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Sunday, August 31, 2014

Daily Consumption of Pistachios May Improve Metabolic Risk Profiles in People with Prediabetes

Medscape reported that research published online in Diabetes Care suggests that “daily consumption of pistachios may improve the metabolic risk profiles for people with prediabetes.” Researchers found that “fasting plasma glucose dropped by 5.17 mg/dL from baseline with the pistachio diet in the intent-to-treat analysis, whereas it rose by 6.72 mg/dL after the control diet, resulting in a significant difference between the 2 diets.” Meanwhile, “fasting plasma insulin levels dropped by 2.04 mU/mL from baseline with the pistachio diet and rose by 2.52 mU/mL in the control diet, which was also a significant difference.”

Investigational Drug Blocks Inflammation-Induced Decrease in Blood Iron Levels

An experimental drug that regulates the blood’s iron supply shows promise as a viable first treatment for anemia of inflammation. Investigators induced a safe and temporary model of anemia of inflammation (through a low dose of E. coli endotoxin) in 24 healthy male adults who were randomized to receive lexaptepid (an anti-hepcidin L-oligoribonucleotide) or placebo 30 minutes later. After 9 hours, iron in the blood increased by 15.9 ┬Ámol/L from baseline in lexaptepid-treated participants compared to a decrease of 8.3 ┬Ámol/L in placebo-treated individuals. Theresults are published in Blood.

Mineral and Bone Parameters in Dialysis Patients Vary by Time of Day

Plasma phosphate levels demonstrated significant circadian variation, peaking around 3:30 a.m. with the nadir occurring around 11:00 a.m. In a study of 17 dialysis patients, the peak and nadir for ionized calcium were around 12:15 p.m. and 8:00 p.m., respectively; the peak and nadir for PTH were 5:45 p.m. and 10:15 a.m., respectively; and the peak and nadir for 25-hydroxyvitamin D were 9:45 a.m. and 4:00 p.m., respectively. FGF-23 did not show a significant circadian variation. Among 8 healthy volunteers, only phosphate and PTH levels demonstrated circadian variation. All participants of the Journal of Nephrology study were on controlled diets.

Dietary Acid Load May Predict Risk of CKD

A recent study found poverty, black race, and being male were significantly linked with an increasing level of estimated net acid excretion (NAEes), a measure of dietary acid load. Analysis of >12,000 adults aged 40 to 60 years in NHANES 1999–2004 noted higher levels of NAEes, which compared to lower levels, were associated with a 1.57 greater odds of albuminuria. Investigators also observed a trend toward greater NAEes with higher risk of low eGFR. The BMC Nephrology findings suggest dietary acid load may be an important target for future interventions in populations at high risk for CKD.

Acute Hemodialysis May Be Linked to Increased Risk of Premature Death

In a recent study of patients admitted to the hospital with varying degrees of kidney failure but without ESRD, those who received acute hemodialysis were 82% more likely to die within 1 year, after adjusting for confounding factors, than similarly ill patients who did not receive acute hemodialysis. The PLOS ONE findings raise questions about the presumed benefits of acute hemodialysis. The results come from a retrospective cohort study of acute-care hospitalizations in Pennsylvania from October 2005 to December 2007. In 2,131,248 admissions of adults without ESRD, there were 6657 instances of acute hemodialysis.

Rare Disease Becoming More Common in Dialysis Patients

The incidence of calciphylaxis (a highly morbid syndrome of vascular calcification and skin necrosis) per 10,000 chronic hemodialysis patients rose significantly from 3.7 in 2007 to 5.7 in 2011, researchers found. Also, mortality rates among calciphylaxis patients were 2.5 to 3 times higher than average mortality rates for chronic hemodialysis patients. For this Journal of General Internal Medicine study, researchers developed an algorithm using the Partners Research Patient Data Registry, identifying 11,451 patients on chronic hemodialysis from 2002 to 2011. They then used the algorithm to determine the incidence of calciphylaxis and associated mortality using the USRDS database.

Federal government tightens restrictions on hydrocodone combination products.

News that the Federal government is tightening restrictions on hydrocodone combination painkillers in an effort to curb widespread abuse received wide coverage, with several major newspapers and news agencies reporting. Some news outlets noted that the rule change was welcomed by many, including lawmakers from states that have been plagued by opioid abuse. Others quoted sources who were skeptical whether the rule change would help curb abuse of the painkillers.

        USA Today (8/21, Leger) reports the change, for instance, will “sharply reduce how many pills a doctor can prescribe for them at one time.” Also, manufacturers and pharmacies will now have to keep hydrocodone combination products such as Vicodin (acetaminophen and hydrocodone) under tighter security, along with “more extensive records.” The new rule, which takes effect from mid-October, elevates the painkillers to Schedule II from Schedule III under the Controlled Substances Act.

        Highlighting the importance of the rule change, theNew York Times (8/22, A12, Tavernise, Subscription Publication) notes that it is “one of the most far-reaching efforts to stop the growing epidemic of prescription drug abuse.” The paper points to a grim statistic, noting that “more than 20,000 Americans die every year because of prescription drug abuse,” citing Federal data. Still, the Times notes, the change is expected to “draw strong criticism from some pain management experts,” who argue that the new restrictions impose “unfair obstacles for patients in chronic pain, making it harder, for example, on those who cannot easily make a trip to the doctor.”

