• Viability, necrosis, and death of immune cells are influenced by BPA concentrations in components of dialysis machines. • Alternative polymers for dialysis machine components may reduce cells’ exposure to BPA during dialysis
• For each 10 gram increase in vegetable protein intake, participants in a study had a 14% lower risk of dying during follow-up.
The American Society of Nephrology will recognize 6 leaders in the fight against kidney disease at the society's annual meeting, Kidney Week. A patient advocate, educational leader, and preeminent researchers are among the honorees. Kidney Week 2013 is November 5-10 in Atlanta, GA.
• Kidney disease is a growing public health threat affecting more than 20 million Americans. • Since 1996, the American Society of Nephrology and its foundation have awarded more than $25 million in grants and travel support.
• Bacterial infections in dialysis patients leave an “immune fingerprint” that can be used to improve diagnosis and to guide treatment. • Routine monitoring of complex immune fingerprints could also benefit patients with different types of infections.
Highlights • After a median of 2.4 years of follow up, 86.5% of transplants of donor kidneys considered “high-risk” for infection and disease were functioning with no evidence of infections. • Such “high-risk” organs are relatively safe when screened with current methods.
• Paying living donors $10,000 could be cost-saving even if it only resulted in a 5% increase in the number of donors.
Highlights • Kidney transplant recipients who discontinue immunosuppressive drugs before conception have a higher rate of live births and a lower rate of birth defects without an increased risk of kidney problems.
The American Society of Nephrology strongly recommends that all adults undergo routine screening for chronic kidney disease (CKD), the 8th leading cause of death in the U.S. This contradicts screening guidelines recently released by the American College of Physicians (ACP).
• Among kidney failure patients with depression who received behavioral therapy chair-side for three months while undergoing dialysis, 89% were not depressed at the end of treatment. Only 38% of patients in a control group were not depressed. • Patients in the treatment group experienced greater improvements in quality of life and were better able to control fluid intake between dialysis sessions (which makes the next dialysis session more efficient).
• Among kidney transplant recipients younger than 40 years of age, African Americans and individuals with less education were more likely to receive lower-quality organs than Caucasians and those with college degrees. • African Americans with higher education levels were not more likely to receive a lower-quality kidney than Caucasians with college degrees.
• Hispanics were just as likely as non-Hispanic whites to be put on the kidney transplant waitlist. • Once waitlisted, Hispanics were less likely to receive a transplant from a deceased donor. This disparity was largely explained by differences in patient blood type and regional variability of organ supply among organ procurement organizations across the country.
• Unlike in normal-weight mice with kidney disease, a degradation process called autophagy is suppressed in obese mice with kidney disease. This suppression leads to kidney cell damage. • Obese kidney disease patients also have suppressed autophagy.
• Complications and hospital length-of-stay following kidney donation have both declined since 1998. • Rates of complications and length-of-stay for donors are comparable with other relatively low risk abdominal surgeries such as appendectomies. • Depression, hypothyroidism, hypertension, and obesity have increased over time among donors.
• A genetic variant on chromosome 2 is linked with kidney failure in women with type 1 diabetes but not in men. • Diabetic women with the risk variant had a nearly two-fold increased risk of developing kidney failure compared with diabetic women who did not have the risk variant.
• A protein called polycystin-1 may help shepherd another protein, polycystin-2, to a cell’s antenna, or cilium. This process is defective in induced pluripotent stem cells derived from patients with autosomal dominant polycystic kidney disease. • Placement of the normal polycystin-1 protein back into cells can correct this defect. • Pluripotent stem cells from polycystic kidney patients may be useful as “disease in a dish” models for developing new therapeutics.
• Diabetics with persistent protein in the urine over four to five years had greater declines in cognitive function than diabetics without protein in the urine. • The decline was subtle; however, over 10 to 15 years it could translate into noticeable impairment.
• Income status is strongly associated with living kidney donation: lower income populations have lower rates of living kidney donation compared with higher income populations among both African Americans and Whites. • In low income populations, African Americans have lower rates of kidney donation compared with White Americans, but in high income populations, African Americans actually have higher rates of kidney donation compared with White Americans.
