BOOK
Chronic Kidney Disease, Dialysis, and Transplantation E-Book
Jonathan Himmelfarb | T. Alp Ikizler
(2018)
Additional Information
Book Details
Abstract
- Contains expanded content on economics and outcomes of treatment, as well as acute kidney injury.
- Covers hot topics such as the genetic causes of chronic kidney disease, ethical challenges and palliative care, and home hemodialysis.
- Discusses the latest advances in hypertensive kidney disease, vitamin D deficiency, diabetes management, transplantation, and more.
- Provides a clear visual understanding of complex information with high-quality line drawings, photographs, and diagnostic and treatment algorithms.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| IFC | ES1 | ||
| Chronic Kidney Disease, Dialysis, and Transplantation: A Companion to Brenner and Rector’s The Kidney | i | ||
| Copyright | ii | ||
| Dedication | iii | ||
| PREFACE | iv | ||
| SECTION EDITORS | v | ||
| List of Contributors | vi | ||
| CONTENTS | xi | ||
| I - Chronic Kidney Disease | 1 | ||
| 1 - Chronic Kidney Disease: Definition, Epidemiology, Cost, and Outcomes | 2 | ||
| DEFINITION AND STAGING OF CHRONIC KIDNEY DISEASE | 2 | ||
| Definition | 2 | ||
| Staging | 3 | ||
| Strengths and Limitations of the Current Chronic Kidney Disease Classification System | 5 | ||
| Limitations | 6 | ||
| Future Directions | 6 | ||
| EPIDEMIOLOGY OF CHRONIC KIDNEY DISEASE | 6 | ||
| Etiology of Chronic Kidney Disease | 7 | ||
| Prevalence and Incidence of Chronic Kidney Disease | 7 | ||
| Prevalence of Chronic Kidney Disease | 7 | ||
| Incidence of Chronic Kidney Disease | 12 | ||
| Prevalence and Incidence of Kidney Failure | 12 | ||
| Prevalence of Treated Kidney Failure | 13 | ||
| Incidence of Treated Kidney Failure | 14 | ||
| COSTS OF CHRONIC KIDNEY DISEASE | 14 | ||
| Chronic Kidney Disease (Not on Kidney Replacement Therapy) Costs | 14 | ||
| End-Stage Renal Disease Costs | 15 | ||
| OUTCOMES OF CHRONIC KIDNEY DISEASE | 15 | ||
| Outcomes Before Kidney Replacement Therapy | 17 | ||
| Outcomes on Kidney Replacement Therapy | 20 | ||
| CONCLUSION | 22 | ||
| 2 - Measurement and Estimation of Kidney Function | 23 | ||
| GLOMERULAR FILTRATION | 23 | ||
| Determinants of Glomerular Filtration Rate | 23 | ||
| Variability of Glomerular Filtration Rate | 24 | ||
| MEASUREMENT OF GLOMERULAR FILTRATION RATE | 25 | ||
| Physiology of Urinary Clearance and the Measurement of GFR | 25 | ||
| True GFR versus Measured GFR | 26 | ||
| Clearance Methods | 26 | ||
| Exogenous Filtration Markers | 27 | ||
| ESTIMATION OF GLOMERULAR FILTRATION RATE | 29 | ||
| Relationship of Glomerular Filtration Rate to Plasma Solute Concentrations | 29 | ||
| Estimating Equations for Glomerular Filtration Rate | 30 | ||
| Interpretation of Glomerular Filtration Rate Estimates | 31 | ||
| ENDOGENOUS FILTRATION MARKERS | 32 | ||
| Creatinine | 32 | ||
| 1. Structure and Function | 32 | ||
| 2. Plasma Levels | 32 | ||
| 3. Generation | 32 | ||
| 4. Renal Handling | 33 | ||
| 5. Extrarenal Elimination | 34 | ||
| 6. Assay | 34 | ||
| 7. Creatinine as a Filtration Marker | 34 | ||
| Cystatin C | 36 | ||
| 1. Structure and Function | 36 | ||
| 2. Plasma Levels | 36 | ||
| 3. Generation | 37 | ||
| 4. Renal Handling | 37 | ||
| 5. Extrarenal Elimination | 37 | ||
| 6. Assay | 37 | ||
| 7. Cystatin C as a Filtration Marker | 37 | ||
| Urea | 38 | ||
| 1. Structure and Function | 38 | ||
| 2. Plasma Levels | 38 | ||
| 3. Generation | 38 | ||
| 4. Renal Handling of Urea | 38 | ||
| 5. Extrarenal Elimination | 40 | ||
| 6. Assay | 40 | ||
| 7. Urea as a Filtration Marker | 40 | ||
| Novel Markers | 40 | ||
| 3 - Diabetic Kidney Disease | 42 | ||
| INTRODUCTION | 42 | ||
| DIAGNOSIS AND CLASSIFICATION OF DIABETIC KIDNEY DISEASE | 42 | ||
| RISK FACTORS | 43 | ||
| Demographic Factors | 43 | ||
| Alterations of Developmental Programming | 43 | ||
| Hereditary Risk Factors | 43 | ||
| Hyperglycemia | 44 | ||
| Hypertension | 44 | ||
| Obesity | 44 | ||
| Acute Kidney Injury | 44 | ||
| Protein Intake | 45 | ||
| NATURAL HISTORY | 45 | ||
| KIDNEY STRUCTURAL CHANGES IN DIABETIC KIDNEY DISEASE | 46 | ||
| PATHOPHYSIOLOGICAL MECHANISMS IN DKD | 47 | ||
| CURRENT TREATMENT OF DKD | 51 | ||
| Glycemic Control | 51 | ||
| Antihypertensive Therapy | 53 | ||
| Dietary Management | 55 | ||
| Effect of Multiple Risk Factor Interventions in Diabetes | 55 | ||
| Population-Based Approaches | 55 | ||
| NEW THERAPIES FOR DIABETIC KIDNEY DISEASE | 55 | ||
| Newer Antihyperglycemic Agents | 55 | ||
| Glucagon-like Peptide-1 Receptor Agonists | 55 | ||
| Sodium–Glucose Cotransporter 2 Inhibitors | 57 | ||
| New Treatments for Diabetic Kidney Disease Targeting Intrinsic Kidney Mechanisms | 58 | ||
| CONCLUSIONS | 58 | ||
| 4 - Hypertensive Chronic Kidney Disease | 62 | ||
| INTRODUCTION | 62 | ||
| POTENTIAL MECHANISMS OF RENAL INJURY IN HYPERTENSION | 62 | ||
| Pathophysiology of Renal Injury in Hypertensive Nephrosclerosis | 62 | ||
| Genetic Risk Markers | 64 | ||
| DIAGNOSIS AND CLINICAL MANIFESTATIONS | 64 | ||
| Clinical Manifestations and Risk Factors | 64 | ||
| Role of Kidney Biopsy | 64 | ||
| THERAPEUTICS | 64 | ||
| Target Level of BP Control | 64 | ||
| THERAPEUTIC AGENTS | 67 | ||
| RAAS Blockade | 67 | ||
| ANGIOTENSIN CONVERTING ENZIME INHIBITORS | 67 | ||
| ANGIOTENSIN RECEPTOR BLOCKERS | 68 | ||
| COMBINATION THERAPY ACEI AND ARBS | 69 | ||
| DIRECT RENIN INHIBITORS | 69 | ||
| ALDOSTERONE ANTAGONISTS | 69 | ||
| Diuretics | 70 | ||
| CALCIUM CHANNEL BLOCKERS | 70 | ||
| ADRENERGIC BLOCKERS | 70 | ||
| Surgical Management | 70 | ||
| Lifestyle Modification | 71 | ||
| CONCLUSION | 72 | ||
| 5 - Chronic Kidney Disease in the Elderly | 73 | ||
| INTRODUCTION | 73 | ||
| KIDNEY STRUCTURAL AND PHYSIOLOGIC CHANGES ASSOCIATED WITH AGING | 73 | ||
| Changes in the Glomerulus | 73 | ||
| Changes in Renal Vasculature and Renal Tubules | 74 | ||
| Age-Related Changes in Renal-Active Hormones and Vasodilators | 74 | ||
| Changes in Glomerular Filtration Rate | 74 | ||
| Proteinuria | 74 | ||
| Electrolyte Management | 74 | ||
| Clinical Implications of Age-Associated Physiological Changes | 75 | ||
| IDENTIFICATION OF CKD IN OLDER ADULTS | 75 | ||
| CHARACTERISTICS OF OLDER ADULTS WITH CKD | 77 | ||
| OUTCOMES ASSOCIATED WITH CKD IN OLDER ADULTS | 77 | ||
| MANAGEMENT OF SPECIFIC COMORBIDITIES AND CHARACTERISTICS IN OLDER ADULTS WITH CKD | 78 | ||
| Hypertension Management | 78 | ||
| Proteinuria | 80 | ||
| MULTIMORBIDITY AND COMPLEXITY IN OLDER ADULTS WITH CHRONIC KIDNEY DISEASE | 81 | ||
| MANAGEMENT OPTIONS IN ADVANCED RENAL DISEASE IN OLDER ADULTS | 82 | ||
| Dialysis Initiation in Older Adults | 82 | ||
| Resources to Inform Productive Discussion | 83 | ||
| Palliative Support as an Alternative or Adjunct to Dialysis Preparation | 86 | ||
| 6 - The Pediatric Patient With Chronic Kidney Disease | 87 | ||
| EPIDEMIOLOGY OF PEDIATRIC CHRONIC KIDNEY DISEASE | 87 | ||
| DEFINING CHRONIC KIDNEY DISEASE | 88 | ||
| NATURAL HISTORY AND PROGRESSION OF CHRONIC KIDNEY DISEASE | 89 | ||
| PREVENTION OF PROGRESSION | 90 | ||
| GROWTH FAILURE | 90 | ||
| NUTRITIONAL ISSUES AND METABOLIC CONCERNS | 93 | ||
| Energy | 94 | ||
| Protein | 94 | ||
| Acid-Base and Electrolytes | 94 | ||
| Vitamins and Micronutrients | 95 | ||
| Carnitine | 95 | ||
| NEUROCOGNITIVE DEVELOPMENT AND SCHOOL PERFORMANCE | 95 | ||
| ANEMIA | 96 | ||
| MINERAL AND BONE DISORDERS | 98 | ||
| Calcium | 100 | ||
| Phosphorus | 100 | ||
| Vitamin D | 101 | ||
| CARDIOVASCULAR DISEASE | 102 | ||
| Hypertension | 102 | ||
| Lipids | 103 | ||
| QUALITY OF LIFE AND TRANSITIONS TO ADULTHOOD | 104 | ||
| 7 - Genetic Causes of Chronic Kidney Disease | 105 | ||
| INTRODUCTION | 105 | ||
| NEPHROTIC SYNDROME | 105 | ||
| Autosomal Recessive Diseases | 105 | ||
| Congenital Nephrotic Syndrome | 105 | ||
| Corticosteroid-Resistant Nephrotic Syndrome | 107 | ||
| Corticosteroid-Sensitive Nephrotic Syndrome | 109 | ||
| Autosomal Dominant Diseases | 111 | ||
| Syndromic Proteinuric Kidney Disease | 113 | ||
| X-Linked Diseases | 116 | ||
| Autosomal Dominant Diseases | 117 | ||
| Sporadic Disease | 118 | ||
| POLYCYSTIC KIDNEY DISEASE | 119 | ||
| Treatment of Genetic Disease | 119 | ||
| II - Complications and Management of Chronic Kidney Disease | 120 | ||
| 8 - The Role of the Chronic Kidney Disease Clinic and Multidisciplinary Team Care | 121 | ||
