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 July 2020 issue:

Myeloperoxidase and the Risk of CKD Progression, Cardiovascular Disease, and Death in the Chronic Renal Insufficiency Cohort (CRIC) Study by Simon Correa and Jessy Korina Pena-Esparragoza et al 

From the authors: Oxidative stress has been associated with the progression of CKD and CVD in the general population. Myeloperoxidase (MPO) is an enzyme produced primarily by neutrophils and catalyzes the formation of oxidative stress mediators. Prior studies have demonstrated the association of other oxidative stress markers with CKD progression, and smaller studies have provided mixed results for the association of MPO and CKD. In the present study, we analyzed data from the CRIC study to assess the association of baseline MPO with CKD progression, CVD and death in patients with preexisting CKD. We found that MPO was significantly associated with CKD progression, independent of traditional risk factors and other inflammatory biomarkers. However, MPO was not significantly associated with the risk of CVD and death.

DOI: 10.1053/j.ajkd.2019.09.006

Peritoneal Dialysis–Related Infection Rates and Outcomes: Results From the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) by Jeffrey Perl et al [Open Access] 

From the authors: Using Peritoneal Dialysis Outcomes and Practice Patterns Study data, we explored peritoneal dialysis-associated peritonitis incidence, organism type, hospitalization risks, and associations of certain facility characteristics and treatment practices with peritonitis risk. Facility peritonitis rates varied within each country; overall rates by country varied from 0.26-0.29 episodes/patient-year in Canada, Japan, and the US to 0.35-0.40 episodes/patient-year in Australia and New Zealand, Thailand, and the UK. The proportions of culture-negative peritonitis (no organisms grown) and Gram-negative infections were high in Thailand. Higher use of automated peritoneal dialysis, antibiotics at PD catheter insertion and facilities with training duration ≥6 days were associated with lower peritonitis risk. Peritonitis remains a major problem across centers. Differences in microbiology, hospitalization episodes, and risk factors across clinics suggest the need for local preventative strategies and better global adherence to evidence-based practices.

DOI: 10.1053/j.ajkd.2019.09.016

Comparability of Plasma Iohexol Clearance Across Population-Based Cohorts by Bjørn O. Eriksen et al [Open Access] 

From the authors: Research on kidney function assessed as the glomerular filtration rate assumes that measurements made in different laboratories and by different methods are comparable. We compared assays of iohexol and different protocols for measuring the glomerular filtration rate as plasma iohexol clearance between three centers in Europe. We found substantial agreement between high performance liquid chromatography methods for measuring iohexol when remeasuring iohexol from three general population cohorts in one laboratory. There was also substantial agreement when the multiple- and single-sample protocols for calculating iohexol clearance were compared in two of the cohorts. The results indicate that the glomerular filtration rate measurements in these three cohorts are comparable.

DOI: 10.1053/j.ajkd.2019.10.008

Acute Kidney Injury and Electrolyte Abnormalities After Chimeric Antigen Receptor T-Cell (CAR-T) Therapy for Diffuse Large B-Cell Lymphoma by Shruti Gupta et al 

From the authors: Chimeric antigen receptor T-cell (CAR-T) therapy is a major breakthrough in cancer treatment. Rates of acute kidney injury (AKI) and electrolyte disorders after CAR-T therapy are not well-described. We reviewed the clinical course of 78 patients who received CAR-T therapy for diffuse large B cell lymphoma at two institutions and observed that 15 patients (19%) developed AKI. Eight patients had pre-renal azotemia, 6 had acute tubular necrosis, and 1 developed urinary obstruction. Intrinsic AKI was associated with increasing length of hospital stay and higher mortality. Electrolytes abnormalities, such as low levels of sodium, potassium, and phosphorous, were common, affecting > 50% of patients. As CAR-T use is likely to increase, these findings underscore the need for physicians caring for these patients to be vigilant for the renal complications that are associated with a high level of morbidity and a high rate of mortality.

