American Journal of Kidney Diseases (Am J Kidney Dis )

Publisher: National Kidney Foundation

Description

American Journal of Kidney Diseases not only publishes a broad range of clinical and basic investigations in human renal function but also describes the impact of the advances on clinical practice. Coverage encompasses applied physiology, dialysis/chronic uremia, hypertension, urology, pathology, and transplantation. In addition to peer-reviewed original articles and case reports, the Journal includes regular features such as in-depth reviews of relevant clinical topics; presentation and discussion of renal biopsy teaching cases; discussion and analysis of important recent articles; and forum discussions of ethical, moral, and legal issues related to kidney disease. The Journal's website includes such exclusive features as "Atlas of Renal Pathology," CME exercises, clinical nephrology teaching cases, and web-only case reports.

  • Impact factor
    5.29
  • 5-year impact
    5.42
  • Cited half-life
    8.60
  • Immediacy index
    1.72
  • Eigenfactor
    0.04
  • Article influence
    1.93
  • Website
    American Journal of Kidney Diseases website
  • Other titles
    American journal of kidney diseases (Online), American journal of kidney diseases, AJKD
  • ISSN
    1523-6838
  • OCLC
    40756717
  • Material type
    Document, Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: http://www.ajkd.org/article/S0272-6386(14)01262-1/abstract
    American Journal of Kidney Diseases 12/2014; 64(6):1000.
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    ABSTRACT: Exercise capacity, which is predictive of all-cause mortality and cardiovascular disease risk, is reduced significantly in patients with non-dialysis-dependent chronic kidney disease. This pilot study examined the effect of moderate-intensity exercise training on kidney function and indexes of cardiovascular risk in patients with progressive chronic kidney disease stages 3 to 4.
    American Journal of Kidney Diseases 09/2014;
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    ABSTRACT: Background No comprehensive systematic review of the accuracy of glomerular filtration rate (GFR) measurement methods using renal inulin clearance as reference has been published. Study Design Systematic review with meta-analysis of cross-sectional diagnostic studies. Setting & Population Published original studies and systematic reviews in any population. Selection Criteria for Studies Index and reference measurements conducted within 48 hours; at least 15 participants studied; GFR markers measured in plasma or urine; plasma clearance calculation algorithm verified in another study; tubular secretion of creatinine had not been blocked by medicines. Index Tests Endogenous creatinine clearance; renal or plasma clearance of chromium 51−labeled ethylenediaminetetraacetic acid (51Cr-EDTA), diethylenetriaminepentaacetic acid (DTPA), iohexol, and iothalamate; and plasma clearance of inulin. Reference Test Renal inulin clearance measured under continuous inulin infusion and urine collection. Results Mean bias < 10%, median bias < 5%, the proportion of errors in the index measurements that did not exceed 30% (P30) ≥ 80%, and P10 ≥ 50% were set as requirements for sufficient accuracy. Based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach, the quality of evidence across studies was rated for each index method. Renal clearance of iothalamate measured GFR with sufficient accuracy (strong evidence). Renal and plasma clearance of 51Cr-EDTA and plasma clearance of iohexol were sufficiently accurate to measure GFR (moderately strong evidence). Renal clearance of DTPA, renal clearance of iohexol, and plasma clearance of inulin had sufficient accuracy (limited evidence). Endogenous creatinine clearance was an inaccurate method (strong evidence), as was plasma clearance of DTPA (limited evidence). The evidence to determine the accuracy of plasma iothalamate clearance was insufficient. With the exception of plasma clearance of inulin only, renal clearance methods had P30 > 90%. Limitations The included studies were few and most were old and small, which may limit generalizability. Requirements for sufficient accuracy may depend on clinical setting. Conclusions At least moderately strong evidence suggests that renal clearance of 51Cr-EDTA or iothalamate and plasma clearance of 51Cr-EDTA or iohexol are sufficiently accurate methods to measure GFR.
