Editor’s Note: We asked authors of Original Investigations to provide short plain-language summaries that would briefly summarize what inspired their study, the basic approach taken, what was learned, and why it matters. We hope our readers will find this valuable in helping them keep up with the latest research in the field of nephrology.
Highlights from the February 2024 issue:
Experiences of Indigenous Patients Receiving Dialysis: Systematic Review of Qualitative Studies by Marianne Kerr et al
From the authors: Worldwide Indigenous populations suffer a high incidence of chronic disease leading to lower life expectancy, particularly for kidney disease, an insidious condition requiring long-term dialysis treatment. By listening to Indigenous dialysis patients’ stories, we hoped to understand how to improve their experience. We gathered 28 qualitative research studies from four countries reporting Indigenous adults’ experiences of dialysis. They described lacking awareness of kidney disease, poor access to health services, systemic racism, inadequate cultural safety, and being dislocated from family, community, and culture. These findings indicate that respectful collaboration with Indigenous Peoples to craft and implement policy changes holds promise to improve prevention, integrate culturally responsive health care practices, and provide better access to local dialysis services and opportunities for kidney transplants.
DOI: 10.1053/j.ajkd.2023.07.014
EDITORIAL: The Importance of Indigenous Leadership for Reducing Inequities in the Treatment of Kidney Failure by Caroline Tait et al [FREE]
Urinary Biomarkers and Kidney Injury in VA NEPHRON-D: Phenotyping Acute Kidney Injury in Clinical Trials by Elizabeth A. Kiernan et al (OPEN ACCESS)
From the authors: The VA NEPHRON-D trial investigated inhibition of the renin-angiotensin-aldosterone system (RAAS) hormonal axis on kidney outcomes in a large population of diabetic chronic kidney disease patients. The trial was stopped early due to increased events of serum creatinine–defined acute kidney injury in the combination therapy arm. Urine biomarkers can serve as an adjunct to serum creatinine in identifying kidney injury. We found that urinary biomarkers in the combination therapy group were not associated with a pattern of harm and damage to the kidney, despite the increased number of kidney injury events in that group. This suggests that serum creatinine alone may be insufficient for defining kidney injury and supports further exploration of how other biomarkers might improve identification of kidney injury in clinical trials.
DOI: 10.1053/j.ajkd.2023.07.012
EDITORIAL: Combined Angiotensin Inhibition for CKD: The Truth Is Rarely Pure and Never Simple by Anand Srivastava et al [FREE]
Apathy Symptoms, Physical and Cognitive Function, Health-Related Quality of Life, and Mortality in Older Patients With CKD: A Longitudinal Observational Study by Carlijn G.N. Voorend et al
From the authors: We observed that older kidney patients often present apathy symptoms, such as less motivation, fewer goal-directed behaviors, fewer emotions, and less social engagement. Prior research has not extensively described apathy in kidney disease. We investigated the link between apathy symptoms and poor outcomes. We measured physical functioning, cognitive functioning, and quality of life. We learned that one-third of our older kidney patients showed symptoms of apathy, only half of whom had symptoms of depression. Patients with apathy symptoms showed lower quality of life and lower physical and cognitive performance. They also had a higher risk of death. These findings highlight the need for awareness of apathy symptoms in older kidney patients.
DOI: 10.1053/j.ajkd.2023.07.021
EDITORIAL: Is Apathy a New Risk Factor for Adverse Health Outcomes Among Older Adults With CKD? by Brett Burrows et al [FREE]
Kidney Transplant Clinicians’ Perceptions of Palliative Care for Patients With Failing Allografts in the US: A Mixed Methods Study by Naoka Murakami et al
From the authors: Kidney transplant patients experience physical and psychological suffering in the context of their illnesses that may be amenable to palliative care. However, palliative care is often underutilized in this population. In this mixed-methods study, we surveyed 149 clinicians across the United States, and 19 of them completed semistructured interviews. Our study results demonstrate that several patient, clinician, system, and policy factors need to be addressed to improve palliative care delivery to this vulnerable population.
