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Introduction: A Foreword to CKD
VOL. 36, NO. 4
JULY 2016
Introduction: A Foreword to CKD
C
hronic kidney disease (CKD) is estimated to affect more than one tenth of the population worldwide, and is associated with billions of dollars of health care expenditures each year. CKD is marked by a substantial burden of morbidity and mortality owing to its disproportionate risk of cardiovascular disease and progression toward end-stage renal disease. Over the past decade, there has been increased awareness of the burden and clinical importance of CKD, and noteworthy discoveries and advances toward a better understanding of the causes and consequences of CKD progression. Pursuant to the recent strides in characterizing CKD and its progression, this issue of Seminars in Nephrology addresses salient topics including observed patterns of and risk factors for CKD progression, the importance of acute kidney injury (AKI), the substantial impact of CKD on functioning and cardiovascular health, and the economics of CKD. In this issue, readers will find a comprehensive review by Panwar and Gutierrez, who characterize recent discoveries in iron biology, the dysregulation of iron homeostasis, and the burden of anemia associated with CKD that has transformed our understanding of the physiological basis of morbidity in this disease. Vart and Grahams next detail the historical evolution and modern day practices of measurement and assessment of kidney function including glomerular filtration rate and albuminuria, as well as a description of the recently revised CKD staging scheme. Collister et al review recent observations of varied patterns of kidney function change over time, and characterize the traditional and novel risk factors for CKD progression, as well as the most promising predictive models. Hsu and Hsu then detail new insights into our understanding of AKI as a risk factor for CKD along with a discussion of current controversies in the bidirectional relationship between AKI and CKD. Go’s contribution provides a review of recent findings that enhance
our understanding of the impact of CKD on the risk for myocardial ischemic events, heart failure events, arrhythmias, and death. Kittiskulnam et al review recent evidence relating CKD to physical, cognitive, and emotional function, as well as quality of life, in particular among older adults with CKD. Wang et al provide a perspective on the economic burden of CKD and end-stage renal disease on patients, caregivers, and society informed not only by the direct costs of disease management, but also by the substantial indirect costs of reduced productivity and from the impact on caregivers. Finally, despite the challenges we have faced in identifying therapeutic advances in CKD, Polanco and Fried speak to the promising novel treatments to slow CKD progression after a comprehensive review of established therapies, including those targeting renin-angiotensin blockade as well as tight blood pressure and glycemic control. We are confident that readers will find the material on these pages enhances their understanding of the enormous progress we have made in understanding the genesis and consequences of CKD. We remain optimistic that these insights will continue to inform the development of therapeutic opportunities in CKD that promise to stem its enormous associated burdens of diminished function, cardiovascular morbidity, premature death, and cost.
Harold I. Feldman, MD, MSCE Amanda Hyre Anderson, PhD, MPH Guest Editors Department of Biostatistics and Epidemiology Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine Philadelphia, PA
Financial disclosure and conflict of interest statements: none. 0270-9295/ - see front matter & 2016 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.semnephrol.2016.05.001 Seminars in Nephrology, Vol 36, No 4, July 2016, p 251
251
JULY 2016
Introduction: A Foreword to CKD
C
hronic kidney disease (CKD) is estimated to affect more than one tenth of the population worldwide, and is associated with billions of dollars of health care expenditures each year. CKD is marked by a substantial burden of morbidity and mortality owing to its disproportionate risk of cardiovascular disease and progression toward end-stage renal disease. Over the past decade, there has been increased awareness of the burden and clinical importance of CKD, and noteworthy discoveries and advances toward a better understanding of the causes and consequences of CKD progression. Pursuant to the recent strides in characterizing CKD and its progression, this issue of Seminars in Nephrology addresses salient topics including observed patterns of and risk factors for CKD progression, the importance of acute kidney injury (AKI), the substantial impact of CKD on functioning and cardiovascular health, and the economics of CKD. In this issue, readers will find a comprehensive review by Panwar and Gutierrez, who characterize recent discoveries in iron biology, the dysregulation of iron homeostasis, and the burden of anemia associated with CKD that has transformed our understanding of the physiological basis of morbidity in this disease. Vart and Grahams next detail the historical evolution and modern day practices of measurement and assessment of kidney function including glomerular filtration rate and albuminuria, as well as a description of the recently revised CKD staging scheme. Collister et al review recent observations of varied patterns of kidney function change over time, and characterize the traditional and novel risk factors for CKD progression, as well as the most promising predictive models. Hsu and Hsu then detail new insights into our understanding of AKI as a risk factor for CKD along with a discussion of current controversies in the bidirectional relationship between AKI and CKD. Go’s contribution provides a review of recent findings that enhance
our understanding of the impact of CKD on the risk for myocardial ischemic events, heart failure events, arrhythmias, and death. Kittiskulnam et al review recent evidence relating CKD to physical, cognitive, and emotional function, as well as quality of life, in particular among older adults with CKD. Wang et al provide a perspective on the economic burden of CKD and end-stage renal disease on patients, caregivers, and society informed not only by the direct costs of disease management, but also by the substantial indirect costs of reduced productivity and from the impact on caregivers. Finally, despite the challenges we have faced in identifying therapeutic advances in CKD, Polanco and Fried speak to the promising novel treatments to slow CKD progression after a comprehensive review of established therapies, including those targeting renin-angiotensin blockade as well as tight blood pressure and glycemic control. We are confident that readers will find the material on these pages enhances their understanding of the enormous progress we have made in understanding the genesis and consequences of CKD. We remain optimistic that these insights will continue to inform the development of therapeutic opportunities in CKD that promise to stem its enormous associated burdens of diminished function, cardiovascular morbidity, premature death, and cost.
Harold I. Feldman, MD, MSCE Amanda Hyre Anderson, PhD, MPH Guest Editors Department of Biostatistics and Epidemiology Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine Philadelphia, PA
Financial disclosure and conflict of interest statements: none. 0270-9295/ - see front matter & 2016 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.semnephrol.2016.05.001 Seminars in Nephrology, Vol 36, No 4, July 2016, p 251
251