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Thursday, September 06, 2012

By Matthew Coleman

 

Among patients with chronic kidney disease (CKD) in northeast Japan, those treated with sympatholytics did not experience the sudden rise in blood pressure after the 2011 earthquake that their counterparts did, according to a brief communication published in the American Journal of Hypertension (2012;25:951-954).

 

The study, which was led by Kenichi Tanaka of the Department of Nephrology and Hypertension at Fukushima Medical University, included 132 hypertensive outpatients with Stage 3-4 CKD who were residents of Fukushima City.

 

Patients had been treated for at least three months before the earthquake and visited the hospital one to three weeks following the disaster. Clinic blood pressures and heart rates were measured at baseline (previous visit within two months before the earthquake) and twice after the earthquake (at one to three weeks and five to seven weeks).

 

For the 106 patients not taking sympatholytics, mean baseline systolic and diastolic blood pressures were 135 and 78 mmHg, respectively.

 

On their first visit after the earthquake, mean systolic blood pressure had shot up to 139 mmHg, and diastolic blood pressure to 81 mmHg. By the second visit, systolic blood pressure had gone down to 135 mmHg, and diastolic blood pressure to 77 mmHg.

 

Sympatholytics were given to 26 (19.7%) of patients with chronic kidney disease. In this group, baseline mean systolic blood pressure was 133 mmHg, and mean diastolic blood pressure was 71 mmHg.

 

On their first visit after the earthquake, mean blood pressure remained level at 131 mmHg (systolic) and 71 mmHg (diastolic). The second visit showed no significant change, with systolic blood pressure holding at 134 mmHg and diastolic blood pressure at 72 mmHg.

 

“The beneficial effect of sympatholytics on blood pressure control after the earthquake might reflect that the increases in blood pressure were caused by activation of the sympathetic nervous system after the earthquake in CKD patients,” Dr. Tanaka and colleagues wrote.

 

The study is limited by the fact that it was only a retrospective analysis of a small group of hypertensive CKD patients without a control group of non-CKD hypertensive patients.

 

“[F]urther investigation is needed to clarify the association between earthquake-induced deterioration of blood pressure control and cardiovascular events after earthquakes in CKD patients, and whether sympatholytic medications reduce the incidence of cardiovascular disease or mortality.”


Thursday, August 30, 2012

By Matthew Coleman

 

Internal medicine subspecialists experience below-average burnout rates compared with other physicians, but they also report the least satisfaction with work-life-balance, according to a study published online first by Archives of Internal Medicine.

 

In the overall sample of US physicians from all specialties, 45.8% indicated at least one symptom of burnout, as assessed using the 22-item Maslach Burnout Inventory.

 

“Burnout can have serious personal repercussions for physicians, including problematic alcohol use, broken relationships, and suicidal ideation,” wrote lead author Tait D. Shanafelt, MD, of the Mayo Clinic, and colleagues.

 

“When considered with the mounting evidence that physician burnout adversely affects quality of care, these findings suggest a highly prevalent and systemic problem threatening the foundation of the US medical care system.”

 

Rates of burnout showed deep divergence across specialties. Emergency medicine, general internal medicine, neurology, and family medicine had the highest rates of burnout, while pathology, dermatology, general pediatrics, and preventive medicine had the lowest.

 

In terms of work-life balance, dermatology, general pediatrics, and preventive medicine had the highest rated satisfaction, and general surgery, general surgery subspecialties, and obstetrics/gynecology the lowest.

 

The 7,288 physicians were also assessed using a two-item burnout measure, and their responses were compared with those from a probability-based sample of 3,442 working US adults who were not physicians.

 

Of the physicians, 37.9% had symptoms of burnout and 40.1% were dissatisfied with work-life balance, compared with 27.8% and 23.1% of working adults, respectively.

 

“In contrast to these differences in burnout, no statistically significant differences between physicians and controls were observed in symptoms of depression or suicidal ideation in the past 12 months, suggesting that the higher distress among physicians was limited to professional burnout,” the authors wrote.

 

Limitations of the research included the low response rate of 26.7% among physicians invited to participate, as well as the cross-sectional nature of the survey, which meant it was unable to determine whether the observed associations were causally related.

 

“Given the evidence that burnout may adversely affect quality of care and negatively affect physician health, additional research is needed to identify personal, organizational, and societal interventions to address this problem,” Dr. Shanafelt and colleagues wrote.

