Clinical Journal of the American Society of Nephrology




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A Dialysis Patient’s View on Dialysis Employment Loss

Erich Ditschman

doi : 10.2215/CJN.03450321

CJASN May 2021, 16 (5) 669-670

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A Patient Perspective on Genetic Testing for ADPKD

Dwight Odland

doi : 10.2215/CJN.14051119

CJASN May 2021, 16 (5) 671-673

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Moving beyond Sedentarism in CKD

Tae Youn Kim and Baback Roshanravan

doi : 10.2215/CJN.03460321

CJASN May 2021, 16 (5) 674-676

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Growing Understanding of the Antigenic Basis for Membranous Nephropathy

Vesna Brglez and Barbara Seitz-Polski

doi : 10.2215/CJN.03530321

CJASN May 2021, 16 (5) 677-678

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Twenty-First Century Solutions to Increase Medication Optimization and Safety in Kidney Transplant Patients

Wendy L. St. Peter and Timothy D. Aungst

doi : 10.2215/CJN.04160321

CJASN May 2021, 16 (5) 679-681

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Novel Therapeutic Options for Cardiovascular Disease with CKD

Carmine Zoccali and Francesca Mallamaci

doi : 10.2215/CJN.03270321

CJASN May 2021, 16 (5) 682-684

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Association between Postmortem Kidney Biopsy Findings and Acute Kidney Injury from Patients with SARS-CoV-2 (COVID-19)

Jes?s Rivero, Maribel Merino-L?pez, Rossana Olmedo, Rubén Garrido-Roldan, Bernardo Moguel, Gustavo Rojas, Alfonso Chavez-Morales, Pablo Alvarez-Maldonado, Pablo Duarte-Molina, Rodolfo Casta?o-Guerra, Ivon Karina Ruiz-Lopez, Elizabeth Soria-Castro, Cesar Luna, Alejandro Bonilla-Méndez, Francisco Baranda, Carlos Zabal, Magdalena Madero, Rafael Valdez-Ortiz, Ma. Virgilia Soto-Abraham and Armando Vazquez-Rangel

doi : 10.2215/CJN.16281020

CJASN May 2021, 16 (5) 685-693

Background and objectives AKI in coronavirus disease 2019 (COVID-19) is associated with higher morbidity and mortality. The objective of this study was to identify the kidney histopathologic characteristics of deceased patients with diagnosis of COVID-19 and evaluate the association between biopsy findings and clinical variables, including AKI severity.

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Cognitive Dysfunction and Gait Abnormalities in CKD

Melanie J. Koren, Helena M. Blumen, Emmeline I. Ayers, Joe Verghese and Matthew K. Abramowitz

doi : 10.2215/CJN.16091020

CJASN May 2021, 16 (5) 694-704

Background and objectives Cognitive impairment is a major cause of morbidity in CKD. We hypothesized that gait abnormalities share a common pathogenesis with cognitive dysfunction in CKD, and therefore would be associated with impaired cognitive function in older adults with CKD, and focused on a recently defined gait phenotype linked with CKD.

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Effect of Apabetalone on Cardiovascular Events in Diabetes, CKD, and Recent Acute Coronary Syndrome

Kamyar Kalantar-Zadeh, Gregory G. Schwartz, Stephen J. Nicholls, Kevin A. Buhr, Henry N. Ginsberg, Jan O. Johansson, Ewelina Kulikowski, Kenneth Lebioda, Peter P. Toth, Norman Wong, Michael Sweeney, Kausik K. Ray and on behalf of the BETonMACE Investigators

doi : 10.2215/CJN.16751020

CJASN May 2021, 16 (5) 705-716

Background and objectives CKD and type 2 diabetes mellitus interact to increase the risk of major adverse cardiovascular events (i.e., cardiovascular death, nonfatal myocardial infarction, or stroke) and congestive heart failure. A maladaptive epigenetic response may be a cardiovascular risk driver and amenable to modification with apabetalone, a selective modulator of the bromodomain and extraterminal domain transcription system. We examined this question in a prespecified analysis of BETonMACE, a phase 3 trial.

