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Chronic kidney disease management and treatment

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https://www.readbyqxmd.com/read/28445881/absence-of-decline-of-kidney-function-in-human-immunodeficiency-virus-infected-patients-under-routine-clinical-management
#1
Julie Boucquemont, Sylvie Lawson-Ayayi, Claire Rigothier, Fabrice Bonnet, Cécile Proust-Lima, Didier Neau, Carine Greib, Ghada Miremont-Salamé, François Dabis, Michel Dupon, Frédéric-Antoine Dauchy
BACKGROUND: Since the introduction of antiretroviral therapy (ART), human immunodeficiency virus (HIV)-infected patients have a drastically improved prognosis but at the same time they are also more affected by non-HIV related complications, such as chronic kidney disease. The objective of our study was to investigate the effect of proteinuria and tenofovir (TDF)-containing ART regimens on the temporal evolution of estimated glomerular filtration rate (eGFR). METHODS: Between April 2008 and October 2012, we enrolled 395 patients with a complete renal evaluation among patients from the ANRS C03 Aquitaine cohort, a prospective hospital-based cohort of HIV-1-infected patients under routine clinical management in southwestern France...
April 26, 2017: Nephron
https://www.readbyqxmd.com/read/28437620/american-association-of-clinical-endocrinologists-and-american-college-of-endocrinology-guidelines-for-management-of-dyslipidemia-and-prevention-of-cardiovascular-disease
#2
Paul S Jellinger, Yehuda Handelsman, Paul D Rosenblit, Zachary T Bloomgarden, Vivian A Fonseca, Alan J Garber, George Grunberger, Chris K Guerin, David S H Bell, Jeffrey I Mechanick, Rachel Pessah-Pollack, Kathleen Wyne, Donald Smith, Eliot A Brinton, Sergio Fazio, Michael Davidson
OBJECTIVE: The development of these guidelines is mandated by the American Association of Clinical Endocrinologists (AACE) Board of Directors and American College of Endocrinology (ACE) Board of Trustees and adheres with published AACE protocols for the standardized production of clinical practice guidelines (CPGs). METHODS: Recommendations are based on diligent reviews of the clinical evidence with transparent incorporation of subjective factors, according to established AACE/ACE guidelines for guidelines protocols...
April 2017: Endocrine Practice
https://www.readbyqxmd.com/read/28436256/clinical-and-economic-impact-of-hyperkalemia-in-patients-with-chronic-kidney-disease-and-heart-failure
#3
Michael Polson, Todd C Lord, Anne Kangethe, Lindsay Speicher, Carolyn Farnum, Melanie Brenner, Nina Oestreicher, Paula Alvarez
BACKGROUND: Hyperkalemia (HK) is a concern for patients with chronic kidney disease (CKD) and heart failure (HF), and for those receiving treatments that inhibit the renin-angiotensin-aldosterone system (RAASi). An analysis of 1.7 million medical records of patients in the United States revealed that among individuals with more than 2 potassium values during 2007 to 2012, HK was detected in 34.6% of patients with CKD and 30.0% of patients with HF. OBJECTIVE: To evaluate the association of HK and use of RAASi therapies at optimal and suboptimal doses in patients with CKD and/or HF with health care resource utilization and overall cost of care in a diverse cohort of commercially insured patients...
April 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28434650/global-kidney-health-2017-and-beyond-a-roadmap-for-closing-gaps-in-care-research-and-policy
#4
REVIEW
Adeera Levin, Marcello Tonelli, Joseph Bonventre, Josef Coresh, Jo-Ann Donner, Agnes B Fogo, Caroline S Fox, Ron T Gansevoort, Hiddo J L Heerspink, Meg Jardine, Bertram Kasiske, Anna Köttgen, Matthias Kretzler, Andrew S Levey, Valerie A Luyckx, Ravindra Mehta, Orson Moe, Gregorio Obrador, Neesh Pannu, Chirag R Parikh, Vlado Perkovic, Carol Pollock, Peter Stenvinkel, Katherine R Tuttle, David C Wheeler, Kai-Uwe Eckardt
The global nephrology community recognises the need for a cohesive plan to address the problem of chronic kidney disease (CKD). In July, 2016, the International Society of Nephrology hosted a CKD summit of more than 85 people with diverse expertise and professional backgrounds from around the globe. The purpose was to identify and prioritise key activities for the next 5-10 years in the domains of clinical care, research, and advocacy and to create an action plan and performance framework based on ten themes: strengthen CKD surveillance; tackle major risk factors for CKD; reduce acute kidney injury-a special risk factor for CKD; enhance understanding of the genetic causes of CKD; establish better diagnostic methods in CKD; improve understanding of the natural course of CKD; assess and implement established treatment options in patients with CKD; improve management of symptoms and complications of CKD; develop novel therapeutic interventions to slow CKD progression and reduce CKD complications; and increase the quantity and quality of clinical trials in CKD...
