This Month in AJKD
Article Outline
- US and Canadian Commentaries on the KDIGO Kidney Transplant Guidelines
- The Role of Uric Acid in Kidney Function and Cardiovascular Disease
- The Zuni Kidney Project
- Association Between Obesity and Glomerular Hyperfiltration
US and Canadian Commentaries on the KDIGO Kidney Transplant Guidelines
See Bia et al, pages 189-218; and Knoll et al, pages 219-246.
In November 2009, KDIGO (Kidney Disease: Improving Global Outcomes) published guidelines for the management of care of kidney transplant recipients. In this issue, 2 articles comment on the relevance and applicability of these guidelines to local transplant practices. Both commentaries express broad general agreement with the KDIGO recommendations. Bia et al, writing from a US perspective on behalf of KDOQI (Kidney Disease Outcomes Quality Initiative), specifically caution against use of these guidelines as a basis for policy or performance measures, reflecting the paucity of high-level evidence. Knoll et al, writing on behalf of the Canadian Society of Transplantation and the Canadian Society of Nephrology, illustrate key differences between current Canadian practices and several of the KDIGO guidelines, emphasizing the role of the KDIGO guideline in highlighting the tenuous body of evidence that informs management of kidney transplant recipients.
The Role of Uric Acid in Kidney Function and Cardiovascular Disease
See Bellomo et al, pages 264-272; Wen et al, pages 273-288; and Tangri & Weiner, pages 247-250.
In this issue, 2 articles promote the hypotheses that uric acid may directly affect both kidney function and cardiovascular disease. In the first study, Bellomo et al quantify the association between uric acid and change in estimated GFR in 900 apparently healthy normotensive adult blood donors in Italy. They demonstrated an association between higher uric acid levels and subsequent worsening kidney function, suggesting that higher uric acid levels may lead to a progressive decline in kidney function in these individuals. In the second study, Wen et al evaluate 484,568 individuals in Taiwan and describe an independent association between higher serum uric acid level and both all-cause and cardiovascular disease mortality; this association persisted even in individuals at very low cardiovascular risk. In an editorial, Drs Tangri and Weiner stress that large randomized trials are needed to determine whether therapy for asymptomatic hyperuricemia may play a role in preventing subsequent cardiovascular disease and kidney disease.
The Zuni Kidney Project
See MacCluer et al, pages 289-302; and Rao et al, pages 251-254.
Zuni Indians suffer epidemic rates of CKD, with the prevalence of kidney failure treated by dialysis or transplantation ranging between 5-20 times higher than other demographic groups. In this issue, MacCluer and colleagues describe their experience assessing heritable complex traits in 821 Zuni Indians participating in the Zuni Kidney Project, with 805 belonging to a single family. The prevalence of kidney disease and cardiovascular risk factors was considerable; kidney disease was identified in 23%, diabetes in 17%, hypertension in 35%, and overweight or obesity in over 60% of the participants. There was significant heritability for estimated GFR, urine albumin-creatinine ratio, serum creatinine, serum urea nitrogen, and uric acid, and a variety of phenotypes related to obesity, diabetes, and cardiovascular disease. In an editorial, Rao and colleagues commend MacCluer et al for their family-based genetic study, which they stress is an important first step in profiling the genetic landscape of a complex trait.
Association Between Obesity and Glomerular Hyperfiltration
See Wuerzner et al, pages 303-312; and Kramer & Levey, pages 255-258.
Obesity and African American ethnicity are established risk factors for the development of CKD; however, few data exist about the association between obesity and kidney function in the Africa region, where environmental factors differ from those in the United States. In this issue, Wuerzner et al performed detailed physiologic evaluations of 301 nondiabetic adults of African ancestry from 66 families living in Seychelles. The prevalence of glomerular hyperfiltration, assessed by inulin clearance, was 3-fold higher among obese participants (body mass index [BMI] ≫30 kg/m2) than lean participants (BMI <25 kg/m2). Higher BMI was also associated with higher effective renal plasma flow, assessed by p-aminohippuric acid clearance. However, following adjustment for body surface area, no association was found between BMI categories and GFR. In an editorial, Drs Levey and Kramer address the clinical and research implications of 3 issues: the origin of body surface area correction for GFR and appropriate uses and misuses, the paucity of data on measured GFR in representative populations, and the implications of hyperfiltration as a risk factor for CKD.
PII: S0272-6386(10)00973-X
doi:10.1053/S0272-6386(10)00973-X
