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The randomized, controlled IDEAL study reports no survival advantage of 'early' dialysis initiation and data from this study support an estimated glomerular filtration rate of around 7 ml/min/1.73 m2 as a guideline for dialysis initiation. The results of the IDEAL study supplement data from eight observational studies involving over 1.2 million patients which showed a comorbidity-adjusted incremental survival disadvantage of 'early' dialysis initiation.
One recent trial failed to show any beneficial effect of homocysteine lowering using vitamin B therapy on survival and cardiovascular events in patients with end-stage renal disease, and results of another study in patients with early-stage diabetic nephropathy actually suggested that vitamin B therapy has harmful effects. Do these findings mark the end of the era of studies investigating homocysteine lowering in patients with chronic kidney disease?
Two trials recently reported in the New England Journal of Medicine report that use of mammalian target of rapamycin inhibitors does little to halt the progression of autosomal dominant polycystic kidney disease. Do these therapies still have a future in the treatment of this disease?
Iron deficiency is common in patients with chronic kidney disease (CKD) and administration of iron supplements could help maintain target levels of hemoglobin and reduce, or remove, the need for erythropoiesis-stimulating agents. In this Review, Besarab & Coyne discuss the efficacy, safety and practical recommendations for oral and intravenous therapy in the treatment of anemia in patients with CKD.
Cytomegalovirus (CMV) infections are among the most common infections that can occur following solid organ transplantation. Although overall awareness of CMV disease has improved, several challenges remain with regards to its management. In this Review, Camille Kotton provides an overview of CMV diagnostics, methods for the prevention of CMV infection, and progress in the management of this disease.
The prevalence of cardiovascular disease is high in patients with chronic kidney disease (CKD), especially in those with end-stage renal disease. In this Review, Drüeke and Massy discuss the contribution of atherosclerosis to the development of cardiovascular disease in patients with CKD and describe data from clinical, imaging, morphological and experimental studies that provide evidence for atherogenesis as CKD progresses.
Although living donor kidney transplantation is often presented as the best option for patients awaiting renal transplantation, patients whose renal failure is the result of an inherited disease might not be suitable candidates for transplantation from a living related donor. In this Review, Patrick Niaudet discusses hereditary nephropathies for which living donor kidney transplantation is a viable option as well as diseases for which living donor transplantation is contraindicated.
Increased uric acid has often been associated with pre-eclampsia in pregnant women, an issue re-examined in this Perspective by Martin and Brown. The authors call for further examination of the relationship between maternal plasma uric acid levels and maternal endothelial dysfunction and utero-placental bloodflow in pre-eclampsia, and suggest that uric acid is a pathogenic amplifier of this condition.
