Highlights from the August 2021 Issue
Editor’s Note: We asked authors of Original Investigations to provide short plain-language summaries that would briefly summarize what inspired their study, the basic approach taken, what was learned, and why it matters. We hope our readers will find this valuable in helping them keep up with the latest research in the field of nephrology. From theAugust 2021问题：
CKD Progression in Medicare Beneficiaries With Nonvalvular Atrial Fibrillation Treated With Apixaban Versus WarfarinJames B. Wetmore等人
来自作者：Warfarin may be injurious to kidney health. We hypothesized that, in patients with CKD and atrial ﬁbrillation, apixaban, a direct oral anticoagulant, would be associated with a lower risk of worsening of CKD and development of kidney failure than warfarin. Using data from Medicare and weighted regression to control for differences between groups in known characteristics, we compared patients using apixaban with those using warfarin. We found that apixaban was associated with a lower risk of worsening of CKD stage than warfarin. Apixaban may be less harmful to kidney health than warfarin, making it a potentially attractive treatment option in older patients with CKD and atrial ﬁbrillation, but more clinical trial data are needed.
Editorial:Is Warfarin Being Relegated to the Pharmaceutical Dustbin?by Ziv Harel and Manish M. Sood[FREE]
男性和女人的CKD进展和死亡率：瑞典的全国研究by Oskar Swartling et al[开放访问]
来自作者：Women are overrepresented in the early chronic kidney disease (CKD) population. Recent evidence has found sex-speciﬁc differences in CKD progression and mortality. However, those studies have mostly been general population cohorts or smaller risk cohorts. The present study used a national CKD registry in Sweden that included all nephrology outpatient visits from 2008-2018 with CKD stages 3b-5. Women were found to be less likely to progress by 1 CKD stage or start kidney replacement therapy, and had a slower loss of eGFR per year, with differences also in primary renal diagnoses. In addition, women overall had lower all-cause and cardiovascular mortality. Understanding sex differences in CKD outcomes are central for kidney disease planning and prevention.
Editorial:性别和性别是否在肾脏和心血管疾病中？by Sofia B. Ahmed and Sandra M. Dumanski[FREE]
Sex Differences in Cardiovascular Outcomes in CKD: Findings From the CRIC Studyby Stephanie M. Toth-Manikowski et al
Editorial:性别和性别是否在肾脏和心血管疾病中？by Sofia B. Ahmed and Sandra M. Dumanski[FREE]
Assessing the Relationship Between Serum Urate and Urolithiasis Using Mendelian Randomization: An Analysis of the UK Biobankby Ravi K. Narang et al
来自作者：An association between serum urate level and urinary system stones has been previously reported in multiple observational studies, but these are subject to residual confounding. Mendelian randomization is a statistical genetics technique that permits cause and effect to be disentangled in the presence of confounding. In the UK Biobank resource, which includes 359,827 participants, we implemented Mendelian randomization and found no causal effect of serum urate level on stones. This suggests that serum urate does not play a causal role in the pathogenesis of stones and that previously reported associations between serum urate and stones were due to residual confounding.
Concurrent Anti–Glomerular Basement Membrane Antibody Disease and Membranous Nephropathy: A Case Series由Syeda B. Ahmad等人
来自作者：Anti–glomerular basement membrane (GBM) disease is a rapidly progressive glomerulopathy that can occur in conjunction with membranous nephropathy on rare occasions. Our aim was to characterize patients with this clinical presentation and describe their outcomes. We examined the kidney pathology database at Columbia University Medical Center from 2001-2019 and found 12 such cases. Treatment was largely focused on anti-GBM disease and was heterogeneous. Kidney disease outcomes were poor, with most patients requiring kidney replacement therapy (eg, maintenance dialysis or transplantation).
分泌溶质和心血管事件的肾脏清除之间的关联：慢性肾功能不全队列（CRIC）研究by Yan Chen et al
来自作者：保留肾脏消除毒素2》sms: glomerular ﬁltration and tubular secretion. Yet, current assessment of kidney function is based primarily on measurements of glomerular ﬁltration. We developed a novel procedure to measure kidney tubular secretory clearance. We estimated this kidney function in a national cohort study of patients with chronic kidney disease (CKD). We found that lower kidney clearances of secretory solutes was associated with greater risks of incident heart failure and myocardial infarction but not stroke, over long-term follow-up. However, these associations were removed by adjustment for the estimated glomerular ﬁltration rate. These ﬁndings suggest that tubular secretory clearance provides little additional information about the development of cardiovascular disease beyond glomerular measures in mild-to-moderate CKD.
通过特定于捐助者的风险问卷来量化潜在的活肾脏供体之间的风险承受能力by Carrie Thiessen et al[开放访问]
老年人的非酯化脂肪酸和肾功能下降：心血管健康研究的发现由Carl P. Walther等人
来自作者：Circulating nonesteriﬁed fatty acids (also called free fatty acids), substances in the blood derived from food and from the body’s metabolism, are important energy sources for the kidneys and other organs. However, they could cause injury to organs if their levels are too high. We investigated whether high levels were associated with worsened kidney function over the long term. We did not ﬁnd that high levels were associated with worsened kidney function, after other things that affect kidney function (such as diabetes and arterial disease) were adjusted for. This may be because certain types of nonesteriﬁed fatty acids may be harmful to the kidneys while others may be protective.
Policy Forum Editorial from theAugust 2021Issue:
Inpatient Dialysis Services: Nephrologist Leadership and Improving Quality and Safety由Kamyar Kalantar-Zadeh等人[FREE]
来自作者：Despite the high level of complexity of inpatient dialysis therapies, currently there is no CMS or other governing body regulation that describes the qualifications and responsibilities for physician leadership oversight for kidney replacement therapy (KRT) performed in hospitalized patients. The heterogeneity of presentations of patients requiring dialysis therapies in hospitals, the acuity level of such patients, and the complexity of available KRT modalities mandate a well-functioning inpatient dialysis therapy service, with a high level of expertise, led and staffed by qualified personnel. We believe that inpatient dialysis services should function under the oversight of qualified physician leader, specifically a qualified and experienced nephrologist, with defined areas of responsibility and accountability related to quality assurance and safe practice of dialysis and hemofiltration therapies.
On the Cover:Sexual dimorphism in nature can be dramatic. Take, for example, the case of theeclectus parrot;当欧洲鸟类学家首先遇到这些美丽的鸟类时，他们认为男性和女性是2种不同的物种。尽管人类可能不会在性别之间表现出如此巨大的差异，但男女可能会遇到CKD进展和与CKD相关的结果的不同差异。这些问题是在本月发行的3篇文章中探讨的问题ajkd:Swartling et alexplore CKD progression and mortality among men and women in Sweden,Toth-Manikowski et alinvestigate differences in cardiovascular outcomes, andAhmed & Dumanskidiscuss the implications of these findings.
The photograph “Eclectus Parrots” by Paul Balfe is released on Flickr under the CC BY 2.0 license.
NephMadness 2022: Call for Topic Suggestions
NephMadness 2021 just wrapped up, but it’s already time to start planning NephMadness 2022! Which topics would you like to see in next year’s edition of the madness? Now is the time to let us know!