Serum Uric Acid and Risk of CKD in Type 2 Diabetes.
This longitudinal study of a cohort of patients with type 2 diabetes from the database of the Italian Association of Clinical Diabetologists network. Urinary albumin excretion, GFR, and serum uric acid were available in 13,964 patients. They further assessed the association of serum uric acid quintiles with onset of CKD components by multinomial logistic regression model adjusting for potential confounders. At 4-year follow-up, the incidence of eGFR <60 ml/min per 1.73 m(2) increased in parallel with uric acid quintile. Serum uric acid was significantly associated with albuminuria only in presence of eGFR &...
Source: Nephrology Now - November 30, 2015 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Chronic Kidney Disease Clinical Nephrology Clinical Trial Results Diabetes Source Type: research
Peritoneal Equilibration Test and Patient Outcomes.
This US study of over 10 000 peritoneal dialysis patients looked at the association of peritoneal equilibration test parameters with all-cause mortality, technique failure and hospitalization rate. The median follow-up period was 15.8 months and 87% with on CCPD. The results show a linear association between dialysate/plasma creatinine and mortality (adjusted hazards ratio per 0.1 unit higher, 1.07; 95% confidence interval, 1.02 to 1.13) and hospitalization rate (adjusted incidence rate ratio per 0.1 unit higher, 1.05; 95% confidence interval, 1.03 to 1.06). Ultrafiltration volume was inversely related with hospitalizati...
Source: Nephrology Now - November 30, 2015 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Clinical Trial Results Peritoneal Dialysis Source Type: research
Onco-Nephrology: Core Curriculum 2015.
This edition of the core curriculum nicely details the relationship between oncology and nephrology and the conditions in which they intersect.
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Hemodialysis: core curriculum 2014.
CKD–Mineral and Bone Disorder: Core Curriculum 2011
Interventional Nephrology: Core Curriculum 2009 (Source: Nephrology Now)
Source: Nephrology Now - November 30, 2015 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: AJKD Core Curriculum Source Type: research
Performance of Temporary Hemodialysis Catheter Insertion by Nephrology Fellows and Attending Nephrologists
This pre- post-intervention study with a pretest-only comparison group was conducted at the University of Toronto in September of 2014. Participants were nephrology fellows and attending nephrologists from three university-affiliated academic hospitals who underwent baseline assessment of internal jugular temporary hemodialysis catheter insertion skills using a central venous catheter simulator. A total of 19 attending nephrologists and 20 nephrology fellows participated in the study. Mean attending nephrologist checklist scores (46.1%; SD=29.5%) were similar to baseline scores of fellows (41.1% item...
Source: Nephrology Now - November 30, 2015 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Clinical Nephrology Clinical Trial Results Hemodialysis Source Type: research
The mortality and hospitalization rates associated with the long interdialytic gap in thrice-weekly hemodialysis patients.
This article aimed to identify factors associated with mortality and hospitalization events in England from 2002-2006 comparing the 2 day vs 3 day intradialytic gap. Higher admission rates were seen after the 2-day gap irrespective of whether thrice-weekly dialysis sequence commenced on a Monday or Tuesday (2.4 per year after the 2-day gap vs. 1.4 for the rest of the week, rate ratio 1.7). Increased mortality following the 2-day gap was similarly independent of session pattern (20.5 vs. 16.7 per 100 patient years, rate ratio 1.22), with these increases being driven by out-of-hospital death (rate ratio 1.59 vs. 1.06 for in-...
Source: Nephrology Now - November 30, 2015 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Clinical Nephrology Clinical Trial Results Hemodialysis Source Type: research
A randomized trial of intravenous and oral iron in chronic kidney disease.
This trial randomly assigned patients with stage 3 and 4 CKD and IDA to either open-label oral ferrous sulfate (69 patients to 325 mg three times daily for 8 weeks) or intravenous iron sucrose (67 patients to 200 mg every 2 weeks, total 1 g). The trial was terminated early on the recommendation of an independent data and safety due to higher risk of serious adverse events in the intravenous iron treatment group. There were 36 serious cardiovascular events among 19 participants assigned to the oral iron treatment group and 55 events among 17 participants of the intravenous irongroup (adjusted incidence ...
Source: Nephrology Now - November 30, 2015 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Chronic Kidney Disease Clinical Trial Results General Nephrology Source Type: research
Comparison of standard and accelerated initiation of renal replacement therapy in acute kidney injury
This 12-center open-label pilot trial of critically ill adults with volume replete severe AKI randomized atients were randomized to accelerated (12 h or less from eligibility) or standard RRT initiation. The enrollment median serum creatinine was 268 micromoles/l and urine output was 356 ml per 24 h. Clinical outcomes at 90 days included mortality which was 38% in the accelerated and 37% in the standard arm. The feasibility and findings of this study can be used to inform a large-scale effectiveness randomized control trial.
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The Hannover Dialysis Outcome study: comparison of standard versus intensified ...
Source: Nephrology Now - November 30, 2015 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Acute Kidney Injury Clinical Nephrology Clinical Trial Results Source Type: research
Case Records of the Massachusetts General Hospital. Case 35-2015: A 72-Year-Old Woman with Proteinuria and a Kidney Mass.
An interesting case of a 72 year old woman who presents with a flank pain, proteinuria and a new kidney mass.
