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Hemodialysis.com | Hemodialysis | Dialysis | Kidney Disease

  1. 1. Hemodialysis.com Hemodialysis research, author interviews, dialysis updates and information on chronic kidney disease and end stage renal failure. Editor: Marie Benz, MD [email_address] .com
  2. 3. Author Interview: Prof. Sergio Stefoni Thrombosis of Tunneled-Cuffed Hemodialysis Catheters: Treatment With High-Dose Urokinase Lock Therapy. Donati G, Colì L, Cianciolo G, La Manna G, Cuna V, Montanari M, Gozzetti F, Stefoni S. Nephrology Dialysis and Renal Transplantation Unit, S.Orsola University Hospital, Bologna, Italy. Artif Organs. 2011 Aug 16. doi: 10.1111/j.1525-1594.2011.01290.x. <ul><li>What are the main findings of the study? </li></ul><ul><li>High dose urokinase lock therapy allows an optimal TCC patency without bleeding complications. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>The TCC survival with high dose urokinase lock therapy is higher than in the low dose group reaching 95% at 3 years. </li></ul><ul><li>What should clinicians and patients take away from this study? </li></ul><ul><li>The addition of urokinase lock therapy is useful if an adequate anticoagulation therapy with warfarin is administered to prevent TCC thrombosis. This is true especially in patients who did not have alternatives to TCC for vascular access. </li></ul>Read the rest of the interview on Hemodialysis.com
  3. 4. Authors Interview' : Drs. Carl-Johan Jakobsen & Dorthe Nielsen Perioperative aminoglycoside treatment is associated with a higher incidence of postoperative dialysis in adult cardiac surgery patients. Nielsen DV, Hjortdal V, Larsson H, Johnsen SP, Jakobsen CJ. J Thorac Cardiovasc Surg. 2011 Sep;142(3):656-61. <ul><li>What are the main findings of the study? </li></ul><ul><li>The major findings were the substantial increased risk of postoperative dialysis in cardiac surgery patients, if they had received aminoglycosides and that this risk was more or less independent on dose size and dose numbers. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>In general endocarditis is believed to be associated with a high risk of postoperative dialysis. This was also demonstrated in our data with a relatively high crude risk ratio which more or less disappeared when using both adjusted risk ratio and propensity score match. </li></ul><ul><li>Another point of interest is that the general definitions of failing renal function does not fully apply after cardiac surgery using cardiopulmonary bypass as there is a general haemodilution effect which indicate that renal failure may be present somewhat later than expected. </li></ul>Read the rest of the interview on Hemodialysis.com
  4. 5. Author Interview: Dr Luca Neri Joint Association of Hyperuricemia and Reduced GFR on Cardiovascular Morbidity: A Historical Cohort Study Based on Laboratory and Claims Data From a National Insurance Provider . Neri L, Rocca Rey LA, Lentine KL, Hinyard LJ, Pinsky B, Xiao H, Dukes J, Schnitzler MA. Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO; Dipartimento di Medicina del Lavoro, Clinica del Lavoro &quot;L. Devoto,&quot; Milan, Italy. Am J Kidney Dis. 2011 Sep;58(3):398-408. Epub 2011 Jul 23. <ul><li>What are the main findings of the study? </li></ul><ul><li>We performed a historical cohort study evaluating the risk of cardiovascular events in adult beneficiaries of a national health insurance provider. We augmented billing claims data with extracts from outpatient laboratory results and prescription medications. Data were available since January 2003 to December 2006. We identified 148,217 patients who met the inclusion criteria of the study (182,730 person-years overall). </li></ul><ul><li>We observed that increased serum uric acid concentration was associated with excess cardiovascular hospitalization risk independent of established risk factors and severity of decreased kidney function. In our study cardiovascular risk increased at uric acid levels lower than the threshold currently defining hyperuricemia. In addition, we found that the association between serum uric acid level and cardiovascular risk was stronger in patients with more severe decreases in kidney function. </li></ul>Read the rest of the interview on Hemodialysis.com
  5. 6. Author Interview: Dr. Timm H. Westhoff Urinary Calprotectin and the Distinction between Prerenal and Intrinsic Acute Kidney Injury CJASN September 1, 2011 CJN.02490311; published ahead of print September 1, 2011, doi:10.2215/CJN.02490311 <ul><li>What are the main findings of the study? </li></ul><ul><li>To date there is no reliable marker for the differentiation of prerenal and intrinsic acute kidney injury (AKI). Our study indicates that calprotectin, a mediator protein of the innate immune system, may eventually serve as a diagnostic marker in AKI. </li></ul><ul><li>In our study population patients with prerenal AKI had urinary calprotectin concentrations similar to healthy control subjects, whereas the mean calprotectin concentration in intrinsic AKI was increased by a factor of 60. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>In gastroenterology, fecal calprotectin is a well established parameter for the differentiation between inflammatory bowel disease and irritable bowel syndrome. </li></ul><ul><li>In analogy to irritable bowel syndrome, epithelial structures are completely intact in prerenal AKI. Therefore, the basic hypothesis of the present study was that urinary calprotectin concentrations are low in prerenal AKI. The results of our study supported this hypothesis. </li></ul><ul><li>Thus, the findings of our study were rather expected than unexpected. </li></ul>Read the rest of the interview on Hemodialysis.com
  6. 7. Author Interview: Michael Heung MDFluid overload at initiation of renal replacement therapy is associated with lack of renal recoveryin patients with acute kidney injury Michael Heung ,Dawn F. Wolfgram ,Mallika Kommareddi, Youna Hu, Peter X. Song ,Akinlolu O. Ojo Nephrol. Dial. Transplant. (2011) doi: 10.1093/ndt/gfr470 First published online: August 19, 2011 <ul><li>What are the main findings of the study? </li></ul><ul><li>We observed that a greater degree of fluid overload at the time of dialysis initiation in patients with acute renal failure was associated with a lower likelihood of recovering enough renal function to come off dialysis. </li></ul><ul><li>A strength of this study was that we examined renal recovery up to 1 year out from the time of dialysis initiation and not just at hospital discharge. Greater degree of fluid overload was also associated with higher mortality. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>Although we had hypothesized that greater degree of fluid overload would be associated with lower renal recovery, this had not been previously shown. Another finding that was surprising was that a longer interval between nephrology consultation and dialysis initiation was associated with a lower likelihood of renal recovery. </li></ul><ul><li>We believe this may reflect delays in the initiation of dialysis. </li></ul>Read the rest of the interview on Hemodialysis.com
  7. 8. Author Interview: Dr. Csaba Kovesdy MD Paricalcitol Versus Ergocalciferol for Secondary Hyperparathyroidism in CKD Stages 3 and 4: A Randomized Controlled Trial Csaba P. Kovesdy, Jun L. Lu, Sandra M. Malakauskas, Dennis L. Andress, Kamyar Kalantar-Zadeh, Shahram Ahmadzadeh American Journal of Kidney Diseases - 01 September 2011 (10.1053/j.ajkd.2011.06.027) <ul><li>What are the main findings of the study? </li></ul><ul><li>We designed a randomized controlled trial of oral fixed dose paricalcitol vs. titrated ergocalciferol (utilizing a regimen similar to one recommended by K-DOQI) for treatment of secondary hyperparathyroidism in patients with CKD stages 3 and 4. We found that after 4 months of treatment paricalcitol suppressed PTH levels significantly more effectively than ergocalciferol. </li></ul><ul><li>Both treatments were well tolerated. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>Ergocalciferol had minimal effect on PTH levels, which may be surprising to some. It is possible, though, that higher doses of ergocalciferol may be more effective, hence we hope that future studies using different dosing protocols from what K-DOQI recommends will address this issue. </li></ul>Read the rest of the interview on Hemodialysis.com
  8. 9. Author Interview: Dr. Navdeep Tangriβ-Blockers for Prevention of Sudden Cardiac Death in Patients on Hemodialysis: A Propensity Score Analysis of the HEMO Study Navdeep Tangri, Shani Shastri, Hocine Tighiouart, Gerald J. Beck, Alfred K. Cheung, Garabed Eknoyan, Mark J. Sarnak American Journal of Kidney Diseases - 29 August 2011 (10.1053/j.ajkd.2011.06.024) <ul><li>What are the main findings of the study? </li></ul><ul><li>The main findings of the study showed that beta blockers are not associated with a lower risk of sudden cardiac death in patients on hemodialysis. An additional finding found a trend towards benefit in patients with pre-existing ischemic heart disease. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>Our findings on the lack of benefit in patients with pre-existing heart failure were somewhat unexpected. However, heart failure in patients on hemodialysis can have a multifactorial etiology, and may include volume overload and diastolic dysfunction rather than systolic dysfunction, which is predominant in the general population. </li></ul><ul><li>In addition, the overlap between symptoms of volume overload and cardiac dysfunction related heart failure, that occurs in dialysis, may lead to misclassification of the exposure. </li></ul>Read the rest of the interview on Hemodialysis.com
  9. 10. Author Interview: Dr Richard Mc Gee Diagnostic Test Studies in Nephrology: Quantity, Quality, and Scope. McGee RG, Neuen BL, Mitchell RL, Craig JC, Webster AC. Centre for Kidney Research and Cochrane Renal Group, The Children's Hospital at Westmead, Westmead, Australia; Sydney School of Public Health, University of Sydney, Sydney, Australia. Am J Kidney Dis. 2011 Aug 18. <ul><li>What are the main findings of the study? </li></ul><ul><li>The main findings are that diagnostic research in nephrology is published less frequently than most other medical specialities. The quality of diagnostic test accuracy studies that are published is variable and leaves room for improvement. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>A similar study (Stripolli 2004) looking at randomised controlled trials found that randomised controlled trials were conducted less frequently in nephrology than other specialities. So we were not too surprised to see that we made a similar finding in relation to diagnostic tests. </li></ul>Read the rest of the interview on Hemodialysis.com
  10. 11. Author Interview: Donald E. Wesson, M.DDietary acid reduction with fruits and vegetables or bicarbonate attenuates kidney injury in patients with a moderately reduced glomerular filtration rate due to hypertensive nephropathy Nimrit Goraya, Jan Simoni, Chanhee Jo and Donald E Wesson Kidney Int advance online publication, August 31, 2011; doi:10.1038/ki.2011.313 <ul><li>What are the main findings of the study? </li></ul><ul><li>Our study shows that dietary acid reduction with two interventions, addition of sodium bicarbonate (NaHCO3) or addition of base-inducing fruits, each reduces urine parameters of kidney injury in subjects with chronic kidney disease (CKD) due to hypertensive nephropathy. </li></ul><ul><li>These data are consistent with reduced kidney injury in the study subjects who had kidney injury as reflected by their high levels of these urine indicators of kidney injury and their reduced kidney function as measured by reduced glomerular filtration rate (GFR). </li></ul><ul><li>These findings complement multiple published animal studies from our and other laboratories showing that reduced dietary acid with alkali or with base-inducing dietary protein reduces kidney injury in animal models of CKD. </li></ul>Read the rest of the interview on Hemodialysis.com
