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. Highlights from the April 2023 issue:

Short-term Blood Pressure Variability and Incident CKD in Patients With Hypertension: Findings From the Cardiovascular and Metabolic Disease Etiology Research Center–High Risk (CMERC-HI) Study by Jong Hyun Jhee et al 

From the authors: Ambulatory blood pressure monitoring (ABPM) provides useful BP profiles, including short-term BP variability (BPV). However, little evidence exists documenting the usefulness of short-term BPV to stratify the risk of developing chronic kidney disease (CKD). This study evaluated the association between short-term BPV and incident CKD in patients with hypertension. This study found that high SBP- and DBP-average real variability (ARV) assessed by ABPM was associated with an increased risk of new-onset CKD. However, other measures for short-term BPV including standard deviation, coefficient of variation, or dipping patterns were not similarly associated. This study suggests that 24-hour ARV may be a useful tool to assess the risk of developing CKD in patients with hypertension.

DOI: 10.1053/j.ajkd.2022.08.017

Editorial: The Need to Reduce Variability in the Study of Blood Pressure Variability by Mario Funes Hernandez et al. (FREE)

SARS-CoV-2 Vaccine Effectiveness and Breakthrough Infections Among Patients Receiving Maintenance Dialysis by Harold J. Manley et al (FREE)

From the authors: SARS-CoV-2 vaccine effectiveness and the association between antibody levels and severe COVID-19 clinical outcomes (ie, hospitalization or death) among maintenance dialysis patients are poorly defined. From February 1 through June 18, 2021 (pre–Delta variant period) and June 19 through December 18, 2021 (Delta variant–dominant period), vaccine effectiveness rates against severe COVID-19 events were 84% and 70%, respectively. A longer interval since achievement of full vaccination status was associated with higher risk for severe COVID events. Having antibodies to SARS-CoV-2 spike protein above a key threshold level was associated with lower risks of COVID-19 diagnosis and COVID-related hospitalization or death. Barring changes associated with new SARS-CoV-2 variants, our findings demonstrate high effectiveness of SARS-CoV-2 vaccines and suggest that monitoring SARS-CoV-2 antibody levels and administering additional vaccine doses to maintain adequate immunity may be beneficial.

DOI: 10.1053/j.ajkd.2022.10.010

Use of Histologic Parameters to Predict Glomerular Disease Progression: Findings From the China Kidney Biopsy Cohort Study by Xiaodong Zhang et al.

From the authors: Risk prediction and stratification remain big challenges for treatment decisions and clinical research design for patients with glomerular diseases. The extent of chronic changes is an important component of kidney biopsy evaluations in glomerular disease. In this large multicenter cohort including 4,982 Chinese adults undergoing native kidney biopsy, we evaluated whether histologic chronicity scores, when added to clinical data, could improve the prediction of disease prognosis for a diverse set of glomerular diseases. We observed that adding histologic chronicity scores to the kidney failure risk equation improved the prediction of kidney disease progression at the time of kidney biopsy in patients with glomerular diseases.

DOI: 10.1053/j.ajkd.2022.08.021

Risk of CKD Following Detection of Microscopic Hematuria: A Retrospective Cohort Study by Yoo Jin Um et al. (FREE)

From the authors: Hematuria, the presence of blood in the urine, has been reported to be associated with an increased risk of chronic kidney disease (CKD). However, the relationship between hematuria that persists over time and kidney function is not clear. In this large study consisting of relatively young and healthy Korean adults, we investigated the association between episodes of microscopic hematuria and the development of CKD. We found that microscopic hematuria, especially when persistent, was associated with worse kidney function. These associations were stronger in men compared with women but were readily apparent in both sex groups. Our study suggests that individuals with prolonged hematuria should be monitored and that they may be candidates for early preventive strategies to decrease the risk of subsequent CKD.

DOI: 10.1053/j.ajkd.2022.09.012

Cardiac and Kidney Adverse Effects of HIF Prolyl-Hydroxylase Inhibitors for Anemia in Patients With CKD Not Receiving Dialysis: A Systematic Review and Meta-analysis by Qiyan Zheng et al.