| INTRODUCTION | 121 | ||
| STAGING AND TERMINOLOGY FOR CHRONIC KIDNEY DISEASE AND EFFECT ON NEED FOR COORDINATED CARE | 122 | ||
| OVERVIEW OF CHRONIC KIDNEY DISEASE CLINIC | 122 | ||
| Philosophical Basis | 122 | ||
| Role of Multidisciplinary Clinics | 123 | ||
| Structure and Definition of Multidisciplinary Clinics | 124 | ||
| Formal Multidisciplinary Team | 124 | ||
| Informal Multidisciplinary Resources | 124 | ||
| No Multidisciplinary Team | 124 | ||
| KEY GOALS OF CHRONIC KIDNEY DISEASE CARE | 124 | ||
| Diagnosis | 124 | ||
| Education | 124 | ||
| Delay of Kidney Disease Progression | 125 | ||
| Management of Comorbidities | 125 | ||
| Cardiovascular Disease | 125 | ||
| Anemia | 126 | ||
| CKD-MBD | 126 | ||
| Nutrition | 126 | ||
| Primary Prevention | 127 | ||
| Vaccinations | 127 | ||
| Aspirin | 127 | ||
| Dyslipidemia | 127 | ||
| Diabetes Control | 127 | ||
| Lifestyle Modification and Rehabilitation | 128 | ||
| PREPARATION FOR KIDNEY REPLACEMENT THERAPY | 128 | ||
| Modality Selection | 128 | ||
| Vascular Access Creation | 129 | ||
| Timely Initiation | 129 | ||
| Independent Therapies | 130 | ||
| Home Hemodialysis | 130 | ||
| Peritoneal Dialysis | 130 | ||
| In-Center Hemodialysis | 130 | ||
| Transplant | 130 | ||
| Maximum Conservative Management | 131 | ||
| Advanced Care Planning | 131 | ||
| CLINIC LOGISTICS | 131 | ||
| Services | 131 | ||
| Key Components of the Clinic | 131 | ||
| Individual Roles | 132 | ||
| Nurse | 132 | ||
| Dietitian | 132 | ||
| Social Worker | 132 | ||
| Pharmacist | 132 | ||
| Clerical or Administrative Support | 132 | ||
| Chronic Kidney Disease Clinic Role in Longitudinal Care: Different Stages of Chronic Kidney Disease | 132 | ||
| Chronic Kidney Disease Clinic Role in Parallel Care: Integrating With Other Caregivers | 133 | ||
| Other Benefits of the Chronic Kidney Disease Clinic and Organized Protocol-Based Care | 133 | ||
| RECENT AND FUTURE STUDIES | 134 | ||
| CONCLUSION | 135 | ||
| 9 - Anemia in Chronic Kidney Disease | 136 | ||
| PATHOGENESIS | 136 | ||
| CLINICAL CONSEQUENCES OF ANEMIA AND EFFECTS OF CORRECTION | 137 | ||
| Health-Related Quality of Life (HRQoL) | 137 | ||
| Cognitive Function | 137 | ||
| Cardiovascular Disease and Mortality | 138 | ||
| THERAPIES FOR CHRONIC KIDNEY DISEASE–RELATED ANEMIA | 138 | ||
| Erythropoiesis-Stimulating Agents | 138 | ||
| Iron | 140 | ||
| Other Therapies | 142 | ||
| TARGET HEMOGLOBIN LEVELS FOR ERYTHROPOIESIS-STIMULATING AGENT–TREATED PATIENTS | 142 | ||
| Data From Clinical Trials | 142 | ||
| US Regulatory and Fiscal Policy | 143 | ||
| Clinical Practice Guidelines for Erythropoiesis-Stimulating Agents and Iron Therapy | 143 | ||
| Erythropoiesis-Stimulating Agent Hyporesponsiveness | 143 | ||
| 10 - Mineral Bone Disorders in Chronic Kidney Disease | 145 | ||
| INTRODUCTION | 145 | ||
| Phosphorus | 145 | ||
| Normal Physiology | 145 | ||
| Abnormal Physiology in Chronic Kidney Disease | 146 | ||
| Clinical Consequences of Abnormal Phosphate | 147 | ||
| Management of Elevated Phosphate in Chronic Kidney Disease | 147 | ||
| Calcium | 151 | ||
| Normal Physiology | 151 | ||
| Abnormal Physiology in CKD | 152 | ||
| Clinical Consequences of Abnormal Calcium Homeostasis | 153 | ||
| Management of Calcium in Chronic Kidney Disease | 153 | ||
| Parathyroid Hormone | 153 | ||
| Normal Physiology | 153 | ||
| Abnormal Physiology in Chronic Kidney Disease | 154 | ||
| Measurement of Parathyroid Hormone | 154 | ||
| Management of Secondary Hyperparathyroidism | 154 | ||
| Fibroblast Growth Factor 23 | 156 | ||
| Normal Fibroblast Growth Factor 23 Physiology | 156 | ||
| FGF-23 in Chronic Kidney Disease | 156 | ||
| Clinical Consequences of Elevated FGF-23 | 157 | ||
| Treatment of Elevated FGF-23 | 157 | ||
| Renal Osteodystrophy | 157 | ||
| Cardiovascular Disease and Vascular Calcification in Chronic Kidney Disease | 158 | ||
| CONCLUSION | 161 | ||
| 11 - Vitamin D Disorders in Chronic Kidney Disease | 162 | ||
| PATHOPHYSIOLOGY | 162 | ||
| Vitamin D | 162 | ||
| Vitamin D–Binding Protein | 163 | ||
| Calcitriol | 164 | ||
| Vitamin D Clearance | 164 | ||
| Disturbances in Chronic Kidney Disease | 165 | ||
| EPIDEMIOLOGY | 165 | ||
| Assessment of Vitamin D Deficiency | 165 | ||
| Definition of Vitamin D Deficiency | 166 | ||
| Prevalence of Vitamin D Deficiency | 166 | ||
| Calcitriol Deficiency | 168 | ||
| CONSEQUENCES | 168 | ||
| Pleiotropy | 168 | ||
| Autocrine and Paracrine Effects | 168 | ||
| Mortality | 169 | ||
| Cell Growth and Differentiation | 169 | ||
| Immune Cell Function | 170 | ||
| Renin-Angiotensin-Aldosterone System | 170 | ||
| Glucose Metabolism | 170 | ||
| Cardiovascular Disease | 171 | ||
| Chronic Kidney Disease | 171 | ||
| THERAPY | 172 | ||
| Goals of Therapy | 172 | ||
| Current Practice by Stage of Chronic Kidney Disease | 172 | ||
| Cholecalciferol | 172 | ||
| Ergocalciferol | 173 | ||
| Calcifediol | 174 | ||
| Calcitriol | 174 | ||
| Other Vitamin D Receptor Agonists | 174 | ||
| Recommendations for Therapy | 174 | ||
| UNANSWERED QUESTIONS | 174 | ||
| CONCLUSIONS | 175 | ||
| 12 - Cardiovascular Disease in Chronic Kidney Disease | 176 | ||
| EPIDEMIOLOGY | 176 | ||
| Stage 1 to 2 Chronic Kidney Disease | 176 | ||
| Stage 3 to 4 Chronic Kidney Disease | 176 | ||
| Dialysis | 178 | ||
| Risk Factors | 179 | ||
| MECHANISMS OF CARDIOVASCULAR DISEASE RISK IN CHRONIC KIDNEY DISEASE | 179 | ||
| TRADITIONAL CARDIOVASCULAR DISEASE RISK FACTORS | 180 | ||
| Hypertension and Blood Pressure | 180 | ||
| Chronic Kidney Disease Stage 3 to 4 | 180 | ||
| Dialysis | 182 | ||
| Dyslipidemia | 182 | ||
| Chronic Kidney Disease Stage 3 to 4 | 182 | ||
| Dialysis | 183 | ||
| Diabetes Mellitus | 184 | ||
| Left Ventricular Hypertrophy and Cardiomyopathy | 184 | ||
| Epidemiology | 185 | ||
| Pathogenesis | 185 | ||
| Diagnosis | 185 | ||
| Therapy | 185 | ||
| Other Traditional Risk Factors | 186 | ||
| NONTRADITIONAL CARDIOVASCULAR DISEASE RISK FACTORS | 186 | ||
| Oxidative Stress and Inflammation | 186 | ||
| Nitric Oxide, Asymmetrical Dimethylarginine, and Endothelial Function | 186 | ||
| Homocysteine | 187 | ||
| Chronic Kidney Disease–Mineral Bone Disorder | 187 | ||
| Other Nontraditional Risk Factors | 188 | ||
| CARDIOVASCULAR DISEASE CLINICAL SYNDROMES | 188 | ||
| Ischemic Heart Disease | 188 | ||
| Epidemiology | 188 | ||
| Pathophysiology and Manifestations: Atherosclerosis and Vascular Stiffness | 188 | ||
| Diagnosis | 189 | ||
| Prevention and Treatment | 190 | ||
| Heart Failure | 190 | ||
| Epidemiology | 191 | ||
| Diagnosis | 191 | ||
| Treatment | 191 | ||
| STRUCTURAL DISEASE: PERCARDIAL AND VALVULAR CONDITIONS | 192 | ||
| Pericardial Disease | 192 | ||
| Endocarditis | 192 | ||
| Mitral Annular Calcification | 192 | ||
| Aortic Calcification and Stenosis | 192 | ||
| ARRHYTHMIA AND SUDDEN CARDIAC DEATH | 193 | ||
| Atrial Fibrillation | 193 | ||
| Ventricular Arrhythmias and Sudden Death | 193 | ||
| 13 - Nutrient Metabolism and Protein-Energy Wasting in Chronic Kidney Disease | 194 | ||
| THE ROLE OF THE KIDNEY IN NUTRIENT HOMEOSTASIS | 194 | ||
| RATIONALE AND NUTRITIONAL REQUIREMENTS FOR PATIENTS WITH CHRONIC KIDNEY DISEASE | 194 | ||
| Rationale | 194 | ||
| Energy Requirements | 194 | ||
| Protein Requirements | 195 | ||
| Electrolytes | 197 | ||
| Sodium and Fluid Balance | 197 | ||
| Phosphorus | 197 | ||
| Potassium | 197 | ||
| Dietary Quality | 197 | ||
| PROTEIN-ENERGY WASTING IN CHRONIC KIDNEY DISEASE | 197 | ||
| Concept of Protein-Energy Wasting | 197 | ||
| Causes of Protein-Energy Wasting in Chronic Kidney Disease | 199 | ||
| Decreased Protein and Energy Intake | 199 | ||
| Hypermetabolism | 199 | ||
| Decreased Anabolism | 199 | ||
| Comorbidities and Poor Physical Activity | 200 | ||
| Dialysis | 200 | ||
| Prevalence of Protein-Energy Wasting in Chronic Kidney Disease | 200 | ||
| Consequences of Protein-Energy Wasting in Chronic Kidney Disease | 201 | ||
| Mortality, Cardiovascular Events, Infections, and Hospitalizations | 201 | ||
| Frailty and Poor Quality of Life | 201 | ||
| NUTRITION SCREENING AND ASSESSMENT | 201 | ||
| Screening Tools | 201 | ||
| Nutrition Assessment Tools | 202 | ||
| Anthropometry and Body Composition | 202 | ||
| Biochemistry | 202 | ||
| Dietary Intake Assessment Methods | 203 | ||
