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Research in kidney disease: an acute and chronic history

See World Report page 1935 See Perspectives page 1937

For the Think Kidneys Ipsos MORI 2014 survey see https:// www.thinkkidneys.nhs.uk/wpcontent/uploads/2015/01/ThinkKidneys-Report-Understandingwhat-the-public-knowJan-2015-11.pdf

Kidneys are remarkable organs. Both blood filters and endocrine organs, kidneys remove waste, regulate electrolytes and acid-base homoeostasis, control fluid balance and blood pressure, and regulate bone metabolism and red blood cell production. They are intimately connected with the functioning of other organs, such as the heart and liver, and can be devastated by diseases as varied as diabetes, autoimmune disorders, and many infections. Yet, more than almost any other organ, they are often ignored and misunderstood. A UK survey for the Think Kidneys campaign in 2014 found that only 51% of people knew that kidneys made urine, and 8% thought the kidneys pumped blood and fluids around the body. The kidney’s public image might, paradoxically, be a victim of its own success. People can live normal, symptom-free lives until they have lost almost 70% of their renal function. When kidneys do fail, they can be replaced—because of a century of pioneering research. Human haemodialysis was first tried in 1924 in Giessen, Germany, and, as a World Report in today’s Lancet shows, peritoneal dialysis is now available in some of the

most deprived countries on earth. The first successful human organ transplantation was of a kidney in Boston, USA, in 1954, and kidneys are the most commonly transplanted organs today. This renal-themed issue of The Lancet contains research articles on topics as diverse as a new antibiotic for complicated urinary tract infections, renal denervation for hypertension, and a hospital-based electronic alert system for acute kidney injury. Two Series papers discuss advances in the understanding of membranous nephropathy and management of autosomal dominant polycystic kidney disease, and the Profile is of Andrzej Więcek, a nephrologist whose present focus is on adipose tissue as an endocrine organ. But the very nature of kidneys means that assessments of renal function and disease are made on the basis of proxy markers, and these estimates are often far from perfect. Much research focusing on biomarkers and targets for treatment is, by necessity, preliminary and preclinical. Research in kidney disease has come a very long way, and has a very long way to go. „ The Lancet

Rick Gomez/Corbis

The Hispanic paradox

For the CDC’s Vital Signs report see http://www.cdc.gov/mmwr/ preview/mmwrhtml/ mm6417a5.htm?s_ cid=mm6417a5_w


Nearly 30 years ago, Kyriakos Markides coined the term “the Hispanic paradox” to describe the epidemiological mystery of why Hispanic individuals in the USA live longer than their white counterparts despite generally lower socioeconomic status and health-care access. Hispanics and Latinos comprise 18% of the total US population; however, few national health estimates have been stratified by Hispanic country of origin or have provided robust data about differences in subpopulations. On May 5, the US Centers for Disease Control and Prevention published their Vital Signs report on the health and causes of death of Hispanics in the USA. Using mortality figures and national health surveillance data, the report’s findings support Markides’ paradox, confirming the disparate health outcomes of Hispanic compared with white individuals. Hispanics had a 24% lower risk of all-cause mortality and lower risks of nine of the leading 15 causes of death in the USA (notably, cancer and heart disease). However, the report shows serious issues that particularly affect the health of

Hispanic people in the USA. Deaths from diabetes, liver disease, and homicide were substantially higher than in white people, as was the prevalence of obesity. Access to health care was worryingly low; more than 40% of individuals reported no health insurance. Important variations existed in risk behaviour and disease prevalence between individuals of different Hispanic origins, and between those who were US or foreign born. Interventions should be personalised to account for original ethnic origin and birth location. As a young population, targeting of Hispanic individuals could have a hugely beneficial effect on future disease rates. Culturally appropriate health care with outreach to individuals who do not speak English and encouragement to engage with clinical screening through lay health workers might help to prevent future increases in mortality. The USA cannot ignore the health of Hispanic people and, as the spotlight falls on patient-centred medicine, it is important to recognise the health differences and needs of subpopulations in all societies worldwide. „ The Lancet www.thelancet.com Vol 385 May 16, 2015

Research in kidney disease: an acute and chronic history.

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