Prediction of Progression in Polycystic Kidney Disease Using the Kidney Failure Risk Equation and Ultrasound Parameters.

BACKGROUND: The kidney failure risk equation (KFRE) is a validated risk algorithm for predicting the risk of kidney failure in chronic kidney disease (CKD) patients regardless of etiology. Patients with autosomal dominant polycystic kidney disease (AD-PCKD) experience long disease trajectories and as such identifying individuals at risk of kidney failure would aid in intervention. OBJECTIVE: To examine the utility of the KFRE in predicting adverse kidney outcomes compared with existing risk factors in a cohort of patients with AD-PCKD. METHODS: Retrospective cohort study of AD-PCKD patients referred to a tertiary care center with a baseline kidney ultrasound and a KFRE calculation. Cox proportional hazards were used to examine the association of the KFRE and composite of an eGFR decline of >30% or the need for dialysis/transplantation. Discrimination and calibration of a parsimonious fully adjusted model and a model containing only total kidney volume (TKV) with and without the addition of the KFRE was determined. RESULTS: Of 340 patients with AD-PCKD eligible, 221 (65%) met inclusion criteria. Older age, cardiac disease, cancer, higher systolic blood pressure, albuminuria, lower eGFR and a higher initial TKV were more common in patients with a higher KFRE. A total of 120 events occurred over a median patient follow-up time of 3.2 years. KFRE was independently associated with the composite kidney outcome. Addition of the KFRE significantly improved discrimination and calibration in a TKV only model and a fully adjusted model. CONCLUSIONS: In a diverse, referral population with AD-PCKD, the KFRE was associated with adverse kidney outcomes and improved risk prediction.

CONTEXTE: L'équation KFRE (kidney failure risk equation) est un algorithme validé pour prédire le risque de défaillance rénale chez les patients atteints d'IRC, quelle que soit l'étiologie. Les patients souffrant de polykystose rénale autosomique dominante (ADPKD) connaissent une longue trajectoire de maladie et, à ce titre, le dépistage des individus présentant un risque élevé d'insuffisance rénale pourrait faciliter les interventions. OBJECTIF: Examiner l'efficacité de la KFRE à prédire le risque d'issues rénales défavorables dans une cohorte de patients atteints d'ADPKD comparativement aux facteurs de risque existants. MÉTHODOLOGIE: Cette étude de cohorte rétrospective porte sur des patients atteints d'ADPKD aiguillés vers un centre de soins tertiaires avec une échographie rénale de référence et un calcul de KFRE. Un modèle de risques proportionnels de Cox a été employé pour analyser la relation entre la KFRE et un déclin composite du DFGe supérieur à 30% ou le besoin de dialyse ou de transplantation. La discrimination et la calibration d'un modèle parcimonieux entièrement corrigé et d'un modèle ne tenant compte que du volume rénal total (VRT), avec ou sans l'ajout de la KFRE, ont été déterminées. RÉSULTATS: Des 340 patients atteints d'ADPKD et admissibles à l'étude, 221 (65%) satisfaisaient les critères d'inclusion. Les patients présentant un résultat élevé à la KFRE étaient souvent plus âgés et étaient plus fréquemment atteints des troubles suivants: maladies cardiovasculaires, cancer, pression systolique élevée, albuminurie, faible DFGe et VRT initial plus élevé. Un total de 120 événements sont survenus au cours de la période de suivi médiane (3,2 ans). La KFRE a été associée de façon indépendante à l'issue rénale composite. L'ajout de la valeur de KFRE a considérablement amélioré la discrimination et la calibration des deux modèles employés (VRT seulement et modèle entièrement corrigé). CONCLUSION: L'utilisation de la KFRE a été associée à des issues rénales défavorables et à une meilleure prédiction du risque d'insuffisance rénale dans une population de référence diversifiée composée de patients atteints d'ADPKD.

Benefits and Barriers to and Desired Outcomes with Exercise in Patients with ESKD.

BACKGROUND AND OBJECTIVES: Patients with ESKD are sedentary. When patient-identified barriers to exercise are addressed, recruitment and retention in exercise trials remain low, suggesting that the trial design may not resonate with them. Therefore, we conducted a survey of patients on dialysis to assess perceived benefits and barriers to exercise and discover preferred outcomes and exercise type by dialysis modality and age in anticipation of designing future randomized, controlled trials. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: English- and French-speaking patients with ESKD treated with hemodialysis or peritoneal dialysis were recruited from two tertiary care hospitals in Ottawa and Montreal, Canada. Summary descriptive statistics were used to describe patient responses; then, they were separated by dialysis modality and age category. RESULTS: The survey was completed by 423 participants. Current activity levels were similar across modalities (P=0.35); 78% of younger patients walked at least 10 minutes at a time on 3 or more days compared with only 58% of older patients (P=0.001). The two most desired benefits of exercise were improved energy (18%) and strength (14%). The third priority differed, such that improved sleep, maintenance of independence, and longevity were selected by patients on peritoneal dialysis, patients on in-center hemodialysis, and patients on home hemodialysis, respectively. Older patients were most interested in improvements in energy, strength, and maintenance of independence, whereas younger patients were interested in improving energy, longevity, and transplant candidacy. Only 25% of patients were able to exercise without difficulty; the major barriers for the remaining patients were feeling patients were feeling too tired (55%), short of breath (50%), and too weak (49%). If patients were to exercise, they wanted to exercise at home (73%) using a combination of aerobic and resistance training (41%), regardless of modality or age category. CONCLUSIONS: The majority of patients undergoing maintenance dialysis in two tertiary hospitals in Ottawa and Montreal report similar desired outcomes and barriers, with greater differences by age category than modality.

Systemic Toxicity of Intraperitoneal Vancomycin.

Intraperitoneal vancomycin is used for empiric treatment of peritoneal dialysis peritonitis. It is dosed intermittently and a high systemic concentration is often achieved. Despite this, there are very few reports of systemic toxicity from intraperitoneal vancomycin. We report the course of a patient who developed a drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome after three weeks of intraperitoneal vancomycin. We review the literature and conclude that this is the first ever reported case of DRESS syndrome from intraperitoneal vancomycin.