| Nutritional Assessment Scores | 203 | ||
| TREATMENT OF PROTEIN-ENERGY WASTING IN CHRONIC KIDNEY DISEASE | 203 | ||
| Dietary Counseling and Use of Oral Nutritional Supplements | 204 | ||
| Intradialytic Parental Nutrition | 205 | ||
| Nonnutritional Interventions | 206 | ||
| Interventions to Reduce Inflammation | 206 | ||
| Megestrol Acetate | 207 | ||
| Exercise and Anabolic Agents | 207 | ||
| SUMMARY AND CONCLUSIONS | 207 | ||
| 14 - Inflammation in Chronic Kidney Disease | 208 | ||
| CHRONIC INFLAMMATION: A MALADAPTIVE RESPONSE IN A PARTICULAR SETTING | 208 | ||
| CHRONIC PERSISTENT INFLAMMATION IN CHRONIC KIDNEY DISEASE | 209 | ||
| Description of the Problem | 209 | ||
| Etiology of Inflammation in Chronic Kidney Disease | 209 | ||
| Immune Dysfunction Proper of Chronic Kidney Disease | 210 | ||
| Oxidative Stress | 210 | ||
| Fluid Overload and Sodium Expansion | 211 | ||
| Metabolic Acidosis | 211 | ||
| Comorbidities | 211 | ||
| Lifestyle Factors | 213 | ||
| Genetic Predisposition | 213 | ||
| Dialysis Technique | 214 | ||
| CONSEQUENCES OF INFLAMMATION IN CHRONIC KIDNEY DISEASE | 214 | ||
| Mortality | 215 | ||
| Development and Progression of Chronic Kidney Disease | 215 | ||
| Protein-Energy Wasting | 215 | ||
| Vascular Calcification | 215 | ||
| Anemia and Erythropoiesis-Stimulating Agent Resistance | 216 | ||
| Depression and Cognitive Impairment | 216 | ||
| Endocrine Disorders | 216 | ||
| Insulin Resistance | 217 | ||
| Premature Senescence | 217 | ||
| Quality of Life | 218 | ||
| MEASURING INFLAMMATION IN CHRONIC KIDNEY DISEASE PATIENTS | 218 | ||
| C-Reactive Protein | 218 | ||
| Interleukins | 219 | ||
| Other Biomarkers of Inflammation | 219 | ||
| MANAGING THE INFLAMED CHRONIC KIDNEY DISEASE PATIENT | 220 | ||
| Approaching a Patient With Inflammation | 220 | ||
| Therapeutic Strategies in Inflamed Chronic Kidney Disease Patients | 221 | ||
| Treating the Basics | 221 | ||
| Pharmacological Interventions | 222 | ||
| CONCLUSIONS | 223 | ||
| ACKNOWLEDGMENT | 223 | ||
| CONFLICT OF INTEREST | 223 | ||
| 15 - Sleep Disorders in Chronic Kidney Disease | 224 | ||
| SLEEP IN CHRONIC KIDNEY DISEASE | 224 | ||
| SLEEP IN END-STAGE KIDNEY DISEASE | 226 | ||
| Sleep in Hemodialysis | 227 | ||
| Sleep in Peritoneal Dialysis | 229 | ||
| SLEEP IN PEDIATRIC CHRONIC KIDNEY DISEASE | 231 | ||
| SLEEP IN KIDNEY TRANSPLANTATION | 233 | ||
| CONCLUSIONS | 236 | ||
| 16 - Depression and Neurocognitive Function in Chronic Kidney Disease | 237 | ||
| EPIDEMIOLOGY OF DEPRESSION | 238 | ||
| DIFFERENTIATING DEPRESSION FROM MEDICAL ILLNESS | 239 | ||
| PREVALENCE | 239 | ||
| SEQUELAE OF DEPRESSION | 240 | ||
| Suicide | 240 | ||
| Malnutrition | 240 | ||
| Treatment Compliance | 240 | ||
| Social Support | 240 | ||
| Immunological Response | 240 | ||
| Mortality | 241 | ||
| Marital Issues | 241 | ||
| COMORBIDITIES OF DEPRESSION | 241 | ||
| Substance Use | 241 | ||
| Anxiety Disorders | 242 | ||
| Dementia/Delirium | 242 | ||
| TREATMENT OF DEPRESSION | 242 | ||
| Psychotherapeutic Options | 242 | ||
| Pharmacotherapy | 242 | ||
| CASE PRESENTATION | 243 | ||
| SUMMARY OF DEPRESSION IN CHRONIC KIDNEY DISEASE | 243 | ||
| PREVALENCE OF NEUROCOGNITIVE IMPAIRMENT | 247 | ||
| NEUROCOGNITIVE FUNCTIONING AFTER TRANSPLANTATION | 248 | ||
| SEQUELAE OF NEUROCOGNITIVE IMPAIRMENT | 248 | ||
| TREATMENT OF NEUROCOGNITIVE IMPAIRMENT | 249 | ||
| CASE PRESENTATION | 249 | ||
| SUMMARY OF NEUROCOGNITIVE FUNCTION IN CHRONIC KIDNEY DISEASE | 249 | ||
| 17 - Improving Drug Use and Dosing in Chronic Kidney Disease | 250 | ||
| ASSESSMENT OF KIDNEY FUNCTION FOR DRUG DOSING, INCLUDING SPECIAL POPULATIONS | 251 | ||
| GENERAL PHARMACOKINETIC AND PHARMACODYNAMIC PRINCIPLES | 253 | ||
| Absorption | 254 | ||
| Distribution | 254 | ||
| Metabolism | 255 | ||
| Elimination | 255 | ||
| GENERAL APPROACH FOR DRUG REGIMEN DESIGN IN CHRONIC KIDNEY DISEASE | 256 | ||
| DOSING OF SELECT NEWER AGENTS IN CHRONIC KIDNEY DISEASE | 257 | ||
| Direct Oral Anticoagulants | 257 | ||
| Pharmacokinetics and Pharmacodynamics in Chronic Kidney Disease | 257 | ||
| Agents for Type 2 Diabetes Mellitus—Sodium–Glucose Cotransporter 2 Inhibitors | 259 | ||
| Pharmacokinetics and Pharmacodynamics in Chronic Kidney Disease | 259 | ||
| Kidney-Related Outcomes and Drug Safety | 264 | ||
| Agents for Type 2 Diabetes Mellitus—Dipeptidyl Peptidase-4 Inhibitors | 264 | ||
| Pharmacokinetics and Pharmacodynamics in Chronic Kidney Disease | 264 | ||
| Cardiovascular Outcomes | 264 | ||
| Kidney-Related Outcomes | 264 | ||
| Agents for Type 2 Diabetes Mellitus—Glucagon-Like Peptide-1 Receptor Agonists | 264 | ||
| Pharmacokinetics and Pharmacodynamics in Chronic Kidney Disease | 265 | ||
| Kidney-Related Outcomes and Safety | 265 | ||
| Metformin | 265 | ||
| DRUG DOSING IN DIALYSIS PATIENTS | 265 | ||
| CONSIDERATIONS FOR DRUG REMOVAL BY RENAL REPLACEMENT THERAPIES | 266 | ||
| Case Example: Dosing Brivaracetam in Hemodialysis and Continuous Kidney Replacement Therapy | 267 | ||
| Q1: Should Brivaracetam Dosing be Altered in This End-Stage Kidney Disease Patient? | 268 | ||
| Q2: Is Brivaracetam Dialyzable? | 268 | ||
| Q3: How Should Brivaracetam Dose be Altered in This Patient With Intermittent Hemodialysis? | 268 | ||
| Q4: What If This Patient had Acute Kidney Injury and was Receiving Continuous Venovenous Hemofiltration With the Following Conti... | 268 | ||
| DRUG INTERACTIONS IN CHRONIC KIDNEY DISEASE | 269 | ||
| IMPORTANCE OF INTERDISCIPLINARY TEAMS IN IMPROVING CHRONIC KIDNEY DISEASE CARE | 269 | ||
| IMPROVING CHRONIC KIDNEY DISEASE CARE DURING TRANSITIONS | 270 | ||
| INFORMATICS APPROACHES TO IMPROVE CHRONIC KIDNEY DISEASE CARE | 270 | ||
| 18 - The Pathophysiology of Uremia | 273 | ||
| UREMIA: THE CLINICAL SYNDROME | 274 | ||
| Classic Signs and Symptoms | 274 | ||
| Uremia After Dialysis Initiation | 275 | ||
| Uremic Cardiovascular Toxicity | 275 | ||
| Uremic Metabolic Toxicity | 275 | ||
| UREMIA AND SOLUTE RETENTION | 275 | ||
| Normal Kidney Function | 276 | ||
| Renal Failure and Solute Retention | 276 | ||
| Residual Clearance | 276 | ||
| SOLUTE PRODUCTION | 276 | ||
| Solute Production From Food | 276 | ||
| Solute Production and the Gut Microbiome | 278 | ||
| UREMIC INFLAMMATION AND OXIDATIVE STRESS | 278 | ||
| CURRENT CATALOG OF UREMIC SOLUTES | 279 | ||
| Metabolomics Studies | 279 | ||
| Proving Causality in Uremia | 280 | ||
| Uremic Solutes Associated With Adverse Clinical Outcomes | 280 | ||
| Potential Mechanisms of Solute Toxicity | 282 | ||
| Direct Cellular Toxicity | 282 | ||
| Inflammation and Oxidative Stress | 282 | ||
| Hormonal Functions | 282 | ||
| Enzyme Inhibition | 282 | ||
| GPCR (G-Protein Coupled Receptor) Signaling | 282 | ||
| Central Nervous System Activity | 283 | ||
| Protein Modification | 283 | ||
| Tissue Deposition | 283 | ||
| Solute Depletion | 283 | ||
| TREATMENT OF UREMIA | 283 | ||
| Extracorporeal Methods | 283 | ||
| Nonextracorporeal Methods | 284 | ||
| CONCLUSIONS | 284 | ||
| 19 - Timing, Initiation, and Modality Options for Renal Replacement Therapy | 286 | ||
| INDICATIONS FOR INITIATION OF DIALYSIS IN CHRONIC KIDNEY DISEASE | 287 | ||
| EVOLUTION OF CLINICAL PRACTICE GUIDELINES FOR INITIATION OF DIALYSIS | 287 | ||
| Past Kidney Disease Outcomes Quality Initiative Recommendations for Timing of Initiation of Dialysis | 287 | ||
| Initiation Dialysis Early and Late (IDEAL) Trial | 288 | ||
| Current Kidney Disease Outcomes Quality Initiative Recommendations for Timing of Initiation of Dialysis | 288 | ||
| Other Clinical Practice Guidelines for Timing of Initiation of Dialysis | 289 | ||
| TRENDS IN TIMING OF INITIATION OF DIALYSIS | 290 | ||
| PREPARATION FOR RENAL REPLACEMENT THERAPY | 291 | ||
| Timeliness of Nephrology Referral | 291 | ||
| Predialysis Chronic Kidney Disease Education | 292 | ||
| Timing of Dialysis Access Placement | 292 | ||
| Timing of Referral for Kidney Transplant Evaluation | 292 | ||
| DIALYSIS MODALITY SELECTION | 292 | ||
| IN-CENTER DIALYSIS MODALITIES | 293 | ||
| Conventional In-Center Hemodialysis | 293 | ||
| Extended-Hours Dialysis | 293 | ||
| FREQUENT IN-CENTER HEMODIALYSIS | 293 | ||
| HOME DIALYSIS MODALITIES | 293 | ||
| Peritoneal Dialysis | 293 | ||
| Home Hemodialysis | 294 | ||
| TRANSPLANTATION | 295 | ||
| CONCLUSIONS | 295 | ||
