- 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.
- The kidney is a wonderful organ. It is exquisitely responsive to changes in environment and physiology. What is referred to as acute renal failure in response to acute kidney injury is in some measure acute renal success. A decrease in urine output, for example, in a dehydrated patient helps restore or maintain central volume. Our guest editors have provided a series of articles that address cutting-edge issues in what is now being termed acute kidney injury (AKI) in an attempt to better define and tease out varying causes of acute kidney failure and ultimately improve outcomes.
- 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.
- Technology can be a blessing and a curse. It can make life easier, make us more efficient, enable us to make better decisions or take better care of patients, or make these objectives more difficult to accomplish because of the cumbersome nature of a device or program or the lack of insight on the part of the developer/manufacturer to consult or understand the end user. Drs Fadem, Yee, and Spry look at the effect of modern technology on the care of patients with chronic kidney disease. Their issue, Practical Management of Chronic Kidney Disease, is divided into 3 sections: regulatory issues, practice management, and information technology.
- Early in the history of dialysis, patients dialyzed for many more hours than is the current practice. This occurred, at least partially, because dialyzers were much less efficient than today’s models. Because of the longer dialysis times, weight fluctuations were frequently not as dramatic as some of the intradialytic weight gains that we often see today. That is not to say that patients actually felt better; the vogue was low-protein diets, and patients lacked energy and felt badly. As noted by Drs Kliger and Gellens, “modern” dialysis has not changed much in the past 30 years; the “norm” is 3 to 4 hours 3 times weekly.
- Drs Sharon Moe and Stephen Fadem selected a timely and important topic for this issue: chronic kidney disease mineral bone disorder. Just when we think we have something figured out, the treatment of bone and mineral disorders in chronic kidney disease (CKD), we realize we have put our foot in it. Patients with CKD and end-stage renal disease (ESRD) are living long enough to suffer the complications of “old” therapies that will lead us to seek “new” therapies, always trying to stay one step ahead.
- This week, I have been editing this April 2006 issue of Advances in Chronic Kidney Disease on genetic diseases of the kidney. By remarkable coincidence, I have just returned from a medicine grand rounds at Vanderbilt University, given by Dan M. Roden, MD, entitled, “Towards a Vision of Personalized Medicine: A Vanderbilt Progress Report.” I did not know what to expect. Dr Roden is a cardiologist, professor of clinical pharmacology and medicine, and director of the Division of Clinical Pharmacology, who has a particular interest in arrhythmias, particularly torsades de pointes.
- When I was in medical school and a resident in internal medicine, I considered transplant patients to be mysterious and magical. To be able to replace solid organs with those from a living donor or cadaver donor (deceased donor is the politically correct term today) seemed awesome. When I became a nephrologist and had the opportunity to work with the transplant team, I have to tell you that the magic did not dissipate. Transplantation is still awesome. We have come a long way since the first successful kidney transplant just over 50 years ago, but success creates its own problems, and many of those are addressed in this issue of Advances in Chronic Kidney Disease, which is devoted to chronic kidney disease in the transplant recipient.
- Welcome to the second year of Advances in Chronic Kidney Disease! The change in name has allowed us to broaden the scope of the journal and, we hope, has made it more relevant to your practice. We’ve made what we believe are a lot of positive changes for the journal in the past year, and have new things planned for 2005 as well: