Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Hemodialysis.com Research Interviews January 5 2013

681 views

Published on

Nephrology Research exclusvie author interviews on ESRD, CKD, dialysis and hemodialysis.

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

Hemodialysis.com Research Interviews January 5 2013

  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 info@hemodialysis.com December 15 2012 For Informational Purposes Only: Not for Specific Medical Advice.For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  2. 2. Hemodialysis.com Interviews January 5 2013For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  3. 3. Medical Disclaimer | Terms and Conditions• The contents of the Hemodialysis.com Site, such as text, graphics, images, and other material contained on the Hemodialysis.com Site ("Content") are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on the Hemodialysis.com Site!• If you think you may have a medical emergency, call your doctor or 911 immediately. Hemodialysis.com does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Site. Reliance on any information provided by Hemodialysis.com or other Eminent Domains Inc (EDI) websites, EDI employees, others appearing on the Site at the invitation of Hemodialysis.com or EDI, or other visitors to the Site is solely at your own risk.• The Site may contain health- or medical-related materials that are sexually explicit. If you find these materials offensive, you may not want to use our Site. The Site and the Content are provided on an "as is" basis.For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  4. 4. Microalbuminuria and hyperfiltration in subjects with nephro-urological disorders Hemodialysis.com Author Interview: Francois Cachat MD Department of Pediatrics, Division of Pediatric Nephrology, University Hospital, Lausanne, Switzerland• Hemodialysis.com Editor Marie Benz: What are the main findings of the study?• In children with chronic nephro-urological disorders, there was only a weak association between microalbuminuria and filtration fraction, and this only in children with a single kidney and normal GFR. In all other patients, there was no association between microalbuminuria and filtration fraction.• Hemodialysis.com: Were any of the findings unexpected?• The fact that children with a single kidney showed only a weak association between microalbuminuria and filtration fraction is surprising. These children have lost 50% of their nephron mass, sometimes more, and one would expect a much stronger association in that case. Their young age might explain in part this negative finding.For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  5. 5. Microalbuminuria and hyperfiltration in subjects with nephro-urological disorders Hemodialysis.com Author Interview: Francois Cachat MD Department of Pediatrics, Division of Pediatric Nephrology, University Hospital, Lausanne, Switzerland (cont)• Hemodialysis.com: What should clinicians and patients take away from your report?• Microalbuminuria should not be used to suspect or detect hyperfiltration in children with chronic nephro-urological disorders.• Hemodialysis.com: What recommendations do you have for future research as a result of this study?• It would be interesting to study subjects with a single kidney at a much later age, to see if they finally develop microalbuminuria in relation to a high filtration rate. Also, adult kidney donors would be interesting to study: adults might react differently to an acute loss of nephron than children with congenital anomalies.• Reference:• Microalbuminuria and hyperfiltration in subjects with nephro-urological disorders Francois Cachat, Christophe Combescure, Hassib Chehade, Gregory Zeier, Dolores Mosig, Blaise Meyrat, Peter Frey, and Eric Girardin Microalbuminuria and hyperfiltration in subjects with nephro-urological disorders Nephrol. Dial. Transplant. first published online December 6, 2012 doi:10.1093/ndt/gfs494For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  6. 6. Serum Adiponectin Levels and Mortality after Kidney Transplantation Hemodialysis.com Author Interview: Ahsan Alam, MD, CM, MS, FRCP(C) Assistant Professor of Medicin Division of Nephrology McGill University Health Centre - Royal Victoria Hospital Montreal, Quebec, Canada H3A 1A1• Hemodialysis.com Editor Marie Benz: What are the main findings of the study?• Our study examined the association of an adipose-tissue derived hormone, adiponectin, on clinical outcomes in prevalent kidney transplant recipients. We found plasma levels of adiponectin to be associated with a 44% increase hazard for all-cause mortality in a large cohort of prevalent, stable kidney transplant recipients. This association was independent of estimated GFR and many conventional cardiovascular risk factors.• Hemodialysis.com: Were any of the findings unexpected?• Adiponectin has been identified to have anti-inflammatory and cardioprotective properties in healthy individuals, although patients with CKD and on hemodialysis exhibit a paradoxical risk relationship where higher levels are associated with adverse outcomes. In stable kidney transplant recipients with partial restoration of kidney function we found this this protective role was not re-established. Instead, all-cause mortality was higher in those with higher plasma adiponectin levels. Interestingly, death-censored graft failure was not associated with adiponectin. Also, in our study we did not find the risk of adiponectin on all-cause mortality was accounted for by markers of malnutrition or inflammation.For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  7. 7. Serum Adiponectin Levels and Mortality after Kidney Transplantation Hemodialysis.com Author Interview: Ahsan Alam, MD, CM, MS, FRCP(C) Assistant Professor of Medicin Division of Nephrology McGill University Health Centre - Royal Victoria Hospital Montreal, Quebec, Canada H3A 1A1 (cont)• Hemodialysis.com: What should clinicians and patients take away from your report?• Over the past several decades, advances in immunosuppression management have led to improved early graft and patient outcomes. Nevertheless, the burden of cardiovascular mortality remains a central long-term challenge in this population. Attention should be placed on non- traditional cardiovascular risk factors. Adiponectin, a non-traditional atherosclerotic risk factor in those with kidney disease, may help to identify individuals at a higher risk of all-cause mortality after kidney transplantation.• Hemodialysis.com: What recommendations do you have for future research as a result of this study?• It remains unclear from our study whether plasma adiponectin levels are indeed pathologic or simply a biomarker for increased mortality after kidney transplantation. Factors that modulate plasma adiponectin levels and its relationship with other novel biomarkers should be explored. Whether modifying adiponectin levels could represent a therapeutic target or directly alter patient outcomes remains to be determined in future clinical studies and trials.• Reference:• Serum Adiponectin Levels and Mortality after Kidney Transplantation. Alam A, Molnar MZ, Czira ME, Rudas A, Ujszaszi A, Kalantar-Zadeh K, Rosivall L, Mucsi I. Division of Nephrology, McGill University Health Centre, Montreal, Quebec, Canada;, †Institute of Pathophysiology and, ‡Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary;, §Harold Simmons Center for Chronic Disease Research & Epidemiology, University of California Irvine Medical Center, Irvine, California; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California;, ‖Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada, ¶Division of Nephrology & Hypertension, University of California Irvine Medical Center, Orange, California. Clin J Am Soc Nephrol. 2012 Dec 6. [Epub ahead of print]For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  8. 8. Cost effectiveness of the interferon-γ release assay for tuberculosis screening of hemodialysis patients Hemodialysis.com Author Interview: Akiko Kowada, MD, PhD Kojiya Haneda Healthcare Service, Ota City Public Health Office, Tokyo, Japan• Hemodialysis.com Editor Marie Benz: What are the main findings of the study?