Study Finds LOKELMA™ (sodium zirconium cyclosilicate) Reduces Elevated Potassium in Hemodialysis Patients

MedicalResearch.com Interview with:

Steven Fishbane MD Chief, Division of Kidney Disease and Hypertension Vice President, Northwell Health for Network Dialysis Services, Northwell Health Professor of Medicine Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York

Dr. Fishbane

Steven Fishbane MD
Chief, Division of Kidney Disease and Hypertension
Vice President, Northwell Health for Network Dialysis Services, Northwell Health
Professor of Medicine
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Department of Medicine, Zucker School of Medicine at Hofstra/Northwell,
Great Neck, New York 


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

Response: Patients on hemodialysis have a great frequency of hyperkalemia. The hemodialysis treatment removes some potassium but not enough to get rid of this problem. Available medications to bind potassium have not been tested among these patients.

The purpose of the study was to see if sodium zirconium cyclosilicate could be used as a potassium binder to reduce the risk of hyperkalemia in patients on a hemodialysis.

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Many Dialysis Patients Do Not Think of Themselves As Having a Life Limiting Condition

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?

Response: We know that survival for people undergoing dialysis is generally quite limited.  Only a few studies have attempted to elicit how patients undergoing dialysis understand prognosis and how their prognostic awareness might be related to their interest in planning for the future, their preferences for resuscitation and the kind of care they would want if they were seriously ill or dying.

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Social Risk Factors May Influence Dialysis Quality Measures and Financial Penalties

MedicalResearch.com Interview with:
"Plugged into dialysis" by Dan is licensed under CC BY 2.0Andrew C. Qi,  Medical student

Karen E. Joynt Maddox MD MPH
Assistant professor of medicine
Washington University School of Medicine
Saint Louis, Missouri. 

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

Response: The End-Stage Renal Disease Quality Incentive Program (ESRD QIP) is a Medicare program that evaluates dialysis facilities in the U.S. based on a set of quality measures, and penalizes low-performing facilities. We’ve seen a growing understanding of how social risk factors like poverty and race/ethnicity impact patient outcomes in other settings, making it difficult for providers caring for disadvantaged populations to perform as well in these kinds of pay-for-performance programs. We were interested in seeing if this was the case for dialysis facilities as well, especially since patients receiving dialysis are already a vulnerable population.

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FARXIGA (dapagliflozin) Reduced Kidney Function Decline in Type II Diabetes

MedicalResearch.com Interview with:

Naeem Khan MD Vice President at AstraZeneca

Dr. Khan

Naeem Khan MD
Vice President at AstraZeneca 

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

Response: A pre-specified exploratory analysis of renal data from the DECLARE-TIMI 58 trial, the largest SGLT-2 inhibitor (SGLT-2i) cardiovascular outcomes trial (CVOT) conducted to date, showed that FARXIGA (dapagliflozin) reduced the composite of kidney function decline, end-stage renal disease (ESRD) or renal death by 47% in patients with type 2 diabetes (T2D).

Additionally, FARXIGA reduced the relative risk of a cardio-renal composite of kidney function decline, ESRD, or renal or cardiovascular (CV) death by 24% compared to placebo.

The analysis evaluated 17,160 patients with type 2 diabetes and predominantly preserved renal function, irrespective of underlying atherosclerotic CV disease (ASCVD).

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Use of AV Grafts Drops in Dialysis Patients, But Still Room For Improvement

MedicalResearch.com Interview with:

Caitlin W. Hicks, M.D., M.S. Assistant Professor of Surgery Recipient of the Department of Surgery Rothman Early Career Development Award for Surgical Research Johns Hopkins Medicine

Dr. Hicks

Caitlin W. Hicks, M.D., M.S.
Assistant Professor of Surgery
Recipient of the Department of Surgery
Rothman Early Career Development Award for Surgical Research
Johns Hopkins Medicine

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

Response: Arteriovenous fistula are associated with better long-term patency, lower rates of infection, and lower long-term costs compared to arteriovenous graft. As a result, the Fistula First Catheter Last Guidelines recommend placement of an arteriovenous fistula over an AVG whenever possible.

