Oxpentifylline versus placebo in the treatment of erythropoietin-resistant anaemia: a randomized controlled trial

Background: The main hypothesis of this study is that Oxpentifylline administration will effectively treat erythropoietin-or darbepoietin-resistant anaemia in chronic kidney disease patients

Carvedilol and cardiac biomarkers in dialysis patients: Secondary analysis of a randomized controlled trial

Published online: December 04, 2017Background/Aims: Cardiac biomarkers are associated with cardiac abnormalities and adverse outcomes in dialysis patients. Our aim was to report the effect of the beta-blocker carvedilol on cardiac biomarkers in adult dialysis patients. Methods: The Beta-Blocker to Lower Cardiovascular Dialysis Events Feasibility Study was a randomized controlled trial comparing carvedilol to placebo. Serum and plasma were collected before the run-in, then 6 and 12 months post-randomization to measure B-type Natriuretic Peptide (BNP), N-terminal BNP (NT-ProBNP), high-sensitivity cardiac troponins I (hs-TnI) and T (hs-TnT), and galectin-3. Left ventricular global longitudinal strain (GLS) was measured by echocardiography at baseline. Results: Seventy-two participants were recruited of whom 49 completed the run-in and were randomized to carvedilol (n=26) or placebo (n=23). Baseline echocardiography demonstrated median (inter-quartile range) GLS of -14.27% (-16.63 to -11.93). NTproBNP and hs-TnT correlated with GLS (Spearman’s rho=0.34 [p=0.018] and rho=0.28 [p=0.049], respectively). Median change scores from baseline to 12 months did not differ significantly between participants with complete biomarker data randomized to carvedilol (n=15) or placebo (n=16) for any biomarkers. Conclusions: NT-proBNP and hs-TnT were associated with GLS. However, changes in levels of the biomarkers from baseline to 12 months were not different between groups randomized to carvedilol and placebo.Matthew A. Roberts, Darsy Darssan, Sunil V. Badve, Robert P. Carroll, Magid A. Fahim, Brian A. Haluska, Carmel M. Hawley, Nicole M. Isbel, Mark R. Marshall, Elaine M. Pascoe, Eugenie Pedagogos, Helen L. Pilmore, Paul Snelling, Tony Stanton, Ken-Soon Tan, Andrew M. Tonkin, Liza A. Vergara, Francesco L. Ierin

Can we IMPROVE cardiovascular outcomes through phosphate lowering in CKD? Rationale and protocol for the IMpact of Phosphate Reduction on Vascular End-points in Chronic Kidney Disease (IMPROVE-CKD) study

Introduction: Patients with chronic kidney disease (CKD) are at heightened cardiovascular risk, which has been associated with abnormalities of bone and mineral metabolism. A deeper understanding of these abnormalities should facilitate improved treatment strategies and patient-level outcomes, but at present there are few large, randomised controlled clinical trials to guide management. Positive associations between serum phosphate and fibroblast growth factor 23 (FGF-23) and cardiovascular morbidity and mortality in both the general and CKD populations have resulted in clinical guidelines suggesting that serum phosphate be targeted towards the normal range, although few randomised and placebo-controlled studies have addressed clinical outcomes using interventions to improve phosphate control. Early preventive measures to reduce the development and progression of vascular calcification, left ventricular hypertrophy and arterial stiffness are crucial in patients with CKD. Methods and analysis: We outline the rationale and protocol for an international, multicentre, randomised parallel-group trial assessing the impact of the non-calcium-based phosphate binder, lanthanum carbonate, compared with placebo on surrogate markers of cardiovascular disease in a predialysis CKD population—the IM pact of P hosphate R eduction O n V ascular E nd-points (IMPROVE)-CKD study. The primary objective of the IMPROVE-CKD study is to determine if the use of lanthanum carbonate reduces the burden of cardiovascular disease in patients with CKD stages 3b and 4 when compared with placebo. The primary end-point of the study is change in arterial compliance measured by pulse wave velocity over a 96-week period. Secondary outcomes include change in aortic calcification and biochemical parameters of serum phosphate, parathyroid hormone and FGF-23 levels. Ethics and dissemination: Ethical approval for the IMPROVE-CKD trial was obtained by each local Institutional Ethics Committee for all 17 participating sites in Australia, New Zealand and Malaysia prior to study commencement. Results of this clinical trial will be published in peer-reviewed journals and presented at conferences.Nicole Lioufas, Nigel D Toussaint, Eugenia Pedagogos, Grahame Elder, Sunil V Badve, Elaine Pascoe, Andrea Valks, Carmel Hawley, Geoffrey A Block, Neil C Boudville, Katrina Campbell, James D Cameron, Sylvia S M Chen, Randall J Faull, Stephen G Holt, Lai S Hooi, Dana Jackson, Meg J Jardine, David W Johnson, Peter G Kerr, Kenneth K Lau, Alicia Morrish, Vlado Perkovic, Kevan R Polkinghorne, Carol A Pollock, Donna Reidlinger, Laura Robison, Edward R Smith, Robert J Walker, Angela Yee Moon Wang

