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The Kidney Health Initiative (KHI) is hosting a new workshop on August 12 and 13 to gather input from patients with kidney disease and their family members on future treatment options. The KHI workshop—Understanding Patients’ Preferences: Stimulating Medical Device Development in Kidney Disease—will help inform development of therapeutics and devices for kidney disease, which affects more than 20 million Americans.

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• Among children with chronic kidney disease, those with lower vitamin D levels had higher levels of blood markers related to kidney dysfunction as well as greater kidney function loss over time. • Five-year kidney survival was 75% in patients with vitamin D levels ≥50 nMol/L at the start of the study and 50% in those with lower levels.

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The Kidney Health Initiative (KHI) has announced the creation and appointment of the inaugural Patient and Family Partnership Council (PFPC). The PFPC will provide patient and caregiver input into current and future KHI projects to promote and address kidney health issues.

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• In Ontario, Canada, the incidence of acute kidney injury that requires dialysis is 1 in 10,000 pregnancies. • Otherwise healthy women who acquire a major pregnancy-related complication are at increased risk. • In pregnancies affected by severe acute kidney injury, babies are at increased risk of having low birth weights or being born prematurely.

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• Patients who received dexamethasone during heart surgery had about a 2.5-times lower risk of developing kidney failure requiring dialysis compared with those receiving a placebo. • The greatest benefits of dexamethasone were seen in patients with pre-existing advanced chronic kidney disease.

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In an observational study that followed participants for an average of just under 3 years, a “trade-off” of sedentary activity with low-intensity activity was not beneficial, but a trade-off of 2 minutes/hour of sedentary activity with an equal amount of light-intensity activity was associated with 33% lower risk of dying in the general population and a 41% lower risk of dying in the individuals with chronic kidney disease.

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• Members of the public in Australia considered reimbursement and justifiable recompensation of costs related to organ donation to be legitimate ways of supporting living donors. • Financial payment beyond reimbursement was regarded as morally reprehensible.

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Among dialysis patients, genetically related family members have about a 70% increased risk of cardiac arrest compared with unrelated dialysis patients. Spouses on dialysis do not have an increased risk.

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• Researchers have developed a system that could be used to identify novel drug candidates that protect the function of the kidney cells that are damaged in patients with chronic kidney disease. • One drug identified through the system effectively protected the kidney cells of rodents exposed to kidney damaging agents.

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The Kidney Health Initiative (KHI) is seeking input from patients with kidney disease and their family members on future treatment options. The perspectives gathered in this new KHI project will help inform development of therapeutics and devices for kidney disease, which affects more than 20 million Americans.

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• High parathyroid hormone levels and subsequent bone loss are major risk factors for worsening of coronary artery calcification in patients on dialysis.

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• For older patients in need of a kidney transplant, rapid transplantation from an older deceased donor is superior to delayed transplantation from a younger donor. • Kidneys from older donors do not have sufficient longevity to provide younger patients with a lifetime of kidney function, but they do have sufficient longevity to provide older patients who have a shorter life expectancy with a lifetime of kidney function.

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• Compared with uninfected (HIV-/HCV-) kidney transplant recipients, mono-infected HIV+ (HIV+/HCV-) recipients had similar 5-year and 10-year kidney survival rates, while HIV+ recipients co-infected with HCV (HIV+/HCV+) had worse kidney survival rates. • Patient survival among mono-infected HIV+ recipients was similar to uninfected recipients but was significantly lower for co-infected recipients.

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Highlights • Among pregnant women, the risk for adverse pregnancy outcomes—such as preterm delivery or the need for neonatal intensive care—increased across stages of chronic kidney disease. • The risks of intrauterine death or fetal malformations were not higher in women with chronic kidney disease.

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• In kidney disease patients on hemodialysis or peritoneal dialysis, enzyme activities involved in HDL metabolism and HDL maturation were significantly altered. • The normal function of HDL was also compromised in patients on hemodialysis or peritoneal dialysis.

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• High phosphate levels cause a stress signal inside the cells that line blood vessels, leading to the release of microparticles that promote the formation of blood clots.

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• Urinary angiotensinogen levels at the time of hospital admission predicted acute decompensated heart failure patients’ risk of developing acute kidney injury with considerable accuracy. • Patients’ urinary angiotensinogen level at the time of admission also helped clinicians predict patients’ risk of being rehospitalized or dying within one year.

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• In VA medical centers, patients started dialysis progressively earlier in the course of their kidney disease in more recent years. • There were no measurable differences in how sick patients were at the time of initiation or in the reasons for dialysis initiation to explain this trend.

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• In a study of patients with pre-dialysis chronic kidney disease, most patients reported chronic pain. • More severe pain was linked with both proper and improper use of pain medications.

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• Among patients with chronic kidney disease, patients who consumed high acid diets were 3-times more likely to develop kidney failure than patients who consumed low acid diets. • Low acid load diets are rich in fruits and vegetables, while high acid diets contain more meats.

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• An enzyme called heme oxygenase-1 (HO-1) affects immune cells as they travel through the body in response to kidney injury. • In mice, the absence of HO-1 leads to poor recovery after acute kidney injury.

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The American Society of Nephrology (ASN) is partnering with the Harold Amos Medical Faculty Development Program (AMFDP) of the Robert Wood Johnson Foundation to create the ASN-AMFDP Award and improve diversity in kidney health. The ASN-AMFDP Award will support the career development of a kidney research scholar and future health care leader from a historically disadvantaged background for 4 years.

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• A simple test performed with the FDA-approved medication furosemide, along with a measurement of urine output, can predict which patients with acute kidney injury will later require dialysis. • The test could help clinicians safeguard patients’ kidney health.