• A structured exercise and lifestyle program can help kidney disease patients become fitter and lose weight, and it can improve their heart health. • Exercise can be safe in patients with kidney disease even if they have various other medical problems.
• Variants in the gene that encodes ABIN1—which is involved in the control of inflammation—are linked with an increased risk for kidney complications in patients with lupus. • The finding may point to improved treatments for kidney complications in patients with the disease.
• Nephrologists whose dialysis patients had the best survival over six years had a significantly lower patient caseload than nephrologists whose patients had the worst survival. • For every additional 50 patients cared for by a nephrologist, patients had a 2% higher risk of dying within six years.
• Medicare spending attributable to moderate stages of chronic kidney disease is likely to exceed $48 billion per year. • Efforts to prevent the development of chronic kidney disease may lead to significant medical cost savings.
• Ultrasound treatment can help prevent acute kidney injury in animals. • Anti-inflammatory effects of the treatment appear to give it its kidney-protective properties.
• The frequency and duration of patient-doctor contact during dialysis care vary appreciably across countries. • More frequent and longer contact with physicians is linked to fewer deaths and hospitalizations of dialysis patients.
• Researchers found a strong, graded association between worse kidney function and the presence of hypertension that is resistant to medications. • More than 50% of individuals with moderate CKD had resistant hypertension. • Among people with CKD, blacks and those with a larger waist circumference, diabetes, and a history of heart attacks or strokes were more likely to have resistant hypertension.
American Society of Nephrology (ASN) and the ASN Foundation for Kidney Research will fund $3 million in original, meritorious research in 2013.
• A novel drug called Bendavia can help prevent acute kidney injury in animal models and is currently being studied in clinical trials for kidney disease. • Bendavia acts by protecting a unique compound called cardiolipin, which is only found in mitochondria and is essential for keeping cells alive and functioning.
• Among kidney disease patients receiving pre-dialysis care in a universal healthcare system, black patients experienced a faster progression to kidney failure than whites. • The faster decline in kidney function among black compared with white patients was predominantly present in patients with diabetes and in patients with more advanced kidney dysfunction.
Patients in areas where dialysis care is already limited may be most vulnerable.
• Elderly kidney failure patients using catheters to access the blood for dialysis have the highest risks of dying prematurely compared with patients using other types of vascular access. • Two other types of vascular access—arteriovenous fistulas and arteriovenous grafts—provide similar survival advantages for elderly dialysis patients.
• Providing a large amount of intravenous iron over a short period of time increases dialysis patients’ risk of developing a serious infection. • Smaller doses given less frequently do not increase infection risk for patients.
• Compared with kidney disease patients who had zero or one heart healthy lifestyle component in the ideal range, those with two, three, and four ideal factors had progressively lower risks for kidney failure over four years. • No kidney disease patients with five to seven ideal factors developed kidney failure. • Patients’ risk of dying during the study followed a similar trend
• Among patients with chronic kidney disease, those with very low kidney function had a higher risk of having a heart attack than those with higher kidney function over a four-year period. • The link between higher LDL cholesterol and heart attack risk was weaker for patients with very low kidney function than for patients with higher kidney function. 60 million people globally have chronic kidney disease.
• The phosphate binder sevelamer carbonate did not improve cardiovascular measures in patients with early chronic kidney disease. • For now, reducing dietary intake of phosphate may be the best way for these patients to reduce the mineral’s negative effects on the heart. High phosphate levels—in kidney disease patients and in the general population—increase the risk of dying from cardiovascular causes.
• In patients with chronic kidney disease, measures of lower extremity performance were at least 30% lower than predicted, but handgrip strength was relatively preserved. • Each 0.1-meter per second slower walking speed was linked with a 26% higher risk for death over an average three-year follow-up period. • Adding gait speed tests to laboratory tests of kidney function significantly improved the prediction of three-year mortality. 60 million people globally have chronic kidney disease.
• There is substantial regional variation in the magnitude of racial differences in end-of-life care among US adults with kidney failure. • Black-white differences in dialysis discontinuation and hospice referral are most pronounced in regions with the highest levels of end-of-life spending.
