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The announcement by Medtronic that the SYMPLICITY HTN-3 trial failed to meet its primary effectiveness end point calls the blood pressure lowering effects of renal denervation into question. However, its safety is proven, which raises the possibility that the procedure might have beneficial effects on the kidneys beyond blood pressure reduction.
A new study reports that 30.5% of kidney transplant recipients have an early hospital readmission (EHR; defined as within 30 days of discharge). As EHR is a strong independent risk factor for allograft loss and mortality, efforts should be made to implement and improve systems to minimize risk of EHR in these patients.
Pulsatile perfusion is increasingly being used to preserve kidneys harvested from non-standard-criteria donors. Indeed, retrospective analyses have shown that machine preservation is associated with reduced rates of delayed graft function. However, well-designed prospective clinical trials are needed to evaluate its impact on organ discard, rejection, long-term graft function, and cost.
Failure to achieve blood pressure control in patients with hypertension despite the use of three or more antihypertensive drugs is becoming more frequent. Although treatment-resistant hypertension has been associated with an increased risk of cardiovascular events, new evidence indicates treatment-resistant hypertension is an important risk factor for end-stage renal disease.
Fujii and colleagues define 'subacute' kidney injury (s-AKI) as AKI that takes >7 days to develop, timed from admission or lowest creatinine measurement after admission. Although s-AKI is unlikely to be a distinct syndrome from AKI, the association with increased mortality highlights the need to monitor patient creatinine levels.
A new haemodialysis catheter-care procedure has been reported, including exit-site disinfection with chlorhexidine gluconate that results in a sustained reduction in bacteraemia rates, new intravenous antibiotic starts and sepsis-associated and access-associated hospitalization rates compared with standard care. These findings have potential implications for the prevention of haemodialysis catheter-associated infections.
For most patients with end-stage renal disease (ESRD), a kidney transplant is the best treatment option. Compared with dialysis, a successful kidney transplant is associated with increased life expectancy and improved quality of life; a living donor transplant is associated with better long-term results than a deceased donor transplant.
'Chronic kidney disease (CKD) in older people' is the focus of World Kidney Day 2014. In this article, we discuss the key links between kidney function, age, health and illness, as well as the implications of the ageing population for the care of people with CKD.
