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 June 2019 issue:

Serum Calcification Propensity and Coronary Artery Calcification Among Patients With CKD: The CRIC (Chronic Renal Insufficiency Cohort) Study by Joshua D. Bundy, et al [FREE until July 10, 2019]

From the authors: Cardiovascular disease (CVD) is the leading cause of death among patients with chronic kidney disease (CKD), and vascular calcification is one pathway by which risk of CVD is increased. We evaluated the associations of a novel measure of propensity for calcification, the T₅₀ test, with coronary artery calcification (CAC) prevalence, severity, incidence, and progression. We found that lower T₅₀, or higher calcification propensity, was not associated with prevalence nor incidence of CAC. However, lower T₅₀ was associated with severity and progression of CAC. These findings suggest that T₅₀ may provide clinically-useful information about CAC burden and risk for CAC progression.

DOI: 10.1053/j.ajkd.2019.01.024

Correlation Between Baseline GFR and Subsequent Change in GFR in Norwegian Adults Without Diabetes and in Pima Indians by Toralf Melsom, et al  

From the authors: Abnormally elevated kidney filtration, or hyperfiltration, causes kidney damage in animal experiments. Elevated kidney filtration is common in persons with prediabetes, obesity and diabetes, but it is unclear if it leads to loss of kidney function in humans. We measured kidney function in two longitudinal studies; 319 Native Americans in Arizona, most of whom had type 2 diabetes, and 1,594 middle-aged Norwegians without diabetes. In both studies, we found that individuals with higher kidney filtration had an increased risk for subsequent loss of kidney function during 6-9 years of follow-up with a stronger relationship observed in the Native Americans who had higher levels of kidney function at the beginning of follow-up. If a higher baseline GFR is demonstrated to be the cause of a faster rate of decline in kidney function, elevated kidney filtration may be a target for early preventive treatment that may reduce kidney function loss in persons with diabetes at risk for chronic kidney disease.

DOI: 10.1053/j.ajkd.2018.11.011

Editorial Glomerular Filtration: Too Much of a Good Thing? by Amy K. Mottl, et al [FREE]

Renal Hemodynamic Function and RAAS Activation Over the Natural History of Type 1 Diabetes by Yuliya Lytvyn

From the authors: Renin angiotensin aldosterone system (RAAS) is associated with kidney and heart complications in type 1 diabetes (T1D), which are not completely prevented with by RAAS blockers. To improve understanding, we examined how kidney function changes across a wide range of T1D durations by studying adolescents, young adults, and older adults. The results of our analyses demonstrated that adolescents with T1D have low RAAS activity and have dilated arterioles flowing into the kidney. This may cause an increased glomerular filtration rate that is thought to be a predictor of kidney injury. The older adults with T1D had increased RAAS activity and constricted arterioles flowing into the kidney. Our results suggest that exploring medications that alter the tone of kidney inflow arterioles may help protect or delay kidney complications in both early and longstanding T1D.

DOI: 10.1053/j.ajkd.2018.12.034

Editorial A Delicate Balance: Intraglomerular Hemodynamics Across Ages in Type 1 Diabetes by Natasha N. Dave and Matthew A. Sparks [FREE]

Mortality in Incident Maintenance Dialysis Patients Versus Incident Solid Organ Cancer Patients: A Population-Based Cohort by Kyla L Naylor, et al [FREE temporarily]

From the authors: A better understanding of mortality risk in maintenance dialysis patients relative to other diseases will help put their mortality burden into context and could have implications for future funding decisions. We conducted this study to examine the survival experience of patients initiating maintenance dialysis for end-stage kidney disease (ESKD) compared to patients with common cancers (women: breast, colorectal, lung, or pancreas; men: prostate, colorectal, lung, or pancreas). Male dialysis patients had a worse 5-year survival compared to prostate and colorectal cancer, but better survival than lung and pancreas cancer. Female dialysis patients had a worse 5-year survival compared to breast and colorectal cancer, but better survival than lung and pancreatic cancer. These findings highlight the need to develop interventions to improve survival in dialysis patients and may be used to aid advance care planning especially for elderly patients with ESKD.

DOI: 10.1053/j.ajkd.2018.12.011

Editorial ESKD or Cancer: Given the Choice, Which Would You Rather Have? by Kevan R. Polkinghorne [FREE]

Estimated GFR at Dialysis Initiation and Mortality in Children and Adolescents by Yusuke Okuda, et al 

From the authors: The association of estimated glomerular filtration rate (eGFR) at dialysis initiation with mortality has not been well investigated in pediatric dialysis patients. In this retrospective cohort study, we examined the association between eGFR and mortality among pediatric dialysis patients using a national database in the United States. We found a trend toward higher mortality risk among children with higher eGFR. When we separately examined the association according to age, a similar trend was observed among patients ≥6 years of age while the eGFR-mortality association was attenuated in patients <6 years of age. Our results indicate the potential usefulness of eGFR at dialysis initiation for future risk assessment in children with end-stage renal disease (ESRD) on dialysis.