 

The study was funded by the American Medical Association and the Mayo Clinic Department of Medicine Program on Physician Well-Being.


Wednesday, May 02, 2012

Daily fish oil capsules significantly lengthened the time to loss of arteriovenous graft patency and cut the rate of corrective interventions and thromboses among patients receiving chronic hemodialysis, the Fish Oil Inhibition of Stenosis in Hemodialysis Grafts (FISH) study reported in today's issue of the Journal of the American Medical Association.

 

However, these outcomes were secondary endpoints of the multicenter, randomized, double-blind, placebo-controlled clinical trial, and fish oil had no significant effect on the primary endpoint, the proportion of grafts with a loss of native patency within 12 months.

 

To read expert analysis of what these results mean for the field, please go to http://bit.ly/FISHStudy, or click the below link. There you will find Nephrology Times’ full coverage of the trial results, as first presented during the American Society of Nephrology Kidney Week 2011.


Tuesday, April 24, 2012

The once-monthly erythropoiesis-stimulating agent (ESA) peginesatide (Omontys) is now available for the treatment of anemia due to chronic kidney disease (CKD) in adult patients on dialysis. The agent was approved by the Food and Drug Administration (FDA) on March 27.

 

“Today’s announcement represents an important milestone in the field as nephrologists and anemia nurses will now be able to use the first once-monthly treatment for anemia for adult dialysis patients available in the United States,” said John Orwin, Chief Executive Officer of Affymax, in a statement. “We are excited to partner with the dialysis community and support the important work they do for patients.”

 

Omontys is co-marketed by Affymax and Takeda Pharmaceuticals USA and distributed by the latter. The synthetic, pegylated, peptide-based ESA is not indicated and is not recommended for use in patients with CKD who are not on dialysis, in patients receiving treatment for cancer and whose anemia is not due to CKD, or as a substitute for red-blood-cell transfusions in patients who require immediate correction of anemia.


Friday, February 03, 2012

 

By Matthew Coleman

 

Dialysis patients living at high altitudes have lower cardiovascular event rates, reported a recent study published online ahead of print by Nephrology Dialysis Transplantation.

 

Cardiovascular risk was 20% lower for patients residing at 4,000-5,999 feet and 19% lower for patients residing at 6,000 ft or higher, compared with otherwise similar patients who lived at or near sea level, found the researchers, who were led by Wolfgang C. Winkelmayer, MD, ScD, of Stanford University School of Medicine.

 

This work built on the researchers' previous observation that US dialysis patients and members of the general population who resided at higher altitudes had lower all-cause mortality rates.

 

In the new study, rates of myocardial infarction, stroke, and cardiovascular death were 31%, 32%, and 23% lower, respectively, among patients living above 6,000 ft compared with patients residing at or near sea level.

 

Dr. Winkelmayer and colleagues studied all adult patients from the US Renal Data System with sufficient data who initiated hemodialysis treatment between 1995 and 2006. Of the 984,265 patients included, almost 95% resided below 2,000 ft (40.3% below 250 ft, and 54.5% at 250-1,999 ft), and 4,356 patients (0.4%) resided above 6,000 ft.

 

Patients who lived at higher altitudes were younger, less likely to be covered by Medicaid, and more likely to be on peritoneal dialysis at the initiation of therapy.

 

While rates of most comorbid conditions were similar across altitude groups, patients at higher altitudes had more diagnosed diabetes and hypertension, slightly less arteriosclerotic heart disease and heart failure, and few instances of reported inability to ambulate or transfer.

 

There were 574,063 deaths observed, 257,955 (44.93%) of which were reported as cardiovascular. There was no meaningful association between altitude and non-cardiovascular death.

 

“The fact that altitude is shown to selectively attenuate the risk of cardiovascular mortality in dialysis patients suggests that there are underlying biological mechanisms that are activated at higher altitudes to protect these patients from cardiovascular risk,” the authors wrote. “These findings need to be considered with caution, however, and residual confounding remains a possibility.”

 

The inverse relationship between altitude and cardiovascular outcomes was examined in multivariable models.

 

“This observation was only slightly attenuated even after adjusting for a large number of patient characteristics and is consistent with previous studies that have demonstrated the protective effect of HIF [hypoxia-inducible factor]-1 activation on the cardiovascular system,” the authors wrote. “We propose that HIF-1 plays an important role in conferring a protective effect on cardiovascular outcomes in dialysis patients.”

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