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Publisher: Elsevier   (Total: 3182 journals)

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Showing 1 - 200 of 3182 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 39, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 26, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 105, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 28, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 42, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 7)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6)
Acta Astronautica     Hybrid Journal   (Followers: 442, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 29, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 3)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 11, SJR: 0.18, CiteScore: 1)
Acta Histochemica     Hybrid Journal   (Followers: 5, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 319, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 12, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 26, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access   (Followers: 1)
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 7, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 8)
Acute Pain     Full-text available via subscription   (Followers: 15, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 18, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 9, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 11, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 23)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 187, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 12, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 17, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 30, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 12, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 12, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 24, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 15, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 34, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 5)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 14)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 29, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 11, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 26, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 20, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 15)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 13)
Advances in Digestive Medicine     Open Access   (Followers: 12)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 7)
Advances in Drug Research     Full-text available via subscription   (Followers: 26)
Advances in Ecological Research     Full-text available via subscription   (Followers: 44, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 29, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 8)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 52, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 67, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 17)
Advances in Genetics     Full-text available via subscription   (Followers: 21, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 7, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 26, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 11, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 3, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 37, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 10, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 9, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 21, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 15, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 8, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 25)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 5)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 18, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 27, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 19)
Advances in Pharmacology     Full-text available via subscription   (Followers: 17, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 10)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 6)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 19)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 68)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 2, SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 6)
Advances in Space Research     Full-text available via subscription   (Followers: 424, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 13, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 38, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 20)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 6, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 54, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 388, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 12, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 482, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 18, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 44, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 4)
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 58, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 8, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 12, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 12)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 2, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 11, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 11, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 53, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 6, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 6, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 58, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 66, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 47, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 12)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 37, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 29, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 36, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 50)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 264, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 66, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 32, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 28, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 39, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 7)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 67, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 25, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 5, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 44, SJR: 1.512, CiteScore: 5)
Analytica Chimica Acta : X     Open Access  
Analytical Biochemistry     Hybrid Journal   (Followers: 212, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 13, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 14)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 25, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)
Animal Behaviour     Hybrid Journal   (Followers: 227, SJR: 1.58, CiteScore: 3)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 7, SJR: 0.937, CiteScore: 2)
Animal Reproduction Science     Hybrid Journal   (Followers: 7, SJR: 0.704, CiteScore: 2)

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Similar Journals
Journal Cover
American Journal of Kidney Diseases
Journal Prestige (SJR): 2.973
Citation Impact (citeScore): 4
Number of Followers: 36  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0272-6386 - ISSN (Online) 1523-6838
Published by Elsevier Homepage  [3182 journals]
  • Heavy Chain Deposition Disease: Clinicopathologic Characteristics of a
           Chinese Case Series
    • Abstract: Publication date: Available online 5 November 2019Source: American Journal of Kidney DiseasesAuthor(s): Yuan Zhang, Xiaomei Li, Dandan Liang, Feng Xu, Shaoshan Liang, Xiaodong Zhu, Nanjun Zheng, Xianghua Huang, Zhihong Liu, Caihong ZengRationale & ObjectiveHeavy chain deposition disease (HCDD) is a rare consequence of monoclonal immunoglobulin deposition disease that has not been well characterized in non-white populations. To explore the clinicopathologic characteristics and outcomes of HCDD in Chinese individuals, we report on a case series assembled in a single center in China.Study DesignCase series.Setting & Participants25 patients with biopsy-proven HCDD were studied retrospectively.Results14 men and 11 women with an average age of 50.3 years were studied. The patients presented with hypertension (76%), edema (96%), anemia (84%), serum creatinine level> 1.2 mg/dL (68%), nephrotic-range proteinuria (56%), and microscopic hematuria (80%). One (4%) patient had multiple myeloma diagnosed. Serum immunofixation electrophoresis showed that 10 of 21 (48%) patients were positive for monoclonal immunoglobulin. Hypocomplementemia of C3 was found in 68% of patients. Nodular mesangial sclerosis was identified in all patients by using light microscopy. Using immunofluorescence, all 25 patients had deposition of heavy chains of immunoglobulin G class (γ1, 13; γ2, 2; γ3, 6; γ4, 2; γ1 and γ4, 1; and γ2 and γ4, 1). During an average of 40.1 months of follow-up of 20 patients, 65% had improved kidney function, 10% had worsening kidney function, and 25% progressed to kidney failure. Mean values for kidney and patient survival were 37.8 and 40.1 months, respectively. Kidney survival was higher among patients who received chemotherapy.LimitationsRetrospective study, single-center experience.ConclusionsIn this case series of HCDD in a single center in China, the heavy chain deposits seen in the kidney biopies of all individuals were of immunoglobulin G class. Chemotherapy improved kidney function, especially among individuals in an early stage of the disease.
       
  • US Renal Data System 2019 Annual Data Report: Epidemiology of Kidney
           Disease in the United States
    • Abstract: Publication date: Available online 5 November 2019Source: American Journal of Kidney DiseasesAuthor(s): Rajiv Saran, Bruce Robinson, Kevin C. Abbott, Jennifer Bragg-Gresham, Xiaoying Chen, Debbie Gipson, Haoyu Gu, Richard A. Hirth, David Hutton, Yan Jin, Alissa Kapke, Vivian Kurtz, Yiting Li, Keith McCullough, Zubin Modi, Hal Morgenstern, Purna Mukhopadhyay, Jeffrey Pearson, Ronald Pisoni, Kaitlyn Repeck
       
  • Dialysis Care and Dialysis Funding in Asia
    • Abstract: Publication date: Available online 5 November 2019Source: American Journal of Kidney DiseasesAuthor(s): Sydney C.W. Tang, Xueqing Yu, Hung Chun Chen, Naoki Kashihara, Hyeong Cheon Park, Adrian Liew, Bak Leong Goh, Maria Gina C. Nazareth, Sakarn Bunnag, Jackson Tan, Virithy Lun, Aida Lydia, Sanjib K. Sharma, Ehteshamul Hoque, Ariunaa Togtokh, Mohammad Ghnaimet, Vivekanand JhaAsia is the largest and most populated continent in the world, with a high burden of kidney failure. In this Policy Forum article, we explore dialysis care and dialysis funding in 17 countries in Asia, describing conditions in both developed and developing nations across the region. In 13 of the 17 countries surveyed, diabetes is the most common cause of kidney failure. Due to great variation in gross domestic product per capita across Asian countries, disparities in the provision of kidney replacement therapy (KRT) exist both within and between countries. A number of Asian nations have satisfactory access to KRT and have comprehensive KRT registries to help inform practices, but some do not, particularly among low- and low-to-middle-income countries. Given these differences, we describe the economic status, burden of kidney failure, and cost of KRT across the different modalities to both governments and patients and how changes in health policy over time affect outcomes. Emerging trends suggest that more affluent nations and those with universal health care or access to insurance have much higher prevalent dialysis and transplantation rates, while in less affluent nations, dialysis access may be limited and when available, provided less frequently than optimal. These trends are also reflected by an association between nephrologist prevalence and individual nations’ incomes and a disparity in the number of nephrologists per million population and per thousand KRT patients.
       
  • US Renal Data System 2019 Annual Data Report: Epidemiology of Kidney
           Disease in the United States
    • Abstract: Publication date: Available online 5 November 2019Source: American Journal of Kidney DiseasesAuthor(s):
       
  • A Walking Intervention to Increase Weekly Steps in Dialysis Patients: A
           Pilot Randomized Controlled Trial
    • Abstract: Publication date: Available online 1 November 2019Source: American Journal of Kidney DiseasesAuthor(s): Anoop Sheshadri, Piyawan Kittiskulnam, Ann A. Lazar, Kirsten L. JohansenRationale & ObjectivePatients receiving dialysis report very low physical activity. We implemented a pilot trial to assess the feasibility of a pedometer-based intervention to gather preliminary evidence about its impact on physical activity, symptoms, and surrogates of cardiovascular risk.Study DesignPilot randomized controlled trial.Setting & Participants60 dialysis patients from San Francisco dialysis clinics.InterventionParticipants were randomly assigned 1:1 to receiving pedometers with weekly step goals or usual care for 3 months.OutcomesThe primary outcome was step counts, measured using pedometers. Secondary outcomes included physical performance using the Short Physical Performance Battery, the Physical Function and Vitality scales of the 36-Item Short Form Health Survey, the Dialysis Symptoms Index, and the Center for Epidemiologic Studies–Depression Scale, with endothelial function as a secondary and heart rate variability as an exploratory surrogate measure of cardiovascular risk. Targeted enrollment was 50% and targeted completion was 85%.Results49% of approached patients were enrolled, and 92% completed the study. After 3 months, patients randomly assigned to the intervention (n = 30) increased their average daily steps by 2,256 (95% CI, 978-3,537) more than the 30 controls (P 
       
