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Pregnancy and kidney disease: It is time for the birth of prospective registries
Shilpanjali Jesudason
doi : 10.1111/nep.13971
Volume 26, Issue 11 p. 849-850
A working partnership: A review of shared decision-making in nephrology
Noa Amir,Hugh J. McCarthy,Allison Tong
doi : 10.1111/nep.13902
Volume 26, Issue 11 p. 851-857
Patients with chronic kidney disease are required to make difficult decisions, negotiating between the risks, burdens and benefits for any proposed course. This process can be extremely challenging, since these decisions involve inherent risks, which can impact on survival and quality of life. Shared decision-making offers a patient-centred approach in partnering with patients to make decisions about their treatment, which reflect their values and preferences. Shared decision-making can improve patient preparedness, motivation, satisfaction, and adherence to the treatment or decision agreed upon. In this review article, we outline the key principles of shared decision-making, and provide a framework with communication strategies to facilitate shared decision-making. We highlight the broad range and context of decisions faced by patients in several areas of nephrology care and discuss patient-important outcomes, priorities and motivations that underpin their decision-making. Preserving patient autonomy through shared decision-making ensures close consideration of patient preferences to enhance satisfaction with the decision reached and optimize outcomes important to patients.
Sodium-glucose cotransporter-2 inhibitors and non-steroidal mineralocorticoid receptor antagonists: Ushering in a new era of nephroprotection beyond renin-angiotensin system blockade
Srinivas Vinayak Shenoy,Shankar Prasad Nagaraju,Mohan Varadanayakanahalli Bhojaraja,Ravindra Attur Prabhu,Dharshan Rangaswamy,Indu Ramachandra Rao
doi : 10.1111/nep.13917
Volume 26, Issue 11 p. 858-871
The therapeutic options for preventing or slowing the progression of chronic kidney disease (CKD) have been thus far limited. While angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) are, without a doubt, safe and effective drugs, a significant proportion of patients with CKD still progress to end-stage kidney disease. After decades of negative trials, nephrologists have finally found cause for optimism with the introduction of sodium-glucose cotransporter-2 (SGLT2) inhibitors and non-steroidal mineralocorticoid receptor antagonists (MRAs). Recent trials such as EMPA-REG OUTCOME and CREDENCE have provided evidence of the renal benefits of SGLT2 inhibitors, which have now found widespread acceptance as first-line agents for diabetic CKD, in addition to ACEi/ARBs. Considering results from the DAPA-CKD study, it is expected that their use will soon be expanded to other causes of albuminuric CKD as well, although confirmation from further trials, such as the EMPA-KIDNEY study is awaited. Likewise, although the role of mineralocorticoid receptor overactivation in CKD progression has been known for decades, it is only now with the FIDELIO-DKD study that we have evidence of benefits of MRAs on hard renal endpoints, specifically in patients with diabetic CKD. While further research is ongoing, given the evidence of synergism between the three drug classes, it is foreseeable that a combination of two or more of these drugs may soon become the standard of care for CKD, regardless of underlying aetiology. This review describes pathophysiologic mechanisms, current evidence and future perspectives on the use of SGLT2 inhibitors and novel MRAs in CKD.
Kinetic changes in serum procalcitonin predict persistent acute kidney injury in critical patients
Kan Shen,Wei Qu,Guang-Kuo Zhao,Zhi-Hui Cheng,Jun Li,Xing-Qi Deng,Dong-Wei Xu
doi : 10.1111/nep.13972
Volume 26, Issue 11 p. 872-878
Persistent acute kidney injury (AKI) has been shown to be closely associated with poor prognosis in critical patients. Recent studies have shown that procalcitonin (PCT) is valuable for the early prediction of AKI in critically patients. Our aim was to determine whether PCT and its kinetic changes could predict the occurrence of persistent AKI in critical patients.
Comparison of hospitalization outcomes for delivery and resource utilization between pregnant women with kidney transplants and chronic kidney disease in the United States
Api Chewcharat,Andrea G. Kattah,Charat Thongprayoon,Wisit Cheungpasitporn,Boonphiphop Boonpheng,Maria L. Gonzalez Suarez,Iasmina M. Craici,Vesna D. Garovic
doi : 10.1111/nep.13938
Volume 26, Issue 11 p. 879-889
This study aimed to assess outcomes of delivery hospitalizations, including acute kidney injury (AKI), obstetric and foetal events and resource utilization among pregnant women with kidney transplants compared with pregnant women with no known kidney disease and those with chronic kidney disease (CKD) Stages 3–5.
