Risk factors

Left ventricular ejection fraction (LVEF) values could be used to stratify mortality risk in patients starting hemodialysis, suggest researchers in Japan. Yamada and colleagues measured LVEF within 1 month of initiating hemodialysis in 1,254 consecutive patients with end-stage renal disease. The patients were followed for up to 7 years. LVEF was inversely associated with the risks of death from all causes and from cardiovascular events, even after adjustment for other risk factors.

Diabetes

The DCCT/EDIC trial investigators report that macroalbuminuria is a strong predictor of accelerated loss of estimated glomerular filtration rate (eGFR) in patients with type 1 diabetes mellitus. In their report, however, Molitch and colleagues note that screening by albumin excretion rate alone is not sufficient to identify all individuals at risk of developing stage 3 chronic kidney disease as this strategy would have missed 24% of the patients who experienced a sustained decrease in eGFR to <60 ml/min/1.73 m2.

End-stage renal disease

A retrospective analysis of data from >120,000 patients on hemodialysis in the US indicates that the toxic effects of digoxin might be increased by hypokalemia, a common problem among patients on dialysis. Chan et al. found that digoxin use in patients on hemodialysis was associated with a 28% increase in mortality risk. Individuals with lower serum potassium levels before hemodialysis initiation seem to be particularly at risk.

Stem cells

A case report of an attempt to treat diffuse, proliferative lupus nephritis by direct renal injection of autologous stem cells derived from peripheral blood suggests that such therapy may result in adverse outcomes. Thirabanjasak and colleagues report that a patient developed angiomyeloproliferative lesions at the injection sites and hematuria within 6 months of transplantation. The researchers consider this previously undescribed pathological entity to be either derived from or induced by the transplanted stem cells.