Turning Human Pluripotent Stem Cells Into Mesoderm That Forms Kidney Tubules

Hemodialysis.com Interview with: Albert Q. Lam, MD Harvard Medical School, Boston, MA More »

ACEIs/ARBs Lowered Dialysis Risk in CKD Hypertensive Patients

Hemodialysis.com Interview with: Dr. Der-Cherng Tarng and Dr. Chih-Cheng Hsu. More »

Kidney Stones: Value of Weekly Exercise

Hemodialysis.com Interview with: Mathew Sorensen, MD, MS More »

Albuminuria and Exposure to Phthaltes

Hemodialysis.com Interview with: Dr. Howard Trachtman MD More »

Self Rated Health Good Predictor of Kidney Disease Progression and Mortality

Cassianne Robinson-Cohen, PhD Kidney Research Institute Department of Medicine University of Washington  Hemodialysis.com Interview with:
Cassianne Robinson-Cohen, PhD
Kidney Research Institute
Department of Medicine
University of Washington

Hemodialysis.com: What are the main findings of this study?

Dr. Robinson-Cohen: The primary findings of the study show that a simple measure of self-rated health, a CKD patient’s answer to the question “In general, would you say your health is excellent, very good, good, fair, or poor?”, predicts mortality and kidney disease progression at least as well as traditional risk models and a panel of novel biomarkers.

The assessment of general self-rated health could be incorporated into patient evaluation to provide a quick and easy tool for identifying patients who might benefit from closer surveillance or more intensive risk factor management.

Further research is needed to determine the best way to incorporate this assessment into clinical practice, as well as to investigate whether interventions targeting self-reported health translate into improved outcomes for patients.

Citation:

Self-Rated Health and Adverse Events in CKD

Cassianne Robinson-Cohen, Yoshio N. Hall, Ronit Katz, Matthew B. Rivara, Ian H. de Boer, Bryan R. Kestenbaum, and Jonathan Himmelfarb

CJASN CJN.03140314; published ahead of print October 9, 2014, doi:10.2215/CJN.03140314

 

Spot Urine Sample For Proteinuria Predictive of Kidney Transplant Decline

Hemodialysis.com Interview with:
Ayub Akbari, MD, MSc
Associate Professor of Medicine
The Ottawa Hospital and the University of Ottawa
Hemodialysis.com: What are the main findings of the study?

Dr. Akbari: Single sample of urine is as good as 24 hour urine  collection  for predicting severe decline in transplant function, transplant loss and death.

Current Oversight May Stifle Growth of Transplantation Centers

Dr. Jesse Schold, PHD Quantitative Health Sciences Assistant Staff Cleveland Clinic Main Campus Cleveland, OH 44195Hemodialysis.com Interview with:
Dr. Jesse Schold PhD
Department of Quantitative Health Sciences
Cleveland Clinic, Cleveland, OH

Hemodialysis.com: What are the main findings of the study?

Dr. Schold: The primary findings of the study illustrate that the survival benefit of transplantation is modified by the measured quality of individual transplant centers. However, this variation is relatively mild compared to the benefit associated with transplantation as compared to maintenance dialysis. Specifically, the expected patient survival at centers even with significantly low performance dramatically exceeds the expected survival of patients remaining on the waiting list. As such policies to promote access to transplantation are paramount as compared to assessing differences between the quality of transplant centers. These findings are particularly important as empirical studies suggest an attenuation of transplant rates at centers with lower measured performance.

Hemodialysis.com: Were any of the findings unexpected?

Dr. Schold: The magnitude of difference in expected survival between high and low performing centers is relatively incremental and these differences are consistent within subgroups of the population.

Hemodialysis.com: What should clinicians and patients take away from this study?

Dr. Schold: Emphasizing early access to transplantation remains the paramount priority for eligible patients with End Stage Renal Disease.

Hemodialysis.com: What recommendations do you have for future research as a result of your study?

Dr. Schold: There is a need to develop quality assurance tools and policies that can simultaneously promote access to transplantation and transplant rates concurrent with evaluation of post-transplant outcomes among centers. Current oversight may stifle growth of transplantation and providing more comprehensive evaluation of care for potential transplant patients may better align incentives for patients and transplant centers.

