Cover Stories

Study Examines First and Second Fistula Catheter-Free Use

Worldwide, more than 2 million people with chronic kidney failure receive treatment via hemodialysis therapy. Reliable access to the bloodstream is achieved using an arteriovenous fistula, an arteriovenous graft, or a central venous catheter. The most common forms of access in Canada are fistulas and catheters; grafts are used in <5% of patients. Relative to use of a graft or ... Read More »

AKI Following Contrast-Enhanced Computed Tomography in Pediatric Patients

Contrast-induced nephropathy (CIN) is the development of acute kidney injury (AKI) following exposure to iodinated contrast material, with incidence of AKI following intravenous contrast administration estimated to range from 1% to 20%, depending on the definition of AKI and the patient cohort. Compared with patients who do not develop CIN, those that do experience a higher rate of need for ... Read More »

Scheduled versus Emergency-Only Dialysis in Undocumented Immigrants

Despite nearly universal coverage for scheduled dialysis in the United States via Medicare and Medicaid, in 40 of 50 states, undocumented immigrants receive emergency-only dialysis, defined as intermittent and provided in emergency departments (EDs) when patients present with imminently life-threatening indications including severe metabolic acidosis, hyperkalemia with impending fatal arrhythmia, uremia with altered sensorium,, or severe volume overload with hypoxia. ... Read More »

ACEI and ARB Use Reduces Risk of Mortality in Patients with AKI

Hospitalized patients may experience acute kidney injury (AKI), putting them at increased long-term risk for mortality, do novo or worsening chronic kidney disease (CKD), and end-stage renal disease (ESRD). Compared with patients who do not develop AKI while hospitalized, there is a 40% increased risk of death in the 2 years following discharge among those discharged after an episode of ... Read More »

Changes in Cognitive Function among Patients Undergoing Peritoneal Dialysis

Patients undergoing peritoneal dialysis as home-care therapy are required to self-monitor and self-manage their treatment; effective cognitive functioning is key for this patient population. However, the prevalence of cognitive impairment is high among patients with end-stage renal disease, with estimates of cognitive impairment ranging from 27% to 67%. Previous studies have shown an association between cognitive impairment and mortality and ... Read More »

Mortality Rates in Medicaid Expansion States among Patients Initiating Dialysis

The Affordable Care Act (ACA) expanded eligibility for Medicaid to include nonelderly citizens and permanent residents with incomes below 138% of the federal poverty level in participating states. As of September 2018, Medicaid expansion had been adopted in 33 states and the District of Columbia. There are data showing an association between Medicaid expansion and improved coverage, access to care, ... Read More »

Low-Level Lead Exposure Associated with Decreased Kidney Function

Although exposure to lead has decreased in recent decades, environmental exposure to lead remains a public health problem. Even at low levels of exposure, adults and children experience adverse health effects. Lead exposure occurs through ingestion of contaminated food and drinking water, and through inhalation of polluted air. Dietary contributors in Europe and the United States include cereals, leafy vegetables, ... Read More »

Physical Status Score plus Serum Albumin Level Predicts All-Cause Mortality in Hemodialysis Patients

Patients with end-stage renal disease (ESRD) commonly experience physical frailty, exhibited by reduced functional mobility and muscle weakness. Previous studies have demonstrated that at least 70% of older adults with ESRD receiving hemodialysis have physical frailty. There are strong associations between poor physical status and increased risks of adverse events and mortality in this patient population. Patients with chronic kidney ... Read More »

Effect of Primary Care CKD Registry in Public Safety-Net Healthcare Delivery

There are an estimated 20 million Americans with chronic kidney disease (CKD). Independent of age, sex, and other comorbid conditions, patients with CKD are at increased risk of a premature cardiovascular event or death compared with the general population. Patients with lower income and those in racial/ethnic minorities are more likely to have kidney failure, creating a burden on healthcare ... Read More »