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Publisher: Elsevier   (Total: 3118 journals)

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Showing 1 - 200 of 3118 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 7)
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 25, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 89, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 30, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 372, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 27, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 236, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 10, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 25, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 4, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 2)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 5)
Acute Pain     Full-text available via subscription   (Followers: 13)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 6)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Cement Based Materials     Full-text available via subscription   (Followers: 3)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 137, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 27, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 11, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 26, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 4)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 13)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 26, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 9, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 29, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Dermatology     Full-text available via subscription   (Followers: 12)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 12)
Advances in Digestive Medicine     Open Access   (Followers: 7)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 6)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 46, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 26, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 8)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 44, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 52, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 16)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 22, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 36, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 23)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 9, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 62)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.1, h-index: 2)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 366, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 8, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 31, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 16)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 6, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 45, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 335, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 5, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 9, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 448, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 41, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 56, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 11, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 8)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access   (Followers: 1)
Algal Research     Partially Free   (Followers: 8, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 4, SJR: 0.776, h-index: 35)
Alpha Omegan     Full-text available via subscription   (SJR: 0.121, h-index: 9)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 48, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 49, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 48, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 41, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 9, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 32, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 26, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 31, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 46, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 202, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 60, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 6)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 24, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 27, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 26, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 35, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 6)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 59, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 13)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 4, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 36, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 163, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 12)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  

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Journal Cover American Journal of Kidney Diseases
  [SJR: 2.313]   [H-I: 172]   [31 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0272-6386 - ISSN (Online) 1523-6838
   Published by Elsevier Homepage  [3118 journals]
  • Update on Anemia in ESRD and Earlier Stages of CKD: Core Curriculum 2018
    • Authors: Steven Fishbane; Bruce Spinowitz
      Abstract: Publication date: Available online 11 January 2018
      Source:American Journal of Kidney Diseases
      Author(s): Steven Fishbane, Bruce Spinowitz
      Anemia is a frequent complication during the later stages of chronic kidney disease. When present, it may cause symptoms such as fatigue and shortness of breath. The pathogenesis of anemia in chronic kidney disease is complex, but a central feature is a relative deficit of erythropoietin. New information has elucidated the critical role of the hypoxia-sensing system in mediating erythropoietin synthesis and release. Iron deficiency is a second important factor in the anemia of chronic kidney disease. New insights into the dynamics of iron metabolism have clarified the role of chronic inflammation and hepcidin as key mediators of impaired iron utilization. In this article, we review the epidemiology, pathobiology, clinical evaluation, and treatment of anemia in chronic kidney disease.

      PubDate: 2018-01-13T18:08:39Z
       
  • Evaluation of Kidney Donors: Core Curriculum 2018
    • Authors: Deirdre Sawinski; Jayme Locke
      Abstract: Publication date: Available online 11 January 2018
      Source:American Journal of Kidney Diseases
      Author(s): Deirdre Sawinski, Jayme E. Locke
      Nearly 100,000 patients are waiting for a kidney transplant, yet each year only 11,000 undergo transplantation with a deceased donor kidney. Annual death rates among waitlist registrants range from 5% to 15%; many die before receiving a transplant. Not surprisingly, registrants turn to family and friends to become living kidney donors on their behalf. Living kidney donor selection practices aim to quantify lifetime risk for kidney failure based on a candidate’s predonation demographic and health characteristics. It has been established that estimated lifetime risk for kidney failure varies considerably based on predonation comorbid conditions, and as such, it is of paramount importance that potential living donor candidates undergo proper medical, surgical, and psychosocial screening before donation. This installment of AJKD’s Core Curriculum in Nephrology provides readers with the tools necessary for proper evaluation of living kidney donor candidates.

      PubDate: 2018-01-13T18:08:39Z
       
  • Factors Associated With Withdrawal From Maintenance Dialysis: A
           Case-Control Analysis
    • Authors: James Wetmore; Heng Yan Yan David Gilbertson Jiannong Liu
      Abstract: Publication date: Available online 10 January 2018
      Source:American Journal of Kidney Diseases
      Author(s): James B. Wetmore, Heng Yan, Yan Hu, David T. Gilbertson, Jiannong Liu
      Background Little is known about differences in the clinical course between patients receiving maintenance dialysis who do and do not withdraw from dialysis therapy. Study Design Case-control analysis. Setting & Participants US patients with Medicare coverage who received maintenance hemodialysis for 1 year or longer in 2008 through 2011. Predictors Comorbid conditions, hospitalizations, skilled nursing facility stays, and a morbidity score based on durable medical equipment claims. Outcome Withdrawal from dialysis therapy. Measurements Rates of medical events, hospitalizations, skilled nursing facility stays, and a morbidity score. Results The analysis included 18,367 (7.7%) patients who withdrew and 220,443 (92.3%) who did not. Patients who withdrew were older (mean age, 75.3±11.5 [SD] vs 66.2±14.1 years) and more likely to be women and of white race, and had higher comorbid condition burdens. The odds of withdrawal among women were 7% (95% CI, 4%-11%) higher than among men. Compared to age 65 to 74 years, age 85 years or older was associated with higher adjusted odds of withdrawal (adjusted OR, 1.61; 95% CI, 1.54-1.68), and age 18 to 44 years with lower adjusted odds (adjusted OR, 0.36; 95% CI, 0.32-0.40). Blacks, Asians, and Hispanics were less likely to withdraw than whites (adjusted ORs of 0.36 [95% CI, 0.35-0.38], 0.47 [95% CI, 0.42-0.53], and 0.46 [95% CI, 0.44-0.49], respectively). A higher durable medical equipment claims-based morbidity score was associated with withdrawal, even after adjustment for traditional comorbid conditions and hospitalization; compared to a score of 0 (lowest presumed morbidity), adjusted ORs of withdrawal were 3.48 (95% CI, 3.29-3.67) for a score of 3 to 4 and 12.10 (95% CI, 11.37-12.87) for a score ≥7. Rates of medical events and institutionalization tended to increase in the months preceding withdrawal, as did morbidity score. Limitations Results may not be generalizable beyond US Medicare patients; people who withdrew less than 1 year after dialysis therapy initiation were not studied. Conclusions Women, older patients, and those of white race were more likely to withdraw from dialysis therapy. The period before withdrawal was characterized by higher rates of medical events and higher levels of morbidity.

      PubDate: 2018-01-13T18:08:39Z
       
  • End-of-Life Care for Patients With Advanced Kidney Disease in the US
           Veterans Affairs Health Care System, 2000-2011
    • Authors: Susan P.Y.; Wong Margaret Pamela Green Chuan-Fen Liu Paul Hebert
      Abstract: Publication date: Available online 10 January 2018
      Source:American Journal of Kidney Diseases
      Author(s): Susan P.Y. Wong, Margaret K. Yu, Pamela K. Green, Chuan-Fen Liu, Paul L. Hebert, Ann M. O’Hare
      Background Little is known about patterns of end-of-life care for patients with advanced kidney disease not treated with maintenance dialysis. Study Design Case series. Setting & Participants A sample of 14,071 patients with sustained estimated glomerular filtration rates < 15mL/min/1.73m2 treated in the US Veterans Affairs health care system who died during 2000 to 2011. Before death, 12,756 of these patients had been treated with dialysis, 503 had been discussing and/or preparing for dialysis therapy, and for 812, there had been a decision not to pursue dialysis therapy. Outcomes Hospitalization and receipt of an intensive procedure during the final month of life, in-hospital death, and palliative care consultation and hospice enrollment before death. Results Compared with decedents treated with dialysis, those for whom a decision not to pursue dialysis therapy had been made were less often hospitalized (57.3% vs 76.8%; OR, 0.40 [95% CI, 0.34-0.46]), less often the recipient of an intensive procedure (3.5% vs 24.6%; OR, 0.15 [95% CI, 0.10-0.22]), more often the recipient of a palliative care consultation (52.6% vs 21.6%; OR, 4.19 [95% CI, 3.58-4.90]), more often used hospice services (38.7% vs 18.2%; OR, 3.32 [95% CI, 2.83-3.89]), and died less frequently in a hospital (41.4% vs 57.3%; OR, 0.78 [95% CI, 0.74-0.82]). Hospitalization (55.5%; OR, 0.39 [95% CI, 0.32-0.46]), receipt of an intensive procedure (13.7%; OR, 0.60 [95% CI, 0.46-0.77]), and in-hospital death (39.0%; OR, 0.47 [95% CI, 0.39-0.56]) were also less common among decedents who had been discussing and/or preparing for dialysis therapy, but their use of palliative care and hospice services was similar. Limitations Findings may not be generalizable to groups not well represented in the Veterans Affairs health care system. Conclusions Among decedents, patients not treated with dialysis before death received less intensive patterns of end-of-life care than those treated with dialysis. Decedents for whom there had been a decision not to pursue dialysis therapy before death were more likely to receive palliative care and hospice.

