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Latest & greatest articles for chronic kidney disease
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Cases in Precision Medicine: APOL1 and Genetic Testing in the Evaluation of ChronicKidneyDisease and Potential Transplant. This article discusses potential indications for genetic testing in an African American patient with chronickidneydisease who is being evaluated for a kidney transplant. Two known risk variants in the APOL1 (apolipoprotein L1) gene predispose to kidneydisease and are found almost exclusively in persons of African ancestry. APOL1 risk variants are considered, including (...) whether clinicians should incorporate genetic testing in the screening process for living kidney donors. In addition to APOL1 testing, the role of diagnostic exome sequencing in evaluating potential transplant recipients and donors with a positive family history of kidneydisease is discussed.
Dietary Priority Screening for ChronicKidneyDisease: Clinical Effectiveness and Guidelines Dietary Priority Screening for ChronicKidneyDisease: Clinical Effectiveness and Guidelines | CADTH.ca Find the information you need Dietary Priority Screening for ChronicKidneyDisease: Clinical Effectiveness and Guidelines Dietary Priority Screening for ChronicKidneyDisease: Clinical Effectiveness and Guidelines Last updated: January 14, 2019 Project Number: RB1297-000 Product Line: Research Type (...) : Devices and Systems Report Type: Summary of Abstracts Result type: Report Question What is the clinical effectiveness of dietary/nutrition priority screening tools for in-patients and outpatients with chronickidneydisease? What are the evidence-based guidelines for the use of dietary/nutrition prioritization tools for the delivery of nutritional therapy in the chronickidneydisease setting? Key Message One non-randomized study and three evidence based guidelines were identified regarding the use
ChronicKidneyDisease Diagnosis and Management: A Review. Chronickidneydisease (CKD) is the 16th leading cause of years of life lost worldwide. Appropriate screening, diagnosis, and management by primary care clinicians are necessary to prevent adverse CKD-associated outcomes, including cardiovascular disease, end-stage kidneydisease, and death.Defined as a persistent abnormality in kidney structure or function (eg, glomerular filtration rate [GFR] <60 mL/min/1.73 m2 or albuminuria ≥30 mg (...) per 24 hours) for more than 3 months, CKD affects 8% to 16% of the population worldwide. In developed countries, CKD is most commonly attributed to diabetes and hypertension. However, less than 5% of patients with early CKD report awareness of their disease. Among individuals diagnosed as having CKD, staging and new risk assessment tools that incorporate GFR and albuminuria can help guide treatment, monitoring, and referral strategies. Optimal management of CKD includes cardiovascular risk
Prevention, Diagnosis, Evaluation, and Treatment of Hepatitis C Virus Infection in ChronicKidneyDisease: Synopsis of the KidneyDisease: Improving Global Outcomes 2018 Clinical Practice Guideline. The KidneyDisease: Improving Global Outcomes (KDIGO) 2018 clinical practice guideline for the prevention, diagnosis, evaluation, and treatment of hepatitis C virus (HCV) infection in chronickidneydisease (CKD) is an extensive update of KDIGO's 2008 guideline on HCV infection in CKD. This update
Patiromer versus placebo to enable spironolactone use in patients with resistant hypertension and chronickidneydisease (AMBER): a phase 2, randomised, double-blind, placebo-controlled trial. Spironolactone is effective at reducing blood pressure in patients with uncontrolled resistant hypertension. However, the use of spironolactone in patients with chronickidneydisease can be restricted by hyperkalaemia. We evaluated use of the potassium binder patiromer to allow more persistent use (...) of spironolactone in patients with chronickidneydisease and resistant hypertension.In this phase 2 multicentre, randomised, double-blind, placebo-controlled study, we enrolled participants aged 18 years and older with chronickidneydisease (estimated glomerular filtration rate 25 to ≤45 mL/min per 1·73 m2) and uncontrolled resistant hypertension from 62 outpatient centres in ten countries (Bulgaria, Croatia, Georgia, Hungary, Ukraine, France, Germany, South Africa, the UK, and the USA). Patients meeting all
Canagliflozin and Cardiovascular and Renal Outcomes in Type 2 Diabetes Mellitus and ChronicKidneyDisease in Primary and Secondary Cardiovascular Prevention Groups Canagliflozin reduces the risk of kidney failure in patients with type 2 diabetes mellitus and chronickidneydisease, but effects on specific cardiovascular outcomes are uncertain, as are effects in people without previous cardiovascular disease (primary prevention).In CREDENCE (Canagliflozin and Renal Events in Diabetes (...) With Established Nephropathy Clinical Evaluation), 4401 participants with type 2 diabetes mellitus and chronickidneydisease were randomly assigned to canagliflozin or placebo on a background of optimized standard of care.Primary prevention participants (n=2181, 49.6%) were younger (61 versus 65 years), were more often female (37% versus 31%), and had shorter duration of diabetes mellitus (15 years versus 16 years) compared with secondary prevention participants (n=2220, 50.4%). Canagliflozin reduced the risk