  11. 12. Author Interview: Kyoko Kogawa Sato, MD, PhDElevated White Blood Cell Count Worsens Proteinuria but Not Estimated Glomerular Filtration Rate: The Kansai Healthcare Study. Sato KK, Hayashi T, Harita N, Koh H, Maeda I, Endo G, Nakamura Y, Kambe H, Fukuda K. Department of Preventive Medicine and Environmental Health, Osaka City University Graduate School of Medicine, Osaka, Japan. Am J Nephrol. 2011 Aug 18;34(4):324-329. <ul><li>What are the main findings of the study? </li></ul><ul><li>A: We followed 10008 Japanese men aged 40-55 years who had neither proteinuria nor low eGFR without taking antihypertensive medications to examine the relationships of white blood cell (WBC) count, as a marker of inflammation, with two outcomes; proteinuria and low estimated glomerular filtration rate (eGFR) in the prospective study during the 6-year observation period. Proteinuria was defined as 1+ or higher on urine dipstick. Low eGFR was defined if eGFR was <60 mL/min/1.73 m2. </li></ul><ul><li>Elevated WBC count was associated with an increased risk of proteinuria, independent of age, body mass index categories, fasting plasma glucose, systolic blood pressure, diastolic blood pressure, presence/absence of antidiabetic medications, alcohol consumption categories, smoking categories, regular leisure-time physical activity, and eGFR categories at baseline. </li></ul><ul><li>However, no association was found between WBC count and the risk of low eGFR. </li></ul>Read the rest of the interview on Hemodialysis.com
  12. 13. Author Interview: Dr Ilia Beberashvili MDIL-6 Levels, Nutritional Status, and Mortality in Prevalent Hemodialysis Patients. Beberashvili I, Sinuani I, Azar A, Yasur H, Shapiro G, Feldman L, Averbukh Z, Weissgarten J. Clin J Am Soc Nephrol. 2011 Aug 18 <ul><li>What are the main findings of the study? </li></ul><ul><li>In this prospective longitudinal study we evaluated whether nutritional status was associated with longitudinal changes in IL-6 levels, and, in addition, whether observed changes in nutritional parameters could be related to survival of our cohort. </li></ul><ul><li>We showed that chronic inflammation, as measured by higher serum IL-6 levels, is associated with all-cause death without association with changes in clinical and laboratory markers of nutritional status in clinically stable HD patients. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>Yes - higher IL-6 levels in clinically stable and well nourished prevalent hemodialysis patients are associated with higher mortality without inducing measurable protein-energy wasting (PEW) in this population during 2 years of longitudinal observation. </li></ul>Read the rest of the interview on Hemodialysis.com
  13. 14. Author Interview: David P. Calfee , MD, MSClinical and Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus among Patients in an Ambulatory Hemodialysis Center. Patel G, Jenkins SG, Mediavilla JR, Kreiswirth BN, Radbill B, Salgado CD, Calfee DP. Department of Medicine, Mount Sinai School of Medicine, New York, New York. Infect Control Hosp Epidemiol. 2011 Sep;32(9):881-8. <ul><li>What are the main findings of the study? </li></ul><ul><li>In this single center study of ambulatory dialysis patients, asymptomatic carriage of MRSA was relatively common. The baseline prevalence was 12%. Hospital admission during the previous six months, failed renal transplant, and receipt of a first generation cephalosporin, cefepime or vancomycin were associated with MRSA carriage at baseline. </li></ul><ul><li>During the 6 month follow-up period of active surveillance testing, six additional patients acquired MRSA. Thus, the incidence of MRSA acquisition was 1.2 per 100 patient-months and the overall prevalence was 18%. </li></ul><ul><li>Over the course of the 12-month study period, 4 MRSA carriers (17.6%) developed invasive MRSA infection (3 primary bloodstream infections and one skin infection). </li></ul>Read the rest of the interview on Hemodialysis.com
  14. 15. Author Interview: Dr Jyoti Baharani FRCP(UK)Why did I start dialysis? A qualitative study on views and expectations from an elderly cohort of patients with end-stage renal failure starting haemodialysis in the United Kingdom. Stringer S, Baharani J. Department of Renal Medicine, Birmingham Heartlands Hospital, Heart of England Foundation Trust, Bordesley Green East, Birmingham, B95SS, UK Int Urol Nephrol. 2011 Aug 18. <ul><li>What are the main findings of the study? </li></ul><ul><li>This was a prospective interview study of elderly patients commencing haemodialysis in a centre in the United Kingdom. We were interested in knowing patients views on haemodialysis treatment at the start and to see if these views changed over a 6 month period following treatment. </li></ul><ul><li>We interviewed 22 patients within a month of starting treatment. 70% had attended a pre-dialysis clinic and had received dialysis education before starting haemodialysis. </li></ul><ul><li>Despite this many of the patients expressed views about having had little choice in starting dialysis and seemed uncertain about what dialysis would involve. Even so, over 90% of those interviewed were optimistic about dialysis and had high expectations from treatment and were not keen to discuss advance care planning at first interview. </li></ul><ul><li>We then re-interviewed 16 of the 22 patients at 6 months (4 patients had died within 6 months and 2 had been transferred to other centres). </li></ul><ul><li>At this stage, we found a substantial change in patients’ attitude, with only 45% still finding dialysis acceptable and more patients now keen to discuss advance care planning. More patients also had a higher symptom burden at 6 months than at initiation of dialysis treatment. </li></ul>Read the rest of the interview on Hemodialysis.com
  15. 16. Author Interview: Te-Chao Fang M.D. & Ph.D.Increased risk of cancer in chronic dialysis patients: a population-based cohort study in Taiwan. Lin HF, Li YH, Wang CH, Chou CL, Kuo DJ, Fang TC. 1Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan. Nephrol Dial Transplant. 2011 Aug 22. <ul><li>What are the main findings of the study? </li></ul><ul><li>Our study has six major findings. Firstly, the annual incidence of cancer development in chronic dialysis patients was 1.1%. </li></ul><ul><li>Secondly, there is an increment in the standardized incidence ratio (SIR) of developing overall cancer in chronic dialysis patients (SIR: 1.4, 95% CI: 1.3–1.4) that is independent of age, sex and duration of dialysis. </li></ul><ul><li>Thirdly, patients aged <35 years old and patients having a duration of dialysis of <5 years had a higher risk of cancer. </li></ul><ul><li>Fourthly, the highest SIR of cancers in our study was attributed to genitourinary tract cancers. Fifthly, the cancers with the highest rates of incidence in our study were bladder, liver and kidney cancers. Sixthly, our study showed that chronic dialysis patients had a reduced SIR (SIR: 0.5, 95% CI: 0.5–0.6) of developing lung cancer than the general population. </li></ul>Read the rest of the interview on Hemodialysis.com
  16. 17. Author Interview: Dr. Justyna Golebiewska MDInfluence of megestrol acetate on nutrition, inflammation and quality of life in dialysis patients. Golebiewska JE, Lichodziejewska-Niemierko M, Aleksandrowicz-Wrona E, Majkowicz M, Lysiak-Szyd?owska W, Rutkowski B. Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gda?sk, ul. Debinki 7, 80-952, Gdansk, Poland. Int Urol Nephrol. 2011 Jul 31. <ul><li>What are the main findings of the study? </li></ul><ul><li>We have demonstrated that in hypoalbuminemic MHD and CPD patients 160mg ofan oral suspension of megestrol acetate taken daily for up to 6 month improved several markers of nutritional state without any influence on inflammation or quality of life. </li></ul><ul><li>The most impressive was the significant increase in albumin concentration beginning from the first month, and continuing throughout the whole trial period. Significant weight gains and increases in BMI were noted in the following months. </li></ul><ul><li>Weight gain was significantly lower in diabetics, while the rate of increase in serum albumin concentration remained unaffected. Unlike the presence of diabetes, the mode of dialysis did not alter the pace of changes in nutritional status. Side effects were prevalent and significant. </li></ul>Read the rest of the interview on Hemodialysis.com
  17. 18. Author Interview: Dr. Carlo Briguori , MD, PhDRenal Insufficiency After Contrast Media Administration Trial II (REMEDIAL II): RenalGuard System in High-Risk Patients for Contrast-Induced Acute Kidney Injury. Briguori C, Visconti G, Focaccio A, Airoldi F, Valgimigli M, Sangiorgi GM, Golia B, Ricciardelli B, Condorelli G; for the REMEDIAL II Investigator Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples. Circulation. 2011 Aug 11 <ul><li>Were any of the findings unexpected? </li></ul><ul><li>We observed a significantly lower dialysis rate in the Renalguard group. Although this was not the primary end-point, this was a pre-specified secondary endpoint. The occurrence of dialysis is of course the worst scenario that we may have during CI-AKI. Having a strategy preventing dialysis in this high risk population represents an important improvement in our clinical practice. </li></ul><ul><li>What should clinicians and patients take away from this study? </li></ul><ul><li>When dealing with patients with GFR<30 and or high risk score the CIAKI rate is still high (20%) event with aggressive prophylactic approaches (sodium bicarbonate solution infusion and high dose of NAC). Also, in this population we should expect approximately a 4-5% dialysis rate within 30 days from contrast exposure. The Renalguard system is an effective and safe strategy significantly reduce the rate of CIAKI in this high risk population. </li></ul>Read the rest of the interview on Hemodialysis.com
  18. 19. Author Interview: Drs. André de Smet MD PhD and Ninos Ayez MDSecondary interventions in patients with autologous arteriovenous fistulas strongly improve patency rates. Ayez N, Fioole B, Aarts RA, Dorpel MA, Akkersdijk GP, Dinkelman MK, de Smet AA. Department of Vascular Surgery, Maasstad Hospital, Rotterdam, The Netherlands. J Vasc Surg. 2011 Aug 11 <ul><li>What are the main findings of the study? </li></ul><ul><li>The aim of this study was to evaluate the results after secondary interventions in patients with an upper extremity arteriovenous fistula. </li></ul><ul><li>The 1-year primary patency rates of arteriovenous fistulas (AVF) are poor. To improve these results several secondary interventions can be performed. </li></ul><ul><li>We found that due to mostly endovascular secondary interventions, 2-year primary assisted and secondary patency rates of more than 70% can be obtained. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>We didn’t expect that the arteriovenous fistulas performed so well after secondary interventions. </li></ul><ul><li>We expected that some patients received more interventions, but that the outcome after several interventions would be poor. </li></ul><ul><li>Unexpected was the fact that patients received up to eleven interventions, with a still functioning hemodialysis access. </li></ul>Read the rest of the interview on Hemodialysis.com
  19. 20. Author Interview: Dr. Robert L Hanson MD Albuminuria and Estimated Glomerular Filtration Rate as Predictors of Diabetic End-Stage Renal Disease and Death. Berhane AM, Weil EJ, Knowler WC, Nelson RG, Hanson RL. Phoenix Epidemiology and Clinical Research Branch, NIDDH Phoenix, Arizona. Clin J Am Soc Nephrol. 2011 Aug 18. <ul><li>What are the main findings of the study? </li></ul><ul><li>The main findings of the study are that both albuminuria (which is measured by the albumin-creatinine ratio from a urine sample) and eGFR (a measure of kidney function derived from the blood) , separately and together, predicted which patients developed end stage renal disease (ESRD) and which patients were likely to experience early mortality. All patients were Pima Indians participating in a longitudinal study. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>Similar findings have been seen in other studies that included mostly people who did not have diabetes, but few studies have been done in patients with diabetes. The present study showed that this is also true in people with diabetes. This isn’t entirely unexpected, but since diabetic kidney disease is characterized by a high level of protein in the urine, the result could not be predicted beforehand. In fact, in our study the level of albuminuria was a stronger predictor of who went on to develop ESRD. </li></ul>Read the rest of the interview on Hemodialysis.com
