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 May 2024 issue:
Development and Validation of the Rating of CKD Knowledge Among Older Adults (Know-CKD) With Kidney Failure by Susan Koch-Weser et al [FREE]
From the authors: The Rating of CKD Knowledge Among Older Adults (Know-CKD) study measures knowledge of chronic kidney disease (CKD) and is designed for older adults. Most existing knowledge measures for CKD focus on people of all ages and all CKD stages. This measure is useful because it will allow researchers to assess how well patient education efforts are working. Patient education is a way to help patients make decisions about their care. We describe how the measure was developed by a team of doctors, researchers, and patients, and how the measure performed among persons with advanced CKD aged 70 years and older. Know-CKD can inform efforts to improve shared decision-making research and practice for older patients with kidney disease.
DOI: 10.1053/j.ajkd.2023.09.024
EDITORIAL: Challenges to Informed, Patient-Centered, and Shared Decision Making for Treatment of Kidney Failure in Older Adults by Elizabeth Kiernan et al [FREE]
Variations in Incidence and Prognosis of Stage 4 CKD Among Adults Identified Using Different Algorithms: A Population-Based Cohort Study by Mitchell Rath et al
From the authors: Although guidelines recommend >3 months to define chronic kidney disease (CKD), the methods for defining specific stages, particularly G4 (eGFR 15-29 mL/min/1.73 m2) when referral to nephrology services is recommended, have been implemented differently across studies and surveillance programs. We studied differences in incidence and prognosis of CKD G4 cohorts identified by 4 algorithms using administrative and outpatient laboratory databases in Alberta, Canada. We found that, compared with a single-test definition, more stringent definitions resulted in a lower disease incidence and identified a group with worse short-term kidney outcomes. These findings highlight the impact of the choice of algorithm used to define CKD G4 on disease burden estimates at the population level, on individual prognosis, and on treatment/referral decisions.
DOI: 10.1053/j.ajkd.2023.10.010
EDITORIAL: A “Fit for Purpose” Approach to CKD Classification? by Jin Ho Hwang et al [FREE]
Anti–Phospholipase A2 Receptor 1 and Anti–Cysteine Rich Antibodies, Domain Recognition and Rituximab Efficacy in Membranous Nephropathy: A Prospective Cohort Study by Piero Ruggenenti et al
From the authors: Primary membranous nephropathy (MN), a leading cause of nephrotic syndrome (NS) in adults, is an autoimmune disease caused by autoantibodies binding to the podocyte antigen phospholipase A2 receptor 1 (PLA2R1). We assessed whether the effects of anti-CD20 cytolytic therapy with the monoclonal antibody rituximab are associated with detection rates and levels of anti-PLA2R1 antibodies and antibodies against PLA2R1 domains such as cysteine-rich (CysR), and C-type lectin 1, 7, and 8 (CTLD1, 7, and 8), in patients with PLA2R1-related MN and persistent NS. The probability of rituximab-induced complete or partial NS remission was associated with baseline anti-PLA2R1 and anti-CysR antibody titers, but not with anti-CTLD1, 7 and 8 antibodies or multidomain recognition. Integrated evaluation of anti-PLA2R1 or anti-CysR antibodies with proteinuria and kidney function may play a role in monitoring the effects of rituximab in patients with PLA2R1-related NS and MN.
DOI: 10.1053/j.ajkd.2023.10.013
EDITORIAL: Quantity Versus Quality of Anti–Phospholipase A2 Receptor 1 Autoantibodies in the Assessment of Clinical Outcome in Membranous Nephropathy: The Debate Continues by Laurence H. Beck Jr. [FREE]
Kidney Function Decline and Serious Adverse Drug Reactions in Patients With CKD by Solène M. Laville et al [OPEN ACCESS]
From the authors: Patients with chronic kidney disease (CKD) have complex clinical presentations, take multiple medications, and often receive inappropriate prescriptions. Using data from a large, prospective CKD cohort, we found a high incidence of serious adverse drug reactions (ADRs). The 2 most common serious ADRs were drug-induced acute kidney injury and bleeding. A large proportion of serious ADRs required hospital admission, and 11% led to death or were life threatening. Lower kidney function was a major risk factor for serious ADRs. Many of these serious ADRs were determined to be partly preventable through greater adherence to prescription guidelines. This report enhances our understanding of the potential toxicity of drugs taken by patients with moderate to advanced CKD. It emphasizes the importance of monitoring kidney function when prescribing drugs, particularly for high-risk medications such as antithrombotic agents.
