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Bridget M. Kuehn

A growing understanding of the health and psychosocial risks associated with being a living kidney donor is helping drive innovations that will improve the informed consent process, according to recent research.

Receiving a kidney donated by a living donor greatly improves the outcomes of patients with kidney failure. But it also creates risks for the 30,000 otherwise healthy donors around the world who donate kidneys each year. Ensuring that living donors give proper informed consent is essential. Now, a growing body of evidence on the risks associated with living kidney donation and emerging tools to help clinicians and patients assess

In a diverse urban population, low dietary quality is associated with an increased risk of declining kidney function among adults with hypertension, reports a study in the Journal of Renal Nutrition.

The study included data on 1534 participants in the “Healthy Aging in Neighborhoods of Diversity across the Life Span” (HANDLS) study: African Americans and whites, aged 30 to 64 years, with a baseline estimated glomerular filtration rate (eGFR) of 60 mL/min/1.73 m2 or higher. Mean age was 48 years; 59% of participants were African American.

A Dietary Approaches to Stop Hypertension (DASH) score, based on

For patients with diabetes—including but not limited to low-income patients—switching to high-deductible health plan (HDHPs) leads to major increases in emergency department visits for preventable acute diabetic complications, reports a study in JAMA Internal Medicine.

The researchers analyzed the effects of an employer-mandated switch to HDHPs in 12,084 diabetic patients, aged 12 to 64 years. All were enrolled in a low-deductible plan ($500 or less) for 1 year, followed by 2 years in an HDHP ($1000 or higher). The HDHP patients were propensity score-matched to patients who remained on low-deductible plans only.

The effects of switching to an

Among patients initiating dialysis, mortality is higher for those with a primary indication of volume overload or hypertension, suggests a study in the American Journal of Kidney Diseases.

The retrospective analysis included 461 patients who initiated hemodialysis or peritoneal dialysis (24 patients) from 2004 through 2012 at 14 facilities. All-cause mortality was analyzed for patients with differing primary indications for dialysis initiation: laboratory evidence of kidney function decline (reference category), uremic symptoms, volume overload, hypertension, or “other/unknown.”

At a median follow-up of 2.4 years, 40% percent of patients had died. Crude mortality was 21.7 per 100 patient-years for

Treatment with fish oil and/or aspirin does not reduce the risk of arteriovenous fistula (AVF) failure, reports a randomized trial in JAMA Internal Medicine.

The “Omega-3 Fatty Acids (Fish Oils) and Aspirin in Vascular Access Outcomes in Renal Disease” (FAVOURED) study included 567 patients at 35 dialysis centers in Australia, Malaysia, New Zealand, and the United Kingdom. All patients had stage 4 or 5 chronic kidney disease and were undergoing surgical AVF creation.

Patients were randomly assigned to receive fish oil, 4 g/d, or placebo. A subset of 406 patients were further assigned to aspirin, 100 mg/d, or

Among living kidney donors, the long-term risk of ESRD is close to doubled for those who are obese, reports a study in Kidney International.

The study included data on 119,769 living kidney donors, linked to Centers for Medicare & Medicaid Services data to determine ESRD status. There were 20,588 obese donors, body mass index (BMI) 30 kg/m2 or higher; and 58,004 nonobese donors. (The remaining 41,177 donors had missing data on BMI.) Postdonation risk of ESRD was compared between groups, with adjustment for potential confounders.

Twenty years after living kidney donation, the cumulative incidence of ESRD

More than 1 billion people worldwide now have hypertension, with the highest levels now seen in low-income countries in south Asia and sub-Saharan Africa, according to a report in The Lancet.

The NCD Risk Factor Collaboration analyzed pooled data from 1479 studies that had measured blood pressure in 19.1 million adults. The researchers analyzed trends in mean systolic and diastolic blood pressure from 1975 to 2015, as well as the prevalence of raised blood pressure (140/90 mm Hg or higher) in 200 countries.

In 2015, global age-standardized mean blood pressure increased systolic blood pressure was 127.0/78.7 mm Hg

The quality of primary care management of diabetes is lower for physicians with higher-volume practices, but higher for those with greater diabetes-specific volume, reports a study in Annals of Internal Medicine.

Using Ontario health databases, the researchers analyzed data on more than 1 million adults with diabetes who received care from approximately 9000 primary care physicians during 2011. For each physician, overall ambulatory volume and diabetes-specific volume were assessed. These two measures were analyzed for association with six selected indicators of quality of diabetes care, addressing disease monitoring, prescription of appropriate medications, and adverse clinical outcomes.

For most

Risk of end stage renal disease (ESRD) shows more than twofold variation across different racial/ethnic groups, according to a paper in the American Journal of Kidney Diseases.

The researchers analyzed USRDS data to estimate the short- and long-term probabilities (risks) of ESRD by age, sex, and race/ethnicity. Based on 2013 data, the lifetime risks of ESRD among males varied substantially by racial/ethnic group: 3.1% for non-Hispanic whites, 3.8% for Native Americans, 5.1% for Asian/Pacific Islanders, 6.2% for Hispanics, and 8.0% for non-Hispanic blacks. Lifetime risks were lower but also variable among females: 2.0% for non-Hispanic whites, 3.6% for

Data on kidney function and microalbuminuria are associated with the risk of congestive heart failure in an African American population, reports a study in Nephrology Dialysis Transplantation.

The researchers present data from 3332 African American participants enrolled in the community-based Jackson Heart Study. All were initially free of heart failure. Baseline measurements showed that 5% of participants had an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m2, while 12% had a urine albumin:creatinine ratio (ACR) of 30 mg/g or higher. These kidney disease measures were evaluated for association with later subclinical evidence (based on