Kidney Disease
20 Nov Exercise Improves Outcomes in Dialysis Patients
MedicalResearch.com Interview with:
Prof. Francesca Mallamaci
Professor of Nephrology
Head of the Hypertension Unit at the Department of Nephro-Urology, CNR-IBIM Research on Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
Medical Research: What is the background for this study? What are the main findings?
Dr. Mallamaci: It is well known that physical activity is beneficial both in normal individuals and in patients with heart failure which represent a high risk category of patients. We have scanty information about physical activity in dialysis patients. So the aim of our study was to test the effectiveness of a low-intensity, easy to implement, home exercise program on physical performance in about 300 dialysis patients in a multicenter, randomized, controlled clinical trial (EXCITE, ClinicalTrials.gov NCT01255969). What we found in our study was that dialysis patients who performed exercise improved their physical performance and this was documented by 2 well known and validated performance tests such as the Six Minute Walking Test and the Sit-to-stand-to sit test. We found also that after 2 year follow-up dialysis patients who were in the active exercise arm had a lower rate of hospitalization and a trend to a better survival, compared to dialysis patients in the control arm of the study.
19 Nov Modified-Release Calcifediol Corrects Vitamin D Deficiency, Secondary Hyperparathyroidism in Chronic Kidney Disease
MedicalResearch.com Interview with:with
Stuart M. Sprague, DO, FACP, FASN, FNKF
Chairperson, Division of Nephrology and Hypertension
NorthShore University HealthSystem
Evanston, Illinois 60201
Medical Research: Congratulations, Dr. Sprague, on your presentation of another successful phase 3 clinical trial program at the recently concluded Annual Meeting of the American Society of Nephrology. Your presentation unveiled a new vitamin D repletion therapy that effectively controls secondary hyperparathyroidism in chronic kidney disease. Can you give us a little background for the presented studies?
Dr. Sprague: Thanks! Vitamin D insufficiency is a big problem in chronic kidney decease (or CKD): it afflicts more than 20 million adults in the United States who have stages 1 through 4 CKD. Its prevalence increases with CKD severity and it drives secondary hyperparathyroidism. The studies which I presented evaluated a novel therapy to treat secondary hyperparathyroidism (SHPT) arising from vitamin D insufficiency in patients diagnosed with stage 3 or 4 CKD. This new therapy is a modified-release formulation of calcifediol.
Medical Research: Can you tell us more about vitamin D insufficiency?
Dr. Sprague: Vitamin D insufficiency is a condition in which the body has low vitamin D stores. It is characterized by inadequate blood levels of the vitamin D, known as 25-hydroxyvitamin D. An estimated 70-90% of CKD patients have vitamin D insufficiency, which can lead to SHPT and resultant debilitating bone diseases. Vitamin D insufficiency has also been associated with increased mortality in CKD.
16 Nov Many Dialysis Patients Have Limited Disaster Preparedness
Posted at 12:57h
in Kidney Disease
MedicalResearch.com Interview with:
Anu Wadhwa, M.D.
Assistant Professor of Medicine
Division of Nephrology and Hypertension
Loyola University Medical Center/ Hines VA Hospital
Maywood, IL-60153
Medical Research: What is the background for this study?
Dr. Wadhwa: Patients with end stage renal disease rely on dialysis treatments to survive. Hence this population is very vulnerable during emergencies or disaster situations. We believe that patient education on an individual level is the cornerstone of a successful disaster plan. In this quality improvement study, we assessed disaster preparedness in our dialysis patients and evaluated multidisciplinary approach to disseminate this information. Multidisciplinary team of physicians, nurses, dieticians and social workers reviewed preparedness-relevant topics with the patients. Patients were provided purple cards (created by KCER) with emergency information to carry with them at all times. A simple yes/no questionnaire asking disaster preparedness relevant questions was given to the patients before and after this education was provided. Disaster preparedness was defined as perceived preparedness (survey question) and a positive response to at least three key questions-having a plan they have had discussed with a family member or dialysis unit, knowledge of backup dialysis facility and familiarity with emergency diet plan.
