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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SPRINT Trial: Greater Mean Blood Pressure Reductions Linked To Increased Risk of Kidney Function Decline

MedicalResearch.com Interview with:
Rita Magriço MD

Hospital Garcia de Orta
Almada, Portugal 
 

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

Response: The SPRINT trial showed that in non-diabetic patients with high cardiovascular risk, intensive systolic blood pressure treatment (<120 mmHg) was associated with lower rates of major cardiovascular events and mortality. However, intensive treatment was unexpectedly associated with increased kidney function decline.

We thought that lowering blood pressure could compromise kidney perfusion, evaluated by mean arterial pressure (MAP). If so, the magnitude of MAP reduction was expected to be associated with kidney function decline. We hypothesized that a greater difference between the baseline MAP and the lowest achieved MAP may be associated with a higher risk of kidney function decline.

Our analysis supports this hypothesis. We discovered that MAP reduction >20 mmHg in patients with a target systolic BP <120 mmHg was associated with higher incidence of kidney function decline. The benefit-risk balance of intensive treatment seemed to be less favourable with greater MAP reduction. Prospective studies evaluating the effect of MAP reduction in addition to hypertension treatment target on kidney function decline and cardiovascular events are warranted.

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Vasopressin-Inhibitor Tolvaptan Reduces Kidney Function Decline in Polycystic Kidney Disease

MedicalResearch.com Interview with:
Dr. TorresVicente E. Torres, M.D., Ph.D.

Director of the Mayo Clinic Translational Polycystic Kidney Disease (PKD) Center

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

Response: Experimental work pioneered by Dr. Jared Grantham showed that cyclic AMP, an intracellular signaling molecule, promotes the development and growth of cysts. Vasopressin, a hormone produced by the pituitary gland, stimulates the production of cyclic AMP in the collecting ducts, from which most cysts derive in autosomal dominant polycystic kidney disease (ADPKD). While this effect of vasopressin is necessary for the kidneys to concentrate and reduce the volume of urine, it promotes the development and growth of cysts in patients with ADPKD. Dr. Vincent Gattone realized that inhibiting the action of vasopressin could be protective in polycystic kidney disease. Work in our and other laboratories confirmed that suppression of vasopressin production, release or action reduces cyst burden, protects kidney function, and prolongs survival in rodent models of the disease.

This experimental work provided a strong rationale for clinical trials of tolvaptan, a vasopressin V2 receptor antagonist. Tolvaptan reduced the rate of kidney growth in the TEMPO 3:4 trial, in patients with early ADPKD. It also reduced the rate of decline in kidney function, measured by the estimated glomerular filtration rate (eGFR), from 10.1 to 6.8 mL/min/1.73 m2 over three years. The eGFR benefit was maintained during two additional years when all the patients were treated with tolvaptan in an open label extension of the TEMPO 3:4 trial (TEMPO 4:4). Safety laboratory tests performed every four months showed elevations of liver transaminases in blood in 4.4% of tolvaptan and 1% of placebo-treated patients. Three of 1,271 tolvaptan-treated patients during TEMPO 3:4 and TEMPO 4:4 had evidence of potentially serious drug-induced liver injury. These abnormalities occurred all within the first 18 months of exposure to tolvaptan.

Based on the TEMPO 3:4 results, tolvaptan was approved for the treatment of rapidly progressive ADPKD in Japan, Canada, European Union, Switzerland and South Korea. In the United States, the Food and Drug Administration requested additional data to further evaluate the efficacy and safety of this drug. The REPRISE trial was performed to determine the efficacy and safety of tolvaptan in patients with later stage ADPKD.

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Non-Medical Factors Affect Racial Disparities in Kidney Transplant Wait Lists

MedicalResearch.com Interview with:
Yue-Harn Ng,
MD
University of New Mexico

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

Response: ​African Americans (AA) have a higher incidence of end-stage renal disease but lower rates of kidney transplantation (KT) compared to whites (WH).  Disparities persist after adjusting for medical factors.  We assessed the relationship of non-medical (eg. cultural, psychosocial, knowledge) factors with kidney transplantation wait-listing (WL) within the context of racial differences.

​In this longitudinal cohort study, we found that African American patients were less likely to be wait-listed compared to White patients.  This difference was influenced by factors including age, comorbidities, socio-economic status, being on dialysis, having a living donor, transplant knowledge and social support.

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Poor Functional Status Predicts Increased Mortality After Dialysis Initiation

MedicalResearch.com Interview with:

Silvi Shah, MD, FACP, FASN Assistant Professor, Division of Nephrology University of Cincinnati Cincinnati, OH

Dr. Shah

Silvi Shah, MD, FACP, FASN|
Assistant Professor
Division of Nephrology
University of Cincinnati
Cincinnati, OH

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

Response: Elderly represent the fastest growing segment of incident dialysis patients in Unites States. The annual mortality in end stage renal disease (ESRD) patients is very high ~ 20%.

Since most of the deaths occur in the first year of dialysis, it is possible that health conditions present prior to initiation of dialysis may impact long-term outcomes. In this study, we determined the impact of poor functional status at the time of dialysis initiation and pre-dialysis health status on type of dialysis modality, type of hemodialysis access and one-year mortality in elderly dialysis patients. We evaluated 49,645 adult incident dialysis patients (1/1/2008 to 12/31/2008) from the United Data Renal Data System (USRDS) with linked Medicare data for at least 2 years prior to dialysis initiation. Mean age of our study population was 72 years. At dialysis initiation, 18.7% reported poor functional status, 88.9% has pre-dialysis hospitalization, and 27.8% did not receive pre-dialysis nephrology care. Patients with poor functional status had higher odds of being initiated on hemodialysis than peritoneal dialysis, lower odds of using arteriovenous access as compared to central venous catheter for dialysis and higher risk of one-year mortality.

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PPIs for Reflux Linked To Increased Risk of Chronic Kidney Disease

MedicalResearch.com Interview with:
Charat Thongprayoon, MD

Bassett Medical Center
Cooperstown, NY 13326

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

Response: We conducted a meta-analysis including 5 observational studies with 536,902 patients to assess the risks of chronic kidney disease (CKD) and/or end-stage kidney disease (ESRD) in patients who are taking proton pump inhibitors (PPIs) and/or H2 receptor antagonists (H2RAs).

We found a statistically significant association between the use of PPI and 1.3-fold increased risk of CKD or ESRD development. Compared with H2Ras, the use of proton pump inhibitors was significantly associated with 1.3-fold higher risk for CKD development.

Conversely, there was no significant association between the use of H2RAs and chronic kidney disease.

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Elderly Frail Patients At Higher Risk Of Mortality After Dialysis Initiation

MedicalResearch.com Interview with:

Silvi Shah, MD, FACP, FASN Assistant Professor, Division of Nephrology University of Cincinnati Cincinnati, OH

Dr. Shah

Silvi Shah, MD, FACP, FASN
Assistant Professor, Division of Nephrology
University of Cincinnati
Cincinnati, OH

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

Response: Elderly represent the fastest growing segment of incident dialysis patients in Unites States. The annual mortality in end stage renal disease (ESRD) patients is very high ~ 20%. Since most of the deaths occur in the first year of dialysis, it is possible that health conditions present prior to initiation of dialysis may impact long-term outcomes.

In this study, we determined the impact of poor functional status at the time of dialysis initiation and pre-dialysis health status on type of dialysis modality, type of hemodialysis access and one-year mortality in elderly dialysis patients. We evaluated 49,645 adult incident dialysis patients (1/1/2008 to 12/31/2008) from the United Data Renal Data System (USRDS) with linked Medicare data for at least 2 years prior to dialysis initiation. Mean age of our study population was 72 years. At dialysis initiation, 18.7% reported poor functional status, 88.9% has pre-dialysis hospitalization, and 27.8% did not receive pre-dialysis nephrology care. Patients with poor functional status had higher odds of being initiated on hemodialysis than peritoneal dialysis, lower odds of using arteriovenous access as compared to central venous catheter for dialysis and higher risk of one-year mortality.