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Targeting Sedentary Behavior in CKD

Kate Lyden, Robert Boucher, Guo Wei, Na Zhou, Jesse Christensen, Glenn M. Chertow, Tom Greene and Srinivasan Beddhu

doi : 10.2215/CJN.12300720

CJASN May 2021, 16 (5) 717-726

Background and objectives We tested the feasibility of reducing sedentary behavior common in CKD.

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Neural Epidermal Growth Factor–Like 1 Protein–Positive Membranous Nephropathy in Chinese Patients

Guoqin Wang, Lijun Sun, Hongrui Dong, Yanyan Wang, Xiaoyi Xu, Zhirui Zhao, Wenrong Cheng, Xuejiao Liu, Xiaoyi Zhao, Yanqiu Geng, Siqin Bao, Yipu Chen and Hong Cheng

doi : 10.2215/CJN.11860720

CJASN May 2021, 16 (5) 727-735

Background and objectives The neural EGF-like 1 (NELL-1) protein is a novel antigen in primary membranous nephropathy. The prevalence and clinical characteristics of NELL-1–positive membranous nephropathy in Chinese individuals with primary membranous nephropathy are unclear.

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Effects of Myo-inositol Hexaphosphate (SNF472) on Bone Mineral Density in Patients Receiving Hemodialysis

David A. Bushinsky, Paolo Raggi, Jordi Bover, Markus Ketteler, Antonio Bellasi, Mariano Rodriguez, Smeeta Sinha, Rekha Garg, Joan Perell?, Alex Gold, Glenn M. Chertow and on behalf of the CaLIPSO Investigators*

doi : 10.2215/CJN.16931020

CJASN May 2021, 16 (5) 736-745

Background and objectives In the CaLIPSO study, intravenous administration of SNF472 (300 or 600 mg) during hemodialysis significantly attenuated progression of coronary artery and aortic valve calcification. SNF472 selectively inhibits formation of hydroxyapatite, the final step in cardiovascular calcification. Because bone mineral is predominantly hydroxyapatite, we assessed changes in bone mineral density in CaLIPSO.

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Estimated Loss of Lifetime Employment Duration for Patients Undergoing Maintenance Dialysis in Taiwan

Yu-Tzu Chang, Fuhmei Wang, Wen-Yen Huang, Hsuan Hsiao, Jung-Der Wang and Chang-Ching Lin

doi : 10.2215/CJN.13480820

CJASN May 2021, 16 (5) 746-756

Background and objectives An accurate estimate of the loss of lifetime employment duration resulting from kidney failure can facilitate comprehensive evaluation of societal financial burdens.

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Prasugrel and Ticagrelor in Patients with Drug-Eluting Stents and Kidney Failure

Thomas A. Mavrakanas, Omer Kamal and David M. Charytan

doi : 10.2215/CJN.12120720

CJASN May 2021, 16 (5) 757-764

Background and objectives Prasugrel and ticagrelor have superior efficacy compared with clopidogrel in moderate CKD but have not been studied in kidney failure. The study objective is to determine the effectiveness and safety of prasugrel and ticagrelor in kidney failure.

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Deceased-Donor Acute Kidney Injury and BK Polyomavirus in Kidney Transplant Recipients

Isaac E. Hall, Peter Philip Reese, Sherry G. Mansour, Sumit Mohan, Yaqi Jia, Heather R. Thiessen-Philbrook, Daniel C. Brennan, Mona D. Doshi, Thangamani Muthukumar, Enver Akalin, Meera Nair Harhay, Bernd Schr?ppel, Pooja Singh, Francis L. Weng, Jonathan S. Bromberg and Chirag R. Parikh

doi : 10.2215/CJN.18101120

CJASN May 2021, 16 (5) 765-775

Background and objectives BK polyomavirus (BKV) infection commonly complicates kidney transplantation, contributing to morbidity and allograft failure. The virus is often donor-derived and influenced by ischemia-reperfusion processes and disruption of structural allograft integrity. We hypothesized that deceased-donor AKI associates with BKV infection in recipients.