DOI: 10.1053/j.ajkd.2023.09.012
Changes in Natriuretic Peptide Levels and Subsequent Kidney Function Decline in SPRINT by Simon B. Ascher et al [OPEN ACCESS]
From the authors: N-terminal pro–B-type natriuretic peptide (NT–proBNP) is a biomarker in the blood that reflects mechanical stress on the heart. Measuring NT–proBNP may be helpful in assessing the risk of long-term losses of kidney function. In this study, we investigated the association of changes in NT–proBNP with subsequent kidney function among individuals with and without chronic kidney disease. We found that increases in NT–proBNP are associated with a faster rate of decline of kidney function, independent of baseline kidney measures. The associations were more pronounced in individuals with chronic kidney disease. Our results advance the notion of considering NT–proBNP as a dynamic tool for assessing kidney disease risk.
DOI: 10.1053/j.ajkd.2023.09.018
Adherence to Plant-Based Diets and Risk of CKD Progression and All-Cause Mortality: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study by Saira Amir et al
From the authors: Plant-based diets are healthful dietary patterns that have been linked to a lower risk of chronic diseases. However, the impact of plant-based diets on clinical outcomes in patients with chronic kidney disease (CKD) is not well established. In 2,539 individuals with CKD, we examined the associations of adherence to 3 different types of plant-based diets with the risks of CKD progression and all-cause mortality. We found that following an overall plant-based diet and a healthy plant-based diet was associated with a lower risk of all-cause mortality. By contrast, following an unhealthy plant-based diet was associated with a higher risk of CKD progression and all-cause mortality. These results suggest that the quality of plant-based diets may be important for CKD management.
DOI: 10.1053/j.ajkd.2023.09.020
Core Curriculum from the May 2024 issue:
Toxic Nephropathies of the Tubulointerstitium: Core Curriculum 2024 by Namrata Krishnan et al
This installment of AJKD’s Core Curriculum in Nephrology focuses on discussing mechanisms of common toxin-induced tubulointerstitial renal injury and reviews their causes, clinical presentations, diagnosis, and management.
DOI: 10.1053/j.ajkd.2023.09.017
On the Cover:
Nineteenth century physician Sir William Osler once wrote, “The good physician treats the disease; the great physician treats the patient who has the disease.” The art featured on this month’s cover illustrates this sentiment and the importance of the patient-provider relationship. It serves as a reminder of the need to involve patients in their own care, particularly when navigating the complex and difficult treatment decisions surrounding kidney failure. In this month’s issue of AJKD, two articles remind us that keeping patients at the center of care and arming them with the requisite knowledge and support to make informed and shared decisions which honor their values and wishes is paramount to preserving the sacred patient-provider relationship. Koch-Weser and colleagues report on findings from the Rating of CKD Knowledge Older Adults (Know-CKD) study, which validated the reliability of an instrument to assess kidney disease knowledge among older adults with kidney failure. Weiner and colleagues report on a KDOQI workshop where participants favored a quality system that stresses highly meaningful and adaptive measures that incorporate patient-centered principles, individual life goals, and social risk factors.
The photograh “holding hands” by Waithamai is released on Flickr under the CC BY 2.0 Deed license. Special thanks to Editorial Intern Megan Urbanski for curating the cover image and drafting the cover blurb for this issue
Read the most popular articles from the January-December 2023 issues of AJKD.
- The Renal Warrior Project. Join Now
- Source: https://ajkdblog.org/2024/05/01/highlights-from-the-may-2024-issue/