Friday, November 29, 2013

Increased AKI Admissions in England May Be Tied to ACEI and ARA Prescriptions

A new PLOS ONE analysis suggests that more than 1600 AKI admissions might have been avoided in England in 2010 and 2011 if prescribing rates of ACE inhibitors (ACE-Is) and angiotensin-receptor antagonists (ARAs) were at the 2007 to 2008 level, equivalent to 14.8% of the total increase in AKI admissions. Crude AKI admission rates showed a 51.6% increase, and national annual ACE-I/ARA prescribing rates increased by 15.8%. The increase in prescriptions seen in a typical practice corresponded to an increase in admissions of approximately 5.1%.

Blacks Have Lower Levels of Total 25-Hydroxyvitamin D and Vitamin D–Binding Protein than Whites

In the 2085-participant Healthy Aging in Neighborhoods of Diversity across the Life Span cohort, average levels of both total 25-hydroxyvitamin D and vitamin D–binding protein (which keeps vitamin D from being used right away) were lower in blacks than in whites, leading to similar concentrations of bioavailable vitamin D overall. The NEJMfindings suggest that a low level of total 25-hydroxyvitamin D does not necessarily indicate a need to replace vitamin D. Racial differences in common genetic polymorphisms explained 79.4% and 9.9% of the variation in vitamin D–binding protein and total 25-hydroxyvitamin D levels, respectively.

ACE Inhibitors Cut Mortality in Renal Patients


ACE Inhibitors Cut Mortality in Renal Patients

Published: Nov 21, 2013


Chronic kidney disease patients who did not depend on dialysis were significantly less likely to die during the study period if they received angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), researchers found.

Among older patients with nondialysis chronic kidney disease who had never taken ACE inhibitors and AR blockers, administration of either agent was associated with a 19% lower hazard of death (95% CI 0.78-0.84, P<0.001) in an intention-to-treat analysis, according toCsaba Kovesdy, MD, of the Memphis Veterans Affairs Medical Center in Tennessee, and colleagues.

Subgroup analysis also showed that the association with lower risk of mortality was significant across all subgroups, they wrote online in the Journal of the American College of Cardiology.

Recent research has shown that dual treatment with ARBs and ACE inhibitors has been associated with acute kidney injury and hyperkalemia when compared with monotherapy, and that increased prescription rates for either drug class has been tied to increased risks for renal injuries. However, links between ARBs and myocardial infarction have been dispelled.

The authors conducted an analysis of mortality risk with use of ARBs and ACE inhibitors in a population of 40,494 U.S. veterans with chronic kidney disease that did not require dialysis and who had no prior exposure to treatment with either drug class.

They noted that prior research has been inconclusive, and that much of it has been "limited to patients with certain comorbid characteristics."

Participants' glomerular filtration rate (GFR) was estimated through measurement of serum creatinine and demographic characteristics based on the Chronic Kidney Disease Epidemiology Collaboration equation. This was used to establish the presence of chronic kidney disease, which they defined as a stable estimated GFR of less than 60 mL/min/1.73 m2 or a stable GFR of 60 or more mL/min/1.73 m2 and elevated urinary microalbumin.

Researchers recorded whether participants received ACE inhibitors or ARBs within 1 year after entering the cohort (n=20,247) or if they were untreated during the study (n=20,247).

Patient demographic information was available through the Veterans Affairs Corporate Data Warehouse, which included age, sex, race, and blood pressure, the latter of which was gathered from October 2004 to October 2009. Patients' comorbidities were recorded in the Veterans Affairs Inpatient and Outpatient Medical SAS Datasets, and included coronary artery disease, angina, myocardial infarction, percutaneous coronary intervention receipt, and receipt of coronary artery bypass grafting.

All-cause mortality was reported through a Veterans Affairs registry of death dates or date of last medical or administrative encounter.

Associations between drug treatment and risk for mortality were measured in intention-to-treat and as-treated models, the latter of which allowed patients "to switch treatment groups in time-dependent analyses according to actual subsequent exposure status."

Patients were analyzed in subgroups categorized by sociodemographic characteristics, presence or absence of comorbid conditions, and laboratory and blood pressure variables.

