July 20, 2010

Rituximab versus Cyclophosphamide in ANCA-Associated Renal Vasculitis

This RCT did not find that a rituximab-based regimen was superior to standard intravenous cyclophosphamide for severe ANCA-associated vasculitis.

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Leave a Comment! Posted in Acute Renal Failure, Vasculitis
July 20, 2010

Rituximab versus Cyclophosphamide for ANCA-Associated Vasculitis

This non-inferiority trial finds that rituximab therapy was not inferior to daily cyclophosphamide treatment for induction of remission in severe ANCA-associated vasculitis and may be superior in relapsing disease.
See the associated editorial.

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Leave a Comment! Posted in Acute Renal Failure, Vasculitis
July 20, 2010

Peritoneal Dialysis-Related Infections Recommendations: 2010 Update.

Li PK, Szeto CC, Piraino B, Bernardini J, Figueiredo AE, Gupta A, Johnson DW, Kuijper EJ, Lye WC, Salzer W, Schaefer F, Struijk DG.   Perit Dial Int.   2010 Jul;30(4):393-423

This update from the ISPD focuses on the treatment of exit-site & tunnel infections as well as peritonitis.  Guidelines regarding prevention of PD-related infections will be covered in a separate ISPD position statement.

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Leave a Comment! Posted in Clinical Practice Guidelines, Peritoneal Dialysis
July 20, 2010

Clinical Practice Guidelines For Peritoneal Access

Figueiredo A, Goh BL, Jenkins S, Johnson DW, Mactier R, Ramalakshmi S, Shrestha B, Struijk D, Wilkie M.   Perit Dial Int.   2010 Jul;30(4):424-9

This clinical practice guideline provides recommendations for best practice in creating peritoneal access.

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Leave a Comment! Posted in Clinical Practice Guidelines, Peritoneal Dialysis
July 20, 2010

Daily oral sodium bicarbonate preserves glomerular filtration rate by slowing its decline in early hypertensive nephropathy

Mahajan A, Simoni J, Sheather SJ, Broglio KR, Rajab MH, Wesson DE.   Kidney Int.   2010 Aug;78(3):303-9

It has previously been demonstrated that oral sodium bicarbonate slows GFR decline in patients with low GFR.  This 5-year RCT evaluated whether daily oral sodium bicarbonate slowed GFR decline in patients with hypertensive nephropathy with reduced but relatively preserved eGFR (mean 75 ml/min). The rate of eGFR decline was slower and eGFR was higher in [...]

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Leave a Comment! Posted in Chronic Kidney Disease
July 20, 2010

High-dose renal replacement therapy for acute kidney injury: Systematic review and meta-analysis.

Van Wert R, Friedrich JO, Scales DC, Wald R, Adhikari NK, University of Toronto Acute Kidney Injury Research Group.   Crit Care Med.   2010 May;38(5):1360-9

This meta-analysis examining high-dose renal replacement therapy in acute kidney injury did not show any improvement in patient survival or recovery of renal function.

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Leave a Comment! Posted in Critical Care, Hemodialysis
July 20, 2010

Trimethoprim-Sulfamethoxazole-Induced Hyperkalemia in Patients Receiving Inhibitors of the Renin-Angiotensin System: A Population-Based Study

Antoniou T, Gomes T, Juurlink DN, Loutfy MR, Glazier RH, Mamdani MM.   Arch Intern Med.   2010 Jun 28;170(12):1045-9

This case control study suggests that older patients taking ACEIs or ARBs have a major increase in the risk of hyperkalemia-associated hospitalization when using trimethoprim-sulfamethoxazole.

