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Publisher: Elsevier   (Total: 3163 journals)

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Showing 1 - 200 of 3163 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 9)
AASRI Procedia     Open Access   (Followers: 14)
Academic Pediatrics     Hybrid Journal   (Followers: 30, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 88, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 35, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 5)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 7)
Acta Astronautica     Hybrid Journal   (Followers: 395, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 27, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 2)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.18, CiteScore: 1)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.128, CiteScore: 0)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 244, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 10, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 1, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 27, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 6, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 6)
Acute Pain     Full-text available via subscription   (Followers: 15, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 16, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 8, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 9, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Cement Based Materials     Full-text available via subscription   (Followers: 3, SJR: 0.732, CiteScore: 3)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 135, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 8, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 12, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 28, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 10, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 14, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 29, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 7, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 3)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 27, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 19, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 15)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 8)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 23)
Advances in Ecological Research     Full-text available via subscription   (Followers: 42, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 27, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 43, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 53, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 17)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 8, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 21, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 11, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 22)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 37, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 14, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 11, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 21)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 3)
Advances in Oncobiology     Full-text available via subscription   (Followers: 1)
Advances in Organ Biology     Full-text available via subscription   (Followers: 1)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 16, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 6, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 10)
Advances in Pharmacology     Full-text available via subscription   (Followers: 16, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 19, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 59)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 385, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 10, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 30, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 17)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 46, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 337, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 10, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 438, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 43, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 1)
Agriculture and Natural Resources     Open Access   (Followers: 2)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 56, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 6, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 11, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 9)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 10, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 50, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 6)
American Heart J.     Hybrid Journal   (Followers: 50, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 51, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 44, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 10)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 32, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 26, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 34, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 43)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 203, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 62, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 6, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 27, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 27, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 37, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 6)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 63, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 15, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 5, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 39, SJR: 1.512, CiteScore: 5)
Analytical Biochemistry     Hybrid Journal   (Followers: 175, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 10, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 23, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)

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Journal Cover
American Journal of Kidney Diseases
Journal Prestige (SJR): 2.973
Citation Impact (citeScore): 4
Number of Followers: 34  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0272-6386 - ISSN (Online) 1523-6838
Published by Elsevier Homepage  [3163 journals]
  • Arterial Stiffness in CKD: A Review
    • Abstract: Publication date: Available online 19 June 2018
      Source:American Journal of Kidney Diseases
      Author(s): Raymond R. Townsend
      This narrative review summarizes a decade of experience examining the cross-sectional and longitudinal relationships of arterial stiffness, as assessed using carotid-femoral pulse wave velocity, with outcomes in patients with chronic kidney disease enrolled in the Chronic Renal Insufficiency Cohort. Our goal is to review the importance of the pulse wave contour and pulse wave velocity and present data on the reproducibility of pulse wave velocity measurements, determinants of pulse wave velocity, and the relationship that velocity measurements have with longitudinal kidney and cardiovascular outcomes. Measures of arterial stiffness have contributed substantially to our understanding of mechanisms of cardiovascular disease, kidney disease progression, and all-cause mortality. Given the independent relationship of arterial stiffness to a variety of outcomes, it is our hope that future developments in behavioral, nutritional, and pharmacologic approaches to vascular destiffening will provide interventions that benefit patients with chronic kidney diseases.

      PubDate: 2018-06-21T06:53:36Z
       
  • Collapsing Glomerulopathy in Lambda Light Chain Amyloidosis: A Report of 2
           Cases
    • Abstract: Publication date: Available online 19 June 2018
      Source:American Journal of Kidney Diseases
      Author(s): Mazdak A. Khalighi, Alexander J. Gallan, Anthony Chang, Shane M. Meehan
      Amyloid nephropathy is an uncommon disease that frequently presents with reduced kidney function and proteinuria and, in developed nations, is most often associated with underlying paraproteinemia. The histologic appearance of glomerular amyloid deposition includes mesangial and capillary wall infiltration by an amorphous eosinophilic material, and features of endo- or extracapillary proliferation are not typically seen. Rare cases of crescentic injury have been reported in a subset of patients with amyloid nephropathy, particularly those with amyloid derived from serum amyloid A protein. Collapsing glomerulopathy, which like crescentic injury is associated with an extracapillary proliferation, has not to our knowledge been reported in the setting of amyloid nephropathy. We report 2 patients presenting with acute kidney injury and nephrotic syndrome found to have amyloid nephropathy with prominent epithelial cell hyperplasia and glomerular collapse on biopsy. This injury is likely multifactorial and related to direct podocyte injury and vascular compromise and expands further the spectrum of paraprotein-associated renal injury.

      PubDate: 2018-06-21T06:53:36Z
       
  • The Role of Big Data in the Development and Evaluation of US Dialysis Care
    • Abstract: Publication date: Available online 18 June 2018
      Source:American Journal of Kidney Diseases
      Author(s): Kevin F. Erickson, Samaya Qureshi, Wolfgang C. Winkelmayer
      Rapid growth in electronic communications and digitalization, combined with advances in data management, analysis, and storage, have led to an era of “Big Data.” The Social Security Amendments of 1972 turned end-stage renal disease (ESRD) care into a single-payer system for most patients requiring dialysis in the United States. As a result, there are few areas of medicine that have been as influenced by Big Data as dialysis care, for which Medicare’s large administrative data sets have had a central role in the evaluation and development of public policy for several decades. In the 1970/1980s, Medicare data helped identify concerning trends in costs, access to dialysis care, and quality of care delivered. As the research community and policymakers made Medicare’s administrative data increasingly accessible for investigation, analyses of Medicare claims have had a large role in facilitating policy synthesis and refinement. Efforts to address the skyrocketing cost of injectable drugs in the 1990s and 2000s exemplify this expanded role of Big Data. Although there are opportunities for large government and nongovernmental administrative data sets to continue serving a critical role in the evaluation and development of ESRD policies, it is important to understand challenges and limitations associated with their use.

