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Publisher: Elsevier   (Total: 3030 journals)

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Showing 1 - 200 of 3030 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 20, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 16, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 79, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 22, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 27, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 303, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription  
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 196, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 9, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 21, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 5, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 2)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 4)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 5)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 20)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 120, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 8, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 24, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 21, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 26, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 24, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 8, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 4)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 39, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 38, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 41, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 14)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 18, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 22)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 33, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 4)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 7, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 5, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 21)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 6, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 3)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 20, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 14)
Advances in Pharmacology     Full-text available via subscription   (Followers: 13, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 17, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 56)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 1, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 332, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 7)
Advances in Surgery     Full-text available via subscription   (Followers: 6, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 28, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 14)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 12)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 42, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 304, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 4, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 7, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 390, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 29, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 36, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 1)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 48, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 3, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 9, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 5)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access  
Algal Research     Partially Free   (Followers: 7, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 5, SJR: 0.776, h-index: 35)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 6, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 45, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 5)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 3)
American Heart J.     Hybrid Journal   (Followers: 45, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 47, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 34, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 6, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 32, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 25, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 31, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 48, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 174, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 51, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 2)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 22, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 23, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 21, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 32, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 13, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 52, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 3)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 38, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 154, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 7, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 10)
Anesthésie & Réanimation     Full-text available via subscription  
Anesthesiology Clinics     Full-text available via subscription   (Followers: 21, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 143, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
Annales d'Endocrinologie     Full-text available via subscription   (SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
Annales de Chirurgie Plastique Esthétique     Full-text available via subscription   (Followers: 2, SJR: 0.354, h-index: 22)
Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

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Journal Cover American Journal of Kidney Diseases
  [SJR: 2.313]   [H-I: 172]   [31 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0272-6386 - ISSN (Online) 1523-6838
   Published by Elsevier Homepage  [3030 journals]
  • Stimulating Patient Engagement in Medical Device Development in Kidney
           Disease: A Report of a Kidney Health Initiative Workshop
    • Abstract: Publication date: Available online 27 April 2017
      Source:American Journal of Kidney Diseases
      Author(s): Frank P. Hurst, Dolph Chianchiano, Linda Upchurch, Benjamin R. Fisher, Jennifer E. Flythe, Celeste Castillo Lee, Terri Hill, Carolyn Y. Neuland
      New technologies challenge current dialysis treatment paradigms as devices become smaller, more portable, and increasingly used outside the dialysis clinic. It is unclear how patients will view this care transition, and it will be important to consider patient and care partner perspectives during all aspects of development for novel dialysis therapies, from design and clinical trials to regulatory approval. To gain insight into this area, the Kidney Health Initiative, a public-private partnership between the American Society of Nephrology, the US Food and Drug Administration, and nearly 80 member organizations and companies dedicated to enhancing patient safety and fostering innovation in kidney disease, convened a workshop of patients, care partners, and other kidney community stakeholders. The workshop included background presentations followed by focused small group discussions in 3 areas (device design, clinical trials, and regulatory approval). Participants explored how to involve patients throughout the life cycle of a medical device, including discussions of how patients can influence device design, assist in the planning and implementation of clinical trials, and provide input to affect regulatory decisions. Patients were engaged in the workshop discussion and interested in sharing their perspectives, but they recommended additional efforts around education, communication, and outreach in these areas.

      PubDate: 2017-04-28T01:30:48Z
       
  • Management of Gout and Hyperuricemia in CKD
    • Abstract: Publication date: Available online 26 April 2017
      Source:American Journal of Kidney Diseases
      Author(s): Ana Beatriz Vargas-Santos, Tuhina Neogi
      Hyperuricemia and gout, the clinical manifestation of monosodium urate crystal deposition, are common in patients with chronic kidney disease (CKD). Although the presence of CKD poses additional challenges in gout management, effective urate lowering is possible for most patients with CKD. Initial doses of urate-lowering therapy are lower than in the non-CKD population, whereas incremental dose escalation is guided by regular monitoring of serum urate levels to reach the target level of <6mg/dL (or <5mg/dL for patients with tophi). Management of gout flares with presently available agents can be more challenging due to potential nephrotoxicity and/or contraindications in the setting of other common comorbid conditions. At present, asymptomatic hyperuricemia is not an indication for urate-lowering therapy, though emerging data may support a potential renoprotective effect.

      PubDate: 2017-04-28T01:30:48Z
       
  • Urinary Anomalies in 22q11.2 Deletion (DiGeorge syndrome): From Copy
           Number Variations to Single-Gene Determinants of Phenotype
    • Abstract: Publication date: Available online 26 April 2017
      Source:American Journal of Kidney Diseases
      Author(s): Gentzon Hall, Jonathan C. Routh, Rasheed A. Gbadegesin


