Tuesday, May 27, 2014

Mysterious Kidney Disease in Farming Communities

Researchers are working to understand cases of unexplained kidney failure that have been reported over the past decade in Central America, rural areas of Sri Lanka, coastal regional of eastern India, and along the Danube River in the Balkans. Those most commonly affected are men who are agricultural, farm, or sugarcane workers. Other common factors are poverty, hot and humid environments, insufficient access to health care, and suboptimum water quality and sanitation. Potential causes include exposure to environmental toxins, use of indigenous herbs, use of over-the-counter pain killers, and chronic dehydration, according to a Lancet news article.

Sunday, May 25, 2014

Canadian Study Finds Kidney Transplantation Superior to Intensive Home Hemodialysis

A new Canadian study found kidney transplant patients had a 55% to 61% (depending on organ donor type) reduced risk of treatment failure or premature death compared with patients on intensive home hemodialysis (≥16 hours/week). Risk for hospital admission was higher for some transplant patients up to 1 year after transplantation, but lower in the long term compared with dialysis patients. The JASN study included 173 intensive home hemodialysis patients and 1517 transplant recipients (673 living donor, 642 standard criteria donor, and 202 expanded criteria donor recipients) who received care between 2000 and 2011 at a Canadian medical center.

PKD Patients May Have a Reduced Cancer Risk Compared to Patients with Other Kidney Diseases

Kidney transplant recipients with polycystic kidney disease (PKD) were 16% less likely to develop cancer than recipients without PKD in a recent analysis of 10,166 kidney transplant recipients with PKD and 107,339 without. The median follow-up was 4.12 years after transplant for PKD recipients and 3.64 years for non-PKD recipients. Compared with the general population, overall cancer risk increased 48% in PKD recipients, while the overall cancer risk in non-PKD recipients increased 86%. Investigators for the JASN studyanalyzed information from the National Cancer Institute’s Transplant Cancer Match Study and from 15 population-based US cancer registries.

Combined Effects of Genetic and Lifestyle Factors on Type 2 Diabetes Risk Quantified

The contribution of genetics to the risk of developing type 2 diabetes is greatest in younger and leaner individuals; however, this group is at low absolute risk, according to a study of >28,000 middle-aged individuals. The 10-year cumulative incidence of type 2 diabetes rose from 0.25% to 0.89% across extreme quartiles of the genetic score in normal weight individuals, compared with 4.22% to 7.99% in obese individuals. The high absolute risk associated with obesity at any level of genetic risk highlights the importance of universal rather than targeted lifestyle interventions. The findings are published in PLOS Medicine.

Saturday, May 24, 2014

Study: E-cigarettes may enhance bacteria’s resistance to antibiotics.

TIME (5/21, Park) reports that according to a study published in the American Journal of Preventive Medicine, “the vapor from e-cigs prompts bacteria to become more resistant to antibiotics.” While conventional cigarette smoke produces this effect as well, researchers did not expect e-cigarettes to do the same, “given that they were not supposed to contain the health-harming carcinogens that tobacco smoke does.” However, “when stressed by the e-cig vapors to defend themselves, the bacteria produced copious amounts of biofilm, a sticky, slimy polymer that acts as their armor against things like antibiotics.”

E-Cigarettes may help people quit smoking.

Major print, wire source and Internet media coverage is given to a study finding that electronic cigarettes may help people quit smoking. The New York Times (5/21, A3, Tavernise, Subscription Publication) reports that a study published online May 21 in the journal Addiction “has found that smokers trying to quit were substantially more likely to succeed if they used electronic cigarettes than over-the-counter therapies such as nicotine patches or gum.” After interviewing nearly “6,000 smokers who had tried to quit on their own without counseling from a health professional,” researchers found that “about a fifth of those who said they were using e-cigarettes had stopped smoking at the time of the survey, compared with about a tenth of people who had used patches and gum.”
        The Los Angeles Times (5/21, Kaplan) reports in “Science Now” that public health officials and researchers “are eager to sort out the pros and cons of e-cigarettes, which are lightly regulated and increasingly popular.” Advocates for e-cigarettes “say they promote health by providing an alternative to traditional cigarettes and the poisonous tars and carbon monoxide that come with them.” However, “critics – including Dr. Tom Frieden, director of the Centers for Disease Control and Prevention – counter that e-cigarettes get people (especially kids) to get hooked on nicotine, increasing the risk that they will move on to regular cigarettes.”
        The Washington Post (5/20, Phillip) “To Your Health” blog reports, “About 42 million Americans currently smoke, according to the Centers for Disease Control and Prevention.” Of those who smoke, “more than 68 percent are trying to quit.” Today’s study findings notwithstanding, “the Food and Drug Administration still plans to regulate e-cigarettes, which could curb sales to minors and force manufacturers to put health warnings on their labels.”
        Bloomberg News (5/20, Kresge) reported that questions remain as to whether e-cigarettes “could serve as a gateway for teenagers to start smoking the real thing.” Recently, a CDC survey “found that one in 10 American high school students reported using an e-cigarette in 2012, compared to 4.7 percent a year earlier.”
        Also covering the story are Reuters (5/20, Kelland), the Huffington Post (5/21, Almendrala), the Daily Caller (5/21, Deutsch), theChristian Science Monitor (5/21, Swan), Newsweek (5/21, Bekiempis), HealthDay (5/21, Reinberg) and MedPage Today (5/21, Wickline).

