along with the original co-chair, Paul Stevens, MB, and a majority of the 2024 CKD Guideline Work Group, in order to ensure continuity and expertise.

“New cardiovascular and kidney outcomes trial data for SGLT2 inhibitors, GLP-1-based therapies, and nonsteroidal MRAs are raising important questions about how these therapies should be used in people with CKD who do not have diabetes,” said Stevens. “Our goal is to carefully review this evolving evidence and provide clear, practical guidance for healthcare professionals around the world.”

Kidney Disease: Defining Global Outcomes (KDIGO). CKD Evaluation and Management – KDIGO. KDIGO. Published 2024. Accessed March 17, 2026. 

https://kdigo.org/guidelines/ckd-evaluation-and-management/

Babitt JL, Berns JS, Bozkurt B, et al. Executive Summary of the KDIGO 2026 Clinical Practice Guideline for the Management of Anemia in Chronic Kidney Disease (CKD). 

https://doi.org/10.1016/j.kint.2025.06.005

KDIGO has initiated a focused update to the 2024 CKD Clinical Practice Guideline, targeting Chapter 3 on delaying progression and managing complications. The update is driven by emerging cardiovascular and kidney outcomes data extending benefits of cornerstone pharmacotherapies beyond the original evidence base centered on diabetes and/or significant albuminuria. KDIGO aims to recalibrate prior stepwise recommendations for ACEi/ARB, SGLT2 inhibitors, GLP-1–based therapies, and nonsteroidal MRAs, balancing efficacy with safety concerns such as hyperkalemia and acute eGFR changes through a rigorous evidence-review process.

KDIGO Launches Focused Update to 2024 CKD Guideline on Emerging Therapies


Expanding Use of Lower-Quality Kidneys Could Boost Transplants, Improve Equity, With Matthew Kaufmann, PhD

Allocating lower but acceptable quality kidneys to high-risk patients could introduce equity, along with shortened waiting times for underrepresented patient populations, according to new research.

cost-effective nature of having transplant centers utilize lower quality kidneys for adults ≥65 years of age

, especially when assessing the effects of increasing transplant rates by 25%.

“Hispanic and Black patients have longer than average wait times, and we found that increasing the rate of transplantation for all patients provides even greater health benefits for patients who have historically longer wait times,” said Matthew Kaufmann, PhD, Midwest Analytics and Disease Modeling Center Postdoctoral Fellow. “Therefore, we estimate that it would improve health equity.”

Within the US allocation system, approximately 20% of deceased donor kidneys are discarded each year. Specifically, >50% of those with a KDPI > 85 are discarded. In most clinical cases, when compared with staying on dialysis, even a KDPI = 99 kidney is suggested to offer improved longevity to transplant candidates.

To address this gap, investigators selected a synthetic cohort of adult candidates ≥ 65 years of age with end-stage kidney disease (ESKD) on the transplant waiting list, a patient population with markedly reduced rates of transplants compared to those <65 years of age.

“We believe there are clear benefits to honoring patient preferences—not just for older candidates, but also for patients with lower expected post-transplant survival and poorer outcomes on dialysis or the waitlist. We initially thought lower—but still acceptable—quality kidneys might offer limited benefit in this population. However, our findings show the opposite: these patients can derive substantial benefit, and this approach can be cost-effective. Ultimately, any patient who prioritizes shorter wait times and is willing to accept the risks of lower-quality kidneys should have access to them.”

Clinically, investigators found an association between deceased donor transplantation rate with a substantially decreased deaths on the waiting list and decreased waiting list removals as well as increased total net number of people undergoing transplants. Additionally, using lower-quality donor kidneys was associated with an increased risk of delayed graft function (DGF), but reduced wait times were associated with a decrease in this risk.

At a 5% increase in transplant rate, the DGF rate increased from the status quo. However, as the rate increased to 25%, the DGF rate moved back toward the status quo because of offsetting risk factors, a recurring pattern for the graft failure rate. Although lower kidney quality was associated with an increased risk of graft failure, reduced pretransplant dialysis time had a protective association.

The scenario analysis revealed that even if as many as 20% of transplanted kidneys were of lower quality than their given KDPI, increasing the transplantation rate by 25% would still be associated with 141 (range, 118-161) averted waiting list deaths and 375 (range, 350-396) waiting list removals per 10,000 candidates and 175 (range, 25-385) additional DGF cases and 103 (range, 9-266) additional graft loss events per 10,000 recipients.

Economically, when transplantation rates were increased by 25%, investigators noted an improvement in HRQOL cost-effectively, along with the most QALYs and lowest costs.

