• Certain mutations and combinations of mutations in immune-related genes affect individuals’ risk of developing a rare but serious kidney condition. • These mutations also affect patient prognosis following different treatments. About half of patients with the condition, called atypical hemolytic uremic syndrome, develop kidney failure.
• A technique that removes additional toxins during dialysis decreased kidney failure patients’ risk of dying from any cause by 30% over three years. • The technique also reduced patients’ risk of dying from heart-related causes or infections.
• Adding fruits and vegetables to the diet is an effective alternative to medication to reduce metabolic acidosis and kidney injury in late-stage chronic kidney disease. Metabolic acidosis is a common complication of kidney disease.
• Compared with standard dialysis, frequent dialysis can cause complications related to repeated access to the blood. • The findings provide valuable information for dialysis patients and their physicians.
• African Americans and individuals without private health insurance are less likely to receive a kidney transplant before needing dialysis. • Geographic region is not a major factor in determining whether a patient receives a kidney transplant before starting dialysis.
• The breast milk of mothers taking the immunosuppressant tacrolimus contains only very low levels of the drug. • Women taking tacrolimus who wish to breast-feed after appropriate counseling should not be discouraged from doing so. Increasing numbers of pregnant women are taking tacrolimus after organ transplantation and for other conditions.
• Among people without diabetes or kidney disease, 10-year mortality was 7.7%. • Among individuals with diabetes but without kidney disease, mortality was 11.5%. • Among those with both diabetes and kidney disease, mortality was 31.1%.
• Residence in areas with higher average household income was linked with improved survival in kidney failure patients. • In White patients, income inequality was associated with mortality. • In Black patients exclusively, residence in highly segregated areas was associated with increased mortality. More than 590,000 Americans in 2010 were treated for kidney failure.
• While safe and well-tolerated, angiotensin II blockade did not lessen tissue scarring or prevent kidney failure in kidney transplant recipients. Angiotensin II blockade is known to slow kidney disease progression in individuals without transplants.
• Retention of certain compounds that are normally excreted by the kidneys may cause insulin resistance, or prediabetes, in kidney disease patients. • When mice with kidney disease were treated with a prebiotic that reduces blood levels of these compounds, insulin resistance and lipid abnormalities were prevented.
• Six months of steroid treatment in children with nephrotic syndrome did not reduce relapse rates or side effects compared with three months of treatment. • Because many children with nephrotic syndrome face frequent relapses, future research should focus on preventing relapses through new treatment strategies. Nephrotic syndrome has an estimated incidence of two to seven cases per 100,000 children and a prevalence of nearly 16 cases per 100,000.
• Blocking the receptor for endothelin lowers novel cardiovascular risk factors in patients with chronic kidney disease independent of blood pressure. • The findings suggest that blocking the receptor may provide heart-related benefits to these patients. 60 million people globally have chronic kidney disease.
• In a study of African Americans with kidney disease, levels of mineral metabolites rose over time; those with faster rates of kidney function decline had the greatest increases in metabolites. • Higher baseline levels of metabolites were linked with an increased risk for kidney failure or death independent of kidney function. Disordered mineral metabolism is more severe in African Americans with chronic kidney disease, which might partially explain why their disease progresses more rapidly to kidney failure.
• The incidence of the most severe form of acute kidney injury has increased 10% per year on average over the past decade. • Deaths associated with the condition have doubled during that time.
• Among individuals with chronic kidney disease, African Americans experience faster progression of the disease during later stages compared with other races. • Screening of African Americans with chronic kidney disease can help improve care and is cost-effective. Chronic kidney disease affects an estimated 26 million adults in the United States.
• For kidney failure patients with blocked arteries surrounding the heart, open heart surgery is linked with a lower risk of dying or having a heart attack compared with angioplasty. • Among patients undergoing these revascularization procedures, the five-year survival of patients without kidney disease is over 90%, but survival in kidney failure patients is dismal.
• The detection of preformed donor-specific antibodies by newer tests, despite negative results from traditional tests, nearly doubles a kidney transplant recipient’s risk for rejection. • It also increases the risk of kidney failure by 76%. Nearly 17,000 kidney transplants take place each year in the United States.
