Poor Nutrition at Dialysis Start Ups Mortality Odds

Reduced Kidney Function Raises SCD Risk

Recent findings ‘open up new avenues for future research,’ according to investigators

EVEN MILDLY or moderately reduced kidney function is associated with an increased risk for sudden cardiac death (SCD) in the general population, independent of other important SCD risk factors, according to a recent report.

“The high incidence of SCD worldwide together with the devastating consequences and the sudden aspect of this event show the importance of identifying modifiable risk factors for SCD, such as kidney function, and of identifying these subgroups at risk,” Anna C. van der Burgh, BSc, of Erasmus Medical Center, University Medical Center Rotterdam, The Netherlands, and colleagues reported in the Clinical Kidney Journal. “Our study suggests an increased SCD risk with lower levels of eGFR in middleaged and elderly individuals from the general population, even without CKD, only when using serum cystatin C measurements.”

In a study that included 9687 participants with a mean age of 65.3 years and median follow-up of 8.9 years, each 10 mL/min/1.73 m2 decrease in

estimated glomerular filtration rate (eGFR) based on cystatin C measurements was significantly associated with a 23% increased risk for SCD after adjusting for age, sex, history of coronary heart disease, hypertension, and diabetes, and other potential confounders.

When evaluating kidney function using both serum cystatin and creatinine measurements, each 10 mL/ min/1.73 m2 decrease in eGFR was significantly associated with a 17% increased risk for SCD.

Based on serum cystatin C measurements, an eGFR less than 60 mL/ min/1.73 m2 was significantly associated with a 2.1-fold increased risk for SCD compared with an eGFR above 90 mL/ min/1.73 m2, according to the investigators. The 10-year absolute risks for SCD rose from 1.0% to 2.5% when comparing an eGFR of 90 to 60 mL/min/1.73 m2 .

“Our findings could be clinically relevant, as they open up new avenues for future research,” van der Burgh and colleagues concluded. “This includes further investigation of the pathophysiological mechanisms underlying the association between kidney function and SCD. Unravelling these unknown mechanisms could identify potential therapeutic targets, which is crucial as SCD is often the first manifestation of underlying [cardiovascular disease].”

Study strengths include a large number of participants from a populationbased cohort study with middle-aged and elderly individuals, which includes a population at high risk for SCD, the investigators noted. In addition, the prospective population-based design along with a high participation rate reduced the likelihood of selection bias, making the results applicable to the general population.

The study also had limitations. The investigators had only a single assessment of eGFR using cystatin alone and both creatinine-cystatin measurements available. In addition, the study included mainly White individuals older than 45 years, so the generalizability of their results to other populations might be limited. ■

The link, observed in the general population, is independent of other risk factors.

Alprostadil May Protect Against CIN

ALPROSTADIL may lower the risk for contrast-induced nephropathy (CIN) in patients undergoing percutaneous coronary intervention (PCI).

Xiaogang Liu, MD, of Tianin Chest Hospital in Tianjin, China, and colleagues randomly assigned 1146 patients undergoing PCI to an alprostadil plus hydration group and a control group that received hydration only. They classified patients into groups at low, moderate, and high risk for CIN as ascertained using the Mehran risk score. Among patients with moderate and high risk, alprostadil recipients had significant 65.7% lower odds of CIN compared with controls, the researchers reported in Angiology.In the low-, moderate-, and high-risk groups, the incidence of CIN in the control and alprostadil group was 2.9 vs 2.6%, 11.4 vs 4.9%, and 19.1 vs 7.7%, respectively.

Alprostadil’s protective effect may be related to an anti-inflammatory response, the authors concluded. ■

BCG Efficacy Unaffected by Prostate RT

PRIOR RADIATION treatment for prostate cancer does not increase the risk for bladder cancer recurrence following bacillus Calmette-Guérin (BCG) induction for high-risk nonmuscle-invasive bladder cancer (NMIBC), investigators reported at the ASCO Genitourinary Cancers Symposium 2022.

“Despite known associations with history of radiation and worse oncologic outcomes in bladder cancer, our study provides preliminary evidence that BCG intravesical therapy in high-grade NMIBC remains effective in patients with prior prostate radiotherapy,” said Adri M. Durant, MD, of Mayo Clinic Arizona in Phoenix, who presented the findings. “With high BCG failure rates and current BCG shortages, this data provides reassurance that BCG therapy is being appropriately allocated to this population.”

Badder cancer is not more likely to recur in patients with high-risk NMIBC, data show.

The retrospective study included 199 patients who received at least 1 induction course of BCG for NMIBC. Of these, 23 patients had a history of prostate radiotherapy, 17 had a prior radical prostatectomy, and 159 had no prostate cancer history. The 1-year bladder cancer recurrence rates in these patients were 39.1%, 29.4%, and 42.8%, respectively. The rates of progression to MIBC were 8.7%, 0%, and 6.9%, respectively; the rates of progression to metastatic disease were 4.3%, 5.9%, and 6.9%, respectively. None of the differences in these rates among the groups were statistically significant.

Study limitations included the retrospective design, the small number of patients treated with radiation, and the lack of full radiation histories, such as dose and length of treatment. ■

Cystectomy vs Trimodal Treatment for MIBC

OVERALL survival appears comparable after radical cystectomy (RC) and trimodal therapy (TMT) for muscleinvasive bladder cancer among patients who receive chemotherapy, except in the case of higher-stage disease, according to investigators.

Among 2048 patients (aged 40 to 79 years) with cT2-3 N0 M0 urothelial carcinoma in the 2006-2015 National Cancer Database, 1812 patients were treated with multiagent neoadjuvant chemotherapy and RC with lymphadenectomy (RC arm) and 236 were treated with transurethral resection of bladder tumor (TURBT), multi-agent chemotherapy, and 3D conformal radiation therapy (TMT arm). The median follow-up was 29 months.

After propensity-score adjustment, overall survival did not differ significantly between the RC and TMT arms, Boris Gershman, MD, of Beth Israel Deaconess Medical Center, Boston, Massachusetts, and colleagues reported in Urologic Oncology. Among patients with cT3 disease, however, the risk for all-cause mortality was a significant 58% lower for patients who underwent RC vs TMT. Survival did not differ by age or comorbidity burden.

The database lacked information on tumor characteristics and completeness of TURBT, which is a study limitation. ■