Interventional nephrology is in the midst of an exponential growth phase, with data from the U.S. Renal Data System suggesting that at least 25 percent of total vascular access procedure costs are billed by nephrologists (1). Indeed, it is likely that the growth of interventional nephrology as a distinct discipline within nephrology has played an important role in the success of process-of-care initiatives, such as Fistula First, which has raised the arteriovenous fistula (AVF) prevalence rate from 34 percent in December 2003 at the start of this initiative to 59.5 percent as of August 2011 (2).
Hemodialysis (HD) sustains life for those with ESRD. Currently, nearly 400,000 individuals in the United States receive HD as management of ESRD (1). Sustainable vascular access that provides high-volume blood flow rates (Qb) above 300 mL/min is essential, whether through arteriovenous autologous fistulas, synthetic grafts, or tunneled dialysis catheters (TDCs) (2). Unfortunately, the overwhelming majority of incident patients begin HD treatments with a TDC: 82 percent, according to the most recent data from the U.S. Renal Data System (1). More than 20 percent of prevalent patients become or remain dependent on long-term TDC use,
Arterial calcification is a common problem in advanced kidney disease and contributes to the high prevalence of cardiovascular disease. There are two forms: neointimal calcification, associated with atherosclerosis, and medial calcification. The former is not exclusive to renal failure and occurs in anyone with atherosclerosis. It is unclear whether this has any clinical significance other than being a convenient marker of atherosclerosis. Medial calcification is independent of atherosclerosis and is strongly linked with chronic kidney disease (CKD). Recent data based on mammography show that there is a more than threefold risk of medial calcification in ESRD and that this risk
Keith Hruska, MD, chief of pediatric nephrology at Washington University in St. Louis, becomes the new president of the American Society for Bone and Mineral Research (ASBMR) at this month’s annual meeting of the ASBMR in San Diego. He will be the first nephrologist to hold this prestigious position in the history of the society.
“The bone–kidney connection has changed with new understanding of the pathophysiology of chronic kidney disease (CKD)-mineral bone disorder (MBD),” said Hruska, a longstanding member of the American Society of Nephrology (ASN). “The nephrology contingent in the ASBMR used to be much stronger. Hopefully we can
Phosphate is a true uremic toxin. Cross-sectional studies in patients undergoing dialysis uniformly demonstrate an increased risk of mortality with increasing phosphate levels. The population-attributable risk of mortality in dialysis patients is markedly greater for phosphate than anemia or urea reduction ratio. Additional cross-sectional studies in patients with and without chronic kidney disease (CKD) who are not yet receiving dialysis have demonstrated that phosphate levels in the upper quartile or tertile within this normal range have increased cardiovascular and/or all-cause mortality. In vitro, animal, and some human studies demonstrate that control of extracellular phosphate levels attenuates the process of vascular
One might think that rare diseases are rare. But if one were to combine all the rare diseases that affect Americans, the overall prevalence is not rare at all. In fact, 30 million Americans, or roughly 10 percent of the population, are affected by a rare disease. Many of these disorders are severe and lead to a significant effect on people’s lives and life expectancy. To bring new and concentrated attention to these often poorly studied disorders, 19 collaborative consortia were funded in 2009 by the Rare Disease Clinical Research Network, a project jointly sponsored by the National Institutes of
Of longstanding interest to nephrologists, vitamin D has now become a hot topic in the general medical and lay literature. While the beneficial effects of vitamin D on mineral metabolism have been appreciated for a century, a burgeoning body of literature attests to a multitude of other effects including modulation of the immune system, anti-infectious and anti-neoplastic effects, anti-proteinuric effects, antagonism of the renin angiotensin system with attendant cardiovascular benefits, and insulin-sensitizing effects.
Low vitamin D levels have been correlated with a greater incidence of several cancers including prostate and breast; autoimmune diseases such as multiple sclerosis; and metabolic syndrome.
Patients with advanced chronic kidney disease (CKD) and type 2 diabetes who took bardoxolone, a first-in-class oral antioxidant inflammation modulator, continued to show improvements in their estimated glomerular filtration rates (eGFR) at 52 weeks, mirroring results at 24 weeks that were presented at least year’s American Society of Nephrology meeting in Denver.
Speaking at the 48th Congress of the European Renal Association – European Dialysis and Transplant Association (ERA-EDTA) in Prague, David Warnock, MD, professor of medicine at the University of Alabama at Birmingham, told the congress that these latest results suggest that the drug may be useful for treating
One simple, no-cost change appears to lower cardiovascular (CV) risk among patients with resistant hypertension. By taking their antihypertensive medications at bedtime instead of in the morning, patients in a Spanish trial significantly reduced their cardiovascular risk.
Researchers have known that sleep-time blood pressure (BP) better predicts CV risk than does either the awake or 24-hour BP means. However, all previous studies relied on a single baseline ambulatory blood pressure monitoring (ABPM) profile on each participant at the beginning of the study. Thus, they could not detect changes in the pattern or level of BP if they occurred.
With the incidence and prevalence of cardiovascular disease (CVD) increasing worldwide and its connection to chronic kidney disease (CKD), the new president of the European Renal Association – European Dialysis and Transplant Association outlined in a news conference at the association’s 48th Congress in Prague several steps by which physicians can help to alleviate the personal and economic burdens of CVD. CVD is responsible for about 10 percent of all illness and 30 percent of all deaths in the world.
Raymond Vanholder, MD, PhD, professor of medicine at the University of Ghent and clinical head of the nephrology division of