One-year mortality is higher for hemodialysis patients starting carvedilol compared to those starting metoprolol, suggests a study in the American Journal of Kidney Diseases.
The retrospective analysis included 27,064 Medicare patients starting hemodialysis in a large US dialysis organization from 2007 through 2012. All included patients who initiated beta-blocker therapy with metoprolol (64.7% of patients) or carvedilol (35.3%). These two groups were compared for the 1-year outcomes of all-cause mortality, cardiovascular mortality, and intradialytic hypotension, with adjustment for demographic, clinical, laboratory, and dialysis treatment covariates.
Propensity score analysis suggested that the two groups were highly comparable. All-cause mortality
Direct-acting antivirals (DAAs) can prevent hepatitis C virus (HCV) transmission from HCV-infected kidney donors to noninfected recipients, according to an initial clinical trial in the Annals of Internal Medicine.
The open-label trial included 10 non-HCV–infected patients receiving kidneys from HCV-infected donors at one transplant center. All recipients were over age 50 (median 71 years) and had no available living donor. The deceased donors, median age 30 years, had positive HCV RNA and HCV antibody test results. Six donors had died of drug overdose.
Immediately before transplantation, all patients were treated with grazoprevir (GZR) 100 mg and elbasvir (EBR)
Analysis of 24-hour urine samples from a large sample of US adults provides important baseline data on estimated sodium and potassium intake, reports a study in The Journal of the American Medical Association.
The cross-sectional study included 24-hour urine collections from 827 men and women aged 20 to 69 years. The subjects were drawn from the examination component of the National Health and Nutrition Examination Survey (NHANES) in 2014. The researchers estimated 24-hour urinary sodium and potassium excretion and their molar ratios.
Nearly two-thirds of the study population were white; Hispanic, black, and Asian racial/ethnic groups were represented
In patients with rheumatoid arthritis, treatment with biologic agents is associated with a lower risk of declining renal function and chronic kidney disease (CKD), reports a study in Kidney International.
Using a Department of Veterans Affairs database, the researchers identified 20,757 veterans diagnosed with RA between 2004 and 2006, with follow-up to 2013. All included patients had initially normal kidney function: estimated glomerular filtration rate (eGFR) 60 mL/min/1.73 m2 or higher. Treatment with biologic agents was examined for association with incident CKD, defined as eGFR less than 60 mL/min/1.73 m2, with at least a
In both critically ill and non-critically ill adults, balanced crystalloids are associated with a lower risk of adverse renal events compared to saline, according to a pair of trials in The New England Journal of Medicine.
The “Saline Against Lactated Ringer’s or Plasma-Lyte in the Emergency Department” (SALT-ED) study included 13,347 adult patients seen in the emergency department (ED) and subsequently hospitalized outside the ICU. Over 16 months, the ED crossed-over monthly from treatment using balanced crystalloids (lactated Ringer’s solution or Plasma-Lyte A). Median volume of crystalloids administered in the ED was 1079 mL; about 88% of patients
In diabetic patients on hemodialysis, glycated albumin (GA) might provide a valuable alternative for predicting mortality, according to a study in Nephrology Dialysis Transplantation.
The study included a cohort of 84,282 diabetic patients on maintenance hemodialysis in Japan, identified from the Japanese Society for Dialysis Therapy Renal Data Registry. Mean age was 67 years and mean time on dialysis 6.4 years; about 70% of patients were male. Measurements of both GA and glycated hemoglobin (HbA1c) were available for 22,441 patients. One-year follow-up data were used to assess the two measures as predictors of mortality, with adjustment for potential
Urinary albumin excretion is independently associated with a range of adverse cardiovascular outcomes in patients with type 2 diabetes, reports a study in JAMA Cardiology.
The study included data on 15,760 patients from the SAVOR-TIMI 53 study: a randomized, placebo-controlled trial of the oral hypoglycemic drug saxagliptin in patients with type 2 diabetes at high cardiovascular risk. Two-thirds of patients were men. Baseline urinary albumin to creatinine ratio (UACR) was less than 10 mg/g in 36.8% of patients, 10 to 30 mg/g in 24.7%, 30 to 300 mg/g in 28.1%, and greater than 300 mg/g in 10.4%.
In older adults with chronic kidney disease (CKD), new anticoagulant therapy for atrial fibrillation (AF) is associated with increased risks of ischemic stroke and hemorrhage, reports a study in the British Medical Journal.
From a UK general practice database, the researchers identified 6977 CKD patients newly diagnosed with AF. Of these, 2434 were started on anticoagulation within 60 days. Propensity scores were used to create matched pairs of patients, exposed or not exposed to anticoagulant therapy. Mean age was about 82 years. At a median follow-up of 506 days, rates of ischemic stroke, cerebral or gastrointestinal bleeding, and
One-third of living-donor kidney transplant recipients are started on dialysis before transplantation—even while their donor’s evaluation is proceeding, reports a study in Transplantation.
The retrospective study included 478 patients who ultimately received a living-donor kidney transplant, and who were not on dialysis when their donor was being evaluated for at least 3 months. The transplants were performed at five centers in Ontario between 2004 and 2014. The proportion of patients initiating dialysis before transplantation was analyzed, along with factors associated with this outcome.
Thirty-five percent of patients initiated dialysis a median of 9.7 months after their donor started
Current or past use of marijuana does not appear to affect the risk of developing kidney disease or decreased renal function, reports a study in The American Journal of Medicine.
The cross-sectional study included data from 13,995 respondents, aged 15 to 59, to the National Health and Nutrition Examination Survey from 2007 to 2014. Self-reported marijuana use, recent or past, was analyzed for association with renal outcomes: serum creatinine concentration, estimated glomerular filtration rate, and chronic kidney disease (stage 2 or higher).
In the nationally representative survey, 46.3% of respondents said they had never used marijuana, 39.3% were