Volume 7 Issue 9, September 2011

In contrast to reports of favorable survival in incident patients on peritoneal dialysis compared with hemodialysis, a recent study has shown similar survival outcome depending on type of vascular access. Central venous catheters for hemodialysis have an inherent risk of sepsis, which accounts for the early survival advantage of peritoneal dialysis.

Levels of glycated albumin seem to predict mortality and hospitalization more accurately than does levels of glycated hemoglobin in patients with diabetes mellitus who are on dialysis. Should we be measuring glycated albumin instead of glycated hemoglobin in this group of patients?

A recent retrospective study has shown that statins can reduce the incidence of acute kidney injury in elderly patients undergoing major elective surgery. However, more data, preferably from randomized controlled trials, are required before a change in practice can be recommended.

Self-monitoring of blood pressure at home is widely used and regarded as an effective tool to improve long-term management and control of hypertension. A new meta-analysis assessing the utility of home blood pressure monitoring supported by telecommunication shows that this system has the potential to further improve the care of patients with hypertension.

According to a recent study, the renoprotective effect of losartan is partly owing to its ability to reduce levels of serum uric acid. This finding, along with supporting evidence from cohort studies, points to lowering of serum uric acid levels as a potential method to prevent end-stage renal disease in patients with diabetes mellitus.

Circulating anti-phospholipase A₂ receptor (PLA₂R) antibodies have been identified as an immunological marker of disease activity in patients with idiopathic membranous nephropathy. A simple assay has been developed to detect anti-PLA₂R antibodies in serum. Now, we can monitor the response to drugs and adapt therapy in daily clinical practice.

Low-molecular-weight heparins are replacing unfractionated heparin as the anticoagulant of choice for patients receiving hemodialysis. However, clotting can still be a problem during hemodialysis. This Review discusses the different anticoagulant options for these patients.

Extraosseous calcifications are highly prevalent in patients with chronic kidney disease. Several pathological mechanisms of extraosseous calcification have been identified, which might serve as therapeutic targets. The authors of this Review describe some of the processes involved in calcification, including the role of calciprotein particles, osteogenic transdifferentiation and vitamin K. They also discuss promising agents for the treatment of extraosseous calcification and present some of the questions that remain.

Patients with cirrhosis of the liver have a high risk of developing various types of renal failure, among which hepatorenal syndrome is the most characteristic. In this Review, Arroyo and Fernández discuss type 1 and type 2 hepatorenal syndrome. They describe the diagnosis, pathogenesis and management of these two clinically distinct syndromes in detail.

The incidence of encapsulating peritoneal sclerosis (EPS)—the most severe complication of long-term peritoneal dialysis—has increased in the past 20 years; however, no criteria exist for detecting this disease in early stages. In this Review, Korte and colleagues present the pathophysiology of EPS as a as a multiple-hit process with a central role for transforming growth factor β. They also describe the progress made in the early identification and diagnosis of EPS and potential therapeutic strategies.

Several mechanisms in critically ill patients make them susceptible to augmented renal clearance (ARC). The authors of this Perspectives article focus on the causes, risk factors and monitoring of ARC in these patients, and examine the clinical consequences of ARC with regard to achieving target therapeutic concentrations of renally excreted drugs.