Chapters authored
Innovations in Hemodialysis Access
The established types of vascular access for hemodialysis are central venous catheters (CVCs), arteriovenous fistulas (AVFs), and arteriovenous grafts (AVGs). Innovations in CVC tip and coating design may improve patency and blood flow rates. AVFs are preferred over CVCs as they are less prone to clotting and infection, while providing reliable and adequate blood flow rates. However, AVF creation requires a surgical procedure with associated risks. Because of a paucity of surgeons available to create high-quality dialysis access, newer access creation techniques have been developed, including a percutaneous endovascular method that has the potential to revolutionize dialysis access. Innovations in AVGs include drug-eluting devices that may reduce neointimal hyperplasia and bioengineered blood vessels. To bypass vessel stenoses, a hybrid AVG/CVC device has been developed. Although many of these innovations have yet to become mainstream, they promise to improve dialysis access in the future.
Part of the book: Updates on Hemodialysis
Evidence for Novel Pharmacotherapies in Diabetic Kidney Disease
Chronic kidney disease, defined as abnormal kidney function for more than 3 months, affects roughly 15% of the US, and approximately 40% of people with chronic kidney disease have type 2 diabetes. In the last decade, pharmacotherapies have been approved that may reduce chronic kidney disease progression and its complications. Sodium-glucose cotransporter-2 inhibitors (SGLT2Is) are recommended for diabetic kidney disease as they may reduce chronic kidney disease progression and cardiovascular events. Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) are recommended for those with diabetic kidney disease who have not achieved glycemic targets with metformin and SGLT2Is. Finerenone (a nonsteroidal mineralocorticoid receptor antagonist [MRA]) may reduce chronic kidney disease progression and cardiovascular events. This chapter will review the evidence for these pharmacotherapies for diabetic kidney disease.
Part of the book: Chronic Kidney Disease