  • Medical Record Documentation of Goals-of-Care Discussions Among Older
           Veterans With Incident Kidney Failure
    • Abstract: Publication date: Available online 1 November 2019Source: American Journal of Kidney DiseasesAuthor(s): Christina L. Bradshaw, Randall C. Gale, Alexis Chettiar, Sharfun J. Ghaus, I-Chun Thomas, Enrica Fung, Karl Lorenz, Steven M. Asch, Shuchi Anand, Manjula Kurella TamuraRationale & ObjectiveElicitation and documentation of patient preferences is at the core of shared decision making and is particularly important among patients with high anticipated mortality. The extent to which older patients with incident kidney failure undertake such discussions with their providers is unknown and its characterization was the focus of this study.Study DesignRetrospective cohort study.Setting & ParticipantsA random sample of veterans 67 years and older with incident kidney failure receiving care from the US Veterans Health Administration between 2005 and 2010.ExposuresDemographic and facility characteristics, as well as predicted 6-month mortality risk after dialysis initiation and documentation of resuscitation preferences.OutcomesDocumented discussions of dialysis treatment and supportive care.Analytical ApproachWe reviewed medical records over the 2 years before incident kidney failure and up to 1 year afterward to ascertain the frequency and timing of documented discussions about dialysis treatment, supportive care, and resuscitation. Logistic regression was used to identify factors associated with these documented discussions.ResultsThe cohort of 821 veterans had a mean age of 80.9 ± 7.2 years, and 37.2% had a predicted 6-month mortality risk > 20% with dialysis. Documented discussions addressing dialysis treatment and resuscitation were present in 55.6% and 77.1% of patients, respectively. Those addressing supportive care were present in 32.4%. The frequency of documentation varied by mortality risk and whether the patient ultimately started dialysis. In adjusted analyses, the frequency and pattern of documentation were more strongly associated with geographic location and receipt of outpatient nephrology care than with patient demographic or clinical characteristics.LimitationsDocumentation may not fully reflect the quality and content of discussions, and generalizability to nonveteran patients is limited.ConclusionsAmong older veterans with incident kidney failure, discussions of dialysis treatment are decoupled from other aspects of advance care planning and are suboptimally documented, even among patients at high risk for mortality.
       
  • Machine Learning to Predict Acute Kidney Injury
    • Abstract: Publication date: Available online 31 October 2019Source: American Journal of Kidney DiseasesAuthor(s): F. Perry Wilson
       
  • Conservative Kidney Management: Caring for Patients Unlikely to Benefit
           From Dialysis
    • Abstract: Publication date: Available online 31 October 2019Source: American Journal of Kidney DiseasesAuthor(s): Sara N. Davison
       
  • Change in Albuminuria and Estimated GFR as End Points for Clinical Trials
           in Early Stages of CKD: A Perspective From European Regulators
    • Abstract: Publication date: Available online 28 October 2019Source: American Journal of Kidney DiseasesAuthor(s): Frank Holtkamp, Hrefna Gudmundsdottir, Romaldas Maciulaitis, Norbert Benda, Andrew Thomson, Thorsten Vetter
       
  • Change in Estimated GFR and Albuminuria as End Points in Clinical Trials:
           A Viewpoint From the FDA
    • Abstract: Publication date: Available online 28 October 2019Source: American Journal of Kidney DiseasesAuthor(s): Aliza Thompson, Kimberly Smith, John Lawrence
       
  • Change in Estimated GFR and Albuminuria as End Points in Clinical Trials:
           A Perspective of People Living With Kidney Disease
    • Abstract: Publication date: Available online 28 October 2019Source: American Journal of Kidney DiseasesAuthor(s): Mary Baliker, Kent Bressler, Derek Forfang, Kevin J. Fowler, Amanda Grandinetti
       
  • CD9 Is a Novel Target in Glomerular Diseases Typified by Parietal
           Epithelial Cell Activation
    • Abstract: Publication date: Available online 25 October 2019Source: American Journal of Kidney DiseasesAuthor(s): Bart Smeets, Laura Miesen, Stuart J. Shankland
       
  • Characteristics Associated With Peritoneal Dialysis Technique Failure: Are
           We Asking the Right Questions'
    • Abstract: Publication date: November 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 5Author(s): Annie-Claire Nadeau-Fredette, Joanne M. Bargman
       
  • Two Pilgrims
    • Abstract: Publication date: November 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 5Author(s): Özant Helvacı
       
  • Erratum Regarding “Fasting Urinary Osmolality, CKD Progression, and
           Mortality: A Prospective Observational Study” (Am J Kidney Dis.
           2019;73[5]:596-604)
    • Abstract: Publication date: November 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 5Author(s):
       
  • The Association of Altitude and the Prevalence of Anemia Among People With
           CKD
    • Abstract: Publication date: November 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 5Author(s): Yue-Harn Ng, Orrin Myers, Xin Shore, V. Shane Pankratz, Keith C. Norris, Joseph A. Vassalotti, Christos Argyropoulos
       
  • Glucose Control and the Effect of Empagliflozin on Kidney Outcomes in Type
           2 Diabetes: An Analysis From the EMPA-REG OUTCOME Trial
    • Abstract: Publication date: November 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 5Author(s): Mark E. Cooper, Silvio E. Inzucchi, Bernard Zinman, Stefan Hantel, Maximilian von Eynatten, Christoph Wanner, Audrey Koitka-Weber
       
  • Kinetics of Vascular Endothelial Growth Factor and Endothelin 1 Levels in
           Acute Kidney Injury
    • Abstract: Publication date: November 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 5Author(s): Rajesh Mohandas, Bhagwan Dass, A. Ahsan Ejaz
       
  • Déjà Vu But New: Using T Cells to Deplete B Cells to Treat Lupus
    • Abstract: Publication date: November 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 5Author(s): Rebecca E. Sadun, Mary H. Foster
       
  • Acute Renal Colic Due to Immunoglobulin Free Light Chain Kidney Stones: A
           Case Report of an Unusual Complication of Multiple Myeloma
    • Abstract: Publication date: November 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 5Author(s): Antonin Bouchet, Cécile Teuma, Mathilde Nouvier, Pascal Rousset, Vincent Javaugue, Anne Lazareth, Christine Lombard, Sylvie Isaac, Denis FouqueKidney failure is common in patients with a monoclonal gammopathy, most frequently due to hypercalcemia or myeloma cast nephropathy. Immunoglobulin crystallization is an uncommon phenomenon that also results in kidney injury. We report the case of a 74-year-old man with recurrent renal colic and acute kidney injury. He presented with κ light chain Bence-Jones proteinuria, hypogammaglobulinemia, anemia, and high plasma κ light chain level, leading to the diagnosis of κ light chain multiple myeloma. One calculus was collected and its analysis revealed a unique protein structure consisting of κ immunoglobulin free light chain. Genetic sequencing of the κ light chain identified a subgroup of variable domain previously identified as prone to crystallization. Eight cycles of cyclophosphamide-bortezomib-dexamethasone chemotherapy resulted in a partial hematologic response and kidney recovery without recurrence of renal colic. This rare case of urinary light chain nephrolithiasis highlights the importance of genetic and molecular analysis of the immunoglobulin variable domain to better understand the wide spectrum of monoclonal gammopathies.
       
  • Acute Kidney Injury Associated With Human Granulocytic Anaplasmosis: A
           Case Report
    • Abstract: Publication date: November 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 5Author(s): Min Zhuo, Hila Calev, Staci J. Saunders, Jiahua Li, Isaac E. Stillman, John DanzigerTick-borne illnesses are a growing problem in the United States. Human granulocytic anaplasmosis (HGA), carried by the Ixodes scapularis tick, is caused by Anaplasma phagocytophilum. While the clinical manifestations of HGA may be protean, ranging from asymptomatic infection to life-threatening multiorgan failure, renal involvement is uncommon. We report a case of a 64-year-old man presenting with a febrile illness and acute nephritis in the setting of HGA infection. The patient’s kidney biopsy was characterized by a membranoproliferative glomerulonephritis pattern and acute interstitial inflammation. After appropriate antibiotic treatment and high-dose steroids, the patient had a marked improvement in kidney function, although a subsequent recrudescence of nephritis required a 6-month course of additional steroids. As the prevalence of tick-borne diseases continues to spread across the United States, raising awareness of the potential for atypical presentations is important, particularly because early diagnosis and treatment can be curative and prevent further complications.
       
  • Physiology and Pathophysiology of Potassium Homeostasis: Core Curriculum
           2019
    • Abstract: Publication date: November 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 5Author(s): Biff F. Palmer, Deborah J. CleggTotal-body potassium (K+) content and appropriate distribution of K+ across the cell membrane is vitally important for normal cellular function. Total-body K+ content is determined by changes in excretion of K+ by the kidneys in response to intake levels. Under normal conditions, insulin and β-adrenergic tone also make important contributions in maintaining internal distribution of K+. However, despite these homeostatic pathways, disorders of altered K+ homeostasis are common. Appreciating the pathophysiology and regulatory influences that determine the internal distribution and external balance of K+ is critical in designing effective treatments to restore K+ homeostasis. We provide an up-to-date review of the regulatory aspects of normal K+ physiology as a preface to highlighting common disorders in K+ homeostasis and their treatment. This review of K+ homeostasis is designed as a resource for clinicians and a tool for educators who are teaching trainees to understand the pivotal factors involved in K+ balance.
       
