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Predictors of NMIBC Upstaging Identi ed
Predictors of NMIBC Upstaging Identified
Risk factors include advanced age and lymphovascular invasion, and other histologic features
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PATHOLOGIC UPSTAGING among patients with nonmuscle-invasive bladder cancer (NMIBC) is more likely among older patients and those with lymphovascular invasion (LVI) and other histologic features, according to recent study findings presented at the 22nd Annual Meeting of the Society of Urologic Oncology.
The findings are from a study of 8620 patients with NMIBC who underwent radical cystectomy (RC), of whom 3100 (36%) were upstaged. Age 80 years or older was significantly associated with 1.6-fold greater odds of upstaging compared with age less than 60 years, Ahmed Elshabrawy, MD, and colleagues from UT Health San Antonio in Texas, reported in a poster presentation. LVI was significantly associated with 7.7-fold greater odds of upstaging compared with no LVI. Sarcomatoid and squamous histologies were significantly associated with 1.4- and 6.4-fold greater odds of upstaging, respectively, compared with urothelial disease.
The study also identified predictors of RC, which included younger age, male gender, treatment at academic medical centers, and the presence of LVI and
histologic variants. Compared with patients younger than 60 years, those aged 80 years or older had 76% lower odds of RC. Male vs female sex was significantly associated with 22% greater odds of RC. Treatment at academic medical centers was significantly associated with 7.2-fold greater odds of RC. The presence of LVI, compared with its absence, was significantly associated with 4.0-fold greater odds of RC. Pure urothelial vs variant histology was significantly associated with 60% lower odds of RC.
Upstaged patients had significantly lower 5-year overall survival compared with patients who were not upstaged (40% vs 71%). Positive surgical margins and neuroendocrine or sarcomatoid variants were significantly associated with higher death risks.
“On a nationwide level, predictable adverse pathological features are associated with pathological upstaging,” the investigators concluded in their poster. This upstaging is associated with significantly poor overall survival, especially in patients with non-organ-confined disease, they noted.
“These features should be considered when counseling patients regarding early radical cystectomy,” they wrote.
The lower odds of RC among older patients observed in the current study can be attributed to multiple factors, said senior author Ahmed M. Mansour, MD.For example, the procedure is associated with greater morbidity among older patients, he explained. Thus, older patients might opt for other treatment.
In a paper published recently in Urologic Oncology (2021;39:236.e9-236. e20), he and his colleagues reported findings from a study of 74,159 patients with muscle-invasive bladder cancer showing that 5.4% refused RC despite physician recommendations. On multivariate analysis, predictors of RC refusal included advanced age (80 years or older vs younger than 60 years), Black race, and female sex. Median survival after RC was 40.4 vs 12.5 months in refusal group, according to the investigators. ■
Pathologic upstaging is associated with significantly worse survival, data show.
LN Remission Lowers Fetal Loss Risk Rate
WOMEN WITH LUPUS nephritis (LN) who have a complete renal remission prior to pregnancy tend to experience good fetal outcomes and less LN relapse, a new study finds.
Investigators analyzed the pregnancy outcomes of 158 pregnancies in 155 Chinese patients with LN. Of these, 130 patients had achieved complete renal remission (CRR) and a systemic lupus erythematosus disease activity index 2000 (SLEDAI-2K) of 4 or lower prior to pregnancy, and 25 patients had not. CRR was defined as proteinuria less than 0.5 g/24 h, no active urinary sediment, serum albumin 35 g/L or higher, and normal serum creatinine.
The remission group had significantly lower rates of LN relapse (11.3% vs 72.0%), LN relapse in early pregnancy (3.0% vs 44.0%), fetal loss (5.3% vs 20.0%), and premature birth (23.3% vs 48.0%) compared with the control group.
The odds of LN relapse significantly increased 11.2- and 5.2-fold in patients with a pre-pregnancy CRR duration of less than 18 months and anti-C1q antibody positivity, respectively, Weixin Hu, MD, and colleagues from Jinling Hospital, Nanjing University School of Medicine in China, reported in Nephrology Dialysis Transplantation. The odds of fetal loss significantly increased 9.3-fold with anti-phospholipid antibody positivity, and the odds of premature birth significantly increased 3.9-fold with a prednisone dosage of 12.5 mg/d or higher during pregnancy. Age older than 30 years was an independent risk factor for both preeclampsia and premature birth.
