Highlights from the September 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 September 2019 issue:
Prediction and Risk Stratification of Kidney Outcomes in IgA Nephropathy by Tingyu Chen, et al
From the authors: IgA nephropathy (IgAN) is a common disease worldwide with varied clinical outcomes related to the progression of kidney disease. Accurately stratifying risk and predicting prognosis are important. An IgAN prognosis prediction system combining widely accepted clinical and pathological variables is lacking. This study built and validated a risk stratification tool (the Nanjing IgAN Risk Stratification System) in a large, multicenter cohort of individuals with IgAN followed for 5 years using a type of analysis known as machine learning in addition to more traditional methods of data analysis. The Nanjing IgAN Risk Stratification System can estimate prognosis of patients with IgAN, potentially assisting in clinical care and the selection of those who may be enrolled into treatment trials.
Editorial Machine Learning in Glomerular Diseases: Promise for Precision Medicine by Girish Nadkarni, et al [FREE]
Association Between Hypertension and Kidney Function Decline: The Atherosclerosis Risk in Communities (ARIC) Study by Zhi Yu, et al [FREE]
From the authors: Using data from a community-based cohort, the Atherosclerosis Risk in Communities study, we examined the association between baseline hypertension status and kidney function decline over 30 years. People with hypertension had both faster decline in estimated glomerular filtration rate and greater risk of developing chronic kidney disease than those without hypertension. People with severe hypertension that was not treated with medication had the highest risk. Our study highlights that population-level efforts to lower blood pressure may help to reduce the onset of kidney disease.
Editorial More Evidence to Suggest a Relation of Blood Pressure to Long-term Progression of Kidney Disease: Is It Causal? by Wendy McCallum, et al [FREE]
Effects of Water Loading on Observed and Predicted Plasma Sodium, and Fluid and Urine Cation Excretion in Healthy Individuals by Rosa Wouda, et al
From the authors: For years, it was thought that the kidney is the key organ responsible for the water and sodium (Na+) content of the body. However, recently it was discovered that significant amounts of Na+ can be stored without concurrent water retention. These observations point to the presence of an additional compartment for Na+ storage that is not accompanied by water (osmotically inactive storage). The role of this compartment in responding to the intake of hypotonic fluids is not known. This study suggests that healthy individuals may be able to release osmotically inactivated Na+ after rapid water intake. This observation suggests that the osmotically inactive storage compartment for Na+ might play an important role in adapting to hypotonic stress. Moreover, understanding osmotic inactivation and reactivation of Na+ is likely important in accurately predicting plasma [Na+] changes in response to treatment of patients with hypernatremia.
Editorial Osmotically Inactivated Sodium in Acute Hyponatremia: Stay With Edelman by Horacio J. Adrogué and Nicolaos E. Madias [FREE]
Safety and Effectiveness of Bexagliflozin in Patients With Type 2 Diabetes Mellitus and Stage 3a/3b CKD by Andrew S. Allegretti, et al
From the authors: Hyperglycemia accelerates the progression of chronic kidney disease (CKD). Few oral glucose-lowering therapies are effective for patients with diabetes and CKD, especially in stage 3b CKD. This study reports results from a phase 3, randomized, controlled trial comparing bexagliflozin, a novel sodium-glucose cotransporter-2 inhibitor, to placebo, in patients with stage 3a and 3b CKD. Patients treated with bexagliflozin had significantly lower hemoglobin A1c levels, body weight, systolic blood pressure, and albuminuria. Adverse events were similar between treatment groups. Bexagliflozin may be a safe and effective agent for the treatment of hyperglycemia in patients with stage 3a and 3b CKD.
Blog Post by Bexagliflozin in Patients With Type 2 Diabetes Mellitus and Stage 3 CKD by Claudia Rodriguez and Edgar Lerma [FREE]
Effects of Sevelamer Carbonate in Patients With CKD and Proteinuria: The ANSWER Randomized Trial by Barbara Ruggiero, et al
From the authors: Chronic protein loss is associated with poor clinical outcomes among patients with kidney disease. Strategies that reduce proteinuria reduce progression of kidney disease. Hyper-phosphatemia has been associated with progression of the kidney disease and with a reduced ability of ACE-inhibitors and angiotensin-receptor blockers drugs known as RAS inhibitors to reduce proteinuria. We evaluated whether a drug that reduces phosphate levels in the blood, sevelamer carbonate, also enhances the reduction of proteinuria when administered with RAS inhibitors.