• Kidney specialists do not routinely receive formal education on how to talk with patients about end-of-life and other serious issues. • A new workshop helps nephrology fellows be prepared to deliver bad news, express empathy, and discuss dialysis initiation and withdrawal.
• Most patients with a leading cause of kidney failure, have high levels of suPAR circulating in their blood. • suPAR levels could help doctors monitor the disease’s progression as well as patients’ response to different therapies. • suPAR might be a therapeutic target of future treatments.
Bruce A. Molitoris, MD, FASN starts his term November 4, 2012.
• Aliskiren on top of standard therapy does not seem to help type 2 diabetic patients at high risk for developing heart and kidney problems. • Tolvaptan benefits patients with autosomal dominant polycystic kidney disease. • Cinacalcet does not significantly reduce the risk of premature death or major heart-related events in dialysis patients with secondary hyperparathyroidism.
• Some kidney donors have an increased risk of developing high blood pressure after donation. • Individuals with prediabetes can safely donate kidneys without increasing their risk of developing diabetes or kidney failure. • Among children with advanced kidney disease, blacks and Hispanics are less likely than whites to receive optimal care.
• Adding fruits and vegetables to the diet improves kidney disease patients’ health. • Poor nutrition plays a role in the link between poverty and kidney disease. • Among kidney disease patients, Blacks are more likely to have uncontrolled blood pressure than Whites
ASN President highlights necessary steps as he opens ASN’s annual meeting. (Media can request full text of speech, under embargo).
The ASN Foundation for Kidney Research will propel major advances in understanding the 8th leading cause of death in America. African Americans, Hispanics, and Native Americans face up to a 4-fold risk of kidney disease. Rates of kidney disease and kidney failure are rising globally and will increase with the rise in diabetes, hypertension and obesity.
• Kidney failure patients have less sugar coating along the insides of their blood vessels, and they have high levels of the coating’s constituents in the blood, consistent with increased shedding. • Damage to this sugar coating may be responsible for kidney failure patients’ increased risks of heart problems. Heart disease is the number one killer of individuals with kidney disease.
• From suspensions of single kidney cells, researchers have constructed “organoids” that can carry out kidney functions when implanted into a living animal. • The advance marks a considerable step toward the goal of engineering kidney tissues suitable for transplantation. Tissue engineering of kidneys could help alleviate the shortage of kidneys for transplantation.
• A drug that activates the liver x receptor blocks expression of an inflammatory molecule involved in diabetic nephropathy, the leading cause of kidney failure. • The drug improves kidney health and function in diabetic mice. • Such a drug might help protect the health of diabetic patients’ kidneys. About 20%-30% of patients with diabetes develop evidence of diabetic nephropathy.
• In the largest study of its kind, a variant within the multidrug resistance 1 (MDR-1) gene in kidney transplant donors was linked to a 69% increased risk for long-term failure of transplanted organs. • This variant affects the expression of the protein that the MDR-1 gene encodes, which pumps drugs out of cells. (Immunosuppressant drugs are critical for preventing organ rejection but are also toxic to the kidneys.)
• Home hemodialysis could allow patients to enjoy increased freedom, quality of life, greater ability to travel, and tangible health improvements. • Increased physician and patient education can eliminate barriers to home hemodialysis and increase its use. Approximately 2 million patients in the world receive some sort of dialysis treatment.
• 70% and 40% of survey respondents found financial incentives to be acceptable for deceased and living kidney donors, respectively. • 45%, 14% and 27% of the public, health professionals, and people with or affected by kidney disease, respectively, supported monetary payment as incentives for living donors.
• ASN and FDA announce a new partnership—the Kidney Health Initiative (KHI)—to improve patient safety and promote development of new therapies for patients with kidney disease. • Up to 26 million Americans have kidney disease, and African Americans, Hispanics, and Native Americans face up to a four-fold risk. • Kidney disease is the 8th leading cause of death in America.
• Kidney disease patients and their physicians should question and discuss certain medical tests and procedures, taking into consideration patients’ preferences, needs, and health goals. • Doing so can improve care and reduce costs. An estimated 30% of care in America goes to unnecessary tests and procedures.
