Volume 14 Issue 6, June 2018

A new subclassification of diabetes based on quantitative traits, including age, body mass index, insulin resistance and β-cell function suggests five clusters with distinct phenotypes and prognoses. This approach may offer a novel way to classify diabetes by providing more information on risks and potential therapeutic strategies.

A recent observational study reports that implantable cardioverter defibrillators were not associated with improved survival in patients with heart failure, reduced left ventricular ejection fraction and chronic kidney disease. Further studies are needed to identify which of these high-risk patients are most likely to benefit from this potentially life-saving therapy.

Two new clinical trials together involving nearly 30,000 patients support previous observational evidence that the most common solution used for intravenous fluid therapy in the world is associated with kidney damage. Both trials found that 0.9% saline was inferior to solutions with more physiological chloride concentrations and resulted in greater rates of major adverse kidney events.

Patients who present with chronic kidney disease and diabetes mellitus can have true diabetic kidney disease (DKD), nondiabetic kidney disease (NDKD), or a combination of both DKD and NDKD. Here, Anders and colleagues discuss the mechanisms underlying these entities and how greater appreciation of distinctions between these entities might facilitate the development of new treatments.

Current in vitro nephrotoxicity screens are poorly predictive of toxicity in humans. Here, the authors describe mechanisms of nephrotoxic injury, the functional features of tubular cell models that are essential for predicting the toxicity of pharmaceutical compounds, and novel in vitro cell models under development.

Haemodialysis membranes are traditionally classified on the basis of their composition and water permeability. In this Review, the authors discuss the advances in materials technology, polymer chemistry, surface functionalization and dialyser assembly that mandate new classification approaches.