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Trajectory of Kidney Function After AKI and Long-Term Clinical Outcomes

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Trajectory of Kidney Function After AKI and Long-Term Clinical Outcomes July / August 2020 VOLUME 12, NUMBER 5 QIP Scores and Rates of Cardiovascular Risk Mortality among Incident Increased in Healthy Dialysis Patients Mortality rates were higher at Individuals with GHF facilities with Quality Incentive hronic kidney disease (CKD) Program scores <45. 13 is a risk factor for cardiovas- C cular morbidity and mortality. Antioxidant Vitamins for Among individuals with supranormal estimated glomerular filtration rate, Patients with Diabetes glomerular hyperfiltration (GHF), the and Albuminuria risk of cardiovascular disease may also Antioxidant vitamins reduced be increased. In high risk conditions systolic blood pressure in patients such as diabetes, metabolic syndrome, with diabetic kidney disease. 14 hypertension, and smoking-related disorders, GHF may be a marker of Trajectory of Kidney Function CONFERENCE COVERAGE vascular dysfunction and is associated NKF Spring Clinical with increased rates of cardiovascular after AKI and Long-Term events. The definition of GHF is highly Meetings variable, making interpretation of stud- Clinical Outcomes Part Two of coverage of posters and ies in this patient population complex. presentations from the National Further, it is unknown whether GHF cute kidney injury (AKI) is common among hospitalized patients, is associ- Kidney Foundation 2020 Spring is associated with abnormal vascular ated with poor outcomes, and accounts for $10 billion in healthcare costs Clinical Meetings. 8 dysfunction in apparently healthy A each year. The Kidney Disease Improving Global Outcomes (KDIGO) con- individuals. sensus group defines AKI as an increase in the concentration of serum creatinine American Transplant Marie-Eve Dupuis, MD, and col- (SCr) of ≥0.3 mg/dL or ≥50% of the baseline value within a 48-hour period or Congress leagues conducted a population-based within 7 days after hospitalization or a decrease in urine output. KDIGO severity Coverage of posters and cohort study to determine whether classification of AKI ranges from 0 (no AKI) to stage 3; the classification is based presentations at the virtual there is an association between GHF ATC meeting in May. 16 and increased cardiovascular risk in continued on page 5 healthy individuals. The research- ers used an epidemiologic definition PLUS.... of hyperfiltration with stratification Pulmonary Hypertension Associated FROM THE FIELD for age and sex. Results of the study with Poor Survival in Patients with CKD A Year of Change were reported in JAMA Network Open Working from home and changes [2020;3(4):e202377]. pproximately 21% to 41% of patients with chronic kidney disease (CKD) in telehealth services billing The study utilized longitudinal are diagnosed with pulmonary hypertension (PH); in patients with kidney requirements. 31 follow-up data from the CARTaGENE A failure requiring dialysis, the percentage is 60%. There are no targeted population cohort. Enrollment oc- treatments available for PH in patients with CKD. In previous studies of PH in curred from August 2009 to October this patient population, diagnosis and quantification of PH severity has relied on 2010, with follow-up available through transthoracic echocardiography. Right heart catheterization can provide more March 31, 2016. Data analysis oc- detailed insight into potential underlying mechanisms of PH. curred in October 2019. The cohort PH is defined as mean pulmonary artery pressure ≥25 mm Hg on right heart catheterization at rest. PH can be stratified into subtypes, including precapillary continued on page 6 PH, isolated postcapillary PH, and combined pre- and postcapillary PH. There are few data available on how CKD affects PH subtypes. Among patients with CKD with PH, the combined pre- and postcapillary subtype may contribute to the overall PH burden due to a combination of: (1) chronic volume overload; (2) pulmonary vascular remodeling due to increases in vasoactive factors such as nitric oxide, prostacyclin, and endothelin; (3) inflammation; and (4) comorbid lung disease. Daniel L. Edmonston, MD, and colleagues conducted an observational retrospective study designed to examine the prevalence and consequences of subtypes of PH in patients with CKD. Results of the study were reported in the continued on page 7 Updated KDIGO guidelines recommend limiting the use of calcium-based binders… SWITCHING TO VELPHORO CAN MAKE A WORLD OF DIFFERENCE Double the percentage of patients achieved phosphorus goal with half the pill burden*1 Visit RealWorldVelphoro.com TO SEE THE DIFFERENCE A SWITCH CAN MAKE KDIGO = Kidney Disease: Improving Global Outcomes. INDICATION • Velphoro can be administered concomitantly with oral Velphoro® (sucroferric oxyhydroxide) is a