Participants had a mean baseline age of 74.8; 89% were white, 8% were black. Roughly one quarter had diabetes (22%) and they had a mean eGFR of 50 mL/min/1.73 m2.

Patients who received drug treatment were younger, more likely to be black, and were more likely to have diabetes, hypertension, congestive heart failure, and cardiovascular disease. They also had a higher eGFR.

Over a median 4.7 years of follow-up, there were 5,028 deaths in the treatment group versus 6,450 deaths in the untreated group. Most patients received their medication more than half of the time during follow-up (66%), though only 8.4% received their medication 100% of the time during follow-up.

In the as-treated analysis, receipt of ACE inhibitor or ARB was associated with a 63% reduced odds of mortality (95% 0.34-0.41).

The authors noted that uncertainty about the effects of these drugs in non-dialysis dependent patients with chronic kidney disease "stems from the paucity of clinical trials with a mortality end-point in this patient population," such as those with renal end points or with the exclusion of patients with moderate or advanced disease.

Potential mechanisms of effect for this relationship may include decrease of severity of left ventricular hypertrophy, dilation, remodeling, and heart failure with treatment, as well as renoprotection offered by the drugs.

They noted that these data may not generalize to patients outside of the Veterans Affairs system. Their study was also limited by lack of data on end stage renal disease or hospitalizations, lack of data on cause of death, absent information on smoking status, and lack of comparison or measurement of effects of other antihypertensive agents.

The study was supported by the Department of Veterans Affairs.

The authors declared that they had no conflicts of interest

Kidney Impairment Linked with Increased Risk for Postoperative Abdominal Surgery Complications

Any degree of preoperative kidney impairment was linked with increases in 30-day postoperative morbidity and mortality following major abdominal surgery in a recent analysis of 24,572 patients. Compared with patients with normal preoperative kidney function, patients with modest CKD (GFR of 45 to 60 mL/min/1.73 m²) were 1.62 times more likely to die after surgery. Patients with GFR between 30 and 45 mL/min/1.73 m² were 2.84 times more likely to die postsurgery, and those with GFR between 15 and 30 mL/min/1.73 m² were 5.56 times more likely to die. TheJournal of Gastrointestinal Surgery study also found CKD was associated with increased postoperative complications. 

Amgen’s new class of cholesterol drug cuts LDL by 52 percent, study says.

Reuters (11/20, Berkrot, Pierson) reports Amgen Inc.’s experimental heart medicine belonging to a new class of drugs caused a decline in bad LDL cholesterol by 52 percent, without any major jump in serious side effects, after one year. The medicine, evolocumab, belongs to a class of drugs called PCSK9 inhibitors. The side effects were compared with those caused by drugs generally used to treat cholesterol such as statins, reports Reuters. Study results were presented Tuesday at the American Heart Association meeting in Dallas.

Aspirin before bed may reduce morning heart attack, stroke risk.

USA Today (11/19, Hellmich, 5.82M) reports that according to a study presented a Tuesday’s AHA meeting, “taking the aspirin before bed may reduce the chance of having a heart attack or stroke in the morning.” Study author Tobias Bonten of the Leiden University Medical Center in the Netherlands explained, “Platelet activity is highest in the morning, and that is also the time that most heart attacks and strokes occur, so if you reduce platelet activity during the morning hours, you might reduce heart attacks and stroke at that time.”

        The New York Times (11/19, 9.61M) reports in its “Well” blog that Bonten said, “I think in most Western countries, people take aspirin in the morning. It’s already one of our most effective medications. But maybe we can improve it a little bit more by switching the time.”

        Also reporting this story are HealthDay (11/20, 5K), the Daily Telegraph (UK) (11/20, Gray, 3.22M), and the Daily Mail (UK) (11/20, 2.92M).

Dopamine or Nesiritide Does Not Improve Kidney Function in Acute Heart Failure Patients

In 360 hospitalized acute heart failure patients with kidney dysfunction, neither low-dose dopamine nor low-dose nesiritide (recombinant B-type natriuretic peptide) enhanced decongestion or improved renal function when added to diuretic therapy. The JAMA findings come from the multicenter, double-blind, placebo-controlled Renal Optimization Strategies Evaluation (ROSE) trial. Guidelines for acute heart failure management state that use of low-dose dopamine to improve diuresis and preserve renal function during diuretic therapy may be considered, but the ROSE trial findings do not provide support for this strategy in patients with renal dysfunction who are at risk for inadequate decongestion and worsening renal function. 