  • Women’s Reproductive Health for the Nephrologist
    • Abstract: Publication date: November 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 5Author(s): Anna Burgner, Michelle A. HladunewichWomen with chronic kidney disease (CKD) are faced with complex decisions and significant challenges during their reproductive years. Contraceptive choices have a variety of side effects that can disproportionately affect women with CKD, limiting choice. CKD itself and the therapies needed to treat severe disease can affect future fertility. When conception is desired, young women with CKD must plan meticulously because an ill-timed pregnancy can result in disease progression or flare and exposure of an unborn child to potentially teratogenic medications. Among women with CKD, pregnancy risks are substantial, with up to 10-fold higher risk for preeclampsia and 6-fold higher risk for preterm delivery. These pregnancy complications associated with inadequate placentation also increase maternal and newborn risks for cardiovascular morbidity and mortality and progression to kidney failure later in life. As such, it is the obligation of every nephrologist caring for women of reproductive age to provide guidance in the choice of methods to prevent unplanned pregnancies, to choose treatments that preserve fertility, and to participate in shared decision making that optimizes pregnancy timing and outcomes. In this perspective, we review the many challenges associated with reproductive counseling in women with CKD.
       
  • The Use of Erythropoiesis-Stimulating Agents in Patients With CKD and
           Cancer: A Clinical Approach
    • Abstract: Publication date: November 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 5Author(s): Sumeska Thavarajah, Michael J. ChoiErythropoiesis-stimulating agents (ESAs) have been used to manage anemia in chronic kidney disease (CKD) to reduce transfusion requirements and anemia symptoms. Lack of objective benefit of normalizing hemoglobin (Hb) levels and increased evidence of ESA-induced complications in persons with anemia has resulted in clinicians generally attempting to maintain Hb levels in the 10- to 11-g/dL range. In 2000, concerns in patients with cancer arose attributable to associations of ESA use with increased mortality, thrombotic complications, and cerebrovascular accidents led to a change in US Food and Drug Administration oncology guidelines regarding limitation of ESA use for chemotherapy-induced anemia. No guidance was rendered for individuals with CKD and cancer. Persons with CKD with remote or active malignancy should receive the lowest ESA doses possible that achieve a maximum Hb level of 10 g/dL. Based on current data, although ESAs may promote progression or worsen outcomes in some cancers, we lack data that ESAs increase the likelihood of developing new cancers in patients on dialysis or earlier stages of CKD.
       
  • Ethical Issues in Pragmatic Cluster-Randomized Trials in Dialysis
           Facilities
    • Abstract: Publication date: November 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 5Author(s): Cory E. Goldstein, Charles Weijer, Monica Taljaard, Ahmed A. Al-Jaishi, Erika Basile, Jamie Brehaut, Charles L. Cook, Jeremy M. Grimshaw, Eduardo Lacson, Craig Lindsay, Meg Jardine, Laura M. Dember, Amit X. GargA pragmatic cluster-randomized trial (CRT) is a research design that may be used to efficiently test promising interventions that directly inform dialysis care. While the Ottawa Statement on the Ethical Design and Conduct of Cluster Randomized Trials provides general ethical guidance for CRTs, the dialysis setting raises additional considerations. In this article, we outline ethical issues raised by pragmatic CRTs in dialysis facilities. These issues may be divided into 7 key domains: justifying the use of cluster randomization, adopting randomly allocated individual-level interventions as a facility standard of care, conducting benefit-harm analyses, gatekeepers and their responsibilities, obtaining informed consent from research participants, patient notification, and including vulnerable participants. We describe existing guidelines relevant to each domain, illustrate how they were considered in the Time to Reduce Mortality in End-Stage Renal Disease (TiME) trial (a prototypical pragmatic hemodialysis CRT), and highlight remaining areas of uncertainty. The following is the first step in an interdisciplinary mixed-methods research project to guide the design and conduct of pragmatic CRTs in dialysis facilities. Subsequent work will expand on these concepts and when possible, argue for a preferred solution.
       
  • Direct Delivery of Kidney Transplant Education to Black and Low-Income
           Patients Receiving Dialysis: A Randomized Controlled Trial
    • Abstract: Publication date: November 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 5Author(s): Amy D. Waterman, John Devin Peipert, Anna-Michelle McSorley, Christina J. Goalby, Jennifer L. Beaumont, Leanne PeaceRationale & ObjectiveCompared with others, black and low-income patients receiving dialysis are less likely to receive kidney transplantation (KT) education within dialysis centers. We examined the efficacy of 2 supplementary KT education approaches delivered directly to patients.Study DesignProspective, 3-arm parallel-group, randomized, controlled trial.Settings & ParticipantsAdult, black, and white low-income patients receiving dialysis in Missouri.InterventionPatients were randomly assigned to 1 of 3 educational conditions: (1) standard of care, usual KT education provided in dialysis centers (control); (2) Explore Transplant @ Home patient-guided, 4 modules of KT education sent directly to patients using print, video, and text messages; and (3) Explore Transplant @ Home educator-guided, the patient-guided intervention plus 4 telephonic discussions with an educator.OutcomesPrimary: patient knowledge of living (LDKT) and deceased donor KT (DDKT). Secondary: informed decision making, change in attitudes in favor of LDKT and DDKT, and change in the number of new steps taken toward KT.ResultsIn intent-to-treat analyses, patients randomly assigned to educator- and patient-guided interventions had greater knowledge gains (1.4 point increase) than control patients (0.8 point increase; P = 0.02 and P = 0.01, respectively). Compared with control patients, more patients randomly assigned to educator- and patient-guided interventions were able to make informed decisions about starting KT evaluation (82% vs 91% and 95%; P = 0.003), pursuing DDKT (70% vs 84% and 84%; P = 0.003), and pursuing LDKT (73% vs 91% and 92%; P 
       
  • Microangiopathic Lesions in IgA Nephropathy: A Cohort Study
    • Abstract: Publication date: November 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 5Author(s): Qingqing Cai, Sufang Shi, Suxia Wang, Yali Ren, Wanyin Hou, Lijun Liu, Jicheng Lv, Mark Haas, Hong ZhangRationale & ObjectiveRenal arteriolar microangiopathic lesions may occur in immunoglobulin A nephropathy (IgAN), but their role in disease progression remains unclear. We sought to understand the prevalence and character of microangiopathic lesions in IgAN and their role in disease progression.Study DesignA retrospective cohort study.Setting & ParticipantsIn this study, we enrolled a Chinese cohort with 944 adult patients with IgAN who had been followed up for at least 1 year.PredictorsRenal arteriolar microangiopathic lesions.OutcomesComposite kidney end point event defined as a >50% reduction in estimated glomerular filtration rate, end-stage kidney disease, or death.Analytical ApproachAll kidney biopsies were independently reviewed by 2 investigators. Renal arteriolar microangiopathic lesions were detected using light microscopy. Multivariable Cox regression analysis was used to test the association between microangiopathic lesions and the outcomes.ResultsOverall, 194 (20.6%) patients had renal arteriolar microangiopathic lesions. Patients with microangiopathic lesions presented with higher blood pressures, more severe proteinuria, and lower estimated glomerular filtration rates (all P 
       
  • Intraperitoneal Cefepime Monotherapy Versus Combination Therapy of
           Cefazolin Plus Ceftazidime for Empirical Treatment of CAPD-Associated
           Peritonitis: A Multicenter, Open-Label, Noninferiority, Randomized,
           Controlled Trial
    • Abstract: Publication date: November 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 5Author(s): Thidarat Kitrungphaiboon, Pongpratch Puapatanakul, Piyatida Chuengsaman, Krittaya Tiskajornsiri, Guttiga Halue, Monchai Siribamrungwong, Saraporn Matayart, Kamonrat Chongthanakorn, Ussanee Poonvivatchaikarn, Chanchana Boonyakrai, Wanida Somboonsilp, Pisut Katavetin, Kearkiat Praditpornsilpa, Somchai Eiam-Ong, David W. Johnson, Talerngsak KanjanabuchRationale & ObjectiveCompared to combination therapy, intraperitoneal (IP) cefepime monotherapy for continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis may provide potential benefits in lowering staff burden, shortening time-consuming antibiotic preparation, and reducing bag contamination risk. This study sought to evaluate whether cefepime monotherapy is noninferior to combination regimens.Study DesignMulticenter, open-label, noninferiority, randomized, controlled trial.Setting & ParticipantsAdult incident peritoneal dialysis (PD) patients with CAPD-associated peritonitis in 8 PD centers in Thailand.InterventionsRandom assignment to either IP monotherapy of cefepime, 1 g/d, or IP combination of cefazolin and ceftazidime, 1 g/d, both given as continuous dosing.OutcomesPrimary end point: resolution of peritonitis at day 10 (primary treatment response). Secondary outcomes: initial response (day 5), complete cure (relapse/recurrence-free response 28 days after treatment completion), relapsing/recurrent peritonitis, and death from any cause. Noninferiority would be confirmed for the primary outcome if the lower margin of the 1-sided 95% CI was not less than −10% for difference in the primary response rate. A 2-sided 90% CI was used to demonstrate the upper or lower border of the 1-sided 95% CI.ResultsThere were 144 eligible patients with CAPD-associated peritonitis, of whom 70 and 74 patients were in the monotherapy and combination-therapy groups, respectively. Baseline demographic and clinical characteristics were not different between the groups. The primary response was 82.6% in the monotherapy group and 81.1% in the combination-therapy group (treatment difference, 1.5%; 90% CI, −9.1% to 12.1%; P = 0.04). There was no significant difference in the monotherapy group compared with the combination-therapy group in terms of initial response rate (65.7% vs 60.8%; treatment difference, 4.9%; 95% CI, −10.8% to 20.6%; P = 0.5) and complete cure rate (80.0% vs 80.6%; treatment difference, −0.6%; 95% CI, −13.9% to 12.8%; P = 0.7). Relapsing and recurrent peritonitis occurred in 4.6% and 4.6% of the monotherapy group and 4.2% and 5.6% of the combination-therapy group (P = 0.9 and P = 0.8, respectively). There was nominally higher all-cause mortality in the monotherapy group (7.1% vs 2.7%; treatment difference, 4.4%; 95% CI, −2.6% to 11.5%), but this difference was not statistically significant (P = 0.2).LimitationNot double blind.ConclusionsIP cefepime monotherapy was noninferior to conventional combination therapy for resolution of CAPD-associated peritonitis at day 10 and may be a reasonable alternative first-line treatment.FundingThis study is supported by The Kidney Foundation of Thailand (R5879), Thailand; Rachadaphiseksompotch Fund (RA56/006) and Rachadaphicseksompotch Endorsement Fund (CU-GRS_61_06_30_01), Chulalongkorn University, Thailand; National Research Council of Thailand (156/2560), Thailand; and Thailand Research Foundation (IRG5780017), Thailand.Trial RegistrationRegistered at ClinicalTrials.gov with study number NCT02872038.Graphical abstractGraphical abstract for this article
       
