Tuesday, March 28, 2023
Attendees from around the world at Renal Week 2010, the American Society of Nephrology (ASN) 43rd Annual Meeting, held November 16 - 21, 2010, in Denver, Colorado, heard groundbreaking research in basic, translational, and clinical sciences concerning kidney disease. The theme of this year's meeting was "Advancing Science and Medicine to Improve Kidney Health." Key presentations included how physicians can improve patient outcomes on dialysis, genetic factors that might increase the incidence of end-stage renal disease in blacks, and novel biomarkers of acute kidney injury.
A number of late-breaking clinical trials reported here will "likely influence how kidney disease is treated and will have a direct impact on patient care," ASN Program Chair David Ellison, MD, FASN, told Medscape Medical News. Among them:
- dialysis 6 times a week is associated with lower cardiovascular mortality;
- once-monthly peginesatide effectively maintains hemoglobin levels in dialysis-related anemia;
- albuminuria predicts cognitive decline independent of kidney function;
- potassium citrate boosts bone density in the elderly; and
- the novel anti-inflammatory bardoxolone improves glomerular filtration rate in chronic kidney disease.
Preliminary findings on bardoxolone for chronic kidney disease (CKD) were reported by Pablo E. Pergola, MD, PhD, from the University of Texas, in San Antonio. Results through week 24 of a 52-week multicenter placebo-controlled study of the drug in 227 patients with moderate to severe CKD and type 2 diabetes showed a rapid and "clinically significant" increase in glomerular filtration rate in the treatment group and no improvement in the placebo group. More than half of patients receiving bardoxolone had an improvement in CKD status of at least 1 stage compared with only about 16% of those patients receiving placebo. Cramps and hypomagnesemia were frequent adverse events.
Full news coverage: Novel Anti-Inflammatory Bardoxolone Improves GFR in CKD
Drinking pomegranate juice may offer some protection against infection in patients receiving dialysis, according to a small study funded by the Israeli Ministry of Health. In a placebo-controlled trial of 101 patients receiving dialysis, those who drank half a cup of pomegranate juice 3 times a week for a year had fewer hospital admissions resulting from infections. Frank Brosius, MD (pictured), from the University of Michigan Health System, Ann Arbor, was skeptical of the benefits, although he said the juice was unlikely to cause harm. Clearly, further study is needed, he said.
Full news coverage: Pomegranate Juice Could Help Kidney Patients
Elderly patients who are even mildly hyponatremic have a much greater risk for falls and fractures than those with normal sodium levels, according to new data on more than 5200 elderly Dutch subjects in The Rotterdam Study. "Mild hyponatremia appears to be a new risk factor for fractures in the elderly, and if replicated, screening and treatment for hyponatremia might prevent fractures," Ewout J. Hoorn, MD, PhD, from Erasmus Medical Center, in Rotterdam, the Netherlands, reported. The mechanism remains to be determined; lower bone mineral density in hyponatremic patients did not appear to explain it.
Full news coverage: Higher Fracture Rates Seen Among Elderly With Mild Hyponatremia
In a group of patients with hypertension-related kidney disease, increased consumption of fruits and vegetables for 30 days led to significant improvements in several urinary parameters of kidney injury, Nimirit Goraya, MD, from Texas A&M College of Medicine in Temple, told attendees. "The findings underscore that just this simple, inexpensive measure can make an enormous difference in helping our chronic kidney disease patients. Most of them do really listen to dietary changes, because they don't want to add more and more medicines to their regimen," she said.
Full news coverage: Fruits, Vegetables Slow Kidney Disease Decline in Hypertensive Patients
A study from Marije Russcher, PharmD, from Meander Medical Center in Amersfoort, the Netherlands, suggests that 3 mg melatonin daily can help relieve sleep disturbances in patients undergoing dialysis. Unfortunately, the benefits seem to wane with time. "We are thinking that perhaps introducing drug holidays might help, or maybe the doses we gave were too high, and a lower dose might have a longer-term efficacy," she said. "The timing of the dose might also play a role, as might the addition of light therapy, but those are all ideas for future research."
Full news coverage: Melatonin Supplements Improve Sleep in Hemodialysis Patients
Doubling the frequency of in-center hemodialysis sessions from the traditional 3 sessions per week to 6 might lead to better cardiovascular health for patients with kidney disease and may slow the dialysis-associated increase in left ventricular mass, according to results of a randomized 3-year clinical trial reported by Alan Kliger, MD, from Yale University in New Haven, Connecticut. Magnetic resonance images taken at the beginning and end of a year of high-frequency dialysis revealed that left ventricle mass decreased by 13.8% in patients who underwent dialysis 6 times per week compared with those undergoing thrice-weekly dialysis.
Full news coverage: Dialysis 6 Times a Week Associated With Lower Cardiovascular Mortality
A Dutch study of 600 kidney transplant recipients found that patients who drink alcohol moderately were 44% less likely to die over an average of 7 years and were as much as 67% less likely to develop diabetes than those who consumed more or less alcohol. An improvement in mortality rates for kidney transplant patients has particular relevance because their rates of death typically increase after transplantation, Dorien M. Zelle, MSc, from University Medical Center Groningen, the Netherlands, said.
