Research Advances

In a study of patients who underwent coronary artery bypass grafting (CABG) surgery, poor preoperative kidney function was strongly associated with elevated costs related to the surgery. As creatinine clearance decreased from 80 mL/min to 60 mL/min, 40 mL/min, and 20 mL/min, predicted total costs increased by 10%, 20%, and 30%, respectively. Worsening kidney function also was related to a longer length of hospital stay and an increased likelihood of needing dialysis or dying after surgery.

Diabetes may elevate the prevalence of hyperkalemia in patients with CKD stage 3, a new study found. The study included 180 type 2 diabetics and 180 non-diabetic patients with CKD. In patients with CKD stage 3, 28.6% of diabetics experienced hyperkalemia vs. 17.5% of non-diabetics. No difference was noted among patients with CKD stage 2; in CKD stage 4 hyperkalemia was equally high in both groups (35.5% vs. 32.3%). CKD stage 4 and use of ACE inhibitors were associated with 4.5-fold and 2.2-fold increased risks of hyperkalemia, respectively.

In an analysis of all chronic hemodialysis patients of China Medical University Hospital in 2014, the median abdominal aortic calcification score was 9 in patients with loss of residual renal function (RRF) vs. 5 in patients who maintained RRF. Loss of RRF was associated with higher abdominal aortic calcification scores independent of patients' age, diabetes, C-reactive protein, calcium-phosphorus product, and vintage of dialysis.

New research indicates that people with diabetes who suffer from diabetic foot (a severe but preventable condition characterized by non-healing foot ulcers and necrosis) may have significantly impaired cognitive function. The study found that those with diabetic foot remember less, have decreased concentration, difficulty with learning, decreased inhibition, slower cognitive and psychomotor responses, and decreased verbal fluency compared with diabetics without foot complications.

A study that assessed National Health and Nutrition Examination Survey (NHANES) trends from 1971 to 2012 found that US adults with diabetes lose about twice as many teeth as adults without diabetes. Although overall tooth loss generally declined over the study period, diabetics still were more commonly affected. The authors of the Preventing Chronic Disease study also found that black Americans with diabetes were at a greater risk of tooth loss than white and Mexican Americans with diabetes.

A systematic review suggests that patients with kidney disease are often underrepresented in clinical trials testing cardiovascular medications and procedures. Considering the growing number of patients affected by both cardiovascular disease and kidney disease, the authors argue this underrepresentation may create discrepancies in the results among different patient populations. Investigators identified 371 randomized controlled trials testing clinical interventions in a total of 590,040 patients with acute coronary syndrome or heart failure.

In a recent analysis from Denmark, when a nationwide news story focused on the risks of statins, the rate of discontinuations increased by 9%. When a positive story appeared, the rate of discontinuations decreased by 8%. For the European Heart Journal study, researchers tracked 674,900 people who started taking statins between 1995 and 2010, and they identified 1931 statin-related news stories during that time.

The composition and function of intestinal bacteria change when diabetic patients are treated with metformin, according to new research. The changes boost the bacteria’s capability to produce certain types of short-chain fatty acids, such as butyric acid and propionic acid, which can reduce blood glucose levels. The study also revealed that patients treated with metformin have more Escherichia bacterial species, which may contribute to the drug’s gastrointestinal adverse effects.

Results from a small clinical trial indicate that losing less than a gram of fat in the pancreas following weight loss surgery may reverse type 2 diabetes. For the trial, 18 patients with type 2 diabetes and 9 with normal glucose tolerance were studied before and 8 weeks after surgery. Weight loss after surgery was similar as was the change in fat mass, but pancreatic triacylglycerol did not change in nondiabetics while it decreased in diabetics. First-phase insulin response to a stepped intravenous glucose infusion did not change in nondiabetics but normalized in diabetics.

According to a systematic review evaluating the risk of active tuberculosis in CKD populations, adjusted rate ratio data in dialysis populations showed an increased rate of 3.62 compared with the general population, while unadjusted risk ratio data in transplant populations showed an increased risk of 11.35 compared with the general population. Investigators screened 3406 papers and identified 12 eligible studies with 71,374 end-stage renal disease patients and 560 tuberculosis cases.

There was a substantial increase in certified programs (18%) and positions (25%) in the first “All-In” nephrology Match compared with last year, according to yesterday’s NRMP SMS results. For appointment year (AY) 2016, there was an increase in the number of matched nephrology fellows (8.7%) and applicants preferring nephrology (11%). Although there was a slight uptick in US medical graduate applications, international medical graduate applications continued a 6-year decline. Unfilled programs and positions continued to rise (36.8% and 58.3%, respectively, compared with AY 2015).

Researchers have discovered a genetic variant candidate associated with altering the response to conventional heart failure therapy. In a mouse model of heart failure, administering orexin led to better systolic heart function. Furthermore, mice missing the orexin receptor had greater diastolic heart dysfunction. The variant impacts expression of the orexin receptor, which is known to be involved in the control of sleep, appetite, and blood pressure. The team also found that expression of the orexin receptor is increased in diseased human heart tissue.

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