Articles in PressThis Month in AJKD
Regional Citrate Anticoagulation
See Wu et al and Tolwani and Wille.Continuous renal replacement therapy is the preferred form of kidney replacement therapy when managing acute kidney injury in critically ill patients. While heparin is the most commonly prescribed anticoagulant, it carries significant drawbacks, such as increased risk of bleeding and heparin-induced thrombocytopenia. Of the many alternative therapies under consideration, regional citrate anticoagulation has garnered the most interest. Wu et al conducted a systematic review and meta-analysis of all randomized controlled trials comparing citrate to heparin in order to compare the efficacy and safety of regional citrate treatment to heparin anticoagulation, noting that citrate was associated with a significantly lower risk of bleeding complications while successfully maintaining circuit patency. In an accompanying editorial, Tolwani and Wille reflect on the limitations of the study before considering the crucial question of how to best apply these results to clinical practice.
Expanded-Criteria Donor Kidneys
See Molnar et al and Heldal and Midtvedt.Kidney transplant wait lists are growing longer and include more adults 65 years old and older every day. One approach to increasing the number of kidney transplants to patients on the waiting list is to expand the criteria for accepting kidneys from deceased donors. In this issue of AJKD, Molnar et al examine the outcomes of kidney transplantation using extended-criteria donor kidneys, focusing on older recipients. The authors found that extended-criteria donor kidneys transplanted from deceased donors to recipients older than 70 years are not associated with increased mortality or transplant failure. Heldal and Midtvedt's accompanying editorial explores how expanding the criteria for deceased donor kidneys could be an important tool to increase the donor pool for kidney transplant.
Racial Disparities in Living Donor Transplantation
See Hall et al and Reese et al.Disparity between African Americans and non–African Americans in access to living donor kidney transplantation (LDKT) persists. Hall et al describe and quantify center-level variation in the racial disparity of LDKT in a national cohort. The authors found that, while none of the 275 transplant centers in the US had racial parity, the amount of racial disparity varied greatly, and those centers with the highest rates of LDKT typically had less racial disparity in LDKT attainment. In their accompanying editorial, Reese et al find hope in this center-level variation, as it raises the possibility that center practices have a role in promoting LDKT for African American patients. The authors call on the nephrology community to take action to eliminate racial disparities while waiting for clinical trial results to guide us.
Bone Health in Kidney Donors
See Young et al and Garg et al.A number of complex biochemical changes in individuals with kidney disease have been implicated in a weakened skeleton. This month, AJKD features two articles that evaluate living kidney donation as a unique population to investigate the potential relationship between kidney function and bone health. In a cross-sectional study, Young et al found that the fibroblast growth factor 23 pathway may be activated in living kidney donors who show early biochemical changes compatible with chronic kidney disease–mineral and bone disorder. Reassuringly, Garg et al found no evidence of increased fragility fracture risk in living kidney donors. The authors consider these data to be an important reassurance for living kidney donors and their care providers that the practice is safe.
-
CKD–Mineral and Bone Disorder: Core Curriculum 2011December 2011 (Vol. 58 | No. 6 | Pages 1022-1036)
-
This Month in AJKDMarch 2012 (Vol. 59 | No. 3 | Pages A25-A26)
-
This Month in AJKDFebruary 2012 (Vol. 59 | No. 2 | Pages A27-A28)
-
New Anemia Therapies: Translating Novel Strategies From Bench to BedsideMarch 2012 (Vol. 59 | No. 3 | Pages 444-451)
-
Managing Older Adults With CKD: Individualized Versus Disease-Based ApproachesFebruary 2012 (Vol. 59 | No. 2 | Pages 293-302)
The "Most Read" list is updated quarterly and includes the most highly read articles for the three-month period.
