Researchers at the University of California, San Diego School of Medicine say that, while a prevailing theory suggests elevated cellular levels of glucose ultimately result in diabetic kidney disease, the truth may, in fact, be quite the opposite. The findings could fundamentally change understanding of how diabetes-related diseases develop – and how they might be better treated.
Highlights • After a median of 2.4 years of follow up, 86.5% of transplants of donor kidneys considered “high-risk” for infection and disease were functioning with no evidence of infections. • Such “high-risk” organs are relatively safe when screened with current methods.
• Paying living donors $10,000 could be cost-saving even if it only resulted in a 5% increase in the number of donors.
The American Society of Nephrology strongly recommends that all adults undergo routine screening for chronic kidney disease (CKD), the 8th leading cause of death in the U.S. This contradicts screening guidelines recently released by the American College of Physicians (ACP).
Increased vitamin D levels may prevent a wide range of diseases, according to recent studies. However, some previous studies led to a concern that vitamin D supplementation could increase an individual’s risk of developing kidney stones.
Children who undergo transplants of solid organs have a high risk of developing advanced kidney disease, according to a new national study. The findings reinforce the importance of continued screening of kidney function in these children.
• Among kidney failure patients with depression who received behavioral therapy chair-side for three months while undergoing dialysis, 89% were not depressed at the end of treatment. Only 38% of patients in a control group were not depressed. • Patients in the treatment group experienced greater improvements in quality of life and were better able to control fluid intake between dialysis sessions (which makes the next dialysis session more efficient).
• Among kidney transplant recipients younger than 40 years of age, African Americans and individuals with less education were more likely to receive lower-quality organs than Caucasians and those with college degrees. • African Americans with higher education levels were not more likely to receive a lower-quality kidney than Caucasians with college degrees.
• Hispanics were just as likely as non-Hispanic whites to be put on the kidney transplant waitlist. • Once waitlisted, Hispanics were less likely to receive a transplant from a deceased donor. This disparity was largely explained by differences in patient blood type and regional variability of organ supply among organ procurement organizations across the country.
Researchers at the University of California, San Diego School of Medicine have identified 13 metabolites – small molecules produced by cellular metabolism – that are significantly different in patients with diabetes and chronic kidney disease compared to healthy controls.
• Unlike in normal-weight mice with kidney disease, a degradation process called autophagy is suppressed in obese mice with kidney disease. This suppression leads to kidney cell damage. • Obese kidney disease patients also have suppressed autophagy.
Study is first to reveal the role of the kidney in the regulation of iron metabolism following injury.
• A protein called polycystin-1 may help shepherd another protein, polycystin-2, to a cell’s antenna, or cilium. This process is defective in induced pluripotent stem cells derived from patients with autosomal dominant polycystic kidney disease. • Placement of the normal polycystin-1 protein back into cells can correct this defect. • Pluripotent stem cells from polycystic kidney patients may be useful as “disease in a dish” models for developing new therapeutics.
Dialectical Behavioral Therapy (DBT) shows early evidence as an effective tool in improving medical regimen adherence in adolescents with chronic kidney disease (CKD), enabling them to accept their illness, have a better quality of life and gain eligibility for organ transplantation.
A new, international study found that use of blood levels of cystatin C to estimate kidney function—alone or in combination with creatinine—strengthens the association between kidney function and risks of death and end-stage renal disease. The findings suggest that the use of cystatin C as a measurement of kidney function could lead to better staging and risk classification of chronic kidney disease.
A new, international study from the Chronic Kidney Disease Prognosis Consortium found that use of blood levels of cystatin C to estimate kidney function—alone or in combination with creatinine—strengthens the association between kidney function and risks of death and end-stage renal disease.
Disproving commonly held beliefs, a new study by researchers at the Perelman School of Medicine at the University of Pennsylvania showed that despite a lower frequency of dialysis on Sunday, patients with acute kidney injury (AKI) have mortality rates similar to that of patients who receive the therapy on any other day of the week.
