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 November 2024 issue:
Efficacy and Safety of Allopurinol and Febuxostat in Patients With Gout and CKD: Subgroup Analysis of the STOP Gout Trial by Lindsay N. Helget et al
From the authors: The STOP Gout Trial was a multicenter, randomized, double-blind, noninferiority, comparative effectiveness trial, which found that allopurinol was noninferior to febuxostat in gout flare prevention and that both medications were similarly efficacious in reaching a serum urate goal when used as part of a treat-to-target approach. A significant proportion of patients with chronic kidney disease (CKD) are afflicted by gout, yet there is a lack of high-quality comparative effectiveness data comparing allopurinol and febuxostat in these patients. We evaluated the efficacy and safety of allopurinol and febuxostat in the subgroup of STOP Gout Trial participants with stage 3 CKD and found that allopurinol and febuxostat are similarly efficacious and well-tolerated in the treatment of gout in people with CKD when used in a treat-to-target regimen, with lower incidence of gout flares in participants randomized to allopurinol.
DOI: 10.1053/j.ajkd.2024.04.017
EDITORIAL: Yet More Reassurance: Treat-to-Target With Allopurinol or Febuxostat is Safe and Effective in Lowering Serum Urate in People With CKD by Lisa K. Stamp et al [FREE]
Sex and the Risk of Atheromatous and Nonatheromatous Cardiovascular Disease in CKD: Findings From the CKD-REIN Cohort Study by Anne-Laure Faucon et al [FREE]
From the authors: Sex differences in the risks of atheromatous and nonatheromatous cardiovascular disease (CVD) are well established in the general population. If or how chronic kidney disease (CKD) might modify these risks is unknown. In this large cohort of 3,010 patients with CKD, women had a lower risk than men of atheromatous CVDs such as coronary artery disease or stroke when they were at an early stage of CKD. This advantage, partly due to women’s better cardiovascular risk profile, tended to attenuate as CKD progressed to kidney failure. In contrast, the risk of nonatheromatous CVDs such as heart failure for women with CKD appeared similar to that of men with CKD at all kidney function levels.
DOI: 10.1053/j.ajkd.2024.04.013
EDITORIAL: Steps in the Right Direction: The Importance of High-Quality Sex- and Gender-Based Analyses in CKD and Cardiovascular Disease Research by Kristin K. Clemens et al [FREE]
Social Isolation, Loneliness, and Risk of Microvascular Complications Among Individuals With Type 2 Diabetes Mellitus by Yannis Yan Liang et al
From the authors: Social isolation and loneliness are important social determinants that are associated with adverse cardiometabolic health. Individuals with diabetes are particularly vulnerable to social isolation and loneliness. However, the relationship of social isolation or loneliness with diabetic microvascular complications (DMCs) remains unclear. Our study used the UK Biobank study data to investigate the associations of social isolation and loneliness with the development of DMCs. We found that social isolation and loneliness were independently associated with a higher risk of incident DMCs. Remarkably, their association with DMCs was comparable to those of other lifestyle factors such as smoking, blood pressure, and physical activity. These findings collectively imply that social isolation and loneliness are 2 important potentially modifiable risk factors for DMCs among individuals with type 2 diabetes mellitus.
DOI: 10.1053/j.ajkd.2024.05.004
EDITORIAL: Social Connection: A Neglected Social Determinant of Health and an Opportunity to Improve Disease Management by Sanya Tinaikar and Sarah J. Schrauben [FREE]
Identifying Major Barriers to Home Dialysis (The IM-HOME Study): Findings From a National Survey of Patients, Care Partners, and Providers by Yuvaram N.V. Reddy et al [OPEN ACCESS]
From the authors: There are many barriers to home dialysis use in the United States. However, we know little about which barriers are the most important to patients and clinicians. This makes it challenging to develop strategies to increase home dialysis use. In this study, we surveyed patients, care partners, and clinicians across the country to identify the most important barriers to home dialysis, namely (1) patients/care partners identified fear of home dialysis, lack of space, and lack of home-based support; and (2) clinicians identified poor patient education, limited support for staff and patients, and lack of experienced staff. These findings suggest that patients and clinicians perceive different barriers and that both sets of barriers should be addressed to expand home dialysis use.
DOI: 10.1053/j.ajkd.2024.04.007
Extreme Humid-Heat Exposure and Mortality Among Patients Receiving Dialysis by Matthew F. Blum et al.
From the authors: Patients who receive dialysis are vulnerable to extreme weather events, and rising global temperatures may bring more frequent extreme heat events. We sought to determine whether extreme heat exposure was associated with an increased risk of death in urban-dwelling patients receiving dialysis across the United States. We found that people receiving dialysis were more likely to die during extreme humid-heat events, defined by a heat index exceeding 40.6°C (105°F) for≥2 days or 46.1°C (115°F) for≥1day. These findings inform the nephrology community about the potential importance of protecting patients receiving maintenance dialysis from the risks associated with extreme heat.
