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Diabetes is a leading cause of kidney failure leading to CKD (chronic kidney disease) and kidney failure, that may necessitate Dialysis or Hemodialysis. Diabetes is an increasing problem in the United States, often associated with the growing obesity epidemic.
Hemodialysis.com presents ongoing research articles into diabetes research and management and the implications for chronic kidney disease.
Diabetes | Dialysis | Hemodialysis
| Chronic Kidney Disease
Author Interview: Tomonari Ogawa, M.D. Ph.D
Ogawa, T., Murakawa, M., Matsuda, A., Kanozawa, K., Kato, H., Hasegawa, H. and Mitarai, T. (2011),Hemodialysis International. doi: 10.1111/j.1542-4758.2011.00640.x
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ASN 2011 Abstract Authors' Interview:
Hypoglycemia-Related Hospitalization in Diabetic Hemodialysis Patients.
Eduardo Lacson, Jr., MD, MPH, Weiling Wang, MS, Michael Lazarus, MD, Mark Williams, MD
Fresenius Medical Care, Waltham, MA, and Joslin Diabetes Center, Boston, MA
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Author Interview: Sirin Jiwakanon, MD.
Change in Ankle-Brachial Indices over Time and Mortality in Diabetics with Proteinuria
ASN 2011 Abstract:
Sirin Jiwakanon, MD, Sharon G. Adler, MD, FASN, Rajnish Mehrotra, MD, FASN. Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA; Medicine, Hatyai Hospital, Hatyai, Songkhla, Thailand.
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Author Interview: Dr. Timothy Kenealy
Timothy Kenealy, Carolyn Raina Elley, John F. Collins, Simon A. Moyes,
Patricia A. Metcalf, and Paul L. Drury Nephrol. Dial. Transplant.
(2011)first published online September 13, 2011 doi:10.1093/ndt/gfr540
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Fresenius Medical Care Will Be a Speaker Sponsor at the American Diabetes Association's EXPO Pittsburgh
Company to Host Educational Seminars to Promote Awareness of Kidney Disease for the At-Risk Community
PITTSBURGH – November 1, 2011 – Diabetes is the single leading cause of kidney failure in the U.S., accounting for about 44 percent of the people who start treatment for kidney failure each year. To help raise awareness of the links between diabetes and chronic kidney disease (CKD), Fresenius Medical Care North America (FMCNA), the nation’s leading network of dialysis facilities, will be a speaker sponsor at the American Diabetes Association (the Association) EXPO Pittsburgh, to be held at the David L. Lawrence Convention Center, on Saturday, Nov. 5, from 9:00 a.m. – 4:00 p.m.
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Author Interview: Matthew Budoff, MD
Relationship of Estimated GFR and Coronary Artery Calcification in the CRIC (Chronic Renal Insufficiency Cohort) Study.
Budoff MJ, Rader DJ, Reilly MP, Mohler ER 3rd, Lash J, Yang W, Rosen L, Glenn M, Teal V, Feldman HI; CRIC Study Investigators.Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA.
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Holdaas H, Holme I, Schmieder RE, Jardine AG, Zannad F, Norby GE, Fellström BC; on behalf of the AURORA study group.
J Am Soc Nephrol. 2011 Jul;22(7):1335-1341
Renal Section, Oslo University Hospital, Rikshospitalet, Oslo, Sognsvannsveien 22, 0072 Oslo, Norway
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Author Interview: Barry I. Freedman, M.D.
Glycated Albumin and Risk of Death and Hospitalizations in Diabetic Dialysis Patients.
Freedman BI, Andries L, Shihabi ZK, Rocco MV, Byers JR, Cardona CY, Pickard MA, Henderson DL, Sadler MV, Courchene LM, Jordan JR, Balderston SS, Graham AD, Mauck VL, Russell GB, Bleyer AJ.
Clin J Am Soc Nephrol. 2011 May 19 |
Author Interview: Dr. Hallvard Holdaas:
Rosuvastatin in Diabetic Hemodialysis Patients.
Am Soc Nephrol. 2011 May 12.
Holdaas H, Holme I, Schmieder RE, Jardine AG, Zannad F, Norby GE, Fellström BC; on behalf of the AURORA study group.
Department of Nephrology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; |
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Centers for Disease Control and Prevention (CDC).
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Am J Med Sci. 2010 Oct 4.
