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    3663 results match your criteria Clinical Journal of the American Society of Nephrology CJASN[Journal]

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    Regulatory T Cells and Kidney Transplantation.
    Clin J Am Soc Nephrol 2018 May 22. Epub 2018 May 22.
    Transplantation Research Center, Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and
    The ability of the immune system to differentiate self from nonself is critical in determining the immune response to antigens expressed on transplanted tissue. Even with conventional immunosuppression, acceptance of the allograft is an active process often determined by the presence of regulatory T cells (Tregs). Tregs classically are CD4 cells that constitutively express high levels of the IL-2 receptor chain CD25, along with the transcription factor Foxp3. Read More

    Acute Kidney Injury and Risk of Heart Failure and Atherosclerotic Events.
    Clin J Am Soc Nephrol 2018 May 17. Epub 2018 May 17.
    Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California; and.
    Background And Objectives: AKI in the hospital is common and is associated with excess mortality. We examined whether AKI is also independently associated with a higher risk of different cardiovascular events in the first year after discharge.

    Design, Setting, Participants, & Measurements: We conducted a retrospective analysis of a cohort between 2006 and 2013 with follow-up through 2014, within Kaiser Permanente Northern California. Read More

    Clinical Pharmacodynamics: Principles of Drug Response and Alterations in Kidney Disease.
    Clin J Am Soc Nephrol 2018 May 16. Epub 2018 May 16.
    Center for Internal Medicine, University Hospital, Ulm, Germany.
    Pharmacokinetics and pharmacodynamics follow the logic of cause and consequence. Receptor-mediated and reversible effects can be distinguished from direct and irreversible effects. Reversible effects are capacity-limited and saturable whereas irreversible effects are limited only by the number of viable targets. Read More

    Microbiome and Cardiovascular Disease in CKD.
    Clin J Am Soc Nephrol 2018 May 9. Epub 2018 May 9.
    The Jared Grantham Kidney Institute, Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas.
    Patients with CKD exhibit a disproportionate burden of cardiovascular mortality, which likely stems from the presence of unique, nontraditional risk factors that accompany deteriorating kidney function. Mounting evidence suggests that alterations to the intestinal microbiome in CKD may serve as one such risk factor. The human intestinal tract is home to >100 trillion micro-organisms made up of a collection of commensal, symbiotic, and pathogenic species. Read More

    Prevalence of Central Vein Stenosis in Patients Referred for Vein Mapping.
    Clin J Am Soc Nephrol 2018 May 8. Epub 2018 May 8.
    Division of Nephrology.
    Background And Objectives: Central vein stenosis is considered to be common in patients on hemodialysis but its exact prevalence is not known. In this study, we report the prevalence of central vein stenosis in patients with CKD referred for vein mapping.

    Design, Setting, Participants, & Measurements: We conducted a retrospective study of adult patients who had bilateral upper extremity venographic vein mapping from September 1, 2011 to December 31, 2015. Read More

    Sleep Duration and Health-Related Quality of Life in Predialysis CKD.
    Clin J Am Soc Nephrol 2018 May 3. Epub 2018 May 3.
    Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
    Background And Objectives: Sleep duration has been associated with cardiometabolic risk and mortality. The health-related quality of life represents a patient's comprehensive perception of health and is accepted as a health outcome. We examined the relationship between sleep duration and health-related quality of life in predialysis CKD. Read More

    Teaching Pediatric Peritoneal Dialysis Globally through Virtual Simulation.
    Clin J Am Soc Nephrol 2018 May 2. Epub 2018 May 2.
    Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and the Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts;
    Background And Objectives: Despite the increasing prevalence of childhood kidney disease worldwide, there is a shortage of clinicians trained to provide peritoneal dialysis (PD). E-learning technologies may provide a solution to improve knowledge in PD. We describe the development of a virtual PD simulator and report the first 22 months of online usage. Read More

    HLA-DQ Mismatching and Kidney Transplant Outcomes.
    Clin J Am Soc Nephrol 2018 May 23;13(5):763-771. Epub 2018 Apr 23.
    Transplant Institute, and.
    Background And Objectives: Recent evidence suggests that HLA epitope-mismatching at HLA-DQ loci is associated with the development of anti-DQ donor-specific antibodies and adverse graft outcomes. However, the clinical significance of broad antigen HLA-DQ mismatching for graft outcomes is not well examined.