We looked at individual physician utilization of AVF vs AVG for first-time AV access in Medicare beneficiaries. We found that the median physician utilization rate for AVG was only 18%, but that 21% of physicians use AVG in more than 34% of cases, which is above currently recommended  practice guidelines. 

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PCSK9 Inhibitor (evolocumab) Added to Statin Lowered Risk of Cardiovascular Events in Kidney Disease Patients

MedicalResearch.com Interview with:

David Charytan, MD MSc Chief, Nephrology Division NYU Langone Medical Center New York, NY 10010

Dr. Charytan

David Charytan, MD MSc
Chief, Nephrology Division
NYU Langone Medical Center
New York, NY 10010 

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

Response: Cardiovascular events are much more frequent in patients with impaired kidney function (chronic kidney disease), and cardiovascular disease is the most common cause of death in advanced chronic kidney disease. This risk remains high despite the use of standard medical therapies including statins, the most commonly used cholesterol lowering agents.

The PCSK9 inhibitor evolocumab is a new class of highly potent cholesterol lowering medications that can further reduce the risk of cardiovascular events in patients already taking statins. We analyzed data from the FOURIER trial, which randomized study patients with clinically evident atherosclerosis and an LDL cholesterol level >=70 mg/dL or HDL cholesterol level >= while on a statin, to assess the safety and efficacy of evolocumab, a PCSK9 inhibitor, compared with placebo in individuals with mild to moderate chronic kidney disease.

There were several major findings

  • a) evolocumab appears to be equally safe in individuals with preserved and mild to moderately impaired kidney function
  • b) evolocumab appears to have preserved efficacy at preventing cardiovascular events as kidney function declines.
  • c) We were unable to detect any significant impact on kidney function.
  • In addition, because the baseline risk of cardiovascular events is much higher in individuals with  chronic kidney disease, the absolute benefits of treatment with evolocumab appear  to be magnified as kidney function declines.  Continue reading

Kidney Transplant: Alternative Immunosuppressant Regimens with Belatacept (NULOJIX®) May Improve Outcomes

MedicalResearch.com Interview with:

Rita R. Alloway, PharmD, FCCP Research Professor of Medicine Director, Transplant Clinical Research University of Cincinnati College of Medicine, Department of Internal Medicine Division of Nephrology  Kidney C.A.R.E. Program  (Clinical Advancement, Research & Education) Cincinnati OH 45267

Dr. Alloway

Rita R. Alloway, PharmD, FCCP
Research Professor of Medicine
Director, Transplant Clinical Research
University of Cincinnati
College of Medicine, Department of Internal Medicine
Division of Nephrology
Kidney C.A.R.E. Program
(Clinical Advancement, Research & Education)
Cincinnati OH 45267 

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

Response: Transplant recipients are required to take lifelong immunosuppression to sustain the function of their transplant.  Unfortunately these immunosuppressants have significant side effects.  The most significant of these side effects are worsening kidney function, hypertension, hypercholesterolemia, post transplant diabetes, tremors and headaches.  Researchers focused on improving post transplant outcomes are looking for immunosuppressant regimens with similar efficacy while minimizing harmful side effects.

Tacrolimus and steroids are the immunosuppressants associated with the worst side effect profiles.  This study eliminated both of these immunosuppressants and replace tacrolimus with belatacept.  Belatacept is a once monthly intravenous infusion with a more favorable side effect profile compared to tacrolimus.  In addition, since it is a monthly infusion, adherence can improved compared to an oral medication taken twice daily.

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Many ER Patients with Elevated Potassium, End up Being Admitted After Discharge

MedicalResearch.com Interview with:
AstraZenecaJill Davis, MS
Director, Health Economics and Outcomes Research
AstraZeneca 

MedicalResearch.com: What is the background for this study? Who is most at risk for hyperkalemia post discharge?

