February 2018

Editor’s Note: In an effort to improve the understanding of Original Investigation articles published in AJKD, we asked authors to provide short nontechnical summaries that would briefly summarize what inspired their study, the basic approach taken, what was learned, and why it matters. We hope our readers will find this service valuable in helping them to keep up with the latest research in the field of nephrology.

HDL Cholesterol, LDL Cholesterol, and Triglycerides as Risk Factors for CKD: A Mendelian Randomization Study by Matthew B. Lanktree et al [FREE until March 12, 2018]
From the authors: The effect of high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides on progression of chronic kidney disease is unknown. Drugs that lower LDL cholesterol prevent heart attacks, but do not appear to slow progression of kidney disease. Drugs that raise HDL cholesterol have been unsuccessful at reducing rates of heart attacks, but their effects on kidney disease are unknown. We looked at previously discovered genetic changes that alter HDL cholesterol, LDL cholesterol, and triglycerides, and examined the effect these changes have on kidney traits. Genetically determined higher HDL cholesterol was associated with better kidney function, suggesting a causal relationship; changes in LDL cholesterol and triglycerides were not associated with kidney function. The mechanisms underlying the association are yet to be determined.

Editorial Challenges in Interpreting Multivariable Mendelian Randomization: Might “Good Cholesterol” Be Good After All? by Michael V. Holmes and George Davey Smith [FREE]

Figure 1 from Holmes and Smith, AJKD © National Kidney Foundation.

Blog Post  When The Fault Lies in Our Genes: Untying the Causation Knot by Swapnil Hiremath

Hip Fracture Trends in Japanese Dialysis Patients, 2008-2013 by Minako Wakasugi et al

From the authors: Dialysis patients have definitively higher risks of hip fracture compared with the general population. Recent studies from the United States found that hip fracture incidence has declined since around 2005, both in incident dialysis patients and prevalent hemodialysis patients. These trends differ from those observed in the general population, suggesting that the improved trend is due to factors unique to dialysis patients. This is the first study to report trends for hip fracture incidence among dialysis patients outside of the United States, and demonstrates that the trends have declined and not changed in female and male Japanese dialysis patients, respectively, at the national level since 2008. Given the continual increases in age-adjusted rates of hip fracture in the Japanese general population, these findings are likely due to factors unique to dialysis patients, and are consistent with previous reports from the United States.

Editorial Declining Hip Fracture Rates in Dialysis Patients: Is This Winning the War? by Michelle Denburg & Thomas L. Nickola [FREE]

Association of Citizenship Status With Kidney Transplantation in Medicaid Patients by Jenny I. Shen et al [FREE]

From the authors: Kidney transplantation offers patients with end-stage kidney disease a longer and better quality of life at a lower cost than dialysis, the other form of treatment. Although US citizens can receive subsidized care for kidney transplantation, most states do not provide this service for undocumented immigrants. We sought to answer the question of whether undocumented immigrants do just as well as US citizens after receiving kidney transplants if similarly insured by Medicaid, a joint federal and state program health insurance program. In this observational study of over 10,000 patients, we found that only 3% of patients with Medicaid transplanted in the U.S. were undocumented immigrants. They had a lower risk of losing their transplant compared to US citizens. Policymakers should consider expanding coverage for kidney transplantation in undocumented immigrants as it is linked to high quality outcomes.

Editorial The United States Needs a National Policy on Dialysis for Undocumented Immigrants With ESRD by Lilia Cervantes et al [FREE]

Incident Atrial Fibrillation and the Risk of Congestive Heart Failure, Myocardial Infarction, End-Stage Kidney Disease, and Mortality Among Patients With a Decreased Estimated GFR by David Massicotte-Azarniouch et al

Association Between High Environmental Heat and Risk of Acute Kidney Injury Among Older Adults in a Northern Climate: A Matched Case-Control Study by Rebecca K. McTavish et al

From the authors: The dramatic increase in carbon dioxide emissions worldwide is contributing to more frequent, intense, and longer-lasting heat waves. Previous research has shown that environmental heat associates with increased risk of acute kidney injury (AKI). However, previous research has often been limited to settings with consistently high temperatures. This study shows that a modest association between environmental heat and risk of AKI is generalizable to older adults in northern settings with more fluctuating temperatures, such as Ontario, Canada. Interventions that minimize heat exposure should be considered alongside existing interventions as part of an overall strategy for mitigating the risk of AKI in older adults, even in climates not traditionally viewed as hot.

