Clinical Care

Among 6272 people diagnosed with hyperparathyroidism between 1995 and 2010, there were 56 hip fractures per 1000 people after 10 years among those not treated for hyperparathyroidism. Among those who had parathyroid surgery, there were just 20 fractures per 1000 people. Surprisingly, the hip fracture rate was highest among those taking bisphosphonates, at 86 fractures per 1000 patients. Similar results were seen for bone fractures of all types.

Hospitalizations for pulmonary hypertension (PH) in US children doubled from 1 in 1000 in 1997 to 1 in 500 in 2012, according to a Pediatrics analysis of a national administrative database of pediatric hospital discharges. Inflation-adjusted national charges for PH hospitalizations rose from $926 million in 1997 to $3.12 billion in 2012. Mortality decreased from 11.3% of hospitalizations in 1997 to 5.9% in 2012. Patients without congenital heart defects accounted for 56.4% of PH hospitalizations in 2012.

On August 6–7, a living-donor kidney transplant chain that began on December 5, 2013, reached a record milestone of 51 transplants at the University of Alabama at Birmingham (UAB). The chain of transplants involved people from 11 states, and was started by an altruistic donation from Paula Kok. In all, there have been 102 total surgeries since, which included 51 nephrectomies and 51 transplants. Jayme Locke, MD, surgical director of the Incompatible Kidney Transplant Program in UAB’s School of Medicine, said that since Ms.

In a study that examined cancer risk in recipients of kidney retransplantation, investigators found that overall cancer risk did not differ in retransplants compared with primary recipients.; hHowever, renal cell carcinoma occurred in excess among retransplants, with an adjusted incidence rate ratio of 2.03. The researchers noted that this increased risk may be explained by the presence of acquired cystic kidney disease, which is more likely to develop with additional time with kidney disease and time spent on dialysis waiting for retransplantatio

A new report summarizes the recommendations of the US Department of Veterans Affairs and Department of Defense on managing dyslipidemia to reduce cardiovascular disease risk in adults, focusing on elimination of treatment targets, additional tests for risk prediction, primary and secondary prevention, and laboratory testing. The guideline recommends additional tests to refine risk only when the rationale is clear and recommends shared decision-making to determine the benefits and harms of each medication once the patient's 10-year risk has been determined.

A number of emotional barriers can prevent someone from asking for and accepting a kidney, research shows. Investigators who examined 39 studies from 13 countries with 1791 CKD patients found that guilt was a major obstacle, as were patients’ worries about jeopardizing donor health and causing donor inconvenience or regret. Patients also worried about experiencing unrelenting indebtedness, among other concerns.

In a recent study, women with a low birthweight (<6 pounds) were 2 times more likely to develop type 2 diabetes than women with a birthweight of 8 to 10 pounds. Insulin resistance contributed most strongly, accounting for 47% of the effect. High levels of E-selectin (a marker of problems with blood vessel lining) accounted for 25%, low levels of sex-hormone binding globulin contributed 24%, and high systolic blood pressure accounted for 8%.

In a recent literature search and meta-analysis, a history of kidney stones was associated with a 43% increased risk of coronary heart disease in women. An association was not significant in males. The North American Journal of Medical Sciences analysis included 7 populations from 4 cohort studies and 1 cross-sectional study.

Among 3405 patients with CKD, a hemoglobin level <10 g/dL was linked with an 84% increased risk of a composite endpoint of all-cause mortality, cerebrovascular events, and myocardial infarction compared with a reference level of ≥10 or higher but <11.

Among 16,524 patients with acute heart failure syndrome who presented to the emergency department, those with blood glucose levels between 6.1 and 7.8 mmol/L had a 26% higher risk of death within 30 days from any cause, a 28% higher risk of death from cardiovascular causes, and a 61% higher risk of diabetes compared with a reference group of patients with blood glucose levels between 3.9 and 6.1 mmol/L.

After adjustments, positive stone culture was independently associated with a 6.9 times increased likelihood of postoperative sepsis after stone percutaneous nephrolithotomy in a recent study. Postoperative sepsis occurred in 31% of the 45 patients who had a positive stone culture vs. 5.9% of the 161 patients who had a sterile stone culture. Among the patients with positive cultures, Enterococcus species (29.4%) and Escherichia coli (21.6%) were the most prevalent gram positive and gram negative bacteria, respectively.

After adjusting for age and preoperative eGFR, cardiopulmonary bypass patients in the highest quartile of plasma catalytic iron compared with the lowest quartile on postoperative day 1 had a 6.71 greater likelihood of experiencing a composite outcome of AKI requiring renal replacement therapy or in-hospital mortality. They also had an increased likelihood of experiencing AKI, hospital mortality, and postoperative myocardial injury.

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