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Publisher: Elsevier   (Total: 3051 journals)

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Showing 1 - 200 of 3048 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 7)
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 24, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 86, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 30, 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: 358, 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   (Followers: 1)
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: 226, 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: 10, 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: 1)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 24, 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: 4)
Acute Pain     Full-text available via subscription   (Followers: 13)
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: 6)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 21)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 132, 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: 17, 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: 26, 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: 11, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, 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 Cell Aging and Gerontology     Full-text available via subscription   (Followers: 4)
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: 27, 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: 29, 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 Dermatology     Full-text available via subscription   (Followers: 12)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 6)
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: 43, 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: 42, 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: 50, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 16)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 22, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
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: 36, 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: 6)
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: 6, 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: 8, 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 Organ Biology     Full-text available via subscription   (Followers: 2)
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: 24, 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: 8, 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: 17)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 62)
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 Biology and Medicine     Full-text available via subscription   (Followers: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 362, 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: 7, 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: 16)
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: 326, 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: 411, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 16, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 40, 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: 54, 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: 11, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 8)
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   (Followers: 1)
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)
Alpha Omegan     Full-text available via subscription   (SJR: 0.121, h-index: 9)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 46, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 49, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 47, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 40, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 9, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 32, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 26, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 32, 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: 200, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 59, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 6)
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: 25, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 26, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 24, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 35, 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: 58, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 12)
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: 4, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 37, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 165, 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: 12)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 23, 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: 168, SJR: 1.907, h-index: 126)

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Journal Cover American Journal of Kidney Diseases
  [SJR: 2.313]   [H-I: 172]   [32 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0272-6386 - ISSN (Online) 1523-6838
   Published by Elsevier Homepage  [3051 journals]
  • Association of Citizenship Status With Kidney Transplantation in Medicaid
           Patients
    • Authors: Jenny Shen; Daniel Hercz Lilly Barba Holly Wilhalme Erik Lum
      Abstract: Publication date: Available online 8 November 2017
      Source:American Journal of Kidney Diseases
      Author(s): Jenny I. Shen, Daniel Hercz, Lilly M. Barba, Holly Wilhalme, Erik L. Lum, Edmund Huang, Uttam Reddy, Leslie Salas, Sitaram Vangala, Keith C. Norris
      Background Although individuals classified as nonresident aliens, including undocumented immigrants, are entitled to receive emergency dialysis in the United States regardless of their ability to pay, most states do not provide them with subsidized care for maintenance dialysis or kidney transplantation. We explored whether nonresident aliens have similar outcomes to US citizens after receiving kidney transplants covered by Medicaid, a joint federal and state health insurance program. Study Design Retrospective observational cohort study. Setting & Participants All adult Medicaid patients in the US Renal Data System who received their first kidney transplant from 1990 to 2011. Predictor Citizenship status, categorized as US citizen, nonresident alien, or permanent resident. Outcome All-cause transplant loss. Measurements HRs and 95% CIs estimated by applying Cox proportional hazards frailty models with transplantation center as a random effect. Results Of 10,495 patients, 8,660 (82%) were US citizens, 1,489 (14%) were permanent residents, and 346 (3%) were nonresident aliens, whom we assumed were undocumented immigrants. Nonresident aliens were younger, healthier, receiving dialysis longer, and more likely to have had a living donor. 71% underwent transplantation in California, and 61% underwent transplantation after 2005. Nonresident aliens had a lower unadjusted risk for transplant loss compared with US citizens (HR, 0.48; 95% CI, 0.35-0.65). Results were attenuated but still significant when adjusted for demographics, comorbid conditions, dialysis, and transplant-related factors (HR, 0.67; 95% CI, 0.46-0.94). Limitations Citizenship status was self-reported, possible residual confounding. Conclusions Our study suggests that the select group of insured nonresident aliens who undergo transplantation with Medicaid do just as well as US citizens with Medicaid. Policymakers should consider expanding coverage for kidney transplantation in nonresident aliens, including undocumented immigrants, given the associated high-quality outcomes in these patients.

      PubDate: 2017-11-11T02:26:17Z
       
  • Association Between Gestational Diabetes and Incident Maternal CKD: The
           Coronary Artery Risk Development in Young Adults (CARDIA) Study
    • Authors: Elizabeth Dehmer; Milind Phadnis Erica Gunderson Cora Lewis Kirsten Bibbins-Domingo
      Abstract: Publication date: Available online 8 November 2017
      Source:American Journal of Kidney Diseases
      Author(s): Elizabeth W. Dehmer, Milind A. Phadnis, Erica P. Gunderson, Cora E. Lewis, Kirsten Bibbins-Domingo, Stephanie M. Engel, Michele Jonsson Funk, Holly Kramer, Abhijit V. Kshirsagar, Gerardo Heiss
      Background Gestational diabetes mellitus (GDM) is associated with increased risk for diabetes mellitus, metabolic syndrome, and cardiovascular disease. We evaluated whether GDM is associated with incident chronic kidney disease (CKD), controlling for prepregnancy risk factors for both conditions. Study Design Prospective cohort. Setting & Participants Of 2,747 women (aged 18-30 years) enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) Study in 1985 to 86, we studied 820 who were nulliparous at enrollment, delivered at least 1 pregnancy longer than 20 weeks’ gestation, and had kidney function measurements during 25 years of follow-up. Predictor GDM was self-reported by women for each pregnancy. Outcomes CKD was defined as the development of estimated glomerular filtration rate (eGFR)<60mL/min/1.73m2 or urine albumin-creatinine ratio ≥ 25mg/g at any one CARDIA examination in years 10, 15, 20, or 25. Measurements HRs for developing CKD were estimated for women who developed GDM versus women without GDM using complementary log-log models, adjusting for prepregnancy age, systolic blood pressure, dyslipidemia, body mass index, smoking, education, eGFR, fasting glucose concentration, physical activity level (all measured at the CARDIA examination before the first pregnancy), race, and family history of diabetes. We explored for an interaction between race and GDM. Results During a mean follow-up of 20.8 years, 105 of 820 (12.8%) women developed CKD, predominantly increased urine albumin excretion (98 albuminuria only, 4 decreased eGFR only, and 3 both). There was evidence of a GDM-race interaction on CKD risk (P =0.06). Among black women, the adjusted HR for CKD was 1.96 (95% CI, 1.04-3.67) in GDM compared with those without GDM. Among white women, the HR was 0.65 (95% CI, 0.23-1.83). Limitations Albuminuria was assessed by single untimed measurements of urine albumin and creatinine. Conclusions GDM is associated with the subsequent development of albuminuria among black women in CARDIA.

