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By Isabel Acosta-Ochoa Nephrology senior staff. Valladolid. Spain
Junichi Ishigami, Marco Trevisan, Hong Xu, Josef Coresh, Kunihiro Matsushita, Juan-Jesus Carrero
RATIONALE & OBJECTIVE: Low estimated glomerular filtration rate (eGFR) increases infection risk, but its contribution to hospital-acquired infection following major surgery is unknown. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: Residents of Stockholm, Sweden, 18 years or older with at least 1 recorded serum creatinine measurement, no recent diagnoses of infection, and hospitalized for orthopedic, abdominal, cardiothoracic and vascular, or neurologic surgery between January 2007 and December 2011...
September 7, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Anna Jonsson, Helena Norberg, Ellinor Bergdahl, Krister Lindmark
AIM: Previous studies and national assessments indicate an undertreatment of mineralocorticoid receptor antagonists (MRA) in heart failure with reduced ejection fraction (HFrEF). This study aimed to investigate why MRA is not used to full extent. METHODS: A complete community-based heart failure population was studied. Several variables were collected, and medical records were scrutinized to identify reasons for not prescribing MRA. RESULTS: Of 2029 patients, 812 had EF ≤40%...
October 2018: Cardiovascular Therapeutics
Melissa Corson, Ashley Moch, Sammy Saab
An important interplay exists between hepatitis C virus (HCV) infection and chronic kidney disease (CKD). HCV infection is associated with an increased risk of morbidity and mortality in patients coinfected with CKD, and patients with CKD have an increased risk of HCV infection. Direct-acting antiviral (DAA) agents have changed the landscape of treatment with excellent sustained virologic response rates and fewer side effects than previously seen. An increasing number of studies demonstrate that DAA agents are efficacious and safe both in patients on dialysis and in patients who have undergone kidney transplantation...
May 2018: Gastroenterology & Hepatology
Gabriela Ferreira Dias, Natalia Borges Bonan, Thiago Maass Steiner, Sara Soares Tozoni, Silvia Rodrigues, Lia Sumie Nakao, Viktoriya Kuntsevich, Roberto Pecoits Filho, Peter Kotanko, Andréa N Moreno-Amaral
It is hypothesized that the uremic toxin indoxyl sulfate (IS) plays a role in the pathogenesis of renal anemia. To further explore that hypothesis, we examined the effects of IS on reactive oxygen species (ROS) production, levels of reduced glutathione (GSH), and erythrocyte death (eryptosis) in red blood cells (RBC) from healthy controls (CON-RBC) and hemodialyzed patients (HD-RBC), respectively. RBC were incubated either in either TRIS-Glc-BSA buffer or IS at concentrations of 0.01, 0.09, and 0.17 mM, respectively...
July 5, 2018: Toxins
Kaori Morimoto, Yuuta Tominaga, Yuta Agatsuma, Masanari Miyamoto, Shota Kashiwagura, Akira Takahashi, Yoshimi Sano, Kentaro Yano, Chihaya Kakinuma, Takuo Ogihara, Mikio Tomita
Indoxyl sulfate (IS) is a protein-bound uremic toxin that progressively accumulates in plasma during chronic kidney disease (CKD), and its accumulation is associated with the progression of CKD. This study examined the intestinal secretion of IS using in situ single-pass intestinal perfusion in a rat model of renal insufficiency, MRP2- and BCRP-overexpressing Sf9 membrane vesicles, and Caco-2 cell monolayers. An in situ single-pass perfusion study in CKD model rats demonstrated that a small amount of IS is secreted into intestinal lumen after iv administration of IS, and the clearance increased AUC-dependently...
July 2018: Biopharmaceutics & Drug Disposition
Jennifer A Hirst, Maria Dla Vazquez Montes, Clare J Taylor, José M Ordóñez-Mena, Emma Ogburn, Vanshika Sharma, Brian Shine, Tim James, Fd Richard Hobbs
BACKGROUND: Chronic kidney disease (CKD) is diagnosed using the estimated glomerular filtration rate (eGFR) and the urinary albumin:creatinine ratio (ACR). The eGFR is calculated from serum creatinine levels using the Modification of Diet in Renal Disease (MDRD) or Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. AIM: To compare the performance of one versus two eGFR/ACR measurements, and the impact of equation choice, on CKD diagnosis and classification...
