December 21, 2013

KDIGO 2013 Clinical Practice Guideline for Lipid Management in Chronic Kidney Disease

The full KDIGO lipid guidelines are available here.

Leave a Comment! Posted in Chronic Kidney Disease, Clinical Practice Guidelines, Internal Medicine for Nephrologists, Vascular Disease/Calcification
December 21, 2013

Lipid Management in Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2013 Clinical Practice Guideline

Tonelli M, Wanner C, Kidney Disease: Improving Global Outcomes Lipid Guideline Development Work Group Members.   Ann Intern Med.   2014 Feb 4;160(3):182

This synopsis of the recently published KDIGO guidelines focuses on 8 recommendations related to assessment of lipid status and treatment with a statin-based regimen in adults.

Leave a Comment! Posted in Chronic Kidney Disease, Internal Medicine for Nephrologists, Vascular Disease/Calcification
December 21, 2013

Stenting and Medical Therapy for Atherosclerotic Renal-Artery Stenosis

Cooper CJ, Murphy TP, Cutlip DE, Jamerson K, Henrich W, Reid DM, Cohen DJ, Matsumoto AH, Steffes M, Jaff MR, Prince MR, Lewis EF, Tuttle KR, Shapiro JI, Rundback JH, Massaro JM, D'Agostino RB Sr, Dworkin LD, CORAL Investigators.   N Engl J Med.   2014 Jan 2;370(1):13-22

The CORAL trial failed to show any benefit of renal-artery stenting when added on to medical therapy in patients with atherosclerotic renal-artery stenosis.

Leave a Comment! Posted in Renal Artery Stenosis
December 21, 2013

Treatment of severe alcoholic hepatitis with corticosteroids and pentoxifylline.

Halegoua-De Marzio DL, Fenkel JM.   JAMA.   2013 Sep 11;310(10):1029-30

This RCT in alcoholic hepatitis showed a trend to a reduction in hepatorenal syndrome in patients treated with pentoxifylline-prednisolone compared to placebo-prednisolone group (8.4% vs 15.3%, P = .07).

Leave a Comment! Posted in Acute Kidney Injury
December 21, 2013

Kidney Disease in the Setting of Liver Failure: Core Curriculum 2013

Gonwa TA, Wadei HM.   Am J Kidney Dis.   2013 Dec;62(6):1198-212

This review from the AJKD Core Curriculum goes over kidney disease in the setting of liver failure.

Leave a Comment! Posted in AJKD Core Curriculum, General Nephrology, Review
December 21, 2013

Evidence-Based Cardiology in Hemodialysis Patients.

Allon M.   J Am Soc Nephrol.   2013 Dec;24(12):1934-43

This paper reviews RCTs to evaluate management of cardiovascular disease in hemodialysis patients.

Leave a Comment! Posted in Hemodialysis, Review, Vascular Disease/Calcification
December 21, 2013

Screening, Monitoring, and Treatment of Stage 1 to 3 Chronic Kidney Disease: A Clinical Practice Guideline From the Clinical Guidelines Committee of the American College of Physicians.

Qaseem A, Hopkins RH Jr, Sweet DE, Starkey M, Shekelle P, Clinical Guidelines Committee of the American College of Physicians.   Ann Intern Med.   2013 Dec 17;159(12):835-47

This ACP guideline recommends a) against screening for chronic kidney disease in asymptomatic adults without risk factors for CKD, b) against testing for proteinuria in adults currently taking an ACEi or ARB, c) using an ACEi or ARB in patients with hypertension and CKD, and d) using a statin to manage elevated LDL in patients […]

1 Comment Posted in Chronic Kidney Disease, Hypertension, RAS Blockade
December 21, 2013

Diet and Kidney Disease in High-Risk Individuals With Type 2 Diabetes Mellitus

Dunkler D, Dehghan M, Teo KK, Heinze G, Gao P, Kohl M, Clase CM, Mann JF, Yusuf S, Oberbauer R, ONTARGET Investigators.   JAMA Intern Med.   2013 Oct 14;173(18):1682-92

This observational study of the ONTARGET type 2 diabetic patient population showed that a healthy diet (consisting of more than 3 servings of fruit per week) and a moderate intake of alcohol may decrease the incidence or progression of CKD in this population. Interestingly, sodium and normal protein intake were not associated with CKD.

