July 20, 2010

Clinical Practice Guidelines For Peritoneal Access

Figueiredo A, Goh BL, Jenkins S, Johnson DW, Mactier R, Ramalakshmi S, Shrestha B, Struijk D, Wilkie M.   Perit Dial Int.   2010 Jul;30(4):424-9

This clinical practice guideline provides recommendations for best practice in creating peritoneal access.

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Leave a Comment! Posted in Clinical Practice Guidelines, Peritoneal Dialysis
July 20, 2010

Daily oral sodium bicarbonate preserves glomerular filtration rate by slowing its decline in early hypertensive nephropathy

Mahajan A, Simoni J, Sheather SJ, Broglio KR, Rajab MH, Wesson DE.   Kidney Int.   2010 Aug;78(3):303-9

It has previously been demonstrated that oral sodium bicarbonate slows GFR decline in patients with low GFR.  This 5-year RCT evaluated whether daily oral sodium bicarbonate slowed GFR decline in patients with hypertensive nephropathy with reduced but relatively preserved eGFR (mean 75 ml/min). The rate of eGFR decline was slower and eGFR was higher in [...]

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Leave a Comment! Posted in Chronic Kidney Disease
July 20, 2010

High-dose renal replacement therapy for acute kidney injury: Systematic review and meta-analysis.

Van Wert R, Friedrich JO, Scales DC, Wald R, Adhikari NK, University of Toronto Acute Kidney Injury Research Group.   Crit Care Med.   2010 May;38(5):1360-9

This meta-analysis examining high-dose renal replacement therapy in acute kidney injury did not show any improvement in patient survival or recovery of renal function.

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1 Comment Posted in Critical Care, Hemodialysis
July 20, 2010

Trimethoprim-Sulfamethoxazole-Induced Hyperkalemia in Patients Receiving Inhibitors of the Renin-Angiotensin System: A Population-Based Study

Antoniou T, Gomes T, Juurlink DN, Loutfy MR, Glazier RH, Mamdani MM.   Arch Intern Med.   2010 Jun 28;170(12):1045-9

This case control study suggests that older patients taking ACEIs or ARBs have a major increase in the risk of hyperkalemia-associated hospitalization when using trimethoprim-sulfamethoxazole.

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1 Comment Posted in Chronic Kidney Disease, Fluid & Electrolytes, RAS Blockade
July 20, 2010

Switch to a Sirolimus-Based Immunosuppression in Long-Term Renal Transplant Recipients: Reduced Rate of (Pre-)Malignancies and Nonmelanoma Skin Cancer in a Prospective, Randomized, Assessor-Blinded, Controlled Clinical Trial

Salgo R, Gossmann J, Schöfer H, Kachel HG, Kuck J, Geiger H, Kaufmann R, Scheuermann EH.   Am J Transplant.   2010 Jun;10(6):1385-93

Early studies showed fewer new skin-cancers in patients randomized to sirolimus at the time of transplant. In this single-center trial, patients with a previous non-melanoma skin cancer were randomized to sirolimus or to continue on their current immunosuppression. There was fewer new skin cancers or premalignant lesions in the sirolimus group. This is a small [...]

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Leave a Comment! Posted in Renal Transplantation
July 20, 2010

Everolimus Plus Reduced-Exposure CsA versus Mycophenolic Acid Plus Standard-Exposure CsA in Renal-Transplant Recipients

Tedesco Silva H Jr, Cibrik D, Johnston T, Lackova E, Mange K, Panis C, Walker R, Wang Z, Zibari G, Kim YS.   Am J Transplant.   2010 Jun;10(6):1401-13

Everolimus is an mTOR inhibitor, in the same family as sirolimus. Previous studies combining mTOR inhibitors with usual dosing of calcineurin inhibitors showed worse renal function and graft survival, despite  equal efficacy in preventing acute rejection as a calcineurin inhibitor/mycophenolic acid combination. In this RCT, everolimus at two different target levels was combined with low-dose [...]

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Leave a Comment! Posted in Renal Transplantation
July 20, 2010

Kidney and Recipient Weight Incompatibility Reduces Long-Term Graft Survival

Giral M, Foucher Y, Karam G, Labrune Y, Kessler M, de Ligny BH, Büchler M, Bayle F, Meyer C, Trehet N, Daguin P, Renaudin K, Moreau A, Soulillou JP.   J Am Soc Nephrol.   2010 Jun;21(6):1022-9

Nephron mass plays an important role in providing adequate renal function, with loss of nephron mass a risk factor for later deterioration of renal function. In this study, a low ratio of the weight of the donor kidney before implantation to recipient weight was associated with worse long-term renal function and outcomes.

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Leave a Comment! Posted in Renal Transplantation
July 20, 2010

Kidneys from Donors after Cardiac Death Provide Survival Benefit

Snoeijs MG, Schaubel DE, Hené R, Hoitsma AJ, Idu MM, Ijzermans JN, Ploeg RJ, Ringers J, Christiaans MH, Buurman WA, van Heurn LW.   J Am Soc Nephrol.   2010 Jun;21(6):1015-21

Kidneys obtained from donors after cardiac death (DCD) have been increasing over the last several years. DCD kidneys have a higher risk for delayed graft function compared to kidneys obtained from standard kidneys from brain-dead donors (DBD). In this analysis of transplantation in the Netherlands, patients receiving a DCD kidney had improved survival compared to [...]

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Leave a Comment! Posted in Renal Transplantation
July 20, 2010

Cholesterol Lowering, Cardiovascular Diseases, and the Rosuvastatin – JUPITER Controversy A Critical Reappraisal

de Lorgeril M, Salen P, Abramson J, Dodin S, Hamazaki T, Kostucki W, Okuyama H, Pavy B, Rabaeus M.   Arch Intern Med.   2010 Jun 28;170(12):1032-6

This article critically reviews the trial JUPITER which reported a substantial decrease in the risk of cardiovascular diseases among patients without coronary heart disease and with normal or low cholesterol levels. Concern was expressed that the trial was flawed as it was discontinued (according to prespecified rules) after fewer than 2 years of follow-up, with [...]

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Leave a Comment! Posted in Internal Medicine for Nephrologists
July 20, 2010

Update in Nephrology

Muirhead N.   Ann Intern Med.   2010 Jun 1;152(11):721-5

This article highlights the findings of several key trials that were published in the field of chronic kidney disease in 2009.

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Leave a Comment! Posted in General Nephrology, Review
June 27, 2010

A Randomized, Controlled Trial of Early versus Late Initiation of Dialysis

This landmark clinical trial randomized CKD patients to a strategy of early (GFR 10-14 ml/min) vs late (GFR 5-7 ml/min) initiation of dialysis.   After a median follow-up of 3.6 years, no difference was seen in mortality, cardiovascular events, infections, or complications of dialysis.  Careful note should be made that the majority of patient randomized to late [...]

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4 Comments Posted in Hemodialysis, Peritoneal Dialysis
June 27, 2010

The Initiation of Renal-Replacement Therapy — Just-in-Time Delivery

This editorial provides insight into the interpretation of the article ‘A Randomized, Controlled Trial of Early versus Late Initiation of Dialysis‘.

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Leave a Comment! Posted in Editorial, Hemodialysis, Peritoneal Dialysis
June 6, 2010

Nutritional Considerations in Kidney Disease: Core Curriculum 2010

Bailey JL, Franch HA.   Am J Kidney Dis.   2010 Jun;55(6):1146-61

This addition to the AJKD Core Curriculum series reviews nutritional considerations in the management of kidney disease.

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Leave a Comment! Posted in AJKD Core Curriculum, Chronic Kidney Disease
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