  • Targeting Zero Infections in Hemodialysis
    • Abstract: Publication date: November 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 5Author(s): Alan S. Kliger, Renee Garrick
       
  • Cefepime as Empirical Peritoneal Dialysis–Associated Peritonitis
           Treatment: Something to Dwell On'
    • Abstract: Publication date: November 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 5Author(s): Muthana Al Sahlawi, Adrian Liew, Jeffrey Perl
       
  • Missing the Forest and the Trees: Challenges and Opportunities in Ensuring
           Timely Follow-up of Abnormal Estimated GFR
    • Abstract: Publication date: November 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 5Author(s): Salman Ahmed, Gearoid M. McMahon, Mallika L. Mendu
       
  • Major Advancements in Slowing Diabetic Kidney Disease Progression: Focus
           on SGLT2 Inhibitors
    • Abstract: Publication date: November 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 5Author(s): George L. Bakris
       
  • Longitudinal Evolution of Markers of Mineral Metabolism in Patients With
           CKD: The Chronic Renal Insufficiency Cohort (CRIC) Study
    • Abstract: Publication date: Available online 23 October 2019Source: American Journal of Kidney DiseasesAuthor(s): Tamara Isakova, Xuan Cai, Jungwha Lee, Rupal Mehta, Xiaoming Zhang, Wei Yang, Lisa Nessel, Amanda Hyre Anderson, Joan Lo, Anna Porter, Julie Wright Nunes, Lavinia Negrea, Lee Hamm, Edward Horwitz, Jing Chen, Julia J. Scialla, Ian H. de Boer, Mary B. Leonard, Harold I. Feldman, Myles WolfRationale & ObjectiveThe pathogenesis of disordered mineral metabolism in chronic kidney disease (CKD) is largely informed by cross-sectional studies of humans and longitudinal animal studies. We sought to characterize the longitudinal evolution of disordered mineral metabolism during the course of CKD.Study DesignRetrospective analysis nested in a cohort study.Setting & ParticipantsParticipants in the Chronic Renal Insufficiency Cohort (CRIC) Study who had up to 5 serial annual measurements of estimated glomerular filtration rate, fibroblast growth factor 23 (FGF-23), parathyroid hormone (PTH), serum phosphate, and serum calcium and who subsequently reached end-stage kidney disease (ESKD) during follow-up (n = 847).ExposureYears before ESKD.OutcomesSerial FGF-23, PTH, serum phosphate, and serum calcium levels.Analytical ApproachTo assess longitudinal dynamics of disordered mineral metabolism in human CKD, we used “ESKD-anchored longitudinal analyses” to express time as years before ESKD, enabling assessments of mineral metabolites spanning 8 years of CKD progression before ESKD.ResultsMean FGF-23 levels increased markedly as time before ESKD decreased, while PTH and phosphate levels increased modestly and calcium levels declined minimally. Compared with other mineral metabolites, FGF-23 levels demonstrated the highest rate of change (velocity: first derivative of the function of concentration over time) and magnitude of acceleration (second derivative). These changes became evident approximately 5 years before ESKD and persisted without deceleration through ESKD onset. Rates of changes in PTH and phosphate levels increased modestly and without marked acceleration around the same time, with modest deceleration immediately before ESKD, when use of active vitamin D and phosphate binders increased.LimitationsIndividuals who entered the CRIC Study at early stages of CKD and who did not progress to ESKD were not studied.ConclusionsAmong patients with progressive CKD, FGF-23 levels begin to increase 5 years before ESKD and continue to rapidly accelerate until transition to ESKD.
       
  • In Reply to ‘Bloodstream Infections in Hemodialysis Patients: The Role
           of Dialysis Providers’
    • Abstract: Publication date: Available online 21 October 2019Source: American Journal of Kidney DiseasesAuthor(s): Shannon A. Novosad, Priti R. Patel
       
  • Bloodstream Infections in Hemodialysis Patients: The Role of Dialysis
           Providers
    • Abstract: Publication date: Available online 21 October 2019Source: American Journal of Kidney DiseasesAuthor(s): Robert S. Brown
       
  • Antibiotics and Kidney Stones: Perturbation of the Gut-Kidney Axis
    • Abstract: Publication date: Available online 18 October 2019Source: American Journal of Kidney DiseasesAuthor(s): Gregory Tasian, Aaron Miller, Dirk Lange
       
  • Repairing the Broken
    • Abstract: Publication date: Available online 16 October 2019Source: American Journal of Kidney DiseasesAuthor(s): Maia Celeste Alix-Arbatin
       
  • Symptoms of Secondary Hyperparathyroidism in Patients Receiving
           Maintenance Hemodialysis: A Prospective Cohort Study
    • Abstract: Publication date: Available online 16 October 2019Source: American Journal of Kidney DiseasesAuthor(s): Adrian R. Levy, Shan Xing, Steven M. Brunelli, Kerry Cooper, Fredric O. Finkelstein, Michael J. Germain, Miriam Kimel, Robert W. Platt, Vasily BelozeroffRationale & ObjectiveAlthough multiple lines of evidence suggest a negative impact of secondary hyperparathyroidism on patients with kidney failure treated by hemodialysis, it is uncertain whether patients can detect associated symptoms. The objective was to determine whether changes in parathyroid hormone (PTH) levels are associated with changes in symptoms within this patient population.Study DesignProspective cohort.Setting & Participants165 adults with hyperparathyroidism secondary to kidney failure diagnosed, a range of dialysis vintages, and receiving regular hemodialysis from a US single-provider organization.ExposureChange in PTH levels over 24 weeks.Outcomes19 putative symptoms of secondary hyperparathyroidism measured up to 4 times using a self-administered questionnaire that assessed severity on a 5-level ordinal scale.Analytical ApproachLongitudinal associations between changes in PTH levels and symptom severity were assessed using generalized additive models.ResultsThe 165 participants studied represented 81% of enrollees (N = 204) who had sufficiently complete data for analysis. Mean age was 56 years and 54% were women. Increases in PTH levels over time were associated (P 
       
  • Effect of Vitamin B12 Levels on the Association Between Folic Acid
           Treatment and CKD Progression: A Post Hoc Analysis of a Folic Acid
           Interventional Trial
    • Abstract: Publication date: Available online 16 October 2019Source: American Journal of Kidney DiseasesAuthor(s): Youbao Li, J. David Spence, Xiaobin Wang, Yong Huo, Xiping Xu, Xianhui QinRationale & ObjectiveIn populations with folic acid fortification or supplementation, the main nutritional determinant of total homocysteine levels is vitamin B12 (B12) status. We aimed to evaluate the modifying effect of B12 levels on the association between folic acid treatment and chronic kidney disease (CKD) progression.Study DesignA post hoc analysis of an interventional trial.Setting & ParticipantsThis is a post hoc analysis of 1,374 hypertensive adults with mild to moderate CKD and B12 measurements at baseline from the kidney disease substudy of the China Stroke Primary Prevention Trial (CSPPT), conducted in 20 communities in Jiangsu province in China, a region with low folate consumption.InterventionsAssignments to a double-blinded daily treatment of enalapril, 10 mg, and folic acid, 0.8 mg; or enalapril, 10 mg, alone.OutcomesThe primary outcome was progression of CKD (defined as a decrease in estimated glomerular filtration rate [eGFR] ≥ 30% and to a level of 
       
  • Light Chains With Heavy Effects
    • Abstract: Publication date: Available online 16 October 2019Source: American Journal of Kidney DiseasesAuthor(s): Laura Obici, Giampaolo Merlini
       
  • A Quality Improvement Initiative Targeting CRRT Delivered Dose: The What,
           the How, and the Why
    • Abstract: Publication date: Available online 15 October 2019Source: American Journal of Kidney DiseasesAuthor(s): Javier A. Neyra, Ashita J. Tolwani
       
  • Genetics and ESKD Disparities in African Americans
    • Abstract: Publication date: Available online 10 October 2019Source: American Journal of Kidney DiseasesAuthor(s): Ebele M. Umeukeje, Bessie A. YoungAfrican Americans have a 2- to 4-fold greater incidence of end-stage kidney disease (ESKD) than whites, which has long raised the possibility of a genetic cause for this disparity. Recent advances in genetic studies have shown a causal association of polymorphisms at the apolipoprotein L1 gene (APOL1) with the markedly increased risk for the nondiabetic component of the overall disparity in ESKD in African Americans. Although APOL1-associated kidney disease is thought to account for a substantial proportion of ESKD in African Americans, not all the increased risk for ESKD is accounted for, and a complete cataloging of disparities in genetic causes of ESKD eludes our current understanding of genetic-associated kidney disease. Genetic testing aids the screening, diagnosis, prognosis, and treatment of diseases with a genetic basis. Widespread use of genetic testing in clinical practice is limited by the small number of actionable genetic variants, limited health literacy of providers and patients, and underlying complex ethical, legal, and social issues. This perspective reviews racial and ethnic differences associated with genetic diseases and the development of ESKD in African Americans and discusses potential uncertainties associated with our current understanding of penetrance of genetically linked kidney disease and population-attributable risk percent.
       
