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The quest for cardiovascular disease risk prediction models in patients with nondialysis chronic kidney disease
Purpose of review Cardiovascular disease (CVD) is the leading cause of death in patients with chronic kidney disease (CKD). However, traditional CVD risk prediction equations do not work well in patients with CKD, and inclusion of kidney disease metrics such as albuminuria and estimated glomerular filtration rate have a modest to no benefit in improving prediction. Recent findings As CKD progresses, the strength of traditional CVD risk factors in predicting clinical outcomes weakens. A pooled cohort equation used for CVD risk prediction is a useful tool for guiding clinicians on management of patients with CVD r...
Source: Current Opinion in Nephrology and Hypertension - December 2, 2020 Category: Urology & Nephrology Tags: NOVEL THERAPEUTIC APPROACHES IN NEPHROLOGY AND HYPERTENSION: Edited by Kamyar Kalantar-Zadeh and Ekamol Tantisattamo Source Type: research

Novel approaches to management of hyperkalaemia in kidney transplantation
Purpose of review Medications used frequently after kidney transplantation, including calcineurin inhibitors, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta blockers and antimicrobials, are considered the leading culprit for posttransplant hyperkalaemia in recipients with a well functioning allograft. Other risk factors include comorbidities such as diabetes, hypertension and heart failure; and consumption of a potassium-enriched diet. We review the mechanisms for hyperkalaemia following kidney transplantation that are addressed using nonpharmacological and pharmacological interventions. ...
Source: Current Opinion in Nephrology and Hypertension - December 2, 2020 Category: Urology & Nephrology Tags: NOVEL THERAPEUTIC APPROACHES IN NEPHROLOGY AND HYPERTENSION: Edited by Kamyar Kalantar-Zadeh and Ekamol Tantisattamo Source Type: research

Novel approaches to sarcopenic obesity and weight management before and after kidney transplantation
Purpose of review Although a widely recognized and complex pathophysiological condition, sarcopenic obesity remains less appreciated and may elude diagnosis and workup in both kidney transplant waitlisted candidates and kidney transplant recipients. The lack of consensus definition, and practical diagnostic tools for evaluating waitlisted candidates and transplant recipients are barriers to early detect and initiate therapeutic management for sarcopenic obesity. Although sarcopenia leads to poor clinical outcomes, posttransplant obesity yields conflicting results. Exercise and nutritional managements are common therapi...
Source: Current Opinion in Nephrology and Hypertension - December 2, 2020 Category: Urology & Nephrology Tags: NOVEL THERAPEUTIC APPROACHES IN NEPHROLOGY AND HYPERTENSION: Edited by Kamyar Kalantar-Zadeh and Ekamol Tantisattamo Source Type: research

Novel management of diabetes in kidney transplantation
Purpose of review Posttransplant diabetes mellitus (PTDM) is a prevalent complication in kidney transplant recipients, and has been associated with worse short-term and long-term outcomes. Recent findings While hyperglycemia is frequently seen in the early posttransplant period because of surgical stress, infection, and use of high-dose steroids, the diagnosis of PTDM should be established after patients are clinically stable and on stable maintenance immunosuppression. In the early posttransplant period, hyperglycemia is typically treated with insulin, and pilot data have suggested potential benefit of lower vs...
Source: Current Opinion in Nephrology and Hypertension - December 2, 2020 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, uremia and kidney transplantation: past, present and future
No abstract available (Source: Current Opinion in Nephrology and Hypertension)
Source: Current Opinion in Nephrology and Hypertension - December 2, 2020 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 - December 2, 2020 Category: Urology & Nephrology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Pain management in patients with chronic kidney disease and end-stage kidney disease
Purpose of review This review evaluates current recommendations for pain management in chronic kidney disease (CKD) and end-stage kidney disease (ESKD) with a specific focus on evidence for opioid analgesia, including the partial agonist, buprenorphine. Recent findings Recent evidence supports the use of physical activity and other nonpharmacologic therapies, either alone or with pharmacological therapies, for pain management. Nonopioid analgesics, including acetaminophen, topical analgesics, gabapentinoids, serotonin–norepinephrine reuptake inhibitors, and TCA may be considered based on pain cause and type, with ca...
Source: Current Opinion in Nephrology and Hypertension - October 5, 2020 Category: Urology & Nephrology Tags: SPECIAL COMMENTARY Source Type: research

Volume management in haemodialysis patients
Purpose of review Accumulating evidence supports the important contribution of volume-related metrics to morbidity and mortality in patients receiving chronic haemodialysis. The purpose of this review is to summarize recent advances in the understanding and management of volume status in this high-risk group. Recent findings Delivery of optimal volume management involves three key components: accurate estimation of volume status, correction of extracellular fluid overload and prevention of intradialytic instability. The lack of a gold standard for assessing volume status makes accurate estimation difficult to achieve;...
Source: Current Opinion in Nephrology and Hypertension - October 5, 2020 Category: Urology & Nephrology Tags: DIALYSIS AND TRANSPLANTATION: Edited by David J. Cohen Source Type: research