      PubDate: 2017-11-11T02:26:17Z
       
  • Palliative Nephrology: Time for New Insights
    • Authors: Emma Murphy; Michael Germain Fliss Murtagh
      Abstract: Publication date: November 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 5
      Author(s): Emma Murphy, Michael J. Germain, Fliss Murtagh


      PubDate: 2017-10-28T07:01:14Z
       
  • Deprescribing in CKD: The Proof Is in the Process
    • Authors: Chanel Whittaker; Jeffrey Fink
      Abstract: Publication date: November 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 5
      Author(s): Chanel F. Whittaker, Jeffrey C. Fink


      PubDate: 2017-10-28T07:01:14Z
       
  • System-Level Barriers and Facilitators for Foregoing or Withdrawing
           Dialysis: A Qualitative Study of Nephrologists in the United States and
           England
    • Authors: Vanessa Grubbs; Delphine Tuot Neil Powe Donal Catherine Chesla
      Abstract: Publication date: November 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 5
      Author(s): Vanessa Grubbs, Delphine S. Tuot, Neil R. Powe, Donal O’Donoghue, Catherine A. Chesla
      Background Despite a growing body of literature suggesting that dialysis does not confer morbidity or mortality benefits for all patients with chronic kidney failure, the initiation and continuation of dialysis therapy in patients with poor prognosis is commonplace. Our goal was to elicit nephrologists’ perspectives on factors that affect decision making regarding end-stage renal disease. Study Design Semistructured, individual, qualitative interviews. Methodology Participants were purposively sampled based on age, race, sex, geographic location, and practice type. Each was asked about his or her perspectives and experiences related to foregoing and withdrawing dialysis therapy. Analytical Approach Interviews were audiotaped, transcribed, and analyzed using narrative and thematic analysis. Results We conducted 59 semistructured interviews with nephrologists from the United States (n=41) and England (n=18). Most participants were 45 years or younger, men, and white. Average time since completing nephrology training was 14.2±11.6 (SD) years. Identified system-level facilitators and barriers for foregoing and withdrawing dialysis therapy stemmed from national and institutional policies and structural factors, how providers practice medicine (the culture of medicine), and beliefs and behaviors of the public (societal culture). In both countries, the predominant barriers described included lack of training in end-of-life conversations and expectations for aggressive care among non-nephrologists and the general public. Primary differences included financial incentives to dialyze in the United States and widespread outpatient conservative management programs in England. Limitations Participants’ views may not fully capture those of all American or English nephrologists. Conclusions Nephrologists in the United States and England identified several system-level factors that both facilitated and interfered with decision making around foregoing and withdrawing dialysis therapy. Efforts to expand facilitators while reducing barriers could lead to care practices more in keeping with patient prognosis.

      PubDate: 2017-10-28T07:01:14Z
       
  • Targeted Deprescribing in an Outpatient Hemodialysis Unit: A Quality
           Improvement Study to Decrease Polypharmacy
    • Authors: Caitlin McIntyre; Rory McQuillan Chaim Bell Marisa Battistella
      Abstract: Publication date: November 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 5
      Author(s): Caitlin McIntyre, Rory McQuillan, Chaim Bell, Marisa Battistella
      Background Polypharmacy in hemodialysis patients can result in adverse patient outcomes. Deprescribing tools can reduce polypharmacy, yet no method exists for an outpatient hemodialysis population. Design Quality improvement study. Setting & Participants 240 patients in a tertiary-care outpatient hemodialysis unit. Quality Improvement Plan We aimed to: (1) develop a deprescribing tool for target medications with poor evidence for efficacy and safety, (2) determine its effectiveness in decreasing polypharmacy, and (3) monitor patient safety and satisfaction. Outcomes The primary outcome was the proportion of target medications completely deprescribed after 4 weeks. Secondary outcomes were the proportion of target medications completely deprescribed after 6 months, average number of medications per patient before and after deprescription, and proportion of successful deprescriptions for each target medication. Measurements Number of medications deprescribed at 4 weeks and 6 months. Patient safety and satisfaction were monitored using drug-specific monitoring parameters. Results A deprescribing tool for specific medications was developed and implemented in the hemodialysis unit. 5 medication classes were selected: quinine, diuretics, α1-blockers, proton pump inhibitors, and 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins). All 240 patients in the unit were screened using the deprescribing tool. There were 171 of 240 (71%) patients prescribed at least 1 of the 5 target medications, and after applying the tool, 35 of 40 (88%) eligible patients had the medications deprescribed. There were 31 of 40 (78%) target medications completely deprescribed. 6 months after the study, only 5 of 31 (16%) medications discontinued were represcribed. At the end of the study, 57% of patients were taking fewer medications than at baseline. No adverse events were observed. Limitations Single-center study that relied on patient self-reporting of medication use and adherence to our recommendations. Conclusions Deprescribing tools can be applied successfully in an outpatient hemodialysis unit to reduce polypharmacy while maintaining patient safety and satisfaction.

      PubDate: 2017-10-28T07:01:14Z
       
  • Associations of Early Kidney Disease With Brain Magnetic Resonance Imaging
           
    • Authors: Barry Freedman; Kaycee Sink Christina Hugenschmidt Timothy Hughes Jeff Williamson
      Abstract: Publication date: November 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 5
      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.
      Graphical abstract
      PubDate: 2017-10-28T07:01:14Z
       
