Feature Channels: Kidney Disease

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Kidney disease a growing public health problem: ASN urges Congress to make a difference.

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• A technique that removes additional toxins during dialysis does not improve kidney failure patients’ survival or heart health, but intense treatments may provide a benefit. • The technique, called hemodiafiltration, deserves more study. Kidney failure is on the rise and currently afflicts 2 million people worldwide.

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• A policy instituted in 2005 has reduced racial disparities in deceased-donor kidney transplantation among children. • Since the institution of the policy, called Share 35, fewer children receive kidneys from living donors. More than 800 children and adolescents in the U.S. are waiting for a kidney transplant.

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1) Information on a mandatory Medicare form regarding the care that older chronic kidney disease patients receive doesn’t match the actual care that is billed by physicians. 2) Better accuracy and consistency are needed when clinicians complete this form and submit it to Medicare.

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New research by scientists at Washington University School of Medicine in St. Louis provides evidence to explain why some people are more likely to develop kidney stones than others. Their discovery opens the door to finding effective drug treatments and a test that could assess a person’s risk of the condition.

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• Minorities–especially African Americans, Hispanics, Pacific Islanders, and Native Americans–face a disproportionately increased risk for developing kidney disease. • The American Society of Nephrology, Dialysis Patient Citizens, and the National Urban League are hosting a Kidney Health Disparities Congressional Briefing this week.

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Kidney cancer patients who had only their tumor removed had better survival than patients who had their entire kidney removed, according to a new study from researchers at the University of Michigan Comprehensive Cancer Center.

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Aristolochic acid (AA), a component of a plant used in herbal remedies since ancient times, leads to kidney failure and upper urinary tract cancer (UUC) in individuals exposed to the toxin.

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Highlights: • In the largest observational study of its kind, 84% of all women and 55% of sexually active women on hemodialysis experienced sexual problems. • Sexual dysfunction was reported more often by women who were older, were less educated, had signs of depression, had reached menopause, had diabetes, and took diuretic therapy, or ‘water pills.’

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• For most kidney failure patients, the age of a live donor—ranging from 18 to 64 years—has an insignificant effect on the long-term health of a transplanted kidney. • The finding should encourage more people to take part in living donor paired exchange programs, or kidney swaps.

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• Patients with kidney failure have relatively poor physical health. • Frequent dialysis does not markedly improve kidney failure patients’ overall physical capacity compared with conventional dialysis.

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Researchers from Mount Sinai School of Medicine have identified a regulator protein that plays a crucial role in kidney fibrosis, a condition that leads to kidney failure. Finding this regulator provides a new therapeutic target for the millions of Americans affected by kidney failure.

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• Chronic kidney disease doesn’t always lead to kidney failure, and in some cases, kidney function can improve. • In this study, 10% of patients did not experience progressive kidney dysfunction, and 3% demonstrated clearly improved kidney function. • 60 million people globally have chronic kidney disease.

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Elderly people with the metabolic syndrome—defined as having multiple risk factors associated with developing diabetes and heart disease—had an increased risk of chronic kidney disease, according to a recent study accepted for publication in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM).

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• Kidney disease patients experience low complication rates after weight-loss surgery. • Maintaining weight loss is challenging for kidney disease patients, and obesity can limit their eligibility for kidney transplants. • Long-term studies are needed to determine whether the potential benefits of weight-loss surgery outweigh risks for kidney disease patients.

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1) Frequent or extended dialysis treatments during the day or at night may improve patients’ survival compared with conventional dialysis. 2) Nighttime or daily dialysis may also improve patients’ health and reduce their need for medications. 3) Approximately 2 million patients in the world receive some sort of dialysis treatment.

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A Loyola University Medical Center patient has become the final link in the world's longest living-donor kidney transplant chain. The chain involved 30 donors, 30 recipients and 17 hospitals nationwide. Loyola is the only Illinois hospital in the chain.

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Highlights: 1) Certain treatment reminders meant to improve primary care physicians’ prescribing habits for patients with chronic kidney disease (CKD) are ineffective. 2) Nearly 20% of people over the age of 65 years have CKD, and primary care physicians care for the vast majority of them. 3) Additional studies are needed to find ways to help improve physicians’ care of CKD patients.

