2 Minute Medicine ® - Nephrology

1. In this randomized controlled trial, in patients undergoing cardiopulmonary bypass, continuous intravenous (IV) administration of amino acids was found to be associated with lower rates of acute kidney injury (AKI). 2. There was no significant difference in adverse outcomes in the IV amino acid group as compared to the placebo control group.  Evidence Rating Level: 1 (Excellent) Study Rundown: AKI is a common complication of cardiac surgery, often resulting from reduced renal blood flow. While it is associated with long-term morbidity and kidney dysfunction, there is currently no standardized protocol to prevent the occurrence of AKI in cardiac surgery patients...

1. In this retrospective cohort study, among patients with type 2 diabetes (T2D) and stage five chronic kidney disease (CKD), the use of a sodium-glucose cotransporter-2 inhibitor (SGLT2i) was associated with a lower risk of dialysis, cardiovascular events, diabetic ketoacidosis (DKA), and acute kidney injury (AKI). 2. SGLT2i use was not associated with a difference in all-cause mortality. Evidence Rating Level: 2 (Good) Study Rundown: The incidence and prevalence of CKD have increased steadily worldwide, resulting in significant morbidity and mortality...

1. In this prospective cohort study involving patients with chronic kidney disease (CKD), those with urine albumin levels on the higher side of normal had a greater risk of disease progression compared to those with lower urine albumin. 2. Patients with higher albuminuria also had a greater incidence of overt kidney failure compared to their lower albuminuria counterparts. Evidence Rating Level: 2 (Good) Study Rundown: It is well-established in the literature that excessive albumin secretion into the urine is closely linked to heightened risks for kidney failure...

1. In this randomized controlled trial, algorithmic identification based on electronic health records (EHRs) and practice facilitators did not reduce hospitalization rates among patients with chronic kidney disease (CKD). 2. Among patients with an unknown ASCVD risk score, those deemed statin-eligible by the model were nearly twice as likely to have incident MACE. Evidence Rating Level: 1 (Excellent) Study Rundown: CKD, type 2 diabetes, and hypertension (kidney-dysfunction triad [KDT]) are chronic common comorbidities that carry a significant risk of major adverse cardiovascular events, kidney failure, and death...

1. In patients undergoing peritoneal dialysis, osteoporosis is highly prevalent but does not correlate to 25-vitamin D levels. Evidence Rating Level: 3 (Average)  One complication in patients with chronic kidney disease (CKD is increased bone turnover and decreased bone density. Bone mineral density (BMD) indicates bone mass and mineralization. It is determined using a Dual-Energy X-ray Absorptiometry (DEXA) scan at both the posteroanterior lumber spine (L1-L4) and the hip (femoral neck or total proximal femur)...

1. In this randomized controlled trial, among hospitalized adults with a complicated urinary tract infection (UTI), cefepime-taniborbactam was superior to meropenem in achieving microbiologic and clinical resolution. 2. Cefepime-taniborbactam had a similar safety profile to meropenem with comparable rates of serious adverse events. Evidence Rating Level: 1 (Excellent) Study Rundown: Complicated UTI, including acute pyelonephritis, accounts for a high number of hospitalizations. Emerging bacterial resistance to b-lactam antibiotics poses a challenge in treating these serious infections...

1. In this cohort study, estimated glomerular filtration rate based on both creatinine and cystatin C (eGFRcr-cys   ) was more strongly associated with cardiovascular events than estimates based on creatinine alone (eGFRcr). 2. Nearly one-third of individuals were reclassified into a different severity category after recalculation. Evidence Rating Level: 2 (Good) Study Rundown: GFR is used to define chronic kidney disease (CKD) and is typically estimated using serum creatinine. However, loss of muscle mass in old age can depress circulating creatinine levels, creating the illusion of better renal function...

1. When comparing cohorts of patients above and below 75 years of age, hypertension had a greater association with mortality, cardio-kidney composite events, and overt dementia in patients aged 45-74 years. Evidence Rating Level: 2 (Good) Blood pressure (BP) gets increasingly higher as people begin aging. Not only does hypertension increase, but other risk factors for high BP such as diabetes also have higher prevalence in older individuals. High BP is typically treated with antihypertensives; however, it is important to establish the point where this intervention is needed...

1. This large cohort study found that in the general population, a higher self-reported frequency of adding salt to foods was significantly associated with increased chronic kidney disease (CKD) risk. Evidence Rating Level : 2 (Good) Sodium intake is essential for various physiological functions, but high consumption has been associated with hypertension and CKD. Self-reported frequency of adding salt to foods is associated with an increased risk of cardiovascular diseases, premature mortality, and type 2 diabetes, but there are no studies investigating its relation with CKD...

1. Recurrence-free survival was significantly different between the adjuvant everolimus and placebo groups. 2. Grade 3 or higher adverse events were more frequent in the everolimus group with oral mucositis being the most reported within this treatment arm. Evidence Rating Level : 1 (Excellent) Study Rundown: Patients with renal cell carcinoma face a high risk of disease relapse after surgery. Until now, tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors have been used as systemic therapy following surgery of other solid tumours...

