Direct-acting antiviral agents improve kidney survival in hepatitis C virus-associated cryoglobulinemia

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Up to 50% of patients with hepatitis C virus (HCV) infection have elevated cryoglobulin levels, but only 2-3% develop vasculiticsymptoms of HCV-related mixed cryoglobulinemia (HCV-MC). The recently introduced direct antiviral agents (DAA) have yielded high rates of sustainable viral response in chronic HCV infection, even in chronic kidney disease patients. The RENALCRYOGLOBULINEMIC observational multicentre cohort study aimed to evaluate kidney survival and mortality in CKD patients with HCV-MC treated with DAAs. The recently published results indicate that DAA treatment significantly reduced overall mortality and improved kidney survival compared to historical controls treated with interferon and ribavirin and untreated patients.

Read more at: https://academic.oup.com/ckj/advance-article/doi/10.1093/ckj/sfz178/5716107

 

 

New GlomCon/ERA-EDTA Webinar on “Trends in Excess Mortality in European Adult Patients on Renal Replacement Therapy”!

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The new GlomCon/ERA-EDTA roundtable discussion is scheduled tomorrow, February 14, 2020 at 5 pm CET, 4 pm GMT and 8 am PST. Dr Rianne Boenink will discuss on “Trends in Excess Mortality in European Adult Patients on Renal Replacement Therapy”. The moderator will be Dr Sokratis Stoumpos and the panelists will be Prof Kitty J. Jager (ERA-EDTA Registry Managing Director), Dr Samira Bell, Prof J. Patrik Finne and Prof Leonid Pravoverov.

Click here to join the webinar. ID: 422122779

Did you miss the CTDay2019? View the webcast!

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The webcast of the CTDay (Clinical Transplantation Day), held on November 29,2019 in Barcelona (Spain), is available on the ERA-EDTA website. The access to the webcast is for healthcare professionals only.

View the webcast https://www.era-online.org/en/virtual-meeting/#!resourcegroups/event_ids=253&page=1

The newest recommendations from the Pediatric Renal Nutrition Taskforce

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Both malnutrition and obesity are important problems in children with chronic kidney disease (CKD). The latest recommendations from the Pediatric Renal Nutrition Taskforce wererecently published to help guide nutritional recommendations for children with CKD stages 2–5 and those on dialysis. They emphasize the importance of breastfeeding or feeding with breastmilk for infants with CKD. The suggested protein intake should be at the upper end of the standard daily intake in CKD stages 2-5, and even higher in dialysis patients to compensate for dialysate protein loss. In overweight or obese children, energy intake should be adjusted to achieve a healthy weight, without compromising nutrition.

Read the full recommendations at: https://link.springer.com/article/10.1007%2Fs00467-019-04426-0

Soluble urokinase-type plasminogen activator receptor levels are independent of primary cause of idiopathic nephritic syndrome

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Serum levels of soluble urokinase-type plasminogen activator receptor (suPAR) are increased in inflammation and have been associated with endothelial dysfunction and cardiovascular risk. Patients with nephrotic syndrome (NS) show signs of endothelial dysfunction and so suPAR levels were evaluated in 152 patients with idopathic NS due to minimal change disease, focal segmental glomerulosclerosis or membranous nephropathy. Results showed that circulating levels of suPAR are independent of the primary renal disease and are significantly associated with age, glomerular filtration rate and levels of various endothelial markers (i.e. VWF, syndecan-1 and VCAM-1). Further studies should elucidate the potential role of suPAR as a biomarker of vascular disease in patients with NS.

Read more at: https://academic.oup.com/ckj/advance-article/doi/10.1093/ckj/sfz173/5709132

 

Results from the 2012-18 DOPPS in the Gulf Cooperation Council countries now available

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The newest results from the prospective cohort Dialysis Outcomes and Practice Patterns Study (DOPPS) in the Gulf Cooperation Council (GCC) describe Kt/V achievement, its predictors and its relationship with mortality. The analysis included 1544 patients aged ≥18 years dialyzed for at least 180 days in Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. A relatively large proportion of patients had Kt/V<1.2 (34%, range 10% to 54%), which was associated with larger body weight and height, male sex, shorter treatment time, lower blood flow rate, greater comorbidity burden and using HD versus hemodiafiltration. Low Kt/V was strongly related to higher mortality in women, but not in men.

