nephrology Tag

11 Nov

Posted at 21:04h in JAMA, Kidney Disease, Transplantation
Health notice: This interview is for general information and is not medical advice. People considering living kidney donation should discuss future pregnancy plans with their transplant team, as recommended in the KDIGO (Kidney Disease: Improving Global Outcomes) living kidney donor guideline. Kidney donors who become pregnant should tell their obstetric care provider about their donation. Seek urgent care during pregnancy for severe headache, vision changes, upper abdominal pain, sudden swelling of the face or hands, shortness of breath or other unexplained symptoms.

MedicalResearch.com Interview with:

[caption id="attachment_77168" align="alignleft" width="200"]Dr. Amit Garg Dr. Amit Garg, MD, PhD[/caption]

Amit X. Garg, MD, PhD

Associate Dean, Clinical Research, Schulich School of Medicine & Dentistry Department of Medicine, Division of Nephrology Department of Epidemiology and Biostatistics Past President, Canadian Society of Nephrology Scientist, Lawson Health Research Institute Lead, ICES Provincial Kidney, Dialysis and Transplantation Program (ICES KDT) Schulich School of Medicine & Dentistry

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

Response: Living kidney donation provides an important opportunity for someone with kidney failure to receive a transplant and live a longer, healthier life. Many living kidney donors may also consider pregnancy after donation, so it is important that they have reliable information about potential pregnancy-related risks when making an informed decision about donation.

Earlier studies suggested that gestational hypertension and preeclampsia may occur more often after kidney donation, but the number of postdonation pregnancies studied was relatively small and uncertainty remained about the magnitude of the risk. We therefore expanded our previous Ontario study across three Canadian provinces to provide more precise estimates and to examine a broader range of maternal, fetal, and neonatal outcomes.

18 Dec

Posted at 22:18h in Author Interviews, Diabetes, Heart Disease, Kidney Disease
MedicalResearch.com Interview with: [caption id="attachment_71837" align="alignleft" width="150"]dr_kramer_headshot Dr. Holly Kramer[/caption] Dr. Holly Kramer MD, MPH Professor of Public Health Sciences and Medicine Division of Nephrology and Hypertension Loyola University Chicago MedicalResearch.com: What is the background for this survey? How is UACR measured? Would you explain the significance of albumin in the urine and what creatinine represents? Response: Approximately 36 million people live with type 2 diabetes (T2D) in the U.S. today, with cardiovascular disease (CVD) being the number one cause of death for this patient population. About 1 in 3 adults with T2D has UACR >30 mg/g with prevalence approaching 40% in older patients. Compared to patients with T2D alone, those with elevated UACR face:
    • 5-times higher risk of hospitalization for heart failure
    • 4-times higher risk of CV mortality
    • 3-times higher risk of myocardial infarction
Interestingly, once thought of as a traditional renal biomarker, urine albumin-to-creatinine ratio (UACR) >30 is also a critical biomarker and urgent signal of cardiovascular (CV) risk. When checking UACR, we look at two things: the amount of albumin leaking into the urine and the creatinine level. Albumin shouldn’t be getting through the kidneys’ filters at all, so when we see a UACR >30 mg/g, it’s a sign of systemic vascular endothelial dysfunction. So, if albumin is leaking through the blood vessels inside the kidneys, there’s also damage in the vessels across other organs, like the heart. UACR is such an important early indicator of CV risk in T2D because even small increases follow a clear ‘rule of three’s’. Healthy kidneys secrete 3 mg/g of albumin to creatinine per day, but when it rises to 30 mg/g, a tenfold increase that signals vascular dysfunction and increasing CV risk. At 300 mg/g, another tenfold increase, the damage is more advanced, and CV risk accelerates. Patients with eGFR >60 BUT UACR >30 mg/g can have up to 3.6 times increased risk of CV mortality. As a nephrologist, I’ve been vocal about the potential for this common urine test that we regularly perform, a UACR test, in helping detect CV risk, not just kidney damage, in more patients.

12 Nov

Posted at 15:39h in Annals Internal Medicine, Author Interviews, Kidney Disease, Pediatrics
MedicalResearch.com Interview with: [caption id="attachment_55860" align="alignleft" width="150"]Prof. Dr. Hans Pottel Professeur Invité (titre honorifique) Faculté de Médecine Université de Liège Prof. Pottel[/caption] Prof. Dr. Hans Pottel PhD Professeur Invité (titre honorifique) Faculté de Médecine Université de Liège KULeuven-KULAK, Kortrijk, Belgium  MedicalResearch.com: What is the background for this study? Why do we need a new GFR? Response: The currently recommended equations have flaws, mainly because there is one equation (CKiD) recommended for children, and one recommended (CKD-EPI) for adults (by KDIGO). When transitioning from pediatric nephrology care to adult nephrology care, the switch from CKiD to CKD-EPI causes implausible jumps (of more than 50%), mainly because CKD-EPI largely overestimates GFR in young adults (18-30 years). The new equation overcomes this problem as it applies for all ages (for children and adults) and overcomes the known flaws of the currently most used equations. The new equation is less biased and more precise across the full age spectrum and for the full range of serum creatinine concentrations. The equation was developed in 11 251 participants from 7 cohorts (development and internal validation datasets) and validated in 8 378 participants from 6 cohorts (external validation dataset). Data were coming from European and American nephrology centers. No patients of African-American ancestry were included. Actually, the previously published FAS-equation served as the basic mathematical form for the equation, but we adjusted the power coefficients for serum creatinine (very much like it was done in the CKD-EPI equation). You could say that we used properties of both the FAS and CKD-EPI equation to come to an improved equation to estimate GFR.