Sports-Related Trauma Often Produces Isolated High-Grade Renal Injury

Among renal trauma patients treated at Utah-based trauma centers between 2005 and 2011, 30% of injuries to a kidney were sustained during sporting activities, with more men experiencing an injury than women. Cycling, skiing, and snowboarding accounted for the majority of isolated high-grade (grade 3 to 5) sports-related renal injuries. The average trauma grade was 3.5 for sport-related injuries and 3.7 for non-sport-related injuries. The average injury severity score for sports-related trauma was 12.6 and for non-sports related trauma was 27.3. The findings were presented at the American Urological Association’s Annual Scientific Meeting.

Researchers recommend seven servings of fruit and vegetables per day.

The Los Angeles Times (5/20, Macvean) reports that a study published in the Journal of Epidemiology and Community Health suggests that five servings of fruit and vegetables every day “might not be enough to get the best protection from disease and early death.” The researchers, led by Oyinlola Oyebode of University College London, wrote, “We have shown that those eating seven or more portions of fruit and vegetables daily have the lowest risk of mortality from any cause.”

Albuminuria Does Not Elevate LDL Cholesterol in Patients with Stage 5 CKD

Patients with stage 5 CKD with albuminuria have normal concentrations of low-density lipoprotein cholesterol, according to recent 30-patient study. Although the study is small, it calls for additional research to assess any links between albuminuria and low-density lipoprotein cholesterol in CKD patients. The Journal of Applied Medical Sciences findings suggest that impairment of renal function may have a positive impact on the metabolism of low-density lipoprotein cholesterol.

Cardiometabolic Risk Factor Trends Relate to Deaths Due to Heart Disease, CKD, and Diabetes

In 2010, high blood pressure was the leading risk factor for deaths due to cardiovascular diseases, CKD, and diabetes, causing more than 40% of worldwide deaths from these diseases. Additionally, high BMI and glucose were each responsible for about 15% of the deaths, and high cholesterol for more than 10%. After accounting for multicausality, 63% of deaths from these diseases in 2010 were attributable to the combined effect of these 4 metabolic risk factors, compared with 67% in 1980. The mortality burden of high BMI and glucose nearly doubled from 1980 to 2010, according to the Lancet Diabetes & Endocrinology analysis.

Seat Belts and Airbags Help Protect the Kidneys

The combined use of airbags and seatbelts reduced the risk of serious kidney injuries by about 23% in a study of motor vehicle accident injuries in 2010 and 2011 from the National Trauma Data Bank. Injured vehicle occupants without a protective device had a 44.3% rate of high grade renal injury compared with a 40.1% rate for those only wearing seat belts, a 42.3% rate for those protected by airbags, and a 34.1% rate for those protected by both seat belts and airbags. The findings were presented at the 109ᵗʰ Annual Scientific Meeting of the American Urological Association.

Meta-Analysis Disputes Study Linking High-Potency Statins to Increased AKI Risk

Medscape reported that a meta-analysis published in the American Journal of Cardiology “is calling into question the conclusions of aprovocative 2013 study suggesting that high-potency statins increased the risk of acute kidney injury (AKI).” Investigators found, “at 120 days,” that there were “no significant differences in the rate of renal-related serious adverse events for either the placebo-controlled trials or the high- vs-low-dose statin trials.” Meanwhile, “a similar pattern was seen for the period beyond 120 days and for drug withdrawals due to AKIs.”

Walking May Reduce CKD Patients’ Risks of Premature Death and Need For Dialysis

Among 6363 patients with CKD who were followed for an average of 1.3 years, those who walked for exercise were 33% less likely to die during the study and 21% less likely to need dialysis or a transplant. Plus, the more patients walked, the more they benefited. Compared with those who did not walk, patients who walked 1-2, 3-4, 5-6, and ≥7 times per week were 17%, 28%, 58%, and 59% less likely to die during the study, respectively. They were also 19%, 27%, 43%, and 44% less likely to need dialysis or a transplant, according to the CJASN study.

Treatments for ADPKD May Not Reduce Patients’ Need for Dialysis or Transplantation

Conventional CKD treatments do not reduce the need for renal replacement therapy (RRT) in autosomal dominant polycystic kidney disease (ADPKD), according to a new analysis of 315,444 patients starting RRT in 12 countries from 1991 to 2010 (with 20,596 due to ADPKD). There was no change over time in the incidence of RRT for ADPKD up to age 50, while the incidence in patients over age 70 increased. The increased age at RRT onset was most likely due to increased access for elderly ADPKD patients or lower competing risk prior to RRT rather than effective emerging treatments. The findings were published in Kidney International.

