Viewpoints

 
 
  • Could a VA Directive Overhaul Kidney Care? Directive 1053 may have gotten lost in the pandemic news, but it could have widespread implications for the management of CKD by nephrologists and primary care. Tejas Desai, MD, takes a closer look.
  • Hypertension in Pregnancy: Which Drug Is Best? Nephrologist Tejas Desai reviews one of the few randomized clinical trials to include pregnant women, comparing three drugs for the safe management of very high blood pressure.
  • COVID-19: Don't Forget About Plasmapheresis The strategy to filter out virions from infected plasma has been tested with the Middle East respiratory syndrome coronavirus. Why not consider it for SARS-CoV2, asks nephrologist Tejas Desai.
  • Salt Loading in ADHF -- Really? Hypertonic saline in acute decompensated heart failure promotes anxiety in physicians; however, a new study rekindles the idea of promoting natriuresis through increasing renal plasma flow.
  • Managing Hypervolemia: Is More Diuretic Better? Dr Tejas Desai compares the seemingly contradictory results of the DOSE and DRAIN trials of loop diuretics in acute decompensated heart failure.
  • AIN: Maybe Nephrologists Don't Know It All Are nephrologists too complacent about acute interstitial nephritis? Tejas Desai, MD, reviews recent data suggesting that AIN is on the rise and is a major contributor to acute kidney injury.
  • Do PPIs Increase the Risk for Renal Damage or Mortality? Dr Tejas Desai looks into the latest analysis on the potential adverse effects of proton pump inhibitors and asks whether de-escalation measures should be implemented.
  • Dialysis Industry Mergers: Profits Rise as Outcomes Worsen An economic analysis of the dialysis industry shows how the usual benefits of mergers are negated in the healthcare industry by imprudent financial incentives and lack of true competitive market forces.
  • Promising Biomarkers for Diabetic Nephropathy A big-data analysis identifies various glycolytic pathway enzymes, particularly PKM2, that could serve as potential therapeutic targets for diabetic kidney disease.
  • Does Kidney Disease Without AKI Warrant More Attention? An analysis from Canada suggests that acute kidney disease with 'subclinical' acute kidney injury may portend a worse outcome than previously thought.
  • Study Underscores Need for Long-term Follow-up After AKI Focusing on eGFR alone may underestimate long-term kidney damage in some patients with AKI, concludes Dr Nisha Bansal in reviewing a new study.
  • AKI Prediction Models: Room for Improvement Tejas Desai, MD, discusses the pros and cons of three models used to predict progression or regression of acute kidney injury.
  • Advancing American Kidney Health: The Ultimate RCT? President Trump's Executive Order puts nephrology center stage. Tejas Desai, MD, reviews what the initiative entails for kidney disease clinicians and what details are yet to come.
  • Out With the Old, in With the New: The Role of Novelty Bias Are we overenamored of new drugs and treatments at the expense of older, proven therapies? The recent hoopla over CREDENCE and SONAR set Tejas Desai, MD, to ponder novelty bias.
  • Phosphate Binders and Transport Inhibitors on FGF-23 in CKD Nisha Bansal, MD, reviews the COMBINE trial on nicotinamide and lanthanum carbonate and changes in phosphate and fibroblast growth factor-23 levels in patients with chronic kidney disease.
  • Renin or Lactate to Predict Hospital Death? A new proof- of-concept study underscores the need to find a reliable marker of microvascular hypoperfusion.
  • Urinary Oxalate and CKD Progression: Is There an Association? Dr Bansal reviews a study that examines whether higher urinary oxalate excretion predisposes patients to kidney disease progression.
  • No Firm Answers for Kidneys From LIRICO and VALID Studies Is dual RAS blockade in patients with diabetes with kidney disease beneficial? Dr Desai reviews two studies designed to answer that question.
  • Burden of CKD in the United States: What Have We Learned? Dr Desai discusses 'epi' studies aiming to identify underresourced areas that require more financial and human capital.
  • Two Therapies for Treating Depression in Dialysis Patients Dr Bansal describes a new study that compares CBT and sertraline for depressed patients on hemodialysis for end- stage renal disease.