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Sodium intake and progression of chronic kidney disease—has the time finally come to do the impossible: a prospective randomized controlled trial?
Michel Burnier
doi : 10.1093/ndt/gfaa120
Volume 36, Issue 3, March 2021, Pages 381–384
According to the Global Burden of Diseases, Injuries, and Risk Factors Study 2017, chronic kidney disease (CKD) affects 9.1% of the population worldwide, with Stages 1 and 2 accounting for >50% of CKD cases [1]. The age-standardized prevalence is higher in females (9.5%) than in males (7.3%), but the incidence of end-stage kidney disease (ESKD) is lower in females. Moreover, the CKD prevalence is very heterogeneous in different areas of the world depending on the sociodemographic situation, the burden of disease being greater in countries with lower socio-economic development. In contrast to many other non-communicable diseases [2], such as ischaemic heart disease or stroke, the global age-standardized mortality rate...
Drug prescription in patients with chronic kidney disease: a true challenge
Sophie Liabeuf, Maurice Laville
doi : 10.1093/ndt/gfaa164
Volume 36, Issue 3, March 2021, Pages 385–386
Patients with chronic kidney disease (CKD) have a substantial comorbidity burden, which often results in polypharmacy. A recent study found that the patients seen by nephrologists were the most complex to treat because of their high number of comorbidities {mean 4.2 [95% confidence interval (CI) 4.2–4.3]} and high number of prescription medications [mean 14.2 (95% CI 14.2–14.3)] [1].
Big data and outcomes in paediatric haemodialysis: how can nephrologists use these new tools in daily practice?
Bruno Ranchin, Delphine Maucort-Boulch, Justine Bacchetta
doi : 10.1093/ndt/gfaa225
Volume 36, Issue 3, March 2021, Pages 387–391
In this issue of Nephrology Dialysis Transplantation, in their paper entitled ‘Identifying key predictors of mortality in young patients on chronic haemodialysis—a machine learning approach’, Gotta et al. describe the interest of artificial intelligence (AI) to predict 5-year mortality in paediatric and young adult patients undergoing maintenance haemodialysis (HD) [1]. With such a technique, they predict mortality with a high accuracy (81%), using 12 multifactorial ‘routine’ markers of nutrition, inflammation, anaemia and dialysis dose, in a cohort of 363 patients with at least a 5-year follow-up on dialysis, corresponding to a subgroup analysis of their previously published papers but also likely corresponding to the most severe paediatric patients in...
On the origins of experimental renal physiology
Garabed Eknoyan
doi : 10.1093/ndt/gfaa238
Volume 36, Issue 3, March 2021, Pages 392–395
The 19th century was a transformative period in the progress of medicine. It was in its first half that combining observational studies of pathological anatomy with exacting clinical descriptions of diseases led to a revolution in diagnosis. And it was in its second half that physiology emerged as a discipline that would lay the foundation of experimental medicine. It is within this time frame that nephrology was conceived.
Sudden cardiac death in dialysis patients: different causes and management strategies
Simonetta Genovesi, Giuseppe Boriani, Adrian Covic, Robin W M Vernooij, Christian Combe ...
doi : 10.1093/ndt/gfz182
Volume 36, Issue 3, March 2021, Pages 396–405
Sudden cardiac death (SCD) represents a major cause of death in end-stage kidney disease (ESKD). The precise estimate of its incidence is difficult to establish because studies on the incidence of SCD in ESKD are often combined with those related to sudden cardiac arrest (SCA) occurring during a haemodialysis (HD) session.
Phosphate and bone fracture risk in chronic kidney disease patients
Maria Fusaro, Rachel Holden, Charmaine Lok, Giorgio Iervasi, Mario Plebani ...
doi : 10.1093/ndt/gfz196
Volume 36, Issue 3, March 2021, Pages 405–412
In chronic kidney disease (CKD), phosphate homoeostasis plays a central role in the development of mineral and bone disorder (MBD) together with decreased serum calcium and elevated serum parathyroid hormone, fibroblast growth factor 23 and sclerostin levels. Today there are only a few data exploring the direct role of abnormal phosphate homoeostasis and hyperphosphataemia in the development of CKD-MBD.
Bone evaluation in paediatric chronic kidney disease: clinical practice points from the European Society for Paediatric Nephrology CKD-MBD and Dialysis working groups and CKD-MBD working group of the ERA-EDTA
Sevcan A Bakkaloglu, Justine Bacchetta, Alexander D Lalayiannis, Maren Leifheit-Nestler, Stella Stabouli ...
doi : 10.1093/ndt/gfaa210
Volume 36, Issue 3, March 2021, Pages 413–425
Mineral and bone disorder (MBD) is widely prevalent in children with chronic kidney disease (CKD) and is associated with significant morbidity. CKD may cause disturbances in bone remodelling/modelling, which are more pronounced in the growing skeleton, manifesting as short stature, bone pain and deformities, fractures, slipped epiphyses and ectopic calcifications. Although assessment of bone health is a key element in the clinical care of children with CKD, it remains a major challenge for physicians.
