Patients undergoing regular dialysis have overly optimistic expectations of their prognosis, according to a study in JAMA Internal Medicine.
The cross-sectional survey study included 996 patients receiving regular dialysis at 31 nonprofit facilities in two US metropolitan areas (Seattle and Nashville). The main outcome of interest was response to the question: “How long would you guess people your age with similar health conditions usually live?” Responses were classified as less than 5 years, 5 to 10 years, more than 10 years, or “not sure.”
Patients’ expectations of survival were compared with those of a cohort of more than
Only 1 out of 7 patients who initiate peritoneal dialysis (PD) in the United States are still on PD at 5 years’ follow-up, reports a study in the American Journal of Kidney Diseases.
The retrospective study included 25,573 adults who initiated PD from 2008 through 2011, identified via the US Renal Data System (USRDS). Five-year follow-up data were analyzed to assess the proportion of patients transferring to hemodialysis (HD), along with the competing outcomes of death and kidney transplant. The patients’ mean age was 58 years: 56% were male, 71% white, and 22% African American. Mean baseline estimated
Reducing the human and financial burden of progressive diabetic kidney disease (DKD) and ESKD stalled after the landmark trials of renin-angiotensin system inhibitors (RASi) in the early 2000s. The recent introduction of sodium glucose co-transporter 2 inhibitors (SGLT-2i) appears to reverse 20 years of stagnation in this area. This short review summarizes the key findings in this emerging success story of nephrology therapeutics.
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According to the Brenner hypothesis (1), hyperfiltration drives nephrons to glomerulosclerosis and eventually leads to chronic kidney disease (CKD) and ESKD. Reducing hyperfiltration has been the major paradigm for slowing the progression
Contrary to current guidelines, peripherally inserted central catheters (PICCs) are used in a high percentage of hospitalized patients with chronic kidney disease (CKD), reports a study in Annals of Internal Medicine.
The prospective cohort study analyzed the frequency of PICC use and associated characteristics among patients with stage 3b or higher CKD: estimated glomerular filtration rate (eGFR) less than 45 mL/min/1.73 m2. The collaborative quality initiative included data from 52 participating hospitals in the Michigan Hospital Medicine Safety Consortium. Primary analysis included 20,545 (of a total 23,392) PICC placements between 2013 and 2016.
Among patients who successfully lost weight in the Diabetes Prevention Program (DPP) study, long-term maintenance of weight loss is better for those initially assigned to metformin compared to a lifestyle intervention, reports a study in Annals of Internal Medicine.
In the original DPP, 3234 overweight or obese patients with elevated glucose levels were randomly assigned to metformin, an intensive lifestyle intervention, or placebo. At an average follow-up of 2.8 years, diabetes risk was reduced by 31% with metformin and 58% with the lifestyle intervention, compared to placebo. Weight loss averaged 2.1 and 5.6 kg, respectively, and was the
In children with end stage kidney disease (ESKD), there is no specific level of renal function at which dialysis initiation leads to improved patient outcomes, concludes a registry study in Nephrology Dialysis Transplantation.
The researchers analyzed data on 2963 children enrolled in the European Society for Pediatric Nephrology/European Renal Association–European Dialysis and Transplant Association (ESPN/ERA-EDTA) Registry between 2000 and 2014. Drawn from 21 countries, all patients were less than 18 years old when they initiated renal replacement therapy. Patient survival and access to transplantation were compared for 1411 children with early initiation, estimated glomerular filtration rate (eGFR) 8
Lack of interest in the subject is the most common reason why medical students and residents say they wouldn’t want to pursue a career in nephrology, reports a survey study in the open-access journal BMC Nephrology.
The researchers distributed an anonymous survey regarding specialty choice to 4199 US upper-level medical students and internal medicine residents. The survey targeted respondents at institutions with an associated nephrology fellowship program. Perceptions of nephrology and factors affecting specialty choice were evaluated.
Response rate was 15.3%, including 315 medical students and 308 residents from 30 institutions. Ninety-two percent of trainees cited personal interest in a
Combination therapies including amlodipine improve blood pressure (BP) control in sub-Saharan African patients with hypertension, concludes a trial in The New England Journal of Medicine.
The randomized controlled “Comparison of Three Combination Therapies in Lowering Blood Pressure in Black Africans” (CREOLE) trial included 728 black patients with uncontrolled hypertension in six sub-Saharan African countries. Enrolled patients had BP of 140/90 mm Hg or higher on no antihypertensive therapy or a single-drug regimen. The patients’ average age was 51 years; 63% were women.
Patients were assigned to one of three antihypertensive drug combinations: the calcium-channel blocker amlodipine (5 mg)
Exposure to high doses of nonsteroidal anti-inflammatory drugs (NSAIDs) shows a modest but significant association with kidney disease in a military population, reports a study in the open-access journal JAMA Network Open.
The retrospective analysis included data on more than 764,000 US Army soldiers on active duty from 2011 through 2014. Eighty-six percent of participants were men; median age was 27 years. Dispensing and dose of prescription NSAIDs were evaluated for association with incident diagnoses of acute kidney injury (AKI) and chronic kidney disease (CKD).
The participants received a total of 1.6 million distinct NSAID prescriptions during the
Among patients with chronic kidney disease (CKD), baseline biomarkers of tubule cell function are independent predictors of the later development of acute kidney injury (AKI), reports a study in Kidney International.
The researchers analyzed data on 2351 participants from the randomized Systolic Blood Pressure Intervention Trial (SPRINT). All had CKD (mean estimated glomerular filtration rate [eGFR] 49 mL/min/1.73 m2) and hypertension at baseline, but not diabetes. Participants were assigned intensive or standard systolic blood pressure targets: less than 120 versus less than 140 mm Hg. Study outcomes showed lower rates of cardiovascular disease and death with