  • Diagnosis and Management of Disorders of Body Tonicity—Hyponatremia and
           Hypernatremia: Core Curriculum 2020
    • Abstract: Publication date: Available online 10 October 2019Source: American Journal of Kidney DiseasesAuthor(s): N. Winn Seay, Ruediger W. Lehrich, Arthur GreenbergOverall body fluid concentration is regulated within a narrow range by the concerted action of the hypothalamic-pituitary axis to influence water intake through thirst and water excretion via the effect of vasopressin, or antidiuretic hormone, on renal collecting duct water permeability. Sodium is the principal extracellular cation; abnormalities in overall effective body fluid concentration, or tonicity, manifest as disturbances in serum sodium concentration. Depending on its severity and chronicity, hyponatremia can lead to significant symptoms, primarily related to central nervous system function. Failure to correct hyponatremia can lead to permanent neurologic damage, as can over rapid correction. It is thus essential to stay within specific limits for correction, particularly for chronic hyponatremia. Hypernatremia also leads to central nervous system dysfunction, although goals for its correction rate are less well established. This Core Curriculum article discusses the normal regulation of tonicity and serum sodium concentration and the diagnosis and management of hypo- and hypernatremia.
       
  • Proton Pump Inhibitors and the Kidney: Implications of Current Evidence
           for Clinical Practice and When and How to Deprescribe
    • Abstract: Publication date: Available online 10 October 2019Source: American Journal of Kidney DiseasesAuthor(s): Ziyad Al-Aly, Geetha Maddukuri, Yan XieProton pump inhibitors (PPIs), long thought to be safe, are associated with a number of nonkidney adverse health outcomes and several untoward kidney outcomes, including hypomagnesemia, acute kidney injury, acute interstitial nephritis, incident chronic kidney disease, kidney disease progression, kidney failure, and increased risk for all-cause mortality and mortality due to chronic kidney disease. PPIs are abundantly prescribed, rarely deprescribed, and frequently purchased over the counter. They are frequently used without medical indication, and when medically indicated, they are often used for much longer than needed. In this In Practice review, we summarize evidence linking PPI use with adverse events in general and adverse kidney outcomes in particular. We review the literature on the association of PPI use and risk for hypomagnesemia, acute kidney injury, acute interstitial nephritis, incident chronic kidney disease, kidney disease progression, end-stage kidney disease, and death. We provide an assessment of how this evidence should inform clinical practice. We review the impact of this evidence on patients’ perception of risk, synthesize PPI deprescription literature, and provide our recommendations on how to approach PPI use and deprescription.
       
  • Time to Reconsider Calcium-Based Phosphate Binders in Dialysis' A Call
           for a Well-Designed Randomized Controlled Trial
    • Abstract: Publication date: Available online 9 October 2019Source: American Journal of Kidney DiseasesAuthor(s): Anna Jovanovich
       
  • Trends in Mortality Among Patients Initiating Maintenance Dialysis in
           Puerto Rico Compared to US States, 2006-2015
    • Abstract: Publication date: Available online 9 October 2019Source: American Journal of Kidney DiseasesAuthor(s): Maricruz Rivera-Hernandez, Shailender Swaminathan, Rebecca Thorsness, Yoojin Lee, Rajnish Mehrotra, Benjamin D. Sommers, Amal N. Trivedi
       
  • Health Outcomes and Health Care Utilization Among Obstetric Deliveries
           With Concurrent CKD in the United States
    • Abstract: Publication date: Available online 9 October 2019Source: American Journal of Kidney DiseasesAuthor(s): Andrea L. Oliverio, Lindsay K. Admon, Laura H. Mariani, Tyler N.A. Winkelman, Vanessa K. Dalton
       
  • Thiazide-Associated Hyponatremia: Clinical Manifestations and
           Pathophysiology
    • Abstract: Publication date: Available online 9 October 2019Source: American Journal of Kidney DiseasesAuthor(s): Edward J. Filippone, Mohammed Ruzieh, Andrew FoyHyponatremia can complicate thiazide use in a minority of susceptible individuals and can result in significant morbidity and even mortality. Risk factors for thiazide-associated hyponatremia include age, female sex, and possibly low body mass. A genetic susceptibility has recently been uncovered. Although frequently developing early after thiazide treatment initiation, many cases of hyponatremia present after months or years of use. Many cases are asymptomatic or have mild symptoms, but seizures and/or coma may develop, especially in those with acute onset. The pathophysiology is incompletely understood and includes some combination of excessive fluid intake, cation (sodium and potassium) depletion, osmotic inactivation of sodium, and reduced ability to excrete free water. Reduced distal delivery of filtrate, reduced solute load (urea), direct inhibition of the sodium-chloride cotransporter, and increased collecting duct permeability to water mediated by some combination of antidiuretic hormone, prostaglandins, and thiazides themselves may contribute to this diluting defect. The predominant pathophysiologic mechanism(s) varies from patient to patient. The cornerstone of therapy is cessation of thiazide use, cation repletion, and oral fluid restriction. If severely symptomatic, 3% saline solution may be indicated. Overly rapid correction of chronic hyponatremia must be avoided in all cases.
       
  • Catheter Type, Placement, and Insertion Techniques for Preventing
           Catheter-Related Infections in Maintenance Peritoneal Dialysis Patients:
           Summary of a Cochrane Review
    • Abstract: Publication date: Available online 23 September 2019Source: American Journal of Kidney DiseasesAuthor(s): Htay Htay, David W. Johnson
       
  • Putting Peritoneal Dialysis Catheter Infections Into Perspective
    • Abstract: Publication date: Available online 23 September 2019Source: American Journal of Kidney DiseasesAuthor(s): Beth M. Piraino
       
  • A Diet Rich in Vegetables and Fruit and Incident CKD: A Community-Based
           Prospective Cohort Study
    • Abstract: Publication date: October 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 4Author(s): Jong Hyun Jhee, Youn Kyung Kee, Jung Tak Park, Tae-Ik Chang, Ea Wha Kang, Tae-Hyun Yoo, Shin-Wook Kang, Seung Hyeok HanRationale & ObjectiveA diet rich in vegetables and fruit can lower blood pressure and may reduce cardiovascular risk. However, the association between this dietary pattern and incident chronic kidney disease in the general population is unknown.Study DesignA community-based prospective cohort study.Setting & Participants9,229 study participants with normal kidney function from the Korean Genome and Epidemiology Study database.PredictorsDaily consumption of nonfermented and fermented vegetables and fruit classified into tertiles based on a validated semiquantitative food-frequency questionnaire.OutcomesIncident occurrence of estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2, incident proteinuria (≥1+ by dipstick test), and repeated measures of estimated net endogenous acid production.Analytical ApproachMultivariable cause-specific hazards model to assess the association of vegetable and fruit intake with incident chronic kidney disease.ResultsDuring a mean follow-up of 8.2 years, 1,741 (21.9/1,000 person-years [PY]) participants developed eGFRs < 60 mL/min/1.73 m2. Incident eGFR < 60 mL/min/1.73 m2 occurred less frequently with higher intake of nonfermented vegetables, occurring at rates of 22.8/1,000 PY, 22.7/1,000 PY, and 20.1/1,000 PY for the lowest, middle, and highest tertiles, respectively; P for trend < 0.001. The incidence of proteinuria was also lower in the middle and highest tertiles. In a multivariable cause-specific hazards model, the highest tertile of nonfermented vegetable intake was associated with 14% lower risk for incident eGFR < 60 mL/min/1.73 m2 than the lowest tertile. The highest tertile was also associated with 32% lower risk for proteinuria than the lowest tertile. There were no associations of fermented vegetable and fruit intake with incidence of eGFR < 60 mL/min/1.73 m2. However, the highest tertiles of both fermented vegetable and fruit intake were associated with 14% and 45% lower risks for incident proteinuria compared with the lowest tertiles (both P < 0.001). During follow-up, estimated net endogenous acid production increased in the lowest tertile of intake of nonfermented or fermented vegetables and fruit, whereas it decreased in the highest tertile.LimitationsSelf-reported dietary intake, single ethnicity population.ConclusionsA diet rich in vegetables and fruit may reduce the risk for kidney disease.
       
