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NEWS - Nephrology

Cardiovascular disease risk factors in chronic kidney disease: A systematic review and meta-analysis – PLOS One (free)

“In addition to established traditional general population cardiovascular risk factors, left ventricular hypertrophy, serum albumin, phosphate, urate and hemoglobin were all found to be statistically significant in their association with future cardiovascular events”.


First-line drugs for hypertension – Cochrane Library (free)

Summary: Thiazides best first choice for hypertension – Cochrane Library (free)

“First-line low-dose thiazides reduced all morbidity and mortality outcomes in adult patients with moderate to severe primary hypertension. First-line ACE inhibitors and calcium channel blockers may be similarly effective, but the evidence was of lower quality”.


Acid‐suppressive drugs and risk of kidney disease: A systematic review and meta‐analysis – Journal of Gastroenterology and Hepatology (link to abstract – $ for full-text)

Source: Hospital Medicine Virtual Journal Club

Proton pump inhibitors were associated with higher risks of acute interstitial nephritis (HR, 2.78; 95% CI, 1.25‐6.17), acute kidney injury (HR, 1.85; 95% CI, 1.33‐2.59), chronic kidney disease (HR, 1.47; 95% CI, 1.03‐2.09), and end‐stage renal disease (HR, 1.61; 95% CI, 1.26‐2.04) than non‐PPI therapy. Similar risks were not identified for H2RA therapy.


Blood pressure-lowering treatment strategies based on cardiovascular risk versus blood pressure: A meta-analysis of individual participant data – PLOS Medicine (free)

Related study with similar conclusions: Impact of Cardiovascular Risk on the Relative Benefit and Harm of Intensive Treatment of Hypertension – Journal of the American College of Cardiology (link to abstract – $ for full-text)

“An intelligent approach towards blood pressure management: by the individual’s risk instead of just their measurements” (via @EricTopol see Tweet)


Balanced Crystalloids versus Saline in Critically Ill Adults – New England Journal of Medicine (free)

Related article: Balanced Crystalloids versus Saline in Noncritically Ill Adults – New England Journal of Medicine (free)

Commentary: Balanced Crystalloids May Be Better Than Saline for Critically Ill Patients – NEJM Physician’s First Watch (free)

“Balanced crystalloids may be superior to saline in critically ill patients — but not in patients hospitalized outside an ICU” (from Physician’s First Watch)


Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): an unmasked randomised controlled trial – The Lancet (free)

Commentaries: Hypertension: time for doctors to switch the driver’s seat? (free) AND Should home-based blood pressure monitoring be commonplace in NHS? – University of Oxford News & Events (free)

“Self-monitoring, with or without telemonitoring, when used by general practitioners to titrate antihypertensive medication in individuals with poorly controlled blood pressure, leads to significantly lower blood pressure than titration guided by clinic readings”.


Readmissions Following a Hospitalization for Cardiovascular Events in Dialysis Patients: A Retrospective Cohort Study – Journal of the American Heart Association (free for a limited period)

“Roughly 1 in 3 CVD hospitalizations resulted in 30‐day readmission; nearly 1 in 20 was followed by death within 30 days”.


Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine – New England Journal of Medicine (link to abstract – $ for full-text)

Commentaries: No benefit of sodium bicarbonate or acetylcysteine for prevention of complications after angiography: The PRESERVE trial – 2 Minute Medicine (free) AND Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine – NEJM Resident 360 (free)

“Among patients at high risk for renal complications who were undergoing angiography, there was no benefit of intravenous sodium bicarbonate over intravenous sodium chloride or of oral acetylcysteine over placebo for the prevention of death, need for dialysis, or persistent decline in kidney function at 90 days or for the prevention of contrast-associated acute kidney injury”.


Trimethoprim use for urinary tract infection and risk of adverse outcomes in older patients: cohort study – The BMJ (free)

“Trimethoprim is associated with a greater risk of acute kidney injury and hyperkalaemia compared with other antibiotics used to treat UTIs, but not a greater risk of death”


Peritoneal dialysis for acute kidney injury – Cochrane Library (link to abstract – $ for full-text)


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”.


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)


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)

Commentary: Community Intervention among Low-Income Patients Results in Improved Blood Pressure Control – The JAMA Network (free)

“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”.


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)

Commentary: Cardiovascular benefits of intensive systolic blood pressure control may outweigh risks of chronic kidney disease events – 2 Minute 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”


Medical News & Perspectives: Medical Students Fall Short on Blood Pressure Check Challenge – JAMA (free)

Original Article: Medical students and measuring blood pressure: Results from the American Medical Association Blood Pressure Check Challenge – The Journal of Clinical Hypertension (free)

“Only 1 out of 159 medical students correctly performed all 11 elements in a BP check challenge w simulated patients” (RT @JAMA_current see Tweet)


Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017 – Intensive Care Medicine (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)

Related article: Risk of Acute Kidney Injury After Intravenous Contrast Media Administration – Annals of Emergency Medicine (free)

Source: Hospital Medicine Virtual Journal Club

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.


Blood pressure targets for hypertension in older adults – Cochrane Library (free)

Full review: Blood pressure targets for hypertension in older adults – Cochrane Library (link to abstract – $ for full-text)

Related guideline: Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older to Higher Versus Lower Blood Pressure Targets: A Clinical Practice Guideline From ACP and AAFP (free)

“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”


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.


Incidence of and risk factors for nephrolithiasis in patients with gout and the general population, a cohort study – Arthritis Research & Therapy (free)

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)

Commentaries: Steroid treatment for type of kidney disease associated with increased risk for serious infections – The JAMA Network (free)

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)


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.


Serum uric acid levels and multiple health outcomes: umbrella review of evidence from observational studies, randomised controlled trials, and Mendelian randomisation studies – The BMJ (free)

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.


Systolic Blood Pressure Reduction and Risk of Cardiovascular Disease and Mortality: A Systematic Review and Network Meta-analysis – JAMA Cardiology (free) (RT @GreenlandRohan see Tweet)

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.


Correspondence: Trial of Transplantation of HCV-Infected Kidneys into Uninfected Recipients – The New England Journal of Medicine (free)

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.


Cost-effectiveness of Common Diagnostic Approaches for Evaluation of Asymptomatic Microscopic Hematuria – JAMA Internal Medicine (free)

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.


Screening for Endocrine Hypertension: An Endocrine Society Scientific Statement (free)

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”


ACR Appropriateness Criteria Adds Topics, Covers More Clinical Variants Than Ever Before (free)

Browse Appropriateness Criteria Topics (free)

Source: Newswise

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.


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