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As Houston area residents fight to survive Hurricane Harvey’s flood waters and wreckage, the American Society of Nephrology (ASN) joins efforts by the American Kidney Fund (AKF) and the Kidney Community Emergency Response (KCER) coalition to provide continuity of care for displaced kidney dialysis patients in need of treatment. ASN Supports Hurricane Harvey Kidney Patient Relief Efforts Washington, DC (August 23, 2017)—As Houston area residents fight to survive Hurricane Harvey’s flood waters and wreckage, the American Society of Nephrology (ASN) joins efforts by the American Kidney Fund (AKF) and the Kidney Community Emergency Response (KCER) coalition to provide continuity of care for displaced kidney dialysis patients in need of treatment. Today, ASN announces a $10,000 donation to the relief efforts for dialysis patients coordinated by AKF. These funds will help those affected by the catastrophic flooding and damage by helping replace medications, providing transportation t

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• In a recent study of healthy young adults, marijuana use was not associated with change in kidney function over time or the appearance of albumin in the urine, which is a sign of kidney damage. • Additional studies are needed to assess the effects of marijuana in older adults and patients with kidney disease.

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• A tyrosine kinase inhibitor approved for the treatment of certain cases of chronic myeloid leukemia slowed cyst growth in patients with autosomal dominant polycystic kidney disease.

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• In a new study, individuals with poor kidney function had an increased risk of developing community-acquired infections. • The relative proportion of lower respiratory tract infections, urinary tract infections, and sepsis became increasingly higher as kidney function decreased.

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• There are very few high quality studies on strategies to increase living kidney donation. • From the limited data available, educational interventions directed at potential recipients and their social networks are the most promising.

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• Investigators observed a step-wise increase in the risk of atrial fibrillation with decreasing kidney function. Compared with patients without kidney disease, those with severe kidney disease had a two-fold higher risk for developing atrial fibrillation. • This link held even after accounting for a range of possible contributors, including measures of cardiovascular health, and it was consistent across subgroups of participants.

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• Deficits in the ability to smell are common among individuals with chronic kidney disease, and the severity of these deficits increases with the severity of their disease. • Reductions in several markers of nutrition correlated with patients’ impaired sense of smell. • Treatment with intranasal theophylline, an asthma drug, led to improvements in the ability to smell in 5 of 7 patients with kidney failure.

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• From 2007-2012, deceased donor kidneys in the United States were offered a median of 7 times before finally being accepted for transplantation. • Such refusals may have contributed to racial and ethnic disparities that exist in access to transplantation in the United States.

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• A new test may help to rapidly diagnose preeclampsia in pregnant women. Elevated levels of fetal hemoglobin in the blood may play a role in the development of kidney damage associated with preeclampsia.

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• A molecular analysis of the mismatch between the tissues of donors and recipients helped predict which recipients required high doses of immune modulating drugs and which needed only low doses.

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n a new study, patients discharged home from the emergency department with acute kidney injury remained at increased risk of poor 30-day outcomes.

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• In hemodialysis patients, hypothyroidism was linked with impairments across multiple areas of health-related quality of life, including lower energy and greater fatigue, poorer physical function, and greater pain.

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• Kidney biopsy results had no impact on the function of kidneys transplanted from living donors. • Outcomes following kidney transplantation using deceased donor kidneys were influenced by biopsy findings; however, even transplantation with kidneys with the worst biopsy findings would result in 5 additional years of life for a patient compared with remaining on dialysis. • Most deceased donor kidneys with suboptimal biopsy results were still functioning 5 years after transplantation.

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The ASN Foundation for Kidney Research announced the names of its 2017 research grant recipients who are working to improve our understanding of kidney diseases and to develop new and advanced treatment options.

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• Most bloodstream infections in dialysis patients continue to occur in those with central venous catheters used to access their blood. The findings come from 2014 data from US dialysis facilities. • Staphylococcus aureus was the most commonly isolated pathogen that caused bloodstream infections, and in many cases they were antibiotic-resistant.

