ASN Kidney Week 2012

SAN DIEGO – Beta-blocker use by patients with advanced chronic kidney disease was not associated with a lower risk of all-cause mortality or initiation of chronic dialysis, results from a large study demonstrated.

"The sympathetic nervous system is increased in chronic kidney disease and end-stage renal disease," Dr. Anna Jovanovich said in an interview during a poster session at Kidney Week 2012. "That can be associated with mortality – you can have more arrhythmias when your sympathetic drive is higher. You would think that beta-blockers might help decrease the sympathetic drive and then decrease mortality, but from this observational study we don’t see that association."

Dr. Jovanovich, a second-year renal fellow at the University of Colorado, Denver, and her associates evaluated 1,099 advanced kidney disease patients not yet on dialysis who participated in the Homocysteine in Kidney and End-Stage Renal Disease (HOST) study, conducted between 2001 and 2006.

The mean age of patients was 69 years, 98% were male, 26% were African American, and the mean estimated glomerular filtration rate was 18 mL/min per 1.73 m². During a mean follow-up of 3 years, 453 patients (41%) died from any cause and 615 (56%) started chronic dialysis.

After adjustment for age, gender, race, smoking status, diabetes, hypertension, cardiovascular disease, body mass index, systolic blood pressure, albumin, and eGFR, baseline beta-blocker use was not associated with lower risk of all-cause mortality (adjusted HR of 1.14; P = .07), nor was it associated with a lower risk of initiation of chronic dialysis (adjusted HR of 0.90).

"This is only an observational study so we can’t draw conclusions, but in a kidney disease patient who has heart failure, I think beta-blockers are an important medication in their armamentarium," she said. "However, in a kidney disease patient without heart failure there may be other blood pressure–lowering medications to try first before you try a beta-blocker."

Dr. Jovanovich said that the findings support those of the Hemodialysis Study (Am. J. Kidney Dis. 2011;58:939-45).

Dr. Jovanovich said that she had no relevant financial conflicts to disclose.

The meeting was sponsored by the American Society of Nephrology.

SAN DIEGO – Beta-blocker use by patients with advanced chronic kidney disease was not associated with a lower risk of all-cause mortality or initiation of chronic dialysis, results from a large study demonstrated.

"The sympathetic nervous system is increased in chronic kidney disease and end-stage renal disease," Dr. Anna Jovanovich said in an interview during a poster session at Kidney Week 2012. "That can be associated with mortality – you can have more arrhythmias when your sympathetic drive is higher. You would think that beta-blockers might help decrease the sympathetic drive and then decrease mortality, but from this observational study we don’t see that association."

Dr. Jovanovich, a second-year renal fellow at the University of Colorado, Denver, and her associates evaluated 1,099 advanced kidney disease patients not yet on dialysis who participated in the Homocysteine in Kidney and End-Stage Renal Disease (HOST) study, conducted between 2001 and 2006.

The mean age of patients was 69 years, 98% were male, 26% were African American, and the mean estimated glomerular filtration rate was 18 mL/min per 1.73 m². During a mean follow-up of 3 years, 453 patients (41%) died from any cause and 615 (56%) started chronic dialysis.

After adjustment for age, gender, race, smoking status, diabetes, hypertension, cardiovascular disease, body mass index, systolic blood pressure, albumin, and eGFR, baseline beta-blocker use was not associated with lower risk of all-cause mortality (adjusted HR of 1.14; P = .07), nor was it associated with a lower risk of initiation of chronic dialysis (adjusted HR of 0.90).

"This is only an observational study so we can’t draw conclusions, but in a kidney disease patient who has heart failure, I think beta-blockers are an important medication in their armamentarium," she said. "However, in a kidney disease patient without heart failure there may be other blood pressure–lowering medications to try first before you try a beta-blocker."

Dr. Jovanovich said that the findings support those of the Hemodialysis Study (Am. J. Kidney Dis. 2011;58:939-45).

Dr. Jovanovich said that she had no relevant financial conflicts to disclose.

The meeting was sponsored by the American Society of Nephrology.

SAN DIEGO – Beta-blocker use by patients with advanced chronic kidney disease was not associated with a lower risk of all-cause mortality or initiation of chronic dialysis, results from a large study demonstrated.

"The sympathetic nervous system is increased in chronic kidney disease and end-stage renal disease," Dr. Anna Jovanovich said in an interview during a poster session at Kidney Week 2012. "That can be associated with mortality – you can have more arrhythmias when your sympathetic drive is higher. You would think that beta-blockers might help decrease the sympathetic drive and then decrease mortality, but from this observational study we don’t see that association."

Dr. Jovanovich, a second-year renal fellow at the University of Colorado, Denver, and her associates evaluated 1,099 advanced kidney disease patients not yet on dialysis who participated in the Homocysteine in Kidney and End-Stage Renal Disease (HOST) study, conducted between 2001 and 2006.

The mean age of patients was 69 years, 98% were male, 26% were African American, and the mean estimated glomerular filtration rate was 18 mL/min per 1.73 m². During a mean follow-up of 3 years, 453 patients (41%) died from any cause and 615 (56%) started chronic dialysis.

After adjustment for age, gender, race, smoking status, diabetes, hypertension, cardiovascular disease, body mass index, systolic blood pressure, albumin, and eGFR, baseline beta-blocker use was not associated with lower risk of all-cause mortality (adjusted HR of 1.14; P = .07), nor was it associated with a lower risk of initiation of chronic dialysis (adjusted HR of 0.90).

"This is only an observational study so we can’t draw conclusions, but in a kidney disease patient who has heart failure, I think beta-blockers are an important medication in their armamentarium," she said. "However, in a kidney disease patient without heart failure there may be other blood pressure–lowering medications to try first before you try a beta-blocker."

Dr. Jovanovich said that the findings support those of the Hemodialysis Study (Am. J. Kidney Dis. 2011;58:939-45).

Dr. Jovanovich said that she had no relevant financial conflicts to disclose.

The meeting was sponsored by the American Society of Nephrology.

SAN DIEGO – A 12-week exercise program improved the physical capacity of patients with stage 3 and 4 chronic kidney disease, results from a single-center demonstrated.

The intervention also improved patient perceptions of general health, vitality, and physical functioning. "We believe that renal rehabilitation exercise programs can be integrated into standard chronic kidney disease treatment," Dr. Ana Paula Rossi, a nephrology fellow at Maine Medical Center, Portland, said at Kidney Week 2012.

"We need longer follow-up and larger studies to determine if this will translate into decreased mortality rates and slow the progression of CKD," she said.

In a 12-week study conducted in 2011, Dr. Rossi and her associates randomized 48 patients with stage 3 and 4 CKD to usual care and 59 patients to an exercise intervention, which consisted of guided exercise at a cardiac rehabilitation facility two times per week for 3 months. Patients were encouraged to exercise an additional day per week on their own.

Exercise consisted of treadmill walking and/or stationary cycling. The duration was increased by 2-3 minutes per session, with the ultimate goal of 60 minutes of continuous exercise. Patients also did weight training with upper and lower extremity extensions and flexions with free weights. They started with one set of 10 repetitions per exercise, which was increased to a goal of three sets of 15 repetitions before the weight was increased. They also did stretching exercises.

Outcomes included the results of the 6-minute walk test (the number of feet walked per 6 minutes), the sit-to-stand test in which the patient is asked to sit and stand up 10 times (time reported is the percentage of age-predicted time), and the gait-speed test, a measurement of centimeters per second walked over a distance of 20 feet. To assess quality of life, the researchers administered the RAND 36-item Short Form Health Survey.

Patients with ongoing angina or transient ischemic attacks were excluded from the study, as were those with chronic lung disease resulting in significant shortness of breath or oxygen desaturation at rest, and those with lower-extremity amputation with no prosthesis or with an orthopedic disorder severely exacerbated by activity.

Patients in both groups were around 69 years old and had similar baseline reported levels of activity.

After the 12-week study period, the usual care group had no significant improvements in the three main outcomes. Patients in the exercise intervention group had significant improvements in the 6-minute walk test (19%, from 1,117 to 1,327 feet per 6 minutes; P = less than .0001) and in the sit-to-stand test (29%, from 68% to 97% of age predicted; P = .0004), but not in the gait-speed test (183 vs. 171 cm; P = .06).

Compared with their counterparts in the usual care group, patients in the intervention group reported significant improvements in energy (P = .01), physical functioning (P less than .01), and in general health (P = .03). Neither group experienced significant improvements in pain, emotional well-being, or in social functioning.

The study was funded by the Maine Medical Center Research Institute. Dr. Rossi said that she had no relevant financial conflicts to disclose.

The meeting was sponsored by the American Society of Nephrology.

SAN DIEGO – A 12-week exercise program improved the physical capacity of patients with stage 3 and 4 chronic kidney disease, results from a single-center demonstrated.

The intervention also improved patient perceptions of general health, vitality, and physical functioning. "We believe that renal rehabilitation exercise programs can be integrated into standard chronic kidney disease treatment," Dr. Ana Paula Rossi, a nephrology fellow at Maine Medical Center, Portland, said at Kidney Week 2012.

"We need longer follow-up and larger studies to determine if this will translate into decreased mortality rates and slow the progression of CKD," she said.

In a 12-week study conducted in 2011, Dr. Rossi and her associates randomized 48 patients with stage 3 and 4 CKD to usual care and 59 patients to an exercise intervention, which consisted of guided exercise at a cardiac rehabilitation facility two times per week for 3 months. Patients were encouraged to exercise an additional day per week on their own.

Exercise consisted of treadmill walking and/or stationary cycling. The duration was increased by 2-3 minutes per session, with the ultimate goal of 60 minutes of continuous exercise. Patients also did weight training with upper and lower extremity extensions and flexions with free weights. They started with one set of 10 repetitions per exercise, which was increased to a goal of three sets of 15 repetitions before the weight was increased. They also did stretching exercises.

