Nephrosphere

This site is still under development

Several studies have looked for a link between anemia and now another study finds that 25-OH vitamin D levels below 20 ng/ml were associated with a marginally increased risk of anemia (OR 1.17, 95% CI 1.03-1.32) in pre-dialysis CKD. Statistically significant, but not all that impressive overall.

25-Hydroxyvitamin D Deficiency and Inflammation and Their Association with Hemoglobin Levels in Chronic Kidney Disease.

Not any chewing gum, but a gum with added phosphorous binder seems to have some promise. Take a look.

Management of IgA nephropathy has been controversial for some time, with many debating whether it is even worth treating with immunosuppressive agents. This retrospective study from the American Journal of Nephrology suggests that, among subjects with a creatinine below 2 at renal biopsy, patients treated more recently (1996-2006) did better than those treated in the past (1981-1995), with the main change in management being increased use of ACEIs/ARBs and steroids. It’s not clear, however, which of these classes of agents might be responsible for such a change, or whether some other, confounding factor is at work.

This study by Lins, et al. published in Nephrology Dialysis Transplanation addresses the age old question of whether continuous renal replacement therapy (CRRT) is superior to hemodialysis (HD) in acute kidney injury. The authors stratified by severity of illness and conclude that there’s no difference between the groups. In my mind, however, the fatal flaw is the people who were left out of the study. Out of the 650 subjects eligible and in need of RRT, over half (n=344) were excluded, 37% of them for clinical reasons (including coagulation distubrances and hemodynamic instability). In other words, the most unstable patietns, the ones most likely to benefit from CRRT, were excluded from the study! It’s hard to conclude much from this other than CRRT probably isn’t advantageous in more stable patients.

A French group in the NEJM performed an open-label multicenter trial of patients with ANCA vasculitis (Wegener’s or MPA) comparing remission maintenance with azathioprine (Imuran) or methotrexate. All 126 patients had remission induced with IV steroids and cyclophosphamide prior to maintenance treatment. The study was 12 months long and the primary endpoint was an adverse event requiring study drug termination or death. There were no differences between the group in the primary endpoint, or in secondary endpoints (serious adverse effects or relapse). As the primary endpoint suggests, the main goal was to compare safety, rather than efficacy, but relapse rates were nearly identical as well.

The nephrosphere is coming soon.