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 »

Peritoneal Dialysis: Skin Autofluorescence Correlates With Increased Heart Disease and Mortality Risk

Hemodialysis.com Interview with:
Emília Mácsai MD. PhD. nephrologist, diabetologist

Emília Mácsai MD. PhD. nephrologist, diabetologist

 

Attila Benke MD. Medical Director 3-rd Dialysiscentre BBRAUN Hungarian Network
Attila Benke MD.
Medical Director 3-rd Dialysiscentre BBRAUN Hungarian Network

 

 

Professor B. BraunProfessor B. Braun
Professor B. Braun

Semmelweis University Budapest 2-nd Department of Internal Medicine Geriatrics Group
Medical Director 1-st Dialyiscentre BBRAUN Hungarian Network

 

Hemodialysis.com: What are the main finding of the study? Were any of the findings unexpected?

Response: Advanced glycation end-products are well-known markers of cardiovascular mortality in hemodialysed patients, they represent subgroup of uremic toxins and molecular mediators of diabetic complications. Their tissue accumulation is measurable with a special AGE Reader device. Skin autofluorescence evaluating with this simple non-invasive method signs in our study the previous cumulative glucose burden (higher rates in case of diabetes), correlates with presence of cardiovascular disease and in 3 years term predicts mortality in patients on peritoneal dialysis. Peritoneal glucose exposure and elapsed time in peritoneal dialysis also connected with skin autofluorescence, which indicate  additional dialysis-associated glycemic effect.

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

Response: This method seems to be suitable to evaluate the extent of long-term damage in connective tissues caused by diabetes and decreased renal elimination of advanced glycation end-products, and signifies patients with high cardiovascular risk in this vulnerable population. Helps us to recognize patients who mostly need for non-glucose based peritoneal solution and multidisciplinary intervention.
Hemodialysis.com: What recommendations do you have for future research as a result of your study?

Response: More biocompatible low glucose peritoneal dialysis solutions should be introduced more extensively, further result could prove their advantageous effect on skin autofluorescence and simultaneous changes in mortality and cardiovascular events.

Citation:

 

Background Skin autofluorescence (SAF) is a proven prognostic factor of mortality in hemodialysis patients. Traditional and non-traditional risk components are similar in peritoneal dialysis (PD), and as well cardiovascular disease (CVD) is the leading cause of death. Moreover peritoneal glucose absorption accelerates degenerative processes of the connective tissues, like in diabetes. In our study we examined the predictive value of SAF for mortality in PD population.

Methods Data were taken from 198 prevalent adult Caucasian PD patients, 126 of them (mean age 66.2 year; male 73; diabetes ratio 75/126) had anamnestic CVD (coronary heart disease, cerebrovascular disease, peripheral arterial disease). Initially we evaluated the factors affecting SAF and CVD by multivariate linear regression. Registering the clinical and demographic data associations with mortality during the next 36 months survival were estimated using Kaplan-Meier method, analysis were stratified on presence of CVD and SAF level above or below the upper tercils 3.61.

Results SAF was influenced by CVD (p<0.01; CI 0.1-0.5) and white blood cell count (p<0.001; CI 0.031-0.117). According Spearman correlation it connected with  peritoneal cumulative glucose exposure (p=0.02) and elapsed time in PD (p=0.008). CVD related with age (p<0.001; CI 1.24-1.65) and diabetes (p<0.001; CI 2.58-10.66). More death were observed in the high SAF group, than in the low SAF group (34/68 v. 44/130; p=0.04). Comparing the CVD(-) low SAF group survival (mean 33.9 month; SE 1.39) to CVD(+) low SAF  (mean 30.5 month; SE 1.37; p=0.03) and to CVD(+) high SAF group (mean 27.1; month; SE 1.83; p=0.001) the difference was significant.

Conclusions Among patients on PD the SAF value over 3.61 seems to be predictor of mortality. Relationship with glucose-exposure, CVD and diabetes suggests its suitability to characterize systemic cumulative glucose load.

 

Contrast Associated AKI Associated With Decreased Medication Use Post Discharge

Hemodialysis.com Interview with:

Matthew James, MD, PhD, FRCPC Division of Nephrology Department of Medicine Department of Community Health Sciences University of CalgaryMatthew James, MD, PhD, FRCPC
Division of Nephrology
Department of Medicine
Department of Community Health Sciences
University of Calgary

Dr. Kelvin Leung MD Cinical Investigator Program University of  Calgary
Dr. Kelvin Leung MD

Cinical Investigator Program
University of  Calgary

 

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

Response: We followed over 5900 elderly patients, hospitalized with acute coronary syndrome for development of acute kidney injury (AKI) after coronary angiography. We found that those who developed stage 1 and stage 2-3 AKI had 35% and 66% low odds of use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers after hospital discharge. The odds of use of statins and beta-blockers after discharge were also lower in those who developed stage 2-3 AKI by 56% and 54%, respectively. The lower use of these medications after discharge was seen across a number of subgroups, including those with diabetes, heart failure, chronic kidney disease, and proteinuria.

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.

Latest update: 16-12-2014 . 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