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UROLOGY, NEPHROLOGY AND ANDROLOGY (159 journals)                     

Showing 1 - 159 of 159 Journals sorted alphabetically
Acta Urológica Portuguesa     Open Access   (Followers: 1)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 11)
Advances in Urology     Open Access   (Followers: 13)
African Journal of Nephrology     Open Access  
African Journal of Urology     Open Access   (Followers: 7)
AJP Renal Physiology     Hybrid Journal   (Followers: 8)
Aktuelle Urologie     Hybrid Journal   (Followers: 4)
American Journal of Kidney Diseases     Hybrid Journal   (Followers: 43)
American Journal of Men's Health     Open Access   (Followers: 9)
American Journal of Nephrology     Full-text available via subscription   (Followers: 38)
Andrologia     Hybrid Journal   (Followers: 2)
Andrology     Hybrid Journal   (Followers: 4)
Andrology & Gynecology : Current Research     Hybrid Journal   (Followers: 4)
Andrology and Genital Surgery     Open Access   (Followers: 7)
Andrology-Open Access     Open Access  
Annales d'Urologie     Full-text available via subscription  
Arab Journal of Nephrology and Transplantation     Open Access   (Followers: 1)
Arab Journal of Urology     Open Access   (Followers: 7)
Archives of Clinical Nephrology     Open Access   (Followers: 2)
Archivio Italiano di Urologia e Andrologia     Open Access   (Followers: 1)
Archivos Españoles de Urología     Open Access  
Asian Journal of Andrology     Open Access   (Followers: 1)
Asian Journal of Urology     Open Access   (Followers: 3)
Bangladesh Journal of Urology     Open Access   (Followers: 5)
BANTAO Journal     Open Access  
Basic and Clinical Andrology     Open Access  
BJU International     Hybrid Journal   (Followers: 34)
BJUI Compass     Open Access   (Followers: 2)
BMC Nephrology     Open Access   (Followers: 11)
BMC Urology     Open Access   (Followers: 14)
Canadian Journal of Kidney Health and Disease     Open Access   (Followers: 8)
Canadian Urological Association Journal     Open Access   (Followers: 2)
Cancer Urology     Open Access   (Followers: 2)
Cardiorenal Medicine     Full-text available via subscription   (Followers: 1)
Case Reports in Nephrology     Open Access   (Followers: 5)
Case Reports in Nephrology and Dialysis     Open Access   (Followers: 9)
Case Reports in Urology     Open Access   (Followers: 12)
Clinical and Experimental Nephrology     Hybrid Journal   (Followers: 4)
Clinical Journal of the American Society of Nephrology     Full-text available via subscription   (Followers: 22)
Clinical Kidney Journal     Open Access   (Followers: 4)
Clinical Medicine Insights : Urology     Open Access   (Followers: 3)
Clinical Nephrology     Full-text available via subscription   (Followers: 8)
Clinical Nephrology and Urology Science     Open Access   (Followers: 6)
Clinical Queries: Nephrology     Hybrid Journal   (Followers: 1)
Cuadernos de Cirugía     Open Access   (Followers: 3)
Current Opinion in Nephrology & Hypertension     Hybrid Journal   (Followers: 10)
Current Opinion in Urology     Hybrid Journal   (Followers: 12)
Current Urology     Open Access   (Followers: 10)
Current Urology Reports     Hybrid Journal   (Followers: 5)
Der Nephrologe     Hybrid Journal  
Der Urologe     Hybrid Journal   (Followers: 1)
Diabetic Nephropathy     Open Access   (Followers: 1)
EMC - Urología     Full-text available via subscription  
Enfermería Nefrológica     Open Access   (Followers: 1)
European Urology     Full-text available via subscription   (Followers: 33)
European Urology Focus     Hybrid Journal   (Followers: 5)
European Urology Oncology     Hybrid Journal   (Followers: 1)
European Urology Open Science     Open Access   (Followers: 10)
Forum Nefrologiczne     Full-text available via subscription  
Geriatric Nephrology and Urology     Hybrid Journal   (Followers: 7)
Giornale di Clinica Nefrologica e Dialisi     Open Access  
Herald Urology     Open Access   (Followers: 2)
Hong Kong Journal of Nephrology     Open Access   (Followers: 3)
Human Andrology     Partially Free   (Followers: 2)
IJU Case Reports     Open Access  
Indian Journal of Nephrology     Open Access   (Followers: 2)
Indian Journal of Urology     Open Access   (Followers: 5)
International Brazilian Journal of Urology     Open Access   (Followers: 5)
International Journal of Nephrology     Open Access   (Followers: 2)
International Journal of Nephrology and Renovascular Disease     Open Access   (Followers: 2)
International Journal of Urology     Hybrid Journal   (Followers: 12)
International Urology and Nephrology     Hybrid Journal   (Followers: 7)
Jornal Brasileiro de Nefrologia     Open Access  
Journal für Urologie und Urogynäkologie/Österreich     Hybrid Journal  
Journal of Clinical Nephrology     Open Access   (Followers: 2)
Journal of Clinical Urology     Hybrid Journal   (Followers: 14)
Journal of Endoluminal Endourology     Open Access  
Journal of Endourology     Hybrid Journal   (Followers: 2)
Journal of Endourology Case Reports     Hybrid Journal  
Journal of Genital System & Disorders     Hybrid Journal   (Followers: 3)
