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Welcome editorial by the new CKJ Editor-in-Chief: Facing the future of CKJ with enthusiasm!
MarÃa José Soler
doi : 10.1093/ckj/sfac121
Clinical Kidney Journal, Volume 15, Issue 6, June 2022, Pages 1029–1033
Can ketogenic dietary interventions slow disease progression in ADPKD: what we know and what we don't
Albert C M Ong, Roser Torra
doi : 10.1093/ckj/sfac103
Clinical Kidney Journal, Volume 15, Issue 6, June 2022, Pages 1034–1036
Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disease leading to kidney failure. To date, there is no cure for the disease although there is one approved disease-modifying therapy: tolvaptan. In this context, a common question that ADPKD patients ask in clinical practice is whether there is anything they can do to slow their disease by modifying their diet or lifestyle. Recent evidence from experimental PKD models has shown the potential benefits of caloric restriction, high water intake and especially ketogenic diets in preserving kidney function. Whether these benefits are translatable to humans remains unknown. In this issue of CKJ, Strubl et al. report results of a self-enrolled survey of autosomal dominant polycystic kidney disease (ADPKD) patients who have self-administered a ketogenic diet [1]. These results provide interesting insights into the tolerability, potential benefits and harms of such an intervention that could inform a future clinical trial.
Stopping kidney protection in the elderly following acute kidney injury: think mortality
Sol Carriazo, Alberto Ortiz
doi : 10.1093/ckj/sfac024
Clinical Kidney Journal, Volume 15, Issue 6, June 2022, Pages 1037–1040
Chronic kidney disease (CKD) is projected to become the fifth most common global cause of death by 2040. This illustrates a key consequence of CKD, i.e. premature mortality. Since nephroprotective drugs such as renin–angiotensin system (RAS) blockers and sodium–glucose transport protein 2 (SGLT2) inhibitors decrease glomerular hyperfiltration, they may be stopped following an episode of acute kidney injury (AKI). This may theoretically modify the risks of subsequent events, ranging from hyperkalaemia to CKD progression to cardiovascular events, but the evidence so far has been inconsistent. Roemer et al. have now addressed the shortcomings of prior studies. In a population of mostly elderly (median age 78 years) prevalent users of RAS blockers with an indication for this therapy and who survived for at least 3 months after discharge following a hospitalization characterized by moderate to severe AKI, roughly 50% had stopped RAS blockade at 3 months. Stopping RAS blockade was associated with an increased risk of a primary composite outcome of death, myocardial infarction and stroke, of which a large majority (80%) of events were deaths. In contrast, the risk of hyperkalaemia was reduced and the risk of repeated AKI, CKD progression or heart failure hospitalization was unchanged in patients who stopped RAS blockers. These findings call for a re-evaluation of the practice of stopping RAS blockers in the long-term following AKI and suggest that studies are needed regarding similar practices for SGLT2 inhibitors.
An update of proliferative glomerulonephritis with monoclonal immunoglobulin deposits
Manna Li, Gaosi Xu
doi : 10.1093/ckj/sfab269
Clinical Kidney Journal, Volume 15, Issue 6, June 2022, Pages 1041–1048
As aging increases, monoclonal gammopathy is becoming more common and monoclonal gammopathy of renal significance (MGRS) is gaining attention due to frequent renal involvement. Within MGRS, proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) is a special category. The disease was first described in 2004 and the research history on it is relatively short. Compared with other MGRS, the detection rate of circulating clones is lower in patients with PGNMID, which is easy to miss and misdiagnose in clinical work. In this review, the etiology and clinical features of PGNMID are discussed. It is noted that PGNMID is associated not only with MGRS, but also with malignancy, infection and other factors. PGNMID is not a disease exclusive to the elderly—young people can also develop this disease. Due to the low detection rate of circulating clones in most patients, confirmation of the disease needs to be combined with renal pathology, which emphasizes the importance of completing light and heavy chain subtype staining. Treatment options for patients with PGNMID differ by etiology. For MGRS-associated PGNMID, the current treatment is primarily empirical and more research evidence is needed to fill the treatment gap.
Trimming the fat: is there a health economic case for the use of new lipid-lowering drugs in chronic kidney disease? A scoping review
Alexandra Gallagher, Blaise Agresta, Brendan Smyth, Meg Jardine, Charles Ferro, Rachael L Morton
doi : 10.1093/ckj/sfab288
Clinical Kidney Journal, Volume 15, Issue 6, June 2022, Pages 1049–1059
Individuals with chronic kidney disease (CKD) are at a very high risk for atherosclerotic cardiovascular disease (ASCVD). New lipid-lowering agents offer hope of improved outcomes where traditional agents have been less efficacious, yet the cost of these agents needs consideration in this population before their widespread application.
