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Highlights From The April 2024 Issue –

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 April 2024 issue:

Secular Trend in GFR Decline in Non-Dialysis CKD Based on Observational Data From Standard of Care Arms of Trials by Carlo Garofalo et al [OPEN ACCESS]

From the authors: This study evaluated the secular trend in the change in glomerular filtration rate (GFR) decline in the placebo arms of randomized controlled trials (RCTs) that were studying approaches to protect the kidneys in the setting of chronic kidney disease. The placebo groups of RCTs are useful for examining whether the rate of progression of kidney disease has changed over time. We found an improvement in the slope of change in GFR over time. These findings suggest that adherence to standards of kidney care as implemented in clinical trials may be associated with improved clinical outcomes, and these data may inform the design of future RCTs in nephrology.

DOI: 10.1053/j.ajkd.2023.09.014

EDITORIAL: Improvements in Kidney Outcomes Over the Years: Reason for Optimism but a Challenge for Trialists by Doreen Zhu et al [FREE]

Tunneled Hemodialysis Catheter Tip Design and Risk of Catheter Dysfunction: An Australian Nationwide Cohort Study by Benjamin Lazarus et al 

From the authors: Central venous catheters are widely used to facilitate vascular access for life-sustaining hemodialysis treatments but often fail due to blood clots or other mechanical problems that impede blood flow. A range of adaptations to the design of tunneled hemodialysis catheters have been developed, but it is unclear which designs have the greatest longevity. We analyzed data from an Australian nationwide cohort of patients who received hemodialysis via a tunneled catheter and found that catheters with a step tip design failed more quickly than those with a symmetrical tip. Split tip catheters performed well but were infrequently used and require further study. Use of symmetrical rather than step tip hemodialysis catheters may reduce mechanical failures and unnecessary procedures for patients.

DOI: 10.1053/j.ajkd.2023.09.021

EDITORIAL: Dialysis Catheter Tip Design and Dysfunction: An Unsolved Challenge by Pallavi Prasad et al [FREE]

Impact of Parathyroidectomy Versus Oral Cinacalcet on Bone Mineral Density in Patients on Peritoneal Dialysis With Advanced Secondary Hyperparathyroidism: The PROCEED Pilot Randomized Trial by Angela Yee-Moon Wang et al 

From the authors: It is not known whether oral cinacalcet and surgical parathyroidectomy differ in their effects on bone parameters in patients with advanced secondary hyperparathyroidism (SHPT) receiving peritoneal dialysis. This pilot randomized trial evaluated the effect of medical versus surgical therapy on bone mineral densities (BMD) as prespecified secondary study end points. The findings showed that a large proportion of peritoneal dialysis patients with advanced SHPT had low bone densities and osteopenia/osteoporosis. Parathyroidectomy increased the BMD of the lumbar spine and femoral neck more than cinacalcet over 12 months. Parathyroidectomy reduced the proportion of patients with osteopenia/osteoporosis at the lumbar spine and femoral neck more than cinacalcet after 12 months. Neither intervention led to an increase in the BMD of the distal radius over 12 months.

DOI: 10.1053/j.ajkd.2023.10.007

EDITORIAL: Reducing Elevated Parathyroid Hormone to Protect Bone Strength in End-Stage Kidney Disease by Tamara Isakova and Thomas L. Nickolas [FREE]

Automated Urinary Chemokine Assays for Noninvasive Detection of Kidney Transplant Rejection: A Prospective Cohort Study by Elisabet Van Loon et al [OPEN ACCESS]

From the authors:  Urinary chemokines CXCL9 and CXCL10 have been suggested to be good noninvasive biomarkers of kidney transplant rejection. However, defining a context of use and integration with clinical information is necessary before clinical implementation can begin. In this study, we demonstrated that urinary chemokines CXCL9 and CXCL10, together with clinical information, have substantial diagnostic accuracy for the detection of acute kidney transplant rejection. Application of urinary chemokines together with clinical information may guide biopsy practices following kidney transplantation and potentially reduce the need for kidney transplant biopsies.

DOI: 10.1053/j.ajkd.2023.07.022

Association of Stroke With Metabolic Dysfunction–Associated Fatty Liver Disease With and Without CKD by Yuhao Li et al

From the authors: Metabolic dysfunction–associated fatty liver disease (MAFLD), which is recognized as a risk factor for stroke in the general population, is highly prevalent among individuals with chronic kidney disease (CKD). However, the impact of MAFLD on the risk of stroke in patients with CKD remains uncertain. We investigated the association of MAFLD with stroke in individuals with and without CKD. Our analysis revealed that MAFLD was associated with a significantly increased risk of stroke in individuals with CKD, and the magnitude of this increased risk was greater in the setting of CKD. These findings highlight the need for increased attention to MAFLD in patients with CKD and emphasize that addressing and preventing MAFLD in this population may contribute to reduced morbidity from stroke.

DOI: 10.1053/j.ajkd.2023.08.016

Modification of Association of Cystatin C With Kidney and Cardiovascular Outcomes by Obesity by Debbie C. Chen et al 

From the authors: Cystatin C is increasingly used in clinical practice to estimate kidney function, and cystatin C–based eGFR (eGFRcys) may be used to determine risk for adverse clinical outcomes. Adiposity may increase serum levels of cystatin C, independent of kidney function. This cohort study investigated whether associations of eGFRcys with adverse kidney and cardiovascular outcomes are modified by measures of obesity, waist circumference, and body mass index. We found that obesity does not modify associations of eGFRcys with 4 clinical outcomes and conclude that among individuals with obesity, cystatin C may be used to provide eGFR-based risk prognostication for adverse outcomes.

DOI: 10.1053/j.ajkd.2023.08.021

Association Between Urinary Biomarkers and CKD in Extremely Low Gestational Age Neonates by Sangeeta R. Hingorani et al 

From the authors:  Approximately 15 million neonates worldwide are born prematurely, and 2 million are born before 28 weeks’ gestation. Many of these children go on to experience chronic kidney disease. Urine biomarkers may allow for early recognition of those at risk for the development of kidney disease. In this study of more than 300 children born before 28 weeks’ gestational age, we found higher mean urinary levels of α-glutathione-S-transferase at 27, 30, and 34 weeks in children whose estimated glomerular filtration rate was <90 mL/min/1.73 m2 at 2 years compared with children whose estimated glomerular filtration rate was >90 mL/min/1.73 m2 at 2 years. Measurement of urinary biomarkers may assist in monitoring neonates who are at risk for chronic kidney disease. Additional studies are needed to confirm our findings.

DOI: 10.1053/j.ajkd.2023.09.008

Core Curriculum from the April 2024 issue:

Performance and Interpretation of Sonography in the Practice of Nephrology: Core Curriculum 2024 by Vandana Dua Niyyar

This installment of AJKD’s Core Curriculum in Nephrology illustrates how ultrasonography can be incorporated into clinical decision-making across the spectrum of kidney disease to optimize the care nephrologists provide to patients.

DOI: 10.1053/j.ajkd.2023.09.006

On the Cover:

The koalas pictured on the cover, like other marsupials, grow normally despite early birth in a near-fetal state. The very premature human infant is regrettably less fortunate, and may face a future of developmental delays and serious physical handicaps. In this issue of AJKD, Hingorani et al report on the use of urinary biomarkers to identify neonates and infants whose birth at an extremely low gestational age places them at risk for chronic kidney disease later in life.

The photograph “Koala Family” by Matthias Appel is available via Flickr and released into the public domain.