        The Wall Street Journal (8/22, A3, Radnofsky, Walker, Subscription Publication) examines both sides of the debate, citing sources who are against tighter restrictions and those who seek tougher rules. The paper notes that Linden Barber, a former DEA attorney, who now works with the law firm Quarles & Brady LLP in Indianapolis, pointed out the rule change may not have a major impact because painkillers such as OxyContin (oxycodone), which already have tough safeguards in place, continue to be abused. The AP (8/22, Perrone) also covers the story.

Cholesterol Drug Cuts Heart and Stroke Risk in Patients with Type 2 Diabetes

In a 5-year study of more than 10,000 type 2 diabetics with an elevated risk of cardiovascular disease (high levels of triglycerides and low levels of HDL), the cholesterol-lowering drug fenofibrate cut adverse cardiovascular outcomes by 30% in women and 24% in men. The results, which come from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study, are published in Diabetologia. Fenofibrate stimulates the action of an enzyme that breaks down triglycerides and low-density lipoproteins.


Wednesday, August 20, 2014

Atypical antipsychotics associated with acute kidney injuries in elderly adults.

HealthDay (8/20, Haelle) reports that according to a study(8/20) published Aug. 19 in the Annals of Internal Medicine, acute “kidney injury can be added to the list of possible harms related to use of three antipsychotic medications often prescribed to treat behavioral symptoms of dementia in older adults.” For the study, researchers examined health records of some 97,000 seniors over the age of 64 in Ontario, Canada, who were taking the atypical antipsychotics Seroquel (quetiapine), Zyprexa (olanzapine) or Risperdal (risperidone), medicines which are often used “off-label” to treat agitation in people with dementia.

        MedPage Today (8/20, Fiore) points out that use of atypical antipsychotics in this population was also tied to “an increased risk of hospitalization for: hypotension: RR 1.91 (95% CI 1.60-2.28), acute urinary retention: RR 1.98 (95% CI 1.63-2.40),” and “all-cause mortality: RR 2.39 (95% CI 2.28-2.50).”

        Medscape (8/20, Brauser) reports that the study authors “note that the US Food and Drug Administration issued a black-box warning in 2005 on the basis of 17 randomized controlled trials showing that elderly patients with dementia who received an atypical antipsychotic had a 1.6 to 1.7 times’ greater mortality risk than those who received placebo.” The study’s lead author expressed his surprise “that so many patients were still receiving these prescriptions.”

New Antibacterial Gel Kills Pseudomonas aeruginosa, Staphylococci, and E coli

Researchers have developed the first innovative antibacterial gel that acts to kill Pseudomonas aeruginosa, staphylococci, and E. coli using short peptides conjugated to naphthalene, an organic molecule. The gels break down the thick jelly-like coating (biofilms) that cover bacteria and make them highly resistant to current therapies, while leaving healthy cells unaffected. The advance is described in aBiomacromolecules paper.

Study suggests too many individuals screened for cancer near the end of their lives.

Reuters (8/19, Seaman) reports that research published in JAMA Internal Medicine suggests that too many individuals are being screened for cancer near the end of their lives.

        Bloomberg News (8/19, Ostrow) reports that researchers found that “more than half of men 65 and older who had a very high risk of dying in nine years were screened for prostate cancer, a slow-moving disease.” Nearly “38 percent of older women with a similar life expectancy were screened for breast cancer and 31 percent were screened for cervical cancer despite some having undergone a hysterectomy.”

        Vox (8/19) reports, “Among patients with the shortest life expectancies (about five years), 40 percent had been screened for colorectal cancer.”

        HealthDay (8/19, Reinberg) reports that the researchers did find that “fewer men were screened for prostate cancer and fewer women for cervical cancer in more recent years, compared with 2000.”

        MedPage Today (8/19, Bankhead) reports that a “second study” published in JAMA Internal Medicine “showed that reducing the screening colonoscopy interval from 10 to 5 years would lead to a minimal gain in quality-adjusted life years (QALYs) at a cost exceeding $700,000 per QALY.” Medscape (8/19, Nelson) also covers the story.

Diet Of Fried Foods And Sweet Drinks May Be Deadly For Kidney Disease Patients

HealthDay (8/15) reports that a new study published online in the American Journal of Kidney Diseases suggests that “fried foods, sweet drinks and processed meals – may be deadly for people with kidney disease.” Such a diet “was associated with a 50 percent greater risk of death over a 6-year period for people with kidney disease.” Meanwhile, “a diet high in fruits and vegetables appears to reduce the risk of death by nearly a quarter in kidney patients.” The study was based on an analysis of the diets of “nearly 4,000 people with chronic kidney disease who had not started dialysis.” 

One in 10 Cardiovascular Deaths Associated with High Sodium Intake

A recent modeling study consisting of data from 66 countries found 1.65 million deaths from cardiovascular causes that occurred in 2010 were attributed to sodium consumption above a reference level of 2.0 g per day, the limit recommended by the World Health Organization. The NEJMfindings indicate that sodium intake above this recommendation accounts for almost 1 in 10 cardiovascular deaths globally each year. Four of every 5 deaths occurred in low- and middle-income countries, and 2 of every 5 deaths were before 70 years of age. The average level of global sodium consumption was 3.95 g per day. 

Thursday, August 14, 2014

Public health officials say sports, energy drinks “not actually healthier” than soda.

