Advances in Nephrology http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Fragility Fractures in Chronic Kidney Disease: Assessment and Pharmacologic Management Tue, 16 Sep 2014 11:36:28 +0000 http://www.hindawi.com/journals/an/2014/727135/ Fractures are common in all stages of chronic kidney disease (CKD), and are associated with increased morbidity and mortality. Both CKD and osteoporosis often coexist as they both are strongly age associated. However, the management of fragility fractures in CKD poses many dilemmas. These include diagnosing the aetiology of fractures and choosing appropriate treatment. This paper reviews the current evidence for the assessment and pharmacologic management of fragility fractures in CKD. Mahesan Anpalahan, Sudharsan Venkatesan, and Aksharaa Anpalahan Copyright © 2014 Mahesan Anpalahan et al. All rights reserved. Chronic Kidney Disease: Evolution of Healthcare Costs and Resource Consumption from Predialysis to Dialysis in Piedmont Region, Italy Tue, 16 Sep 2014 09:33:46 +0000 http://www.hindawi.com/journals/an/2014/680737/ This study aims at assessing the evolution in healthcare costs for chronic kidney disease (CKD) patients through the analysis of administrative databases of Piedmont region, Italy. This is a retrospective, observational study, for which patients undergoing at least one dialysis for CKD in the period of June 1, 2010–May 31, 2011 were selected. Two subpopulations were evaluated: patients incident-to-dialysis observed for the 12 months preceding dialysis entrance (PreD) and “established” dialysis patients (at least 120 dialyses/year) observed for 12 months (EstD). Overall, 1,059 PreD and 2,018 EstD patients were selected. The average yearly cost per PreD patient accounted for 11,123€ ± 15,095€ (75% hospitalizations, 17% drugs, and 8% diagnostic/therapeutic procedures). The average yearly cost per EstD patient accounted for 53,764€ ± 14,685€ (59% dialysis, 21% diagnostic/therapeutic procedures, 13% hospitalizations, and 6.7% drugs). Among EstD population, hemodialysis patients cost 56,049€ ± 13,473€ per year, whereas peritoneal dialysis patients cost 34,978€ ± 10,847€ per year. The significant difference in expenditure between predialysis and dialysis suggests that prevention, early diagnosis, and the consequent possible delay of dialysis entrance could lead to important savings for healthcare services, as well as a better global health status for patients. Daniela Paola Roggeri, Alessandro Roggeri, and Mario Salomone Copyright © 2014 Daniela Paola Roggeri et al. All rights reserved. Risk Factors of Arterial Damage Assessed by ABI and baPWV among Hemodialysis Patients in Macau Tue, 09 Sep 2014 08:38:15 +0000 http://www.hindawi.com/journals/an/2014/743174/ Cardiovascular disease (CVD) is the leading cause of mortality and morbidity among patients with ESRD on chronic dialysis. Arterial damage is one of the characteristics of CVD. But the association between arterial damage and conventional risk factors for CVD has not yet been fully highlighted in chronic hemodialysis patients. Here we validate the clinical value of assessment of arterial damage by ABI and PWV in chronic hemodialysis patients in Macau. Mingxin Li, Jing Xin, Ding-Wei Kuang, Un-I Kuok, Chiu-Leong Li, Kin Cheung, and Weng-In Lio Copyright © 2014 Mingxin Li et al. All rights reserved. Calcium Carbonate versus Sevelamer Hydrochloride as Phosphate Binders after Long-Term Disease Progression in 5/6 Nephrectomized Rats Sun, 24 Aug 2014 07:56:52 +0000 http://www.hindawi.com/journals/an/2014/538392/ Our aim was to compare the effects of calcium carbonate and sevelamer-HCl treatments on calcium-phosphate metabolism and renal function in 5/6 nephrectomized (NX) rats so that long-term disease progression preceded the treatment. After 15-week progression, calcium carbonate (3.0%), sevelamer-HCl (3.0%), or control diets (0.3% calcium) were given for 9 weeks. Subtotal nephrectomy reduced creatinine clearance (−40%), plasma calcidiol (−25%), and calcitriol (−70%) and increased phosphate (+37%), parathyroid hormone (PTH) (11-fold), and fibroblast growth factor-23 (FGF-23) (4-fold). In NX rats, calcium carbonate diet increased plasma (+20%) and urinary calcium (6-fold), reduced plasma phosphate (−50%) and calcidiol (−30%), decreased creatinine clearance (−35%) and FGF 23 (−85%), and suppressed PTH without influencing blood pH. In NX rats, sevelamer-HCl increased urinary calcium (4-fold) and decreased creatinine clearance (−45%), PTH (−75%), blood pH (by 0.20 units), plasma calcidiol (−40%), and calcitriol (−65%). Plasma phosphate and FGF-23 were unchanged. In conclusion, when initiated after long-term progression of experimental renal insufficiency, calcium carbonate diet reduced plasma phosphate and FGF-23 while sevelamer-HCl did not. The