      PubDate: 2017-04-28T01:30:48Z
       
  • Modified Creatinine Index and the Risk of Bone Fracture in Patients
           Undergoing Hemodialysis: The Q-Cohort Study
    • Abstract: Publication date: Available online 25 April 2017
      Source:American Journal of Kidney Diseases
      Author(s): Shunsuke Yamada, Masatomo Taniguchi, Masanori Tokumoto, Ryota Yoshitomi, Hisako Yoshida, Narihito Tatsumoto, Hideki Hirakata, Satoru Fujimi, Takanari Kitazono, Kazuhiko Tsuruya
      Background Hemodialysis patients are at increased risk for bone fracture and sarcopenia. There is close interplay between skeletal muscle and bone. However, it is still unclear whether lower skeletal muscle mass increases the risk for bone fracture. Study Design Cross-sectional study and prospective longitudinal cohort study. Setting & Participants An independent cohort of 78 hemodialysis patients in the cross-sectional study and 3,030 prevalent patients undergoing maintenance hemodialysis prospectively followed up for 4 years. Predictor Skeletal muscle mass measured by bioelectrical impedance analysis (BIA) and modified creatinine index, an estimate of skeletal muscle mass based on age, sex, Kt/V for urea, and serum creatinine level. Outcomes Bone fracture at any site. Results In the cross-sectional study, modified creatinine index was significantly correlated with skeletal muscle mass measured by BIA. During a median follow-up of 3.9 years, 140 patients had bone fracture. When patients were divided into sex-specific quartiles based on modified creatinine index, risk for bone fracture estimated by a Fine-Gray proportional subdistribution hazards model with all-cause death as a competing risk was significantly higher in the lower modified creatinine index quartiles (Q1 and Q2) compared to the highest modified creatinine index quartile (Q4) as the reference value in both sexes (multivariable-adjusted HRs for men were 7.81 [95% CI, 2.63-23.26], 5.48 [95% CI, 2.08-14.40], 2.24 [95% CI, 0.72-7.00], and 1.00 [P for trend < 0.001], and for women were 4.44 [95% CI, 1.50-13.11], 2.33 [95% CI, 0.86-6.31], 1.96 [95% CI, 0.82-4.65], and 1.00 [P for trend = 0.007] for Q1, Q2, Q3, and Q4, respectively). Limitations One-time assessment of modified creatinine index; no data for residual kidney function and fracture sites and causes. Conclusions Modified creatinine index was correlated with skeletal muscle mass measured by BIA. Lower modified creatinine index was associated with increased risk for bone fracture in male and female hemodialysis patients.

      PubDate: 2017-04-28T01:30:48Z
       
  • In Reply to ‘Opioid Overuse or NSAID Underuse' A Response to the
           Pain Guide'
    • Abstract: Publication date: Available online 25 April 2017
      Source:American Journal of Kidney Diseases
      Author(s): Holly M. Koncicki, Mark Unruh, Jane O. Schell


      PubDate: 2017-04-28T01:30:48Z
       
  • Opioid Overuse or NSAID Underuse' A Response to the Pain Guide
    • Abstract: Publication date: Available online 25 April 2017
      Source:American Journal of Kidney Diseases
      Author(s): Swapnil Hiremath, David S. Goldfarb, David N. Juurlink


      PubDate: 2017-04-28T01:30:48Z
       
  • Why ELAIN and AKIKI Should Not Be Compared: Resolving Discordant Studies
    • Abstract: Publication date: Available online 21 April 2017
      Source:American Journal of Kidney Diseases
      Author(s): Didier Dreyfuss, David Hajage, Stéphane Gaudry


      PubDate: 2017-04-28T01:30:48Z
       
  • In Reply to ‘Why ELAIN and AKIKI Should Not Be Compared: Resolving
           Discordant Studies’
    • Abstract: Publication date: Available online 21 April 2017
      Source:American Journal of Kidney Diseases
      Author(s): Ron Wald, Martin Gallagher, Sean M. Bagshaw


      PubDate: 2017-04-28T01:30:48Z
       
  • Quiz Page May 2017
    • Authors: Jonathan Hogan; Matthew Palmer Alison Loren Benjamin Laskin
      Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5
      Author(s): Jonathan J. Hogan, Matthew D. Palmer, Alison W. Loren, Benjamin L. Laskin


      PubDate: 2017-04-21T01:16:50Z
       
  • Scoring Risk Scores: Considerations Before Incorporating Clinical Risk
           Prediction Tools Into Your Practice
    • Authors: Celine Foote; Mark Woodward Meg Jardine
      Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5
      Author(s): Celine Foote, Mark Woodward, Meg J. Jardine


      PubDate: 2017-04-21T01:16:50Z
       
  • Improving Nutrition Research in Nephrology: An Appetite for Change
    • Authors: Katrina Campbell; Suetonia Palmer David Johnson
      Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5
      Author(s): Katrina L. Campbell, Suetonia C. Palmer, David W. Johnson


      PubDate: 2017-04-21T01:16:50Z
       
  • Belatacept: Where the BENEFITS Outweigh the Risk
    • Authors: Hallvard Holdaas; Geir Alan Jardine
      Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5
      Author(s): Hallvard Holdaas, Geir Mjøen, Alan G. Jardine


      PubDate: 2017-04-21T01:16:50Z
       
  • Families’ Perception of End-of-Life Care for Patients With Serious
           Illness
    • Authors: Susan P.Y.; Wong Ann OHare
      Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5
      Author(s): Susan P.Y. Wong, Ann M. O'Hare


      PubDate: 2017-04-21T01:16:50Z
       
  • A Clinical Risk Prediction Tool for 6-Month Mortality After Dialysis
           Initiation Among Older Adults
    • Authors: James Wick; Tanvir Turin Peter Faris Jennifer MacRae Robert Weaver
      Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5
      Author(s): James P. Wick, Tanvir C. Turin, Peter D. Faris, Jennifer M. MacRae, Robert G. Weaver, Marcello Tonelli, Braden J. Manns, Brenda R. Hemmelgarn
      Background Information on an individual’s risk for death following dialysis therapy initiation may inform the decision to initiate maintenance dialysis for older adults. We derived and validated a clinical risk prediction tool for all-cause mortality among older adults during the first 6 months of maintenance dialysis treatment. Study Design Prediction model using retrospective administrative and clinical data. Setting & Participants We linked administrative and clinical data to define a cohort of 2,199 older adults (age ≥ 65 years) in Alberta, Canada, who initiated maintenance dialysis therapy (excluding acute kidney injury) in May 2003 to March 2012. Candidate Predictors Demographics, laboratory data, comorbid conditions, and measures of health system use. Outcomes All-cause mortality within 6 months of dialysis therapy initiation. Analytical Approach Predicted mortality by logistic regression with 10-fold cross-validation. Results 375 (17.1%) older adults died within 6 months. We developed a 19-point risk score for 6-month mortality that included age 80 years or older (2 points), glomerular filtration rate of 10 to 14.9mL/min/1.73m2 (1 point) or ≥15mL/min/1.73m2 (3 points), atrial fibrillation (2 points), lymphoma (5 points), congestive heart failure (2 points), hospitalization in the prior 6 months (2 points), and metastatic cancer (3 points). Model discrimination (C statistic = 0.72) and calibration (Hosmer-Lemeshow χ2 =10.36; P =0.2) were reasonable. As examples, a score < 5 equated to <25% of individuals dying in 6 months, whereas a score > 12 predicted that more than half the individuals would die in the first 6 months. Limitations The tool has not been externally validated; thus, generalizability cannot be assessed. Conclusions We used readily available clinical information to derive and internally validate a 7-variable tool to predict early mortality among older adults after dialysis therapy initiation. Following successful external validation, the tool may be useful as a clinical decision tool to aid decision making for older adults with kidney failure.