Are borderline changes real rejection? Current viewpoints
Purpose of review The clinical significance and treatment of borderline changes are controversial. The lowest detectable margin for rejection on histology is unclear. We review recent evidence about borderline changes and related biomarkers. Recent findings Borderline change (Banff ≥ t1i1) is associated with progressive fibrosis, a greater propensity to form de-novo DSA, and reduced graft survival. Isolated tubulitis appears to have similar kidney allograft outcomes with normal controls, but this finding should be validated in a larger, diverse population. When borderline change was treated, a higher chance of kidne...
Source: Current Opinion in Nephrology and Hypertension - October 5, 2020 Category: Urology & Nephrology Tags: DIALYSIS AND TRANSPLANTATION: Edited by David J. Cohen Source Type: research

Apolipoprotein L1: role in the evaluation of kidney transplant donors
Purpose of review To summarize the current state of evidence regarding the role of apolipoprotein L1 (APOL1) genotyping in evaluating donors for kidney transplantation. Recent findings African ancestry is associated with an increased risk of kidney failure following living donation. Moreover, kidney transplants from African ancestry deceased donors have an increased risk of graft failure. Preliminary evidence suggests that APOL1 genotype may mediate at least a portion of this racial variation, with high-risk APOL1 genotypes defined by presence of two renal risk variants (RRVs). A pilot study 136 African ancestry livin...
Source: Current Opinion in Nephrology and Hypertension - October 5, 2020 Category: Urology & Nephrology Tags: DIALYSIS AND TRANSPLANTATION: Edited by David J. Cohen Source Type: research

Recurrent glomerulonephritis after renal transplantation
Purpose of review The current understanding of the incidence, predisposing factors, pathophysiology and effective treatment of recurrent glomerulonephritis (RGN) in renal transplants remains at best patchy and at worst, completely lacking. Current reports have been limited by inconsistencies in study design, sample populations and lengths of follow-up. Making sense of the available evidence will provide the tools to support transplant nephrologists in their management of allograft donors and recipients. Recent findings With better survival of renal allografts, RGN has become a dominant factor influencing allograft sur...
Source: Current Opinion in Nephrology and Hypertension - October 5, 2020 Category: Urology & Nephrology Tags: DIALYSIS AND TRANSPLANTATION: Edited by David J. Cohen Source Type: research

More precise donor–recipient matching: the role of eplet matching
Purpose of review A precise understanding of the alloimmune risk faced by individual recipients at the time of transplant is an unmet need in transplantation. Although conventional HLA donor–recipient mismatch is too imprecise to fulfil this need, HLA molecular mismatch increases the precision in alloimmune risk assessment by quantifying the difference between donors and recipients at the molecular level. Recent findings Within each conventional HLA mismatch the number, type, and position of mismatched amino acids create a wide range of HLA molecular mismatches between recipients and donors. Multiple different solid...
Source: Current Opinion in Nephrology and Hypertension - October 5, 2020 Category: Urology & Nephrology Tags: DIALYSIS AND TRANSPLANTATION: Edited by David J. Cohen Source Type: research

Waiting times in renal transplant candidates with a history of malignancy: time for a change?
Purpose of review With the aging population of kidney transplant candidates, a history of malignancy is an increasingly prevalent finding. Tumors can constitute a contraindication for transplantation or can lead to a delay of acceptance to the waiting-list. Current waiting time guidelines mainly refer to early data collected nearly 30 years ago, when the knowledge on tumors was, by current standards, still limited. Recent findings Today, cancers can usually be divided into many different biological subtypes, according to histological and molecular subclassification and the availability of genetic testing. A more preci...
Source: Current Opinion in Nephrology and Hypertension - October 5, 2020 Category: Urology & Nephrology Tags: DIALYSIS AND TRANSPLANTATION: Edited by David J. Cohen Source Type: research

Editorial: Taking the long view
No abstract available (Source: Current Opinion in Nephrology and Hypertension)
Source: Current Opinion in Nephrology and Hypertension - October 5, 2020 Category: Urology & Nephrology Tags: DIALYSIS AND TRANSPLANTATION: Edited by David J. Cohen Source Type: research

Extracellular vesicles: a novel window into kidney function and disease
Purpose of review There has been an increasing interest in extracellular vesicles as potential diagnostic, prognostic or therapeutic biomarkers for various kidney diseases, as extracellular vesicles mediate cell-cell or intercellular communication. This review explores the current state of knowledge regarding extracellular vesicles as a tool for examining kidney physiology and disease. Recent findings Urinary extracellular vesicles may be useful as biomarkers to detect abnormal function in renal endothelial and tubular cells as well as podocytes. Recent studies suggest that urinary extracellular vesicles may facilitat...
Source: Current Opinion in Nephrology and Hypertension - October 5, 2020 Category: Urology & Nephrology Tags: DIAGNOSTICS AND TECHNIQUES: Edited by Maarten W. Taal Source Type: research