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Ciclosporin-induced hypertension is associated with increased sodium transporter of the loop of Henle. This elegant study further elucidates the mechanisms of ciclosporin-induced hypertension, by demonstrating that renal sodium and water retention is associated with an increase in the Na-K-2Cl co-transporter of the loop of Henle (NKCC2). This rise in protein is associated with an increase in NKCC2 mRNA, pointing to a transcriptional regulation of this sodium transporter.See article by Esteva-Font et al., pages 2810–2816
The effects of insulin therapy and acute kidney injury in the critically ill have been systematically reviewed.
Intensive insulin therapy has been found to reduce mortality in certain critically ill patients. By meta-analysis across all studies, intensive insulin therapy reduced the incidence of AKI by 38%; in addition, this therapy showed a tendency to reduce the incidence of dialysis requirement. On the other hand, intensive insulin therapy is associated with an >4-fold increase in the risk of hypoglycaemia.
See article by Thomas et al., pages 2849–2855
The clinical efficacy of sevelamer and the cost-effectiveness of this new drug in dialysis patients have been carefully analysed in two separate papers and an invited editorial. The meta-analysis of efficacy and safety studies found no differences between sevelamer and calcium-based phosphate binders for all-cause mortality, cardiovascular mortality, adverse events, or hospitalisation rates. The comprehensive economic analysis, modelled on North American cohorts and costs, calculated that the risk of hospitalisation resulting from the prescription of sevelamer would need to be reduced by over 30 percent in order to generate cost savings justifying the drug-alone expense of sevelamer.
The invited editorial comment puts the two other papers into a more detailed perspective.
See articles by Tonelli et al., pages 2856–2866; Manns et al., pages 2867–2878; and Palmer et al., pages 2742–2745
Automated vs CAPD: a systematic review of randomized controlled trials. In this very carefully performed analysis, APD appears to be more beneficial than CAPD, in terms of reducing peritonitis rates and with respect to certain social issues that have an impact on patients' quality of life. However, many trials included in the review were of small size and had short follow-up periods, so that more adequately powered trials are required to confirm the benefits for APD found in this review.
Related to the problem of randomized trials in PD in general, the accompanying invited editorial points out that quite a significant number of important randomized trials have been performed in PD but that comparative and conclusive studies will need to include an excess of 1000 patients. This will need large-scale, multicentre and international cooperation and funding.
See article by Rabindranath et al., pages 2991–2998; and Blake pages 2746–2748
Angiogenic factors in preeclampsia. This timely review carefully summarizes recent advances in the understanding of preeclampsia, which have opened up new possibilities for the identification of women at risk for developing this disease and intrauterine growth restriction. The use of the soluble form of fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) as biomarkers before the clinical onset of preeclampsia should be compared with traditional screening, such as uterine artery Doppler imaging, in women at low and high risk for preeclampsia.
See article by Berkane et al., pages 2753–2756
High peritoneal membrane transport status has traditionally been viewed as a risk factor for survival. This paper found that the survival disadvantage did not persist following transfer of these patients to HD, provided the transfer was early enough.
See article by Wiggins et al., pages 3005–3012
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Related articles in NDT:
- Sevelamer: a promising but unproven drug
- Suetonia C. Palmer, Jonathan C. Craig, and Giovanni F. M. Strippoli
NDT 2007 22: 2742-2745.[Extract] [FREE Full Text] - Randomized controlled trials in PD
- Peter G. Blake
NDT 2007 22: 2746-2748.[Extract] [FREE Full Text] - Angiogenic factors in preeclampsia: so complex, so simple?
- Nadia Berkane, Guillaume Lefevre, and Alexandre Hertig
NDT 2007 22: 2753-2756.[Extract] [FREE Full Text] - Ciclosporin-induced hypertension is associated with increased sodium transporter of the loop of Henle (NKCC2)
- Cristina Esteva-Font, Elisabet Ars, Elena Guillen-Gomez, Josep Maria Campistol, Laia Sanz, Wladimiro Jiménez, Mark Alan Knepper, Ferran Torres, Roser Torra, José Aurelio Ballarín, and Patricia Fernández-Llama
NDT 2007 22: 2810-2816.[Abstract] [FREE Full Text] - Insulin therapy and acute kidney injury in critically ill patients—a systematic review
- George Thomas, Maria C. Rojas, Scott K. Epstein, Ethan M. Balk, Orfeas Liangos, and Bertrand L. Jaber
NDT 2007 22: 2849-2855.[Abstract] [FREE Full Text] - Systematic review of the clinical efficacy and safety of sevelamer in dialysis patients
- Marcello Tonelli, Natasha Wiebe, Bruce Culleton, Helen Lee, Scott Klarenbach, Fiona Shrive, Braden Manns, and for the Alberta Kidney Disease Network
NDT 2007 22: 2856-2866.[Abstract] [FREE Full Text] - Economic evaluation of sevelamer in patients with end-stage renal disease
- Braden Manns, Scott Klarenbach, Helen Lee, Bruce Culleton, Fiona Shrive, and Marcello Tonelli
NDT 2007 22: 2867-2878.[Abstract] [FREE Full Text] - Automated vs continuous ambulatory peritoneal dialysis: a systematic review of randomized controlled trials
- Kannaiyan S. Rabindranath, James Adams, Tariq Z. Ali, Conal Daly, Luke Vale, and Alison M. MacLeod
NDT 2007 22: 2991-2998.[Abstract] [FREE Full Text] - High membrane transport status on peritoneal dialysis is not associated with reduced survival following transfer to haemodialysis
- Kathryn J. Wiggins, Stephen P. McDonald, Fiona G. Brown, Johan B. Rosman, and David W. Johnson
NDT 2007 22: 3005-3012.[Abstract] [FREE Full Text]
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