    Design, Setting, Participants, & Measurements: Using the United Network Organ Sharing/the Organ Procurement and Transplantation Network (UNOS/OPTN) data, patients with primary kidney transplants performed between 2005 and 2014 were included. Read More

    Healthcare Utilization after Acute Kidney Injury in the Pediatric Intensive Care Unit.
    Clin J Am Soc Nephrol 2018 May 20;13(5):685-692. Epub 2018 Apr 20.
    Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
    Background And Objectives: Little is known about the long-term burden of AKI in the pediatric intensive care unit. We aim to evaluate if pediatric AKI is associated with higher health service use post-hospital discharge.

    Design, Setting, Participants, & Measurements: This is a retrospective cohort study of children (≤18 years old) admitted to two tertiary centers in Montreal, Canada. Read More

    Opioid Analgesics and Adverse Outcomes among Hemodialysis Patients.
    Clin J Am Soc Nephrol 2018 May 19;13(5):746-753. Epub 2018 Apr 19.
    Departments of Medicine and.
    Background And Objectives: Patients on hemodialysis frequently experience pain and may be particularly vulnerable to opioid-related complications. However, data evaluating the risks of opioid use in patients on hemodialysis are limited.

    Design, Setting, Participants, & Measurements: Using the US Renal Data System, we conducted a cohort study evaluating the association between opioid use (modeled as a time-varying exposure and expressed in standardized oral morphine equivalents) and time to first emergency room visit or hospitalization for altered mental status, fall, and fracture among 140,899 Medicare-covered adults receiving hemodialysis in 2011. Read More

    Prevalence of Hypertension in Children with Early-Stage ADPKD.
    Clin J Am Soc Nephrol 2018 Apr 19. Epub 2018 Apr 19.
    Division of Nephrology, Department of Pediatric Subspecialties, and
    Background And Objectives: Autosomal dominant polycystic kidney disease is the most common inheritable kidney disease, frequently thought to become symptomatic in adulthood. However, patients with autosomal dominant polycystic kidney disease may develop signs or symptoms during childhood, in particular hypertension. Although ambulatory BP monitoring is the preferred method to diagnose hypertension in pediatrics, data in children with autosomal dominant polycystic kidney disease are limited. Read More

    Survey of Kidney Biopsy Clinical Practice and Training in the United States.
    Clin J Am Soc Nephrol 2018 May 18;13(5):718-725. Epub 2018 Apr 18.
    Nephrology Service, and.
    Background And Objectives: Practicing clinical nephrologists are performing fewer diagnostic kidney biopsies. Requiring biopsy procedural competence for graduating nephrology fellows is controversial.

    Design, Setting, Participants, & Measurements: An anonymous, on-line survey of all Walter Reed training program graduates (=82; 1985-2017) and all United States nephrology program directors (=149; August to October of 2017), regarding kidney biopsy practice and training, was undertaken. Read More

    Changes in Glomerular Filtration Rate and Impact on Long-Term Survival among Adults after Hematopoietic Cell Transplantation: A Prospective Cohort Study.
    Clin J Am Soc Nephrol 2018 Apr 18. Epub 2018 Apr 18.
    Division of Pediatrics and Medicine, University of Washington, Clinical Research Division.
    Background And Objectives: Kidney injury is a significant complication for patients undergoing hematopoietic cell transplantation (HCT), but few studies have prospectively examined changes in GFR in long-term survivors of HCT. We described the association between changes in GFR and all-cause mortality in patients up to 10 years after HCT.

    Design, Setting, Participants, & Measurements: We conducted a prospective, observational cohort study of adult patients undergoing HCT at the Fred Hutchinson Cancer Center in Seattle, Washington from 2003 to 2015. Read More

    Hydroxychloroquine Use and Risk of CKD in Patients with Rheumatoid Arthritis.
    Clin J Am Soc Nephrol 2018 May 16;13(5):702-709. Epub 2018 Apr 16.
    Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
    Background And Objectives: Hydroxychloroquine is widely used in patients with rheumatoid arthritis. However, large-scale studies examining the long-term effects of hydroxychloroquine on the development of kidney disease in patients with rheumatoid arthritis are lacking. We aimed to assess the long-term association of hydroxychloroquine use with the risk of developing CKD in this population. Read More

    Awareness of Racial Disparities in Kidney Transplantation among Health Care Providers in Dialysis Facilities.
    Clin J Am Soc Nephrol 2018 May 12;13(5):772-781. Epub 2018 Apr 12.
    Division of Transplantation, Department of Surgery and
    Background And Objectives: Despite the important role that health care providers at dialysis facilities have in reducing racial disparities in access to kidney transplantation in the United States, little is known about provider awareness of these disparities. We aimed to evaluate health care providers' awareness of racial disparities in kidney transplant waitlisting and identify factors associated with awareness.