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Acute Care Hospitalizations Prior To Initiation of Dialysis Signal Greater Mortality Risk

MedicalResearch.com Interview with:
Charuhas Thakar, MD Professor

Director of the Division of Nephrology Kidney CARE program
University of Cincinnati

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

Response: Based on the plausibility that pre-dialysis health status can impact outcomes after initiation of chronic dialysis, we examined large national USRDS dataset with linked Medicare claims prior to dialysis. We found that 88% of patients who initiate dialysis experience at least one acute care hospitalization in two years preceding their dialysis start.

If they do, that is associated with a significant increase in the risk of mortality at one year. We also examined effect of different types of hospitalizations in the pre-dialysis period – Cardiovascular, Infections, both, and neither of the two. There were statistical differences in the effect of type of hospitalization and post dialysis mortality.

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Chronic Insomnia Associated With Higher Risk of End Stage Kidney Disease and Mortality

MedicalResearch.com Interview with:
Dr. Jun Ling (Lucy) Lu, MD, CCRP
Senior Clinical Research Coordinator in the Department of Medicine

Csaba P Kovesdy MD FASN
Fred Hatch Professor of Medicine
Director, Clinical Outcomes and Clinical Trials Program

Division of Nephrology, University of Tennessee Health Science Center
Nephrology Section Chief, Memphis VA Medical Center
Memphis TN, 38163 

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

Response: Around one third of the world’s population suffers from insomnia. Previous studies showed that sleep disorders affect the hypothalamic–pituitary–adrenal axis and the sympatho-adrenal system, which may cause abnormalities in several organ systems and pathways causing metabolic or cardiovascular abnormalities. However, there is inadequate evidence of an association between chronic insomnia and adverse renal outcomes.

After examining 938,473 US veterans (4.4% of them had chronic insomnia) with baseline estimated eGFR >60 ml/min/1.73m2, we found that chronic insomnia is associated with a 43% higher risk of all-cause mortality, a 2.5-fold higher incidence of eGFR ≤45ml/min/1.73m2, a 2.3-fold higher ESRD risk, and with rapid loss of kidney function.

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Coffee – Caffeine Linked To Decreased All-Cause Mortality in Kidney Disease Patients

MedicalResearch.com Interview with:
Coffee Wikipedia imageMedicalResearch.com Interview with:
Miguel Bigotte Vieira, MD

Centro Hospitalar Lisboa Norte
Lisboa, Portugal

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 2328 patients with CKD in a prospective nationwide cohort, using the continuous National Health and Nutrition Examination Survey (NHANES) 1999-2010.

A dose-dependent inverse association between caffeine and all-cause mortality was observed in patients with CKD. This association was independent of influential factors including age, gender, race, annual family income, education level, estimated GFR, albumin/creatinine ratio, hypertension, smoking status, dyslipidemia, body mass index, previous cardiovascular events and diet: consumption of alcohol, carbohydrates, polyunsaturated fatty acids and fibers.

Comparing with 1st quartile of caffeine consumption, adjusted HR for death was 0.88 (95% CI, 0.68-1.44) for 2nd quartile, 0.78 (95% CI, 0.60-1.01) for 3rd quartile and 0.76 (95% CI, 0.59-0.97) for 4th quartile (p=0.027 for trend across quartiles)

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Caffeine Linked To Decrease in All-Cause Mortality in Chronic Kidney Disease Patients

MedicalResearch.com Interview with:

Miguel Bigotte Vieira MD Centro Hospitalar Lisboa Norte Lisbon, Portugal

Dr. Bigotte Vieira

Miguel Bigotte Vieira MD
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 2328 patients with CKD in a prospective nationwide cohort, using the continuous National Health and Nutrition Examination Survey (NHANES) 1999-2010.

A dose-dependent inverse association between caffeine and all-cause mortality was observed in patients with CKD. This association was independent of influential factors including age, gender, race, annual family income, education level, estimated GFR, albumin/creatinine ratio, hypertension, smoking status, dyslipidemia, body mass index, previous cardiovascular events and diet: consumption of alcohol, carbohydrates, polyunsaturated fatty acids and fibers.

Comparing with 1st quartile of caffeine consumption, adjusted HR for death was 0.88 (95% CI, 0.68-1.44) for 2nd quartile, 0.78 (95% CI, 0.60-1.01) for 3rd quartile and 0.76 (95% CI, 0.59-0.97) for 4th quartile (p=0.027 for trend across quartiles)

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Robotic-Assisted Radical Nephrectomy: No Difference in Outcomes But Takes Longer and Costs More

MedicalResearch.com Interview with:
In Gab Jeong, MD

Associate Professor
Department of Urology, Asan Medical Center
University of Ulsan College of Medicine
Seoul, Korea

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

Response: Use of robotic surgery has increased in urological practice over the last decade especially for the surgery that was difficult to perform with laparoscopic techniques such as radical prostatectomy for prostate cancer or partial resection of kidney cancer. However, the use, outcomes, and costs of robotic nephrectomy are unknown.

We examined the trend in use of robotic-assisted operations for radical nephrectomy in the United States and compared the perioperative outcomes and costs with laparoscopic radical nephrectomy. The proportion of radical nephrectomies using robotic-assisted operations increased from 1.5% in 2003 to 27.0% in 2015. Although there was no significant difference between robotic-assisted vs laparoscopic radical nephrectomy in major postoperative complications, robotic-assisted procedures were associated with longer operating time and higher direct hospital costs. The rate of prolonged operating time (>4 hours) for patients undergoing the robotic-assisted procedure was higher than for patients receiving the laparoscopic procedure (46.3% vs 25.8%; risk difference, 20.5%; 95% CI, 14.2% to 26.8%). Robotic-assisted radical nephrectomy was associated with higher mean 90-day direct hospital costs ($19530 vs $16851; difference, $2678; 95% CI, $838 to $4519).

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Prebiotin™ Fiber Supplement Tested in NIH/NIDDK Pilot Study In End-Stage Kidney Disease Patients

MedicalResearch.com Interview with:

Ron Walborn Jr. Prebiotin CEO

Ron Walborn Jr.

Ron Walborn Jr.
Prebiotin CEO 

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

Response: The product Prebiotin™ Prebiotic Fiber was brought to market in 2007 by Dr. Frank Jackson, a gastroenterologist out of Harrisburg, PA. He found through 40 years of experience with his patients that a variety of digestive issues benefitted from daily supplementation with a soluble prebiotic fiber, specifically, oligofructose-enriched inulin (OEI) derived from chicory root.

In the late summer of 2012, Prebiotin caught the attention of Dr. Dominic Raj at the Internal Medicine Department of George Washington University. Dr. Raj’s laboratory showed that patients with kidney disease may have a higher level of release of endotoxins like p-Cresol sulfate and indole from the bacteria in the gut, which can move into the bloodstream and promote inflammation.

This early work was the basis of a successful grant application. Researchers were interested in investigating the therapeutic potential of altering the composition and/or function of the gut microbiome in this patient population, based on the understanding that by building up the levels of healthy bacteria in the gut, undesirable bacteria is eventually crowded out, thereby reducing the release of harmful endotoxins into the system.

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Heavy Marijuana Use May Harm Kidneys, But More Study Needed

MedicalResearch.com Interview with:

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

Dr. Ishida

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

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

Response: Marijuana is becoming increasingly accepted in the United States, and animal studies suggest that marijuana could affect kidney function. However, data in humans are limited to case reports of acute kidney injury related to synthetic cannabinoid use and small cohort studies of relatively short duration.