Leave a Comment! Posted in Chronic Kidney Disease, Clinical Nephrology, Diabetes
December 21, 2013

Citrate Versus Heparin Lock for Hemodialysis Catheters: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Zhao Y, Li Z, Zhang L, Yang J, Yang Y, Tang Y, Fu P.   Am J Kidney Dis.   2014 Mar;63(3):479-90

This meta-analysis suggests that an antimicrobial-containing citrate lock is better than heparin lock for prevention of catheter-related infection, while citrate alone fails to show a similar advantage. As compared to heparin, citrate locking showed a reduction in bleeding episodes.

Leave a Comment! Posted in Hemodialysis, Vascular Access
December 21, 2013

Use of phosphate-binding agents is associated with a lower risk of mortality

Cannata-Andía JB, Fernández-Martín JL, Locatelli F, London G, Gorriz JL, Floege J, Ketteler M, Ferreira A, Covic A, Rutkowski B, Memmos D, Bos WJ, Teplan V, Nagy J, Tielemans C, Verbeelen D, Goldsmith D, Kramar R, Martin PY, Wüthrich RP, Pavlovic D, Benedik M, Sánchez JE, Martínez-Camblor P, Naves-Díaz M, Carrero JJ, Zoccali C.   Kidney Int.   2013 Nov;84(5):998-1008

In this mulitcenter, observational, prospective study of stage 5 CKD patients on dialysis, the use of phosphate-binding agents was shown to lower all-cause and cardiovascular mortality by 29% and 22% respectively. All agents proved to be beneficial except aluminum salts. There interesting findings need to be confirmed in randomized clinical trials.

Leave a Comment! Posted in Bone Mineral Metabolism, Chronic Kidney Disease, Clinical Nephrology, Hemodialysis
December 21, 2013

No independent association of serum phosphorus with risk for death or progression to end-stage renal disease in a large screen for chronic kidney disease

Mehrotra R, Peralta CA, Chen SC, Li S, Sachs M, Shah A, Norris K, Saab G, Whaley-Connell A, Kestenbaum B, McCullough PA, Kidney Early Evaluation Program (KEEP) Investigators.   Kidney Int.   2013 Nov;84(5):989-97

Contrary to the generally held belief, this study showed that when adjusted for potential confounders, serum phosphorus was not independently found to be associated with a risk of death or progression to ESRD in the group of over 10 000 patients with eGFRs < 60 ml/min.

Leave a Comment! Posted in Bone Mineral Metabolism, Chronic Kidney Disease, Clinical Nephrology, General Nephrology
December 21, 2013

Efficacy of Remission-Induction Regimens for ANCA-Associated Vasculitis

Specks U, Merkel PA, Seo P, Spiera R, Langford CA, Hoffman GS, Kallenberg CG, St Clair EW, Fessler BJ, Ding L, Viviano L, Tchao NK, Phippard DJ, Asare AL, Lim N, Ikle D, Jepson B, Brunetta P, Allen NB, Fervenza FC, Geetha D, Keogh K, Kissin EY, Monach PA, Peikert T, Stegeman C, Ytterberg SR, Mueller M, Sejismundo LP, Mieras K, Stone JH, RAVE-ITN Research Group.   N Engl J Med.   2013 Aug 1;369(5):417-27

This randomized trial compared rituximab with cyclophosphamide followed by azathioprine in severe ANCA-associated vasculitis. This noninferiority trial showed that there was no difference at 18 months for the induction and maintenance of remissions between groups.

Leave a Comment! Posted in Clinical Nephrology, Clinical Trial Results, Glomerulonephritis, Vasculitis
September 8, 2013

A single-blind randomized controlled trial to evaluate the effect of 6 months of progressive aerobic exercise training in patients with uraemic restless legs syndrome

Giannaki CD, Hadjigeorgiou GM, Karatzaferi C, Maridaki MD, Koutedakis Y, Founta P, Tsianas N, Stefanidis I, Sakkas GK.   Nephrol Dial Transplant.   2013 Nov;28(11):2834-40

This small single-center study showed that a 6-month intradialytic progressive exercise training program reduces severity of restless leg syndrome in HD patients.

Leave a Comment! Posted in Hemodialysis