Kidney Pathological Changes in Metabolic Syndrome: A Cross-sectional Study
, 02 April 2009
Mariam P. Alexander, Tejas V. Patel, Youssef M.K. Farag, Adriana Florez, Helmut G. Rennke, Ajay K. Singh
American Journal of Kidney Diseases
May 2009 (Vol. 53, Issue 5, Pages 751-759) Abstract |
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Kidney Damage in Metabolic Syndrome: Nip It in the Bud
Eberhard Ritz
American Journal of Kidney Diseases
May 2009 (Vol. 53, Issue 5, Pages 726-729) Full Text |
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Health Literacy and Kidney Disease: Toward a New Line of Research
, 27 March 2009
Radhika Devraj, Elisa J. Gordon
American Journal of Kidney Diseases
May 2009 (Vol. 53, Issue 5, Pages 884-889) Abstract |
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Focusing on Health Literacy Might Help Us Cross the Quality Chasm
Bryan N. Becker
American Journal of Kidney Diseases
May 2009 (Vol. 53, Issue 5, Pages 730-732) Full Text |
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Focused Atorvastatin Therapy in Managed-Care Patients With Coronary Heart Disease and CKD
, 12 February 2009
Michael J. Koren, Michael H. Davidson, Daniel J. Wilson, Rana S. Fayyad, Andrea Zuckerman, David P. Reed, ALLIANCE Investigators
American Journal of Kidney Diseases
May 2009 (Vol. 53, Issue 5, Pages 741-750) Abstract |
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Statin Effects in CKD: Is There a “Point of No Return”?
Christoph Wanner
American Journal of Kidney Diseases
May 2009 (Vol. 53, Issue 5, Pages 723-725) Full Text |
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Conversion of Vascular Access Type Among Incident Hemodialysis Patients: Description and Association With Mortality
, 06 March 2009
Brian D. Bradbury, Fangfei Chen, Anna Furniss, Ronald L. Pisoni, Marcia Keen, Donna Mapes, Mahesh Krishnan
American Journal of Kidney Diseases
May 2009 (Vol. 53, Issue 5, Pages 804-814) Abstract |
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See Alexander et al, pages 751-759; and Ritz, pages 726-729.
Metabolic syndrome is associated with CKD, but renal pathological findings in patients with metabolic syndrome have not been well described. In this issue, Alexander et al retrospectively screened clinical information for 146 patients who underwent elective nephrectomy for renal cell carcinoma between January 2005 and March 2007 at Brigham and Women's Hospital (Boston, MA). To assess histological characteristics, 2 pathologists blinded to the clinical diagnosis compared nephrectomy specimens from patients with metabolic syndrome (n = 12) with specimens from age- and sex-matched controls who did not have any of the criteria for metabolic syndrome (n = 12). Patients with metabolic syndrome compared with controls had a greater prevalence of tubular atrophy, interstitial fibrosis, and arterial sclerosis, suggesting microvascular disease. Patients with metabolic syndrome had greater global and segmental glomerulosclerosis. One year after nephrectomy, estimated GFR was significantly lower in patients with metabolic syndrome compared with controls. An editorial by Dr Ritz commends Alexander et al on their study, noting the importance of examining the earliest pathological changes in metabolic syndrome to better understand the underlying pathophysiology and to devise targeted interventions.
See Devraj and Gordon, pages 884-889; and Becker, pages 730-732.
Low health literacy is a widespread problem in the general population, affecting over 90 million Americans. A growing body of research has demonstrated the association between low health literacy and worse health outcomes in a variety of chronic conditions. Despite the increasing prevalence of CKD and the considerable interest in health literacy, there has been limited research examining the role of health literacy in individuals at all stages of CKD. In this issue, Devraj and Gordon examine the role of health literacy in kidney disease by reviewing early research on the topic, providing a conceptual model of the relationship between health literacy and health outcomes, and highlighting potential areas for future research on health literacy in CKD. An editorial by Dr Becker reviews the 6 aims of optimal healthcare identified by the Institute of Medicine: healthcare should be safe, effective, patient-centered, timely, efficient, and equitable. He supports Devraj and Gordon's approach to health literacy and suggests that research on health literacy will likely add to our scientific literature, expand our ways of caring for patients, and move towards improving quality of care.
Statin Therapy in Patients With Coronary Heart Disease and CKD
See Koren et al, pages 741-750; and Wanner, pages 723-725.
Recent clinical evidence has suggested that statin therapy may be effective in slowing progression of CKD. In this issue, a post-hoc analysis of the Aggressive Lipid-Lowering Initiation Abates New Cardiac Events (ALLIANCE) Study investigates the effect of focused atorvastatin therapy versus usual care on cardiovascular outcomes in patients with coronary heart disease (CHD) according to baseline estimated GFR (N = 2,442; mean age 61.6 years). Koren et al administered atorvastatin therapy to reach a low-density lipoprotein cholesterol goal of less than 80 mg/dL or maximum dose of 80 mg/d versus usual care. At baseline, 579 patients (23.7%) had estimated GFR less than 60 mL/min/1.73 m2. Mean estimated GFR in this group was 51 mL/min/1.73 m2. Among these patients, 31.6% experienced a primary cardiovascular event during the study versus 23.6% of patients without CKD. Compared with usual care, atorvastatin therapy reduced the relative risk of a primary outcome by 28% in patients with estimated GFR less than 60 mL/min/1.73 m2 and 11% in patients with estimated GFR 60 mL/min/1.73 m2 or greater (P = 0.2), leading the authors to conclude that atorvastatin was as effective in CKD as in those without CKD. An editorial by Dr Wanner stresses that while this study shows statin treatment to be safe and effective in patients with mean GFR around 50 mL/min/1.73 m2, relatively little is known about the efficacy of statins in patients with CKD stage 4, therefore future studies should address this population.
There are limited data describing the effect of converting to and from a catheter on subsequent mortality risk during the first year of hemodialysis treatment. In this issue, Bradbury et al studied a random sample of incident hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS) from 1996 to 2004 (N = 4,532). At dialysis initiation, 69.2% of patients used a catheter, 17.6% had an arteriovenous graft (AVG), and 13.1% had an arteriovenous fistula (AVF). In patients initiating therapy with an AVF or AVG, 22% experienced a vascular access conversion (failure of the AVF or AVG and new catheter requirement) over a median time of 2 to 3 months. In patients initiating with a catheter, 59% converted to an AVF or AVG (57% AVG, 43% AVF); median times to first conversion were 92 days for an AVF and 66 days for an AVG. Conversion to an AVF or an AVG was associated with an adjusted mortality hazard ratio of 0.69 (95% confidence interval, 0.55 to 0.85), with similar effects for each, while conversion from an AVF or AVG to a catheter was associated with an adjusted mortality hazard ratio of 1.81 (95% confidence interval, 1.22 to 2.68). Based on these results, Bradbury et al hypothesize that continued efforts to increase early nephrologist referral and permanent vascular access placement may help decrease mortality risk in incident dialysis patients.
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