former induced hypercalcemia, the latter induced acidosis, while both treatments reduced vitamin D metabolites and deteriorated renal function. Thus, delayed initiation influences the effects of these phosphate binders in remnant kidney rats. Suvi Törmänen, Arttu Eräranta, Asko Riutta, Peeter Kööbi, Teemu Honkanen, Emmanouil Karavalakis, Onni Niemelä, Heikki Tokola, Heikki Ruskoaho, Jukka Mustonen, and Ilkka Pörsti Copyright © 2014 Suvi Törmänen et al. All rights reserved. Association between Severity of Anemia and 30-Day Readmission Rate: Archival Data of 847 Patients with Acute Decompensated Heart Failure Mon, 14 Jul 2014 13:35:27 +0000 http://www.hindawi.com/journals/an/2014/261531/ Hospitals today are facing adjustments to reimbursements from excessive readmission rates. One of the most common and expensive causes of readmissions is exacerbation of a heart failure condition. The objective of this paper was to determine if there was an association between the presence of anemia in patients with acute decompensated heart failure and their readmission rate. Using archival data of 4 hospitals in the Miami area, a sample of 847 inpatients with a diagnostic related group (DRG) of HF at discharge was considered. There was a significant association between low hemoglobin values and a high rate of readmissions at 14 days and at 30 days in subjects with normal sodium and creatinine values. For subjects with low sodium and high creatinine values, a higher readmission rate was seen in men with low hemoglobin but not in women. These results support a prospective effort to measure the impact of anemia and its treatment on readmission rates. Jorge C. Busse, Tanya M. Cohn, Rosalina Butao, and Julie Lamoureux Copyright © 2014 Jorge C. Busse et al. All rights reserved. Rho-GTPase Signalling in the Pathogenesis of Nephrotic Syndrome Sun, 15 Jun 2014 06:25:11 +0000 http://www.hindawi.com/journals/an/2014/903158/ Nephrotic syndrome (NS) is characterized by heavy proteinuria, hypoalbuminemia, and edema. The underlying causes of NS are diverse and are tied to inheritable and environmental factors. A common diagnostic marker for NS is effacement of podocyte foot processes. The formation and maintenance of foot processes are under the control of many signalling molecules including Rho-GTPases. Our knowledge of Rho-GTPases is based largely on the functions of three prototypic members: RhoA, Rac1, and Cdc42. In the event of podocyte injury, the rearrangement to the actin cytoskeleton is orchestrated largely by this family of proteins. The importance of maintaining proper actin dynamics in podocytes has led to much investigation as to how Rho-GTPases and their regulatory molecules form and maintain foot processes as a critical component of the kidney’s filtration barrier. Modern sequencing techniques have allowed for the identification of novel disease causing mutations in genes such as ARHGDIA, encoding Rho-GDIα. Continued use of whole exome sequencing has the potential to lead to the identification of new mutations in genes encoding Rho-GTPases or their regulatory proteins. Expanding our knowledge of the dynamic regulation of the actin network by Rho-GTPases in podocytes will pave the way for effective therapeutic options for NS patients. Richard Robins and Tomoko Takano Copyright © 2014 Richard Robins and Tomoko Takano. All rights reserved. Managing End-Stage Renal Disease in Older Patients: A Single Centre Experience with Renal Transplantation in the Elderly Tue, 25 Mar 2014 07:45:23 +0000 http://www.hindawi.com/journals/an/2014/516381/ The increase of patients developing end-stage renal disease (ESRD) has occurred predominantly in the older adult population. As a consequence, the nephrologists will need to decide whom of these older patients are siutable for transplantation. There are very few absolute contraindications, such as active infection and recent malignancy, but there are many relative or potential contraindications in older patients. Worldwide, organs available for transplantation are limited. Some centers are reluctant to use organs from expanded criteria donors also in elderly recipients. This leads to long waiting lists and many older patients will die while they are waiting for an organ. It is vital that the patients who are accepted for renal transplantation are those who will derive most benefit, and correct selection of patients and donor organs is therefore of outmost importance. This paper describes the previous and planned research our research group has performed with focus on older renal transplant recipients with special emphasis on survival, basic immunosuppression, selection of organs, and health related quality of life. Karsten Midtvedt, Kjersti Lønning, and Kristian Heldal Copyright © 2014 Karsten Midtvedt et al. All rights reserved.