Obert DM, Hua P, Pilkerton ME, Feng W, Jaimes EA.
From the Division of Nephrology (dmo, ph, mep, wf, eaj), Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; and VA Medical Center (eaj), Birmingham, Alabama. |
| Erythropoietic Response and Outcomes in Kidney Disease and Type 2 Diabetes
N Engl J Med 2010; 363:1146-1155 September 16 2010 Scott D. Solomon, M.D., Hajime Uno, Ph.D., Eldrin F. Lewis, M.D., M.P.H., Kai-Uwe Eckardt, M.D., Julie Lin, M.D., M.P.H., Emmanuel A. Burdmann, M.D., Ph.D., Dick de Zeeuw, M.D., Ph.D., Peter Ivanovich, M.D., Andrew S. Levey, M.D., Patrick Parfrey, M.D., Giuseppe Remuzzi, M.D., Ajay K. Singh, M.D., Robert Toto, M.D., Fannie Huang, M.S., Jerome Rossert, M.D., Ph.D., John J.V. McMurray, M.D., and Marc A. Pfeffer, M.D., Ph.D. for the Trial to Reduce Cardiovascular Events with Aranesp Therapy (TREAT) Investigators |
J Ren Nutr. 2010 Sep;20(5 Suppl):S89-94. Ngo B, Rongey C, Hiscox B, Rendell M, Woodley D, Smogorzewski M.
Department of Dermatology, University of Southern California, Keck School of Medicine, Los Angeles, California, USA. |
Clin J Am Soc Nephrol. 2010 Jul 29.
Williams ME et al
Joslin Diabetes Center, Boston, Massachusetts et al
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Clin J Am Soc Nephrol. 2010 Jul 29.
Ix JH. |
The heart and diabetic nephropathy.
Methodist Debakey Cardiovasc J. 2010 Apr-Jun;6(2):9-14.
Olivero JJ Jr.
Methodists DeBakey Heart & Vascular Center, Houston, Texas. |
Int Urol Nephrol. 2010 Jul 24. Israel E, et al
Department of Internal Medicine, Nephrology Division, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY, USA. |
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Curr Diab Rep. 2010 Jun 8.
Ndip A, et al |
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Semin Dial. 2010 Mar;23(2):191-7.
Passadakis PS, Oreopoulos DG. |
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This study explored factors in childhood that may help pediatricians and physicians predict the risk of diabetes later in adulthood.
Risk factors included:
Elevated Body Mass Index (BMI)
Elevated blood pressure
Parental diabetes
Laboratory changes: Glucose, Lipids, Insulin
The authors used a combination of these factors in childhood to predict later onset of Type II diabetes.
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Cerebral Microvascular Disease Predicts Renal Failure in Type 2 Diabetes -- Abstract
Takashi Uzu et al
Shiga University of Medical Science, Otsu, Shiga, Japan et al
Journal of the American Society of Nephrology
American Society of Nephrology
doi: 10.1681/ASN.2009050558 |
This study evaluated patients with Type 2 Diabetes for evidence of silent cerbral vascular injury by using MRI imaging. The authors report an increased risk of development of end stage renal disease in patients with abnormal, silent findings of cerebral vascular disease and concluded:
"independent of microalbuminuria, cerebral microvascular disease predicted renal morbidity among patients with type 2 diabetes.". |
Author Interviews: hemodialysis
- Dialysis - ESRD - CKD |
| Predictors of eGFR Decline in Type 2 Diabetes & Preserved Kidney Function: Dr. Chonchol CJASN |
| Tenecteplase for improvement of blood flow in dysfunctional hemodialysis catheters: Dr. Goldman Clin Neph |
| Religious coping, psychological distress and quality of life in hemodialysis: Dr. Carvalho J Psychosom Res. |
| Effect of captopril on recuperation from ischemia/reperfusion-induced AKI Nephrology Dialysis Transplant |
| Restless legs syndrome in dialysis: comparison of hemodialysis & CAPD: Dr. Merlino Neurol Sci. |
| International practice patterns & non-conventional hemodialysis utilization : Dr. Sood BMC Nephrology |
| Decreased PON1 in hemodialyzed & renal transplanted patients. Dr. Paragh Nephrol. Dial. Transplant |
