Annals Internal Medicine, Author Interviews, Hepatitis - Liver Disease, Kidney Disease, Transplantation / 18.07.2018

MedicalResearch.com Interview with: Mark H. Eckman, MD Posey Professor of Clinical Medicine Director, Division of General Internal Medicine Director, Center for Clinical Effectiveness University of Cincinnati Medical Center Cincinnati, OH  MedicalResearch.com: What is the background for this study? Response: People who are infected with hepatitis C virus and have kidney failure need a kidney transplant. Recent studies have found that it is possible to transplant kidneys from donors who are infected with hepatitis C virus into patients who need a transplant and are already infected with the virus. In addition, drugs are available to cure most patients of hepatitis C virus, including those who have kidney failure. Infected patients who need a kidney transplant have 2 options. One option is to receive an infected kidney and then use drugs after the transplant to cure themselves and the transplanted kidney of the virus. Another option is to use the drugs first to get rid of the virus and then to receive a kidney from a donor who does not have hepatitis C virus infection. For the more than 500,000 patients receiving dialysis for end-stage renal disease (ESRD), less than 4% receive kidney transplants. Because of the limited organ availability, hemodialysis is the final treatment for most patients with ESRD. Of the 10% or so of U.S. patients receiving dialysis who are infected with the hepatitis C virus (HCV), some are willing to accept HCV-infected kidneys, in part, because the wait times for such kidneys are shorter than those for HCV-uninfected kidneys. Because the yearly mortality rate for patients receiving hemodialysis is so high, between 4% and 16%, reducing the time to kidney transplant can have a dramatic effect on both survival and quality of life. Because it may not be possible to do this type of research with actual people, we created a model that allowed us to estimate possible outcomes without using actual people. The model was a computer program that combined the best available information to approximate what might happen to participants in a real-world clinical trial. (more…)
Author Interviews, Kidney Disease, Social Issues / 07.07.2018

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 MedicalResearch.com: What is the background for this study? What are the main findings? Response: We set out to conduct a qualitative study among patients with advanced kidney disease to learn about their thoughts and experience with advance care planning. Our questions, especially at the beginning of the interview were quite broad and asked patients more generally about their experiences of illness and care. Although we did not ask patients about the emotional impact of illness and care, this came across as a strong theme when we analyzed the interviews, and that is what we describe here. (more…)
Annals Internal Medicine, Author Interviews, Cancer Research, Kidney Disease, Radiology, Surgical Research / 30.06.2018

MedicalResearch.com Interview with: Adam Talenfeld, M.D Assistant Professor of Radiology Weill Cornell Medical College Assistant Attending Radiologist New York-Presbyterian Hospital. MedicalResearch.com: What is the background for this study? What are the main findings? Response: We know that renal function decreases as we age, and we know that decreased renal function is independently associated with increased mortality. This is why medical society guidelines recommend partial nephrectomy, which preserves kidney tissue and function, over radical nephrectomy for the treatment of the smallest kidney cancers, stage T1a tumors, which are under 4 cm diameter. Paradoxically, though, we know older patients are more likely than younger patients to receive radical nephrectomy for these smallest tumors, probably because it’s a simpler surgery than partial nephrectomy. Percutaneous ablation, focal tissue destruction using heat or cold emanating from the tip of a needle, is a newer, image-guided, minimally-invasive, tissue-sparing treatment for solid organ tumors. We wanted to test how well percutaneous ablation would compare to partial nephrectomy and radical nephrectomy for these smallest kidney cancers. We found that percutaneous ablation was associated with similar 5-year overall and cancer-specific survival compared to radical nephrectomy. At the same time, ablation was associated with significantly lower rates of new-onset chronic renal insufficiency and one-fifth as many serious non-urological complications than radical nephrectomy within 30 days of treatment. These were complications, such as deep venous thrombosis or pneumonia, that resulted in emergency department visits or new hospital admissions. The outcomes of percutaneous ablation compared with partial nephrectomy were somewhat less clear, though ablation was again associated with fewer perioperative complications. (more…)
Author Interviews, Kidney Disease, Neurological Disorders, Pain Research, UCSF / 06.06.2018

