For dialysis patients with nonvalvular atrial fibrillation (AF), anti-coagulation with apixaban—at both standard and below-label doses—lowers the risk of bleeding events compared with warfarin, concludes a study in the American Journal of Kidney Diseases.
Using US Renal Data System data from 2013 to 2018, the researchers identified 17,156 Medicare beneficiaries with nonvalvular AF receiving maintenance hemodialysis. All patients (12,517) had a new prescription for warfarin, and 2382 patients had apixaban at a label-concordant dose of 5 mg twice daily, or 2257 patients had apixaban at a lower dose of 2.5 mg twice daily. Outcomes, including stroke or systemic
An analysis of a large cohort of patients with autosomal-dominant polycystic kidney disease (ADPKD) adds new knowledge about risk factors for intracranial aneurysm (IA), including an increase in IA risk for women after menopause, according to a pre-proof paper in Nephrology Dialysis Transplantation.
The cross-sectional, population-based study included 2449 patients with ADPKD (median age, 55 years) from 26 nephrology centers in western France. On genetic analysis in 2386 patients, 67.6% had PKD1 pathogenic variants, and 19.0% had PKD2 pathogenic variants. The researchers analyzed the frequency of diagnosis of ruptured and unruptured IA, along with
The four-variable kidney failure risk equation (KFRE) is a better predictor of end stage kidney disease (ESKD) risk compared with the estimated glomerular filtration rate (eGFR) alone, with or without adjustment for race, reports a study in the Annals of Internal Medicine.
The researchers used data from the Chronic Renal Insufficiency Cohort to evaluate different eGFR equations for prediction of ESKD, defined as dialysis initiation or transplantation. The analysis included data on 3873 participants with chronic kidney disease (CKD), with a total of 13,902 2-year risk periods.
For each participant, eGFR was calculated using the CKD Epidemiology Collaboration
Solid-organ transplant recipients can maintain peripheral immunity for up to 6 months after SARS-CoV-2 infection—especially with greater clinical severity—reports a pre-proof paper in Kidney International.
The researchers evaluated serologic and functional T-cell and B-cell immune memory against major immunogenic SARS-CoV-2 antigens. The cross-sectional study included two groups of COVID-19 convalescent patients: 53 solid-organ transplant recipients (38 kidney recipients) and 49 immunocompetent patients.
In both groups, patients were classified as having severe COVID-19, requiring hospitalization and supplemental oxygen; mild COVID-19, not requiring hospitalization; or asymptomatic infection. Immunologic assessments included SARS-CoV-2-specific serologic memory and immunoglobulin G (IgG)-producing memory B cells
For patients with chronic kidney disease (CKD), discontinuing renin-angiotensin-aldosterone system inhibitors (RAASi) during episodes of hyperkalemia is associated with increased mortality and cardiovascular events, reports a pre-proof paper in the American Journal of Kidney Diseases.
The retrospective study included data on adult CKD patients with new episodes of RAASi-related hyperkalemia with a serum potassium level 5.5 mM or higher. Drawn from Canadian provincial databases, the analysis included 7200 patients in Manitoba and 71,290 patients in Ontario. The mean ages were 72.39 and 79.48 years, respectively. Several types of comorbidity were more frequent in the Manitoba cohort.
Renal cell and non-renal cell carcinomas associated with von Hippel−Lindau (VHL) disease show evidence of response to the hypoxia-inducible factor inhibitor belzutifan, reports a study in The New England Journal of Medicine.
The phase 2, open-label trial included 61 adults with VHL disease, with diagnosis based on the presence of germ- line VHL alterations and at least one renal cell carcinoma measuring at least 10 mm. All patients were treated with belzutifan, a novel oral hypoxia-inducible factor 2α (HIF-2α) inhibitor, at a dose of 120 mg/day. Complete or partial objective responses were assessed by an independent radiology review
A nationwide data analysis confirms that SARS-CoV-2 antibody responses to vaccination decrease rapidly in dialysis patients, leaving them at risk of breakthrough infection, reports Annals of Internal Medicine.
The researchers analyzed real-world data on 4791 patients receiving care in a large US network of dialysis facilities. Residual plasma from routine monthly tests performed at a central laboratory was used to measure qualitative and quantitative antibodies to the SARS-CoV-2 receptor-binding domain (RBD). The analysis began in January 2021, before COVID-19 vaccines were widely available. By mid-September 2021, 2563 patients were fully vaccinated.
Trends in antibody levels were assessed, including the
Even after decades of follow-up, kidneys transplanted after circulatory determination of death (DCD) show similar outcomes to kidneys donated after brain death (DBD), reports a study in Nephrology Dialysis Transplantation.
Of 1133 kidney transplants performed between 1985 and 2000 at the authors’ Swiss medical center, 122 used DCD grafts. The DCD kidney recipients—74 men and 48 women, median age 46 years—were matched one to one for sex, age, and transplant year to patients receiving DBD grafts during the same period. Outcomes were assessed through 2020.
At 35 years’ follow-up, median graft survival was almost identical between groups: 24.5
For older adults with type 2 diabetes, treatment with a sodium glucose cotransporter-2 inhibitor (SGLT2i) is associated with a lower risk of acute kidney injury (AKI), compared with other antidiabetic medications, according to a pre-proof paper in the American Journal of Kidney Diseases.
The population-based cohort study used Medicare fee-for-service data on more than 417,000 patients, aged 66 years or older, with type 2 diabetes. All enrolled patients had a newly filled prescription for an SGLT2i, a dipeptidyl peptidase 4 inhibitor (DPP-4i), or a glucagon-like peptide-1 receptor agonist (GLP-1RA) from 2013 through 2017. New SGLT2i users were propensity
In older adults requiring intensification of antihypertensive therapy, adding a new medication leads to a greater reduction in blood pressure (BP), but maximizing dosage provides a more sustainable effect, reports a study in Annals of Internal Medicine.
The observational study included 178,562 patients requiring intensified antihypertensive treatment in the Veterans Health Administration (VA) system between 2011 and 2013. All patients were aged 65 years or older, had systolic BP (SBP) of 130 mm Hg or higher, and were taking one or more antihypertensive medications at less than maximum dose. Mean age was 75.8 years, and 98.1% of patients