Outcomes included the results of the 6-minute walk test (the number of feet walked per 6 minutes), the sit-to-stand test in which the patient is asked to sit and stand up 10 times (time reported is the percentage of age-predicted time), and the gait-speed test, a measurement of centimeters per second walked over a distance of 20 feet. To assess quality of life, the researchers administered the RAND 36-item Short Form Health Survey.

Patients with ongoing angina or transient ischemic attacks were excluded from the study, as were those with chronic lung disease resulting in significant shortness of breath or oxygen desaturation at rest, and those with lower-extremity amputation with no prosthesis or with an orthopedic disorder severely exacerbated by activity.

Patients in both groups were around 69 years old and had similar baseline reported levels of activity.

After the 12-week study period, the usual care group had no significant improvements in the three main outcomes. Patients in the exercise intervention group had significant improvements in the 6-minute walk test (19%, from 1,117 to 1,327 feet per 6 minutes; P = less than .0001) and in the sit-to-stand test (29%, from 68% to 97% of age predicted; P = .0004), but not in the gait-speed test (183 vs. 171 cm; P = .06).

Compared with their counterparts in the usual care group, patients in the intervention group reported significant improvements in energy (P = .01), physical functioning (P less than .01), and in general health (P = .03). Neither group experienced significant improvements in pain, emotional well-being, or in social functioning.

The study was funded by the Maine Medical Center Research Institute. Dr. Rossi said that she had no relevant financial conflicts to disclose.

The meeting was sponsored by the American Society of Nephrology.

SAN DIEGO – A 12-week exercise program improved the physical capacity of patients with stage 3 and 4 chronic kidney disease, results from a single-center demonstrated.

The intervention also improved patient perceptions of general health, vitality, and physical functioning. "We believe that renal rehabilitation exercise programs can be integrated into standard chronic kidney disease treatment," Dr. Ana Paula Rossi, a nephrology fellow at Maine Medical Center, Portland, said at Kidney Week 2012.

"We need longer follow-up and larger studies to determine if this will translate into decreased mortality rates and slow the progression of CKD," she said.

In a 12-week study conducted in 2011, Dr. Rossi and her associates randomized 48 patients with stage 3 and 4 CKD to usual care and 59 patients to an exercise intervention, which consisted of guided exercise at a cardiac rehabilitation facility two times per week for 3 months. Patients were encouraged to exercise an additional day per week on their own.

Exercise consisted of treadmill walking and/or stationary cycling. The duration was increased by 2-3 minutes per session, with the ultimate goal of 60 minutes of continuous exercise. Patients also did weight training with upper and lower extremity extensions and flexions with free weights. They started with one set of 10 repetitions per exercise, which was increased to a goal of three sets of 15 repetitions before the weight was increased. They also did stretching exercises.

Outcomes included the results of the 6-minute walk test (the number of feet walked per 6 minutes), the sit-to-stand test in which the patient is asked to sit and stand up 10 times (time reported is the percentage of age-predicted time), and the gait-speed test, a measurement of centimeters per second walked over a distance of 20 feet. To assess quality of life, the researchers administered the RAND 36-item Short Form Health Survey.

Patients with ongoing angina or transient ischemic attacks were excluded from the study, as were those with chronic lung disease resulting in significant shortness of breath or oxygen desaturation at rest, and those with lower-extremity amputation with no prosthesis or with an orthopedic disorder severely exacerbated by activity.

Patients in both groups were around 69 years old and had similar baseline reported levels of activity.

After the 12-week study period, the usual care group had no significant improvements in the three main outcomes. Patients in the exercise intervention group had significant improvements in the 6-minute walk test (19%, from 1,117 to 1,327 feet per 6 minutes; P = less than .0001) and in the sit-to-stand test (29%, from 68% to 97% of age predicted; P = .0004), but not in the gait-speed test (183 vs. 171 cm; P = .06).

Compared with their counterparts in the usual care group, patients in the intervention group reported significant improvements in energy (P = .01), physical functioning (P less than .01), and in general health (P = .03). Neither group experienced significant improvements in pain, emotional well-being, or in social functioning.

The study was funded by the Maine Medical Center Research Institute. Dr. Rossi said that she had no relevant financial conflicts to disclose.

The meeting was sponsored by the American Society of Nephrology.

SAN DIEGO – Being catheter free and having a serum albumin level of at least 4 g/dL were among the quality indicators associated with the ability of dialysis patients to return to work, judging from the results of a large study.

"There has been limited attention to employment issues in this patient population," Nancy G. Kutner, Ph.D., said in an interview during a poster session at Kidney Week 2012. "There has been a general impression that most people aren’t going to even try to resume employment – even those who were employed immediately before starting dialysis."

Doug Brunk/IMNG Medical Media

Dr. Kutner, professor of rehabilitation medicine at Emory University, Atlanta, and her associates enrolled 509 patients who were on hemodialysis treatment for 3 months or longer during 2009-2011 for a U.S. Renal Data System study conducted in seven outpatient clinics in San Francisco and seven in Atlanta. The patients were between the ages of 18 and 64 years, and they responded to the question: "Are you now able to work for pay (full-time or part-time)?"

Using a logistic regression model adjusted for age, gender, race, educational level, diabetes, congestive heart failure, presence of symptoms of depression, length of time on dialysis, and facility clustering, the researchers investigated whether incremental achievement of certain hemodialysis quality indicator (HD QI) goals were correlated with patient-reported ability to work. The HD QI goals were standardized Kt/V of 1.2 or greater; being catheter free; and having a hemoglobin level of 10-12 g/dL, a serum albumin level of 4 g/dL or greater, and a serum phosphorus level of 3.5 mg/dL to 5.5 mg/dL.

The mean age of the patients was 50 years, and 61% were male. Of the 509 patients, 36% said that they were able to work and 13% were actually employed. The mean number of HD QI goals met was 3.31, and the patients’ likelihood of reporting being able to work increased with an increasing number of QI goals met (odds ratio 1.28; P = .02). "Achieving a quality indicator goal is likely a joint process between the provider and the patient," said Dr. Kutner, who directs the USRDS Rehabilitation/QoL Special Studies Center at Emory.

"The end result seems to be that as more of these goals are met, it furthers the potential for work and rehabilitation. This is very encouraging," she said at the meeting, which was sponsored by the American Society of Nephrology.

Compared with their counterparts who reported being unable to work, a higher proportion of those who reported being able to work met the QI goals of Kt/V of 1.2 or greater (92% vs. 90%, respectively), being catheter free (84% vs. 74%), having a hemoglobin level of 10-12 g/dL (62% vs. 60%), and having a serum albumin of 4.0 g/dL or greater (59% vs. 49%). The proportion of those reporting a serum phosphorus level of 3.5-5.5 mg/dL was similar between the two groups (48% vs. 50%).

Dr. Kutner said that she had no relevant financial conflicts to disclose.

SAN DIEGO – Being catheter free and having a serum albumin level of at least 4 g/dL were among the quality indicators associated with the ability of dialysis patients to return to work, judging from the results of a large study.

"There has been limited attention to employment issues in this patient population," Nancy G. Kutner, Ph.D., said in an interview during a poster session at Kidney Week 2012. "There has been a general impression that most people aren’t going to even try to resume employment – even those who were employed immediately before starting dialysis."

Doug Brunk/IMNG Medical Media

Dr. Kutner, professor of rehabilitation medicine at Emory University, Atlanta, and her associates enrolled 509 patients who were on hemodialysis treatment for 3 months or longer during 2009-2011 for a U.S. Renal Data System study conducted in seven outpatient clinics in San Francisco and seven in Atlanta. The patients were between the ages of 18 and 64 years, and they responded to the question: "Are you now able to work for pay (full-time or part-time)?"

Using a logistic regression model adjusted for age, gender, race, educational level, diabetes, congestive heart failure, presence of symptoms of depression, length of time on dialysis, and facility clustering, the researchers investigated whether incremental achievement of certain hemodialysis quality indicator (HD QI) goals were correlated with patient-reported ability to work. The HD QI goals were standardized Kt/V of 1.2 or greater; being catheter free; and having a hemoglobin level of 10-12 g/dL, a serum albumin level of 4 g/dL or greater, and a serum phosphorus level of 3.5 mg/dL to 5.5 mg/dL.

The mean age of the patients was 50 years, and 61% were male. Of the 509 patients, 36% said that they were able to work and 13% were actually employed. The mean number of HD QI goals met was 3.31, and the patients’ likelihood of reporting being able to work increased with an increasing number of QI goals met (odds ratio 1.28; P = .02). "Achieving a quality indicator goal is likely a joint process between the provider and the patient," said Dr. Kutner, who directs the USRDS Rehabilitation/QoL Special Studies Center at Emory.

"The end result seems to be that as more of these goals are met, it furthers the potential for work and rehabilitation. This is very encouraging," she said at the meeting, which was sponsored by the American Society of Nephrology.

Compared with their counterparts who reported being unable to work, a higher proportion of those who reported being able to work met the QI goals of Kt/V of 1.2 or greater (92% vs. 90%, respectively), being catheter free (84% vs. 74%), having a hemoglobin level of 10-12 g/dL (62% vs. 60%), and having a serum albumin of 4.0 g/dL or greater (59% vs. 49%). The proportion of those reporting a serum phosphorus level of 3.5-5.5 mg/dL was similar between the two groups (48% vs. 50%).

Dr. Kutner said that she had no relevant financial conflicts to disclose.

SAN DIEGO – Being catheter free and having a serum albumin level of at least 4 g/dL were among the quality indicators associated with the ability of dialysis patients to return to work, judging from the results of a large study.

