Perfluorinated Chemicals as Emerging Environmental Threats to Kidney Health

MedicalResearch.com Interview with:
John W. Stanifer, MD MSc
Duke Health

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: The key take home for me is that Perfluorinated Chemicals (PFAS) are a globally ubiquitous pollutant with high human exposure and concerning chemical properties that appear to be capable of kidney kidney disease through several plausible different mechanisms; yet, we know almost nothing about long term kidney health outcomes, who is at greatest risk for adverse outcomes, or which communities may be most negatively impacted.

The original impetus for the study was the discovery of GenX in the drinking water of Wilmington NC, a pollutant from a company upstream (see: https://www.newsobserver.com/news/politics-government/state-politics/article199846619.html ). It has been a huge story in NC and every day more and more is being discovered about how pervasive the pollution has become (https://www.usnews.com/news/best-states/north-carolina/articles/2017-12-05/genx-compound-now-detected-in-food-product-in-n-carolina). While this was what caught my attention, as a North Carolinian, I quickly realized that these news stories are all over the place as any quick google search will reveal towns and communities contaminated with these from truly all of the United States. As a health disparities researcher in kidney disease,

I have been studying disparate rural populations in North Carolina, including American Indians, who live in communities with exceptionally high rates of kidney disease, which does not appear to be fully explained by “traditional” risk factors alone such as diabetes, hypertension, obesity, etc. So with that context in mind, I really have begun to focus on these chemicals as potential second-hits or augmenters of kidney disease; we have been doing preliminary studies, in which we have found them in the serum of individuals from these areas, but before we can go further, we really needed to understand what all is known about them and the plausibility that they could cause kidney disease. Therefore, we conducted this comprehensive study to characterize what the potential mechanisms between these chemicals and kidney disease are and where the biggest gaps are.

MedicalResearch.com: Were you surprised by any of the findings?

Response: I was actually surprised by a few things about it. I thought that the link between these chemicals and kidney disease would be pretty weak, with very little to suggest these could be primary drivers of kidney disease. And while the epidemiological studies provided conflicting evidence that mostly but not overwhelmingly pointed toward an association, the toxicology and pharmacokinetic studies demonstrated several key mechanisms that could explain how these chemicals cause kidney disease, including oxidative stress pathways, peroxisome proliferators-activated receptor pathways, NF-E2– related factor 2 pathways, partial epithelial mesenchymal transition, and enhanced endothelial permeability through actin filament modeling.

It was also very interesting to learn that these compounds are taken up by the very same proximal tubule transporters that several known nephrotoxic drugs are taken up, including most notably the herb Aristocholic Acid which was of course responsible for the Balken Endemic Nephropathy that perplexed everyone for so long.

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: Many gaps still exist. The biggest ones to me are that there are literally 1000s of these compounds, with only slight chemical variations, which make detection and regulation challenging. In fact most are still under proprietary aegis which prevents any type of study on them, and several of the “alternative” or “newer” PFCs (e.g. GEnX) have chemical properties that are particularly concerning, despite being marketed as “less toxic”. It is also very concerning to me that children and adolescents have the highest exposure; yet the long-term consequences are completely unknown and life-course epidemiology studies are very much needed. Finally, in the context of kidney disease, these are like so many other environmental toxins in that we don’t know how they interact to worsen or augment kidney disease in people with other risk factors such as diabetes or hypertension. So for example, wonder if you have diabetic nephropathy and are being exposed to these in high quantities? What does that mean for disparities in kidney disease and outcomes??

None of the authors have any disclosures with regards to this work.