Vox (8/14, Lopez) reports that despite research suggesting that Americans are “quitting sugar-loaded soda,” added-sugar remains the “culprit” catalyst in “America’s obesity and diabetes epidemics.” The most recent Beverage-Digest has found that “while soda consumption is down, beverages like sports and energy drinks are on their way up.” Public health officials and experts agree that these “replacement beverages aren’t actually healthier than soda.”

Studies examine implications of regulating dietary sodium.

On its front page, the Wall Street Journal (8/14, A1, Winslow, Subscription Publication) reports that according toresearch published in the New England Journal of Medicine, the consumption of less than 3,000 milligrams of sodium daily may increase the risk for death, stroke or heart attack. Researchers arrived at this conclusion after following for three years some 100,000 people in 17 countries. The Food and Drug Administration has announced its intention to review the research. Currently, the FDA is putting together voluntary guidelines which will ask the food industry to reduce the amount of sodium in processed foods.

        The Los Angeles Times (8/14, Healy) “Science Now” blog reports that another study published in the NEJM “concludes that one in 10 cardiovascular deaths can be attributed to excessive sodium consumption, and one in five of those among people younger than 70.” Meanwhile, “an invited editorial touted the study as a ‘herculean effort’ to glean the effects of excess salt consumption in a broad population.” Nevertheless, “citing the findings of two studies published alongside the global assessment, University of Alabama vascular expert Dr. Suzanne Oparil declared it too early for public health officials to take up the cudgels against dietary sodium.”

        The AP (8/14, Marchione) points out that “guidelines from various groups for heart disease prevention recommend 1.5 to 2.4 grams of sodium a day.” For example, “the American Heart Association advises no more than 1.5 grams.” In any case, “limiting salt is still important for people with” hypertension.

        Bloomberg News (8/14, Cortez) reports that experts are in agreement that “too much sodium is dangerous and it comes mainly from packaged foods and restaurant meals” and that just “a small proportion stems from salt added to a homemade meal or shaken on food at the kitchen table.” Experts also stress the importance of reading “food labels to get a good sense of how much salt” is consumed on a daily basis.

        MedPage Today (8/13, Yurkiewicz) reports that a third paper, “a meta-analysis of 107 randomized interventions in 103 trials,” revealed “a linear dose-response relationship between reduced sodium intake and blood pressure.” Its authors concluded, “Globally, 1.65 million annual deaths from cardiovascular causes (95% uncertainty interval [confidence interval], 1.10 million-2.22 million) were attributed to sodium intake above the reference level.” In discussing all the studies, some experts, including editorialist Dr. Oparil, are of the opinion that “encouraging diets high in potassium may be an alternative approach to reducing blood pressure and cardiovascular events.”

        Also covering the studies are Reuters (8/13, Emery), the NBC News (8/13, Silverman, Tolin) website, the NPR(8/13, Aubrey) “Goats and Soda” blog, Forbes (8/13, Husten), HealthDay (8/13, Thompson) and Medscape(8/13, Busko).

Colonoscopies after age 75 may present more risk than benefit.

Reuters (8/12, Doyle) reports on a study published online in JAMA Internal Medicine finding that the risks from colonoscopies after age 75 may outweigh benefits due to the low recurrence rate of colon cancer. The study covered over 5,000 persons over 75 who were undergoing surveillance colonoscopies due to a previous history of colorectal cancer or high-risk polyps. It found that just five colon cancers were identified in older patients, but that 527 patients were hospitalized in the month following a colonoscopy, about one-third of which were due to complications from the colonoscopy. Researchers concluded that colonoscopies after age 75 should be conducted only rarely.

Study: Hand sanitizer not effective in reducing classroom absences.

USA Today (8/13, Healy) reports that a new study in PLOS Medicine suggests that “putting alcohol-based hand sanitizers in classrooms in the hopes of reducing school absences due to illness may not be worth the expense in high-income countries where clean water for washing hands is readily available.” Researchers compared two groups of New Zealand school children and “found that the rate of absences due to illness was similar in both the intervention schools that received the dispensers and the control schools that washed with soap and water.”
        The CNN (8/13, Wade) “The Chart” blog reports the researchers noted that “an unexpected flu epidemic during the course of the study may have affected the findings” by creating “heightened awareness about the benefits of clean hands.” Also covering the story are ABC World News (8/12, story 9, 0:10, Muir), TIME (8/13, Sifferlin) and HealthDay (8/13, Preidt).

WHO approves use of experimental medication to fight Ebola.