| 20 - Ethical Challenges and the Role of Palliative Care in Kidney Disease | 297 | ||
| ETHICAL PRINCIPLES | 297 | ||
| MEDICAL ETHICS IN NEPHROLOGY | 297 | ||
| ESTIMATING PROGNOSIS | 298 | ||
| ADVANCE CARE PLANNING | 298 | ||
| SHARED DECISION-MAKING | 299 | ||
| If Appropriate, Forgo (Withhold Initiation or Withdraw Ongoing) Dialysis for Patients with AKI, CKD, or ESRD in Certain, Well-De... | 299 | ||
| Consider Forgoing Dialysis for AKI, CKD, or ESRD Patients Who Have a Very Poor Prognosis or for Whom Dialysis Cannot be Provided... | 299 | ||
| CONFLICT RESOLUTION | 299 | ||
| Providing Supportive (Palliative) Care | 301 | ||
| End-of-Life Care | 302 | ||
| Doctor–Patient/Family Communication | 304 | ||
| Symptom Assessment and Treatment | 304 | ||
| Summary | 304 | ||
| III - Dialysis | 310 | ||
| 21 - Dialysis and End-Stage Kidney Disease: Epidemiology, Costs, and Outcomes | 311 | ||
| DEVELOPMENT OF END-STAGE RENAL DISEASE: CONCEPTUAL CONSIDERATIONS | 311 | ||
| EPIDEMIOLOGY OF END-STAGE RENAL DISEASE | 311 | ||
| Causes of End-Stage Renal Disease and Indications for Maintenance Dialysis | 311 | ||
| Incidence and Prevalence of End-Stage Renal Disease | 313 | ||
| Incidence of Treated End-Stage Renal Disease | 313 | ||
| Prevalence of ESRD | 314 | ||
| Timing of Dialysis Initiation | 317 | ||
| OUTCOMES IN END-STAGE RENAL DISEASE | 319 | ||
| Mortality Trends in Patients Receiving Maintenance Dialysis | 319 | ||
| Cause-Specific Mortality | 321 | ||
| Morbidity and Hospitalizations | 321 | ||
| Overall Trends | 321 | ||
| Cardiovascular Disease: Implications for Morbidity and Mortality | 325 | ||
| Infectious Diseases: Implications for Morbidity and Mortality | 330 | ||
| Dialysis Modality | 331 | ||
| Vascular Access | 335 | ||
| COSTS OF END-STAGE RENAL DISEASE | 335 | ||
| Conclusions | 337 | ||
| 22 - Principles of Hemodialysis | 339 | ||
| FUNDAMENTAL CONCEPTS | 339 | ||
| Historical Development | 339 | ||
| Kidney Replacement Therapy | 340 | ||
| Definitions | 340 | ||
| UREMIA: THE TARGET OF HEMODIALYSIS | 340 | ||
| Clinical Syndrome | 340 | ||
| Uremic Toxins | 342 | ||
| Residual Syndrome | 342 | ||
| Goals of Hemodialysis | 343 | ||
| DIALYSIS | 344 | ||
| Laws of Diffusion | 344 | ||
| Effects of Temperature, Pressure, and Molecular Weight | 345 | ||
| Dialysate | 345 | ||
| HEMODIALYZERS | 345 | ||
| Membrane Composition, Configuration, and Surface Area | 345 | ||
| Composition of the Membrane | 345 | ||
| Hollow-Fiber Dialyzers | 346 | ||
| Surface Area Considerations | 346 | ||
| Effects of Flow on Clearance | 346 | ||
| Blood Flow | 346 | ||
| Dialysate Flow | 347 | ||
| KOA, the Mass Transfer Area Coefficient | 347 | ||
| Boundary Layers and Streaming Effects | 347 | ||
| High-Efficiency and High-Flux Dialyzers | 347 | ||
| HEMODIALYSIS | 348 | ||
| Types of Clearance | 348 | ||
| Quantifying Hemodialysis | 350 | ||
| Mathematical Models of Urea Kinetics | 351 | ||
| Kt/Vurea | 351 | ||
| Residual Clearance | 352 | ||
| Dialysate Methods | 352 | ||
| Volume of Urea Distribution | 352 | ||
| Urea Generation and Protein Catabolism | 352 | ||
| Solute Disequilibrium | 353 | ||
| Body Size and Dialysis Adequacy | 354 | ||
| Adequacy of Hemodialysis: Current Recommendations | 354 | ||
| Filtration and Dialysis | 354 | ||
| Dialyzer Ultrafiltration Coefficient | 354 | ||
| Quantitative Contribution of Filtration to Solute Removal | 355 | ||
| Hemofiltration and Hemodiafiltration Therapy | 355 | ||
| Filtration Effects on Blood Pressure, Regional Blood Flow, and Solute Removal | 355 | ||
| Middle and Large Molecule Removal | 355 | ||
| Importance of Treatment Time | 356 | ||
| MECHANICS OF HEMODIALYSIS | 356 | ||
| Dialysate Delivery Systems | 357 | ||
| Mechanical and Safety Monitors | 357 | ||
| Bicarbonate Delivery | 357 | ||
| Water Quality | 358 | ||
| Blood Circuit Components | 358 | ||
| Computer Controls | 358 | ||
| Anticoagulation | 359 | ||
| Online Monitoring of Clearance, Hematocrit, and Access Flow | 359 | ||
| Monitoring Clearance | 359 | ||
| Monitoring Hematocrit | 359 | ||
| Monitoring Access Flow | 359 | ||
| FUTURE CONSIDERATIONS | 360 | ||
| 23 - Vascular Access | 361 | ||
| ARTERIOVENOUS FISTULA | 361 | ||
| TYPES OF ARTERIOVENOUS FISTULAS | 361 | ||
| Classification of Fistulas | 361 | ||
| Fistula Types Based on Anatomy | 362 | ||
| Life Cycle of the Arteriovenous Fistula | 362 | ||
| Phase 1: Creation | 363 | ||
| Phase 2: Maturation | 363 | ||
| Phase 3: Clinical Use, Initial | 363 | ||
| Phase 4: Clinical Use, Sustained | 364 | ||
| Phase 5: Dysfunction | 364 | ||
| COMPLICATIONS ASSOCIATED WITH ARTERIOVENOUS FISTULAS | 364 | ||
| Failure to Mature | 364 | ||
| Late Arteriovenous Fistula Failure | 365 | ||
| Excessive Flow | 365 | ||
| Hand Ischemia: Dialysis Access Steal Syndrome | 367 | ||
| Aneurysm Formation | 368 | ||
| Infection | 368 | ||
| Secondary Arteriovenous Fistulas | 368 | ||
| ARTERIOVENOUS GRAFT | 369 | ||
| Advantages of Arteriovenous Graft | 370 | ||
| Types of Arteriovenous Grafts | 370 | ||
| COMPLICATIONS OF ARTERIOVENOUS GRAFTS | 370 | ||
| Venous Stenosis | 370 | ||
| Infection | 370 | ||
| Pseudoaneurysm Formation | 372 | ||
| Hand Ischemia: Dialysis Access Steal Syndrome | 372 | ||
| HEMODIALYSIS RELIABLE OUTFLOW VASCULAR ACCESS DEVICE | 372 | ||
| DIALYSIS CATHETERS | 373 | ||
| Catheter Design | 374 | ||
| Catheter-Associated Problems | 374 | ||
| Adequacy of Dialysis | 374 | ||
| Problems Related to Catheter Placement | 376 | ||
| Catheter Dysfunction | 376 | ||
| Catheter-Related Infection | 377 | ||
| ACUTE DIALYSIS CATHETERS | 377 | ||
| 24 - Hemodialysis Adequacy | 379 | ||
| UREMIC RETENTION SOLUTES | 379 | ||
| MECHANISMS OF MOLECULAR MOVEMENT DURING DIALYSIS | 380 | ||
| USING UREA TO QUANTIFY DIALYSIS DOSE | 381 | ||
| Collection of Blood Samples Before and After Hemodialysis | 381 | ||
| Urea Reduction Ratio | 382 | ||
| Single-Pool Kt/V | 382 | ||
| Equilibrated Kt/V | 383 | ||
| Standard Kt/V | 384 | ||
| Urea Kinetic Modeling | 385 | ||
| Normalized Protein Catabolic Ratio | 385 | ||
| LIMITATIONS OF UREA-BASED MEASURES OF DIALYSIS ADEQUACY | 386 | ||
| KEY STUDIES OF OPTIMAL DIALYSIS DOSE | 387 | ||
| 25 - Hemodialysis-Associated Infections* | 389 | ||
| INTRODUCTION | 389 | ||
| FACTORS CONTRIBUTING TO INFECTIONS AMONG HEMODIALYSIS PATIENTS | 389 | ||
| Microbial Contamination of Water | 390 | ||
| Distribution Systems | 391 | ||
| Hemodialysis Machines, Effluent, and Environmental Surfaces | 392 | ||
| Hemodialyzer Reuse | 392 | ||
| High-Flux Dialysis and Bicarbonate Dialysate | 397 | ||
| Disinfection of Hemodialysis Systems | 397 | ||
| Monitoring of Water and Dialysis Fluid | 398 | ||
| DIALYSIS-ASSOCIATED PYROGENIC REACTIONS | 398 | ||
| DISINFECTION, STERILIZATION, AND ENVIRONMENTAL CLEANING IN DIALYSIS FACILITIES | 399 | ||
| BLOODSTREAM INFECTIONS AND OTHER INFECTIONS | 400 | ||
| Vascular Access Infections | 401 | ||
| Etiology and Prevention of Bloodstream Infection | 401 | ||
| Respiratory Infections | 403 | ||
| Antimicrobial-Resistant Bacteria | 403 | ||
| HEPATITIS C VIRUS | 404 | ||
| Epidemiology | 405 | ||
| Screening and Diagnostic Tests | 405 | ||
| Prevention of Hepatitis C Virus Transmission | 405 | ||
| HEPATITIS B VIRUS | 406 | ||
| Epidemiology | 406 | ||
| Screening and Diagnostic Tests | 407 | ||
| Prevention of Hepatitis B Virus Transmission | 407 | ||
| HEPATITIS DELTA VIRUS | 408 | ||
| HUMAN IMMUNODEFICIENCY VIRUS INFECTION | 408 | ||
| OTHER EMERGING INFECTIONS | 408 | ||
| SUMMARY OF RECOMMENDATIONS AND FUTURE DIRECTIONS | 408 | ||
| Future Directions | 410 | ||
| Acknowledgments | 410 | ||
| 26 - Acute Complications of Hemodialysis | 411 | ||
| INVESTIGATING AN ADVERSE EVENT ON HEMODIALYSIS | 411 | ||
| ACUTE REACTIONS OCCURRING DURING HEMODIALYSIS | 412 | ||
| Anaphylaxis and Anaphylactoid Reactions | 412 | ||
| Reactions Associated With the Dialysis Circuit | 412 | ||
| Reactions Associated With Drugs and Other Exposures | 413 | ||
| Approach to the Dialysis Patient With a Reaction | 414 | ||
| Complications Associated With Microbiological Contamination | 415 | ||
| NEUROLOGICAL AND MUSCULAR COMPLICATIONS DURING HEMODIALYSIS | 415 | ||
| Muscle Cramps | 415 | ||
| Headache | 416 | ||
| Dialysis Disequilibrium Syndrome (DDS) | 417 | ||
| Restless Legs Syndrome | 417 | ||
| Seizures | 418 | ||
| Other Neurological Complications | 419 | ||
