926 results match your criteria Advances in chronic kidney disease[Journal]


Immune Dysfunction and Risk of Infection in Chronic Kidney Disease.

Adv Chronic Kidney Dis 2019 Jan;26(1):8-15

Texas A&M Health Science Center College of Medicine, Scott & White Medical Center-Temple, Temple, TX. Electronic address:

Cardiovascular disease and infections are directly or indirectly associated with an altered immune response, which leads to a high incidence of morbidity and mortality, and together, they account for up to 70% of all deaths among patients with chronic kidney dysfunction. Impairment of the normal reaction of the innate and adaptive immune systems in chronic kidney disease predisposes patients to an increased risk of infections, virus-associated cancers, and a diminished vaccine response. On the other hand, an abnormal, exaggerated reaction of the immune systems can also occur in this group of patients, resulting in increased production and decreased clearance of proinflammatory cytokines, which can lead to inflammation and its sequelae (eg, atherosclerotic cardiovascular disease). Read More

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http://dx.doi.org/10.1053/j.ackd.2019.01.004DOI Listing
January 2019
1 Read

Erratum to "Leadership as Tribal Leader".

Authors:

Adv Chronic Kidney Dis 2019 Jan;26(1):79

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http://dx.doi.org/10.1053/j.ackd.2019.01.005DOI Listing
January 2019

Vaccination in Chronic Kidney Disease.

Adv Chronic Kidney Dis 2019 Jan;26(1):72-78

Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI.

Infections after cardiovascular disease are the second most common cause of death in the chronic kidney disease population. Vaccination is an important component of maintaining health and wellness in patients with kidney disease. There is a changing epidemiologic landscape for several vaccine-preventable illnesses from childhood to adulthood and unfounded public perception of safety concerns. Read More

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http://dx.doi.org/10.1053/j.ackd.2018.10.002DOI Listing
January 2019
10 Reads

Antibiotic Dosing in Chronic Kidney Disease and End-Stage Renal Disease: A Focus on Contemporary Challenges.

Authors:
A Mary Vilay

Adv Chronic Kidney Dis 2019 Jan;26(1):61-71

University of New Mexico, College of Pharmacy, Albuquerque, NM. Electronic address:

Infections are an important cause of morbidity and mortality among patients with chronic kidney disease. Therefore, appropriate antibiotic dosing is imperative to achieve positive patient outcomes while minimizing antibiotic dose-related toxicity. Accurately assessing renal function and determining the influence of renal replacement therapy on antibiotic clearance makes drug dosing in this patient population challenging. Read More

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http://dx.doi.org/10.1053/j.ackd.2018.10.006DOI Listing
January 2019

Prevention and Treatment of Multidrug-Resistant Organisms in End-Stage Renal Disease.

Adv Chronic Kidney Dis 2019 Jan;26(1):51-60

Internal Medicine Department, Division of Infectious Disease, Baylor Scott & White Health, Temple, TX.

Chronic kidney disease patients are at high risk for infections because of multidrug-resistant organisms. Infections are the second most common cause of death in patients with ESRD. Patients with ESRD are prone to infections given alterations in immunity, increased rates of colonization with multidrug-resistant organisms, increased hospitalizations, and interactions with health care systems. Read More

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http://dx.doi.org/10.1053/j.ackd.2018.09.003DOI Listing
January 2019

The Many Faces of Infection in CKD: Evolving Paradigms, Insights, and Novel Therapies.

Adv Chronic Kidney Dis 2019 Jan;26(1):5-7

Clinical Associate Professor of Medicine, Division of Nephrology & Hypertension, Texas A&M Health Science Center College of Medicine, Baylor Scott & White Medical Center, Temple, TX. Electronic address:

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http://dx.doi.org/10.1053/j.ackd.2018.10.001DOI Listing
January 2019

Pathophysiology and Treatment of Hepatitis B and C Infections in Patients With End-Stage Renal Disease.

Adv Chronic Kidney Dis 2019 Jan;26(1):41-50

Division of Nephrology & Hypertension, Henry Ford Health System, Detroit, MI.

An in-depth understanding of viral hepatitis is important to the care of patients with end-stage renal disease undergoing hemodialysis. Both hepatitis B and C viruses are acquired through hematogenous spread and can lead to horizontal transmission. Concurrent hepatic and renal injuries have ominous outcomes with significant morbidity. Read More

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http://dx.doi.org/10.1053/j.ackd.2018.10.004DOI Listing
January 2019

Mycobacterial Infections in Patients With Chronic Kidney Disease and Kidney Transplantation.

