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Publisher: Elsevier   (Total: 3044 journals)

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Showing 1 - 200 of 3044 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 22, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 21, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 84, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 24, 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: 342, 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: 215, 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: 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)
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: 5)
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: 135, 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: 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: 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 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: 26, 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: 10, 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 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: 5)
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: 41, 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 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: 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: 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 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: 6)
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: 15, 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: 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: 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: 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: 61)
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: 350, 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: 317, 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: 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: 39, 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: 9, 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  
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: 8, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 47, 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: 48, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 45, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 39, 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: 31, 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: 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: 192, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 56, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 4)
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: 24, 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: 21, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 34, 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: 37, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 167, 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   (Followers: 1)
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: 160, 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   (Followers: 1, 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]   [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  [3044 journals]
  • 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
       
  • PKD2-Related Autosomal Dominant Polycystic Kidney Disease: Prevalence,
           Clinical Presentation, Mutation Spectrum, and Prognosis
    • Authors: Emilie Cornec-Le; Gall Marie-Pierre Eric Renaudineau Maryvonne Hourmant Christophe Charasse
      Abstract: Publication date: October 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 4
      Author(s): Emilie Cornec-Le Gall, Marie-Pierre Audrézet, Eric Renaudineau, Maryvonne Hourmant, Christophe Charasse, Eric Michez, Thierry Frouget, Cécile Vigneau, Jacques Dantal, Pascale Siohan, Hélène Longuet, Philippe Gatault, Laure Ecotière, Frank Bridoux, Lise Mandart, Catherine Hanrotel-Saliou, Corina Stanescu, Pascale Depraetre, Sophie Gie, Michiel Massad, Aude Kersalé, Guillaume Séret, Jean-François Augusto, Philippe Saliou, Sandrine Maestri, Jian-Min Chen, Peter C. Harris, Claude Férec, Yannick Le Meur
      Background PKD2-related autosomal dominant polycystic kidney disease (ADPKD) is widely acknowledged to be of milder severity than PKD1-related disease, but population-based studies depicting the exact burden of the disease are lacking. We aimed to revisit PKD2 prevalence, clinical presentation, mutation spectrum, and prognosis through the Genkyst cohort. Study Design Case series, January 2010 to March 2016. Settings & Participants Genkyst study participants are individuals older than 18 years from 22 nephrology centers from western France with a diagnosis of ADPKD based on Pei criteria or at least 10 bilateral kidney cysts in the absence of a familial history. Publicly available whole-exome sequencing data from the ExAC database were used to provide an estimate of the genetic prevalence of the disease. Outcomes Molecular analysis of PKD1 and PKD2 genes. Renal survival, age- and sex-adjusted estimated glomerular filtration rate. Results The Genkyst cohort included 293 patients with PKD2 mutations (203 pedigrees). PKD2 patients with a nephrology follow-up corresponded to 0.63 (95% CI, 0.54-0.72)/10,000 in Brittany, while PKD2 genetic prevalence was calculated at 1.64 (95% CI, 1.10-3.51)/10,000 inhabitants in the European population. Median age at diagnosis was 42 years. Flank pain was reported in 38.9%; macroscopic hematuria, in 31.1%; and cyst infections, in 15.3% of patients. At age 60 years, the cumulative probability of end-stage renal disease (ESRD) was 9.8% (95% CI, 5.2%-14.4%), whereas the probability of hypertension was 75.2% (95% CI, 68.5%-81.9%). Although there was no sex influence on renal survival, men had lower kidney function than women. Nontruncating mutations (n=36) were associated with higher age-adjusted estimated glomerular filtration rates. Among the 18 patients with more severe outcomes (ESRD before age 60), 44% had associated conditions or nephropathies likely to account for the early progression to ESRD. Limitations Younger patients and patients presenting with milder forms of PKD2-related disease may not be diagnosed or referred to nephrology centers. Conclusions Patients with PKD2-related ADPKD typically present with mild disease. In case of accelerated degradation of kidney function, a concomitant nephropathy should be ruled out.

      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
       
  • Association of Unilateral Renal Agenesis With Adverse Outcomes in
           Pregnancy: A Matched Cohort Study
    • Authors: Jessica Kendrick; John Holmen Zhiying Gerard Smits Michel Chonchol
      Abstract: Publication date: October 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 4
      Author(s): Jessica Kendrick, John Holmen, Zhiying You, Gerard Smits, Michel Chonchol
      Background Data regarding the effect of a solitary kidney during pregnancy have come from studies of living kidney donors. We evaluated the risk for adverse pregnancy outcomes in women with a single kidney from renal agenesis. Study Design Matched cohort study. Setting & Participants Using data from 7,079 childbirths from an integrated health care delivery system from 1996 through 2015, we identified births from women with renal agenesis. Only first pregnancies and singleton births were included. After excluding those with diabetes and kidney disease, 200 women with renal agenesis were matched 1:4 by age (within 2 years), race, and history of hypertension to women with 2 kidneys. Predictor Renal agenesis defined by International Classification of Diseases, Ninth Revision (ICD-9) codes prior to pregnancy. Outcomes The primary outcome was adverse maternal outcomes, including preterm delivery, delivery by cesarean section, preeclampsia/eclampsia, and hospital length of stay. Adverse neonatal end points were considered as a secondary outcome and included low birth weight (<2,500g) and infant death/transfer to acute inpatient facility. Results Mean gestational age at delivery was 37.9±2.1 weeks for women with renal agenesis compared to 38.6±1.8 weeks for women with 2 kidneys. Compared with women with 2 kidneys, those with renal agenesis had increased risk for preterm delivery (OR, 2.88; 95% CI, 1.86-4.45), delivery by cesarean section (OR, 2.11; 95% CI, 1.49-2.99), preeclampsia/eclampsia (OR, 2.41; 95% CI, 1.23-4.72), and length of stay longer than 3 days (OR, 1.81; 95% CI, 1.18-2.78). Renal agenesis was not significantly associated with increased risk for infant death/transfer to acute facility (OR, 2.60; 95% CI, 0.57-11.89) or low birth weight after accounting for preterm delivery (OR, 2.11; 95% CI, 0.76-5.88). Limitations Renal agenesis was identified by ICD-9 code, not by imaging of the abdomen. Conclusion Women with unilateral renal agenesis have a higher risk for adverse outcomes in pregnancy.

