Cover Stories

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 »

Metformin Therapy in Patients with Type 2 Diabetes and Mild to Moderate CKD

Worldwide, there are an estimated 380 million people affected by type 2 diabetes mellitus; approximately 20% of those patients have an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. Due to low cost, favorable adverse event profile, and a possible beneficial effect on cardiovascular risk, metformin hydrochloride is the recommended first-line medication for treatment of type 2 diabetes. Because of ... Read More »

Blood Pressure Changes in Young Adulthood Associated with Subsequent Decline in Kidney Function

Studies of hypertension and related complications are conducted most often in populations >40 years of age; studies of outcomes associated with elevated blood pressure in young adulthood have been focused on associations between elevated blood pressure and cardiovascular risks. There are few available data on whether there is an association between exposure to elevated blood pressure early in life and ... Read More »

Risk of Mortality Higher in Patients with Kidney Disease and Pulmonary Hypertension

Patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) commonly experience pulmonary hypertension. Depending on the methods used to diagnose pulmonary hypertension and evaluate the stages of CKD, the prevalence ranges from 10% to 70%. One factor in the presence of pulmonary hypertension in patients with kidney disease is the pathophysiologic sequelae of CKD, including volume overload, congestive ... Read More »

Medicare Paid $2.3 Billion in 2013 for Vascular-Access Related Services

Reliable access to the bloodstream is essential to successful treatment of end-stage renal disease (ESRD) with maintenance hemodialysis. Patients typically receive hemodialysis three times a week; the vascular access is the patient’s lifeline. There are three types of hemodialysis vascular access: (1) arteriovenous fistula (AVF); (2) arteriovenous graft (AVG); and (3) central venous catheter (CVC). Numerous studies have found reduced ... Read More »

Outcomes and Care Associated with Residential Area Life Expectancy in Patients with ESRD

The general population of the United States faces significant geographic variation in health status due to complex factors that include regional differences in health indicators such as morbidity, mortality, and physical and mental disability. There is also regional variation in social determinants of health that include environmental and behavioral risk factors, access to healthcare and a healthy diet, education level, ... Read More »

Pre-ESRD Nephrology Care in Medicare versus VA Healthcare Systems

There are few available data on the benefits of maintenance dialysis for older adults with kidney failure or end-stage renal disease (ESRD) in the setting of another serious illness or multimorbidity. In that patient population, survival with dialysis may be limited, functional outcomes are often poor, and patients commonly discontinue dialysis. Guidelines are designed to encourage sharing decision-making that considers ... Read More »