Over 100,000 Medicare Patients May Suffer from Glomerulonephritis

Glomerulonephritis may be caused by problems with the body's immune system. Often, the exact cause of glomerulonephritis is unknown. Many of the diseases are characterised by inflammation either of the glomeruli or small blood vessels in the kidneys, hence the name, but not all diseases necessarily have an inflammatory component. If the illness continues, the kidneys may stop working completely, resulting in kidney failure.

PHILADELPHIA—Researchers calculated that glomerulonephritis (GN) likely afflicts more than 100,000 Medicare patients, and the condition appears to be associated with high hospitalization and death rates, according to findings presented at the 2014 Kidney Week meeting.

James B. Wetmore, MD, and colleagues with the Chronic Disease Research Group in Minneapolis, Minn., used the 20% Medicare sample from 2007 to 2011 to identify GN cases. They calculated GN prevalence per 100,000 patients by dividing the number of GN cases by the total number of individuals in the database during the study period. The study population included a total of 8,276,664 individuals with a mean age of 68 years.

From 2007 to 2011, the GN prevalence was 433 primary GN cases per 100,000 individuals, representing 35,870 total cases. In addition, the study showed that there were 878 cases of GN resulting from systemic diseases per 100,000 individuals, which translated into 72,666 total cases.

Moreover, Dr. Wetmore's team found that the incidence rates of primary GN and GN resulting from systemic diseases were 86.7 and 136.1 cases per 100,000 patient-years, respectively. Total hospitalization rates were 2,083 and 2,093 hospitalizations per 1,000 patient-years, respectively, and death rates were 136 and 195 deaths per 1,000 patient-years, respectively.

Chronic Glomerulonephritis is caused by the ultra immune responses in kidneys caused by the kidneys hypoxic-ischemic, even worse, it is the result of long time’s blood pollution. So the treatment in our hospital, Traditional Chinese Medicine, work on cleaning the toxins in blood and promoting blood circulation to remove blood clots.

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Lupus Nephritis ESRD Rates Stable

Up to 60% of lupus patients will develop lupus nephritis. When the kidneys are inflamed, they can't function normally and can leak protein. Normally, the immune system helps protect the body from infection or harmful substances. But in patients with an autoimmune disease, the immune system cannot tell the difference between harmful substances and healthy ones. Every day, the two kidneys filter about 120 to 150 of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid.

In a retrospective study using the U.S. Renal Data System database, investigators at the Chronic Disease Research Group of the Minneapolis Medical Research Foundation in Minneapolis, analyzed data from 1,557,117 individuals who initiated renal replacement therapy (RRT) from 1995–2010. Of these, 16,649 had ESRD from systemic lupus erythematosus (SLE).

The researchers, led by Robert N. Foley, MD, calculated standardized incidence ratios (SIRs) to 1995–1996, when the rate of SLE-related ESRD was 3.2 cases per million per year. Rates per million during 1995–1996 were higher for African Americans (11.1), female subjects (4.9), and individuals aged 20–29 (4.9), 30–44 (4.6), and 45–64 (4.0).

For the overall population, the SIRs of SLE-related ESRD requiring RRT were 1.19 in 1997–1998, 1.17 in 1999–2000, 1.17 in 2001–2002, 1.21 in 2003–2004, 1.18 in 2005–2006, 1.16 in 2007–2008, and 1.05 in 2009–2010, according to findings published online ahead of print in the Clinical Journal of the American Society of Nephrology.

During a median follow-up of 4.4 years, 42.6% of individuals with ESRD from SLE died, 45.3% were listed for renal transplantation, and 28.7% underwent transplantation.

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Compared with white patients, African-American patients were 23% more likely to die, after adjusting for age, sex, and other variables. Although African-American patients were 11% more likely that white patients to be listed for a renal transplant, they were 46% less likely to receive one.

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Diabetic Nephropathy Not Improved by Dual Regimen

Nephropathy means kidney disease or damage. Diabetic nephropathy is damage to your kidneys caused by diabetes. It is characterized by nephrotic syndrome and diffuse glomerulosclerosis. It is due to longstanding diabetes mellitus, and is a prime indication for dialysis in many developed countries. In people with diabetes, the nephrons slowly thicken and become scarred over time. The kidneys begin to leak and protein (albumin) passes into the urine. This damage can happen years before any symptoms begin.

Combination therapy with an ACE inhibitor and angiotensin-receptor blocker (ARB) is not more effective than an ARB alone in slowing renal disease progression in patients with diabetic nephropathy, but it is associated with an increased risk of acute kidney injury (AKI) and hyperkalemia, according to a recent study.