The Adoption of a One-Day Donor Assessment Model in a Living Kidney Donor Transplant Program: A Quality Improvement Project by Judi M. Graham & Aisling E. Courtney

From the authors: Living donor kidney transplantation offers the best treatment for patients with end-stage renal failure in terms of life expectancy and quality of life. Historically, the low rate of living donor kidney transplantation was linked to the lengthy and complex process of donor assessment. In an effort to improve this, we initiated a new pathway for assessing potential donors in March 2010 whereby potential donors deemed to be suitable after a screening questionnaire attended a comprehensive one-day evaluation including all investigations that had been previously been implemented across multiple clinical visits.  Since implementing this new program for assessing potential donors, we have observed a significant and sustained rise in the rates of living kidney donation and pre-emptive transplantation in our region. Making it easier for people to evaluate their suitability to donate has been an important reason for the success of our living donation program.

Figure 2 from Graham and Courtney, AJKD © National Kidney Foundation.

Blog Post How Did Northern Ireland Revolutionize Their Living Kidney Donor Transplantation Program? by Paul Phelan

An Interview Study of Patient and Caregiver Perspectives on Advance Care Planning in ESRD by Marcus Sellars et al 

From the authors: Advance care planning (ACP) is consistent with a more patient-centered approach to care; however, ACP is rarely offered to patients with end-stage kidney disease (ESKD).  ACP can be ethically and emotionally challenging for patients, their caregivers, and clinicians. We conducted qualitative interviews with patients with ESKD and their caregivers to learn how to optimize the content and delivery of ACP. While ACP fostered acceptance of the inevitability of death for some patients and caregivers, others had difficulty accepting patients’ illnesses. Some patients and providers who refused ACP found that it forced them to consider topics they considered taboo. These findings have the potential to improve the delivery of ACP and end-of-life care by addressing the goals, values and concerns of patients with ESKD.

Development of the Autosomal Dominant Polycystic Kidney Disease Impact Scale: A New Health-Related Quality-of-Life Instrument by Dorothee Oberdhan et al [OPEN ACCESS]

From the authors: Tools to measure patient-reported disease burden in ADPKD have not been well-established. Prior use of generic health-related quality of life questionnaires may not have fully measured the impact of ADPKD, potentially incorrectly suggesting that patients are not impacted by their disease until they develop kidney failure, often decades after their diagnosis. These prior findings conflicted with anecdotal information from patient reports. To develop a new patient-centered tool for assessing the impact of ADPKD on patients, we interviewed clinicians and patients, and tested the performance of the new questionnaire in an independent group of patients. The tool we developed demonstrated sound measurement properties to assess overall disease burden in patients with ADPKD, and the ability to detect changes in quality of life across CKD stages.

Figure 2 from Oberdhan et al, AJKD © National Kidney Foundation.

Blog Post Advancing Patient-Centered Care in Autosomal Dominant Polycystic Kidney Disease by Kevin J. Fowler

February 2018

On the Cover: Healthcare and immigration are critically important and actively debated topics in America’s public forum, with many points of intersection that connect the two. For example, Ellis Island, the entry point for millions of immigrants to the United States from 1892 to 1954, also operated a hospital for the quarantine and treatment of people from very diverse backgrounds. In sight of the Statue of Liberty, Ellis Island did much to fulfill Emma Lazarus’ famous sonnet, even as entry to this country was often limited by immigration quotas based on national origin. Americans’ conflicted attitudes toward immigration persist to this day. In this month’s issue of AJKD, Jenny I. Shen and colleagues examine kidney transplantation in undocumented immigrants “who are eligible for transplantation only in select states” and compare their transplant outcomes with those of US citizens and permanent residents. 

“Immigrants’ Landing, Ellis Island” Library of Congress, Prints & Photographs Division, Detroit Publishing Company Collection [reproduction number LC-DIG-det-4a25608].