Protein Loss in Peritoneal Dialysis Patients Underestimated in Current Equations

The risk of losing muscle mass is elevated in patients with chronic kidney disease (CKD) due, in part, to episodes of metabolic acidosis during disease progression, low-protein diets aiming to slow CKD progression, bone and mineral disorders, and background inflammation. Current clinical guidelines call for regular assessment of dietary protein intake; nutritional targets are designed to reduce muscle breakdown and ... Read More »

No Change in Frequency of Hypotensive Events in Patients Receiving Meals during Hemodialysis

End-stage renal disease (ESRD) poses a major public health concern in the United States; the standard treatment for ESRD is hemodialysis. Patients receiving maintenance hemodialysis have dietary needs and restrictions, including requirements for increased protein (1.2 g/kg/day) and energy (30-35 kcal/kg/day) intake and restricted intake of phosphorus, sodium, potassium, and/or fluid. The restrictions add to the difficulty of meeting the ... Read More »

Association of Periodontitis with Decreased Kidney Function Over Time

Chronic periodontitis is a local inflammatory condition that affects the tooth-supporting tissues. There is an association between periodontitis and higher levels of locally produced proinflammatory markers, contributing to low-grade systemic inflammation. It is possible that periodontitis contributes to decline in kidney function because: (1) periodontitis contributes to overall systemic inflammatory burden, possibly triggering kidney function decline; and (2) periodontal bacteria ... Read More »

Association of Plasma Metabolites and Lipids with Kidney Function in Early ADPKD

Autosomal dominant polycystic kidney disease (ADPKD), characterized by gradual enlargement of numerous cysts in the kidneys over decades, affects one in 1000 individuals. The disease process begins before loss of estimated glomerular filtration rate (eGFR) occurs. The most common genetic cause of ADPKD are mutations in polycystin 1 (PKD1, ~75%); the second most common are mutations in polycystin 2 (PKD2, ... Read More »

Age Variations in Risks of Complications Related to CVC Use in Hemodialysis

The most common treatment for patients with chronic kidney failure is hemodialysis, requiring reliable access to the bloodstream. There are three types of vascular access: arteriovenous fistulas (AVFs), arteriovenous grafts (AVGs), and central venous catheters (CVCs). AVFs are strongly recommended in international guidelines; guidelines also discourage the use of CVCs for long-term vascular access. However, the use of CVCs worldwide ... Read More »

Transition versus Nontransition to Dialysis and Glycemic Status and Mortality

Because most previous trials of glycemic control excluded patients with advanced kidney disease, the optimal glycemic target in patients with chronic kidney disease (CKD) remains unclear. Earlier studies have shown microvascular and macrovascular benefits of intensive glycemic control in patients with both type 1 and type 2 diabetes with minimal to no kidney damage. However, more recent trials have shown ... Read More »

Muscle Relaxant Use and Risk for Adverse Outcomes in Patients Receiving Hemodialysis

Muscle relaxants are used by individuals in the United States for a variety of conditions, including musculoskeletal and spastic disorders, despite lack of clear evidence of their efficacy and safety. Associations between use of muscle relaxants and central nervous system side effects such as drowsiness and sedation have been seen in the general population, as well as increased risk for ... Read More »

Cost-Effectiveness of Screening for Latent Tuberculosis Infection in Migrants with CKD

Worldwide, tuberculosis (TB) remains a leading cause of death due to infectious disease despite steady declines in TB incidence. For some countries that receive immigrants, the continuance of TB is due, in part, to reactivation of undetected latent TB infection (LTBI). Identification and effective treatment of LTBI significantly reduces TB reactivation. Mass screening is not cost-effective; however, targeted screening of ... Read More »