Archive for the ‘Clinical Nephrology’ Category

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

Hospitalization Rates for Patients on Assisted Peritoneal Dialysis Compared with In-Center Hemodialysis

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This multicenter, retrospective cohort study by linked a quality assurance dataset to administrative health data in Ontario, Canada. The study included 872 patients in the in-center hemodialysis group and 203 patients in the assisted peritoneal dialysis group. Using an intention to treat approach, patients on assisted peritoneal dialysis had a similar hospitalization rate of 11.1 d/yr (95% confidence interval, 9.4 to 13.0) compared with 12.9 d/yr (95% confidence interval, 10.3 to 16.1) in the hemodialysis group (P=0.19). […]

No Comments Posted in Clinical Nephrology, Hemodialysis, Peritoneal Dialysis
November 11, 2016

Pathophysiology of Renal Tubular Acidosis: Core Curriculum 2016

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This core curriculum is a valuable resource in deconstructing the pathophysiology of renal tubular acidosis.        

No Comments Posted in AJKD Core Curriculum, Clinical Nephrology
November 11, 2016

The relatively poor correlation between random and 24-hour urine protein excretion in patients with biopsy-proven glomerular diseases

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This study measured the urine protein and creatinine centrally in random and 24-hour urine collections at biopsy and longitudinally every 6 months in individuals participating in the Nephrotic Syndrome Study Network (NEPTUNE) cohort with glomerular disease. The results show that in patients with glomerular disease and proteinuria, the urine protein creatinine ratio correlates only moderately with 24-hour urine protein excretion. The results were used to develop estimating equation to derive 24-hour urine protein excretion from random urine protein creatinine ratio values with improved precision. […]

No Comments Posted in Clinical Nephrology, General Nephrology, Glomerulonephritis
November 11, 2016

A new model to predict acute kidney injury requiring renal replacement therapy after cardiac surgery

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The authors of this study developed and validated a risk prediction model for acute kidney injury requiring renal replacement therapy within 14 days after cardiac surgery.  They identified 8 independent predictors of acute kidney injury requiring renal replacement therapy in the derivation model(adjusted odds ratio, 95% confidence interval [CI]): congestive heart failure (3.03, 2.00-4.58), Canadian Cardiovascular Society angina class III or higher (1.66, […]

No Comments Posted in Acute Kidney Injury, Clinical Nephrology, Hemodialysis
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

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

Renal Complications of Hematopoietic-Cell Transplantation

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This is a nice review of the topic.

No Comments Posted in Clinical Nephrology, Review
August 14, 2016

Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit

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   This multicenter randomized trial assigned 620 ICU patients with severe stages 1-3 AKI with either an early dialysis start (at randomization) or late dialysis start (a classic indication to initiate).  The primary outcome was survival at day 60.  There was no survival difference between the groups at day 60; 150 deaths occurred among 311 […]

No Comments Posted in Acute Kidney Injury, 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
August 14, 2016

Lupus nephritis management guidelines compared

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This review summarizes the 6 difference guidelines for treatment lupus nephritis – the commonalities, differences as well as highlights the recent literature.    

No Comments Posted in Clinical Nephrology, Clinical Practice Guidelines, Glomerulonephritis, Lupus
May 29, 2016

Pregnancy across the spectrum of chronic kidney disease

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  This paper highlights some of the available data as well as management strategies for nephrologists managing pregnant patients with chronic kidney disease.    

No Comments Posted in Clinical Nephrology, Pregnancy and Hypertension/Renal Disease