      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
       
  • Stimulating Patient Engagement in Medical Device Development in Kidney
           Disease: A Report of a Kidney Health Initiative Workshop
    • Authors: Frank Hurst; Dolph Chianchiano Linda Upchurch Benjamin Fisher Jennifer Flythe
      Abstract: Publication date: October 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 4
      Author(s): Frank P. Hurst, Dolph Chianchiano, Linda Upchurch, Benjamin R. Fisher, Jennifer E. Flythe, Celeste Castillo Lee, Terri Hill, Carolyn Y. Neuland
      New technologies challenge current dialysis treatment paradigms as devices become smaller, more portable, and increasingly used outside the dialysis clinic. It is unclear how patients will view this care transition, and it will be important to consider patient and care partner perspectives during all aspects of development for novel dialysis therapies, from design and clinical trials to regulatory approval. To gain insight into this area, the Kidney Health Initiative, a public-private partnership between the American Society of Nephrology, the US Food and Drug Administration, and nearly 80 member organizations and companies dedicated to enhancing patient safety and fostering innovation in kidney disease, convened a workshop of patients, care partners, and other kidney community stakeholders. The workshop included background presentations followed by focused small group discussions in 3 areas (device design, clinical trials, and regulatory approval). Participants explored how to involve patients throughout the life cycle of a medical device, including discussions of how patients can influence device design, assist in the planning and implementation of clinical trials, and provide input to affect regulatory decisions. Patients were engaged in the workshop discussion and interested in sharing their perspectives, but they recommended additional efforts around education, communication, and outreach in these areas.

      PubDate: 2017-09-23T13:40:44Z
       
  • Fatal Dialysis Vascular Access Hemorrhage
    • Authors: Matthew Jose; Mark Marshall Gail Read Nicole Lioufas Jon Ling
      Abstract: Publication date: October 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 4
      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: 2017-09-23T13:40:44Z
       
  • Atazanavir-Associated Crystalline Nephropathy
    • Authors: Dominick Santoriello; Majdi Al-Nabulsi Aravinda Reddy Julius Salamera Vivette Glen
      Abstract: Publication date: October 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 4
      Author(s): Dominick Santoriello, Majdi Al-Nabulsi, Aravinda Reddy, Julius Salamera, Vivette D. D’Agati, Glen S. Markowitz
      Crystalline nephropathy can occur following treatment with multiple therapeutic agents. We describe a human immunodeficiency virus (HIV)-infected patient treated for 2 years with combination antiretroviral therapy including atazanavir (ATV). Kidney biopsy revealed a crystalline nephropathy associated with diffuse chronic and granulomatous interstitial inflammation. Following the biopsy, treatment with ATV was discontinued and kidney function returned to pretreatment baseline levels. ATV, which has a well-established association with nephrolithiasis, is a rare but important cause of crystalline nephropathy. Recognition of this association and prompt withdrawal of the offending agent are critical to optimize outcomes.

      PubDate: 2017-09-23T13:40:44Z
       
  • 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: October 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 4
      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: 2017-09-23T13:40:44Z
       
  • Comparing Newer GFR Estimating Equations Using Creatinine and Cystatin C
           to the CKD-EPI Equations in Adults
    • Authors: Andrew Levey; Hocine Tighiouart Andrew Simon Lesley Inker
      Abstract: Publication date: October 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 4
      Author(s): Andrew S. Levey, Hocine Tighiouart, Andrew L. Simon, Lesley A. Inker


      PubDate: 2017-09-23T13:40:44Z
       
  • Use of the Furosemide Fludrocortisone Test to Clinically Assess Distal
           Tubular Acidification
    • Authors: Anneke Bech; Jack F.M. Wetzels Tom Nijenhuis
      Abstract: Publication date: October 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 4
      Author(s): Anneke P. Bech, Jack F.M. Wetzels, Tom Nijenhuis


      PubDate: 2017-09-23T13:40:44Z
       
  • Erratum Regarding “AJKD Atlas of Renal Pathology: Kidney Disease in
           Primary Sjögren Syndrome” (Am J Kidney Dis. 2017;69[6]:e29-e30)
    • Abstract: Publication date: October 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 4


      PubDate: 2017-09-23T13:40:44Z
       
  • AJKD Atlas of Renal Pathology: Nail-Patella Syndrome–Associated
           Nephropathy
    • Authors: Behzad Najafian; Kelly Smith Mark Lusco Charles Alpers Agnes Fogo
      Abstract: Publication date: October 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 4
      Author(s): Behzad Najafian, Kelly Smith, Mark A. Lusco, Charles E. Alpers, Agnes B. Fogo