New Method Rapidly Detects Blood Infections

A new simple and inexpensive method can identify microorganisms in the blood in less than 20 minutes. The method combines a selective lysis step in which blood cells in the sample are destroyed, a centrifugation step to collect any bacteria or fungi in the sample, and a fluorescence step that analyzes the particular fingerprint of any pathogens present in the sample. Tests show the method correctly identifies the species of bacteria or fungi in 96.5 % of positive blood culture samples. The advance, which is described in an mBio article, could help doctors make life-saving decisions for infected patients.

Stenting Does Not Improve Outcomes for Patients with Narrowed Renal Arteries

In a new study, renal-artery stenting did not confer significant benefits with respect to preventing clinical events when added to comprehensive, multifactorial medical therapy in people with atherosclerotic renal-artery stenosis and hypertension or chronic kidney disease. The NEJM results pertain to The CORAL (Cardiovascular Outcomes in Renal Atherosclerotic Lesions) study, which involved 947 participants at more than 100 sites in various countries. Participants were randomly assigned to medical therapy plus renal-artery stenting or medical therapy alone, with a median follow-up of 3.6 years. During follow-up, there was a consistent modest difference in systolic blood pressure favoring the stent group. 

Friday, November 15, 2013

Physical Activity Affects Cardiovascular Risks in Patients with Type 2 Diabetes

In a study of 15,462 type 2 diabetics who were followed for 5 years, those in the low physical activity group (never exercising or exercising once or twice a week for 30 minutes) had a 25% greater risk of coronary and cardiovascular events than those in the high activity group (exercising three or more times a week), and a 69% greater risk of a fatal cardiovascular event. Individuals with both baseline and final low physical activity levels had a 68% higher risk of coronary and cardiovascular disease and death than all others in the European Journal of Preventive Cardiology study.

Initiating Dialysis After Conception, Not Before, May Improve Birth Rates

Among all pregnancies reported to the Australian and New Zealand Dialysis and Transplantation Registry from 2001 to 2011, women who conceived before starting dialysis had a better live birth rate than women who conceived after starting dialysis (91% vs. 63%), but their infants were of similar birth weight and gestational age. In both groups, babies were likely to be premature and of low birthweight. According to the CJASN study, more than 40% of pregnancies reached beyond 34 weeks, extreme prematurity occurred in 11.4% of pregnancies, and almost all babies who were born survived beyond 28 days after birth.

Thursday, November 14, 2013

New Guidelines Published for Preventing Cardiovascular Disease

Four new guidelines released by the American College of Cardiology and American Heart Association address cardiovascular disease prevention. They include a new equation for estimating a patient’s risk of having an atherosclerotic cardiovascular disease event in the next 10 years, as well as methods to identify appropriate preventive therapies for individual patients. The guidelines state that statins have the strongest evidence of a favorable risk-benefit ratio. A new risk equation can be used to determine whether patients with diabetes and elevated LDL cholesterol levels should receive high-intensity or moderate-intensity statin therapies. The guidelines also address lifestyle and obesity/overweight management.

Wednesday, November 13, 2013

New guidelines may lead to higher statin use.

New guidelines that could lead to higher statin use among US adults were discussed on all three of last night’s national news broadcasts, where they received a total of eight minutes of coverage. The guidelines also garnered extensive coverage in print, with stories featured on the front pages of at least four major US papers, and online. Many sources portray the guidelines as a major shift in the treatment of high cholesterol. Some of the sources also characterize the guidelines as “controversial.”

        NBC Nightly News reported that “the first new guidelines in a decade about how” statins “should be prescribed” have been released, and they “could result in many more Americans taking these” medications.

        On ABC World News, ABC’s Dr. Richard Besser said that the “new guidelines...dramatically expand” the use of statins “to one third of adults.”