Response: In the United States, an estimated 30 million people suffer from chronic kidney disease (CKD), about 3.7 million of which have hyperkalemia (elevated potassium level). Hyperkalemia (HK) can be chronic, so it’s important that those who have been diagnosed with hyperkalemia previously or have CKD have their potassium levels monitored by their healthcare provider. Additionally, although HK is estimated to be prevalent in more than 66,000 emergency department (ED) visits annually, there is limited knowledge about the management of patients with HK in the ED setting and post-discharge. We decided to focus our study to better understand and compare the ED management and post-discharge outcomes among patients with varying levels of hyperkalemia

To conduct this study, we analyzed the electronic medical record data from the Research Action for Health Network (2012-2018) of 6,222 adult patients with a randomly selected HK-related ED visit. We concluded that improved management of HK patients in the ED and post-discharge period is needed to reduce the recurrence of hyperkalemia.

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Dialysis Unit Profit Primarily From Small Percentage of Privately Insured Patients

MedicalResearch.com Interview with:

Chris Childers, MD, PhDDivision of General SurgeryDavid Geffen School of Medicine at UCLA10833 Le Conte Ave., CHS 72-247Los Angeles, CA 90095

Dr. Childers

Chris Childers, MD, PhD
Division of General Surgery
David Geffen School of Medicine at UCLA
Los Angeles, CA 90095

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

Response: Patients with end-stage renal disease – poorly functioning kidneys – often have to receive dialysis. This typically requires a patient to visit an outpatient clinic several times a week to have their blood filtered by a machine. Over the past few years, two for-profit companies have increased their control over the outpatient dialysis market – DaVita and Fresenius. Combined they control approximately ¾ of the market.  A number of concerns have been raised against these for-profit companies suggesting that the quality of care they deliver may be worse than the care delivered at not-for-profit companies. But, because they control so much of the market and because patients have to receive dialysis so frequently, patients may not have much choice in the clinic they visit.

Medicare covers patients who are 65 years or older and also patients on dialysis regardless of age.  Medicare pays a fixed rate for dialysis which they believe is adequate to cover the clinics’ costs. However, if a patient also has private insurance, the insurer is required to pay for dialysis instead of Medicare. Whereas Medicare rates are fixed by the federal government, private insurers have to negotiate the price they pay, and may pay much more as a result.

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Performance of Formulas for Estimating Kidney Function in the Elderly

MedicalResearch.com Interview with:
Dr. Luciano da Silva Selistre MD MS PhD

Professor de Medicina – UCS

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

Response:   We have found that no equation for estimating renal function in the elderly is fully accurate. There are important mistakes between them.

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Angion Receives Support to Develop Drug Candidate for a Scarring Form of Kidney Disease, FSGS

MedicalResearch.com Interview with:

Dr. Jay Venkatesan MDPresident and CEO of Angion

Dr. Venkatesan

Dr. Jay Venkatesan MD
President and CEO of Angion

Dr. Venkatesan discusses the recent announcement that ANGION, has received DOD funding for the study of ANG-3070, in treatment of CKD caused by focal segmental glomerulosclerosis, 

MedicalResearch.com: What is the background for this announcement? Would you tell us a little about focal segmental glomerulosclerosis (FSGS)? How does ANG-3070 work to prevent kidney scarring?

Response: Angion has received a follow-on grant from the Department of Defense (DoD) for $4.76 million in support of the development of ANG-3070, our drug candidate for a form of chronic kidney disease known as focal segmental glomerulosclerosis (FSGS). This funding will allow us to expand our proof-of-concept data for ANG-3070 as a potential anti-fibrotic agent for slowing the progression of FSGS.

FSGS is a serious kidney disorder characterized by progressive scarring of the glomeruli, the filtering units of the kidney. There are approximately 80,000 cases of FSGS in the U.S. and Europe, involving both children and young adults. If uncontrolled, FSGS can lead to kidney failure, which may lead to the need for dialysis or a kidney transplant. No therapies exist that treat the underlying cause of FSGS. Therapies such as corticosteroids, immunosuppressants or diuretics  are used, but are mainly supportive and a large proportion of patients progress to end-stage renal disease over a 5-10 year period of time.

