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HCV increases mortality among patients with CKD - Healio PDF Print

Veterans with chronic kidney disease and hepatitis C virus infection were found to have an increased rate of mortality, risk of lower kidney function and incidence of loss of kidney function vs. veterans without the infection, according to new study data.

“Hepatitis C affects 4 million Americans [and] previous studies have not established unanimously whether hepatitis C is associated with the development and progression of chronic kidney disease,” Csaba P. Kovesdy, MD, director of the Clinical Outcomes and Clinical Trials Program at Memphis VA Medical Center in Tenn., told Healio.com/Hepatology. “[The study] examined the association of hepatitis C infection with mortality, with the development of new onset chronic kidney disease, with end stage renal disease and with the speed of loss of kidney function in over 1 million U.S. veterans. We found that hepatitis C infection was associated with a significantly increased risk of all these end points.”

Csaba P. Kovesdy

Kovesdy and colleagues analyzed data from 100,518 veterans with chronic kidney disease (CKD) positive for HCV and 920,531 US veterans without HCV with normal baseline estimated glomerular filtration rate (eGFR). The incidence of decreased kidney function was defined as an eGFR < 60 mL/min/1.73 m? and a 25% decrease in eGFR.

Using multivariable adjusted models, the researchers found that HCV was associated with a 2.2-fold higher mortality (fully adjusted HR = 2.17; 95% CI, 2.13-2.21), a 15% higher incident rate of decreased kidney function (adjust HR = 1.15; 95% CI, 1.12-1.17), a 22% higher risk of steeper slopes of eGFR (adjusted OR = 1.22; 95% CI, 1.19-1.26) and a 98% higher hazard of end-stage renal disease (ESRD; adjusted HR = 1.98; 95% CI, 1.81-2.16), according to the research.

“The strongest association was with higher mortality and ESRD,” Kovesdy said.

In a competing-risk regression analysis, HCV-positive status was also found to be associated with an increased risk of new-onset eGFR < 60 mL/min/1.73 m? and an increased risk of ESRD. Viremic patients also had a 10% higher risk for new-onset eGFR < 60 mL/min/1.73 m? (HR = 1.1; 95% CI, 1.05-1.16), 62% higher risk for ESRD (HR = 1.62; 95% CI, 1.26-2.07) and a 23% higher risk for deterioration of kidney function (HR = 1.23; 95% CI, 1.14-1.33) compared with patients who were negative for HCV antibody.

“Our results suggest that treatment of hepatitis C may be beneficial in lowering mortality and both in preventing the development of new onset CKD and the progression of established CKD,” Kovesdy said. “The emergence of new therapeutic agents for hepatitis C now offer the potential to treat hepatitis C even in patients with CKD, which makes the results concerning progression of CKD especially interesting. These hypotheses will need to be tested in clinical trials.” – by Melinda Stevens

Disclosures:Molnar and Kovesdy report no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.

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Aultman to open new dialysis center in Navarre - The-review PDF Print

Aultman Hospital is opening a new dialysis center this June. The dialysis center will be located on the Altercare of Navarre for Rehabilitation & Nursing Care Inc. campus. Aultman will celebrate the new dialysis center opening with a community open house from 4-6 p.m. on June 9.

“When health care providers collaborate to meet the community’s needs, it’s a ‘win’ for everyone,” said Aultman Chief Nursing Officer Anne Gunther, DNP, RN, NE-BC. “We invite community members to tour the new facility and learn more about our services.”

The Aultman Dialysis Center of Navarre is located at 517 Park St. in Navarre.

"Altercare of Navarre is grateful that the residents of Navarre and the surrounding communities are now offered a safe and comfortable dialysis experience,” said Eileen D’Alessandris, administrator of Altercare of Navarre. “We support the Aultman Dialysis Center and its service to our patients.”            

Aultman Dialysis Center of Navarre provides patients with a convenient, high-quality dialysis facility by offering in-center hemodialysis. Dialysis is a common treatment method for people with kidney failure, which is also known as end stage renal disease (ESRD). With early detection of underlying causes of ESRD, you may be able to delay the start of dialysis. Ways to be proactive include:

  • Knowing your family’s medical history.
  • Keeping regular medical checkups.
  • Know your kidney numbers.
  • Taking medication prescribed for high blood pressure and diabetes.

The primary causes of renal failure are high blood pressure and diabetes. Individuals who reach stage five chronic kidney disease will need dialysis or a kidney transplant for treatment. For more information about the services available at Aultman Dialysis Center of Navarre or for scheduling availability, please call 330-791-7791.

In addition to the Aultman Dialysis Center of Navarre, Aultman also offers an outpatient dialysis center located at 2912 Tuscarawas St. W. in Canton. Home dialysis units are also available. Call 330-458-0150 to learn more.

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Factors Predicting Non-Diagnostic Renal Mass Biopsies ID'd - Renal and Urology News PDF Print
May 12, 2015 Factors Predicting Non-Diagnostic Renal Mass Biopsies ID'd - Renal and Urology News
When patients with specific tumor-related features were excluded from biopsy, the non-diagnostic rate dropped from 14.7 to 8.7%.

Investigators have identified criteria that predict which renal mass biopsies are likely to be non-diagnostic, according to a recently published report. Excluding patients with these criteria from biopsy decreased the non-diagnostic rate from 14.7% to 8.7%.

These factors include renal masses with cystic features, radiologic enhancement less than 20 HU, small size (less than 4 cm), and a skin-to-tumor distance of 13 cm or greater.