      PubDate: 2018-01-13T18:08:39Z
       
  • Atypical Presentation of Pregnancy-Related Hemolytic Uremic Syndrome
    • Authors: Salim Baghli; Catherine Abendroth Umar Farooq Jennifer Schaub
      Abstract: Publication date: Available online 10 January 2018
      Source:American Journal of Kidney Diseases
      Author(s): Salim Baghli, Catherine Abendroth, Umar Farooq, Jennifer A. Schaub
      The cause of acute kidney injury during pregnancy and in the postpartum period can be particularly challenging to diagnose, especially when it is necessary to differentiate among preeclampsia; eclampsia; hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome; and thrombotic microangiopathies (TMAs). All these disease entities can present with kidney failure, microangiopathic hemolytic anemia, and thrombocytopenia. We present a teaching case of atypical hemolytic uremic syndrome in the postpartum period in a young woman who was found to have mutations of uncertain clinical significance in the complement cascade, including in C3, CFH, and CFI. We use this as an opportunity to review the clinical presentation and pathophysiology of preeclampsia, eclampsia, and the TMAs. We focus on diagnostic challenges, especially because many patients with TMA do not present with thrombocytopenia, which can delay diagnosis. We additionally review the clinical settings in which administration of eculizumab, a C5 membrane attack complex inhibitor, is appropriate.

      PubDate: 2018-01-13T18:08:39Z
       
  • NephMadness After 5 Years: A Recap and Game Plan for the Future
    • Authors: Matthew Sparks; Joel Topf
      Abstract: Publication date: Available online 8 January 2018
      Source:American Journal of Kidney Diseases
      Author(s): Matthew A. Sparks, Joel M. Topf


      PubDate: 2018-01-13T18:08:39Z
       
  • Prognostic Value of High-Sensitivity Versus Conventional Cardiac Troponin
           T Assays Among Patients With Type 2 Diabetes Mellitus Undergoing
           Maintenance Hemodialysis
    • Authors: Till Keller; Christoph Wanner Vera Krane Daniel Kraus Bernd Genser
      Abstract: Publication date: Available online 6 January 2018
      Source:American Journal of Kidney Diseases
      Author(s): Till Keller, Christoph Wanner, Vera Krane, Daniel Kraus, Bernd Genser, Hubert Scharnagl, Winfried März, Christiane Drechsler
      Background Mortality is high among patients undergoing hemodialysis for whom cardiac troponin concentration is a strong predictor of outcome. Modern troponin assays allow measurement of very low concentrations. Study Design Using data from a randomized controlled trial, a cohort analysis to evaluate the prognostic value of very low cardiac troponin T (TnT) concentrations. Setting & Participants 1,255 patients with end-stage renal disease and type 2 diabetes mellitus undergoing maintenance hemodialysis from the German Diabetes and Dialysis Study (4D) who had a median follow-up of 4 years. Index Test, Reference Test, and Outcome Cardiac TnT was measured using a high-sensitivity assay (hs-TnT) and a conventional assay (conventional TnT) in a subpopulation (n=1,034) with valid measurements for both assays. Outcome measures were all-cause mortality and a composite cardiovascular end point including cardiac death, myocardial infarction, or stroke. Results Among the 1,034 study participants, 505 died and 377 had a cardiovascular event. Both hs-TnT and conventional TnT concentrations were associated with mortality and cardiovascular events in models adjusted for cardiovascular risk factors and dialysis-associated variables. 455 (44%) patients with very low TnT concentrations (hs-TNT < 50ng/L) would have been classified as normal by the conventional TnT assay. Among these patients, hs-TnT concentrations were also associated with mortality. Limitations The study of patients with type 2 diabetes may limit generalizability. These findings have not been externally validated. Conclusions In patients with type 2 diabetes mellitus receiving hemodialysis, cardiac TnT is associated with long-term mortality and cardiovascular outcomes. Concentrations of TnT not measurable with acceptable precision using a conventional TnT assay were associated with a poor prognosis when measured using a high-sensitivity assay.

      PubDate: 2018-01-13T18:08:39Z
       
  • Patterns of Kidney Function Decline in Autosomal Dominant Polycystic
           Kidney Disease: A Post Hoc Analysis From the HALT-PKD Trials
    • Authors: Godela Brosnahan; Kaleab Abebe Charity Moore Frederic Rahbari-Oskoui Kyongtae Bae
      Abstract: Publication date: Available online 3 January 2018
      Source:American Journal of Kidney Diseases
      Author(s): Godela M. Brosnahan, Kaleab Z. Abebe, Charity G. Moore, Frederic F. Rahbari-Oskoui, Kyongtae T. Bae, Jared J. Grantham, Robert W. Schrier, William E. Braun, Arlene B. Chapman, Michael F. Flessner, Peter C. Harris, Marie C. Hogan, Ronald D. Perrone, Dana C. Miskulin, Theodore I. Steinman, Vicente E. Torres
      Background Previous clinical studies of autosomal dominant polycystic kidney disease (ADPKD) reported that loss of kidney function usually follows a steep and relentless course. A detailed examination of individual patterns of decline in estimated glomerular filtration rate (eGFR) has not been performed. Study Design Longitudinal post hoc analysis of data collected during the Halt Progression of Polycystic Kidney Disease (HALT-PKD) trials. Setting & Participants 494 HALT-PKD Study A participants (younger; preserved eGFR) and 435 Study B participants (older; reduced eGFR) who had more than 3 years of follow-up and 7 or more eGFR assessments. Measurements Longitudinal eGFR assessments using the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) creatinine equation. Predictors Demographic, clinical, laboratory, and imaging features of participants. Outcomes Probability of linear and nonlinear decline patterns or of stable eGFR calculated for each participant from a Bayesian model of individual eGFR trajectories. Results Most (62.5% in Study A and 81% in Study B) participants had a linear decline in eGFR during up to 8 years of follow-up. A proportion (22% in Study A and 13% in Study B) of progressors had a nonlinear pattern. 15.5% of participants in Study A and 6% in Study B had a prolonged (≥4.5 years) period of stable eGFRs. These individuals (Study A) had significantly smaller total kidney volumes, higher renal blood flows, lower urinary albumin excretion, and lower body mass index at baseline and study end. In Study B, participants with reduced but stable eGFRs were older than the progressors. Two-thirds of nonprogressors in both studies had PKD1 mutations, with enrichment for weak nontruncating mutations. Limitations Relatively short follow-up of a clinical trial population. Conclusions Although many individuals with ADPKD have a linear decline in eGFR, prolonged intervals of stable GFRs occur in a substantial fraction. Lower body mass index was associated with more stable kidney function in early ADPKD.

      PubDate: 2018-01-03T10:10:56Z
       
  • Impact of Electronic Acute Kidney Injury (AKI) Alerts With Automated
           Nephrologist Consultation on Detection and Severity of AKI: A Quality
           Improvement Study
    • Authors: Sehoon Park; Seon Baek Soyeon Ahn Kee-Hyuk Lee Hee Hwang
      Abstract: Publication date: January 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 1
      Author(s): Sehoon Park, Seon Ha Baek, Soyeon Ahn, Kee-Hyuk Lee, Hee Hwang, Jiwon Ryu, Shin Young Ahn, Ho Jun Chin, Ki Young Na, Dong-Wan Chae, Sejoong Kim
      Background Several electronic alert systems for acute kidney injury (AKI) have been introduced. However, their clinical benefits require further investigation. Study Design Before-and-after quality improvement study. Setting & Participants A tertiary teaching hospital in Korea, which adopted an AKI alert system on June 1, 2014. Before and after launch of the alert system, 1,884 and 1,309 patients with AKI were included in the usual-care and alert groups, respectively. Quality Improvement Plan Implementation of an AKI alert system through which clinicians could generate automated consultations to the nephrology division for all hospitalized patients. Outcomes Primary outcomes included overlooked AKI events, defined as not measuring the follow-up creatinine value, and the consultation pattern of clinicians. Secondary outcomes were severe AKI events; AKI recovery, defined based on the creatinine-based criterion; and patient mortality. Measurements ORs for events of overlooked AKI, early consultation, and severe AKI were calculated with logistic regression. AKI recovery rate and patient mortality were assessed using Cox regression. Results After introduction of the alert system, the odds of overlooked AKI events were significantly lower (adjusted OR, 0.40; 95% CI, 0.30-0.52), and the odds of an early consultation with a nephrologist were greater (adjusted OR, 6.13; 95% CI, 4.80-7.82). The odds of a severe AKI event was reduced after implementation of the alerts (adjusted OR, 0.75; 95% CI, 0.64-0.89). Furthermore, the likelihood of AKI recovery was improved in the alert group (adjusted HR, 1.70; 95% CI, 1.53-1.88). Mortality was not affected by the AKI alert system (adjusted HR, 1.07; 95% CI, 0.68-1.68). Limitations Possible unreported differences between the alert and usual-care groups. Conclusions Implementation of the AKI alert system was associated with beneficial effects in terms of an improved rate of recovery from AKI. Therefore, widespread adoption of such systems could be considered in general hospitals.