April 20, 2017: Lancet
https://www.readbyqxmd.com/read/28434480/how-to-assess-and-manage-cardiovascular-risk-associated-with-lipid-alterations-beyond-ldl
#5
Maurizio Averna, Erik Stroes
BACKGROUND AND AIMS: The maintenance of clinically recommended levels of low-density lipoprotein cholesterol (LDL-C) through a statin therapy is a gold standard in the management of patients with dyslipidaemia and cardiovascular disease (CVD). However, even when LDL-C levels are at or below clinically recommended target levels, residual cardiovascular (CV) risk still remains. Therefore, assessing lipoproteins beyond LDL-C in managing CV risk is imperative. METHODS: A working group of clinical experts have assessed the role of lipoproteins other than LDL-C in identifying the CV risk in patients with dyslipidaemia and CVD and in the management of atherogenic dyslipidaemia associated with a number of other diseases...
April 2017: Atherosclerosis. Supplements
https://www.readbyqxmd.com/read/28431138/cardiovascular-outcome-trials-in-patients-with-chronic-kidney-disease-challenges-associated-with-selection-of-patients-and-endpoints
#6
Patrick Rossignol, Rajiv Agarwal, Bernard Canaud, Alan Charney, Gilles Chatellier, Jonathan C Craig, William C Cushman, Ronald T Gansevoort, Bengt Fellström, Dahlia Garza, Nicolas Guzman, Frank A Holtkamp, Gerard M London, Ziad A Massy, Alexandre Mebazaa, Peter G M Mol, Marc A Pfeffer, Yves Rosenberg, Luis M Ruilope, Jonathan Seltzer, Amil M Shah, Salim Shah, Bhupinder Singh, Bergur V Stefánsson, Norman Stockbridge, Wendy Gattis Stough, Kristian Thygesen, Michael Walsh, Christoph Wanner, David G Warnock, Christopher S Wilcox, Janet Wittes, Bertram Pitt, Aliza Thompson, Faiez Zannad
Although cardiovascular disease is a major health burden for patients with chronic kidney disease, most cardiovascular outcome trials have excluded patients with advanced chronic kidney disease. Moreover, the major cardiovascular outcome trials that have been conducted in patients with end-stage renal disease have not demonstrated a treatment benefit. Thus, clinicians have limited evidence to guide the management of cardiovascular disease in patients with chronic kidney disease, particularly those on dialysis...
April 18, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28429555/management-of-mineral-and-bone-disorders-in-renal-transplant-recipients
#7
Matthew J Damasiewicz, Peter R Ebeling
The management of post-transplantation bone disease is a complex problem that remains under-appreciated in clinical practice. In these patients, pre-existing metabolic bone disorder is further impacted by the use of immunosuppressive medications (glucocorticoids and calcineurin-inhibitors), variable post-transplantation renal allograft function and post-transplantation diabetes mellitus. The treatment of post-transplantation bone loss should begin pre-transplantation. All patients active on transplant waiting lists should be screened for bone disease...
March 2017: Nephrology
https://www.readbyqxmd.com/read/28429554/is-there-a-practical-role-for-bone-biopsy-in-chronic-kidney-disease
#8
Terrence Diamond, Grahame J Elder
Bone biopsy is currently the only means to accurately assess renal osteodystrophy and responses to therapeutic interventions. With sedation, the technique is relatively painless, and complications are uncommon. Bone biopsy should be considered when the aetiology of symptoms or biochemical abnormalities is in question, and results may lead to changes in therapy. Although it remains prudent to use antiresorptive drugs cautiously in patients with chronic kidney disease (CKD) stages 3a-4 and low bone mineral density, bone biopsy may not be warranted before commencing therapy in these patients...
March 2017: Nephrology
https://www.readbyqxmd.com/read/28429550/parathyroid-hormone-targets-in-chronic-kidney-disease-and-managing-severe-hyperparathyroidism
#9
Carmel M Hawley, Stephen G Holt
Appropriate targets for parathyroid hormone (PTH) in patients with chronic kidney disease (CKD) stages 3-5D are controversial, as are the means by which these targets might be achieved. Secondary hyperparathyroidism is linked to symptoms like bone pain and itch, in addition to less clinically overt issues like bone fragility as well as vascular and soft tissue calcification which may lead to adverse hard endpoints, particularly fracture and death. Recognized therapies for managing a rising PTH include vitamin D analogues, with or without calcimimetic (where available), in addition to management of serum mineral concentrations with diet, binders and dialysis...
