This Month in AJKD

Article Outline

• World Kidney Day: March 8, 2007
• Pioneers in Dialysis Treatment
• Prevention of S. aureus Catheter-Related Bacteremia With Aspirin
• Coronary Arteriographic Findings as Mortality Predictors in Dialysis

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World Kidney Day: March 8, 2007 

See Couser and Shah, pages 349-351.

On March 8, 2007, countries worldwide will observe World Kidney Day to spread the crucial message that kidney disease is common, harmful and treatable. Last month’s issue included an editorial from US kidney societies. In this issue, a joint editorial from the International Society of Nephrology (ISN) and International Federation of Kidney Foundations (IFKF) adds international voices to the call for action. The editorial emphasizes that kidney disease has worldwide impact, serious health consequences, and great potential for treatment. In addition, it stresses the importance of early detection and prevention programs, and the major impact on global public health that education and such programs could bring.

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Pioneers in Dialysis Treatment 

See Blagg, pages 482-496, and Kurkus et al, pages 471-476.

In the decades since hemodialysis was first used, dramatic advances have been made in the understanding and treatment of chronic kidney disease. In this issue, two articles describe the unique challenges faced by early pioneers in dialysis treatment. In AJKD’s inaugural World Kidney Forum, Dr. Christopher Blagg chronicles the early history of dialysis in the United States, focusing on the work of Belding Scribner and others in Seattle, Washington. His account provides a fascinating look at the technical advances in dialysis, as well as the political aspects of dialysis treatment and transplantation. Kurkus et al provide a tribute to another dialysis pioneer, Swedish nephrologist Nils Alwall. They describe two patients whom Alwall initiated on hemodialysis, both of whom have survived for over 35 years, and whose experiences have contributed to the gradual discovery of dialysis-related clinical complications.

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Prevention of S. aureus Catheter-Related Bacteremia With Aspirin 

See Sedlacek et al, pages 401-408.

Hemodialysis patients with tunneled catheters are at increased risk for Staphylococcus aureus bacteremia, and both in vitro and in vivo studies have shown that aspirin has direct antistaphylococcal effects. In this issue, Sedlacek et al retrospectively analyze 4,722 blood cultures of 872 patients (representing over 476 patient-catheter years). They find a lower rate of catheter-associated S. aureus bacteremia in patients treated with aspirin versus non-aspirin treated patients (0.17 v 0.34 events per patient-catheter year, p=0.003), while no such difference was observed for other bacteria. In addition, the authors find that the risk of developing a first episode of S. aureus bacteremia was reduced by 54% in patients taking aspirin.

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• Photo credit: Janice Carr (c) 2005

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Coronary Arteriographic Findings as Mortality Predictors in Dialysis 

See Charytan et al, pages 409 -416.

In order to identify which long-term dialysis patients have a high risk of cardiovascular disease, better information is needed about the distribution of coronary artery disease and the relationship between lesion location and mortality. In this issue, Charytan et al evaluate results of coronary arteriography performed in asymptomatic hemodialysis patients. Among 67 individuals, 41% had obstructive coronary artery disease and more than 28% had lesions in proximal segments. In addition, after a median follow-up of 2.7 years, the presence of proximal coronary artery disease was associated with a three-fold higher risk of death (p=0.008). Based on these findings, the authors suggest that the presence or absence of proximal coronary artery disease can be used to improve risk stratification in long-term hemodialysis patients, and question whether an increased use of coronary angiography in these patients may be warranted.

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