Left Ventricular Hypertrophy in Mild and Moderate Reduction in Kidney Function Determined Using Cardiac Magnetic Resonance Imaging and Cystatin C: The Multi-Ethnic Study of Atherosclerosis (MESA)
, 09 October 2008
Andrew Moran, Ronit Katz, Nancy Swords Jenny, Brad Astor, David A. Bluemke, João A.C. Lima, David Siscovick, Alain G. Bertoni, Michael G. Shlipak
American Journal of Kidney Diseases
November 2008 (Vol. 52, Issue 5, Pages 839-848) Abstract |
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Prevalence and Associations of Coronary Artery Calcification in Patients With Stages 3 to 5 CKD Without Cardiovascular Disease
, 18 June 2008
Jocelyn S. Garland, Rachel M. Holden, Patti A. Groome, Miu Lam, Robert L. Nolan, A. Ross Morton, William Pickett
American Journal of Kidney Diseases
November 2008 (Vol. 52, Issue 5, Pages 849-858) Abstract |
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Intravenous Versus Oral Iron Supplementation for the Treatment of Anemia in CKD: Systematic Review and Meta-analysis
, 09 October 2008
Benaya Rozen-Zvi, Anat Gafter-Gvili, Mical Paul, Leonard Leibovici, Ofer Shpilberg, Uzi Gafter
American Journal of Kidney Diseases
November 2008 (Vol. 52, Issue 5, Pages 897-906) Abstract |
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Add-Ons
Safety of Ferumoxytol in Patients With Anemia and CKD
, 29 September 2008
Ajay Singh, Tejas Patel, Joachim Hertel, Marializa Bernardo, Annamaria Kausz, Louis Brenner
American Journal of Kidney Diseases
November 2008 (Vol. 52, Issue 5, Pages 907-915) Abstract |
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Ferumoxytol as a New, Safer, Easier-to-Administer Intravenous Iron: Yes or No?
Michael Auerbach
American Journal of Kidney Diseases
November 2008 (Vol. 52, Issue 5, Pages 826-829) Full Text |
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Cost-Effectiveness of Breast Cancer Screening in Women on Dialysis
, 16 September 2008
Germaine Wong, Kirsten Howard, Jeremy R. Chapman, Jonathan C. Craig
American Journal of Kidney Diseases
November 2008 (Vol. 52, Issue 5, Pages 916-929) Abstract |
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Add-Ons
Breast Cancer Screening and Dialysis: Too Much or Too Little
Idris Guessous, Valerie Duhn, William McClellan
American Journal of Kidney Diseases
November 2008 (Vol. 52, Issue 5, Pages 830-833) Full Text |
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Management of Hyperuricemia and Gout in CKD
Angelo L. Gaffo, Kenneth G. Saag
American Journal of Kidney Diseases
November 2008 (Vol. 52, Issue 5, Pages 994-1009) Full Text |
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Left Ventricular Hypertrophy (LVH) is associated with later stages of CKD, but the association of LVH with mild reduction in kidney function is not known. In this issue, Moran and colleagues examined serum cystatin C levels and cardiac MRI in 4,971 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) Study with creatinine-based estimated GFR above 60 mL/min/1.73 m2. Participants with cystatin C–based estimated GFR 75 mL/min/1.73 m2 or less had a 2.3 g/m2 higher mean left ventricular mass index than those with estimated GFR above 75 after adjustment for age, sex, ethnicity, MESA site, current smoking, and diabetes; this remained significant after adjusting for hypertension. These findings suggest that increased cardiovascular risk may begin in very early stages of CKD.
Coronary Artery Calcification in Stages 3-5 CKD Without Clinical Cardiovascular Disease
See Garland et al, pages 849-858.
CKD patients have a high prevalence of coronary artery calcification, suggesting that the CKD milieu may induce vascular calcification. In this issue, Garland et al examined 119 patients with stage 3 to 5 CKD (excluding patients on dialysis) without known cardiovascular disease. Coronary artery calcification was measured by multi-slice CT scan and GFR estimated using the 4-variable MDRD Study equation. There were 32.8% of patients with minimal calcification (Agaston score <10) despite substantially reduced kidney function. In univariate and adjusted models, coronary artery calcification was associated with traditional cardiovascular disease risk factors but not with estimated GFR, suggesting that cardiovascular risk may be more closely associated with traditional factors than kidney function itself.
See Rozen-Zvi et al, pages 897-906; Singh et al, pages 907-915; and Auerbach et al, pages 826-829.
Two articles examining intravenous iron supplementation for the treatment of anemia in CKD appear in this issue of AJKD. In the first, Rozen-Zvi et al perform a systematic review and meta-analysis of randomized controlled trials comparing the safety and efficacy of intravenous to oral iron in stages 3 to 5 CKD patients (including dialysis). They noted that hemoglobin response was 0.8 g/dL greater in dialysis patients treated with intravenous iron; this difference was smaller but remained significant in CKD patients not on dialysis. There was no difference in adverse events between the IV and orally treated patients. In the second article, Singh et al report the results of a randomized trial comparing the safety of ferumoxytol, an intravenous iron preparation, to placebo for the treatment of patients with CKD, showing no increased risk of side effects with ferumoxytol. In an accompanying editorial, Dr Auerbach reviews options for iron supplementation and scrutinizes the risks associated with intravenous iron preparations.
See Wong et al, pages 916-929; and Guessous et al, pages 830-833.
Screening mammography is recommended for women over age 50 in the general population, but the shorter life expectancy among dialysis patients due to mortality from causes other than breast cancer raises questions about the utility of this practice in dialysis patients. In this issue, Wong et al use a deterministic Markov model to estimate the incremental costs and benefits of breast cancer screening in a hypothetical cohort of 1,000 nondiabetic and diabetic women who initiated dialysis at 50 years of age and did not receive a kidney transplant. Over 30 years, breast cancer mammography screening prevented 1 death with a net gain in life expectancy of 1.3 days for each woman in the cohort. The cost per life years saved was $109,852 for the overall cohort and approached $1 million when limited to diabetic women on dialysis. An editorial by Guessous and colleagues outlines potential ways to increase cost-effectiveness of breast cancer screening among women on dialysis and reminds us that no model can substitute for a clinical trial.
The management of hyperuricemia and gout in patients with CKD and decreased kidney function presents many challenges. In this issue’s In Practice feature, Drs Gaffo and Saag review the epidemiology, pathophysiology, and clinical manifestations of hyperuricemia and gout, and discuss the different therapeutic options.
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