Current guidelines for the management of pregnancy in LN patients are mostly based on patients with SLE, but the risk of LN relapse during pregnancy is 2- to 3-fold higher in LN, the investigators noted.
According to Dr Hu’s team, “our study showed that LN patients with complete renal remission for more than 18 months were associated with good pregnancy outcomes and lower LN relapse during pregnancy.”
For immunosuppression during pregnancy, the remission group received prednisone (82.7%), prednisone plus a calcineurin inhibitor (7.5%), or prednisone plus azathioprine (4.5%). Fewer patients in the control group received prednisone alone (28.0%), and more received prednisone plus a calcineurin inhibitor (56.0%) or plus azathioprine (12.0%). Medications contraindicated in pregnancy were discontinued. ■
Dyskalemias Before Hemodialysis Sessions May Increase Mortality
LOW AND HIGH serum potassium levels before hemodialysis (HD) sessions are associated with an increased risk for death, according to a recent prospective study of adult patients new to HD.
Predialysis levels of 4.0 mmol/L or lower and levels higher than 6.0 mmol/L are associated with 1.4- and 1.3-fold increased risks for 6-month all-cause mortality, respectively, in adjusted analyses compared with an optimum level of about 5.1 mmol/L, Esther N.M. de Rooijj, MD, of Leiden University Medical Center in Leiden, The Netherlands, and colleagues reported in Kidney Medicine.
“If proven causal, the clinical implication of these results is that potassiumlowering therapy should be used with caution in hemodialysis patients with normal or low serum potassium level before the dialysis session,” the investigators reported. “Furthermore, as low predialysis serum potassium could result from malnourishment, the associated mortality risk emphasizes the importance of preventing nutritional disorders in hemodialysis patients.”
The study included 1117 incident HD patients older than 18 years from the Netherlands Cooperative Study on the Adequacy of Dialysis. Researchers followed up patients from their first HD treatment until death, transplantation, switch to peritoneal dialysis, or a maximum of 10 years.
At baseline, the study population had a mean age of 63 years; 58% of patients were men, 26% smoked, 24% had diabetes, and 32% had cardiovascular disease. The mean serum potassium level was 5.0 mmol/L. In addition, 7% had low subjective global assessment scores. The median residual kidney function was 3.5 mL/min/1.73m2 . A total of 555 deaths occurred during 10 years of follow-up.
The authors noted that, to their knowledge, their study is the first to include only incident HD. “All previous studies investigating the relation between predialysis serum potassium and death included mainly prevalent hemodialysis patients, thus being susceptible to survivor bias,” they wrote. ■
RFA Found Safe, Effective for Refractory SHPT
MINIMALLY invasive radiofrequency ablation (RFA) can treat refractory secondary hyperparathyroidism (SHPT) with relative safety and efficacy compared with surgery, according to investigators. In a retrospective study, 80 patients on dialysis who had parathyroid hormone (PTH) levels exceeding 800 ng/mL underwent ultrasound-guided RFA or parathyroidectomy with autotransplantation (PTx + AT) from January 2018 to February 2021. Compared with baseline, PTH levels had significantly declined at day 1 (160.7 and 226.6 ng/ mL), day 7 (184.6 and 122.3 ng/mL), and 6 months (272.1 and 488.2 ng/mL) in the RFA and PTx + AT groups, respectively. Serum calcium, serum phosphorus, and visual analog scale scores also significantly declined from baseline in both groups, according to findings published by Song-Song Wu, MD, of Fujian Provincial Hospital in China, and colleagues in Kidney International Reports. Significant between-group differences in these biochemical parameters largely diminished by 3 months.
Recurrent laryngeal nerve injury occurred in more patients in the RFA than PTx + AT group (26.7% vs 16.7%, respectively) but the difference was nonsignificant. However, RFA significantly decreased the risk of severe hypocalcemia (20% vs 46.7%) and led to a significantly shorter hospital stay (7.53 vs 12.13 days) compared with PTx + AT, the researchers reported.
