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
March 18, 2015

Peritoneal dialysis catheter implantation by nephrologists is associated with higher rates of peritoneal dialysis utilization: a population-based study

Perl J, Pierratos A, Kandasamy G, McCormick BB, Quinn RR, Jain AK, Huang A, Paterson JM, Oliver MJ.   Nephrol Dial Transplant.   2015 Feb;30(2):301-9

This population-based retrospective cohort study using administrative data looked at 3886 PD catheter insertions between 2002-2010.  The findings suggest that insertions by nephrologists resulted in lower overall PD nonuse rates.  The authors suggest that this greater use may be related to timing/technique of insertion or the greater desire on the part of a nephrologist for […]

Leave a Comment! Posted in Clinical Nephrology, Peritoneal Dialysis
March 18, 2015

Warfarin use, mortality, bleeding and stroke in haemodialysis patients with atrial fibrillation

Genovesi S, Rossi E, Gallieni M, Stella A, Badiali F, Conte F, Pasquali S, Bertoli S, Ondei P, Bonforte G, Pozzi C, Rebora P, Valsecchi MG, Santoro A.   Nephrol Dial Transplant.   2015 Mar;30(3):491-8

This interesting study of hemodialysis patients on oral anticoagulation for atrial fibrillation showed that although their overall mortality was high – it was not associated with warfarin.  In fact, warfarin was associated with better survival and antiplatelet agents increased overall mortality. .

Leave a Comment! Posted in Clinical Nephrology, Hemodialysis
March 18, 2015

Emerging treatments for amyloidosis

Sayed RH, Hawkins PN, Lachmann HJ.   Kidney Int.   2015 Mar;87(3):516-526

This review briefs us on the novel approaches for the treatment of amyloidosis.  These targeted therapies may be better options for a disease that frequently has a very poor prognosis.

Leave a Comment! Posted in Acute Kidney Injury, Clinical Nephrology, General Nephrology, Review
March 18, 2015

Renal dysfunction in cirrhosis is not just a vasomotor nephropathy

Adebayo D, Morabito V, Davenport A, Jalan R.   Kidney Int.   2015 Mar;87(3):509-15

This mini-review discusses the factors implicated in the development of hepatorenal syndrome in patients with progressive cirrhosis.

Leave a Comment! Posted in Acute Kidney Injury, Clinical Nephrology, Review
March 18, 2015

ESRD and Death after Heart Failure in CKD

Sud M, Tangri N, Pintilie M, Levey AS, Naimark DM.   J Am Soc Nephrol.   2015 Mar;26(3):715-22

This retrospective study of a Toronto CKD population showed that heart failure hospitalizations were associated with a stepwise increase in the risk of ESRD and death before ESRD (adjusted hazard ratio of ESRD from 4.89 to 10.27 to 14.16 and the adjusted hazard ratio death before ESRD from 3.30 to 4.20 to 6.87 for one […]

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

CKD in Elderly Patients Managed without Dialysis: Survival, Symptoms, and Quality of Life

Brown MA, Collett GK, Josland EA, Foote C, Li Q, Brennan FP.   Clin J Am Soc Nephrol.   2015 Feb 6;10(2):260-8

This is a very important prospective observational study looking at conservative management in a predialysis population managed without dialysis.  The elderly population that chose not to initiate dialysis survived a median of 16 months in part due to palliative care that provided “reasonable” symptom management and quality of life.

Leave a Comment! Posted in General Nephrology
March 18, 2015

Statin Therapy and Risk of Fracture: Results From the JUPITER Randomized Clinical Trial

Peña JM, Aspberg S, MacFadyen J, Glynn RJ, Solomon DH, Ridker PM.   JAMA Intern Med.   2015 Feb;175(2):171-7

This analysis of the JUPITER trialled showed that rosuvastatin did not reduce fracture risk in the enrolled patients with elevated hs-CRP levels.  Furthermore, higher baseline hs-CRP levels were nor associated with an increased risk of fractures in both groups.

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

1 Comment Posted in Chronic Kidney Disease, Clinical Nephrology, Clinical Trial Results, General Nephrology