Our findings do not support the hypothesis that preoperative statin use is associated with a decrease in the incidence of acute kidney injury following cardiac surgery utilizing cardiopulmonary bypass.

The authors report the results of implementing a diabetes mellitus guideline in a group practice in which uniform, technology-generated care processes were produced for patients, clinical staff, and providers. The objective was to increase the annual rate of recommended tests and examinations for patients with diabetes and to reduce levels of glycosylated hemoglobin, blood pressure, and low-density lipoprotein cholesterol. A process change for type 2 diabetes mellitus was implemented that included changes in office visit structure, protocol-driven electronic prompts for nursing and physician staffs, clinical decision support built into a new electronic medical record form, and audit with feedback. Twelve primary care physicians treated a total of 1592 patients with diabetes between January 2007 and January 2008. There were prompt and statistically significant improvements in 5 process measures and 2 outcome measures; a quality summary measure showed 8% overall improvement. Statistically significant improvements with moderate effect size were observed after a multitiered intervention.

We prospectively compared anti-Xa activity in 61 elderly (>65 years) subjects receiving enoxaparin according to standard or adjusted body weight (ABW) dosing. In the ABW dosing group, mean patient age was 76 years, mean weight 80 kg, mean serum creatinine 1.0 mg/dl, and mean CrCl 48 ml/min. ABW dosing resulted in 57% of elderly study subjects achieving anti-Xa activity of 0.5-1.0 IU/ml, and 80% achieving anti-Xa activity of 0.5-1.2 IU/ml. Compared to standard dosing, for all subjects ABW dosing of enoxaparin was associated with a more favorable mean anti-Xa activity (0.98 IU/ml vs. 1.28 IU/ml, P = 0.001), fewer highest-risk (>1.5 IU/ml) supratherapeutic anti-Xa levels (0% vs. 28%, P = 0.001), and more frequent therapeutic levels among women (64% vs. 25%, P = 0.001). ABW dosing of enoxaparin may be beneficial in elderly patients aged 65 and older, and its benefit appears to be more pronounced in female patients.

No abstract

Introduction: Patients with chronic kidney disease (CKD) lack evidence-based therapeutic options to delay progression to end-stage kidney disease (ESKD) and reduce the risk of CV events. Dapagliflozin has been shown to reduce the risk of sustained eGFR decline, ESKD, hospitalization for heart failure, CV death and all-cause mortality, in adults with CKD at risk of progression. To determine the dapagliflozin-eligible CKD population in the US, and to understand the presence of CV comorbidities and use of key medications, NHANES was evaluated. Methods: The dapagliflozin-eligible population was extracted from NHANES 2017-2018 data. Inclusion criteria were: UACR ≥ 30 mg/g and/or an eGFR < 60 mL/min/1.73 m 2 in line with the approved indications for dapagliflozin. These patients are at risk of CKD progression, CV events and premature mortality, according to KDIGO 2012 CKD guidelines. Dialysis patients were excluded. Sampling weights were generated using NHANES analytical guidance. The data set was scaled in line with the US population. Results: NHANES data indicate that, of the adult US population, 35,422,098 individuals (14.4%) are eligible for dapagliflozin treatment. Of those eligible, 64.5% are non-Hispanic white, 13.2% are Hispanic, and 12.4% are non-Hispanic black. Non-Hispanic Asian and other races account for the remaining 10%. Among the eligible population, 22,104,903 individuals (62.6%) have hypertension, 10,998,581 (32.1%) have diabetes, 3,186,685 (9.1%) have a history of stroke, 2,755,256 (7.9%) have previous myocardial infarction, and 2,688,886 (7.7%) have heart failure. Renin-angiotensin-aldosterone system (RAAS) inhibitor therapy is used in 43% of these individuals. Conclusions: NHANES 2017-2018 data indicate a substantial dapagliflozin-eligible CKD population in the US. These patients are at risk of progression to ESKD or CV complications and could benefit from the availability of effective treatment options.