        The CBS Evening News called the new guidelines “controversial,” and reported that they “put less emphasis on cholesterol numbers and more on other risk factors in determining who should take medication.”

        In a second segment on NBC Nightly News, Dr. Tanya Benninson, Chief Medical Officer at NBC Universal, discussed the guidelines.

        In a front-page story, the New York Times (11/13, A1, Kolata, Subscription Publication, 9.61M) reports, “The new guidelines, formulated by the American Heart Association and the American College of Cardiology and based on a four-year review of the evidence, simplify the current complex, five-step process for evaluating who needs to take” the drugs.

        USA Today (11/13, Szabo, 5.82M) reports, “The guidelines identify four high-risk groups who could benefit from statins: people with pre-existing heart disease, such as those who have had a heart attack; people ages 40 to 75 who have diabetes; patients ages 40 to 75 with at least a 7.5% risk of developing cardiovascular disease over the next decade, according to a formula described in the guidelines; and patients with the sort of super-high cholesterol that sometimes runs in families, as evidenced by an LDL of 190 milligrams per deciliter or higher.”

        The Washington Post (11/13, A1, Dennis, Bernstein, 4.28M) reports on its front page that Kim Williams, vice president of the American College of Cardiology said, “Lower [LDL] is better, and no one’s arguing that, but once you have a reason to treat someone, they should be treated fully.”

        In a nearly 1,200-word article on its front page, the Los Angeles Times (11/13, Healy, 3.07M) reports that the new “guidelines will align physician practices with a welter of new research showing what works – and what doesn’t – in preventing heart attacks and strokes, said Dr. Steven Nissen, an influential Cleveland Clinic cardiologist who was not involved in drafting the new” guidelines.

        Bloomberg News (11/13, Cortez, 1.91M) reports that the aim “is to identify people most likely to benefit from treatment and stop trying to hit arbitrary targets that haven’t been proven to improve health, said Neil Stone...chairman of the panel that wrote the cholesterol guidelines.” However, it could “be difficult for some doctors and patients to adjust.”

        In fact, the Wall Street Journal (11/13, A2, Winslow, Subscription Publication, 5.91M) points out that both those in favor of and against the new guidelines are concerned that they will lead to confusion among physicians and patients.

        Additionally, the Boston Globe (11/13, A1, Kotz, 1.75M) reports on its front page that some physicians are concerned that nearly “one-third of American adults could now qualify for lifelong statin use, even if they do not have high cholesterol levels or any signs of heart disease.”

        The AP (11/13, Marchione) points out that the “National Heart, Lung and Blood Institute appointed expert panels to write the new guidelines in 2008, but in June said it would leave drafting them to the” AHA and ACC. In addition to the statin guidelines, “new guidelines on lifestyle and obesity” were released yesterday, “and ones on blood pressure are coming soon.”

        The New York Daily News (11/13, Miller, 3.94M) points out that “the new guidelines were published online” yesterday “and will appear in upcoming issues of the Journal of the American College of Cardiology and the AHA journal Circulation.”

        The Los Angeles Times (11/13, Healy, 3.07M) “Science Now” blog reports that this “new game plan for statins represents a stark shift from approaches embraced by cardiologists and primary care physicians for most of the past decade.”

        Similarly, CNN (11/13, Sloane, 14.53M) reports on its website that the new guidelines are “being called a tectonic shift in the way doctors will treat high cholesterol.” Also covering the story are Reuters (11/13, Berkrot), the CBS News(11/13, Jaslow, 3.87M) website, the NPR (11/13, Knox, 465K) “Shots” blog, AFP (11/13), The Oregonian (11/13, Muldoon, 751K), the Time (11/13, Park, 13.4M) website, Forbes (11/13, Herper, 6.03M), HealthDay (11/13, 5K),Medscape (11/13, O'Riordan, 164K), and the Baltimore Sun (11/13, Cohn, 812K) “Picture of Health” blog.

