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Clinical Journal of the American Society of Nephrology: CJASN

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https://www.readbyqxmd.com/read/28057703/advance-directives-and-end-of-life-care-among-nursing-home-residents-receiving-maintenance-dialysis
#1
Manjula Kurella Tamura, Maria E Montez-Rath, Yoshio N Hall, Ronit Katz, Ann M O'Hare
BACKGROUND AND OBJECTIVES: Little is known about the relation between the content of advance directives and downstream treatment decisions among patients receiving maintenance dialysis. In this study, we determined the prevalence of advance directives specifying treatment limitations and/or surrogate decision-makers in the last year of life and their association with end-of-life care among nursing home residents. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Using national data from 2006 to 2007, we compared the content of advance directives among 30,716 nursing home residents receiving dialysis to 30,825 nursing home residents with other serious illnesses during the year before death...
January 5, 2017: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/28031417/serious-illness-conversations-in-esrd
#2
Ernest I Mandel, Rachelle E Bernacki, Susan D Block
Dialysis-dependent ESRD is a serious illness with high disease burden, morbidity, and mortality. Mortality in the first year on dialysis for individuals over age 75 years old approaches 40%, and even those with better prognoses face multiple hospitalizations and declining functional status. In the last month of life, patients on dialysis over age 65 years old experience higher rates of hospitalization, intensive care unit admission, procedures, and death in hospital than patients with cancer or heart failure, while using hospice services less...
December 28, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/28028050/new-organ-allocation-system-for-combined-liver-kidney-transplants-and-the-availability-of-kidneys-for-transplant-to-patients-with-stage-4-5-ckd
#3
William S Asch, Margaret J Bia
A new proposal has been created for establishing medical criteria for organ allocation in recipients receiving simultaneous liver-kidney transplants. In this article, we describe the new policy, elaborate on the points of greatest controversy, and offer a perspective on the policy going forward. Although we applaud the fact that simultaneous liver-kidney transplant activity will now be monitored and appreciate the creation of medical criteria for allocation in simultaneous liver-kidney transplants, we argue that some of the criteria proposed, especially those for allocating a kidney to a liver recipient with AKI, are too liberal...
December 27, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/28007773/maternal-smoking-during-pregnancy-household-smoking-after-the-child-s-birth-and-childhood-proteinuria-at-age-3-years
#4
Maki Shinzawa, Shiro Tanaka, Hironobu Tokumasu, Daisuke Takada, Tatsuo Tsukamoto, Motoko Yanagita, Koji Kawakami
BACKGROUND AND OBJECTIVES: Smoking is a well known risk factor of proteinuria in adults; however, clinical studies in children are limited. The purpose of this study is to clarify the associations of maternal smoking during pregnancy and household smoking after the child's birth with the risk of proteinuria at age 3 years old. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We performed a population-based retrospective cohort study on 44,595 children using data on prenatal health checkups, home visit neonatal health checkups, and health checkups at 4, 9, and 18 months and 3 years of age in Kobe City, Japan...
December 22, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/27979977/long-term-outcomes-and-discard-rate-of-kidneys-by-decade-of-extended-criteria-donor-age
#5
Maria Messina, Davide Diena, Sergio Dellepiane, Gabriella Guzzo, Luca Lo Sardo, Fabrizio Fop, Giuseppe P Segoloni, Antonio Amoroso, Paola Magistroni, Luigi Biancone
BACKGROUND AND OBJECTIVES: Extended criteria donors represent nowadays a main resource for kidney transplantation, and recovery criteria are becoming increasingly inclusive. However, the limits of this approach are not clear as well as the effects of extreme donor ages on long-term kidney transplantation outcomes. To address these issues, we performed a retrospective study on extended criteria donor kidney transplantation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In total, 647 consecutive extended criteria donor kidney transplantations performed over 11 years (2003-2013) were included...
December 15, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/27940460/minimal-change-disease
#6
Marina Vivarelli, Laura Massella, Barbara Ruggiero, Francesco Emma
Minimal change disease (MCD) is a major cause of idiopathic nephrotic syndrome (NS), characterized by intense proteinuria leading to edema and intravascular volume depletion. In adults, it accounts for approximately 15% of patients with idiopathic NS, reaching a much higher percentage at younger ages, up to 70%-90% in children >1 year of age. In the pediatric setting, a renal biopsy is usually not performed if presentation is typical and the patient responds to therapy with oral prednisone at conventional doses...
December 9, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/27940459/a-multicenter-cohort-study-of-histologic-findings-and-long-term-outcomes-of-kidney-disease-in-women-who-have-been-pregnant
#7
Philip Webster, Louise M Webster, H Terence Cook, Catherine Horsfield, Paul T Seed, Raquel Vaz, Clara Santos, Isabelle Lydon, Michele Homsy, Liz Lightstone, Kate Bramham
BACKGROUND AND OBJECTIVES: For many women pregnancy is the first contact with health services, thus providing an opportunity to identify renal disease. This study compares causes and long-term renal outcomes of biopsy-proven renal disease identified during pregnancy or within 1 year postpartum, with nonpregnant women. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Native renal biopsies (1997-2012), in women of childbearing age (16 to <50 years), from 21 hospitals were studied...