      PubDate: 2018-06-21T06:53:36Z
       
  • Childhood Kidney Disease: A Troubling Prognosis'
    • Abstract: Publication date: Available online 18 June 2018
      Source:American Journal of Kidney Diseases
      Author(s): Darcy K. Weidemann, Bradley A. Warady, Susan L. Furth


      PubDate: 2018-06-21T06:53:36Z
       
  • ESRD and Hospice Care in the United States: Are Dialysis Patients
           Welcome'
    • Abstract: Publication date: Available online 18 June 2018
      Source:American Journal of Kidney Diseases
      Author(s): Vanessa Grubbs


      PubDate: 2018-06-21T06:53:36Z
       
  • CKD and Sedentary Time: Results From the Canadian Health
           Measures Survey
    • Abstract: Publication date: Available online 15 June 2018
      Source:American Journal of Kidney Diseases
      Author(s): Tamara Glavinovic, Thomas Ferguson, Paul Komenda, Claudio Rigatto, Todd A. Duhamel, Navdeep Tangri, Clara Bohm
      Rationale & Objective Sedentary behavior and low physical activity are associated with incident diabetes, cardiovascular disease, and early mortality. Previous studies have examined associations between chronic kidney disease (CKD) and physical activity, but little is known about the role of sedentary time. Study Design Cross-sectional national survey. Setting & Participants A nationally representative sample of adults (n=8,444) participating in the Canadian Health Measures Survey’s (CHMS) activity monitoring component (2007-2013). Predictor Estimated glomerular filtration rate (eGFR). Outcomes Sedentary time (total sedentary minutes/total wear time) measured using triaxial accelerometry. Analytical Approach Multivariable ordinal logistic regression for quartiles of sedentary time and linear regression for sedentary time measured on a continuous scale were performed in the entire study population and in the subgroup with CKD. Results Mean proportion of sedentary time ranged from 58% (least sedentary quartile: Q1) to 81% (most sedentary quartile: Q4). Lower eGFR, older age, lower serum albumin level, higher blood pressure, cardiovascular disease, diabetes, and higher body mass index were independently associated with a higher proportion of sedentary time. Patients with eGFRs < 45mL/min/1.73m2 had more than 4-fold higher likelihood of being sedentary (OR, 4.2; 95% CI, 2.5-7.3). Within the CKD subgroup, greater sedentary time was associated with diabetes (OR, 2.68; 95% CI, 1.56-4.59) and arthritis (OR, 2.32; 95% CI, 1.43-3.77) in adjusted analysis. Limitations Cross-sectional design precluded evaluation of longitudinal outcomes and establishment of the causal nature of observed associations. Small sample of individuals with advanced CKD. Conclusions In this cross-sectional survey, reduced eGFR was strongly and independently associated with greater sedentary time. This risk was further heightened by the presence of diabetes and arthritis. Studies to determine causes for sedentary behavior and assess the feasibility and value of interventions to reduce sedentary time in CKD are needed.

      PubDate: 2018-06-18T06:48:07Z
       
  • Exome Sequencing for CKD Diagnosis: Coming Soon to a Clinic Near You'
    • Abstract: Publication date: Available online 14 June 2018
      Source:American Journal of Kidney Diseases
      Author(s): David J. Friedman


      PubDate: 2018-06-18T06:48:07Z
       
  • Congophilic Fibrillary Glomerulonephritis: A Case Series
    • Abstract: Publication date: Available online 14 June 2018
      Source:American Journal of Kidney Diseases
      Author(s): Mariam P. Alexander, Surendra Dasari, Julie A. Vrana, Julie Riopel, Anthony M. Valeri, Glen S. Markowitz, Aviv Hever, Vanesa Bijol, Christopher P. Larsen, Lynn D. Cornell, Mary E. Fidler, Samar M. Said, Sanjeev Sethi, Loren Paola Herrera Hernandez, Joseph P. Grande, Stephen B. Erickson, Fernando C. Fervenza, Nelson Leung, Paul J. Kurtin, Samih H. Nasr
      Rationale & Objective Congo Red positivity with birefringence under polarized light has traditionally permitted classification of organized glomerular deposits as from amyloid or nonamyloid diseases. The absence of congophilia has been used to differentiate fibrillary glomerulonephritis (GN) from amyloidosis. We describe a series of fibrillary GN cases in which the deposits are Congo Red–positive (congophilic fibrillary GN) and discuss the role of DNAJB9 in distinguishing congophilic fibrillary GN from amyloidosis. Study Design Case series. Setting & Participants Analysis of the clinicopathologic characteristics of 18 cases of congophilic fibrillary GN. Mass spectrometry was performed and compared with 24 cases of Congo Red–negative fibrillary GN, 145 cases of amyloidosis, and 12 apparently healthy individuals. DNAJB9 immunohistochemistry was obtained for a subset of cases. Results The proteomic signature of amyloid was not detected using mass spectrometry among cases of congophilic fibrillary GN. DNAJB9, a recently discovered proteomic marker for fibrillary GN, was detected using mass spectrometry in all cases of fibrillary GN regardless of congophilia and was absent in cases of amyloidosis and in healthy individuals. DNAJB9 immunohistochemistry confirmed the mass spectrometry findings. The congophilic fibrillary GN cases included 11 men and 7 women with a mean age at diagnosis of 65 years. Concomitant monoclonal gammopathy, hepatitis C virus infection, malignancy, or autoimmune disease was present in 35%, 22%, 17%, and 11% of patients, respectively. No patient had evidence of extrarenal amyloidosis. Patients presented with proteinuria (100%), nephrotic syndrome (47%), hematuria (78%), and chronic kidney disease (83%). After a mean follow-up of 23 months, 31% of patients progressed to end-stage kidney disease and the remaining 69% had persistently reduced kidney function. Limitations Retrospective nature. Blinded pathology evaluations were not performed. Conclusions The congophilic properties of organized fibrillary deposits should not be solely relied on in differentiating fibrillary GN from renal amyloidosis. Mass spectrometry and DNAJB9 immunohistochemistry can be useful in making this distinction.

      PubDate: 2018-06-18T06:48:07Z
       
  • SGLT2 Inhibition for the Prevention and Treatment of Diabetic Kidney
           Disease: A Review
    • Abstract: Publication date: Available online 14 June 2018
      Source:American Journal of Kidney Diseases
      Author(s): Radica Z. Alicic, Emily J. Johnson, Katherine R. Tuttle
      Diabetic kidney disease (DKD) is the leading cause of end-stage kidney disease in the United States and the world alike, and there is a great unmet need for treatments to reduce DKD development and progression. Inhibition of sodium/glucose co-transporter 2 (SGLT2) in the proximal tubule of the kidney has emerged as an effective antihyperglycemic treatment, leading to regulatory approval of several first-generation SGLT2 inhibitors for the treatment of type 2 diabetes. In follow-on clinical trials for the cardiovascular safety of the SGLT2 inhibitors, secondary effects to prevent or reduce albuminuria and decline in estimated glomerular filtration rate spurred further investigation into their potential application in DKD. This review summarizes the current understanding of mechanisms by which SGLT2 inhibitors block glucose reabsorption in the proximal tubule and improve systemic glucose homeostasis, the hypothesized mechanisms for kidney-protective effects of SGLT2 inhibition, and current recommendations for use of this class of antihyperglycemic agents in diabetic patients with low estimated glomerular filtration rates. Results of ongoing clinical trials in patients with DKD are eagerly awaited to expand knowledge of how SGLT2 inhibitors might be used for prevention and treatment.

