A 10-year follow-up of the MAINTAIN Nephritis trial showed no advantage of mycophenolate mofetil (MMF) over azathioprine (AZA) for lupus nephritis (LN)maintenance therapy.

The data confirm the relevance of recommendations from the European Renal Association-European Dialysis and Transplant Association and American College of Rheumatology regarding maintenance therapy of LN, namely that AZA and MMF can be prescribed, stated a research team led by Frédéric A. Houssiau, MD, professor of rheumatology at Universite catholique de Louvain, Brussels, Belgium.

The original MAINTAIN trial randomized 105 mostly Caucasian LN patients to maintenance MMF or AZA in 2002-2006. For the 10-year analysis, the investigators examined long-term outcomes, such as survival, kidney function, 24-hour proteinuria, and renal flares.

The researchers found that the time to renal flare did not differ between the AZA and MMF patients, according to results published online ahead of print in the Annals of Rheumatic Disease.

Furthermore, they discovered that patients with an early proteinuria decrease of 0.5g/day or less at 12 months have a very low risk of long-term renal impairment at 10 years. (Proteinuria greater than 0.5 g/day was not predictive of poor outcome, however.)

“At the bedside, the clinician can therefore confidently reassure patients who achieve a durable early response in proteinuria but should not consider a switch to an alternative agent based only on non-achievement of this target,” the researchers said.

Source

1. Tamirou, F, et al. Ann Rheum Dis 2015; doi: 10.1136/annrheumdis-2014-206897.

...

Posted: Thursday, March 26, 2015 11:54 am

Medicare Part C: The choice of Medicare Advantage Plans 0 comments

This article is the third in a series examining what Medicare does and does not cover. This segment addresses Part C, which allows the insured to choose Medicare Advantage plans instead of regular Medicare.

What are Medicare Advantage Plans?

Subscription Required

An online service is needed to view this article in its entirety. You need an online service to view this article in its entirety.

Have an online subscription?

Need an online subscription?

Login

Or, use your linked account:

Choose an online service.

• 1 Online Only Subscription – Subscribe or Renew $26.00 for 365 days To become a new online only subscriber, please choose this option. By doing so, you will first proceed to a registration form. Upon completion of the registration form you will then continue by completing the subscription form. For assistance please call 254-965-3124. Thank you.Please note - If you have already registered during a previous visit to this web site go to directly to the login button at the top right and then proceed to the subscription form.
• 2 Online Only Subscription- Auto Renew $6.95 for 28 days To become a new online only subscriber, and have your payment automatically charged every four weeks, please choose this option. By doing so, you will first proceed to a registration form. Upon completion of the registration form you will then continue by completing the subscription form. For assistance please call 254-965-3124. Thank you.Please note - If you have already registered during a previous visit to this web site go to directly to the login button at the top right and then proceed to the subscription form.
• 3 Print & Online Subscription - Subscribe or Renew $26.00 for 365 days $40.00 for 365 days $60.00 for 365 days To become a new print and online subscriber, please choose this option. By doing so, you will first proceed to a registration form. Upon completion of the registration form you will then continue by completing the subscription form. For assistance please call 254-965-3124. Thank you.Please note - If you have already registered during a previous visit to this web site go to directly to the login button at the top right and then proceed to the subscription form

Current print subscribers

• 1 Add Online Access for Print Subscribers If you are a current print subscriber and would like to add Online Access to your subscription package, please choose this option. By doing so, you will first proceed to a registration form. Please note, you must provide a current Account Number for your subscription. Enter your account number including the leading "0": 0123456. For assistance please call 254-965-3124. Thank you.Please note - If you have already registered during a previous visit to this web site go to directly to the login button at the top right and then proceed to the subscription form.

Need an account? Create one now.

You must login to view the full content on this page.

Or, use your linked account:

Thank you for reading 6 free articles on our site. You can come back at the end of your 30-day period for another 6 free articles, or you can purchase a subscription at this time and continue to enjoy valuable local news and information. If you need help, please contact our office at 254-897-2282. You need an online service to view this article in its entirety.

Have an online subscription?

Need an online subscription?

Login

Or, use your linked account:

Choose an online service.

