Highlights from the May 2021 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 May 2021 issue:

A New Panel-Estimated GFR, Including β2-Microglobulin and β-Trace Protein and Not Including Race, Developed in a Diverse Population by Lesley A. Inker et al [FREE] 

From the authors: Assessment of glomerular filtration rate (GFR) is critical for many aspects of medical practice. GFR estimation based on creatinine and cystatin C together (eGFRcr-cys) is more accurate than eGFR based on creatinine or cystatin C alone, but the inclusion of creatinine in eGFRcr-cys requires specification of a person’s race. β2-Microglobulin and β-trace protein are alternative filtration markers that appear to be less influenced by race than creatinine is. In a pooled dataset of 7 studies (5,017 participants), new estimating equations were developed based on the combinations of these markers with and without age or sex and race. In a separate pooled dataset of 7 studies (2,245 participants), an equation that used all 4 markers, including age and sex but not race, was as accurate as eGFRcr-cys. A more accurate race-free eGFR could be an important advance.

DOI: 10.1053/j.ajkd.2020.11.005

Editorial: Race-Free Biomarkers to Quantify Kidney Function: Health Equity Lessons Learned From Population-Based Research by Nwamaka D. Eneanya et al [FREE] 


Validation of a Histologic Scoring Index for C3 Glomerulopathy by Fernando Caravaca-Fontán et al  

From the authors: This study aimed to validate the association between the previously proposed C3 glomerulopathy histologic index and the risk of kidney failure in a multicenter cohort of 111 patients with C3 glomerulopathy in Spain. A total of 48 patients (43%) reached kidney failure after a mean follow-up of 65 ± 27 months. Models with clinical, histologic, and the previously proposed C3 glomerulopathy histologic index variables were created to analyze the main predictors of kidney failure. Baseline estimated glomerular filtration rate, 24-hour proteinuria, and treatment with immunosuppression were predictors in the clinical model, whereas tubular atrophy and interstitial fibrosis were predictors in the histologic model. The total chronicity score was the main predictor of kidney failure in the model that included the C3 glomerulopathy histologic index variables. In conclusion, we validated the predictive performance of the previously proposed C3 glomerulopathy histologic index in a Spanish population of patients with C3 glomerulopathy.

DOI: 10.1053/j.ajkd.2020.11.011

Editorial: Slowly Unraveling the Mysteries of C3G by Daniel C. Cattran and Sanjeev Sethi [FREE] 


Latent Tuberculosis Therapy Outcomes in Dialysis Patients: A Retrospective Cohort by Leslie Y. Chiang et al

From the authors: People receiving maintenance dialysis are at an increased risk for active tuberculosis (TB). However, preventative therapy for people receiving maintenance dialysis with latent TB infection (LTBI) is often not provided due to the perceived risks for adverse events (AEs) and potential drug-drug interactions in this population. To study the treatment outcomes and AEs associated with LTBI therapy in this population, we retrospectively analyzed and compared data for British Columbians receiving maintenance dialysis established on a course of LTBI therapy from 2001 to 2017. We found that despite experiencing AEs, a high proportion of maintenance dialysis patients were able to safely complete LTBI therapy.

DOI: 10.1053/j.ajkd.2020.06.017


Perceptions of Home Dialysis Training and Experience Among US Nephrology Fellows by Nupur Gupta et al 

From the authors: Home dialysis education during fellowship training remains an area of concern. Published studies report a lack of trainees’ preparedness in home dialysis modalities. Our study assessed nephrology fellows’ confidence and clinical experience with these therapies near the completion of their training. We surveyed trainee attendees of 3 separate home dialysis–focused conferences. Overall, perceived preparedness was moderate for peritoneal dialysis and low for home hemodialysis. Most reported participation in a continuity clinic and other home dialysis education, but nearly all desired more focused teaching on peritoneal dialysis and home hemodialysis. In conclusion, this study suggests that redesign of nephrology fellowship training in home dialysis is warranted.

DOI: 10.1053/j.ajkd.2020.09.014


Comparative Effectiveness of Renin-Angiotensin System Inhibitors and Calcium Channel Blockers in Individuals With Advanced CKD: A Nationwide Observational Cohort Study by Edouard L. Fu et al [Open Access] 

From the authors: There is uncertainty regarding the best antihypertensive medications to use in patients with advanced chronic kidney disease (CKD) because they are often excluded from clinical trials. In a population-based Swedish database, we studied the clinical outcomes of starting renin-angiotensin system (RAS) inhibitor or calcium channel blocker (CCB) therapy in patients with advanced CKD who were using neither and were followed up by a nephrologist. Compared with CCBs, RAS inhibitor therapy initiation was associated with lower risk for kidney replacement therapy but similar risks for mortality and major adverse cardiovascular events. These findings suggest that RAS inhibitor therapy initiation might slow the progression of kidney disease compared with CCBs in patients with advanced CKD and offer similar cardiovascular protection.