Among 3,765 participants with normal kidney function in the Coronary Artery Risk Development in Young Adults or CARDIA study, my colleagues and I found that higher marijuana use was associated with lower kidney function at the start of the our study. However, we did not find that marijuana was associated with change in kidney function or albuminuria, which is a sign of kidney damage, over long-term follow-up.

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Deceased Donor Kidneys Offered Median of 7 Times Before Acceptance For Transplant

MedicalResearch.com Interview with:

Dr. Anne Huml MD Center for Reducing Health Disparities Case Western Reserve University MetroHealth Medical Center Cleveland, Ohio

Dr. Huml

Dr. Anne Huml MD
Center for Reducing Health Disparities
Case Western Reserve University
MetroHealth Medical Center
Cleveland, Ohio 

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

Response: Overall, about 600,000 Americans have end stage renal disease and require chronic dialysis treatment or a kidney transplant to survive. Compared to chronic dialysis, kidney transplantation results in better survival and quality of life and lower health care costs. Approximately 100,000 patients are listed for a kidney transplant. However, only 17,000 transplants occur per year with two-thirds of these coming from deceased donor organs. Annually, over 8,000 patients either die waiting for a kidney transplant or are removed from the waiting list for being too ill. Waiting times vary based on geography, but it is not unusual for patients to wait upwards of 5 years for a kidney transplant. There are sizeable race, gender, and socioeconomic disparities in access to kidney transplantation.

In this study, we evaluated the outcomes of deceased donor kidney offers and their association with donor and waitlisted patient characteristics. Differences in kidney offer outcomes to patients at the top of the waiting list may contribute to disparities in transplantation.

When a deceased donor organ becomes available, a match run list is created that ranks potential recipients in priority order based upon several characteristics, including waiting time and immunologic criteria. At the discretion of the transplant center, organ offers to patients on their waiting list can be accepted for transplant, or refused for a particular patient. The offers continue down the match run list in sequential order. For each potential recipient in whom the organ is not transplanted, a refusal code is generated and catalogued with the United Network of Organ Sharing, or UNOS. UNOS identifies 37 unique refusal codes and categorizes them into donor-related, transplant center bypassed for pre-specified criteria, recipient-related, histocompatibility-related, program-related, or other reasons for refusal.

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IgG Endopeptidase Has Potential To Reduce Kidney Transplant Rejection

MedicalResearch.com Interview with:

Stanley C. Jordan, M.D Director, Division of Nephrology Medical Director, Kidney Transplant Program Medical Director, Human Leukocyte Antigen and Transplant Immunology Laboratory Cedars-Sinai, Los Angeles, CA

Dr. Jordan

Stanley C. Jordan, M.D
DirectorDivision of Nephrology
Medical DirectorKidney Transplant Program
Medical Director, Human Leukocyte Antigen and Transplant Immunology Laboratory
Cedars-Sinai, Los Angeles, CA 

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

Response: The background for this study is as follows: Patients who are highly HLA sensitized have antibodies to transplant targets create an immunologic barrier to transplant. Currently, there are no approved therapies for elimination of these antibodies. Desensitization is available but is not always successful and most desensitized patients are still transplanted with a positive crossmatch. Thus, many patients are not able to receive life-saving kidney transplants unless newer therapies to remove antibodies are found.

The findings of our study published in the New England Journal of Medicine revealed that the use of the enzyme from streptococcal pyogenes called IdeS® (IgG endopeptidase) is very effective in eliminating donor specific antibodies and allowing transplantation to occur. Antibodies were eliminated from one week up to two months after one treatment with Ides® allowing a safe environment for the transplant to occur. Rejections episodes did occur in some of the patients but were generally mild and easily treatable. Only one patient of 25 lost his allograft during the study. Thus, the study shows promising results for a new approach for elimination of pathogenic antibodies that did not exist before.

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Pain and Depression in ESRD- End Stage Renal Disease

MedicalResearch.com Interview with:
Kathy Aebel-Groesch, MSW,LCSW
Manager, Social Work Services
DaVita Inc.

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

Response: Chronic pain and depression can impact quality of life and adherence to treatment regimen among patients with end-stage renal disease (ESRD). Previous research has demonstrated that patients with ESRD experience pain and depression more frequently than the general population. From 2016, CMS has required that all eligible ESRD patients are evaluated regularly for pain and depressive symptoms.

We assessed pain and depression symptom scores among patients of a large dialysis organization (LDO) over the period Mar-Oct 2016. Pain was assessed monthly by LDO nurses using the Wong-Baker pain scale (0-10). Depression screenings were conducted biannually by LDO social workers using the PHQ-2 (scale 0-6) and excluded patients with existing diagnosis of depression or bipolar disorder, cognitive impairment or language barrier, and those who were hospitalized or refused screening.

A total of 688,346 pain responses from 160,626 individual patients and 223,421 depression screening responses from 158,172 patients were considered. A score of 0 (no pain) was reported for 83.5% of pain responses and 65.7% of patients had a 0 score in all pain assessments. A score of 10 (most severe pain) was reported at least once during the study period by 3.0% of patients. Patients with a pain score of 10 were more frequently female (55%) and patients on peritoneal dialysis were less likely to have a pain score of 10 than those on other modalities. A depression score of 0 (patient answered “Not at all” to both “Little interest or pleasure in doing things” and “Feeling down, depressed, or hopeless”) was reported for 69.1% of all responses and 62.6% of patients had a 0 score in all assessments; 1.8% of patients had at least one score of 6 (patient responded “Nearly every day” to both questions) and 9.7% had at least one score of 3 or more. Patients with a score of 0 were more likely to be male vs. female, HHD vs. PD or ICHD, ≥ age 70 years.

The majority of ESRD patients did not report pain symptoms and, among those not excluded from screening due to an existing diagnosis of depression or other reason, the majority did not report symptoms of depression. However, routine assessment of pain and depression enables the timely identification of new or increased symptoms, thus allowing earlier implementation of interventions that may improve patient experience. The LDO has since revised its depression screening policy to remove diagnosis of depression from exclusion criteria and to administer the PHQ-9 to patients with a PHQ-2 score ≥ 3.

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High Hepatitis C Cure Rate Using Elbasvir plus Grazoprevir In Chronic Kidney Disease

MedicalResearch.com Interview with:

Annette Bruchfeld MD, PhD Senior Consultant Associate Professor Karolinska Institute Dept of Renal Medicine, M99 Karolinska University Hospital Huddinge Stockholm, Sweden

Dr. Bruchfeld

Annette Bruchfeld MD, PhD Senior Consultant
Associate Professor
Karolinska Institute
Dept of Renal Medicine, M99
Karolinska University Hospital Huddinge
Stockholm, Sweden

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

Response: In patients with stage 4–5 chronic kidney disease(CKD), hepatitis C virus (HCV) infection can accelerate the decline in kidney function, impair health-related quality of life (HRQOL), and decrease survival chances of both patients and grafts in transplantation recipients.

In this study additional data from patients with stage 4–5 chronic kidney disease undergoing treatment for HCV infection in the C-SURFER study, including HRQOL and resistance analyses was presented not previously reported for this patient population with gwnotype 1 infection.

The final virological analysis of this study indicated a high cure rate with sustained virological response at 12 weeks after the end of treatment (SVR12) in more than 98% of all treated patients. Even in patients with resistance-associated substitutions (RASs) the SVR was high in 11 (84·6%) of 13 patients genotype 1a infection.