At 6 months, SHPT recurrence rates were comparable between groups: 23.3% RFA vs 30% PTX + AT group.
“Taken together, RFA is associated with less injury, faster recovery, fewer complications, and a significantly lower risk of postoperative [severe hypocalcemia] compared with PTX + AT, while achieving similar clinical efficacy, improvement in clinical symptoms, and long-term recurrence rate,” the investigators concluded. ■
High-Dose IV Iron in HD Cuts MI Risk
HIGH-DOSE intravenous (IV) iron reduces the risk for acute myocardial infarction (MI) in patients receiving maintenance hemodialysis compared with low-dose IV iron, researchers reported in Cardiovascular Research.
The findings are from both a prespecified and post hoc analysis of the Proactive IV Iron Therapy in Hemodialysis Patients (PIVOTAL) randomized trial, which included 2141 patients with a ferritin concentration less than 400 µg per liter and a transferrin saturation less than 30%. Over a median 2.1 years, 8.4% of patients experienced a fatal or nonfatal MI.
In time-to-first event analyses, proactive high-dose IV iron reduced the risk for nonfatal and fatal MI by a significant 31% compared with reactive low-dose IV iron, Mark C Petrie, MD, of the University of Glasgow in Glasgow, UK, and colleagues reported. High-dose IV iron reduced the risk for type 1 MI by a significant 29% but did not reduce the risk for nonfatal type 2 MIs. ■
KT Candidates Hit Hard by COVID-19
Waitlisted kidney transplant candidates and kidney transplant recipients experienced excess deaths
BY NATASHA PERSAUD Kidney transplant (KT) candidates and recipients in the United States experienced excess deaths in 2020 related to COVID-19, with a disproportionate number of those deaths occurring among minorities, according to a study of nationwide registry data from the United Network for Organ Sharing.
Together, Black and Hispanic patients accounted for 72% of COVID-19related deaths among waitlisted candidates and 62% of COVID-19-related deaths among kidney transplant recipients, Sumit Mohan, MD, PhD, of the Columbia University Vagelos College of Physicians and Surgeons in New York, New York, and colleagues reported in the Clinical Journal of the American Society of Nephrology.
“The excess risk of COVID-19 mortality for both candidates and recipients may alter the amount of benefit associated with transplantation and impact clinical decision-making,” Dr Mohan’s team wrote.
Waitlisted Patients Of 134,948 patients on a kidney transplant waitlist in 2020, a total of 4774 died, including 516 (11%) from COVID19-related causes. The investigators found that a greater proportion of male waitlist candidates died from COVID-19-related causes than from other causes (72% vs 65%) and at a higher rate compared with the same period in 2019 (63%). Racial and ethnic minorities were more likely to die from COVID-19 than from other causes (85% vs 60%), as were obese candidates (53% vs 45%), according to the investigators.
Among White transplant candidates, 15% died from COVID-19-related causes and 40% died from other causes in 2020, and 39% died from any causes in 2019. By comparison, the death rates were 34%, 31%, and 32% among Black candidates, respectively, and 37%, 19%, and 19% among Hispanic candidates, respectively.
Transplant Recipients Among 190,481 transplant recipients in 2020, a total of 5435 died, including 893 (16%) from COVID-19-related causes. Recipients who died from COVID-19 were younger than recipients who died from other causes (median age 65 vs 68 years). They also were more likely to be obese (body mass index of 30 kg/m2 or higher). In 2020, 44% died from COVID-19-associated causes and 36% died from non-COVID-19 causes. In 2019, prior to the COVID-19 pandemic, 36% died from all causes, Dr Mohan and colleagues reported.
Among White recipients, 30% and 54% died from COVID-19-associated complications and causes not related to COVID-19, respectively, in 2020, and 59% died from any cause in 2019, the researchers reported. Among Black recipients, 31% died from COVID19-associated causes and 25% died from causes not related to COVID-19 in 2020, and 24% died from any cause in 2019. The rates were 31%, 13%, and 11% among Hispanic recipients.