USPSTF: Little evidence vitamins prevent heart disease, cancer

On its website, Time (11/12, Sifferlin, 13.4M) reports that the “U.S. Preventive Services Task Force [USPSTF] says that for most vitamins and minerals, there is not enough evidence to determine whether the pills can lower risk of heart disease or cancer.” With regard “to beta-carotene (found in carrots and tomatoes) and vitamin E, there is no evidence that they can protect against either heart disease or cancer; in fact, beta-carotene use contributed to an increased risk of lung cancer in smokers.”

        On its website, NBC News (11/12, Fox, 6.79M) reports that an analysis published in the Annals of Internal Medicine was “used as the basis” for the recommendations.

        CQ (11/12, Young, Subscription Publication, 967) reports that the USPSTF “said that ‘eating a diet rich in fruits, vegetables, whole grains, fat-free and low-fat dairy products, and seafood may play a role in the prevention of cancer or cardiovascular disease,’ even though no benefit has been shown for vitamins supplements in this connection.”

        Reuters (11/12, Seaman) quotes Dr. Michael LeFevre, co-vice chair of the USPSTF, as saying, “At this point in time the science is not sufficient for us to estimate how much benefit or harm there is from taking vitamin or multivitamin supplements to prevent cancer or heart disease.”

        MedPage Today (11/12, Neale, 122K) reports that “the guidance” released as a draft recommendation, “applies to primary prevention in healthy adults without nutrient deficiencies, with the exception of women who are pregnant or may become pregnant, a group that ‘should take a daily supplement containing folic acid to help prevent neural tube defects.’” The article points out that “the new proposed guidance is consistent with that from other organizations, including the National Institutes of Health and the Academy of Nutrition and Dietetics, which also found insufficient evidence to recommend the use of multivitamins” as a way to “prevent chronic disease.” HealthDay (11/12, 5K) also covers the story.

Not Getting Enough Sleep May Be Linked to Higher Risk of Heart Disease

Reuters reported that research published online in Sleep Medicine suggests that not getting enough sleep may be linked to a higher risk of heart disease. Researchers found that individuals who usually slept less than six hours per night faced a higher risk of developing hypertension, high cholesterol, and diabetes. They were also more likely to be obese. The study indicated that the effect was strongest in black and Hispanic participants.

Consuming More Vegetable Protein May Help Kidney Disease Patients Live Longer

In 1104 CKD patients participating in the 1988-1994 NHANES III, for each 10 gram increase in vegetable protein intake per day, participants had a 14% lower risk of dying by the end of 2006, after controlling for various factors such as age, smoking, and BMI. Thefindings were presented at ASN Kidney Week 2013. Previous research has shown that compared with animal protein consumption, vegetable protein intake is linked with lower production of uremic toxins. Interventional trials are needed to determine whether increasing vegetable protein will prolong CKD patients’ lives.

FDA unveils “bold” move to phase out trans fat.

News that the FDA plans to eliminate artificial trans fats, which are found in crackers, cookies and many other baked goods, and are said to be responsible for thousands of heart attacks and deaths, was widely covered across the US media Thursday. The move earned praise from many health experts. However, results of a Pew poll and comments from some consumer groups suggest that many oppose the ban, with some seeing it as meddling too much in the food supply. ABC World News reported in its broadcast that the Food and Drug Administration issued a warning that “No amount of trans fat, no matter how small is safe.” The FDA estimates that 7,000 lives would be saved each year if trans fats and other partly hydrogenated oils were banned.

        In its broadcast, NBC Nightly News characterizes the FDA move as a “bold” step, noting that while trans fat, also called as partially hydrogenated oil, makes the food taste better, it can make good cholesterol go bad and “bad cholesterol worse,” and “can make heart trouble for all.”

        CBS Evening News interviewed FDA Commissioner Margaret Hamburg, who pointedly says: “This action will save lives. The CDC estimates that if we can reduce the levels of trans fat currently in the American diet,” the US could prevent heart attacks and save lives.

        The Washington Post (11/8, Dennis, 4.28M) says the move by the FDA is the “most aggressive efforts to limit Americans’ consumption of a specific food ingredient” aimed “at ending the era of trans fats altogether.” The Post provides specific numbers of heart attacks and deaths it can prevent, noting that the ban could prevent 20,000 heart attacks and 7,000 deaths due to heart disease every year. The Post says that though products containing trans fats have “increasingly disappeared from grocery stores and restaurant menus” over the past few years, they “still linger in an array of processed foods, including pancake mix, packaged cookies and ready-made frosting.”