"There has been limited attention to employment issues in this patient population," Nancy G. Kutner, Ph.D., said in an interview during a poster session at Kidney Week 2012. "There has been a general impression that most people aren’t going to even try to resume employment – even those who were employed immediately before starting dialysis."

Doug Brunk/IMNG Medical Media

Dr. Kutner, professor of rehabilitation medicine at Emory University, Atlanta, and her associates enrolled 509 patients who were on hemodialysis treatment for 3 months or longer during 2009-2011 for a U.S. Renal Data System study conducted in seven outpatient clinics in San Francisco and seven in Atlanta. The patients were between the ages of 18 and 64 years, and they responded to the question: "Are you now able to work for pay (full-time or part-time)?"

Using a logistic regression model adjusted for age, gender, race, educational level, diabetes, congestive heart failure, presence of symptoms of depression, length of time on dialysis, and facility clustering, the researchers investigated whether incremental achievement of certain hemodialysis quality indicator (HD QI) goals were correlated with patient-reported ability to work. The HD QI goals were standardized Kt/V of 1.2 or greater; being catheter free; and having a hemoglobin level of 10-12 g/dL, a serum albumin level of 4 g/dL or greater, and a serum phosphorus level of 3.5 mg/dL to 5.5 mg/dL.

The mean age of the patients was 50 years, and 61% were male. Of the 509 patients, 36% said that they were able to work and 13% were actually employed. The mean number of HD QI goals met was 3.31, and the patients’ likelihood of reporting being able to work increased with an increasing number of QI goals met (odds ratio 1.28; P = .02). "Achieving a quality indicator goal is likely a joint process between the provider and the patient," said Dr. Kutner, who directs the USRDS Rehabilitation/QoL Special Studies Center at Emory.

"The end result seems to be that as more of these goals are met, it furthers the potential for work and rehabilitation. This is very encouraging," she said at the meeting, which was sponsored by the American Society of Nephrology.

Compared with their counterparts who reported being unable to work, a higher proportion of those who reported being able to work met the QI goals of Kt/V of 1.2 or greater (92% vs. 90%, respectively), being catheter free (84% vs. 74%), having a hemoglobin level of 10-12 g/dL (62% vs. 60%), and having a serum albumin of 4.0 g/dL or greater (59% vs. 49%). The proportion of those reporting a serum phosphorus level of 3.5-5.5 mg/dL was similar between the two groups (48% vs. 50%).

Dr. Kutner said that she had no relevant financial conflicts to disclose.

SAN DIEGO – Levels of calcium, phosphorus, and parathyroid hormone are poorer in patients with heart failure at each stage of chronic kidney disease, results from a large study showed.

The finding "raises more questions than it answers," Dr. Claudine T. Jurkovitz said in an interview during a poster session at Kidney Week 2012. "The question is, are these patients less well managed for their metabolic bone disease than the patients without HF? If so, why? Is it because their HF is so severe, or is it because the nephrologists count on cardiologists or primary care physicians to treat the patients’ metabolic bone disease also? And do cardiologists identify metabolic bone disease in patients with HF?"

Doug Brunk/IMNG Medical Media

Dr. Jurkovitz, a physician scientist with Christiana Care Health System in Newark, Del., and her associates compared the management of CKD-associated metabolic bone disease between patients with and without HF who were treated at a local nephrology practice between 2000 and 2010. They evaluated the medical records of 11,883 patients with CKD stage 3 and above, and excluded dialysis and transplant patients. The researchers calculated average calcium, phosphorus, and intact parathyroid hormone (iPTH) by radioimmunoassay for each patient, and used multilinear regressions to determine the effects of CKD and HF on calcium, phosphorus, and iPTH after controlling for age, race, and gender.

The mean follow-up of the 11,883 patients was 4 years. Of these, nearly one-quarter (24%) had HF at baseline, while 76% had stage 3 CKD, 22% had stage 4 CKD, and 2% had stage 5 CKD. Patients with HF were slightly older, with a mean of 69 years, than were their counterparts without HF, who had a mean 66 years.

Dr. Jurkovitz and her associates found that the adjusted mean for calcium was significantly lower in patients with HF at each CKD stage. The interaction between CKD and HF was statistically significant. The adjusted means for phosphorus and iPTH were significantly higher in patients with HF at each CKD stage, while the interactions between CKD and HF were not significant.

"Physicians need to be concerned about the management of chronic kidney disease in their patients with HF, and the management of metabolic bone disease addressed on a case by case basis in a dialogue between the cardiologists, nephrologists, and primary care physicians," she concluded.

The meeting was sponsored by the American Society of Nephrology. Dr. Jurkovitz said that she had no relevant financial conflicts to disclose.

SAN DIEGO – Levels of calcium, phosphorus, and parathyroid hormone are poorer in patients with heart failure at each stage of chronic kidney disease, results from a large study showed.

The finding "raises more questions than it answers," Dr. Claudine T. Jurkovitz said in an interview during a poster session at Kidney Week 2012. "The question is, are these patients less well managed for their metabolic bone disease than the patients without HF? If so, why? Is it because their HF is so severe, or is it because the nephrologists count on cardiologists or primary care physicians to treat the patients’ metabolic bone disease also? And do cardiologists identify metabolic bone disease in patients with HF?"

Doug Brunk/IMNG Medical Media

Dr. Jurkovitz, a physician scientist with Christiana Care Health System in Newark, Del., and her associates compared the management of CKD-associated metabolic bone disease between patients with and without HF who were treated at a local nephrology practice between 2000 and 2010. They evaluated the medical records of 11,883 patients with CKD stage 3 and above, and excluded dialysis and transplant patients. The researchers calculated average calcium, phosphorus, and intact parathyroid hormone (iPTH) by radioimmunoassay for each patient, and used multilinear regressions to determine the effects of CKD and HF on calcium, phosphorus, and iPTH after controlling for age, race, and gender.

The mean follow-up of the 11,883 patients was 4 years. Of these, nearly one-quarter (24%) had HF at baseline, while 76% had stage 3 CKD, 22% had stage 4 CKD, and 2% had stage 5 CKD. Patients with HF were slightly older, with a mean of 69 years, than were their counterparts without HF, who had a mean 66 years.

Dr. Jurkovitz and her associates found that the adjusted mean for calcium was significantly lower in patients with HF at each CKD stage. The interaction between CKD and HF was statistically significant. The adjusted means for phosphorus and iPTH were significantly higher in patients with HF at each CKD stage, while the interactions between CKD and HF were not significant.

"Physicians need to be concerned about the management of chronic kidney disease in their patients with HF, and the management of metabolic bone disease addressed on a case by case basis in a dialogue between the cardiologists, nephrologists, and primary care physicians," she concluded.

The meeting was sponsored by the American Society of Nephrology. Dr. Jurkovitz said that she had no relevant financial conflicts to disclose.

SAN DIEGO – Levels of calcium, phosphorus, and parathyroid hormone are poorer in patients with heart failure at each stage of chronic kidney disease, results from a large study showed.

The finding "raises more questions than it answers," Dr. Claudine T. Jurkovitz said in an interview during a poster session at Kidney Week 2012. "The question is, are these patients less well managed for their metabolic bone disease than the patients without HF? If so, why? Is it because their HF is so severe, or is it because the nephrologists count on cardiologists or primary care physicians to treat the patients’ metabolic bone disease also? And do cardiologists identify metabolic bone disease in patients with HF?"

Doug Brunk/IMNG Medical Media

Dr. Jurkovitz, a physician scientist with Christiana Care Health System in Newark, Del., and her associates compared the management of CKD-associated metabolic bone disease between patients with and without HF who were treated at a local nephrology practice between 2000 and 2010. They evaluated the medical records of 11,883 patients with CKD stage 3 and above, and excluded dialysis and transplant patients. The researchers calculated average calcium, phosphorus, and intact parathyroid hormone (iPTH) by radioimmunoassay for each patient, and used multilinear regressions to determine the effects of CKD and HF on calcium, phosphorus, and iPTH after controlling for age, race, and gender.

The mean follow-up of the 11,883 patients was 4 years. Of these, nearly one-quarter (24%) had HF at baseline, while 76% had stage 3 CKD, 22% had stage 4 CKD, and 2% had stage 5 CKD. Patients with HF were slightly older, with a mean of 69 years, than were their counterparts without HF, who had a mean 66 years.

Dr. Jurkovitz and her associates found that the adjusted mean for calcium was significantly lower in patients with HF at each CKD stage. The interaction between CKD and HF was statistically significant. The adjusted means for phosphorus and iPTH were significantly higher in patients with HF at each CKD stage, while the interactions between CKD and HF were not significant.

"Physicians need to be concerned about the management of chronic kidney disease in their patients with HF, and the management of metabolic bone disease addressed on a case by case basis in a dialogue between the cardiologists, nephrologists, and primary care physicians," she concluded.

The meeting was sponsored by the American Society of Nephrology. Dr. Jurkovitz said that she had no relevant financial conflicts to disclose.

SAN DIEGO – Chronic kidney disease patients with subclinical hypothyroidism who were treated with thyroid hormone had better preserved renal function than did those who did not receive the treatment, a study has shown.

In addition, thyroid hormone replacement therapy was an independent predictor of renal outcomes in this subset of patients, Dr. Shin-Wook Kang reported at Kidney Week 2012.

"Subclinical hyperthyroidism is not a rare disorder, especially in females and in the elderly, and it is frequently observed in CKD [chronic kidney disease] patients," said Dr. Kang of the department of internal medicine at Yonsei University College of Medicine, Seoul, Korea. "In contrast to overt hypothyroidism, thyroid hormone treatment is seldom necessary in patients with subclinical hypothyroidism. Even though previous studies have demonstrated that thyroid hormone improves cardiac dysfunction and reduces total and LDL cholesterol levels in patients with subclinical hypothyroidism, the impact of thyroid hormone replacement therapy on renal function has never been studied in these patients."

