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 December 2021 issue:

Barriers to and Facilitators of Sustained Employment: A Qualitative Study of Experiences in Dutch Patients With CKD by Sijrike F. van der Mei et al [Open Access]

From the authors: Work is beneficial for people’s health and well-being. Symptoms and treatment (dialysis, kidney transplant) of chronic kidney disease (CKD) limit patients’ physical health, and many cannot maintain their job. Interviews with patients showed multiple factors that hindered sustained employment, such as fatigue, decreased concentration, dialysis, transplant waitlist, psychological impact, and issues at work. However, patients also expressed factors that were believed to help them remain at work, such as personalized dialysis, transplant before the need to start dialysis, having a positive attitude, job satisfaction, supports at work, and work accommodations. Clinicians can support patients by monitoring work-related problems and support needs, offering treatment (dialysis/transplant) that fits patients’ work circumstances and referring patients for occupational counseling when needed.

DOI: 10.1053/j.ajkd.2021.04.008

Editorial: Supporting the Employment Goals of People With Kidney Disease by Ann M. O’Hare et al [FREE] 

Combination of Rituximab, Low-Dose Cyclophosphamide, and Prednisone for Primary Membranous Nephropathy: A Case Series With Extended Follow Up by Reza Zonozi et al [Open Access]

From the authors: Membranous nephropathy (MN) is an autoimmune disease resulting in the nephrotic syndrome. Patients are at an increased risk for progressive kidney injury, cardiovascular disease, thromboembolic disease, and infections. B-cell depletion with rituximab has emerged as a new first-line therapy. However, only a minority of patients achieve complete remission with rituximab monotherapy. We analyzed a series of 60 patients with primary MN whom we treated with rituximab combined with an initial short course of low-dose oral cyclophosphamide and a rapidly tapered course of prednisone. All patients achieved partial remission, and the majority achieved complete remission. All patients rapidly achieved immunologic remission. The relapse rate was low, and the safety profile was acceptable.

DOI: 10.1053/j.ajkd.2021.04.014

Editorial: Multitarget Combination Immunosuppressive Therapy for Primary Membranous Nephropathy by Najia Idrees and Laurence H. Beck Jr. [FREE] 

Incidence and Outcomes of COVID-19 in People With CKD: A Systematic Review and Meta-analysis by Edmund Y.M. Chung et al [FREE] 

From the authors: Previous studies suggest that people with chronic kidney disease (CKD) may be severely affected by coronavirus disease 2019 (COVID-19). We searched for observational studies that investigated how many people with CKD were diagnosed with COVID-19 and experienced related health outcomes, including death, respiratory failure, and need for dialysis. Data were pooled from 348 studies that included a total of more than 1 million people with CKD. COVID-19 occurred more commonly in people who required long-term dialysis than in those with CKD not requiring dialysis (including kidney transplant recipients). People with CKD and COVID-19 may have a 10-fold higher risk of death than people with CKD without COVID-19.

DOI: 10.1053/j.ajkd.2021.07.003

Editorial: Understanding the Burden of the COVID-19 Pandemic for People With Kidney Disease by James B. Wetmore [FREE] 

Changes in Body Composition, Muscle Strength, and Fat Distribution Following Kidney Transplantation by Thomas Dienemann et al 

From the authors: The impact of kidney transplantation on muscle mass, muscle quality, fat mass, and fat distribution has not been established. Low muscle mass relative to fat mass (relative sarcopenia) is associated with mortality and disability in chronic kidney disease and the general population. Among 60 individuals with an age range of 20 to 60 years observed for 2 years after transplantation, the prevalence of obesity increased from 18% to 45%. Gains in fat mass outpaced gains in muscle mass, resulting in persistent relative sarcopenia. Muscle strength improved but remained low for the amount of muscle mass and low compared with healthy individuals. Future studies are needed to determine the impact of relative sarcopenia on disability and mortality after transplantation, and to identify strategies to improve muscle quality.

