Editor’s Note: We asked authors of Original Investigations to provide short plain language 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 valuable in helping them keep up with the latest research in nephrology. From the December 2018 issue:
The Validity of Drug Effects on Proteinuria, Albuminuria, Serum Creatinine, and Estimated GFR as Surrogate End Points for ESKD: A Systematic Review by Suetonia C. Palmer et al [OPEN ACCESS]
From the authors: Blood and urine tests hold the potential to predict whether a patient receiving medication to lower blood pressure might be prevented from developing kidney failure in the future. However, despite the widespread use of blood and urine tests as treatment endpoints, there is limited evidence they have utility in understanding patient responses to therapy. We combined data from all available trials of blood pressure lowering medications to measure whether serum creatinine and urine albumin and protein endpoints can act as surrogate markers for treatment effects on kidney failure. We found that there was little certainty in any correlation between the surrogate blood and urine tests with the outcome of end-stage kidney disease (ESKD). Based on these findings, blood and urine markers of kidney function do not provide sufficient information to reliably replace definitive kidney outcomes in research trials or policy development.
Editorial Evaluation of Surrogate End Points for Progression to ESKD: Necessary and Challenging by Lesley A. Inker and Hiddo L. Heerspink [FREE]
Risk of ESRD and Mortality in Kidney and Bladder Stone Formers by Tsering Dhondup et al [FREE]
From the authors: We studied outcomes in different categories of kidney and bladder stone formers. Recurrent symptomatic kidney stone formers were at increased risk of ESKD but this was not observed among individuals with a first-time symptomatic kidney stone. Asymptomatic kidney stone formers, bladder stone formers, and individuals mistakenly coded as stone formers were at higher risk for ESKD, death, or both, an elevated risk that was likely due to conditions other than kidney or bladder stones.
Febuxostat Therapy for Patients With Stage 3 CKD and Asymptomatic Hyperuricemia: A Randomized Trial by Kenjiro Kimura et al [OPEN ACCESS]
From the authors: We conducted a randomized, double-blind, placebo-controlled trial of febuxostat in 467 patients with stage 3 chronic kidney disease (CKD) and asymptomatic hyperuricemia at 55 medical institutions in Japan. The primary endpoint was the slope (mL/min/1.73 m2 per year) of the estimated glomerular filtration rate (eGFR). No significant difference was found in the mean eGFR slope between the febuxostat and the placebo groups. A benefit from febuxostat was observed within the subgroups of patients with more preserved kidney function and patients with less protein in the urine. Adverse events specific to febuxostat did not occur.
Editorial Urate-Lowering Therapy for Preventing Kidney Disease Progression: Are We There Yet? by Pietro Manuel Ferraro and Gary C. Curhan [FREE]
Postcontrast Acute Kidney Injury in Pediatric Patients: A Cohort Study by Jennifer S. McDonald et al
From the authors: Acute kidney injury (AKI) following iodinated contrast material exposure, also known as contrast-induced nephropathy, has not been well-studied in the pediatric population. We examined the rate of post-contrast AKI, dialysis, and death in a cohort of pediatric patients who underwent contrast-enhanced CT exams and compared those rates to clinically-similar pediatric patients who did not receive contrast. We found that the rates of these outcomes were low overall and were not detectably different from that observed in pediatric patients who did and did not get contrast. These findings provide additional evidence regarding the safety of iodinated contrast material usage in pediatric patients.
Blog Post Postcontrast AKI in Pediatrics: Not Just Little Adults by Aadil Kakajiwala and Vikas Dharnidarka [FREE]
On the Cover: Descriptions of nephrolithiasis appear throughout history in medical texts from ancient civilizations such as Mesopotamia, Greece, India, and Rome. Modern-day tools now permit the characterization of stone composition and inform our understanding of the genesis and treatment of stone disease. The cover image shows a density-dependent electron micrograph of stone crystals composed of calcium, oxalate, and urate. Two articles featured in this month’s issue examine risks of and potential approaches to prevent kidney disease progression in the setting of nephrolithiasis and hyperuricemia, respectively. Dhondup et al examine associations between risk of ESKD and categories of stone formers, while Kimura et al examine whether febuxostat slows CKD progression.
“Kidney Stone” by Sergio Bertazzo, Imperial College London; Dominique Bazin, UPMC; Chantal Jouanneau, INSERM. From Wellcome Collection, London, released under the CC BY license.
More highlights from the December 2018 issue:
Use of Renin-Angiotensin System Blockade in Advanced CKD: An NKF-KDOQI Controversies Report by Matthew R. Weir et al
Blog Post RAAS Blockade in Advanced CKD: A Serpentine Path by Roger Rodby [FREE]
Blog Post Thrombotic Microangiopathies and Stem Cell Transplant: An interview with authors, Rimda Wanchoo and Kenar Jhaveri [FREE]