Full news coverage: Some Alcohol Use Reduces Diabetes, Mortality After Kidney Transplant
Colin Baigent, MD (pictured), and Martin Landray, MD, from the Clinical Trials Service Unit in Oxford, United Kingdom, reported the much-anticipated final results of the Study of Heart and Renal Protection (SHARP), which show that cholesterol lowering with a combination of simvastatin and ezetimibe (Vytorin; Merck) in patients with kidney disease significantly reduced the risk for major atherosclerotic events by 17% and major vascular events by almost the same degree. There was no suggestion of an increased incidence of cancer with the drug.
Full news coverage: SHARP: Ezetimibe/Simvastatin Combo Cuts Atherosclerotic and Vascular Events in Kidney-Disease Patients
Jonathan Himmelfarb, director of the Kidney Research Institute at the University of Washington in Seattle, discussed the state of dialysis care in the United States — and the changes ahead that promise to improve outcomes — with Medscape Medical News. "The dialysis field is going to be one of the earliest in which the federal government will to try to implement some pay-for-performance. It's an innovative area in terms of healthcare policy. You get paid better if your outcomes are better, according to a variety of different quality metrics, which are all being actively developed," Dr. Himmelfarb said.
Full interview: US Dialysis Mortality Rates High but Vary Widely Between Centers
In a look back at data from the Nationwide Inpatient Sample from 2007, researchers found that the mortality rate among patients with end-stage renal disease admitted on weekends was 17% higher than for those admitted on weekdays, even after controlling for comorbid conditions. Ankit Sakhuja, MD, a third-year resident in internal medicine at The Medical College of Wisconsin in Milwaukee, who reported the findings, noted that the leading cause of death with weekend admission was infection.
Full news coverage: Weekend Admission for ESRD Associated With High Mortality
In dialysis patients, as well as other chronic disease states, it has been shown that being overweight or obese yields a survival advantage. But in a new twist to the so-called "obesity paradox," Ellen K. Hoogeveen, MD, from Jeroen Bosch Hospital in 'S-Hertogenbosch, the Netherlands, reported that this does not apply to younger patients. In a study of 1700 patients receiving dialysis, Dr. Hoogeveen and colleagues found that obese patients younger than age 65 years had a higher risk of dying within 7 years compared with their normal-weight counterparts. However, obesity was not associated with a higher risk of dying in patients older than 65 years.
Full news coverage: Older, Overweight Dialysis Patients Benefit From "Obesity Paradox"
The dietary acid-loads typical of the Western diet are thought to decrease bone mass and contribute to the current osteoporosis epidemic, but neutralizing diet-induced acid load with potassium citrate may help. Sigrid Jehle, MD, from the University of Basel, in Switzerland, reported a study of 201 healthy elderly subjects with normal baseline bone mineral density who received either 60 mmol potassium citrate or placebo daily for 2 years. Potassium citrate induced a significant and sustained increase in bone density at all sites, Dr. Jehle told attendees, providing evidence of a "quantitatively" important role for potassium citrate in preventing and even treating age-associated decreases in bone mineral density.
Full news coverage: Potassium Citrate Boosts Bone Density in the Elderly
Preeclampsia can be predicted by urinary proteomic profiling of spot urine samples in early pregnancy with high accuracy, according to a prospective, longitudinal study presented by Matt Hall, MD, from the University of Leicester in the United Kingdom. Among 145 pregnant women, 11 (7.6%) developed preeclampsia; 10 at more than 37 weeks' gestation and 1 at 31 weeks' gestation. Spectral analysis of urine samples obtained before 20 weeks' gestation identified a panel of 5 peaks that corrected predicted preeclampsia with 92% accuracy. Validation of the test data sets showed a sensitivity of 87% and a specificity of 82%. Early prediction of preeclampsia should permit focused monitoring and tailoring of therapy to improve maternal and fetal outcomes, the researchers say.
Full news coverage: Urine Test Early in Pregnancy Can Predict Preeclampsia
Blacks and some Hispanics have significantly faster rates of decline in kidney function before the onset of chronic kidney disease, according to an analysis of 5179 patients in the Multi-Ethnic Study of Atherosclerosis (MESA). "We adjusted for the traditional risk factors that affect kidney function, and it didn't change things very much," reported study chief Carmen J. Peralta, MD, from the University of California at San Francisco and the San Francisco Veteran's Affairs Medical Center.
Full news coverage: Significant Racial Differences Seen in Rate of Progression of CKD
Credits
Photographs by Nick Teti, Denver, Colorado
Martha Kerr, Conference News Editor, Medscape Medical News, East Haddam, Connecticut
Martha Kerr has disclosed no relevant financial relationships.
Jane Hwang, Senior Editor/Photo, Medscape, New York City
Jane Hwang has disclosed no relevant financial relationships.
Nancy Melville, Freelance Journalist, Tucson, Arizona
Nancy Melville has disclosed no relevant financial relationships.
Megan Brooks, Freelance Journalist, Weston, Connecticut
Megan Brooks has disclosed no relevant financial relationships.
For more information, see the following resources:
Top News Stories From ACR 2010
Top News From IDSA 2010
Top News from AHA 2010
Top News From the ASCO® 2010 Annual Meeting
Top News From the APA 2010 Annual Meeting
