July 26, 2019
New KDOQI US Commentary on the 2017 ACC/AHA Hypertension Guideline: The Kidney Disease Outcomes Quality Initiative (KDOQI) commented on the recommendations of the 2017 American College of Cardiology and the American Heart Association (ACC/AHA) Hypertension guidelines, related to individuals at risk of chronic kidney disease (CKD) or with non-dialysis dependent CKD. The KDOQI work group is supportive of a systolic blood pressure (SBP) goal of <130 mmHg for individuals with CKD stages 1-3, with an exception for those with a previous stroke where the SBP goal is modified to <140 mmHg. Any first-line antihypertensive agent (a thiazide, angiotensin-converting enzyme (ACE) inhibitor, angiotensin II receptor blocker (ARB) or calcium channel blocker (CCB)) may be initiated to treat hypertension, but an ACE inhibitor or ARB may be preferable if moderate-to-severe albuminuria is present. Due to lack of evidence, the group provides no comments on the optimal blood pressure management in CKD stage 4-5, but highlights the urgent research need in this area.
May. 10, 2019
Beneficial Cardiorenal Effects of SGLT2 Inhibitors: Type 2 diabetes (T2D) is a significant risk factor for additional health problems, such as chronic kidney disease (CKD) and cardiovascular events. Current guidelines suggest use of an SGLT2 inhibitor or GLP-1 agonist for T2D patients with established atherosclerotic cardiovascular disease (ASCVD) or CKD but do not address cardiorenal outcomes in patients without ASCVD or CKD. Three recent clinical trials provide evidence of cardiorenal benefits of SGLT2 inhibitors in patients with T2D. The two drugs evaluated, canagliflozin and dapagliflozin, prevented and reduced hospitalizations due to heart failure and progressive kidney disease. The studies included patients with and without prior cardiovascular events, as well as varying levels of kidney function, and found no heterogeneity. Together with the known beneficial effects of empagliflozin, this new information indicates that cardiorenal benefits are a class effect of SGLT2 inhibitors.
Jan. 14, 2019
New Evidence Supports Use of High-Dose IV Iron to Treat Anemia in Patients Undergoing Maintenance Hemodialysis: A randomized controlled trial of high-dose vs. low-dose IV iron sucrose in adults with end-stage renal disease on maintenance hemodialysis found that high-dose iron was noninferior to low-dose iron with respect to the primary composite outcomes of myocardial infarction, nonfatal stroke, hospitalization for heart failure, or death from any cause. The median monthly iron dose was 264 mg in the high-dose group and 145 mg in the low-dose group. The cumulative dose of erythropoiesis-stimulating agents (ESAs) was 19.4% lower in the high-dose group. Patients who received high-dose iron required fewer blood transfusions and lower ESA doses to maintain target Hb concentrations, indicating an ESA dose-sparing effect. Although these results are promising, further study is needed to determine optimal iron dosing, generalizability to other iron formulations, and long-term effects of high-dose iron.
May 16, 2018
Anticoagulation in Older Patients with Atrial Fibrillation and Chronic Kidney Disease: A retrospective propensity-matched cohort study in the UK evaluated the safety and effectiveness of anticoagulation for thromboprophylaxis in older patients with chronic kidney disease (CKD) after being diagnosed with atrial fibrillation (AF). Compared to matched controls, patients receiving anticoagulation were more likely to experience ischemic stroke and cerebral or GI hemorrhage but had lower all-cause mortality. Although anticoagulants may improve all-cause mortality in these patients, additional trials are needed to determine the effect of anticoagulation on stroke risk. Anticoagulant use should be based on assessment of individual bleeding and thromboembolic risks and benefits, along with consideration of patient preferences.