作者: Nitsch, Dorothea ; Rankin, Laura ; Henner, David ; Howard, Andrew ; Atkinson, Ralph ; Chen, Jing ; Landry, Daniel ; Molony, Donald ; Pastan, Stephen O ; Ulasi, Ifeoma ; Agarwal, Sanjay Kumar ; Sam, Ramin ; Kalantar-Zadeh, Kamyar ; Frantzen, Luc ; Wagner, John

Vaccinating patients receiving dialysis may prevent morbidity and mortality in this vulnerable population. The National Forum of End-Stage Renal Disease Networks (the Forum) published a revised vaccination toolkit in 2021 to update evidence and recommendations on vaccination for patients receiving dialysis. Significant changes in the last 10 years include more data supporting the use of a high-dose influenza vaccine, the introduction of the Heplisav-B vaccine for hepatitis B, and changes in pneumococcal vaccines, including the approval of the PCV15 and PCV20 to replace the PCV13 and PPSV23 vaccines. Additional key items include the introduction of vaccines against severe acute respiratory syndrome coronavirus 2, the virus that causes coronavirus disease 2019 (COVID-19), and a new vaccine to prevent respiratory syncytial virus disease. Historically, influenza and pneumococcal vaccinations were routinely administered by dialysis facilities, and because of possible risks of hematogenous spread of hepatitis B, dialysis providers often have detailed hepatitis B vaccine protocols. In March 2021, COVID-19 vaccines were made available for dialysis facilities to administer, although with the end of the public health emergency, vaccine policies by dialysis facilities against COVID-19 remains uncertain. The respiratory syncytial virus vaccine was authorized in 2023, and how dialysis facilities will approach this vaccine also remains uncertain. This review summarizes the Forum's vaccination toolkit and discusses the role of the dialysis facility in vaccinating patients to reduce the risk of severe infections.

2021-07-01·Kidney International Reports

NELL1-Associated Membranous Glomerulopathy After Hematopoietic Stem Cell Transplantation

作者: Batal, Ibrahim ; Santoriello, Dominick ; Kudose, Satoru ; Sekulic, Miroslav ; Mehring, Collette J ; Markowitz, Glen S ; D'Agati, Vivette D ; Stokes, M Barry

Membranous glomerulopathy (MGN) is among the most common glomerular diseases identified in adult patients with nephrotic syndrome. Traditionally, MGN is classified into primary and secondary forms depending on the clinical context (i.e., renal-limited vs. associated with a systemic disorder), with a presumed secondary etiology identified in approximately 30% of cases. Since the discovery of phospholipase A2 receptor (PLA2R) as a major target antigen in primary MGN,1 multiple additional antigenic targets have been discovered. Most if not all of these antigens are expressed on podocytes, including thrombospondin type-1 domain-containing 7A2 and neural epidermal growth factor–like 1 (NELL1), both of which have been described in both primary MGN and in MGN in the setting of malignancy.3, 4, 5 The discovery of these and other new antigens has led some to advocate for classification based on the deposited antigen.6 In contrast to PLA2R-associated MGN where deposits are globally distributed and immunoglobulin G4 (IgG4)–dominant, NELL1-associated MGN is characterized by IgG1-dominant subepithelial deposits that are often segmental or segmental to global in distribution and can occur in association with malignancy.3, 4, 5 To date, there have been no reports of NELL1-associated MGN in the setting of hematopoietic stem cell transplantation (HSCT) or with findings of tubular basement membrane (TBM) deposits.3, 4, 5 Herein, we report the first case of NELL1-associated segmental MGN with TBM deposits following allogeneic HSCT complicated by graft-versus-host disease (GVHD).

2020-09-01·Kidney360

A Systematic Approach To Promoting Home Hemodialysis during End Stage Kidney Disease

Review

作者: Glickman, Joel ; Carver, Michelle ; Weinhandl, Eric ; Miller, Brent ; Spry, Leslie ; Lockridge, Robert ; Schreiber, Martin ; Tailor, Prayus ; Kraus, Michael

Home dialysis has garnered much attention since the advent of the Advancing American Kidney Health initiative. For many patients and nephrologists, home dialysis and peritoneal dialysis are synonymous. However, home hemodialysis (HHD) should not be forgotten. Since 2004, HHD has grown more rapidly than other dialytic modalities. The cardinal feature of HHD is customizability of treatment intensity, which can be titrated to address the vexing problems of volume and pressure loading during interdialytic gaps and ultrafiltration intensity during each hemodialysis session. Growing HHD utilization requires commitment to introducing patients to the modality throughout the course of ESKD. In this article, we describe a set of strategies for introducing HHD concepts and equipment. First, patients initiating dialysis may attend a transitional care unit, which offers an educational program about all dialytic modalities during 3–5 weeks of in-facility hemodialysis, possibly using HHD equipment. Second, prevalent patients on hemodialysis may participate in “trial-run” programs, which allow patients to experience increased treatment frequency and HHD equipment for several weeks, but without the overt commitment of initiating HHD training. In both models, perceived barriers to HHD—including fear of equipment, anxiety about self-cannulation, catheter dependence, and the absence of a care partner—can be addressed in a supportive setting. Third, patients on peritoneal dialysis who are nearing a transition to hemodialysis may be encouraged to consider a home-to-home transition (i.e., from peritoneal dialysis to HHD). Taken together, these strategies represent a systematic approach to growing HHD utilization in multiple phenotypes of patients on dialysis. With the feature of facilitating intensive hemodialysis, HHD can be a key not only to satiating demand for home dialysis, but also to improving the health of patients on dialysis.

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