Mineralocorticoid receptor antagonists in heart failure patients with chronic kidney disease: why, when, and how?
Purpose of review Congestive heart failure (CHF) and chronic kidney disease (CKD) often coexist. However, and despite their established benefits, the use of mineralcorticoid receptor antagonists (MRAs) in patients with both comorbidities is inconsistent. This review will focus on the role of aldosterone in CHF, as well as timing, selection, and management of MRAs in CHF patients with CKD. Recent findings Aldosterone in CHF patients contributes to worsening sodium retention, hypokalemia, metabolic alkalosis, cardiac fibrosis, and CKD progression. MRAs are beneficial in CHF patients with CKD despite the adverse events o...
Source: Current Opinion in Nephrology and Hypertension - January 30, 2020 Category: Urology & Nephrology Tags: CLINICAL NEPHROLOGY: Edited by David S. Goldfarb Source Type: research

The nephrologist's guide to cannabis and cannabinoids
Purpose of review Cannabis (marijuana, weed, pot, ganja, Mary Jane) is the most commonly used federally illicit drug in the United States. The present review provides an overview of cannabis and cannabinoids with relevance to the practice of nephrology so that clinicians can best take care of patients. Recent findings Cannabis may have medicinal benefits for treating symptoms of advanced chronic kidney disease (CKD) and end-stage renal disease including as a pain adjuvant potentially reducing the need for opioids. Cannabis does not seem to affect kidney function in healthy individuals. However, renal function should b...
Source: Current Opinion in Nephrology and Hypertension - January 30, 2020 Category: Urology & Nephrology Tags: CLINICAL NEPHROLOGY: Edited by David S. Goldfarb Source Type: research

Vitamin D in chronic kidney disease: is there a role outside of PTH control?
Purpose of review Vitamin D deficiency is common in patients with kidney disease and many patients receive vitamin D supplementation. Several large, well-designed clinical trials have been published in the last few years evaluating the effects of vitamin D supplementation on important outcomes for patients with kidney disease including effects on cardiovascular disease, secondary hyperparathyroidism, and kidney disease progression. Recent findings Several negative trials have been published showing no effect of cholecalciferol supplementation on cardiovascular events, kidney disease progression, and albuminuria. Long-...
Source: Current Opinion in Nephrology and Hypertension - January 30, 2020 Category: Urology & Nephrology Tags: CLINICAL NEPHROLOGY: Edited by David S. Goldfarb Source Type: research

Chronic kidney disease and kidney stones
Purpose of review Both chronic kidney disease (CKD) and kidney stones are major public health problems, which are closely interrelated. Recurrent kidney stones predispose to CKD although CKD seems to decrease risk of further kidney stone formation. Herein, we review new information of this interrelationship. Recent findings Several epidemiological studies in the past have shown an association between history of kidney stones and risk for CKD and CKD progression. Recent literature supports this concept and it is reviewed in this article. The issue of whether CKD protects against new kidney stone formation remains unset...
Source: Current Opinion in Nephrology and Hypertension - January 30, 2020 Category: Urology & Nephrology Tags: CLINICAL NEPHROLOGY: Edited by David S. Goldfarb Source Type: research

Occupational kidney stones
Purpose of review Kidney stones are a common and preventable disorder. Certain occupations may increase risk for stone disease which will be discussed in this review. Few observational studies have examined this association. Recent findings Some occupations prevent individuals from drinking enough fluids to maintain a dilute urine or to void when they need to. People may have poor access to fluids or to bathroom facilities. These issues pose a risk for stone disease and are exacerbated by those who work in warmer climates. Individuals who do more activity while working, especially outdoors, perspire more, leading to m...
Source: Current Opinion in Nephrology and Hypertension - January 30, 2020 Category: Urology & Nephrology Tags: CLINICAL NEPHROLOGY: Edited by David S. Goldfarb Source Type: research

Using race in the estimation of glomerular filtration rates: time for a reversal?
Purpose of review Bedside estimates of renal function are essential for clinical practice in the modern era and have largely relied on serum creatinine concentrations despite the known drawbacks associated with this choice of biomarker, including the fact that creatinine clearance overestimates the glomerular filtration rate. Recent findings Initial estimates relied primarily on equations that incorporated factors known to influence creatinine concentrations such as age, sex and anthropometric measures. More recent estimates of glomerular filtration rate have replaced the anthropometric measures with the social constr...
Source: Current Opinion in Nephrology and Hypertension - January 30, 2020 Category: Urology & Nephrology Tags: CLINICAL NEPHROLOGY: Edited by David S. Goldfarb Source Type: research

