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Controlling pain in dialysis care: a choice among undesirable options
Andrea Cowan, Amit X Garg
doi : 10.1093/ndt/gfaa256
Volume 36, Issue 5, May 2021, Pages 749–751
Chronic pain and analgesic medication use are common among patients who receive ongoing dialysis [1–3]. According to recommendations in the World Health Organization pain ladder, opioids are generally avoided until nonopioid medications are proven ineffective [4]. Regularly scheduled acetaminophen is used, however, many patients report little benefit. In the dialysis population, many physicians recommend ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs), reassured that once a person’s kidneys fail the risk of nephrotoxicity is far less relevant.
A plea for renin–angiotensin system blockers as first-line treatment in cases of severe acute hypertension
Sébastien Rubin, Romain Boulestreau, Philippe Gosse, Christian Combe
doi : 10.1093/ndt/gfaa313
Volume 36, Issue 5, May 2021, Pages 752–753
The management of hypertension as a chronic disease is now well codified. Over the last 10 years, blockers of the renin–angiotensin system (RAS) have become first-line drugs, often combined with diuretics or calcium channel blockers, particularly in the population of patients with chronic kidney disease [1]. The management of acute and severe hypertension is much less clear-cut. Expert recommendations in this area are based on very low levels of evidence. However, there is a relative consensus on treatment based on intravenous (IV) infusion of antihypertensive therapy in the first days. Labetalol, nicardipine and urapidil are the most frequently used drugs in this setting. The aim is to progressively reduce blood pressure...
New evidence shows it is time to stop unnecessary use of antibiotics in kidney transplant recipients with asymptomatic bacteriuria
Julien Coussement, Nassim Kamar, Daniel Abramowicz
doi : 10.1093/ndt/gfaa341
Volume 36, Issue 5, May 2021, Pages 754–756
In 2014, we published an article in Nephrology Dialysis Transplantation questioning the usefulness of screening for and treating asymptomatic bacteriuria in kidney transplant recipients [1]. At that time, it was common practice in our institutions and in many others to routinely screen for asymptomatic bacteriuria after kidney transplantation. A urine culture was therefore systematically ordered at each post-transplant follow-up visit. Patients found to have bacteriuria were regularly prescribed antibiotics, even if they had no symptoms of urinary tract infection. A survey in 2017 confirmed that this practice was still common in European transplant centers [2].
Sodium zirconium cyclosilicate for hyperkalemia: a collateral acid–base benefit?
Donald E Wesson
doi : 10.1093/ndt/gfaa241
Volume 36, Issue 5, May 2021, Pages 756–760
Clinicians recognize the toxicity of hyperkalemia, and its need for treatment, due to compromised kidney potassium (K+) excretory capacity that accompanies a progressive loss of glomerular filtration rate (GFR) in patients with chronic kidney disease (CKD) [1]. Less recognized is the growing evidence supporting the toxicity of acid (hydrogen, H+) accumulation that also occurs with progressive GFR decline. Normally functioning kidneys can balance metabolic H+ production with excretion to avoid ongoing H+ accumulation. Patients with CKD and progressive GFR decline are less able to fully excrete metabolically produced H+, causing progressive H+ accumulation [2].
Dickkopf 3—a novel biomarker of the ‘kidney injury continuum’
Stefan J Schunk, Thimoteus Speer, Ioannis Petrakis, Danilo Fliser
doi : 10.1093/ndt/gfaa003
Volume 36, Issue 5, May 2021, Pages 761–767
Chronic kidney disease (CKD) is a global public health problem accompanied by substantial comorbidities and reduced life expectancy. In this respect, progressive CKD leading to uraemia can be seen as a systemic disease with a critical impact on virtually all organ systems. Therefore, it is of particular importance to identify patients with ongoing CKD progression, which is challenging, because the individual course of CKD is difficult to predict.
The evolution of the therapeutic approach to membranous nephropathy
Claudio Ponticelli, Passerini Patrizia, Lucia Del Vecchio, Francesco Locatelli
doi : 10.1093/ndt/gfaa014
Volume 36, Issue 5, May 2021, Pages 768–773
Primary membranous nephropathy (MN) is a frequent cause of nephrotic syndrome (NS) in adults. In untreated patients, the outcome is variable, with one-third of the patients entering remission while the remaining ones show persisting proteinuria or progression to end-stage renal disease. Randomized clinical trials reported the efficacy of a 6-month regimen alternating intravenous and oral glucocorticoids with an alkylating agent every other month.
