NephrologyNow The Ultimate Guide to Kidney Disease Research

These extensive clinical practice guidelines provide by KDIGO are intended to assist decision-making in the area of acute kidney injury.

This small observational study suggests that PD patients who require cardiac surgery do not experience more complications or worse 2-year survival as compared to HD patients.  It also sugggests that 2-year survival for dialysis patients after cardiac surgery is acceptable.

This study surveyed patients with stage 3-5 CKD in Australia to assess factors which influence patients to choose dialysis versus conservative care.  Dialysis was more likely to be chosen if patients felt it increased life expectancy, would be given the choice of time to dialyze (evening rather than day only) or would receive subsidized transport. [...]

This systematic review and meta-analysis was designed to summarize the effects of antiplatelet treatment on cardiovascular events, mortality and bleeding in patients with CKD.  The results showed that serious bleeding was increased while there was no benefit on all-cause CV mortality or myocardial infarction in patients with CKD.  In patients with stable or absent cardiovascular [...]

These notes are taken from the changes to the Canadian product monograph for the anticoagulant Pradax (dabigatran etexilate) which have been updated to include new recommendations regarding renal function. Given that renal impairment is a risk factor for bleeding with Pradax®: Prior to initiation of treatment, renal function should be assessed in all patients to [...]

MPGN accounts for approximately 10% of cases of glomerulonephritis.  This article nicely reviews the causes, pathogenesis and clinical management.

This prospective study of 40 patients with stage 4-5 CKD assessed the benefits of 6 months of regular walking.  Self-reported improvements were noted in exercise tolerance, quality of life and uremic symptoms.  While more studies need to be done with larger patient populations to understand the nature and mechanism of these benefits, this study does [...]

This analysis of administrative data estimated the risk of fistula non-use in predialysis patients with a fistula.  Eighty-one percent of patients initiated dialysis; 9% of patients died without receiving dialysis, and 10% of patients remained predialysis. These results suggest that a fistula is used in the majority of patients in whom it is created.

In this randomized controlled trial, use of erythropoietin in renal transplant recipients to normalize hemoglobin to normal levels (130-150 g/L) resulted in less decline in graft function, less graft failure and fewer deaths compared to maintaining hemoglobin in the range recommended by current renal guidelines (105-115 g/L). This is a surprising result, as there have [...]

Understanding the causes of renal allograft failure is key in improving long-term graft survival. In this study, for-cause biopsies were analyzed, and outcomes were related to the biopsy finding. Notably, acute T-cell mediated cellular rejection rarely led to graft loss. In contrast, all patients who experienced graft loss demonstrated some degree of antibody-mediated rejection on [...]

In the last few years, the tacrolimus and mycophenolic acid has become the most popular therapy used in renal transplant, rather than the older cyclosporine and azathioprine combination. These authors conducted a randomized controlled trial to see whether the use of lymphocyte-depleting induction therapy would give equivalent results between these two drug regimens. In fact, [...]

There have been a number of randomized controlled trials over the last few years comparing early corticosteroid withdrawal post-renal transplant to long-term low-dose steroids. This meta-analysis found nine randomized controlled trials using modern immunosuppression protocols to assess the impact of early steroid withdrawal. Patients received tacrolimus or cyclosporine; mycophenolic acid or an mTOR inhibitor; and [...]

This article reflects on the success of kidney transplantation for the therapy of ESRD to commemorate World Kidney Day on March 8, 2012.