August 2018: British Journal of General Practice: the Journal of the Royal College of General Practitioners
Amanda Reis, Caitlyn Luecke, Thomas Keefe Davis, Aadil Kakajiwala
Pain is a common problem in children with chronic kidney disease (CKD); however, limited data exist regarding its management. Although most pain is managed pharmacologically, in some instances non-pharmacologic management can aid in safely ameliorating discomfort. Because of the accumulation of toxic metabolites, many common pain medications have adverse effects on kidney function or altered pharmacokinetics in the setting of CKD. Decreased clearance impacts safe dosing of analgesics. The pain management of patients on renal replacement therapy requires an understanding of drug clearance due to the different modalities of dialysis...
May 2018: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
Maarten W Taal
PURPOSE OF REVIEW: The prevalence of chronic kidney disease (CKD) steeply rises with age but there is controversy regarding the diagnosis and clinical significance of CKD in older people. This article reviews recent advances in our understanding with respect to the diagnosis, aetiology and adverse outcomes associated with CKD in older people. RECENT FINDINGS: Comparisons with measured glomerular filtration rate in a cohort of older people found that the Chronic Kidney Disease Epidemiology Collaboration equation using creatinine and cystatin C performs at least as well as other equations developed to estimate glomerular filtration rate in older populations...
November 2015: Current Opinion in Nephrology and Hypertension
Fabio Angeli, Giorgio Gentile, Monica Trapasso, Paolo Verdecchia, Gianpaolo Reboldi
Hypertension is a key risk factor for chronic kidney disease (CKD), but can also be a detrimental consequence of established CKD. Unsurprisingly, the majority of subjects with abnormal creatinine in the general population are also hypertensive, with a huge toll on national health care systems worldwide due to a staggering increase in the risk of cardiovascular complications and end-stage renal disease requiring renal replacement therapy. In this setting, a comprehensive and careful assessment of the whole 24-h blood pressure (BP) profile could be of paramount importance in ensuring a timely diagnosis of hypertension and an optimal therapeutic control...
June 13, 2018: Journal of Human Hypertension
Claire Trivin-Avillach, Éric Thervet
Chronic kidney disease (CKD) is associated with significant infectious complications leading to adverse health outcomes. This increased susceptibility to infection can be related to the nephropathy itself as observed in nephrotic syndrome, to the treatment especially in situations requiring immunosuppressive drugs or related to dialysis. Despite a less effective response to vaccination, some data emphasize similar benefits from immunization among people with CKD to the general population. However, some situations encountered in nephrology require adaptation of immunization practices...
June 7, 2018: Néphrologie & Thérapeutique
Nishank Jain, Robert F Reilly
Oral anticoagulants are commonly used drugs in patients with CKD and patients with ESKD to treat atrial fibrillation to reduce stroke and systemic embolism. Some of these drugs are used to treat or prevent deep venous thrombosis and pulmonary embolism in patients with CKD who undergo knee and hip replacement surgeries. Warfarin is the only anticoagulant that is approved for use by the Food and Drug Administration in individuals with mechanical heart valves. Each oral anticoagulant affects the coagulation profile in the laboratory uniquely...
May 25, 2018: Clinical Journal of the American Society of Nephrology: CJASN
Carola van Dipten, Saskia van Berkel, Wim J C de Grauw, Nynke D Scherpbier-de Haan, Bouke Brongers, Karel van Spaendonck, Jack F M Wetzels, Willem J J Assendelft, Marianne K Dees
BACKGROUND: Guideline adherence in chronic kidney disease management is low, despite guideline implementation initiatives. Knowing general practitioners' (GPs') perspectives of management of early-stage chronic kidney disease (CKD) and the applicability of the national interdisciplinary guideline could support strategies to improve quality of care. METHOD: Qualitative focus group study with 27 GPs in the Netherlands. Three analysts open-coded and comparatively analysed the data...