  • Treatment of Uremic Pruritus: A Systematic Review
    • Authors: Elizabeth Simonsen; Paul Komenda Blake Lerner Nicole Askin Clara Bohm
      Abstract: Publication date: November 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 5
      Author(s): Elizabeth Simonsen, Paul Komenda, Blake Lerner, Nicole Askin, Clara Bohm, James Shaw, Navdeep Tangri, Claudio Rigatto
      Background Uremic pruritus is a common and burdensome symptom afflicting patients with advanced chronic kidney disease (CKD) and has been declared a priority for CKD research by patients. The optimal treatments for uremic pruritus are not well defined. Study Design Systematic review. Setting & Population Adult patients with advanced CKD (stage ≥ 3) or receiving any form of dialysis. Selection Criteria for Studies PubMed, CINAHL, Embase, International Pharmaceutical s, Scopus, Cochrane Library, and ClinicalTrials.gov from their inception to March 6, 2017, were systematically searched for randomized controlled trials (RCTs) of uremic pruritus treatments in patients with advanced CKD (stage ≥ 3) or receiving any form of dialysis. 2 reviewers extracted data independently. Risk of bias was assessed using the Cochrane Collaboration risk-of-bias tool. Intervention Any intervention for the treatment of uremic pruritus was included. Outcomes A quantitative change in pruritus intensity on a visual analogue, verbal rating, or numerical rating scale. Results 44 RCTs examining 39 different treatments were included in the review. These treatments included gabapentin, pregabalin, mast cell stabilizers, phototherapy, hemodialysis modifications, and multiple other systemic and topical treatments. The largest body of evidence was found for the effectiveness of gabapentin. Due to the limited number of trials for the other treatments included, we are unable to comment on their efficacy. Risk of bias in most studies was high. Limitations Heterogeneity in design, treatments, and outcome measures rendered comparisons difficult and precluded meta-analysis. Conclusions Despite the acknowledged importance of uremic pruritus to patients, with the exception of gabapentin, the current evidence for treatments is weak. Large, simple, rigorous, multiarm RCTs of promising therapies are urgently needed.

      PubDate: 2017-10-28T07:01:14Z
       
  • Effects of Higher Quality of Care on Initiation of Long-term Dialysis in
           Patients With CKD and Diabetes
    • Authors: Hon-Yen Shingo; Fukuma Sayaka Shimizu Edward Norton Yu-Kang Kuan-Yu Hung
      Abstract: Publication date: November 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 5
      Author(s): Hon-Yen Wu, Shingo Fukuma, Sayaka Shimizu, Edward C. Norton, Yu-Kang Tu, Kuan-Yu Hung, Mei-Ru Chen, Kuo-Liong Chien, Shunichi Fukuhara
      Background The burden of diabetes-related chronic kidney disease (CKD) on individuals and society is increasing, shifting attention toward improving the quality of care for patients with CKD and diabetes. We assessed the quality of CKD care and its association with long-term dialysis, acute kidney injury (AKI), and death. Study Design Retrospective cohort study (2004-2011). Setting & Participants Adults in Taiwan with incident CKD enrolled in the Longitudinal Cohort of Diabetes Patients. Predictors 3 CKD-care quality indicators based on medical and pharmacy claims data were studied: prescription of renin-angiotensin system inhibitors, testing for proteinuria, and nutritional guidance. Each was examined individually, and all were summed into an overall quality score. Outcomes The primary outcome was initiation of long-term dialysis therapy. Secondary outcomes were hospitalization due to AKI and death from any cause. Measurements Using instrumental variables related to the quality indicators to minimize both unmeasured and measured confounding, we fit a 2-stage residual inclusion model to estimate HRs and 95% CIs for each outcome. Results Among the 63,260 patients enrolled, 43.9% were prescribed renin-angiotensin system inhibitors, 60.6% were tested for proteinuria, and 13.4% received nutritional guidance. During a median follow-up of 37.9 months, 1,471 patients started long-term dialysis therapy, 2,739 patients were hospitalized due to AKI, and 4,407 patients died. Higher overall quality scores were associated with lower hazards for long-term dialysis in instrumental variable analyses (HR of 0.62 [95% CI, 0.40-0.98] per 1-point greater score) and hospitalization due to AKI (HR of 0.69 [95% CI, 0.50-0.96] per 1-point greater score). The hazard for all-cause death was nonsignificantly lower (HR of 0.80 [95% CI, 0.62-1.03] per 1-point greater score). Limitations Potential misclassification and uncontrolled confounding by indication. Conclusions Our findings suggest potential opportunities to improve long-term outcomes among patients with diabetes and CKD by improving the quality of their CKD care.

      PubDate: 2017-10-28T07:01:14Z
       
  • Lung Function and Incident Kidney Disease: The Atherosclerosis Risk in
           Communities (ARIC) Study
    • Authors: Keiichi Sumida; Lucia Kwak Morgan Grams Kunihiro Yamagata Naresh Punjabi
      Abstract: Publication date: November 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 5
      Author(s): Keiichi Sumida, Lucia Kwak, Morgan E. Grams, Kunihiro Yamagata, Naresh M. Punjabi, Csaba P. Kovesdy, Josef Coresh, Kunihiro Matsushita
      Background Reduced lung function is associated with clinical outcomes such as cardiovascular disease. However, little is known about its association with incident end-stage renal disease (ESRD) and chronic kidney disease (CKD). Study Design Prospective cohort study. Setting & Participants 14,946 participants aged 45 to 64 years at baseline (1987-1989) in the Atherosclerosis Risk in Communities (ARIC) Study (45.0% men and 25.2% black), with follow-up through 2012. Predictors Race- and sex-specific quartiles of percent-predicted forced vital capacity (FVC) and the proportion of forced expiratory volume in 1 second of expiration to FVC (FEV1/FVC) at baseline determined with spirometry. Outcomes Incident ESRD (defined here as renal replacement therapy or death due to CKD) as the primary outcome and incident CKD (defined here as ESRD, ≥25% decline in estimated glomerular filtration rate to a level <60mL/min/1.73m2, or CKD-related hospitalizations/deaths) as the secondary outcome. Results During a median follow-up of 23.6 years, 526 (3.5%) participants developed ESRD. After adjusting for potential confounders, the cause-specific HR of incident ESRD for the lowest (vs highest) quartile was 1.72 (95% CI, 1.31-2.26) for percent-predicted FVC and 1.33 (95% CI, 1.03-1.73) for FEV1/FVC. Compared to a high-normal lung function pattern, a mixed pattern (ie, percent-predicted FVC<80% and FEV1/FVC<70%; 3.4% of participants) demonstrated the highest adjusted cause-specific HR of ESRD at 2.28 (95% CI, 1.50-3.45), followed by the restrictive pattern (ie, percent-predicted FVC<80% and FEV1/FVC≥70%; 4.8% of participants) at 2.03 (95% CI, 1.47-2.81), obstructive pattern (ie, percent-predicted FVC≥80% and FEV1/FVC<70%; 18.9% of participants) at 1.47 (95% CI, 1.09-1.99), and low-normal pattern (ie, percent-predicted FVC 80%-<100% and FEV1/FVC≥70%, or percent-predicted FVC≥80% and FEV1/FVC 70%-<75%; 44.3% of participants) at 1.21 (95% CI, 0.94-1.55). Similar associations were seen with incident CKD. Limitations Limited number of participants with moderate/severe lung dysfunction and spirometry only at baseline. Conclusions Reduced lung function, particularly lower percent-predicted FVC, is independently associated with CKD progression. Our findings suggest a potential pathophysiologic contribution of reduced lung function to the development of CKD and a need for monitoring kidney function in persons with reduced lung function.