15 Nov Over Half US Population Not Healthy Enough To Donate A Kidney
MedicalResearch.com Interview with:
Anthony Bleyer, Jr.
Wake Forest University Class of 2015, Economics
President, Club Sports Union
Senior Captain, Wake Forest Men's Ultimate
Medical Research: What is the background for this study? What are the main findings?
Response: There are over 100,000 individuals waiting for a kidney transplant, but each year only approximately 6,000 individuals have living donors who donate them a kidney; the rest of the individuals must remain on dialysis until they receive a kidney from an individual who has died and is a kidney donor. A major limiting factor for kidney donation is that many individuals are not healthy enough to donate a kidney because they have excessive obesity, diabetes mellitus, blood pressure that is too high, or they have other health conditions. While it was known that obesity, hypertension, and other health conditions are contraindications to kidney transplant, there was no data about what percentage of the US population would be able to donate a kidney. To study this, we (a team of kidney doctors and researchers at Wake Forest School of Medicine, Winston-Salem, NC) analyzed data from the National Health and Nutrition Survey. This study is a population-based sample that is representative of the US population.
Based on data from this study, we determined that 55.2% of the U.S. population would not have met eligibility criteria for kidney donation, often due to preventable health conditions. 19.2% of the population would have been unable to donate due to hypertension, 15% due to obesity, 11.6% due to excessive alcohol intake, and 11.5% due to diabetes. 60.1% of individuals with an adjusted family household income (AFHI) <$35,000 did not meet eligibility criteria vs. 49.3% for an AFHI > $100,000. If one considers non-US citizenship and a family income below the poverty threshold as exclusion criteria, 68.5% of the US population would be unable to donate.
14 Nov Dialysis Patients Generally Unprepared For Natural Disasters
MedicalResearch.com Interview with: Naoka Murakami MD PhD Mount Sinai Beth Israel Department of Medicine Medical Research: What is the background of the study? What are the main findings? Dr. Murakami: Dialysis patients live in a complex sociomedical situation and are highly dependent on technologies to sustain their lives; such as transportation, electricity and water for the dialysis apparatus. Interruption of this infrastructure by a natural disaster can result in devastating outcomes. During triage of patients arriving at Mount Sinai Beth Israel in the immediate aftermath of hurricane Sandy, we observed that many dialysis patients did not know about their medications, their comorbid conditions nor their dialysis prescriptions. Therefore we conducted a cross-sectional follow-up study of 357 hemodialysis patients in five dialysis units in lower Manhattan, New York. Using checklists prepared by the National Kidney Foundation and the Department of Homeland Security, we found that 26.3% subjects missed dialysis sessions and 66.1% received dialysis at non-regular dialysis unit(s). We observed that the distribution of a “Dialysis emergency packet” significantly improved retention of medical records at home. Analysis showed that dialysis-specific preparedness, racial ethnicity (non-African American, Hispanic or Caucasian), reception of dialysis in affiliated units, and older age, were associated with a significant reduction in missed dialyses.06 Nov LDL Linked to Acute Kidney Injury in Stent Surgery Patients
MedicalResearch.com Interview with: Ning Tan, MD, PHD Senior Consultant Cardiologist. Department of Cardiology Guangdong Cardiovascular Institute Guangdong General Hospital Guangdong Academy of Medical Sciences Guangzhou, Guangdong, China Medical Research: What are the main findings of the study? Dr. Tan: In this study, we evaluated whether Low density lipoprotein cholesterol (LDL-C) is an independent risk factor of contrast-induced acute kidney injury (CI-AKI) in patients undergoing percutaneous coronary intervention (PCI). We prospectively enrolled 3236 consecutive patients undergoing PCI in our hospital and demonstrated that LDL-C is significantly and independently associated with CI-AKI in patients undergoing PCI.13 Oct Patients with Atrial Fibrillation Recurrence More Likely To Have Kidney Function Decline
MedicalResearch.com Interview with:
Dr Jelena Kornej
Department of Electrophysiology
Heart Center Leipzig Leipzig Germany;
Medical Research: What are the main findings of the study?
