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Kidney Disease Burden and Kidney Transplantation: A True Story
David Rodriguez
doi : 10.2215/CJN.06620521
CJASN July 2021, 16 (7) 989-990
The Patient Voice in Health Care Decision Making
Tami Sadusky and Clint Hurst
doi : 10.2215/CJN.18191120
CJASN July 2021, 16 (7) 991-992
Over Four Decades of Life with Dialysis: A Tale of Self-Empowerment
Franklin G. Strauss and Judy Weintraub
doi : 10.2215/CJN.03210321
CJASN July 2021, 16 (7) 993-995
mRNA COVID-19 Vaccine for People with Kidney Failure: Hope but Prudence Warranted
Dana C. Miskulin and Christian Combe
doi : 10.2215/CJN.04500421
CJASN July 2021, 16 (7) 996-998
Planning Patient Care after Acute Kidney Injury: Not as Easy as It May Seem
Nicholas M. Selby and Rebecca A. Noble
doi : 10.2215/CJN.06380521
CJASN July 2021, 16 (7) 999-1001
Shining More Light on RAS Inhibition during the COVID-19 Pandemic
Fitra Rianto and Matthew A. Sparks
doi : 10.2215/CJN.06000521
CJASN July 2021, 16 (7) 1002-1004
Nephrologist Follow-Up versus Usual Care after an Acute Kidney Injury Hospitalization (FUSION): A Randomized Controlled Trial
Samuel A. Silver, Neill K. Adhikari, Chaim M. Bell, Christopher T. Chan, Ziv Harel, Abhijat Kitchlu, Alejandro Meraz-Mu?oz, Patrick A. Norman, Adic Perez, Alireza Zahirieh and Ron Wald
doi : 10.2215/CJN.17331120
CJASN July 2021, 16 (7) 1005-1014
Survivors of AKI are at higher risk of CKD and death, but few patients see a nephrologist after hospital discharge. Our objectives during this 2-year vanguard phase trial were to determine the feasibility of randomizing survivors of AKI to early follow-up with a nephrologist or usual care, and to collect data on care processes and outcomes.
Prediction of Incident Atrial Fibrillation in Chronic Kidney Disease: The Chronic Renal Insufficiency Cohort Study
Leila R. Zelnick, Michael G. Shlipak, Elsayed Z. Soliman, Amanda Anderson, Robert Christenson, James Lash, Rajat Deo, Panduranga Rao, Farsad Afshinnia, Jing Chen, Jiang He, Stephen Seliger, Raymond Townsend, Debbie L. Cohen, Alan Go and Nisha Bansal
doi : 10.2215/CJN.01060121
CJASN July 2021, 16 (7) 1015-1024
Atrial fibrillation (AF) is common in CKD and associated with poor kidney and cardiovascular outcomes. Prediction models developed using novel methods may be useful to identify patients with CKD at highest risk of incident AF. We compared a previously published prediction model with models developed using machine learning methods in a CKD population.
Phase 1/2 Study of Lumasiran for Treatment of Primary Hyperoxaluria Type 1
Yaacov Frishberg, Georges Deschênes, Jaap W. Groothoff, Sally-Anne Hulton, Daniella Magen, Jérôme Harambat, William G. van’t Hoff, Ulrike Lorch, Dawn S. Milliner, John C. Lieske, Patrick Haslett, Pushkal P. Garg, Akshay K. Vaishnaw, Sandeep Talamudupula, Jiandong Lu, Bahru A. Habtemariam, David V. Erbe, Tracy L. McGregor, Pierre Cochat and on behalf of the study collaborators
doi : 10.2215/CJN.14730920
CJASN July 2021, 16 (7) 1025-1036
In the rare disease primary hyperoxaluria type 1, overproduction of oxalate by the liver causes kidney stones, nephrocalcinosis, kidney failure, and systemic oxalosis. Lumasiran, an RNA interference therapeutic, suppresses glycolate oxidase, reducing hepatic oxalate production. The objective of this first-in-human, randomized, placebo-controlled trial was to evaluate the safety, pharmacokinetic, and pharmacodynamic profiles of lumasiran in healthy participants and patients with primary hyperoxaluria type 1.
