www.renalandurologynews.com
SPRING 2022
Renal & Urology News 5
Diabetes May Complicate Renal Biopsy Recent study reveals an increased risk for major bleeding complications and need for transfusion THE RISK FOR MAJOR bleeding complications after percutaneous renal biopsy is higher among patients with than without diabetes, according to a new Japanese study. All percutaneous renal biopsies in Japan are performed in the hospital. In a nationwide inpatient database of 76,302 Japanese patients who underwent percutaneous renal biopsy, major bleeding complications occurred in 678 patients (0.9%), including 622 (0.8%) with red blood cell (RBC) transfusion within 7 days and 109 (0.1%) with invasive hemostasis requiring transcatheter arterial embolization or nephrectomy. Of the cohort, 8245 had diabetes mellitus. Major bleeding complications (3.1% vs 0.6%), including requiring RBC transfusion (2.9% vs 0.66%), transfusion of more than 1 L (1.6% vs 0.1%), and invasive hemostasis (0.3% vs 0.1%)
was significantly more common in the group with vs without diabetes. In multivariate analysis, the diabetes group had a 2.4-fold increased risk for major
Researchers report results from their study of 76,302 Japanese patients. bleeding complications and a 2.4- and 1.9-fold increased risk for transfusion and invasive hemostasis, respectively, corresponding author Hideo Yasunaga, PhD, of The University of Tokyo in Japan, and colleagues reported in Kidney International Reports. Multiagent or insulin for diabetes treatment was significantly associated
Cardiovascular Calcification Increases Death Risk in ESKD CALCIFICATION IN cardiac valves and
not be overlooked and can be used
aorta portends worse survival and
for risk assessment in maintenance
progresses faster in patients with end-
HD patients,” Dr Cao and colleagues
stage kidney disease (ESKD), according
wrote. “Moreover, it can help identify
to a recent study.
patients who are appropriate for
In a study of 434 patients receiving hemodialysis (HD), 27.2% of patients displayed mitral valve calcification
intensive medical treatment to reduce cardiovascular events.” In a second study, researchers
(MVC) and 31.8% aortic valve calci-
examined progression of aortic calci-
fication (AVC) on echocardiography.
fication in 150 patients with stage 4-5
The group with vs without cardiovas-
chronic kidney disease transitioning to
cular calcification had significantly
dialysis or transplantation or continuing
higher all-cause and cardiovascular
conservative care. The median abdomi-
mortality rates, Ning Cao, MD, of
nal aortic calcification (AAC) score
General Hospital of Northern Theater
significantly increased from 4.8 before
Command, Liaoning, China, and col-
renal replacement therapy or conser-
leagues reported in BMC Nephrology.
vative care to 8.0 at 3 years after the
The presence of MVC and AVC was
transition, with no difference among
significantly associated with 1.5- and
treatment modalities, Roosa Lankinen,
1.4-fold increased risks for all-cause
MD, of University of Turku, Finland,
mortality and 2.3- and 2.4-fold
and colleagues reported in Kidney and
increased risks for cardiovascular mor-
Blood Pressure Research.
tality, respectively. Left atrial dimen-
The annual rate of AAC increase was
sion also significantly correlated with
significantly associated with a 1.4-fold
all-cause and cardiovascular death.
higher risk for mortality and, in trans-
Cardiovascular calcification on
plant recipients, a longer time on the
routine echocardiography “should
transplant waiting list.
■
with a 1.6-fold increased risk for major bleeding complications compared with single-agent treatment. The patients with diabetes tended to be older, male, and steroid users with acute kidney injury (AKI), chronic kidney disease (CKD), or rapidly progressing glomerulonephritis (RPGN). In multivariable analysis, older age, female sex, AKI, CKD, or RPGN, and steroid use each were associated with higher risks of major bleeding. Diabetes remained a risk factor after adjustment for patient and hospital characteristics and in a sensitivity analysis considering anemia, according to the investigators. Dr Yasunaga’s team acknowledged that the study was limited by a lack of information on needle gauge, glucose control, timing of discontinuation and resumption of antithrombotic agents, and some other relevant factors.
The researchers concluded that “nephrologists should carefully judge whether the anticipated benefits outweigh the relatively high risk of major bleeding complications when considering [percutaneous renal biopsy] for patients with diabetes.” In an accompanying editorial, Emilio D. Poggio, MD, of Glickman Urological and Kidney Institute at Cleveland Clinic in Cleveland, Ohio, and colleagues wrote that they “strongly support the practice of [percutaneous renal biopsy] in patients with diabetes when a secondary diagnosis is suspected, and identification of that disease would alter management with the hopes of reducing the progression to end-stage kidney disease. As in all patients with or without diabetic kidney disease, we recommend aggressively managing modifiable risk factors to reduce the risk of bleeding.” ■
Study Finds Continuous Rise in mPCa
California’s Keck School of Medicine in Los Angeles, and colleagues reported in JAMA Network Open. Among men aged 75 years or older, mPCa incidence significantly decreased 1.5% annually from 2004 to 2011, but significantly increased 6.5% annually from 2011 to 2018. The rise in mPCa occurred despite a significant concurrent reduction in overall PCa diagnoses, according to the investigators. “Although the reasons behind this recent rising incidence of mPCa are multifactorial, it is unlikely to be due to a true change in cancer biology in such a short period,” the authors wrote. “Factors such as environmental exposures or germline variations leading to changes in epidemiological signatures of cancers take substantially longer. Rather, changes in clinical policy and/ or practice such as screening strategies and use of diagnostic imaging are much more likely to explain such short-term changes in cancer epidemiological trends.” Regardless of the cause, Dr Desai and colleagues noted, the finding of a rising incidence of mPCa by itself does not imply that screening practices should be changed. “The overall risk vs benefit of PSA-based screening is extremely complex and must take into account various other factors that impact the overall health of the community.” ■
METASTATIC PROSTATE cancer (mPCa) incidence continues to increase in the US, a trend temporally associated with changes in guidelines from the US Preventive Services Task Force (USPSTF), according to the latest data. The USPSTF recommended against routine PSA screening of men older than 75 years in 2008 and all men in 2012, but revised their recommendation in 2018, advising personalized decision-making for screening men aged 55 to 69 years. Investigators observed the trend when they analyzed data from 836,282 PCa cases in the Surveillance, Epidemiology, and End Results (SEER) 18 registry. They identified 26,642 men (56.5%) aged 45 to 74 years and 20,507 (43.5%) men aged 75 years or older diagnosed with metastatic PCa from 2004 through 2018. Among men aged 45 to 74 years, mPCa incidence was stable from 2004 to 2010 (-0.4% annually), but significantly increased 5.3% annually from 2010 to 2018, Mihir M. Desai, MD, MPH, of the University of Southern