 

Citation:

Perfluorinated Chemicals as Emerging Environmental Threats to Kidney Health
A Scoping Review

John W. Stanifer, Heather M. Stapleton, Tomokazu Souma, Ashley Wittmer, Xinlu Zhao and L. Ebony Boulware

CJASN September 2018, CJN.04670418; DOI: https://doi.org/10.2215/CJN.04670418 

Sep 19, 2018 @ 2:20 pm 

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

An Atypical Parvovirus Linked to Chronic Kidney Disease

MedicalResearch.com Interview with:

Ben Roediger PhD Head of the Skin Inflammation Group within Professor Wolfgang Weninger’s Immune Imaging Laboratory Centenary Institute, Faculty of Medicine and Health, The University of Sydney,  Camperdown,, Australia

Dr. Roediger

Ben Roediger PhD
Head of the Skin Inflammation Group within
Professor Wolfgang Weninger’s Immune Imaging Laboratory
Centenary Institute, Faculty of Medicine and Health,
The University of Sydney,
Camperdown,, Australia

MedicalResearch.com: What is the background for this study?

Response: We use several strains of mice for our research, including animals with immunodeficiencies. One of our lines started succumbing to kidney disease and we decided to investigate.

Continue reading

Study Finds Protective Effect of Caffeine in Chronic Kidney Disease

MedicalResearch.com Interview with:

Coffee Wikipedia image

Coffee
Wikipedia image

Miguel Bigotte Vieira  MD
Nephrology and Renal Transplantation Department
Centro Hospitalar Lisboa Norte
Lisbon, Portugal

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: An inverse relationship between coffee consumption and mortality has been reported in the general population. However, the association between caffeine consumption and mortality in patients with chronic kidney disease (CKD) remains unclear. We examined the association between varying levels of caffeine consumption and mortality among 4863 patients with CKD in a prospective nationwide cohort, using the continuous National Health and Nutrition Examination Survey (NHANES) 1999-2010.

Our study showed a protective effect of caffeine consumption among patients with chronic kidney disease. The reduction in mortality was present even after considering other important factors such as age, gender, race, smoking, other diseases, and diet.  Continue reading

Insights into Neurobiology of Restless Legs Syndrome

MedicalResearch.com Interview with:

Rachel Marie E. Salas, MD, MEHP, FAAN Associate Professor, Neurology and Nursing at Johns Hopkins Medicine Director, Interprofessional Education and Interprofessional Collaborative Practice Director, Neurology Clerkship Director, PreDoc Program Meyer/Neuro Sleep Baltimore, MD

Dr Salas

Rachel Marie E. Salas, MD, MEHP, FAAN
Associate Professor, Neurology and Nursing at Johns Hopkins Medicine
Director, Interprofessional Education and Interprofessional Collaborative Practice
Director, Neurology Clerkship
Director, PreDoc Program Meyer/Neuro Sleep
Baltimore, MD

MedicalResearch.com: What is the background for this study? Can you briefly describe what is meant by RLS  and who suffers from it?

Response: Restless Legs Syndrome (RLS) is a common neurological disorder characterized by an irritating, overwhelming urge to move (akathisia) the legs while at rest or sleep (conditions of diminished arousal), which almost immediately abates with mental or physical activity (conditions of maintained arousal).

One of the most clinically-profound and scientifically relevant consequences of this disease process is an increased arousal state producing significant wake during sleep times and a relative sustainable degree of daytime alertness despite the degree of diseased-imposed sleep loss. The focus of most previous RLS research has been on the (limb) akathisia with associated periodic movements and reduction of these with dopaminergic treatment. Little research has been done to understand the broader biological dimensions​ of RLS. Patients with RLS have altered sleep-wake homeostasis with increased arousal and wakefulness (hyperarousal) not only driving the signature clinical symptoms (“the urge to move” and sleep loss) but also supporting arousal over sleep drive at night and in the day. We hypothesize that there is a basic glutamate-hyperarousal process producing both disrupted sleep (increased wake time) and cortical excitability (as demonstrated by transcranial magnetic stimulation (TMS)).​  Continue reading

Kidney Cancer: Biomarker Linked to Detection and Progression

MedicalResearch.com Interview with:

Dr. David Muller, PhD  Faculty of Medicine, School of Public Health Research Fellow in Epidemiology and Biostatistics Imperial College London

Dr. Muller

Dr. David C. Muller PhD
Faculty of Medicine, School of Public Health
Research Fellow in Epidemiology and Biostatistics
Imperial College, London

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our colleagues in the U.S. have been working on KIM-1 for years, particularly in the context of chronic kidney disease. Recently they found that KIM-1 is also elevated at the time of diagnosis of kidney cancer.

