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Hemodialysis research, author interviews, dialysis updates and information on chronic kidney disease and end stage renal failure.

Editor: Marie Benz, [email protected]

July 10 2012

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http://www.hemodialysis.com/author_interviews/vascular_access_hemorrhages_hemodialysis_deaths.html

Author Interview: Kate Ellingson, PhD,Epidemiologist Vascular access hemorrhages contribute to deaths among hemodialysis patientsKidney International , (13 June

2012) • What are the main findings of the study?• This study describes fatal instances of vascular access hemorrhage among chronic dialysis patients and is

the first study to examine risk factors for this devastating complication.

• In order to receive life-saving hemodialysis treatment, patients require a catheter, arteriovenous (AV) fistula, or AV graft. These three types of vascular access are a way to reach the bloodstream in order to remove toxins from the blood.

• Unfortunately, in rare instances, a problem with the vascular access can cause the site to rupture and bleed uncontrollably, in some cases, resulting in death. These fatal instances of vascular access hemorrhage constitute a rare but potentially preventable cause of death in hemodialysis patients.

• The majority of the 88 events reviewed between 2000-2007 in Maryland, District of Columbia and Virginia involved patients who experienced major hemorrhages at home or in a nursing home, and the majority of these patients had experienced complications of their vascular access in the six months prior to death.

Read the rest of the interview on Hemodialysis.com



http://www.hemodialysis.com/author_interviews/missed_dialysis_sessions_during_holidays.html

Author Interview: Hemodialysis.com Author Interview:Odds of Missed Hemodialysis Sessions Are Increased

During Holiday Periods Among In-Center Hemodialysis PatientsStephen Crawford ISPOR poster 2012

What are the main findings of the study?

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

••• The data suggest that there was an increasing trend in the proportion of missed sessions

from 2006 to 2010, particularly during the Thanksgiving and Christmas holiday travel periods.

•••••

Hemodialysis.com: Were any of the findings unexpected?

•• The large increase in the proportion of missed sessions during the 2008 and 2009

Christmas and New Year holidays was not anticipated. • In contrast, the lower rate during Christmas, 2010 may be due to the shorter period of

observation due to truncation of the data on December 31st, 2010.•••••

Hemodialysis.com: What should clinicians and patients take away from your report?

•




http://www.hemodialysis.com/author_interviews/antibiotic_lock_solutions_and_catheter_malfunctions.html

Author Interview: Hemodialysis.com Author Interview:Antibiotic lock solutions allow less systemic antibiotic exposure and less catheter malfunction without

adversely affecting antimicrobial resistance patterns. Hemodialysis International. A. M. Onder, MD

• Hemodialysis.com: What are the main findings of the study?• We looked at our data by breaking the timeline into three separate periods; no antibiotic lock (ABL) use,

ABL use as needed and ABL use per protocol in the unit.

• By looking at our 10 years retrospective data, we were able to demonstrate that the use of antibiotic locks (mainly tobramycin-tissue plasminogen activator (TPA) locks) as protocol in our unit, there was a significant decrease in total systemic antibiotic exposure and the percentage of catheters lost to malfunction.

• This was achieved with similar CRB prevalence between the three ERAs and there was no noted increase in the infection-related complications.

• Therefore, addendum of ABL to systemic antibiotics for treatment and using them for prevention in the high risk population offered similar CRB treatment success rates with less exposure to cumulative dose of systemic antibiotics.

••••


http://www.hemodialysis.com/author_interviews/pregnancy_and_ckd.html



Author Interview: Hemodialysis.com Author Interview:Pregnancy in CKD: whom should we follow and why?Barbara Giorgina Piccoli MD

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

• CKD is a risk factor in pregnancy in all stages. Also stage 1 CKD patients are at increased risk for adverse pregnancy outcomes, such as Caesarean section, preterm delivery and need for NICU (Neonatal Intensive Care Unit). The risk for adverse pregnancy related events increases along with the CKD stage.

• Pregnancy is a important occasion for early diagnosis of CKD in stage 1 patients. In our series the prevalence of new diagnosis was high (over 40%).

• Hemodialysis.com: Were any of the findings unexpected?• In this study, our analysis was focused on CKD stage 1 patients, both in comparison with a cohort of 267 low-risk pregnancies,

and with 49 patients in later CKD stages.

• At difference with our previous study, in which the results recorded in stage 1 and stage 2 CKD were almost equal, the stepwise increase along stages is more clear and statistical difference is reached between stage 1 and 2 CKD as for birth weight and gestational age.

• Therefore, even minor differences in kidney function (stage 2 vs stage 1) increase the risk for adverse pregnancy related outcomes.


http://www.hemodialysis.com/author_interviews/gfr_ckd_epi_mdrd_and_mortality.html



Author Interview: Hemodialysis.com Author Interview:Comparing the association of GFR estimated by the CKD-EPI and MDRD study equations and mortality: the third national health and nutrition examination survey (NHANES III) examination survey (NHANES III).Tariq Shafi,

MBBS, MHS, FACP, FASN, FNKF


• The Chronic Kidney Disease Epidemiology Collaboration equation for estimation of glomerular filtration rate (eGFR-CKDEPI) improves GFR estimation from serum creatinine compared to the Modification of Diet in Renal Disease Study equation (eGFR-MDRD). We wanted to assess if this improvement in GFR estimation translates into better prediction of the risk of death among those with reduced eGFR.

• We first categorized the population into five eGFR groups based on the current standard which is eGFR-MDRD. The eGFR groups were >120, 90-119, 60-89, 30-59 and <30 ml/min/1.73 m2. We then calculated eGFR-CKDEPI and re-categorized the population using the same cut-offs but basing it on eGFR-CKDEPI instead of eGFR-MDRD.

• We found that by using eGFR-CKDEPI compared with eGFR-MDRD, 26.9% of the US population will be reclassified into higher eGFR categories and 2.2% will be reclassified to lower eGFR categories. Our next goal was to determine the effect of this reclassification on the risk of death from any cause and death from cardiovascular disease (CVD).

• When we looked at those with eGFR-MDRD 30-59 ml/min/1.73 m2, we found that 19.4% of this population was reclassified to a higher eGFR-CKDEPI category and these individuals had a lower risk of death; 47% lower risk of death from any cause and 49% lower risk of death from CVD. We then looked at those with eGFR-MDRD >60 ml/min/1.73 m2. In this group, 0.5% were reclassified to lower eGFR-CKDEPI and these individuals had a higher risk of death; 31% higher risk of death from any cause and 42% higher risk of death from CVD.

• So, in summary, we found that categorizing individuals based on eGFR-CKDEPI improves risk prediction compared with categorization based on eGFR-MDRD.





Author Interview: Hemodialysis.com Author Interview:Anorexia nervosa and the kidneyDrs. Pierre Delanaye and Antoine Bouquegneau


• AN and eating disorders are frequent and affect a young population.

• Kidney diseases are very frequent and various in these patients: CKD, AKI, lithiasis and electrolytes disturbance.• However, all these kidney injuries are underestimated.

• Hemodialysis.com: Were any of the findings unexpected?• When we did the literature review for this paper, we noticed that the prevalence of eating disorders is blurry.

• This is due to the different definitions of these disorders used by the physicians. Also, it is difficult to diagnose CKD in patients with eating disorders. The frequency and the mechanics of kidney disturbances are neither up to date, nor fully understood.

• Once again, it seems that this type of patients is somewhat neglected.


http://www.hemodialysis.com/author_interviews/anorexia_nervosa_and_the_kidney.html

http://www.hemodialysis.com/author_interviews/anorexia_nervosa_and_the_kidney.html


Author Interview: Hemodialysis.com Author Interview:A Cause Analysis of Absence of Functional Arterio-Venous (AV)

Access in a Prevalent Hemodialysis Patients CohortDrs. Mireille El TersM.D and Marie Hogan M.D. Ph.D


• We found in this study a strong and independent association between PICC use and lack of a functioning AVF and this association persisted after adjustment for confounders, including upper-extremity vein and artery diameters, sex, and history of central venous catheter.

• We also found that PICC use is common among our end stage renal disease (ESRD) population evaluated (30% of our studied hemodialysis patients) with 54% of these placed after dialysis therapy initiation.

•Hemodialysis.com: Were any of the findings unexpected?

• We hypothesized that prior history of PICC is associated with a higher likelihood of lack of functioning arterio-venous fistula (AVF) by way of venous injury, such as venous thrombosis and stenosis.

• So the finding of a strong and independent association between prior PICC use and a lack of functioning AVF was not unexpected.

• We were however surprised by the high proportion of ESRD patients receiving a PICC (30%),especially that the majority occurred after initiation of dialysis (54%).

• It is worthy to note that the most common indication for PICC in our population was antibiotic use,which could arguably be administered during hemodialysis and thus sparing the patient the need for a PICC line placement.


http://www.hemodialysis.com/author_interviews/analysis_of_absence_of_av_access_in_hemodialysis.html

http://www.hemodialysis.com/author_interviews/analysis_of_absence_of_av_access_in_hemodialysis.html

http://www.hemodialysis.com/author_interviews/urolithiasis_and_risk_esrd.html

Author Interview: Hemodialysis.com Author Interview:Urolithiasis and the Risk of ESRDCJASN

Ziad M. El-Zoghby, M.D.


• In this large population-based study, we found that symptomatic stone formers are at increased risk of developing end-stage renal disease (ESRD) compared to matched controls.

• The mechanism of renal failure in stone former appears to be related to their kidney stones and related urological co-morbidities and procedures, rather than other risk factors known to cause ESRD (hypertension, diabetes, etc.) that are commonly found in stone formers.

• Hemodialysis.com: Were any of the findings unexpected?

• We previously reported that stone formers have an increased risk of chronic kidney disease (CKD). Hence it is not surprising that they also have an increased risk of ESRD.

• Furthermore, our new finding that certain urologic conditions which predispose to stone disease (i.e. hydronephrosis, recurrent urinary tract infection, acquired single kidney, obstruction, neurogenic bladder) associate with ESRD also was not surprising.

• However, the risk of ESRD attributable to stone disease (5.1%) was much higher than expected. In fact, this figure is 20-fold above previous estimates (0.2%) that were based upon primary cause of ESRD reported to the United States Renal Data System.


http://www.hemodialysis.com/author_interviews/quality_outcomes_ami_by_kidney_function.html



Author Interview: Hemodialysis.com Author Interview:Quality of Care and Outcomes Among Patients With Acute Myocardial Infarction by Level of Kidney Function at Admission: Report From the Get With The Guidelines

Coronary Artery Disease Program.CJASNDeepak L. Bhatt, MD


• Among patients presenting with ST-elevation myocardial infarction (STEMI), patients with abnormal kidney function received less guideline-recommended care and had higher in-hospital mortality.