• A structured exercise and lifestyle program can help kidney disease patients become fitter and lose weight, and it can improve their heart health. • Exercise can be safe in patients with kidney disease even if they have various other medical problems.
Eating a healthy diet and drinking a moderate amount of alcohol may be associated with decreased risk or progression of chronic kidney disease (CKD) in patients with type 2 diabetes mellitus, according to a report published by JAMA Internal Medicine, a JAMA Network publication.
• Nephrologists whose dialysis patients had the best survival over six years had a significantly lower patient caseload than nephrologists whose patients had the worst survival. • For every additional 50 patients cared for by a nephrologist, patients had a 2% higher risk of dying within six years.
Early stages of kidney disease cost Medicare tens of billions of dollars each year, according to a study by researchers at RTI International, U.S. Centers for Disease Control and Prevention, and University of Michigan.
• The frequency and duration of patient-doctor contact during dialysis care vary appreciably across countries. • More frequent and longer contact with physicians is linked to fewer deaths and hospitalizations of dialysis patients.
• Researchers found a strong, graded association between worse kidney function and the presence of hypertension that is resistant to medications. • More than 50% of individuals with moderate CKD had resistant hypertension. • Among people with CKD, blacks and those with a larger waist circumference, diabetes, and a history of heart attacks or strokes were more likely to have resistant hypertension.
American Society of Nephrology (ASN) and the ASN Foundation for Kidney Research will fund $3 million in original, meritorious research in 2013.
• Among kidney disease patients receiving pre-dialysis care in a universal healthcare system, black patients experienced a faster progression to kidney failure than whites. • The faster decline in kidney function among black compared with white patients was predominantly present in patients with diabetes and in patients with more advanced kidney dysfunction.
Patients in areas where dialysis care is already limited may be most vulnerable.
A new study from Beth Israel Deaconess Medical Center finds that doctors who treat patients with kidney failure are reluctant to discuss a difficult prognosis, and their patients are likely to have distorted expectations about their own probable outcomes.
• Compared with kidney disease patients who had zero or one heart healthy lifestyle component in the ideal range, those with two, three, and four ideal factors had progressively lower risks for kidney failure over four years. • No kidney disease patients with five to seven ideal factors developed kidney failure. • Patients’ risk of dying during the study followed a similar trend
New research from the UAB School of Public Health shows that patients with chronic kidney disease may improve their health by making lifestyle behavior changes.
• Among patients with chronic kidney disease, those with very low kidney function had a higher risk of having a heart attack than those with higher kidney function over a four-year period. • The link between higher LDL cholesterol and heart attack risk was weaker for patients with very low kidney function than for patients with higher kidney function. 60 million people globally have chronic kidney disease.
Researchers are the first to discover that dramatic creativity can help people with failing kidneys.
• The phosphate binder sevelamer carbonate did not improve cardiovascular measures in patients with early chronic kidney disease. • For now, reducing dietary intake of phosphate may be the best way for these patients to reduce the mineral’s negative effects on the heart. High phosphate levels—in kidney disease patients and in the general population—increase the risk of dying from cardiovascular causes.
• In patients with chronic kidney disease, measures of lower extremity performance were at least 30% lower than predicted, but handgrip strength was relatively preserved. • Each 0.1-meter per second slower walking speed was linked with a 26% higher risk for death over an average three-year follow-up period. • Adding gait speed tests to laboratory tests of kidney function significantly improved the prediction of three-year mortality. 60 million people globally have chronic kidney disease.
• People with apple-shaped bodies tend to have lower kidney function, lower kidney blood flow, and higher blood pressure within the kidneys than people with pear-shaped bodies. • The findings may help explain why people with apple-shaped bodies are more likely than those with pear-shaped bodies to develop kidney disease.
Johns Hopkins scientists have created a free, Web-based tool to help patients decide whether it's best to accept an immediately available, but less-than-ideal deceased donor kidney for transplant, or wait for a healthier one in the future.
