The Effect of Predialysis Fistula Attempt on Risk of All-Cause and Access-Related Death
This is a retrospective cohort study of 2300 patients aged ≥18 years who initiated hemodialysis between 2004 and 2012 at five Canadian dialysis programs. The authors observed significantly lower mortality in individuals who underwent a predialysis fistula attempt than in those without a predialysis fistula attempt in patients aged <65 years and in the first 2 years of follow-up in those aged ≥65 years. Only 2.3% of deaths to be access-related. In summary, predialysis fistula attempt maybe associated with a lower risk of mortality. However, the excess mortality observed in patients treated with catheters does not app...
Source: Nephrology Now - February 9, 2017 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Chronic Kidney Disease Clinical Nephrology Clinical Trial Results Hemodialysis Vascular Access Source Type: research
Update on Nephrolithiasis: Core Curriculum 2016
This core curriculum nicely review nephrolithiasis.
:
Hemodialysis: core curriculum 2014.
Continuous Dialysis Therapies: Core Curriculum 2016
Onco-Nephrology: Core Curriculum 2015. (Source: Nephrology Now)
Source: Nephrology Now - February 9, 2017 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: AJKD Core Curriculum Nephrolithiasis Source Type: research
DASH (Dietary Approaches to Stop Hypertension) Diet and Risk of Subsequent Kidney Disease
This trial looked Atherosclerosis Risk in Communities (ARIC) Study participants with baseline estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2 (N = 14,882). 3,720 participants developed kidney disease during a median follow-up of 23 years. Participants with a DASH diet score in the lowest tertile were 16% more likely to develop kidney disease than those with the highest score tertile (HR, 1.16; 95% CI, 1.07-1.26; P for trend < 0.001), independent of demographic characteristics, established kidney risk factors, and baseline kidney function. Of the individual components of the DASH diet sco...
Source: Nephrology Now - February 9, 2017 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Clinical Nephrology Clinical Trial Results General Nephrology Hypertension Source Type: research
Comparative Effectiveness of 12 Treatment Strategies for Preventing Contrast-Induced Acute Kidney Injury: A Systematic Review and Bayesian Network Meta-analysis
This systematic review included 150 trials with 31,631 participants and 4,182 contrast-induced AKI events assessing 12 different interventions. The conclusion was that high-dose statin plus NAC or high-dose statin alone were ranked the one/two for preventing contrast-induced AKI with no significant changes noted in metaregressions or subgroup and sensitivity analyses.
:
Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis.
Sodium Bicarbonate for the Prevention of Contrast Induced-Acute Kidney Injury: A Systematic Review and Meta-analysis
An a...
Source: Nephrology Now - February 9, 2017 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Acute Kidney Injury Contrast Nephropathy Source Type: research
Liraglutide and Renal Outcomes in Type 2 Diabetes: Results of the LEADER Trial
ASN 2016 High Impact Clinical Trial
Johannes F. Mann, Kristine Brown Fandsen, Gilbert Daniels, Peter Kristensen, Michael Nauck, Steve Nissen, Stuart Pocock, Neil Poulter, Soren Rasmussen, William Steinberg, Mette Stockner, Bernard Zinman, Florian Baeres, Richard Bergenstal, Steve Marso, John Buse. Erlangen, Germany.
Liraglutide, as compared to placebo, was studied in a RCT of 9340 high-risk type 2 diabetic patients to examine the impact on the primary composite outcome of nonfatal MI, nonfatal stroke, and cardiovascular death. The secondary renal endpoint (composite of doubling serum creatinine, ESRD, death due to renal ...
Source: Nephrology Now - November 19, 2016 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Clinical Trial Results Conference Alert Source Type: research
Remote ischaemic preconditioning (RIPC) leads to sustained improvement in allograft function following live donor (LD) kidney transplantation: 5 year follow up in the REnal Protection Against Ischaemia Reperfusion in transplantation (REPAIR) study
ASN 2016 High Impact Clinical Trial
Kristin Veighey, Jennifer Nicholas, Tim Clayton, Raymond Macallister
Using 4 cycles of ischemia/reperfusion in the preoperative living donors, remote ischemic preconditioning (RIPC) was evaluated regarding its impact on post-tranplant outcomes. The primary endpoint was iohexal GFR at 12 months and secondary endpoints were change in eGFR, graft loss or death. There was no difference in the primary outcome. At 5 years post-transplantation, in the early RIPC group vs control, there was an overall improvement in eGFR by 4.8 ml/min (p = 0.003). There was no impact in the late RIPC or...