  • Acute Kidney Injury, Anemia, and Recurrent Dark Red Urine
    • Abstract: Publication date: October 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 4Author(s): Luís P. Falcão, Inês Colaço, Diogo Cruz, Mário Góis, Mário Raimundo
       
  • LECT2 Amyloidosis in Kidney Transplantation: A Report of 5 Cases
    • Abstract: Publication date: October 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 4Author(s): Juan M. Mejia-Vilet, Laura R. Cárdenas-Mastrascusa, Erick J. Palacios-Cebreros, Montserrat Reyes-Macedo, Andrea Portilla-Jiménez, Luis E. Morales-Buenrostro, Abraham Cohen-Bucay, José A. Niño-Cruz, Norma O. Uribe-UribeLeukocyte chemotactic factor 2 (LECT2) amyloidosis is a recently recognized entity that often affects the kidneys. Little information is available regarding kidney transplant outcomes in patients with LECT2 amyloidosis or who received kidney allografts containing LECT2 amyloid. We present clinical findings and allograft outcomes of 5 patients who received kidneys with donor-derived LECT2 amyloidosis. In all 5, LECT2 amyloidosis was discovered during protocol biopsies or in evaluation of suspected rejection. Less than 10% of kidney parenchyma was involved, with mostly interstitial and vascular deposits. Allograft function was not impaired and the amyloid deposits persisted for up to 8 years of follow-up. We conclude that kidneys with limited and localized LECT2 amyloid deposits that are otherwise suitable for transplantation need not be automatically discarded.
       
  • Paraneoplastic Cast Nephropathy Associated With Pancreatic Mixed
           Acinar-Neuroendocrine Carcinoma: A Case Report
    • Abstract: Publication date: October 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 4Author(s): Samih H. Nasr, Edgard Wehbe, Samar M. Said, Surendra Dasari, Truong Quoc, Paul J. KurtinAcute kidney injury is common in patients with cancer and may result from sepsis, obstruction, radiotherapy, chemotherapeutic agents, and nonsteroidal anti-inflammatory drugs. Rare reports of acute kidney injury due to cast nephropathy in patients with pancreatic acinar cell carcinoma have been described, but a pathogenetic link between cast nephropathy and carcinoma was not established. We report a patient with pancreatic mixed acinar-neuroendocrine carcinoma who developed severe acute kidney injury. Kidney biopsy showed cast nephropathy characterized by fractured periodic acid–Schiff–negative casts, associated with mononuclear and giant cell reaction. The patient did not have multiple myeloma and casts did not show immunoglobulin light chain restriction on immunofluorescence. Analysis using liquid chromatography–tandem mass spectrometry and immunohistochemistry identified 2 acinar cell–specific proteins, regenerating islet-derived 1α and carboxypeptidase A1, in both tubular casts and tumor cells. Thus, this case demonstrates that solid tumor–specific proteins can be nephropathic by obstructing renal tubules, resulting in acute kidney injury, a previously proposed but not characterized pathophysiologic mechanism for paraneoplastic nephropathy associated with carcinoma.
       
  • Genetics of Nephrotic Syndrome Presenting in Childhood: Core Curriculum
           2019
    • Abstract: Publication date: October 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 4Author(s): Andreia Watanabe, Luciana S. Feltran, Matthew G. SampsonNephrotic syndrome (NS) is one of the most challenging conditions to manage and treat, partly because we lack a specific molecular understanding of its pathogenesis and progression. This limits our ability to provide targeted therapy or precise prognostications. Fortunately, genomic discovery in NS and its translation to genomic-informed medicine is allowing us to improve our understanding of the molecular anatomy of NS and our ability to care for patients with NS. In this Core Curriculum, we review the specific genes and loci discovered in childhood NS, specifically NS of Mendelian origin, APOL1-associated NS in black patients, HLA region variants associated with steroid-sensitive NS, their biological impacts, prevalence across populations, and clinical correlates. We also review the fundamentals of genetic architecture of human disease, technologies, and analytic strategies that currently exist to discover disease-related genetic variations. A facility with the concepts and vocabulary of modern genomics and ability to interpret results of genetic studies are essential skills for nephrologists caring for children with NS. As such, we hope to empower them to understand the literature in this area, appropriately order genetic tests and accurately interpret the results, and consider how they may participate in or drive the next wave of genomic discoveries in NS.
       
  • APOL1 Genetic Testing in Living Kidney Transplant Donors
    • Abstract: Publication date: October 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 4Author(s): Sumit Mohan, Ana S. Iltis, Deirdre Sawinski, James M. DuBoisThe presence of 2 apolipoprotein L1 gene (APOL1) risk variants is associated with increased risk for chronic kidney disease and end-stage kidney disease. Inferior allograft outcomes following transplantation with kidneys from donors with 2 risk variants have also been reported. These data, coupled with anecdotal case reports and a recent cohort study of living donors, raise important questions about the potential increased kidney disease risk for living donors with APOL1 risk variants and the need for testing as part of the standard living donor evaluation process. We identify a series of questions that are central to the development of clinical policy regarding APOL1 testing of potential living kidney donors given the current uncertainty over the clinical implications of having 2 risk variants. We explore the ethical challenges that arise when determining when and to whom APOL1 testing should be offered, what potential donors should be told about APOL1 testing, how test results should be used to determine suitability for donation, if and when recipients should have access to results, and how clinical policy regarding APOL1 testing should be established.
       
  • The P274S Mutation of Lecithin-Cholesterol Acyltransferase (LCAT) and Its
           Clinical Manifestations in a Large Kindred
    • Abstract: Publication date: October 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 4Author(s): Nikolaos Fountoulakis, Eirini Lioudaki, Dimitra Lygerou, Eleftheria-Kleio Dermitzaki, Ioanna Papakitsou, Vasiliki Kounali, Adriaan G. Holleboom, Spyros Stratigis, Christina Belogianni, Paraskevi Syngelaki, Stavros Stratakis, Athanasios Evangeliou, Hariklia Gakiopoulou, Jan Albert Kuivenhoven, Ron Wevers, Eugene Dafnis, Kostas StylianouRationale & ObjectiveLecithin-cholesterol acyltransferase (LCAT) catalyzes the maturation of high-density lipoprotein. Homozygosity for loss-of-function mutations causes familial LCAT deficiency (FLD), characterized by corneal opacities, anemia, and renal involvement. This study sought to characterize kidney biopsy findings and clinical outcomes in a family with FLD.Study DesignProspective observational study.Setting & Participants2 (related) index patients with clinically apparent FLD were initially identified. 110 of 122 family members who consented to genetic analysis were also studied.PredictorsDemographic and laboratory parameters (including lipid profiles and LCAT activity) and full sequence analysis of the LCAT gene. Kidney histologic examination was performed with samples from 6 participants.OutcomesCardiovascular and renal events during a median follow-up of 12 years. Estimation of annual rate of decline in glomerular filtration rate.Analytical ApproachAnalysis of variance, linear regression analysis, and Fine-Gray competing-risk survival analysis.Results9 homozygous, 57 heterozygous, and 44 unaffected family members were identified. In all affected individuals, full sequence analysis of the LCAT gene revealed a mutation (c.820C>T) predicted to cause a proline to serine substitution at amino acid 274 (P274S). Homozygosity caused a complete loss of LCAT activity. Kidney biopsy findings demonstrated lipid deposition causing glomerular basement membrane thickening, mesangial expansion, and “foam-cell” infiltration of kidney tissue. Tubular atrophy, glomerular sclerosis, and complement fixation were associated with worse kidney outcomes. Estimated glomerular filtration rate deteriorated among homozygous family members at an average annual rate of 3.56 mL/min/1.73 m2. The incidence of cardiovascular and renal complications was higher among homozygous family members compared with heterozygous and unaffected members. Mild thrombocytopenia was a common finding among homozygous participants.LimitationsThe presence of cardiovascular disease was mainly based on medical history.ConclusionsThe P274S LCAT mutation was found to cause FLD with renal involvement. Tubular atrophy, glomerular sclerosis, and complement fixation were associated with a worse renal prognosis.
       
  • Association of Serum Uromodulin With ESKD and Kidney Function Decline in
           the Elderly: The Cardiovascular Health Study
    • Abstract: Publication date: October 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 4Author(s): Dominik Steubl, Petra Buzkova, Pranav S. Garimella, Joachim H. Ix, Prasad Devarajan, Michael R. Bennett, Paolo H.M. Chaves, Michael G. Shlipak, Nisha Bansal, Mark J. SarnakRationale & ObjectiveUromodulin is released by tubular epithelial cells into the serum and lower levels are associated with more severe interstitial fibrosis and tubular atrophy. Low serum uromodulin (sUMOD) levels are associated with mortality and cardiovascular disease. However, little is known about the association of sUMOD levels with long-term kidney outcomes in older adults, a population with a high prevalence of interstitial fibrosis and tubular atrophy.Study DesignCase-cohort study and case-control study.Setting & ParticipantsRandom subcohort (n = 933) and additional cases of end-stage kidney disease (ESKD) and kidney function decline (≥30% decline in estimated glomerular filtration rate [eGFR]) during follow-up of the Cardiovascular Health Study (CHS).PredictorsUMOD level.OutcomesESKD (n = 14) from the random subcohort and all additional ESKD cases from outside the random subcohort (n = 39) during follow-up (10 years, case-cohort study); kidney function decline of ≥30% eGFR at 9 years of follow-up in individuals with repeated eGFR assessments from the random subcohort (n = 56) and additional cases (n = 123). 224 participants from the random subcohort served as controls (case-control study).Analytical ApproachModified multivariable Cox regression for ESKD and multivariable logistic regression for kidney function decline. Both analyses adjusted for demographics, eGFR, urinary albumin-creatinine ratio, and other kidney disease progression risk factors.ResultsMean age of the random subcohort was 78 years, 40% were men, 15% were black. Mean sUMOD level was 127 ± 64 ng/mL and eGFR was 63 ± 19 mL/min/1.73 m2. In multivariable analysis, each 1-SD higher sUMOD level was associated with 63% lower risk for ESKD (HR, 0.37; 95% CI, 0.14-0.95). In demographic-adjusted analyses of kidney function decline, each 1-SD higher sUMOD level was associated with 25% lower odds of kidney function decline (OR, 0.75; 95% CI, 0.60-0.95); after multivariable adjustment, the association was attenuated and no longer significant (OR, 0.88; 95% CI, 0.68-1.14).LimitationsPossibility of survival bias in the kidney function decline analysis.ConclusionsHigher sUMOD levels may identify elderly persons at reduced risk for ESKD.
       
