A Randomized, Controlled Trial of Rituximab in IgA Nephropathy with Proteinuria and Renal Dysfunction
In this open label, multicenter study conducted over 1-year follow-up randomized 34 adult patients with biopsy-proven IgA nephropathy and proteinuria >1 g/d, maintained on angiotensin-converting enzyme inhibitors or angiotensin receptor blockers with well controlled BP and eGFR<90 ml/min per 1.73 m2, to receive standard therapy or rituximab with standard therapy. median baseline serum creatinine level (range) was 1.4 (0.8-2.4) mg/dl, and proteinuria was 2.1 (0.6-5.3) g/d. eGFR did not change in either group. Rituximab did not alter the level of proteinuria compared with that at baseline or in the control group;...
Source: Nephrology Now - May 1, 2017 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Clinical Nephrology General Nephrology Glomerulonephritis Source Type: research
Pain Management in CKD: A Guide for Nephrology Providers
This review provides nephrology providers with basic skills for pain management. These skills include recognition of types of pain (nociceptive and neuropathic) syndromes and appropriate history-taking skills. Furthermore, providers are taught to assess clinical circumstances in which specialist referral is beneficial, including those who are at high risk for addiction, at risk for adverse effects to medications, and those with complicated care needs such as patients with a limited prognosis.
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Risk of adverse events among older adults following co-prescription of clarithromycin and statins not...
Source: Nephrology Now - May 1, 2017 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Chronic Kidney Disease Review Source Type: research
A Clinical Risk Prediction Tool for 6-Month Mortality After Dialysis Initiation Among Older Adults
This study derived and validated a clinical risk prediction tool for all-cause mortality among older adults during the first 6 months of maintenance dialysis treatment using linked administrative and clinical data to define a cohort of 2,199 older adults (age ≥ 65 years) in Alberta, Canada.
A 19-point risk score was developed for 6-month mortality that included age 80 years or older (2 points), glomerular filtration rate of 10 to 14.9 mL/min/1.73 m2 (1 point) or ≥15 mL/min/1.73 m2 (3 points), atrial fibrillation (2 points), lymphoma (5 points), congestive heart failure (2 points), hospitalization in the pri...
Source: Nephrology Now - May 1, 2017 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Clinical Nephrology Hemodialysis Source Type: research
The Effect of Predialysis Fistula Attempt on Risk of All-Cause and Access-Related Death
This study was designed to determine the proportion of access-related deaths in a retrospective cohort study of 2300 patients aged ≥18 years who initiated hemodialysis between 2004 and 2012 at five Canadian dialysis programs. There was significantly lower mortality in individuals who underwent a predialysis fistula attempt than in those without a predialysis fistula attempt in patients aged <65 years (hazard ratio [HR], 0.49; 95% confidence interval [95% CI], 0.29 to 0.82) and in the first 2 years of follow-up in those aged ≥65 years (HR0–24 months, 0.60; 95% CI, 0.43 to 0.84; HR24+ months, 1.83; 95% CI, 1.25 to 2...
Source: Nephrology Now - May 1, 2017 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Chronic Kidney Disease Hemodialysis Vascular Access Source Type: research
Dietary salt restriction is beneficial to the management of autosomal dominant polycystic kidney disease
This is a post hoc analysis of the HALT-PKD clinical trials looked to determine if sodium restriction slows the progression of ADPKD. Linear mixed models examined whether dietary sodium affected rates of total kidney volume or change in estimated glomerular filtration rate (eGFR) in patients with an eGFR over 60 ml/min/1.73 m2 (Study A) or the risk for a composite endpoint of 50% reduction in eGFR, end-stage renal disease or death, or the rate of eGFR decline in patients with an eGFR 25–60 ml/min/1.73 m2 (Study B) in all patients initiated on an under 100 mEq sodium diet. During the trial urinary sodium excretion signi...
