Cover Stories

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 »

AHA Life’s Simple 7 Goals Predict Risk of Incident CKD

The American Heart Association (AHA) has set goals for the year 2020 that include a 20% improvement in cardiovascular health and a 20% reduction in deaths due to cardiovascular disease and stroke in the United States. Recommendations made by the AHA to achieve these goals are seven health factors for the prevention of cardiovascular disease. The factors—Life’s Simple 7—are related ... Read More »

Telehealth for Patients with CKD Feasible but Outcomes Not Improved

In the area of management of chronic diseases, telehealth and interprofessional case management are recent strategies of care. Chronic disease care aims for the reduction of adverse health outcomes, the provision of timely and convenient care for patients regardless of location, and high value designed to reduce overall health system costs. Telehealth has been used with and without the addition ... Read More »

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 »