In an effort to investigate whether restoration of euthyroidism is beneficial in terms of preserving renal function in CKD patients with subclinical hypothyroidism, he and his associates retrospectively studied the medical records of 309 patients with stage 2-4 CKD who were diagnosed with subclinical hypothyroidism and treated at the college of medicine during 2005-2010. They assessed demographic, clinical, and biochemical data including levels of calcium/phosphorus, albumin, total cholesterol, and triglycerides and estimated glomerular filtration rate (GFR). The researchers used a linear mixed model to compare changes in estimated GFR over time between patients who received thyroid hormone replacement therapy and those who did not.

Of the 309 patients, 180 (58%) were treated with l-thyroxine at an initial dose of 25 mcg/day (treatment group) while the remaining 42% were not (nontreatment group). Among patients in the treatment group, the dose of l-thyroxine was adjusted 5-6 weeks after the start of therapy and then every 3 months based on the patient’s serum TSH levels.

At baseline, levels of serum cholesterol and triglyceride were significantly higher in the treatment vs. the nontreatment group (180.0 vs. 161.3 mg/dL and 162.7 vs. 125.6 mg/dL, respectively).

During a mean follow-up of 34.8 months, the overall rate of decline in estimated GFR was significantly greater in the nontreatment group than in the treatment group (–5.93 vs. –2.11 mL/min per year per 1.73 mm2). Dr. Kang also reported that a linear mixed model showed a significant difference in the rates of estimated GFR over time between the two groups, while Kaplan-Meier analysis also showed that renal event-free survival was significantly higher in the treatment group.

Multivariate Cox regression analysis revealed that thyroid hormone replacement therapy was an independent predictor of renal outcome (hazard ratio, 0.28; P =.01).

"Thyroid hormone therapy not only preserved renal function better but also was an independent predictor of renal outcome in CKD patients with subclinical hypothyroidism, suggesting that thyroid hormone replacement should be considered in these patients," Dr. Kang said.

Dr. Kang said he had no relevant financial conflicts to disclose.

SAN DIEGO – Chronic kidney disease patients with subclinical hypothyroidism who were treated with thyroid hormone had better preserved renal function than did those who did not receive the treatment, a study has shown.

In addition, thyroid hormone replacement therapy was an independent predictor of renal outcomes in this subset of patients, Dr. Shin-Wook Kang reported at Kidney Week 2012.

"Subclinical hyperthyroidism is not a rare disorder, especially in females and in the elderly, and it is frequently observed in CKD [chronic kidney disease] patients," said Dr. Kang of the department of internal medicine at Yonsei University College of Medicine, Seoul, Korea. "In contrast to overt hypothyroidism, thyroid hormone treatment is seldom necessary in patients with subclinical hypothyroidism. Even though previous studies have demonstrated that thyroid hormone improves cardiac dysfunction and reduces total and LDL cholesterol levels in patients with subclinical hypothyroidism, the impact of thyroid hormone replacement therapy on renal function has never been studied in these patients."

In an effort to investigate whether restoration of euthyroidism is beneficial in terms of preserving renal function in CKD patients with subclinical hypothyroidism, he and his associates retrospectively studied the medical records of 309 patients with stage 2-4 CKD who were diagnosed with subclinical hypothyroidism and treated at the college of medicine during 2005-2010. They assessed demographic, clinical, and biochemical data including levels of calcium/phosphorus, albumin, total cholesterol, and triglycerides and estimated glomerular filtration rate (GFR). The researchers used a linear mixed model to compare changes in estimated GFR over time between patients who received thyroid hormone replacement therapy and those who did not.

Of the 309 patients, 180 (58%) were treated with l-thyroxine at an initial dose of 25 mcg/day (treatment group) while the remaining 42% were not (nontreatment group). Among patients in the treatment group, the dose of l-thyroxine was adjusted 5-6 weeks after the start of therapy and then every 3 months based on the patient’s serum TSH levels.

At baseline, levels of serum cholesterol and triglyceride were significantly higher in the treatment vs. the nontreatment group (180.0 vs. 161.3 mg/dL and 162.7 vs. 125.6 mg/dL, respectively).

During a mean follow-up of 34.8 months, the overall rate of decline in estimated GFR was significantly greater in the nontreatment group than in the treatment group (–5.93 vs. –2.11 mL/min per year per 1.73 mm2). Dr. Kang also reported that a linear mixed model showed a significant difference in the rates of estimated GFR over time between the two groups, while Kaplan-Meier analysis also showed that renal event-free survival was significantly higher in the treatment group.

Multivariate Cox regression analysis revealed that thyroid hormone replacement therapy was an independent predictor of renal outcome (hazard ratio, 0.28; P =.01).

"Thyroid hormone therapy not only preserved renal function better but also was an independent predictor of renal outcome in CKD patients with subclinical hypothyroidism, suggesting that thyroid hormone replacement should be considered in these patients," Dr. Kang said.

Dr. Kang said he had no relevant financial conflicts to disclose.

SAN DIEGO – Chronic kidney disease patients with subclinical hypothyroidism who were treated with thyroid hormone had better preserved renal function than did those who did not receive the treatment, a study has shown.

In addition, thyroid hormone replacement therapy was an independent predictor of renal outcomes in this subset of patients, Dr. Shin-Wook Kang reported at Kidney Week 2012.

"Subclinical hyperthyroidism is not a rare disorder, especially in females and in the elderly, and it is frequently observed in CKD [chronic kidney disease] patients," said Dr. Kang of the department of internal medicine at Yonsei University College of Medicine, Seoul, Korea. "In contrast to overt hypothyroidism, thyroid hormone treatment is seldom necessary in patients with subclinical hypothyroidism. Even though previous studies have demonstrated that thyroid hormone improves cardiac dysfunction and reduces total and LDL cholesterol levels in patients with subclinical hypothyroidism, the impact of thyroid hormone replacement therapy on renal function has never been studied in these patients."

In an effort to investigate whether restoration of euthyroidism is beneficial in terms of preserving renal function in CKD patients with subclinical hypothyroidism, he and his associates retrospectively studied the medical records of 309 patients with stage 2-4 CKD who were diagnosed with subclinical hypothyroidism and treated at the college of medicine during 2005-2010. They assessed demographic, clinical, and biochemical data including levels of calcium/phosphorus, albumin, total cholesterol, and triglycerides and estimated glomerular filtration rate (GFR). The researchers used a linear mixed model to compare changes in estimated GFR over time between patients who received thyroid hormone replacement therapy and those who did not.

Of the 309 patients, 180 (58%) were treated with l-thyroxine at an initial dose of 25 mcg/day (treatment group) while the remaining 42% were not (nontreatment group). Among patients in the treatment group, the dose of l-thyroxine was adjusted 5-6 weeks after the start of therapy and then every 3 months based on the patient’s serum TSH levels.

At baseline, levels of serum cholesterol and triglyceride were significantly higher in the treatment vs. the nontreatment group (180.0 vs. 161.3 mg/dL and 162.7 vs. 125.6 mg/dL, respectively).

During a mean follow-up of 34.8 months, the overall rate of decline in estimated GFR was significantly greater in the nontreatment group than in the treatment group (–5.93 vs. –2.11 mL/min per year per 1.73 mm2). Dr. Kang also reported that a linear mixed model showed a significant difference in the rates of estimated GFR over time between the two groups, while Kaplan-Meier analysis also showed that renal event-free survival was significantly higher in the treatment group.

Multivariate Cox regression analysis revealed that thyroid hormone replacement therapy was an independent predictor of renal outcome (hazard ratio, 0.28; P =.01).

"Thyroid hormone therapy not only preserved renal function better but also was an independent predictor of renal outcome in CKD patients with subclinical hypothyroidism, suggesting that thyroid hormone replacement should be considered in these patients," Dr. Kang said.

Dr. Kang said he had no relevant financial conflicts to disclose.

SAN DIEGO – Since the January 2011 move to bundled Medicare payments for outpatient dialysis services, mortality and hospitalizations appear to be stable among chronic kidney disease patients – but there have been dramatic trends toward lower hemoglobin levels and less use of intravenous epoetin, along with a rise in transfusions.

The findings come from the latest review of data contained in the Dialysis Outcomes and Practice Patterns Study (DOPPS) Practice Monitor, an ongoing effort to provide up-to-date trends in clinical care for dialysis patients.

During a special session at Kidney Week 2012, Dr. Bruce M. Robinson, a nephrologist and vice president for clinical research at Arbor Research Collaborative for Health in Ann Arbor, Mich., presented findings from a stratified random sample of more than 5,000 hemodialysis patients who were treated at about 140 dialysis facilities in the United States between August 2010 and April 2012.

Over that time period, the dialysis landscape changed dramatically, Dr. Robinson said.

Not only did Medicare launch its Prospective Payment System (PPS), but the Food and Drug Administration also modified dosing recommendations for erythropoietin-stimulating agents (such as epoetin) in patients with chronic kidney disease. In addition, new anemia guidelines debuted from Kidney Disease: Improving Global Outcomes (KDIGO), a global organization managed by the National Kidney Foundation. Finally, "a lot of folks are focused on what’s going to happen with the expected introduction of oral renal medications in the bundle in January 2014," said Dr. Robinson.

Since the introduction of the PPS, there has been no clear trend in mortality or hospitalizations, based on DOPPS data corroborated by Medicare claims data. Mortality ranged between 1.5% and 2% per month, or "close to 20% per year," said Dr. Robinson. "There certainly remains substantial room for improvement."

Hospitalizations stand at around 15%, "which has been flat over the study period," he said. "This translates into about two hospitalizations per patient per year."

He went on to report four key trends related to anemia management in the DOPPS data:

• First, median hemoglobin levels declined by 0.62 g/dL over the study period. "We have about 16% of patients overall with a hemoglobin level of less than 10 g/dL, and about 4% with hemoglobin less than 9 g/dL," Dr. Robinson said.

