Rationale & Objective Longer and more frequent hemodialysis sessions are associated with both benefits and harms. However, their relative importance to patients and how they influence acceptability for patients have not been quantified. Study Design Discrete-choice experiment in which a scenario followed by 12 treatment choice sets were presented to patients in conjunction with varying information

Assessment of glomerular filtration rate (GFR) is fundamental to clinical practice, public health, and research. The kidney has several critical functions; GFR is used as an overall assessment of these kidney functions. GFR is used to diagnose, stage, and manage chronic kidney disease (CKD); ascertain the prognosis for chronic kidney disease–related events and mortality; and determine drug dosages

Rationale and Objective Concerns about non-adherent behaviors often prevent dialysis patients from entering waitlists for transplantation, despite an inconsistent association with posttransplant outcomes. We examined the association between plausible metrics of non-adherence related to dialysis treatment and posttransplant outcomes. Study Design Retrospective cohort. We linked national dialysis treatment

Rationale & Objective Patients receiving maintenance dialysis have higher mortality following primary percutaneous coronary intervention (pPCI) than patients not receiving dialysis. Whether pPCI confers a similar benefit to patients receiving dialysis remains unknown. We compared the effect of pPCI on in-hospital outcomes among patients hospitalized for STEMI and receiving maintenance dialysis to the

Rationale & Objectives Hypervolemia and vitamin D (Vit D) deficiency occur frequently in patients receiving peritoneal dialysis and may contribute to left ventricular hypertrophy (LVH). The effect of bioimpedance analysis-guided volume management or Vit D supplementation on LV mass among those receiving peritoneal dialysis is uncertain. Study Design Two-by-two factorial randomized controlled trial

Dr Susan Hou began her illustrious nephrology career at a time when pregnancy in women with chronic kidney disease (CKD) was hazardous and actively discouraged. Her pioneering research in women’s health provided much of the early outcome data that shaped our current understanding of CKD and pregnancy. Although many uncertainties regarding optimal management of this vulnerable patient group remain,

Despite the high prevalence and economic burden of chronic kidney disease (CKD), federal funding for kidney-related research, prevention, and education activities under the National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK) remains substantially lower compared to other chronic diseases. More federal support is needed to promote critical research that will expand knowledge of kidney

Hepatorenal syndrome (HRS) is a form of acute kidney injury occurring in patients with advanced cirrhosis and is associated with significant morbidity and mortality. The pathophysiology underlying HRS begins with increasing portal pressures leading to the release of vasodilatory substances which result in pooling blood in the splanchnic system and a corresponding reduction in effective circulating

The most common cause of kidney failure in the United States and across the world is diabetes mellitus (DM). Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in persons with diabetes, and chronic kidney disease (CKD) further increases overall CVD risk. It is important to individualize glycemic targets for patients to maintain glucose levels that will reduce the development

Metastatic disease in the kidney is relatively uncommon compared to other body sites. In most cases it presents as an unilateral and unifocal mass in the tubulointerstitial region. Intraglomerular metastases are even rarer, and their diagnosis is hampered by the limitation of imaging techniques to detect them. We describe the finding of intraglomerular metastases in a patient affected by a malignant

Blocking the complement system as a therapeutic strategy has been proposed for numerous glomerular diseases but presents a myriad of questions and challenges, not the least of which is demonstrating efficacy and safety. In light of these potential issues and because there are an increasing number of anti-complement therapy trials either planned or underway, the National Kidney Foundation (NKF) facilitated

Rationale and Objectives Tubular secretion plays an important role in the efficient elimination of endogenous solutes and medications, and lower secretory clearance is associated with risk of kidney function decline. We evaluated whether histopathologic quantification of interstitial fibrosis and tubular atrophy (IFTA) was associated with lower tubular secretory clearance in persons undergoing kidney

Rationale & Objective Fibrosis is a major driver of chronic kidney disease and epithelial-mesenchymal transition (EMT) may contribute to its development. A polyubiquitinated form of phosphatase and tensin homolog (PTEN K27polyub) promotes EMT in vitro. Thus, it is a potentially useful biomarker of progressive kidney fibrosis and may predict loss of kidney function. Study Design Observational cohort

Rationale & Objective The shortage of deceased donor kidneys identified for potential transplantation in the United States is exacerbated by a high proportion of deceased donor kidneys discarded after procurement. We estimated the impact of a policy proposal aiming to increase organ utilization by extending eligibility for waiting time reinstatement for recipients experiencing allograft failure following

The anion gap (AG) is a mathematical construct that compares the blood sodium concentration with the sum of the chloride and bicarbonate concentrations. It is a helpful calculation that divides the metabolic acidoses into 2 categories: high AG metabolic acidosis (HAGMA) and hyperchloremic metabolic acidosis—and thereby delimits the potential etiologies of the disorder. When the [AG] is compared with