MedicalResearch.com Interview with: Dr. Julie H. Ishida MD Department of Medicine, Division of Nephrology University of California, San Francisco and San Francisco Veterans Affairs Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Gabapentin and pregabalin are used for the management of symptoms such as neuropathic pain, itching, and restless leg syndrome in patients receiving hemodialysis. However, hemodialysis patients may be particularly vulnerable to adverse events related to these agents, which are cleared by the kidney, but there is limited data evaluating their risk in this population. Gabapentin and pregabalin use were associated with risk for altered mental status, fall, and fracture, and in some cases, even at doses that would be considered safe for use in this population.  (more…)
AstraZeneca, Author Interviews, Kidney Disease, Mineral Metabolism / 24.05.2018

MedicalResearch.com Interview with: Steven Fishbane, MD, Chief, Division of Kidney Disease and Hypertension, Northwell Health Vice President, Northwell Health for Network Dialysis Services, Northwell Health Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Lead investigator of the ZS 005 study MedicalResearch.com: What is the background for this announcement? Would you briefly explain what is meant by hyperkalemia?What are the dangers of an elevated potassium and how does LOKELMA differ from prior standard treatments?  Response: Hyperkalemia is when the potassium in the blood rises to potentially harmful levels. High potassium is primarily harmful for the heart. As the potassium level rises the risk for abnormal electrical rhythms or disruption of the heart’s pumping occur. When severe, a high potassium level can cause death. Lokelma has been demonstrated to be effective for lowering potassium levels with a great degree of consistency. It is well tolerated and has a fairly rapid onset of potassium lowering compared to other drugs for the purpose.  (more…)
Annals Internal Medicine, Author Interviews, Cost of Health Care, Kidney Disease / 22.05.2018

MedicalResearch.com Interview with: Lilia Cervantes, M.D. Internal Medicine, Hospitalist Denver Health and Hospital Authority Assistant Professor, Division of General Internal Medicine Founder, Healthcare Interest Program and Health Equity Lecture Series at Denver Health University of Colorado Health Sciences Center MedicalResearch.com: What is the background for this study? What are the main findings?  Response:  For most undocumented immigrants with kidney failure in the U.S., access to hemodialysis is limited and they can only receive it when they are critically ill and near-death.  This type of “emergency-only” hemodialysis is already known to be nearly 4-fold more costly, has 14-fold higher mortality rate, and leads to debilitating physical and psychosocial distress for these patients compared to those receiving regular hemodialysis. This study shows that clinicians who are forced to provide this substandard care are also harmed.  They experience moral distress, emotional exhaustion, and several other drives of professional burnout due to witnessing needless suffering and high mortality.  (more…)
Author Interviews, JAMA, Kidney Disease / 11.05.2018

MedicalResearch.com Interview with: “Glass of Water” by Greg Riegler is licensed under CC BY 2.0Dr. William Clark Lawson Health Research Institute  MedicalResearch.com: What is the background for this study? What are the main findings? Response:  This study is about the use of increased water intake in people with chronic kidney disease (CKD). Although there are a large number of benefits claimed most are not substantiated by evidence. However there is a growing body of evidence (animal and human observational studies) that increased hydration with the suppression of antidiuretic hormone preserves kidney function in CKD. This led to our current randomised clinical trial of 631 patients with stage 3 CKD and proteinuria to determine if drinking an extra 4-6 glasses of water per day for 1 year would slow their progressive loss of kidney  function as measured by eGFR. The main findings were that those coached to increase their water intake versus those coached to sustain their normal fluid intake suffered no ill effects from the intervention and on average were able to sustain an average increase of approximately 3 glasses of water per day. At the end of 1 year the increased hydration group had suppressed their antidiuretic hormone levels (copeptin) significantly but did not demonstrate a greater preservation in their eGFR. (more…)
Author Interviews, Compliance, Kidney Disease, Transplantation / 27.03.2018

MedicalResearch.com Interview with: Bethany J. Foster, MD MSCE Montreal Children’s Hospital Department of Pediatrics, Department of Epidemiology, Biostatistics, and Occupational Health McGill University, Montreal, QC, Canada MedicalResearch.com: What is the background for this study? Response: Adolescent and young adult kidney transplant recipients have the highest risk of graft loss of any age group. One of the main reasons for this is not taking their anti-rejection medications as prescribed. Our study had the goal of testing an intervention to try to improve young patients' adherence to their strict medication schedule. The intervention included feedback of how well they were taking their medications (which was monitored electronically), text message reminders for medication doses, and individualized coaching to address their personal barriers to taking their medications. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Kidney Disease, NEJM, Vanderbilt / 01.03.2018

