Highlights from the March 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 March 2019 issue:

Trends in Incidence of ESKD in People With Type 1 and Type 2 Diabetes in Australia, 2002-2013 by Digsu N. Koye et al

From the authors: In a national registry-based study in Australia, with over a million people with diabetes, we showed different trends in risk of developing end-stage kidney disease (ESKD) in type 1 and type 2 diabetes. In type 1 diabetes, the risk was stable between 2002−2013. In contrast, the risk of developing ESKD increased steadily in type 2 diabetes over the 12 years, driven mainly by those younger than 50 and those older than 80 years.

DOI: 10.1053/j.ajkd.2018.10.005

Editorial Increasing ESKD in Diabetes in the Land Down Under: What Can Be Done, We Must Wonder by Peter Rossing et al [FREE]

Treatment of Anemia With Darbepoetin Prior to Dialysis Initiation and Clinical Outcomes: Analyses From the Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT) by Finnian R. Mc Causland et al

DOI: 10.1053/j.ajkd.2018.10.006

Editorial Anemia in Non–Dialysis-Dependent CKD: To Treat or Not to Treat? by Steven Fishbane et al [FREE]

Blog Post Anemia in Patients Approaching Dialysis: Moving From When to TREAT to Whether to TREAT by Daniel Coyne [FREE]

Kidney Transplantation in C3 Glomerulopathy: A Case Series by Renu Regunathan-Shenk, et al 

From the authors: C3 glomerulopathy (C3G) is a rare form of progressive kidney disease due to over-activation of a part of the immune system known as the complement pathway whose normal function is to help prevent and lessen the severity of bacterial infection. C3G often leads to kidney failure necessitating dialysis or transplantation despite treatment with immunosuppressive medications. We examined the baseline laboratory features and clinical course of 19 patients with C3G who underwent kidney transplantation to better understand the natural history of the disease after receipt of a transplant. We observed that a large percentage of our patients with C3G developed recurrent disease in the kidney transplant and that a large percentage of kidney transplants permanently stopped functioning despite treatment with transplant immunosuppression medications. In a small subset of patients with recurrent disease who were treated with a medication that directly inhibits the complement system, the outcomes were not consistently beneficial.

DOI: 10.1053/j.ajkd.2018.09.002

Dialysis Modality and Incident Atrial Fibrillation in Older Patients With ESRD by Jingbo Niu et al  

From the authors: Atrial fibrillation is a common heart rhythm disorder that is associated with a poor prognosis in affected patients. Individuals with irreversible kidney failure who require dialysis have been shown to have a high burden of this arrhythmia, but it was previously unknown whether the risk of developing atrial fibrillation varied among different types of dialysis. This study evaluated older patients with irreversible kidney failure new to dialysis. It found that those whose kidney failure was treated with peritoneal dialysis, a treatment modality some patients can perform in their homes, had lower rates of developing atrial fibrillation than did patients who were treated with hemodialysis delivered in specialized treatment centers. The risk of atrial fibrillation was lower with peritoneal dialysis during the first 3 months of treatment for kidney failure but not thereafter. As many patient have a choice between different types of dialysis, they and their physicians can factor this new information into their decision-making.

DOI: 10.1053/j.ajkd.2018.09.011

Burden of Care and Quality of Life Among Caregivers for Adults Receiving Maintenance Dialysis: A Systematic Review by Elise L. Gilbertson et al [FREE] 

From the authors: End-stage kidney disease (ESKD) needing dialysis is a burdensome condition. While there has been much attention on the people needing dialysis, the experience of caregivers on whom they are often reliant for support has been less well-characterized. We conducted a systematic review of published literature on the burden experienced by and quality of life of caregivers of adult dialysis patients. We found that caregivers suffer significantly from the burden and experience poorer quality of life than the general population. Their quality of life was comparable to caregivers of people with other forms of chronic disease. However, the studies reviewed were of poor quality and difficult to compare. Further studies are needed to better measure caregiver quality of life, to further examine the impact of different types of dialysis, and to identify and implement interventions that improve caregiver well-being.

