For patients with gout, starting urate-lowering therapy with allopurinol does not appear to lead to an increased risk of developing stage 3 or higher chronic kidney disease (CKD), reports a study in JAMA Internal Medicine.
Using a UK general practice database, the researchers identified two propensity-score matched groups of patients with newly diagnosed gout. One group of 4760 patients initiated urate-lowering treatment with allopurinol. The comparison group included the same number of patients who did not receive allopurinol. About 83% of patients in both groups were men. Mean age was 57 years and mean body mass index was 30.
There is a “dearth of convincing evidence” that lipid-lowering treatment with statin drugs plays any major role in improving outcomes other than cardiovascular disease (CVD), concludes a review and meta-analysis in Annals of Internal Medicine.
The researchers report an “umbrella” review of 268 previous meta-analyses of data on non-CVD outcomes of statin treatment. Their review identified 144 papers reporting 297 meta-analyses of randomized controlled trials (RCTs) and 112 papers reporting 268 meta-analyses of observational studies. The analysis examined a total of 278 unique non-CVD outcomes. It included credibility assessments incorporating summary effect sizes, study heterogeneity, 95% prediction intervals,
Routine catheter replacement does not improve outcomes for hospitalized patients with catheter-associated urinary tract infection (UTI), according to a report in Journal of the American Geriatric Society.
The prospective, observational cohort study included 315 patients who developed a symptomatic UTI after having an indwelling urinary catheter in place for longer than 1 week. The patients, mean age 79.2 years, were being treated in six internal medicine departments and the geriatric department of an Israeli university hospital. Most were residents of a nursing home or other long-term care facility; they had high comorbidity, with a median Charlson score of 3.
In patients with heart failure and renal impairment, the calcium sensitizer levosimendan is associated with improved kidney function, compared to no improvement with dobutamine, reports a randomized trial in the open-access Journal of the American Heart Association.
The double-blind trial included 32 patients with chronic heart failure, left ventricular ejection fraction (LVEF) less than 40%; and impaired renal function. Most patients were men in New York Heart Association class III; the most common cause of heart failure was dilated cardiomyopathy. The mean age was 58 years.
Patients were randomly assigned to receive levosimendan, loading dose 12 µg/kg plus
The α-adrenergic receptor blocker tamsulosin does not increase passage of small, symptomatic ureteral stones, reports a randomized clinical trial in JAMA Internal Medicine.
The two-phase trial included 512 adults seen in the emergency department with symptomatic ureteral stones. All patients had a symptomatic ureteral stone measuring less than 9 mm in diameter (mean 3.8 mm) on computed tomography. About three-fourths of patents were male and one-fourth were non-white; the mean age was 40.6 years.
Patients were assigned to 28 days of treatment with tamsulosin, 0.4 mg, or placebo. The main outcome of interest was stone passage by 28
Sulfonylureas are widely used as second-line oral antidiabetic therapy, despite potential cardiotoxicity and hypoglycemia risk. A new UK population-based cohort study suggests that such second-line treatment with sulfonylureas is associated with increased risks of myocardial infarction, death, and severe hypoglycemia. The study was published in the British Medical Journal.
Using the UK Clinical Practice Research Datalink, the researchers identified 77,138 patients with type 2 diabetes who started metformin monotherapy between 1998 and 2013. In a prevalent new-user design, the analysis included 23,592 patients who added or switched to sulfonylurea as second-line therapy and the same number
Rituximab appears more effective than tacrolimus in children with corticosteroid-dependent nephrotic syndrome (CDNS), reports a trial in JAMA Pediatrics.
The randomized, open-label trial included children and adolescents (aged 3 to 16 years) with CDNS. The patients, seen at a tertiary care center in India over a 16-month period, had received no previous corticosteroid-sparing therapy. They were randomly assigned to tacrolimus, along with tapering alternate-day prednisolone, for 12 months; or a single course of rituximab, two 375 mg/m2 infusions. Twelve-month relapse-free survival was compared between groups.
Of 176 patients screened, 120 were enrolled in the study; all
In patients with type 2 diabetes, canagliflozin has cardiovascular and renal benefits even at lower levels of kidney function, according to an analysis of clinical trial data reported in Circulation.
The analysis included data on 10,142 patients with type 2 diabetes and high cardiovascular risk enrolled in the industry-sponsored “Canagliflozin Cardiovascular Assessment Study” (CANVAS). Patients were randomly assigned to treatments with canagliflozin, a sodium-glucose co-transporter 2 inhibitor, or placebo. About 20% of patients had CKD, defined as a baseline eGFR of less than 60 mL/min/1.73 m2. Of this group, about 72% had a history of cardiovascular
A team-based CKD registry improves some clinical measures and care processes for patients in a safety-net primary care setting, reports a trial in the American Journal of Kidney Diseases.
Many patients with CKD do not receive guideline-based care shown to improve clinical outcomes. Disease registries embedded in electronic health records can improve quality of care for some chronic diseases.
The pragmatic trial evaluated in the AJKD study looked at an electronic CKD registry designed to identify patients with CKD and provide primary care team members with data relevant to their care. The study included 746 patients
Rates of lower-extremity amputation among ESRD patients on dialysis have decreased by about half in recent years, but mortality remains high among those who do undergo amputation, reports a study in JAMA Internal Medicine.
The study included 3.7 million records of ESRD patients receiving dialysis from 2000 through 2014, drawn from the US Renal Data System. Yearly cohorts were analyzed to assess trends in nontraumatic lower extremity amputations, classified as major (above- or below-knee) and minor (below-ankle). The effects of age, sex, diabetes, and hospital referral region were examined, along with one-year mortality after amputation.