  20. 21. Author Interview: Pascal Meier MD FASNReferral Patterns and Outcomes in Noncritically Ill Patients with Hospital-Acquired Acute Kidney Injury.Meier P, Meier Bonfils R, Vogt B, Burnand B, Burnier M. Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland; Clin J Am Soc Nephrol. 2011 Aug 18. <ul><li>What are the main findings of the study? </li></ul><ul><li>In this retrospective study, patients with hospital-acquired acute kidney injury (HA-AKI) who were not referred (nrHA-AKI) or late referred (lrHA-AKI) to the nephrologist represented an important percentage of the hospitalized population. Furthermore, these conditions were associated with patients’ in-hospital mortality, less recovery of renal function, and need for renal replacement therapy (RRT). </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>The potential reasons why 22.3% and 58.3% of the patients hospitalized were either not referred or referred to the nephrologist late, respectively, are multiple. One explanation may be the definition of AKI, which is neither uniformly known nor accepted in the non-nephrologic community. Serum creatinine level alone is a relatively late and imprecise biomarker of kidney dysfunction, which may also lead to delayed referral. Finally, patients with AKI had more comorbidities, increasing the complexity of medical care and possibly increasing the time required to make treatment decisions. </li></ul>Read the rest of the interview on Hemodialysis.com
  21. 22. Author Interview: Susan Furth , MD, PhDMetabolic Abnormalities, Cardiovascular Disease Risk Factors, and GFR Decline in Children with Chronic Kidney Disease. Furth SL, Abraham AG, Jerry-Fluker J, Schwartz GJ, Benfield M, Kaskel F, Wong C, Mak RH, Moxey-Mims M, Warady BA Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Clin J Am Soc Nephrol. 2011 Aug 12 <ul><li>What are the main findings of the study? </li></ul><ul><li>Ours is the first large, North American study of children with moderate Chronic Kidney Disease. We show that significant growth failure and pubertal delay are common even in individuals with mild to moderate decrements of kidney function. Additionally, the constellation of cardiovascular disease risk factors seen in these children with primary kidney disease is remarkable, and suggests that decreased kidney function is a causal factor in the excessive cardiovascular disease mortality in individuals with kidney disease. </li></ul><ul><li>Ours is the first to report rates of kidney function decline using a precise measurement of kidney function, and shows remarkable differences in the rates of GFR decline depending on the cause of kidney disease in these children. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>Our study shows potential treatment targets that might slow down the worsening of kidney function over time in children. It is also the first study to report rates of measured GFR decline in children. </li></ul><ul><li>Our findings suggest a potential explanation for why a high proportion of young people with kidney disease present for medical care late, when they are close to needing dialysis. Our findings show much more rapid decline in kidney function in a subgroup of children with underlying glomerular disease, which predominantly occurs in African Americans. </li></ul>Read the rest of the interview on Hemodialysis.com
  22. 23. Author Interview: Susan Furth , MD, PhDMetabolic Abnormalities, Cardiovascular Disease Risk Factors, and GFR Declinein Children with Chronic Kidney Disease. Furth SL, Abraham AG, Jerry-Fluker J, Schwartz GJ, Benfield M, Kaskel F, Wong C, Mak RH, Moxey-Mims M, Warady BA Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Clin J Am Soc Nephrol. 2011 Aug 12 <ul><li>What are the main findings of the study? </li></ul><ul><li>Ours is the first large, North American study of children with moderate Chronic Kidney Disease. We show that significant growth failure and pubertal delay are common even in individuals with mild to moderate decrements of kidney function. Additionally, the constellation of cardiovascular disease risk factors seen in these children with primary kidney disease is remarkable, and suggests that decreased kidney function is a causal factor in the excessive cardiovascular disease mortality in individuals with kidney disease. </li></ul><ul><li>Ours is the first to report rates of kidney function decline using a precise measurement of kidney function, and shows remarkable differences in the rates of GFR decline depending on the cause of kidney disease in these children. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>Our study shows potential treatment targets that might slow down the worsening of kidney function over time in children. It is also the first study to report rates of measured GFR decline in children. </li></ul><ul><li>Our findings suggest a potential explanation for why a high proportion of young people with kidney disease present for medical care late, when they are close to needing dialysis. Our findings show much more rapid decline in kidney function in a subgroup of children with underlying glomerular disease, which predominantly occurs in African Americans. </li></ul>Read the rest of the interview on Hemodialysis.com
  23. 24. An interview with Drs. Miklos Z Molnar and Kamyar Kalantar-Zadeh from Harbor-UCLAHigh platelet count as a link between renal cachexia and cardiovascular mortality in end-stage renal disease patients. Molnar MZ, Streja E, Kovesdy CP, Budoff MJ, Nissenson AR, Krishnan M, Anker SD, Norris KC, Fonarow GC, Kalantar-Zadeh K. Institute at Harbor-University of California Los Angeles Medical Center, Torrance, CA. Am J Clin Nutr. 2011 Aug 3 <ul><li>What are the main findings of the study? </li></ul><ul><li>Relatively higher platelet count is associated with surrogates of renal cachexia and cardiovascular mortality in hemodialysis patients. However, the association of “relative thrombocytosis” with all-cause and cardiovascular mortality is accounted for by indices of renal cachexia. </li></ul><ul><li>To our knowledge, this is the first study that indicates that renal cachexia increases mortality via activating platelet pathway. However, these results need to be confirmed in additional studies including the potential link between malnutrition or cachexia and thromboembolic or cardiovascular events, and as usual our findings may not necessarily imply a causal relationship. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>Discovering the pathophysiological mechanisms underlying the PEW-death link can be a major step towards improving clinical management of chronic diseases states with wasting syndrome. To our knowledge, this is the first study that suggests that renal cachexia increases mortality via platelet link. </li></ul>Read the rest of the interview on Hemodialysis.com
  24. 25. American Society of Nephrology Press Release: Metabolic syndrome may cause kidney disease High blood pressure, high blood sugar, abdominal fat, low good cholesterol may contribute to kidney disease <ul><li>Metabolic syndrome comprises a group of medical disorders that increase people's risk of diabetes, heart disease, stroke, and premature death when they occur together. A patient is diagnosed with the syndrome when he or she exhibits three or more of the following characteristics: high blood pressure, high blood sugar, excess body fat in the waist/abdomen, low good cholesterol, and higher levels of fatty acids (the building blocks of fat). </li></ul><ul><li>People with metabolic abnormalities are at increased risk of developing kidney disease, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN). </li></ul><ul><li>Sankar Navaneethan, MD (Cleveland Clinic) and his colleagues searched the medical literature and combined data from 11 studies examining the relationship between metabolic syndrome and kidney disease. Altogether, they included 30,416 individuals from various ethnic groups. </li></ul><ul><li>People with metabolic syndrome have a 55% increased risk of developing kidney problems, especially lower kidney function, indicative of kidney disease. </li></ul><ul><li>Individual components of metabolic syndrome are linked with the development of kidney disease. </li></ul><ul><li>Kidney disease risk increases as the number of metabolic syndrome components increases. </li></ul>Read the rest of the interview on Hemodialysis.com
  25. 26. Author Interview: Dr. Sankar Navaneethan Metabolic Syndrome and Kidney Disease: A Systematic Review and Meta-analysis George Thomas ,Ashwini R. Sehgal , Sangeeta R. Kashyap ,Titte R. Srinivas , John P. Kirwan , Sankar D. Navaneethan CJASN August 2011 CJN.02180311 <ul><li>What are the main findings of the study? </li></ul><ul><li>The major finding of our study was that patients with metabolic syndrome, which includes a cluster of 3 or more of the following cardiovascular risk factors - high blood pressure, high fasting blood sugar, a large waist circumference, low HDL and high triglyceride levels - have a 55% increase in the risk for development of chronic kidney disease (CKD) as assessed by an eGFR < 60ml/min/1.73 m2. </li></ul><ul><li>The results of our study also show that the risk for CKD increases as the number of components of metabolic syndrome increase. Each individual risk factor was associated with development of kidney disease. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>Metabolic syndrome has been associated with cardiovascular disease, stroke, and all-cause mortality in the general population. </li></ul><ul><li>We hoped to synthesize the results of existing epidemiologic evidence that explored the association of metabolic syndrome and the risk for development of chronic kidney disease as evidenced by proteinuria and/or decreased glomerular filtration rate. </li></ul><ul><li>The results of our analysis adds to the growing evidence that metabolic syndrome and its components are associated with the development of CKD. The risk seems to be consistent across studies conducted in different countries in different ethnic groups and and that used different definitions of metabolic syndrome. </li></ul>Read the rest of the interview on Hemodialysis.com
  26. 27. Author Interview: Dr. Carla Avesani Annual variation in body fat is associated with systemic inflammation in chronic kidney disease patients Stages 3 and 4: a longitudinal study. Carvalho LK, Barreto Silva MI, da Silva Vale B, Bregman R, Martucci RB, Carrero JJ, Avesani CM. 1Clinical and Experimental Physiopathology Program, Rio de Janeiro State University, Rio de Janeiro, Brazil. Nephrol Dial Transplant. 2011 Aug 8. <ul><li>What are the main findings of the study? </li></ul><ul><li>A.We prospectively followed patients with CKD stages 3 and 4 for 12 months and found that changes in markers of adiposity, such as BMI (body mass index) and WC (waist circumference), were directly associated with changes in CRP (c-reactive protein), a marker of systemic inflammation. It is important to highlight that 45% of our patients had BMI ≥ 25 kgm2, none of them showed signs of PEW (protein energy wasting) and all of them were being regularly followed by a dietitian in a multidisciplinary CKD outpatient clinic. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>These findings were not unexpected as in non-CKD patients, similar findings were observed in overweight subjects. However, our study is the first one to show these findings in a population of CKD patients. </li></ul>Read the rest of the interview on Hemodialysis.com
  27. 28. Author Interview: Rodney G. Bowden, PhDReverse Epidemiology of Lipid-Death Associations in a Cohort of End-StageRenal Disease Patients. Bowden RG, La Bounty P, Shelmadine B, Beaujean AA, Wilson RL, Hebert S. School of Education, Baylor University, Waco, Tex., USA. Nephron Clin Pract. 2011 Aug 11;119(3):c214-c219. <ul><li>What are the main findings of the study? </li></ul><ul><li>Our study discovered a reverse epidemiological effect (normal values associated with higher rates of mortality) for LDL, LDL particle number, LDL size, VLDL, triglycerides, and total cholesterol. </li></ul><ul><li>Additionally regression revealed that LDL and total cholesterol were predictors of mortality with lower levels being more predictive of death. Additionally, a Cox multiple regression death hazard ratio revealed LDL particle size as a significant predictor of mortality with lower levels more predictive of death. </li></ul><ul><li>The results of our study support the findings of the few database studies that have been published regarding this topic and discovered the existence of a reverse epidemiological effect regarding cholesterol variables and morality in ESRD patients. </li></ul>Read the rest of the interview on Hemodialysis.com
