Kidney360 Podcast

This podcast discusses a post hoc analysis of the STOP-ACEi trial, examining whether baseline loop diuretic use modifies the effect of Renin–Angiotensin System Inhibitors in advanced CKD. Among patients not receiving loop diuretics, stopping Renin-angiotensin system inhibitors was associated with lower eGFR at three years and a faster decline in kidney function. In contrast, among patients taking loop diuretics, the decline in eGFR was slower and withdrawal of RAS inhibitors had little effect on eGFR decline. Rates of ESKD and KRT were similar between groups, although mortality appeared higher in patients receiving loop diuretics. Overall, the findings suggest that discontinuing RAS inhibitors may be more harmful in advanced CKD patients who are not taking loop diuretics.

This episode highlights data from a qualitative substudy of the AV Access trial, a randomized controlled trial studying outcomes of older adults who are receiving hemodialysis with a central venous catheter.

In this prospective cohort of patients with severe and symptomatic ESKD requiring an urgent start of HD or PD owing to uremic syndrome, both modalities offer similar outcomes in terms of mortality, correction of uremia, and technical survival. Authors found that the urgent start of PD is feasible and effective in the short- and long-term compared to HD. Suggesting that the reluctance to use PD as the initial modality in these urgent scenarios requires further consideration and ongoing evaluation.

This retrospective single-center study examined the effects of socioeconomic status on preemptive kidney transplantation in children. Using an individual-level SES measure, HOUSES, generated by linking recipients' address information to publicly available real property data, which they categorized into quartiles, researchers found significantly lower odds of preemptive kidney transplantation in children with lower SES (Q1 HOUSES quartile) compared to children with higher SES (Q2-4 HOUSES quartile) after adjusting for age at kidney failure sex, donor type, insurance type, and the cause of kidney failure.

Patients on dialysis want to discuss their preferences for treatment. The Shared Decision-Making-Renal Supportive Care intervention effectively elicited dialysis patient preferences for end-of-life care. The HIGHWay project updated this intervention to scale it for broader implementation of advance care planning to all patients during their regular dialysis session and to address barriers previously found.

This episode discusses a study that measured objective nocturnal sleep duration of patients on hemodialysis and characterized natural and dialysis-imposed patterns of sleep duration using a commercially available wearable activity tracker.

Data from nearly 16,000 French peritoneal dialysis (PD) patients were analyzed in this large observational study, to understand factors influencing transfers to hemodialysis for different reasons. Nurse-assisted PD was associated with a reduced risk of infection-related transfers in the first 18 months and inadequacy-related transfers after 6 months. Continuous ambulatory PD showed higher mechanical issue risks early on but better outcomes after 18 months. Suboptimal-starters had increased psychosocial-related transfer risks in the first 6 months. These findings suggest that understanding timing-specific risk factors could help implement targeted preventive strategies to maintain patients on PD longer.

A Kidney360 study examined the living kidney donor evaluation process to determine the point at which sex imbalance arises. The authors conducted a single institution retrospective chart review of self-referrals for living donor evaluation between 2009-2022. Exclusion at each stage was recorded and compared between sexes using log binomial regression. Overall, there were 1,861 self-referrals (65.2% females, 34.8% males), resulting in 146 approvals and 125 donations (60.8% females, 39.2% males). The adjusted risk ratios indicated no significant differences in completing workup, having contraindications, being approved for donation, and proceeding with donation. Thus, female overrepresentation stems from a 1.9x higher self-referral rate.

This episode highlights a study that aimed to analyze the time-varying effect of assistance on the risk of PD cessation. This study was conducted using data from the RDPLF of 15675 incident PD patients between 2002 and 2018. Patients treated with assisted PD had a greater risk of death and a lower risk of transfer to HD. However, the protective effect of assisted PD on the risk of transfer to HD was not constant over time; it started between the first 6 to 12 months on PD. Assisted PD programs should be sustainable for at least 6 months to observe their benefits.

In an analysis of patients undergoing kidney transplantation, depression and health related quality of life (HRQOL) were measured using the Beck Depression Inventory-II (BDI-II) and Kidney Disease Quality of Life Short Form Version 1.3 (KDQOL) physical health composite score (PCS) and mental health composite score (MCS) at 3-months and 1-year post-transplantation. Depression and HRQOL improve with KT. While depression improves in all ages, the improvement in HRQOL, especially PCS, is more evident in younger patients. This improvement in depression and HRQOL is sustained until at least 1-year post-KT.

In a Kidney 360 article of 31 patients with native kidney biopsy proven oxalate nephropathy described from the Cleveland Clinic Kidney Biopsy Epidemiology Project, 10 of 31 patients had multifactorial etiologies of oxalate nephropathy, such as enteric hyperoxaluria and excessive precursor intake. 10 of 31 had a single etiology and 11 had risk factors but the etiology was unknown. Key findings included additional diagnoses such as ATN and diabetic kidney disease in 27 of 31 patients, moderate to severe interstitial fibrosis on biopsy at diagnosis in 90% of patients, with 21 of 26 patients with 1 year follow up data being dialysis dependent at 1 year.