      PubDate: 2017-04-21T01:16:50Z
       
  • Sodium Restriction in Patients With CKD: A Randomized Controlled Trial of
           Self-management Support
    • Authors: Yvette Meuleman; Tiny Hoekstra Friedo Dekker Gerjan Navis Liffert Vogt
      Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5
      Author(s): Yvette Meuleman, Tiny Hoekstra, Friedo W. Dekker, Gerjan Navis, Liffert Vogt, Paul J.M. van der Boog, Willem Jan W. Bos, Gert A. van Montfrans, Sandra van Dijk
      Background To evaluate the effectiveness and sustainability of self-managed sodium restriction in patients with chronic kidney disease. Study Design Open randomized controlled trial. Setting & Participants Patients with moderately decreased kidney function from 4 hospitals in the Netherlands. Intervention Regular care was compared with regular care plus an intervention comprising education, motivational interviewing, coaching, and self-monitoring of blood pressure (BP) and sodium. Outcomes Primary outcomes were sodium excretion and BP after the 3-month intervention and at 6-month follow-up. Secondary outcomes were protein excretion, kidney function, antihypertensive medication, self-efficacy, and health-related quality of life (HRQoL). Results At baseline, mean sodium excretion rate was 163.6±64.9 (SD) mmol/24 h; mean estimated glomerular filtration rate was 49.7±25.6mL/min/1.73m2; median protein excretion rate was 0.8 (IQR, 0.4-1.7) g/24 h; and mean 24-hour ambulatory systolic and diastolic BPs were 129±15 and 76±9mmHg, respectively. Compared to regular care only (n=71), at 3 months, the intervention group (n=67) showed reduced sodium excretion rate (mean change, −30.3 [95% CI, −54.7 to −5.9] mmol/24 h), daytime ambulatory diastolic BP (mean change, −3.4 [95% CI, −6.3 to −0.6] mmHg), diastolic office BP (mean change, −5.2 [95% CI, −8.4 to −2.1] mmHg), protein excretion (mean change, −0.4 [95% CI, −0.7 to −0.1] g/24h), and improved self-efficacy (mean change, 0.5 [95% CI, 0.1 to 0.9]). At 6 months, differences in sodium excretion rates and ambulatory BPs between the groups were not significant, but differences were detected in systolic and diastolic office BPs (mean changes of −7.3 [95% CI, −12.7 to −1.9] and −3.8 [95% CI, −6.9 to −0.6] mmHg, respectively), protein excretion (mean changes, −0.3 [95% CI, −0.6 to −0.1] g/24h), and self-efficacy (mean change, 0.5 [95% CI, 0.0 to 0.9]). No differences in kidney function, medication, and HRQoL were observed. Limitations Nonblinding, relatively low response rate, and missing data. Conclusions Compared to regular care only, this self-management intervention modestly improved outcomes, although effects on sodium excretion and ambulatory BP diminish over time.

      PubDate: 2017-04-21T01:16:50Z
       
  • Safety and Efficacy Outcomes 3 Years After Switching to Belatacept From a
           Calcineurin Inhibitor in Kidney Transplant Recipients: Results From a
           Phase 2 Randomized Trial
    • Authors: Josep Maria; del Carmen Rial Josefina Alberu Steven Steinberg Roberto
      Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5
      Author(s): Josep M. Grinyó, Maria del Carmen Rial, Josefina Alberu, Steven M. Steinberg, Roberto C. Manfro, Georgy Nainan, Flavio Vincenti, Charlotte Jones-Burton, Nassim Kamar
      Background In a phase 2 study, kidney transplant recipients of low immunologic risk who switched from a calcineurin inhibitor (CNI) to belatacept had improved kidney function at 12 months postconversion versus those continuing CNI therapy, with a low rate of acute rejection and no transplant loss. Study Design 36-month follow-up of the intention-to-treat population. Setting & Participants CNI-treated adult kidney transplant recipients with stable transplant function (estimated glomerular filtration rate [eGFR], 35-75mL/min/1.73m2). Interventions At 6 to 36 months posttransplantation, patients were randomly assigned to switch to belatacept-based immunosuppression (n=84) or continue CNI-based therapy (n=89). Outcomes Safety was the primary outcome. eGFR, acute rejection, transplant loss, and death were also assessed. Measurements Treatment exposure−adjusted incidence rates for safety, repeated-measures modeling for eGFR, Kaplan-Meier analyses for efficacy. Results Serious adverse events occurred in 33 (39%) belatacept-treated patients and 36 (40%) patients in the CNI group. Treatment exposure−adjusted incidence rates for serious infections (belatacept vs CNI, 10.21 vs 9.31 per 100 person-years) and malignancies (3.01 vs 3.41 per 100 person-years) were similar. More patients in the belatacept versus CNI group had any-grade viral infections (14.60 vs 11.00 per 100 person-years). No posttransplantation lymphoproliferative disorder was reported. Belatacept-treated patients had a significantly greater estimated gain in mean eGFR (1.90 vs 0.07mL/min/1.73m2 per year; P for time-by-treatment interaction effect = 0.01). The probability of acute rejection was not significantly different for belatacept (8.38% vs 3.60%; HR, 2.50 [95% CI, 0.65-9.65; P =0.2). HR for the comparison of belatacept to the CNI group for time to death or transplant loss was 1.00 (95% CI, 0.14-7.07; P =0.9). Limitations Exploratory post hoc analysis with a small sample size. Conclusions Switching patients from a CNI to belatacept may represent a safe approach to immunosuppression and is being further explored in an ongoing phase 3b trial.

