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Adv Chronic Kidney Dis 2021 11;28(6):596-605

Department of Medicine, Division of Nephrology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA. Electronic address:

Diabetes mellitus (DM) is one of the most common complications after kidney transplantation and is associated with unfavorable outcomes including death. DM can be present before transplant but post-transplant DM (PTDM) refers to diabetes that is diagnosed after solid organ transplantation. Despite its high prevalence, optimal treatment to prevent complications of PTDM is unknown. Read More

Adv Chronic Kidney Dis 2021 11;28(6):587-595

Comprehensive Transplant Center, Cedars Sinai Medical Center, Los Angeles, CA.

Human leukocyte antigen (HLA)-incompatible kidney transplantation offers survival benefit compared with ongoing dialysis. There have been considerable advances in the last decade to allow for increased access to transplant for the HLA-sensitized kidney transplant candidates. These include increased priority in the kidney allocation system, kidney paired donation, and novel desensitization strategies. Read More

Adv Chronic Kidney Dis 2021 11;28(6):577-586

Division of Nephrology, Thomas Jefferson University-Sidney Kimmel College of Medicine, Philadelphia, PA. Electronic address:

Nonkidney solid organ transplants (NKSOTs) are increasing in the United States with improving long-term allograft and patient survival. CKD is prevalent in patients with NKSOT and is associated with increased morbidity and mortality especially in those who progress to end-stage kidney disease. Calcineurin inhibitor nephrotoxicity is a main contributor to CKD after NKSOT, but other factors in the pretransplant, peritransplant, and post-transplant period can predispose to progressive kidney dysfunction. Read More

Adv Chronic Kidney Dis 2021 11;28(6):570-576

Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC. Electronic address:

Young adult kidney transplant recipients experience poorer outcomes. Specifically worse allograft survival has been reported in the United States and worldwide. Pediatric to adult transition-related research has focused predominantly on medication nonadherence. Read More

Adv Chronic Kidney Dis 2021 11;28(6):561-569

Department of Medicine, Nephrology Division, University of Nebraska Medical Center, Omaha, NE.

The incidence of kidney dysfunction has increased in liver transplant and heart transplant candidates, reflecting a changing patient population and allocation policies that prioritize the most urgent candidates. A higher burden of pretransplant kidney dysfunction has resulted in a substantial rise in the utilization of multiorgan transplantation (MOT). Owing to a shortage of available deceased donor kidneys, the increased use of MOT has the potential to disadvantage kidney-alone transplant candidates, as current allocation policies generally provide priority for MOT candidates above all kidney-alone transplant candidates. Read More

Adv Chronic Kidney Dis 2021 11;28(6):548-560

Department of Pathology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.

Transplantation remains the optimal mode of kidney replacement therapy, but unfortunately long-term graft survival after 1 year remains suboptimal. The main mechanism of chronic allograft injury is alloimmune, and current clinical monitoring of kidney transplants includes measuring serum creatinine, proteinuria, and immunosuppressive drug levels. The most important biomarker routinely monitored is human leukocyte antigen (HLA) donor-specific antibodies (DSAs) with the frequency based on underlying immunologic risk. Read More

Adv Chronic Kidney Dis 2021 11;28(6):542-547

Department of Medicine, Thomas Jefferson University, Philadelphia, PA.

Access to transplant centers is a key barrier for kidney transplant evaluation and follow-up care for both the recipient and donor. Potential kidney transplant recipients and living kidney donors may face geographic, financial, and logistical challenges in engaging with a transplant center and maintaining post-transplant continuity of care. Telemedicine via synchronous video visits has the potential to overcome the access barrier to transplant centers. Read More

Adv Chronic Kidney Dis 2021 11;28(6):528-541

Department of Medicine, Drexel University College of Medicine, Philadelphia, PA; Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA; Tower Health Transplant Institute, Tower Health System, West Reading, PA. Electronic address:

In this review, we discuss the increasing prevalence of obesity among people with chronic and end-stage kidney disease (ESKD) and implications for kidney transplant (KT) candidate selection and management. Although people with obesity and ESKD receive survival and quality-of-life benefits from KT, most KT programs maintain strict body mass index (BMI) cutoffs to determine transplant eligibility. However, BMI does not distinguish between visceral adiposity, which confers higher cardiovascular risks and risks of perioperative and adverse posttransplant outcomes, and muscle mass, which is protective in ESKD. Read More

Adv Chronic Kidney Dis 2021 11;28(6):517-527

Center for Community and Population Health Improvement, Clinical and Translational Science Institute, Duke University School of Medicine, Durham, NC; Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC.

