Highlights from the March 2020 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 2020 issue:

Effect of Vitamin B12 Levels on the Association Between Folic Acid Treatment and CKD Progression: A Post Hoc Analysis of a Folic Acid Interventional Trial by Youbao Li et al 

From the authors: In populations with folic acid fortification or supplementation, the main nutritional determinant of total homocysteine levels is vitamin B12 (B12) status. Nevertheless, the effect of naturally occurring serum B12 levels, without supplementation, on the association between folic acid treatment and chronic kidney disease (CKD) progression has not been previously studied. As a post-hoc analysis of the Kidney Disease Sub-study of the China Stroke Primary Prevention Trial, our study found that, compared with enalapril alone, enalapril plus folic acid treatment was associated with an 83% reduction in the odds of CKD progression among patients with mild-to-moderate CKD when baseline vitamin B12 levels were ≥248 pmol/L, but not when B12 levels were <248 pmol/L. Our study suggests that further investigation of a potential benefit of vitamin B12 (methylcobalamin) supplementation combined with folic acid supplementation in the setting of CKD is warranted.

DOI: 10.1053/j.ajkd.2019.07.020

Editorial: Does Vitamin B12 Delay CKD Progression? by Angela Yee-Moon Wang [FREE] 

Ultrafiltration Rate, Residual Kidney Function, and Survival Among Patients Treated With Reduced-Frequency Hemodialysis by Yu-Ji Lee et al 

From the authors: There is growing interest in less-frequent hemodialysis (HD) such as twice or less per week treatments as it has been associated with better preservation of residual kidney function (RKF) and higher health-related quality of life. Higher ultrafiltration rates (UFR) often required with less-frequent HD may lead to intradialytic hypotension and, thereby, poorer clinical outcomes. This study investigated the association between UFR and outcomes among a subset of patients receiving less frequent hemodialysis and showed that higher UFR increased the odds of experiencing a faster decline in RKF. Furthermore, higher UFRs were associated with greater all-cause and cardiovascular mortality, especially among those without substantial RKF.

DOI: 10.1053/j.ajkd.2019.08.019

Editorial: Ultrafiltration Rate and Residual Kidney Function Decline: Yet Another Good Reason to Ask About Urine by Magdalene M. Assimon and Jennifer E. Flythe [FREE] 

Selective Serotonin Reuptake Inhibitor Use and Hip Fracture Risk Among Patients on Hemodialysis by Chandan Vangala et al [FREE temporarily] 

From the authors: Many patients with end-stage kidney disease suffer with depression and recognized disease is frequently treated with selective serotonin reuptake inhibitors. In a large, nationally representative case-control study we found robust evidence linking selective serotonin reuptake inhibitor use to hip fracture risk in patients with end-stage kidney disease dependent on hemodialysis. With equivocal benefit in treating symptoms of depression in this subset of the general population, adverse effects become increasingly important. Therefore, selective serotonin reuptake inhibitor use should be monitored for effectiveness in each patient to avoid unnecessary exposure to additional risks of fracture.

DOI: 10.1053/j.ajkd.2019.07.015

Dietary Patterns and Mortality in a Multinational Cohort of Adults Receiving Hemodialysis  by Valeria M. Saglimbene et al

From the authors: Mortality among patients on hemodialysis is approximately 10-fold higher than the general population principally due to cardiovascular diseases. Diet is a potential but under-explored modifiable risk factor. Clinical practice guidelines recommend modification of individual nutrients, but are supported by limited evidence. Consideration of dietary patterns may have greater impact on ameliorating pathological processes than individual nutrient changes and may be easier to implement. In this prospective cohort study of 8110 patients on maintenance hemodialysis, two common dietary patterns were observed; one based on fruits and vegetables and one reflecting a Western-style diet. Current findings did not confirm that either dietary pattern was associated with lower cardiovascular or all-cause mortality.

DOI: 10.1053/j.ajkd.2019.05.028

Urinary Matrix Metalloproteinase 7 and Prediction of IgA Nephropathy Progression by Xiaobing Yang et al  [Open Access]

From the authors: A major challenge in the management of IgAN is the inability to identify patients at high risk for disease progression at an early stage. Whether biomarker(s), alone or combined with the clinical data at time of kidney biopsy, improves risk prediction of IgAN progression has not been previously examined. In this prospective, two-center study of 946 patients with IgAN, we observed that urinary matrix metalloproteinases-7 (uMMP-7) is an independent predictor for IgAN progression (defined as 40% decline in kidney function, ESKD, or death) and outperformed previously reported biomarkers. The addition of uMMP-7 to the clinical data obtained at the time of biopsy (eGFR, MAP, proteinuria) and MEST-C score significantly improved the 3-year risk prediction of IgAN progression. The predictive performance of uMMP-7 was confirmed in an external validation set.

DOI: 10.1053/j.ajkd.2019.07.018

Race and Mortality in CKD and Dialysis: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study by Elaine Ku et al 

From the authors: Many studies have shown that African Americans receiving chronic dialysis have lower mortality than whites. We confirmed this observation among Chronic Renal Insufficiency Cohort Study participants but showed that this may be due to selected transition of patients with different severity of co-morbid conditions onto dialysis, since mortality risk was higher in African Americans than whites if one were to track deaths comprehensively from the non-dialysis requiring chronic kidney disease phase of illness through dialysis. In an advance over prior studies, we showed that risk factors such as heart failure appear to have different implications for African Americans versus whites with chronic kidney disease. Thus selected transition of a subset of whites with more severe comorbid conditions onto dialysis is likely an important contributor to the observation of a “racial survival paradox” among dialysis patients.

DOI: 10.1053/j.ajkd.2019.08.011

In Practice from the March 2020 Issue:

Practical Guide to Vaccination in All Stages of CKD, Including Patients Treated by Dialysis or Kidney Transplantation by Karen M. Krueger et al

Immunization is an important component of preventative care for patients with kidney disease. Because nephrologists often serve as primary care physicians for patients with CKD, it is important to understand the role of vaccinations in the preventive care of this patient population.

DOI: 10.1053/j.ajkd.2019.06.014

Podcast: Vaccines for Patients with CKD [FREE] 

Also from the March 2020 Issue:

KDOQI US Commentary on the 2017 KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors by Didier A. Mandelbrot et al [FREE temporarily] 

KDIGO published its clinical practice guideline on the evaluation and care of living kidney donors in 2017. To assist the US practitioner in interpreting and applying the KDIGO guidelines, NKF-KDOQI convened a work group to write a commentary focused on how these guidelines may or may not strictly apply in the US context, given the explicit regulatory requirements of UNOS and the Centers for Medicaid & Medicare Services (CMS), as well as the history of living donor practices and conventions in the United States.

DOI: 10.1053/j.ajkd.2019.10.005 

On the Cover: AJKD is proud to present the 8th annual NephMadness, which will begin on March 13 when we reveal which 8 topics in nephrology have made the cut. This educational initiative was launched in 2013 to celebrate World Kidney Day, an international campaign to increase awareness of kidney disease. Join the fun and learning as you predict which team will be the most likely to change nephrology care in the next 5 years. Participants in the United States can claim up to 8.0 CME credits and MOC points. More information available at www.AJKDBlog.org.

Bonus: Check out this Special Collection of articles from previous years’ tournaments.

NephMadness 2020 logo is created by Peter Dong © AJKD.

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 within 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.



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