  28. 29. Author Interview: Dr. Ian De BoerSerum 25-Hydroxyvitamin D and Change in Estimated Glomerular Filtration Rate. de Boer IH, Katz R, Chonchol M, Ix JH, Sarnak MJ, Shlipak MG, Siscovick DS, Kestenbaum B. Clin J Am Soc Nephrol. 2011 Aug 11. <ul><li>What are the main findings of the study? </li></ul><ul><li>This longitudinal observational study demonstrated that lower serum concentrations of 25-hydroxyvitamin D (25(OH)D) were associated with increased risk of estimated GFR loss. </li></ul><ul><li>The study was conducted among community-dwelling older adults with predominantly normal baseline eGFR who participated in the Cardiovascular Health Study. Adjusting for potential confounding characteristics, each 10 ng/mL lower 25(OH)D concentration was associated with a 25% greater risk of rapid GFR loss, defined as a loss of at least 12 mL/min/1.73m2 eGFR over the four years of follow-up (95% confidence interval 5%, 49%, p=0.01). </li></ul><ul><li>Compared with 25(OH)D >= 30 ng/mL, serum 25(OH)D concentration < 15 ng/mL was associated with a 68% higher risk of rapid GFR loss (95% confidence interval 1%, 177). Associations of 25(OH)D concentration with GFR loss were observed for participants with and without diabetes, but tended to be stronger among participants with diabetes. </li></ul><ul><li>Similar findings were observed evaluating a composite endpoint of rapid GFR loss, end stage renal disease, and death. </li></ul>Read the rest of the interview on Hemodialysis.com
  29. 30. Author Interview: Karen Shalansky , Pharm .D.Iron Indices After Administration of Sodium Ferric Gluconate Complex in Hemodialysis Patients Karen Shalansky, Jennifer Hanko, Morris Pudek, Guiyun Li, Jacek Jastrzebski American journal of kidney diseases 16 August 2011 (DOI: 10.1053/j.ajkd.2011.05.021) <ul><li>What are the main findings of the study? </li></ul><ul><li>Many hemodialysis units hold IV iron therapy for 2 weeks prior to assessing iron parameters (TSAT and Ferritin). The main finding in our study was that iron parameters can be measured 7 days after a dose of sodium ferric gluconate complex (FerrlecitÒ) to determine whether a change in iron dosage is required. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>The literature currently varies to hold IV iron compounds from 2-14 days prior to assessment of iron parameters; thus our conclusions are within the realm of the literature recommendations, and so are not unexpected. </li></ul><ul><li>What should clinicians and patients take away from this study? </li></ul><ul><li>Patients receiving maintenance IV iron therapy every 1-4 weeks do not need to have their dosage interrupted as iron indices can be measured 7 days after the last dose has been administered. From the patient’s perspective, they are less likely to experience fluctuations in the management of their anemia. </li></ul>Read the rest of the interview on Hemodialysis.com
  30. 31. Author Interview: Valjbona Tiric Preljevic MDPsychiatric disorders, body mass index and C-reactive protein in dialysis patients . Preljevic VT, Osthus TB, Sandvik L, Bringager CB, Opjordsmoen S, Nordhus IH, Os I, Dammen T. Department of Psychiatry, Oslo University Hospital Ullevål, 0407 Oslo, Norway; Faculty of Medicine, University of Oslo, 0316 Oslo, Norway. Gen Hosp Psychiatry. 2011 Aug 8. <ul><li>What are the main findings of the study? </li></ul><ul><li>A major finding was that dialysis patients with a BMI £ 21 kg/m2 and a CRP level ³ 6 mmol/L had four times higher odds of having depressive and/or anxiety disorder. As the majority of our patients with psychiatric comorbidity had such levels of CRP and BMI, this indicate a possible association between psychiatric comorbidity, inflammation, and malnutrition. Furthermore, we found a significant association between depressive disorder, high CRP and low BMI levels, which indicates that an association between psychiatric disorder, high CRP and low BMI was more likely to be explained by depression rather than by anxiety. </li></ul><ul><li>About one third of the dialyis patients in our study had depressive, anxiety, or somatoform disorder. Depression was the most common psychiatric disorder and was observed in one fifth of the patients. </li></ul><ul><li>We did not find any significant differences between the prevalence of depression or anxiety in patients on different dialysis modality. However, we observed a tendency toward lower psychiatric comorbidity in patients using PD. </li></ul><ul><li>Dialysis patients with psychiatric comorbidity had lower HRQoL scores, which indicates that suffering from anxiety and depression contribute to impaired HRQoL. . </li></ul>Read the rest of the interview on Hemodialysis.com
  31. 32. Author Interview Dr. Hitinder S. Gurm Renal Function-Based Contrast Dosing to Define Safe Limits of Radiographic Contrast Media in Patients Undergoing Percutaneous Coronary Interventions Hitinder S. Gurm, MD*,*, Simon R. Dixon, MBChB{dagger}, Dean E. Smith, PhD, MPH*, David Share, MD*, Thomas LaLonde, MD{ddagger}, Adam Greenbaum, MD§, Mauro Moscucci, MD, MBA|| BMC2 (Blue Cross Blue Shield of Michigan Cardiovascular Consortium) Registry J Am Coll Cardiol, 2011; 58:907-914, doi:10.1016/j.jacc.2011.05.023 <ul><li>What are the main findings of the study? </li></ul><ul><li>THE RISK OF CONTRAST INDUCED NEPHROPATHY WAS LOWEST WHEN THE CONTRAST DOSE/CREATININE CLEARANCE DID NOT EXCEED 2 AND WAS MARKEDLY ELEVATED WHEN THE RATION EXCEEDED 3. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>THESE FINDINGS ARE NOT UNEXPECTED SINCE IT FOLLOWS FROM BASIC PHARMACOLOGY PRINCIPLES. </li></ul><ul><li>What should clinicians and patients take away from this study? </li></ul><ul><li>ALL EFFORTS SHOULD BE MADE TO MINIMISE THE CONTRAST VOLUME USED FOR PCI. CATHETRIZATION LABORATORIES MAY WANT TO CONSIDER STRATEGIES TO MONITOR THE CONTRAST VOLUME/CREATININE RATIO TO ENSURE THAT EXCESSIVE DOSES OF CONTRAST ARE NOT BEING USED </li></ul>Read the rest of the interview on Hemodialysis.com
  32. 33. Authors' Interview:Julie A. Wright Nunes , MD MPH Kerri L. Cavanaugh, MD MHSAssociations among perceived and objective disease knowledge and satisfaction with physician communication in patients with chronic kidney disease Julie A Wright Nunes, Kenneth A Wallston, Svetlana K Eden, Ayumi K Shintani, T Alp Ikizler and Kerri L Cavanaugh Kidney International , (10 August 2011) | doi:10.1038/ki.2011.240? <ul><li>What are the main findings of the study? </li></ul><ul><li>The main finding of this study is that patients’ perceived knowledge is limited about many topics important to kidney disease care. In fact, the majority of the 400 patients surveyed reported knowing little or nothing about medications that help the kidney, medications that hurt the kidney, foods to avoid if kidney function is low, symptoms of chronic kidney disease, and functions of the kidney. We found a low-to-moderate correlation between perceived and objective kidney disease knowledge. Additionally, patients with higher perceived knowledge had higher odds of being satisfied with their provider’s communication. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>Our study revealed that although patient perceived and objective disease knowledge are associated, this association is low-to-moderate (0.32 Spearman correlation). Interestingly, their respective associations with patient’s satisfaction of communication are opposite. Higher perceived knowledge was associated with higher odds of greater satisfaction, but higher objective knowledge was associated with lower odds of satisfaction. Thus, it appears that perceived and objective disease knowledge are largely two separate constructs and may impact patient satisfaction, and possibly other outcomes, in very different ways. </li></ul>Read the rest of the interview on Hemodialysis.com
  33. 34. Author Interview: Ditte Hansen MDNo difference between alfacalcidol and paricalcitol in the treatment of secondary hyperparathyroidism in hemodialysis patients: a randomized crossover trial. Hansen D, Rasmussen K, Danielsen H, Meyer-Hofmann H, Bacevicius E, Lauridsen TG, Madsen JK, Tougaard BG, Marckmann P, Thye-Roenn P, Nielsen JE, Kreiner S, Brandi L. Kidney Int. 2011 Aug 10. doi: 10.1038/ki.2011.226. <ul><li>What are the main findings of the study? </li></ul><ul><li>Alfacalcidol has been used for treatment of secondary hyperparathyroidism and hypocalcemia for many years by the Danish and many European Nephrologists. Paricalcitol was introduced as a less hypercalcemic and hyperphosphatemic vitamin D analog. This was based on comparative studies mostly in animals between paricalcitol and another vitamin D analog; calcitriol. The present study compared alfacalcidol and paricalcitol in the treatment of secondary hyperparathyroidism in hemodialysis patients. </li></ul><ul><li>We found alfalcalcidol and paricalcitol to equally suppress secondary hyperparathyroidism, without any difference in the elevation of calcium or phosphate levels. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>As alfacalcidol is hydroxylated by the liver into calcitriol, we might expect similar findings as in the animal studies mentioned above.This would be a reduced increase in s-calcium and s-phosphate in the paricalcitol tretaed group. The present study may indicate an intrinsic effect of alfacalcidol or reflect that the results in animal studies not always can be applied into human. </li></ul>Read the rest of the interview on Hemodialysis.com
  34. 35. Author Interview: Dr. Elif Ari Accelerated atherosclerosis in haemodialysis patients; correlation of endothelial function with oxidative DNA damage. Kaya Y, Ari E, Demir H, Soylemez N, Cebi A, Alp H, Bakan E, Gecit I, Asicioglu E, Beytur A. Nephrol Dial Transplant. 2011 Aug 5. <ul><li>What are the main findings of the study? </li></ul><ul><li>In this cross-sectional analysis, we found that serum levels of oxidative stress markers and oxidative DNA damage are correlated with endothelial function in hemodialysis patients. We suggest that 8-hydroxydeoxyguanosine/deoxyguanosine ratio (8-OHdG/dG ratio) as well as oxidative enzyme malondialdehyde (MDA) and antioxidant enzymes superoxide dismutase (SOD) and glutathione peroxidase (GPx) are independent determinants of endothelial function in maintenance hemodialysis patients without known atherosclerotic disease. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>The association between oxidative DNA damage in terms of 8-OHdG/dG ratio and endothelial function in maintenance hemodialysis patients is a new finding in the current literature. </li></ul>Read the rest of the interview on Hemodialysis.com
  35. 36. Author Interview: Dr. Paraskevi Theofilou Quality of Life in Patients Undergoing Hemodialysis or Peritoneal Dialysis Treatment J Clin Med Res. 2011 May 19; 3(3): 132–138 Paraskevi Theofilou, Department of Psychology, Panteion University, Eratous 12, 14568, Athens, Greece. <ul><li>What are the main findings of the study? </li></ul><ul><li>Patients in the HD treatment, compared to PD treatment patients, reported a more compromised QoL in the domains of environment and social relationships. Accordingly, the HD group indicated experiencing less support from their community and social relationships. </li></ul><ul><li>Furthermore, HD compared to PD patients, indicated more problems in different aspects of their environment with a more negative evaluation, including availability/quality of health services, transportation, finances, recreation and opportunities for acquiring new skills and knowledge. </li></ul><ul><li>Regarding mental health, HD patients were found to evaluate less favourably their overall health status, reporting more physical and psychological symptoms, such as anxiety, sleeping problems and suicidal thoughts. </li></ul><ul><li>Concerning internal beliefs about current condition of health, both groups are comparable presenting a similar pattern, that is scoring higher in the dimension of internal locus, which is followed by the dimensions of chance, doctors and important others. A difference between the two treatment modalities concerns the relatively higher values of the HD patients in internal locus, indicating probably the emphasis on their own behavior for control over their current condition of health, perhaps a counterbalance for feelings of dependence on the machine. </li></ul><ul><li>On the contrary, PD seemed to give more importance to the function of doctors, probably because they need to be trained in peritoneal dialysis procedures with the help of medical professionals. </li></ul>Read the rest of the interview on Hemodialysis.com
