In 2017, we established an annual celebration of articles that our editorial team designated as “Editors’ Choice” selections. The editors are delighted to recognize the articles listed below that have been selected to receive the 2021 Editors’ Choice Award. These articles will be freely available at AJKD.org until February 15, 2022. Congratulations to all the authors!

Relative and Absolute Risk Reductions in Cardiovascular and Kidney Outcomes With Canagliflozin Across KDIGO Risk Categories: Findings From the CANVAS Program by Brendon L. Neuen, Toshiaki Ohkuma, Bruce Neal, David R. Matthews, Dick de Zeeuw, Kenneth W. Mahaffey, Greg Fulcher, Jaime Blais, Qiang Li, Meg J. Jardine, Vlado Perkovic, and David C. Wheeler (January 2021)

From the authors: Canagliflozin reduces the risk for cardiovascular and kidney outcomes in patients with type 2 diabetes. This post hoc analysis of the phase 3 randomized placebo-controlled CANagliflozin cardioVascular Assessment Study (CANVAS) Program (n = 10,142) assessed the effect of canagliflozin on these outcomes in participants with different levels of risk for chronic kidney disease outcomes, defined by the KDIGO (Kidney Disease: Improving Global Outcomes) classification based on estimated glomerular filtration rate and urinary albumin-creatinine ratio. The relative effects of canagliflozin on cardiovascular and kidney outcomes were similar across KDIGO risk categories, but absolute risk reductions were likely greater for individuals within higher-risk KDIGO categories. The KDIGO classification system may be able to be used to identify individuals who would derive greater benefits for end-organ protection from treatment with canagliflozin.

DOI:10.1053/j.ajkd.2020.06.018

Editorial What Is the Utility of KDIGO Criteria to Identify High-Risk Populations? by Christoph Wanner and Kai Lopau [FREE]

Validation of Risk Prediction Models to Inform Clinical Decisions After Acute Kidney Injury [Open Access] by Simon Sawhney, Zhi Tan, Corri Black, Angharad Marks, David J. Mclernon, Paul Ronksley, and Matthew T. James (July 2021)

Care processes over the first (A) 30 and (B) 90 days after discharge, following hospital admission with AKI. The figure shows the flow of people from hospital discharge through care events including the accident and emergency department (A&E); primary care general practice (GP); outpatient specialty clinics (outpatient), and hospital readmission or death. Dashed lines represent cohort entry following discharge and exit after 30 and 90 days have elapsed, respectively. Directed arrows are the most common paths between events, weighted by number of people. Numbers beside the arrows between boxes represent the movement of people, and the median days (d) and hours (hrs) between events underneath. Figure 3 from Sawhney et al, AJKD © The Authors, released under CC BY 4.0 license.

From the authors: Despite frequent poor outcomes, there is limited evidence to guide the way in which we prioritize care after acute kidney injury (AKI). This study validates 2 clinical risk models for outcomes in hospital survivors and AKI survivors. We used decision curve analysis to compare which decision strategies provide more benefit than harm. We found that risk models predicting death or readmission and chronic kidney disease have the potential to assist follow-up decisions after AKI and could be superior to alternative strategies such as prioritizing AKI severity or kidney recovery alone. We also found that many patients currently receive little or no postdischarge monitoring after AKI. This indicates possible opportunities for the implementation of decision support to guide postdischarge care for people hospitalized with AKI.

DOI: 10.1053/j.ajkd.2020.12.008

Editorial We Won’t Get Fooled Again: Finding the Who to Follow After Acute Kidney Injury by Javier A. Neyra and Samuel A. Silver [FREE] 

Social Determinants of Cardiovascular Health in African American Children With CKD: An Analysis of the Chronic Kidney Disease in Children (CKiD) Study by Kristen Sgambat, Jennifer Roem, Tammy M. Brady, Joseph T. Flynn, Mark Mitsnefes, Joshua A. Samuels, Bradley A. Warady, Susan L. Furth, and Asha Moudgil (July 2021)

Estimates for Cardiovascular Markers by African American Versus White Race Among 463 Children With Nonglomerular CKD Over 2,371 Visits. Table 4 from Sgambat et al, AJKD © The National Kidney Foundation

From the authors: African American children with chronic kidney disease (CKD) are disproportionately affected by socioeconomic disadvantages compared with White children. The degree to which cardiovascular markers differ by race is influenced by disease etiology. African Americans with nonglomerular CKD have increased left ventricular mass index (LVMI), more ambulatory hypertension, and favorable lipid profile, but attenuation in magnitude after adjustment for socioeconomic factors (SES) was observed. African Americans with glomerular CKD had increased LVMI, which persisted after SES adjustment. As many social determinants of health were not captured, future research should examine effects of systemic racism on cardiovascular health in this population.

DOI: 10.1053/j.ajkd.2020.11.013

Risk of Symptomatic Kidney Stones During and After Pregnancy by Charat Thongprayoon, Lisa E. Vaughan, Api Chewcharat, Andrea G. Kattah, Felicity T. Enders, Rajiv Kumar, John C. Lieske, Vernon M. Pais, Vesna D. Garovic, and Andrew D. Rule (September 2021)

Table 3 from Thongprayoon et al, AJKD © National Kidney Foundation

From the authors: Although several well-known anatomical and physiological changes during pregnancy could contribute to kidney stone formation, the evidence that these changes increase the risk of kidney stones during pregnancy is lacking. In a population-based case-control study using 945 female first-time symptomatic stone formers and 1,890 aged-matched female controls in Olmsted County, MN, pregnancy was associated with an increased risk of a symptomatic kidney stone, starting during the second trimester, peaking around the time of delivery, and persisting until 1 year after delivery. Awareness of the higher risk of symptomatic kidney stones during pregnancy and the postpartum period informs diagnostic and preventive strategies in women, particularly for women who are already at high risk for kidney stones.

DOI: 10.1053/j.ajkd.2021.01.008

~2021 NKF MISSION AWARD~

“Recognizing research published in AJKD that has great promise to enhance the lives of those affected by kidney disease”

CKD Awareness Among US Adults by Future Risk of Kidney Failure (August 2020)

by Chi D. Chu, Charles E. McCulloch, Tanushree Banerjee, Meda E. Pavkov, Nilka R. Burrows, Brenda W. Gillespie, Rajiv Saran, Michael G. Shlipak, Neil R. Powe, Delphine S. Tuot, on behalf of the CDC CKD Surveillance Team

From the authors: In this nationally representative sample of US adults, we found that although CKD awareness was higher among persons with higher 5-year kidney failure risk, approximately half the participants with ≥15% risk for developing kidney failure within 5 years were unaware of having kidney disease. Additionally, no statistically significant trends over time were observed in CKD awareness for any risk groups except among those with minimal-risk CKD, but this trend was not significant in adjusted analyses. After adjustment for demographic factors and comorbid conditions, we found that higher predicted kidney failure risk was associated with increased odds of CKD awareness.

DOI: 10.1053/j.ajkd.2020.01.007

Editorial Knowledge Is Power: Patient Education as a Tool for Patient Activation by Jennifer Chen, Kevin J. Fowler, and Morgan Grams [FREE]