Exploring old concepts and new paradigms

Exploring old concepts and new paradigms EDITORIAL URRENT PINION Bertrand L. Jaber In the current issue of the Journal, the clinical to estimated glomerular filtration rate ratio prior to a nephrology section explores old concepts and new planned cardiovascular procedure as an approach to paradigms, including the role of alkali therapy for minimize contrast volume and prevent contrast- retarding progression of chronic kidney disease induced AKI. The authors call for the system-wide (CKD); an update on the nephrotoxicity of the implementation of evidence-based care bundles to antiviral drug tenofovir disoproxil fumarate (TDF) prevent contrast-induced AKI, which incorporate the maximal allowable contrast dose. and availability of tenofovir alafenamide (TAF), an alternative prodrug with an improved kidney safety Finally, Mehboob and colleagues explore candi- profile; a review of the current evidence for the CKD- date AKI-related quality of care measures that might associated acquired mitochondrial myopathy; a crit- potentially be linked to pay-per-performance. They ical appraisal of the utility of the maximal allowable assess the strength of evidence supporting the use of contrast dose, a modifiable risk factor for the pre- each measure, including the use of electronic alert diction of contrast-induced acute kidney injury systems for the early detection of AKI, timely (AKI); and an in-depth examination of candidate nephrology consultation for AKI, the use of com- quality of care measures for AKI. puterized provider order entry-based alert systems Kraut and Madias describe the mechanisms to support medication dosing management in the through which increased tissue acidity accelerates setting of AKI, AKI-associated hospital length of the progression of CKD, modalities for countering stay, hospital costs and hospital mortality, postdi- acid retention and their impact on progression of scharge AKI transition of care and 30-day hospital CKD and current recommendations for therapy. readmissions. Chan and colleagues review the kidney and I thank the authors for lending their time, effort bone-related safety data of TDF, which is a member and expertise, and hope that the contributions of the nucleoside reverse-transcriptase inhibitor offered in this issue will inform nephrologists on class of antiretroviral drugs used for the treatment some of these old concepts and emerging para- of HIV and hepatitis B virus infection; they explore digms, and provide new questions requiring further the potential public health implications given the research to improve the care of patients with kidney large number of individuals worldwide exposed to disease. TDF for both treatment of HIV infection and pre- exposure prophylaxis to reduce the risk of HIV Acknowledgements infection. The authors also examine the safety data None. of TAF as a less nephrotoxic prodrug, but call for further studies to confirm the long-term safety of Financial support and sponsorship this alternative agent. None. Rao and colleagues provide an overview of the clinical and experimental evidence that postulates Conflicts of interest a role for reduction in mitochondrial mass and The author declares no conflicts of interest pertaining to function in the myopathy associated with CKD. this article and the Clinical Nephrology section of this They review causes for these muscle mitochondrial issue of the Journal. abnormalities, and offer potential therapeutic inter- ventions to improve mitochondrial function and skeletal muscle performance in patients with CKD, which merit further study. Department of Medicine, Tufts University School of Medicine, St. Aoun and colleagues review the literature sum- Elizabeth’s Medical Center, Boston, Massachusetts, USA marizing the utility of the maximal allowable con- Correspondence to Bertrand L. Jaber, MD, MS, St. Elizabeth’s Medical trast dose, as a modifiable risk factor for contrast- Center, 736 Cambridge Street Boston, MA 02135, USA. E-mail: Bertrand.Jaber@steward.org induced AKI. They propose a two-step algorithm Curr Opin Nephrol Hypertens 2018, 27:93 incorporating the determination of the maximal allowable contrast dose, and the contrast volume DOI:10.1097/MNH.0000000000000397 1062-4821 Copyright  2018 Wolters Kluwer Health, Inc. All rights reserved. www.co-nephrolhypertens.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Current Opinion in Nephrology & Hypertension Wolters Kluwer Health

