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https://www.readbyqxmd.com/read/28431157/agreement-between-renal-prescribing-references-and-determination-of-prescribing-appropriateness-in-hospitalised-patients-with-chronic-kidney-disease
#1
Michelle O'Shaughnessy, Niamh Allen, John O'Regan, Edwina Payne-Danson, Lise Mentre, Dawn Davin, Peter Lavin, Tamasine Grimes
Background: Chronic kidney disease (CKD) is a risk factor for adverse drug events. The clinical significance of discordance between renal prescribing references is unknown. Aim: We determined the prevalence of potentially inappropriate prescribing (PIP) in CKD, measured agreement between two prescribing references, and assessed potential for harm consequent to PIP. Design: Single-centre observational study. Methods: A random sample of hospitalised patients with CKD were grouped according to baseline CKD stage (3, 4, or 5)...
April 18, 2017: QJM: Monthly Journal of the Association of Physicians
https://www.readbyqxmd.com/read/28431138/cardiovascular-outcome-trials-in-patients-with-chronic-kidney-disease-challenges-associated-with-selection-of-patients-and-endpoints
#2
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/28430830/assessment-of-global-kidney-health-care-status
#3
Aminu K Bello, Adeera Levin, Marcello Tonelli, Ikechi G Okpechi, John Feehally, David Harris, Kailash Jindal, Babatunde L Salako, Ahmed Rateb, Mohamed A Osman, Bilal Qarni, Syed Saad, Meaghan Lunney, Natasha Wiebe, Feng Ye, David W Johnson
Importance: Kidney disease is a substantial worldwide clinical and public health problem, but information about available care is limited. Objective: To collect information on the current state of readiness, capacity, and competence for the delivery of kidney care across countries and regions of the world. Design, Setting, and Participants: Questionnaire survey administered from May to September 2016 by the International Society of Nephrology (ISN) to 130 ISN-affiliated countries with sampling of key stakeholders (national nephrology society leadership, policy makers, and patient organization representatives) identified by the country and regional nephrology leadership through the ISN...
April 21, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28429560/is-there-a-role-for-newer-biomarkers-in-chronic-kidney-disease-mineral-and-bone-disorder-management
#4
Sven-Jean Tan, Michael Mx Cai
The current management of Chronic Kidney Disease-Mineral Bone Disorder (CKD-MBD) relies largely on clinical judgement and assessment of biochemical parameters including serum calcium, phosphate and intact parathyroid hormone concentrations. In the past two decades, there has been a leap in the understanding of the pathophysiology of CKD-MBD, leading to the discovery of novel biomarkers. The potential utility of these markers in this clinical setting is an area of intense investigation. In the absence of any guidelines aiding the clinician's understanding and application of these markers, we summarise the current available literature surrounding fibroblast growth factor-23, α-Klotho, sclerostin and serum calcification propensity testing and their respective assays in the context of CKD-MBD management...
March 2017: Nephrology
https://www.readbyqxmd.com/read/28429557/use-of-dual-energy-x-ray-absorptiometry-the-trabecular-bone-score-and-quantitative-computed-tomography-in-the-evaluation-of-chronic-kidney-disease-mineral-and-bone-disorders
#5
Nicholas Pocock
In subjects with chronic kidney disease (CKD) who suffer a minimal trauma fracture, the problem is to differentiate between osteoporosis and the various forms of renal bone disease associated with CKD-mineral and bone disorder. This problem is exacerbated by the fact that renal osteodystrophy may coexist with osteoporosis. The World Health Organization's bone mineral density (BMD) criteria for osteopenia ( -2.5 < T-score < -1.0) and osteoporosis (a T-score ≤ -2.5) may be used in patients with CKD stages 1-3...
March 2017: Nephrology
https://www.readbyqxmd.com/read/28429555/management-of-mineral-and-bone-disorders-in-renal-transplant-recipients
#6
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/28429550/parathyroid-hormone-targets-in-chronic-kidney-disease-and-managing-severe-hyperparathyroidism
#7
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/28429549/is-there-a-practical-role-for-a-virtual-bone-biopsy-using-high-resolution-imaging-of-bone-in-patients-with-chronic-kidney-disease
#8
Ashish K Sharma, Nigel D Toussaint
Renal osteodystrophy (ROD) refers to alterations in bone turnover, mineralisation, mass and microarchitecture in patients with chronic kidney disease (CKD) and represents the skeletal component of 'CKD-mineral and bone disorder'. Changes in bone structure lead to impaired bone quality, compromised bone strength and increased susceptibility to fractures with associated significant morbidity, mortality and financial cost. Diagnosis and management of ROD is hindered by the inadequacy of currently available diagnostic methods to interpret the complex pathophysiology...
