A KI, a common clinical syndrome, is associated with more rapid progression of chronic kidney disease (CKD), 1 cardiovascular disease (CVD), 2 and death. 3-5 The SPRINT trial randomized hypertensive, nondiabetic

Instructional videos on bowel preparation have been shown to improve bowel preparation scores during colonoscopy. YouTube™ is one of the most frequently visited website on the internet and contains videos on bowel preparation. In an era where patients are increasingly turning to social media for guidance on their health, the content of these videos merits further investigation. We assessed the content of bowel preparation videos available on YouTube™ to determine the proportion of YouTube™ videos on bowel preparation that are high-content videos and the characteristics of these videos. YouTube™ videos were assessed for the following content: (1) definition of bowel preparation, (2) importance of bowel preparation, (3) instructions on home medications, (4) name of bowel cleansing agent (BCA), (5) instructions on when to start taking BCA, (6) instructions on volume and frequency of BCA intake, (7) diet instructions, (8) instructions on fluid intake, (9) adverse events associated with BCA, and (10) rectal effluent. Each content parameter was given 1 point for a total of 10 points. Videos with ≥5 points were considered by our group to be high-content videos. Videos with ≤4 points were considered low-content videos. Forty-nine (59 %) videos were low-content videos while 34 (41 %) were high-content videos. There was no association between number of views, number of comments, thumbs up, thumbs down or engagement score, and videos deemed high-content. Multiple regression analysis revealed bowel preparation videos on YouTube™ with length >4 minutes and non-patient authorship to be associated with high-content videos.

No abstract

Acute kidney injury (AKI) continues to be a major therapeutic challenge. Despite significant advances made in cellular and molecular pathophysiology of AKI, major gaps in knowledge exist regarding the changes in renal hemodynamics and oxygenation in the early stages and through the continuum of AKI. Particular features of renal hemodynamics and oxygenation increase the susceptibility of the kidney to sustain injury due to oxygen demand-supply mismatch and also play an important role in the recovery and repair from AKI as well as the transition of AKI to chronic kidney disease. However, lack of well-established physiological biomarkers and noninvasive imaging techniques limit our understanding of the interactions between renal macro and microcirculation and tissue oxygenation in AKI. Advances in our ability to assess these parameters in preclinical and clinical AKI will enable the development of targeted therapeutics to improve clinical outcomes.

Chronic kidney disease (CKD) is a significant health problem associated with high morbidity and mortality. Despite significant research into various pathways involved in the pathophysiology of CKD, the therapeutic options are limited in diabetes and hypertension induced CKD to blood pressure control, hyperglycemia management (in diabetic nephropathy) and reduction of proteinuria, mainly with renin-angiotensin blockade therapy. Recently, renal oxygenation in pathophysiology of CKD progression has received a lot of interest. Several advances have been made in our understanding of the determinants and regulators of renal oxygenation in normal and diseased kidneys. The goal of this review is to discuss the alterations in renal oxygenation (delivery, consumption and tissue oxygen tension) in pre-clinical and clinical studies in diabetic and hypertensive CKD along with the underlying mechanisms and potential therapeutic options.

Context Higher fibroblast growth factor-23 (FGF23) concentrations are associated with heart failure and mortality in diverse populations, but the strengths of associations differ markedly depending upon which assay is used. Objective We sought to evaluate whether iron deficiency, inflammation, and kidney function account for differences in the strengths of associations between these two FGF23 assays with clinical outcomes. Design Case-cohort from the Cardiovascular Health Study. Setting 844 community-dwelling individuals aged ≥ 65 years with and without chronic kidney disease who were followed for 10 years. Outcomes Death, incident heart failure, and incident myocardial infarctions. Exposure was baseline Intact and C-terminal FGF23. Using modified Cox models, adjusting sequentially we tested whether observed associations of each assay with outcomes were attenuated by iron status, inflammation, kidney function, or their combinations. Results FGF23 measured by either assay was associated with mortality in unadjusted analysis (intact FGF23 HR per two-fold higher 1.45; 95% CI 1.25-1.68; C-terminal FGF23 HR 1.38; 1.26-1.50). Adjustment for kidney function completely attenuated associations of intact FGF23 with mortality (HR 1.00; 0.85, 1.17), but had much less influence on the association of C-terminal FGF23 where results remained significant after adjustment (HR 1.15; 1.04, 1.28). Attenuation was much less with adjustment for iron status or inflammation. Results were similar for the heart failure endpoint. Neither C-terminal or intact FGF23 was associated with MI risk. Conclusions The relationship of FGF23 with clinical endpoints is markedly different depending upon the type of FGF23 assay utilized. The associations of biologically active FGF23 with clinical endpoints may be confounded by kidney disease, and thus much weaker than previously thought.

Use of complementary therapies such as massage and acupuncture during HD may contribute toward improvement of HR-QOL and thus should be considered when addressing overall health status of these patients.

Intradialytic hypotension (IDH) is the most common dialytic complication. Recurrent episodes of ischemia secondary to hemodynamic instability are associated with cardiomyopathy, increased risk of thrombosis of arteriovenous fistula, decreased quality of life, and increased mortality. Cool dialysate may be an effective approach to reducing intradialytic hypotension by promoting peripheral vasoconstriction. Most studies to date are small and do not employ individualized cool dialysates (ICD). The study consisted of standard and cool phases, with patients as their own controls. During the standard phase, participants underwent hemodialysis (HD) at their usual dialysate temperature at 37°C for six consecutive hemodialysis sessions. In the cool phase, the dialysate temperature was set at the core baseline temperature -0.5°C for six more sessions. We compared hemodynamic parameters during the standard and cool phases. A total of 93 participants were included. The number of IDH episodes during the standard and cool phases were 3.3 ± 2.8 and 2.0 ± 2.2 per patient respectively (P < 0.001). Other hemodynamic parameters including lowest intradialytic mean arterial pressure were significantly increased with ICD. We found that there was a high baseline rate of feeling cold among all participants and it increased after the implementation of ICD; however, the dropout rate was approximately 5%. ICD is an effective tool to decrease the frequency of IDH in the HD population and we provide a pragmatic, real-world approach to implement this technique.