ABC World News (8/12, story 6, 1:30, Schiavocampo) reported on “major developments in the Ebola outbreak,” noting that fatalities are now over 1,000 and ABC (Schiavocampo) added that the World Health Organization “approved the use of Z-Mapp to combat Ebola,” though it “can take weeks to produce” and “the available supply has been exhausted.”
        The New York Times (8/12, Cumming-Bruce, Cowell, Subscription Publication) reports that the WHO “endorsed the use of untested drugs”
        The Washington Post (8/12, Phillip, Bernstein) reports that the WHO “said the use of unproven, experimental treatments and vaccines is ethical given the magnitude of the crisis.” Given Mapp’s statement that the supply is “exhausted”, Marie-Paule Kieny, assistant WHO director general, “said she hopes that efforts to produce more” might succeed in producing enough to help by “late this year or early in 2015.” In the US, the Food and Drug Administration is working with the National Institutes of Health “to fund the development of Ebola drugs and to speed up treatments already in the pipeline.”
        The Los Angeles Times (8/13, Morin) reports that Kieny said the decision that use of “experimental, nonapproved drugs” is ethical was the unanimous decision of the experts. In response, she said that “a panel of experts would meet at the end of this month to review what experimental treatments were available and which had shown the greatest promise following animal experiments.” She did point out that in addition to ZMapp, there are “stocks of other experimental drugs available” including “blood-derived medications” and vaccines.
        The Wall Street Journal (8/13, McKay, Loftus, Subscription Publication) reports that the WHO announcement is intended to get manufacturers to produce more of their experimental medications, but it is not known whether that is even possible in the case of ZMapp.
        TIME (8/13, Kedmey) reports that the WHO “endorsed the use of untested experimental drugs for Ebola patients” given “the particular circumstances of this outbreak.”
        Bloomberg News (8/13, Bennett) reports that the WHO decision “gives stricken West African nations more confidence to request drugs and may yield valuable information on whether, and how, the medicines work.” Other experts questioned the WHO decision noting that there has been no testing for safety of the experimental medications. Still one expert said that ZMapp is expected to be fairly safe because “it’s a natural antibody.” Yet another specialist said that it may be possible “to use antibodies from the blood of survivors.” Meanwhile US National Institute of Allergy and Infectious Diseases director Anthony Fauci pointed out that a small supply of experimental medications cannot be expected to “control an outbreak with hundreds and hundreds of people,” adding that the focus must be on public health efforts to stop the spread.

Comedian’s suicide underscores importance of treating depression.

Major television network newscasts, newspapers, and Internet media sources continue coverage of the suicide of comedian and actor Robin Williams, nearly all mentioning the fact that Williams suffered from severe depression. All three television networks led their nightly newscasts with the story. Some sources point out that older white men who are depressed are in a group at a higher risk for suicide, while others note that despite heightened awareness, stigma remains surrounding depression and its treatment, which may make some people reluctant to reach out for help.
        In its lead story, ABC World News (8/12, lead story, 3:55, Muir) reported that Williams appeared to have committed suicide by hanging. Marin County, California Assistant Deputy Chief Coroner Keith Boyd Keith Boyd was shown saying that Williams “had been seeking treatment for depression,” while in its lead story, NBC Nightly News (8/12, lead story, 2:55, Williams) pointed out that toxicology testing is now underway to determine what, if any, “chemical substances were in Mr. Williams’ system at the time of his death.” The CBS Evening News (8/12, lead story, 2:35, Pelley) led its newscast with similar coverage.
        In a different segment, NBC Nightly News (8/12, story 6, 2:45, Williams) quoted American Psychiatric Association president Paul Summergrad, MD, who addressed the stigma of mental illnesses, including depression, saying, “It’s very important that we stop seeing these illnesses as faults and blames, and see them as what they are, medical conditions, genetic conditions, brain disorders which require appropriate diagnosis, treatment, care and support.” Medical editor Nancy Snyderman, MD, reached out to people who need help, saying, “If you have concerns about suicide, call this national number, 1-800-273-TALK.”
        In another segment, the CBS Evening News (8/12, story 2, 2:40, Pelley) reported that according to the US Centers for Disease Control and Prevention, there are “more than 39,000 suicides each year. That’s an average of 108 each day.” Correspondent Jim Axelrod mentioned that US suicide prevention hotlines experienced a big increase in the number of calls following the announcement of Williams’ suicide.
        ABC World News (8/12, story 3, 0:50, Muir) also reported the spike in the number of calls made to suicide prevention hotlines across the US, and medical correspondent Jenn Ashton, MD, emphasized that “new and effective treatments” make both depression and addiction “treatable” diseases. In yet another segment, ABC World News (8/12, story 2, 1:30, Muir) pointed out that last month, Williams was in rehab to deal with “his struggles with addiction.”
        USA Today (8/13, Szabo) reports that advocates for people with mental illness hope that Williams’ death “will also renew efforts to prevent suicide.” The US “suicide rate has been stubbornly high for decades, with more than 39,000 annual deaths – a number that has been growing even as deaths from other causes have fallen, says Thomas Insel, director of the National Institute of Mental Health. “ Dr. Insel pointed out that suicide “now kills twice as many people as homicides, yet receives only a fraction of the attention.”
        Bloomberg News (8/13, French, Basak) reports that according to the National Institute of Mental Health, symptoms of depression “vary and can include feelings of hopelessness, extreme anxiety, appetite changes, insomnia or excessive sleeping, and suicide risk.” Sadly, “just half of Americans diagnosed with major depression are treated and only 20 percent are cared for according to practice guidelines, according to the National Institutes of Health.” Bloomberg News quotes American Psychiatric Association president Paul Summergrad, MD, who said, “Not everybody who has a depression disorder gets recognized.” In a telephone interview, Dr. Summergrad explained that depression “affects rich people, it affects poor people, it affects people across the spectrum.”
        The Washington Post (8/13, Millman) “Wonkblog” reports the effect that stigma has on mental illness and depression, noting that a study published two years ago in the APA’s American Journal of Psychiatry “showed that Americans, between 1996 and 2006, developed a greater awareness of the neurobiological basis of mental illness and became more supportive of medical treatment.” Nevertheless, “the social stigma associated with mental illness” remains “significant – and in some instances, actually increased from 1996 to 2006,” the study found.
        In wake of Williams’ death, Murphy calls for action on mental health reform. The Hill (8/13, Viebeck) reports that yesterday, Rep. Tim Murphy (R-PA) “called for action on mental health reform in response to the death of actor Robin Williams.” Rep. Murphy, “a psychologist, said mental health problems have become a ‘national crisis that demands our response.’” Murphy is the author of a mental health reform measure which “has proven too controversial to move in one piece, though Murphy is keeping up the pressure.”

