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Research identifies best treatment for blood pressure in diabetic kidney disease - NephrologyNews.com |
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Blood pressure lowering drugs do not improve life expectancy among adults with diabetes and kidney disease, a new study of the global evidence published in The Lancet reveals.
However, the study, which brings together 157 studies involving more than 43,000 adults with diabetes, shows that angiotensin-converting-enzyme (ACE) inhibitors and angiotensin-receptor blocker (ARB) treatments, alone or in combination, are the most effective drug regimen for preventing end-stage renal disease—an important finding given that diabetes is now the leading cause of people starting dialysis.
This finding is important because until now it has not been known whether any available treatment can protect kidney function in the long term, and combination therapy of an ACE inhibitor and an ARB has been thought to cause harm.
"The findings of our analysis show that differing efficacy of ACEi and ARB alone or in combination has not been proven for mortality and end-stage kidney disease or adverse treatment effects and this is a major challenge for future research," said Senior author, Professor Giovanni Strippoli of the University of Bari, an Adjunct Associate Professor of Epidemiology at the University of Sydney and Chairman of the Diaverum Academy.
While treatments in the new study have been shown to help patients, it also shows that any benefits of treatment need to be balanced against potential side effects. In fact, the study provides a unique opportunity for busy clinicians, who simply cannot read all the literature, to review existing evidence that has been analyzed using the highly innovative technology of network meta-analysis, the researchers said. This measures specifically both the benefits and harms of all available treatments and provides a ranking of the most effective interventions.
"In absolute terms, our findings suggest that giving 1,000 adults with diabetes and kidney disease a combination of an ACE inhibitor and an ARB for one year might prevent 14 patients developing end-stage kidney disease and induce regression of albuminuria in 208, at the cost of 55 patients having acute kidney injury and 135 developing hyperkalemia," says contributing author, Professor Jonathan Craig, a renal physician and professor of clinical epidemiology at the University of Sydney.
In the clinic, this means a careful conversation between doctors and patients, which can be informed by this study.
"The study brings together overwhelming numbers of research studies into one place so they can help doctors and patients make confident treatment decisions," says author Associate Professor Suetonia Palmer, a practicing kidney specialist at the University of Otago Christchurch in New Zealand. "This has been a global team working to convert all the available studies around the world into a single study that can be used by consumers, doctors, and policy makers."
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ADT Therapy for Prostate Cancer Linked to Impaired Thinking - Renal and Urology News |
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May 22, 2015
Men with a particular gene mutation affected most, researchers find.
(HealthDay News) -- Men undergoing androgen-deprivation therapy (ADT) to treat prostate cancer may experience impaired cognitive function within the first 6 months that persists for at least a year, a new study suggests. The report was published online in the Journal of Clinical Oncology.
Brian Gonzalez, Ph.D., of the Moffitt Cancer Center in Tampa, Fla., and colleagues evaluated 58 prostate cancer patients before they began ADT and 6 months and 12 months later. The investigators compared them with 84 men who were treated with prostatectomy and 88 men without prostate cancer.
Impaired cognitive functioning was worse for men receiving ADT. But men with the gene mutation rs1047776 were 14 times more likely to have cognitive issues related to ADT than men without this mutation, Gonzalez told HealthDay.
"Men who are considering hormone therapy for prostate cancer should be aware of the possible mental side effects," Gonzalez said. Gonzalez suspects altering testosterone levels might cause cognitive impairment. But men on ADT also experience fatigue and depression, which might affect their mental abilities, too, he said.
Source
- Gonzalez, BD, et al. Journal of Clinical Oncology, published online before print May 11, 2015; doi: 10.1200/JCO.2014.60.1963.
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Dialysis center educates patients about kidney transplants - Daily Tribune News |
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DaVita Dialysis Center of Cartersville hosted Transplant Education Days on Tuesday and Wednesday to help raise awareness about the options available for those experiencing kidney failure.
The event was created in conjunction with the Southeastern Kidney Council, an organization dedicated to the improvement of the lives of people with end-stage renal disease. Those with ESRD are unable to live without special treatment or a transplant. DaVita Social Worker Jacqueline Hayley said that the purpose of Transplant Education Days was to ensure DaVita’s dialysis patients were well-informed about the possibility of undergoing transplants. Representatives from two transplant centers in Georgia were present to speak with the patients.
“We’re talking to the patients about why transplant may be a good option for them and (we) have the coordinators here on hand to answer any questions they may have about the evaluation process, what happens during transplant and then anything having to do with post-transplant questions,” said Hayley.