Dr. Komej: Both atrial fibrillation (AF) and renal impairment are known to coexist and associated with increased morbidity and mortality. However, there is only limited data on changes of renal function after AF catheter ablation and predictors thereof. This is the largest study analyzing the effects of atrial fibrillation catheter ablation on renal function and changes thereof in a contemporary population during mid-term follow-up. We found that lower baseline eGFR was associated with higher CHADS2 and CHA2DS2-VASc scores and that both scores were independently associated with eGFR changes after atrial fibrillation catheter ablation as were atrial fibrillation recurrences.
30 Sep Serum IL-31 Linked to Itching in Hemodialysis Patients
MedicalResearch.com Interview wth: Mei-Ju Ko, MD, PhD Department of Dermatology, Taipei City Hospital Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. Medical Research: What are the main findings of the study? Dr. Ko: In this study, not only did we find that serum levels of interleukin (IL)-31 were significantly higher in hemodialysis patients with pruritus symptoms, but we also demonstrated a positive exposure-response relationship between IL-31 levels and visual analog scale (VAS) scores of pruritus intensity. We also noted an inverse correlation between the severity of pruritus and the dialysis dose assessed by Kt/V.27 Sep Physical Activity Did Not Reduce Incidence of Kidney Stones
MedicalResearch.com Interview with:
Pietro Manuel Ferraro, MD PhD Candidate
Division of Nephrology
Catholic University of the Sacred Heart
Rome Italy
Medical Research: What are the main findings of the study?
Dr. Ferraro: We analyzed the association between physical activity and energy intake and the risk of developing kidney stones in three large cohorts of U.S. health professionals. The 215,133 participants included did not have any history of kidney stones when follow-up began. During 20 years of follow-up, 5,355 of them developed a kidney stone. Initially, we found that participants with higher physical activity levels had a reduced risk of developing stones in two of the three cohorts. However, after accounting for a number of factors that could potentially confound the association such as age, body mass index and dietary intake, the association was no longer significant. Similarly, energy intake was not associated with a reduced risk of developing kidney stones.
22 Sep Chronic Kidney Disease: Lower Blood Pressure May Equal Higher Mortality
Posted at 00:25h
in Author Interviews, Blood Pressure - Hypertension, General Medicine, JAMA, Kidney Disease
MedicalResearch.com: Interview Invitation
Dr. Csaba P. Kovesdy, MD
Professor of Medicine
University of Tennessee Health Science Center
Chief of Nephrology
Memphis Veterans Affairs Medical Center
Medical Research: What are the main findings of the study?
Dr. Kovesdy: We applied the structure of a clinical trial of hypertension management to our cohort of >600,000 patients with prevalent Chronic Kidney Disease (CKD). We first identified patients with baseline uncontrolled hypertension (using the definition applied by the SPRINT trial), then isolated the ones who had a decline in their baseline systolic blood pressure to two different levels (<120 and 120-139 mmHg) in response to a concomitant increase in prescribed antihypertensives, similar to what would happen in a trial examining two different systolic blood pressure targets. We then matched patients in the two groups to end up with identical baseline characteristics, similar to a randomized trial. When we examined the all-cause mortality of these two groups, we found that the group with follow-up systolic blood pressure of <120 had a 70% higher mortality.
21 Aug Recurrent Hypoglycemia Raises Stroke Risk in Kidney Disease Patients
MedicalResearch.com Interview with: Prof. Chia-Huang Kao From the Graduate Institute of Clinical Medical Science Department of Radiation Oncology and Nuclear Medicine and PET Center Graduate Institute of Clinical Medical Science China Medical University Hospital, Taichung, Taiwan. Medical Research: What are the main findings of the study? Prof. Kao: Patients with chronic kidney disease (CKD) are at high risk for hypoglycemia; several factors are reported to contribute to hypoglycemia in these patients. However, most previous studies were limited by the relatively small number of patients with CKD included in the study by the exclusion of cases with CKD. In the present study, the incidence rate of hypoglycemia in patients with CKD was 4.5%, which is approximately twice the value noted in previous reports and multivariate analysis revealed a 2.53-fold increase in the risk of death for CKD patients with hypoglycemia after adjusting for related confounding factors including hypertension, hyperlipidemia, diabetes, and antidiabetic drugs.20 Aug Chronic Kidney Disease Checklist Improves Primary Care Management
Posted at 20:26h
in Author Interviews, Brigham & Women's - Harvard, Compliance, Kidney Disease, Primary Care
MedicalResearch.com Interview with:
Mallika L. Mendu, M.D.
