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VOLUME 13, ISSUE NUMBER 9
Tighter BP Control Not Always Best Stricter blood pressure targets may not improve outcomes, according to new study findings BY JODY A. CHARNOW OPTIMAL BLOOD pressure targets in patients with hypertension may need to be reconsidered in light of the findings of recently published studies. In one study, researchers led by Csaba P. Kovesdy, MD, chief of nephrology at the Memphis VA Medical Center in Memphis, found that stricter control of systolic blood pressure (SBP) is associated with higher all-cause mortality in patients with chronic kidney disease (CKD). The other study, led by John J. Sim, MD, area research chair, Kaiser
IN THIS ISSUE 9 14
Hypothyroidism may increase risk of diabetic nephropathy CKD found to raise risk of surgical complications
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Visceral fat area predicts subtypes of renal cell carcinoma
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Alcohol may protect against renal function decline in men
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Stents may benefit some patients with renal artery stenosis Experts offer advice on how to measure physician productivity in a practice. PAGE 20
Permanente Los Angeles Medical Center, demonstrated that systolic and diastolic pressures higher and lower than 130–139 mm Hg systolic and 60–79 diastolic are associated with an increased risk of death and development of end-stage renal disease (ESRD) in patients with and without CKD. In a study using a nationwide cohort of U.S. veterans, Dr. Kovesdy and his colleagues analyzed data from 77,765 CKD patients with uncontrolled hypertension who then received 1 or more additional antihypertensive med-
ESRD Clusters in Families, Study Finds END-STAGE renal disease (ESRD) clusters in families, including ESRD without known hereditary causes, a Norwegian study found. The study, by Rannveig Skrunes, MD, of Haukeland University Hospital in Bergen, and colleagues, included 5,119,134 individuals recorded in the Norwegian Population Registry. These were people born in Norway and who were alive in 1980, when the Norwegian Renal Registry started registering all individuals developing ESRD requiring chronic renal replacement therapy. ESRD developed in 8,203 subjects during follow-up; 27,046 had a continued on page 8
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www.renalandurologynews.com
LOWER BP MAY RAISE DEATH RISK Lower blood pressure (BP) targets in hypertensive patients with chronic kidney disease may increase their death risk, a study found. Below are the death rates per 1,000 patient-years in patients in the following BP ranges: 100
Death rate per 1,000 patient-years
S E P T E M B E R 2 014
80
80.9
Blood pressure (mm Hg)
60 40
Less than 120
41.8
120 –139
20 0
Source: Kovesdy CP et al. Observational modeling of strict vs conventional blood pressure control in patients with chronic kidney disease. JAMA Intern Med (published online ahead of print).
ications with evidence of a decrease in SBP. Of the 77,765 patients, 5,760 had a treated SBP of less than 120 mm Hg and 72,005 patients had SBP of 120–139 mm Hg at follow-up. During a median follow-up of 6 years, 19,517
died. The death rate was 80.9 per 1,000 patient-years in the SBP below 120 mm Hg group compared with 41.8 per 1,000 patient-years in the SBP 120–139 mm Hg group, Dr. Kovesdy’s continued on page 8
DKTs May Improve Kidney Use BY JODY A. CHARNOW SAN FRANCISCO—Dual kidney transplants (DKTs) using organs from marginal donors that might otherwise be discarded are a viable option that could help counteract the growing shortage of acceptable single kidneys, researchers reported at the 2014 World Transplant Congress. Robert J. Stratta, MD, and colleagues at Wake Forest School of Medicine in Winston-Salem, N.C., studied 72 DKTs performed over a 12-year period, including 45 (62.5%) using expanded criteria donor (ECD) kidneys, 17 (23.6%) using kidneys donated after cardiac death (DCD), and 10 (13.9%)
CME FEATURE
using standard criteria donor (SCD) kidneys. After a mean follow-up time of 58 months, the actual patient and graft survival rates were 85%, and 71%, respectively. The 1-year and death-censored graft survival rates were 90% and 80%. The outcomes did not differ by donor source or recipient age. Delayed graft function (DGF) and primary non-function occurred in 24% and 2.8% of recipients, respectively. “The increasing disparity between organ supply and demand challenges the transplant community to maximize and optimize the use of organs from all consented deceased donors,” continued on page 8
Earn 1 CME credit in this issue
Shared Decision Making in Managing Idiopathic and Neurogenic OAB PAGE 26
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