Tag Archives: ckd
Sevelamer Versus Calcium Carbonate in Incident Hemodialysis Patients: Results of an Open-Label 24-Month Randomized Clinical Trial
Hemodialysis.com eInterview with:
Dr. Antonio Bellasi
UOC Nefrologia e Dialisi
Azienda Ospedaliera S.Anna (CO), Via Ravona,
22020 San Fermo della Battaglia (Como), Italy
and Dr. Biagio Raffaele Di Iorio
Università degli Studi di Napoli Federico II
Hemodialysis.com: What are the main findings of the study?
Response: The main findings are that non-calcium containing phosphate binder maybe superior than calcium containing phosphate binder in CKD-5D dialysis patients. Current results expand the existing body of evidence, confirming what reported by Block et al in a secondary analysis of the RIND study (Block et al Kidney Int 2007; 71(5):438-41) and suggesting the survival benefit is mainly driven by the different impact of these 2 phosphate binder regimens on the cardiovascular system.
Indeed, we did not observe any non-CV survival difference between groups.
Finally, numerous studies suggest now that calcium supplementation maybe associated with a significant increase in the CV risk in post-menopausal women further questioning the excessive use of calcium (Bolland et al Br Med J 2010; 341:C3691).
Marie Benz, MD on Google+Seroprevalence of Streptococcal Inhibitor of Complement (SIC) suggests association of streptococcal infection with chronic kidney disease
Hemodialysis.com eInterview with:
Dr.M.G.Karmarkar
Professor of Microbiology
Seth G.S Medical College
& K.E.M Hospital,
Parel, Mumbai – 40
Hemodialysis.com: What are the main findings of the study?
Dr. Karmarkar: Past infection with SIC positive GAS is a risk factor for development of CKD and ESRD in Mumbai Population. SIC seropositivity is predictive of POOR prognosis of CKD patients. emm typing of GAS strains isolated from School children during project period showed great diversity as reported in other parts of the country. Although in two of our recent studies, very few isolates have genetic capability to produce SIC and DRS. As compared to healthy controls, seropositivity to SIC was found to be significantly elevated in CKD and ESRD cohort’s .Also, Prevalence of SIC seropositivity is independent of age, sex and diabetes status in the study sample of people with renal disease.
Management of protein-energy wasting in non-dialysis-dependent chronic kidney disease: reconciling low protein intake with nutritional therapy.
Hemodialysis.com Author Interview:
Csaba P. Kovesdy MD FASN.
The Fred Hatch Professor of Medicine
Director, Clinical Outcomes and Clinical Trials Program in Nephrology
University of Tennessee Health Science Center
Chief of Nephrology
Division of Nephrology, Memphis VA Medical Center
Comments from Dr. Kovesdy:
Protein energy wasting (PEW) is common in patients with CKD: according to some studies as many as 20-25% of patients with non-dialysis dependent CKD have PEW. PEW is associated with significantly higher mortality, it is thus important to consider what interventions might be used to prevent it from developing, and to treat it once it has occurred. The reason for the development and worsening of PEW as CKD advances are very complex, and include various mechanisms that induce either decreased nutrient intake, or increased catabolism, or both. Interventions against PEW can thus target any, or several of these mechanisms. The practical implementation of such interventions is, however, hampered by a lack of clinical trials providing definitive answers about their efficacy and safety towards improving hard clinical end points.
RAGE Polymorphism Is Associated with Chronic Kidney Disease Progression in Subjects Affected by Nephrocardiovascular Disease
Hemodialysis.com eInterview with Drs. Ivano Baragetti and Giuseppe Danilo Norata
Affiliations: Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy, Center for the Study of Atherosclerosis, Italian Society for the Study of Atherosclerosis (SISA) Lombardia Chapter, Bassini Hospital, Cinisello Balsamo, Milan, Italy, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen’s Mary University, London, United Kingdom
Nephrology and Dialysis Unit, Bassini Hospital, Cinisello Balsamo, Milan, Italy
Written Interview conducted with author by Marie Benz, MD
Hemodialysis.com: What are the main findings of the study?