        The move to eliminate trans fat was hailed as “lifesaving” by health experts, says USA Today (11/7, Weise, 5.82M). The paper quotes FDA commissioner Margaret Hamburg as saying, “There really is no safe level of consumption of trans fat.” Dean , a professor of medicine at the University of California-San Francisco, says these fats “increase the shelf life of foods but decrease the shelf life of humans.” Thomas , director of the Centers for Disease Control and Prevention says “5,000 Americans a year die of heart disease because artificial trans fat is in the food supply and another 15,000 will get heart disease.”

        On its website, CBS News (11/8, 3.87M) quotes Dr. David , a cardiologist with the Cleveland Clinic, who says that “trans fatty acids are added to processed foods as an inexpensive way to improve taste and texture and lengthen shelf life, but there are other ways of achieving these results that do not directly promote the development of heart disease.”

        In a front-page article, the Wall Street Journal (11/8, A1, Burton, Jargon, Subscription Publication, 5.91M) says an important moment in the history of trans fat was in middle of the last decade when the FDA mandated that food makers disclose trans fat in food products. The move led food makers to start using oils instead of trans fat, in a bid to stop noting the substance on the “Nutrition Facts” label, reports the Journal.

Prevalence of Dialysis Therapy Is Skyrocketing Worldwide

Worldwide, there has been a 165% increase in dialysis treatments for ESRD over the past two decades, according to research presented at ASN Kidney Week 2013. The prevalence of dialysis therapy for countries with universal dialysis access increased by 134% after adjusting for population growth and aging. For countries without universal dialysis access, adjusted prevalence increased by 102%. The findings come from an analysis of information from the Global Burden of Disease database, national and regional ESRD registries, and a literature review of studies from 1990 and 2010. Data from 26 countries that lack routine access to dialysis were excluded.

Diabetes: Risk Factors, Prevention, and Management

More than 8% of Americans have diabetes and about 35% of American adults have prediabetes. Prediabetes is a condition in which blood glucose levels are higher than normal. Without healthy lifestyle changes, those with prediabetes may develop diabetes. 

To protect your health, get information about:

Risk Factors - Family history, blood pressure, and other factors can affect your chances of developing diabetes. Take a quick test to learn your level of risk. 

Prevention - The onset of Type 2 diabetes can sometimes be prevented or delayed through moderate weight loss, good nutrition, and exercise.

How to Manage Diabetes - If you've been diagnosed with diabetes, learn how to stay healthy and keep the disease under control.

Statistics - Get some basic facts, including the prevalence of Type 1 versus Type 2 diabetes.

Initiating Dialysis Can Cause Burdens for Elderly Patients

n a study of 379 patients aged 75 years and older who initiated dialysis, 75% started treatments in the hospital because of an acute illness or surgery, and loss of independent living frequently occurred following such hospitalizations. Of 254 patients who came from home, 28% died in the hospital or were discharged to hospice, and only 37% could return home. Thirty-nine percent of patients died within 6 months of starting treatment; most of these initiated treatment in the ICU, while patients who started dialysis as outpatients had reasonably good survival. The findings were presented at ASN Kidney Week 2013.

Metformin Lowers Blood Glucose by Reducing Fat in the Liver

Researchers report that when mice with mutated acetyl-CoA carboxylase—which regulates fat production as well as the ability to burn fat—are given the diabetes drug metformin, the drug does not lower the animals’ blood sugar levels. It appears that inhibitory phosphorylation of acetyl-CoA carboxylase is essential for the control of lipid metabolism and for metformin-induced improvements in insulin action. The Nature Medicine findings indicate that metformin does not directly reduce sugar metabolism but instead reduces fat in the liver, which then allows insulin to work better.

Testosterone replacement therapy may be linked to increased heart risks.

Research published in JAMA linking testosterone therapy to higher heart risks was covered on one of last night’s national news broadcasts, as well as on several major websites, although it received little coverage in major print media.

        The CBS Evening News reported that new research suggests that testosterone replacement therapy may be linked to heart risks in certain individuals.