| CARDIOVASCULAR COMPLICATIONS DURING HEMODIALYSIS | 419 | ||
| Intradialytic Hypotension | 419 | ||
| Intradialytic Hypertension | 419 | ||
| Arrhythmias | 420 | ||
| Sudden Cardiac Death | 420 | ||
| Myocardial Stunning | 420 | ||
| VASCULAR ACCESS–RELATED COMPLICATIONS | 421 | ||
| Dialysis-Associated Steal Syndrome | 421 | ||
| Vascular Access Bleeding | 422 | ||
| Access Thrombosis | 422 | ||
| HEMATOLOGIC COMPLICATIONS | 423 | ||
| Dialysis-Associated Leukopenia | 423 | ||
| Dialysis-Associated Hemolysis | 423 | ||
| Dialysis-Associated Thrombocytopenia | 424 | ||
| Hemorrhage | 424 | ||
| PULMONARY COMPLICATIONS | 425 | ||
| Dialysis-Associated Hypoxemia | 425 | ||
| TECHNICAL ISSUES | 425 | ||
| Air Embolism | 425 | ||
| Dialysate Composition | 426 | ||
| Blood Loss | 426 | ||
| Summary | 426 | ||
| 27 - Frequent Hemodialysis: Physiological, Epidemiological, and Practical Aspects | 427 | ||
| DEFINITION OF TERMS | 427 | ||
| HISTORY OF FREQUENT HEMODIALYSIS | 427 | ||
| PHYSIOLOGICAL RATIONALE | 428 | ||
| Improved “Unphysiology” With Frequent Hemodialysis | 428 | ||
| Improved Clearance of Small Water-Soluble Solutes | 428 | ||
| Improved Clearance of Small Protein-Bound Solutes | 428 | ||
| Improved Clearance of Middle Molecules | 429 | ||
| Improved Fluid Status With Lower Ultrafiltration Rates | 429 | ||
| BENEFITS AND RISKS: REVIEW OF THE CURRENT EVIDENCE | 429 | ||
| Clinical Benefits | 429 | ||
| Survival | 429 | ||
| Cardiovascular Benefits | 430 | ||
| Blood Pressure | 430 | ||
| Mineral Metabolism | 430 | ||
| Sleep | 431 | ||
| Fertility and Pregnancy | 431 | ||
| Quality of Life | 431 | ||
| Risks and Complications | 431 | ||
| Noninfectious Vascular Complications | 431 | ||
| Infectious Complications | 432 | ||
| Residual Kidney Function | 432 | ||
| Technique Failure | 432 | ||
| CLINICAL INDICATIONS | 432 | ||
| PRESCRIPTIONS FOR FREQUENT HEMODIALYSIS | 432 | ||
| Dialysis Machines | 432 | ||
| Target Weight | 433 | ||
| Phosphate Additives | 433 | ||
| Anticoagulation | 433 | ||
| Vascular Access | 433 | ||
| Measuring Dialysis Adequacy With Frequent Hemodialysis | 434 | ||
| IMPLEMENTING A FREQUENT HEMODIALYSIS PROGRAM | 434 | ||
| Frequent Home Hemodialysis program | 434 | ||
| In-center Daily Hemodialysis Program | 435 | ||
| In-center Nocturnal Hemodialysis Program | 435 | ||
| ECONOMIC CONSIDERATIONS | 435 | ||
| MEDICATION DOSING CONSIDERATIONS | 435 | ||
| INTERNATIONAL TRENDS AND VARIATION | 436 | ||
| OVERCOMING BARRIERS IN UPTAKE OF FREQUENT HEMODIALYSIS | 436 | ||
| FREQUENT HEMODIALYSIS IN CHILDREN | 436 | ||
| FUTURE DIRECTIONS | 436 | ||
| 28 - Home Hemodialysis | 437 | ||
| INTRODUCTION | 437 | ||
| BURDEN OF CONVENTIONAL HEMODIALYSIS | 437 | ||
| HOME HEMODIALYSIS: BENEFITS AND POTENTIAL RISKS | 437 | ||
| Left Ventricular Hypertrophy and Cardiovascular Complications | 438 | ||
| Blood Pressure and Antihypertensive Medication Use | 439 | ||
| Mineral and Bone Disorder and Phosphate Binder Use | 440 | ||
| Health-Related Quality of Life | 442 | ||
| Treatment Complications and Tolerability | 443 | ||
| Potential Risks of Intensive Hemodialysis | 445 | ||
| PROVIDING HOME DIALYSIS: CLINICAL IMPLICATIONS | 447 | ||
| Patient Selection | 447 | ||
| Training and Clinics | 448 | ||
| Dialysis Prescription | 448 | ||
| Barrier to Home Dialysis | 449 | ||
| 29 - Peritoneal Physiology | 450 | ||
| PERITONEAL ANATOMY | 450 | ||
| HISTOLOGY | 451 | ||
| Mesothelium | 451 | ||
| Interstitium | 451 | ||
| Capillary Wall | 452 | ||
| PERITONEAL BLOOD FLOW | 452 | ||
| PERITONEAL LYMPHATICS | 453 | ||
| The Anatomy of Peritoneal Lymphatics | 453 | ||
| Importance of Lymphatic Flow for Peritoneal Fluid Absorption | 453 | ||
| PERITONEAL LOCAL REACTION TO INFECTION | 453 | ||
| PERITONEAL TRANSPORT PHYSIOLOGY | 454 | ||
| Barriers to Transperitoneal Exchange | 454 | ||
| Modeling of Peritoneal Transport | 454 | ||
| Fluid Transport | 454 | ||
| Ultrafiltration | 454 | ||
| Fluid Absorption | 456 | ||
| Pathways for Peritoneal Absorptive Flow | 457 | ||
| Relative Importance of Lymphatic Absorption and Absorption into Adjacent Tissues | 457 | ||
| Solute Transport | 457 | ||
| Diffusive Transport | 457 | ||
| Permeability Surface Area Product Under Standard Conditions | 458 | ||
| Convective Transport | 458 | ||
| Importance of Different Parts of the Peritoneum for Peritoneal Transport | 458 | ||
| Tests to Assess Peritoneal Transport | 459 | ||
| Diffusive Mass Transport Coefficients | 459 | ||
| Peritoneal Equilibration Test | 459 | ||
| Personal Dialysis Capacity Test | 461 | ||
| Peritoneal Transport Groups | 461 | ||
| Effluent Soluble Markers of the Peritoneal Membrane | 461 | ||
| Factors Affecting Peritoneal Transport | 462 | ||
| Temperature | 462 | ||
| Intraperitoneal Hydrostatic Pressure | 462 | ||
| Dialysate Volume | 462 | ||
| Effect of Body Posture on Peritoneal Transport | 462 | ||
| Effect of Dialysate Composition on Peritoneal Transport | 463 | ||
| Glucose Concentration and Osmolality | 463 | ||
| Alternative Osmotic Agents | 463 | ||
| Effect of pH and Different Buffers on Peritoneal Transport | 464 | ||
| Effect of Biocompatible Solutions on Peritoneal Transport | 464 | ||
| Pharmacological Effects on Peritoneal Transport | 464 | ||
| Vasoactive Drugs | 464 | ||
| Changes in Peritoneal Transport During Peritonitis | 464 | ||
| Changes in Water and Solute Transport With Time on Peritoneal Dialysis | 465 | ||
| Changes in Peritoneal Transport With Long-Term Peritoneal Dialysis | 465 | ||
| Loss of Ultrafiltration Capacity | 465 | ||
| Relation Between Peritoneal Transport Characteristics and Clinical Outcome | 466 | ||
| Changes in Peritoneal Morphology With Time on Peritoneal Dialysis | 467 | ||
| Pathophysiological Considerations | 468 | ||
| Potentially Causative Factors | 468 | ||
| Physiological Mechanisms | 468 | ||
| 30 - The Use and Outcomes of Peritoneal Dialysis | 470 | ||
| Peritoneal Dialysis Use | 470 | ||
| Framework for Understanding Peritoneal Dialysis Use | 470 | ||
| Identification of Potential Peritoneal Dialysis Patients | 470 | ||
| Assessment of Peritoneal Dialysis Eligibility | 471 | ||
| Offer and Choice | 472 | ||
| Insertion of the Peritoneal Dialysis Catheter | 473 | ||
| Receipt of Peritoneal Dialysis | 473 | ||
| Outcomes of Peritoneal Dialysis Therapy | 473 | ||
| Attempts at Randomized Comparisons of Peritoneal Dialysis and Hemodialysis | 473 | ||
| Data Validity | 474 | ||
| Comparing the Outcomes of Patients Treated With Peritoneal Dialysis and Hemodialysis: Survival | 474 | ||
| Eligibility for Peritoneal Dialysis and Hemodialysis | 474 | ||
| Cohort Formation | 475 | ||
| The Impact of Urgent Starts | 475 | ||
| Incident Versus Prevalent Patients | 475 | ||
| Changes in Treatment Modality | 475 | ||
| Setting | 475 | ||
| Statistical Considerations | 476 | ||
| Comparing the Outcomes of Patients Treated With Peritoneal Dialysis and Hemodialysis: Hospitalization | 477 | ||
| Comparing the Outcomes of Patients Treated With Peritoneal Dialysis and Hemodialysis: Cost | 477 | ||
| Comparing the Outcomes of Patients Treated With Peritoneal Dialysis and Hemodialysis: Quality of Life | 478 | ||
| Summary | 478 | ||
| 31 - Peritoneal Dialysis Solutions, Prescription and Adequacy | 480 | ||
| PERITONEAL DIALYSIS SOLUTIONS | 480 | ||
| Constituents of Peritoneal Dialysis Solutions | 480 | ||
| Dialysate Buffer | 482 | ||
| Dialysate Calcium | 482 | ||
| Glucose-Based Solutions | 483 | ||
| Local Effects | 483 | ||
| Systemic Effects of Glucose-Based Peritoneal Dialysis Solutions | 484 | ||
| Non–Glucose-Based Peritoneal Dialysis Solutions | 485 | ||
| Glucose Polymer Solutions | 485 | ||
| Biocompatible Peritoneal Dialysis Solutions | 487 | ||
| Amino Acid Peritoneal Dialysis Solutions | 491 | ||
| Low-Sodium Peritoneal Dialysis Solutions | 492 | ||
| Future Development in Peritoneal Dialysis Solutions | 492 | ||
| CONCLUSIONS | 492 | ||
| DIALYSIS ADEQUACY AND PRESCRIPTION | 493 | ||
| Defining Dialysis Adequacy | 493 | ||
| Measuring Biochemical Indices of Dialysis Adequacy | 493 | ||
| Normalization Factor for Urea and Creatinine Clearance | 495 | ||
| Estimation of Residual Kidney Function | 495 | ||
| Frequency of Monitoring of Biochemical Indices of Dialysis Adequacy | 495 | ||
| Peritoneal Equilibration Test | 495 | ||