March 2017: Nephrology
https://www.readbyqxmd.com/read/28429545/do-the-benefits-of-using-calcitriol-and-other-vitamin-d-receptor-activators-in-patients-with-chronic-kidney-disease-outweigh-the-harms
#10
Nigel D Toussaint, Matthew J Damasiewicz
The primary indication for administration of calcitriol or other vitamin D receptor activators (VDRA) in chronic kidney disease (CKD) is secondary hyperparathyroidism (SHPT). Prevention and treatment of SHPT appears important, as imbalances in mineral metabolism are associated with renal osteodystrophy, and higher parathyroid hormone (PTH) levels are associated with increased rates of mortality and morbidity in CKD patients. There is, however, a lack of controlled trial data that show lowering PTH with calcitriol/VDRA equates to improved clinical outcomes...
March 2017: Nephrology
https://www.readbyqxmd.com/read/28420060/risk-factors-to-predict-the-development-of-chronic-kidney-disease-in-patients-with-lupus-nephritis
#11
D J Park, J H Kang, J W Lee, K E Lee, T J Kim, Y W Park, J S Lee, Y D Choi, S S Lee
Objectives We analyzed the clinical follow-up results of 88 lupus nephritis patients to find prognostic factors for the development of chronic kidney disease in ethnically homogeneous Korean patients with biopsy-proven lupus nephritis. Methods Sociodemographic, clinical, laboratory, and treatment-related data at the time of kidney biopsy and during follow-up were obtained. Renal biopsy specimens were reclassified according to the International Society of Pathology/Renal Pathology Society classification, separately, by two renal pathologists blinded to the previous classification...
January 1, 2017: Lupus
https://www.readbyqxmd.com/read/28419972/neprilysin-inhibitors-a-new-hope-to-halt-the-diabetic-cardiovascular-and-renal-complications
#12
REVIEW
Vajir Malek, Anil Bhanudas Gaikwad
Diabetes is an enormous and ever-growing calamity and a global public health threat of the 21st century. Besides insulin and oral hypoglycaemic drugs, blockage of the renin-angiotensin system (RAS) denotes a key pharmacotherapy for the management of cardiovascular (CVD) and chronic kidney diseases (CKD), which are the leading causes of disability and death among diabetic patients. Neprilysin (NEP) inhibition, auxiliary to RAS blockage increases the bioavailability of natriuretic peptides and benefits the cardio-renal system...
April 15, 2017: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
https://www.readbyqxmd.com/read/28417662/clinician-views-of-patient-decisional-conflict-when-deciding-between-dialysis-and-conservative-management-qualitative-findings-from-the-palliative-care-in-chronic-kidney-disease-packs-study
#13
Helen Noble, Kevin Brazil, Aine Burns, Sarah Hallahan, Charles Normand, Paul Roderick, Colin Thompson, Peter Maxwell, Magdi Yaqoob
BACKGROUND: Only a paucity of studies have addressed clinician perspectives on patient decisional conflict, in making complex decisions between dialysis and conservative management (renal supportive and palliative care). AIM: To explore clinician views on decisional conflict in patients with end-stage kidney disease. DESIGN: Interpretive, qualitative study. SETTING AND PARTICIPANTS: As part of the wider National Institute for Health Research, PAlliative Care in chronic Kidney diSease study, semi-structured interviews were conducted with clinicians (nephrologists n = 12; 7 female and clinical nurse specialists n = 15; 15 female) across 10 renal centres in the United Kingdom...
April 1, 2017: Palliative Medicine
https://www.readbyqxmd.com/read/28417430/the-emergence-of-kidney-stone-disease-during-childhood-impact-on-adults
#14
REVIEW
Jeremy R Bonzo, Gregory E Tasian
PURPOSE OF REVIEW: The goal of this chapter is to review the recent epidemiologic trends of kidney stone disease and discuss the impact of the increasing incidence of nephrolithiasis among children on adults with respect to extra-renal manifestations, surgical management, and secondary prevention. RECENT FINDINGS: Among pediatric patients, kidney stone disease has been increasing at a rate of approximately 5-10% annually. Kidney stone disease has been associated with increased risks of coronary heart disease, chronic kidney disease, hypertension, and decreased bone mineral density, which is concerning for patients diagnosed at a young age...
June 2017: Current Urology Reports
https://www.readbyqxmd.com/read/28413969/optimizing-the-management-of-uncontrolled-hypertension-what-do-triple-fixed-dose-drug-combinations-add
#15
Costas Thomopoulos, Georgios Katsimagklis, Stefanos Archontakis, Georgios Skalis, Thomas Makris
Fixed-dose triple drug combinations represent one of the latest innovations of pharmacotherapy for hypertension (HT). They combine a traditional renin-angiotensin system blocker, a diuretic and a calcium channel blocker. The main benefit is the simplification of treatment regimen because 3 different agents are combined at different doses in a single pill. Improving adherence to treatment partly explains why this kind of combination may effectively reduce blood pressure (BP). BP lowering by a single-pill triple-drug combination can be approximately predicted, by using appropriate formulas described in previous meta-analysis of randomized trials...
