Relationship Between the Prognostic Expectations of Seriously Ill Patients Undergoing Hemodialysis and Their Nephrologists
This very interesting study emphasizes the need for better communication strategies between patients and their health care providers. Although in this cohort, patients’ expectations about 1-year survival were more accurate than those of their nephrologists; their longer-term survival expectations were significantly overestimated. In order to optimally guide their choices, patients need to have better prognostic information
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Routine Preoperative Vascular Ultrasound Improves Patency and Use of Arteriovenous Fistulas for Hemodialysis: A Randomized Trial
Long-Term Renal Allograft Survival in the United States: A Critical...
Source: Nephrology Now - August 23, 2013 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Clinical Nephrology Educational Resource Hemodialysis Source Type: research
Risk of acute kidney injury associated with the use of fluoroquinolones
This interesting study examined the risk of acute kidney injury when using fluoroquinolones. The current use of this class of antibiotics in patients had a >2-fold (95% confidence interval [CI] 1.74-2.73) higher adjusted relative risk (RR) of acute kidney injury compared with no use. Furthermore, the dual use of fluoroquinolones and renin-angiotensin-system blockers had RR of 4.46 (95% CI 2.84-6.99) for acute kidney injury.
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Proteinuria: Is the ONTARGET renal substudy actually off target?
The effect of combination treatment with aliskiren and blockers of the renin-angiotensin system on hyperkalaemia and acute kidney i...
Source: Nephrology Now - August 23, 2013 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Acute Kidney Injury General Nephrology Source Type: research
Androgen Deprivation Therapy and Risk of Acute Kidney Injury in Patients With Prostate Cancer
This nested case-control analysis showed that in patients with nonmetastatic prostate cancer, there was a significant increase in the incidence of acute kidney injury with androgen deprivation therapy. These findings need to be further investigated and studied.
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Risk of acute kidney injury associated with the use of fluoroquinolones
Treatment of Kidney Transplant Recipients With ACEi/ARB and Risk of Respiratory Tract Cancer: A Collaborative Transplant Study Report
The Pattern of Excess Cancer in Dialysis and Transplantation (Source: Nephrology Now)
Source: Nephrology Now - August 23, 2013 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Acute Kidney Injury General Nephrology Source Type: research
Efficacy of Remission-Induction Regimens for ANCA-Associated Vasculitis
This randomized double-blind noninferiority trial compared the 18-month efficacy of rituximab + placebo vs cyclophosphamide + azathioprine for the treatment of ANCA-associated vasculitis. Of the 197 patients enrolled, 64% of the patients in the rituximab group, as compared with 53% of the patients in the cyclophosphamide-azathioprine group, had a complete remission by 6 months. The results were similar at 12 and 18 months. The authors concluded that both regimens were effective as both induction and maintenance therapies for ANCA-associated vasculitis over 18 months of follow-up.
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Prolonged disease-free remission follo...
Source: Nephrology Now - August 23, 2013 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Clinical Nephrology General Nephrology Glomerulonephritis Source Type: research
Peritoneal Dialysis Access Guide
This guide to peritoneal dialysis access is based in part on ISPD guidelines. It provides a concise review of catheter insertion and post-procedure care, non-infectious complications of PD catheters, infectious complications of PD catheters and antibiotic dosing guidelines.
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PD Access Guide
iPhone App ‘Calculate by QxMD’ adds PD Content
Risk of Pneumocystis jiroveci pneumonia in patients long after renal transplantation (Source: Nephrology Now)
Source: Nephrology Now - August 2, 2013 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Educational Resource Peritoneal Dialysis Source Type: research
The demise of calcium-based phosphate binders
This editorial provides commentary on the paper Effect of calcium-based versus non-calcium-based phosphate binders on mortality in patients with chronic kidney disease: an updated systematic review and meta-analysis.
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Effect of calcium-based versus non-calcium-based phosphate binders on mortality in patients with chronic kidney disease: an updated systematic review and meta-analysis.
Interventions for bone disease in children with chronic kidney disease.
Benefits and Harms of Statin Therapy for Persons With Chronic Kidney Disease: A Systematic Review and Meta-analysis (Source: Nephrology Now)
Source: Nephrology Now - July 26, 2013 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Bone Mineral Metabolism Chronic Kidney Disease Vascular Disease/Calcification Source Type: research
Effect of calcium-based versus non-calcium-based phosphate binders on mortality in patients with chronic kidney disease: an updated systematic review and meta-analysis.
This meta-analysis looks at the effect of calcium-based versus non-calcium-based phosphate binders on mortality in patients with chronic kidney disease. It has been updated from a 2009 meta-analysis (read it here) looking at the same question but with the benefit of additional clinical trial data. Analysis of the trials that reported mortality showed a 22% reduction in all-cause mortality (risk ratio 0·78, 95% CI 0·61-0·98) in patients assigned to non-calcium-based binders.
Will this change your practice? Please comment.
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The demise of calcium-based phosphate binders
Lipid-Lowering Therapy in Persons With Chroni...
Source: Nephrology Now - July 26, 2013 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Bone Mineral Metabolism Chronic Kidney Disease Vascular Disease/Calcification Source Type: research
Effect of lower sodium intake on health: systematic review and meta-analyses
This is another article that supports the literature for reduction in salt intake for overall population health. This systematic further shows that not only does salt lower blood pressure, but there are no adverse effects on lipids, catecholamine levels of renal function. Furthermore, it is associated with lower risk of stroke and fatal coronary heart disease in adults.