How and when to assess bone mineral density and bone quality in chronic kidney disease patients?
Pascale Khairallah, Thomas L Nickolas, Maria Fusaro
doi : 10.1093/ndt/gfz198
Volume 36, Issue 5, May 2021, Pages 774–776
Chronic kidney disease mineral and bone disorder (CKD-MBD) refers to the mineral and bone abnormalities and the extraskeletal manifestations of CKD [1]. Parathyroid hormone (PTH), fibroblast growth factor 23, 1,25-dihydroxy vitamin D and ?-klotho regulate calcium and phosphorus levels, ensuring the availability of these minerals for bone formation, resorption and remodeling. The kidney is the main regulator of the feedback loops that maintain mineral metabolite homeostasis. Therefore CKD, even in its early stages, results in mineral metabolite derangements that are ultimately associated with increased morbidity and mortality in patients with CKD [1].
Cytomegalovirus nephropathy in the transplant patient
Ana Carina Ferreira, David Navarro
doi : 10.1093/ndt/gfz194
Volume 36, Issue 5, May 2021, Pages 777–778
Human cytomegalovirus (CMV), or human herpesvirus 5, is a DNA virus belonging to the herpesviridae family. While CMV is a common cause of benign infection in immunocompetent hosts, it is one of the most important opportunistic diseases in kidney-transplanted patients [1]. CMV infection is associated with significant morbidity and mortality, graft dysfunction and increased health care resource utilization [2].
The emerging challenge of sickle cell nephropathy
Rute B Baptista, Edgar Almeida
doi : 10.1093/ndt/gfz197
Volume 36, Issue 5, May 2021, Pages 779–781
Sickle cell disease (SCD) prevalence has been rising in Europe following population migrations. SCD is now the most common severe genetic disorder in France and the UK [1]. In high-income countries, survival of SCD patients into adulthood exceeds 93%. Nevertheless, lifespan is still shortened by 20–30?years [2]. Sickle cell nephropathy (SCN), which refers to the spectrum of SCD-related abnormalities in the kidney, contributes substantially to premature deaths, accounting for 16–18% of mortality [3].
Mass spectrometry-based screening identifies circulating immunoglobulinA–?1-microglobulin complex as potential biomarker in immunoglobulin A nephropathy
Boyang Xu, Li Zhu, Qingsong Wang, Yanfeng Zhao, Meng Jia ...
doi : 10.1093/ndt/gfaa352
Volume 36, Issue 5, May 2021, Pages 782–792
Immunoglobulin A nephropathy (IgAN) is characterized by predominant IgA deposition in the glomerular mesangium. Previous studies have proved that renal-deposited IgA in IgAN came from circulating IgA1-containing complexes (CICs).
Effects of calcitriol and paricalcitol on renal fibrosis in CKD
Laura Mart?nez-Arias, Sara Panizo, Cristina Alonso-Montes, Julia Mart?n-V?rgala, Beatriz Mart?n-Carro ...
doi : 10.1093/ndt/gfaa373
Volume 36, Issue 5, May 2021, Pages 793–803
In chronic kidney disease, the activation of the renin–angiotensin–aldosterone system (RAAS) and renal inflammation stimulates renal fibrosis and the progression to end-stage renal disease. The low levels of vitamin D receptor (VDR) and its activators (VDRAs) contribute to worsen secondary hyperparathyroidism and renal fibrosis.
Renal SPECT/CT with 99mTc–dimercaptosuccinic acid is a non-invasive predictive marker for the development of interstitial fibrosis in a rat model of renal insufficiency
Mickaël Bobot, Guillaume Hache, Anaïs Moyon, Samantha Fernandez, Laure Balasse ...
doi : 10.1093/ndt/gfaa374
Volume 36, Issue 5, May 2021, Pages 804–810
Chronic kidney disease (CKD) increases cardiovascular risk and mortality. Renal fibrosis plays a major role in the progression of CKD but, to date, histology remains the gold standard to assess fibrosis. Non-invasive techniques are needed to assess renal parenchymal impairment and to perform the longitudinal evaluation of renal structure. Thus we evaluated renal isotopic imaging by single-photon emission computed tomography/computed tomography (SPECT/CT) with technetium-99m (99mTc)–dimercaptosuccinic acid (DMSA) to monitor renal impairment during renal insufficiency in rats.