Bisphosphonate therapy in CKD: the current state of affairs
Purpose of review Chronic kidney disease (CKD) is associated with the development of mineral and bone disorders (MBD), including renal osteodystrophy (ROD). ROD is a global disorder of bone strength that is associated with an increased fracture risk. The use of bisphosphonates for fracture risk reduction in CKD remains controversial. This review provides a synopsis of the state-of-the literature regarding the safety and potential antifracture benefits of bisphosphonates in CKD patients. Recent findings In preclinical studies of animals with CKD 3–4 and evidence of CKD-MBD, bisphosphonates resulted in changes in ...
Source: Current Opinion in Nephrology and Hypertension - January 30, 2020 Category: Urology & Nephrology Tags: CLINICAL NEPHROLOGY: Edited by David S. Goldfarb Source Type: research

Evolution and evolving resolution of controversy over existence and prevalence of cerebral/renal salt wasting
Purpose of review The topic of hyponatremia is in a state of flux. We review a new approach to diagnosis that is superior to previous methods. It simplifies identifying the causes of hyponatremia, the most important issue being the differentiation of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) from cerebral/renal salt wasting (RSW). We also report on the high prevalence of RSW without cerebral disease in the general wards of the hospital. Recent findings We applied our new approach to hyponatremia by utilizing sound pathophysiologic criteria in 62 hyponatremic patients. Seventeen (27%) had ...
Source: Current Opinion in Nephrology and Hypertension - January 30, 2020 Category: Urology & Nephrology Tags: CLINICAL NEPHROLOGY: Edited by David S. Goldfarb Source Type: research

Mechanisms of sodium retention in nephrotic syndrome
Purpose of review Proteinuria in nephrotic syndrome is associated with sodium retention and edema. Recent studies from mice, rats and humans have shown that the sodium retention depends on urinary serine proteases and that it can be mitigated by blockers (amiloride, triamterene) of the epithelial sodium channel ENaC. The present review outlines the mechanisms of protease-stimulated sodium retention during proteinuric diseases. Recent findings Inhibition of protease activity in nephrotic mice using aprotinin alleviates sodium retention. From both human and mice studies, an increased proteolytic cleavage of the γE...
Source: Current Opinion in Nephrology and Hypertension - January 30, 2020 Category: Urology & Nephrology Tags: CLINICAL NEPHROLOGY: Edited by David S. Goldfarb Source Type: research

Nephrolithiasis in women: how different from men?
Purpose of review Men have more kidney stones compared with women; however, the difference is progressively decreasing. The reasons for higher prevalence of stones in men, as well as increasing prevalence in women, is a subject of ongoing speculation. In this review, we summarize the evidence of differences between men and women and expand on the speculative causes. Recent findings Stone incidence is rising in women and adolescent girls. Stone disease is more heritable among men than women, and women demonstrate greater influence of the unique environment. Women under the age of 50 years who have been pregnant, have m...
Source: Current Opinion in Nephrology and Hypertension - January 30, 2020 Category: Urology & Nephrology Tags: CLINICAL NEPHROLOGY: Edited by David S. Goldfarb Source Type: research

Editorial: Uronephrology: a new nephrology subspecialty
No abstract available (Source: Current Opinion in Nephrology and Hypertension)
Source: Current Opinion in Nephrology and Hypertension - January 30, 2020 Category: Urology & Nephrology Tags: CLINICAL NEPHROLOGY: Edited by David S. Goldfarb Source Type: research

Renal effects of SGLT2 inhibitors: an update
Purpose of review SGLT2 inhibitors are a new class of antihyperglycemic drugs that protect kidneys and hearts of type 2 diabetic (T2DM) patients with preserved kidney function from failing. Here we discuss new insights on renal protection. Recent findings Also in T2DM patients with CKD, SGLT2 inhibition causes an immediate functional reduction in glomerular filtration rate (GFR) and reduces blood pressure and preserves kidney and heart function in the long-term, despite a lesser antihyperglycemic effect. According to modeling studies, the GFR reduction reduces the tubular transport work and metabolic demand, thereby i...
Source: Current Opinion in Nephrology and Hypertension - January 30, 2020 Category: Urology & Nephrology Tags: PATHOPHYSIOLOGY OF HYPERTENSION: Edited by Nancy J. Brown Source Type: research

Targeting angiotensinogen with RNA-based therapeutics
Purpose of review To summarize all available data on targeting angiotensinogen with RNA-based therapeutics as a new tool to combat cardiovascular diseases. Recent findings Liver-targeted, stable antisense oligonucleotides and small interfering RNA targeting angiotensinogen are now available, and may allow treatment with at most a few injections per year, thereby improving adherence. Promising results have been obtained in hypertensive animal models, as well as in rodent models of atherosclerosis, polycystic kidney disease and pulmonary fibrosis. The next step will be to evaluate the optimal degree of suppression, syne...
Source: Current Opinion in Nephrology and Hypertension - January 30, 2020 Category: Urology & Nephrology Tags: PATHOPHYSIOLOGY OF HYPERTENSION: Edited by Nancy J. Brown Source Type: research