      PubDate: 2018-06-18T06:48:07Z
       
  • Distant Organ Dysfunction in Acute Kidney Injury: A Review
    • Abstract: Publication date: Available online 14 June 2018
      Source:American Journal of Kidney Diseases
      Author(s): Sul A Lee, Martina Cozzi, Errol L. Bush, Hamid Rabb
      Acute kidney injury (AKI) is common in critically ill patients and is associated with increased morbidity and mortality. Dysfunction of other organs is an important cause of poor outcomes from AKI. Ample clinical and epidemiologic data show that AKI is associated with distant organ dysfunction in lung, heart, brain, and liver. Recent advancements in basic and clinical research have demonstrated physiologic and molecular mechanisms of distant organ interactions in AKI, including leukocyte activation and infiltration, generation of soluble factors such as inflammatory cytokines/chemokines, and endothelial injury. Oxidative stress and production of reactive oxygen species, as well as dysregulation of cell death in distant organs, are also important mechanism of AKI-induced distant organ dysfunction. This review updates recent clinical and experimental findings on organ crosstalk in AKI and highlights potential molecular mechanisms and therapeutic targets to improve clinical outcomes during AKI.

      PubDate: 2018-06-18T06:48:07Z
       
  • GDF-15, Galectin 3, Soluble ST2, and Risk of Mortality and Cardiovascular
           Events in CKD
    • Abstract: Publication date: Available online 14 June 2018
      Source:American Journal of Kidney Diseases
      Author(s): Courtney Tuegel, Ronit Katz, Mariam Alam, Zeenat Bhat, Keith Bellovich, Ian de Boer, Frank Brosius, Crystal Gadegbeku, Debbie Gipson, Jennifer Hawkins, Jonathan Himmelfarb, Wenjun Ju, Bryan Kestenbaum, Matthias Kretzler, Cassianne Robinson-Cohen, Susan Steigerwalt, Nisha Bansal
      Rationale & Objective Inflammation, cardiac remodeling, and fibrosis may explain in part the excess risk for cardiovascular disease (CVD) in patients with chronic kidney disease (CKD). Growth differentiation factor 15 (GDF-15), galectin 3 (Gal-3), and soluble ST2 (sST2) are possible biomarkers of these pathways in patients with CKD. Study Design Observational cohort study. Setting & Participants Individuals with CKD enrolled in either of 2 multicenter CKD cohort studies: the Seattle Kidney Study or C-PROBE (Clinical Phenotyping and Resource Biobank Study). Exposures Circulating GDF-15, Gal-3, and sST2 measured at baseline. Outcomes Primary outcome was all-cause mortality. Secondary outcomes included hospitalization for physician-adjudicated heart failure and the atherosclerotic CVD events of myocardial infarction and cerebrovascular accident. Analytic Approach Cox proportional hazards models used to test the association of each biomarker with each outcome, adjusting for demographics, CVD risk factors, and kidney function. Results Among 883 participants, mean estimated glomerular filtration rate was 49±19mL/min/1.73m2. Higher GDF-15 (adjusted HR [aHR] per 1-SD higher, 1.87; 95% CI, 1.53-2.29), Gal-3 (aHR per 1-SD higher, 1.51; 95% CI, 1.36-1.78), and sST2 (aHR per 1-SD higher, 1.36; 95% CI, 1.17-1.58) concentrations were significantly associated with mortality. Only GDF-15 level was also associated with heart failure events (HR per 1-SD higher, 1.56; 95% CI, 1.12-2.16). There were no detectable associations between GDF-15, Gal-3, or sST2 concentrations and atherosclerotic CVD events. Limitations Event rates for heart failure and atherosclerotic CVD were low. Conclusions Adults with CKD and higher circulating GDF-15, Gal-3, and sST2 concentrations experienced greater mortality. Elevated GDF-15 concentration was also associated with an increased rate of heart failure. Further work is needed to elucidate the mechanisms linking these circulating biomarkers with CVD in patients with CKD.

      PubDate: 2018-06-18T06:48:07Z
       
  • Volcanoes
    • Abstract: Publication date: Available online 11 June 2018
      Source:American Journal of Kidney Diseases
      Author(s): Jason E. Jones


      PubDate: 2018-06-12T06:26:11Z
       
  • In Reply to ‘Is Sugar-Sweetened Beverage Consumption a Possible
           Confounder in the Inverse Association Between Coffee and Kidney
           Disease'’
    • Abstract: Publication date: Available online 11 June 2018
      Source:American Journal of Kidney Diseases
      Author(s): Emily A. Hu, Casey M. Rebholz


      PubDate: 2018-06-12T06:26:11Z
       
  • In Reply to ‘Pulmonary Hypertension or Cardiorenal Syndrome: The Devil
           Is in the Details’
    • Abstract: Publication date: Available online 11 June 2018
      Source:American Journal of Kidney Diseases
      Author(s): Mengyao Tang


      PubDate: 2018-06-12T06:26:11Z
       
  • Is Sugar-Sweetened Beverage Consumption a Possible Confounder in the
           Inverse Association Between Coffee and Kidney Disease'
    • Abstract: Publication date: Available online 11 June 2018
      Source:American Journal of Kidney Diseases
      Author(s): Fausta Natella, Gianni Pastore, Raffaella Canali, Stefania Sette


      PubDate: 2018-06-12T06:26:11Z
       
  • Pulmonary Hypertension or Cardiorenal Syndrome: The Devil Is in the
           Details
    • Abstract: Publication date: Available online 11 June 2018
      Source:American Journal of Kidney Diseases
      Author(s): Amir Kazory


