Comparison of efficacy of the phosphate binders nicotinic acid and sevelamer hydrochloride in hemodialysis patients

Farrokhlagha Ahmadi¹, Fatemeh Shamekhi², Mahbob Lessan-Pezeshki¹, Mohammad Reza Khatami^1
1 Department of Nephrology Research Center, Tehran University of Medical Science, Imam Khomeni Hospital; Tehran, Iran
² Department of Nephrology, Ziaean Hospital, Tehran, Iran

http://www.sjkdt.org/article.asp?issn=1319-2442;year=2012;volume=23;issue=5;spage=934;epage=938;aulast=Ahmadi;type=0

Abstract

Hyperphosphatemia is a significant risk factor for the development of ectopic calcification and coronary artery diseases in patients on hemodialysis (HD), and must be controlled with the use of phosphate binders. Studies comparing the effects of sevelamer and nicotinic acid, both similar non-calcium and non-aluminum phosphate binders, are not available. In this study, 40 patients on HD with a serum phosphorus level of more than 6 mg/dL were enrolled. After a two week washout period without phosphate binders, the patients were randomly divided into two equal groups (n = 20) and were started on nicotinic acid or sevelamer for a period of four weeks. The dose of nicotinic acid used was 500 mg and that of sevelamer was 1600 mg daily. Blood samples were drawn for the measurement of the total calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), triglyceride (TG), total cholesterol (Chol), high-density lipoprotein (HDL), low-density lipoprotein (LDL), uric acid and parathyroid hormone (PTH). Patients receiving sevelamer showed a significant reduction in serum P level (2.2 ± 0.69 mg/dL; P <0.0001) in comparison with the nicotinic acid group (1.7 ± 1.06 mg/dL; P = 0.004). Reduction in the Ca-P product was significantly different in the two groups; in the sevelamer group, it was 21 ± 7; (P <0.0001) while in the nicotinic acid group, it was 16 ± 11 (P = 0.007). Also, patients on sevelamer showed greater reduction in the mean TG level (38.9 ± 92 mg/dL; P = 0.005). No significant changes were observed in the mean serum Ca, total Chol, HDL, LDL, ALP and iPTH levels in the two study groups. Our short-term study suggests that although nicotinic acid reduced hyperphosphatemia, sevelamer showed higher efficacy in controlling hyperphosphatemia as well as the Ca-P product.

Cefotaxime-heparin lock prophylaxis against hemodialysis catheter-related sepsis amongStaphylococcus aureus nasal carriers

Anil K Saxena¹, Bodh R Panhotra², Abdul Aziz Al-hafiz³, Dasappan S Sundaram³, Bassam Abu-Oyun³, Khalifa Al Mulhim^4
1 Nephrology Division, Al-Rahba Hospital-Johns Hopkins Medicine International, Abu Dhabi, United Arab Emirates
² Department of Microbiology, King Fahad Hospital and Tertiary Care Center, Hofuf, Al-Hassa, Eastern Province, Kingdom of Saudi Arabia
³ Nephrology Division, King Fahad Hospital and Tertiary Care Center, Hofuf, Al-Hassa, Eastern Province, Kingdom of Saudi Arabia
⁴ Department of Family Medicine, King Fahad Hospital and Tertiary Care Center, Hofuf, Al-Hassa, Eastern Province, Kingdom of Saudi Arabia

Abstract

Staphylococcus aureus nasal carriers undergoing hemodialysis (HD) through tunneled cuffed catheters (TCCs) form a high-risk group for the development of catheter-related bloodstream infections (CRBSI) and ensuing morbidity. The efficacy of antibiotic-locks on the outcomes of TCCs among S. aureus nasal carriers has not been studied earlier. Persistent nasal carriage was defined by two or more positive cultures for methicillin-susceptible (MSSA) or methicillin-resistant (MRSA) S. aureus of five standardized nasal swabs taken from all the participants dialyzed at a large out-patient HD center affiliated to a tertiary care hospital. Of 218 participants, 82 S. aureus nasal carriers dialyzed through TCCs (n = 88) were identified through April 2005 to March 2006 and randomized to two groups. Group I comprised of 39 nasal carriers who had TCCs (n = 41) "locked" with cefotaxime/heparin while group II included 43 patients with TCCs (n = 47) filled with standard heparin. The CRBSI incidence and TCC survival at 365 days were statistically compared between the two groups. A significantly lower CRBSI incidence (1.47 vs. 3.44/1000 catheter-days, P <0.001) and higher infection-free TCC survival rates at 365 days (80.5 vs. 40.4%, P <0.0001) were observed in the cefotaxime group compared with the stan dard heparin group. However, no significant difference in MRSA-associated CRBSI incidence was observed between the two groups. Cefotaxime-heparin "locks" effectively reduced CRBSI-incidence associated with gram-positive cocci, including MSSA, among S. aureus nasal carriers. There remains a compelling requirement for antibiotic-locks effective against MRSA.

Merdeka!

Merdeka!

Merdeka!

The early decline in renal function in patients with type 1 diabetes and proteinuria predicts the risk of end-stage renal disease

Jan Skupien^1,2, James H Warram¹, Adam M Smiles¹, Monika A Niewczas^1,2, Tomohito Gohda^1,2,3, Marcus G Pezzolesi^1,2, Diego Cantarovich⁴, Robert Stanton^1,5 and Andrzej S Krolewski^1,2

1. ¹Research and Clinic Divisions, Joslin Diabetes Center, Boston, Massachusetts, USA
2. ²Department of Medicine, Brigham and Women Hospital, Boston, Massachusetts, USA
3. ³Division of Nephrology, Department of Internal Medicine, Juntendo University School of Medicine, Tokyo, Japan
4. ⁴Institut de Transplantation, Urologie et Néphrologie, Nantes University Hospital, Nantes, France
5. 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

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Wishing All Our

Muslim Brothers and Sisters

A Blessed

Selamat Hari Raya Aidil Firtri

"May we celebrate together many more

 Hari Raya

in Peace and Harmony"

Best wishes and regards

MalaysianKidneySPA

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

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.