Soma Sanyal, Peter Marckmann, Susanne Scherer, Jerrold L Abraham
BACKGROUND: Nephrogenic systemic fibrosis (NSF) is a systemic disorder of patients with severe renal insufficiency who have received gadolinium (Gd)-based magnetic resonance contrast agents (GBCAs). The causative association with Gd exposure was strengthened by the demonstration of Gd in various tissues of NSF patients, predominantly at the bulk chemical level. The distribution of Gd at the histologic level of organs other than skin has not been reported previously. METHODS: We analysed tissues from an autopsy case with verified advanced NSF by light microscopy and scanning electron microscopy/energy-dispersive X-ray spectroscopy...
November 2011: Nephrology, Dialysis, Transplantation
Matthew R Weir, George L Bakris, David A Bushinsky, Martha R Mayo, Dahlia Garza, Yuri Stasiv, Janet Wittes, Heidi Christ-Schmidt, Lance Berman, Bertram Pitt
BACKGROUND: Hyperkalemia increases the risk of death and limits the use of inhibitors of the renin-angiotensin-aldosterone system (RAAS) in high-risk patients. We assessed the safety and efficacy of patiromer, a nonabsorbed potassium binder, in a multicenter, prospective trial. METHODS: Patients with chronic kidney disease who were receiving RAAS inhibitors and who had serum potassium levels of 5.1 to less than 6.5 mmol per liter received patiromer (at an initial dose of 4...
January 15, 2015: New England Journal of Medicine
Navdeep Tangri, Dana C Miskulin, Jing Zhou, Karen Bandeen-Roche, Wieneke M Michels, Patti L Ephraim, Aidan McDermott, Deidra C Crews, Julia J Scialla, Stephen M Sozio, Tariq Shafi, Bernard G Jaar, Klemens Meyer, L Ebony Boulware
BACKGROUND: Intravenous iron use in hemodialysis patients has greatly increased over the last decade, despite limited studies on the safety of iron. METHODS: We studied the association of receipt of intravenous iron with hospitalizations in an incident cohort of hemodialysis patients. We examined 9544 patients from Dialysis Clinic, Inc. (DCI). We ascertained intravenous iron use from DCI electronic medical record and USRDS data files, and hospitalizations through Medicare claims...
April 2015: Nephrology, Dialysis, Transplantation
Amir Qaseem, Robert H Hopkins, Donna E Sweet, Melissa Starkey, Paul Shekelle
DESCRIPTION: The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on the screening, monitoring, and treatment of adults with stage 1 to 3 chronic kidney disease. METHODS: This guideline is based on a systematic evidence review evaluating the published literature on this topic from 1985 through November 2011 that was identified by using MEDLINE and the Cochrane Database of Systematic Reviews...
December 17, 2013: Annals of Internal Medicine
Alice Sabatino, Giuseppe Regolisti, Irene Brusasco, Aderville Cabassi, Santo Morabito, Enrico Fiaccadori
Recent studies have highlighted the close relationship between the kidney and the gastrointestinal (GI) tract--frequently referred to as the kidney--gut axis--in patients with chronic kidney disease (CKD). In this regard, two important pathophysiological concepts have evolved: (i) production and accumulation of toxic end-products derived from increased bacterial fermentation of protein and other nitrogen-containing substances in the GI tract, (ii) translocation of endotoxins and live bacteria from gut lumen into the bloodstream, due to damage of the intestinal epithelial barrier and quantitative/qualitative alterations of the intestinal microbiota associated with the uraemic milieu...
June 2015: Nephrology, Dialysis, Transplantation
Martin R Pollak
Focal segmental glomerulosclerosis (FSGS) and nephrotic syndrome can be caused by rare highly penetrant mutations in number of genes. FSGS can follow both recessive and dominant inheritance patterns. In general, recessive forms present early, whereas the autosomal dominant forms present in adolescence or adulthood. Many of the genes found to be mutated in FSGS and nephrotic syndrome patients encode proteins essential for normal podocyte structure and/or function. An exception appears to be APOL1, which harbors common variants responsible for the high rate of FSGS and other nephropathies in people of recent African ancestry...
September 2014: Advances in Chronic Kidney Disease
Keng-Thye Woo, Marjorie Foo, Hui-Lin Choong, Han-Kim Tan, Kok-Seng Wong, Choong-Meng Chan
No abstract text is available yet for this article.
