Since the 1990s, the risk of death has decreased for patients with end stage renal disease due to granulomatosis with polyangiitis (GPA-ESRD), reports a study in Arthritis Care & Research.
From the US Renal Data System, the researchers identified 5929 patients diagnosed with GPA-ESRD between 1995 and 2014, representing nearly all incident cases during that time. Trends in overall and cause-specific mortality were analyzed in subgroups of patients defined by year of ESRD onset: 1995–99, 2000–04, 2005–09, and 2010–14. The overall incidence of GPA-ESRD per million population increased from 0.81 in 1995–99 to 1.15 in 2005–09, stabilizing at
Overtreatment of type 2 diabetes is common and potentially harmful in older adults, according to a primary care study in Diabetes, Obesity and Metabolism.
The observational study included 1002 patients being treated for type 2 diabetes at five Dutch primary care centers, including 319 patients aged 70 years or older. These older patients were classified into subgroups according to Dutch guidelines, based on glycated hemoglobin targets: 7%, 7.5%, and 8%. Levels of personalized care for type 2 diabetes were assessed, focusing on overtreatment.
The analysis identified 165 patients aged 70 or older with an HbA1c target of greater
Elevated blood urea nitrogen (BUN) levels are associated with an increased risk of developing diabetes, according to a study in Kidney International.
The researchers analyzed a national cohort of more than 1.3 million US veterans enrolled in the VA Health Care System. All patients were initially free of diabetes. At the time of cohort entry, 8.77% of individuals had an elevated BUN level of greater than 25 mg/dL. Risk of incident diabetes associated with BUN was assessed over a median follow-up of nearly 5 years, including joint risk models of estimated glomerular filtration rate (eGFR) and BUN.
Any history of childhood kidney disease is associated with a substantially increased risk of end stage renal disease (ESRD) in adulthood, reports a study from Israel in The New England Journal of Medicine.
The historical cohort study included more than 1.5 million Israeli adolescents undergoing medical assessment before military conscription between 1967 and 1997. History of childhood kidney disease was assessed, including congenital anomalies of the kidney and urinary tract, pyelonephritis, and glomerular disease. When evaluated at a mean age of 17.7 years, all individuals had normal kidney function and blood pressure.
For non-preemptive living donor kidney transplant recipients, longer pretransplant dialysis exposure is associated with a higher risk of allograft failure, reports a study in the American Journal of Kidney Diseases.
The retrospective study included 77,607 adult, first-time, kidney-only living donor transplant recipients reported to the Scientific Registry of Transplant Recipients between 2000 and 2016. Of these, 51,390 underwent non-preemptive transplantation. Duration of pretransplant dialysis exposure was examined for association with kidney transplant failure from any cause including death. Median duration of dialysis exposure in the non-preemptive transplant group was 14 months.
Patients with longer pretransplant dialysis exposure were
At mid- to long-term follow-up, living kidney donors are at significantly increased risk of end stage renal disease (ESRD) and preeclampsia, concludes a meta-analysis in the Annals of Internal Medicine.
A systematic review identified 52 observational studies comparing a broad range of health outcomes in living kidney donors, with follow-up of 1 to 24 years. Meta-analysis included 118,426 living kidney donors and 117,656 controls.
The data showed no significant difference in all-cause mortality for living kidney donors compared to nondonors. Several other outcomes of concern were also similar between groups, including cardiovascular disease, hypertension, and type 2 diabetes.
A salivary urea nitrogen (SUN) dipstick test is specific—but not sensitive—for diagnosis of obstetric-related acute kidney injury (AKI) in high-risk Malawian women, reports a study in the open-access journal Kidney International Reports.
The study included 301 pregnant or postpartum women at high risk of AKI. The women were admitted to the obstetric unit of a district hospital in Blantyre, Malawi, over a 12-week period. The patients’ mean age was 26 years, and 11% were HIV positive. On admission, patients underwent the SUN dipstick test as well as serum creatinine measurement, with additional testing as indicated.
For undocumented immigrants with end stage renal disease (ESRD), standard dialysis three times weekly reduces mortality and hospital days, compared to emergency-only dialysis, reports a study in The Journal of the American Medical Association.
The retrospective cohort included 211 undocumented immigrants with ESRD treated at three US centers between 2007 and 2014. Patients at centers in Denver and Houston received emergency-only dialysis based on signs of critical illness. Patients treated at a San Francisco hospital received standard dialysis, scheduled three times weekly. The main outcome of interest was mortality at 3 years, adjusted for propensity to undergo emergency
In children with chronic kidney disease (CKD), the kidney failure risk equation (KFRE) performs well in predicting the risk of progression to end stage renal disease (ESRD), concludes a study in JAMA Pediatrics.
The retrospective analysis included 603 children from a multicenter pediatric CKD cohort study. About 63% of the patients were boys. Their median age at study entry was 12 years and they had a median estimated glomerular filtration rate (eGFR) of 44 mL/min/1.73 m2. Two versions of the KFRE were analyzed for their ability to predict progression to ESRD: a four-variable version (age, sex,
Multilevel, multicomponent strategies provide the greatest reductions in blood pressure (BP) for patients with hypertension, concludes a meta-analysis in Annals of Internal Medicine.
The researchers performed a systematic review and meta-analysis of randomized trials comparing the effectiveness of eight implementation strategies for BP control in adults with hypertension, compared to regular care. There were two patient-level strategies (home coaching and home BP monitoring), three provider-level strategies (provider training, audit and feedback, and electronic decision-support systems), and three multilevel strategies (multilevel strategy without team-based care and team-based care with medication titration by physicians or nonphysicians). The meta-analysis included 121