Costs for CKD-MBD Medications in Medicare Part D–Enrolled Dialysis Patients Are Rising Rapidly

The most common chronic kidney disease–mineral and bone disorder (CKD-MBD) medications used from 2007 to 2010 were found to be phosphate binders (83%) and intravenous vitamin D (78%-79%). Prescription phosphate-binder, intravenous vitamin D, and cinacalcet use was significantly higher for low-income subsidy than for non–low-income subsidy patients, according to the American Journal of Kidney Diseasesanalysis. CKD-MBD Part D medication costs increased 36% from 2007 to 2010, compared with a 22% increase for total Part D medication costs. For Part D–enrolled dialysis patients, CKD-MBD medications represented approximately 50% of overall net Part D costs in 2010.

Short Exercise Bursts before Meals Help Control Blood Glucose in Individuals with Insulin Resistance

Short bursts of intense exercise before main meals are more effective at improving glycemic control than a continuous moderate-intensity 30-minute session in individuals with insulin resistance, particularly 3-hour post-meal glucose following breakfast (17% reduction compared with no exercise) and dinner (13% reduction compared with continuous 30 minute exercise). While 30 minutes of moderate-intensity exercise did not improve glycemic control in the Diabetologia study, distributing the same volume of exercise as 3 brief pre-meal “exercise snacks” resulted in a 12% reduction in post-meal blood glucose concentration that was sustained for the subsequent 18 hours following the last exercise snack.

Renin–Angiontensin System Antagonists May Reduce Osteopontin Levels in Lupus and Other Patients

In a study of 101 lupus patients and 115 healthy controls, the median level of osteopontin—a bone-related glycoprotein linked with cardiovascular disease, diabetic nephropathy, and autoimmune disease—in lupus patients was 17.93 ng/mL compared with 5.62 ng/mL in healthy controls. High osteopontin serum levels were linked with a 4.9-fold increased risk of CKD, a 4.6-fold increased risk of proteinuria, and a 4.7-fold increased risk of anemia. Patients taking renin–angiontensin system antagonists had decreased osteopontin levels, an effect that is consistent with the inhibitory effect of these drugs on osteopontin renal expression. The findings are published in Clinical Rheumatology.

Study finds recycled blood more useful than donated blood.

The Washington Post (5/10, Bernstein) reported that “during some surgeries, operating room personnel try to capture as much blood as possible and return the red blood cells to your system, instead of, or in addition to, donated blood from a blood bank.” Researchers have found “that patients have better outcomes when transfused with their own blood.” A study published recently in Anesthesia and Analgesia shows that “as banked blood sits on shelves for as long as 42 days, the membranes of red blood cells become less able to change shape and squeeze through the smallest capillaries to deliver critical oxygen to tissues.”

Study: Common exercise recommendations may not be sufficient to prevent weight gain.

Reuters (5/12, Cohen) reports that a new report suggests that the commonly-recommended exercise routine of 150 minutes of moderate intensity workouts per week, or 60 minutes of vigorous exercise, suggests that that level is insufficient to prevent weight gain. The study, which examined 19,000 adults over 22 years, found that only those that exceeded those recommendations managed to avoid serious weight gain.
        Study suggests breaking up exercise better than longer sessions. TIME (5/12, Park) reports that the latest study published in the journal Diabetologia suggests that individuals should “think of exercise the same way you think of food, and break it up into snack-sized sessions rather than marathon ones.” The study “showed that parsing physical activity into short bouts of intense exercise is better than working out once a day.” Times says that while the trial was “small,” it “provides some encouraging ways to make exercise more efficient.”

Synthetic stimulants found in weight-loss supplement: study.

USA Today (5/12, Young) reported researchers have discovered “a ‘cocktail of synthetic stimulants’” in a US-made “Dexaprine weight-loss supplements,” citing test results published recently in scientific journal Drug Testing and Analysis. The scientists found the stimulants while probing “a series of health problems experienced by Dutch consumers.” The paper noted that “health officials in the Netherlands have issued alerts since last summer about Dexaprine products after consumers reported effects including nausea, agitation, palpitations and one cardiac arrest.” However, no such alerts have been sent out in the US, the article pointed out.

Saturday, May 10, 2014

Meeting Risk Targets Would Reduce Premature Mortality From Main NCDs By 25% By 2025

MedPage Today (5/5, Neale) reported that research published online in The Lancet suggests that “meeting target levels of six risk factors would bring the world close to reducing premature mortality from the main noncommunicable diseases (NCDs) by 25% by 2025 – the so-called ‘25 x 25’ goal.” Researchers found that “achieving targets for tobacco smoking, alcohol use, salt intake, obesity, blood pressure, and blood glucose and diabetes would reduce the risk of dying prematurely from cardiovascular diseases (including stroke), chronic respiratory diseases, cancer, and diabetes by 22% in men and by 19% in women by that date.” This is the equivalent to “the delay or prevention of more than 37 million deaths – 16 million in people ages 30 to 69, and 21 million in those 70 or older.”

