NephrologyNow The Ultimate Guide to Kidney Disease Research

This analysis of observational DOPPS data examined the impact of reduced dialysate sodium on clinical outcomes.  While lowering dialysate sodium was associated with lower interdialytic weight gain, it was also associated with increased hospitalization.  No mortality benefit was associated with reduced dialysate sodium.

In the wake of the termination of the Altitude study, this meta-analysis identifies an increase risk of hyperkalemia but not acute kidney injury in the combination of aliskiren and angiotensin converting enzyme inhibitors or angiotensin receptor blockers.

The impact of sodium intake on clinical outcomes has recently come under some scrutiny and the topic is surrounded by debate.  In this retrospective analysis of the REIN study, patients with non-diabetic CKD who had high dietary salt (>14 g daily) had a blunted antiproteinuric effect from ACE inhibitor therapy and increase the risk for [...]

This review discusses the role of diuretics and ultrafiltration in acute decompensated heart failure.

FSGS accounts for appoximately 40% of adult nephrotic syndrome.  This review provides an approaches to the diagnosis and management of this disease.

Voclosporin is a new calcineurin inhibitor being assessed for transplantation. In this dose-ranging non-inferiority trial, three therapeutic levels of voclosporin were compared to tacrolimus in new renal transplant recipients. The incidence of acute rejection was similar in all voclosporin groups compared to tacrolimus. The incidence of diabetes increased in the higher-dose voclosporin group. Further studies [...]

Arteriolar hyalinosis has been considered as the hallmark of calcineurin-inhibitor toxicity. In this retrospective study, renal biopsies were compared between patients who did and did not receive cyclosporine. No histologic lesion, including arteriolar hyalinosis, was seen exclusively in cyclosporine-treated patients. The accompanying editorial discusses the need to develop specific markers of calcineurin-inhibitor toxicity.

Patients who are desensitized prior to renal transplant require more intensive immunosuppression compared to average-risk patients. In this single-centre, non-randomized study, the use of rituximab was not associated with an increased risk of bacterial, viral or fungal infections.

This randomized controlled trial assessed the effect of conversion from tacrolimus to sirolimus at one month post-transplant. In comparison to other such trials of early conversion to an mTOR inhibitor, this trial was notable for including protocol biopsies. Conversion to sirolimus did not affect the frequency of chronic changes seen on biopsy at one year [...]

Novartis announced the termination of the ALTITUDE study in high-risk patients with diabetes and renal impairment. The study was designed to determine if aliskiren could reduce cardiovascular and renal morbidity and mortality, compared with placebo, when added to conventional treatment (including ACEi or ARB). Based on the recommendation from the Data Monitoring committee, it was felt [...]

An observational analysis of cohorts from the ONTARGET and TRANSCEND trials looked at the association of urinary sodium and potassium with CV events and mortality. Sodium excretion and CV events showed a J-shaped relationship: sodium excretion of  < 3 g and >7 g per day was associated with an increased risk of CV events.  Risk [...]

This open-label single-center trial examines the impact on cardiovascular events in hypertensive patients with CKD treated with ≥1 hypertension medication at bedtime vs taking all anti-hypertensive medications upon waking. See the accompanying editorial: http://jasn.asnjournals.org/content/22/12/2152.full Free full text kindly provided by the American Society of Nephrology

While the included RCT failed to show any significant difference between PD catheter type, the meta-analysis also performed suggests that coiled catheters may be more prone to migration and dysfunction than straight catheters.