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Depressive Symptoms and Rapid Kidney Function Decline
Mary H. Wu
doi : 10.2215/CJN.04050321
CJASN June 2021, 16 (6) 839
Sincere Integration of Patients’ Perspectives into Kidney Care: Affirming and Adopting Patient Activation
Devika Nair and Kerri L. Cavanaugh
doi : 10.2215/CJN.05050421
CJASN June 2021, 16 (6) 840-842
Mineralocorticoid Receptor Antagonists and Cardiovascular Health with Kidney Failure
Qandeel H. Soomro and David M. Charytan
doi : 10.2215/CJN.04460421
CJASN June 2021, 16 (6) 843-845
Dialysis and Transplant Access: Kidney Capitalism at a Crossroads?
Divya Raghavan and Isaac E. Hall
doi : 10.2215/CJN.04680421
CJASN June 2021, 16 (6) 846-847
Dialyzing Acute Kidney Injury Patients after Hospital Discharge
Ian McCoy and Chi-yuan Hsu
doi : 10.2215/CJN.04590421
CJASN June 2021, 16 (6) 848-849
To Add Weight to Overweight
Maatje D.A. van Gastel and Esther Meijer
doi : 10.2215/CJN.04150321
CJASN June 2021, 16 (6) 850-852
Acute Kidney Injury Requiring Dialysis and Incident Dialysis Patient Outcomes in US Outpatient Dialysis Facilities
Claudia Dahlerus, Jonathan H. Segal, Kevin He, Wenbo Wu, Shu Chen, Tempie H. Shearon, Yating Sun, Aaron Pearson, Xiang Li and Joseph M. Messana
doi : 10.2215/CJN.18311120
CJASN June 2021, 16 (6) 853-861
About 30% of patients with AKI may require ongoing dialysis in the outpatient setting after hospital discharge. A 2017 Centers for Medicare & Medicaid Services policy change allows Medicare beneficiaries with AKI requiring dialysis to receive outpatient treatment in dialysis facilities. Outcomes for these patients have not been reported. We compare patient characteristics and mortality among patients with AKI requiring dialysis and patients without AKI requiring incident dialysis.
Severe Acute Kidney Injury and Mortality in Extremely Low Gestational Age Neonates
Sangeeta Hingorani, Robert H. Schmicker, Patrick D. Brophy, Patrick J. Heagerty, Sandra E. Juul, Stuart L. Goldstein and David Askenazi; on behalf of PENUT Investigators
doi : 10.2215/CJN.18841220
CJASN June 2021, 16 (6) 862-869
AKI is associated with poor short- and long-term outcomes. Questions remain about the frequency and timing of AKI, and whether AKI is a cause of death in extremely low gestational age neonates.
Smoking Cessation and Coronary Artery Calcification in CKD
Mi Jung Lee, Jung Tak Park, Tae Ik Chang, Young Su Joo, Tae-Hyun Yoo, Sue Kyung Park, Wookyung Chung, Yong-Soo Kim, Soo Wan Kim, Kook-Hwan Oh, Shin-Wook Kang, Kyu Hun Choi, Curie Ahn and Seung Hyeok Han
doi : 10.2215/CJN.15751020
CJASN June 2021, 16 (6) 870-879
Smoking is associated with vascular calcification and a higher risk of cardiovascular disease. In this study, we investigated the association of smoking dose and cessation with coronary artery calcification (CAC) in patients with CKD.
Reliability and Validity of the Patient Activation Measure in Kidney Disease: Results of Rasch Analysis
Courtney J. Lightfoot, Thomas J. Wilkinson, Katherine E. Memory, Jared Palmer and Alice C. Smith
doi : 10.2215/CJN.19611220
CJASN June 2021, 16 (6) 880-888
Despite the increasing prioritization of the promotion of patient activation in nephrology, its applicability to people with CKD is not well established. Before the Patient Activation Measure is universally adopted for use in CKD, it is important to critically evaluate this measure. The aim of this study was to describe the psychometric properties of the Patient Activation Measure in CKD.
Association of Depressive Symptoms with Rapid Kidney Function Decline in Adults with Normal Kidney Function
Zhuxian Zhang, Panpan He, Mengyi Liu, Chun Zhou, Chengzhang Liu, Huan Li, Yuanyuan Zhang, Qinqin Li, Ziliang Ye, Qimeng Wu, Guobao Wang, Min Liang and Xianhui Qin
doi : 10.2215/CJN.18441120
CJASN June 2021, 16 (6) 889-897
The relationship of depressive symptoms with kidney function remains poorly investigated. We aimed to evaluate the prospective association between depressive symptoms and rapid decline in kidney function in Chinese adults with normal kidney function.