        The Wall Street Journal (11/6, Beck, Subscription Publication, 5.91M) reports that for the study, investigators looked at data on more than 8,700 men with low testosterone who underwent coronary angiography at some time between 2005 and 2011 in the US Veterans Affairs health system.

        The Los Angeles Times (11/6, Healy, 3.07M) “Science Now” blog reports that patients “taking testosterone were 30% more likely to suffer an adverse event – a stroke, a heart attack or death.”

        Forbes (11/6, 6.03M) contributor Larry Husten writes that “after adjusting for differences between the groups there was a significant 29% increase in risk associated with testosterone (CI 1.05-1.58, p = 0.02).” The researchers found that “the effect size was the same in the groups of people who had coronary artery disease and those who did not.”

        AFP (11/6) reports that “the increased risk of catastrophic events was especially notable, said researcher Anne Cappola of the University of Pennsylvania, because ‘the men who were taking testosterone in this study were slightly healthier to begin with.’”

        The CNN (11/6, 14.53M) “The Chart” blog reports, however, that some physicians “who looked at the study questioned the methods, saying many of these men already had heart issues.”

        Bloomberg News (11/6, Ostrow, 1.91M) points out that previous research on “testosterone elderly males, funded by the U.S. National Institute on Aging and run at Boston Medical Center, was” halted after “an audit found it caused more heart attacks and high blood pressure.” Also covering the story are Reuters (11/6, Pittman), the AP (11/6, Tanner), the NBC News (11/6, Alexander, 6.79M) website, HealthDay (11/6, Dotinga, 5K),MedPage Today (11/6, Raeburn, 122K), and Medscape (11/6, O'Riordan, 164K).

Uncontrolled and Resistant Hypertension Increases with Advanced Diabetic Nephropathy

The prevalence of uncontrolled and resistant hypertension increased with advanced diabetic nephropathy in aDiabetes Care study of 3678 patients with type 1 diabetes. In patients with normal urinary albumin excretion, 14.1% were on antihypertensive treatment and 74.6% had uncontrolled blood pressure despite treatment. The corresponding figures were 60.5 and 71.2% for microalbuminuric, 90.3% and 80.0% for macroalbuminuric, 88.6% and 88.1% for dialysis, and 91.2% and 90.4% for kidney transplanted patients. The prevalence of resistant hypertension was 1.2% in the normoalbuminuric, 4.7% in the microalbuminuric, 28.1% in the macroalbuminuric, 36.6% in the dialysis, and 26.3% in the kidney transplant groups.

Recent Gout Guidelines Help Control Kidney Disease in People with Hyperuricemia

In a recent trial, patients with hyperuricemia who took urate lowering therapy and achieved a serum uric acid of less than 6 mg/dL—consistent with the 2012 American College of Rheumatology Guidelines for Management of Gout—experienced a 37% reduction in progression of renal disease. The majority of patients who took urate-lowering therapy during the course of the study were taking allopurinol. The findings, presented at the American College of Rheumatology Annual Meeting, suggest that treating to the guidelines is an effective way of preventing and controlling kidney disease in people with hyperuricemia.

Analysis: Paying living kidney donors may save lives, money.

On its website, NBC News (10/25, Aleccia, 6.79M) reports that, according to an analysis published Oct. 24 in the Clinical Journal of the American Society of Nephrology, “paying living kidney donors $10,000 to give up their organs would save money over the current system based solely on altruism – even if it only boosts donations by a conservative five percent.” For the study, researchers from the University of Calgary “compared cost data from a cohort of kidney patients identified in 2004 and followed them for three years.” Investigators calculated that “paying living kidney donors $10,000 apiece would save about $340 per patient, compared with the ongoing costs of dialysis, and would also provide a modest boost of .11 in quality-adjusted life years.”

        The Time (10/25, Alter, 13.4M) “Healthland” blog points out that “if the money actually results in a 10% or 20% increase, the savings per patient could reach thousands of dollars,” for the reason that “most patients wait 2-3 years for a kidney, and the cost of dialysis during the wait is usually higher than $10,000.” The analysis did not “address ethical concerns or the potential for abuse,” however.