Humoral Response to the Pfizer BNT162b2 Vaccine in Patients Undergoing Maintenance Hemodialysis
Ayelet Grupper, Nechama Sharon, Talya Finn, Regev Cohen, Meital Israel, Amir Agbaria, Yoav Rechavi, Idit F. Schwartz, Doron Schwartz, Yonatan Lellouch and Moshe Shashar
doi : 10.2215/CJN.03500321
CJASN July 2021, 16 (7) 1037-1042
Coronavirus disease 2019 (COVID-19) is associated with higher morbidity and mortality in patients on maintenance hemodialysis. Patients on dialysis tend to have a reduced immune response to infection or vaccination. We aimed to assess, for the first time to the best of our knowledge, the humoral response following vaccination with the BNT162b2 vaccine in patients on maintenance hemodialysis and the factors associated with it.
Prognostic Factors and Long-Term Outcome with ANCA-Associated Kidney Vasculitis in Childhood
Marta Calatroni, Filippo Consonni, Marco Allinovi, Alessandra Bettiol, Natasha Jawa, Susanna Fiasella, Dritan Curi, Sarah Abu Rumeileh, Leonardo Tomei, Laura Fortunato, Elena Gelain, Davide Gianfreda, Elena Oliva, Guido Jeannin, Chiara Salviani, Giacomo Emmi, Monica Bodria, Renato A. Sinico, Gabriella Moroni, Giuseppe A. Ramirez, Enrica Bozzolo, Enrico Tombetti, Sara Monti, Claudia Bracaglia, Giulia Marucci, Serena Pastore, Pasquale Esposito, Maria G. Catanoso, Barbara Crapella, Giovanni Montini, Rosa Roperto, Marco Materassi, Giovanni M. Rossi, Salvatore Badalamenti, Rae S.M. Yeung, Paola Romagnani, Gian M. Ghiggeri, Damien Noone and Augusto Vaglio
doi : 10.2215/CJN.19181220
CJASN July 2021, 16 (7) 1043-1051
ANCA-associated vasculitis is extremely rare in children. We report the clinicopathologic features, long-term outcomes, and prognostic factors of a large pediatric cohort of patients with ANCA-associated kidney vasculitis.
Patient-Reported Experiences with Dialysis Care and Provider Visit Frequency
Brian M. Brady, Bo Zhao, Bich N. Dang, Wolfgang C. Winkelmayer, Glenn M. Chertow and Kevin F. Erickson
doi : 10.2215/CJN.16621020
CJASN July 2021, 16 (7) 1052-1060
New payment models resulting from the Advancing American Kidney Health initiative may create incentives for nephrologists to focus less on face-to-face in-center hemodialysis visits. This study aimed to understand whether more frequent nephrology practitioner dialysis visits improved patient experience and could help inform future policy.
Renin-Angiotensin System Blockers and the Risk of COVID-19–Related Mortality in Patients with Kidney Failure
Maria Jose Soler, Marlies Noordzij, Daniel Abramowicz, Gabriel de Arriba, Carlo Basile, Marjolijn van Buren, Adrian Covic, Marta Crespo, Raphaël Duivenvoorden, Ziad A. Massy, Alberto Ortiz, J. Emilio Sanchez, Emily Petridou, Kate Stevens, Colin White, Priya Vart and Ron T. Gansevoort; the ERACODA Collaborators
doi : 10.2215/CJN.18961220
CJASN July 2021, 16 (7) 1061-1072
There is concern about potential deleterious effects of angiotensin-converting enzyme inhibitors (ACEis) and angiotensin II receptor blockers (ARBs) in patients with coronavirus disease 2019 (COVID-19). Patients with kidney failure, who often use ACEis/ARBs, are at higher risk of more severe COVID-19. However, there are no data available on the association of ACEi/ARB use with COVID-19 severity in this population.