December 9, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/27940458/blood-calcification-propensity-cardiovascular-events-and-survival-in-patients-receiving-hemodialysis-in-the-evolve-trial
#8
Andreas Pasch, Geoffrey A Block, Matthias Bachtler, Edward R Smith, Wilhelm Jahnen-Dechent, Spyridon Arampatzis, Glenn M Chertow, Patrick Parfrey, Xiaoye Ma, Juergen Floege
BACKGROUND AND OBJECTIVES: Patients receiving hemodialysis are at risk of cardiovascular events. A novel blood test (T50 test) determines the individual calcification propensity of blood. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: T50 was determined in 2785 baseline serum samples of patients receiving hemodialysis enrolled in the Evaluation of Cinacalcet Therapy to Lower Cardiovascular Events (EVOLVE) trial and the T50 results were related to patient outcomes...
December 9, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/27932391/healthy-dietary-patterns-and-risk-of-mortality-and-esrd-in-ckd-a-meta-analysis-of-cohort-studies
#9
Jaimon T Kelly, Suetonia C Palmer, Shu Ning Wai, Marinella Ruospo, Juan-Jesus Carrero, Katrina L Campbell, Giovanni F M Strippoli
BACKGROUND AND OBJECTIVES: Patients with CKD are advised to follow dietary recommendations that restrict individual nutrients. Emerging evidence indicates overall eating patterns may better predict clinical outcomes, however, current data on dietary patterns in kidney disease are limited. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This systematic review aimed to evaluate the association between dietary patterns and mortality or ESRD among adults with CKD. Medline, Embase, and reference lists were systematically searched up to November 24, 2015 by two independent review authors...
December 8, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/27920031/what-are-we-doing-a-survey-of-united-states-nephrology-fellowship-program-directors
#10
Scott E Liebman, Catherine A Moore, Rebeca D Monk, Mahrukh S Rizvi
Interest in nephrology has been declining in recent years. Long work hours and a poor work/life balance may be partially responsible, and may also affect a fellowship's educational mission. We surveyed nephrology program directors using a web-based survey in order to define current clinical and educational practice patterns and identify areas for improvement. Our survey explored fellowship program demographics, fellows' workload, call structure, and education. Program directors were asked to estimate the average and maximum number of patients on each of their inpatient services, the number of patients seen by fellows in clinic, and to provide details regarding their overnight and weekend call...
December 5, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/27908905/mortality-hospitalization-and-quality-of-life-among-patients-with-hepatitis-c-infection-on-hemodialysis
#11
David A Goodkin, Brian Bieber, Michel Jadoul, Paul Martin, Eiichiro Kanda, Ronald L Pisoni
BACKGROUND AND OBJECTIVES: Hepatitis C virus (HCV) infection is widely prevalent among patients on hemodialysis (HD), but very rarely treated. The aim of our study is to evaluate the burdens of HCV suffered by patients on HD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The Dialysis Outcomes and Practice Patterns Study is an international, prospective, cohort study of patients on HD. We reviewed the HCV status of 76,689 adults enrolled between 1996 and 2015. We compared HCV-positive (HCV+) with HCV-negative (HCV-) patients for risk of mortality, hospitalization, decline in hemoglobin concentration <8...
December 1, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/27903598/the-ckd-classification-system-in-the-precision-medicine-era
#12
Yoshio N Hall, Jonathan Himmelfarb
No abstract text is available yet for this article.
November 30, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/27895136/recognition-and-management-of-resistant-hypertension
#13
REVIEW
Branko Braam, Sandra J Taler, Mahboob Rahman, Jennifer A Fillaus, Barbara A Greco, John P Forman, Efrain Reisin, Debbie L Cohen, Mohammad G Saklayen, S Susan Hedayati
Despite improvements in hypertension awareness and treatment, 30%-60% of hypertensive patients do not achieve BP targets and subsequently remain at risk for target organ damage. This therapeutic gap is particularly important to nephrologists, who frequently encounter treatment-resistant hypertension in patients with CKD. Data are limited on how best to treat patients with CKD and resistant hypertension, because patients with CKD have historically been excluded from hypertension treatment trials. First, we propose a consistent definition of resistant hypertension as BP levels confirmed by both in-office and out-of-office measurements that exceed appropriate targets while the patient is receiving treatment with at least three antihypertensive medications, including a diuretic, at dosages optimized to provide maximum benefit in the absence of intolerable side effects...
November 28, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/27831511/diagnosis-treatment-and-prevention-of-hemodialysis-emergencies
#14
REVIEW
Manish Saha, Michael Allon
Given the high comorbidity in patients on hemodialysis and the complexity of the dialysis treatment, it is remarkable how rarely a life-threatening complication occurs during dialysis. The low rate of dialysis emergencies can be attributed to numerous safety features in modern dialysis machines; meticulous treatment and testing of the dialysate solution to prevent exposure to trace elements, toxins, and pathogens; adherence to detailed treatment protocols; and extensive training of dialysis staff to handle medical emergencies...
