Advances in Chronic Kidney Disease RSS feed: Current Issue. The purpose of Advances in Chronic Kidney Disease is to provide in-depth, scholarly review articles about the care and management of persons with early kidney disease and kidney failure, as well as those at risk for kidney disease. Emphasis is on articles related to the early identification of kidney disease; prevention or delay in progression of kidney disease; the multidisciplinary case management of patients with chronic kidney disease or kidney failure, organ effects of kidney disease; epidemiology and outcomes research in chronic kidney disease; benefits and complications of the primary treatment methods, dialysis and transplantation; technical aspects of the delivery of uremia therapy; care of the critically ill patient with kidney failure in the intensive care setting; new therapies for kidney failure; and health care research in chronic kidney disease. The full spectrum of basic science through clinical care is covered in these reviews. Clinical care issues stress the multidisciplinary team approach to the care of kidney patients. Topics covered will be of interest to practicing nephrologists (pediatric and adult), nephrology fellows (pediatric and adult), nurses, technicians, dietitians, and social workers caring for patients with kidney disease. Each bimonthly issue of Advances in Chronic Kidney Disease presents focused review articles devoted to a single topic of current importance in clinical nephrology and related fields. 2012 Issues, Vol. 19 January CKD: Is There Evidence? Don Molony, MD March Role of Glomerular Injury in Progressive Renal Disease Cynthia Nast, MD, Laura Barisoni, MD May Harm: Man-Made and Natural Paul Kellerman, MD July Living Kidney Donation: Looking to the Future Anita Patel, MD, Connie Davis, MD, Milagros Samaniego- Picota, MD September Evolving Strategies in the Diagnosis, Treatment, and Monitoring of Myeloma Kidney Colin Hutchinson, MD, Paul Sanders, MD November Gout Anthony Bleyer http://www.ackdjournal.org/?rss=yesElsevier Inc.en © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc All rights reserved. Advances in Chronic Kidney Disease1548-5595193May 2012 © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc All rights reserved. healthpermissions@elsevier.comhttp://www.ackdjournal.org/article/PIIS1548559512000845/abstract?rss=yesConfident in the classical biophysical knowledge that governs vectorial translocation of molecules in solution, most nephrologists are unmistakably shaken when things go awry for their patients undergoing hemodialysis or other renal replacement therapies. The calculations and formulas were without error, but errors occurred anyway, with harm as the extant corollary. The reason is simple, what happens to ideal gases and solvents is not ideal when one deals with the variability of reality in man, where “to err is human.”Harm in Nephrology: Its SystematizationJerry Yee10.1053/j.ackd.2012.04.007Advances in Chronic Kidney Disease 19, 3 (2012)2012-05-01Advances in Chronic Kidney Disease2012-05-01193S1548-5595(12)X0003-XEditorial125126http://www.ackdjournal.org/article/PIIS1548559512000857/abstract?rss=yesPrimum non nocere, which translates to “First (Above all), do no harm,” is taught conceptually to all medical students, and the common myth is that this is derived from the Hippocratic Oath. But primum non nocere is Latin, and Hippocrates was Greek. Use of the Greek language died out during the Middle Ages, and the Hippocratic Oath was translated into Latin, likely both by monks and physicians, and first appeared in print in Latin in the fifteenth century. Although it is true that the Hippocratic Oath, both the original and classic translations, includes comments on never harming patients with either dietary or medicinal advice, this concept was better laid out in the Hippocratic Corpus in Epidemics (Bk 1, Sect 11), where it was stated that “The physician must….have two special objects in view with regard to disease, namely, to do good or to do no harm.” This book was not known in medieval Europe and was not printed until the sixteenth century in Latin translation.Primum Non Nocere—Preventing Harm in Nephrology PracticePaul S. Kellerman10.1053/j.ackd.2012.04.008Advances in Chronic Kidney Disease 19, 3 (2012)2012-05-01Advances in Chronic Kidney Disease2012-05-01193S1548-5595(12)X0003-XGuest Editorial127128http://www.ackdjournal.org/article/PIIS1548559512000821/abstract?rss=yesThe use of alternative medicine is highly prevalent around the world; in many areas, this is so because of lack of access to, or trust in, Western medicine, and also because they are considered “natural” and therefore safe. The kidney is an organ vulnerable to toxic insults by virtue of its anatomy and function. Reports of nephrotoxicity associated with alternative medicine use encompass all forms of renal dysfunction, ranging from electrolyte abnormalities and proteinuria to acute and CKD, renal failure, and death. In countries where intensive care and dialysis support are not available, mortality is high. Mechanisms of alternative medicine-associated kidney injury include direct nephrotoxicity, which may be augmented by underlying predisposing conditions such as dehydration; contamination, or adulteration of remedies; inappropriate use or preparation of a remedy; or interactions with other medications. The use of alternative medicines is underreported to clinicians. Because many patients strongly