Use of a Decision Aid for Patients Considering Peritoneal Dialysis and In-Center Hemodialysis: A Randomized Controlled Trial by Lalita Subramanian, et al [Open Access]
From the authors: An online decision aid (DA) was tested to assess if it helped patients with chronic kidney disease (CKD) make decisions about the type of dialysis that would best fit their needs and lifestyle. The DA, developed collaboratively with patients, patient advocates, and clinicians, increased knowledge about CKD and treatment options and decreased uncertainty. The proportion of patients unsure of their treatment preference decreased from 47% to 16% after DA use. However, it did not change patients’ self-confidence in selecting a treatment option. Participation was limited to 140 English-speaking people with advanced CKD, internet access, and computer literacy, which may have limited the generalizability of the findings. Studying long-term effects on treatment choice in a wider population of CKD patients in the future may provide further insights into the benefits of the DA.
Blog Post Choosing Wisely: A Decision Aid for Dialysis Therapies to Facilitate Person-Centered Kidney Care by Devika Nair [FREE]
Association Between Weight Loss Before Deceased Donor Kidney Transplantation and Posttransplantation Outcomes by Meera Nair Harhay, et al
From the authors: Patients with advanced kidney disease may lose weight due to protein energy malnutrition and progressive wasting, increasing their risk of death. Among adults who received a deceased donor kidney transplant in the United States from 2004-2014, we examined whether, compared to recipients who did not lose weight before transplant, recipients with ≥10% pre-transplant weight loss demonstrated differences in post-transplant outcomes. We found that more than one-in-ten recipients had lost 10% or more of their body weight pre-transplant, and that these recipients had longer transplant hospitalizations and were more likely to die. These findings suggest that weight loss among kidney transplant candidates is an important signal of vulnerability, and that transplant recipients with substantial pre-transplant weight loss may benefit from additional post-transplant surveillance and support.
Reduced Estimated GFR and Cardiac Remodeling: A Population-Based Autopsy Study by Kensuke Izumaru, et al [Open Access]
From the authors: The rising prevalence of chronic kidney disease (CKD) is increasing the health economic burden worldwide. Patients with CKD have been acknowledged to be at a higher cardiovascular risk. Several epidemiological and experimental studies have suggested patients with CKD develop cardiac hypertrophy and remodeling of the normal configuration of cardiac tissue. However, there are few studies examining the histology of the heart that address the association between CKD and cardiac abnormalities. Using samples of heart tissue obtained at autopsy, the present study demonstrated that lower kidney function was significantly associated with a greater left ventricular thickness, cardiac cell size, and percentage of cardiac fibrosis. The association between CKD and the cardiac cell size was stronger in patients with anemia. Our findings may help to elucidate the relationship between cardiac abnormalities and kidney disease.
On the Cover: Dams, such as the one shown on the cover, regulate stores of water permitting adaptation to climatic changes. Dam malfunctions can lead to disastrous consequences spanning from dry and infertile conditions to extensive flooding. Like environmental water management, regulation of total body water is a critical homeostatic function. The body has a variety of mechanisms to regulate total body water and plasma osmolarity in the face of fluctuations in water intake. As discussed by Wouda and colleagues, regulation of nonosmotically stored sodium can mitigate changes in the serum sodium concentration after water loading before urine flow and water excretion change in response to vasopressin inhibition-in essence describing a “dam-independent” mechanism for regulation of plasma osmolarity.
The photograph “Holyoke Gas and Electric” is by American Public Power Association on Unsplash. Released under the Unsplash license.
Narrative Review from the September 2019 Issue:
Pathophysiology and Management of Hyperammonemia in Organ Transplant Patients by Harish Seethapathy and Andrew Z. Fenves
Hyperammonemia in a transplant recipient poses specific challenges beyond the actual condition because the treatment (RRT) involves significant hemodynamic fluctuations that may affect the graft. In this review, we describe a patient with posttransplantation hyperammonemia and discuss the pathways of ammonia metabolism, potential factors underlying the development of hyperammonemia posttransplantation, and choice of appropriate therapeutic options in these patients.
Blog Post Hyperammonemia and Organ Transplantation Interview with the authors [FREE]
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:
- The manuscript reports original research within the scope of AJKD and could be reformatted to AJKD style; and
- The authors supply an unmodified decision letter (including reviews) from a high-impact journal; and
- 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
Details for AJKD Express are available in this blog post.
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