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Clinical Kidney Journal

Pauline Vanderweckene, Laurent Weekers, Patrizio Lancellotti, François Jouret
Arteriovenous fistula (AVF) is regarded as the best vascular access for chronic haemodialysis (HD). Still, AVF inherently causes significant haemodynamic changes. Although the necessity for vascular access despite its putative cardiovascular complications favours AVF creation in patients under chronic HD, one may question whether sustaining a functional AVF after successful kidney transplantation extends the haemodynamic threat. Small prospective series suggest that AVF ligation causes rapid and sustained reduction in left ventricular hypertrophy...
June 2018: Clinical Kidney Journal
Guido Filler, Sepideh Taheri, Christopher McIntyre, Connor Smith, Lakshmimathy Subramanian, Gerhard Fusch, Christoph Fusch
Background: Small, dense low-density lipoprotein (sd-LDL) and glycated LDL (g-LDL) have been associated with cardiovascular disease (CVD) in chronic kidney disease (CKD) in patients >60 years of age. Since young adult and paediatric patients have shorter exposure to Framingham-type risk factors, our study aims to determine whether younger CKD patients exhibit the same sd-LDL and g-LDL pattern. Methods: After ethics board approval, this cross-sectional study was conducted at two universities with 44 patients (mean ± standard deviation age 12...
June 2018: Clinical Kidney Journal
Christian D Fankhauser, Thomas Hermanns, Laura Lieger, Olivia Diethelm, Martin Umbehr, Thomas Luginbühl, Tullio Sulser, Michael Müntener, Cédric Poyet
Background: The reported success rates for treatments of kidney stones with either extracorporeal shock wave lithotripsy (ESWL) or flexible ureterorenoscopy (URS) are conflicting. We aimed to compare the efficacy and safety of ESWL and URS for previously untreated renal calculi. Methods: All patients treated with ESWL or URS at our tertiary care centre between 2003 and 2015 were retrospectively identified. Patients with previously untreated kidney stones and a stone diameter of 5-20 mm were included...
June 2018: Clinical Kidney Journal
Ahmad A Al Turk, Christopher Estiverne, Pratik R Agrawal, Jennine M Michaud
Background: Despite an inordinate share of health care resources being utilized by patients with kidney disease, morbidity and mortality in these patients remain high. Although renal biopsy is an intervention to identify potential treatment-modifiable causes of disease, large-scale data studying the safety and outcomes of percutaneous native kidney biopsy in hospitalized patients are lacking. Methods: We queried the Nationwide Inpatient Sample database from 2008 to 2012 and identified all hospital admissions during which a percutaneous renal biopsy was performed...
June 2018: Clinical Kidney Journal
Baris Afsar, Rengin E Afsar, Tuncay Dagel, Ege Kaya, Suat Erus, Alberto Ortiz, Adrian Covic, Mehmet Kanbay
Capillary rarefaction is broadly defined as a reduction in vascular density. Capillary rarefaction in the kidneys is thought to promote hypoxia, impair hemodynamic responses and predispose to chronic kidney disease (CKD) progression and hypertension development. Various mechanisms have been suggested to play a role in the development of capillary rarefaction, including inflammation, an altered endothelial-tubular epithelial cell crosstalk, a relative deficiency in angiogenic growth factors, loss of pericytes, increased activity of Transforming growth factor -β1 and thrombospondin-1, vitamin D deficiency, a link to lymphatic neoangiogenesis and INK4a/ARF (Cylin-dependent kinase inhibitor 2a; CDKN2A)...
June 2018: Clinical Kidney Journal
Marc Xipell, Lida M Rodas, Jesús Villarreal, Alicia Molina, Johanna Reinoso-Moreno, Miquel Blasco, Esteban Poch, Fritz Diekmann, Jose M Campistol, Luis F Quintana
Membranous nephropathy (MN) is estimated to cause end-stage renal disease in ∼ 5% of patients, in whom renal transplantation is the therapy of choice. Among patients receiving a transplant for MN, the disease will recur in the graft in 30-50%; among these, graft loss will occur in 50% within 10 years. Several studies have suggested that phospholipase A2 receptor autoantibody (aPLA2R) levels before transplantation might be useful in predicting recurrence, and their titration after transplantation is clinically relevant to assess the risk of recurrence and progression, to guide treatment indications and to monitor treatment response...