      PubDate: 2018-06-12T06:26:11Z
       
  • Association of Medicare's Bundled Payment Reform With Changes in Use of
           Vitamin D Among Patients Receiving Maintenance Hemodialysis: An
           Interrupted Time-Series Analysis
    • Authors: Julia Spoendlin; Sebastian Schneeweiss Theodore Tsacogianis Julie Paik Michael Fischer
      Abstract: Publication date: Available online 8 June 2018
      Source:American Journal of Kidney Diseases
      Author(s): Julia Spoendlin, Sebastian Schneeweiss, Theodore Tsacogianis, Julie M. Paik, Michael A. Fischer, Seoyoung C. Kim, Rishi J. Desai
      Background & Rationale Medicare’s 2011 prospective payment system (PPS) was introduced to curb overuse of separately billable injectable drugs. After epoietin, intravenous (IV) vitamin D analogues are the biggest drug cost drivers in hemodialysis (HD) patients, but the association between PPS introduction and vitamin D therapy has been scarcely investigated. Study Design Interrupted time-series analyses. Setting & Participants Adult US HD patients represented in the US Renal Data System between 2008 and 2013. Exposures PPS implementation. Outcomes The cumulative dose of IV vitamin D analogues (paricalcitol equivalents) per patient per calendar quarter in prevalent HD patients. The average starting dose of IV vitamin D analogues and quarterly rates of new vitamin D use (initiations/100 person-months) in incident HD patients within 90 days of beginning HD therapy. Analytical Approach Segmented linear regression models of the immediate change and slope change over time of vitamin D use after PPS implementation. Results Among 359,600 prevalent HD patients, IV vitamin D analogues accounted for 99% of the total use, and this trend was unchanged over time. PPS resulted in an immediate 7% decline in the average dose of IV vitamin D analogues (average baseline dose = 186.5 μg per quarter; immediate change = −13.5 μg [P < 0.001]; slope change = 0.43 per quarter [P = 0.3]) and in the starting dose of IV vitamin D analogues in incident HD patients (average baseline starting dose = 5.22 μg; immediate change = −0.40 μg [P < 0.001]; slope change = −0.03 per quarter [P = 0.03]). The baseline rate of vitamin D therapy initiation among 99,970 incident HD patients was 44.9/100 person-months and decreased over time, even before PPS implementation (pre-PPS β = −0.46/100 person-months [P < 0.001]; slope change = −0.19/100 person-months [P = 0.2]). PPS implementation was associated with an immediate change in initiation levels (by −4.5/100 person-months; P < 0.001). Limitations Incident HD patients were restricted to those 65 years or older. Conclusion PPS implementation was associated with a 7% reduction in the average dose and starting dose of IV vitamin D analogues and a 10% reduction in the rate of vitamin D therapy initiation.

      PubDate: 2018-06-09T06:06:03Z
       
  • iRhoms: A Potential Path to More Specific Therapeutic Targeting of Lupus
           Nephritis
    • Authors: Andreas Herrlich; Eirini Kefaloyianni
      Abstract: Publication date: Available online 7 June 2018
      Source:American Journal of Kidney Diseases
      Author(s): Andreas Herrlich, Eirini Kefaloyianni


      PubDate: 2018-06-09T06:06:03Z
       
  • Bioelectrical Impedance Analysis Measures and Clinical Outcomes in CKD
    • Authors: Nisha Bansal; Leila Zelnick Jonathan Himmelfarb Glenn Chertow
      Abstract: Publication date: Available online 6 June 2018
      Source:American Journal of Kidney Diseases
      Author(s): Nisha Bansal, Leila R. Zelnick, Jonathan Himmelfarb, Glenn M. Chertow
      Rationale & Objective Bioelectrical impedance analysis (BIA) provides a noninvasive assessment of body composition. BIA measures of cell integrity (phase angle) and hydration (vector length) have been associated with mortality among patients receiving dialysis. Whether these measures are associated with clinical outcomes in patients with chronic kidney disease (CKD) is unknown. Study Design Observational study. Settings & Participants We studied 3,751 participants with CKD in the prospective multicenter Chronic Renal Insufficiency Cohort (CRIC) who had baseline single-frequency BIA performed. Predictors Predictors included phase angle and vector length, which were calculated from measurements of resistance and reactance from BIA. We ranked phase angle and vector length into quartiles and compared the 2 narrower quartiles of phase angle and shorter quartiles of vector length with the 2 upper quartiles. Outcomes Mortality, heart failure, atherosclerotic cardiovascular disease, and progression of CKD (30% decline in estimated glomerular filtration rate or end-stage kidney disease). Analytic Approach We tested associations of phase angle and vector length with risks for mortality and progression of CKD using Cox proportional hazard models and the association with heart failure and atherosclerotic cardiovascular disease using Fine and Gray models. All models were adjusted for demographics, comorbid conditions, and kidney function. Results Mean phase angle and vector length were 6.6°±1.8° and 470 ± 96 Ω/m, respectively. Relative to phase angle ≥ 6.40o, narrower phase angle (<5.59o) was significantly associated with mortality (HR, 1.31; 95% CI, 1.09-1.58). Relative to vector length ≥ 459 Ω/m, shorter vector length (<401 Ω/m) was significantly associated with heart failure (HR, 1.28; 95% CI, 1.01-1.61). Neither measure was associated with atherosclerotic cardiovascular disease or a composite renal end point. Limitations Observational study. Conclusions Adjusted for key confounders, BIA-derived measures of cellular integrity and tissue hydration were significantly associated with death and incident heart failure, respectively.

