On The Cover

Sodium Zirconium Cyclosilicate for Management of Predialysis Hyperkalemia

Renal potassium excretion is severely reduced in patients with end-stage renal disease (ESRD), requiring hemodialysis or peritoneal dialysis to maintain normal serum potassium levels. However, despite receiving dialysis, many patients experience persistent predialysis hyperkalemia, a condition that is potentially life-threatening and associated with cardiac arrhythmias and death. There is an association between a serum potassium concentration of ≥5.6 mmol/L and ... Read More »

Postdialysis Hypokalemia and All-cause Mortality in Patients on Hemodialysis

Among patients on hemodialysis, the mortality rate is 13.6 per 100 person-years, higher than in the general population. Sudden cardiac death is the leading cause of death in patients on hemodialysis, caused primarily by hyperkalemia, making serum potassium of particular interest in the management of dialysis patients. Serum potassium levels during dialysis are determined on the basis of the predialysis ... Read More »

Cause of CKD among Agricultural Workers in Central America Unknown

During the past two or three decades, a large number of young workers in the sugarcane fields in Central America have been diagnosed with end-stage renal disease (ESRD). During the same time period (2002), researchers in El Salvador also reported an upsurge in chronic kidney disease (CKD). A key finding of the report was that the patients with CKD and/or ... Read More »

Young Adults with ESRD at Increased Risk for Cardiovascular Disease and Mortality

In patients with end-stage renal disease (ESRD), including children and adults, cardiovascular disease (CVD) is a leading cause of morbidity and mortality. In individuals ≥45 years of age, 87% have developed CVD at the time of ESRD onset and approximately 50% of deaths are attributed to CVD. In children with ESRD in the United States, CVD-related mortality occurs in 23%; ... 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 »

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 »

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 »