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Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses
Benefits and harms of erythropoiesis-stimulating agents for anemia related to cancer: a meta-analysis.
Systematic Review: Vitamin D and...
Source: Nephrology Now - July 15, 2013 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: General Nephrology Hypertension Source Type: research
Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses
Salt seems to get the most press, but potassium is an important player in the prevention of vascular disease. This systematic review of 22 RCTs and 11 cohort studies shows that systolic blood pressure was reduced by 7.16 (1.91 to 12.41) mm Hg when the potassium intake was 90-120 mmol/day, without any dose response. Furthermore, there was a 24% lower risk of stroke. The results suggest that patients without impaired renal excretion of potassium would potentially see the most benefit with respect to hypertension and stroke prevention with increased potassium intake.
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Effect of lower sodium intake on health: systematic revi...
Source: Nephrology Now - July 15, 2013 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: General Nephrology Hypertension Source Type: research
Medical Management to Prevent Recurrent Nephrolithiasis in Adults: A Systematic Review for an American College of Physicians Clinical Guideline
This systematic review nicely distills the basics of renal stone management. In patients with idiopathic calcium-containing kidney stones the principle of management is the following: increase fluid intake. If they are recurrent, then addition of thiazide or citrate may further reduce the risk. Allopurinol was beneficial in the subgroup that had baseline hyperuricemia or hyperuricosuria.
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Systematic Review: Vitamin D and Calcium Supplementation in Prevention of Cardiovascular Events
Antihypertensives for Kidney Transplant Recipients: Systematic Review and Meta-Analysis of Randomized Controlled Trials
Interventions for bo...
Source: Nephrology Now - July 15, 2013 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Clinical Nephrology Clinical Practice Guidelines General Nephrology Nephrolithiasis Source Type: research
Antiplatelet Therapy in the Management of Cardiovascular Disease in Patients with CKD: What Is the Evidence?
This review discusses gaps in knowledge related to the use of anti-platelet agents in patients with chronic kidney disease.
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Exercise training for adults with chronic kidney disease.
Does TREAT Give the Boot to ESAs in the Treatment of CKD Anemia?
Oral Phosphate Binders in Patients with Kidney Failure (Source: Nephrology Now)
Source: Nephrology Now - July 14, 2013 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Chronic Kidney Disease Internal Medicine for Nephrologists Source Type: research
Mycophenolate Mofetil or Intravenous Cyclophosphamide for Lupus Nephritis With Poor Kidney Function: A Subgroup Analysis of the Aspreva Lupus Management Study
This post hoc subgroup analysis of the ALMS trial (comparing MMF to cyclophosphamide in lupus nephritis) specifically assessed patients with GFR < 30 ml/min/1.73m2. No difference was detected in the primary outcome of response to treatment (decrease in proteinuria and stabilization or improvement of serum creatinine level). The accompanying editorial asks whether post-hoc subgroup analyses should change treatment patterns: https://readbyqxmd.com/read/23582251/mycophenolate-mofetil-in-severe-lupus-nephritis-should-post-hoc-analyses-change-treatment-patterns
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Mycophenolate versus Azathioprine as Maintenance Therapy for L...
Source: Nephrology Now - July 14, 2013 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Lupus Source Type: research
Impact of the ALMS and MAINTAIN trials on the management of lupus nephritis
This review discusses how ALMS and MAINTAIN guide the choice of maintenance therapy in lupus nephritis, as well as drug dosing and total duration of therapy.
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Should mycophenolate mofetil replace cyclophosphamide as first-line therapy for severe lupus nephritis?
Mycophenolate Mofetil or Intravenous Cyclophosphamide for Lupus Nephritis With Poor Kidney Function: A Subgroup Analysis of the Aspreva Lupus Management Study
Updates on the Treatment of Lupus Nephritis (Source: Nephrology Now)
Source: Nephrology Now - July 14, 2013 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Lupus Review Source Type: research
Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised trials
This Cochrane study supports the notion that our society needs to reduce total salt intake.. Thirty-four trials and over 3000 participants were included in this meta-analysis. The results are impressive: the mean change in urinary sodium was −75 mmol/24 h with an associated mean change in systolic blood pressure of −4.18 mm Hg (95% confidence interval −5.18 to −3.18, I2=75%) and −2.06 mm Hg (−2.67 to −1.45, I2=68%) for diastolic blood pressure.
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Fatal and Nonfatal Outcomes, Incidence of Hypertension, and Blood Pressure Changes in Relation to Urinary Sodium Excretion
Effect of increased potassium intake on ...
Source: Nephrology Now - July 14, 2013 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: General Nephrology Hypertension Source Type: research
Comparing Mortality of Peritoneal and Hemodialysis Patients in the First 2 Years of Dialysis Therapy: A Marginal Structural Model Analysis
This impressive study using marginal structural models analyses and DaVita data shows that PD is associated with 48% lower mortality in the first 2 years of dialysis therapy. This was independent of modality switching or transplantation rates.
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Posttransplantation Encapsulating Peritoneal Sclerosis Contributes Significantly to Mortality after Kidney Transplantation
Frailty, Dialysis Initiation, and Mortality in End-Stage Renal Disease
Dialysis-requiring acute renal failure increases the risk of progressive chronic kidney disease (Source: Nephrology Now)
Source: Nephrology Now - July 14, 2013 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Chronic Kidney Disease Clinical Trial Results Hemodialysis Peritoneal Dialysis Source Type: research