DOI: 10.1053/j.ajkd.2019.10.011

Risk of Vascular Access Infection Associated With Buttonhole Cannulation of Fistulas: Data From the National Healthcare Safety Network by Meghan Lyman et al 

From the authors: Buttonhole or “constant site” cannulation is a technique in which cannulation of arteriovenous fistulas (AVFs) occurs with blunt needles using an established track created by repeatedly cannulating at the same site. Compared to conventional methods referred to as rope ladder cannulation (RLC), use of buttonhole cannulation (BHC) may be associated with increased risk of infections. We used national surveillance data to describe the infection burden and risk among in-center hemodialysis patients with AVFs using BHC. In 2014, 9% of all AVF patient-months reported to NHSN were associated with BHC. After adjusting for facility characteristics and practices, compared to rope ladder cannulation, buttonhole cannulation was associated with higher risk of vascular access-related infection among in-center hemodialysis patients. Decisions about the use of BHC in dialysis centers should take into account the higher risk of infection.

DOI: 10.1053/j.ajkd.2019.11.006

Persistent Hematuria and Kidney Disease Progression in IgA Nephropathy: A Cohort Study by Gui-zhen Yu et al  

From the authors: Hematuria is the most typical presentation of IgA nephropathy, but the role of hematuria in disease progression remains controversial. In this study of 1333 Chinese patients with IgA nephropathy followed at a referral center for a median follow-up of 45 months, we found that time-varying hematuria during follow-up was an independent risk factor for composite kidney disease progression events, remission of hematuria during the 6 months following diagnosis was associated with slower progression of kidney disease among those who had persistent proteinuria. Another key finding of this study was that a simple and rapid urine analysis using automated methods provided similar findings as traditional microscopic examination of the urine by a laboratory technician.

DOI: 10.1053/j.ajkd.2019.11.008

Association of Genetic Polymorphisms of TGF-β1, HMOX1, and APOL1 With CKD in Nigerian Patients With and Without HIV by Udeme E. Ekrikpo et al [Open Access] 

From the authors: A third of adult patients initiated on haemodialysis in the extreme Southern regions of Nigeria are HIV positive. Identifying genetic factors that predispose to the development of chronic kidney disease (CKD) in the adult HIV population is an important step in predicting which patients will go develop kidney failure. We investigated the relationship between CKD and the occurrence of the APOL1 high-risk genotype as well as minor alleles of TGF-β1 and HMOX1 among patients with HIV. The HIV-CKD group was at least 2 times more likely to carry the APOL1 high-risk genotype than patients with HIV but without CKD. One of the TGF-β1 genes may be protective against developing CKD but HMOX1 had no effect on CKD occurrence.

DOI: 10.1053/j.ajkd.2020.01.006

This month’s Special Report:

Establishing Core Cardiovascular Outcome Measures for Trials in Hemodialysis: Report of an International Consensus Workshop by Emma O’Lone et al 

Cardiovascular disease (CVD) affects more than two-thirds of patients receiving hemodialysis and is the leading cause of death in this population, yet CVD outcomes are infrequently and inconsistently reported in trials in patients receiving hemodialysis. We convened a consensus workshop with eight patients or caregivers and 46 health professionals from 15 countries to discuss selection and implementation of proposed core outcome measures. Based on the five themes identified, participants supported the use of myocardial infarction and sudden cardiac death as core outcome measures of CVD to be reported in all hemodialysis trials.

DOI: 10.1053/j.ajkd.2020.01.022

On the Cover: The extraordinary compassion and sacrifice of those battling to contain and treat the COVID-19 pandemic will be long remembered. We devote this month’s cover to express our gratitude for health care workers on the front line. This collage of cards expressing messages of thanks and encouragement for the health care workers at Penn Medicine, the academic medical center where AJKD is based, reflects sentiments felt around the nation and the world. This issue of the Journal contains 3 pieces stemming from the early days of the pandemic: Alp Ikizler shares insights on the impact of COVID-19 within dialysis facilities, Durvasula et al share their experience with COVID-19 in the acute-care setting, and Wang et al report on patients receiving maintenance hemodialysis who developed COVID-19.

Image courtesy of the Perelman School of Medicine at the University of Pennsylvania, collected from submissions to PennMedicineTogether. Previously posted on Twitter, May 1, 2020. Reproduced with permission.

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.