Journal of Integrative Nephrology and Andrology     Open Access   (Followers: 2)
Journal of Kidney Cancer and VHL     Open Access  
Journal of Lower Genital Tract Disease     Hybrid Journal  
Journal of Nephrology     Hybrid Journal   (Followers: 4)
Journal of Nephrology Research     Open Access   (Followers: 3)
Journal of Pediatric Nephrology     Open Access   (Followers: 5)
Journal of Renal Care     Hybrid Journal   (Followers: 8)
Journal of Renal Nursing     Full-text available via subscription   (Followers: 12)
Journal of Renal Nutrition     Hybrid Journal   (Followers: 28)
Journal of Renal Nutrition and Metabolism     Open Access   (Followers: 1)
Journal of the American Society of Nephrology     Full-text available via subscription   (Followers: 31)
Journal of The Egyptian Society of Nephrology and Transplantation     Open Access  
Journal of Translational Neurosciences     Open Access  
Journal of Urology     Full-text available via subscription   (Followers: 46)
Journal of Urology & Nephrology     Open Access   (Followers: 2)
Kidney Disease and Transplantation     Open Access   (Followers: 4)
Kidney Diseases     Open Access   (Followers: 3)
Kidney International     Hybrid Journal   (Followers: 47)
Kidney International Reports     Open Access   (Followers: 3)
Kidney Medicine     Open Access  
Kidney Research Journal     Open Access   (Followers: 6)
Kidneys (Počki)     Open Access   (Followers: 1)
Nature Reviews Nephrology     Full-text available via subscription   (Followers: 23)
Nature Reviews Urology     Full-text available via subscription   (Followers: 13)
Nefrología (English Edition)     Open Access  
Nefrología (Madrid)     Open Access  
Nephro-Urology Monthly     Open Access   (Followers: 1)
Nephrology     Hybrid Journal   (Followers: 13)
Nephrology Dialysis Transplantation     Hybrid Journal   (Followers: 27)
Nephron     Hybrid Journal   (Followers: 4)
Nephron Clinical Practice     Full-text available via subscription   (Followers: 4)
Nephron Experimental Nephrology     Full-text available via subscription   (Followers: 4)
Nephron Extra     Open Access   (Followers: 1)
Nephron Physiology     Full-text available via subscription   (Followers: 4)
Neurourology and Urodynamics     Hybrid Journal   (Followers: 1)
OA Nephrology     Open Access   (Followers: 2)
Open Access Journal of Urology     Open Access   (Followers: 6)
Open Journal of Nephrology     Open Access   (Followers: 5)
Open Journal of Urology     Open Access   (Followers: 6)
Open Urology & Nephrology Journal     Open Access  
Pediatric Urology Case Reports     Open Access   (Followers: 7)
Portuguese Journal of Nephrology & Hypertension     Open Access   (Followers: 1)
Progrès en Urologie     Full-text available via subscription  
Progrès en Urologie - FMC     Full-text available via subscription  
Prostate Cancer and Prostatic Diseases     Hybrid Journal   (Followers: 6)
Renal Failure     Open Access   (Followers: 12)
Renal Replacement Therapy     Open Access   (Followers: 4)
Research and Reports in Urology     Open Access   (Followers: 4)
Revista de Nefrología, Diálisis y Trasplante     Open Access   (Followers: 1)
Revista Mexicana de Urología     Open Access   (Followers: 1)
Revista Urologia Colombiana     Open Access  
Saudi Journal of Kidney Diseases and Transplantation     Open Access   (Followers: 2)
Scandinavian Journal of Urology     Hybrid Journal   (Followers: 7)
Seminars in Nephrology     Hybrid Journal   (Followers: 11)
The Prostate     Hybrid Journal   (Followers: 8)
Therapeutic Advances in Urology     Open Access   (Followers: 4)
Trends in Urology & Men's Health     Partially Free   (Followers: 1)
Ukrainian Journal of Nephrology and Dialysis     Open Access   (Followers: 1)
Uro-News     Hybrid Journal   (Followers: 1)
Urolithiasis     Hybrid Journal   (Followers: 2)
Urologia Internationalis     Full-text available via subscription   (Followers: 2)
Urologia Journal     Hybrid Journal  
Urologic Clinics of North America     Full-text available via subscription   (Followers: 4)
Urologic Nursing     Full-text available via subscription   (Followers: 4)
Urologic Radiology     Hybrid Journal  
Urological Science     Open Access  
Urologicheskie Vedomosti     Open Access  
Urologie in der Praxis     Hybrid Journal  
Urologie Scan     Hybrid Journal  
Urology     Hybrid Journal   (Followers: 33)
Urology Annals     Open Access   (Followers: 4)
Urology Case Reports     Open Access   (Followers: 3)
Urology Practice     Full-text available via subscription   (Followers: 2)
Urology Times     Free   (Followers: 3)
Urology Video Journal     Open Access   (Followers: 1)
World Journal of Nephrology and Urology     Open Access   (Followers: 15)
World Journal of Urology     Hybrid Journal   (Followers: 11)


Similar Journals
Journal Cover
Clinical Journal of the American Society of Nephrology
Journal Prestige (SJR): 3.099
Citation Impact (citeScore): 5
Number of Followers: 22  
  Full-text available via subscription Subscription journal
ISSN (Print) 1555-9041 - ISSN (Online) 1555-905X
Published by American Society of Nephrology Homepage  [2 journals]
  • Dementia in Dialysis: An Eye on Best Practices
    • Authors: Weintraub J.
