Background: Consumption of ultra‐processed food, which is manufactured food that is high in additives and sparse in intact foods, is adversely associated with cardiovascular health, primarily in non‐US study populations. We aimed to estimate the association between ultra‐processed food consumption and incident hypertension in middle‐aged adults in the United States. Methods and Results: We included 8923 ARIC (Atherosclerosis Risk in Communities) study participants who were hypertension free at baseline and had complete dietary, covariate, and hypertension data from visit 1 (1987–1989). Over a median (25th, 75th percentile) follow‐up of 13 (6–21) years, 79% of participants developed hypertension. Participants in the highest quartile of ultra‐processed food consumption had 15% higher risk of incident hypertension than those in the lowest quartile (hazard ratio [HR], 1.15 [95% CI, 1.08–1.23]). Participants in the highest quartile of consumption of sugar‐sweetened beverages, red and processed meat, and margarine had 16% (HR, 1.16 [95% CI, 1.08–1.24]; p‐trend <0.001), 10% (HR, 1.10 [95% CI, 1.03–1.19]; P trend = 0.005), and 6% (HR, 1.06 [95% CI, 0.99, 1.45]; P trend = 0.045) higher risk of incident hypertension, respectively, when compared with the lowest quartiles of consumption. Each additional serving of minimally or unprocessed food was associated with a 2% lower risk of incident hypertension (HR, 0.98 [95% CI, 0.98, 0.99], P <0.001). Conclusions: High consumption of ultra‐processed foods, specifically of sugar‐sweetened beverages, red and processed meat, and margarine, was associated with a higher incidence of hypertension, whereas minimally or unprocessed food consumption was associated with lower hypertension risk.

Limited data exist on patient perspectives of the implications of kidney biopsies. We explored patients' perspectives alongside those of clinicians to better understand how kidney biopsies affect patients' viewpoints and the clinical utility of biopsies. Prospective Cohort Study. Patient participants and clinicians in the Kidney Precision Medicine Project, a prospective cohort study of patients who undergo a research protocol biopsy, at 9 recruitment sites across the United States. Surveys were completed at enrollment before biopsy and additional timepoints after biopsy (participants: 28 days, 6 months; clinicians: 2 weeks). Kappa statistics assessed prebiopsy etiology concordance between clinicians and participants. Participant perspectives after biopsy were analyzed using a thematic approach. Clinician ratings of clinical management value were compared to prebiopsy ratings with Wilcoxon matched-pairs signed-rank tests and paired t tests. A total of 167 participants undergoing biopsy (124 participants with chronic kidney disease [CKD], 43 participants with acute kidney injury [AKI]) and 58 clinicians were included in this study. CKD participants and clinicians had low etiology concordance for the 2 leading causes of CKD: diabetes (k = 0.358) and hypertension (k = 0.081). At 28 days postbiopsy, 46 (84%) participants reported that the biopsy affected their understanding of their diagnosis, and 21 (38%) participants reported that the results of the biopsy affected their medications. Participants also shared biopsy impressions in free-text responses, including impacts on lifestyle and concurrent condition management. The biopsy positively shifted clinician perceptions of the procedure’s clinical management benefits, while perceptions of prognostic value decreased and diagnostic ratings remained unchanged. Our study did not have demographic data of clinicians and could not provide insight into postbiopsy experiences for participants who did not respond to follow-up surveys. Participant perspectives of the personal implications of kidney biopsy can be integrated into shared decision-making between clinicians and patients. Enhanced biopsy reports and interactions between nephrologists and pathologists could augment the management and prognostic value of kidney biopsies. The utility of kidney biopsy is debated among clinicians, and patients’ perspectives are even less explored. To address these gaps, we synthesized perspectives from clinicians and patient participants of the Kidney Precision Medicine Project (KPMP). Both before and after biopsy, clinicians were surveyed on how the procedure affected their clinical management, diagnosis, and prognosis. After biopsy, participants shared how the procedure affected their diagnosis, medication, and lifestyle changes. Clinicians and patients shared an appreciation for the biopsy’s impact on medical management but diverged in their takeaways on diagnosis and prognosis. These findings highlight the need for greater collaboration between patients and clinicians, particularly as they navigate shared decision-making when considering kidney biopsy.