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1 Comment Posted in Chronic Kidney Disease, Fluid & Electrolytes, RAS Blockade
July 20, 2010

Switch to a Sirolimus-Based Immunosuppression in Long-Term Renal Transplant Recipients: Reduced Rate of (Pre-)Malignancies and Nonmelanoma Skin Cancer in a Prospective, Randomized, Assessor-Blinded, Controlled Clinical Trial

Salgo R, Gossmann J, Schöfer H, Kachel HG, Kuck J, Geiger H, Kaufmann R, Scheuermann EH.   Am J Transplant.   2010 Jun;10(6):1385-93

Early studies showed fewer new skin-cancers in patients randomized to sirolimus at the time of transplant. In this single-center trial, patients with a previous non-melanoma skin cancer were randomized to sirolimus or to continue on their current immunosuppression. There was fewer new skin cancers or premalignant lesions in the sirolimus group. This is a small [...]

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Leave a Comment! Posted in Renal Transplantation
July 20, 2010

Everolimus Plus Reduced-Exposure CsA versus Mycophenolic Acid Plus Standard-Exposure CsA in Renal-Transplant Recipients

Tedesco Silva H Jr, Cibrik D, Johnston T, Lackova E, Mange K, Panis C, Walker R, Wang Z, Zibari G, Kim YS.   Am J Transplant.   2010 Jun;10(6):1401-13

Everolimus is an mTOR inhibitor, in the same family as sirolimus. Previous studies combining mTOR inhibitors with usual dosing of calcineurin inhibitors showed worse renal function and graft survival, despite  equal efficacy in preventing acute rejection as a calcineurin inhibitor/mycophenolic acid combination. In this RCT, everolimus at two different target levels was combined with low-dose [...]

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Leave a Comment! Posted in Renal Transplantation
July 20, 2010

Kidney and Recipient Weight Incompatibility Reduces Long-Term Graft Survival

Giral M, Foucher Y, Karam G, Labrune Y, Kessler M, de Ligny BH, Büchler M, Bayle F, Meyer C, Trehet N, Daguin P, Renaudin K, Moreau A, Soulillou JP.   J Am Soc Nephrol.   2010 Jun;21(6):1022-9

Nephron mass plays an important role in providing adequate renal function, with loss of nephron mass a risk factor for later deterioration of renal function. In this study, a low ratio of the weight of the donor kidney before implantation to recipient weight was associated with worse long-term renal function and outcomes.

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Leave a Comment! Posted in Renal Transplantation
July 20, 2010

Kidneys from Donors after Cardiac Death Provide Survival Benefit

Snoeijs MG, Schaubel DE, Hené R, Hoitsma AJ, Idu MM, Ijzermans JN, Ploeg RJ, Ringers J, Christiaans MH, Buurman WA, van Heurn LW.   J Am Soc Nephrol.   2010 Jun;21(6):1015-21

Kidneys obtained from donors after cardiac death (DCD) have been increasing over the last several years. DCD kidneys have a higher risk for delayed graft function compared to kidneys obtained from standard kidneys from brain-dead donors (DBD). In this analysis of transplantation in the Netherlands, patients receiving a DCD kidney had improved survival compared to [...]

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Leave a Comment! Posted in Renal Transplantation
July 20, 2010

Cholesterol Lowering, Cardiovascular Diseases, and the Rosuvastatin – JUPITER Controversy A Critical Reappraisal

de Lorgeril M, Salen P, Abramson J, Dodin S, Hamazaki T, Kostucki W, Okuyama H, Pavy B, Rabaeus M.   Arch Intern Med.   2010 Jun 28;170(12):1032-6

This article critically reviews the trial JUPITER which reported a substantial decrease in the risk of cardiovascular diseases among patients without coronary heart disease and with normal or low cholesterol levels. Concern was expressed that the trial was flawed as it was discontinued (according to prespecified rules) after fewer than 2 years of follow-up, with [...]

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Leave a Comment! Posted in Internal Medicine for Nephrologists
July 20, 2010

Update in Nephrology

Muirhead N.   Ann Intern Med.   2010 Jun 1;152(11):721-5

This article highlights the findings of several key trials that were published in the field of chronic kidney disease in 2009.

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Leave a Comment! Posted in General Nephrology, Review
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