believe in the powers of alternative medicines, it is important that alternative medicines not be demonized as a whole, but that their use and consequences be closely observed and reported to build a more comprehensive understanding of their impact in our clinical practice and to foster research on the potential harm or, in some cases, possible benefits.Nephrotoxicity of Alternative Medicine PracticeValerie A. Luyckx10.1053/j.ackd.2012.04.005Advances in Chronic Kidney Disease 19, 3 (2012)2012-05-01Advances in Chronic Kidney Disease2012-05-01193S1548-5595(12)X0003-XArticles129141http://www.ackdjournal.org/article/PIIS1548559512000778/abstract?rss=yesAcute kidney injury (AKI) affects approximately 5% of all hospitalized patients, and its incidence continues to increase. The treatment of AKI involves tremendous financial costs, estimated to exceed $10 billion in the United States annually. Although our understanding of the pathophysiology of AKI has progressed at a tremendous pace, mortality remains high at 50% to 80%, with no improvement during the past several decades. More questions than answers currently exist regarding the optimal dialysis dose, optimal modality, and optimal timing of the initiation of renal replacement therapy in the setting of AKI, making it particularly difficult for the practicing clinician to both optimize treatment and practice cost-effective medicine. This article will review current evidence and concerns regarding these issues and identify areas of future research.Preventing Harm During Treatment of Acute Kidney Injury: What Do We Really Know?R. Michael Hofmann10.1053/j.ackd.2012.03.006Advances in Chronic Kidney Disease 19, 3 (2012)2012-05-01Advances in Chronic Kidney Disease2012-05-01193S1548-5595(12)X0003-XArticles142148http://www.ackdjournal.org/article/PIIS1548559512000766/abstract?rss=yesCurrent knowledge about managing acute kidney injury in disaster situations stems mostly from lessons learned while taking care of crush syndrome patients during major earthquakes. More recently, there has been a greater focus on emergency preparedness for ESRD management. Natural or man-made disasters create an “austere environment,” wherein resources to administer standard of care are limited. Advance planning and timely coordinated intervention during disasters are paramount to administer effective therapies and save lives. This article reviews the presentation and management of disaster victims with acute kidney injury and those requiring renal replacement therapies. Major contributions of some key national and international organizations in the field of disaster nephrology are highlighted. The article intends to increase awareness about nephrology care of disaster victims, among nephrology and non-nephrology providers alike.Acute Kidney Injury and ESRD Management in Austere EnvironmentsGaurav Raman, Robert M. Perkins, Bernard G. Jaar10.1053/j.ackd.2012.03.005Advances in Chronic Kidney Disease 19, 3 (2012)2012-05-01Advances in Chronic Kidney Disease2012-05-01193S1548-5595(12)X0003-XArticles149157http://www.ackdjournal.org/article/PIIS1548559512000742/abstract?rss=yesVariations in intradialytic blood pressure (BP) are a common and predictable occurrence in ESRD patients. These are caused by a decrease in blood volume provoked by ultrafiltration, lack of normal compensatory responses to fluid removal, underlying cardiac disease, and electrolyte changes that may adversely affect cardiovascular function. Intradialytic hypotension is the most frequent complication of the hemodialysis (HD) procedure and is fundamentally a consequence of an ultrafiltration rate that surpasses mechanisms activated to avert a decline in BP. Intradialytic hypertension is a less well-understood problem that has been recently associated with increased mortality. Fundamental patient characteristics and components of the HD procedure are involved in the pathophysiology of intradialytic hypotension and intradialytic hypertension. Correction of patient factors, modulation of HD prescription, and management of pharmacologic agents are the strategies to deal with adverse intradialytic BP changes.How Should We Manage Adverse Intradialytic Blood Pressure Changes?Sergio F.F. Santos, Aldo J. Peixoto, Mark A. Perazella10.1053/j.ackd.2012.03.003Advances in Chronic Kidney Disease 19, 3 (2012)2012-05-01Advances in Chronic Kidney Disease2012-05-01193S1548-5595(12)X0003-XArticles158165http://www.ackdjournal.org/article/PIIS1548559512000754/abstract?rss=yesAppropriate dialysate composition is critical for effective and safe hemodialysis. Unfortunately, there are few randomized trials to guide practice, and although solute clearance is well understood, there is a limited understanding of balance in dialysis patients. The current practice of simply trying to normalize serum electrolyte and mineral concentrations measured predialysis may not provide optimal care. More thought should be given to normalizing balance with respect to sodium, bicarbonate, magnesium, and potassium and minimizing wide swings in serum concentrations that may have adverse effects. In practice, this would require longer or more frequent dialysis with less steep chemical gradients. With respect to calcium, the goal should be to optimize bone and vascular health. Clinicians should also be mindful that the dialysis procedure itself exposes patients to potential toxins, and efforts to minimize these risks should be stressed.Avoiding Harm and Achieving Optimal