Author Archives: Kerri Fitzgerald

Access Longevity Not Improved with Preemptive Stenosis Correction

There was no improvement in longevity of functional arteriovenous (AV) hemodialysis access with preemptive stenosis correction. That was the primary finding of a systematic review and meta-analysis of randomized controlled trials conducted recently by Pietro Ravani, MD, PhD, and colleagues. Results were reported in the American Journal of Kidney Diseases [2016;67(3):446-460]. A native AV fistula is the optimal type of ... Read More »

Changes in Body Composition Seen Following Dialysis Initiation

Patients with end-stage renal disease (ESRD) transitioning to hemodialysis presented with distinctive changes in body composition in a recent study. Daniele Marcelli, MD, MBA, and colleagues conducted the observational study to assess changes in body composition in the initial phase of renal replacement therapy (RRT). They reported study results in the Journal of Renal Nutrition [2016;26(2):72-80]. Dialysis patients experience protein-energy ... Read More »

From the Field: Misinterpreting Dialysis Frequency Rules

Rick Collins Home dialysis programs are taking a big financial hit as several commercial payers are refusing to pay for more than 13 peritoneal dialysis (PD) treatments per month. The payers appear to have misinterpreted a portion of the Medicare Benefit policy manual regarding frequency of dialysis. The information in this article will help home dialysis programs fight this misinterpretation ... Read More »

From the Editor: Should Renal Replacement Therapy Begin Early in ICU Patients with AKI? A Tale of Two Studies

Ajay K. Singh, MD The timing of initiating renal replacement therapy (RRT) among patients with acute kidney injury (AKI) in the intensive care unit (ICU), i.e., among critically ill patients, is controversial. Intuitively, it seems reasonable to think that there should be no downside to initiating therapy early in complex relatively unstable patients, especially since renal-related complications, such as severe ... Read More »

Reporting Quality of Life Outcomes Infrequent in Immunosuppression Trials

Quality-of-life (QoL) outcomes are important in informing patient-centered care, and should be reported in clinical trials in cases where treatments have adverse outcomes that may affect patient experience and well-being. For patients undergoing kidney transplantation, lifelong immunosuppression to maintain optimal transplant function. Immunosuppression drugs have a range of side-effect profiles, affect QOL, and increase the patient’s risk for serious adverse ... Read More »

Vascular Calcification in Kidney Transplant Patients

San Diego—Researchers in Italy recently conducted a study designed to assess (1) the prevalence of bone mineral anomalies, (2) the factors related to femoral bone mineral density, and (3) the relationship of femoral bone mineral density with aortic calcifications and coronary calcifications in a cohort of kidney transplantation patients who underwent femoral DEXA (dual-energy x-ray absorptiometry). To avoid confounders between ... Read More »

Once-Daily Extended Release Tacrolimus Noninferior to Twice-Daily Formation

The most commonly used immunosuppressant in kidney transplantation patients is tacrolimus; it is used both early post-transplantation and as part of long-term maintenance regimens. However, according to researchers, tacrolimus has some limitations, including a narrow therapeutic window that requires drug monitoring and individual dose titration, inter-individual variation in absorption, and low bioavailablity of the immediate-release tacrolimus (IR-Tac) twice-daily capsule formation. ... Read More »

Hospital-Acquired AKI Substantial Risk Factor for Subsequent CKD

Rates of hospital mortality related to the development of acute kidney injury (AKI) are nearly 25% overall and >50% in severe cases. For patients who survive AKI, severe cases requiring dialysis may result in nonrecovery (end-stage renal disease [ESRD]) or incomplete recovery of kidney function (non–dialysis-dependent chronic kidney disease [CKD]). Of late, clinicians are recognizing that even patients with AKI ... Read More »

Timing of RRT Initiation in Patients with Acute Kidney Injury

There are few data on the best timing for renal replacement therapy (RRT) initiation in patients with severe acute kidney injury (AKI) without life-threatening indications. AKI-related mortality rates are high; the need for RRT in this patient population is clear, but the optimal timing remains unclear. Benefits may be provided with earlier RRT initiation, including avoiding hypervolemia, eliminating toxins, establishing ... Read More »

Early versus Delayed Initiation of Renal Replacement Therapy in ICU Patients with AKI

Patients in the intensive care unit (ICU) often experience acute kidney injury (AKI); there is an association between the occurrence of AKI in the ICU and increased morbidity and mortality. Severe AKI is managed with initiation of renal replacement therapy (RRT), but it is unclear when RRT should be initiated in the absence of a life-threatening complication directly related to ... Read More »