News & Views

Chronic kidney disease is associated with an increased risk of cardiovascular disease that often exceeds risk of progression to end-stage renal disease. A meta-analysis has shown that the addition of glomerular filtration rate and albuminuria to traditional risk factors for cardiovascular outcomes improves the discrimination of cardiovascular risk prediction models.

Cardiac surgery often requires the use of cardiopulmonary bypass, which can cause an inflammatory cascade that results in acute kidney injury (AKI). A recent post hoc analysis of a placebo-controlled, randomized trial suggests that intraoperative steroids might lower the risk of renal replacement therapy for AKI after cardiac surgery.

A new study reports abnormal peripheral lymphocyte counts and an increased incidence of hospital admission for infections among infants born to mothers with kidney transplants. Further studies are required to investigate the effects of in utero exposure to immunosuppressive agents on immune system development and long-term disease risk in this population.

Despite reductions in morbidity and mortality owing to widespread use of highly effective antiretroviral therapy (ART), HIV-positive patients remain at high risk of chronic kidney disease (CKD) and end-stage renal disease. A new report provides a HIV-specific CKD risk score to balance the potential benefits and harms of nephrotoxic ART.

Assessment of arterial stiffness by pulse wave velocity can predict cardiovascular mortality in patients with renal failure. New research shows that atenolol is superior to lisinopril in reducing arterial stiffness in patients with hypertension undergoing haemodialysis. This finding might revive interest for further studies on vascular protection mediated by β-blockers.

Kidney transplantation in patients with end-stage renal disease is efficacious, cost-effective, and improves quality of life relative to maintenance dialysis; the availability of donor kidneys, however, is limited. Determining the most appropriate method by which to allocate deceased donor organs in an efficient and just manner poses a complex challenge.

The traditional definition of sepsis requires the presence of at least two systemic inflammatory response syndrome (SIRS) criteria in addition to a suspected or proven infection. A recent large retrospective study, however, suggests that the requirement for two SIRS criteria excludes one in eight patients with severe sepsis.

Despite aggressive therapy, lupus nephritis (LN) remains an important predictor of morbidity in patients with systemic lupus erythematosus. Clinical trials of novel drugs have not improved LN outcomes; however, re-analysis of well-characterized cohorts has identified surrogate end points of long-term renal survival, which will facilitate testing and qualification of novel treatments.

Although consensus guidelines promote the use of arteriovenous fistulas for vascular access, the vast majority of US patients initiate haemodialysis using a central venous catheter. Malas et al. evaluate the impact of the type of incident vascular access on patient survival after initiation of haemodialysis.

Automated, real-time alert systems have the potential to improve recognition and management of acute kidney injury (AKI). A recent patient-level, randomized controlled trial, however, demonstrated no effect of such a system on AKI progression, receipt of dialysis or death. These findings inform the future implementation and testing of AKI alerts.

Variation exists in the number and utility of diagnostic tests performed at nephrology referral. Recent data suggest that a large battery of diagnostic tests might be unnecessary and costly for the majority of patients. A risk-based approach to triage could instead help inform which patients will benefit from intensive testing.

Strategies for the management of hypertension in patients with type 2 diabetes mellitus are controversial. New data from a landmark meta-analysis support the use of antihypertensive therapy in these patients but the impact of blood pressure-lowering on albuminuria and progression of chronic kidney disease remains unclear.

Corticosteroids are frequently used to treat patients with IgA nephropathy (IgAN) despite a paucity of data to support their use in individuals with substantially reduced renal function. A retrospective study provides evidence that these agents may slow the rate of decline in renal function in high-risk patients with IgAN.

Statins reduce the risk of atherosclerotic vascular disease in healthy individuals and those with chronic kidney disease (CKD); however, clinical trials have suggested a minimal effect of statins on CKD progression. The PLANET trials compared the renal effects of rosuvastatin and atorvastatin, but the findings leave many questions unanswered.

The SUPPORT trial evaluated the effect of adding the angiotensin-receptor blocker olmesartan to a combination of angiotensin-converting-enzyme inhibitors and β-blockers in hypertensive patients with chronic stable heart failure. Unfortunately, this triple renin–angiotensin–aldosterone system blockade was associated with worsening of renal function and increases in cardiac events and mortality.

A new trial provides further evidence that rituximab treatment can reduce the risk of relapse in children with steroid-dependent idiopathic nephrotic syndrome. Addition of a single infusion of rituximab to steroid therapy was associated with a decrease in proteinuria at 3 months and a significant increase in the relapse-free period.

In patients with resistant hypertension, renal denervation plus standardized stepped-care antihypertensive treatment (SSAHT) resulted in significant blood-pressure lowering compared with SSAHT alone. These new data from the DENERHTN trial may indicate that despite the failure of SYMPLICITY HTN-3, there is light at the end of the tunnel for renal denervation.

In the USA, mortality among patients with chronic kidney disease (CKD) and end-stage renal disease has declined over the past two decades. By contrast, new data indicate that the rate of CKD-associated deaths is increasing worldwide. This important finding highlights CKD as a major contributor to global morbidity and mortality.

Whether anticoagulation with warfarin is safe and reduces risk of stroke in patients with atrial fibrillation and chronic kidney disease is unclear. A recent observational study shows a net clinical benefit of warfarin—without increased risk of bleeding—in this population, including in patients on dialysis.

Numerous studies have suggested the utility of non-invasive molecular biomarkers to monitor recipients of kidney transplants. A new correlation-based algorithm using stepwise analysis of gene expression data from peripheral blood samples, claiming to detect subclinical, and predict clinical acute allograft rejection, requires corroboration before testing in prospective validation studies.