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 November 2019 issue:

Follow-up of Abnormal Estimated GFR Results Within a Large Integrated Health Care Delivery System: A Mixed-Methods Study by Kim N Danforth et al [Open Access]

From the authors: Researchers sought to understand why patients with abnormal test results may not get timely follow-up. They used creatinine-based eGFR results for chronic kidney disease (CKD) diagnosis as an example. The study conducted at Kaiser Permanente Southern California combined quantitative data from comprehensive electronic health records and qualitative data from interviews with physicians. Researchers found that over half of the patients with a newly abnormal eGFR did not get timely follow-up. They identified several ways that health systems can reduce delays in CKD diagnosis and promote higher quality, safer care, including:
• Flagging abnormal eGFR results in electronic health records,
• Increasing the role of nurses in team-based management of lab results, and
• Boosting patient engagement with improvements to the patient portal.

DOI: 10.1053/j.ajkd.2019.05.003

Editorial Missing the Forest and the Trees: Challenges and Opportunities in Ensuring Timely Follow-up of Abnormal Estimated GFR by Salman Ahmed et al [FREE] 

Intraperitoneal Cefepime Monotherapy Versus Combination Therapy of Cefazolin Plus Ceftazidime for Empirical Treatment of CAPD-Associated Peritonitis: A Multicenter, Open-Label, Noninferiority, Randomized, Controlled Trial by Thidarat Kitrungphaiboon et al  

DOI: 10.1053/j.ajkd.2019.05.011

Editorial Cefepime as Empirical Peritoneal Dialysis–Associated Peritonitis Treatment: Something to Dwell On? by Muthana Al Sahlawi et al [FREE] 

Blog Post Empirical Treatment of CAPD-Associated Peritonitis: ID Perspective [FREE] 

Multicenter Outbreak of Gram-Negative Bloodstream Infections in Hemodialysis Patients by Shannon A Novosad et al

From the authors: In this outbreak investigation of 58 gram-negative bloodstream infections, dialysis station wall boxes, reservoirs for contaminated fluid in the dialysis treatment station not previously linked to healthcare-associated infections (HAIs), were found to be the source of the infecting bacteria. Wall boxes are located in all hemodialysis facilities potentially increasing the risk of HAIs for a large number of patients. Healthcare facilities should be aware of sources of contaminated water and other fluids in the healthcare environment and employ strategies to reduce the risk of infections from these sources.

DOI: 10.1053/j.ajkd.2019.05.012

Editorial Targeting Zero Infections in Hemodialysis by Alan S Kliger and Renee Garrick [FREE] 

Transfers to Hemodialysis Among US Patients Initiating Renal Replacement Therapy With Peritoneal Dialysis  by Rita L McGill et al

From the authors: Clinicians are not able to effectively identify which peritoneal dialysis (PD) patients will transition to hemodialysis (HD), and thereby miss opportunities to prepare them for modality change. We analyzed a large group of PD patients in order to build a prediction model for HD transfer based on clinical characteristics at the time of PD initiation, accounting for the competing outcomes of kidney transplantation and death. We also estimated the impact of PD-associated peritonitis on outcomes. We found that HD transfer was as common as the combined outcomes of transplant and death, and that few patients remained on PD after five years. The findings of this study provide guidance in predicting individual patient risk for needing to convert to HD.

DOI: 10.1053/j.ajkd.2019.05.014

Editorial Characteristics Associated With Peritoneal Dialysis Technique Failure: Are We Asking the Right Questions? by Annie-Claire Nadeau-Fredette and Joanne M Bargman [FREE] 

Microangiopathic Lesions in IgA Nephropathy: A Cohort Study by Qingqing Cai et al 

From the authors: It has long been recognized that renal vascular lesions, including arterial intimal thickening, arteriolar hyaline changes, and microangiopathic lesions, are common in IgA nephropathy. The role of these lesions in disease progression remains controversial. In this study of 944 individuals who had a biopsy-proven diagnosis of IgA nephropathy, we demonstrated that renal arteriolar microangiopathic lesions were common and that their presence was an independent risk factor for kidney disease progression. The risk of kidney disease progression was greater with a more severe microangiopathic lesions. These findings suggest that microangiopathic lesions may be valuable additions to formal classification schemes such as the Oxford classification of IgAN.

DOI: 10.1053/j.ajkd.2019.03.416

Direct Delivery of Kidney Transplant Education to Black and Low-Income Patients Receiving Dialysis: A Randomized Controlled Trial by Amy D Waterman et al

From the authors: Black and low-income patients receiving dialysis are less likely to receive comprehensive kidney transplant education. This study compared the effectiveness of the Explore Transplant @ Home Patient-Guided education program (ETH-PG), consisting of 4 modules of patient education using print, video, and text messages delivered directly to patients, to traditional dialysis education for improving transplant knowledge. Some (ETH-PG) study participants also had telephone conversations with a transplant educator. Adult, Black and White, low-income patients receiving dialysis in Missouri were enrolled. Compared to patients receiving traditional education, patients enrolled in ETH-PG, with or without telephone conversations with educators, experienced improved knowledge about kidney transplantation and were able to make more informed decisions. Delivering educational content to patients directly may help support dialysis patients learn more about transplantation and living donation.

DOI: 10.1053/j.ajkd.2019.03.430

Acute Kidney Injury With Ventricular Assist Device Placement: National Estimates of Trends and Outcomes by Carl P Walther et al 

From the authors: Ventricular assist devices (VADs) are blood pumps inserted by surgeons in patients with severe heart failure to support the failing heart for months or even years. Injury to the kidneys in this setting is common, from the severe heart failure, the surgery, and complications. We used a national database to investigate what proportion of VAD placement hospitalizations are complicated by kidney injury, including its most severe form, kidney injury requiring dialysis. We learned that in recent years more patients are being diagnosed with kidney injury, but that fewer are suffering the severest form. Those who have kidney injury requiring dialysis have high mortality rates, which have not improved much in recent years.

DOI: 10.1053/j.ajkd.2019.03.423

On the Cover: The ceiling of the Library of Congress in Washington, DC majestically spans the world’s largest library, housing millions of volumes of books, recordings, images, newspapers, maps, and manuscripts. A stunningly beautiful building, the Library has captivated and inspired visitors since it was first opened to the public in 1897. The Library serves as an enduring source of diverse knowledge for countless patrons, including members of the US Congress and their staff, whose thousands of requests for information every year make possible the drafting of so much of the legislation that impacts our lives. If you’re in Washington, DC, for Kidney Week, visit the Library of Congress, and also pick up a complimentary copy of the journal at the NKF booth, where we hope to meet many readers, authors, reviewers, and editors.

Public Domain photo by Shawn Miller available via the Library of Congress flickr page.

Policy Forum from the November 2019 Issue:

Ethical Issues in Pragmatic Cluster-Randomized Trials in Dialysis Facilities by Cory E Goldstein et al [Open Access]

A pragmatic cluster-randomized trial (CRT) is a research design that may be used to efficiently test promising interventions that directly inform dialysis care. This outlines ethical issues raised by pragmatic CRTs in dialysis facilities.

DOI: 10.1053/j.ajkd.2019.04.019

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) sent from a high-impact journal with the last 30 days; 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

Details for AJKD Express are available in this blog post.