Adv Chronic Kidney Dis 2019 Jan;26(1):35-40

Scott & White Medical Center-Temple, Division of Infectious Diseases, Department of Medicine, Texas A&M Health Science Center College of Medicine, TX.

Patients with chronic kidney disease have impaired immunity that increases their risk of infection. Increased incidence of mycobacterial infections, in particular Mycobacterium tuberculosis, is described in patients undergoing hemodialysis and peritoneal dialysis as well as after kidney transplantation in low-prevalence and high-prevalence settings. Diagnosis of this infection can be challenging because of atypical presentations that may lead to treatment delay and, consequently, increased mortality; however, recent advances in molecular testing have improved diagnostic accuracy. Read More

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January 2019
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Clostridioides difficile Infection in Chronic Kidney Disease/End-Stage Renal Disease.

Adv Chronic Kidney Dis 2019 Jan;26(1):30-34

Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit MI.

Clostridioides difficile infection (CDI) is a major health-care burden and increasingly seen in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). Increased antibiotic use, alteration in host defenses, and gastric acid suppression are some of the etiologies for increased risk of CDI in these populations. Patients with CKD/ESRD have a higher risk of initial episode, recurrence, and development of severe CDI than those without CKD or ESRD. Read More

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http://dx.doi.org/10.1053/j.ackd.2019.01.001DOI Listing
January 2019
2 Reads

Peritoneal Dialysis Access Associated Infections.

Adv Chronic Kidney Dis 2019 Jan;26(1):23-29

Division of Nephrology, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA.

Infection is a significant driver of morbidity and mortality in patients with end-stage renal disease undergoing maintenance dialysis. In the United States, septicemia and other infections account for 8% deaths in patients undergoing dialysis. In patients undergoing peritoneal dialysis (PD), PD-related peritonitis remains the most frequent treatment-related infection and is the greatest contributor to infection-related morbidity, including risk for hospitalization, and temporary or permanent transfer to hemodialysis. Read More

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http://dx.doi.org/10.1053/j.ackd.2018.09.002DOI Listing
January 2019

Current Concepts in Hemodialysis Vascular Access Infections.

Adv Chronic Kidney Dis 2019 Jan;26(1):16-22

Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI.

Infection-related causes are second only to cardiovascular events for mortality among end-stage renal disease patients. This review will provide an overview of hemodialysis catheter-, graft-, and fistula-related infections with emphasis on diagnosis and management in specific settings. Use of catheters at the initiation of dialysis has remained unchanged at 80%. Read More

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http://dx.doi.org/10.1053/j.ackd.2018.10.005DOI Listing
January 2019
1 Read

Hemodialysis Catheter Device Protection: Damned if We Do; Patients Are Damned if We Don't.

Adv Chronic Kidney Dis 2019 Jan;26(1):1-4

Henry Ford Hospital, Detroit, MI; Professor of Clinical Medicine, Wayne State University, Detroit, MI.

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http://dx.doi.org/10.1053/j.ackd.2018.11.001DOI Listing
January 2019

Leadership in the Industry Arena: Nephrologists in Nonclinical Leadership Roles.

Authors:
Akhtar Ashfaq

Adv Chronic Kidney Dis 2018 Nov;25(6):530-534

Clinical Research & Development and Medical Affairs, OPKO Pharmaceuticals, Miami, FL. Electronic address:

Of late, fewer residents are choosing nephrology as a career. Contributing factors may include lack of prestige, uncertain potential of future income, and poor work-life balance. Some current nephrologists are considering transitioning to another career for similar reasons. Read More

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http://dx.doi.org/10.1053/j.ackd.2018.08.003DOI Listing
November 2018
1 Read

Leading Integrated Kidney Care Entities of the Future.

Adv Chronic Kidney Dis 2018 Nov;25(6):523-529

Dialysis Clinic, Inc, Nashville, TN and Division of Nephrology, Tufts Medical Center, Boston, MA. Electronic address:

The leaders of 20th century kidney failure treatment took chances; 21st century leaders of integrated kidney care must do the same. Some risks are clinical, some are organizational, and some are financial. Decent and constructive leadership entails humility. Read More

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November 2018
11 Reads

Women in Nephrology Leadership.

