The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) has provided evidence-based guidelines for all stages of chronic kidney disease (CKD) and related complications since 1997. The 2015 update of the KDOQI Clinical Practice Guideline for Hemodialysis Adequacy is intended to assist practitioners caring for patients in preparation for and during hemodialysis. The literature reviewed for this update includes clinical trials and observational studies published between 2000 and March 2014. New topics include high-frequency hemodialysis and risks; prescription flexibility in initiation timing, frequency, duration, and ultrafiltration rate; and more emphasis on volume and blood pressure control. Appraisal of the quality of the evidence and the strength of recommendations followed the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach. Limitations of the evidence are discussed and specific suggestions are provided for future research.

Animal studies suggest that calcium-phosphorus homeostatic abnormalities cause cardiovascular disease in uremia; few observational studies in humans have explored this. Associations in the retrospective United States Renal Data System Waves 1, 3, and 4 Study of 14,829 patients who were on hemodialysis on December 31, 1993, were examined. Mean age and duration of renal replacement therapy were 60.0 and 3.2 yr, respectively; 40.7% had diabetes. Quintiles (Q 1 to Q 5 ) of (albumin-adjusted) calcium were <8.7, 8.8 to 9.2, 9.3 to 9.6, 9.7 to 10.2, and >10.2 mg/dl; phosphorus, <4.4, 4.5 to 5.3, 5.4 to 6.3, 6.4 to 7.5, and >7.5 mg/dl; calcium-phosphorus product, <40.9, 41.0 to 50.1, 50.2 to 59.2, 59.3 to 71.0, and >71.0 mg 2 /dl 2 ; and parathyroid hormone (PTH), <37, 38 to 99, 100 to 210, 211 to 480, and >480 pg/ml. Higher calcium levels were associated with fatal or nonfatal cardiovascular events (adjusted hazards ratio, 1.08 for Q 5 , versus Q 1 ) and all-cause mortality (Q 2 , 1.07; Q 4 , 1.11; Q 5 , 1.14). Phosphorus levels were associated with cardiovascular events (Q 2 , 1.06; Q 3 , 1.13; Q 4 , 1.14; Q 5 , 1.25) and mortality (Q 4 , 1.10; Q 5 , 1.19), calcium-phosphorus product was associated with cardiovascular events (Q 3 , 1.09; Q 4 , 1.14; Q 5 , 1.24) and mortality (Q 4 , 1.09; Q 5 , 1.19), and PTH levels were associated with cardiovascular events (Q 5 , 1.12) and mortality (Q 5 , 1.17). Despite limitations (including retrospective design; noncurrent study era; and lack of serial calcium, phosphorus, and PTH measurements), this study suggests that disorders of calcium homeostasis are associated with fatal and nonfatal cardiovascular events and all-cause mortality in hemodialysis patients.

Objective: To The prevalence of 25 hydroxyvitamin D [25(OH)D] deficiency, defined as 25(OH)D level less than 20 ng/mL, is high, especially among the elderly, with 25% to 65% affected. [1][2][3][4][5][6] While much research has focused on the adverse effect of 25(OH)D deficiency on bone health, 5,7 associations between 25(OH)D deficiency and non-bone health outcomes, including hypertension, 8 cardiovascular morbidity, 9 diabetes, 10,11 and cancer, 12,13 have also been reported. In addition, there is a growing body of literature to support the role of vitamin D in brain function and development.14 -25 Despite the experimental and animal evidence supporting an important role for vitamin D in mood and cognition, epidemiologic studies testing this hye-Pub ahead of print on November 25, 2009, at www.neurology.org.

Low 25(OH)D levels among older women were associated with a higher odds of global cognitive impairment and a higher risk of global cognitive decline.

Objectives To examine the association of kidney function with cognitive impairment and decline in elderly men. Design Observational prospective cohort. Setting Community based. Participants 5529 community dwelling men, aged 65 years or older (mean age 73.6 ± 5.9). Measurements Estimated Glomerular filtration rate (eGFR) calculated using the standardized Modification of Diet in Renal Disease (MDRD) equation; cognitive function assessed with Modified Mini-Mental State Examination (3MS) and Trail Making Test B (Trails B). Results At baseline, 148 (2.7%) and 494 (9.1%) men were classified as cognitively impaired and, in the 5-year prospective analysis, 931 (23%) and 432 (11.6%) met the criteria for cognitive decline at follow-up defined by 3MS and Trails B performance, respectively. In unadjusted analysis, the odds of prevalent cognitive impairment and risk of cognitive decline were significantly higher among men with eGFR of <45 and 45–59 mL/min/1.73m2, compared to men with eGFR ≥60 mL/min/1.73m2. These associations were largely explained by difference in age, race, and education between the eGFR categories, with the exception of the association between reduced renal function and higher odds of impairment based on Trails B test score which persisted despite adjustment for multiple potential confounders. Conclusion This study found evidence of an independent association between mild to moderate reductions in kidney function and poor executive function at baseline, but not with global cognitive impairment or risk of cognitive decline in older men.