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Publisher: Elsevier   (Total: 3042 journals)

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Showing 1 - 200 of 3042 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: 17, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 81, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 23, 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: 327, 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: 205, 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: 23, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, 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: 4, 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: 3)
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: 128, 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: 9, 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: 25, 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: 20, 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: 25, 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: 9, 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: 40, 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: 40, 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: 48, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 15)
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: 12)
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: 21, 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: 25)
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: 35, 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: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
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: 22)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
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: 25, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, 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: 19, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 59)
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: 2, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 341, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
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: 30, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 15)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 43, 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: 309, 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: 5, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 8, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 402, 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: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 38, 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: 50, 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: 5, 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: 6)
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: 8, 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: 4, 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: 7, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 48, 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: 47, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 44, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 36, 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: 16, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 30, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 24, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 34, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 46, 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: 179, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 55, 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: 23, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 24, 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: 33, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, 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: 55, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 9)
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: 157, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription  
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, 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: 151, 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]   [34 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0272-6386 - ISSN (Online) 1523-6838
   Published by Elsevier Homepage  [3042 journals]
  • Detection of Urate Crystals in Kidney Tissue
    • Authors: Yimin
      Abstract: Publication date: Available online 7 July 2017
      Source:American Journal of Kidney Diseases
      Author(s): Yimin Lu


      PubDate: 2017-07-13T09:17:51Z
       
  • In Reply to 'Detection of Urate Crystals in Kidney Tissue'
    • Authors: Julia Magnus; Annika Wernerson
      Abstract: Publication date: Available online 7 July 2017
      Source:American Journal of Kidney Diseases
      Author(s): Julia Wijkström, Magnus Söderberg, Annika Wernerson


      PubDate: 2017-07-13T09:17:51Z
       
  • Dialysis Modality and Readmission Following Hospital Discharge: A
           Population-Based Cohort Study
    • Authors: Jeffrey Perl; Eric McArthur Chaim Bell Amit Garg Joanne Bargman
      Abstract: Publication date: July 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 1
      Author(s): Jeffrey Perl, Eric McArthur, Chaim Bell, Amit X. Garg, Joanne M. Bargman, Christopher T. Chan, Shai Harel, Lihua Li, Arsh K. Jain, Danielle M. Nash, Ziv Harel
      Background Readmissions following hospital discharge among maintenance dialysis patients are common, potentially modifiable, and costly. Compared with patients receiving in-center hemodialysis (HD), patients receiving peritoneal dialysis (PD) have fewer routine dialysis clinic encounters and as a result may be more susceptible to a hospital readmission following discharge. Study Design Population-based retrospective-cohort observational study. Settings & Participants Patients treated with maintenance dialysis who were discharged following an acute-care hospitalization during January 1, 2003, to December 31, 2013, across 164 acute-care hospitals in Ontario, Canada. For those with multiple hospitalizations, we randomly selected a single hospitalization as the index hospitalization. Predictor Dialysis modality PD or in-center HD. Propensity scores were used to match each patient on PD therapy to 2 patients on in-center HD therapy to ensure that baseline indicators of health were similar between the 2 groups. Outcome All-cause 30-day readmission following the index hospital discharge. Results 28,026 dialysis patients were included in the study. 4,013 PD patients were matched to 8,026 in-center HD patients. Among the matched cohort, 30-day readmission rates were 7.1 (95% CI, 6.6-7.6) per 1,000 person-days for patients on PD therapy and 6.0 (95% CI, 5.7-6.3) per 1,000 person-days for patients on in-center HD therapy. The risk for a 30-day readmission among patients on PD therapy was higher compared with those on in-center HD therapy (adjusted HR, 1.19; 95% CI, 1.08-1.31). The primary results were consistent across several key prespecified subgroups. Limitations Lack of information for the frequency of nephrology physician encounters following discharge from the hospital in both the PD and in-center HD cohorts. Limited validation of International Classification of Diseases, Tenth Revision codes. Conclusions The risk for 30-day readmission is higher for patients on home-based PD compared to in-center HD therapy. Interventions to improve transitions in care between the inpatient and outpatient settings are needed, particularly for patients on PD therapy.

      PubDate: 2017-07-04T09:03:37Z
       
  • Hypoglycemia Incidence in Older Adults by Estimated GFR
    • Authors: Meryl Hodge; Eric McArthur Amit Garg Navdeep Tangri Kristin Clemens
      Abstract: Publication date: July 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 1
      Author(s): Meryl Hodge, Eric McArthur, Amit X. Garg, Navdeep Tangri, Kristin K. Clemens
      Background Bedside estimates of the risk for hypoglycemia by estimated glomerular filtration rate (eGFR), urine albumin-creatinine ratio (ACR), and use of antihyperglycemic medications would be helpful. Study Design Population-based cohort study. Setting & Participants Older adults (mean age, 75 years) in Ontario, Canada, from April 2002 through March 2013. Factors eGFR stage, ACR stage, and use of antihyperglycemic medications. Outcome 3-year incidence rate of a hospital encounter with hypoglycemia (emergency department or inpatient encounter). Results In users and nonusers of antihyperglycemic medications, there was a graded increase in risk for hypoglycemia by eGFR stage. Incidence rates in antihyperglycemic medication users were 82 (95% CI, 71-94), 122 (95% CI, 115-130), 235 (95% CI, 218-254), 379 (95% CI, 349-413), 596 (95% CI, 524-678), and 785 (95% CI, 689-894) encounters per 10,000 person-years when eGFR was ≥90, 60 to <90, 45 to <60, 30 to <45, 15 to <30, and <15mL/min/1.73m2 or the patient was receiving dialysis, respectively (P <0.001). Corresponding values in nonusers were 2 (95% CI, 2-4), 3 (95% CI, 3-4), 3 (95% CI, 2-4), 7 (95% CI, 5-9), 14 (95% CI, 9-22), and 55 (95% CI, 43-71) encounters/10,000 person-years, respectively (P <0.001). A similar relationship was evident by eGFR and ACR risk category. Limitations Only hypoglycemia episodes that were associated with a hospital encounter were assessed. Results cannot be generalized to younger patients. Conclusions In older adults, the risk for hypoglycemia is higher in those with lower kidney function. Our results may aid the patient-provider dialogue and inform future studies to prevent hypoglycemia in an at-risk population.

      PubDate: 2017-07-04T09:03:37Z
       
  • Urgent-Start Peritoneal Dialysis Complications: Prevalence and Risk
           Factors
    • Authors: Damin Tianjiao; Liu Jie Dong
      Abstract: Publication date: July 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 1
      Author(s): Damin Xu, Tianjiao Liu, Jie Dong
      Background Mechanical complications are of particular concern in urgent-start peritoneal dialysis (PD) because of the shorter break-in period. However, risk factors have been reported inconsistently and data in urgent-start PD populations are limited. Study Design Observational cohort study. Setting & Participants All patients treated with urgent-start PD, defined as PD therapy initiated within 1 week after catheter insertion, January 2003 to May 2013. Predictors Age, sex, abdominal surgery history, body mass index, hemoglobin level, albumin level, C-reactive protein level, break-in period (period between catheter insertion and PD therapy initiation), dialysate exchange volume, and use of overnight dwell. Outcomes The presence of mechanical complications related to abdominal wall or catheter, including hernia, hydrothorax, hydrocele, subcutaneous leak, pericatheter leak, catheter malposition, omental wrap, and obstruction. Results 922 patients on urgent-start PD therapy were enrolled (mean age, 59.1±15.0 [SD] years). Prevalences of abdominal wall and catheter complications were 4.8% and 9.5%, respectively. The most common abdominal wall complication was hernia (55%), followed by hydrothorax (25%). On adjustment, male sex (HR, 5.41; 95% CI, 2.15-13.59; P <0.001) and history of abdominal surgery (HR, 2.34; 95% CI, 1.04-5.26; P =0.04) were independently associated with higher risk for developing abdominal wall complications. Limitations As a cohort study, comparisons could not be established between urgent-start PD and conventional PD. Conclusions Urgent-start PD is a safe and practicable approach. Male sex and history of abdominal surgery could contribute to the development of abdominal wall complications.

