June 10, 2009

Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials.

Antithrombotic Trialists' (ATT) Collaboration, Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, Peto R, Buring J, Hennekens C, Kearney P, Meade T, Patrono C, Roncaglioni MC, Zanchetti A.   Lancet.   2009 May 30;373(9678):1849-60

Nephrologists often see patients at elevated vascular risk and may consider using aspirin for primary or secondary prophylaxis. This meta-analysis confirms the known benefit of aspirin for secondary prophylaxis, but raises some questions as to the balance of risks and benefits for primary prophylaxis in the general population.

1 Comment Posted in General Internal Medicine
June 10, 2009

Effect of dipyridamole plus aspirin on hemodialysis graft patency

Dixon BS, Beck GJ, Vazquez MA, Greenberg A, Delmez JA, Allon M, Dember LM, Himmelfarb J, Gassman JJ, Greene T, Radeva MK, Davidson IJ, Ikizler TA, Braden GL, Fenves AZ, Kaufman JS, Cotton JR Jr, Martin KJ, McNeil JW, Rahman A, Lawson JH, Whiting JF, Hu B, Meyers CM, Kusek JW, Feldman HI, DAC Study Group.   N Engl J Med.   2009 May 21;360(21):2191-201

This randomized controlled trial provides evidence that treatment with dipyridamole plus aspirin had a modest effect in reducing the risk of stenosis and improving the duration of primary unassisted patency of newly created grafts.

View the Accompanying editorial by C Lok
Antiplatelet therapy and vascular-access patency.
N Engl J Med. 2009 May 21;360(21):2240-2.

No Comments Posted in Hemodialysis, Vascular Access
June 10, 2009

Effect of Telmisartan on Renal Outcomes: A Randomized Trial.

Mann JF, Schmieder RE, Dyal L, McQueen MJ, Schumacher H, Pogue J, Wang X, Probstfield JL, Avezum A, Cardona-Munoz E, Dagenais GR, Diaz R, Fodor G, Maillon JM, Rydén L, Yu CM, Teo KK, Yusuf S, for the TRANSCEND (Telmisartan Randomised Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease) Investigators.   Ann Intern Med.   2009 May 18;

This pre-specified subgroup analysis of the TRANSCEND study failed to show any significant benefit on renal outcomes between the intervention arm (using telmisartan) and placebo arm. This was not a study of chronic kidney disease patients, but rather examined patients with cardiovascular disease or diabetes, but without macroalbuminuria or heart failure.

No Comments Posted in Chronic Kidney Disease, Hypertension, RAS Blockade
June 10, 2009

Benefits and harms of erythropoiesis-stimulating agents for anemia related to cancer: a meta-analysis.

Tonelli M, Hemmelgarn B, Reiman T, Manns B, Reaume MN, Lloyd A, Wiebe N, Klarenbach S.   CMAJ.   2009 May 26;180(11):E62-71

This systematic review of 52 RCTs looked at the clinical efficacy and harms related to erythropoeisis-stimulating agents in the treatment of anemia related to cancer or chemotherapy (not renal failure). The study shows that ESAs improve quality of life and decrease blood transfusions, but with increased the risk of death and serious adverse events. The [...]

No Comments Posted in General Internal Medicine
June 10, 2009

Achieving Chronic Kidney Disease Treatment Targets in Renal Transplant Recipients: Results From a Cross-Sectional Study in Spain.

Marcén R, del Castillo D, Capdevila L, Fernandez-Fresnedo G, Rodrigo E, Cantarell C, Fernández-Rodriguez A, López-Oliva MO, Camps J, Aljama P, Ortuño J, Arias M.   Transplantation.   2009 May 15;87(9):1340-6

This cross-sectional study shows the prevalence of CKD in a large cohort of patients. Complications of CKD, including anemia, hyperparathyroidism, and hyperlipidemia are common in transplant patients, and may increase with worsening renal function.

No Comments Posted in Renal Transplantation
June 10, 2009

Liver-kidney transplantation to cure atypical hemolytic uremic syndrome.

Saland JM, Ruggenenti P, Remuzzi G, Consensus Study Group.   J Am Soc Nephrol.   2009 May;20(5):940-9

Some cases of hemolytic uremic syndrome are due to genetic mutations rather than E.Coli O157:H7 infection, and are associated with a high risk of recurrence post-kidney transplant. This article summarizes the results of a consensus conference on treatment of these patients, including the use of a combined liver/kidney transplantation in the setting of ESRD to [...]

No Comments Posted in Renal Transplantation, Uncategorized
June 10, 2009

Daclizumab versus antithymocyte globulin in high-immunological-risk renal transplant recipients.

Noël C, Abramowicz D, Durand D, Mourad G, Lang P, Kessler M, Charpentier B, Touchard G, Berthoux F, Merville P, Ouali N, Squifflet JP, Bayle F, Wissing KM, Hazzan M.   J Am Soc Nephrol.   2009 Jun;20(6):1385-92

Previous comparisons of IL-2 receptor antibodies and thymoglobulin compared either low-risk patients, or patients at high risk due to long cold ischemia times. This trial enrolled patients at high immunologic risk (mean peak PRA around 70%). Thymoglobulin reduced the risk of biopsy-proven acute rejection, but this trial was not powered to look at differences in [...]

No Comments Posted in Renal Transplantation
June 10, 2009

Anti-Human Leukocyte Antigen and Donor-Specific Antibodies Detected by Luminex Posttransplant Serve as Biomarkers for Chronic Rejection of Renal Allografts

Lachmann N, Terasaki PI, Budde K, Liefeldt L, Kahl A, Reinke P, Pratschke J, Rudolph B, Schmidt D, Salama A, Schönemann C.   Transplantation.   2009 May 27;87(10):1505-13

The presence of donor-specific antibodies is associated with an increased risk of graft loss. In this paper, the development of non-donor specific antibodies was also associated with worse graft outcomes, although not as bad as patients with donor-specific antibody. Whether treatment to reduce the production of antibody once it is established would improve graft outcomes [...]

No Comments Posted in Renal Transplantation
June 9, 2009

The importance of residual kidney function for patients on dialysis: a critical review.

Perl J, Bargman JM.   Am J Kidney Dis.   2009 Jun;53(6):1068-81

This review highlights the evidence to support maintaining residual renal function and its impact on survival and quality of life of dialysis patients.

No Comments Posted in Hemodialysis, Peritoneal Dialysis, Residual Renal Function
June 9, 2009

Fomepizole for ethylene glycol and methanol poisoning.

Brent J.   N Engl J Med.   2009 May 21;360(21):2216-23

This clinical vignette reviews the indications of fomepizole in toxic ingestions from medical toxicology perspective.

No Comments Posted in Poisonings, Review