June 6, 2018: BMC Family Practice
Danielle L Kirkman, Bryce J Muth, Joseph M Stock, Raymond R Townsend, David G Edwards
Background Reductions in exercise capacity associated with exercise intolerance augment cardiovascular disease risk and predict mortality in chronic kidney disease. This study utilized cardiopulmonary exercise testing to (a) investigate mechanisms of exercise intolerance; (b) unmask subclinical abnormalities that may precede cardiovascular disease in chronic kidney disease. Design The design of this study was cross-sectional. Methods Cardiopulmonary exercise testing was carried out in 31 Stage 3-4 chronic kidney disease patients (60 ± 11 years; estimated glomerular filtration rate 43 ± 13 ml/min/1...
January 1, 2018: European Journal of Preventive Cardiology
Ting Gan, Xin Liu, Gaosi Xu
Introduction: It is inaccurate to assess blood glucose with glycated hemoglobin (HbA1c) in patients with diabetes and chronic kidney disease (CKD), and whether glycated albumin (GA) is better than HbA1c in these patients remains unclear. Methods: We searched PubMed, Embase, Web of Science, Scopus, the Cochrane Library, and MEDLINE to July 2017 for studies that investigated the correlation between GA or HbA1c and the average glucose levels (AG) relevant to this theme...
May 2018: KI Reports
Thomas D Nolin, Mark A Perazella
No abstract text is available yet for this article.
July 6, 2018: Clinical Journal of the American Society of Nephrology: CJASN
Thomas D Sequist, Alison M Holliday, E John Orav, David W Bates, Bradley M Denker
OBJECTIVES: To determine if electronic health record (EHR) tools and patient engagement can improve the quality of chronic kidney disease (CKD) care. STUDY DESIGN: Randomized controlled trial. METHODS: We enrolled 153 primary care physicians caring for 3947 high-risk and 3744 low-risk patients with stage III CKD across 13 ambulatory health centers in eastern Massachusetts. Intervention physicians received a set of electronic alerts during office visits recommending risk-appropriate CKD care...
April 1, 2018: American Journal of Managed Care
Claudio Jommi, Patrizio Armeni, Margherita Battista, Paolo di Procolo, Giuseppe Conte, Claudio Ronco, Mario Cozzolino, Anna Maria Costanzo, Umberto di Luzio Paparatti, Gabriella Concas, Giuseppe Remuzzi
BACKGROUND: Chronic kidney disease (CKD) is an important public health problem. Most of the evidence on its costs relates to patients receiving dialysis or kidney transplants, which shows that, in these phases, CKD poses a high burden to payers. Less evidence is available on the costs of the predialytic phase. OBJECTIVE: The aim of this study was to estimate the annual cost of patients with CKD not receiving dialysis treatment, using the Italian healthcare system perspective and a prospective approach...
December 4, 2017: PharmacoEconomics Open
Jose Luis Górriz, Maria Jesús Puchades
No abstract text is available yet for this article.
March 2018: Semergen
John W Stanifer, David M Charytan, Jennifer White, Yuliya Lokhnygina, Christopher P Cannon, Matthew T Roe, Michael A Blazing
Efficacy of statin-based therapies in reducing cardiovascular mortality in individuals with CKD seems to diminish as eGFR declines. The strongest evidence supporting the cardiovascular benefit of statins in individuals with CKD was shown with ezetimibe plus simvastatin versus placebo. However, whether combination therapy or statin alone resulted in cardiovascular benefit is uncertain. Therefore, we estimated GFR in 18,015 individuals from the IMPROVE-IT (ezetimibe plus simvastatin versus simvastatin alone in individuals with cardiovascular disease and creatinine clearance >30 ml/min) and examined post hoc the relationship of eGFR with end points across treatment arms...
October 2017: Journal of the American Society of Nephrology: JASN
Adamasco Cupisti, Csaba P Kovesdy, Claudia D'Alessandro, Kamyar Kalantar-Zadeh
Whereas the adequate intake of potassium is relatively high in healthy adults, i.e., 4.7 g per day, a dietary potassium restriction of usually less than 3 g per day is recommended in the management of patients with reduced kidney function, especially those who tend to develop hyperkalaemia including patients who are treated with angiotensin pathway modulators. Most potassium-rich foods are considered heart-healthy nutrients with high fibre, high anti-oxidant vitamins and high alkali content such as fresh fruits and vegetables; hence, the main challenge of dietary potassium management is to maintain high fibre intake and a low net fixed-acid load, because constipation and metabolic acidosis are per se major risk factors for hyperkalaemia...
February 25, 2018: Nutrients
2018-03-04 10:44:02
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