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Factors Affecting Interest in Transplant Among ESRD Patients Receiving Dialysis

MedicalResearch.com Interview with:

Deborah Evans, MA, MSW, LCSW Manager, Social Work Services DaVita Kidney Care

Deborah Evans

Deborah Evans, MA, MSW, LCSW
Manager, Social Work Services
DaVita Kidney Care

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

Response: For patients with end-stage renal disease (ESRD) receiving dialysis, receipt of a transplant offers the best possible long-term treatment option. However, the process of becoming qualified to receive a transplant involves many steps, beginning with the patient’s statement of interest.

In this study, we sought to characterize transplant interest among patients in a large dialysis organization in the U.S. and to explore reasons identified by the patients for lack of interest in transplant when applicable.

As of November 2016, of the 182,906 patients with available transplant status information in the LDO database, 58,057 (31.7%) expressed that they were not interested in transplant. Among patients not interested in transplant, the most frequently identified reasons for lack of interest were:

  • Advanced age (25.7%)
  • Perceived poor health (12.0%)
  • Comfortable with current modality (12.0%)
  • Uninterested in further surgeries (11.9%)
  • 13.2% of patients not interested in transplant indicated that “other” factors were responsible for their lack of interest. At the time of the study, we didn’t have any further insight into what might account for these “other” factors.

Compared to patients with transplant status listed as active, those not interested in transplant were:

  • Older (21.4% < 60 years vs 64.6%)
  • More likely to be female (47.7% vs 36.6%)
  • More likely to be white (43.9% vs 30.4%) and less likely to be Hispanic (14.7% vs 22.2%)
  • More likely to be receiving in-center hemodialysis (92.0% vs 73.7%)
  • More likely to have Medicare/Medicaid as primary insurance (91.3% vs. 77.3%)

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Worsening Kidney Function Associated With Significantly Higher Medical Costs

MedicalResearch.com Interview with:

Shaum Kabadi</strong> HEOR Director at AstraZeneca

Shaum Kabadi

Shaum Kabadi
HEOR Director at AstraZeneca

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

Response: More than 20 million adults – roughly 1 in 10 adults – in the US are estimated to have chronic kidney disease (CKD), and this population is expected to grow as the US population ages. Patients with CKD are at high risk for progression to end-stage renal disease (ESRD), a condition requiring dialysis or kidney transplantation to maintain patients’ long-term survival. The cost of treating ESRD patients was over $40 billion in public and private funds in 2009. Prior research shows per-person annual Medicare expenses attributable to CKD were $1,700 for Stage 2, $3,500 for Stage 3, and $12,700 for Stage 4. Additional research is required to understand the economic burden of CKD by stage in a contemporary cohort of commercially insured patients with non-dialysis-dependent (NDD)-CKD.

This retrospective cohort study utilized data from the HealthCore Integrated Research Environment, which contained medical and pharmacy administrative claims integrated with laboratory result values from 14 regionally dispersed Anthem health plans in the US.

Of 16,030 patients identified with CKD, the mean (SD) estimated glomerular filtration rate (eGFR) (all in mL/min/1.73 m2) in 2014 was 44.3 (±18.7), and the breakdown by eGFR levels was: Stage 1 (≥90) 3%, Stage 2 (60–89) 13%, Stage 3a (45–59) 27%, Stage 3b (30–44) 35%, Stage 4 (15–29) 19%, and Stage 5 (<15) 3%. Mean age across all stages was 67.4 years, and 47% were women. Hospitalization rate (%) and number of outpatient encounters (visits per patient per year) by stage were: Stage 1 (11.6%, 19.8), Stage 2 (14.9%, 22.5), Stage 3a (16.2%, 23.6), Stage 3b (23.7%, 29.5), Stage 4 (30.7%, 36.3), and Stage 5 (30.8%, 61.7) (p-trend).

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Chronic Kidney Disease Still Highly Prevalent in Hypertensive Patients

MedicalResearch.com Interview with:
Tanushree Banerjee, M.S., M.Phil., Ph.D.
Research Specialist,
Department of General Internal Medicine,
San Francisco General Hospital,
University of California, San Francisco,

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

Response: Prevalence of chronic kidney disease (CKD) has increased among adults with diagnosed hypertension (HTN), undiagnosed HTN and pre-hypertension as compared to normotension. However, whether CKD prevalence has changed across each of these groups is unknown.

The prevalence of CKD decreased over time among persons with diagnosed, undiagnosed, and pre-hypertension while there was not any change in normotensives.

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How Do Patients With Compromised Kidney Function Do After TAVR?

MedicalResearch.com Interview with:

Nirat Beohar, MD Vice-Chief of Cardiology Director Cardiac Catheterization Laboratory Director Structural Heart Disease Program Director Interventional Cardiology Fellowship program Cardiac Catheterization Laboratory Columbia University Division of Cardiology, Mount Sinai Medical Center Miami Beach, Miami, FL 33140

Dr. Beohar

Nirat Beohar, MD
Vice-Chief of Cardiology
Director Cardiac Catheterization Laboratory
Director Structural Heart Disease Program
Director Interventional Cardiology Fellowship program
Cardiac Catheterization Laboratory
Columbia University Division of Cardiology,
Mount Sinai Medical Center
Miami Beach, Miami, FL 33140

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

Response: Nirat Beohar MD, Director of the Cardiovascular Catheterization Laboratory and Vice-Chief of Cardiology at the Columbia University Division of Cardiology at the Mount Sinai Medical Center and co-authors report the effect of trans-catheter aortic valve replacement (TAVR) on subsequent renal function and outcomes in high-risk and inoperable patients presenting with baseline renal dysfunction (eGFR < 60 ml/min/1.73 m2). This was a sub-study of patients undergoing TAVR in the PARTNER 1 trial and continued access registry that was conducted in 25 centers in the United States and Canada.

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Support Required To Encourage Patients With End Stage Kidney Disease To Return to Work

MedicalResearch.com Interview with:

Wendy Tan Senior Medical Social Worker Medical Social Work The National Kidney Foundation

Wendy Tan

Wendy Tan
Senior Medical Social Worker
Medical Social Work
The National Kidney Foundation

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

Response: End Stage Renal Disease (ESRD) patients experience significant changes to their daily routine and lifestyle. Their time and attention were often centred solely on their sickness whilst receiving treatment accentuating the employment isolation.

This study determined the need for extra support to assist patients adjust (e.g. learning about their psychological wellbeing, change of role and mindset, suitable work conditions and employment support) in returning to work. It also sheds light on how individuals perceive the particular situations they are facing, how they are making sense of their health conditions and the society at large in relations to seeking continued employment.

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Elevated Kidney Biomarker Creatinine Predicts Worse Outcome in STEMI Heart Attack

MedicalResearch.com Interview with:

MedicalResearch.com Interview with: Mohamed Khayata, MD Internal Medicine Resident PGY-3 Cleveland Clinic Akron General, Akron, Ohio MedicalResearch.com: What is the background for this study? What are the main findings? Response: Previous studies showed that patients with ST-elevation myocardial infarction (STEMI) who had elevated creatinine and/or impaired creatinine clearance on presentation had higher short- and long-term mortality independent of other cardiovascular risk factors. We used the National Cardiovascular Database Registry to investigate the impact of creatinine levels at the time of presentation on the cardiovascular outcomes in patients who presented with STEMI. Our study showed that elevated creatinine levels correlated with higher incidence of atrial fibrillation, bleeding, heart failure, and cardiogenic shock during hospital stay after the percutaneous intervention. MedicalResearch.com: What should readers take away from your report? Response: Creatinine level is being checked in almost all patients who present with STEMI within few hours of presentation. Based on previous reports and our results, creatinine is a critical marker that correlate not only with mortality, but is also with morbidity during hospital stay. This marker should be used as a predictor of worse outcomes; thus, patients with higher creatinine levels should be provided higher attention. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Response: Based on our study limitations, I would encourage performing similar outcomes analysis in larger group, multi-center registries. I would also suggest extending outcomes to post-discharge status including quality of life besides cardiovascular compilcations. MedicalResearch.com: Is there anything else you would like to add? Response: MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community. Citation: Abstract presented at the 2017 National Kidney Foundation Spring Clinical Meeting https://www.kidney.org/spring-clinical The Impact of Admission Serum Creatinine on Major Adverse Clinical Events in ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions. More Medical Research Interviews on MedicalResearch.com

Dr. Khayata

Mohamed Khayata, MD
Internal Medicine Resident PGY-3
Cleveland Clinic Akron General
Akron, Ohio

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

Response: Previous studies showed that patients with ST-elevation myocardial infarction (STEMI) who had elevated creatinine and/or impaired creatinine clearance on presentation had higher short- and long-term mortality independent of other cardiovascular risk factors.

