Clinical journal of the American Society of Nephrology : CJASN
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Clin J Am Soc Nephrol · Jul 2013
Disentangling the ultrafiltration rate-mortality association: the respective roles of session length and weight gain.
Rapid ultrafiltration rate is associated with increased mortality among hemodialysis patients. Ultrafiltration rates are determined by interdialytic weight gain and session length. Although both interdialytic weight gain and session length have been linked to mortality, the relationship of each to mortality, independent of the other, is not adequately defined. This study was designed to evaluate whether shorter session length independent of weight gain and larger weight gain independent of session length are associated with increased mortality. ⋯ Among patients with adequate urea clearance, shorter dialysis session length and greater interdialytic weight gain are associated with increased mortality; thus, both are viable targets for directed intervention.
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Clin J Am Soc Nephrol · Jul 2013
Observational StudyVascular and renal hemodynamic changes after renal denervation.
Renal denervation (RDN) has been shown to be effective in reducing BP in treatment-resistant hypertension. Measurement of the renal and sympathetic activity revealed a decrease in sympathetic drive to the kidney and small resistance vessels after RDN. However, the consequences on renal perfusion and renal vascular resistance (RVR), as well as central hemodynamics, are unknown. ⋯ The data indicate that RDN significantly reduced peripheral and central BP. Despite reduced systemic BP, renal perfusion and function did not change after RDN.
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Clin J Am Soc Nephrol · Jun 2013
Comparative StudyVariation in nephrologist visits to patients on hemodialysis across dialysis facilities and geographic locations.
Geographic and other variations in medical practices lead to differences in medical costs, often without a clear link to health outcomes. This work examined variation in the frequency of physician visits to patients receiving hemodialysis to measure the relative importance of provider practice patterns (including those patterns linked to geographic region) and patient health in determining visit frequency. ⋯ In hemodialysis, provider visit frequency depends more on geography and facility location and characteristics than patients' health status or acuity of illness. The magnitude of variation unrelated to patient health suggests that provider visit frequency practices do not reflect optimal management of patients on dialysis.
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Clin J Am Soc Nephrol · Jun 2013
ReviewClinical utility of biomarkers of AKI in cardiac surgery and critical illness.
AKI is a common and serious complication that is associated with several adverse outcomes in hospitalized patients. The past several years have seen a large number of multicenter investigations of biomarkers of AKI in the setting of cardiac surgery and critical illness. ⋯ Analyses of biomarkers concentrations from the Acute Respiratory Distress Syndrome Network, EARLY ARF, and other studies of critically ill subjects have similarly shown that biomarkers measured early in the clinical course can forecast the development of AKI and need for renal replacement therapy as well as inpatient mortality. Although biomarkers have informed the diagnosis, prognosis, and treatment of AKI and are inching closer to clinical application, large multicenter interventional clinical trials to prevent AKI using biomarkers should continue to be an active area of clinical investigation.
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Clin J Am Soc Nephrol · May 2013
Serum FGF23 and risk of cardiovascular events in relation to mineral metabolism and cardiovascular pathology.
Circulating fibroblast growth factor-23 is associated with adverse cardiovascular outcomes in CKD and non-CKD individuals, but the underlying mechanism remains unclear. This study tested whether this association is independent of mineral metabolism and indices of subclinical cardiovascular pathology. ⋯ Fibroblast growth factor-23 is an independent predictor of cardiovascular events in the community, even after accounting for mineral metabolism abnormalities and subclinical cardiovascular damage. Circulating fibroblast growth factor-23 may reflect novel and important aspects of cardiovascular risk yet to be unraveled.