Read more at: https://academic.oup.com/ckj/advance-article/doi/10.1093/ckj/sfz195/5714102

What should a nephrologist know about surgical assessment of potential renal transplant recipients?

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Pre-emptive transplantation is the optimum renal replacement therapy in terms of increasing life expectancy, improving quality of life and achieving the highest cost-effectiveness. Planning for the procedure requires an understanding of the following technical preconditions for successful transplant surgery: arterial and venous factors, urinary drainage, organ and recipient factors. Vasculature should be carefully evaluated in clinically significant peripheral vascular disease to identify the optimal implantation site. Venous stenosis and venous abnormalities should be carefully considered. Urological investigations should include ultrasound, urodynamics, cystoscopy, and some patients will require active surgical management, ranging from intermittent catheterization to a conduit, bladder augmentation or cutaneous ureterostomy. There are ongoing trials evaluating ex vivo machine perfusion viability and risk assessment based on pre-implantation graft histology.

Read more at: https://academic.oup.com/ndt/advance-article/doi/10.1093/ndt/gfz253/5699248

Clinical considerations and strategies for treating hypertension in CKD patients

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Hypertension is both a major cause and consequence of chronic kidney disease (CKD). It is associated with increased risk of cardiac events, stroke and kidney disease progression. The latest National Kidney Foundation Clinical Practice Guidelines recommend a blood pressure goal of <130mmHg systolic and <80mmHg diastolic for all CKD patients, regardless of the level of albuminuria. Several non-pharmacological interventions are recommended to achieve this, including weight loss, salt intake restriction and physical activity. As for pharmacological treatment, a combination of renin-angiotensin system (RAS) blocker (either ACE inhibitor or ARB, in case of ACE inhibitor intolerance) with a calcium channel blocker or a diuretic is recommended as initial therapy in patients with CKD stage 3 or higher. A combination of two RAS blockers is not recommended

Read the article https://academic.oup.com/ndt/advance-article/doi/10.1093/ndt/gfz279/5700448

Vitamin K supplementation protects kidneys and heart

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Vitamin K naturally occurs as type 1, which predominantly activates hepatic, i.e. coagulation-relevant vitamin K-dependent proteins (VKDPs), and type 2, activating the extra-hepatic VKDPs, including the Matrix gla protein (MGP) and osteocalcin. The latter VKDPs seem to be involved in the prevention of ectopic mineralization, thus contributing to cardiovascular disease prevention. Patients with chronic kidney disease (CKD) commonly experience sub-clinical vitamin K deficiency, characterized by low levels of circulating vitamin K and high levels of inactive VKDPs, which is further aggravated by the use of vitamin K antagonists (VKA). The latest NDT Digest article reports on the promising protective and therapeutic potential of vitamin K supplementation in CKD patients.

Read more https://academic.oup.com/ndt/advance-article/doi/10.1093/ndt/gfz291/5704440

The EQUAL study reports an association between kidney function decline and symptom development

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Patients with advanced chronic kidney disease (CKD) suffer from a wide range of symptoms influencing their quality of life, morbidity and mortality rates. In order to provide better insight into the association between kidney function decline and symptom development in elderly patients with advanced CKD (eGFR ≤20mL/min/1.73m2) a prospective European Quality study on treatment in advanced CKD (EQUAL study) was undertaken, involving over 1000 patients from six European countries. Although there was no association between the initial level of kidney function and symptom development, each mL/min/1.73m2 of annual kidney function decline was associated with an increase in the number of symptoms and overall symptom severity. These results may prove very valuable in decision-making for dialysis initiation.

Read more https://academic.oup.com/ndt/advance-article-abstract/doi/10.1093/ndt/gfz277/5704439