MedicalResearch.com Interview with: Wesley H. Self, MD, MPH Associate Professor Department of Emergency Medicine Vanderbilt University Medical Center Nashville, TN   MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Doctors have been giving IV fluids to patients for more than 100 years. The most common IV fluid during this time has been saline; it has high levels of sodium and chloride in it (similar to table salt).  Balanced fluids are an alternative type of IV fluid that has lower levels of sodium and chloride that are more similar to human blood. Our studies were designed to see if treating patients with these balanced fluids resulted in better outcomes than saline.  We found that patients treated with balanced fluids had lower rates of death and kidney damage than patients treated with saline. (more…)
Author Interviews, Cost of Health Care, Critical Care - Intensive Care - ICUs, JAMA, Kidney Disease / 26.02.2018

MedicalResearch.com Interview with: Rodrigo F. Alban, MD FACS Associate Director Performance Improvement Associate Residency Program Director NSQIP Surgeon Champion Department of Surgery Cedars-Sinai Medical Center  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Continuous Renal Replacement Therapy (CRRT) is a modality of hemodialysis commonly used to manage renal failure in critically ill patients who have significant hemodynamic compromise.  However, it is also resource-intensive and costly and its usage is highly variable and lacks standardization. Our institution organized a multidisciplinary task force to target high value care in critically ill patients requiring CRRT by standardizing its process flow, promoting cross-disciplinary discussions with patients and family members, and increasing visibility/awareness of CRRT use.  After our interventions, the mean duration of CRRT decreased by 11.3% from 7.43 to 6.59 days per patient.  We also saw a 9.8% decrease in the mean direct cost of CRRT from $11642 to $10506 per patient.  Finally, we also saw a decrease in the proportion of patients expiring on CRRT, and an increase in the proportion of patients transitioning to comfort care. (more…)
Author Interviews, Education, Kidney Disease, Pediatrics / 25.02.2018

MedicalResearch.com Interview with: Dr. Kerry Chen Centre for Kidney Research, The Kids Research Institute The Children’s Hospital at Westmead, Sydney School of Public Health, The University of Sydney Sydney, New South Wales, Australia MedicalResearch.com: What is the background for this study? Response: Chronic kidney disease is a major public health issue, with end-stage disease often requiring a combination of complex medication regimens, dialysis and/or transplant surgery. In children, the major causes of CKD are genetic and congenital. The consequences of CKD in children can be long-term and debilitating especially as they transition into adulthood, affecting their physical, intellectual and emotional well-being. To better understand these changes, the Kids Health and Wealth Study (KCAD) is the largest longitudinal cohort study of children and adolescents with CKD in Australia and New Zealand. Spread across 5 paediatric nephrology centres so far, the KCAD Study takes a life-course approach to collecting and analysing data pertaining to the interactions between reduced renal function and associated clinical, socio-economic, quality of life, psychological, cognitive and educational outcomes in children, especially as they progress in CKD stage and also as they transition into adulthood. (more…)
Author Interviews, Cognitive Issues, Geriatrics, Kidney Disease, Salt-Sodium / 11.02.2018

MedicalResearch.com Interview with: Dr. Kristen L. Nowak PhD Division of Renal Diseases and Hypertension University of Colorado Anschutz Medical Campus Aurora, CO 80045 MedicalResearch.com: What is the background for this study?   Response: Subtle impairments in cognition are common with aging, even in the absence of clinically apparent dementia. Mild hyponatremia is a common finding in older adults; however, the association of lower serum sodium with cognition in older adults is currently uncertain. We hypothesized that lower normal serum sodium would be associated with prevalent cognitive impairment and the risk of cognitive decline over time in asymptomatic, community-dwelling older men. (more…)
Author Interviews, Baylor College of Medicine Houston, Kidney Disease, Occupational Health / 01.02.2018

MedicalResearch.com Interview with: Dr. Kevin F. Erickson MD, MS Section of Nephrology and Selzman Institute for Kidney Health Baylor College of Medicine Houston, TX MedicalResearch.com: What is the background for this study? Response: An amendment to the Social Security Act passed in 1972 made it so nearly every person who develops end-stage renal disease – or ESRD – in the U.S. becomes eligible for Medicare, regardless of their age. At the time the law was passed, the bill’s supporters argued that access to life-sustaining dialysis therapy would enable patients to continue being productive members of society through work and activities at home. While the law has succeeded in providing access to dialysis therapy for many patients who would have otherwise died from kidney failure, it has been less successful at helping patients to continue working. The rate of employment among patients with ESRD who are receiving dialysis in the U.S. is low and has continued to decrease over time, despite both financial benefits from employment and evidence suggesting that patients who are employed experience improved quality of life and sense of wellbeing. We used a national ESRD registry to examine trends in employment between 1996 and 2013 among patients starting dialysis in the U.S. and in the six months before ESRD. Our goal was to determine whether difficulties that patients face when trying to work begin even before they develop ESRD. (more…)
Author Interviews, JAMA, Johns Hopkins, Kidney Disease, Transplantation / 23.01.2018

