Nephrology
Cohort Study: Increased fracture risk linked with initiation of antihypertensive medication in older veterans
26 Apr, 2024 | 12:29h | UTCStudy Design and Population:
This retrospective cohort study evaluated the association between antihypertensive medication initiation and fracture risk among older long-term care nursing home residents within the Veterans Health Administration. Conducted from 2006 to 2019 with data analysis spanning 2021 to 2023, the study utilized target trial emulation techniques and included 29,648 residents. A 1:4 propensity score-matched method was employed to compare medication initiators with non-initiators.
Main Findings:
Out of the matched cohort of 64,710 residents, those who initiated antihypertensive medication showed a higher incidence of fractures (5.4 per 100 person-years) compared to controls (2.2 per 100 person-years). The adjusted hazard ratio for fractures was 2.42. Notably, higher risks were observed in subgroups with dementia or elevated blood pressure thresholds (systolic ≥140 mm Hg or diastolic ≥80 mm Hg). Risks for severe falls and syncope were also elevated in the medication-initiating group.
Implications for Practice:
The study indicates a significant association between the initiation of antihypertensive medications and increased fracture risks among older, frail nursing home residents. Given these findings, clinicians should exercise caution and consider enhanced monitoring and preventive strategies when prescribing these medications to this vulnerable population.
Reference (link to abstract – $ for full-text):
Dave, C. V. et al. (2024). Antihypertensive Medication and Fracture Risk in Older Veterans Health Administration Nursing Home Residents. JAMA Intern Med, Published online April 22, 2024. DOI:10.1001/jamainternmed.2024.0507.
Cohort Study: The impact of rare kidney diseases on kidney failure and survival rates in the UK’s RaDaR cohort
22 Mar, 2024 | 11:29h | UTCStudy Design and Population: This cohort study utilized data from the UK National Registry of Rare Kidney Diseases (RaDaR), encompassing 27,285 participants aged 0-96 years with 28 types of rare kidney diseases, recruited from 108 renal care facilities across the UK. The primary outcomes assessed were the cumulative incidence of mortality and kidney failure, compared with those of a general population with chronic kidney disease (CKD).
Main Findings: Over a median follow-up of 9.6 years, participants with rare kidney diseases exhibited a significantly higher 5-year cumulative incidence of kidney failure (28%) compared to the broader UK CKD population (1%, p<0.0001). However, they also showed better survival rates, with a standardized mortality ratio of 0.42. There was considerable variability in median ages at kidney failure and death, time from dialysis start to death, and time from diagnosis to reaching specific eGFR thresholds among different rare diseases.
Implications for Practice: This study highlights the distinct trajectory of rare kidney diseases compared to more common forms of CKD, with higher rates of kidney failure but improved survival outcomes. These findings emphasize the over-representation of patients with rare kidney diseases in kidney replacement therapy cohorts and underscore the urgent need for targeted therapeutic interventions. Addressing this unmet need could significantly reduce the demand for long-term kidney replacement therapy, benefiting patients and easing healthcare system burdens.
Reference
Wong K, Pitcher D, Braddon F, Downward L, Steenkamp R, Annear N, et al. (2024). Effects of rare kidney diseases on kidney failure: a longitudinal analysis of the UK National Registry of Rare Kidney Diseases (RaDaR) cohort. The Lancet, 395(10223), P1234-P1245. DOI: https://doi.org/10.1016/S0140-6736(23)02843-X. Access the study here: Link
RCT: Quadruple quarter-dose hypertension medication versus monotherapy for ambulatory blood pressure control
20 Mar, 2024 | 18:00h | UTCStudy Design and Population: This randomized clinical trial investigated the efficacy of a combination of four ultra-low-dose blood pressure medications (quadpill) compared to standard monotherapy in adults with hypertension. A total of 591 participants, either untreated or currently on monotherapy for hypertension, were enrolled and randomly assigned to receive either the quadpill (irbesartan 37.5 mg, amlodipine 1.25 mg, indapamide 0.625 mg, and bisoprolol 2.5 mg) or a monotherapy control (irbesartan 150 mg).
