Automated office blood pressure (AOBP) readings are more accurate than office measurements and should be the “preferred method” for recording BP in clinical practice, concludes a meta-analysis in JAMA Internal Medicine.
A systematic review of the literature identified 31 articles related to AOBP including a total of 9279 patients. All of the studies included at least 30 patients with properly recorded AOBP measurements: patient unattended and sitting in a quiet place. The studies provided data enabling comparison of AOBP with awake ambulatory BP, research-quality office BP, or routine office BP measurements.
Both sertraline and cognitive-behavioral therapy (CBT) improve depression symptoms in hemodialysis patients, but an engagement interview does not increase patient acceptance of depression therapy, reports a two-phase trial in Annals of Internal Medicine.
The open-label, randomized trial included 184 maintenance dialysis patients at 31 facilities in three US metropolitan areas. All had been receiving dialysis for at least 3 months and scored 15 or higher on the Beck Depression Inventory-II (BD-II). In an initial sample of nearly 2600 patients completing the BD-II, about one-fourth scored 15 or higher.
In the first phase of the study, patients were assigned
For children and adolescents with end stage renal disease, a higher estimated glomerular filtration rate (eGFR) at the time of dialysis initiation is associated with an increased risk of death, reports a study in the American Journal of Kidney Diseases.
The study used US Renal Data System data on 9963 patients aged 1 to 17 (median 13 years) starting dialysis between 1995 and 2016. Using the pediatric-specific bedside Schwarz equation, initial eGFR was classified as less than 5 mL/min/1.73 m2 in 19% of patients, between 5 and 7 mL/min/1.73 m2 in 22%, between 7
Spironolactone does not reduce left ventricular mass (LVM) in hemodialysis patients, concludes a randomized trial in Kidney International.
The Mineralocorticoid Receptor Antagonists in End-Stage Renal Disease (MiREnDa) trial included 97 adults receiving maintenance hemodialysis: 75 men and 22 women, mean age 60 years. They were assigned to treatment with spironolactone, 50 mg once daily, or placebo. At 40 weeks, cardiac MRI was performed to assess change in LVM index. Secondary outcomes included the incidence and severity of hyperkalemia and change in residual renal function.
Change in LVM index was not significantly different between treatment groups: 2.86 with spironolactone
Hepatitis C virus (HCV)-positive patients with kidney failure may have difficulty accessing kidney transplantation—but when they do, they rapidly achieve a significant survival benefit, reports a study in the American Journal of Kidney Diseases.
The retrospective cohort study included more than 442,000 adult dialysis patients, identified from clinical data provided by a large national dialysis provider. Of these patients, 7.2% were reported as HCV-seropositive. The HCV-seropositive group were younger (median age 56 versus 64), more likely to be men (66% versus 54%), and more likely to be African American (54% versus 29%).
Compared to sunitinib, a combination of avelumab plus axitinib improves progression-free survival in patients with advanced clear-cell renal cell carcinoma (RCC), reports a phase 3 randomized trial in The New England Journal of Medicine.
The industry-sponsored JAVELIN Renal 101 trial included 886 patients with previously untreated advanced RCC with a clear-cell component—the most common type of kidney cancer. Patients assigned to the intervention group received the immunotherapy drug avelumab plus the highly selective vascular endothelial growth factor (VEGF) receptor inhibitor axitinib. Those in the comparison group received the anti-VEGF agent sunitinib, which has been a standard treatment for
Higher urinary oxalate excretion is linked to an increased risk of progressive chronic kidney disease (CKD), reports a study in JAMA Internal Medicine.
The analysis included 3123 patients with stage 2 to 4 CKD, drawn from the Chronic Renal Insufficiency Study. Twenty-four-hour urinary oxalate excretion was measured at enrollment in 2003–08. Median oxalate excretion was 18.6 mg/24 hours; this value was inversely correlated with estimated glomerular filtration rate (eGFR) and positively correlated with 24-hour proteinuria.
Progression of CKD was evaluated in 2003–08, with a total follow-up of 22,318 person-years. At follow-up, 752 patients had developed end stage renal
Kidney transplantation reduces mortality, mainly due to cardiovascular disease and infection, in patients with lupus nephritis, reports a study in Annals of Internal Medicine.
Through the United States Renal Data System, the researchers identified 20,974 individuals with kidney failure due to lupus nephritis (ESRD-LN) between 1995 and 2014. Of 9659 waitlisted patients, 5738 (59%) received a kidney transplant. Eighty-two percent of waitlisted patients were women and 60% were nonwhite.
Analyzed as a time-varying exposure, renal transplantation was associated with lower all-cause mortality among waitlisted patients: adjusted hazard ratio (HR) 0.30. There were also significant reductions in mortality due
Otherwise-healthy adolescents with hypertension are at double the risk of developing end stage renal disease (ESRD) as adults, reports a study in JAMA Internal Medicine.
The retrospective study included nearly 2.7 million healthy Israeli youth, aged 16 to 19, who underwent medical evaluation before military conscription from 1967 through 2013. Sixty percent of participants were male. The mean age was 17.4 years. The analysis excluded those with evidence of kidney damage or risk factors for kidney disease. Adolescent hypertension was evaluated for association with ESRD diagnosed from 1990 through 2014, based on national registry data.
Proactive, high-dose intravenous iron reduces mortality and major cardiovascular events in hemodialysis patients, reports a randomized trial in The New England Journal of Medicine.
The Proactive IV Iron Therapy in Dialysis Patients (PIVOTAL) trial included 2141 adults undergoing maintenance hemodialysis and receiving an erythropoiesis-stimulating agent (ESA) at 50 UK sites. One group was assigned to a proactive high-dose iron strategy: iron sucrose 400 mg IV administered monthly, unless ferritin concentration was greater than 700 µg/L or transferrin saturation was 40% or higher. The other group received a low-dose reactive iron strategy: IV iron sucrose in doses