Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
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Nephrol. Dial. Transplant. · Jun 2009
Multicenter StudyOutcomes of critically ill patients with acute kidney injury and end-stage renal disease requiring renal replacement therapy: a case-control study.
This study aimed to evaluate and compare the characteristics and outcomes of patients with end-stage renal disease (ESRD) with those of matched controls of patients with acute kidney injury (AKI) requiring renal replacement therapy. ⋯ ESRD patients with life-threatening complications had significantly better outcome than AKI patients.
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Nephrol. Dial. Transplant. · Jun 2009
Estimation of glomerular filtration rate: does haemoglobin discriminate between ageing and true CKD?
The aim of this study was to analyse the association between chronic kidney disease (CKD) defined by an estimated glomerular filtration rate (eGFR) <60 ml/min/ 1.73 m(2) and anaemia in older people. ⋯ An eGFR <60 ml/min/1.73 m(2) is very common in older people. Only an eGFR <45 ml/min/1.73 m(2) identified a smaller sub-group of older people with an increased prevalence of significant anaemia suggesting a clinically relevant disease. The benefits of identifying older people with an eGFR > or =45 ml/min/1.73 m(2) need to be determined.
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Nephrol. Dial. Transplant. · Jun 2009
Increased indoleamine 2,3-dioxygenase (IDO) activity and elevated serum levels of tryptophan catabolites in patients with chronic kidney disease: a possible link between chronic inflammation and uraemic symptoms.
Tryptophan (Trp) is catabolized by indoleamine 2,3-dioxygenase (IDO). Changes in Trp metabolism and IDO activity in chronic kidney disease (CKD) have not been widely studied, and the impact of haemodialysis is uncertain. Here we investigate Trp catabolism, IDO activity and the role of inflammation in moderate to very severe CKD and haemodialysis. ⋯ IDO activity and serum levels of tryptophan catabolites of the kynurenine pathway increase with CKD severity. In CKD, induction of IDO may primarily be a consequence of chronic inflammation.
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Nephrol. Dial. Transplant. · May 2009
Randomized Controlled TrialAliskiren Trial in Type 2 Diabetes Using Cardio-Renal Endpoints (ALTITUDE): rationale and study design.
Patients with type 2 diabetes are at increased risk of macro- and microvascular disease, and the presence of albuminuria and/or reduced kidney function further enhances macrovascular risk. Angiotensin-converting-enzyme inhibitors reduce both macro- and microvascular events, yet the residual renal and cardiovascular risk still remains high. Aliskiren a novel oral direct renin inhibitor that unlike ACEi and ARBs, lowers plasma renin activity, angiotensin I and angiotensin II levels, may thereby provide greater benefit compared to ACEi or ARB alone. ⋯ ALTITUDE will determine whether dual RAAS blockade with the direct renin inhibitor aliskiren in combination with an ACEi or ARB will reduce major morbidity and mortality in a broad range of high-risk patients with type 2 diabetes.
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Nephrol. Dial. Transplant. · May 2009
Hypokalaemia: an independent risk factor of Enterobacteriaceae peritonitis in CAPD patients.
Hypokalaemia is a relatively common complication in uraemic patients undergoing continuous ambulatory peritoneal dialysis (CAPD). The hazards of hypokalaemia are multiple and have been correlated with patient morbidity and mortality. Whether it is associated with increased risk of peritonitis remains to be addressed. ⋯ CAPD patients with hypokalaemia are associated with a higher prevalence of peritonitis and poor nutritional status. Enterobacteriaceae were the predominant organisms causing peritonitis in the group with hypokalaemia. This unique and novel finding implies the translocation of these organisms from intestinal mucosa into the peritoneal cavity. A pathogenic mechanism linking malnutrition and hypokalaemia is also proposed.