Dr Mohan’s team found that the allcause mortality rate in 2020 was higher among waitlisted candidates (24%) than among kidney transplant recipients (20%) compared with 2019.
“Although 11% of deaths on the waitlist in 2020 were attributed to COVID19, the remainder of the difference in mortality observed is also likely to be COVID-19 related to the extent that the pandemic has adversely impacted access to and delivery of health care, particularly during the peak of the initial surge,” the investigators wrote. ■
Death While on a Waiting List
Kidney transplant candidates who died from COVID-19 in 2020 were significantly more likely to be male, obese, and belong to a racial/ethnic minority.
100 80 60 40
72%
53% 85%
65%
■ Male ■ Obese candidates ■ Racial/ethnic minority
45% 60%
20 0
COVID-19-related death Death from other causes
Source: Mohan S, et al. COVID-19-associated mortality among kidney transplant recipients and candidates in the United States. Clin J Am Soc Nephrol. Published online ahead of print October 21, 2021.
CKD Care Differs by Race, Ethnicity, Study Finds
AMONG PATIENTS with nondialysis-dependent chronic kidney disease (CKD), racial and ethnic minorities are more likely than White individuals to receive guideline-directed care in several key areas, a new study finds. Black and Hispanic patients, however, are less likely to have their high blood pressure and diabetes under control.
Of 452,238 commercially insured and Medicare Advantage patients with CKD who received care during 2012 to 2019, 1.7% were categorized as Asian, 11.0% Black, 3.4% Hispanic, and 83.8% White.
Investigators led by Chi D. Chu, MD, MAS, of the University of California, San Francisco, identified CKD care delivery measures based on Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guidelines. Use of ACE inhibitors and angiotensin II receptor blockers was higher among Black (76.7%), Hispanic (79.9%), and Asian (79.8%) patients compared with White patients (72.3%) in 2018-2019, they reported in JAMA Network Open. Statin use was also higher among minority groups — Black (69.1%), Asian (72.6%), and Hispanic (74.1%) — compared with White patients (61.5%). Avoidance of long-term prescription of nonsteroidal anti-inflammatory drugs (NSAIDs) was consistently greater than 80% across all racial groups. Predialysis nephrology care was received by greater proportions of non-White (64.8% Asian, 69.4% Hispanic, and 72.9% Black) compared with White patients (58.3%), the investigators reported. Albuminuria testing occurred in 41.0%, 52.6%, and 53.9% of Black, Hispanic, and Asian patients, respectively, but only 30.7% of White patients. Compared with White patients, Black, Hispanic, and Asian patients with an estimated glomerular filtration rate less than 30 mL/min/1.73 m2 had significant 73%, 61%, and 32% increased odds of receiving nephrology care, respectively, in a fully adjusted model. Black, Hispanic, and Asian patients also had 14%, 63%, and 113% increased odds of albuminuria testing, respectively. Although minority groups received guideline-recommended care in key areas, a lower proportion of Black patients
(63.3%) achieved blood pressure control to less than 140/90 mm Hg, compared with Hispanic (69.8%), Asian (71.8%), and White patients (72.9%). Diabetes control to a hemoglobin A1c target of less than 7.0% occurred in 46.0% and 49.3% of Hispanic and Black patients, respectively, compared with 50.1% and 50.3% of Asian and White patients, respectively. Using White patients as the reference group, Black, Hispanic, and Asian patients had significant 30%, 16%, and 14% decreased odds of blood pressure control and 6%, 21%, and 7% decreased odds of glycemic control, respectively.
“Lower achievement of blood pressure and glycemic targets despite better performance on process-type care delivery measures suggests that more aggressive health care — testing, prescribing, and referring to match guideline recommendations — is likely inadequate in isolation for narrowing health disparities,” Dr Chu’s team concluded. “An alternative might be exploring how interventions addressing social determinants of health (eg, food insecurity, housing instability, and health literacy) may help mitigate the burden of CKD risk factors and health consequences among non-White individuals, including Black and Hispanic persons.” ■
Black and Hispanic patients are less likely to have their diabetes under control.