  36. 37. Author Interview: Dr. Ian De BoerSerum 25-Hydroxyvitamin D and Change in Estimated Glomerular Filtration Rate. de Boer IH, Katz R, Chonchol M, Ix JH, Sarnak MJ, Shlipak MG, Siscovick DS, Kestenbaum B. Clin J Am Soc Nephrol. 2011 Aug 11. <ul><li>What are the main findings of the study? </li></ul><ul><li>This longitudinal observational study demonstrated that lower serum concentrations of 25-hydroxyvitamin D (25(OH)D) were associated with increased risk of estimated GFR loss. </li></ul><ul><li>The study was conducted among community-dwelling older adults with predominantly normal baseline eGFR who participated in the Cardiovascular Health Study. Adjusting for potential confounding characteristics, each 10 ng/mL lower 25(OH)D concentration was associated with a 25% greater risk of rapid GFR loss, defined as a loss of at least 12 mL/min/1.73m2 eGFR over the four years of follow-up (95% confidence interval 5%, 49%, p=0.01). </li></ul><ul><li>Compared with 25(OH)D >= 30 ng/mL, serum 25(OH)D concentration < 15 ng/mL was associated with a 68% higher risk of rapid GFR loss (95% confidence interval 1%, 177). Associations of 25(OH)D concentration with GFR loss were observed for participants with and without diabetes, but tended to be stronger among participants with diabetes. </li></ul><ul><li>Similar findings were observed evaluating a composite endpoint of rapid GFR loss, end stage renal disease, and death. </li></ul>Read the rest of the interview on Hemodialysis.com
  37. 38. Author Interview: Steven M. Brunelli A Model of Systolic Blood Pressure During the Course of Dialysis and Clinical Factors Associated With Various Blood Pressure Behaviors Kumar Dinesh, Srikanth Kunaparaju, Kathryn Cape, Jennifer E. Flythe, Harold I. Feldman, Steven M. Brunelli DOI: 10.1053/j.ajkd.2011.05.028 <ul><li>What are the main findings of the study? </li></ul><ul><li>Despite long-standing and widespread interest in blood pressure in the peri-dialytic period, we were surprised to realize that no one had characterized the patterns of blood pressure seen over the course of hemodialysis itself. There were several findings from this study that bear note. First, blood pressure over the course of dialysis does not decline in monotonic form. Instead, on average, it declines rapidly over the first quarter of treatment and much less rapidly over the remaining three quarters of treatment. Second, we identified several modifiable clinical practices that associate with different intra-dialytic blood pressure behaviors including fluid removal goals, ultrafiltration rate and choice among phosphate binders. Third, we determined that pre-to-post blood pressure rise is seen in approximately 1/3 of treatments, is associated with a wholly different intra-dialytic blood pressure pattern, and identified some potential precipitants thereof. </li></ul>Read the rest of the interview on Hemodialysis.com
  38. 39. Author Interview: Akshay S. Desai, MD and Marc A. Pfeffer , MD, PhDAssociation Between Cardiac Biomarkers and the Development of ESRD in Patients With Type 2 Diabetes Mellitus, Anemia, and CKD Desai AS, Toto R, Jarolim P, Uno H, Eckardt K-U, Kewalramani R, Levey AS, Lewis EF, McMurray JJV, Parving H-H, Solomon SD, Pfeffer MA. Cardiovascular Division, Brigham and Women's Hospital, Boston, MA. Am J Kid Dis 2011. <ul><li>What are the main findings of the study? </li></ul><ul><li>We studied the association between the cardiac-derived biomarkers troponin T (TnT) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and the development of end-stage renal disease (ESRD) in the first 1000 subjects with type 2 diabetes, chronic kidney disease, and anemia enrolled in TREAT (Trial to Reduce Cardiovascular Events with Aranesp Therapy). </li></ul><ul><li>In this ambulatory CKD population, we found that levels of both cardiac biomarkers were frequently elevated; 45% had TnT levels detectable at greater than the usual reference limit for myocardial necrosis and 38% had NT-proBNP levels exceeding conservative thresholds for heart failure diagnosis. </li></ul><ul><li>Levels of both cardiac biomarkers were higher in patients with lower eGFR and also in those with greater baseline proteinuria. TnT and NT-proBNP levels were associated independently with the risk of ESRD and the composite of death or ESRD even after adjustment for eGFR, proteinuria, and other known predictors of CKD progression. </li></ul>Read the rest of the interview on Hemodialysis.com
  39. 40. FMC to spend $2.1 billion on U.S. dialysis acquisitions for Liberty Dialysis and American Access Care <ul><li>(Reuters) - Fresenius Medical Care (FMEG.DE) announced two U.S. takeovers with a combined price tag of $2.09 billion on Tuesday, extending its lead as the largest dialysis company in the United States. </li></ul><ul><li>The Germany-based company said it would buy privately held Liberty Dialysis Holdings for $1.7 billion including about $1 billion in assumed debt. </li></ul><ul><li>That would add about 19,000 U.S. patients to the 140,000 FMC already has, while its nearest rival, DaVita (DVA.N), has 128,000 patients. </li></ul><ul><li>The U.S. Medicare system, which provides insurance for about 80 percent of FMC's U.S. patients, no longer pays clinic operators for individual services and drugs but instead pays a so-called &quot;bundled rate&quot; per dialysis session. </li></ul><ul><li>The lump-sum reimbursement, which is only paid if patients are being kept in good health, has created fresh incentives for clinics to cut costs, use drugs sparingly and renegotiate procurement prices, which tends to be easier for bigger operators. </li></ul><ul><li>Liberty is controlled by buyout firms KRG Capital Partners and Bain Capital and the deal, which is expected to close in early 2012, will add about $1 billion to FMC's annual sales. </li></ul>Read the rest of the interview on Hemodialysis.com
  40. 41. DaVita to Launch Dialyzer Recycling Pilot Project through Collaboration with Waste Management and BD, Becton, Dickinson and Company <ul><li>DENVER (Aug. 2, 2011) – DaVita Inc. (NYSE: DVA), a leading provider of kidney care services for those diagnosed with end stage renal disease (ESRD) and chronic kidney disease (CKD), today announced the company is leveraging the expertise of WM Healthcare Solutions, Inc., a subsidiary of Waste Management, Inc. (NYSE: WM), and BD (Becton, Dickinson and Company) to launch a dialyzer recycling pilot in 106 DaVita® dialysis clinics in Southern California. This recycling pilot project is expected to be the first of its kind in North America. </li></ul><ul><li>“ We have the potential to offset 350,000 pounds of dialyzer waste in this trial alone, which is incredible because until now, there has not been a ‘green’ way to dispose of dialyzers or other medical waste,” said Kent Thiry, chairman and CEO of DaVita. “This pilot program has the potential to change the landscape of sustainable health care, particularly in the dialysis industry, and we are excited to be at the forefront of it.” </li></ul><ul><li>This dialyzer recycling pilot builds on business solutions developed by BD and WM through the BD ecoFinity™ Life Cycle Solution program, which DaVita is also launching in the 106 pilot facilities. With the BD ecoFinity program, single-use medical sharps devices such as needles and syringes are collected on-site, then treated and processed by WM to recover reusable materials. BD then uses the recycled plastic to make new BD container products. The dialyzer recycling pilot follows a similar process: WM will treat and recover recyclable materials from the dialyzers, and then BD plans to use the recycled plastic to make new BD products or other applications, creating a closed-loop waste recovery solution of the recyclable materials. </li></ul>Read the rest of the interview on Hemodialysis.com
  41. 42. Author Interview: Eva Schepers Symmetric Dimethylarginine as a Proinflammatory Agent in Chronic Kidney Disease. Schepers E, Barreto DV, Liabeuf S, Glorieux G, Eloot S, Barreto FC, Massy Z, Vanholder R. Department of Internal Medicine, University Hospital Gent, Gent, Belgium; Clin J Am Soc Nephrol. 2011 Aug 4 <ul><li>What are the main findings of the study? </li></ul><ul><li>In our study we demonstrated both in vitro and in vivo, that SDMA, a uremic retention solute, is associated to the chronic inflammatory status in CKD patients. In vitro, SDMA activates NF-κB in monocytes resulting in an increased expression of TNF-α and IL-6 and both these effects were abbrogated by NAC. The pro-inflammatory character of SDMA was further confirmed in a clinical study in patients at different stages of CKD in which SDMA, besides being a marker for renal function, was shown to be associated with several markers of inflammation, like IL-6 and TNF-α. </li></ul><ul><li>ADMA, the structural counterpart of SDMA, was evaluated in parallel, but showed no in vitro effects and its association with inflammatory parameters in the clinical study was less pronounced. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>SDMA was for a long time considered to be inert while ADMA, an inhibitor of NOS, was generally accepted to be a marker of endothelial dysfunction and a predictor of cardiovascular disease. Therefore SDMA had rarely been considered in in vitro or clinical trials until recently. </li></ul><ul><li>In vitro, our group demonstrated that SDMA induced ROS production in monocytes involving Ca2+ influx, while ADMA did not. Also, in a holistic in vitro approach evaluating ten guanidino compounds SDMA exerted the highest number of pro-inflammatory and vascular damaging effects. Therefore, it was no surprise that SDMA induced cytokine production. The fact that ADMA showed no effect at all in vitro, even at rather high concentrations, was not necessarily expected. </li></ul><ul><li>The fact that SDMA was a better marker for renal function than ADMA might be attributed to their different removal from the body. While SDMA is completely eliminated by the kidneys in healthy conditions, ADMA is mainly enzymatically removed. Correlations of both compounds with inflammation described in literature are rather scarce, but are in correspondence to our in vitro findings. </li></ul>Read the rest of the interview on Hemodialysis.com
  42. 43. Author Interview: Shih-Bin Su, M.D., PhDRisk of Acute Kidney Injury after Exposure to Gadolinium-Based Contrast in Patients with Renal Impairment . Chien CC, Wang HY, Wang JJ, Kan WC, Chien TW, Lin CY, Su SB. Department of Nephrology, Chi-Mei Medical Center , Tainan , Taiwan. Ren Fail. 2011 Jul 22. <ul><li>What are the main findings of the study? </li></ul><ul><li>Answer: We found that baseline GFR, coronary artery disease, liver cirrhosis, diabetic mellitus, and hypertension were not significantly associated with the development of acute kidney injury (AKI) after Gadolinium-based contrast media (Gd-CM ) administrated at the usual dose for magnetic resonance imaging or magnetic resonance angiography examinations. </li></ul><ul><li>However, sepsis was an independent risk factor for AKI after Gd-CM administrated (adjusted odds ratio: 4.417; 95% confidence interval: 1.671, 11.676, P =.03) in patient with GFR below 90 ml/min/1.73m2. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>Answer: In our study, we found baseline GFR, diabetic mellitus were not associated with AKI after Gd-CM administrated; however, it is potential AKI after Gd-CM administrated under sepsis condition at the dose for MRI and MRA examinations. </li></ul>Read the rest of the interview on Hemodialysis.com
  43. 44. Author Interview: Dr. Manish M Sood The Role of Functional Status in Discharge to Assisted Care Facilities and In-Hospital Death Among Dialysis Patients. Sood MM, Rigatto C, Bueti J, Jassal V, Miller L, Verrelli M, Bohm C, Mojica J, Roberts D, Komenda P.University of Manitoba, Winnipeg, Manitoba, Canada; St Boniface Hospital, Winnipeg, Manitoba, Canada. Am J Kidney Dis. 2011 Aug 4. <ul><li>What are the main findings of the study? </li></ul><ul><li>We investigated 1,286 ESRD patients for survival and discharge to an Assisted living facility among patients admitted to one of 11 are hospitals in Winnipeg, Manitoba, Canada. </li></ul><ul><li>We found a simple 6 domain (bathing, dressing, feeding, transferring, toileting, continence) activities of daily living measurement within 24 hours of admission combined with age was highly predictive of in-hospital death or discharge to an assisted care facility. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>We were surprised on how well the simple ADL score predicted patient outcomes! </li></ul><ul><li>The ADL score was performed entirely by Allied Health care (physiotherapists, occupational therapists and nursing) over a network of eleven hospitals and in situations where assessment of the ADLs was unattainable due to illness, the measure was estimated. </li></ul><ul><li>Nevertheless the score combined with age differentiated the risk of death from 4.8-46.6% and discharge to an assisted care facility from 0.6-17.8%, a ten- and thirty-fold increase. Thus this cheap, easy, applicable on a large scale and sometimes, estimated measure was highly predictive. </li></ul>Read the rest of the interview on Hemodialysis.com