      PubDate: 2017-07-04T09:03:37Z
       
  • Erratum Regarding “Phosphate-Binding Agents in Adults With CKD: A
           Network Meta-analysis of Randomized Trials” (Am J Kidney Dis.
           2016;68[5]:691-702)
    • Abstract: Publication date: Available online 1 July 2017
      Source:American Journal of Kidney Diseases


      PubDate: 2017-07-04T09:03:37Z
       
  • Treatment of Gabapentin Toxicity With Peritoneal Dialysis: Assessment of
           Gabapentin Clearance
    • Authors: Hisham Ibrahim; Zachary Oman Matthew Schuelke John Edwards
      Abstract: Publication date: Available online 1 July 2017
      Source:American Journal of Kidney Diseases
      Author(s): Hisham Ibrahim, Zachary Oman, Matthew Schuelke, John C. Edwards
      Gabapentin is almost exclusively cleared by the kidney and thus presents challenges in patients with kidney failure. Gabapentin is known to be effectively cleared by hemodialysis, but the efficiency of clearance by peritoneal dialysis (PD) has not been previously described. We report a case of gabapentin toxicity in a patient on long-term PD who was treated with continuous automated cycling PD. We find that continuous PD provides significant clearance of gabapentin. With 2-L exchanges every 2 hours, we document an apparent elimination half-life of 41.33 hours, which is substantially shorter than the reported elimination half-life of 132 hours in the absence of kidney function. Further, our patient's symptoms of gabapentin toxicity gradually improved and had fully resolved after about 36 hours of dialysis. Gabapentin clearance by PD was estimated at 94% of urea clearance. We conclude that intensive PD provides gabapentin clearance that approximates that of urea and is an effective but slow method to treat gabapentin overdose and toxicity.

      PubDate: 2017-07-04T09:03:37Z
       
  • Fatal Dialysis Vascular Access Hemorrhage
    • Authors: Matthew Jose; Mark Marshall Gail Read Nicole Lioufas Jon Ling
      Abstract: Publication date: Available online 30 June 2017
      Source:American Journal of Kidney Diseases
      Author(s): Matthew D. Jose, Mark R. Marshall, Gail Read, Nicole Lioufas, Jon Ling, Paul Snelling, Kevan R. Polkinghorne
      Bleeding from dialysis vascular access (arteriovenous fistulas, arteriovenous grafts, and vascular catheters) is uncommon. Death from these bleeds is rare and likely to be under-reported, with incident rates of fewer than 1 episode for every 1,000 patient-years on dialysis, meaning that dialysis units may experience this catastrophic event only once a decade. There is an opportunity to learn from (and therefore prevent) these bleeding deaths. We reviewed all reported episodes of death due to vascular access bleeding in Australia and New Zealand over a 14-year period together with individual dialysis units’ root cause analyses on each event. In this perspective, we provide a clinically useful summary of the evidence and knowledge gained from these rare events. Our conclusion is that death due to dialysis vascular access hemorrhage is an uncommon, catastrophic, but potentially preventable event if the right policies and procedures are put in place.

      PubDate: 2017-07-04T09:03:37Z
       
  • Sulfasalazine-Induced Crystalluria Causing Severe
           Acute Kidney Injury
    • Authors: Michael Durando; Hannah Tiu James Soo Kim
      Abstract: Publication date: Available online 29 June 2017
      Source:American Journal of Kidney Diseases
      Author(s): Michael Durando, Hannah Tiu, James Soo Kim
      Sulfasalazine is an anti-inflammatory agent commonly used in the treatment of autoimmune conditions such as inflammatory bowel disease and rheumatoid arthritis. Sulfasalazine is converted by gut bacteria into sulfapyridine and the clinically active metabolite 5-aminosalicylic acid (5-ASA), and its efficacy is proportional to the 5-ASA concentration within the intestinal lumen. Renal complications are commonly reported for the chemically similar 5-ASA derivative mesalamine, but are not well-known side effects of sulfasalazine therapy. We report a 72-year-old patient with Crohn’s disease managed with sulfasalazine for more than 10 years who presented with severe acute kidney injury (serum creatinine, 9.7mg/dL). Renal ultrasound revealed calculi and he subsequently spontaneously voided innumerable stones, which were composed of sulfasalazine metabolites. His renal calculi cleared and serum creatinine concentration improved to 3.1mg/dL after discontinuing sulfasalazine therapy and intravenous fluid hydration. His kidney function eventually returned to baseline. This case demonstrates that renal complications, in particular nephrolithiasis, may be an under-reported but potentially serious phenomenon in patients with inflammatory bowel disease treated with sulfasalazine and that their hydration status may play an important role in this process.

      PubDate: 2017-07-04T09:03:37Z
       
  • Dialysis Payment Model Reform: Managing Conflicts Between Profits and
           Patient Goals of Care Decision Making
    • Authors: Jeffrey Berns; Joel Glickman Peter Reese
      Abstract: Publication date: Available online 26 June 2017
      Source:American Journal of Kidney Diseases
      Author(s): Jeffrey S. Berns, Joel D. Glickman, Peter P. Reese


      PubDate: 2017-07-04T09:03:37Z
       
  • Family Aggregation and Heritability of ESRD in Taiwan: A Population-Based
           Study
    • Authors: Hsin Hsu; Chang Kuo Jung Cheng Hao Weng Cheng Chia
      Abstract: Publication date: Available online 26 June 2017
      Source:American Journal of Kidney Diseases
      Author(s): Hsin Hsu Wu, Chang Fu Kuo, I. Jung Li, Cheng Hao Weng, Cheng Chia Lee, Kun Hua Tu, Shou Hsuan Liu, Yung Chang Chen, Chih Wei Yang, Shue Fen Luo, Lai Chu See, Kuang Hui Yu, Lu Hsiang Huang, Weiya Zhang, Michael Doherty, Ya Chung Tian
      Background Aggregation of end-stage renal disease (ESRD) has been observed in families of European origin, as well as those of African origin. However, it is not well documented if this disease aggregates in Asian families. Furthermore, the contribution of genetic factors and shared environmental factors to family aggregation remains unclear. Study Design Population-based cross-sectional cohort study. Setting & Participants All 23,422,955 individuals registered in the Taiwan National Health Insurance Research Database in 2013. Among these, 47.45%, 57.45%, 47.29%, and 1.51% had a known parent, child, sibling, or twin, respectively. We identified 87,849 patients who had a diagnosis of ESRD. Predictor Family history of ESRD. Outcomes & Measurements ESRD and heritability defined as the proportion of phenotypic variance attributable to genetic factors. Results Having an affected first-degree relative with ESRD was associated with an adjusted relative risk of 2.46 (95% CI, 2.32-2.62). Relative risks were 96.38 (95% CI, 48.3-192.34) for twins of patients with ESRD, 2.15 (95% CI, 2.02-2.29) for parents, 2.78 (95% CI, 2.53-3.05) for offspring, 4.96 (95% CI, 4.19-5.88) for siblings, and 1.66 (95% CI, 1.54-1.78) for spouses without genetic similarities. Heritability in this study was 31.1% to 11.4% for shared environmental factors and 57.5% for nonshared environmental factors. Limitations This was a registry database study and we did not have detailed information about clinical findings or the definite causes of ESRD. Conclusions This whole population−based family study in Asia confirmed, in a Taiwanese population, that a family history of ESRD is a strong risk factor for this disease. Moderate heritability was noted and environmental factors were related to disease. Family history of ESRD is an important piece of clinical information.

      PubDate: 2017-07-04T09:03:37Z
       
  • Community Pharmacist Training-and-Communication Network and Drug-Related
           Problems in Patients With CKD: A Multicenter, Cluster-Randomized,
           Controlled Trial
    • Authors: Lyne Lalonde; Patricia Anne Lord Robert Bell Anne-Marie Daigneault Legris
      Abstract: Publication date: Available online 26 June 2017
      Source:American Journal of Kidney Diseases
      Author(s): Lyne Lalonde, Patricia Quintana-Bárcena, Anne Lord, Robert Bell, Valérie Clément, Anne-Marie Daigneault, Marie-Ève Legris, Sara Letendre, Marie Mouchbahani, Ghaya Jouini, Joëlle Azar, Élisabeth Martin, Djamal Berbiche, Stephanie Beaulieu, Sébastien Beaunoyer, Émilie Bertin, Marianne Bouvrette, Noémie Charbonneau-Séguin, Jean-François Desrochers, Katherine Desforges, Ariane Dumoulin-Charette, Sébastien Dupuis, Maryame El Bouchikhi, Roxanne Forget, Marianne Guay, Jean-Phillippe Lemieux, Claudia Morin-Bélanger, Isabelle Noël, Stephanie Ricard, Patricia Sauvé, François Ste-Marie Paradis
      Background Appropriate training for community pharmacists may improve the quality of medication use. Few studies have reported the impact of such programs on medication management for patients with chronic kidney disease (CKD). Study Design Multicenter, cluster-randomized, controlled trial. Setting & Participants Patients with CKD stage 3a, 3b, or 4 from 6 CKD clinics (Quebec, Canada) and their community pharmacies. Intervention Each cluster (a pharmacy and its patients) was randomly assigned to either ProFiL, a training-and-communication network program, or the control group. ProFiL pharmacists completed a 90-minute interactive web-based training program on use of medications in CKD and received a clinical guide, patients’ clinical summaries, and facilitated access to the CKD clinic. Outcomes Drug-related problems (primary outcome), pharmacists’ knowledge and clinical skills, and patients’ clinical attributes (eg, blood pressure and glycated hemoglobin concentration). Measurements Drug-related problems were evaluated the year before and after the recruitment of patients using a validated set of significant drug-related problems, the Pharmacotherapy Assessment in Chronic Renal Disease (PAIR) criteria. Pharmacists’ questionnaires were completed at baseline and after 1 year. Clinical attributes were documented at baseline and after 1 year using available information in medical charts. Results 207 community pharmacies, 494 pharmacists, and 442 patients with CKD participated. After 1 year, the mean number of drug-related problems per patient decreased from 2.16 to 1.60 and from 1.70 to 1.62 in the ProFiL and control groups, respectively. The difference in reduction of drug-related problems per patient between the ProFiL and control groups was −0.32 (95% CI, −0.63 to −0.01). Improvements in knowledge (difference, 4.5%; 95% CI, 1.6%-7.4%) and clinical competencies (difference, 7.4%; 95% CI, 3.5%-11.3%) were observed among ProFiL pharmacists. No significant differences in clinical attributes were observed across the groups. Limitations High proportion of missing data on knowledge and clinical skills questionnaire (34.6%) and clinical attributes (11.1%). Conclusions Providing community pharmacists with essential clinical data, appropriate training, and support from hospital pharmacists with expertise in nephrology increases pharmacists’ knowledge and r...
      PubDate: 2017-07-04T09:03:37Z
       
