- As nephrologists taking care of patients with end-stage renal disease (ESRD), we tend to concentrate on calculating KT/V, decreasing mortality, the appropriate level of hemoglobin, and the calcium phosphorous product. The “softer” side of dialysis gets short shrift (ie, the patient’s quality of life and psychosocial situation, the patient’s environment [is their home accessible if they are disabled, do they have adequate food, is their home clean, do they have or need a caregiver, is their home safe?], the patient’s support system, and transportation issues).
- Because I have spent most of my career in the Veterans Administration, although always in association with one or more academic affiliates, one might think that I would not have much experience with pregnant transplant and chronic kidney (CKD) disease patients. However, the first few years that I was at the St. Louis Veterans Administration Hospital, the St. Louis University Transplant Program was based at the VA Hospital, and we transplanted nonveterans as well as veterans. In addition, for a number of years I attended as a nephrologist at St.
- The news is almost impossible to avoid: whether in the medical literature, the “throw away” journals, the lay press, popular magazines, or on the Internet—obesity, particularly among Americans, has become an epidemic. “Pudginess is no longer a plague of just the poor. Obesity is growing fastest among Americans who make $60,000 or more.”1
- It has been recognized for many years that patients with chronic kidney disease (CKD) have abnormalities of immune function1 that make this population more susceptible to infection. The altered immune status of uremia includes impaired cell-mediated2 and humoral3 immunity, absolute lymphopenia4-6 with a decrease in circulating T and B lymphocytes,7 cutaneous anergy,8 impaired phagocytosis,9 delayed graft rejection,10 altered response to infection,11 and an increased incidence of malignancy.12 More recently, inflammation has been recognized to be implicated in the development of atherosclerosis and cardiovascular disease,13,14 and it is clear that poor outcomes in CKD patients are because, in large part, of the increased incidence of cardiovascular disease.
- “Children are not little adults.” I remember hearing that mantra throughout my medical school education and residency training. Children react differently to medication, the environment, and disease; they are more vulnerable to small changes in the physiologic milieu. I love children—I have four of my own—but as a physician for adults, I have to say they frighten me. During a short period, early in my academic career, I made a decision to share call with the two pediatric nephrologists on staff (who were, and still are, married to each other).
- Dr. Eknoyan has assembled a unique and important set of papers for this issue centered on the theme of Complementary and Alternative Medicine (CAM). Practitioners of conventional medicine tend to ignore complementary and alternative medicine, yet surveys show that almost two-thirds of our patients in the United States use CAM, whether it be acupuncture, spiritual healing, dietary supplements, herbals, or over the counter vitamins and minerals.1 Worldwide the percentage of people who use some form of CAM is greater than 80 percent.
- It is impossible to be a nephrologist and not take care of large numbers of patients with type 1 and type 2 diabetes mellitus. It is the most common cause of end-stage renal disease; patients with diabetes comprise a large proportion of patients in the general nephrology practice. With increasing rates of childhood obesity, we are seeing type 2 diabetes in children as well, and it is likely we will be seeing younger diabetics with significant diabetic nephropathy. The current issue on Diabetic Kidney Disease by Dan Batlle, Mark Williams and Janet McGill is, therefore, very timely and important.
- This issue concludes the first year of the new Advances in Chronic Kidney Disease. There have been a number of changes this year: