Archive for the ‘Clinical Trial Results’ Category

May 29, 2016

Effect of Early vs Delayed Initiation of Renal Replacement Therapy on Mortality in Critically Ill Patients With Acute Kidney Injury The ELAIN Randomized Clinical Trial

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This single-center randomized clinical trial of 231 critically ill patients with AKI KDIGO stage 2 looked at early (within 8 hours of diagnosis of KDIGO stage 2; n = 112) or delayed (within 12 hours of stage 3 AKI or no initiation; n = 119) initiation of RRT.  The results show that early initiation of RRT significantly reduced 90-day mortality (39.3% vs 54.7%).  More patients in the early group recovered renal function by day 90 (53.6% vs 38.7%) in the delayed group.  Furthermore, duration of […]

No Comments Posted in Acute Kidney Injury, Clinical Trial Results, Hemodialysis
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
March 23, 2016

Modality of RRT and Recovery of Kidney Function after AKI in Patients Surviving to Hospital Discharge.

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This retrospective cohort study examined 4738 patients with KDIGO stage 3 AKI admitted to intensive care units from 2000 to 2008 who received RRT for AKI and survived to hospital discharge or 90 days.   There was no significant difference in hazards for nonrecovery or reasons for nonrecovery (mortality or ESRD) with intermittent hemodialysis versus continuous RRT.  

No Comments Posted in Acute Kidney Injury, Clinical Nephrology, Clinical Trial Results
March 23, 2016

Sevelamer Versus Calcium-Based Binders for Treatment of Hyperphosphatemia in CKD: A Meta-Analysis of Randomized Controlled Trials

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This meta-analysis included 25 studies with a total of 4770 participants, of which 88% were on hemodialysis.  The results show that for patients with CKD stages 3-5 using sevelamer have lower all-cause mortality compared with those using calcium based binders. However, due to the lack of placebo-controlled studies, the benefit of phosphate binders for patients with CKD stages 3-5 and not on […]

No Comments Posted in Bone Mineral Metabolism, Clinical Trial Results, Vascular Disease/Calcification
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

Peritoneal Equilibration Test and Patient Outcomes.

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This US study of over 10 000 peritoneal dialysis patients looked at the association of peritoneal equilibration test parameters with all-cause mortality, technique failure and hospitalization rate. The median follow-up period was 15.8 months and 87% with on CCPD.  The results show a linear association between dialysate/plasma creatinine and mortality (adjusted hazards ratio per 0.1 […]

No Comments Posted in Clinical Trial Results, Peritoneal Dialysis
November 30, 2015

Performance of Temporary Hemodialysis Catheter Insertion by Nephrology Fellows and Attending Nephrologists

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This pre- post-intervention study with a pretest-only comparison group was conducted at the University of Toronto in September of 2014. Participants were nephrology fellows and attending nephrologists from three university-affiliated academic hospitals who underwent baseline assessment of internal jugular temporary hemodialysis catheter insertion skills using a central venous catheter simulator. A total of 19 attending nephrologists and 20 nephrology fellows participated in the study. Mean attending nephrologist checklist scores (46.1%; SD=29.5%) were similar to baseline scores […]

No Comments Posted in Clinical Nephrology, Clinical Trial Results, Hemodialysis
November 30, 2015

The mortality and hospitalization rates associated with the long interdialytic gap in thrice-weekly hemodialysis patients.

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This article aimed to identify factors associated with mortality and hospitalization events in England from 2002-2006 comparing the 2 day vs 3 day intradialytic gap. Higher admission rates were seen after the 2-day gap irrespective of whether thrice-weekly dialysis sequence commenced on a Monday or Tuesday (2.4 per year after the 2-day gap vs. 1.4 […]

No Comments Posted in Clinical Nephrology, Clinical Trial Results, Hemodialysis
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
November 30, 2015

Comparison of standard and accelerated initiation of renal replacement therapy in acute kidney injury

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This 12-center open-label pilot trial of critically ill adults with volume replete severe AKI randomized atients were randomized to accelerated (12 h or less from eligibility) or standard RRT initiation. The enrollment median serum creatinine was 268 micromoles/l and urine output was 356 ml per 24 h. Clinical outcomes at 90 days included mortality which was 38% in the accelerated and 37% in the standard arm. The feasibility […]

No Comments Posted in Acute Kidney Injury, Clinical Nephrology, Clinical Trial Results
November 30, 2015

Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial

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This is a double-blind, placebo-controlled, crossover trial in patients with resistant hypertension that were taking maximally tolerated doses of 3 or more drugs. The authors found that the average reduction in home systolic blood pressure by spironolactone was superior to placebo (-8•70 mm Hg [95% CI -9•72 to -7•69]; p<0•0001), superior to the mean of […]

No Comments Posted in Clinical Nephrology, Clinical Trial Results, Hypertension
September 21, 2015

An Incident Cohort Study Comparing Survival on Home Hemodialysis and Peritoneal Dialysis (Australia and New Zealand Dialysis and Transplantation Registry)

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This Australia and New Zealand Dialysis and Transplantation Registry database study compared patient and technique survival between patients on home hemodialysis with those on peritoneal dialysis.  Overall, on every level that was assessed home hemodialysis was associated with better outcomes than peritoneal dialysis, including 5 year survival (85% vs 44%, respectively; log-rank P<0.001).  Patients eligible for both modalities may benefit from this […]

No Comments Posted in Clinical Nephrology, Clinical Trial Results, Hemodialysis, Peritoneal Dialysis
July 13, 2015

A simple clinical tool to inform the decision-making process to refer elderly incident dialysis patients for kidney transplant evaluation

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Using data from the French national prospective registry, the authors developed and validated a clinical screening score to identify ESRD patients over the age of 70 years with an acceptable prognosis and hence most suitable for kidney transplantation. This scoring card can be helping to the practicing nephrologist to select suitable patients over the age […]

Comments Off on A simple clinical tool to inform the decision-making process to refer elderly incident dialysis patients for kidney transplant evaluation Posted in Clinical Nephrology, Clinical Trial Results, Hemodialysis, Renal Transplantation