In this issue ...
The renal and cardiac effects of anti-hypertensive treatment of an ACE inhibitor (ramipril) vs a β-blocker (metoprolol) were explored in patients with ADPKD.In this study population of hypertensive ADPKD patients, no differences in renal function, urinary albumin excretion or left ventricular mass index were detected between those treated with ramipril or metoprolol, respectively, during a 3-year follow-up.
This study was further discussed in an invited commentary that summarized the results of other studies and previewed the HALT PKD study, currently running in the USA.
(See editorial comment by Steinman, pages 431–433 and article Zeltner et al., pages 573–579).
Haemodiafiltration is more and more widely used as chronic renal replacement therapy for CKD stage 5D, and is believed to be associated with a number of advantages when compared with haemodialysis and haemofiltration used separately. However, is the future as bright as that promised by the majority of the observational studies performed today?
This editorial comment emphasizes the need for properly designed randomized controlled trials.
(See editorial by van der Weerd et al., pages 438–443).
The effect of stem cell mobilization therapy on the progression of renal fibrosis was explored in a mouse model of chronic obstructive nephropathy. Despite an enhanced availability of haematopoietic stem cells to the obstructed kidney, the progression of renal fibrosis could not be delayed or halted.
(See article by Stokman et al., pages 483–491).
The renal and cardiovascular protective effects of AGE inhibitors were investigated in rat models of renal and cardiovascular injury and chronic allograft nephropathy.
TM2002, a novel non-toxic AGE inhibitor acting through angiotensin receptor blocking-like mechanisms, is able to prevent renal and cardiovascular diseases, independently of blood pressure lowering.
Pyridoxamine, another AGE inhibitor, exerts renoprotective effects and decreases renal pentosidine accumulation in a non-diabetic model of experimental allograft nephropathy.
(See article by Izuhara et al., pages 497–509 and Waanders et al., pages 518–524).
Standard equations, like the MDRD equation for estimation of GFR (eGFR), have been used to determine the prevalence of CKD in many parts of the world. One of the problems associated with using these equations is the use of uncalibrated serum creatinine values. However, improved accuracy of eGFR is obtainable by using IDMS creatinine correction, especially in the earlier stages of CKD 1–3.
One article in this issue indicates that this improved accuracy could lead to reduced prevalence estimates and, potentially, a decreased likelihood of onward referral to nephrology services, particularly in older females.
As suggested by two other articles, the introduction of an algorithm-based, primary care disease management programme for patients with CKD, based on automated diagnosis using eGFR reporting, suggests that chronic disease management in this form is an effective method of identifying and managing patients with CKD, at least within the UK. The improvement in cardiovascular risk factors and reduction in the rate of decline of renal function should have significant health benefits for the patients and should result in cost savings for the health economy. In addition, in the UK, the vast majority of patients with CKD stages 3–5 are cared for within the primary care setting and there are marked gender differences in the prevalence of CKD stages 3–5 that are not reflected by referral patterns to nephrology services. Finally, the same MDRD formula has been used in a private laboratory in Paris, to monitor outpatients treated with lithium salts (Li) for bipolar disease. It appears that a very high percentage of Li-treated outpatients have a low eGFR. GFR monitoring is neglected in these patients, the majority of whom are no longer attending specialized clinics. Hypercalcaemia is less common but serum calcium monitoring is even more neglected. Ambulatory laboratory database surveillance provides a powerful means to contribute to CKD screening and monitoring in this population.
(See articles by Quinn et al., pages 542–548; Richards et al., pages 549–555 and pages 556–561; Bassilios et al., pages 562–565).
There is great interest nowadays in the early diagnosis of acute kidney injury (AKI) by monitoring urinary concentrations of biomarkers, including Il-18.
In a large group of non-septic critically ill children, it was shown that urinary IL-18 rises prior to serum creatinine, predicts severity of AKI and is an independent predictor of mortality.
(See article by Washburn, et al., pages 566–572).
Vascular calcifications (VCs), and arterial stiffness assessed by pulse wave velocity (PWV) are independent predictors of cardiovascular mortality and are inversely correlated with bone mineral density (BMD) in advanced CKD.
A cross-sectional study in Australia demonstrated a high prevalence of VC in pre-dialysis CKD patients and a correlation exists between VC and pulse PWV: determination of one or both may be useful for CKD patient cardiovascular risk assessment. Femoral BMD is inversely associated with VC in the superficial femoral artery VC, but measurement of vertebral BMD by DEXA is unreliable in CKD patients with aortic VC.
(See article by Toussaint et al., pages 586–593).
Dobutamine stress echocardiography (DSE) is used for risk stratification of patients with suspected coronary artery disease (CAD). However, the prognostic value of DSE in the entire strata of renal function has yet to be determined.
An article assessed the prognostic value of renal function relative to DSE findings in 2292 patients, who underwent DSE for the evaluation of known or suspected CAD and who were followed for a mean of 8 years. It was found that the presence and severity of renal dysfunction has additional independent prognostic value over DSE findings. The low-risk guarantee period after a normal DSE is determined by the severity of renal dysfunction.
(See article by Karagiannis, pages 601–607).
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