Safety of intravenous ferric carboxymaltose versus oral iron in patients with nondialysis-dependent CKD: an analysis of the 1-year FIND-CKD trial.

Background: The evidence base regarding the safety of intravenous (IV) iron therapy in patients with chronic kidney disease (CKD) is incomplete and largely based on small studies of relatively short duration. Methods: FIND-CKD (ClinicalTrials.gov number NCT00994318) was a 1-year, open-label, multicenter, prospective study of patients with nondialysis-dependent CKD, anemia and iron deficiency randomized (1:1:2) to IV ferric carboxymaltose (FCM), targeting higher (400-600 µg/L) or lower (100-200 µg/L) ferritin, or oral iron. A post hoc analysis of adverse event rates per 100 patient-years was performed to assess the safety of FCM versus oral iron over an extended period. Results: The safety population included 616 patients. The incidence of one or more adverse events was 91.0, 100.0 and 105.0 per 100 patient-years in the high ferritin FCM, low ferritin FCM and oral iron groups, respectively. The incidence of adverse events with a suspected relation to study drug was 15.9, 17.8 and 36.7 per 100 patient-years in the three groups; for serious adverse events, the incidence was 28.2, 27.9 and 24.3 per 100 patient-years. The incidence of cardiac disorders and infections was similar between groups. At least one ferritin level ≥800 µg/L occurred in 26.6% of high ferritin FCM patients, with no associated increase in adverse events. No patient with ferritin ≥800 µg/L discontinued the study drug due to adverse events. Estimated glomerular filtration rate remained the stable in all groups. Conclusions: These results further support the conclusion that correction of iron deficiency anemia with IV FCM is safe in patients with nondialysis-dependent CKD

Chronic allograft nephropathy: The major problem in long-term survival: Review of etiology and interpretation

Kidney transplantation (Tx) has evolved as the treatment of choice in patients with end-stage renal failure. Unfortunately, after Tx, there is a gradual deterioration in graft function and the patient develops chronic allograft nephropathy (CAN). This can happen as soon as 3 months or as late as many years. Therefore, CAN is the major clinical problem in renal Tx, as the pathophysiological mechanisms remain obscure. In this article, we try to review the risk factors and causes of CAN and their possible explanation. In conclusion, and as a consequence from the bibliography, we can see clearly that CAN is the result of interplay or synergistic action between alloantigen-dependent and alloantigen-independent factors, which each act with different significance at each stage in the life span of a transplant. The exactly pathogenesis of CAN is elusive but we have a common trigger (tissue injury) and common response (inflammatory response). © 2005 Elsevier Inc. All rights reserved

Yield and nutrient status in the root environment of tomatoes (lycopersicon esculentum) grown on chemically active and inactive inorganic substrates

Tomato plants were grown in perlite (control), zeolite, and mixtures of perlite and zeolite (78:22 v/v), zeolite and diatomite (60:40 v/v) perlite and diatomite (75:25 v/v) and perlite, diatomite and zeolite (80:11:9 v/v). All substrate treatments were supplied with nutrient solution having the same composition. The Mg concentration in the nutrient solution supplied to the plants was high because the available raw water contained 8.70 meq L -1 Mg. The drainage water was left to run off throughout the cropping period. The early yield was significantly higher in perlite. However, after 3 months of harvesting, the highest yield was obtained from the plants grown in zeolite, followed by the treatment involving zeolite and diatomite, due to an enhanced mean fruit weight. The mixture of perlite with either diatomite, or zeolite, or both, resulted in the lowest yields. The better performance of the plants grown in zeolite or zeolite and diatomite was ascribed to the considerable cation exchange capacity of the former, which enabled a more efficient buffering of excess ammonium and Mg concentrations in the root environment. In contrast, under the specific conditions of the present trial, the lack of buffering capacity in perlite resulted in too high NH4 + concentrations and hence in too low pH levels in the root environment of the plants. Moreover, zeolite was capable of adsorbing part of the excess Mg, thus resulting in more balanced macronutrient cation ratios in the root environment. On the other hand, during the initial wetting of the substrates with nutrient solution, most of K was adsorbed on the surface of zeolite. As a result, the K concentration was sharply reduced in the drain solutions collected from substrates including zeolite as a constituent

