Cover Stories

More Intensive Blood Pressure Control Associated with Lower All-Cause Mortality Risk

Chronic kidney disease affects an estimated 26 million people in the United States and 200 million individuals worldwide. The risks for cardiovascular disease, progression to end-stage renal disease (ESRD), and mortality are increased in people with CKD. Hypertension is a risk factor for cardiovascular disease and there have been several studies designed to identify the optimal blood pressure target in ... Read More »

Biliary Tract Disease a Distinct Extrarenal Complication of ADPKD

The most common inherited kidney disease is autosomal dominant polycystic kidney disease (ADPKD), which is characterized by progressive enlargement of the kidneys with multiple bilateral cysts, leading to eventual loss of kidney function and development of end-stage renal disease in middle age. ADPKD is the primary diagnosis for 10% of patients on renal replacement therapy in the United Kingdom and ... Read More »

Serum Soluble Urokinase Receptor Levels as Markers of CKD Progression Risk in Children

Children diagnosed with chronic kidney disease (CKD) face significant comorbidities and reduced life expectancy and quality of life, as well as psychosocial integration during childhood and into adulthood. The ESCAPE (Effect of Strict Blood Pressure Control and ACE Inhibition on the Progression of CRF in Pediatric Patients) trial established strict blood pressure control and antiproteinuric pharmacotherapy as the first effective ... Read More »

Hemoglobin A1c Level Control and Risk of ESRD and Mortality in Patients with CKD

Patients with both diabetes and chronic kidney disease (CKD) are at increased risk for death, compared with those with diabetes or CKD alone. Diabetic kidney disease is increasing in prevalence; diabetic nephropathy is the leading cause of end-stage renal disease (ESRD). The ideal level of glycated hemoglobin (hemoglobin A1c [HbA1c]) has not been positively established; results of some clinical trials ... Read More »

Biomarkers of Kidney Injury and Repair Measured in Marathon Runners

In 2014, a record number of individuals in the United States competed in a marathon; the increase in marathon participation to 550,600 has subsequently increased the need to more closely examine the relationship between marathon running and kidney injury. Because runners are generally seen as healthy athletes with trained physiology to tolerate high states of energy expenditure, the relationship between ... Read More »

Predialysis Systolic Blood Pressure and Risk of All-Cause Mortality Postdialysis

The incidence of end-stage renal disease (ESRD) among individuals with chronic kidney disease (CKD) is high, despite advances in the understanding of CKD progression. Patients with CKD not dependent on dialysis who transition to ESRD have the highest mortality within the first few months following the transition to dialysis therapy. Those patients also have exceptionally high healthcare costs and burden. ... Read More »

Endovascular AVF May Be Viable Option for Vascular Access in Hemodialysis Patients

The recommended method of vascular access is the surgical creation of an arteriovenous fistula (AVF), a technique developed in 1966. At present, only 14% of patients with end-stage renal disease in the United States initiate hemodialysis with an AVF; in addition, prevalent use of AVFs is low in many regions worldwide. Factors contributing to underuse of AVF include long cumulative ... Read More »

Associated Costs Lower for Endovascular AVF Creation

Arteriovenous fistula (AVF) is the preferred access type, offering longer access survival, lower risk of mortality, and reductions in rate of infection. AVF also requires fewer interventions following successful maturation and use. Recent studies have suggested that maturation and maintenance of function may require two or more additional procedures following the initial AVF creation. Additional procedures notwithstanding, a proportion of ... Read More »

Initial Dialysis Session Duration Associated with Patient Outcomes

Following expansion of Medicare coverage to patients with end-stage renal disease (ESRD) 40 years ago, the average number of hours per hemodialysis session has decreased from 6 hours in 1973 to 3.5 to 4 hours in 2010. The decline is explained in part by the improved efficiency of dialyzers; however, there are few data on the clinical consequences of shorter ... Read More »

Recovery Times in Hemodiafiltration and High-Flux Hemodialysis

Both duration and quality of life are adversely affected by the presence of end-stage renal disease (ESRD); worldwide, approximately 1.9 million people receive renal replacement therapy. Intermittent renal replacement therapy is essential for many patients with ESRD. In the developed world, extracorporeal treatments for ESRD such as hemodialysis and hemodiafiltration are more prevalent than peritoneal dialysis. While observational data have ... Read More »