Mortality Associated with Metformin Versus Sulfonylurea Initiation: A Cohort Study of Veterans with Diabetes and Chronic Kidney Disease – Journal of General Internal Medicine (link to abstract – $ for full-text)
Commentaries: Metformin appears better than sulfonylureas as first-line therapy for patients with CKD – ACP Diabetes (free) AND Metformin May Up Survival in Older Men With Moderate CKD – Medscape (free registration required)
Non-invasive cardiovascular imaging for evaluating subclinical target organ damage in hypertensive patients: A consensus paper from the European Association of Cardiovascular Imaging (EACVI), the European Society of Cardiology Council on Hypertension, and the European Society of Hypertension (ESH) – European Heart Journal Cardiovascular Imaging (free)
Blood Pressure Trajectories in the 20 Years Before Death – JAMA Internal Medicine (link to abstract – $ for full-text)
Commentaries: Blood pressure declines 14 to 18 years before death – University of Connecticut, via ScienceDaily (free) AND Long, Slow Decline in BP Often Precedes Seniors’ Death – MedPage Today (free registration required)
Commentaries: Adult Survivors of Childhood Cancer Are More Likely to Develop High Blood Pressure – American Association for Cancer Research (free) AND Childhood cancer survivors 70% likely to develop hypertension as adults – Cardiovascular Business (free)
Systematic Review and Meta-analysis Comparing the Efficacy of Nonsteroidal Anti-inflammatory Drugs, Opioids, and Paracetamol in the Treatment of Acute Renal Colic – European Urology (free) (via @KariTikkinen and @EUplatinum)
“In kidney stone–related acute pain episodes in patients with adequate renal function, treatment with nonsteroidal anti-inflammatory drugs offers effective and most sustained pain relief, with fewer side effects, when compared with opioids or paracetamol”.
“Initial combination therapy can be recommended for patients with BP >150/95 mm Hg”
Effects of Sodium Reduction and the DASH Diet in Relation to Baseline Blood Pressure – Journal of The American College of Cardiology (link to abstract – $ for full-text)
Commentaries: DASH Diet, Sodium, and Baseline Blood Pressure – Latest in Cardiology, American College of Cardiology (free) AND Big BP Reductions When DASH Diet Combined With Low Sodium Intake – TCTMD (free)
Clinical Guidelines Synopsis: Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults – JAMA (free)
Related Viewpoint: The 2017 Clinical Practice Guideline for High Blood Pressure (free)
See original AHA/ACC Hypertension Guidelines and related resources in our November 13th issue (see #1)
Commentary: Bariatric Surgery Can Lead to HTN ‘Remission’ in Obese: GATEWAY – Medscape (free) AND Gastric Bypass to Treat Obese Patients With Steady Hypertension – GATEWAY – American College of Cardiology, Latest in Cardiology (free)
Association of Blood Pressure Lowering With Mortality and Cardiovascular Disease Across Blood Pressure Levels: A Systematic Review and Meta-analysis – JAMA Internal Medicine (link to abstract – $ for full-text)
Commentaries: Treating modestly high blood pressure may not boost survival odds – Reuters (free) AND No cardiovascular disease reduction with intensive blood pressure lowering treatment – Umea University, via EurekAlert (free)
See also new AHA/ACC Hypertension Guidelines and related resources in our November 13th issue (see #1)
“”Primary preventive BP lowering is associated with reduced risk for death and CVD if baseline SBP is 140 mm Hg or higher.” published same day as @ACCinTouch guideline w/SBP goals <130 mm Hg. Cognitive dissonance?” (RT @kennylinafp see Tweet)
Commentaries: Neither Sodium Bicarbonate nor Oral Acetylcysteine Prevents Contrast-Induced Kidney Injury – Physician’s First Watch (free) AND PRESERVE: No Benefit from Sodium Bicarbonate, Acetylcysteine After Angiography – Medscape (free registration required)
Vancomycin Plus Piperacillin-Tazobactam and Acute Kidney Injury in Adults: A Systematic Review and Meta-Analysis – Critical Care Medicine (link to abstract – $ for full-text)
Related article: Association of Acute Kidney Injury With Concomitant Vancomycin and Piperacillin/Tazobactam Treatment Among Hospitalized Children – JAMA Pediatrics (link to abstract – $ for full-text)
Commentaries: Landmark Trials Deliver Evidence to Rethink Saline Use – Medscape (free registration required) AND Saline on the Ropes? Studies find balanced crystalloid fluids safer – MedPage Today (free registration required)
News release: KDIGO Guidelines on Living Kidney Donors: A Call for A Paradigm Shift (free)
Impact of the Commercialization of Three Generic Angiotensin II Receptor Blockers on Adverse Events in Quebec, Canada: A Population-Based Time Series Analysis – Circulation: Cardiovascular Quality and Outcomes (free)
As in any observational study, association does not necessarily imply causation.