Management of acute renal replacement therapy in critically ill cirrhotic patients
Jimena Del Risco-Zevallos, Alicia Molina Andújar, Gastón Piñeiro, Enric Reverter, Néstor David Toapanta, Miquel Sanz, Miquel Blasco, Javier Fernández, Esteban Poch
doi : 10.1093/ckj/sfac025
Clinical Kidney Journal, Volume 15, Issue 6, June 2022, Pages 1060–1070
Renal replacement therapy (RRT) in cirrhotic patients encompasses a number of issues related to the particular characteristics of this population, especially in the intensive care unit (ICU) setting. The short-term prognosis of cirrhotic patients with acute kidney injury is poor, with a mortality rate higher than 65% in patients with RRT requirement, raising questions about the futility of its initiation. Regarding the management of the RRT itself, there is still no consensus with respect to the modality (continuous versus intermittent) or the anticoagulation required to improve the circuit life, which is shorter than similar at-risk populations, despite the altered haemostasis in traditional coagulation tests frequently found in these patients. Furthermore, volume management is one of the most complex issues in this cohort, where tools used for ambulatory dialysis have not yet been successfully reproducible in the ICU setting.
Stability and compatibility of antibiotics in peritoneal dialysis solutions
Simon Wai Yin So, Lu Chen, Alex Yuk Hei Woo, Derek Man Him Ng, Jennifer Ka Wah Wong, Kai Ming Chow, Naomi Runnegar, David W Johnson, Philip Kam-Tao Li
doi : 10.1093/ckj/sfac012
Clinical Kidney Journal, Volume 15, Issue 6, June 2022, Pages 1071–1078
Intraperitoneal (IP) administration of antibiotics is a preferred treatment of peritoneal dialysis (PD)-related peritonitis. Given the treatment duration of up to 2–3 weeks, it is important that robust data on antibiotic stability and compatibility are available to achieve notable treatment success. This article provides a comprehensive review of recent stability and compatibility studies pertaining to a wide range of antibiotics admixed in various PD solutions.
Ketogenic dietary interventions in autosomal dominant polycystic kidney disease—a retrospective case series study: first insights into feasibility, safety and effects
Sebastian Strubl, Simon Oehm, Jacob A Torres, Franziska Grundmann, Jazmine Haratani, Morgan Decker, Sabrina Vuong, Amrit Kaur Bhandal, Nils Methot, Rhianna Haynie-Cion, Franziska Meyer, Florian Siedek, Uwe Korst, Roman-Ulrich Müller, Thomas Weimbs
doi : 10.1093/ckj/sfab162
Clinical Kidney Journal, Volume 15, Issue 6, June 2022, Pages 1079–1092
Our laboratory published the first evidence that nutritional ketosis, induced by a ketogenic diet (KD) or time-restricted diet (TRD), ameliorates disease progression in polycystic kidney disease (PKD) animal models. We reasoned that, due to their frequent use for numerous health benefits, some autosomal dominant PKD (ADPKD) patients may already have had experience with ketogenic dietary interventions (KDIs). This retrospective case series study is designed to collect the first real-life observations of ADPKD patients about safety, feasibility and possible benefits of KDIs in ADPKD as part of a translational project pipeline.
Association of urinary albumin:creatinine ratio with incident frailty in older populations
Mengyi Liu, Panpan He, Chun Zhou, Zhuxian Zhang, Yuanyuan Zhang, Huan Li, Chengzhang Liu, Jing Nie, Min Liang, Xianhui Qin
doi : 10.1093/ckj/sfac002
Clinical Kidney Journal, Volume 15, Issue 6, June 2022, Pages 1093–1099
The longitudinal relationship of albuminuria with incident frailty remains unknown. Therefore we aimed to evaluate the relation of albuminuria with the risk of incident frailty in older adults.
Timing of the pre-transplant workup for renal transplantation: is there room for improvement?
Marie Dirix, Ester Philipse, Rowena Vleut, Vera Hartman, Bart Bracke, Thierry Chapelle, Geert Roeyen, Dirk Ysebaert, Gerda Van Beeumen, Erik Snelders, Annick Massart, Katrien Leyssens, Marie M Couttenye, Daniel Abramowicz, Rachel Hellemans
doi : 10.1093/ckj/sfac006
Clinical Kidney Journal, Volume 15, Issue 6, June 2022, Pages 1100–1108
Since patient survival after kidney transplantation is significantly improved with a shorter time on dialysis, it is recommended to start the transplant workup in a timely fashion.
Stopping versus continuing renin–angiotensin–system inhibitors after acute kidney injury and adverse clinical outcomes: an observational study from routine care data
Roemer J Janse, Edouard L Fu, Catherine M Clase, Laurie Tomlinson, Bengt Lindholm, Merel van Diepen, Friedo W Dekker, Juan-Jesus Carrero
doi : 10.1093/ckj/sfac003
Clinical Kidney Journal, Volume 15, Issue 6, June 2022, Pages 1109–1119
The risk–benefit ratio of continuing with renin–angiotensin system inhibitors (RASi) after an episode of acute kidney injury (AKI) is unclear. While stopping RASi may prevent recurrent AKI or hyperkalaemia, it may deprive patients of the cardiovascular benefits of using RASi.