Division of Renal Medicine
Brigham and Women’s Hospital
Boston, MA 02115.
Medical Research: What are the main findings of the study?
Dr. Mendu: Our study found that implementation of a chronic kidney disease (CKD) checklist, a tool that succinctly and clearly outlines CKD management guidelines, in a primary care clinic improved adherence to a number of significant management guidelines. We conducted a prospective study during a one year period among 13 primary care providers, four of whom were assigned to use a CKD checklist incorporated into the electronic medical record during visits with patients with CKD. Patients whose providers utilized a CKD checklist had higher rates of adherence to annual albuminuria testing, parathyroid hormone testing, phosphate testing, achieving a hemoglobin A1c target<7, documentation of avoidance of nonsteroidal anti-inflammatory drugs, use of an angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker and vaccination for annual influenza and 5-year pneumococcus.
05 Aug Is There A Sweet Spot For Systolic Blood Pressure Control?
MedicalResearch.com Interview with:
Dr. John J. Sim
Division of Nephrology and Hypertension
Kaiser Permanente Los Angeles Medical Center, Los Angeles,
Medical Research: What are the main findings of the study?
Dr. Sim: Among a large diverse population of treated hypertensive people, those who achieved systolic blood pressures (SBP) in the ranges of 130-139mm Hg had the lowest risk for death and end stage renal disease (kidney failure). Not surprisingly, those with SBP above 139 had incrementally greater risk, but somewhat surprising was that those with SBP under 130 also had a greater risk for death and kidney failure.
31 Jul Need For Better Measure of Kidney Function in Severe Obesity
Posted at 15:15h
in Author Interviews, Gender Differences, Kidney Disease, Mayo Clinic, Weight Research
MedicalResearch.com Interview with
Dr. John C. Lieske, MD
Mayo Clinic, Rochester, MN
Medical Research: What are the main findings of the study?
Dr. Lieske: We followed 11 women before, 6 and 12 months after Roux en Y gastric bypass surgery. The patients successfully lost weight as mean BMI fell from 46 kg/m2 preoperatively to 28 kg/m2 postoperatively. Mean serum creatinine did not significantly change from baseline (0.8 mg/dl) to 12 months (0.7 mg/dl). Hence mean GFR estimated by the CKD-EPI equation (eGFR) did not significantly change from 84 ml/min/1.73 m2 (baseline) to 90 ml/min/1.73 m2 (12 months). However, GFR measured by iothalamate clearance (mGFR) significantly decreased from 108 ml/min/1.73m2 (121 ml/min) to 85 ml/min/1.73 m2 (90 ml/min).
31 Jul Team Approach Improved Patient Safety From Cath Lab Procedures
MedicalResearch.com Interview with:
Jeremiah R. Brown, PhD MS
Assistant Professor of Health Policy and Clinical Practic
The Dartmouth Institute
Lebanon, NH
Medical Research: What are the main findings of the study?
Dr. Brown: Using simple team-based quality improvement methods we prevented kidney injury in 20% of patients having a procedure in the cardiac catheterization lab. Among patients with pre-existing kidney disease, we prevent kidney injury in 30% of patients.
We believed that using a team-based approach and having teams at different medical centers in northern New England learn from one-another to provide the best care possible for their patients. Some of the most innovative ideas came from these teams and identified simple solutions to protect patients from kidney injury from the contrast dye exposure; these included:
- Getting patients to self-hydrate with water before the procedure (8 glasses of water before and after the procedure),
- Allow patient to drink fluids up to 2-hours before the procedure (whereas before they were "NPO" for up to 12 hours and came in dehydrated),
- Training the doctors to use less contrast in the procedure (which is good for the patient and saves the hospital money),
- and creating stops in the system to delay a procedure if that patient had not received enough oral or IV fluids before the case (rather, they would delay the case until the patient received adequate fluids).Our success was really about hospital teams talking and innovating with one another instead of competing in the health care market, which resulted in simple, homegrown, easy to do solutions that improved patient safety.
