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There is insufficient evidence on the utility of potassium-binding resins in patients with end-stage renal disease on dialysis. In addition, their poor tolerability raises concerns of patient adherence. We aimed to assess the efficacy of calcium resonium and investigate the impact of counseling on adherence pattern as well as treatment response. Adult patients on hemodialysis receiving calcium resonium were enrolled with a control group not on treatment. Adherence patterns and adverse effects were recorded following patient interviews. Patients were stratified into 28 adherent (A), 42 non-adherent (NA), and 30 controls (C). Patient education was undertaken, and serum potassium levels were evaluated for 3 months pre-and post-counseling with inter-and intra-group comparison. A statistically significant difference was observed between potassium levels at baseline in A and NA groups but not post-education, which was related to worsening control in former and not due to improvement in NA patients. The poor effectiveness of calcium resonium in the control of hyperkalemia was likely related to non-compliance due to gastrointestinal (GI) intolerability. Dietary indiscretions as well as lack of consistent use of cathartics may have also contributed. No difference in dialysis adequacy was noted among groups, although the contribution of residual renal function was not assessed. These findings raise concern regarding cost-efficacy of this medication and lend credence to investing in traditional measures in hyperkalemia management, namely dietary compliance and adequate dialysis. Further long-term trials are awaited to better define the role of calcium resonium in the dialysis setting.

Though clinicians must be critical in the application of GFR estimates to patient care, LBW adjustment appears to be the most practical solution to its estimation in the obese patients. This is particularly true for patients with normal renal function but appears to be also applicable to those with compromised kidney function. Future studies are needed to compare these equations with a gold standard GFR measure as well as to explore whether the renal benefits from bariatric surgery are sustained or seen in more advanced CKD stages.

Fabry disease (FD) is a rare, X-linked inherited disease of glycosphingolipid metabolism due to deficiency of lysosomal α-galactosidase A activity. Scarce activity of lysosomal α-galactosidase A results in progressive accumulation of globotriaosylceramide (Gb3) within lysosomes, believed to trigger a flow of cellular changes that lead to the clinical manifestation of the disease. We present a 23-year-old male with renal variant of FD who was born from non-affected parents, which, to the best of our knowledge, has not been reported in the literature so far. In conclusion, FD can occur due to sporadic GLA gene mutation. Pure renal involvement might be associated with progressive disease which leads to end-stage renal disease within a short period. Physicians should have a high index of suspicion for FD especially in male cases with unexplained renal failure that are slowly progressive in nature, even in the absence of a clear hereditary component. Early renal biopsy is recommended in any progressive renal impairment.

Accurate assessment of renal function is of key importance, given its prognostic value. However, gold standard measures are cumbersome, and serum creatinine itself is an insensitive predictor, especially in renal transplant recipients. Though GFR-estimating formulae have been relied upon, they do have their own limitations. Nevertheless, renal biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C, among others, are now emerging as potentially useful indicators of GFR. We aimed to evaluate the diagnostic performance of NGAL versus cystatin C and eGFR using CKD-EPI, MDRD and cystatin C in renal transplant recipients and non-transplant CKD patients. We found a significant correlation between NGAL, serum creatinine, cystatin C and eGFR. The latter parameters were also strong predictors of serum NGAL levels. However, performance of NGAL, based on receiver operating characteristic curves, was inferior to that of the reference tests. It appears that in renal transplant recipients NGAL correlates well with cystatin C and eGFR, most strongly with cystatin-based formula. Though this suggests potential use of NGAL as a screening test, its weaker diagnostic performance raises some concern about its clinical usefulness. Larger studies are needed to explore this further.

Although daily dosing overall was more effective for treatment of SHPT, dialysis dosing was effective in patients with less severe SHPT. This warrants a larger study considering the limitations of this pilot trial. In the meantime, dialysis dosing can be considered in non-compliant patients with less severe SHPT.

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