Thursday, December 11, 2014

Higher Insulin Doses May Increase Risks for Patients with Type 2 Diabetes

Researchers have uncovered a link between an increased dosage of insulin and a heightened risk of premature death and other events in patients with type 2 diabetes. The observational study included 6484 patients with type 2 diabetes who progressed to treatment with insulin monotherapy and were followed for an average of 3.3 years. Increased risks in relation to 1-unit increases in insulin dose were 54% for all-cause mortality, 37% for major adverse cardiovascular events, and 35% for cancer during follow-up. The results are published in Diabetes, Obesity, and Metabolism.

Wednesday, December 10, 2014

BPA Exposure from Canned Beverages May Increase Blood Pressure

In a new study, when older adults drank 2 cans of soy milk, their average concentration of urinary bisphenol A (BPA) increased 16 times above baseline within 2 hours. Systolic blood pressure increased 4.5 mm Hg on average. On days when they drank the same beverage from glass bottles, which do not use BPA linings, there was no significant change in their BPA levels or blood pressure. The Hypertension study included 60 older adults who drank soy milk from cans or glass bottles on 3 separate occasions, weeks apart. BPA is an endocrine disruptor that can mimic estrogen.

Report: Half Of Patients Prescribed Opioid For 30 Days Still Using Drug Three Years Later.

In continuing coverage, ABC World News (12/9, story 7, 1:10, Muir) Chief Medical Editor Dr. Richard Besser reported on a study from Express Scripts that looked at 36 million prescriptions and found that “nearly half of those patients who are described a narcotic and took it for more than 30 days, they were still on it three years later.” Dr. Besser said these drugs “are meant for short-term use,” and according to the CDC “46 people die from narcotic overdose, when they are combined with anxiety medication or sleeping pills” every day.

TIME (12/10, Sifferlin) reports that although “the rate of Americans using pain medications like codeine, morphine, oxycodone and hydrocodone long term has remained stable in the last five years,” the amount “of medication they take has increased.” The report found that “use was most rampant in small Southeastern cities, and two-thirds of patients were prescribed the drugs by two or more physicians.” Nearly “40% filled their prescriptions at multiple pharmacies.”

CBS News (12/10) reports on its website that according to the National Institute on Drug Abuse, “the U.S. accounts for only 5 percent of the world’s population, yet as a country we consume at least 75 percent of all opioid prescription drugs.”

Tuesday, December 9, 2014

Intravenous Magnesium Sulfate May Help Prevent Contrast-Induced Nephropathy

Research suggests that prophylactic use of intravenous magnesium may provide added benefits to traditional hydration for preventing contrast-induced AKI. In a study of 122 patients undergoing percutaneous coronary interventions who were randomized to receive routine treatment or routine treatment plus intravenous magnesium sulfate just before the procedure, contrast-induced AKI occurred in 26.6% of patients in the control group and 14.5% of patients in the study group. There were no deaths or need for hemodialysis in either group in the International Urology and Nephrology study.

Saturday, December 6, 2014

US Adults at High Lifetime Risk of Developing CKD, Model Suggests

A new simulation model projects that more than half of healthy US adults between the ages of 30 and 64 will develop CKD at some point during their lifetimes. US adults without CKD who are 30 to 49, 50 to 64, and ≥65 years of age were estimated to have a 54%, 52%, and 42% risk, respectively. The prevalence of CKD in adults ≥30 years of age is projected to increase from 13.2% currently to 14.4% in 2020 and 16.7% in 2030. Based on the American Journal of Kidney Diseases findings, knowing these risks may raise general awareness among the public while encouraging individuals to take steps to prevent CKD.

