Nephrology
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From Glucocentricity to a Multi-Risk Strategy: An Updated Approach to Managing Chronic Kidney Disease
This article discusses an important microvascular complication of diabetes mellitus, chronic kidney disease (CKD), which affects more than one-third of patients with diabetes. There is substantial evidence that early diagnosis and management can delay or prevent the progression of CKD, making its prevention, diagnosis, and treatment a priority for the primary care clinician.
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Sotagliflozin Tablets (Inpefa)
Sotagliflozin tablets can be prescribed to lower the risk of cardiovascular death, hospitalization for heart failure, and urgent heart failure visits among adults living with heart failure or type 2 diabetes mellitus, chronic kidney disease, and other cardiovascular risk factors.
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Direct Oral Anticoagulants vs. Warfarin When Treating Renal Dysfunction
A patient-level meta-analysis of five pivotal trials of direct oral anticoagulants (DOACs) vs. warfarin for patients with atrial fibrillation and creatinine clearance levels ranging from normal to 25 mL/min revealed standard-dose DOACs exhibit superior safety and efficacy compared to adjusted-dose warfarin and lower-dose DOACs.
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Sparsentan Tablets (Filspari)
Sparsentan can be prescribed to alleviate proteinuria in adults with primary immunoglobulin A nephropathy who are at risk of rapid disease progression — generally, a urine protein-to-creatinine ratio 1.5 mg/g or higher.
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Daprodustat (Jesduvroq)
Daprodustat can be prescribed to treat anemia caused by chronic kidney disease in adults who have been receiving dialysis for at least four months.
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Are Renal Artery Denervation Efficacy Claims Too Good to Be True?
Three-year follow-up data from the SYMPLICITY HTN-3 trial of renal denervation provide support for long-term safety of this technique and suggest blood pressure benefit.
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Predicting the Tolerability of Sacubitril/Valsartan in Advanced Heart Failure
An analysis of the sacubitril/valsartan run-in period for chronic, advanced heart failure patients showed 18% could not tolerate the lowest dose, usually because of hypotension or renal dysfunction. Investigators identified six predictors of non-tolerance, which may help clinicians choose the best candidates.
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Overdiagnosis of Chronic Kidney Disease in the Elderly
Older patients experience a physiological decline in estimated glomerular filtration rate. However, if the same levels are used to define chronic kidney disease for all adults, older patients not at a higher risk for kidney failure might still be classified with the disease.
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Difelikefalin Injection (Korsuva)
Difelikefalin can be prescribed to treat moderate-to-severe pruritus associated with chronic kidney disease in adults undergoing hemodialysis.
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For Most Patients on Dialysis, Religious/Spiritual Beliefs Are Important
Researchers surveyed 937 patients receiving dialysis at 31 facilities in Nashville and Seattle from 2015 to 2018. Those for whom religious or spiritual beliefs were more important were more likely to favor a shared decision-making role, more likely to favor resuscitation and mechanical ventilation, and less likely to have considered stopping dialysis.