Early experience under the revised kidney allocation system (KAS) shows continued quick access to high-quality deceased-donor organs for prior living donors (PLDs), reports a study in the American Journal of Transplantation.
Using Organ Procurement and Transplantation Network data, the researchers compared access to deceased donor kidney transplants for two groups of PLDs. The study compared prevalent and incident cohorts of 50 patients for the year before KAS implementation in December 2014, and 39 patients for the year after implementation. Transplant rates per patient-year and waiting times were assessed, along with the Kidney Donor Profile Index (KDPI) of the
A targeted-release formulation of budesonide—designed to deliver drug to the distal ileum—reduces proteinuria in patients with IgA nephropathy who don’t respond to first-line treatment, reports a trial in The Lancet.
The phase 2b NEFIGAN trial included patients with confirmed IgA nephropathy and persistent proteinuria at 62 European nephrology clinics. All patients were on optimized renin-angiotensin system (RAS) blockade, which continued throughout the study. After stratification by baseline urine protein creatinine ratio (UPCR), patients were randomly assigned to TRF-budesonide, 8 or 16 mg/d, or placebo. The main efficacy outcome was change in UPCR from baseline to 9 months of
Nearly two-thirds of children with type 1 diabetes hospitalized for diabetic ketoacidosis (DKA) will develop acute kidney injury (AKI), suggests a study in JAMA Pediatrics.
The researchers reviewed all DKA admissions at a Canadian children’s hospital from 2008 to 2013. Complete medical records were available for 165 patients. The median age was 10.6 years; 54% were female. Three-fourths of patients were newly diagnosed with type 1 diabetes. Fifty-five percent were transferred from another hospital and nearly one-fourth were admitted to the ICU. Median initial pH was 7.1 and serum bicarbonate level 7.0 mEq/L.
Currently available data cannot establish the safety and efficacy of osteoporosis medications for patients with chronic kidney disease (CKD), concludes a meta-analysis in Annals of Internal Medicine.
A systematic review identified 13 randomized trials, including a total of 9850 patients, evaluating the clinical benefits and safety outcomes of osteoporosis medications in CKD patients. The medications studied were bisphosphonates, teriparatide, raloxifene, and denosumab. Outcomes of interest were bone mineral density (BMD), fractures, mortality, and adverse events. Kidney transplant recipients were enrolled in six trials, postmenopausal women with CKD in four, and patients with CKD stage 3 to 5 or on
Anticoagulants don’t reduce the risk of stroke in older adults with atrial fibrillation and chronic kidney disease, suggests a study in Kidney International.
The researchers analyzed data on 6544 Ontario residents aged 66 years or older with advanced CKD—estimated glomerular filtration rate less than 45 mL/min/1.73 m2—and atrial fibrillation. Of these, 1475 filled an anticoagulant prescription, mainly for vitamin K antagonists. Propensity matching was used to identify 1417 matched pairs with or without anticoagulation; median follow-up was 269 and 254 days, respectively. Risks of ischemic stroke, hemorrhagic events, or death were compared between groups.
Intensive blood pressure control does not further reduce the risk of kidney disease progression among nondiabetic patients with kidney disease, concludes a meta-analysis in JAMA Internal Medicine.
A systematic review identified nine randomized controlled trials comparing intensive BP control—targeting levels less than 130/80 mm Hg—with standard BP control in CKD patients without diabetes. The studies included a total of 8127 patients with a median follow-up time of 3.3 years, including more than 800 kidney disease progression events. Meta-analysis was performed for the outcomes of annual rate of change in glomerular filtration rate (GFR), doubling of serum creatinine or
Patients who have even relatively small increases in creatinine after starting angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) treatment are at increased risk of adverse cardiorenal events, suggests a study in the British Medical Journal.
Using linked UK primary care and hospital databases, the researchers identified 122,363 patients who initiated treatment with ACEIs or ARBs between 1997 and 2014. Of these, 1.7% had creatinine increases of 30% or more after starting renin-angiotensin system blockade. Rates of end stage renal disease, myocardial infarction, heart failure, and death were compared for patients with and without a 30% increase in creatinine, with
For Latino patients with limited English proficiency (LEP), switching to a primary care provider who speaks Spanish is associated with improved control of type 2 diabetes, reports a study in JAMA Internal Medicine.
Using data from the Kaiser Permanente Northern California healthcare system from 2007 through 2013, the researchers analyzed the effects of language-concordant (LC) versus language discordant (LD) care on risk factor control among LEP Latino patients with type 2 diabetes. Of 1605 patients (mean age 60.5 years), about 26% switched from LD to LC care—i.e., from a primary care provider who spoke English only to one
Added to diet and exercise, once-daily treatment with subcutaneous liraglutide reduces the risk of developing diabetes among obese adults with prediabetes, concludes a trial in The Lancet.
The multicenter trial included 2254 obese adults (body mass index 30 kg/m2 or higher, or 27 kg/m2 or higher with comorbid conditions) meeting criteria for prediabetes. In a 2:1 ratio, patients were randomly assigned to receive once-daily liraglutide, 3.0 mg sc, or matching placebo. Both groups received a diet and exercise intervention. The main outcome of interest was time to onset of type 2 diabetes over 3
In patients with chronic kidney disease (CKD), higher urine potassium excretion—as a surrogate for dietary potassium intake—is associated with a lower risk of death but no difference in the risk of kidney failure, reports a study in American Journal of Kidney Diseases.
The study was a post hoc analysis of 812 participants from the Modification of Diet in Renal Disease study. That trial, performed between 1989 and 1993, analyzed the effects of blood pressure control and dietary protein restriction on progression of stage 2 to 4 CKD. The current study analyzed the association of 24-hour urine potassium excretion,