March 2017: Nephrology
https://www.readbyqxmd.com/read/28429548/is-serum-phosphate-a-useful-target-in-patients-with-chronic-kidney-disease-and-what-is-the-role-for-dietary-phosphate-restriction
#9
Nigel D Toussaint, Stephen G Holt
A complex system of endocrine and paracrine signals exists to control phosphate balance. Dysregulation of these systems in patients with chronic kidney disease has serious clinical consequences. Whilst observational studies have shown associations between higher serum phosphate levels and poor clinical outcomes, the direction of causality has not been demonstrated. Whether there is a target level of serum phosphate remains controversial and no randomized trials to date have proved that strategies to lower extracellular phosphate actually improve clinical outcomes...
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/28429520/performance-in-adolescents-of-the-two-japanese-serum-creatinine-based-estimated-glomerular-filtration-rate-equations-for-adults-and-paediatric-patients-a-study-of-the-japan-renal-biopsy-registry-and-japan-kidney-disease-registry-from-2007-to-2013
#11
Osamu Uemura, Hitoshi Yokoyama, Kenji Ishikura, Yoshimitsu Gotoh, Hiroshi Sato, Hitoshi Sugiyama, Masataka Honda, Seiichi Matsuo
There are two different Japanese serum creatinine-based equations for estimated glomerular filtration rate (eGFR), for adults and paediatric patients, with both equations deemed applicable to 18-year-old subjects. This study assessed the relative accuracy of the two equations in assessing eGFR in patients aged 18 years with chronic kidney disease. A total of 3042 patients (1679 males and 1363 females), aged 2-20 years, who were registered in the Japan Renal Biopsy Registry or the Japan Kidney Disease Registry between 2007 and 2013 were evaluated...
June 2017: Nephrology
https://www.readbyqxmd.com/read/28429254/biomarkers-predicting-bone-turnover-in-the-setting-of-ckd
#12
REVIEW
Pieter Evenepoel, Etienne Cavalier, Patrick C D'Haese
PURPOSE OF THE REVIEW: Impaired bone quality contributes to the increased fracture risk in chronic kidney disease patients. Both low and high turnover bone disease may compromise bone quality. The question arises whether bone biomarkers may be additive or replace bone histormorphometry for diagnosing the extremes of bone turnover. RECENT FINDINGS: Studies exploring the performance of established and emerging bone biomarkers against histomorphometric assessment of bone turnover are limited and overall yield inconclusive results as to their diagnostic utility...
April 20, 2017: Current Osteoporosis Reports
https://www.readbyqxmd.com/read/28429111/impact-of-serum-albumin-levels-on-long-term-outcomes-in-patients-undergoing-percutaneous-coronary-intervention
#13
Hideki Wada, Tomotaka Dohi, Katsumi Miyauchi, Jun Shitara, Hirohisa Endo, Shinichiro Doi, Ryo Naito, Hirokazu Konishi, Shuta Tsuboi, Manabu Ogita, Takatoshi Kasai, Shinya Okazaki, Kikuo Isoda, Satoru Suwa, Hiroyuki Daida
Epidemiological studies have demonstrated an association between low serum albumin levels and both coronary artery disease (CAD) and mortality. However, the long-term clinical impact of low serum albumin level in patients with CAD undergoing percutaneous coronary intervention (PCI) has not yet been fully investigated. We studied 2860 all-comer patients with CAD who underwent their first PCI and had data available for pre-procedural serum albumin between 2000 and 2011. Patients were assigned to tertiles based on pre-procedural albumin levels...
April 20, 2017: Heart and Vessels
https://www.readbyqxmd.com/read/28428650/routine-mammography-an-opportunity-for-the-diagnosis-of-chronic-degenerative-diseases-a-cross-sectional-study
#14
Flávio Augusto Teixeira Ronzani, Filomena Maria Kirchmaier, Nathália Mussi Monteze, Edson José de Carvalho Magacho, Marcus Gomes Bastos, Natália Maria da Silva Fernandes
OBJECTIVE: The aim of this study was to evaluate breast arterial calcification (BAC) detected on routine mammography, analyzing its association with chronic degenerative disease. MATERIALS AND METHODS: This was a cross-sectional study involving women treated at a specialized outpatient clinic for high-risk hypertension, diabetes, or chronic kidney disease, as well as volunteers who participated in a study to validate a method of screening for occult renal disease...
March 2017: Radiologia Brasileira
https://www.readbyqxmd.com/read/28428450/independent-and-combined-effects-of-serum-albumin-and-c-reactive-protein-on-long-term-outcomes-of-patients-undergoing-percutaneous-coronary-intervention
#15
Hideki Wada, Tomotaka Dohi, Katsumi Miyauchi, Shinichiro Doi, Ryo Naito, Hirokazu Konishi, Shuta Tsuboi, Manabu Ogita, Takatoshi Kasai, Shinya Okazaki, Kikuo Isoda, Satoru Suwa, Hiroyuki Daida
BACKGROUND: Both inflammation and malnutrition have been reported to be closely linked to atherosclerosis, especially in patients with chronic kidney disease (CKD). The combined effects of serum albumin and C-reactive protein (CRP) on clinical outcomes after percutaneous coronary intervention (PCI) were investigated.Methods and Results:A total of 2,164 all-comer patients with coronary artery disease who underwent their first PCI and had data available for preprocedural serum albumin and hs-CRP levels between 2000 and 2011 were studied...