From the authors: To date, numerous studies have demonstrated that hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) are clinically efficacious in treating patients with chronic kidney disease (CKD) and anemia. Our meta-analysis evaluated the safety of HIF-PHIs in terms of the cardiac and kidney-related adverse events (AEs) among such patients. The results indicate that HIF-PHIs were not significantly associated with the occurrence of cardiac AEs, kidney-related AEs, kidney failure events, severe AEs, or death for patients with anemia and CKD who were not receiving maintenance dialysis. However, HIF-PHIs were associated with a greater risk of hypertension and hyperkalemia when compared with the placebo but with a lower risk of hypertension compared with erythropoiesis-stimulating agents. This suggests that HIF-PHIs may be an option for anemic patients with CKD and poor blood pressure control.

DOI: 10.1053/j.ajkd.2022.09.014

Heart Failure–Type Symptom Score Trajectories in CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study by Carl P. Walther et al. 

From the authors: People who have chronic kidney disease often experience symptoms that reduce their quality of life. Some symptoms common in kidney disease (such as fatigue, shortness of breath, and swelling) may be caused by kidney disease, heart disease, or other problems. We investigated how these symptoms might evolve or change in people with chronic kidney disease over several years. We found that most people have stable symptoms, at minimal, mild, or severe levels. These findings may inform future studies of how to improve these symptoms.

DOI:10.1053/j.ajkd.2022.09.016

Longitudinal Relationship Between Anemia and Statural Growth Impairment in Children and Adolescents With Nonglomerular CKD: Findings From the Chronic Kidney Disease in Children (CKiD) Study by Oleh Akchurin et al. 

From the authors: Both anemia and short stature are common complications of chronic kidney disease (CKD) in children. In children without CKD, anemia has been shown to impair physical development; however, the relationship between anemia and growth in children with CKD remains unclear. Using data from the Chronic Kidney Disease in Children (CKiD) cohort study, we demonstrated that children with the most common (nonglomerular) origin of CKD and lower hemoglobin values are more likely to grow poorly, independent of their kidney function, sex, and age. These findings are important for the refinement of guidelines for the management of anemia and short stature in children with CKD.

DOI: 10.1053/j.ajkd.2022.09.019

Core Curriculum from the April 2023 issue:

Therapeutic Plasma Exchange: Core Curriculum 2023 by C. Elena Cervantes et al (FREE)

From producing individual blood components for transfusion to the removal of pathogenic substances, apheresis is a cornerstone of modern medical therapies. The use of therapeutic plasma exchange (TPE), in which plasma and its soluble constituents are removed from the body in exchange for a replacement fluid, can be organ- and life-saving in many diseases. This review discusses therapeutic plasma exchange (TPE) from the perspective of a nephrologist responsible for prescribing and managing TPE, as well as nephrologists engaged in the care of patients undergoing the procedure.

DOI: 10.1053/j.ajkd.2022.10.017

Figure 1 from Cervantes et al, AJKD © National Kidney Foundation

On the Cover: Illustrated in this month’s cover is “Blood Swept Lands and Seas of Red,” a public art installation created in the proximity of the Tower of London, England in 2014. It was established to commemorate the centenary of the outbreak of World War I and consists of 888,246 ceramic red poppies, each intended to represent one British or Colonial serviceman killed in the War. The work contains a sea of ceramic red poppies, in a design which appears to flow out of the Tower itself in a ripple effect, which is evocative of flowing blood. In this issue of AJKD, Um et al report how persistent hematuria is associated with increased risk of chronic kidney disease.

The photograph “Blood Swept Lands and Seas of Red” by Aurelien Guichard is released on Flickr under the CC BY 2.0 license

Call for Applications: AJKD Editorial Internship ProgramThe AJKD Editorial Internship Program provides editorial experience to early career researchers interested in education, teaching, or medical editing/writing. Applications are due by April 30, 2023. Details on how to apply are provided here.