  44. 45. Author Interview: Cheng-Chia Lee, MD Comparable ten-year outcome in hemodialysis patients with hepatitis C virus and hepatitis B virus coinfection and single hepatitis B virus infection. Lee CC, Li IJ, Chen YC, Cheng JW, Wu HH, Weng CH, Fang JT, Tian YC. Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital, Taipei, and Department of Medicine, Chang Gung University, Taiwan, ROC. Blood Purif. 2011;32(2):89-95. <ul><li>What are the main findings of the study? </li></ul><ul><li>In this prospective observation analysis, we found that HBV and HCV coinfection in hemodialysis patients did not cause more severe liver disease or increase patient mortality in comparison with single HBV infection during 10-year follow-up. Moreover, HCV can suppress HBV replication in hemodialysis patients with HBV and HCV coinfection. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>It has been well documented that HBV and HCV coinfection causes more severeliver damage when compared with single HBV infection in nonuremic patients. However, this study demonstrated that HBV and HCV coinfection in hemodialysis patients did not cause more severe liver outcome with respect to the incidence of acute hepatitis, the development of liver cirrhosis and HCC during 10-year follow-up. </li></ul><ul><li>The serum HBV DNA level in patients with HBV and HCV coinfection was significantly lower than that in patients with single HBV infection. Nevertheless, complete eradication of serum HBV by HCV coinfection determined by both HBsAg and HBeAg seroclearance did not occur in patients with HBV and HCV coinfection, implying a suppressive but not eradication effect. </li></ul>Read the rest of the interview on Hemodialysis.com
  45. 46. Author Interview: Dr. María José Pérez-Sáez , Tandem Plasmapheresis and Hemodialysis: Efficacy and Safety. Pérez-Sáez MJ, Toledo K, Ojeda R, Crespo R, Soriano S, Alvarez de Lara MA, Martín-Malo A, Aljama P. Department of Nephrology, Hospital Universitario Reina Sofía , Córdoba , Spain. Ren Fail. 2011 Jul 20. <ul><li>What are the main findings of the study? </li></ul><ul><li>In our study, we analyzed our experience during the last 12 years using a technique that performs plasmapheresis and hemodialysis simultaneously. These two modalities are usually carried out independently on patients who require renal replacement therapy. We observed in 36 patients that tandem plasmapheresis and hemodialyisis significantly reduces the time of patient exposure to an extracorporeal circuit, decreasing the risks that are associated with anticoagulation agents and optimizing the human resources. There were not major complications during the 287 sessions that we analyzed. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>In fact, we expected a higher rate of extracorporeal circuit clotting, as there were two circuits simultaneously with a similar anticoagulation dose. Instead, we observed that it was not a frequent problem as it was not higher than we usually observed in our hemodialysis patients. </li></ul><ul><li>What should clinicians and patients take away from this study? </li></ul><ul><li>There is a very concise message: patients who need plasmapheresis and hemodialysis are suitable to undergo both techniques together, what means less time of treatment and, indirectly, less costs. </li></ul>Read the rest of the interview on Hemodialysis.com
  46. 47. Author Interview: Dr. Kurella Tamura Albuminuria , Kidney Function, and the Incidence of Cognitive Impairment Among Adults in the United States. Kurella Tamura M, Muntner P, Wadley V, Cushman M, Zakai NA, Bradbury BD, Kissela B, Unverzagt F, Howard G, Warnock D, McClellan W. Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA; Geriatric Research and Education Clinical Center, Palo Alto VA Health Care System, Palo Alto, CA. Am J Kidney Dis. 2011 Aug 2. <ul><li>What are the main findings of the study? </li></ul><ul><li>We found that albuminuria and low estimated GFR (glomerular filtration rate) were complementary but not additive risk factors for cognitive impairment in a large cohort of US adults. That is, when estimated GFR was preserved, albuminuria independently predicted cognitive impairment. When albuminuria was low or absent, low estimated GFR independently predicted cognitive impairment. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>Previous studies have shown that albuminuria and low estimated GFR were independent risk factors for death, cardiovascular events, and ESRD. We expected but did not find a similar relationship for cognitive impairment, and we speculate that this finding may reflect some distinct aspects about the pathophysiology of cognitive impairment versus other vascular outcomes. </li></ul><ul><li>What should clinicians and patients take away from this study? </li></ul><ul><li>One important take-home point is that patients who have a preserved estimated GFR (>60) but albuminuria were at the highest risk for cognitive impairment in our study. </li></ul><ul><li>What recommendations do you have for nephrology health care providers as a result of your study? </li></ul><ul><li>Markers of kidney function such as GFR and albuminuria may prove to be useful and simple measures to assess future risk for dementia and cognitive decline. </li></ul>Read the rest of the interview on Hemodialysis.com
  47. 48. Author Interview: Matthew Budoff , MDRelationship of Estimated GFR and Coronary Artery Calcification in the CRIC (Chronic Renal Insufficiency Cohort) Study. Budoff MJ, Rader DJ, Reilly MP, Mohler ER 3rd, Lash J, Yang W, Rosen L, Glenn M, Teal V, Feldman HI; CRIC Study Investigators. Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA. <ul><li>What are the main findings of the study? </li></ul><ul><li>This large prospective study (Chronic Renal Insufficiency Cohort study) demonstrated that renal insufficiency was independently associated with coronary atherosclerosis (as measured by coronary calcium), after controlling for cardiovascular risk factors and other measures. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>We found that phosphate levels were still strongly related to coronary calcium, even in the setting of chronic kidney disease (dialysis patients were excluded). This supports hypotheses that we need to start phosphate control and consider phosphate lowering therapies pre-dialysis. </li></ul><ul><li>What should clinicians and patients take away from this study? </li></ul><ul><li>Given the recent results of the SHARP trial, demonstrating that patients with renal insufficiency benefit from cholesterol lowering, and prior work that Coronary calcium is associated with adverse events, reinforces the need for clinicians to measure coronary calcium in patients with chronic kidney disease and treat accordingly (consider phosphate control if needed, consider statins and other anti-atherosclerotic therapies) </li></ul>Read the rest of the interview on Hemodialysis.com
  48. 49. Author Interview: Baris Afsar , M.DHbA1c Is Related with Uremic Pruritus in Diabetic and Nondiabetic Hemodialysis Patient Afsar B, Elsurer Afsar R. Department of Nephrology, Zonguldak Atatürk Government Hospital, Zonguldak, Turkey. Ren Fail. 2011 Mar 4. <ul><li>What are the main findings of the study? </li></ul><ul><li>The main findind of our study was that in both diabetic and non-diabetic subjects uremic pruritus was associated with hemoglobin A1c (HbA1c). </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>The unexpected finding of the study was the presence of association also in non-diabetic patients. Our findings are novel and preliminary. </li></ul><ul><li>What should clinicians and patients take away from this study? </li></ul><ul><li>As a take home massage it should be examined in randomized trials whether strict glycemic control lowers uremic pruritus. </li></ul>Read the rest of the interview on Hemodialysis.com
  49. 50. Author Interview: Luca De Nicola, MD-PhDPrognosis of CKD Patients Receiving Outpatient Nephrology Care in Italy CJASN August 2011 CJN.01180211 Luca De Nicola Paolo Chiodini Carmine Zoccali Silvio Borrelli Bruno Cianciaruso Biagio Di Iorio Domenico Santoro Vincenzo Giancaspro Cataldo Abateruss Ciro Gallo Giuseppe Conte Roberto Minutolo for the SIN-TABLE CKD Study Group <ul><li>What are the main findings of the study? </li></ul><ul><li>For the first time this study addresses the prognosis of CKD patients already seen (from at least one year) by nephrologist and the main findings in this specific population are </li></ul><ul><li>(1) ESRD is more frequent than death in stage 4 and 5 CKD, but the opposite is true in stage 3; </li></ul><ul><li>(2) among the main modifiable risk factors, proteinuria and high phosphate predict ESRD, whereas proteinuria, high uric acid, and anemia predict death; </li></ul><ul><li>(3) proteinuria must be considered in conjunction with eGFR to refine risk stratification. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>Absence of any predictive role of BP is somehow unexpected. </li></ul><ul><li>However, a recent paper from our group ( Minutolo R, Agarwal R, Borrelli S, Chiodini P, Bellizzi V, Nappi F, Cianciaruso B, Zamboli P, Conte G, Gabbai FB, De Nicola L. Prognostic role of ambulatory blood pressure monitoring in patients with non-dialysis CKD. Arch Int Med 2011; 171:1090-1098) has revealed in a large cohort of non-dialysis CKD patients that ABPM measures (24h BP) are more effective than office BP in predicting outcome. </li></ul>Read the rest of the interview on Hemodialysis.com
  50. 51. Author Interview: Tara I Chang, MD, MSSystolic Blood Pressure and Mortality in Patients on Hemodialysis. Chang TI. Curr Hypertens Rep. 2011 Jul 30. <ul><li>What should clinicians and patients take away from this review? </li></ul><ul><li>This review highlights and updates the reader on recent research and ongoing controversies regarding systolic blood pressure in patients on hemodialysis. For example, what blood pressure levels to target, how best to measure blood pressure (pre-dialysis, post-dialysis, home blood pressure or some other measurement), and how best to treat blood pressure (both pharmacological and non-pharmacological) remain uncertain. </li></ul><ul><li>What recommendations do you have for nephrology health care providers as a result of your review? </li></ul><ul><li>This review underscores the fact that although current guidelines provide a framework to guide nephrologists in managing blood pressure in patients on hemodialysis, many of these guidelines are based on relatively scant evidence. </li></ul><ul><li>Future research trials focusing on several aspects of blood pressure management in hemodialysis are still greatly needed. </li></ul>Read the rest of the interview on Hemodialysis.com
  51. 52. Author Interview: Dr. Joaquim Abian Proteomic Analysis of Polypeptides Captured from Blood during Extracorporeal Albumin Dialysis in Patients with Cholestasis and Resistant Pruritus . Gay M, Pares A, Carrascal M, Bosch-I-Crespo P, Gorga M, Mas A, Abian J. CSIC/UAB Proteomics Laboratory, Bellaterra, Spain. <ul><li>What are the main findings of the study? </li></ul><ul><li>A: We have identified a number of proteins that are captured from blood during albumin dialysis in a MARS system. It is accepted that the clinical effects of MARS dialysis are related to the removal of albumin-bound substances from the patient’s blood. However, there is little information on the collection of molecules captured, specially from peptides and proteins, as well as on the mechanisms involved. Some of the proteins we have detected in the albumin dialyzates are known to have important biological functions and their removal could be related either to therapeutic effects or to posible adverse effects associated with albumin dialysis. </li></ul><ul><li>We have also shown that SLURP1, one of the proteins removed by MARS from patients’ blood, was overrepresented in serum from patients with cholestasis. </li></ul>Read the rest of the interview on Hemodialysis.com
