Thursday, July 10, 2014

Extreme Obesity Shortens Life Expectancy up to 14 Years

People who are extremely obese—with BMIs between 40 and 59 kg/m²—die 6.5 to 13.7 years earlier than healthy-weight individuals, according to researchers. The expected years of life lost continued to increase for BMIs beyond 50 kg/m², at which point the loss in life expectancy exceeded that for current smokers vs. those who never smoked. Extreme obesity was linked with increased risks for nearly every major cause of death, suggesting that excess weight can have a wide range of physiological effects. The PLOS Medicine analysis was based on data from 20 large studies from the United States, Sweden, and Australia.

Kidney Donation Appears Safe for Healthy Older Adults

In a study of 3368 older kidney donors who were matched 1:1 to older healthy nondonors and followed for a median of 7.8 years, mortality rates did not differ between donors and matched pairs. Among donors with Medicare, death or cardiovascular disease rates were similar between donors and nondonors. Donors also did not have an elevated risk of diabetes compared with matched nondonors. Thefindings are published in the American Journal of Transplantation.

Wednesday, July 9, 2014

High-Dose Intravenous Vancomycin May Cause Less Nephrotoxicity than Previously Reported

A study of 80 hospitalized adult patients with normal baseline renal function who received ≥4 g/day of intravenous vancomycin for ≥48 hours revealed the overall rate of nephrotoxicity was 6%. Trough concentrations >20 mg/L were observed in a similar proportion of patients who did and did not develop nephrotoxicity. The Clinical Therapeutics study found that patients who developed nephrotoxicity trended toward having a lower BMI, higher daily dose, longer duration of therapy, and greater exposure to intravenous contrast and nephrotoxic medications. In a multivariable analysis, the combination of intravenous contrast and nephrotoxic medications predicted nephrotoxicity, and duration of high-dose vancomycin was a significant confounder.

Physical Fitness May Improve Kidney Function in Patients with Type 2 Diabetes

Researchers following 2007 type 2 diabetics with normal kidney function for an average of 7 years found that highly fit patients had a 68% lower combined rate of CKD and premature death compared to the least fit group. The moderately fit group had a 51% lower rate, and the low-fit group had a 41% lower rate than the least fit. A pilot study of 15 diabetics with stage 3 CKD who completed a 12-week exercise program improved their exercise capacity and kidney function, with 53% of patients improving their CKD to stage 2. Thefindings were presented at ICE/ENDO 2014.

Interdialytic Weight Gain Linked with Increased Cardiovascular Risks

In a prospective study of incident dialysis patients, those with an interdialytic weight gain (IDWG) ≥4.0% had a 93% increased risk of experiencing major adverse cardiac and cerebrovascular events over an average follow-up of 18.7 months compared to patients with an IDWG of 1.0% to 1.9%. After adjusting for residual renal function and 24-hour urine volume, an IDWG ≥4.0% was associated with twice the risk of experiencing major adverse cardiac and cerebrovascular events. The findings, which pertain to 1013 patients from 36 dialysis centers in Korea, are published in the American Journal of Nephrology.

Proton Pump Inhibitors Emerging as Important Contributor to Acute Interstitial Nephritis

In a retrospective study of 133 patients with biopsy-proven acute interstitial nephritis, drugs were the cause in 70% of cases, autoimmune diseases caused 20%, and infections caused 4%. Results showed that 49% of the drug-related cases were due to antibiotics, 14% were due to proton pump inhibitors, and 11% were due to non-steroidal anti-inflammatory agents. The top 3 drug causes were omeprazole (12%), amoxicillin (8%), and ciprofloxacin (8%). The American Journal of Kidney Diseases findingssuggest that the cause of acute interstitial nephritis may be shifting, with proton pump inhibitors emerging as an important contributor to this disease.

Risk Factors for CKD Present Decades before Diagnosis

An analysis of 441 new cases of CKD and 882 controls (all Framingham Heart Study participants) revealed those who developed CKD were 76% more likely to have had hypertension, 71% more likely to have been obese, and 43% more likely to have had higher triglycerides 30 years before diagnosis. At 20 years before diagnosis, they were 38% more likely to have had hypertension, 35% more likely to have had higher triglyceride levels, and nearly 3 times more likely to have had diabetes. Based on these JASN results, the more risk factors present in the past, the higher the likelihood of developing CKD.

FDA faces challenges with oversight of fecal transplants.

