J U N E /J U LY 2 016
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VOLUME 15, ISSUE NUMBER 5
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www.renalandurologynews.com
AKI Patients Benefit from Early RRT Study demonstrates improved 90-day survival and greater likelihood of recovering renal function EARLY RRT IMPROVES OUTCOMES Early initiation of renal replacement therapy (RRT) improves 90-day survival and recovery of renal function compared with delayed initiation, data show. 70 60
61%
Survival at 90-days 54%
50
45%
40
Renal function recovery at 90 days 39%
30 20 10 0
Early RRT
Delayed RRT
Percentages have been rounded off.
Source: Zarbock A, et al. Effect of early vs delayed initiation of renal replacement therapy on mortality in critically ill patients with acute kidney injury. The ELAIN Randomized Clinical Trial. JAMA 2016;315:2190-2199. Data also presented May 22, 2016 at the ERA-EDTA 53rd Congress in Vienna. Abstract LB02.
Obesity-CKD Link Challenged BY JODY A. CHARNOW BOSTON—Study findings presented at the National Kidney Foundation’s 2016 Spring Clinical Meetings challenge whether obesity has an association with chronic kidney disease (CKD). “Much of the medical literature states that there is a direct effect of obesity on CKD, independent from the
effects of diabetes and hypertension as a result of obesity,” lead researcher Patrick Albertus, MPH, of the Kidney Epidemiology and Cost Center at the University of Michigan in Ann Arbor, told Renal & Urology News. “Our fi ndings from a large survey, which is demographically representative of continued on page 11
EXPERT Q&A
Ishir Bhan, MD, MPH, explains why SHPT remains a management challenge. PAGE 12
BY JODY A. CHARNOW EARLY INITIATION of renal replacement therapy (RRT) improves 90-day survival among critically ill patients with acute kidney injury (AKI), according to study findings presented at the 53rd Congress of the European Renal Association-European Dialysis and Transplant Association in Vienna. In a randomized single-center trial that enrolled 231 patients, Alexander Zarbock, MD, of the University of Muenster in Germany, and colleagues found that early initiation of RRT was associated with a significant 34% decreased risk of death compared with delayed initiation. The investigators defined early RRT as RRT started within 8 hours of a diag-
Statins May Lower Kidney Stone Risk BY JODY A. CHARNOW SAN DIEGO—Individuals who take statins may be at lower risk of kidney stone formation, according to study findings presented at the American Urological Association 2016 annual meeting. The study, by Andrew Cohen, MD, of the University of Chicago Medical Center, and colleagues, compared 1,785 recurrent stone formers and 97,563 patients with no history of stones. Patients prescribed statins were significantly older (60.7 vs. 51.9 years) and had a significantly higher body mass index (BMI, 29.2 vs. 28.1 kg/m2). In the stone-former group, new stones developed in 33.8% of those on statins compared with 53% of non-statin users. In the stone-naïve patients, new stones developed in 3.8% of those on statins compared with 4.7% of non-statin users. In multivariable analysis, statin use was associated with a significant 43% and 47% decreased odds of new stones among stone naïve patients and recurcontinued on page 11
nosis of Kidney Disease: Improving Global Outcomes (KDIGO) stage 2 AKI and delayed RRT as RRT started within 12 hours of KDIGO stage 3 AKI or no RRT initiation. To be included in the trial, patients had to have a plasma level of neutrophil gelatinase-associated lipocalin—an early biomarker for AKI in the adult intensive care unit population—greater than 150 ng/mL. Of the 231 patients, 112 and 119 were randomly assigned to the early and delayed RRT groups, respectively. RRT for all patients was continuous venovenous hemodiafiltration. At 90 days, 68 patients in the early group (60.7%) were alive compared with 54 (45.3%) in the delayed group. continued on page 11
IN THIS ISSUE 4
Elevated FGF23 levels increase the risk of respiratory infection
5
Low fitness levels in midlife raise risk of late life CKD
7
CKD not linked to urologic procedures for kidney stones
11
ESA doses are lower for patients living at higher elevations
20
Warfarin, diabetes identified as calciphylaxis risk factors
21
Smoking found to increase CKD risk in blacks
25
High uric acid ups non-fatal stroke risk in CKD patients
A new study has independently validated a proposed new grading system for prostate cancer. PAGE 15