Adv Chronic Kidney Dis 2018 Nov;25(6):519-522

Department of Medicine, Division of Nephrology, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Medicine, Oregon Health & Science University, Portland, OR.

Women and men tend to take different paths to leadership, with men being more intentional. When women do undertake leadership activities, they tend to be surprised by how much they enjoy it. Women's leadership styles tend to be more collaborative and inclusive. Read More

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http://dx.doi.org/10.1053/j.ackd.2018.08.014DOI Listing
November 2018
11 Reads

Mentorship in Medicine and Nephrology: More Important Than Ever.

Adv Chronic Kidney Dis 2018 Nov;25(6):514-518

Division of Nephrology/Department of Medicine, Jacobi Medical Center, Bronx, NY; Henry Ford Hospital, Division of Nephrology and Hypertension, Detroit, MI. Electronic address:

Mentorship has always been important in medicine. In fact, one can argue that that is how doctors are trained. Moreover, mentorship has been proven to preserve and elevate those who wish to pursue academic medicine. Read More

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http://dx.doi.org/10.1053/j.ackd.2018.07.002DOI Listing
November 2018
1 Read

Nephrologist Leadership in Advocacy and Public Policy.

Adv Chronic Kidney Dis 2018 Nov;25(6):505-513

Renal Physicians Association, Rockville, MD; and the Section of Nephrology, West Virginia University School of Medicine, Morgantown.

As a specialty and profession, nephrology has deep roots in the arenas of advocacy and public policy, with nephrologists playing a significant role in garnering legislative attention on the needs of patients with end-stage renal disease. The depth of experiences and unique perspectives of nephrologists and sharing our positions with legislators, regulators, and decision makers are central to achieving the Triple Aim for patients with kidney disease. Advocacy and public policy are conducted externally as well as internally to the House of Medicine and shape the future of kidney care and nephrology practice. Read More

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http://dx.doi.org/10.1053/j.ackd.2018.08.020DOI Listing
November 2018
11 Reads

Leading the Dialysis Unit: Role of the Medical Director.

Adv Chronic Kidney Dis 2018 Nov;25(6):499-504

University of Cincinnati, Cincinnati, OH; and Indiana University Health, Indianapolis, IN. Electronic address:

The responsibilities of a dialysis unit medical director are specified in the ESRD Conditions for Coverage and encompass multiple quality, safety, and educational domains. Many of these responsibilities require leadership skills that are neither intuitive nor acquired as part of the medical director's training. An effective medical director is able to shape the culture of the dialysis facility such that patients and staff feel free to communicate their concerns regarding suboptimal processes without fear of retribution, and there is a continuous iterative process of quality improvement and safety, which values input from all stakeholders. Read More

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http://dx.doi.org/10.1053/j.ackd.2018.03.004DOI Listing
November 2018
2 Reads

Leadership in a Private Nephrology Practice: Autonomy Is More Than a Dream!

Adv Chronic Kidney Dis 2018 Nov;25(6):494-498

Valley Kidney Specialists and the Department of Nephrology, Lehigh Valley Hospital, Allentown, PA.

Private practice is entering an era of diminishing reimbursement and increasing overhead associated with federally mandated payment reforms resulting in a need to move from the traditional fee-for-service to a value-based model, changes that place financial and organizational strain on nephrology practices. In addition, the changing geopolitical scene is one of mergers and consolidation of health care networks, which in turn are developing their own insurance plans or partnering with commercial payers. The new landscape will require the leadership of a private nephrology practice to vigilantly monitor and adapt to these changes for success. Read More

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http://dx.doi.org/10.1053/j.ackd.2018.08.019DOI Listing
November 2018
3 Reads

Administrative Leadership: Nephrologists in Non-nephrology Leadership Roles.

Adv Chronic Kidney Dis 2018 Nov;25(6):490-493

Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Medicine, Division of Nephrology, Great Neck, NY. Electronic address:

Nephrologists, perhaps more than other physicians, are drawn to health-care leadership positions. In this article, we consider reasons that nephrologists are uniquely suited to serve in these roles. We briefly review key aspects of leadership principles and skills. Read More

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http://dx.doi.org/10.1053/j.ackd.2018.07.001DOI Listing
November 2018
1 Read

Leading a Dialysis Organization: Role and Responsibilities of the Chief Medical Officer (Nephrologist Leadership in a Dialysis Provider Organization).

