NN&I - July 2010
Clinical 18 Nephrology News & Issues July 2010Subscribe to our free eNewsletter at www.nephronline.com Compiled by Rebecca ZumoffKidney function and damage markers predict overall mortality risk'Cardiac biomarker' indicates fluid overloadCommon tests of kidney function and damage predict the risk of death from cardiovascular diseases and all causes, according to a paper from the Chronic Kidney Disease Prognosis Consortium, established last year by the National Kidney Foundation's Kidney Disease: Improving Global Outcomes. This analysis of 21 studies, with more than 1.2 million study partici-pants from 14 countries, found that checking the creatinine clearance rate and looking for proteinuria (albumin) to determine kidney damage were strongly related to mortality risk. The results were published in the May 17 issue of The Lancet . "The risk of mortality was elevated by nearly 50% at 30 mg/g albumin to creatinine ratio, which is the threshold for defining chronic kidney disease," said Kunihiro Matsushita, MD, PhD, lead author of the study and a post -doctoral fellow with the Johns Hopkins Bloomberg School of Public Health's Department of Epidemiology. "In addi-tion, mortality risk increased more than four-fold at high levels of albu-minuria compared to an optimal level of 5 mg/g." Lowering sodium intake might be best way to manage hypertension in dialysis patients Strategy may help translate research findings about BP treatment into clinical practiceReducing fluid build-up in the blood is a more effective approach to hyper -tension in dialysis patients than using medications, according to an analy-sis in the June issue of the Clinical Journal of the American Society of Nephrology. Researchers from Indiana University School of Medicine and University of Maryland Medical Center analyzed available information in medical litera-ture related to dry weight and its use in achieving blood pressure control. They found that dry weight can be assessed inexpensively through rela- tive plasma volume and bioimpedance analysis. They also discovered that restricting salt intake could make it easier for patients to get down to a proper dry weight. Studies suggest that salt restriction and dry-weight reduc-tion through dialysis provide more ben-efits to the heart than antihypertensive medications. According to the study authors, this is an effective but forgot-ten strategy in controlling and main-taining blood pressure control among hypertensive patients on dialysis. A biomarker in dialysis patients commonly called the "cardiac biomarker" because it is considered useful in predicting an increased risk of cardiovascular events and death in patients with kidney disease, works better at indicating fluid overload, according to a study published online in the May 27 issue of the Clinical Journal of the American Society of Nephrology. The researchers measured the biomark-er, NT-proBNP, levels after a dialysis ses-sion in 72 stable dialysis patients. The patients also underwent tests of heart function. Levels of NT-proBNP were ini-tially high, but decreased after dialysis. Indicators of fluid overload also decreased after dialysis. "Our study did not show any sustained association between NT-proBNP and car -diac function," Davenport said. The results contrast with previous studies that sug-gested that NT-proBNP might be a use-ful biomarker to predict increased risk of cardiovascular events in kidney disease patients. An association with NT-proBNP and heart dysfunction was found in those who had a history of hypertension and were taking beta blockers. High levels might also indicate malnutrition, the authors said. A clinical trial and associated clinical guidelinesthe Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)both emphasized the prescription of medications called thiazide-type diuretics to reduce blood pressure. As part of a joint dissemination project, 147 investigator-educators were trained to present ALLHAT results and the JNC7 guidelines as the foundation for achiev-ing blood pressure control. Between 2004 and 2007, these investigator-educators made presentations to small, selected groups of practitioners who prescribe medi-cations for hypertension, eventually reaching 18,524 physicians in 1,698 venues. Physician survey data showed that the percentage of hypertension visits where the physician recorded a thiazide-type diuretic increased the most in counties where academic detailing activity was the highest. Clinical_NNI0710_4.indd 18 6/16/10 1:37:46 PM
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