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
An approach using artificial intelligence enables continuous prediction of acute kidney injury (AKI) in hospitalized patients, according to a research letter in Nature.
The authors developed a deep learning approach for continuous risk prediction of future AKI, based on individual electronic health records. The model was developed by use of retrospective data on more than 700,000 adult patients from the US Department of Veterans Affairs, including 172 inpatient and 1062 outpatient sites. The researchers write, “At every point throughout an admission, the model provides updated estimates of future AKI risk along with an associated degree of uncertainty.” The
The sodium–glucose cotransporter-2 inhibitor empagliflozin may help prevent progression of chronic kidney disease (CKD) in patients with type 2 diabetes, independently of background medications that alter intrarenal hemodynamics, reports a study in Kidney International.
The post hoc exploratory analysis used data from the industry-sponsored BI 10773 (Empagliflozin) Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients (EMPA-REG OUTCOME) trial.
In that earlier study, 7020 patients with type 2 diabetes and established cardiovascular disease were randomly assigned to empagliflozin 10 mg or 25 mg or placebo, added to standard care. On primary analysis, empagliflozin reduced major cardiovascular events,
Extreme heat events (EHE) are associated with increases in hospital admission and death for patients with kidney failure, reports a study in JAMA Network Open.
The study included data on 7445 patients with kidney failure treated at dialysis facilities in the Boston, New York City, and Philadelphia areas from 2001 through 2012. Meteorologic records were used to identify EHEs, based on 95th percentile maximum temperature thresholds specific to each calendar day and location. The researchers examined the associations of EHEs with daily all-cause hospital admissions and all-cause mortality.
The analysis included data on 2953 deaths and 44,941 hospital
Wall boxes were found to be the source of contamination for an outbreak of gram-negative bloodstream infections (BSIs) at three dialysis facilities, according to a report in American Journal of Kidney Diseases.
In August 2016, the Centers for Disease Control and Prevention (CDC) identified a cluster of five BSIs with Serratia marcescens among patients at an outpatient hemodialysis center. The outbreak was identified by means of routine surveillance data reported to the National Healthcare Safety Network.
Further analysis identified BSIs caused by S. marcescens or similar gram-negative bacteria at two additional dialysis facilities owned
Sodium–glucose cotransporter-2 (SGLT-2) inhibitors are not associated with an increased risk of severe urinary tract infection (UTI) in routine clinical practice, concludes a study in Annals of Internal Medicine.
Using two large commercial claims databases based in the United States, the researchers created propensity-matched cohorts of adults with type 2 diabetes who were initiating treatment with SGLT-2 inhibitors versus other antidiabetic drugs. Cohort 1 included matched groups of 61,876 patients starting SGLT-2 inhibitors versus dipeptidyl peptidase-4 inhibitors. Cohort 2 included groups of 55,989 patients starting SGLT-2 inhibitors versus glucagon-like peptide-1 receptor agonists. Severe UTIs were defined as hospitalization
The selective hydrochloric acid binder veverimer is a safe and efficacious treatment for metabolic acidosis in patients with CKD, according to a randomized trial report in the Lancet.
The study was a 40-week extension of a previous international industry-sponsored trial comparing veverimer with placebo for patients with CKD (estimated GFR 20–40 mL/min per 1.73 m2) and metabolic acidosis (serum bicarbonate 10–20 mmol/L). In that study (Lancet 2019; 393:1417–1427), 59% of patients in the veverimer group met a composite primary endpoint of increased sodium bicarbonate, compared with 22% of the placebo group.
For patients with early CKD, non–vitamin K oral anticoagulants (NOACs) have a better risk-to-benefit profile than vitamin K antagonists (VKAs), concludes a meta-analysis in Annals of Internal Medicine.
In a systematic review of the literature, the researchers identified 45 randomized controlled trials that evaluated the two types of oral anticoagulants for any indication and included data on efficacy or bleeding outcomes. The studies included a total of 34,082 patients with early-stage or advanced CKD or with ESKD.
The most frequent indications were atrial fibrillation (AF) and venous thromboembolism (VTE), 11 trials each. Other indications included cardiovascular disease other
The sodium-glucose co-transporter 2 (SGLT2) inhibitor canagliflozin reduces cardiovascular and renal events in diabetic patients with chronic kidney disease—even those with no previous history of cardiovascular disease, according to a clinical trial report in Circulation.
The analysis included 4401 individuals from the phase 3 CREDENCE trial (Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation) with type 2 diabetes and CKD but no previous cardiovascular disease. In CREDENCE, patients were randomly assigned to canagliflozin or placebo, while continuing optimized standard therapy.
Compared to 2220 secondary prevention patients, those in the primary prevention group were younger, 61
Patients enrolled in major clinical trials of end stage kidney disease (ESKD) differ in key demographic and clinical characteristics, compared to the general population of dialysis patients, concludes a meta-analysis in JAMA Internal Medicine.
A systematic review identified 189 randomized clinical trials enrolling dialysis-dependent adults with ESKD. The studies, which enrolled at least 100 patients from 2 or more sites, included a total of 80,104 participants. Meta-analysis compared pre-specified characteristics of the RCT participants to patients in the US Renal Data System (USRDS) registry. Study characteristics associated with measures of generalizability were analyzed as well.