- N Engl J Med 2022; 386:2120-2128
Testing for kidney disease is routine in clinical practice. This review focuses on advances in clinical evaluation of the glomerular filtration rate and albuminuria and their use in detecting acute and chronic kidney disease, designing trials of disease progression, and predicting risk in clinical practice.
- N Engl J Med 2022; 386:2024-2034
Gliflozins — sodium–glucose cotransporter 2 inhibitors — lower blood glucose and glycated hemoglobin in patients with type 2 diabetes without causing hypoglycemia. The agents also improve cardiac function in patients who have heart failure with or without type 2 diabetes and improve renal function, with few adverse effects.
- N Engl J Med 2022; 386:976-976
A 40-year-old man with end-stage kidney disease and calcium oxalate nephrolithiasis presented to the emergency department with joint pain. A workup was notable for nephrocalcinosis on imaging; dense, metaphyseal bands on radiography of the hands; and calcium deposition in the cornea and skin. A diagnosis of primary hyperoxaluria was made...
- N Engl J Med 2022; 386:e12
A 57-year-old man presented with itching of the whole body. Examination showed hyperpigmentation and excoriations, with sparing of a butterfly-shaped area on his back. Laboratory studies showed evidence of advanced kidney disease, and chronic generalized pruritus due to chronic kidney disease was diagnosed. Hemodialysis was initiated, and his symptoms abated.
- N Engl J Med 2021; 385:2574-2575
Control of hypertension is central to the management of chronic kidney disease, both to preserve residual kidney function and to reduce the associated high risk of cardiovascular events. International guidelines recently updated by the Kidney Disease: Improving Global Outcomes Organization recommend that patients with chronic kidney disease and hypertension be...
- N Engl J Med 2021; 385:2507-2519
In this trial, patients with stage 4 chronic kidney disease and poorly controlled hypertension, as confirmed by 24-hour ambulatory blood-pressure monitoring, were randomly assigned to receive chlorthalidone (12.5 mg per day, with increases every 4 weeks if needed to a maximum dose of 50 mg per day) or placebo. Chlorthalidone...
- N Engl J Med 2021; 385:2325-2335
This trial compared the oral HIF-PHI daprodustat with conventional erythropoiesis-stimulating agents for the treatment of anemia in patients with chronic kidney disease receiving dialysis. Daprodustat was noninferior to ESAs regarding the change in the hemoglobin level from baseline and cardiovascular outcomes.
- N Engl J Med 2021; 385:2390-2391
The prevalence of anemia increases as chronic kidney disease (CKD) progresses. Ultimately, anemia occurs in most patients who undergo dialysis, as well as in many patients with CKD who do not undergo dialysis. Non–dialysis-dependent CKD (NDD-CKD) and dialysis-dependent CKD (DD-CKD) should be studied separately for three reasons. First, the hemoglobin...
- N Engl J Med 2021; 385:2313-2324
This randomized trial compared daprodustat, an oral hypoxia-inducible factor prolyl hydroxylase inhibitor, with darbepoetin alfa for the treatment of anemia in patients with chronic kidney disease who were not undergoing dialysis. Daprodustat was noninferior to darbepoetin alfa with respect to the change in hemoglobin level and cardiovascular outcomes.
- N Engl J Med 2021; 385:2252-2263
In this double-blind trial, patients with stage 1 to 4 chronic kidney disease and type 2 diabetes were randomly assigned to receive finerenone or placebo. Finerenone treatment was superior with regard to the primary composite outcome of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart...
- N Engl J Med 2021; 385:1737-1749
Equations for estimating GFR with serum creatinine overestimate measured GFR in Blacks. The authors report new equations, without race as an inflation factor, using cystatin C and creatinine that reduced errors in estimation between Black participants and non-Black participants.
- N Engl J Med 2021; 385:1804-1806
In the wake of the racial reckoning since the spring of 2020 in the United States, efforts have emerged to identify hidden structural determinants of systemic racism in medicine. Such efforts have led to examination of traditional medical algorithms that incorporate race modifiers and may have led to disparities in...
- N Engl J Med 2021; 385:1750-1760
The use of race in equations that estimate the glomerular filtration rate is problematic. In this study, the use of the serum creatinine level to estimate the GFR without race (or genetic ancestry) introduced systematic misclassification. Estimating GFR with cystatin C generated similar results but eliminated negative consequences of race-based...
- N Engl J Med 2021; 385:1617-1619
Peritoneal dialysis in adults involves diffusion and osmosis through a peritoneal membrane, measuring 1 m2, that is highly vascularized (flow rate, 100 to 150 ml per minute) and has a total available capillary surface area of approximately 2 m2.1 For decades, glucose has been...
- N Engl J Med 2021; 385:1570-1580
Variability in ultrafiltration influences prescriptions and outcomes in patients treated with peritoneal dialysis. This study showed that a common variant in AQP1, the gene that encodes the water channel aquaporin-1, was associated with decreased ultrafiltration and an increased risk of death or technique failure among such patients.
- N Engl J Med 2021; 385:896-907
This trial compared weekly injections of efpeglenatide, an exendin-based glucagon-like peptide-1 receptor agonist, at a dose of 4 or 6 mg with placebo in participants with known type 2 diabetes and either a history of cardiovascular disease or current kidney disease plus at least one other cardiovascular risk factor. The...
- N Engl J Med 2021; 385:503-515
This open-label, 40-week, phase 3 trial assessed the efficacy and safety of tirzepatide, a weekly dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist under development for type 2 diabetes. Tirzepatide was noninferior and superior to semaglutide with respect to the mean change in the glycated hemoglobin level from baseline...
- N Engl J Med 2021; 385:560-561
The number of persons with diabetes is projected to grow from 463 million to 700 million worldwide between 2019 and 2045, with the greatest effect occurring in low- and middle-income countries.1 Given the growing number of cases of diabetes (90% of which are type 2), an increased incidence...
- N Engl J Med 2021; 385:416-426
A clinical trial assessed the efficacy of three treatments, all involving metformin, on glycemic control in youth-onset type 2 diabetes. This follow-up study shows that the risk of complications increased steadily over time, and complications developed in most participants by young adulthood.
- N Engl J Med 2021; 385:153-163
Hematuria comes in two main varieties: gross and microscopic. A wide range of ailments can lead to hematuria, and the central task is to rule out life-threatening disease, mainly cancer. This article suggests a useful diagnostic approach.