09 Jun

Posted at 00:37h in Author Interviews, Clots - Coagulation, JAMA, Kidney Disease
MedicalResearch.com Interview with: [caption id="attachment_54478" align="alignleft" width="133"]Manish M Sood MD FRCPC MSc Jindal Research Chair for the Prevention of Kidney Disease Associate Professor of Medicine, Dept. of Medicine and the School of Epidemiology and Public Health University of Ottawa Scientist, Ottawa Hospital Research Institute  Nephrologist, The Ottawa Hospital Ottawa, Ontario, Canada Dr. Sood[/caption] Manish M Sood MD FRCPC MSc Jindal Research Chair for the Prevention of Kidney Disease Associate Professor of Medicine, Dept. of Medicine and the School of Epidemiology and Public Health University of Ottawa Scientist, Ottawa Hospital Research Institute Nephrologist, The Ottawa Hospital Ottawa, Ontario, Canada  MedicalResearch.com: What is the background for this study? Response: Early work has suggested a very commonly used antibiotic, clarithromycin, may interfere with the metabolism of the most widely used type of blood thinning medication (called direct oral anticoagulants or DOACs) such that the blood level of the DOAC increases and may place the patient at a higher risk for bleeding.  In our study we looked at patients of advanced age (>66 years old) who were given clarithromycin while on a DOAC in Ontario, Canada. We compared patients on clairthromycin-DOAC to patients given a very similar antibiotic, azithromycin, that does not interfere with the metabolism of DOAC.

13 Jun

Posted at 15:58h in Author Interviews, JACC, Kidney Disease, NYU/NYMC
MedicalResearch.com Interview with: [caption id="attachment_49703" align="alignleft" width="225"]David Charytan, MD MSc Chief, Nephrology Division NYU Langone Medical Center New York, NY 10010 Dr. Charytan[/caption] David Charytan, MD MSc Chief, Nephrology Division NYU Langone Medical Center New York, NY 10010  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Cardiovascular events are much more frequent in patients with impaired kidney function (chronic kidney disease), and cardiovascular disease is the most common cause of death in advanced chronic kidney disease. This risk remains high despite the use of standard medical therapies including statins, the most commonly used cholesterol lowering agents. The PCSK9 inhibitor evolocumab is a new class of highly potent cholesterol lowering medications that can further reduce the risk of cardiovascular events in patients already taking statins. We analyzed data from the FOURIER trial, which randomized study patients with clinically evident atherosclerosis and an LDL cholesterol level >=70 mg/dL or HDL cholesterol level >= while on a statin, to assess the safety and efficacy of evolocumab, a PCSK9 inhibitor, compared with placebo in individuals with mild to moderate chronic kidney disease. There were several major findings
  • a) evolocumab appears to be equally safe in individuals with preserved and mild to moderately impaired kidney function
  • b) evolocumab appears to have preserved efficacy at preventing cardiovascular events as kidney function declines.
  • c) We were unable to detect any significant impact on kidney function.
  • In addition, because the baseline risk of cardiovascular events is much higher in individuals with  chronic kidney disease, the absolute benefits of treatment with evolocumab appear  to be magnified as kidney function declines. 

24 Feb

Posted at 02:30h in Author Interviews, Exercise - Fitness, Kidney Disease, Nutrition, UT Southwestern
MedicalResearch.com Interview with: [caption id="attachment_34742" align="alignleft" width="132"]Wanpen Vongpatanasin, M.D. Professor of Medicine Norman & Audrey Kaplan Chair in Hypertension Fredric L. Coe Professorship in Nephrolithiasis and Mineral Metabolism Research Director, Hypertension Section, Cardiology Division, UT Southwestern Medical Center Dallas, TX 75390-8586 Dr. Vongpatanasin[/caption] Dr. Wanpen Vongpatanasin, M.D. Professor of Medicine Norman & Audrey Kaplan Chair in Hypertension Fredric L. Coe Professorship in Nephrolithiasis and Mineral Metabolism Research Director, Hypertension Section, Cardiology Division, UT Southwestern Medical Center    MedicalResearch.com: What is the background for this study? Response: Increased sedentary activity is commonly seen in people who regularly consume fast food but previously studies have not identified potential mechanisms beyond increased obesity and lack of motivation. Our study seeks to determine if inorganic phosphate, a commonly used food additives that are present in up to 70% of foods in the American diet, maybe the culprit. These food additives (which may come in the form of monocalcium phosphate, phosphoric acid, or tetrasodium phosphate, etc. are used to make the food taste better and/or last longer. It is found mostly in prepackaged foods, cola drinks, and bakery items (cookies, cake, and bread). This is very different from organic phosphates that are found naturally in many healthful foods, such as fruits and vegetables, which are not not readily absorbed from the GI tract. In the Dallas Heart Study, a multiethnic population-based study, we found that serum phosphate is significantly associated with sedentary time and increased time spent in moderate-to-vigorous physical activity which was measured by wrist actigraphy device. This is not explained by reduce cardiac function as ejection fraction remains normal at higher serum phosphate.

28 Feb

Posted at 13:19h in Author Interviews, Geriatrics, Kidney Disease
Nisha Bansal MD MAS Assistant Professor Associate Program Director for Research Kidney Research Institute Division of Nephrology University of WashingtonMedicalResearch.com Interview with: Nisha Bansal MD MAS Assistant Professor Associate Program Director for Research Kidney Research Institute Division of Nephrology University of Washington Medical Research: What is the background for this study? What are the main findings? Dr. Bansal: We pursued this study to develop a prediction equation for death among elderly patients with chronic kidney disease (CKD), a high-risk patient population that is often difficult to manage given competing risks of end stage renal disease (ESRD) vs. death. In this paper, we developed and validated a simple prediction equation using variables that are readily available to all clinicians.