      PubDate: 2017-09-23T13:40:44Z
       
  • Oral Anticoagulants to Prevent Stroke in Nonvalvular Atrial Fibrillation
           in Patients With CKD Stage 5D: An NKF-KDOQI Controversies Report
    • Authors: Vinod Bansal; Charles Herzog Mark Sarnak Michael Choi Ravindra Mehta
      Abstract: Publication date: Available online 21 September 2017
      Source:American Journal of Kidney Diseases
      Author(s): Vinod K. Bansal, Charles A. Herzog, Mark J. Sarnak, Michael J. Choi, Ravindra Mehta, Bernard G. Jaar, Michael V. Rocco, Holly Kramer
      Stroke risk may be more than 3-fold higher among patients with chronic kidney disease stage 5D (CKD-5D) compared to the general population, with the highest stroke rates noted among those 85 years and older. Atrial fibrillation (AF), a strong risk factor for stroke, is the most common arrhythmia and affects >7% of the population with CKD-5D. Warfarin use is widely acknowledged as an important intervention for stroke prevention with nonvalvular AF in the general population. However, use of oral anticoagulants for stroke prevention in patients with CKD-5D and nonvalvular AF continues to be debated by the nephrology community. In this National Kidney Foundation–Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) controversies report, we discuss the existing observational studies that examine warfarin use and associated stroke and bleeding risks in adults with CKD-5D and AF. Non–vitamin K–dependent oral anticoagulants and their potential use for stroke prevention in patients with CKD-5D and nonvalvular AF are also discussed. Data from randomized clinical trials are urgently needed to determine the benefits and risks of oral anticoagulant use for stroke prevention in the setting of AF among patients with CKD-5D.

      PubDate: 2017-09-23T13:40:44Z
       
  • KDOQI US Commentary on the 2017 KDIGO Clinical Practice Guideline Update
           for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic
           Kidney Disease–Mineral and Bone Disorder (CKD-MBD)
    • Authors: Tamara Isakova; Thomas Nickolas Michelle Denburg Sri Yarlagadda Daniel Weiner
      Abstract: Publication date: Available online 21 September 2017
      Source:American Journal of Kidney Diseases
      Author(s): Tamara Isakova, Thomas L. Nickolas, Michelle Denburg, Sri Yarlagadda, Daniel E. Weiner, Orlando M. Gutiérrez, Vinod Bansal, Sylvia E. Rosas, Sagar Nigwekar, Jerry Yee, Holly Kramer
      Chronic kidney disease–mineral and bone disorder (CKD-MBD) encompasses laboratory and bone abnormalities and vascular calcification and has deleterious effects on clinical outcomes. KDOQI (Kidney Disease Outcomes Quality Initiative), an initiative of the National Kidney Foundation, addressed this issue with the publication of a clinical practice guideline for bone metabolism and disease in CKD in 2003, and 2 years later, a new definition and classification scheme for CKD-MBD was developed following a KDIGO (Kidney Disease: Improving Global Outcomes) Controversies Conference. The initial KDIGO guideline on CKD-MBD was then published in 2009. New evidence was subsequently reviewed at the 2013 KDIGO Controversies Conference, and in 2017, KDIGO issued a clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of CKD-MBD. This commentary presents the views of the KDOQI CKD-MBD work group convened by the National Kidney Foundation. The KDOQI work group agrees with most of the KDIGO guideline update recommendations, particularly the suggestions regarding bone mineral density testing, joint assessments of longitudinal trends in mineral metabolism markers, and dietary phosphate counseling focused on phosphate additives. However, the KDOQI work group has some concerns about the suggestions related to hypocalcemia and hypercalcemia, phosphate-binder choice, and treatment of abnormal parathyroid hormone concentrations. The overall goal of this commentary is to provide a broad discussion for the US nephrology community regarding CKD-MBD and its diagnosis, prevention, and treatment.

      PubDate: 2017-09-23T13:40:44Z
       
  • Effectiveness of Pharmacist Interventions on Cardiovascular Risk in
           Patients With CKD: A Subgroup Analysis of the Randomized Controlled RxEACH
           Trial
    • Authors: Yazid Hamarneh; Ross Tsuyuki Charlotte Jones Braden Manns Marcello Tonelli
      Abstract: Publication date: Available online 12 September 2017
      Source:American Journal of Kidney Diseases
      Author(s): Yazid N. Al Hamarneh, Ross T. Tsuyuki, Charlotte A. Jones, Braden Manns, Marcello Tonelli, Nairne Scott-Douglass, Kailash Jindal, Wendy Tink, Brenda R. Hemmelgarn
      Background Affecting a substantial proportion of adults, chronic kidney disease (CKD) is considered a major risk factor for cardiovascular (CV) events. It has been reported that patients with CKD are underserved when it comes to CV risk reduction efforts. Study Design Prespecified subgroup analysis of a randomized controlled trial. Setting & Participants Adults with CKD and at least 1 uncontrolled CV risk factor were enrolled from 56 pharmacies across Alberta, Canada. Intervention Patient, laboratory, and individualized CV risk assessments; treatment recommendations; prescription adaptation(s) and/or initiation as necessary; and regular monthly follow-up for 3 months. Outcomes The primary outcome was change in estimated CV risk from baseline to 3 months after randomization. Secondary outcomes were change between baseline and 3 months after randomization in individual CV risk factors (ie, low-density lipoprotein cholesterol, blood pressure, and hemoglobin A1c), risk for developing end-stage renal disease, and medication use and dosage; tobacco cessation 3 months after randomization for those who used tobacco at baseline; and the impact of rural versus urban residence on the difference in change in estimated CV risk. Measurements CV risk was estimated using the Framingham, UK Prospective Diabetes Study, and international risk assessment equations depending on the patients’ comorbid conditions. Results 290 of the 723 participants enrolled in RxEACH had CKD. After adjusting for baseline values, the difference in change in CV risk was 20% (P <0.001). Changes of 0.2mmol/L in low-density lipoprotein cholesterol concentration (P =0.004), 10.5mmHg in systolic blood pressure (P <0.001), 0.7% in hemoglobin A1c concentration (P <0.001), and 19.6% in smoking cessation (P =0.04) were observed when comparing the intervention and control groups. There was a larger reduction in CV risk in patients living in rural locations versus those living in urban areas. Limitations The 3-month follow-up period can be considered relatively short. It is possible that larger reduction in CV risk could have been observed with a longer follow up period. Conclusions This subgroup analysis demonstrated that a community pharmacy–based intervention program reduced CV risk and improved control of individual CV risk factors. This represents a promising approach to identifying and managing patients with CKD that could have important public health implications.