What does a PTH of 300?pg/mL actually mean?
Etienne Cavalier
doi : 10.1093/ndt/gfz163
Volume 36, Issue 3, March 2021, Pages 426–427
At nephrology meetings, when presenting clinical cases, nephrologists often discuss patients with parathyroid hormone (PTH) levels of ‘300?pg/mL’. But what does ‘300?pg/mL’ mean, especially in the context of chronic kidney disease (CKD)?
MicroRNAs as non-invasive biomarkers of renal disease
Katie L Connor, Laura Denby
doi : 10.1093/ndt/gfz183
Volume 36, Issue 3, March 2021, Pages 428–429
With an estimated global prevalence of chronic kidney disease (CKD) of 11–13%, non-invasive biomarkers of renal pathology are desperately required to enhance early diagnosis, guide prognosis and monitor response to treatment [1]. Currently, the mainstay of renal functional monitoring remains measurement of blood urea, serum creatinine and urinalysis, with renal biopsies adopted when diagnostic clarity is required.
Inhibition of apoptosis signal-regulating kinase 1 mitigates the pathogenesis of human immunodeficiency virus-associated nephropathy
Anqun Chen, Jin Xu, Han Lai, Vivette D D’Agati, Tian-Jun Guan ...
doi : 10.1093/ndt/gfaa198
Volume 36, Issue 3, March 2021, Pages 430–441
Chronic kidney disease (CKD) is a common cause of morbidity and mortality in human immunodeficiency virus (HIV)-positive individuals. Among the HIV-related kidney diseases, HIV-associated nephropathy (HIVAN) is a rapidly progressive renal disease characterized by collapsing focal glomerulosclerosis (GS), microcystic tubular dilation, interstitial inflammation and fibrosis.
Active vitamin D is cardioprotective in experimental uraemia but not in children with CKD Stages 3–5
Anne Sch?n, Maren Leifheit-Nestler, Jennifer Deppe, Dagmar-Christiane Fischer, Aysun K Bayazit ...
doi : 10.1093/ndt/gfaa227
Volume 36, Issue 3, March 2021, Pages 442–451
Uraemic cardiac remodelling is associated with vitamin D and Klotho deficiency, elevated fibroblast growth factor 23 (FGF23) and activation of the renin–angiotensin system (RAS). The cardioprotective properties of active vitamin D analogues in this setting are unclear.
High levels of gut-homing immunoglobulin A+ B lymphocytes support the pathogenic role of intestinal mucosal hyperresponsiveness in immunoglobulin A nephropathy patients
Fabio Sallustio, Claudia Curci, Nada Chaoul, Giulia Font?, Gabriella Lauriero ...
doi : 10.1093/ndt/gfaa264
Volume 36, Issue 3, March 2021, Pages 452–464
Immunoglobulin A nephropathy (IgAN) is the most frequent primary glomerulonephritis. The role of the microbiota and mucosal immunity in the pathogenesis of IgAN remains a key element. To date, the hypothetical relationship between commensal bacteria, elevated tumour necrosis factor (TNF) superfamily member 13 [also known as B-cell activating factor (BAFF)] levels, perturbed homoeostasis of intestinal-activated B cells and intestinal IgA class switch has not been clearly shown in IgAN patients.
Iron sucrose (‘RBT-3’) activates the hepatic and renal HAMP1 gene, evoking renal hepcidin loading and resistance to cisplatin nephrotoxicity
Richard A Zager, Ali C M Johnson, Renibus Therapeutics
doi : 10.1093/ndt/gfaa348
Volume 36, Issue 3, March 2021, Pages 465–474
Iron sucrose (FeS) administration induces a state of renal preconditioning, protecting against selected forms of acute kidney injury (AKI). Recent evidence suggests that recombinant hepcidin also mitigates acute renal damage. Hence the goals of this study were to determine whether a new proprietary FeS formulation (‘RBT-3’) can acutely activate the hepcidin (HAMP1) gene in humans, raising plasma and renal hepcidin concentrations; assess whether the kidney participates in this posited RBT-3–hepcidin generation response; test whether RBT-3 can mitigate a clinically relevant AKI model (experimental cisplatin toxicity) and explore whether mechanisms in addition to hepcidin generation are operative in RBT-3’s cytoprotective effects.
