Kidney International

The OSCAR study was a multicenter, prospective randomized open-label blinded end-point study of 1164 Japanese elderly hypertensive patients comparing the efficacy of angiotensin II receptor blocker (ARB) uptitration to an ARB plus calcium channel blocker (CCB) combination. In this prospective study, we performed prespecified subgroup analysis according to baseline estimated glomerular filtration rate (eGFR) with chronic kidney disease (CKD) defined as an eGFR <60 ml/min per 1.73 m2.

Dialysis time is increasingly being appreciated as an important measure of dialysis adequacy. Increased dialysis time leads to better control of volume excess, to reduced occurrence of intradialytic hypotension, and to better control of serum phosphorus. Nevertheless, the amount of benefit obtainable by moderate increases in dialysis time in patients following a three-times-per-week schedule has not been well established, and the analysis is confounded by associations between prescribed and/or delivered dialysis time and factors related to patient mortality.

A 60-year-old man presented to the emergency department with a chief complaint of shortness of breath and lower extremity edema for approximately 1 month. On further interview, the patient reported intermittent claudication progressing to the point he could not climb a flight of stairs. His only other history was a remote abdominal stab wound suffered some 30 years prior…

Hemodialysis patients have high rates of mortality that may be related to aspects of the dialytic procedure. In prior studies, shorter length dialysis sessions have been associated with decreased survival, but these studies may have been confounded by body size differences. Here we tested whether in-center three-times-weekly hemodialysis patients with adequate urea clearances but shorter dialysis session length is associated with mortality independent of body size. Data were taken from a large national cohort of patients from a large dialysis organization undergoing three-times-weekly in-center hemodialysis. In the primary analysis, patients with prescribed dialysis sessions greater and less than 240 min were pair-matched on post-dialysis weight as well as on age, gender, and vascular access type. Compared to prescribed longer dialysis sessions, session lengths less than 240 min were significantly associated with increased all-cause mortality (adjusted hazard ratio 1.26). The association was consistent across strata of age, gender, and dialysis post-weight. Secondary analyses found a dose–response between prescribed session length and survival. Thus, among patients with adequate urea clearance, shorter dialysis session lengths are associated with increased mortality independent of body weight.

The function of the kidney with its highly differentiated and specialized cell types is affected by infection with several viruses. Viral infections of the kidney have a negative impact not only on patients undergoing renal transplantation and immunosuppression. Besides the increasing number of patients suffering from HIV-associated nephropathy, another group of viruses infects immunocompetent patients and induces renal failure. Hantaviruses belong nowadays to the emerging zoonoses that increase in number and geographic distribution.

Nephropathy progression is slowed and cardiovascular events reduced in patients with stage 3 or higher chronic kidney disease when blood pressure is controlled using combinations of renin–angiotensin system (RAS) blockers with dihydropyridine calcium channel blockers or diuretics. We discuss a trial comparing high-dose RAS blockade with lower-dose RAS blockade combined with a dihydropyridine calcium channel blocker. The primary outcome was cardiovascular events. The combination group had better blood pressure control and fewer total events.

The KI journal Club are synopses that bring you the latest research highlights from across a wide spectrum of journals in fields relevant to renal research.

The ISN presents a selection of images, articles and abstracts from Kidney International Volume 5, Issue 4, December 2012, from our editorial office in China.

The KI journal Club are synopses that bring you the latest research highlights from across a wide spectrum of journals in fields relevant to renal research.

A 34-year-old patient with diabetes insipidus after removal of a hypothalamic tumor, developed difficulties with his treatment and presented with hypernatremia. On admission his blood pressure was normal, he was confused, had polyuria and secondary hyperaldosteronism, and his serum [Na+] was 162 mmol/l.