DOI: 10.1053/j.ajkd.2020.10.006


Intradialytic Hypotension and Newly Recognized Peripheral Artery Disease in Patients Receiving Hemodialysis by Eun Young Seong et al 

From the authors: Peripheral artery disease (PAD) is a condition characterized by progressive atherosclerotic narrowing or occlusion of the arteries, particularly to the lower extremities. PAD often goes undiagnosed in patients with kidney failure who may not experience conventional symptoms of claudication. It is plausible that sudden reduction in blood pressure as occurs during intradialytic hypotension (IDH) could reduce limb perfusion and lead to more PAD events or exacerbate PAD symptoms. Using a large nationwide registry of hemodialysis patients and the electronic health records of a large dialysis provider, we found that more frequent IDH was associated with a higher incidence of recognized PAD. Our results suggest that patients with more frequent IDH warrant careful examination for PAD such as foot examinations or other diagnostic evaluations.

DOI: 10.1053/j.ajkd.2020.10.012


Transplantation of Kidneys From Hepatitis C Virus-Infected Donors to Hepatitis C Virus-Negative Recipients: One-Year Kidney Allograft Outcomes by Miklos Z. Molnar et al 

From the authors: Transplantation centers are increasingly willing to transplant kidneys from hepatitis C virus (HCV)-infected donors to HCV-negative recipients. Data for long-term outcomes following these recipients are sparse. The aim of this single-center, retrospective study was to compare 1-year kidney outcomes in HCV-negative transplant recipients who received an organ either from a donor with or without HCV infection. The 1-year posttransplantation kidney outcomes (including allograft function, development of de novo donor-specific antibodies, findings of for-cause and surveillance protocol graft biopsies) were similar in these 2 groups of recipients.

DOI: 10.1053/j.ajkd.2020.10.017


COVID-19 Among US Dialysis Patients: Risk Factors and Outcomes From a National Dialysis Provider by Caroline M. Hsu et al [FREE] 

From the authors: Maintenance dialysis patients are a vulnerable population during the COVID-19 pandemic due to their comorbid conditions and limited ability to physically distance themselves from others. This cohort study of risk factors for and outcomes from COVID-19 among patients receiving maintenance dialysis showed a 5.5% rate of infection in clinics with at least 1 case and that residence in a congregate setting was the strongest risk factor for disease. During this initial COVID-19 surge period, patients receiving maintenance dialysis who contracted COVID-19 had a mortality rate approaching 25%, far higher than that for the general population. These data suggest that the maintenance dialysis population requires substantial support during the pandemic, whether through expanded testing, early vaccination, or coordination of complex care.

DOI: 10.1053/j.ajkd.2021.01.003


Special Report from the May 2021 Issue:

Opportunities to Improve Antibiotic Prescribing in Outpatient Hemodialysis Facilities: A Report From the American Society of Nephrology and Centers for Disease Control and Prevention Antibiotic Stewardship White Paper Writing Group by Ibironke W. Apata et al 

From the authors: Antibiotic use is necessary in the outpatient hemodialysis setting because patients receiving hemodialysis are at increased risk for infections and sepsis. However, inappropriate antibiotic use can lead to adverse drug events, including adverse drug reactions and infections with Clostridioides difficile and antibiotic-resistant bacteria. Optimizing antibiotic use can decrease adverse events and improve infection cure rates and patient outcomes. This Special Report is from the Antibiotic Stewardship in Hemodialysis White Paper Writing Group, comprising experts in antibiotic stewardship, infectious diseases, nephrology, and public health, to highlight strategies that can improve antibiotic prescribing for patients receiving maintenance hemodialysis.

DOI: 10.1053/j.ajkd.2020.08.011


On the Cover: Opium is extracted from the seed pods of the poppy Papaver somniferum, first cultivated in 3400 BCE in Mesopotamia. Morphine, derived from opium at the beginning of the 19th century, and related semisynthetic opioid analgesics have revolutionized pain control. However, their abuse accounts for more than 450,000 US deaths since 2000, underscoring the importance of opioid management programs. In this month’s issue of AJKD, Lu et al describe opioid use for analgesia in individuals with CKD. They propose a stepwise strategy to individualize opioid use assessment and prescription, offering guidance to optimize pain control, reduce side effects, and maintain opioid stewardship best practices.

The photograph “Poppyseed” is by Devanath on Pixabay. Released under the Pixabay license (https://pixabay.com/service/terms/#license).


SPECIAL COLLECTION: WORLD KIDNEY DAY

In celebration of World Kidney Day on March 11, AJKD presents this special collection of recent publications from around the world addressing a variety of important aspects of kidney disease research. All articles are freely available until May 17, 2021.

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