September 2014: Kidney International
Laetitia Dou, Marion Sallée, Claire Cerini, Stéphane Poitevin, Bertrand Gondouin, Noemie Jourde-Chiche, Karim Fallague, Philippe Brunet, Raymond Calaf, Bertrand Dussol, Bernard Mallet, Françoise Dignat-George, Stephane Burtey
In CKD, uremic solutes may induce endothelial dysfunction, inflammation, and oxidative stress, leading to increased cardiovascular risk. We investigated whether the uremic solute indole-3 acetic acid (IAA) predicts clinical outcomes in patients with CKD and has prooxidant and proinflammatory effects. We studied 120 patients with CKD. During the median study period of 966 days, 29 patients died and 35 experienced a major cardiovascular event. Kaplan-Meier analysis revealed that mortality and cardiovascular events were significantly higher in the higher IAA group (IAA>3...
April 2015: Journal of the American Society of Nephrology: JASN
Rafia S Al-Lamki, Tanya N Mayadas
Tumor necrosis factor (TNF), initially reported to induce tumor cell apoptosis and cachexia, is now considered a central mediator of a broad range of biological activities from cell proliferation, cell death and differentiation to induction of inflammation and immune modulation. TNF exerts its biological responses via interaction with two cell surface receptors: TNFR1 and TNFR2. (TNFRs). These receptors trigger shared and distinct signaling pathways upon TNF binding, which in turn result in cellular outputs that may promote tissue injury on one hand but may also induce protective, beneficial responses...
February 2015: Kidney International
Yajuan Yang, Tong Liu, Jianping Zhao, Guangping Li
No abstract text is available yet for this article.
October 20, 2014: International Journal of Cardiology
David W Johnson, Elaine M Pascoe, Sunil V Badve, Kim Dalziel, Alan Cass, Philip Clarke, Paolo Ferrari, Stephen P McDonald, Alicia T Morrish, Eugenie Pedagogos, Vlado Perkovic, Donna Reidlinger, Anish Scaria, Rowan Walker, Liza A Vergara, Carmel M Hawley
BACKGROUND: Erythropoiesis-stimulating agent (ESA)-hyporesponsive anemia is common in chronic kidney disease (CKD). Pentoxifylline shows promise as a treatment for ESA-hyporesponsive anemia, but has not been rigorously evaluated. STUDY DESIGN: Multicenter, double-blind, randomized, controlled trial. SETTING & PARTICIPANTS: 53 adult patients with CKD stage 4 or 5 (including dialysis) and ESA-hyporesponsive anemia (hemoglobin≤120g/L and ESA resistance index [calculated as weight-adjusted weekly ESA dose in IU/kg/wk divided by hemoglobin concentration in g/L]≥1...
January 2015: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Anders Gottsäter, Bengt Lindblad
Fibromuscular dysplasia (FMD) is a nonatherosclerotic, noninflammatory angiopathy of unknown cause affecting medium-sized (most commonly renal) arteries and causing renovascular hypertension. The most common medial multifocal type of FMD (with the "string of beads" appearance) is more than four times more prevalent in females than in males. FMD accounts for up to 10% of cases of renovascular hypertension. Compared with patients with atherosclerotic renal artery stenosis, patients with FMD are younger, have fewer risk factors for atherosclerosis, and a lower occurrence of atherosclerosis in other vessels...
2014: Therapeutics and Clinical Risk Management
Sylvie R Stacy, Catalina Suarez-Cuervo, Zackary Berger, Lisa M Wilson, Hsin-Chieh Yeh, Eric B Bass, Erin D Michos
BACKGROUND: Patients with chronic kidney disease (CKD) have high prevalence of elevated serum troponin levels, which makes diagnosis of acute coronary syndrome (ACS) challenging. PURPOSE: To evaluate the utility of troponin in ACS diagnosis, treatment, and prognosis among patients with CKD. DATA SOURCES: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials through May 2014. STUDY SELECTION: Studies examining elevated versus normal troponin levels in terms of their diagnostic performance in detection of ACS, effect on ACS management strategies, and prognostic value for mortality or cardiovascular events after ACS among patients with CKD...
October 7, 2014: Annals of Internal Medicine
Erin D Michos, Lisa M Wilson, Hsin-Chieh Yeh, Zackary Berger, Catalina Suarez-Cuervo, Sylvie R Stacy, Eric B Bass
BACKGROUND: Clinicians face uncertainty about the prognostic value of troponin testing in patients with chronic kidney disease (CKD) without suspected acute coronary syndrome (ACS). PURPOSE: To systematically review the literature on troponin testing in patients with CKD without ACS. DATA SOURCES: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials through May 2014. STUDY SELECTION: Studies examining elevated versus normal troponin levels in patients with CKD without ACS...