      PubDate: 2017-09-17T13:08:27Z
       
  • 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
       
  • Formulas for Calculated Osmolarity and Osmolal Gap: A Study of Diagnostic
           Accuracy
    • Authors: Fanny Lepeytre; Marc Ghannoum Ammann Madore Troyanov Goupil Bouchard
      Abstract: Publication date: September 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 3
      Author(s): Fanny Lepeytre, Marc Ghannoum, Hélène Ammann, François Madore, Stéphan Troyanov, Rémi Goupil, Josée Bouchard
      Background The osmolal gap has been used for decades to screen for exposure to toxic alcohols. However, several issues may affect its reliability. We aimed to develop equations to calculate osmolarity with improved performance when used to screen for intoxication to toxic alcohols. Study Design Retrospective cohort study. Setting & Participants 7,525 patients undergoing simultaneous measurements of osmolality, sodium, potassium, urea, glucose, and ethanol or undergoing similar measurements performed within 30 minutes of a measurement of toxic alcohol levels at a single tertiary-care center from April 2001 to June 2016. Patients with detectable toxic alcohols were excluded. Index Test Equations to calculate osmolarity using multiple linear regression. Outcomes The performance of new equations compared with published equations developed to calculate osmolarity, and to diagnose toxic alcohol intoxications more accurately. Results We obtained 7,525 measurements, including 100 with undetectable toxic alcohols. Among them, 3,875 had undetectable and 3,650 had detectable ethanol levels. In the entire cohort, the best equation to calculate osmolarity was 2.006×Na + 1.228×Urea + 1.387×Glucose + 1.207×Ethanol (values in mmol/L, R 2 =0.96). A simplified equation, 2.0×Na + 1.2×Urea + 1.4×Glucose + 1.2×Ethanol, had a similar R 2 with 95% of osmolal gap values between −10.9 and 13.8. In patients with undetectable ethanol concentrations, the range of 95% of osmolal gap values was narrower than previous published formulas, and in patients with detectable ethanol concentrations, the range was narrower or similar. We performed a subanalysis of 138 cases for which both the toxic alcohol concentration could be measured and the osmolal gap could be calculated. Our simplified equation had superior diagnostic accuracy for toxic alcohol exposure. Limitations Single center, no external validation, limited number of cases with detectable toxic alcohols. Conclusions In a large cohort, coefficients from regression analyses estimating the contribution of glucose, urea, and ethanol were higher than 1.0. Our simplified formula to precisely calculate osmolarity yielded improved diagnostic accuracy for suspected toxic alcohol exposures than previously published formulas.

      PubDate: 2017-09-17T13:08:27Z
       
  • Cost-effectiveness Analysis of Vascular Access Referral Policies in
           CKD
    • Authors: Steven Shechter; Talon Chandler Reza Skandari Nadia Zalunardo
      Abstract: Publication date: September 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 3
      Author(s): Steven M. Shechter, Talon Chandler, M. Reza Skandari, Nadia Zalunardo
      Background The optimal timing of vascular access referral for patients with chronic kidney disease who may need hemodialysis (HD) is a pressing question in nephrology. Current referral policies have not been rigorously compared with respect to costs and benefits and do not consider patient-specific factors such as age. Study Design Monte Carlo simulation model. Setting & Population Patients with chronic kidney disease, referred to a multidisciplinary kidney clinic in a universal health care system. Model, Perspective, & Timeframe Cost-effectiveness analysis, payer perspective, lifetime horizon. Intervention The following vascular access referral policies are considered: central venous catheter (CVC) only, arteriovenous fistula (AVF) or graft (AVG) referral upon HD initiation, AVF (or AVG) referral when HD is forecast to begin within 12 (or 3 for AVG) months, AVF (or AVG) referral when estimated glomerular filtration rate is <15 (or <10 for AVG) mL/min/1.73m2. Outcomes Incremental cost-effectiveness ratios (ICERs, in 2014 US dollars per quality-adjusted life-year [QALY] gained). Results The ICER of AVF (AVG) referral within 12 (3) months of forecasted HD initiation, compared to using only a CVC, is ∼$105k/QALY ($101k/QALY) at a population level (HD costs included). Pre-HD AVF or AVG referral dominates delaying referral until HD initiation. The ICER of pre-HD referral increases with patient age. Results are most sensitive to erythropoietin costs, ongoing HD costs, and patients’ utilities for HD. When ongoing HD costs are excluded from the analysis, pre-HD AVF dominates both pre-HD AVG and CVC-only policies. Limitations Literature-based estimates for HD, AVF, and AVG utilities are limited. Conclusions The cost-effectiveness of vascular access referral is largely driven by the annual costs of HD, erythropoietin costs, and access-specific utilities. Further research is needed in the field of dialysis-related quality of life to inform decision making regarding vascular access referral.