Micromechanical Properties of Injection-Molded Starch–Wood Particle Composites

The micromechanical properties of injection molded starch–wood particle composites were investigated as a function of particle content and humidity conditions. The composite materials were characterized by scanning electron microscopy and X-ray diffraction methods. The microhardness of the composites was shown to increase notably with the concentration of the wood particles. In addition,creep behavior under the indenter and temperature dependence were evaluated in terms of the independent contribution of the starch matrix and the wood microparticles to the hardness value. The influence of drying time on the density and weight uptake of the injection-molded composites was highlighted. The results revealed the role of the mechanism of water evaporation, showing that the dependence of water uptake and temperature was greater for the starch–wood composites than for the pure starch sample. Experiments performed during the drying process at 70°C indicated that the wood in the starch composites did not prevent water loss from the samples.Peer reviewe

Action myoclonus–renal failure syndrome: A cause for worsening tremor in young adults

Action myoclonus–renal failure syndrome (AMRF) is an autosomal recessive disorder first described in 4 French Canadian patients, followed by a recent description of 15 cases from various countries. The condition independently affects the kidney, with focal glomerulosclerosis causing renal failure and the brain causing progressive myoclonus epilepsy (PME) or progressive myoclonic ataxia (PMA). Tremor is often an early feature. The diagnosis of tremor and myoclonus in patients with severe renal disease is challenging. Here we highlight the evolution of tremor in this syndrome in two new cases and emphasize problems in early diagnosis. Copyright: ©2006AAN Enterprises, Inc

Patterns of use and appropriateness of antibiotics prescribed to patients receiving haemodialysis: an observational study

BACKGROUND: There are limited published data on the types and appropriateness of oral and intravenous (IV) antibiotics prescribed to patients receiving haemodialysis. This information is critical to optimise antibiotic prescribing. Therefore this study aims to describe the patterns of use and the appropriateness of oral and IV antibiotics prescribed to patients receiving haemodialysis. METHODS: This was a prospective, observational study across four community and two hospital inpatient haemodialysis units in Melbourne, Australia. Data were collected from July 2014 to January 2015 from participants. Antibiotic regimens prescribed were compared with nationally available antibiotic guidelines and then classified as being either appropriate, inappropriate or not assessable by an expert multidisciplinary team using the National Antimicrobial Prescribing Survey tool. RESULTS: Overall, 114 participants consented to this study where 55.3% (63/114) received antibiotics and 235 antibiotic regimens were prescribed at a rate of 69.1 antibiotic regimens/100 patient-months. The most common oral antibiotics prescribed were amoxycillin/clavulanic acid and cephalexin. The most common IV antibiotics prescribed were vancomycin, piperacillin/tazobactam, cephazolin and ceftriaxone. The percentage of inappropriate antibiotic regimens prescribed were 34.9% (15/43) in the community setting and 22.1% (40/181) in the hospital setting. Furthermore, 29.4% (30/102) of oral and 20.5% (25/122) of IV antibiotic regimens were inappropriate with incorrect dosing as the primary reason. CONCLUSION: Although this study is limited by the sample size, it describes the high antibiotic exposure that patients receiving haemodialysis experience. Of concern is inappropriate dose and frequency being a major issue. This requires interventions focused on the quality use of medicines and antimicrobial stewardship aspects of prescribing in this population