| Ultrafiltration and Volume Control as a Target for Dialysis Adequacy | 497 | ||
| Nutrition Status as a Target for Dialysis Adequacy | 498 | ||
| Initial Peritoneal Dialysis Prescription | 500 | ||
| Clinical Evaluation of Patients With Low Delivered Urea Clearance | 501 | ||
| Adjusting Peritoneal Dialysis Prescription | 501 | ||
| High Transporters | 502 | ||
| Factors Contributing to More Adverse Outcomes in High Transporters | 502 | ||
| Acute Membrane Injury | 503 | ||
| Ultrafiltration Failure | 503 | ||
| CONCLUSIONS | 504 | ||
| RESIDUAL KIDNEY FUNCTION | 504 | ||
| Importance of Residual Kidney Function in Peritoneal Dialysis | 504 | ||
| Decline of Residual Kidney Function | 506 | ||
| Monitoring of RKF | 508 | ||
| CONCLUSION | 508 | ||
| 32 - Peritoneal Dialysis-Related Infections | 509 | ||
| PERITONEAL DIALYSIS-RELATED PERITONITIS | 509 | ||
| Pathogenesis | 509 | ||
| Host Defense Mechanisms of the Peritoneal Cavity | 510 | ||
| Humoral Immunity | 510 | ||
| Cellular Immunity | 510 | ||
| Effects of Peritoneal Dialysis Solutions on Peritoneal Defense | 510 | ||
| Presentation | 511 | ||
| Diagnosis | 511 | ||
| Treatment of Peritonitis | 511 | ||
| Initial Evaluation | 511 | ||
| Empirical Therapy | 511 | ||
| Practical Aspects of Antibiotic Therapy | 512 | ||
| Adjuvant Therapy | 512 | ||
| Therapy for Specific Organisms | 513 | ||
| Coagulase-Negative Staphylococcal Species | 513 | ||
| Staphylococcus aureus | 513 | ||
| Streptococcal Species | 513 | ||
| Enterococcus Species | 513 | ||
| Pseudomonas Species | 514 | ||
| Other Gram-Negative Bacteria | 514 | ||
| Polymicrobial Peritonitis | 514 | ||
| Mycobacterial Peritonitis | 515 | ||
| Tuberculous Peritonitis | 515 | ||
| Nontuberculous Mycobacterial Peritonitis | 515 | ||
| Reassessment After Therapy | 515 | ||
| Catheter Removal | 515 | ||
| Complications of Peritoneal Dialysis Peritonitis | 515 | ||
| CATHETER-RELATED INFECTIONS | 516 | ||
| Definitions | 516 | ||
| Risk Factors | 516 | ||
| Treatment | 516 | ||
| Clinical Presentation and Assessment | 516 | ||
| Exit-Site Care | 516 | ||
| Antibiotic Therapy | 516 | ||
| Catheter Removal | 517 | ||
| Other Catheter Interventions | 517 | ||
| PREVENTION | 517 | ||
| Catheter Design and Insertion | 517 | ||
| Connectology and Dialysis Solutions | 517 | ||
| Training and Continuous Quality Improvement Programs | 518 | ||
| Exit-Site Care | 518 | ||
| Management of S. aureus Carrier | 518 | ||
| Other Modifiable Risk Factors | 518 | ||
| Secondary Prevention of Peritonitis | 519 | ||
| 33 - Noninfectious Complications of Peritoneal Dialysis | 520 | ||
| COMPLICATIONS RELATED TO INCREASED INTRAABDOMINAL PRESSURE | 520 | ||
| Hernia Formation | 520 | ||
| Incidence, Types of Hernia, and Etiological Factors | 520 | ||
| Clinical Presentation and Diagnosis | 521 | ||
| Treatment | 522 | ||
| Dialysate Leaks | 522 | ||
| Incidence, Classification of Leaks, and Risk Factors | 522 | ||
| Complications of Dialysate Leaks | 523 | ||
| Prevention of Dialysate Leaks | 524 | ||
| Hydrothorax | 524 | ||
| Pathogenesis | 524 | ||
| Incidence and Risk Factors | 525 | ||
| Clinical Presentation | 525 | ||
| Diagnosis | 526 | ||
| Management | 526 | ||
| MALFUNCTION OF THE PERITONEAL CATHETER | 527 | ||
| DRAIN PAIN | 528 | ||
| HEMOPERITONEUM | 529 | ||
| CHYLOPERITONEUM | 530 | ||
| METABOLIC COMPLICATIONS | 531 | ||
| Hyperglycemia | 531 | ||
| Lipid Abnormalities | 531 | ||
| Insulin Resistance | 531 | ||
| Hepatic Subcapsular Steatosis | 531 | ||
| ELECTROLYTE DISORDERS | 532 | ||
| ENCAPSULATING PERITONEAL SCLEROSIS | 532 | ||
| Definition and Epidemiology | 532 | ||
| Risk Factors | 533 | ||
| Pathophysiology | 533 | ||
| Therapeutic Approaches in Encapsulating Peritoneal Sclerosis | 535 | ||
| Prevention of Encapsulating Peritoneal Sclerosis | 537 | ||
| ENCAPSULATING PERITONEAL SCLEROSIS AND RENAL TRANSPLANTATION | 537 | ||
| IV - Transplantation | 538 | ||
| 34 - The Epidemiology, Outcomes, and Costs of Contemporary Kidney Transplantation | 539 | ||
| INTRODUCTION | 539 | ||
| LIVING DONOR TRANSPLANTATION | 542 | ||
| IMMUNOSUPPRESSION: TRENDS AND CURRENT PRACTICE | 543 | ||
| Induction Immunosuppression | 543 | ||
| Maintenance Immunosuppression | 544 | ||
| POSTTRANSPLANT OUTCOMES | 547 | ||
| Acute Rejection | 548 | ||
| Graft Survival | 549 | ||
| Patient Survival | 549 | ||
| CENTER PERFORMANCE GRADING | 549 | ||
| Centers for Medicare & Medicaid Services | 549 | ||
| Effect of Performance Monitoring | 549 | ||
| UNMEASURED AND NOVEL RISK FACTORS | 550 | ||
| ECONOMICS OF KIDNEY TRANSPLANTATION | 551 | ||
| ECONOMIC IMPLICATIONS OF PRACTICE INNOVATION: ABO- AND HLA-INCOMPATIBLE KIDNEY TRANSPLANTATION | 553 | ||
| CONCLUSIONS | 553 | ||
| 35 - Transplantation Immunobiology | 555 | ||
| THE ALLOIMMUNE RESPONSE | 555 | ||
| A. Transplantation Antigens | 555 | ||
| Minor Transplantation Antigens | 558 | ||
| ABO Blood Group Antigens | 558 | ||
| Monocyte and Endothelial Cell Antigens | 558 | ||
| B. Cellular Events Leading to Allograft Rejection | 558 | ||
| Allorecognition Pathways | 559 | ||
| T-Cell Activation | 561 | ||
| Effector Mechanisms of Allograft Rejection | 566 | ||
| Resolution and Memory | 567 | ||
| TOLERANCE | 567 | ||
| SUMMARY | 569 | ||
| 36 - Evaluation of Donors and Recipients | 570 | ||
| EVALUATION OF THE LIVING DONOR | 570 | ||
| CLINICAL ASSESSMENT OF THE LIVING DONOR | 570 | ||
| Kidney Function | 571 | ||
| Proteinuria | 571 | ||
| Microscopic Hematuria | 572 | ||
| Cardiovascular Risk | 572 | ||
| Hypertension | 572 | ||
| Diabetes | 572 | ||
| Obesity | 572 | ||
| Inherited Renal Disease | 572 | ||
| Nephrolithiasis | 573 | ||
| Psychosocial Evaluation and Informed Consent | 573 | ||
| SURGICAL TECHNIQUES AND RISKS | 573 | ||
| LONG-TERM RISKS TO THE DONOR | 573 | ||
| End-Stage Renal Disease | 573 | ||
| Pregnancy | 573 | ||
| Quality of Life | 574 | ||
| Long-Term Medical Care | 574 | ||
| CONCLUSIONS | 574 | ||
| EVALUATION OF THE RECIPIENT | 574 | ||
| CLINICAL ASSESSMENT OF THE RECIPIENT | 574 | ||
| History, Physical Examination, and Diagnostic Testing | 574 | ||
| SELECTED ISSUES IN THE RECIPIENT EVALUATION | 576 | ||
| Cardiovascular Disease | 576 | ||
| Coronary Artery Disease | 576 | ||
| Congestive Heart Failure and Valvular Heart Disease | 577 | ||
| Peripheral Vascular Disease | 577 | ||
| Diabetes Mellitus | 577 | ||
| Pulmonary Disease | 577 | ||
| Obstructive and Restrictive Lung Disease | 577 | ||
| Pulmonary Hypertension | 578 | ||
| Cancer | 578 | ||
| Obesity | 578 | ||
| Infections | 578 | ||
| Hepatitis C | 578 | ||
| Hepatitis B | 578 | ||
| Human Immunodeficiency Virus | 579 | ||
| Tuberculosis | 579 | ||
| Systemic Diseases | 579 | ||
| Emerging Risk Factors That May Affect Kidney Transplant Candidacy | 580 | ||
| Hypotension on Hemodialysis | 580 | ||
| Frailty and Functional Status | 580 | ||
| History of a Failed Allograft | 580 | ||
| High Sensitization to Human Leukocyte Antigens | 581 | ||
| Psychosocial Issues | 581 | ||
| Counseling and Education | 581 | ||
| Management of the Waiting List | 581 | ||
| CONCLUSIONS | 581 | ||
| 37 - Surgical Management of the Renal Transplant Recipient | 582 | ||
| LIVE DONOR KIDNEY TRANSPLANTATION | 582 | ||
| Live Donor Evaluation | 582 | ||
| Live Donor Nephrectomy | 583 | ||
| RECIPIENT EVALUATION | 583 | ||
| DECEASED DONOR KIDNEY EVALUATION: KIDNEY DONOR PROFILE INDEX | 584 | ||
| SURGICAL TECHNIQUE | 584 | ||
| IMMEDIATE POSTOPERATIVE MANAGEMENT | 585 | ||
| POSTOPERATIVE COMPLICATIONS | 586 | ||
| Vascular Complications | 586 | ||
| Transplant Renal Artery Stenosis | 586 | ||
| Renal Vein Thrombosis | 587 | ||
| Ureteral Complications | 588 | ||
| Urine Leak | 588 | ||
| Urinary Obstruction | 588 | ||
| Other Complications | 589 | ||
| Lymphocele | 589 | ||
| Surgical Site Infection | 589 | ||
| CONCLUSIONS | 590 | ||
| 38 - Immunosuppressive Therapy | 591 | ||
| INTRODUCTION | 591 | ||
| HISTORICAL PERSPECTIVE | 591 | ||
| Early Era (1954–1962) | 591 | ||
| The Azathioprine Era (1962–1980) | 591 | ||
| The Cyclosporine Era (1980s–1990s) | 592 | ||
| The Contemporary Era (1990s–Present) | 592 | ||
| RISK STRATIFICATION | 592 | ||
| Immunological Risk | 592 | ||
| Medical Risk | 592 | ||
| Overall Efficacy | 592 | ||
| CONTEMPORARY IMMUNOSUPPRESSIVE THERAPY | 592 | ||
| INDUCTION THERAPY | 594 | ||
| Lymphocyte-Depleting Agents | 594 | ||