      PubDate: 2018-01-03T10:10:56Z
       
  • Insights From the 2016 Peer Kidney Care Initiative Report: Still a Ways to
           Go to Improve Care for Dialysis Patients
    • Authors: James Wetmore; Suying Julia Molony Haifeng Guo Charles Herzog David
      Abstract: Publication date: January 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 1
      Author(s): James B. Wetmore, Suying Li, Julia T. Molony, Haifeng Guo, Charles A. Herzog, David T. Gilbertson, Yi Peng, Allan J. Collins
      Although outcomes improved during the past decade for patients receiving maintenance dialysis, gains were few in certain key areas, as highlighted in the 2016 Peer Kidney Care Initiative Report. Overall incidence rates of dialysis therapy initiation in adults remained relatively stable (∼42 per 100,000 US population, 2009-2013), but rates varied more than 2-fold, from 26 to 54, across US geographic regions. Hospitalization rates in incident patients decreased from 261 hospitalizations per 100 patient-years in 2003 to 207 in 2012, but observation stay rates increased from 40 to 67, attenuating the decline in hospitalizations by half. Decreases in prevalent patient hospitalizations for heart failure, from 15.6 per 100 patient-years in 2004 to 9.5 in 2013, were partially offset by increases in hospitalizations for volume overload, from 3.0 in 2004 to 6.1 in 2013. Prevalent patient rates of hospitalizations for arrhythmias (∼4.6 per 100 patient-years) did not improve during the past decade, whereas sudden cardiac death as a proportion of total cardiovascular deaths increased from 53% to 73%. Hospitalization rates for pneumonia/influenza, at about 8.3 per 100 patient-years in prevalent patients, did not decrease during this period, while hospitalization rates for bacteremia/sepsis increased from 8.6 to 12.0. If decreases in mortality rates are to be sustained, novel approaches to these challenges will be required.

      PubDate: 2018-01-03T10:10:56Z
       
  • Old Friends: Maintaining the Physician-Patient Connection in the 21st
           Century
    • Authors: Paul Kellerman
      Abstract: Publication date: Available online 29 December 2017
      Source:American Journal of Kidney Diseases
      Author(s): Paul S. Kellerman


      PubDate: 2018-01-03T10:10:56Z
       
  • Center Effects and Peritoneal Dialysis Peritonitis Outcomes: Analysis of a
           National Registry
    • Authors: Htay Htay; Yeoungjee Cho Elaine Pascoe Darsy Darssan Annie-Claire Nadeau-Fredette
      Abstract: Publication date: Available online 28 December 2017
      Source:American Journal of Kidney Diseases
      Author(s): Htay Htay, Yeoungjee Cho, Elaine M. Pascoe, Darsy Darssan, Annie-Claire Nadeau-Fredette, Carmel Hawley, Philip A. Clayton, Monique Borlace, Sunil V. Badve, Kamal Sud, Neil Boudville, Stephen P. McDonald, David W. Johnson
      Background Peritonitis is a common cause of technique failure in peritoneal dialysis (PD). Dialysis center−level characteristics may influence PD peritonitis outcomes independent of patient-level characteristics. Study Design Retrospective cohort study. Setting & Participants Using Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data, all incident Australian PD patients who had peritonitis from 2004 through 2014 were included. Predictors Patient- (including demographic data, causal organisms, and comorbid conditions) and center- (including center size, proportion of patients treated with PD, and summary measures related to type, cause, and outcome of peritonitis episodes) level predictors. Outcomes & Measurement The primary outcome was cure of peritonitis with antibiotics. Secondary outcomes were peritonitis-related catheter removal, hemodialysis therapy transfer, peritonitis relapse/recurrence, hospitalization, and mortality. Outcomes were analyzed using multilevel mixed logistic regression. Results The study included 9,100 episodes of peritonitis among 4,428 patients across 51 centers. Cure with antibiotics was achieved in 6,285 (69%) peritonitis episodes and varied between 38% and 86% across centers. Centers with higher proportions of dialysis patients treated with PD (>29%) had significantly higher odds of peritonitis cure (adjusted OR, 1.21; 95% CI, 1.04-1.40) and lower odds of catheter removal (OR, 0.78; 95% CI, 0.62-0.97), hemodialysis therapy transfer (OR, 0.78; 95% CI, 0.62-0.97), and peritonitis relapse/recurrence (OR, 0.68; 95% CI, 0.48-0.98). Centers with higher proportions of peritonitis episodes receiving empirical antibiotics covering both Gram-positive and Gram-negative organisms had higher odds of cure with antibiotics (OR, 1.22; 95% CI, 1.06-1.42). Patient-level characteristics associated with higher odds of cure were younger age and less virulent causative organisms (coagulase-negative staphylococci, streptococci, and culture negative). The variation in odds of cure across centers was 9% higher after adjustment for patient-level characteristics, but 66% lower after adjustment for center-level characteristics. Limitations Retrospective study design using registry data. Conclusions These results suggest that center effects contribute substantially to the appreciable variation in PD peritonitis outcomes that exist across PD centers within Australia.

      PubDate: 2018-01-03T10:10:56Z
       
  • Kidney Function After a Hypertensive Disorder of Pregnancy: A
           Longitudinal Study
    • Authors: Nina Paauw; Anne Marijn van der Graaf Rita Bozoglan David
      Abstract: Publication date: Available online 28 December 2017
      Source:American Journal of Kidney Diseases
      Author(s): Nina D. Paauw, Anne Marijn van der Graaf, Rita Bozoglan, David P. van der Ham, Gerjan Navis, Ron T. Gansevoort, Henk Groen, A. Titia Lely
      Background Registry-based studies report an increased risk for end-stage kidney disease after hypertensive disorders of pregnancy (HDPs). It is unclear whether HDPs lead to an increased incidence of chronic kidney disease (CKD) and/or progression of kidney function decline. Study Design Subanalysis of the Prevention of Renal and Vascular Endstage Disease (PREVEND) Study, a Dutch population-based cohort with follow-up of 5 visits approximately 3 years apart. Setting & Participants Women without and with patient-reported HDPs (non-HDP, n=1,805; HDP, n=977) were identified. Mean age was 50 years at baseline and median follow-up was 11 years. Factor An HDP. Outcomes (1) The incidence of CKD using Cox regression and (2) the course of kidney function (estimated glomerular filtration rate [eGFR] and 24-hour albuminuria) over 5 visits using generalized estimating equation analysis adjusted for age, mean arterial pressure, and renin-angiotensin system (RAS) blockade. CKD was defined as eGFR<60mL/min/1.73m2 and/or 24-hour albuminuria with albumin excretion > 30mg, and end-stage kidney disease was defined as receiving dialysis or kidney transplantation. Results During follow-up, none of the women developed end-stage renal disease and the incidence of CKD during follow-up was similar across HDP groups (HR, 1.04; 95% CI, 0.79-1.37; P =0.8). Use of RAS blockade was higher after HDP at all visits. During a median of 11 years, we observed a decrease in eGFR in both groups, with a slightly steeper decline in the HDP group (98±15 to 88±16 vs 99±17 to 91±15mL/min/1.73m2; P group <0.01, P group*visit <0.05). The group effect remained significant after adjusting for mean arterial pressure, but disappeared after adjusting for RAS blockade. The 24-hour albuminuria did not differ between groups. Limitations No obstetric records available. HDPs defined by patient report rather than health records. Conclusions HDPs did not detectably increase the incidence of CKD. During follow-up, we observed no differences in albuminuria, but observed a marginally lower eGFR after HDP that was no longer statistically significant after adjusting for the use of RAS blockers. In this population, we were unable to identify a significant risk for kidney function decline after patient-reported HDP.

      PubDate: 2018-01-03T10:10:56Z
       
  • Mortality and Allograft Loss Trends Among US Pediatric Kidney Transplant
           Recipients With and Without Focal Segmental Glomerulosclerosis
    • Authors: Chia-shi Wang; Jennifer Gander Rachel Patzer Larry Greenbaum
      Abstract: Publication date: Available online 23 December 2017
      Source:American Journal of Kidney Diseases
      Author(s): Chia-shi Wang, Jennifer Gander, Rachel E. Patzer, Larry A. Greenbaum
      Background Pediatric patients with focal segmental glomerulosclerosis (FSGS) have high rates of disease recurrence and allograft failure after kidney transplantation, but there are few data for long-term survival posttransplantation. Study Design Retrospective cohort study. Setting & Participants 12,303 pediatric patients (aged <18 years), including 1,408 (11%) patients with FSGS, who received a first kidney transplant in 1990 through 2009 and were followed up through June 2015 were identified from the US Renal Data System database. Predictors Primary cause of end-stage renal disease, FSGS or other. Outcomes All-cause patient mortality and allograft loss. Results All-cause mortality significantly improved for patients with FSGS who underwent transplantation in the 2000s versus the 1990s (6.72 vs 12.24 deaths/1,000 patient-years; HR, 0.55; 95% CI, 0.39-0.78; P <0.001). Reductions in allograft loss were less dramatic (75.91 vs 89.05 events/1,000 patient-years; HR, 0.85; 95% CI, 0.74-0.98; P =0.02). After adjusting for baseline characteristics at the time of transplantation, patients with FSGS had similar rates of death compared with patients without FSGS (HRs of 0.81 [P =0.6] and 1.06 [P =0.2] among those who underwent transplantation in the 2000s and 1990s, respectively) despite higher rates of allograft loss (HRs of 1.17 [P = 0.03] and 1.27 [P <0.001], respectively). Among patients who underwent transplantation in the 2000s, further adjustment for allograft failure as a time-varying covariate demonstrated a lower rate of death among patients with FSGS compared with those without FSGS (HR, 0.70; P = 0.02). Limitations Lack of information about certain risk factors for mortality, including duration of chronic kidney disease; missing data; and potential primary disease misclassification. Conclusions Survival of pediatric kidney transplant recipients with FSGS improved between the 1990s and 2000s and was similar to that of recipients without FSGS. Interestingly, adjustment for allograft failure showed greater survival for pediatric patients with FSGS who underwent transplantation in the 2000s as compared with others, suggesting that effective interventions to decrease allograft loss due to disease recurrence may improve patient survival.