October 7, 2014: Annals of Internal Medicine
Maria-Eleni Roumelioti, Mark Unruh
No abstract text is available yet for this article.
July 1, 2014: Annals of Internal Medicine
Jun Ling Lu, Kamyar Kalantar-Zadeh, Jennie Z Ma, L Darryl Quarles, Csaba P Kovesdy
Obesity is associated with higher mortality in the general population, but this association is reversed in patients on dialysis. The nature of the relationship of obesity with adverse clinical outcomes in nondialysis-dependent CKD and the putative interaction of the severity of disease with this association are unclear. We analyzed data from a nationally representative cohort of 453,946 United States veterans with eGFR<60 ml/min per 1.73 m(2). The associations of body mass index categories (<20, 20 to <25, 25 to <30, 30 to <35, 35 to <40, 40 to <45, 45 to <50, and ≥50 kg/m(2)) with all-cause mortality and disease progression (using multiple definitions, including incidence of ESRD, doubling of serum creatinine, and the slopes of eGFR) were examined in Cox proportional hazards models and logistic regression models...
September 2014: Journal of the American Society of Nephrology: JASN
Maarten W Taal, Victoria Thurston, Natasha J McIntyre, Richard J Fluck, Christopher W McIntyre
Fibroblast growth factor (FGF) 23 is an important regulator of phosphaturia. Its serum level was found to increase before that of parathyroid hormone (PTH) in early chronic kidney disease (CKD) in some but not all previous studies. As vitamin D insufficiency is associated with elevated PTH, we determined the effect of vitamin D status on FGF23 and PTH levels in relation to glomerular filtration rate (GFR) in people with CKD stage 3. Serum intact FGF23, PTH, and 25(OH)vitamin D3 were measured in 1664 patients who were prospectively recruited from primary care...
August 2014: Kidney International
Brian Bieber, Jiaqi Qian, Shuchi Anand, Yucheng Yan, Nan Chen, Mia Wang, Mei Wang, Li Zuo, Fan Fan Hou, Ronald L Pisoni, Bruce M Robinson, Sylvia P B Ramirez
BACKGROUND: Renal replacement therapy is rapidly expanding in China, and two-times weekly dialysis is common, but detailed data on practice patterns are currently limited. Using cross-sectional data from the China Dialysis Outcomes and Practice Patterns Study (DOPPS), we describe the hemodialysis practice in China compared with other DOPPS countries, examining demographic, social and clinical characteristics of patients on two-times weekly dialysis. METHODS: The DOPPS protocol was implemented in 2011 among a cross-section of 1379 patients in 45 facilities in Beijing, Guangzhou and Shanghai...
September 2014: Nephrology, Dialysis, Transplantation
Davide Bolignano, Evi V Nagler, Wim Van Biesen, Carmine Zoccali
Among renal diseases, over 100 conditions meet the epidemiological criteria to be defined as rare, including disorders in development, transport and metabolism. Clinical management of rare diseases is likely to be less investigated than that of common disorders and for this reason the scientific evidence to support clinical practice is limited. Furthermore, no specific and validated methods for designing, carrying out or analyzing clinical trials in small populations exist with important consequences for evidence-based medicine...
September 2014: Nephrology, Dialysis, Transplantation
Steven Fishbane, Brigitte Schiller, Francesco Locatelli, Adrian C Covic, Robert Provenzano, Andrzej Wiecek, Nathan W Levin, Mark Kaplan, Iain C Macdougall, Carol Francisco, Martha R Mayo, Krishna R Polu, Anne-Marie Duliege, Anatole Besarab
BACKGROUND: Peginesatide, a synthetic peptide-based erythropoiesis-stimulating agent (ESA), is a potential therapy for anemia in patients with advanced chronic kidney disease. METHODS: We conducted two randomized, controlled, open-label studies (EMERALD 1 and EMERALD 2) involving patients undergoing hemodialysis. Cardiovascular safety was evaluated by analysis of an adjudicated composite safety end point--death from any cause, stroke, myocardial infarction, or serious adverse events of congestive heart failure, unstable angina, or arrhythmia--with the use of pooled data from the two EMERALD studies and two studies involving patients not undergoing dialysis...
January 24, 2013: New England Journal of Medicine
2014-10-04 18:41:13
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