The urinary proteomics classifier chronic kidney disease 273 predicts cardiovascular outcome in patients with chronic kidney disease
Francis Verbeke, Justyna Siwy, Wim Van Biesen, Harald Mischak, Anneleen Pletinck ...
doi : 10.1093/ndt/gfz242
Volume 36, Issue 5, May 2021, Pages 811–818
The urinary proteomic classifier chronic kidney disease 273 (CKD273) is predictive for the development and progression of chronic kidney disease (CKD) and/or albuminuria in type 2 diabetes. This study evaluates its role in the prediction of cardiovascular (CV) events in patients with CKD Stages G1–G5.
Can sodium fluorescein cause contrast-induced nephropathy?
Donghwan Yun, Dong Ki Kim, Jung Pyo Lee, Yon Su Kim, Sohee Oh ...
doi : 10.1093/ndt/gfz243
Volume 36, Issue 5, May 2021, Pages 819–825
Contrast-induced nephropathy (CIN) is a common cause of acute kidney injury (AKI), and can be diagnosed when the etiology of AKI is unclear other than via a contrast agent. Fluorescent angiography (FAG) with fluorescein sodium dye is generally considered to be safe for patients with kidney diseases. However, it remains unresolved whether or not FAG can induce CIN.
Risk of hyperkalemia from renin–angiotensin–aldosterone system inhibitors and factors associated with treatment discontinuities in a real-world population
James B Wetmore, Heng Yan, Laura Horne, Yi Peng, David T Gilbertson
doi : 10.1093/ndt/gfz263
Volume 36, Issue 5, May 2021, Pages 826–839
Hyperkalemia rates in renin–angiotensin–aldosterone system (RAAS) inhibitor users, and factors associated with treatment interruptions and cessations, have not been explored in a large, population-wide database.
The association of microhematuria with mesangial hypercellularity, endocapillary hypercellularity, crescent score and renal outcomes in immunoglobulin A nephropathy
Shane A Bobart, Mariam P Alexander, Khaled Shawwa, Lisa E Vaughan, Ranine Ghamrawi ...
doi : 10.1093/ndt/gfz267
Volume 36, Issue 5, May 2021, Pages 840–847
Microhematuria is common in immunoglobulin A nephropathy (IgAN). However, current prognostication is based on proteinuria and mesangial hypercellularity, endocapillary hypercellularity, segmental sclerosis, tubulointerstitial fibrosis and crescent (MEST-C) scores.
Non-medical barriers reported by nephrologists when providing renal replacement therapy or comprehensive conservative management to end-stage kidney disease patients: a systematic review
Rianne W de Jong, Vianda S Stel, James G Heaf, Mark Murphy, Ziad A Massy ...
doi : 10.1093/ndt/gfz271
Volume 36, Issue 5, May 2021, Pages 848–862
Large international differences exist in access to renal replacement therapy (RRT) modalities and comprehensive conservative management (CCM) for patients with end-stage kidney disease (ESKD), suggesting that some patients are not receiving the most appropriate treatment. Previous studies mainly focused on barriers reported by patients or medical barriers (e.g. comorbidities) reported by nephrologists. An overview of the non-medical barriers reported by nephrologists when providing the most appropriate form of RRT (other than conventional in-centre haemodialysis) or CCM is lacking.
Kidney function and symptom development over time in elderly patients with advanced chronic kidney disease: results of the EQUAL cohort study
Cynthia J Janmaat, Merel van Diepen, Yvette Meuleman, Nicholas C Chesnaye, Christiane Drechsler ...
doi : 10.1093/ndt/gfz277
Volume 36, Issue 5, May 2021, Pages 862–870
Initiation of renal replacement therapy often results from a combination of kidney function deterioration and symptoms related to chronic kidney disease (CKD) progression. We investigated the association between kidney function decline and symptom development in patients with advanced CKD.
Sodium zirconium cyclosilicate increases serum bicarbonate concentrations among patients with hyperkalaemia: exploratory analyses from three randomized, multi-dose, placebo-controlled trials
Simon D Roger, Bruce S Spinowitz, Edgar V Lerma, Steven Fishbane, Stephen R Ash ...
doi : 10.1093/ndt/gfaa158
Volume 36, Issue 5, May 2021, Pages 871–883
Sodium zirconium cyclosilicate (SZC) binds potassium and ammonium in the gastrointestinal tract. In addition to serum potassium reduction, Phase 2 trial data have shown increased serum bicarbonate with SZC, which may be clinically beneficial because maintaining serum bicarbonate ?22?mmol/L preserves kidney function. This exploratory analysis examined serum bicarbonate and urea, and urine pH data from three SZC randomized, placebo-controlled Phase 3 studies among patients with hyperkalaemia [ZS-003 (n?=?753), HARMONIZE (n?=?258) and HARMONIZE-Global (n?=?267)].