Comparative Risks of Nonsteroidal Anti-Inflammatory Drugs on CKD
Eric Yuk Fai Wan, Esther Yee Tak Yu, Linda Chan, Anna Hoi Ying Mok, Yuan Wang, Esther Wai Yin Chan, Ian Chi Kei Wong and Cindy Lo Kuen Lam
doi : 10.2215/CJN.18501120
CJASN June 2021, 16 (6) 898-907
There have been doubts about the association between nonsteroidal anti-inflammatory drug use and worsening kidney function, and whether there is a difference between risks of individual nonsteroidal anti-inflammatory drugs is presently unclear. Therefore, this study aimed to evaluate the association between nonsteroidal anti-inflammatory drug exposure and the risk of incident eGFR <60 ml/min per 1.73 m2 and compare the risks between nonsteroidal anti-inflammatory drug subtypes in the Chinese population.
Overweight and Obesity and Progression of ADPKD
Kristen L. Nowak, Cortney Steele, Berenice Gitomer, Wenchyi Wang, John Ouyang and Michel B. Chonchol
doi : 10.2215/CJN.16871020
CJASN June 2021, 16 (6) 908-915
On the basis of earlier observations, we evaluated the association between overweight and obesity and rapid progression of autosomal dominant polycystic kidney disease in participants in the Tolvaptan Efficacy and Safety in Management of Autosomal Dominant Polycystic Kidney Disease and Its Outcomes (TEMPO) 3:4 trial. More importantly, we also determined whether efficacy of tolvaptan was attenuated in individuals with baseline overweight or obesity.
Efficacy and Safety of Mineralocorticoid Receptor Antagonists in Kidney Failure Patients Treated with Dialysis: A Systematic Review and Meta-Analysis
Kuan-Ting Chen, Yi-No Kang, Yen-Chung Lin, I-Lin Tsai, Wei-Chiao Chang, Te-Chao Fang, Mai-Szu Wu and Chih-Chin Kao
doi : 10.2215/CJN.15841020
CJASN June 2021, 16 (6) 916-925
Patients with kidney failure have a high risk of cardiovascular disease due to cardiac remodeling, left ventricular fibrosis, and hyperaldosteronism, all of which can be potentially mitigated by mineralocorticoid receptor antagonists. However, because of the fear of hyperkalemia, the use of mineralocorticoid receptor antagonists in patients with kidney failure is limited in current clinical practice, and few studies have investigated the efficacy and safety. Thus, we aimed to determine the benefits and side effects of mineralocorticoid receptor antagonists in patients with kidney failure treated with dialysis.
Dialysis Facility Profit Status and Early Steps in Kidney Transplantation in the Southeastern United States
Laura J. McPherson, Elizabeth R. Walker, Yi-Ting Hana Lee, Jennifer C. Gander, Zhensheng Wang, Amber M. Reeves-Daniel, Teri Browne, Matthew J. Ellis, Ana P. Rossi, Stephen O. Pastan, Rachel E. Patzer and on behalf of the Southeastern Kidney Transplant Coalition
doi : 10.2215/CJN.17691120
CJASN June 2021, 16 (6) 926-936
Dialysis facilities in the United States play a key role in access to kidney transplantation. Previous studies reported that patients treated at for-profit facilities are less likely to be waitlisted and receive a transplant, but their effect on early steps in the transplant process is unknown. The study’s objective was to determine the association between dialysis facility profit status and critical steps in the transplantation process in Georgia, North Carolina, and South Carolina.
Vaccines and Disease Relapses in Children with Nephrotic Syndrome
Andrea Angeletti, Maurizio Bruschi, Silvia Bianchin, Irene Bonato, Carolina Montobbio, Enrico Verrina, Francesca Lugani, Paolo Cravedi and Gian Marco Ghiggeri
doi : 10.2215/CJN.01890221
CJASN June 2021, 16 (6) 937-938
Limited Significance of Antifactor H Antibodies in Patients with Membranous Nephropathy
Amit Sethi, Jing Miao, Maria Alice V. Willrich, Jody L. Frinack, Daniel C. Cattran and Fernando C. Fervenza; for the MENTOR study Investigators
doi : 10.2215/CJN.16631020
CJASN June 2021, 16 (6) 939-941
Inherited Kidney Complement Diseases
Mathieu Lemaire, Damien Noone, Anne-Laure Lapeyraque, Christoph Licht and Véronique Frémeaux-Bacchi
doi : 10.2215/CJN.11830720
CJASN June 2021, 16 (6) 942-956
In the past 20 years, we have witnessed tremendous advances in our ability to diagnose and treat genetic diseases of the kidney caused by complement dysregulation. Staggering progress was realized toward a better understanding of the genetic underpinnings and pathophysiology of many forms of atypical hemolytic uremic syndrome (aHUS) and C3-dominant glomerulopathies that are driven by complement system abnormalities. Many of these seminal discoveries paved the way for the design and characterization of several innovative therapies, some of which have already radically improved patients’ outcomes. This review offers a broad overview of the exciting developments that have occurred in the recent past, with a particular focus on single-gene (or Mendelian), complement-driven aHUS and C3-dominant glomerulopathies that should be of interest to both nephrologists and kidney researchers. The discussion is restricted to genes with robust associations with both aHUS and C3-dominant glomerulopathies (complement factor H, complement component 3, complement factor H–related proteins) or only aHUS (complement factor B, complement factor I, and membrane cofactor protein). Key questions and challenges are highlighted, along with potential avenues for future directions.