• Hemodialysis.com: Were any of the findings unexpected?

• Of note, patients with STEMI who had severe renal dysfunction (GFR 15–30 mL/min/1.73 m2) had adjusted in-hospital mortality rates that were as high as patients on dialysis (in other words, a very high rate of mortality).

• Hemodialysis.com: What should clinicians and patients take away from your report?

• In patients with STEMI and various degrees of renal dysfunction, the treating physicians need to make sure that the patients are getting appropriate evidence-based care.


http://www.hemodialysis.com/author_interviews/treatment_intensity_end_of_life_elderly_dialysis.html



Author Interview: Hemodialysis.com Author Interview:

Treatment Intensity at the End of Life in Older Adults Receiving Long-term DialysisSusan Wong MD

• Hemodialysis.com: What are the main findings of the study?• In this large retrospective mortality study, we present end-of-life care practices among older Medicare beneficiaries receiving

chronic dialysis.

• We found that older dialysis patients experience very aggressive care at the end-of-life, and hospitalization, intensive care unit admission, and use of intensive procedures (mechanical ventilation, cardiopulmonary resuscitation, and feeding tube placement) during the final month of life are common.

• Hemodialysis.com: Were any of the findings unexpected?• Intensity of care at the end-of-life is more strongly and consistently associated with regional healthcare spending than with

individual patient characteristics in older dialysis patients.

• Rates of hospitalization and use of intensive procedures at the end-of-life in this population also greatly exceed those reported for other Medicare patients with life-limiting illnesses, such as cancer and heart failure.


Author Interview: Prof. Sergio StefoniThrombosis 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.

• What are the main findings of the study?• High dose urokinase lock therapy allows an optimal TCC patency without

bleeding complications.

• Were any of the findings unexpected?• The TCC survival with high dose urokinase lock therapy is higher than in the low

dose group reaching 95% at 3 years.

• What should clinicians and patients take away from this study?• 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.


http://www.hemodialysis.com/author_interview_dr_stefoni_thrombosis_of_tunneled_cuffed_hemodialysis_catheters.html




Authors Interview' : Drs. Carl-Johan Jakobsen & Dorthe NielsenPerioperative 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.

• What are the main findings of the study?• 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.

• Were any of the findings unexpected?• 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.

• 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.


http://www.hemodialysis.com/authors_interview__perioperative_aminoglycoside_perioperative_dialysis.html




Author Interview: Dr Luca NeriJoint 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 "L. Devoto," Milan, Italy.Am J Kidney Dis. 2011 Sep;58(3):398-408. Epub 2011 Jul 23.

• What are the main findings of the study?• 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).

• 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.


http://www.hemodialysis.com/author_interview_dr_neri_hyperuricemia_reduced_gft_cv_mortality.html





Author Interview: Dr. Timm H. WesthoffUrinary Calprotectin and the Distinction between Prerenal and Intrinsic Acute Kidney InjuryCJASN

September 1, 2011 CJN.02490311; published ahead of print September 1, 2011,doi:10.2215/CJN.02490311

• What are the main findings of the study?• 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.

• 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.

• Were any of the findings unexpected?• In gastroenterology, fecal calprotectin is a well established parameter for the differentiation

between inflammatory bowel disease and irritable bowel syndrome.

• 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.

• Thus, the findings of our study were rather expected than unexpected.


http://www.hemodialysis.com/author_interview_dr_westhoff_calprotectin_prerenal_instrinsic_aki.html



Author Interview: Michael Heung MDFluid overload at initiation of renal replacement therapy is associated with lack of renal recovery

in patients with acute kidney injuryMichael Heung ,Dawn F. Wolfgram ,Mallika Kommareddi, Youna Hu,Peter X. Song ,Akinlolu O. Ojo

Nephrol. Dial. Transplant. (2011) doi: 10.1093/ndt/gfr470First published online: August 19, 2011

• What are the main findings of the study?• 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.

• 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.

• Were any of the findings unexpected?• 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.

• We believe this may reflect delays in the initiation of dialysis.


http://www.hemodialysis.com/author_interview_dr_heung_fluid_overload_at_initiation_of_dialysis.html




Author Interview: Dr. Csaba Kovesdy MDParicalcitol Versus Ergocalciferol for Secondary Hyperparathyroidism in CKD Stages 3 and 4:

A Randomized Controlled TrialCsaba 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)

• What are the main findings of the study?• 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.

• Both treatments were well tolerated.

• Were any of the findings unexpected?• 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.


http://www.hemodialysis.com/author_interview_dr_kovesdy_paricalcitol_vs_ergocalciferol.html




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. SarnakAmerican Journal of Kidney Diseases - 29 August 2011 (10.1053/j.ajkd.2011.06.024)

• What are the main findings of the study?• 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.

• Were any of the findings unexpected?• 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.

• 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.


http://www.hemodialysis.com/author_interview_dr_tangri_beta_blockers_sudden_cardiac_death_hemodialysis_patients.html




Author Interview: Dr Richard Mc GeeDiagnostic 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.

• What are the main findings of the study?• 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.

• Were any of the findings unexpected?• 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.


http://www.hemodialysis.com/author_interview_d_mcgee_diagnostic_tests_in_nephrology.html

http://www.hemodialysis.com/author_interview_d_mcgee_diagnostic_tests_in_nephrology.html

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 WessonKidney Int advance online publication, August 31, 2011; doi:10.1038/ki.2011.313

• What are the main findings of the study?• 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.

• 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).

• 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.


http://www.hemodialysis.com/author_interview_dr_wesson_dietary_acid_reduction_and_kidney_injury.html




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.

• What are the main findings of the study?• 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.

• 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.

• However, no association was found between WBC count and the risk of low eGFR.


http://www.hemodialysis.com/author_interview_dr_sato_elevated_wbc_proteinuria_and_gfr.html




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

• What are the main findings of the study?• 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.

• 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.

• Were any of the findings unexpected?

• 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.


http://www.hemodialysis.com/author_interview_dr_beberashvili_il6_nutrition_mortality_hemodialysis.html



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.

• What are the main findings of the study?• 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.

• 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%.

• 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).


http://www.hemodialysis.com/author_interview_dr_calfee_epidemiology_of_mrsa_in_hemodialysis_center.html




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.

• What are the main findings of the study?• 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.

• 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.

• 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.

• 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).

• 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.


http://www.hemodialysis.com/author_interview_dr_baharani_why_did_i_start_dialysis.html




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.

• What are the main findings of the study?• Our study has six major findings. Firstly, the annual incidence of cancer development in

chronic dialysis patients was 1.1%.

• 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.

• Thirdly, patients aged <35 years old and patients having a duration of dialysis of <5 years had a higher risk of cancer.

• 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.


http://www.hemodialysis.com/author_interview_dr_fang_cancer_in_dialysis_patients.html



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.

• What are the main findings of the study?• 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.

• 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.

• 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.


http://www.hemodialysis.com/author_interview_dr_golebiewska_megestrol_acetate_nutrition_inflammation_qol_dialysis.html



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 InvestigatorLaboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples.

Circulation. 2011 Aug 11

• Were any of the findings unexpected?• 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.

• What should clinicians and patients take away from this study?• 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.


http://www.hemodialysis.com/author_interview_dr_briguori_renal_guard_system_for_cin.html




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

• What are the main findings of the study?• The aim of this study was to evaluate the results after secondary interventions in patients

with an upper extremity arteriovenous fistula.• The 1-year primary patency rates of arteriovenous fistulas (AVF) are poor. To improve these

results several secondary interventions can be performed.• We found that due to mostly endovascular secondary interventions, 2-year primary assisted

and secondary patency rates of more than 70% can be obtained.

• Were any of the findings unexpected?• We didn’t expect that the arteriovenous fistulas performed so well after secondary

interventions.• We expected that some patients received more interventions, but that the outcome after

several interventions would be poor.• Unexpected was the fact that patients received up to eleven interventions, with a still

functioning hemodialysis access.


http://www.hemodialysis.com/authors_interview_secondary_interventions_in_av_fistulas_improve_patency_rates.html




Author Interview: Dr. Robert L Hanson MDAlbuminuria 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.

• What are the main findings of the study?• 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.

• Were any of the findings unexpected?• 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.


http://www.hemodialysis.com/author_interview_dr_hanson_albuminuria_gfr_death_diabetic_esrd.html




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.

• What are the main findings of the study?

• 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).


• 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.


http://www.hemodialysis.com/author_interview_dr_meier_referral_patterns_in_hospital_aki.html




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 BAChildren's Hospital of Philadelphia, Philadelphia, Pennsylvania;

Clin J Am Soc Nephrol. 2011 Aug 12

• What are the main findings of the study?• 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.

• 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.

• Were any of the findings unexpected?• 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.

• 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.


http://www.hemodialysis.com/author_interview_dr_furth_metabolic_abnormalties_cvd_gfr_ckd.html




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 BAChildren's Hospital of Philadelphia, Philadelphia, Pennsylvania;


• What are the main findings of the study?• 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.

• 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.

• Were any of the findings unexpected?• 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.

• 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.






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

• What are the main findings of the study?• 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.

• 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.

• Were any of the findings unexpected?• 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.


http://www.hemodialysis.com/authors_interview_molnar_zadeh_high_platelet_count_cachexia_cv_mortality_esrd.html




American Society of Nephrology Press Release: Metabolic syndrome may cause kidney diseaseHigh blood pressure, high blood sugar, abdominal fat, low good cholesterol may contribute to kidney disease

• 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).

• 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).

• 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.

• People with metabolic syndrome have a 55% increased risk of developing kidney problems, especially lower kidney function, indicative of kidney disease.

• Individual components of metabolic syndrome are linked with the development of kidney disease.

• Kidney disease risk increases as the number of metabolic syndrome components increases.


http://www.hemodialysis.com/asn_metabolic_syndrome_may_cause_kidney_disease.html

http://www.hemodialysis.com/asn_metabolic_syndrome_may_cause_kidney_disease.html

Author Interview: Dr. Sankar NavaneethanMetabolic Syndrome and Kidney Disease: A Systematic Review and Meta-analysisGeorge

Thomas ,Ashwini R. Sehgal , Sangeeta R. Kashyap ,Titte R. Srinivas ,John P. Kirwan , Sankar D. Navaneethan

CJASN August 2011 CJN.02180311

• What are the main findings of the study?• 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.

• 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.

• Were any of the findings unexpected?• Metabolic syndrome has been associated with cardiovascular disease, stroke, and all-cause mortality in

the general population.

• 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.

• 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.


http://www.hemodialysis.com/author_interview_dr_navaneethan_metabolic_syndrome_and_kidney_disease.html



Author Interview: Dr. Carla AvesaniAnnual 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.

• What are the main findings of the study?• 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.