Answer: The main finding of the present study is the observation of the association of a single nucleotide polymorphism of the Receptor for Advanced Glycation End Products (-374 T/A RAGE) with the progression of chronic kidney disease (CKD). In particular, CKD patients carrying the A allele show a faster decline of renal function (doubled creatinine plasma concentrations and dialysis) than T carriers. This polymorphism induces an enhanced transcription of RAGE mRNA and a potential major expression of membrane RAGE at renal level, thus enhancing the binding of circulating AGEs with RAGE, especially at mesangial level. This effect could in turn sustain local inflammation. Indeed inflammation typical of CKD increases production and accumulation of RAGE ligands: AGEs [1], AOPPs (advanced oxidation protein products), HMGB1, S100 proteins, β2-integrin Mac/CD11b, amyloid β peptide, β sheet-fibrils, complement C3a, lipopolysaccharides and phosphatidylserine on the surface of apoptotic cells [2]. All these molecules are pro-inflammatory [3]. RAGE is expressed at low levels in normal tissues and vessels, but it is upregulated under pathological conditions in sites where the pro-inflammatory ligands accumulate [4] and following activation gives rise to NF-kB mediated cellular responses [5].
Chronic kidney disease is associated with neovascularization and intraplaque hemorrhage in coronary atherosclerosis in elders: results from the Hisayama Study.
Hemodialysis.com eInterview with Toshiaki Nakano, MD, PhD
Department of Medicine and Clinical Science
Graduate School of Medical Sciences, Kyushu University
3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
Written Interview conducted with author by Editor Marie Benz, MD
Hemodialysis.com: What are the main findings of the study?
Dr. Nakano: In this population-based autopsy study, we examined the relationships of chronic kidney disease (CKD) with neovascularization and intraplaque hemorrhage in coronary atherosclerosis from 375 autopsy samples from 126 subjects. Lower eGFR was associated with increased numbers of newly formed blood vessels. The multivariate-adjusted odds ratio of the presence of intraplaque hemorrhages was 6.22 (95% CI, 1.10–35.04) in subjects with an eGFR of <30 mL/min/1.73 m2 compared with those with an eGFR of ≥60 mL/min/1.73 m2. We found that elderly patients with CKD have higher risks of intimal neoangiogenesis and intraplaque hemorrhages in coronary arteries.
Effects of recombinant human erythropoietin on resistance artery endothelial function in stage 4 chronic kidney disease.
Hemodialysis.com eInterview with Dr. Marie Briet
Department of Pharmacology and Institut National de la Santé et de la Recherche Médicale
U970-PARCC, Hôpital Européen Georges Pompidou,
Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
Ernesto L. Schiffrin, CM, MD, PhD, FRSC, FRCPC, FACP
Physician-in-Chief, Sir Mortimer B. Davis-Jewish General Hospital,
Canada Research Chair in Hypertension and Vascular Research
Lady Davis Institute for Medical Research
Professor and Vice-Chair (Research), Department of Medicine
McGill University.
Written Interview conducted with author by Editor Marie Benz, MD
Hemodialysis.com: What are the main findings of the study?
Dr. Briet: The main finding is that EPO induces an endothelial dysfunction of small resistance arteries isolated from subcutaneous biopsies performed in chronic kidney disease patients. Considering that small arteries are the key determinants of blood pressure levels, the endothelial dysfunction induced by EPO could contribute to the increase in blood pressure and CV events observed in large interventional trials.
Central Body Fat Distribution Associates with Unfavorable Renal Hemodynamics Independent of Body Mass Index
Hemodialysis.com eInterview: Dr. Arjan J. Kwakernaak
Department of Medicine, Division of Nephrology
University Medical Center Groningen
PO Box 30001, NL-9700 RB
Groningen, The Netherlands
Hemodialysis.com: What was the rationale for the study?
Dr. Kwakernaak: Body fat distribution is a well-established risk factor for long-term kidney damage. The mechanisms underlying this increased renal risk in association with a central body fat distribution is often attributed to associated conditions, such as overall weight excess, hypertension, and diabetes. We suspected that body fat distribution might also exert an adverse effect on renal hemodynamics, independent from these factors. We therefore investigated whether a central body fat distribution was associated with an altered renal hemodynamic profile, independent of overall weight excess.
Impact of non-dialysis chronic kidney disease on survival in patients with septic shock
Hemodialysis.com Author Interview: Julien Maizel, MD
Medical Intensive Care Unit, Department of Nephrology,
Amiens University Medical Center
Amiens, France and INSERM U-1088, Jules Verne University of Picardie
Amiens, France
Hemodialysis.com: What are the main findings of the study?
Answer: The key finding from this retrospective study is that CKD (not on dialysis) is an independent factor of mortality after septic shock.
