This Month in AJKD

Article Outline

• Epoetin Dosing in Dialysis Facilities: The Authors Respond
• Kidney Function After Premature Birth and Intrauterine Growth Restriction
• Predicting Kidney Failure and Mortality in CKD
• RCT of Resistance Training to Target Muscle Wasting in Hemodialysis Patients

Back to Article Outline

Epoetin Dosing in Dialysis Facilities: The Authors Respond 

See Thamer et al, pages 538-541.

The September issue of AJKD featured a collection of editorials discussing the recent article by Thamer et al, “Dialysis Facility Ownership and Epoetin Dosing in Patients Receiving Hemodialysis” from the April 2007 issue of Journal of the American Medical Association. The editorials came from multiple perspectives in anemia care in hemodialysis, including those of a US physician, a physician in the United Kingdom practicing in a setting of capitation, medical economists, and medical officers of a large for-profit dialysis provider. In this issue, Thamer et al respond to each editorial, highlighting areas of controversy and identifying goals for new research. In particular, the authors challenge the arguments of Lazarus and Hakim regarding the role of financial incentives in epoetin dosing at for-profit providers. The authors also recognize the continuing controversy regarding optimal hemoglobin levels, and conclude by echoing the editorialists’ call for more research to optimize anemia management and improve reimbursement policy. Readers are invited to submit alternative viewpoints as Letters to the Editor.

• 
  • View Large Image
  • Download to PowerPoint

Back to Article Outline

Kidney Function After Premature Birth and Intrauterine Growth Restriction 

See Keijzer-Veen et al, pages 542-551; and Hughson, pages 531-534.

It has been hypothesized that preterm birth in combination with intrauterine growth restriction contributes to decreased kidney function at young adult age, but few studies to date have substantiated this hypothesis. In this issue, Keijzer-Veen et al recruited 52 individuals at 20 years of age who were born prematurely (gestational age < 32 weeks; 23 small for gestational age [SGA] and 29 appropriate for gestational age [AGA]) and 30 controls (gestational age 37-42 weeks). They compared basal and stimulated glomerular filtration rate (GFR), measures of kidney size, and urinary albumin. Height, weight, kidney length and volume, and GFR were lower in the SGA group than in either the AGA or control group. After adjustment for body surface area, GFR did not differ significantly among groups, either before or after stimulation. Microalbuminuria was present in 2 (8.7%) of the SGA group, but in none of the AGA group or controls. The authors conclude that the findings do not fully support the hypothesis, but that larger studies are needed for more definitive evaluation. An editorial by Dr Hughson further examines the findings in this and other studies on the relationship between low birth weight and kidney function.

• 
  • View Large Image
  • Download to PowerPoint

Back to Article Outline

Predicting Kidney Failure and Mortality in CKD 

See Johnson et al, pages 559-565.

Prognostic risk scores that predict the risk of progression from early stages of chronic kidney disease (CKD) to kidney failure or death may allow health providers to intervene more effectively to reduce risk. In this issue, Johnson et al report a retrospective cohort study of 6,500 members of the Kaiser Permanente Northwest health network with CKD. Mortality was 7 times higher than treated kidney failure (11.4 deaths versus 1.6 cases of initiation of dialysis or transplantation per 100 person-years). They found that 6 characteristics all predicted treated kidney failure: age, sex, estimated glomerular filtration rate, diabetes, hypertension, and anemia (c statistic, 0.91). The same characteristics predicted mortality and the composite endpoint, but hypertension and age predicted in the opposite direction, and predictions were less accurate (c statistic 0.70 and 0.71, respectively). Johnson et al conclude that predicting kidney failure and mortality require separate risk scores.

• 
  • View Large Image
  • Download to PowerPoint

Back to Article Outline

RCT of Resistance Training to Target Muscle Wasting in Hemodialysis Patients 

See Cheema et al, pages 574-584.

Skeletal muscle wasting is common in kidney failure, and may be associated with mortality. Yet little is known about the potential effectiveness of interventions designed to prevent muscle wasting. Cheema et al previously reported a randomized trial in hemodialysis patients comparing 12 weeks of high-intensity intradialytic progressive resistance training (PRT) to a control group without PRT. They noted no significant difference in thigh muscle cross-sectional area but improved intramuscular lipid content in the PRT group. In this issue, the authors report the effects of an additional 12 weeks of PRT in each group. The group receiving 24 weeks of PRT had further improvement in muscle strength, measures of exercise capacity, and muscle area; however, there were no significant differences in muscle area or intramuscular lipid content between groups. The authors concluded that a 24-week course of intradialytic PRT in hemodialysis patients did not significantly improve these measures of muscle composition compared to a 12-week course, but more study is necessary to understand the clinical importance and magnitude of muscle adaptations to PRT.

• 
  • View Large Image
  • Download to PowerPoint