Archive for April, 2011

April 24, 2011

Summary of Recommendations: Guidelines for the Prevention of Intravascular Catheter-related Infections

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Given the large number of central venous catheters placed by Nephrologists, this clinical practice guideline reviews preventative strategies to reduce infections.   Areas of focus include a) educating and training healthcare personnel who insert and maintain catheters; b) using maximal sterile barrier precautions during central venous catheter insertion; c) using a > 0.5% chlorhexidine skin preparation […]

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April 24, 2011

Olmesartan for the Delay or Prevention of Microalbuminuria in Type 2 Diabetes

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This large randomized multicentre trial showed delayed onset of microalbuminuria in Type 2 diabetics with normoalbuminuria that were treated with olmesartan 40 mg daily as compared to the placebo group, but a higher rate of fatal cardiovascular events in those with preexisting heart disease. Editorial http://www.nejm.org/doi/full/10.1056/NEJMe1014147 UKidney Discussion http://qx.md/y

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April 24, 2011

Clinical Practice Guidelines and Recommendations on Peritoneal Dialysis Adequacy 2011

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This set of guidelines, released by the Canadian Society of Nephrology (CSN), updates the last set of guidelines from 1999 and addresses key points in PD adequacy. Free full text access kindly provided by the Canadian Society of Nephrology Available for iPhone Available for iPad Available for Android

Comments Off on Clinical Practice Guidelines and Recommendations on Peritoneal Dialysis Adequacy 2011 Posted in Peritoneal Dialysis
April 24, 2011

A Predictive Model for Progression of Chronic Kidney Disease to Kidney Failure

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The Kidney Failure Risk Equation is described, which offers a robust prediction model to determine the probability of renal replacement therapy (dialysis or transplant) in patients with baseline GFR of 10-60 ml/min.  The results were first presented at the recent World Congress of Nephrology and a point of care calculator was simultaneously released as part […]

Comments Off on A Predictive Model for Progression of Chronic Kidney Disease to Kidney Failure Posted in Chronic Kidney Disease
April 24, 2011

Detection of Chronic Kidney Disease With Creatinine, Cystatin C, and Urine Albumin-to-Creatinine Ratio and Association With Progression to End-Stage Renal Disease and Mortality

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This large prospective cohort study looked at the predictive power of adding cystatin C to the combination of creatinine and urine ACR.  The study revealed  improved predictive accuracy for all-cause mortality and end-stage renal disease.

Comments Off on Detection of Chronic Kidney Disease With Creatinine, Cystatin C, and Urine Albumin-to-Creatinine Ratio and Association With Progression to End-Stage Renal Disease and Mortality Posted in Chronic Kidney Disease
April 24, 2011

Systematic Review: Blood Pressure Target in Chronic Kidney Disease and Proteinuria as an Effect Modifier

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In this systematic review of non-diabetics with chronic kidney disease, no overall advantage of a blood pressure target of less than 125/75 to 130/80 mm Hg was found compared to a target of <140/90 mm Hg. Lower-quality evidence suggests that a low target may be beneficial in subgroups with proteinuria greater than 300 to 1000 […]

Comments Off on Systematic Review: Blood Pressure Target in Chronic Kidney Disease and Proteinuria as an Effect Modifier Posted in Chronic Kidney Disease, Hypertension
April 24, 2011

Early Start of Hemodialysis May Be Harmful

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This US study was designed to ascertain whether early initiation of hemodialysis is associated with survival benefit or harm.  The results show that in 20-64 year-old patients with ESRD and hypertension alone as a comorbidity, early initiation of hemodialysis (≥15.0 mL/min/1.73 m2) had increased mortality ratio in the first year of dialysis.

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April 24, 2011

The safety of combining angiotensin-converting-enzyme inhibitors with angiotensin-receptor blockers in elderly patients: a population-based longitudinal analysis

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This population-based study using administrative data showed that 86% of patients on dual ACE inhibitor and angiotensin-II receptor blocker therapy did not have established indications, such as CHF or proteinuria.  Renal dysfunction and hyperkalemia was more common in the combination group, re-emphasizing what has already been shown in randomized controlled trials.

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April 24, 2011

Long-term Renal Outcomes of Patients With Type 1 Diabetes Mellitus and Microalbuminuria

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This study is a long-term follow-up of patients with microalbuminuria enrolled in the DCCT/EDIC trial.  After a median follow-up of 13 years, intensive glycemic control, lower blood pressure, and improved lipid profile were associated with improved clinical outcomes.

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April 24, 2011

Use of Aspirin Associates with Longer Primary Patency of Hemodialysis Grafts

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This study was designed to assess the contribution of ASA alone after the recently published trial that showed extended-release dipyridamole plus low-dose aspirin (ERDP/ASA) prolongs primary unassisted graft patency of newly created hemodialysis arteriovenous grafts.  The results show that aspirin use caused a trend toward longer primary patency, but was not associated with prolongation of […]

Comments Off on Use of Aspirin Associates with Longer Primary Patency of Hemodialysis Grafts Posted in Vascular Access
April 24, 2011

Randomized, Double-blind Study with Glycerol and Paraffin in Uremic Xerosis

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This small RCT addresses a practical problem seen in the dialysis units, management of uremic xerosis.  This trial found that using a twice daily emulsion combining glycerol and paraffin resulted in a treatment response in 73% vs 44% in placebo arm.  As well, significant improvements in pruritus and quality of life were noted in the […]

Comments Off on Randomized, Double-blind Study with Glycerol and Paraffin in Uremic Xerosis Posted in Chronic Kidney Disease, Hemodialysis, Peritoneal Dialysis
April 24, 2011

Update in Nephrology: Evidence Published in 2010

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This article takes a similar approach to Nephrology Now, attempting to provide a summary of last year’s landmark articles in the field of Nephrology.

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April 24, 2011

Everolimus-based, calcineurin-inhibitor-free regimen in recipients of de-novo kidney transplants: an open-label, randomised, controlled trial

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Everolimus is an mTOR inhibitor and does not cause the nephrotoxicity seen with cyclosporine or tacrolimus. Use of mTOR inhibitors as initial immunosuppression at the time of transplant is associated with a higher risk of acute rejection. In this RCT, patients 4.5 months post-transplant were randomized to continue cyclosporine or switch to everolimus. At 12 […]

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