      Pages: 1305 - 1306
      PubDate: 2018-09-07T13:00:23-07:00
      DOI: 10.2215/CJN.08610718
      Issue No: Vol. 13, No. 9 (2018)
  • Determinants of Arteriovenous Fistula Maturation
    • Authors: Hentschel D. M.
      Pages: 1307 - 1308
      PubDate: 2018-09-07T13:00:23-07:00
      DOI: 10.2215/CJN.08860718
      Issue No: Vol. 13, No. 9 (2018)
  • Magnesium Concentration in Dialysate: Is Higher Better'
    • Authors: Floege J.
      Pages: 1309 - 1310
      PubDate: 2018-09-07T13:00:23-07:00
      DOI: 10.2215/CJN.08380718
      Issue No: Vol. 13, No. 9 (2018)
  • Gut-Derived Metabolites and Chronic Kidney Disease: The Forest (F)or the
    • Authors: Vanholder, R; Glorieux, G.
      Pages: 1311 - 1313
      PubDate: 2018-09-07T13:00:24-07:00
      DOI: 10.2215/CJN.08200718
      Issue No: Vol. 13, No. 9 (2018)
  • Incident Atrial Fibrillation and the Risk of Stroke in Adults with Chronic
           Kidney Disease: The Stockholm CREAtinine Measurements (SCREAM) Project
    • Authors: Carrero, J. J; Trevisan, M, Sood, M. M, Barany, P, Xu, H, Evans, M, Friberg, L, Szummer, K.
      Pages: 1314 - 1320
      Abstract: Background and objectivesPatients with CKD have a high risk of atrial fibrillation. Both CKD and atrial fibrillation are associated with higher risk of stroke and death. However, the effect of incident atrial fibrillation on stroke risk among patients with CKD is unknown.Design, setting, participants, & measurementsOur study included adults with CKD (eGFR
      PubDate: 2018-09-07T13:00:24-07:00
      DOI: 10.2215/CJN.04060318
      Issue No: Vol. 13, No. 9 (2018)
  • Association of Urinary Biomarkers of Kidney Injury with Estimated GFR
           Decline in HIV-Infected Individuals following Tenofovir Disoproxil
           Fumarate Initiation
    • Authors: Ascher, S. B; Scherzer, R, Estrella, M. M, Zhang, W. R, Muiru, A. N, Jotwani, V, Grunfeld, C, Parikh, C. R, Gustafson, D, Young, M, Sharma, A, Cohen, M. H, Ng, D. K, Palella, F. J, Witt, M. D, Ho, K, Shlipak, M. G.
      Pages: 1321 - 1329
      Abstract: Background and objectivesTenofovir disoproxil fumarate (tenofovir) is associated with elevated concentrations of biomarkers of kidney damage and dysfunction in individuals with HIV. The relationship of these kidney biomarkers with longitudinal kidney function decline is unknown.Design, setting, participants, & measurementsWe evaluated associations of 14 urinary biomarkers of kidney injury with changes in eGFR among 198 men and women with HIV who initiated tenofovir between 2009 and 2015 in the Multicenter AIDS Cohort Study and Women’s Interagency HIV Study. Urinary biomarkers included albumin-to-creatinine ratio, α-1-microglobulin, β-2-microglobulin, cystatin C, kidney injury molecule-1 (KIM-1), IL-18, neutrophil gelatinase–associated lipocalin (NGAL), clusterin, osteopontin, uromodulin, monocyte chemoattractant protein-1, EGF, trefoil factor 3, and chitinase 3-like protein 1. We used multivariable linear mixed-effect models controlling for demographics, traditional kidney disease risk factors, and HIV-related risk factors to evaluate associations of baseline biomarkers with first-year changes in eGFR, and associations of year 1 and first-year change in biomarkers with changes in eGFR from year 1 to year 3. We used the least absolute shrinkage and selection operator method to identify a parsimonious set of biomarkers jointly associated with changes in eGFR.ResultsMedian eGFR before tenofovir initiation was 103 (interquartile range, 88–116) ml/min per 1.73 m2. During the first year of tenofovir use, eGFR decreased on average by 9.2 (95% confidence interval, 6.5 to 11.9) ml/min per 1.73 m2 and was stable afterward (decrease of 0.62; 95% confidence interval, –0.85 to 2.1 ml/min per 1.73 m2 per year). After multivariable adjustment, higher baseline β-2-microglobulin, KIM-1, and clusterin were associated with larger first-year eGFR declines, whereas higher baseline uromodulin was associated with a smaller eGFR decline. First-year increase in urinary cystatin C and higher year 1 IL-18 were associated with larger annual eGFR declines from year 1 to year 3. The parsimonious models identified higher pre-tenofovir clusterin and KIM-1, lower pre-tenofovir uromodulin, and higher year 1 IL-18 as jointly associated with larger eGFR declines.ConclusionsUrinary biomarkers of kidney injury measured before and after tenofovir initiation are associated with subsequent changes in eGFR in individuals with HIV.PodcastThis article contains a podcast at
      PubDate: 2018-09-07T13:00:24-07:00
      DOI: 10.2215/CJN.01700218
      Issue No: Vol. 13, No. 9 (2018)
  • IgA Nephropathy Susceptibility Loci and Disease Progression
    • Authors: Shi, M; Ouyang, Y, Yang, M, Yang, M, Zhang, X, Huang, W, Wang, W, Wang, Z, Zhang, W, Chen, X, Pan, X, Ren, H, Chen, N, Xie, J.