| Preoperative Proteinuria & Long-Term Progression to Chronic Dialysis & Mortality after CABG: Drs. Chao & Ko : PLoS ONE |
| Creatinine generation is reduced in CVHD & predicts mortality: Dr. Wilson: Nephrology Dialysis Transplant |
Importance of normohydration for the long-term survival in hemodialysis : Dr. Wabel
Nephrology Dialysis Transplant |
| Local Tissue Renin-Angiotensin System Activation in Cardiorenal Metabolic Syndrome & Type 2 Diabetes: Dr.Hayden Cardiorenal Med |
| Group I nonreciprocal inhibition in restless legs syndrome secondary to CKD : Dr. Marconi Parkinsonism & Related Disorders |
Low-Dose ESAs and CV Geometry in CKD: Is Darbepoetin-α More Effective than Expected? Dr. Di Lullo
Cardiorenal Med |
Pharmacotherapy to improve outcomes in vascular access surgery: Dr. Jackson
Nephrology Dialysis Transplant |
| Parathyroidectomy for the attainment of NKF-K/DOQI™ and KDIGO recommended values for bone & mineral metabolism in dialysis with uncontrollable secondary hyperparathyroidism. Langenbecks Arch Surg |
| Bisphosphonate Therapy, Death, and Cardiovascular Events Among Female Patients With CKD: Dr. Perkins |
| Losartan prevents the development of the pro-inflammatory monocytes CD14+CD16+ in hemodialysis : Dr. Merino Nephrology Dialysis Transplant |
| Does Dialysis Modality Influence the Oxidative Stress of Uremia? Dr. Capusa Kidney Blood Press Res |
| Treatment of Periodontal Diseases Reduces Inflammation in Hemodialysis : Dr. Siribamrungwong |
| Declining Rates of Deceased Donor Renal Transplantation in the US Over Successive Years of Listing: Dr. Trivedi |
| When Is the Best Moment to Assess the Ankle Brachial Index: Pre- or Post-Hemodialysis?Dr. RM Elias |
| Role of Race and Poverty on Steps to Kidney Transplantation in the Southeastern US |
| Validity & Reliability of the MUST and MST Nutrition Screening Tools in Renal Inpatients : C. Lawson |
| Target-Orientated Algorithm for Regional Citrate-Calcium Anticoagulation in Extracorporeal Therapies: Dr. Brandl |
| Evaluation of bone microarchitecture by HR-pQCT in hemodialysis : Dr. Negri |
| Erectile Dysfunction in Chronic Hemodialysis : Dr. Strippoli |
| Have Renal Dietitians Successfully Implemented Evidence-Based Guidelines Into Practice? E. Joy |
| Regional Citrate Versus Heparin Anticoagulation for CRRT: Drs. Tam & Wu |
| von Willebrand factor predicts mortality in CRRT : Dr. Péquériaux |
| Clinical Outcome of Twice-Weekly Hemodialysis Patients in Shanghai | Dr. Qian |
| Persistently low intact PTH levels predict aortic arch calcification progression in hemodialysis patients : Dr. Song |
| Lack of Awareness among Future Medical Professionals about the Risk of Consuming Hidden Phosphate-Containing Processed Food & Drinks : Dr. Razzaque |
| 51Cr-EDTA plasma & urinary clearance as a measure of residual renal function in dialysis :Dr. Kjaergaard |
| Obesity and Mortality Risk among Younger Dialysis Patients: Dr. Hoogeveen |
| Solar-Assisted Hemodialysis: Dr. Agar |
| Hydrogen sulfide inhibits high glucose-induced matrix protein synthesis by activating AMP-activated protein kinase in renal epithelial cells Drs. Lee & Kasinath |
| Mineral, bone disorders, survival in hemodialysis with & without PKD : Drs. Molnar & Kalantar-Zadeh |
| Hydrogen sulfide inhibits high glucose-induced matrix protein synthesis by activating AMP-activated protein kinase in renal epithelial cells Drs. Lee & Kasinath |
| Mineral, bone disorders, survival in hemodialysis with & without PKD : Drs. Molnar & Kalantar-Zadeh |
| Downregulation of the renal & hepatic hydrogen sulfide-producing enzymes and capacity in CKD - Dr. Vaziri |
| A predictive algorithm for management of anemia in hemodialysis based on ESA pharmacodynamics : Dr. Lines |
| Factors Associated With Intradialytic Systolic Blood Pressure Variability: Dr. Flythe |
| Safety and predictors of complications of renal biopsy in the outpatient setting : Dr. Jiang |