      PubDate: 2018-01-03T10:10:56Z
       
  • Risk Predictors and Causes of Technique Failure Within the First Year of
           Peritoneal Dialysis: An Australia and New Zealand Dialysis and Transplant
           Registry (ANZDATA) Study
    • Authors: Emily See; David Johnson Carmel Hawley Elaine Pascoe Sunil Badve
      Abstract: Publication date: Available online 23 December 2017
      Source:American Journal of Kidney Diseases
      Author(s): Emily J. See, David W. Johnson, Carmel M. Hawley, Elaine M. Pascoe, Sunil V. Badve, Neil Boudville, Philip A. Clayton, Kamal Sud, Kevan R. Polkinghorne, Monique Borlace, Yeoungjee Cho
      Background Concern regarding technique failure is a major barrier to increased uptake of peritoneal dialysis (PD), and the first year of therapy is a particularly vulnerable time. Study Design A cohort study using competing-risk regression analyses to identify the key risk factors and risk periods for early transfer to hemodialysis therapy or death in incident PD patients. Setting & Participants All adult patients who initiated PD therapy in Australia and New Zealand in 2000 through 2014. Predictors Patient demographics and comorbid conditions, duration of prior renal replacement therapy, timing of referral, PD modality, dialysis era, and center size. Outcomes Technique failure within the first year, defined as transfer to hemodialysis therapy for more than 30 days or death. Results Of 16,748 patients included in the study, 4,389 developed early technique failure. Factors associated with increased risk included age older than 70 years, diabetes or vascular disease, prior renal replacement therapy, late referral to a nephrology service, or management in a smaller center. Asian or other race and use of continuous ambulatory PD were associated with reduced risk, as was initiation of PD therapy in 2010 through 2014. Although the risk for technique failure due to death or infection was constant during the first year, mechanical and other causes accounted for a greater number of cases within the initial 9 months of treatment. Limitations Potential for residual confounding due to limited data for residual kidney function, dialysis prescription, and socioeconomic factors. Conclusions Several modifiable and nonmodifiable factors are associated with early technique failure in PD. Targeted interventions should be considered in high-risk patients to avoid the consequences of an unplanned transfer to hemodialysis therapy or death.

      PubDate: 2018-01-03T10:10:56Z
       
  • Perspectives on Research Participation and Facilitation Among Dialysis
           Patients, Clinic Personnel, and Medical Providers: A Focus Group Study
    • Authors: Jennifer Flythe; Julia Narendra Adeline Dorough Jonathan Oberlander Antoinette Ordish
      Abstract: Publication date: Available online 27 December 2017
      Source:American Journal of Kidney Diseases
      Author(s): Jennifer E. Flythe, Julia H. Narendra, Adeline Dorough, Jonathan Oberlander, Antoinette Ordish, Caroline Wilkie, Laura M. Dember
      Background Most prospective studies involving individuals receiving maintenance dialysis have been small, and many have had poor clinical translatability. Research relevance can be enhanced through stakeholder engagement. However, little is known about dialysis clinic stakeholders’ perceptions of research participation and facilitation. The objective of this study was to characterize the perspectives of dialysis clinic stakeholders (patients, clinic personnel, and medical providers) on: (1) research participation by patients and (2) research facilitation by clinic personnel and medical providers. We also sought to elucidate stakeholder preferences for research communication. Study Design Qualitative study. Setting & Participants 7 focus groups (59 participants: 8 clinic managers, 14 nurses/patient care technicians, 8 social workers/dietitians, 11 nephrologists/advanced practice providers, and 18 patients/care partners) from 7 North Carolina dialysis clinics. Methodology Clinics and participants were purposively sampled. Focus groups were recorded and transcribed. Analytical Approach Thematic analysis. Results We identified 11 themes that captured barriers to and facilitators of research participation by patients and research facilitation by clinic personnel and medical providers. We collapsed these themes into 4 categories to create an organizational framework for considering stakeholder (narrow research understanding, competing personal priorities, and low patient literacy and education levels), relationship (trust, buy-in, and altruistic motivations), research design (convenience, follow-up, and patient incentives), and dialysis clinic (professional demands, teamwork, and communication) aspects that may affect stakeholder interest in participating in or facilitating research. These themes appear to shape the degree of research readiness of a dialysis clinic environment. Participants preferred short research communications delivered in multiple formats. Limitations Potential selection bias and inclusion of English-speaking participants only. Conclusions Our findings revealed patient interest in participating in research and clinical personnel and medical provider interest in facilitating research. Overall, our results suggest that dialysis clinic research readiness may be enhanced through increased stakeholder research knowledge and alignment of clinical and research activities.

      PubDate: 2017-12-27T09:06:04Z
       
  • In Reply to ‘How Valid Are GFR Estimation Results From the CKD-EPI
           Databases'’
    • Authors: Andrew Levey; Hocine Tighiouart Andrew Simon Lesley Inker
      Abstract: Publication date: Available online 26 December 2017
      Source:American Journal of Kidney Diseases
      Author(s): Andrew S. Levey, Hocine Tighiouart, Andrew L. Simon, Lesley A. Inker


      PubDate: 2017-12-27T09:06:04Z
       
  • How Valid Are GFR Estimation Results From the CKD-EPI Databases'
    • Authors: Jonas Sten-Erik; Gunnar Nordin Ulf Nyman
      Abstract: Publication date: Available online 26 December 2017
      Source:American Journal of Kidney Diseases
      Author(s): Jonas Björk, Sten-Erik Bäck, Gunnar Nordin, Ulf Nyman


      PubDate: 2017-12-27T09:06:04Z
       
  • Electronic Alerts for Acute Kidney Injury
    • Authors: Paul Palevsky
      Abstract: Publication date: January 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 1
      Author(s): Paul M. Palevsky


      PubDate: 2017-12-24T08:28:32Z
       
  • Developmental Origins of CKD: Big Problems From Small Packages
    • Authors: Jennifer Charlton; Robert Chevalier
      Abstract: Publication date: January 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 1
      Author(s): Jennifer R. Charlton, Robert L. Chevalier


      PubDate: 2017-12-24T08:28:32Z
       
  • Closer to the Source: Targeted-Release Corticosteroids for Immunoglobulin
           A Nephropathy
    • Authors: Heather Reich
      Abstract: Publication date: January 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 1
      Author(s): Heather N. Reich


      PubDate: 2017-12-24T08:28:32Z
       
  • Prenatal Growth and CKD in Older Adults: Longitudinal Findings From the
           Helsinki Birth Cohort Study, 1924-1944
    • Authors: Johan Eriksson; Minna Salonen Eero Kajantie Clive Osmond
      Abstract: Publication date: January 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 1
      Author(s): Johan G. Eriksson, Minna K. Salonen, Eero Kajantie, Clive Osmond
      Background According to the Developmental Origins of Health and Disease (DOHaD) hypothesis, several noncommunicable diseases, including hypertension, type 2 diabetes, and coronary heart disease, have their origins in early life. Chronic kidney disease (CKD) has traditionally been assumed to develop as the result of an interaction between genetic and environmental factors, although more recently, the importance of factors present early in life has been recognized. Study Design Longitudinal birth cohort study. Setting & Participants 20,431 people born in 1924 to 1944 in Helsinki, Finland, who were part of the Helsinki Birth Cohort Study were followed up through their life course from birth until death or age 86 years. Predictor Prenatal growth and socioeconomic factors. Outcomes Death or hospitalization for CKD. Results Smaller body size at birth was associated with increased risk for developing CKD. Each standard deviation higher birth weight was associated with an HR for CKD of 0.82 (95% CI, 0.74-0.91; P <0.001). Associations with ponderal index at birth, placental weight, and birth length were also statistically significant (P <0.001, P <0.001, and P =0.002, respectively), but only among men. Prematurity also predicted increased risk for CKD. Limitations The study was restricted to people who were born in Helsinki in 1924 to 1944. Conclusions Smaller body size at birth was associated with increased risk for developing CKD in men. Prematurity was also associated with increased risk for CKD in women. These findings in the Helsinki Birth Cohort Study support the importance of early life factors in the development of CKD.
      Graphical abstract image

