Foreword


Richard Solomon, MD, FASN, is the Patrick Professor of Medicine at the University of Vermont College of Medicine and Director of the Division of Nephrology and Hypertension at Fletcher Allen Health Care. His research interests include acute kidney injury particularly following administration of iodinated contrast media and the impact on long-term morbidity and mortality. He is a member of the National Institutes of Health (NIH) foundation for biomarker evaluation in kidney disease and serves on a number of acute kidney injury clinical trial scientific advisory boards.


he classification and staging of chronic kidney disease (CKD) implies an orderly and almost predictable progression toward end-stage kidney disease. Over the past few years, the nephrology community has come to appreciate that the rate of progression to end-stage kidney disease can be modified by a variety of therapies or accelerated by an equivalent variety of adverse events, some of which may also be modifiable, such as acute kidney injury/insufficiency (AKI). With the rapid development of our understanding of these processes, we have perhaps slowed the progression of chronic kidney disease for many patients, only to realize that most patients will succumb to cardiovascular events, a consequence in part of the burden of ‘non-traditional’ risk factors which accumulate as renal function diminishes. One could arguably ask whether we have improved either the quantity or quality of life of patients with CKD. As we move forward, improving quality as well as quantity of life for patients with CKD will require consideration of all of the factors which contribute to morbidity and mortality in these patients, regardless of the stage of their illness.


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In this issue of US Nephrology, this holistic approach to chronic kidney disease is further developed, starting with a simplified classification schema for CKD presented by Pottel et al. The role of exercise training in CKD is discussed by Clyne. The importance of hyperphosphatemia, secondary hyperparathyroidism, anemia, and proteinuria are addressed in articles by Stennett, Macdougall, Bárány, Rocchetti, and Martin, reviewing our current and future therapies and the importance of these factors as predictors of the rate of progression. AKI can also impact the development and progression of CKD. The role of biomarkers in the early detection of AKI and further efforts to uniformly define and grade the severity of AKI are presented by Devarajan and Srisawat. Older patients are at greater risk for AKI and the unique aspects of glomerular disease in this aging population are discussed by Abrass. Perhaps one of the most vexing yet common challenges are the patients with cardiorenal syndrome. Prevention and management of these complex patients are highlighted in another timely paper by McCullough et al. Finally, rapid progression to end-stage kidney disease is a unique and poorly understood syndrome and is explored in a paper by Macaulay et al.


For those patients who survive and reach end-stage kidney disease, dialysis adequacy, the impact of peritoneal sclerosis (on PD adequacy) and the dialysis access for home patients are discussed by Phadke, Harel, and Wu. Transplantation is generally considered a better renal replacement therapy for many patients. Immunosuppressive regimes have changed significantly over the last few decades and our current approaches are discussed by Singh.


The theme of this volume of US Nephrology embraces the diversity of factors which influence the course of CKD and the impact on patient care. We would like to thank the authors for their timely and informative reviews and all those who have supported these efforts to improve patient care through education. n


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© TOUCH BRIEFINGS 2010


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