Stark racial disparities in access to and receipt of kidney transplantation, especially living donor and pre-emptive transplantation, have persisted despite decades of investigation and intervention. The causes of these disparities are complex, are inter-related, and result from a cascade of structural barriers to transplantation which disproportionately impact minoritized individuals and communities. Structural barriers contributing to racial transplant inequities have been acknowledged but are often not fully explored with regard to transplant equity. Read More

Adv Chronic Kidney Dis 2021 11;28(6):511-516

Department of Surgery, Thomas Jefferson University, Philadelphia, PA. Electronic address:

Despite an increase in the number of kidney transplants performed annually, there remain more than 90,000 individuals awaiting transplantation in the United States. As kidney transplantation has evolved, so has kidney allocation policies. The Kidney Allocation System, which was introduced in 2014, made significant strides to improve utility and equity, but regional and geographic disparities remain. Read More

Adv Chronic Kidney Dis 2021 11;28(6):509-510

Department of Medicine, Division of Nephrology, Thomas Jefferson University-Sidney Kimmel College of Medicine, Philadelphia, PA.

Adv Chronic Kidney Dis 2021 09;28(5):502-508.e1

Department of Medicine, Renal Service, Memorial Sloan Kettering Cancer Center, New York, NY.

The incidence of cancer is higher in patients with end-stage kidney disease (ESKD) than among the general population. Despite this, screening for cancer is generally not cost-effective and may worsen quality of life in these patients. This is due to high mortality rates (patients are not living long enough to reap the benefits of screening), the inaccuracy of cancer screening tests, and the increased risks associated with therapy in patients with ESKD. Read More

Adv Chronic Kidney Dis 2021 09;28(5):490-501.e1

Division of Pediatric Nephrology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada.

Childhood cancer therapy carries a high risk of treatment-related toxicities and complications that can impact kidney function. Although many of these adverse effects in the acute setting are well described, less is known about the latent effects of childhood cancer treatments on long-term kidney health. With decades of advancements in treatment protocols for many pediatric malignancies, more children than ever before are surviving into adulthood after being cured of their disease and with lower long-term morbidity. Read More

Adv Chronic Kidney Dis 2021 09;28(5):477-489.e1

Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC; Renal Section, Durham VA Health Care System, Durham, NC. Electronic address:

Cancer is one of the leading causes of death worldwide. With the introduction of newer chemotherapeutic agents, targeted therapies, and immunotherapy, the prognosis and survival of patients with cancer has remarkably improved. As a result, patients are living longer and experiencing long-term cardiovascular complications. Read More

Adv Chronic Kidney Dis 2021 09;28(5):469-476.e1

Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA. Electronic address:

As breakthroughs in cancer care are leading to improved long-term outcomes in a subset of advanced cancers, there is a growing population of long-term cancer survivors that are at risk of long-term complications. In this review, we summarize what is known about chronic kidney disease in cancer survivors, focusing on the following high-risk groups: survivors of childhood cancers, stem cell transplant recipients, patients with renal cell carcinoma, patients exposed to cisplatin and other nephrotoxic chemotherapies, and patients receiving immunotherapy for cancer. As new anticancer therapies are developed, more research is needed to understand the long-term risks of kidney function decline and to devise methods to prevent chronic kidney disease. Read More

Adv Chronic Kidney Dis 2021 09;28(5):460-468.e1

Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address:

The association between chronic kidney disease (CKD) and renal cell carcinoma (RCC) is bidirectional and multifactorial. Risk factors such as hypertension, diabetes mellitus, obesity, and smoking increase the risk of both CKD and RCC. CKD can lead to RCC via an underlying cystic disease or oxidative stress. Read More

