Clinical journal of the American Society of Nephrology : CJASN
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Clin J Am Soc Nephrol · Feb 2009
Randomized Controlled Trial Multicenter StudyDesign of combination angiotensin receptor blocker and angiotensin-converting enzyme inhibitor for treatment of diabetic nephropathy (VA NEPHRON-D).
Both angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) can slow the progression of diabetic nephropathy. Even with ACEI or ARB treatment, the proportion of patients who progress to end-stage renal disease (ESRD) remains high. Interventions that achieve more complete blockade of the renin-angiotensin system, such as combination ACEI and ARB, might be beneficial. ⋯ Tertiary endpoints are cardiovascular events, slope of change in eGFR, and change in albuminuria at 1 yr. Specific safety endpoints are serious hyperkalemia (potassium > 6 mEq/L, requiring admission, emergency room visit, or dialysis), all-cause mortality, and other serious adverse events. This paper discusses the design and key methodological issues that arose during the planning of the study.
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Clin J Am Soc Nephrol · Feb 2009
Neutrophil gelatinase-associated lipocalin (NGAL) and progression of chronic kidney disease.
Chronic kidney disease (CKD) has recently assumed epidemic proportion, becoming a troubling emerging cause of morbidity, especially if it progresses to terminal stage (ESRD). The authors aimed to evaluate whether neutrophil gelatinase-associated lipocalin (NGAL), a novel specific biomarker of acute kidney injury, could predict the progression of CKD. ⋯ In patients with CKD, NGAL closely reflects the entity of renal impairment and represents a strong and independent risk marker for progression of CKD.
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Clin J Am Soc Nephrol · Jan 2009
Comparative Study Clinical TrialCorrelation of point-of-care International Normalized Ratio to laboratory International Normalized Ratio in hemodialysis patients taking warfarin.
To determine whether point-of-care (POC) International Normalized Ratio (INR) test results correlate with plasma INR measures in intermittent hemodialysis (IHD) patients on warfarin. Anemia is thought to reduce the accuracy of POC INR assay results. Whether POC INR testing could be implemented for hemodialysis patients on chronic warfarin, who are often anemic despite hematopoietic therapy, has not been established. ⋯ POC INR correlates well with plasma INR measures in IHD patients requiring chronic warfarin, and anemia did not influence this reliability. Blood sampling from finger stick or arteriovenous graft or fistula showed excellent correlation with laboratory INR, whereas sampling from dialysis catheters was unsatisfactory, likely from heparin contamination.
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Clin J Am Soc Nephrol · Jan 2009
ReviewNephrology training programs and applicants: a very good match.
A critical mission of academic nephrology programs is training the next generation of nephrologists. Attracting high-quality candidates into nephrology training programs is the first step in this process. The training program directors (TPDs) in nephrology launched an initiative several years ago to standardize the application and recruitment process for applicants to their programs. ⋯ On the basis of a survey of nephrology TPDs, the match process was successful, with almost all respondents planning on participating in the match with a start date of July 1, 2010. Certain issues remain, including determining the correct number of interviews, how many applicants to rank, and whether four tracks are necessary. It is concluded that the nephrology match is of benefit to both training programs and applicants.