  • Hypertonic Mannitol for the Prevention of Intradialytic Hypotension: A
           Randomized Controlled Trial
    • Abstract: Publication date: October 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 4Author(s): Finnian R. Mc Causland, Brian Claggett, Venkata S. Sabbisetti, Petr Jarolim, Sushrut S. WaikarRationale & ObjectiveIntradialytic hypotension (IDH) is a common complication at the initiation of hemodialysis (HD) therapy, is associated with greater mortality, and may be related to relatively rapid shifts in plasma osmolality. This study sought to evaluate the effect of an intervention to minimize intradialytic changes in plasma osmolality on the occurrence of IDH.Study DesignDouble-blind, single-center, randomized, controlled trial.Setting & ParticipantsIndividuals requiring initiation of HD for acute or chronic kidney disease.InterventionMannitol, 0.25 g/kg/h, versus a similar volume of 0.9% saline solution during the first 3 HD sessions.OutcomesThe primary end point was average decline in systolic blood pressure (SBP). The secondary end point was the proportion of total sessions complicated by IDH (defined as a decrease ≥ 20 mm Hg from the pre-HD SBP). Exploratory end points included biomarkers of cardiac and kidney injury.Results52 patients were randomly assigned and contributed to 156 study visits. There were no significant differences in average SBP decline between the mannitol and placebo groups (15 ± 11 vs 19 ± 16 mm Hg; P = 0.3). The proportion of total sessions complicated by IDH was lower in the mannitol group compared to placebo (25% vs 43%), with a nominally lower risk for developing an episode of IDH (OR, 0.38; 95% CI, 0.14-1.00), though this finding was of borderline statistical significance (P = 0.05). There were no consistent differences in cardiac and kidney injury biomarker levels between treatment groups.LimitationsModest sample size and number of events.ConclusionsIn this pilot randomized controlled trial studying patients requiring initiation of HD, we found no difference in absolute SBP decline between those who received mannitol and those who received saline solution. However, there were fewer overall IDH events and a nominally lower risk for dialysis sessions being complicated by IDH in the mannitol group. A larger multicenter randomized controlled trial is warranted.FundingGovernment funding to an author (Dr Mc Causland is supported by National Institute of Diabetes and Digestive and Kidney Diseases grant K23DK102511).Trial RegistrationRegistered at ClinicalTrials.gov with study number NCT01520207.
       
  • Identifying Needs for Self-management Interventions for Adults With CKD
           and Their Caregivers: A Qualitative Study
    • Abstract: Publication date: October 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 4Author(s): Maoliosa Donald, Heather Beanlands, Sharon Straus, Paul Ronksley, Helen Tam-Tham, Juli Finlay, Jennifer MacKay, Meghan Elliott, Gwen Herrington, Lori Harwood, Chantel A. Large, Claire L. Large, Blair Waldvogel, Dwight Sparkes, Maria Delgado, Allison Tong, Allan Grill, Marta Novak, Matthew T. James, K. Scott BrimbleRationale & ObjectiveFostering the ability of patients to self-manage their chronic kidney disease (CKD), with support from caregivers and providers, may slow disease progression and improve health outcomes. However, little is known about such patients’ needs for self-management interventions. We aimed to identify and describe the needs of adults with CKD and informal caregivers for CKD self-management support.Study DesignDescriptive qualitative study using semi-structured interviews and focus groups.Setting & Participants6 focus groups (37 participants) and 11 telephone interviews with adults with CKD (stages 1-5, not on renal replacement therapy) and informal caregivers from across Canada.Analytic ApproachThematic analysis.Results3 major themes were identified: (1) empowerment through knowledge (awareness and understanding of CKD, diet challenges, medication and alternative treatments, attuning to the body, financial implications, mental and physical health consequences, travel and transportation restrictions, and maintaining work and education), (2) activation through information sharing (access, meaningful and relevant, timing, and amount), and (3) tangible supports for the health journey (family, community, and professionals).LimitationsParticipants were primarily white, educated, married, and English speaking, which limits generalizability.ConclusionsThere are opportunities to enhance CKD self-management support by addressing knowledge pertinent to living well with CKD and priority areas for sharing information and providing tangible support. Future efforts may consider the development of innovative CKD self-management support interventions based on the diverse patient and caregiver needs identified in this study.
       
  • Associations of Cognitive Function and Education Level With All-Cause
           
    • Abstract: Publication date: October 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 4Author(s): Anita van Zwieten, Germaine Wong, Marinella Ruospo, Suetonia C. Palmer, Armando Teixeira-Pinto, Maria Rosaria Barulli, Annalisa Iurillo, Valeria Saglimbene, Patrizia Natale, Letizia Gargano, Marco Murgo, Clement T. Loy, Rosanna Tortelli, Jonathan C. Craig, David W. Johnson, Marcello Tonelli, Jörgen Hegbrant, Charlotta Wollheim, Giancarlo Logroscino, Giovanni F.M. StrippoliRationale & ObjectiveIn the general population, cognitive impairment is associated with increased mortality, and higher levels of education are associated with lower risks for cognitive impairment and mortality. These associations are not well studied in patients receiving long-term hemodialysis and were the focus of the current investigation.Study DesignProspective cohort study.Setting & ParticipantsAdult hemodialysis patients treated in 20 Italian dialysis clinics.ExposuresPatients’ cognitive function across 5 domains (memory, attention, executive function, language, and perceptual-motor function), measured using a neuropsychological assessment comprising 10 tests; and patients’ self-reported years of education.OutcomeAll-cause mortality.Analytical ApproachNested multivariable Cox regression models were used to examine associations of cognition (any domain impaired, number of domains impaired, and global function score from principal components analysis of unadjusted test scores) and education with mortality and whether there were interactions between them.Results676 (70.6%) patients participated, with a median age of 70.9 years and including 38.8% women. Cognitive impairment was present in 79.4% (527/664; 95% CI, 76.3%-82.5%). During a median follow-up of 3.3 years (1,874 person-years), 206 deaths occurred. Compared to no cognitive impairment, adjusted HRs for mortality were 1.77 (95% CI, 1.07-2.93) for any impairment, 1.48 (95% CI, 0.82-2.68) for 1 domain impaired, 1.88 (95% CI, 1.01-3.53) for 2 domains, and 2.01 (95% CI, 1.14-3.55) for 3 to 5 domains. The adjusted HR was 0.68 (95% CI, 0.51-0.92) per standard deviation increase in global cognitive function score. Compared with primary or lower education, adjusted HRs were 0.79 (95% CI, 0.53-1.20) for lower secondary and 1.13 (95% CI, 0.80-1.59) for upper secondary or higher. The cognition-by-education interaction was not significant (P = 0.7).LimitationsPotential selection bias from nonparticipation and missing data; no data for cognitive decline; associations with education were not adjusted for other socioeconomic factors.ConclusionsCognitive impairment is associated with premature mortality in hemodialysis patients. Education does not appear to be associated with mortality.Graphical abstractGraphical abstract for this article
       
  • Association of Kidney Transplant Center Volume With 3-Year Clinical
           Outcomes
    • Abstract: Publication date: October 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 4Author(s): Elizabeth M. Sonnenberg, Jordana B. Cohen, Jesse Y. Hsu, Vishnu S. Potluri, Matthew H. Levine, Peter L. Abt, Peter P. ReeseRationale & ObjectiveA robust relationship between procedure volume and clinical outcomes has been demonstrated across many surgical fields. This study assessed whether a center volume–outcome relationship exists for contemporary kidney transplantation, specifically for diabetic recipients, older recipients (aged ≥65 years), and recipients of high kidney donor profile index (KDPI ≥ 85) kidneys.Study DesignRetrospective cohort study.Setting & ParticipantsAdult kidney-only transplant recipients who underwent transplantation between 2009 and 2013 (N = 79,581).ExposuresThe primary exposure variable was center volume, categorized into quartiles based on the total kidney transplantation volume. Quartile 1 (Q1) centers performed a mean of fewer than 66 kidney transplantations per year, whereas Q4 centers performed a mean of more than 196 kidney transplantations per year.OutcomesAll-cause graft failure and mortality within 3 years of transplantation.Analytical ApproachMultivariable Cox frailty models were used to adjust for donor characteristics, recipient characteristics, and cold ischemia time.ResultsMinor differences in rates of 3-year deceased donor all-cause graft failure across quartiles of center volume were observed (14.9% for Q1 vs 16.7% for Q4), including in subgroups (diabetic recipients, 18.4% for Q1 vs 19.7% for Q4; older recipients, 19.4% for Q1 vs 22.5% for Q4; recipients of high KDPI kidneys, 26.5% for Q1 vs 26.5% for Q4). Results were similar for 3-year mortality. After adjustment for donor, recipient, and graft characteristics using Cox regression, center volume was not significantly associated with all-cause graft failure or mortality within 3 years, except that diabetic recipients at Q3 centers had slightly lower mortality (compared with Q1 centers, adjusted HR of 0.85 [95% CI, 0.73-0.99]).LimitationsPotential unmeasured confounding from patient comorbid conditions and organ selection.ConclusionsThese findings provide little evidence that care in higher volume centers is associated with better adjusted outcomes for kidney transplant recipients, even in populations anticipated to be at increased risk for graft failure or death.
       
