Vitamin D compounds for people with chronic kidney disease not requiring dialysis.

Background: Vitamin D compounds are used to suppress elevated serum parathyroid hormone (PTH) in people with chronic kidney disease (CKD).

Objectives: To assess the efficacy of vitamin D therapy on biochemical, bone, cardiovascular, and mortality outcomes in people with CKD and not requiring dialysis.

Search Strategy: We searched The Cochrane Renal Group's specialised register, Cochrane's Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and reference lists of retrieved articles.

Vitamin D compounds for people with chronic kidney disease requiring dialysis.

Background: Clinical guidelines recommend vitamin D compounds to suppress serum parathyroid hormone (PTH) in chronic kidney disease (CKD), however treatment may be associated with increased serum phosphorus and calcium, which are associated with increased mortality in observational studies. Observational data also indicate vitamin D therapy may be independently associated with reduced mortality in CKD.

Objectives: We assessed the effects of vitamin D compounds on clinical, biochemical, and bone outcomes in people with CKD and receiving dialysis.

Proteinuria and clinical outcomes in hypertensive patients.

This narrative review focuses on outcomes related to proteinuria in hypertension (HT), and also examines the role of current and future therapeutic strategies. Proteinuria is an independent marker of renal and cardiovascular (CV) disease in hypertensive populations, particularly in high-risk groups such as diabetic patients. Effective blood pressure (BP) control and proteinuria management are associated with significant improvements in the risk of key adverse outcomes, although a causative relationship needs careful assessment.

Usefulness of coronary flow reserve measured by echocardiography to improve the identification of significant left anterior descending coronary artery stenosis assessed by multidetector computed tomography.

Multidetector computed tomography (MDCT) detects coronary artery disease. However, an overestimation of coronary artery stenosis and artifacts can prevent accurate identification of significant coronary narrowing. The combination of MDCT with coronary flow reserve (CFR), the hyperemic/baseline peak flow velocity ratio, measured by transthoracic Doppler echocardiography might be helpful.

Benefits and harms of phosphate binders in CKD: a systematic review of randomized controlled trials.

Background: Phosphate binders are widely used to control serum phosphorus levels in patients with chronic kidney disease (CKD). We analyzed the effects of phosphate binders on biochemical and patient-level end points in patients with CKD.

Study Design: Systematic review and meta-analysis by searching MEDLINE (1966 to April 2009), EMBASE (1980 to April 2009), and the Cochrane Renal Group Specialised Register and the Cochrane Central Register of Controlled Trials (CENTRAL).

Aldosterone antagonists for preventing the progression of chronic kidney disease.

Background: Treatment with angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) is increasingly used to reduce proteinuria and retard the progression of chronic kidney disease (CKD). But some patients do not attain complete resolution of proteinuria and might have higher aldosterone levels within few months of treatment. The addition of aldosterone antagonists may be beneficial to these patients for reduction of progression of renal damage.

HMG CoA reductase inhibitors (statins) for dialysis patients.

Background: Cardiovascular disease accounts for more than half the number of deaths among dialysis patients. The role of HMG CoA reductase inhibitors (statins) in the treatment of dyslipidaemia in dialysis patients is unclear and their safety has not been established.

Objectives: To assess the benefits and harms of statins in peritoneal dialysis (PD) and haemodialysis patients (HD).

Risk factors for the development and progression of renal diseases in disadvantaged populations: role of the renin-angiotensin system blockade.

Chronic kidney disease is becoming a public health challenge due to the high risk of progression to end-stage kidney disease, the increased cardiovascular burden and management costs, especially among disadvantaged communities. Although the high prevalence of hypertension and diabetes in these populations are recognized risk factors and a leading cause of chronic kidney disease, ethnic populations show a greater likelihood of developing end-stage kidney disease regardless of these cardiovascular risk factors. The association between low socioeconomic status and the prevalence/progression of chronic kidney disease observed in population-based studies suggests that socioeconomic disadvantage could be a plausible reason for the increased burden of renal disease among minorities.

HMG CoA reductase inhibitors (statins) for people with chronic kidney disease not requiring dialysis.

Background: Dyslipidaemia occurs frequently in chronic kidney disease (CKD) patients and contributes both to cardiovascular disease and worsening renal function. Statins are widely used in non-dialysis dependent CKD patients (pre-dialysis) even though evidence favouring their use is lacking.

Objectives: To evaluate the benefits and harms of statins in CKD patients who were not receiving renal replacement therapy.

HMG CoA reductase inhibitors (statins) for kidney transplant recipients.

Background: Cardiovascular deaths account for the majority of deaths in kidney transplant recipients and dyslipidaemia contributes significantly to their cardiovascular disease. Statins are widely used in kidney transplant patients given their established benefits in the general population, however evidence favouring their use is lacking.

Objectives: To assess the benefits and harms of statin therapy on mortality and renal outcomes in kidney transplant recipients.