      PubDate: 2017-09-17T13:08:27Z
       
  • Baclofen Toxicity in Kidney Disease
    • Authors: Erin Wolf; Niraj Kothari John Roberts Matthew Sparks
      Abstract: Publication date: Available online 9 September 2017
      Source:American Journal of Kidney Diseases
      Author(s): Erin Wolf, Niraj R. Kothari, John K. Roberts, Matthew A. Sparks
      Baclofen, a commonly prescribed muscle relaxant, is primarily excreted via the kidneys; toxicity is a potentially serious adverse outcome in patients with decreased kidney function. We describe a patient with end-stage kidney disease receiving hemodialysis who developed neurotoxicity and hemodynamic instability after receiving baclofen for muscle spasms. In this case, prompt recognition of baclofen toxicity and urgent hemodialysis were effective in reversing this toxicity. This case is used to examine the pharmacokinetics and pathophysiology of baclofen toxicity and discuss appropriate diagnosis and management of baclofen toxicity. We recommend reducing the baclofen dose in patients who have moderately reduced kidney function (estimated glomerular filtration rate, 30-60mL/min/1.73m2) and avoiding use in patients with severely reduced kidney function (estimated glomerular filtration rate < 30mL/min/1.73m2) or on renal replacement therapy.

      PubDate: 2017-09-11T15:44:57Z
       
  • 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
       
  • Steps Toward Sustainable Change in Advance Care Planning
    • Authors: Jane Schell; Daniel Lam
      Abstract: Publication date: September 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 3
      Author(s): Jane O. Schell, Daniel Lam


      PubDate: 2017-08-28T20:19:07Z
       
  • After 4 Decades of Lupus Nephritis Trials, Is There a “Best”
           Therapy'
    • Authors: Andrew Bomback
      Abstract: Publication date: September 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 3
      Author(s): Andrew S. Bomback


      PubDate: 2017-08-28T20:19:07Z
       
  • Treating to Target in Older Hypertensive Patients: Where Is the
           Bull’s Eye'
    • Authors: Gary Schwartz
      Abstract: Publication date: September 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 3
      Author(s): Gary L. Schwartz


      PubDate: 2017-08-28T20:19:07Z
       
  • Clinicians’ Perspectives on Advance Care Planning for Patients With CKD
           in Australia: An Interview Study
    • Authors: Marcus Sellars; Allison Tong Tim Luckett Rachael Morton Carol Pollock
      Abstract: Publication date: September 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 3
      Author(s): Marcus Sellars, Allison Tong, Tim Luckett, Rachael L. Morton, Carol A. Pollock, Lucy Spencer, William Silvester, Josephine M. Clayton
      Background Advance care planning (ACP) empowers patients to consider and communicate their current and future treatment goals. However, ACP is not widely implemented in chronic kidney disease (CKD) care settings. This study aims to describe clinicians’ beliefs, challenges, and perspectives of ACP in patients with CKD. Study Design Qualitative study. Setting & Participants Nephrologists (n=20), nurses (n=7), and social workers (n=4) with a range of experience in facilitating ACP for patients with CKD across Australia. Methodology Semistructured interviews were digitally recorded and transcribed verbatim. Analytical Approach Transcripts were analyzed using thematic analysis. Results 5 major themes were identified: facilitating informed decision making (avoiding preconceptions, conveying complete truths, focusing on supportive care, and synchronizing with evolving priorities), negotiating moral boundaries (contending with medical futility and respecting patient vs family autonomy), navigating vulnerable conversations (jeopardizing the therapeutic relationship, compromising professional confidence, emotionally invested, and enriching experiences), professional disempowerment (unsupportive culture, doubting logistical feasibility, and making uncertain judgments), and clarifying responsibilities (governing facilitation, managing tensions, and transforming multidisciplinary relationships). Limitations Some findings may be specific to the Australian context. Conclusions The tensions among themes reflect that ACP is paradoxically rewarding for clinicians because ACP empowers patients yet can expose personal and professional vulnerabilities. Clinicians believe that a more collaborative approach is needed, with increased efforts to identify the evolving and individualized needs and goals of patients with CKD. Models of ACP that address clinicians’ personal and professional vulnerabilities when initiating ACP may foster greater confidence and cultural acceptance of ACP in the CKD setting.

