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 August 2024 issue:
Low-Dose Continuous Kidney Replacement Therapy and Mortality in Critically Ill Patients With Acute Kidney Injury: A Retrospective Cohort Study by Keisuke Okamoto et al
From the authors: The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend delivering a continuous kidney replacement therapy (CKRT) dose of 20-25 mL/kg/h. However, it is not clear if it is safe to use delivered CKRT doses below this recommendation. In this study, over 90% of the patients received CKRT with a delivered dose below the KDIGO recommendation. We divided these patients into 2 groups based on the median delivered CKRT dose. Our findings show that a delivered CKRT dose below the median was associated with increased risk of death within 90 days. These findings show that a lower delivered CKRT dose was independently associated with higher 90-day mortality among critically ill patients who mostly received dosing below current KDIGO recommendations.
DOI: 10.1053/j.ajkd.2024.01.526
EDITORIAL: How Low Can You Go With Dose of Continuous Kidney Replacement Therapy? Is That the Right Question to Ask? by J. Pedro Teixeira et al [FREE]
AJKDBlog INTERVIEW: We Know the Ceiling, But Where is the Floor? An Interview on Low-Dose CKRT by Timothy Yau [FREE]
24-Hour Urinary Chemistries and Kidney Stone Risk by Pietro Manuel Ferraro et al [OPEN ACCESS]
From the authors: Kidney stones are common and likely to recur. Certain urinary factors play a role in the development of stones, but their independent roles, relative importance, and shapes of association with stone formation are not well-characterized. We analyzed 24-hour urine collections from individuals with and without kidney stones. Stones were less likely in those with higher urine volume, citrate, potassium, magnesium, and uric acid and were more likely in those with higher calcium, oxalate, phosphorus, and sodium. The acidity of the urine was not related to stones. The urinary parameters showed different degrees of relative importance, with calcium, volume, and citrate being greatest. All parameters exhibited a linear or close-to-linear shape of association with stone formation.
DOI: 10.1053/j.ajkd.2024.02.010
EDITORIAL: The Case for Incremental Thinking About Kidney Stone Disease by Alan C. Pao [FREE]
Time-Varying Proteinuria and Progression of IgA Nephropathy: A Cohort Study by Chen Tang et al
From the authors: The presence of proteinuria has often been considered a surrogate end point and a possible therapeutic target in clinical trials in IgA nephropathy (IgAN). Some guidelines recommend a reduction in proteinuria to <1 g/day as a treatment goal based on the results of previous longitudinal studies. However, these findings may have been biased because they did not properly adjust for time-dependent confounders. Using marginal structural models to appropriately account for these confounding influences, we observed that patients with IgAN and proteinuria levels ≥ 0.5 g/day have an elevated risk of kidney failure, especially among patients who had proteinuria levels of ≥1.0 g/day before initiating treatment. These data may serve to inform the selection of proteinuria targets in the treatment of IgAN.
DOI: 10.1053/j.ajkd.2023.12.016
Plasma Levels of Polyunsaturated Fatty Acids and Adverse Kidney Outcomes by Hee Byung Koh et al
From the authors: Low amounts of polyunsaturated fatty acids (PUFA) in the blood are suspected of increasing the chances of heart disease, but it is not known whether the PUFA relates to kidney disease occurrence. In a large group without kidney disease in the United Kingdom, people with higher levels of PUFA in their blood tended to have a lower risk of developing kidney disease compared to those with lower PUFA levels. This relationship was consistently observed for all PUFA types. However, in the group with kidney disease, only higher levels of docosahexaenoic acid, a subtype of PUFAs, were associated with a lower risk of developing severe kidney problems that required kidney replacement therapy. These findings suggest that higher levels of PUFA, found in certain healthy fats, might protect against the development of kidney disease in the general population. As kidney function declines, only the docosahexaenoic acid, a subtype of PUFA, appears to be associated with preserved kidney function.
DOI: 10.1053/j.ajkd.2023.12.020
Impact of Prior Abdominal Procedures on Peritoneal Dialysis Catheter Outcomes: Findings From the North American Peritoneal Dialysis Catheter Registry by Wazaira A. Khan et al
From the authors: Peritoneal dialysis (PD) is a life-saving therapy for individuals with kidney failure that can be done at home. PD requires the placement of a tube, or catheter, into the abdomen to allow the exchange of dialysis fluid during treatment. There is concern that individuals who have undergone prior abdominal procedures and are referred for a catheter might have scarring that could affect catheter function. In some institutions, they might not even be offered PD therapy as an option. In this study, we found that a history of prior abdominal procedures did not increase the risk of PD catheter complications and should not dissuade patients from choosing PD or providers from recommending it.