      PubDate: 2017-10-28T07:01:14Z
       
  • Concentrations of Trace Elements in Hemodialysis Patients:
           A Prospective Cohort Study
    • Authors: Marcello Tonelli; Natasha Wiebe Aminu Bello Catherine Field John Gill
      Abstract: Publication date: November 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 5
      Author(s): Marcello Tonelli, Natasha Wiebe, Aminu Bello, Catherine J. Field, John S. Gill, Brenda R. Hemmelgarn, Daniel T. Holmes, Kailash Jindal, Scott W. Klarenbach, Braden J. Manns, Ravi Thadhani, David Kinniburgh
      Background Low concentrations and excessive concentrations of trace elements have been commonly reported in hemodialysis patients, but available studies have several important limitations. Study Design Random sample of patients drawn from a prospective cohort. Setting & Participants 198 incident hemodialysis patients treated in 3 Canadian centers. Measurements We used mass spectrometry to measure plasma concentrations of the 25 elements at baseline, 6 months, 1 year, and 2 years following enrollment in the cohort. We focused on low concentrations of zinc, selenium, and manganese and excessive concentrations of lead, arsenic, and mercury; low and excessive concentrations of the other 19 trace elements were treated as exploratory analyses. Low and excessive concentrations were based on the 5th and 95th percentile plasma concentrations from healthy reference populations. Results At all 4 occasions, low zinc, selenium, and manganese concentrations were uncommon in study participants (≤5.1%, ≤1.8%, and ≤0.9% for zinc, selenium, and manganese, respectively) and a substantial proportion of participants had concentrations that exceeded the 95th percentile (≥65.2%, ≥74.2%, and ≥19.7%, respectively). Almost all participants had plasma lead concentrations above the 95th percentile at all time points. The proportion of participants with plasma arsenic concentrations exceeding the 95th percentile was relatively constant over time (9.1%-9.8%); the proportion with plasma mercury concentrations that exceeded the 95th percentile varied between 15.2% and 29.3%. Low arsenic, platinum, tungsten, and beryllium concentrations were common (>50%), as were excessive cobalt, manganese, zinc, vanadium, cadmium, selenium, barium, antimony, nickel, molybdenum, lead, and chromium concentrations. Conclusions There was no evidence that low zinc, selenium, or manganese concentrations exist in most contemporary Canadian hemodialysis patients. Some patients have excessive plasma arsenic and mercury concentrations, and excessive lead concentrations were common. These findings require further investigation.

      PubDate: 2017-10-28T07:01:14Z
       
  • Receipt of Nephrology Care and Clinical Outcomes Among Veterans With
           Advanced CKD
    • Authors: Enrica Fung; Tara Chang Glenn Chertow I-Chun Thomas Steven Asch
      Abstract: Publication date: November 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 5
      Author(s): Enrica Fung, Tara I. Chang, Glenn M. Chertow, I-Chun Thomas, Steven M. Asch, Manjula Kurella Tamura
      Background Clinical practice guidelines recommend referral to nephrology when estimated glomerular filtration rate (eGFR) decreases to <30mL/min/1.73m2; however, evidence for benefits of nephrology care are mixed. Study Design Observational cohort using landmark analysis. Settings & Participants A national cohort of veterans with advanced chronic kidney disease, defined as an outpatient eGFR≤30mL/min/1.73m2 for January 1, 2010, through December 31, 2010, and a prior eGFR<60mL/min/1.73m2, using administrative and laboratory data from the Department of Veterans Affairs and the US Renal Data System. Predictor Receipt and frequency of outpatient nephrology care over 12 months. Outcomes Survival and progression to end-stage renal disease (ESRD; receipt of dialysis or kidney transplantation) were the primary outcomes. In addition, control of associated clinical parameters over 12 months were intermediate outcomes. Results Of 39,669 patients included in the cohort, 14,983 (37.8%) received nephrology care. Older age, heart failure, dementia, depression, and rapidly declining kidney function were independently associated with the absence of nephrology care. During a mean follow-up of 2.9 years, 14,719 (37.1%) patients died and 4,310 (10.9%) progressed to ESRD. In models adjusting for demographics, comorbid conditions, and trajectory of kidney function, nephrology care was associated with lower risk for death (HR, 0.88; 95% CI, 0.85-0.91), but higher risk for ESRD (HR, 1.48; 95% CI, 1.38-1.58). Among patients with clinical parameters outside guideline recommendations at cohort entry, a significantly higher adjusted proportion of patients who received nephrology care had improvement in control of hemoglobin, potassium, albumin, calcium, and phosphorus concentrations compared with those who did not receive nephrology care. Limitations May not be generalizable to nonveterans. Conclusions Among patients with advanced chronic kidney disease, nephrology care was associated with lower mortality, but was not associated with lower risk for progression to ESRD.

      PubDate: 2017-10-28T07:01:14Z
       
  • Thrombotic Microangiopathy: A Multidisciplinary Team Approach
    • Authors: Craig Gordon; Vipul Chitalia Mark Sloan David Salant David Coleman
      Abstract: Publication date: November 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 5
      Author(s): Craig E. Gordon, Vipul C. Chitalia, J. Mark Sloan, David J. Salant, David L. Coleman, Karen Quillen, Katya Ravid, Jean M. Francis
      Thrombotic microangiopathy (TMA) is characterized by the presence of microangiopathic hemolytic anemia and thrombocytopenia along with organ dysfunction, and pathologically, by the presence of microthrombi in multiple microvascular beds. Delays in diagnosis and initiation of therapy are common due to the low incidence, variable presentation, and poor awareness of these diseases, underscoring the need for interdisciplinary approaches to clinical care for TMA. We describe a new approach to improve clinical management via a TMA team that originally stemmed from an Affinity Research Collaborative team focused on thrombosis and hemostasis. The TMA team consists of clinical faculty from different disciplines who together are charged with the responsibility to quickly analyze clinical presentations, guide laboratory testing, and streamline prompt institution of treatment. The TMA team also includes faculty members from a broad range of disciplines collaborating to elucidate the pathogenesis of TMA. To this end, a clinical database and biorepository have been constructed. TMA leaders educate front-line providers from other departments through presentations in various forums across multiple specialties. Facilitated by an Affinity Research Collaborative mechanism, we describe an interdisciplinary team dedicated to improving both clinical care and translational research in TMA.

