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Emily Dryer

KDIGO (Kidney Disease: Improving Global Outcomes) recently updated its guidelines for hypertension management in patients with chronic kidney disease (CKD). While awaiting forthcoming trials for better evidence, the guidelines are a reminder to use an individualized approach to all patients, including patients with end stage kidney disease (ESKD) and kidney transplant recipients (KTRs) (1).

The patient with ESKD

A major challenge in managing hypertension in the ESKD population lies in finding balance between attaining euvolemia while minimizing risk of complications from both hypertension and hypotension (2). Establishing blood pressure (BP) targets for this population is also

Karen Blum

Recent clinical trials in fluid therapies, COVID-19 treatment, and sepsis management were presented at Kidney Week 2021 to keep nephrologists up to date in critical care medicine: The Balanced Solutions in Intensive Care Study (BaSICS) trial (1, 2) of balanced solution versus 0.9% saline in critically ill patients; the Efficacy and Safety of Baricitinib for the Treatment of Hospitalized Adults with COVID-19 (COV-BARRIER) trial (3); and the Vitamin C, Thiamine, and Steroids in Sepsis (VICTAS) trial (4) of vitamin C, thiamine, and hydrocortisone on ventilator- and vasopressor-free days in sepsis.

BaSICS

There

Karen Blum

A new wellness module offered through ASN’s website aims to promote balanced mental health among people who work in dialysis facilities. It conveys that feelings of compassion fatigue experienced during the ongoing COVID-19 pandemic are understandable and offers resources and strategies on how to cope and move forward.

“We’re just beginning to see the mental health fallout of COVID,” said Daniel Cukor, PhD, a coauthor of the new module and director of behavioral health at the Rogosin Institute in New York. There’s a great shift happening now in hesitancy over returning to work in the general population, he said, which

Haresh Selvaskandan

Immunoglobulin A nephropathy (IgAN) is the most common glomerular disorder reported following biopsy worldwide (1-3). A wide variety of histopathological findings can be seen in IgAN, including crescents. Crescents are defined as two or more cell layers in Bowman's space (4). Their presence indicates active inflammation and predicts a poor prognosis in IgAN (4). The temptation to employ immunosuppression in crescentic IgAN is often strong, given the common practice in other glomerular disorders, but is it appropriate in IgAN? Let's consider a case study and explore the evidence for immunosuppression in crescentic

Bridget M. Kuehn

A reduced dose of the inexpensive oral methylprednisolone reduced the risk of kidney failure by 41% over 4 years in patients with immunoglobulin A (IgA) nephropathy in the Therapeutic Evaluation of Steroids in IgA Nephropathy Global (TESTING) study presented during Kidney Week 2021. The drug, however, was associated with an increased risk of severe infection, particularly in the first months of treatment. The TESTING trial results were among several results that promise to help solve “clinical conundrums” in the field of nephrology, presented during the High-Impact Clinical Trials session at Kidney Week 2021.

“These are exciting times in the field

In older adults requiring intensification of antihypertensive therapy, adding a new medication leads to a greater reduction in blood pressure (BP), but maximizing dosage provides a more sustainable effect, reports a study in Annals of Internal Medicine.

The observational study included 178,562 patients requiring intensified antihypertensive treatment in the Veterans Health Administration (VA) system between 2011 and 2013. All patients were aged 65 years or older, had systolic BP (SBP) of 130 mm Hg or higher, and were taking one or more antihypertensive medications at less than maximum dose. Mean age was 75.8 years, and 98.1% of patients

Rachel K.Y. Hung

It is well established that the best treatment for kidney failure is kidney transplantation and that it should be the treatment of choice for all eligible patients. The greatest economic impacts of kidney transplantation, both living and deceased, are savings to the National Health Service (NHS; the universal health service in the United Kingdom) in dialysis costs (1). Living donor kidney transplantation (LDKT) maximizes the opportunity to avoid dialysis via preemptive transplantation. It has a higher success rate of graft survival (as compared to deceased donor kidney transplantation), while adding to the overall supply of organs.

Donation rates

Jose Ibeas

One of the areas with the most promising potential in nephrology is interventional nephrology. However, paradoxically, it is possibly one of the areas most historically neglected by the specialty itself. Its resurgence in recent years, although not an easy process, reflects a history that is common to the entire nephrology community. In Spain, we have not been oblivious to this process, and now it has become one of the greatest challenges in our specialty.

Diagnostic and interventional nephrology is defined as a discipline that uses imaging and interventional procedures in the kidney patient. Although these techniques were mainly developed by

Calculation of the urine anion gap (UAG) was suggested in the 1980s as an easy way to indirectly estimate urine ammonium (NH4) in patients with hyperchloremic metabolic acidosis. This calculation was used by necessity because clinical laboratories were not measuring UNH4 at that time. Despite significant technological advances ever since, most clinical laboratories in this country still do not measure UNH4. The UAG has fallen short as a surrogate for UNH4 for many reasons, and its shortcomings have been recently reviewed in detail (1). The undersigned believe that direct measurement of UNH4 is a test [that] is long

Kate Wyburn

Australia, like many countries around the world, has experienced a decline in living donor transplantation compared to deceased donors. The 2020 Australia and New Zealand Dialysis and Transplant Registry Annual Report (1) (reflecting complete data to 2019) reports that a total of 1104 kidney transplants were performed in 2019, an overall rate of 11.6 transplants per 100 dialysis-years (of people on dialysis aged 15−64 years). Living donor kidneys accounted for 22% of all kidney transplants performed in Australia in 2019. Of the 12,815 (prevalent) people with functioning kidney transplants, 30% (3797) originated from living kidney donors, and living