Prognosis and acute complications at the first onset of idiopathic nephrotic syndrome in children: a nationwide survey in Japan (JP-SHINE study)
Mai Sato, Kenji Ishikura, Takashi Ando, Kaori Kikunaga, Chikako Terano ...
doi : 10.1093/ndt/gfz185
Volume 36, Issue 3, March 2021, Pages 475–481
Information on the epidemiology of idiopathic nephrotic syndrome (INS) in children, complications of INS and the side effects of steroid therapy is scarce.
Incidence, prognostic impact and clinical outcomes of renal impairment in patients with multiple myeloma: a population-based registry
Maxime Courant, Sebastien Orazio, Alain Monnereau, Julie Preterre, Christian Combe ...
doi : 10.1093/ndt/gfz211
Volume 36, Issue 3, March 2021, Pages 482–490
Renal impairment (RI), a severe complication in multiple myeloma (MM), is considered as a poor prognostic factor. Patient survival has increased with the use of novel drugs and autologous stem-cell transplantation (ASCT). However, specific evolution of the incidence of RI in MM and its impact on prognosis remain unclear.
Major adverse renal events (MARE): a proposal to unify renal endpoints
Friedrich C Prischl, Peter Rossing, George Bakris, Gert Mayer, Christoph Wanner
doi : 10.1093/ndt/gfz212
Volume 36, Issue 3, March 2021, Pages 491–497
In renal studies, various outcome endpoints are used with variable definitions, making it nearly impossible to perform meta-analyses and deduce meaningful conclusions. Increasing attention is directed towards standardization of renal outcome reporting.
Renal outcomes in adult patients with horseshoe kidney
Minjung Kang, Yong Chul Kim, Hajeong Lee, Dong Ki Kim, Kook-Hwan Oh ...
doi : 10.1093/ndt/gfz217
Volume 36, Issue 3, March 2021, Pages 498–503
Horseshoe kidney (HSK) is a congenital disorder that is usually asymptomatic, but that increases the risks of kidney stones and infectious disease. However, renal outcomes such as end-stage renal disease (ESRD) in patients with HSK remain unclear.
International prescribing patterns and polypharmacy in older people with advanced chronic kidney disease: results from the European Quality study
Samantha Hayward, Barnaby Hole, Rachel Denholm, Polly Duncan, James E Morris ...
doi : 10.1093/ndt/gfaa064
Volume 36, Issue 3, March 2021, Pages 503–511
People with chronic kidney disease (CKD) are at high risk of polypharmacy. However, no previous study has investigated international prescribing patterns in this group. This article aims to examine prescribing and polypharmacy patterns among older people with advanced CKD across the countries involved in the European Quality (EQUAL) study.
Measured sodium excretion is associated with CKD progression: results from the KNOW-CKD study
Minjung Kang, Eunjeong Kang, Hyunjin Ryu, Yeji Hong, Seung Seok Han ...
doi : 10.1093/ndt/gfaa107
Volume 36, Issue 3, March 2021, Pages 512–519
Diet is a modifiable factor of chronic kidney disease (CKD) progression. However, the effect of dietary salt intake on CKD progression remains unclear. Therefore, we analyzed the effect of dietary salt intake on renal outcome in Korean patients with CKD.
Identifying key predictors of mortality in young patients on chronic haemodialysis—a machine learning approach
Verena Gotta, Georgi Tancev, Olivera Marsenic, Julia E Vogt, Marc Pfister
doi : 10.1093/ndt/gfaa128
Volume 36, Issue 3, March 2021, Pages 519–528
The mortality risk remains significant in paediatric and adult patients on chronic haemodialysis (HD) treatment. We aimed to identify factors associated with mortality in patients who started HD as children and continued HD as adults.
Vascular endothelial growth factor D is a biomarker of fluid overload in haemodialysis patients
Seraina von Moos, Stephan Segerer, Andrew Davenport, Malha Sadoune, Kerem Gerritsen ...
doi : 10.1093/ndt/gfz281
Volume 36, Issue 3, March 2021, Pages 529–536
Improved understanding and assessment of the complex physiology of volume regulation in haemodialysis (HD) patients are required to improve patient care and reduce mortality associated with fluid overload (FO).
High-flow arteriovenous fistula is not associated with increased extracellular volume or right ventricular dysfunction in haemodialysis patients
David A Jaques, Andrew Davenport
doi : 10.1093/ndt/gfaa188
Volume 36, Issue 3, March 2021, Pages 536–543
High-output congestive heart failure secondary to high-flow arteriovenous fistula (AVF) has been reported in haemodialysis (HD) patients. As high-flow AVF (HFA) would be expected to result in fluid retention, we conducted an observational study to characterize the relationship between AVF flow (Qa) and extracellular water (ECW) in HD patients.