Daily fruit, vegetable consumption may reduce risk of stroke.

ABC World News (5/8, story 10, 0:20, Sawyer) reported, “A new medical review says fruit every day can decrease the risk of stroke.”
        Reuters (5/9, Seaman) reports that for the study, published online in Stroke, investigators looked at data from 20 studies that included a total of more than 760,000 participants.
        The ABC News (5/8, Lalani) “Medical Unit” blog reports that the researchers found that “eating 200 grams of fruit a day – the equivalent of two small apples – can” reduce an individual’s “stroke risk by almost a third.” Meanwhile, “stroke risk drops 11 percent with every 200 grams of vegetables consumed daily, according to the study.” Medscape (5/9, Brooks) and HealthDay (5/9, Preidt) also cover the story.

Dialysis Patients with Low Treatment Compliance Have Poorer BMD Control

In an analysis of 509 prevalent adult patients on chronic hemodialysis in Italy, poor control of mineral and bone disorders was discovered in 56% of patients. Low compliance to treatment was the major determinant of failure (in 43.5 % of cases), and there was a direct correlation between a high degree of compliance and the achievement of therapeutic targets. Only a minority of proposed interventions (14.7%) included strategies to improve patient compliance. The findings are published in the Journal of Nephrology.

An Extra Doctor Visit May Help Prevent Rehospitalization of Dialysis Patients

An additional provider visit in the month following hospital discharge was estimated to reduce the probability of 30-day hospital readmission by 3.5% in a study of 26,613 patients who were on dialysis in the US between 2004 and 2009. The reduction in such readmission ranged from 0.5% to 4.9% in an additional 4 groups of patients, depending on population density around facilities, facility profit status, and patient Medicaid eligibility. At current Medicare reimbursement rates, seeing patients 1 additional time in the month following discharge could lead to 31,370 fewer hospitalizations per year and $240 million per year saved, according to the JASNstudy.

ACE inhibitors improved all-cause mortality, cardiovascular outcomes versus ARBs

Angiotensin-converting enzyme (ACE) inhibitors improved all-cause mortality, cardiovascular mortality, and major cardiovascular events compared with angiotensin II receptor blockers (ARBs) in patients with diabetes, a new study found.
Researchers performed a meta-analysis to examine how ACE inhibitors and ARBs affect all-cause mortality, cardiovascular deaths, and major cardiovascular events in diabetic patients. Randomized clinical trials that were published between 1966 and 2012, reported the effects of both classes of drugs on these outcomes, and had an observation period of 12 months or longer were included.
The researchers analyzed dichotomous outcomes data from individual trials by using risk ratios (RRs) and 95% CIs and random-effects models, and differences between subgroup estimates were calculated with tests for interactions. Heterogeneity was identified via meta-regression analyses. The study's primary end points were all-cause and cardiovascular mortality, while secondary end points were effects of both drug classes on cardiovascular events. The study results were published online March 31 and in the May issue of JAMA Internal Medicine.
Of the trials identified and included in the study, 23 compared ACE inhibitors with control therapy (n=32,827 patients) and 13 compared ARBs with control therapy (n=23,867 patients). ACE inhibitors reduced all-cause mortality by 13% (20 trials; RR, 0.87; 95% CI, 0.78 to 0.98), cardiovascular deaths by 17% (13 trials; RR, 0.83; 95% CI, 0.70 to 0.99), and major cardiovascular events by 14% (14 trials; RR, 0.86; 95% CI, 0.77 to 0.95) compared with control therapy. ARBs, in contrast, did not appear to significantly affect any of the study end points besides heart failure events (4 trials; RR, 0.70; 95% CI, 0.59 to 0.82). Neither class of drugs appeared to reduce stroke risk in diabetics.
The authors noted that their study compared ACE inhibitors and ARBs only indirectly, that the populations of the included studies varied significantly, and that the trials examining each class of drug were not equivalent. However, they concluded that ACE inhibitors decrease all-cause mortality, cardiovascular mortality, and major cardiovascular events in patients with diabetes while ARBs appear to have no similar effects. Based on their findings, they concluded, "ACE [inhibitors] should be considered as first-line therapy to limit the excess mortality and morbidity in this population."

Antiangiogenic Therapies Often Cause Hypertension that Requires Treatment in Cancer Patients

Anticancer therapies that block vascular endothelial growth factor (VEGF) signaling have improved outcomes in many cancer patients; however, almost all patients who take VEGF inhibitors develop high blood pressure, and a subset develops severe hypertension. A new Canadian Journal of Cardiology article notes that the molecular mechanisms underlying VEGF inhibitor–induced hypertension are unclear, but endothelial dysfunction and increased vascular resistance, due to impaired nitric oxide signaling, reduced prostacyclin production, endothelin-1 upregulation, oxidative stress, and rarefaction have been implicated. The authors highlight potential therapeutic strategies, noting that angiotensin-converting enzyme inhibitors and dihydropyridine calcium channel blockers are commonly used.

