January 24, 2015

Gestational Hypertension and Preeclampsia in Living Kidney Donors

Garg AX, Nevis IF, McArthur E, Sontrop JM, Koval JJ, Lam NN, Hildebrand AM, Reese PP, Storsley L, Gill JS, Segev DL, Habbous S, Bugeja A, Knoll GA, Dipchand C, Monroy-Cuadros M, Lentine KL, DONOR Network.   N Engl J Med.   2015 Jan 8;372(2):124-33

This retrospective cohort study of living donors matched to healthy nondonors in Ontario, Canada showed that young women who donated a kidney were more likely to suffer from gestational hypertension or preeclampsia (OR for donors 2.4).  There were no significant differences with respect to preterm birth or low birth weight.

Leave a Comment! Posted in Hypertension, Pregnancy and Hypertension/Renal Disease
January 24, 2015

Con: Frequent haemodialysis for all chronic haemodialysis patients.

Labriola L, Morelle J, Jadoul M.   Nephrol Dial Transplant.   2015 Jan;30(1):23-7

The flipside of this debated is showcased here with the authors taking a more “conservative” approach to the increasing frequency of dialysis debate.

Leave a Comment! Posted in Hemodialysis
January 24, 2015

Effect of Pentoxifylline on Renal Function and Urinary Albumin Excretion in Patients with Diabetic KidneyDisease: The PREDIAN Trial.

Navarro-González JF, Mora-Fernández C, Muros de Fuentes M, Chahin J, Méndez ML, Gallego E, Macía M, Del Castillo N, Rivero A, Getino MA, García P, Jarque A, García J.   J Am Soc Nephrol.   2015 Jan;26(1):220-9

This open-label prospective, randomized trial showed that pentoxifylline in addition to RAS inhibitors resulted in a smaller decrease in eGFR and great reduction of albuminuria at two years in Type 2 diabetics with stage 3-4 CKD.

Leave a Comment! Posted in Chronic Kidney Disease, Clinical Nephrology, Clinical Trial Results, General Nephrology
January 24, 2015

Effects of Blood Pressure Reduction in Mild Hypertension: A Systematic Review and Meta-analysis.

Sundström J, Arima H, Jackson R, Turnbull F, Rahimi K, Chalmers J, Woodward M, Neal B, on behalf of the Blood Pressure Lowering Treatment Trialists' Collaboration*.   Ann Intern Med.   2014 Dec 23;

This meta-analysis reveals the medical therapy in managing grade 1 hypertension (140-159/90-99 mmHg)  is likely to prevent stroke and death.

Leave a Comment! Posted in Clinical Nephrology, Hypertension
January 24, 2015

Pro: Should we move to more frequent haemodialysis schedules?

Georgianos PI, Sarafidis PA.   Nephrol Dial Transplant.   2015 Jan;30(1):18-22

This article on the pro side of this debate summarizes the evidence supporting more frequent dialysis.  The authors how longer interdialytic intervals may be associated with elevated cardiovascular risk and how this risk may be mitigated with more frequent dialysis.

Leave a Comment! Posted in Hemodialysis
January 24, 2015

Diagnostic and Predictive Accuracy of Blood Pressure Screening Methods With Consideration of Rescreening Intervals: An Updated Systematic Review for the U.S. Preventive Services Task Force.

Piper MA, Evans CV, Burda BU, Margolis KL, O'Connor E, Whitlock EP.   Ann Intern Med.   2014 Dec 23;

This task force shows the evidence that supports using ambulatory blood pressure monitoring as the reference standard for confirming elevated office blood pressure.  This will serve to confirm elevated blood pressure and avoid misdiagnosis and/or overtreatment.

Leave a Comment! Posted in Clinical Nephrology, Hypertension
January 24, 2015

Effect of Low Versus High Dialysate Sodium Concentration on Blood Pressure and Endothelial-Derived Vasoregulators During Hemodialysis: A Randomized Crossover Study.

