1,721,007 research outputs found
Effects of the dose of erythropoiesis stimulating agents on cardiovascular events, quality of life, and health-related costs in hemodialysis patients: the clinical evaluation of the dose of erythropoietins (C.E.DOSE).
No full textAn "evidence-based" survey of therapeutic options for IgA nephropathy: assessment and criticism
No full textHemoglobin targets for the anemia of chronic kidney disease: a meta-analysis of randomized, controlled trials
No full textAnemia affects almost all patients with chronic kidney disease (CKD), reduces quality of life, and is a risk factor for early death. Higher hemoglobin (Hb) targets have been widely advocated because of data from observational studies showing that higher Hb is associated with improved survival and quality of life, but higher Hb targets may cause access thrombosis and hypertension and are costly. This study aimed to evaluate the benefits and harms of different Hb targets in CKDonthe basis of randomized trial evidence. A comprehensive search of the Cochrane Trials Registry, Medline, Embase, and reference lists was performed. Two independent reviewers assessed studies for inclusion criteria and extracted data on all-cause mortality, cardiovascular disease, strokes, hypertension, seizures, hyperkalemia, access thrombosis, and quality of life.
Phosphate binders for preventing and treating Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD)
No full textCalcimimetics, phosphate binders, vitamin D and its analogues for treating secondary hyperparathyroidism in chronic kidney disease: guideline from the Italian Society of Nephrology.
No full textHaemoglobin and haematocrit targets for the anaemia of chronic renal disease (Cochrane Review)
No full textEvidence-based guidelines and nephrological clinical practice: the GRADE system for rating of evidence
No full textChorea in hemodialysis: Is chorea just a neurological syndrome or is it related to uremia or dialysis?
No full textA novel simpler histological classification for renal survival in IgA nephropathy: a retrospective study
No full textBackground: Patients with immunoglobulin A (IgA) nephropathy may progress to end-stage renal
disease (ESRD) within 10 to 20 years after renal biopsy. We evaluated factors associated with long-term
renal survival by using a novel simplified histological classification.
Study Design: Retrospective study.
Setting & Participants: 437 patients (296 men, 141 women) with IgA nephropathy seen at our single
center from January 1971 to December 2006. Most patients received treatment with renin-angiotensin
system inhibitors.
Predictors: Baseline age, sex, presence of hematuria, presence of hypertension, serum creatinine
level, urine protein at baseline, and 2 histological classifications.
Outcomes & Measurements: Relationship of baseline factors to time to ESRD was evaluated by
means of univariate and multivariate analysis with log-rank test and the Cox proportional hazard
method.
Results: In a mean follow-up of 107.6 months, 72 ESRD events occurred. The 5-, 10-, 15-, and 20-year
renal survival rates after renal biopsy were 94.1%, 82.1%, 73.1%, and 60.3%, respectively. Independent
baseline predictors of increased ESRD risk were microhematuria with absence of recurrent macrohematuria
(adjusted hazard ratio [HR], 2.18; 95% confidence interval [CI], 1.30 to 3.65; P 0.003), 1.0 mg/dL (88.4
mol/L) higher serum creatinine level (HR, 1.50; 95% CI, 1.10 to 2.07; P 0.013), proteinuria with 1.0 g/dL
(10.0 g/L) greater protein (HR, 1.28; 95% CI, 1.07 to 1.52; P 0.006), and grading of histological lesions. A
1-grade increase according to our 3-grade classification was associated with a nearly 6-fold ESRD risk
increase (adjusted HR, 5.95; 95% CI, 3.54 to 10.01; P0.0001).
Limitations: Lack of adjustment for changes in treatment that may have occurred during the study
period.
Conclusions: Renal damage progression in patients with IgA nephropathy was associated with
microscopic hematuria at clinical onset, increased serum creatinine level, increased proteinuria, and
grading of histological lesions. Our classification system appears simpler than other classifications and
is associated with ESRD risk, which could help identify individual high-risk patients and stratify patients
enrolled in randomized clinical trials into homogeneous groups
Predictors of bleeding complications in percutaneous ultrasound-guided renal biopsy
No full textBACKGROUND:
The risks associated with performing a percutaneous renal biopsy have substantially decreased in the past two decades because of technical advances in the method. However, bleeding complications still occur, resulting in increased hospital stay and treatment costs.
METHODS:
We investigated the predictive value of demographics (age, gender), clinical data (blood pressure), baseline chemistry (hemoglobin/hematocrit, prothrombin time, partial thromboplastin time, bleeding time, serum creatinine, daily proteinuria), and needle size for the risk of major (need for blood transfusion, nephrectomy, or angiography) or minor (no need for any intervention) postrenal biopsy bleeding complications. This was a prospective cohort study of 471 patients who underwent ultrasound-guided biopsy of native kidney by automated needle in a single center; all biopsies were performed by two experienced nephrologists. Patients with transplant kidneys were excluded from the study. Predictors of postbiopsy bleeding were assessed by multiple linear and multivariate logistic regression analysis. Data are presented as unadjusted (OR) and adjusted odds ratios (AOR) with 95% confidence intervals (CI).
RESULTS:
The study cohort consisted of 471 (277 males, 194 females) patients. Of these, 161 (34.1%) experienced postbiopsy bleeding [157 (33.3%) hematomas, 2 (0.4%) gross hematuria, 2 (0.4%) arteriovenous fistula]. Major complications were seen in 6 (1.2%) patients (blood transfusion, N= 2; angiography, N= 3; nephrectomy, N= 1), but no deaths occurred. The risk of postbiopsy bleeding was higher in women (39.7% women, 30.3% men, AOR 2.05, 95% CI 1.26 to 3.31, P= 0.004), younger subjects (35.0 +/- 14.5 years vs. 40.3 + 15.4, AOR 0.80, CI 0.68 to 0.94, P= 0.006), and patients with higher baseline partial thromboplastin time (102.7 + 11.8% vs. 100.1 + 10.0%, AOR 1.26, CI 1.02 to 1.54, P= 0.032). These findings were independent of size of hematoma.
CONCLUSION:
Although the methods for performing a percutaneous renal biopsy have improved in the past two decades, renal biopsy is still not a risk-free procedure. Of the data routinely collected for potential predictors of postbiopsy bleeding complications, only gender, age, and baseline partial thromboplastin time show a significant predictive value. The other variables investigated do not have any predictive value
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