Exploring old concepts and new paradigms

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Wolters Kluwer
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Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
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1062-4821
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10.1097/MNH.0000000000000397
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Abstract

EDITORIAL URRENT PINION Bertrand L. Jaber In the current issue of the Journal, the clinical to estimated glomerular filtration rate ratio prior to a nephrology section explores old concepts and new planned cardiovascular procedure as an approach to paradigms, including the role of alkali therapy for minimize contrast volume and prevent contrast- retarding progression of chronic kidney disease induced AKI. The authors call for the system-wide (CKD); an update on the nephrotoxicity of the implementation of evidence-based care bundles to antiviral drug tenofovir disoproxil fumarate (TDF) prevent contrast-induced AKI, which incorporate the maximal allowable contrast dose. and availability of tenofovir alafenamide (TAF), an alternative prodrug with an improved kidney safety Finally, Mehboob and colleagues explore candi- profile; a review of the current evidence for the CKD- date AKI-related quality of care measures that might associated acquired mitochondrial myopathy; a crit- potentially be linked to pay-per-performance. They ical appraisal of the utility of the maximal allowable assess the strength of evidence supporting the use of contrast dose, a modifiable risk factor for the pre- each measure, including the use of electronic alert diction of contrast-induced acute kidney injury systems for the early detection of AKI, timely (AKI); and an in-depth examination of candidate nephrology consultation for AKI, the use of com- quality of care measures for AKI. puterized provider order entry-based alert systems Kraut and Madias describe the mechanisms to support medication dosing management in the through which increased tissue acidity accelerates setting of AKI, AKI-associated hospital length of the progression of CKD, modalities for countering stay, hospital costs and hospital mortality, postdi- acid retention and their impact on progression of scharge AKI transition of care and 30-day hospital CKD and current recommendations for therapy. readmissions. Chan and colleagues review the kidney and I thank the authors for lending their time, effort bone-related safety data of TDF, which is a member and expertise, and hope that the contributions of the nucleoside reverse-transcriptase inhibitor offered in this issue will inform nephrologists on class of antiretroviral drugs used for the treatment some of these old concepts and emerging para- of HIV and hepatitis B virus infection; they explore digms, and provide new questions requiring further the potential public health implications given the research to improve the care of patients with kidney large number of individuals worldwide exposed to disease. TDF for both treatment of HIV infection and pre- exposure prophylaxis to reduce the risk of HIV Acknowledgements infection. The authors also examine the safety data None. of TAF as a less nephrotoxic prodrug, but call for further studies to confirm the long-term safety of Financial support and sponsorship this alternative agent. None. Rao and colleagues provide an overview of the clinical and experimental evidence that postulates Conflicts of interest a role for reduction in mitochondrial mass and The author declares no conflicts of interest pertaining to function in the myopathy associated with CKD. this article and the Clinical Nephrology section of this They review causes for these muscle mitochondrial issue of the Journal. abnormalities, and offer potential therapeutic inter- ventions to improve mitochondrial function and skeletal muscle performance in patients with CKD, which merit further study. Department of Medicine, Tufts University School of Medicine, St. Aoun and colleagues review the literature sum- Elizabeth’s Medical Center, Boston, Massachusetts, USA marizing the utility of the maximal allowable con- Correspondence to Bertrand L. Jaber, MD, MS, St. Elizabeth’s Medical trast dose, as a modifiable risk factor for contrast- Center, 736 Cambridge Street Boston, MA 02135, USA. E-mail: Bertrand.Jaber@steward.org induced AKI. They propose a two-step algorithm Curr Opin Nephrol Hypertens 2018, 27:93 incorporating the determination of the maximal allowable contrast dose, and the contrast volume DOI:10.1097/MNH.0000000000000397 1062-4821 Copyright  2018 Wolters Kluwer Health, Inc. All rights reserved. www.co-nephrolhypertens.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

Journal

Current Opinion in Nephrology & HypertensionWolters Kluwer Health

Published: Mar 1, 2018

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