March 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.

Results of ASERTAA, a Randomized Prospective Crossover Pharmacogenetic Study of Immediate-Release Versus Extended-Release Tacrolimus in African American Kidney Transplant Recipients by Jennifer Trofe-Clark et al [OPEN ACCESS]

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Editorial Tacrolimus Formulations and African American Kidney Transplant Recipients: When Do Details Matter? by Dirk R.J. Kuypers [FREE]

Blog Post  ASERTAA: Towards Optimizing Tacrolimus-based Immunosuppression in African American Kidney Transplant Recipients by Beatrice Concepcion

Patient-Reported Outcome Measures for Fatigue in Patients on Hemodialysis: A Systematic Review by Angela Ju et al

Editorial Assessing Fatigue in the ESRD Patient: A Step Forward by Fredric O. Finkelstein & Susan H. Finkelstein [FREE]

Blog Post Studying Fatigue in Hemodialysis Patients: Are We Doing It Wrong? by Nathaniel Reisinger

Comparison of Patient Survival Between Hemodialysis and Peritoneal Dialysis Among Patients Eligible for Both Modalities by Ben Wong et al

From the authors: To compare survival between in–center and home dialysis, we studied patients who developed end-stage kidney failure and who were deemed fit enough to undergo either type of dialysis. Using data from seven dialysis centers in Canada between January 2004 and December 2013, we found that neither type of dialysis was associated with longer survival regardless of age. The effect of the type of dialysis on survival also did not appear to change over time. This study supports the use of home dialysis therapy, which remains underutilized, despite its lower costs to the healthcare system.

Editorial Dialysis Modality Survival Comparison: Time to End the Debate, It’s a Tie by Bernard G. Jaar  & Luis F. Gimenez [FREE]

Photo: ardisd / 123RF

Blog Post  PD or HD: Which Road Do We Take? by Roger Rodby

Effects of Intensive Blood Pressure Treatment on Acute Kidney Injury Events in the Systolic Blood Pressure Intervention Trial (SPRINT) by Michael V. Rocco et al

From the authors: The SPRINT trial demonstrated a beneficial effect of a lower systolic blood pressure (120 mm Hg versus 140 mm Hg) on cardiovascular events and all-cause mortality in participants with an increased risk of cardiovascular events. One of the adverse effects of the intervention was an increase in the number of acute kidney injury (AKI) events in the lower blood pressure arm of the trial. These AKI events were relatively rare, seen in less than 5% of SPRINT participants. The AKI was usually mild in severity, based on standard criteria, and the level of severity was not different between the two study arms. Finally, most cases of AKI were reversible with recovery to within 20% of the pre-AKI creatinine value.  

Blog Post: Lower Blood Pressure, Higher Creatinine? No Need to Worry! by Swapnil Hiremath

Uric Acid and the Risks of Kidney Failure and Death in Individuals With CKD by Anand Srivastava et al

From the authors: Plasma uric acid levels rise in patients with chronic kidney disease (CKD) due to impaired excretion. Uric acid may be a uremic or cardiovascular toxin that causes kidney injury, endothelial dysfunction, and oxidative stress. We tested the association between plasma uric acid levels at baseline and the future development of kidney failure and death in a cohort of individuals with established CKD. During a median follow-up time of 7.9 years, we found that higher levels of uric acid were associated with increased risk for kidney failure, primarily in those with less advanced CKD at baseline. In addition, the relationship between plasma uric acid and death was ‘J’-shaped, suggesting a higher risk for death in individuals with high and low plasma uric acid levels. Future randomized, placebo-controlled trials in CKD are needed to test whether urate lowering may prove to be an effective approach to prevent complications and progression of CKD.

Hemodialysis Self-management Intervention Randomized Trial (HED-SMART): A Practical Low-Intensity Intervention to Improve Adherence and Clinical Markers in Patients Receiving Hemodialysis by Konstadina Griva et al

From the authors: Hemodialysis patients have to make major lifestyle changes regarding their diet, fluid intake, and medication. Meeting these demands is difficult, but improving compliance may reduce complications. This project evaluated an intervention based on self-management principles, designed to empower patients and give them increased abilities in managing their kidney disease. Renal health professionals were trained to deliver the intervention comprising 4 group sessions. Patients were randomly assigned to the program and were compared to patients receiving usual care with respect to self-reported compliance, self-management, and clinical markers of disease management. The program led to improvements in both physical health (e.g., reduced interdialytic weight gains and potassium) and psychological well-being. The feasibility of this program suggests that it may have the potential to benefit patients if added to their usual care.

Vascular Access Outcomes Reported in Maintenance Hemodialysis Trials: A Systematic Review by Andrea K. Viecelli et al 

From the authors: A reliably functioning vascular access is associated with improved health outcomes and overall well-being of patients on hemodialysis. Improving vascular access outcomes is a high priority for patients, their caregivers, and health professionals. This study outlines the substantial variability and inconsistency in vascular access outcome measures reported in hemodialysis trials, with very little focus on patient-reported outcomes; this makes it very difficult to reliably evaluate the comparative effectiveness of different interventions designed to improve the lives of people on hemodialysis. This study helps to develop standardized vascular access outcome measures that are relevant to patients, clinicians, and policy makers to improve the quality of trial evidence and to facilitate informed decision-making by clinicians and patients.

Mortality and Allograft Loss Trends Among US Pediatric Kidney Transplant Recipients With and Without Focal Segmental Glomerulosclerosis by Chia-shi Wang et al 

From the authors: Focal segmental glomerulosclerosis (FSGS) is one of the most common causes of kidney failure and need for kidney transplantation in children. One unique challenge facing young patients with FSGS is that FSGS can recur after transplantation and cause graft loss. We used the largest renal disease registry in the United States to determine the rates of mortality and allograft loss among children with and without FSGS. We found that patients with FSGS had an increased risk of allograft loss compared to patients without FSGS. Surprisingly, this risk was even more prominent among patients transplanted in the 2000s than in the 1990s. Despite this increased risk for allograft loss, patients with FSGS did not have higher mortality compared to patients without FSGS. This is encouraging news for patients with FSGS, but our results highlight that there is still much work to be done to address the issue of allograft failure in FSGS.

March 2018

On the Cover: On March 8, 2018, the 13th annual World Kidney Day will direct our attention to the unique aspects of kidney disease in women. International Women’s Day 2018 will share this day with its campaign theme of “Press for Progress” toward gender parity. Both events call attention to gender-specific aspects of kidney disease such as preeclampsia, the effects of CKD on pregnancy outcomes, and disparities that negatively affect the lives of women around the globe: a greater incidence and severity of autoimmune diseases, differential access to renal replacement therapies (including kidney transplantation), and an increased risk of hospitalization. Beyond seeking causes for and strategies to reduce gender disparities in kidney disease, AJKD also supports efforts to “include, value, and empower” the role and voice of women in research. World Kidney Day is a joint initiative of the International Society of Nephrology and the International Federation of Kidney Foundations.