• Second, median weekly IV epoetin doses declined by 31%. "The ceiling dose has dropped more substantially," he said. "The 90th percentile dose declined by 42%, while the 10th percentile dose declined by 21% and is now under 3,000 units per week."

• The third trend related to anemia management was observed in the rising proportion of patients who received IV iron, growing from 58% per month in August 2010 to 73% per month in April 2012.

"Clearly, there is movement toward more patients getting IV iron on a regular basis," Dr. Robinson said. "When we surveyed dialysis facility medical directors, about 75% of them told us that they’re using maintenance IV iron dosing on a weekly or biweekly basis."

• The fourth trend related to anemia management was that median serum ferritin levels have increased by 28%. In fact, 39% of hemodialysis patients have ferritin levels at or above 800 ng/mL, and 10% of patients are at or above 1,200 ng/mL.

Dr. Robinson also reported that there has been an apparent rise in the percentage of patients receiving red blood cell transfusions, presenting Medicare claims data that indicated a 0.6% increase per month between November 2010 and November 2011.

"Making some assumptions, that translates to roughly 1 in 20 to 1 in 40 patients per year, so perhaps one additional patient per dialysis shift each year," he said.

In his opinion, this unwelcome trend may be preventable. In the DOPPS data, 12% of facilities reported at least 10% of their patients had hemoglobin levels less than 9 g/dL. DOPPS survey data indicate that 15% of facilities use a lower target for hemoglobin of 9 g/dL. It’s this practice that likely raises transfusion risk.

In what Dr. Robinson characterized as a surprising finding, serum albumin levels rose during the study period, from a mean of 3.8 g/dL to a mean of 4.0 g/dL. "That’s good news," he said. "The question is, why? It may be that this is due to greater use of oral nutritional supplements; but this topic needs further investigation."

The next update of the DOPPS Practice Monitor is scheduled for December 2012.

Kidney Week 2012 was sponsored by the American Society of Nephrology. DOPPS is supported by scientific research grants from Abbott Laboratories, Amgen, Baxter Healthcare, Fresenius Medical Care, Kyowa Hakko Kirin, Sanofi Renal, and Vifor Fresenius Medical Care Renal Pharma without restrictions on publications. Dr. Robinson said that he had no other relevant financial conflicts to disclose.

SAN DIEGO – Since the January 2011 move to bundled Medicare payments for outpatient dialysis services, mortality and hospitalizations appear to be stable among chronic kidney disease patients – but there have been dramatic trends toward lower hemoglobin levels and less use of intravenous epoetin, along with a rise in transfusions.

The findings come from the latest review of data contained in the Dialysis Outcomes and Practice Patterns Study (DOPPS) Practice Monitor, an ongoing effort to provide up-to-date trends in clinical care for dialysis patients.

During a special session at Kidney Week 2012, Dr. Bruce M. Robinson, a nephrologist and vice president for clinical research at Arbor Research Collaborative for Health in Ann Arbor, Mich., presented findings from a stratified random sample of more than 5,000 hemodialysis patients who were treated at about 140 dialysis facilities in the United States between August 2010 and April 2012.

Over that time period, the dialysis landscape changed dramatically, Dr. Robinson said.

Not only did Medicare launch its Prospective Payment System (PPS), but the Food and Drug Administration also modified dosing recommendations for erythropoietin-stimulating agents (such as epoetin) in patients with chronic kidney disease. In addition, new anemia guidelines debuted from Kidney Disease: Improving Global Outcomes (KDIGO), a global organization managed by the National Kidney Foundation. Finally, "a lot of folks are focused on what’s going to happen with the expected introduction of oral renal medications in the bundle in January 2014," said Dr. Robinson.

Since the introduction of the PPS, there has been no clear trend in mortality or hospitalizations, based on DOPPS data corroborated by Medicare claims data. Mortality ranged between 1.5% and 2% per month, or "close to 20% per year," said Dr. Robinson. "There certainly remains substantial room for improvement."

Hospitalizations stand at around 15%, "which has been flat over the study period," he said. "This translates into about two hospitalizations per patient per year."

He went on to report four key trends related to anemia management in the DOPPS data:

• First, median hemoglobin levels declined by 0.62 g/dL over the study period. "We have about 16% of patients overall with a hemoglobin level of less than 10 g/dL, and about 4% with hemoglobin less than 9 g/dL," Dr. Robinson said.

• Second, median weekly IV epoetin doses declined by 31%. "The ceiling dose has dropped more substantially," he said. "The 90th percentile dose declined by 42%, while the 10th percentile dose declined by 21% and is now under 3,000 units per week."

• The third trend related to anemia management was observed in the rising proportion of patients who received IV iron, growing from 58% per month in August 2010 to 73% per month in April 2012.

"Clearly, there is movement toward more patients getting IV iron on a regular basis," Dr. Robinson said. "When we surveyed dialysis facility medical directors, about 75% of them told us that they’re using maintenance IV iron dosing on a weekly or biweekly basis."

• The fourth trend related to anemia management was that median serum ferritin levels have increased by 28%. In fact, 39% of hemodialysis patients have ferritin levels at or above 800 ng/mL, and 10% of patients are at or above 1,200 ng/mL.

Dr. Robinson also reported that there has been an apparent rise in the percentage of patients receiving red blood cell transfusions, presenting Medicare claims data that indicated a 0.6% increase per month between November 2010 and November 2011.

"Making some assumptions, that translates to roughly 1 in 20 to 1 in 40 patients per year, so perhaps one additional patient per dialysis shift each year," he said.

In his opinion, this unwelcome trend may be preventable. In the DOPPS data, 12% of facilities reported at least 10% of their patients had hemoglobin levels less than 9 g/dL. DOPPS survey data indicate that 15% of facilities use a lower target for hemoglobin of 9 g/dL. It’s this practice that likely raises transfusion risk.

In what Dr. Robinson characterized as a surprising finding, serum albumin levels rose during the study period, from a mean of 3.8 g/dL to a mean of 4.0 g/dL. "That’s good news," he said. "The question is, why? It may be that this is due to greater use of oral nutritional supplements; but this topic needs further investigation."

The next update of the DOPPS Practice Monitor is scheduled for December 2012.

Kidney Week 2012 was sponsored by the American Society of Nephrology. DOPPS is supported by scientific research grants from Abbott Laboratories, Amgen, Baxter Healthcare, Fresenius Medical Care, Kyowa Hakko Kirin, Sanofi Renal, and Vifor Fresenius Medical Care Renal Pharma without restrictions on publications. Dr. Robinson said that he had no other relevant financial conflicts to disclose.

SAN DIEGO – Since the January 2011 move to bundled Medicare payments for outpatient dialysis services, mortality and hospitalizations appear to be stable among chronic kidney disease patients – but there have been dramatic trends toward lower hemoglobin levels and less use of intravenous epoetin, along with a rise in transfusions.

The findings come from the latest review of data contained in the Dialysis Outcomes and Practice Patterns Study (DOPPS) Practice Monitor, an ongoing effort to provide up-to-date trends in clinical care for dialysis patients.

During a special session at Kidney Week 2012, Dr. Bruce M. Robinson, a nephrologist and vice president for clinical research at Arbor Research Collaborative for Health in Ann Arbor, Mich., presented findings from a stratified random sample of more than 5,000 hemodialysis patients who were treated at about 140 dialysis facilities in the United States between August 2010 and April 2012.

Over that time period, the dialysis landscape changed dramatically, Dr. Robinson said.

Not only did Medicare launch its Prospective Payment System (PPS), but the Food and Drug Administration also modified dosing recommendations for erythropoietin-stimulating agents (such as epoetin) in patients with chronic kidney disease. In addition, new anemia guidelines debuted from Kidney Disease: Improving Global Outcomes (KDIGO), a global organization managed by the National Kidney Foundation. Finally, "a lot of folks are focused on what’s going to happen with the expected introduction of oral renal medications in the bundle in January 2014," said Dr. Robinson.

Since the introduction of the PPS, there has been no clear trend in mortality or hospitalizations, based on DOPPS data corroborated by Medicare claims data. Mortality ranged between 1.5% and 2% per month, or "close to 20% per year," said Dr. Robinson. "There certainly remains substantial room for improvement."

Hospitalizations stand at around 15%, "which has been flat over the study period," he said. "This translates into about two hospitalizations per patient per year."

He went on to report four key trends related to anemia management in the DOPPS data:

• First, median hemoglobin levels declined by 0.62 g/dL over the study period. "We have about 16% of patients overall with a hemoglobin level of less than 10 g/dL, and about 4% with hemoglobin less than 9 g/dL," Dr. Robinson said.

• Second, median weekly IV epoetin doses declined by 31%. "The ceiling dose has dropped more substantially," he said. "The 90th percentile dose declined by 42%, while the 10th percentile dose declined by 21% and is now under 3,000 units per week."

• The third trend related to anemia management was observed in the rising proportion of patients who received IV iron, growing from 58% per month in August 2010 to 73% per month in April 2012.

"Clearly, there is movement toward more patients getting IV iron on a regular basis," Dr. Robinson said. "When we surveyed dialysis facility medical directors, about 75% of them told us that they’re using maintenance IV iron dosing on a weekly or biweekly basis."

• The fourth trend related to anemia management was that median serum ferritin levels have increased by 28%. In fact, 39% of hemodialysis patients have ferritin levels at or above 800 ng/mL, and 10% of patients are at or above 1,200 ng/mL.

Dr. Robinson also reported that there has been an apparent rise in the percentage of patients receiving red blood cell transfusions, presenting Medicare claims data that indicated a 0.6% increase per month between November 2010 and November 2011.

"Making some assumptions, that translates to roughly 1 in 20 to 1 in 40 patients per year, so perhaps one additional patient per dialysis shift each year," he said.

