Reviews & Analysis

A new study reports cardiovascular and renal events in patients with hypertension and chronic kidney disease stratified according to ambulatory blood pressure and to the absence or presence of resistant hypertension by office measurements. Outcomes were worst in patients with hypertension according to both office and ambulatory blood pressure, but definition issues detract from the impact of the study's findings.

A recent meta-analysis reports that cinacalcet hydrochloride has no significant effect on all-cause and cardiovascular mortality in dialysis patients with secondary hyperparathyroidism. However, these findings must be interpreted with caution, given the limitations of the trials included in the meta-analysis.

Mehrotra and colleagues report that serum phosphate does not predict subsequent death or development of end-stage renal disease in a community-based cohort of people with chronic kidney disease (CKD). This finding conflicts with previous research and questions the relevance of serum phosphate level to outcomes in the context of CKD.

Plasma exchange (PLEX) is often included in the initial therapy of patients with antineutrophil cytoplasmic autoantibody-associated glomerulonephritis who present with severe kidney failure. However, new long-term follow-up data from the MEPEX trial suggest that PLEX may not improve survival in these patients.

High-flux biocompatible synthetic dialyser membranes and ultrapure dialysate might improve the quality and effectiveness of haemodialysis. However, a recent randomized controlled trial showed no effect of membrane permeability or dialysate bacteriological quality on the incidence of fatal and nonfatal cardiovascular events in patients with end-stage renal disease undergoing haemodialysis.

Sodium reduction lowers blood pressure and should prevent cardiovascular disease, yet some studies have challenged this viewpoint. Here, we review three recently published meta-analyses that examined the effects of sodium and potassium intake on blood pressure and other health outcomes. In brief, the evidence for population-wide sodium reduction remains robust.

A new paper by Sridharan and colleagues compares the roles of energy metabolism, body composition and energy expenditure in determining uraemic toxin generation in patients on haemodialysis. The researchers conclude that these factors have an important role in the generation of small solute uraemic toxins and may influence minimum dialysis requirements.

A new study suggests that low-cost generic statins are cost-effective for primary prevention of cardiovascular disease in high-risk but not in low-risk subgroups of patients with mild-to-moderate chronic kidney disease (CKD). The cost-effectiveness of statins is markedly reduced in patients with progressive CKD and in those at high-risk of drug-related adverse events.

Shen et al. report that heparin-free haemodialysis is not associated with a decreased risk of death, bleeding, atherothrombosis and venous thromboembolism compared with standard haemodialysis using heparin. These data suggest that the assumption that avoiding heparin use during haemodialysis may have beneficial effects may be incorrect.

New data suggest that the survival of elderly kidney transplant recipients is better than that of the general elderly population. These findings draw attention to the growing category of elderly patients with end-stage renal disease who require an enhanced depiction of their risk profile for renal transplantation.

In a new study, Lipska et al. genetically screened an unselected cohort of 227 adolescents with steroid-resistant nephrotic syndrome (SRNS). From their findings, the authors make suggestions for what they feel would be the most rational and cost-effective approach for genetic screening in sporadic adolescent SRNS.

O'Leary et al. report that the presence of anti-HLA antibodies at the time of simultaneous liver–kidney transplantation is associated with allograft dysfunction and shortened organ and patient survival. Preformed class I alloantibodies were eliminated after transplantation, whereas class II donor-specific antibodies persisted and were associated with poor outcomes.

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.

Mutations in the genes that encode polycystin-1 and polycystin-2 are the principal cause of autosomal dominant polycystic kidney disease. These proteins form a receptor–ion-channel complex and were thought to regulate tubule luminal diameter in a codependent manner. However, new data suggest a more antagonistic relationship between the proteins.

Proteinuria is a known marker of poor prognosis in kidney transplant recipients. A recent study by Amer et al. brings further insights to this topic by investigating whether the composition of proteinuria affects outcomes.

Hur et al. report that fluid management guided by bioimpedance spectroscopy devices might improve cardiovascular parameters in patients on haemodialysis. However, caution is advisable when using these devices for extracellular volume assessment as overzealous reduction of target weights based on extracellular to intracellular volume ratios could cause premature loss of residual renal function.