      Pages: 1330 - 1338
      Abstract: Background and objectivesAt least 20 susceptibility loci of IgA nephropathy have been identified by genome-wide association studies to date. Whether these loci were associated with disease progression is unclear.Design, setting, participants, & measurementsWe enrolled 613 adult patients with IgA nephropathy for a follow-up of ≥12 months. All 20 IgA nephropathy susceptibility loci were selected and their tag single nucleotide polymorphisms (SNPs) were genotyped. After strict quality control, 16 SNPs and 517 patients with IgA nephropathy were eligible for subsequent analysis. Progression was defined as ESKD or 50% decrease in eGFR. A stepwise Cox regression analysis of all SNPs on Akaike information criterion was performed to select the best model.ResultsA four-SNP model, rs11150612 (ITGAM-ITGAX), rs7634389 (ST6GAL1), rs2412971 (HORMAD2), and rs2856717 (HLA-DQ/DR), was selected as the best predictive model. The genetic risk score calculated on the basis of the four SNPs was independently associated with disease progression before (hazard ratio [HR], 1.65; 95% confidence interval [95% CI], 1.29 to 2.12) and after adjustment by a recently reported clinical model (HR, 1.29; 95% CI, 1.03 to 1.62) or clinical–pathologic model (HR, 1.35; 95% CI, 1.03 to 1.77). Compared with low genetic risk, patients with middle genetic risk had a 2.12-fold (95% CI, 1.33 to 3.40) increase of progression risk, whereas patients with high genetic risk had 3.61-fold (95% CI, 2.00 to 6.52) progression risk increase. In addition, incorporation of genetic risk score could potentially increase discrimination of the clinical model (c-statistic increase from 0.83 to 0.86) or the clinical–pathologic model (c-statistic increase from 0.82 to 0.85) in predicting 5-year progression risk.ConclusionsThe four-SNP genetic risk score was independently associated with IgA nephropathy progression and could enhance the performance of clinical and clinical–pathologic risk models.
      PubDate: 2018-09-07T13:00:24-07:00
      DOI: 10.2215/CJN.13701217
      Issue No: Vol. 13, No. 9 (2018)
  • Dementia, Alzheimers Disease, and Mortality after Hemodialysis Initiation
    • Authors: McAdams-DeMarco, M. A; Daubresse, M, Bae, S, Gross, A. L, Carlson, M. C, Segev, D. L.
      Pages: 1339 - 1347
      Abstract: Background and objectivesOlder patients with ESKD experience rapid declines in executive function after initiating hemodialysis; these impairments might lead to high rates of dementia and Alzheimer’s disease in this population. We estimated incidence, risk factors, and sequelae of diagnosis with dementia and Alzheimer’s disease among older patients with ESKD initiating hemodialysis.Design, setting, participants, & measurementsWe studied 356,668 older (age ≥66 years old) patients on hemodialysis (January 1, 2001 to December 31, 2013) from national registry data (US Renal Data System) linked to Medicare. We estimated the risk (cumulative incidence) of diagnosis of dementia and Alzheimer’s disease and studied factors associated with these disorders using competing risks models to account for death, change in dialysis modality, and kidney transplant. We estimated the risk of subsequent mortality using Cox proportional hazards models.ResultsThe 1- and 5-year risks of diagnosed dementia accounting for competing risks were 4.6% and 16% for women, respectively, and 3.7% and 13% for men, respectively. The corresponding Alzheimer’s disease diagnosis risks were 0.6% and 2.6% for women, respectively, and 0.4% and 2.0% for men, respectively. The strongest independent risk factors for diagnosis of dementia and Alzheimer’s disease were age ≥86 years old (dementia: hazard ratio, 2.11; 95% confidence interval, 2.04 to 2.18; Alzheimer’s disease: hazard ratio, 2.11; 95% confidence interval, 1.97 to 2.25), black race (dementia: hazard ratio, 1.70; 95% confidence interval, 1.67 to 1.73; Alzheimer’s disease: hazard ratio, 1.78; 95% confidence interval, 1.71 to 1.85), women (dementia: hazard ratio, 1.10; 95% confidence interval, 1.08 to 1.12; Alzheimer’s disease: hazard ratio, 1.12; 95% confidence interval, 1.08 to 1.16), and institutionalization (dementia: hazard ratio, 1.36; 95% confidence interval, 1.33 to 1.39; Alzheimer’s disease: hazard ratio, 1.10; 95% confidence interval, 1.05 to 1.15). Older patients on hemodialysis with a diagnosis of dementia were at 2.14-fold (95% confidence interval, 2.07 to 2.22) higher risk of subsequent mortality; those with a diagnosis of Alzheimer’s disease were at 2.01-fold (95% confidence interval, 1.89 to 2.15) higher mortality risk.ConclusionsOlder patients on hemodialysis are at substantial risk of diagnosis with dementia and Alzheimer’s disease, and carrying these diagnoses is associated with a twofold higher mortality.
