In this issue ...
Haem oxygenase-I plays a major role in vascular pathology, atherosclerosis, hypertension, acute kidney injury, and in the chronic nephropathy as complication of sickle cell disease. The role of this enzyme system is dual: potentially beneficial as well as injurious. Further studies on the identification of the effects of HO-I induction would provide us new insights on mechanisms reducing tissue pathology. See article by Hill-Kapturczak and Agarwal, pages 1495–1498The occurrence of extraosseous calcification and its prevention is one of the "hot" topics in nephrology. A number of inhibitors of ectopic calcification have been identified and among them fetuin-A has received the most attention. In this elegant study, using wild-type and fetuin-A-deficient mice, further evidence for the "protective" role of fetuin-A was provided. The authors could demonstrate that fetuin-A deficiency, chronic kidney diseases and a high phosphate diet act synergistically in the pathogenesis of extraosseous calcification. See article by Westenfeld et al., pages 1537–1546
The use of biphosphonates in patients with kidney disease has become widespread; however, where rather convincing evidence exists on the effectiveness of these drugs in the non-renal population or in glucocorticoid-treated patients with near normal renal function, the results in patients with serious renal disease or after transplantation are more equivocal. The "renal safety" of these drugs is also questioned, certainly with the high doses used in oncology or because of their direct action in reducing the bone turnover. An editorial commentary and two original papers exploring these issues in CKD patients are published in this issue. See articles by Cunningham, pages 1505–1507
Fujii et al., pages 1601–1607
Kikuchi et al., pages 1593–1600
The role of insulin resistance as common denominator of type 2 diabetes mellitus and vascular diseases is rather well accepted. Whether insulin resistance and the concomitant hyperinsulinaemia may accelerate age-related decline in renal function through induction of glomerular hyperfiltration even in non-diabetic patients has been explored in the PREVEND study. Based on analysis of fasting insulin levels in 3432 subjects, representing the general population, it was found that hyperinsulinaemia was associated with a stronger inverse parabolic relation between age and creatinine clearance, suggesting indeed that insulin resistance could contribute to the increased incidence of ESRD. See article by Oterdoom et al., pages 1587–1592
Implementation of a vascular access quality programme improves vascular access care as was demonstrated in the Netherlands where the initiation of such a surveillance programme resulted in the placement of more autogenous arterio-venous fistulas, an increased number of percutaneous transluminal angioplasty for malfunctioning accesses, and more surgical interventions. See article by van Loon et al., pages 1628–1632
Dyslipidaemia as a predictor of progressive renal failure was studied in a single-centre outpatient setting where it was found that a high apo B at baseline appeared to be the strongest risk factor among various lipid parameters for progression of renal failure over the follow-up years. Atorvastatin, aimed at lowering the plasma LDL-cholesterol level, reduced proteinuria while renal outcome was also better in those patients with the lowest LDL-cholesterol on treatment. See article by Ozsoy et al., pages 1578–1586
Estimation of the residual renal GFR in dialysis patients with insufficient 24-h urine output is either a burden or even impossible with the standard clearance techniques. In a high number of both haemodialysis and peritoneal dialysis patients, a formula for residual GFR was applied; using either plasma cystatin C or the MDRD formula were used. The cystatin C formula showed better accuracy and precision than the MDRD formula, when compared to the measured GFR based on the mean of creatinine and urea clearance. See article by Hoek et al., pages 1633–1638
The operative mortality of coronary artery bypass surgery in dialysis patients, irrespective of the high rates of comorbidity in these patients, is still high despite advances in CABG surgery. A retrospective analysis, based on administrative data and ICD-9CM codes, studied the peri-operative mortality in 77 323 non-dialysis and 635 dialysis patients. Even after adjustment for a number of well-known surgical risk factors, the odds for in-hospital death were 3.38 (2.54-4.50) times higher in the dialysis patients. Because there is a very high risk of cardiovascular death without intervention, CABG may nevertheless be a life-saving therapy in dialysis patients. See article by Charytan and Kuntz, pages 1665–1671
The introduction of pure bicarbonate low glucose degradation products (GDP) in peritoneal dialysis has been associated with a number of advantages for in vitro and in vivo animal experiments.
In a Spanish centre, the incidence of CAPD-associated peritonitis was studied in 50 patients dialysed with the "new solution" compared to 50 patients dialysed with the conventional lactate-buffered and GDP-containing dialysis solution.
The peritonitis incidence was one episode every 21 patient months with the conventional solution and was significantly reduced (OR 0.58) to one episode every 36 patient months with the "new" solution. See article by Montenegro et al., pages 1703–1708
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Related articles in NDT:
- Haem oxygenase-1—a culprit in vascular and renal damage?
- Nathalie Hill-Kapturczak and Anupam Agarwal
NDT 2007 22: 1495-1499.[Extract] [FREE Full Text] - Bisphosphonates in the renal patient
- John Cunningham
NDT 2007 22: 1505-1507.[Extract] [FREE Full Text] - Fetuin-A (AHSG) prevents extraosseous calcification induced by uraemia and phosphate challenge in mice
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NDT 2007 22: 1537-1546.[Abstract] [FREE Full Text] - Dyslipidaemia as predictor of progressive renal failure and the impact of treatment with atorvastatin
- Riza C. Ozsoy, Wim A. van der Steeg, John J. P. Kastelein, Lambertus Arisz, and Marion G. Koopman
NDT 2007 22: 1578-1586.[Abstract] [FREE Full Text] - Fasting insulin modifies the relation between age and renal function
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NDT 2007 22: 1593-1600.[Abstract] [FREE Full Text] - Risedronate, an effective treatment for glucocorticoid-induced bone loss in CKD patients with or without concomitant active vitamin D (PRIUS-CKD)
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NDT 2007 22: 1601-1607.[Abstract] [FREE Full Text] - Implementation of a vascular access quality programme improves vascular access care
- M. van Loon, W. van der Mark, N. Beukers, C. de Bruin, P. J. Blankestijn, R. M. Huisman, J. J. Zijlstra, F. M. van der Sande, and J. H. M. Tordoir
NDT 2007 22: 1628-1632.[Abstract] [FREE Full Text] - Estimation of residual glomerular filtration rate in dialysis patients from the plasma cystatin C level
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NDT 2007 22: 1633-1638.[Abstract] [FREE Full Text] - Risks of coronary artery bypass surgery in dialysis-dependent patients—analysis of the 2001 National Inpatient Sample
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NDT 2007 22: 1665-1671.[Abstract] [FREE Full Text] - Use of pure bicarbonate-buffered peritoneal dialysis fluid reduces the incidence of CAPD peritonitis
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NDT 2007 22: 1703-1708.[Abstract] [FREE Full Text]
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