    American Journal of Kidney Diseases 09/2014;
  • American Journal of Kidney Diseases 07/2014;
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    ABSTRACT: Background The benefit of a primary prevention implantable cardioverter-defibrillator (ICD) among patients with chronic kidney disease is uncertain. Study Design Meta-analysis of patient-level data from randomized controlled trials. Setting & Population Patients with symptomatic heart failure and left ventricular ejection fraction < 35%. Selection Criteria for Studies From 7 available randomized controlled studies with patient-level data, we selected studies with available data for important covariates. Studies without patient-level data for baseline estimated glomerular filtration rate (eGFR) were excluded. Intervention Primary prevention ICD versus usual care effect modification by eGFR. Outcomes Mortality, rehospitalizations, and effect modification by eGFR. Results We included data from the Multicenter Automatic Defibrillator Implantation Trial I (MADIT-I), MADIT-II, and the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT). 2,867 patients were included; 36.3% had eGFR < 60 mL/min/1.73 m2. Kaplan-Meier estimate of the probability of death during follow-up was 43.3% for 1,334 patients receiving usual care and 35.8% for 1,533 ICD recipients. After adjustment for baseline differences, there was evidence that the survival benefit of ICDs in comparison to usual care depends on eGFR (posterior probability for null interaction P < 0.001). The ICD was associated with survival benefit for patients with eGFR ≥ 60 mL/min/1.73 m2 (adjusted HR, 0.49; 95% posterior credible interval, 0.24-0.95), but not for patients with eGFR < 60 mL/min/1.73 m2 (adjusted HR, 0.80; 95% posterior credible interval, 0.40-1.53). eGFR did not modify the association between the ICD and rehospitalizations. Limitations Few patients with eGFR < 30 mL/min/1.73 m2 were available. Differences in trial-to-trial measurement techniques may lead to residual confounding. Conclusions Reductions in baseline eGFR decrease the survival benefit associated with the ICD. These findings should be confirmed by additional studies specifically targeting patients with varying eGFRs.
    American Journal of Kidney Diseases 07/2014;
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    ABSTRACT: Background Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is a potentially powerful tool for analysis of kidney structure and function. The ability to measure functional and hypofunctional tissues could provide important information in groups at risk for chronic kidney disease (CKD), such as the elderly. Study Design Observational study with a cross-sectional design. Setting & Participants 493 volunteers (aged 72-94 years; 278 women; mean estimated glomerular filtration rate [eGFR], 67 ± 15 mL/min/1.73 m2; 40% with CKD) in the Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study. Predictor DCE-MRI kidney segmentation data. Outcomes & Measurements eGFR, urine albumin-creatinine ratio (ACR), and risk factors for and complications of CKD. Results After adjustment for age, sex, and height, eGFR was related to kidney volume (ΔR² = 0.19; P < 0.001), cortex volume (ΔR² = 0.14; P < 0.001), medulla volume (ΔR² = 0.18; P < 0.001), and volume percentages of fibrosis (ΔR² = 0.03; P < 0.001) and fat (ΔR² = 0.01; P = 0.03). In similarly adjusted models, log(ACR) was related to kidney volume (ΔR² = 0.02; P < 0.001) and fibrosis volume percentage (ΔR² = 0.03; P < 0.001). Using multivariable regression models adjusted for eGFR, ACR, age, sex, and height, kidney volume was related positively to body mass index (B = 29.9 ± 2.1 [SE] mL; P < 0.001), smoking (B = 19.7 ± 7.7 mL; P = 0.01), and diabetes mellitus (B = 14.8 ± 7.1 mL; P = 0.04) and negatively to hematocrit (B = −4.4 ± 2.1 mL; P = 0.04 [model R² = 0.72; P < 0.001]); relations were per 1-SD greater value of the variable. Fibrosis volume percentage was associated positively with body mass index (B = 0.28 ± 0.03; P < 0.001), cardiac output (B = 0.15 ± 0.03; P < 0.001), and heart rate (B = 0.08 ± 0.03; P = 0.01) and negatively with hematocrit (B = −0.07 ± 0.3; P = 0.02) and augmentation index (B = −0.06 ± 0.03; P = 0.04 [model R² = 0.49; P < 0.001]); again, relations are per 1-SD greater value of the variable. Limitations Automatic segmentations were not validated by histology. The limited age range prevented meaningful interpretation of age effects on measured data or the automatic segmentation procedure. Conclusions Kidney volume, cortex volume, and hypofunctional volume fraction assessed by DCE-MRI may provide information about CKD risk and prognosis beyond that provided by eGFR and urine ACR.
