Author Interviews, JAMA, Kidney Disease / 12.01.2015

MedicalResearch.com Interview with: James Flory MD, MSCE Division of Endocrinology and Department of Healthcare Policy and Research Weill Cornell Medical College, NY NY Medical Research: What is the background for this study? What are the main findings? Dr. Flory: Metformin is the first-line drug for type 2 diabetes, with much better evidence for safety and improved clinical outcomes than any alternative. The one major safety concern about metformin is the fear that it can cause lactic acidosis, which led to a Food and Drug Administration black box warning against using metformin in patients with even a modest degree of renal impairment. These fears and warnings were based on serious problems with an older drug in the same class, not on experiences with metformin itself, and over the past 20 years it has become clear that the risk of lactic acidosis with metformin is extremely low, and that this warning against the use of the drug in mild renal failure is overly strict. (Dr. Lipska and colleagues published a superb review of this issue a few years back: Diabetes Care June 2011 vol. 34 no. 6 1431-1437) This is important from a public health perspective because so many patients with diabetes have mild to moderate kidney disease, and we were concerned that the FDA warning was preventing the use of metformin in these patients. Our study was intended to estimate how many patients who would benefit from metformin are not taking it because they have mild kidney disease. We found that rates of metformin use are much lower in patients with mild kidney disease – just the population where the FDA warning discourages use, but modern data show that metformin is safe. In all, at least 1 million patients with type 2 diabetes who would benefit from metformin appear not to be taking it because clinicians are following the FDA warning and being too conservative. (more…)
Author Interviews, HIV, Johns Hopkins, Kidney Disease / 06.01.2015

Alison G Abraham PhD Associate Scientist Department of Epidemiology Johns Hopkins Bloomberg School of Public HealthMedicalResearch.com Interview with: Alison G Abraham PhD Associate Scientist Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Medical Research: What was the motivation for this study? Dr. Abraham: HIV-infected individuals are at higher risk for kidney dysfunction compared to the general population.  Prior to effective antiretroviral therapy, very aggressive forms of kidney disease were described primarily among black HIV-infected individuals.  While effective therapy and increasing viral suppression rates have made HIV-associated nephropathy rare, some of these same drugs have nephrotoxic effects.  In addition, the reduction in AIDS and mortality has led to HIV-infected individuals living long enough to experience age-related chronic diseases, which are also risk factors for kidney disease and end-stage renal disease.  Thus we wanted to know how these competing forces were affecting end-stage renal disease risk in the well-treated HIV-infected North American population over time.  Are we seeing more ESRD as a result of nephrotoxic drugs and chronic disease, or less ESRD as a result of better viral suppression and large reductions in HIV-associated nephropathy? Medical Research: What are the main findings? Dr. Abraham: We found that end stage renal disease rates have been steadily falling over the past 10 years coincident with notable improvements in viral suppression prevalence.  However a large racial discrepancy in ESRD risk has persisted even though HIV-associated nephropathy cases are now rare.  While ESRD cases among blacks in our study tended to have higher viral loads and lower CD4 counts compared to non-black ESRD cases, suggesting less effective HIV treatment, we found that the racial discrepancy in ESRD risk persisted even among the well-suppressed subset, i.e. those who had undetectable viral loads for 90% of their follow-up time. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Kidney Disease, University of Pittsburgh / 22.12.2014

MedicalResearch.com Interview with: Florentina E. Sileanu BS Center for Critical Care Nephrology and Clinical Research, Investigation, and Systems Modeling of Acute Illness Center Departments of Critical Care Medicine and Department of Biostatistics, University of Pittsburgh Graduate School of Public Health and Dr. John A. Kellum, MD, MCCM Professor of Medicine, Bioengineering and Clinical & Translational Science Vice Chair for Research Center for Critical Care Nephrology, University of Pittsburgh School of Medicine Pittsburgh, PA Medical Research: What is the background for this study? What are the main findings? Response: Acute Kidney Injury (AKI) affects millions of Americans each year resulting in increased short and long-term complications including need for dialysis and death. Many trials recruiting subjects at risk for AKI have focused on those with other (e.g. cardiovascular and respiratory) organ failures because these patients are at highest for AKI. However, patients without these conditions might not be at low-risk for AKI. We explored whether Acute Kidney Injury occurring as a single organ failure or occurring before other organ failures would be associated with the same outcomes as in sicker patients. Using a large, academic medical center database, with records from July 2000 through October 2008, we identified a "low-risk" cohort as patients without cardiovascular and respiratory organ failures defined as not receiving vasopressor support or mechanical ventilation within the first 24 hours of ICU admission. We were able to show that low-risk patients have a substantial likelihood of developing AKI and that the relative impact on mortality of AKI is actually greater for low-risk patients (OR, 2.99; 95% 2.62-3.41) than for high-risk patients (OR, 1.19; 95% 1.09-1.3). (more…)
Heart Disease, Kidney Disease, Stem Cells / 20.12.2014

