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Why Nephrologists Exclude Patients from Referral for Kidney Transplant: A Survey

A recent anonymous survey among nephrologists suggests that patients' social support, ability to understand the transplant process, and age are the most important factors influencing nephrologists' decisions to exclude them from kidney transplant referral.

Tales of the Anion Gap, Part II: Metabolic Acidosis

In this installment, we look at underlying causes of metabolic acidosis, approaches for evaluating patients with suspected metabolic acidosis, and why measurement of the anion gap is of great usefulness in these cases.

Gloomy Number Forecast

Increased risk of cardiovascular disease among middle-aged women due to glycemic load

We conducted a study among 15 714 Dutch middle-aged women consuming modest-glycemic-load diets. Results showed that high dietary glycemic load and glycemic index increased the risk of cardiovascular disease. This association was particularly evident among overweight women. Recommendations to follow a high-carbohydrate diet may therefore not be optimal in the prevention of cardiovascular diseases.

Chest pain syndrome in women: A diagnostic dilemma

The ability to diagnose coronary artery disease (CAD) in women may be limited by the sensitivity and specificity of symptoms as well as of noninvasive testing. The choice of which test should be performed to evaluate the presence of CAD in women remains controversial. Currently American Heart Association/American College of Cardiology guidelines recommend initial evaluation with exercise electrocardiogram (ECG) testing. In a meta-analysis of 3721 women, however, exercise ECG had a sensitivity of 61% and a specificity of 70%1 as compared to 68% sensitivity and 77% specificity in men.

Cholesterol-lowering therapies and C-reactive protein

Low-density lipoprotein (LDL) cholesterol-lowering therapy decreases C-reactive protein (CRP) levels, but the importance of LDL cholesterol-independent effects is uncertain because of the variability in measuring LDL cholesterol and CRP levels in any individual patient. In this study, this variability was reduced by comparing average changes in LDL cholesterol and CRP levels after treatment with lipid-lowering therapy across different studies.

Testosterone Levels Not Associated with Stroke Risk

Researchers reported no association between endogenous testosterone and incident stroke and ischemic changes in men evaluated via brain MRI imaging.

Is circulating heat shock protein 60 a marker for susceptibility to cardiovascular disease in patients with diabetes?

The vital cell stress protein, heat shock protein (Hsp)60, has recently been found in the circulation of healthy subjects over an extremely large concentration range. We performed an analysis of subjects with diabetes to determine whether Hsp60 is associated with biochemical markers of cardiovascular disease. Results showed that high circulating levels of Hsp60 are associated with clinically manifest cardiovascular disease. Hsp60 has cytokine-like actions, which may be responsible for this association.

Rapid Triage Testing Could Improve Outcomes for Patients with Acute Kidney Injury

David Ludvigson and Nam Tran, PhD, write about the need for rapid triage testing as a method of improving outcomes for patients with acute kidney injury.

So when should sinus rhythm be restored?

This review summarizes an important substudy of the Rate Control Versus Electrical Cardioversion (RACE) trial, which randomized 522 patients with atrial fibrillation (AF) to rate versus rhythm control treatment strategies and followed them for up to 2.3 years with a primary composite endpoint that included cardiovascular mortality, heart failure, thromboembolic complications, bleeding, severe adverse effects of anti-arrhythmic agents, and pacemaker implantation.

Double infarct syndrome: Simultaneous subacute ST-segment elevation myocardial infarction involving the right coronary and the left circumflex arteries

Ruptured or vulnerable plaques exist not only at the culprit lesion but also in the whole coronary artery in some acute coronary syndrome (ACS) patients.Goldstein et al found features of instability of nonculprit plaques in nearly 40% of patients by angiography,1 whereas actual rupture in a remote site other than the angiographic culprit lesion was found in approximately 13% to 79% of cases when evaluated by intravascular ultrasound.

Intracranial hemorrhage in atrial fibrillation: Is there a racial/ethnic difference?

We evaluated a multiethnic cohort of subjects with nonrheumatic atrial fibrillation hospitalized over a 6-year period to determine the racial and ethnic differences in the risk of intracranial hemorrhage (ICH) and the effect of warfarin treatment on ICH risk. Treatment with warfarin was associated with a 2-fold greater risk of ICH in whites, a 4- to 5-fold greater risk in both blacks and Hispanics, and a 15-fold greater risk in Asians. After adjusting for established stroke risk factors and warfarin use, Asians were 4 times as likely as whites to have ICH, whereas blacks and Hispanics were twice as likely.

Smartphones Moving to the Front Line of Mobile Technology for Physicians

Traditionally, physicians have relied on textbooks, conferences, and, more recently, the Internet to keep abreast of the latest clinical data and support clinical decision-making