ANG-3070 is an oral small molecule that selectively inhibits molecular pathways associated with scarring or fibrosis in the kidney and other organs. Our current preclinical study in collaboration with NEPTUNE aims to identify the “signalosome,” or human disease and drug response profile based on the genes, networks and pathways that correlate with the therapeutic activity of ANG-3070 in FSGS. Ultimately, this collaboration will allow us to  develop a precision medicine approach to identify and treat patients in whom ANG-3070 is most likely to block the pathways causing FSGS. 

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Integrated Approach to Laboratory Measurements to Identify Acute Kidney Diseases

MedicalResearch.com Interview with:

Matthew T James MD, PhDAssistant ProfessorUniversity of Calgary

Dr. James

Matthew T James MD, PhD
Assistant Professor
University of Calgary 

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

Response: The Acute Kidney Disease and Disorders (AKD) criteria from the KDIGO Acute Kidney Injury guidelines identified many patients who do not meet existing criteria for Chronic Kidney Disease or Acute Kidney Injury (AKI), and the majority of AKD events occured in the community rather than hospital setting.

This study characterized the frequency and outcome for patients with AKD (without  AKI) as well as AKD with CKD from among over 1.1 million adults  residing in Alberta Canada who received  kidney function testing and were followed for up to 8 years.

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Peptide May Reduce Inflammation in Kidney Disease

MedicalResearch.com Interview with:

Rudolf Lucas, PhDProfessor Pharmacology and ToxicologyVascular Biology Center, Division of Pulmonary Medicine

Dr. Lucas

Rudolf Lucas, PhD
Professor Pharmacology and Toxicology
Vascular Biology Center, Division of Pulmonary Medicine

Michael P. Madaio, MDSydenstricker Professor and ChairmanDepartment of Medicine

Dr. Madaio


Michael P. Madaio, MD

Sydenstricker Professor and Chairman
Department of Medicine

Medical College of Georgia
Augusta University
Augusta, Georgia 30912, USA.

 

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

Response: The pro-inflammatory cytokine tumor necrosis factor (TNF) is a crucial mediator of glomerulonephritis, but the cytokine is also important in defense to bacterial infections. As such, chronically inhibiting TNF, using soluble TNF receptor constructs or neutralizing anti-TNF antibodies can promote infection.

In this study, we wanted to develop a novel therapeutic strategy to specifically inhibiting deleterious TNF signaling, while preserving the beneficial anti-bacterial actions of the cytokine.

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Kidney Transplant Patients Risk Transplant Rejection When Medicare Coverage Ends

MedicalResearch.com Interview with:

Allyson Hart MD MSDepartment of Medicine, Hennepin Healthcare,University of MinnesotaMinneapolis, Minnesota

Dr. Hart

Allyson Hart MD MS
Department of Medicine, Hennepin Healthcare,
University of Minnesota
Minneapolis, Minnesota

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

Response: Kidney transplantation confers profound survival, quality of life, and cost benefits over dialysis for the treatment of end-stage kidney disease. Kidney transplant recipients under 65 years of age qualify for Medicare coverage following transplantation, but coverage ends after three years for patients who are not disabled.

We studied 78,861 Medicare-covered kidney transplant recipients under the age of 65, and found that failure of the transplanted kidney was 990 percent to 1630 percent higher for recipients who lost Medicare coverage before this three-year time point compared with recipients who lost Medicare on time. Those who lost coverage after 3 years had a lesser, but still very marked, increased risk of kidney failure. Recipients who lost coverage before or after the three-year time point also filled immunosuppressive medications at a significantly lower rate than those who lost coverage on time. Continue reading

Excessive Inorganic Phosphate Food Additives May Make Us More Sedentary

MedicalResearch.com Interview with:

Wanpen Vongpatanasin, M.D. Professor of Medicine Norman & Audrey Kaplan Chair in Hypertension Fredric L. Coe Professorship in Nephrolithiasis and Mineral Metabolism Research Director, Hypertension Section, Cardiology Division, UT Southwestern Medical Center Dallas, TX 75390-8586