Madhav Swaminathan, MBBS, MD, FASE, FAHA Associate Professor with Tenure Clinical Director, Division of Cardiothoracic Anesthesiology & Critical Care Medicine Department of Anesthesiology Duke University Health System Durham, NC 27710MedicalResearch.com Interview with: Madhav Swaminathan, MBBS, MD, FASE, FAHA Associate Professor with Tenure Clinical Director, Division of Cardiothoracic Anesthesiology & Critical Care Medicine Department of Anesthesiology Duke University Health System Durham, NC 27710 Medical Research: What is the background for this study? What are the main findings? Dr. Swaminathan: The background is the need for salvage therapies for acute kidney injury (AKI,) which is a common complication in hospitalized patients. It is particularly a problem in the postoperative period after cardiac surgery. Preventive strategies have not worked well for decades. Hence the focus on strategies that target kidney recovery. Mesenchymal stem cells have been shown to be useful in enhancing kidney recovery in pre-clinical trials. We therefore hypothesized that administration of human Mesenchymal stem cells (AC607, Allocure Inc, Burlington, MA) to patients with established post-cardiac surgery AKI would result in a shorter time to kidney recovery. We conducted a phase 2, double blinded, placebo controlled, randomized clinical trial to test our hypothesis. Unfortunately we could not confirm the hypothesis and there were no significant differences in time to kidney recovery among patients that received AC607 versus placebo in 156 randomized cardiac surgery subjects. (more…)
Author Interviews, Heart Disease, Kidney Disease / 11.12.2014

Anders Nissen Bonde MBs Department of Cardiology Copenhagen University Hospital Gentofte, Gentofte, Denmark MedicalResearch.com Interview with: Anders Nissen Bonde MBs Department of Cardiology Copenhagen University Hospital Gentofte, Gentofte, Denmark Medical Research: What is the background for this study? What are the main findings? Response: Patients with severe chronic kidney disease have been excluded from randomized trials of antithrombotic therapy in atrial fibrillation.They represent a very fragile group as they are both at increased risk of stroke/thromboembolism and major bleedings, and previous observational studies have had conflicting conclusions regarding the safety and benefits of the treatment. A previous study from our department reported both increased risk of bleeding and reduced risk of stroke with warfarin. We wanted to assess the net clinical benefit of aspirin and warfarin in these patients, balancing stroke and major bleeding associated with the treatment. (more…)
Author Interviews, Kidney Disease, Vanderbilt / 09.12.2014

Dr. Julia Lewis, MD, Lead Investigator Nephrologist and Professor of Medicine Vanderbilt University Medical CenterMedicalResearch.com Interview with: Dr. Julia Lewis, MD, Lead Investigator Nephrologist and Professor of Medicine Vanderbilt University Medical Center Medical Research: What is the background for this study? What are the main findings? Dr. Lewis: The 48-week Open Label Extension (OLE) study for Auryxia™ (ferric citrate) was conducted to determine long term safety following the Phase 3 52-week active-control period. The study also evaluated changes in serum phosphorus, transferrin saturation (TSAT), serum ferritin, hemoglobin, hematocrit and additional parameters, as well as intravenous (IV) iron and erythropoiesis-stimulating agent (ESA) usage. In the OLE study, Auryxia demonstrated long-term safety in dialysis-dependent chronic kidney disease (CKD) patients. The results were consistent with those seen in the published pivotal Phase 3 trial. The study demonstrated that the adverse events (AE’s) profile of Auryxia was similar to that seen in the Phase 3 52-week active-control period. AEs occurred in 142 patients treated with Auryxia. They were primarily non-serious gastrointestinal (GI) - related AE’s, including diarrhea, nausea, vomiting and constipation. Serious adverse events occurred in 75 patients, though none were related to Auryxia. In addition, there were no clinically or statistically significant differences in liver enzymes or aluminum levels observed from baseline to the end of the 48 weeks. Similar to the original trial, we witnessed excellent phosphorus control with the drug, along with an increase and then a plateau in serum ferritin and TSAT levels with Auryxia. The plateauing of serum ferritin and TSAT further supports iron absorption is highly regulated by the gastrointestinal track as seen in the 52-week active control period. This suggests that the body absorbs iron as needed for effective erythropoiesis. Additionally, iron store increases from ferric citrate resulted in, by the end of the extension study, 85% of subjects not using any IV iron. We presented this data at the 2014 American Society of Nephrology Meeting. The abstract can be found online at www.asn-online.org. (more…)
Author Interviews, Kidney Disease, Lipids / 01.12.2014

Thomas Weichhart, PhD Associate Professor, Medical University of Vienna Institute of Medical Genetics Vienna AustriaMedicalResearch.com Interview with: Thomas Weichhart, PhD Associate Professor, Medical University of Vienna Institute of Medical Genetics Vienna Austria Medical Research: What is the background for this study? Dr.  Weichhart: Impairment of high-density lipoprotein (HDL) function has been associated with cardiovascular events in patients with kidney failure on hemodialysis. The protein composition of HDLs is altered in these patients presumably compromising the cardioprotective effects of HDLs. In an earlier study we found that two proteins in particular, namely Serum Amyloid A (SAA) and Surfactant Protein B (SP-B), are significantly raised in the HDL of dialysis patients, and these also contribute towards HDL losing its protective effect. In the current study we have now developed an novel test that can quickly and directly measure the SAA and SP-B bound to HDL. (more…)
Author Interviews, General Medicine, Heart Disease, JAMA, Kidney Disease / 30.11.2014