      PubDate: 2017-10-28T07:01:14Z
       
  • A Case of Oxalate Nephropathy: When a Single
           Cause Is Not Crystal Clear
    • Authors: Sofia Marques; Sofia Santos Kimberly Fremin Agnes Fogo
      Abstract: Publication date: November 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 5
      Author(s): Sofia Marques, Sofia Santos, Kimberly Fremin, Agnes B. Fogo
      Hyperoxaluria can result in oxalate nephropathy with intratubular calcium oxalate crystallization and acute tubular injury. Primary inherited enzymatic deficiency or secondary causes such as excessive dietary intake, enteric increased absorption, or high doses of vitamin C, which is metabolized to oxalate, may underlie hyperoxaluria and oxalate nephropathy. We report a case of acute kidney injury due to oxalate nephropathy in a patient using chelating therapy with oral ethylenediamine tetra acetic acid (EDTA), intravenous supplementation with vitamin C, and chronic diarrhea and discuss the potential kidney damage these factors can cause in particular settings. To our knowledge, this is the first report suggesting an association between oral EDTA and oxalate nephropathy.

      PubDate: 2017-10-28T07:01:14Z
       
  • Peptide Receptor Radionuclide Therapy–Induced Gitelman-like Syndrome
    • Authors: Aurelio Negro; Giovanni Rossi Davide Nicoli Annibale Versari Enrico Farnetti
      Abstract: Publication date: November 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 5
      Author(s): Aurelio Negro, Giovanni M. Rossi, Davide Nicoli, Annibale Versari, Enrico Farnetti, Rosaria Santi, Stefano De Pietri
      Peptide receptor radionuclide therapy (PRRT) is a molecular-targeted therapy in which a somatostatin analogue (a small peptide) is coupled with a radioligand so that the radiation dose is selectively administered to somatostatin receptor–expressing metastasized neuroendocrine tumors, particularly gastroenteropancreatic. Reported toxicities include myelotoxicity and nephrotoxicity, the latter manifesting as decreased kidney function, often developing months to years after treatment completion. We present a case of PRRT-induced kidney toxicity manifesting as a severe Gitelman-like tubulopathy with preserved kidney function. Because profound hypokalemia and hypocalcemia can lead to life-threatening arrhythmias, we highlight the necessity for careful monitoring of serum and urine electrolytes in patients receiving PRRT.

      PubDate: 2017-10-28T07:01:14Z
       
  • Proximal Renal Tubular Acidosis (Fanconi Syndrome) Induced by Apremilast:
           A Case Report
    • Authors: Dana Perrone; Faraz Afridi Kelli King-Morris Ashwini Komarla Pran Kar
      Abstract: Publication date: November 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 5
      Author(s): Dana Perrone, Faraz Afridi, Kelli King-Morris, Ashwini Komarla, Pran Kar
      Apremilast is a recently developed phosphodiesterase 4–inhibitory medication approved for use to treat psoriasis and psoriatic arthritis. We report a case of Fanconi syndrome and proximal renal tubular acidosis that was associated with this medication. Our patient was started on treatment with apremilast 2 weeks before his admission. On arrival, laboratory test results were significant for hypokalemia, hyperchloremic metabolic acidosis, low uric acid concentration, positive urine anion gap, and proteinuria, which resolved on discontinuation of the drug. Two months after the hospitalization, he was restarted on apremilast therapy; 17 days after resumption, the patient was admitted for similar laboratory values, which again improved when apremilast treatment was discontinued. After discharge, laboratory values remained normal without long-term electrolyte repletion. Proximal renal tubular acidosis (Fanconi syndrome) with quick correction of electrolyte concentrations on discontinuation of the drug was diagnosed. Our patient lacked evidence of other causes. Our patient fulfilled criteria associated with this disease and responded well off treatment with the offending agent. Literature review did not reveal prior cases associated with this medication.

      PubDate: 2017-10-28T07:01:14Z
       
  • 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: November 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 5
      Author(s): Jérémie Diolez, Nicolas Venisse, Simohamed Belmouaz, Marc-André Bauwens, Frank Bridoux, Guillaume Beraud


      PubDate: 2017-10-28T07:01:14Z
       
  • Erratum Regarding “Preemptive Correction of Arteriovenous Access
           Stenosis: A Systematic Review and Meta-analysis of Randomized Controlled
           Trials” (Am J Kidney Dis. 67[3]:446-460)
    • Abstract: Publication date: November 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 5


      PubDate: 2017-10-28T07:01:14Z
       
  • AJKD Atlas of Renal Pathology: Fibronectin Glomerulopathy
    • Authors: Mark Lusco; Yi-pu Chen Hong Cheng Hong-rui Dong Behzad Najafian
      Abstract: Publication date: November 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 5
      Author(s): Mark A. Lusco, Yi-pu Chen, Hong Cheng, Hong-rui Dong, Behzad Najafian, Charles E. Alpers, Agnes B. Fogo


      PubDate: 2017-10-28T07:01:14Z
       
  • Acute Kidney Injury, Hypercalcemia, and Osteolytic Lesions:
           A Familiar Triad With a Rare Cause Complicated by
           Posterior Reversible Encephalopathy Syndrome
    • Authors: Nilesh Hanumant; Pawar Priscilla Pei Sze Chiam Jessica Han Ying
      Abstract: Publication date: November 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 5
      Author(s): Nilesh Hanumant Pawar, Priscilla Pei Sze Chiam, Jessica Han Ying Tan, Jiashen Loh, Derrick Chen-Wee Aw, Shashidhar Baikunje