We used the National Cardiovascular Database Registry to investigate the impact of creatinine levels at the time of presentation on the cardiovascular outcomes in patients who presented with STEMI.

Our study showed that elevated creatinine levels correlated with higher incidence of atrial fibrillation, bleeding, heart failure, and cardiogenic shock during hospital stay after the percutaneous intervention.

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Spark Study: Does Low Dose Lasix Provide Kidney Protection in AKI?

MedicalResearch.com Interview with:
Sean Bagshaw MD MSc
Director for Research for the Division of Critical Care Medicine
School of Public Health
University of Alberta, Canada

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

Response: The rationale for SPARK stemmed from two general observations.

First, experimental and pre-clinical data have suggested the timely utilization of loop diuretics in early AKI could provide “kidney protection” largely mediated through reduction in medullary oxygen demand. Yet, this is in apparent paradox with clinical data (largely derived from older observational studies at some risk of bias) suggesting use of loop diuretics in AKI may be associated with increased risk for death and/or non-recovery of kidney function.

Second, in AKI, loop diuretics are used exceedingly often. Surveys of healthcare practitioners and observational data suggest more than two-thirds to three-quarters of patients are exposed to diuretics at some point during their course. This represents a significant misalignment between evidence and clinical practice. This would suggest there is need to generate new evidence and knowledge that would ideally help inform best practice in the management of AKI.

SPARK was designed as a pilot trial largely aimed at evaluating the feasibility of the approach to use of loop diuretics in early AKI. While SPARK did not find significant differences in risk of worsening AKI, utilization of RRT or mortality, we recognize the trial was underpowered to meaningfully inform about these and other patient-centered outcomes. We did see differences in secondary endpoints (i.e., fluid balance); however, use of loop diuretics in this setting was also associated with greater incidence of electrolyte abnormalities.

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Prevalence of Chronic Kidney Disease In US Tops 30 Million

MedicalResearch.com Interview with:

Jennifer L. Bragg-Gresham, MS, PhD Assistant Research Scientist Kidney Epidemiology and Cost Center Department of Internal Medicine - Nephrology University of Michigan Ann Arbor, MI 48109

Dr. Bragg-Gresham

Jennifer L. Bragg-Gresham, MS, PhD
Assistant Research Scientist
Kidney Epidemiology and Cost Center
Department of Internal Medicine – Nephrology
University of Michigan Ann Arbor, MI 48109 

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

Response: While a trend toward stabilization in CKD prevalence had been detected over the past decade, the most recent data from NHANES (2013-2014) suggests this trend may be ending.

MedicalResearch.com: What are the main findings?

Response: Data from 2013-2014 shows that 15.5% of the US population has reduced kidney function, up from 14.1% (2011-2012) and 12.0% (1988-1994). Over the same time period we have witnessed an increase in risk factors for CKD (age and diabetes, in particular). Adjusting for this fact accounted for much, but not all, of the increase in CKD prevalence.

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

Response: Despite this finding, we should not become complacent in our fight against kidney disease, as the absolute number of individuals with CKD has increased from approximately 19.2 million (1988-2004) to 33.6 million (2013-2014) in our latest estimates. We must continue to improve awareness and detection of early stages of CKD, as well as improve treatment for CKD risk factors.

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

Response: We must continue to improve awareness and detection of early stages of CKD, as well as improve treatment for CKD risk factors.

MedicalResearch.com: Is there anything else you would like to add?

Response: Health surveillance is paramount to the success of all public health initiatives to understand current data and varied aspects of disease, which supports correct allocation of resources.

Disclosures: This poster was supported by the Supporting, Maintaining and Improving the Surveillance System for Chronic Kidney Disease in the U.S., Cooperative Agreement Number, U58 DP006254, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the Department of Health and Human Services.
Paragraph form:

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Abstract presented at the Spring 2017 National Kidney Foundation Meeting
RISING CKD PREVALENCE IN THE UNITED STATES (1988-2014)

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Food Costs Can Lead To Less Protein and Phosphorous in Indigent Kidney Transplant Patients

MedicalResearch.com Interview with:

Ms. Shifra Mincer Medical Student in the class of 2019 SUNY Downstate Medical School

Shifra Mincer

Ms. Shifra Mincer
Medical Student in the class of 2019
SUNY Downstate Medical School

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

Response: Hypophosphatemia is commonly encountered in the post-transplant setting. Early post-transplant hypophosphatemia has been ascribed to excess FGF23 and hyperphosphaturia.

Many patients remain hypohosphatemic months or even years after their transplant and the mechanism was assumed to be the same, however, our group recently reported that patients with late post-transplant hypophosphatemia had very little phosphorous in their urine (Wu S, Brar A, Markell, MS. Am J Kidney Dis. 2016,67(5): A18). We hypothesized that they were not eating enough phosphorous to compensate for the acute phosphorous losses they experienced immediately post-transplant.

In this study, using both 3-day diet journals and 24-hour diet recall questionnaires, we found that mean intake of phosphorous and protein was barely at the Recommended Daily Allowance, and that despite 70% of the patients using EBT, 30% of those patients still reported concerns regarding food security. Patients who reported that the cost of food influenced their dietary choices ate 43% less protein (average 48,5 gms vs. 85.8 gms) and 29% less phosphorous (average 887 mg vs 1257 mg). When ability to rise from a chair over a 30 second period was evaluated, only patients who expressed food cost concerns were unable to complete the test.

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Trial To Test Effect of Aspirin on Progression of Kidney Disease in Diabetes

MedicalResearch.com Interview with:
Francesco Violi MD
Department of Internal Medicine and Medical Specialties e Sapienza University
Rome, Italy

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

Response: The paper reports on the protocol of a trial where we will test the effect of aspirin on renal disease progression in diabetic patients. The study will start shortly and will be terminate next year.

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Donor Sex and Size Important to Kidney Transplant Success

MedicalResearch.com Interview with:
Amanda Miller, MD, FRCPC

Dalhousie University
Transplant Nephrology

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

Response: Earlier studies have shown that there may be a higher risk of kidney transplant failure if a kidney donor is smaller than their recipient. This may be due to increased strain on the relatively smaller transplanted kidney. Very few studies have investigated outcomes associated with donor and recipient weight mismatch measured directly by differences in body weight however. There is also a suggestion that sex mismatch between kidney donor and recipient may lead to worse outcomes post-transplant, however results from earlier studies have been controversial and conflicting. The combined effect of weight and sex matching/mismatching between kidney donor and recipient (two very important and physiologically relevant factors) has not been rigorously studied previously.

