The Return of Renal Nutrition Update

In December 2022, Renal & Urology News brought back Renal Nutrition Update, which had been a regular monthly department before it was discontinued more than a decade ago. Its reprise is a response to the apparent growing importance of renal nutrition in the care of patients with kidney disease, as reflected in part by the surging medical literature on the topic. For example, a PubMed search using the search terms renal or kidney and nutrition or diet retrieved 9067 citations in 2000, 18,155 in 2010, and 34,503 in 2022. Further, dietary issues related to kidney care seem to be gaining in prominence at nephrology conferences in terms of sessions and poster and oral presentations.

The return of Renal Nutrition Update in print begins with this issue (page 14). The article deals with KDOQI’s 2020 revision of potassium intake recommendations for patients with chronic kidney disease that suggest an individualized approach to patients’ needs. The department appears monthly on our website (renalandurologynews.com).

Also in this issue is an article about the possible effect of climate change on kidney stone prevalence (page 6). Rising temperatures, especially in urban areas, may increase the likelihood of dehydration. This could lead to greater concentrations of stone-forming substances in urine such as calcium, oxalate, phosphate, and uric acid. Kidney stone prevalence has already been on the rise, and a warming earth could exacerbate the problem.

And be sure to read our report on a study showing that people who live in the so-called stroke belt of the United States (a region of the southeast including Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, and Tennessee) are at higher risk for chronic kidney disease compared with individuals who live elsewhere independent of conventional risk factors (page 11). The investigators wrote that people who live in the stroke belt may have different environmental exposures compared with those who inhabit other regions.

Renal & Urology News Staff

Editor Jody A. Charnow

Web editor Natasha Persaud

Production editor Kim Daigneau

Group creative director Jennifer Dvoretz

Senior production manager Krassi Varbanov

Vice president, sales operations and production Louise Morrin Boyle

National accounts manager William Canning

Editorial director, Haymarket Oncology Lauren Burke

Vice president, content, medical communications Kathleen Walsh Tulley

Chief commercial officer James Burke, RPh

President, medical communications Michael Graziani

Chairman & CEO, Haymarket Media Inc. Lee Maniscalco

Lastly, I would like to highlight our article about the 2022 Advanced Prostate Cancer Consensus Conference in which a multidisciplinary international panel of experts offered their opinions on how to approach controversial areas in prostate cancer management (page 8). The goal was to help supplement evidence-based guidelines. Notably, the panel reached consensus on the appropriate use of PSMA PET in various clinical situations. For example, the panel favored its upfront use, in addition to prostate MRI, with or without subsequent conventional imaging for systemic staging of clinically localized prostate cancer. The panel strongly agreed not to recommend PSMA PET for the majority of patients with clinically localized favorable intermediate-risk localized prostate cancer. These and other consensus statements no doubt are welcome guidance at a time of rapid advancements in therapeutics and imaging, when it may take a while to determine their optimal use.

Jody A. Charnow Editor

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Nephrology

4 Stone Treatment in Kidney Grafts Characterized Antegrade approaches may yield the highest stone-free rates for patients with de novo nephrolithiasis in kidney grafts.

5 CKD-Related Pruritus Risk Factors ID’d Older individuals, those with a higher body mass index, and current smokers among those with a greater likelihood of the condition.

6 Global Warming Could Lead to More Kidney Stones

Higher temperatures can cause dehydration, which concentrates substances in urine that can foster development of kidney stones.

11 CKD Risk Higher in the American ‘Stroke Belt’ Inhabitants have a significant 14% higher risk for incident CKD compared with those who do not.

Urology

4 Long-Term PCa Outcomes Worse With AS Prostate cancer-specific survival at 10 years is slightly lower among men with low-grade disease undergoing active surveillance vs definitive initial treatment

5 Statin Use During Prostate Cancer ADT Ups Survival

A systematic review and meta-analysis demonstrated that concurrent statin use was significantly associated with a 27% reduced risk of all-cause mortality.

13 PCA vs Partial Nephrectomy for cT1b Renal Tumors Both procedures offer comparable distant oncologic outcomes, but percutaneous cryoablation is associated with a higher local recurrence rate, data show.

13 Use of 5-ARIs Increases Risk for Dementia Finasteride and dutasteride are significantly associated with a 22% and 10% increased risk of all-cause dementia, respectively.

Editor’s note: The 2023 conference listings below include information provided by the sponsoring organizations on their websites as this issue went to press.

Annual Dialysis Conference

March 3-6

Kansas City, MO

European Association of Urology

Annual Congress

March 10-13

Milan, Italy

National Kidney Foundation

Spring Clinical Meetings

April 11-15

Austin, TX

American Urological Association

Annual Meeting

April 28-May 1

Chicago, IL

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14

15

16

Short Takes

UI Tied to Artificially Sweetened Drinks

Women who drink 1 or more servings per day of artificially sweetened beverages are 10% more likely to report having mixed urinary incontinence (UI) compared with women who drank less than 1 serving per week or never drank these beverages, according to study findings published in Menopause

The finding is from a secondary analysis of data from 80,388 women in the Women’s Health Initiative Observational Study.