1. In this randomized controlled trial, prophylactic antibiotics resulted in significantly lower rates of first-occurrence urinary tract infections (UTIs) in infants with vesicoureteral reflux.  2. The groups did not differ in kidney scarring, kidney filtration function, or hospitalization rates due to UTI. Evidence Rating Level: 1 (Excellent) Study Rundown: Infants with vesicoureteral reflux are at an elevated risk of developing UTIs. This increases their cumulative risk of adverse events such as kidney scarring and reduced filtration function...

1. Reduction in time-weighted glomerular filtration rate (GFR) decline was significantly greater in Nefecon versus placebo. 2. Majority of adverse events were mild-to-moderate in nature with no treatment-related deaths. Evidence Rating Level: 1 (Excellent) Study Rundown : IgA nephropathy is a chronic immune-mediated kidney disease with marked proteinuria. Nefecon, a novel, targeted-release form of budesonide, is designed to inhibit galactose-deficient IgA1 (gd-IgA1) within the gastrointestinal tract, although little is currently known...

1. A secondary  analysis of a randomized clinical trial found that when correcting for fluid balance, AKI was more commonly diagnosed in extremely premature neonates.  2. A diagnosis of fluid-corrected AKI resulted in a significantly higher risk of requiring mechanical ventilation, longer hospital stay, and bronchopulmonary dysplasia (BPD). Evidence Rating Level: 1 (Excellent) Acute kidney injury (AKI) is a common condition in premature neonates, particularly those of extremely low gestational age. The potential complications of AKI do not exist solely in the short term; AKI in neonates also increases the risk of future chronic kidney disease...

1. For patients newly initiated on lithium or valproate, the absolute risks of chronic kidney disease (CKD) progression or acute kidney injury (AKI) were low and similar. 2. Higher cumulative exposure to lithium was associated with greater risk of CKD progression compared to valproate. 3. Higher median lithium levels were associated with increased risk of AKI in a dose-response relationship. EvidEnce Rating Level: 2 (Good) Study Rundown:  Lithium is used in the treatment of bipolar disorder, but has always been associated with concerns of nephrotoxicity, although the pathophysiology is not well understood...

1. In this prospective cohort study, there was a limited association between acute kidney injury (AKI) and worsening kidney function in patients with chronic kidney disease (CKD). 2. There was no significant decrease in estimated glomerular filtration rate (eGFR) after a mild to moderate AKI in patients with CKD.  Evidence Rating Level: 1 (Excellent) Study Rundown: AKI is typically considered a significant risk factor for the progression of loss of kidney function. However, in prior studies that examined this association, there were many methodological limitations...

1. For patients with IgA nephropathy (IgAN), long-term use of hydroxychloroquine demonstrated antiproteinuric effects compared to corticosteroids at 24 months.  Evidence Rating Level : 3 (Average) IgAN is the most common form of primary glomerulonephritis, occurring in 1 in 100 people worldwide, and can lead to end-stage renal disease. No specific treatment currently exists for IgAN, but corticosteroids (CS) are widely used as supportive treatment to maintain renal function in patients, despite their significant side effects...

1. Patients in sparsentan group reported a 50% reduction in proteinuria compared to 15% in the irbesartan group at week 36. 2. Complete remission of proteinuria was significantly higher in the sparsentan group. Evidence Rating Level: 1 (Excellent) Study Rundown: IgA nephropathy is the most common cause of primary glomerulonephritis worldwide. Although renin-angiotensin blockers (ARBs), such as irbesartan, have been primarily used for treatment, some patients continue to have persistent proteinuria. Sparsentan, a novel single-molecule, angiotensin II receptor antagonist, may have improved efficacy in patients with refractory proteinuria although existing trials suggest mixed results...

1. Intradialytic exercise for a minimum of 60 minutes during thrice weekly dialysis sessions improved survival rates in adult patients who are receiving hemodialysis (HD). Evidence Rating Level :1 (Excellent) Chronic kidney disease is becoming increasingly prevalent worldwide, leading to an exponential increase in the number of individuals experiencing kidney failure requiring kidney-replacement therapy (KRT), which is primarily achieved through hemodialysis. Patients undergoing HD experience high rates of morbidity, and a mortality rate 10-30 times higher than those with normal kidney function...

1. In this target emulation trial, parathyroidectomy did not affect long-term renal function in adults with primary hyperparathyroidism (PHPT). 2. Patients with parathyroidectomy had no difference in the estimated glomerular filtration rate (eGFR) decline compared to those without parathyroidectomy. Evidence Rating Level: 1 (Excellent) Study Rundown: The definitive treatment for PHPT is parathyroidectomy to remove one or more abnormal parathyroid glands. However, observation for disease progression is an alternative that can be considered in patients without apparent end-organ damage related to PHPT...

1. In vascular access intervention therapy (VAIVT) for hemodialysis patients, patient factors for vessel rupture include lower BMI, fewer prior VAIVT procedures, and shorter access vintage. 2. Hemodynamic risk factors for vessel rupture found on ultrasound imaging include lower blood flow quantity, higher resistance index, and lower brachial artery flow volume. Evidence Rating Level: 2 (Good) Vascular access for hemodialysis patients, including arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs), can have high failure rates due to thrombosis or stenosis, with 1-year patency rates of 86% and 51% for AVF and AVG respectively...