Survival Rates of Diabetic, Nondiabetic Transplant Patients Nearly Equal

Among 1688 kidney recipients, including 413 with diabetes prior to transplant between 1996 and 2007, those with diabetes had a 2.7-fold increased risk of dying within 5 years compared to nondiabetics. However, 5-year mortality in patients with diabetes declined over time, narrowing the mortality difference and in more recent years largely eliminating it. Posttransplant, diabetics experienced a significant decline in major fatal/nonfatal cardiac events and infectious deaths over time. Neither cardiac events nor overall mortality declined in nondiabetics. Improvements in survival of kidney recipients with diabetes likely reflect enhanced posttransplant management and outcomes, according to the Kidney International study.

Family Members’ Education Level Impacts Peritoneal Dialysis Patient Outcomes

Family members’ education level was found to be a novel predictor of patient outcomes in a PLOS ONE study of 2264 patients on chronic peritoneal dialysis who were followed for an average of 27.6 months. Using elementary school or lower as reference, premature mortality risks during the study were 32%, 36%, and 34% reduced when family members had middle school, high school, and more advanced levels of education, respectively. The patients’ level of education was not linked with premature mortality risk, and neither patients’ nor family members’ education levels correlated with risks for cardiovascular death or initial-episode peritonitis.

Studies May Explain Link between FGF23 and Cardiovascular Risk in CKD Patients

Fibroblast growth factor‐23 (FGF23), a hormone that controls renal phosphate reabsorption and vitamin D synthesis in renal proximal tubules, also regulates renal sodium reabsorption and plasma volume, according to an EMBO Molecular Medicine study. Mice lacking FGF23 excreted higher amounts of sodium in their urine, resulting in low blood pressure, while animals with high FGF23 had high blood levels of sodium, and in turn, high blood pressure. Another study published by the group in EMBO revealed that FGF23 also controls calcium levels. Too much FGF23 leads to increased uptake of calcium by the kidneys, and results in vascular calcification.

Type 1 and Type 2 Diabetes on the Rise in US Youth

From 2001 to 2009, the prevalence of type 1 diabetes increased 21% and the prevalence of type 2 diabetes increased 30% among US children and adolescents. In 2009, the highest prevalence of type 1 diabetes was 2.55 per 1000 among white youth, and the lowest was 0.35 per 1000 in American Indian youth. The prevalence of type 2 diabetes was 1.20 per 1000 among American Indian youth, 1.06 per 1000 among black youth, 0.79 per 1000 among Hispanic youth, and 0.17 per 1000 among white youth. The JAMAfindings come from an analysis of 3.3 million children and adolescents in 5 states.

First case of MERS in US confirmed.

News that a man infected with the MERS (Middle East Respiratory Syndrome) virus has been identified in the US received extensive coverage since Friday. On Friday, network news broadcasts devoted more than four minutes of coverage to the story. Stories followed on network news broadcasts on Saturday and Sunday. All major US newspapers and wire sources have been following the story. Most stories feature quotes from officials at the CDC. NBC Nightly News (5/2, story 6, 2:05, Holt) reported, “The first case of a deadly and mysterious virus that until now had confined itself to the Middle East has turned up in the US in Indiana. It’s a respiratory virus more lethal than the flu. It’s called MERS.”
        ABC World News (5/2, story 5, 0:30, Sawyer) reported that the patient “had recently returned from Saudi Arabia, flying to Chicago, taking a bus to Indiana.” Now “he is in isolation in an Indiana hospital.”
        On the CBS Evening News (5/2, story 3, 1:35, Pelley), the CDC’s Dr. Anne Schuchat was shown saying, “We are working with partners in England and others around the world to make sure the people who were on the airplanes are contacted and notified to be on the lookout for signs or symptoms.” CBS’ Dr. Jon Lapook added, however, “The CDC believes this first US case represents a very low risk to the general public.”
        On the ABC World News (5/3, story 7, 1:30, Muir) Saturday broadcast, ABC’s Senior Medical Contributor Dr. Jen Ashton said, “There’s no evidence the virus has spread here in the US, but the CDC will not breathe a sigh of relief until they’ve contacted all passengers on that plane and bus.”
        On Sunday’s broadcast, NBC Nightly News (5/4, story 3, 0:30, Holt) reported, “Health officials in Indiana say” the man “is in good condition and improving.”
        USA Today (5/5, Hampson) reports, “Since MERS appeared two years ago, the World Health Organization has confirmed infections in 262 people,” 93 of whom “have died.” Another “100 people have tested positive for the disease but are not included in the health organization’s tally, according to” Dr. Schuchat.
        The Washington Post (5/5, Sun) quotes CDC Director Tom Frieden as saying, “In this interconnected world we live in, we expected MERS-CoV to make its way to the United States.” Frieden added, “We have been preparing since 2012 for this possibility.”
        The Wall Street Journal (5/5, McKay, Subscription Publication) reports that there is currently no vaccine or treatment for the virus, according to the CDC.
        The New York Times (5/3, McNeil, Subscription Publication) reported, “The typical incubation period for MERS is five days, and the patient is not known to have infected anyone else.” While “airline passenger lists will be used to contact everyone who sat near him,” due to the fact that “bus companies often do not know who bought tickets or who sat where, ‘that bus ride may be a challenge,’ said Tom Skinner, a C.D.C. spokesman.”
        Reuters (5/5, Steenhuysen) reports that in an exclusive interview, Dr Michael Bell, deputy director of the division of healthcare quality promotion at the CDC, said, “We take this very seriously,” adding that “in a worst-case scenario, this could spread rapidly.”
        The San Francisco Chronicle (5/5, Allday) reports that Dr. Schuchat said, “We should not be surprised if additional cases are identified among health care providers who had close contact with the patient. People will understandably be concerned by the news.”
        The AP (5/5) points out that “staff members at the hospital who had direct contact with him before he was isolated have themselves been placed in temporary home isolation and are being monitored.”
        In a separate story, USA Today (5/5, Weintraub, Stanglin) reports, meanwhile, that “Indiana Gov. Mike Pence (R) offered reassurance to state residents.” Pence stated, “I want to assure every Hoosier that we have deployed the full resources of the Indiana State Department of Health to engage in tracking this case, assessing the risk to the public and working together to prevent the spread of the virus.”
        The Chicago Tribune (5/5) reports, “The Indiana State Department of Health is working with the hospital, the” CDC “and others to monitor the situation and prevent the spread of the virus.”
        The NPR (5/5, Silver) “Shots” blog reports that currently, the “CDC does not recommend any change in travel plans for the general public.” However, “it does suggest that anyone who has visited countries in or near the Arabian peninsula and who develops a fever, cough or shortness of breath within 14 days should see a” physician. Also covering the story are the NBC News (5/5, Fox) website, theLos Angeles Times (5/5, Khan) “Science Now” blog, Reuters (5/5, Steenhuysen, Begley), The Hill (5/5, Neff), the AP (5/5, Stobbe), andBloomberg News (5/5, Edney, Wayne).

