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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.
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.
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.
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.
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.
Immunosuppressive treatment of patients with idiopathic membranous nephropathy is controversial because of the toxicity of the therapy and the variable natural course of the disease. In this Review, the authors discuss the 2012 Kidney Disease: Improving Global Outcomes guideline for the treatment of patients with idiopathic membranous nephropathy and highlight the remaining areas of uncertainty.
Over the past 20 years, it has become clear that aldosterone exerts direct effects on the vasculature, heart and kidney beyond its effects on electrolyte handling in the distal tubule. In addition, mineralocorticoid-receptor activation has been shown to contribute to cardiovascular fibrosis and remodelling as well as to renal disease. This Review describes in detail the proinflammatory and profibrotic effects of aldosterone and mineralocorticoid-receptor activation in the heart, vasculature and kidney.
The glomerular basement membrane (GBM) is the central layer of the glomerular filtration barrier and is situated between endothelial cells and podocyte foot processes. The functional importance of the GBM versus that of podocytes and endothelial cells for establishing the glomerular filtration barrier to albumin is still debated. This Review discusses the proposed mechanisms whereby the GBM serves as the major albumin barrier and describes two genetic kidney diseases that target GBM components.
A growing number of studies in nephrology are focusing on biomarkers for chronic kidney disease (CKD). Here, Michael Shlipak and Erica Day describe biomarkers that are used to predict risk of developing CKD and outline the statistical methods that can be used to assess the performance of candidate biomarkers. The authors also provide a conceptual framework for interpreting the results of studies evaluating biomarkers of declining kidney function and incident CKD.
Acute kidney injury (AKI) is a growing problem in hospitalized patients and is associated with adverse outcomes. Recognizing renal injury earlier—at the stage of 'incipient AKI'—may enable renoprotective strategies to be initiated at a time when more kidney tissue is salvageable. In this article, the authors propose three strategies that may preserve kidney function and minimize further kidney injury in patients with 'incipient AKI'.
