Highlights from the May 2022 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 2022 issue:

Dialysis Outcomes for Children With Lupus Nephritis Compared to Children With Other Forms of Nephritis: A Retrospective Cohort Study by Heather Wasik et al

From the authors: Systemic lupus erythematosus is an autoimmune disease that affects many organ systems including the kidneys. Children with lupus are more likely than adults with lupus to develop kidney disease. When they do, they also have a high risk of initiating dialysis due to kidney failure. We used data collected over 30 years in a large North American pediatric registry to compare the outcomes among children on dialysis with lupus kidney disease compared with children on dialysis because of kidney disease from other causes. We found that children with lupus were more likely to be hospitalized and had a lower rate of kidney transplantation.

DOI: 10.1053/j.ajkd.2021.07.013

Editorial: Kidney Failure in Systemic Lupus Erythematosus: A Fraught Complication in a Fraught Disease by Brad H. Rovin [FREE] 


Incidence of Kidney Replacement Therapy and Subsequent Outcomes Among Patients With Systemic Lupus Erythematosus: Findings From the ERA Registry by Andrej Derner et al [OPEN ACCESS]

From the authors: There is a dearth of information about the incidence and prognosis among patients with systemic lupus erythematosus (SLE) requiring kidney replacement therapy (KRT). We performed a study using data from the European Renal Association Registry focusing on the period between 1992 and 2016 in which we compared patients with SLE in whom a need for KRT developed versus patients who required KRT as a result of another cause of kidney disease. The overall survival of patients with SLE receiving KRT was not identified to differ from the survival in the comparator group despite higher infection-related mortality rates, lower kidney trans-plant rates, and higher patient mortality rates after kidney transplant in the setting of SLE. Graft survival was also not different between groups. The incidence of patients with SLE receiving KRT in the European population studied remained stable over time.

DOI: 10.1053/j.ajkd.2021.09.016

Editorial: Kidney Failure in Systemic Lupus Erythematosus: A Fraught Complication in a Fraught Disease by Brad H. Rovin [FREE] 


Biomarkers During Recovery From AKI and Prediction of Long-term Reductions in Estimated GFR by Michelle Wilson et al

From the authors: Acute kidney injury (AKI), a sudden reduction in kidney function, often causes or worsens long-term kidney damage (ie, chronic kidney disease). This research evaluates a number of blood tests in people who have had AKI, aiming to use these biomarkers improve the ability to assess risk of new or progressive kidney dis-ease. Among a panel of 11 biomarkers tested, a combination of the most promising were identified, comprising soluble tumor necrosis factor receptors 1 and 2, cystatin C, and estimated glomerular filtration rate. This combination discriminated between those with and without worsening chronic kidney disease after 3 years and was particularly good at identifying those at lowest risk for progressive kidney disease. These findings suggest that, after AKI, biomarkers may be useful in identifying patients with very low risk of subsequent kidney dysfunction and less need for medical follow-up.

DOI: 10.1053/j.ajkd.2021.08.017

Editorial: Biomarkers to Predict CKD After Acute Kidney Injury: News or Noise? by Samuel A. Silver and Simon Sawhney [FREE] 


Challenges to Shared Decision Making About Treatment of Advanced CKD: A Qualitative Study of Patients and Clinicians by Taylor R. House et al 

From the authors: Although shared decision making is widely promoted, its implementation in decisions about treatment of advanced chronic kidney disease (CKD) remains challenging. We conducted a qualitative study using interviews with older patients with advanced CKD and their clinicians along with medical record review to ascertain perceived challenges with decision making about treatment of their kidney disease. Patients and their clinicians reported that it was difficult to find common ground in four areas: (1) balancing CKD among other priorities; (2) focusing on the present versus preparing for the future; (3) taking a standardized versus an individualized approach to treatment of advanced CKD; and (4) navigating power differentials in the therapeutic relationship. Steps to promote shared decision making for treatment of advanced CKD should explicitly address these challenges.

DOI: 10.1053/j.ajkd.2021.08.021

Editorial: The Elusive Promise of Shared Decision Making: A Step Forward by Keren Ladin and Rebecca S. Frazier [FREE] 


Diagnostic Accuracy of Noninvasive Bone Turnover Markers in Renal Osteodystrophy by Hanne Skou Jørgensen et al 

From the authors: Skeletal remodeling is disturbed in chronic kidney disease, and knowledge of the bone turnover status may help guide treatment decisions. Currently, a bone biopsy is the diagnostic standard to evaluate bone turnover, but this invasive procedure is not well suited for everyday clinical practice. This study investigates the diagnostic potential of noninvasive biochemical bone turnover markers for a diagnosis of high or low bone turnover in patients with chronic kidney disease. Our results suggest that biomarkers may be used to rule out the presence of both high and low bone turnover with a high degree of certainty. The clinical implications of these findings are that biochemical bone turnover markers may aid treatment decisions and potentially decrease the need for invasive bone biopsies in patients with chronic kidney disease.