We wanted to see if KIM-1 concentrations could predict the chances of a future diagnosis of kidney cancer. We found that KIM-1 was a strong predictor of being diagnosis with kidney cancer in the next 5 years. We also found that higher pre-diagnostic KIM-1 was associated with worse survival after diagnosis.  Continue reading

Artificial Antibody Knocks Out Kidney Inflammation

MedicalResearch.com Interview with:

Michael P. Madaio, MD Sydenstricker Professor and Chairman Department of Medicine Medical College of Georgia at  Augusta University

Dr. Madaio

Michael P. Madaio, MD
Sydenstricker Professor and Chairman
Department of Medicine
Medical College of Georgia at
Augusta University

MedicalResearch.com: What is the background for this study?

Response: Glomerulonephritis is a inflammatory disease of the kidney.  Glomeruli are the filtering units in the kidney. This is most often immunologically mediated and are autoimmune.

Most therapies are directed at inhibiting the Immune/autoimmune process (immunotherapy) systemically.

Continue reading

Hepatitis C Treatment After Kidney Transplant May Extend Lives and Decrease Costs

MedicalResearch.com Interview with:

Mark H. Eckman, MD Posey Professor of Clinical Medicine Director, Division of General Internal Medicine Director, Center for Clinical Effectiveness University of Cincinnati Medical Center Cincinnati, OH

Dr. Eckman

Mark H. Eckman, MD
Posey Professor of Clinical Medicine
Director, Division of General Internal Medicine
Director, Center for Clinical Effectiveness
University of Cincinnati Medical Center
Cincinnati, OH 

MedicalResearch.com: What is the background for this study?

Response: People who are infected with hepatitis C virus and have kidney failure need a kidney transplant.

Recent studies have found that it is possible to transplant kidneys from donors who are infected with hepatitis C virus into patients who need a transplant and are already infected with the virus. In addition, drugs are available to cure most patients of hepatitis C virus, including those who have kidney failure. Infected patients who need a kidney transplant have 2 options. One option is to receive an infected kidney and then use drugs after the transplant to cure themselves and the transplanted kidney of the virus. Another option is to use the drugs first to get rid of the virus and then to receive a kidney from a donor who does not have hepatitis C virus infection.

For the more than 500,000 patients receiving dialysis for end-stage renal disease (ESRD), less than 4% receive kidney transplants. Because of the limited organ availability, hemodialysis is the final treatment for most patients with ESRD. Of the 10% or so of U.S. patients receiving dialysis who are infected with the hepatitis C virus (HCV), some are willing to accept HCV-infected kidneys, in part, because the wait times for such kidneys are shorter than those for HCV-uninfected kidneys. Because the yearly mortality rate for patients receiving hemodialysis is so high, between 4% and 16%, reducing the time to kidney transplant can have a dramatic effect on both survival and quality of life.

Because it may not be possible to do this type of research with actual people, we created a model that allowed us to estimate possible outcomes without using actual people.

The model was a computer program that combined the best available information to approximate what might happen to participants in a real-world clinical trial. Continue reading

Chronic Kidney Disease Patients Struggle to Make Meaning of Their Illness

MedicalResearch.com Interview with:

Dr. Ann M. O’Hare, MD Professor,Division of Nephrology University of Washington Investigator, VA HSR&D Center of Excellence Affiliate Investigator, Group Health Research Institute Seattle, WA 

Prof. O’Hare

Dr. Ann M. O’Hare, MD
Professor,Division of Nephrology
University of Washington
Investigator, VA HSR&D Center of Excellence
Affiliate Investigator, Group Health Research Institute
Seattle, WA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We set out to conduct a qualitative study among patients with advanced kidney disease to learn about their thoughts and experience with advance care planning.