Adv Chronic Kidney Dis 2018 Nov;25(6):485-489

Satellite Healthcare, San Jose, CA. Electronic address:

The early beginning of the end-stage kidney disease program with the introduction of the Medicare Act of 1973 was marked by nephrologist entrepreneurs pioneering dialysis centers to deliver dialysis addressing the clinical needs of patients in a collaborative effort between physicians and nurses. As the number of patients grew, a system reliably providing dialysis treatments for many more patients than was ever anticipated was required to enable the demands of the increased scale. Solutions appropriate to respond to the growing needs of out-patient dialysis centers were developed combining emerging technology, clinical advances, and operational efficiency. Read More

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http://dx.doi.org/10.1053/j.ackd.2018.08.015DOI Listing
November 2018
1 Read

Leadership as a Division Chief of Nephrology.

Authors:
Eleanor Lederer

Adv Chronic Kidney Dis 2018 Nov;25(6):480-484

Interim Chair of Medicine, Division Chief of Nephrology and Hypertension, University of Louisville School of Medicine, St Louisville, KY, and ACOS for Research and Development, Robley Rex VA Medical Center, Louisville, KY. Electronic address:

The position of chief of a division of nephrology in an academic medical center is a hands-on job, offering the opportunity to influence the future of the field through the creation of unique clinical, research, and education programs. Today, most academic centers face significant financial challenges, thus the division chief must develop a variety of skills to accomplish his or her goals. Interactions and relationships with the leadership of the academic center, including the hospital executives, can facilitate or impede progress on proposed projects; therefore, aligning the goals of the division with the goals of leadership is an imperative. Read More

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http://dx.doi.org/10.1053/j.ackd.2018.08.005DOI Listing
November 2018
1 Read

A History of Leadership in Dialysis: Perspectives From Seasoned Leaders.

Authors:
Dugan W Maddux

Adv Chronic Kidney Dis 2018 Nov;25(6):474-479

Fresenius Medical Care North America, Waltham, MA. Electronic address:

The history of chronic dialysis in the United States highlights the impact nephrology leaders have on improving kidney disease care. Belding Scribner and his Seattle team transformed end-stage renal disease from a fatal illness to a treatable condition with use of the first successful Scribner shunt in 1960. Advances in dialysis machines emerged from Les Babb and Richard Drake finding ways to treat more patients. Read More

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http://dx.doi.org/10.1053/j.ackd.2018.08.016DOI Listing
November 2018
1 Read

Leadership in Nephrology: Vital to the Future of Our Profession.

Adv Chronic Kidney Dis 2018 Nov;25(6):472-473

Professor of Medicine, Section of Nephrology, Department of Medicine, West Virginia University School of Medicine, WVU Medicine, Morgantown, WV.

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http://dx.doi.org/10.1053/j.ackd.2018.08.018DOI Listing
November 2018
1 Read

Leadership as Tribal Leader.

Authors:
Jerry Yee

Adv Chronic Kidney Dis 2018 Nov;25(6):469-471

Editor-in-Chief, Henry Ford Hospital, Detroit, MI; Professor of Clinical Medicine, Wayne State University, Detroit, MI.

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http://dx.doi.org/10.1053/j.ackd.2018.10.003DOI Listing
November 2018
1 Read

Working Toward an Improved Understanding of Chronic Cardiorenal Syndrome Type 4.

Adv Chronic Kidney Dis 2018 Sep;25(5):454-467

Division of Nephrology, Department of Medicine, Duke University, Durham, NC 27705. Electronic address:

Chronic diseases of the heart and of the kidneys commonly coexist in individuals. Certainly combined and persistent heart and kidney failure can arise from a common pathologic insult, for example, as a consequence of poorly controlled hypertension or of severe diffuse arterial disease. However, strong evidence is emerging to suggest that cross talk exists between the heart and the kidney. Read More

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http://dx.doi.org/10.1053/j.ackd.2018.08.010DOI Listing
September 2018
1 Read

Advanced Heart Failure Therapies and Cardiorenal Syndrome.

Adv Chronic Kidney Dis 2018 Sep;25(5):443-453

Henry Ford Hospital, Advanced Heart Failure & Cardiac Transplant Program, Detroit, MI.

