NN&I - April 2010
Clinical 16 Nephrology News & Issues April 2010www.nephronline.comNxStage FREEDOM data show daily HHD improves sleep quality, restless legs syndromeNxStage Medical Inc. announced the latest interim results from its ongoing FREEDOM (Following Rehabilitation, Economics and Everyday Dialysis Out-come Measurements) study, which show improvement of overall sleep quality and restless legs syndrome (RLS) experienced by patients after four months of daily home hemodialy -sis therapy with the company's System One dialysis machine. NxStage compared these inter -im results to the Medical Outcomes Study (MOS) Sleep Survey and the International RLS Study Group Rating Scale (IRLS) at baseline and four months. Improvements identified in this planned interim analysis included: Obesity may affect kidneys differently in whites, blacksObese black Americans may be more vulnerable to the effects of chronic kidney disease than obese whites, new findings from the National Kidney Foundation's Kidney Early Evaluation Program show. KEEP has screened more than 140,000 people across the United States at high risk for chronic kidney disease since its launch in 2000. In the new study, Andrew S. Bomback, MD, of Columbia University Medical Center and his colleagues looked at 37,107 obese KEEP participants (52% white, 48% black) to investigate whether there might be ethnic differences in how obesity affected kidney function. The study appears in the March issue of the American Journal of Kidney Diseases. While white Americans were more likely than black Americans to have components of the metabolic syn-drome, black individuals were more likely to show signs of failure in kidney hormone function, Bomback and his team reported. And while the kidneys of obese whites were more likely than those of obese blacks to show severe impair -ment in blood filtering capacity, blacks were more likely than whites to be excreting abnormal amounts of protein in their urine, which is a sign of ongoing kidney damage and increased cardio-vascular risk. The researchers also found that among people with more advanced kidney disease, blacks were more likely than whites to have anemia and exces- sive secretion of parathyroid hormone, which is responsible for regulating lev-els of calcium in the body. Compiled by Rebecca ZumoffOverall sleep quality significantly \037 improved from baseline to month four. Four of the five individual sleep \037 scalessleep adequacy, daytime som-nolence (or "drowsiness"), sleep initia-tion and maintenance, and respiratory disturbancesdisplayed significant improvement. There was a significant reduction in \037 the number of patients reporting RLS at four months compared to baseline. Of those patients who experienced \037 RLS at baseline, 36% no longer experi-enced RLS at month four. "NxStage continues to invest in proving the wide range of clinical and quality of life benefits possible with more frequent hemodialysis," said Jeff Burbank, CEO of NxStage Medical Inc. "These results add to the growing evi-dence supporting daily home hemo -dialysis with our System One versus conventional, thrice-weekly in-center therapy." The ongoing FREEDOM study is the largest study of its kind to measure the clinical and economic benefits of daily home hemodialysis treatment, as com -pared to conventional, thrice-weekly in-center hemodialysis treatment for patients requiring dialysis therapy. All daily home hemodialysis patients in the FREEDOM study use the NxStage System One as their treatment delivery system, and all have Medicare as their primary insurance payer.Fatigue may predict heart attack in ESRDFor dialysis patients, high scores on a new fatigue rating scale predicted an increased risk of heart attack or other cardiovascular events, accord-ing to a study in the March issue of the Clinical Journal of the American Society of Nephrology . Fatigue could be an important warning sign of serious cardiovascular eventsespecially in patients without other obvious risk factors, according to the study led by Hidenori Koyama, MD, PhD, and Yoshiki Nishizawa, MD, PhD of Osaka City University Graduate School of Medicine, Japan. The researchers evaluated results from a questionnaire completed by 788 patients. About 16% had a high fatigue score. At two years' follow up, those with high scores were more than twice as likely to have cardiovascular events. Fatigue was the strongest predictor of cardiovascular risk, even in patients without risk factors such as malnutri -tion, diabetes, and previous CVD. Clinical_NNI0410_3.indd 16 3/18/10 2:20:18 PM
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