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[Nephrology : what's new in 2018 ?]
Sophie De Seigneux1, Belen Ponte1, Karine Hadaya1
1Service de néphrologie, Département des spécialités médicales, HUG, 1211 Genève 14.
Revue Medicale Suisse
|January 11, 2019
Summary
Recent kidney disease research shows no benefit to early dialysis initiation and highlights iron supplementation safety in hemodialysis patients. Cognitive decline may link to hemodialysis, and antibody persistence predicts transplant loss.
Area of Science:
- Nephrology
- Renal Medicine
- Transplantation
Background:
- Significant advancements in treating ANCA-associated vasculitis, IgA nephropathy, and autosomal dominant polycystic kidney disease have emerged.
- Current understanding of renal replacement therapy (RRT) and supportive care in kidney disease requires updates.
Purpose of the Study:
- To review recent findings on the efficacy and safety of various kidney disease treatments and management strategies.
- To evaluate the impact of early RRT, fluid management, iron supplementation, dialysis modalities, and post-transplant antibody levels on patient outcomes.
Main Methods:
- Literature review of major advances in nephrology published within the past year.
- Analysis of studies concerning renal replacement therapy, iron supplementation, dialysis-associated cognitive decline, and kidney transplantation outcomes.
Main Results:
- Early initiation of RRT in intensive care units shows no clear benefit.
- Chloride-poor solutions do not prevent kidney failure.
- Parenteral iron supplementation in hemodialysis patients is safe, with no increased infectious or cardiovascular risks.
- Hemodialysis may be more associated with cognitive decline than peritoneal dialysis.
- Persistent complement-binding donor-specific antibodies post-treatment predict graft loss in transplantation.
- Tocilizumab shows promise for treating chronic antibody-mediated rejection.
Conclusions:
- Current evidence does not support early RRT initiation or the use of chloride-poor solutions for preventing kidney failure.
- Parenteral iron is safe for hemodialysis patients. Hemodialysis may pose a higher risk for cognitive decline.
- Monitoring donor-specific antibodies post-transplant is crucial for predicting graft survival. Tocilizumab is a potential therapy for chronic antibody-mediated rejection.