Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain
the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in
Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles
and JavaScript.
Blockade of the renin-angiotensin-aldosterone system (RAAS) is a standard treatment for patients with chronic kidney disease (CKD). Intensive strategies with single-agent or dual-agent RAAS blockade have been used to reduce proteinuria and blood pressure in these patients. This Review discusses strategies for improving the long-term outcomes of patients with CKD treated with RAAS blockade, focusing on the effects of combined low-dietary sodium intake and RAAS-blockade on the risk of renal and cardiovascular outcomes.
Heart failure and renal dysfunction frequently coexist. The term cardiorenal syndrome (CRS) is frequently used to describe this scenario, but the definition of CRS has been a matter of debate and has evolved over time. Here, the authors review the concept of CRS and its evolution and classification, and describe current and future targets for the clinical management of CRS. In addition, they propose a new classification system with seven distinct categories.
In the past few years, basic research and epidemiological studies have provided a wealth of new data on renal prognosis following acute kidney injury (AKI) and the potential association of AKI with incident chronic kidney disease (CKD), progression of CKD, and incident end-stage renal disease. The authors of this Review describe these findings and discuss the possible mechanisms by which AKI might lead to CKD or CKD progression.
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.
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.