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 October 2021 issue:
Burden of Kidney Disease, Health-Related Quality of Life, and Employment Among Patients Receiving Peritoneal Dialysis and In-Center Hemodialysis: Findings From the DOPPS Program by Edwina A. Brown et al
From the authors: This is a report on quality of life (QOL; mental well-being and physical functioning) for over 7,700 dialysis patients in 6 countries. Mental well-being and depression were similar in patients receiving hemodialysis (HD) or peritoneal dialysis (PD), although those receiving PD reported a lower burden of kidney disease. QOL showed little change over 1 year for most patients. In both HD and PD populations, (1) people having problems performing basic tasks of daily living had lower QOL and experienced a higher burden of kidney disease, and (2) the prevalence of physician-diagnosed depression was lower than the frequency of patient-reported symptoms consistent with depression. Levels of mental well-being in these patients were similar to those in recent reports in persons having stage 3-5 chronic kidney disease (CKD), but the self-reported levels of physical functioning were lower. This work emphasizes the need to study approaches to improve dialysis patient experiences and QOL.
Editorial: What Is the “Maintenance” in Maintenance Dialysis? by Taylor R. House and Susan P. Y. Wong [FREE]
Recipient Obesity and Kidney Transplant Outcomes: A Mate-Kidney Analysis by Kalathil K. Sureshkumar et al
From the authors: Patients with kidney disease, like all other Americans, struggle with obesity. Patients with obesity have improved survival after kidney transplantation compared with continued maintenance dialysis. Many transplant centers limit the eligibility of patients with body mass index (BMI) >35 kg/m2 for kidney trans-plantation because of safety concerns. We examined patient and transplant outcomes among recipients with BMI >35 kg/m2 versus recipients with BMI 18-25 (ie, non-obese), >25-30, and >30-35 kg/m2. Neither patient survival nor hospital length of stay differed across BMI categories. Delayed graft function was more common when BMI was >35 kg/m2. Death-censored graft failure was greater among the groups with BMI >30 kg/m2 compared with the non-obese groups. Our results suggest that strict BMI criteria for kidney transplantation may deserve reconsideration.
Editorial: Kidney Transplantation and Candidate BMI: Viability Is in the Eye of the Beholder by Anne M. Humi and Jesse D. Schold [FREE]
Comparison of Ellipsys Percutaneous and Proximal Forearm Gracz-Type Surgical Arteriovenous Fistulas by Robert Shahverdyan et al [Open Access]
From the authors: We compared Ellipsys percutaneous arteriovenous ﬁstulas (AVF) with a surgical proximal forearm surgical AVF as they use the same anatomical site and vascular anatomy. We retrospectively reviewed our center’s vascular access procedures over a 34-month period. No demographic differences were observed. Both percutaneous and surgical AVF demonstrated similarly high technical success rates and secondary patency rates. The percutaneous AVFs required dramatically shorter procedure times. The rate of required interventions was similar. When both surgical and percutaneous AVF used proximal radial artery inﬂow, secondary patency was higher for percutaneous AVFs. If a distal radial artery AVF is not feasible, percutaneous AVF might offer an appropriate procedure for creating a safe and functional access.
From the authors: Standard measures of kidney function, including estimated glomerular ﬁltration rate and albuminuria, do not reliably capture the health of the kidney tubules, which may provide additional insight into the relationship between kidney function and cognition and frailty among older adults. We evaluated the relation-ship between 8 urine markers of kidney tubule function and injury with cognitive function and frailty among 2,253 participants with chronic kidney disease in the Systolic Blood Pressure Intervention Trial. We found that participants with higher concentrations of urine KIM-1, MCP-1, and A1M were more likely to be categorized as frail. We also found that participants with higher concentrations of urine B2M had lower cognitive scores. These associations were statistically signiﬁcant beyond adjustment for estimated glomerular ﬁltration rate and urine albumin.