The AP (6/27, Perrone) took a broad look at the status of fecal transplants in the country to treat Clostridium difficile, noting that the FDA is grappling with the challenges posed by the procedure. The AP noted the FDA has decided to “regulate” fecal treatment as “an experimental drug,” and has agreed that it “shows promise in treating C. difficile infection that has not been responsive to other therapies.’” Most researchers noted that FDA’s concerns are legitimate because “patients can contract HIV, hepatitis and other viruses and parasites from fecal matter that is not properly screened,” according to the article. However, the piece noted, due to the “unresolved status” of FDA’s oversight, many doctors shy away from offering the treatment.

CDC study: One in 10 deaths among working-age adults attributable to excessive drinking.

USA Today (6/26) reports that a study conducted by the Centers for Disease Control and Prevention found that excessive drinking was the cause of one in 10 deaths among working-age adults between 2006 and 2010. The paper notes that the CDC defined excessive drinking activities to include “binge drinking, heavy weekly alcohol consumption and drinking while underage or pregnant.” The CDC found those activities instigated “long-term health effects such as liver disease and heart disease, as well as short-period effects such as violence, alcohol poisoning, car crashes and drowning.”
        The Washington Post (6/27, Bernstein) “To Your Health” blog reports that CDC researchers estimated that “excessive drinking cost the United States about $224 billion in 2006, or about $1.90 per drink” in public health costs. The study found that deaths caused by excessive drinking varied greatly by state from the 16.9% of deaths occurring in New Mexico as the highest to the 7.6% of deaths occurring in Maryland as the lowest nationwide,
        The Los Angeles Times (6/27, Kaplan) “Science Now” blog reports that to calculate the years of life lost, the CDC “compared the age at which victims died to their expected life span,” which was based on age and gender. Following the calculation the paper reports that the CDC found that “the total number of unlived years added up to an average of 2,560,290 per year.” Also covering the story areBloomberg BusinessWeek (6/26), NBC News (6/27, Carroll), NPR (6/27, Shute), Congressional Quarterly (6/27, Subscription Publication) , HealthDay (6/27), MedPage Today (6/27), the Huffington Post (6/27, Almendrala), CNN (6/27, Christensen, Cnn), theNew Orleans Times-Picayune (6/27), and the Milwaukee Journal Sentinel (6/27).

Low Levels of Vitamin D May Cause High Blood Pressure

HealthDay reported that research published online in The Lancet Diabetes & Endocrinology suggests that “low levels of vitamin D may be a cause of high blood pressure.” Investigators “analyzed genetic data from more than 146,500 people of European descent in Europe and North America.” The researchers found that “for each 10 percent increase in vitamin D levels, there was an 8 percent decrease in the risk of developing high blood pressure.”

Analysis: Vaccine complications rare; no evidence vaccines cause autism.

USA Today (7/1, Szabo) reports that according to an analysis published online in Pediatrics, “serious complications related to vaccines are very rare, and there is no evidence that immunizations cause autism.” Researchers arrived at those conclusions after having analyzed data from 67 separate studies. In a report issued in April, the Centers for Disease Control and Prevention explained that vaccines given to babies and youngsters over the past 20 years “will prevent 322 million illnesses, 21 million hospitalizations and 732,000 deaths over the course of their lifetimes.” TIME (7/1) also reports on this story.
        The AP (7/1, Stobbe) reports that the analysis also “mirrors and updates a 2011 report on vaccine safety by the US Institute of Medicine” which “found vaccines can cause certain side effects but serious ones are very rare.” According to experts, “such risks need to be balanced against the benefits of vaccines – the prevention of millions of illnesses and thousands of deaths annually.”
        CNN (7/1, Christensen) reports that an accompanying editorial “suggests doctors, who parents typically trust to tell the truth about medical information, need to use this study to speak with confidence about the importance of vaccinating children.”
        The NBC News (7/1, Fox) website also covers the analysis, which was conducted by Dr. Courtney Gidengil and colleagues at the RAND Corporation and commissioned by the Federal government.

Sibling Blood Stem Cell Transplants Reverse Sickle Cell Disease

Half of patients in a trial have safely stopped taking immunosuppressant medication for their sickle cell disease following a modified blood stem cell transplant. The treatment (which consisted of alemtuzumab, total-body irradiation, sirolimus, and infusion of peripheral blood stem cells from human leukocyte antigen–matched siblings) reversed sickle cell disease in 26 of 30 patients and allowed them to achieve stable mixed donor chimerism, a condition in which a person has genetically distinct cell types in the blood. Fifteen patients discontinued immunosuppression medication with continued stable donor chimerism and no graft vs. host disease. The findings are published in JAMA