PPARγ is a gatekeeper for extracellular matrix and vascular cell homeostasis: beneficial role in pulmonary hypertension and renal/cardiac/pulmonary fibrosis
Purpose of review Pulmonary arterial hypertension (PAH) is characterized by pulmonary arterial endothelial cell (PAEC) dysfunction and apoptosis, pulmonary arterial smooth muscle cell (PASMC) proliferation, inflammation, vasoconstriction, and metabolic disturbances that include disrupted bone morphogenetic protein receptor (BMPR2)-peroxisome proliferator-activated receptor gamma (PPARγ) axis and DNA damage. Activation of PPARγ improves many of these mechanisms, although erroneous reports on potential adverse effects of thiazolidinedione (TZD)-class PPARγ agonists reduced their clinical use in the past d...
Source: Current Opinion in Nephrology and Hypertension - January 30, 2020 Category: Urology & Nephrology Tags: PATHOPHYSIOLOGY OF HYPERTENSION: Edited by Nancy J. Brown Source Type: research

PPARγ and RhoBTB1 in hypertension
Purpose of review This review provides an up-to-date understanding of how peroxisome proliferator activated receptor γ (PPARγ) exerts its cardioprotective effect in the vasculature through its activation of novel PPARγ target genes in endothelium and vascular smooth muscle. Recent findings In vascular endothelial cells, PPARγ plays a protective role by increasing nitric oxide bioavailability and preventing oxidative stress. RBP7 is a PPARγ target gene enriched in vascular endothelial cells, which is likely to form a positive feedback loop with PPARγ. In vascular smooth muscle cells,...
Source: Current Opinion in Nephrology and Hypertension - January 30, 2020 Category: Urology & Nephrology Tags: PATHOPHYSIOLOGY OF HYPERTENSION: Edited by Nancy J. Brown Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Nephrology and Hypertension)
Source: Current Opinion in Nephrology and Hypertension - January 30, 2020 Category: Urology & Nephrology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Preventing a nonexistent entity: the curious case of contrast and acute kidney injury
Purpose of review In recent years, doubt has been cast on the existence of contrast-induced acute kidney injury. The skepticism has stemmed from observational studies from large administrative healthcare databases. Although they correctly call that contrast-induced acute kidney injury is less common than previously thought, they cannot completely exclude selection bias. Recent findings Though less common than previously thought, contrast-induced acute kidney injury still exists. The only prophylactic method that remains valid is that of isotonic volume expansion, which is still deemed beneficial in high-risk patients....
Source: Current Opinion in Nephrology and Hypertension - November 29, 2019 Category: Urology & Nephrology Tags: SPECIAL COMMENTARY Source Type: research

Mitigating risk of aldosterone in diabetic kidney disease
Purpose of review Diabetic kidney disease is a growing problem leading to end-stage kidney disease but also atherosclerotic cardiovascular disease and heart failure. Aldosterone is a key risk factor promoting inflammation and fibrosis causing cardio-renal failure. Current options and challenges with mitigating the risk of aldosterone are reviewed. Recent findings More aggressive renin–angiotensin–aldosterone system (RAAS) blockade can be maintained in individuals with hyperkalemia if new potassium binders are added. Aldosterone synthase inhibitors may lower aldosterone without causing hyperkalemia. Novel n...
Source: Current Opinion in Nephrology and Hypertension - November 29, 2019 Category: Urology & Nephrology Tags: HORMONES, AUTACOIDS, NEUROTRANSMITTERS AND GROWTH FACTORS: Edited by Mark Cooper and Merlin Thomas Source Type: research

The emerging role of activins in renal disease
Purpose of review This review highlights recent discoveries and advances that have been made in understanding the role of the TGFβ superfamily members activins, and in particular, activin A (ActA), in renal disease. Recent findings A deleterious role for ActA in renal disease and its complications has begun to emerge. We summarize data supporting an important contribution of ActA to kidney fibrosis and inflammation of varying causes, as well as its role in the development of a particular bone mineral disorder seen in chronic kidney disease (CKD) called mineral bone disorder (MBD), including vascular calcification...
Source: Current Opinion in Nephrology and Hypertension - November 29, 2019 Category: Urology & Nephrology Tags: HORMONES, AUTACOIDS, NEUROTRANSMITTERS AND GROWTH FACTORS: Edited by Mark Cooper and Merlin Thomas Source Type: research

Nuclear factor erythroid 2-related factor 2 as a treatment target of kidney diseases
Purpose of review Nuclear factor erythroid 2-related factor 2 (Nrf2) is a transcription factor which regulates a wider range of downstream pathways than previously thought. This review focuses on the novel findings about the internal regulatory mechanisms of Nrf2, the expanding understanding of its role in maintaining cellular homeostasis and the attempts to broaden the clinical application of its activators. Recent findings Nrf2 is in charge of the maintenance of cellular homeostasis under stress and there exist the internal regulatory mechanisms for Nrf2 which have recently been elucidated. New downstream pathways o...
Source: Current Opinion in Nephrology and Hypertension - November 29, 2019 Category: Urology & Nephrology Tags: HORMONES, AUTACOIDS, NEUROTRANSMITTERS AND GROWTH FACTORS: Edited by Mark Cooper and Merlin Thomas Source Type: research

