Articles related to Nephrology

Phosphodiesterase-5 inhibitors (PDE5i) have been found to reduce the risk of major adverse cardiovascular events in men with both coronary artery disease (CAD) and erectile dysfunction (ED), with tadalafil showing greater cardiac benefits compared to sildenafil, according to a study presented at the American Urological Association’s annual meeting. The retrospective study analyzed over 41,000 men with CAD and ED and found that those who took tadalafil or sildenafil had significantly lower 5-year risks of heart failure, myocardial infarction, and overall mortality compared to those who received no PDE5i treatment. Tadalafil recipients had even lower risks than sildenafil recipients across all categories. The study suggests that understanding the specific differences among PDE5i medications is crucial for addressing cardiac outcomes in patients with ED and CAD, with tadalafil potentially offering superior benefits due to differences in pharmacokinetics and longer duration of efficacy. However, further research is needed before definitive conclusions can be made regarding preferential prescription of tadalafil over other PDE5i medications.

At the 2023 HIMSS meeting, Dr. Sandra Kane-Gill discussed a new alert system being developed at UPMC to improve care for patients at risk for drug-associated acute kidney injury (AKI). According to Dr. Kane-Gill, drugs are involved in approximately 30% of AKI cases in hospitalized patients, but imprecise alert systems mean that at-risk patients could be overlooked. To address this challenge, Dr. Kane-Gill led a consensus-building project to identify 20 drugs that are probably or definitely nephrotoxic with routine use. UPMC has developed a prototype alert tool for AKI that uses this list of nephrotoxic drugs to accurately detect AKI in patients. Preliminary results indicate that for every five alerts generated, there was one case of drug-associated AKI, a higher accuracy rate than for other alert systems. Dr. Kane-Gill plans to further refine the alert tool before deploying it in practice at UPMC and is also interested in using machine learning to prevent episodes of kidney injury.

The Organ Transplant and Procurement Network (OTPN) is set to undergo modernization and improvement after being criticized for lack of transparency, long waits, mishandling of organs, and the number of people who die on the waitlist each year. The Health Resources and Services Administration (HRSA) has launched the OTPN modernization project, which will focus on accountability. The current system is outdated and has been responsible for 70 deaths between 2010 and 2020, according to a 2022 senate report. The HRSA plans to take steps, such as creating a new dashboard, to provide transparency and better serve patients and their families. Additional modernization will focus on overhauling the operations of the OTPN system to ensure higher compliance and a greater focus on patient safety. Organ transplants and the OTPN disproportionately affect the Black community in the US. About 30% of the ONTP waitlist is Black Americans, and about 90% are waiting for kidney transplants. The HRSA’s plan hopes to address the inequality by improving accountability, transparency, and systems of organ retrieval and matching. The changes will benefit patients, and physicians might be able to see more of their patients receive the life-saving transplants they need.

A young woman with progressive autosomal dominant PKD is seen for follow up. She had a recent infected kidney cyst. Except for a palpable right kidney, the exam is unremarkable. Labs show a decrease in eGFR from a year prior. She is on lisinopril. What is your approach to treatment now?

In this target trial emulation involving nearly 44,000 patients with primary hyperparathyroidism (PHPT), similar declines in kidney function at 5 and 10 years were seen in patients managed with parathyroidectomy and in those managed nonoperatively. Thus, in this study, parathyroidectomy had no effect on long-term kidney function in older adults with PHPT.

This trial including more than 6,500 patients randomized to empagliflozin or placebo and followed for a median of 2 years. Progression of kidney disease or death from cardiovascular causes was monitored over the course of the trial. Those outcomes occurred in approximately 13% of patients in the empagliflozin group versus approximately 17% of patients in the placebo group.