Editor’s Note: We asked authors of Original Investigations to provide short plain-language summaries that would briefly summarize what inspired their study, the basic approach taken, what was learned, and why it matters. We hope our readers will find this valuable in helping them keep up with the latest research in the field of nephrology. Highlights from the December 2023 issue:
A Predictive Model for Kidney Failure After Nephrectomy for Localized Kidney Cancer: The Kidney Cancer Risk Equation by Oksana Harasemiw et al
From the authors: Patients with localized kidney cancer often experience a lot of worry about whether their kidney function will remain stable or will decline if they choose to undergo surgery for treatment. To help patients make an informed treatment decision, we developed a simple equation that incorporates 6 easily accessible pieces of patient information to predict the risk of reaching kidney failure 5 years after kidney cancer surgery. We expect that this tool has the potential to inform patient-centered discussions tailored around individualized risk, helping ensure that patients receive the most appropriate risk-based care.
DOI: 10.1053/j.ajkd.2023.06.002
EDITORIAL: The Nephrologist’s Role in the Management of Kidney Cancer: A Renaissance by Calyani Ganesan (FREE)
Pruritus in Hemodialysis Patients: Longitudinal Associations With Clinical and Patient-Reported Outcomes by Nidhi Sukul et al (OPEN ACCESS)
From the authors: Previous research has studied itching and its consequences in hemodialysis recipients only at a single time point. We surveyed 7,976 patients receiving maintenance hemodialysis to assess itching over a period of 1 year. We found that, among those experiencing itching at the initial assessment, more than half had persistent symptoms 1 year later. Those in whom itching developed during follow-up were more likely to experience depression, poor sleep, long recovery times after dialysis, and feeling faint or drained. These patients also rated their quality of life as poorer than those who did not experience itching. These findings emphasize the potential value of clinical detection of itching and the pursuit of effective treatments for patients receiving dialysis experiencing these symptoms.
DOI: 10.1053/j.ajkd.2023.04.008
EDITORIAL: One-Year Pruritus Trends Among Patients Receiving Hemodialysis and Associated Outcomes by Kendra E. Wulczyn (FREE)
Shared Decision Making in Health Care Visits for CKD: Patients’ Decisional Role Preferences and Experiences by Dorinde E.M. van der Horst et al
From the authors: Shared decision making (SDM) may be a valuable approach for common chronic kidney disease (CKD) decisions, but our knowledge is limited. We collected patient surveys after health care visits for CKD. Patients most frequently experienced decisions regarding planning, medication, and lifestyle. Three decisional roles were preferred by comparable numbers of patients: let the clinician alone decide, let the clinician decide for the most part, or “equally share” the decision. Patients’ experiences of who made the decision did not always match their preferences. In audio recordings of the health care visits, we observed low levels of SDM behavior. These findings suggest that the preference for “sharing decisions” is often unmet for a large number of patients.
DOI: 10.1053/j.ajkd.2023.04.012
EDITORIAL: It Shouldn’t Be a Battle: Customizing Shared Decision Making to Meet Patients’ Preferences by Dale E. Lupu (FREE)
Association of Plant Protein Intake With Risk of Incident CKD: A UK Biobank Study by Ga Young Heo et al
From the authors: Plant-based diets confer various health benefits, including lowering the risk of cardiovascular disease and certain cancers. However, the relationship between plant protein intake and the risk of chronic kidney disease (CKD) remains unclear. Our study investigated the association between plant protein intake and the development of CKD. Using the UK Biobank Study data, we found that participants with a higher plant protein intake had a lower risk of developing CKD. Our finding suggests that a higher dietary intake of plant-based protein may be beneficial for kidney health and provides insight into dietary interventions to prevent CKD in primary care settings.
DOI: 10.1053/j.ajkd.2023.05.007
EDITORIAL: Moving Away From High Biologic Value: Findings From the UK Biobank Study by Holly Kramer (FREE)
Preeclampsia and Long-term Kidney Outcomes: An Observational Cohort Study by Nityasree Srialluri et al
From the authors: Preeclampsia is a significant contributor to perinatal and maternal morbidity and is marked by new-onset hypertension and end-organ damage, including acute kidney injury or proteinuria. To gain insight into the long-term kidney effects of the disease, we compared adults with deliveries complicated by preeclampsia with those without preeclampsia in the Geisinger Health System, while also assessing postpartum testing rates. Our results demonstrate that pregnant individuals with preeclampsia are at a heightened risk for future hypertension, reduced eGFR, and albuminuria, with overall low rates of postpartum testing among both individuals with and without preeclampsia. These findings underscore the need to consider preeclampsia as an important risk factor for the development of chronic kidney disease. Further studies are required to determine optimal postpreeclampsia monitoring strategies.