30 Jul Insulin Sensitivity Predicts Kidney Health in Adolescent Diabetes
MedicalResearch.com Interview with: Petter Bjornstad, M.D. Children's Hospital Colorado University of Colorado Denver Aurora, CO 80045 Medical Research: What are the main findings of the study? Dr. Bjornstad: Type 2 diabetes is the most common cause of end-stage renal disease in the Western world. It is therefore of paramount importance to develop a better understanding of the determinants of diabetic nephropathy risk and progression, to improve outcome in adolescents with type 2 diabetes. We report high rates of microalbuminuria and renal hyperfiltration in adolescents with type 2 diabetes, which forecast early renal morbidity and mortality. In our observational study, insulin sensitivity measured by hyperinsulinemic-euglycemic clamp studies, rather than adiposity, blood pressure, lipid and glycemic control was associated with markers of renal health (albumin-to-creatinine ratio and estimated glomerular filtration rate).28 Jul Kidney Transplant: Rejection Decreased By New Drug Regimen
MedicalResearch.com Interview with Dr. Richard Haynes Clinical Trial Service Unit and Epidemiological Studies Unit Roosevelt Drive, Headington Oxford OX3 Medical Research: What are the main findings of the study? Dr. Haynes: The main result from this analysis is that alemtuzumab-based induction therapy (ie, alemtuzumab followed by low-dose mycophenolate and tacrolimus with steroid avoidance) reduced biopsy-proven acute rejection by about half during the first 6 months after transplantation among a wide variety of different types of participant, compared to standard basiliximab-based induction therapy (basiliximab followed by standard dose mycophenolate, tacrolimus and steroids). This reduction was achieved despite the lower doses of tacrolimus used and there was no excess of infection observed.18 Jul Chronic Kidney Disease Patients Receiving Less ESA Therapy For Anemia
MedicalResearch.com Interview with: Dennis J. Cotter President Medical Technology and Practice Patterns Institute, Inc. Bethesda, MD 20816 Medical Research: What are the main findings of the study? Answer: This is the first study to document anemia management practice patterns among predialysis CKD patients before and after publication of TREAT. Using a retrospective observational design based on a large US health plan database with over 1.2 million claims for predialysis CKD stage 3 and 4 patients, we report 4 main study findings. 1) For CKD stage 3 patients, the proportion prescribed ESA therapy declined from 17% pre-TREAT to 11% post-TREAT (a 38% decline) and for CKD stage 4 patients, from 34% to 27% (a 22% decline). 2) Prescribing of ESA therapy was declining even before TREAT, but the decline accelerated in the post-TREAT period. 3) ESA prescribing declined after TREAT regardless of anemia status; among patients with hemoglobin <10 g/dL, only 25% of stage 3 and 33% of stage 4 CKD were prescribed ESAs two years after TREAT, a notable 50% decline. 4) After adjusting for all covariates, the probability of prescribing ESAs was 35% less during a two year period after vs. before TREAT publication.15 Jul What is the Risk To Donors of Giving Away A Kidney?
MedicalResearch.com Interview with:
Dr Hallvard Holdaas
Consultant in Nephrology
Department of Transplant Medicine
Oslo University Hospital
Rikshospitalet, Oslo Norway.
Medical Research: What are the main findings of the study?
Dr. Holdaas: Most studies examining long-term risk for living kidney donors have included comparators from the background population with hypertension, diabetes mellitus, reduced renal function, cancer and other concomitant diseases; or for the few studies with more “healthy” comparators the follow-up time have been restricted. In our study we compared living donors to a healthy non-donor population which would have qualified as donors themselves, with median follow-up of 15.1 years for the donors. The relative risk for the living donors compared to a healthy control was 11.38 for endstage renal disease (ESRD), 1.4 for cardiovascular death and 1.3 for all-cause mortality (Mjoen et al., 2014).
15 Jul Acute and Chronic Kidney Diseases May Be Better Approached As Combined Syndrome
MedicalResearch.com Interview with:
Paul Kimmel, M.D.