DOI: 10.1053/j.ajkd.2021.07.027


Kidney Disease, Hypertension Treatment, and Cerebral Perfusion and Structure by Manjule Kurella Tamura et al 

From the authors: The Systolic Blood Pressure Intervention Trial found that intensive versus standard blood pressure (BP) treatment reduced mortality, major cardiovascular events, mild cognitive impairment, and progression of brain white matter lesions, but the cognitive benefits were attenuated in persons with kidney disease. This analysis evaluated the effects of intensive versus standard BP treatment on brain perfusion and structure in participants with kidney disease. Among adults with hypertension who have primarily early kidney disease, intensive versus standard BP treatment did not appear to have a detrimental effect on brain perfusion or structure. The findings support the safety of intensive BP treatment targets on brain health in persons with early kidney disease.

DOI: 10.1053/j.ajkd.2021.07.024


Healthy Lifestyle and Mortality Among Adults Receiving Hemodialysis: The DIET-HD Study by Guobin Su et al 

From the authors: A healthy lifestyle is associated with a reduced mortality risk in the general population. It is uncertain if this is also true within the hemodialysis population. We examined the association between healthy lifestyle (measured by a composite of smoking, physical activity, diet, and systolic blood pressure) and mortality among 5,483 patients treated with maintenance hemodialysis. A healthier lifestyle was associated with lower all-cause and cardiovascular mortality in this population. These findings may encourage clinicians to recommend to their hemodialysis patients that they adopt a healthy lifestyle that includes stopping smoking and being physically active.

DOI: 10.1053/j.ajkd.2021.07.022


Advance Care Planning Coaching in CKD Clinics: A Pragmatic Randomized Clinical Trial by Dale E. Lupu et al [FREE] 

From the authors: Advance care planning (ACP) is key to incorporating patient preferences into decisions regarding future health care. Studies have described successful approaches to incorporating ACP into dialysis care, but none had investigated implementation of ACP earlier in the course of chronic kidney disease—an approach recommended by patients. This pragmatic randomized trial enrolled 254 patients at 3 chronic kidney disease clinics and used ACP “coaching” through a program called Make Your Wishes About You (MY WAY). Based on motivational interviewing, MY WAY provides a flexible approach to elicit and document patient goals and preferences. Patients who received coaching were 79% more likely to have an advance directive in their clinic chart and scored 1.9 points higher on an engagement measure, although this effect of MY WAY was only observed at 1 of the 3 clinical study sites.

DOI: 10.1053/j.ajkd.2021.08.019


Review from the May 2022 Issue:

Pathophysiology and Management of Hyperoxaluria and Oxalate Nephropathy: A Review by Nathalie Demoulin et al [FREE] 

Hyperoxaluria results from either inherited disorders of glyoxylate metabolism leading to hepatic oxalate overproduction (primary hyperoxaluria), or increased intestinal oxalate absorption (secondary hyperoxaluria). Hyperoxaluria may lead to urinary supersaturation of calcium oxalate and crystal formation, contributing to urolithiasis and deposition of calcium oxalate crystals in the kidney parenchyma, leading to a condition termed oxalate nephropathy. We discuss the progress made in the understanding of intestinal and renal handling of oxalate and crystal-induced kidney damage and review the diagnosis and management of primary and secondary hyperoxaluria.

DOI: 10.1053/j.ajkd.2021.07.018


On the Cover: As the sun sets in Arches National Park, Balanced Rock comes into view with the stunning La Sal Mountain Range in the background. Arches National Park exhibits a diverse landscape of over 2,000 natural arches, soaring pinnacles, and other enormous gracefully balancing stone formations. Balanced Rock is a metaphor of the poise and resilience required of home dialysis patients who balance so many competing obligations when managing their home dialysis treatments safely and independently in the community setting. In this issue of AJKD, Liu et al discuss policies to support home dialysis patients with a particular focus on making it easier to initiate and sustain home dialysis as treatment for kidney failure that requires replacement therapy.

Public Domain photo by NPS/Chris Wonderly available via the Arches National Park flickr page.


Special 40th Anniversary Collection: DIALYSIS

AJKD is celebrating its 40th year of publication. In this special collection, the editors highlight landmark papers on dialysis that have been published in the journal over the past four decades.

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