Cover Stories

Outcomes of Acute Kidney Injury Episodes Vary over Time

One in seven hospital admissions results in acute kidney injury (AKI). Patients with increases in creatinine levels have a four-fold greater rate of hospital mortality than those with no increase in creatinine level. Further, the prognosis for patients who survive to hospital discharge is poor. According to Simon Sawhney, MBChB, and colleagues in Scotland, there are few data on how ... Read More »

Patient Perspectives on Dialysis Modality Decision Making and Choice

More than 100,000 patients initiate replacement therapy for kidney failure each year. Clinical practice guidelines and the Centers for Medicare & Medicaid Services Conditions for Coverage call for patients with kidney failure being provided with information about all options for renal replacement therapy (RRT). However, according to researchers, >90% of patients in the United States initiating RRT are started on ... Read More »

Lifetime Risk of ESRD in the United States Varies by Race/Ethnicity

There were more than 600,000 prevalent patients with end-stage renal disease (ESRD) in the United States at the end of 2012. For prevalent patients 60 to 65 years of age, those in dialysis had a life expectancy of 5.5 years and those who received a kidney transplant had a life expectancy of 15.4 years. Those life expectancies compared with 19.1 ... Read More »

Ultrafiltration Rate and Mortality in Hemodialysis Patients

Among patients on hemodialysis, fluid removal practices likely contribute to poor outcomes, including high rates of morbidity and mortality. There are data that suggest an association between more rapid fluid removal during dialysis and greater mortality. It is plausible that end-organ ischemia of the heart, brain, and gut from overt and subclinical hemodynamic instability underlie this association, according to Magdalene ... Read More »

Nonadherence to Medication Is Risk Factor for Mortality in Predialysis Patients

Patients with end-stage renal disease (ESRD) have high mortality rates, creating a need for the identification and correction of modifiable risk factors that are associated with all-cause mortality in that patient population. The few interventions that have been shown to be associated with improved outcomes in patients with ESRD include timely arteriovenous fistula creation and adequate access to specialist care ... Read More »

High-Dose Continuous Venovenous Hemodiafiltration Not Superior to Conventional Dose

Critically ill patients often experience acute kidney injury (AKI). AKI has a poor prognostic impact on morbidity and mortality among patients with AKI; the mortality rate in that patient population increases to approximately 60% to 80%. The most common cause of AKI is sepsis, particularly among patients admitted to the intensive care unit (ICU). Sepsis accounts for >50% of all ... Read More »

Serum Magnesium Level and Risk of Hospitalization in Peritoneal Dialysis Patients

The fourth most abundant cation in the body is magnesium. After potassium, magnesium is the second most plentiful intracellular cation. Nearly 70% of serum magnesium is in the free ionized form, which has a key role in maintaining internal homeostasis via actions in the endocrine, musculoskeletal, nervous, and cellular messenger systems. In adults, the reference range for total serum magnesium ... Read More »

Incremental Hemodialysis Schedule Preserves Residual Kidney Function

Regardless of a patient’s residual kidney function (RFK), maintenance hemodialysis is most often prescribed three times a week. RKF in end-stage renal disease patients is critical in dialysis adequacy, quality of life, and survival. There is an association between endogenous clearance conferred by RKF and greater survival compared with dialysis clearance per se. Further, at a certain RKF level, higher ... Read More »

Acute Kidney Injury and Risk of Chronic Kidney Disease after Heart Transplantation in Children

Children with congenital heart disease who undergo heart transplantation commonly experience acute kidney injury (AKI) following the procedure; rates of AKI as high as 61% have been reported. AKI after heart transplantation has been associated with poor long-term kidney outcomes. In the population of children, adolescents, and young adults, risk factors for AKI have been identified, including preoperative kidney function, ... Read More »

Hemodiafiltration Associated with Better Survival versus Standard Hemodialysis

In the late 2000s, data from the observational Dialysis Outcomes and Practice Patterns Study (DOPPS) and from a small randomized controlled study of hemofiltration, provided evidence of improved survival with hemodiafiltration (HDF). HDF combines diffusion and convection to improve removal of uremic toxins in the middle-molecule range. At that time, the percentage of hemodialysis patients treated with HDF was low. ... Read More »