- Pain is very common, and therefore so is the use of analgesics. If analgesics in widespread use even slightly increase cardiovascular risk, the knock-on effects can be huge; if the single most common analgesic worldwide were to cause a significant increase in blood pressure, this would be a public health disaster.
- The prevalence of hypertension has increased substantially over time, even after adjusting for age, and so have the associated disabilities and deaths.1 Based on physiology principles and epidemiological studies, high sodium intake has been recognized as a key contributor to high blood pressure (BP). Previous randomized controlled trials (RCTs) have demonstrated that lowering sodium intake to <2 g/d versus maintaining sodium levels at ≥2 g/d reduces BP by about 3.5/1.8 mm Hg.2 Another meta-analysis showed that for every 50 mmol (∼1.15 g of sodium) decrease in 24-hour sodium excretion, the BP was lowered by 1.1/0.3 mm Hg.
- Medicine has adopted the use of intravenous fluids as a foundational treatment some 185 years ago. Buffered saline solutions were first used in the resuscitation of patients during the London cholera epidemic of 1832.1 Intravenous fluids are still the primary intervention to treat shock. Despite this long history, fundamental questions regarding the content, timing, rate, and amount of fluid remain unanswered.2 In this editorial, we discuss the literature around the use of balanced solutions and kidney injury.
- Hyperphosphatemia is one of the metabolic complications that accompanies decreasing kidney function and is associated with bone and vascular disease. Despite the lack of randomized clinical trials showing that lowering of phosphate improves clinical outcomes and to what extent we should lower phosphate, this strategy has made it into guidelines on the basis of physiology, plausibility, and confounded observational studies. Adding another layer to this is the choice of phosphate binders. Excess calcium intake has been associated with vascular calcification; thus, conventional teaching has suggested that the avoidance of calcium-based binders may improve long-term cardiovascular outcomes in patients with kidney failure.
- Kidney involvement in systemic lupus erythematosus (SLE) is common with 40% to 70% of patients who develop some form of lupus nephritis. Approximately 6% to 19% of patients with lupus nephritis will develop end-stage kidney disease within a decade of an SLE diagnosis.1,2 Patients with lupus nephritis are usually treated with immunosuppressive therapy that may include a combination of glucocorticoids, mycophenolate mofetil (MMF), or cyclophosphamide. There have been several controlled clinical trials in lupus nephritis, with both biologic agents and conventional cytotoxic and antimetabolite medications.
- Traditional journal clubs are fine; one sits with your fellow trainees and attending physicians in the department and one of you presents the article. A few leagues up from this is the nephrology twitter journal club, named “#NephJC.” Here, hundreds of health care professionals, study authors, trainees, content experts, and the occasional patient meet online to share their insights and learn from each other’s experiences in a welcoming environment, straddling specialty silos and flattening medical hierarchy.