Two successfully treated cases of Staphylococcus lugdunensis endocarditis

Prosthetic valve and pacemaker lead endocarditis by Staphylococcus lugdunensis remain very rare, while the former is associated with an ominous prognosis. Two cases involving a prosthetic aortic valve and a pacemaker lead, respectively, are reported. Despite disease severity and delayed diagnosis, patients recovered fully with combined antimicrobial and surgical treatment. © 2010 Elsevier Inc

Two successfully treated cases of Staphylococcus lugdunensis endocarditis

Prosthetic valve and pacemaker lead endocarditis by Staphylococcus lugdunensis remain very rare, while the former is associated with an ominous prognosis Two cases involving a prosthetic aortic valve and a pacemaker lead, respectively, are reported Despite disease seventy and delayed diagnosis, patients recovered fully with combined antimicrobial and surgical treatment (C) 2010 Elsevier Inc All rights reserve

Immunosuppressive regimens based on Cyclophospamide or Calcineurin inhibitors: Comparison of their effect in the long term outcome of Primary Membranous Nephropathy

Introduction Management of the Primary Membranous Nephropathy (PMN) usually involves administration of immunosuppressives. Cyclophosphamide (Cyclo) and Calcineurin Inhibitors (CNIs) are both widely used but only limited data exist to compare their efficacy in long term followup. Aim The aim of the present study was to estimate and compare long term effects of Cyclo and CNIs in patients with PMN. Patients-methods Clinical data, histologic findings and long term outcome were retrospectively studied. The response to treatment and rate of relapse was compared between patients treated with CNIs or Cyclo based immunosuppressive regimens. Results Twenty three centers participated in the study, with 752 PMN patients (Mean age 53.4(14- 87) yrs, M/F 467/285), followed for 10.1±5.7 years. All patients were initially treated with Renin Angiotensin Aldosterone System inhibitors (RAASi) for at least 6 months. Based on their response and tolerance to initial treatment, patients were divided into 3 groups, group I with spontaneous remission, who had no further treatment, group II, continued on RAASi only, and group III on RAASi+immunosuppression. Immunosuppressive regimes were mainly based on CNIs or Cyclo. Frequent relapses and failure to treatment were more common between patients who had started on CNIs (n = 381) compared to those initially treated with Cyclo (n = 110), relapse rate: 25.2% vs. 6.4%, p<0.0001, and no response rate: 22.5% vs. 13.6%, p = 0.04, respectively. Conclusions Long term follow up showed that administration of Cyclo in PMN is followed by better preservation of renal function, increased response rate and less frequent relapses, compared to CNIs. © 2019 Stangou et al

Erythropoietic response to oral iron in patients with nondialysis-dependent chronic kidney disease in the FIND-CKD trial

Aims: To evaluate erythropoietic response rates to oral iron over time in iron-deficient anemic patients with nondialysis- dependent chronic kidney disease (NDCKD). Materials and methods: FIND-CKD was a 1-year, randomized, multicenter trial of iron therapy in patients with ND-CKD, anemia, and iron deficiency, without erythropoiesis- stimulating agent (ESA) therapy. Patients with active infection or C-reactive protein > 20 mg/L were excluded. In this post-hoc analysis, response was defined as 65 1 g/dL increase in hemoglobin (Hb) from baseline, before initiation of alternative anemia therapy (i.e., ESA, transfusion, or intravenous iron). Results: 308 patients received oral iron (200 mg elemental iron/day). Mean (SD) Hb at baseline was 10.4 (0.7) g/dL. At week 4, Hb data were available from 292 patients without alternative anemia therapy: 63/292 (21.6%) showed a response. Among the 229 nonresponders at week 4, 48.8% showed a cumulative response on 651 occasion by week 52 (11.1%, 19.9%, 25.9%, and 28.7% had a response at weeks 8, 12, 24, and 52, respectively), and 27.9% had received alternative iron therapy by week 52. Baseline levels of Hb, ferritin, and transferrin saturation were lower in responders than in nonresponders. Neither concomitant medication nor adherence (as assessed by medication count) was substantially different between early responders and nonresponders. Conclusion: Four weeks after starting oral iron therapy, only 21.6% of anemic patients with ND-CKD and iron deficiency showed an Hb increase of at least 1 g/dL. Among early nonresponders, < 30% responded at any subsequent time point. Earlier consideration of alternative therapy could improve anemia management in this population