  • Development of Focal Segmental Glomerulosclerosis Patient-Reported Outcome
           Measures: Symptom Diary and Symptom Impact Questionnaire
    • Authors: Susan Mathias; Susan Vallow Debbie Gipson Kevin Thorneloe Dennis Sprecher
      Abstract: Publication date: Available online 26 June 2017
      Source:American Journal of Kidney Diseases
      Author(s): Susan D. Mathias, Susan Vallow, Debbie S. Gipson, Kevin S. Thorneloe, Dennis Sprecher
      Background Focal segmental glomerulosclerosis (FSGS) is a kidney disease that affects patients’ functioning and well-being. This study aimed to develop patient-reported outcome questionnaires to measure patient experiences related to FSGS. Study Design Qualitative patient interviews to identify important symptoms and concepts (concept elicitation) formed the basis for the development of 2 questionnaires, one on symptoms and one on their impact. Additional qualitative interviews were implemented to evaluate/refine the questionnaires (cognitive debriefing). Transcripts of concept elicitation and cognitive debriefing interviews, conducted by telephone, were analyzed for concepts of interest using qualitative text analysis. Setting & Participants Patients with FSGS (aged 18-65 years with estimated glomerular filtration rates ≥ 40mL/min/1.73m2) whose disease remained inadequately controlled after 2 or fewer courses of treatment. Methodology Qualitative concept elicitation and cognitive debriefing interviews. Analytical Approach Interview transcripts were analyzed using qualitative software, MAXQDA. Results 30 patients completed concept elicitation interviews; 9 patients completed cognitive debriefing interviews. Frequently mentioned symptoms included swelling from the waist down/legs/knees/feet/ankles (67%), fatigue (57%), stomach/abdomen swelling (43%), body pain/pressure (30%), and shortness of breath (20%), as well as impacts on physical (52%), emotional (68%), and social functioning (89%). Based on analyses of interview transcripts and clinical input, 2 questionnaires, one on symptoms and one on the impact of the symptom, were drafted. The 23-item FSGS Symptom Diary (assessing the frequency and severity of FSGS symptoms during the past 24 hours) and the FSGS Symptom Impact Questionnaire (17 items assessing interference with activities and emotions during the past 7 days) were iteratively revised based on cognitive debriefing interviews. Limitations The study was restricted to English-speaking adults located in the United States, and the concept elicitation interview group had a low number of African Americans. Conclusions The FSGS Symptom Diary and FSGS Symptom Impact Questionnaire are new FSGS-specific patient-reported outcomes measures designed to support a comprehensive assessment of symptoms and symptom impact in adults with FSGS. Future research is needed to evaluate their quantitative measurement properties.

      PubDate: 2017-07-04T09:03:37Z
       
  • Home Alone: Does Modality Matter' Revisiting Hospital Readmissions in
           Dialysis
    • Authors: Jenny Shen; Natasha Dave Kevin Erickson
      Abstract: Publication date: July 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 1
      Author(s): Jenny I. Shen, Natasha N. Dave, Kevin F. Erickson


      PubDate: 2017-06-24T05:52:17Z
       
  • Serum Potassium and the Long Interdialytic Interval:
           Minding the Gap
    • Authors: Connie Rhee
      Abstract: Publication date: July 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 1
      Author(s): Connie M. Rhee


      PubDate: 2017-06-24T05:52:17Z
       
  • Urinary Anomalies in 22q11.2 Deletion (DiGeorge syndrome): From Copy
           Number Variations to Single-Gene Determinants of Phenotype
    • Authors: Gentzon Hall; Jonathan Routh Rasheed Gbadegesin
      Abstract: Publication date: July 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 1
      Author(s): Gentzon Hall, Jonathan C. Routh, Rasheed A. Gbadegesin


      PubDate: 2017-06-24T05:52:17Z
       
  • Serum Potassium and Short-term Clinical Outcomes Among Hemodialysis
           Patients: Impact of the Long Interdialytic Interval
    • Authors: Steven Brunelli; Charles Mond Nina Oestreicher Viatcheslav Rakov David Spiegel
      Abstract: Publication date: July 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 1
      Author(s): Steven M. Brunelli, Charles Du Mond, Nina Oestreicher, Viatcheslav Rakov, David M. Spiegel
      Background Hyperkalemia is common among hemodialysis patients and is associated with morbidity and mortality. The long interdialytic interval is likewise associated with adverse outcomes. However, the interplay among serum potassium, dialysis cycle phase, and clinical outcomes has not been examined. Study Design Retrospective observational study. Setting & Participants 52,734 patients receiving in-center hemodialysis at a large dialysis organization during 2010 and 2011 contributed 533,889 potassium measurements (230,634 on Monday; 285,522 on Wednesday; 17,733 on Friday). Predictor Serum potassium concentration, day of the week of potassium measurement. Outcomes Death, hospitalization, emergency department (ED) visit. Results There was a significant association between higher serum potassium and risk of hospitalization within 96 hours that was of greater magnitude on Fridays (389 hospitalizations) than Mondays or Wednesdays (4,582 and 4,629 hospitalizations, respectively; P for interaction = 0.008). Serum potassium of 5.5 to <6.0 (vs the referent category of 4.0-<4.5 mEq/L) was associated with increased risk of hospitalization on Fridays, with an adjusted OR of 1.68 (95% CI, 1.22-2.30). However, serum potassium of 5.5 to <6.0 mEq/L was associated with only mild elevation of risk on Mondays and no significantly increased risk on Wednesdays (adjusted ORs of 1.12 [95% CI, 1.00-1.24] and 1.04 [95% CI, 0.94-1.16], respectively). Associations of elevated serum potassium (6.0-<6.5 mEq/L or greater) with death and ED visit were significant, but did not differ based on day of the week. Limitations There were insufficient observations to detect effect modification by day of the week for deaths, ED visits, and specific causes of hospitalizations. Confounding may have influenced results. Conclusions Higher serum potassium is associated with increased short-term risk of hospitalization, ED visit, and death. The association between serum potassium and hospitalization risk is modified by day of the week, consistent with a contribution of accumulated potassium to adverse outcomes following the long interdialytic interval. Further work is needed to determine whether directed interventions ameliorate this risk.

