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For hemodialysis (HD) patients, a 6-month progressive exercise intervention leads to significant reductions in left ventricular (LV) mass, according to results from a clinical trial in Kidney International.

The CYCLE-HD study included 130 patients receiving HD at three UK centers. In open-label, cluster-randomized fashion, patients were assigned to a structured intradialytic cycling (IDC) intervention or usual care. With the use of specially adapted cycle ergometers, patients in the intervention group performed supervised cycling three times weekly during dialysis sessions, targeting 30 minutes of continuous cycling at a rating of perceived exertion of 12 to 14. Ergometer resistance was

For patients with COVID-19, two newer classes of antihyperglycemic medications are associated with lower rates of death and other adverse outcomes, according to a study in Diabetes Care.

The observational study included 12,466 adult patients with polymerase chain reaction-diagnosed SARS-CoV-2 infection, drawn from the US National COVID Cohort Collective. Included patients had an ambulatory prescription for at least one of three antihyperglycemic medication classes over 24 months before diagnosis: glucagon-like peptide-1 receptor agonist (GLP1-RA), sodium-glucose cotransporter-2 inhibitor (SGLT2i), or dipeptidyl peptidase 4 inhibitor (DPP4i). The patients' mean age was 58.6 years, 53.4% were women, and 62.5% were White

Dialysis centers hit with financial penalties under the Centers for Medicare & Medicaid Services' (CMS) mandatory End-Stage Renal Disease Quality Incentive Program (ESRD QIP) do not show subsequent improvement in quality of care, concludes a study in Annals of Internal Medicine.

The study used publicly available Medicare data on 5830 dialysis centers from 2015 to 2018. In 2017, financial penalties (based on 2015 performance) were levied on 1109 centers, representing 19.0% of the total. Regression discontinuity models were used to evaluate the association between penalization and subsequent changes in dialysis center quality, based on data from 2017 and

Final results from the Systolic Blood Pressure Intervention Trial (SPRINT) support an intensive strategy targeting a systolic blood pressure (BP) of less than 120 mm Hg, reports The New England Journal of Medicine.

The analysis included patients, aged 50 years or older, with baseline systolic BP of 130 to 8 mm Hg and increased risk for cardiovascular disease, but without diabetes or a history of stroke. Patients were randomly assigned to intensive or standard treatment, with systolic BP targets of less than 120 or 140 mm Hg, respectively. The study was halted early in 2015—at a median follow-up

Nephrology fellows experience high rates of moral distress during their fellowship training, according to a survey study in American Journal of Nephrology.

An online survey link was sent to the directors of 148 US nephrology fellowship programs, with a request to forward the survey to fellowship trainees. Adapted from a previous questionnaire, the survey focused on workplace scenarios relevant to nephrology training and practice in five domains: dialysis decision-making, futility of care, interdisciplinary communication, perceived powerlessness, and the institutional ethical environment.

Directors reported forwarding the survey to 386 nephrology fellows, of whom 142 responded: a rate of 37%.

Early dialysis withdrawal consistently accounts for about one-third of early deaths in the year after dialysis initiation, concludes an Australian study in Nephrology Dialysis Transplantation.

The researchers analyzed data on 32,274 patients initiating dialysis in Australia between 2005 and 2018, drawn from the Australian and New Zealand Dialysis and Transplant Registry. Early deaths (within 12 months) from dialysis withdrawal attributed to psychosocial or medical reasons were analyzed, including trends over time and associated risk factors.

Overall, 11% of patients died within 12 months after dialysis initiation. Twenty-two percent of these early deaths were ascribed to early withdrawal due

Levels of plasma kidney injury molecule-1 (KIM-1) are associated with diagnoses, pathologic findings, and kidney failure risk in patients with a wide range of kidney disease diagnoses, according to a report in the American Journal of Kidney Diseases.

The analysis included participants in two prospective, observational cohort studies: 524 patients undergoing clinically indicated native kidney biopsy enrolled in the Boston Kidney Biopsy Cohort (BKBC) and 3800 patients with common types of chronic kidney disease (CKD) from the Chronic Renal Insufficiency Cohort (CRIC) study. Baseline plasma KIM-1 levels were analyzed for association with subsequent kidney failure (defined as initiation

The combination of increased urinary albumin-creatinine ratio (UACR) and decreased estimated glomerular filtration rate (eGFR) is strongly associated with an increased risk of advanced chronic kidney disease (CKD), reports a UK population-based study in the American Journal of Kidney Diseases.

The analysis included more than 91,319 UK primary care patients, identified from the Clinical Practice Research Datalink between 2000 and 2015. Mean eGFR was 72.6 mL/min/1.73 m2 and median UACR 9.7 mg/g; 77.7% of patients had diabetes.

Patterns of change in UACR and eGFR—a 30% or greater increase, stable, or a 30% or greater decrease—were analyzed

Patients with comorbid kidney disease and those on continuous renal replacement therapy (CRRT) are at increased risk of severe COVID-19, concludes a meta-analysis in Clinical and Experimental Medicine.

A systematic review of the literature was performed to identify studies providing information on comorbid chronic kidney disease (CKD), acute kidney injury (AKI), and CRRT and outcomes of hospitalized patients with laboratory-confirmed COVID-19. The meta-analysis included data from 29 observational studies including a total of 15,017 COVID-19 patients. The studies were published through August 2020, with 20 studies performed in China and 6 in the United States. Severe COVID-19 was

For patients with COVID-19-associated acute kidney injury (AKI), the postdischarge rate of decrease in kidney function is greater than in AKI patients without COVID-19, reports a paper in JAMA Network Open.

The retrospective study included two groups of patients with AKI treated at five hospitals in a New England health system from March through August 2020. One hundred eighty-two patients had COVID-19-associated AKI, with positive results on a SARS-CoV-2 reverse transcription-polymerase chain reaction test at a study hospital. Another 1430 patients had AKI not associated with COVID-19. In both groups, all patients survived past discharge, did not require