Editorial issue 234

Vascular access hemorrhages contribute to deaths among hemodialysis patients


After a hopefully restful summer vacation  it is now time to take part in the 234th issue of NDT-E in which you will find a couple of interesting full papers from Kidney International, Nephrology Dialysis and Transplantation and J Nephrology to read. In the first paper published in Kidney IntKatherine Ellingson et al. retrospectively examined the epidemiology of fatal vascular access hemorrhages in hemodialysis patients and found that risk factors for such events included the presence of an arteriovenous graft, access-related complications within 6 months of death, and hypertension; presence of a central venous catheter was significantly protective. In another paper published in Kidney Int Cortney Bosworth et al. demonstrated that chronic kidney disease is a state of stagnant vitamin D metabolism characterized by decreases in both 1,25(OH)2D production and vitamin D catabolism. You will also be able to read an article published in the Public forum of Kidney Int about the Iranian model of living renal transplantation by Mitra Mahdavi-Mazdeh. This issue of NDT-E also includes an interesting narrative review by Mariacristina Vecchio et al. published in NDT on the important issue of depression and sexual dysfunction in chronic kidney disease. You will also find an original publication by Tora Almquist et al. on a randomized trial in 18 patients showing that the combination simvastatin + ezetimibe decreased platelet–leukocyte aggregation and plasma sCD40L in diabetic patients with CKD. Chronic kidney disease is found at epidemic levels in certain populations of the Pacific Coast in northwestern Nicaragua especially in younger men. It is therefore of interest that Timothy Laux et al. in a paper published in J Nephrology showed a much lower prevalence of chronic kidney disease in a high-altitude, coffee-growing village compared to portions of northwestern Nicaragua. Thus, there is heterogeneity in the prevalence of chronic kidney disease across Nicaragua.


In this issue of NDT-E you will also find four of the remaining oral presentations from the ERA-EDTA meeting in Prague 2011. In the first talkGünter Breithardt, Münster, Germany will discuss “ATRIAL FIBRILLATION AND ORAL ANTICOAGULANTS” and present a useful algorithm for the use oral anticoagulation in atrial fibrillation and CKD. The 2nd talk is presented by Kerstin Amann, Erlangen, Germany, who will discuss “SYMPATHATIC OVERACTIVITY IN CKD: MECHANISMS AND CLINICAL IMPLICATIONS”. The important issue of “SUDDEN DEATH IN CHRONIC KIDNEY DISEASE - A NEGLECTED PRIORITY FOR INTERVENTION” is presented by David Goldsmith, London, UK. In his talk Dr. Goldsmith discusses implantable defibrillators, and states that about 70% of all dialysis patients with arrhythmia do not fulfill current usage criteria. In the final talk, Prof Carmine Zoccali, Reggio Calabria, Italy discusses “BIOMARKERS OF SYMPATHETIC ACTIVITY AND CARDIOVASCULAR RISK IN CKD”. Dr. Zoccali concludes that statistical modeling suggests that high sympathetic activity and high ADMA are in the same pathway conducive to left ventricular hypertrophy.


Do not forget to test your knowledge on nutritional recommendations and food choices for patients with chronic kidney disease in the survey and study the case report on “Pain in the fistula hand” by Klara Paudel.


Enjoy your NDT-E!


Peter Stenvinkel, Editor in Chief NDT-Educational