Volume 2 Issue 9, September 2006

Could the shortage of transplantable kidneys in the developed world be reduced by allowing willing individuals to sell their organs? To answer this question, the authors examine the outcomes of patients who have received paid kidneys, and the financial compensation and postoperative care received by their donors. Adoption of commercial kidney transplantation in the Western world would have inevitable knock-on effects in developing countries, they argue.

Parasites are an under-recognized cause of serious complications following organ and tissue transplantation. This comprehensive overview of the infectious species most commonly encountered in immunocompromised graft recipients—including protozoa, such as malaria and leishmania, and nematodes—aims to increase clinicians' index of suspicion when presented with pyrexial illness in this patient population. Routes of infection, key clinical characteristics, diagnostic techniques and treatments are discussed.

The ideal vascular access for hemodialysis would have a long functional life, facilitate blood flow sufficient to achieve dialysis prescription, and have a low rate of associated complications. This Review assesses the success with which available forms of access fulfill these criteria. The discussion is set in the context of the 2000 K/DOQI dialysis access guidelines and data published in the past 5 years.

Few studies have specifically addressed treatment of cardiovascular disease in kidney transplantees. As such, extrapolation from trials in other patient populations forms the basis for current management regimens. Here, the etiology of, and major risk factors for, cardiovascular complications in renal transplant recipients are reviewed. Evidence for risk factor-specific interventions for left ventricular hypertrophy, congestive heart failure and ischemic heart disease in this population is also appraised.

Here, Mak and colleagues shed light on the molecules associated with acidosis and inflammation that contribute to the development of nutritional abnormalities in patients with end-stage renal disease. Targeting these hormones, which act on the hypothalamic melanocortin system, ameliorates experimental cachexia. Using these new insights as the basis for developing human therapies should help to reduce cachexia-related mortality in the uremic population.