Happy World Kidney Day

Dallas Cowboy TE Supporting World Kidney Day

With his Truly Blessed Foundation, Martellus Bennett (tight end for the Dallas Cowboys) will support World Kidney Day tomorrow by supporting initiatives that raise awareness regarding diabetes and the role it plays in chronic kidney disease.

Bennett lost a loved one in 2009 to diabetes and a grandmother was recently diagnosed with the disease.

Bennett, along with his brother, Michael, who plays for Tampa Bay, and his father Michael Sr., is urging the public to take advantage of the free kidney health screenings that will take place at Dallas City Hall on Thursday.

"I am honored to stand with my sons in support of an initiative that potentially could mobilize hundreds, thousands or hundreds of thousands of people to become proactive - get the facts - and take charge of their kidney health and overall well-being. Many people afflicted with diabetes and/or kidney disease may have lacked the resources or the awareness to prevent the progression of their illnesses," Michael Bennett, Sr., President of Truly Blessed Foundation, said in a press release. "It is my solemn hope that through this effort that provides free health screenings to any member of the community willing to partake, that number will diminish tremendously. I'm hopeful."

Are We Overly Concerned About NSF in CKD Patients?

Over the past decade or so, the concern about nephrogenic systemic fibrosis (NSF) has blossomed. NSF is no doubt a devastating condition, but are we just a little too concerned about NSF? NSF has been reported in patients who have severe renal impairment and have been exposed to a gadolinium (Gd)-based contrast agent during magnetic resonance imaging (MRI). Accordingly, many patients with CKD who could benefit by this imaging modality have been turned away for fear of NSF.

A recent study in the Clinical Journal of the American Society of Nephrology has taken another look at the safety of Gd-MRI in patients with CKD and varying levels of estimated GFR (eGFR).

The study was retrospective analysis of 2053 unselected patients from the United Kingdom who had CKD and had received Gd-MRI between 1999 and 2009, so as to determine the risk for NSF related to level of CKD, nature of Gd preparation, and Gd dosage.

Results: Overall, 2053 patients (63.5% men; mean age 60.6 ± 15.7 years) had 2278 Gd-MRI scans; their mean eGFR was 40.7 ± 23.7 ml/min. A total of 918 (44.7%) patients had stage 3, 491 (23.9%) had stage 4, and 117 (5.7%) had predialysis stage 5 CKD. No cases of NSF were identified during an average follow-up period of 28.6 ± 18.2 months.

Conclusions: In this study, no patients developed NSF during extended follow-up, even after multiple Gd doses in some. Gd-MRI can be safely undertaken in the majority of patients with CKD, but caution is merited for dialysis patients and those with acute kidney injury, with relative caution for predialysis patients with stage 5 CKD.

This is one study from the UK with limitations. But, I tend to agree that perhaps we have gone from not recognizing this devastating affliction... to now becoming a little overly concerned about NSF. Perhaps we should consider softening restrictions to Gd-MRIs which in many centers are not being allowed in any patient with a CrCl < 30 ml/min due to the fear of NSF.

New NephSAP released: Hypertension

For those of you paying attention I will not reiterate my feelings for NephSAP. Well, maybe just a few words... while I think the content is great, I can't make it through the first 5 minutes of any of these podcasts. I have since given up trying. Although, I may attempt to use the podcast to help my teething baby boy get some sleep....

Nevertheless, for those for you interested... the new NephSAP is available: Volume 9, Number 2 - Hypertension .... enjoy!

ARB Use in Children for Proteinuria

So, how do we treat children with proteinuric renal disease? Angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy? Maybe... but where is the data? Until now, no large, randomized, double-blind trials in children with proteinuria treated with ACE inhibitors or ARBs have previously been reported. Enter a new study published in the latest issue of the Clinical Journal of the American Society of Nephrology.

This study lasted 12-week, it was a double-blind, multinational study that investigated the effects of losartan 0.7 to 1.4 mg/kg per day compared with placebo (normotensive stratum) or amlodipine 0.1 to 0.2 mg/kg per day up to 5 mg/d (hypertensive stratum) on proteinuria (morning-void urinary protein-creatinine ratio, baseline ≥0.3 g/g) in 306 children up to 17 years of age. At twelve weeks of treatment with losartan significantly reduced proteinuria compared with amlodipine/placebo: losartan –35.8% (95% confidence interval: –27.6% to –43.1%) versus amlodipine/placebo 1.4% (95% confidence interval: –10.3% to 14.5%), P ≤ 0.001.  Adverse event incidence was low and comparable in all groups.