Promoting resolution in kidney disease: are we nearly there yet?
We describe our current understanding of SPMs for this purpose in acute and chronic kidney disease. These studies cement the place of inflammation and its defective resolution in the pathogenesis of kidney disease, and highlight new avenues for therapy. Summary Targeting resolution of inflammation is a viable approach to treating kidney disease. We optimistically look forward to translating these experimental advances into tractable therapeutics to treat kidney disease. (Source: Current Opinion in Nephrology and Hypertension)
Source: Current Opinion in Nephrology and Hypertension - November 29, 2019 Category: Urology & Nephrology Tags: HORMONES, AUTACOIDS, NEUROTRANSMITTERS AND GROWTH FACTORS: Edited by Mark Cooper and Merlin Thomas Source Type: research

Renoprotective effects of sodium-glucose cotransporter-2 inhibitors and underlying mechanisms
Purpose of review Emerging data have demonstrated that sodium-glucose cotransporter-2 (SGLT2) inhibitors prevent cardiovascular events, especially heart failure-associated endpoints. Cardiovascular outcome trials have also suggested their renoprotective effects. One large clinical trial investigated renal primary endpoints and demonstrated that SGLT2 inhibitors slowed the progression of diabetic kidney disease (DKD). This review summarizes clinical trial data on renal outcomes and discusses potential underlying mechanisms. Recent findings The EMPA-REG, CANVAS, and DECLARE-TIMI 58 studies revealed that SGLT2 inhibitors...
Source: Current Opinion in Nephrology and Hypertension - November 29, 2019 Category: Urology & Nephrology Tags: HORMONES, AUTACOIDS, NEUROTRANSMITTERS AND GROWTH FACTORS: Edited by Mark Cooper and Merlin Thomas Source Type: research

Renoprotection in diabetic kidney disease: can incretin-based therapies deliver?
Purpose of review Incretin-based therapies mimic or augment the gut-hormone glucagon-like peptide (GLP)-1 and, due to their glucose-lowering potential and beneficial safety profile, as well as their cardiovascular safety and/or protection, are prescribed on a large scale to treat individuals with type 2 diabetes (T2D). However, whether the two drug-classes that belong to this category, respectively GLP-1 receptor agonists and dipeptidyl peptidase (DPP)-4 inhibitors, also reduce the risk of diabetic kidney disease (DKD) is at present heavily debated. This review aims to discuss the current evidence. Recent findings Evi...
Source: Current Opinion in Nephrology and Hypertension - November 29, 2019 Category: Urology & Nephrology Tags: HORMONES, AUTACOIDS, NEUROTRANSMITTERS AND GROWTH FACTORS: Edited by Mark Cooper and Merlin Thomas Source Type: research

Conservative vs. preservative management of chronic kidney disease: similarities and distinctions
Purpose of review Dialysis has been the prevailing treatment paradigm in advanced chronic kidney disease (CKD) for patients ineligible for or unlikely to receive kidney transplantation. As dialysis may neither offer survival benefit nor improved quality of life in certain groups, there has been increasing interest in conservative management as an alternative approach. Recent findings Experts and workgroups suggest the main goals of conservative management are to optimize quality of life, treat symptoms of end-stage renal disease without dialysis or transplant, and improve survival and cardiovascular health. Given the ...
Source: Current Opinion in Nephrology and Hypertension - November 29, 2019 Category: Urology & Nephrology Tags: NOVEL THERAPEUTIC APPROACHES IN NEPHROLOGY AND HYPERTENSION: Edited by Kamyar Kalantar-Zadeh and Ekamol Tantisattamo Source Type: research

Novel options for failing allograft in kidney transplanted patients to avoid or defer dialysis therapy
Purpose of review Despite improvement in short-term renal allograft survival in recent years, renal transplant recipients (RTR) have poorer long-term allograft outcomes. Allograft function slowly declines with periods of stable function similar to natural progression of chronic kidney disease in nontransplant population. Nearly all RTR transitions to failing renal allograft (FRG) period and require transition to dialysis. Conservative chronic kidney disease management before transition to end-stage renal disease is an increasingly important topic; however, there is limited data in RTR regarding how to delay dialysis init...
Source: Current Opinion in Nephrology and Hypertension - November 29, 2019 Category: Urology & Nephrology Tags: NOVEL THERAPEUTIC APPROACHES IN NEPHROLOGY AND HYPERTENSION: Edited by Kamyar Kalantar-Zadeh and Ekamol Tantisattamo Source Type: research