Utilizing a multinational collaborative network, a study provided the first systematic description of urinary vacuolar casts in patients with acute or chronic kidney disease. Notably, these casts are not included in most textbooks of urinalysis and/or urine microscopy. The investigators reported that these distinct type of casts are associated with the presence of a glomerular disease and overt proteinuria. Moreover, individuals in which vacuolar casts were identified via urinary sediment microscopy had greater degree of proteinuria and greater percentage of glomerular obsolescence than a control group of patients without vacuolar casts. Further studies will be needed to examine the prognostic value of vacuolar casts.

Evidence based approaches to care, like a personalized group visit model, can provide education, coaching, and peer support to patients with late-stage diabetic disease and their caregivers and, as a result, improve outcomes and quality of life. Telehealth or virtual care is increasingly common but there is little guidance on how to adapt existing, evidence-based approaches designed to be delivered in-person for virtual delivery. A new Kidney360 study describes the Duke Center for Personalized Health Care's experience adapting and pilot testing a group visit approach using existing telehealth infrastructure.

We found that most PD patients enrolled in the units surveyed did not have to change their home accommodations during the pandemic or have issues getting their dialysis supplies and medications delivered. Most of the patients felt comfortable coming to the dialysis unit if they needed to during the pandemic. Most of the patients felt supported by their dialysis staff during the peak of COVID-19 and had modified PHQ-2 and GAD-2 scores not consistent with depression or anxiety. Finally, less than 10% of patients considered changing their dialysis modality. Our survey findings demonstrate that the adjustments made by the dialysis units during the peak of the pandemic were effective in maneuvering the challenges faced by our patients during the COVID-19 pandemic while providing high-quality medical care.

There have been several reports of IgA nephropathy patients with gross hematuria and acute deterioration of urinary findings and kidney function after SARS-CoV 2 mRNA vaccination. Recent case series studies have indicated a possible link between the status of urinary findings at the time of vaccination and the subsequent appearance of gross hematuria. A new Kidney360 study describes the association between the pre-vaccination microscopic hematuria or proteinuria and post-vaccination gross hematuria.

After kidney transplantation, it is still not well established what we should do with the functioning arteriovenous fistula of kidney transplant recipients with stable renal function. To close or not to close: this question remains debatable. In this prospective study including 43 kidney transplant recipients, we have investigated the impact of the surgical closure of functioning arteriovenous fistula on blood pressure levels, as well as on the cardiac and renal functions.

Acute kidney injury occurs in approximately half of critically ill patients and increasing evidence indicates that quality of life of these patients may be impacted after hospital discharge. A new study in Kidney 360 examines the health utility of patients at 60 days after dialysis-requiring acute kidney injury and identifies 3 subgroups of AKI survivors with distinct health utility profiles. The study further examines risk factors associated with these patient subgroups as well as the 1-year outcomes of these 3 subgroups.

There is no published literature evaluating the exposure to transplant patients by pediatric nephrology fellows. The survey results reveal a highly varied fellowship experience when it comes to pediatric kidney transplant patient care. Pediatric Nephrology Fellowship graduates are lacking in exposure to observation of the actual transplant procedures, care of the post-transplant patient (immediately following, first 6 months after, and long-term), and advocacy opportunities. Given the lack of a transplant-specific curriculum within the ACGME guidelines, the Transplant Interest Group (under the American Society of Pediatric Nephrology) has worked to create a transplant specific curriculum, which is available on the ASPN website.

Opportunities exist for clinical decision support (CDS) to help transplant nephrologists counsel living donors receiving APOL1 genetic test results. A new Kidney360 study provides insights from transplant nephrologists on how this CDS should be developed.

This Podcast discusses a new Kidney360 study that examines sociodemographic risk factors for food insecurity and housing instability among people on hemodialysis and their association with substance use.

Patient Interview by Audrey A. Shi and Sherry G. Mansour of the "Kidney Brothers": The Case for Peer Support in Kidney Transplant

Jane S. Davis brought together four hemodialysis patients to talk about central venous catheters versus permanent accesses. The conversation took a surprising turn when the participants began discussing their own issues.

This is an article summary of "Mission and 1-Year Outcomes of a Cardiorenal Subspecialty Consultation Service" by Nisha Bansal and Stuart Shankland on behalf of coauthors.

This is an article summary of "Asymptomatic Pyuria as a Prognostic Biomarker in Autosomal Dominant Polycystic Kidney Disease" by Fouad Chebib on behalf of coauthors.

