Archive for the ‘Chronic Kidney Disease’ Category

February 9, 2017

The Effect of Predialysis Fistula Attempt on Risk of All-Cause and Access-Related Death

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This is a retrospective cohort study of 2300 patients aged ≥18 years who initiated hemodialysis between 2004 and 2012 at five Canadian dialysis programs. The authors observed significantly lower mortality in individuals who underwent a predialysis fistula attempt than in those without a predialysis fistula attempt in patients aged <65 years and in the first […]

No Comments Posted in Chronic Kidney Disease, Clinical Nephrology, Clinical Trial Results, Hemodialysis, Vascular Access
November 11, 2016

The Risk of Major Hemorrhage with CKD

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This retrospective cohort study (2002-2010)  grouped 516,197 adults ≥40 years old by eGFR (≥90, 60 to <90, 45 to <60, 30 to <45, 15 to <30, or <15 ml/min per 1.73 m(2)) and urine albumin-to-creatinine ratio (ACR; >300, 30-300, or <30 mg/g) to examine incidence of hemorrhage. The 3-year cumulative incidence of hemorrhage increased 20-fold across declining eGFR […]

No Comments Posted in Chronic Kidney Disease, Clinical Nephrology, General Nephrology
November 11, 2016

Proton Pump Inhibitors and Risk of Incident CKD & Progression to ESRD

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The Department of Veterans Affairs national databases were used in this study to build a primary cohort of new users of PPI (n=173,321) and new users of histamine H2-receptor antagonists (H2blockers; n=20,270.  These patients were followed for over 5 years to ascertain renal outcomes. In adjusted Cox survival models, the PPI group, compared with the […]

No Comments Posted in Chronic Kidney Disease, Clinical Nephrology, General Nephrology
November 11, 2016

Efficacy of Folic Acid Therapy on the Progression of Chronic Kidney Disease The Renal Substudy of the China Stroke Primary Prevention Trial

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In this substudy of eligible China Stroke Primary Prevention Trial (CSPPT), 15 104 participants with an estimated glomerular filtration rate (eGFR) 30 mL/min/1.73 m2 or greater, were randomized to receive a single tablet daily containing 10 mg enalapril and 0.8 mg folic acid (n = 7545) or 10 mg enalapril alone (n = 7559). Overall, 15 104 Chinese adults with a mean (range) age of 60 (45-75) years were recruited; median follow-up […]

No Comments Posted in Chronic Kidney Disease, Clinical Nephrology
August 14, 2016

Bariatric surgery is associated with improvement in kidney outcomes

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In this matched cohort study, 985 patients who underwent bariatric surgery were compared 985 patients that did not.  The mean 1-year weight loss was 40.4 kg in the surgery group compared with 1.4 kg in the matched cohort. In adjusted analyses, bariatric surgery patients had a 58% lower risk for an eGFR decline of ≥30% (hazard ratio 0.42, 95% confidence interval 0.32-0.55) […]

No Comments Posted in Chronic Kidney Disease, General Nephrology
August 14, 2016

Past Decline Versus Current eGFR and Subsequent ESRD Risk

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This CKD Prognosis Consortium study examined 22 cohorts to determine the association of past slopes and current eGFR level with subsequent ESRD.  5163 ESRD events were recorded in the 1,080,223 participants during a mean follow-up of 2.0 years. The results showed that current eGFR [30 versus 50 ml/min per 1.73 m(2) (a difference of 20 ml/min per 1.73 m(2)) associated with an adjusted hazard ratio […]

No Comments Posted in Chronic Kidney Disease, Clinical Nephrology, General Nephrology
August 14, 2016

Past Decline Versus Current eGFR and Subsequent Mortality Risk

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This is an individual-level meta-analysis of the risk of mortality associated with antecedent eGFR slope among 1.2 million subjects within the CKD Prognosis Consortium. Over a 3-year antecedent period, compared with a slope of 0 ml/min per 1.73 m(2) per year, a slope of -6 ml/min per 1.73 m(2) per year was associated with adjusted hazard ratios for all-cause mortality of […]

No Comments Posted in Chronic Kidney Disease, Clinical Nephrology, Clinical Trial Results
August 14, 2016

Empagliflozin and Progression of Kidney Disease in Type 2 Diabetes

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  This randomized control trial of over 4000 high risk patients with Type 2 diabetes and eGFR > 30 ml/min, empagliflozin (a sodium-glucose cotransporter 2 inhibitor) when compared with placebo was associated with slower progression of kidney disease (12.7% vs 18.8% for worsening nephropathy and 1.5% vs 2.6% for doubling of serum creatinine) when added to the standard of care.  […]

No Comments Posted in Chronic Kidney Disease, Clinical Nephrology, Clinical Trial Results, Diabetes, General Nephrology
May 29, 2016

Controversies Regarding Lipid Management and Statin Use for Cardiovascular Risk Reduction in Patients With CKD

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It is known that patients with chronic kidney disease are at increased risk of death from cardiovascular disease. This review nicely addresses the identification and management of lipid levels in patients with CKD and discusses the controversies regarding testing and treatment of lipid levels in this population.

No Comments Posted in Chronic Kidney Disease, Clinical Nephrology
March 23, 2016

Multinational Assessment of Accuracy of Equations for Predicting Risk of Kidney Failure: A Meta-analysis.

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Thirty-one cohorts participating in the CKD Prognosis Consortium, including 721,357 participants with CKD stages 3 to 5 in more than 30 countries spanning 4 continents, were studied to evaluate the accuracy of the kidney failure risk equations.  During a median follow-up of 4 years of 721,357 participants with CKD, 23,829 cases kidney failure were observed. The original risk equations achieved excellent discrimination across all […]

No Comments Posted in Chronic Kidney Disease, Clinical Nephrology, General Nephrology
March 23, 2016

Vascular Access Type and Patient and Technique Survival in Home Hemodialysis Patients: The Canadian Organ Replacement Register.

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This registry-based retrospective observational cohort study assessed 1217 incident HHD patients in The Canadian Organ Replacement Register who had information for vascular access type (CVC vs AV access) within the first year of HHD therapy initiation.  The results showed that AV access use (n=694) was associated with lower risk for the composite event of death and technique failure (490 events; adjusted HR, 0.78; 95% CI, 0.64-0.94) and lower adjusted all-cause […]

No Comments Posted in Chronic Kidney Disease, Clinical Trial Results, Vascular Access
November 30, 2015

Serum Uric Acid and Risk of CKD in Type 2 Diabetes.

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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 […]

No Comments Posted in Chronic Kidney Disease, Clinical Nephrology, Clinical Trial Results, Diabetes
November 30, 2015

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

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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 […]

No Comments Posted in Chronic Kidney Disease, Clinical Trial Results, General Nephrology