    Design, Setting, Participants, & Measurements: We conducted a cross-sectional analysis of a survey of providers from low-waitlisting dialysis facilities (=655) across all 18 ESRD networks administered in 2016 in the United States merged with 2014 US Renal Data System and 2014 US Census data. Read More

    Family Consultation to Reduce Early Hospital Readmissions among Patients with End Stage Kidney Disease: A Randomized Controlled Trial.
    Clin J Am Soc Nephrol 2018 Apr 10. Epub 2018 Apr 10.
    Psychiatry, Henry Ford Hospital, Henry Ford Health System, Detroit, Michigan.
    Background And Objectives: The US Centers for Medicare and Medicaid Services have mandated reducing early (30-day) hospital readmissions to improve patient care and reduce costs. Patients with ESKD have elevated early readmission rates, due in part to complex medical regimens but also cognitive impairment, literacy difficulties, low social support, and mood problems. We developed a brief family consultation intervention to address these risk factors and tested whether it would reduce early readmissions. Read More

    Pharmacology behind Common Drug Nephrotoxicities.
    Clin J Am Soc Nephrol 2018 Apr 5. Epub 2018 Apr 5.
    Section of Nephrology, Department of Medicine, Yale University, New Haven, Connecticut and Veterans Affairs Medical Center, West Haven, Connecticut
    Patients are exposed to numerous prescribed and over-the-counter medications. Unfortunately, drugs remain a relatively common cause of acute and chronic kidney injury. A combination of factors including the innate nephrotoxicity of drugs, underlying patient characteristics that increase their risk for kidney injury, and the metabolism and pathway of excretion by the kidneys of the various agents administered enhance risk for drug-induced nephrotoxicity. Read More

    Secular Trends in Infection-Related Mortality after Kidney Transplantation.
    Clin J Am Soc Nephrol 2018 May 5;13(5):755-762. Epub 2018 Apr 5.
    Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; and
    Background And Objectives: Infections are the most common noncardiovascular causes of death after kidney transplantation. We analyzed the current infection-related mortality among kidney transplant recipients in a nationwide cohort in Finland.

    Design, Setting, Participants, & Measurements: Altogether, 3249 adult recipients of a first kidney transplant from 1990 to 2012 were included. Read More

    Utility of Electronic Medical Record Alerts to Prevent Drug Nephrotoxicity.
    Clin J Am Soc Nephrol 2018 Apr 5. Epub 2018 Apr 5.
    Program of Applied Translational Research, Yale School of Medicine, New Haven, Connecticut; and
    Nephrotoxin-induced AKI is an iatrogenic form of AKI that can be potentially avoided or ameliorated by prompt recognition and appropriate prescriber actions. Drug-targeted alerts, either for patients at risk of AKI or patients with existing AKI, may lead to more appropriate drug dosing and management and improved clinical outcomes. However, alerts of this type are complicated to create, have a high potential for error and off-target effects, and may be difficult to evaluate. Read More

    Nephrotoxicity and Chinese Herbal Medicine.
    Clin J Am Soc Nephrol 2018 Apr 3. Epub 2018 Apr 3.
    International Renal Research Institute of Vicenza and
    Chinese herbal medicine has been practiced for the prevention, treatment, and cure of diseases for thousands of years. Herbal medicine involves the use of natural compounds, which have relatively complex active ingredients with varying degrees of side effects. Some of these herbal medicines are known to cause nephrotoxicity, which can be overlooked by physicians and patients due to the belief that herbal medications are innocuous. Read More

    Time-Centered Approach to Understanding Risk Factors for the Progression of CKD.
    Clin J Am Soc Nephrol 2018 May 30;13(5):693-701. Epub 2018 Mar 30.
    Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
    Background And Objectives: Traditional approaches to modeling risk of CKD progression do not provide estimates of the time it takes for disease progression to occur, which could be useful in guiding therapeutic interactions between patients and providers. Our objective was to estimate median time spent in each of CKD stages 3a-5 and how the time differs according to risk factors associated with progression of disease.