      PubDate: 2017-10-28T07:01:14Z
       
  • Association Between High Environmental Heat and Risk of Acute Kidney
           Injury Among Older Adults in a Northern Climate: A Matched Case-Control
           Study
    • Authors: Rebecca McTavish; Lucie Richard Eric McArthur Salimah Shariff Rey Acedillo
      Abstract: Publication date: Available online 23 October 2017
      Source:American Journal of Kidney Diseases
      Author(s): Rebecca K. McTavish, Lucie Richard, Eric McArthur, Salimah Z. Shariff, Rey Acedillo, Chirag R. Parikh, Ron Wald, Piotr Wilk, Amit X. Garg
      Background An association between high heat and acute kidney injury (AKI) has been reported in warm climates. However, whether this association generalizes to a northern climate, with more variable temperatures, is unknown. Study Design Matched case-control study. Setting & Participants Our study focused on older adults (mean age, 80 years) in the northern climate of Ontario, Canada. 52,913 case patients who had a hospital encounter with AKI in April through September 2005 to 2012 were matched with 174,222 controls for exact date, age, sex, rural residence, income, and history of chronic kidney disease. Predictor Heat periods were defined as 3 consecutive days exceeding the 95th percentile of area-specific maximum temperature. Outcomes Hospital encounter (inpatient admission or emergency department visit) with a diagnosis of AKI. Measurements ORs (95% CIs) were used to assess the association between heat periods and AKI. To quantify the effect in absolute terms, we multiplied the population incidence rate of AKI in the absence of heat periods by our adjusted OR (an approximate of relative risk). Results Heat periods were significantly associated with higher risk for AKI (adjusted OR, 1.11; 95% CI, 1.00-1.23). Heat periods in absolute terms were associated with an additional 182 cases of AKI per 100,000 person-years during the warm season. Limitations We did not know how long persons were outside or if they had access to air conditioning. Conclusions In a northern climate, periods of higher environmental heat were associated with a modestly higher risk for hospital encounter with AKI among older adults.

      PubDate: 2017-10-28T07:01:14Z
       
  • Defining Renal Neoplastic Disease, One Cell at a Time: Mass Cytometry, a
           New Tool for the Study of Kidney Biology and Disease
    • Authors: Peter Nelson; Matthias Kretzler
      Abstract: Publication date: Available online 12 October 2017
      Source:American Journal of Kidney Diseases
      Author(s): Peter J. Nelson, Matthias Kretzler


      PubDate: 2017-10-13T14:22:49Z
       
  • Potassium Homeostasis in Health and Disease: A Scientific Workshop
           Cosponsored by the National Kidney Foundation and the American Society of
           Hypertension
    • Authors: Csaba Kovesdy; Lawrence Appel Morgan Grams Lisa Gutekunst Peter McCullough
      Abstract: Publication date: Available online 10 October 2017
      Source:American Journal of Kidney Diseases
      Author(s): Csaba P. Kovesdy, Lawrence J. Appel, Morgan E. Grams, Lisa Gutekunst, Peter A. McCullough, Biff F. Palmer, Bertram Pitt, Dominic A. Sica, Raymond R. Townsend
      While much emphasis, and some controversy, centers on recommendations for sodium intake, there has been considerably less interest in recommendations for dietary potassium intake, in both the general population and patients with medical conditions, particularly acute and chronic kidney disease. Physiology literature and cohort studies have noted that the relative balance in sodium and potassium intakes is an important determinant of many of the sodium-related outcomes. A noteworthy characteristic of potassium in clinical medicine is the extreme concern shared by many practitioners when confronted by a patient with hyperkalemia. Fear of this often asymptomatic finding limits enthusiasm for recommending potassium intake and often limits the use of renin-angiotensin-aldosterone system blockers in patients with heart failure and chronic kidney diseases. New agents for managing hyperkalemia may alter the long-term management of heart failure and the hypertension, proteinuria, and further function loss in chronic kidney diseases. In this jointly sponsored effort between the American Society of Hypertension and the National Kidney Foundation, 3 panels of researchers and practitioners from various disciplines discussed and summarized current understanding of the role of potassium in health and disease, focusing on cardiovascular, nutritional, and kidney considerations associated with both hypo- and hyperkalemia.

      PubDate: 2017-10-13T14:22:49Z
       
  • In Reply to ‘Idarucizumab Dosing in Kidney Failure’
    • Authors: James Novak; Khalid Alamiri Jerry Yee
      Abstract: Publication date: Available online 3 October 2017
      Source:American Journal of Kidney Diseases
      Author(s): James E. Novak, Khalid Alamiri, Jerry Yee


      PubDate: 2017-10-06T14:02:08Z
       
  • Idarucizumab Dosing in Kidney Failure
    • Authors: Luke Yip; Jou-Fang Deng
      Abstract: Publication date: Available online 3 October 2017
      Source:American Journal of Kidney Diseases
      Author(s): Luke Yip, Jou-Fang Deng


      PubDate: 2017-10-06T14:02:08Z
       
  • Acute Kidney Injury and Nephrotic-Range Proteinuria in a Patient 18 Months
           After Bone Marrow Transplantation
    • Authors: Jagman Chahal; Cinthia Drachenberg Thomas Pallone
      Abstract: Publication date: October 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 4
      Author(s): Jagman Chahal, Cinthia Drachenberg, Thomas Pallone


      PubDate: 2017-09-23T13:40:44Z
       
  • Embracing Complexity: How to Build an Evidence Base Capable of Supporting
           Patient-Centered Care
    • Authors: Ann
      Abstract: Publication date: October 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 4
      Author(s): Ann M. O’Hare


      PubDate: 2017-09-23T13:40:44Z
       
  • Autosomal Dominant PKD in Patients With PKD2 Mutations–A Benign
           Disorder'
    • Authors: Ahsan Alam; Ronald Perrone
      Abstract: Publication date: October 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 4
      Author(s): Ahsan Alam, Ronald D. Perrone


      PubDate: 2017-09-23T13:40:44Z
       
  • Novel Endovascular Access Trial: The Wave of the Future or
           Just Another Neat Technique'
    • Authors: Thomas Huber
      Abstract: Publication date: October 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 4
      Author(s): Thomas S. Huber


      PubDate: 2017-09-23T13:40:44Z
       
  • A New Mouse Model of APOL1-Associated Kidney Diseases: When Traffic Gets
           Snarled, the Podocyte Suffers
    • Authors: John Leslie; Bruggeman John Sedor
      Abstract: Publication date: October 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 4
      Author(s): John F. O’Toole, Leslie A. Bruggeman, John R. Sedor


