Clinical journal of the American Society of Nephrology : CJASN
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Clin J Am Soc Nephrol · Sep 2017
Multicenter StudyInitiation of Sevelamer and Mortality among Hemodialysis Patients Treated with Calcium-Based Phosphate Binders.
Prior studies have shown that sevelamer attenuates progression of arterial calcification and may reduce the risk of death compared with calcium-based phosphate binders. In clinical practice, however, sevelamer is used not only as an alternative but also as an add-on therapy in patients already being treated with calcium-based phosphate binders. We analyzed the Dialysis Outcomes and Practice Patterns Study (DOPPS) data to test the hypothesis that the initiation of sevelamer is associated with improved survival in patients on hemodialysis treated with calcium-based phosphate binders. ⋯ The use of sevelamer as an add-on or alternative therapy to calcium-based phosphate binders is associated with improved survival in patients on maintenance hemodialysis.
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Clin J Am Soc Nephrol · Jun 2017
Multicenter StudySleep and CKD in Chinese Adults: A Cross-Sectional Study.
To assess the association between self-reported sleep duration and quality and odds of having CKD in Chinese adults on the basis of a community study. ⋯ Worse overall sleep quality was associated with higher odds of being high or very high risk for CKD and proteinuria in Chinese adults.
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Clin J Am Soc Nephrol · Jun 2017
Multicenter Study Observational StudyAlbuminuria, Proteinuria, and Renal Disease Progression in Children with CKD.
The role of albuminuria as an indicator of progression has not been investigated in children with CKD in the absence of diabetes. ⋯ In children with CKD without diabetes, the utility of an initial UP/C, ACR, and Unon-alb/cr for characterizing progression is similar.
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Clin J Am Soc Nephrol · Feb 2017
Randomized Controlled Trial Multicenter StudySertraline Versus Placebo in Patients with Major Depressive Disorder Undergoing Hemodialysis: A Randomized, Controlled Feasibility Trial.
Depression is common in patients on hemodialysis, but data on the benefits and risks of antidepressants in this setting are limited. We conducted a multicenter, randomized, double-blind, placebo-controlled trial of sertraline over 6 months in patients on hemodialysis with depression to determine study feasibility, safety, and effectiveness. ⋯ Although small, this is the largest randomized trial to date of antidepressant medication in patients on hemodialysis. Our results highlight recruitment issues. No benefit was observed, but trial size and the substantial dropout render consideration of benefit inconclusive. A definitive trial could use shorter follow-up and include depressed patients already taking antidepressants.
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Clin J Am Soc Nephrol · Jan 2017
Multicenter StudyAssociation of Preoperative Urinary Uromodulin with AKI after Cardiac Surgery.
AKI is a serious complication after cardiac surgery. Although high urinary concentrations of the tubular protein uromodulin, a marker of tubular health, are associated with less AKI in animal models, its relationship in humans is unknown. ⋯ Lower uromodulin-to-creatinine ratio is associated with higher odds of AKI and higher peak serum creatinine after cardiac surgery. Additional studies are needed to confirm these preliminary results.