From the health care sector perspective, this would cost $8100 (95% credible interval [CrI], $700 to $141,00) per QALY gained. Notably, smaller increments of increased transplant rates cost more per QALY gained. Investigators believe smaller increases would mean fewer people undergo transplants, along with an increased mean time to transplant, which can result in additional adverse outcomes and costs.

Compared with the status quo, investigators observed a gain of 0.56 QALYs (95% CrI, 0.35 to 0.90 QALYs) and savings of $10,200 (95% CrI, $3400 to $17,900) for older adults.

Even for individuals ≥ 75 years of age, increasing deceased donor transplants by 25% was associated with HRQOL gains and cost $7800 (95% CrI, $1300 to $14,500) per QALY gained.

At a WTP threshold of $100,000 per QALY gained, choosing the status quo as opposed to the 25% increase transplantation rate was predicted to result in an expected loss of $51,400 per person, for a total of $886 million, from the health care sector perspective, and $58,300 per person, for a total of $1 billion, from the modified health care sector perspective.

While the study did not consider the downstream effects of new policies on younger candidates, investigators noted they would expect to see younger candidates benefit from shorter waiting times for all candidates.

Editor’s Note: Kaufmann reports no relevant disclosures.

Kaufmann MB, Tan JC, Owens DK, Chertow GM, Goldhaber-Fiebert JD. Cost-Effectiveness of Acceptable-Quality Deceased Donor Kidneys for Transplant in Older Candidates. 

https://doi.org/10.1001/jamanetworkopen.2025.55428

Kaufmann M. Using Lower Quality Kidneys to Reduce Costs, Increase Transplants for Older Adults, With Matthew Kaufmann, PhD. HCPLive. Published March 9, 2026. Accessed March 17, 2026. 

https://www.hcplive.com/view/using-lower-quality-kidneys-to-reduce-costs-and-increase-transplants-for-older-adults

Friedewald JJ, Schantz K, Mehrotra S. Kidney organ allocation: reducing discards. 

https://doi.org/10.1097/mot.0000000000001049

Allocating lower but acceptable quality kidneys to high-risk patients could introduce equity. 

Resilience, Rejection, and Recognition in Academic Dermatology

, dermatologist Natasha Mesinkovska, MD, PhD, reflects on career development, mentorship, and communication style, offering several practical insights relevant to clinicians navigating academic medicine.

Mesinkovska emphasizes the importance of proactively seeking opportunities early in one’s career. She describes a willingness to “ask for anything,” even offering to perform logistical tasks simply to gain exposure to academic meetings and professional environments. This mindset, prioritizing access and experience over prestige or compensation, ultimately facilitated speaking opportunities and career advancement. Her experience underscores a key principle: visibility and initiative often precede recognition. For clinicians, particularly early-career physicians and trainees, explicitly expressing interest in roles or opportunities may significantly increase the likelihood of inclusion.

Importantly, Mesinkovska acknowledges that self-advocacy does not always come naturally. She notes a personal discomfort with advocating for herself, contrasting this with her strong advocacy for mentees. This dichotomy highlights a common challenge among clinicians, especially women, who may hesitate to promote their own accomplishments or request opportunities. Nevertheless, she identifies “asking” as a foundational rule in mentorship, emphasizing that rejection is both common and necessary. She contextualizes success as a numbers game, numerous rejections accompany each acceptance, whether for publications, presentations, or awards. This normalization of rejection reframes it as an expected component of academic progression rather than a deterrent.

Mentorship emerges as another central theme. Mesinkovska describes a deliberate effort to “pay forward” the opportunities she received by supporting junior colleagues. She actively promotes mentees’ achievements and views their success as a shared accomplishment. This approach aligns with best practices in academic medicine, where sponsorship, actively advocating for trainees and junior faculty, can be as impactful as traditional mentorship. Her comments also suggest that fostering a supportive team culture requires intentional recognition of contributions, even for high-performing individuals who may otherwise go unnoticed.

The discussion also explores Mesinkovska’s approach to medical education and lecturing. She attributes her distinctive presentation style to a strong foundation in basic science (as a PhD-trained physician) combined with an emphasis on simplification and audience engagement. Her ability to translate complex scientific concepts into accessible, memorable content reflects experience in patient-facing scientific communication. She notes that preparing a single lecture may require 20–30 hours, highlighting the substantial effort behind effective teaching. This serves as a reminder that high-quality educational delivery is a skill requiring both time investment and deliberate practice.