eHealth interventions for people with chronickidneydisease. Chronickidneydisease (CKD) is associated with high morbidity and death, which increases as CKD progresses to end-stage kidneydisease (ESKD). There has been increasing interest in developing innovative, effective and cost-efficient methods to engage with patient populations and improve health behaviours and outcomes. Worldwide there has been a tremendous increase in the use of technologies, with increasing interest in using eHealth (...) interventions to improve patient access to relevant health information, enhance the quality of healthcare and encourage the adoption of healthy behaviours.This review aims to evaluate the benefits and harms of using eHealth interventions to change health behaviours in people with CKD.We searched the Cochrane Kidney and Transplant Register of Studies up to 14 January 2019 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through
Benefits and Harms of Oral Anticoagulant Therapy in ChronicKidneyDisease: A Systematic Review and Meta-analysis. Effects of oral anticoagulation in chronickidneydisease (CKD) are uncertain.To evaluate the benefits and harms of vitamin K antagonists (VKAs) and non-vitamin K oral anticoagulants (NOACs) in adults with CKD stages 3 to 5, including those with dialysis-dependent end-stage kidneydisease (ESKD).English-language searches of MEDLINE, EMBASE, and Cochrane databases (inception (...) ), prevention of dialysis access thrombosis (8 trials), and cardiovascular disease other than AF (9 trials) were included. All but the 8 trials involving patients with ESKD excluded participants with creatinine clearance less than 20 mL/min or estimated glomerular filtration rate less than 15 mL/min/1.73 m2. In AF, compared with VKAs, NOACs reduced risks for stroke or systemic embolism (risk ratio [RR], 0.79 [95% CI, 0.66 to 0.93]; high-certainty evidence) and hemorrhagic stroke (RR, 0.48 [CI, 0.30 to 0.76
Dialysate temperature reduction for intradialytic hypotension for people with chronickidneydisease requiring haemodialysis. Intradialytic hypotension (IDH) is a common complication of haemodialysis (HD), and a risk factor of cardiovascular morbidity and death. Several clinical studies suggested that reduction of dialysate temperature, such as fixed reduction of dialysate temperature or isothermal dialysate using a biofeedback system, might improve the IDH rate.This review aimed to evaluate (...) the benefits and harms of dialysate temperature reduction for IDH among patients with chronickidneydisease requiring HD, compared with standard dialysate temperature.We searched Cochrane Kidney and Transplant's Specialised Register up to 14 May 2019 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search
Long-term safety and efficacy of veverimer in patients with metabolic acidosis in chronickidneydisease: a multicentre, randomised, blinded, placebo-controlled, 40-week extension. Metabolic acidosis, a complication of chronickidneydisease, causes protein catabolism and bone demineralisation and is associated with adverse kidney outcomes and mortality. Veverimer, a non-absorbed, counterion-free, polymeric drug candidate selectively binds and removes hydrochloric acid from the gastrointestinal (...) lumen.We did a multicentre, randomised, blinded, placebo-controlled, 40-week extension of a 12-week parent study at 29 sites (hospitals and specialty clinics) in seven countries (Bulgaria, Georgia, Hungary, Serbia, Slovenia, Ukraine, and the USA). Eligible patients were those with chronickidneydisease (estimated glomerular filtration rate 20-40 mL/min per 1·73 m2) and metabolic acidosis (serum bicarbonate 12-20 mmol/L), who had completed the 12-week parent study, for which they were randomly assigned
Use of Peripherally Inserted Central Catheters in Patients With Advanced ChronicKidneyDisease: A Prospective Cohort Study. Existing guidelines, including Choosing Wisely recommendations, endorse avoiding placement of peripherally inserted central catheters (PICCs) in patients with chronickidneydisease (CKD).To describe the frequency of and characteristics associated with PICC use in hospitalized patients with stage 3b or greater CKD (glomerular filtration rate [GFR] <45 mL/min/1.73 m2
Growth Monitoring for Children with ChronicKidneyDisease S Trace, E Cameron, C Inward, CP Burren, Feb 2019 Review date Feb 2022 Page 1 of 5 Bristol Royal Hospital for Children Growth Monitoring Guideline for Children with CKD Contents Page 1-2 Scope, Background, Rationale and Evidence base for guideline Page 2 Definition of Stages of ChronicKidneyDisease (CKD) Page 3 Notes on Growth Monitoring and Referral Page 4 Growth Monitoring Timetable Page 5 References The guideline scope extends (...) and reviews. Multiple measures are necessary 8,9 to give a broad and reliable picture of Clinical Guideline MONITORING GROWTH IN CHILDREN WITH CHRONICKIDNEYDISEASE S Trace, E Cameron, C Inward, CP Burren, Feb 2019 Review date Feb 2022 Page 2 of 5 Bristol Royal Hospital for Children Growth Monitoring Guideline for Children with CKD growth and nutrition, and the frequency of measurement will depend on the child’s age and stage of CKD (see page2). Children displaying growth delay or unstable medical
