Nephrology

Older patients with heart and kidney failure can be helped with cardiac resynchronization therapy, a new study finds. But implanting devices to treat them is expensive, invasive, and not a full cure for many patients. Maybe it's better to ask these patients if they wouldn't rather die, two physicians argue.

As more is learned about the affect of newly developed PCSK9 medications cardiologists are looking at new patient populations and how to provide them the highest quality care.

In heart failure patients with diabetes and/or chronic kidney disease, a new, non-steroidal mineralocorticoid receptor antagonist called finerenone was no more effective than the currently approved MRA eplerenone in reducing the heart failure biomarker N-terminal pro-B-type natriuretic peptide. But it had other benefits.

Diabetes researchers looked at the impact of chronic kidney disease on the glucose-regulating drug empagliflozin.

Besides being the most common cause of chronic liver disease in industrialized nations, non-alcoholic fatty liver disease has serious hepatic consequences. It is expected to be the most frequent indication for liver transplantation by 2030.

Mortality in patients with type 1 diabetes mellitus (T1DM) is higher than in the general population, and whether mortality improves or alters with glycemic control is unknown.

Children who get lung transplants face a higher risk of developing chronic kidney disease. New research looks at risk assessment and prevention.

The presence of chronic kidney disease (CKD) in patients with atrial fibrillation increases the risk of stroke and thromboembolism (TE) as well as the risk of bleeding, thus complicating their treatment. In this context, it has been suggested that CKD should be included in the CHA2DS2-VASc (Congestive heart failure; Hypertension; Age ≥75 years; Diabetes mellitus; previous Stroke, transient ischemic attack, or thromboembolism; Vascular disease; Age 65 to 74 years; Sex category) score.

Lack of sleep and chronic kidney disease (CKD) independently lead to hypertension, diabetes mellitus, lower quality of life, and shorter life expectancy. Severity of CKD and sleep disturbances may also worsen diabetes and hypertension synergistically.

The US Food and Drug Administration (FDA) issued a strong warning on a drug used to treat iron deficiency anemia in patients with chronic kidney disease. Intravenous injections of ferumoxytol (Feraheme/Amag Pharmaceuticals) can cause serious allergic reactions including death in patients who are sensitive to the drug, the FDA cautioned in a new boxed warning. The drug was approved in 2009.

Chronic kidney disease developed in association with exposure to antiretrovirals in people with initially normal levels of estimated glomerular filtration rate (eGFR) was not limited to increased incidence immediately after starting therapy but in fact increased over time and exposure.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) reported that one in 10 American adults had some level of chronic kidney disease (CKD), and that kidney disease is the 9th leading cause of death in the US.

The US Food and Drug Administration approved ferric pyrophosphate citrate (Triferic/Rockwell) for use as an iron replacement therapy in patients with end-stage renal disease, the company announced. It is also indicated for chronic kidney disease. The drug is for adults.

Kidney donors may have lower 1,25-dihydroxyvitamin D and phosphate levels. Their parathyroid hormone levels may be elevated, but with minimal effect on calcium levels.

Recent updates by the 8th Joint National Committee (JNC 8), the American and International Societies of Hypertension (ASH-ISH), and KDIGO recommend target blood pressure of less than 140/90 mm Hg for most individuals, including those with CKD.

Two major sets of hypertension guidelines released in 2014 contain more common threads than differences, and are intended to serve different purposes. Clinicians seeking guidance for managing hypertension in chronic kidney disease (CKD) can look for this common ground to avoid "guideline overload."

Guidelines for hypertension have converged on a blood pressure target of less than 140/90 mm Hg for most individuals with chronic kidney disease (CKD). However, studies still need to clarify optimal BPs for advanced disease and optimal cardiovascular prevention.

Though warfarin has long been the mainstay of anticoagulation in atrial fibrillation (AF), dosing is complicated by a host of factors, and the drug has a famously narrow therapeutic range. One way to fine-tune warfarin therapy is to account for genetic variation.

Anticoagulation is recommended for members of the general population with atrial fibrillation, but its significant risks must be weighed carefully in the medically fragile chronic kidney disease population.

Treatment of atrial fibrillation (AF) in patients with CKD may help prevent disease progression. Ablation has been shown produce marked improvement in kidney function as measured by eGFR. A prospective study of individuals undergoing catheter ablation for AF showed that most patients remained AF-free, and that eGFR improved significantly for those with persistent or longstanding persistent AF.

Secondary hyperparathyroidism can occur in CKD when the kidney loses its ability to produce active metabolites of vitamin D, and reduces phosphorus excretion. Cinacalcet seeks to interrupt the progression to severe unremitting hyperparathyroidism by mimicking calcium to the calcium-sensing receptors that control parathyroid hormone levels.

Physicians caring for individuals with chronic kidney disease (CKD) must strike a balance between ensuring optimal lipid control for protection from vascular events, while avoiding undue risk.

Despite achieving optimal goals for "bad" cholesterol levels, individuals with diabetes and chronic kidney disease still have an elevated risk of vascular complications.

Prompted by almost-epidemic rates of diabetes in the United States and globally, the American Diabetes Association recently convened a consensus panel to examine diabetic kidney disease, one of the most frequent complications associated with diabetes.

Researchers have developed a math model that can accurately predict the progression from nephritis to interstitial fibrosis in patients with systemic lupus erythematosus.

Despite these improvements in medical technology, diabetic nephropathy remains unpredictable and life-threatening. Identifying high-risk patients at an early stage could help clinicians take appropriate steps to reduce risk.

Clinicians must anticipate changes in kidney function during acute illness and surgical procedures, as well as frequently reassess metformin use in older patients, since kidney function declines predictably with age.

A new study urges primary care physicians to be more alert in identifying patients with underlying chronic kidney disease because they are more likely to have resistant hypertension.

Revising the definition of chronic kidney disease progression that is currently used in clinical trials could speed the development of new therapies.

Rheumatoid arthritis patients have a 1-in-4 chance of developing chronic kidney disease, according to research published in the American Journal of Kidney Disease.