DOI: 10.1053/j.ajkd.2020.11.032

Risk of Potentially Inappropriate Medications in Adults With CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study by Rasheeda K. Hall et al 

From the authors: Potentially inappropriate medications (PIMs) bring more risk of harm than benefit in older adults. The frequency of use of these medications and their asso-ciation with adverse outcomes in the adult population with CKD has not been well studied. To address this knowledge gap, we examined data from participants in the Chronic Renal Insufficiency Cohort (CRIC) study to determine the prevalence of PIM prescriptions and the association between PIMs and adverse outcomes, including death, hospitalization, falls, and progression of kidney disease. The most commonly used PIMS were proton pump inhibitors, α-blockers, and nonsteroidal anti-inflammatory drugs (NSAIDs). The first 2 were used more frequently in older study participants, and NSAIDs were more commonly used by the younger participants. Study participants, regardless of age, were more likely to have an increased risk of hospitalization, mortality, and falls after prescriptions for PIMs, with the greatest risk occurring with prescriptions for more than 1 type of PIM.

DOI: 10.1053/j.ajkd.2021.03.019

Oral Ferric Maltol for the Treatment of Iron-Deficiency Anemia in Patients With CKD: A Randomized Trial and Open-Label Extension by Pablo E. Pergola and Nelson P. Kopyt [Open Access]

From the authors: People with chronic kidney disease (CKD) often have anemia (low levels of the oxygen-carrying protein hemoglobin in the blood); as a result, they may feel tired or weak and have trouble concentrating. In people with CKD, anemia is often associated with low levels of iron in the blood. We studied whether a form of iron that can be taken orally would raise participants’ hemoglobin and iron levels. Our study involved 167 adults at 30 US centers with moderate to severe CKD and anemia due to low blood iron levels. They were split into two groups, one of which was given the drug ferric maltol, and the other received a placebo; both groups took their capsules twice daily for 16 weeks. After that, participants were all given ferric maltol for another 36 weeks so that we could look at the long-term effects of treatment. After 16 weeks, we found that the group taking ferric maltol had, on average, significantly higher levels of hemoglobin in their blood compared with the group receiving placebo. Hemoglobin levels stayed at the new higher level during long-term treatment (36 additional weeks). Patients in both groups reported some side effects, such as diarrhea or constipation, but, nevertheless, more than 9 in every 10 patients were able to keep taking the treatment. We conclude that people with CKD who took ferric maltol had significant and sustained increases in hemoglobin, with manageable side effects.

DOI: 10.1053/j.ajkd.2021.03.020

Policy Forum Perspective from the December 2021 Issue:

Funding Innovative Dialysis Technology in the United States: Home Dialysis and the ESRD Transitional Add-on Payment for New and Innovative Equipment and Supplies (TPNIES) by Yuvaram N.V. Reddy et al  

From the authors: Innovative, patient-centered, and pragmatic dialysis technologies are urgently needed to accommodate the growing national interest in home dialysis use. Although barriers to innovation exist in nephrology, recent coordinated efforts have been undertaken to overcome them. As the kidney community looks toward the entry of innovative technologies into the market, we must consider methods to facilitate more rapid implementation of these technologies into practice, including limiting the financial disincentives that hinder adoption of newer technologies. In this perspective, we provide an overview of a recent US Centers for Medicare & Medicaid Services (CMS) proposal to incentivize home dialysis innovation: the transitional add-on payment for new and innovative equipment and supplies (TPNIES). In doing so, we aim to draw attention to areas of concern within the policy as well as emphasize the need for nephrologists, professional nephrology societies, and the greater kidney community to remain active members in decision-making in health policy.

DOI: 10.1053/j.ajkd.2021.03.025

On the Cover: Human beings have used plants and minerals for their medicinal qualities since time immemorial. Western civilization’s emergence from the Middle Ages in the 16th century saw the development of organized pharmaceutical practices. Our cover image depicts a Parisian professor regaling students with tales of the miraculous products of the Pharmacie Centrale de France. While this enthusiasm for pharmaceuticals as a pathway to healthier living continues to this day, a more circumspect approach may be warranted for patients particularly vulnerable to adverse drug effects such as in the setting of CKD. In this issue of AJKD, Rasheeda K. Hall and colleagues share their findings concerning the risks of adverse effects faced by adults with CKD treated with potentially inappropriate medications.

The chromolithograph “Pharmacie Centrale de France et Maison Droguerie Menier” is from the Wellcome Collection and is in the public domain.

SPECIAL 40th ANNIVERSARY COLLECTION: CKD

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.