Renal

Risk of hyperkalemia with trimethoprim-sulfamethoxazole

In this population-based case-control study of elderly patients on an ACE or ARB, the risk of hyperkalemia-associated hospitalization was 7 times higher for patients with a recent prescription for trimethoprim-sulfamethoxazole, compared to amoxicillin (with no increased risk with other comparator antibiotics), even after matching for age, sex, renal insufficiency, and diabetes. For elderly patients on an ACE or ARB, the risk of hyperkalemia should be considered before being prescribed trimethoprim-sulfamethoxazole (abstract)

Initiation of dialysis can be delayed until symptoms develop

In this large trial of patients with end stage kidney disease, patients were randomized to initiation of dialysis at a GFR of 10-14 or GFR of 5-7. Mean time to dialysis initiation was 1.8 months versus 7.4 months, but there was no difference between the groups (after a median of 3.6 years) in death or adverse events (including complications of dialysis). Dialysis initiation can be delayed until the development of symptoms (abstract)

Incidence of renal failure in critically ill influenza

In this observational cohort of 50 critically ill patients with 2009 pandemic H1N1 influenza infection, the incidence of kidney injury and dialysis was 67% and 11%, and mortality was 16%. Renal failure is common in patients with pandemic influenza (abstract).

Incidence of CIN after emergency PCI

In this retrospective cohort of 338 patients undergoing emergency PCI for ACS, 28% developed CIN, which was significantly more common in women, those with an LAD lesion, a contrast volume >200cc, or an end-diastolic pulmonary artery pressure > 15mmHg. Mortality in the CIN group was significantly higher than the non-CIN group (10% vs 3%). CIN is common and associated with high mortality post-emergency PCI. Better peri-procedural management is required to reduce the associated morbidity and mortality (abstract)

Darbepoetin associated with stroke

In this trial of 4038 diabetic patients with chronic kidney disease (not on dialysis) and anemia, patients were randomized to darbepoetin or placebo for a Hb goal of 13 g/dL (with rescue darbepoetin if Hb fell to 9 g/dL in the placebo group). There was no difference between the groups in the primary endpoints (death / cardiovascular event, or death / end stage renal disease), but the darbepoetin group had a higher rate of stroke (hazard ratio 1.92, CI 1.38-2.68). Risks of darbepoetin outweigh the benefits in this patient population (abstract)
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