Clinical Care

A new study suggests patients with CKD may be at higher risk of developing kidney failure when they eat diets with high levels of acid. Researchers analyzed information from 1486 patients with CKD participating in the National Health and Nutrition Examination Survey III and followed them over a median of 14.2 years. Patients who consumed high-acid diets were 3 times more likely to develop kidney failure than patients who consumed low-acid diets.

Among 635 kidney transplant recipients with ≥6 months of follow-up, urologic complications occurred in 29 cases (4.6%) at a median of 40 days post-transplantation. These included ureteral strictures (2.6%), ureteral obstructions due to donor-derived stones or intraluminal thrombus (0.8%), and urine leaks (1.1%). On multivariate analysis, donor renal artery multiplicity was linked with a 2.4-times increased risk for urologic complications.

In a prospective analysis of 197 African American and 197 Japanese individuals with nondiabetic CKD matched by age and kidney function, higher sleep-trough morning blood pressure (BP) surge was independently associated with a nearly twofold increased risk of cardiovascular events in Japanese participants, but no increased risk was observed in African American patients. Nocturnal BP dipping was not associated with cardiovascular events in either racial group.

In an observational study of 263 patients in a single hemodialysis center, 75% had poor periodontal status and 23% had severe periodontal disease. Patients with periodontal disease were older, and higher percentages of them smoked, had diabetes, and had malnutrition and inflammation. Patients with severe periodontal disease had higher hemodialysis vintage, lower hemoglobin, and required higher darbepoetin doses than those with healthy periodontium.

In a study of 22,001 hospitalized adults, the 30-, 60-, and 90-day hospitalization rates were 15%, 20%, and 23%, respectively, for patients who experienced acute kidney injury (AKI) during the index hospitalization compared to 11%, 15%, and 18% for non-AKI patients, respectively. In adjusted analyses, the AKI patients had a 21%, 15%, and 13% increased likelihood of readmission within 30, 60, and 90 days, respectively, compared to non-AKI patients.

Hyponatremia was an independent predictor of mortality in a prospective observational study of 441 patients who started peritoneal dialysis between 2000 and 2005. All-cause death occurred in 81 (55.9%) patients in the lowest tertile with respect to serum sodium levels compared to 37 (25.0%) and 31 (20.9%) patients in the middle and highest tertiles, respectively.

In a study of Swedish men who had a physical examination in the early 1970s (when the majority of them were 18 and 19 years old), the presence of proteinuria in adolescence was associated with a sevenfold increased risk of developing ESRD. Low-grade inflammation found by testing for the erythrocyte sedimentation rate in blood indicated a twofold increase in kidney failure risk. Hypertension quadrupled the risk of developing ESRD, while a BMI ≥30 kg/m2 increased the ESRD risk by 3.5 times.

In a study of 500 young adults (aged 18 to 39 years) with incident hypertension, only 55% had received tips on how to lower their blood pressure within 1 year of being diagnosed. Exercise was the most frequent topic addressed (64%), followed by smoking cessation. Only 25% of counseled patients received advice on how they can lower their blood pressure by changing their diets. Lifestyle education was more likely given to women and to patients who made regular visits to the doctor to manage chronic conditions.

A multidrug, multitarget regimen is superior to intravenous cyclophosphamide as induction therapy for lupus nephritis, according to a 24-week randomized, controlled trial published in the Annals of Internal Medicine. Patients receiving the multitarget regimen (which included mycophenolate mofetil and tacrolimus each 2 times per day) had greater changes in urine protein and serum albumin.

Among 3604 patients with CKD, lower urinary creatinine excretion was linked with an increased risk of premature death or developing ESRD over a median follow-up time of 4.2 years that was independent of fat-free mass, as assessed by bioelectrical impedance analyses. The CJASN findings suggest that muscle mass may not be an accurate predictor of CKD progression.

Patients treated with peritoneal dialysis were 10% less likely to die during a 6-year study than patients treated with 3-times per week in-center hemodialysis. Patients receiving home hemodialysis 6 times per week were 26% less likely to die than those receiving standard in-center hemodialysis. Patients receiving less frequent home hemodialysis (4 or 5 times per week) had mortality risks that were similar to those of patients receiving in-center hemodialysis. Patients receiving home hemodialysis 3 times per week were 47% more likely to die than patients receiving in-center hemodialysis.

In an analysis of 19 sodium-reduced meat and poultry products from the main grocery store chains in Canada, the sodium-reduced products contained 25% to 55% less sodium than their non-sodium-reduced counterparts, but the potassium content of sodium-reduced products ranged from 210 to 1500 mg/100 g and was significantly higher than non-sodium-reduced products by 195 mg/100 g. Potassium-containing additives were found on the ingredient list in 63% of the sodium-reduced products and 25% of the non-sodium-reduced products.

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