Dr. Vongpatanasin

Dr. Wanpen Vongpatanasin, M.D.
Professor of Medicine
Norman & Audrey Kaplan Chair in Hypertension
Fredric L. Coe Professorship in Nephrolithiasis and Mineral Metabolism Research
Director, Hypertension Section,
Cardiology Division,
UT Southwestern Medical Center 

 

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

Response: Increased sedentary activity is commonly seen in people who regularly consume fast food but previously studies have not identified potential mechanisms beyond increased obesity and lack of motivation. Our study seeks to determine if inorganic phosphate, a commonly used food additives that are present in up to 70% of foods in the American diet, maybe the culprit. These food additives (which may come in the form of monocalcium phosphate, phosphoric acid, or tetrasodium phosphate, etc. are used to make the food taste better and/or last longer. It is found mostly in prepackaged foods, cola drinks, and bakery items (cookies, cake, and bread). This is very different from organic phosphates that are found naturally in many healthful foods, such as fruits and vegetables, which are not not readily absorbed from the GI tract.

In the Dallas Heart Study, a multiethnic population-based study, we found that serum phosphate is significantly associated with sedentary time and increased time spent in moderate-to-vigorous physical activity which was measured by wrist actigraphy device. This is not explained by reduce cardiac function as ejection fraction remains normal at higher serum phosphate. Continue reading

Highest NSAID Usage Levels in Working Age Adults Linked to Greater Risk of Kidney Disease

MedicalResearch.com Interview with:
Alan Nelson, MPAS, PhD
Division of Primary Care and Population Health, Department of Medicine
Stanford University School of Medicine
Stanford, California 

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

Response: The past research literature has provided relatively little information on the appropriate level of concern regarding non-steroidal anti-inflammatory drugs (NSAIDs) and kidney disease risk among younger, apparently healthy patients. Clinicians are generally most concerned about the effects of these medications on the kidneys among patients with existing renal impairment and persons at risk for it, especially older patients.

Given that NSAID use appears to be high and rising in the US, we were interested in developing evidence on this topic in a population of working-age adults.

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Kidney Transplant Patients at Increased Risk of Skin Cancer, Even After Graft Stops Working

MedicalResearch.com Interview with
"Kidney Model 9" by GreenFlames09 is licensed under CC BY 2.0. To view a copy of this license, visit: https://creativecommons.org/licenses/by/2.0Donal JSextonMD, PhD
Department of Nephrology and Kidney Transplantation
Beaumont Hospital
Royal College of Surgeons in Ireland
Dublin, Ireland

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

Response: Patients who receive a kidney transplant as treatment for end stage kidney disease are at risk of malignancy due to immunosuppression. In contrast to

other solid organ transplant types, when kidney transplants fail it is possible for recipients to return to dialysis. Immunosuppression is usually reduced or completely stopped when  the allograft fails due to the risk of infection on dialysis.

We decided to investigate what the trajectory of risk for non-melanoma skin cancer and invasive cancers overall (composite group) looked like for patients who have received multiple consecutive kidney transplants with intervening periods of graft failure. We compared cancer risk during periods of allograft failure and periods of functioning kidney transplants.   Continue reading

End Stage Kidney Disease: Decoding How Patients Decide to Forgo Dialysis

MedicalResearch.com Interview with:

Susan P. Y. Wong, MD MS Assistant Professor Division of Nephrology University of Washington VA Puget Sound Health Care System 

Dr. Wong

Susan P. Y. Wong, MD MS
Assistant Professor
Division of Nephrology
University of Washington
VA Puget Sound Health Care System 

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

Response: Patients who reach the advanced stages of kidney disease  must often face the difficult decision of whether to undergo maintenance dialysis.