MedicalResearch.com Interview with: Tanjala S. Purnell, PhD MPH Assistant Professor of Surgery, Epidemiology, and Health Behavior and Society Core Faculty, Epidemiology Research Group in Organ Transplantation Johns Hopkins University Associate Director for Education and Training, Johns Hopkins Center for Health Equity Member, OPTN/UNOS Minority Affairs Committee  MedicalResearch.com: What is the background for this study?
  • Our study was motivated by the fact that we know live donor kidney transplants are associated with longer life expectancy and higher quality of life than deceased donor kidney transplants or long-term dialysis treatment. We also know that Black and Hispanic adults are more likely than White adults to have end-stage kidney disease but are less likely than White patients to receive live donor kidney transplants.
  • Over the last 2 decades, there have been several transplant education programs implemented within transplant centers and dialysis centers, and legislative policies enacted to improve overall access to live donor kidney transplants for patients. We wanted to see whether these programs and policies resulted in narrowed racial and ethnic disparities in access to live donor kidney transplants in the United States. 
(more…)
ASCO, Author Interviews, Cancer Research, Journal Clinical Oncology, Kidney Disease, UT Southwestern / 01.01.2018

MedicalResearch.com Interview with: Kevin D. Courtney, M.D., Ph.D.  Assistant Professor UT Southwestern Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Clear cell renal cell carcinoma (ccRCC) is the most common form of kidney cancer. Metastatic ccRCC does not respond to traditional chemotherapy. Current standard treatments for metastatic ccRCC include drugs called vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR TKIs) that block the growth of new blood vessels that feed the cancer, as well as drugs that inhibit an enzyme called mTOR that is involved in ccRCC growth and immune therapies that rev up the body’s immune response to try to fight the cancer. Each of these treatments can have significant side effects for patients that can make them difficult to tolerate. Metastatic ccRCC is largely incurable, and we need novel and better-tolerated treatments. A central driver of ccRCC is a protein called hypoxia inducible factor 2alpha (HIF-2alpha). This protein has been very difficult to try to target with a drug. This study is the first to test a drug that targets HIF-2alpha in patients with metastatic ccRCC. The study results showed that the HIF-2alpha inhibitor, PT2385 (Peloton Therapeutics) was active in fighting metastatic ccRCC and was well-tolerated. (more…)
Author Interviews, Heart Disease, JACC, Kidney Disease, Mayo Clinic / 21.11.2017

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. (more…)
Author Interviews, Depression, Kidney Disease, UT Southwestern / 08.11.2017

MedicalResearch.com Interview with: 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. (more…)
Author Interviews, CDC, Diabetes, Kidney Disease / 08.11.2017

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. (more…)
Author Interviews, Blood Pressure - Hypertension, Kidney Disease / 06.11.2017

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. (more…)
Author Interviews, Kidney Disease, Mayo Clinic, NEJM / 06.11.2017

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. (more…)
Author Interviews, Kidney Disease, Transplantation / 06.11.2017

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. (more…)
Author Interviews, Fertility, Geriatrics, Kidney Disease / 06.11.2017

MedicalResearch.com Interview with: 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. (more…)
Author Interviews, Gastrointestinal Disease, Kidney Disease / 06.11.2017

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. (more…)
Author Interviews, Frailty, Kidney Disease / 04.11.2017

MedicalResearch.com Interview with: 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. (more…)
Author Interviews, Geriatrics, Kidney Disease / 04.11.2017

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. (more…)
Author Interviews, Insomnia, Kidney Disease / 04.11.2017

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. (more…)
Author Interviews, Coffee, Kidney Disease / 04.11.2017

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) (more…)
Author Interviews, Coffee, Kidney Disease / 01.11.2017

MedicalResearch.com Interview with: 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) (more…)
Author Interviews, JAMA, Kidney Disease, Surgical Research / 25.10.2017

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). (more…)