• The interferon-gamma release assay (IGRA) yields greater benefits at a lower cost than tuberculin skin test and chest x-ray examination for the tuberculosis screening of hemodialysis patients.• Hemodialysis.com: Were any of the findings unexpected?• The cost-effectiveness was not sensitive to the rates of latent tuberculosis infection and active tuberculosis in dialysis patients.• Hemodialysis.com: What should clinicians and patients take away from your report?• Clinicians should recommend the IGRA for tuberculosis screening of hemodialysis patients on the basis of the cost-effectiveness, as well as its superior sensitivity and specificity, instead of tuberculin skin test and chest x-ray examination.• Hemodialysis.com: What recommendations do you have for future research as a result of this study?• Future research is needed to evaluate the results of this cost effectiveness by using the data of prospective cohort studies in dialysis patients.• Reference:• Cost effectiveness of the interferon-γ release assay for tuberculosis screening of hemodialysis patients Akiko Kowad Nephrol. Dial. Transplant. first published online December 13, 2012 doi:10.1093/ndt/gfs479For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  9. 9. Reliability of Blood Pressure Parameters for Dry Weight Estimation in Hemodialysis Patients Hemodialysis.com Authors Interview: Paweena Susantitaphong, MD Prof. Somchai Eiam-Ong, MD Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University Bangkok, Thailand• Hemodialysis.com Editor Marie Benz: What is the Study Purpose?• Chronic volume overload resulting from interdialytic weight gain and inadequate fluid removal plays a significant role in poorly controlled high blood pressure (BP) in hemodialysis (HD) patients. There was a direct relationship between decreased body weight and reduced BP during follow-up. Clinical judgment could lead to over- or under-estimation of dry weight (DW). Bioimpedance analysis (BIA) has been introduced for accurately assessing the ideal DW. Because of the limited availability of BIA instrument, it is of interest to determine the role of BP parameters in assessing hydration status. Therefore, we examined the correlation between the hydration status measured by BIA and BP parameters. Extracellular water/total body water (ECW/TBW) determined by sum of segments from BIA was utilized as an index of hydration status.• Hemodialysis.com: What are the main findings of the study?• Pre-dialysis ECW/TBW was significantly correlated with only pulse pressure (PP) whereas post-dialysis ECW/TBW had significant correlations with PP, systolic blood pressure (SBP), and diastolic blood pressure (DBP). ECW/TBW was used to classify the patients into normohydration (£0.4) and overhydration (>0.4) groups. SBP, mean arterial pressure, and PP significantly reduced after dialysis in normohydration group but did not significantly change in overhydration group. Pre-dialysis PP, post-dialysis PP, and post-dialysis SBP in overhydration group were significantly higher than normohydration group.For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  10. 10. Reliability of Blood Pressure Parameters for Dry Weight Estimation in Hemodialysis Patients Hemodialysis.com Authors Interview: Paweena Susantitaphong, MD Prof. Somchai Eiam-Ong, MD Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University Bangkok, Thailand (cont)• Hemodialysis.com: What should clinicians and patients take away from your report?• Achieving actual DW is the goal standard of HD care. Frequent and continuous DW assessments are of important concerns. Due to the efficacy, simplicity, and cost reason, bed-side intervention such as monitoring of BP parameters, especially PP, might be an alternative option in determining hydration status in HD patients. In special population groups such as elderly and diabetes patients that might have non-volume factors, however, it should be cautious to use these BP parameters alone to assess hydration status.• Hemodialysis.com: What recommendations do you have for future research as a result of this study?• The strength of the present study is the use of the bed-side intervention as BP parameters which are simple and inexpensive to help the clinicians in assessing hydration status in HD patients. However, some limitations should be emphasized. 1) we did not examine the long-term effect of fluid removal on BP parameters as well as hard outcomes such as cardiovascular morbidity and mortality. 2) The exact cut-off value of ECW/TBW to determine the normohydration in HD patients is still unestablished. Finally, the sample size was quite small, calling for the design of the larger sample size, randomized controlled trials with long-term follow up.• Reference:• Reliability of Blood Pressure Parameters for Dry Weight Estimation in Hemodialysis PatientsFor Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  11. 11. Intravenous ferric carboxymaltose versus standard medical care in the treatment of iron deficiency anemia in patients with chronic kidney disease: a randomized, active-controlled, multi-center study Hemodialysis.com Author Interview: Chaim Charytan, M.D. Director, Nephrology, New York Hospital Medical Center of Queens, Flushing, NY, Adjunct Clinical Professor of Medicine at Weill Medical College of Cornell University• Hemodialysis.com Editor Marie Benz: What are the main findings of the study?• In this study, we evaluated Ferric carboxymaltose (FCM), a stable, iron formulation that does not contain dextran or dextran derivatives. FCM was developed for rapid IV administration in high doses. The population studied had either hemodialysis dependent or nondialysis dependent chronic kidney disease (HD-CKD or NDD-CKD). We provided evidence that rapid administration of FCM in doses of 200 mg for HD-CKD patients and up to 1000 mg in NDD-CKD patients were well tolerated and displayed comparable efficacy to other IV iron formulations.• Hemodialysis.com: Were any of the findings unexpected?• There were no surprises in this study, in that the results were consistent with other studies supporting the safety and efficacy of FCM in subjects with Iron Deficiency Anemia in the setting of CKD as well as other clinical settings (including gastrointestinal disease, heavy uterine bleeding, and the postpartum period). We feel it is important for practitioners to have access to data comparing the safety of this new IV iron formulation (FCM) to other available iron formulations.For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  12. 12. Intravenous ferric carboxymaltose versus standard medical care in the treatment of iron deficiency anemia in patients with chronic kidney disease: a randomized, active-controlled, multi-center study Hemodialysis.com Author Interview: Chaim Charytan, M.D. Director, Nephrology, New York Hospital Medical Center of Queens, Flushing, NY, Adjunct Clinical Professor of Medicine at Weill Medical College of Cornell University (Cont)• Hemodialysis.com: What should clinicians and patients take away from your report?• Currently available IV irons vary in indication, dosing regimens and safety profiles. Maximum doses given in a single visit is limited by the in vivo stability of the iron-carbohydrate moieties. In addition, the use of IV iron can be limited by anaphylactic reactions. FCM, a non-dextran iron, was developed for rapid IV administration in high doses and in this study, FCM was well tolerated and efficacious when compared to standard medical care.• Hemodialysis.com: What recommendations do you have for future research as a result of this study?• Since FCM can be given in high doses, FCM is well suited for outpatient use. A cost-effectiveness analysis would be interesting since FCM will require fewer clinical visits and venipunctures. In addition studies evaluating effect on number of transfusion required and patient reported measures of quality of life would be interesting.