      PubDate: 2017-04-21T01:16:50Z
       
  • Proton Pump Inhibitor Use and Risk of Hip Fracture in Kidney Transplant
           Recipients
    • Authors: Colin Lenihan; Sumi Sukumaran Nair Chandan Vangala Venkat Ramanathan Maria
      Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5
      Author(s): Colin R. Lenihan, Sumi Sukumaran Nair, Chandan Vangala, Venkat Ramanathan, Maria E. Montez-Rath, Wolfgang C. Winkelmayer
      Background Posttransplantation bone disease is a significant problem, with few well-evidenced therapeutic options. Proton pump inhibitors (PPIs) are associated with hip fracture in the general population and are widely prescribed for kidney transplant recipients. Study Design A case-control study. Setting & Participants From the US Renal Data System, we identified from diagnoses and procedures 231 kidney transplant recipients with a first hip fracture. Cases were matched at the hip fracture index date with 15,575 controls on age, sex, race, and transplantation year. Predictor PPI use. Outcomes First hip fracture. Results In the year prior to the index date, a PPI was prescribed to 65.4% of cases and 57.4% of controls. Additionally, in 34.6% of cases and 28.9% of controls, a PPI was prescribed for >80% of the year preceding the index date (higher PPI users). Unadjusted ORs of hip fracture associated with any and higher PPI use were 1.55 (95% CI, 1.18-2.05) and 1.65 (95% CI, 1.2-2.27), respectively. When adjusted for baseline demographic, clinical, and pharmacologic covariables, any and higher PPI use remained associated with hip fracture, with ORs of 1.39 (95% CI, 1.04-1.84) and 1.41 (95% CI, 1.02-1.95), respectively. Limitations Potential residual confounding through either incorrectly ascertained or unavailable confounders; cohort limited to Medicare beneficiaries receiving low-income subsidy. Conclusions In summary, PPI use was associated with hip fracture risk in the US kidney transplant population.

      PubDate: 2017-04-21T01:16:50Z
       
  • Donor and Recipient Views on Their Relationship in Living Kidney Donation:
           Thematic Synthesis of Qualitative Studies
    • Authors: Angelique Ralph; Phyllis Butow Camilla Hanson Steve Chadban Jeremy Chapman
      Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5
      Author(s): Angelique F. Ralph, Phyllis Butow, Camilla S. Hanson, Steve J. Chadban, Jeremy R. Chapman, Jonathan C. Craig, John Kanellis, Grant Luxton, Allison Tong
      Background Many donors and recipients report an improved relationship after transplantation; however, tension, neglect, guilt, and proprietorial concern over the recipient can impede donor and recipient well-being and outcomes. We aimed to describe donor and recipient expectations and experiences of their relationship in the context of living kidney donation. Study Design Thematic synthesis of qualitative studies. Setting & Population Living kidney donors and recipients. Search Strategy & Sources Electronic databases were searched to October 2015. Analytical Approach Thematic synthesis. Results From 40 studies involving 1,440 participants (889 donors and 551 recipients) from 13 countries, we identified 6 themes. “Burden of obligation” described the recipient’s perpetual sense of duty to demonstrate gratitude to the donor. “Earning acceptance” was the expectation that donation would restore relationships. “Developing a unique connection” reflected the inexplicable bond that donor-recipient dyads developed postdonation. “Desiring attention” was expressed by donors who wanted recognition for the act of donation and were envious and resentful of the attention the recipient received. “Retaining kidney ownership” reflected the donor’s inclination to ensure that the recipient protected “their” kidney. “Enhancing social participation” encompassed relieving both the caregiver from the constraints of dialysis and the recipient from increased involvement and contribution in family life. Limitations Non-English articles were excluded. Conclusions Living kidney donation can strengthen donor-recipient relationships but may trigger or exacerbate unresolved angst, tension, jealousy, and resentment. Facilitating access to pre- and posttransplantation psychological support that addresses potential relationship changes may help donors and recipients better adjust to changes in the relationship dynamics, which in turn may contribute to improved psychosocial and transplantation outcomes following living kidney donation.