Dialysis Outcomes—The Dialysate ComponentDavid M. Spiegel10.1053/j.ackd.2012.03.004Advances in Chronic Kidney Disease 19, 3 (2012)2012-05-01Advances in Chronic Kidney Disease2012-05-01193S1548-5595(12)X0003-XArticles166170http://www.ackdjournal.org/article/PIIS1548559512000791/abstract?rss=yesThis review is focused on minimizing complications and avoiding harm in peritoneal dialysis (PD) patients. Issues related to planning for PD are covered first, with emphasis on PD versus hemodialysis outcomes. Catheter types and insertion techniques are described next, including relevant recommendations by the International Society for Peritoneal Dialysis. A brief review of both noninfectious and infectious complications follows, with emphasis on cardiovascular and metabolic complications. Finally, recommendations for preventing PD-related infections are provided. In conclusion, with proper catheter insertion technique, good training, and attention to detail during the tenure in PD, excellent outcomes can be obtained in a well-informed motivated patient.Avoiding Harm in Peritoneal Dialysis PatientsFilitsa H. Bender10.1053/j.ackd.2012.04.002Advances in Chronic Kidney Disease 19, 3 (2012)2012-05-01Advances in Chronic Kidney Disease2012-05-01193S1548-5595(12)X0003-XArticles171178http://www.ackdjournal.org/article/PIIS1548559512000808/abstract?rss=yesPercutaneous kidney biopsy is an integral part of a nephrologist's practice. It has helped to define nephrology as a subspecialty. When indicated, it is a necessary procedure to help patients, as it allows for diagnostic, prognostic, and therapeutic information. Although very safe, this procedure can give rise to complications, mainly related to bleeding. Since its development in the 1950s, modifications have been made to the approach and the technique, which have improved the diagnostic yield while keeping it a safe procedure. Alterations to the standard approach may be necessary if risk factors for bleeding are present. In addition, obesity, pregnancy, and solitary kidney biopsy are all special circumstances that change the procedure itself or the risk of the procedure. Today, kidney biopsy is a vital procedure for the nephrologist: clinically relevant, safe, and effective.Complications of the Percutaneous Kidney BiopsyWilliam L. Whittier10.1053/j.ackd.2012.04.003Advances in Chronic Kidney Disease 19, 3 (2012)2012-05-01Advances in Chronic Kidney Disease2012-05-01193S1548-5595(12)X0003-XArticles179187http://www.ackdjournal.org/article/PIIS154855951200081X/abstract?rss=yesCentral venous catheters for hemodialysis remain an indispensable modality of vascular access in the United States. Despite strong recommendations by the NKF-KDOQI guidelines to reduce the dependence on catheters, >80% of all patients initiate hemodialysis using a central venous catheter. Although the tunneled dialysis catheters have some advantages, their disadvantages are many and often dwarf the miniscule advantages. This review is intended to discuss the complications—both acute and chronic—related to the use of tunneled dialysis catheters for hemodialysis access.Complications of Catheters: Tunneled and NontunneledHemender Singh Vats10.1053/j.ackd.2012.04.004Advances in Chronic Kidney Disease 19, 3 (2012)2012-05-01Advances in Chronic Kidney Disease2012-05-01193S1548-5595(12)X0003-XArticles188194http://www.ackdjournal.org/article/PIIS154855951200078X/abstract?rss=yesVascular access is the lifeline of hemodialysis patients. Currently, arteriovenous fistulae and grafts are considered permanent options for vascular access, and they share common access problems. The successful creation of a permanent vascular access depends on patient characteristics, vessel parameters, and possibly genetic factors. Utilization of a dialysis access at least 3 times a week leads to significant wear and tear of the access. The buttonhole technique is associated with a higher incidence of infection, and evidence regarding various perceived advantages remain contradictory. Infiltration and aneurysm formation of an access are common, and the literature on its impact on vascular access outcomes is limited. A patient who undergoes hemodialysis often requires multiple accesses during his or her lifetime, and the maintenance of a persistent vascular access may require creative solutions. Intensified research is crucial to comprehending the pathophysiology and treatment options for some of the common problems of vascular accesses.Complications of Arteriovenous Fistulae: Beyond Venous StenosisLalathaksha Kumbar10.1053/j.ackd.2012.04.001Advances in Chronic Kidney Disease 19, 3 (2012)2012-05-01Advances in Chronic Kidney Disease2012-05-01193S1548-5595(12)X0003-XArticles195201http://www.ackdjournal.org/article/PIIS1548559512000894/abstract?rss=yesMasthead10.1053/S1548-5595(12)00089-4Advances in Chronic Kidney Disease 19, 3 (2012)2012-05-01Advances in Chronic Kidney Disease2012-05-01193S1548-5595(12)X0003-XFrontmatterA1A1http://www.ackdjournal.org/article/PIIS1548559512000900/abstract?rss=yesEditorial Board10.1053/S1548-5595(12)00090-0Advances in Chronic Kidney Disease 19, 3 (2012)2012-05-01Advances in Chronic Kidney Disease2012-05-01193S1548-5595(12)X0003-XFrontmatterA2A2http://www.ackdjournal.org/article/PIIS1548559512000912/abstract?rss=yesTable of Contents10.1053/S1548-5595(12)00091-2Advances in Chronic Kidney Disease 19, 3 (2012)2012-05-01Advances in Chronic Kidney Disease2012-05-01193S1548-5595(12)X0003-XFrontmatterA4A5