• Reference:• Intravenous ferric carboxymaltose versus standard medical care in the treatment of iron deficiency anemia in patients with chronic kidney disease: a randomized, active-controlled, multi-center study Nephrol. Dial. Transplant. first published online December 5, 2012 doi:10.1093/ndt/gfs528For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  13. 13. Pentraxin 3, a Sensitive Early Marker of Hemodialysis-Induced Inflammation Hemodialysis.com Author Interview: Peter Bárány, MD, PhD Renal Medicine, K56 Karolinska University Hospital Huddinge SE–141 86 Stockholm (Sweden)• Hemodialysis.com Editor Marie Benz: What are the main findings of the study?• Pentraxin 3 (PTX-3) is a sensitive marker of inflammation. During hemodialysis, PTX-3 start to rise during the first hour and peaks at 180 minutes. The levels of CRP and IL-6 did not change during dialysis and TNF-alpha concentrations decreased. The effect of changing membrane from low-flux to high-flux or changing from hemodialysis to hemodiafiltration had no significant effect on the intra-dialytic increase in PTX-3 levels.• Hemodialysis.com: Were any of the findings unexpected?• The rapid response with increase of PTX-3 during the first hour was not expected. We believe that this early rise is mediated by release of stored PTX-3 from granulae in the circulating neutrophils. During repeated HD sessions the individual response was very similar, i.e. the amount of released PTX-3, as estimated by area under the curve of the concentrations, did not change.For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  14. 14. Pentraxin 3, a Sensitive Early Marker of Hemodialysis-Induced Inflammation Hemodialysis.com Author Interview: Peter Bárány, MD, PhD Renal Medicine, K56 Karolinska University Hospital Huddinge SE–141 86 Stockholm (Sweden) (Cont)• Hemodialysis.com: What should clinicians and patients take away from your report?• Sensitive methods are necessary to detect hemodialysis-induced inflammatory activity. PTX-3 is a sensitive marker, but its role in the acute phase response and effect on the vasculature is not clear.• Hemodialysis.com: What recommendations do you have for future research as a result of this study?• PTX-3 appears to be a marker of endothelial dysfunction so it may be logical to follow-up with studies of the effect of hemodialysis on the endothelium and the relationship to neutrophil activation and PTX-3 release.• Reference:• Pentraxin 3, a Sensitive Early Marker of Hemodialysis-Induced Inflammation• Sjöberg B, Qureshi AR, Anderstam B, Alvestrand A, Bárány P. Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden. Blood Purif. 2012 Dec 7;34(3-4):290-297. [Epub ahead of print]For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  15. 15. Ultrafiltration in Decompensated Heart Failure with Cardiorenal Syndrome Dr. Bart is Chief of Cardiology at Hennepin County Medical Center.He is also the director of clinical programs including nuclear cardiology, EECP (enhanced external counterpulsation for the treatment of severe angina), therapeutic hypothermia for the treatment of cardiac arrest survivors, and ultrafiltration for advanced heart failure at Hennepin County Medical Center.• Hemodialysis.com Editor Marie Benz: What are the main findings of the study?• The main result of CARRESS HF was that in patients with decompensated heart failure, worsened renal function and persistent congestion, an aggressive diuretic-based stepped pharmacologic care algorithm was superior to ultrafiltration for change in creatinine 96 hours after enrollment with similar weight loss. Creatinine increased by 0.23 mg/dL in the ultrafiltartion group at 96 hours and this increase in creatinine was transient. In addition, rates of complete clinical decongestion were very low in both groups (10%) and clinical outcomes were poor with nearly 40% of patients experiencing death or heart failure readmission within 60 days of enrollment.• Hemodialysis.com: Were any of the findings unexpected?• The transient increase in creatinine in the ultrafiltration group was unexpected. One possible explanation for this is an overly aggressive ultrafiltration prescription resulting in transient intravascular volume depletion. However, there are few objective measures to support this possibility - there was no drop in blood pressure or increase in heart rate, there was no hemoconcentration measured by change in hemoglobin, there was no change in other measures of kidney function such as eGFR, cystatin C or NGAL. Another possible explanation is the extensive use of IV diuretics in the ultrafiltration group. Nine percent of the patients in the ultrafiltration group received IV diuretics instead of ultrafiltration and 30% of patients who did receive ultrafiltration were treated with IV diuretics after the completion of ultrafiltration. The presence of ischemic heart disease could also explain the unexpected finding of an increase in creatinine in the ultrafiltration group. There were more patients with ischemic cardiomyopathy in the ultrafiltration group. These patients had undergone more heart catheterizations and revascularization procedures - repeated insults to the kidney not experienced by the pharmacologic care group. The presence of atherosclerosis, the increased probability of renovascular disease, and repeated exposures to catheterization and IV radiocontrast material could have predisposed patients in the ultrafiltration group to be more susceptible to acute kidney injury during volume reduction therapies.For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  16. 16. Ultrafiltration in Decompensated Heart Failure with Cardiorenal Syndrome Dr. Bart is Chief of Cardiology at Hennepin County Medical Center.He is also the director of clinical programs including nuclear cardiology, EECP (enhanced external counterpulsation for the treatment of severe angina), therapeutic hypothermia for the treatment of cardiac arrest survivors, and ultrafiltration for advanced heart failure at Hennepin County Medical Center. (Cont)• Hemodialysis.com: What should clinicians and patients take away from your report?• The most striking finding in CARRESS HF is the large unmet need among patients with decompensated heart failure, worsened renal function, and persistent congestion.• Success in relieving congestion is severely limited and the rates of death and rehospitalization continue to be unacceptably high. Small, transient increases in creatinine are probably not a useful clinical surrogate and more research in the area of acute decongestion strategies is needed.• Hemodialysis.com: What recommendations do you have for future research as a result of this study?• Clinical decongestion is an important treatment goal with a large, unmet need.• Termination conditions need to be better defined for patients• undergoing acute decongestion treatment (phamacologically or with extracorporal techniques).•• Improved technologies and better understanding of ultrafiltration prescription will lead to better patient outcomes.• Reference:• Ultrafiltration in Decompensated Heart Failure with Cardiorenal Syndrome• Bradley A. Bart, M.D., Steven R. Goldsmith, M.D., Kerry L. Lee, Ph.D., Michael M. Givertz, M.D., Christopher M. OConnor, M.D., David A. Bull, M.D., Margaret M. Redfield, M.D., Anita Deswal, M.D., M.P.H., Jean L. Rouleau, M.D., Martin M. LeWinter, M.D., Elizabeth O. Ofili, M.D., M.P.H., Lynne W. Stevenson, M.D., Marc J. Semigran, M.D., G. Michael Felker, M.D., Horng H. Chen, M.D., Adrian F. Hernandez, M.D., Kevin J. Anstrom, Ph.D., Steven E. McNulty, M.S., Eric J. Velazquez, M.D., Jenny C. Ibarra, R.N., M.S.N., Alice M. Mascette, M.D., and Eugene Braunwald, M.D. for the Heart Failure Clinical Research Network• November 6, 2012DOI: 10.1056/NEJMoa1210357For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  17. 17. Comparison and clinical suitability of eight prediction models for cardiac surgery-related acute kidney injury Hemodialysis.com Authors Interview: Peter Pickkers, M.D., Ph.D and Harmke Dorien Kiers Department of Intensive Care Medicine, Radboud University Nijmegen Medical Centre, Nijmegen,the Netherlands Department of Cardiothoracic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen,the Netherlands• Hemodialysis.com Editor Marie Benz: What are the main findings of the study?