Bench to Bedside

People genetically predisposed to have high systolic blood pressure may be at decreased risk of developing Alzheimer’s disease (AD). In a recent study, investigators identified causal associations between potentially modifiable risk factors and AD risk by analyzing genetic data from 17,008 individuals with AD and 37,154 controls.

In a retrospective study of patients with both primary hyperparathyroidism and renal disease, parathyroidectomy stopped the progression of kidney function decline. After parathyroidectomy, eGFR did not change in patients with eGFR <60 mL/min/1.73 m2, whereas it was significantly reduced in patients with higher eGFR. Presurgical kidney function was the most relevant predictor of kidney function change after parathyroidectomy in the 109-patient study.

In mice that were fed sugar in doses proportional to what many people eat, a fructose-glucose mixture found in high-fructose corn syrup was more toxic than sucrose or table sugar in females, increasing their death rates by 1.9-times and reducing their reproductive capacity by 26%. No differences were seen in males. Both high-fructose corn syrup and table sugar contain roughly equal amounts of fructose and glucose, but they exist as separate molecules, or monosaccharides, in corn syrup. In sucrose or table sugar, they exist as a disaccharide compound.

Among 94 patients with focal segmental glomerulosclerosis (FSGS), those with 2 APOL1 variants tended to have more advanced disease at diagnosis, which fits with observations that this genetic form of FSGS progresses rapidly. Patients with the variants responded to cyclosporine and mycophenolate mofetil just as well as other patients, but they progressed more rapidly to kidney failure.

A new study has found that the ratio of urine and blood urea nitrogen concentration (UUN/BUN) can predict the response to an arginine vasopressin receptor 2 antagonist, tolvaptan (TLV), in patients with decompensated heart failure. Among 70 patients, measuring UUN/BUN before administering TLV showed good prediction for 2 different outcomes: having >300 mL increase in urine volume on the first day (immediate urine output response) and having any decrease in body weight within 1 week after starting TLV treatment (subsequent clinical response).

Implementation of the JNC8 2014 hypertension guidelines for US adults aged 35–74 years could potentially prevent about 56,000 cardiovascular events and 13,000 deaths each year while saving costs. Researchers used the Cardiovascular Disease Policy Model to assess cost-effectiveness according to age, hypertension level, and the presence or absence of CKD or diabetes.

In a study of 111 kidney transplant recipients ≥50 years of age who received rabbit antithymocyte globulin (rATG) or interleukin 2 receptor antagonists (IL-2RA) in addition to tacrolimus, mycophenolate mofetil, and corticosteroids, patients who received rATG had a trend toward lower acute rejection rates, fewer readmissions, and fewer supratherapeutic tacrolimus troughs, with similar rates of infections. Quality-of-life analyses demonstrated that patients who received rATG were more likely to experience improvements in physical and social functioning posttransplantation.

In a recent study, low birth weight in mothers was a significant predictor for low birth weight in offspring after adjusting for maternal age, placental pathology, preeclampsia, and parity. Likewise, preeclampsia was also noted as a significant intergenerational factor after adjusting for maternal age and parity.

Among 77 patients with early AKI, researchers found that a simple test performed with a one-time dose of furosemide, in addition to a measurement of urine output, can predict which patients with AKI will later develop serious kidney problems that require dialysis. The test is called the Furosemide Stress Test (FST). Furosemide, being a diuretic, is predominantly cleared by the kidneys and can be used to assess certain aspects of kidney function.

Researchers who analyzed data for all potential adult cardiac organ donors in the US between 1995 and 2010 found that 34% were accepted and 48% were declined (with 18% used for other purposes). Donor heart acceptance decreased from 44% in 1995 to 29% in 2006, then increased slightly to 32% in 2010. Older donor age, female sex, and medical comorbidities predicted non-acceptance. Age and comorbidities increased over time, with a concomitant decrease in acceptance from donors with undesirable characteristics.

In a review and meta-analysis of large-scale randomized controlled trials of blood pressure–lowering treatments over the past 5 decades, each 10 mm Hg lower systolic blood pressure among type 2 diabetics was associated with a 13% lower risk of premature mortality, an 11% lower risk of cardiovascular events, a 12% lower risk of coronary heart disease, a 27% lower risk of stroke, a 17% lower risk of albuminuria, and a 13% lower risk of retinopathy. Lower risks were observed among those with baseline systolic blood pressure levels ≥140 mm Hg.

Among 27 HIV-positive patients in South Africa who underwent kidney transplantation, the rate of patient survival was 84% at 1 year, 84% at 3 years, and 74% at 5 years. The corresponding rates of graft survival were 93%, 84%, and 84%. Rejection rates were 8% at 1 year and 22% at 3 years, according to the NEJM study. HIV infection remained well controlled, with the virus undetectable in the blood post-transplantation. 

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