| Interleukin-2 Receptor Blockers | 594 | ||
| Landmark Trials With Induction Therapy | 594 | ||
| MAINTENANCE IMMUNOSUPPRESSIVE THERAPY | 595 | ||
| Corticosteroids | 595 | ||
| Calcineurin Inhibitors | 595 | ||
| Mycophenolic Acid | 596 | ||
| Azathioprine | 596 | ||
| mTOR Inhibitors | 596 | ||
| Belatacept | 596 | ||
| Combination Therapies and Trials That Led to Current Standards | 596 | ||
| CNI-SPARING THERAPIES | 597 | ||
| STEROID-SPARING REGIMENS | 602 | ||
| OUR RECOMMENATIONS | 602 | ||
| GENERIC IMMUNOSUPPRESSION | 602 | ||
| LOOKING FORWARD | 602 | ||
| CONCLUSION | 604 | ||
| 39 - Diagnosis and Therapy of Graft Dysfunction | 605 | ||
| INTRODUCTION | 605 | ||
| DELAYED GRAFT FUNCTION | 605 | ||
| Definition | 605 | ||
| Differential Diagnosis | 606 | ||
| Prediction and Prevention of Delayed Graft Function | 607 | ||
| Management of Delayed Graft Function | 608 | ||
| Diagnostic Studies in Persistent Oliguria or Anuria | 608 | ||
| OTHER CAUSES OF GRAFT DYSFUNCTION DURING THE FIRST WEEK AFTER TRANSPLANTATION | 609 | ||
| Rejection | 609 | ||
| Hyperacute Rejection | 609 | ||
| Accelerated Acute Rejection | 609 | ||
| Early T-Cell Acute Rejection | 609 | ||
| Nonimmunological Causes | 609 | ||
| Long-Term Impact of Immediate Graft Dysfunction | 609 | ||
| Graft Dysfunction in the Early Posttransplant Period | 610 | ||
| ACUTE REJECTION | 610 | ||
| Clinical Presentation | 610 | ||
| Imaging Studies | 610 | ||
| Core Biopsy | 610 | ||
| Histopathological Diagnosis | 610 | ||
| TYPES OF ACUTE REJECTION | 610 | ||
| Acute T-Cell–Mediated Rejection | 611 | ||
| Acute Antibody-Mediated Rejection | 611 | ||
| Noninvasive Diagnostic Biomarkers | 611 | ||
| Calcineurin Inhibitor-Mediated Nephrotoxicity | 612 | ||
| Histological Features of Calcineurin Inhibitor-Mediated Nephrotoxicity | 612 | ||
| THROMBOTIC MICROANGIOPATHY | 612 | ||
| INFECTION | 613 | ||
| VASCULAR COMPLICATIONS | 613 | ||
| Renal Artery Stenosis | 613 | ||
| Allograft Thrombosis | 614 | ||
| Ureteral Obstruction | 614 | ||
| Perinephric Fluid Collections | 614 | ||
| LATE GRAFT DYSFUNCTION | 614 | ||
| Differential Diagnosis of Chronic Allograft Injury | 615 | ||
| Antigen-Dependent Causes of Late Graft Loss | 615 | ||
| Histocompatibility | 616 | ||
| Prior Sensitization | 617 | ||
| Alloantigen-Independent Factors | 617 | ||
| Donor Age | 617 | ||
| Chronic CNI Nephrotoxicity | 617 | ||
| Histopathological Features of Chronic Graft Dysfunction | 617 | ||
| Strategies to Prevent Late Graft Loss (Also See Chapter 44) | 618 | ||
| BK Nephropathy | 619 | ||
| Recurrent Diseases | 620 | ||
| Nonadherence | 620 | ||
| ACKNOWLEDGMENTS | 620 | ||
| 40 - Infection in Renal Transplant Recipients | 621 | ||
| INTRODUCTION | 621 | ||
| PRETRANSPLANT RECIPIENT EVALUATION | 621 | ||
| DONOR EVALUATION | 623 | ||
| TIMELINE OF INFECTION | 624 | ||
| The Early Posttransplant Period (Month 0 to 1) | 626 | ||
| Months 1 to 6 | 626 | ||
| Beyond 6 Months | 626 | ||
| SELECTED INFECTIONS OF IMPORTANCE | 627 | ||
| Cytomegalovirus | 627 | ||
| Patterns of transmission | 627 | ||
| Pathogenesis/Risk Factors | 628 | ||
| Diagnosis | 628 | ||
| Prevention | 628 | ||
| Treatment | 629 | ||
| Epstein-Barr Virus and Posttransplant Lymphoproliferative Disease | 629 | ||
| Posttransplant Lymphoproliferative Disease | 629 | ||
| Diagnosis of Epstein-Barr Virus and Posttransplant Lymphoproliferative Disease | 629 | ||
| Treatment and Prognosis of Posttransplant Lymphoproliferative Disease | 630 | ||
| Prevention | 630 | ||
| BK Virus | 630 | ||
| Risk Factors | 630 | ||
| Viral Load Monitoring, Diagnosis, and Prevention of BK Nephropathy | 630 | ||
| Treatment | 630 | ||
| Hepatitis C | 631 | ||
| Kidney Transplantation in Hepatitis C Virus-positive Patients | 631 | ||
| Use of Hepatitis C Virus-positive Donors | 631 | ||
| Treatment of Hepatitis C Virus With Direct-Acting Antiviral | 632 | ||
| Hepatitis B | 632 | ||
| Treatment of Hepatitis B Virus | 633 | ||
| Use of Hepatitis B Virus-positive Donors | 633 | ||
| Human Immunodeficiency Virus | 633 | ||
| Acute Rejection | 634 | ||
| Drug–Drug Interactions | 634 | ||
| Infection | 634 | ||
| Use of Human Immunodeficiency Virus-positive Donors | 634 | ||
| FUNGAL PATHOGENS | 635 | ||
| Candida | 635 | ||
| Cryptococcus | 635 | ||
| Aspergillus | 636 | ||
| Pneumocystis jirovecii | 636 | ||
| BACTERIAL INFECTIONS | 636 | ||
| Urinary Tract Infections | 637 | ||
| PREVENTION | 637 | ||
| Immunization | 637 | ||
| 41 - Noninfectious Complications After Kidney Transplantation | 639 | ||
| INTRODUCTION | 639 | ||
| CARDIOVASCULAR DISEASE | 639 | ||
| Nontraditional Risk Factors | 640 | ||
| Hypertension | 640 | ||
| Smoking | 641 | ||
| Dyslipidemia | 641 | ||
| New-Onset Diabetes After Transplantation | 642 | ||
| Metabolic Syndrome | 642 | ||
| Obesity | 642 | ||
| Peripheral and Cerebrovascular Disease | 643 | ||
| Posttransplantation Anemia | 643 | ||
| Evaluation of Atherosclerotic Cardiovascular Disease Before Transplantation | 644 | ||
| MALIGNANCY AFTER KIDNEY TRANSPLANTATION | 644 | ||
| Effect of Immunosuppression | 645 | ||
| Posttransplantation Lymphoproliferative Disease | 646 | ||
| Treatment of Posttransplant Lymphoproliferative Disease | 646 | ||
| ELECTROLYTE DISORDERS | 646 | ||
| MUSCULOSKELETAL COMPLICATIONS OF TRANSPLANTATION | 647 | ||
| Osteopenia and Osteoporosis Posttransplantation | 647 | ||
| Treatment of Posttransplant Osteopenia and Osteoporosis | 647 | ||
| Osteoarticular Pain Posttransplantation | 648 | ||
| Tendonitis | 648 | ||
| NEUROPSYCHIATRIC COMPLICATIONS OF TRANSPLANTATION | 648 | ||
| Depression | 649 | ||
| Suicide | 649 | ||
| Nonadherence | 649 | ||
| Psychopharmacology | 649 | ||
| Neurological Complications | 650 | ||
| VISUAL DISTURBANCES AFTER TRANSPLANTATION | 650 | ||
| SUMMARY AND CONCLUSION | 650 | ||
| 42 - Recurrent and De Novo Renal Diseases After Kidney Transplantation | 651 | ||
| THE EFFECT OF RECURRENT OR DE NOVO DISEASE ON TRANSPLANT OUTCOME | 651 | ||
| PRIMARY GLOMERULOPATHIES | 653 | ||
| Focal Segmental Glomerulosclerosis | 653 | ||
| Membranous Nephropathy | 654 | ||
| IgA Nephropathy | 655 | ||
| Antiglomerular Basement Membrane Disease | 655 | ||
| Membranoproliferative Glomerulonephritis and C3 Glomerulopathy | 655 | ||
| SECONDARY GLOMERULOPATHIES | 656 | ||
| Systemic Lupus Erythematosus | 656 | ||
| Antiphospholipid Syndrome | 656 | ||
| Antineutrophil Cytoplasmic Antibody-Associated Vasculitis | 656 | ||
| Henoch-Schonlein Purpura | 657 | ||
| Systemic Sclerosis | 657 | ||
| Hemolytic Uremic Syndrome and Other Thrombotic Microangiopathies | 657 | ||
| Diabetic Nephropathy | 658 | ||
| GLOMERULAR DEPOSITION DISEASES | 658 | ||
| Diseases Associated With Plasma Cell Dyscrasia | 658 | ||
| AL Amyloidosis | 658 | ||
| Multiple Myeloma/Cast Nephropathy | 658 | ||
| Light-Chain Deposition Disease | 659 | ||
| Amyloid A and Other Amyloidoses | 659 | ||
| Fibrillary-Immunotactoid Glomerulopathy | 659 | ||
| NONGLOMERULAR DISEASES | 659 | ||
| Oxalosis | 659 | ||
| Fabry Disease | 659 | ||
| Cystinosis | 660 | ||
| Sarcoidosis | 660 | ||
| Sickle Cell Disease | 660 | ||
| 43 - Pediatric Renal Transplantation | 661 | ||
| ROLE OF TRANSPLANTATION | 661 | ||
| Incidence and Frequency of Pediatric Renal Transplantation | 662 | ||
| Etiology of End-Stage Renal Disease in Children | 662 | ||
| Indications for Renal Transplantation in Children | 662 | ||
| PRETRANSPLANT PREPARATION | 663 | ||
| Recipient Age at Transplantation | 663 | ||
| Recipient Preparation | 663 | ||
| Urological Preparation | 663 | ||
| Donor Preparation | 664 | ||
| Donor Selection | 664 | ||
| THE TRANSPLANTATION PROCEDURE | 664 | ||
| Technical Issues in Transplantation | 664 | ||
| Evaluation of Graft Dysfunction | 665 | ||
| Delayed Graft Function | 665 | ||
| Graft Thrombosis | 665 | ||
| Obstruction, Urinary Leak, and Urological Complications | 666 | ||
| Immunosuppression Strategies | 666 | ||
| ALLOGRAFT DYSFUNCTION | 667 | ||
| Hyperacute Rejection | 667 | ||
| Acute Rejection | 667 | ||
| Diagnosis of Acute Rejection | 668 | ||
| Pediatric Renal Transplant Biopsy | 668 | ||
| Treatment of Acute Rejection | 668 | ||
| Reversibility of Acute Rejection | 668 | ||
| Chronic Allograft Dysfunction | 668 | ||
| Recurrent Kidney Disease | 669 | ||
| Focal Segmental Glomerulosclerosis | 669 | ||