    American Journal of Kidney Diseases 07/2014;
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    ABSTRACT: Background Whether convective modalities of dialysis, including hemofiltration (HF) and hemodiafiltration (HDF), improve cardiovascular outcomes and mortality is unclear. Study Design Systematic review and meta-analysis. Setting & Population Patients receiving HDF, HF, or standard hemodialysis (HD). Selection Criteria for Studies Randomized controlled trials. Intervention Convective modalities of dialysis (HDF and HF) versus standard HD. Outcomes The primary outcome was clinical cardiovascular outcomes. Secondary outcomes were all-cause mortality, episodes of symptomatic hypotension, dialysis adequacy, and β2-microglobulin level. Relative risks (RRs) or weighted mean differences with 95% CIs for individual trials were pooled using random-effects models. Results The search yielded 16 trials including 3,220 patients. Therapies assessed were convective modalities (HDF or HF) compared with standard HD. Compared with HD, convective modalities did not significantly reduce the risk of cardiovascular events (RR, 0.85; 95% CI, 0.66-1.10) or all-cause mortality (RR, 0.83; 95% CI, 0.65-1.05). Convective modalities reduced symptomatic hypotension (RR, 0.49; 95% CI, 0.30-0.81) and improved serum β2-microglobulin levels (−5.95 mg/L; 95% CI, −10.27 to −1.64), but had no impact on small-molecule clearance (weighted mean difference in Kt/V, 0.04; 95% CI, −0.04 to 0.12). There was a nonsignificant trend to a greater likelihood of receiving a kidney transplant for participants allocated to filtration therapies (RR, 1.19; 95% CI, 0.99-1.42). Limitations The trials were predominantly of suboptimal quality and underpowered, with imbalance in some prognostic variables at baseline. Intention-to-treat analysis was not used in some trials. Our analysis was limited to published outcomes. Conclusions The potential benefits of convective modalities over standard HD for cardiovascular outcomes and mortality remain unproved. Further high-quality randomized trials are needed to define the impact of these modalities on clinically important outcomes.
    American Journal of Kidney Diseases 06/2014;
  • American Journal of Kidney Diseases 06/2014;
  • American Journal of Kidney Diseases 06/2014;
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    ABSTRACT: Information is limited regarding utilization patterns and costs for chronic kidney disease-mineral and bone disorder (CKD-MBD) medications in Medicare Part D-enrolled dialysis patients. Retrospective cohort study. Annual cohorts of dialysis patients, 2007-2010. Cohort year, low-income subsidy status, and dialysis provider. Utilization and costs of prescription phosphate binders, oral and intravenous vitamin D analogues, and cinacalcet. Using logistic regression, we calculated adjusted odds of medication use for low-income subsidy versus non-low-income subsidy patients and for patients from various dialysis organizations, and we report per-member-per-month and average out-of-pocket costs. Phosphate binders (∼83%) and intravenous vitamin D (77.5%-79.3%) were the most commonly used CKD-MBD medications in 2007 through 2010. The adjusted odds of prescription phosphate-binder, intravenous vitamin D, and cinacalcet use were significantly higher for low-income subsidy than for non-low-income subsidy patients. Total Part D versus CKD-MBD Part D medication costs increased 22% versus 36% from 2007 to 2010. For Part D-enrolled dialysis patients, CKD-MBD medications represented ∼50% of overall net Part D costs in 2010. Inability to describe utilization and costs of calcium carbonate, an over-the-counter agent not covered under Medicare Part D; inability to reliably identify prescriptions filled through a non-Part D reimbursement or payment mechanism; findings may not apply to dialysis patients without Medicare Part D benefits or with Medicare Advantage plans, or to pediatric dialysis patients; could identify only prescription drugs dispensed in the outpatient setting; inability to adjust for MBD laboratory values. Part D net costs for CKD-MBD medications increased at a faster rate than costs for all Part D medications in dialysis patients despite relatively stable use within medication classes. In a bundled environment, there may be incentives to shift to generic phosphate binders and reduce cinacalcet use.