      PubDate: 2017-12-24T08:28:32Z
       
  • Deoxycholic Acid, a Metabolite of Circulating Bile Acids, and Coronary
           Artery Vascular Calcification in CKD
    • Authors: Anna Jovanovich; Tamara Isakova Geoffrey Block Jason Stubbs Gerard Smits
      Abstract: Publication date: January 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 1
      Author(s): Anna Jovanovich, Tamara Isakova, Geoffrey Block, Jason Stubbs, Gerard Smits, Michel Chonchol, Makoto Miyazaki
      Background Vascular calcification is common among patients with chronic kidney disease (CKD), and it is associated with all-cause and cardiovascular disease mortality. Deoxycholic acid, a metabolite of circulating bile acids, is elevated in CKD and induces vascular mineralization and osteogenic differentiation in animal models. Study Design Cohort analysis of clinical trial participants. Setting & Participants 112 patients with moderate to severe CKD (estimated glomerular filtration rate, 20-45mL/min/1.73m2) who participated in a randomized controlled study to examine the effects of phosphate binders on vascular calcification. Predictor Serum deoxycholic acid concentration. Outcomes Baseline coronary artery calcification (CAC) volume score and bone mineral density (BMD) and change in CAC volume score and BMD after 9 months. Measurements Deoxycholic acid was assayed in stored baseline serum samples using liquid chromatography−tandem mass spectrometry, CAC was measured using a GE-Imitron C150 scanner, and BMD was determined using computed tomographic scans of the abdomen with calibrated phantom of known density. Results Higher serum deoxycholic acid concentrations were significantly correlated with greater baseline CAC volume and lower baseline BMD. After adjusting for demographics, coexisting illness, body mass index, estimated glomerular filtration rate, and concentrations of circulating markers of mineral metabolism, including serum calcium, phosphorus, vitamin D, parathyroid hormone, and fibroblast growth factor 23, a serum deoxycholic acid concentration > 58ng/mL (the median) was positively associated with baseline CAC volume (β=0.71; 95% CI, 0.26-1.16; P =0.003) and negatively associated with baseline BMD (β = −20.3; 95% CI, −1.5 to −39.1; P =0.04). Serum deoxycholic acid concentration > 58ng/mL was not significantly associated with change in CAC volume score after 9 months (β=0.06; 95% CI, −0.09 to 0.21; P =0.4). The analysis for the relationship between baseline deoxycholic acid concentrations and change in BMD after 9 months was not statistically significant, but was underpowered. Limitations The use of nonfasting serum samples is a limitation because deoxycholic acid concentrations may vary based on time of day and dietary intake. Few trial participants with complete data to evaluate the change in CAC volume score (n=75) and BMD (n=59). No data for changes in deoxycholic acid concentrations over time. Conclusions Among patients with moderate to severe CKD, higher serum deoxycholic acid concentrations were independently associated with greater baseline CAC vo...
      PubDate: 2017-12-24T08:28:32Z
       
  • Association Between Sonographically Diagnosed Nephrolithiasis and
           Subclinical Coronary Artery Calcification in Adults
    • Authors: Seolhye Kim; Yoosoo Chang Eunju Sung Jeong Gyu Kang Kyung
      Abstract: Publication date: January 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 1
      Author(s): Seolhye Kim, Yoosoo Chang, Eunju Sung, Jeong Gyu Kang, Kyung Eun Yun, Hyun-Suk Jung, Young Youl Hyun, Kyu-Beck Lee, Kwan Joong Joo, Hocheol Shin, Seungho Ryu
      Background Although recent studies suggest an association between nephrolithiasis and clinical cardiovascular events, this association has been underexplored. Study Design Cross-sectional study. Setting & Participants 62,091 asymptomatic adults without known coronary heart disease who underwent a screening health examination that included cardiac tomography. Predictor Nephrolithiasis. Outcome Coronary artery calcification (CAC). Measurements Nephrolithiasis assessed using ultrasonography of the abdomen. CAC scoring assessed using cardiac computed tomography. Results The prevalence of CAC scores > 0 was 13.1% overall. Participants with nephrolithiasis had a higher prevalence of coronary calcification than those without (19.1% vs 12.8%). In Tobit models adjusted for age and sex, the CAC score ratio comparing participants with nephrolithiasis with those without nephrolithiasis was 1.56 (95% CI, 1.19-2.05). After further adjustment for screening center, year of screening examination, physical activity, alcohol intake, smoking status, education level, body mass index, family history of cardiovascular disease, total energy intake, glucose concentration, systolic blood pressure, triglyceride concentration, high-density lipoprotein cholesterol concentration, uric acid concentration, and estimated glomerular filtration rate, the CAC score ratio was attenuated, but remained significant (CAC score ratio, 1.31; 95% CI, 1.00-1.71). Limitations Computed tomographic diagnosis of nephrolithiasis was unavailable. Conclusions Nephrolithiasis was associated with the presence of CAC in adults without known coronary heart disease, supporting the hypothesis that these 2 health conditions share a common pathophysiology.

      PubDate: 2017-12-24T08:28:32Z
       
  • Effectiveness of Pharmacist Interventions on Cardiovascular Risk in
           Patients With CKD: A Subgroup Analysis of the Randomized Controlled RxEACH
           Trial
    • Authors: Yazid Hamarneh; Ross Tsuyuki Charlotte Jones Braden Manns Marcello Tonelli
      Abstract: Publication date: January 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 1
      Author(s): Yazid N. Al Hamarneh, Ross T. Tsuyuki, Charlotte A. Jones, Braden Manns, Marcello Tonelli, Nairne Scott-Douglass, Kailash Jindal, Wendy Tink, Brenda R. Hemmelgarn
      Background Affecting a substantial proportion of adults, chronic kidney disease (CKD) is considered a major risk factor for cardiovascular (CV) events. It has been reported that patients with CKD are underserved when it comes to CV risk reduction efforts. Study Design Prespecified subgroup analysis of a randomized controlled trial. Setting & Participants Adults with CKD and at least 1 uncontrolled CV risk factor were enrolled from 56 pharmacies across Alberta, Canada. Intervention Patient, laboratory, and individualized CV risk assessments; treatment recommendations; prescription adaptation(s) and/or initiation as necessary; and regular monthly follow-up for 3 months. Outcomes The primary outcome was change in estimated CV risk from baseline to 3 months after randomization. Secondary outcomes were change between baseline and 3 months after randomization in individual CV risk factors (ie, low-density lipoprotein cholesterol, blood pressure, and hemoglobin A1c), risk for developing end-stage renal disease, and medication use and dosage; tobacco cessation 3 months after randomization for those who used tobacco at baseline; and the impact of rural versus urban residence on the difference in change in estimated CV risk. Measurements CV risk was estimated using the Framingham, UK Prospective Diabetes Study, and international risk assessment equations depending on the patients’ comorbid conditions. Results 290 of the 723 participants enrolled in RxEACH had CKD. After adjusting for baseline values, the difference in change in CV risk was 20% (P <0.001). Changes of 0.2mmol/L in low-density lipoprotein cholesterol concentration (P =0.004), 10.5mmHg in systolic blood pressure (P <0.001), 0.7% in hemoglobin A1c concentration (P <0.001), and 19.6% in smoking cessation (P =0.04) were observed when comparing the intervention and control groups. There was a larger reduction in CV risk in patients living in rural locations versus those living in urban areas. Limitations The 3-month follow-up period can be considered relatively short. It is possible that larger reduction in CV risk could have been observed with a longer follow up period. Conclusions This subgroup analysis demonstrated that a community pharmacy–based intervention program reduced CV risk and improved control of individual CV risk factors. This represents a promising approach to identifying and managing patients with CKD that could have important public health implications.

      PubDate: 2017-12-24T08:28:32Z
       
  • Donor and Recipient Perspectives on Anonymity in Kidney Donation From Live
           Donors: A Multicenter Survey Study
    • Authors: Dorthe Slaats; Annette Lennerling Mathilde Pronk Karlijn A.M.I. van der
      Abstract: Publication date: January 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 1
      Author(s): Dorthe Slaats, Annette Lennerling, Mathilde C. Pronk, Karlijn A.M.I. van der Pant, Ine M. Dooper, Judith M. Wierdsma, Carla Schrauwers, Hannah Maple, Jacqueline van de Wetering, Willem Weimar, Willij C. Zuidema, Nizam Mamode, Frank J.M.F. Dor, Emma K. Massey
      Background Maintaining anonymity is a requirement in the Netherlands and Sweden for kidney donation from live donors in the context of nondirected (or unspecified) and paired exchange (or specified indirect) donation. Despite this policy, some donors and recipients express the desire to know one another. Little empirical evidence informs the debate on anonymity. This study explored the experiences, preferences, and attitudes of donors and recipients toward anonymity. Study Design Retrospective observational multicenter study using both qualitative and quantitative methods. Setting & Participants 414 participants from Dutch and Swedish transplantation centers who received or donated a kidney anonymously (nondirected or paired exchange) completed a questionnaire about anonymity. Participation was a median of 31 months after surgery. Factors Country of residence, donor/recipient status, transplant type, time since surgery. Outcomes Experiences, preferences, and attitudes toward anonymity. Results Most participants were satisfied with their experience of anonymity before and after surgery. A minority would have liked to have met the other party before (donors, 7%; recipients, 15%) or after (donors, 22%; recipients, 31%) surgery. Significantly more recipients than donors wanted to meet the other party. Most study participants were open to meeting the other party if the desire was mutual (donors, 58%; recipients, 60%). Donors agree significantly more with the principle of anonymity before and after surgery than recipients. Donors and recipients thought that if both parties agreed, it should be permissible to meet before or after surgery. There were few associations between country or time since surgery and experiences or attitudes. The pros and cons of anonymity reported by participants were clustered into relational and emotional, ethical, and practical and logistical domains. Limitations The relatively low response rate of recipients may have reduced generalizability. Recall bias was possible given the time lag between transplantation and data collection. Conclusions This exploratory study illustrated that although donors and recipients were usually satisfied with anonymity, the majority viewed a strict policy on anonymity as unnecessary. These results may inform policy and education on anonymity.

