Editor’s Note: We asked authors of Original Investigations to provide short plain-language summaries that would briefly summarize what inspired their study, the basic approach taken, what was learned, and why it matters. We hope our readers will find this valuable in helping them keep up with the latest research in the field of nephrology. From the April 2020 issue:
From the authors: Though regularly-scheduled blood sampling is a routine part of the surveillance provided to maintenance hemodialysis recipients, there is little evidence to guide the frequency of such assessments. In this population-wide retrospective cohort study comparing patients who received more frequent (monthly) assessments versus less frequent assessments (every 6 weeks), more frequent testing did not show evidence of a survival advantage, a reduction in cardiovascular events or hospitalizations. Our data demonstrate the potential safety of widening the interval between routine blood testing in hemodialysis recipients, a practice which could have a favorable impact on resource consumption and utilization.
Editorial: Routine Monthly Blood Draws in Hemodialysis: Where Is the Evidence? by Eduardo Lacson Jr. and Klemens B. Meyer [FREE]
A Novel Inside-out Access Approach for Hemodialysis Catheter Placement in Patients With Thoracic Central Venous Occlusion by Roman Reindl-Schwaighofer et al
From the authors: Left-sided internal jugular and all subclavian central venous catheters are associated with an increased risk of occluded central veins (TCVO). These occlusions often lead to diminished vascular access options and lengthy and risky interventions to restore them.
We obtained right-sided jugular vascular accesses successfully and quickly in 97% of attempts among 36 patients using “inside-out access” (IOA) approach and observed no complications. Implementing this procedure involves passing a novel device from the right femoral vein to and through the thoracic venous blockage, thereby creating a channel to pass a central venous catheter that can be used for hemodialysis. The IOA approach makes it possible to gain dialysis access consistently in patients with central venous occlusions. Additional experience is needed to understand the generalizability of these observations.
Editorial: Endovascular Bypass for Thoracic Vein Occlusion: An Innovative Technique for Hemodialysis Vascular Access by Tushar J. Vachharajani et al [FREE]
From the authors: Patients with end-stage kidney disease have low levels of physical activity, which correspond to lower functional status and quality of life and may increase cardiovascular risk. Prior studies have focused on moderate or vigorous exercise to improve functioning and other outcomes, but many patients on dialysis are unable to participate in such interventions. We hypothesized that lower intensity interventions might be beneficial and more feasible. We conducted a pilot trial of a pedometer-based intervention to increase walking. Patients assigned to the intervention increased their average daily step counts compared to those in the control group. Heart rate variability (a surrogate measure of cardiac risk) improved among patients assigned to the intervention. However, improvements were not sustained after the intervention ended.
This month’s In Practice:
Proton pump inhibitors (PPIs) are abundantly prescribed, rarely deprescribed, and frequently purchased over the counter. They are frequently used without medical indication, and when medically indicated, they are often used for much longer than needed. This review summarizes evidence linking PPI use with adverse events in general and adverse kidney outcomes in particular.
Blog post: “Doc, I heard on the news that this heartburn medicine is bad for my kidneys. What should I do?” by Timothy Yau [FREE]
On the Cover: Home to St. Louis Cathedral, the oldest continually-operating cathedral in the United States, and Canal Street, once the widest street in the world, historic Crescent City will host this year’s NKF Spring Clinical Meetings from March 25-29, 2020. Join nephrologists, pharmacists, nurse practitioners, dieticians, social workers, allied health professionals, medical trainees, and others in this multidisciplinary conference with presentations spanning the spectrum of clinical nephrology and clinical research focused on improving the care of patients with kidney disease. Don’t forget to stroll through the Garden District, listen to live jazz on Frenchmen street, and sample Cajun and Creole cuisine in the French Quarter in between some exciting sessions. Stop by the NKF booth for a complimentary copy of the journal with abstracts from the meeting.
The photograph “Miltenberger House” is by David Ohmer on Flickr, released under a CC BY 2.0 license.