      PubDate: 2018-09-07T13:00:24-07:00
      DOI: 10.2215/CJN.10150917
      Issue No: Vol. 13, No. 9 (2018)
  • Variations in 24-Hour BP Profiles in Cohorts of Patients with Kidney
           Disease around the World: The I-DARE Study
    • Authors: Drawz, P. E; Brown, R, De Nicola, L, Fujii, N, Gabbai, F. B, Gassman, J, He, J, Iimuro, S, Lash, J, Minutolo, R, Phillips, R. A, Rudser, K, Ruilope, L, Steigerwalt, S, Townsend, R. R, Xie, D, Rahman, M, the CRIC Study Investigators
      Pages: 1348 - 1357
      Abstract: Background and objectivesAmbulatory BP is increasingly recognized as a better measure of the risk for adverse outcomes related to hypertension, an important comorbidity in patients with CKD. Varying definitions of white-coat and masked hypertension have made it difficult to evaluate differences in prevalence of these BP patterns across CKD cohorts.Design, setting, participants, & measurementsThe International Database of Ambulatory BP in Renal Patients collaborative group established a large database of demographic, clinical, and ambulatory BP data from patients with CKD from cohorts in Italy, Spain, the Chronic Renal Insufficiency Cohort (CRIC) and the African American Study of Kidney Disease and Hypertension Cohort Study (AASK) in the United States, and the CKD Japan Cohort (CKD-JAC). Participants (n=7518) with CKD were included in the present analyses. Cutoffs for defining controlled BP were 140/90 mm Hg for clinic and 130/80 mm Hg for 24-hour ambulatory BP.ResultsAmong those with controlled clinic BP, compared with CKD-JAC, AASK participants were more likely to have masked hypertension (prevalence ratio [PR], 1.21; 95% confidence interval [95% CI], 1.04 to 1.41) whereas CRIC (PR, 0.82; 0.72 to 0.94), Italian (PR, 0.73; 0.56 to 0.95), and Spanish participants (PR, 0.75; 0.64 to 0.88) were less likely. Among those with elevated clinic BP, AASK participants were more likely to have sustained hypertension (PR, 1.22; 95% CI, 1.13 to 1.32) whereas Italian (PR, 0.78; 0.70 to 0.87) and Spanish participants (PR, 0.89; 0.82 to 0.96) were less likely, although CRIC participants had similar prevalence as CKD-JAC. Prevalence of masked and sustained hypertension was elevated in males, patients with diabetes, participants on four or more antihypertensives, and those with moderate-to-severe proteinuria.ConclusionsIn a large, multinational database, the prevalence of masked and sustained hypertension varied across cohorts independent of important comorbidities.
      PubDate: 2018-09-07T13:00:24-07:00
      DOI: 10.2215/CJN.13181117
      Issue No: Vol. 13, No. 9 (2018)
  • Association of Preexisting Arterial Intimal Hyperplasia with Arteriovenous
           Fistula Outcomes
    • Authors: Allon, M; Litovsky, S. H, Zhang, Y, Le, H, Cheung, A. K, Shiu, Y.-T.
      Pages: 1358 - 1363
      Abstract: Background and objectivesPreoperative arterial function is associated with arteriovenous fistula (AVF) development. Because arterial pathology may correlate with its function, preexisting arterial intimal hyperplasia may be associated with AVF development.Design, setting, participants, & measurementsVascular specimens obtained from 125 patients (with minimal 2 mm arterial diameter and 2.5 mm venous diameter) undergoing AVF creation were quantified for arterial intimal hyperplasia, arterial medial fibrosis, arterial microcalcification, and venous intimal hyperplasia. A 6-week postoperative ultrasound quantified AVF diameter, blood flow, and stenosis. Clinical AVF maturation was assessed using a predefined protocol. In a prospective cohort study design, we investigated the association of preexisting arterial intimal hyperplasia with the postoperative AVF diameter, blood flow, stenosis, and clinical maturation failure, after controlling for baseline demographics, comorbidities, and preoperative vein diameter. Additional analyses evaluated whether other vascular pathologies interacted with arterial intimal hyperplasia in affecting AVF outcomes.ResultsThe median intimal thickness of the native artery was 22.0 μm (interquartile range, 14.8–37.1 μm). The median postoperative AVF diameter was 4.8 (interquartile range, 3.7–6.8) mm, blood flow was 796 (interquartile range, 413–1036) ml/min, and stenosis was present in 37 out of 98 patients with ultrasound data (38%). AVF nonmaturation occurred in 37 out of 125 patients (30%). Preexisting arterial intimal thickness was not significantly associated with AVF blood flow (–12 ml/min; 95% confidence interval [95% CI], –55 to 30 ml/min), diameter (–0.04 mm; 95% CI, –0.21 to 0.14 mm), stenosis (odds ratio, 0.93; 95% CI, 0.75 to 1.14), or clinical maturation failure (odds ratio, 1.07; 95% CI, 0.90 to 1.28), all per 10 μm increase. There was no significant interaction of preexisting arterial intimal thickness and postoperative AVF outcomes with arterial medial fibrosis, arterial microcalcification, or venous intimal hyperplasia.ConclusionsPreexisting arterial intimal hyperplasia is not associated with the 6-week AVF blood flow, diameter or stenosis, or clinical maturation when the preoperative arterial diameter is ≥2 mm.
      PubDate: 2018-09-07T13:00:24-07:00
      DOI: 10.2215/CJN.13431217
      Issue No: Vol. 13, No. 9 (2018)
  • Postoperative Ultrasound, Unassisted Maturation, and Subsequent Primary
           Patency of Arteriovenous Fistulas
    • Authors: Farrington, C. A; Robbin, M. L, Lee, T, Barker-Finkel, J, Allon, M.
