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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

For general surgery patients in the surgical ICU, the chances of survival to discharge decrease with each day of continuous renal replacement therapy (CRRT), according to a study in JAMA Surgery.

The retrospective study included 108 surgical ICU patients receiving CRRT at a tertiary care medical center from 2012 to 2016. The patients were 64 men and 44 women, mean age 62 years. Fifty-three patients were treated before or after general surgery; the remaining 55 were admitted before or for evaluation of liver transplantation. Survival to discharge after differing durations of CRRT was evaluated.

In the general surgery

In kidney transplant recipients with low kidney function, early conversion from tacrolimus- to belatacept-based immunosuppression leads to a small but significant increase in estimated glomerular filtration rate (GFR), reports a study in Transplantation.

The retrospective study included two groups of 30 matched transplant recipients with low but stable eGFR: typically less than less than 40 mL/min/m2 (median 23 mL/min/m2. From 2012 to 2016, the study center had a protocol to convert patients with low kidney function at least 1 month posttransplant from tacrolimus to belatacept. Cases were matched on a wide range of variables

Very long-term follow-up suggests a twofold increase in chronic kidney disease (CKD) risk among black women with pregnancies affected by gestational diabetes mellitus, reports a study in American Journal of Kidney Diseases.

The researchers analyzed data on 2747 women, aged 18 to 30, from the community-based “Coronary Artery Risk Development in Young Adults” (CARDIA) study. Of these, 820 women were nulliparous at baseline, had one or more pregnancies lasting 20 weeks or longer, and had available data on kidney function at up to 25 years of follow-up. Associations between gestational diabetes and CKD were assessed, with adjustment for

Anti-inflammatory therapy with canakinumab—targeting the interleukin-1β (IL-1β) innate immunity pathway—reduces cardiovascular events in patients with previous myocardial infarction (MI), reports a trial in The New England Journal of Medicine.

The industry-sponsored “Canakinumab Antiinflammatory Thrombosis Outcome Study” (CANTOS) enrolled 10,061 adults with a history of MI. All had a persistent proinflammatory response, with high-sensitivity C-reactive protein of 2 mg/L or higher. Patients were randomly assigned to receive canakinumab every 3 months, 50, 150, or 300 mg sc; or placebo. Rates of nonfatal MI or stroke or cardiovascular death were compared between groups.

All three canakinumab doses reduced high-sensitivity C-reactive

Chronic hepatitis C virus (HCV) infection is associated with an increased risk of chronic kidney disease (CKD), with the extent of risk depending on viral load and genotype, reports a study in Kidney International.

The researchers analyzed data on 13,805 Taiwanese adults from a prospective, community-based cohort study. Mean age at enrollment was 47.5 years. Based on detectable HCV load, 431 patients had chronic HCV infection. Chronic HCV infection, viral load, and phenotype were evaluated for association with CKD, defined as consecutive proteinuria or an estimated glomerular filtration rate of less than 60 mL/min/1.73 m2.

Subjects

Vanessa Grubbs and Glenda Payne

Hardcover, 261 pages, Amistad

The effect of disparity on kidney transplant

In Hundreds of Interlaced Fingers: A Kidney Doctor’s Search for the Perfect Match, Dr. Vanessa Grubbs describes her personal journey from a primary care physician never really interested in nephrology to meeting and falling in love with a man on dialysis, to volunteering as a kidney donor, and finally, to deciding to specialize in nephrology. During this journey, she recognized the implicit racism that continues to exist in the medical community, where assumptions are made on the basis of preconceived ideas regarding ability to pay for medications,

For patients with acute myocardial infarction, nonadherence to beta blockers doesn’t reduce mortality—as long as they are taking their prescribed angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) and statins, reports a study in the Journal of the American College of Cardiology.

The researchers analyzed “tradeoffs in adherence” to multiple preventive therapies using data on nearly 91,000 Medicare beneficiaries aged 65 or older with acute myocardial infarction between 2008 and 2010. All patients survived at least 180 days after being hospitalized for acute myocardial infarction and received prescriptions for ACEIs/ARBs, beta blockers, and statins.

Medicare Part D prescription claims were

Glycated hemoglobin (HbA1c) levels may underestimate mean glucose level in African Americans with type 1 diabetes, reports a study in Annals of Internal Medicine.

The T1D Exchange Racial Differences Study Group analyzed data on 104 non-Hispanic black and 104 non-Hispanic white patients with type 1 diabetes, enrolled at 10 US centers. (Individuals with anemia or hemoglobinopathy were excluded.) All subjects were at least 8 years old and had had type 1 diabetes for at least 2 years. Mean glucose concentration was measured by continuous glucose monitoring, and racial differences in the relationship between glucose and HbA1c were assessed.

Contrast media exposure is not a “primary pathogenetic factor” in the development of acute kidney injury (AKI) after primary angioplasty, reports a study in the open-access Journal of the American Heart Association.

The researchers analyzed 2025 patients with ST segment-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention at an Israeli hospital between 2000 and 2015. Median contrast dose was 150 mL. Rates of AKI were compared with those of 1025 patients undergoing fibrinolysis or no reperfusion therapy, who were not exposed to contrast medium. Acute kidney injury was defined as a creatinine level of 0.5 mg/dL