Charcoal for the management of pruritus and uremic toxins in patients with chronic kidney disease
Purpose of review Pruritus is an important, prevalent but often neglected symptom in patients with advanced chronic kidney disease (CKD) or on dialysis. This review addresses the use of activated charcoal and its analogs in the treatment of uremic pruritus, which can be a sign of uremic toxicity. Recent findings When common causes are corrected and dialysis efficiency is optimized, pruritus is mainly ascribed to the retention of middle and protein-bound molecules, of which indoxyl sulfate and p-cresyl sulfate are the best studied. While hemodialysis and hemodiafiltration are of limited use, activated charcoal and its ...
Source: Current Opinion in Nephrology and Hypertension - November 29, 2019 Category: Urology & Nephrology Tags: NOVEL THERAPEUTIC APPROACHES IN NEPHROLOGY AND HYPERTENSION: Edited by Kamyar Kalantar-Zadeh and Ekamol Tantisattamo Source Type: research

Intestinal dialysis for conservative management of Uremia
Purpose of review Renal replacement therapies, such as hemodialysis are invasive and impose significant financial burden as well as burden on quality of life. Conservative and ‘gentler’ forms of renal replacement therapy for the frail and palliative care patient is an unmet medical need. Recent findings The treatment of uremia using the gut as a substitute for the kidney has been proposed but is not practiced widely because of proven lack of long-term mortality benefit coupled with complications like edema and hyperchloremia. Mounting evidence showed that endotoxins from gastrointestinal tract are a major ...
Source: Current Opinion in Nephrology and Hypertension - November 29, 2019 Category: Urology & Nephrology Tags: NOVEL THERAPEUTIC APPROACHES IN NEPHROLOGY AND HYPERTENSION: Edited by Kamyar Kalantar-Zadeh and Ekamol Tantisattamo Source Type: research

Perspiration interventions for conservative management of kidney disease and uremia
Purpose of review There has been an increasing interest in developing novel technologies to treat patients with chronic kidney disease as evidenced by KidneyX, the public–private partnership between government and industry. Perhaps a simple technology for treating kidney failure would be to utilize perspiration. It is a physiological process, and when used properly it might not be an unpleasant experience. This review will explore the current state of knowledge regarding perspiration therapy in the setting of far advanced kidney failure. Recent findings A literature review using the PubMed database was conducted...
Source: Current Opinion in Nephrology and Hypertension - November 29, 2019 Category: Urology & Nephrology Tags: NOVEL THERAPEUTIC APPROACHES IN NEPHROLOGY AND HYPERTENSION: Edited by Kamyar Kalantar-Zadeh and Ekamol Tantisattamo Source Type: research

Microbiome modulation to correct uremic toxins and to preserve kidney functions
Purpose of review The association between dysbiosis and CKD is well established. This review focuses on the current understanding of microbiome, in normal individuals and CKD patients, in order to hypothesize how to correct uremic toxins levels and preserve the renal function and reduce associated comorbidities. Here we discuss our current opinion on microbiome modulation in order to manage the CKD-associated dysbiosis. Recent findings Emerging evidence confirms the role of gut microbiome in the progression of CKD. In this scenario, the need is felt to set up multifaceted approaches for dysbiosis management. Among man...
Source: Current Opinion in Nephrology and Hypertension - November 29, 2019 Category: Urology & Nephrology Tags: NOVEL THERAPEUTIC APPROACHES IN NEPHROLOGY AND HYPERTENSION: Edited by Kamyar Kalantar-Zadeh and Ekamol Tantisattamo Source Type: research

Novel dietary and pharmacologic approaches for acid–base modulation to preserve kidney function and manage uremia
Purpose of review We review mechanisms for chronic kidney disease (CKD) progression that might be addressed with nonpharmacologic and novel pharmacologic interventions as strategies by which to slow or even prevent CKD progression. Recent findings Evolving data support the contribution of the broad spectrum of disorders of acid (H+) accumulation, which we refer to as ‘H+ stress’, to CKD progression. Recent studies support that amelioration of H+ stress, including spectra of H+ accumulation that are insufficient to cause metabolic acidosis, is kidney-protective. In addition, gut-derived toxins appear to con...
Source: Current Opinion in Nephrology and Hypertension - November 29, 2019 Category: Urology & Nephrology Tags: NOVEL THERAPEUTIC APPROACHES IN NEPHROLOGY AND HYPERTENSION: Edited by Kamyar Kalantar-Zadeh and Ekamol Tantisattamo Source Type: research

Potassium binding for conservative and preservative management of chronic kidney disease
In conclusion, there are new well tolerated and effective K+-binding agents for acutely and chronically managing hyperkalemia. (Source: Current Opinion in Nephrology and Hypertension)
Source: Current Opinion in Nephrology and Hypertension - November 29, 2019 Category: Urology & Nephrology Tags: NOVEL THERAPEUTIC APPROACHES IN NEPHROLOGY AND HYPERTENSION: Edited by Kamyar Kalantar-Zadeh and Ekamol Tantisattamo Source Type: research