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-New study published in Science Translational Medicine demonstrates microRNA-21 contributes to fibrogenesis in the kidney -Regulus, in partnership with Sanofi, developing novel anti-fibrotic therapies targeting microRNAs

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Patients with chronic kidney disease who received the vitamin D compound paricalcitol for up to 48 weeks did not show improvement on measures of cardiac structure, function, or left ventricular mass, compared to patients who received placebo, according to a study in the February 15 issue of JAMA.

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Tenofovir, one of the most effective and commonly prescribed antiretroviral medications for HIV/AIDS, is associated with a significant risk of kidney damage and chronic kidney disease that increases over time, according to a study of more than 10,000 patients led by researchers at the San Francisco VA Medical Center and the University of California, San Francisco (UCSF).

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1) Home-based dialysis treatments for kidney failure are on the rise, particularly in developing countries. 2) Developed countries appear to be turning to home-based dialysis less. 3) Approximately 2 million kidney disease patients in the world receive some sort of dialysis treatment.

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Highlights • More than 20 million adults in the United States have chronic kidney disease. • Drugs that treat red blood cell deficiencies are critical for maintaining many chronic kidney disease patients’ health. • Experts comment on newly released federal recommendations for these drugs.

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Highlights • High levels of TNF receptors in the blood increased diabetes patients’ risk of developing kidney problems by three- to five-fold a decade later. • Measuring blood levels of TNF receptors may help predict which patients’ kidneys are in jeopardy, and targeting TNF receptors may help protect them. • Half a million people in the U.S. have kidney failure and require dialysis or a kidney transplant, and 44% of these cases are due to diabetes.

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Highlights • Bleeding in the upper gastrointestinal tract occurs more than 10 times as often in kidney failure patients than in individuals in the general population. • Upper gastrointestinal bleeding causes serious health problems—and even early deaths—for many patients with kidney failure. • More than 600,000 patients in the United States have kidney failure.

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1) Certain measures of kidney health can also predict who is likely to die prematurely. 2) Blood levels of the proteins creatinine, beta trace protein, and cystatin C may portray aspects of health that go beyond the kidneys. 3) Future studies should investigate whether a panel of markers of kidney function would provide a better prediction of an individual’s prognosis than any one marker alone.

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1) Among patients on dialysis, African Americans tend to live longer than whites. 2) This survival difference only exists among patients with high levels of inflammation. 3) Determining inflammation’s role may improve survival for all patients treated with dialysis.

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Mayo Clinic in Florida is now offering kidney and pancreas transplants to HIV positive patients with advanced kidney disease and diabetes.

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Highlights: 1) People with type 1 diabetes are at high risk of developing kidney disease. 2) Intensive diabetes therapy can preserve kidney function in patients with type 1 diabetes. 3) Between one million and three million Americans may have type 1 diabetes. Each year, more than 15,000 children and 15,000 adults - approximately 80 people per day - are diagnosed with type 1 diabetes in the United States.

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Highlights: 1) Medicare will soon reduce reimbursements to some dialysis facilities, which may lead to closures. Patients will have to drive further to get care at other facilities, which could compromise their health. 2) The Healthy People initiative provides 10-year national objectives for improving the health of all Americans. Healthy People 2020 presents new kidney-related objectives.

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Highlights: 1) Sitagliptin is as effective as glipizide at lowering blood sugar levels in patients with type 2 diabetes and chronic kidney disease. 2) Sitagliptin is less likely than glipizide to cause dangerously low blood sugar levels. 3) Patients on sitagliptin tend to lose weight, while those on glipizide gain weight.

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Highlights: 1) Pomegranate juice lowers kidney disease patients’ cholesterol, blood pressure, and the need for blood pressure medications. 2) More than 15% of kidney disease patients take herbs or dietary supplements that the National Kidney Foundation says may be harmful to their health.

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Highlights: 1) Pediatric racial minorities are much less likely than whites to get kidney transplants before they need dialysis, regardless of their families’ income. 2) Among children with kidney failure waiting for a transplant, blacks with no health insurance are more likely to die than whites, while Hispanics are less likely to die than other racial groups regardless of insurance status.

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1) Healthy individuals over 70 years old can safely donate a kidney. 2) Kidneys from elderly donors do not last as long as those from younger living donors, but they last just as long as organs from younger deceased donors. 3) Nearly 90,000 people in the U.S. are waiting for a kidney transplant, and many will die before a suitable organ becomes available.