Key Points: We identified metabolomic markers of dietary potassium and diet-related metabolites that were associated with incident CKD in US adults. These metabolites may be prioritized for elucidating mechanisms that could be modified by dietary strategies to prevent CKD. Background: Discovering metabolomic markers of dietary potassium may help improve dietary assessment of potassium and trace the effect of dietary potassium on CKD development. Methods: We included adults from the Atherosclerosis Risk in Communities study without CKD at visit 1 (N=3812). Cross-sectional associations between dietary potassium and serum metabolites were assessed using multivariable linear regression models. Cox regression models estimated hazard ratios for potassium-related metabolites and incident CKD. Incident CKD was defined as eGFR (<60 ml/min per 1.73 m² and ≥25% decline), CKD-related hospitalization or death, or KRT identified using the United States Renal Data System registry from visit 1 (1987–1989) through December 31, 2020. Results: There were 33 significant associations between dietary potassium and serum metabolites, including pyridoxate, N-methylproline, stachydrine, pantothenate, and scyllo-inositol. During more than two decades of follow-up (median: 23 years, 25th–75th percentile: 14–30), 1616 (42%) of participants developed incident CKD. Ten of the 33 potassium-related metabolites were significantly associated with incident CKD. Metabolites involved in phenylalanine and tyrosine metabolism—3-(4-hydroxyphenyl)lactate and 3-phenylpropionate—were significantly associated with dietary potassium and CKD. In addition, glycerate, involved in glucose metabolism, was positively associated with dietary potassium (β=0.09, P = 4.01×10⁻¹⁷) and inversely associated with CKD (hazard ratio, 0.77; 95% confidence interval, 0.69 to 0.85; P = 8.57×10⁻⁷). There was a significant trend for CKD risk across quartiles of 3-(4-hydroxyphenyl)lactate, 3-phenylpropionate, and glycerate. Conclusions: Dietary potassium was associated with 33 serum metabolites. 3-(4-hydroxyphenyl)lactate 3-phenylpropionate and glycerate are candidate markers of dietary potassium's effect on CKD.

Key Points: We identified ten plasma proteins associated with dietary potassium and CKD risk in a US adult population. These proteins highlighted mechanisms involving iron deposition, mitochondrial function, kidney inflammation, and fibrosis. Promoting the consumption of potassium-rich foods could be an effective strategy for CKD prevention. Background: There is a need for objective biomarkers of dietary potassium. The mechanisms through which dietary potassium influences kidney health are incompletely understood. Methods: Atherosclerosis Risk in Communities study participants at visit 3 (1993–1995) with dietary and proteomics data were randomly divided into discovery ( n =6814) and replication ( n =3380) sets. We examined associations between dietary potassium and 4955 aptamers using multivariable linear regression, adjusting for sociodemographic factors, health behaviors, and eGFR, with a false discovery rate of 0.05. Then, we tested the prospective associations between potassium-related proteins and incident CKD. Results: Dietary potassium was significantly associated with 147 proteins in discovery, of which 85 (33 positive, 52 negative) replicated. Of 85 replicated proteins, 30 were selected by elastic net and improved prediction of high dietary potassium individually and collectively. Over a median follow-up of 21 years, 1698 CKD cases developed. A score derived from 30 elastic net-selected dietary potassium-related proteins was associated with 7% lower risk of CKD (95% confidence interval, 0.88 to 0.98; P = 0.01). Of 85 potassium-related proteins from replication, 10 were associated with incident CKD. Specifically, pigment epithelium-derived factor and follistatin-related protein 3 were inversely associated with potassium and linked to 57% and 55% higher risk of CKD, respectively. Positively associated with potassium, TOM1-like protein 1 and serine/threonine-protein kinase pim-1 were associated with 28% and 26% lower risk of CKD, respectively. A score of 6 proteins mediated the association between potassium and CKD risk was associated with 13% lower risk of CKD (95% confidence interval, 0.83 to 0.92; P = 8.09×10 ⁻⁷ ). Conclusion: Proteins associated with dietary potassium and incident CKD represented biologic pathways including iron metabolism, mitochondrial function, fibrosis, and immune-inflammatory responses, which help explain the effect of potassium intake on CKD.

Background: People who inject drugs (PWID) comprise the majority of patients with native tricuspid valve (TV) infective endocarditis (IE). Many patients require surgical repair or replacement of their TV, but some may be deemed ineligible for surgical management due to high operative risk or patient preference. Vacuum-assisted percutaneous mechanical aspiration (PMA) has emerged as a potential alternative to surgical management in this population. The objective of this study was to describe real world patient characteristics and clinical outcomes in PWID who underwent PMA or surgical management of TV IE. Methods: We retrospectively reviewed PWID hospitalized with endocarditis at a single tertiary care center (2016–2025) who underwent an isolated PMA or surgical TV repair/replacement (TVR). Baseline demographic, clinical, microbiologic, and echocardiographic characteristics were described. Clinical outcomes were compared descriptively between groups, recognizing imbalances in treatment selection. Results: 40 PWID met inclusion criteria; 17 underwent PMA and 23 underwent surgical TVR. There was substantial baseline clinical heterogeneity between the two groups. Procedural success was numerically higher with surgery than PMA (95.7% vs 88.2%). Clinical success, a composite of procedural success, treatment completion, and lack of need for reintervention, was numerically higher in the TVR group (73.9% vs 52.9%). One-year mortality was similar between groups. Conclusion: In this single-center retrospective observational cohort of PWID with TV IE, patients who underwent PMA experienced lower rates of procedural and clinical success compared with TVR, although outcomes may be reflective of baseline differences between groups. These findings emphasize the importance of patient selection when deciding on TV IE intervention. PMA may be a feasible source-control strategy for select patients not eligible for immediate surgery; however, larger prospective studies are needed to define optimal patient selection factors and comparative effectiveness.