Serum Calcium and Risk of Sudden Cardiac Arrest in the General Population – Mayo Clinic Proceedings (link to abstract – $ for full-text)
Effect of a Community Health Worker–Led Multicomponent Intervention on Blood Pressure Control in Low-Income Patients in Argentina: A Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)
“The proportion of patients with controlled hypertension (BP <140/90 mm Hg) increased from 17 percent at baseline to 73 percent in the intervention group and from 18 percent to 52 percent in the usual care group”.
Commentaries: Hypertensive disorders of pregnancy increase future risk of heart disease – Cardiovascular Business (free) AND A type of hypertension during pregnancy more dangerous than thought – AHA News (free)
Effects of Intensive Systolic Blood Pressure Control on Kidney and Cardiovascular Outcomes in Persons Without Kidney Disease: A Secondary Analysis of a Randomized Trial – Annals of Internal Medicine (free)
Blood pressure measures in the SPRINT trial were done in a different way than most trials. If these results are to be incorporated in clinical practice, blood pressure measurement must be done in the same way. More details in Cardiobrief: Can SPRINT Be Used To Inform Hypertension Treatment? (free)
FDA Drug Safety Communication: FDA recommends separating dosing of potassium-lowering drug sodium polystyrene sulfonate (Kayexalate) from all other oral drugs (free)
Commentary: Don’t Give Kayexalate With Other Oral Drugs, FDA Warns – Medscape (free registration required)
“Patients should take orally administered prescription and over-the-counter (OTC) medicines at least 3 hours before or 3 hours after sodium polystyrene sulfonate”
Association Between More Intensive vs Less Intensive Blood Pressure Lowering and Risk of Mortality in Chronic Kidney Disease Stages 3 to 5: A Systematic Review and Meta-analysis – JAMA Internal Medicine (link to abstract – $ for full-text)
Commentaries: Intensive blood pressure lowering linked to decreased mortality in patients with chronic kidney disease – 2 Minute Medicine (free) AND Intensive BP Lowering in Chronic Kidney Disease Associated with Lower Mortality – Physician’s First Watch (free) AND Is Strict BP Control a Good Bet for CKD Patients? – MedPage Today (free registration required)
Editorial: Talking With Patients Is Better Than Talking to Patients (free)
Commentaries: Hypertension Medication Adherence May Be Improved by Collaborate Communication – Cardiology Advisor (free) AND Better Provider Communication Might Improve Medication Adherence – Medscape (free registration required) AND Talk Why, Not What for Better Antihypertensive Adherence – MedPage Today (free)
Differential blood pressure effects of ibuprofen, naproxen, and celecoxib in patients with arthritis: the PRECISION-ABPM (Prospective Randomized Evaluation of Celecoxib Integrated Safety Versus Ibuprofen or Naproxen Ambulatory Blood Pressure Measurement) Trial – European Heart Journal (free)
Commentaries: Under Pressure: PRECISION Substudy Shows Adverse BP Effects of Ibuprofen – TCTMD (free) AND Increases in BP, Hypertension Incidence Linked to Certain NSAIDs – MPR (free) AND Ibuprofen Ups Systolic BP, New-Onset Hypertension Risk – Medscape (free registration required)
Medical News & Perspectives: Medical Students Fall Short on Blood Pressure Check Challenge – JAMA (free)
Expert opinion of the Working Group on Prevention, AKI section, European Society of Intensive Care Medicine
Acute Kidney Injury After Computed Tomography: A Meta-analysis – Annals of Emergency Medicine (link to abstract – $ for full-text)
Commentary: When kidneys are injured, CT contrast isn’t the culprit – Health Imaging (free)
Compared with noncontrast CT, contrast-enhanced CT was not significantly associated with either acute kidney injury, need for renal replacement therapy, or all-cause mortality.