New-onset anemia and associated risk of ESKD and death in non-dialysis CKD patients: a multicohort observational study
Roberto Minutolo, Michele Provenzano, Paolo Chiodini, Silvio Borrelli, Carlo Garofalo, Michele Andreucci, Maria Elena Liberti, Vincenzo Bellizzi, Gius
doi : 10.1093/ckj/sfac004
Clinical Kidney Journal, Volume 15, Issue 6, June 2022, Pages 1120–1128
Anemia is a common complication of chronic kidney disease (CKD), but its incidence in nephrology settings is poorly investigated. Similarly, the risks of adverse outcomes associated with new-onset anemia are not known.
Outcomes and predictors of skin sodium concentration in dialysis patients
Fabio R Salerno, Alireza Akbari, Sandrine Lemoine, Guido Filler, Timothy J Scholl, Christopher W McIntyre
doi : 10.1093/ckj/sfac021
Clinical Kidney Journal, Volume 15, Issue 6, June 2022, Pages 1129–1136
Sodium-23 magnetic resonance imaging (23Na MRI) allows the measurement of skin sodium concentration ([Na+]). In patients requiring dialysis, no data are available relating to the clinical outcomes associated with skin sodium accumulation or the determinants of increasing deposition.
Postoperative outcomes of cancer surgery in patients with and without kidney failure with dialysis therapy: a matched-pair cohort study
Yoshihisa Miyamoto, Masao Iwagami, Shotaro Aso, Kazuaki Uda, Kiyohide Fushimi, Yoshifumi Hamasaki, Masaomi Nangaku, Hideo Yasunaga, Kent Doi
doi : 10.1093/ckj/sfac005
Clinical Kidney Journal, Volume 15, Issue 6, June 2022, Pages 1137–1143
The difference in outcomes of cancer surgery between patients with and without kidney failure with dialysis therapy (KFDT) remains uncertain.
Sex differences in chronic kidney disease prevalence in Asia: a systematic review and meta-analysis
Carinna Hockham, Lexia Bao, Anushree Tiku, Sunil V Badve, Aminu K Bello, Meg J Jardine, Vivekanand Jha, Tadashi Toyama, Mark Woodward, Min Jun
doi : 10.1093/ckj/sfac030
Clinical Kidney Journal, Volume 15, Issue 6, June 2022, Pages 1144–1151
Previous reports on the prevalence of chronic kidney disease (CKD) in Asia have suggested important sex disparities but have been inconsistent in nature. We sought to synthesize available sex-disaggregated CKD prevalence data in Asia to quantify sex disparities in the region.
Cancer among kidney transplant recipients >20 years after transplantation: post-transplant lymphoproliferative disorder remains the most common cancer type in the ultra long-term
Julia D Fuhrmann, Kristyna Valkova, Seraina von Moos, Rudolf P Wüthrich, Thomas F Müller, Thomas Schachtner
doi : 10.1093/ckj/sfac013
Clinical Kidney Journal, Volume 15, Issue 6, June 2022, Pages 1152–1159
Cancer risk is increased by 2- to 4-fold in kidney transplant recipients (KTRs) compared with the general population. Little attention, however, has been given to KTRs with ultra long-term survival >20 years.
Individualized everolimus treatment for tuberous sclerosis-related angiomyolipoma promotes treatment adherence and response
Noelle K X Chung, Peter Metherall, Janet A McCormick, Roslyn J Simms, Albert C M Ong
doi : 10.1093/ckj/sfac037
Clinical Kidney Journal, Volume 15, Issue 6, June 2022, Pages 1160–1168
Everolimus is a potential alternative to embolization and nephrectomy for managing tuberous sclerosis complex (TSC)-associated renal angiomyolipoma (AML). In 2016, National Health Service England approved its use through regional centres for renal AML ≥30 mm showing interval growth. Evidence of lesion stabilization or reduction after 6 months is mandated for continuation of long-term treatment.
Efficacy and safety of warfarin in patients with non-valvular atrial fibrillation and CKD G3–G5D
Frida Welander, Henrik Renlund, Emöke Dimény, Henrik Holmberg, Anders Själander
doi : 10.1093/ckj/sfac022
Clinical Kidney Journal, Volume 15, Issue 6, June 2022, Pages 1169–1178
Observational data comparing warfarin with no treatment for patients with non-valvular atrial fibrillation (NVAF) and severely reduced glomerular filtration rate (GFR) are conflicting and randomized controlled trials (RCTs) are lacking. Most studies do not provide information on warfarin treatment quality, making them difficult to compare.
