This Month in AJKD

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Forced Euvolemic Diuresis With Mannitol and Furosemide for Prevention of Contrast-Induced Nephropathy in Patients With CKD Undergoing Coronary Angiography: A Randomized Controlled Trial , 18 June 2009
Sumit R. Majumdar, Carl M. Kjellstrand, Wayne J. Tymchak, Marilou Hervas-Malo, Dylan A. Taylor, Koon K. Teo
American Journal of Kidney Diseases
October 2009 (Vol. 54, Issue 4, Pages 602-609)
Abstract | Full Text | Full-Text PDF (440 KB)

Sodium Bicarbonate Plus Isotonic Saline Versus Saline for Prevention of Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography: A Randomized Controlled Trial , 21 July 2009
Ali Vasheghani-Farahani, Gelareh Sadigh, Seyed Ebrahim Kassaian, Seyed Mohammad Reza Khatami, Akbar Fotouhi, Seyed Amir Hossein Razavi, Mohammad Ali Mansournia, Ahmad Yamini-Sharif, Alireza Amirzadegan, Mojtaba Salarifar, Saeed Sadeghian, Gholamreza Davoodi, Mohammad Ali Borumand, Farah Aiatollahzade Esfehani, Sirous Darabian
American Journal of Kidney Diseases
October 2009 (Vol. 54, Issue 4, Pages 610-618)
Abstract | Full Text | Full-Text PDF (431 KB)

Contrast-Induced Nephropathy: We Need All the Data to Discern the Truth
Brendan J. Barrett
American Journal of Kidney Diseases
October 2009 (Vol. 54, Issue 4, Pages 587-589)
Full Text | Full-Text PDF (134 KB)

Benefits and Harms of Phosphate Binders in CKD: A Systematic Review of Randomized Controlled Trials , 19 August 2009
Sankar D. Navaneethan, Suetonia C. Palmer, Jonathan C. Craig, Grahame J. Elder, Giovanni F.M. Strippoli
American Journal of Kidney Diseases
October 2009 (Vol. 54, Issue 4, Pages 619-637)
Abstract | Full Text | Full-Text PDF (763 KB) | Add-Ons

Prehypertension, Obesity, and Risk of Kidney Disease: 20-Year Follow-up of the HUNT I Study in Norway , 11 June 2009
John Munkhaugen, Stian Lydersen, Tor-Erik Widerøe, Stein Hallan
American Journal of Kidney Diseases
October 2009 (Vol. 54, Issue 4, Pages 638-646)
Abstract | Full Text | Full-Text PDF (334 KB)

Recurrent and Relapsing Peritonitis: Causative Organisms and Response to Treatment , 06 July 2009
Cheuk-Chun Szeto, Bonnie Ching-Ha Kwan, Kai-Ming Chow, Man-Ching Law, Wing-Fai Pang, Kwok-Yi Chung, Chi-Bon Leung, Philip Kam-Tao Li
American Journal of Kidney Diseases
October 2009 (Vol. 54, Issue 4, Pages 702-710)
Abstract | Full Text | Full-Text PDF (688 KB)

Article Outline

• Approaches to Prevention of Contrast-Induced Nephropathy

• Benefits and Harms of Phosphate Binders in CKD

• Prehypertension, Obesity, and Risk of Kidney Disease

• Causative Organisms and Response to Treatment of Recurrent and Relapsing Peritonitis

Approaches to Prevention of Contrast-Induced Nephropathy

See Majumdar et al, pages 602-609; Vasheghani-Farahani et al, pages 610-618; and Barrett, pages 587-589.

