American Journal of Kidney Diseases

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Recent advances in glomerular biology have expanded our understanding of glomerular diseases, leading to more precise therapeutic options. Since the discovery of the autoantigen phospholipase A2 receptor in primary membranous nephropathy 10 years ago, the serologic evaluation of glomerular diseases has become more detailed and nuanced for nephrologists. In addition to phospholipase A2 receptor antibodies, circulating autoantibodies now include thrombospondin type 1 domain-containing 7A and most recently, neural epidermal growth factor-like 1 protein for membranous nephropathy...

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Obesity prevalence continues to increase worldwide, accompanied by a rising tide of hypertension, diabetes, and chronic kidney disease (CKD). While body mass index is typically used to assess obesity in clinical practice, altered body composition (e.g. reduced muscle mass, increased visceral adiposity) are common among patients with CKD. Weight loss achieved through behavioral modification or medications reduces albuminuria, and in some cases, slows decline in estimated glomerular filtration rate (eGFR). Use of medications that promote weight loss with favorable cardiovascular risk profiles should be promoted, particularly in patients with type 2 diabetes, obesity, and CKD...

In recent years, a growing body of evidence has emerged on the benefits of plant-based diets on the prevention and treatment of lifestyle diseases. In parallel, data now exist regarding the treatment of chronic kidney disease (CKD) and its most common complications with this dietary pattern. Improving the nutrient quality of patients by including a higher proportion of plant-based foods while reducing total - and animal protein - intake may reduce the need for - or complement - nephroprotective medications, improve kidney disease complications, and, perhaps, favorably affect disease progression and patient survival...

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Antibiotic use is necessary in the outpatient hemodialysis setting, as patients on hemodialysis are at increased risk for infections and sepsis. However, inappropriate antibiotic use can lead to adverse drug events, including adverse drug reactions and infections with Clostridioides difficile and antibiotic-resistant bacteria. Optimizing antibiotic use can decrease adverse events and improve infection cure rates and patient outcomes. The American Society of Nephrology (ASN) and the Centers for Disease Control and Prevention (CDC) created the Antibiotic Stewardship in Hemodialysis White Paper Writing Group, comprising experts in antibiotic stewardship, infectious diseases, nephrology, and public health, to highlight strategies that can improve antibiotic prescribing for patients on maintenance hemodialysis...

RATIONALE AND OBJECTIVE: Kidney biopsy data inform us about pathologic processes associated with SARS CoV-2 infection. We conducted a multi-center evaluation of kidney biopsy findings in living patients to identify various kidney disease pathology in patients with COVID-19 and their association with SARS-CoV-2 infection. STUDY DESIGN: Case series. SETTING AND PARTICIPANTS: We identified 14 native and 3 transplant kidney biopsies performed for-cause in patients with documented recent or concurrent COVID-19 infection treated at 7 large hospital systems in the United States...

Primary cilia are specialized sensory organelles that protrude from the apical surface of most cell types. Over the past two decades, they have been found to play important roles in tissue development and signal transduction, with mutations in ciliary-associated proteins resulting in a group of diseases collectively known as ciliopathies. Many of these mutations manifest as renal ciliopathies, characterized by kidney dysfunction resulting from aberrant cilia or ciliary functions. This group of overlapping and genetically heterogeneous diseases includes polycystic kidney disease (PKD), nephronophthisis (NPHP) and Bardet-Biedl syndrome (BBS) as the main focus of this review...

RATIONALE & OBJECTIVE: Kidney disease is associated with an increased risk of postoperative morbidity and mortality. However, the incidence of major surgery on a population level is unknown. We aimed to determine the incidence of major surgery by level of kidney function. STUDY DESIGN: Retrospective cohort study with entry from January 1 2008 until December 31 2009, and outcome surveillance from January 1 2010 to December 31 2016. SETTING & PARTICIPANTS: Population-based study using administrative health data from Alberta, Canada; adults with an outpatient serum creatinine measurement or on chronic dialysis formed the study cohort...

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RATIONALE & OBJECTIVE: Little is known about perceptions of conservative care for patients with advanced chronic kidney disease (CKD) in the United States. STUDY DESIGN: Qualitative study using cognitive interviewing about attitudes regarding conservative care using decision aids on treatments for advanced CKD developed outside the United States. SETTING & PARTICIPANTS: 14 patients aged ≥75 years with advanced CKD, defined as an eGFR ≤20 ml/min/1...

The COVID-19 pandemic, technological advancements, regulatory waivers, and user acceptance converged to boost telehealth activities during the public health emergency. Providers were able to deliver and bill for services across state lines for new and established patients via HIPAA and non-HIPAA compliant platforms with home as the originating site and without geographic restrictions. Platforms were developed or purchased to perform videoconferencing. The interdisciplinary dialysis team adapted to perform virtual visits...

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No abstract text is available yet for this article.

RATIONALE & OBJECTIVE: The impact of chronic kidney disease (CKD) on inpatient health care utilization is unknown. This study aimed to describe the prevalence of pediatric CKD among children hospitalized in the United States and examine the association of CKD on hospital outcomes. STUDY DESIGN: Cross-sectional national survey of pediatric discharges SETTING AND PARTICIPANTS: Hospital discharges of children (ages >28 days to 19 years) with a chronic medical diagnosis included in the Health Cost and Utilization Project Kids Inpatient Database for the years 2006, 2009, 2012, and 2016...

RATIONAL & OBJECTIVE: β-blockers are recommended for heart failure (HF) patients but their benefit in the dialysis population is uncertain. β-blockers are heterogeneous including with respect to their removal by hemodialysis. We sought to evaluate whether β-blocker use and their dialyzability characteristics were associated with early mortality among chronic kidney disease (CKD) patients with HF who transitioned to dialysis. STUDY DESIGN: Retrospective cohort study SETTING AND PARTICIPANTS: Adults patients with CKD (age ≥ 18 years) and HF who initiated either hemodialysis or peritoneal dialysis during 1/1/2007-6/30/2016 within an integrated health system were included...