This podcast is an article summary of "Short and Long-term Recovery after Moderate/Severe Acute Kidney Injury in patients with and without COVID-19" by Farrukh Koraishy on behalf of co-authors.

This is an article summary of "Quantitative super-resolution microscopy reveals promoting mitochondrial interconnectivity protects against AKI" by Kensei Taguchi, Craig R Brooks, and Bertha C Elias on behalf of coauthors.

This is an article summary of "Challenges, Facilitators, and Recommendations for Implementation of Home Dialysis in the Veterans Health Administration: Patient, Caregiver, and Clinician Perceptions" by Lindsey A. Jones on behalf of coauthors.

This podcast is an article summary of "Reconsidering donor race in predicting allograft and patient survival among kidney transplant recipients" by Yue-Harn Ng and Christos P. Argyropoulos on behalf of coauthors.

This podcast is a summary of article "Monocytes and Macrophages in Kidney Transplantation and Insights from Single Cell RNA-Seq Studies" by Andrew Malone.

This podcast is a summary of article "Global Perspective on Kidney Transplantation: France" by Gillian Divard and Valentin Goutaudier.

This is a podcast article summary of "Less is More: Deprescribing Medications in Older Adults with Kidney Disease: A Review" by Dinushika Mohottige, Harold Manley, and Rasheeda Hall.

This is a podcast article summary of "New Vancomycin Dosing Guidelines for Hemodialysis Patients: Rationale, Caveats, and Limitations" by Susan J. Lewis and Thomas D. Nolin.

This is a podcast article summary of "Expression of ACE2 in the Intact and Acutely Injured Kidney" by Karl A. Nath and Vesna D. Garovic.

This is a podcast article summary of "Global Perspective on Kidney Transplantation: Turkey" by Oya Andacoglu and Fazil Tuncay Aki.

This is a podcast article summary of "Implementation of Surprise Question Assessments using the Electronic Health Record in Older Adults with Advanced CKD" by Natalie C. Ernecoff on behalf of coauthors.

This is a podcast article summary of "A hyaluronan synthesis inhibitor delays progression of diabetic kidney disease in a mouse experimental model" by Loay H. Salman and Laisel Martinez on behalf of coauthors.

This is an article summary of "Real-Life Prescribing of SGLT2 Inhibitors: How to Handle the Other Medications, Including Glucose-Lowering Drugs and Diuretics" by Aisha Shaikh on behalf of coauthors.

This is an article summary of "Implementation of an Electronic Catheter Checklist in Outpatient Hemodialysis Facilities: Results of a Pilot Quality Improvement Project" by Michele Mokrzycki and Vandana Niyyar on behalf of their coauthors.

This is a podcast article summary of "A Call to Action for Addressing Disparities and Increasing Diversity in Academic Nephrology" by Claretha Lyas.

This is a podcast article summary of "A Comparison Study of Coronavirus Disease 2019 Outcomes in Hospitalized Kidney Transplant Recipients" by Divyanshu Malhotra and Sherry G Mansour on behalf of coauthors.

This is a podcast article summary of "Long-Term Outcomes and Prognostic Factors in Kidney Transplant Recipients with Polycystic Kidney Disease" by Gauri Bhutani on behalf of coauthors.

This is a podcast article summary of "Urine Microscopy for Internal Medicine Residents: A Needs Assessment & Implementation of Virtual Teaching Sessions" by Samira Farouk and Matthew Sparks.

This is a podcast article summary of "Characteristics, outcomes and 60-day hospital mortality of ICU patients with Covid-19 and acute kidney injury" by Sumit Kapoor and Jyotsana Thakkar.

This is a podcast article summary of "Histopathologic and Clinical Features in Patients with Diabetes and Kidney Disease" by Sarah F. Sanghavi and Charles E. Alpers.

This is a podcast article summary of "Survey of Clinician Opinions on Kidney Transplantation from Hepatitis-C Virus-Positive Donors: Identifying and Overcoming Barriers" by Krista L. Lentine and David A. Axelrod.

This is a podcast article summary of "Substitution of oral for intravenous cyclophosphamide in membranous nephropathy" by Leonella Luzardo and Oscar Noboa.

This is a podcast article summary of "Chronic Hemodialysis Patients Hospitalized with COVID-19: Short-term Outcomes in the Bronx, New York" by Molly Fisher and Milagros Yunes.

This is a podcast article summary of "Foreign Perspective on Achieving a Successful Peritoneal Dialysis-First Program" by Philip Kam-Tao Li and Mark E. Rosenberg.

This is a podcast summary of "Global Dialysis Perspective: Mexico" by Magdalena Madero Rovalo and Enzo Christopher Vazquez

Anil K. Agarwal and Khaled K. Boubes discuss the recently published Debate in Nephrology "Should buttonhole cannulation of arteriovenous fistulas be used?"