In older adults with kidney failure, the decision to undergo maintenance dialysis is associated with increased hospital and ICU days and decreased use of inpatient palliative care, reports a study in JAMA Network Open.
Using Alberta health data, the researchers identified 968 older adults (65 or older) with kidney failure: 489 men and 479 women, median age 78.5 years. All had at least two consecutive outpatient estimated glomerular filtration rate (eGFR) measurements of less than 10 mL/min/1.73 m2 over at least 90 days—a level at which patients and physicians discuss and decide whether to pursue maintenance
For patients with CKD stage 3, the standard practice of prehydration before contrast administration does not reduce the risk of AKI, reports a randomized trial in JAMA Internal Medicine.
The “Kompas” trial included 523 patients with stage 3 CKD undergoing nonemergency contrast-enhanced computed tomography (CECT) at six hospitals in the Netherlands. The patients were 336 men and 187 women, median age 74 years. They were assigned to undergo prehydration or no prehydration before contrast administration. Prehydration consisted of 1-hour infusion of 250 mL of 1.4% sodium bicarbonate.
The two groups were compared for their mean relative increase in
Hispanic Americans have the highest racial/ethnic prevalence of diabetes, while diabetes prevalence is similar in Asian and black Americans, according to a nationally representative study in The Journal of the American Medical Association.
The study included data on 7575 US adults aged 20 years or older (mean 47.5) from the National Health and Nutrition Examination Surveys 2011–16. Participants were asked if they had been diagnosed with diabetes by a physician; undiagnosed diabetes was assessed by measurement of hemoglobin A1c, tasting plasma glucose, or 2-hour fasting plasma glucose. Racial/ethnic differences in diabetes prevalence were assessed, including selected subgroups within
Patients with moderate to severe kidney disease have a higher risk of peripheral artery disease (PAD) with an increased risk of lower-limb complications and other adverse outcomes, reports a study in the American Journal of Kidney Diseases.
The retrospective analysis used administrative data on nearly 454,000 adult residents of Manitoba, Canada, who had at least one serum creatinine measurement between 2007 and 2014. Based on hospital discharge diagnostic codes and medical claims, 4.5% of patients had a diagnosis of PAD. Associations between PAD and CKD were analyzed, including the impact on lower-limb complications, cardiovascular events, and mortality.
Direct-acting antiviral therapy for hepatitis C virus (HCV) slows the decline in kidney function for patients with comorbid chronic kidney disease (CKD), reports a study in Kidney International.
The retrospective study included 1178 HCV-infected patients who started DAA therapy between 2013 and 2017. All included patients were compliant with DAA treatment, had not undergone organ transplantation or started dialysis, and had available data on baseline creatinine. The patients’ mean age was 46 years; 64% were male and 71% were white, 42% had cirrhosis, and 21% had diabetes. The slope of decline in estimated glomerular filtration rate (eGFR) was
Women who take antibiotics for two months or longer are at increased risk of developing incident kidney stones later in life, suggests a study in American Journal of Kidney Diseases.
The researchers analyzed prospective data on female registered nurses enrolled in the Nurses’ Health Study (NHS) I and II cohorts. Among other medical history items, the women provided information on cumulative time they took antibiotics from age 20 to 39 and from age 40 to 49 (NHS II) or 40 to 59 (NHS I). Incident symptomatic kidney stones were elicited, along with further information about these episodes.
Among patients with even minimal perfusion defects on quantitative single-photon emission computerized tomography (SPECT), the impact on risk of major adverse cardiovascular events (MACE) is significantly higher in those with diabetes, reports a study in Diabetes Care.
Data were drawn from the international, observational REgistry of Fast Myocardial Perfusion Imaging with NExt generation SPECT (REFINE SPECT) study. In that study, patients with known or suspected coronary artery disease underwent quantitative myocardial perfusion imaging using cadmium zinc telluride cameras. From the overall study population of more than 20,000 participants, the researchers identified propensity score–matched groups of 2951 patients with
A new integrative box risk prediction (iBox) score performs well in predicting long-term kidney allograft failure across countries and clinical settings, reports a study in the British Medical Journal.
The score was developed using data from a prospectively enrolled derivation cohort of 4000 consecutive adult kidney transplant recipients (from living or deceased donors) at three French hospitals between 2005 and 2014. Allograft loss, defined as definitive return to dialysis or preemptive transplantation, was assessed using follow-up data to 2018. Independent predictors on multivariable analysis—including demographic factors, measures of allograft function and histology, and the recipient’s immunologic profile—were incorporated
Compared to white Americans, racial/ethnic minority groups have a higher prevalence of diabetes and prediabetes at a lower body mass index (BMI), reports a study in Diabetes Care.
The study included approximately 4.9 million adults aged 20 years or older in 2012–2013. Data were drawn from a consortium of three US integrated healthcare systems (Kaiser Permanente, HealthPartners Minnesota, and Denver Health). Race/ethnicity was classified as white in 50% of individuals, Hispanic in 21.6%, Asian in 12.7%, black in 9.5%, Hawaiian/Pacific Islander in 1.4%, and American Indian/Alaska Native in 0.5%.
Cases of diabetes and prediabetes were ascertained by diagnosis,
Sodium-glucose cotransporter-2 (SGLT2) inhibitors lower the risk of dialysis and other clinically important kidney outcomes in patients with type 2 diabetes, concludes a systematic review and meta-analysis in The Lancet Diabetes & Endocrinology.
The review identified four randomized controlled trials of SGLT2 inhibitors that reported data on major kidney outcomes in patients with type 2 diabetes. The EMPA-REG OUTCOME trial evaluated empa-gliflozin in 7020 patients; the CANVAS Program and CREDENCE trial evaluated canagliflozin in 10,142 and 4401 patients, respectively; and the DECLARE-TIMI 58 trial evaluated dapagliflozin in 17,160 patients. The CREDENCE study was designed as an event-driven kidney