• People with apple-shaped bodies tend to have lower kidney function, lower kidney blood flow, and higher blood pressure within the kidneys than people with pear-shaped bodies. • The findings may help explain why people with apple-shaped bodies are more likely than those with pear-shaped bodies to develop kidney disease.
• Growth hormone therapy can help reverse growth problems in children with kidney failure. • Growth hormone therapy increases bone turnover in children on dialysis • Additional studies are needed to evaluate the impact of growth hormone therapy on final height, fracture risk, bone deformities, and puberty in children with kidney failure. Growth failure occurs early in chronic kidney disease and causes severe short stature in children.
• Individuals who are overweight starting in early adulthood are twice as likely to have chronic kidney disease at age 60 to 64 years than those who are not overweight. • Larger waist-to-hip ratios (“apple-shaped” bodies) during middle age are also linked with chronic kidney disease at age 60 to 64 years.
• Among dialysis patients, Hispanics tend to live the longer than Blacks, who in turn live longer than whites. • Determining the reasons for these racial and ethnic disparities may be important for improving care. As of 2010, there were approximately 410,000 dialysis patients in the United States.
• Low vitamin D levels measured at three months after kidney transplantation were linked with lower kidney function and increased kidney scarring at 12 months post-transplant. • Other hormones involved with mineral metabolism were not predictors of kidney function or scarring after one year. Vitamin D deficiency is prevalent in patients with kidney failure.
• Among individuals with chronic kidney disease, adherence to a healthy lifestyle was associated with a greater likelihood of surviving over a 13-year period. • The greatest survival benefits were related to nonsmoking. 60 million people globally have chronic kidney disease.
• In an analysis of 695 patients with kidney failure, Blacks had received less transplant education, were less knowledgeable about transplantation, and were less willing to pursue deceased or living donor transplantation than Whites. • Patients who began a transplant evaluation process with a greater knowledge of transplantation and greater motivation to receive living donor transplants were ultimately more successful at receiving a living donor transplant. In 2010, a total of 28,662 kidney transplants took place in the U.S. Of those, only 6,809 were from living donors.
• Suboptimal kidney response to the hormone FGF-23 may put chronic kidney disease patients at increased risk of premature death and cardiovascular events. • Resistance to the hormonal actions of FGF-23 in the kidney may identify novel aspects of kidney dysfunction. 60 million people globally have chronic kidney disease.
• African Americans with kidney disease whose blood pressure changed significantly from day to day were nearly three times as likely to die prematurely than patients whose blood pressure changed very little. African Americans are more likely than whites to develop kidney disease and die prematurely.
• A study of kidney failure patients found that fewer patients in large-metro and rural counties received kidney specialist care before developing kidney failure than patients in medium/small-metro counties. • In all geographic areas, black patients received less care before developing kidney failure than their white counterparts. More than 590,000 Americans in 2010 were treated for kidney failure; more than 20 million Americans had some level of chronic kidney disease.
• Control of anemia in children on dialysis varies by region around the globe. • Poor response to anemia medications is linked with inflammation, fluid retention, and hyperparathyroidism. • Anemia and the need for high doses of anemia medications are linked with an increased risk of dying prematurely.
Pediatric kidney transplant recipients who have antibodies directed against their new organ are more likely to experience kidney injury and rejection than patients without these antibodies. • Steroids do not prevent this antibody-mediated injury and rejection. Approximately 2,500 children received a kidney transplant last year in the United States
• Lung ultrasound can detect asymptomatic lung congestion in dialysis patients and can predict their risk of dying prematurely or experiencing heart attacks or other cardiac events. • Treating asymptomatic lung congestion may help improve cardiovascular health and prevent cardiovascular deaths in dialysis patients. Lung congestion is highly prevalent and often asymptomatic among patients with kidney failure.
• Dialysis patients using catheters to access the blood have the highest risks for death, infections, and cardiovascular events compared with patients using other types of vascular access. • Higher quality studies are needed to determine the true safety of different types of vascular access used for hemodialysis. Worldwide, more than 1.5 million people are treated with hemodialysis.
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