Our questions, especially at the beginning of the interview were quite broad and asked patients more generally about their experiences of illness and care. Although we did not ask patients about the emotional impact of illness and care, this came across as a strong theme when we analyzed the interviews, and that is what we describe here.

Continue reading

Small Renal Cancers: For Select Older Patients, Percutaneous Ablation May Be As Effective and Safer

MedicalResearch.com Interview with:

Adam Talenfeld, M.D Assistant Professor of Radiology Weill Cornell Medical College Assistant Attending Radiologist New York-Presbyterian Hospital. 

Dr. Talenfeld

Adam Talenfeld, M.D
Assistant Professor of Radiology
Weill Cornell Medical College
Assistant Attending Radiologist
New York-Presbyterian Hospital.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We know that renal function decreases as we age, and we know that decreased renal function is independently associated with increased mortality. This is why medical society guidelines recommend partial nephrectomy, which preserves kidney tissue and function, over radical nephrectomy for the treatment of the smallest kidney cancers, stage T1a tumors, which are under 4 cm diameter. Paradoxically, though, we know older patients are more likely than younger patients to receive radical nephrectomy for these smallest tumors, probably because it’s a simpler surgery than partial nephrectomy.

Percutaneous ablation, focal tissue destruction using heat or cold emanating from the tip of a needle, is a newer, image-guided, minimally-invasive, tissue-sparing treatment for solid organ tumors. We wanted to test how well percutaneous ablation would compare to partial nephrectomy and radical nephrectomy for these smallest kidney cancers.

We found that percutaneous ablation was associated with similar 5-year overall and cancer-specific survival compared to radical nephrectomy. At the same time, ablation was associated with significantly lower rates of new-onset chronic renal insufficiency and one-fifth as many serious non-urological complications than radical nephrectomy within 30 days of treatment. These were complications, such as deep venous thrombosis or pneumonia, that resulted in emergency department visits or new hospital admissions. The outcomes of percutaneous ablation compared with partial nephrectomy were somewhat less clear, though ablation was again associated with fewer perioperative complications. Continue reading

Gabapentin and Pregabalin Should Be Used Cautiously in Hemodialysis Patients

MedicalResearch.com Interview with:

Dr. Julie H. Ishida MD Department of Medicine, Division of Nephrology University of California, San Francisco and San Francisco Veterans Affairs Medical Center

Dr. Ishida

Dr. Julie H. Ishida MD
Department of Medicine, Division of Nephrology
University of California, San Francisco and
San Francisco Veterans Affairs Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Gabapentin and pregabalin are used for the management of symptoms such as neuropathic pain, itching, and restless leg syndrome in patients receiving hemodialysis. However, hemodialysis patients may be particularly vulnerable to adverse events related to these agents, which are cleared by the kidney, but there is limited data evaluating their risk in this population.

Gabapentin and pregabalin use were associated with risk for altered mental status, fall, and fracture, and in some cases, even at doses that would be considered safe for use in this population.  Continue reading

Lokelma Receives FDA Approval To Treat Elevated Potassium, Hyperkalemia

MedicalResearch.com Interview with:

Steven Fishbane, MD, Chief, Division of Kidney Disease and Hypertension, Northwell Health Vice President, Northwell Health for Network Dialysis Services, Northwell Health Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Lead investigator of the ZS 005 study.

Dr. Fishbane

Steven Fishbane, MD,
Chief, Division of Kidney Disease and Hypertension, Northwell Health
Vice President, Northwell Health for Network Dialysis Services, Northwell Health
Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Lead investigator of the ZS 005 study

MedicalResearch.com: What is the background for this announcement? Would you briefly explain what is meant by hyperkalemia?What are the dangers of an elevated potassium and how does LOKELMA differ from prior standard treatments?

 Response: Hyperkalemia is when the potassium in the blood rises to potentially harmful levels. High potassium is primarily harmful for the heart. As the potassium level rises the risk for abnormal electrical rhythms or disruption of the heart’s pumping occur. When severe, a high potassium level can cause death.