      PubDate: 2018-06-09T06:06:03Z
       
  • Serum Calcitriol Concentrations and Kidney Function Decline, Heart
           Failure, and Mortality in Elderly Community-Living Adults: The Health,
           Aging, and Body Composition Study
    • Authors: Umut Selamet; Ronit Katz Charles Ginsberg Dena Rifkin Linda Fried
      Abstract: Publication date: Available online 6 June 2018
      Source:American Journal of Kidney Diseases
      Author(s): Umut Selamet, Ronit Katz, Charles Ginsberg, Dena E. Rifkin, Linda F. Fried, Stephen B. Kritchevsky, Andrew N. Hoofnagle, Kirsten Bibbins-Domingo, David Drew, Tamara Harris, Anne Newman, Orlando M. Gutiérrez, Mark J. Sarnak, Michael G. Shlipak, Joachim H. Ix
      Rationale & Objectives Lower 25-hydroxyvitamin D concentrations have been associated with risk for kidney function decline, heart failure, and mortality. However, 25-hydroxyvitamin D requires conversion to its active metabolite, calcitriol, for most biological effects. The associations of calcitriol concentrations with clinical events have not been well explored. Study Design Case-cohort study. Setting & Participants Well-functioning community-living older adults aged 70 to 79 years at inception who participated in the Health, Aging, and Body Composition (Health ABC) Study. Predictor Serum calcitriol measured using positive ion electrospray ionization-tandem mass spectrometry. Outcomes Major kidney function decline (≥30% decline in estimated glomerular filtration rate from baseline), incident heart failure (HF), and all-cause mortality during 10 years of follow-up. Analytic Approach Baseline calcitriol concentrations were measured in a random subcohort of 479 participants and also in cases with major kidney function decline [n=397]) and incident HF (n=207) during 10 years of follow-up. Associations of serum calcitriol concentrations with these end points were evaluated using weighted Cox regression to account for the case-cohort design, while associations with mortality were assessed in the subcohort alone using unweighted Cox regression. Results During 8.6 years of mean follow-up, 212 (44%) subcohort participants died. In fully adjusted models, each 1–standard deviation lower calcitriol concentration was associated with 30% higher risk for major kidney function decline (95% CI, 1.03-1.65; P =0.03). Calcitriol was not significantly associated with incident HF (HR, 1.16; 95% CI, 0.94-1.47) or mortality (HR, 1.01; 95% CI, 0.81-1.26). We observed no significant interactions between calcitriol concentrations and chronic kidney disease status, baseline intact parathyroid or fibroblast factor 23 concentrations. Limitations Observational study design, calcitriol measurements at a single time point, selective study population of older adults only of white or black race. Conclusions Lower calcitriol concentrations are independently associated with kidney function decline in community-living older adults. Future studies will be needed to clarify whether these associations reflect lower calcitriol concentrations resulting from abnormal kidney tubule dysfunction or direct mechanisms relating lower calcitriol concentrations to more rapid loss of kidney function.

      PubDate: 2018-06-09T06:06:03Z
       
  • Clinical Course of a Patient With Kidney Failure Due to Isolated Bilateral
           Renal Extramedullary Plasmacytomas
    • Authors: Braden Lawrence; Emily Petersen Wayne Riches David Pfeiffer
      Abstract: Publication date: Available online 6 June 2018
      Source:American Journal of Kidney Diseases
      Author(s): Braden J. Lawrence, Emily L. Petersen, Wayne G. Riches, David C. Pfeiffer
      Plasmacytomas are rare immunoproliferative monoclonal plasma cell diseases of lymphoid lineage that may present in an isolated or systemic manner. Systemic involvement is much more common than occurrences isolated to a particular organ, and for this reason, it is imperative to rule out systemic involvement for osseous and nonosseous isolated neoplasms. These neoplasms present unique challenges due to their location, extent of involvement, vague presentation, and dearth of treatment protocol. We report the case of a 69-year-old man who developed chronic kidney disease stage 4 between 2009 and 2012. Precipitous kidney failure, anorexia, fatigue, and flank pain necessitated clinical follow-up that ultimately led to thorough imaging and bilateral kidney biopsy. Protein electrophoresis, immunohistochemistry, and immunofluorescence were all consistent with bilateral renal extramedullary plasmacytomas. Treatment recommendations are often limited to prior case successes; however, chemotherapy, radiation, and surgery are the mainstay of treatment. Although surgery or combined therapy provides the best results for patients, such options are unfeasible with bilateral kidney involvement. Therefore, a chemotherapy regimen, similar to that for multiple myeloma, was determined to be most reasonable. Treatment consisted of 4 cycles of a bortezomib, cyclophosphamide, and dexamethasone regimen. Three months following chemotherapy, kidney function returned to baseline levels.

      PubDate: 2018-06-09T06:06:03Z
       
  • Tolvaptan for the Syndrome of Inappropriate Secretion of Antidiuretic
           Hormone: Is the Dose Too High'
    • Authors: Richard Sterns
      Abstract: Publication date: June 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 6
      Author(s): Richard H. Sterns


      PubDate: 2018-05-28T04:28:41Z
       
  • More Realistic Estimation of Time to ESRD in Children
    • Authors: Guido Filler; Christopher McIntyre
      Abstract: Publication date: June 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 6
      Author(s): Guido Filler, Christopher W. McIntyre


      PubDate: 2018-05-28T04:28:41Z
       
  • Altered Prostaglandin Signaling as a Cause of Thiazide-Induced
           Hyponatremia
    • Authors: Biff Palmer; Deborah Clegg
      Abstract: Publication date: June 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 6
      Author(s): Biff F. Palmer, Deborah J. Clegg


      PubDate: 2018-05-28T04:28:41Z
       
  • Rapidity of Correction of Hyponatremia Due to Syndrome of Inappropriate
           Secretion of Antidiuretic Hormone Following Tolvaptan
    • Authors: Jesse Morris; Nicole Bohm Branden Nemecek Rachel Crawford Denise Kelley
      Abstract: Publication date: June 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 6
      Author(s): Jesse H. Morris, Nicole M. Bohm, Branden D. Nemecek, Rachel Crawford, Denise Kelley, Bhavna Bhasin, Paul J. Nietert, Juan Carlos Q. Velez
      Background Tolvaptan effectively corrects hyponatremia due to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), but undesired overcorrection can occur. We hypothesized that pretherapy parameters can predict the rapidity of response to tolvaptan in SIADH. Study Design Multicenter historical cohort study. Setting & Participants Adults with SIADH or congestive heart failure (CHF) treated with tolvaptan for a serum sodium concentration ≤ 130 mEq/L at 5 US hospitals. Predictors Demographic and laboratory parameters. Outcomes Rate of change in serum sodium concentration. Measurements Spearman correlations, analysis of variance, and multivariable linear mixed-effects models. Results 28 patients with SIADH and 39 patients with CHF treated with tolvaptan (mean baseline serum sodium, 120.6 and 122.4 mEq/L, respectively) were studied. Correction of serum sodium concentration > 12 mEq/L/d occurred in 25% of patients with SIADH compared to 3% of those with CHF (P <0.001). Among patients with SIADH, the increase in serum sodium over 24 hours was correlated with baseline serum sodium concentration (r =−0.78; P <0.001), serum urea nitrogen concentration (SUN; r =−0.76; P <0.001), and estimated glomerular filtration rate (r =0.58; P =0.01). Baseline serum sodium and SUN concentrations were identified as independent predictors of change in serum sodium concentration in multivariable analyses. When patients were grouped into 4 categories according to baseline serum sodium and SUN median values, those with both low baseline serum sodium (≤121 mEq/L) and low baseline SUN concentrations (≤10mg/dL) exhibited a significantly greater rate of increase in serum sodium concentration (mean 24-hour increase of 15.4 mEq/L) than the other 3 categories (P <0.05). Among patients with CHF, only baseline SUN concentration was identified as an independent predictor of change in serum sodium concentration over time. Limitations Lack of uniformity in serial serum sodium concentration determinations and documentation of water intake. Conclusions Baseline serum sodium and SUN values are predictive of the rapidity of hyponatremia correction following tolvaptan use in SIADH. We advise caution when dosing tolvaptan in patients with both low serum sodium and SUN concentrations.