Finally, Mesinkovska touches on the importance of valuing intellectual property in academic work. Initially sharing her materials freely, she later recognized the need to protect the significant effort involved in content creation. This perspective may resonate with clinicians increasingly contributing to educational and digital platforms.

Overall, the segment reinforces several actionable themes for clinicians: proactively seek opportunities, normalize rejection, invest in mentorship and sponsorship, prioritize clarity in communication, and recognize the value of one’s academic contributions.

Editor’s note: This episode was produced with the help of AI tools.

This segment of the latest episode of The Medical Sisterhood highlights insights into the career of Natasha Mesinkovska, MD, PhD.

 Race-Neutral Spirometry Gains Support as Standard Practice, With Nicole Ramsey, MD, PhD

Updated guidance on lung function testing has prompted growing discussion around 

2026 American Academy of Allergy, Asthma & Immunology (AAAAI) 

annual meeting in Philadelphia, Nicole Ramsey, MD, PhD, assistant professor of pediatric allergy and immunology at the Icahn School of Medicine at Mount Sinai, discussed the rationale for race-neutral equations for spirometry and their potential clinical impact.

, Ramsey described a study in which surgeons evaluated a hypothetical patient and recommended lobectomy based on spirometry values calculated using either race-neutral or race-specific equations.

“It showed that surgeons would be less likely to do surgery on patients…if they're using the race-neutral and more likely to do it if they're using the race-specific. It's actually a counterargument using race-neutral equations,” Ramsey said. “However, it's possible that those people [who] would be less likely to do surgery on have worse outcomes. We don't know, but it's just because they have poor lung function that they’re less they're less excited to do surgery on someone because the numbers suggest that they might not have a good outcome.”

Spirometry is a fundamental tool used to evaluate lung function and diagnose conditions such as asthma and chronic obstructive pulmonary disease. Historically, interpretation of spirometry results relied on race-specific reference equations, which adjusted predicted lung function values based on a patient’s racial category. Earlier models, including the 1999 reference equations, required clinicians to modify raw spirometry values differently for patients identified as Black, White, or Mexican American.

Ramsey explained that these adjustments were originally based on the assumption that biological differences between racial groups influenced lung capacity. However, emerging evidence suggests that environmental exposures and social determinants of health, rather than race itself, better explain differences observed in lung function across populations.

She noted that historical environmental inequities likely contributed to early observations that shaped race-based equations. For example, greater exposure to industrial pollution and occupational hazards among Black populations during earlier decades may have influenced lung function measurements used in historical datasets.

Professional societies have begun responding to this evolving evidence base. The American Thoracic Society now recommends using race-neutral spirometry equations, including updated reference values introduced through the Global Lung Function Initiative’s 2022 model. These equations incorporate data from diverse populations without applying race-specific correction factors.

Despite these recommendations, adoption has not yet been universal. Ramsey noted that practical barriers, such as outdated spirometry equipment and software, may slow implementation. Many older spirometers cannot easily integrate newer reference equations, meaning clinics may need to upgrade hardware or software to transition fully.

Beyond clinical care, changes in spirometry interpretation could have broader societal implications. Ramsey highlighted that algorithms used in areas such as life insurance underwriting may interpret lung function differently depending on whether race-based adjustments are applied.

Ramsey emphasized that race-neutral spirometry represents a step toward more accurate and equitable lung health assessment, though continued research will be needed to refine predictive tools.

“We need better risk calculators to take people's whole [clinical context] into account, not just their race, not just their height, but other things that they might be exposed to that might be contributing to their lung health,” Ramsey said. “We need additional studies, and we need different predictors, potentially using AI or other advanced statistical tools, to help us interpret our spirometry results.”

ALK-Abello, Inc., and Genentech USA, Inc.

Ramsey, N. Using Race-Neutral Spirometry Equations Improves Diagnostic Accuracy. Session presented at the 2026 American Academy of Allergy, Asthma, & Immunology in Philadelphia on March 2, 2026.

At AAAAI 2026, Ramsey discussed the shift toward race-neutral spirometry equations, their clinical implications, and barriers to widespread adoption.

Race-Neutral Spirometry Gains Support as Standard Practice, With Nicole Ramsey, MD, PhD

Image Credit: US Food and Drug Administration

The US Food and Drug Administration has issued a Complete Response Letter (CRL) to Aldeyra Therapeutics’ New Drug Application (NDA) of reproxalap, an investigational drug candidate, for the treatment of dry eye disease. 