Early Humoral Responses of Hemodialysis Patients after COVID-19 Vaccination with BNT162b2
Claudius Speer, Daniel G?th, Louise Benning, Mirabel Buylaert, Matthias Schaier, Julia Grenz, Christian Nusshag, Florian K?lble, Martin Kreysing, Paula Reichel, Maximilian T?llner, Asa Hidmark, Gerald Ponath, Paul Schnitzler, Martin Zeier, Caner Süsal, Christian Morath and Katrin Klein
doi : 10.2215/CJN.03700321
CJASN July 2021, 16 (7) 1073-1082
Patients receiving hemodialysis are at high risk for both severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and severe coronavirus disease 2019. A lifesaving vaccine is available, but sensitivity to vaccines is generally lower in patients on dialysis. Little is yet known about antibody responses after coronavirus disease 2019 (COVID-19) vaccination in this vulnerable group.
Kidney Disease Symptoms before and after Kidney Transplantation
Kathryn Taylor, Nadia M. Chu, Xiaomeng Chen, Zhan Shi, Eileen Rosello, Sneha Kunwar, Paul Butz, Silas P. Norman, Deidra C. Crews, Keiko I. Greenberg, Aarti Mathur, Dorry L. Segev, Tariq Shafi and Mara A. McAdams-DeMarco
doi : 10.2215/CJN.19031220
CJASN July 2021, 16 (7) 1083-1093
Patients with kidney failure report a high symptom burden, which likely increases while on dialysis due to physical and mental stressors and decreases after kidney transplantation due to restoration of kidney function.
Sodium-Glucose Cotransporter-2 Inhibitors and the Risk of Abnormal Serum Potassium Level
Y. Joseph Hwang, Beini Lyu, Alex R. Chang, Lesley A. Inker, Morgan E. Grams and Jung-Im Shin
doi : 10.2215/CJN.02130221
CJASN July 2021, 16 (7) 1094-1096
Prevalence of SARS-CoV-2-IgG Antibodies in Children with CKD or Immunosuppression
William Morello, Antonio Mastrangelo, Isabella Guzzo, Lisa Cusinato, Luigi Annicchiarico Petruzzelli, Chiara Benevenuta, Laura Martelli, Roberto Dall’Amico, Federica Alessandra Vianello, Giuseppe Puccio, Laura Massella, Elisa Benetti, Carmine Pecoraro, Licia Peruzzi and Giovanni Montini; on behalf of the COVID-19 Task Force of the Italian Society of Pediatric Nephrology
doi : 10.2215/CJN.00330121
CJASN July 2021, 16 (7) 1097-1099
Correction: Inherited Tubulopathies of the Kidney: Insights from Genetics
doi : 10.2215/CJN.05570421
CJASN July 2021, 16 (7) 1100
Genetic Basis of Type IV Collagen Disorders of the Kidney
Catherine Quinlan and Michelle N. Rheault
doi : 10.2215/CJN.19171220
CJASN July 2021, 16 (7) 1101-1109
The glomerular basement membrane is a vital component of the filtration barrier of the kidney and is primarily composed of a highly structured matrix of type IV collagen. Specific isoforms of type IV collagen, the ?3(IV), ?4(IV), and ?5(IV) isoforms, assemble into trimers that are required for normal glomerular basement membrane function. Disruption or alteration in these isoforms leads to breakdown of the glomerular basement membrane structure and function and can lead to progressive CKD known as Alport syndrome. However, there is wide variability in phenotype among patients with mutations affecting type IV collagen that depends on a complex interplay of sex, genotype, and X-chromosome inactivation. This article reviews the genetic basis of collagen disorders of the kidney as well as potential treatments for these conditions, including direct alteration of the DNA, RNA therapies, and manipulation of collagen proteins.