For the study, investigators from the University of Wisconsin School of Medicine and Public Health in Madison reviewed the records and pre-biopsy imaging for 525 patients at their institution who had renal tumors 7 cm or less.

Following biopsy, 14.7% of patients overall and 17.4% of patients with renal masses 4 cm or smaller had non-diagnostic findings, according to results published in The Journal of Urology (2015;193:1899-1904). For those undergoing a repeat biopsy, the rate of non-diagnostic findings was similar at 20.8%. Radiologist or pathologist experience was ruled out as a contributing factor.

“In patients with tumors at a distance of 13 cm or greater from the body surface the rate of non-diagnostic biopsy was 27%, likely reflecting the increased technical difficulty of maneuvering the biopsy needle in deep tissue and the decreased visualization of the needle and tumor when using US guidance for these biopsies,” the authors wrote. 

Tiny tumors, cystic masses with small areas of malignant cells, and lack of radiological enhancement also present targeting challenges. 

Source
  1. Prince, J, et al. The Journal of Urology; doi: 10.1016/j.juro.2014.12.021.

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Controversy over ACP guidelines for kidney stone management PDF Print
Read a letter to the ACP by David Goldfarb, concerning the shortcomings of their kidney stone management guidelines, and comparison with a competing set of guidelines published by the American Urologic Association.

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Back in the saddle: How nocturnal dialysis helped me get my life back - NephrologyNews.com PDF Print

When faced with going on dialysis in the spring of 2006, I was given two options: in-center hemodialysis three times weekly for long periods of time, or daily PD (peritoneal dialysis) which I could do at home, several times a day. And no needles. I hated needles. In the beginning, PD was the easy choice for me.

Richardson I’m a big guy with a physique more like a lumberjack, so my doctor recommended a few extra exchanges to make up for my size. While PD works for many people, the therapy did not bode well with my schedule. I was (and currently am) a full-time teacher with a part-time gig as a ghost tour guide in Savannah, Ga., where I live. On top of that, I was in graduate school getting my masters online in Special Education. Just coming off of a divorce, when I wasn’t working or studying I’d want to head downtown to keep my social life alive. There was not much extra time for dialysis treatment.

After trying out a few dialysis clinics in Savannah for my treatment, I finally ended up at a new center in 2008. Whenever I discussed my lifestyle and treatment with my nephrologist, he would urge me to seriously consider home nocturnal hemodialysis. He explained the benefits of being treated overnight, and how helpful it could be for my busy schedule.

But I couldn’t get past self-cannulation and my fear of needles.

Who wants to be different?

I didn’t want to accept that living with dialysis meant I needed to live differently than the average guy. I would tell myself I was fine, that I was not sick. But, what I really needed to do was take time to make my treatment a priority.

By 2010, PD was no longer an effective treatment for me. I could barely make it through my 40-hour work week at school. Eventually, I had to give up my passion of tour guiding, and if I wasn’t at work or completing coursework online for my masters, I was alone watching reruns of Scrubs,a TV show.

I looked horrible. I shuffled when I walked. My phosphorous level was through the roof. Every meal made me nauseous and sick, and I lost over 60 pounds.

I no longer felt like the Robby I used to be, and I hid my kidney disease from the world. I started giving up on living my life the way I wanted to live it. Thankfully, the doctors and nurses at my center never gave up on me.

After many discussions, I made the switch over to home hemodialysis. In the fall of 2010, I had the surgery for my fistula and began the Center’s training program to perform hemodialysis at home.

With the help of my team at the dialysis center, I found the training program for nocturnal dialysis at home to be comprehensive and easy to follow. My fear of needles was tough, but they guided me through it. After completing training, I started home treatments on a small portable hemodialysis machine, the NxStage System One. After two weeks of performing more frequent home hemodialysis therapy, I started to feel better both physically and emotionally. I was finally accepting the Robby I not only wanted to be, but the Robby that I needed to be.

Getting Robby back

Richardson I eventually found that frequent home nocturnal hemodialysis (6x a week for me) fit better into my busy schedule because I was being treated while I was sleeping, in my own bed. The shuffling went away and that ol’ Robby strut I was always teased about slowly came back. I had more energy to get back out into the world and start living again. I started dating and even ended up meeting the love of my life.

It’s hard to describe dialysis unless you’ve gone through it, but this is the best analogy I’ve ever heard. For me it’s like a three way light. The lowest setting, where it’s dim, is what PD felt like. For me, the middle setting is just like home hemodialysis; it’s bright but I could tell it could be even better. My home nocturnal hemodialysis therapy is like the highest setting for me; I can see everything clearly and I feel great.

I completed my master’s degree, I still teach Special Education in high school, and just over a year ago started tour guiding again, building up my own company. I married the best wife I could ever ask for who has blessed me with two wonderful stepchildren. And we laugh. A lot. Almost as much as we love.

I don’t hide my treatments from the world anymore. While I don’t feel a need to broadcast my condition, I do not feel any shame about who I am now. I no longer feel alone.

Everyone in my family knows that at about seven o’clock each night I go into my room and begin setting up to perform my home nocturnal therapy. About the time my cycler is primed and my needles are in, my son, Jude, has had his shower and he joins me as we watch reruns of The Big Bang Theory together. It’s our routine. It’s my lifestyle now.

Oh, I still hate needles. But I love feeling good, so it’s more than a fair trade off.

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