Thus, the aim of this study was to determine if receiving a kidney transplant from a smaller donor of the opposite sex would impact transplant outcomes. Accounting for other transplant variables, we demonstrated that if a kidney transplant recipient is more than 30 kg (66 pounds) heavier than the donor there is a 28% increased risk of the transplant failing compared to equally weighted donors and recipients. If the kidney is from a smaller donor of the opposite sex, the risk of transplant failure is further increased to 35% for a male receiving a kidney from a female donor, and 50% for a female receiving a kidney from a male donor. This risk is high and is similar to that when a recipient receives a kidney transplant from a donor who has diabetes; a known risk factor for kidney failure in the non-transplant population.

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Acute Kidney Injury Is A Frequent Complication of Pediatric Diabetic Ketoacidosis

MedicalResearch.com Interview with:

Constadina Panagiotopoulos, MD, FRCPC Department of Pediatrics, Endocrinology & Diabetes Unit British Columbia Children’s Hospital Vancouver, British Columbia, Canada

Dr. Panagiotopoulos

Constadina Panagiotopoulos, MD, FRCPC
Department of Pediatrics, Endocrinology & Diabetes Unit
British Columbia Children’s Hospital
Vancouver, British Columbia, Canada

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

Response: I decided to conduct this study after observing a few cases of severe acute kidney injury (AKI) in children hospitalized with diabetic ketoacidosis (DKA) (with two patients requiring dialysis) while on call in the 18 months prior to initiating the study. While caring for these patients, I scanned the literature and realized that aside from 2 published case reports, there had been no large-scale systematic studies assessing AKI in children with DKA. It immediately became apparent to me that managing patients with AKI and DKA was more challenging. On presentation to hospital, many of these children with DKA present quite volume depleted but fluid management is conservative because of the risk for cerebral edema.

One of the most important management strategies for acute kidney injury in patients with DKA is early detection and correcting volume depletion in a timely manner to prevent further injury. I discussed my observations and these clinical cases with pediatric nephrologist and co-investigator Dr. Cherry Mammen, a pediatric AKI expert, and he confirmed my initial literature review findings. Thus, we decided to conduct this study to better understand the scope of the problem and any associated risk factors.

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Association of Intensive Blood Pressure Control and Kidney Disease Progression in Nondiabetic Patients With CKD

MedicalResearch.com Interview with:
Hon-Yen Wu, MD, PhD, on behalf of all authors

Attending Physician and Assistant Professor, Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
Assistant Professor, Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
Assistant Professor, National Taiwan University Hospital and College of Medicine,
National Taiwan University, Taipei, Taiwan.
Assistant Professor, School of Medicine, National Yang-Ming University, Taipei, Taiwan. 

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

Response: The effect of intensive blood pressure (BP) control in nondiabetic patients with chronic kidney disease (CKD) has long been a topic of debate. We summarized the published information comparing intensive BP control (< 130/80 mmHg) with standard BP control (< 140/90 mmHg) on major renal outcomes in CKD patients without diabetes. We pooled data from 9 randomized clinical trials with more than 8000 patients and over 800 events of kidney disease progression. We found that targeting blood pressure below the current standard did not provide additional benefit for renal outcomes compared with standard BP control, but may benefit nonblack patients or those with heavy proteinuria.

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

Response: For the optimal blood pressure target in CKD patients without diabetes, an individually tailored treatment rather than a general rule to control hypertension is suggested.

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Genetic Variants Tied To Kidney Disease in African Americans

MedicalResearch.com Interview with:

Katalin Susztak MD, PhD Associate Professor of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia, PA 19104

Dr. Susztak

Katalin Susztak MD, PhD
Associate Professor of Medicine
Perelman School of Medicine
University of Pennsylvania
Philadelphia, PA 19104

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

Response: Previous studies showed an association between genetic variants in the APOL1 gene and kidney disease development, but it has not been confidently shown that this genetic variant is actually causal for kidney disease. For this reason we developed a mouse model that recapitulates the human phenotype.

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IV Etelcalcetide (Parsibiv®) Can Treat Elevated PTH in Dialysis Patients More Effectively Than Oral Medication

MedicalResearch.com Interview with:

Geoffrey A. Block, MD Director of Research at Denver Nephrology Denver, Colorado

Dr. Geoffrey Block

Geoffrey A. Block, MD
Director of Research at Denver Nephrology
Denver, Colorado

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

Response: Secondary hyperparathyroidism is a chronic and progressive disorder characterized by elevations in parathyroid hormone (PTH). It is seen in most patients with advanced chronic kidney disease and has been associated with a number of important adverse health effects such as bone pain, fracture, premature cardiovascular disease, abnormal heart enlargement, pathologic calcium accumulation in blood vessels and tissues and premature death.

Currently there are several classes of drugs used to treat high PTH but each are associated with challenging side effects which limit their effectiveness. Active vitamin D compounds are effective in lowering PTH but do so at the expense of causing elevations in other minerals such as calcium and phosphorus which are felt to be harmful.

An oral drug known as cinacalcet (Sensipar®) is in the class of medicine known as ‘calcimimetics’ and reduces PTH and simultaneously reduces calcium and phosphorus however it must be taken daily due to its short half-life and is commonly associated with nausea when first initiated or the dose is increased. Clinical trials with cinacalcet are suggestive though not conclusive of a beneficial effect on improving cardiovascular events and prolonging life.

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Non-Dialysis Chronic Kidney Disease Expenses On Par With Cancer and Stroke

MedicalResearch.com Interview with:

Talar W. Markossian PhD MPH Assistant Professor of Health Policy Loyola University Chicago 2160 S. First Ave, CTRE 554 Maywood, IL 60153

Dr. Talar Markossian

Talar W. Markossian PhD MPH
Assistant Professor of Health Policy
Loyola University Chicago
2160 S. First Ave, CTRE 554
Maywood, IL 60153

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

Response: Approximately 10% of U.S. adults currently have non-dialysis dependent chronic kidney disease (CKD), while dialysis dependent CKD accounts for only 0.5% of the U.S. population. The escalation in healthcare expenditures associated with CKD starts prior to requirement for dialysis, and treatment costs escalate as non-dialysis dependent CKD progresses.

We examined the total healthcare expenditures including out-of-pocket costs for non-dialysis dependent chronic kidney disease and compared these expenditures with those incurred for cancer and stroke in the U.S. adult population. After adjusting for demographics and comorbidities, the adjusted difference in total direct healthcare expenditures was $4746 (95% CI $1775-$7718) for CKD, $8608 (95% CI $6167-$11,049) for cancer and $5992 (95% CI $4208-$7775) for stroke vs. group without CKD, cancer or stroke. Adjusted difference in out-of-pocket healthcare expenditures was highest for adults with CKD ($760; 95% CI 0-$1745) and was larger than difference noted for cancer ($419; 95% CI 158–679) or stroke ($246; 95% CI 87–406) relative to group without CKD, cancer or stroke. Continue reading

Novel Oral Iron Formulation Can Correct Anemia in Non-Dialysis CKD

MedicalResearch.com Interview with:

Dr. Glenn M. Chertow, MD Professor Medicine, Nephrology Stanford University School of Medicine

Dr. Glenn M. Chertow

Dr. Glenn M. Chertow, MD
Professor Medicine, Nephrology
Stanford University School of Medicine

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

Response: Iron deficiency is common in persons with moderate to advanced (non-dialysis-dependent) chronic kidney disease (CKD), for a variety of reasons. Conventional iron supplements tend to be poorly tolerated and of limited effectiveness. In earlier studies of patients treated with ferric citrate for its effect as a phosphate binder, we saw increases in transferrin saturation and ferritin (markers of iron stores) and hemoglobin and hematocrit (the “blood count”). Therefore, we thought we should test the safety and efficacy of ferric citrate specifically for the treatment of iron deficiency anemia (IDA).