June 2018: Clinical Kidney Journal
Edoardo Melilli, Anna Manonelles, Nuria Montero, Josep Grinyo, Alberto Martinez-Castelao, Oriol Bestard, Josep Cruzado
Arterial stiffness is a biologic process related to ageing and its relationship with cardiovascular risk is well established. Several methods are currently available for non-invasive measurement of arterial stiffness that provide valuable information to further assess patients' vascular status in real time. In kidney transplantation recipients, several factors could accelerate the stiffness process, such as the use of calcineurin inhibitors (CNIs), the presence of chronic kidney disease and other classical cardiovascular factors, which would explain, at least in part, the high cardiovascular mortality and morbidity...
June 2018: Clinical Kidney Journal
Suresh Reddy, Raj Kumar Sharma, Sonia Mehrotra, Narayan Prasad, Amit Gupta, Anupma Kaul, Dharmendra Singh Bhadauria
Background: The objectives of this pilot study were to assess the efficacy and safety of an interferon-free sofosbuvir and ribavirin combination regimen to treat chronic hepatitis C virus (HCV) infection in kidney transplant recipients and to study the impact of sofosbuvir on calcineurin inhibitor (CNI) drug levels. Methods: A total of 10 kidney transplant recipients with chronic HCV infection were included in the study. All received sofosbuvir and ribavirin combination therapy...
June 2018: Clinical Kidney Journal
Wolfgang Pommer, Steffen Wagner, Dominik Müller, Julia Thumfart
Background: Assisted home dialysis (AHD) is an option to combine the benefits of home dialysis therapy with the needs of dialysis patients who are unable to perform self-treatment at home. While this method is growing in many countries worldwide, no data so far are reported for Germany. Methods: A survey was designed to identify the barriers to the implementation of AHD with the focus on attitudes and beliefs concerning AHD. The survey was sent to all 2060 members of the Germany Society of Nephrology...
June 2018: Clinical Kidney Journal
Edward A Ross, Jennifer L Paugh-Miller, Robert W Nappo
Background: The monitoring of dialysate ultraviolet (UV) absorbance is a validated technology to measure hemodialysis adequacy and allows for continuous and real-time tracking every session as opposed to the typical once-monthly assessments. Clinical care guidelines are needed to interpret the findings so as to troubleshoot problematic absorbance patterns and intervene during an individual treatment as needed. Methods: When paired with highly structured clinical care protocols that allow autonomous nursing actions, this technology has the potential to improve treatment outcomes...
June 2018: Clinical Kidney Journal
Mohammed A Kaballo, Mark Canney, Patrick O'Kelly, Yvonne Williams, Conall M O'Seaghdha, Peter J Conlon
Background: Kidney transplant survival benefits are not observed for around 8 months after transplantation because of a higher complications rate in early post-transplant periods. This study compares survival of patients awaiting transplantation with survival of transplant recipients and non-listed dialysis patients in Ireland. Methods: In this retrospective analysis, the relative-risk (RR) of death was assessed with time-dependent, non-proportional hazards analysis, with adjustment for age, cause of end-stage kidney disease (ESKD), time from first treatment for ESKD to placement on the waiting list and year of initial placement on the list...
June 2018: Clinical Kidney Journal
John W Stanifer, Lawrence Landerman, Carl F Pieper, Kim M Huffman, William E Kraus
Background: Biomarkers improving risk prediction for elderly populations with chronic kidney disease (CKD), an independent predictor of mortality, could be particularly useful. We previously observed that interleukin-6 (IL-6), D-dimer and soluble vascular adhesion molecule (s-VCAM) were independent biomarkers of mortality in elderly individuals. Therefore, we investigated whether these established biomarkers were independently associated with both estimated glomerular filtration rate (eGFR) and mortality...
June 2018: Clinical Kidney Journal
Almudena Vega, Soraya Abad, Nicolás Macías, Inés Aragoncillo, Ana García-Prieto, Tania Linares, Esther Torres, Andrés Hernández, José Luño
Background: Overhydration (OH) is associated with mortality in chronic kidney disease (CKD). A relative overhydration adjusted for extracellular water (OH/ECW) measured by bioimpedance >15% has shown an increased mortality risk in haemodialysis but few studies have been developed in advanced CKD. Our objective was to evaluate the effect of OH on mortality in patients with Stage 4 or 5 non-dialysis CKD. Methods: We performed a prospective study of 356 patients enrolled in 2011 and followed up until 2016...
