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DaVita Expands With $4.42 Billion HealthCare Partners Purchase San Francisco Chronicle May 21 (Bloomberg) -- DaVita Inc., a provider of kidney dialysis care, agreed to buy HealthCare Partners for about $4.42 billion in cash and stock, expanding into broader medical services as it sees dialysis moving to a new payment model. DaVita to buy physician network operator HealthCare Partners in $4.42 billion deal Washington Post DaVita to buy HealthCare Partners in $4.42B deal The Seattle Times all 187 news articles »

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WASHINGTON—For patients with impaired renal function, performing CABG off-pump rather than on-pump appears to improve outcomes, a retrospective study showed.

Across the range of renal function, off-pump CABG was associated with a slightly lower rate of in-hospital death or the need for renal replacement therapy compared with on-pump CABG (1.8% versus 2%), according to Lakhmir Chawla, MD, of George Washington University Medical Center, and colleagues.

The benefit of off-pump CABG increased as renal function worsened, the researchers reported online in the Journal of the American Society of Nephrology.

"Prospective trials comparing these procedures in patients with impaired preoperative renal function are warranted," they wrote.

Patients with prolonged exposure to cardiopulmonary bypass have been shown to have a greater risk of postoperative acute kidney injury, and off-pump CABG has been proposed for high-risk patients.

"The link between cardiopulmonary bypass and acute kidney injury is plausible, especially among patients with limited preoperative renal reserve," the researchers wrote, citing detrimental effects from low mean arterial pressures during bypass, the kidney's vulnerability to ischemia, and possible contributions from nonpulsatile renal perfusion, microemboli, and systemic inflammation.

"Despite this mechanistic association, prospective controlled trials of off-pump CABG have included few patients with chronic kidney disease," they wrote.

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MELBOURNE, Australia—Catheter-based renal nerve ablation helps lower resistant hypertension, but now researchers have found that it works as well in those with chronic kidney disease (CKD), a pilot study showed.

In 15 patients with resistant hypertension and stage 3 and 4 CKD, bilateral renal denervation lowered blood pressure by a mean of 34/14 mmHg at 1 month and 32/15 mmHg at 6 months, reported Markus Schlaich, MD, of the Baker IDI Heart & Diabetes Institute in Melbourne, Australia, and colleagues.

The mean estimated glomerular filtration rate (eGFR) did not change after the procedure, even though patients received contrast media for renal catheterization or CO₂ angiography, according to the study published online in the Journal of the American Society of Nephrology.

Ablating renal nerves via the renal arteries by scarring the tissue with radiofrequency energy reduces sympathetic nerve activity, which then reduces blood pressure.

However, sympathetic nerve activation is also associated with the progression of chronic kidney disease and adverse cardiovascular outcomes, Schlaich and colleagues said.

Consequently, renal denervation performed to lower blood pressure might also have beneficial effects for kidney disease, they suggested.

Previous studies of renal denervation to reduce resistant hypertension included patients with an eGFR greater than 45 mL/min per 1.73 m². In the current study, the mean eGFR was 31 mL/min per 1.73 m².

The mean age of patients was 61 and three-quarters had diabetes. Patients were on a mean of 5.6 antihypertensive drugs, and the average systolic office blood pressure was 174 mmHg. The cohort of 15 patients comprised six women and the mean body mass index was 33 kg/m².

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