      PubDate: 2017-08-28T20:19:07Z
       
  • Induction and Maintenance Immunosuppression Treatment of Proliferative
           Lupus Nephritis: A Network Meta-analysis of Randomized Trials
    • Authors: Suetonia Palmer; David Tunnicliffe Davinder Singh-Grewal Dimitris Mavridis Marcello Tonelli
      Abstract: Publication date: September 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 3
      Author(s): Suetonia C. Palmer, David J. Tunnicliffe, Davinder Singh-Grewal, Dimitris Mavridis, Marcello Tonelli, David W. Johnson, Jonathan C. Craig, Allison Tong, Giovanni F.M. Strippoli
      Background Intravenous (IV) cyclophosphamide has been first-line treatment for inducing disease remission in lupus nephritis. The comparative efficacy and toxicity of newer agents such as mycophenolate mofetil (MMF) and calcineurin inhibitors are uncertain. Study Design Network meta-analysis. Setting & Population Patients with proliferative lupus nephritis. Selection Criteria for Studies Randomized trials of immunosuppression to induce or maintain disease remission. Interventions IV cyclophosphamide, oral cyclophosphamide, MMF, calcineurin inhibitor, plasma exchange, rituximab, or azathioprine, alone or in combination. Outcomes Complete remission, end-stage kidney disease, all-cause mortality, doubling of serum creatinine level, relapse, and adverse events. Results 53 studies involving 4,222 participants were eligible. Induction and maintenance treatments were administered for 12 (IQR, 6-84) and 25 (IQR, 12-48) months, respectively. There was no evidence of different effects between therapies on all-cause mortality, doubling of serum creatinine level, or end-stage kidney disease. Compared to IV cyclophosphamide, the most effective treatments to induce remission in moderate- to high-quality evidence were combined MMF and calcineurin inhibitor therapy, calcineurin inhibitors, and MMF (ORs were 2.69 [95% CI, 1.74-4.16], 1.86 [95% CI, 1.05-3.30], and 1.54 [95% CI, 1.04-2.30], respectively). MMF was significantly less likely than IV cyclophosphamide to cause alopecia (OR, 0.21; 95% CI, 0.12-0.36), and MMF combined with calcineurin inhibitor therapy was less likely to cause ovarian failure (OR, 0.25; 95% CI, 0.07-0.93). Regimens generally had similar odds of major infection. MMF was the most effective strategy to maintain remission. Limitations Outcome definitions not standardized, short duration of follow-up, and possible confounding by previous or subsequent therapy. Conclusions Evidence for induction therapy for lupus nephritis is inconclusive based on treatment effects on all-cause mortality, doubling of serum creatinine level, and end-stage kidney disease. MMF, calcineurin inhibitors, or their combination were most effective for inducing remission compared to IV cyclophosphamide, while conferring similar or lower treatment toxicity. MMF was the most effective maintenance therapy.

      PubDate: 2017-08-28T20:19:07Z
       
  • Risks of Adverse Events in Advanced CKD: The Chronic Renal Insufficiency
           Cohort (CRIC) Study
    • Authors: Morgan Grams; Wei Yang Casey Rebholz Xue Wang Anna Porter
      Abstract: Publication date: September 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 3
      Author(s): Morgan E. Grams, Wei Yang, Casey M. Rebholz, Xue Wang, Anna C. Porter, Lesley A. Inker, Edward Horwitz, James H. Sondheimer, L. Lee Hamm, Jiang He, Matthew R. Weir, Bernard G. Jaar, Tariq Shafi, Lawrence J. Appel, Chi-yuan Hsu
      Background People with advanced chronic kidney disease are at risk for the development of end-stage renal disease (ESRD), but also many other adverse outcomes, including cardiovascular disease (CVD) events and death. Determination of risk factors that explain the variability in prognosis and timing of these adverse outcomes can aid patient counseling and medical decision making. Study Design Prospective research cohort. Setting & Participants 1,798 participants with estimated glomerular filtration rates (eGFRs)<30mL/min/1.73m2 in the CRIC Study were followed up for a median of 5.5 years. Predictors Age, race, sex, eGFR, proteinuria, diabetes mellitus, body mass index, ejection fraction, systolic blood pressure, history of CVD, and smoking history. Outcomes ESRD, CVD (congestive heart failure, stroke, myocardial infarction, and peripheral artery disease), and death. Results Baseline age of the cohort was 60 years, 46% were women, and 46% were African American. Although 52.3% of participants progressed to ESRD during follow-up, the path by which this occurred was variable. For example, predicted 1-year probabilities for a hypothetical 60-year-old white woman with eGFR of 30mL/min/1.73m2, urine protein excretion of 1.8g/d, and no diabetes or CVD (risk characteristics similar to the average participant) were 3.3%, 4.1%, and 0.3%, for first developing CVD, ESRD, and death, respectively. For a 40-year-old African American man with similar characteristics but higher systolic blood pressure, the corresponding 1-year probabilities were 2.4%, 13.2%, and 0.1%. For all participants, the development of ESRD or CVD increased the risk for subsequent mortality, with no differences by patient race or body mass index. Limitations The CRIC population was specifically recruited for kidney disease, and the vast majority had seen a nephrologist. Conclusions The prognosis and timing of adverse outcomes in chronic kidney disease vary by patient characteristics. These results may help guide the development of personalized approaches for managing patients with advanced CKD.
      Graphical abstract image

      PubDate: 2017-08-28T20:19:07Z
       
  • 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: September 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 3
      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: 2017-08-28T20:19:07Z
       
