Merdeka!
Merdeka!
Merdeka!
Friday, August 31, 2012
Monday, August 27, 2012
The early decline in renal function in patients with type 1 diabetes and proteinuria predicts the risk of end-stage renal disease
Jan Skupien1,2, James H Warram1, Adam M Smiles1, Monika A Niewczas1,2, Tomohito Gohda1,2,3, Marcus G Pezzolesi1,2, Diego Cantarovich4, Robert Stanton1,5 and Andrzej S Krolewski1,2
- 1Research and Clinic Divisions, Joslin Diabetes Center, Boston, Massachusetts, USA
- 2Department of Medicine, Brigham and Women Hospital, Boston, Massachusetts, USA
- 3Division of Nephrology, Department of Internal Medicine, Juntendo University School of Medicine, Tokyo, Japan
- 4Institut de Transplantation, Urologie et Néphrologie, Nantes University Hospital, Nantes, France
- 5Renal Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
Kidney International (2012) 82, 589–597; doi:10.1038/ki.2012.189; published online 23 May 2012
Abstract:
The risk of end-stage renal disease (ESRD) remains high in patients with type 1 diabetes and proteinuria; however, little is known about the rate of decline in their renal function. To help determine this, we enrolled patients with type 1 diabetes and proteinuria whose estimated glomerular filtration rate (eGFR) was normal (equal to or above 60 ml/min per 1.73 m2).
Using a minimum of five serial measurements of serum creatinine for 161 patients, we determined individual trajectories of eGFR change and the occurrence of ESRD during 5–18 years of follow-up. The rates were linear for 110 patients, for 24 the nonlinear rate was mild enough to satisfy a linear model, and the rates were clearly nonlinear for only 27 patients. Overall, in more than one-third of patients, the eGFR decline was less than 3.5 ml/min per 1.73 m2 per year and the lifetime risk of ESRD could be considered negligible. In the remainder of patients, eGFR declined with widely different slopes and ESRD developed within 2 to 18 years.
Based on up to 5 years observation, when renal function was within the normal range, the estimates of early eGFR slope predicted the risk of ESRD during subsequent follow-up better than the baseline clinical characteristics of glycated hemoglobin, blood pressure, or the albumin to creatinine ratio. Thus, the early slope of eGFR decline in patients with type 1 diabetes and proteinuria can be used to predict the risk of ESRD
Tuesday, August 14, 2012
Monday, August 6, 2012
China arrests 137 over organ-trafficking ring
The Sun Daily 6/8/2012 http://www.thesundaily.my/news/455439
BEIJING (Aug 5, 2012): Chinese police arrested 137 people, among them doctors, suspected of trafficking human organs in a nationwide crime ring that profited from the huge demand for transplants, authorities said.
In a sting operation beginning in late July, police pounced across 18 provinces and regions and "rescued" 127 people who had agreed to donate organs to illicit traders, the Ministry of Public Security said.
Eighteen doctors were among those detained, suspected of performing illegal transplant operations, the ministry said in a report posted on its website late Saturday.
"The suspects usually used forged identities to recruit healthy candidates from the Internet and put them under secret confinement separated from the outside world," it said.
"The suspects sought patients in need of organ transplants from hospitals or the Internet and matched them with healthy donors."
The crackdown on traffickers comes after state media reported in April that a teenage high-school student sold a kidney for an illicit transplant operation and used the proceeds to buy an iPhone and iPad.
The 17-year-old boy, who was paid 22,000 yuan ($3,500), was recruited from an online chatroom. The Xinhua news agency said at the time the boy was suffering from kidney failure and in deteriorating health.
More than 1.5 million Chinese need organ transplants, but only about 10,000 such operations are performed in the nation annually, Xinhua said, citing statistics from the health ministry.
The huge demand has led to a thriving illegal market for organs, the ministry said.
Executed prisoners remain the main source of organs used in transplant operations due to the lack of voluntary donations, Vice Health Minister Huang Jiefu was quoted by state media as saying early this year.
Following repeated criticism from overseas rights groups, Huang pledged to wean the nation off of its dependency on organs from prisoners.
International human rights groups have long accused China of harvesting organs from executed prisoners without the consent of the prisoner or their family -- charges the government has denied.
The lack of available organs for transplants largely stems from an absence of a "transplant culture" in China compared to the West and the traditional idea that the body must be left as it is at death. – AFP
Friday, August 3, 2012
Is Cinacalcet Cost-Effective?
Komaba et al, pages 262-271; and Yuan et al, pages 179-181.
American Journal of Kidney Diseases Volume 60, Issue 2 , Pages A23-A24, August 2012
Secondary hyperparathyroidism (SHPT) is ubiquitous in patients with chronic kidney failure treated by long-term dialysis; cinacalcet effectively reduces elevated levels of parathyroid hormone in these patients. In this issue of AJKD, Komaba and colleagues report a pharmacoeconomic analysis of cinacalcet plus conventional therapy compared with conventional therapy alone in a theoretical cohort of Japanese hemodialysis patients. Strikingly, the investigators found that while cinacalcet was cost-effective in less than 1% of simulations in patients who were eligible for parathyroidectomy, cinacalcet was cost-effective in more than 99% of simulations in those who were not surgery candidates. Yuan et al comment on this striking dichotomy and call for nephrologists to consider establishing the optimal use of cinacalcet as an opportunity to set priorities in order to reduce expenditures in the face of global reimbursement reduction.
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