A Randomized, Placebo-Controlled Trial of Pentoxifylline on Erythropoiesis-Stimulating Agent Hyporesponsiveness in Anemic Patients With CKD: The Handling Erythropoietin Resistance With Oxpentifylline (HERO) Trial

The HERO Study Collaborative Group comprises the Trial Management Committee (Emmanuel d’Almeida [Department of Nephrology, John Hunter Hospital, Newcastle, Australia], Rob Fassett [Department of Nephrology, Royal Brisbane and Women’s Hospital, Brisbane, Australia], Carl Kirkpatrick [Center for Medicine Use and Safety, Monash University, Melbourne, Australia], Richard Phoon [Department of Nephrology, Westmead Hospital, Sydney, Australia], and the members of the Writing Committee); the Data and Safety Monitoring Board (Andrew Tonkin [Chair; Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia], Andrew Forbes [Statistician; Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia], Adeera Levin [Department of Medicine, University of British Columbia, Vancouver, Canada], David C. Wheeler [Center for Nephrology, Royal Free and University College Medical School, London]); the Investigators (Meg Jardine, Jenny Burman, Samantha Hand [New South Wales: Concord Repatriation General Hospital]; Emmanuel D’Almeida, Leanne Garvey [John Hunter Hospital]; Michael Suranyi, Margaret Gilbert [Liverpool Hospital]; Zoltan Endre, Katheen McNamara [Prince of Wales]; Paul Snelling, Jenny Burman, Samantha Hand [Royal Prince Alfred Hospital]; Kumar Mahadevan, Andrea Pollock [Queensland: Nambour General Hospital]; David Johnson, Diana Leary [Princess Alexandra Hospital]; Sharad Ratanjee, Julie Kirby [Royal Brisbane Women’s Hospital]; Rajiv Juneja, Kathy Hill [South Australia: Flinders Medical Center]; Natasha Cook, Pascal Bisscheroux [Victoria: Austin Health]; Lawrence McMahon, Annette Kent [Eastern Health Integrated Renal Service- Box Hill Hospital]; Eugenie Pedagogos, Matija Raspudic [Royal Melbourne Hospital]; Paolo Ferrari, Uli Steinwandel [Western Australia: Fremantle Hospital]; Sharan Dogra, Susan Pellicano [Sir Charles Gairdner Hospital]; and the Project Management Team (Alicia Morrish, Elaine Pascoe, Peta-Anne Paul-Brent, Donna Reidlinger, Anish Scaria, Liza Vergara [Australasian Kidney Trials Network, Brisbane, Queensland, Australia]). The authors listed on the first page of this article constitute the HERO Trial Writing Committee.Abstract not availableDavid W. Johnson, Elaine M. Pascoe, Sunil V. Badve, Kim Dalziel, Alan Cass, Philip Clarke, Paolo Ferrari, Stephen P. McDonald, Alicia T. Morrish, Eugenie Pedagogos, Vlado Perkovic, Donna Reidlinger, Anish Scaria, Rowan Walker, Liza A. Vergara and Carmel M. Hawley, on behalf of the HERO Study Collaborative Grou

Association between serum alkaline phosphatase and resistance to erythropoiesis stimulating agents in chronic kidney disease: a post-hoc analysis of the HERO trial

Abstract not availableDW Johnson, E Pascoe, SV Badve, K Dalziel, A Cass, P Clarke, P Ferrari, SP Mcdonald, AT Morrish, E Pedagogos, V Perkovic, A Scaria, R Walker, LA Vergara, CM Hawle