MedicalResearch.com Interview with:
Magnus G. Rasch MD
Faculty of Health Sciences, University of Copenhagen
1455 København K, Denmark
Department of Infectious Diseases
Copenhagen University Hospital, Rigshospitalet, Denmark
MedicalResearch.com: What are the main findings of the study?
Dr. Rasch: In the study “Increased risk of dialysis and end-stage renal disease among HIV patients in Denmark compared with the background population” we found that the risk of acute renal replacement therapy (aRRT) and the risk of chronic renal replacement therapy (cRRT) was increased substantially in HIV patients compared with the background population.
The risk of aRRT was highest the first year after HIV diagnosis.
Factors associated with increased risk of aRRT were intravenous drug use, hypertension and an AIDS-defining illness. Risk factors for cRRT were hypertension and baseline estimated glomerular filtration rate.
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Author Interviews, Diabetes, Kidney Disease, Stroke / 10.09.2013
Diabetes: Stroke and Measure of Kidney Function, GFR
MedicalResearch.com Interview with:
Yongjun Wang, MD
Department of Neurology, Beijing Tiantan Hospital
Capital Medical University, Beijing, China
MedicalResearch.com: What are the main findings of the study?
Answer: Our study demonstrated that reduced eGFR was independently associated with all-cause mortality and other post-stroke outcomes in type 2 diabetic patients; stroke subtype analysis in our cohort showed that this association was only evident in ischemic stroke and TIA. We also observed a U-shaped relationship between variation of eGFR and post-stroke outcomes, that is, increased odds ratios were seen among those with low and high levels of eGFR. The cutoff points of eGFR associated with poor outcomes of stroke were eGFR<45 ml/min/1.73m2 and≥ 120 ml/min/1.73m2, respectively.
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Author Interviews, Brigham & Women's - Harvard, JAMA, Kidney Disease, Medical Research Centers / 05.09.2013
Rhabdomyolysis: Risk Prediction Score for Kidney Failure or Mortality
MedicalResearch.com Interview with:
Gearoid M. McMahon, MB, BCh
Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston,
Massachusetts Framingham Heart Study, National Heart, Lung, and Blood Institute, and Center for Population Studies, Framingham, Massachusetts
MedicalResearch.com: What are the main findings of the study?
Answer: This study examined the incidence, causes and outcomes of rhabdomyolysis in two large University Teaching hospitals. Rhabdomyolysis is a characterized by an increase in serum creatine phosphokinase (CPK) and results from muscle damage from a variety of causes. The most important complication of rhabdomyolysis is acute kidney injury which can result in a need for dialysis. Using a series of laboratory and clinical variables that are readily available on admission, we constructed a risk score that can predict with some accuracy the likelihood that a patient with rhabdomyolysis might die or need dialysis during an admission. The final variables included in the model were age, gender, the cause of rhabdomyolysis and the admission CPK, creatinine, phosphate, bicarbonate and calcium. One of the advantages of this study was, because we had access to data from two institutions, we were able to derive the risk score in one hospital and confirm its accuracy in the second institution.
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Author Interviews, Kidney Disease, University of Michigan / 03.09.2013
Spontaneous Renal Artery Dissection: Characteristics, Course, Associations
Afshinnia, Farsad, M.D., M.S.
Research Fellow and Clinical Lecturer
Department of Nephrology
University of Michigan Health System
MedicalResearch.com: What are the main findings of the study?
Answer: Spontaneous Renal Artery Dissection (SRAD) is most commonly observed in middle aged individuals. Although SRAD can have no association with other comorbidities at the time of presentation, we have noticed association with a number of systemic disorders such as hypertension, cancer, congestive heart failure, and rheumatologic diseases. In particular clustering of Fibromascular dysplasia (FMD), Ehlers-Danlos syndrome, poly arteritis nodosa, Poland syndrome, and nail patella syndrome in our patients has been striking. The most commonly observed presenting symptom is sudden onset severe flank pain which may be spontaneous or following physical stress. Other presenting features may include uncontrolled hypertension, groin and/or testicular pain, headache, nausea, vomiting, fever, dysuria, hematuria and blurry vision.
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Author Interviews, JACC, Kidney Disease, Vitamin C / 30.08.2013
Coronary Angiography: Vitamin C and Protection Against Contrast-Induced Kidney Disease
MedicalResearch.com Interview with:
Umar Sadat, MD, PhD
Addenbrooke’s Hospital
Cambridge, United Kingdom
MedicalResearch.com: What are the main findings of the study?
Dr. Sadat: Vitamin C offers significant nephroprotection against contrast induced-acute kidney injury (CI-AKI) in patients undergoing coronary angiography.
Patients receiving Vitamin C were observed to have 33% less risk of CI-AKI compared to those receiving placebo or other treatment.
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Author Interviews, Kidney Disease, Rheumatology / 27.08.2013
Lupus Nephritis Susceptibility Genes Identified
Hemodialysis.com Interview with: Dr. David W. Powell PhD Associate Director of Clinical Proteomics Assistant Professor of Medicine Assistant Professor of Biochemistry and Molecular...
