This Month in AJKD

Article Outline

• Variation in Age at ESRD Onset in ADPKD
• Race, Sex, and Differences in Hypertension Control in CKD: Results From KEEP
• Mineralocorticoid Receptor Blockers in CKD
• Catheter Locking Solutions and Catheter-Related Infections in Hemodialysis

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Variation in Age at ESRD Onset in ADPKD 

See Reed et al, pages 173-183; Wang et al, pages 184-191; and Vora et al, pages 307-318.

In some families with autosomal dominant polycystic kidney disease (ADPKD), children reach end-stage renal disease (ESRD) at an earlier age than the parent. It is unclear whether this variation reflects the phenomenon of genetic anticipation (earlier onset and more severe disease in successive generations). In this issue, Reed et al analyze 413 families with ADPKD and find no difference in age at ESRD onset between parents and offspring after adjustment for correlations among family members and sex (HR, 1.02; 95% CI, 0.92-1.13; P = 0.7). They conclude that the observed variation in age at ESRD may result from other genetic or environmental causes. A related article by Wang et al looks at potential markers of oxidative stress in ADPKD, and a narrative review by Vora et al examines reproductive issues in ADPKD.

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Race, Sex, and Differences in Hypertension Control in CKD: Results From KEEP 

See Duru et al, pages 192-198.

African American men with chronic kidney disease (CKD) progress to end-stage renal disease more quickly than African American women or whites; blood pressure control may have a role in this difference. In this issue, Duru et al examine hypertension control in 10,827 individuals with CKD and self-reported hypertension who were screened in the Kidney Early Evaluation Program (KEEP). They find that of those with CKD stages 1-2, African American women, white men, and white women all had greater odds of hypertension control (defined as blood pressure < 130/80 mm Hg) than African American men. In those with CKD stages 3 to 5, both white men and women had greater odds of hypertension control than African American men. The authors conclude that hypertension control is worse in African American men and speculate that intensive treating of hypertension in African American men might help to narrow the race and sex disparities in progression to end-stage renal disease.

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Mineralocorticoid Receptor Blockers in CKD 

See Bomback et al, pages 199-211.

The use of mineralocorticoid receptor blockers (MRBs) in CKD is becoming more widespread, but little is known about their efficacy in reducing proteinuria. In this issue, Bomback et al perform a systematic review of studies which added MRBs to angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers in adult patients with CKD and proteinuria. The primary outcome was change in proteinuria and secondary outcomes included rate of hyperkalemia, change of blood pressure, and change in glomerular filtration rate. They found that when MRBs were added, proteinuria decreased by 15% to 54%, with most estimates in the 30% to 40% range. In addition, incidence of hyperkalemia and impaired kidney function were not significantly increased with MRBs.

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• From The Merck Manual of Medical Information – Second Home Edition, p. 133, edited by Mark H. Beers. Copyright 2003 by Merck & Co., Inc., Whitehouse Station, NJ. Available at: http://www.merck.com/mmhe. Accessed 12/12/2007.

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Catheter Locking Solutions and Catheter-Related Infections in Hemodialysis 

See Jaffer et al, pages 233-241; and Allon, pages 165-168.

Catheter-related infections are a major complication of the long-term use of venous catheters in hemodialysis patients, yet it is unclear whether there is an optimal strategy for preventing these infections. In this issue, Jaffer et al examine 7 clinical trials (comprising 624 patients) which compared the efficacy of antimicrobial locking solutions to heparin locking solutions in preventing catheter-related infections over a maximum follow-up of 12 months. They find that the incidence of catheter-related infections was 7.72 times lower with antimicrobial locking solutions (95% CI, 5.11-10.33), and that there was no evidence of increased antibiotic resistance. In an accompanying editorial, Dr Allon comments on the findings of their meta-analysis and discusses why antimicrobial locking solutions are not more frequently used, given the convincing data in their favor. He cites concerns about the potential for increased antibiotic resistance over a longer period of use, the issue of who would pay for the treatments, potential toxicity, and lack of US Food and Drug Administration approval.

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