May 8, 2015

Outcomes of Elderly Patients after Predialysis Vascular Access Creation

Lee T, Thamer M, Zhang Y, Zhang Q, Allon M.   J Am Soc Nephrol.   2015 Apr 8;

A cohort of 3418 CKD patients ≥70 years who underwent predialysis AVF or AVG creation from 2004 to 2009 were assessed and followed.  The results show that 67% of patients with predialysis AVF and 71% of patients with predialysis AVG creation initiated dialysis within 2 years of access placement, but the overall risk of dialysis initiation was modified by patient age and race. Only one half of patients initiated […]

Leave a Comment! Posted in Clinical Nephrology, Hemodialysis, Vascular Access
May 8, 2015

Outcomes of In-Hospital Cardiopulmonary Resuscitation in Maintenance Dialysis Patients

Saeed F, Adil MM, Malik AA, Schold JD, Holley JL.   J Am Soc Nephrol.   2015 Apr 23;

This study using data from the Nationwide Inpatient Sample (2005-2011) compared data from 56 069 patients with ESRD who underwent in hospital CPR to 323 620 patients from the general population.  After adjustment, patients with ESRD had higher odds of mortality (odds ratio, 1.24; 95% confidence interval, 1.11 to 1.3; P<0.001). Survival after CPR improved in the […]

Leave a Comment! Posted in Clinical Nephrology, Hemodialysis
May 8, 2015

Trends in In-Hospital Cardiopulmonary Resuscitation and Survival in Adults Receiving Maintenance Dialysis

Wong SP, Kreuter W, Curtis JR, Hall YN, O'Hare AM.   JAMA Intern Med.   2015 Jun;175(6):1028-35

This important study helps us to understand the outcomes of in-hospital CPR from a Medicare registry in US adults receiving maintenance hemodialysis.  The annual incidence of CPR for the overall cohort was 1.4 events per 1000 in-hospital days with a  total of 21.9% CPR recipients surviving to hospital discharge.  The median post discharge survival was 5 months.  

Leave a Comment! Posted in Clinical Nephrology, Hemodialysis
May 8, 2015

Extended Daily Dialysis Versus Continuous Renal Replacement Therapy for Acute Kidney Injury: A Meta-analysis

Zhang L, Yang J, Eastwood GM, Zhu G, Tanaka A, Bellomo R.   Am J Kidney Dis.   2015 Apr 2;

This systematic review and meta-analysis shows that extended daily dialysis and continuous renal replacement therapy were associated with similar outcomes in the treatment of AKI in RCT data. The only evidence that EDD was associated with better mortality was from observational data which is potentially subject to bias.  

Leave a Comment! Posted in Clinical Nephrology, Hemodialysis
May 8, 2015

Long-term Effects of Frequent Nocturnal Hemodialysis on Mortality: The Frequent Hemodialysis Network (FHN) Nocturnal Trial

Rocco MV, Daugirdas JT, Greene T, Lockridge RS, Chan C, Pierratos A, Lindsay R, Larive B, Chertow GM, Beck GJ, Eggers PW, Kliger AS, FHN Trial Group.   Am J Kidney Dis.   2015 Apr 8;

This is a long-term follow-up of the FHN Nocturnal trials.  After a median follow-up of 3.7 years, the randomly assigned 87 patients to 1 year of 6 times a week nocturnal and 3 times per week hemodialysis were assessed.  In the nocturnal arm, there were 2 deaths during the 12-month trial period and an additional 12 deaths during the […]

Leave a Comment! Posted in Clinical Nephrology, Hemodialysis, Nocturnal Hemodialysis
May 8, 2015

Continuous Proton Pump Inhibitor Therapy and the Associated Risk of Recurrent Clostridium difficileInfection

McDonald EG, Milligan J, Frenette C, Lee TC.   JAMA Intern Med.   2015 May;175(5):784-91

This retrospective cohort study found that patients on proton pump inhibitors were at higher risk of C. difficile infections after adjustment for other independent risk factors for recurrence. This important study highlights the importance of medication review – which suggests consideration of discontinuation of PPIs at the time of CDI diagnosis. PMID:25730198

Leave a Comment! Posted in General Nephrology
May 8, 2015

β-Blocker Dialyzability and Mortality in Older Patients Receiving Hemodialysis

Weir MA, Dixon SN, Fleet JL, Roberts MA, Hackam DG, Oliver MJ, Suri RS, Quinn RR, Ozair S, Beyea MM, Kitchlu A, Garg AX.   J Am Soc Nephrol.   2015 Apr;26(4):987-96

