Cover Stories

Dialysis Modality and Rates of Incident Atrial Fibrillation in Older Adults

Atrial fibrillation (AF), the most common sustained arrhythmia in the general population, is particularly common among patients with end-stage renal disease (ESRD). The prevalence of AF is as high as 10% among patients in the United States on hemodialysis. There is a steep increase in the percentage with age, reaching as high as 25% of patients ≥85 years of age. ... Read More »

Illuminating the Decision-Making Process among Patients with Advanced CKD Opting to Forgo Dialysis

For patients with advanced chronic kidney disease (CKD), maintenance dialysis offers life-saving benefits that can include restoration of health and improved quality of life. However, the potential benefits of dialysis in extending life and managing the signs and symptoms of uremia are outweighed by the harms that may be associated with maintenance dialysis for some patients, including substantial treatment burden ... Read More »

Real-World Long-Term Effectiveness of Sucroferric Oxyhydroxide in Managing Hyperphosphatemia

Patients with advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) often experience hyperphosphatemia. Due primarily to the progressive inability of the kidneys to appropriately excrete phosphorus, disrupted phosphorus homeostasis leads to phosphorus accumulation. There have been associations between high levels of serum phosphorus and increased risk of cardiovascular morbidity and mortality. In a previous large national study, the ... Read More »

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 »