      PubDate: 2017-12-24T08:28:32Z
       
  • Insulin Sensitivity and Diabetic Kidney Disease in Children and
           Adolescents With Type 2 Diabetes: An Observational Analysis of Data From
           the TODAY Clinical Trial
    • Authors: Petter Bjornstad; Edward Nehus Laure ghormli Fida Bacha Ingrid Libman
      Abstract: Publication date: January 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 1
      Author(s): Petter Bjornstad, Edward Nehus, Laure El ghormli, Fida Bacha, Ingrid M. Libman, Siripoom McKay, Steven M. Willi, Lori Laffel, Silva Arslanian, Kristen J. Nadeau
      Background Diabetic kidney disease is a major cause of premature mortality in type 2 diabetes mellitus (T2DM). Worsening insulin sensitivity independent of glycemic control may contribute to the development of diabetic kidney disease. We investigated the longitudinal association of insulin sensitivity with hyperfiltration and increased albumin excretion in adolescents with T2DM. Study Design Observational prospective cohort study. Setting & Participants 532 TODAY (Treatment Options for Type 2 Diabetes in Adolescents and Youth) participants aged 12 to 17 years with T2DM duration less than 2 years at baseline. The TODAY Study was a multicenter randomized clinical trial that examined the efficacy of 3 treatment regimens (metformin monotherapy, metformin plus rosiglitazone, or metformin plus an intensive lifestyle intervention program) to achieve durable glycemic control. Predictors Natural log–transformed estimated insulin sensitivity (reciprocal of fasting insulin), hemoglobin A1c concentration, age, race-ethnicity, treatment group, body mass index, loss of glycemic control, and hypertension. Outcomes Hyperfiltration was defined as 99th percentile or higher of estimated glomerular filtration rate (≥140mL/min/1.73m2) when referenced to healthy adolescents (NHANES 1999-2002) and albumin-creatinine ratio ≥ 30μg/mg at 3 consecutive annual visits. Results Hyperfiltration was observed in 7.0% of participants at baseline and in 13.3% by 5 years, with a cumulative incidence of 5.0% over 5 years. The prevalence of increased albumin excretion was 6% at baseline and 18% by 5 years, with a cumulative incidence of 13.4%. There was an 8% increase in risk for hyperfiltration per 10% lower estimated insulin sensitivity in unadjusted and adjusted models (P =0.01). Increased albumin excretion was associated with hemoglobin A1c concentration, but not estimated insulin sensitivity. Limitations Longer follow-up is needed to capture the transition from hyperfiltration to rapid glomerular filtration rate decline in youth-onset T2DM. Conclusions Lower estimated insulin sensitivity was associated with risk for hyperfiltration over time, whereas increased albumin excretion was associated with hyperglycemia in youth-onset T2DM.

      PubDate: 2017-12-24T08:28:32Z
       
  • Phosphate Kinetic Models in Hemodialysis: A Systematic Review
    • Authors: Sisse Laursen; Peter Vestergaard Ole Hejlesen
      Abstract: Publication date: January 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 1
      Author(s): Sisse H. Laursen, Peter Vestergaard, Ole K. Hejlesen
      Background Understanding phosphate kinetics in dialysis patients is important for the prevention of hyperphosphatemia and related complications. One approach to gain new insights into phosphate behavior is physiologic modeling. Various models that describe and quantify intra- and/or interdialytic phosphate kinetics have been proposed, but there is a dearth of comprehensive comparisons of the available models. The objective of this analysis was to provide a systematic review of existing published models of phosphate metabolism in the setting of maintenance hemodialysis therapy. Study Design Systematic review. Setting & Population Hemodialysis patients. Selection Criteria for Studies Studies published in peer-reviewed journals in English about phosphate kinetic modeling in the setting of hemodialysis therapy. Predictor Modeling equations from specific reviewed studies. Outcomes Changes in plasma phosphate or serum phosphate concentrations. Results Of 1,964 nonduplicate studies evaluated, 11 were included, comprising 9 different phosphate models with 1-, 2-, 3-, or 4-compartment assumptions. Between 2 and 11 model parameters were included in the models studied. Quality scores of the studies using the Newcastle-Ottawa Scale ranged from 2 to 11 (scale, 0-14). 2 studies were considered low quality, 6 were considered medium quality, and 3 were considered high quality. Limitations Only English-language studies were included. Conclusions Many parameters known to influence phosphate balance are not included in existing phosphate models that do not fully reflect the physiology of phosphate metabolism in the setting of hemodialysis. Moreover, models have not been sufficiently validated for their use as a tool to simulate phosphate kinetics in hemodialysis therapy.

      PubDate: 2017-12-24T08:28:32Z
       
  • Longitudinal Estimated GFR Trajectories in Patients With and Without Type
           2 Diabetes and Nephropathy
    • Authors: Misghina Weldegiorgis; Dick Zeeuw Liang Hans-Henrik Parving Fan Fan Hou
      Abstract: Publication date: January 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 1
      Author(s): Misghina Weldegiorgis, Dick de Zeeuw, Liang Li, Hans-Henrik Parving, Fan Fan Hou, Giuseppe Remuzzi, Tom Greene, Hiddo J.L. Heerspink
      Background In clinical practice and clinical trials, changes in serum creatinine concentrations are used to evaluate changes in kidney function. It has been assumed that these changes follow a linear pattern when serum creatinine concentration is converted to estimated glomerular filtration rate (eGFR). However, the paradigm that kidney function declines linearly over time has been questioned by studies showing either linear or nonlinear patterns. To verify how this impacts on kidney end points in intervention trials, we analyzed eGFR trajectories in multiple clinical trials of patients with and without diabetes. Study Design Longitudinal observational study. Setting & Participants 6 clinical trials with repeated measurements of serum creatinine. Predictor Patient demographic and clinical parameters. Outcomes Probability of nonlinear eGFR function trajectory calculated for each patient from a Bayesian model of individual eGFR trajectories. Results The median probability of a nonlinear eGFR decline in all trials was 0.26 (interquartile range, 0.13-0.48). The median probability was 0.28 in diabetes versus 0.09 in nondiabetes trials (P <0.01). The percentage of patients with a >50% probability of nonlinear eGFR decline was generally low, ranging from 19.3% to 31.7% in the diabetes trials and from 15.1% to 21.2% in the nondiabetes trials. In the pooled data set, multivariable linear regression showed that higher baseline eGFR, male sex, diabetes status, steeper eGFR slope, and non–renin-angiotensin-aldosterone-system antihypertensives were independently associated with a greater probability of a nonlinear eGFR trajectory. Limitations Relatively short follow-up and no measured GFR. Conclusions In both diabetes and nondiabetes trials, the majority of patients show a more or less linear eGFR decline. These data support the paradigm that in diabetic and nondiabetic kidney disease, eGFR decline progresses linearly over time during a clinical trial period. However, in diabetes, one should take the nonlinearity proportion into account in the design of a clinical trial.

      PubDate: 2017-12-24T08:28:32Z
       
  • Impact of Diabetes Mellitus on the Association of Vascular Disease Before
           Transplantation With Long-term Transplant and Patient Outcomes After
           Kidney Transplantation: A Population Cohort Study
    • Authors: Wai Lim; David Johnson Carmel Hawley Elaine Pascoe Germaine Wong
      Abstract: Publication date: January 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 1
      Author(s): Wai H. Lim, David W. Johnson, Carmel M. Hawley, Elaine Pascoe, Germaine Wong
      Background Advances in kidney transplantation have led to considerable improvements in short-term transplant and patient outcomes, but there are few data regarding long-term transplant outcomes in patients with vascular comorbid conditions. This study examined the association of vascular disease before transplantation with transplant and patient survival after transplantation and evaluated whether this association was modified by diabetes. Study Design All deceased donor kidney transplant recipients recorded in the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) for 1990 to 2012. Predictor Vascular disease burden. Outcomes All-cause mortality and overall transplant loss. Potential interactions between diabetes and vascular disease for mortality and transplant loss were assessed using 2-way interaction terms. Results Of 7,128 recipients with 58,120 patient-years of follow-up, 854 (12.0%) and 263 (3.7%) had vascular diseases at 1 and 2 or more sites, respectively. Overall survival for recipients without vascular disease 15 years after transplantation was 65% compared with 35% and 22% among recipients with vascular disease at 1 and 2 or more sites, respectively (P <0.001). Compared with recipients without vascular disease, adjusted HRs for mortality and transplant loss were 1.75 (95% CI, 1.39-2.20; P <0.001) and 1.61 (95% CI, 1.30-1.99; P <0.001), respectively, for recipients with 2 or more vascular diseases. Among recipients without diabetes but with 2 or more vascular diseases, adjusted HRs for mortality and transplant loss were 2.10 (95% CI, 1.56-2.82; P <0.001) and 1.84 (95% CI, 1.39-2.42; P <0.001), respectively, compared with those without vascular disease. Similar associations were not observed for recipients with diabetes mellitus (P for interaction < 0.001). Limitations Selection bias and unmeasured residual confounders, such as the severity/extent of comorbid conditions likely to be present. Conclusions The impact of vascular disease on long-term outcomes was modified by the presence of diabetes, whereby excess risks for death and transplant loss are more apparent in recipients without diabetes.