DOI: 10.1053/j.ajkd.2018.12.038

Editorial When to Initiate Dialysis in Children and Adolescents: Is Waiting Worthwhile? by Edward Nehus and Mark M. Mitsnefes [FREE]

Mortality and Kidney Transplantation Outcomes Among Hepatitis C Virus–Seropositive Maintenance Dialysis Patients: A Retrospective Cohort Study by Deirdre Sawinski, et al 

From the authors: Many chronic dialysis patients are infected with hepatitis C virus (HCV). The medical community does not have good information on whether dialysis patients with HCV have equal access to kidney transplantation or whether they should accept a kidney transplant from a donor who also has HCV. We studied 442,171 dialysis patients and identified 31,624 (7.2%) with positive blood tests for HCV. HCV-positive dialysis patients had lower survival on dialysis and a much lower chance of getting on the kidney transplant waitlist. Once wait-listed, HCV-positive patients were able to receive transplants at the same rate as other patients and benefitted from transplantation. Finally, HCV-seropositive patients lived longer when they accepted kidneys from HCV-positive donors instead of waiting for an uninfected kidney.

DOI: 10.1053/j.ajkd.2018.11.009

Lipids, Apolipoproteins, and Risk of Atherosclerotic Cardiovascular Disease in Persons With CKD by Archna Bajaj, et al [FREE]

From the authors: Atherosclerotic cardiovascular disease is the primary cause of morbidity and mortality in patients with chronic kidney disease (CKD). Further, there remains a large residual risk of cardiovascular disease after standard treatment with statins in this population. This study evaluates the association between lipid and apolipoprotein measures and risk for myocardial infarction and ischemic stroke in the Chronic Renal Insufficiency Cohort (CRIC) Study, a prospective study of 3,939 adults with non-dialysis dependent chronic kidney disease at baseline. In this population, there was a higher risk of events for those with higher VLDL-C and apolipoprotein B, as well as lower HDL-C and apolipoprotein A-I. These findings support future investigations into pharmacologic targeting of lipid subclasses beyond LDL-C in the CKD population.

DOI: 10.1053/j.ajkd.2018.11.010

On the Cover: Nephrologists often have to be the bearers of unwelcome news, informing patients that their kidneys are failing and that they will need dialysis or a kidney transplant. The diagnosis of chronic kidney disease (CKD) can be unsettling and frightening, forcing patients to confront extensive and difficult life changes. Dr Mayleen Jeniffer L. Laico, a practicing nephrologist in Cebu City, Philippines, has found a unique way to share a hopeful message with her patients and colleagues. A talented artist, she creates floral paintings in the shape of kidneys. This issue’s cover art is one of many paintings she has created, communicating hope and care for many who battle kidney disease.

“Flower Kidneys: There Is Hope” © 2018 Mayleen Jeniffer L. Laico. Follow her at @toxicnephro.

This image was submitted as part of AJKD’s In A Few Words series.

Perspective from the June 2019 issue:

Tolerance to Sodium in Patients With CKD-Induced Metabolic Acidosis: Does the Accompanying Anion Matter? by David A. Bushinsky, et al [Open Access]

Patients with chronic kidney disease (CKD) continue to produce endogenous acids but have a reduction in net acid excretion, resulting in a primary decrease in serum bicarbonate concentration, which is termed chronic metabolic acidosis. This article examines the effect of the anion that accompanies sodium delivered with these therapies.

DOI: 10.1053/j.ajkd.2018.09.004

Special Announcement: AJKD Express

Recognizing the efficiency losses to authors and reviewers when a manuscript turned down by a high-profile journal is submitted to a new journal, AJKD is excited to offer a new expedited consideration process for manuscripts that meet the following criteria:

1. The manuscript reports original research within the scope of AJKD and could be reformatted to AJKD style; and
2. The authors supply an unmodified decision letter (including reviews) from a high-impact journal; and
3. The author list excludes any AJKD EIC/Deputy Editor/Education Editor/Associate Editor/International Editor.

In this accelerated manuscript consideration process, the editors aim to provide to authors:

• Notification within 2 business days indicating eligibility for AJKD Express
• Decision letter within a further 5-14 days

AJKD Express will launch on June 1, 2019. Details in this blog post.