KDOQI US Commentary on the 2017 KDIGO Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD)

Isakova, Tamara; Nickolas, Thomas L.; Denburg, Michelle R.; Yarlagadda, Sri G.; Weiner, Daniel E.; Gutiérrez, Orlando M.; Bansal, Vinod; Rosas, Sylvia E.; Nigwekar, Sagar U.; Yee, Jerry; Kramer, Holly

doi:10.1053/j.ajkd.2017.07.019

Cited by 302 publications

(270 citation statements)

References 57 publications

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“…It was shown that, in patients with appropriate or high GFR before the first CP administration, eGFR formulae have good accuracy in relation to the reference standard for calculation of the CP dose; CKD-EPI had the best performance (i.e., 0.65), and this has been observed in other nononcology populations with elevated GFR [8]. The formula with the worst performance was CG (i.e., 0.48), which suggests that it is not the best equation to be employed in this group of patients.…”

Section: Discussionmentioning

confidence: 99%

“…Creatinuria as a reference standard has some limitations itself, considering that it is the less recommended filtration marker, compared to exogenous markers [8], which, unfortunately, are not performed in Colombia.…”

Section: Discussionmentioning

confidence: 99%

“…The independent variables were: the CP dose calculated according to the GFR by the different formulae; platelets; neutrophils; serum creatinine; Eastern Cooperative Oncology Group (ECOG) score; acute kidney injury as per the Acute Kidney Injury Network [8]; death, defined as one that occurred within 21 days after a chemotherapy cycle; response based on imaging (classified as: remission, partial/stable response, or progression); and percentage of variation of the CP dose (taking as basis the dose calculated through creatinuria for classification as: underdosing, overdosing, or dose without variation).…”

Section: Methodsmentioning

confidence: 99%

“…The Cockroft-Gault (CG) formula is the most used, even though its inaccuracy may favor CP dose overestimation or underestimation and cause variation in the eGFR of patients with extreme glomerular filtrations (very low or very high) or with alterations in creatinine metabolism (e.g., cancer patients) [7, 8]. Therefore, it is important to identify among the other existing formulas for eGFR the one that yields an estimate closest to the mGFR in order to have a reliable replacement.…”

Section: Introductionmentioning

confidence: 99%

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Carboplatin Dosing Accuracy by Estimation of Glomerular Filtration versus Creatinuria in Cancer Patients

2018

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Background: The glomerular filtration rate (GFR) is essential for calculating the dose and the monitoring of carboplatin. Although GFR measurement (mGFR) by external markers is ideal, in most cases these are not employed; the most used method is GFR estimation (eGFR) by formulae, hence the need to identify the formula with the best performance. Methods: Patients admitted between 2011 and 2017 and diagnosed with ovarian, endometrial, lung, esophageal, or testicular cancer were assessed retrospectively. The accuracy of the carboplatin dose calculated by creatinine concordance and by the Cockroft-Gault (CG), CKD-EPI, MDRD, Wright, and Jelliffe formulae was assessed using the intraclass correlation coefficient. Results: Fifty-six medical histories were analyzed. The best accuracy was observed between the Wright formula (i.e., 0.71) and the dose calculated based on the 24-h creatinine clearance. Stratification by CKD was made in depurations < 60 mL/min, where the Jelliffe value was excellent (i.e., 0.75). In depurations ≥60 mL/min, CKD-EPI was the best formula, with an accuracy of 0.65. CG was the formula with the worst performance in calculating the dose and glomerular filtration, losing its usefulness with very low filtrations. Conclusions: GFR formulae and calculation of the carboplatin dose have good accuracy with the GFR obtained based on the 24-h creatinine clearance, with the Wright formula being the one with best performance and CG the one with worst performance.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Carboplatin Dosing Accuracy by Estimation of Glomerular Filtration versus Creatinuria in Cancer Patients

2018

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“…However, this recommendation generates some uncertainty and does not provide clear advice on how to treat low BMD in CKD patients, as this patient population was excluded from most RCTs [8]. The language of the updated CKD-MBD guideline is often inconclusive, and all recommendations are at the level of “we suggest” (no level 1 “we recommend”) and the majority have “low” or “very low” levels of evidence.…”

Section: Ckd – Mineral and Bone Disordersmentioning

confidence: 99%

Impact of Recent Clinical Trials on Nephrology Practice: Are We in a Stagnant Era?