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1) Patients with an autoimmune disease called anti-neutrophil cytoplasmic antibody-associated vasculitis produce antibodies that damage blood vessels in the kidneys. 2) Patients with the disease harbor elevated blood levels of the protein Flt1, which hinders blood vessel repair. 3) Inhibiting Flt1 may help prevent kidney failure in the 1:50,000 patients around the world who have anti-neutrophil cytoplasmic antibody-associated vasculitis, plus those with other more frequent diseases involving blood vessels in the kidneys.

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1) Pyridorin, a vitamin B6 derivative, may help slow or prevent the progression of mild kidney disease in some patients with diabetes. 2) The drug does not appear to help diabetics with more advanced kidney disease. 3) The prevalence of type 2 diabetes is expected to double by 2030. Kidney disease cases are sure to rise in parallel.

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1) Suloxdexide is no better than placebo at preventing kidney failure or reducing urinary protein excretion in diabetes patients with kidney failure. 2) Kidney disease due to diabetes is the most common cause of kidney failure in developed countries. 3) The prevalence of type 2 diabetes is expected to double by 2030. Kidney disease cases are sure to rise in parallel.

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1) Autosomal dominant polycystic kidney disease affects 12.5 million people worldwide; some patients develop severe disease during early childhood 2) Certain genetic mutations aggravate the disease and cause early symptoms 3) Genetic tests could identify who’s at risk for early disease.

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1) One out of 20,000 newborns has autosomal recessive polycystic kidney disease, and 30% die shortly after birth. 2) The gene that’s implicated in the disease produces a protein that’s important for signaling in the kidneys 3) New urine tests might help diagnose the disease.

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Gene testing could help identify patients who need early treatment.

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Effects of a particularly devastating human kidney disease may be blunted by making a certain cellular protein receptor much less receptive, according to new research by scientists from North Carolina State University and French universities and hospitals.

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Researchers at Albert Einstein College of Medicine of Yeshiva University have shown that close supervision by rheumatologists and the use of immunosuppressant drugs improve the survival of lupus patients with end-stage kidney disease—a finding that could reverse long-standing clinical practice. Their study appeared in the September 1 online edition of the Journal of Rheumatology.

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Clinicians can monitor kidney function with a simple equation.

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Researchers at Wake Forest Baptist Medical Center report that sickle cell trait is not a risk factor for the development of severe kidney disease in African-Americans. This study, published in the August online issue of Kidney International, contradicts findings from a 2010 study that first suggested that having one copy of the sickle cell gene was a kidney disease risk factor.

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1) High blood levels of the hormone FGF-23 warn of heart problems, need for dialysis, and early death among chronic kidney disease patients. 2) Tests for FGF-23 could identified those at risk. 3) 60 million people globally have chronic kidney disease, and most die from heart-related problems.

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1) People with metabolic syndrome have a 55% increased risk of developing kidney problems; 2) Approximately 34% of US adults have metabolic syndrome; 3) Approximately 60 million people globally have chronic kidney disease. Early detection and prevention of kidney disease is the only way to prevent kidney failure.

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1) A minocycline-EDTA solution prevents bacterial infections in the catheters of dialysis patients; 2) Multicenter, randomized, controlled trial compared minocycline-EDTA with heparin as catheter solutions; 3) Catheter-related infections present major challenges in dialysis care; infections represent the second leading cause of death in dialysis patients.

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1) One dose produced antibodies in 81.8% of healthy controls, but only 41.8% of transplant patients and 33.3% of dialysis patients; 2) These special groups probably need two doses of the vaccine, say authors.

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1) Chronic kidney disease (CKD) patients with high blood phosphate levels develop kidney dysfunction or kidney failure faster than patients with low blood phosphate levels; 2) High blood phosphate interferes with important kidney medications; 3) Nearly 17% of the adult U.S. population has CKD; effective treatment is crucial to prevent kidney failure.

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Heart disease causes 35% of deaths in young adults with chronic kidney disease Children with only mildly impaired kidney function experience poor growth, delayed puberty, metabolic problems, and high blood pressure. Treating these conditions during childhood might slow kidney disease and prevent heart-related deaths in young adults.