Heart failure (HF) is extremely prevalent and for those with end-stage (stage D) disease, 1-year survival is only 25-50%. Several studies have captured the mortality impact of kidney disease on patients with HF, and measures of kidney function are a component of many HF risk stratification scores. The management of advanced HF complicated by cardiorenal syndrome (CRS) is challenging, and irreversible kidney failure often limits patient candidacy for advanced HF therapies, such as transplant or left ventricular assist device therapy. Read More

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September 2018
20 Reads

Extracorporeal Isolated Ultrafiltration for Management of Congestion in Heart Failure and Cardiorenal Syndrome.

Adv Chronic Kidney Dis 2018 Sep;25(5):434-442

Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, FL; and Advocate Heart Institute, Naperville, IL. Electronic address:

Acute decompensated heart failure has the highest rate of hospital readmission among all medical conditions and portends a significant financial burden on health care system. Congestion, the hallmark of acute decompensated heart failure, represents the primary reason for hospitalization and the driver of adverse outcomes in these patients. Although diuretic-based medical regimens remain the mainstay of management of acute decompensated heart failure, they often show suboptimal efficacy and safety profiles in this setting. Read More

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http://dx.doi.org/10.1053/j.ackd.2018.08.007DOI Listing
September 2018
5 Reads

Diuretics in the Management of Cardiorenal Syndrome.

Adv Chronic Kidney Dis 2018 Sep;25(5):425-433

Henry Ford Hospital, Detroit, MI.

The leading cause of death worldwide is cardiovascular disease. The heart and the kidneys are functionally interdependent, such that dysfunction in one organ may cause dysfunction in the other. By one estimate, more than 60% of patients with congestive heart failure develop chronic kidney disease. Read More

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http://dx.doi.org/10.1053/j.ackd.2018.08.008DOI Listing
September 2018
10 Reads

Toward Precision Medicine in the Cardiorenal Syndrome.

Adv Chronic Kidney Dis 2018 Sep;25(5):418-424

Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, La Jolla, CA; and Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, California. Electronic address:

Although the field of oncology has made significant steps toward individualized precision medicine, cardiology and nephrology still often use a "one size fits all" approach. This applies to the intersection of the heart-kidney interaction and the cardiorenal syndrome as well. Recent studies have shown that the prognostic implications of worsening renal function (WRF) in acute heart failure are variable; thus, there is a need to differentiate the implications of WRF to better guide precise care. Read More

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http://dx.doi.org/10.1053/j.ackd.2018.08.017DOI Listing
September 2018
6 Reads

Heart-Kidney Interactions in Cardiorenal Syndrome Type 1.

Adv Chronic Kidney Dis 2018 Sep;25(5):408-417

Department of Internal Medicine, Cardiovascular Diseases Unit, S Maria alle Scotte Hospital University of Siena, Italy.

The exact significance of kidney function deterioration during acute decompensated heart failure (ADHF) episodes is still under debate. Several studies reported a wide percentage of worsening renal function (WRF) in ADHF patients ranging from 20% to 40%. This is probably because of different populations enrolled with different baseline kidney and cardiac function, varying definition of acute kidney injury (AKI), etiology of kidney dysfunction (KD), and occurrence of transient or permanent KD over the observational period. Read More

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September 2018
13 Reads

Pathophysiological Mechanisms in Cardiorenal Syndrome.

Adv Chronic Kidney Dis 2018 Sep;25(5):400-407

Department of Medicine, Division of Nephrology, Einstein Medical Center; Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA; and Division of Nephrology, William Jennings Bryan Dorn VA Medical Center, Columbia, SC.

Cardiorenal syndrome represents the confluence of intricate hemodynamic, neurohormonal, and inflammatory pathways that initiate and propagate the maladaptive cross talk between the heart and kidneys. Several of these pathophysiological principles were described in older historical experiments. The last decade has witnessed major efforts in streamlining its definition, clinical phenotypes, and classification to improve diagnostic accuracy and deliver optimal goal-directed medical therapies. Read More

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http://dx.doi.org/10.1053/j.ackd.2018.08.006DOI Listing
September 2018
1 Read

Epidemiology of Cardiorenal Syndrome.

Authors:
Junior Uduman

Adv Chronic Kidney Dis 2018 Sep;25(5):391-399

Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI, and Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI. Electronic address:

Cardiorenal syndrome is a spectrum of disorders that emphasizes the bidirectional nature of cardiac and kidney injury. Observational and retrospective studies have helped us to understand the prevalence and burden of each of the 5 types of cardiorenal syndromes. Cardiorenal syndrome type 1 is the most common. Read More

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September 2018
9 Reads

Cardiorenal Syndrome: An Overview.