DOI: 10.1053/j.ajkd.2023.12.023
BLOG POST: Abdominal Surgery History and Peritoneal Dialysis Catheter Failure: Can We Really Know Who’s at Risk? by Michael Granda [FREE]
Urinary Plasminogen as a Marker of Disease Progression in Human Glomerular Disease by Marina de Cos et al [OPEN ACCESS]
From the authors: Glomerular diseases are an important cause of morbidity and mortality in patients of all ages. Knowing the individual risk of progression to dialysis or transplantation would help to plan the follow-up and treatment of these patients. Our work studies the usefulness of urinary plasminogen as a marker of progression in this context, since previous studies indicate that plasminogen may be involved in the mechanisms responsible for the progression of these disorders. Our work in a sample of 1,010 patients with glomerular disease demonstrates that urinary plasminogen (as well as the ratio of measured to expected plasminogen) is associated with the risk of progression to end-stage kidney disease. Urine plasminogen exhibited good performance and, if further validated, could enable risk stratification for timely interventions in patients with proteinuria and glomerular disease.
DOI: 10.1053/j.ajkd.2024.01.520
Gestational Exposure to Maternal Systemic Glucocorticoids and Childhood Risk of CKD by You-Lin Tain et al
From the authors: In a singleton-born cohort of neonates, maternal exposure to antenatal systemic glucocorticoids was significantly associated with a 1.7-fold increased risk of the children developing chronic kidney disease over the first 10 years of life. Children of mothers who received >24 mg of hydrocortisone equivalent, systemic glucocorticoid treatment in second trimester of gestation, and children born at <37 weeks of gestational age had a higher risk of childhood kidney disease after gestational systemic glucocorticoid exposure. If these findings are confirmed, they may inform clinicians who are considering prescribing systemic glucocorticoids during pregnancy.
DOI: 10.1053/j.ajkd.2024.01.523
BLOG POST: Do Gestational Corticosteroids Associate with Childhood CKD? by Sehrish Ali and Sarwar Khan [FREE]
Review in the August 2024 issue:
Hereditary Transthyretin Amyloidosis and the Impact of Classic and New Treatments on Kidney Function: A Review by Evelyn Meléndrez-Balcázar et al
New treatments for amyloidosis may have an impact on kidney function, including drugs that target specific pathways involved in the disease. Tafamidis and diflunisal, which are TTR stabilizers, patisiran (RNA interference agent), and inotersen (antisense oligonucleotide inhibitor) have been shown to reduce TTR amyloid. Tafamidis and patisiran are medications that have reduced the progression of kidney disease in amyloidosis, but inotersen and diflunisal may damage kidney function.
DOI: 10.1053/j.ajkd.2024.01.527
Built in 1646, the De Kat (“The Cat”) grinds flax using two 10-ton stones animated by the windmill pictured above. Spanning nearly 350 years of operation, the windmill is now the only remaining windmill in the world used to pulverize a variety of pigments that are then emulsified in linoleic acid from pulverized linseeds to create paint. Linoleic acid is a polyunsaturated, omega-6 fatty acid (PUFA), an essential nutrient, and precursor to signaling molecules like prostaglandins, leukotrienes, and thromboxanes. A popular topic in cardiovascular health, the association between exposure to linoleic acid and other PUFAs and kidney health is less well studied. In this issue of AJKD, Koh et al examine plasma levels of several polyunsaturated fatty acids and the risk for incident chronic kidney disease (CKD) among 73,419 participants without baseline CKD, and the risk for incident kidney replacement therapy among 6,735 participants with baseline CKD.
The image “Converting Wind to Color” by LASZLO ILYES is released on Flickr under the CC BY 2.0 deed license. Special thanks to Editorial Intern Michael Granda for curating the cover image and drafting the cover blurb for this issue.
SPECIAL COLLECTION: HIGHLY CITED
The articles in this special collection highlight the top cited Original Investigations published in 2021 and 2022 that contributed to AJKD’s 2023 Impact Factor of 9.4.