Antibodies to COVID-19 Vaccines Wane Quickly in Dialysis Patients
ANTIBODY RESPONSES to vaccination against SARS-CoV-2, the coronavirus that causes COVID-19, wane quickly in patients receiving dialysis, and this decline is associated with an increased risk for breakthrough infection, new data suggest.
The findings are from a prospective case-control study of a nationwide sample of 4791 patients in which investigators examined the relationship between levels of vaccine-induced antibodies to the receptor-binding domain (RBD) of SARS-CoV-2 and development of breakthrough infection. They matched each breakthrough case patient to 5 control patients by age, sex, and vaccination month and adjusted for diabetes status and region of residence. The study population had a mean age of 63.4 years. The racial or ethnic composition was 29.7% nonHispanic White, 23.4% non-Hispanic Black, 13.3% Hispanic, and 14.3% non-Hispanic “other.” Information on race or ethnicity was missing for 19.4% of patients.
Among the 2563 fully vaccinated patients, the estimated proportion with an undetectable antibody response
Investigators studied 4791 dialysis patients vaccinated against SARS-CoV-2.
increased from 6.6% 14-30 days after vaccination to 20.2% 5-6 months after vaccination, Shuchi Anand, MD, of Stanford University in Palo Alto, California, and colleagues reported in Annals of Internal Medicine. Estimated median index values decreased from 91.9 14-30 days after vaccination to 8.4 5-6 months after vaccination.
During a median follow-up period of 152 days, clinically documented COVID-19 developed in 56 (2%) of the fully vaccinated patients.
Compared with pre-breakthrough index RBD antibody values of 23 or higher (equivalent to 506 binding antibody units [BAU]/mL or greater), prebreakthrough RBD values less than 10 (equivalent to 218 BAU/mL) and values from 10 to less than 23 were significantly associated with an 11.6- and 6.0fold greater likelihood of breakthrough infection, respectively, Dr Anand and colleagues reported.
“Our analysis suggests that a majority of vaccinated patients have circulating antibody levels 5 months after vaccination that render them vulnerable to a breakthrough infection,” the authors wrote. “Although the overall number of breakthrough infections was low, even in the group with low antibody levels, exposure to SARS-CoV-2 is not uniform and patients are likely to have used other mitigation strategies, such as masking and social distancing.”
The investigators acknowledged that reliance on a single measure of vaccine response and ascertainment of COVID19 diagnoses from electronic medical records were study limitations. ■
Extended PLND During RP May Up Survival
EXTENDED PELVIC lymph node dissection (PLND) during radical prostatectomy for intermediate- and highrisk prostate cancer (PCa) is associated with improved survival, according to data presented at the 22nd annual meeting of the Society of Urologic Oncology.
Study demonstrates benefit of removing 10 to 19 lymph nodes vs less than 10.
In a propensity score analysis, removal of 10 to 19 lymph nodes was significantly associated with a 14% decreased risk for death compared with removal of less than 10 lymph nodes among patients with intermediate-risk PCa, Furkan Dursun, MD, of the University of Texas Health San Antonio, reported on behalf of his research team. Removal of 20 or more lymph nodes was significantly associated with a 39% decreased risk for death among patients with high-risk PCa.
The study included 103,250 patients identified using the National Cancer Database. Of these, 74.2% and 25.8% had intermediate- and high-risk PCa. The number of excised lymph nodes was less than 10 for 80.5% of patients, 10 to 19 for 15.9%, and 20 or more for 3.6%. In both the intermediate- and high-risk groups, pathologically proven lymph nodepositive disease rates were significantly higher among patients with 20 or more excised lymph nodes compared with those who had fewer than 10 and 10-19 excised lymph nodes (9.25% vs 1.53% and 4.45% for intermediate-risk patients and 25.25% vs 5.65% and 15.53%, respectively, for high-risk patients).
Dr Dursun and colleagues defined intermediate-risk PCa as cT2b-2c and/or PSA level 10-20 ng/mL and/or Grade Group 2 or 3 disease and highrisk PCa as cT3 or higher and/or PSA level greater than 20 ng/mL, and/or Grade Group 4 or 5.