  • Treatment Strategies in CKD Patients With Suspected Coronary Artery
           Disease
    • Abstract: Publication date: October 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 4Author(s): Robert N. Foley
       
  • Probiotics and CKD Progression: Are Creatinine-Based Estimates of GFR
           Applicable'
    • Abstract: Publication date: October 2019Source: American Journal of Kidney Diseases, Volume 74, Issue 4Author(s): Kenneth D. Lempert
       
  • A Psychiatrist’s View on Patient-Reported Outcomes in Patients
           Undergoing Hemodialysis
    • Abstract: Publication date: Available online 19 September 2019Source: American Journal of Kidney DiseasesAuthor(s): Jakub Grabowski, Alicja Kubanek
       
  • In Reply to ‘A Psychiatrist’s View on Patient-Reported Outcomes in
           Patients Undergoing Hemodialysis’
    • Abstract: Publication date: Available online 19 September 2019Source: American Journal of Kidney DiseasesAuthor(s): Nicola Elizabeth Anderson, Melanie Calvert, Paul Cockwell, Mary Dutton, Derek Kyte
       
  • In Reply to ‘Urinary Concentration Capacity, Glomerular Filtration Rate,
           and Mortality in the General American Population’
    • Abstract: Publication date: Available online 26 August 2019Source: American Journal of Kidney DiseasesAuthor(s): Nahid Tabibzadeh, Bénédicte Stengel, Jean-Philippe Haymann
       
  • Urinary Concentration Capacity, Glomerular Filtration Rate, and Mortality
           in the General American Population
    • Abstract: Publication date: Available online 26 August 2019Source: American Journal of Kidney DiseasesAuthor(s): Jacob J.E. Koopman
       
  • Transplant Center Volume: Is Bigger Better'
    • Abstract: Publication date: Available online 26 July 2019Source: American Journal of Kidney DiseasesAuthor(s): John R. Montgomery, Randall S. Sung, Kenneth J. Woodside
       
  • Cognitive Impairment and Mortality in Patients Receiving Hemodialysis:
           Implications and Future Research Avenues
    • Abstract: Publication date: Available online 24 July 2019Source: American Journal of Kidney DiseasesAuthor(s): Katharine L. Cheung, Michael A. LaMantia
       
  • Kidney Complications of Immune Checkpoint Inhibitors: A Review
    • Abstract: Publication date: Available online 11 July 2019Source: American Journal of Kidney DiseasesAuthor(s): Roman Shingarev, Ilya G. GlezermanImmunologic control of malignancy has long been recognized as an important determinant of disease progression. Recent advances in immunology have led to the focus on several mechanisms that can be targeted to achieve tumor suppression. In particular, checkpoint inhibition has evolved in less than a decade to become one of the most important strategies in cancer therapy, with a meaningful improvement in patient survival. Six agents have been approved for clinical use to date and many more are in the industry pipeline. The spectrum of malignancies responsive to immunotherapy ranges from advanced melanoma, for which the first immune checkpoint inhibitor ipilimumab was approved, to Hodgkin lymphoma, non–small cell lung cancer, renal cell carcinoma, and others. Notwithstanding its clinical benefits, checkpoint inhibition carries a risk for significant off-target toxicity stemming from the immune system activation. In this review, we discuss general principles of checkpoint inhibition, mechanisms of toxicity, and kidney complications of the treatment and propose diagnostic and treatment strategies when kidney injury occurs.
       
  • Are There Consequences of Adolescent Blood Pressure on Kidney Function in
           Adulthood'
    • Abstract: Publication date: Available online 27 June 2019Source: American Journal of Kidney DiseasesAuthor(s): Douglas L. Blowey, Joseph T. Flynn, Bradley A. Warady
       
  • Second-Chance Placement of Hemodialysis Patients After Involuntary
           Discharge for Disruptive Behavior
    • Abstract: Publication date: Available online 27 June 2019Source: American Journal of Kidney DiseasesAuthor(s): Michael Allon, Denyse Thornley-Brown, Dana V. Rizk, Arlene J. CarrasquilloA small subset of hemodialysis patients exhibits persistently disruptive behavior. When all reasonable attempts to stop such behavior have been exhausted, they may undergo involuntary discharge from their dialysis unit. Such patients typically present repeatedly to the emergency department for urgent inpatient dialysis. We describe a novel approach to achieve a successful “second-chance” placement at a new outpatient dialysis unit. The patients were required to dialyze in the inpatient unit for a minimum of 3 months, during which their compliance and behavior were observed closely. In parallel, an experienced social worker in the emergency department applied a structured protocol. The approach included debriefing about the incident leading to the discharge, coaching about building a trusting relationship with the nephrologist and dialysis staff, education about constructive handling of grievances, and arranging a face-to-face office interview with the medical director to determine their potential acceptance. Finally, the emergency department social worker conducted a formal handoff with the social worker at the accepting facility. During a 4-year period, we accrued 12 patients with an involuntary discharge. Following this protocol, 7 of them have been successfully placed at a new outpatient dialysis unit for 77 to 650 days without recurrence of disruptive behavior.
       
  • Comparative Effectiveness of Medical Therapy, Percutaneous
           Revascularization, and Surgical Coronary Revascularization in
           Cardiovascular Risk Subgroups of Patients With CKD: A Retrospective Cohort
           Study of Medicare Beneficiaries
    • Abstract: Publication date: Available online 27 June 2019Source: American Journal of Kidney DiseasesAuthor(s): David M. Charytan, Tanya Natwick, Craig A. Solid, Shuling Li, Tingting Gong, Charles A. HerzogRationale & ObjectivePrior studies suggesting that medical therapy is inferior to percutaneous (percutaneous coronary intervention [PCI]) or surgical (coronary artery bypass grafting [CABG]) coronary revascularization in chronic kidney disease (CKD) have not adequately considered medication optimization or baseline cardiovascular risk and have infrequently evaluated progression to kidney failure. We compared, separately, the risks for kidney failure and death after treatment with PCI, CABG, or optimized medical therapy for coronary disease among patients with CKD stratified by cardiovascular disease risk.Study DesignRetrospective cohort study.Setting & Participants34,385 individuals with CKD identified from a national 20% Medicare sample who underwent angiography or diagnostic stress testing without (low risk) or with (medium risk) prior cardiovascular disease or who presented with acute coronary syndrome (high risk).ExposuresPCI, CABG, or optimized medical therapy (defined by the addition of cardiovascular medications in the absence of coronary revascularization).OutcomesDeath, kidney failure, composite outcome of death or kidney failure.Analytical ApproachAdjusted relative rates of death, kidney failure, and the composite of death or kidney failure estimated from Cox proportional hazards models.ResultsAmong low-risk patients, 960 underwent PCI, 391 underwent CABG, and 6,426 received medical therapy alone; among medium-risk patients, 1,812 underwent PCI, 512 underwent CABG, and 9,984 received medical therapy alone; and among high-risk patients, 4,608 underwent PCI, 1,330 underwent CABG, and 8,362 received medical therapy alone. Among low- and medium-risk patients, neither CABG (HRs of 1.22 [95% CI, 0.96-1.53] and 1.08 [95% CI, 0.91-1.29] for low- and medium-risk patients, respectively) nor PCI (HRs of 1.14 [95% CI, 0.98-1.33] and 1.02 [95% CI, 0.93-1.12], respectively) were associated with reduced mortality compared with medical therapy, but in low-risk patients, CABG was associated with a higher rate of the composite, death or kidney failure (HR, 1.25; 95% CI, 1.02-1.53). In high-risk patients, CABG and PCI were associated with lower mortality (HRs of 0.57 [95% CI, 0.51-0.63] and 0.70 [95% CI, 0.66-0.74], respectively). Also, in high-risk patients, CABG was associated with a higher rate of kidney failure (HR, 1.40; 95% CI, 1.16-1.69).LimitationsPossible residual confounding; lack of data for coronary angiography or left ventricular ejection fraction; possible differences in decreased kidney function severity between therapy groups.ConclusionsOutcomes associated with cardiovascular therapies among patients with CKD differed by baseline cardiovascular risk. Coronary revascularization was not associated with improved survival in low-risk patients, but was associated with improved survival in high-risk patients despite a greater observed rate of kidney failure. These findings may inform clinical decision making in the care of patients with both CKD and cardiovascular disease.
       
 
 
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