Thursday, December 4, 2014

Iron Supplementation Linked with Reduced Risk of Premature Death in Dialysis Patients

In a study of 235 incident dialysis patients, those who took iron supplements had a 78% decreased risk of death over a median follow-up of 34 months. They also had a 69% reduced risk of death due to cardiovascular and sepsis-related causes. Increasing ferritin concentrations in patients with normal C-reactive protein was associated with a decreased risk of death, whereas in patients with elevated C-reactive protein values, ferritin levels >800 ng/mL were linked with increased mortality. For the PLOS One study, 191 patients received intravenous iron, 13 patients received oral iron, and 31 patients never received iron supplements.

Wednesday, December 3, 2014

New Kidney Allocation System Begins this Month

The Organ Procurement and Transplantation Network (OPTN) is implementing substantial changes to the US deceased donor kidney (DDK) allocation system this month. These modifications aim to increase life years for DDKs that are transplanted by adding allocation priority for longevity matching for potential recipients with an estimated survival in the top 20%; improve access to transplantation for moderately and highly sensitized candidates on the waiting list; improve access to transplantation for ethnic minorities; and improve efficiency and utilization of DDKs by providing more granular information regarding organ quality. OPTN has provided numerous resources related to the change.

Wednesday, November 26, 2014

Yogurt Consumption Linked with Reduced Risk of Developing Type 2 Diabetes

Eating a 28 g serving of yogurt every day was associated with an 18% lower risk of developing type 2 diabetes in a meta-analysis of 14 prospective cohorts with 459,790 participants and 35,863 incident type 2 diabetes cases. Other dairy foods and consumption of total dairy were not appreciably associated with diabetes incidence. The BMC Medicinefindings suggest that randomized clinical trials are warranted to examine the causal effects of yogurt consumption on diabetes as well as the potential of probiotics to affect body weight and insulin resistance.

Tuesday, November 25, 2014

Administration To Unveil Calorie Labeling Rules On Tuesday.

The Wall Street Journal (11/25, Tracy, Subscription Publication) reports that the Administration and the FDA are planning on unveiling final rules expanding calorie labeling on Tuesday. The rules will require restaurants with at least 20 locations to display calorie counts on their menus. In addition, the rules will apply to amusement parks, convenience stores, movie theaters, and others. The rules have been repeatedly delayed, and have faced significant opposition from the food industry.

The Washington Post (11/24, Dennis) reports that, according to FDA Commissioner Margaret A. Hamburg, “Americans eat and drink about one-third of their calories away from home,” and as a result “people today expect clear information about the products they consume.” Hamburg expressed hope that the new rules will aid people in making “more informed choices” about the food they eat. The Post adds that “activists who for years have pushed for more transparent and consistent menu labeling,” as a means of managing the nation’s epidemic of obesity, “praised the FDA’s action.”

Bloomberg News (11/25, Edney) reports that, among the critics of the rules were grocery stores, who cited concern that “calculating and posting calories would curtail offerings in their fresh prepared foods sections, because the offerings are constantly changing.” According to Rob Rosado, director of government relations with the Food Marketing Institute, “testing and labeling them all could have cost the industry as much as $1 billion.”

The New York Times (11/25, Tavernise, Strom, Subscription Publication) adds, “Perhaps the most surprising element of the new rules was the inclusion of alcoholic beverages, which had not been part of an earlier proposal.” FDA officials said “Beverages served in food establishments that are on menus and menu boards will be included, but a mixed drink at a bar will not.”

Also reporting on the story are USA Today (11/25, Horovitz), Reuters (11/25, Clarke, Athavaley)The Hill (11/25, Devaney), Politico (11/25, Evich)Yahoo! News (11/25, Jalonick), the Minneapolis Star Tribune (11/25), and in the NPR (11/24) “The Salt” Blog.

Exercise May Improve Physical Function, Lessen Pain in Patients with CKD

A12-week course of exercise done in a supervised setting similar to a cardiac rehab center was effective in improving physical function and quality of life among patients with CKD. Also, the exercise program decreased pain as assessed by patient questionnaires. The CJASNstudyincluded 107 patients with CKD stages 3 or 4, with 59 undergoing the exercise program and 48 receiving usual care. The exercise program consisted of treadmill walking and/or stationary cycling, plus weight training with free weights, done twice weekly at local facilities. Additionally, exercise participants were given pedometers and encouraged to walk 5,000 to 10,000 steps daily.

