Nephro Trial Files Throwback Thursday: Grazoprevir + Elbasvir in HCV + CKD, Increased Peritoneal Small-Solute Clearances in PD, and BP Control in HTN
Grazoprevir plus elbasvir in treatment-naive and treatment-experienced patients with hepatitis C virus genotype 1 infection and stage 4–5 chronic kidney disease (the C-SURFER study)
Roth D et al. The Lancet (October 2015)
Bottom Line: This phase 3 randomized study evaluated the safety and efficacy of an all-oral, ribavirin-free regimen in patients with HCV genotype 1 infection and stage 4-5 chronic kidney disease. The intervention group received grazoprevir (100 mg) and elbasvir (50 mg) once daily for 12 weeks, while the comparator group received placebo. The primary outcome was sustained virological response at 12 weeks (SVR12), which was significantly higher in the intervention group (99%) compared to a historical control of 45%. The intervention group also had a low rate of adverse events. In conclusion, once-daily grazoprevir and elbasvir for 12 weeks was effective and well-tolerated in this patient population.
Effects of Increased Peritoneal Clearances on Mortality Rates in Peritoneal Dialysis (ADEMEX)
Paniagua R et al. JASN (May 2002)
Bottom Line: This prospective, randomized, controlled, clinical trial studied the effects of increased peritoneal small-solute clearances on clinical outcomes among patients with end-stage renal disease being treated with PD. A total of 965 patients were randomly assigned to receive either a modified prescription to achieve a peritoneal creatinine clearance (pCrCl) of 60 L/wk per 1.73 m(2) (intervention group) or their preexisting PD prescription (control group). The primary endpoint was death, and the study groups were similar in terms of demographic characteristics, causes of renal disease, and other factors. Results showed no significant difference in survival between the intervention and control groups, indicating that increases in peritoneal small-solute clearances within the studied range have a neutral effect on patient survival.
Trial of Intensive Blood-Pressure Control in Older Patients with Hypertension
Zhang W et al. NEJM (August 2021)
Bottom Line: This is a multicenter, randomized, controlled trial in Chinese patients 60 to 80 years of age with hypertension. The study compared intensive treatment with a systolic blood-pressure target of 110 to less than 130 mm Hg to standard treatment with a target of 130 to less than 150 mm Hg. The sample size was 8511 patients. The primary outcome was a composite of stroke, acute coronary syndrome, acute decompensated heart failure, coronary revascularization, atrial fibrillation, or death from cardiovascular causes at 3.34 years of follow-up. The intensive-treatment group had a significantly lower incidence of primary outcome events compared to the standard-treatment group (hazard ratio, 0.74; 95% CI, 0.60 to 0.92; P‚Äâ=‚Äâ0.007). The results for most of the individual components of the primary outcome also favored intensive treatment. Safety outcomes did not differ significantly between the two groups, except for a higher incidence of hypotension in the intensive-treatment group. In conclusion, intensive treatment with a systolic blood-pressure target of 110 to less than 130 mm Hg resulted in a lower incidence of cardiovascular events in older patients with hypertension.
Nephro Trial Files Issue #NPH-2025-09
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