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A recent meta-analysis concluded that the risk-to-benefit ratio of dual (versus single-drug) renin–angiotensin system blockade argues against the use of dual therapy. This conclusion, however, seems inconsistent with the actual data and may convey to physicians a misleading message that could misdirect important decisions on treatment.
Martini and colleagues recently used a novel genomics approach to assess the functional context of a noncoding variant located near to the promoter of the FRMD3 gene, which is associated with diabetic nephropathy. Their findings suggest a mechanistic link between FRMD3 and diabetic nephropathy that involves the bone morphogenetic protein signalling pathway.
Aspirin and other antiplatelet agents are widely used in patients with chronic kidney disease. However, their use is often based on data obtained in patients with normal renal function. A recent Cochrane Collaboration systematic review analysed the benefits and risks of these agents in patients with chronic kidney disease.
Online haemodiafiltration is the most advanced dialysis treatment currently available, but widespread implementation of this technique has been delayed pending conclusive evidence of its benefits from randomized studies. The results of the randomized, controlled ESHOL study are now available. Will they change practice?
Cystatin C was introduced as a potential alternative or supplement to the estimation of glomerular filtration rate (GFR) using creatinine. Although cystatin C is well supported as a better predictor of outcomes than creatinine, its reflection of actual renal function compared with creatinine is widely debated. A new study by Rule et al. asserts that cystatin-C-based estimated GFR is biased by non-GFR-associated risk factors for chronic kidney disease.
Treatments administered to patients with primary IgA nephropathy (IgAN) and those with Henoch–Schönlein nephritis are largely based on opinion or weak evidence, and the recent KDIGO Clinical Practice Guidelines for Glomerulonephritis assigned low levels of evidence for the majority of recommendations and suggestions related to these two diseases. In this Review, Floege and Feehally describe an algorithm for structuring the treatment of IgAN depending on the clinical scenario, and discuss ongoing studies to investigate treatments.
Exciting advances in podocyte research over the past decade have provided new insights into the role of podocytes in the function of the glomerular filtration barrier. Here, the authors explain the importance of podocytes for the maintenance of an intact glomerular filtration barrier and prevention of albuminuria. They describe signalling pathways that regulate podocyte structure and function and discuss the potential of live podocyte imaging to further advance our understanding of podocyte biology.
Vitamin D deficiency has been linked to a variety of disorders, including hypertension, type 2 diabetes and chronic kidney disease. A potential role for vitamin D deficiency in cardiovascular morbidity and mortality has also emerged. In this Review, the authors describe the evidence for an association between risk factors for cardiovascular disease and vitamin D status, and discuss the limitations of available data on vitamin D therapy in patients at increased risk of cardiovascular events.
Dialysis vascular access continues to be both a 'lifeline' and an 'Achilles' heel' for patients on haemodialysis. In this Review, the authors address some of the problems associated with vascular access, including dialysis access stenosis and arteriovenous fistula (AVF) maturation failure. They discuss the role of monitoring and surveillance, describe process of care pathways intended to increase AVF rates and decrease catheter use, and discuss novel therapies designed to reduce vascular access dysfunction.
The prevalence of increased blood pressure during sleep and a blunted sleep-time-relative blood pressure decline is high in patients with chronic kidney disease (CKD) and increases with disease severity. Here, the authors describe 24 h blood pressure variation and discuss data suggesting that bedtime dosing of hypertension medications might improve blood pressure control and reduce cardiovascular risk in hypertensive patients, including those with CKD.