      PubDate: 2017-04-21T01:16:50Z
       
  • Infants Requiring Maintenance Dialysis: Outcomes of Hemodialysis and
           Peritoneal Dialysis
    • Authors: Enrico Vidal; Karlijn van Stralen Nicholas Chesnaye Marjolein Bonthuis Christer
      Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5
      Author(s): Enrico Vidal, Karlijn J. van Stralen, Nicholas C. Chesnaye, Marjolein Bonthuis, Christer Holmberg, Aleksandra Zurowska, Antonella Trivelli, José Eduardo Esteves Da Silva, Maria Herthelius, Brigitte Adams, Anna Bjerre, Augustina Jankauskiene, Polina Miteva, Khadizha Emirova, Aysun K. Bayazit, Christoph J. Mache, Ana Sánchez-Moreno, Jérôme Harambat, Jaap W. Groothoff, Kitty J. Jager, Franz Schaefer, Enrico Verrina
      Background The impact of different dialysis modalities on clinical outcomes has not been explored in young infants with chronic kidney failure. Study Design Cohort study. Setting & Participants Data were extracted from the ESPN/ERA-EDTA Registry. This analysis included 1,063 infants 12 months or younger who initiated dialysis therapy in 1991 to 2013. Factor Type of dialysis modality. Outcomes & Measurements Differences between infants treated with peritoneal dialysis (PD) or hemodialysis (HD) in patient survival, technique survival, and access to kidney transplantation were examined using Cox regression analysis while adjusting for age at dialysis therapy initiation, sex, underlying kidney disease, and country of residence. Results 917 infants initiated dialysis therapy on PD, and 146, on HD. Median age at dialysis therapy initiation was 4.5 (IQR, 0.7-7.9) months, and median body weight was 5.7 (IQR, 3.7-7.5) kg. Although the groups were homogeneous regarding age and sex, infants treated with PD more often had congenital anomalies of the kidney and urinary tract (CAKUT; 48% vs 27%), whereas those on HD therapy more frequently had metabolic disorders (12% vs 4%). Risk factors for death were younger age at dialysis therapy initiation (HR per each 1-month later initiation, 0.95; 95% CI, 0.90-0.97) and non-CAKUT cause of chronic kidney failure (HR, 1.49; 95% CI, 1.08-2.04). Mortality risk and likelihood of transplantation were equal in PD and HD patients, whereas HD patients had a higher risk for changing dialysis treatment (adjusted HR, 1.64; 95% CI, 1.17-2.31). Limitations Inability to control for unmeasured confounders not included in the Registry database and missing data (ie, comorbid conditions). Low statistical power because of relatively small number of participants. Conclusions Despite a widespread preconception that HD should be reserved for cases in which PD is not feasible, in Europe, we found 1 in 8 infants in need of maintenance dialysis to be initiated on HD therapy. Patient characteristics at dialysis therapy initiation, prospective survival, and time to transplantation were very similar for infants initiated on PD or HD therapy.

      PubDate: 2017-04-21T01:16:50Z
       
  • Renal Morphology, Clinical Findings, and Progression Rate in Mesoamerican
           Nephropathy
    • Authors: Julia Marvin; Mario Hernandez Zulma Trujillo Kjell Hultenby Anneli Ring
      Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5
      Author(s): Julia Wijkström, Marvin González-Quiroz, Mario Hernandez, Zulma Trujillo, Kjell Hultenby, Anneli Ring, Magnus Söderberg, Aurora Aragón, Carl-Gustaf Elinder, Annika Wernerson
      Background Mesoamerican nephropathy (MeN) is a chronic kidney disease affecting rural inhabitants in Central America. We have previously described the renal morphology in 8 patients from El Salvador. To confirm the renal pathology, we have studied kidney biopsies from patients with MeN in Nicaragua. Follow-up urine and blood samples from both biopsy studies were collected to investigate the natural history. Study Design Case series. Settings & Participants In the kidney biopsy study, 19 male sugarcane workers in Nicaragua with suspected MeN were investigated with questionnaires, kidney biopsies, and blood and urine analysis. Inclusion criteria were age 20 to 65 years and plasma creatinine level of 1.13 to 2.49mg/dL or estimated glomerular filtration rate (eGFR) of 30 to 80mL/min/1.73m2. Exclusion criteria were proteinuria with protein excretion > 3g/24 h, uncontrolled hypertension, diabetes mellitus, or other known kidney disease. In the follow up-study, blood and urine from the kidney biopsy study in Nicaragua (n=18) and our previous biopsy study of MeN cases in El Salvador (n=7) were collected 1 to 1.5 and 2 to 2.5 years after biopsy, respectively. Outcomes Renal morphology, clinical, and biochemical characteristics, change in eGFR per year. Measurements eGFR was calculated using the CKD-EPI creatinine (eGFRcr), cystatin C (eGFRcys), and creatinine-cystatin C (eGFRcr-cys) equations. Results In the kidney biopsy study, participants had a mean eGFRcr of 57 (range, 33-96) mL/min/1.73m2. 47% had low plasma sodium and 21% had low plasma potassium levels. 16 kidney biopsies were representative and showed glomerulosclerosis (mean, 38%), glomerular hypertrophy, and signs of chronic glomerular ischemia. Mild to moderate tubulointerstitial damage and mostly mild vascular changes were seen. In the follow up-study, median duration of follow-up was 13 (range, 13-27) months. Mean change in eGFRcr was −4.4±8.4 (range, −27.7 to 10.2) mL/min/1.73m2 per year. Most patients had stopped working with sugarcane cultivation. Limitations 3 biopsy specimens had 4 or fewer glomeruli. Conclusions This study confirms the renal morphology of MeN: chronic glomerular and tubulointerstitial damage with glomerulosclerosis and chronic glomerular ischemia. Follow-up data show that eGFRs, on average, deteriorated.

      PubDate: 2017-04-21T01:16:50Z
       
  • The Clinical Course of Minimal Change Nephrotic Syndrome With Onset in
           Adulthood or Late Adolescence: A Case Series
    • Authors: Rutger Maas; Jeroen Deegens Johan Beukhof Louis Reichert Marc ten
      Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5
      Author(s): Rutger J. Maas, Jeroen K. Deegens, Johan R. Beukhof, Louis J. Reichert, Marc A. ten Dam, Jaap J. Beutler, A. Warmold L. van den Wall Bake, Pieter L. Rensma, Constantijn J. Konings, Daniel A. Geerse, Geert W. Feith, Willi H. Van Kuijk, Jack F. Wetzels
      Background Few studies have examined the treatment and outcome of adult-onset minimal change nephrotic syndrome (MCNS). We retrospectively studied 125 patients who had MCNS with onset in either adulthood or late adolescence. Presenting characteristics, duration of initial treatment and response to treatment, relapse patterns, complications, and long-term outcome were studied. Study Design Case series. Setting & Participants Patients with new-onset nephrotic syndrome 16 years or older and a histologic diagnosis of MCNS in 1985 to 2011 were identified from pathology records of 10 participating centers. Outcomes Partial and complete remission, treatment resistance, relapse, complications, renal survival. Results Corticosteroids were given as initial treatment in 105 (84%) patients. After 16 weeks of corticosteroid treatment, 92 (88%) of these patients had reached remission. Median time to remission was 4 (IQR, 2-7) weeks. 7 (6%) patients initially received cyclophosphamide with or without corticosteroids, and all attained remission after a median of 4 (IQR, 3-11) weeks. 13 (10%) patients reached remission without immunosuppressive treatment. One or more relapses were observed in 57 (54%) patients who received initial corticosteroid treatment. Second-line cyclophosphamide resulted in stable remission in 57% of patients with relapsing MCNS. Acute kidney injury was observed in 50 (40%) patients. Recovery of kidney function occurred almost without exception. Arterial or venous thrombosis occurred in 11 (9%) patients. At the last follow-up, 113 (90%) patients were in remission and had preserved kidney function. 3 patients with steroid-resistant MCNS progressed to end-stage renal disease, which was associated with focal segmental glomerulosclerosis lesions on repeat biopsy. Limitations Retrospective design, variable treatment protocols. Conclusions The large majority of patients who had MCNS with onset in adulthood or late adolescence were treated with corticosteroids and reached remission, but many had relapses. Cyclophosphamide resulted in stable remission in many patients with relapses. Significant morbidity was observed due to acute kidney injury and other complications. Progression to end-stage renal disease occurred in a few patients and was explained by focal segmental glomerulosclerosis.

