November 16, 2014

Follow-up of Blood-Pressure Lowering and Glucose Control in Type 2 Diabetes

Zoungas S, Chalmers J, Neal B, Billot L, Li Q, Hirakawa Y, Arima H, Monaghan H, Joshi R, Colagiuri S, Cooper ME, Glasziou P, Grobbee D, Hamet P, Harrap S, Heller S, Lisheng L, Mancia G, Marre M, Matthews DR, Mogensen CE, Perkovic V, Poulter N, Rodgers A, Williams B, MacMahon S, Patel A, Woodward M, ADVANCE-ON Collaborative Group.   N Engl J Med.   2014 Oct 9;371(15):1392-406

In this 6-year follow-up study of patients enrolled in ADVANCE, there was no evidence that intensive glucose control during the trial led to long-term benefits with respect to mortality or macrovascular events. Though event rates were small, there was a reduction in end-stage renal disease in those patients in the intensive glucose arm, hazard ratio 0.54; […]

Leave a Comment! Posted in Chronic Kidney Disease, Diabetes
November 16, 2014

Rituximab versus azathioprine for maintenance in ANCA-associated vasculitis

Guillevin L, Pagnoux C, Karras A, Khouatra C, Aumaître O, Cohen P, Maurier F, Decaux O, Ninet J, Gobert P, Quémeneur T, Blanchard-Delaunay C, Godmer P, Puéchal X, Carron PL, Hatron PY, Limal N, Hamidou M, Ducret M, Daugas E, Papo T, Bonnotte B, Mahr A, Ravaud P, Mouthon L, French Vasculitis Study Group.   N Engl J Med.   2014 Nov 6;371(19):1771-80

In this RCT, patients with ANCA-associated vasculitis who achieved complete remission after a cyclophosphamide-glucocorticoid regimen were randomly assigned to receive intermittent rituximab (days 0 and 14 and at months 6, 12, and 18) or daily azathioprine until month 22.  Major relapse was less common in the rituximab arm than the azathioprine arm (5% vs 29%) […]

Leave a Comment! Posted in Vasculitis
November 16, 2014

Integration of Acid–Base and Electrolyte Disorders

Seifter JL.   N Engl J Med.   2014 Nov 6;371(19):1821-31

This review, appropriate for trainees and practicing physicians, provides an approach to the diagnosis of acid-base disorders.

Leave a Comment! Posted in Fluid & Electrolytes
November 16, 2014

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, the DONOR Network.   N Engl J Med.   2014 Nov 14;

This retrospective cohort study showed an increased risk of gestational hypertension or preeclampsia in women who have been living kidney donors, 11% in donors vs 5% in non-donors (OR 2.4; 95% CI, 1.2 to 5.0; P=0.01).

Leave a Comment! Posted in Pregnancy and Hypertension/Renal Disease, Renal Transplantation
November 16, 2014

Blood Pressure in Early Autosomal Dominant Polycystic Kidney Disease

In patients with early PKD, dual blockage of the RAS system provided no advantage over ACE inhibitor alone.  Patients targeted to the standard blood pressure target (120/70 to 130/80 mm Hg) vs a low blood-pressure target (95/60 to 110/75 mm Hg) had reduced annual % increase in total kidney volume (6.6% vs. 5.6%, P=0.006) and more reduction in […]

Leave a Comment! Posted in Chronic Kidney Disease, Polycystic Kidney Disease
November 16, 2014

Successful Delivery of RRT in Ebola Virus Disease

Connor MJ Jr, Kraft C, Mehta AK, Varkey JB, Lyon GM, Crozier I, Ströher U, Ribner BS, Franch HA.   J Am Soc Nephrol.   2014 Nov 14;

This timely article describes the protocol used at Emory University Hospital to provide dialysis in a patient with Ebola virus and proposes clinical practice guidelines for acute dialysis in this infection.

Leave a Comment! Posted in Acute Kidney Injury, Clinical Nephrology, Critical Care
November 16, 2014

Perioperative Aspirin and Clonidine and Risk of Acute Kidney Injury

Garg AX, Kurz A, Sessler DI, Cuerden M, Robinson A, Mrkobrada M, Parikh CR, Mizera R, Jones PM, Tiboni M, Font A, Cegarra V, Gomez MF, Meyhoff CS, VanHelder T, Chan MT, Torres D, Parlow J, Clanchet MD, Amir M, Bidgoli SJ, Pasin L, Martinsen K, Malaga G, Myles P, Acedillo R, Roshanov PS, Walsh M, Dresser G, Kumar P, Fleischmann E, Villar JC, Painter T, Biccard B, Bergese S, Srinathan S, Cata JP, Chan V, Mehra B, Wijeysundera DN, Leslie K, Forget P, Whitlock R, Yusuf S, Devereaux PJ, for the POISE-2 Investigators.   JAMA.   2014 Nov 15;