  52. 53. Author Interview: Tara I Chang, MD, MS Intradialytic Hypotension and Vascular Access Thrombosis Chang TI, Paik J, Greene T, Desai M, Bech F, Cheung AK, Chertow GM. Division of Nephrology, Stanford University School of Medicine, J Am Soc Nephrol. 2011 Aug;22(8):1526-33. <ul><li>What are the main findings of the study? </li></ul><ul><li>We found that intradialytic hypotension was significantly associated with vascular access thrombosis, and specifically with arteriovenous fistula thrombosis. </li></ul><ul><li>Patients on maintenance hemodialysis in the highest quartile of episodes intradialytic hypotension (defined as a drop in blood pressure during dialysis requiring an intervention), had a two-fold higher risk of fistula thrombosis compared to patients in the lowest quartile. </li></ul><ul><li>However, intravascular hypotension was not significantly associated with graft thrombosis after multivariable adjustment. We also showed that lower pre- and post-dialysis systolic blood pressure were associated with higher rates of both fistula and graft thrombosis. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>We were somewhat surprised at the lack of significant association of intravascular hypotension with graft thrombosis. </li></ul><ul><li>We hypothesized that this may have been due to the high inherent thrombogenicity of grafts, such that intradialytic hypotension would have minimal contribution to the graft’s intrinsically high risk of thrombosis. </li></ul>Read the rest of the interview on Hemodialysis.com
  53. 54. Author Interview: Dr. Stephen R. Hooper Neurocognitive functioning of children and adolescents with mild-to-moderate chronic kidney disease. Hooper SR, Gerson AC, Butler RW, Gipson DS, Mendley SR, Lande MB, Shinnar S, Wentz A, Matheson M, Cox C, Furth SL, Warady, BA. (2011).Clin J Am Soc Nephrol 6: 1824-1830. <ul><li>What are the main findings of the study? </li></ul><ul><li>The relationship between chronic kidney disease (CKD) and neurodevelopmental dysfunction in children has been examined using various approaches for the past several decades, with key studies dating back into the early 1980s. Despite this history, most of the published studies have focused on children with ESRD and/or samples comprised of different degrees of severity, with few studies focusing on the neurocognitive functioning of children with mild-to-moderate CKD. </li></ul><ul><li>The Chronic Kidney Disease in Children (CKiD) prospective cohort study is a multicenter longitudinal investigation which focuses exclusively on children with mild-to-moderate CKD. Utilization of the CKiD sample has provided one of the first large-scale opportunities to examine the neurocognitive functioning of children and adolescents with mild to moderate CKD. Several key findings were uncovered from this study. </li></ul><ul><li>First, consistent with earlier investigations of children with severe CKD or mixed severity samples, our results revealed that most children with mild-to-moderate CKD had average intelligence, age-appropriate academic skills, and intact attention/executive functioning. </li></ul>Read the rest of the interview on Hemodialysis.com
  54. 55. Author Interview: Dr. Delphine Tuot , MDCMChronic Kidney Disease Awareness Is Low Among Individuals with Clinical Markers of Kidney Dysfunction. Tuot DS, Plantinga LC, Hsu CY, Jordan R, Burrows NR, Hedgeman E, Yee J, Saran R, Powe NR; for the Centers for Disease Control Chronic Kidney Disease Surveillance Team. University of California, San Francisco, California; Clin J Am Soc Nephrol. 2011 Jul 22 <ul><li>What are the main findings of the study? </li></ul><ul><li>This study demonstrated that a person’s awareness of his/her chronic kidney disease (CKD) is related to the number of abnormal manifestations that often accompany kidney disease; this happens independent of eGFR. </li></ul><ul><li>However, only 1 in 8 persons in the United States with both CKD and at least 6 clinical markers of CKD is aware of their kidney disease. Of the common markers of CKD (anemia, acidosis, hyperkalemia, hyperphosphatemia, elevated blood urea nitrogen, uncontrolled hypertension and albuminuria) only albuminuria is associated with increased awareness of chronic kidney disease. </li></ul>Read the rest of the interview on Hemodialysis.com
  55. 56. Author Interview: Dr. Craig GordonLong-Term Viral Negativity After Interferon for Chronic Hepatitis C Virus Infection in Hemodialysis. Gordon CE, Uhlig K, Schmid CH, Levey AS, Wong JB. Department of Medicine, Boston University Medical Center, Boston, Massachusetts; Clin J Am Soc Nephrol. 2011 Jul 22. <ul><li>What are the main findings of the study? </li></ul><ul><li>We found through a systematic review of the literature and meta-analysis that most hepatitis C virus infected patients undergoing hemodialysis who are successfully treated with interferon or pegylated-interferon-based treatment and achieved sustained virological response (hepatitis C virus negative 6 months after treatment) remain viral negative after four years of followup or longer. Importantly, this long-term viral negativity occured in patients who remained on hemodialysis and those who later underwent kidney transplantation, in spite of the possibility that immunosuppression could lead to a viral relapse. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>These findings were not necessarily expected because the assumption is that hepatitis C virus treatment is less effective in dialysis patients, so this is an important finding that not only do hemodialysis patients have reasonably high rates of clearing the virus, but that about 90% of patients will remain viral negative for 4 years or longer. This is comparable to the rates seen in the general population. </li></ul>Read the rest of the interview on Hemodialysis.com
  56. 57. Author Interview: Dr. Carlo MannoDesmopressin acetate in percutaneous ultrasound-guided kidney biopsy: a randomized controlled trial. Manno C, Bonifati C, Torres DD, Campobasso N, Schena FP. Nephrology, Dialysis and Transplant Unit, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, Bari, Italy. Am J Kidney Dis. 2011 Jun;57(6):850-5. <ul><li>The main findings of the randomized controlled trial are: </li></ul><ul><li>a) Post-biopsy bleeding were less common in patients who received desmopressin [ 13.7% versus 30.5%; relative risk 0.45, 95% CI 0.24-0.85] than in patients receiving placebo; </li></ul><ul><li>b) the size of hematoma in patients who experienced bleeding on the screening ultrasound was smaller in those receiving desmopressin; </li></ul><ul><li>c) the drug was well tolerated; </li></ul><ul><li>d) mean hospital stay was less in the desmopressin group than in placebo group. </li></ul>Read the rest of the interview on Hemodialysis.com
  57. 58. Author Interview: Dr. Laura Maursetter Review of the mechanism and nutrition recommendations for patients undergoing continuous renal replacement therapy. Maursetter L, Kight CE, Mennig J, Hofmann RM. R. Michael Hofmann, Section of Nephrology, Department of Internal Medicine, University of Wisconsin School Nutr Clin Pract. 2011 Aug;26(4):382-90. <ul><li>What are the main findings of the study? </li></ul><ul><li>Continuous renal replacement therapy can be a topic of confusion for health care providers. </li></ul><ul><li>A basic understanding is important for all of those taking care of the critically ill patient so optimal drug administration, nutrition administration and fluid balance can be provided. </li></ul><ul><li>Herein we review the topic of continuous renal replacement written while keeping the non-nephrologist in mind. </li></ul><ul><li>The goal of the publication is to provide a basic mechanistic understanding for all health care providers to be able to tailor their services for a patient receiving this therapy. </li></ul><ul><li>It also reviews topics concerning nutrition, considerations surrounding drug dosing and brings up issues that the primary care team needs to know about continuous dialysis. </li></ul><ul><li>It is an article that is useful for as an overview or reference that can be understood by the entire health team. </li></ul>Read the rest of the interview on Hemodialysis.com
  58. 59. Author Interview: Dr. Giuseppe Cianciolo VDR Expression on Circulating Endothelial Progenitor Cells in Dialysis Patients Is Modulated by 25(OH)D Serum Levels and Calcitriol Therapy. Cianciolo G, La Manna G, Cappuccilli ML, Lanci N, Della Bella E, Cuna V, Dormi A, Todeschini P, Donati G, Alviano F, Costa R, Bagnara GP, Stefoni S. Blood Purif. 2011 Jul 9;32(3):161-173. <ul><li>What are the main findings of the study? </li></ul><ul><li>Endothelial progenitor cells (EPCs) play a key role in maintaining and repairing vascular integrity in response to endothelial injury. Reduced EPC number affects the risk of coronary artery disease and cardiovascular mortality and morbidity in subjects with normal renal function and CKD. The exact role and the factors involved in the regulation of EPCs (number and function) in patients with cardiovascular disease with or without ESRD remain controversial. There is evidence supporting the hypothesis that there are multiple VDR-mediated cardiovascular functions and it has also been suggested that Vitamin D may directly affect endothelial function. </li></ul><ul><li>The present study was planned to evaluate in ESRD patients either the factors involved in the number of endothelial progenitor cells (EPCs) or to ascertain the presence of VDR on these cells as well as the determinants of its expression on EPCs. </li></ul><ul><li>We demonstrated that some factors differently involved in uremic syndrome (namely inflammation, hemoglobin, reticulocyte counts, diabetes, 25(OH)D and therapy with vitamin D) could influence, to different extents, the number of EPCs and VDR expression. </li></ul>Read the rest of the interview on Hemodialysis.com
  59. 60. . Author Interview: Yueh-Han Hsu, MD, MPHThe Association of Betel Nut Chewing with Chronic Kidney Disease: A Retrospective 7-year Study in Taiwan Nephrology (Carlton). 2011 Jul 7. <ul><li>What are the main findings of the study? </li></ul><ul><li>In this cross-sectional study, we found a conditional association of BN chewing with CKD in males, non-drinkers, and those without diabetes or proteinuria, which is unique to previous studies. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>It is interesting to note that, on collective data, non-chewing population seemed to have higher prevalence of CKD than chewing population; however, when the data was further stratified by age per decades, chewing people have higher CKD prevalence than non-chewing people in all age groups. </li></ul><ul><li>It is understandable that age composition of the cohort may not be even, and may therefore influence the result. </li></ul>Read the rest of the interview on Hemodialysis.com
  60. 61. Author Interview: Katherine Pearson, MPPTransplanting Kidneys Without Points for HLA-B Matching: Consequences of the Policy Change. American Journal of Transplantation. Ashby, V. B., Port, F. K., Wolfe, R. A., Wynn, J. J., Williams, W. W., Roberts, J. P. and Leichtman, A. B. <ul><li>What are the main findings of the study? </li></ul><ul><li>That kidney allocation without priority for HLA-B similarity promotes equitable opportunity for transplant candidates of all races, and is not associated with adverse outcomes. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>These findings were expected based upon SRTR modeling. </li></ul><ul><li>What should clinicians and patients take away from this study? </li></ul><ul><li>That kidney allocation without priority for HLA-B similarity promotes equitable opportunity for transplant candidates of all races, and is not associated with adverse outcomes. </li></ul>Read the rest of the interview on Hemodialysis.com