Division of Kidney, Urologic and Hematologic Diseases
National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health
Professor Division of Renal Diseases and Hypertension
The George Washington University
Medical Research: What are the main findings of the review?
Dr. Kimmel: AKI (Acute Kidney Injury) and CKD (Chronic Kidney Disease), two syndromes approached separately in medical school curricula as well as in the clinical arena are inextricably intertwined. They should be taught as a combined entity, culminating in progressive loss of renal function necessitating renal replacement therapy (dialysis or transplantation).
The two syndromes increase risk for cardiovascular disease and diminished quality of life as well. Preventive and therapeutic strategies should be directed at the combined entity.
11 Jul End Stage Kidney Disease: Does Peritoneal Dialysis Offer A Survival Advantage?
MedicalResearch.com Interview with: Victoria A. Kumar, M.D. Internal Medicine/Nephrology Division of Nephrology Department of Internal Medicine Southern California Permanente Medical Group Los Angeles, California, USA Medical Research: What are the main findings of the study? Dr. Kumar: There was over a 2 fold increase in patient survival in incident peritoneal dialysis patients in the first year on dialysis compared to propensity matched incident hemodialysis patients. We excluded any patients who utilized a central dialysis catheter at any point during the first 90 days on hemodialysis in an effort to reduce the mortality bias associated with hemodialysis patients who start with a catheter. All hemodialysis patients had pre-dialysis care by a nephrologist prior to starting dialysis. The 2+ fold increase in survival among peritoneal dialysis patients resulted in a 2-3 year cumulative survival advantage for peritoneal dialysis patients, using both intent to treat and as-treated analyses.01 Jul Small Changes Improve Geographic Disparity in Kidney Transplantation
MedicalResearch.com Interview with
Daniela P Ladner, MD, MPH, FACS
Assistant Professor Transplant Surgery
Department of Surgery, Division of Organ Transplantation
Director Northwestern University Transplant Outcomes Research Collaborative (NUTORC)
Comprehensive Transplant Center
Feinberg School of Medicine, Northwestern University
MedicalResearch: What are the main findings of the study?
Dr. Ladner: With the current kidney organ allocation system, there exists significant geographic disparity between the 58 Donor Services Areas (DSAs) in the US, which are distributed among 11 regions. This means that depending on where a patient lives it might take shorter or longer to receive a kidney organ for transplantation. Despite efforts, this has not improved over the course of 20 years and in most regions this has worsened. In 1991 and 1992 respectively, two states changed their kidney allocation system, such that kidneys would first be allocated with the DSA of procurement, then statewide, then regionally (which may include several states) and then nationally. Usually kidneys don’t get allocated statewide before regionally.
The main finding of this study is that in those two states (FL, TN), where a minor change to the kidney allocation was put into place, there was significant reduction in the geographic disparity between their Donor Services Areas. In other comparable states (equal numbers of DSAs within the state) the geographic disparity did not improve and in many the geographic disparity worsened.
28 May Dialysis Patients: A Standardized Transfusion Ratio to Evaluate Anemia Management
MedicalResearch.com Interview with: David T. Gilbertson, Ph.D. Chronic Disease Research Group Center for Observational Research, Amgen, Inc, Thousand Oaks, CA MedicalResearch: What were the main findings of the study? Dr. Gilbertson: Since transfusion avoidance is important in patients receiving maintenance hemodialysis, development of a measure of red blood cell transfusion use to assess dialysis facility anemia management is reasonable. Because dialysis facility size varies widely, calculation of a standardized transfusion ratio (STfR) using standard methods is possible, but these methods result in significant instability in estimates for small dialysis facilities. Use of more advanced statistical methods results in standardized transfusion ratio estimates that are considerably more stable and more consistently precise across dialysis facilities of all sizes.11 Apr Rheumatoid Arthritis Patients Have Higher Risk of Kidney Disease
MedicalResearch.com Interview with:
Eric Matteson, M.D.
Chairman of Rheumatology
Mayo Clinic, Rochester, Minn
MedicalResearch.com: What are the main findings of the study?