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• Researchers have shown that the messenger protein IL-6, which is rapidly produced at high levels during an acute inflammatory form of kidney disease, potently dampens activation of tissue-destructive immune cells called macrophages. • The findings may have broad clinical implications because elevated IL-6 is observed in many different inflammatory diseases, and macrophages are often crucially involved in their pathogenesis.

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• Salt intake accelerated kidney scarring in rats with chronic kidney disease by activating a brain-kidney connection called the renin-angiotensin axis that interlinks the damaged kidney and brain by afferent and efferent sympathetic nerves. • Targeting these nerves reduced salt-induced kidney scarring.

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• People who develop recurrent kidney stones have more calcification in their arteries, which could explain their increased risk for heart disease. • Kidney stone formers also have less dense bones, increasing their risk for osteoporosis.

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• Both low and high blood calcium levels, as well as high phosphorus levels, were linked with an increased risk of dying prematurely in dialysis patients, regardless of the type of dialysis. • The findings address a pending Medicare quality measure related to dialysis patients’ blood calcium levels.

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• A new algorithm is a useful tool for measuring chronic kidney disease patients’ readiness for making decisions about initiating dialysis. • Patients who have knowledge about their options and have fewer lifestyle barriers to home dialysis are more likely to be ready to make decisions. Doctors who explain all of the treatment options that are available can increase patients’ readiness for decision-making.

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• Among patients with a kidney disease called focal segmental glomerulosclerosis (FSGS), those who had certain genetic variants tended to have more advanced disease when they were diagnosed. • Patients with the variants responded to immunosuppressant treatments just as well as other patients but tended to progress more rapidly to kidney failure.

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The American Society of Nephrology (ASN), the world’s largest organization of kidney health professionals, has published a new report analyzing the results of the 2014 Nephrology Fellows Survey. Authored by leading health workforce researchers at George Washington University, the report provides key insights from future kidney health professionals. The report’s release follows the announced formation of the ASN Nephrology Match Task Force and the disappointing results of the 2015–2016 nephrology Match.

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Kidney donors with hypertension had slightly fewer nephrons (the kidney’s filtering units) at the time of donation than similarly aged donors with normal blood pressure; however, 6 months following their surgery, hypertensive and non-hypertensive donors both maintained excellent blood pressure control and had similarly robust compensatory kidney responses.

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The American Society of Nephrology (ASN), the world’s largest organization of kidney health professionals, has received the Accreditation Council for Continuing Medical Education's highest level of accreditation—Accreditation with Commendation. ASN is among the top of continuing medical education providers that have obtained Accreditation with Commendation.

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• In patients on dialysis, cinacalcet reduced the rate of bone fracture by 16% to 29%, after accounting for patient characteristics and other factors.

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• Decreased blood levels of a protein called Klotho increases the risk of heart disease in mice with chronic kidney disease. • If confirmed in humans, increasing Klotho levels may help protect the hearts of patients with chronic kidney disease.

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• A simple model using 5 commonly available variables from electronic health records adequately discriminates between socially disadvantaged individuals with chronic kidney disease who will and will not progress to kidney failure.

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Researchers presented two preliminary studies at ASN Kidney Week 2014 in Philadelphia, PA, that demonstrate the potential of a small-molecule inhibitor of NHE3 to help reduce phosphorus absorption in patients with kidney disease. Patients with reduced kidney function are unable to maintain normal levels of phosphorus, which can lead to hyperphosphatemia.

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Researchers have identified genetic markers that may help to identify individuals at risk for acute kidney injury (AKI) in the hospital setting. Presented at ASN Kidney Week 2014 in Philadelphia, PA, the study offers new clues about the development of AKI and could lead to potential therapeutic interventions.

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• A 12-week course of aerobic exercise improved physical function and quality of life in patients with advanced chronic kidney disease. • The exercise program also decreased patients’ pain.

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• Living organ donors who later need kidney transplants have much shorter waiting times, and they receive higher quality kidneys compared with similar people on the waiting list who were not organ donors.

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Rates of diabetic kidney disease could be higher than currently assumed according to a new study presented at ASN Kidney Week 2014 in Philadelphia. In an autopsy study of 150 individuals with type both type 1 and type 2 diabetes, researchers found 49.3% of individuals had diabetic nephropathy

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An international team of researchers from France, Germany, and the US have identified a protein that turns a person’s immune system against itself in a form of kidney disease called membranous nephropathy (MN). The new research was presented at ASN Kidney Week 2014 in Philadelphia and published online in the New England Journal of Medicine.

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A healthy diet may help protect the kidneys.

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The American Society of Nephrology (ASN), the world’s largest organization of kidney health professionals, has elected Jonathan Himmelfarb, MD, FASN, as the next ASN President. Dr. Himmelfarb’s election took place during the society’s annual meeting, ASN Kidney Week 2014, the largest gathering of kidney disease specialists in the world.

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Patients’ access to specialized care before kidney failure develops varies significantly across the United States and among different racial groups.

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Perceived racial discrimination may contribute to disparities related to kidney disease.

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Air pollution may play a role in the development of kidney disease.

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Potassium additives are frequently added to sodium-reduced meat products in amounts that may be dangerous for patients with kidney disease.

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Home dialysis therapies may help prolong the lives of patients with kidney failure compared with hemodialysis treatments administered in medical centers.

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The results of numerous high-impact clinical trials that could affect kidney-related medical care will be presented at ASN Kidney Week 2014, November 11¬–16 at the Pennsylvania Convention Center in Philadelphia, PA.

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The results of numerous high-impact clinical trials that could affect kidney-related medical care will be presented at ASN Kidney Week 2014, November 11–16 at the Pennsylvania Convention Center in Philadelphia, PA.