Adv Chronic Kidney Dis 2018 Sep;25(5):382-390

International Renal Research Institute, S. Bortolo Hospital, Vicenza, Italy; Department of Nephrology and Dialysis, ASST Lariana, S. Anna Hospital, Como, Italy; and Department of Nephrology and Dialysis, L. Parodi - Delfino Hospital, Colleferro, Italy. Electronic address:

It is well established that a large number of patients with acute decompensated heart failure present with various degrees of heart and kidney dysfunction usually primary disease of heart or kidney often involve dysfunction or injury to the other. The term cardiorenal syndrome increasingly had been used without a consistent or well-accepted definition. To include the vast array of interrelated derangements and to stress the bidirectional nature of heart-kidney interactions, a new classification of the cardiorenal syndrome with 5 subtypes that reflect the pathophysiology, the time frame, and the nature of concomitant cardiac and renal dysfunction was proposed. Read More

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http://dx.doi.org/10.1053/j.ackd.2018.08.004DOI Listing
September 2018
9 Reads

Cardiorenal Syndrome: A Call to Action for a Pressing Medical Issue.

Adv Chronic Kidney Dis 2018 Sep;25(5):379-381

Division of Nephrology, Henry Ford Hospital, Detroit, MI.

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http://dx.doi.org/10.1053/j.ackd.2018.08.011DOI Listing
September 2018
2 Reads

A Tale of Two Failures: A Guide to Shared Decision-Making for Heart and Renal Failure.

Adv Chronic Kidney Dis 2018 Sep;25(5):375-378

Editor-in-Chief, Henry Ford Hospital, Detroit, MI; Professor of Clinical Medicine, Wayne State University, Detroit, MI.

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http://dx.doi.org/10.1053/j.ackd.2018.08.002DOI Listing
September 2018
2 Reads

Incomplete Distal Renal Tubular Acidosis and Kidney Stones.

Adv Chronic Kidney Dis 2018 Jul;25(4):366-374

Division of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern; Swiss National Centre of Competence in Research NCCR TransCure, University of Bern, Bern, Switzerland; and the Departments of Internal Medicine and Physiology, and the Charles and Jane Pak Center of Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX.

Renal tubular acidosis (RTA) is comprised of a diverse group of congenital or acquired diseases with the common denominator of defective renal acid excretion with protean manifestation, but in adults, recurrent kidney stones and nephrocalcinosis are mainly found in presentation. Calcium phosphate (CaP) stones and nephrocalcinosis are frequently encountered in distal hypokalemic RTA type I. Alkaline urinary pH, hypocitraturia, and, less frequently, hypercalciuria are the tripartite lithogenic factors in distal RTA (dRTA) predisposing to CaP stone formation; the latter 2 are also commonly encountered in other causes of urolithiasis. Read More

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http://dx.doi.org/10.1053/j.ackd.2018.05.007DOI Listing
July 2018
24 Reads

Pseudo-Renal Tubular Acidosis: Conditions Mimicking Renal Tubular Acidosis.

Adv Chronic Kidney Dis 2018 Jul;25(4):358-365

Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI; and Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI.

Hyperchloremic metabolic acidosis, particularly renal tubular acidosis, can pose diagnostic challenges. The laboratory phenotype of a low total carbon dioxide content, normal anion gap, and hyperchloremia may be misconstrued as hypobicarbonatemia from renal tubular acidosis. Several disorders can mimic renal tubular acidosis, and these must be appropriately diagnosed to prevent inadvertent and inappropriate application of alkali therapy. Read More

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http://dx.doi.org/10.1053/j.ackd.2018.05.001DOI Listing
July 2018
7 Reads

Clinical Approach to Proximal Renal Tubular Acidosis in Children.

Adv Chronic Kidney Dis 2018 Jul;25(4):351-357

Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, USA; and Pediatrics Department B, Schneider Children's Medical Center of Israel, Sackler School of Medicine, Tel Aviv University, Israel.