Source: Nephrology Now - November 19, 2016 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Clinical Trial Results Conference Alert Source Type: research
Efficacy and Safety of Sparsentan, a Dual Angiotensin II (Ang II) and Endothelin (ET) Type A Receptor Antagonist, in Patients with Focal Segmental Glomerulosclerosis (FSGS): A Phase 2 Trial (DUET)
High Impact Clinical Trials ASN 2016
Howard Trachtman, Peter J. Nelson, Radko Komers
In the phase 2 DUET trial that included 96 patients with focal segmental glomerulosclerosis (FSGS), sparsentan, a dual angiotensin II and endothelin type A receptor antagonist, was evaluated to determine the impact on proteinuria.
As compared to irbesartan, urinary protein excretion was suppressed to a greater extent than blockade of angiotensin II alone. No hard clinical endpoints were evaluated.
:
Moderate dietary sodium restriction added to angiotensin converting enzyme inhibition compared with dual blockade in lowering proteinuria a...
Source: Nephrology Now - November 19, 2016 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Clinical Trial Results Conference Alert Source Type: research
AURA-LV: Successful Treatment of Active Lupus Nephritis with Voclosporin
ASN 2016 High Impact Clinical Trial
William Franklin Pendergraft, James A. Tumlin, Brad H. Rovin, Mary Anne Dooley, David R.W. Jayne, David Wofsy, Frederic A. Houssiau, David Isenberg, Tak Mao Chan, Neil Solomons, Robert B. Huizinga
In patients with biopsy proven lupus nephritis, complete remission at 24 weeks was reached by 32.6% (p = 0.045) in low dose voclosporin arm, compared to 27.3%(p=0.204) in the high-dose arm and 19.3% in control arm. Voclosporin was used in combination with MMF and corticosteroids.
:
The PROMISE Study: A Phase 2b Multicenter Study of Voclosporin (ISA247) Versus Tacrolimus in De Novo Kidney Tra...
Source: Nephrology Now - November 19, 2016 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Clinical Trial Results Conference Alert Source Type: research
The Sodium Lowering in Dialysate (SoLID) Trial: A Randomised Controlled Trial of Low versus Standard Dialysate Sodium Concentration (DNa) during Hemodialysis (HD) for Regression of Left Ventricular (LV) Mass
ASN 2016 High Impact Clinical Trial
Mark R. Marshall, Alain C. Vandal, Joanna Leigh Dunlop, Janak Rashme de Zoysa, Imad A. Haloob, Christopher J. Hood, John Irvine, Philip J. Matheson, David Mcgregor, Kannaiyan Samuel Rabindranath, David Semple. Auckland, New Zealand.
Dialysate sodium (Na) concentration of 135 mmol/L vs 140 mmol/L did not effectively reduce left ventricular mass.
:
Dialysate Sodium Concentration and the Association with Interdialytic Weight Gain, Hospitalization, and Mortality
Effect of Low Versus High Dialysate Sodium Concentration on Blood Pressure and Endothelial-Derived Vasoregulators During Hemodial...
Source: Nephrology Now - November 19, 2016 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Clinical Trial Results Conference Alert Source Type: research
ASN 2016 Rabbit-ATG or Basiliximab Induction for Rapid Steroid Withdrawal after Renal Transplantation: An Open-Label, Multicentre, Randomized Controlled Trial
High Impact Clinical Trial Session at the 2016 ASN
Christian Hugo, Michael Sean Wiesener, Mirian Opgenoorth, Oliver Thomusch. Dresden, Germany
In low-tacrolimus treated, immunologically low-risk renal transplant recipients, rapid steroid withdrawal is safe with no impact on survival or biopsy-proven acute rejection. Post-transplantation diabetes incidence is reduced from 39.2% to 23.9%(Basiliximab) or 22.7% (rATG) in rapid steroid withdrawal.