      PubDate: 2017-12-24T08:28:32Z
       
  • Dialysis Payment Model Reform: Managing Conflicts Between Profits and
           Patient Goals of Care Decision Making
    • Authors: Jeffrey Berns; Joel Glickman Peter Reese
      Abstract: Publication date: January 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 1
      Author(s): Jeffrey S. Berns, Joel D. Glickman, Peter P. Reese


      PubDate: 2017-12-24T08:28:32Z
       
  • Dabigatran Reversal in a Patient With End-Stage Liver Disease and
           Acute Kidney Injury
    • Authors: James Novak; Khalid Alamiri Jerry Yee
      Abstract: Publication date: January 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 1
      Author(s): James E. Novak, Khalid Alamiri, Jerry Yee
      Dabigatran, a direct thrombin inhibitor and one of the new class of direct oral anticoagulants, is increasingly used in preference to warfarin because of its efficacy and ease of administration. However, because the drug is cleared by the kidneys, it can accumulate in plasma and increase the risk for bleeding in patients with decreased kidney function. We report a patient with end-stage liver disease who developed life-threatening hemorrhage and acute kidney injury while taking dabigatran, 150mg, twice daily. Although the patient received idarucizumab, an anti-dabigatran antibody fragment used as an antidote, hemostasis could not be achieved. Administration of vitamin K, fresh frozen plasma, desmopressin, octreotide, and pantoprazole did not arrest bleeding or affect coagulation parameters, and it was not possible to establish vascular access for hemodialysis. In patients with end-stage liver disease, who are at increased risk for both bleeding and acute kidney injury, dabigatran should be prescribed cautiously and at decreased dose.

      PubDate: 2017-12-24T08:28:32Z
       
  • Interstitial Nephritis Secondary to Vedolizumab Treatment in Crohn Disease
           and Safe Rechallenge Using Steroids: A Case Report
    • Authors: Elodie Bailly; Florent Von Tokarski Beau-Salinas Laurence Picon Elodie Miquelestorena-Standley
      Abstract: Publication date: January 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 1
      Author(s): Elodie Bailly, Florent Von Tokarski, Frédérique Beau-Salinas, Laurence Picon, Elodie Miquelestorena-Standley, Geoffroy Rousseau, Annie-Pierre Jonville-Bera, Jean-Michel Halimi
      Vedolizumab is a gut-selective humanized monoclonal antibody that binds selectively to the α4 β7 integrin and acts as a lymphocyte-homing antagonist. It is indicated in ulcerative colitis and Crohn disease. We report a case of acute interstitial nephritis following vedolizumab infusion in a 55-year-old white woman treated for severe Crohn disease resistant to several therapies. Other kidney disease causes were ruled out. Glucocorticoids were administrated, leading to full renal recovery. In the absence of other therapeutic options, vedolizumab was re-administered along with transient corticosteroids; this treatment was well tolerated. Fewer than 10 cases of immunoallergic acute interstitial nephritis following treatment with monoclonal antibody have previously been reported in the literature. The pathophysiology of delayed-type hypersensitivity secondary to monoclonal antibody therapeutics is discussed in this case report.

      PubDate: 2017-12-24T08:28:32Z
       
  • AJKD Atlas of Renal Pathology: Adenovirus Infection
    • Authors: Mark Lusco; Agnes Fogo Behzad Najafian Charles Alpers
      Abstract: Publication date: January 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 1
      Author(s): Mark A. Lusco, Agnes B. Fogo, Behzad Najafian, Charles E. Alpers


      PubDate: 2017-12-24T08:28:32Z
       
  • Announcement
    • Abstract: Publication date: January 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 1


      PubDate: 2017-12-24T08:28:32Z
       
  • Decision Making in Medicine: The Physician and the Family
    • Authors: Mayleen Jeniffer; Laico
      Abstract: Publication date: January 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 1
      Author(s): Mayleen Jeniffer L. Laico


      PubDate: 2017-12-24T08:28:32Z
       
  • Adult-Onset Proximal Tubule Dysfunction
    • Authors: Arjun Sekar; James Simon Jonathan Taliercio
      Abstract: Publication date: January 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 1
      Author(s): Arjun Sekar, James Simon, Jonathan Taliercio


      PubDate: 2017-12-24T08:28:32Z
       
  • Health Insurance and the Use of Peritoneal Dialysis in the United States
    • Authors: Jose Perez; Zhao Samaya Qureshi Wolfgang Winkelmayer Kevin Erickson
      Abstract: Publication date: Available online 23 December 2017
      Source:American Journal of Kidney Diseases
      Author(s): Jose J. Perez, Bo Zhao, Samaya Qureshi, Wolfgang C. Winkelmayer, Kevin F. Erickson
      Background Many patients in the United States have limited or no health insurance at the time they develop end-stage renal disease (ESRD). We examined whether health insurance limitations affected the likelihood of peritoneal dialysis (PD) use. Study Design Retrospective cohort analysis of patients from the US Renal Data System initiating dialysis therapy in 2006 through 2012. Setting & Participants We identified socioeconomically similar groups of patients to examine the association between health insurance and PD use. Patients aged 60 to 64 years with “limited insurance” (defined as having Medicaid or no insurance) at ESRD onset were compared with patients aged 66 to 70 years who were dually eligible for Medicare and Medicaid at ESRD onset. Predictor Type of insurance coverage at ESRD onset. Outcomes The likelihoods of receiving PD before dialysis month 4, when all patients qualified for Medicare due to ESRD, and of switching to PD therapy following receipt of Medicare. Results After adjusting for observable patient and geographic differences, patients with limited insurance had an absolute 2.4% (95% CI, 1.1%-3.7%) lower probability of PD use by dialysis month 4 compared with patients with Medicare at ESRD onset. The association between insurance and PD use reversed when patients became Medicare eligible; patients with limited insurance had a 3-fold higher rate of switching to PD therapy between months 4 and 12 of dialysis (HR, 2.9; 95% CI, 1.8-4.6) compared with patients with Medicare at ESRD onset. Limitations Because this study was observational, there is a potential for bias from unmeasured patient-level factors. Conclusions Despite Medicare’s policy of covering patients in the month that they initiate PD therapy, insurance limitations remain a barrier to PD use for many patients. Educating providers about Medicare reimbursement policy and expanding access to pre-ESRD education and training may help overcome these barriers.

      PubDate: 2017-12-24T08:28:32Z
       
  • Osmotic Demyelination Unrelated to Hyponatremia
    • Authors: Maulin Shah; Sreedhar Mandayam Horacio
      Abstract: Publication date: Available online 23 December 2017
      Source:American Journal of Kidney Diseases
      Author(s): Maulin K. Shah, Sreedhar Mandayam, Horacio J. Adrogué
      Osmotic demyelination unrelated to hyponatremia is rarely reported. We present a case of osmotic demyelination in a patient with hypernatremia in the absence of preceding hyponatremia and review previously reported cases of osmotic demyelination in nonhyponatremic patients. We conclude that a rapid increase in serum sodium concentration and plasma tonicity even in the absence of preceding hyponatremia may surpass the brain’s capacity for adaptation to hypertonicity and lead to osmotic demyelination in predisposed individuals. Risk factors for osmotic demyelination in patients with chronic hyponatremia and without hyponatremia are probably similar and are usually associated with states of limited brain osmolyte response, such as alcoholism, liver disease (including those undergoing orthotopic liver transplantation), malnutrition, malignancy, pregnancy/postpartum state, severe illness/sepsis, adrenal insufficiency, and metabolic derangements. Clinicians should be vigilant in identifying individuals who may, even in the absence of hyponatremia, have increased susceptibility to osmotic demyelination and avoid rapid fluctuations in serum sodium concentrations in such patients.

      PubDate: 2017-12-24T08:28:32Z
       
  • HLA-DQA1 and APOL1 as Risk Loci for Childhood-Onset Steroid-Sensitive and
           Steroid-Resistant Nephrotic Syndrome
    • Authors: Adebowale Adeyemo; Christopher Esezobor Adaobi Solarin Asiri Abeyagunawardena Jameela Kari
      Abstract: Publication date: Available online 23 December 2017
      Source:American Journal of Kidney Diseases
      Author(s): Adebowale Adeyemo, Christopher Esezobor, Adaobi Solarin, Asiri Abeyagunawardena, Jameela A. Kari, Sherif El Desoky, Larry A. Greenbaum, Margret Kamel, Mahmoud Kallash, Cynthia Silva, Alex Young, Tracey E. Hunley, Nilka de Jesus-Gonzalez, Tarak Srivastava, Rasheed Gbadegesin
      Background Few data exist for the genetic variants underlying the risk for steroid-sensitive nephrotic syndrome (SSNS) in children. The objectives of this study were to evaluate HLA-DQA1 and APOL1 variants as risk factors for SSNS in African American children and use classic HLA antigen types and amino acid inference to refine the HLA-DQA1 association. Study Design Case-control study. Setting & Participants African American children with SSNS or steroid-resistant nephrotic syndrome (SRNS) were enrolled from Duke University and centers participating in the Midwest Pediatric Nephrology Consortium. Factor Genetic variants in HLA-DQA1 (C34Y [rs1129740]; F41S [rs1071630]) and APOL1 high-risk alleles. Outcomes SSNS and SRNS. Measurements Direct sequencing for the HLA-DQA1 and APOL1 variants in 115 African American children (65 with SSNS and 50 with SRNS). Imputation of classic HLA alleles and amino acids was done in 363 South Asian children. Results The 2 HLA-DQA1 variants were significantly associated with SSNS in African American children (C34Y: P =5.7 × 10-11; OR, 3.53; 95% CI, 2.33-5.42; F41S: P =1.2 × 10-13; OR, 4.08; 95% CI, 2.70-6.28), but not with SRNS (C34Y: P =0.6; F41S: P =0.2). APOL1 high-risk variants were not associated with SSNS (P =0.5) but showed significant associations with SRNS (P =1.04 × 10-7; OR, 4.17; 95% CI, 2.23-7.64). HLA-DQA1*0201, HLA-DQB1*0201, and HLA-DRB1*0701 were the classic HLA alleles with the most significant associations with SSNS risk. The most significantly associated amino acid positions were HLA-DQα1 56 and 76 (both P =2.8 × 10-7). Conditional analysis revealed that these variants most likely account for the observed association. Limitations Modest sample size and limited statistical power to detect small to moderate effect sizes. Children studied may not be representative of all African American children in the United States. Conclusions HLA-DQA1 is a risk locus for SSNS, but not SRNS, in African American children, consistent with its role in SSNS risk in children of European, Asian, and African ancestries. There is little evidence of a significant role for the APOL1 high-risk alleles in childhood SSN...
      PubDate: 2017-12-24T08:28:32Z
       