Adv Chronic Kidney Dis 2021 09;28(5):447-459.e1

Division of Nephrology, University of Virginia Health System, Charlottesville, VA. Electronic address:

Disorders of the divalent ions (magnesium, calcium, and phosphorous) are frequently encountered in patients with cancer. Of these, hypomagnesemia, hypocalcemia, hypercalcemia, and hypophosphatemia are seen most commonly. These electrolyte disturbances may be related to the underlying malignancy or due to side effects of anticancer therapy. Read More

Adv Chronic Kidney Dis 2021 09;28(5):438-446.e1

Renal Service, Department of Medicine, Memorial Sloan Kettering Cancer Center; Weill Cornell Medical College, New York, NY. Electronic address:

Tumor lysis syndrome (TLS) is an oncologic emergency due to massive tumor cell lysis with the release of large amounts of potassium, phosphate, and nucleic acids into the systemic circulation. Clinical presentation is characterized by hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia. Acute kidney injury due to tumor lysis is potentiated by the precipitation of uric acid and calcium phosphate as well as renal vasoconstriction. Read More

Adv Chronic Kidney Dis 2021 09;28(5):429-437.e1

Section of Nephrology, Yale University School of Medicine, New Haven, CT and VA Medical Center, Section of Nephrology, West Have, CT.

Nephrotoxicity associated with immunotherapy is increasingly being encountered in clinical practice. Drugs that augment the immune system to eradicate cancer are revolutionary in the field of oncology. Older generation immunotherapies such as high-dose interleukin and interferon-alpha are now being replaced with more effective immune checkpoint inhibitors and chimeric antigen receptor T-cell therapies, which have shown promising results in numerous clinical trials. Read More

Adv Chronic Kidney Dis 2021 09;28(5):415-428.e1

Department of Nephrology, Peupliers Private Hospital, Ramsay Générale de Santé, Paris, France.

The introduction of novel molecularly targeted therapies in the last 2 decades has significantly improved the patient survival compared to standard conventional chemotherapies. However, this improvement has been accompanied by a whole new spectrum of kidney adverse events. Although known as "targeted," many of these agents lack specificity and selectivity, and they have a tendency to inhibit multiple targets including those in the kidneys. Read More

Adv Chronic Kidney Dis 2021 09;28(5):402-414.e1

Division of Nephrology, University Health Network, University of Toronto, Toronto, ON, Canada. Electronic address:

Conventional chemotherapies remain the mainstay of treatment for many malignancies. Kidney complications of these therapies are not infrequent and may have serious implications for future kidney function, cancer treatment options, eligibility for clinical trials, and overall survival. Kidney adverse effects may include acute kidney injury (via tubular injury, tubulointerstitial nephritis, glomerular disease and thrombotic microangiopathy), long-term kidney function loss and CKD, and electrolyte disturbances. Read More

Adv Chronic Kidney Dis 2021 09;28(5):394-401.e1

Division of Nephrology, Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada. Electronic address:

Over the past 2 decades, significant research and advancements have been made in oncology and its therapeutics. Thanks to novel diagnostic methods, treatments, and supportive measures, patients with cancer live longer and have a better quality of life. However, an unforeseen consequence of this progress has been increasing medical complications, including acute kidney injury. Read More

Adv Chronic Kidney Dis 2021 09;28(5):391-393

Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY.

Adv Chronic Kidney Dis 2021 07;28(4):378-390

David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA. Electronic address:

Chronic low-grade inflammation, now coined by the new paradigm as "metaflammation" or "metainflammation", has been linked to chronic kidney disease and its progression. In diabetes, altered metabolism denotes factors associated with the metabolic syndrome and hyperglycemia, among others. The interplay among hyperglycemia, oxidative stress, and inflammation in the pathogenesis of diabetic kidney disease (DKD) has been broadly explored. Read More

Adv Chronic Kidney Dis 2021 07;28(4):371-377

Department of Medicine, Am. Heart Assoc. Comprehensive Hypertension Center, University of Chicago Medicine, Chicago, IL. Electronic address:

