If we needed another reason to get our ESRD patients transplanted, here is one more. In a prospective study published in JASN, waitlisted patients underwent cardiovascular testing to identify those with poor cardiovascular reserve (Anaerobic threshold(AT) <40% of peak VO2). Survival was significantly poorer for those with poor reserve compared to those with AT>40%. Also patients in the poor reserve group who got transplanted had a significantly better outcomes than who did not.
In a recent issue of AJKD - Kraut and Madias pen an excellent review on Lactic Acidosis - Current treatment and future directions. #mustread. Also in the same vein AJKD has two more acid base reviews one onDiabetic Ketoacidosis and its managementby Kamel and Halperin, and the other on a side by side analysis of the physiologic and the strong ion approach to acid base problems by Adrogue and Madias.
The science of AKI, a new review from Nature Reviews presents the spectrum of pathophysiology of AKI. It details the mechanism of initial tissue injury and repair and likens it to an accelerated aging of the kidney and CKD.
If middle molecules are the problem, should we use high/medium cut off dialyzer membranes for our hemodialysis patients? Some food for thought. In a small study several types of medium cut off hemodialyzers were used to assess the middle molecule removal and the safety of these dialyzers. Published recently in NDT.
Peritoneal dialysis has several "bones of contention" - too obese a person - maybe unsuitable, abdominal surgeries/ostomy - PD is a bad idea, high glucose solutions damage the membrane etc. While some feel inherently correct is there evidence for the same? In an interesting article - "Myths in Peritoneal Dialysis" Joanne Bargman explores the evidence behind these common (mis?)conceptions.
In a comprehensive review published in JASN, Dorry Segev presents all the pertinent data we need to understand and communicate all the various medical risks associated with living kidney donation. A handy paper to reach for before the living donor interview.
Also from JASN a new study which used the new eGFR and albuminuria based classification of CKD to assess the risk of hemorrhage. In this retrospective cohort study they identified that both declining eGFR and increasing albuminuria both were independently increased the risk of hemorrhage in CKD populations.
And lastly another "Polar Views" series in NDT. This time on the use of Calcineurin inhibitors in Lupus Nephritis. Get the Pro view , Con view and the Moderator articles here.
-- Nikhil Shah (@dr_nikhilshah)