A comparison of early versus late initiation of renal replacement therapy for acute kidney injury in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials – BMC Nephrology (free)
Source: Critical Care Reviews Newsletter
Early initiation of RRT in critically ill patients did not result in reduced mortality, change in renal function recovery, dependence, duration of RRT, renal recovery time, mechanical ventilation time or complications.
Full review: Blood pressure targets for hypertension in older adults – Cochrane Library (link to abstract – $ for full-text)
“At the present time there is insufficient evidence to know whether a higher BP target (less than150 to 160/95 to 105 mmHg) or a lower BP target (less than 140/90 mmHg) is better for older adults with high BP”
Ibuprofen versus placebo effect on acute kidney injury in ultramarathons: a randomised controlled trial – Emergency Medicine Journal (link to abstract – $ for full-text)
Commentaries: Fluctuations in home-monitored blood pressure may raise dementia risk – Circulation Journal Report (free) AND Fluctuations in Blood Pressure Linked to Vascular Dementia – MedPage Today (free registration required) AND Fluctuating Home Blood Pressure Linked to Dementia – Medscape (free registration required) AND Blood pressure fluctuations linked to dementia – Reuters (free)
Narrative review: Palliative and end-of-life care in nephrology: moving from observations to interventions – Current Opinion in Nephrology & Hypertension, via Medscape (free registration required)
Lithium Use, but Not Valproate Use, Is Associated With a Higher Risk of Chronic Kidney Disease in Older Adults With Mental Illness – The Journal of Clinical Psychiatry (link to abstract -$ for full-text)
Case-control study suggests Lithium is associated with increased risk of chronic kidney disease.
Commentaries: Gout Patients Run Higher Risk of Kidney Stones – MedPage Today (free registration required) AND Gout associated with elevated risk for kidney stones – MedWire News (free)
“60% increased risk of first-time nephrolithiasis versus general population, with little protection from allopurinol” (from MedPage Today)
Effect of Oral Methylprednisolone on Clinical Outcomes in Patients With IgA Nephropathy: The TESTING Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)
Renal outcomes seemed to be less frequent in the group using methylprednisolone (5,9% vs 15,9%), but the trial was stopped early due to a significantly increased risk of serious adverse events with oral methylprednisolone vs placebo (14.7% vs 3.2%, primarily excess infections)
Related: Global kidney health 2017 and beyond: a roadmap for closing gaps in care, research, and policy – The Lancet (free registration required) AND Worldwide access to treatment for end-stage kidney disease: a systematic review – The Lancet (free registration required) AND One in 10 People Worldwide Have Chronic Kidney Disease – Medscape (free registration required)
As Workouts Intensify, a Harmful Side Effect Grows More Common – New York Times (10 articles per month are free)
Related practical review: Exercise-Induced Emergencies in the Heat: Rhabdomyolysis & Exertional Heat Stroke – emDocs (free)
Editorial: Hypertensive disorders of pregnancy – The BMJ (free)
Summary with 10 key points to remember: Diagnosis and Management of Resistant Hypertension – American College of Cardiology, Latest in Cardiology (free)
Original article: Diagnosis and management of resistant hypertension – Heart (link to abstract – $ for full-text)
Full report: The technical report on sodium intake and cardiovascular disease in low- and middle-income countries by the joint working group of the World Heart Federation, the European Society of Hypertension and the European Public Health Association (free)
Summary of the technical report on sodium intake and cardiovascular disease with key recommendations for individuals and policymakers.