Lokelma has been demonstrated to be effective for lowering potassium levels with a great degree of consistency. It is well tolerated and has a fairly rapid onset of potassium lowering compared to other drugs for the purpose.  Continue reading

Lack of Dialysis Access for Undocumented Immigrants Stresses Patients and Providers

MedicalResearch.com Interview with:

Lilia Cervantes, M.D. Internal Medicine, Hospitalist Denver Health and Hospital Authority Assistant Professor, Division of General Internal Medicine Founder, Healthcare Interest Program and Health Equity Lecture Series at Denver Health University of Colorado Health Sciences Center

Dr. Cervantes

Lilia Cervantes, M.D.
Internal Medicine, Hospitalist
Denver Health and Hospital Authority
Assistant Professor, Division of General Internal Medicine
Founder, Healthcare Interest Program and Health Equity Lecture Series
at Denver Health
University of Colorado Health Sciences Center

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response:  For most undocumented immigrants with kidney failure in the U.S., access to hemodialysis is limited and they can only receive it when they are critically ill and near-death.  This type of “emergency-only” hemodialysis is already known to be nearly 4-fold more costly, has 14-fold higher mortality rate, and leads to debilitating physical and psychosocial distress for these patients compared to those receiving regular hemodialysis.

This study shows that clinicians who are forced to provide this substandard care are also harmed.  They experience moral distress, emotional exhaustion, and several other drives of professional burnout due to witnessing needless suffering and high mortality.  Continue reading

Does Drinking More Water Preserve Kidney Function?

MedicalResearch.com Interview with:
“Glass of Water” by Greg Riegler is licensed under CC BY 2.0Dr. William Clark
Lawson Health Research Institute 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response:  This study is about the use of increased water intake in people with chronic kidney disease (CKD).

Although there are a large number of benefits claimed most are not substantiated by evidence. However there is a growing body of evidence (animal and human observational studies) that increased hydration with the suppression of antidiuretic hormone preserves kidney function in CKD. This led to our current randomised clinical trial of 631 patients with stage 3 CKD and proteinuria to determine if drinking an extra 4-6 glasses of water per day for 1 year would slow their progressive loss of kidney  function as measured by eGFR.

The main findings were that those coached to increase their water intake versus those coached to sustain their normal fluid intake suffered no ill effects from the intervention and on average were able to sustain an average increase of approximately 3 glasses of water per day. At the end of 1 year the increased hydration group had suppressed their antidiuretic hormone levels (copeptin) significantly but did not demonstrate a greater preservation in their eGFR.

Continue reading

Electronic Pillbox May Improve Adherence To Complicated Medication Regime

MedicalResearch.com Interview with:

Bethany J. Foster, MD MSCE Montreal Children’s Hospital Department of Pediatrics,  Department of Epidemiology, Biostatistics, and Occupational Health McGill University, Montreal, QC, Canada

Dr. Foster

Bethany J. Foster, MD MSCE
Montreal Children’s Hospital
Department of Pediatrics,
Department of Epidemiology, Biostatistics, and Occupational Health
McGill University, Montreal, QC, Canada

MedicalResearch.com: What is the background for this study?

Response: Adolescent and young adult kidney transplant recipients have the highest risk of graft loss of any age group. One of the main reasons for this is not taking their anti-rejection medications as prescribed. Our study had the goal of testing an intervention to try to improve young patients’ adherence to their strict medication schedule. The intervention included feedback of how well they were taking their medications (which was monitored electronically), text message reminders for medication doses, and individualized coaching to address their personal barriers to taking their medications.

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For Most Patients Balanced IV Fluids Better Than Saline

MedicalResearch.com Interview with:

Wesley H. Self, MD, MPH Associate Professor Department of Emergency Medicine Vanderbilt University Medical Center Nashville, TN 

Dr. Self

Wesley H. Self, MD, MPH
Associate Professor
Department of Emergency Medicine
Vanderbilt University Medical Center
Nashville, TN  

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Doctors have been giving IV fluids to patients for more than 100 years. The most common IV fluid during this time has been saline; it has high levels of sodium and chloride in it (similar to table salt).  Balanced fluids are an alternative type of IV fluid that has lower levels of sodium and chloride that are more similar to human blood.