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Pharmacist-Led Mobile Health Intervention and Transplant Medication Safety

Haley M. Gonzales, James N. Fleming, Mulugeta Gebregziabher, Maria Aurora Posadas-Salas, Zemin Su, John W. McGillicuddy and David J. Taber

doi : 10.2215/CJN.15911020

CJASN May 2021, 16 (5) 776-784;

Background and objectives Medication safety events are predominant contributors to suboptimal graft outcomes in kidney transplant recipients. The goal of this study was to examine the efficacy of improving medication safety through a pharmacist-led, mobile health–based intervention.

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Outcomes of COVID-19 in CKD Patients

Haig Pakhchanian, Rahul Raiker, Amrita Mukherjee, Ahmad Khan, Shailendra Singh and Arka Chatterjee

doi : 10.2215/CJN.13820820

CJASN May 2021, 16 (5) 785-786

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Uromodulin, Salt, and 24-Hour Blood Pressure in the General Population

Belen Ponte, Menno Pruijm, Daniel Ackermann, Eric Olinger, Sonia Youhanna, Bruno Vogt, Michel Burnier, Antoinette Pechere-Bertschi, Murielle Bochud and Olivier Devuyst

doi : 10.2215/CJN.11230720

CJASN May 2021, 16 (5) 787-789

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Insights into Autosomal Dominant Polycystic Kidney Disease from Genetic Studies

Matthew B. Lanktree, Amirreza Haghighi, Ighli di Bari, Xuewen Song and York Pei

doi : 10.2215/CJN.02320220

CJASN May 2021, 16 (5) 790-799

Autosomal dominant polycystic kidney disease is the most common monogenic cause of ESKD. Genetic studies from patients and animal models have informed disease pathobiology and strongly support a “threshold model” in which cyst formation is triggered by reduced functional polycystin dosage below a critical threshold within individual tubular epithelial cells due to (1) germline and somatic PKD1 and/or PKD2 mutations, (2) mutations of genes (e.g., SEC63, SEC61B, GANAB, PRKCSH, DNAJB11, ALG8, and ALG9) in the endoplasmic reticulum protein biosynthetic pathway, or (3) somatic mosaicism. Genetic testing has the potential to provide diagnostic and prognostic information in cystic kidney disease. However, mutation screening of PKD1 is challenging due to its large size and complexity, making it both costly and labor intensive. Moreover, conventional Sanger sequencing–based genetic testing is currently limited in elucidating the causes of atypical polycystic kidney disease, such as within-family disease discordance, atypical kidney imaging patterns, and discordant disease severity between total kidney volume and rate of eGFR decline. In addition, environmental factors, genetic modifiers, and somatic mosaicism also contribute to disease variability, further limiting prognostication by mutation class in individual patients. Recent innovations in next-generation sequencing are poised to transform and extend molecular diagnostics at reasonable costs. By comprehensive screening of multiple cystic disease and modifier genes, targeted gene panel, whole-exome, or whole-genome sequencing is expected to improve both diagnostic and prognostic accuracy to advance personalized medicine in autosomal dominant polycystic kidney disease.

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Trust the Patient: An Unusual Case of Metabolic Alkalosis

Melanie Paige Hoenig and Stewart H. Lecker

doi : 10.2215/CJN.18031120

CJASN May 2021, 16 (5) 800-802

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Social Determinants of Health in People with Kidney Disease

Alan M. Weinstein and Paul L. Kimmel

doi : 10.2215/CJN.12600720

CJASN May 2021, 16 (5) 803-805

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The Pathogenesis of Race and Ethnic Disparities

Neil R. Powe

doi : 10.2215/CJN.12640820

CJASN May 2021, 16 (5) 806-808

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Social Determinants of Kidney Health

Keith C. Norris and Bettina M. Beech

doi : 10.2215/CJN.12710820

CJASN May 2021, 16 (5) 809-811

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Reducing the Burden of CKD among Latinx

Rocio I. Pereira and Lilia Cervantes

doi : 10.2215/CJN.12890820

CJASN May 2021, 16 (5) 812-814

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The Seen and the Unseen: Race and Social Inequities Affecting Kidney Care

