Volume 58, Issue 3 , Pages A24-A25, September 2011
This Month in AJKD
Article Outline
Loss to Analysis in RCTs
See Deo et al, pages 349-355; and Palmer et al, pages 335-337.
Nephrology has few RCTs when compared with many other medical specialties, in part because many kidney diseases progress slowly and long-term follow-up is necessary to explore hard outcomes. Given this, the quality of many RCTs can be compromised by lack of transparency in accounting for loss of participants to analysis. In this issue, Deo et al systematically evaluated RCTs in individuals with CKD regarding reporting and accounting of missing data in outcome analysis. They concluded it was unclear who was included or excluded in primary analyses in many CKD trials, leading to questions on validity and the need to have more uniform and transparent reporting methods. In the accompanying editorial, Palmer et al agree with the authors on the need to improve reporting to foster both better trials and more confidence in the results of intervention trials in nephrology.
ICDs in Dialysis Patients
See Charytan et al, pages 409-417; and Lam et al, pages 338-339.
Sudden cardiac death is the leading cause of death in dialysis patients. ICD use in dialysis patients has been increasing, yet it remains unknown whether these devices have a meaningful mortality benefit in dialysis patients. In this issue, Charytan et al analyzed trends of ICD use and estimated rates and correlates of fatal and nonfatal outcomes in dialysis patients who received an ICD. The authors concluded that, despite the rise in the use of ICDs, the rates of all-cause and cardiovascular mortality remained high in dialysis patients receiving these devices and that there was no evidence of an enduring benefit associated with ICD placement. They emphasize that randomized trials of ICDs in dialysis patients are needed to determine their efficacy and safety. In the accompanying editorial, Lam et al suggest that due to cost, feasibility, and ethical concerns it is unlikely many large RCTs of ICDs will be performed in long-term dialysis patients. They emphasize the importance of realistic discussions between nephrologists and the patients and families regarding prognosis and health care goals when deciding which treatments are most appropriate.
Serum Albumin and Mortality in PD
See Mehrotra et al, pages 418-428.
Over the years, the US Centers for Medicare & Medicaid Services has launched initiatives to monitor the quality of care in dialysis units. Serum albumin has been a key measure included in some of these initiatives. Low serum albumin is associated with increased mortality in dialysis patients and may represent a simple measure of their health status. In part reflecting albumin loss with PD, the level of serum albumin for which mortality risk increases for PD patients may differ from that in HD patients. In this issue, Mehrotra et al conclude that serum albumin levels differ by dialysis modality, with increased mortality risk not seen until lower serum albumin threshold in PD versus HD. They suggest that this difference should be considered by agencies and organizations when setting quality of care standards.
PII: S0272-6386(11)01082-1
doi:10.1053/S0272-6386(11)01082-1
Volume 58, Issue 3 , Pages A24-A25, September 2011
