According to the 2007 National Health Interview survey, fish oil is the most popular dietary supplement used by adult Americans (1). This follows on the heels of decades of well-publicized basic science and clinical research into the biology of long-chain omega-3 fatty acids—the major active ingredient in fish oil—and their influence on a variety of disease processes. Although clinical trials of the use of fish oil in the general population have reported conflicting results, patients with chronic kidney disease (CKD)—in particular end stage renal disease—have several characteristics that may make them an ideal group in which to study
Clinicians are trained to review prescription drugs with patients during their clinic visits and hospital admissions. However, less emphasis is placed on appropriate review and documentation of foods and nutrients that are known or suspected to interact with medications. This scenario places kidney disease patients at significant risk, given the 10 to 12 different medications that are typically prescribed (1). Although the clinician’s time is a limiting factor in conducting nutrient reviews, an even greater problem is the lack of knowledge by clinicians of what nutrients can interact with which drugs and the mechanisms for the interactions. The
Phosphorus levels are elevated in patients with chronic kidney disease due to decreased urinary excretion. Higher levels of blood phosphorus are associated with increased mortality in patients on dialysis, patients with kidney disease not yet on dialysis, and in the general population. In animal studies, adding phosphorus to the diet causes calcification of arteries and progression of kidney disease.
In the petri dish in the lab, adding phosphorus to artery vascular smooth muscle cells results in a change of the cell to become a bone-like cell and to calcify. This and other data support the hypothesis that phosphorus is a
Although cardiologists and nephrologists have debated for years about the relative contributions of the vasculature and the kidney to the pathogenesis of hypertension, new data have emerged that may recast essential hypertension as an autoimmune disease. These studies do not discount the importance of vascular tone and regulation of intravascular volume in the determination of blood pressure. Rather, these novel experiments illustrate that immune cells and inflammatory mediators can influence blood pressure precisely by impacting vascular function and renal sodium handling. Moreover, these recent findings have stimulated renewed interest in earlier, pioneering studies that first hinted at a role for
Body sodium content is most intimately coupled with extracellular water content. The idea is that body fluids inside and outside the cells readily equilibrate, resulting in constant electrolyte concentrations in extra- and intracellular fluids. This concept of constancy of internal environment composition is perhaps one of the hallmarks of medical physiology established by Claude Bernard in the 19th century (1). Sodium homeostasis seems to perfectly fit into this model. Sodium is the major cation in the extracellular fluid compartment where it acts to hold water, thereby determining the extracellular volume. Elaborated from this model, three major assumptions dominate
Renal denervation is an emerging and promising new therapy for resistant hypertension. Although 54 percent of all hypertension is “uncontrolled” (1), not all uncontrolled hypertension is considered resistant. The American Heart Association (AHA) definition of resistant hypertension is BP above goal on at least three antihypertensive medications of different classes, one of which is a diuretic, or BP that requires four or more medications to get to goal. Prevalence in the general hypertensive population is relatively low, but resistant hypertension is commonly seen in nephrology offices.
In evaluating a patient with resistant hypertension, it’s important to consider reversible
Most people with chronic kidney disease (CKD) have high blood pressure. Treatment of hypertension in patients with CKD is considered critical to prevent CKD progression and related cardiovascular events. However, questions remain about the appropriate BP goal. Most evidence indicates there is no benefit of treating to a goal any lower than 140/90 mm Hg, but there is some suggestion that such a goal may be appropriate for patients with albuminuria. Given recent evidence that a lower goal in patients with diabetes (without CKD) actually increases risk, and the subsequent change in American Diabetes Association guidelines from 130/80 mm Hg
Hypertension is a common condition that is a significant risk factor for development of other cardiovascular diseases. The prevalence of hypertension is higher in men than women until after menopause, when the prevalence reverses and is higher in women. In addition, more women die of cardiovascular disease each year than do men.
There is mounting evidence that blood pressure in women is less well controlled than in age-matched men, despite the facts that women see their physicians more frequently and are often more compliant with their medications than men. This statistic makes one consider that either physicians are not as
In 1995, Ratner, Kavoussi, and colleagues at Johns Hopkins University revolutionized live kidney donor transplantation through the development of the laparoscopic donor nephrectomy (1). Since then, the number of live donor transplants in the United States doubled, the number of live donors who are not biologically related to the recipient rose by more than fivefold, and the proportion of donor nephrectomies performed laparoscopically (or laparoscopically assisted) neared 100 percent. Today, approximately one-third of donor nephrectomies are performed using pure laparoscopic techniques, and approximately two-thirds are performed with the additional insertion of one of the surgeon’s hands into the
Transplantation from a living kidney donor provides the best outcomes in recipients with end stage renal disease. However, our knowledge regarding the effects of kidney donation on long-term mental and physical health of the living donor remains incomplete. Published data are largely derived from single-center retrospective studies in young, healthy, and mostly white populations (1), whereas donors in today’s environment are increasingly older, larger, racially diverse, and medically complex (2).
We also suffer from a paucity of information on the psychological and socioeconomic consequences of donation, including the long-term health-related quality of life, financial consequences of