      PubDate: 2018-05-28T04:28:41Z
       
  • Impact of Obesity on Modality Longevity, Residual Kidney Function,
           Peritonitis, and Survival Among Incident Peritoneal Dialysis Patients
    • Authors: Yoshitsugu Obi; Elani Streja Rajnish Mehrotra Matthew Rivara Connie Rhee
      Abstract: Publication date: June 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 6
      Author(s): Yoshitsugu Obi, Elani Streja, Rajnish Mehrotra, Matthew B. Rivara, Connie M. Rhee, Melissa Soohoo, Daniel L. Gillen, Wei-Ling Lau, Csaba P. Kovesdy, Kamyar Kalantar-Zadeh
      Background The prevalence of severe obesity, often considered a contraindication to peritoneal dialysis (PD), has increased over time. However, mortality has decreased more rapidly in the PD population than the hemodialysis (HD) population in the United States. The association between obesity and clinical outcomes among patients with end-stage kidney disease remains unclear in the current era. Study Design Historical cohort study. Setting & Participants 15,573 incident PD patients from a large US dialysis organization (2007-2011). Predictor Body mass index (BMI). Outcomes Modality longevity, residual renal creatinine clearance, peritonitis, and survival. Results Higher BMI was significantly associated with shorter time to transfer to HD therapy (P for trend < 0.001), longer time to kidney transplantation (P for trend < 0.001), and, with borderline significance, more frequent peritonitis-related hospitalization (P for trend = 0.05). Compared with lean patients, obese patients had faster declines in residual kidney function (P for trend < 0.001) and consistently achieved lower total Kt/V over time (P for trend < 0.001) despite greater increases in dialysis Kt/V (P for trend < 0.001). There was a U-shaped association between BMI and mortality, with the greatest survival associated with the BMI range of 30 to < 35kg/m2 in the case-mix adjusted model. Compared with matched HD patients, PD patients had lower mortality in the BMI categories of < 25 and 25 to < 35kg/m2 and had equivalent survival in the BMI category ≥ 35kg/m2 (P for interaction = 0.001 [vs < 25 kg/m2]). This attenuation in survival difference among patients with severe obesity was observed only in patients with diabetes, but not those without diabetes. Limitations Inability to evaluate causal associations. Potential indication bias. Conclusions Whereas obese PD patients had higher risk for complications than nonobese PD patients, their survival was no worse than matched HD patients.

      PubDate: 2018-05-28T04:28:41Z
       
  • 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: June 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 6
      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: 2018-05-28T04:28:41Z
       
  • Factors Associated With Withdrawal From Maintenance Dialysis: A
           Case-Control Analysis
    • Authors: James Wetmore; Heng Yan Yan David Gilbertson Jiannong Liu
      Abstract: Publication date: June 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 6
      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: 2018-05-28T04:28:41Z
       
  • Validity of a Risk Prediction Equation for CKD After 10 Years of Follow-up
           in a Japanese Population: The Ibaraki Prefectural Health Study
    • Authors: Mitsumasa Umesawa; Toshimi Sairenchi Yasuo Haruyama Masanori Nagao Kazumasa Yamagishi
      Abstract: Publication date: June 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 6
      Author(s): Mitsumasa Umesawa, Toshimi Sairenchi, Yasuo Haruyama, Masanori Nagao, Kazumasa Yamagishi, Fujiko Irie, Hiroshi Watanabe, Gen Kobashi, Hiroyasu Iso, Hitoshi Ota
      Background Chronic kidney disease (CKD) is an important health problem for which risk equations have been developed for Western populations. This study aimed to develop and validate a risk prediction equation for CKD in a Japanese population. Study Design Observational cohort study. Setting & Participants The study included 135,007 participants who completed an annual health checkup in 1993 to 1996 in the Ibaraki Prefecture in Japan. Participants were initially free of CKD (defined as stage 3, 4, or 5 CKD or proteinuria [2+ or 3+] by dipstick). Follow-up information was available from health checkups 10 years after the initial evaluation. We used data from 40,963 women and 17,892 men in the northern region of the prefecture for the development of risk prediction equations and 53,042 women and 23,110 men in the southern region for external validation. Predictors Age, estimated glomerular filtration rate (eGFR), body mass index, proteinuria, hematuria, hypertension, diabetes mellitus, smoking, and drinking. Outcome Occurrence of CKD (defined as eGFR<60mL/min/1.73m2 and/or proteinuria [2+ or 3+] by dipstick). Analytical Approach Logistic regression analysis to estimate risk for CKD stratified by sex. Results During follow-up, 7,500 cases of CKD developed in the northern region and 8,964, in the southern region. Older age, proteinuria (1+), higher systolic blood pressure, medication for hypertension, and current smoking were associated with increased risk for CKD in both sexes, whereas higher eGFR and daily alcohol intake were associated with lower risk. C statistics of risk estimation equations for CKD at 10 years were >0.8 for both the development and external validation populations, and discrimination of the risk estimation was fairly good in women and men. Limitations Fluctuations in variables were not evaluated because the study used annual health checkups. This study excluded a large number of people for whom a 10-year health checkup was not available. Conclusions Estimations of risk for CKD after 10 years of follow-up in a general Japanese population can be achieved with a high level of validity.