Smoking Timing, Healthy Diet, and Risk of Incident CKD Among Smokers: Findings From UK Biobank
by Rui Tang et al
From the authors: This study explored the association of the daily timing of first cigarette smoking and the occurrence of kidney disease. Further, we addressed whether this association was influenced by the quality of the diet. The study found that smoking very soon after waking, especially when combined with a poorer quality diet, was associated with a significantly increased risk of developing chronic kidney disease. This research emphasizes the value of healthier lifestyle choices for kidney health.
DOI: 10.1053/j.ajkd.2024.04.011
Frailty and Duration of Maintenance Dialysis: A Japanese Nationwide Cross-Sectional Study by Suguru Yamamoto et al
From the authors: End-stage kidney disease increases the risk of frailty. Understanding how long-term dialysis affects physical function may help patients and caregivers plan their lives better. Our research explores the relationship between duration of maintenance dialysis and frailty. We found that longer durations of maintenance dialysis, especially longer than 30 years, were associated with a higher risk of frailty and being bedridden among Japanese patients. The factors responsible for these associations should be the focus of future research.
DOI: 10.1053/j.ajkd.2024.04.012
Chronic Tonsillitis and IgA Nephropathy: Findings From a Nationwide Japanese Cohort Study
by Takashin Nakayama et al [OPEN ACCESS]
From the authors: IgA nephropathy (IgAN), the most prevalent form of primary glomerulonephritis worldwide, is associated with unfavorable long-term kidney survival and life expectancy. Despite the substantial implications, the early detection of IgAN still remains challenging due to its commonly asymptomatic clinical presentation. Consequently, the exploration of risk factors assumes a critical research priority. Prior studies have reported the potential role of tonsilitis in the pathogenesis of IgAN. In this study, we assessed whether chronic tonsillitis was associated with the subsequent development of IgAN using a nationwide epidemiological dataset incorporating over 4,000,000 individuals. Within this large-scale cohort, our findings revealed an association between a history of tonsillitis and a greater risk of developing IgAN. These findings should heighten awareness of the potential susceptibility of people with chronic tonsilitis to IgAN.
DOI: 10.1053/j.ajkd.2024.04.015
Review in the November 2024 issue:
Kidney Care in Times of Crises: A Review by Sami Alasfar et al [FREE]
The global burden of kidney disease is increasing, paralleled by a rising number of natural and man-made crises. During these tumultuous times, accessing vital health care resources becomes challenging, posing significant risks to individuals, particularly those with kidney disease. This review delves into the impact of crises on kidney disease, with a particular focus on acute kidney injury (AKI), kidney failure, and kidney transplant. Patients experiencing crush injuries leading to AKI may encounter delayed diagnosis due to the chaotic nature of disasters and limited availability of resources. In chronic crises such as conflicts, patients with kidney failure are particularly affected, and deviations from dialysis standards are unfortunately common, impacting morbidity and mortality rates. Additionally, crises also disrupt access to kidney transplants, potentially compromising transplant outcomes. This review underscores the critical importance of preparedness measures and proactive management for kidney disease in crisis settings. Collaborative efforts among government bodies, rescue teams, health care providers, humanitarian agencies, and nongovernmental organizations are imperative to ensure equitable and reasonable care for kidney disease patients during times of crises, with the aim of saving lives and improving outcomes.
DOI: 10.1053/j.ajkd.2024.03.030
On the Cover:
“There’s no place like home.” This simple yet powerful phrase from the classic film, The Wizard of Oz, rings true for many patients considering options for kidney replacement therapy. This month’s cover illustrates this sentiment with its portrayal of a bucolic country farmhouse on a sunny day. Most patients living with kidney failure in the United States are treated outside of their homes. In this issue, Reddy and colleagues present findings from a mixed methods study that explored patient, care partner, and provider perspectives on barriers to home dialysis informing implementation strategies to increase uptake of home dialysis. Their findings are highly actionable and remind us that the nephrology community must seek creative solutions to increase access to this treatment option for patients who wish to receive dialysis at home.
The painting “Farmhouse with flowering fruit tree” by Graham Beards 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.
SPECIAL COLLECTION: CARDIORENAL
The notion of a clinical connection between disorders of the kidneys and the heart has been around since the days William Osler. In more recent years, it has been increasingly accepted that acute or chronic dysfunction of either organ often leads to acute or chronic dysfunction of the other. These AJKD articles highlight the cardiorenal connection, emphasizing what is known and reminding us that there is still much more to learn and understand.
- The Renal Warrior Project. Join Now
- Source: https://ajkdblog.org/2024/11/01/highlights-from-the-november-2024-issue/