In his opinion, this unwelcome trend may be preventable. In the DOPPS data, 12% of facilities reported at least 10% of their patients had hemoglobin levels less than 9 g/dL. DOPPS survey data indicate that 15% of facilities use a lower target for hemoglobin of 9 g/dL. It’s this practice that likely raises transfusion risk.

In what Dr. Robinson characterized as a surprising finding, serum albumin levels rose during the study period, from a mean of 3.8 g/dL to a mean of 4.0 g/dL. "That’s good news," he said. "The question is, why? It may be that this is due to greater use of oral nutritional supplements; but this topic needs further investigation."

The next update of the DOPPS Practice Monitor is scheduled for December 2012.

Kidney Week 2012 was sponsored by the American Society of Nephrology. DOPPS is supported by scientific research grants from Abbott Laboratories, Amgen, Baxter Healthcare, Fresenius Medical Care, Kyowa Hakko Kirin, Sanofi Renal, and Vifor Fresenius Medical Care Renal Pharma without restrictions on publications. Dr. Robinson said that he had no other relevant financial conflicts to disclose.

SAN DIEGO – Regular consumption of sugar-sweetened sodas and punch are linked with an increased risk of kidney stone formation while consumption of coffee, tea, and other beverages may be protective, results from a large analysis demonstrated.

The findings confirm earlier reports of beverages believed to be associated with a reduced risk of kidney stone formation, Dr. Pietro Manuel Ferraro said in an interview during a poster session Kidney Week 2012. "Patients with a previous kidney stone are advised to ingest at least two liters of fluid per day, but not all fluids are equally beneficial," said Dr. Ferraro, a nephrologist at Catholic University of the Sacred Heart, Rome. "What we can say from this analysis is that it’s best to reduce consumption of sugar-sweetened beverages in these patients."

Doug Brunk/IMNG Medical Media

For the study, which Dr. Ferraro and his associates conducted over the past year at the Channing Division of Network Medicine in Boston, the researchers analyzed data from three large ongoing cohort studies: the Health Professionals Follow-Up Study, and the Nurses’ Health Study I and II. They used a Cox model to assess the risk of developing kidney stones associated with each beverage and adjusted for covariates including age, race, physical activity, body mass index, diabetes, high blood pressure, gout, use of diuretics and intake of calcium, potassium, animal protein, phytate, vitamin C, total energy, and alcohol.

Dr. Ferraro reported data from 194,095 participants in the pooled analysis, which represented 2,643,708 person-years of follow-up. Five categories of beverage consumption were evaluated: less than 1 beverage/week (the reference category), 1/week, 2-4/week, 5-6/week, and 1 or more/day. The researchers found that consumption of sugar-sweetened cola was significantly associated with kidney stone formation (hazard ratio of 1.07 for 1/week; HR, 1.19 for 2-4/week; HR, 1.28 for 5-6/week; and HR, 1.23 for 1 or more/day, compared with the less than 1/week category; P = .02), as was consumption of sugar-sweetened non-cola (HR, 1.17, 1.07, 1.22, and 1.33, respectively; P = .003) and sugar-sweetened punch (HR, 1.10, 1.15, 1.21, and 1.18, respectively; P = .04).

At the same time, consumption of certain beverages were found to be inversely associated with kidney stone formation, including coffee (P less than .001), tea (P = .02), red wine (P = .004), white wine (P = .002), beer (P less than .001), and orange juice (P = .004).

The study, which is the largest of its kind, was supported by a grant from the National Institutes of Health. Dr. Ferraro said that he had no relevant financial conflicts to disclose.

SAN DIEGO – Regular consumption of sugar-sweetened sodas and punch are linked with an increased risk of kidney stone formation while consumption of coffee, tea, and other beverages may be protective, results from a large analysis demonstrated.

The findings confirm earlier reports of beverages believed to be associated with a reduced risk of kidney stone formation, Dr. Pietro Manuel Ferraro said in an interview during a poster session Kidney Week 2012. "Patients with a previous kidney stone are advised to ingest at least two liters of fluid per day, but not all fluids are equally beneficial," said Dr. Ferraro, a nephrologist at Catholic University of the Sacred Heart, Rome. "What we can say from this analysis is that it’s best to reduce consumption of sugar-sweetened beverages in these patients."

Doug Brunk/IMNG Medical Media

For the study, which Dr. Ferraro and his associates conducted over the past year at the Channing Division of Network Medicine in Boston, the researchers analyzed data from three large ongoing cohort studies: the Health Professionals Follow-Up Study, and the Nurses’ Health Study I and II. They used a Cox model to assess the risk of developing kidney stones associated with each beverage and adjusted for covariates including age, race, physical activity, body mass index, diabetes, high blood pressure, gout, use of diuretics and intake of calcium, potassium, animal protein, phytate, vitamin C, total energy, and alcohol.

Dr. Ferraro reported data from 194,095 participants in the pooled analysis, which represented 2,643,708 person-years of follow-up. Five categories of beverage consumption were evaluated: less than 1 beverage/week (the reference category), 1/week, 2-4/week, 5-6/week, and 1 or more/day. The researchers found that consumption of sugar-sweetened cola was significantly associated with kidney stone formation (hazard ratio of 1.07 for 1/week; HR, 1.19 for 2-4/week; HR, 1.28 for 5-6/week; and HR, 1.23 for 1 or more/day, compared with the less than 1/week category; P = .02), as was consumption of sugar-sweetened non-cola (HR, 1.17, 1.07, 1.22, and 1.33, respectively; P = .003) and sugar-sweetened punch (HR, 1.10, 1.15, 1.21, and 1.18, respectively; P = .04).

At the same time, consumption of certain beverages were found to be inversely associated with kidney stone formation, including coffee (P less than .001), tea (P = .02), red wine (P = .004), white wine (P = .002), beer (P less than .001), and orange juice (P = .004).

The study, which is the largest of its kind, was supported by a grant from the National Institutes of Health. Dr. Ferraro said that he had no relevant financial conflicts to disclose.

SAN DIEGO – Regular consumption of sugar-sweetened sodas and punch are linked with an increased risk of kidney stone formation while consumption of coffee, tea, and other beverages may be protective, results from a large analysis demonstrated.

The findings confirm earlier reports of beverages believed to be associated with a reduced risk of kidney stone formation, Dr. Pietro Manuel Ferraro said in an interview during a poster session Kidney Week 2012. "Patients with a previous kidney stone are advised to ingest at least two liters of fluid per day, but not all fluids are equally beneficial," said Dr. Ferraro, a nephrologist at Catholic University of the Sacred Heart, Rome. "What we can say from this analysis is that it’s best to reduce consumption of sugar-sweetened beverages in these patients."

Doug Brunk/IMNG Medical Media

For the study, which Dr. Ferraro and his associates conducted over the past year at the Channing Division of Network Medicine in Boston, the researchers analyzed data from three large ongoing cohort studies: the Health Professionals Follow-Up Study, and the Nurses’ Health Study I and II. They used a Cox model to assess the risk of developing kidney stones associated with each beverage and adjusted for covariates including age, race, physical activity, body mass index, diabetes, high blood pressure, gout, use of diuretics and intake of calcium, potassium, animal protein, phytate, vitamin C, total energy, and alcohol.

Dr. Ferraro reported data from 194,095 participants in the pooled analysis, which represented 2,643,708 person-years of follow-up. Five categories of beverage consumption were evaluated: less than 1 beverage/week (the reference category), 1/week, 2-4/week, 5-6/week, and 1 or more/day. The researchers found that consumption of sugar-sweetened cola was significantly associated with kidney stone formation (hazard ratio of 1.07 for 1/week; HR, 1.19 for 2-4/week; HR, 1.28 for 5-6/week; and HR, 1.23 for 1 or more/day, compared with the less than 1/week category; P = .02), as was consumption of sugar-sweetened non-cola (HR, 1.17, 1.07, 1.22, and 1.33, respectively; P = .003) and sugar-sweetened punch (HR, 1.10, 1.15, 1.21, and 1.18, respectively; P = .04).

At the same time, consumption of certain beverages were found to be inversely associated with kidney stone formation, including coffee (P less than .001), tea (P = .02), red wine (P = .004), white wine (P = .002), beer (P less than .001), and orange juice (P = .004).

The study, which is the largest of its kind, was supported by a grant from the National Institutes of Health. Dr. Ferraro said that he had no relevant financial conflicts to disclose.

SAN DIEGO – A healthy lifestyle cut the risk of cardiovascular events and death in chronic kidney disease, but it had no significant impact on the risk of renal events, preliminary results from an ongoing study have demonstrated.

"The impact of a healthy lifestyle has been studied most often in the general population, but lifestyle as a predictor of adverse outcomes has not been previously evaluated in individuals with CKD," Dr. Ana C. Ricardo said in an interview during a poster session at Kidney Week 2012.

"There have been studies looking at individual risk factors such as smoking and chronic kidney disease progression alone, and exercise and mortality alone; but none have examined the impact of adherence to multiple lifestyle factors."

The findings come from 4 years of follow-up in 3,670 men and women with mild to moderate kidney disease who are enrolled in the Chronic Renal Insufficiency Cohort (CRIC) study, a multicenter, nationwide study supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) to examine the epidemiology, management, and outcomes of CKD.

Dr. Ricardo, a nephrologist with the University of Illinois at Chicago, and her colleagues evaluated the association of a healthy lifestyle with clinical outcomes based on each participant’s healthy lifestyle score. This was calculated by allocating one point for each of the following factors measured at study entry: not currently smoking, engaged in moderate exercise (defined as 150 minutes or greater per week), engaged in vigorous exercise (defined as 75 minutes or greater per week), and having a urinary sodium output of less than 100 mEq/day.