Author Interviews, Blood Pressure - Hypertension, Kidney Disease, Nature / 20.08.2013
Chronic Kidney Disease: Blood Pressure and Mortality
MedicalResearch.com Interview with:
Dr.Csaba P. Kovesdy MD FASN.
The Fred Hatch Professor of Medicine
Director, Clinical Outcomes and Clinical Trials Program in Nephrology
University of Tennessee Health Science Center
Chief of Nephrology
Division of Nephrology, Memphis VA Medical Center
MedicalResearch.com: What are the main findings of the study?
Dr. Kovesdy: In this study of >650,000 US veterans with CKD we found that categories of lower SBP/DBP combinations are associated with lower mortality only as long as the DBP component remains above a threshold of approximately 70 mmHg, and that patients with BP values in the range of 130-159/70-89 mmHg had the lowest mortality. Patients who might be considered to have “ideal” blood pressure (<130/80) actually had increased mortality due to the inclusion of individuals with low systolic and diastolic blood pressures.
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Dr.Csaba P. Kovesdy MD FASN.
The Fred Hatch Professor of Medicine
Director, Clinical Outcomes and Clinical Trials Program in Nephrology
University of Tennessee Health Science Center
Chief of Nephrology
Division of Nephrology, Memphis VA Medical Center
MedicalResearch.com: What are the main findings of the study?
Dr. Kovesdy: In this study of >650,000 US veterans with CKD we found that categories of lower SBP/DBP combinations are associated with lower mortality only as long as the DBP component remains above a threshold of approximately 70 mmHg, and that patients with BP values in the range of 130-159/70-89 mmHg had the lowest mortality. Patients who might be considered to have “ideal” blood pressure (<130/80) actually had increased mortality due to the inclusion of individuals with low systolic and diastolic blood pressures.
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Author Interviews, Genetic Research, Kidney Disease, Nature, University of Pennsylvania / 12.08.2013
Chronic Kidney Disease: Novel variants of APOL1 gene may play a role in susceptibility
MedicalResearch.com Interview with:
Dr. Wen-Ya Ko, Ph.D.
Postdoctoral Fellow, First author of the paper
Department of Genetics
School of Medicine
University of Pennsylvania
426 Clinical Research Building
415 Curie Boulevard
Philadelphia, PA 19104-6145
Dr. Sarah Tishkoff, Ph.D., Senior author of the paper
David and Lyn Silfen University Professor
Departments of Genetics and Biology
School of Medicine
School of Arts and Sciences
University of Pennsylvania
MedicalResearch.com: What are the main findings of the study?
Answer: In humans the APOL1 gene codes for Apolipoprotein L1, a major component of the trypanolytic factor in serum. The APOL1 gene harbors two risk alleles (G1 and G2) associated with chronic kidney disease (CKD) among individuals of recent African ancestry. We studied APOL1 across genetically and geographically diverse ethnic groups in Africa. We have discovered a number of novel variants at the APOL1 functional domains that are required to lyse trypanosome parasites inside human blood vessels.
We further identified signatures of natural selection influencing the pattern of variation on chromosomes carrying some of these variants. In particular, we have identified a haplotype (a cluster of genetic variants linked along a short region of a chromosome), termed G3, that has evolved adaptively in the Fulani population who have been practicing cattle herding which has been historically documented as early as in the medieval ages (but which could have begun thousands of years earlier). Many of the novel variants discovered in this study are candidates to play a role conferring protection against trypanosomiasis and/or to play a role in susceptibility of CKD in humans.
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Dr. Wen-Ya Ko, Ph.D.
Postdoctoral Fellow, First author of the paper
Department of Genetics
School of Medicine
University of Pennsylvania
426 Clinical Research Building
415 Curie Boulevard
Philadelphia, PA 19104-6145
Dr. Sarah Tishkoff, Ph.D., Senior author of the paper
David and Lyn Silfen University Professor
Departments of Genetics and Biology
School of Medicine
School of Arts and Sciences
University of Pennsylvania
MedicalResearch.com: What are the main findings of the study?
Answer: In humans the APOL1 gene codes for Apolipoprotein L1, a major component of the trypanolytic factor in serum. The APOL1 gene harbors two risk alleles (G1 and G2) associated with chronic kidney disease (CKD) among individuals of recent African ancestry. We studied APOL1 across genetically and geographically diverse ethnic groups in Africa. We have discovered a number of novel variants at the APOL1 functional domains that are required to lyse trypanosome parasites inside human blood vessels.
We further identified signatures of natural selection influencing the pattern of variation on chromosomes carrying some of these variants. In particular, we have identified a haplotype (a cluster of genetic variants linked along a short region of a chromosome), termed G3, that has evolved adaptively in the Fulani population who have been practicing cattle herding which has been historically documented as early as in the medieval ages (but which could have begun thousands of years earlier). Many of the novel variants discovered in this study are candidates to play a role conferring protection against trypanosomiasis and/or to play a role in susceptibility of CKD in humans.