Inrig JK, Molina C, D'Silva K, Kim C, Van Buren P, Allen JD, Toto R.   Am J Kidney Dis.   2014 Dec 16;

This interesting study looked at the effect of dialysate sodium concentrations (low (5 mEq/L below serum sodium) versus high (5 mEq/L above serum sodium)) and the effect on blood pressure during dialysis.  The results showed that low sodium dialysate significantly decreased systolic BP and ameliorated intradialytic hypertension. However, longer studies are needed to determine the long-term effects.

Leave a Comment! Posted in Clinical Nephrology, Fluid & Electrolytes, Hemodialysis
January 24, 2015

Risk of adverse events among older adults following co-prescription of clarithromycin and statins notmetabolized by cytochrome P450 3A4.

Li DQ, Kim R, McArthur E, Fleet JL, Bailey DG, Juurlink D, Shariff SZ, Gomes T, Mamdani M, Gandhi S, Dixon S, Garg AX.   CMAJ.   2014 Dec 22;

 Among older adults taking a statin not metabolized by CYP3A4 (rosuvastatin/pravastatin/fluvastatin), co-prescription of clarithromycin versus azithromycin was associated with a modest but statistically significant increase in the 30-day absolute risk of adverse outcomes, including AKI and admission with hyperkalemia.

Leave a Comment! Posted in Acute Kidney Injury, Internal Medicine for Nephrologists
January 24, 2015

Disorders of Plasma Sodium — Causes, Consequences, and Correction

Sterns RH.   N Engl J Med.   2015 Jan 1;372(1):55-65

Leave a Comment! Posted in Clinical Nephrology, Fluid & Electrolytes
January 24, 2015

Angiotensin Blockade in Late Autosomal Dominant Polycystic Kidney Disease

Torres VE, Abebe KZ, Chapman AB, Schrier RW, Braun WE, Steinman TI, Winklhofer FT, Brosnahan G, Czarnecki PG, Hogan MC, Miskulin DC, Rahbari-Oskoui FF, Grantham JJ, Harris PC, Flessner MF, Moore CG, Perrone RD, HALT-PKD Trial Investigators.   N Engl J Med.   2014 Dec 11;371(24):2267-76

This elegant double-blind, placebo-controlled trial shows the addition of an ARB in patients with ADPKD already on an ACE inhibitor did not alter the decline in estimated GFR.  Based on this evidence, there seems to be no role for dual RAAS blockade in this population.

Leave a Comment! Posted in Chronic Kidney Disease, Polycystic Kidney Disease
January 24, 2015

Metformin in Patients With Type 2 Diabetes and Kidney Disease: A Systematic Review

Inzucchi SE, Lipska KJ, Mayo H, Bailey CJ, McGuire DK.   JAMA.   2014 Dec 24-31;312(24):2668-75

This review nicely summarizes the risks of metformin therapy in patients with mild to moderate chronic kidney disease.  According to the authors, there is room for “cautious expansion” of use in this population.

Leave a Comment! Posted in Clinical Nephrology, Diabetes
December 17, 2014

Hypertension

Weir MR.   Ann Intern Med.   2014 Dec 2;161(11):ITC1-15; quiz ITC16

This is a comprehensive clinical overview of hypertension.  Drawn from the ACP resources, it focusses on hypertension prevention, diagnosis, treatment, practice improvement, and patient information.    

Leave a Comment! Posted in Clinical Nephrology, Hypertension
December 17, 2014

Protein electrophoresis and immunofixation for the diagnosis of monoclonal gammopathies

Rajkumar SV, Kyle RA.   JAMA.   2014 Nov 26;312(20):2160-1

This case-based article from the JAMA Diagnostic Test Interpretation series and has an associated quiz.  It is designed to help the reader interpret diagnostic tests in the context of monoclonal gammopathies.

Leave a Comment! Posted in Clinical Nephrology, General Nephrology