2018 saw AJKD publish 96 Original Investigations out of approximately 1,000 submissions, each a reflection of the outstanding science conducted by our authors and the diligence and dedication of our editors, editorial staff, and expert reviewers. Every one of these contributions surpasses AJKD’s high standards for validity, relevance, and clinical importance.

While difficult to select from among these articles a set that best exemplifies these ideals, we have continued the tradition established in 2017 and selected four articles to receive our 2018 Editors’ Choice Award. They are listed below, along with the plain language summaries provided by the authors:

Effects of Intensive Blood Pressure Treatment on Acute Kidney Injury Events in the Systolic Blood Pressure Intervention Trial (SPRINT) by Michael V. Rocco, Kaycee M. Sink, Laura C. Lovato, Dawn F. Wolfgram, Thomas B. Wiegmann, Barry M. Wall, Kausik Umanath, Frederic Rahbari-Oskoui, Anna C. Porter, Roberto Pisoni, Cora E. Lewis, Julia B. Lewis, James P. Lash, Lois A. Katz, Amret T. Hawfield, William E. Haley, Barry I. Freedman, Jamie P. Dwyer, Paul E. Drawz, Mirela Dobre, Alfred K. Cheung, Ruth C. Campbell, Udayan Bhatt, Srinivasan Beddhu, Paul L. Kimmel, David M. Reboussin, and Glenn M. Chertow on behalf of the SPRINT Research Group (March 2018)

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.  

Residential Area Life Expectancy: Association With Outcomes and Processes of Care for Patients With ESRD in the United States by Jesse D. Schold, Stuart M. Flechner, Emilio D. Poggio, Joshua J. Augustine, David A. Goldfarb, John R. Sedor, and Laura D. Buccini (July 2018)

Proportion of patients with end-stage renal disease (ESRD) from lower life expectancy residential communities by ESRD Network. Life expectancy quintiles for women defined as quintile 1 (Q1) = (71.6, 78.7) and Q2 = (78.8, 80.0) and for men Q1 = (63.1, 73.6) and Q2 = (73.7, 75.2). Figure 4 from Schold et al, AJKD, © National Kidney Foundation.

There is wide variation in life expectancy in the United States based on residential location, thought to be a proxy for often unmeasured socioeconomic, environmental, genetic, and behavioral factors. The aim of this study was to evaluate the association of residential life expectancy with processes of care and health outcomes for patients with end-stage kidney disease (ESKD). The results indicate that patients with ESKD residing in communities with lower life expectancy have a reduced likelihood of important processes of care and decreased survival, independent of demographic characteristics and comorbid conditions. These findings illustrate that community-level measures of health are strongly and independently associated with patient outcomes.

A Randomized Trial of a Multicomponent Intervention to Promote Medication Adherence: The Teen Adherence in Kidney Transplant Effectiveness of Intervention Trial (TAKE-IT) by Bethany J. Foster, Ahna L.H. Pai, Nataliya Zelikovsky, Sandra Amaral, Lorraine Bell, Vikas R. Dharnidharka, Diane Hebert, Crystal Holly, Baerbel Knauper, Douglas Matsell, Veronique Phan, Rachel Rogers, Jodi M. Smith, Huaqing Zhao, and Susan L. Furth (July 2018)

From the authors: Poor adherence to immunosuppressive medications is a major cause of premature graft failure. Adolescents and young adults are at particularly high risk for poor adherence. We conducted a multicenter randomized clinical trial, in adolescent and young adult kidney transplant recipients, of an adherence-promoting intervention which included education, electronic adherence monitoring with feedback, text message dose reminders, identification of adherence barriers, problem-solving, and tailored action planning to address personal barriers. All participants met with a study coach every 3 months for 15 months; those assigned to intervention received all the above components while controls used the electronic monitor but received only general social support. Adherence was significantly better among patients who received the intervention than among controls. Better adherence is likely to lead to better graft survival.

A Comparative Study of Carvedilol Versus Metoprolol Initiation and 1-Year Mortality Among Individuals Receiving Maintenance Hemodialysis by Magdalene M. Assimon, M. Alan Brookhart, Jason P. Fine, Gerardo Heiss, J. Bradley Layton, and Jennifer E. Flythe (September 2018)

From the authors: Carvedilol and metoprolol are the most common beta-blockers prescribed to US hemodialysis patients. Key differences in how these medications work and are eliminated from the body may alter their risk-benefit profiles in the hemodialysis population. Carvedilol causes blood vessels to dilate or widen, but metoprolol does not. Metoprolol is removed from the body by the hemodialysis procedure, but carvedilol is not. This observational study of over 27,000 hemodialysis patients found that individuals who started carvedilol therapy had higher rates of 1-year all-cause and cardiovascular mortality compared to individuals who started metoprolol therapy. It also showed that individuals who started carvedilol therapy experienced low blood pressure during dialysis treatments more often during follow-up compared to individuals who started metoprolol therapy. These findings suggest that medical providers should consider the properties of carvedilol and metoprolol along with patient blood pressure histories when prescribing beta-blockers to individuals receiving maintenance hemodialysis.

These articles will be freely available at AJKD.org until January 25, 2019. The editors are delighted to recognize these articles and congratulate all of their authors on being selected to receive a 2018 Editors’ Choice Award.