• We analyzed eight different models that were designed to predict Acute Kidney Injury and/or renal replacement therapy after cardiac surgery. We found that the model of Thakar offered the best prediction on risk of Acute Kidney Injury and dialysis.• Hemodialysis.com: Were any of the findings unexpected?• Not al models were widely applicable; some were not designed to predict the risks of AKI and/or dialysis for all patient categories, and in some models postoperative data was needed, making them not useful in the pre-operative setting.For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  18. 18. Comparison and clinical suitability of eight prediction models for cardiac surgery-related acute kidney injury Hemodialysis.com Authors Interview: Peter Pickkers, M.D., Ph.D and Harmke Dorien Kiers Department of Intensive Care Medicine, Radboud University Nijmegen Medical Centre, Nijmegen,the Netherlands Department of Cardiothoracic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen,the Netherlands (cont)• Hemodialysis.com: What should clinicians and patients take away from your report?• The model of Thakar is an easy to use tool which can be used in the pre-operative setting, it uses only variables that are readily available in the pre-operative setting; so extra diagnostics are not needed. When the score on this model is high, the risk of postoperative acute kidney injury or dialysis is increased. In these patients, additional attention and monitoring of renal function may be beneficial.• Hemodialysis.com: What recommendations do you have for future research as a result of this study?• Knowing which patients are at risk of acute kidney injury and dialysis post-cardiac surgery is the first step towards finding strategies to protect this group. Up to now, there are no known pharmacological or other techniques proven to prevent these complications. However, identifying these patients will make it possible to study new strategies on these particular high-risk patients. The simplest way to have your interview posted is to reply to this email with your responses and I will upload them promptly with a link to your interview.• Reference:• Comparison and clinical suitability of eight prediction models for cardiac surgery-related acute kidney injury• Harmke D. Kiers, Mark van den Boogaard, Micha C.J. Schoenmakers, Johannes G. van der Hoeven, Henry A. van Swieten, Suzanne Heemskerk, and Peter Pickkers• Nephrol. Dial. Transplant. first published online December 4, 2012 doi:10.1093/ndt/gfs518For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  19. 19. Comparison and clinical suitability of eight prediction models for cardiac surgery-related acute kidney injury Hemodialysis.com Authors Interview: Peter Pickkers, M.D., Ph.D and Harmke Dorien Kiers Department of Intensive Care Medicine, Radboud University Nijmegen Medical Centre, Nijmegen,the Netherlands Department of Cardiothoracic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen,the Netherlands• Hemodialysis.com Editor Marie Benz: What are the main findings of the study?• We analyzed eight different models that were designed to predict Acute Kidney Injury and/or renal replacement therapy after cardiac surgery. We found that the model of Thakar offered the best prediction on risk of Acute Kidney Injury and dialysis.• Hemodialysis.com: Were any of the findings unexpected?• Not al models were widely applicable; some were not designed to predict the risks of AKI and/or dialysis for all patient categories, and in some models postoperative data was needed, making them not useful in the pre-operative setting.For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  20. 20. Comparison and clinical suitability of eight prediction models for cardiac surgery-related acute kidney injury Hemodialysis.com Authors Interview: Peter Pickkers, M.D., Ph.D and Harmke Dorien Kiers Department of Intensive Care Medicine, Radboud University Nijmegen Medical Centre, Nijmegen,the Netherlands Department of Cardiothoracic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen,the Netherlands (cont)• Hemodialysis.com: What should clinicians and patients take away from your report?• The model of Thakar is an easy to use tool which can be used in the pre-operative setting, it uses only variables that are readily available in the pre-operative setting; so extra diagnostics are not needed. When the score on this model is high, the risk of postoperative acute kidney injury or dialysis is increased. In these patients, additional attention and monitoring of renal function may be beneficial.• Hemodialysis.com: What recommendations do you have for future research as a result of this study?• Knowing which patients are at risk of acute kidney injury and dialysis post-cardiac surgery is the first step towards finding strategies to protect this group. Up to now, there are no known pharmacological or other techniques proven to prevent these complications. However, identifying these patients will make it possible to study new strategies on these particular high-risk patients. Reference:• Comparison and clinical suitability of eight prediction models for cardiac surgery-related acute kidney injury• Harmke D. Kiers, Mark van den Boogaard, Micha C.J. Schoenmakers, Johannes G. van der Hoeven, Henry A. van Swieten, Suzanne Heemskerk, and Peter Pickkers• Nephrol. Dial. Transplant. first published online December 4, 2012 doi:10.1093/ndt/gfs518For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  21. 21. Cause-Specific Excess Mortality Among Dialysis Patients: Comparison With the General Population in Japan Hemodialysis.com Author Interview: Minako Wakasugi, M.D., M.P.H., Ph.D. Specially Appointed Assistant Professor Center for Inter-organ Communication Research, Niigata University Graduate School of Medical and Dental Sciences Asahimachi 1-757, Chuo-ku, Niigata 951-8510, JAPAN• Hemodialysis.com Editor Marie Benz: What are the main findings of the study?• The age-adjusted mortality rate difference between dialysis patients and the general population for cardiovascular diseases was similar to that for non-cardiovascular diseases, indicating that preventing both cardiovascular and non-cardiovascular deaths is important for decreasing all-cause mortality among Japanese dialysis patients.• Hemodialysis.com: Were any of the findings unexpected?• Mortality due to accidental death was similar between dialysis patients and the general population. Because Japan experienced many different natural disasters during the study period, Japanese disaster relief activity might protect dialysis patients against mortality from these natural disasters.For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  22. 22. Cause-Specific Excess Mortality Among Dialysis Patients: Comparison With the General Population in Japan Hemodialysis.com Author Interview: Minako Wakasugi, M.D., M.P.H., Ph.D. Specially Appointed Assistant Professor Center for Inter-organ Communication Research, Niigata University Graduate School of Medical and Dental Sciences Asahimachi 1-757, Chuo-ku, Niigata 951-8510, JAPAN (cot)• Hemodialysis.com: What should clinicians and patients take away from your report?• There is still significant room for improvement in life prognosis for dialysis patients. Preventing not only cardiovascular but also non-cardiovascular deaths is important.• Hemodialysis.com: What recommendations do you have for future research as a result of this study? Because excess mortality in dialysis patients differed with cause of death, cause-specific mortality studies should be planned to improve life expectancies of dialysis patients.• Reference:• Cause-Specific Excess Mortality Among Dialysis Patients: Comparison With the General Population in Japan Wakasugi, M., Kazama, J. J., Yamamoto, S., Kawamura, K. and Narita, I. (2012), Cause-Specific Excess Mortality Among Dialysis Patients: Comparison With the General Population in Japan. Therapeutic Apheresis and Dialysis. doi: 10.1111/j.1744-9987.2012.01144.xFor Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  23. 