Highlights from the May 2023 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. Highlights from the May 2023 issue:
Associations Between Ambient Extreme Heat Exposure and Emergency Department Visits Related to Kidney Disease by Yanji Qu et al
From the authors: Given the increasing frequency and intensity of extreme heat exposure due to climate change and the growing prevalence of kidney disease worldwide, we examined their association with one another. We examined the association between extreme heat exposure and kidney disease–related emergency department visits based on seasons and disease subtypes in New York state. Extreme heat exposure was significantly associated with an increased risk of emergency department visits for multiple types of kidney disease (mainly acute kidney injury, kidney stones, and urinary tract infections). Furthermore, the impact of extreme heat exposure lasted a week and was stronger in the transitional months (May and September) than the summer months.
Editorial: Climate Change, Heat-Related Acute Kidney Disease, and the Need for Action by Alex Gallagher et al. [FREE]
Venglustat, a Novel Glucosylceramide Synthase Inhibitor, in Patients at Risk of Rapidly Progressing ADPKD: Primary Results of a Double-Blind, Placebo-Controlled, Phase 2/3 Randomized Clinical Trial by Ronald T. Gansevoort et al (OPEN ACCESS)
From the authors: Patients with autosomal dominant polycystic kidney disease (ADPKD) develop cysts in the kidneys that lead to inflammation, scarring, and obstruction of urine flow with progression to kidney failure. Currently, there is only one drug that is approved for the treatment of ADPKD, but it is associated with liver toxicity. Venglustat is an oral medication that has been shown to prevent the development of kidney cysts and preserve kidney function in preclinical studies of ADPKD. STAGED-PKD, a clinical trial, evaluated the efficacy and safety of venglustat in patients with rapidly progressing ADPKD. In this patient population, venglustat provided no benefit and in fact resulted in a faster decline in kidney function. Based on these preliminary findings, STAGED-PKD was stopped.
Editorial: Targeting Glycosphingolipid Metabolism in ADPKD: Another Roadblock for Treatment by Cortney N. Steele and Kristen L. Nowak [FREE]
Antimicrobial Photodynamic Therapy in the Nasal Decolonization of Maintenance Hemodialysis Patients: A Pilot Randomized Trial by Daniella Teixeira Bezerra et al.
From the authors: Prior studies have demonstrated that colonization of the interior surfaces of the nose by the bacterium Staphylococcus aureus is a risk factor for systemic infection and death among patients with chronic kidney disease receiving maintenance dialysis. This study was motivated by the possibility of using a photodynamic therapy, a bactericidal treatment that uses a specific type of red light, to kill nasal bacteria without inducing bacterial resistance as occurs with topical antibiotic medications. We conducted a pilot study to guide subsequent research aimed at understanding whether the effectiveness of nasal decolonization by photodynamic therapy is similar to standard antibiotic treatment in patients with nasal carriage of S aureus undergoing hemodialysis. We found that photodynamic therapy was accepted and well-tolerated by patients. Larger studies will be needed to definitively assess whether its effectiveness is equal to topical antibiotics.
Association of Retinal Age Gap and Risk of Kidney Failure: A UK Biobank Study by Shiran Zhang et al. (OPEN ACCESS)
From the authors: There is a pressing need to identify early predictive biomarkers of kidney failure, given its associated substantial morbidity and mortality. Biomarkers of aging have been shown to be associated with kidney failure, but their clinical application has been challenging. This study identified that retinal age gap (the difference between a person’s predicted age based on sophisticated imaging of their retina and their actual chronological age), a clinically validated biomarker of aging, was associated with the future risk of kidney failure among residents of the United Kingdom. This noninvasive biomarker may hold promise to assist in the identification of people at elevated risk for kidney failure.
Association of an Acute Kidney Injury Follow-up Clinic With Patient Outcomes and Care Processes: A Cohort Study by Samuel A. Silver et al.