:
A Systematic Review on Steroid Withdrawal Between 3 and 6 Months After Kidney Transplantation
A Randomized Trial to Assess the Impact of Early Steroid Withdrawal on Growth in Ped...
Source: Nephrology Now - November 19, 2016 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Clinical Trial Results Conference Alert Source Type: research
The Risk of Major Hemorrhage with CKD
This retrospective cohort study (2002-2010) grouped 516,197 adults ≥40 years old by eGFR (≥90, 60 to <90, 45 to <60, 30 to <45, 15 to <30, or <15 ml/min per 1.73 m(2)) and urine albumin-to-creatinine ratio (ACR; >300, 30-300, or <30 mg/g) to examine incidence of hemorrhage. The 3-year cumulative incidence of hemorrhage increased 20-fold across declining eGFR and increasing urine ACR groupings (highest eGFR/lowest ACR: 0.5%; lowest eGFR/highest ACR: 10.1%). The associations attenuated but remained significant after adjustment for anticoagulant and antiplatelet use in patients ≥66 years old....
Source: Nephrology Now - November 11, 2016 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Chronic Kidney Disease Clinical Nephrology General Nephrology Source Type: research
Proton Pump Inhibitors and Risk of Incident CKD & Progression to ESRD
The Department of Veterans Affairs national databases were used in this study to build a primary cohort of new users of PPI (n=173,321) and new users of histamine H2-receptor antagonists (H2blockers; n=20,270. These patients were followed for over 5 years to ascertain renal outcomes. In adjusted Cox survival models, the PPI group, compared with the H2 blockers group, had an increased risk of incident eGFR<60 ml/min per 1.73 m2 and of incident CKD (HR, 1.22). Patients treated with PPI also had a significantly elevated risk of doubling of serum creatinine level (HR, 1.53), of eGFR decline >30% (HR, 1.32), a...
Source: Nephrology Now - November 11, 2016 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Chronic Kidney Disease Clinical Nephrology General Nephrology Source Type: research
Proton Pump Inhibitors and Risk of Incident CKD and Progression to ESRD
The Department of Veterans Affairs national databases were used in this study to build a primary cohort of new users of PPI (n=173,321) and new users of histamine H2-receptor antagonists (H2blockers; n=20,270. These patients were followed for over 5 years to ascertain renal outcomes. In adjusted Cox survival models, the PPI group, compared with the H2 blockers group, had an increased risk of incident eGFR<60 ml/min per 1.73 m2 and of incident CKD (HR, 1.22). Patients treated with PPI also had a significantly elevated risk of doubling of serum creatinine level (HR, 1.53), of eGFR decline >30% (HR, 1.32), a...
Source: Nephrology Now - November 11, 2016 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Chronic Kidney Disease Clinical Nephrology General Nephrology Source Type: research
Hospitalization Rates for Patients on Assisted Peritoneal Dialysis Compared with In-Center Hemodialysis
This multicenter, retrospective cohort study by linked a quality assurance dataset to administrative health data in Ontario, Canada. The study included 872 patients in the in-center hemodialysis group and 203 patients in the assisted peritoneal dialysis group. Using an intention to treat approach, patients on assisted peritoneal dialysis had a similar hospitalization rate of 11.1 d/yr (95% confidence interval, 9.4 to 13.0) compared with 12.9 d/yr (95% confidence interval, 10.3 to 16.1) in the hemodialysis group (P=0.19). Patients on assisted peritoneal dialysis who experienced peritonitis and t...
Source: Nephrology Now - November 11, 2016 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Clinical Nephrology Hemodialysis Peritoneal Dialysis Source Type: research
Pathophysiology of Renal Tubular Acidosis: Core Curriculum 2016
This core curriculum is a valuable resource in deconstructing the pathophysiology of renal tubular acidosis.
:
Tubular Transport: Core Curriculum 2010
Proximal renal tubular acidosis: a not so rare disorder of multiple etiologies
Autosomal Dominant Polycystic Kidney Disease: Core Curriculum 2016 (Source: Nephrology Now)
Source: Nephrology Now - November 11, 2016 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: AJKD Core Curriculum Clinical Nephrology Source Type: research