Saturday, November 22, 2014

Majority of LN Patients In Complete Remission and with Preserved Renal Function Have Persistent Hypertension

MedPage Today reported that research published online in Clinical Rheumatology suggests that “more than half of lupus nephritis (LN) patients in complete remission and with preserved renal function still have persistent hypertension.” Investigators found that “independent factors associated with hypertension (P<0.05) were: disease duration (odds ratio 1.06, 95% CI 0.91-1.24); longer duration interval to complete remission (OR 1.10, 95% CI 1.02-1.19); number or relapses (OR 2.53, 95% CI 1.01-6.3); and CyA use (OR 5.3, 95% CI 1.14-23.9).”

Plasma Lithium Levels Above Advised Range Tied to Transient Kidney Function Reduction

Medwire News reported that according to a study published Nov. 7 in the BMJ Open, “plasma levels of lithium above the advised range are associated with a transient reduction in kidney function.” The study of 699 patients “found a dose-response effect, with plasma lithium levels of 1.01–1.20mmol/L associated with a 3.88 percentage point reduction in estimated glomerular filtration rate (eGFR) measured within three months of the lithium value, while levels of 1.21–2.00 mmol/L were associated with a 5.40 percentage point reduction.” Such reductions remained “significant after accounting for age and gender.”

More Dialysis May Not Be Better When it Comes to QoL

MedPage Today reported that according to research presented at the American Society of Nephrology’s Kidney Week, “more dialysis may not be better when it comes to quality of life [QoL].” Researchers reported that in the 200-patient “ACTIVE trial, patients aiming for 24 hours per week of dialysis saw no improvements in quality of life compared with those who did a standard number of hours per week.”

Amniotic Membrane Allografts May Be Effective against Difficult-to-Treat Ulcers

Dehydrated human amnion/chorion membrane (dHACM) allograft is a viable option for treating patients with ulcerations refractory to standard of care therapy, according to a study presented at Desert Foot 2014. Among the 22 diabetic patients in the study, the average wound size at the time of the initial dHACM application was 2.79 cm²; among the 18 non-diabetic study participants, the average wound size was 4.96 cm². The average number of dHACM applications was 3.36 in diabetics and 3.11 in non-diabetics, and the average number of weeks to wound closure was 5.89 in diabetics and 5.94 in non-diabetics.

Friday, November 21, 2014

Drug Helps Lower Potassium Levels in Patients with Hyperkalemia

Zirconium cyclosilicate (a nonabsorbed cation exchanger that selectively binds potassium in the intestine) maintained normal potassium levels in patients with hyperkalemia throughout a 28-day clinical trial published in JAMA. Normal potassium levels were achieved in 84% of patients within 24 hours and 98% within 48 hours of treatment initiation. Compared to placebo, all treatment doses resulted in significantly higher proportions of patients with normal potassium levels. After 258 patients received zirconium cyclosilicate in an initial 48-hour open-label phase, patients achieving normal potassium levels were then randomized to receive 5 g, 10 g, or 15 g of zirconium cyclosilicate or a placebo daily.

Thursday, November 20, 2014

Using a statin for five years in middle age may reduce heart, death risks for decades.

The AP (11/20, Marchione) reports that research presented at the American Heart Association meeting suggests that using a statin “for five years in middle age can lower heart and death risks for decades afterward, and the benefits seem to grow over time.” The research, which began in 1989, included approximately 6,600 middle-aged men who had high LDL. Half of the participants were given a placebo and the other half were given pravastatin. Researchers found that “five years later, there were 35 percent fewer heart-related deaths and also fewer heart attacks” among those who had been given pravastatin. The investigators also found that “twenty year after the study began, the risk of heart-related deaths was 27 percent lower among the men who took” pravastatin “for those first five years.”