Fluid overload as a therapeutic target for the preservative management of chronic kidney disease
Purpose of review There is growing clinical evidence of adverse effects of fluid overload on kidney outcomes in patients with cardiovascular disease who are not yet receiving kidney replacement therapy. In this review, we discuss the patient populations most at risk for fluid overload, the pathophysiology associated with fluid overload, and finally treatment options. Recent findings The severity of fluid overload is an independent risk factor for both an increased risk of rapidly declining kidney function and increased risk for the need of kidney replacement therapy. High venous pressure within the kidney secondarily ...
Source: Current Opinion in Nephrology and Hypertension - November 29, 2019 Category: Urology & Nephrology Tags: NOVEL THERAPEUTIC APPROACHES IN NEPHROLOGY AND HYPERTENSION: Edited by Kamyar Kalantar-Zadeh and Ekamol Tantisattamo Source Type: research

Plant-based diets for prevention and management of chronic kidney disease
Purpose of review Plant-based diets have been used with growing popularity for the treatment of a wide range of lifestyle-related diseases, including diabetes, hypertension, and obesity. With the reinvigoration of the dietary management of chronic kidney disease (CKD) and the use of low protein diets for secondary prevention of CKD to delay or prevent dialysis therapy, there is an increasing interest in the potential role of plant-based diets for these patients. Recent findings Recently, a body of evidence related to the role of plant-based diets in preventing CKD has reemerged. Several observational studies have show...
Source: Current Opinion in Nephrology and Hypertension - November 29, 2019 Category: Urology & Nephrology Tags: NOVEL THERAPEUTIC APPROACHES IN NEPHROLOGY AND HYPERTENSION: Edited by Kamyar Kalantar-Zadeh and Ekamol Tantisattamo Source Type: research

Pharmacologic epigenetic modulators of alkaline phosphatase in chronic kidney disease
Purpose of review In chronic kidney disease (CKD), disturbance of several metabolic regulatory mechanisms cause premature ageing, accelerated cardiovascular disease (CVD), and mortality. Single-target interventions have repeatedly failed to improve the prognosis for CKD patients. Epigenetic interventions have the potential to modulate several pathogenetic processes simultaneously. Alkaline phosphatase (ALP) is a robust predictor of CVD and all-cause mortality and implicated in pathogenic processes associated with CVD in CKD. Recent findings In experimental studies, epigenetic modulation of ALP by microRNAs or bromodom...
Source: Current Opinion in Nephrology and Hypertension - November 29, 2019 Category: Urology & Nephrology Tags: NOVEL THERAPEUTIC APPROACHES IN NEPHROLOGY AND HYPERTENSION: Edited by Kamyar Kalantar-Zadeh and Ekamol Tantisattamo Source Type: research

Editorial: Novel therapeutic approaches in chronic kidney disease and uremia management
No abstract available (Source: Current Opinion in Nephrology and Hypertension)
Source: Current Opinion in Nephrology and Hypertension - November 29, 2019 Category: Urology & Nephrology Tags: NOVEL THERAPEUTIC APPROACHES IN NEPHROLOGY AND HYPERTENSION: Edited by Kamyar Kalantar-Zadeh and Ekamol Tantisattamo Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Nephrology and Hypertension)
Source: Current Opinion in Nephrology and Hypertension - November 29, 2019 Category: Urology & Nephrology Tags: EDITORIAL INTRODUCTIONS Source Type: research

When are you too old to get a kidney transplant?
Purpose of review With the increasing incidence and prevalence of ESRD in the elderly, we are now transplanting more elderly patients. Although we know from previous reports that transplantation provides increased survival advantage and/or quality of life when compared to being on dialysis, we also know that transplantation is not the best option for all patients. In this review, we try to identify the upper age limit (if any) for deceased donor renal transplantation, predictive factors that can identify the risks for transplant outcomes, frailty, and immunosenescence. Recent findings Review of data over the last 5 ye...
Source: Current Opinion in Nephrology and Hypertension - November 1, 2019 Category: Urology & Nephrology Tags: DIALYSIS AND TRANSPLANTATION: Edited by Anil Chandraker and J. Kevin Tucker Source Type: research

Can incremental haemodialysis reduce early mortality rates in patients starting maintenance haemodialysis?
Purpose of review Early mortality rates after the start of maintenance haemodialysis therapy are high. Compared with three-times weekly haemodialysis, incremental haemodialysis is associated with better preservation of residual renal function (RRF) and at least equivalent mid-term to long-term survival. However, there is paucity of data in relation to its use as a means of helping patients through the transitional period, when they first become dialysis dependent. Recent findings Studies of incremental haemodialysis have overlooked early mortality as an outcome measure. This is primarily due to their retrospective des...
Source: Current Opinion in Nephrology and Hypertension - October 8, 2019 Category: Urology & Nephrology Tags: SPECIAL COMMENTARY Source Type: research