      PubDate: 2017-06-24T05:52:17Z
       
  • Intraperitoneal Vancomycin Plus Either Oral Moxifloxacin or
           Intraperitoneal Ceftazidime for the Treatment of Peritoneal
           Dialysis−Related Peritonitis: A Randomized Controlled Pilot Study
    • Authors: Rong Zhikai; Yang Zhen Huan Wang Xue Tian David Johnson
      Abstract: Publication date: July 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 1
      Author(s): Rong Xu, Zhikai Yang, Zhen Qu, Huan Wang, Xue Tian, David W. Johnson, Jie Dong
      Background Intraperitoneal administration of antibiotics is recommended as a first treatment for managing peritoneal dialysis (PD)-related peritonitis. However, the efficacy of oral administration of quinolones has not been well studied. Study Design Randomized controlled pilot study. Setting & Participants 80 eligible patients with PD-related peritonitis from Peking University First Hospital (40 in each arm). Intervention Intraperitoneal vancomycin, 1g, every 5 days plus oral moxifloxacin, 400mg, every day (treatment group) versus intraperitoneal vancomycin, 1g, every 5 days plus intraperitoneal ceftazidime, 1g, every day (control group). Outcomes The primary end point was complete resolution of peritonitis, and secondary end points were primary or secondary treatment failure. Measurements PD effluent white blood cell count. Results Baseline demographic and clinical characteristics of the 2 groups were comparable. There were 24 and 22 Gram-positive organisms, 6 and 7 Gram-negative organisms, 9 and 10 culture-negative samples, and 1 and 1 fungal sample in the treatment and control groups, respectively. Complete resolution of peritonitis was achieved in 78% and 80% of cases in the treatment and control groups, respectively (OR, 0.86; 95% CI, 0.30-2.52; P =0.8). There were 3 and 1 cases of relapse in the treatment and control groups, respectively. Primary and secondary treatment failure rates were not significantly different (33% vs 20% and 10% vs 13%, respectively). In each group, there was 1 peritonitis-related death and 6 transfers to hemodialysis therapy. During the 3-month follow-up period, 7 and 3 successive episodes of peritonitis occurred in the treatment and control groups, respectively. Only 2 adverse drug reactions (mild nausea and mild rash, respectively) were observed in the 2 groups. Limitations Sample size was relatively small and the eligibility ratio was low. Also, the number of peritonitis episodes was low, limiting the power to detect a difference between groups. Conclusions This pilot study suggests that intraperitoneal vancomycin with oral moxifloxacin is a safe, well-tolerated, practical, and effective first-line treatment for PD-related peritonitis. Larger adequately powered clinical trials are warranted.

      PubDate: 2017-06-24T05:52:17Z
       
  • Food Insecurity, CKD, and Subsequent ESRD in US Adults
    • Authors: Tanushree Banerjee; Deidra Crews Donald Wesson Sai Dharmarajan Rajiv Saran
      Abstract: Publication date: July 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 1
      Author(s): Tanushree Banerjee, Deidra C. Crews, Donald E. Wesson, Sai Dharmarajan, Rajiv Saran, Nilka Ríos Burrows, Sharon Saydah, Neil R. Powe
      Background Poor access to food among low-income adults has been recognized as a risk factor for chronic kidney disease (CKD), but there are no data for the impact of food insecurity on progression to end-stage renal disease (ESRD). We hypothesized that food insecurity would be independently associated with risk for ESRD among persons with and without earlier stages of CKD. Study Design Longitudinal cohort study. Setting & Participants 2,320 adults (aged ≥ 20 years) with CKD and 10,448 adults with no CKD enrolled in NHANES III (1988-1994) with household income ≤ 400% of the federal poverty level linked to the Medicare ESRD Registry for a median follow-up of 12 years. Predictor Food insecurity, defined as an affirmative response to the food-insecurity screening question. Outcome Development of ESRD. Measurements Demographics, income, diabetes, hypertension, estimated glomerular filtration rate, and albuminuria. Dietary acid load was estimated from 24-hour dietary recall. We used a Fine-Gray competing-risk model to estimate the relative hazard (RH) for ESRD associated with food insecurity after adjusting for covariates. Results 4.5% of adults with CKD were food insecure. Food-insecure individuals were more likely to be younger and have diabetes (29.9%), hypertension (73.9%), or albuminuria (90.4%) as compared with their counterparts (P <0.05). Median dietary acid load in the food-secure versus food-insecure group was 51.2 mEq/d versus 55.6 mEq/d, respectively (P =0.05). Food-insecure adults were more likely to develop ESRD (RH, 1.38; 95% CI, 1.08-3.10) compared with food-secure adults after adjustment for demographics, income, diabetes, hypertension, estimated glomerular filtration rate, and albuminuria. In the non-CKD group, 5.7% were food insecure. We did not find a significant association between food insecurity and ESRD (RH, 0.77; 95% CI, 0.40-1.49). Limitations Use of single 24-hour diet recall; lack of laboratory follow-up data and measure of changes in food insecurity over time; follow-up of cohort ended 10 years ago. Conclusions Among adults with CKD, food insecurity was independently associated with a higher likelihood of developing ESRD. Innovative approaches to address food insecurity should be tested for their impact on CKD outcomes.

      PubDate: 2017-06-24T05:52:17Z
       
  • Serum Asymmetric and Symmetric Dimethylarginine and Morbidity and
           Mortality in Hemodialysis Patients
    • Authors: Tariq Shafi; Thomas Hostetter Timothy Meyer Seungyoung Hwang Xin Hai
      Abstract: Publication date: July 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 1
      Author(s): Tariq Shafi, Thomas H. Hostetter, Timothy W. Meyer, Seungyoung Hwang, Xin Hai, Michal L. Melamed, Tanushree Banerjee, Josef Coresh, Neil R. Powe
      Background Asymmetric (ADMA) and symmetric dimethylarginine (SDMA) are putative uremic toxins that may exert toxicity by a number of mechanisms, including impaired nitric oxide synthesis and generation of reactive oxygen species. The study goal was to determine the association between these metabolites and cardiovascular outcomes in hemodialysis patients. Study Design Post hoc analysis of the Hemodialysis (HEMO) Study. Setting & Participants 1,276 prevalent hemodialysis patients with available samples 3 to 6 months after randomization. Predictor ADMA and SDMA measured in stored specimens. Outcomes Cardiac death, sudden cardiac death, first cardiovascular event, and any-cause death. Association with predictors analyzed using Cox regression adjusted for potential confounders (including demographics, clinical characteristics, comorbid conditions, albumin level, and residual kidney function). Results Mean age of patients was 57±14 (SD) years, 63% were black, and 57% were women. Mean ADMA (0.9±0.2μmol/L) and SDMA levels (4.3±1.4μmol/L) were moderately correlated (r =0.418). Higher dialysis dose or longer session length were not associated with lower predialysis ADMA or SDMA concentrations. In fully adjusted models, each doubling of ADMA level was associated with higher risk (HR per 2-fold higher concentration; 95% CI) of cardiac death (1.83; 1.29-2.58), sudden cardiac death (1.79; 1.19-2.69), first cardiovascular event (1.50; 1.20-1.87), and any-cause death (1.44; 1.13-1.83). Compared to the lowest ADMA quintile (<0.745 μmol/L), the highest ADMA quintile (≥1.07μmol/L) was associated with higher risk (HR; 95% CI) of cardiac death (2.10; 1.44-3.05), sudden cardiac death (2.06; 1.46-2.90), first cardiovascular event (1.75; 1.35-2.27), and any-cause death (1.56; 1.21-2.00). SDMA level was associated with higher risk for cardiac death (HR, 1.40; 95% CI, 1.03-1.92), but this was no longer statistically significant after adjusting for ADMA level (HR, 1.20; 95% CI, 0.86-1.68). Limitations Single time-point measurement of ADMA and SDMA. Conclusions ADMA and, to a lesser extent, SDMA levels are associated with cardiovascular outcomes in hemodialysis patients.

      PubDate: 2017-06-24T05:52:17Z
       
  • Initial Session Duration and Mortality Among Incident Hemodialysis
           Patients
    • Authors: Shailender Swaminathan; Vincent Mor Rajnish Mehrotra Amal Trivedi
      Abstract: Publication date: July 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 1
      Author(s): Shailender Swaminathan, Vincent Mor, Rajnish Mehrotra, Amal N. Trivedi
      Background The association of dialysis session duration with mortality in patients undergoing maintenance hemodialysis is unclear. We compared mortality rates of patients treated in dialysis facilities that used initial session durations of either ≥ 4 versus 3 hours for all incident patients. Study Design Retrospective cohort study. Settings & Participants Patients with end-stage renal disease beginning maintenance hemodialysis therapy in January 2006 to December 2010 and followed up through December 2012, including 39,172 patients in 852 facilities who initiated treatment for ≥ 4 hours and 47,721 patients in 631 facilities who initiated treatment for 3 hours. Predictor Initial session duration of ≥ 4 hours versus 3 hours. Outcome 2- and 1-year mortality rates. Results Total numbers of deaths observed within 2 years after initiating dialysis therapy were 8,945 in the ≥ 4-hour group and 15,624 in the 3-hour group. The corresponding numbers of deaths observed within 1 year were 5,492 and 10,372, respectively. The 2-year adjusted HR in the ≥ 4-hour versus 3-hour group was 0.79 (95% CI, 0.73-0.86). The corresponding 1-year adjusted HR was 0.77 (95% CI, 0.70-0.84). Results were robust when analyses were restricted to specific subgroups of patients classified by age, sex, race, and select clinical characteristics. Limitations We did not observe hemodialysis duration in sessions subsequent to initiation. We only included patients treated in facilities with uniform session length (at initiation) for all their patients. Furthermore, we lacked information for dialysis dosage and patients’ baseline residual kidney function. Conclusions Patients in facilities routinely initiating hemodialysis therapy for ≥ 4 hours may have substantially lower mortality as compared with patients in facilities initiating for only 3 hours of treatment.