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The American Society of Nephrology (ASN) believes the Better Care Reconciliation Act’s passage would negatively impact millions of patients. ASN has written to Majority Leader Mitch McConnell and Minority Leader Charles E. Schumer to express its concerns.

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• In individuals with chronic kidney disease, targeting a systolic blood pressure to <120 mm Hg resulted in lower risks of cardiovascular events and premature death, compared with standard targeting to <140 mm Hg. • There was a slightly faster decline in kidney function in the intensive group, but no increase in rates of kidney failure or serious adverse events.

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Josephine P. Briggs, MD, begins her term on January 1, 2018 as Editor-in-Chief of the Journal of American Society of Nephrology (JASN), considered the leading specialty journal in nephrology.

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• A new calculator estimates the likelihood that a given patient who receives a kidney transplant from a particular living donor will maintain a functioning kidney. • The calculator may be especially useful for kidney paired donation.

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The American Society of Nephrology (ASN) applauds the Trump Administration’s decision to extend Francis S. Collins’, MD, Ph.D, tenure as the Director of the National Institutes of Health (NIH).

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• Patients who received kidney transplants from donors with diabetes had better survival compared with those who remained on the waitlist. • Patients at high risk of dying while on the waitlist and those at centers with long wait times may benefit the most from transplantation with kidneys from diabetic donors.

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ASN Denounces Administration’s Proposed Massive Cuts for the National Institutes of Health – “Would Disrupt Medical Research”

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• In a new study, a higher amount of body fat was linked with an increased risk of developing chronic kidney disease. • Simple ways of measuring body size—such as waist circumference or body mass index—provided similar information on risk as more sophisticated methods, such as imaging scans, to measure different types of body fat.

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• Patients who were admitted to the hospital with sepsis, heart diseases, polytrauma, liver disease, and cardiovascular surgery were at elevated risk for developing acute kidney injury (AKI). • The medical records of most patients who developed hospital-acquired AKI did not include the diagnosis code for AKI.

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• Chronic fluid overload was linked with an increased risk of early death in patients undergoing hemodialysis. • The magnitude of this risk was comparable to that of coronary artery disease or congestive heart failure.

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• Researchers have developed a risk calculator that estimates the risk of kidney failure after donation. • Overall risk was quite low, but black race and male sex were associated with increased risks of developing kidney failure in living kidney donors. • Older age was associated with greater kidney failure risk in nonblack donors, but not in in black donors. • Higher body mass index and a close biological relationship to the transplant recipient were also associated with increased risks of kidney failure.

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• Potentially preventable hospital acquired complications were associated with increased risks of dying while hospitalized or within 90 days of discharge, as well as with a greater likelihood of staying longer in the hospital and needing to be readmitted. • The magnitude of these associations was larger in patients with chronic kidney disease than in those with normal kidney function.

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• Most nephrology fellows rated overall quality of teaching in fellowships as either “good” or “excellent,” and over half of second-year fellows felt “fully prepared” for independent practice. • Fellows indicated a desire for more education in several core nephrology topics, including peritoneal dialysis and home hemodialysis, ultrasound, and kidney pathology.

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• In 2013, reduced kidney function was associated with 4% of deaths worldwide, or 2.2 million deaths. • More than half of these deaths were cardiovascular deaths.

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In patients with chronic kidney disease, low urine ammonium excretion identified individuals at high risk of kidney disease progression or death.

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• Among deceased donor kidney transplant recipients, those who were >30 kg (66 pounds) heavier than the donor had a 28% higher risk of transplant failure compared with equally weighted donors and recipients. • If the kidney was from a smaller donor of the opposite sex, the relative risk of transplant failure was further elevated to 35% for a male receiving a kidney from a female donor and 50% for a female receiving a kidney from a male donor.

