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
March 23, 2016

Modality of RRT and Recovery of Kidney Function after AKI in Patients Surviving to Hospital Discharge.

Liang KV, Sileanu FE, Clermont G, Murugan R, Pike F, Palevsky PM, Kellum JA.   Clin J Am Soc Nephrol.   2016 Jan 7;11(1):30-8

This retrospective cohort study examined 4738 patients with KDIGO stage 3 AKI admitted to intensive care units from 2000 to 2008 who received RRT for AKI and survived to hospital discharge or 90 days.   There was no significant difference in hazards for nonrecovery or reasons for nonrecovery (mortality or ESRD) with intermittent hemodialysis versus continuous RRT.  

Leave a Comment! Posted in Acute Kidney Injury, Clinical Nephrology, Clinical Trial Results
March 23, 2016

The Native Kidney Biopsy: Update and Evidence for Best Practice.

Hogan JJ, Mocanu M, Berns JS.   Clin J Am Soc Nephrol.   2016 Feb 5;11(2):354-62

This review nicely summarizes kidney biopsy indications, techniques and complications.  

Leave a Comment! Posted in Clinical Nephrology, Educational Resource
March 23, 2016

Sevelamer Versus Calcium-Based Binders for Treatment of Hyperphosphatemia in CKD: A Meta-Analysis of Randomized Controlled Trials

Patel L, Bernard LM, Elder GJ.   Clin J Am Soc Nephrol.   2016 Feb 5;11(2):232-44

This meta-analysis included 25 studies with a total of 4770 participants, of which 88% were on hemodialysis.  The results show that for patients with CKD stages 3-5 using sevelamer have lower all-cause mortality compared with those using calcium based binders. However, due to the lack of placebo-controlled studies, the benefit of phosphate binders for patients with CKD stages 3-5 and not on […]

Leave a Comment! Posted in Bone Mineral Metabolism, Clinical Trial Results, Vascular Disease/Calcification
March 23, 2016

Comparison of low-dose intravenous cyclophosphamide with oral mycophenolate mofetil in the treatment of lupus nephritis

Rathi M, Goyal A, Jaryal A, Sharma A, Gupta PK, Ramachandran R, Kumar V, Kohli HS, Sakhuja V, Jha V, Gupta KL.   Kidney Int.   2016 Jan;89(1):235-42

This study randomized patients with LN (class III, IV, or V) to receive induction with low-dose CYC or oral MMF with the exclusion of patients with crescentic LN, a serum creatinine over 265 μmol/l, and neurological or pulmonary lupus were excluded. Maintenance therapy with azathioprine and low-dose corticosteroid was started at end of induction therapy. The complete remission rate was 50% in CYC and […]

Leave a Comment! Posted in Acute Kidney Injury, General Nephrology, Glomerulonephritis
November 30, 2015

Serum Uric Acid and Risk of CKD in Type 2 Diabetes.

De Cosmo S, Viazzi F, Pacilli A, Giorda C, Ceriello A, Gentile S, Russo G, Rossi MC, Nicolucci A, Guida P, Feig D, Johnson RJ, Pontremoli R, AMD-Annals Study Group.   Clin J Am Soc Nephrol.   2015 Nov 6;10(11):1921-9

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 […]

Leave a Comment! Posted in Chronic Kidney Disease, Clinical Nephrology, Clinical Trial Results, Diabetes
November 30, 2015

Peritoneal Equilibration Test and Patient Outcomes.

Mehrotra R, Ravel V, Streja E, Kuttykrishnan S, Adams SV, Katz R, Molnar MZ, Kalantar-Zadeh K.   Clin J Am Soc Nephrol.   2015 Nov 6;10(11):1990-2001

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 […]

Leave a Comment! Posted in Clinical Trial Results, Peritoneal Dialysis
November 30, 2015

Onco-Nephrology: Core Curriculum 2015.

Cohen EP, Krzesinski JM, Launay-Vacher V, Sprangers B.   Am J Kidney Dis.   2015 Nov;66(5):869-83

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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November 30, 2015

Performance of Temporary Hemodialysis Catheter Insertion by Nephrology Fellows and Attending Nephrologists

McQuillan RF, Clark E, Zahirieh A, Cohen ER, Paparello JJ, Wayne DB, Barsuk JH.   Clin J Am Soc Nephrol.   2015 Oct 7;10(10):1767-72

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 […]

Leave a Comment! Posted in Clinical Nephrology, Clinical Trial Results, Hemodialysis
November 30, 2015

The mortality and hospitalization rates associated with the long interdialytic gap in thrice-weekly hemodialysis patients.

Fotheringham J, Fogarty DG, El Nahas M, Campbell MJ, Farrington K.   Kidney Int.   2015 Sep;88(3):569-75

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 […]

Leave a Comment! Posted in Clinical Nephrology, Clinical Trial Results, Hemodialysis