The multicenter, double-blind Veterans Affairs Nephropathy in Diabetes study included 1,448 patients with proteinuric diabetic kidney disease (urinary albumin-to-creatinine ratio of at least 300) and an estimated glomerular filtration rate (eGFR) of 30.0-89.9 mL/min/1.73 m2. The investigators, led by Linda F. Fried, MD, MPH, of the VA Pittsburgh Healthcare System in Pittsburgh, randomly assigned patients to receive the ARB losartan plus placebo or losartan plus the ACE inhibitor lisinopril. The patients had a median follow-up of 2.2 years. The primary endpoint was the first occurrence of a change in eGFR (a decline of 30 or more if the initial eGFR was 60 or greater or a decline of 50% or more if the initial eGFR was less than 60), end-stage renal disease, or death.

Last but not least, if kidney damage has been formed by diabetes, the medical treatment should be applied as early as possible. In our Chronic Kidney Disease (CKD) Center, we do use Blood Pollution Therapy to deal with kidney damage. The treatment aims at treating the polluted blood not the kidneys. Under help of various techniques of cleaning blood, the wastes and toxins in blood can be discharged effectively and in the way, the internal environment of the body can be cleaned. Then, some effective reprative medicine and different elements can be supplied.

Primary endpoint events occurred in 152 (21%) of the 724 patients in the monotherapy arm and 132 (18.2%) of the 724 patients in the combination-therapy, a non-significant difference between the groups, the researchers reported in the New England Journal of Medicine (2013;369:1892-1903).

Compared with the monotherapy arm, the combination-therapy arm had significantly higher rates of AKI (12.2 vs. 6.7 events per 100 person-years) and hyperkalemia (6.3 vs. 2.6 events per 100 person-years). kidneyhospitalabroad@hotmail.com

Further Data on Diabetic Retinopathy Drug Requested

Diabetes is due to either the pancreas not producing enough insulin or the cells of the body not responding properly to the insulin produced. Patients with high blood sugar will typically experience polyuria (frequent urination), they will become increasingly thirsty (polydipsia) and hungry (polyphagia). Prevention and treatment involve a healthy diet, physical exercise, not using tobacco and being a normal body weight.

Eli Lilly and Company has received an approvable letter from the FDA requesting additional supporting data for its new drug application for ruboxistaurin mesylate (proposed trade name: Arxxant), Lilly's investigational oral therapy for diabetic retinopathy.

The company plans to meet with the FDA to determine whether a new study is required to meet the request or if data from an ongoing study will suffice.

“We will be working closely with the FDA to address issues outlined in the approvable letter and to define the pathway forward,” said Timothy R. Franson, MD, the company's vice president of global regulatory affairs.

Last but not least, if kidney damage has been formed by diabetes, the medical treatment should be applied as early as possible. In our Chronic Kidney Disease (CKD) Center, we do use Blood Pollution Therapy to deal with kidney damage. The treatment aims at treating the polluted blood not the kidneys. Under help of various techniques of cleaning blood, the wastes and toxins in blood can be discharged effectively and in the way, the internal environment of the body can be cleaned. Then, some effective reprative medicine and different elements can be supplied.

kidneyhospitalabroad@hotmail.com

Phosphate Binders Cut Mortality, Up ESRD Risk

The ESRD composite rate payment system differs from most other prospective payment systems because there is a single product category to define the service Medicare is buying. Although different equipment, supplies, and labor are needed for hemodialysis and peritoneal dialysis, the current system does not differentiate payment based on dialysis method, location (home or incenter) or equipment used.

Phosphate binder use was associated with lower mortality risk but a higher risk of end-stage renal disease (ESRD) among patients with chronic kidney disease (CKD) and high phosphorus levels, according to study findings presented at the National Kidney Foundation's 2015 Spring Clinical Meetings in Dallas.

In a retrospective longitudinal cohort study, Ardeshir Khosraviani, MD, and colleagues at Kaiser Permanente Southern California compared phosphate binder use and non-use among 3,026 non-dialysis CKD patients with hyperphosphatemia (phosphorus levels 5.5 mg/dL or higher). Compared with patients who did not use phosphate binders, those who did had a 15% decreased mortality risk and a nearly 3-fold increased risk of ESRD, the investigators reported.

“These findings underscore the need to better understand whether earlier phosphorus management may impact morbidity and mortality in advanced CKD,” the authors concluded in a poster presentation. Of the 3,026 subjects, 596 used binders and 2,430 did not. Study subjects had a mean age was 65.5 years; 49% were female, 49% were white, 24% were Hispanic, 17.3% were black, and 8.5% were Asian. The binder group had higher rates of diabetes, hypertension, and coronary artery disease.

