CKD for internists

IMPORTANCE: Primary aldosteronism (PA) is a common cause of secondary hypertension and an independent risk factor for cardiovascular morbidity and mortality. Fewer than 2% to 4% of patients at risk are evaluated for PA. OBJECTIVE: To develop and evaluate an electronic health record best-practice advisory (BPA) that assists with PA screening. DESIGN, SETTING, AND PARTICIPANTS: This prospective quality improvement study was conducted at academic center outpatient clinics...

The practice of outpatient medicine is demanding, encompasses a wide scope of practice, and leaves little time for internists to stay up to date with the current literature. This article reviews 5 studies published in 2022 and 2023 that have the potential to change the practice of outpatient medicine. Topics covered include chronic kidney disease, secondary cardiovascular disease, kidney stones, obesity, and lipid management.

BACKGROUND: Atherosclerosis-related cardiovascular diseases (coronary heart diseases, ischemic stroke, and peripheral vascular diseases) account for the majority of deaths in diabetic and other high-risk patients. Statin therapy reduces major vascular events, coronary death or nonfatal myocardial infarction, coronary revascularization, and ischemic stroke. However, a gap exists between guideline recommendations and the clinical practice of primary statin preventive therapy. This was a cross-sectional study that aimed to determine the prevalence and some associated risk factors of...

PURPOSE OF REVIEW: In recent years, there has been growing attention to pediatric kidney health, especially pediatric acute kidney injury (AKI). However, there has been limited focus on the role of pediatric AKI on adult kidney health, specifically considerations for the critical care physician. RECENT FINDINGS: We summarize what is known in the field of pediatric AKI to inform adult medical care including factors throughout the early life course, including perinatal, neonatal, and pediatric exposures that impact survivor care later in adulthood...

Chronic kidney disease (CKD) affects about 10% of the world's population. Hyperkalemia is a life-threatening complication in patients with CKD, as it is associated with adverse cardiovascular and kidney outcomes. There are still many challenges and questions to address to improve the currently available therapeutic strategies to treat hyperkalemia, such as how to approach the emergency management of hyperkalemia. In recent years, in addition to novel oral potassium binders, great progress has been made in the application of novel kidney protective strategies, such as mineralocorticoid receptor antagonists and sodium-glucose cotransporter 2 inhibitors (SGLT2i) in hyperkalemia therapy...

Dwindling interest in nephrology amid a growing prevalence of kidney disease has inspired nephrologists to create educational initiatives for trainees. Engagement at all levels is crucial to fostering interest in the field, and experience for internal medicine residents has been a significant area for growth. In this article, we review the literature on available educational programs at the residency level. These interventions were largely met with high trainee satisfaction and positive feedback, particularly when designed with the goal to create superb internists rather than future nephrologists...

INTRODUCTION: Assessment of the medical fitness to serve in the armed forces has two objectives: to prevent the military operations from being jeopardized by a medical issue, and to protect soldiers from the sequelae of diseases that could become complicated in the operational field, especially in overseas operations where soldiers are exposed to a remote setting and a long evacuation time. Little is known about fitness decisions for soldiers with systemic or autoimmune diseases. Therefore, we conducted a single-center retrospective study of internal medicine fitness decisions...

Current estimates forecast that chronic kidney diseases will be the fifth most common cause of death worldwide by 2040. The prevalence of chronic renal diseases increases with age and, in many countries, affects patients with overweight, diabetes and hypertension. The primary objective of the treatment of chronic renal diseases is the delay of disease progression. Established markers for the deterioration of renal function include glomerular filtration rate and albuminuria. Pharmacological blockade of the renin-angiotensin-aldosterone system (RAAS) by angiotensin-converting enzyme inhibitors (ACE) or angiotensin receptor blockers (ARB) represents the cornerstone of drug-related nephroprotection...

BACKGROUND & OBJECTIVES: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) represents a group of rare chronic autoimmune diseases characterized by recurrent systemic inflammation provoking multiple morbidities. AAV patients suffer from various organ manifestations and treatment-related severe adverse effects. This retrospective study investigated the concrete burden of AAV disease on patients in Germany. METHODS: Based on anonymized longitudinal German statutory health insurance (SHI) claims data from the years 2011-2016, a representative cohort of approximately 3 million insured persons was used to identify patients with granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA), and selected clinical aspects were systematically assessed...

Comorbidities are frequently observed in patients suffering from pulmonary diseases due to shared risk factors and intricate interactions between various organ systems. This article aims to characterize the effects of selected diseases of the respiratory system on the cardiovascular system and kidneys. Advanced chronic obstructive pulmonary disease (COPD) often leads to a prognostically unfavorable increased pressure in the pulmonary circulation. In this respect treatment of these patients is primarily aimed at the underlying pulmonary disease and targeted treatment of the pulmonary hypertension should only be carried out according to invasive diagnostics and in an individualized manner...

