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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,

A broadening donor pool, increased risk aversion, and inefficient organ allocation may all contribute to the long-term increase in the percentage of deceased donor kidneys discarded, concludes a study in Transplantation.

The researchers analyzed Organ Procurement and Transplantation Network data to explore possible reasons for the well-documented, two-decade-long increase in the US deceased donor kidney discard rate (DKR). Beginning at 5.1% in 1988, the KDR rose more or less steadily to a high of 19.1% in 2009. This trend occurred at a time when the number of kidneys nearly doubled, from 7705 to 14,394. The KDR subsequently stabilized

Undocumented immigrants with end-stage renal disease (ESRD) suffer from serious physical symptoms and psychosocial distress—particularly related to receiving hemodialysis on an “emergent-only” basis, reports a qualitative study in JAMA Internal Medicine.

The investigators performed semi-structured interviews with 20 undocumented Latino patients with ESRD seen at a safety-net hospital in Colorado. The patients were 10 men and 10 women, mean age 51 years. All had been in the United States for at least 5 years before ESRD diagnosis.

Analysis of interviews identified themes in four major categories. Patients experienced a gradual and distressing increase in symptoms after emergency hemodialysis,

Diabetes is present in one-tenth of US adults being treated for HIV infection, suggests a study in BMJ Open Diabetes Research & Care.

The researchers compared the weighted prevalence of diabetes in two populations from nationally representative studies: 8610 HIV-infected adults from the Medical Monitoring Project and 5604 general population subjects from the National Health and Nutrition Survey (2009-10 data from both studies). Diabetes was assessed as a physician diagnosis or use of medications for diabetes.

The unadjusted prevalence of diabetes among HIV-positive adults was 10.3%, compared to 8.3% in the general population sample. On adjusted analysis, diabetes prevalence

Tight glycemic control—with a blood glucose target of 80 to 110 mg/dL—does not improve outcomes for critically ill children, concludes a trial in The New England Journal of Medicine.

The randomized, multicenter trial included 713 critically ill children with confirmed hyperglycemia, excluding cardiac surgery patients. Patients were assigned a target blood glucose range of 80 to 100 mg/dL (tight glycemic control) or 150 to 180 mg/dL. The study included continuous glucose monitoring with explicitly guided insulin adjustments. The main outcome of interest was number of ICU-free days up to day 28.

Recruitment was halted at 50% enrollment when

The mineralocorticoid receptor blocker spironolactone does not reduce the risk of acute kidney injury (AKI) in patients undergoing cardiac surgery, concludes a trial in American Journal of Kidney Diseases.

The randomized, double-blind trial included 233 adults (mean age 53) undergoing cardiac surgery with cardiopulmonary bypass. Starting the day before surgery, one group received spironolactone—100 mg, with three further 25 mg doses given on postoperative days 0, 1, and 2—while the other group received placebo. Patient characteristics were similar between groups: mean serum creatinine level was 0.9 mg/d, while the median Thakar score (used to estimate AKI risk) was

Renal biopsy can be useful in establishing the correct diagnosis and treatment in patients with diabetes—a population with a high prevalence of nondiabetic renal disease (NDRD), according to a meta-analysis in Nephrology Dialysis Transplantation.

The researchers identified and analyzed data on the frequency of diabetic nephropathy, NDRD, and “mixed” forms of kidney disease among patients with diabetes. The analysis included data on 4876 patients undergoing renal biopsy, reported in 48 studies.

For all three diagnostic categories, prevalence varied widely: from 6.5% to 94% for diabetic nephropathy, 3.0% to 82.9% for NDRD, and 4.0% to 45.5% for mixed kidney

Patients with chronic kidney disease (CKD) need a “multimodal, person-centered framework” to support disease self-management, with a special focus on everyday strategies, according to a study in BMC Nephrology.

The cross-sectional survey study solicited Australian CKD patients’ views on their desires for support in self-management of their disease. Thirty-six patients filled out a paper survey at a primary care clinic, and another 61 patients completed an online survey.

About 60% of respondents were women; mean age was 56 years and mean time since diagnosis 8 years. The patients expressed the wish for more support in 10 previously identified

Acute kidney injury (AKI) is strongly associated with an increased risk of unplanned hospital readmissions—especially for acute pulmonary edema, according to a study in BMC Nephrology.

The researchers analyzed Scottish population-based data on 16,453 patients who were hospitalized and survived to discharge in 2003. Of these, 2623 patients had AKI, based on KDIGO criteria. AKI and other candidate predictors were analyzed as risk factors for unplanned readmission or death within 90 days.

The main study outcome occurred in 18.6% of patients: readmission in 2701 and death without readmission in 363. On multivariable analysis, AKI was a strong risk

Screening for elevated albuminuria and hypertension may identify a group of patients at increased risk of faster decline in kidney function, reports a study in Nephrology Dialysis Transplantation.

The study included 6471 participants from the population-based Prevention of Renal and Vascular End-stage Disease (PREVEND) study. All had at least two (median four) measurements of estimated glomerular filtration rate (eGFR) over a median 11.3 years’ follow-up. Elevated albuminuria was defined as an albumin concentration of 20 mg/L or higher in a first morning urine sample, confirmed by an albumin excretion of 30 mg/d or higher in two 24-hour urine