Device for tackling sleep apnea gets FDA nod.

The AP (5/2) reported the FDA approved a “pacemaker-like device” for people suffering from sleep apnea, a “first-of-kind device” that helps keep the air passages open by delivering an electric current. The device, from Inspire Medical Systems, has been approved for sleep apnea patients “who have trouble with the current standard of care: machines that blow air through a bedtime mask,” the article noted. Data from NIH indicate 12 million to 18 million people in the US have sleep apnea, according to the story.
        The Minneapolis Star Tribune (5/2, Alexander) provided details of the device, noting Inspire Medical’s “Upper Airway Stimulation” therapy “uses an implantable, pacemaker-like device” that sends mild shocks to a nerve in the neck “to keep breathing passageways open without waking the patient,” citing Tim Herbert, the company’s CEO. The device costs $30,000 the article noted.
        The news was also covered by the Minneapolis-St. Paul (MN) Business Journal (5/2, Subscription Publication) reports in its “TechFlash” blog, as did HealthDay (5/2), MedPage Today (5/2) and Medscape (5/2, Lowes).

CDC: Thousands of premature deaths in US are preventable.

USA Today (5/2, Weintraub) reports, “There is a huge range in the death rates across American states, driven by public policy, regional habits and socioeconomics, Tom Frieden, the director of the Centers for Disease Control and Prevention, said” yesterday. Researchpublished in Morbidity and Mortality Weekly Report indicates that “the death rate from the five major causes varies at least twofold between the healthiest states – such as Colorado, Utah and Vermont – and the least healthy, most of which are found in the Southeast, Frieden said.” The majority of the differences “can be explained by differences in smoking habits, obesity, lack of exercise, poor diet, drug and alcohol abuse and access to medications – all of which can be modified with better habits and policies, Frieden said.”
        On its website, CBS News (5/2, Firger) reports that investigators “reviewed state to state data on death records between 2008 and 2010 of people younger than age 80.” The researchers “then calculated premature death rates that could have been prevented if all states had the same number of deaths as states with the lowest rates for each cause.”
        The Washington Post (5/2) “GovBeat” blog reports that across the US, approximately “one in three deaths from heart or cerebrovascular (stroke) disease could have been prevented, while the same was true for just over one in five cancer deaths.” The data indicated that almost “two in five deaths from unintentional injuries and chronic lower respiratory diseases could have been prevented.”
        The Los Angeles Times (5/2, Kaplan) “Science Now” blog offers the numbers, reporting that the researchers “found that 91,757 Americans die unnecessarily of heart disease each year.” An additional “84,443 die prematurely of cancer, 28,831 die early because of chronic lower respiratory diseases, 16,973 are killed by preventable strokes, and 36,836 die as a result of unnecessary accidents.”
        TIME (5/2, Park) reports on its website that “the eight states with the highest death rates from each of the top five causes included Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina and Tennessee.”
        The Hill (5/2, Al-Faruque) reports that although “individual lifestyle changes can improve life expectancy, Frieden emphasized government programs such as the CDC’s Million Hearts campaign to improve access to healthier living, and said heart screening can greatly reduce mortality rates.” Additionally, Frieden “said the Affordable Care Act will help people get screened and treated for diseases earlier.”
        In a piece for CNN (5/2), Dr. Frieden writes that “We already know how to” reduce the number of preventable deaths, “now we need to act on what we know.” Also covering the story are the Modern Healthcare (5/2, Johnson, Subscription Publication) “Vital Signs” blog, the NBC News (5/2, Fox) website, HealthDay (5/2, Thompson), Medscape (5/2, Hand), and the Baltimore Business Journal (5/2, Subscription Publication).