Source: Nephrology Now - May 1, 2017 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Chronic Kidney Disease Polycystic Kidney Disease Source Type: research
Obesity increases the risk of end-stage renal disease among living kidney donors
This study looked at the risk of ESRD associated with obesity at the time of donation among 119 769 live kidney donors in the United States with a maximum follow-up was 20 years. The estimated risk of ESRD 20 years after donation was 93.9 per 10 000 for obese; significantly greater than the 39.7 per 10 000 for non-obese live kidney donors. When adjusted for age, sex, ethnicity, blood pressure, baseline estimated glomerular filtration rate, and relationship to recipient, obese live kidney donors had a significant 86% increased risk of ESRD compared to their non-obese counterparts (adjusted hazard ratio 1.86; 95% confidence...
Source: Nephrology Now - May 1, 2017 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Chronic Kidney Disease General Nephrology Renal Transplantation Source Type: research
Cigarette smoking and chronic kidney disease in the general population: a systematic review and meta-analysis of prospective cohort studies
This meta-analysis looked at 15 prospective cohort studies, including 65 064 incident CKD cases. Compared with never-smokers, the summary relative risks of incident CKD were 1.27 (95% CI 1.19–1.35) for ever-smokers, 1.34 (95% CI 1.23–1.47) for current smokers and 1.15 (95% CI 1.08–1.23) for former smokers. The SRRs for end-stage renal disease development were 1.51 (95% CI 1.24–1.84) for ever-smokers, 1.44 (95% CI 1.00–2.09) for former smokers and 1.91 (95% CI 1.39–2.64) for current smokers. This data suggests that cigarette smoking is an independent risk factor for incident CKD.
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Source: Nephrology Now - May 1, 2017 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Chronic Kidney Disease Clinical Nephrology Source Type: research
ISPD Catheter-Related Infection Recommendations: 2017 Update
The International Society of Peritoneal Dialysis updated recommendations on the catheter-related infections.
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Peritoneal Dialysis-Related Infections Recommendations: 2010 Update | NOW FREE FULL TEXT
Clinical Practice Guidelines For Peritoneal Access – NOW FREE FULL TEXT
Consensus Guidelines for the Prevention and Treatment of Catheter-related Infections and Peritonitis in Pediatric Patients Receiving Peritoneal Dialysis: 2012 Update (Source: Nephrology Now)
Source: Nephrology Now - May 1, 2017 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Clinical Nephrology Clinical Practice Guidelines Peritoneal Dialysis Source Type: research
SPD Catheter-Related Infection Recommendations: 2017 Update
The Society of Peritoneal Dialysis updated recommendations on the catheter-related infections.
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Consensus Guidelines for the Prevention and Treatment of Catheter-related Infections and Peritonitis in Pediatric Patients Receiving Peritoneal Dialysis: 2012 Update
Peritoneal Dialysis-Related Infections Recommendations: 2010 Update | NOW FREE FULL TEXT
PD Access Guide (Source: Nephrology Now)
Source: Nephrology Now - May 1, 2017 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Clinical Nephrology Clinical Practice Guidelines Peritoneal Dialysis Source Type: research
Association between Preoperative Vascular Function and Postoperative Arteriovenous Fistula Development
Arteriovenous fistula (AVF) maturation failure is the primary cause of dialysis vascular access dysfunction. To evaluate whether preoperative vascular functional properties predict postoperative AVF measurements, patients enrolled in the Hemodialysis Fistula Maturation Study underwent up to five preoperative vascular function tests (VFTs): flow-mediated dilation (FMD), nitroglycerin-mediated dilation (NMD), carotid-femoral pulse wave velocity, carotid-radial pulse wave velocity, and venous occlusion plethysmography. The authors mixed effects multiple regression analyses to relate each preoperative VFT to ultrasound measure...
Source: Nephrology Now - February 9, 2017 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Clinical Nephrology Hemodialysis Vascular Access Source Type: research
Managing glomerular disease in pregnancy
This article reviews the pre-pregnancy counseling that women with glomerular-based diseases should ideally receive to allow them to make an informed decision about proceeding with a pregnancy as well as an approach to the diagnosis of pregnancy-associated worsening of kidney function and proteinuria as well as pregnancy-safe management strategies.
