April 5, 2012

KDIGO Clinical Practice Guidelines for AKI

These extensive clinical practice guidelines provide by KDIGO are intended to assist decision-making in the area of acute kidney injury.

Leave a Comment! Posted in Acute Kidney Injury, Clinical Practice Guidelines
April 5, 2012

Comparing Cardiac Surgery in Peritoneal Dialysis and Hemodialysis Patients: Perioperative Outcomes and Two-Year Survival

Kumar VA, Ananthakrishnan S, Rasgon SA, Yan E, Burchette R, Dewar K.   Perit Dial Int.   2012 Mar-Apr;32(2):137-41

This small observational study suggests that PD patients who require cardiac surgery do not experience more complications or worse 2-year survival as compared to HD patients.  It also sugggests that 2-year survival for dialysis patients after cardiac surgery is acceptable.

Leave a Comment! Posted in Peritoneal Dialysis, Vascular Disease/Calcification
April 5, 2012

Factors influencing patient choice of dialysis versus conservative care to treat end-stage kidney disease

Morton RL, Snelling P, Webster AC, Rose J, Masterson R, Johnson DW, Howard K.   CMAJ.   2012 Mar 20;184(5):E277-83

This study surveyed patients with stage 3-5 CKD in Australia to assess factors which influence patients to choose dialysis versus conservative care.  Dialysis was more likely to be chosen if patients felt it increased life expectancy, would be given the choice of time to dialyze (evening rather than day only) or would receive subsidized transport. [...]

Leave a Comment! Posted in Chronic Kidney Disease, Hemodialysis, Peritoneal Dialysis
April 5, 2012

Effects of Antiplatelet Therapy on Mortality and Cardiovascular and Bleeding Outcomes in Persons With Chronic Kidney Disease: A Systematic Review and Meta-analysis

Palmer SC, Di Micco L, Razavian M, Craig JC, Perkovic V, Pellegrini F, Copetti M, Graziano G, Tognoni G, Jardine M, Webster A, Nicolucci A, Zoungas S, Strippoli GF.   Ann Intern Med.   2012 Mar 20;156(6):445-59

This systematic review and meta-analysis was designed to summarize the effects of antiplatelet treatment on cardiovascular events, mortality and bleeding in patients with CKD.  The results showed that serious bleeding was increased while there was no benefit on all-cause CV mortality or myocardial infarction in patients with CKD.  In patients with stable or absent cardiovascular [...]

Leave a Comment! Posted in Chronic Kidney Disease
April 5, 2012

Updated Labelling for Pradax Regarding Kidney Function and Risk of Bleeding

These notes are taken from the changes to the Canadian product monograph for the anticoagulant Pradax (dabigatran etexilate) which have been updated to include new recommendations regarding renal function. Given that renal impairment is a risk factor for bleeding with Pradax®: Prior to initiation of treatment, renal function should be assessed in all patients to [...]

Leave a Comment! Posted in Chronic Kidney Disease
April 5, 2012

Membranoproliferative Glomerulonephritis — A New Look at an Old Entity

Sethi S, Fervenza FC.   N Engl J Med.   2012 Mar 22;366(12):1119-31

MPGN accounts for approximately 10% of cases of glomerulonephritis.  This article nicely reviews the causes, pathogenesis and clinical management.

Leave a Comment! Posted in Glomerulonephritis, Review
April 5, 2012

Benefits of regular walking exercise in advanced pre-dialysis chronic kidney disease

Kosmadakis GC, John SG, Clapp EL, Viana JL, Smith AC, Bishop NC, Bevington A, Owen PJ, McIntyre CW, Feehally J.   Nephrol Dial Transplant.   2012 Mar;27(3):997-1004

This prospective study of 40 patients with stage 4-5 CKD assessed the benefits of 6 months of regular walking.  Self-reported improvements were noted in exercise tolerance, quality of life and uremic symptoms.  While more studies need to be done with larger patient populations to understand the nature and mechanism of these benefits, this study does [...]