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread around the world. As of the end of June 2021, there were approximately 181 million confirmed cases and more than 3.9 million deaths across the globe. The colossal impact of coronavirus disease 2019 (COVID-19) is driving the biggest vaccination campaign in human history. All 3 vaccines authorized for emergency use by the

Rationale & Objective eGFR equations that incorporate a term for race assign a higher value to Black individuals compared to non-Black individuals not attributable to sex, age, or serum creatinine. This difference may contribute to racial disparities in kidney transplant access. We sought to 1) compare time from meeting a transplant eligibility threshold of eGFR ≤20 ml/min/1.73M2 to kidney failure

In the early days of dialysis, because of a lack of existing in-center infrastructure, home hemodialysis (HHD) was frequently used to expand dialysis programs. Recently, HHD has been thrust into the spotlight of kidney care programs once again. Patients and policymakers are demanding more choices for the management of kidney failure while controlling for cost. Perhaps it is not surprising that the

Hyperoxaluria results from either inherited disorders of glyoxylate metabolism leading to hepatic oxalate overproduction (primary hyperoxaluria), or increased intestinal oxalate absorption (secondary hyperoxaluria). Hyperoxaluria may lead to urinary supersaturation of calcium oxalate and crystal formation, causing urolithiasis and deposition of calcium oxalate crystals in the kidney parenchyma, a condition

Hypertonic saline has been used for the treatment of hyponatremia for nearly a century. There is now general consensus that hypertonic saline should be used in patients with hyponatremia associated with moderate or severe symptoms to prevent neurological complications. However, much less agreement exists among experts regarding other aspects of its use. Should hypertonic saline be administered as a

Tubular basement membrane (TBM) deposits are very uncommon in non-lupus membranous nephropathy. We report a series of 5 patients with membranous nephropathy and extensive TBM deposits following allogeneic hematopoietic cell transplant. Patients presented with nephrotic syndrome with (n=3) acute kidney injury, late post-transplant in association with chronic graft-vs-host disease (cGVHD). Kidney biopsies

There continues to be rapid advancement in the understanding of pathogenesis of immune mediated kidney disease. This progress has culminated into development of multiple therapeutic agents that have consistently improved renal and patient outcomes. The focus of this review is to discuss these recent advancements in immune mediated kidney disease via the lens of direct and indirect immune mediated mechanisms

Rationale & Objective Though studies have demonstrated a relationship between hypertensive disorders of pregnancy (HDP) and chronic kidney disease, there are limited data on the risk of acute kidney injury (AKI) following HDP. We examined the risk of AKI following the occurrence of HDP. Study Design Retrospective population-based cohort study. Setting & Participants Pregnant women of Ontario, Canada

Rationale & Objective Children with lupus nephritis (LN) are at high risk of developing end-stage kidney disease (ESKD) requiring dialysis initiation. This study aimed to compare outcomes among children on dialysis with LN to those with non-lupus glomerular disease (NLGD) and to investigate risk factors for adverse outcomes among children with LN on dialysis. Study Design Retrospective cohort study

Patient activation, the measure of patients’ readiness and willingness to manage their own health care, is low among people on in-center hemodialysis (HD), exacerbated by how passively patients receive care. In our pursuit of person-centered care and value-based medicine, enabling patients to take a more active role in their care can lead to healthy behaviors, with subsequent reductions in individual

The optimal timing of kidney support therapy (KST) in critically ill patients with acute kidney injury (AKI) without life-threatening complications related to AKI is controversial. Recent multicenter randomized controlled studies have questioned the need for earlier initiation of therapy, despite one study showing a benefit in survival and others with no differences in mortality based on the timing

Rationale and objective The risk of developing colorectal cancer in patients with chronic kidney disease (CKD) is twice that of the general population, but the factors associated with colorectal cancer are poorly understood. The aim of this study was to identify factors associated with advanced colorectal neoplasia in patients with CKD. Study Design Prospective cohort study. Setting & Participants

Post-transplant lymphoproliferative disorder is a growing complication of kidney transplantation (KT) associated with a dismal prognosis. Anti-CD19 chimeric antigen receptor (CAR) T-cell therapy is a game-changing treatment option modifying the outcome of refractory hematological cancers. Here, we report the case of a 40-year-old KT patient who developed a Burkitt-like Lymphoma with 11q aberration

Rationale and Objectiv Current guidelines for nephrology referral are based on laboratory criteria. We sought to evaluate whether nephrology referral patterns reflect current clinical practice guidelines and to estimate change in referral volume if they were based on the estimated risk of kidney failure. Study Design Observational cohort. Setting and Participants Retrospective study of 399,644 veterans