Bring On the Exercise, Hold the Painkillers – The New York Times (10 articles per month are free)
Taking anti-inflammatories during exercise may increase the risk of kidney injury.
News release and available resources: CKD-Mineral and Bone Disorder (CKD-MBD) (free)
Is aircraft noise exposure associated with cardiovascular disease and hypertension? Results from a cohort study in Athens, Greece – Occupational and Environmental Medicine (link to abstract – $ for full-text)
Commentaries: Noise May Raise Blood Pressure Risk – New York Times (10 articles per month are free) AND Long term exposure to aircraft noise linked to high blood pressure – The BMJ, via EurekAlert (free) AND Live Near an Airport? Nighttime Airplane Noise May Cause Hypertension – Medscape (free registration required)
Cohort study suggests a possible association.
Observational studies suggest that high serum uric acid levels are associated with multiple health outcomes, including cardiovascular and metabolic diseases. This review findings suggest there is a clear association only for gout and nephrolithiasis.
Small study (85 patients) suggests many of the devices are too inaccurate to be useful.
Commentaries: Reducing blood pressure below recommended targets significantly reduces CVD, mortality risk – Clinical Advisor (free registration required) And New Review Supports Aggressive BP Targets – MedPage Today (free registration required)
Ideal blood pressure targets are controversial and recommendations vary across hypertension guidelines. This new meta-analysis suggests the risk of cardiovascular disease would be lowest with a systolic blood pressure between 120-124 mmHg.
Series: Acute Kidney Injury in the Intensive Care Unit
Source: Critical Care Reviews Newsletter
Transplantation of HCV-infected-kidneys into uninfected recipients seems feasible in this era of direct-acting antiviral agents, maybe shortening waiting times for those willing to take the risk.
Global kidney health 2017 and beyond: a roadmap for closing gaps in care, research, and policy – The Lancet (free registration required)
Chronic kidney disease is increasingly recognized as a global public health problem affecting as many as 10–15% of the population worldwide. It is associated with impaired quality of life and strongly reduced life expectancy. The article identifies key activities for the next 5-10 years to address the problem.
Invited commentary: Asymptomatic Microscopic Hematuria – Rethinking the Diagnostic Algorithm (free)
Routine urinalysis for screening is not presently recommended by any major health organization, but asymptomatic microscopic hematuria is a common incidental finding. This study suggests that the combination of renal ultrasound and cystoscopy is the most cost-effective approach for the evaluation of these patients.
Source: Screen for Endocrine Hypertension, Endocrine Society Says – Medscape (free registration required)
“The statement provides guidance on screening for 15 hormonal disorders that present with hypertension and that can be potentially cured with surgery or treated with medication” (from Medscape commentary above).
Achieved blood pressure and cardiovascular outcomes in high-risk patients: results from ONTARGET and TRANSCEND trials – The Lancet (link to abstract – $ required for full-text) (RT @AnilMakam “Lower achieved blood pressure in high risk patients for cardiovascular disease do WORSE” see Tweets)
In high-risk patients, patients who achieved a systolic blood pressure < 120 mmHg or a diastolic blood pressure < 70 mmHg had HIGHER risk of complications. “These data suggest that the lowest blood pressure possible is not necessarily the optimal target for high-risk patients”
Browse Appropriateness Criteria Topics (free)
This comprehensive guide from American College of Radiology (ACR) covers 230 topics with more than 1,100 clinical indications and has just been updated. It is a very useful resource for doctors in all specialties to guide which exam is most appropriate in each clinical situation.