      PubDate: 2017-09-23T13:40:44Z
       
  • Developing a Set of Core Outcomes for Trials in Hemodialysis: An
           International Delphi Survey
    • Authors: Nicole Evangelidis; Allison Tong Braden Manns Brenda Hemmelgarn David Wheeler
      Abstract: Publication date: October 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 4
      Author(s): Nicole Evangelidis, Allison Tong, Braden Manns, Brenda Hemmelgarn, David C. Wheeler, Peter Tugwell, Sally Crowe, Tess Harris, Wim Van Biesen, Wolfgang C. Winkelmayer, Benedicte Sautenet, Donal O’Donoghue, Helen Tam-Tham, Sajeda Youssouf, Sreedhar Mandayam, Angela Ju, Carmel Hawley, Carol Pollock, David C. Harris, David W. Johnson, Dena E. Rifkin, Francesca Tentori, John Agar, Kevan R. Polkinghorne, Martin Gallagher, Peter G. Kerr, Stephen P. McDonald, Kirsten Howard, Martin Howell, Jonathan C. Craig
      Background Survival and quality of life for patients on hemodialysis therapy remain poor despite substantial research efforts. Existing trials often report surrogate outcomes that may not be relevant to patients and clinicians. The aim of this project was to generate a consensus-based prioritized list of core outcomes for trials in hemodialysis. Study Design In a Delphi survey, participants rated the importance of outcomes using a 9-point Likert scale in round 1 and then re-rated outcomes in rounds 2 and 3 after reviewing other respondents’ scores. For each outcome, the median, mean, and proportion rating as 7 to 9 (critically important) were calculated. Setting & Participants 1,181 participants (202 [17%] patients/caregivers, 979 health professionals) from 73 countries completed round 1, with 838 (71%) completing round 3. Outcomes & Measurements Outcomes included in the potential core outcome set met the following criteria for both patients/caregivers and health professionals: median score ≥ 8, mean score ≥ 7.5, proportion rating the outcome as critically important ≥ 75%, and median score in the forced ranking question < 10. Results Patients/caregivers rated 4 outcomes higher than health professionals: ability to travel, dialysis-free time, dialysis adequacy, and washed out after dialysis (mean differences of 0.9, 0.5, 0.3, and 0.2, respectively). Health professionals gave a higher rating for mortality, hospitalization, decrease in blood pressure, vascular access complications, depression, cardiovascular disease, target weight, infection, and potassium (mean differences of 1.0, 1.0, 1.0, 0.9, 0.9, 0.8, 0.7, 0.4, and 0.4, respectively). Limitations The Delphi survey was conducted online in English and excludes participants without access to a computer and internet connection. Conclusions Patients/caregivers gave higher priority to lifestyle-related outcomes than health professionals. The prioritized outcomes for both groups were vascular access problems, dialysis adequacy, fatigue, cardiovascular disease, and mortality. This process will inform a core outcome set that in turn will improve the relevance, efficiency, and comparability of trial evidence to facilitate treatment decisions.

      PubDate: 2017-09-23T13:40:44Z
       
  • 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: October 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 4
      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.
      Graphical abstract image

      PubDate: 2017-09-23T13:40:44Z
       
  • Augmented Nurse Care Management in CKD Stages 4 to 5: A Randomized
           Trial
    • Authors: Steven Fishbane; Sofia Agoritsas Alessandro Bellucci Candice Halinski Hitesh Shah
      Abstract: Publication date: October 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 4
      Author(s): Steven Fishbane, Sofia Agoritsas, Alessandro Bellucci, Candice Halinski, Hitesh H. Shah, Vipul Sakhiya, Leah Balsam
      Background Outcomes for patients with late-stage chronic kidney disease (CKD) in the United States are suboptimal. There is poor education and preparation for end-stage kidney disease, as well as a high rate of hospitalization in this group of patients. Study Design A randomized, parallel-group, 2-arm, controlled trial. Setting & Participants The study was conducted at 3 sites: a clinic of an academic medical center, a public hospital academic clinic, and a community-based private practice. All participants had late-stage CKD (stages 4-5 CKD). Patients were excluded only if they had significant cognitive impairment. Intervention The care management intervention involved nurse care manager coordination aided by the use of a disease-based informatics system for monitoring patients’ clinical status, enhancing CKD education, and facilitating preparation for end-stage kidney disease. The comparison control group received usual late-stage CKD care alone. Outcomes The primary outcome was rate of hospitalization. Measurements Rates of preemptive transplantation, home dialysis, hemodialysis (HD) starts without a hospitalization, and HD therapy initiation rates with catheters or with functioning accesses. Results 130 patients were randomly assigned. The hospitalization rate was significantly lower in the intervention group versus controls: 0.61 versus 0.92 per year, respectively (incidence rate ratio, 0.66; 95% CI, 0.43-0.99; P =0.04). Peritoneal dialysis or preemptive transplantation was the initial end-stage kidney disease treatment in 11 of 30 (37%) participants receiving the intervention versus 3 of 29 (10%) receiving usual care. Among HD starts, treatment was initiated without hospitalization in 11 of 19 (58%) participants in the intervention group versus 6 of 26 (23%) in the control group. At the time of HD therapy initiation, a catheter was present in 7 of 19 (37%) participants in the intervention group versus 18 of 26 (69%) in the control group. A functioning arteriovenous access was in place in 10 of 19 (53%) participants in the intervention group and 7 of 26 (27%) in the control group Limitations Moderate sample size, limited geographic scope. Conclusions The augmented nurse care management intervention resulted in reduced hospitalizations in late-stage CKD and there were suggestions of improved end-stage kidney disease preparation. Given suboptimal outcomes in late-stage CKD, care management interventions could potentially improve patient outcomes.