“Our study raises the question of whether earlier management and control of hyperphosphatemia in the CKD population with binder therapy may improve patient survival in terms of mortality prior to and after [transition to ESRD],” Dr. Khosraviani told Renal & Urology News.

He said he and his colleagues believe their study adds to the literature on the topic because it looked at a real-world practice environment using a large and heterogeneous CKD population, and the results provide insights into CKD mineral-bone management strategies as patients transition to ESRD.

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Tea Overconsumption Causes Nephropathy

Did you know that African Americans are 3 times more likely to experience kidney failure? Causes of kidney disease include deposition of the IgA antibodies in the glomerulus, administration of analgesics, xanthine oxidase deficiency, toxicity of chemotherapy agents, and long-term exposure to lead or its salts. What foods are good for treatment of nephropathy?

Excessive consumption of iced tea has been linked to renal failure caused by oxalate nephropathy in a case study appearing in the New England Journal of Medicine.

In the article, a 56-year-old man presented to the hospital with weakness, fatigue, body aches, and an elevated serum creatinine level (400μmol per liter). His previous medical records noted rising creatinine levels (110 μmol per liter to 220 μmol per liter); he had no proteinuria, hematuria, personal history of kidney stones, family history of kidney disease, history of gastric bypass surgery, or malabsorptive symptoms. However, his urine sediment was remarkable for the presence of abundant calcium oxalate crystals. Dialysis was initiated due to worsening renal failure with uremic symptoms.

Because ultrasonography showed normal kidney size despite the rapidly progressive nature of the patient's renal failure, a renal biopsy was performed. Oxalate crystals, interstitial inflammation with eosinophils, and interstitial edema consistent with a diagnosis of oxalate nephropathy were observed in the sample.

The patient admitted to drinking sixteen 8 oz glasses of iced tea daily, which the doctors believe contributed to oxalate nephropathy leading to renal failure. The patient was consuming more than 1500 mg of oxalate daily from black tea, which is 3–10 times more than the daily average American intake.

With this conclusion, the author advises that in cases of unexplained renal failure in which proteinuria is absent and abundant oxalate crystals are present in urine sediment, a thorough dietary history should be obtained that includes assessing consumption of oxalate-rich sources like tea.

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Alternate Night Home Hemodialysis Improves Anemia

Healthy kidneys clean your blood and remove extra fluid in the form of urine. You need dialysis if your kidneys no longer remove enough wastes and fluid from your blood to keep you healthy. Hemodialysis is the most common method used to treat advanced and permanent kidney failure.

Nocturnal home hemodialysis (NHHD) performed on alternate nights improves anemia and decreases the need for an erythropoiesis-stimulating agent (ESA) compared with conventional hemodialysis, according to a new study.

Clara K. Y. Poon, MD, of Princess Margaret Hospital in Hong Kong, and colleagues compared 23 patients receiving NHHD with 25 in-center patients receiving conventional hemodialysis (CHD). In the NHHD group, mean hemoglobin levels increased significantly from 9.37 g/dL at baseline to 11.34 g/dL at 24 months, the investigators reported online ahead of print in Hemodialysis International.

During that same period, the mean weekly ESA requirement decreased significantly from 103.4 U/kg to 47.3 U/kg. In the CHD group, mean hemoglobin levels were 9.5 g/dL at baseline and 9.3 g/dL at 24 months, a non-significant difference. The weekly ESA requirement increased significantly from 89.7 U/kg to 105.9 U/kg. In addition, 26% of the NHHD patients were able to discontinue ESA therapy compared with none of the CHD patients, according to the researchers.

The NHHD group experienced greater increase in standard Kt/V compared with the CHD group.

“NHHD with an alternate night schedule improves anemia and reduces ESA requirement as a result of enhanced uremic clearance,” the authors concluded.

Dr. Poon's team commented that NHHD on alternate nights may be superior to NHHD performed 6 or 7 times a week in terms of anemia management. They cited a cohort study in which investigators examined anemia parameters in patients receiving daily long nocturnal hemodialysis and those undergoing short daily hemodialysis and CHD.

The study, published in the American Journal of Kidney Diseases (2003;42 (S1):S18–S23), found that all patients lost a significant amount of blood in hemodialysis tubing and as a result of laboratory testing compared with baseline, the groups undergoing dailiy hemodialysis experienced a significantly greater amount of blood compared with the CHD group.

“Hence, prolonged and more frequent hemodialysis may increase total blood loss to the blood circuit and it may offset the benefits to anemia by long duration of hemodialysis,” Dr. Poon's team noted.

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