Volume 8 Issue 12, December 2012

The appropriate use of lipid-lowering therapy in patients with chronic kidney disease (CKD) remains unclear. The results of two recent, robust systematic reviews and meta-analyses of lipid-lowering therapy in patients with CKD seem to support the use of lipid-lowering therapy. But is the story more complex?

Surprising new data from Sever and colleagues suggest that in patients who have hypertension and cardiovascular disease risk factors, increased plasma renin activity is associated with future renal impairment but not with cardiovascular events or all-cause mortality. These novel data are important but difficult to explain.

A recently published study suggests that sirolimus is an attractive treatment option for the prevention of secondary skin cancer in kidney transplant recipients. However, before we think about switching all patients with a previous skin cancer (or with any other malignancy) to sirolimus, we should have a closer look at the data.

Data from the ARISTOTLE trial showed that apixaban, compared with warfarin, reduced the rates of stroke, death and major bleeding in patients with atrial fibrillation, regardless of renal function. Is the problem of balancing the risks of thromboembolism and bleeding in patients with atrial fibrillation and chronic kidney disease finally solved?

Mineralocorticoid-receptor antagonists (MRAs) effectively reduce blood pressure and albuminuria in patients with chronic kidney disease who experience aldosterone breakthrough. Use of MRAs is limited, however, by the occurrence of hyperkalaemia, which frequently develops in patients with impaired kidney function, and/or diabetes. This Review discusses potential approaches to identify patients who are particularly prone to developing hyperkalaemia with MRA therapy and describes currently available and promising strategies to prevent and control hyperkalaemia in patients with CKD.

As the world population continues to age, the number of elderly patients with chronic kidney disease who require a kidney transplant is increasing. In this Review, the effects of aging on the adaptive and innate immune systems are discussed, with a focus on the implications of age-related changes in the immune system on kidney transplantation and immunosuppression in elderly patients.

Flares of systemic lupus erythematosus are broadly defined as an increase in disease activity requiring an intensification of therapy. A renal flare is indicated by an increase in proteinuria and/or serum creatinine concentration, abnormal urine sediment or a reduction in creatinine clearance rate as a result of active disease. In this Review the authors examine current definitions of renal flares and describe developments in the diagnosis and treatment of renal flares.

In this Review, Finkelstein and colleagues discuss the effects of end-stage renal disease (ESRD) and therapy on the health-related quality of life (HRQOL) of patients. They suggest that monitoring HRQOL—using standardized tools that incorporate assessment of patient-reported outcomes—should form part of the routine care of patients with ESRD, and emphasize the importance of developing strategies to improve the HRQOL of these patients.

Water used for dialysis can be contaminated by many chemical and microbiological factors that are potentially harmful to patients on haemodialysis. The quality of dialysis water has improved over the years, and in this Review the authors describe the evolution of the current standards for the provision of water quality. In addition, they outline new developments, with a particular focus on haemodialysis in the home.

Emerging evidence suggests that 15–20% of patients who do not fulfill current consensus criteria for AKI have acute tubular damage, which is associated with adverse outcomes. Haase et al. argue that the spectrum of AKI should be extended to incorporate subclinical forms of the disorder diagnosed on the basis of biomarkers of tubular damage.