Patients with end-stage kidney disease have markedly abnormal cortical hip parameters by dual-energy X-ray absorptiometry
Jasna Aleksova, Frances Milat, Mark A Kotowicz, Julie A Pasco, Chris Schultz ...
doi : 10.1093/ndt/gfz195
Volume 36, Issue 3, March 2021, Pages 543–550
Patients with end-stage kidney disease (ESKD) have higher fracture rates and post-fracture mortality than the general population, but bone mineral density by dual-energy X-ray absorptiometry (DXA) is less predictive of fracture in this patient group. Bone biopsy and high-resolution imaging indicate that cortical thickness (CT) is reduced and cortical porosity is increased in ESKD. The aim of this study was to assess cortical parameters using DXA in patients with ESKD. It was hypothesized that these parameters would show deterioration and be associated with fracture.
Kidney transplantation after rescue allocation—meticulous selection yields the chance for excellent outcome
Volker Assfalg, Svea Misselwitz, Lutz Renders, Norbert Hüser, Alexander Novotny ...
doi : 10.1093/ndt/gfaa286
Volume 36, Issue 3, March 2021, Pages 551–560
The small number of organ donors forces transplant centres to consider potentially suboptimal kidneys for transplantation. Eurotransplant established an algorithm for rescue allocation (RA) of kidneys repeatedly declined or not allocated within 5?h after procurement. Data on the outcomes and benefits of RA are scarce to date.
Serum levels of IL-6, IL-8 and IL-10 and risks of end-stage kidney disease and mortality
Teresa K Chen, Michelle M Estrella, Lawrence J Appel, Josef Coresh, Shengyuan Luo ...
doi : 10.1093/ndt/gfaa260
Volume 36, Issue 3, March 2021, Pages 561–563
A complex interplay of pro-inflammatory and anti-inflammatory cytokines likely affects the development and progression of chronic kidney disease (CKD). Specific cytokines include interleukin (IL)-6 and IL-8, which promote inflammation, and IL-10, which is generally considered to be anti-inflammatory [1]. We aimed to study associations of serum IL-6, IL-8 and IL-10 with the risk of incident end-stage kidney disease (ESKD) and all-cause mortality among participants of the African American Study of Kidney Disease and Hypertension (AASK). African Americans are at higher risk of ESKD, in part due to the prevalence of apolipoprotein L1 (APOL1) risk variants. Many suggest that a ‘second hit’ is required for kidney disease to develop in...
Serum potassium laboratory reference ranges influence provider treatment behaviors for hyperkalemia
Jamie S Hirsch, Rushang Parikh, Safiya Richardson, Kevin R Bock, Vipulbhai Sakhiya ...
doi : 10.1093/ndt/gfaa270
Volume 36, Issue 3, March 2021, Pages 563–565
The prevalence of hyperkalemia in hospitalized patients ranges between 1 and 10% [1] and treatment commonly commences when serum potassium is 5–6 mEq/L [2–4]. Aside from certain cardiovascular diseases [3, 5], the risk of adverse events with serum potassium <5.5 mEq/L is low [2] and treatment has not been shown to mitigate the risk [3]. Serum potassium results are typically reported along with reference ranges, with abnormal results flagged and highlighted. While hyperkalemia treatment guidelines have not changed, laboratory reference ranges have. These ranges are largely based on updates aimed at incorporating a 95% reference population rather than considering adverse event data...
Errata
Loreto Fernandez-Lorente, Paloma L Martin-Moreno, Jesus Arteaga
doi : 10.1093/ndt/gfaa119
Volume 36, Issue 3, March 2021, Page 566
Acute kidney failure in the cirrhotic patient: management, kidney biopsy and dual kidney liver transplantation indication, Nephrol Dial Transplant 2019; gfz068. doi:10.1093/ndt/gfz068
The COVID-19 outbreak and the angiotensin-converting enzyme 2: too little or too much
Marie Essig, Morgan Matt, Ziad Massy
doi : 10.1093/ndt/gfaa138
Volume 36, Issue 3, March 2021, Page 566
The COVID-19 outbreak and the angiotensin-converting enzyme 2: too little or too much?, Nephrol Dial Transplant 2020; gfaa113. doi: 10.1093/ndt/gfaa113
Con: Nutritional vitamin D replacement in chronic kidney disease and end-stage renal disease
doi : 10.1093/ndt/gfaa172
Volume 36, Issue 3, March 2021, Pages 566–567
While conducting a meta-analysis on vitamin D supplementation, Joel Gunnarsson, Senior Research Analyst at Quantify Research, Stockholm, Sweden pointed out a typographical error in the meta-analysis of vitamin D supplementation in chronic kidney disease (CKD) 1. The authors confirmed that a minus sign was inadvertently omitted in measuring change from baseline in parathyroid hormone (PTH) values in a 25 patient study 2; they corrected the error and the replacement Figure 2 is reproduced below.