      Pages: 1364 - 1372
      Abstract: Background and objectivesPostoperative ultrasound is commonly used to assess arteriovenous fistula (AVF) maturation for hemodialysis, but its utility for predicting unassisted AVF maturation or primary AVF patency for hemodialysis has not been well defined. This study assessed the predictive value of postoperative AVF ultrasound measurements for these clinical AVF outcomes.Design, setting, participants, & measurementsWe queried a prospective vascular access database to identify 246 patients on catheter-dependent hemodialysis who underwent AVF creation between 2010 and 2016 and obtained a postoperative ultrasound within 90 days. Multivariable logistic regression was used to evaluate the association of clinical characteristics and postoperative ultrasound measurements with unassisted AVF maturation. A receiver operating characteristic curve estimated the predictive value of these factors for unassisted AVF maturation. Finally, multivariable survival analysis was used to identify factors associated with primary AVF patency in patients with unassisted AVF maturation.ResultsUnassisted AVF maturation occurred in 121 out of 246 patients (49%), assisted maturation in 55 patients (22%), and failure to mature in 70 patients (28%). Using multivariable logistic regression, unassisted AVF maturation was associated with AVF blood flow (odds ratio [OR], 1.30; 95% confidence interval [95% CI], 1.18 to 1.45 per 100 ml/min increase; P
      PubDate: 2018-09-07T13:00:24-07:00
      DOI: 10.2215/CJN.02230218
      Issue No: Vol. 13, No. 9 (2018)
  • The Effect of Increasing Dialysate Magnesium on Serum Calcification
           Propensity in Subjects with End Stage Kidney Disease: A Randomized,
           Controlled Clinical Trial
    • Authors: Bressendorff, I; Hansen, D, Schou, M, Pasch, A, Brandi, L.
      Pages: 1373 - 1380
      Abstract: Background and objectivesSerum calcification propensity is a novel functional test that quantifies the functionality of the humeral system of calcification control. Serum calcification propensity is measured by T50, the time taken to convert from primary to secondary calciprotein particle in the serum. Lower T50 represents higher calcification propensity and is associated with higher risk of cardiovascular events and death in patients with ESKD. Increasing magnesium in serum increases T50, but so far, no clinical trials have investigated whether increasing serum magnesium increases serum calcification propensity in subjects with ESKD.Design, setting, participants, & measurementsWe conducted a single-center, randomized, double-blinded, parallel group, controlled clinical trial, in which we examined the effect of increasing dialysate magnesium from 1.0 to 2.0 mEq/L for 28 days compared with maintaining dialysate magnesium at 1.0 mEq/L on T50 in subjects undergoing hemodialysis for ESKD. The primary end point was the value of T50 at the end of the intervention.ResultsFifty-nine subjects were enrolled in the trial, and of these, 57 completed the intervention and were analyzed for the primary outcome. In the standard dialysate magnesium group, T50 was 233±81 minutes (mean±SD) at baseline (mean of days –7 and 0) and 229±93 minutes at follow-up (mean of days 21 and 28), whereas in the high dialysate magnesium group, T50 was 247±69 minutes at baseline and 302±66 minutes at follow-up. The difference in T50 between the two groups at follow-up (primary analysis) was 73 minutes (between-group difference; 95% confidence interval, 30 to 116; P
      PubDate: 2018-09-07T13:00:24-07:00
      DOI: 10.2215/CJN.13921217
      Issue No: Vol. 13, No. 9 (2018)
  • Two-Year Observational Study of Bloodstream Infection Rates in
           Hemodialysis Facility Patients with and without Catheters
    • Authors: Brown, R. S; Brickel, K, Davis, R. B.
      Pages: 1381 - 1388
      Abstract: Background and objectivesBloodstream infection rates of patients on hemodialysis with catheters are greater than with other vascular accesses and are an important quality measure. Our goal was to compare relative bloodstream infection rates of patients with and without catheters as a quality parameter among the facilities providing hemodialysis.Design, setting, participants, & measurementsWe used CROWNWeb and National Healthcare Safety Network data from all 179 Medicare facilities providing adult outpatient hemodialysis in New England for>6 months throughout 2015–2016 (mean, 12,693 patients per month). There was a median of 60 (interquartile range, 43–93) patients per facility, with 17% having catheters.ResultsAmong the five batch-submitting dialysis organizations, the bloodstream infection rate in patients with a catheter in four organizations had adjusted risk ratios of 1.44 (95% confidence interval, 1.07 to 1.93) to 1.91 (95% confidence interval, 1.39 to 2.63) times relative to the reference dialysis provider group (P
      PubDate: 2018-09-07T13:00:24-07:00
      DOI: 10.2215/CJN.13551217
      Issue No: Vol. 13, No. 9 (2018)
  • Clinical and Economic Benefits of Antimicrobial Stewardship Programs in
           Hemodialysis Facilities: A Decision Analytic Model
    • Authors: DAgata, E. M. C; Tran, D, Bautista, J, Shemin, D, Grima, D.