  • Serum Phosphorus and Risk of Cardiovascular Disease, All-Cause Mortality,
           or Graft Failure in Kidney Transplant Recipients: An Ancillary Study of
           the FAVORIT Trial Cohort
    • Authors: Basma Merhi; Theresa Shireman Myra Carpenter John Kusek Paul Jacques
      Abstract: Publication date: September 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 3
      Author(s): Basma Merhi, Theresa Shireman, Myra A. Carpenter, John W. Kusek, Paul Jacques, Marc Pfeffer, Madhumathi Rao, Meredith C. Foster, S. Joseph Kim, Todd E. Pesavento, Stephen R. Smith, Clifton E. Kew, Andrew A. House, Reginald Gohh, Daniel E. Weiner, Andrew S. Levey, Joachim H. Ix, Andrew Bostom
      Background Mild hyperphosphatemia is a putative risk factor for cardiovascular disease [CVD], loss of kidney function, and mortality. Very limited data are available from sizable multicenter kidney transplant recipient (KTR) cohorts assessing the potential relationships between serum phosphorus levels and the development of CVD outcomes, transplant failure, or all-cause mortality. Study Design Cohort study. Setting & Participants The Folic Acid for Vascular Outcome Reduction in Transplantation (FAVORIT) Trial, a large, multicenter, multiethnic, controlled clinical trial that provided definitive evidence that high-dose vitamin B−based lowering of plasma homocysteine levels did not reduce CVD events, transplant failure, or total mortality in stable KTRs. Predictor Serum phosphorus levels were determined in 3,138 FAVORIT trial participants at randomization. Results During a median follow-up of 4.0 years, the cohort had 436 CVD events, 238 transplant failures, and 348 deaths. Proportional hazards modeling revealed that each 1-mg/dL higher serum phosphorus level was not associated with a significant increase in CVD risk (HR, 1.06; 95% CI, 0.92-1.22), but increased transplant failure (HR, 1.36; 95% CI, 1.15-1.62) and total mortality risk associations (HR, 1.21; 95% CI, 1.04-1.40) when adjusted for treatment allocation, traditional CVD risk factors, kidney measures, type of kidney transplant, transplant vintage, and use of calcineurin inhibitors, steroids, or lipid-lowering drugs. These associations were strengthened in models without kidney measures: CVD (HR, 1.14; 95% CI, 1.00-1.31), transplant failure (HR, 1.72; 95% CI, 1.46-2.01), and mortality (HR, 1.34; 95% CI, 1.15-1.54). Limitations We lacked data for concentrations of parathyroid hormone, fibroblast growth factor 23, or vitamin D metabolites. Conclusions Serum phosphorus level is marginally associated with CVD and more strongly associated with transplant failure and total mortality in long-term KTRs. A randomized controlled clinical trial in KTRs that assesses the potential impact of phosphorus-lowering therapy on these hard outcomes may be warranted.

      PubDate: 2017-08-28T20:19:07Z
       
  • 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: September 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 3
      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 ...
      PubDate: 2017-08-28T20:19:07Z
       
  • Relationships of Measured Iohexol GFR and Estimated GFR With CKD-Related
           Biomarkers in Children and Adolescents
    • Authors: Derek George; Schwartz Bradley Warady Susan Furth Alvaro
      Abstract: Publication date: September 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 3
      Author(s): Derek K. Ng, George J. Schwartz, Bradley A. Warady, Susan L. Furth, Alvaro Muñoz
      Background 2 valid and reliable estimated glomerular filtration rate (GFR) equations for the pediatric population have been developed from directly measured GFR data in the Chronic Kidney Disease in Children (CKiD) cohort: the full CKiD and bedside CKiD equations. Although adult GFR estimating equations replicate relationships of measured GFR with biomarkers, it is unclear whether similar patterns exist among children and adolescents with chronic kidney disease (CKD). Study Design Prospective cohort study in children and adolescents. Settings & Participants 730 participants contributed 1,539 study visits. Predictors Measured GFR by plasma iohexol disappearance (mGFR), estimated GFR by the full CKiD equation (eGFRCKiDfull; based on serum creatinine, cystatin C, serum urea nitrogen, height, and sex), and estimated GFR by the bedside CKiD equation (eGFRCKiDbed; calculated as 41.3 × height [m]/serum creatinine [mg/dL]) were predictors of CKD-related biomarkers. Deviations of mGFR from eGFRCKiDfull and deviations of eGFRCKiDfull from eGFRCKiDbed from linear regressions (ie, residuals) were included in bivariate analyses. Outcomes & Measurements: CKD-related biomarkers included values for urine protein-creatinine ratio, blood hemoglobin, serum phosphate, bicarbonate, potassium, systolic and diastolic blood pressure z scores, and height z scores. Results The median age of 730 participants with CKD was 12.5 years, with median mGFR, eGFRCKiDfull, and eGFRCKiDbed of 51.8, 54.0, and 53.2mL/min/1.73m2, respectively. eGFRCKiDfull demonstrated as strong or stronger associations with CKD-related biomarkers than mGFR; eGFRCKiDbed associations were significantly attenuated (ie, closer to the null). Residual information in mGFR did not substantially increase explained variability. eGFRCKiDbed estimated faster GFR decline relative to mGFR and eGFRCKiDfull. Limitations Simple linear summaries of biomarkers may not capture nonlinear associations. Conclusions eGFRCKiDfull closely approximated mGFR to describe relationships with CKD-severity indicators and progression in this pediatric CKD population. eGFRCKiDbed offered similar inferences, but associations were attenuated and rate of progression was overestimated. The eGFRCKiDfull equation from 2012 is preferred for pediatric research purposes.