23. The Relationship between Red Cell Distribution Width with Erythropoietin Resistance in Iron Replete Hemodialysis Patients Hemodialysis.com Author Interview: Baris Afsar, Ass. Prof of Nephrology Department of Medicine, Division of Nephrology, Konya Numune State Hospital, Konya, Turkey--• Hemodialysis.com Editor Marie Benz: What are the main findings of the study?• The main and novel finding of the study is the independent relationship between red cell distribution width and epo resistance.• Hemodialysis.com: Were any of the findings unexpected?• Known factors such as inflammation, albumin and PTH did not related with epo resistance as an unexpected finding.• Hemodialysis.com: What should clinicians and patients take away from your report?• Should search for novel factors such as red cell distribution width for the epo resistance.• Hemodialysis.com: What recommendations do you have for future research as a result of this study?• Studies are needed to confirm and understand the underlying mechanism regarding RDW and EPO resistance.• Reference:• The Relationship between Red Cell Distribution Width with Erythropoietin Resistance in Iron Replete Hemodialysis Patients Baris Afsar , Mustafa Saglam , Cetin Yuceturk , Erhan Agca European Journal of Internal Medicine, In Press, Corrected Proof, Available online 12 December 201For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  24. 24. Associations among nocturnal sleep, daytime intradialytic sleep, and mortality risk in patients on daytime conventional hemodialysis: US Renal Data System special study data Hemodialysis.com Author Interview: Donald L. Bliwise, Ph.D. Professor of Neurology, Psychiatry and Behavioral Sciences, and Nursing, Director, Program in Sleep, Aging and Chronobiology, Emory University School of Medicine, Atlanta, Georgia 30329• Hemodialysis.com Editor Marie Benz: What are the main findings of the study?• The main finding from this study was that, even after controlling for many other variables that are known to be associated with earlier mortality in patients with renal disease, sleep (and more specifically a longer reported duration of sleep) appeared to be an important correlate of survival.• Hemodialysis.com: Were any of the findings unexpected?• Yes and no. In our experience, nephrologists do not generally consider sleep, sleep disturbance, sleep duration, or intra-dialytic sleep to be nearly as important as comorbid diseases (e.g., obesity, albumin, adequacy of dialysis) when discussing survival of ESRD patients. To the extent that we found that sleep was important, this may be surprising to some. As we point out in the Introduction, there is certainly ample literature from non- dialysis populations to suggest that sleep durations, and possibly napping as well, are important factors associated with mortality. In that sense, the results were not at all unexpected to us.For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  25. 25. Associations among nocturnal sleep, daytime intradialytic sleep, and mortality risk in patients on daytime conventional hemodialysis: US Renal Data System special study data Hemodialysis.com Author Interview: Donald L. Bliwise, Ph.D. Professor of Neurology, Psychiatry and Behavioral Sciences, and Nursing, Director, Program in Sleep, Aging and Chronobiology, Emory University School of Medicine, Atlanta, Georgia 30329 (cont)• Hemodialysis.com: What should clinicians and patients take away from your report?• At this point, it is far too premature to make recommendations for patient care regarding what should and should not be done in terms of an individual patient’s treatment plan involving sleep. We would certainly agree with the suggestion, however, that physicians must be more aware of these issues in their patients. For example, a patient sleeping excessively during the night (and perhaps during HD as well) should be evaluated for specific sleep disorders, such as obstructive sleep apnea (OSA) or restless legs syndrome (RLS), that may be contributing to their high total amounts of sleep. Conditions such as OSA and RLS can be effectively and safely treated in a number of pharmacologic and occasionally non-pharmacologic approaches in HD patients.• Hemodialysis.com: What recommendations do you have for future research as a result of this study?• There are many avenues for future research. First, it must be recalled that our data are all based on patients’ reports of their own sleep—not objective measurements of sleep (i.e., polysomnography). In order to achieve a more accurate rendering of such apparent tendencies, objective measurements should be made. Secondly, before implementing routine changes in patient care, carefully performed interventional trials would be required, perhaps shortening sleep durations (both nocturnally and perhaps intra-dialytically, as well) to determine whether there was any benefit. Finally, any future study manipulating sleep in HD patients would need to appreciate fully the complex psychosocial matrix in which this basic biologic drive occurs. As can be seen on Table 1 of our study, HD patients are more likely to doze during HD if they have an early morning shift and/or if they are still gainfully employed. In that sense, at least some sleep observed on the dialysis unit may well be compensatory for an inadequate amount of sleep obtained elsewhere during the 24-hour day. Obviously, there may be many reasons that HD patients sleep or otherwise elect to sleep while they dialyze. The best way to start to understand this phenomenon is to start to study it and collect data about it. To date, the number of studies that have done this even descriptively could be summarized on a page not much longer than the one this is printed on.• Reference:• Associations among nocturnal sleep, daytime intradialytic sleep, and mortality risk in patients on daytime conventional hemodialysis: US Renal Data System special study data Kutner, N., Zhang, R., Johansen, K. and Bliwise, D. (2012), Associations among nocturnal sleep, daytime intradialytic sleep, and mortality risk in patients on daytime conventional hemodialysis: US Renal Data System special study data. Hemodialysis International. doi: 10.1111/hdi.12005For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  26. 26. Obesity and Kidney Transplant Candidates: How Big Is Too Big for Transplantation Hemodialysis.com Author Interview: Krista L. Lentine, MD, MS Associate Professor of Medicine Saint Louis University Center for Outcomes Research & Department of Medicine/Division of Nephrology• The obesity epidemic has not spared the ESRD population. In the United States, the prevalence of obesity among kidney transplant recipients increased from 23 to 33% in the past decade. Obesity impacts many inter-related considerations for transplant practice including candidate selection, outcomes prediction before and after transplant, and waitlist management. Our article describes an approach for applying available data on the importance of body composition to the kidney transplant population that separates implications for candidate selection, risk stratification among selected candidates, and interventions to optimize health of the individual• Hemodialysis.com: Were any of the findings unexpected?