Vitamin D receptor activators may not reduce cardiovascular risk in patients undergoing hemodialysis.

1. In this randomized clinical trial, patients on hemodialysis who received a vitamin D receptor activator (VDRA) did not have better cardiovascular health compared to those with placebo. 2. Patients receiving active vitamin D did not have reduced mortality. Evidence Rating Level: 1 (Excellent) Study Rundown: Patients with advanced chronic kidney disease (CKD) on hemodialysis []

Renin-angiotensin inhibitors may reduce mortality and heart failure readmissions in patients with transcatheter aortic valve replacement

1. In this retrospective cohort study of transcatheter aortic valve replacement (TAVR) patients, Renin-Angiotensin System (RAS) inhibitors administered at hospital discharge reduced mortality and hospital readmission in patients with preserved but not reduced Left Ventricular Ejection Fraction (LVEF). 2. There was no clinically meaningful difference in disease-specific health status with RAS inhibitors. Evidence Rating Level: []

Interpreting genetic variants in kidney and genitourinary disorders will likely require systematic curation of clinical variant databases

1. This secondary analysis of genetic data emphasized the high number of potentially "pathogenic" variants that are revealed through exome sequencing when analyzing a large cohort of self-reported healthy adults. 2. The authors of this study concluded that with exome sequencing becoming a more frequently used tool in clinical diagnostics, it will be critical to ensure systematic curation of clinical variant databases across medical subspecialties and large, longitudinal studies.

Diabetes patients with high-deductible health care plans may delay seeking crucial care

1. In this study, patients with high-deductible health care plans were more likely to delay seeking care for the treatment of macrovascular complications of diabetes. 2. Patients with high-deductible health care plans, compared to those with low-deductible health care plans, were also less likely to undergo procedure-based treatments for diabetes complications. Evidence Rating Level: 2 []

Quick Take: Intravenous Iron in Patients Undergoing Maintenance Hemodialysis

Patients undergoing hemodialysis typically receive intravenous iron, despite a lack of established clinical efficacy. In this randomized controlled trial, investigators randomized 2141 patients undergoing hemodialysis to either high-dose iron sucrose, administrated proactively, or low-dose iron-sucrose, administered reactively to compare the safety and efficacy of these regimens in patients undergoing hemodialysis. The primary outcome examined was []

Angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use linked with decreased mortality after inpatient acute kidney injury.

1. In this retrospective cohort study looking at patients admitted to hospital with acute kidney injury, use of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker within six months was associated with decreased mortality. 2. Angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use was also associated with increased risk of hospitalization for a renal cause (hyperkalemia, []

Intensive blood pressure lowering favored to not induce kidney disease, contrary to prior research

1. Patients managed with intensive blood pressure reduction were found to have significantly greater decreases in kidney damage biomarkers compared to standard blood pressure management. 2. Higher levels of kidney damage biomarkers at baseline were associated with greater odds of developing chronic kidney disease. Evidence Rating Level: 2 (Good) Study Rundown: Systolic blood pressure (SBP) []

Early and delayed renal-replacement therapy for septic shock associated acute kidney injury show similar mortality: the IDEAL-ICU trial

1. Among patients with septic shock and acute kidney injury (AKI), there was no significant difference in 90-day mortality between early (within 12 hours) and delayed (after 48 hours) initiation of renal-replacement therapy (RRT). 2. Patients in the delayed group had significantly more days free from RRT, with no significant differences compared to the early []

Lower patient satisfaction reported at for-profit dialysis centers

1. Patient reported experience has recently been incorporated into Quality Incentive Programs for dialysis centers across the United States. Lower patient experience scores were reported in for-profit, free-standing, and large dialysis organization centers. 2. Centers with higher proportion of black and Native American patients had lower patient reported experience scores. Evidence Rating Level: 3 (Average)       []

Nonsurgical treatment of small tumor renal cancer may be as effective as radical nephrectomy but with fewer complications

1. Rates of renal insufficiency were highest in patients receiving renal nephrectomy, compared to less invasive treatments. 2. Survival rates for renal nephrectomy and partial nephrectomy were very similar, suggesting little difference in efficacy between these treatments. Evidence Rating Level: 2 (Good) Study Rundown: Renal stage carcinoma (RCC) has relatively low mortality rates with respect []

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