As described in a March 17, 2026, release from the Company, the CRL stated that there is “a lack of substantial evidence consisting of adequate and well-controlled investigations … that the drug product will have the effect it purports or is represented to have under the conditions of use prescribed, recommended, or suggested in its proposed labeling” and that “the application has failed to demonstrate efficacy in adequate and well controlled studies in the treatment of signs and symptoms of dry eye disease.” The letter also stated that the “inconsistency of study results raises serious concerns about the reliability and meaningfulness of the positive findings” and that the “totality of evidence from the completed clinical trials does not support the effectiveness of the product.” Consistent with prior NDA reviews of reproxalap, no safety or manufacturing concerns were identified.

“To the thousands of American and Canadian patients who participated in our clinical trials and to the tens of millions of patients with dry eye disease worldwide, I want to assure you that we will work with urgency to support the FDA in enabling market access to what is, to our knowledge, the only drug with clinical activity within minutes of administration in patients with dry eye disease, a condition that is today treated with medications that require weeks or months of treatment to achieve even modest improvement,” stated Todd Brady, MD, PhD, President and Chief Executive Officer of Aldeyra.

Aldeyra first submitted an NDA for reproxalap in early 2023; they received a CRL on November 16, 2023, which stated that the NDA did not exhibit “efficacy in treating ocular symptoms associated with dry eyes” as defined by the FDA. Aldeyra announced the resubmission of the NDA on October 3, 2024. After another CRL in April of 2025, Aldeyra conducted an additional dry eye chamber trial, supplementing the NDA with these data in June of 2025.

The latest NDA was supported by results from both the ALLEVIATE trial, a Phase 3 randomized, double-masked, vehicle-controlled clinical trial which achieved its primary endpoint in August of 2024, and the more recent dry eye chamber trial, requested after the FDA administered another CRL in April of 2025. According to Aldeyra, the ALLEVIATE trial indicated the superiority of reproxalap over vehicle in treating ocular discomfort (

 = .004), which is an FDA accepted symptom of dry eye disease.

During the trial, participants were administered vehicle – the drug product sans active ingredient – before and during exposure to a dry eye chamber. The 132 qualifying patients were then randomized to either another dose of vehicle or reproxalap before and during exposure to another dry eye chamber. 66 patients received vehicle and 66 received reproxalap. The primary endpoint of the trial was ocular discomfort from 80-100 minutes of exposure to the chamber.

Investigators reported no safety signals observed during the trial, and reproxalap was well tolerated by the participants. The most reported adverse event was, according to Aldeyra, mild and transient instillation site discomfort, which was consistent with prior trials.

In May of 2025, Aldeyra announced the completion of the dry eye chamber trial, which demonstrated reproxalap’s capacity to reduce ocular discomfort. No notable differences in baseline scores were noted across treatment arms during this trial, and no safety concerns were identified. As with prior trials, the most common adverse event was mild and transient installation site discomfort, rarely lasting longer than 1 minute.

In the latest CRL, the FDA recommended that the reasons for failure in certain trials be explored, and that populations or certain conditions in which reproxalap may be effective be identified. The Agency did not recommend conducting additional trials or request submission of additional confirmatory evidence.

In the press release, Aldeyra indicated it does not currently expect to pursue additional clinical trials and intends to expeditiously request a Type A meeting to understand the actions needed for NDA approval. Per Prescription Drug User Fee Act (PDUFA) goals, the target Type A meeting date is within 30 days of receipt of the meeting request.

Aldeyra Therapeutics. Aldeyra Therapeutics Receives Complete Response Letter from the U.S. Food and Drug Administration for the Reproxalap New Drug Application for the Treatment of Signs and Symptoms of Dry Eye Disease. March 17, 2026. Accessed March 17, 2026. 

https://ir.aldeyra.com/news-releases/news-release-details/aldeyra-therapeutics-receives-complete-response-letter-us-food-1

Clark D, Cavanagh B, Shields AL, Karpecki P, Sheppard J, Brady TC. Clinically Relevant Activity of the Novel RASP Inhibitor Reproxalap in Allergic Conjunctivitis: The Phase 3 ALLEVIATE Trial. 