Atrial fibrillation and heart failure with preserved left ventricular (LV) ejection fraction (HFpEF) are of high importance in cardiology due to the increasing number of cases. Both diseases can mutually affect each other and important cardiovascular risk factors, e.g. arterial hypertension, diabetes mellitus, obesity and chronic renal insufficiency can be observed with increasing frequency. Currently proven treatment concepts for patients with heart failure and reduced ejection fraction (HFrEF) do not appear to have a comparable prognostic or symptomatic benefit for patients with HFpEF...

Use of renin-angiotensin-aldosterone system inhibitors (RAASi) in patients with heart failure (HF) and reduced ejection fraction is associated with functional improvement, an increase in perceived quality of life, a reduction in the probability of cardiovascular death, and a decrease in the number of hospitalizations. Some of these drugs are also efficacious in patients with chronic kidney disease and albuminuria as well as in patients with resistant hypertension. Despite their numerous benefits, RAASi are associated with an increase in incidence of hyperkalemia, especially in patients with concomitant chronic kidney disease...

AIM: To study the pathogenetic and clinical features of nephrolithiasis in patients with concomitant chronic cardiovascular diseases (CVD), particularly the chemical composition of renal stones, the frequency of relapses, as well as the daily dynamics of the urine specific gravity and acidity level as the main factors of stone formation. MATERIALS AND METHODS: A total of 270 patients were treated in the Department of the urology No. 1 of the "Main Military Clinical Hospital named after N...

Introduction : Sodium-glucose cotransporter 2 inhibitors (SGLT2i) reduce blood glucose and glycosylated hemoglobin (HbA1c), the risk of hospitalization for heart failure (HF) and the incidence of serious adverse kidney function events (chronic kidney disease, CKD) in patients with type 2 diabetes mellitus (T2DM). Ertugliflozin is the last SGLT2i approved by Food and Drug Administration (FDA) in the USA and European Medical Agency (EMA) in Europe for the treatment of T2DM alone or in combination with other drugs...

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has also resulted in substantial challenges for nephrology worldwide. Patients with chronic kidney diseases are a particularly vulnerable patient group in this context and in severe courses of COVID-19 the kidneys are most frequently affected by organ failure after the lungs. MATERIAL AND METHODS: In order to reliably evaluate the prevalence and mortality of dialysis patients in Germany with respect to COVID-19, during the first wave in spring 2020 the German Society of Nephrology implemented a registry for dialysis patients...

In the last decade, direct oral anticoagulants (DOACs) have entered the clinical practice of different specialists for the prevention of cardioembolic stroke in patients with non-valvular atrial fibrillation (NVAF) and the prevention and treatment of venous thromboembolism (VTE). Owing to the persistent uncertainties about the use of DOACs in daily clinical scenarios not fully explored in the clinical trials, we conducted a national Delphi consensus regarding issues deemed interesting by the Italian Atherosclerosis, Thrombosis and Vascular Biology (ATBV) Study Group in relation to: (i) elderly and/or frail patients; (ii) chronic kidney disease; (iii) drug-drug interactions; (iv) lower doses and safety; (v) criteria for choosing individual drugs and compliance; (vi) VTE in the cancer patient...

Exceeding the need for care in general practitioner (GP) practices is a known problem that affects the work of approximately 16,000 specialists for internal medicine in the family practice context every day in Germany. In order to spare patients unnecessary treatment and measures, these must be critically questioned on a regular basis. Subclinical hypothyroidism (SH) and hyperuricemia (HU) are frequent laboratory constellations. The selected articles by Stott et al., de Montmollin et al. and Mooijaart et al...

BACKGROUND AND OBJECTIVE: Diuretics are key elements of the pharmacotherapy of diseases in internal medicine. Currently, they are particularly used in the treatment of edema and hypertension. For the treatment with diuretics some rules exist that help to improve the effectiveness and success. The article explains these rules, especially regarding combination treatment and meaningful dose escalation. Additionally, the side effects of treatment are critically discussed. RESULTS AND CONCLUSION: There is little evidence for the influence of diuretics in the treatment of edema on prognostic factors, such as mortality and comorbidities...

BACKGROUND: The majority of patients with non-dialysis chronic kidney disease are cared for by general practitioners. Especially for Germany, the evidence of this topic is still very low. The aim of the survey was to estimate the perceived frequency of non-dialysis chronic kidney disease in general practice, the use of diagnostics and therapy, used tools considering the professional background and experience of the responding general practitioners. METHODS: A questionnaire was self-designed in the cooperation of several disciplines...

Anticoagulation-related nephropathy (ARN) is a clinical entity that has significant morbidity and mortality consequences/burden but has not been well described. Consequently, ARN has been underdiagnosed and sub-optimally managed. ARN has been reported with warfarin use especially in the setting of supratherapeutic international normalized ratio (INR) but the association is far less established with the use of direct-acting oral anticoagulants (DOAC). Accelerated progression to CKD and ultimately ESRD has been reported in patients with ARN...