      PubDate: 2017-06-24T05:52:17Z
       
  • Serious Fall Injuries Before and After Initiation of Hemodialysis Among
           Older ESRD Patients in the United States: A Retrospective Cohort Study
    • Authors: Laura Plantinga; Rachel Patzer Harold Franch Barrett Bowling
      Abstract: Publication date: July 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 1
      Author(s): Laura C. Plantinga, Rachel E. Patzer, Harold A. Franch, C. Barrett Bowling
      Background Because initiation of dialysis therapy often occurs in the setting of acute illness and may signal worsening health and functional decline, we examined whether rates of serious fall injuries among older hemodialysis patients differ before and after dialysis therapy initiation. Study Design Retrospective cohort study of claims data from the 2 years spanning dialysis therapy initiation among patients initiating dialysis therapy in 2010 to 2012. Setting & Participants Claims from 81,653 Medicare end-stage renal disease beneficiaries aged 67 to 100 years. Predictor Post– versus pre–dialysis therapy initiation periods, defined as on or after versus before dialysis therapy initiation. Outcomes Serious fall injuries were defined using diagnostic codes for falls in combination with fractures, brain injuries, or joint dislocation. Incidence rate ratios (overall and stratified) for post– versus pre–dialysis therapy initiation periods were estimated using generalized estimating equation models with a negative binomial link. Results Overall, 12,757 serious fall injuries occurred in the pre– and post–dialysis therapy initiation periods. Annual rates of serious fall injuries were 64.4 (95% CI, 62.7-66.2) and 107.8 (95% CI, 105.4-110.3) per 1,000 patient-years, respectively, in the pre– and post–dialysis therapy initiation periods (incidence rate ratio, 1.62; 95% CI, 1.56-1.67). Relative rates of serious fall injuries in the post– vs pre–dialysis initiation periods were of greater magnitude among patients who were younger (<75 years), had pre–end-stage renal disease nephrology care, had albumin levels > 3g/dL, were able to walk and transfer, did not need assistance with activities of daily living, and were not institutionalized compared with relative rates among their counterparts. Limitations Potential misclassification due to the use of claims data and survival bias among those initiating hemodialysis therapy. Conclusions Among older Medicare beneficiaries receiving hemodialysis, serious fall injuries are common, the post–dialysis initiation period is a high-risk time for falls, and dialysis therapy initiation may be an important time to screen for fall risk factors and implement multifactorial fall prevention strategies.

      PubDate: 2017-06-24T05:52:17Z
       
  • Cardiothoracic Ratio and All-Cause Mortality and Cardiovascular Disease
           Events in Hemodialysis Patients: The Q-Cohort Study
    • Authors: Ryusuke Yotsueda; Masatomo Taniguchi Shigeru Tanaka Masahiro Eriguchi Kiichiro Fujisaki
      Abstract: Publication date: July 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 1
      Author(s): Ryusuke Yotsueda, Masatomo Taniguchi, Shigeru Tanaka, Masahiro Eriguchi, Kiichiro Fujisaki, Kumiko Torisu, Kosuke Masutani, Hideki Hirakata, Takanari Kitazono, Kazuhiko Tsuruya
      Background Cardiothoracic ratio by chest radiography is commonly used to assess volume status. Little is known about the relationships between cardiothoracic ratio and the incidence of clinical outcomes in patients undergoing hemodialysis (HD). Study Design Prospective cohort study. Setting & Participants 3,436 participants in the Q-Cohort Study 18 years or older who underwent maintenance HD in Japan. Predictor Cardiothoracic ratio. Outcomes & Measurements All-cause mortality and cardiovascular disease (CVD) events. Results During a 4-year follow-up period, 564 (16.4%) patients died of any cause and 590 (17.2%) developed CVD events. From baseline cardiothoracic ratios, participants were categorized into sex-specific quartiles because cardiothoracic ratio distribution differed by sex. The 4-year event-free survival rate, in terms of all-cause mortality and CVD events, was significantly lower with higher cardiothoracic ratios. Compared to the lowest cardiothoracic ratio (quartile 1), multivariable-adjusted HRs for all-cause mortality were 0.89 (95% CI, 0.66-1.20), 1.41 (1.08-1.86), and 1.52 (1.17-2.00) in patients from quartiles 2, 3, and 4, respectively. Similarly, in comparison to quartile 1, multivariable-adjusted HRs for CVD events were 1.00 (95% CI, 0.77-1.31), 1.18 (0.92-1.53), and 1.37 (1.07-1.76) in patients from quartiles 2, 3, and 4, respectively. Furthermore, the combination of higher cardiothoracic ratio and normohypotension (systolic blood pressure < 140mmHg and diastolic blood pressure < 90mmHg) was associated with higher risk for CVD events. Limitations Single measurement of all variables, potentially less-heterogeneous patient population, and limited ascertainment of cardiac parameters and the outcomes. Conclusions Higher cardiothoracic ratio is associated with higher risk for both all-cause mortality and CVD events in patients undergoing HD.

      PubDate: 2017-06-24T05:52:17Z
       
  • Reliability and Utility of the Surprise Question in CKD Stages 4 to 5
    • Authors: Andrei Javier; Rocio Figueroa Edward Siew Huzaifah Salat Jennifer Morse
      Abstract: Publication date: July 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 1
      Author(s): Andrei D. Javier, Rocio Figueroa, Edward D. Siew, Huzaifah Salat, Jennifer Morse, Thomas G. Stewart, Rakesh Malhotra, Manisha Jhamb, Jane O. Schell, Cesar Y. Cardona, Cathy A. Maxwell, T. Alp Ikizler, Khaled Abdel-Kader
      Background Prognostic uncertainty is one barrier to engaging in goals-of-care discussions in chronic kidney disease (CKD). The surprise question (“Would you be surprised if this patient died in the next 12 months'”) is a tool to assist in prognostication. However, it has not been studied in non−dialysis-dependent CKD and its reliability is unknown. Study Design Observational study. Setting & Participants 388 patients at least 60 years of age with non−dialysis-dependent CKD stages 4 to 5 who were seen at an outpatient nephrology clinic. Predictor Trinary (ie, Yes, Neutral, or No) and binary (Yes or No) surprise question response. Outcomes Mortality, test-retest reliability, and blinded inter-rater reliability. Measurements Baseline comorbid conditions, Charlson Comorbidity Index, cause of CKD, and baseline laboratory values (ie, serum creatinine/estimated glomerular filtration rate, serum albumin, and hemoglobin). Results Median patient age was 71 years with median follow-up of 1.4 years, during which time 52 (13%) patients died. Using the trinary surprise question, providers responded Yes, Neutral, and No for 202 (52%), 80 (21%), and 106 (27%) patients, respectively. About 5%, 15%, and 27% of Yes, Neutral, and No patients died, respectively (P <0.001). Trinary surprise question inter-rater reliability was 0.58 (95% CI, 0.42-0.72), and test-retest reliability was 0.63 (95% CI, 0.54–0.72). The trinary surprise question No response had sensitivity and specificity of 55% and 76%, respectively (95% CIs, 38%-71% and 71%-80%, respectively). The binary surprise question had sensitivity of 66% (95% CI, 49%-80%; P =0.3 vs trinary), but lower specificity of 68% (95% CI, 63%-73%; P =0.02 vs trinary). Limitations Single center, small number of deaths. Conclusions The surprise question associates with mortality in CKD stages 4 to 5 and demonstrates moderate to good reliability. Future studies should examine how best to deploy the surprise question to facilitate advance care planning in advanced non−dialysis-dependent CKD.

      PubDate: 2017-06-24T05:52:17Z
       
  • Kidney Disease and the Westernization and Industrialization of Food
    • Authors: Holly Kramer
      Abstract: Publication date: July 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 1
      Author(s): Holly Kramer
      The industrialization of food in the United States has led to lower prices, and families now spend a smaller percentage of their total income on food compared with past generations. The decline in prices for food commodities has led to sharp increases in food consumption, with average caloric intake in the United States now more than 500 calories higher per day compared to the 1970s. This increase in total food consumption has fueled the ongoing obesity epidemic, which in turn has likely played a role in the epidemic of end-stage renal disease during the last 2 decades. A close examination of dietary behaviors in the United States reveals high consumption of salt and animal protein, which negatively affects kidney disease progression. An interprofessional approach is necessary to address obesity, and studies are needed to identify best practices for integrating medical nutrition therapy into the long-term care of patients with chronic kidney disease.