Most Adults Need to Double Fruit and Vegetable Intake to Meet Global Recommendations

A new study found that the majority of adults worldwide have to at least double their current consumption of fruits and vegetables to meet the World Health Organization’s minimum recommendation of 5 servings (400 grams) per day. Researchers examined the impact of low fruit and vegetable consumption on phytonutrient intake (organic compounds found in fruits and vegetables) in 13 regions. Adults consuming 5 or more daily servings of fruits and vegetables had 2 to 6 times the average intake of phytonutrients of adults consuming fewer than 5 servings per day. The findings are published in the British Journal of Nutrition

Treatment for liver disease seen effective in trials.

The Wall Street Journal (8/12, Loftus, Subscription Publication) reports Intercept Pharmaceuticals Inc. disclosed its medication, obeticholic acid, has been found to be effective in mid-stage studies for the treatment of liver disease due to fat accumulation.
        Reuters (8/12) reports the company disclosed 46% of patients receiving the experimental medication met the trial’s goal of improvement in liver health, compared with 21 percent in the placebo group.

Digoxin tied to increased risk of death in new aFib patients.

In print and in its “Well” blog, the New York Times (8/11, D4, O'Connor) reports that digoxin, “one of the oldest and most commonly used heart medications, may shorten the lives of patients with atrial fibrillation,” according to a study published online Aug. 11 in the Journal of the American College of Cardiology. For the study, investigators “followed more than 100,000 people with newly diagnosed atrial fibrillation and found that those prescribed digoxin were 20 percent more likely to die over the next several years than those who received other treatments.” Mintu Turakhia, MD, of the Stanford University School of Medicine and one of the study’s authors, pointed out that “because of the potential issues with digoxin, and the fact that there are several alternatives – like beta blockers and calcium channel blockers – doctors should prescribe digoxin to atrial fibrillation patients only when there is a very good reason for doing so.”
        MedPage Today (8/12, Yurkiewicz) reports, “The American Heart Association and American College of Cardiology Foundationrecommendations (8/10) from March of this year point out that digoxin ‘is not usually first-line therapy. It may be combined with a beta blocker and/or a nondihydropyridine calcium channel blocker when ventricular rate control is insufficient and may be useful in patients with’” heart failure.
        HealthDay (8/12) reports that even though “the current research found an association between the drug digoxin and a higher risk of death for people with atrial fibrillation or flutter, the study does not show that the drug caused the higher risk of death.” Nevertheless, Dr. “Turakhia thinks the risk may be the result of digoxin causing other dangerous abnormal heart rhythms.” Also covering the study are Forbes (8/12, Husten) and Medscape (8/12, Busko).

Interval Training May Help Control Blood Sugar in People with T2D, Prediabetes

On its “All Things Considered” program and in its “Shots” blog, NPR reported that a study published in the journal Diabetologia suggests that “interval training may help the millions of people with type 2 diabetes [T2D] and prediabetes who are trying to control their blood sugar.” One group of study volunteers “was instructed to walk three minutes briskly, followed by three minutes at a more restful pace” for one hour, while the other “walked at a continuous pace for the same amount of time.” Researchers found that “the interval walkers did improve,” but that “the steady-paced walkers saw no improvement at all.”

Wearable Artificial Kidney Will Soon Undergo First US Trial

The FDA recently approved a human trial of the Wearable Artificial Kidney (WAK), which has been involved in laboratory and clinical testing since 2001. Investigators have already completed successful human clinical trials in Italy and England. The WAK won an award from the FDA’s Innovation Challenge, a pilot program for innovative devices to treat ESRD. The goal of the US trial is to prove that WAK can remove as much physiologic fluid and salt from the body as kidneys do. The trial’s aims and expectations are described in a recent Nephrology News & Issues blog post.

Tick bites causing red meat allergy.

The AP (8/8, Marchione) reports that US physicians “are seeing a surge of sudden meat allergies in people bitten by a certain kind of tick” known as the Lone Star Tick, which has begun to “spread from the Southwest and the East to more parts of the United States.” According to the AP, the ticks “harbor a sugar that humans don’t have, called alpha-gal,” which is found in red meat. A bite from the tick “triggers an immune system response...and makes antibodies to it.” Dr. Scott Commins, of the University of Virginia in Charlottesville, “who with a colleague, Dr. Thomas Platts-Mills, published the first paper tying the tick to the illness in 2011,” pointed out that the allergy “does not seem to be lifelong, but the caveat is, additional tick bites bring it back.”
        TIME (8/8, Dockterman) also reports that “as the so-called Lone Star ticks have spread from the Southwest to the East Coast, more people are getting bit and then going into anaphylactic shock when they try to eat red meat.” The article notes that both patients and physicians “are slow to recognize the risk,” because, according to one allergist, “why would someone think they’re allergic to meat when they’ve been eating it their whole life?”