Proximal renal tubular acidosis (pRTA) is an inherited or acquired clinical syndrome in which there is a decreased bicarbonate reclamation in the proximal tubule resulting in normal anion gap hyperchloremic metabolic acidosis. In children, pRTA may be isolated but is often associated with a general proximal tubular dysfunction known as Fanconi syndrome which frequently heralds an underlying systemic disorder from which it arises. When accompanied by Fanconi syndrome, pRTA is characterized by additional renal wasting of phosphate, glucose, uric acid, and amino acids. Read More

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http://dx.doi.org/10.1053/j.ackd.2018.05.006DOI Listing
July 2018
18 Reads

Renal Tubular Acidosis: H/Base and Ammonia Transport Abnormalities and Clinical Syndromes.

Authors:
Ira Kurtz

Adv Chronic Kidney Dis 2018 Jul;25(4):334-350

Division of Nephrology, David Geffen School of Medicine, and Brain Research Institute, UCLA, Los Angeles, CA. Electronic address:

Renal tubular acidosis (RTA) represents a group of diseases characterized by (1) a normal anion gap metabolic acidosis; (2) abnormalities in renal HCO absorption or new renal HCO generation; (3) changes in renal NH, Ca, K, and HO homeostasis; and (4) extrarenal manifestations that provide etiologic diagnostic clues. The focus of this review is to give a general overview of the pathogenesis of the various clinical syndromes causing RTA with a particular emphasis on type I (hypokalemic distal RTA) and type II (proximal) RTA while reviewing their pathogenesis from a physiological "bottom-up" approach. In addition, the factors involved in the generation of metabolic acidosis in both type I and II RTA are reviewed highlighting the importance of altered renal ammonia production/partitioning and new HCO generation. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S15485595183010
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http://dx.doi.org/10.1053/j.ackd.2018.05.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6128697PMC
July 2018
26 Reads

Hyperkalemic Forms of Renal Tubular Acidosis: Clinical and Pathophysiological Aspects.

Adv Chronic Kidney Dis 2018 Jul;25(4):321-333

Division of Nephrology, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Nephrology, University of Illinois at Chicago, Chicago, IL.

In contrast to distal type I or classic renal tubular acidosis (RTA) that is associated with hypokalemia, hyperkalemic forms of RTA also occur usually in the setting of mild-to-moderate CKD. Two pathogenic types of hyperkalemic metabolic acidosis are frequently encountered in adults with underlying CKD. One type, which corresponds to some extent to the animal model of selective aldosterone deficiency (SAD) created experimentally by adrenalectomy and glucocorticoid replacement, is manifested in humans by low plasma and urinary aldosterone levels, reduced ammonium excretion, and preserved ability to lower urine pH below 5. Read More

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http://dx.doi.org/10.1053/j.ackd.2018.05.004DOI Listing
July 2018
22 Reads

Hypokalemic Distal Renal Tubular Acidosis.

Adv Chronic Kidney Dis 2018 Jul;25(4):303-320

Pathophysiology Division, Pathology Department, School of Medicine, National University of Cuyo, Mendoza, Argentina; and Division of Nephrology, Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL. Electronic address:

Distal renal tubular acidosis (DRTA) is defined as hyperchloremic, non-anion gap metabolic acidosis with impaired urinary acid excretion in the presence of a normal or moderately reduced glomerular filtration rate. Failure in urinary acid excretion results from reduced H secretion by intercalated cells in the distal nephron. This results in decreased excretion of NH and other acids collectively referred as titratable acids while urine pH is typically above 5. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S15485595183009
Publisher Site
http://dx.doi.org/10.1053/j.ackd.2018.05.003DOI Listing
July 2018
20 Reads

Renal Tubular Acidosis and the Nephrology Teaching Paradigm.

Adv Chronic Kidney Dis 2018 Jul;25(4):301-302

Chief Division of Nephrology, Professor of Medicine, University of Illinois at Chicago, Chicago, IL.

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http://dx.doi.org/10.1053/j.ackd.2018.05.002DOI Listing
July 2018
3 Reads

It Is Really Time for Ammonium Measurement.

Adv Chronic Kidney Dis 2018 Jul;25(4):297-300

Henry Ford Hospital, Detroit, MI; Professor of Clinical Medicine, Wayne State University, Detroit, MI.

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http://dx.doi.org/10.1053/j.ackd.2018.03.003DOI Listing
July 2018
2 Reads

Renal Functional Reserve Revisited.

Adv Chronic Kidney Dis 2018 May;25(3):e1-e8

Brigham and Women's Hospital, Harvard Medical School, Boston, MA.