      PubDate: 2017-06-24T05:52:17Z
       
  • Kidney Disease Population Health Management in the Era of Accountable
           Care: A Conceptual Framework for Optimizing Care Across the CKD Spectrum
    • Authors: Mallika Mendu; Sushrut Waikar Sandhya Rao
      Abstract: Publication date: July 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 1
      Author(s): Mallika L. Mendu, Sushrut S. Waikar, Sandhya K. Rao
      Since its passage in 2010, the Affordable Care Act has led to the creation of numerous accountable care organizations that face the challenge of transforming the traditional care delivery model to provide more patient-centered, high-quality, and low-cost care. Complex patients, including those with chronic kidney disease (CKD), present the most challenges and opportunities. CKD is a condition with significant morbidity, mortality, and cost and thought to be partly secondary to known gaps in care delivery. Successful population management for CKD requires consideration of the needs of patients at all phases of the disease. In this article, we offer a comprehensive framework for a population-based approach to CKD and examples of programs we are implementing in each area. These initiatives include the development and implementation of an electronic nephrology consult (e-consult) platform, CKD quality metrics, CKD registry, CKD collaborative care agreement, multidisciplinary care clinic for advanced CKD, end-stage renal disease care coordinator program, shared decision-making tools for renal replacement, CKD education videos, and a tablet-based CKD patient-reported outcome measures tool.

      PubDate: 2017-06-24T05:52:17Z
       
  • Nephrologists and Integrated Kidney Disease Care: Roles and Skills
           Essential for Nephrologists for Future Success
    • Authors: Allen Nissenson; Franklin Maddux
      Abstract: Publication date: July 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 1
      Author(s): Allen R. Nissenson, Franklin W. Maddux
      As the costs of caring for patients with end-stage renal disease have grown, so has the pressure to provide high-quality care at a lower cost. Prompted in large part by regulatory and legislative changes, reimbursement is shifting from a fee-for-service environment to one of value-based payment models. Nephrologists in this new environment are increasingly responsible not only for direct patient care, but also for population management and the associated clinical outcomes for this vulnerable population. This Perspective article aims to recognize the key role and skills needed in order to successfully practice within these new value-based care models. The new paradigm of delivering and financing care also presents opportunities for nephrologists to shape how care is delivered, define meaningful quality metrics, and share in the financial outcomes of these approaches. Though it will take time, the training and mind-set of nephrologists must evolve to accommodate these expanded practice expectations required by a system that demands measurement, reporting, accountability, and improvement, not only for individuals but also for populations of patients.

      PubDate: 2017-06-24T05:52:17Z
       
  • COQ6 Mutations in Children With Steroid-Resistant Focal Segmental
           Glomerulosclerosis and Sensorineural Hearing Loss
    • Authors: Eujin Park; Han Ahn Hee Gyung Kang Kee Hwan Yoo
      Abstract: Publication date: July 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 1
      Author(s): Eujin Park, Yo Han Ahn, Hee Gyung Kang, Kee Hwan Yoo, Nam Hee Won, Kyoung Bun Lee, Kyung Chul Moon, Moon-Woo Seong, Tae rin Gwon, Sung Sup Park, Hae Il Cheong
      The phenotypic combination of steroid-resistant focal segmental glomerulosclerosis (SR-FSGS) and sensorineural hearing loss has been mainly reported in patients with mitochondrial cytopathies, including primary coenzyme Q10 (CoQ10) deficiency. In this report of 10 children with SR-FSGS and sensorineural hearing loss, we found 6 patients with biallelic COQ6 mutations. Median age at the onset of nephrotic syndrome was 29 (range, 15-47) months. All patients progressed to end-stage renal disease within a median of 13 (range, 1-27) months after the onset. Kidney biopsy revealed abnormal mitochondrial proliferation in podocytes in all 6 patients. None of the 5 patients who underwent kidney transplantation developed recurrence of FSGS. Primary CoQ10 deficiency due to COQ6 mutations should be considered in children presenting with both SR-FSGS and sensorineural hearing loss. An early diagnosis of COQ6 mutations is essential because the condition is treatable when CoQ10 supplementation is started at the early stage. We recommend early kidney biopsy because detection of abnormal mitochondrial proliferation in podocytes might provide an earlier diagnostic clue.

      PubDate: 2017-06-24T05:52:17Z
       
  • BRAF Signaling Pathway Inhibition, Podocyte Injury, and Nephrotic Syndrome
    • Authors: Luca Perico; Mario Arrigo Schieppati Camillo Carrara Paola Rizzo Sara
      Abstract: Publication date: July 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 1
      Author(s): Luca Perico, Mario Mandalà, Arrigo Schieppati, Camillo Carrara, Paola Rizzo, Sara Conti, Lorena Longaretti, Ariela Benigni, Giuseppe Remuzzi
      Dabrafenib and trametinib, BRAF and MEK inhibitors, respectively, are effective targeted metastatic melanoma therapies, but little is known about their nephrotoxicity. Although tubulointerstitial injury has been the most widely reported renal side effect of targeted melanoma therapy, nephrotic syndrome has not been reported before. We report on a patient with metastatic melanoma who developed nephrotic syndrome during dabrafenib and trametinib treatment. Kidney biopsy showed diffuse loss of podocyte cytoarchitecture, extensive foot-process effacement, and glomerular endothelial injury. Kidney function and glomerular ultrastructural changes recovered fully after drug withdrawal. In vitro, BRAF inhibition decreased PLCε1 expression in podocytes, accompanied by a reduction in nephrin expression and an increase in permeability to albumin. Additionally, these drugs inhibited the podocyte–vascular endothelial growth factor (VEGF) system. In addition to implications for nephrotic syndrome pathophysiology, we suggest that patients given dabrafenib and trametinib be monitored closely for potential glomerular damage.

      PubDate: 2017-06-24T05:52:17Z
       
  • Urinary Excretion of α1-Microglobulin Does Not Predict Graft Loss in
           Stable Kidney Transplant Recipients
    • Authors: Anneke Bech; Judith Hoogendijk Jack Wetzels
      Abstract: Publication date: July 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 1
      Author(s): Anneke P. Bech, Judith M. Hoogendijk, Jack F. Wetzels


      PubDate: 2017-06-24T05:52:17Z
       
  • In Reply to ‘Urinary Excretion of α1-Microglobulin Does Not Predict
           Graft Loss in Stable Kidney Transplant Recipients’
    • Authors: Joachim Vasantha; Jotwani Michael Shlipak
      Abstract: Publication date: July 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 1
      Author(s): Joachim H. Ix, Vasantha Jotwani, Michael G. Shlipak


      PubDate: 2017-06-24T05:52:17Z
       
  • Assessing the Effect of Spironolactone on Acute Kidney Injury After
           Cardiac Surgery
    • Authors: Wei Zhang; Feng Xue Hai chen Chu
      Abstract: Publication date: July 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 1
      Author(s): Wei Zhang, Feng Xue, Hai chen Chu


      PubDate: 2017-06-24T05:52:17Z
       
  • In Reply to ‘Assessing the Effect of Spironolactone on Acute Kidney
           Injury After Cardiac Surgery’
    • Authors: Magdalena Madero; Armando Vazquez-Rangel Gerardo Gamba
      Abstract: Publication date: July 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 1
      Author(s): Magdalena Madero, Armando Vazquez-Rangel, Gerardo Gamba


      PubDate: 2017-06-24T05:52:17Z
       
  • Predictive Value of Using Initial Versus Terminal Deceased Donor
           Creatinine to Calculate the Kidney Donor Risk Index
    • Authors: Mariana Chiles; Ali Husain Whitney Skillen Samnang Lee Dustin Carpenter
      Abstract: Publication date: July 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 1
      Author(s): Mariana C. Chiles, S. Ali Husain, Whitney Skillen, Samnang Lee, Dustin Carpenter, Stephen O. Pastan, Rachel E. Patzer, Bekir Tanriover, Sumit Mohan


      PubDate: 2017-06-24T05:52:17Z
       
  • AJKD Atlas of Renal Pathology: Chronic Interstitial Nephritis
    • Authors: Agnes Fogo; Mark Lusco Behzad Najafian Charles Alpers
      Abstract: Publication date: July 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 1
      Author(s): Agnes B. Fogo, Mark A. Lusco, Behzad Najafian, Charles E. Alpers


      PubDate: 2017-06-24T05:52:17Z
       
  • AJKD Atlas of Renal Pathology: Anti–Tubular Basement Membrane
           Antibody Disease
    • Authors: Mark Lusco; Agnes Fogo Behzad Najafian Charles Alpers
      Abstract: Publication date: July 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 1
      Author(s): Mark A. Lusco, Agnes B. Fogo, Behzad Najafian, Charles E. Alpers


      PubDate: 2017-06-24T05:52:17Z
       
  • AJKD Atlas of Renal Pathology: Lecithin–Cholesterol Acyltransferase
           (LCAT) Deficiency
    • Authors: Behzad Najafian; Mark Lusco Laura Finn Charles Alpers Agnes Fogo
      Abstract: Publication date: July 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 1
      Author(s): Behzad Najafian, Mark A. Lusco, Laura S. Finn, Charles E. Alpers, Agnes B. Fogo


