Clinical journal of the American Society of Nephrology : CJASN
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Clin J Am Soc Nephrol · Feb 2012
Comparative StudyDialysis modality and outcomes in kidney transplant recipients.
The influence of pretransplant dialysis modality on post-transplant outcomes is not clear. This study examined associations of pretransplant dialysis modality with post-transplant outcomes in a large national cohort of kidney transplant recipients. ⋯ Compared with hemodialysis, patients treated with peritoneal dialysis before transplantation had lower mortality but similar graft loss or delayed graft function. Confounding by residual selection bias cannot be ruled out.
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Clin J Am Soc Nephrol · Feb 2012
Erythropoietic stimulating agents and quality of a patient's life: individualizing anemia treatment.
Erythropoietic stimulating agents (ESAs) such as erythropoietin have been used for decades to treat the anemia of CKD. Clinical practice guidelines suggest target hemoglobin levels >10 g/dl, and average Hb levels have risen from 9.6 to 12.0 g/dl. Several studies have shown trends for higher mortality and myocardial infarction, higher BP, increased vascular access thrombosis, and strokes in patients treated to target Hb ≥13 g/dl. ⋯ We propose that instead of Hb targets for all patients, treatment of anemia should be directed toward improving the areas of patient-perceived quality of life most affected by anemia. PROs can be used by individual patients to prioritize the risks and benefits of ESA treatment. Patients, along with their physicians, can examine Hb level in the context of patients' perception of their quality of life and use ESAs judiciously to improve these perceptions.
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Clin J Am Soc Nephrol · Feb 2012
Association of AKI with adverse outcomes in burned military casualties.
Although associated with increased morbidity and mortality, AKI has not been systematically examined in military personnel injured from combat operations in Iraq and Afghanistan. ⋯ AKI is prevalent in military casualties with burn injury and is independently associated with morbidity and mortality after adjustment for factors associated with injury severity.
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Clin J Am Soc Nephrol · Feb 2012
The new FDA labeling for ESA--implications for patients and providers.
Recent clinical trials comparing the use of erythropoiesis-stimulating agents targeting low (generally a hemoglobin of 90-115 g/L) and near-normal hemoglobin targets (generally a hemoglobin >130 g/L) in patients with chronic kidney disease have shown no improvements in clinical outcomes (aside from a small reduction in transfusion) and potential harm for erythropoiesis-stimulating agents use targeting near-normal hemoglobin targets. Based on these results, the US Food and Drug Administration recently released modified recommendations for more conservative dosing of erythropoiesis-stimulating agents in patients with CKD. ⋯ Also, the US Food and Drug Administration labeling changes are discussed, and areas of controversy are highlighted. Although the US Food and Drug Administration labeling changes are based on the results of recent large randomized trials testing ESAs targeting near-normal hemoglobin levels, more specific guidance to clinicians would have been helpful.