      PubDate: 2017-04-21T01:16:50Z
       
  • Community-Acquired Acute Kidney Injury: A Nationwide Survey in China
    • Authors: Yafang Wang; Jinwei Wang Tao Zhen Minghui Zhao Yang
      Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5
      Author(s): Yafang Wang, Jinwei Wang, Tao Su, Zhen Qu, Minghui Zhao, Li Yang
      Background This study aimed to describe the burden of community-acquired acute kidney injury (AKI) in China based on a nationwide survey about AKI. Study Design Cross-sectional and retrospective study. Setting & Participants A national sample of 2,223,230 hospitalized adult patients from 44 academic/local hospitals in Mainland China was used. AKI was defined according to the 2012 KDIGO AKI creatinine criteria or an increase or decrease in serum creatinine level of 50% during the hospital stay. Community-acquired AKI was identified when a patient had AKI that could be defined at hospital admission. Predictors The rate, cause, recognition, and treatment of community-acquired AKI were stratified according to hospital type, latitude, and economic development of the regions in which the patients were admitted. Outcomes All-cause in-hospital mortality and recovery of kidney function at hospital discharge. Results 4,136 patients with community-acquired AKI were identified during the 2 single-month snapshots (January 2013 and July 2013). Of these, 2,020 (48.8%) had cases related to decreased kidney perfusion; 1,111 (26.9%), to intrinsic kidney disease; and 499 (12.1%), to urinary tract obstruction. In the north versus the south, more patients were exposed to nephrotoxins or had urinary tract obstructions. 536 (13.0%) patients with community-acquired AKI had indications for renal replacement therapy (RRT), but only 347 (64.7%) of them received RRT. Rates of timely diagnosis and appropriate use of RRT were higher in regions with higher per capita gross domestic product. All-cause in-hospital mortality was 7.3% (295 of 4,068). Delayed AKI recognition and being located in northern China were independent risk factors for in-hospital mortality, and referral to nephrology providers was an independent protective factor. Limitations Possible misclassification of AKI and community-acquired AKI due to nonstandard definitions and missing data for serum creatinine. Conclusions The features of community-acquired AKI varied substantially in different regions of China and were closely linked to the environment, economy, and medical resources.

      PubDate: 2017-04-21T01:16:50Z
       
  • Cystatin C–Guided Vancomycin Dosing in Critically Ill Patients:
           A Quality Improvement Project
    • Authors: Erin Frazee; Andrew Rule John Lieske Kianoush Kashani Jason Barreto
      Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5
      Author(s): Erin Frazee, Andrew D. Rule, John C. Lieske, Kianoush B. Kashani, Jason N. Barreto, Abinash Virk, Philip J. Kuper, Ross A. Dierkhising, Nelson Leung
      Background The aim of the study was to determine whether a vancomycin dosing algorithm based on estimated glomerular filtration rate from creatinine and cystatin C levels (eGFRcr-cys) improves target trough concentration achievement compared to an algorithm based on estimated creatinine clearance (eCLcr) in critically ill patients. Study Design This prospective quality improvement project evaluated intensive care unit (ICU) patients started on intravenous vancomycin using one of 2 different strategies. Dosing regimens were selected and implemented after an individualized goal trough range was established (10-15 or 15-20mg/L). Steady-state goal trough achievement was compared between treatment arms with and without adjustment for potential confounders. Setting & Participants 3 medical and surgical ICUs at a single tertiary medical center. Quality Improvement Plan During January 2012 to October 2013, vancomycin was dosed according to eCLcr using the Cockcroft-Gault formula (control arm). During December 2013 to May 2015, a multidisciplinary quality improvement team implemented a novel vancomycin dosing algorithm according to eGFRcr-cys using the CKD-EPI equation (intervention arm). Outcome Steady-state initial goal vancomycin trough concentration achievement. Measurements & Results More patients in the intervention arm (67 of 135 [50%]) achieved therapeutic trough vancomycin levels than in the control arm (74 of 264 [28%]; OR, 2.53; 95% CI, 1.65-3.90; P <0.001). Improved trough achievement was maintained even after adjustment for age, sex, APACHE (Acute Physiology and Chronic Health Evaluation) III score, fluid balance, baseline CLcr, surgical admission diagnosis, presence of sepsis, and goal trough concentration range (adjusted OR, 2.79; 95% CI, 1.76-4.44; P <0.001). Clinical outcomes were similar between groups. Limitations Nonrandomized, incomplete algorithm compliance. Conclusions A vancomycin dosing nomogram based on eGFRcr-cys significantly improved goal trough achievement compared to eCLcr among ICU patients with stable kidney function. Further studies are warranted to characterize the relationship between use of cystatin C−guided dosing and clinical outcomes.