June 2018: Clinical Kidney Journal
Doruk C Karaaslan, Baris Afsar, Mehmet Kanbay
It is well known that one of the main determinants of mortality and morbidity in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients is fluid overload acting on the cardiovascular system causing hypertension, increased arterial stiffness, left ventricular hypertrophy and eventually heart failure. Therefore, assessment and management of volume status is crucial. Bioimpedance spectroscopy is one of the most popular and practical methods for volume evaluation. Volume evaluation should be a routine part of following CKD and ESRD patients, in order to decrease associated mortality and morbidity...
June 2018: Clinical Kidney Journal
Pietro Manuel Ferraro, Francesco Pinto, Giovanni Gambaro
Kidney stones are a common condition with high direct and indirect costs; to date, the optimal urological approach for some particular presentations including non-lower pole kidney stones between 10 and 20 mm of diameter is not clear. A limited number of randomized controlled trials and observational longitudinal studies suggests that ureterorenoscopy (URS) could be superior to shock-wave lithotripsy (SWL) in achieving stone-free rates in this setting; however, such reports are generally weakened by a number of limitations including small sample size and scarce control for confounding...
June 2018: Clinical Kidney Journal
Thijs T Jansz, Marianne C Verhaar, Gérard M London, Brigit C van Jaarsveld
Background: Progression of coronary artery calcification is an important marker for cardiovascular morbidity in end-stage renal disease patients. Therefore, we reviewed the evidence on coronary artery calcification progression in different renal replacement therapies. Methods: MEDLINE (PubMed), Embase and TRIP databases were searched from 1999 - 2016. Additionally, bibliographies were searched by hand and citation tracking of key publications was performed. Prospective studies were included that examined coronary artery calcification with two or more multislice computed tomography scans ≥6 months apart in patients 18-75 years old receiving any renal replacement therapy, including kidney transplantation...
June 2018: Clinical Kidney Journal
Ramanathan Sakthirajan, Jeyachandran Dhanapriya, Arun Varghese, Karunamoorthy Saravanakumar, Thanigachalam Dineshkumar, Thopalan Balasubramaniyan, Natarajan Gopalakrishnan, Anila Abraham Kurien
Background: Pigment nephropathy represents one of the most severe complications of rhabdomyolysis or hemolysis. Methods: We performed a retrospective observational study to analyze the etiology, clinical manifestation, laboratory profile and outcome in patients with biopsy-proven pigment-induced nephropathy between January 2011 and December 2016. History, clinical examination findings, laboratory investigations and outcome were recorded. Results: A total of 46 patients were included with mean follow-up of 14 ± 5...
June 2018: Clinical Kidney Journal
Kittrawee Kritmetapak, Sirirat Anutrakulchai, Chatlert Pongchaiyakul, Anucha Puapairoj
Background: Renal involvement in type 2 diabetes is mainly due to diabetic nephropathy (DN). Nevertheless, a sizable proportion of diabetic patients could actually have nondiabetic renal diseases (NDRDs) or DN plus NDRDs. This study aimed to explore the pathological features of NDRD in diabetic patients and to assess the predictability of diagnosing NDRD (±DN) versus isolated DN on the basis of clinical parameters. Methods: Medical records of type 2 diabetes patients who underwent renal biopsy under suspicion of NDRD from January 2011 through November 2015 were analyzed retrospectively...
June 2018: Clinical Kidney Journal
Soumita Bagchi, Arun Kumar Subbiah, Dipankar Bhowmik, Sandeep Mahajan, Raj Kanwar Yadav, Mani Kalaivani, Geetika Singh, Amit Dinda, Sanjay Kumar Agarwal
Background: Persistent significant proteinuria has been associated with increased risk of progression to end-stage kidney disease in patients with idiopathic membranous nephropathy (IMN). Rituximab (RTX) therapy has given encouraging results in IMN, but most of the studies have used a higher dose, which is limited by the high cost as well as a potential increased risk of infections. Our study aimed to assess the efficacy and safety of low-dose RTX in patients with immunosuppression-resistant IMN...
June 2018: Clinical Kidney Journal
Ben Sprangers, Vinay Nair, Vincent Launay-Vacher, Leonardo V Riella, Kenar D Jhaveri
In kidney transplant recipients, cancer is one of the leading causes of death with a functioning graft beyond the first year of kidney transplantation, and malignancies account for 8-10% of all deaths in the USA (2.6 deaths/1000 patient-years) and exceed 30% of deaths in Australia (5/1000 patient-years) in kidney transplant recipients. Patient-, transplant- and medication-related factors contribute to the increased cancer risk following kidney transplantation. While it is well established that the overall immunosuppressive dose is associated with an increased risk for cancer following transplantation, the contributive effect of different immunosuppressive agents is not well established...
June 2018: Clinical Kidney Journal
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