November 9, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/27831510/consolidation-in-the-dialysis-industry-patient-choice-and-local-market-competition
#15
Kevin F Erickson, Yuanchao Zheng, Wolfgang C Winkelmayer, Vivian Ho, Jay Bhattacharya, Glenn M Chertow
The Medicare program insures >80% of patients with ESRD in the United States. An emphasis on reducing outpatient dialysis costs has motivated consolidation among dialysis providers, with two for-profit corporations now providing dialysis for >70% of patients. It is unknown whether industry consolidation has affected patients' ability to choose among competing dialysis providers. We identified patients receiving in-center hemodialysis at the start of 2001 and 2011 from the national ESRD registry and ascertained dialysis facility ownership...
November 9, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/27821390/update-on-lupus-nephritis
#16
Salem Almaani, Alexa Meara, Brad H Rovin
SLE is a chronic inflammatory disease that affects the kidneys in about 50% of patients. Lupus nephritis is a major risk factor for overall morbidity and mortality in SLE, and despite potent anti-inflammatory and immunosuppressive therapies still ends in CKD or ESRD for too many patients. This review highlights recent updates in our understanding of disease epidemiology, genetics, pathogenesis, and treatment in an effort to establish a framework for lupus nephritis management that is patient-specific and oriented toward maintaining long-term kidney function in patients with lupus...
November 7, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/27797895/viral-associated-gn-hepatitis-c-and-hiv
#17
Warren L Kupin
Viruses are capable of inducing a wide spectrum of glomerular disorders that can be categorized on the basis of the duration of active viremia: acute, subacute, or chronic. The variable responses of the adaptive immune system to each time period of viral infection results mechanistically in different histologic forms of glomerular injury. The unique presence of a chronic viremic carrier state with either hepatitis C (HCV) or HIV has led to the opportunity to study in detail various pathogenic mechanisms of viral-induced glomerular injury, including direct viral infection of renal tissue and the development of circulating immune complexes composed of viral antigens that deposit along the glomerular basement membrane...
October 24, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/28062678/facility-practice-variation-to-help-understand-the-effects-of-public-policy-insights-from-the-dialysis-outcomes-and-practice-patterns-study-dopps
#18
Douglas S Fuller, Bruce M Robinson
Recent Centers for Medicare & Medicaid Services policies have used dialysis facility practice variation to develop public ratings and adjust payments. In the Dialysis Facility Compare star rating system (DFC SRS), facility-relative rates of performance-based clinical measures varied nearly two-fold for mortality (standardized mortality ratio; 10th/90th percentiles: 0.71, 1.34) and hospitalization (standardized hospitalization ratio; 10th/90th percentiles: 0.64, 1.37), and nearly four-fold for transfusion (standardized transfusion ratio; 10th/90th percentiles: 0...
January 6, 2017: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/28062677/filtration-markers-as-predictors-of-esrd-and-mortality-individual-participant-data-meta-analysis
#19
Lesley A Inker, Josef Coresh, Yingying Sang, Chi-Yuan Hsu, Meredith C Foster, John H Eckfeldt, Amy B Karger, Robert G Nelson, Xun Liu, Mark Sarnak, Lawrence J Appel, Morgan Grams, Dawei Xie, Paul L Kimmel, Harold Feldman, Vasan Ramachandran, Andrew S Levey
BACKGROUND AND OBJECTIVES: Serum β-trace protein (BTP) and β-2 microglobulin (B2M) are associated with risk of ESRD and death in the general population and in populations at high risk for these outcomes (GP/HR) and those with CKD, but results differ among studies. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We performed an individual patient-level meta-analysis including three GP/HR studies (n=17,903 participants) and three CKD studies (n=5415). We compared associations, risk prediction, and improvement in reclassification of eGFR using BTP (eGFRBTP) and B2M (eGFRB2M) alone and the average (eGFRavg) of eGFRBTP, eGFRB2M, creatinine (eGFRcr), and cystatin C (eGFRcys), to eGFRcr, eGFRcys, and their combination (eGFRcr-cys) for ESRD (2075 events) and death (7275 events)...
January 6, 2017: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/28062676/associations-of-conventional-echocardiographic-measures-with-incident-heart-failure-and-mortality-the-chronic-renal-insufficiency-cohort
#20
Ruth F Dubin, Rajat Deo, Nisha Bansal, Amanda H Anderson, Peter Yang, Alan S Go, Martin Keane, Ray Townsend, Anna Porter, Matthew Budoff, Shaista Malik, Jiang He, Mahboob Rahman, Jackson Wright, Thomas Cappola, Radhakrishna Kallem, Jason Roy, Daohang Sha, Michael G Shlipak
BACKGROUND AND OBJECTIVES: Heart failure is the most frequent cardiac complication of CKD. Left ventricular hypertrophy is common and develops early in CKD, but studies have not adequately evaluated the association of left ventricular mass index with heart failure incidence among men and women with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We evaluated echocardiograms of 2567 participants without self-reported heart failure enrolled in the Chronic Renal Insufficiency Cohort Study...
January 6, 2017: Clinical Journal of the American Society of Nephrology: CJASN
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