  • High-Output Cardiac Failure and Coronary Steal With an Arteriovenous
           Fistula
    • Authors: Amtul Aala; Sairah Sharif Leslie Parikh Paul Gordon Susie
      Abstract: Publication date: Available online 23 December 2017
      Source:American Journal of Kidney Diseases
      Author(s): Amtul Aala, Sairah Sharif, Leslie Parikh, Paul C. Gordon, Susie L. Hu
      Creation of an arteriovenous access for hemodialysis can provoke a sequence of events that significantly affects cardiovascular hemodynamics. We present a 78-year-old man with end-stage renal disease and concomitant coronary artery disease previously requiring coronary artery bypass grafting including a left internal mammary graft to the left anterior descending artery, ischemic cardiomyopathy with left ventricular systolic dysfunction, and severe aortic stenosis who developed hypotension unresponsive to medical therapy after recent angioplasty of his ipsilateral arteriovenous fistula for high-grade outflow stenosis. This case highlights the long-term effects of dialysis access on the cardiovascular system, with special emphasis on complications such as high-output cardiac failure and coronary artery steal syndrome. Banding of the arteriovenous fistula provided symptomatic relief with a decrease in cardiac output. Avoidance of arteriovenous access creation on the ipsilateral upper extremity in patients with a left internal mammary artery bypass graft may prevent coronary artery steal syndrome.

      PubDate: 2017-12-24T08:28:32Z
       
  • Use of Lung Ultrasound for the Assessment of Volume Status in CKD
    • Authors: Adrian Covic; Dimitrie Siriopol Luminita Voroneanu
      Abstract: Publication date: Available online 21 December 2017
      Source:American Journal of Kidney Diseases
      Author(s): Adrian Covic, Dimitrie Siriopol, Luminita Voroneanu
      Adequate assessment of fluid status is an imperative objective in the management of all types of patients in cardiology, intensive care, and especially nephrology. Fluid overload is one of the most common modifiable risk factors directly associated with hypertension, heart failure, left ventricular hypertrophy, and eventually, higher morbidity and mortality risk in these categories of patients. Different methods are commonly used to determine fluid status (eg, clinical assessment, natriuretic peptide concentrations, echocardiography, inferior vena cava measurements, or bioimpedance analysis). In recent years, lung ultrasonography (LUS), through the assessment of extravascular lung water, has received growing attention in clinical research. This article summarizes available studies that compare LUS with other methods for fluid status assessment in patients with kidney diseases. At the same time, it also presents the association of LUS with different outcomes (physical functioning, mortality, and cardiovascular events) in the same population. It appears that this simple bedside noninvasive technique has significant clinical potential in nephrology.

      PubDate: 2017-12-24T08:28:32Z
       
  • Caring for Migrants and Refugees With End-Stage Kidney Disease in Europe
    • Authors: Wim Van; Biesen Raymond Vanholder Thomas Ernandez Daniel Drewniak Valerie
      Abstract: Publication date: Available online 21 December 2017
      Source:American Journal of Kidney Diseases
      Author(s): Wim Van Biesen, Raymond Vanholder, Thomas Ernandez, Daniel Drewniak, Valerie Luyckx
      With the number of migrants and refugees increasing globally, the nephrology community is increasingly confronted with issues relating to the management of end-stage kidney disease in this population, including medical, logistical, financial, and moral-ethical questions. Beginning with data for the state of affairs regarding refugees in Europe and grounded in moral reasoning theory, this Policy Forum Perspective contends that to improve care for this specific population, there is a need for: (1) clear demarcations of responsibilities across the societal (macro), local (meso), and individual (micro) levels, such that individual providers are aware of available resources and able to provide essential medical care while societies and local communities determine the general approach to dialysis care for refugees; (2) additional data and evidence to facilitate decision making based on facts rather than emotions; and (3) better information and education in a broad sense (cultural sensitivity, legal rights and obligations, and medical knowledge) to address specific needs in this population. Although the nephrology community cannot leverage a change in the geopolitical framework, we are in a position to generate accurate data describing the dimensions of care of refugee or migrant patients with end-stage kidney disease to advocate for a holistic approach to treatment for this unique patient population.

      PubDate: 2017-12-24T08:28:32Z
       
  • Left Ventricular Assist Devices, Kidney Disease, and Dialysis
    • Authors: Bethany Roehm; Amanda Vest Daniel Weiner
      Abstract: Publication date: Available online 14 December 2017
      Source:American Journal of Kidney Diseases
      Author(s): Bethany Roehm, Amanda R. Vest, Daniel E. Weiner
      Left ventricular assist devices (LVADs) improve survival in patients with advanced heart failure. As LVAD use increases, so do the number of patients with LVADs who also have kidney disease. However, there are only sparse data on how best to care for these patients. This review provides an overview of LVAD principles and indications, including blood pressure assessment and criteria for receipt of both destination and bridge to transplantation LVADs. Following LVAD implantation, kidney function may improve in the short term, particularly if cardiorenal physiology was present; in the longer term, data remain limited. Individuals with glomerular filtration rates chronically < 30mL/min/1.73m2, including those treated with maintenance dialysis, are generally ineligible for destination LVADs. However, select patients with advanced chronic kidney disease can be considered for LVADs as a bridge to heart or heart-kidney transplantation. Patients who develop acute kidney injury and require dialysis following LVAD implantation have high mortality rates. Although thrice-weekly hemodialysis is the most common modality for patients with LVADs, peritoneal dialysis and home hemodialysis are additional options. Peritoneal dialysis in particular may be associated with lower risk for bloodstream infection and fewer hemodynamic shifts. For those treated with hemodialysis, arteriovenous fistulas can successfully be used for vascular access. Many questions remain, including optimal anemia management and refinement of hemodialysis protocols for patients with an LVAD, and further research is needed in this field.

      PubDate: 2017-12-24T08:28:32Z
       
  • Association Between Gestational Diabetes and Incident Maternal CKD: The
           Coronary Artery Risk Development in Young Adults (CARDIA) Study
    • Authors: Elizabeth Dehmer; Milind Phadnis Erica Gunderson Cora Lewis Kirsten Bibbins-Domingo
      Abstract: Publication date: Available online 8 November 2017
      Source:American Journal of Kidney Diseases
      Author(s): Elizabeth W. Dehmer, Milind A. Phadnis, Erica P. Gunderson, Cora E. Lewis, Kirsten Bibbins-Domingo, Stephanie M. Engel, Michele Jonsson Funk, Holly Kramer, Abhijit V. Kshirsagar, Gerardo Heiss
      Background Gestational diabetes mellitus (GDM) is associated with increased risk for diabetes mellitus, metabolic syndrome, and cardiovascular disease. We evaluated whether GDM is associated with incident chronic kidney disease (CKD), controlling for prepregnancy risk factors for both conditions. Study Design Prospective cohort. Setting & Participants Of 2,747 women (aged 18-30 years) enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) Study in 1985 to 86, we studied 820 who were nulliparous at enrollment, delivered at least 1 pregnancy longer than 20 weeks’ gestation, and had kidney function measurements during 25 years of follow-up. Predictor GDM was self-reported by women for each pregnancy. Outcomes CKD was defined as the development of estimated glomerular filtration rate (eGFR)<60mL/min/1.73m2 or urine albumin-creatinine ratio ≥ 25mg/g at any one CARDIA examination in years 10, 15, 20, or 25. Measurements HRs for developing CKD were estimated for women who developed GDM versus women without GDM using complementary log-log models, adjusting for prepregnancy age, systolic blood pressure, dyslipidemia, body mass index, smoking, education, eGFR, fasting glucose concentration, physical activity level (all measured at the CARDIA examination before the first pregnancy), race, and family history of diabetes. We explored for an interaction between race and GDM. Results During a mean follow-up of 20.8 years, 105 of 820 (12.8%) women developed CKD, predominantly increased urine albumin excretion (98 albuminuria only, 4 decreased eGFR only, and 3 both). There was evidence of a GDM-race interaction on CKD risk (P =0.06). Among black women, the adjusted HR for CKD was 1.96 (95% CI, 1.04-3.67) in GDM compared with those without GDM. Among white women, the HR was 0.65 (95% CI, 0.23-1.83). Limitations Albuminuria was assessed by single untimed measurements of urine albumin and creatinine. Conclusions GDM is associated with the subsequent development of albuminuria among black women in CARDIA.

      PubDate: 2017-11-11T02:26:17Z
       
  • In Reply to ‘Idarucizumab Dosing in Kidney Failure’
    • Authors: James Novak; Khalid Alamiri Jerry Yee
      Abstract: Publication date: Available online 3 October 2017
      Source:American Journal of Kidney Diseases
      Author(s): James E. Novak, Khalid Alamiri, Jerry Yee


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


      PubDate: 2017-10-06T14:02:08Z
       
 
 
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