April 14, 2017: Current Vascular Pharmacology
https://www.readbyqxmd.com/read/28405576/evaluation-of-anti-diabetic-activity-of-ahpl-aytab-0513-tablet-in-streptozotocin-induced-diabetes-in-rats
#16
Sanjay U Nipanikar, Soham S Chitlange, Dheeraj Nagore
BACKGROUND: Diabetes is a chronic, progressive disease associated with several complications leading to significant mortality and morbidity. Limitations and drawbacks of the conventional treatment generate need for safer, effective complimentary therapies to prevent complications, and maintain normoglycemic status. AIM AND OBJECTIVES: The aim of this study is to to evaluate antidiabetic activity of AHPL/AYTAB/0513 tablet alone, oral hypoglycemic agents (OHA[s]), and combination of AHPL/AYTAB/0513 tablet and OHA(s) in streptozotocin-induced diabetes in rats...
January 2017: International Journal of Pharmaceutical Investigation
https://www.readbyqxmd.com/read/28399844/implementation-of-a-pragmatic-randomized-trial-of-screening-for-chronic-kidney-disease-to-improve-care-among-non-diabetic-hypertensive-veterans
#17
Carmen A Peralta, Martin Frigaard, Anna D Rubinsky, Leticia Rolon, Lowell Lo, Santhi Voora, Karen Seal, Delphine Tuot, Shirley Chao, Kimberly Lui, Phillip Chiao, Neil Powe, Michael Shlipak
BACKGROUND: Whether screening for chronic kidney disease (CKD) can improve the care of persons at high risk for complications remains uncertain. We describe the design and early implementation experience of a pilot, cluster-randomized pragmatic trial to evaluate the feasibility, implementation, and effectiveness of a "triple marker" CKD screening program (creatinine, cystatin C and albumin to creatinine ratio) for improving care among hypertensive veterans seen in primary care at one Veterans Administration Hospital...
April 12, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28399810/a-programme-to-spread-egfr-graph-surveillance-for-the-early-identification-support-and-treatment-of-people-with-progressive-chronic-kidney-disease-assist-ckd-protocol-for-the-stepped-wedge-implementation-and-evaluation-of-an-intervention-to-reduce-late-presentation
#18
Hugh Gallagher, Shona Methven, Anna Casula, Nicola Thomas, Charles R V Tomson, Fergus J Caskey, Tracey Rose, Stephen J Walters, David Kennedy, Anne Dawnay, Martin Cassidy, Richard Fluck, Hugh C Rayner, Michael Nation
BACKGROUND: Patients who start renal replacement therapy (RRT) for End-Stage Kidney Disease (ESKD) without having had timely access to specialist renal services have poor outcomes. At one NHS Trust in England, a community-wide CKD management system has led to a decline in the incident rate of RRT and the lowest percentage of patients presenting within 90 days of starting RRT in the UK. We describe the protocol for a quality improvement project to scale up and evaluate this innovation...
April 11, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28398983/effectiveness-of-educational-or-behavioral-interventions-on-adherence-to-phosphate-control-in-adults-receiving-hemodialysis-a-systematic-review
#19
Molly Milazi, Ann Bonner, Clint Douglas
BACKGROUND: People with end-stage kidney disease (ESKD) develop impaired excretion of phosphate. Hyperphosphatemia develops in ESKD as a result of the kidney's reduced ability to excrete ingested phosphate load and is characterized by high bone turnover and increased musculoskeletal morbidity including bone pain and muscle weakness. Increased serum phosphate levels are also associated with cardiovascular disease and associated mortality. These effects are significant considering that cardiovascular disease is the leading cause of death in ESKD, making phosphate control a crucial treatment goal...
April 2017: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/28396108/augmented-nurse-care-management-in-ckd-stages-4-to-5-a%C3%A2-randomized-trial
#20
Steven Fishbane, Sofia Agoritsas, Alessandro Bellucci, Candice Halinski, Hitesh H Shah, Vipul Sakhiya, Leah Balsam
BACKGROUND: Outcomes for patients with late-stage chronic kidney disease (CKD) in the United States are suboptimal. There is poor education and preparation for end-stage kidney disease, as well as a high rate of hospitalization in this group of patients. STUDY DESIGN: A randomized, parallel-group, 2-arm, controlled trial. SETTING & PARTICIPANTS: The study was conducted at 3 sites: a clinic of an academic medical center, a public hospital academic clinic, and a community-based private practice...
April 7, 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
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