Apixaban in patients on haemodialysis: a single-dose pharmacokinetics study
Ines Van den Bosch, Thomas Bouillon, Peter Verhamme, Thomas Vanassche, Marc Jacquemin ...
doi : 10.1093/ndt/gfaa351
Volume 36, Issue 5, May 2021, Pages 884–889
Apixaban, a direct oral anticoagulant inhibiting factor Xa, has been proven to reduce the risk of atrial fibrillation-related stroke and thromboembolism in patients with mild to moderate renal insufficiency. Patients on renal replacement therapy, however, were excluded from randomized controlled trials. Therefore, uncertainty remains concerning benefits, dosing and timing of intake in haemodialysis population.
Patient-reported outcome measures for life participation in peritoneal dialysis: a systematic review
Karine E Manera, Angela Ju, Amanda Baumgart, Elyssa Hannan, Wenjing Qiao ...
doi : 10.1093/ndt/gfaa244
Volume 36, Issue 5, May 2021, Pages 890–901
Patients receiving peritoneal dialysis (PD) endure an ongoing regimen of daily fluid exchanges and are at risk of potentially life-threatening complications and debilitating symptoms that can limit their ability to participate in life activities. The aim of the study was to identify the characteristics, content and psychometric properties of measures for life participation used in research in PD.
Impact of dialysis modality on major adverse cardiovascular events and all-cause mortality: a national population-based study
Ping-Jen Hu, Yu-Wei Chen, Tzu-Ting Chen, Li-Chin Sung, Mei-Yi Wu ...
doi : 10.1093/ndt/gfaa282
Volume 36, Issue 5, May 2021, Pages 901–908
Only few studies with inconsistent results comparing the relative risk of cardiac mortality between peritoneal dialysis (PD) and hemodialysis (HD). Switches between renal replacement therapy (RRT) modalities render objective assessment of survival benefits a greater challenge.
Cardiovascular risk of nonsteroidal anti-inflammatory drugs in dialysis patients: a nationwide population-based study
Hyung Ah Jo, Dong Ki Kim, Seokwoo Park, Yaerim Kim, Seung Seok Han ...
doi : 10.1093/ndt/gfz276
Volume 36, Issue 5, May 2021, Pages 909–917
Given the cardiovascular risk of nonsteroidal anti-inflammatory drugs (NSAIDs), it is essential to identify the relationship between NSAIDs and cardiovascular outcomes in dialysis patients who have elevated cardiovascular risk.
Does kidney transplantation with a standard or expanded criteria donor improve patient survival? Results from a Belgian cohort
Rachel Hellemans, Anneke Kramer, Johan De Meester, Frederic Collart, Dirk Kuypers ...
doi : 10.1093/ndt/gfab024
Volume 36, Issue 5, May 2021, Pages 918–926
Changes in recipient and donor factors have reopened the question of survival benefits of kidney transplantation versus dialysis.
Dynamic prediction models for graft failure in paediatric kidney transplantation
Rémi Kaboré, Loïc Ferrer, Cécile Couchoud, Julien Hogan, Pierre Cochat ...
doi : 10.1093/ndt/gfaa180
Volume 36, Issue 5, May 2021, Pages 927–935
Several models have been proposed to predict kidney graft failure in adult recipients but none in younger recipients. Our objective was to propose a dynamic prediction model for graft failure in young kidney transplant recipients.
Triglyceride/HDL cholesterol ratio and premature all-cause mortality in renal transplant recipients
Josephine L C Anderson, Stephan J L Bakker, Uwe J F Tietge
doi : 10.1093/ndt/gfaa321
Volume 36, Issue 5, May 2021, Pages 936–938
The numbers of renal transplant recipients (RTR) are constantly increasing, already surpassing in several countries those of patients receiving haemodialysis treatment [1]. However, RTR still suffers an exceptionally high, but poorly understood, mortality burden [2]. This is partly attributable to a declining allograft function, and partly to dyslipidaemia, including decreased high-density lipoprotein cholesterol (HDL-C) and increased triglycerides (TGs) [3]. Frequently, HDL-C is low when TGs are high, a relationship particularly well reflected in the TG/HDL-C ratio [4]. As the only existing guideline that addresses lipid treatment in RTR, Kidney Disease: Improving Global Outcome (KDIGO), solely advises lifestyle changes to combat raised TG levels [5...
