NephrologyNow The Ultimate Guide to Kidney Disease Research

This NEJM “Perspectives” article from the Food and Drug Administration discusses the data driving a need to re-evaluate the use of ESAs in the treatment of anemia due to chronic kidney disease.

This editorial by Dr. Ajay Singh discusses the implications of TREAT in the context of the existing evidence base on the management of anemia due to chronic kidney disease.

This NEJM clinical practice article highlights the management of chronic kidney disease with a look at supporting evidence and review of formal guidelines.

This review of prehypertension emphasizes the importance of diagnosing this entity early as a view to preventing cardiovascular outcomes in the population as a whole and not just those patients at high-risk.

Results of two randomized trial using induction treatment with either MMF or intravenous cyclophosphamide were pooled in this article. At 24 weeks, the results show that both groups were similar with respect to percentage change in proteinuria and serum creatinine as end points when used to treat patients with class V lupus.

This re-analysis of data from the North American Symptomatic Carotid Endarterectomy Trial showed that patients with stage 3 CKD and symptomatic high-grade carotid stenosis gained a large benefit in stroke risk reduction after endarterectomy.
Free full text access kindly provided by the American Society of Nephrology.

Rituximab is being used in renal transplantation to treat donor-specific antibodies pre-transplant of acute humoral rejection post-transplant. This is a single-center retrospective study of transplant patients who received rituximab for a variety of reasons. Compared to a control group, there was an increase rate of death from infection, including unusual infections.

ADMA is a known risk factor for mortality and cardiovascular events in the CKD and ESRD populations. This study found that transplant recipients with higher levels of ADMA were at an increased risk of graft failure, cardiovascular events and death. Whether therapeutic interventions that lower ADMA levels would decrease the risk of death is unknown.

Quantifying the risks of living donation is important information for potential living donors and members of the transplant team. This registry includes all donors over a 12-year period. Major postoperative complications occurred in 3% of patients, while minor complications, mostly UTIs, occurred in 18%. There were no deaths.

Previous studies have suggested that hemodialysis immediately before transplant surgery may increase the risk of delayed graft function. In this RCT, patients were randomized to be dialyzed or not pre-transplant; patients with a potassium > 5.0 were randomized to citrate or heparin
anticoagulation. There were no differences in the incidence of DGF, acute rejection or early [...]

This observational study identified that patients with renal failure undergoing PCI (percutaneous coronary intervention) frequently receive contraindicated anticoagulants such as enoxaparin and eptifibatide.  Such exposure was associated with an increased risk of in-hospital major bleeding.

This next addition to the AJKD Core Curriculum series provides a detailed overview of the topic of “Home Hemodialysis, Daily Hemodialysis and Nocturnal Hemodialysis”.

Like sirolimus, everolimus is an inhibitor of mTOR. Previous studies have shown that the combination of a calcineurin inhibitor at full-dose with an mTOR inhibitor is associated with increased nephrotoxicity. This RCT compared standard-dose everolimus and low-dose cyclosporine to high-dose everolimus and very-low dose cyclosporine (measured by C2 levels, which are more accurate). There was no difference in renal function [...]