Clinical Care

A Taiwanese study of 326 patients with CKD stages 3–5 found an association between fluid retention and anemia severity with adverse cardiovascular and renal outcomes. Patients were divided into 3 groups: those with no anemia (105), true anemia (82), and anemia with excess hydration (139). Results of the JAHA study showed a negative correlation between fluid status and hemoglobin concentrations at baseline.

New research reveals many older diabetics with compromised health who maintain intensive treatment regimens with tight glycemic control and diabetes medications may have a higher risk of hypoglycemia and other adverse effects. The JAMA Internal Medicine study analyzed NHANES data (2001 through 2010) from 1288 patients ≥65 years who were divided into 3 categories: relatively healthy, those with complex medical histories, and those with significant additional illnesses.

Maternal pregestational diabetes was associated with congenital anomalies of the kidney and urinary tract (CAKUT) in offspring whereas gestational diabetes was not, according to new research. Maternal pregestational diabetes was present in 4.1% of 945 infants with CAKUT and 2.3% of 4725 matched controls. Both large and small for gestational age infants were also associated with CAKUT.

An analysis of Medicaid claims from 47 US states and Washington, DC, filed between 2000 and 2006 uncovered 42,221 lupus patients, with 8191 having lupus nephritis. The racial/ethnic breakdown of patients with lupus or lupus nephritis was 40% black, 38% white, 15% Hispanic, 5% Asian, and 2% Native American. According to the Arthritis & Rheumatology study, the annual mortality rate for lupus patients per 1000 person-years was highest in Native Americans (27.52), blacks (24.13), and whites (20.17).

Researchers have found that the “behavioral stage of change” model, originally used to help people quit smoking, can help patients with CKD take action and make decisions about their dialysis options. Surveys of 55 patients with CKD revealed that those who had knowledge about their options and had fewer lifestyle barriers to home dialysis were more likely to be ready to make decisions. The findings are published in CJASN.

New guidelines from the Endocrine Society recommend first managing obesity with lifestyle changes and medications, then managing any remaining comorbidities such as dyslipidemia, hypertension, and impaired glucose tolerance. People with diabetes who are obese or overweight should receive medications that promote weight loss or have no effect on weight as first- and second-line treatments. Diet, exercise, and behavioral modifications should be part of all obesity management approaches.

A study of US dialysis patients found that more frequent face-to-face visits with physicians and advanced practitioners were linked with a 13% greater likelihood of undergoing more procedures and therapeutic interventions aimed at preserving vascular accesses, but were not associated with prolonged vascular access survival. One additional provider visit was associated with a 9% lower likelihood of hospitalization for vascular access infection and a 9% higher likelihood of outpatient intravenous antibiotic administration.

In patients undergoing coronary angiography or percutaneous coronary intervention (which use dyes to help surgeons visualize the arteries), a high dose of atorvastatin was linked with a reduction in serum creatinine and a lower incidence of AKI compared with a low dose of the statin.

Adults ≥65 years of age who develop pneumonia that requires hospitalization are at increased risk of cardiovascular disease events (heart attack, stroke, or fatal coronary heart disease), according to a new study. The risk was highest (fourfold) in the first 30 days after pneumonia, and although it progressively declined during the first year, it remained approximately 1.5-fold higher in subsequent years. The association persisted after adjusting for demographics, the burden of cardiovascular risk factors, and frailty measures.

New research suggests there were modest improvements in blood cholesterol levels and stable blood pressure levels among US children between 1999 and 2012. In 2011–2012, approximately 1 in 5 children and adolescents had an adverse lipid profile, and slightly more than 1 in 10 had either borderline high or high blood pressure.

Among 129,076 patients on hemodialysis or peritoneal dialysis who were treated between 2001 and 2006, uncorrected serum calcium levels <8.5 or ≥10.2 mg/dL were linked with an increased risk of premature death, regardless of dialysis modality. Albumin-corrected calcium ≥10.2 mg/dL and serum phosphorus ≥6.4 mg/dL were also associated with increased risk of premature death in the JASN study.

New Canadian guidelines recommend that primary care physicians measure patients’ BMI at every visit. The guidelines also suggest that overweight and obese adults, especially those at high risk of diabetes, be referred to structured behavioral interventions for weight loss; however, medications should not routinely be offered to help people lose weight.

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