The oral antidiabetic drug metformin does not increase the risk of hospitalization for acidosis in patients with mild to moderate CKD, according to a “real world” study in JAMA Internal Medicine.
The community-based cohort study included 75,413 patients with type 2 diabetes in a large regional healthcare system who had serum creatinine measurements between 2004 and 2017. Metformin use and dose were analyzed for association with hospital admission for acidosis, accounting for time-related changes in eGFR. The study included replication in a sample of 67,578 new metformin users and 14,439 new sulfonylurea users, drawn from an individual-level inpatient
A new “AMI READMITS” score—based on renal function, diabetes, and low blood pressure, among other factors in the first 24 hours in the hospital—identifies patients at high risk of readmission after acute myocardial infarction, reports a study in the open-access Journal of the American Heart Association.
Using data from consecutive AMI hospitalizations to six diverse Texas hospitals in 2009–2010, the researchers sought to develop a pragmatic model to predict the risk of all-cause, nonelective hospital readmission within 30 days. The model was derived using data on 826 patients, 13% of whom were readmitted within 30 days. Two separate
Renal denervation safely reduces blood pressure in patients with uncontrolled hypertension who continue taking antihypertensive medications, reports a trial in The Lancet.
The SPYRAL HTN-ON MED trial enrolled 487 adults with uncontrolled hypertension at 25 centers in Asia, Australia, Europe, and North America. All had uncontrolled hypertension, including an ambulatory systolic BP of 140 to 170 mm Hg despite at least 6 weeks on stable doses of one to three antihypertensive medications. After renal angiography, patients were randomly assigned to catheter-based renal denervation of the main renal arteries and branches or a sham procedure with sensory masking. All
Ambulatory blood pressure measurements are a consistently better predictor of mortality than clinic BP measurements, concludes a study in The New England Journal of Medicine.
The study included 63,910 adult primary care patients enrolled in the national Spanish Ambulatory Blood Pressure Registry from 2004 through 2014. Clinic and 24-hour blood pressure measurements were compared for associations with all-cause and cardiovascular mortality. The researchers also analyzed mortality associations for specific hypertension phenotypes: sustained hypertension (both clinic and ambulatory BP elevated), “white-coat” hypertension (elevated clinic but normal ambulatory BP), masked hypertension (normal clinic but elevated ambulatory BP), and normal BP
Older veterans receiving pre-ESRD nephrology care in the Department of Veterans Affairs (VA) healthcare system have a lower rate of dialysis initiation—and lower mortality—than those receiving pre-ESRD care via Medicare, reports a study in JAMA Internal Medicine.
Using data from the VA, Medicare claims, and the US Renal Data System, the researchers identified 11,215 veterans aged 67 years or older who developed kidney failure from 2008 through 2011. Nearly 99% of patients were men; mean age was 79 years. Within 2 years after diagnosis of kidney failure, 63.0% of patients initiated dialysis and 47.1% died.
In young to middle-aged adults, higher fibroblast growth factor-23 (FGF23) levels are independently associated with rising blood pressure levels over time, according to a report in Hypertension.
The analysis included data on a multiethnic cohort of 1758 adults participating in the Coronary Artery Risk Development in Young Adults (CARDIA) study. All were free of hypertension or cardiovascular disease when participating in year 20 follow-up examination. At that time, the subjects’ mean age was 45 years—about 58% were women, and 40% were black.
Levels of C-terminal FGF23 at year 20 were analyzed for association with longitudinal BP levels and
In patients undergoing major abdominal surgery, a restrictive fluid policy leads to an increased rate of acute kidney injury compared to liberal fluid therapy, while other outcomes are similar between groups, reports a study in The New England Journal of Medicine.
The “Restrictive versus Liberal Fluid Therapy in Major Abdominal Surgery” (RELIEF) trial included 3000 patients considered at increased risk of complications while undergoing major abdominal surgery. High-risk criteria included age 70 or older, heart disease, diabetes, renal impairment, and morbid obesity. The patients, enrolled at 47 centers in 7 countries, were randomly assigned to restrictive or liberal
Discarded and transplanted deceased-donor kidneys overlap considerably in quality, with many potentially transplantable organs being discarded, suggests a study in Kidney International.
Using the Scientific Registry of Transplant Recipients, the researchers identified 212,305 deceased-donor kidneys recovered for transplantation between 2000 and 2015. Of these, 36,700 kidneys were discarded: a rate of 36.7%. Reasons for organ discard were analyzed, along with associated donor- and organ-related factors. The quality of transplanted and discarded organs was compared using the Kidney Donor Risk Index and the Kidney Donor Profile Index.
Three-fourths of discarded kidneys were bilateral discards. The most common reason for
A health promotion intervention in black-owned barbershops—incorporating medication management by pharmacists—reduces blood pressure in black men with uncontrolled hypertension, reports a study in The New England Journal of Medicine.
The cluster randomized trial included 319 non-Hispanic black men with hypertension (systolic BP 140 mm Hg or higher) who were regular customers at 52 black-owned barbershops in Los Angeles County. One group of barbershops was assigned to a pharmacist-led intervention, in which barbers encouraged men to meet with specialty-trained pharmacists. The pharmacists prescribed and monitored antihypertensive drug therapy in a collaborative practice agreement with the patients’ physicians. Barbershops assigned
Early administration of caffeine citrate can reduce the risk of acute kidney injury (AKI) in preterm newborns, according to a study in JAMA Pediatrics.
The researchers analyzed data on a multicenter cohort of 675 preterm neonates enrolled in the “Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates” (AWAKEN). The infants were admitted to 24 participating level III or IV neonatal intensive care units. About 55% were male; mean gestational age was 28.9 weeks and mean birthweight 1285 g.
Acute kidney injury developed during the first week after birth in 18.1% of infants, based on the modified neonatal