The Annual Meeting of the American Society of Nephrology, Kidney Week 2017
The annual meeting of the American Society of Nephrology was held from Oct. 15 to Nov. 5 in New Orleans and attracted approximately 13,000 participants from around the world, including nephrology specialists, researchers, scientists, and other health care professionals. The conference featured presentations focusing on the latest advances in the management of patients with kidney diseases and related disorders.
In one study, Marc Dewey, M.D., of Charité in Berlin, and colleagues found that acute kidney injury was less likely after intravenous rather than after intra-arterial contrast agent administration in patients with suspected coronary artery disease (CAD).
The investigators found that contrast-induced acute kidney injury occurred in 5.6 percent of patients in the coronary computed tomography angiography (CTA) group and 13.2 percent of patients in the cardiac catheterization group. If only patients without obstructive CAD by the two tests were analyzed, contrast-induced acute kidney injury again occurred less often in the CTA group (4.3 percent) as compared with the cardiac catheterization group (11.9 percent).
At long-term follow-up after a median of 1.9 years, a greater proportion of patients with acute kidney injury still had increased creatinine (38 versus 6 percent).
“Importantly, contrast-induced acute kidney injury was associated with impaired chronic kidney function. This information should be considered for clinical decision making in patients who have a clinical indication for imaging procedures with intravenous or intra-arterial contrast agent administration,” said Dewey. “Further trials in other patient cohorts are warranted.”
In the Time to Reduce Mortality in End-Stage Renal Disease (TiME) trial, Laura M. Dember, M.D., of the University of Pennsylvania Perelman School of Medicine in Philadelphia, and colleagues randomized dialysis units to either the intervention group or the usual care group. Facilities with intervention units were to adopt an approach of prescribing dialysis sessions of at least 4.25 hours for incident patients. Facilities with usual care units had no trial-driven approach to session duration. The primary outcome was mortality, and the major secondary outcomes were hospitalizations and quality of life.
The investigators found no between-group differences in mortality or hospitalization rate.
“The results of the trial will not have an immediate impact on clinical practice but provide extremely important precedents and lessons that will advance the conduct of pragmatic trials in dialysis and more broadly,” said Dember.
Several authors disclosed financial ties to pharmaceutical and medical device companies.
In the REPRISE trial, Vicente E. Torres, M.D., of the Mayo Clinic in Rochester, Minnesota, and colleagues found that tolvaptan is effective in treating autosomal dominant polycystic kidney disease (ADPKD) and may delay the need for dialysis or kidney transplantation.
“Based on the TEMPO 3:4 [trial] results, tolvaptan was approved for the treatment of rapidly progressive ADPKD in Japan, Canada, European Union, Switzerland, and South Korea,” said Torres. “In the United States, the Food and Drug Administration requested additional data to further evaluate its efficacy and safety. The REPRISE trial was performed to determine the efficacy and safety of tolvaptan in more advanced ADPKD (eGFR 25 to 65 ml/minute/1.73 m²) with monthly monitoring of liver enzymes,” said Torres.
He added that the results of REPRISE over one year in patients with later-stage disease, together with those of TEMPO 3:4 and TEMPO 4:4 over five years in early-stage disease, show that tolvaptan is effective and may delay the need for dialysis or kidney transplantation.
“Assuming that tolvaptan treatment would continue to slow the decrement in the estimated glomerular filtration rate (eGFR) by 1.27 milliliters per minute per year, the time from an eGFR of 41 ml/minute/1.73 m² (average baseline eGFR in REPRISE) to chronic kidney disease [stage 5] (eGFR of 15 mL/minute) would be extended from 6.2 years to nine years. A larger benefit might be expected if treatment were started earlier,” Torres said.
The study was funded by Otsuka Pharmaceuticals and Otsuka Pharmaceutical Development and Commercialization.
ASN: Tolvaptan Slows eGFR Decline in Later-Stage ADPKD
MONDAY, Nov. 6, 2017 (HealthDay News) — For patients with later-stage autosomal dominant polycystic kidney disease (ADPKD), tolvaptan is associated with a slower decline in estimated glomerular filtration rate (eGFR) than placebo, according to a study published online Nov. 4 in the New England Journal of Medicine to coincide with presentation at the annual meeting of the American Society of Nephrology, being held Oct. 31 to Nov. 5 in New Orleans.
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