AJKD: Temporary iron depletion and relative thrombocytosis may underline increased mortality with high doses of EPO.

AJKD: Results: Higher platelet count was associated with lower iron stores and greater prescribed rHuEPO dose. Compared with a hemoglobin level of 12 to 13 g/dL, a hemoglobin level of 13 g/dL or greater was associated with increased mortality in the presence of relative thrombocytosis, ie, platelet count of 300,000/microL or greater (case-mix–adjusted death-rate ratio, 1.21; 95% confidence limits, 1.02 to 1.44; P = 0.03) as opposed to the absence of relative thrombocytosis (death-rate ratio, 1.04; 95% confidence limits, 0.98 to 1.08; P = 0.1). A prescribed rHuEPO dose greater than 20,000 U/wk was associated with a greater likelihood of iron depletion (iron saturation ratio < 20%) and relative thrombocytosis (case-mix–adjusted odds ratio, 2.53; 95% confidence limits, 2.37 to 2.69; and 1.36; 95% confidence limits, 1.30 to 1.42, respectively; P < 0.001) and increased mortality during 3 years (death-rate ratio, 1.59; 95% confidence limits, 1.54 to 1.65; P < 0.001). Limitations ................................... Our results may incorporate uncontrolled confounding. Achieved hemoglobin level may have different mortality predictability than targeted hemoglobin level.......... Conclusions: Iron depletion and associated relative thrombocytosis might contribute to increased mortality when administering high rHuEPO doses to achieve hemoglobin levels of 13 g/dL or greater in long-term hemodialysis patients. Randomized trials are needed to test these observational associations.

Clopidogrel decreases arteriovenous fistula thrombosis but does not improve fistula maturation

Clopidogrel decreases arteriovenous fistula thrombosis but does not improve fistula maturation

Nature Clinical Practice Nephrology 4, 476 (2008). doi:10.1038/ncpneph0908

Author: Michael S Gersch

Autosomal dominant polycystic kidney disease can be associated with lung abnormalities

Autosomal dominant polycystic kidney disease can be associated with lung abnormalities

Nature Clinical Practice Nephrology 4, 467 (2008). doi:10.1038/ncpneph0872

RPA and ESRD networks launch kidney patient safety initiative, including a new website.

Kidney Patients Safety: he web site aims to provide information and best practices to prevent the occurrence of the Five Adverse Patient Safety Events identified through patient and professional surveys that form the core of the site. Keeping Kidney Patients Safe also assists nephrology professionals in meeting the quality assessment and performance improvement (QAPI) portion of the Centers for Medicare and Medicaid Services (CMS) Conditions for Coverage for End Stage Renal Disease Facilities. Links to other patient safety resources, a patient safety improvement program toolkit and articles spotlighting various safety improvement programs and other resources are also offered to nephrology professionals.

In vitro studies suggest role for antihistamine clemizole in treating hepatitis C

EurekAlert: In all, the team found 18 drugs that substantially reduced NS4B binding to its target RNA, but they focused on clemizole because it is already known to be safe in humans. Quake said several of the other compounds were also interesting starting points for developing useful medicines. Should clemizole prove effective in human trials, Glenn said, it could become an essential component in a new class of multidrug treatments for hepatitis C. Other components could be drugs under development elsewhere that target specific enzymes in the virus. The goal is to improve on the current treatment, a combination of the general antiviral drugs interferon and ribavirin. Those only work about half the time, but have uncomfortable, flulike side effects.