Articles in 2012

A new multinational cohort study reports that patients receiving daily haemodialysis had a significantly higher mortality rate than those receiving conventional thrice-weekly treatments. Other studies have suggested that daily haemodialysis has beneficial effects. What are patients and nephrologists to make of these conflicting findings?

Flares of systemic lupus erythematosus are broadly defined as an increase in disease activity requiring an intensification of therapy. A renal flare is indicated by an increase in proteinuria and/or serum creatinine concentration, abnormal urine sediment or a reduction in creatinine clearance rate as a result of active disease. In this Review the authors examine current definitions of renal flares and describe developments in the diagnosis and treatment of renal flares.

As the world population continues to age, the number of elderly patients with chronic kidney disease who require a kidney transplant is increasing. In this Review, the effects of aging on the adaptive and innate immune systems are discussed, with a focus on the implications of age-related changes in the immune system on kidney transplantation and immunosuppression in elderly patients.

The appropriate use of lipid-lowering therapy in patients with chronic kidney disease (CKD) remains unclear. The results of two recent, robust systematic reviews and meta-analyses of lipid-lowering therapy in patients with CKD seem to support the use of lipid-lowering therapy. But is the story more complex?

Surprising new data from Sever and colleagues suggest that in patients who have hypertension and cardiovascular disease risk factors, increased plasma renin activity is associated with future renal impairment but not with cardiovascular events or all-cause mortality. These novel data are important but difficult to explain.

In this Review, Finkelstein and colleagues discuss the effects of end-stage renal disease (ESRD) and therapy on the health-related quality of life (HRQOL) of patients. They suggest that monitoring HRQOL—using standardized tools that incorporate assessment of patient-reported outcomes—should form part of the routine care of patients with ESRD, and emphasize the importance of developing strategies to improve the HRQOL of these patients.

Water used for dialysis can be contaminated by many chemical and microbiological factors that are potentially harmful to patients on haemodialysis. The quality of dialysis water has improved over the years, and in this Review the authors describe the evolution of the current standards for the provision of water quality. In addition, they outline new developments, with a particular focus on haemodialysis in the home.

Prospective cohort studies have shown that anaemia is an independent predictor of adverse outcomes in patients with chronic kidney disease. However, randomized controlled trials of the use of erythropoiesis-stimulating agents to correct moderate anaemia in this patient group have failed to show clinical benefit, and indicate that such treatment may even be harmful. Here, Patrick Parfrey discusses possible explanations for these seemingly contradictory results.

Mineralocorticoid-receptor antagonists (MRAs) effectively reduce blood pressure and albuminuria in patients with chronic kidney disease who experience aldosterone breakthrough. Use of MRAs is limited, however, by the occurrence of hyperkalaemia, which frequently develops in patients with impaired kidney function, and/or diabetes. This Review discusses potential approaches to identify patients who are particularly prone to developing hyperkalaemia with MRA therapy and describes currently available and promising strategies to prevent and control hyperkalaemia in patients with CKD.

Oral phosphate binder therapy is considered a 'tower of strength' in the ever-expanding armamentarium of drugs used to treat abnormal mineral metabolism in patients with chronic kidney disease (CKD) and use of these agents early in the course of CKD is gaining much interest. Recent data from a randomized controlled study by Block et al. challenge this strategy, raise doubts about its safety and indicate the need for additional studies of hard end points.