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Risk of Adverse Pregnancy Outcomes in Women with CKD
Management of hypertensive disorders during pregnancy: summary of NICE guidance
Vitamins C and E to Prevent Complications of Pregnancy-Associated Hypertension (Source: Nephrology Now)
Source: Nephrology Now - February 9, 2017 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Clinical Nephrology Pregnancy and Hypertension/Renal Disease Review Source Type: research
Dietary salt restriction is beneficial to the management of autosomal dominant polycystic kidney disease
This is a post hoc analysis of the HALT-PKD clinical trials of renin-angiotensin blockade in patients with ADPKD showed that sodium restriction is beneficial in the management of ADPKD.
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Moderate dietary sodium restriction added to angiotensin converting enzyme inhibition compared with dual blockade in lowering proteinuria and blood pressure: randomised controlled trial
Proteinuria: Is the ONTARGET renal substudy actually off target?
Efficacy and Safety of Sparsentan, a Dual Angiotensin II (Ang II) and Endothelin (ET) Type A Receptor Antagonist, in Patients with Focal Segmental Glomerulosclerosis (FS...
Source: Nephrology Now - February 9, 2017 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Clinical Nephrology Polycystic Kidney Disease Source Type: research
Residual Kidney Function Decline and Mortality in Incident Hemodialysis Patients
This study examined the association of annual change in renal CLurea rate with subsequent survival. The median (interquartile range) baseline value and mean±SD annual change of CLurea were 3.3 (1.9–5.0) and −1.1±2.8 ml/min per 1.73 m2, respectively. Greater CLurea rate 1 year after hemodialysis initiation associated with better survival. Further study needs to be done to determine the clinical benefits of RKF preservation strategies on mortality should be de
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Early Start of Hemodialysis May Be Harmful
Long-term Effects of Frequent Nocturnal Hemodialysis on Mortality: The Frequent Hemodialysis Network (FHN) Noc...
Source: Nephrology Now - February 9, 2017 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Clinical Nephrology Hemodialysis Source Type: research
AKI and Long-Term Risk for Cardiovascular Events and Mortality
This systematic review and meta-analysis of 25 studies involving 254 408 patients assessed whether AKI associates with long-term cardiovascular disease. AKI associated with an 86% and a 38% increased risk of cardiovascular mortality and major cardiovascular events, respectively ([RR 1.86; 95% confidence interval (95% CI), 1.72 to 2.01] and [RR 1.38; 95% CI, 1.23 to 1.55], respectively), particularly heart failure [58% increased risk of heart failure (RR 1.58; 95% CI, 1.46 to 1.72)] and acute myocardial infarction [40% increased risk of acute myocardial infarction (RR 1.40; 95% CI, 1.23 to 1.59)]
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Effects of intensive blo...
Source: Nephrology Now - February 9, 2017 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Acute Kidney Injury Clinical Nephrology General Nephrology Source Type: research
Rituximab for Severe Membranous Nephropathy: A 6-Month Trial with Extended Follow-Up
This is a multicenter, randomized, controlled trial conducted at 31 French hospital. Patients with biopsy-proven PMN and nephrotic syndrome after 6 months of nonimmunosuppressive antiproteinuric treatment (NIAT) were randomly assigned to 6-month therapy with NIAT and 375 mg/m2 intravenous rituximab on days 1 and 8 (n=37) or NIAT alone (n=38). During the observational phase, remission rates before change of assigned treatment were 24 of 37 (64.9%) and 13 of 38 (34.2%) patients in NIAT-rituximab and NIAT groups, respectively (P<0.01). Positive effect of rituximab on proteinuria remission occurred after 6 months.
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Source: Nephrology Now - February 9, 2017 Category: Urology & Nephrology Authors: Nephrology Now editors Tags: Clinical Nephrology Clinical Trial Results Glomerulonephritis Source Type: research
