Highlights from the January 2019 Issue

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 the field of nephrology. From the January 2019 issue:

Estimated GFR and Hospital-Acquired Infections Following Major Surgery by Junichi Ishigami et al

From the authors: Reduced kidney function increases the chance of infection. However, it is not well-understood whether patients with reduced kidney function have a high risk of developing hospital-acquired infections when they undergo a major surgery. In this study, we analyzed the post-operative incidence of hospital-acquired infections using data from a health care cohort of residents in Stockholm, Sweden, who underwent orthopedic, abdominal, cardiothoracic and vascular, or neurological surgery. We found that patients with reduced kidney function had a higher chance of developing hospital-acquired infections following the surgery compared to patients with preserved kidney function. Reduced kidney function had the strongest association with hospital-acquired infection risk among other risk factors, such as cancer, heart failure, cerebrovascular disease, chronic obstructive lung disease, coronary heart disease, diabetes, and liver disease. These findings may inform policies directed at reducing hospital-acquired infections following major surgery.

Editorial Kidney Function and Hospital-Acquired Infections: Worth a Deeper Look by Seth Wright et al [FREE]

Effects of Intensive Blood Pressure Lowering on Kidney Tubule Injury in CKD: A Longitudinal Subgroup Analysis in SPRINT by Rakesh Malhotra et al 

Editorial Estimated GFR Decline and Tubular Injury Biomarkers With Intensive Blood Pressure Control by Carl P. Walther et al [FREE]

Effect of Intensive Blood Pressure Lowering on Kidney Tubule Injury: Findings From the ACCORD Trial Study Participants by Girish N. Nadkarni et al 

Editorial Estimated GFR Decline and Tubular Injury Biomarkers With Intensive Blood Pressure Control by Carl P. Walther et al [FREE]

Screening for Latent Tuberculosis Infection in Migrants With CKD: A Cost-effectiveness Analysis by Jonathon R. Campbell et al

From the authors: Tuberculosis is the leading cause of death to due to infectious disease worldwide. In low-tuberculosis incidence countries, such as Canada and the United States, most tuberculosis emerge in individuals with long-standing latent tuberculosis infection from countries with an elevated incidence of tuberculosis. To eliminate tuberculosis, innovative approaches are required that consider both feasibility and cost. In this study, we evaluate the cost-effectiveness of a targeted approach to latent tuberculosis screening and treatment in migrants to Canada who either require dialysis or have chronic kidney disease (CKD). We found that latent tuberculosis screening and treatment in migrants requiring dialysis from elevated-incidence countries is likely feasible and cost-effective, while screening migrants who were 60 years of age and older with CKD was also cost-effective. These results suggest that it could also be cost-effective to screen other migrant populations with medical risk-factors for tuberculosis, such as those on immunosuppressants or with certain cancers.

Editorial Decision Science at Work: The Case of Latent Tuberculosis Screening by Abriana Tasillo and Benjamin P. Linas [FREE]

Outcomes of the First and Second Hemodialysis Fistula: A Cohort Study by Fareed Kamar et al 

From the authors: Arteriovenous fistulas are the best form of vascular access for hemodialysis, but they often fail, and patients need to decide whether to undergo a second placement of a fistula. We studied a cohort of over 1,000 Canadian hemodialysis patients who received at least one fistula and measured how often the first and second fistula were used successfully. We also sought to determine whether successful use of the first fistula predicted successful use of the second fistula in patients who received two fistulas. We found that the initial fistula was successfully used for a longer period of time than the second fistula. Among patients who received two fistulas, successful use of the initial fistula predicted successful use of the second fistula, but the association was weak. Successful use of fistulas is difficult to predict based on clinical characteristics and previous vascular access history. These findings can inform vascular access counseling and decision-making.

Blog Post Fistula First? Fistula Second? by Sean Kalloo [FREE]

Incident Type 2 Diabetes Among Individuals With CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study by Christopher Jepson et al [FREE]

From the authors: Few studies have been conducted to determine the risk of developing type 2 diabetes mellitus (T2DM) in patients with CKD prior to end-stage renal disease (ESRD). In this analysis of data from the Chronic Renal Insufficiency Cohort (CRIC) Study, the main goals were to examine rates of and risk factors for T2DM. The overall incidence rate was 17.81 cases per 100 person-years, substantially higher than rates seen in the general population. A number of potential risk factors that have been found to be associated with T2DM in the general population were examined, in addition to two measures of kidney function and damage. All of these factors were measured at study entry. In analyses controlling for confounding variables, two risk factors were significantly associated with risk of subsequently developing T2DM: fasting blood sugar and family history of diabetes.

Using All Longitudinal Data to Define Time to Specified Percentages of Estimated GFR Decline: A Simulation Study by Jarcy Zee et al 

From the authors: Clinical research studies of CKD progression are often interested in time to a specified percentage decline in kidney function based on the estimated glomerular filtration rate (eGFR). The standard method for calculating this event time may be inaccurate because it is based on only two eGFR measures. This study presents a new method that uses all eGFR values over a patient’s follow-up to calculate the time to a percentage decline in eGFR. Computer simulations were used to compare the accuracy of the new and standard methods under a broad set of assumptions. These two methods were also compared using data from the Nephrotic Syndrome Study Network (NEPTUNE) and the Clinical Phenotyping and Resource Biobank Core (C-PROBE) Study, two heterogeneous cohorts of individuals with CKD. The new method, using all longitudinal eGFR values, was more accurate and powerful than traditional methods and represents a new tool for studying kidney disease progression.

On the Cover: Over the 35 years since the discovery of human immunodeficiency virus (HIV) as the causative agent of AIDS, tremendous progress has been made in the understanding and treatment of HIV infection. As a result, what was once a uniformly lethal infection, commonly complicated by kidney disease, is now highly treatable and compatible with a long, healthy life-span for many. Remarkably, these advances have also made accessible kidney transplantation for HIV-positive patients who develop kidney failure. This month’s cover illustration depicts a maturing virion in the last step in the 7-stage life cycle of HIV. In this issue of AJKD, Malat et al describe their center’s 16-year experience and success with kidney transplantation for patients infected with HIV:

Kidney Transplantation in HIV-Positive Patients: A Single-Center, 16-Year Experience by Gregory E. Malat et al

The image “HIV maturation, HIV viral life cycle, illustration” is by David S. Goodsell, PhD, The Scripps Research Institute. From the Wellcome Collection, available under a CC BY license.



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