Recap of eAJKD’s coverage of the NKF 2012 Spring Clinical Meetings

May 15, 2012 By Leave a Comment

Missed anything at this year’s National Kidney Foundation Spring Clinical Meetings? Check out eAJKD’s coverage of the meeting below and @eAJKD on Twitter!

Topic Themes from eAJKD’s coverage:

(*)= video/audio interview

Critical Care Nephrology

Therapeutics in Post Surgical AKI
Biomarkers for AKI after Major Surgery
Epidemiology of Post operative Acute Kidney Injury
Fluids and Vasopressors in Critical Care Nephrology
De Novo Dipstick Proteinuria (DP) as Predictor of Acute Kidney Injury (AKI) in Critically Ill Septic Patients (*)

Transplantation

Outcome of Second Kidney Allograft Transplants vs. Primary Transplant from Paired Donors (*)
Obesity As A Barrier To Living Kidney Donation – A Center Based Analysis (*)

Glomerular Diseases

Updates in Glomerular Diseases – Lupus Nephritis
Miracles in nephrology still happen (also see interview*)
Role of plasma exchange in ANCA-associated vasculitis
Role of cyclophosphamide in ANCA-associated vasculitis
Role of B cell therapy in ANCA-associated vasculitis

Public Policy and Dialysis

Disease Management Program ESRD Patients Have Lower Overall Medical Costs (*)

Use of Talking Control Support Therapy in Chronic Hemodialysis Patients Results in Higher Patient Satisfaction Survey Response and Implementation of a “Getting Better” Health Awareness Patient Education Initiative; Using Talking Control Support Therapy in Chronic Hemodialysis Results in Improved or Stabilized Laboratory Values (*)

Long Term Outcomes with PD: Similar or Inferior to HD
Presidential Address: The person and the policy
Poster Session Winners

Bone Disease

PTH and FGF-23
Clinical Assessment of Bone Mineral Status

Filed Under: NKF 2012 Spring Clinical Meetings Tagged With: , ,

SCM12: Therapeutics in post surgical AKI

May 13, 2012 By 1 Comment

Therapeutics in post-surgical AKI
Jonathan Himmelfarb, MD (University of Washington)

In our last blog for the 2012 NKF meetings, Dr. Himmelfarb gave a fantastic lecture on the therapies available for treating AKI.  In short, there are no FDA-approved drugs to hasten renal recovery.  You could stop reading at this point, but I’d advise that you continue because Dr. Himmelfarb provided some excellent information regarding 1) atrial natriuretic peptide (ANP), and 2) remote ischemic preconditioning.

ANP was first identified in the late 1970′s by Dr. deBold.  He took the hearts of rats, separated the atria and ventricles, ground up both of them, then injected the ground atria into one set of rats, ground ventricles in the other.  He noted that those rats with the atria injected had a brisk and larger natriuresis than the ventricle-injected rats.  Interestingly, and of note to young physician-scientists, his paper was rejected by every journal.  In the end, the paper was published in an obscure journal, Life Sciences, in 1981.  Not discouraged, he continued his research and in 1985, published a paper in Science.  Well, lo-and-behold the original paper in Life Sciences was cited by the 1985 Science paper, and his original article became one of the greatest cited papers in all of medical science (in an obscure journal).

There was much promise and hope with ANP.  Phase 1 and 2 trials were all positive.  Unfortunately, every phase 3 clinical trial has been negative.  Dr. Himmelfarb mentioned one negative trial in particular (NEJM 1997).  Though it showed negative results (i.e., ANP versus placebo showed no difference in dialysis-free survival), the trial was underpowered, had a heterogeneous population, and entered patients late in their disease (eGFRs from 3-12).  Newer studies are small in number but are showing some promise for ANP.  We know need larger powered studies to determine, once and for all, if ANP has a role in treating AKI.

Next is remote ischemic preconditioning (RIP)(Lancet 2009 p. 1557).  This is a very interesting therapy, as it has nothing to do with developing a molecule.  The idea is that the body has its own defense mechanisms against ischemia to keep target-organs safe.  Thus, one should iatrogenically induce ischemia (e.g., a limb), allowing these unknown ischemia-protective molecules to be released into the systemic circulation.  Once this is done, surgery can be scheduled knowing that these protective molecules are in the circulation, protecting vital organs just prior to the surgery.

Remote ischemic preconditioning is under investigation but early data (though underpowered) is showing some promise.

Stay tuned for more info about ANP and RIP

Check out all of eAJKD’s coverage of SCM12 here and on Twitter (@eAJKD)!

Filed Under: NKF 2012 Spring Clinical Meetings Tagged With: , ,

SCM12: Biomarkers for AKI after Major Surgery

May 13, 2012 By 2 Comments

Biomarkers for AKI after Major Surgery
Chirag Parikh, MD PhD (Yale University)

Dr. Parikh has done incredible work in the area of early AKI biomarkers.  In fact, his work has been so influential in the field that he started the TRIBE-AKI Consortium – a group of physician-scientists (and their respective research teams) who are working to identify these early biomarkers.  Creatinine remains the most common biomarker for kidney disease, but has many limitations that can only be overcome by identifying new biomarkers.  For example, creatinine represents glomerular function, which isn’t very useful in AKI where there is much tubular injury that isn’t detected by creatinine.  Creatinine takes 24-48h to increase *after* the initial insult, delaying our ability to detect AKI and intervene appropriately.