Our studies were designed to see if treating patients with these balanced fluids resulted in better outcomes than saline.  We found that patients treated with balanced fluids had lower rates of death and kidney damage than patients treated with saline.

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Standardization and Collaboration Reduced Use of Costly CRRT Treatment for Critically Ill Patients

MedicalResearch.com Interview with:

Rodrigo F. Alban, MD FACS Associate Director Performance Improvement Associate Residency Program Director NSQIP Surgeon Champion Department of Surgery Cedars-Sinai Medical Center

Dr. Alban

Rodrigo F. Alban, MD FACS
Associate Director Performance Improvement
Associate Residency Program Director
NSQIP Surgeon Champion
Department of Surgery
Cedars-Sinai Medical Center 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Continuous Renal Replacement Therapy (CRRT) is a modality of hemodialysis commonly used to manage renal failure in critically ill patients who have significant hemodynamic compromise.  However, it is also resource-intensive and costly and its usage is highly variable and lacks standardization.

Our institution organized a multidisciplinary task force to target high value care in critically ill patients requiring CRRT by standardizing its process flow, promoting cross-disciplinary discussions with patients and family members, and increasing visibility/awareness of CRRT use.  After our interventions, the mean duration of CRRT decreased by 11.3% from 7.43 to 6.59 days per patient.  We also saw a 9.8% decrease in the mean direct cost of CRRT from $11642 to $10506 per patient.  Finally, we also saw a decrease in the proportion of patients expiring on CRRT, and an increase in the proportion of patients transitioning to comfort care.

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Kids with Kidney Disease Likely To Experience Lower IQ and Educational Outcomes Into Adulthood

MedicalResearch.com Interview with:

L-R: Kerry Chen, Anita van Zwieten, Madeleine Didsbury, Germaine Wong

L-R: Kerry Chen, Anita van Zwieten, Madeleine Didsbury, Germaine Wong

Dr. Kerry Chen
Centre for Kidney Research, The Kids Research Institute
The Children’s Hospital at Westmead, Sydney School of Public Health,
The University of Sydney
Sydney, New South Wales, Australia

MedicalResearch.com: What is the background for this study?

Response: Chronic kidney disease is a major public health issue, with end-stage disease often requiring a combination of complex medication regimens, dialysis and/or transplant surgery. In children, the major causes of CKD are genetic and congenital. The consequences of CKD in children can be long-term and debilitating especially as they transition into adulthood, affecting their physical, intellectual and emotional well-being.

To better understand these changes, the Kids Health and Wealth Study (KCAD) is the largest longitudinal cohort study of children and adolescents with CKD in Australia and New Zealand. Spread across 5 paediatric nephrology centres so far, the KCAD Study takes a life-course approach to collecting and analysing data pertaining to the interactions between reduced renal function and associated clinical, socio-economic, quality of life, psychological, cognitive and educational outcomes in children, especially as they progress in CKD stage and also as they transition into adulthood.

Continue reading

Low Sodium Levels Linked To Cognitive Impairment in Older Adults

MedicalResearch.com Interview with:

Dr. Kristen L. Nowak PhD Division of Renal Diseases and Hypertension University of Colorado Anschutz Medical Campus Aurora, CO 80045

Dr. Nowak

Dr. Kristen L. Nowak PhD
Division of Renal Diseases and Hypertension
University of Colorado Anschutz Medical Campus
Aurora, CO 80045

MedicalResearch.com: What is the background for this study?  

Response: Subtle impairments in cognition are common with aging, even in the absence of clinically apparent dementia. Mild hyponatremia is a common finding in older adults; however, the association of lower serum sodium with cognition in older adults is currently uncertain.

We hypothesized that lower normal serum sodium would be associated with prevalent cognitive impairment and the risk of cognitive decline over time in asymptomatic, community-dwelling older men.

