This Month in AJKD

Article Outline

• Hyponatremia in Cancer Patients
• Tuberous Sclerosis–Associated Angiomyolipomas
• Managing Older Adults With CKD
• DOPPS Practice Monitor

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Hyponatremia in Cancer Patients 

See Doshi et al, pages 222-228; and Fakhouri et al, pages 168-169.

Hyponatremia is the most frequently observed electrolyte abnormality in hospitalized patients. Doshi et al studied the frequency and severity of hyponatremia in hospitalized patients with cancer, examining the association of hyponatremia with length of stay and mortality, noting that those patients with cancer whose hyponatremia corrected had a lower risk of morality. In the accompanying editorial, Fakhouri et al note that Doshi and colleagues demonstrate a strong association between hyponatremia and mortality, but are lacking hard evidence of a causal link between the two. The editorialists agree with the authors that additional studies are needed to determine whether correction of hyponatremia itself or the ability to correct hyponatremia is the driver of improved outcomes.

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Tuberous Sclerosis–Associated Angiomyolipomas 

See Budde & Gaedeke, pages 276-283.

Tuberous sclerosis complex (TSC) is an autosomal dominant disorder promoting the development of benign tumors in multiple organ systems, including the skin, brain, and kidneys. Kidney angiomyolipomas are associated with spontaneous bleeding and potentially life-threatening hemorrhage. With the goal of conserving kidney function and limiting potentially fatal hemorrhages, treatment with mTOR inhibitors has shown promising efficacy in the clinical setting in patients with TSC-associated angiomyolipomas. This review explores the diagnosis and current management of TSC-associated angiomyolipomas and the potential of mTOR inhibitor therapy to treat the underlying cause of TSC.

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Managing Older Adults With CKD 

See Bowling & O’Hare, pages 293-302.

CKD is highly prevalent in older adults. For many older adults who meet criteria for CKD, an individualized patient-centered approach may have more to offer than the traditional disease-oriented approach. The individualized patient-centered model of care prioritizes patient preferences and embraces the idea that observed signs and symptoms, particularly in the older adult, often do not reflect a single unifying disease process, but rather may reflect the complex interplay between many factors. In contrast, many disease-oriented models do not account for the presence of more than one comorbid condition, and applying single disease–focused guidelines to patients with multiple chronic conditions can have unintended harmful consequences. Bowling and O’Hare use 2 cases to illustrate the limitations and complexities associated with a disease-based approach to CKD in older adults.

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DOPPS Practice Monitor 

See Robinson et al, pages 309-312; and Winkelmayer & Weiner, pages 312-314.

The new ESRD prospective payment system, also called the expanded bundle, represents the most significant change in dialysis funding in the United States in the last 30 years. The effects of this policy change on patient outcomes remain unknown. The Dialysis Outcomes and Practice Patterns Study (DOPPS) Practice Monitor (DPM) reports recent trends in dialysis care from a representative sample of US dialysis facilities, comparing patient data from before to after implementation of the expanded bundle. This first overview of DPM findings, the initial publication in what will be an ongoing series, covers data through April 2011, demonstrating small but significant changes in anemia management and other practice patterns. An editorial by Winkelmayer and Weiner places these changes into the wider context of clinical dialysis care.

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