April 19, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/28427790/exercise-and-ckd-skeletal-muscle-dysfunction-and-practical-application-of-exercise-to-prevent-and-treat-physical-impairments-in-ckd
#16
Baback Roshanravan, Jorge Gamboa, Kenneth Wilund
Patients with chronic kidney disease experience substantial loss of muscle mass, weakness, and poor physical performance. As kidney disease progresses, skeletal muscle dysfunction forms a common pathway for mobility limitation, loss of functional independence, and vulnerability to disease complications. Screening for those at high risk for mobility disability by self-reported and objective measures of function is an essential first step in developing an interdisciplinary approach to treatment that includes rehabilitative therapies and counseling on physical activity...
April 18, 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/28424878/oral-health-in-patients-with-renal-disease-a-longitudinal-study-from-predialysis-to-kidney-transplantation
#17
Karita M Nylund, Jukka H Meurman, Anna Maria Heikkinen, Jussi O Furuholm, Fernanda Ortiz, Hellevi M Ruokonen
OBJECTIVES: The aim of this longitudinal study was to compare the oral health of chronic kidney disease patients at the predialysis (baseline) and post-transplantation (follow-up) stages and to investigate differences in oral health between diabetic nephropathy and other kidney disease patients at follow-up. MATERIALS AND METHODS: Fifty-three kidney disease patients (34 men) aged 31-86 years were followed up to 157 months. Clinical and radiological oral examinations, salivary and laboratory analyses, and oral health behavior questionnaires were conducted at the predialysis and follow-up stages at Helsinki University Hospital, Finland...
April 20, 2017: Clinical Oral Investigations
https://www.readbyqxmd.com/read/28422144/risk-and-prediction-of-sudden-cardiac-death-and-ventricular-arrhythmias-for-patients-with-atrial-fibrillation-a-nationwide-cohort-study
#18
Tze-Fan Chao, Chia-Jen Liu, Ta-Chuan Tuan, Su-Jung Chen, Tzeng-Ji Chen, Gregory Y H Lip, Shih-Ann Chen
Sudden cardiac death (SCD) is the most devastating manifestation of ventricular arrhythmias (VAs), and is the leading cause of mortality among atrial fibrillation (AF) patients. The goal of the present study was to investigate the incidence of SCD/VAs amongst patients with and without AF. We also aimed to identify important risk factors of SCD/VAs among AF patients. Using the "National Health Insurance Research Database" in Taiwan, a total of 352,656 AF and 352,656 non-AF patients without antecedent SCD/VAs were identified...
April 19, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28420802/clinical-decision-making-for-the-hemodynamic-gray-zone-ffr-0-75-0-80-and-long-term-outcomes
#19
Shiv Kumar Agarwal, Srikanth Kasula, Mohan M Edupuganti, Sameer Raina, Fnu Shailesh, Ahmed Almomani, Jason J Payne, Naga V Pothineni, Barry F Uretsky, Abdul Hakeem
BACKGROUND: Fractional flow reserve (FFR) value between 0.75 and 0.80 is considered the "gray zone" and outcomes data relative to treatment strategy (revascularization vs medical therapy alone [deferral]) are limited for this group. METHODS AND RESULTS: A total of 238 patients (64.3 ± 8.6 years; 97% male; 45% diabetic) with gray-zone FFR were followed for the primary endpoint of major adverse cardiovascular event (MACE), defined as a composite of death, myocardial infarction (MI), and target-vessel revascularization...
April 15, 2017: Journal of Invasive Cardiology
https://www.readbyqxmd.com/read/28420700/diabetes-associated-clinical-spectrum-long-term-prognosis-and-genotype-phenotype-correlations-in-201-adult-patients-with-hepatocyte-nuclear-factor-1-b-hnf1b-molecular-defects
#20
Danièle Dubois-Laforgue, Erika Cornu, Cécile Saint-Martin, Joël Coste, Christine Bellanné-Chantelot, José Timsit
OBJECTIVE: Molecular defects of hepatocyte nuclear factor 1B (HNF1B) are associated with a multiorgan disease, including diabetes (maturity-onset diabetes of the young 5) and kidney abnormalities. The HNF1B-syndrome is related to HNF1B mutations or to a 17q12 deletion spanning 15 genes, including HNF1B. Here, we described HNF1B-related diabetes and associated phenotypes and assessed genotype/phenotype correlations at diagnosis and in the long-term. RESEARCH DESIGN AND METHODS: This multicenter retrospective cohort study included 201 patients, aged 18 or older at follow-up, with HNF1B mutations (n = 101) or deletion (n = 100)...
April 18, 2017: Diabetes Care
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