• Competing concerns and a lack of randomized evidence on obesity management has led to widely varying BMI limits for candidate selection across transplant centers. With respect to the question of appropriate thresholds for candidate listing, markers of increased adiposity (including BMI and waist circumference) are associated with worse posttransplant outcomes (e.g. DGF, graft failure, cardiac disease, high costs) compared with ideal body composition in most studies. However, current data have not identified limits of body composition that preclude clinical benefit from kidney transplant compared to continued waiting on dialysis. Regarding prognostication, BMI frequently shows ‘reverse’ associations with dialysis survival. But, as noted above, compared to recipients with normal BMI, kidney transplant recipients with elevated BMI appear in many studies to face increased risk of adverse outcomes. Notably, BMI is a surrogate measure of adiposity, and prediction may improve when combined with other measures, such as waist circumference and measures of muscle mass. With respect to the management of obese transplant candidates, observational studies have not shown benefits among dialysis patients who lost weight before transplant. However, association studies cannot distinguish intentional from unintentional weight loss as a result of illness and comorbidity, and offer little guidance on potential benefits of purposeful weight reduction.For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  27. 27. Obesity and Kidney Transplant Candidates: How Big Is Too Big for Transplantation Hemodialysis.com Author Interview: Krista L. Lentine, MD, MS Associate Professor of Medicine Saint Louis University Center for Outcomes Research & Department of Medicine/Division of Nephrology (cont)• Hemodialysis.com: What should clinicians and patients take away from your report?• Pending more urgently needed research, the answer to ‘How big is too big for transplant?’ is that it appears to depend on the experience and risk tolerance of the individual transplant center at this time.• Hemodialysis.com: What recommendations do you have for future research as a result of this study?• A main objective of our report is to remind future investigators in the broad field of transplant obesity to be explicit about the purpose and scope of inferences from a particular study. We encourage research relevant to the following topic areas as follows:• Candidate selection.• Defining whether there are limits of body composition that preclude clinical benefit from kidney transplant compared to continued dialysis.• Formal cost-effectiveness studies, including appropriate quality of life adjustments that capture impact of complications, to determine if payers and society should be compensating centers for clinical and financial risks of transplanting obese ESRD patients• Risk stratification among selected candidates.• Defining practical measures of body composition that refine accuracy for outcomes prediction, including attention to subgroups• Interventions to optimize health of the individual• Prospective evaluations of the impact of intentional weight loss efforts among obese ESRD patients including dietary changes, monitored exercise programs, and bariatric surgery.• Reference:• Obesity and Kidney Transplant Candidates: How Big Is Too Big for Transplantation.• Lentine KL, Delos Santos R, Axelrod D, Schnitzler MA, Brennan DC, Tuttle-Newhall JE: Am J Nephrol 2012;36:575-586 (DOI: 10.1159/000345476)For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  28. 28. BK polyoma virus nephropathy in the native kidney Hemodialysis.com Author Interview: Dr Shree Gopal Sharma Shree G Sharma, M.D. Assistant Professor of Pathology University of Arkansas for Medical Sciences Little Rock, AR• Hemodialysis.com Editor Marie Benz: What are the main findings of the study?• The present series describes the risk factors and clinical course of polyoma virus nephropathy (PVN) in the native kidney. All 8 of our cases had an immunocompromised state, including 6 patients with hematological malignancies, 1 with double lung transplant for cystic fibrosis and 1 with diabetes and tuberculosis. In addition, 3 of the patients with hematologic malignancy had undergone bone marrow transplant (2 allo- and 1 haploidentical) for which they were receiving antirejection immunosuppressive therapy for up to 4 years. The patients were all male, predominantly Caucasian, and varied in age from young to elderly (mean 47.4 yr; range 16-66 yr). From these data and our review of 18 cases reported in the literature, we conclude that patients with hematologic malignancy and non-renal organ transplants are particularly at risk for development of PVN in the native kidney.• Hemodialysis.com: Were any of the findings unexpected?• BK polyoma virus nephropathy is not commonly thought outside the setting of renal transplantation. It is reported in patients with other organ transplants. Two of the patients reported in the series had unusual combination of diseases. One patient was without hematological malignancy or organ transplant had both diabetes mellitus and tuberculosis as potential predisposing conditions to an immunocompromised state, a combination that has not been reported previously as associated with PVN. The other patient with chronic lymphocytic leukemia had BK PVN and subsequently also developed progressive multifocal leukoencephalopathy due to JC virus. To our knowledge this is the first such reported case.For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  29. 29. BK polyoma virus nephropathy in the native kidney Hemodialysis.com Author Interview: Dr Shree Gopal Sharma Shree G Sharma, M.D. Assistant Professor of Pathology University of Arkansas for Medical Sciences Little Rock, AR (cont)• Hemodialysis.com: What should clinicians and patients take away from your report?• A high level of suspicion in immunocompromised patients is needed to diagnose PVN in an early stage that may respond more favorably to antiviral therapy.• Hemodialysis.com: What recommendations do you have for future research as a result of this study?• As the number of solid organ transplants continues to rise, the incidence of renal dysfunction in this population has also increased. It will be important to distinguish the rare development of PVN in this population from the more common situation of BKV activation. These outcome data underscore importance of careful screening and prompt use of a renal biopsy for early detection of PVN involving the native kidney in at risk patients with hematologic malignancies and/or organ transplants who develop AKI. Ideally, monitoring of at risk patients with urinary decoy cell screening, serum PCR assays for BKV and renal functional studies coupled with the judicious use of renal biopsy are potential strategies for earlier detection. Greater awareness of the potential development of PVN in the native kidney is needed to avoid under-recognition of this newly emerging entity.• Reference:• BK polyoma virus nephropathy in the native kidney• Shree G. Sharma, Volker Nickeleit, Leal C. Herlitz, Anne K. de Gonzalez, Michael B. Stokes, Harsharan K. Singh, Glen S. Markowitz, and Vivette D. DAgati• Nephrol. Dial. Transplant. first published online December 18, 2012 doi:10.1093/ndt/gfs537For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  30. 30. Multivessel coronary artery bypass grafting versus percutaneous coronary intervention in ESRD Hemodialysis.com Author Interview: Dr. Tara I. Chang MD Stanford University, Division of Nephrology, Palo Alto, CA 94304• Hemodialysis.com Editor Marie Benz: What is the background of the study?• The study included patients (n=21,981) from the United States Renal Data System, a database of all patients on dialysis in the United States with primary Medicare coverage. Patients received initial coronary revascularization with either multivessel CABG or PCI between 1997 and 2009 and had at least 6 months of prior Medicare coverage as their primary payer. Overall, 5-year survival for patients was low — 22% to 25% — regardless of revascularization strategy. Multivariable-adjusted proportional hazards regression analysis revealed that CABG compared with PCI led to a significantly lower risk for all-cause death (HR=0.87; 95% CI, 0.84- 0.90) and the composite of all-cause death or MI (HR=0.88; 95% CI, 0.86-0.91). Results were similar in analyses using a propensity score-matched cohort.• Hemodialysis.com Editor Marie Benz: What are the main findings of the study?