Archive for the ‘Chronic Kidney Disease’ Category

June 16, 2011

The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial

Baigent C, Landray MJ, Reith C, Emberson J, Wheeler DC, Tomson C, Wanner C, Krane V, Cass A, Craig J, Neal B, Jiang L, Hooi LS, Levin A, Agodoa L, Gaziano M, Kasiske B, Walker R, Massy ZA, Feldt-Rasmussen B, Krairittichai U, Ophascharoensuk V, Fellström B, Holdaas H, Tesar V, Wiecek A, Grobbee D, de Zeeuw D, Grönhagen-Riska C, Dasgupta T, Lewis D, Herrington W, Mafham M, Majoni W, Wallendszus K, Grimm R, Pedersen T, Tobert J, Armitage J, Baxter A, Bray C, Chen Y, Chen Z, Hill M, Knott C, Parish S, Simpson D, Sleight P, Young A, Collins R, SHARP Investigators.   Lancet.   2011 Jun 25;377(9784):2181-92

The SHARP study was a large randomized controlled trial which assessed the efficacy and safety of the combination of simvastatin plus ezetimibe in patient with moderate-to-severe kidney disease. Consistent with Nephrology Now’s report on the trial results as presented at the 2010 ASN meeting, the intervention arm had a 17% relative risk reduction in major [...]

6 Comments Posted in Chronic Kidney Disease, Internal Medicine for Nephrologists, Vascular Disease/Calcification
June 15, 2011

A Nurse-coordinated Model of Care versus Usual Care for Stage 3/4 Chronic Kidney Disease in the Community: A Randomized Controlled Trial

Barrett BJ, Garg AX, Goeree R, Levin A, Molzahn A, Rigatto C, Singer J, Soltys G, Soroka S, Ayers D, Parfrey PS.   Clin J Am Soc Nephrol.   2011 Jun;6(6):1241-7

The CanPREVENT study was an unblinded randomized clinical trial that provided either usual care or nurse-coordinated and nephrologist-supported care for patient identified with CKD stages 3 and 4. While the clinical endpoints were no different between groups, the economic analysis published in the same issue of CJASN suggests the program was cost effective with better [...]

4 Comments Posted in Chronic Kidney Disease
April 24, 2011

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

Tangri N, Stevens LA, Griffith J, Tighiouart H, Djurdjev O, Naimark D, Levin A, Levey AS.   JAMA.   2011 Apr 20;305(15):1553-9

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 [...]

No Comments 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

Peralta CA, Shlipak MG, Judd S, Cushman M, McClellan W, Zakai NA, Safford MM, Zhang X, Muntner P, Warnock D.   JAMA.   2011 Apr 20;305(15):1545-52

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.

No Comments Posted in Chronic Kidney Disease
April 24, 2011

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

Upadhyay A, Earley A, Haynes SM, Uhlig K.   Ann Intern Med.   2011 Apr 19;154(8):541-8

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 [...]

No Comments Posted in Chronic Kidney Disease, Hypertension
April 24, 2011

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

Balaskas E, Szepietowski JC, Bessis D, Ioannides D, Ponticelli C, Ghienne C, Taberly A, Dupuy P.   Clin J Am Soc Nephrol.   2011 Apr;6(4):748-52

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 [...]

No Comments Posted in Chronic Kidney Disease, Hemodialysis, Peritoneal Dialysis
March 15, 2011

Cardiovascular and Renal Outcomes With Telmisartan, Ramipril, or Both in People at High Renal Risk: Results From the ONTARGET and TRANSCEND Studies.

Tobe SW, Clase CM, Gao P, McQueen M, Grosshennig A, Wang X, Teo KK, Yusuf S, Mann JF, ONTARGET and TRANSCEND Investigators.   Circulation.   2011 Mar 15;123(10):1098-107

This post hoc analysis examines the renal subgroups in the studies ONTARGET and TRANSCEND. The results do not support dual therapy over monotherapy in high-vascular risk patients with low glomerular filtration rate or albuminuria.

No Comments Posted in Chronic Kidney Disease, RAS Blockade
February 8, 2011

Raloxifene, a selective estrogen receptor modulator, is renoprotective: a post-hoc analysis

Melamed ML, Blackwell T, Neugarten J, Arnsten JH, Ensrud KE, Ishani A, Cummings SR, Silbiger SR.   Kidney Int.   2011 Jan;79(2):241-9

This study is a post-hoc analysis of the Multiple Outcomes of Raloxifene Evaluation Trial, a double-masked, placebo-controlled randomized clinical trial of post-menopausal women with osteoporosis who were randomized to raloxifene or placebo. Compared with those in the placebo group, participants on raloxifene had a significantly slower yearly rate of decrease in eGFR.

No Comments Posted in Bone Mineral Metabolism, Chronic Kidney Disease
November 1, 2010

Erythropoietic Response and Outcomes in Kidney Disease and Type 2 Diabetes

Solomon SD, Uno H, Lewis EF, Eckardt KU, Lin J, Burdmann EA, de Zeeuw D, Ivanovich P, Levey AS, Parfrey P, Remuzzi G, Singh AK, Toto R, Huang F, Rossert J, McMurray JJ, Pfeffer MA, Trial to Reduce Cardiovascular Events with Aranesp Therapy (TREAT) Investigators.   N Engl J Med.   2010 Sep 16;363(12):1146-55

This study assessed the relationship between initial responsiveness to darbepoetin alfa and outcomes in patients with chronic kidney disease and type 2 diabetes mellitus. A poor initial hematopoietic response was associated with an increased risk of death or cardiovascular events.

1 Comment Posted in Anemia, Chronic Kidney Disease
September 27, 2010

Intensive Blood-Pressure Control in Hypertensive Chronic Kidney Disease

Appel LJ, Wright JT Jr, Greene T, Agodoa LY, Astor BC, Bakris GL, Cleveland WH, Charleston J, Contreras G, Faulkner ML, Gabbai FB, Gassman JJ, Hebert LA, Jamerson KA, Kopple JD, Kusek JW, Lash JP, Lea JP, Lewis JB, Lipkowitz MS, Massry SG, Miller ER, Norris K, Phillips RA, Pogue VA, Randall OS, Rostand SG, Smogorzewski MJ, Toto RD, Wang X, AASK Collaborative Research Group.   N Engl J Med.   2010 Sep 2;363(10):918-29

This follow-up to the AASK study followed a large patient cohort after the completion of the randomized controlled trial.  The original AASK randomized controlled trial examined anti-hypertensive choice and blood pressure control intensity in African-Americans with hypertensive renal disease.   The cohort study targeted a blood pressure of <130/80. While the study failed to show that [...]

No Comments Posted in Chronic Kidney Disease, Hypertension
August 20, 2010

Guidelines for the prevention and management of Mycobacterium tuberculosis infection and disease in adult patients with chronic kidney disease.

British Thoracic Society Standards of Care Committee and Joint Tuberculosis Committee, Milburn H, Ashman N, Davies P, Doffman S, Drobniewski F, Khoo S, Ormerod P, Ostermann M, Snelson C.   Thorax.   2010 Jun;65(6):557-70

Theses guidelines have been prepared by British Thoracic Society Standards of Care Committee and Joint Tuberculosis Committee. Free full text kindly provided through the British Thoracic Society website.

No Comments Posted in Chronic Kidney Disease, Internal Medicine for Nephrologists
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 [...]

No Comments Posted in Chronic Kidney Disease
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.

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