The fact that chronic kidney disease (CKD) and cardiovascular diseases (CVDs) are closely related would not surprise any healthcare professional. Of note, the data show that the primary cause of death resulting from CKD is a cardiovascular event and also that CKD is one of the important risk factors for CVD.
We have established data that CKD awareness and research are lagging despite the significant impact of this disease on patients and the healthcare system. CVD, traditionally thought to be a “male” problem, is actually the main killer of older people of both sexes universally. In fact, each year CVD
Only recently, clonal hematopoiesis of indeterminate potential (CHIP) has been proposed as a novel cardiovascular risk factor linking the innate immune system with aging and vascular inflammation (1, 2).
Somatic gene mutations can spontaneously occur in different cell types and are thought to accumulate throughout a lifetime (3). Certain acquired mutations in hematologic stem cells provide proliferative stimuli and survival advantages and lead to a disproportionate expansion of myeloid leukocyte progenies in peripheral blood. This mechanism has been described for mutations in a set of genes often referred to as leukemia-associated genes or leukemia
In people with chronic kidney disease (CKD), the risk of cardiovascular events is independently related to coronary microvascular dysfunction—and not to estimated glomerular filtration rate (eGFR), according to a study by Navkaranbir S. Bajaj and colleagues in a recent issue of Circulation.
The longitudinal study included 352 patients referred for stress myocardial perfusion positron emission tomography (PET) at the authors’ hospital from 2006 through 2016. Other evaluations included two-dimensional echocardiography and serum creatinine measurement. Patients with overt obstructive coronary artery disease were excluded from the analysis.
The patients’ median age was 55 years; 63% were women and 22%
On April 15, 2019, the results of the CREDENCE (1) and SONAR (2) trials were published. Both trials showed a 35% reduction in the relative risk of composite renal events in people with type 2 diabetes and kidney disease (DKD). Canagliflozin is now the first drug approved by the US Food and Drug Administration in almost two decades for slowing the progression of chronic kidney disease (CKD) in people with type 2 diabetes. By contrast, the future of endothelin receptor antagonists (ERAs) for treating DKD is uncertain. Various forums within the nephrology community have discussed aspects
The Nephrology Match yielded disappointing results again this year.
At the same time, the current state of medical practice as a whole continues to suffer numerous problems, which are well described and largely obvious. Among them is a progressive degree of compartmentalization: Outpatient physicians are abandoning the hospital as a practice site, and hospitalists are quantitatively dominating inpatient medical care, with abandonment of the outpatient setting. This has afforded many efficiencies and advantages, including apparently favorable impacts on hospital metrics. It has also allowed for a form of subspecialization, a supporting argument being that this may better facilitate mastery and
The enduring success of solid organ transplantation over the past six decades is also accompanied by the need for immunosuppression regimens with their related systemic toxicity. Transplantation between immunologically diverse individuals led to shortened allograft survival for immunologic reasons (acute and chronic rejection) and nonimmunologic reasons (toxicity of the immunosuppressive medication regimens).
As a proof of concept, kidney transplantation between genetically identical twins without the requirement of immunosuppressive regimens was successful and ushered in a new era. However, for the larger majority of individuals undergoing allotransplantation, the concept that transplanting the donor’s immune system (bone marrow) along with the solid
A top area to watch in 2020 is the new emphasis on home dialysis. On July 10, 2019, President Donald Trump signed an executive order launching Advancing American Kidney Health. Based on this executive order, the US Department of Health and Human Services (HHS) released three major goals to improve kidney health. The first goal is that 80% of incident kidney failure patients in 2025 receive a home modality of dialysis or a transplant. To facilitate this goal, mandatory and voluntary reimbursement models are being released. The mandatory model, ESRD Treatment Choices, will incentivize the provision of dialysis in the
Advancement in hypoxia-inducible factor (HIF) stabilizers for treating anemia of chronic kidney disease (CKD) is a prime area to watch in 2020.
Anemia is a major complication of CKD. Defining anemia as serum hemoglobin ≤12 g/dL in women and ≤13 g/dL in men, one study found that with an estimated 14% of the US adult population having CKD during 2007–2010, anemia was twice as prevalent in people with CKD (15.4%) compared with the general population (7.6%). Anemia prevalence increased with stage of CKD, from 8.4% at stage 1 to 53.4% at stage 5 (1). Among 22.8% of CKD
The World Health Organization has declared 2020, the 200th anniversary of the birth of Florence Nightingale, the Year of the Nurse. Nurses are encouraged by the exposure this will bring to the profession, as it promises to highlight their many roles. Further, nephrology nurses are cautiously excited about the recent focus on kidney health and the role nephrology nurses will play in implementing the Advancing American Kidney Health (AAKH) initiative launched in 2019. This executive order places a focus on kidney health by increasing patient choice with a focus on home dialysis therapy options, kidney disease prevention, and strategies to
Every morning people wake up and start their day. They take their kidney health for granted. I was one of those people. For me, that all changed in May 2008 when I received a diagnosis of IgA nephropathy.
I would like to share my transplantation journey for a few reasons: to encourage others to become more aware of their kidney health, to let other people with kidney failure know that there is hope for them, and last, to raise awareness of the need for organ donors and inspire others to become living donors.