From the authors: Survivors of acute kidney injury (AKI) are a high-risk population, but many gaps exist in follow-up care. At our tertiary-care hospital, patients seen by the nephrology inpatient service with moderate to severe AKI are referred at discharge to an AKI follow-up clinic where they receive a standardized assessment that emphasizes management of cardiovascular risk and kidney complications. We compared outcomes among patients who attended the AKI follow-up clinic versus similar patients who received standard care. Even though attendance at the AKI follow-up clinic was not associated with less dialysis or kidney disease, it was associated with lower mortality rates and more prescriptions for some cardioprotective medications. These findings illustrate potential benefits of an AKI follow-up clinic, which require confirmation in randomized trials.
Consensus Recommendations for Sick Day Medication Guidance for People With Diabetes, Kidney, or Cardiovascular Disease: A Modified Delphi Process by Kaitlyn E. Watson et al. (OPEN ACCESS)
From the authors: Sick day medication guidance (SDMG) is intended to prevent adverse events during acute illness; however, varying recommendations exist. This study included 26 clinical experts in a modified Delphi process to develop consensus SDMG recommendations for patients with diabetes, kidney, or cardiovascular disease. Participants reached a consensus on 42 recommendations for SDMG, including recommendations on the signs and symptoms that should trigger SDMG, the signs that should prompt urgent contact with a health care provider, and scenarios and strategies for patient self-management. Eleven medication classes were recommended to be temporarily stopped or adjusted, and guidelines were provided for the resumption of medications. These consensus recommendations may inform the design of studies that examine the effectiveness of different strategies for implementing SDMG.
Sex and Gender in Randomized Controlled Trials of Adults Receiving Maintenance Dialysis: A Meta-epidemiologic Study by David Collister et al.
How Do Kidney Disease Clinicians View Kidney Supportive Care and Palliative Care? A Qualitative Study by Kathryn Ducharlet et al.
From the authors: People with advanced kidney disease have many health issues with a heavy burden of symptoms and complex considerations for future treatment planning, including end-of-life care. Kidney supportive care (KSC) and palliative care are clinical approaches that aim to improve quality of life; however, little is known about how they are applied in practice. This interview study aimed to understand kidney doctors’ and nurses’ experiences with KSC, palliative care, and end-of-life care and recommend ways to improve care experiences. Fifty-four clinicians from Victoria, Australia, were interviewed. A wide variation of KSC approaches was described, with limited integration of palliative care contributing to challenging experiences for clinicians. Aspirations to improve KSC and recommendations for clinical service development were demonstrated.
Review from the May 2023 issue:
Renal Thrombotic Microangiopathy: A Review by Dominique Suzanne Genest et al (FREE)
Thrombotic microangiopathy (TMA), a pathological lesion observed in a wide spectrum of diseases, is triggered by endothelial injury and/or dysfunction. Although TMA lesions are often accompanied by clinical features of microangiopathic hemolytic anemia, thrombocytopenia, and ischemic end-organ injury, renal-limited forms of TMA are not infrequently encountered in clinical practice. The presence of renal-limited manifestations can be diagnostically challenging, often delaying the initiation of targeted therapy. Prompt investigation and empirical treatment of TMA is warranted to reduce associated morbidity and mortality. Major advances have been made with respect to the pathophysiology of primary TMA entities, with the subsequent development of novel diagnostic tools and lifesaving therapies for diseases like thrombotic thrombocytopenic purpura and complement-mediated TMA. This article reviews the clinical presentation and pathologic hallmarks of TMA involving the kidney, and the disease-specific mechanisms that contribute to the endothelial injury that characterizes TMA lesions. Diagnostic approach and both empirical and disease-specific treatment strategies is discussed, along with the potential role for emerging targeted disease-specific therapies.
On the Cover: Deadvlei is a clay pan inside the Namib-Naukluft Park in Namibia. Deadvlei was formed as a result of the Tsauchab River flooding causing trees to grow. Then, due to climate change sand dunes encroached on the pan, blocking the river from reaching the area. In this issue of AJKD, Qu et al discuss the association between extreme heat exposure due to climate change and the growing prevalence of kidney disease worldwide.
The photograph “Ruthless desert” by Vitor Esteves is released on Flickr under the CC BY 2.0 license. Special thanks to Editorial Intern Alissar El Chediak for curating the cover image and drafting the cover blurb for this issue.
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