• Were any of the findings unexpected?• 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.


http://www.hemodialysis.com/author_interview_dr_avesani_annual_body_fat_variation_inflammation_and_ckd.html




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.


• 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.

• 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.

• 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.


http://www.hemodialysis.com/author_interview_dr_bowden_reverse_epidemiology_of_lipid_death_associations_in_esrd.html




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.


• What are the main findings of the study?• 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.

• 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).

• 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.

• Similar findings were observed evaluating a composite endpoint of rapid GFR loss, end stage renal disease, and death.


http://www.hemodialysis.com/author_interview_dr_deboer_vitamin_d_and_gfr.html



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)


• 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.


• 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.

• What should clinicians and patients take away from this study?

• 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.


http://www.hemodialysis.com/author_interview_dr_shalansky_iron_indices_after_ferric_complex_in_hemodialysis.html



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.


• 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.

• 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.

• 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.

• Dialysis patients with psychiatric comorbidity had lower HRQoL scores, which indicates that suffering from anxiety and depression contribute to impaired HRQoL. .


http://www.hemodialysis.com/author_interview_dr_preljevic_psychiatric_disorders_bmi_crp_in_dialysis_patients.html



Author Interview Dr. Hitinder S. GurmRenal 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) RegistryJ Am Coll Cardiol, 2011; 58:907-914, doi:10.1016/j.jacc.2011.05.023


• 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.


• THESE FINDINGS ARE NOT UNEXPECTED SINCE IT FOLLOWS FROM BASIC PHARMACOLOGY PRINCIPLES.

• What should clinicians and patients take away from this study?• 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


http://www.hemodialysis.com/author_interview_dr_gurm_renal_function_based_contrast_dosing_in_pci.html




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?

• What are the main findings of the study?• 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.

• Were any of the findings unexpected?• 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.


http://www.hemodialysis.com/authors_interview_nunes_cavanaugh_patient_perception_and_physician_satisfaction.html





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.

• What are the main findings of the study?• 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.

• We found alfalcalcidol and paricalcitol to equally suppress secondary hyperparathyroidism, without any difference in the elevation of calcium or phosphate levels.

• Were any of the findings unexpected?• 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.


http://www.hemodialysis.com/author_interview_dr_hansen_alfacalcidol_and_paricalcitol_in_secondary_hyperparathyroidisim.html




Author Interview: Dr. Elif AriAccelerated 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.

• What are the main findings of the study?• 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.

• Were any of the findings unexpected?• 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.


http://www.hemodialysis.com/author_interview_dr_ari_accelerated_atherosclerosis_in_hemodialysis_patients.html




Author Interview: Dr.Paraskevi TheofilouQuality of Life in Patients Undergoing Hemodialysis or Peritoneal Dialysis TreatmentJ Clin Med Res. 2011

May 19; 3(3): 132–138Paraskevi Theofilou, Department of Psychology, Panteion University, Eratous 12, 14568, Athens, Greece.

• What are the main findings of the study?• 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.

• 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.

• 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.

• 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.

• 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.


http://www.hemodialysis.com/author_interview_dr_theofilou_qol_in_hemodialysis_or_peritoneal_dialysis.html



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.


• What are the main findings of the study?• 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.

• 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).

• 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.

• Similar findings were observed evaluating a composite endpoint of rapid GFR loss, end stage renal disease, and death.





Author Interview: Steven M. BrunelliA 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. BrunelliDOI: 10.1053/j.ajkd.2011.05.028

• What are the main findings of the study?• 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.


http://www.hemodialysis.com/author_interview_dr_brunelli_model_of_systolic_blood_pressure_during_course_of_dialysis.html




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 CKDDesai 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.

• What are the main findings of the study?• 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).

• 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.

• 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.


http://www.hemodialysis.com/authors_interview_drs_desai_pfeffer_cardiac_biomarkers_esrd_diabetes_anemia_ckd.html




FMC to spend $2.1 billion on U.S. dialysis acquisitions for Liberty Dialysis and American Access Care

• (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.

• The Germany-based company said it would buy privately held Liberty Dialysis Holdings for $1.7 billion including about $1 billion in assumed debt.

• 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.

• 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 "bundled rate" per dialysis session.

• 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.

• 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.


http://www.hemodialysis.com/fresenius_to_buy_liberty_dialysis_and_american_access.html



DaVita to Launch Dialyzer Recycling Pilot Project through Collaboration with Waste Management and BD, Becton, Dickinson and Company

• 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.

• “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.”

• 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.


http://www.hemodialysis.com/davita_to_launch_dialyzer_recycling_pilot.html



Author Interview: Eva SchepersSymmetric 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;


• What are the main findings of the study?• 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.

• 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.

• Were any of the findings unexpected?• 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.

• 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.

• 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.


http://www.hemodialysis.com/author_interview_dr_schepers_dimethylarginine_as_proinflammatory_agent_in_ckd.html



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.

• What are the main findings of the study?• 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.

• 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.

• Were any of the findings unexpected?• 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.


http://www.hemodialysis.com/author_interview_dr_su_aki_after_gadolinium_in_renal_impaired_patients.html



Author Interview: Dr. Manish M SoodThe 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.

• What are the main findings of the study?• 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.

• 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.

• Were any of the findings unexpected?• We were surprised on how well the simple ADL score predicted patient outcomes!

• 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.

• 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.


http://www.hemodialysis.com/author_interview_dr_sood_functional_status_in_discharge_to_assisted_care.html




Author Interview: Cheng-Chia Lee, MDComparable 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.

• What are the main findings of the study?• 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.

• Were any of the findings unexpected?• 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.

• 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.


http://www.hemodialysis.com/author_interview_dr_lee_comparable_outcome_hemodialysis_patients_hep_c_and_hep_b.html




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.

• What are the main findings of the study?• 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.

• Were any of the findings unexpected?• 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.

• What should clinicians and patients take away from this study?• 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.


http://www.hemodialysis.com/author_interview_dr_perez_saez_tandem_plasmapheresis_and_hemodialysis.html



Author Interview: Dr. Kurella TamuraAlbuminuria, 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.

• What are the main findings of the study?• 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.

• Were any of the findings unexpected?• 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.

• What should clinicians and patients take away from this study?• 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. • What recommendations do you have for nephrology health care providers as a result of your

study?• 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.


http://www.hemodialysis.com/author_interview_dr_tamura_albuminuria_kidney_function_and_cognitive_impairment.html



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.

• What are the main findings of the study?• 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.

• Were any of the findings unexpected?• 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.

• What should clinicians and patients take away from this study?• 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)


http://www.hemodialysis.com/author_interview_dr_budoff_gfr_and_coronary_artery_calcification_in_the_cric_study.html




Author Interview: Baris Afsar, M.DHbA1c Is Related with Uremic Pruritus in Diabetic and Nondiabetic Hemodialysis PatientAfsar B, Elsurer

Afsar R.Department of Nephrology, Zonguldak Atatürk Government Hospital, Zonguldak, Turkey.

Ren Fail. 2011 Mar 4.

• What are the main findings of the study?• The main findind of our study was that in both diabetic and non-diabetic subjects uremic

pruritus was associated with hemoglobin A1c (HbA1c).

• Were any of the findings unexpected?• The unexpected finding of the study was the presence of association also in non-diabetic

patients. Our findings are novel and preliminary.

• What should clinicians and patients take away from this study?• As a take home massage it should be examined in randomized trials whether strict

glycemic control lowers uremic pruritus.


http://www.hemodialysis.com/author_interview_dr_afsar_hba1c_and_uremic_pruritus_in_diabetic_and_non_diabetic_hemodialysis_patients.html



Author Interview: Luca De Nicola, MD-PhDPrognosis of CKD Patients Receiving Outpatient Nephrology Care in ItalyCJASN August 2011

CJN.01180211Luca De Nicola Paolo Chiodini Carmine Zoccali Silvio Borrelli

Bruno Cianciaruso Biagio Di Iorio Domenico SantoroVincenzo Giancaspro Cataldo Abateruss Ciro Gallo

Giuseppe Conte Roberto Minutolo for the SIN-TABLE CKD Study Group

• What are the main findings of the study?• 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• (1) ESRD is more frequent than death in stage 4 and 5 CKD, but the opposite is true in stage 3;• (2) among the main modifiable risk factors, proteinuria and high phosphate predict ESRD, whereas

proteinuria, high uric acid, and anemia predict death;• (3) proteinuria must be considered in conjunction with eGFR to refine risk stratification.

• Were any of the findings unexpected?• Absence of any predictive role of BP is somehow unexpected.

• 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.


http://www.hemodialysis.com/author_interview_dr_denicola_prognosis_of_ckd_patients_in_italy.html



Author Interview: Tara I Chang, MD, MSSystolic Blood Pressure and Mortality in Patients on Hemodialysis.

Chang TI.Curr Hypertens Rep. 2011 Jul 30.

• What should clinicians and patients take away from this review? • 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.

• What recommendations do you have for nephrology health care providers as a result of your review?

• 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.

• Future research trials focusing on several aspects of blood pressure management in hemodialysis are still greatly needed.


http://www.hemodialysis.com/author_interview_dr_chang_review_systolic_blood_pressure_and_mortality_in_hemodialysis_patients.html



Author Interview: Dr. Joaquim AbianProteomic 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.


• 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.

• We have also shown that SLURP1, one of the proteins removed by MARS from patients’ blood, was overrepresented in serum from patients with cholestasis.


http://www.hemodialysis.com/author_interview_dr_abian_polypeptides_from_dialysis_in_patients_with_cholestasis_and_resistant_pruritus.html




Author Interview: Tara I Chang, MD, MSIntradialytic Hypotension and Vascular Access ThrombosisChang 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.

• What are the main findings of the study?• We found that intradialytic hypotension was significantly associated with vascular access thrombosis, and

specifically with arteriovenous fistula thrombosis.

• 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.

• 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.

• Were any of the findings unexpected?• We were somewhat surprised at the lack of significant association of intravascular hypotension with graft

thrombosis.

• 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.


http://www.hemodialysis.com/author_interview_dr_chang_intradialytic_hypotension_and_vascular_access_thrombosis.html



Author Interview: Dr. Stephen R. HooperNeurocognitive 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.

• What are the main findings of the study?• 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.

• 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.

• 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.


http://www.hemodialysis.com/author_interview_dr_hooper_neurocognitive_functioning_of_children_adolescents_with_ckd.html



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

• What are the main findings of the study?• 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.

• 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.


http://www.hemodialysis.com/author_interview_dr_tuot_ckd_awareness_among_patients_with_markers_of_kidney_dysfunction.html




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.

• What are the main findings of the study?• 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.

• Were any of the findings unexpected?• 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.


http://www.hemodialysis.com/author_interview_dr_gordon_viral_negativity_after_interferon_for_hepatitis_c_in_hemodialysis.html



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.