Aldeyra Therapeutics, Inc. Aldeyra Therapeutics Receives Complete Response Letter from the U.S. Food and Drug Administration for the Reproxalap New Drug Application for the Treatment of Dry Eye Disease. November 27, 2023. Accessed April 1, 2025. 

https://ir.aldeyra.com/news-releases/news-release-details/aldeyra-therapeutics-receives-complete-response-letter-us-food

Aldeyra Therapeutics, Inc. Aldeyra Therapeutics Resubmits Reproxalap New Drug Application for the Treatment of Dry Eye Disease. October 3, 2024. Accessed April 1, 2025. 

https://ir.aldeyra.com/news-releases/news-release-details/aldeyra-therapeutics-resubmits-reproxalap-new-drug-application

Aldeyra Therapeutics, Inc. Aldeyra Therapeutics Achieves Primary Endpoint in Phase 3 Dry Eye Disease Clinical Trial of Reproxalap. August 8, 2024. Accessed April 1, 2025. 

https://ir.aldeyra.com/news-releases/news-release-details/aldeyra-therapeutics-achieves-primary-endpoint-phase-3-dry-eye

Aldeyra Therapeutics, Inc. Aldeyra Therapeutics Resubmits Reproxalap New Drug Application for the Treatment of Dry Eye Disease. June 17, 2025. Accessed March 13, 2026. 

https://ir.aldeyra.com/news-releases/news-release-details/aldeyra-therapeutics-resubmits-reproxalap-new-drug-application-0

The FDA issued a Complete Response Letter for reproxalap’s NDA in dry eye disease, citing insufficient substantial evidence from adequate, well-controlled studies and inconsistent efficacy findings across the program. No safety or manufacturing deficiencies were identified, aligning with prior reviews. Supportive data included a Phase 3 randomized, double-masked, vehicle-controlled trial meeting a symptom endpoint for ocular discomfort and a subsequent dry eye chamber study showing reduced discomfort with favorable tolerability. The Agency advised root-cause exploration and responder population identification.

The FDA has issued its third CRL to topical ocular reproxalap for the treatment of signs and symptoms of dry eye disease.

FDA Issues Third Reproxalap CRL for Dry Eye Disease

Even Routine Urinalysis Can Reveal Hidden IgAN In Young Patients, With Corey Cavanaugh, DO

 often silent presentation, clinicians should remain vigilant for hypertension and microscopic hematuria during routine evaluations, particularly among younger adults.

“It's not unusual that patients get a life insurance policy evaluation and get screened for hematuria, or they're getting some sort of surgery and a pre-op evaluation. Clinicians should pay close attention to hypertension and microscopic hematuria, especially in young people. Of course, this is a young person's disease,” said Corey Cavanaugh, DO, an academic nephrologist at the Cleveland Clinic, in an interview with HCPLive. “It can be easy to talk away these things, or at least give them a reasonable explanation that isn't IgAN, because they're non-specific features, so it requires a high index of suspicion and an astute clinician for the non-nephrologist, especially.”

The majority of patients with IgAN present with non-visible hematuria, proteinuria, impaired kidney function, or hypertension, features often classified as silent symptoms. A recent study found that approximately 60% of IgAN cases were detected incidentally through hematuria or proteinuria on urinalysis.

Since many early symptoms are subtle, clinicians often rely on measurable markers to assess disease activity and progression risk. Among these, proteinuria remains one of the most important indicators for identifying patients at greater risk of disease progression and kidney failure.

“The most powerful prognostic clinical indicators are few, actually, but the most powerful one I tend to adhere to is still proteinuria,” said Cavanaugh.

Proteinuria often serves as a key trigger for further diagnostic evaluation. According to the 2025 

Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guidelines for IgAN and IgA Vasculitis (IgAV)

, clinicians should perform a kidney biopsy to confirm diagnosis in patients with suspected IgAN and persistent proteinuria ≥0.5 g/day.

Early detection is increasingly important as the therapeutic landscape for IgAN expands. New targeted treatments, including selective corticosteroids, dual endothelin-angiotensin blockers, and emerging complement inhibitors, offer opportunities to slow disease progression and reduce proteinuria.

Editor’s Note: Cavanaugh reports relevant disclosures with Otsuka Pharmaceutical Co, Novartis Pharmaceutical Corporation, Travere Therapeutics, and Vera Therapeutics.

Stoneman S, Teh JW, O’Shaughnessy MM. IgA Nephropathy in Adults. JAMA. Published online January 26, 2026. doi:

Floege J, Barratt J, Cook HT, et al. Executive summary of the KDIGO 2025 Clinical Practice Guideline for the Management of Immunoglobulin A Nephropathy (IgAN) and Immunoglobulin A Vasculitis (IgAV). Kidney international. 2025;108(4):548-554. doi:

https://doi.org/10.1016/j.kint.2025.04.003

Even Routine Urinalysis Can Reveal Hidden IgA Nephropathy, Especially in Young Adults

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