Clinical Care

Among women with a functioning kidney transplant in the Australia and New Zealand dialysis and transplant registry who were pregnant between 1963 and 2012, live births resulted from 76% of pregnancies in women who received transplants as children and 77% of pregnancies in women who received transplants as adults. The incidence of premature babies was similar (45% vs. 53%), as was the proportion of preterm babies who were small for gestational age (22% vs.10%). Term babies were frequently small for gestational age compared with term babies in the general population (57% vs.

In a study of 2744 hypertensive patients with CKD who were not on dialysis and followed for a median of 1.9 years, use of an angiotensin II receptor blocker was linked with a 47% decreased risk of experiencing upper gastrointestinal bleeding, after adjustments. A history of upper gastrointestinal bleeding, Helicobacter pylori infection, diabetes, lower eGFR, elevated blood urea nitrogen, and decreased serum albumin were independently associated with an increased risk of upper gastrointestinal bleeding.

Approximately 9% of Americans ≥18 years of age have diagnosed diabetes, but the CDC reports 19% of adults aged 18–39 had no contact with a doctor or health care professional in the past 6 months. This figure is lower for older adults aged 40–64 years (11%) and ≥65 years (7%). Adult diabetics <40 years of age were less likely than older patients to have had their blood pressure or cholesterol checked in the previous year (81% vs. 89% among patients aged 40–64 years and 93% among patients aged ≥65 years).

Investigators who examined 1074 US infant and toddler foods and drinks found that all but 2 of the 657 infant vegetables, dinners, fruits, dry cereals, and ready-to-serve mixed grains and fruits were low sodium. The majority of these foods did not contain added sugars; however, 35 of 79 infant mixed grains and fruits contained >35% calories from sugar. Seventy-two percent of 72 toddler dinners were high in sodium content.

A new study compared the Pediatric RIFLE (pRIFLE), AKI Network (AKIN), and Kidney Disease Improving Global Outcomes (KDIGO) criteria for defining AKI in children. Researchers examined electronic medical records of 14,795 hospitalizations at a children’s hospital and found AKI incidences according to pRIFLE, AKIN, and KDIGO were 51.1%, 37.3%, and 40.3%. AKI by any definition was associated with greater mortality and length of stay in the ICU and greater length of stay outside the ICU.

Among 8052 patients with the large artery atherosclerotic subtype of acute ischemic stroke, patients had a 10%, 60%, and 60% increased risk of worse functional outcomes within 6 months of a stroke when their initial eGFR was 30–59, 15–29, and <15 mL/min/1.73 m2, respectively, compared with those with an eGFR of 60–119 mL/min/1.73 m2. Kidney function and stroke severity had a synergistic association with 6-month mortality in the Atherosclerosis study.

Among 482,510 patients in Medicare’s ESRD program who received in-center hemodialysis, cancer was diagnosed in 37,128 within 5 years of dialysis initiation. The 5-year cumulative incidence of any cancer was 9.48% and was higher for older individuals, males, nonwhites, non-Hispanics, those undergoing recent dialysis therapy initiation, patients with a history of transplantation evaluation, and those for whom nondiabetes was a primary ESRD cause.

A new study found that women whose mothers smoked while pregnant were 2- to 3-times more likely to be diabetic as adults. Fathers who smoked while their daughter was in utero also contributed to an increased diabetes risk for their child, but more research is needed to establish the extent of that risk.

Among 3,587,879 US patients seeking emergency care for upper urinary tract stones between 2006 and 2009, those with inflammatory bowel disease (IBD; 14,352 patients) were significantly more likely than non-IBD patients to present with infections (10.4% vs. 9.1%), sepsis (0.6% vs. 0.2%), and end-stage organ failure (6.3% vs. 1.6% [5.3% vs. 1.2% for kidney failure]). In adjusted analyses, IBD patients had a 30% increased risk of pyelonephritis/cystitis, an 80% increased risk of sepsis, and a 3.3-fold increased risk of hospital admission compared with non-IBD patients.

In a study of 2148 children who were 3 to 18 years old in 1980 and were followed until 2007 (when they were 30 to 45 years old), children in the lowest quarter for vitamin D levels (<40 nmol/L) had a 70% increased likelihood of having high-risk thickening of the carotid artery as adults, after adjusting for age, sex, and childhood risk factors. They had an 80% increased risk after further adjustments for adult risk factors, including adult vitamin D levels.

In a study of 1706 people >60 years of age who did not have diabetes or CKD, stroke risk was 70% higher for those with systolic pressure in the 140–149 mm Hg range compared with those whose readings were <140 mm Hg, after adjustments. Women with a systolic pressure of 140–149 mm Hg faced nearly double the risk of a first stroke. Stroke risk was 80% higher for participants with readings ≥150 mm Hg compared with those whose pressure was <140 mm Hg.

Among 168 ischemic stroke patients, almost half were dehydrated upon hospital admittance. Researchers gathered baseline lab measurements and MRI scans on these patients between July 2013 and April 2014, and hydration levels were evaluated based on BUN/creatinine ratio and urine specific gravity. It was noted that dehydrated stroke patients had a greater risk of their condition worsening compared with more hydrated stroke patients.