• The main findings of the randomized controlled trial are:• 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;

• b) the size of hematoma in patients who experienced bleeding on the screening ultrasound was smaller in those receiving desmopressin;

• c) the drug was well tolerated;• d) mean hospital stay was less in the desmopressin group than in placebo

group.


http://www.hemodialysis.com/author_interview_dr_manno_desmopressin_in_kidney_biopsy.html



Author Interview: Dr. Laura MaursetterReview 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.

• What are the main findings of the study?• Continuous renal replacement therapy can be a topic of confusion for health care providers.

• 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.

• Herein we review the topic of continuous renal replacement written while keeping the non-nephrologist in mind.

• 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.

• 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.

• It is an article that is useful for as an overview or reference that can be understood by the entire health team.


http://www.hemodialysis.com/author_interview_dr_maursetter_review_of_nutrition_in_crrt.html



Author Interview: Dr. Giuseppe CiancioloVDR 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.

• What are the main findings of the study?• 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.

• 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.

• 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.


http://www.hemodialysis.com/author_interview_dr_cianciolo_vdr_expression_dialysis_patients_and_vitamin_d_and_calcitriol.html




. 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.


• 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.


• 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.

• It is understandable that age composition of the cohort may not be even, and may therefore influence the result.


http://www.hemodialysis.com/author_interview_dr_hsu_betel_nut_chewing_and_ckd.html



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.

• What are the main findings of the study?• 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.

• Were any of the findings unexpected?• These findings were expected based upon SRTR modeling.

• What should clinicians and patients take away from this study?• 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.


http://www.hemodialysis.com/author_interview_pearson_transplanting_kidneys_without_points_for_hla_b_matching.html




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.

• What are the main findings of the study?• Our study demonstrated that medical improvement in parathyroid hormone level by

cinacalcet is associated with a reduction in darbepoietin requirement.• In addition, the magnitude of PTH reduction is directly associated with the degree in

darbepoetin dose reduction.

• Were any of the findings unexpected?• 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.• 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.


http://www.hemodialysis.com/author_interview_dr_chan_improved_pth_control_by_cinacalcet_associated_with_reduction_in_darbopoetin.html




Author Interview: Dr. Elif AriOxidative 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)

• What are the main findings of the study?• 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.

• Were any of the findings unexpected?• 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.


http://www.hemodialysis.com/author_interview_dr_ari_oxidative_dna_damage_carotid_artery_atherosclerosis_in_hemodialysis_patients.html



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.

• What are the main findings of the study?• Cardiac output appears to be elevated in patients with end stage renal failure

and this is independent of the presence of arterio-venous fistula.

• This finding is unexpected as previous literature has focused on cardiac output in only those patients in end stage renal failure with fistulas.

• 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.

• SPECT/CT perfusion imaging or echocardiography provide convenient methods of assessing cardiac output and myocardial function and perfusion.

• As elevated cardiac output can predispose to high output failure, drug treatment may need to be monitored in order not to exacerbate the situation.


http://www.hemodialysis.com/author_interview_dr_coffey_spect_mibi_for_cardiac_output_and_index_in_esrd.html



Drs. Nazanin Noori MD Ph.D & Kamyar Kalantar-Zadeh, MD, MPH, PhDDietary Omega-3 Fatty Acid, Ratio of Omega-6 to Omega-3 Intake, Inflammation,

and Survival in Long-term Hemodialysis PatientsAm J Kidney Dis. 2011 Jun 7.

• What are the main findings of the study?• 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.

• 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.

• Were any of the findings unexpected?• Higher Omega 3 in the diet alone was not strongly associated with lower mortality.

• 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.


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

• What are the main findings of the study?• 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.

• 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.

• 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.

• Critically, a screening test like the minimental state examination provided no insight into the presence of cognitive impairment in executive function domains.


http://www.hemodialysis.com/author_interview_dr_weiner_cv_disease_and_cognitive_function_in_hemodialysis_patients.html



Author Interview: Dr. Florence SensSurvival 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]

• What are the main findings of the study?• 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.

• Were any of the findings unexpected?• 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.


http://www.hemodialysis.com/author_interview_dr_sens_survival_of_hd_relative_to_pd_in_esrd_and_chf.html




Author Interview: Dr. Rajnish MehrotraAssociation of Hemoglobin and Survival in Peritoneal Dialysis PatientsMiklos Z. Molnar, Rajnish Mehrotra,

Uyen Duong, Csaba P. Kovesdy, and Kamyar Kalantar-Zadeh

CJASN July 22, 2011 CJN.010502

• What are the main findings of the study?• 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.

• 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.

• Were any of the findings unexpected?• 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.

• 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.


http://www.hemodialysis.com/author_interview_dr_mehrotra_hemoglobin_and_survival_in_peritoneal_dialysis_patients.html



Author Interview: Dr. Gerjan NavisVascular 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

• 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.

• 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


http://www.hemodialysis.com/author_interview_dr_navis_vegf_c_and_dietary_salt__in_proteinuric_ckd_and_healthy_subjects.html





Author Interview: Dr. Florian KnollCoumarins 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.

• What are the main findings of the study?• 1.) Dialysis patients have a high incidence and prevalence of atrial fibrillation.

• 2.) Mortality in dialysis patients with atrial fibrillation was significantly higher compared to dialysis patients with sinus rhythm.

• 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.

• 4.) No patient under sufficient oral anticoagulation therapy and close monitoring experienced a stroke or a fatal bleeding event.

• 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.


http://www.hemodialysis.com/author_interview_dr_knoll_coumarins_and_survival_in_incident_dialysis_patients.html



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

Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.Am J Kidney Dis. 2011 Jul;58(1):29-38.


• Serum bicarbonate levels <23 mEq/L were associated with slower gait speed,• reduced quadriceps muscle strength, and greater likelihood of• self-reported disability among Americans 50 years of age or older in the• general population.


• The prevalence of acidosis (defined as serum bicarbonate ><23 mEq/L) was• 22.7%, which was substantially higher than previous estimates in cohorts• of individuals largely free of overt kidney disease.


http://www.hemodialysis.com/author_interview_dr_abramowitz_serum_bicarbonate_gait_speed_and_strength.html



Author Interview: Dr. Lee A. Hebert, MDRelapse or Worsening of Nephrotic Syndrome in Idiopathic Membranous Nephropathy Can Occur even though the Glomerular Immune Deposits Have Been Eradicated.

Barnes CE, Wilmer WA, Hernandez RA Jr, Valentine C, Hiremath LS, Nadasdy T, Satoskar AA, Shim RL, Rovin BH, Hebert LA.

Departments of Internal Medicine and Pathology, The Ohio State University Medical CenterNephron Clin Pract. 2011 Jul 8;119(2):c145-c153

• What should clinicians and patients take away from this study?• It is generally assumed that when proteinuria increases in a patient with

membranous nephropathy this is evidence that the membranous nephropathy has recurred and therefore the patient requires renewed treatment, usually a repeat of the immunosuppressive therapy. Our data show that this is often incorrect.

• Our data also show that the reason for the marked increase in proteinuria appears to be poor control of blood pressure or very high salt intake.


http://www.hemodialysis.com/author_interview_dr_hebert_nephrotic_syndrome_in_idiopathic_membranous_nephropathy.html




Nephros Receives 510k Approval to Market Additional Ultrafiltration Products

RIVER EDGE, N.J., July 21, 2011 /PRNewswire/ -- Nephros, Inc. (OTC Bulletin Board: NEPH)a medical device company developing and marketing filtration products for therapeutic applications, infection control,and water purification,today announced that the Company has received 510k clearance from the U.S. Food and Drug Administration to market its MSU and SSU ultrafiltersto filter out biological contaminants from water and bicarbonate solution used in hemodialysis procedures.

"Nephros is pleased to have received clearance from the FDA to market the MSU and SSU for hemodialysis applications," said Dr. Paul Mieyal, Acting CEO of Nephros, Inc.

"The MSU and SSU represent extensions of the Nephros ultrafiltration product line

and enable Nephros products to address a wider range of fluid flow requirements."

Author Interview: Prof. Dr.Jozsef BallaHydrogen sulfide inhibits the calcification and osteoblastic differentiation

of vascular smooth muscle cells.Zavaczki E, Jeney V, Agarwal A, Zarjou A, Oros M, Katkó M, Varga Z, Balla G, Balla J.Kidney Int. 2011 Jun 29. doi: 10.1038/ki.2011.212.

Hemostasis, Thrombosis and Vascular Biology Research

• What are the main findings of the study?• The purpose of our study was to investigate whether hydrogen sulfide (H2S) and biogeneration of H2S

play a role in the process of human vascular smooth muscle cell (VSMC) mineralization and transition of VSMCs into osteoblast like cells.

• H2S has traditionally been considered as a toxic gas; however, recently it has been recognized as the third endogenous gaseous transmitter besides carbon monoxide and nitric oxide. In mammals H2S is produced by two enzymes: cystathionine beta-synthase (CBS) and cystathionine gamma-lyase (CSE) via the transsulfuration pathway using homocysteine, cystathionine and L-cysteine as substrates. In the vasculature, H2S is generated mainly by vascular smooth muscle cells by CSE.

• High extracellular phosphate (Pi) has been widely established to induce vascular calcification. Pi uptake through a sodium-dependent phosphate co-transporter, Pit-1, is essential for VSMC calcification and phenotypic modulation in response to elevated Pi. Contrary to previous conception, accumulating evidence now suggests that vascular calcification is a delicate and well regulated cellular process where VSMCs gain an osteoblastic phenotype. This is indicated by the increase in expression of core binding factor alpha-1 (Cbfa1) which is an osteoblast-specific transcription factor required for osteoblast differentiation, bone matrix gene expression, and consequently, bone mineralization. Upregulation of alkaline phosphatase (ALP) (an important enzyme in early osteogenesis) and osteocalcin (a major noncollagenous protein in bone matrix that regulates mineralization) was also demonstrated to occur.


http://www.hemodialysis.com/author_interview_dr_balla_hydrogen_sulfide_inhibits_calcification_of_smooth_muscle_cells.html




Author Interview: Dr. C. Barrett Bowling, MDRelationship between Stage of Kidney Disease and Incident Heart Failure in Older Adults .Bowling CB,

Feller MA, Mujib M, Pawar PP, Zhang Y, Ekundayo OJ, Aban IB,Love TE, Sanders PW, Anker SD, Fonarow GC, Ahmed A.

VA Medical Center, Birmingham, Ala., USA.Am J Nephrol. 2011 Jul 4;34(2):135-141

• What are the main findings of the study?• Among community-dwelling older adults, chronic kidney disease (CKD) stage 3A, defined

as an estimated glomerular filtration rate (eGFR) 45–59 ml/min/1.73 m2 was a predictor of incident heart failure (HF), but this association lacked independence. In contrast, CKD stage ≥ 3B (eGFR < 45 ml/min/1.73 m2) was a stronger, independent predictor of incident HF.


