BOSTON—In stable kidney transplant recipients, kidney function, as determined by estimated glomerular filtration rate (eGFR), is independently associated with cardiovascular (CVD) events and death, according to research published online in the American Journal of Transplantation.

Daniel E. Weiner, MD, of Tufts Medical Center in Boston, and colleagues conducted a post hoc analysis of data from 4,016 participants in the Folic Acid for Vascular Outcome Reduction in Transplantation trial to assess CVD and mortality risk factors in renal transplant recipients.

The researchers found that 20 percent of participants had prior CVD, and the mean eGFR was 49 mL/min/1.73 m². Over a median of 3.8 years, the researchers identified a total of 527 CVD events in 3,676 participants for whom complete data were available. For those with eGFR values below 45 mL/min/1.73 m², for every 5 mL/min/1.73 m² increase in eGFR, the risk of CVD and death was 15 percent lower in adjusted analyses. No association was found for those with an eGFR above 45 mL/min/1.73 m².

"In conclusion, in stable kidney transplant recipients, lower eGFR is independently associated with adverse events, suggesting that reduced kidney function itself rather than preexisting comorbidity may lead to CVD," the authors wrote.

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ADELAIDE, South Australia—This news comes even with the highest odds for peritonitis in the 30 days before death, according to a study published online May 24 in the Journal of the American Society of Nephrology.

Neil Boudville, M.D., from the Australia and New Zealand Dialysis and Transplant Registry in Adelaide, and colleagues conducted a case-crossover study involving 1,316 patients (mean age, 70 years) who received peritoneal dialysis (mean duration, three years) either died on peritoneal dialysis or within 30 days of transfer to hemodialysis. Each patient served as his or her own control.

The researchers identified 1,446 reported episodes of peritonitis, with 27 percent of patients having two or more episodes. There were significantly increased odds of peritonitis during the 120 days before death compared to during the rest of the year, and the magnitude of this association was even greater during the 30 days before death. The odds for peritonitis was six-fold higher during the 30 days immediately before death (odds ratio, 6.2) compared with a 30-day window six months before death.

"Peritonitis significantly associates with mortality in peritoneal dialysis patients," the authors write. "The increased odds extend up to 120 days after an episode of peritonitis but the magnitude is greater during the initial 30 days."

Several authors disclosed financial ties to the health care and pharmaceutical industries.

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PARIS—Statin medications appear to have different effects on patients with chronic kidney disease (CKD)depending on their disease stage, researchers reported at the 49^th Congress of the European Renal Association-European Dialysis and Transplant Association.

Suetonia Palmer, MD, senior lecturer at the University of Otago in Christchurch, New Zealand, and associates elsewhere examined the benefits of statin therapy based on CKD severity. For their study, the group conducted a meta-analysis that included 51,099 adults with CKD who were enrolled in 80 randomized controlled trials that compared statins with placebo or no treatment. Results showed that treatment benefits varied significantly between stages of CKD.  Within stages of CKD, treatment effects were consistent.

“We are desperately trying to find treatments that will improve mortality in patients on hemodialysis,” Dr. Palmer said. “In the U.S. registries, about 20% of patients on dialysis die each year, and in most cases because of cardiovascular disease. The literature on the benefits of statins in CKD patients has produced contradictory results, and thus we did a meta-analysis to provide more definitive answers.”

An examination of data on all-cause mortality from the meta-analysis revealed that statins lowered the risk of premature death by 19% in patients with CKD who were not on dialysis but had little or no effect in patients on dialysis.  Treatment effects in kidney transplant recipients were uncertain. 

Statins reduced major cardiovascular events by 24% in CKD patients not on dialysis but had little or no effect in patients on dialysis.  Again, treatment effects in kidney transplant recipients were uncertain.  

“Statins don't reduce major cardiovascular events in patients on dialysis probably because cardiovascular events in dialysis patients are more likely to be related to the thickness of the heart muscle and heart failure and not blockage of the arteries,” Dr. Palmer said. “While statins reduce the risk of arterial blockage, arterial blockage is a much less important cause of cardiovascular death in dialysis patients.”

Statins had no significant effects on cancer, myalgia, liver function, or withdrawal from treatment.

The extent of benefit conferred by statins in CKD patients not on dialysis is on a par with that seen in the general population as well as in individuals with cardiovascular disease, she said.

“I am telling clinicians that patients not on dialysis would clearly benefit from a statin,” she added.  “However, you are clearly obliged to tell patients once they reach dialysis not that they should stop statins but rather that their chances of clinical benefit are very small.”

She cautioned that the analyses “were limited by reliance on post-hoc subgroup data for earlier stages of CKD.”

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Ginsbach awarded for nursing excellence Dell Rapids Tribune Ginsbach, whose credits include RN, nephrology nurse case manager, specialty medicine and PCSMSL, was nominated by fellow nurse Lois Plooster. Among the other recipients of the 2012 awards were Michelle Laska, surgery, and Brigette Kooima, LPN.

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