Volume 7 Issue 11, November 2011

Patients with chronic kidney disease (CKD) are at increased risk of cardiovascular disease. Following publication of the results from the SHARP trial, are we any closer to knowing whether statins are beneficial for preventing cardiovascular events in patients with CKD, particularly those on dialysis?

Frequent nocturnal hemodialysis has emerged as a promising option for patients, with some studies demonstrating that it improves clinical outcomes. However, the negative results of a recent randomized trial have cast some doubt on whether nocturnal home hemodialysis has any advantages over conventional hemodialysis.

A recent analysis from a French registry indicates that in incident patients with end-stage renal disease and congestive heart failure, peritoneal dialysis has a higher mortality risk than hemodialysis. Whether the results of this study should alter the choice of dialysis modality in such patients is debatable.

After many years of research, poor growth remains a problem for children with chronic kidney disease. Causes are multifactorial, and include malnutrition, cachexia, hematological factors, endocrine problems and metabolic abnormalities. The Review focuses on the impact of inadequate nutrition on growth disturbances in children with chronic kidney disease, and discusses all aspects of the epidemiology, causes and potential treatments.

Control of bone and mineral homeostasis is essential in children with chronic kidney disease to prevent skeletal complications, achieve adequate growth and maintain cardiovascular health. This Review describes the pediatric aspects of chronic kidney disease mineral and bone disorder and discusses the potential of the latest therapeutic agents.

Anemia in children with chronic kidney disease (CKD) is associated with increased morbidity and mortality. In this Review, Atkinson and Furth outline the adverse effects associated with the anemia of CKD in children and discuss factors that contribute to the development of anemia in this population. Treatment strategies and the challenges of managing this condition in children with CKD are also discussed.

Cardiovascular disease is the main cause of death in children with chronic kidney disease, as these patients have a high prevalence of traditional and uremia-related risk factors for cardiovascular disease. This Review discusses the vascular and cardiac adaptations that occur in these patients, the pathological factors that stimulate these alterations and the consequences for cardiorespiratory fitness and physical functioning.

Pediatric patients with end-stage renal disease (ESRD) usually receive dialysis treatment before undergoing transplantation. The development of dialysis programs in specialized pediatric nephrology units has led to the improved survival and rehabilitation of children with ESRD. The authors of this Review discuss the various medical, surgical, nutritional and psychosocial factors that need to be considered in order to provide optimal hemodialysis to children with ESRD.

Peritoneal dialysis is the preferred dialysis modality for most children with end-stage renal disease. Although advances in treatment have led to increased technique and patient survival, challenges remain. In this Review, Schaefer and Warady discuss data from multiple pediatric dialysis registries and describe the technical issues associated with peritoneal dialysis in pediatric patients.

Use of thiazide diuretics leads to decreased urinary calcium excretion, which in turn reduces the recurrence rate of calcium-containing stones. Whether the hypocalciuria results from increased calcium reabsorption in the proximal or distal nephron is still a matter of debate. In this Perspectives article, the authors discuss the evidence supporting the hypocalciuric effects of NaCl cotransporter inhibition in the proximal and distal nephron.

Chronic kidney disease (CKD) is much more common in adults than in children, but the incidence of CKD in children has increased steadily over the past two decades, and the treatment of CKD in this age-group presents unique challenges. This Focus Issue on CKD in children contains six specially commissioned Review articles that discuss the following important aspects of CKD in children: anemia, growth and nutrition, bone and mineral disorders, cardiovascular complications, hemodialysis, and peritoneal dialysis. The Focus Issue is accompanied by a library of articles related to this topic published by Nature Publishing Group journals.