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| This Month in AJKD | |
Low adherence to antihypertensive medication is a significant obstacle to achieving blood pressure control, and few data are available for medication adherence in adults with CKD. In this issue, Muntner et al conducted a cross-sectional analysis of data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. They describe an overall medication adherence rate of only 69% among CKD patients, as assessed using a validated 4-Item Morisky scale. In an editorial, Drs Chang and Winkelmayer describe the limitations of self-report questionnaires like the 4-Item Morisky scale and stress that technologic and computing advances, such as electronically tracking pharmacy fill data, may lead to improved ways to measure medication adherence. Finally, a review by Drs Browne and Merighi examines the barriers to patient self-management of oral medications and offers recommendations for an interdisciplinary program that focuses on the patient as an integral member of the dialysis health care team.
| Gadolinium for Magnetic Resonance Imaging in CKD
See Kim et al, pages 458-467; and Martin, pages 427-430.
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Exposure to gadolinium has been linked to the development of nephrogenic systemic fibrosis in patients with kidney disease, prompting the US Food and Drug Administration to issue warnings against its use in this population. In this issue, Kim et al studied the impact of the FDA warnings on the use of gadolinium-enhanced magnetic resonance (GE-MR) studies in patients with decreased estimated GFR and the practice of measuring serum creatinine before gadolinium exposure. They found a 71% decrease in the rate of GE-MR use in patients with GFR <30 mL/min/1.73 m2 2 years after the first public health advisory. The proportion of GE-MR studies with serum creatinine measured within 1 month before the study increased by 99%. In an editorial, Dr Martin finds these results compelling, but believes an immediate goal should be to understand the relative differential risks for use of safer GE-MR protocols in patients who have severely decreased kidney function and to understand the relative risks of the alternatives.
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Infection is a significant cause of hospitalization and death in patients receiving dialysis, and few studies have examined the full range of infections experienced by these patients. In this issue, Dalrymple et al examine the types, rates, and risk factors for infection in older persons starting dialysis therapy. Of the 119,858 patients studied (aged 65-100 years, 7,401 on peritoneal dialysis), during a median follow-up of 1.9 years, infection-related diagnoses were observed in approximately 35% of all hospitalizations. Approximately 50% of patients had at least 1 infection-related hospitalization. Many of these infections were unrelated to dialysis access. In an “In Practice” review, Patel and colleagues describe the current epidemiologic characteristics of bloodstream infections in hemodialysis patients and effective prevention practices to decrease the incidence of these devastating infections. They conclude that the success of strategies aimed at improving adherence to currently recommended evidence-based practices will require continuous input of direct patient care staff to recognize barriers to implementation and develop local solutions to overcome them.
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Malnutrition, inflammation, and oxidative stress are inter-related mechanisms linked to the progression of cardiovascular disease and prognosis of long-term hemodialysis (HD) patients. In this issue, Kalousová et al examine the role of antioxidant vitamins and trace elements (retinol, retinol-binding protein, a-tocopherol, zinc, and selenium) and the relationship of their serum levels to the prognosis of 261 long-term HD patients. Of note, the authors observe that lower plasma concentrations of retinol (and lower retinol to retinol-binding protein ratio) were strong predictors of overall and cardiovascular mortality in this population. This is the first study showing a lower retinol level as an independent predictor of overall and cardiovascular mortality in HD patients. An editorial by Drs Ahmad and Himmelfarb suggests that, while novel, the study by Kalousová et al raises many questions, and they suggest that the antioxidant potential of retinol may warrant closer examination in HD patients.
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| | AJKD News |
As a result of AJKD’s new “author confirmation” system, all authors of accepted Original Investigations will now be contacted by email to confirm that that they fulfill the journal’s authorship requirements and have agreed to be listed on the published article. This step protects against inappropriate attributions, and is one more way AJKD helps both authors and readers maintain confidence in the publishing process.
According to the 2009 Journal Citation Reports®, published by Thomson Reuters, the 2009 impact factor for AJKD is 5.152! | NKF | 
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