• Previous studies have shown an association between elevated creatinine and HF, however serum creatinine is a poor marker of kidney function in older adults. Many older adults with normal creatinine may have kidney disease. Therefore, we identified older adults with CKD who participated in the Cardiovascular Health Study by estimating GFR.

• Interestingly, we showed that moderate CKD was associated with developing HF, but this association was not apparent after statistical adjustment for other factors that lead to HF. More advanced CKD remained a significant risk factor for developing HF even after statistical adjustment.


http://www.hemodialysis.com/author_interview_dr_bowling_stage_of_kidney_disease_and_heart_failure.html




Author Interview: Dr. Margaret FangA New Risk Scheme to Predict Warfarin-Associated HemorrhageThe ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) Study.

Fang MC, Go AS, Chang Y, Borowsky LH, Pomernacki NK, Udaltsova N, Singer DE.Department of Medicine, University of California, San Francisco, San Francisco, California.

J Am Coll Cardiol. 2011 Jul 19;58(4):395-401.


• The “ATRIA Study”, based at Kaiser Permanente of Northern California, is a cohort of 13,559 patients with atrial fibrillation and a study that has provided many important insights into the risks and benefits of warfarin in real-world patients with atrial fibrillation. The goal of our study was to develop a clinically-useful tool to help providers estimate a person’s risk for major bleeding while taking warfarin. Our main findings were that 5 easily obtainable risk factors could be used to estimate a person’s risk for warfarin-related bleeding: anemia, severely-impaired renal function, older age, a history of bleeding, and high blood pressure.


• We were somewhat surprised that the overall, average rates of bleeding in our patient population were fairly low, even though our patients were generally of older age and with chronic medical conditions. However, depending on what clinical risk factors were present, the annual bleeding risk could be very high, exceeding 17% per year.


http://www.hemodialysis.com/author_interview_dr_fang_new_scheme_to_predict_warfarin_hemorrhage.html



Author Interview: Dr. Martin Wagner, MD MSEndogenous erythropoietin and the association with inflammation

and mortality in diabetic chronic kidney disease.Wagner M, Alam A, Zimmermann J, Rauh K, Koljaja-Batzner A, Raff U, Wanner C, Schramm L.

Clin J Am Soc Nephrol. 2011 Jul;6(7):1573-9.University Hospital Würzburg, Department of Medicine I, Division of Nephrology

• What are the main findings of the study?• Anemia is a common finding in diabetic patients with chronic kidney disease (CKD). The

underlying mechanisms remain uncertain.• In our study on 215 diabetic patients with CKD, we found that elevated endogenous EPO-

levels were associated with inflammatory markers, largely independent from kidney function. There was no evidence for absolute EPO deficiency, in fact EPO-resistance due to inflammation may be a possible explanation for this phenomenon. Furthermore, elevated EPO-level were independently related to all-cause mortality.

• Were any of the findings unexpected?• It was interesting, that while elevated EPO-level were associated with impaired kidney

function in univariate analyses, the relationship became non-significant by inclusion of markers of inflammation (CRP, albumin) and iron-status (ferritin).

• Moreover, elevated EPO-level represented a stronger predictor of all-cause mortality than it was CRP.


http://www.hemodialysis.com/author_interview_dr_wagner_endogenous_epo_and_mortality_in_diabetic_ckd.html




Author Interview: Dr. Allen ChengVancomycin dosing: assessment of time to therapeutic concentration and

predictive accuracy of pharmacokinetic modeling software.Nunn MO, Corallo CE, Aubron C, Poole S, Dooley MJ, Cheng AC.

Ann Pharmacother. 2011 Jun;45(6):757-63.School of Pharmacy, University of Nottingham, University Park, Nottingham, England.

• What are the main findings of the study?• Vancomycin is an important antibiotic for the treatment of some infections, including those due to MRSA.

Studies suggest that, not unexpectedly, underdosing results in treatment failure and the development of resistance.

• Vancomycin is notoriously difficult to model due to non-renal clearance and distribution into a second compartment. We performed a validation study where we took information available to the clinician (dose, patient weight, creatinine) to see if a pharmacokinetic modelling program (USC-PACK, Laboratory of Applied Pharmacokinetics, University of Southern California) could predict the vancomycin concentration that was subsequently measured (Nunn Ann Pharmacother 2011 45(6) 757-63). We found that the program was reasonably accurate at predicting vancomycin trough levels.

• Were any of the findings unexpected?• In the course of checking levels, we found that the majority of vancomycin trough concentrations were

regarded as low, suggesting that the current clinical practice (at least at our hospital in Australia) resulted in under-dosing.

• This resulted in delays to achieving therapeutic levels, particularly in patients under the age of 65 years with higher renal clearance of vancomycin.


http://www.hemodialysis.com/author_interview_dr_cheng_vancomycin_dosing_time_to_therapeutic_concentration_and_modeling_software.html





Author Interview: The SHARP clinical team on behalf of Professor Colin BaigentThe effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial.

Lancet. 2011 Jun 25;377(9784):2181-92.Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK.

• What are the main findings of the study?• · Taking the combination of simvastatin 20mg plus ezetimibe 10mg long-term reduced

the risk of heart attacks, strokes and operations to open blocked arteries by about one quarter in people with chronic kidney disease, irrespective of the severity of their disease.

• · This combination treatment reduced risk safely, and may be particularly good for kidney patients as it avoids the possibility of side-effects with high statin doses.

• · There was no support for previous concerns with ezetimibe about possible adverse effects on cancer, and no evidence of an increased risk of muscle or liver problems.

• · More details can be found on our website: www.sharpinfo.org

• Were any of the findings unexpected?• In those patients not on dialysis, taking simvastatin plus ezetimibe did not prevent the

progression of their kidney disease to the stage where dialysis or transplantation was required.


http://www.hemodialysis.com/author_interview_dr_baigent_ldl_lowering_with_simvastatin_plus_ezetimibe_in_ckd.html




Author Interview: Dr. G. CrambertChronic potassium depletion increases adrenal progesterone production that is necessary for

efficient renal retention of potassium.Elabida B, Edwards A, Salhi A, Azroyan A, Fodstad H, Meneton P,

Doucet A, Bloch-Faure M, Crambert G.SourceKidney Int. 2011 Aug;80(3):256-62. doi: 10.1038/ki.2011.15

UPMC Univ Paris 6/INSERM/CNRS, Laboratoire de Génomique, Physiologie et Physiopathologie Rénales,

• What are the main findings of the study?• In this study, we report the identification of progesterone, produced by adrenal glands, as

an anti-kaliuretic hormone participating in the adaptation to dietary potassium restriction in male mouse. This steroid, well-known, for its reproductive functions, turns out to participate in renal electrolyte balance by acting on the kidney to promote the expression of a specific ion transporter, the H,K-ATPase type 2.

• This finding were confirmed in men.

• Indeed, we report a correlation between a low potassium intake and an increased concentration of circulating progesterone.

• Were any of the findings unexpected?• Contrary to many other studies, we decided to undergo a global research aiming at

understanding how the adrenal steroidogenesis is regulated by sodium and potassium intake by building a mathematical model of this pathway. This result was therefore unexpected since progesterone, in the steroidogenesis, is not an end product and was considered, up to now, only as an intermediary.


http://www.hemodialysis.com/author_interview_dr_crambert_chronic_potassium_depletion_increases_adrenal_progesterone.html




Author Interview: Dr. Wenzheng Zhang, Ph.D Af17 Deficiency Increases Sodium Excretion and Decreases Blood PressureChen L, Wu H, Pochynyuk OM, Reisenauer MR, Zhang Z, Huang L, Zaika OL, Mamenko M, Zhang W, Zhou Q, Liu M, Xia Y, Zhang W.Department of Internal Medicine, The University of Texas Medical School at Houston

J Am Soc Nephrol. 2011 Jun;22(6):1076-86.


•

Response: The main finding of this study is that for the first time AF17 is demonstrated to be a physiologically relevant and important regulator of Na+ handling and BP maintenance.

Using an AF17 global knockout mouse model, this study provided ample evidence suggesting that ENaC expression and activity are impaired at multiple levels in the mutant mice vs. the wild-type controls under normal conditions.

These observations are consistent with our earlier in vitro studies suggesting that AF17 regulates ENaC mRNA expression and ENaC-mediated Na+ transport.

Physiologically, reduced ENaC expression and activity in AF17 mutant mice are coupled with enhanced Na+ excretion, polyuria, and hypotension

•• Were any of the findings unexpected?•••

•• Response: This study not only confirms that AF17 upregulates ENaC activity by increasing its mRNA

expression, but also unexpectedly reveals that AF17 increases ENaC open probability through unknown mechanisms.

•Another unexpected finding is that high levels of circulating aldosterone can completely compensate for the loss of Af17 deficiency and can rescue the AF17-/- phenotype, while low levels of aldosterone have little effect.

••••••


http://www.hemodialysis.com/author_interview_dr_zhang_af17_deficiency_increases_sodium_excretion

http://www.hemodialysis.com/author_interview_dr_zhang_af17_deficiency_increases_sodium_excretion

http://www.hemodialysis.com/author_interview_dr_zhang_af17_deficiency_increases_sodium_excretion.html

Author Interview: Dr.Talal M Al-Qaoud, MBChB MSc Socioeconomic Status and Reduced Kidney Function in the Whitehall II Study: Role of Obesity and Metabolic Syndrome.

Al-Qaoud TM, Nitsch D, Wells J, Witte DR, Brunner EJ.Am J Kidney Dis. 2011 Jun 28.

Department of Epidemiology and Public Health, University College London, London, UK

• What were the main findings of the study?• The main findings of this study on participants from the Whitehall II cohort of British civil

servants are, first of all, that a socioeconomic disparity in renal function is evident whereby individuals of lower occupational grade have a higher odds of having reduced kidney function compared to individuals of higher occupational grade.

• This has lead us to explore what underlies this social inequality in kidney function, finding that differences in body mass, hence obesity, and metabolic syndrome components, provide a substantial explanation which can be potentially modified.

•••••

Where any of the findings unexpected?•• Diabetes is considered one of the most important well established risk factors for the

progression of atherosclerosis and hence renal disease, however the effect of diabetes on renal function was not significant in our analysis.

•• This can be partly explained by the notion of hyper-filtration in the initial stages, however

given the nature of our cross-sectional design, the effect of diabetes is more likely to be pronounced in a longitudinal analysis.

••••


http://www.hemodialysis.com/author_interview_dr_al_aqoud_socioeconomic_status_and_reduced_kidney_function.html

http://www.hemodialysis.com/author_interview_dr_al_aqoud_socioeconomic_status_and_reduced_kidney_function.html

Author Interview: Bulent Cuhaci, MD Weight-based loading of Vancomycin in patients on Hemodialysis.