| Heparin induced antibodies in chronic hemodialysis patients and cardiac surgery patients: Dr. Shavit |
| Atrial Fibrillation in Medicare/Medicaid-eligible dialysis patients: Dr. Wetmore |
| Newly identified anorexigenic adipokine nesfatin-1 in hemodialysis patients: J. Saldanha |
| Correction of Post kidney Transplant Anemia Reduces Progression of Allograft Nephropathy: Dr. Choukrou |
| Mild and moderate pre-dialysis CKD is associated with increased coronary artery calcium: Dr. Budoff |
| Endogenous factors modified by hemodialysis and accuracy of blood glucose-measuring device: Dr. Ogawa |
| Narrow-band UVV increases serum vitamin D levels in hemodialysis patients Dr. Ala-Houhala |
| Predicting hospital cost in CKD patients through blood chemistry values: Dr. Bessette |
| Nutritional vitamin D supplementation in hemodialysis: a potential vascular benefit? D. Mason |
| Volume excess in chronic hemodialysis effects of treatment frequency & treatment spacing : Dr. Schneditz |
| Acid reduction with fruits/veges or bicarb attenuates kidney injury in hypertensive nephropathy with reduced GFR |
Predicting Number of US Medical Graduates Entering Adult Nephrology Fellowships
Using Search Terms Dr. Desai |
| Potential influence of sevelamer hydrochloride on responsiveness to ESAs in hemodialysis patients: Dr. Ikee |
| Anemia Management in Dialysis : ESAs vs Transfusions: Clinical & Economic Consequences :Dr. Naci |
| Increased risk of death and de novo chronic kidney disease following reversible acute kidney injury: Dr. Perkins |
| Filtration Markers May Have Prognostic Value Independent of Glomerular Filtration Rate : Dr. Tangri |
| Stopping Renin-Angiotensin System Inhibitors in Chronic Kidney Disease: Predictors of Response |
| Insights into nephrologist training, clinical practice, and dialysis choice: Dr. Mehrotra |
| Early ACE inhibition in Alport syndrome delays renal failure and improves life expectancy: Dr. Gross |
| Blunted insulinemia using high dialysate glucose concentration during hemodialysis : Dr. Schneditz |
| Prevalence of Inadequate Platelet Inhibition by Clopidogrel in Patients Receiving Hemodialysis: Dr. Alexopoulos |
| Live kidney donation: attitudes towards donor approach, motives and factors promoting donation: Dr. Mazaris |
| High-dose ESAs, inflammatory biomarkers, and soluble erythropoietin receptors : Dr. Inrig |
| Association of AKI with Adverse Outcomes in Burned Military Casualties : Dr. Stewart |
| Sodium Intake, ACE Inhibition, and Progression to ESRD Dr. Ruggenenti |
DOPPS Practice Monitor: Update on Trends in US Hemodialysis Care Following Launch of Bundled Payment System and Revisions to ESA Labels January 6 2011 |
Emerging trends in hemodialysis care through August 2011, based on a sample of US dialysis facilities, are included in the latest update to the DOPPS Practice Monitor (DPM, at http://www.dopps.org/DPM), run by the Dialysis Outcomes and Practice Patterns Study (DOPPS) at Arbor Research Collaborative for Health.
Ongoing Changes in the US Dialysis Environment – Recent changes in dialysis payment and regulatory guidance are expected to affect hemodialysis practice. In January 2011, the Centers for Medicare & Medicaid Services (CMS) launched a new Prospective Payment System (PPS) with the intent to control dialysis costs through bundled payments. In June 2011, the FDA approved revised prescribing information for erythropoiesis-stimulating agents (ESAs), used to treat anemia in most dialysis patients. Previously, the label recommended a hemoglobin target range of 10-12 g/dL. The June 2011 update removed the target range, advising instead to start ESA therapy for dialysis patients at hemoglobin less than 10 g/dL, and to reduce or interrupt the dose when the hemoglobin approaches or exceeds 11 g/dL.