• 1 Online Only Subscription – Subscribe or Renew $26.00 for 365 days To become a new online only subscriber, please choose this option. By doing so, you will first proceed to a registration form. Upon completion of the registration form you will then continue by completing the subscription form. For assistance please call 254-965-3124. Thank you.Please note - If you have already registered during a previous visit to this web site go to directly to the login button at the top right and then proceed to the subscription form.
• 2 Online Only Subscription- Auto Renew $6.95 for 28 days To become a new online only subscriber, and have your payment automatically charged every four weeks, please choose this option. By doing so, you will first proceed to a registration form. Upon completion of the registration form you will then continue by completing the subscription form. For assistance please call 254-965-3124. Thank you.Please note - If you have already registered during a previous visit to this web site go to directly to the login button at the top right and then proceed to the subscription form.
• 3 Print & Online Subscription - Subscribe or Renew $26.00 for 365 days $40.00 for 365 days $60.00 for 365 days To become a new print and online subscriber, please choose this option. By doing so, you will first proceed to a registration form. Upon completion of the registration form you will then continue by completing the subscription form. For assistance please call 254-965-3124. Thank you.Please note - If you have already registered during a previous visit to this web site go to directly to the login button at the top right and then proceed to the subscription form

Current print subscribers

• 1 Add Online Access for Print Subscribers If you are a current print subscriber and would like to add Online Access to your subscription package, please choose this option. By doing so, you will first proceed to a registration form. Please note, you must provide a current Account Number for your subscription. Enter your account number including the leading "0": 0123456. For assistance please call 254-965-3124. Thank you.Please note - If you have already registered during a previous visit to this web site go to directly to the login button at the top right and then proceed to the subscription form.

Need an account? Create one now.

• Discuss
• Print

Posted in Columnists on Thursday, March 26, 2015 11:54 am.

...

Patients with end-stage renal disease (ESRD)who initiate renal replacement therapy on peritoneal dialysis (PD) are at lower risk of dementia than those who start on hemodialysis (HD), researchers concluded.

In a retrospective study of 121,623 patients initiating dialysis, Dawn F. Wolfgram, MD, of the Medical College of Wisconsin in Milwaukee, and colleagues found that those who started on PD had a 25% decreased risk of dementia compared with those who started on HD, after adjusting for age, gender, and other potential confounders. They obtained similar results when patients were matched by propensity score.

“This is the largest study to date in support of the hypothesis that the HD process itself, rather than simply the presence of ESRD, may contribute to the well-known higher prevalence of dementia among persons with ESRD,” the authors wrote in Peritoneal Dialysis International.

Dr. Wolfgram's team noted that their study “emphasizes the need for clinicians to regularly assess cognitive function among persons undergoing dialysis.” By helping clinicians tailor management to patients' cognitive abilities, early recognition of dementia may improve patient outcomes, they stated.

PD was the initial dialysis modality for 8,663 of the 121,623 study subjects. The mean age of the total cohort was 69.2 years.

The researchers used U.S. Renal Data System data for incident ESRD patients during calendar years 2006–2008. For all patients, they obtained Medicare claims data for 2004 through 2009, which includes ICD-9 comorbid disease diagnosis codes.

“Our use of Medicare data allowed us to exclude people who carried a dementia diagnosis at baseline, or who were recognized as having dementia during the 90 days after they initiated dialysis,” they wrote. “Thus we were not simply documenting that persons with dementia are unlikely to be able to initiate PD, a therapy which requires greater involvement of patients in care.”

The investigators also acknowledged study limitations. For example, they pointed out that non-medical factors impact the choice between PD and HD. “Physicians are more likely to encourage patients with subtle evidence of cognitive impairment to choose HD as their initial modality, biasing our results toward higher dementia risk in those initiated on HD. Although we excluded patients with pre-existing dementia from our analysis, it is possible that significant differences in baseline cognitive function between the PD and HD groups affected our results.”

Another limitation was that the researchers required 2 years of Medicare eligibility prior to the diagnosis of ESRD. As a result, their cohort was substantially older than the overall ESRD population and may have been healthier due to a survival effect, they noted. “Thus we cannot extrapolate our findings to younger persons with ESRD.”

...

According to a recent study published online early in the International Journal of Hematology, researchers have found that adjusting the starting dose of lenalidomide according to renal function did not compromise the efficacy or safety of lenalidomide plus low-dose dexamethasone in Chinese patients with advanced relapsed and/or refractory multiple myeloma and renal impairment.

For the study, researchers conducted a subgroup analysis of the MM-021 trial to assess the efficacy and safety of lenalidomide plus low-dose dexamethasone in Chinese patients with advanced relapsed or refractory multiple myeloma and renal impairment.

Researchers classified patients as having either no/mild renal impairment (CrCl ?60mL/min), moderate impairment (CrCl ?30 to <60 mL/min), or severe renal impairment (CrCl <30 mL/min).

Patients received lenalidomide at a starting dose of 25 mg/day on days 1-21, which was adjusted for baseline renal function. Patients received the regimen until disease progression or discontinuation.

In regard to safety, grade 3-4 anemia, neutropenia, and thrombocytopenia were more common in patients with severe renal impairment.

Reference

1. Zhou B-b, Yu L, Du X, et al. Lenalidomide plus low-dose dexamethasone in Chinese patients with relpased or refractory multiple myeloma and renal impairment. Int J Hematol. 2015. [Epub ahead of print]. doi: 10.1007/s12185-015-1771-7.

...