Active deprescribing program in chronic kidney disease patients undergoing haemodialysis
Jyothi Susan George,Rajesh Joseph,E. T. Arun Thomas,Geo Philip John,Anu Siby,Midhun M. Nair
doi : 10.1111/nep.13936
Volume 26, Issue 11 p. 890-897
Deprescribing is gaining attention of medical community to address polypharmacy. Existing deprescribing tools were not validated in haemodialysis population. We designed this study to assess the pill burden of patients undergoing haemodialysis and to measure the outcome after implementation of an active deprescribing program.
Peritoneal dialysis: Status report in South and South East Asia
Vinant Bhargava,Sanjiv Jasuja,Sydney Chi-Wai Tang,Anil K. Bhalla,Gaurav Sagar,Vivekanand Jha,Raja Ramachandran,Manisha Sahay,Suceena Alexander,Tushar Vachharajani,Aida Lydia,Mamun Mostafi,Jayakrishnan K. Pisharam,Chakko Jacob,Atma Gunawan,Goh Bak Leong,Khin Thida Thwin,Rajendra Kumar Agrawal,Kriengsak Vareesangthip,Roberto Tanchanco,Lina Choong,Chula Herath,Chih-Ching Lin,Syed Fazal Akhtar,Ali Alsahow,Devender Singh Rana,Mohan M. Rajapurkar,Vijay Kher,Shalini Verma,Sampathkumar Krishnaswamy,Amit Gupta,Anupam Bahl,Ashwani Gupta,Umesh B. Khanna,Santosh Varughese,Maurizio Gallieni
doi : 10.1111/nep.13949
Volume 26, Issue 11 p. 898-906
Peritoneal dialysis (PD) as a modality of kidney replacement therapy (KRT) is largely underutilized globally. We analyzed PD utilization, impact of economic status, projected growth and impact of state policy(s) on PD growth in South Asia and Southeast Asia (SA&SEA) region.
Reducing non-melanoma skin cancer risk in renal transplant recipients
Zaw Thet,Alfred K. Lam,Dwarakanathan Ranganathan,Soe Yu Aung,Thin Han,Tien K. Khoo
doi : 10.1111/nep.13939
Volume 26, Issue 11 p. 907-919
With an increasing number of renal transplant recipients (RTRs) and improving patient survival, a higher incidence of non-melanoma skin cancer (NMSC) has been observed. NMSC in RTRs are often more numerous and biologically more aggressive than the general population, thus contributing towards an increase in morbidity and to a lesser degree, mortality. The resultant cumulative health and financial burden is a recognized concern. Proposed strategies in mitigating risks of developing NMSC and early therapeutic options thereof include tailored modification of immunosuppressants in conjunction with sun protection in all transplant patients. This review highlights the clinical and financial burden of transplant-associated skin cancers, carcinogenic mechanisms in association with immunosuppression, importance of skin cancer awareness campaign and integrated transplant skin clinic, and the potential role of chemoprotective agents. A scheme is proposed for primary and secondary prevention of NMSC based on the available evidence.
Possible role of the mitochondrial genome in the pathogenesis of autosomal dominant polycystic kidney disease
Sayanthooran Saravanabavan,Gopala K. Rangan
doi : 10.1111/nep.13957
Volume 26, Issue 11 p. 920-930
Autosomal dominant polycystic kidney disease (ADPKD) is the most common monogenic renal disease in adults and is due to heterozygous germ line variants in either PKD1, PKD2 or rarely other genes. It is characterized by marked intra-familial disease variability suggesting that other genetic and/or environmental factors are involved in determining the lifetime course ADPKD. Recently, research indicates that polycystin-mediated mitochondrial dysfunction and metabolic re-programming contributes to the progression of ADPKD. Although biochemical abnormalities have gained the most interest, variants in the mitochondrial genome could be one of the mechanisms underlying the phenotypic variability in ADPKD. This narrative review aims to evaluate the role of the mitochondrial genome in the pathogenesis of APDKD.
Enhancing women representation in nephrology in Asia: The why and the how
Joyita Bharati
doi : 10.1111/nep.13908
Volume 26, Issue 11 p. 931-931
Renal graft artery thrombosis following COVID-19 infection
Prem P. Varma,Vivek B. Kute,Geet Bajpai
doi : 10.1111/nep.13919
Volume 26, Issue 11 p. 932-933