Access to Simultaneous Dialysis and Hospice Care Upheld in CMS Ruling

The Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1609-F) updating the Medicare hospice wage index and hospice payment rates for fiscal year 2015. Thus, hospices serving Medicare beneficiaries will see an estimated increase of $230 million in their payments. CMS also confirmed that patients can continue to receive both dialysis services and hospice services for terminal conditions other than ESRD. ASN had urged CMS to continue to support the eligibility of dialysis patients with non–ESRD-related terminal diagnoses to receive Medicare- covered services under both the Medicare ESRD and Hospice programs, and the society was pleased CMS acknowledged the importance of this access to care in its final rule.

Stricter Systolic BP Control Linked with Higher Premature Death in CKD Patients

In a study of 77,765 patients with CKD, the mortality rate in those with a goal systolic blood pressure (SBP) <120 mm Hg was significantly higher than for those with a goal SBP of 120 to 139 mm Hg, with patients in the tighter SBP group having a 70% increased risk of dying over a median of 6 years. The death rate in the tighter SBP group was 80.9/1000 patient-years, compared with 41.8/1000 patient-years in the looser SBP group. The increased risk associated with tighter SBP was also present in subgroup analyses of patients with conditions such as diabetes and heart failure, according to the JAMA Internal Medicine findings.

Study Adds to the Growing Uncertainty about Blood Pressure Treatment Targets

Analysis of electronic health records from nearly 400,000 adults on antihypertensive medications found patients with systolic BP between 130 and 139 mm Hg and diastolic BP between 60 and 79 mm Hg were at the lowest risk of kidney failure and death during the study period (2006–2010). Compared to patients with systolic BP between 130 and 139 mm Hg, patients with measurements between 120 and 129 mm Hg (widely accepted as normal) and between 140 and 149 mm Hg were 10% and 40% more likely to die prematurely or develop kidney failure during the study period, respectively. The findings were published in the Journal of the American College of Cardiology.

Daily Home Hemodialysis Linked With Lower Cardiovascular, Higher Infection-Related Hospital Admissions

New research demonstrated lower incidence of cardiovascular-related admissions after 1 year for 3480 daily home hemodialysis (HHD) patients (24.1%) compared with 17,400 matched thrice-weekly in-center hemodialysis patients (26.7%)—an 11% difference. HHD patients had an 8% and 13% decreased risk of a first admission and readmission for cardiovascular causes, respectively. The incidence of infection-related admissions was 29.5% among HHD patients vs. 22.9% among in-center hemodialysis patients, an 18% difference. HHD patients had a 35% and 3% increased risk of a first admission and readmission for infection-related causes, respectively, according to the American Journal of Kidney Diseases findings.

Tree Nut Consumption Decreases Triglycerides, Fasting Blood Glucose, and HbA1c Levels

Consuming 2 oz. of tree nuts per day decreased triglycerides by approximately 0.06 mmol/L and decreased fasting blood glucose by approximately 0.08 mmol/L over an average follow-up of 8 weeks, according to a BMJ Open meta-analysis of 49 randomized control trials with 2226 participants who were otherwise healthy or had metabolic syndrome criteria, dyslipidemia, or type 2 diabetes. A PLOS ONE meta-analysis of 12 randomized clinical trials with 450 type 2 diabetics also found that diets emphasizing consuming 2 oz. of tree nuts per day significantly lowered HbA1c and fasting glucose compared with control diets. Tree nuts include almonds, Brazil nuts, cashews, hazelnuts, macadamias, pecans, pine nuts, pistachios, and walnuts.

Eating five servings of produce daily may increase longevity.

The Los Angeles Times (7/30, MacVean) “Science Now” blog reports, “Eating five servings of fruits and vegetables every day can help us live longer,” according to a review of “16 studies covering 833,234 people” published online July 29 in the BMJ. The review concluded that “the average risk of death from all causes was reduced by 5% for each additional daily serving of fruits or vegetables; risk of cardiovascular death was reduced by 4% for each serving.” Researcher “Wei Bao, of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, said his group’s analysis did not find additional benefits over five portions.”

Living Kidney Donors May Be at Increased Risk of Developing Gout

Gout developed in 3.5% of living kidney donors compared to 2.0% of nondonors in a recent study that followed 21,868 participants for a median of 8.4 years. The difference translated into a 60% increased risk of gout among living donors. In addition, 3.8% of donors vs. 1.3% of nondonors received prescriptions of the gout medicines allopurinol or colchicine, which translated into a 3.2 times increased likelihood of a gout medication prescription. The study, which included 1988 living kidney donors and 19,880 matched healthy nondonors, was presented at the 2014 World Transplant Congress and highlighted by Renal & Urology News.

Alemtuzumab Reduces Risk of Early Rejection after Kidney Transplantation

n a randomized study of 852 adults scheduled to receive a kidney transplant, those who received an alemtuzumab-based treatment at the time of transplantation had a 58% reduced risk of acute rejection compared to those who received a basiliximab-based treatment. According to the Lancet study, there were no between-group differences in treatment effect on transplant failure or serious infection during the first 6 months after transplantation; however, 11 (3%) patients given alemtuzumab-based treatment and six (1%) patients given basiliximab-based treatment died. Alemtuzumab is a monoclonal antibody against CD52 on mature lymphocytes. Basiliximab is a chimeric mouse-human monoclonal antibody against CD25 on T cells.

Running linked to reduced risk of heart-related death.