      PubDate: 2018-05-28T04:28:41Z
       
  • Palliative Care Disincentives in CKD: Changing Policy to Improve CKD Care
    • Authors: Manjula Kurella; Tamura Ann Eugene Lin Laura Holdsworth Elizabeth Malcolm
      Abstract: Publication date: June 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 6
      Author(s): Manjula Kurella Tamura, Ann M. O’Hare, Eugene Lin, Laura M. Holdsworth, Elizabeth Malcolm, Alvin H. Moss
      The dominant health delivery model for advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) in the United States, which focuses on provision of dialysis, is ill-equipped to address many of the needs of seriously ill patients. Although palliative care may address some of these gaps in care, its integration into advanced CKD care has been suboptimal due to several health system barriers. These barriers include uneven access to specialty palliative care services, underdeveloped models of care for seriously ill patients with advanced CKD, and misaligned policy incentives. This article reviews policies that affect the delivery of palliative care for this population, discusses reforms that could address disincentives to palliative care, identifies quality measurement issues for palliative care for individuals with advanced CKD and ESRD, and considers potential pitfalls in the implementation of new models of integrated palliative care. Reforming health care delivery in ways that remove policy disincentives to palliative care for patients with advanced CKD and ESRD will fill a critical gap in care.

      PubDate: 2018-05-28T04:28:41Z
       
  • CRISPR Gene Editing in the Kidney
    • Authors: Nelly Cruz; Benjamin Freedman
      Abstract: Publication date: June 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 6
      Author(s): Nelly M. Cruz, Benjamin S. Freedman
      CRISPR is a nuclease guidance system that enables rapid and efficient gene editing of specific DNA sequences within genomes. We review applications of CRISPR for the study and treatment of kidney disease. CRISPR enables functional experiments in cell lines and model organisms to validate candidate genes arising from genetic studies. CRISPR has furthermore been used to establish the first models of genetic disease in human kidney organoids derived from pluripotent stem cells. These gene-edited organoids are providing new insight into the cellular mechanisms of polycystic kidney disease and nephrotic syndrome. CRISPR-engineered cell therapies are currently in clinical trials for cancers and immunologic syndromes, an approach that may be applicable to inflammatory conditions such as lupus nephritis. Use of CRISPR in large domestic species such as pigs raises the possibility of farming kidneys for transplantation to alleviate the shortage of donor organs. However, significant challenges remain, including how to effectively deliver CRISPR to kidneys and how to control gene editing events within the genome. Thorough testing of CRISPR in preclinical models will be critical to the safe and efficacious translation of this powerful young technology into therapies.

      PubDate: 2018-05-28T04:28:41Z
       
  • Update on Diabetic Nephropathy: Core Curriculum 2018
    • Authors: Kausik Umanath; Julia Lewis
      Abstract: Publication date: June 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 6
      Author(s): Kausik Umanath, Julia B. Lewis
      Diabetic kidney disease and diabetic nephropathy are the leading cause of end-stage kidney disease in the United States and most developed countries. Diabetes accounts for 30% to 50% of the incident cases of end-stage kidney disease in the United States. Although this represents a significant public health concern, it is important to note that only 30% to 40% of patients with diabetes develop diabetic nephropathy. Specific treatment of patients with diabetic nephropathy can be divided into 4 major arenas: cardiovascular risk reduction, glycemic control, blood pressure control, and inhibition of the renin-angiotensin system (RAS). Recommendations for therapy include targeting a hemoglobin A1c concentration < 7% and blood pressure < 140/90mmHg with therapy anchored around the use of a RAS-blocking agent. The single best evidence-based therapy for diabetic nephropathy is therapy with a RAS-blocking medication. This Core Curriculum outlines and discusses in detail the epidemiology, pathophysiology, diagnosis, and management of diabetic nephropathy.

      PubDate: 2018-05-28T04:28:41Z
       
  • High-Output Cardiac Failure and Coronary Steal With an Arteriovenous
           Fistula
    • Authors: Amtul Aala; Sairah Sharif Leslie Parikh Paul Gordon Susie
      Abstract: Publication date: June 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 6
      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: 2018-05-28T04:28:41Z
       
  • The Clinical and Immunologic Features of Patients With Combined Anti-GBM
           Disease and Castleman Disease
    • Authors: Qiu-hua Xiao-yu; Jia Shui-yi Su-xia Wang Wan-zhong Zou Zhao Cui
      Abstract: Publication date: June 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 6
      Author(s): Qiu-hua Gu, Xiao-yu Jia, Shui-yi Hu, Su-xia Wang, Wan-zhong Zou, Zhao Cui, Ming-hui Zhao
      Patients with both anti–glomerular basement membrane (anti-GBM) disease and Castleman disease have been rarely reported. In this study, we report 3 patients with this combination. They had immunologic features similar to patients with classic anti-GBM disease. Sera from the 3 patients recognized the noncollagenous (NC) domain of the α3 chain of type IV collagen (α3(IV)NC1) and its 2 major epitopes, EA and EB. All 4 immunogloblin G (IgG) subclasses against α3(IV)NC1 were detectable, with predominance of IgG1. In one patient with lymph node biopsy specimens available, sporadic plasma cells producing α3(IV)NC1-IgG were found, suggesting a causal relationship between the 2 diseases. One patient, who achieved remission with antibody clearance and normalization of serum creatinine and interleukin 6 concentrations after plasma exchange and 3 cycles of chemotherapy, experienced recurrence of anti-GBM antibodies and an increase in interleukin 6 concentration after chemotherapy discontinuation because of adverse effects, but both returned to normal after another cycle of chemotherapy. This clinical course and the pathologic findings support the hypothesis that the Castleman disease–associated tumor cells are the source of the anti-GBM autoantibodies.