    American Journal of Kidney Diseases 05/2014;
  • American Journal of Kidney Diseases 05/2014;
  • American Journal of Kidney Diseases 05/2014;
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    ABSTRACT: Because transfusion avoidance has been the cornerstone of anemia treatment for patients with kidney disease, direct measurement of red blood cell transfusion use to assess dialysis facility anemia management performance is reasonable. We aimed to explore methods for estimating facility-level standardized transfusion ratios (STfRs) to assess provider anemia treatment practices. Retrospective cohort study. Point prevalent US hemodialysis patients on January 1, 2009, with Medicare as primary payer and dialysis duration of 90 days or longer were included (n=223,901). All dialysis facilities with eligible patients were included (n=5,345). Dialysis facility assignment. Receiving a red blood cell transfusion in the inpatient or outpatient setting. We evaluated 3 approaches for estimating STfR: ratio of observed to expected numbers of transfusions (STfRobs), a Bayesian approach (STfRBayes), and a modified version of the Bayesian approach (STfRmodBayes). The overall national transfusion rate in 2009 was 23.2 per 100 patient-years. Our model for predicting the expected number of transfusions performed well. For large facilities, all 3 STfRs worked well. However, for small facilities, while the STfRmodBayes worked well, STfRobs values demonstrated instability and the STfRBayes may produce more bias. Administration of transfusions to dialysis patients reflects medical practice both within and outside the dialysis unit. Some transfusions may be deemed unavoidable and transfusion practices are subject to considerable regional variation. Development of an STfR metric is feasible and reasonable for assessing anemia treatment at dialysis facilities. The STfRobs is simple to calculate and works well for larger dialysis facilities. The STfRmodBayes is more analytically complex, but facilitates comparisons across all dialysis facilities, including small facilities.
    American Journal of Kidney Diseases 05/2014;
  • American Journal of Kidney Diseases 05/2014;
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    ABSTRACT: World Kidney Day 2013 focused on raising awareness of the impact and consequences of acute kidney injury (AKI). Although many studies have examined rates of AKI in hospitalized patients, we were interested in the impact of AKI on the workload of nephrologists. Cross-sectional forced-choice internet-based survey. 598 survey respondents who were US-based nephrologist members of the American Society of Nephrology. Numbers of inpatients and outpatients seen on World Kidney Day 2013 for the management of AKI or other conditions (and specifically in-hospital renal replacement therapies [RRTs]), based on self-report of number/percentage of patients seen on World Kidney Day and in the prior year. Of 598 physician respondents (response rate, 12%), 310 saw patients in the hospital on World Kidney Day. Of 3,285 patients seen by respondents, 1,500 were seen for AKI (46%); 1,233, for end-stage renal disease (37%); and 552, for non-AKI/end-stage renal disease-related problems (17%). Of patients with AKI, 688 (46%) were in the intensive care unit and 415 (28%) received RRT. Intermittent hemodialysis was performed in 315 patients (76%) who received RRT. Delivered dialysis dose was quantified in only 48 (15%) of those receiving intermittent hemodialysis. 260 respondents saw 2,380 patients in the ambulatory setting, of whom 207 (9%) were seen for follow-up of AKI. There was a low response rate to the survey. Numbers of patients were self-reported. This is the first physician survey examining the care of patients and impact of AKI on current in-hospital and ambulatory nephrology practices. In our sample, AKI was the most common reason for in-hospital nephrology consultation. Furthermore, our findings point to significant areas in which improvement is needed, including inadequate quantification of dialysis delivered dose. Finally, our survey highlights that AKI is a major public health issue.
    American Journal of Kidney Diseases 05/2014;