Dr. Matteson: “The main points are that kidney disease is more common in patients with rheumatoid arthritis than in the general population and that moderate reduction in kidney function was more likely to be associated with cardiovascular disease in these patients as well. Patients with more active disease week are also at higher risk for kidney disease. “
06 Apr Acute Kidney Injury Risk From PCI Surgery Lower With Radial Approach
MedicalResearch.com Interview with:
Judith Kooiman
Department of Thrombosis and Hemostasis
Leiden University Medical Center
Leiden, The Netherlands
MedicalResearch.com: What are the main findings of the study?
Dr. Kooiman: The main finding of our study is that trans radial PCI (TRI) is associated with a significantly lower risk of AKI compared with trans femoral PCI (TFI), after adjustment for confounding factors.
30 Mar Diabetic Kidney Disease: Potential New Therapeutic Target Discovered
MedicalResearch.com Interview with:
Dr. Paolo Fiorina, MD PhD
Assistant Professor, Division of Nephrology,
Harvard Medical School
and
Dr. Roberto Bassi
Post-doctoral research fellow
Nephrology Department at Children's Hospital Boston.
MedicalResearch.com: What are the main findings of the study?
Dr. Fiorina: It is common knowledge that type 2 diabetes is a worldwide epidemic and that diabetic nephropathy has become the leading cause of renal failure in the western world. One of the main drivers and worsening factors for the diabetic kidney disease is proteinuria associated with various degrees of tubular damage, and unfortunately, therapies to halt or prevent this complication are not available so far. Our findings show that B7-1 when expressed on podocytes (a specific subset of renal cells) determines alterations in podocytes function and morphology, predisposing individuals with T2D to the loss of proteins into the urine. We also demonstrate that Abatacept, an immunomodulatory drug currently employed for the treatment of a variety of autoimmune diseases, is able to specifically target this malignant pathway, preventing podocytes cellular alterations in vitro and proteinuria development in two murine models of diabetic nephropathy in vivo.
27 Mar Dialysis Patients with Atrial Fibrillation: Warfarin and Risk of Stroke and Bleeding
MedicalResearch.com Interview with:
Louise Pilote, MD, MPH, PhD
Department of Medicine, McGill University
Department of Epidemiology and Biostatistics, McGill University
MedicalResearch.com: What are the main findings of the study?
Dr. Pilote: Our study found that in patients with atrial fibrillation (AF) undergoing dialysis, warfarin use, compared to no-warfarin use, did not reduce the risk for stroke (adjusted hazard ratio (HR): 1.14, 95% confidence interval (CI): 0.78 to 1.67) but it was associated with a 44% higher risk for bleeding event (adjusted HR: 1.44, 95% CI: 1.13 to 1.85). However, warfarin use in non-dialysis patients with AF was associated with a 13% lower risk for stroke (adjusted HR: 0.87, 95% CI: 0.85 to 0.90) and only a 19% higher risk for bleeding event (adjusted HR: 1.19, 95% CI: 1.16 to 1.22).
14 Mar Diabetes: TNFR1 As Biomarker of Renal Disease and Mortality
MedicalResearch.com Interview with:
Prof Samy Hadjadj:
Université de Poitiers, UFR Médecine Pharmacie, Centre d’Investigation clinique,
CHU de Poitiers, Centre d’Investigation clinique, Poitiers, France
MedicalResearch.com: What are the main findings of the study?
Prof: Hadjadj: The study helps to establish sTNFR1 as a valid biomarker not only for renal outcomes in type 2 diabetes but also for all cause death. Interestingly the addition of sTNFR1 concentration to the UKPDS model outcome equation showed to add some clinical prognostic value to this model for all-cause death.
13 Mar CABG Surgery in Patients with Acute Coronary Syndromes and Chronic Kidney Disease
MedicalResearch.com Interview with:
Martin Holzmann, MD, PhD
Department of Emergency Medicine,
Karolinska University Hospital
Stockholm Sweden.
MedicalResearch.com: What are the main findings of the study?
Dr. Holzmann: The main finding is that patients with renal dysfunction are at increased risk of cardiovascular events after undergoing CABG for acute coronary syndromes.