    Design, Setting, Participants, & Measurements: We included 3682 participants of the Chronic Renal Insufficiency Cohort in mixed models to estimate person-specific trajectories of function, and used these trajectories to estimate time spent in each CKD stage. Read More

    Concentrations of Trace Elements and Clinical Outcomes in Hemodialysis Patients: A Prospective Cohort Study.
    Clin J Am Soc Nephrol 2018 Mar 29. Epub 2018 Mar 29.
    Physiology and Pharmacology, University of Calgary, Calgary, Canada.
    Background And Objectives: Deficiency of essential trace elements and excess of potentially toxic trace elements are common in patients on hemodialysis. Whether these abnormalities are associated with poor outcomes is unknown but worth investigating, because they are potentially treatable.

    Design, Setting, Participants, & Measurements: We did a prospective longitudinal study of 1278 patients on incident hemodialysis, assessing blood concentrations of 25 trace elements at baseline. Read More

    Identification of Patients Expected to Benefit from Electronic Alerts for Acute Kidney Injury.
    Clin J Am Soc Nephrol 2018 Mar 29. Epub 2018 Mar 29.
    Program of Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut;
    Background And Objectives: Electronic alerts for heterogenous conditions such as AKI may not provide benefit for all eligible patients and can lead to alert fatigue, suggesting that personalized alert targeting may be useful. Uplift-based alert targeting may be superior to purely prognostic-targeting of interventions because uplift models assess marginal treatment effect rather than likelihood of outcome.

    Design, Setting, Participants, & Measurements: This is a secondary analysis of a clinical trial of 2278 adult patients with AKI randomized to an automated, electronic alert system versus usual care. Read More

    Transplant Center Patient Navigator and Access to Transplantation among High-Risk Population: A Randomized, Controlled Trial.
    Clin J Am Soc Nephrol 2018 Apr 26;13(4):620-627. Epub 2018 Mar 26.
    Division of Transplantation, Department of Surgery and
    Background And Objectives: Barriers exist in access to kidney transplantation, where minority and patients with low socioeconomic status are less likely to complete transplant evaluation. The purpose of this study was to examine the effectiveness of a transplant center-based patient navigator in helping patients at high risk of dropping out of the transplant evaluation process access the kidney transplant waiting list.

    Design, Setting, Participants & Measurements: We conducted a randomized, controlled trial of 401 patients (=196 intervention and =205 control) referred for kidney transplant evaluation (January 2013 to August 2014; followed through May 2016) at a single center. Read More

    Add-On Antihypertensive Medications to Angiotensin-Aldosterone System Blockers in Diabetes: A Comparative Effectiveness Study.
    Clin J Am Soc Nephrol 2018 May 23;13(5):727-734. Epub 2018 Mar 23.
    Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado.
    Background And Objectives: In individuals with diabetes, the comparative effectiveness of add-on antihypertensive medications added to an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker on the risk of significant kidney events is unknown.

    Design, Setting Participants, & Measurements: We used an observational, multicenter cohort of 21,897 individuals with diabetes to compare individuals who added -blockers, dihydropyridine calcium channel blockers, loop diuretics, or thiazide diuretics to angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. We examined the hazard of significant kidney events, cardiovascular events, and death using Cox proportional hazard models with propensity score weighting. Read More

    Systems Thinking and Leadership: How Nephrologists Can Transform Dialysis Safety to Prevent Infections.
    Clin J Am Soc Nephrol 2018 Apr 22;13(4):655-662. Epub 2018 Mar 22.
    Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio
    Infections are the second leading cause of death for patients with ESKD. Despite multiple efforts, nephrologists have been unable to prevent infections in dialysis facilities. The American Society of Nephrology and the Centers for Disease Control and Prevention have partnered to create Nephrologists Transforming Dialysis Safety to promote nephrologist leadership and engagement in efforts to "Target Zero" preventable dialysis infections. Read More

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