The area of aldosterone blockade has exploded in the last decade with the development of four new compounds of a different class referred to as nonsteroidal mineralocorticoid receptor antagonists (MRAs). Their chemistry and clinical charatcteristics are distinctly different from their steroidal cousins. Apart from blocking aldosterone activity, albeit in a different way than the steroidal MRAs, they have much less blood pressure (BP) effects and are better tolerated. Read More

Adv Chronic Kidney Dis 2021 07;28(4):361-370

Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Transplant Institute, Boston, MA. Electronic address:

Post-transplant diabetes mellitus is a frequent consequence of or a pre-existing comorbidity in solid organ transplantation (SOT) that is associated with greater morbidity and mortality. Novel glucose-lowering agents that have been shown to have cardiovascular morbidity/mortality benefit and renal protective effects such as sodium glucose transporter 2 inhibitors and glucagon-like peptide-1 receptor agonists are being incorporated into new standard of care for diabetes mellitus. There is a paucity of data regarding the use of these agents in SOT. Read More

Adv Chronic Kidney Dis 2021 07;28(4):347-360

Faculty of Medicine, Hebrew University of Jerusalem, Israel; Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center, Jerusalem, Israel.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are highly effective in reducing glycemia in patients with type 2 diabetes (T2D). These medications effectively reduce cardiovascular (CV) risk in patients with T2D and established CV disease or with multiple risk factors. In addition, treatment with GLP-1 RA may exert protective effects on the diabetic kidney. Read More

Adv Chronic Kidney Dis 2021 07;28(4):337-346

Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO; Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO; Center for Women's Health Research, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO.

The worldwide prevalence of type 2 diabetes (T2D) is steadily increasing, and it remains a challenging public health problem for populations in both developing and developed countries around the world. Despite the recent advances in novel antidiabetic agents, diabetic kidney disease and cardiovascular disease remain the leading causes of morbidity and mortality in T2D. Glucagon-like peptide-1 (GLP-1) receptor agonists (RAs), incretin hormones that stimulate postprandial insulin secretion, serve as a promising avenue for treatment of T2D as they result in a variety of antihyperglycemic effects including increased endogenous insulin secretion, decreased gluconeogenesis, inhibition of pancreatic α-cell glucagon production, decreased pancreatic β-cell apoptosis, and increased β-cell proliferation. Read More

Adv Chronic Kidney Dis 2021 07;28(4):328-336

Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy. Electronic address:

In the past 2 decades, eight glucagon-like peptide-1 receptor agonists (GLP-1RAs) have been approved for the management of type 2 diabetes, each with its peculiar molecular structure, pharmacokinetics, and metabolic effects. Along with their marked glucose-lowering actions, which occur both at fasting and in the postprandial phase without an increased risk of hypoglycemia, GLP-1RAs have provided marked reductions in body weight and ancillary improvements in blood pressure and lipid profile. Recent cardiovascular outcome trials have established the benefits of GLP-1RAs on major cardiovascular events and all-cause mortality, independent of glucose control, with minor effects on preventing hospitalization for heart failure. Read More

Adv Chronic Kidney Dis 2021 07;28(4):318-327

Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA; Department of Medicine, University of Washington School of Medicine, University of Washington, Spokane and Seattle, WA; Department of Medicine, Nephrology Division, Kidney Research Institute, Institute of Translational Health Sciences, University of Washington, Spokane and Seattle, WA.

As a result of the growing number of patients with type 2 diabetes mellitus, the prevalence of diabetic kidney disease (DKD) has proven to be one of the fastest growing health care challenges globally. Early detection and initiation of appropriate interventions to slow the progression of DKD are impeded by low awareness of the health consequences of DKD, high complexity of care that includes the need for lifestyle modifications, difficulties with adhering to increasingly complicated medication regimens, and low acceptance and application of guideline-directed management. After 2 decades of status quo in the care of patients with DKD, recently approved glucose-lowering agents are promising to transform care by demonstrating slowed DKD disease progression and improved survival. Read More