DOI: 10.1053/j.ajkd.2023.07.013
EDITORIAL: Don’t Let the Label “Palliative Care” Stand in the Way of Meeting the Needs of Patients With Graft Loss by Carrie Thiessen et al [FREE]
AJKDBlog Post Kidney Transplant Clinicians’ Perceptions of Palliative Care: An Interview with Drs Naoka Murakami, Amanda J. Reich and Joshua R Lakin
Genetic Markers Among the Israeli Druze Minority Population With End-Stage Kidney Disease by Omer Shlomovitz et al
From the authors: Chronic kidney disease (CKD) affects many people worldwide and has multiple genetic causes. However, there is limited information on the prevalence of genetic etiologies, especially among minority populations. Our national-multicenter study focused on Israeli Druze patients. Using exome-sequencing, we identified previously undetected genetic causes in nearly 20% of patients, including a new and population-specific WDR19 homozygous pathogenic variant. This mutation has not been previously described; it is extremely rare globally but is common among the Druze, which highlights the importance of studying minority populations with high rates of CKD. Our findings provide insights into the genetic basis of end-stage kidney disease in the Israeli Druze, expand the WDR19 phenotypic spectrum, and emphasize the potential value of genetic testing in such populations.
DOI: 10.1053/j.ajkd.2023.06.006
Factors Associated With Non-vaccination for Influenza Among Patients With CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study by Junichi Ishigami et al
From the authors: Identifying risk factors for not receiving an influenza vaccine (“non-vaccination”) in people living with kidney disease, who are at risk of influenza and its complications, could inform strategies for improving vaccine uptake. In this study, we examined whether demographic factors, social determinants of health, and clinical conditions were linked to the status of not receiving an influenza vaccine among people living with kidney disease and receiving nephrology care. We found that younger adults, Black individuals, and those with adverse social determinants of health were more likely to not receive the influenza vaccine. These findings suggest the need for strategies to address these disparities and reduce barriers to vaccination in people living with kidney disease.
DOI: 10.1053/j.ajkd.2023.06.007
AJKDBlog Post Non-Vaccination for Influenza Among Patients With CKD: An Interview with Dr Junichi Ishigami [FREE]
Frailty and Cardiovascular Outcomes in Adults With CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study by Mary Hannan et al [FREE temporarily]
From the authors: Frailty is common in individuals with chronic kidney disease (CKD) and increases the risk of adverse outcomes. We sought to evaluate the association of frailty status with cardiovascular events and death in adults with CKD. Frailty was assessed according to the 5 phenotypic criteria detailed by Fried and colleagues. Among 2,539 participants in the CRIC Study, we found that 12% were frail, 51% were prefrail, and 37% were nonfrail. Frailty status was associated with an increased risk of atherosclerotic events, incident heart failure, and death.
DOI: 10.1053/j.ajkd.2023.06.009
Processes of Care After Hospital Discharge for Survivors of Acute Kidney Injury: A Population-Based Cohort Study by Sandeep Brar et al
From the authors: A study in Alberta, Canada, examined the care received by patients with acute kidney disease (AKI) during hospitalization and after discharge between 2007 and 2019. The results showed that a low proportion of patients with moderate to severe AKI were seen by a kidney specialist during hospitalization or within 90 days after discharge. Fewer than 25% of AKI patients had their kidney function monitored with both blood and urine tests within 90 days of discharge. Additionally, about half of AKI survivors with chronic kidney disease (CKD) were prescribed guideline recommended medications for CKD within 15 months after discharge. There is potential to improve health care delivery to these patients both in hospital and after hospital discharge.
DOI: 10.1053/j.ajkd.2023.07.015
Core Curriculum from the February 2024 issue:
Calcium and Phosphate Disorders: Core Curriculum 2024 by Susan L. Murray
This installment of AJKD’s Core Curriculum in Nephrology reviews the physiology and pathophysiology of calcium and phosphate disorders through the lens of a series of illustrative cases. The cases span clinical conundrums commonly encountered by nephrologists in their daily clinical practice and other less common disorders.
DOI: 10.1053/j.ajkd.2023.04.017
On the Cover: AJKD is honored to present the 12th annual NephMadness, organized by Executive Team members Matthew Sparks, Timothy Yau, Anna Burgner, Samira Farouk, Anna Vinnikova, Elena Cervantes, Jeffrey Kott, and Michelle Lim. This educational initiative highlights 8 important nephrology topics and encourages participants to select the one most likely to change kidney disease care in the next 5 years. US-based physicians can claim up to 8.0 CME credits for this activity. The fun and learning will begin on March 1, 2024, at www.AJKDBlog.org.
The NephMadness 2024 logo is created by Graham T. Gipson, © AJKD
We would like to invite blog post submissions related to next year’s World Kidney Day (WKD) campaign theme: “Kidney Health for All: Advancing equitable access to care and optimal medication practice”. Submissions should be between 800-1,200 words and sent to AJKD@pennmedicine.upenn.edu by February 14th, 2024.