Outcomes of interest were progression of CKD (defined as 50% or greater estimated glomerular filtration rate loss or end-stage renal disease), the development of cardiovascular events (defined as myocardial infarction, stroke, heart failure, or peripheral arterial disease), or death. The researchers used multivariable Cox proportional hazards regression models to determine the impact of the lifestyle factors on these outcomes.

Dr. Ricardo reported that 86% of participants adhered to one or two healthy lifestyle factors. Women, non-Hispanic whites, and college graduates were more likely to have a healthy lifestyle score of 3. Participants with a healthy lifestyle score of 1 had a 35% reduced risk of cardiovascular events or death. This risk was reduced further for those with a score of 2 or 3 (45% and 44%, respectively).

The researchers also found that patients with a healthy lifestyle score of 1 had a 30% reduced risk of CKD progression – but this risk reduction did not reach statistical significance, and risk was not reduced further among those with a score of 2 or 3 (24% and 7%, respectively). "We will explore this in further analyses," Dr. Ricardo said.

She acknowledged certain limitations of the study, including its observational design. "This is a work in progress," she said of the work. "We have more analysis to do. This is just the beginning."

Kidney Week 2012 was sponsored by the American Society of Nephrology. The CRIC study was funded by the NIDDK. Dr. Ricardo said that she had no relevant financial conflicts to disclose.

SAN DIEGO – A healthy lifestyle cut the risk of cardiovascular events and death in chronic kidney disease, but it had no significant impact on the risk of renal events, preliminary results from an ongoing study have demonstrated.

"The impact of a healthy lifestyle has been studied most often in the general population, but lifestyle as a predictor of adverse outcomes has not been previously evaluated in individuals with CKD," Dr. Ana C. Ricardo said in an interview during a poster session at Kidney Week 2012.

"There have been studies looking at individual risk factors such as smoking and chronic kidney disease progression alone, and exercise and mortality alone; but none have examined the impact of adherence to multiple lifestyle factors."

The findings come from 4 years of follow-up in 3,670 men and women with mild to moderate kidney disease who are enrolled in the Chronic Renal Insufficiency Cohort (CRIC) study, a multicenter, nationwide study supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) to examine the epidemiology, management, and outcomes of CKD.

Dr. Ricardo, a nephrologist with the University of Illinois at Chicago, and her colleagues evaluated the association of a healthy lifestyle with clinical outcomes based on each participant’s healthy lifestyle score. This was calculated by allocating one point for each of the following factors measured at study entry: not currently smoking, engaged in moderate exercise (defined as 150 minutes or greater per week), engaged in vigorous exercise (defined as 75 minutes or greater per week), and having a urinary sodium output of less than 100 mEq/day.

Outcomes of interest were progression of CKD (defined as 50% or greater estimated glomerular filtration rate loss or end-stage renal disease), the development of cardiovascular events (defined as myocardial infarction, stroke, heart failure, or peripheral arterial disease), or death. The researchers used multivariable Cox proportional hazards regression models to determine the impact of the lifestyle factors on these outcomes.

Dr. Ricardo reported that 86% of participants adhered to one or two healthy lifestyle factors. Women, non-Hispanic whites, and college graduates were more likely to have a healthy lifestyle score of 3. Participants with a healthy lifestyle score of 1 had a 35% reduced risk of cardiovascular events or death. This risk was reduced further for those with a score of 2 or 3 (45% and 44%, respectively).

The researchers also found that patients with a healthy lifestyle score of 1 had a 30% reduced risk of CKD progression – but this risk reduction did not reach statistical significance, and risk was not reduced further among those with a score of 2 or 3 (24% and 7%, respectively). "We will explore this in further analyses," Dr. Ricardo said.

She acknowledged certain limitations of the study, including its observational design. "This is a work in progress," she said of the work. "We have more analysis to do. This is just the beginning."

Kidney Week 2012 was sponsored by the American Society of Nephrology. The CRIC study was funded by the NIDDK. Dr. Ricardo said that she had no relevant financial conflicts to disclose.

SAN DIEGO – A healthy lifestyle cut the risk of cardiovascular events and death in chronic kidney disease, but it had no significant impact on the risk of renal events, preliminary results from an ongoing study have demonstrated.

"The impact of a healthy lifestyle has been studied most often in the general population, but lifestyle as a predictor of adverse outcomes has not been previously evaluated in individuals with CKD," Dr. Ana C. Ricardo said in an interview during a poster session at Kidney Week 2012.

"There have been studies looking at individual risk factors such as smoking and chronic kidney disease progression alone, and exercise and mortality alone; but none have examined the impact of adherence to multiple lifestyle factors."

The findings come from 4 years of follow-up in 3,670 men and women with mild to moderate kidney disease who are enrolled in the Chronic Renal Insufficiency Cohort (CRIC) study, a multicenter, nationwide study supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) to examine the epidemiology, management, and outcomes of CKD.

Dr. Ricardo, a nephrologist with the University of Illinois at Chicago, and her colleagues evaluated the association of a healthy lifestyle with clinical outcomes based on each participant’s healthy lifestyle score. This was calculated by allocating one point for each of the following factors measured at study entry: not currently smoking, engaged in moderate exercise (defined as 150 minutes or greater per week), engaged in vigorous exercise (defined as 75 minutes or greater per week), and having a urinary sodium output of less than 100 mEq/day.

Outcomes of interest were progression of CKD (defined as 50% or greater estimated glomerular filtration rate loss or end-stage renal disease), the development of cardiovascular events (defined as myocardial infarction, stroke, heart failure, or peripheral arterial disease), or death. The researchers used multivariable Cox proportional hazards regression models to determine the impact of the lifestyle factors on these outcomes.

Dr. Ricardo reported that 86% of participants adhered to one or two healthy lifestyle factors. Women, non-Hispanic whites, and college graduates were more likely to have a healthy lifestyle score of 3. Participants with a healthy lifestyle score of 1 had a 35% reduced risk of cardiovascular events or death. This risk was reduced further for those with a score of 2 or 3 (45% and 44%, respectively).

The researchers also found that patients with a healthy lifestyle score of 1 had a 30% reduced risk of CKD progression – but this risk reduction did not reach statistical significance, and risk was not reduced further among those with a score of 2 or 3 (24% and 7%, respectively). "We will explore this in further analyses," Dr. Ricardo said.

She acknowledged certain limitations of the study, including its observational design. "This is a work in progress," she said of the work. "We have more analysis to do. This is just the beginning."

Kidney Week 2012 was sponsored by the American Society of Nephrology. The CRIC study was funded by the NIDDK. Dr. Ricardo said that she had no relevant financial conflicts to disclose.

SAN DIEGO – Patients who have minor elevations in serum creatinine after noncardiac surgery may be more likely to require a longer postoperative hospital stay and face a twofold increased risk of dying during that stay, preliminary data from a German study have shown.

"This is a big problem, because minor kidney dysfunction may not be noticed postoperatively," Dr. Felix Kork said in an interview during a poster session at Kidney Week 2012 "About 2% of people in general have a small increase in serum creatinine. They are at a greater risk of dying and staying longer in the hospital. Therapeutic options are needed to prevent this minor kidney dysfunction perioperatively."

Dr. Kork of the department of anesthesiology and intensive care medicine at Charité Hospital in Berlin and his associates retrospectively studied the records of 27,616 patients who underwent noncardiac surgery at Charité between 2006 and 2012. The researchers evaluated perioperative renal function by serum creatinine level.

After doing a multivariate analysis that adjusted for age, comorbidities, renal function, high-risk surgery, and postoperative admission to the ICU, the researchers observed that minor elevations in serum creatinine (defined as a range from 0.25 to 0.50 mg/dL) were independently associated with a prolonged hospital length of stay (HR for early discharge, 0.81) and a twofold increased risk of death during the postoperative hospital stay (OR, 1.99) compared with patients without an increase in serum creatinine level. Both findings were statistically significant.

"While adjusting for covariates, we also found that having received radio contrast agent before surgery is independently associated with a greater risk of mortality and hospital length of stay, whether there was kidney dysfunction after the radio contrast agent or not," Dr. Kork added. "We’re still looking into that [association]. It could be that those patients were sicker."

He acknowledged that the study’s retrospective design is a limitation. Because of this "we can only show the association between the serum creatinine increase and the outcome," he said. "We are planning a prospective study right now." Dr. Kork explained that the current study has been submitted for publication in an undisclosed journal, which will contain more detail about these findings.

Dr. Kork said that he had no relevant financial conflicts to disclose.

SAN DIEGO – Patients who have minor elevations in serum creatinine after noncardiac surgery may be more likely to require a longer postoperative hospital stay and face a twofold increased risk of dying during that stay, preliminary data from a German study have shown.

"This is a big problem, because minor kidney dysfunction may not be noticed postoperatively," Dr. Felix Kork said in an interview during a poster session at Kidney Week 2012 "About 2% of people in general have a small increase in serum creatinine. They are at a greater risk of dying and staying longer in the hospital. Therapeutic options are needed to prevent this minor kidney dysfunction perioperatively."

Dr. Kork of the department of anesthesiology and intensive care medicine at Charité Hospital in Berlin and his associates retrospectively studied the records of 27,616 patients who underwent noncardiac surgery at Charité between 2006 and 2012. The researchers evaluated perioperative renal function by serum creatinine level.

After doing a multivariate analysis that adjusted for age, comorbidities, renal function, high-risk surgery, and postoperative admission to the ICU, the researchers observed that minor elevations in serum creatinine (defined as a range from 0.25 to 0.50 mg/dL) were independently associated with a prolonged hospital length of stay (HR for early discharge, 0.81) and a twofold increased risk of death during the postoperative hospital stay (OR, 1.99) compared with patients without an increase in serum creatinine level. Both findings were statistically significant.