      Pages: 1389 - 1397
      Abstract: Background and objectivesInfections caused by multidrug-resistant organisms and Clostridium difficile are associated with substantial morbidity and mortality as well as excess costs. Antimicrobial exposure is the leading cause for these infections. Approximately 30% of antimicrobial doses administered in outpatient hemodialysis facilities are considered unnecessary. Implementing an antimicrobial stewardship program in outpatient hemodialysis facilities aimed at improving prescribing practices would have important clinical and economic benefits.Design, setting, participants, & measurementsWe developed a decision analytic model of antimicrobial use on the clinical and economic consequences of implementing a nationwide antimicrobial stewardship program in outpatient dialysis facilities. The main outcomes were total antimicrobial use, infections caused by multidrug-resistant organisms and C. difficile, infection-related mortality, and total costs. The analysis considered all patients on outpatient hemodialysis in the United States. The value of implementing antimicrobial stewardship programs, assuming a 20% decrease in unnecessary antimicrobial doses, was calculated as the incremental differences in clinical end points and cost outcomes. Event probabilities, antimicrobial regimens, and health care costs were informed by publicly available sources.ResultsOn a national level, implementation of antimicrobial stewardship programs was predicted to result in 2182 fewer infections caused by multidrug-resistant organisms and C. difficile (4.8% reduction), 629 fewer infection-related deaths (4.6% reduction), and a cost savings of $106,893,517 (5.0% reduction) per year. The model was most sensitive to clinical parameters as opposed to antimicrobial costs.ConclusionsThe model suggests that implementation of antimicrobial stewardship programs in outpatient dialysis facilities would result in substantial reductions in infections caused by multidrug-resistant organisms and C. difficile, infection-related deaths, and costs.
      PubDate: 2018-09-07T13:00:24-07:00
      DOI: 10.2215/CJN.12521117
      Issue No: Vol. 13, No. 9 (2018)
  • Characteristics of Colon-Derived Uremic Solutes
    • Authors: Mair, R. D; Sirich, T. L, Plummer, N. S, Meyer, T. W.
      Pages: 1398 - 1404
      Abstract: Background and objectivesColon microbial metabolism produces solutes that are normally excreted in the urine and accumulate in the plasma when the kidneys fail. This study sought to further identify and characterize human colon-derived uremic solutes.Design, setting, participants, & measurementsColon-derived solutes normally excreted in the urine were identified by comparing urine from controls (n=17) and patients with total colectomies (n=12), using an established metabolomic platform. Colon-derived solutes that accumulate in kidney failure were then identified by comparing the plasma of the control patients with that of patients on dialysis (n=14).ResultsNinety-one urinary solutes were classified as colon-derived on the basis of the finding of a urine excretion rate at least four-fold higher in control patients than in patients with total colectomies. Forty-six were solutes with known chemical structure, 35 of which had not previously been identified as colon-derived. Sixty of the colon-derived solutes accumulated in the plasma of patients with ESKD to a degree greater than urea and were therefore classified as uremic. The estimated urinary clearance for 27 out of the 32 colon-derived solutes for which clearance could be calculated exceeded that of creatinine, consistent with tubular secretion. Sulfatase treatment revealed that 42 out of the 91 colon-derived solutes detected were likely conjugates.ConclusionsMetabolomic analysis identified numerous colon-derived solutes that are normally excreted in human urine. Clearance by tubular secretion limits plasma levels of many colon-derived solutes.
      PubDate: 2018-09-07T13:00:24-07:00
      DOI: 10.2215/CJN.03150318
      Issue No: Vol. 13, No. 9 (2018)
  • Circumstances of Death among Undocumented Immigrants Who Rely on
           Emergency-Only Hemodialysis
    • Authors: Cervantes, L; OHare, A, Chonchol, M, Hull, M, Van Bockern, J, Thompson, M, Zoucha, J.
      Pages: 1405 - 1406
      PubDate: 2018-09-07T13:00:24-07:00
      DOI: 10.2215/CJN.03440318
      Issue No: Vol. 13, No. 9 (2018)
  • Management of the Incidental Kidney Mass in the Nephrology Clinic
    • Authors: Hu, S. L; Weiss, R. H.
      Pages: 1407 - 1409
      PubDate: 2018-09-07T13:00:24-07:00
      DOI: 10.2215/CJN.00860118
      Issue No: Vol. 13, No. 9 (2018)
  • A Patient with Hemodialysis Access Problems
    • Authors: Niyyar, V. D; Lok, C. E.
      Pages: 1410 - 1412
      PubDate: 2018-09-07T13:00:24-07:00
      DOI: 10.2215/CJN.02610218
      Issue No: Vol. 13, No. 9 (2018)
  • Clinical Pharmacodynamics: Principles of Drug Response and Alterations in
           Kidney Disease
    • Authors: Keller, F; Hann, A.
      Pages: 1413 - 1420
      Abstract: Pharmacokinetics and pharmacodynamics follow the logic of cause and consequence. Receptor-mediated and reversible effects can be distinguished from direct and irreversible effects. Reversible effects are capacity-limited and saturable whereas irreversible effects are limited only by the number of viable targets. In the case of receptor-mediated and reversible effects a threshold and a ceiling concentration can be defined. Antimicrobial drugs with concentration-dependent action are distinguished from drugs with time-dependent action. Concentration-dependent effects are associated with a high ceiling concentration and the target is the high peak. Time-dependent effects are associated with a high threshold concentration and the target is the high trough. During kidney dysfunction, alterations of drug response are usually attributed to pharmacokinetic but rarely to pharmacodynamic changes. Dose adjustment calculations, therefore, tacitly presume that pharmacodynamic parameters remain unchanged while only pharmacokinetic parameters are altered in kidney failure. Kidney dysfunction influences the pharmacokinetic parameters of at least 50% of all essential drugs. Clinicians usually consider pharmacokinetics when kidney disease is found, but pharmacodynamics is as important. Alterations of pharmacodynamic parameters are conceivable but only rarely reported in kidney failure. Sometimes surprising dosing adjustments are needed when pharmacodynamic concepts are brought into the decision process of which dose to choose. Pharmacokinetics and pharmacodynamics should both be considered when any dosing regimen is determined.