      PubDate: 2017-04-21T01:16:50Z
       
  • FOXP3-Positive Regulatory T Cells and Kidney Allograft Tolerance
    • Authors: Alessandro Alessandrini; Laurence Turka
      Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5
      Author(s): Alessandro Alessandrini, Laurence A. Turka
      Normal immune homeostasis is achieved by several mechanisms, and prominent among them is immunoregulation. Although several types of regulatory lymphocyte populations have been described, CD4 T cells expressing the FOXP3 transcription factor (FOXP3-positive regulatory T cells [FOXP3+ Tregs]) are the best understood. This population of cells is critical for maintaining self-tolerance throughout the life of the organism. FOXP3+ Tregs can develop within the thymus, but also under select circumstances, naive peripheral T cells can be induced to express FOXP3 and become stable Tregs as well. Abundant evidence from animal systems, as well as limited evidence in humans, implicates Tregs in transplant tolerance, although whether these Tregs recognize allo- or self-antigens is not clear. New translational approaches to promote immunosuppression minimization and/or actual tolerance are being designed to exploit these observations. These include strategies to boost the generation, maintenance, and stability of endogenous Tregs, as well as adoptive cellular therapy with exogenous Tregs.

      PubDate: 2017-04-21T01:16:50Z
       
  • Rethinking CKD Evaluation: Should We Be Quantifying Basal or Stimulated
           GFR to Maximize Precision and Sensitivity?
    • Authors: Bruce Molitoris
      Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5
      Author(s): Bruce A. Molitoris
      Chronic kidney disease (CKD) is an increasing clinical problem. Although clinical risk factors and biomarkers for the development and progression of CKD have been identified, there is no commercial surveillance technology to definitively diagnose and quantify the severity and progressive loss of glomerular filtration rate (GFR) in CKD. This has limited the study of potential therapies to late stages of CKD when FDA-registerable events are more likely. Because patient outcomes, including the rate of CKD progression, correlate with disease severity and effective therapy may require early intervention, being able to diagnose and stratify patients by their level of decreased kidney function early on is key for translational progress. In addition, renal reserve, defined as the increase in GFR following stimulation, may improve the quantification of GFR based solely on basal levels. Various groups are developing and characterizing optical measurement techniques using new minimally invasive or noninvasive approaches for quantifying basal and stimulated kidney function. This development has the potential to allow widespread individualization of therapy at an earlier disease stage. Therefore, the purposes of this review are to suggest why quantifying stimulated GFR, by activating renal reserve, may be advantageous in patients and to review fluorescent technologies to deliver patient-specific GFR.

      PubDate: 2017-04-21T01:16:50Z
       
  • Sudden Cardiac Death Among Hemodialysis Patients
    • Authors: Melissa Makar; Patrick Pun
      Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5
      Author(s): Melissa S. Makar, Patrick H. Pun
      Hemodialysis patients carry a large burden of cardiovascular disease; most onerous is the high risk for sudden cardiac death. Defining sudden cardiac death among hemodialysis patients and understanding its pathogenesis are challenging, but inferences from the existing literature reveal differences between sudden cardiac death among hemodialysis patients and the general population. Vascular calcifications and left ventricular hypertrophy may play a role in the pathophysiology of sudden cardiac death, whereas traditional cardiovascular risk factors seem to have a more muted effect. Arrhythmic triggers also differ in this group as compared to the general population, with some arising uniquely from the hemodialysis procedure. Combined, these factors may alter the types of terminal arrhythmias that lead to sudden cardiac death among hemodialysis patients, having important implications for prevention strategies. This review highlights current knowledge on the epidemiology, pathophysiology, and risk factors for sudden cardiac death among hemodialysis patients. We then examine strategies for prevention, including the use of specific cardiac medications and device-based therapies such as implantable defibrillators. We also discuss dialysis-specific prevention strategies, including minimizing exposure to low potassium and calcium dialysate concentrations, extending dialysis treatment times or adding sessions to avoid rapid ultrafiltration, and lowering dialysate temperature.

      PubDate: 2017-04-21T01:16:50Z
       
  • A Methanol Intoxication Outbreak From Recreational Ingestion of Fracking
           Fluid
    • Authors: David Collister; Graham Duff Wesley Palatnick Paul Komenda Navdeep Tangri
      Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5
      Author(s): David Collister, Graham Duff, Wesley Palatnick, Paul Komenda, Navdeep Tangri, Jay Hingwala
      Single-patient methanol intoxications are a common clinical presentation, but outbreaks are rare and usually occur in settings in which there is limited access to ethanol and methanol is consumed as a substitute. In this case report, we describe an outbreak of methanol intoxications that was challenging from a public health perspective and discuss strategies for managing such an outbreak.

      PubDate: 2017-04-21T01:16:50Z
       
  • Acute Kidney Allograft Rejection Precipitated by Lenalidomide Treatment
           for Multiple Myeloma
    • Authors: Erik Lum; Edmund Huang Suphamai Bunnapradist Thu Pham Gabriel Danovitch
      Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5
      Author(s): Erik L. Lum, Edmund Huang, Suphamai Bunnapradist, Thu Pham, Gabriel Danovitch
      Patients who develop malignancy after kidney transplantation typically undergo a reduction in immunosuppression and referral to an oncologist for chemotherapeutic considerations for the management of their malignancy. Traditional cytotoxic chemotherapy agents can result in kidney transplant injury, but the decision about which agents to be used has largely been determined by oncologists without the involvement of nephrologists. More recently, several classes of drugs with immunomodulatory actions have been approved for the treatment of cancer, including multiple myeloma. Activation of the immune system against malignant cells may have unintended consequences in solid-organ transplant recipients, who require suppression of the immune system to avoid transplant rejection. In this report, we present a case of acute kidney transplant rejection in a 65-year-old woman following administration of the newer immunomodulatory agent lenalidomide for the treatment of multiple myeloma. A greater awareness of the mechanisms of newly introduced chemotherapy agents and discussion with the treating oncologist and patient are paramount in caring for patients who develop malignancy following transplantation.

