Clinical journal of the American Society of Nephrology : CJASN
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Clin J Am Soc Nephrol · Apr 2014
Alkaline phosphatase and mortality in patients on peritoneal dialysis.
Elevated total serum alkaline phosphatase levels have been associated with higher mortality in the general population, CKD patients, and hemodialysis patients. However, in peritoneal dialysis patients, this association has received little attention. The aim of this study was to evaluate the association between alkaline phosphatase and all-cause and cardiovascular mortality in peritoneal dialysis patients. ⋯ Higher total serum alkaline phosphatase levels at the commencement of peritoneal dialysis were independently associated with all-cause and cardiovascular mortality in peritoneal dialysis patients.
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Clin J Am Soc Nephrol · Apr 2014
Association of kidney function with changes in the endothelial surface layer.
ESRD is accompanied by endothelial dysfunction. Because the endothelial glycocalyx (endothelial surface layer) governs interactions between flowing blood and the vessel wall, perturbation could influence disease progression. This study used a novel noninvasive sidestream-darkfield imaging method, which measures the accessibility of red blood cells to the endothelial surface layer in the microcirculation (perfused boundary region), to investigate whether renal function is associated with endothelial surface layer dimensions. ⋯ Reduced renal function is strongly associated with low endothelial surface layer dimensions. After successful kidney transplantation, the endothelial surface layer is indistinguishable from control.
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Clin J Am Soc Nephrol · Apr 2014
Randomized Controlled Trial Multicenter Study Comparative StudyA randomized comparison of ferumoxytol and iron sucrose for treating iron deficiency anemia in patients with CKD.
Few randomized controlled trials have compared intravenous iron products head to head in CKD patients with iron deficiency anemia. This study compared the efficacy and safety of two intravenous iron products (ferumoxytol [Feraheme injection] and iron sucrose [Venofer]) in patients with CKD and iron deficiency anemia. ⋯ In this randomized, controlled trial, ferumoxytol and iron sucrose showed comparable efficacy and adverse events rates.
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Clin J Am Soc Nephrol · Apr 2014
Multicenter StudyPerformance and limitations of administrative data in the identification of AKI.
Billing codes are frequently used to identify AKI events in epidemiologic research. The goals of this study were to validate billing code-identified AKI against the current AKI consensus definition and to ascertain whether sensitivity and specificity vary by patient characteristic or over time. ⋯ The use of billing codes to identify AKI has low sensitivity compared with the current KDIGO consensus definition, especially when the urine output criterion is included, and results in the identification of a more severe phenotype. Epidemiologic studies using billing codes may benefit from a high specificity, but the variation in sensitivity may result in bias, particularly when trends over time are the outcome of interest.
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Clin J Am Soc Nephrol · Apr 2014
Long-term maintenance therapy using rituximab-induced continuous B-cell depletion in patients with ANCA vasculitis.
Remission in the majority of ANCA vasculitis patients is not sustained after a single course of rituximab, and risk of relapse warrants development of a successful strategy to ensure durable remission. ⋯ This analysis provides evidence for long-term disease control using continuous B-cell depletion. This treatment strategy in ANCA vasculitis patients also seems to result in survival rates comparable with rates in a matched reference population. These findings suggest that prospective remission maintenance treatment trials using continuous B-cell depletion are warranted.