phosphate binder calcitriol, ciprofl oxacin, digoxin, enalapril, furosemide, indicated for the control of serum phosphorus levels in patients HMG-CoA reductase inhibitors, hydrochlorothiazide, losartan, with chronic kidney disease on dialysis. metoprolol, nifedipine, omeprazole, quinidine and warfarin. IMPORTANT SAFETY INFORMATION For oral medications where a reduction of bioavailability • Velphoro chewable tablets must be administered with meals. would be clinically signifi cant consider separating of the Velphoro should be chewed or crushed. Do not swallow whole. timing of administration. Consider monitoring clinical responses or blood levels of the concomitant medications. • Patients with peritonitis during peritoneal dialysis, signifi cant gastric or hepatic disorders, following major gastrointestinal Please see Brief Summary on adjacent page or visit (GI) surgery, or with a history of hemochromatosis or other www.Velphoro.com for full Prescribing Information. diseases with iron accumulation have not been included * A retrospective analysis of pharmacy data assessed the real-world effectiveness of Velphoro in in clinical studies with Velphoro. Monitor effect and iron 1,029 adult in-center hemodialysis patients who were switched to Velphoro during routine care. The study compared the proportion of patients with phosphorus levels ≤5.5 mg/dL and the homeostasis in such patients. mean prescribed phosphate binder pills/day at baseline (3 months prior to Velphoro; binders included sevelamer carbonate, calcium acetate, and lanthanum carbonate) and during Velphoro • In a parallel design, fi xed-dose study of 6 weeks duration, follow-up (6 months after switch to Velphoro, n=424). This was a noninterventional analysis and the most common adverse drug reactions to Velphoro did not impact prescriptions or prescribing patterns.1 Reference: 1. Coyne DW, Ficociello LH, Parameswaran V, et al. Real-world effectiveness chewable tablets in hemodialysis patients included of sucroferric oxyhydroxide in patients on chronic hemodialysis: a retrospective analysis of discolored feces (12%) and diarrhea (6%). pharmacy data. Clin Nephrol. 2017;88(2):59-67. Velphoro is a registered trademark of Vifor Fresenius Medical Care Renal Pharma Ltd. Distributed by: Fresenius Medical Care North America Waltham, MA 02451 © 2017, 2018 Fresenius Medical Care, all rights reserved. PN 103436-01 Rev. B 09/2018 Brief Summary: Labor and Delivery Please see Full Prescribing Information for additional information No Velphoro treatment-related effects on labor and delivery were seen in animal studies with doses up to 16 times the maximum recommended clinical dose on a body weight basis. The effects of Velphoro on labor and delivery in humans are not known. Nursing Mothers Since the absorption of iron from Velphoro is minimal, excretion of Velphoro in breast milk is unlikely. INDICATIONS AND USAGE Pediatric Use Velphoro (sucroferric oxyhydroxide) is a phosphate binder indicated The safety and efficacy of Velphoro have not been established in for the control of serum phosphorus levels in patients with chronic pediatric patients. kidney disease on dialysis. Geriatric Use DOSAGE AND ADMINISTRATION Of the total number of subjects in two active-controlled clinical Velphoro tablets must be chewed and not swallowed whole. To aid studies of Velphoro (N=835), 29.7% (n=248) were 65 and over. with chewing and swallowing, tablets may be crushed. No overall differences in safety or effectiveness were observed The recommended starting dose of Velphoro is 3 tablets (1,500 mg) between these subjects and younger subjects. per day, administered as 1 tablet (500 mg) 3 times daily with meals. OVERDOSAGE Adjust by 1 tablet per day as needed until an acceptable serum There are no reports of overdosage with Velphoro in patients. phosphorus level is reached, with regular monitoring afterwards. Since the absorption of iron from Velphoro is low, the risk of Titrate as often as weekly. systemic iron toxicity is low. Hypophosphatemia should be DOSAGE FORMS AND STRENGTHS treated by standard clinical practice. Velphoro (sucroferric oxyhydroxide) chewable tablet 500 mg. Velphoro has been studied in doses up to 3,000 mg per day. CONTRAINDICATIONS HOW SUPPLIED/STORAGE AND HANDLING None. Velphoro are chewable tablets supplied as brown, circular, bi-planar tablets, embossed with “PA 500” on 1 side. Each tablet WARNINGS AND PRECAUTIONS of Velphoro contains 500 mg iron as sucroferric oxyhydroxide. Patients with peritonitis during peritoneal dialysis, significant gastric Velphoro tablets are packaged as follows: or hepatic disorders, following major gastrointestinal surgery, or with a history of hemochromatosis or other diseases with iron NDC 49230-645-51 Bottle of 90 chewable tablets accumulation have not been included in clinical studies with Storage Velphoro. Monitor effect and iron homeostasis
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