      PubDate: 2017-06-24T05:52:17Z
       
  • Quiz Page July 2017
    • Authors: Mohamad Hanouneh; Derek Fine Michael Choi Jose Manuel Monroy Trujillo
      Abstract: Publication date: July 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 1
      Author(s): Mohamad Hanouneh, Derek M. Fine, Michael J. Choi, Jose Manuel Monroy Trujillo


      PubDate: 2017-06-24T05:52:17Z
       
  • Nephrotic Syndrome With Cancer Immunotherapies: A Report of 2 Cases
    • Authors: Abhijat Kitchlu; Warren Fingrut Carmen Avila-Casado Christopher Chan Michael Crump
      Abstract: Publication date: Available online 23 June 2017
      Source:American Journal of Kidney Diseases
      Author(s): Abhijat Kitchlu, Warren Fingrut, Carmen Avila-Casado, Christopher T. Chan, Michael Crump, David Hogg, Heather N. Reich
      Oncologic immunotherapies use a patient's immune response to eliminate tumor cells by modulation of immune checkpoints, including programmed cell death 1 (PD-1) and cytotoxic T-lymphocyte–associated antigen 4 (CTLA-4) proteins. Immune-mediated sequelae, including interstitial nephritis, have been reported; however, glomerular disease appears rare. We describe 2 cases of nephrotic syndrome in patients treated with these agents. Patient 1 received the anti–PD-1 antibody pembrolizumab for Hodgkin lymphoma. Following his second dose, he developed nephrotic syndrome and acute kidney injury. Biopsy showed diffuse foot-process effacement consistent with minimal change disease and findings of acute tubular injury. Pembrolizumab therapy cessation and corticosteroid treatment yielded improvement in proteinuria and acute kidney injury. Patient 2 received the CTLA-4 antibody ipilimumab for melanoma. He developed nephrotic syndrome with biopsy changes consistent with minimal change disease. Ipilimumab therapy was stopped and proteinuria resolved following corticosteroid treatment. Ipilimumab rechallenge caused relapse of nephrotic-range proteinuria. These cases suggest an association between therapeutic immune activation and the development of nephrotic syndrome. Given the increasing prevalence of oncologic immunotherapies, monitoring patients for renal sequelae is warranted.

      PubDate: 2017-06-24T05:52:17Z
       
  • Risk of ESRD and Mortality Associated With Change in Filtration Markers
    • Authors: Casey Rebholz; Lesley Inker Yuan Chen Menglu Liang Meredith Foster
      Abstract: Publication date: Available online 23 June 2017
      Source:American Journal of Kidney Diseases
      Author(s): Casey M. Rebholz, Lesley A. Inker, Yuan Chen, Menglu Liang, Meredith C. Foster, John H. Eckfeldt, Paul L. Kimmel, Ramachandran S. Vasan, Harold I. Feldman, Mark J. Sarnak, Chi-yuan Hsu, Andrew S. Levey, Josef Coresh
      Background Using change in estimated glomerular filtration rate (eGFR) based on creatinine concentration as a surrogate outcome in clinical trials of chronic kidney disease has been proposed. Risk for end-stage renal disease (ESRD) and all-cause mortality associated with change in concentrations of other filtration markers has not been studied in chronic kidney disease populations. Study Design Observational analysis of 2 clinical trials. Setting & Participants Participants in the MDRD (Modification of Diet in Renal Disease; n=317) Study and AASK (African American Study of Kidney Disease and Hypertension; n=373). Predictors Creatinine, cystatin C, β-trace protein (BTP), and β2-microglobulin (B2M) were measured in serum samples collected at the 12- and 24-month follow-up visits, along with measured GFR (mGFR) at these time points. Outcomes ESRD and all-cause mortality. Measurements Poisson regression was used to estimate incidence rate ratios and 95% CIs for ESRD and all-cause mortality during long-term follow-up (10-16 years) per 30% decline in mGFR or eGFR for each filtration marker and the average of all 4 markers. Results 1-year decline in mGFR, eGFRcr, eGFRBTP, and the average of the 4 filtration markers was significantly associated with increased risk for incident ESRD in both studies (all P ≤0.02). Compared to mGFR, only decline in eGFRBTP was statistically significantly more strongly associated with ESRD risk in both studies (both P ≤0.03). Decline in eGFRcr, but not mGFR or the other filtration markers, was significantly associated with risk for all-cause mortality in AASK only (incidence rate ratio per 30% decline, 4.17; 95% CI, 1.78-9.74; P <0.001), but this association was not significantly different from decline in mGFR (P =0.2). Limitations Small sample size. Conclusions Declines in mGFR, eGFRcr, eGFRBTP, and the average of 4 filtration markers (creatinine, cystatin C, BTP, and B2M) were consistently associated with progression to ESRD.

      PubDate: 2017-06-24T05:52:17Z
       
  • Associations of Early Kidney Disease With Brain Magnetic Resonance Imaging
           
    • Authors: Barry Freedman; Kaycee Sink Christina Hugenschmidt Timothy Hughes Jeff Williamson
      Abstract: Publication date: Available online 23 June 2017
      Source:American Journal of Kidney Diseases
      Author(s): Barry I. Freedman, Kaycee M. Sink, Christina E. Hugenschmidt, Timothy M. Hughes, Jeff D. Williamson, Christopher T. Whitlow, Nicholette D. Palmer, Michael E. Miller, Laura C. Lovato, Jianzhao Xu, S. Carrie Smith, Lenore J. Launer, Joshua I. Barzilay, Robert M. Cohen, Mark D. Sullivan, R. Nick Bryan, Benjamin C. Wagner, Donald W. Bowden, Joseph A. Maldjian, Jasmin Divers
      Background Relationships between early kidney disease, neurocognitive function, and brain anatomy are poorly defined in African Americans with type 2 diabetes mellitus (T2DM). Study Design Cross-sectional associations were assessed between cerebral anatomy and cognitive performance with estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR) in African Americans with T2DM. Setting & Participants African Americans with cognitive testing and cerebral magnetic resonance imaging (MRI) in the African American−Diabetes Heart Study Memory in Diabetes (AA-DHS MIND; n=512; 480 with MRI) and Action to Control Cardiovascular Risk in Diabetes (ACCORD) MIND (n=484; 104 with MRI) studies. Predictors eGFR (CKD-EPI creatinine equation), spot UACR. Measurements MRI-based cerebral white matter volume (WMV), gray matter volume (GMV), and white matter lesion volume; cognitive performance (Mini-Mental State Examination, Digit Symbol Coding, Stroop Test, and Rey Auditory Verbal Learning Test). Multivariable models adjusted for age, sex, body mass index, scanner, intracranial volume, education, diabetes duration, hemoglobin A1c concentration, low-density lipoprotein cholesterol concentration, smoking, hypertension, and cardiovascular disease were used to test for associations between kidney phenotypes and the brain in each study; a meta-analysis was performed. Results Mean participant age was 60.1±7.9 (SD) years; diabetes duration, 12.1±7.7 years; hemoglobin A1c concentration, 8.3%±1.7%; eGFR, 88.7±21.6mL/min/1.73m2; and UACR, 119.2±336.4mg/g. In the fully adjusted meta-analysis, higher GMV associated with lower UACR (P <0.05), with a trend toward association with higher eGFR. Higher white matter lesion volume was associated with higher UACR (P <0.05) and lower eGFR (P <0.001). WMV was not associated with either kidney parameter. Higher UACR was associated with lower Digit Symbol Coding performance (P <0.001) and a trend toward association with higher Stroop interference; eGFR was not associated with cognitive tests. Limitations Cross-sectional; single UACR measurement. Conclusions In African Americans with T2DM, mildly high UACR and mildly low eGFR were associated with smaller GMV and increased white matter lesion volume. UACR was associated with poorer processing speed and working memory.

