Plasma exchange in the pediatric population

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Therapeutic plasma exchange (TPE) is performed in a wide range of hematologic, neurologic, rheumatologic, renal and conditions related to organ transplantation. However, indications and outcomes are still mostly based on adult studies and evidence-based data are still lacking for the pediatric population which can also benefit from this procedure in specific circumstances. Research by Guntulu et al. provides a thorough overview of the indications, techniques, complications, and outcomes of 135 pediatric patients treated with TPE. In this large case series sepsis with multiorgan dysfunction syndrome and hematological disorders were the leading indications, citrate was the anticoagulant in most cases and procedure-related complication rate was only 16.3%, and mostly related to vascular access.

Read the article https://onlinelibrary.wiley.com/doi/abs/10.1111/1744-9987.13474?af=R

New hope for patients with primary hyperoxaluria type 1

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Lumasiran is an investigational RNAi therapeutic that inhibits oxalate production by targeting hydroxyacid oxidase 1, which depletes glycolate oxidase. The latest results from the phase 3 ILLUMINATE-A trial suggest that lumasiran effectively reduces urinary oxalate excretion at 6 months in patients with type 1 primary hyperoxaluria. Furthermore, it was well tolerated and was not associated with any serious or severe adverse events. Lumasiran is administered subcutaneously at monthly intervals for 3 months, followed by quarterly maintenance doses. Full study results are expected to be presented by the end of March 2020.

Read more https://clinicaltrials.gov/ct2/show/NCT03681184

Valsartan combined with vitamin D more efficiently reduces moderate proteinuria in IgA nephropathy

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IgA nephropathy is a leading causes of chronic renal disease and end stage renal disease (ESRD). The risk of progression to ESRD is associated with the level of proteinuria, thus underlining the importance of adequate proteinuria control. A prospective, single-center, randomized controlled study followed patients with IgA nephropathy and moderate proteinuria of 1.0–3.0 g/24 h receiving valsartan, either alone or combined with calcitriol. While both groups achieved a significant decrease in proteinuria, the change was more prominent in the combination group. The incidence of adverse effects was similar, and no significant change in blood pressure, estimated glomerular filtration rate, serum calcium or serum potassium was observed.

Read the article

Results from the PDOPPS on peritoneal dialysis related infection are available

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Peritonitis is still a major concern for peritoneal dialysis (PD) patients and caregivers. The latest Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) reports the results from an observational prospective cohort investigation of 7,051 adult PD patients from seven countries. The crude peritonitis rate was 0.28 episodes per patient-year, ranging from 0.26 in the United States to 0.40 in Thailand. The microbiology patterns were similar across countries, except in Thailand, where Gram-negative infections and culture-negative peritonitis were more common. Lower peritonitis risk was observed in facilities where PD training duration lasted for six or more days, there was a higher rate of automated PD use and where antibiotics were used at the time of catheter insertion or topical exit-site antibiotic ointment was utilized.

Read more https://www.sciencedirect.com/science/article/pii/S0272638619311059

A new approach to the treatment of uremic itch

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Uremic pruritus remains an important issue in haemodiaysis patients. It has a high prevalence and is often associated with poor sleep quality, psychological disturbances, risk of infections and even death. Several interventions have been attempted with limited success thus far. Difelikefalin, a peripherally restricted and selective agonist of kappa opioid receptors might be a promising new treatment option for this condition. The results of a double-blind, placebo-controlled, phase 3 trial of the effects of difelikefalin published recently in the New England Journal of Medicine showed a significant reduction in itch intensity and improvement in the itch-related quality of life in the experimental compared to the placebo group.

Read more https://www.nejm.org/doi/full/10.1056/NEJMoa1912770

New GlomCon/ERA-EDTA Webinar on “microRNA: From Physiology to Disease – Applications in Nephrology”!

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The new GlomCon/ERA-EDTA roundtable discussion is scheduled today, January 14,2020 at 4 pm CET, 5 pm GMT and 8 am PST. Dr Anastasiia Rind will discuss on “microRNA: From Physiology to Disease – Applications in Nephrology” with Dr Kate Stevens and Dr Laura Denby.

Number of people in need of renal replacement therapy is rising

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The 2017 Annual Report of the ERA-EDTA Registry reveals that only a small fraction of patients accepted for renal replacement therapy are able to start this treatment with the best available therapy, which is transplantation, and that the number of people who are in need of renal replacement therapy is rising. This poses a major challenge to our health systems, therefore everything should be done to fight this trend, e.g. by strengthening prevention.

Read the complete press release here

Read the Registry Report here

Exercise as ERBP guideline topic

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This year, European Renal Best Practice (ERBP), the official guideline body of ERA-EDTA, launched its first open call to explore, understand and evaluate topics that are essential to our most important stakeholders. The submitted topics were critically appraised using a validated methodology for Priority Determination of Topics and the ERBP Advisory Board is pleased to announce that it will include the following topic on ERBP’s future work plan: Benefits and harms of exercise training in people with chronic kidney disease. ERBP is looking forward to starting work on this guideline and hopes you will be available to contribute in a later stage, particularly in the external review phase. Visit our website for more information on ERBP or contact us at guidelines@era-edta.org.

NDT Digest on CKD of undetermined aetiology

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CKD of undetermined aetiology leads to premature loss of life at an unprecedented scale in agricultural communities in low- and middle-income countries. Such a burden of disease is unlikely to have been neglected for so long had it been occurring in high-income settings. As the cause remains unclear, only methodologically robust studies, conducted in partnership with affected communities and local investigators, will provide data on the geographical distribution, insights into pathogenesis and a scientific basis for urgently needed preventative interventions.

Read more here

Effects of a novel medium cut-off dialyser on haemodialysis patients

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Novel medium cut-off (MCO) membrane or ‘expanded haemodialysis’ provides diffusive removal of conventional and large middle molecular weight uraemic toxins, with marginal albumin leak.

Despite significant advances in haemodialysis (HD) in recent decades, current dialysis techniques are limited by inadequate removal of uraemic solutes such as middle molecules and protein-bound uraemic toxins. Novel medium cut-off (MCO) membrane or ‘expanded haemodialysis’ (HDx) provides diffusive removal of conventional and large middle molecular weight uraemic toxins, with marginal albumin leak.

Find out more here