Given that the nephron is made from 3 embryologic structures, it isn’t surprising to Dr. Parikh that each segment of the tubule will have a different biomarker for detecting injury.  An example of these biomarkers (of which some you’ve already heard) include IL-18, urinary and plasma NGAL, and KIM-1 (note this is not an exhaustive list).  A recent trial by the TRIBE-AKI consortium looked at 1200 adults and 300 children who developed AKI to identify legitimate, non-creatinine biomarkers.  They found that, in the adults, urine IL-18 and plasma NGAL were accurate markers for early AKI development (ROC AUC 0.74 and 0.70, respectively).  In children, it was urine IL-18 and urine NGAL (ROC AUC 0.74 and 0.67, respectively).

The work continues in identifying these biomarkers.  Stay tuned for more information in the coming months.

Check out all of eAJKD’s coverage of SCM12 here and on Twitter (@eAJKD)!

Filed Under: NKF 2012 Spring Clinical Meetings Tagged With: , ,

SCM12: Epidemiology of Post operative Acute Kidney Injury

May 13, 2012 By 1 Comment

Epidemiology of post-operative AKI
Charuhas Thakar, MD (University of Cincinnati)

Dr. Thakar started of a great session by putting AKI in proper perspective.  A full 1/3 of all hospitalized acute kidney injury (AKI) patients develop AKI in the operative setting (per the BEST data).  Whether the patient is in the MICU or SICU, 80% of AKI patients usually have stage 1 AKI (Thakar C, CCM 2009).  As it turns out, neurosurgical patients have the lowest risk of all surgical patients to develop AKI; Cardiothoracic patients have the most.    The key elements for *recovering* from AKI include: 1) the time of AKI onset, 2) the severity of the AKI (as measured by the peak serum Cr), and 3) the duration of the AKI.  Each of these 3 elements have been shown, in studies, to impact the likelihood of renal recovery.

Dr. Thakar mentioned some of the risk factors for developing AKI.  Asides from the standard risks, such as older age, presence of diabetes and/or hypertension, he also mentioned hyperglycemia, on-pump cardiac bypass, and degree of proteinuria at baseline.

Check out all of eAJKD’s coverage of SCM12 here and on Twitter (@eAJKD)!

Filed Under: NKF 2012 Spring Clinical Meetings Tagged With: , ,

SCM12: eAJKD interview with Dr Javier Neyra

May 13, 2012 By 1 Comment

Dr. Javier Neyra, from Henry Ford Hospital, discusses his poster for the National Kidney Foundation’s 2012 Spring Clinical Meetings (SCM12), De Novo Dipstick Proteinuria (DP) as Predictor of Acute Kidney Injury (AKI) in Critically Ill Septic Patients, with eAJKD’s Dr. Tejas Desai.

Click here for a full list of SCM12 abstracts of poster presentations.

Check out all of eAJKD’s coverage of SCM12 here and on Twitter (@eAJKD)!

Filed Under: NKF 2012 Spring Clinical Meetings Tagged With: , , ,

SCM12: eAJKD interview with Dr S. Jawad Sher

May 13, 2012 By 1 Comment

Dr. S. Jawad Sher, from Indiana University School of Medicine, discusses his poster for the National Kidney Foundation’s 2012 Spring Clinical Meetings (SCM12), Outcome of Second Kidney Allograft Transplants vs. Primary Transplant from Paired Donors, with eAJKD’s Dr. Tejas Desai.

Click here for a full list of SCM12 abstracts of poster presentations.

Check out all of eAJKD’s coverage of SCM12 here and on Twitter (@eAJKD)!

Filed Under: NKF 2012 Spring Clinical Meetings Tagged With: , ,

SCM12: Updates in Glomerular Diseases – Lupus Nephritis

May 13, 2012 By 2 Comments

Updates in Glomerular Diseases – Lupus Nephritis

Gerald Appel, MD (Columbia University)

This was a good review of trials in the last 5-7 years regarding lupus nephritis.  Since no new data was really presented, I’ll just briefly go over the key points of the trials he mentioned.

  • Eurolupus:  a lower dose of cyclophosphamide (CYC) (500 mg q2 weeks for 3 months) was just as effective as the traditional high-dose CYC (based on body surface area) at inducing remission of WHO Class III and IV lupus nephritis (with less side effects)
  • ALMS:  MMF is just as good as CYC in inducing remission in lupus nephritis
  • ALMS II:  MMF just as good as AZA in maintaining remission in lupus nephritis
  • MAINTAIN:  a European trial that showed no difference between AZA and MMF in maintaining remission
  • LUNAR:  when comparing rituximab (RTX) + MMF to MMF alone, there was no significant difference in any renal endpoint and none of the patients developed progressive multifocal leukoencephalopathy (PML) in the RTX arm

New trials are underway looking at belimumab (Benlysta).  It’s the first drug approved for lupus in the last 50 years, but hasn’t been studied in lupus nephritis patients just yet.

 

Check out all of eAJKD’s coverage of SCM12 here and on Twitter (@eAJKD)!


Filed Under: NKF 2012 Spring Clinical Meetings Tagged With: , , ,
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