Three trials recently published in the NEJM issue last week are rocking the world of nephrology.
These three European Trials come as a major surprise to me.
Two of them deal with the Mtor inhibitors and a clinical trial showing major disappointment in terms of decreasing GFR when used for polycystic kidney disease.
Its not the first time that the basic science data is contradicting clinical data. A nice editorial in NEJM also gives some insightful thoughts on this topic. For now, we have to await some more trails, perhaps longer term to see where we go with this drug.
Another shocker was the IDEAL trial.
This compared early initiation vs late initiation. In this study, planned early initiation of dialysis in patients with stage V chronic kidney disease was not associated with an improvement in survival or clinical outcomes.
This is an interesting study. It compared starting dialysis at 5-7ml/min vs standard practice right now and showed no difference. This goes back to the olden days when people started dialysis when patients got symptomatic rather than just a number. Perhaps we might be just going around in circles.
But some other bloggers have good comments to say.
Take a look
http://www.ncbi.nlm.nih.gov/pubmed/20581422( IDEAL TRIAL)
http://www.ncbi.nlm.nih.gov/pubmed/20581393 ( EDITORIAL NEJM MTOR)
Wednesday, June 30, 2010
IN THE NEWS: Three trials SHOCK the NEPHROLOGY WORLD
Posted by Kenar D Jhaveri( kidney 007) at 10:38 PM
Labels: CKD and ESRD, General Nephrology, In The News
Subscribe to: Post Comments (Atom)
- ► 2022 (18)
- ► 2021 (36)
- ► 2020 (32)
- ► 2019 (42)
- ► 2018 (57)
- ► 2017 (52)
- ► 2016 (45)
- ► 2015 (63)
- ► 2014 (95)
- ► 2013 (133)
- ► 2012 (201)
- ► 2011 (370)
- IN THE NEWS: Three trials SHOCK the NEPHROLOGY WORLD
- IN THE NEWS:- Angiotensin-receptor blockade and r...
- CONSULT ROUNDS: Hypocomplementemia!
- IN THE NEWS ---> Stem Cells and Kidney Damage
- Answer to Immunology Quiz 2
- Rituximab for induction?
- TOPIC DISCUSSION: Phosphorous containing foods
- Panel Reactive Antibody? how do you calculate?
- Topic Discussion: MYH9 Nephropathies
- Pediatrics Grand rounds continue
- CLINICAL CASE 18, ANSWER and SUMMARY
- New blogs of interest
- Topic Discussion: Primary vs Secondary Membranous
- CLINICAL CASE 17, ANSWER AND SUMMARY
- TOPIC DISCUSSION: Amylase in the urine?? Hmm!!
- Gurudakshina in Nephrology
- Are you aware of MICA antibodies?
- ISBP Conference Sept 2010
- Innovative Nephrology teaching tools!
- Kamal Shah's Blog: An Indian CKD registry now exists
- CLINICAL CASE 16 , ANSWER and SUMMARY
- IN THE NEWS- Proteinuria and Avastin
- CONSULT ROUNDS: Dialysis Membrane Reactions- Type B
- IN THE NEWS ---> New treatments for cystic disease
- Immunology Quiz 1 Answers
- Rituximab induced lung injury
- TOPIC DISCUSSION: DIABETIC NEPHROPATHY!!
- B cell signature and Tolerance
- Nephrology World on Intragraft gene expression
- Kidney Transplant as an Outpatient Procedure
- IN THE NEWS ---> Detective Nephron strikes again!
- IN THE NEWS --->NephrologyonDemand
- CONSULT ROUNDS: ANURIC RENAL FAILURE
- CONSULT ROUNDS: Hydronephrosis without evidence on...
- Journal Club: B regulatory cells
- CLINICAL CASE 15 , ANSWER and SUMMARY
- ▼ June (36)
I'm not sure what IDEAL adds to our knowledge/understanding of dialysis. The original KDOQI guidelines suggest initiating RRT once eGFR is less than 15ml/min due to the belief that large mol/IC sequestered toxin clearance is important enough to initiate at this time and that it makes no sense to withhold when GFR is less than what is provided by standard RRT (i.e. 15ml/min of clearance).ReplyDelete
Additionally understand what this paper is suggesting. Over 75% pts were initiated on dialysis before their target start (eGFR 5 - 7ml/min) due to physician discretion (uremic symptoms/complications), but that beginning 6months later is okay since it made no difference in hard outcomes.... so essentially suggesting that waiting for a few months is okay (i.e. patient will not succumb to more CV events) but the patient may be sick...
This will continue to be debated but I'm not exactly sure what this adds