Nephrosphere

The study was terminated early because of excess cardiac events. They did not find any difference in mortality or rate of progression between the two groups. Doesn’t look like a winner.

“Avosentan reduces albuminuria when added to standard treatment in people with type 2 diabetes and overt nephropathy but induces significant fluid overload and congestive heart failure.”

via Avosentan for Overt Diabetic Nephropathy — Mann et al., 10.1681/ASN.2009060593 — Journal of the American Society of Nephrology.

The development of arterial stiffness has been tied to advancing CKD, but these authors argue the contribution of reduced kidney function is not a major player.

“Although eGFR may independently predict PWV, the contribution of GFR per se does not appear to be clinically meaningful when compared with traditional cardiovascular risk factors.”

via Dominance of traditional cardiovascular risk factors over renal function in predicting arterial stiffness in subjects with chronic kidney disease — Sengstock et al. 25 (3): 853 — Nephrology Dialysis Transplantation.

As expected, the realities of dual treatment are challenging.

“Forty-five percent of CKD stage 3–5 patients did not tolerate dual RAS blockade with 20 mg enalapril and 16 mg candesartan daily, primarily due to loss of renal function or hypotension.”

via Feasibility of combined treatment with enalapril and candesartan in advanced chronic kidney disease — Frimodt-Møller et al. 25 3: 842 — Nephrology Dialysis Transplantation.

While sirolimus has been thought to be a safer immunosuppressant than cyclosporine or tacrolimus from the point of view of nephrotoxicity. This AJKD study suggests otherwise, with an increased risk of low-grade proteinuria and tubular damage.

Tubular toxicity in sirolimus- and cyclosporine-ba… [Am J Kidney Dis. 2010] – PubMed result.

This is clearly where dialysis is headed. I don’t see them as viable alternatives to a transplant, but certainly sounds better than trucking over to a dialysis unit three times a week. May at least be a legitimate alternative to PD.

Details here.

AJKD reports that Cinacelcet might be associated with leukocytoclastic vasculitis. Of course, the same can be said for just about any drug.

Cinacalcet-Induced Leukocytoclastic Vasculitis. [Am J Kidney Dis. 2009] – PubMed Result .

AJKD reports that Cinacelcet might be associated with leukocytoclastic vasculitis. Of course, the same can be said for just about any drug.

Cinacalcet-Induced Leukocytoclastic Vasculitis. [Am J Kidney Dis. 2009] – PubMed Result .

Association of environmental cadmium exposure with inflammation and malnutrition in maintenance haemodialysis patients — Hsu et al. 24 (4): 1282 — Nephrology Dialysis Transplantation.

The malnutrition-inflammation complex is thought to be one of the contributors to poor outcomes on hemodialysis. Hsu et al, in this NDT paper, tie it to cadmium exposure. An interesting twist on a mysterious problem.

Carrying a pregnancy to term in patients undergoing hemodialysis can be a challenge. Yukari et al. in Kidney International find that lower BUN levels were associated with birth at a greater likelyhood of carrying pregnancy ? 32 weeks and a greater chance of birth weight ? 1.5kg. Although not the focus of the study, it appears that higher hemoglobins also correlated with improved likelihood of delivery.