Nephron NEWS
Nephron NEWS
Nephron NEWS
Issue 5,2010 [July, 2010]
I strongly encourage the readers of Nephron Digest to engage in a dialogue by emailing me to discuss issues of global nephrological interest. These would be addressed by expert members of the editorial board of Nephron. Also readers are encouraged to request topics that they would like to be updated upon through the Mini Review series of Nephron Clinical Practice.Besides reading Nephron Digest, I hope you are enjoying a great World Cup 2010.
Professor Meguid El Nahas, PhD, FRCP
Editor, Nephron Clinical Practice
nephron@sheffield.ac.uk
m.el-nahas@sheffield.ac.uk
Digest of issue 116/2/2010
Dual RAS Therapy Not on Target, but Fully Alive (H.J. Lambers Heerspink, D. de Zeeuw, The Netherlands; Nephron Clin Pract 2010;116:c137-c142) The ONTARGET renal analysis suggests that the use of dual-agent RAS leads to increased renal risk. This led to vivacious discussions about the benefits and risks of dual-agent RAS in patients with nephropathy. Lambers Heerspink and de Zeeuw review the ONTARGET trial design and interpretation, and offer implications for novel trials.
The Kidney Evaluation and Awareness Program in Sheffield (KEAPS): A Community-Based Screening for Microalbuminuria in a British Population (A. Bello et al., UK; Nephron Clin Pract 2010;116:c95-c103) report the outcome of the KEAPS epidemiological study, a community-based screening program for microalbuminuria. As in other European studies, the authors found a high prevalence of individuals with microalbuminuria (~7%), but note a significant percentage who became negative upon re-testing. This highlights the issue of CKD screening and detection studies based on single testing that invariably overestimate the prevalence of microalbuminuria and, consequently, CKD. The authors also find that the majority of those testing positive have underlying predisposing disease such as hypertension, diabetes or obesity, or are elderly. This study adds credence to the argument for targeted screening of those at risk. In those, microalbuminuria may reflect Cardio-Kidney-Damage (C-K-D; El Nahas, Kidney Int 2010;78:14-18).
Targeted Screening of Adult First-Degree Relatives for Chronic Kidney Disease and Its Risk Factors (S. Bagchi et al., India; Nephron Clin Pract 2010;116:c128-c136) report their findings in first-degree relatives (FDRs) of patients with CKD. They detected new cases of hypertension (21.5%), diabetes mellitus (2.0%), impaired fasting glucose (22.4%) and hypercholesterolemia (18.8%). 5.9% had proteinuria (?1+). 61.2% of FDRs had eGFR in stage 1, 34.7% in stage 2, 3.6% in stage 3, and 0.5% in stage 4-5. 8.6% had CKD (88.5% were unaware). As with the above report from Sheffield, this study implies that first-degree relatives of CKD patients should also be included in a comprehensive targeted screening program. But more importantly, it reminds readers of the prevalence of undiagnosed hypertension and diabetes in communities. This has to be the major screening target of programs aimed at detecting and reducing the impact of chronic non-communicable disease on morbidity and mortality worldwide.
Section on 'Kidney Disease and Population Health' (K.J. Van Stralen and colleagues, The Netherlands and Italy; Nephron Clin Pract 2010;116:c143-c147). The authors discuss the definition and role of confounders in data interpretation and clinical studies. They remind readers of the criteria needed to define a confounder: 1) The variable needs to be associated with the exposure. 2) The variable needs to be associated with the outcome or disease. 3) The variable should not be an intermediate variable in the causal pathway between exposure and outcome. Only if all three criteria are fulfilled is the variable under question a confounder.
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