DOI: 10.1053/j.ajkd.2018.09.006

Use of Measures of Inflammation and Kidney Function for Prediction of Atherosclerotic Vascular Disease Events and Death in Patients With CKD: Findings From the CRIC Study by Richard L. Amdur et al [OPEN ACCESS]

From the authors: Patients with chronic kidney disease (CKD) have accelerated atherosclerosis and an increased risk of cardiovascular death. In this study, we examined whether the knowledge of kidney function and markers of inflammation improves predictions atherosclerotic vascular disease events and death in patients with CKD beyond predictions made using traditional cardiovascular risk factors. We used the data from 2,399 study participants enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study who did not have any history of cardiovascular disease at time of enrollment. During an average follow-up of 7.3 years, about 20% of the patients had experienced either a myocardial infarction, peripheral arterial disease, stroke, or death. Some markers of inflammation measured at baseline were associated with subsequent atherosclerotic vascular events and death. A probability estimate based on traditional cardiovascular risk factors as well as kidney function and markers of inflammation significantly improved the accuracy of risk prediction beyond that achieved by traditional risk factors alone.

DOI: 10.1053/j.ajkd.2018.09.012

Determinants of Urine Volume in ADPKD Patients Using the Vasopressin V2 Receptor Antagonist Tolvaptan by Bart J. Kramers et al 

From the authors: The vasopressin V2 receptor antagonist tolvaptan is the first drug that has been shown to slow disease progression in patients with autosomal dominant polycystic kidney disease (ADPKD). As a side-effect, this drug causes massive polyuria that averages 6 liters per day, limiting tolerability. In this study, we aimed to assess the determinants of urine volume in ADPKD patients using tolvaptan for a period of 3 weeks. In a short-term trial in patients using tolvaptan, we analyzed 24-hour urine volumes, kidney function, and tolvaptan concentrations. We found that osmolar intake (consisting mostly of salt and protein) was the most important determinant of urine volume in patients that use tolvaptan. These findings suggest that dietary osmolar restriction could may decrease polyuria in these patients, and possibly improve tolvaptan tolerability.

DOI: 10.1053/j.ajkd.2018.09.016

Blog Post Predicting Polyuria: Can We Help Patients with ADPKD Better Tolerate Tolvaptan? by Diana Mahbod [FREE]

On the Cover: On March 14, 2019, the 14th annual World Kidney Day (WKD) will focus on the global burden of kidney disease, highlighting disparities in outcomes and access to specialty care. An important goal of WKD is to raise awareness about how political, economic, cultural, and dietary factors influence care across the spectrum of kidney disease, from prevention of chronic kidney disease to end-stage disease. Every year, hundreds of events in many countries are organized on WKD, from health screenings to educational sessions to exercise classes. The mission is simple: to work together toward kidney health equity across the globe.

In celebration of #NationalKidneyMonth and #WorldKidneyDay, AJKD presents a special collection of articles highlighting various health disparities in kidney disease. All articles in this collection will be freely available until May 1, 2019.

Cover image adapted from the WKD 2019 campaign image, ©World Kidney Day 2006-2019.

Special Reports from the March 2019 issue:

Exploring Barriers and Potential Solutions in Home Dialysis: An NKF-KDOQI Conference Outcomes Report by Christopher T. Chan et al [FREE]

Home dialysis therapy, including peritoneal dialysis (PD) and home hemodialysis (HHD), are underused dialysis modalities in the United States. On the occasion of the 20th anniversary of its launch, NKF-KDOQI sponsored a 2-day controversies conference on home dialysis. The conference program was structured to help determine barriers to home dialysis therapy regarding both initiating home dialysis therapy and retention in the home dialysis program, as well as identifying potential solutions to those barriers. In this report, the authors review the major barriers, facilitators, and potential solutions to home dialysis therapy initiation and maintenance discussed at the conference.

DOI: 10.1053/j.ajkd.2018.09.015


Outcomes of the chronic kidney disease standard set divided into 2 tiers, covering essential and important outcomes, to guide implementation. Abbreviations: eGFR, estimated glomerular filtration rate; PD, peritoneal dialysis; PROM, patient-reported outcome measure.. Figure 5 from Verberne et al, AJKD, © National Kidney Foundation.

Value-based health care is increasingly promoted as a strategy for improving care quality by benchmarking outcomes that matter to patients relative to the cost of obtaining those outcomes. To support the shift toward value-based health care in chronic kidney disease (CKD), ICHOM assembled an international working group of health professionals and patient representatives to develop a standardized minimum set of patient-centered outcomes targeted for clinical use. The aim of the project was to propose a standardized minimum set of patient-centered outcomes for CKD, including patient-reported outcome measures (PROMs) and case-mix factors to increase the usefulness of comparisons across treatment modalities and institutions, targeted for clinical use to enable standardization of health outcome measurement in routine clinical practice in different settings.

DOI: 10.1053/j.ajkd.2018.10.007



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