Kidney function, like the function of other organs, is dynamic and continuously adjusts to changes in the internal environment to maintain homeostasis. The glomerular filtration rate, which serves as the primary index of kidney function in clinical practice, increases in response to various physiological and pathological stressors including oral protein intake. The difference between the glomerular filtration rate in the resting state and at maximum capacity has been termed renal functional reserve (RFR). Read More

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http://dx.doi.org/10.1053/j.ackd.2018.03.001DOI Listing
May 2018
3 Reads

Magnesium Balance in Chronic and End-Stage Kidney Disease.

Adv Chronic Kidney Dis 2018 May;25(3):291-295

Centre for Nephrology, Royal Free Hospital, London, UK.

This article explores the effects of CKD and end-stage kidney disease on magnesium balance. In CKD, there is decreased glomerular filtration of magnesium. Decreased tubular reabsorption can compensate to a degree, but once CKD stage 4 is reached there is a tendency toward hypermagnesemia. Read More

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http://dx.doi.org/10.1053/j.ackd.2018.01.004DOI Listing
May 2018
14 Reads

Magnesium as a Calcification Inhibitor.

Adv Chronic Kidney Dis 2018 May;25(3):281-290

INSERM U1088, CURS, Amiens, France; Division of Nephrology, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt/Paris, France; INSERM U1018, Team 5, CESP, UVSQ, Villejuif, France. Electronic address:

Vascular calcification (VC) is associated with elevated cardiovascular mortality rates in patients with CKD. Recent clinical studies of patients with advanced CKD have observed an association between low serum magnesium (Mg) levels on one hand and elevated VC and cardiovascular mortality on the other. These findings have stimulated interest in understanding Mg's impact on CKD in general and the associated VC in particular. Read More

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http://dx.doi.org/10.1053/j.ackd.2017.12.001DOI Listing
May 2018
11 Reads

Magnesium and Progression of Chronic Kidney Disease: Benefits Beyond Cardiovascular Protection?

Adv Chronic Kidney Dis 2018 May;25(3):274-280

Department of Comprehensive Kidney Disease Research, Osaka University Graduate School of Medicine, Suita, Japan and Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan.

Experimental and clinical studies have demonstrated that magnesium deficiency leads to hypertension, insulin resistance, and endothelial dysfunction, and is associated with an increased risk of cardiovascular events. Given that cardiovascular disease and CKD share similar risk factors, the low magnesium status may also contribute to CKD progression. In fact, lower serum magnesium levels and lower dietary magnesium intake are associated with an increased risk of incident CKD and progression to end-stage kidney disease. Read More

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http://dx.doi.org/10.1053/j.ackd.2017.11.001DOI Listing
May 2018
5 Reads

Magnesium and Drugs Commonly Used in Chronic Kidney Disease.

Adv Chronic Kidney Dis 2018 May;25(3):267-273

Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA; and Division of Transplantation, Beth Israel Deaconess Medical Center, Boston, MA. Electronic address:

As with other electrolytes, magnesium homeostasis depends on the balance between gastrointestinal absorption and kidney excretion. Certain drugs used commonly in patients with CKD can decrease gastrointestinal ingestion and kidney reclamation, and potentially cause hypomagnesemia. Other magnesium-containing drugs such as laxatives and cathartics can induce hypermagnesemia, particularly in those with impaired glomerular filtration and magnesium excretion. Read More

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http://dx.doi.org/10.1053/j.ackd.2018.01.005DOI Listing
May 2018
9 Reads

Oral Magnesium Supplementation and Metabolic Syndrome: A Randomized Double-Blind Placebo-Controlled Clinical Trial.

Adv Chronic Kidney Dis 2018 May;25(3):261-266

Biomedical Research Unit of the Mexican Social Security Institute, Durango, Durango, Mexico; and Research Group on Diabetes and Chronic Illnesses, Durango, Durango, Mexico. Electronic address:

The objective of the study was to evaluate the efficacy of oral magnesium supplementation in the improvement of metabolic syndrome (MetS) and its components. This is a randomized double-blind, placebo-controlled clinical trial that enrolled 198 individuals with MetS and hypomagnesemia who were randomly allocated to receive either 30 mL of magnesium chloride 5% solution, equivalent to 382 mg of elemental magnesium (n = 100), or placebo solution (n = 98), daily for 16 weeks. Serum magnesium levels <1. Read More

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http://dx.doi.org/10.1053/j.ackd.2018.02.011DOI Listing
May 2018
9 Reads