Conclusions: Losartan significantly lowered proteinuria and was well tolerated after 12 weeks in children aged 1 to 17 years with proteinuria with or without hypertension, a population that has not previously been rigorously studied.

Urinary Netrin: New Marker for AKI?

Despite all the new and novel ways we discover to diagnose acute kidney injury (AKI) early, nothing has been able to unseat the good 'ol serum creatinine measurement. Aside from the expense of newer markers, there is the laboratory or turn around time issue as well as the question of clinical relevence. Nevertheless, there is a new marker on the block, Netrin-1.

Netrin-1 is a laminin-related axon guidance molecule that is highly induced and excreted in the urine after AKI in animals. A new study in the Clinical Journal of the American Society of Nephrology set to determined the utility of urinary netrin-1 levels to predict AKI in humans undergoing cardiopulmonary bypass (CPB).

The results suggest that netrin-1 is an early, predictive biomarker of AKI after CPB and may allow for the reliable early diagnosis and prognosis of AKI after CPB, before the rise in serum creatinine. Whether this is clinically relevant or will be commercially available is unclear. It is uncertain how this information should materially change the typical post operative ATN patient course or what the health care provider could do differently by obtaining this information. Can they link the early finding of an elevated netrin levels in the urine and a change in the clinical course of a typical post-op ATN? Until then, I will stick to the good old fashioned serum creatinine.

Can Pycnogenol Counteract Kidney Damage and Improve Hypertension?

What is PYCNOGENOL?

A natural plant extract from the bark of the maritime pine tree which grows exclusively along the coast of southwest France in Les Landes de Gascogne. The extract has four basic properties – it’s a powerful antioxidant, acts as a natural anti-inflammatory, selectively binds to collagen and elastin, and finally, it aids in the production of endothelial nitric oxide which helps to dilate blood vessels.
 

Could it be helpful for kidney protection? 

Maybe... A study was recently published in the Journal of Cardiovascular Pharmacology and Therapeutics reveals some data that is starting to build the case for pycnogenol as a renoprotective agent.

The randomized, controlled study conducted by the G D’Annunzio University in Italy investigated 55 hypertensive patients who showed early signs of impaired kidney function, as judged by elevated amounts of proteins found in their urine. There were two groups, one group was given Ramipril, the other group was given Ramipril plus Pycnogenol. The group taking Pycnogenol as an adjunct to Ramipril had a decrease in proteinuria of nearly double compared with anti-hypertensive medication taken alone.

The study also found a statistically significant decrease in patients’ blood pressure when taking Pycnogenol in conjunction with Ramipril. When treated exclusively with Ramipril, systolic blood pressure values dropped by more than 30 percent and diastolic blood pressure values dropped approximately 8 percent. The addition of Pycnogenol decreased both systolic and diastolic pressures by an additional 3 percent to 6 percent. Pycnogenol also was found to lower the patients’ elevated levels of inflammatory marker CRP, a blood protein associated with the risk for acute cardiovascular events such as heart attack, reducing values to a healthy level.

This is obviously a very small study from Italy that needs to be replicated on a much bigger scale. The optimal dose, drug interactions and side effect profile of this supplement is also unclear. Nevertheless, it is worthy of consideration.

Kidney Foundation of Canada

The American Kidney Fund Video

athenahealth and Falcon Launch Integrated Web-Based EHR and Practice Management for Nephrology

DENVER—DaVita Inc. and athenahealth Inc. announced a partnership to deliver an integrated, Web-based electronic health record (EHR) and revenue cycle management service to nephrologists across the country.

"The seamless integration of Falcon EHR and athenaCollector offers a dynamic turnkey solution that enables nephrologists to focus their time, expense, and resources on the most important matters—delivering superior patient care and clinical outcomes," said Anthony Gabriel, Chief Information Officer of DaVita.

The athenaCollector service is a patented knowledge-base of payer reimbursement process rules known as athenaRules, which acts as a proactive utility that is continually updated based on the interactions and experiences of the more than 22,000 medical providers using the system.

When new claim denial trends are encountered, the rules are refreshed and the information is made available to all clients on the network. This enables the system to produce cleaner and more accurate claims with every instance of use.

Falcon EHR helps nephrology practices streamline the workflow of the entire office staff, prevent gaps in communication and response times, and support individual physician preferences for documentation.