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 […]

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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 […]

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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
November 30, 2015

A randomized trial of intravenous and oral iron in chronic kidney disease.

Agarwal R, Kusek JW, Pappas MK.   Kidney Int.   2015 Oct;88(4):905-14

This trial randomly assigned patients with stage 3 and 4 CKD and IDA to either open-label oral ferrous sulfate (69 patients to 325 mg three times daily for 8 weeks) or intravenous iron sucrose (67 patients to 200 mg every 2 weeks, total 1 g). The trial was terminated early on the recommendation of an independent data and safety due to higher risk of serious […]

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

Comparison of standard and accelerated initiation of renal replacement therapy in acute kidney injury

Wald R, Adhikari NK, Smith OM, Weir MA, Pope K, Cohen A, Thorpe K, McIntyre L, Lamontagne F, Soth M, Herridge M, Lapinsky S, Clark E, Garg AX, Hiremath S, Klein D, Mazer CD, Richardson RM, Wilcox ME, Friedrich JO, Burns KE, Bagshaw SM, Canadian Critical Care Trials Group.   Kidney Int.   2015 Oct;88(4):897-904

This 12-center open-label pilot trial of critically ill adults with volume replete severe AKI randomized atients were randomized to accelerated (12 h or less from eligibility) or standard RRT initiation. The enrollment median serum creatinine was 268 micromoles/l and urine output was 356 ml per 24 h. Clinical outcomes at 90 days included mortality which was 38% in the accelerated and 37% in the standard arm. The feasibility […]

Leave a Comment! Posted in Acute Kidney Injury, Clinical Nephrology, Clinical Trial Results
November 30, 2015

Case Records of the Massachusetts General Hospital. Case 35-2015: A 72-Year-Old Woman with Proteinuria and a Kidney Mass.

Hazar DB, Eneanya ND, Kilcoyne A, Rosales IA.   N Engl J Med.   2015 Nov 12;373(20):1958-67

An interesting case of a 72 year old woman who presents with a flank pain, proteinuria and a new kidney mass.

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November 30, 2015

Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial

Williams B, MacDonald TM, Morant S, Webb DJ, Sever P, McInnes G, Ford I, Cruickshank JK, Caulfield MJ, Salsbury J, Mackenzie I, Padmanabhan S, Brown MJ, British Hypertension Society's PATHWAY Studies Group.   Lancet.   2015 Nov 21;386(10008):2059-68

This is a double-blind, placebo-controlled, crossover trial in patients with resistant hypertension that were taking maximally tolerated doses of 3 or more drugs. The authors found that the average reduction in home systolic blood pressure by spironolactone was superior to placebo (-8•70 mm Hg [95% CI -9•72 to -7•69]; p<0•0001), superior to the mean of […]

Leave a Comment! Posted in Clinical Nephrology, Clinical Trial Results, Hypertension
November 10, 2015

Randomized Trial on Efficacy of Mycophenolate Mofeti versus Tacrolimus in Maintaining Remission in Children with Steroid Resistant Nephrotic Syndrome

These are results as presented at the 2015 American Society of Nephrology Kidney Week. In children with steroid resistant nephrotic syndrome who were successfully put into remission, maintenance therapy with MMF 750-1000 mg/m2was compared to tacrolimus 0.1-0.15 mg/kg/day. The primary endpoint of preserved complete or partial remission was achieved in 90.3% of the tacrolimus arm […]

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November 10, 2015

Empagliflozin and Clinical Outcomes in Patients with Type 2 Diabetes and Chronic Kidney Disease

These are results as presented at the 2015 American Society of Nephrology Kidney Week. The effect of empagliflozin vs placebo on cardiovascular events and death was recently reported in the NEJM in Sep 2015, and shown to significantly reduce both the composite cardiovascular primary endpoint and death. During Kidney Week, the renal outcome of new […]

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November 10, 2015

A Randomized Trial of Intensive versus Standard Blood-Pressure Control

In this RCT, a intensive BP target of less than 120 mm Hg was compared to a standard target of less than 140 mm Hg. The primary outcome (a composite of myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes) was reduced (1.65% per year vs. 2.19% per year; HR […]

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September 21, 2015

Corticosteroids in IgA Nephropathy: A Retrospective Analysis from the VALIGA Study

Tesar V, Troyanov S, Bellur S, Verhave JC, Cook HT, Feehally J, Roberts IS, Cattran D, Coppo R, VALIGA study of the ERA-EDTA Immunonephrology Working Group.   J Am Soc Nephrol.   2015 Sep;26(9):2248-58

This retrospective study assessed 1147 patients with IgA nephropathy from the European Validation Study of the Oxford Classification of IgAN (VALIGA) cohort.  From this group as well a propensity matched cohort, the authors concluded that corticosteroids reduced proteinuria and the rate of renal function decline and increased renal survival even in patients with an eGFR < 50 […]

Leave a Comment! Posted in Chronic Kidney Disease, Glomerulonephritis