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Tolvaptan in Patients with Autosomal Dominant Polycystic Kidney Disease
Recurrent Dense Deposit Disease After Renal Transplantation: An Emerging Role for Complementary Therapies
Kidney and Recipient Weight Incompatibility Reduces Long-Term Graft Survival (Source: Nephrology Now)
Source: Nephrology Now - November 30, 2015 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Case Report Clinical Nephrology Source Type: research
Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial
This is a double-blind, placebo-controlled, crossover trial in patients with resistant hypertension that were taking maximally tolerated doses of 3 or more drugs. The authors found that the average reduction in home systolic blood pressure by spironolactone was superior to placebo (-8•70 mm Hg [95% CI -9•72 to -7•69]; p<0•0001), superior to the mean of the other two active treatments (doxazosin and bisoprolol; -4•26 [-5•13 to -3•38]; p<0•0001), and superior when compared with the individual treatments; versus doxazosin (-4•03 [-5•04 to -3•02]; p<0•0001) and versus bisoprolol (-4•48 [-5•...
Source: Nephrology Now - November 30, 2015 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Clinical Nephrology Clinical Trial Results Hypertension Source Type: research
Randomized Trial on Efficacy of Mycophenolate Mofeti versus Tacrolimus in Maintaining Remission in Children with Steroid Resistant Nephrotic Syndrome
These are results as presented at the 2015 American Society of Nephrology Kidney Week.
In children with steroid resistant nephrotic syndrome who were successfully put into remission, maintenance therapy with MMF 750-1000 mg/m2was compared to tacrolimus 0.1-0.15 mg/kg/day. The primary endpoint of preserved complete or partial remission was achieved in 90.3% of the tacrolimus arm vs 44.8% of the MMF arm, p = 0.00045.
Full results publication of these findings is eagerly awaited.
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Late Breaking Clinical Trials at ASN 2011 – FISH study and more
Short-term Outcomes of Induction Therapy With Tacrolimus Versus Cyclophosp...
Source: Nephrology Now - November 10, 2015 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: General Nephrology Source Type: research
Empagliflozin and Clinical Outcomes in Patients with Type 2 Diabetes and Chronic Kidney Disease
These are results as presented at the 2015 American Society of Nephrology Kidney Week.
The effect of empagliflozin vs placebo on cardiovascular events and death was recently reported in the NEJM in Sep 2015, and shown to significantly reduce both the composite cardiovascular primary endpoint and death.
During Kidney Week, the renal outcome of new onset or worsening of nephropathy (defined as a composite of doubling of creatinine, new macroalbuminuria, initiation of RRT or death due to renal disease) was significantly reduced with a hazard ratio of 0.61, P (Source: Nephrology Now)
Source: Nephrology Now - November 10, 2015 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Chronic Kidney Disease Diabetes General Nephrology Source Type: research
A Randomized Trial of Intensive versus Standard Blood-Pressure Control
In this RCT, a intensive BP target of less than 120 mm Hg was compared to a standard target of less than 140 mm Hg. The primary outcome (a composite of myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes) was reduced (1.65% per year vs. 2.19% per year; HR with intensive treatment, 0.75; 95% CI, 0.64 to 0.89; P (Source: Nephrology Now)
Source: Nephrology Now - November 10, 2015 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Hypertension Source Type: research
Corticosteroids in IgA Nephropathy: A Retrospective Analysis from the VALIGA Study
This retrospective study assessed 1147 patients with IgA nephropathy from the European Validation Study of the Oxford Classification of IgAN (VALIGA) cohort. From this group as well a propensity matched cohort, the authors concluded that corticosteroids reduced proteinuria and the rate of renal function decline and increased renal survival even in patients with an eGFR < 50 ml/min compared to renin angiotensin system blockade alone. Furthermore, the benefits were proportionate to the level of proteinuria.
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Proteinuria: Is the ONTARGET renal substudy actually off target?
Moderate dietary sodium restriction added ...
Source: Nephrology Now - September 21, 2015 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Chronic Kidney Disease Glomerulonephritis Source Type: research
Risk of Adverse Pregnancy Outcomes in Women with CKD
With the increasing prevalence of CKD in pregnancy, it is important that both physicians and patients are aware of the risks. In this Torino-Cagliari Observational Study (TOCOS), 504 pregnancies in women with CKD were compared with 836 low-risk pregnancies in women without CKD. There were multiple pregnancy outcomes that were studied and divided into “general” combined outcome (preterm delivery, NICU, SGA); and “severe” combined outcome (early preterm delivery, NICU, SGA). The risk for adverse outcomes increased across stages (for stage 1 versus stages 4-5: “general” combine...
Source: Nephrology Now - September 21, 2015 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Chronic Kidney Disease Pregnancy and Hypertension/Renal Disease Source Type: research
Effect of Neutral-pH, Low –Glucose Degradation Product Peritoneal Dialysis Solutions on Residual Renal Function, Urine Volume, and Ultrafiltration: A Systematic Review and Meta-Analysis
This meta-analysis of eleven trials of 643 patients used a random effects model to evaluate the effect of peritoneal dialysate with neutral-pH, low-glucose degradation products on residual renalfunction, urine volume, peritoneal ultrafiltration, and peritoneal small-solute transport (dialysate to plasma creatinine ratio). The results show a positive effect on preservation of residual renal function and greater urine volumes only. However, the authors rightly conclude more studies are needed to determine the effect of these more costly solutions on harder clinical outcomes.
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Effect of Low Versus High Dialy...
Source: Nephrology Now - September 21, 2015 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Clinical Nephrology Peritoneal Dialysis Residual Renal Function Source Type: research
