TWiN (The Week In Nephrology) June 6 2016


The role of Tregs in kidney disease especially in kidney transplantation is discussed in this review from Kidney International.

The focus of the June issue of Transplantation is Living Donors! Excellent selection of papers from around the world.


Another negative RCT. A study from the Netherlands, published this month in NDT.  investigated the role of extended course of maintenance azathioprine (4 years) vs standard course (1 year) in patients with positive cANCA at remission. There was no difference in the relapse rate in both the arms and hence extended azathioprine maintenance is of limited benefit.

Patient engagement and patient centered investigations are becoming centerstage especially in CKD, ESRD and Transplantation. This recent publication in CJASN looks at patient centered outcomes in glomerulonephritis. Very timely.


The sympathetic nervous system, HTN and renal denervation 101! A comprehensive review on the pathophysiology of SNS in HTN and the various trials investigating the role of RDN. Published in JASH


Another study from the the Netherlands published in April in CJASN. This is a single center observational study comparing outcomes in patients >70 years of age choosing conservative management or RRT. They concluded that patients >70 year old with > 3 comorbid conditions (incl Cardiovascular comorbidity) or patient age > 80 did not have a survival advantage in choosing RRT over conservative care.

An excellent review on pulmonary ultrasound to detect and characterize extra vascular lung water in the European Heart Journal recently. This technique may have potential role in assessing the fluid status of our dialysis patients.

The artificial wearable kidney has been in news for some time now. The first FDA approved trial was recently published in JCI Insight. This demonstrated that WAK is a possibility, however the trial was stopped early due to technical reason related to the device. This serves as a proof of concept for this method of dialysis pending further improvements in the device.

The Lancet published a Series of 3 review papers related to ESRD recently. The first is a review of the heart and the vascular system in dialysis. The second is controversies and problems of volume control and hypertension in dialysis patients and the third is a paper integrating DOPPS and USRDS data on factors affecting outcomes in ESRD patients worldwide. #mustread

#HemoPause - a checklist from the St Mike's Hospital in Toronto is being designed to prevent medical errors in dialysis patients who are inherently complex and may have multiple comorbidities and polypharmacy. The feasibility study of this checklist was published recently in Clincial Kidney Journal.