Volume 4 Issue 11, November 2008

Various strategies have been considered in attempts to improve the outcomes of dialysis patients. Such strategies include increasing dialysis dose, using alternative depuration methods, changing dialysis schedules and focusing on preventing or treating specific co-morbidities and complications. In this Viewpoint, Andreas Pierratos discusses the first three strategies, and concludes that he believes that a paradigm shift, a disruptive change-in the form of daily home nocturnal hemodialysis-is needed to improve dialysis outcomes.

The development of a wearable device that can replace conventional dialysis in patients needing chronic renal replacement therapy is not as far-fetched as it once was. Ronco et al. describe technological achievements, propose future research directions and discuss the clinical, technical and socioeconomic reasons for continuing the push to realize the wearable artificial kidney.

Acute phosphate nephropathy has emerged as an important complication of bowel preparation with oral sodium phosphate solution for colonoscopy. Retrospective studies have revealed that acute kidney injury occurs in 1–4% of individuals exposed to oral sodium phosphate. This Review outlines the presentation, risk factors and pathogenesis of acute phosphate nephropathy. The author proffers several recommendations for minimizing the renal risks of oral sodium phosphate.

As a highly vascularized and excretory organ, the kidney is particularly vulnerable to animal toxins. This Review begins with an overview of the mechanisms by which these toxins cause kidney damage—including direct nephrotoxicity and induction of hemodynamic changes. The presentation, pathophysiology and pathology of the renal changes associated with animal toxin poisoning or envenomation are then discussed for each of the relevant animal species in turn.

Maintenance of a functioning vascular access for hemodialysis is a major challenge. This Review summarizes recent insights into the pathophysiology of the major complications of vascular accesses—thrombosis, stenosis, aneurysms, fistula maturation failure and catheter infection—and outlines innovative ideas for the prevention and treatment of these complications that have emerged as a result of our improved understanding. These ideas include interfering with bacterial quorum sensing, blocking growth factors that are involved in intimal hyperplasia, and inhibiting matrix metalloproteinases.

This article reports on a case of biopsy-proven nodular glomerulosclerosis in a patient with progressively worsening renal function, metabolic syndrome, but no evidence of diabetes. The authors conclude that screening patients with the metabolic syndrome—even those without diabetes—for evidence of impaired renal function and treating eventually detected albuminuria could help prevent progressive kidney disease and reduce the associated morbidity and mortality risks.