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Majority of Dialysis Patients Unemployed

MedicalResearch.com Interview with:

Hemodialysis machine Wikipedia image

Hemodialysis machine
Wikipedia image

Dr. Kevin F. Erickson MD, MS
Section of Nephrology and Selzman Institute for Kidney Health
Baylor College of Medicine
Houston, TX

MedicalResearch.com: What is the background for this study?

Response: An amendment to the Social Security Act passed in 1972 made it so nearly every person who develops end-stage renal disease – or ESRD – in the U.S. becomes eligible for Medicare, regardless of their age. At the time the law was passed, the bill’s supporters argued that access to life-sustaining dialysis therapy would enable patients to continue being productive members of society through work and activities at home. While the law has succeeded in providing access to dialysis therapy for many patients who would have otherwise died from kidney failure, it has been less successful at helping patients to continue working. The rate of employment among patients with ESRD who are receiving dialysis in the U.S. is low and has continued to decrease over time, despite both financial benefits from employment and evidence suggesting that patients who are employed experience improved quality of life and sense of wellbeing.

We used a national ESRD registry to examine trends in employment between 1996 and 2013 among patients starting dialysis in the U.S. and in the six months before ESRD. Our goal was to determine whether difficulties that patients face when trying to work begin even before they develop ESRD.

Continue reading

What Are The Health Risks To Living Kidney Donors?

Emanuele Di Angelantonio MPhl Department of Public Health and Primary Care School of Clinical Medicine University of Cambridge 

Emanuele Di Angelantonio

MedicalResearch.com Interview with:
Emanuele Di Angelantonio MPhl

Department of Public Health and Primary Care
School of Clinical Medicine
University of Cambridge 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: This systematic review supports and expands previous research suggesting that living kidney donors have no increased risk for several major chronic diseases, with the exception of end stage renal disease. Female donors seem to be at increased risk for preeclampsia. Furthermore, there was no evidence that living kidney donors had higher risk for mortality, cardiovascular disease, or type 2 diabetes, or reduced quality of life. –

MedicalResearch.com: What should readers take away from your report?

Response: This study highlights the low but real risks of living kidney donation and emphasise the importance of careful assessment and counseling for all living kidney donors. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: While this systematic review and meta-analysis provide some important answers, the field is still a long way from offering precise risk estimates to prospective donors.  

No disclosures 

Citations:

O’Keeffe LM, Ramond A, Oliver-Williams C, Willeit P, Paige E, Trotter P, et al. Mid- and Long-Term Health Risks in Living Kidney DonorsA Systematic Review and Meta-analysis. Ann Intern Med. [Epub ahead of print 30 January 2018] doi: 10.7326/M17-1235

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Despite 20 Years of Programs and Policies, Racial Disparities in Kidney Transplants Widen

MedicalResearch.com Interview with:

Tanjala S. Purnell, PhD MPH Assistant Professor of Surgery, Epidemiology, and Health Behavior and Society Core Faculty, Epidemiology Research Group in Organ Transplantation Johns Hopkins University Associate Director for Education and Training, Johns Hopkins Center for Health Equity Member, OPTN/UNOS Minority Affairs Committee

Dr. Purnell

Tanjala S. Purnell, PhD MPH
Assistant Professor of Surgery, Epidemiology, and Health Behavior and Society
Core Faculty, Epidemiology Research Group in Organ Transplantation
Johns Hopkins University
Associate Director for Education and Training, Johns Hopkins Center for Health Equity
Member, OPTN/UNOS Minority Affairs Committee 

MedicalResearch.com: What is the background for this study?

  • Our study was motivated by the fact that we know live donor kidney transplants are associated with longer life expectancy and higher quality of life than deceased donor kidney transplants or long-term dialysis treatment. We also know that Black and Hispanic adults are more likely than White adults to have end-stage kidney disease but are less likely than White patients to receive live donor kidney transplants.
  • Over the last 2 decades, there have been several transplant education programs implemented within transplant centers and dialysis centers, and legislative policies enacted to improve overall access to live donor kidney transplants for patients. We wanted to see whether these programs and policies resulted in narrowed racial and ethnic disparities in access to live donor kidney transplants in the United States. 

