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Finerenone Reduces Urine Protein Loss in Diabetic Kidney Disease

Botulinum Toxin Reduces Pain of Skin Leiomyomas

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This study identified that the simple assessment of nutrition impact symptoms is effective in identifying patients who are likely to be at risk of malnutrition and/or experience decline in nutrition status and clinical outcomes in the following 6 to 12 months. This simple assessment is therefore presented as an alternative screening tool, providing a trigger warranting further assessment and nutrition intervention. This tool is advantageous as it does not require any objective measurements, including anthropometry or biochemistry results and can be undertaken by any of the healthcare team.

The main findings of this study, which is a post-hoc analysis of the ADVANCE study, are that the annual progression (expressed as the median percentage change) of the calcification score (Agatston) of coronary artery is less in hemodialysis patients with secondary hyperparathyroidism treated by cinacalcet and respecting the prescription of low doses of active vitamin D (< 6 mcg/weekparicalcitol equivalent), compared with the control group, 17.8% versus 31.3%, respectively. They also show that Agatston calcification score of aortic valve progress much lesser in the cinacalcet treated patients than in control (6.0% versus 51.1%).

2.Hyperphosphatemia is a late phenomenon in the natural history of CKD and insensible phosphate overload may prompt the beginning of CKD-mineral bone disorder (MBD) in normophosphatemic subjects.

We evaluated the impact of stage 5 chronic kidney disease (CKD5) on major bowel resection surgery 30-day outcomes using the National Surgical Quality Improvement Program database, a large clinical database that is nationally representative, utilizes trained data collectors, is routinely audited, and well validated. Patients on dialysis represented 1.4% (1,685 cases) of the total group undergoing bowel resection from 2005-2010.  The overall mortality rate was 4.8% that was dramatically increased in the CKD5 group to 27.5%.  A similar trend was seen for major morbidity with baseline morbidity of 23.1% increasing to 58.3% in CKD5. Within the CKD5 group acute presentation was the strongest predictor of both mortality and major morbidity.  Medical comorbidities were also associated with increased risk including pulmonary comorbidity, and cardiac comorbidity.  Hypoalbuminemia and an open operative approach were also associated with increased risk of poor outcome, suggesting potential targets for outcome improvement. 

Response: The enormous community of microbes that resides in the intestinal tract (microbiome) constitutes a symbiotic ecosystem which provides protection against invasion by pathogenic organisms and contributes to nutritional balance by facilitating absorption of complex carbohydrates, and production of amino acids and various micronutrients including vitamin K, and group B vitamins. The integrity and proper function of the gut microbiome is essential for health and alteration in the composition or function of the microbiome is associated with various illnesses such as inflammatory bowel disease, diabetes, cardiovascular diseases, cancer, obesity, chronic inflammation, lipid disorders, and allergic disorders.

This meta-analysis of more than one million participants from 45 studies shows that the presence of chronic kidney disease (CKD), measured by low kidney function or elevated protein in the urine, is an important risk factor for mortality and kidney failure, regardless of whether an individual has hypertension. Whereas the association of CKD measures with kidney failure was similar in hypertensives versus non-hypertensives, the association of CKD with both mortality outcomes was stronger in non-hypertensives. Prior to this study the importance of CKD in the presence of hypertension was well studied, but the importance of mild to moderate CKD in the absence of hypertension was questionable. Risk assessment in a single study of subjects with CKD without hypertension is hampered by the strong coexistence of CKD with hypertension, leaving insufficient numbers of individuals with only CKD without hypertension. By pooling multiple studies together, we were able to have sufficient numbers of non-hypertensive individuals with CKD.

We developed an inflammation score integrating cytokines and acute phase proteins to determine the prevailing state of inflammation and showed inflammation is highly prevalent among patients with CKD. We also found that within each level of eGFR, urinary excretion of albumin (UACR) was associated with a higher inflammation score. This study is unique in that it uses a large cohort of subjects (about 4000) with varying level of kidney function and diverse ethnicity.

Most hemodialysis patients receiving erythropoesis-stimulating agents (ESA) and intravenous iron supplementation according current clinical practice guidelines (eg KDOQI-2006 and European Best Practice Guideline) have hepatic iron overload on magnetic resonance imaging  (MRI). Mild to severe hepatic iron overload was observed in 100 patients out 119 (84%; CI: 76%-90%), of whom 36%(CI: 27%-46%) had severe hepatic iron overload (Liver iron content (LIC) > 201 µmol/g of dry weight). In these latter hemodialysis patients, severe hepatic iron overload was of the same magnitude that those encountered in genetic hemochromatosis and secondary hemosiderosis of hematological diseases.

The main findings of our study are normotensive hemodialysis patients (blood pressure is controlled with hemodialysis with no need of anti-hypertensive medications) carry a relative low risk as compared with general hemodialysis patients,  and left ventricular function but not vascular factors is an independent predictor for outcome.

Using a combination of qualitative and quantitative methods, we found that many deceased donor kidney recipients had a potential living donor available which they refused or did not want. These recipients mostly waited for a deceased donor because of concern for the donor’s health. They more often expected negative relationship changes than living donor kidney recipients, who also expected positive changes. Living donor kidney recipients on the other hand, mostly accepted the kidney to improve their own quality of life. Donors mostly donated a kidney because transplantation would make the recipient less dependent. After transplantation both positive and negative relationship changes are experienced.

Using a combination of qualitative and quantitative methods, we found that many deceased donor kidney recipients had a potential living donor available which they refused or did not want. These recipients mostly waited for a deceased donor because of concern for the donor’s health. They more often expected negative relationship changes than living donor kidney recipients, who also expected positive changes. Living donor kidney recipients on the other hand, mostly accepted the kidney to improve their own quality of life. Donors mostly donated a kidney because transplantation would make the recipient less dependent. After transplantation both positive and negative relationship changes are experienced

A very high prevalence of sexual dysfunction among women undergoing regular hemodialysis, with a low mean age of 38.9 years, with physical functioning being the main quality of life domain affected among women with sexual dysfunction. Physical functioning was lower among women with sexual dysfunction, and also physical functioning and sexual function scores were positively correlated