American journal of kidney diseases [journal]
- Cancer and Mortality in Solid-Organ Transplantation: Preventable or Inevitable? [EDITORIAL]
- Am J Kidney Dis 2016 Jul 9.
- Pregnancy in Women With CKD: A Success Story. [JOURNAL ARTICLE]
- Am J Kidney Dis 2016 Jun 25.
In women with chronic kidney disease (CKD), pregnancy outcomes have improved over the last 50 years, particularly in the developed world. Maternal mortality is now extremely low, fetal survival has markedly increased (even in women with CKD stages 4-5), and it is now the exception for women with CKD to be advised against embarking on a pregnancy. However, pregnancies are rarely free from complications, and there are unanswered questions about the longer term effects on maternal and infant health. The developments have led to a more optimistic attitude to pregnancy in women with CKD not requiring renal replacement treatment. The remaining problems are described in this World Kidney Forum.
- Vitamin E-Coated and Heparin-Coated Dialyzer Membranes for Heparin-Free Hemodialysis: A Multicenter, Randomized, Crossover Trial. [JOURNAL ARTICLE]
- Am J Kidney Dis 2016 Jun 23.
Hemodialysis requires effective anticoagulation to avoid blood circuit clotting. In patients at high risk for bleeding, several alternative methods have been developed.Multicenter, prospective, randomized, crossover study evaluating the noninferiority of vitamin E-coated compared with heparin-coated dialyzers in a 4-hour heparin-free hemodialysis strategy.32 adult long-term hemodialysis patients from 2 French hemodialysis units with well-functioning fistulas or double-lumen catheters.Patients were randomly allocated to a first period using either vitamin E- or heparin-coated dialyzers. After a washout period of 2 hemodialysis sessions, each patient was switched to the alternative dialyzer for a second period. Each study period started with 2 hemodialysis sessions with reduced heparin dose (50% and 25% of usual heparin dose, respectively, for sessions 1 and 2) followed by 2 heparin-free sessions.The primary end point was the percentage of successful study periods, defined as no circuit-clotting event leading to premature interruption of any of the 4 dialysis sessions. Secondary end points included total number and cumulative duration of hemodialysis sessions without clotting, number of saline solution flushes, dialysis circuit bubble trap status and dialyzer membrane status by visual inspection, and dialysis adequacy.The percentage of success with vitamin E-coated dialyzers (25/32 study periods [78%]) was not inferior to that with heparin-coated dialyzers (26/32 study periods [81%]). Visual inspection showed equal numbers of clean dialysis circuit bubble traps (vitamin E-coated, 34/121; heparin-coated, 32/120), whereas clean fiber bundles were more frequently noted with the vitamin E-coated compared with heparin-coated dialyzers (25/121 vs 2/120; P=0.002).Results may not extrapolate to critically ill patients. Differences in dialyzer transparency may account for visual inspection scores.The success rate of 4-hour heparin-free hemodialysis sessions is lower than that previously claimed in uncontrolled studies. Vitamin E-coated and heparin-coated dialyzers exposed patients to similar and unacceptable high failure rates. Further studies are required to improve heparin-free hemodialysis.
- AJKD Atlas of Renal Pathology: Karyomegalic Nephropathy. [Journal Article]
- Am J Kidney Dis 2016 Jul; 68(1):e7.
- AJKD Atlas of Renal Pathology: Sarcoidosis. [Journal Article]
- Am J Kidney Dis 2016 Jul; 68(1):e5-6.
- AJKD Atlas of Renal Pathology: Sickle Cell Nephropathy. [Journal Article]
- Am J Kidney Dis 2016 Jul; 68(1):e1-3.
- Quiz Page July 2016: Hyponatremia in a Patient With Central Nervous System Lymphoma. [Journal Article]
- Am J Kidney Dis 2016 Jul; 68(1):A17-9.
- Planning Dialysis Care: You Might Be "Surprised". [Editorial]
- Am J Kidney Dis 2016 Jul; 68(1):8-10.
- Telehealth in Nephrology Care-Promises and Challenges. [Editorial]
- Am J Kidney Dis 2016 Jul; 68(1):5-7.
- The Global Promise of Healthy Lifestyle and Social Connections for Better Health in People With Diabetes. [Editorial]
- Am J Kidney Dis 2016 Jul; 68(1):1-4.