More dissimilarities than affinities between DNAJB11-PKD and ADPKD
Isabella Pisani, Marco Allinovi, Viviana Palazzo, Paola Zanelli, Micaela Gentile, Maria Teresa Farina, Sara Giuliotti, Paolo Cravedi, Marco Delsante, Umberto Maggiore, Enrico Fiaccadori, Lucio Manenti
doi : 10.1093/ckj/sfac032
Clinical Kidney Journal, Volume 15, Issue 6, June 2022, Pages 1179–1187
Polycystic kidney diseases (PKD) are an important cause of chronic kidney disease (CKD). Autosomal dominant polycystic kidney disease (ADPKD) due to PKD1 or PKD2 mutations is the most common form, but other genes can be responsible for ADPKD and its phenocopies. Among them, a form of atypical ADPKD caused by DNAJB11 mutations (DNAJB11-PKD) has been recently described.
Association between bone mineral density at different anatomical sites and both mortality and fracture risk in patients receiving renal replacement therapy: a longitudinal study
David A Jaques, Scott Henderson, Andrew Davenport
doi : 10.1093/ckj/sfac034
Clinical Kidney Journal, Volume 15, Issue 6, June 2022, Pages 1188–1195
The clinical utility of bone mineral density (BMD) measurement by dual-energy X-ray absorptiometry (DXA) is debated in end-stage kidney disease (ESKD). We assessed the ability of BMD measured at different anatomical sites to predict mortality and fracture risk in patients requiring renal replacement therapy (RRT).
The mysterious death of the beer drinking champ: potential role for hyperacute water loading and acute hyponatremia
Maria Vanessa Perez-Gomez, Didier Sanchez-Ospina, Alberto Tejedor, Alberto Ortiz
doi : 10.1093/ckj/sfac072
Clinical Kidney Journal, Volume 15, Issue 6, June 2022, Pages 1196–1201
Hyponatremia is acute when present for <48 h. Most cases of acute hyponatremia involve both excess free water intake and an at least partial urinary free water excretion defect. By contrast, hyperacute water intoxication may result from a large excess electrolyte-free water intake in such a short time that properly working urinary free water excretion mechanisms cannot cope. A hyperacute decrease in serum sodium may lead to death before medical intervention takes place. Well-documented cases have been published in the military medicine literature. In addition, news reports suggest the existence of cases of voluntary ingestion of excess free water by non-psychiatric individuals usually during ‘dare’ activities. Education of the public is required to prevent harm from these high-risk activities. Adequate training of emergency medical units may prevent lethal outcomes. Spanish media reported the case of a male who died following his triumph in a 20-min beer drinking contest. ‘From a heart attack. Man dies after drinking six litres of beer in a contest’ ran the news. We now review the physiology underlying hyperacute water intoxication and discuss the potential contribution of hyperacute water loading and acute hyponatremia to the demise of this patient.
Antibody titers against SARS-CoV-2 spike protein 6 months after a third BNT162b2 vaccine in chronic hemodialysis patients
Wael El Haggan, Bruno Berdin, Magdy El Salhy
doi : 10.1093/ckj/sfac087
Clinical Kidney Journal, Volume 15, Issue 6, June 2022, Pages 1202–1203
The 2021 European Society of Cardiology Cardiovascular Disease Prevention Guidelines: adding albuminuria to the SCORE scale increases the prevalence of very high/high cardiovascular risk among patients with chronic kidney disease
Ana Cebrian, Carlos Escobar, Unai Aranda, Beatriz Palacios, Margarita Capel, Antoni Sicras, Aram Sicras, Antonio Hormigo, Nicolás Manito, Manuel Botana, Roberto Alcázar
doi : 10.1093/ckj/sfac019
Clinical Kidney Journal, Volume 15, Issue 6, June 2022, Pages 1204–1208
The misuse of funnel plots in meta-analyses of proportions: are they really useful?
Huzaifa Ahmad Cheema, Abia Shahid, Muhammad Ehsan, Muhammad Ayyan
doi : 10.1093/ckj/sfac035
Clinical Kidney Journal, Volume 15, Issue 6, June 2022, Pages 1209–1210
Haemodiafiltration and haemodialysis should be reported separately by kidney replacement therapy registries
Ulrich Steinwandel, Hugh Davies, Nick Gibson
doi : 10.1093/ckj/sfac039
Clinical Kidney Journal, Volume 15, Issue 6, June 2022, Pages 1211–1212
National survey on genetic test prescription in French adult nephrologists: a call for simplification and education
Alice Doreille, Patricia Villié, Laurent Mesnard
doi : 10.1093/ckj/sfac041
Clinical Kidney Journal, Volume 15, Issue 6, June 2022, Pages 1213–1215