Main Findings: At 12 weeks, the quadpill group demonstrated significantly lower mean 24-hour ambulatory systolic and diastolic blood pressure (SBP and DBP) by 7.7 mmHg and 5.3 mmHg, respectively, compared to the monotherapy group, with similar reductions observed during daytime and night-time. Additionally, the rate of blood pressure control (24-hour average BP < 130/80 mmHg) was significantly higher in the quadpill group (77% vs. 50%). The study highlighted the quadpill’s effectiveness in reducing blood pressure variability and enhancing control rates across a 24-hour period.
Implications for Practice: The findings from this study support the superior efficacy of an ultra-low-dose quadruple medication strategy over monotherapy in managing ambulatory blood pressure among hypertensive patients. These results suggest that a quadpill approach could offer a more effective means for clinicians to achieve and maintain blood pressure control in hypertensive patients, potentially improving cardiovascular outcomes.
Reference: Janis M Nolde et al. (2024). Ambulatory blood pressure after 12 weeks of quadruple combination of quarter doses of blood pressure medication vs. standard medication. J Hypertens, 2024 Feb 29. DOI: 10.1097/HJH.0000000000003683. Access the study here: [Link]
Review | Cardiorenal syndrome in the hospital
7 Aug, 2023 | 14:36h | UTCCardiorenal Syndrome in the Hospital – Clinical Journal of the American Society of Nephrology
Commentary on Twitter
The cardiorenal syndrome refers to a group of complex, bidirectional pathophysiological pathways involving dysfunction in both the heart and kidney. This Review focuses on the cardiorenal syndrome encountered in the hospital setting https://t.co/f05vpOPzCx pic.twitter.com/4Is5A2F1km
— CJASN (@CJASN) July 31, 2023
Review | Primary aldosteronism: a pragmatic approach to diagnosis and management
4 Aug, 2023 | 12:06h | UTCPrimary Aldosteronism: A Pragmatic Approach to Diagnosis and Management – Mayo Clinic Proceedings
KDIGO Conference | Managing the symptom burden associated with maintenance dialysis
4 Aug, 2023 | 12:02h | UTCNews Release: KDIGO Announces Publication of “Managing the Symptom Burden Associated with Maintenance Dialysis”
Commentary on Twitter
KDIGO is pleased to announce the publication of “Managing the Symptom Burden Associated with Maintenance Dialysis” in @Kidney_Int. The Conference Report is based on the KDIGO Symptom-Based Complications in Dialysis Controversies Conference in May 2022.
Read the News Release:… pic.twitter.com/AZKW9TPgxj
— KDIGO (@goKDIGO) August 1, 2023
M-A | Uncertain benefits of blood purification techniques in severe infection or sepsis
4 Aug, 2023 | 11:41h | UTC
International Study | Postoperative acute kidney injury affects one in five patients after major surgery
1 Aug, 2023 | 14:23h | UTC
Commentary on Twitter
? EPIS #AKI, epidemiology of major surgery associated acute kidney injury
➡️ > 10K pts, 1/5 develop PO-AKI: significant burden for health care worldwide!
⬆️ increasing severity of PO-AKI associated with progressive increase in adverse outcomes#FOAMcc
?️ https://t.co/Ps7N7zoMKP pic.twitter.com/gcxkve9OKV— Intensive Care Medicine (@yourICM) July 30, 2023
Novel therapeutics for management of lupus nephritis: what is next?