Most Recent Trends in Care – Over the August 2010 to August 2011 time period, many hemodialysis practices have remained stable; examples include nutrition measures and hemodialysis treatment time and dose. There have been notable trends in the following practice areas:
- Anemia: Hemoglobin levels have decreased since the June 2011 ESA label update. While the mean hemoglobin level declined by 0.12 g/dL over 12 months from August 2010 to July 2011, it declined in August 2011 by another 0.10 g/dL to 11.26 g/dL. The percentage of patients with hemoglobin levels greater than 12 g/dL declined sharply (from 28% to 23%) in July/August 2011, while the percentage with hemoglobin levels less than 10 g/dL increased slightly from 8.5% to 10% and the percentage with hemoglobin levels less than 9 g/dL remained under 3%.
Mean prescribed epoetin dose (among patients receiving epoetin) decreased by 15%, from 21,100 units/wk to 17,900 units/wk, from August 2010 to August 2011, with the greatest decline in June-August 2011. Epoetin doses at the higher end of the dose range have decreased most notably. IV iron use increased from August 2010 to August 2011 though has recently stabilized. In keeping with greater IV iron use, serum ferritin levels (indicative of iron stores) continue to rise. Serum ferritin concentration exceeded 500 ng/mL in 65% of patients, 800 ng/mL in 34% of patients, and 1,200 ng/mL in 11% of patients in August 2011.
- Mineral & Bone Disorder: In our last report, we noted a 29% increase in serum parathyroid hormone (PTH) levels through April 2011, and differences by race were described. Since then, PTH levels have remained stable or declined slightly in both black and non-black patients. In August 2011, 22% of black patients and 12% of non-black patients had very high PTH values (defined here as PTH >600 pg/mL). The percentage of hemodialysis patients for whom PTH is measured has declined slightly since August 2010. There have been no clear changes in serum calcium or serum phosphorus levels.
- Clinical Outcomes: Preliminary data indicate that the 30-day hospitalization rate has increased somewhat from August 2010 to August 2011. The DPM does not report yet on trends in red blood cell transfusions, as dialysis units are often unaware of transfusions occurring in the inpatient setting. Additional efforts to comprehensively monitor trends in transfusions are warranted. To date mortality rate has not changed appreciably, though further follow-up time is necessary as we continue to track this outcome.
Future monitoring of these trends, confirmation with national data when eventually available, and understanding their effect on clinical outcomes, if any, is required.
DPM data are aggregated across dialysis organizations and facilities. Aggregated trends may not reflect trends in individual dialysis organizations or facilities, and are not intended to provide oversight of performance in individual dialysis organizations or facilities.
Read the rest of the DOPPS Practice Monitor: Update on Trends in US Hemodialysis Care Following Launch of Bundled Payment System and Revisions to ESA Labels Press Release |
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Hemodialysis Research Interview of the Week |
Author Interview: Dr. Len Usvyat PhD
Clinical Systems Database Senior Analyst
Renal Research Institute
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Seasonal Variations in Mortality, Clinical, and Laboratory Parameters in Hemodialysis Patients: A 5-Year Cohort Study.
Usvyat LA, Carter M, Thijssen S, Kooman JP, van der Sande FM, Zabetakis P,
Balter P, Levin NW, Kotanko P.
Clin J Am Soc Nephrol. 2011 Nov 17.
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What are the main findings of the study? |
We found that mortality of hemodialysis patients followed a seasonal pattern over a five year period with the highest mortality in the winter and lowest mortality in the summer months.
We also observed that many clinical and laboratory parameters follow a seasonal pattern in our patient population.
For example, pre-dialysis systolic blood pressures are highest in winter and lowest in summer months; pre-dialysis body temperatures are highest in summer and lowest in winter months.
Neutrophils are highest in winter and lowest in summer suggesting higher inflammatory markers in the winter.
This phenomena was observed in various geographic regions in US.
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Were any of the findings unexpected? |
It has been previously shown that mortality follows seasonal trends in healthy population however these findings were never extended to dialysis patients.
While it was shown that blood pressures tend to follow a seasonal pattern, to the best of our knowledge, it has not been shown that neutrophils or interdialytic weight gains also follow a seasonal pattern.
Additionally, we applied a cosinor analysis to show whether these patterns are statistically significant.
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What should clinicians and patients take away from this study? |
These findings are particularly important in designing studies -- taking season into account is key.
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What recommendations do you have for future studies as a result of your study? |
Further research into understanding the biologic factors that contribute to this seasonality is important.
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