Revisting 2011:American College of Nephrology Update

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1. Kidney patients using harmful dietary supplements

About 10-15% patients with chronic kidney disease reported using potentially nephrotoxic dietary supplements, an analysis of a large government database showed. Overall, 52.4% of 21,169 survey respondents reported using dietary supplements. The likelihood of self-reported supplement use was increased among individuals with chronic kidney disease. Total supplement use included substances identified as potentially nephrotoxic by the National Kidney Foundation in 15.3% of cases.

2. Which blood pressure is tied to declining renal function?

A rise in systolic blood pressure (SBP) is associated with greater odds of a rapid decline in kidney function in the general older population. Among men and women 65 and older, those with the highest SBP — 160 mm Hg or greater — had about double the chances of their renal function worsening at a fast clip (OR 2.10, 95% CI 1.64 to 2.67), according to Dr Dena Rifkin,  of the University of California San Diego in the American Society of Nephrology meeting. The relationship is independent of either diastolic blood pressure or pulse pressure.

The placebo arm of the SHEP (Systolic Hypertension in the Elderly Program) trial earlier also had shown similar results.

The study examined  4,365 older adults (mean age 72) enrolled in the Cardiovascular Health Study. The mean estimated glomerular filtration rate at baseline was 80 mL/min/1.73 m2. A rapid decline in kidney function was defined as a drop of at least 3 mL/min/1.73 m2 per year. Baseline SBP readings ranged from less than 120 mm Hg up to 160 mm Hg and higher. Moving from the lowest to the highest pressure groups, there was an increase in the odds of having a rapid kidney function decline for systolic, diastolic, and pulse pressure. The use of antihypertensives did not affect the association.

3. HCV positive patients on dialysis not receiving treatment

In a large, international cohort study of patients on hemodialysis, only one in every 100 of those who were HCV-positive received antiviral treatment, according to David Goodkin, MD, of the Arbor Research Collaborative for Health in Ann Arbor, Mich.

4. Women diabetics more at risk for CKD

Among patients with type 2 diabetes, women are more likely to have risk factors for chronic kidney disease than men, which may also put them at risk for poorer outcomes. At baseline, diabetic women were more likely to be obese, to have high LDL cholesterol, and to have an estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2 (ORs 1.31 to 2.20), according to Margaret Yu, MD, of the University of Washington in Seattle.

5. In CKD keep A1c between 6-8%

In one study of patients on hemodialysis, reported by Kamyar Kalantar-Zadeh, MD, PhD, of the Harbor-UCLA Medical Center in Torrance, Calif., glycated hemoglobin (HbA1c) levels outside of 6-8% were associated with worse survival during six years of follow-up.

6. Safe limits of cola drinks is no more than 1 drink a day

Consuming beverages flavored with either sugar or artificial sweeteners is associated with a higher risk of developing hypertension. In three large, prospective studies of healthcare professionals, drinking at least one sweetened beverage a day was associated with a 6-20% greater relative risk of receiving a hypertension diagnosis from a doctor, John Forman, MD, of Harvard Medical School.

7. Hypertension in pregnancy has lingering effects

Development of a hypertensive pregnancy disorder is associated with greater risks of adverse cardiovascular and renal outcomes for the mother later in life. Among women followed after a successful delivery, those with gestational hypertension or preeclampsia during pregnancy had higher rates of hypertension, renal disease, and stroke in their 40s and beyond (P<0.01 for all), according to Dr Vesna Garovic, of the Mayo Clinic in Rochester, Minn. The association could be explained by risk factors common to both preeclampsia and cardiovascular and renal disease — including endothelial dysfunction — or by metabolic and vascular changes induced by preeclampsia.