| Hemolytic Uremic Syndrome | 669 | ||
| Membranoproliferative Glomerulonephritis, Types I and II | 670 | ||
| Oxalosis, Methylmalonic Acidemia, and Metabolic Diseases | 670 | ||
| Other Autoimmune Diseases | 670 | ||
| Cystinosis | 670 | ||
| GRAFT SURVIVAL | 670 | ||
| GROWTH AFTER TRANSPLANTATION | 671 | ||
| COMPLICATIONS OF PEDIATRIC RENAL TRANSPLANTATION | 672 | ||
| Adherence to Chronic Immunosuppression Treatment | 672 | ||
| Hospitalization | 672 | ||
| Posttransplant Lymphoproliferative Disorder and Malignancy | 672 | ||
| Other Infections | 673 | ||
| Cytomegalovirus | 673 | ||
| Pneumocystis Carinii | 673 | ||
| Varicella | 673 | ||
| Urinary Tract Infection | 674 | ||
| Polyomavirus | 674 | ||
| Hypertension | 674 | ||
| Hyperlipidemia/Dyslipidemia | 674 | ||
| Posttransplantation Diabetes Mellitus | 675 | ||
| LONG-TERM OUTCOMES OF PEDIATRIC RENAL TRANSPLANTATION | 675 | ||
| Rehabilitation | 675 | ||
| Mortality | 675 | ||
| 44 - Chronic Kidney Disease in the Kidney Transplant Recipient | 676 | ||
| INTRODUCTION | 676 | ||
| The Chronic Kidney Disease Classification | 676 | ||
| Rationale for Including Kidney Transplant Recipients in the Chronic Kidney Disease Classification | 678 | ||
| APPLICABILITY OF THE CHRONIC KIDNEY DISEASE CLASSIFICATION IN TRANSPLANT RECIPIENTS | 678 | ||
| Prevalence of Chronic Kidney Disease in Kidney Transplant Recipients | 678 | ||
| Prevalence of Chronic Kidney Disease–Related Complications in Kidney Transplant Recipients | 679 | ||
| The Predictive Value of Chronic Kidney Disease Staging for Outcomes Among Kidney Transplant Recipients | 679 | ||
| CHRONIC KIDNEY DISEASE MANAGEMENT | 680 | ||
| Chronic Kidney Disease Care Before Transplantation | 680 | ||
| Chronic Kidney Disease Care in the Peritransplant Period | 680 | ||
| Chronic Kidney Disease Care in Patients With a Functioning Allograft | 680 | ||
| Chronic Kidney Disease Care in Patients With Transplant Failure | 681 | ||
| V - Acute Kidney Injury | 683 | ||
| 45 - The Epidemiology of Acute Kidney Injury | 684 | ||
| DEFINITION OF ACUTE KIDNEY INJURY | 684 | ||
| Early Cohort Studies of Acute Kidney Injury | 685 | ||
| Multicenter Cohort Studies of Acute Kidney Injury | 686 | ||
| Large Database Studies of Acute Kidney Injury | 687 | ||
| EPIDEMIOLOGY IN DISEASE-SPECIFIC STATES | 688 | ||
| Risk Factors for the Development of Acute Kidney Injury | 688 | ||
| Risk Factors for Mortality Associated With Acute Kidney Injury | 693 | ||
| Acute Kidney Injury in the Setting of Chronic Kidney Disease | 695 | ||
| Long-Term Implications of an Episode of Acute Kidney Injury | 695 | ||
| ACUTE KIDNEY INJURY IN THE DEVELOPING WORLD | 697 | ||
| SUMMARY | 697 | ||
| 46 - Metabolic and Nutritional Complications of Acute Kidney Injury | 698 | ||
| TERMINOLOGY | 698 | ||
| PREVALENCE OF PROTEIN-ENGERY WASTING IN ACUTE KIDNEY INJURY | 698 | ||
| DYSMETABOLISM OF ACUTE KIDNEY INJURY | 699 | ||
| Inflammation | 699 | ||
| Oxidative Stress | 701 | ||
| What Is Oxidative Stress? | 702 | ||
| Animal Models of Oxidative Stress in Acute Kidney Injury | 702 | ||
| Biomarkers of Oxidative Stress in Clinical Acute Kidney Injury | 703 | ||
| Pro- and Antioxidant Enzyme Gene Polymorphisms in Acute Kidney Injury | 703 | ||
| NUTRITIONAL DERANGEMENTS IN ACUTE KIDNEY INJURY | 703 | ||
| Carbohydrate Metabolism | 703 | ||
| The Kidney and Glucose Metabolism | 703 | ||
| Loss of Kidney Function Alters Insulin Dispersion | 703 | ||
| Growth Hormone and Insulin-like Growth Factor I Axis | 703 | ||
| Insulin Resistance in Critical Illness | 704 | ||
| Counterregulatory Hormones and Inflammation in the “Diabetes of Injury” | 704 | ||
| Insulin Resistance in Acute Kidney Injury | 704 | ||
| PROTEIN METABOLISM | 705 | ||
| Causes of Enhanced Protein Catabolism in Acute Kidney Injury | 705 | ||
| Inflammation | 705 | ||
| Insulin Resistance | 705 | ||
| Metabolic Acidosis | 707 | ||
| Renal Replacement Therapy | 707 | ||
| LIPID METABOLISM | 707 | ||
| Provision of Nutritional Support | 707 | ||
| Energy Requirements | 708 | ||
| Protein Requirement | 708 | ||
| Lipids | 709 | ||
| “Immunonutrition,” Micronutrients, and Other Additives | 709 | ||
| Insulin | 710 | ||
| Route | 710 | ||
| Timing | 711 | ||
| Conclusion | 712 | ||
| 47 - Acute Kidney Injury Diagnostics and Biomarkers | 713 | ||
| BIOMARKERS IN ACUTE KIDNEY INJURY | 713 | ||
| Creatinine as a Biomarker | 714 | ||
| U.S. Food and Drug Administration Critical Path Initiative | 715 | ||
| Need for New Biomarkers | 715 | ||
| Specific Biomarkers of Acute Kidney Injury | 715 | ||
| α1-Microglobulin | 716 | ||
| Interleukin-18 | 716 | ||
| Neutrophil Gelatinase-Associated Lipocalin | 717 | ||
| Liver Type Fatty Acid-Binding Protein | 718 | ||
| Kidney Injury Molecule-1 | 719 | ||
| Tissue Inhibitor of Metalloproteinase 2 and Insulin-Like Growth Factor-Binding Protein 7 | 720 | ||
| Osteopontin | 721 | ||
| YKL-40 | 721 | ||
| Uromodulin | 721 | ||
| Interleukin-6/Interleukin-10 | 722 | ||
| Repurposed Biomarkers | 722 | ||
| Urine Microscopy | 723 | ||
| Biomarkers Panels | 723 | ||
| The Future of Biomarkers in Acute Kidney Injury | 723 | ||
| SUMMARY | 724 | ||
| DISCLOSURES | 724 | ||
| 48 - Pharmacological Interventions in Acute Kidney Injury | 725 | ||
| BARRIERS TO SUCCESSFUL CLINICAL TRIALS IN ACUTE KIDNEY INJURY | 726 | ||
| Patient and Comorbid Factors | 726 | ||
| Pathogenesis of Acute Kidney Injury Is Complex | 726 | ||
| Acute Kidney Injury Is a Multisystem Disease | 726 | ||
| PHARMACOLOGICAL INTERVENTIONS | 727 | ||
| Diuretics | 727 | ||
| Antioxidants: N-Acetylcysteine, Vitamin C | 728 | ||
| Insulin | 730 | ||
| Dopamine, Dopamine Analogs, and Natriuretic Peptides | 730 | ||
| Norepinephrine | 731 | ||
| Vasopressin and Analogs | 731 | ||
| Angiotensin II | 732 | ||
| Adenosine Analogs | 732 | ||
| Calcium Channel Antagonists | 732 | ||
| Recombinant Erythropoietin | 732 | ||
| Statins | 733 | ||
| Corticosteroids | 733 | ||
| WHAT DRUGS ARE ON THE HORIZON? | 733 | ||
| Antiapoptotic Drugs | 733 | ||
| α-Melanocyte–Stimulating Hormone | 733 | ||
| Minocycline | 734 | ||
| p53 Small Interfering RNA | 734 | ||
| Antisepsis Drugs | 734 | ||
| Endocannabinoid Receptors | 734 | ||
| Soluble Thrombomodulin | 734 | ||
| Growth Factors | 735 | ||
| Hepatocyte Growth Factor | 735 | ||
| Bone Morphogenic Protein | 735 | ||
| Vasodilators | 735 | ||
| Adenosine Triphosphate–Sensitive K Channel Agonists | 735 | ||
| Antiinflammatory Drugs | 736 | ||
| Sphingosine 1 Phosphate Analogs | 736 | ||
| A2A Agonists and Other Adenosine Analogs | 736 | ||
| Alkaline Phosphatase | 736 | ||
| Mitochondrial Agents | 736 | ||
| Iron Metabolism Agents | 737 | ||
| Deferoxamine and Hepcidin | 737 | ||
| Hypoxia-Inducible Factor 1 Inducing Agents | 737 | ||
| Mesenchymal Stem Cell Therapy | 737 | ||
| Anesthetic Agents | 738 | ||
| DISCLOSURES | 738 | ||
| 49 - Renal Replacement Therapy for Acute Kidney Injury | 739 | ||
| GOALS OF AND INDICATIONS FOR RENAL REPLACEMENT THERAPY | 739 | ||
| MODALITIES OF RENAL REPLACEMENT THERAPY | 739 | ||
| Intermittent Modalities | 741 | ||
| Prolonged Intermittent Renal Replacement Therapies | 741 | ||
| Continuous Modalities | 741 | ||
| Continuous Renal Replacement Therapy | 742 | ||
| TIMING OF INITIATION OF RENAL REPLACEMENT THERAPY | 743 | ||
| SELECTION OF MODALITY OF RENAL REPLACEMENT THERAPY | 745 | ||
| DOSE OF RENAL REPLACEMENT THERAPY | 746 | ||
| Intermittent Hemodialysis and Prolonged Intermittent Renal Replacement Therapy | 747 | ||
| Continuous Renal Replacement Therapy | 748 | ||
| Effect of Dose on Recovery of Kidney Function | 749 | ||
| Volume Management | 749 | ||
| Summary and Recommendations | 749 | ||
| TECHNICAL ASPECTS OF MANAGEMENT OF RRT IN AKI | 750 | ||
| Vascular Access | 750 | ||
| Anticoagulation | 750 | ||
| Membrane Composition | 752 | ||
| Procedure-Related Complications | 752 | ||
| Medication Dosing | 753 | ||
| OUTCOMES | 753 | ||
| SUMMARY | 753 | ||
| INDEX | 754 | ||
| A | 754 | ||
| B | 756 | ||
| C | 757 | ||
| D | 760 | ||
| E | 762 | ||
| F | 763 | ||
| G | 764 | ||
| H | 765 | ||
| I | 767 | ||
| J | 768 | ||
| K | 768 | ||
| L | 769 | ||
| M | 770 | ||
| N | 770 | ||
| O | 771 | ||
| P | 772 | ||
| Q | 774 | ||
| R | 774 | ||
| S | 776 | ||
| T | 777 | ||
| U | 778 | ||
| V | 778 | ||
| W | 779 | ||
| X | 779 | ||
| Y | 779 | ||
| Z | 779 |