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Phase I Study Successfully Targets Metastatic Kidney Cancer

MedicalResearch.com Interview with:

Kevin D. Courtney, M.D., Ph.D.  Assistant Professor UT Southwestern Medical Cente

Dr. Courtney

Kevin D. Courtney, M.D., Ph.D. 
Assistant Professor
UT Southwestern Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Clear cell renal cell carcinoma (ccRCC) is the most common form of kidney cancer. Metastatic ccRCC does not respond to traditional chemotherapy.

Current standard treatments for metastatic ccRCC include drugs called vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR TKIs) that block the growth of new blood vessels that feed the cancer, as well as drugs that inhibit an enzyme called mTOR that is involved in ccRCC growth and immune therapies that rev up the body’s immune response to try to fight the cancer. Each of these treatments can have significant side effects for patients that can make them difficult to tolerate.

Metastatic ccRCC is largely incurable, and we need novel and better-tolerated treatments. A central driver of ccRCC is a protein called hypoxia inducible factor 2alpha (HIF-2alpha). This protein has been very difficult to try to target with a drug. This study is the first to test a drug that targets HIF-2alpha in patients with metastatic ccRCC. The study results showed that the HIF-2alpha inhibitor, PT2385 (Peloton Therapeutics) was active in fighting metastatic ccRCC and was well-tolerated.

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NOACs For Atrial Fib Anticoagulation May Have Lower Risk of Kidney Side Effects

Atrial Fibrillation - Wikipedia image

Normal rhythm tracing (top) Atrial fibrillation (bottom) Wikipedia

Interview with:
Dr Xiaoxi Yao PhD
Assistant Professor
Researcher
Mayo Clinic

What is the background for this study? What are the main findings?

Response: Lifelong oral anticoagulation, either with warfarin or a non-vitamin K antagonist oral anticoagulant (NOAC), is indicated for stroke prevention in most patients with atrial fibrillation (AF). Emerging evidence suggests that NOACs may be associated with better renal outcomes than warfarin.

The study found renal function decline is common among patients with atrial fibrillation treated with oral anticoagulants. NOACs, particularly dabigatran and rivaroxaban, may be associated with lower risks of adverse renal outcomes than warfarin.

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Common Antidepressant Sertraline Does Not Improve Depression in Chronic Kidney Disease Patients

MedicalResearch.com Interview with:

Dr. Susan Hedayati MD University of Texas Southwestern Dallas, Texas

Dr. Hedayati

Dr. Susan Hedayati MD
Yin Quan-Yuen Distinguished Professorship in Nephrology
University of Texas Southwestern
Dallas, Texas

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We previously showed that Major Depression is associated with a significantly higher risk of death, dialysis initiation, and hospitalization among patients with Chronic Kidney Disease (CKD). Now we show that a common antidepressant medication, a selective serotonin reuptake inhibitors (SSRI), sertraline, does not improve depression in this patient population, a chronically ill group that is not only at significantly increased risk for developing depression but also its serious complications.

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Kidney Failure From Diabetes Decreasing Across US

MedicalResearch.com Interview with:
Nilka Ríos Burrows, MPH, MT (ASCP)
Lead, Chronic Kidney Disease Initiative
CDC Division of Diabetes Translation. 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Kidney failure treated with dialysis or a kidney transplant is called end-stage renal disease (ESRD).  ESRD is a costly and disabling condition often resulting in premature death.

During 2000–2014, kidney failure from diabetes among U.S. adults with diabetes decreased by 33%, and it declined significantly in most states, the District of Columbia, and Puerto Rico. No state experienced an increase in kidney failure from diabetes. Continued awareness and interventions to reduce risk factors for kidney failure, improve diabetes care, and prevent type 2 diabetes might sustain these positive trends.

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