Numerous strategies have been tested to prevent contrast-induced nephropathy. Forced euvolemic diuresis with osmotic or loop diuretics was widely used until a study of 78 individuals by Solomon and colleagues noted an unexpected increase in risk of kidney failure with saline plus mannitol or furosemide. In this issue, Majumdar and colleagues report the results of a randomized trial of saline plus mannitol and furosemide versus saline alone in 92 patients undergoing coronary angiography. They found that contrast-induced nephropathy occurred in significantly more patients assigned to the forced diuresis intervention than controls (23 [50%] vs 13 [28%], respectively). In a meta-analysis of a total of 251 patients from their study, the Solomon study, and 1 other trial, the pooled relative risk associated with forced diuresis versus hydration alone was 2.15 (95% confidence interval, 1.37-3.37). Also in this issue, Vasheghani-Farahani et al report the results of a randomized, double-blind, controlled trial comparing the effect of saline supplemented with sodium bicarbonate versus saline alone. Among 265 patients undergoing coronary angiography participating in the trial, only 16 (6%) developed contrast-induced nephropathy and there was no significant difference between groups. An editorial by Dr Barrett raises several methodological issues, and emphasizes the importance of publishing results of confirmatory clinical trials.

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Benefits and Harms of Phosphate Binders in CKD

See Navaneethan et al, pages 619-637.

Phosphate binders are widely used to control serum phosphorus levels in patients with CKD. In this issue, Navaneethan et al performed a systematic review and meta-analysis of published trials to analyze effects of calcium-based phosphate binders, sevelamer, and lanthanum on both clinical and biochemical outcomes. Analyses of 40 trials covering 6,406 participants demonstrated no significant differences in all-cause mortality or hospitalizations among phosphate binder groups. There were significant differences among groups in end-of-treatment serum calcium, phosphorus, calcium-phosphorus product and parathyroid hormone levels, risk of hypercalcemia, and risk of gastrointestinal adverse events. From these results, Navaneethan et al conclude that there are insufficient data to establish the comparative superiority of non–calcium-binding agents over calcium-containing phosphate binders, and that additional trials are still required.

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Prehypertension, Obesity, and Risk of Kidney Disease

See Munkhaugen et al, pages 638-646.

The combined effect of blood pressure and body weight on risk of kidney disease has not been previously studied. In this issue, Munkhaugen et al examine the interaction between blood pressure and body weight on the risk for ESRD- or CKD-related death as part of the Health Study in Nord-Trøndelag (HUNT 1). Blood pressure and body weight of 74,986 adults were measured using standard procedures, and other relevant covariates were obtained from an extensive questionnaire. The authors found that during a median follow-up time of 21 years (1,345,882 person-years), 507 men (1.4%) and 319 women (0.8%) either initiated renal replacement therapy (n = 157) or died from CKD (n = 669). In multivariable models, the risk of outcomes increased continuously at higher blood pressures, with no lower threshold for blood pressure. The risk associated with body weight started to increase from a body mass index of 25 kg/m2; however, there was no increased risk associated with higher BMI in individuals with blood pressure below 120/80 mm Hg. Among participants with prehypertension, an increased risk of kidney outcomes was only appreciated in those with BMI of 30 kg/m2 or higher. Accordingly, the authors conclude that prehypertension is a substantial risk factor for kidney disease outcomes only in individuals with coexistent obesity.

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Causative Organisms and Response to Treatment of Recurrent and Relapsing Peritonitis

See Szeto et al, pages 702-710.

The clinical course and optimal treatment of relapsing and recurrent peritonitis remain poorly understood. In this issue, Szeto et al report a 14-year retrospective single-center study of a large peritoneal dialysis unit. They describe 157 relapsing episodes (defined as peritonitis either due to the same organism or culture-negative episode occurring within 4 weeks of completion of therapy), 125 recurrent episodes (defined as peritonitis ascribed to a different organism within 4 weeks of completion of therapy for a prior episode), and 764 control episodes of peritonitis (first peritonitis episode with neither subsequent relapse nor recurrence). In comparison with the control group, relapsing and recurrent peritonitis differed in causative agents and rates of primary response, complete cure, and mortality. Szeto et al conclude that relapsing and recurrent peritonitis episodes are caused by different spectra of bacteria and probably represent 2 distinct clinical entities, with recurrent peritonitis having a worse prognosis than relapsing peritonitis.

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PII: S0272-6386(09)01093-2

doi:10.1053/S0272-6386(09)01093-2

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