      PubDate: 2018-09-07T13:00:24-07:00
      DOI: 10.2215/CJN.10960917
      Issue No: Vol. 13, No. 9 (2018)
  • The ABCs in the Mapping Progress in Reducing Cardiovascular Risk with
           Kidney Disease: An Introductory Remark on Expert Perspectives
    • Authors: Wanner C.
      Pages: 1421 - 1422
      PubDate: 2018-09-07T13:00:24-07:00
      DOI: 10.2215/CJN.09090718
      Issue No: Vol. 13, No. 9 (2018)
  • Mapping Progress in Reducing Cardiovascular Risk with Kidney Disease:
           Atrial Fibrillation
    • Authors: Winkelmayer W. C.
      Pages: 1423 - 1425
      PubDate: 2018-09-07T13:00:24-07:00
      DOI: 10.2215/CJN.06270518
      Issue No: Vol. 13, No. 9 (2018)
  • Mapping Progress in Reducing Cardiovascular Risk with Kidney Disease: A
           Focus on Heart Failure
    • Authors: Bansal N.
      Pages: 1426 - 1428
      PubDate: 2018-09-07T13:00:24-07:00
      DOI: 10.2215/CJN.01930218
      Issue No: Vol. 13, No. 9 (2018)
  • Mapping Progress in Reducing Cardiovascular Risk with Kidney Disease:
           Sudden Cardiac Death
    • Authors: Shafi, T; Guallar, E.
      Pages: 1429 - 1431
      PubDate: 2018-09-07T13:00:24-07:00
      DOI: 10.2215/CJN.02760218
      Issue No: Vol. 13, No. 9 (2018)
  • Mapping Progress in Reducing Cardiovascular Risk with Kidney Disease:
           Managing Volume Overload
    • Authors: Zoccali, C; Mallamaci, F.
      Pages: 1432 - 1434
      PubDate: 2018-09-07T13:00:24-07:00
      DOI: 10.2215/CJN.01360118
      Issue No: Vol. 13, No. 9 (2018)
  • Hemodiafiltration to Address Unmet Medical Needs ESKD Patients
    • Authors: Canaud, B; Vienken, J, Ash, S, Ward, R. A, on behalf of the Kidney Health Initiative HDF Workgroup
      Pages: 1435 - 1443
      Abstract: Hemodiafiltration combines diffusive and convective solute removal in a single therapy by ultrafiltering 20% or more of the blood volume processed using a high-flux hemodialyzer and maintaining fluid balance by infusing sterile nonpyrogenic replacement fluid directly into the patient’s blood. In online hemodiafiltration, the large volumes of replacement fluid required are obtained by online filtration of standard dialysate through a series of bacteria- and endotoxin-retaining filters. Currently available systems for online hemodiafiltration are on the basis of conventional dialysis machines with added features to safely prepare and infuse replacement fluid and closely control fluid balance. Hemodiafiltration provides greater removal of higher molecular weight uremic retention solutes than conventional high-flux hemodialysis, and recently completed randomized, controlled clinical trials suggest better patient survival with online hemodiafiltration compared with standard high-flux hemodialysis when a high convection volume is delivered. Hemodiafiltration is also associated with improvements in other clinical outcomes, such as a reduction in intradialytic hypotension, and it is now used routinely to treat>100,000 patients, mainly in Europe and Japan.
      PubDate: 2018-09-07T13:00:24-07:00
      DOI: 10.2215/CJN.12631117
      Issue No: Vol. 13, No. 9 (2018)
  • Regulatory Considerations for Hemodiafiltration in the United States
    • Authors: Ward, R. A; Vienken, J, Silverstein, D. M, Ash, S, Canaud, B, on behalf of the Kidney Health Initiative HDF Workgroup
      Pages: 1444 - 1449
      Abstract: Online hemodiafiltration provides greater removal of higher molecular weight uremic retention solutes than conventional high-flux hemodialysis. However, online hemodiafiltration is used sparsely in the United States in part because of a paucity of delivery systems cleared for clinical use by the US Food and Drug Administration. Although a pathway for regulatory approval exists in the United States, concerns remain, particularly regarding online production of the large volumes of sterile, nonpyrogenic substitution fluid infused directly into the bloodstream to maintain fluid balance. Clearly defined testing protocols, acceptable to Food and Drug Administration, will be useful to show that an online hemodiafiltration system is capable of routinely achieving a sterility assurance level of 10–6 and nonpyrogenic levels of endotoxin. Large-scale clinical experience has shown that systems providing this level of performance when combined with certain design features, such as redundancy, and an appropriate quality management process can routinely and safely produce substitution fluid for online hemodiafiltration.
      PubDate: 2018-09-07T13:00:24-07:00
      DOI: 10.2215/CJN.12641117
      Issue No: Vol. 13, No. 9 (2018)
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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