Predictive Formulas for Resting Energy Expenditure May Not Be Valid in Dialysis Patients

Existing equations for resting energy expenditure (REE) are not valid in the dialysis population, researchers report. In a Journal of Renal Nutrition study of 200 dialysis patients, average REE was 1,658 kCal/day (males) and 1,380 kCal/day (females). Weight and height correlated positively with REE and negatively with age >65 years. The energy cost of a unitary kilogram of body weight increased nonlinearly for lower BMI. Existing equations underestimated REE (bias 50–114 kCal/day for 3 equations). Researchers derived a novel equation that performed at least as well as other equations in terms of limits of agreement and reduced bias.

Autosomal Dominant Polycystic Kidney Disease Diminishes Exercise Capacity

Researchers found lower aerobic capacity in young normotensive ADPKD patients with preserved kidney function and inadequate responses of nitric oxide and asymmetric dimethylarginine (ADMA) levels to acute exercise, suggesting early endothelial dysfunction. Among 26 ADPKD patients and 30 controls, peak oxygen uptake and anaerobic threshold were lower in ADPKD patients. Postexercise serum and urinary nitric oxide levels in patients were not significantly different from baseline, while they increased in controls. Postexercise ADMA level was unchanged in patients, while it decreased in controls. A negative correlation between postexercise nitric oxide and ADMA levels occurred in only controls in the AJKD study.

Study Finds Statin Therapy Lowers LDL Cholesterol But Does Not Prevent Kidney Failure

CKD patients taking simvastatin plus ezetimibe for 5 years lowered their LDL cholesterol by an average of approximately 1 mmol/L (39 mg/dL) compared with patients taking placebo. However, the therapy did not significantly reduce the need for dialysis or transplantation (33.9% cases vs. 34.6% cases in the placebo group). Treatment had no effect on the speed at which kidney function declined. Reported in JASN, the Study of Heart and Renal Protection (SHARP) included 6245 nondialysis CKD patients randomized to receive placebo or simvastatin (a statin) plus ezetimibe (a drug that inhibits the intestinal absorption of cholesterol).

Migraines and Hypertension—Is there a Link?

Many people suffer from headaches, with migraines making up a particularly severe form that can greatly affect quality of life.  Anecdotally, we’ve all heard about people who suffered migraines and later found out they had severe high blood pressure that damaged the kidneys. But what does the science show? Are migraines linked to high blood pressure? This possible connection has been a subject of interest for many years and the results are actually conflicting. What complicates this issue further is that some blood pressure medications can cause headaches, while others are used in its prevention.

Tension-type headaches are the most common type of headache.  They are mild to moderate and cause a vise-like pressure band around the head and neck.  Migraines, on the other hand, are severe, pulsating headaches that can be accompanied by an aura or pre-headache. They have been found to be associated with a higher risk of cardiovascular disease and stroke.
Some studies show that hypertension is present in about a third of those with all types of headaches.  More than half of those with chronic tension headaches have hypertension that is independent of the headaches.  Hypertension is less common in people with migraines.  When the effects of the individual components of blood pressure were studied, it was found that the systolic pressure (top number of a blood pressure reading that measures pressure when the heart is pumping blood around the body) had either no correlation or was actually inversely related to migraine episodes.  Diastolic blood pressure (bottom number in a blood pressure reading that measures pressure when the heart is resting between beats), however, is positively correlated, especially in women.
Some blood pressure medications, such as calcium channel blockers, beta-blockers, and, most recently, angiotensin-receptor blockers (ARBs), reduce the frequency of migraine episodes.  Traditionally, beta blockers such as propranolol and metoprolol as well as verapamil, calcium channel blocker, have been used for prophylaxis of migraine headaches. This use of blood-pressure lowering drugs to treat migraines leads to more confusion as to how these diseases are related.
The research on this topic does not all point to the same conclusions. Studies besides the ones previously mentioned have shown that headaches of all types are not associated with hypertension and that people with normal blood pressures are at a greater risk of migraines than those with hypertension.  As the definitions of high blood pressure and headaches continue to change, the correlation between them will change as well.
Bottom Line? Migraine headaches and hypertension are not necessarily linked, but their treatments could be linked. Since pain raises blood pressure, don’t get your pressure checked when you’re having a migraine. Definitely do get it checked regularly, so you can be sure to get your blood pressure under control and prevent kidney damage and other serious issues caused by high blood pressure.

