Nephro Trial Files Throwback Thursday: Revascularization in RAS, ACE+ARB in DM Nephropathy, and NS vs. Balanced Crystalloids in ICU
Revascularization versus Medical Therapy for Renal-Artery Stenosis
The ASTRAL Investigators. NEJM (November 2009)
Bottom Line: This randomized, unblinded trial evaluated the effectiveness of percutaneous revascularization in addition to medical therapy compared to medical therapy alone in 806 patients with atherosclerotic renovascular disease. The primary outcome was renal function at 34 months, with secondary outcomes including blood pressure, time to renal and major cardiovascular events, and mortality. The results showed no significant difference in renal function between the two groups, but a higher risk of serious complications associated with revascularization. The study concluded that there was no worthwhile clinical benefit from revascularization in these patients.
Combined Angiotensin Inhibition for the Treatment of Diabetic Nephropathy
Fried LF et al. NEJM (November 2013)
Bottom Line: This randomized controlled trial evaluated the safety and efficacy of combination therapy with losartan and lisinopril in patients with type 2 diabetes, urinary albumin-to-creatinine ratio‚ ≥300, and estimated GFR of 30.0-89.9 ml/min/1.73 m2. The primary outcome was the first occurrence of a decline in estimated GFR, ESRD, or death. The study was stopped early due to safety concerns, with no significant difference in primary outcome between the combination therapy and monotherapy groups. However, combination therapy was associated with an increased risk of hyperkalemia and acute kidney injury. This study highlights the potential risks of combination therapy with ACE inhibitors and ARBs in patients with diabetic nephropathy.
Balanced Crystalloids versus Saline in Critically Ill Adults
Semler MW et al. NEJM (February 2018)
Bottom Line: This pragmatic, cluster-randomized, multiple-crossover trial aimed to compare the use of balanced crystalloids and saline for intravenous fluid administration in critically ill adults. The study included 15,802 patients and the primary outcome was a major adverse kidney event within 30 days. The results showed that the use of balanced crystalloids resulted in a lower rate of the composite outcome compared to saline. The study did not find a significant difference in in-hospital mortality, new renal-replacement therapy, or persistent renal dysfunction between the two groups. The study was funded by the Vanderbilt Institute for Clinical and Translational Research and others, with ClinicalTrials.gov numbers NCT02444988 and NCT02547779.
Nephro Trial Files Issue #NPH-2024-13
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