With respect to the key findings, more than half (52%) of patients treated with ferric citrate experienced a sizeable (>=1 g/dL) increase in hemoglobin over the 16-week study period compared to fewer than one in five (19%) patients treated with placebo. Rates of adverse events (“side effects”) were similar to placebo; diarrhea in some patients and constipation in others were the most common. There were also favorable effects of ferric citrate on laboratory metrics of bone and mineral metabolism.

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Study Reevaluates NSAIDS For PDA in Premature Infants

MedicalResearch.com Interview with:

Jonathan Slaughter, MD, MPH Assistant Professor of Pediatrics Center for Perinatal Research Nationwide Children's Hospital/The Ohio State University Columbus, OH 43205

Dr. Jonathan Slaughter

Jonathan Slaughter, MD, MPH
Assistant Professor of Pediatrics
Center for Perinatal Research
Nationwide Children’s Hospital/The Ohio State University
Columbus, OH 43205

MedicalResearch.com: What are the main findings?

Response: The ductus arteriosus, a fetal blood vessel that limits blood flow through the lungs, normally closes shortly after birth. However, the ductus often remains open in premature infants, leading to patent ductus arteriosus (PDA). Infants with PDA are more likely to die or develop bronchopulmonary dysplasia (BPD), the major chronic lung disease of preterm infants. Nonsteroidal Anti-inflammatory Drug (NSAID) treatment has been shown to close PDAs in preterm infants and NSAID treatment of PDA is common. However, it has never been shown that PDA closure with NSAIDs leads to decreased mortality or improved long-term respiratory outcomes. NSAID closure of PDA has become increasingly controversial in recent years since NSAID treatment has been associated with acute renal injury. Also, these medications are expensive, with the usual three-dose treatment course costing well over $1000 per patient. Due to these controversies, the likelihood of a preterm infant with PDA being treated with NSAIDs varies by clinician and institution and has decreased over time.
Meta-analyses of randomized trials that investigated NSAID (indomethacin and/or ibuprofen) treatment for PDA closure in preterm infants did not show a benefit. However, they were principally designed only to study whether the ductus itself closed following treatment and not to determine if there was an improvement in mortality risk or in respiratory outcomes following NSAID treatment.
Given the difficulty of conducting randomized trials in preterm infants and the urgent need for practicing clinician’s to know whether treatment of PDA in all preterm infants is beneficial, we used a study design that incorporated the naturally occurring practice variation in NSAID treatment for PDA as a mechanism to reduce the risk of biases that are commonly found in non-randomized investigations. This is based on the premise that if NSAID treatment for PDA in preterm infants is truly effective, we should expect to see improved mortality and respiratory outcomes in instances when clinician preference-based NSAID administration rates are higher.

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Protein Loss in Urine Associated With Increased Risk of Dementia

MedicalResearch.com Interview with:

Kay Deckers, MSc PhD student School for Mental Health and Neuroscience Department of Psychiatry and Neuropsychology Maastricht University The Netherlands

Kay Deckers

Kay Deckers, MSc
PhD student
School for Mental Health and Neuroscience
Department of Psychiatry and Neuropsychology
Maastricht University
The Netherlands

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

Response: In an earlier review (https://www.ncbi.nlm.nih.gov/pubmed/25504093), we found that renal dysfunction was one the new candidate risk factors of dementia and needed further investigation.

MedicalResearch.com: What are the main findings?

Response: Albuminuria is associated with an increased risk of developing cognitive impairment or dementia.

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Hospital and Separate Dialysis Units Have Similar MRSA Rates

MedicalResearch.com Interview with:
Georg Schlieper, MD

MVZ DaVita Rhein-Ruhr
Duesseldorf, Germany

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

Response: Methicillin-resistant Staphylococcus aureus (MRSA) colonization in hemodialysis patients is associated with higher risk for systemic infection. Recent hospitalization and temporary dialysis access are known risk factors for MRSA colonization. Whether MRSA colonization rates in hospital-based dialysis centers differ from separate dialysis centers is unknown. Data on MRSA decolonization strategies in hemodialysis patients are scarce.

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Two Different European Strategies Achieve KDIGO Renal Anemia Targets

MedicalResearch.com Interview with:

Dorota Drozdz M.D., Ph.D Jagiellonian University Kraków

Dr. Dorota Drozdz

Dorota Drozdz M.D., Ph.D
Jagiellonian University
Kraków

Response: In Poland and Portugal we use EPO beta for anemia treatment. Our interest was to find differences in clinical patterns taking in consideration that both countries are adherent to KDIGO recommendations an guidelines.

We found that in both countries the mean hemoglobin (Hb) level and percentage of patients in target Hb level (10-12 g/dl on ESA treatment) are the same, but the approaches were different – in Poland the ESA dose was statistically lower than in Portugal and iron dose was statistically higher than in Portugal. Most other lab tests results were similar. Future secondary outcomes analysis should answer the question, which method is safer.

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New Protocol To Allow Rapid Steroid Reduction After Kidney Transplantation

MedicalResearch.com Interview with:
Prof. Dr. med. Christian Hugo
Head, Division of Nephrology
Medical Clinic III
Universitätsklinikum Carl Gustav Carus
an der Technischen Universität Dresden
Dresden

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

Response: At the end of 2007, the harmony trial was designed predominantly based on the one year results of the ELITE-Symphony trial, demonstrating that low dose tacrolimus, mycophenolate mofetile, and steroids together with monoclonal interleukin-2-receptor (CD 25 antigen) antibody induction therapy has superior efficacy in renal transplant patients compared to all other regimens (low or normal dose cyclosporine or sirolimus) tested. While these advantages of the low dose tacrolimus protocol were so convincing to become the new gold standard of immunosuppressive therapy within the next few years (see KDIGO guide lines for renal transplantation in 2009), the low dose tacrolimus treatment arm also demonstrated increased incidence rates regarding post-transplantation diabetes mellitus (PTDM, at that time called new onset of diabetes after transplantation – NODAT) compared to the low cyclosporine treatment arm. Previous studies had also demonstrated a detrimental association between NODAT and cardiovascular events and mortality, the leading cause of death in renal transplant recipients. Corticosteroid-free or rapid withdrawal regimens were relatively encouraging regarding influencing NODAT rates but only at the price of an increased rate of T cell mediated acute rejections.

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Barriers to Healthful Eating Linked to More Rapid Kidney Function Decline

MedicalResearch.com Interview with:

Deidra C. Crews, MD, ScM, FASN, FACP Associate Professor of Medicine, Division of Nephrology Associate Vice Chair for Diversity and Inclusion, Department of Medicine Director, Doctoral Diversity Program Johns Hopkins University School of Medicine Baltimore MD 21224

Dr. Deidra Crews

Deidra C. Crews, MD, ScM, FASN, FACP
Associate Professor of Medicine, Division of Nephrology
Associate Vice Chair for Diversity and Inclusion, Department of Medicine
Director, Doctoral Diversity Program
Johns Hopkins University School of Medicine
Baltimore MD 21224

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

Response: Studies suggest that dietary patterns influence risk of kidney function decline. Barriers may hinder urban African Americans’ following healthful diets that could mitigate their increased risk of kidney function decline.

In this study, we characterized contextual barriers to healthful eating among urban African Africans with hypertension and examined the association of these barriers to kidney function decline over 1 year. We examined the presence of healthy foods in neighborhood stores of study participants.

We also assessed them for food insecurity (the inability to afford nutritionally adequate and safe foods), directly observed and documented the presence of fruits and vegetables in their homes, and examined their fruit and vegetable intake via questionnaire.

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Anion Gap Associated with Risk of ESRD in Adults with Moderate Chronic Kidney Disease

Tanushree Banerjee, PhD Research Specialist in the Department of Medicine Division of General Internal Medicine UCSFMedicalResearch.com Interview with:
Tanushree Banerjee, PhD
Research Specialist in the Department of Medicine
Division of General Internal Medicine
UCSF

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

Response: Acidosis is usually noted in advanced chronic kidney disease (CKD) while it is relatively unexplored whether changes in the undetermined anions, as measured by anion gap occur earlier in the course of CKD.