ABC World News (7/28, story 10, 0:30, Sawyer) reported that a study suggests that running for “even as little as five or ten minutes a day, even at slow speeds, can cut the risk of heart-related death.”
        On NBC Nightly News (7/28, story 9, 2:25, Williams), NBC’s Rehema Ellis said that the “study...from the journal of the American College of Cardiology shows you only need a few minutes a day to get significant heart health benefits.”
        USA Today (7/29, Bui) reports that researchers “examined more than 50,000 adults between 18 and 100 over a period of 15 years.” The investigators “used data from the Aerobics Center Longitudinal Study, where participants completed a questionnaire about their running habits. In the sample,” approximately “24% of participants reported running as part of their leisure-time exercise.”
        The Los Angeles Times (7/29, Kaplan) “Science Now” blog reports that the data indicated that “compared to those who didn’t run, those who did were 30% less likely to die of any cause during the course of the study.” Additionally, “they were...45% less likely to die as a result of cardiovascular disease.”
        A piece in the Washington Post (7/28, Searing) points out that “running regularly for at least six years...was associated with the best mortality odds, with a 50 percent lower risk for cardiovascular-related death.”
        The CNN (7/29, Wadas-Willingham) “The Chart” blog reports that “runners on average lived three years longer than those who did not hit the pavement.”
        Also covering the story are Reuters (7/29, Doyle), HealthDay (7/29, Thompson), the NBC News (7/29, Carroll) website, TIME(7/29), and Forbes (7/29).
        Heat stroke may be more dangerous for runners than heart rhythm problems. Forbes (7/29) contributor Larry Husten writes that the increasing “popularity of marathons and other extreme sports has sparked worries about the potential dangers of these activities.” Although “the popular press and medical research have both focused on the risk of cardiac arrest and other heart rhythm problems,” research “published in the Journal of the American College of Cardiology finds that a much more serious danger may be heat stroke.”
        HealthDay (7/29, Dallas) reports that investigators “analyzed information compiled on all death and hospitalizations that occurred at 14 long-distance races in Tel Aviv between March 2007 and November 2013.” Among “nearly 140,000 runners, only two serious heart-related events were reported during the study period.” Comparatively, “21 people developed heat stroke.”

Obesity Linked with Delayed Graft Function in Kidney Transplant Recipients

After conducting a literature search of studies up to August 2013 that compared obese and nonobese patients who underwent kidney transplantation, investigators found that obesity was linked with a 41% higher risk of delayed graft function but no higher risk of acute rejection. Graft loss and death were associated with obesity only in an analysis of studies that evaluated patients receiving a kidney graft before 2000. Obesity was linked with a twofold increased risk of death by cardiovascular disease; however, most studies included in this analysis evaluated patients who received a graft after 2000. The findings are published in Transplantation.

CABG Linked with Better Long-Term Outcomes than PCI in ESRD and CKD Patients

A meta-analysis of 17 trials found coronary artery bypass grafting (CABG) decreased late mortality risk by 14% and 18% in patients with ESRD and CKD, respectively, compared to percutaneous coronary intervention (PCI). However, CABG was associated with a 2.0 and 2.5 times increased risk of early mortality in ESRD and CKD patients, respectively, compared to PCI. In ESRD patients, CABG demonstrated a 66% decreased risk of myocardial infarction compared to PCI. The American Journal of Therapeutics findings noted CABG was associated with an 88% and 73% decreased risk of repeat revascularization in ESRD and CKD patients, respectively.

High Salt Intake Linked with Increased Risk of Cardiovascular Disease in Adults with Type 2 Diabetes

In a recent study from Japan that surveyed 1588 adults with type 2 diabetes, those who consumed an average of 5.9 g of sodium daily had double the risk of developing cardiovascular disease than those who ate an average of 2.8 g of sodium daily. Among patients who had HbA1c ≥9.0%, cardiovascular disease risk in patients in the top vs. bottom quartile of sodium intake was dramatically elevated compared with patients with HbA1c <9.0%. The findings are published in the Journal of Clinical Endocrinology & Metabolism.

Blood and Pulse Pressures Affect Kidney Outcomes in Patients with Type 2 Diabetes

Compared to type 2 diabetics with systolic blood pressure (SBP) of 105 to 129 mm Hg, those with SBP of 130 to 139 mm Hg were 88% more likely to have worsening albumin-to-creatinine ratio (ACR) and those with SBP ≥140 mm Hg were 2.5-fold more likely. Compared to a pulse pressure (PP) of 40 to 49 mm Hg, PP <40 was associated with a 64% lower risk of worsening ACR and PP ≥60 with a 2.4-fold increased risk. Patients with SBP ≥140 mm Hg were 15% more likely than those with SBP <140 mm Hg to experience eGFR worsening for each 1% A1C increase. The Diabetes Carestudy included 1791 diabetic veterans.

Study Warns of Risks From Use of Niacin for Controlling Cholesterol

USA Today (7/17, Weintraub, Today) reported that “niacin, a drug commonly prescribed to prevent stroke and heart attack, appears to add little benefit to the statins it is usually taken with, but it may cause significant risks, according to a new study and editorial in The New England Journal of Medicine.” Researchers found that “as many as one in 200 patients may have died as a result of taking the combination of niacin and laropiprant, a drug intended to reduce the facial flushing caused by niacin.”