The study adds to the literature on the value of performing extended PLND during radical prostatectomy. For example, results of a randomized controlled trial published in European Urology (2021;79:595-604) showed that while extended vs limited PLND improved pathologic staging, it did not improve early oncologic outcomes, including the primary endpoint of biochemical recurrence-free survival.
The trial included 300 patients with intermediate- or high-risk prostate cancer randomly assigned to undergo limited or extended PLND (150 patients in each group). ■
Long-Term PCa Mortality Described
MORE THAN half of deaths from prostate cancer (PCa) in the United States occur among men initially diagnosed with low-grade disease, according to the findings of a large populationbased study presented at the Society of Urologic Oncology 22nd annual meeting.
Using data from the US Surveillance, Epidemiology and End Results (SEER) program, Roderick Clark, MSc, of the University Health Network in Toronto, Ontario, Canada, and Steven Narod, MD, of the Familial Breast Cancer Research Unit at Women’s College Hospital, also in Toronto, analyzed long-term prostate cancer mortality rates in a population-based study that included 116,796 men diagnosed with PCa during 1992-1997.
Of the 116,796 men, 21,896 died from PCa. Most of these deaths (55.6%) occurred among men initially diagnosed with low-grade disease, with most deaths occurring more than 5 years after diagnosis, the investigators reported. Among men initially diagnosed with high-grade disease, most PCa deaths (54.3%) occurred within the first 5 years of diagnosis.
Overall, the annual PCa-specific mortality (PCSM) rate was 1.5%, but the rate increased with age at diagnosis, from 0.9% among men younger than 60 years to 1.2% and 2.1% for those 60-70 and older than 70 years, respectively.
Among men older than 60 years with low-grade PCa, annual diseasespecific mortality rates increase continuously with time from diagnosis, according to the investigators.
The overall 10- and 20-year PCaspecific survival rates were 84.6% and 74.5%, respectively. The proportion of PCa deaths during years 1-10 and 10-20 after diagnosis were 69.3 and 25.6%, respectively. These figures varied by age. The 10- and 20-year PCa-specific survival rates were 90.2% and 83.7%, respectively. The proportion of PCa deaths during years 1-10 and 10-20 were 60.3% and 33.1%, respectively. ■
Case Finding Better for CKD Detection
Targeting at-risk individuals is more efficient than population-based screening, study confirms
BY JODY A. CHARNOW Case finding is more efficient and cost-effective than population-based screening for early detection of chronic kidney disease (CKD), recent study findings suggest.
“Case finding was associated with a significant decrease in the number of individuals who required [estimated glomerular filtration rate (eGFR)] testing and increase in the proportion of individuals with CKD for whom a treatment change was indicated,” Marcello Tonelli, MD, MSc, of the University of Calgary in Calgary, Canada, and colleagues concluded in JAMA Network Open.
For the study, Dr Tonelli’s team analyzed data from population-based samples from China, India, Mexico, Senegal, and the United States. A total of 126,242 adults were screened for CKD.
The investigators defined screening as measuring eGFR in all participants and case finding as measuring eGFR in a subset of participants at elevated risk for CKD (those with a self-reported history of hypertension, diabetes, or CKD, or with BP levels of 140/90 or higher or with laboratory evidence of diabetes, hemoglobin A1c [HbA1c] levels of 6.5% or higher, or fasting blood glucose levels of 126.1 mg/dL or higher depending on the cohort). For individuals with CKD, the need for a treatment change was defined as not taking an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) or having BP of 140/90 mm Hg or higher. For participants with CKD who also had diabetes, the need for a treatment change was also defined as having HbA1c levels of 8% or higher or fasting glucose levels of 178.4 mg/dL or greater.
Screening vs Case Finding The prevalence of CKD, as defined by an eGFR less than 60 mL/min/ 1.73 m2, was 2.5%, 2.3%, 10.6%, 13.1%, and 6.8% in the China, India, Mexico, Senegal, and US cohorts, respectively, Dr Tonelli and colleagues reported. Screening for CKD was associated with the identification of additional adults whose treatment would change (beyond those identified by measuring BP and glycemia) per 1000 adults, according to the investigators. In all cohorts, fewer than 15% of participants with CKD were aware that they had it. Among those with CKD, treatment gaps were relatively common, ranging from 68.7% to 97.8% of cases.
