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management of chronic kidney disease

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https://www.readbyqxmd.com/read/28431138/cardiovascular-outcome-trials-in-patients-with-chronic-kidney-disease-challenges-associated-with-selection-of-patients-and-endpoints
#1
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/28429560/is-there-a-role-for-newer-biomarkers-in-chronic-kidney-disease-mineral-and-bone-disorder-management
#2
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/28429555/management-of-mineral-and-bone-disorders-in-renal-transplant-recipients
#3
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
#4
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
#5
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
#6
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/28429547/the-use-of-bone-turnover-markers-in-chronic-kidney-disease-mineral-and-bone-disorders
#7
Cherie Chiang
Bone turnover markers assist in fracture risk prediction, management and monitoring of osteoporosis in patients without chronic kidney disease (CKD). The use in CKD-mineral bone disorder (MBD) has been limited as many of these markers and breakdown products are renally excreted, including the most commonly used and well standardized procollagen type I N propeptide and C-terminal cross-linking telopeptide of type I collagen. Of the markers unaffected by renal function, bone specific alkaline phosphatase is associated with mortality and fracture rate in CKD subjects and is now available on several automated analysers...
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
#8
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/28427351/proteinuria-and-baseline-renal-function-predict-mortality-and-renal-outcomes-after-sirolimus-therapy-in-liver-transplantation-recipients
#9
Lung-Chih Li, Chien-Ning Hsu, Chih-Che Lin, Yu-Fan Cheng, Tsung-Hui Hu, Ding-Wei Chen, Chih-Hsiung Lee, Toshiaki Nakano, Chao-Long Chen
BACKGROUND: Chronic kidney disease is a significant complication after liver transplantation (LT), but the role of pre-existing renal insufficiency and proteinuria remains unclear among LT recipients receiving sirolimus. METHODS: We assessed the effects of proteinuria and baseline renal function on long-term renal and survival outcomes among 576 LT recipients who received SRL in a medical center between 2005 and 2014. Renal outcomes were the incidences of >50% reduction in their baseline estimated glomerular filtration rate and end stage kidney disease requiring renal replacement therapy...
April 20, 2017: BMC Gastroenterology
https://www.readbyqxmd.com/read/28426518/pathophysiologic-insight-into-mesoamerican-nephropathy
#10
Magdalena Madero, Fernando E García-Arroyo, Laura-Gabriela Sánchez-Lozada
PURPOSE OF REVIEW: Mesoamerican nephropathy (MeN) is an emerging pathophysiological entity of Chronic kidney desease (CKD) not related to traditional risk factors (diabetes and hypertension) that have caused thousands of deaths in Central America, mainly in sugarcane workers. The focus of this review is to discuss the risk factors and probable mechanisms involved in the initiation and progression of this devastating disease. RECENT FINDINGS: Frequent episodes of subclinical Acute kidney injury caused by repetitive heat stress, dehydration, and strenuous work have been regarded as the main risk factors for MeN...
April 19, 2017: Current Opinion in Nephrology and Hypertension
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/28416961/predictive-factors-of-methicillin-resistant-staphylococcus-aureus-infection-in-elderly-patients-with-community-onset-pneumonia
#15
Hyeyoung Jwa, Jong Wook Beom, Jong Hoo Lee
BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) infection is a severe and life-threatening disease in patients with community-onset (CO) pneumonia. However, the current guidelines lack specificity for a screening test for MRSA infection. METHODS: This study was retrospectively conducted in elderly patients aged ≥65 years, who had contracted CO-pneumonia during hospitalization at the Jeju National University Hospital, between January 2012 and December 2014...
April 2017: Tuberculosis and Respiratory Diseases
https://www.readbyqxmd.com/read/28413969/optimizing-the-management-of-uncontrolled-hypertension-what-do-triple-fixed-dose-drug-combinations-add
#16
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/28412770/anemia-in-chronic-kidney-disease
#17
Meredith A Atkinson, Bradley A Warady
Anemia is common and associated with adverse outcomes in children with chronic kidney disease (CKD). Many factors contribute to declining hemoglobin as CKD progresses, but impaired production of erythropoietin by failing kidneys is a central cause. Hepcidin-mediated iron restriction also contributes to anemia by downregulating both intestinal iron absorption and release of stored iron for erythropoiesis. The core components of anemia management remain erythropoiesis-stimulating agents (ESA) and iron supplementation, but despite these therapies, a substantial number of children remain anemic...
April 15, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/28412019/renal-function-in-relation-to-sodium-intake-a%C3%A2-quantitative-review-of-the-literature
#18
REVIEW
Kyoko Nomura, Kei Asayama, Lotte Jacobs, Lutgarde Thijs, Jan A Staessen
We undertook a quantitative literature review to search for evidence underpinning current guidelines proposing a reduction of sodium intake to less than 2.4 g/d for the management of chronic kidney disease. We searched PubMed for peer-reviewed articles published from January 1980 through May 2016. Two investigators screened 5072 publications and extracted data from 36, including 11 cross-sectional and 5 longitudinal observational studies and 20 intervention trials. Within-study effect sizes were pooled and standardized to a sodium gradient of 100 mmol/d by using inverse-variance weighted random effects models...
April 12, 2017: Kidney International
https://www.readbyqxmd.com/read/28411954/n-3-polyunsaturated-fatty-acids-for-the-management-of-patients-with-chronic-kidney-disease
#19
EDITORIAL
My Svensson, Juan Jesús Carrero
No abstract text is available yet for this article.
May 2017: Journal of Renal Nutrition
https://www.readbyqxmd.com/read/28410647/disease-trajectories-before-esrd-implications-for-clinical-management
#20
REVIEW
Keiichi Sumida, Csaba P Kovesdy
One of the biggest challenges nephrologists face is to predict complex clinical pathways of kidney disease progression that do not follow a steady linear decline. This unpredictability often becomes a barrier to timely shared decision making between patients and physicians and could lead to adverse patient outcomes. By using numerous analytic approaches to characterize the longitudinal changes in kidney function, emerging evidence has disclosed the heterogeneous trajectories of kidney disease progression, particularly in late-stage chronic kidney disease (CKD) nearing end-stage renal disease (ESRD), and showed their independent associations with various clinical outcomes...
March 2017: Seminars in Nephrology
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