While maintenance dialysis is a remarkable therapy that has extended the lives of many patients, its benefits do not necessarily accrue in older patients with significant comorbidity and functional impairment. It is also a very demanding form of therapy that comes with its own burdens and complications. Based on our prior research in the national VA health system, 1 in 7 patients with very advanced kidney disease (or their decision makers) do not pursue dialysis. We wanted to understand how these decisions to forgo initiation of maintenance dialysis unfold.

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Chronic Kidney Disease: Exome Sequencing Can Help Resolve Some Diagnostic Challenges

MedicalResearch.com Interview with:
Emily E. Groopman, B.A
Departments of Medicine
Hammer Health Sciences, and the Department of Epidemiology
Columbia University, New York

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

Response: Exome sequencing (ES), targeted capture of the protein-coding segments of the human genome, is quickly becoming a first-line diagnostic tool in clinical medicine, particularly for pediatric disorders and cancer. However, the utility of ES has not been investigated for the majority of constitutional disorders in adults, including for chronic kidney disease (CKD), which collectively affects more than 1 in 10 individuals worldwide.

Thus, we performed ES in 3,315 patients with CKD drawn from two independent cohorts, and evaluated the diagnostic yield and the clinical implications of genetic findings. The cohort was predominantly adult (91.6% of patients aged >21 years), ethnically diverse, and encompassed the major CKD subtypes, broadly reflective of the demographic and clinical features of United States CKD patient population.

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Soda, Sugary Drinks Linked to Increased Risk of Kidney Disease

MedicalResearch.com Interview with:

Casey M. Rebholz, PhD, MS, MNSP, MPH, FAHA Assistant Professor, Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Core Faculty, Welch Center for Prevention, Epidemiology, and Clinical Research Baltimore, MD 21287

Dr. Rebholz

Casey M. Rebholz, PhD, MS, MNSP, MPH, FAHA
Assistant Professor, Department of Epidemiology
Johns Hopkins Bloomberg School of Public Health
Core Faculty, Welch Center for Prevention, Epidemiology, and Clinical Research
Baltimore, MD 21287

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

Response: Individual beverages have been previously shown to influence risk of a wide range of cardiometabolic diseases. Less is known about beverage consumption and kidney disease risk.

In this study population, we found that one such beverage pattern consisted of soda, sugar-sweetened beverages, and water, and that higher adherence to the sugar-sweetened beverage pattern was associated with greater odds of developing incident kidney disease, even after accounting for demographic characteristics and established risk factors.  Continue reading

Emergency-Only Dialysis For Undocumented Immigrants Costs More Money and Lives

MedicalResearch.com Interview with:

Oanh Kieu Nguyen, MD, MA Assistant Professor Division of Hospital Medicine Zuckerberg San Francisco General Hospital UCSF

Dr. Nguyen

Oanh Kieu Nguyen, MD, MA
Assistant Professor
Division of Hospital Medicine
Zuckerberg San Francisco General Hospital
UCSF

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

Response: In U.S. citizens and permanent residents with kidney failure or end-stage renal disease (ESRD), having health insurance, Medicare, or Medicaid guarantees access to regularly scheduled hemodialysis 2-3 times per week, the evidence-based standard of care for ESRD. This treatment helps people live relatively normal lives. In 40 of 50 U.S. states, undocumented immigrants with ESRD have limited access to hemodialysis because they are not eligible for any form of federal assistance including Medicare or Medicaid, and must wait until they are life-threateningly ill to receive dialysis through a hospital emergency department, a situation called “emergency-only hemodialysis.” There are an estimated 6,500 undocumented individuals in the U.S. suffering from ESRD.