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MedicalResearch.com Interview with: C Raina Elley
Associate Professor and General Practitioner,
Acting Head, Dept General Practice & Primary Health Care,
Faculty Medical and Health Sciences,
University of Auckland, Private Bag 92019,
Auckland, New Zealand
MedicalResearch.com: What are the main findings of the study?
Answer: Type 2 Diabetes is the leading cause of end-stage renal failure and dialysis in many countries. Early identification of those who are at risk within primary care could prompt more intensive intervention to control glycaemia and blood pressure and use of ACE inhibitors or angiotensin receptor blockers to slow progression. Traditionally estimated glomerular filtration rate and/or urine albumin creatinine ratio have been used to alert clinicians of deteriorating renal function in people with diabetes. However, a far more accurate renal risk score has been developed that combines serum creatinine, demographic characteristics, albuminuria, glycaemia, blood pressure, cardiovascular co-morbidity and duration of diabetes.
The 5-year renal risk score was developed by following more than 25,000 people with type 2 diabetes in New Zealand for a median of 7.3 years (equivalent to 180,497 person-years). The study identified those who commenced dialysis for end-stage renal disease, received a renal transplant or died from renal failure to derive the risk score.
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Associate Professor and General Practitioner,
Acting Head, Dept General Practice & Primary Health Care,
Faculty Medical and Health Sciences,
University of Auckland, Private Bag 92019,
Auckland, New Zealand
MedicalResearch.com: What are the main findings of the study?
Answer: Type 2 Diabetes is the leading cause of end-stage renal failure and dialysis in many countries. Early identification of those who are at risk within primary care could prompt more intensive intervention to control glycaemia and blood pressure and use of ACE inhibitors or angiotensin receptor blockers to slow progression. Traditionally estimated glomerular filtration rate and/or urine albumin creatinine ratio have been used to alert clinicians of deteriorating renal function in people with diabetes. However, a far more accurate renal risk score has been developed that combines serum creatinine, demographic characteristics, albuminuria, glycaemia, blood pressure, cardiovascular co-morbidity and duration of diabetes.
The 5-year renal risk score was developed by following more than 25,000 people with type 2 diabetes in New Zealand for a median of 7.3 years (equivalent to 180,497 person-years). The study identified those who commenced dialysis for end-stage renal disease, received a renal transplant or died from renal failure to derive the risk score.
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Author Interviews, Brigham & Women's - Harvard, Diabetes, Kidney Disease, Medical Research Centers, Mediterranean Diet, Nutrition / 29.05.2013
Kidney Function Following Three Distinct Weight Loss Dietary Strategies
MedicalResearch.com eInterview with Iris Shai, RD, PhD
PI of the DIRECT trial
Ben Gurion University of the Negev,
Israel
MedicalResearch.com: What are the main findings of the study?
Dr. Shai: Low-carbohydrate is as effective as Mediterranean or low-fat diets in improving renal function among moderately obese participants with or without type 2 diabetes, with baseline serum creatinine<176µmol/L (not sever renal stage). The effect is likely to be mediated by weight-loss induced improvements in insulin sensitivity and blood pressure.
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Author Interviews, Blood Pressure - Hypertension, Diabetes, Kidney Disease, Pediatrics / 28.05.2013
Youth With Type 2 Diabetes: Rapid Rise in Hypertension and Nephropathy
MedicalResearch.com eInterview with:
Dr. Jane L Lynch MD
School of Medicine
Pediatrics
University of Texas Health Science Center at San Antonio
MedicalResearch.com: What are the main findings of the study?
Dr. Lynch: American youth with type 2 diabetes who received the best currently available treatment and close monitoring of their diabetes experienced a more rapid progression of co-morbidities far more aggressive than what is typically seen in adults with type 2 diabetes.
MedicalResearch.com: Were any of the findings unexpected?
Dr. Lynch: Youth with type 2 diabetes enrolled in the TODAY study developed early and rapidly progressing signs of heart and kidney disease, poor glycemic control and diabetes-related eye disease; even in the group receiving more intensive two-drug therapy, shown in previously released results to be the most effective treatment for maintenance of glycemic control.
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Dr. Jane L Lynch MD
School of Medicine
Pediatrics
University of Texas Health Science Center at San Antonio
MedicalResearch.com: What are the main findings of the study?
Dr. Lynch: American youth with type 2 diabetes who received the best currently available treatment and close monitoring of their diabetes experienced a more rapid progression of co-morbidities far more aggressive than what is typically seen in adults with type 2 diabetes.
MedicalResearch.com: Were any of the findings unexpected?
Dr. Lynch: Youth with type 2 diabetes enrolled in the TODAY study developed early and rapidly progressing signs of heart and kidney disease, poor glycemic control and diabetes-related eye disease; even in the group receiving more intensive two-drug therapy, shown in previously released results to be the most effective treatment for maintenance of glycemic control.
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