Consumption of animal-sourced protein is acid-inducing and therefore such diet presumably increases undetermined anions. Since higher dietary acid load is associated with progression of CKD, we wanted to explore whether the increase in undetermined anions in moderate CKD is associated with CKD progression.

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Emergency Department Use High Among CKD Patients, Primarily for Heart Failure

MedicalResearch.com Interview with:

Paul E Ronksley, PhD Assistant Professor Department of Community Health Sciences Cumming School of Medicine University of Calgary Calgary Canada

Dr. Paul E Ronksley

Paul E Ronksley, PhD
Assistant Professor
Department of Community Health Sciences
Cumming School of Medicine
University of Calgary
Calgary Canada

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

Response: Prior studies have observed high resource use among patients with chronic kidney disease (CKD), which is related to the medical complexity of this patient population. However, there has been limited exploration of how patients with CKD use the emergency department (ED) and whether utilization is associated with disease severity. While the ED is essential for providing urgent or emergent care, identifying ways of improving ED efficiency and decreasing wait times has been recognized as a priority in multiple countries. Improving coordination and management of care for patients with multiple chronic conditions (the norm for CKD) in an outpatient setting may meet health care needs and ultimately improve patient experience and outcomes while reducing the burden currently placed on the ED. However, this requires an understanding of ED use among patients with CKD and the proportion of use that is amenable to outpatient care. Using a large population-based cohort we explored how rates of ED use vary by kidney disease severity and the proportion of these events that are potentially preventable by high quality ambulatory care.

We identified all adults (≥18 years) with eGFR<60 mL/min/1.73m2 (including dialysis-dependent patients) in Alberta, Canada between April 1, 2010 and March 31, 2011. Patients with CKD were linked to administrative data to capture clinical characteristics and frequency of ED encounters, and followed until death or end of study (March 31, 2013). Within each CKD category we calculated adjusted rates of overall  emergency departmentt use, as well as rates of potentially preventable ED encounters (defined by 4 CKD-specific ambulatory care sensitive conditions (ACSCs); heart failure, hyperkalemia, volume overload, malignant hypertension).

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Patients Who Start Dialysis in Hospital Setting Have More Comorbidities

Csaba P Kovesdy MD Fred Hatch Professor of Medicine Director, Clinical Outcomes and Clinical Trials Program Division of Nephrology, University of Tennessee Health Science Center Nephrology Section Chief, Memphis VA Medical Center Memphis TN, 38163

Dr. Csaba P. Kovesdy

MedicalResearch.com Interview with:
Dr. Csaba P. Kovesdy
Fred Hatch Professor of Medicine
Director, Clinical Outcomes and Clinical Trials Program
Division of Nephrology, University of Tennessee Health Science Center
Nephrology Section Chief, Memphis VA Medical Center
Memphis TN, 38163

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

Response: Many ESRD patients initiate dialysis in an inpatient setting. This practice is expensive, and carries potential risks (e.g. hospital associated infections, medication errors, etc.). There is very little information about the characteristics of patients who transition to ESRD (i.e. start dialysis) in an inpatient setting, and about their outcomes.

We examined a cohort of >50,000 US veterans who started dialysis during 2007-2011, and found that about half of them performed their first treatment in an inpatient setting. Compared to patients starting dialysis as outpatients, those who transitioned in an inpatient setting had a significantly higher prevalence of comorbid conditions, and were much less likely to have received pre-dialysis nephrology care, or to have a mature AV fistula or AV graft at the first hemodialysis treatment. Mortality was significantly higher in the inpatient start group, but the differences were attenuated by adjustment for comorbid conditions and vascular access.

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Difficulty Smelling May Lead to Malnutrition In Chronic Kidney Disease Patients

MedicalResearch.com Interview with:

Dr. Teodor G. Paunescu PhD Assistant Professor of Medicine Harvard Medical School Boston

Dr. Teodor G. Paunescu

Dr. Teodor G. Paunescu PhD
Assistant Professor of Medicine
Harvard Medical School
Boston

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

Response: Patients with kidney disease frequently report food aversion and poor dietary intake leading to malnutrition, a complication associated with high morbidity and mortality. However, there are no effective treatments currently available to address this complication, and the mechanisms underlying anorexia and food aversion in these patients remain unclear.
Because of the critical role of olfaction in flavor appreciation and dietary intake, we decided to quantify olfactory (smelling) deficits in advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients.

We found that patients with kidney disease have significant olfactory deficits that need objective assessments for accurate characterization. Our results also indicate that olfactory deficits likely attribute to nutritional impairment in patients with kidney disease.

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Kidney Organoids Derived from Human Pluripotent Stem Cells Model Polycystic Disease

MedicalResearch.com Interview with:

Ryuji Morizane M.D. Ph.D. Associate Biologist, Renal Division, Brigham and Women’s Hospital Affiliated Faculty, Harvard Stem Cell Institute Instructor, Harvard Medical School

Dr. Ryuji Morizane

Dr. Ryuji Morizane MD, PhD
Associate Biologist, Renal Division
Brigham and Women’s Hospital
Affiliated Faculty, Harvard Stem Cell Institute
Instructor, Harvard Medical School

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

Response: Polycystic kidney disease (PKD) accounts for 10% of end-stage kidney disease (ESKD), and there is currently no curable treatment available for patients with PKD.

The adult onset form of PKD, the most common type of PKD, takes 30 years to form cysts in humans; therefore, it is difficult to study mechanisms of PKD to find novel therapeutics for patients.

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Urate Lowering Therapy in Moderate to Severe Chronic Kidney Disease

MedicalResearch.com Interview with:

Gerald D. Levy MD Internal Medicine/Rheumatology Southern California Kaiser Permanente Downey, CA

Dr. Gerald Levy

Gerald D. Levy MD
Internal Medicine/Rheumatology
Southern California Kaiser Permanente
Downey, CA 

MedicalResearch.com: What are the main findings of your study?

Patients with hyperuricemia and chronic kidney disease (CKD)  improve when serum Uric Acid (sUA) is brought below 6mg/dl with urate lowering therapy.

We found a 6% improvement in this group compared to patients not at goal.

More importantly the stage of CKD appears to be important with CKD II showing approximately 3% who improve with nearly 10% of patients improving in the CKD III group.
We did not see benefit in those patients who are stage 4 CKD.

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No Increased Risk of Chronic Kidney Disease with Allopurinol Use

MedicalResearch.com Interview with:
Dr. Ana Beatriz Vargas dos Santos
Médica do Serviço de Reumatologia
Universidade do Estado do Rio de Janeiro

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

Response: Gout is the most common inflammatory arthritis worldwide and, despite available treatment, the management of gout remains suboptimal. One of the reasons for this suboptimal management of gout is the hesitant use of urate-lowering therapy, including a common reduction in dose or discontinuation of allopurinol in patients with gout who have kidney dysfunction based on the assumption that allopurinol may be worsening kidney function. However, there is no evidence that allopurinol is toxic for the kidneys, and this dose reduction or discontinuation results in more difficult-to-treat gout.

Chronic kidney disease (CKD) stage 3 or above occurs in approximately 20% of people with gout, and there is emerging evidence that urate-lowering therapy may improve kidney function in patients with both gout and CKD. Although CKD is common, most people with gout start out with normal kidney function. Yet, there are limited data regarding the effects of allopurinol on kidney function in such individuals. We, therefore, undertook this study to assess whether people with newly diagnosed gout who are starting allopurinol are at increased risk for developing CKD stage 3 or worse.

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