Citation:

Association between Kidney Transplant Center Performance and the Survival Benefit of Transplantation Versus Dialysis Jesse D. Schold, Laura D. Buccini, David A. Goldfarb, Stuart M. Flechner, Emilio D. Poggio,and Ashwini R. Sehgal

Association between Kidney Transplant Center Performance and the Survival Benefit of Transplantation Versus DialysisCJASN CJN.02380314; published ahead of print September 18, 2014,doi:10.2215/CJN.02380314 

Dialysis Patients Have Higher Risk of Cardiac Injury Even If LV Function Normal

Shih-Han Susan Huang, Assistant Professor, MD FRCPC Department of Medicine, Division of Nephrology, Western University A2-344 Commissioners Road East, London, OntarioHemodialysis.com Interview with:
Shih-Han Susan Huang, Assistant Professor, MD FRCPC
Department of Medicine, Division of Nephrology, Western University
A2-344 Commissioners Road East, London, Ontario

Hemodialysis.com: What are the main findings of the study?

Dr. Huang: Two-dimensional speckle tracked imaging (STI) echocardiography can be used to asses global and regional left ventricular function and it has been shown to be a sensitive method in patients with normal ventricular function. We applied this new method to 104 of our hemodialysis patients. In our prospective observational study, we found that the left ventricular global and segmental strain values were higher than in healthy individuals. In patients who had more segments (>80%) that were affected and/or worse global function measured by STI, they had lower survival rate.

PD vs Hemodialysis: Differences In Infection Risk

Anouk van Diepen Division of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands Hemodialysis.com Interview with:
Anouk van Diepen
Division of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands

Hemodialysis.com: What are the main findings of the study?

Answer: The main finding of the study is that peritoneal dialysis patients carry a high overall infection risk when compared to hemodialysis patients. However, when infections are stratified into infections that are related to the dialysis technique (peritonitis, catheter infections, iv access associated sepsis) and those that are not related to the dialysis technique, it becomes evident that the dialysis technique induces infections in peritoneal dialysis patients, while deficient immunological function appears to be more important in hemodialysis patients.

Does Buttonhole Cannulation Really Reduce Dialysis Access Pain?

Hemodialysis.com Interview with:
Dr. Ben Wong MD
Division of Nephrology and Transplant Immunology
University of Alberta, Edmonton, Alberta, Canada.

Hemodialysis.com: What are the main findings of the study?

Dr. Wong: Reduction in patient-reported cannulation pain, which is one of the purported benefits of buttonhole cannulation, was only demonstrated among pooled observational studies, but not among randomized controlled trials.  This suggests that the buttonhole cannulation technique as a means to reduce needling discomfort is likely overly-stated and over-emphasized in parts of the renal community.  Also, compared to the traditional rope-ladder cannulation technique, there appeared to be a signal towards increased risk of local and systemic infections with the buttonhole technique – this result simply confirms what others have already reported.

HDL Function Remains Compromised After Kidney Transplantation

Dr. Marcus D. Säemann Division of Nephrology and Dialysis Department of Internal Medicine III Medical University of Vienna, Austria.
Hemodialysis.com Interview with:

Dr. Marcus D. Säemann
Division of Nephrology and Dialysis
Department of Internal Medicine III
Medical University of Vienna, Austria.

 

Hemodialysis.com: What are the main findings of the study?

Dr. Säemann: The main focus of our study was to describe HDL quality after renal transplantation to provide information on characteristic lipid
disturbances in this population due to limited information on the high  cardiovascular risk in renal disease patients. We could previously show
that HDL is rendered dysfunctional in hemodialysis patients, including  alterations on the molecular level and wondered whether the impaired HDL quality is recovered after renal transplantation. The major finding of our study is that functional properties of HDL remain compromised after renal transplantation, shown by substantially reduced HDL functions in transplant patients and importantly, which was independent of graft function.

Remarkably, we detected a profound suppression of key  cardioprotective HDL metrics, such as cholesterol efflux capacity and
anti-oxidative activity, along with a characteristic protein composition  across the transplant population which was similar to ESRD patients.

Latest update: 22-10-2014 . Thank you for visitng Hemodialysis.com

Not for specific medical advice. Please consult your physician for recommendations and questions. Editor: Marie Benz info@hemodialysis.com