It is with some sadness that I write this final editorial for the October 2008 issue of Advances in Chronic Kidney Disease. It has been a wonderful 5-year journey to edit this journal, and it could not have happened without the able assistance of the Section Editors, Editorial Board, and Managing Editor. It has truly been a privilege to work with outstanding authors and editors in the production of the journal. Peter McCullough, who guest edited this issue, has been a particular friend and ally in the production of Advances in Chronic Kidney Disease. This issue on Vascular Disease and Chronic Kidney Disease is of particular importance as he notes in his editorial. We are just beginning to understand the intense relationship between atherosclerosis, chronic kidney disease, and related comorbidities. The articles that Dr. McCullough has solicited highlight the importance of these relationships and the work that has yet to be done.
Dr. Khella explores the increased risk of stroke (ischemic, hemorrhagic, and thromboembolic) in patients with chronic kidney disease. He looks at risk factors particular to chronic kidney disease, including anemia and kidney transplantation, and discusses the efficacy or lack of efficacy of various preventative treatments. Dr. Govindarajan and colleagues report on the outcomes of carotid revascularization in patients with chronic kidney disease, looking at carotid endarterectomy, carotid artery angioplasty, and carotid artery stenting. They note that most trials have specifically excluded patients with chronic kidney disease, which makes it difficult to ascertain the most efficacious treatment for this patient population.
Drs. Kiernan, Yan, and Jaff discuss renal artery revascularization in patients with chronic kidney disease. Again, studies in patients with chronic kidney disease are lacking, but there are new techniques, such as renal revascularization with a distal embolic protective device, that look promising and may assist in preserving or improving kidney function. Drs. Warsham and Adams discuss the utility of antiplatelet therapy in acute coronary syndrome patients who also have chronic kidney disease. They note that patients with even mild kidney insufficiency have increased cardiovascular morbidity and mortality, and dialysis patients have a markedly increased risk over patients without kidney disease. Anticoagulation in this group is problematic because patients with chronic kidney disease already have platelet dysfunction and increased risk for bleeding. Again, as noted previously, many clinical trials regarding anticoagulation in acute coronary syndrome specifically exclude patients with chronic kidney disease. This will continue to be a problem unless the kidney community develops its own cooperative clinical trials.
Drs. Ix and Criqui write about an extremely important disorder, peripheral arterial disease in patients with chronic kidney disease, and discuss the unique risk factors associated with chronic kidney disease that affect treatment and outcomes. Dr. Casserly discusses the role of revascularization of critical limb ischemia in chronic kidney disease patients, which is extremely challenging in this patient population. Once again outcomes data are lacking in patients with chronic kidney disease, but because mortality is particularly high in this group strategies should focus on early detection.
Dr. McCullough and colleagues focus on the spectrum of atherosclerotic calcification and Monckeberg's sclerosis in patients with chronic kidney disease, tracing the history of Monckeberg's sclerosis including still popular misconceptions and then the accelerated atherosclerosis well known to occur in patients with chronic kidney disease. They comment on potential treatments as well as the lack of efficacy of some current therapies and call for future trials that may shed light on appropriate treatments in patients with chronic kidney disease. Finally, as part of the basic science section, Dr. Al-Aly discusses the spectrum of vascular calcification in uremia and recent advances in molecular mechanisms.
The new Editor-in-Chief of Advances in Chronic Kidney Disease is Dr. Jerry Yee who is at Henry Ford Hospital in Detroit, MI. Dr. Yee has been of great assistance during my tenure and has guest edited several issues. Beginning with the January 2008 issue, the journal will be published 6 times a year instead of the current 4. I look forward to reading the issues under Dr. Yee's editorship!
© 2008 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.