May 29, 2016

Pregnancy across the spectrum of chronic kidney disease

Hladunewich MA, Melamad N, Bramham K.   Kidney Int.   2016 May;89(5):995-1007

  This paper highlights some of the available data as well as management strategies for nephrologists managing pregnant patients with chronic kidney disease.    

Leave a Comment! Posted in Clinical Nephrology, Pregnancy and Hypertension/Renal Disease
May 29, 2016

Communication Skills and Decision Making for Elderly Patients With Advanced Kidney Disease: A Guide for Nephrologists

Koncicki HM, Schell JO.   Am J Kidney Dis.   2016 Apr;67(4):688-95

As we all know, elderly patients comprise the most rapidly growing population initiating dialysis therapy. This review provides nephrologists with the palliative skills that can help care for this patients and aid in dialysis treatment decisions as well as decisions regarding overall goals of care.  

Leave a Comment! Posted in Clinical Nephrology
May 29, 2016

Autosomal Dominant Polycystic Kidney Disease: Core Curriculum 2016

Chebib FT, Torres VE.   Am J Kidney Dis.   2016 May;67(5):792-810

  This core curriculum is a comprehensive overview on ADPKD that should prove to be valuable to both trainee and consultant physicians.

Leave a Comment! Posted in AJKD Core Curriculum, Clinical Nephrology, Polycystic Kidney Disease
May 29, 2016

Controversies Regarding Lipid Management and Statin Use for Cardiovascular Risk Reduction in Patients With CKD

Markossian T, Burge N, Ling B, Schneider J, Pacold I, Bansal V, Leehey D, Stroupe K, Chang A, Kramer H.   Am J Kidney Dis.   2016 Jun;67(6):965-77

It is known that patients with chronic kidney disease are at increased risk of death from cardiovascular disease. This review nicely addresses the identification and management of lipid levels in patients with CKD and discusses the controversies regarding testing and treatment of lipid levels in this population.

Leave a Comment! Posted in Chronic Kidney Disease, Clinical Nephrology
May 29, 2016

The Effect of Erythropoietin-Stimulating Agents on Health-Related Quality of Life in Anemia of Chronic Kidney Disease: A Systematic Review and Meta-analysis

Collister D, Komenda P, Hiebert B, Gunasekara R, Xu Y, Eng F, Lerner B, Macdonald K, Rigatto C, Tangri N.   Ann Intern Med.   2016 Apr 5;164(7):472-8

This meta-analysis and systematic review of 17 studies showed that higher hemoglobin targets did not result in statistically or clinically significant differences in SF-36 or KDQ domains.  Furthermore, HRQOL were further attenuated in studies at low risk of bias and in subgroups of dialysis patients.    

Leave a Comment! Posted in Anemia, Clinical Nephrology
May 29, 2016

Update in Nephrology and Hypertension: Evidence Published in 2015

Peixoto AJ.   Ann Intern Med.   2016 May 3;164(9):W42-7

  This article nicely summarizes the clinically relevant evidence published in the literature for 2015.      

Leave a Comment! Posted in Clinical Nephrology, Educational Resource
May 29, 2016

Effect of Early vs Delayed Initiation of Renal Replacement Therapy on Mortality in Critically Ill Patients With Acute Kidney Injury The ELAIN Randomized Clinical Trial

Zarbock A, Kellum JA, Schmidt C, Van Aken H, Wempe C, Pavenstädt H, Boanta A, Gerß J, Meersch M.   JAMA.   2016 May 24-31;315(20):2190-9

This single-center randomized clinical trial of 231 critically ill patients with AKI KDIGO stage 2 looked at early (within 8 hours of diagnosis of KDIGO stage 2; n = 112) or delayed (within 12 hours of stage 3 AKI or no initiation; n = 119) initiation of RRT.  The results show that early initiation of RRT significantly reduced 90-day mortality (39.3% vs 54.7%).  More patients in the early group recovered renal function by day 90 (53.6% vs 38.7%) in the delayed group.  Furthermore, duration of […]

Leave a Comment! Posted in Acute Kidney Injury, Clinical Trial Results, Hemodialysis
May 29, 2016