• Individuals who are overweight starting in early adulthood are twice as likely to have chronic kidney disease at age 60 to 64 years than those who are not overweight. • Larger waist-to-hip ratios (“apple-shaped” bodies) during middle age are also linked with chronic kidney disease at age 60 to 64 years.
Researchers at the University of California, San Diego School of Medicine have released study results that show national treatment trends in the surgical management of patients with kidney disease. The study found that partial and complete kidney removal (total nephrectomy) and energy-based techniques to destroy tumors are all on the rise. Surprisingly, the patients most in need of kidney-sparing surgery are still more likely to undergo total nephrectomy.
• Among individuals with chronic kidney disease, adherence to a healthy lifestyle was associated with a greater likelihood of surviving over a 13-year period. • The greatest survival benefits were related to nonsmoking. 60 million people globally have chronic kidney disease.
• Suboptimal kidney response to the hormone FGF-23 may put chronic kidney disease patients at increased risk of premature death and cardiovascular events. • Resistance to the hormonal actions of FGF-23 in the kidney may identify novel aspects of kidney dysfunction. 60 million people globally have chronic kidney disease.
• African Americans with kidney disease whose blood pressure changed significantly from day to day were nearly three times as likely to die prematurely than patients whose blood pressure changed very little. African Americans are more likely than whites to develop kidney disease and die prematurely.
• A study of kidney failure patients found that fewer patients in large-metro and rural counties received kidney specialist care before developing kidney failure than patients in medium/small-metro counties. • In all geographic areas, black patients received less care before developing kidney failure than their white counterparts. More than 590,000 Americans in 2010 were treated for kidney failure; more than 20 million Americans had some level of chronic kidney disease.
• Certain mutations and combinations of mutations in immune-related genes affect individuals’ risk of developing a rare but serious kidney condition. • These mutations also affect patient prognosis following different treatments. About half of patients with the condition, called atypical hemolytic uremic syndrome, develop kidney failure.
• A technique that removes additional toxins during dialysis decreased kidney failure patients’ risk of dying from any cause by 30% over three years. • The technique also reduced patients’ risk of dying from heart-related causes or infections.
University of Alabama at Birmingham (UAB) nephrologists have reported for the first time in medical literature cases of acute kidney injury directly linked with synthetic marijuana use. The case studies are reported online in the Clinical Journal of the American Society of Nephrology and will appear in the March 2013 print edition of the journal.
• Adding fruits and vegetables to the diet is an effective alternative to medication to reduce metabolic acidosis and kidney injury in late-stage chronic kidney disease. Metabolic acidosis is a common complication of kidney disease.
• Compared with standard dialysis, frequent dialysis can cause complications related to repeated access to the blood. • The findings provide valuable information for dialysis patients and their physicians.
Acute kidney injury strikes large numbers of hospitalized patients, including those with no prior kidney-related illness, and is one of the most costly and deadly conditions affecting critically ill patients. Findings published today in Critical Care from a Mayo Clinic-led, multicenter study identify two biomarkers of acute kidney injury that can be easily measured in urine and detect affected patients roughly 12 to 36 hours earlier than current tests.
A new study from the Johns Hopkins Bloomberg School of Public Health and the Chronic Kidney Disease Prognosis Consortium (CKD-PC) found that in general chronic kidney disease is similarly associated with a higher risk of death and end stage renal disease for both women and men. The findings were released online in advance of publication in BMJ.
• Among people without diabetes or kidney disease, 10-year mortality was 7.7%. • Among individuals with diabetes but without kidney disease, mortality was 11.5%. • Among those with both diabetes and kidney disease, mortality was 31.1%.
• Residence in areas with higher average household income was linked with improved survival in kidney failure patients. • In White patients, income inequality was associated with mortality. • In Black patients exclusively, residence in highly segregated areas was associated with increased mortality. More than 590,000 Americans in 2010 were treated for kidney failure.
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