Post-Transplant CMV Glomerulitis
Fahad Aziz and Arjang Djamali
doi : 10.2215/CJN.19061220
CJASN June 2021, 16 (6) 957-959
The Influence of Medical School Debt on Career Choices in Nephrology
Charles Ginsberg
doi : 10.2215/CJN.14260920
CJASN June 2021, 16 (6) 960-962
eGFR Testing around the World: Justice, Access, and Accuracy
Vivekanand Jha and Gopesh K. Modi
doi : 10.2215/CJN.16001020
CJASN June 2021, 16 (6) 963-965
Contextualizing the FHN Nocturnal Trial a Decade Later: How Nocturnal Home Hemodialysis Is Performed Matters to Outcomes
Robert P. Pauly and Brent W. Miller
doi : 10.2215/CJN.09160620
CJASN June 2021, 16 (6) 966-968
BLISS in the Treatment of Lupus Nephritis
Joshua M. Thurman
doi : 10.2215/CJN.17991120
CJASN June 2021, 16 (6) 969-971
NephroTalk Multimodal Conservative Care Curriculum for Nephrology Fellows
Robert A. Cohen, Alexandra Bursic, Emily Chan, Marie K. Norman, Robert M. Arnold and Jane O. Schell
doi : 10.2215/CJN.11770720
CJASN June 2021, 16 (6) 972-979
Conservative care, a comprehensive treatment path for advanced kidney disease most suitable for individuals unlikely to benefit from dialysis, is underutilized in the United States. One reason is an absence of robust education about this approach and how to discuss it with potential candidates. To address this need, we developed a multimodal conservative care curriculum for nephrology fellows. This curriculum consists of four online modules that address essential concepts and communication skills related to conservative care. It is followed by an in-person, interactive, “flipped classroom” session facilitated by designated nephrology educators at participating Accreditation Council for Graduate Medical Education nephrology training programs. Curriculum effect was assessed using surveys completed by participating fellows immediately before and following the curriculum and for participating nephrology educators following flipped classroom teaching; 148 nephrology trainees from 19 programs participated, with 108 completing both pre- and postcurriculum surveys. Mean self-reported preparedness (measured on a five-point Likert scale) increased significantly for all ten concepts taught in the curriculum. The mean correct score on eight knowledge questions increased from 69% to 82% following the curriculum (P<0.001). Fellows rated the curriculum highly and reported that they plan to practice skills learned. For the 19 nephrology program educators, the mean perceived preparedness to teach all curriculum domains increased after, compared with before, facilitating the flipped classroom, reaching significance for seven of the ten concepts measured. Data suggest that fellows' participation in a multimodal curriculum increased knowledge and preparation for fundamental conservative care concepts and communication skills. Fellows rated the curriculum highly. Educator participation appears to have increased preparedness for teaching the curriculum concepts, making it likely that future education in conservative care will become more widespread. Herein, we describe the curriculum content, which we have made publicly available in order to encourage broader implementation, and its effect on participating fellows and the nephrology educators who facilitated it.
Why Is the GFR So High?: Implications for the Treatment of Kidney Failure
Timothy W. Meyer and Thomas H. Hostetter
doi : 10.2215/CJN.14300920
CJASN June 2021, 16 (6) 980-987
The high GFR in vertebrates obligates large energy expenditure. Homer Smith’s teleologic argument that this high GFR was needed to excrete water as vertebrates evolved in dilute seas is outdated. The GFR is proportional to the metabolic rate among vertebrate species and higher in warm-blooded mammals and birds than in cold-blooded fish, amphibians, and reptiles. The kidney clearance of some solutes is raised above the GFR by tubular secretion, and we presume secretion evolved to eliminate particularly toxic compounds. In this regard, high GFRs may provide a fluid stream into which toxic solutes can be readily secreted. Alternatively, the high GFR may be required to clear solutes that are too large or too varied to be secreted, especially bioactive small proteins and peptides. These considerations have potentially important implications for the understanding and treatment of kidney failure.