Urinary ezrin and moesin as novel markers for recovery from acute kidney injury
Win Kulvichit, Xiaoyan Wen, Nattachai Srisawat, Trairak Pisitkun, Ali Smith ...
doi : 10.1093/ndt/gfaa328
Volume 36, Issue 5, May 2021, Pages 938–941
Acute kidney injury (AKI) is a common disorder associated with high morbidity and mortality among critically ill patients. Approximately 5% of all patients admitted to intensive care units around the world develop severe AKI requiring dialysis [1]. Currently there is no effective treatment to facilitate renal recovery in patients with AKI. The ability to forecast renal recovery is extremely valuable since it will provide physicians with an insight to optimize utilization of renal replacement therapy (RRT) and appropriate follow-up timing for these patients.
Need for uniform definitions in childhood nephrotic syndrome
Anne M Schijvens, Aditi Sinha, Arvind Bagga, Michiel F Schreuder
doi : 10.1093/ndt/gfaa338
Volume 36, Issue 5, May 2021, Pages 941–945
Nephrotic syndrome is one of the most common glomerular disorders in childhood [1, 2]. Although the majority of patients achieve complete remission after steroid treatment, >80% experience one or several relapses [3]. A significant proportion of patients progress to steroid-dependent nephrotic syndrome (SDNS) or frequently relapsing nephrotic syndrome (FRNS), which is often an indication for additional immunosuppressive treatment [3, 4]. Patients who do not achieve remission after several weeks of steroid treatment are considered steroid resistant [5].
Pilot study of reloxaliase in patients with severe enteric hyperoxaluria and hyperoxalemia
Anja Pfau, Danica Grujic, Mira T Keddis, Annamaria T Kausz, John C Lieske ...
doi : 10.1093/ndt/gfaa379
Volume 36, Issue 5, May 2021, Pages 945–948
Enteric hyperoxaluria (EH) is a serious condition that affects ?250?000 people in the USA and can lead to recurrent kidney stones, oxalate nephropathy and chronic kidney disease (CKD) with a risk of kidney failure requiring chronic dialysis [1–3]. It is characterized by excessive urine oxalate (UOx) excretion ?40?mg/24?h that is necessitated by increased intestinal oxalate absorption [4] as a consequence of gastrointestinal (GI) conditions associated with fat malabsorption [5]. When estimated glomerular filtration rate (eGFR) declines, plasma oxalate (POx) concentrations rise reflecting systemic oxalate load...
Subfertility and early menopause in women with glomerular disease
Monica L Reynolds, Caroline J Poulton, Lauren N Blazek, Susan L Hogan, Ronald J Falk ...
doi : 10.1093/ndt/gfab005
Volume 36, Issue 5, May 2021, Pages 948–950
Subfertility, an inability to achieve desired conception for an extended period, affects up to one in six couples and leads to considerable psychological distress [1]. Due to an altered hypothalamic–pituitary–ovarian axis, women with advanced chronic kidney disease (CKD) are more likely to experience menstrual irregularities, subfertility and early menopause [2–6]. Autoimmune diseases, including systemic lupus erythematosus and antiphospholipid antibody syndrome, are associated with subfertility related to autoantibodies, autoimmune oophoritis and medical treatment [7, 8].
Errata
Olivia Boyer, Guillaume Dorval, Aude Servais
doi : 10.1093/ndt/gfaa185
Volume 36, Issue 5, May 2021, Page 951
The genetics of steroid-resistant nephrotic syndrome in adults, Nephrol Dial Transplant 2020; gfz257. doi: 10.1093/ndt/gfz257
Erratum to: Novel oral anticoagulants in patients with chronic kidney disease and atrial fibrillation
Eleni Stamellou, Jürgen Floege
doi : 10.1093/ndt/gfaa190
Volume 36, Issue 5, May 2021, Page 952
Novel oral anticoagulants in patients with chronic kidney disease and atrial fibrillation, Nephrol Dial Transplant (2018) 33: 1683–1689; doi: 10.1093/ndt/gfx322
Erratum to: Managing Electrolyte Disorders: Order a Basic Urine Metabolic Profile
Richard H Sterns
doi : 10.1093/ndt/gfaa248
Volume 36, Issue 5, May 2021, Page 952
In the originally published version of this manuscript, there was an error in the URINE NA + K AND ELECTROLYTE-FREE WATER CLEARANCE section. The last sentence of the first paragraph should read: “A urine to plasma ratio >1 predicts that fluid restriction will be ineffective.”, instead of “A urine electrolyte ratio <1 predicts that fluid restriction will be ineffective.” This error has now been corrected online.