Oral anticoagulation in patients with chronickidneydisease: A systematic review and meta-analysis Data regarding the efficacy and safety of warfarin and non-vitamin K antagonist oral anticoagulant (NOAC) among patients with chronickidneydisease (CKD) remain scarce.Systematic review and meta-analysis of studies involving patients with CKD treated with oral anticoagulants were conducted to evaluate the following outcomes: ischemic stroke, intracerebral hemorrhage (ICH), combined ischemic
Undernutrition in ChronicKidneyDisease Clinical Practice Guideline Undernutrition in ChronicKidneyDisease Authors: Dr Mark Wright Consultant Nephrologist, St J am es ’s University Hospital, Leeds Mrs Elizabeth Southcott Senior Specialist Renal Dietitian, St J a m es’s University Hospital, Leeds Dr Helen MacLaughlin, Consultant Dietitian, Kings College Hospital Mr Stuart Wineberg Patient Representative Final Version: June 2019 Review Date: June 2024 2 Endorsements The National Institute (...) with extensive atherosclerotic disease in a particularly toxic combination that is associated with increased mortality risk 3 . The International Society of Renal Nutrition and Metabolism (ISRNM), recommend the term protein energy wasting (PEW) to describe the undernutrition that is prevalent in renal failure populations 4 , though more than one underlying cause may present in any individual. Protein energy wasting is described in 20-40% of patients with stage 4-5 chronickidneydisease (CKD) 3
Interventions for improving sleep quality in people with chronickidneydisease. Sleep disorders are commonly experienced by people with chronickidneydisease (CKD). Several approaches for improving sleep quality are used in clinical practice including relaxation techniques, exercise, acupressure, and medication.To assess the effectiveness and associated adverse events of interventions designed to improve sleep quality among adults and children with CKD including people with end-stage kidney (...) disease (ESKD) treated with dialysis or kidney transplantation.We searched the Cochrane Kidney and Transplant Register of Studies up to 8 October 2018 with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov.We included randomised controlled trials (RCTs) or quasi-randomised RCTs
Preterm birth and risk of chronickidneydisease from childhood into mid-adulthood: national cohort study. To investigate the relation between preterm birth (gestational age <37 weeks) and risk of CKD from childhood into mid-adulthood.National cohort study.Sweden.4 186 615 singleton live births in Sweden during 1973-2014.Gestational age at birth, identified from nationwide birth records in the Swedish birth registry.CKD, identified from nationwide inpatient and outpatient diagnoses through 2015
Atrasentan and renal events in patients with type 2 diabetes and chronickidneydisease (SONAR): a double-blind, randomised, placebo-controlled trial. Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes.We did this double-blind, randomised, placebo-controlled trial (...) % with no substantial fluid retention during the enrichment period (responders) were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days) or end-stage kidneydisease (eGFR <15 mL/min per 1·73 m2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney
Effectiveness of self-management programme in people with chronickidneydisease: A pragmatic randomized controlled trial To examine the effectiveness of a self-management intervention compared with usual care in adults with chronickidneydisease (CKD) on self-management, knowledge, self-efficacy, health-related quality of life, and blood pressure.A parallel group randomized controlled trial.Patients aged ≥ 18 years with CKD stages 3-5 were recruited between November 2015 and June 2016
Veverimer versus placebo in patients with metabolic acidosis associated with chronickidneydisease: a multicentre, randomised, double-blind, controlled, phase 3 trial. Patients with advanced chronickidneydisease lose the capacity to fully excrete endogenous acid, resulting in chronic metabolic acidosis that increases the risk of disease progression and causes muscle catabolism and bone resorption. Veverimer, a non-absorbed, counterion-free, polymeric drug, selectively binds and removes (...) participants were patients aged 18-85 years with non-dialysis-dependent chronickidneydisease (estimated glomerular filtration rate of 20-40 mL/min per 1·73 m2) and metabolic acidosis (serum bicarbonate concentration of 12-20 mmol/L). Patients were randomly assigned (4:3) to veverimer 6 g/day or placebo for 12 weeks while they consumed their typical diet. Both drugs were taken as oral suspensions in water with lunch. Randomisation was done by study site personnel with a computer-generated randomisation