Brown M, Polisetty R, Gracely EJ, Cuhaci B, Schlecht HP.Clin Infect Dis. 2011 Jul;53(2):164-6.

Department of Pharmacy, Hahnemann University Hospital


• This study sought to assess factors that are associated with therapeutic pre-HD serum vancomycin concentration.

• We observed modest but significant correlations between the dose (mg/kg) based on actual body weight and the resulting pre-HD trough level with univariate analysis (P=0.006; r=0.411), and between age and resulting pre-HD trough level (P=0.003; r= -0.449). Actual body weight had a stronger correlation with the trough level than did ideal or adjusted body weight.

• Other variables that showed significant associations with the resulting trough level included time from dose to trough level (P=0.09), anuria (P =0.022), and history of renal transplantation (P=0.09).

• The multivariate stepwise linear regression demonstrated modest correlations of mg/kg dose (P =0.009) and age (P =0.004) with pre-HD trough level. We found age to be a significant negative predictor of vancomycin level in HD patients, which warrants consideration when choosing a loading dose. Our data suggest that a guideline-recommended 15-mg/kg loading dose would reach a mean initial pre-HD concentration of 19.0 mg/L ± 7.1 mg/L (standard error of the estimate [SEE]).


http://www.hemodialysis.com/author_interview_dr_cuhaci_weight_based_loading_of_vancomycin_in_hemodialysis.html

http://www.hemodialysis.com/author_interview_dr_cuhaci_weight_based_loading_of_vancomycin_in_hemodialysis.html

Author Interview: Dr. Hallvard HoldaasRosuvastatin in Diabetic Hemodialysis Patients.Holdaas H, Holme I, Schmieder RE, Jardine AG, Zannad F, Norby GE, Fellström BC;

on behalf of the AURORA study group.J Am Soc Nephrol. 2011 Jul;22(7):1335-1341

Renal Section, Oslo University Hospital, Rikshospitalet, Oslo, Sognsvannsveien 22, 0072 Oslo, Norway.


• In this analysis we focused on 731 diabetic dialysis patients from the AURORA trial because cardiac morbidithy and mortality is prevalent in this population.

• The main finding was that we could demonstrate a one-third reduction in coronary event rate among diabetic dialysis patients assigned to rosuvastatin.

• Were any of the findings unexpected?• No not really.


• The take away-message is that cardiac events in diabetic patients receiving hemodialyses can be reduced by lipid lowering therapy.


http://www.hemodialysis.com/author_interview_dr_holdass_rosuvastatin_in_diabetic_hemodialysis_patients.html

http://www.hemodialysis.com/author_interview_dr_holdass_rosuvastatin_in_diabetic_hemodialysis_patients.html

Author Interview: Dr. Simone Scheithauer :Improving hand hygiene compliance rates in the hemodialysis setting:

more than just more hand rubsNephrol. Dial. Transplant. (2011) doi: 10.1093/ndt/gfr365

Simone Scheithauer Frank Eitner ,Jennifer Mankartz , Helga Haefner ,Katharina Nowicki, Jürgen Floege, Sebastian W. Lemmen


• Overall, our study offers the first detailed data regarding hemodialysis-associated indication-specific hand hygiene.

• The key finding is that a comparably moderate increase in performed hand rubs, in combination with hand hygiene-optimized SOPs, resulted in a major increase of hand rub compliance.


• We did not expect that a relevant part of indications for hand rubs resulted from not optimized work-flow and therefore could be avoided

• Additionally, we did not expect that we were able to achieve the greatest increases of hand hygiene compliance before patient contact and aseptic tasks (WHO Indications 1 and 2). These are the situations with the greatest impact in preventing cross transmission of multi-drug resistant bacteria and blood borne viruses as well as in preventing nosocomial infections.

• It is known that compliance usually is lowest in these situations.


http://www.hemodialysis.com/author_interview_dr_scheithauer.html

http://www.hemodialysis.com/author_interview_dr_scheithauer.html

ERA-EDTA (European Renal Association - European Dialysis and Transplant Association)Late Breaking Clinical Trials: Press Releases from the 48th ERA-EDTA Congress

Press Release 1 on LBCT, 24 June 2011 (download the PDF)Press Release on Late Breaking Clinical Trials, 25 June 2011 (Download PDF)

Press Release “Update on IMPACT study results”, 28 June 2011

• RAVE study: In ANCA-associated vasculitis rituximab is just as effective and safe as• standard therapy

• LONG-TERM EFFICACY AND SAFETY RESULTS OF THE RAVE TRIAL.• Kallenberg CGM, Specks U and Stone JH for the RAVE-ITN Research Group, USA• Abstract No. 2511• Hemodiafiltration reduces mortality only if high substitution volumes are used

• ONLINE HEMODIAFILTRATION VERSUS LOW-FLUX HEMODIALYSIS: EFFECTS ON ALL-CAUSE MORTALITY AND CARDIOVASCULAR EVENTS IN A RANDOMIZED CONTROLLED TRIAL. THE CONVECTIVE TRANSPORT STUDY (CONTRAST).

• Grooteman M, Van den Dorpel R, Bots M et al.• Abstract No. 2507

• COMPARISON OF POSTDILUTION ONLINE HEMODIAFILTRATION AND HEMODIALYSIS (TURKISH HDF STUDY).

• Ok E, Asci G, Ok ES et al.• Abstract No. 2506• Bardoxolone improves renal function in type II diabetics with nephropathy

Read the rest of ERA-EDTA press releases on Hemodialysis.com

http://www.hemodialysis.com/era_edta_48_congress_2011.html



Author Interview: Dr. Guillaume BolléePresentation of HIV-associated nephropathy and outcome in HAART-treated patients

Bigé N, Lanternier F, Viard JP, Kamgang P, Daugas E, Elie C, Jidar K, Walker-Combrouze F, Peraldi MN, Isnard-Bagnis C, Servais A, Lortholary O, Noël LH, Bollée G.

Nephrol Dial Transplant. 2011 Jul 10.1Department of Nephrology, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris,

Paris Descartes University, Paris, France.


• - In this study, we analyzed clinical features and outcome of 57 patients with renal biopsy proven HIVAN. Firstly, we found that some patients showed up with atypical clinical presentation and the diagnosis might have been missed if renal biopsy had not been performed.

• Then, we found that renal outcome was poor despite that all patients received HAART after HIVAN diagnosis (median renal survival was only 40 months) and half of them achieved viral suppression in the peripheral blood during follow-up. This was at least partly explained by the fact that HIVAN diagnosis was often made late, as indicated by the high proportion of sclerotic glomeruli in diagnostic renal biopsy. This may also be explained by the existence of a renal viral reservoir that would be hard to access with antiretroviral therapy, however this remains to be fully demonstrated.

• Were any of the findings unexpected?• - The most unexpected of our findings may be the atypical clinical features at diagnosis observed in a non-

negligible proportion. Although HIVAN was previously reported almost exclusively in patients of Sub-Saharan African ancestry, seven patients (12.3%) were Caucasians or North Africans. In addition, a few patients had low grade proteinuria or mild impairment of renal function despite severe histological injury evidenced by renal biopsy. Moreover, some patients had CD4+ count >200/mm3 or even undetectable HIV viral load in peripheral blood at diagnosis.


http://www.hemodialysis.com/author_interview_dr_bollee_hiv_associated_nephropathy_and_haart_patients.html

DaVita CathAway Program Leads to Lower Catheter Rates in Hemodialysis Patients

• DENVER (July 13, 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 that the company has made landmark progress in reducing “Day 90+” patient central venous catheter (CVC) rates, further cementing its position as the industry leader among large dialysis organizations in catheter reductions through the placement of permanent accesses.

• “The success of our catheter-reduction program is a huge accomplishment for our teammates and physician partners,” explains Dr. Allen R. Nissenson, DaVita’s chief medical officer. “Decreasing patients’ chances of infection, thrombosis, hospitalization and death are the driving forces behind this outstanding continuous quality improvement program.”

• In 2008, DaVita® established CathAway™, the company’s seven-step program for reducing the number of hemodialysis patients with catheters. Since the inception of the program, DaVita has witnessed a 30 percent reduction in the number of “Day 90+” patients (i.e., those patients who have been dialyzing at DaVita for 90 days or more) using a catheter for dialysis access and the company is now at an all-time low catheter rate. This has been DaVita’s most significant clinical initiative in the past two years.

Read the rest of the update on Hemodialysis.com

Author Interview: Dr. Peter Van BurenIntradialytic Hypertension and the Association with Interdialytic Ambulatory Blood Pressure

Peter N. Van Buren Catherine Kim Robert Toto Jula K. InrigCJASN July 2011 6):(7)1684-1691; doi:10.2215/CJN.11041210

• What are the main findings of the study?• Compared to subjects without intradialytic hypertension, subjects with intradialytic

hypertension, or blood pressure increases from pre to post-hemodialysis, had higher average 44-hour ambulatory systolic blood pressure.

• Were any of the findings unexpected?• Individual blood pressure measurements from the hemodialysis unit provide imprecise

estimates of ambulatory blood pressure, the gold standard for estimating blood pressure burden in hemodialysis patients. However, patients with intradialytic hypertension have been shown to have increased morbidity and mortality compared to patients whose blood pressure decreases from pre to post-dialysis. The evidence from this study suggests that these adverse outcomes may in part be related to an overall increased blood pressure burden in this population.

• What should clinicians and patients take away from this study?• Clinicians should be aware of the importance of blood pressure patterns during

hemodialysis treatments. Patients with intradialytic hypertension have an increased interdialytic blood pressure burden.


http://www.hemodialysis.com/author_interview_dr_vanburen_intradialytic_hypertension_and_interdialysic_ambulatory_blood_pressure.html

Fresenius Medical Care of Detroit Continues to Enhance Dialysis Patient Experience With New, "Smart" Dialysis Platform

• DETROIT, Jul 12, 2011 (BUSINESS WIRE) -- Dialysis patients and nephrologists in Detroit now have access to the most advanced dialysis therapy from Fresenius Medical Care the world's largest provider of dialysis products and services. Continuing to enhance the dialysis experience for patients, families, and caregivers, Fresenius Medical Care introduced the Company's new 2008T therapy machine at the Fresenius Medical Care dialysis facility in East Detroit. Investment in these machines is a direct extension of the Company's commitment to UltraCare(R), providing patients with excellent medical care through innovative and efficient programs, cutting-edge technology, continuous quality improvement, and a focus on superior customer service.

• The 2008T combines Fresenius Medical Care's most advanced hemodialysis delivery system with Clinical Data Exchange (CDX), providing caregivers, for the first time, chair-side access to the facility's medical information system and patient data to facilitate real-time adjustments to therapy. This integrated approach allows for more efficient data management, saving administration time so care givers can focus on patient care and dedicate more time to patient interaction during treatment sessions. The 2008T also reduces risk associated with cross-contamination of dialysis and MIS equipment in the facility.

