Archive for the ‘General Nephrology’ Category

February 9, 2017

AKI and Long-Term Risk for Cardiovascular Events and Mortality

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This systematic review and meta-analysis of 25 studies involving 254 408 patients assessed whether AKI associates with long-term cardiovascular disease. AKI associated with an 86% and a 38% increased risk of cardiovascular mortality and major cardiovascular events, respectively ([RR 1.86; 95% confidence interval (95% CI), 1.72 to 2.01] and [RR 1.38; 95% CI, 1.23 to […]

No Comments Posted in Acute Kidney Injury, Clinical Nephrology, General Nephrology
February 9, 2017

DASH (Dietary Approaches to Stop Hypertension) Diet and Risk of Subsequent Kidney Disease

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This trial looked Atherosclerosis Risk in Communities (ARIC) Study participants with baseline estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2 (N = 14,882).  3,720 participants developed kidney disease during a median follow-up of 23 years. Participants with a DASH diet score in the lowest tertile were 16% more likely to develop kidney disease than those with the highest score tertile […]

1 Comment Posted in Clinical Nephrology, Clinical Trial Results, General Nephrology, Hypertension
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

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
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

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
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

Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis.

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This systematic review and meta-analysis of 19 trials included 44,989 participants,  with 2496 major cardiovascular events were recorded during a mean 3·8 years of follow-up.  Patients in the more intensive blood pressure-lowering treatment group had mean blood pressure levels of 133/76 mm Hg, compared with 140/81 mm Hg in the less intensive treatment group. Intensive blood pressure-lowering treatment achieved RR reductions for major cardiovascular events (14% [95% CI 4-22]), myocardial infarction […]

No Comments Posted in General Nephrology, Hypertension, Internal Medicine for Nephrologists
March 23, 2016

Comparison of low-dose intravenous cyclophosphamide with oral mycophenolate mofetil in the treatment of lupus nephritis

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This study randomized patients with LN (class III, IV, or V) to receive induction with low-dose CYC or oral MMF with the exclusion of patients with crescentic LN, a serum creatinine over 265 μmol/l, and neurological or pulmonary lupus were excluded. Maintenance therapy with azathioprine and low-dose corticosteroid was started at end of induction therapy. The complete remission rate was 50% in CYC and […]

No Comments Posted in Acute Kidney Injury, General Nephrology, Glomerulonephritis
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 10, 2015

Randomized Trial on Efficacy of Mycophenolate Mofeti versus Tacrolimus in Maintaining Remission in Children with Steroid Resistant Nephrotic Syndrome

These are results as presented at the 2015 American Society of Nephrology Kidney Week. In children with steroid resistant nephrotic syndrome who were successfully put into remission, maintenance therapy with MMF 750-1000 mg/m2was compared to tacrolimus 0.1-0.15 mg/kg/day. The primary endpoint of preserved complete or partial remission was achieved in 90.3% of the tacrolimus arm […]

No Comments Posted in General Nephrology