Dialysis-Associated Neurovascular Injury (DANI) in Acute Brain Injury
Shivani Ghoshal and Amay Parikh
doi : 10.2215/CJN.15000920
CJASN July 2021, 16 (7) 1110-1112
Nephrology—Taking the Lead
Anupam Agarwal
doi : 10.2215/CJN.20061220
CJASN July 2021, 16 (7) 1113-1116
Slowing Progression in CKD
Kathryn Larmour and Adeera Levin
doi : 10.2215/CJN.20211220
CJASN July 2021, 16 (7) 1117-1119
Racial Health Inequities and Clinical Algorithms
Richard E. Neal and Michelle Morse
doi : 10.2215/CJN.01780221
CJASN July 2021, 16 (7) 1120-1121
no abstract
Balancing the Needs of Acute and Maintenance Dialysis Patients during the COVID-19 Pandemic
Rachel C. Carson, Brian Forzley, Sarah Thomas, Nina Preto, Gaylene Hargrove, Alice Virani, John Antonsen, Melanie Brown, Michael Copland, Marie Michaud, Anurag Singh and Adeera Levin
doi : 10.2215/CJN.07460520
CJASN July 2021, 16 (7) 1122-1130
The COVID-19 pandemic continues to strain health care systems and drive shortages in medical supplies and equipment around the world. Resource allocation in times of scarcity requires transparent, ethical frameworks to optimize decision making and reduce health care worker and patient distress. The complexity of allocating dialysis resources for both patients receiving acute and maintenance dialysis has not previously been addressed. Using a rapid, collaborative, and iterative process, BC Renal, a provincial network in Canada, engaged patients, doctors, ethicists, administrators, and nurses to develop a framework for addressing system capacity, communication challenges, and allocation decisions. The guiding ethical principles that underpin this framework are (1) maximizing benefits, (2) treating people fairly, (3) prioritizing the worst-off individuals, and (4) procedural justice. Algorithms to support resource allocation and triage of patients were tested using simulations, and the final framework was reviewed and endorsed by members of the provincial nephrology community. The unique aspects of this allocation framework are the consideration of two diverse patient groups who require dialysis (acute and maintenance), and the application of two allocation criteria (urgency and prognosis) to each group in a sequential matrix. We acknowledge the context of the Canadian health care system, and a universal payer in which this framework was developed. The intention is to promote fair decision making and to maintain an equitable reallocation of limited resources for a complex problem during a pandemic.
Management of Heart Failure Patient with CKD
Debasish Banerjee, Giuseppe Rosano and Charles A. Herzog
doi : 10.2215/CJN.14180920
CJASN July 2021, 16 (7) 1131-1139
CKD is common in patients with heart failure, associated with high mortality and morbidity, which is even higher in people undergoing long-term dialysis. Despite increasing use of evidence-based drug and device therapy in patients with heart failure in the general population, patients with CKD have not benefitted. This review discusses prevalence and evidence of kidney replacement, device, and drug therapies for heart failure in CKD. Evidence for treatment with ?-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, angiotensin receptor neprilysin inhibitors, and sodium-glucose cotransporter inhibitors in mild-to-moderate CKD has emerged from general population studies in patients with heart failure with reduced ejection fraction (HFrEF). ?-Blockers have been shown to improve outcomes in patients with HFrEF in all stages of CKD, including patients on dialysis. However, studies of HFrEF selected patients with creatinine <2.5 mg/dl for ACE inhibitors, <3.0 mg/dl for angiotensin-receptor blockers, and <2.5 mg/dl for mineralocorticoid receptor antagonists, excluding patients with severe CKD. Angiotensin receptor neprilysin inhibitor therapy was successfully used in randomized trials in patients with eGFR as low as 20 ml/min per 1.73 m2. Hence, the benefits of renin-angiotensin-aldosterone axis inhibitor therapy in patients with mild-to-moderate CKD have been demonstrated, yet such therapy is not used in all suitable patients because of fear of hyperkalemia and worsening kidney function. Sodium-glucose cotransporter inhibitor therapy improved mortality and hospitalization in patients with HFrEF and CKD stages 3 and 4 (eGFR>20 ml/min per 1.73 m2). High-dose and combination diuretic therapy, often necessary, may be complicated with worsening kidney function and electrolyte imbalances, but has been used successfully in patients with CKD stages 3 and 4. Intravenous iron improved symptoms in patients with heart failure and CKD stage 3; and high-dose iron reduced heart failure hospitalizations by 44% in patients on dialysis. Cardiac resynchronization therapy reduced death and hospitalizations in patients with heart failure and CKD stage 3. Peritoneal dialysis in patients with symptomatic fluid overload improved symptoms and prevented hospital admissions. Evidence suggests that combined cardiology-nephrology clinics may help improve management of patients with HFrEF and CKD. A multidisciplinary approach may be necessary for implementation of evidence-based therapy.
