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Rates of lower-extremity amputation among ESRD patients on dialysis have decreased by about half in recent years, but mortality remains high among those who do undergo amputation, reports a study in JAMA Internal Medicine.

The study included 3.7 million records of ESRD patients receiving dialysis from 2000 through 2014, drawn from the US Renal Data System. Yearly cohorts were analyzed to assess trends in nontraumatic lower extremity amputations, classified as major (above- or below-knee) and minor (below-ankle). The effects of age, sex, diabetes, and hospital referral region were examined, along with one-year mortality after amputation.


A new kidney disease gene panel provides a comprehensive, cost-effective tool for genetic diagnosis of patients with cystic and glomerular inherited kidney diseases, reports a clinical investigation in Kidney International.

The researchers developed and evaluated a kidney disease panel consisting of 140 genes having causal or other associations with cystic and glomerular inherited kidney diseases. The study included a validation cohort of 116 patients with known mutations and a diagnostic cohort of 305 patients: 207 with suspected inherited cystic disease and 98 with glomerular disease.

In the validation cohort, 134 of 135 previously known mutations were identified by targeted

In severely obese adults with type 2 diabetes, bariatric surgery reduces the incidence of microvascular complications, including nephropathy, reports a study in Annals of Internal Medicine.

The retrospective study included 4024 patients who underwent bariatric surgery at four US health systems from 2005 to 2011. The patients, aged 19 to 79, were followed up to 2015. About three-fourths of patients were women; the same percentage had a body mass index of 40 kg/m2 or higher.

Bariatric surgery patients were matched for age, sex, body mass index, hemoglobin A1c, insulin use, duration of diabetes, and

Following emergency-only hemodialysis (EOHD) policies for undocumented immigrants causes moral distress and may contribute to burnout among healthcare professionals at safety-net hospitals, reports a qualitative study in Annals of Internal Medicine.

The researchers interviewed 50 physicians, nurses, and other clinicians at safety-net hospitals/systems in two cities (Denver and Houston) that provided a high volume of EOHD for undocumented patients. Thematic analysis was performed to describe the experiences and perspectives of clinicians providing this type of care.

Four major themes were identified. Emergency-only dialysis policies contributed to drivers of professional burnout, with healthcare professionals experiencing emotional exhaustion related to

Fibroblast growth factor 23 (FGF-23) does not consistently predict declining kidney function or development of CKD in healthy older adults, reports a study in Kidney International.

The analysis included 2496 well-functioning older adults, aged 70 to 79 years at baseline, enrolled in the prospective Healthy Aging and Body Composition study. Fifty-two percent of participants were women and 38% were black. Levels of FGF-23, measured using a commercial assay, were analyzed as a predictor of subsequent decline in kidney function and incident CKD (based on repeated measurements of cystatin C).

The median FGF-23 value was 46 pg/mL; participants with

Close to 60% of patients undergoing placement of an indwelling urethral catheter experience complications—mainly noninfectious—within 30 days, reports a study in JAMA Internal Medicine.

The prospective cohort study included 2967 patients undergoing new insertion of an indwelling urethral catheter at four US hospitals (including two VA medical centers) over a 2-year period. All were enrolled within 3 days after catheter placement. Patients underwent a baseline examination, with follow-up contacts at 14 and 30 days after insertion. In addition to catheter-related infectious and noninfectious complications, the study assessed impact on activities of daily living, social activities, and general comfort.

A new “six-risk-stage model” provides useful prognostic information for estimating time to end stage renal disease (ESRD) in children with chronic kidney disease (CKD), reports a study in the American Journal of Kidney Diseases.

The analysis included data on 1169 children and adolescents enrolled in North American and European multicenter study cohorts: the Chronic Kidney Disease in Children (CKiD) study and the Effect of Strict Blood Pressure Control and ACE Inhibition on the Progression of CRF in Pediatric Patients (ESCAPE) trial. Patients were classified according to three variables: glomerular filtration rate (GFR), estimated using the CKiD “beside” equation;

For patients receiving targeted therapies for metastatic renal cell carcinoma, outcomes are similar with sunitinib alone versus nephrectomy followed by sunitinib, concludes a trial in The New England Journal of Medicine.

The phase 3 randomized Clinical Trial to Assess the Importance of Nephrectomy (CARMENA) included 450 patients with biopsy-confirmed metastatic renal cell carcinoma, enrolled at 79 centers in France and other European countries. All were suitable candidates for nephrectomy followed by sunitinib. Memorial Sloan Kettering Cancer Center risk category was intermediate risk in about 58% of patients and poor risk in 42%.

After risk stratification, patients were assigned

A teen adherence intervention improves the use of prescribed immunosuppressive medications in adolescent and young adult kidney transplant recipients, reports a randomized trial in the American Journal of Kidney Diseases.

The “Teen Adherence in Kidney Transplant Effectiveness of Intervention Trial” (TAKE-IT) included 169 prevalent kidney transplant recipients, aged 11 to 24 years. Patients were enrolled at least 3 months after transplantation at eight North American transplant centers between 2012 and 2016. One group was assigned to the TAKE-IT intervention, which included text, e-mail, and/or visual cue dose reminders. Every 3 months, patients met with a coach for review

One out of every five patients with non–dialysis-dependent CKD has some form of cognitive impairment. A new study finds that these individuals may experience important differences in their transition to dialysis compared with patients without cognitive impairment.

Patients with advanced CKD are at risk for cognitive impairment, which is commonly underdiagnosed in clinical practice. It is unknown how cognitive deficits may affect planning and preparation for progression to ESRD, so the authors of the American Journal of Kidney Diseases study set out to investigate.

The retrospective study included 630 patients enrolled in the Chronic Renal Insufficiency Cohort (CRIC)