• We found that in a cohort of more than 20,000 patients with multivessel coronary disease who were on dialysis, CABG was associated with 10-16% lower rate of all-cause death when compared with PCI. However, the overall mortality rates were very high in this cohort, with 5-year life expectancy of only 22-25%, irrespective of revascularization strategy.For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  31. 31. Multivessel coronary artery bypass grafting versus percutaneous coronary intervention in ESRD Hemodialysis.com Author Interview: Dr. Tara I. Chang MD Stanford University, Division of Nephrology, Palo Alto, CA 94304 (cont)• Hemodialysis.com: Were any of the findings unexpected?• We were surprised to see that the overall mortality rates had not improved over the past 15-20 years in this population.• Hemodialysis.com: What should clinicians and patients take away from your report?• It is important to note that because our study was observational, our results cannot prove that CABG is better. But our study suggests that in carefully selected patients on dialysis with multivessel coronary disease, CABG may be preferred rather than PCI.• Reference:• Multivessel coronary artery bypass grafting versus percutaneous coronary intervention in ESRD Chang TI, Shilane D, Kazi DS, Montez-Rath ME, Hlatky MA, Winkelmayer WC. Stanford University, Division of Nephrology, 780 Welch Road Suite 106, Palo Alto, CA 94304. J Am Soc Nephrol. 2012 Dec;23(12):2042-9. doi: 10.1681/ASN.2012060554.For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  32. 32. Anti-glomerular basement membrane antibody disease is an uncommon cause of end-stage renal disease Hemodialysis.com Author Interview: Professor David Johnson MB BS (Hons), FRACP, PhD (Syd), PSM Director, Metro South and Ipswich Nephrology & Transplant Services (MINTS) Professor of Medicine (University of Queensland)• Hemodialysis.com Editor Marie Benz: What are the main findings of the study?• This retrospective, multi-centre, multi-country registry analysis examined the outcomes of 449 end-stage renal disease (ESRD) patients with anti-glomerular basement membrane antibody (anti-GBM) disease compared to 57,973 patients with ESRD due to other causes, using data from the Australian and New Zealand Dialysis and Transplant (ANZDATA) Registry. We found that anti-GBM disease was associated with comparable dialysis survival, renal transplant patient survival and renal allograft survival, although it was associated with an increased probability of recovery of dialysis-independent renal function. In addition, older age and a history of pulmonary haemorrhage in patients with anti-GBM disease was associated with an increased risk of mortality on dialysis.• Hemodialysis.com: Were any of the findings unexpected?• The outcomes of patients with ESRD due to anti-GBM disease have been uncertain until now because the rarity of anti-GBM disease as a cause of ESRD has impeded the study of outcomes of this condition once renal replacement therapy has commenced.For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  33. 33. Anti-glomerular basement membrane antibody disease is an uncommon cause of end-stage renal disease Hemodialysis.com Author Interview: Professor David Johnson MB BS (Hons), FRACP, PhD (Syd), PSM Director, Metro South and Ipswich Nephrology & Transplant Services (MINTS) Professor of Medicine (University of Queensland) (Cont)• Hemodialysis.com: What should clinicians and patients take away from your report?• Anti-GBM disease is an uncommon cause of ESRD. Patients with anti-GBM disease who commence renal replacement therapy can expect similar dialysis and transplant outcomes (in terms of patient survival and renal allograft survival) to the remaining patients with other causes of ESRD. Older age and a history of pulmonary haemorrhage are associated with poorer survival of patients with anti-GBM disease on dialysis.• Hemodialysis.com: What recommendations do you have for future research as a result of this study?• Comparison of anti-GBM ESRD patient outcomes with those of other national registries would be useful.• Reference:• Anti-glomerular basement membrane antibody disease is an uncommon cause of end-stage renal disease• Wen Tang, Stephen P McDonald, Carmel M Hawley, Sunil V Badve, Neil C Boudville, Fiona G Brown, Philip A Clayton, Scott B Campbell, Janak R de Zoysa and David W Johnson Kidney Int advance online publication, December 19, 2012; doi:10.1038/ki.2012.375For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  34. 34. Timing of dialysis initiation in AKI in ICU: international survey. Hemodialysis.com Author Interview: Charuhas V. Thakar, MD, FASN Associate Professor of Medicine Division of Nephrology and Hypertension University of Cincinnati Cincinnati OH 4526• Hemodialysis.com Editor Marie Benz: What are the main findings of the study?• Our analysis of survey of nephrologists found that severity of illness in ICU patients with AKI influences the timing of dialysis initiation. So, survey respondents were more likely to initiate early dialysis in case scenarios portraying higher severity of illness. Whether early dialysis initiation in a higher severity of illness group would modify their outcome remains to be examined. Also, the study found that decision to initiate dialysis in ICU patients with AKI is still largely driven by imminent indications of dialysis (e.g. hyperkalemia, or hypoxemia) rather than a proactive decision based on degree of severity of kidney injury.• Another important finding was that 1-in-3 respondents indicated that early dialysis could be associated with more risk than benefit, given the present state of evidence. Additionally, we found that despite the widespread dissemination of the information related to acute kidney injury definitions, and the data related to severity of kidney injury and related outcome, it seems like dialysis decisions were more heavily influenced by absolute levels of BUN or creatinine rather than degree of elevation from baseline.• Hemodialysis.com: Were any of the findings unexpected?• In a way, yes, as we think that we tend to start early dialysis, but when asked objectively, the indications are still the traditional indications of dialysis. Thus, dialysis remains a subjective clinical decision.For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  35. 35. Timing of dialysis initiation in AKI in ICU: international survey. Hemodialysis.com Author Interview: Charuhas V. Thakar, MD, FASN Associate Professor of Medicine Division of Nephrology and Hypertension University of Cincinnati Cincinnati OH 4526 (cont)• Hemodialysis.com: What should clinicians and patients take away from your report?• Until we have prospective clinical trials, timing of dialysis will remain a subjective decision, one that is dependent on several factors including severity of illness. Whether our decisions modify outcome is unclear.• Hemodialysis.com: What recommendations do you have for future research as a result of this study?• We recommend that prospective trials are needed to come to a consensus in this area. Also, we may have to stratify patients based on expected mortality/severity of illness when such trials are designed, otherwise, interventions such as early dialysis may not necessarily modify hard endpoints.• Reference:• Timing of dialysis initiation in AKI in ICU: international survey. Thakar CV, Rousseau J, Leonard AC. Crit Care. 2012 Dec 19;16(6):R237. [Epub ahead of print]For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  36. 36. Comparison of the glomerular filtration rate in children by the new revised Schwartz formula and a new generalized formula Hemodialysis.com Author Interview: Dr Hassib Chehade Médecin associé Service de néphrologie pédiatrique• Hemodialysis.com Editor Marie Benz: What are the main findings of the study?• This study is the first one to describe a precise cutoff for the validity of the new revised Schwartz formula, and leads to deriving a new generalized Quadratic formula applicable for all glomerular filtration rate (GFR) values, and also to children with failure to thrive.• Hemodialysis.com: Were any of the findings unexpected?