Leave a Comment! Posted in Chronic Kidney Disease
April 5, 2012

Likelihood of Starting Dialysis after Incident Fistula Creation

Oliver MJ, Quinn RR, Garg AX, Kim SJ, Wald R, Paterson JM.   Clin J Am Soc Nephrol.   2012 Mar;7(3):466-71

This analysis of administrative data estimated the risk of fistula non-use in predialysis patients with a fistula.  Eighty-one percent of patients initiated dialysis; 9% of patients died without receiving dialysis, and 10% of patients remained predialysis. These results suggest that a fistula is used in the majority of patients in whom it is created.

Leave a Comment! Posted in Vascular Access
April 5, 2012

Correction of Postkidney Transplant Anemia Reduces Progression of Allograft Nephropathy

Choukroun G, Kamar N, Dussol B, Etienne I, Cassuto-Viguier E, Toupance O, Glowacki F, Moulin B, Lebranchu Y, Touchard G, Jaureguy M, Pallet N, Le Meur Y, Rostaing L, Martinez F, CAPRIT study Investigators.   J Am Soc Nephrol.   2012 Feb;23(2):360-8

In this randomized controlled trial, use of erythropoietin in renal transplant recipients to normalize hemoglobin to normal levels (130-150 g/L) resulted in less decline in graft function, less graft failure and fewer deaths compared to maintaining hemoglobin in the range recommended by current renal guidelines (105-115 g/L). This is a surprising result, as there have [...]

Leave a Comment! Posted in Renal Transplantation
April 5, 2012

Understanding the Causes of Kidney Transplant Failure: The Dominant Role of Antibody-Mediated Rejection and Nonadherence

Sellarés J, de Freitas DG, Mengel M, Reeve J, Einecke G, Sis B, Hidalgo LG, Famulski K, Matas A, Halloran PF.   Am J Transplant.   2012 Feb;12(2):388-99

Understanding the causes of renal allograft failure is key in improving long-term graft survival. In this study, for-cause biopsies were analyzed, and outcomes were related to the biopsy finding. Notably, acute T-cell mediated cellular rejection rarely led to graft loss. In contrast, all patients who experienced graft loss demonstrated some degree of antibody-mediated rejection on [...]

Leave a Comment! Posted in Renal Transplantation
April 5, 2012

A Randomized Trial With Steroids and Antithymocyte Globulins Comparing Cyclosporine/Azathioprine Versus Tacrolimus/Mycophenolate Mofetil (CATM2) in Renal Transplantation

Vacher-Coponat H, Moal V, Indreies M, Purgus R, Loundou A, Burtey S, Brunet P, Moussi-Frances J, Daniel L, Dussol B, Berland Y.   Transplantation.   2012 Feb 27;93(4):437-43

In the last few years, the tacrolimus and mycophenolic acid has become the most popular therapy used in renal transplant, rather than the older cyclosporine and azathioprine combination. These authors conducted a randomized controlled trial to see whether the use of lymphocyte-depleting induction therapy would give equivalent results between these two drug regimens. In fact, [...]

Leave a Comment! Posted in Renal Transplantation
April 5, 2012

Very early steroid withdrawal or complete avoidance for kidney transplant recipients: a systematic review

Pascual J, Royuela A, Galeano C, Crespo M, Zamora J.   Nephrol Dial Transplant.   2012 Feb;27(2):825-32

There have been a number of randomized controlled trials over the last few years comparing early corticosteroid withdrawal post-renal transplant to long-term low-dose steroids. This meta-analysis found nine randomized controlled trials using modern immunosuppression protocols to assess the impact of early steroid withdrawal. Patients received tacrolimus or cyclosporine; mycophenolic acid or an mTOR inhibitor; and [...]

Leave a Comment! Posted in Renal Transplantation
February 26, 2012

World Kidney Day 2012: The Global Role of Kidney Transplantation

Garcia GG, Harden PN, Chapman JR.   Am J Kidney Dis.   2012 Mar;59(3):319-24

This article reflects on the success of kidney transplantation for the therapy of ESRD to commemorate World Kidney Day on March 8, 2012.

Leave a Comment! Posted in Renal Transplantation