DECEMBER 2013
n n n
VOLUME 12, ISSUE NUMBER 12
n n n
www.renalandurologynews.com
Fasting Phosphorus More Predictive BY JODY A. CHARNOW ATLANTA—Fasting serum phosphorus levels have a stronger association with all-cause and cardiovascular mortality than non-fasting levels, researchers reported at the American Society of Nephrology’s Kidney Week 2013. Serum phosphorus levels vary throughout the day, with a nadir occurring in the morning, a small peak in the early afternoon followed by a drop, and then a larger nocturnal peak, explained investigator Alex Chang, MD, MS, of Geisinger Health System in Danville, Pa. “Higher phosphorus
IN THIS ISSUE 13 Stone risk not higher with vitamin D supplement use 14 Neonates among the hardest hit by inpatient AKI 16 CDC releases tools to decrease hemodialysis infections
18 Patients aged 75 and older do poorly after RRT start
19 CKD risk in diabetics higher among women than men
Statin use may protect against adverse renal outcomes in ICU patients
PAGE 18
intake exaggerates the early afternoon rise in serum phosphorus,” Dr. Chang said. The effect of dietary phosphorus could introduce “noise” to randomly measured phosphorus and explain why some studies have not found an association between serum phosphorus and mortality, he said. “For this reason, we examined whether the association between serum phosphorus and mortality differed between those who fasted at least 12 hours and those who fasted less than 12 hours,” he told Renal & Urology News. “We found that fasting
© THINKSTOCK
It has a stronger association with adverse outcomes
DIETARY PHOSPHORUS can throw off serum phosphorus test results.
serum phosphorus was associated with mortality whereas non-fasting serum phosphorus was not associated with increased mortality.” In clinical practice, “we need to recognize that serum phosphorus levels are affected by time of day and dietary
phosphorus intake, Dr. Chang said. “We may want to consider basing management decisions on more than just a single, random serum phosphorus measurement. Unfortunately, it is hard to predict what will happen to serum continued on page 14
Higher Dietary ACP Rejects CKD Screening Acid Load BY DELICIA HONEN YARD trolled trials that compared the effect The American College of Physicians of systematic CKD screening versus Predicts ESRD (ACP) stands by its recommendation no CKD screening on clinical outBY JODY A. CHARNOW ATLANTA—Higher dietary acid load is associated with an increased likelihood of chronic kidney disease (CKD) progression, according to new studies presented at Kidney Week 2013. In a study of 1,486 adults with CKD who participated in the National Health and Nutrition Examination Survey III, Tanushree Banerjee, PhD, of the University of California San Francisco, and colleagues demonstated that higher dietary acid load is associated with development of end-stage renal disease (ESRD) among CKD patients. This is the first longitudinal study on the assocontinued on page 14
against routine screening for chronic kidney disease (CKD) in asymptomatic individuals with no CKD risk factors. The recommendation is part of new guidelines published October 22 in the Annals of Internal Medicine. Guideline authors Amir Qaseem, MD, PhD, MHA, and fellow members of the ACP’s Clinical Guidelines Committee did deem this recommendation to be supported by weak/lowquality evidence. The group’s research had identified no randomized, con-
CME FEATURE
comes or that evaluated the harms of such screening. A subsequent statement from the ASN confirmed that the ASN “strongly recommends” regular screening for kidney disease, regardless of an individual’s risk factors. “ASN and its nearly 15,000 members—all of whom are experts in kidney disease—are disappointed by ACP’s irresponsible recommendation,” asserted ASN Executive Director Todd Ibrahim in the statement. continued on page 14
Earn 1 CME credit in this issue
New Ablative Techniques in Urologic Oncology PAGE 25
RUN1213_Cover_Neph.indd 1
11/21/13 4:23 PM