Investigators found no association between the quantity of artificially sweetened beverages consumed and stress or urgency UI symptoms.

Gene Therapy Approved for High-Risk NMIBC

The US Food and Drug Administration has approved a novel gene therapy called nadofaragene firadenovec-vncg (Adstiladrin, Ferring Pharmaceuticals) for adult patients with high-risk nonmuscle-invasive bladder cancer (NMIBC) that is unresponsive to bacillus Calmette-Guérin (BCG) therapy, according to a news release from the agency.

Nadofaragene firadenovec-vncg is a non-replicating adenoviral vectorbased gene therapy. It is administered every 3 months into the bladder via a urinary catheter. The safety and effectiveness of the therapy were evaluated in a multicenter trial that included 157 patients with high-risk BCG-unresponsive NMIBC.

Post-Op Acetaminophen

Cuts Risk of Severe AKI

Acetaminophen given soon after cardiac surgery is associated with a lower risk for severe acute kidney injury, investigators reported in the American Journal of Kidney Diseases

The study included 9631 patients from 2 registries who underwent cardiac surgery: 5791 in the Medical Information Mart for Intensive Care (MIMIC)-III and 3840 in the eICU Collaborative Research Database (eICU). Acetaminophen was administered in the early postoperative period to 4185 patients (72%) and 2737 patients (71%), respectively. On multivariable analysis, early acetaminophen use was significantly associated with a 14% and 16% reduced risk for severe AKI in the MIMIC-III and eICU groups, respectively.

Prostate Cancer AS On the Rise

Hyperkalemia More Likely With TMP/SMX vs Amoxicillin

Antibiotic treatment with oral trimethoprim-sulfamethoxazole (TMP/SMX) rather than amoxicillin is associated with a more than 3-fold higher risk of a hospital encounter with hyperkalemia, especially among patients with nondialysisdependent chronic kidney disease.

The finding is from a population-based cohort study of adults aged 66 years and older in Ontario, Canada. Investigators compared 58,999 matched pairs of outpatients initiating oral TMP/SMX vs oral amoxicillin from 2008 to 2020. Median prescription duration for both antibiotics was 7 days. The primary outcome, an emergency department visit or hospital admission with hyperkalemia (defined as serum potassium level of 5.5 mmol/L or greater) within 14 days, occurred in a higher proportion of patients treated with TMP/SMX vs amoxicillin: 0.46% vs 0.14%, Y. Joseph Hwang, MD, MSc, of Johns Hopkins University School of Medicine in Baltimore, Maryland, and colleagues reported in Nephrology Dialysis Transplantation TMP/SMX recipients had a significant 3.4-fold increased relative risk of a hospital encounter with hyperkalemia.

Bladder Cancer Risk Higher After PCa Radiation vs RP

Prostate cancer treatment with radiation is associated with a greater risk for bladder cancer compared with surgery, investigators concluded in a presentation at the Society of Urologic Oncology’s 23rd annual meeting in San Diego, California. In a study of 2000 to 2019 data from 418,053 patients in the Surveillance, Epidemiology, and End Results (SEER) database, Steven Monda, MD, from UC Davis Health in Sacramento, California, and colleagues found that brachytherapy and external beam radiation therapy (EBRT) were significantly associated with an approximately 2.4- and 2.5-fold increased risk for bladder cancer, respectively, compared with radical prostatectomy (RP), in adjusted analyses. RP followed by EBRT was significantly associated with a 1.5-fold increased risk for bladder cancer compared with RP alone.

Air Pollution Ups ESKD Risk in IgA Nephropathy

Exposure to air pollution consisting of fine particulates less than 2.5 microns (PM2.5) in diameter independently predicts development of end-stage kidney disease (ESKD) among patients with IgA nepropathy (IgAN), new findings suggest.

Jingyuan Xie, MD, PhD, of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine in China, and colleagues studied PM2.5 exposure across regions in China from 1998 to 2016 using satellite data on aerosols. Among 1979 patients with biopsy-proven IgAN at 7 Chinese centers, ESKD developed in 207. Each 10 μg/m3 increase in annual average concentration of PM2.5 exposure was significantly associated with a 14% increased risk of ESKD before study entry and a 10% increased risk after study entry, Dr Xie’s team reported in Kidney International. When patients were exposed to PM2.5 pollution above the median both before and after study entry (defined as 52.7 and 52.3 μg/m3, respectively), patients had a significant 54% increased risk for ESKD.