Nephrology

Though warfarin has long been the mainstay of anticoagulation in atrial fibrillation (AF), dosing is complicated by a host of factors, and the drug has a famously narrow therapeutic range. One way to fine-tune warfarin therapy is to account for genetic variation.

Anticoagulation is recommended for members of the general population with atrial fibrillation, but its significant risks must be weighed carefully in the medically fragile chronic kidney disease population.

Treatment of atrial fibrillation (AF) in patients with CKD may help prevent disease progression. Ablation has been shown produce marked improvement in kidney function as measured by eGFR. A prospective study of individuals undergoing catheter ablation for AF showed that most patients remained AF-free, and that eGFR improved significantly for those with persistent or longstanding persistent AF.

Secondary hyperparathyroidism can occur in CKD when the kidney loses its ability to produce active metabolites of vitamin D, and reduces phosphorus excretion. Cinacalcet seeks to interrupt the progression to severe unremitting hyperparathyroidism by mimicking calcium to the calcium-sensing receptors that control parathyroid hormone levels.

Physicians caring for individuals with chronic kidney disease (CKD) must strike a balance between ensuring optimal lipid control for protection from vascular events, while avoiding undue risk.

Despite achieving optimal goals for "bad" cholesterol levels, individuals with diabetes and chronic kidney disease still have an elevated risk of vascular complications.

Prompted by almost-epidemic rates of diabetes in the United States and globally, the American Diabetes Association recently convened a consensus panel to examine diabetic kidney disease, one of the most frequent complications associated with diabetes.

Researchers have developed a math model that can accurately predict the progression from nephritis to interstitial fibrosis in patients with systemic lupus erythematosus.

Despite these improvements in medical technology, diabetic nephropathy remains unpredictable and life-threatening. Identifying high-risk patients at an early stage could help clinicians take appropriate steps to reduce risk.

Clinicians must anticipate changes in kidney function during acute illness and surgical procedures, as well as frequently reassess metformin use in older patients, since kidney function declines predictably with age.

A new study urges primary care physicians to be more alert in identifying patients with underlying chronic kidney disease because they are more likely to have resistant hypertension.

Revising the definition of chronic kidney disease progression that is currently used in clinical trials could speed the development of new therapies.

Rheumatoid arthritis patients have a 1-in-4 chance of developing chronic kidney disease, according to research published in the American Journal of Kidney Disease.

Initial results from human clinical trials involving the use of bioengineered blood vessels could point the way to cost-effective alternative therapies for hemodialysis patients with end-stage renal disease.

Although they had more cardiovascular comorbidities, patients with atrial fibrillation and diabetes experienced rates of ischemic stroke comparable to those in AF patients without diabetes.

Study results show hyponatremia is closely associated with all-cause mortality in patients with chronic kidney disease (CKD), but few previous studies have examined this relationship.

Though patients with chronic kidney disease (CKD) have variable risks of death, the population risk prediction tools that are currently available perform poorly.

Patients who have chronic kidney disease (CKD) and end-stage renal disease (ESRD) require 20% less warfarin and more monitoring for bleeding than patients who have normal kidney function.

A recent study presented at Kidney Week 2013 suggests that a plain X-ray is a reliable and inexpensive tool for assessing the risks of cardiovascular events and death in patients who have chronic kidney disease (CKD) and are not on dialysis.

Early diagnosis by primary care physicians and aggressive treatment are essential to slowing the epidemic of kidney and cardiovascular disease.

Many young adults age 18-24 with high blood pressure remain undiagnosed with hypertension, even after long-term physician care.

Randomized controlled trials remain the gold standard, but a researcher at Kidney Week 2012 says that new approaches and study designs are needed that reflect real-world drug use and account for confounding variables.

Results from the TEMPO trial presented at Kidney Week 2012 show that treatment with tolvaptan slowed the increase in total kidney volume and the decline in kidney function in patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD).

Increasing numbers of people are on kidney transplant waiting lists. However, the number of potential living donors may shrink as more Americans qualify as pre-diabetic, making them less than ideal donor candidates.

Experts at Kidney Week 2012 discuss several treatment options for hyponatremia, including fluid restriction, loop diuretics, and the use of selective vasopressin V2-receptor antagonists.

A diet rich in highly alkaline fruits and vegetables helps reduce a marker of kidney injury and preserve kidney function in patients with chronic kidney disease.

The powerful immunosuppressive drugs used to prevent allograft rejection are associated with severe side effects. A "mixed chimerism" strategy in which patients undergo simultaneous bone marrow and kidney transplant from the same donor may improve transplant survival and reduce the need for these drugs.

Use of peritoneal dialysis in patients with end-stage renal disease is declining due to lack of physician training and awareness, financial disincentives, and other factors. However, with proper patient and provider education, it is possible to grow a successful peritoneal dialysis program.

Study results reported at Kidney Week 2012 reveal that patients with early-stage CKD fare better in the public health system, which also appears to produce fewer racial and ethnic health disparities in care delivered to this population.

People with chronic kidney disease, even those who have undergone a kidney transplant, can benefit from regular physical exercise.