Read the rest of the update on Hemodialysis.com

http://www.hemodialysis.com/fresenius_smart_dialysis_platform_detroit.html

Author Interview: Dr. Peter Van Buren

Intradialytic Hypertension and the Association with Interdialytic Ambulatory Blood Pressure

Peter N. Van Buren Catherine Kim Robert Toto Jula K. Inrig

CJASN July 2011 6):(7)1684-1691; doi:10.2215/CJN.11041210


••• Compared to subjects without intradialytic hypertension, subjects with intradialytic


••••••• Were any of the findings unexpected?•••• Individual blood pressure measurements from the hemodialysis unit provide imprecise

estimates of ambulatory blood pressure, the gold standard for estimating blood pressure burden in hemodialysis patients.

However, patients with intradialytic hypertension have been shown to have increased morbidity and mortality compared to patients whose blood pressure decreases from pre to post-dialysis. The evidence from this study suggests that these adverse outcomes may in part be related to an overall increased blood pressure burden in this population.

••••••


http://www.hemodialysis.com/low-level_of_self_reported_physical_activity_in_ambulatory_patients_new_to_dialysis.html

Author Interview: Dr.YanQing TongEffect of Chinese Herbal Fomentation on Arteriovenous Fistula Maturation

The Journal of Alternative and Complementary MedicineYanQing Tong, Yue Jing and ZhengPing Qu.

The Journal of Alternative and Complementary Medicine. - doi:10.1089/acm.2010.0565.


•• Compared to subjects without intradialytic hypertension, subjects with intradialytic


•• Were any of the findings unexpected?•

•• Individual blood pressure measurements from the hemodialysis unit provide imprecise

estimates of ambulatory blood pressure, the gold standard for estimating blood pressure burden in hemodialysis patients. However, patients with intradialytic hypertension have been shown to have increased morbidity and mortality compared to patients whose blood pressure decreases from pre to post-dialysis. The evidence from this study suggests that these adverse outcomes may in part be related to an overall increased blood pressure burden in this population.

••••••


http://www.hemodialysis.com/author_interview_dr_tong_chinese_herbal_fomentation_and_av_maturation.html

Faculty Position in the Division of Nephrology and Hypertension at Georgetown University Hospital

• The division is actively recruiting a nephrologist at the Assistant, Associate, or Full Professor level to join a faculty of 3 clinician/clinical researchers and 12 full time research faculties to fill a position created by the departure of a clinical nephrologist.

• The candidate would have a balance between clinical nephrology practice (inpatient rounding, clinic and limited outpatient dialysis), education of fellows and clinical research. Clinical practice is exclusively at Georgetown University Hospital or one of three dialysis units in the vicinity. There is a strong renal, hepatic and small bowel transplant program, which is integrated with our division. The division started the first home hemodialysis program in DC and will be opening a “home only” dialysis center shortly.

• Currently, the division has more than $4 million annual NIH income. The basic science faculty is supported by a Program Project Grant, seven RO-1 grants, and a number of grants-in-aide. The research focus is on oxidative stress, renal mechanisms of hypertension, hypertensive renal disease and the effects of gender on cardiovascular and kidney diseases. The clinical faculty has eight hypothesis-driven, investigator-initiated clinical and translational grants. Many of these are collaborations with basic science faculty in the division.

• READ THE REST OF THE FACULTY POSITION DESCRIPTION AND CONTACT INFORMATION ON HEMODIALYSIS.COM

http://www.hemodialysis.com/available_faculty_position_georgetown.html

http://www.hemodialysis.com/available_faculty_position_georgetown.html

http://www.hemodialysis.com/author_interview_dr_lacson_effects_of_a_nationawide_predialysis_educational_program.html

http://www.hemodialysis.com/authors_interview_higher_recipient_body_mass_and_post_transplant_graft_function.html

http://www.hemodialysis.com/author_interview_dr_jozsi_factor_h_related_protein_1_in_autoimmune_hus.html

http://www.hemodialysis.com/author_interview_dr_selfarajah_cv_risk_treatment_and_renal_complications.html

http://www.hemodialysis.com/author_interview_dr_tal_power_injection_of_iv_contast_through_hemodialysis_catheters.html

http://www.hemodialysis.com/author_interview_pharmacists_interventions_in_ckd_management.html

http://www.hemodialysis.com/author_interview_dr_ortiz_tweak_tnf_reduce_renal_klotho.html

http://www.hemodialysis.com/author_interview_dr_furuhashi_ckd_and_stress_myocardial_imaging_as_predictors_of_cardiovascular_events.html

http://www.hemodialysis.com/cms_july_2_2_11_qip_rate_changes.html

http://www.hemodialysis.com/renal_advantage_2011_conference_updates.html

From the NKF: National Kidney FoundationTop 5 Summer Travel Tips for Kidney Patients

• Consult your doctor to determine whether your health is stable enough to withstand a trip and discuss your plans in detail, including destination, recreational activities, sports.

• If you do in-center hemodialysis, talk to your social worker or nurse about making arrangements to do dialysis in the city to which you’ll be traveling. Planning 6-8 weeks in advance is necessary in order to secure an appointment for treatment. If you’re traveling to a popular vacation detination or during the holidays, give yourself even more time as guest spots in the dialysis units may be limited.

• Put any essential medical information, your medication and supplies in your carry-on bags in case your luggage gets lost.

• Bring enough medication to last for your entire trip as well as some extra for possible emergencies. Carry a written prescription in case you lose the medication and need more while you’re away from home.

• If you’re traveling by plane or train, arrange for special meals such as low-salt, low-fat or diabetic, at the time that you make your reservation. Don’t wait until you’re on the aircraft or rail because at that time, airline personnel may not be able to accommodate your needs.

For More information, Visit Hemodialysis.com

Author Interview: : Mauricio Monroy-Cuadros, BSc (HON)., M.D., MSc (Epi)., F.A.C.S.Assistant Professor of Surgery Division of Transplant Surgery Foothills Medical Center

Rm. 725 North Tower, 1403-29th Street NWmCalgary, AB T2N 2T9

• Independent prediction factors for primary patency loss in arteriovenous grafts within six months.

• J Vasc Access. 2011 Jun 15. pii: 8077EF7C-99E1-4E06-905E-4A58A48EAB4E.doi: 10.5301/JVA.2011.8425.

• What are the main findings of the study?– The factors that are associated with increased loss of patency are low flow, diabetes, elderly and

peripheral vascular disease

• What should clinicians and patients take away from this study?– Patients for whom the time to fistula maturation as well as the probability of its success is of concern

might benefit more from AVGs.• What recommendations do you have for nephrology health care providers as a result of your study?

– The life expectancy of the access for patients with the identified risk factors associated with loss of primary patency may improve if close monitoring of Arterio-Venous Grafts is implemented

Read the rest of the interview and abstract on Hemodialysis.com

http://www.hemodialysis.com/author_interview_prediction_factors_for_patency_loss_in_av_grafts_within_six_months.html

Author Interview: Dr. Betjes

Premature aging of circulating T cells in patients with end-stage renal disease.Betjes MG, Langerak AW, van der Spek A, de Wit EA, Litjens NH.

Kidney Int. 2011 Jul;80(2):208-17. doi: 10.1038/ki.2011.110.Division of Nephrology, Department of Internal MedicineErasmus Medical Center, Rotterdam, The Netherlands.

• What are the main findings of the study?– Our study documents the premature ageing of circulating T lymphocytes

in patients with end-stage renal disease (ESRD).To establish the Immunological age of these cells, various techniques were used. Theresults of the differents tests were in accordance and show asignificantly aged T lymphocyte system in ESRD patients compared to thecalendar age-matched healthy individuals. The T lymphocytes of ESRD patients are on average prematurely aged by at least 20 years

• Were any of the findings unexpected?– It was already known that T lymphocytes in ESRD patients are affected

and display a different phenotype and function. However, premature mmunological ageing offers a novel explanation for this phenomenom.


– Premature immunological ageing may be the explanation for the well-known ESRD-related immune deficiency, thereby explaining the increased susceptability for infections and the reduced efficiency ofroutine vaccination protocols.


http://www.hemodialysis.com/author_interview_dr_betjes_premature_aging_of_t_cells_in_esrd.html

Author Interview: Chia-Chi Chang, RN, PhDAssociate Professor Taipei Medical University

250 Wu-Xing Street, Taipei , Taiwan, 110, R.O.C

• The Effects of Music as Therapy on the Overall Well-Being of Elderly Patients on Maintenance Hemodialysis. Lin YJ, Lu KC, Chen CM, Chang CC.Biol Res Nurs. 2011 Jun 27. Dialysis Center, Department of Nursing, Cardinal Tien Hospital, New Taipei City, Taiwan, Republic of China.

• What are the main findings of the study?After one week of listening to music as therapy, significantly decreased frequency as well as severity of adverse reactions during dialysis and HSS were noted ( p <0.001). Significantly decreased respiratory rate, significantly increased finger temperature, and increased oxygen saturation ( p < 0.001) were also measured during the same period

• Were any of the findings unexpected?• 1.The HSS was used to measure the level of stress related to HD in the past 1-2 months prior to the

study. Significant attenuation of stress scales was noted in the experimental group after the 2-week study period. In particular, significant improvement of 9 items on the HSS was observed, which implies that some stressors may be amenable to short term music therapy while other sources of stress may require a longer period of intervention.

• 2.The HD procedure constitutes an extracorporeal circulation, which can often lead to hemodynamic instability in elderly patients. The most common reaction is an activation of the autonomic nervous system, which increases the heart rate and causes peripheral vasoconstriction (Wu, 2007). During HD, a patient who experiences a decline in blood pressure 25% (Prakash, Garg, Heidenheim, & House, 2004) or greater from previous readings needs immediate intervention to prevent the development of excessive hypotension and more serious complications. Thus, no significant difference in heart rate, SBP, DBP or the percentage of SBP less than 100 mmHg were observed in this study. However, we cannot exclude the effects of music therapy on autonomic nervous system activity.


http://www.hemodialysis.com/author_interview_dr_chang_music_therapy_in_elderly_hemodialysis_patients.html

Author Interview: Dr. Tatsuhiko FuruhashiImpact of chronic kidney disease and stress myocardial perfusion imaging

as a predictor of cardiovascular events.Furuhashi T, Moroi M, Joki N, Hase H, Masai H, Kunimasa T, Nakazato R, Fukuda H, Sugi K.

