Cover Stories

Decreased eGFR Predicts Poor Outcomes in Patients with Acute Intracerebral Hemorrhage

Due to shared risk factors and pathophysiologic mechanisms that affect the brain and the kidney, patients with cerebrovascular disease often have chronic kidney disease (CKD), defined as reduced estimated glomerular filtration rate (eGFR) or increased urinary albumin excretion. Increasing evidence suggests an association between reduced kidney function and adverse outcomes in patients with acute stroke; however, most of the available ... Read More »

Hospital-Acquired AKI Substantial Risk Factor for Subsequent CKD

Rates of hospital mortality related to the development of acute kidney injury (AKI) are nearly 25% overall and >50% in severe cases. For patients who survive AKI, severe cases requiring dialysis may result in nonrecovery (end-stage renal disease [ESRD]) or incomplete recovery of kidney function (non–dialysis-dependent chronic kidney disease [CKD]). Of late, clinicians are recognizing that even patients with AKI ... Read More »

Timing of RRT Initiation in Patients with Acute Kidney Injury

There are few data on the best timing for renal replacement therapy (RRT) initiation in patients with severe acute kidney injury (AKI) without life-threatening indications. AKI-related mortality rates are high; the need for RRT in this patient population is clear, but the optimal timing remains unclear. Benefits may be provided with earlier RRT initiation, including avoiding hypervolemia, eliminating toxins, establishing ... Read More »

Early versus Delayed Initiation of Renal Replacement Therapy in ICU Patients with AKI

Patients in the intensive care unit (ICU) often experience acute kidney injury (AKI); there is an association between the occurrence of AKI in the ICU and increased morbidity and mortality. Severe AKI is managed with initiation of renal replacement therapy (RRT), but it is unclear when RRT should be initiated in the absence of a life-threatening complication directly related to ... Read More »

Patient-Physician Dynamics Influence Timing of Dialysis Initiation

“We found that decisions about timing of dialysis initiation seemed to be shaped by a complex interplay between physicians’ practice styles, acute clinical events that gave urgency to starting dialysis, and the quality of the interactions between patients and their physicians. These care processes often seemed provider-driven, and were often not aligned with the priorities, concerns, and preferences of patients ... Read More »

SHARP Data Analyzed for Cost-Effectiveness of Simvastatin plus Ezetimibe

Results of SHARP (Study of Heart and Renal Protection) demonstrated that in patients with moderate to severe chronic kidney disease (CKD), lowering low-density lipoprotein (LDL) cholesterol by 0.85 mmol/L with a combination of simvastatin, 20 mg, plus ezetimibe, 10 mg, daily reduced the risk of major atherosclerotic events. There were no adverse events associated with the intervention. The Kidney Disease: ... Read More »

Diabetes Associated with Risk for Discontinuation of Home Hemodialysis

There is an association between home hemodialysis (HHD) and improved clinical and quality-of-life outcomes compared with in-center hemodialysis, yet HHD remains an underused modality in the United States. There are approximately 450,000 individuals with end-stage renal disease (ESRD) in the United States receiving maintenance dialysis; of those, 90% receive dialysis three times a week at dialysis centers. As life-saving as ... Read More »

Incidence of Acute Kidney Injury in Noncritical Pediatric Hospital Inpatients

Among critically ill pediatric hospital inpatients, studies have demonstrated a high rate of acute kidney injury (AKI), which is associated with increased mortality, increased length of stay, permanent loss of kidney function, and increased risk for chronic kidney disease (CKD). However, there are few data available on the incidence of AKI among hospitalized children, adolescents, and young adults not requiring ... Read More »

Differences Found between Prescribed and Delivered Dialysate Sodium Concentrations

In a project conducted recently by Ambreen Gul, MD, and colleagues, there were significant differences between concentrations of prescribed and measured dialysate sodium. That was among the findings of the cross-sectional quality improvement project reported in the American Journal of Kidney Diseases [2016;67 (3):439-445]. To achieve a zero sodium predialysis gradient between dialysate and serum, some investigators suggest the use ... Read More »

Vitamin C Intake Not Associated with Risk of Kidney Stones in Women

According to researchers, previous studies of the association between vitamin C and kidney stones were limited because they were conducted mostly in men. In addition, the studies either demonstrated disparate results for supplemental and dietary vitamin C, or did not examine dietary vitamin C at all. In a study reported in the American Journal of Kidney Diseases [2016;67(3):400-407], Pietro Manuel ... Read More »