      PubDate: 2017-04-21T01:16:50Z
       
  • Long-term Outcomes of Survivors of Acute Kidney Injury Stage 3
    • Authors: Helmut Schiffl
      Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5
      Author(s): Helmut Schiffl


      PubDate: 2017-04-21T01:16:50Z
       
  • In Reply to ‘Long-term Outcomes of Survivors of Acute Kidney Injury
           Stage 3’
    • Authors: Simon Sawhney; Adeera Levin Corri Black
      Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5
      Author(s): Simon Sawhney, Adeera Levin, Corri Black


      PubDate: 2017-04-21T01:16:50Z
       
  • Focus Instead on Determining Lower Limit of Continuous Renal
           Replacement Therapy
    • Authors: Ryota Sato; Sarah Kyuragi Luthe
      Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5
      Author(s): Ryota Sato, Sarah Kyuragi Luthe


      PubDate: 2017-04-21T01:16:50Z
       
  • In Reply to ‘Focus Instead on Determining Lower Limit of Continuous
           Renal Replacement Therapy’
    • Authors: Dong-Ki Kim; Tae-Hyun Yoo
      Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5
      Author(s): Dong-Ki Kim, Tae-Hyun Yoo


      PubDate: 2017-04-21T01:16:50Z
       
  • Sodium-Chloride Difference as a Simple Parameter for Acid-Base
           Status Assessment
    • Authors: Jan Havlin; Karel Matousovic Otto
      Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5
      Author(s): Jan Havlin, Karel Matousovic, Otto Schück


      PubDate: 2017-04-21T01:16:50Z
       
  • In Reply to ‘Sodium-Chloride Difference as a Simple Parameter for
           Acid-Base Status Assessment’
    • Authors: Horacio Nicolaos; Madias
      Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5
      Author(s): Horacio J. Adrogué, Nicolaos E. Madias


      PubDate: 2017-04-21T01:16:50Z
       
  • Vitamins E and C May Differ in Their Effect on Contrast-Induced Acute
           Kidney Injury
    • Authors: Yousef Rezaei; Harri
      Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5
      Author(s): Yousef Rezaei, Harri Hemilä


      PubDate: 2017-04-21T01:16:50Z
       
  • In Reply to ‘Vitamins E and C May Differ in Their Effect on
           Contrast-Induced Acute Kidney Injury’
    • Authors: Xiaole Lijun; Liu
      Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5
      Author(s): Xiaole Su, Lijun Liu


      PubDate: 2017-04-21T01:16:50Z
       
  • Utility of Spot Urine Specimens to Assess Tubular Secretion
    • Authors: Pranav Garimella; Kefeng Jane Naviaux Michael Shlipak Joseph Abdelmalek Erick
      Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5
      Author(s): Pranav S. Garimella, Kefeng Li, Jane C. Naviaux, Michael G. Shlipak, Joseph A. Abdelmalek, Erick Castro, Edmund V. Capparelli, Robert K. Naviaux, Joachim H. Ix


      PubDate: 2017-04-21T01:16:50Z
       
  • Erratum Regarding “US Renal Data System 2016 Annual Data Report:
           Epidemiology of Kidney Disease in the United States” (Am J Kidney Dis.
           2017;69[3][suppl 1]:Svii-Sviii, S1-S668)
    • Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5


      PubDate: 2017-04-21T01:16:50Z
       
  • National Kidney Foundation 2017 Spring Clinical Meetings Late-Breaking
           Abstracts∗∗See the April issue of American Journal of Kidney Diseases
           for full listing of 2017 Spring Clinical Meeting Abstracts. April 18-22,
           2017
    • Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5


      PubDate: 2017-04-21T01:16:50Z
       
  • Spark Study - Low-Dose Furosemide in Critically Ill Patients with Early
           Acute Kidney Injury: A Pilot Randomized Controlled Trial
    • Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5


      PubDate: 2017-04-21T01:16:50Z
       
  • The Effect of Topically Applied Vonapanitase on Fistula Outcomes: Results
           of the Patency-1 Trial
    • Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5


      PubDate: 2017-04-21T01:16:50Z
       
  • Cluster-Randomized Trial of Device to Prevent Catheter-Related Bloodstream
           Infection in Hemodialysis Patients
    • Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5


      PubDate: 2017-04-21T01:16:50Z
       
  • Treatment of Active Lupus Nephritis with Voclosporin: 48 Week Data from
           the Aura-LV Study
    • Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5


      PubDate: 2017-04-21T01:16:50Z
       
  • A Comprehensive Population Health Management Solution for Kidney Disease:
           
    • Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5


      PubDate: 2017-04-21T01:16:50Z
       
  • Hyperkalemia and Serum Potassium Variability in Patients on Hemodialysis
    • Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5


      PubDate: 2017-04-21T01:16:50Z
       
  • AJKD Atlas of Renal Pathology: Calcineurin Inhibitor Nephrotoxicity
    • Authors: Mark Lusco; Agnes Fogo Behzad Najafian Charles Alpers
      Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5
      Author(s): Mark A. Lusco, Agnes B. Fogo, Behzad Najafian, Charles E. Alpers


      PubDate: 2017-04-21T01:16:50Z
       
  • AJKD Atlas of Renal Pathology: Kidney Transplant Interstitial
           Fibrosis/Tubular Atrophy
    • Authors: Agnes Fogo; Mark Lusco Behzad Najafian Charles Alpers
      Abstract: Publication date: May 2017
      Source:American Journal of Kidney Diseases, Volume 69, Issue 5
      Author(s): Agnes B. Fogo, Mark A. Lusco, Behzad Najafian, Charles E. Alpers


      PubDate: 2017-04-21T01:16:50Z
       
 
 
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