"While adjusting for covariates, we also found that having received radio contrast agent before surgery is independently associated with a greater risk of mortality and hospital length of stay, whether there was kidney dysfunction after the radio contrast agent or not," Dr. Kork added. "We’re still looking into that [association]. It could be that those patients were sicker."

He acknowledged that the study’s retrospective design is a limitation. Because of this "we can only show the association between the serum creatinine increase and the outcome," he said. "We are planning a prospective study right now." Dr. Kork explained that the current study has been submitted for publication in an undisclosed journal, which will contain more detail about these findings.

Dr. Kork said that he had no relevant financial conflicts to disclose.

SAN DIEGO – Patients who have minor elevations in serum creatinine after noncardiac surgery may be more likely to require a longer postoperative hospital stay and face a twofold increased risk of dying during that stay, preliminary data from a German study have shown.

"This is a big problem, because minor kidney dysfunction may not be noticed postoperatively," Dr. Felix Kork said in an interview during a poster session at Kidney Week 2012 "About 2% of people in general have a small increase in serum creatinine. They are at a greater risk of dying and staying longer in the hospital. Therapeutic options are needed to prevent this minor kidney dysfunction perioperatively."

Dr. Kork of the department of anesthesiology and intensive care medicine at Charité Hospital in Berlin and his associates retrospectively studied the records of 27,616 patients who underwent noncardiac surgery at Charité between 2006 and 2012. The researchers evaluated perioperative renal function by serum creatinine level.

After doing a multivariate analysis that adjusted for age, comorbidities, renal function, high-risk surgery, and postoperative admission to the ICU, the researchers observed that minor elevations in serum creatinine (defined as a range from 0.25 to 0.50 mg/dL) were independently associated with a prolonged hospital length of stay (HR for early discharge, 0.81) and a twofold increased risk of death during the postoperative hospital stay (OR, 1.99) compared with patients without an increase in serum creatinine level. Both findings were statistically significant.

"While adjusting for covariates, we also found that having received radio contrast agent before surgery is independently associated with a greater risk of mortality and hospital length of stay, whether there was kidney dysfunction after the radio contrast agent or not," Dr. Kork added. "We’re still looking into that [association]. It could be that those patients were sicker."

He acknowledged that the study’s retrospective design is a limitation. Because of this "we can only show the association between the serum creatinine increase and the outcome," he said. "We are planning a prospective study right now." Dr. Kork explained that the current study has been submitted for publication in an undisclosed journal, which will contain more detail about these findings.

Dr. Kork said that he had no relevant financial conflicts to disclose.

SAN DIEGO – Pregnant women with kidney disease face an increased risk of adverse maternal outcomes including maternal mortality independent of underlying comorbid conditions that can occur with kidney disease, according to Dr. Shailendra Sharma.

"Any degree of kidney disease during pregnancy should be recognized and should be treated promptly with respect because we now know that can lead to bad outcomes down the road," Dr. Sharma said in an interview during a poster session at the Kidney Week 2012. "This is not something that should be underestimated."

Dr. Sharma, a second-year renal fellow at the University of Colorado, Aurora, and his associates retrospectively studied the records of 646 women with kidney disease who gave birth in Colorado and Utah between 2000 and 2011 at facilities operated by Intermountain Health Care. For comparison, the researchers randomly selected the records of 62,757 pregnancies from women without kidney disease.

Kidney disease was defined by ICD-9 code, and adverse maternal outcomes were defined as preterm delivery (prior to 37 weeks’ gestation), delivery by cesarean section, length of hospital stay, and maternal death. The researchers used multivariate logistic regression analysis to examine the association between kidney disease and adverse maternal outcomes. Covariates included in the fully adjusted model were maternal age, race, history of diabetes, chronic hypertension, liver disease, and connective tissue disorders.

The mean age of patients was 28 years. Compared with women who did not have kidney disease, those who did were significantly more likely to have comorbid conditions including diabetes (12% vs. 1%, respectively); chronic hypertension (2% vs. 7%); liver disease (9% vs. 1%); and connective tissue disorders (7% vs. 0.4%). They also were more likely to have preeclampsia/eclampsia (11% vs. 3%), to have a longer hospital stay (a mean of 3 vs. 2 days), and to give birth to a lower-weight infant (a mean of 3,067 g vs. 3,325 g).

After the investigators adjusted for age, race, history of diabetes, hypertension, liver disease, and connective tissue disorders, Dr. Sharma and his associates found that pregnant women with kidney disease had a significantly increased risk of death (OR, 3.38); preterm delivery (OR, 1.95); delivery via C-section (OR, 1.38); and longer length of hospital stay (OR, 1.39). "The most striking finding was the association of kidney disease with maternal mortality," Dr. Sharma said at the meeting, which was sponsored by the American Society of Nephrology. "The magnitude of this association surprised us."

He said that the retrospective design of the study is a limitation. "If there’s a prospective study moving forward, specifically designed to answer these questions, then it probably would help us establish the causality."

The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases. Dr. Sharma said he had no relevant financial conflicts to disclose.

SAN DIEGO – Pregnant women with kidney disease face an increased risk of adverse maternal outcomes including maternal mortality independent of underlying comorbid conditions that can occur with kidney disease, according to Dr. Shailendra Sharma.

"Any degree of kidney disease during pregnancy should be recognized and should be treated promptly with respect because we now know that can lead to bad outcomes down the road," Dr. Sharma said in an interview during a poster session at the Kidney Week 2012. "This is not something that should be underestimated."

Dr. Sharma, a second-year renal fellow at the University of Colorado, Aurora, and his associates retrospectively studied the records of 646 women with kidney disease who gave birth in Colorado and Utah between 2000 and 2011 at facilities operated by Intermountain Health Care. For comparison, the researchers randomly selected the records of 62,757 pregnancies from women without kidney disease.

Kidney disease was defined by ICD-9 code, and adverse maternal outcomes were defined as preterm delivery (prior to 37 weeks’ gestation), delivery by cesarean section, length of hospital stay, and maternal death. The researchers used multivariate logistic regression analysis to examine the association between kidney disease and adverse maternal outcomes. Covariates included in the fully adjusted model were maternal age, race, history of diabetes, chronic hypertension, liver disease, and connective tissue disorders.

The mean age of patients was 28 years. Compared with women who did not have kidney disease, those who did were significantly more likely to have comorbid conditions including diabetes (12% vs. 1%, respectively); chronic hypertension (2% vs. 7%); liver disease (9% vs. 1%); and connective tissue disorders (7% vs. 0.4%). They also were more likely to have preeclampsia/eclampsia (11% vs. 3%), to have a longer hospital stay (a mean of 3 vs. 2 days), and to give birth to a lower-weight infant (a mean of 3,067 g vs. 3,325 g).

After the investigators adjusted for age, race, history of diabetes, hypertension, liver disease, and connective tissue disorders, Dr. Sharma and his associates found that pregnant women with kidney disease had a significantly increased risk of death (OR, 3.38); preterm delivery (OR, 1.95); delivery via C-section (OR, 1.38); and longer length of hospital stay (OR, 1.39). "The most striking finding was the association of kidney disease with maternal mortality," Dr. Sharma said at the meeting, which was sponsored by the American Society of Nephrology. "The magnitude of this association surprised us."

He said that the retrospective design of the study is a limitation. "If there’s a prospective study moving forward, specifically designed to answer these questions, then it probably would help us establish the causality."

The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases. Dr. Sharma said he had no relevant financial conflicts to disclose.

SAN DIEGO – Pregnant women with kidney disease face an increased risk of adverse maternal outcomes including maternal mortality independent of underlying comorbid conditions that can occur with kidney disease, according to Dr. Shailendra Sharma.

"Any degree of kidney disease during pregnancy should be recognized and should be treated promptly with respect because we now know that can lead to bad outcomes down the road," Dr. Sharma said in an interview during a poster session at the Kidney Week 2012. "This is not something that should be underestimated."

Dr. Sharma, a second-year renal fellow at the University of Colorado, Aurora, and his associates retrospectively studied the records of 646 women with kidney disease who gave birth in Colorado and Utah between 2000 and 2011 at facilities operated by Intermountain Health Care. For comparison, the researchers randomly selected the records of 62,757 pregnancies from women without kidney disease.

Kidney disease was defined by ICD-9 code, and adverse maternal outcomes were defined as preterm delivery (prior to 37 weeks’ gestation), delivery by cesarean section, length of hospital stay, and maternal death. The researchers used multivariate logistic regression analysis to examine the association between kidney disease and adverse maternal outcomes. Covariates included in the fully adjusted model were maternal age, race, history of diabetes, chronic hypertension, liver disease, and connective tissue disorders.

The mean age of patients was 28 years. Compared with women who did not have kidney disease, those who did were significantly more likely to have comorbid conditions including diabetes (12% vs. 1%, respectively); chronic hypertension (2% vs. 7%); liver disease (9% vs. 1%); and connective tissue disorders (7% vs. 0.4%). They also were more likely to have preeclampsia/eclampsia (11% vs. 3%), to have a longer hospital stay (a mean of 3 vs. 2 days), and to give birth to a lower-weight infant (a mean of 3,067 g vs. 3,325 g).

After the investigators adjusted for age, race, history of diabetes, hypertension, liver disease, and connective tissue disorders, Dr. Sharma and his associates found that pregnant women with kidney disease had a significantly increased risk of death (OR, 3.38); preterm delivery (OR, 1.95); delivery via C-section (OR, 1.38); and longer length of hospital stay (OR, 1.39). "The most striking finding was the association of kidney disease with maternal mortality," Dr. Sharma said at the meeting, which was sponsored by the American Society of Nephrology. "The magnitude of this association surprised us."

He said that the retrospective design of the study is a limitation. "If there’s a prospective study moving forward, specifically designed to answer these questions, then it probably would help us establish the causality."

The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases. Dr. Sharma said he had no relevant financial conflicts to disclose.