Proactive, high-dose intravenous iron reduces mortality and major cardiovascular events in hemodialysis patients, reports a randomized trial in The New England Journal of Medicine.
The Proactive IV Iron Therapy in Dialysis Patients (PIVOTAL) trial included 2141 adults undergoing maintenance hemodialysis and receiving an erythropoiesis-stimulating agent (ESA) at 50 UK sites. One group was assigned to a proactive high-dose iron strategy: iron sucrose 400 mg IV administered monthly, unless ferritin concentration was greater than 700 µg/L or transferrin saturation was 40% or higher. The other group received a low-dose reactive iron strategy: IV iron sucrose in doses
Forty-eight percent of US adults have some type of cardiovascular disease (CVD), according to the American Heart Association’s 2019 Statistical Update, published in Circulation.
Incorporating data from a wide range of sources, the annual report provides a comprehensive overview of the impact of heart disease, stroke, and cardiovascular risk factors, nationally and globally. Based on NHANES data from 2013 to 2016, the US prevalence of CVD in US adults—including coronary heart disease, heart failure, stroke, and hypertension—is estimated at 48.0% overall, with 121.5 million Americans affected in 2016.
The 48% figure represents an increase over past years, mainly
Obesity and related health risks, including diastolic blood pressure and fasting insulin level, are confirmed as risk factors for renal cell carcinoma (RCC), according to a study in the open-access journal PLoS Medicine.
Using a Mendelian randomization framework, the researchers analyzed gene variants associated with 13 obesity-related factors, identified from large-scale genome-wide association studies. The variants were used as proxies for measures of obesity, blood pressure, lipids, type 2 diabetes, insulin, and glucose. These factors were analyzed for association with the development of RCC in 10,784 cases and 20,406 controls. For each risk factor, odds ratios (ORs) for
Three different measures of adiposity are independent risk factors for decline in glomerular filtration rate (GFR) and death, concludes a meta-analysis in the British Medical Journal.
The analysis included individual-level data on nearly 5.5 million adults enrolled in 39 international general population cohorts, drawn from the Chronic Kidney Disease Prognosis Consortium. Eighteen cohorts included nearly 92,000 participants with CKD, while six cohorts included approximately 84,000 individuals at high cardiovascular risk. The study analyzed three indicators of adiposity: body mass index (BMI), waist circumference, and waist-to-height ratio. These measures were examined for association with decline in GFR—defined as eGFR
Plasma endostatin might provide a useful biomarker of the risk of renal dysfunction in patients with type 2 diabetes, according to a study in Kidney International.
The study included banked specimens from 374 participants (187 matched cases and controls) from the Action to Control Cardiovascular Disease (ACCORD) trial as well as samples from a contemporary cohort of 871 patients with type 2 diabetes from the Mount Sinai BioMe Biobank. Plasma endostatin – a fragment of collagen XVIII that may reflect endothelial dysfunction, matrix remodeling after kidney injury, and angiogenesis – was evaluated for association with a composite outcome of 40%
A combined regimen of rituximab and cyclophosphamide improves long-term outcomes in patients with renal anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV), reports a study in Nephrology Dialysis Transplantation.
The study included 66 patients with AAV and biopsy-confirmed renal involvement. All were treated with a regimen of oral corticosteroids and rituximab plus low-dose pulsed intravenous cyclophosphamide. Maintenance therapy consisted of azathioprine and tapered steroid.
Disease activity was assessed using the Birmingham Vasculitis Activity Score (BVAS), along with monitoring of estimated glomerular filtration rate (eGFR). Median follow-up was 56 months. Outcomes were compared with those of 198 propensity-matched patients drawn from
Pediatric organ transplant recipients are at greatly increased risk of hospitalization for vaccine-preventable infections (VPIs), reports a study in JAMA Pediatrics.
The retrospective study included 6980 patients who were less than 18 years old (mean 6.2 years) when they underwent a solid organ transplant from 2004 through 2011. Transplants were performed at 45 not-for-profit US children’s hospitals participating in the Pediatric Health Information System database. There were 2,583 kidney transplant recipients, comprising 37.0% of the sample.
Numbers of hospitalizations for VPIs in the 5 years after transplantation were analyzed, based on diagnostic codes. The morbidity, mortality, and costs
Neighborhood problems and social cohesion are not directly related to decline in kidney function over time—but are still linked to significant differences in chronic kidney disease (CKD) risk factors, according to a study in the American Journal of Kidney Diseases.
The study included data on 6814 men and women from the Multi-Ethnic Study of Atherosclerosis (MESA). Participants were 45 to 84 years old (mean 62 years) and free of cardiovascular disease when they enrolled in MESA in 2000-02. Forty percent of participants were white, 27% black, 22% Hispanic, and 12% Chinese.
Nearly one-fourth of healthy adults participating in exome sequencing studies have “purportedly pathologic” variants associated with kidney and genitourinary diseases, according to a report in Annals of Internal Medicine.
The investigators performed a secondary analysis of exome sequencing data in 7974 adults who identified themselves as being in good health. Participants were enrolled mainly as healthy controls for genetic studies or as healthy family members of probands with suspected genetic diseases not involving the kidney or genitourinary tract. Exome data were analyzed for the presence of candidate pathologic variants of 625 genes linked to kidney and genitourinary disorders.
For patients with type 2 diabetes, increases in serum creatinine after starting blood pressure–lowering treatment—even greater than 30%—do not necessarily mean that antihypertensive therapy should be decreased, reports a study in Hypertension.
The researchers performed a post hoc analysis of data from the ACCORD-BP (Action to Control Cardiovascular Risk in Diabetes Blood Pressure) trial, which compared intensive versus standard BP-lowering therapy (systolic BP cutoffs of 120 and 140 mm Hg, respectively). The analysis included 4733 patients with type 2 diabetes. Mean age was 62.2 years, with a mean estimated glomerular filtration rate of 81.5 mL/min/1.73 m2.