1 Aug, 2023 | 14:22h | UTCNovel Therapeutics for Management of Lupus Nephritis: What Is Next? – Kidney Medicine
Review | Revisiting resistant hypertension
1 Aug, 2023 | 14:16h | UTCRevisiting resistant hypertension: a comprehensive review – Internal Medicine Journal
Related: Resistant hypertension: A stepwise approach – Cleveland Clinic Journal of Medicine
Podcast: #390 Resistant Hypertension – The Curbsiders
Review | Updates on infectious and other complications in peritoneal dialysis
26 Jul, 2023 | 13:23h | UTCUpdates on Infectious and Other Complications in Peritoneal Dialysis: Core Curriculum 2023 – American Journal of Kidney Diseases (free for a limited period)
Related: ISPD Catheter-related Infection Recommendations: 2023 Update – Peritoneal Dialysis International
Commentary on Twitter
Updates on Infectious and Other Complications in Peritoneal Dialysis: Core Curriculum 2023 by Sana F. Khan, MD. https://t.co/DtYjfG79Yw (FREE) pic.twitter.com/lDeZcN3DJO
— AJKD (@AJKDonline) July 24, 2023
Cohort Study | Proton pump inhibitor use linked to increased fatigue in kidney transplant recipients
26 Jul, 2023 | 13:21h | UTC
Commentary on Twitter
Proton Pump Inhibitor Use, Fatigue, and Health-Related Quality of Life in Kidney Transplant Recipients: Results From the TransplantLines Biobank and Cohort Study https://t.co/DkDTvs9zjo #OpenAccess#VisualAbstract @umcg pic.twitter.com/XooY16qFVT
— AJKD (@AJKDonline) July 25, 2023
M-A | P2Y12 monotherapy after 1-3 months DAPT safely reduces bleeding in PCI patients with CAD and CKD
26 Jul, 2023 | 13:18h | UTCRelated:
De-escalation or abbreviation of dual antiplatelet therapy in acute coronary syndromes and percutaneous coronary intervention: a Consensus Statement from an international expert panel on coronary thrombosis – Nature Reviews Cardiology (if the link is paywalled, try this one)
Long-term Effects of P2Y12 Inhibitor Monotherapy After Percutaneous Coronary Intervention: 3-Year Follow-up of the SMART-CHOICE Randomized Clinical Trial – JAMA Cardiology (link to abstract – $ for full-text)
M-A | Early initiation of renal replacement therapy fails to improve survival rates in AKI patients
25 Jul, 2023 | 13:46h | UTC
Systematic Review | Insufficient evidence for ACEi/ARB’s impact on early non-diabetic CKD
24 Jul, 2023 | 12:56h | UTC
Podcast | Hematuria pearls
19 Jul, 2023 | 14:19h | UTC#404 Hematuria with Dr. Derek Fine – The Curbsiders
RCT | Midodrine show promise as an alternative to albumin for the prevention of circulatory disturbance in paracentesis between 3 and 5 L
18 Jul, 2023 | 13:47h | UTC
M-A | First-line thiazide diuretics show reduced cardiovascular events, comparable mortality vs. other antihypertensive drugs
14 Jul, 2023 | 12:55h | UTC
AHA Statement | Indications, evaluation, and outcomes for dual heart-kidney and heart-liver transplantation
14 Jul, 2023 | 12:51h | UTC
Cohort Study | No significant difference in kidney risks between lithium and valproate therapies, but high lithium levels remain a concern
14 Jul, 2023 | 12:46h | UTC
RCT| Exercise during hemodialysis improves physical function in chronic kidney failure patients
13 Jul, 2023 | 13:01h | UTCExercise during Hemodialysis in Patients with Chronic Kidney Failure – NEJM Evidence
Retrospective Analysis | 18% of ICU patients develop sepsis-associated AKI, mostly stage 1, diagnosed by low urine output
12 Jul, 2023 | 13:39h | UTC
Commentary on Twitter
Fulminant myocarditis in #ICU
?short/long‑term prognosis
?clinical suspicion, initial recognition, differential diagnoses
?initial management & temporary #MCS: IABP #ECMO #Impella
?endomyocardial biopsy
?immunomodulatory therapies
?#FOAMcc @yourICM
?️https://t.co/JIGm4p0tv5 pic.twitter.com/o4RctuurEL— Intensive Care Medicine (@yourICM) July 11, 2023
Podcast | Untangling catheter associated UTIs
10 Jul, 2023 | 13:21h | UTC#402 Don’t Get Caught with a CAUTI – The Curbsiders
Review | Cardiovascular outcomes in patients with diabetes and kidney disease
7 Jul, 2023 | 16:13h | UTC
2023 ESH Guidelines for the management of arterial hypertension
3 Jul, 2023 | 14:34h | UTC