DOI: 10.1053/j.ajkd.2023.04.010
Role of Anemia in Dementia Risk Among Veterans With Incident CKD by Alain K. Koyama et al
From the authors: Adults with chronic kidney disease (CKD) often have anemia. Prior studies among adults in the general population suggest anemia is a risk factor for dementia, though it is unclear whether this association persists among adults with CKD. In this large study of veterans in the United States, we studied the association between anemia and the risk of 2 important outcomes in this population: (1) dementia and (2) kidney failure or death. We found that anemia was associated with a greater risk of dementia as well as risk of kidney failure or death. The study findings therefore emphasize the role of anemia as a key predictor of dementia risk among adults with CKD.
DOI: 10.1053/j.ajkd.2023.04.013
Performance of Panel-Estimated GFR Among Hospitalized Older Adults by Esben Iversen et al
From the authors: Inaccurate kidney function assessment can lead to medication errors, a common cause of hospitalization and early readmission among older adults. Several novel methods have been developed to estimate kidney function based on a panel of kidney function markers that can be measured from a single blood sample. We evaluated the accuracy of these new methods (relative to a gold standard method) among 106 hospitalized older adults. We found that kidney function estimates combining 2 markers (creatinine and cystatin C) were highly accurate and noticeably more accurate than estimates based on creatinine alone. Estimates incorporating additional markers such as β-trace protein and β2-microglobulin did not further improve accuracy.
DOI: 10.1053/j.ajkd.2023.05.004
Incidence of and Risk Factors for Active Tuberculosis Disease in Individuals With Glomerular Disease: A Canadian Cohort Study by Mark Canney et al
From the authors: Patients with kidney failure are at high risk of developing tuberculosis (TB), a major infection that can be prevented by identifying and treating patients who have had prior exposure to TB. The risk of TB in specific kidney diseases is unknown. In this Canadian study of 3,079 patients with glomerular disease, a group of autoimmune kidney conditions, the rate of TB was 23 times higher than in the general population. The rate was high irrespective of the use of immunosuppressive drugs or whether patients had immigrated to Canada from another country. These findings suggest that screening patients with glomerular disease for prior TB exposure may be beneficial; however, this needs to be evaluated in a prospective study.
DOI: 10.1053/j.ajkd.2023.05.005
Core Curriculum in Nephrology from the December 2023 issue:
Onconephrology: Core Curriculum 2023 by Niloufarsadat Yarandi et al
Onconephrology focuses on management of kidney disease in cancer, which manifests itself in a variety of clinical syndromes, including acute kidney injury, chronic kidney disease, hypertension, proteinuria, and electrolyte disorders. Many of these syndromes result from cancer treatments including chemotherapy, immunotherapy, chimeric antigen receptor T cells, and stem cell transplant. Others are due to kidney-specific effects of the cancer, as seen with monoclonal gammopathy or glomerular diseases associated with malignancy. Further, cancer risk itself is heightened in patients with kidney disease, particularly kidney transplant recipients, and their care requires specific considerations. In this installment of AJKD’s Core Curriculum in Nephrology, we review these and other core concepts in onconephrology, using a case-based approach to highlight clinical decision making.
DOI: 10.1053/j.ajkd.2023.04.014
On the Cover: The cover of this issue features the zodiac sign Cancer, symbolized by the crab. Hippocrates, the father of medicine, is credited with using the term “karkinos”, Greek for crab, to describe cancerous growths. He was likely motivated by the resemblance of some tumors to a crab’s shape, shell-like hardness, and crab leg-like projections, or by the discomfort caused by a crab’s hard pinch. This issue includes an Original Investigation by Harasemiw et al on prediction of kidney failure after nephrectomy for localized kidney cancer and a Core Curriculum on Onconephrology by Yarandi and Shirali.
“Astrology: signs of the zodiac, Cancer. Coloured engraving by S. Hall” is from the Wellcome Collection and is in the public domain.
Special thanks to Editorial Intern Dilushi Wijayaratne for curating the cover image and drafting the cover blurb for this issue.
The editors are delighted to recognize these articles that have been selected to receive the 2023 AJKD Editors’ Choice Award (all articles are freely available until March 1, 2024).
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- Source: https://ajkdblog.org/2023/12/01/highlights-from-the-december-2023-issue/