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A new study by Chang et al. reports that coronary artery bypass grafting (CABG) may be preferable to percutaneous coronary intervention (PCI) for multivessel coronary revascularization in appropriately selected patients on maintenance dialysis.
New data from Ahmed et al. show that discharge prescriptions for renin–angiotensin–aldosterone inhibitor therapy are associated with a significant reduction in all-cause mortality in elderly patients with diastolic heart failure and chronic kidney disease (CKD). These observational data support the case for prospective studies of RAAS blockade in patients with CKD and diastolic heart failure.
The Lancet publication of the Global Burden of Disease Study 2010 heralds an important milestone in our understanding of population health and disease this century. The articles highlight the value of this collaboration, across countries and disciplines, in furthering our understanding of health, its determinants, and the impact of strategies aimed at addressing specific health issues.
Recently published data from four phase 3 safety and efficacy trials show that the synthetic peptide-based, erythropoietin mimetic, peginesatide, is noninferior to conventional erythropoiesis-stimulating agents in increasing haemoglobin levels in patients with chronic kidney disease (CKD). However, peginesatide therapy increased the risk of a combined cardiovascular end point in patients with CKD not on dialysis.
A new study by Lo et al. presents a novel immunosuppressive combination in a clinically relevant primate model of renal allografting. Using belatacept, a fusion protein that inhibits CD28–CD80/CD86 co-stimulation, plus the mammalian target of rapamycin inhibitor sirolimus, they were able to achieve rejection-free allograft survival without the induction of memory T cells or alloantibody.
Pickering et al. report that unchanging plasma creatinine levels after resuscitated cardiac arrest can indicate substantial acute kidney injury (AKI) as confirmed by increased levels of AKI biomarkers and increased mortality. This finding illustrates the limitations of plasma-creatinine-based diagnosis of AKI in early critical illness.
World Kidney Day will be celebrated on March 14 2013, and this year, aims to increase awareness of the global increase in acute kidney injury (AKI). An urgent need exists for a global health strategy to reduce the burden of AKI; efforts focused on preventing AKI should be coupled with early detection, treatment, and follow-up strategies.
A new meta-analysis shows a strong association between low levels of preformed donor-specific HLA antibodies (DSAs) detected using sensitive solid-phase assays and an increased risk of renal allograft failure. These findings have important implications for stratifying patients with DSAs for organ allocation and for the use of alloantigen desensitization therapies.
According to new data from Hirsch et al., the risk of polyomavirus BK (BKV) viraemia in kidney transplant recipients is increased by high steroid exposure early after transplantation, treatment with tacrolimus rather than ciclosporin A, older donor age and male gender. However, confounding of results due to variations in immunosuppressive drug exposure cannot be excluded.
Hsu et al. report a progressive increase in the incidence of dialysis-requiring acute kidney injury (AKI) and associated deaths in the USA between 2000 and 2009. As with chronic kidney disease, a concerted campaign to increase awareness and alertness of AKI is urgently required. We must prevent “kidney attack”.
Guidelines are painted with broad strokes and cannot possibly cover complex situations that emerge in the care of people with chronic kidney disease and multiple illnesses. The authors of the recent KDIGO blood pressure guidelines should be congratulated on urging us to individualize therapy especially in situations where the evidence base is thin.
Bardoxolone methyl showed promising results in initial studies in patients with type 2 diabetic kidney disease, but a phase III trial was terminated early in October 2012 due to adverse effects and increased mortality. Can adverse findings of analogues of bardoxolone methyl in an animal model explain the human findings?
The aetiology of primary focal segmental glomerulosclerosis has proven elusive. Recent data implicates the soluble urokinase-type plasminogen-activator receptor (suPAR) as the circulating permeability factor in the majority of patients with this condition. These exciting findings may dramatically influence the future diagnosis and management of this often resistant glomerular disease.