A unique opportunity made it feasible for uninsured undocumented immigrants with ESRD receiving emergency-only dialysis in Dallas, Texas, to enroll in private, commercial health insurance plans in 2015 and made it possible for researchers to compare scheduled vs. emergency-only dialysis among undocumented immigrants with ESRD. This natural experiment included 181 undocumented immigrants, 105 of whom received insurance coverage and enrolled in scheduled dialysis and 76 of whom remained uninsured.  Continue reading

Study Finds Kidneys With AKI Can Be Safely Transplanted

MedicalResearch.com Interview with:

Chirag R Parikh, M.B.B.S., Ph.D. Director,Division of Nephrology Professor of Medicine School of Medicine, Johns Hopkins University Baltimore, Maryland 21287

Dr. Parikh

Chirag R Parikh, M.B.B.S., Ph.D.
Director,Division of Nephrology
Professor of Medicine
School of Medicine, Johns Hopkins University
Baltimore, Maryland 21287 

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

Response: The initial study idea stemmed from our earlier cohort studies of predictors of delayed graft function after kidney transplantation.  We previously found that kidneys from donors with Acute Kidney Injury (AKI) were more often discarded than kidneys from donors without AKI, and transplanted donor AKI kidneys were at increased risk for delayed graft function.

It was important to determine whether that increased risk for delayed graft function also translated into worse long-term outcomes for recipients of kidneys from donors with AKI.

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Chronic Kidney Disease Rate Rising Faster Than Other Noncommunicable Diseases

MedicalResearch.com Interview with:

Dr. Ziyad Al-Aly, MD Associate Chief of Staff for Research and Education Veterans Affairs St. Louis Health Care System

Dr. Al-Aly

Dr. Ziyad Al-Aly, MD
Associate Chief of Staff for Research and Education
Veterans Affairs St. Louis Health Care System
Institute for Public Health
Washington University, St. Louis MO

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

Response: A lot has changed in the US over the past 15 years including aging, population growth, and increased exposure to risk factors such as obesity, elevated blood pressure, etc. With all of these changes, we wondered, how did the burden of kidney disease change in the United States over the past 15 years.
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Genome Analysis Can Overestimate Incidence of Chronic Kidney Disease

MedicalResearch.com Interview with:

Hila Milo Rasoul, PhD Postdoctoral research scientist Ali Gharavi Lab Columbia University

Dr. Milo Rasouly

Hila Milo Rasouly, PhD
Postdoctoral research scientist
Ali Gharavi Lab
Columbia University

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

Response: Genome sequencing is increasingly used in clinical medicine to help make a clinical diagnosis and make predictions about potential future complications. The diagnostic yield and limitations for different indications are still being worked out.  We are interested in studying the applications of genome sequencing for chronic kidney diseases. It is estimated that 10% of adults have chronic kidney disease (CKD), and amongst them, 10% are caused by single-gene (Mendelian) forms of disease.

The American College of Medical Genetics and Genomics developed guidelines on how to interpret genetic variants in order to make a genetic diagnosis. Our lab has been engaged in studying the yield and impact of genetic testing for  CKD, and in the course of our research, we realized that a very large number of individuals have genetic variants that may be classified as pathogenic based on automated application of the guidelines. However, in majority of these cases, the genetic variant was much too frequent in the population to be plausibly disease-causing or did not match up well with the clinical diagnosis. This led us to wonder about the risk of false-positive genetic diagnosis. To analyze this risk for false-positive genetic diagnosis, we analyzed the genome sequence of 7,974 self-reported healthy adults.

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Dapagliflozin (FARXIGA): Reduction in Albuminuria Cannot Be Predicted by Clinical Characteristics

MedicalResearch.com Interview with:

Dr-Danilo Verge.png

Dr. Verge

Danilo Verge MD MBA
Vice President, CVRM Global Medical Affairs
AstraZeneca

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

Response: Dapagliflozin, an SGLT2 inhibitor (sodium-glucose co-transporter 2), has been shown to improve glycemic control by decreasing glucose reabsorption in the kidneys and inducing urinary glucose clearance. SGLT2 inhibitors have also been shown to be effective in lowering albuminuria and stabilizing eGFR (estimated glomerular filtration rate). The effect of dapagliflozin on UACR (urine albumin-to-creatinine ratio) has been shown to vary among patients.

The objective of this post-hoc analysis, based on the pooled data from 11 randomized, placebo-controlled clinical trials, was to assess baseline characteristics and concurrent changes in cardiovascular (CV) risk markers associated with UACR response to dapagliflozin.