Ann Nucl Med. 2011 Jul 1.Division of Cardiovascular Medicine, Toho University Ohashi Medical Center

• What are the main findings of the study?• Chronic kidney disease (CKD) or myocardial ischemia detected by stress myocardial

perfusion images (MPI) are independent predictors for cardiovascular events.• Were any of the findings unexpected?• History of coronary artery disease, coronary angioplasty or history of MI could not predict

cardiovascular events. However, ischemia assessed by stress MPI, CKD, and an abnormal stress MPI plus CKD were predictors of cardiovascular events.

• What should clinicians and patients take away from this study?• The present study suggests that the risk of cardiovascular events for patients with CKD

should be stratified earlier than it is currently, and that these patients should receive aggressive medical management for cardiovascular risk factors.

• What recommendations do you have for nephrology health care providers as a result of your study?

• Parameters of stress MPI were significant predictors for cardiovascular events both in non-CKD patients and in CKD patients. Due to the power of CKD affecting to cardiovascular prognosis, the consciences of CKD might be required in interpreting the results of stress MPI.


http://www.hemodialysis.com/author_interview_dr_furuhashi_ckd_and_stress_myocardial_imaging_as_predictors_of_cardiovascular_events.html

Author Interview: Dr. Anna KaltsoudaDefensive coping and health-related quality of life in Chronic Kidney Disease:

a cross-sectional study.

Kaltsouda A, Skapinakis P, Damigos D, Ikonomou M, Kalaitzidis R, Mavreas V, Siamopoulos KC.BMC Nephrol. 2011 Jun 20;12(1):28.


• Coping with the potential threats of Chronic Kidney Disease by defensively denying or suppressing stressful emotions may slightly improve perceived physical health but deteriorates perceived mental health and correlates to increased depressive symptoms.


• The absence of a negative effect of emotional defensiveness on physical well-being was rather unexpected. Previous research provided evidence for the adverse effects of long-term defensive denial on physical health among hemodialysis patients. However, this was a cross-sectional study of pre-dialysis patients mainly, investigating the effects of emotional defensiveness on perceived but not actual health. Thus, we did not provide evidence for the long-term consequences of defensive coping on actual physical health.


http://www.hemodialysis.com/author_interview_dr_kaltsouda_coping_and_qol_in_ckd.html

Author Interview: Basile N. Landis, MDOlfactory function improves following hemodialysis

Basile N Landis1, Nicola MarangonPatrick Saudan, Marianne Hugentobler, Roland Giger ,Pierre-Yves Martin and Jean-Silvain Lacroix

Kidney International advance online publication 22 June 2011; doi: 10.1038/ki.2011.189


• It was already known that patients with chronic renal failure had affected olfactory function. It was also known, that this was reversible, since patients with kidney transplantation show normal olfactory function again. The rapidity of the olfactory improvement was not known. The main finding of the study was to show that olfactory function improves within one single hemodialysis session.


• Yes, the rapidity of olfactory improvement was surprising, but not totally unexpected.• What should clinicians and patients take away from this study?

• Olfactory function improves with a hemodialysis session. As olfaction influences taste and thus appetite, this could have an impact on nutritional aspects in patients undergoing hemodialysis.


http://www.hemodialysis.com/author_interview_olfactory_function_improves_following_hemodialysis.html

Author Interview: Stéphane BurteyAssociation of PKD2 (Polycystin 2) Mutations With Left-Right Laterality Defects

Stanislas Bataille, Nathalie Demoulin, Olivier Devuyst, Marie-Pierre Audrézet, Karin Dahan, Michel Godin, Michel Fontès, Yves Pirson, Stéphane Burtey

American Journal of Kidney Diseases June 30 2011 DOI: 10.1053/j.ajkd.2011.05.015

• What are the main findings of the study?• We identified for the first time, three people with ADPKD secondary to a mutation in PKD2

(ADPKD2) and Left Right laterality defects, one with isolated dextrocardia and two with situs inversus totalis. We extend the phenotype associated with PKD2 mutation. The laterality defect has been previously in mouse and zebrafish without polycystin-2 expression. In the mouse, laterality disorders are the only phenotypic difference between PKD1 and PKD2 KO mice. We think the same phenomena could be expected in humans.


• Our data are not unexpected regarding to the phenotype observed in others vertebrates with PKD2 defective expression.

• We confirmed the importance of PKD2 in the formation of left-right axis. One unexpected finding is in two cases, the molecular anomaly of PKD2 is a large genomic rearrangement, deletion or duplication.


http://www.hemodialysis.com/author_interview_dr_burtey_pkd2_mutations_with_left_right_laterality_defects.html

Author Interview: Dr. Hongmei WuEducation programmes for people with diabetic kidney disease.

Li T, Wu HM, Wang F, Huang CQ, Yang M, Dong BR, Liu GJCochrane Database of Systematic Reviews 2011, Issue 6. Art. No.: CD007374. DOI:

10.1002/14651858.CD007374.pub2


• Dr.Hongmei Wu: The main finding of this systematic review is that education programmes appear to have beneficial effects on improving patients’ knowledge of diabetes and some self-management behavioural changes, patients’ self-efficacy and result in some beliefs changes for patients with diabetes on dialysis or with microalbuminuria.


• From this systematic review, it is unexpected that currently there are few high quality researches focusing on education programmes for diabetic kidney disease.

• What should clinicians and patients take away from this study?• From the current available evidence, clinicians and patients should get to know that

although education programmes seemed to have some beneficial effects on improvement of patients’ knowledge of diabetes, selfefficacy, belief changes and self-management behavioural changes, the small numbers of patients enrolled in the two identified studies and their low methodological quality resulted in cautious assessment. There is, therefore, inadequate evidence to support the beneficial effects of education programmes for people with DKD.


http://www.hemodialysis.com/author_interview_dr_wu_education_programs_in_diabetic_kidney_disease.html

Author Interview: Dr. Guido Filler MD, PhD, FRCPCDiagnostic Accuracy of Cystatin C–Based eGFR Equations at Different GFR Levels in Children

cjasn June 2011, doi: 10.2215/?CJN.10161110Ajay P. Sharma ,Abeer Yasin Amit X. Garg ,Guido Filler


• Cystatin C is emerging as an important and possibly better dialysis adequacy marker when compared to conventional markers such as urea kinetics. A cystatin C value alone will be difficult to interpret, and appropriate eGFR calculations have to occur. There is also evidence that cystatin C-based eGFR is better than creatinine-based. Moreover, cystatin C is independent of muscle mass and body composition. A study on the performance of all of the existing cystatin C-eGFR formulae at different levels of GFR has been elusive. We looked at diagnostic performance across the entire spectrum from CKD stage V to hyperfiltering patients with very high GFR. We found that none of the existing eGFR formulae was perfect, and that each performed best in the range of GFR were most of the patients were recruited. Some formulae performed better than others, but it also depended on how agreement and diagnostic accuracy was defined. Another important finding was that the mathematical approach mattered significantly, and only very few formulae would fit a pathophysiological biological model. The best approach would be to pool all data from the various centres to derive one more robust formulae from pooled data across all GFR ranges and a variety of gold-standard GFR methods to reduce the variability of different approaches.


• We had hoped that a population-based, Baysian approach would be particularly good, however, as seen in figure 1, there was substantial bias in the low range.


http://www.hemodialysis.com/author_interview_dr_filler_cystatin_c_gfr_in_children.html

Author Interview: Dr. Scott LiebmanSmoking in Dialysis Patients: A Systematic Review and Meta-analysis of Mortality

and Cardiovascular Morbidity.

Liebman SE, Lamontagne SP, Huang LS, Messing S, Bushinsky DA.Am J Kidney Dis. 2011 Jun 8.

Division of Nephrology, University of Rochester Medical Center, Rochester, NY.


• The main findings are that smoking is associated with all cause mortality in dialysis patient, but not with cardiovascular events. Active smoking confers a 65%.increased risk of mortality.

• Were any of the findings unexpected?• Given that the vast majority of excess deaths attributable to smoking in the general

population are due to cardiovascular events, It was surprising that our study did not find an association with smoking and CV events.

• What should clinicians and patients take away from this study?• There is no “reverse epidemiology” with smoking and survival and dialysis patients. As in

the general population, smoking is associated with a higher risk of death in dialysis patients.

• What recommendations do you have for nephrology health care providers as a result of your study?

• All ESRD patients should be counseled to quit smoking. • It is still not clear, however, what is the best method to achieve this goal.


http://www.hemodialysis.com/author_interview_dr_liebman_smoking_in_dialysis_patients.html

Author Interview : Dr Luca NeriRegimen Complexity and Prescription Adherence in Dialysis Patients.

Neri L, Martini A, Andreucci VE, Gallieni M, Rocca Rey LA, Brancaccio D.Am J Nephrol. 2011 Jun 14;34(1):71-76.

• What are the main findings of the study?• The key point of our study was that regimen complexity and patients discomfort

fromtherapy were robustly associated with self-reported adherence to prescription medications,independent of possible confounders. However, we also have found that the association between regimen complexity and adherence was stronger in patients with smaller discomfort from oral medications.

• Were any of the findings unexpected?• Even though patients’ decision-making toward medication adherence is not

wellcharacterized in hemodialysis, our finding that regimen complexity might be an important factor in modulating adherence was not unexpected. However, previous studies could not rule out the alternative possibility that patients’ discomfort towards therapy might affect treatment choices and drive the vicious circle between suboptimal therapeutic outcome and increasing drug dosage. Our study suggests that there may be a point at which perceived treatment burden outweighs the benefits of new or additive therapies, adversely affecting patient adherence.


http://www.hemodialysis.com/author_interview_dr_neri_regimen_complexity_and_adherence_in_dialysis_patients.html

Author Interview: Yung-Ming Chen, M.D.

Outcomes following Dialysis for Acute Kidney Injury among Different Stages of Chronic Kidney Disease.Lee PH, Wu VC, Hu FC, Lai CF, Chen YM, Tsai TJ, Wu KD.

Am J Nephrol. 2011 Jun 17;34(2):95-103.


• Among a cohort of chronic kidney disease (CKD) patients suffering dialysis-requiring acute kidney injury, 10% could be withdrawn from acute dialysis and remained dialysis-free after 5 years. More importantly, this beneficial outcome did not occur at the expense of increased mortality.


• The urine output at discontinuation of dialysis was significantly greater in the initial withdrawers by univariate analysis, but not being an independent predictor in the final multivariate model. Nevertheless, patients exhibiting greater urine output might have a better chance of avoiding fluid overload, and the primary care physicians would be much more motivated and willing to taper and remove acute dialysis for these patients.


• In patients with advanced CKD undergoing emergent hemodialysis, weaning from acute dialysis is clinically feasible, and predictors for the successful weaning include non-diabetic, larger kidney size and lower serum Cr levels. The effort of removal from emergent dialysis was not related to long-term mortality.


http://www.hemodialysis.com/author_interview_dr_chen_dialysis_aki_different_ckd_stages.html

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