Urgent-start peritoneal dialysis: is it ready for prime time?
Purpose of review This review aims to provide an up-to-date summary of the definition, current practice and evidence regarding the role of urgent-start peritoneal dialysis (USPD) in patients with end-stage kidney disease who present with unplanned dialysis requirement without functional access. Recent findings USPD can be broadly defined as peritoneal dialysis initiation within the first 2 weeks after catheter insertion. Published practice patterns, in terms of catheter insertion approach, peritoneal dialysis initiation time or initial fill volume, are highly variable. Most evidence comes from small, retrospective, si...
Source: Current Opinion in Nephrology and Hypertension - October 8, 2019 Category: Urology & Nephrology Tags: DIALYSIS AND TRANSPLANTATION: Edited by Anil Chandraker and J. Kevin Tucker Source Type: research

Thyroid disease in end-stage renal disease
Purpose of review Hypothyroidism is a highly prevalent endocrine disorder in the end-stage renal disease (ESRD) population, yet many cases may remain latent and undiagnosed. Recent findings Epidemiologic data show that there is a nearly five-fold higher prevalence of hypothyroidism in advanced chronic kidney disease (CKD) patients vs. those without CKD. Given that the metabolism, degradation, and excretion of thyroid hormone and its metabolites, as well as the regulation of the hypothalamic–pituitary–thyroid axis may be altered in ESRD, certain considerations should be made when interpreting thyroid functi...
Source: Current Opinion in Nephrology and Hypertension - October 8, 2019 Category: Urology & Nephrology Tags: DIALYSIS AND TRANSPLANTATION: Edited by Anil Chandraker and J. Kevin Tucker Source Type: research

Hemodialysis care for undocumented immigrants with end-stage renal disease in the United States
Purpose of review Across the United States, significant variation exists in the provision of care of undocumented immigrants with end-stage renal disease (ESRD), with some states providing standard dialysis, and other states providing emergency-only hemodialysis (EoHD). Recent findings EoHD is associated with higher morbidity and mortality compared with standard hemodialysis. EoHD is also associated with higher healthcare utilization, resulting in more emergency department visits, more days spent in the hospital, and higher healthcare costs. Undocumented immigrants with ESRD who rely on EoHD also experience crippling ...
Source: Current Opinion in Nephrology and Hypertension - October 8, 2019 Category: Urology & Nephrology Tags: DIALYSIS AND TRANSPLANTATION: Edited by Anil Chandraker and J. Kevin Tucker Source Type: research

Influenza in dialysis patients: an opportunity to decrease mortality?
Purpose of review Influenza is a major cause of morbidity in dialysis patients. Recent findings A recent meta-analysis finds reduced influenza infections, hospitalizations and deaths with use of high dose as compared with standard-dose vaccine in the elderly. There remain no randomized clinical trials of vaccine efficacy in dialysis patients. One observational study finds reduced all-cause hospitalization with high-dose as compared with standard-dose vaccine but another study finds no difference in influenza related events. A simulation study, in which the timing of vaccination and antibody waning rates are varied, fi...
Source: Current Opinion in Nephrology and Hypertension - October 8, 2019 Category: Urology & Nephrology Tags: DIALYSIS AND TRANSPLANTATION: Edited by Anil Chandraker and J. Kevin Tucker Source Type: research

Prolyl-hydroxylase inhibitors for the treatment of anemia in chronic kidney disease
Purpose of review Prolyl-hydroxylase inhibitors are a novel class of orally administered drugs that are under development for the treatment of anemia in patients with chronic kidney disease. This review discusses the biology of these drugs and their target – hypoxia-inducible factor and potential advantages and disadvantages of these therapies. Finally, we will discuss current trials in patients with both chronic kidney disease and end-stage renal disease. Recent findings Recent smaller studies have found that prolyl-hydroxylase are as effective as erythropoietin in treating anemia of chronic kidney disease. We ...
Source: Current Opinion in Nephrology and Hypertension - October 8, 2019 Category: Urology & Nephrology Tags: DIALYSIS AND TRANSPLANTATION: Edited by Anil Chandraker and J. Kevin Tucker Source Type: research

When are you too old to get a kidney transplants?
Purpose of review With the increasing incidence and prevalence of ESRD in the elderly, we are now transplanting more elderly patients. Although we know from previous reports that transplantation provides increased survival advantage and/or quality of life when compared to being on dialysis, we also know that transplantation is not the best option for all patients. In this review, we try to identify the upper age limit (if any) for deceased donor renal transplantation, predictive factors that can identify the risks for transplant outcomes, frailty, and immunosenescence. Recent findings Review of data over the last 5 ye...
Source: Current Opinion in Nephrology and Hypertension - October 8, 2019 Category: Urology & Nephrology Tags: DIALYSIS AND TRANSPLANTATION: Edited by Anil Chandraker and J. Kevin Tucker Source Type: research

