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.

Leave a 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
April 19, 2014

Haemodialysis in patients treated with oral anticoagulant: should we heparinize?

Krummel T, Scheidt E, Borni-Duval C, Bazin D, Lefebvre F, Nguyen P, Hannedouche T.   Nephrol Dial Transplant.   2014 Apr;29(4):906-13

This study shows that it is possible to dialyze anticoagulated patients without using heparin in the hemodialysis circuit. The data in the small study show no decrease in dialysis session length or increase circuit clotting scores. Furthermore, there was no benefit to a specialized grafted heparin membrane (HeprAN) as compared to the usual polysulphone variety.

Leave a Comment! Posted in Clinical Trial Results, Hemodialysis
April 19, 2014

Risk of End-Stage Renal Disease Following Live Kidney Donation

Muzaale AD, Massie AB, Wang MC, Montgomery RA, McBride MA, Wainright JL, Segev DL.   JAMA.   2014 Feb 12;311(6):579-86

This study compare the risk of developing ESRD in kidney donors to that of similarly screened healthy nondonors (a cohort of NHANES III participants). The results show estimated lifetime risk of ESRD was 90 per 10 000 donors, 326 per 10 000 unscreened nondonors (general population), and 14 per 10 000 healthy nondonors.

Leave a Comment! Posted in Chronic Kidney Disease, Clinical Trial Results, Renal Transplantation
April 19, 2014

2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8)

James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, Smith SC Jr, Svetkey LP, Taler SJ, Townsend RR, Wright JT Jr, Narva AS, Ortiz E.   JAMA.   2014 Feb 5;311(5):507-20

2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8)

Leave a Comment! Posted in Clinical Practice Guidelines, Hypertension
April 19, 2014

Canadian Society of Nephrology 2014 clinical practice guideline for timing the initiation of chronic dialysis

Nesrallah GE, Mustafa RA, Clark WF, Bass A, Barnieh L, Hemmelgarn BR, Klarenbach S, Quinn RR, Hiremath S, Ravani P, Sood MM, Moist LM, Canadian Society of Nephrology.   CMAJ.   2014 Feb 4;186(2):112-7

The CSN 2014 clinical practice guideline for timing the initiation of chronic dialysis makes the following main points. Early initiation of dialysis does not improve survival, quality of life or hospital admission rates compared with late or deferred initiation of dialysis.  As a result, they  recommend an “intent-to-defer” strategy, whereby patients with an eGFR < 15 mL/ min per 1.73 […]

Leave a Comment! Posted in Chronic Kidney Disease, Clinical Practice Guidelines, Hemodialysis
April 19, 2014

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 paper summarizes 8 key recommendations in the area of lipid management based on Kidney Disease: Improving Global Outcomes (KDIGO) 2013 Clinical Practice Guideline.

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

Cardiovascular protection by β-blockade in hypertensive haemodialysis patients: the Hypertension in Haemodialysis Patients Treated With Atenolol or Lisinopril (HDPAL) trial.

Zoccali C, Mallamaci F.   Nephrol Dial Transplant.   2014 Mar;29(3):483-5

This was an open-label trial of atenolol vs lisinopril administered three times per week post-dialysis in patient with hypertension and left ventricular hypertrophy. The atenolol treated group had lower cardiovascular morbidity and all-cause hospitalizations.

Leave a Comment! Posted in Clinical Trial Results, Hemodialysis, Hypertension
April 19, 2014

High versus Low Blood-Pressure Target in Patients with Septic Shock

Asfar P, Meziani F, Hamel JF, Grelon F, Megarbane B, Anguel N, Mira JP, Dequin PF, Gergaud S, Weiss N, Legay F, Le Tulzo Y, Conrad M, Robert R, Gonzalez F, Guitton C, Tamion F, Tonnelier JM, Guezennec P, Van Der Linden T, Vieillard-Baron A, Mariotte E, Pradel G, Lesieur O, Ricard JD, Hervé F, du Cheyron D, Guerin C, Mercat A, Teboul JL, Radermacher P, SEPSISPAM Investigators.   N Engl J Med.   2014 Apr 24;370(17):1583-93

This multicentre, open label trial randomized over 700 patients with septic shock to undergo resuscitation to MAP target of 80-85 mmHg or 65-70 mmHg. The primary outcome of mortality was no different in either group at 28 or 90 days. However, the higher target group required less renal replacement therapy.

Leave a Comment! Posted in Acute Kidney Injury, Clinical Nephrology, Clinical Trial Results, General Nephrology
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