Giovanni Landoni, M.D. Head of Research,Department of Anesthesiology and Intensive Care Associate Professor at Università Vita-Salute San Raffaele, MilanMedicalResearch.com Interview with: Giovanni Landoni, M.D. Head of Research,Department of Anesthesiology and Intensive Care Associate Professor at Università Vita-Salute San Raffaele, Milan Medical Research: What is the background for this study? Dr. Landoni: The prevention and treatment of acute kidney injury after cardiac surgery is a major therapeutic goal, but no effective agents have yet been identified. Meta-analyses suggested that fenoldopam might be effective. Medical Research: What are the main findings? Dr. Landoni: We found that in cardiac surgery patients with early acute kidney injury (defined as a ≥50% increase of serum creatinine from baseline or oliguria for ≥6 hours), fenoldopam had no impact on the need for renal replacement therapy or 30-day mortality, while increasing the rate of hypotension. (more…)
Exercise - Fitness, Kidney Disease / 20.11.2014

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, ItalyMedicalResearch.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. (more…)
Endocrinology, Kidney Disease, Vitamin D / 19.11.2014

Stuart M. Sprague, DO, FACP, FASN, FNKF Chairperson, Division of Nephrology and Hypertension NorthShore University HealthSystem Evanston, Illinois 60201MedicalResearch.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. (more…)
Kidney Disease / 16.11.2014

Anu Wadhwa, M.D. Assistant Professor of Medicine Division of Nephrology and Hypertension Loyola University Medical Center/ Hines VA Hospital Maywood, IL-60153MedicalResearch.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. (more…)
Kidney Disease, Transplantation / 15.11.2014

Anthony Bleyer, Jr.  Wake Forest University Class of 2015, Economics  President, Club Sports Union  Senior Captain, Wake Forest Men's Ultimate 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. (more…)
Author Interviews, Kidney Disease, Pharmacology / 14.11.2014

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. (more…)
Author Interviews, Heart Disease, Kidney Disease / 06.11.2014

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. (more…)
Author Interviews, BMJ, Heart Disease, Kidney Disease / 13.10.2014

Dr Jelena Kornej Department of Electrophysiology Heart Center Leipzig Leipzig Germany;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. (more…)
Author Interviews, Dermatology, Kidney Disease / 30.09.2014

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. (more…)
Author Interviews, Exercise - Fitness, Kidney Disease / 27.09.2014

Pietro Manuel Ferraro, MD PhD Candidate Division of Nephrology Catholic University of the Sacred Heart Rome ItalyMedicalResearch.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. (more…)
Author Interviews, Blood Pressure - Hypertension, General Medicine, JAMA, Kidney Disease / 22.09.2014

Dr. Csaba P. Kovesdy, MD Professor of Medicine University of Tennessee Health Science Center Chief of Nephrology Memphis Veterans Affairs Medical CentMedicalResearch.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. (more…)
Author Interviews, Diabetes, Kidney Disease, Neurology, Stroke / 21.08.2014

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. (more…)
Author Interviews, Brigham & Women's - Harvard, Compliance, Kidney Disease, Primary Care / 20.08.2014

Mallika L. Mendu, M.D. Division of Renal Medicine Brigham and Women’s Hospital Boston, MA 02115.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. (more…)
Blood Pressure - Hypertension, JACC, JAMA, Kidney Disease / 05.08.2014

Dr. John J. Sim Division of Nephrology and Hypertension Kaiser Permanente Los Angeles Medical Center, Los Angeles,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. (more…)
Author Interviews, Gender Differences, Kidney Disease, Mayo Clinic, Weight Research / 31.07.2014

Dr. John C. Lieske, MD Mayo Clinic, Rochester, MNMedicalResearch.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). (more…)
Author Interviews, Dartmouth, Kidney Disease / 31.07.2014

MedicalResearch.com Interview with: Jeremiah R. Brown, PhD MS Assistant Professor of Health Policy and Clinical Practic The Dartmouth Institute Lebanon, NHMedicalResearch.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.
(more…)
Author Interviews, Diabetes, Diabetes Care, Kidney Disease / 30.07.2014

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). (more…)
Author Interviews, Kidney Disease, Lancet, Transplantation / 28.07.2014

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. (more…)
Anemia, Author Interviews, Kidney Disease / 18.07.2014

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. (more…)
Author Interviews, Kidney Disease, Transplantation / 15.07.2014

Dr Hallvard Holdaas Consultant in Nephrology National Hospital of Oslo, NorwayMedicalResearch.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). (more…)
Author Interviews, Kidney Disease, NEJM, Transplantation / 15.07.2014

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 UniversityMedicalResearch.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. (more…)
Author Interviews, Kidney Disease / 11.07.2014

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. (more…)
Author Interviews, Kidney Disease, Transplantation / 01.07.2014

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 UniversityMedicalResearch.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. (more…)