Acute kidney injury (AKI) develops in nearly 1 out of 5 patients treated with antibiotic-loaded “spacers” for periprosthetic infection after total knee arthroplasty (TKA), reports a study in The Journal of Bone and Joint Surgery.
The retrospective study included 424 patients undergoing surgical treatment for periprosthetic infection after primary TKA at the Mayo Clinic from 2000 to 2017. Treatment included placement of high-dose antibiotic-loaded bone cement (ABLC) spacers in addition to systemic antibiotics. Mean age was 67 years; 15% of patients had pre-existing chronic kidney disease (CKD). AKI was defined as a creatinine increase or 1.5 times baseline
Nearly all dialysis patients infected with SARS-CoV-2 show sustained immune responses through 6 months' follow-up, according to a pre-proof paper in Kidney International.
The researchers screened for two types of SARS-CoV-2 antibodies in a cohort of 356 patients receiving hemodialysis at two UK dialysis centers. Specifically, samples were tested for antibodies to the nucleocapsid protein (anti-NP) and the receptor binding domain (anti-RBD) of the spike protein. Durability and functionality of immune responses to SARSCoV-2 were assessed over time.
At initial screening, 38% of dialysis patients tested positive for one or both types of SARS-CoV-2 antibodies. Most patients (127
For patients with advanced chronic kidney disease (CKD), the transition to dialysis and end-stage kidney disease (ESKD) is associated with substantially increased use of laxatives, reports a study in Nephrology Dialysis Transplantation.
With the use of data from the US Renal Data System Transition of Care in CKD Study, the researchers analyzed patterns of laxative use among 102,477 military veterans who transitioned to ESKD between 2007 and 2015. The analysis focused on the proportion of patients who filled a prescription for any type of laxative during 6-month periods before and after the transition to ESKD. Factors associated with
The synthetic vasopressin analog terlipressin improves kidney function in patients with type 1 hepatorenal syndrome (HRS- 1)—but with a high rate of serious adverse events, reports a clinical trial in The New England Journal of Medicine.
The CONFIRM Study (A Multi-Center, Randomized, Placebo Controlled, Double-Blind Study to Confirm Efficacy and Safety of Terlipressin in Subjects with Hepatorenal Syndrome Type 1), a randomized, phase 3 trial, included 300 adults with cirrhosis and HRS-1 treated at 60 North American centers. In a 2:1 ratio, patients were assigned to 30 days of treatment with terlipressin or placebo; concomitant albumin therapy was
Electronic health record alerts have only a modest impact on care processes for acute kidney injury (AKI), and no impact on important disease outcomes—with a possible increase in adverse outcomes in some settings, according to conclusions from a randomized trial in the British Medical Journal.
The double-blind, multi-center trial was carried out at six hospitals, including four teaching hospitals, in a New England university-affiliated health system. The intervention was a “pop-up” alert in the electronic health record of patients meeting KDIGO (Kidney Disease Improving Global Outcomes) criteria for AKI.
At intervention hospitals, the alert was triggered whenever the
Recovery of kidney function is common for COVID-19 patients with acute kidney injury requiring kidney replacement therapy (AKI-KRT), according to a report in Kidney International.
Researchers at a large German tertiary care center report their experience with 74 hospitalized patients who developed AKI-KRT as a complication of COVID-19 between March and June 2020. The patients’ median age was 65 years and three-fourths were men. All patients were in the ICU when AKI-KRT developed. Nearly all were on mechanical ventilation, and 39.2% were receiving extracorporeal membrane oxygenation.
Outcomes were assessed in October 2020—a median of 151 days after the
For kidney transplant recipients with screening-detected asymptomatic bacteriuria (ASB), antibiotic treatment does not reduce the risk of developing urinary tract infection (UTI) and may lead to emergence of antibiotic-resistant bacteria, reports a study in Clinical Microbiology and Infection.
The pragmatic, open-label Bacteriuria in Renal Transplantation (BiRT) trial included 199 patients with ASB detected by screening at least 2 months after transplantation. Patients were randomly assigned to receive antibiotic treatment, using a drug active against the causative bacteria, or no treatment. The incidence of symptomatic UTI over routine 1-year follow-up was compared between groups.
Long-term corticosteroid therapy may not be necessary in kidney transplant recipients receiving calcineurin-based immunosuppressive therapy, according to a clinical trial report in JAMA Surgery.
The researchers analyzed long-term follow-up data from a previous multi-center, randomized, double-blind trial including 385 adult patients undergoing living or deceased kidney transplantation between 1999 and 2002. All patients were classified at low-to-moderate immune risk and were free of delayed graft function or short-term rejection within the first week.
Patients were assigned to tacrolimus and mycophenolate mofetil, with or without corticosteroids, 7 days after transplantation. Outcomes were assessed via linkage to the national Organ Procurement
Ten-year follow-up data in patients with type 2 diabetes show better outcomes in those undergoing metabolic surgery, compared to conventional medical therapy, reports a study in The Lancet.
The researchers analyzed data from a previous open-label, single-center trial in which 60 obese patients with type 2 diabetes were randomly assigned to medical therapy, Roux-en-Y gastric bypass (RYGB), or biliopancreatic diversion (BPD). The main outcome of interest was diabetes remission, defined as glycated hemoglobin less than 6.5% with a fasting blood glucose level of less than 5.5 mmol and no diabetes medications for at least 1 year. Fifty-seven patients
Better control of blood glucose levels may reduce the risk of AKI in adults with type 2 diabetes and CKD, according to an analysis of US and Swedish data in Diabetes Care.
The study included data on two observational cohorts of patients with type 2 diabetes and confirmed stage G3 to G5 CKD receiving routine care in one US and one Swedish health system. The US cohort, drawn from the Geisinger Health System in Pennsylvania, consisted of 22,877 patients: median age 72 years, 55% female, and estimated glomerular filtration rate (eGFR) 52 mL/min/1.73 m2. The Swedish