• Blood tests of particular autoantibodies can accurately diagnose the autoimmune kidney disease called idiopathic membranous nephropathy. • Patients with high levels of these autoantibodies tend to have more severe disease, while those with low levels often experience remission. Each year, an estimated 50,000 people globally are diagnosed with idiopathic membranous nephropathy.
• Many patients with a common kidney disease who had normal kidney function and only minor urinary abnormalities at diagnosis experienced remission without special treatments. • None developed kidney failure over a 20-year follow-up.
• For the first time, a new test can measure the propensity for calcification to occur in an individual’s blood. • The test could identify people at risk for vascular calcification, a major cause of heart disease.
• For patients with type 2 diabetes, any degree of measurable urinary protein excretion—even in what is considered the normal range—increases their risk of experiencing heart problems. • Many patients with type 2 diabetes may benefit from cardioprotective medications. More than 300 million people worldwide have type 2 diabetes.
• Waiting to treat cytomegalovirus infections in transplant recipients until they reach a certain threshold is better than prophylactically treating all recipients. • Patients who were pre-emptively treated experienced less kidney scaring and better long-term organ survival than patients prophylactically treated. Cytomegalovirus infection is the most common infection in organ transplant recipients.
• The blood levels of certain abnormal proteins and the antibodies that attack them rise according to the severity of one of the most common diseases of the kidney. • The findings may help in the diagnosis and management of the disease, called IgA nephropathy. IgA nephropathy can lead to high blood pressure, swelling and, in some cases, kidney failure.
• Approximately 1 in 40 men and 1 in 60 women of middle age will develop kidney failure if they live into their 90s. • People with reduced kidney function face an even higher risk. Kidney failure is on the rise and currently afflicts 2 million people worldwide.
• Vancomycin was the most commonly prescribed antibiotic in dialysis patients for treating certain bloodstream infections, but cefazolin was 38% better than vancomycin at preventing hospitalizations and deaths from these infections. • Cefazolin was also 48% better at preventing sepsis. Hundreds of thousands of Americans develop bloodstream infections every year.
• Patients with a particular kidney immune disorder experienced remission when taking the immune drug rituximab, even when standard therapies had failed. • Rituximab was safe and well-tolerated by all patients in the study. Each year, an estimated 70,000 people globally are diagnosed with the disorder, called idiopathic membranous nephropathy.
• Young black patients and patients without private health insurance are less likely to be assessed for a kidney transplant when they start dialysis. • These patients are also less likely to be put on the transplant waiting list and to receive a kidney transplant. • The findings may help explain the racial and socioeconomic disparities in access to kidney transplantation that are well documented. A kidney transplant is the best treatment for kidney failure, which afflicts 2 million people worldwide.
• Phosphate binders, drugs commonly prescribed to patients with chronic kidney disease, may not be as effective as previously thought. • Phosphate binders may have negative effects on cardiovascular health. • Additional studies are needed on the safety and effectiveness of these drugs. 60 million people globally have chronic kidney disease.
• Homeless kidney disease patients suffer from much higher rates of depression and substance abuse and are more likely to develop kidney failure and die prematurely than impoverished patients with stable housing. • Homeless kidney disease patients are also far more likely to use costly emergency medical services.
• A low-carbohydrate high-protein weight loss diet does not negatively affect healthy obese patients’ kidney function or their fluid and electrolyte balance compared with a low-fat diet. • Additional studies are needed to evaluate the diet’s effects in different types of individuals, such as those with pre-existing kidney disease.
• Obese patients have an increased risk of developing kidney damage, or acute kidney injury, after heart surgery. • Oxidative stress associated with obesity seems to play a role in this increased risk.
• An infection called peritonitis commonly arises in the weeks before many patients on peritoneal dialysis die. • More studies are needed to determine whether peritonitis causes premature death in dialysis patients. 10% to 20% of dialysis patients receive peritoneal dialysis.
One type of open heart surgery is safer than the other—in terms of both health and survival—for chronic kidney disease patients. Heart disease is the leading cause of death in individuals with chronic kidney disease.
• A minimally invasive procedure called renal denervation, which disrupts certain nerves in the kidneys, lowers blood pressure in patients with chronic kidney disease and hypertension. • The procedure may help protect the kidneys and reduce heart risks in patients with chronic kidney disease.
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