Technique Creates Functional Platelets from Human Pluripotent Stem Cells

Researchers have genetically manipulated human induced pluripotent stem cells to become stable immortalized lines of megakaryocyte progenitors, which could subsequently produce large quantities of platelets with clotting capabilities similar to those of donated platelets. The technique involved expression of BMI1, BCL-XL, and c-MYC genes to suppress senescence and apoptosis and to promote proliferation. Unlike freshly donated platelets, the immortalized megakaryocyte progenitors could be expanded and frozen for long-term storage. The advance, which is described in a Cell Stem Cell article, could possibly eliminate platelet supply shortages.

AKI Increases Risks of Kidney Disease and Death Well Beyond Hospital Discharge

New research indicates AKI patients face increased risks of kidney disease and death after receiving renal replacement therapy, which are not altered by increased dialysis intensity. A study of 1464 ICU patients with AKI randomized to receive 25 mL/kg/hour or 40 mL/kg/hour of continuous hemodiafiltration found 63% of lower-intensity patients and 72% of higher-intensity patients had died at a median of 3.7 years post-randomization. Among survivors to day 90, only 5.1% of lower-intensity patients and 5.8% of higher-intensity patients required maintenance dialysis. The PLOS Medicine study noted albuminuria was observed in 40% of lower-intensity survivors and 44% of higher-intensity survivors.

Noninvasive Test Predicts Contrast-Induced AKI in Stable Coronary Artery Disease Patients

Bioimpedance vector analysis (BIVA), a noninvasive method for measuring fluid status, could predict the development of contrast-induced AKI in a study of 900 patients scheduled to undergo coronary angiography. Patients in the highest quartile of fluid depletion based on BIVA, which is typically used to monitor fluid volume of patients on dialysis or with heart failure, had a nearly 3-fold higher risk of developing AKI within 3 days after contrast administration. The findings are published in the Journal of the American College of Cardiology.

Intensive Dialysis in Pregnant Women with Kidney Failure Benefits Mothers and Babies

In a study of 42 pregnant women with kidney failure, those who underwent dialysis for more than 36 hours per week had a live birth rate of 85%, compared with 48% in women dialyzed for 20 hours or less per week. Infants were a healthier weight at birth when women were dialyzed for more than 20 hours per week than when women were dialyzed for 20 hours or less per week. Pregnancy complications were few and manageable in patients receiving intensive dialysis. The findings are published in JASN.

Increased Intensity of Renal Replacement Therapy Does Not Reduce Premature Mortality in Patients with AKI

Among 1464 patients with AKI in an intensive care unit who required renal replacement therapy (RRT), mortality rates and quality of life among those who survived were essentially the same in patients receiving low intensity RRT or high intensity RRT (63% vs. 62%). Albuminuria was common among survivors, with similar rates in both groups (40% in the low intensity group and 44% in the high intensity group). Patients in the Randomized Evaluation of Normal vs. Augmented Levels of RRT (RENAL) study were followed for a median of 43.9 months. The findings are published in PLOS ONE.

Daily Hemodialysis Improves Height Gain in Children with ESRD

Daily hemodialysis favored a 0.5 gain in standard deviation scores for height in a third of children with ESRD who were followed for an average of 9.3 months. Patients did not receive growth hormone treatment. The cumulative probability of gain in height for age at 12 months was 40% in the 24-patient group receiving daily hemodialysis vs. 15% in the 26-patient group receiving concurrent conventional hemodialysis. Dialysis intensification was not a cause for treatment dropouts. The Pediatric Nephrology findingssuggest that daily hemodialysis should be considered as a treatment for selected cases, especially small children.

High Dietary Acid Load Linked to CKD Progression

A study of 217 elderly CKD patients on a low-protein diet with normal serum bicarbonate levels found high dietary acid load, in terms of net endogenous acid production (NEAP), was associated with CKD progression. Compared with patients in the lowest quartile of NEAP, those in the second, third, and fourth quartiles had 3.9 times, 4.7 times, and 4.3 times increased odds of experiencing a 25% decline in eGFR or starting dialysis, according to the American Journal of Nephrology study. An accompanying editorial notes the need to assess whether reduced NEAP should be standard care for patients with reduced eGFR.