This Month in AJKD

Article Outline

• Quality Improvement Report: Rehabilitation for Older Hemodialysis Patients
• Review of CKD-Associated Pruritus
• Leukoaraiosis in Peritoneal Dialysis Patients
• Successful Reuse of a Transplanted Kidney
• Copyright

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Quality Improvement Report: Rehabilitation for Older Hemodialysis Patients 

See Uhlig and Levey, pages 5-7 and Li et al, pages 90-97.

AJKD is pleased to announce a new category of original investigations: reports on quality improvement activities. This new article type provides a forum to discuss how to improve care for patients with kidney diseases and related conditions, a vital activity for all in the health care profession. In this issue, an editorial by Uhlig and Levey describes the scope and editorial plan for quality improvement reports and details the guidelines for reporting and evaluation. The inaugural article by Li et al reports on the first 3 years of an innovative inpatient geriatric hemodialysis rehabilitation unit in Toronto with on-site dialysis. One novel element of this rehabilitation unit is provision of short daily hemodialysis, allowing patients to engage in daily physical and occupational therapy without the fatigue and time commitment that typically accompanies thrice weekly hemodialysis. The authors found that 82% of patients completing the therapy met some or all of their rehabilitation goals, and suggest that integrated dialysis rehabilitation can decrease health care utilization and long-term institutionalization for elderly dialysis patients with new-onset functional decline.

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Review of CKD-Associated Pruritus 

See Patel et al, pages 11-20.

Pruritus is a common symptom of chronic kidney disease (CKD). Despite improvements in dialysis methods, CKD-associated pruritus (also known as CKD itch) continues to have a profound impact on quality of life in patients with already compromised lifestyles. The pathophysiology of CKD-associated pruritus is not fully understood, and no specific therapy exists for it. In this issue, Patel et al highlight the importance of this topic through a narrative review of recent epidemiological studies, outcomes data, proposed pathophysiologic mechanisms, and emerging treatment options. They stress the recent evidence pointing to poor patient outcome in patients with pruritus and CKD, and conclude that this symptom warrants consideration by nephrologists.

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Leukoaraiosis in Peritoneal Dialysis Patients 

See Kim et al, pages 98-107, and Seliger and Sarnak, pages 8-10.

Patients with chronic kidney disease have an increased risk of cerebrovascular disease compared to the general population. One manifestation of cerebrovascular disease is leukoaraiosis, an abnormal appearance of subcortical white matter of the brain on neuroimaging. While a high prevalence of leukoaraiosis has been shown in patients with kidney failure treated by hemodialysis and in patients with earlier stages of chronic kidney disease, the prevalence in patients on peritoneal dialysis is not known. In this issue, Kim et al evaluated the presence of leukoaraiosis in 57 nondiabetic peritoneal dialysis patients without known cerebrovascular disease and 57 hypertensive controls with normal kidney function. The prevalence of leukoaraiosis was significantly higher in the peritoneal dialysis patients as compared to controls (68.4% versus 17.5%, P<0.001). In addition, kidney failure, increased age, and poor control of blood pressure were all significant independent predictors of leukoaraiosis. An accompanying editorial by Seliger and Sarnak provides a wider context for the findings and discusses the importance of recognizing silent ischemic brain disease in this population.

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Successful Reuse of a Transplanted Kidney 

See Celik et al, pages 143-145.

The waiting list for kidney transplants is continually growing, as the number of new transplantations has not kept pace with the increasing number of patients requiring a transplant. New strategies are being considered to alleviate the shortage, including the use of previously transplanted kidneys. Yet little data are available for the long-term follow-up of such transplants. In this issue, Celik et al report the reuse of a transplanted kidney and a successful 3-year follow-up. After the death of the first donor (a 41-year-old man), his kidney was transplanted into a 50-year-old man with end-stage renal disease, who survived 6 years with a well-functioning graft before dying of a brain hemorrhage. The same kidney was then transplanted into a second recipient, a 27-year-old man, and after 3 years the kidney is still functioning well. The authors suggest that the reuse of kidney allografts should be considered as one way to increase available kidneys for transplant.

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• Reproduced from the 2003 OPTN/SRTR Annual Report, Table 5.1.