Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
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Nephrol. Dial. Transplant. · Feb 2016
Randomized Controlled Trial Multicenter StudyMulticentre randomized controlled trial of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker withdrawal in advanced renal disease: the STOP-ACEi trial.
Blood pressure (BP) control and reduction of urinary protein excretion using agents that block the renin-angiotensin aldosterone system are the mainstay of therapy for chronic kidney disease (CKD). Research has confirmed the benefits in mild CKD, but data on angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) use in advanced CKD are lacking. In the STOP-ACEi trial, we aim to confirm preliminary findings which suggest that withdrawal of ACEi/ARB treatment can stabilize or even improve renal function in patients with advanced progressive CKD. ⋯ The rationale and trial design are presented here. The results of this trial will show whether discontinuation of ACEi/ARBs can improve or stabilize renal function in patients with advanced progressive CKD. It will show whether this simple intervention can improve laboratory and clinical outcomes, including progression to end-stage renal disease, without causing an increase in cardiovascular events.
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Nephrol. Dial. Transplant. · Oct 2015
Randomized Controlled Trial Multicenter StudyRandomized placebo-controlled dose-ranging and pharmacodynamics study of roxadustat (FG-4592) to treat anemia in nondialysis-dependent chronic kidney disease (NDD-CKD) patients.
Roxadustat (FG-4592) is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor that stimulates erythropoiesis. This Phase 2a study tested efficacy (Hb response) and safety of roxadustat in anemic nondialysis-dependent chronic kidney disease (NDD-CKD) subjects. ⋯ Clintrials.gov #NCT00761657.
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Nephrol. Dial. Transplant. · Apr 2015
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialHigh-volume online haemodiafiltration improves erythropoiesis-stimulating agent (ESA) resistance in comparison with low-flux bicarbonate dialysis: results of the REDERT study.
In haemodialysis (HD) patients, anaemia is associated with reduced survival. Despite treatment with erythropoiesis-stimulating agents (ESAs), a large number of patients with chronic kidney disease show resistance to this therapy and require much higher than usual doses of ESAs in order to maintain the recommended haemoglobin (Hb) target, and recent studies suggest that hepcidin (HEP) may mediate the ESA resistance index (ERI). High-volume online haemodiafiltration (HV-OL-HDF) has been shown to improve anaemia and to reduce the need for ESAs in HD patients; this effect is associated with a reduced inflammatory state in these patients. The aim of the REDERT study (role of haemodiafiltration on ERI) was to investigate the effect of different dialysis techniques on ERI and HEP levels in chronic dialysis patients. ⋯ In a uraemic patient population with low-grade inflammation treated with HV-OL-HDF, we observed a significant reduction of ERI values as well as HEP levels. The positive correlation between these two parameters supports a role for HEP in the development of ERI in the dialytic population. Moreover, the lower b2MG and the higher Kt/V achieved in HV-OL-HDF confirms the better depurative effect of this technique in comparison with BHD with respect to middle molecules and small-molecular-weight molecules.
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Nephrol. Dial. Transplant. · Mar 2015
Randomized Controlled TrialPrescription of potentially inappropriate medications to elderly hemodialysis patients: prevalence and predictors.
In elderly hemodialysis (HD) patients, the risk of medication-related problems is particularly high. Thus, certain medications should generally not be prescribed to those patients. The Beers criteria for potentially inappropriate medications (PIMs) have been publicized. Still, with regard to elderly HD patients, the prevalence and risk factors for prescription of PIMs are unknown. ⋯ PIMs were prescribed to many elderly HD patients in Japan. Nephrologists should become more aware of PIMs. Multidisciplinary rounds could benefit patients by reducing the prescription of PIMs.
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Nephrol. Dial. Transplant. · Jan 2015
Randomized Controlled Trial Comparative StudyPlasma S100A12 and soluble receptor of advanced glycation end product levels and mortality in chronic kidney disease Stage 5 patients.
Alterations in the advanced glycation end-products (AGE)-receptor of AGE (RAGE) system are linked to several chronic diseases, which may result from vascular damage. A high circulating level of the pro-inflammatory RAGE-ligand S100A12, also known as EN-RAGE, is thought to promote while a high level of soluble RAGE (sRAGE) is thought to protect against development of atherosclerotic cardiovascular disease (CVD). We evaluated circulating S100A12 and sRAGE in relation to clinical characteristics, nutritional status, inflammation and mortality risk in chronic kidney disease (CKD) Stage 5 patients starting on dialysis. ⋯ Plasma concentrations of sRAGE, S100A12 and the ratio S100A12/sRAGE, are markedly elevated in CKD 5 patients starting on dialysis as well as in CKD 3-4 patients and prevalent dialysis patients suggesting that these alterations are typical for patients with moderate or severe CKD. In CKD 5 patients, an increased concentration of S100A12 are associated with inflammation, comorbidities and increased mortality risk whereas no such associations were observed for sRAGE. These results suggest that while high plasma S100A12 is an independent predictor of increased mortality risk, sRAGE does not seem to be a valid risk marker in this patient population.