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Levels of serum inflammatory biomarkers—such as C-reactive protein—fluctuate substantially over time in patients undergoing dialysis. Monitoring these changes could provide us with useful information concerning the underlying processes that cause inflammation. In this Review, Meuwese and colleagues examine the implications and causes of inflammatory marker variability in patients on dialysis, and discuss the advantages of repeated measurements of inflammation over single measurements in clinical practice.
Acute kidney injury (AKI) is common, especially in the critically ill, and is a serious condition associated with substantial morbidity and mortality. In this Review, Murugan and Kellum discuss the epidemiology and prognosis of critically ill patients with AKI as well as describe the role of AKI criteria, biomarkers and therapy on patient outcomes.
Fluctuating renal and volume status means that drug dosing in critically ill patients with acute kidney injury is complex. In this Review, Eyler and Mueller highlight the substantial variability in pharmacodynamics and pharmacokinetics that exists in this population, and discuss how antibiotic-dosing decisions should not just be based on published guidelines—clinicians must also take into account patient characteristics, choice of renal replacement therapy, and drug-related factors.
Although the relationship between asymptomatic hyperuricemia and chronic kidney disease is not fully understood, data from small studies indicate that reducing high serum urate level may slow disease progression. In this Perspectives article, Badve and colleagues propose that a multicenter pilot randomized controlled trial be performed to investigate the effects of uric-acid-lowering therapy in patients with CKD.
The staging of chronic kidney disease requires measurement of glomerular filtration rate (GFR). As direct GFR measurement is impractical, estimates are used. The MDRD equation was 'Hobson's choice' and although known to be unreliable at higher levels of kidney function it is still in widespread use. The CKD-EPI equation is a new alternative. Is it better?
Prediction of renal allograft outcomes has been elusive despite the number of risk factors that correlate with graft failure. Using a large French transplant database and novel statistical methods, Foucher et al. have produced a predictive scoring system for graft failure worthy of study in other populations.
Infection with hepatitis B virus (HBV) or hepatitis C virus (HCV) in kidney transplant candidates was once considered a contraindication to transplantation, but advances in antiviral therapy have now enabled successful transplantation in these patients. In this Review, Huskey and Wiseman discuss the management of chronic HBV and HCV infection in both kidney donors and recipients, including post-transplantation outcomes and recommendations for treatment and organ allocation in these individuals.
Disturbed intrauterine organogenesis has long-term consequences on organ function in adulthood, so-called prenatal programming. In this Review, Ritz and colleagues outline the concept of prenatal programming and, in particular, describe its role in kidney disease and hypertension. Intrauterine growth restriction (IUGR) as a predictor of renal and cardiovascular disease in adulthood, and the potential of low birthweight as a (clinical) surrogate marker of IUGR, are also discussed.
Annual cardiovascular mortality rates are much higher in patients with chronic kidney disease (CKD) than in the general population. Sudden cardiac death rate increases with CKD stage and could be responsible for 60% of cardiac deaths in patients undergoing dialysis. In this Review, the authors describe the epidemiology and risk factors for sudden cardiac death in patients with CKD and discuss potential therapeutic approaches.
Many patients with diabetic nephropathy progress to end-stage renal disease. New research in disease detection, diagnosis, and novel treatments will hopefully alleviate the burden of diabetic nephropathy in the future.
Few, if any, doubt that renal transplantation should be the first choice of renal replacement therapy whenever this option is possible. But, at which level of remaining kidney function should patients start on dialysis and which dialysis modality should be used? Several studies published in 2010 addressed these questions and will influence dialysis initiation strategies worldwide for years to come.
Several 2010 trials have provided novel information on how best to manage patients with predialysis chronic kidney disease (CKD). Armed with these new findings, nephrologists can find new means of slowing CKD progression by targeting blood-pressure control, acidosis and serum uric acid levels.
Renal transplantation offers the potential for improved quality and length of life to patients with end-stage renal disease; however, graft rejection and immunosuppression-related toxicities can hamper the effectiveness of this therapy. Seminal publications from 2010 have addressed these obstacles, and provide insight into new and innovative approaches to improve outcomes in renal transplant recipients.
Acute kidney injury (AKI) is a serious complication associated with morbidity and mortality. Studies from 2010 have provided insights into the diagnosis and clinical course of AKI, the ability of novel biomarkers to guide therapy, and the quality of life of survivors of severe AKI. It is hoped that these findings will lead to improvements in the diagnosis and prognosis of affected individuals.
2010 saw the publication of a number of papers that provide new information on the relationship between blood pressure and the kidney. The data reinforce the need for future studies to jointly consider cardiovascular and renal outcomes.
Hypokalemia is a common electrolyte disorder, which in serious cases can be life threatening. In this Review, Unwin and colleagues provide an overview of the pathophysiology of hypokalemia and describe the distribution of potassium (K+) ions in the body and renal and extrarenal causes of K+loss. The authors also discuss the management of hypokalemia in clinical practice.
