The theme(s) of this issue is embodied in the photograph on the cover: chronic kidney disease in vulnerable populations, the young, the elderly, and racial/ethnic groups at high risk. The 3 guest editors, Drs Lane, Murray and Narva, have assembled a unique collection of articles that address various aspects of chronic kidney disease in these populations.
The first section addresses perinatal programming of chronic kidney disease. Drs Ojeda, Grigore, and Alexander discuss the effect of the intrauterine milieu on the fetus and subsequent risks of kidney and cardiovascular disease in the child and adult. They report on animal models of fetal programming of adult disease that include decreased nephron number, fetal growth restriction, and hypertension and how manipulation of maternal diet can affect intrauterine growth and uteroplacental perfusion. Dr Ingelfinger notes that renal development continues after birth in infants born before 36 weeks of gestation and that decreased nephron number may affect susceptibility to hypertension and kidney injury in adult life.
Section 2 addresses the opposite end of the spectrum: chronic kidney disease in the geriatric population. Drs Jassal, Chiu, and Li review functional and disability status in geriatric dialysis patients and note that more than 70% of elderly patients can achieve their rehabilitation goals through the use of dedicated geriatric dialysis rehabilitation units. Dr Murray describes cognitive impairment in geriatric dialysis and chronic kidney disease patients, much of which is unrecognized, and how it affects outcomes and quality of life. Drs Germain and Cohen also discuss quality of life in the elderly dialysis patient but also discuss the barriers to palliative care in this vulnerable population. Finally, Dr St. Peter describes the potential impact of Medicare Part D on the end-stage renal disease population.
Section 3 involves chronic kidney disease in racial/ethnic groups at high risk for kidney disease. Drs Burrows, Li, and Williams provide a thoughtful review of the disproportionate burden of chronic kidney disease in racial and ethnic minorities in the United States. They note a promising decrease in the disparity gap between 1995 and 2005 that may be attributed to better health care and decreased prevalence of risk factors. The next article, an exploration of community and academic partnerships and chronic kidney disease by Vargas and coworkers, shows the value of community involvement in addressing the burden of chronic kidney disease in minority populations. Drs Leal and Soto describe the positive effect of a pharmacist-based disease-state management service for chronic kidney disease risk reduction in American Indians with diabetes. Dr Narva describes the Indian Health Service Kidney Disease Program for the screening and management of diabetics with chronic kidney disease that has resulted in a 31% decrease in end-stage renal disease incidence among American Indians between 1989 (the program's inception) and 2006.
We have 2 articles from our section editors. Dolph Chianchiano describes state-based approaches to chronic kidney disease, and Drs Davison and Holley explore ethical issues in vulnerable populations with chronic kidney disease. We also have 2 wildcard articles. The first, by Amato and colleagues, is more basic science–based than our usual articles, but I think it is of great interest because of the recent controversies surrounded anemia management, erythropoiesis-stimulating agents, and cardiovascular disease in chronic kidney disease patients. Their research suggests that certain genetic markers (vitamin D receptors polymorphisms) may be predictive of cardiovascular morbidity and mortality in dialysis patients. The second wildcard by Curtin and coworkers explores the relationship between self-efficacy and self-management behaviors and outcomes in patients with chronic kidney disease.
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