      PubDate: 2018-05-28T04:28:41Z
       
  • Low Birth Weight: Intrauterine Growth Restriction or Prematurity'
    • Authors: Judith Kooiman; Fieke Terstappen Titia Lely
      Abstract: Publication date: June 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 6
      Author(s): Judith Kooiman, Fieke Terstappen, A. Titia Lely


      PubDate: 2018-05-28T04:28:41Z
       
  • In Reply to ‘Low Birth Weight: Intrauterine Growth Restriction or
           Prematurity'’
    • Authors: Johan Eriksson; Eero Kajantie Clive Osmond
      Abstract: Publication date: June 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 6
      Author(s): Johan G. Eriksson, Eero Kajantie, Clive Osmond


      PubDate: 2018-05-28T04:28:41Z
       
  • Thoracic Ultrasound Artifacts: Still a Matter of Discussion
    • Authors: Marco Sperandeo; Maria Giulia Tinti Vincenzo Carnevale
      Abstract: Publication date: June 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 6
      Author(s): Marco Sperandeo, Maria Giulia Tinti, Vincenzo Carnevale


      PubDate: 2018-05-28T04:28:41Z
       
  • In Reply to ‘Thoracic Ultrasound Artifacts: Still a Matter of
           Discussion’
    • Authors: Adrian Covic; Luminita Voroneanu Dimitrie Siriopol
      Abstract: Publication date: June 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 6
      Author(s): Adrian Covic, Luminita Voroneanu, Dimitrie Siriopol


      PubDate: 2018-05-28T04:28:41Z
       
  • Artificial Intelligence Can Predict GFR Decline During the Course of ADPKD
    • Authors: Olivier Niel; Charlotte Boussard Paul Bastard
      Abstract: Publication date: June 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 6
      Author(s): Olivier Niel, Charlotte Boussard, Paul Bastard


      PubDate: 2018-05-28T04:28:41Z
       
  • Linear and Nonlinear Estimated GFR Slopes in ADPKD Patients Reaching ESRD
    • Authors: Matei Neagu; Daniel Coca Albert C.M. Ong
      Abstract: Publication date: June 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 6
      Author(s): Matei Neagu, Daniel Coca, Albert C.M. Ong


      PubDate: 2018-05-28T04:28:41Z
       
  • In Reply to ‘Artificial Intelligence Can Predict GFR Decline During the
           Course of ADPKD’ and ‘Linear and Nonlinear Estimated GFR Slopes in
           ADPKD Patients Reaching ESRD’
    • Authors: Godela Brosnahan; Charity Moore Kaleab Abebe
      Abstract: Publication date: June 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 6
      Author(s): Godela M. Brosnahan, Charity G. Moore, Kaleab Z. Abebe


      PubDate: 2018-05-28T04:28:41Z
       
  • Attempts to Change the Globally Accepted Term, CKDu, to KDUCAL, NUCAL, or
           CINAC Are Inappropriate
    • Authors: Sunil Wimalawansa; Oliver Ileperuma C.S. Weeraratna
      Abstract: Publication date: June 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 6
      Author(s): Sunil Wimalawansa, Oliver Ileperuma, C.S. Weeraratna


      PubDate: 2018-05-28T04:28:41Z
       
  • In Reply to ‘Attempts to Change the Globally Accepted Term, CKDu, to
           KDUCAL, NUCAL, or CINAC Are Inappropriate’
    • Authors: Srinivas Subramanian; Muhammad Javaid
      Abstract: Publication date: June 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 6
      Author(s): Srinivas Subramanian, Muhammad M. Javaid


      PubDate: 2018-05-28T04:28:41Z
       
  • Cryptographic Protocols to Facilitate Decision Making in Kidney Paired
           Donation
    • Authors: Lyndsay Baines; Rahul Jindal
      Abstract: Publication date: June 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 6
      Author(s): Lyndsay S. Baines, Rahul M. Jindal


      PubDate: 2018-05-28T04:28:41Z
       
  • The Relationship of Quantitative Retinal Capillary Network to Kidney
           Function in Type 2 Diabetes
    • Authors: Carol Cheung; Fangyao Tang Danny Raymond Wong Jerry Lok Zihan
      Abstract: Publication date: June 2018
      Source:American Journal of Kidney Diseases, Volume 71, Issue 6
      Author(s): Carol Y. Cheung, Fangyao Tang, Danny S. Ng, Raymond Wong, Jerry Lok, Zihan Sun, Tiffany Tso, Alexander Lam, Marten Brelén, Kelvin K. Chong, Andrea O. Luk, Juliana C. Chan, Tien Y. Wong, Clement C. Tham


      PubDate: 2018-05-28T04:28:41Z
       
  • Estimating Time to ESRD in Children With CKD
    • Authors: Susan Furth; Chris Pierce Wun Fung Hui Colin White Craig
      Abstract: Publication date: Available online 10 April 2018
      Source:American Journal of Kidney Diseases
      Author(s): Susan L. Furth, Chris Pierce, Wun Fung Hui, Colin A. White, Craig S. Wong, Franz Schaefer, Elke Wühl, Alison G. Abraham, Bradley A. Warady
      Rationale & Objective The KDIGO (Kidney Disease: Improving Global Outcomes) guideline for chronic kidney disease (CKD) presented an international classification system that ranks patients’ risk for CKD progression. Few data for children informed guideline development. Study Design Observational cohort study. Settings & Participants Children aged 1 to 18 years enrolled in the North American Chronic Kidney Disease in Children (CKiD) cohort study and the European Effect of Strict Blood Pressure Control and ACE Inhibition on the Progression of CRF in Pediatric Patients (ESCAPE) trial. Predictor Level of estimated glomerular filtration rate (eGFR) and proteinuria (urine protein-creatinine ratio [UPCR]) at study entry. Outcome A composite event of renal replacement therapy, 50% reduction in eGFR, or eGFR<15mL/min/1.73m2. eGFR was estimated using the CKiD-derived “bedside” equation. Analytical Approach Accelerated failure time models of the composite outcome using a conventional generalized gamma distribution. Likelihood ratio statistics of nested models were used to amalgamate levels of similar risk. Results Among 1,232 children, median age was 12 (IQR, 8-15) years, median eGFR was 47 (IQR, 33-62) mL/min/1.73m2, 60% were males, and 13% had UPCRs>2.0mg/mg at study entry. 6 ordered stages with varying combinations of eGFR categories (60-89, 45-59, 30-44, and 15-29mL/min/1.73m2) and UPCR categories (<0.5, 0.5-2.0, and >2.0mg/mg) described the risk continuum. Median times to event ranged from longer than 10 years for eGFRs of 45 to 90mL/min/1.73m2 and UPCRs<0.5mg/mg to 0.8 years for eGFRs of 15 to 30mL/min/1.73m2 and UPCRs>2mg/mg. Children with glomerular disease were estimated to have a 43% shorter time to event than children with nonglomerular disease. Cross-validation demonstrated risk patterns that were consistent across the 10 subsample validation models. Limitations Observational study, used cross-validation rather than external validation. Conclusions CKD staged by level of eGFR and proteinuria characterizes the timeline of progression and can guide management strategies in children.

      PubDate: 2018-04-12T16:33:07Z
       
 
 
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