Wednesday, November 19, 2014

Pollution May Contribute to Kidney Disease

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Chronic kidney disease rates were higher in counties with higher levels of particulate matter 

November 15, 2014 Author:   Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

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(dailyRx News) Factors like aging, diabetes and high blood pressure may raise patients' risk of chronic kidney disease. Now, new research suggests that air pollution may also raise that risk.

The authors of a recent study found that areas with higher pollution had higher rates of chronic kidney disease.

The researchers noted that their findings did not confirm that pollution causes kidney disease. They called for further research on the topic.

Matthew T. Smith, MD, of the Baylor Medical Center at Carrollton in Texas, said past research on kidney disease causes has mostly focused on respiratory and cardiovascular factors.

"Research in how air pollution would cause chronic kidney disease is very early," he told dailyRx News. "At this point there is no direct proven link between air pollution and chronic kidney disease. Ambient air pollution has been implicated in increasing mortality from lung cancer and cardiopulmonary disease. Chronic kidney disease can occur as a result of worsened cardiovascular issues such as hypertension."

Jennifer L. Bragg-Gresham, PhD, of the University of Michigan in Ann Arbor, led the current study. The researchers presented their findings at the American Society of Nephrology Kidney Week in Philadelphia Nov. 15.

Chronic kidney disease is the slow loss of kidney function over time. If the kidneys do not work well, waste can build up in the body. Chronic kidney disease can lead to other health problems, such as high blood pressure, nerve damage and heart disease.

Past research found that rates of chronic kidney disease varied widely across the US. The authors of the current study wanted to study why that variation may occur.

Dr. Bragg-Gresham and colleagues looked at 2010 Medicare data on 1.1 million people across the US. They compared data on how many people with chronic kidney disease lived in each county. They then looked at data on levels of pollution in each of those counties from the Environmental Protection Agency.

They found that areas with about 14 micrograms per cubic meter of particulate matter had high numbers of people with chronic kidney disease. This level of pollution is much lower than what is thought unhealthy for sensitive groups like the elderly. Particulate matter up to 40 micrograms per cubic meter is considered healthy for elderly patients.

According to the World Health Organization, the air quality guideline for cities is to have 20 micrograms per cubic meter of particulate matter or less, but many developing areas far exceed this amount, Many major cities around the globe have around 70 micrograms per cubic meter.

Many particles in the air can cause health concerns, such as respiratory health problems. These particles — known as particulate matter — include nitrates, sulfates, organic chemicals and metals. Future work on this topic should focus on individual types of particles — particularly lead and cadmium, as high blood levels of these two heavy metals have previously been tied to chronic kidney disease, Dr. Bragg-Gresham told dailyRx News.

The study authors adjusted for other factors, such as age, sex, race, diabetes and high blood pressure — all thought to have an effect chronic kidney disease risk — and still found that those living in highly polluted areas were more likely to develop kidney disease.

Dr. Smith said patients should take measures to protect themselves from harmful toxins.

"For patients that smoke, stop smoking," he said. "The concentration of harmful chemicals in cigarette smoke is far higher than what is encountered on the worst air pollution days. For everyone, enjoy the outdoors, but use common sense. For people who are sensitive to air quality, limiting outdoor exposure would be reasonable on days where air quality is not good."

Dr. Bragg Gresham and team could not say for sure that air pollution caused chronic kidney disease. They called for more research to look at individual exposure to air pollution, levels of chronic kidney disease and different factors in pollution that may be responsible for the increased risk for chronic kidney disease, such as metals or acids.

“If this association is borne out by future studies, it would have implications for reducing air pollution exposure for those with chronic kidney disease and also for those at risk for the condition," Dr. Bragg-Gresham concluded. "The potential public health significance of this finding is even greater for regions and countries with much higher levels of air pollution than the United States."

The US government funded this study. The authors disclosed no conflicts of interest.

Research presented at conferences may not have been peer-reviewed.