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Real-World Dosing of RAASi are Associated With Risk of Adverse Events in CKD

MedicalResearch.com Interview with:

Lei Qin

Lei Qin

Lei Qin MS
Director, Health Economics and Payer Analytics
AstraZeneca

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

Response: Renin-angiotensin-aldosterone system inhibitors (RAASi) are guideline-recommended therapies for patients with chronic kidney disease (CKD), but are commonly prescribed at suboptimal doses, which has been associated with worsening clinical outcomes. The objective of our study was to estimate the real-world associations between RAASi dose and adverse clinical outcomes in patients prescribed RAASi therapies with new-onset CKD in the UK.

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LOKELMA (Sodium zirconium cyclosilicate) for Elevated Potassium: Results of the HARMONIZE GLOBAL Study

MedicalResearch.com Interview with:

Rahul Agrawal MD PhD VP, Global Medicines Leader AstraZeneca

Dr. Agrawal

Rahul Agrawal MD PhD
VP, Global Medicines Leader
AstraZeneca

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

About the study: HARMONIZE Global is a Phase III, randomized, multicenter, double-blind, placebo-controlled trial involving 267 patients with hyperkalemia (mean potassium levels greater than 5.0 mEq/L) in 47 study locations across the Asia Pacific region, which will support registration in Japan, Taiwan, Korea and Russia.

Study design: The trial design of HARMONIZE Global is similar to HARMONIZE (NCT02088073) but evaluated two doses of LOKELMATM (sodium zirconium cyclosilicate) instead of three, as well as patients in different geographical regions. Continue reading

Medicaid Expansion Linked To Lower Death Rates for Kidney Failure Patients

MedicalResearch.com Interview with:
"Plugged into dialysis" by Dan is licensed under CC BY 2.0Amal Trivedi, MD, MPH

Associate Professor of Health Services, Policy and Practice
Associate Professor of Medicine
Brown University

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

Response: The Affordable Care Act Medicaid expansion gave states the option to expand coverage to low-income adults. Prior research has reported that these expansions have been associated with increased coverage, improved access to care, and in some studies better self-rated health. To date the impact of Medicaid expansion on mortality rates, particularly for persons with serious chronic illness, remains unknown.

Our study found an association between Medicaid expansion and lower death rates for patients with end-stage renal disease in the first year after initiating dialysis.  Specifically, we found an absolute reduction in 1-year mortality in expansion states of -0.6 percentage points, which represents a 9% relative reduction in 1-year mortality.      Continue reading

New Drug Class Offers Hope for Calcified Blood Vessels

MedicalResearch.com Interview with:

Dr Mattias Ivarsson PhD CEO, Inositec, co-author of data  

Dr. Ivarsson

Dr Mattias Ivarsson PhD
CEO, Inositec, co-author of data

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

Response: When control of factors in the blood that regulate mineral balance in the body is lost, the subsequent build-up of calcium deposits in the arterial walls and cardiac valves lead to an increase in cardiac events, particularly in patients with chronic kidney disease or diabetes, as well as all-cause mortality.

There is a significant unmet need for therapeutic agents capable of reducing pathological mineral accumulation regardless of their root cause. To date, there is no approved therapy for treating calcification-dependent cardiovascular disease.  Continue reading

Is there an Association between Cannabis and Acute Kidney Injury in CKD Patients?

MedicalResearch.com Interview with:
"Big bags of medical #marijuana on Cannabis Culture News LIVE - watch now on www.pot.tv" by Cannabis Culture is licensed under CC BY 2.0Praveen Kumar Potukuchi, B.Pharm, MS
The University of Tennessee Health Science Center

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

Response: Several case reports have indicated that synthetic cannabinoid use is associated with acute kidney injury (AKI). However, it is unclear whether similar adverse effects could occur with medicinal or recreational cannabis use. Previous research has shown that the use of medical marijuana /cannabis for an average of two weeks resulted in no serious adverse effects and no incidence of AKI.

However, there are no studies which investigated the effects of marijuana/cannabis use on the incidence of AKI in patients with advanced CKD.

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