      PubDate: 2017-06-24T05:52:17Z
       
  • Pilot Pharmacokinetic Study of High-Dose Daptomycin in Hemodialysis
           Patients With Infected Medical Devices
    • Authors: Diolez Nicolas; Venisse Simohamed Belmouaz Bauwens Frank Bridoux Guillaume Beraud
      Abstract: Publication date: Available online 21 June 2017
      Source:American Journal of Kidney Diseases
      Author(s): Jérémie Diolez, Nicolas Venisse, Simohamed Belmouaz, Marc-André Bauwens, Frank Bridoux, Guillaume Beraud


      PubDate: 2017-06-24T05:52:17Z
       
  • Acid Load and Phosphorus Homeostasis in CKD
    • Authors: Pascale Khairallah; Tamara Isakova John Asplin Lee Hamm Mirela Dobre
      Abstract: Publication date: Available online 21 June 2017
      Source:American Journal of Kidney Diseases
      Author(s): Pascale Khairallah, Tamara Isakova, John Asplin, Lee Hamm, Mirela Dobre, Mahboob Rahman, Kumar Sharma, Mary Leonard, Edgar Miller, Bernard Jaar, Carolyn Brecklin, Wei Yang, Xue Wang, Harold Feldman, Myles Wolf, Julia J. Scialla
      Background The kidneys maintain acid-base homeostasis through excretion of acid as either ammonium or as titratable acids that primarily use phosphate as a buffer. In chronic kidney disease (CKD), ammoniagenesis is impaired, promoting metabolic acidosis. Metabolic acidosis stimulates phosphaturic hormones, parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF-23) in vitro, possibly to increase urine titratable acid buffers, but this has not been confirmed in humans. We hypothesized that higher acid load and acidosis would associate with altered phosphorus homeostasis, including higher urinary phosphorus excretion and serum PTH and FGF-23. Study Design Cross-sectional. Setting & Participants 980 participants with CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study. Predictors Net acid excretion as measured in 24-hour urine, potential renal acid load (PRAL) estimated from food frequency questionnaire responses, and serum bicarbonate concentration < 22 mEq/L. Outcome & Measurements 24-hour urine phosphorus and calcium excretion and serum phosphorus, FGF-23, and PTH concentrations. Results Using linear and log-linear regression adjusted for demographics, kidney function, comorbid conditions, body mass index, diuretic use, and 24-hour urine creatinine excretion, we found that 24-hour urine phosphorus excretion was higher at higher net acid excretion, higher PRAL, and lower serum bicarbonate concentration (each P <0.05). Serum phosphorus concentration was also higher with higher net acid excretion and lower serum bicarbonate concentration (each P =0.001). Only higher net acid excretion associated with higher 24-hour urine calcium excretion (P <0.001). Neither net acid excretion nor PRAL was associated with FGF-23 or PTH concentrations. PTH, but not FGF-23, concentration (P =0.2) was 26% (95% CI, 13%-40%) higher in participants with a serum bicarbonate concentration <22 versus ≥22 mEq/L (P <0.001). Primary results were similar if stratified by estimated glomerular filtration rate categories or adjusted for iothalamate glomerular filtration rate (n=359), total energy intake, dietary phosphorus, or urine urea nitrogen excretion, when available. Limitations Possible residual confounding by kidney function or nutrition; urine phosphorus excretion was included in calculation of the titratable acid component of net acid excretion. Conclusions In CKD, higher acid load and acidosis associate independently with increased circulating phosphorus concentration and augmented phosphaturia, but not consistently with FGF-23 or PTH concentrations. This may be an adaptation that increases titratable acid excretion and thus helps maintain acid-base homeostasis in CKD. Understanding whether administration of base can lower phosphorus concentrations requires testing in interventional trials.
      PubDate: 2017-06-24T05:52:17Z
       
  • Use of the Furosemide Fludrocortisone Test to Clinically Assess Distal
           Tubular Acidification
    • Authors: Anneke Bech; Jack F.M. Wetzels Tom Nijenhuis
      Abstract: Publication date: Available online 17 June 2017
      Source:American Journal of Kidney Diseases
      Author(s): Anneke P. Bech, Jack F.M. Wetzels, Tom Nijenhuis


      PubDate: 2017-06-24T05:52:17Z
       
  • Endovascular Proximal Forearm Arteriovenous Fistula for Hemodialysis
           Access: Results of the Prospective, Multicenter Novel Endovascular Access
           Trial (NEAT)
    • Authors: Charmaine Lok; Dheeraj Rajan Jason Clement Mercedeh Kiaii Ravi Sidhu
      Abstract: Publication date: Available online 14 June 2017
      Source:American Journal of Kidney Diseases
      Author(s): Charmaine E. Lok, Dheeraj K. Rajan, Jason Clement, Mercedeh Kiaii, Ravi Sidhu, Ken Thomson, George Buldo, Christine Dipchand, Louise Moist, Joanna Sasal
      Background Hemodialysis arteriovenous fistulas (AVFs) are suboptimally used primarily due to problems with maturation, early thrombosis, and patient nonacceptance. An endovascular approach to fistula creation without open surgery offers another hemodialysis vascular access option. Study Design Prospective, single-arm, multicenter study (Novel Endovascular Access Trial [NEAT]). Settings & Participants Consecutive adult non−dialysis-dependent and dialysis-dependent patients referred for vascular access creation at 9 centers in Canada, Australia, and New Zealand. Intervention Using catheter-based endovascular technology and radiofrequency energy, an anastomosis was created between target vessels, resulting in an endovascular AVF (endoAVF). Outcomes Safety, efficacy, functional usability, and patency end points. Measurements Safety as percentage of device-related serious adverse events; efficacy as percentage of endoAVFs physiologically suitable (brachial artery flow ≥ 500mL/min, vein diameter ≥ 4mm) for dialysis within 3 months; functional usability of endoAVFs to provide prescribed dialysis via 2-needle cannulation; primary and cumulative endoAVF patencies per standardized definitions. Results 80 patients were enrolled (20 roll-in and 60 participants in the full analysis set; the latter are reported). EndoAVFs were created in 98% of participants; 8% had a serious procedure-related adverse event (2% device related). 87% were physiologically suitable for dialysis (eg, mean brachial artery flow, 918mL/min; endoAVF vein diameter, 5.2mm [cephalic vein]). EndoAVF functional usability was 64% in participants who received dialysis. 12-month primary and cumulative patencies were 69% and 84%, respectively. Limitations Due to the unique anatomy and vessels used to create endoAVFs, this was a single-arm study without a surgical comparator. Conclusions An endoAVF can be reliably created using a radiofrequency magnetic catheter-based system, without open surgery and with minimal complications. The endoAVF can be successfully used for hemodialysis and demonstrated high 12-month cumulative patencies. It may be a viable alternative option for achieving AVFs for hemodialysis patients in need of vascular access.

      PubDate: 2017-06-19T05:42:00Z
       
  • Treating to Target in Older Hypertensive Patients: Where Is the
           Bull’s Eye'
    • Authors: Gary Schwartz
      Abstract: Publication date: Available online 10 June 2017
      Source:American Journal of Kidney Diseases
      Author(s): Gary L. Schwartz


      PubDate: 2017-06-14T05:37:21Z
       
  • Cognitive Function and Kidney Disease: Baseline Data From the Systolic
           Blood Pressure Intervention Trial (SPRINT)
    • Authors: Daniel Weiner; Sarah Gaussoin John Nord Alexander Auchus Gordon Chelune
      Abstract: Publication date: Available online 9 June 2017
      Source:American Journal of Kidney Diseases
      Author(s): Daniel E. Weiner, Sarah A. Gaussoin, John Nord, Alexander P. Auchus, Gordon J. Chelune, Michel Chonchol, Laura Coker, William E. Haley, Anthony A. Killeen, Paul L. Kimmel, Alan J. Lerner, Suzanne Oparil, Mohammad G. Saklayen, Yelena M. Slinin, Clinton B. Wright, Jeff D. Williamson, Manjula Kurella Tamura
      Background Chronic kidney disease is common and is associated with cardiovascular disease, cerebrovascular disease, and cognitive function, although the nature of this relationship remains uncertain. Study Design Cross-sectional cohort using baseline data from the Systolic Blood Pressure Intervention Trial (SPRINT). Setting & Participants Participants in SPRINT, a randomized clinical trial of blood pressure targets in older community-dwelling adults with cardiovascular disease, chronic kidney disease, or high cardiovascular disease risk and without diabetes or known stroke, who underwent detailed neurocognitive testing in the cognition substudy, SPRINT−Memory and Cognition in Decreased Hypertension (SPRINT-MIND). Predictors Urine albumin-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR). Outcomes Cognitive function, a priori defined as 5 cognitive domains based on 11 cognitive tests using z scores, and abnormal white matter volume quantified by brain magnetic resonance imaging. Results Of 9,361 SPRINT participants, 2,800 participated in SPRINT-MIND and 2,707 had complete data; 637 had brain imaging. Mean age was 68 years, 37% were women, 30% were black, and 20% had known cardiovascular disease. Mean eGFR was 70.8±20.9mL/min/1.73m2 and median urine ACR was 9.7 (IQR, 5.7-22.5) mg/g. In adjusted analyses, higher ACR was associated with worse global cognitive function, executive function, memory, and attention, such that each doubling of urine ACR had the same association with cognitive performance as being 7, 10, 6, and 14 months older, respectively. Lower eGFR was independently associated with worse global cognitive function and memory. In adjusted models, higher ACR, but not eGFR, was associated with larger abnormal white matter volume. Limitations Cross-sectional only, no patients with diabetes were included. Conclusions In older adults, higher urine ACR and lower eGFR have independent associations with global cognitive performance with different affected domains. Albuminuria concurrently identifies a higher burden of abnormal brain white matter disease, suggesting that vascular disease may mediate these relationships.

      PubDate: 2017-06-14T05:37:21Z
       
 
 
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