  61. 62. Author Interview: Dr. Christopher Chan, MDImproved parathyroid hormone control by cinacalcet is associated with reduction in darbepoetin requirement in patients with end-stage renal disease. Battistella M, Richardson RM, Bargman JM, Chan CT. Division of Nephrology, Department of Medicine, University Health Network, Toronto, ON, Canada. Clin Nephrol. 2011 Aug;76(2):99-103. <ul><li>What are the main findings of the study? </li></ul><ul><li>Our study demonstrated that medical improvement in parathyroid hormone level by cinacalcet is associated with a reduction in darbepoietin requirement. </li></ul><ul><li>In addition, the magnitude of PTH reduction is directly associated with the degree in darbepoetin dose reduction. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>It was interesting to note that there were 2 patients who despite achieving greater than 300 pmol/L reduction in PTH levels, their darbepoetin requirements increased. </li></ul><ul><li>It is reasonable to speculate that our present data suggest a threshold where end organ damage caused by sustained severe elevation of parathyroid hormone is no longer reversible and this may be secondary to severe bone marrow fibrosis. </li></ul>Read the rest of the interview on Hemodialysis.com
  62. 63. Author Interview: Dr. Elif Ari Oxidative DNA damage correlates with carotid artery atherosclerosis in hemodialysis patients. Ari, E., Kaya, Y., Demir, H., Cebi, A., Alp, H. H., Bakan, E., Odabasi, D. and Keskin, S. Hemodialysis International. doi: 10.1111/j.1542-4758.2011.00568.x (2011) <ul><li>What are the main findings of the study? </li></ul><ul><li>In this cross-sectional analysis, we found that serum levels of oxidative stress markers and oxidative DNA damage are correlated with carotid artery atherosclerosis in hemodialysis patients. We suggest that 8-hydroxydeoxyguanosine/deoxyguanosine ratio (8-OHdG/dG ratio) as well as oxidative enzyme malondialdehyde (MDA) and antioxidant enzymes superoxide dismutase (SOD) and glutathione peroxidase (GPx) are independent determinants of carotid artery intima-media thickness in maintenance hemodialysis patients without known atherosclerotic disease. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>The association between oxidative stress and antioxidant enzyme status and carotid artery intima-media thickness is a known issue in the current literature. But the association between oxidative DNA damage in terms of 8-OHdG/dG ratio and carotid artery intima-media thickness is a new finding. </li></ul>Read the rest of the interview on Hemodialysis.com
  63. 64. Author Interview: Dr. John CoffeySPECT MIBI imaging for cardiac output and index in end stage renal disease. Coffey JP, Woywodt A, Hill JC. Department of Nuclear Medicine, Royal Preston Hospital, Fulwood, Preston, UK Department of Renal Medicine, Hemodial Int. 2011 Jul;15(3):320-5. doi: 10.1111/j.1542-4758.2011.00565.x. <ul><li>What are the main findings of the study? </li></ul><ul><li>Cardiac output appears to be elevated in patients with end stage renal failure and this is independent of the presence of arterio-venous fistula. </li></ul><ul><li>This finding is unexpected as previous literature has focused on cardiac output in only those patients in end stage renal failure with fistulas. </li></ul><ul><li>Other factors in renal failure such as anaemia and secondary hyperparathyroidism may contribute cumulatively to elevation of cardiac output. These complications should therefore be carefully monitored. </li></ul><ul><li>SPECT/CT perfusion imaging or echocardiography provide convenient methods of assessing cardiac output and myocardial function and perfusion. </li></ul><ul><li>As elevated cardiac output can predispose to high output failure, drug treatment may need to be monitored in order not to exacerbate the situation. </li></ul>Read the rest of the interview on Hemodialysis.com
  64. 65. Drs. Nazanin Noori MD Ph.D & Kamyar Kalantar-Zadeh , MD, MPH, PhD Dietary Omega-3 Fatty Acid, Ratio of Omega-6 to Omega-3 Intake, Inflammation, and Survival in Long-term Hemodialysis Patients Am J Kidney Dis. 2011 Jun 7. <ul><li>What are the main findings of the study? </li></ul><ul><li>The main finding is that lower dietary omega-6 to omega-3 ratio in ingested food may be associated with both decreased inflammation and lower mortality risk in maintenance HD patients even when we adjusted for all related confounders including intakes of energy, saturated fatty acid,trans-fats, cholesterol, and fiber. </li></ul><ul><li>In the fully adjusted models, each 1-unit higher dietary omega-6 to omega-3 ratio was associated with a 0.55-mg/L increase in serum CRP level. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>Higher Omega 3 in the diet alone was not strongly associated with lower mortality. </li></ul><ul><li>Moreover, although higher dietary omega-3 intake alone was associated with higher decrease in serum CRP level the trend was not significant, which may be due to inadequate statistical power from limited sample size. </li></ul>Read the rest of the interview on Hemodialysis.com
  65. 66. Author Interview: Dr. Daniel WeinerCardiovascular Disease and Cognitive Function in Maintenance Hemodialysis Patients. Weiner DE, Scott TM, Giang LM, Agganis BT, Sorensen EP, Tighiouart H, Sarnak MJ. Division of Nephrology, Tufts Medical Center, Boston, MA. Am J Kidney Dis. 2011 Jul 19 <ul><li>What are the main findings of the study? </li></ul><ul><li>Cardiovascular disease is common among dialysis patients, but physicians and other practitioners often pay less attention to other cardiovascular systems beside the heart and the peripheral vasculature. This includes cerebrovascular disease, which may have subtle but important manifestions, the most notable of which is cognitive impairment. </li></ul><ul><li>In this study, we examined whether hemodialysis patients with either coronary disease or peripheral vascular disease had worse cognitive functioning, and we noted that this was in fact the case. In particular, dialysis patients with cardiovascular disease performed, on average, a half standard deviation worse on a detailed assessment of executive functioning but did not have significant memory impairment when compared to hemodialysis patients. </li></ul><ul><li>Executive functions broadly encompass processes responsible for planning, abstract thinking, and cognitive flexibility, all of critical importance for individuals managing a complex chronic illness like kidney failure requiring dialysis, and impairment in executive functioning may make it even more challenging for hemiodialysis patients to follow up on doctors appointments and keep track of medication and nutritional regimens like phosphorus binders and diabetes management - all skills which are very important for hemodialysis patients. </li></ul><ul><li>Critically, a screening test like the minimental state examination provided no insight into the presence of cognitive impairment in executive function domains. </li></ul>Read the rest of the interview on Hemodialysis.com
  66. 67. Author Interview: Dr. Florence Sens Survival advantage of hemodialysis relative to peritoneal dialysis in patients with end-stage renal disease and congestive heart failure. Sens F, Schott-Pethelaz AM, Labeeuw M, Colin C, Villar E. Kidney Int. 2011 Jul 20. doi: 10.1038/ki.2011.233. 1] Department of Nephrology, Hospices Civils de Lyon, Lyon-Sud University Hospital, Pierre Benite, France [2] <ul><li>What are the main findings of the study? </li></ul><ul><li>This study showed that mortality risk associated with peritoneal dialysis was significantly higher than the one associated with hemodialysis. This result was based on a prospective, recent, large, non-selected and population-based cohort from the French Renal Epidemiology and Information Network (REIN) registry. Result was consistent among patient sub-groups by eGFR at dialysis onset, NYHA CHF stages, age or diabetes status, and by origins of follow-up or statistic methods. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>These results in France were in line with results showed in the US by Stack et al (1). But, opposite to France, congestive heart failure patients in Stack’s study were less likely to be treated with PD than non-heart failure patients (10.5% vs. 14.5%). We thought that it could have influenced results, which might have conducted to negative results in our study. This was obviously not the case. </li></ul>Read the rest of the interview on Hemodialysis.com
  67. 68. Author Interview: Dr. Rajnish Mehrotra Association of Hemoglobin and Survival in Peritoneal Dialysis Patients Miklos Z. Molnar, Rajnish Mehrotra, Uyen Duong, Csaba P. Kovesdy, and Kamyar Kalantar-Zadeh CJASN July 22, 2011 CJN.010502 <ul><li>What are the main findings of the study? </li></ul><ul><li>Inability to correct anemia with erythropoiesis-stimulating agents in end-stage renal disease patients treated with peritoneal dialysis is associated with a significantly higher risk for death. </li></ul><ul><li>These findings in peritoneal dialysis patients are consistent with the previous such reports in patients treated with hemodialysis and those with chronic kidney disease prior to the need for dialysis. </li></ul><ul><li>Were any of the findings unexpected? </li></ul><ul><li>Unlike the results of randomized controlled trials, we were unable to demonstrate a higher risk for death in such patients with higher achieved hemoglobin. This suggests that the higher risk for death in patients randomized to higher target hemoglobin levels may be related to a high ESA doses required to achieve the target, rather than the high hemoglobin itself. </li></ul><ul><li>Nothwithstanding this observation, in observational studies like these, it is hard to dissect the precise roles of achieved hemoglobin and ESA doses in mediating the death risk. </li></ul>Read the rest of the interview on Hemodialysis.com
  68. 69. Author Interview: Dr. Gerjan Navis Vascular endothelial growth factor C levels are modulated by dietary salt intake in proteinuric chronic kidney disease patients and in healthy subjects . Slagman MC, Kwakernaak AJ, Yazdani S, Laverman GD, van den Born J, Titze J, Navis G. 1Department of Medicine, Division of Nephrology, University Medical Center Groningen, Nephrol Dial Transplant. 2011 Jul 21 <ul><li>In healthy subjects as well as renal patients, a high sodium intake is associated with a rise in circulating VEGFc levels. In the renal patients, VEGF-c levels were higher than in healthy subjects during low as well as high sodium intake. Our findings support the presence of the VEGFc-macrophage-lymphangiogenesis pathway for non-osmotic storage of sodium and buffering of the effects of high sodium on blood pressure, previoulsy demonstrated in experimental animals, now for the first time in human. </li></ul><ul><li>In the healthy subjects, we also measured extracellular volume. The latter increased during high sodium intake, demonstrating that osmotic and non-osmotic storage of sodium act in concert. In healthy subjects, blood pressure was resistant to the high sodium intake. In the renal patients high sodium intake elicited a rise in blood pressure, despite stimulation of the VEGFc-macrophage-lymphangiogenesis pathway. The latter was apparently unable to buffer the effect of high sodium intake in these patients </li></ul>Read the rest of the interview on Hemodialysis.com
  69. 70. Author Interview: Dr. Florian Knoll Coumarins and survival in incident dialysis patients. Knoll F, Sturm G, Lamina C, Zitt E, Lins F, Freistätter O, Kronenberg F, Lhotta K, Neyer U. 1Department of Nephrology and Dialysis; Feldkirch Academic Teaching Hospital, Feldkirch, Austria. Nephrol Dial Transplant. 2011 Jul 18. <ul><li>What are the main findings of the study? </li></ul><ul><li>1.) Dialysis patients have a high incidence and prevalence of atrial fibrillation. </li></ul><ul><li>2.) Mortality in dialysis patients with atrial fibrillation was significantly higher compared to dialysis patients with sinus rhythm. </li></ul><ul><li>3.) Coumarin therapy with tight control of INR was not associated with an increased mortality risk, both in patients with atrial fibrillation and with sinus rhythm and other clear indications for oral anticoagulation therapy. </li></ul><ul><li>4.) No patient under sufficient oral anticoagulation therapy and close monitoring experienced a stroke or a fatal bleeding event. </li></ul><ul><li>The main differences to studies that reported increased mortality risk with oral anticoagulation in dialysis patients were clear indications and frequent INR monitoring in our study population. Notably, access thrombosis was not an indication for oral anticoagulation. </li></ul>Read the rest of the interview on Hemodialysis.com
  70. 71. Author Interview: Dr. Matthew AbramowitzAssociation of serum bicarbonate levels with gait speed and quadriceps strength in older adults. Abramowitz MK, Hostetter TH, Melamed ML. Division of Nephrology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY; Department of E

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