New treatments for cytomegalovirus in transplant patients
Purpose of review The purpose of this review is to highlight novel advances in prophylaxis against and treatment of CMV in kidney transplant recipients. Current options include intravenous ganciclovir and oral valganciclovir, but use of these agents is limited by side effects, such as myelosuppression as well as evolving resistance in CMV strains. Recent findings Advances in the field include novel drugs that have shown promise in preliminary studies and are now being tested in large-scale clinical trials. Moreover, there is a developing focus in enhancing host immune responses to better protect against viral infectio...
Source: Current Opinion in Nephrology and Hypertension - October 8, 2019 Category: Urology & Nephrology Tags: DIALYSIS AND TRANSPLANTATION: Edited by Anil Chandraker and J. Kevin Tucker Source Type: research

Vaccination for the post-kidney transplant population
Purpose of review Kidney transplant recipients are at high risk of contracting infections, some of which are considered vaccine-preventable, because of their highly immunosuppressed state. In this vulnerable group of patients, infection can lead to poor outcomes including graft failure and death, thus vaccination in the posttransplant population is an important strategy in order to mitigate this risk. The present review is aimed at providing an update on recent advances with respect to vaccination strategies in kidney transplant recipients. Recent findings General principles behind vaccination in kidney transplantatio...
Source: Current Opinion in Nephrology and Hypertension - October 8, 2019 Category: Urology & Nephrology Tags: DIALYSIS AND TRANSPLANTATION: Edited by Anil Chandraker and J. Kevin Tucker Source Type: research

Current opinions in nephrology and hypertension: kidney transplantation in patients with plasma cell dyscrasias
Purpose of review Plasma cell dyscrasias encompass a group of hematological disorders characterized by increased production of immunoglobulins by clonal B cells. Kidney involvement is common. Significant advances in the treatment of plasma cell dyscrasias have resulted in improved survival and may permit kidney transplantation in candidates previously denied transplantation. Treatments may also have effects on kidney transplant recipients who develop plasma cell dyscrasias post transplantation. Recent finding The available evidence suggests that transplantation of candidates with nonmultiple myeloma plasma cell dyscra...
Source: Current Opinion in Nephrology and Hypertension - October 8, 2019 Category: Urology & Nephrology Tags: DIALYSIS AND TRANSPLANTATION: Edited by Anil Chandraker and J. Kevin Tucker Source Type: research

Interventions for improving outcomes in acute kidney injury
Purpose of review Since the adoption of the classification of acute kidney injury (AKI) through changes in serum creatinine and/or urine output, much data have accumulated as to the associated risks in terms of morbidity and mortality after the development of AKI. However, until recently, a nihilistic approach persisted which implied that little could be done to alter the clinical course of a patient with AKI even where early identification was achieved. This view is reinforced by the opinion that given the broad cause underlying the syndrome of AKI, a ‘one size fits all’ approach is unlikely to be successful...
Source: Current Opinion in Nephrology and Hypertension - October 8, 2019 Category: Urology & Nephrology Tags: DIAGNOSTICS AND TECHNIQUES: Edited by Maarten W. Taal Source Type: research

Assessing the health of the nephron in acute kidney injury: biomarkers of kidney function and injury
Purpose of review Serum creatinine and urine output continue to be the mainstays of diagnosis of acute kidney injury, though both of these measures have significant limitations, especially in acutely hospitalized patients. Biomarkers in both blood and urine have been studied extensively in the research setting and are on the verge of clinical practice to improve diagnosis of AKI. Recent findings Blood and urine biomarkers can be localized to specific areas or functions within the nephron. Biomarkers can help to characterize glomerular or tubular function; glomerular, tubular, or interstitial injury; inflammation; or r...
Source: Current Opinion in Nephrology and Hypertension - October 8, 2019 Category: Urology & Nephrology Tags: DIAGNOSTICS AND TECHNIQUES: Edited by Maarten W. Taal Source Type: research

Acute kidney injury prediction models: current concepts and future strategies
Purpose of review Acute kidney injury (AKI) is a critical condition associated with poor patient outcomes. We aimed to review the current concepts and future strategies regarding AKI risk prediction models. Recent findings Recent studies have shown that AKI occurs frequently in patients with common risk factors and certain medical conditions. Prediction models for AKI risk have been reported in medical fields such as critical care medicine, surgery, nephrotoxic agent exposure, and others. However, practical, generalizable, externally validated, and robust AKI prediction models remain relatively rare. Further efforts t...
Source: Current Opinion in Nephrology and Hypertension - October 8, 2019 Category: Urology & Nephrology Tags: DIAGNOSTICS AND TECHNIQUES: Edited by Maarten W. Taal Source Type: research