• When we conducted this study, we aimed to provide additional data that assess the accuracy of the revised Schwartz formula by using another gold standard method of GFR measurement, i.e. inulin clearance, in a cohort of children with renal failure, and also in children with normal renal function or even with supra-normal GFR. What we found out was very interesting: The new Quadratic formula we developed is a tool for bedside GFR estimation in children applicable across all GFR values.• Hemodialysis.com: What should clinicians and patients take away from your report?• The new Quadratic formula assesses GFR equally well or more precisely than the new Schwartz formula and allows pediatricians to have a more precise estimation of high GFR values particularly in cases of hyperfiltration. A more precise GFR estimation will lead to a proper classification of the patients’ chronic kidney disease stages for appropriate treatment.• Hemodialysis.com: What recommendations do you have for future research as a result of this study?• We recommend conducting further studies to perform an external validation of the new Quadratic formula in other pediatric population groups and also assess the accuracy of this formula in adults.• Reference:• Comparison of the glomerular filtration rate in children by the new revised Schwartz formula and a new generalized formula• Anja Gao, Francois Cachat, Mohamed Faouzi, Daniel Bardy, Dolores Mosig, Blaise-Julien Meyrat, Eric Girardin and Hassib Chehade• Kidney Int advance online publication, December 19, 2012; doi:10.1038/ki.2012.388For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  37. 37. Evaluation of Potential Renal Transplant Recipients With Computed Tomography Angiography Hemodialysis.com Author Interview: Matthew Cooper, MD Director, Kidney and Pancreas Transplantation Medstar Georgetown Transplant Institute Washington, DC 20007 (cont)• Hemodialysis.com Editor Marie Benz: What are the main findings of the study?• The concern for contrast-induced nephropathy or overt renal failure in patients who are considered for CT studies has limited its use in what may be a greatly valued test for clinical (or surgical) decision-making.•• In addition to a complete history and physical exam, this study indicated the value of a limited- contrast enhanced CT for all potential recipients of a living donor kidney allograft. Of the 149 patients evaluated using this technique, over 22% had a change in their original operative plan (ie. need for additional surgery, change in operative site location, et al.) based upon the findings on the CT scan. While not necessary in all patients, the study clearly indicates the value of the best non-invasive testing available to plan accordingly for the risk associated with not only the recipient transplant but also that associated with the donor nephrectomy.• Hemodialysis.com: Were any of the findings unexpected?• The study was not limited to potential recipients currently on dialysis. Of the total number of patients, 42 were currently not dialysis-dependent (although all had Stage 4 or 5 CKD). None of these patients following the administration of 100ml of Visipaque required hemodialysis following testing and there was no change in the in the mean SCr value for this cohort compared to pre-test values.For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  38. 38. Evaluation of Potential Renal Transplant Recipients With Computed Tomography Angiography Hemodialysis.com Author Interview: Matthew Cooper, MD Director, Kidney and Pancreas Transplantation Medstar Georgetown Transplant Institute Washington, DC 20007• Hemodialysis.com: What should clinicians and patients take away from your report?• While clinicians should always appreciate the risk associated with all testing including contast enhanced CT, if there is an expected benefit in its use including a potential deviation from standard practice, the fear of contrast induced nephropathy is more lore than data-driven. With appropriate hydration pre- and post- contrast as well as a judicious use of contrast by a knowledgeable radiologic team, most patients will not see a nephrologic effect.• Our study demonstrated an overall cost savings in the use of CTA for this cohort of patients.• Hemodialysis.com: What recommendations do you have for future research as a result of this study?• As there will still be controversy in the use of CTA v. physical exam alone, a well-constructed multi-center trial comparing the use of CTA in all patients v. PE alone with a careful and critical analysis of both intra-operative complications and long-term outcomes would be warranted.• Reference:• Evaluation of Potential Renal Transplant Recipients With Computed Tomography Angiography• Smith D, Chudgar A, Daly B, Cooper M. Arch Surg. 2012 Dec 1;147(12):1114-22. doi: 10.1001/archsurg.2012.1466.For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  39. 39. Hypothyroidism and Mortality among Dialysis Patients. Hemodialysis.com Author Interview: Connie Rhee, MD, MSc, on behalf of the co-authors Rhee CM, Alexander EK, Bhan I, Brunelli SM.• Hemodialysis.com Editor Marie Benz: What are the main findings of the study?• Patients with impaired kidney function have a disproportionately higher prevalence of hypothyroidism compared to the general population. Although hypothyroidism has been associated with adverse cardiovascular outcomes in non-kidney disease populations, the prognostic implications of hypothyroidism in dialysis patients have not been well defined.• Hemodialysis.com: Were any of the findings unexpected?• In the general population, there has been controversy as to whether subclinical (“mild”) hypothyroidism is associated with increased death risk, but there has been a tendency towards positive associations in high cardiovascular risk populations. Thus, we were surprised to find that, compared to dialysis patients with TSH levels in the low-normal range, those with mild hypothyroidism had a significantly higher death risk, and there was a trend towards greater death among those with TSH levels in the high-normal range. This may potentially be due to the high underlying cardiovascular risk in dialysis patients.For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice
  40. 40. Hypothyroidism and Mortality among Dialysis Patients. Hemodialysis.com Author Interview: Connie Rhee, MD, MSc, on behalf of the co-authors Rhee CM, Alexander EK, Bhan I, Brunelli SM. (cont)• Hemodialysis.com: What should clinicians and patients take away from your report?• It should be noted that because this was an observational study, we are unable to show that there is a causal association between hypothyroidism and death in dialysis patients. However, our findings do suggest that hypothyroidism is a negative prognostic indicator in dialysis patients.• Hemodialysis.com: What recommendations do you have for future research as a result of this study?• There are two key findings in our study that prompt future investigation. First, dialysis patients receiving exogenous thyroid hormone with normal thyroid function at baseline (presumed to adequately-treated hypothyroid patients) appear to have a similar mortality risk as those with spontaneously normal thyroid function. This suggests that normalization of thyroid function with treatment may reduce mortality risk associated with hypothyroidism, but future studies examining the effectiveness and safety of longitudinal exogenous thyroid hormone treatment in dialysis patients are needed. Second, we observed that adjustment for cardiovascular risk factors markedly attenuated the hypothyroidism— mortality association. This suggests that hypothyroidism may increase mortality in dialysis patients through cardiovascular pathways. However, future research is needed to identify possible mechanisms by which hypothyroidism may increase death risk in dialysis patients.• Reference:• Rhee CM, Alexander EK, Bhan I, Brunelli SM. Hypothyroidism and Mortality among Dialysis Patients. Clin J Am Soc Nephrol. 2012 Dec 20. [Epub ahead of print]For Informational Purposes Only. Not for Read more interviews on Hemodialysis.comSpecific Medical Advice

×