et al. 2018

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Background: Although renal replacement therapy prevents death from uremia, survival among patients with acute and chronic kidney diseases (CKD) remains an imperative concern. The expected life span of US dialysis patients 60–64 years of age is approximately 4.5 years; this is similar to that of patients with lung cancer. Despite substantial progress in many medical specialties over the past decades (e.g., notable reductions in myocardial infarction, stroke, and mortality rates in the general population), survival among dialysis patients has not improved significantly over the same period. A few decades ago, HIV infection and AIDS were pretty much a death sentence. Because of progress in HIV treatment, now it can be controlled with a daily pill, and ongoing research is pushing treatment even further and controls the virus with longer-acting treatment. A cure is no longer impossible for HIV and other viral infections such as hepatitis B and C and many malignancies, but so far there is no cure for CKD. Summary: Billions of dollars have been spent on kidney disease research in the past decades, with no tangible progress in clinical practice. The challenges of improving the quantity and quality of trials in nephrology are enormous. The number of randomized controlled trials (RCTs) published in nephrology is lower than that in other medical subspecialties, and most of the big RCTs in nephrology yield negative results. Nephrology studies evaluating hard clinical endpoints or surrogate endpoints are scarce. Key Message: Herein we discuss the slow progress in nephrology research that has impacted clinical practice over the last couple of decades and highlight the major obstacles, challenges, and potential solutions.

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Vitamin D Receptor Agonists for Patients Undergoing Hemodialysis

Hall

Scialla

2018

JAMA

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Cardiovascular disease (CVD) is the leading cause of death among patients with end-stage kidney disease (ESKD) who are undergoing hemodialysis, yet many standard cardioprotective therapies have not been effective in reducing CVD in this patient population. 1 This reality has motivated the quest to identify dialysis-related and kidney disease-specific factors that promote CVD.Based on observations from the past 2 decades, deficiency of active vitamin D has been a prime candidate for CVD reduction. In patients with ESKD, activity of the 1-α-hydroxylase enzyme is substantially diminished. This enzyme is primarily expressed in the kidney and converts 25-hydroxyvitamin D to active 1,25 dihydroxyvitamin D (1,25[OH]2D). As a consequence of low 1,25[OH]2D levels, parathyroid hormone (PTH) is stimulated in a feedback loop that attempts to restore 1,25[OH]2D activity and correct abnormal calcium and phosphate levels. In the untreated state, this pathophysiology results in severe secondary or tertiary hyperparathyroidism, which is associated with highly morbid skeletal complications, including fracture, deformity, and growth failure in children. 2 To interrupt this cascade, 1,25[OH]2D is often prescribed to patients with ESKD in the form of vitamin D receptor agonists (VDRAs). As evidence supporting the potential cardiovascular benefits of vitamin D supplementation in the general population increased, the treatment of 1,25[OH]2D deficiency to prevent CVD in patients with ESKD became a prominent area of investigation, and observational studies demonstrated potential benefits. 3,4 However, with the already widespread use of VDRAs to control PTH levels and prevent bone complications in patients with ESKD, clinical trials confirming the potential cardiovascular benefits of this therapy have not been performed.In this issue of JAMA, Shoji et al report the findings of the Japan Dialysis Active Vitamin D (J-DAVID) trial, 5 the most recent trial of VDRAs in patients receiving hemodialysis. Specifically, the J-DAVID trial tested the hypothesis that the VDRA alfacalcidol reduces the risk of cardiovascular events in patients undergoing hemodialysis who do not have overt secondary hyperparathyroidism. In this open-label, blinded end point study conducted from 2008 to 2015 across 108 dialysis centers in Japan, 976 patients were randomly assigned to receive alfacalcidol (n = 495) or usual care without VDRAs (n = 481). At enrollment, eligible participants were adults receiving hemodialysis for at least 90 days, with intact PTH levels less than or equal to 180 pg/mL, serum calcium

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KDOQI US Commentary on the 2017 KDIGO Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD)

Cited by 302 publications

References 57 publications

Carboplatin Dosing Accuracy by Estimation of Glomerular Filtration versus Creatinuria in Cancer Patients

Carboplatin Dosing Accuracy by Estimation of Glomerular Filtration versus Creatinuria in Cancer Patients

Impact of Recent Clinical Trials on Nephrology Practice: Are We in a Stagnant Era?

Vitamin D Receptor Agonists for Patients Undergoing Hemodialysis

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