Bioengineered human acellular vessels for dialysis access in patients with end-stage renal disease: two phase 2 single-arm trials

Lawson JH, Glickman MH, Ilzecki M, Jakimowicz T, Jaroszynski A, Peden EK, Pilgrim AJ, Prichard HL, Guziewicz M, Przywara S, Szmidt J, Turek J, Witkiewicz W, Zapotoczny N, Zubilewicz T, Niklason LE.   Lancet.   2016 May 14;387(10032):2026-34

This phase 2 trial looked at bioengineered human acellular vessel as an option for dialysis access in 60 patients that were not candidates for arteriovenous fistulas.  The results show that onne vessel became infected during 82 patient-years of follow-up. There were no vessels with dilatation and there was rarely any post-cannulation bleeding. At 12 months, […]

Leave a Comment! Posted in Hemodialysis, Vascular Access
March 23, 2016

Multinational Assessment of Accuracy of Equations for Predicting Risk of Kidney Failure: A Meta-analysis.

Tangri N, Grams ME, Levey AS, Coresh J, Appel LJ, Astor BC, Chodick G, Collins AJ, Djurdjev O, Elley CR, Evans M, Garg AX, Hallan SI, Inker LA, Ito S, Jee SH, Kovesdy CP, Kronenberg F, Heerspink HJ, Marks A, Nadkarni GN, Navaneethan SD, Nelson RG, Titze S, Sarnak MJ, Stengel B, Woodward M, Iseki K, CKD Prognosis Consortium.   JAMA.   2016 Jan 12;315(2):164-74

Thirty-one cohorts participating in the CKD Prognosis Consortium, including 721,357 participants with CKD stages 3 to 5 in more than 30 countries spanning 4 continents, were studied to evaluate the accuracy of the kidney failure risk equations.  During a median follow-up of 4 years of 721,357 participants with CKD, 23,829 cases kidney failure were observed. The original risk equations achieved excellent discrimination across all […]

Leave a Comment! Posted in Chronic Kidney Disease, Clinical Nephrology, General Nephrology
March 23, 2016

Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis.

Xie X, Atkins E, Lv J, Bennett A, Neal B, Ninomiya T, Woodward M, MacMahon S, Turnbull F, Hillis GS, Chalmers J, Mant J, Salam A, Rahimi K, Perkovic V, Rodgers A.   Lancet.   2016 Jan 30;387(10017):435-43

This systematic review and meta-analysis of 19 trials included 44,989 participants,  with 2496 major cardiovascular events were recorded during a mean 3·8 years of follow-up.  Patients in the more intensive blood pressure-lowering treatment group had mean blood pressure levels of 133/76 mm Hg, compared with 140/81 mm Hg in the less intensive treatment group. Intensive blood pressure-lowering treatment achieved RR reductions for major cardiovascular events (14% [95% CI 4-22]), myocardial infarction […]

Leave a Comment! Posted in General Nephrology, Hypertension, Internal Medicine for Nephrologists
March 23, 2016

Update on Peritoneal Dialysis: Core Curriculum 2016.

Hansson JH, Watnick S.   Am J Kidney Dis.   2016 Jan;67(1):151-64

This is an update on peritoneal dialysis with this new core curriculum.

Leave a Comment! Posted in AJKD Core Curriculum, Clinical Nephrology
March 23, 2016

Vascular Access Type and Patient and Technique Survival in Home Hemodialysis Patients: The Canadian Organ Replacement Register.

Perl J, Nessim SJ, Moist LM, Wald R, Na Y, Tennankore KK, Chan CT.   Am J Kidney Dis.   2016 Feb;67(2):251-9

This registry-based retrospective observational cohort study assessed 1217 incident HHD patients in The Canadian Organ Replacement Register who had information for vascular access type (CVC vs AV access) within the first year of HHD therapy initiation.  The results showed that AV access use (n=694) was associated with lower risk for the composite event of death and technique failure (490 events; adjusted HR, 0.78; 95% CI, 0.64-0.94) and lower adjusted all-cause […]

Leave a Comment! Posted in Chronic Kidney Disease, Clinical Trial Results, Vascular Access