In this sub-study of the POISE-2 study, neither ASA or clonidine reduced the risk of acute kidney injury after non-cardiac surgery. Of note, aspirin increased the risk of major bleeding (which was associated with a greater risk of acute kidney injury).  As well, clonidine increased the risk of clinically important hypotension (which was associated with […]

Leave a Comment! Posted in Acute Kidney Injury
November 16, 2014

Association of Sickle Cell Trait With Chronic Kidney Disease and Albuminuria in African Americans

Naik RP, Derebail VK, Grams ME, Franceschini N, Auer PL, Peloso GM, Young BA, Lettre G, Peralta CA, Katz R, Hyacinth HI, Quarells RC, Grove ML, Bick AG, Fontanillas P, Rich SS, Smith JD, Boerwinkle E, Rosamond WD, Ito K, Lanzkron S, Coresh J, Correa A, Sarto GE, Key NS, Jacobs DR, Kathiresan S, Bibbins-Domingo K, Kshirsagar AV, Wilson JG, Reiner AP.   JAMA.   2014 Nov 13;

This observational study identified that among African Americans, sickle cell trait was associated with an increased risk of chronic kidney disease and albuminuria, compared with noncarriers.

Leave a Comment! Posted in Chronic Kidney Disease
April 19, 2014

A Controlled Trial of Renal Denervation for Resistant Hypertension

Bhatt DL, Kandzari DE, O'Neill WW, D'Agostino R, Flack JM, Katzen BT, Leon MB, Liu M, Mauri L, Negoita M, Cohen SA, Oparil S, Rocha-Singh K, Townsend RR, Bakris GL, SYMPLICITY HTN-3 Investigators.   N Engl J Med.   2014 Apr 10;370(15):1393-401

The SYMPLICITY HTN-3 trial did not show a significant reduction of systolic blood pressure in patients with resistant hypertension 6 months after renal-artery denervation as compared with a sham control.

1 Comment Posted in Clinical Trial Results, Hypertension
April 19, 2014

Non-selective β Blockers Increase Risk for Hepatorenal Syndrome and Death in Patients with Cirrhosis and Spontaneous Bacterial Peritonitis

Mandorfer M, Bota S, Schwabl P, Bucsics T, Pfisterer N, Kruzik M, Hagmann M, Blacky A, Ferlitsch A, Sieghart W, Trauner M, Peck-Radosavljevic M, Reiberger T.   Gastroenterology.   2014 Jun;146(7):1680-90.e1

This interesting study of non-selective beta blockers in patients with cirrhosis and spontaneous bacterial peritonitis shows that their use increases the risk of acute kidney injury and hepatorenal syndrome in this population. The authors advise against their use in these patients. Furthermore, they worsen hemodynamic instability as well as increase length of hospitalization.

Leave a Comment! Posted in Acute Kidney Injury
April 19, 2014

Hemodialysis: core curriculum 2014.

Golper TA, Fissell R, Fissell WH, Hartle PM, Sanders ML, Schulman G.   Am J Kidney Dis.   2014 Jan;63(1):153-63

Another topic nicely reviewed by the AJKD Core Curriculum.

Leave a Comment! Posted in AJKD Core Curriculum
April 19, 2014

Clinical practice guideline on diagnosis and treatment of hyponatremia

Spasovski G, Vanholder R, Allolio B, Annane D, Ball S, Bichet D, Decaux G, Fenske W, Hoorn EJ, Ichai C, Joannidis M, Soupart A, Zietse R, Haller M, van der Veer S, Van Biesen W, Nagler E, Hyponatraemia Guideline Development Group.   Nephrol Dial Transplant.   2014 Apr;29 Suppl 2:i1-i39

These multispecialty guidelines provide a very practical approach to management of this very common clinical disorder.

Leave a Comment! Posted in Clinical Practice Guidelines, Fluid & Electrolytes
April 19, 2014

Intensive Hemodialysis Associates with Improved Pregnancy Outcomes: A Canadian and United States Cohort Comparison

Hladunewich MA, Hou S, Odutayo A, Cornelis T, Pierratos A, Goldstein M, Tennankore K, Keunen J, Hui D, Chan CT.   J Am Soc Nephrol.   2014 May;25(5):1103-9

This elegant cohort comparison study shows that pregnant ESRD patients in Canada have better pregnancy-related outcomes (including higher live birth rate and mean gestational age) compared to their American counterparts due to more intensive hemodialysis.

Leave a Comment! Posted in Hemodialysis, Pregnancy and Hypertension/Renal Disease