According to the National Kidney Foundation, dialysis removes waste, salt and extra water to prevent them from building up in the body, keeps a safe level of certain chemicals in the blood, such as potassium, sodium and bicarbonate and helps to control blood pressure. But the process can be painstaking. Megan Parker, RN, living donor/transplant coordinator at Piedmont Transplant, said patients are exhausted when they leave dialysis and the fatigue makes it difficult for them to live normal lives.
“One of the main reasons why we did (this event) is trying to increase the number of dialysis patients that are referred to transplant...at least just let them know that this is an option and they can come and find out more at the transplant centers, as well.”
That, however, has been a problem--at least in this state.
“Georgia has been identified as being one of the lowest referral rate states,” explained Jane Hardwick-Triplett, RN, transplant outreach coordinator at Emory Transplant Center, “...and as a result, we’re going out more and more and talking to people in the meantime to see if that will help raise the numbers.”
Hayley pointed out that, if a person’s kidneys have failed, the only way for them to stay alive is through dialysis or a transplant. Thus, it comes down to choosing one or the other.
“The only way not to do dialysis treatment is to get a transplant--that’s your only way out of here (DaVita),” she stated. “Unless there’s some kind of miracle and your kidneys regain function, which is not realistic in a lot of cases. Transplant would give them back their quality of life.”
Parker echoed Hayley’s statement, pointing out that there is an ongoing coordinated effort to increase the number of patients living lives as close to normal as possible.
“We all have the same goal in mind, (it’s) to get these patients well and back to a better quality of life through transplant,” she noted.
So how does the donor process work? Well, there are two primary ways someone can receive a kidney from another person: by way of a living donor or a deceased donor. And by all accounts, the living donor is the superior option. On average, a living donor kidney will function five to 10 years longer than one from a deceased donor. In addition, the process of waiting to be matched with a deceased donor kidney often takes much longer. Hayley said that each one of DaVita’s 50 patients came in during the Transplant Education Days and there was an effort made to educate their family members about the donation process, as well.
Though transplant centers want to ensure that donors come forth out of their own free will, a shortage of available donors means that there is always a need for more of them. Next Monday, from 9 a.m. to 2 p.m., Blood Assurance will hold a blood drive at the intersection of Main Street and Tennessee Street in honor of Cartersville Police Chief Tommy Culpepper, who is currently in need of a kidney transplant. Culpepper began dialysis in late 2013 and has been on the transplant list for over a year. Last month marked the beginning of Chief Culpepper’s Search for a Living Kidney Donor, which was created by associates at CPD in an effort to raise awareness about the situation. Culpepper’s case is a reflection of the ongoing demand for donors and the uncertainty with which patients must go about their search for them.
Even when a donor is identified, the process must be undertaken carefully. Both the patient and donor must be evaluated and deemed suitable candidates for transplant.
“We also recognize that the first step is that a patient needs to be evaluated, and so what we’re trying do (at Transplant Education Days) is get them motivated to do that,” stated Hardwick. “And then, at the same time, we try to talk to family members that are here because they could be the potential living donor or they could go out and help spread the word that this patient needs a living donor.”
According to their website, as of March 31, DaVita Kidney Care operated or provided administrative services at 2,197 outpatient dialysis centers located in the United States, serving about 174,000 patients. The company also operated 93 outpatient dialysis centers located in 10 countries outside the U.S. For more information, visit www.davita.com. To learn more about transplants or becoming a donor, go to www.kidney.org/transplantation.
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Smartphone ECG App Identifies Atrial Fibrillation - Renal and Urology News |
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May 22, 2015
Researchers say smartphone apps can work for atrial fibrillation screening.
(HealthDay News) -- Smartphones could help improve detection and management of atrial fibrillation, researchers say. The findings were presented at the annual meeting of the Heart Rhythm Society.
The researchers gave 865 study participants smartphone-enabled electrocardiogram (ECG) sensors. Heart activity was recorded at 30-second intervals and transmitted to a secure cloud-based server.
Over 6 months, the participants transmitted 57,703 ECGs. Atrial fibrillation was detected in 185 recordings and in 11% of the participants.
"Having an ECG device on smartphones is quite incredible because it makes tracking heart health and behavior accessible to almost anyone," lead author Leslie Saxon, M.D., executive director of the University of Southern California Center for Body Computing in Los Angeles, said in a Heart Rhythm Society news release. Not only does this type of smartphone app allow the patient to be more informed, it also gives doctors the ability to access and analyze real-world data, she added. Ultimately, this can "help improve treatment and overall quality of care," she said.
Source
- Heart Rhythm Society, News Release, May 15, 2015
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