Changes in Albuminuria Predict Mortality and Morbidity in Patients with Vascular Disease
Nephrology
Time to Rethink HOS Void Times in T2DM
The study showed that measuring albumin:creatinine ratio from a first-void urine sample is more accurate for predicting progression of kidney disease in type 2 diabetics than are other commonly used measures.
Undiagnosed CKD in Prediabetes
More than 40% of people with undiagnosed diabetes had chronic kidney disease, based on albuminuria or reduced estimated glomerular filtration rate (eGFR) — just as many as in those with diagnosed diabetes, according to Laura C. Plantinga, ScM, of San Francisco General Hospital and University of California San Francisco, and colleagues.
Notably, 56.2% of chronic kidney disease was stage 3 or 4 among those with prediabetes, indicated by a fasting plasma glucose between 100 and 126 mg/dl, and for whom kidney dysfunction was likely unsuspected.
Proteinuria Matters
The risks of mortality, myocardial infarction, and progression to kidney failure associated with a given level of eGFR are independently increased in patients with higher levels of proteinuria.
Byetta – Watch That Kidney Function
From April 2005 to October 2008, FDA received 78 reports of altered kidney function in patients treated with Byetta. Some of the patients had pre-existing kidney disease and other risk factors for developing kidney problems. Acute renal failure occurred in 62 patients and renal insufficiency in 16 patients.
Byetta (exenatide) – Renal Failure Too
Byetta (exenatide) – Renal Failure
From April 2005 through October 2008, FDA received 78 cases of altered kidney function (62 cases of acute renal failure and 16 cases of renal insufficiency), in patients using Byetta. Some cases occurred in patients with pre-existing kidney disease or in patients with one or more risk factors for developing kidney problems.
Oops.Abnormal Calcium = Increased Mortality in Kidney Disease
Note this is an observational study and causality should not be assumed.
Abnormal levels of serum calcium are associated with increased mortality in patients with non-dialysis-dependent chronic kidney disease, an observational study found.
A one mg/dL elevation in baseline calcium levels was associated with a multivariable adjusted hazard ratio for mortality of 1.31 (95% CI 1.13 to 1.53, P<0.001), according to Csaba P. Kovesdy, MD, of the Salem, Va., Veterans Affairs Medical Center, and colleagues.
There also was a significant interaction between elevated baseline calcium level and the presence of cardiovascular disease, which raised the hazard ratio to 1.58 (95% CI 1.29 to 1.94, P<0.001), the researchers reported online in the Clinical Journal of the American Society of Nephrology.
Acute Kidney Injury = Higher Mortality
Lafrance and Miller looked at VA data involving 864,933 U.S. veterans (4.9% female) who survived at least 90 days after a hospital discharge. Of those, 82,711 had acute kidney injury that did not require dialysis.
Through a mean follow-up of 2.34 years, the rate of death was higher in patients with acute kidney injury — 29.8% versus 16.1%.
After adjustment for demographics, comorbidities, medication use, primary diagnosis of admission, length of stay, mechanical ventilation, and postdischarge kidney function (estimated glomerular filtration rate), patients with acute kidney injury were 41% more likely to die during follow-up (HR 1.41, 95% CI 1.39 to 1.43).
The mortality risk increased significantly with greater severity of acute kidney injury (P<0.001 for trend), reaching a hazard ratio of 1.59 (95% CI 1.54 to 1.65) for those with stage III injury.
The risk of dying during follow-up was reduced, but still elevated, in patients with lower baseline kidney function, older patients, and those with diabetes.
Even among patients whose kidney function declined by 10% or less from the baseline assessment — who were considered to have recovered or to have maintained function — acute kidney injury was still associated with significantly higher mortality (HR 1.47, 95% CI 1.43 to 1.51).
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