Volume 9 Issue 1, January 2013

Surprising new randomized trial data showed no clinically relevant decrease in bone mineral density at various skeletal sites 12 months after kidney transplantation in patients receiving baseline calcitriol and calcium therapy as well as ibandronate or placebo. These data raise important questions regarding strategies to prevent bone loss after renal transplantation.

As granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) share histopathologic and clinical features, including the presence of antineutrophil cytoplasmic autoantibodies (ANCAs), patients with these syndromes are commonly labelled as having ANCA-associated vasculitis (AAV) and are subjected to similar treatments. A recent study suggests that dividing AAV into five classes based on disease phenotype provides better prognostic information than the classic division into GPA and MPA.

A new multinational cohort study reports that patients receiving daily haemodialysis had a significantly higher mortality rate than those receiving conventional thrice-weekly treatments. Other studies have suggested that daily haemodialysis has beneficial effects. What are patients and nephrologists to make of these conflicting findings?

Central venous catheters are currently the primary method of vascular haemodialysis access used by paediatric nephrologists in the USA. However, new data from Ma and colleagues suggest that in children who require chronic haemodialysis, arteriovenous fistulas might be a safer option.

Isakova et al. report that kidney transplant recipients on mammalian target of rapamycin (mTOR) inhibitors do not have a lower risk of allograft failure but do have a higher risk of death than those on calcineurin inhibitors. Careful consideration is, therefore, required before converting to mTOR inhibitors to preserve renal function.

A recent study reports that the combination of an angiotensin-receptor blocker (ARB) and a calcium-channel blocker (versus a high-dose ARB) is associated with improved blood pressure control and reduced cardiovascular, cerebrovascular and heart failure events in an elderly chronic kidney disease population. This finding raises the possibility of using fixed-dose drug combinations to improve efficacy and compliance of antihypertensive medications.

The European Paediatric Dialysis Working Group has recently produced recommendations for the management of infants on dialysis. This document is timely because, despite the fact that such infants are increasingly being accepted onto renal replacement therapy programmes, most centres have very little experience in the care of this demanding group of patients.

Chronic kidney disease (CKD) is an important public health issue that is strongly associated with adverse outcomes. Evaluation of existing therapies, development of new interventions, and timely patient counselling requires accurate prediction models that estimate individual-level risk. Here, Grams and Coresh outline the fundamentals of risk prediction, including considerations pertinent to CKD, common methodological shortcomings in risk prediction studies, and metrics often used to assess the performance of risk prediction models.

The development of blockers of the renin–angiotensin–aldosterone system (RAAS) has led to the identification of new RAAS components that might contribute to the effectiveness and/or adverse effects of these drugs. Here, the authors describe the roles of the prorenin receptor, type 2 angiotensin II receptors, angiotensin 1–7 and aldosterone–angiotensin II interactions and discuss the potential of modulators of these components to enhance RAAS blockade with potentially beneficial effects in patients with cardiovascular and renal diseases.

Hyponatraemia—the most common serum electrolyte disorder—is an important marker of the severity and prognosis of a number of diseases. In this Review, Schrier et al. discuss the effect of hyponatraemia in different patient groups, including those with pneumonia, heart failure, cirrhosis, and the elderly population. The authors discuss the need for prospective studies to examine whether correcting hyponatraemia can improve outcomes or whether hyponatraemia is just a marker of severe disease.

Resistant hypertension is defined as failure to reach goal blood pressure in patients who are compliant with maximal doses of three antihypertensive drugs, one of which is a diuretic. Despite improvements in controlling blood pressure in the past decade, studies show the prevalence of resistant hypertension is increasing. In this Review, the authors define resistant hypertension and discuss current data on its prevalence, associated comorbidities and prognostic implications.

Prospective cohort studies have shown that anaemia is an independent predictor of adverse outcomes in patients with chronic kidney disease. However, randomized controlled trials of the use of erythropoiesis-stimulating agents to correct moderate anaemia in this patient group have failed to show clinical benefit, and indicate that such treatment may even be harmful. Here, Patrick Parfrey discusses possible explanations for these seemingly contradictory results.