In contrast, case finding was associated with the identification of 46.2% to 86.4% of individuals with CKD depending on the country, an increase in the proportion of individuals requiring a treatment change by as much as 89.6% in the US, and a decrease in the proportion of individuals needing eGFR measurements by as much as 57.8% in the US.
“Measuring eGFR or albuminuria was not associated with frequent identification of an indication for a treatment change, suggesting that CKD screening programs may not be associated with a benefit for most participants,” the authors wrote.
The investigators ascertained use of ACEI and ARBs, medications known to prevent progressive loss of kidney function in patients with CKD.
The investigators defined adequate BP control as levels less than 140/90 mm Hg, but noted that American College of Cardiology and American Heart Association (ACC/AHA) guidelines recommend a BP target of less than 130/80 mm Hg for nearly all adults, including those with CKD. “If blood pressure control were defined as in this guideline, a smaller number of individuals would have controlled BP and the potential benefit associated with screening for CKD would be smaller than we estimated in this study.”
“These findings suggest that measuring eGFR or albuminuria in population-based screening programs may not be associated with more frequent identification of an indication for a change in treatment in comparison with simply
measuring blood pressure, inquiring about antihypertension medication use, assessing glycemic control, and first-line use of ACEI or ARB therapy among individuals with diabetes or hypertension.”
SGLT2 Inhibitor Use Not Considered Dr Tonelli’s team acknowledged that they did not consider the use of statins and sodium-glucose cotransporter-2 (SGLT2) inhibitors, which
Researchers analyzed data from the US, India, China, Mexico, and Senegal.
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Video May Improve Precision Medicine for PCa
BY JOHN SCHIESZER AN EDUCATIONAL video that informs men about genetic testing may provide an attractive alternative to genetic counseling (GC), according to findings from a recent study.
Thousands of men are eligible for prostate cancer genetic testing to
inform precision therapy, screening, and hereditary cancer risk, but a shortage of trained genetic counselors is a barrier to testing. Counseling patients with an educational video could address this issue. First Real-World Study “This is the first study with real-world data to publish on a pretest video in a male population in the context of prostate cancer germline testing,” said lead investigator Veda N. Giri, MD, a medical oncologist at the Sidney Kimmel Cancer Center at Thomas Jefferson University in Philadelphia, Pennsylvania, where she is director of Cancer Risk Assessment and Clinical Cancer Genetics. “Results are supportive of practice change for alternate delivery of pretest information for men to make an informed decision for genetic testing.”
The findings, published in JCO Precision Oncology, are from the Evaluation and Management for Prostate Oncology, Wellness, and Risk (EMPOWER) Study, which included 127 men asked to choose between pretest video-based genetic education (VBGE) or GC. Of these, 90.6% had prostate cancer and 85.7% had a family history of cancer. Study participants had a mean age of 65.5 years. The cohort was 85.8% White, 67% had at bachelor’s degree or higher, and 78% were married or living with a partner.
The 11-minute video addressed cancer inheritance, purpose of testing, risks and benefits of testing, multigene panel options, and types of potential results. It also included implications of results for treatment, screening, and cancer management, implications of hereditary cancer risk for blood relatives, genetic discrimination laws, and possible reproductive implications. A link to the video was sent to men who chose it. The men had an opportunity to ask questions of a study investigator before proceeding with genetic testing.
A higher proportion of patients chose VBGE over GC (71% vs 29%). The VBGE group had a higher proportion of patients who intended to share genetic testing results (96.4% vs 86.4%), Dr. Giri’s team reported. Both the VBGE and GC groups had high rates of genetic testing (94.4% and 92.0%). Cancer genetics knowledge improved to a similar extent in both groups.
Factors Affecting Choice Major reasons for choosing the video included greater convenience (62.2%), less time commitment (37.8%), and absence of waiting time to view the video (20.2%). Individuals in the GC arm received personalized counseling by telehealth or telephone. Major reasons for choosing GC included ability to ask questions to a genetics provider (62.2%) and preference or ability to do the visit from home.