HMG CoA reductase inhibitors (statins) for dialysis patients.

Background: Cardiovascular disease accounts for more than half the number of deaths among dialysis patients. The role of HMG CoA reductase inhibitors (statins) in the treatment of dyslipidaemia in dialysis patients is unclear and their safety has not been established.

Objectives: To assess the benefits and harms of statins in peritoneal dialysis (PD) and haemodialysis patients (HD).

Aldosterone antagonists for preventing the progression of chronic kidney disease: a systematic review and meta-analysis.

Background And Objectives: Addition of aldosterone antagonists (AA) might provide renal benefits to proteinuric chronic kidney disease (CKD) patients over and above the inhibition of renin-angiotensin system blockers (RAS). We evaluated the benefits and harms of adding selective and nonselective AA in CKD patients already on RAS.

Design, Setting, Participants, & Measurements: MEDLINE, EMBASE, and Renal Health Library were searched for relevant randomized clinical trials in adult CKD patients.

[The usefulness of Cochrane systematic reviews in nephrology].

Systematic reviews (SRs) of the literature are clinical research studies carried out according to rigorous methodological criteria. They are aimed at searching, critically appraising and summarizing all studies with similar characteristics that address the same research question. The Cochrane Collaboration is the main institution that coordinates the production of SRs.

Treatment options for proliferative lupus nephritis: an update of clinical trial evidence.

Systemic lupus erythematosus involves the kidney in up to 60% of patients, and if untreated, may result in complete loss of kidney function. In this article, we review meta-analyses and clinical trial data on the therapeutic options for proliferative lupus nephritis, and complete a meta-analysis of the use of mycophenolate mofetil (MMF) compared with cyclophosphamide-based regimens. Clinical trials have found that cyclophosphamide-based regimens result in a decreased risk of end-stage renal disease, but are associated with significant toxicity in lupus nephritis.

[Evidence-based guidelines and nephrological clinical practice: the GRADE system for rating of evidence].

It has become widely accepted that decision-making should be based on the best available evidence. The preparation of evidence-based guidelines in the interest of improving long-term outcomes has been a challenging task for many societies. Although nephrology is a relatively young medical discipline and therefore presumably well-disposed towards evidence-based decision making, many problems exist and evidence-based approaches to guidelines have also been widely criticized.

The effect of on-line high-flux hemofiltration versus low-flux hemodialysis on mortality in chronic kidney failure: a small randomized controlled trial.

Background: Given the paucity of prospective randomized controlled trials assessing comparative performances of different dialysis techniques, we compared on-line high-flux hemofiltration (HF) with ultrapure low-flux hemodialysis (HD), assessing survival and morbidity in patients with end-stage renal disease (ESRD).

Study Design: An investigator-driven, prospective, multicenter, 3-year-follow-up, centrally randomized study with no blinding and based on the intention-to-treat principle.

Setting & Participants: Prevalent patients with ESRD (age, 16 to 80 years; vintage > 6 months) receiving renal replacement therapy at 20 Italian dialysis centers.

Antiviral medications for preventing cytomegalovirus disease in solid organ transplant recipients.

Background: The risk of cytomegalovirus (CMV) infection in solid organ transplant recipients has resulted in the frequent use of prophylaxis with the aim of preventing the clinical syndrome associated with CMV infection.

Objectives: To determine the benefits and harms of antiviral medications to prevent CMV disease and all-cause mortality in solid organ transplant recipients.

Search Strategy: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, reference lists and abstracts from conference proceedings without language restriction.

Effects of statins in patients with chronic kidney disease: meta-analysis and meta-regression of randomised controlled trials.

Objective: To analyse the benefits and harms of statins in patients with chronic kidney disease (pre-dialysis, dialysis, and transplant populations).

Design: Meta-analysis.

Data Sources: Cochrane Central Register of Controlled Trials, Medline, Embase, and Renal Health Library (July 2006).

[Patient satisfaction in hemodialysis: a pilot cross-sectional analysis and a review].

Background: Assessment of patient satisfaction is not performed routinely in many healthcare institutions. In this review, we discuss methodological aspects of assessment of patient satisfaction in hemodialysis. We also present a pilot study conducted in the Gambro Healthcare Italy dialysis clinics network.

Treatment for peritoneal dialysis-associated peritonitis.

Background: Peritonitis is a common complication of peritoneal dialysis (PD) and is associated with significant morbidity. Adequate treatment is essential to reduce morbidity and recurrence.

Objectives: To evaluate the benefits and harms of treatments for PD-associated peritonitis.

Interventions for minimal change disease in adults with nephrotic syndrome.

Background: Steroids have been used widely since the early 1970s for the treatment of adult-onset minimal change disease. The response rates to immunosuppressive agents in adult minimal change disease, especially steroids, are more variable than in children. The optimal agent, dose, and duration of treatment for the first episode of nephrotic syndrome, or for disease relapse(s) has not been determined.