L. Ebony Boulware and Dinushika Mohottige

doi : 10.2215/CJN.12630820

CJASN May 2021, 16 (5) 815-817

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Personal Experiences of Patients in the Interaction of Culture and Kidney Disease

Daniel Cukor, Dawn P. Edwards and on behalf of The New York Academy of Medicine’s 2020 Alison Norris Symposium

doi : 10.2215/CJN.12400720

CJASN May 2021, 16 (5) 818-819

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Intravenous Albumin for Mitigating Hypotension and Augmenting Ultrafiltration during Kidney Replacement Therapy

Nicole Hryciw, Michael Joannidis, Swapnil Hiremath, Jeannie Callum and Edward G. Clark

doi : 10.2215/CJN.09670620

CJASN May 2021, 16 (5) 820-828

Among its many functions, owing to its oversized effect on colloid oncotic pressure, intravascular albumin helps preserve the effective circulatory volume. Hypoalbuminemia is common in hospitalized patients and is found especially frequently in patients who require KRT either for AKI or as maintenance hemodialysis. In such patients, hypoalbuminemia is strongly associated with morbidity, intradialytic hypotension, and mortality. Intravenous albumin may be administered in an effort to prevent or treat hypotension or to augment fluid removal, but this practice is controversial. Theoretically, intravenous albumin administration might prevent or treat hypotension by promoting plasma refilling in response to ultrafiltration. However, clinical trials have demonstrated that albumin administration is not nearly as effective a volume expander as might be assumed according to its oncotic properties. Although intravenous albumin is generally considered to be safe, it is also very expensive. In addition, there are potential risks to using it to prevent or treat intradialytic hypotension. Some recent studies have suggested that hyperoncotic albumin solutions may precipitate or worsen AKI in patients with sepsis or shock; however, the overall evidence supporting this effect is weak. In this review, we explore the theoretical benefits and risks of using intravenous albumin to mitigate intradialytic hypotension and/or enhance ultrafiltration and summarize the current evidence relating to this practice. This includes studies relevant to its use in patients on maintenance hemodialysis and critically ill patients with AKI who require KRT in the intensive care unit. Despite evidence of its frequent use and high costs, at present, there are minimal data that support the routine use of intravenous albumin during KRT. As such, adequately powered trials to evaluate the efficacy of intravenous albumin in this setting are clearly needed.

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Mass Disasters and Burnout in Nephrology Personnel

Mehmet Sukru Sever, Alberto Ortiz, Umberto Maggiore, Enrique Bac-Garc?a and Raymond Vanholder

doi : 10.2215/CJN.08400520

CJASN May 2021, 16 (5) 829-837

Mass disasters result in extensive health problems and make health care delivery problematic, as has been the case during the COVID-19 pandemic. Although COVID-19 was initially considered a pulmonary problem, it soon became clear that various other organs were involved. Thus, many care providers, including kidney health personnel, were overwhelmed or developed burnout. This review aims to describe the spectrum of burnout in mass disasters and suggests solutions specifically for nephrology personnel by extending previous experience to the COVID-19 pandemic. Burnout (a psychologic response to work-related stress) is already a frequent part of routine nephrology practice and, not surprisingly, is even more common during mass disasters due to increased workload and specific conditions, in addition to individual factors. Avoiding burnout is essential to prevent psychologic and somatic health problems in personnel as well as malpractice, understaffing, and inadequate health care delivery, all of which increase the health care burden of disasters. Burnout may be prevented by predisaster organizational measures, which include developing an overarching plan and optimizing health care infrastructure, and ad hoc disaster-specific measures that encompass both organizational and individual measures. Organizational measures include increasing safety, decreasing workload and fear of malpractice, optimizing medical staffing and material supplies, motivating personnel, providing mental health support, and enabling flexibility in working circumstances. Individual measures include training on coping with stress and problematic conditions, minimizing the stigma of emotional distress, and maintaining physical health. If these measures fall short, asking for external help is mandatory to avoid an inefficient disaster health care response. Minimizing burnout by applying these measures will improve health care provision, thus saving as many lives as possible.

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