Effects of 1,25(OH)2D3 on compensatory renal growth in the growing rat

Effects of 1,25(OH)2D3 on compensatory renal growth in the growing rat. Renal compensatory growth after uninephrectomy (UNX) was examined in vitamin D replete male 100g Sprague-Dawley rats. Five days after UNX, the contralateral kidney wet weight increased by 25% with the kidney weight/body weight ratio reaching a plateau by day 7 after UNX. The early weight increase was primarily due to an increased cell number, as evaluated by a stereological technique in perfusion-fixed kidneys. Twenty pmol 1,25(OH)2D3 by daily s.c. injection increased time-averaged 1,25(OH)2D3 concentrations 3.3-fold and reduced the increment in the kidney weight of UNX pairfed rats compared to solvent UNX controls. The number of mitoses (whole kidney and different nephron segments) were significantly reduced by giving 1,25(OH)2D3 to UNX animals at different levels of food intake. The effect was also demonstrable in PTX animals on a constant infusion of exogenous PTH (100 ng/kg/hr 1,34 bPTH by osmotic minipump). The data suggest that changes of 1,25(OH)2D3 concentration within a physiologically relevant range modulate compensatory (and possibly basal) growth of the kidney

Cost‐effectiveness analysis of multiple imaging modalities in diagnosis and follow‐up of intermediate complex cystic renal lesions

Objectives: To compare health-economic aspects of multiple imaging modalities used to monitor renal cysts, the present study evaluates costs and outcomes of patients with Bosniak IIF and III renal cysts detected and followed-up by either contrast-enhanced computed tomography (ceCT), contrast-enhanced magnetic resonance imaging (ceMRI), or contrast-enhanced ultrasonography (CEUS). Patients and methods: A simulation using Markov models was implemented and performed with 10 cycles of 1 year each. Proportionate cohorts were allocated to Markov models by a decision tree processing specific incidences of malignancy and levels of diagnostic performance. Costs of imaging and surgical treatment were investigated using internal data of a European university hospital. Multivariate probabilistic sensitivity analysis was performed to confirm results considering input value uncertainties. Patient outcomes were measured in quality-adjusted life years (QALY), and costs as averages per patient including costs of imaging and surgical treatment. Results: Compared to the 'gold standard' of ceCT, ceMRI was more effective but also more expensive, with a resulting incremental cost-effectiveness ratio (ICER) >€70 000 (Euro) per QALY gained. CEUS was dominant compared to ceCT in both Bosniak IIF and III renal cysts in terms of QALYs and costs. Probabilistic sensitivity analysis confirmed these results in the majority of iterations. Conclusion: Both ceMRI and CEUS can be used as alternatives to ceCT in the diagnosis and follow-up of intermediately complex cystic renal lesions without compromising effectiveness, while CEUS is clearly cost-effective. The economic results apply to a large university hospital and must be adapted for smaller hospitals

Erfahrungen, Herausforderungen und Lösungsansätze aus der Extraktion pseudonymer Daten für das Projekt INDEED

Background: In Germany there is currently no health reporting on cross-sectoral care patterns in the context of an emergency department care treatment. The INDEED project (Utilization and trans-sectoral patterns of care for patients admitted to emergency departments in Germany) collects routine data from 16 emergency departments, which are later merged with outpatient billing data from 2014 to 2017 on an individual level. Aim: The methodological challenges in planning of the internal merging of routine clinical and administrative data from emergency departments in Germany up to the final data extraction are presented together with possible solution approaches. Methods: Data were selected in an iterative process according to the research questions, medical relevance, and assumed data availability. After a preparatory phase to clarify formalities (including data protection, ethics), review test data and correct if necessary, the encrypted and pseudonymous data extraction was performed. Results: Data from the 16 cooperating emergency departments came mostly from the emergency department and hospital information systems. There was considerable heterogeneity in the data. Not all variables were available in every emergency department because, for example, they were not standardized and digitally available or the extraction effort was judged to be too high. Conclusion: Relevant data from emergency departments are stored in different structures and in several IT systems. Thus, the creation of a harmonized data set requires considerable resources on the part of the hospital as well as the data processing unit. This needs to be generously calculated for future projects

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Regionale Unterschiede in der Prävalenz kardiovaskulärer Erkrankungen

Hintergrund: Kardiovaskuläre Erkrankungen stehen unverändert an der Spitze der Todesursachenstatistik und verursachen den größten Anteil aller Behandlungskosten in Deutschland. Die Kenntnis regionaler Unterschiede in der Häufigkeit kardiovaskulärer Erkrankungen ist für die Planung zielgerichteter Versorgungsstrukturen und Präventionsmaßnahmen wichtig. Methode: Anhand gepoolter Daten des bundesweiten telefonischen Gesundheitssurveys Gesundheit in Deutschland aktuell (GEDA) 2009, 2010 und 2012 (n = 62 214) wurde die Lebenszeitprävalenz einer bedeutsamen kardiovaskulären Erkrankung (selbst berichtete ärztliche Diagnose von Herzinfarkt, anderer koronarer Herzkrankheit, Schlaganfall oder Herzinsuffizienz) auf Ebene der Bundesländer geschätzt. Der Einfluss soziodemografischer Merkmale auf bundeslandbezogene Prävalenzunterschiede wurde in adjustierten logistischen Regressionsanalysen untersucht. Die Prävalenzen wurden den Mortalitätsraten durch kardiovaskuläre Erkrankungen aus der Todesursachenstatistik gegenübergestellt. Ergebnisse: Die Lebenszeitprävalenz kardiovaskulärer Erkrankungen in Deutschland variierte zwischen 10,0 % in Baden-Württemberg und 15,8 % in Sachsen-Anhalt. Nach Adjustierung für Alter, Geschlecht, Sozialstatus und Gemeindegröße wiesen neun der 15 übrigen Bundesländer mit Odds Ratios zwischen 1,26 (Hessen) und 1,55 (Sachsen-Anhalt) weiterhin signifikant höhere Prävalenzen als Baden-Württemberg auf. Überdurchschnittlich hohe Werte von Prävalenz und Mortalität lagen in vier der fünf neuen Bundesländer vor. Schlussfolgerung: Es existieren relevante Bundeslandunterschiede in der Lebenszeitprävalenz bedeutsamer kardiovaskulärer Erkrankungen in Deutschland. Diese können nur teilweise durch Variationen in Alter, Geschlecht, Sozialstatus und Gemeindegröße erklärt werden