      PubDate: 2017-09-23T13:40:44Z
       
  • Kidney Function, Proteinuria, and Cancer Incidence:
           The Korean Heart Study
    • Authors: Yejin Mok; Kunihiro Matsushita Shoshana Ballew Yingying Sang Keum Jung
      Abstract: Publication date: October 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 4
      Author(s): Yejin Mok, Kunihiro Matsushita, Shoshana H. Ballew, Yingying Sang, Keum Ji Jung, Sunmi Lee, Sun Ha Jee, Josef Coresh
      Background Reported associations of estimated glomerular filtration rate (eGFR) with cancer risk are inconsistent, and data for the proteinuria-cancer relationship are sparse. We sought to quantify the associations of cancer incidence with eGFR and with proteinuria in a large population-based cohort. Study Design A prospective cohort study. Setting & Participants 242,583 adults (30-74 years old) without a diagnosis of cancer at baseline in the Korean Heart Study, based on health checkups in 1996 to 2004 with follow-up until 2012. Predictors Creatinine-based eGFR (≥90, 60-89, 45-59, and <45mL/min/1.73m2) and dipstick proteinuria (undetectable/trace, 1+, 2+, and ≥3+). Outcomes Overall and site-specific cancer incidence based on ICD-10 codes. Results 15,165 cases of cancer were detected. The relationship between eGFR and incidence of any cancer was J shaped, with the lowest risk at 45 to 59mL/min/1.73m2. There was 44% higher risk for any cancer among those with eGFRs<45mL/min/1.73m2 compared with those with eGFRs≥90mL/min/1.73m2 (HR, 1.44; 95% CI, 1.11-1.87). High proteinuria was also associated with cancer risk, showing a dose-response relationship (HRs of 1.24 [95% CI, 1.13-1.35], 1.38 [95% CI, 1.17-1.63], and 1.66 [95% CI, 1.30-2.12] for 1+, 2+, and ≥3+ vs undetectable/trace). Examining site-specific cancer, eGFR<45 (vs ≥45) mL/min/1.73m2 was significantly associated with kidney and ureteral cancer, multiple myeloma, and leukemia, whereas proteinuria ≥ 1+ (vs undetectable/trace) was related to a broader set of cancers (ie, stomach, rectal, liver, lung, ovarian, kidney, bladder, and multiple myeloma). After excluding study participants with follow-up less than 3 years, the associations remained consistent for kidney cancer and myeloma with eGFR and for rectal, liver, lung, and ovarian cancer with proteinuria. Limitations Relatively small number of participants with severely reduced eGFR or 70 years or older. Conclusions Kidney measures, particularly proteinuria, were associated with increased incidence of cancer. Future studies are needed to better understand the pathophysiologic mechanisms underlying these associations.

      PubDate: 2017-09-23T13:40:44Z
       
  • ESRD After Heart Failure, Myocardial Infarction, or Stroke in Type 2
           Diabetic Patients With CKD
    • Authors: David Charytan; Scott Solomon Peter Ivanovich Giuseppe Remuzzi Mark Cooper
      Abstract: Publication date: October 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 4
      Author(s): David M. Charytan, Scott D. Solomon, Peter Ivanovich, Giuseppe Remuzzi, Mark E. Cooper, Janet B. McGill, Hans-Henrik Parving, Patrick Parfrey, Ajay K. Singh, Emmanuel A. Burdmann, Andrew S. Levey, Dick de Zeeuw, Kai-Uwe Eckardt, John J.V. McMurray, Brian Claggett, Eldrin F. Lewis, Marc A. Pfeffer
      Background How cardiovascular (CV) events affect progression to end-stage renal disease (ESRD), particularly in the setting of type 2 diabetes, remains uncertain. Study Design Observational study. Setting & Participants 4,022 patients with type 2 diabetes, anemia, and chronic kidney disease from the Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT). Predictor Postrandomization CV events. Outcomes ESRD (defined as initiation of dialysis for >30 days, kidney transplantation, or refusal or nonavailability of renal replacement therapy) and post-ESRD mortality within 30 days and during overall follow-up after an intercurrent CV event. Limitations Population limited to clinical trial participants with diabetes and anemia. Results 155 of 652 (23.8%) ESRD cases occurred after an intercurrent CV event; 110 (16.9%) cases followed heart failure, 28 (4.3%) followed myocardial infarction, 12 (1.84%) followed stroke, and 5 (0.77%) followed multiple CV events. ESRD rate was higher within 30 days in individuals with an intercurrent CV event compared with those without an intercurrent event (HR, 22.2; 95% CI, 17.0-29.0). Compared to no intercurrent CV events, relative risks for ESRD were higher after the occurrence of heart failure overall (HR, 3.4; 95% CI, 2.7-4.2) and at 30 days (HR, 20.1; 95% CI, 14.5-27.9) than after myocardial infarction or stroke (P <0.001). Compared with individuals without pre-ESRD events, those with ESRD following intercurrent CV events were older, were more likely to have prior CV disease, and had higher (24.4 vs 23.1mL/min/1.73m2; P =0.01) baseline estimated glomerular filtration rates (eGFRs) and higher eGFRs at last measurement before ESRD (18.6 vs 15.2mL/min/1.73m2; P <0.001), whereas race, sex, and medication use were similar. Post-ESRD mortality was similar (P =0.3) with and without preceding CV events. Conclusions Most ESRD cases occurred in individuals without intercurrent CV events who had lower eGFRs than individuals with intercurrent CV events, but similar post-ESRD mortality. Nevertheless, intercurrent CV events, particularly heart failure, are strongly associated with risk for ESRD. These findings underscore the need for kidney-specific therapies in addition to treatment of CV risk factors to lower ESRD incidence in diabetes.

      PubDate: 2017-09-23T13:40:44Z
       
  • 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: October 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 4
      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: 2017-09-23T13:40:44Z
       
  • Acid Load and Phosphorus Homeostasis in CKD
    • Authors: Pascale Khairallah; Tamara Isakova John Asplin Lee Hamm Mirela Dobre
      Abstract: Publication date: October 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 4
      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: 2017-09-23T13:40:44Z
       
  • 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: October 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 4
      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: 2017-09-23T13:40:44Z
       
  • Data Without Numbers
    • Authors: Amar Bansal
      Abstract: Publication date: Available online 12 September 2017
      Source:American Journal of Kidney Diseases
      Author(s): Amar D. Bansal


      PubDate: 2017-09-17T13:08:27Z
       
  • Erratum Regarding “Food Insecurity, CKD, and Subsequent ESRD in US
           Adults” (Am J Kidney Dis. 2017;70[1]:38-47)
    • Abstract: Publication date: Available online 12 September 2017
      Source:American Journal of Kidney Diseases


      PubDate: 2017-09-17T13:08:27Z
       
  • An Increasingly Complex Relationship Between Salt and Water
    • Authors: Evan Ray; Thomas Kleyman
      Abstract: Publication date: Available online 9 September 2017
      Source:American Journal of Kidney Diseases
      Author(s): Evan C. Ray, Thomas R. Kleyman


      PubDate: 2017-09-11T15:44:57Z
       
 
 
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