      PubDate: 2017-08-28T20:19:07Z
       
  • Non-GFR Determinants of Low-Molecular-Weight Serum Protein Filtration
           Markers in the Elderly: AGES-Kidney and MESA-Kidney
    • Authors: Meredith Foster; Andrew Levey Lesley Inker Tariq Shafi Fan Vilmundur
      Abstract: Publication date: September 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 3
      Author(s): Meredith C. Foster, Andrew S. Levey, Lesley A. Inker, Tariq Shafi, Li Fan, Vilmundur Gudnason, Ronit Katz, Gary F. Mitchell, Aghogho Okparavero, Runolfur Palsson, Wendy S. Post, Michael G. Shlipak
      Background Studies in chronic kidney disease populations suggest that the non–glomerular filtration rate (GFR) determinants of serum levels of the low-molecular-weight protein filtration markers cystatin C, β2-microglobulin (B2M), and beta-trace protein (BTP) are less affected by age, sex, and ethnicity than those of creatinine. Study Design Cross-sectional study. Setting & Participants Predominantly elderly participants selected from the Age, Gene/Environment Susceptibility Kidney Study (AGES-Kidney; N=683; mean [SD] age, 79 [4] years; GFR, 62 [17]mL/min/1.73 m2) and from the Multi-Ethnic Study of Atherosclerosis Kidney Study (MESA-Kidney; N=273; mean [SD] age, 70.5 [9] years; GFR, 73 [19]mL/min/1.73 m2). Predictors Demographic and clinical factors hypothesized to be associated with conditions affecting non-GFR determinants of the filtration markers. Outcomes Measured GFRs and estimated GFRs (eGFRs) based on creatinine, cystatin C, B2M, and BTP levels (eGFRcr, eGFRcys, eGFRB2M, and eGFRBTP, respectively). Residual associations of factors with eGFR after accounting for measured GFR as the parameter of interest. Results eGFRcys, eGFRB2M, and eGFRBTP had significantly less strong residual associations with age and sex than eGFRcr in both AGES-Kidney and MESA-Kidney and were not associated with ethnicity (black vs white) in MESA-Kidney. After adjusting for age, sex, and ethnicity, residual associations with most clinical factors were smaller than observed with age and sex. eGFRcys and eGFRB2M, but not eGFRBTP, had significant residual associations with C-reactive protein levels in both studies. Limitations Small sample size may limit power to detect associations. Participants may be healthier than the general population. Conclusions Similar to previous studies in chronic kidney disease, in community-dwelling elders, cystatin C, B2M, and BTP levels are less affected than creatinine level by age and sex and are not affected by ethnicity. Both cystatin C and B2M levels may be affected by inflammation. These findings are important for the development and use of GFR estimating equations based on low-molecular-weight serum proteins throughout the range in GFRs.

      PubDate: 2017-08-28T20:19:07Z
       
  • An Interactive Ambulatory Nephrology Curriculum for Internal Medicine
           Interns: Design, Implementation, and Participant Feedback
    • Authors: Alexis Gomez; Karen Warburton Rachel Miller Dan Negoianu Jordana Cohen
      Abstract: Publication date: September 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 3
      Author(s): Alexis C. Gomez, Karen M. Warburton, Rachel K. Miller, Dan Negoianu, Jordana B. Cohen
      While diminishing nephrology fellow recruitment is a known issue, more work is needed to evaluate possible interventions to reverse this trend. We designed and implemented a curriculum to increase exposure to ambulatory nephrology among internal medicine interns. The curriculum focused on key aspects of outpatient nephrology practice, including supervised clinic visits, formal themed didactic content, and an online interactive forum with assigned evidence-based readings and small-group responses to relevant cases. We obtained postcourse surveys from all participating interns. Of the 43 interns who took part in the first year of the ambulatory nephrology curriculum, 100% reported a positive didactic experience and 91% reported a positive interactive online experience. 77% reported an improvement in their familiarity with clinical nephrology practice (median 2-point increase in familiarity score on a 7-point scale, P <0.001 by signed rank testing). Qualitative feedback included praise for the high-yield topics covered by the lectures and energizing teachers. In conclusion, we successfully implemented an ambulatory nephrology curriculum using a framework that integrated formal didactics, interactive online learning, and key clinical components of outpatient nephrology care. Future investigation will evaluate whether early implementation of this curriculum is associated with increased pursuit of nephrology as a career.

      PubDate: 2017-08-28T20:19:07Z
       
  • Management of Gout and Hyperuricemia in CKD
    • Authors: Ana Beatriz; Vargas-Santos Tuhina Neogi
      Abstract: Publication date: September 2017
      Source:American Journal of Kidney Diseases, Volume 70, Issue 3
      Author(s): Ana Beatriz Vargas-Santos, Tuhina Neogi
      Hyperuricemia and gout, the clinical manifestation of monosodium urate crystal deposition, are common in patients with chronic kidney disease (CKD). Although the presence of CKD poses additional challenges in gout management, effective urate lowering is possible for most patients with CKD. Initial doses of urate-lowering therapy are lower than in the non-CKD population, whereas incremental dose escalation is guided by regular monitoring of serum urate levels to reach the target level of <6mg/dL (or <5mg/dL for patients with tophi). Management of gout flares with presently available agents can be more challenging due to potential nephrotoxicity and/or contraindications in the setting of other common comorbid conditions. At present, asymptomatic hyperuricemia is not an indication for urate-lowering therapy, though emerging data may support a potential renoprotective effect.

      PubDate: 2017-08-28T20:19:07Z
       
  • In Reply to ‘Newer GFR Estimating Equations Require Validation in
           Different Populations’
    • Authors: Andrew Levey; Hocine Tighiouart Andrew Simon Lesley Inker
      Abstract: Publication date: Available online 11 August 2017
      Source:American Journal of Kidney Diseases
      Author(s): Andrew S. Levey, Hocine Tighiouart, Andrew L. Simon, Lesley A. Inker


      PubDate: 2017-08-19T11:23:40Z
       
  • Newer GFR Estimating Equations Require Validation in Different Populations
    • Authors: Pierre Delanaye; Natalie Ebert Hans Pottel
      Abstract: Publication date: Available online 11 August 2017
      Source:American Journal of Kidney Diseases
      Author(s): Pierre Delanaye, Natalie Ebert, Hans Pottel


      PubDate: 2017-08-19T11:23:40Z
       
 
 
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