From the authors: Our study used clinical simulations to assess how well nephrology fellows communicate with patients and family members about the circumstances when patients need a kidney biopsy or require dialysis because of kidney failure or severe acute kidney injury. The simulated patients rated the fellows on their communication skills, and the nephrology faculty rated them on the accuracy of the medical information they transmitted. Overall, the nephrology fellows’ communication skills were good, but some were deﬁcient in giving accurate medical information, especially about urgent dialysis and kidney biopsy. This approach to evaluation can be used to provide fellows with feed-back, to identify fellows who struggle with patient communication, and to help nephrology training pro-grams identify curricular gaps.
From the authors: Regional citrate anticoagulation for continuous dialysis prevents clotting by binding free calcium in the blood. The procedure uses calcium-free dialysate and replacement solutions because of a fear that calcium-containing solutions would lead to ineffective anticoagulation or increased citrate requirements. We implemented regional citrate anticoagulation using calcium-containing solutions in 128 patients, including 32 with liver disease and 28 with sepsis. In our study, median ﬁlter life was 50 hours, comparable to studies that used calcium-free solutions. Patients with liver disease and sepsis had shorter median ﬁlter life than those without these conditions; however, there was no difference in the incidence of complications. This study describes the technique using calcium-containing solutions and practical considerations for patients with liver disease or sepsis.
Clinical and Genetic Features of Autosomal Dominant Alport Syndrome: A Cohort Study by Mónica Furlano et al [Open Access]
From the authors: Autosomal dominant Alport syndrome is among the most underdiagnosed inherited kidney diseases and is not commonly diagnosed by most nephrologists. Compared with X-linked Alport syndrome or the autosomal recessive form, this entity is much less severe: most patients have hematuria but only a minority will experience chronic kidney disease or extrarenal involvement. The relatively low prevalence of this condition, the paucity of clinical features in some patients, and a prominent role of environmental/genetic modiﬁers may account for its infrequent diagnosis. Raising awareness of autosomal dominant Alport syndrome will foster its diagnosis and reduce the number of patients in whom kidney failure develops without an etiologic diagnosis.
Perspective from the October 2021 Issue:
Osteoporosis and Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD): Back to Basics by Michael Pazianas and Paul D. Miller
From the authors: Osteoporosis is only part of a spectrum of skeletal complications that includes osteomalacia and the various forms of renal osteodystrophy of chronic kidney disease–mineral and bone disorder (CKD-MBD). A new label, “CKD-MBD/osteoporosis” brings osteoporosis under the official label of CKD-MBD. Neither laboratory nor noninvasive diagnostic investigations can discriminate osteoporosis from the several forms of renal osteodystrophy. Recently, a classification of metabolic bone diseases based on bone turnover, from low to high, together with mineralization and bone volume, has been proposed. Therapeutically, agents that suppress parathyroid hormone (vitamin D analogues and calcimimetics) are used to treat hyperparathyroid bone disease, while antiresorptive and osteoanabolic agents approved for osteoporosis are being used off-label to treat CKD stages 3b-5 in high-risk patients. It has now been suggested that intermittent administration of parathyroid hormone as early as CKD stage 2 may be beneficial for coexisting osteoporosis.
On the Cover: Dr Edward Jenner, a 19th century physician credited with establishing the use and value of vaccination, is seen on this month’s cover administering a cowpox vaccine to a young child in 1796 to protect him from deadly smallpox. His efforts ultimately made possible worldwide eradication of smallpox by 1980. Today, more than 200 hundred years since Jenner’s pioneering work, the world has been reeling from the COVID-19 pandemic that is slowly being brought under control through vaccination. While immunization with these vaccines has already reduced rates of disease and death, they have rarely been associated with adverse effects. In this issue of the AJKD, Leclerc et al report a case of minimal change disease after the ChAdOx1 nCoV-19 (AZD1222) vaccine and Bomback et al review the link between different COVID-19 vaccines and glomerular diseases.
AJKD is celebrating its 40th year in 2021. In this special collection, the editors highlight landmark papers on chronic kidney disease that have been published in the journal over the past four decades.