Not All Fruits Are Created Equal: 5 Tips For Health

NKF Blog Link

How many times have you been told to eat more fruits and vegetables? According to the USDA, the average person should eat approximately 1.5-2 cups of fruits per day. Fruits are an important source of fiber and antioxidants and have been shown to reduce risk of cancers and other chronic diseases. However, it is important to keep in mind that all fruits are NOT created equal!
The National Kidney Foundation offer 5 tips for making healthy fruit choices:
  1. Watch for the dried disguise. Often touted as a “healthy snack,” dried fruits can be packed with calories and should be limited in your diet. Check out these calorie counts:
    • 1 cup of raisins = 493 calories
    • 1 cup of dried dates = 414 calories
    • 1 cup of dried prunes = 418 calories
  2. These fresh fruit options are all less than 100 calories:
    • 1 medium apple
    • 1 medium banana
    • 1 cup blueberries
    • 1 cup grapes
    To put it in perspective, the dried fruits listed above contain more calories than a chocolate frosted cake donut (370 calories)! Be informed and choose your calories wisely!
  3. Fruits can contain fat. Avocados contain many important vitamins and nutrients, especially Vitamins E and C. They are a source of the “healthy” fats, but avocados are also high in calories. One avocado contains 322 calories. If you choose to eat avocado, eat ¼ of it instead of the whole fruit. 
  4. Drink juice with caution. A study published in BMJ in 2013 linked higher fruit juice consumption with increased risk for developing Type 2 diabetes. In addition, fruit juices are typically high in calories and do not contain the fiber that is found in the whole fruit, so they aren’t likely to “fill you up” in the same way as eating the actual fruit. 
  5. Canned or frozen can come out on top. When fresh fruit is not available, canned or frozen fruit is a good option. Look for fruit that is packaged in 100% fruit juice and does not have any added sugar, syrup or other high calorie ingredients. Canned and frozen fruits may also be less expensive and can be bought in bulk since they have a longer shelf life.
  6. Don’t let prices stand in the way of eating fruit. Fruits currently in season are usually less expensive. Your local farmers market is a good place to shop and celebrate the season! Using coupons when available can also be an effective and cost-effective way to buy fruits. If you like gardening, planting and growing your own fruits can also be a cost-effective way to eat fruit. Buy whole fruits and prep them yourself because fruits that are pre-cut, cubed or sliced are usually more expensive.
The bottom line: Fruits are an important and necessary part of your daily diet, but they do contain natural sugars and calories. Select wisely and consume high calorie fruits and fruit juices in moderation. Remember, variety is as important as quantity!
Please note that actual calorie content may vary by brand.

WHO report warns of antibiotic-resistant superbugs.

One major US television network news broadcast and several major domestic and international newspapers as well as wire sources and consumer medical sites cover the release of a report from the World Health Organization warning that certain bacteria are not just becoming resistant to antibiotics, but are also found around the world. The report cautions that the 21st century is now in danger of becoming the “post-antibiotic era.”
        NBC Nightly News (4/30, story 11, 2:45, Williams) reported, “The World Health Organization wants us all try to treat antibiotics as serious medicine, not to be taken lightly.” According to the WHO’s report, “antibiotics are actually threatening the achievement of modern medicine because of all the things they no longer kill and because of the rise of so-called super bugs that antibiotics cannot touch.”
        USA Today (5/1, Painter) reports that the WHO “report focuses on several types of bacteria responsible for common, serious diseases such as bloodstream infections, diarrhea, pneumonia, urinary tract infections and gonorrhea.” Partly due to “antibiotic overuse and the dearth of new drugs, some bugs that were once easily curable now resist even the latest, most powerful antibiotics, the report says.” That is because bacteria “are always evolving even when the medicines are not.”
        The AP (5/1, Cheng) reports that according to the WHO, “people should use antibiotics only when prescribed by a doctor, that they should complete the full prescription and never share antibiotics with others or use leftover prescriptions.”
        Bloomberg News (5/1, Kitamura) reports that in a response to the WHO study, Jennifer Cohn, medical director at the medical aid group Doctors Without Borders, called for “a solid global plan of action which provides for the rational use of antibiotics so that quality-assured antibiotics reach those who need them, but are not overused or priced beyond reach.” In its report, the WHO concluded that “antimicrobial resistance is a global health security threat that requires cooperation among governments, especially on surveillance that generates reliable data to inform public health strategies.”
        The Washington Post (5/1, Bernstein) “To Your Health” blog reports that last September, “the US Centers for Disease Control and Prevention warned of ‘potentially catastrophic consequences’ of drug-resistant microorganisms, saying they now kill an estimated 23,000 people in this country every year.”
        Also covering the story are the Wall Street Journal (5/1, Larano) “Southeast Asia Realtime” blog, Reuters (5/1, Kelland), the NBC News (5/1, Fox) website, the New York Daily News (5/1, Otis), TIME (5/1, Park), Medscape (5/1, Brown), and the CNN (4/30, Falco) “The Chart” blog.