Statins before Coronary Catheterization Linked with Reduced Risk of Contrast-Induced AKI

Among nearly 5000 patients who underwent coronary catheterization, the incidence of contrast-induced AKI was 3.91% in those who received a statin prior to the procedure, and 6.98% in those who did not. Overall, statin users had a 46% decreased risk of contrast-induced AKI compared to nonusers. Statin use was also associated with a 33% decreased risk of contrast-induced AKI among patients with eGFR <60 mL/min/1.73 m² and a 60% decreased risk among in patients with GFR ≥60. The findings, which pertain to data from 8 randomized controlled trials, are published in the American Journal of Cardiology.

Androgen deprivation therapy may not extend lives of patients with early prostate cancer.

The New York Times (7/15, A16, O'Connor) “Well” blog reports that research published in JAMA Internal Medicine suggests that “androgen deprivation therapy does not extend the lives of” patients with early prostate cancer. Investigators “followed tens of thousands of men with early prostate cancer for as long as 15 years and found that those who received androgen deprivation therapy lived no longer on average than those who did not.”
        The Newark (NJ) Star-Ledger (7/15, Rose) points out that “side effects from ADT include metabolic syndrome – linked to heart disease – and an increased risk of bone fracture, said Grace Lu-Yao, PhD, who led the study.”
        Study: Physicians drive treatment decisions in low-risk prostate cancer. Reuters (7/15, Seaman) reports that researchpublished in JAMA Internal Medicine suggests that physician characteristics may play a larger role than disease characteristics when it comes to how patients with low-risk prostate cancer are initially treated.
        Modern Healthcare (7/14, Subscription Publication) reports that investigators “analyzed data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program as well as Medicare claims for men ages 66 and older.”
        HealthDay (7/15, Reinberg) reports that the investigators “found that most men are getting their prostate removed or undergoing radiation therapy when carefully watching the cancer may be just as effective without the risks and side effects of surgery or radiation.” The study “found that doctors who were older were more likely to recommend surgery or radiation rather than observation.” Additionally, “men were more likely to have surgery or radiation therapy if their urologist did that procedure...added” lead researcher Dr. Karen Hoffman.
        MedPage Today (7/15, Bankhead) reports that altogether, approximately “20% of the men chose active surveillance as the initial approach to management.” The “rates of active surveillance among the diagnosing urologists varied from 4.5% to 64% of patients.”

Total Mass of Hydroxyethyl Starch Molecules Appears to Harm Kidney Cells

The increased risk of kidney injury related to the use of hydroxyethyl starch (HES) in resuscitation fluids reflects the total mass of HES molecules, according to researchers. Other factors, such as differences in the origin or molecular weight of HES solutions, appear to play little or no role in cellular-level toxicity of HES. The effect of HES mass on cultured human renal proximal tubule cells was dose-dependent; the greater the molecular mass, the greater the evidence of cell toxicity. The toxic effects started very soon after cells were exposed to HEC, according to the Anesthesia & Analgesia study.

Hospital-Acquired AKI Linked with High Mortality and Longer Hospital Stays than Community-Acquired AKI

In a recent analysis of 306 patients with AKI who received intermittent hemodialysis at a UK center and had a 6-month follow-up visit, survival rates at hospital discharge were significantly lower for patients who had hospital-acquired AKI than patients who had community-acquired AKI (42.9% vs. 72%). The survival rates at 6 months, however, did not differ significantly (82.8% vs. 87.5%). Investigators also found that 35% of the group with community-acquired AKI was dialysis dependent at hospital discharge compared with 16.7% of the group with hospital-acquired AKI. The findings are published in the European Journal of Internal Medicine.

Genetic Recipe Turns Stem Cells into Blood Cells

Researchers have uncovered 2 genetic programs that direct human stem cells to become red and white blood cells. By overexpressing just 2 transcription factors (ETV2 and GATA2 or GATA2 and TAL1), the researchers could reproduce the sequence of events that occur in the embryo when blood cells are formed. For every million stem cells, the researchers were able to produce 30 million blood cells. A critical aspect of the work is the use of modified messenger RNA to direct stem cells toward particular developmental fates. The advance is described in a Nature Communications study.

Wednesday, August 13, 2014

PN May Be Better Than RN in Preserving Renal Function Despite Kidney Tumor Size

Renal and Urology News reported that research published online in Urologic Oncology suggests that “partial nephrectomy (PN) is superior to radical nephrectomy (RN) in preserving renal function even when tumors are larger than the traditional 4 cm cutoff.” Investigators came to this conclusion after analyzing “data from 973 patients with renal tumors.”

Lack Of Exercise, Rather Than Overeating, May Be Fueling America’s Obesity Epidemic

The Los Angeles Times “Science Now” blog reported that research published in the American Journal of Medicine “suggests that under-exercising, rather than overeating, may be at the heart of America’s obesity epidemic,” with the data indicating “a strong correlation between the rise in obesity and a striking drop in the amount of time Americans spend exercising when not at work over the last 22 years.”

Kidney Stone History Linked with Increased Risk of CKD

Individuals with a history of kidney stones were 1.5 times more likely have CKD and 2.4 times more likely to receive dialysis than those without a history of kidney stones in a recent analysis of 5971 participants of NHANES from 2007 to 2010. The increased risk appeared to be driven by women: those with a history of kidney stones had a 1.8-fold increased risk of CKD and a 3.3-fold increased risk of receiving dialysis. There was not a significant link between kidney stone history and CKD or dialysis treatment in men. Thefindings are published in The Journal of Urology.