This propensity-matched retrospective study showed that initiation of a high (atenolol, acebutolol, or metoprolol) versus low (bisoprolol or propranolol) -dialyzability β-blocker was associated with a higher risk of death in the following 180 days (relative risk, 1.4; 95% confidence interval, 1.1 to 1.8; P<0.01). This study does raise caution, but as the authors indicate, causality is […]

Leave a Comment! Posted in Chronic Kidney Disease, Clinical Nephrology, Hemodialysis
May 8, 2015

Bone histomorphometry before and after long-term treatment with cinacalcet in dialysis patients with secondary hyperparathyroidism

Behets GJ, Spasovski G, Sterling LR, Goodman WG, Spiegel DM, De Broe ME, D'Haese PC.   Kidney Int.   2015 Apr;87(4):846-56

This long-term follow-up study of dialysis patient treated with cinacalcet for 6-12 months showed improved PTH, biochemical markers as well as bone histology.  Of the 77 patients that underwent a second bone biopsy at 12 months, 20 had normal had a normal bone biopsy.  

Leave a Comment! Posted in Bone Mineral Metabolism, Chronic Kidney Disease, Clinical Nephrology
May 8, 2015

Molecular physiology of water balance

Knepper MA, Kwon TH, Nielsen S.   N Engl J Med.   2015 Apr 2;372(14):1349-58

This review describes the recent progress in understanding the roles of selected gene products in the regulation of water balance and their relevance in clinical practice.    

Leave a Comment! Posted in Clinical Nephrology, Fluid & Electrolytes, General Nephrology
May 8, 2015

IMAGES IN CLINICAL MEDICINE Lindsay’s Nails in Chronic Kidney Disease

Yang CS, Robinson-Bostom L.   N Engl J Med.   2015 Apr 30;372(18):1748

This image says it all.  An interesting nail bed finding in CKD.

Leave a Comment! Posted in Chronic Kidney Disease, Clinical Nephrology
March 18, 2015

Less-Tight versus Tight Control of Hypertension in Pregnancy

Magee LA, von Dadelszen P, Rey E, Ross S, Asztalos E, Murphy KE, Menzies J, Sanchez J, Singer J, Gafni A, Gruslin A, Helewa M, Hutton E, Lee SK, Lee T, Logan AG, Ganzevoort W, Welch R, Thornton JG, Moutquin JM.   N Engl J Med.   2015 Jan 29;372(5):407-17

This open, multicentre trial assigned women with nonproteinuric or gestatational hypertension to less tight control (target diastolic BP 100 mmHg) vs tight control (target diastolic BP 85 mmHg) with no difference observed in the primary outcome of pregnancy loss, high level neonatal care or overall maternal complications (secondary outcome).  However, the less tight control group […]

Leave a Comment! Posted in Clinical Nephrology, Clinical Trial Results, General Nephrology, Hypertension, Pregnancy and Hypertension/Renal Disease
March 18, 2015

Acid–Base Problems in Diabetic Ketoacidosis

Kamel KS, Halperin ML.   N Engl J Med.   2015 Feb 5;372(6):546-54

This review focuses on three issues facing clinicians who care for patients with diabetic ketoacidosis: (1) the plasma anion gap, (2) the administration of sodium bicarbonate and (3) the possible contribution of intracellular acidosis to the development of cerebral edema.

Leave a Comment! Posted in Clinical Nephrology, Fluid & Electrolytes, General Nephrology, Review
March 18, 2015

Trimethoprim-sulfamethoxazole and risk of sudden death among patients taking spironolactone

Antoniou T, Hollands S, Macdonald EM, Gomes T, Mamdani MM, Juurlink DN, Canadian Drug Safety and Effectiveness Research Network.   CMAJ.   2015 Mar 3;187(4):E138-43

Compared with amoxicillin, trimethoprim-sulfamethoxazole was associated with a  twofold increase of sudden death (adjusted OR 2.46, 95 % CI 1.55-3.90) as a consequence of hyperkalemia in this population-based study of patients over the age of 65 on spironolactone.

Leave a Comment! Posted in Clinical Nephrology, Fluid & Electrolytes, General Nephrology