Nephro Trial Files: Prednisolone vs. Levamisole in Nephrotic Syndrome, Parathyroidectomy vs. Oral Cinacalcet for Kidney Failure and SHPT, and a Personalized Algorithm vs. Usual Care for CKD
An open label non-inferiority randomized controlled trial evaluated alternate day prednisolone given daily during infections vs. levamisole in frequently relapsing nephrotic syndrome
Sinha A et al. Kidney International (May 2024)
Bottom Line: This open label, non-inferiority trial compared the effectiveness of prednisolone and levamisole in preventing frequent relapses of nephrotic syndrome in children aged 2 to 18. The study included 160 patients and the primary outcome was the proportion of patients with frequent relapses. Results showed that while prednisolone was not non-inferior to levamisole in preventing frequent relapses, both therapies were effective in other outcome measures. Levamisole was also found to be relatively steroid-sparing and may be preferred in patients at risk of steroid toxicity.
Impact of Parathyroidectomy Versus Oral Cinacalcet on Bone Mineral Density in Patients on Peritoneal Dialysis With Advanced Secondary Hyperparathyroidism (PROCEED)
Wang AY et al. American Journal of Kidney Diseases (April 2024)
Bottom Line: This pilot randomized trial compared the effects of total parathyroidectomy and oral cinacalcet treatment on bone mineral density (BMD) in patients with advanced secondary hyperparathyroidism (SHPT) receiving peritoneal dialysis. The study included 65 patients and showed that parathyroidectomy led to a greater increase in BMD of the lumbar spine and femoral neck, as well as a reduction in osteopenia/osteoporosis, compared to cinacalcet treatment. No significant changes were observed in BMD of the distal radius. In conclusion, parathyroidectomy may be a more effective treatment option for improving BMD and reducing osteopenia/osteoporosis in this patient population.
Pragmatic Trial of Hospitalization Rate in Chronic Kidney Disease
Vazquez MA et al. NEJM (April 2024)
Bottom Line: This open-label, cluster-randomized trial involved 11,182 patients with chronic kidney disease, type 2 diabetes, and hypertension. Patients were assigned to receive either a personalized algorithm with practice facilitators or usual care. The primary outcome was hospitalization at 1 year, with no statistically significant difference between the two groups. Secondary outcomes included emergency department visits, readmissions, cardiovascular events, dialysis, and death, which were similar in both groups. Adverse events were also similar, except for a slightly higher rate of acute kidney injury in the intervention group. Overall, the use of an EHR-based algorithm and practice facilitators did not result in reduced hospitalization in this patient population.
Nephro Trial Files Issue #NPH-2024-10
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