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Advocates from the American Society of Nephrology (ASN) and the American Association of Kidney Patients (AAKP) are meeting with Representatives, Senators, and their respective staffs today to urge Congress to continue its historic support of research funding for the National Institutes of Health (NIH) and to cosponsor and pass the Living Donor Protection Act (H.R. 1270), no-cost legislation to eliminate barriers to living donation and increase access to transplants.

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• Colonoscopies are being performed more often on healthier dialysis patients than on those with more limited life expectancies; however, overall, dialysis patients are being screened at a much higher rate relative to their life expectancy than their counterparts without kidney failure.

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Condemns the Administration’s Proposed Funding Cuts for the National Institute of Health

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• In dialysis patients who took 2.5 mg of apixaban twice daily, blood concentrations of the drug were maintained at therapeutic levels.

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• Sickle cell trait, a common hemoglobin variant in African Americans, was associated with a twofold higher risk of developing kidney failure requiring dialysis. • Sickle cell trait conferred a similar degree of risk as APOL1 gene variants, which are currently the most widely recognized genetic contributors to kidney disease in blacks.

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• Kidney rejection initiated by antibodies that were present before transplantation is linked with a better outcome that rejection due to antibodies that arise after transplantation.

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• From 2001 to 2012, HIV+ kidney failure patients on the transplant waiting list were 28% less likely to receive a transplant compared with their HIV- counterparts. • They were half as likely to receive a kidney from a living donor.

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• During rejection of a transplanted kidney, certain immune cells transform into connective tissue cells, which produce collagen and other fibers. • This transition, which is mediated by the TGF-/Smad3 signaling pathway, leads to scarring and decreased kidney function.

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• Receiving advice on limiting salt consumption helped kidney disease patients lower their systolic blood pressure by an average of 11 mmHg. • Limiting salt intake also reduced excess fluid retention that is common among patients with kidney disease.

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• Higher degrees of linguistic isolation were linked with a lower likelihood of transitioning from inactive to active status on the kidney transplant waiting list and with incomplete transplant evaluations. • The association of linguistic isolation appeared to be most influential among Hispanic transplant candidates.

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The American Society of Nephrology (ASN) is pleased to partner with the Department of Veterans Affairs (VA) to host the upcoming Kidney Innovation Summit. The Summit will take place at the Booz Allen Hamilton Center for Innovation in Washington, DC on February 9 – 10, 2017.

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• Elevated sodium content in the skin correlates closely with left ventricular hypertrophy in patients with chronic kidney disease.

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American Society of Nephrology (ASN) President Eleanor D. Lederer, MD, FASN, and the Society’s leadership issued the following statement regarding the January 27, 2017, Presidential Executive Order on Immigration:

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• A new study found that patients on chronic hemodialysis with depression are frequently not interested in modifying or initiating anti-depressant treatment. Kidney specialists caring for these patients are often unwilling to modify or initiate anti-depressant therapy even when patients are willing to accept recommendations from nurses to do so

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• Decreased blood levels of a protein called soluble klothos were linked with an increased likelihood of experiencing kidney function decline in a group elderly well-functioning adults.

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Report Details Imbalance between Kidney Disease Research and Health Impact.

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• In a phase 3 trial of patients with chronic kidney disease, 52.1% of patients receiving oral ferric citrate experienced a significant boost in hemoglobin levels (a reflection of red blood cell counts) compared with 19.1% of patients receiving placebo. • A treatment effect was seen as early as 1-2 weeks after the start of treatment, and the response was durable.

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Rajnish Mehrotra, MD, FASN, begins his 6-year team as Editor-in-Chief of the Clinical Journal of the American Society of Nephrology (CJASN) on January 1, 2017, alongside an incoming editorial team of 17 highly accomplished nephrology researchers.

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• Hemodialysis patients tend to have denser blood clots than individuals without kidney disease. • Dense blood clots were linked to an increased risk of premature death from cardiovascular and other causes.