Nephro Trial Files Throwback Thursday: Stenting in ARAS, Low-Protein Diet in Chronic Renal Disease, and Plasma Exchange in Multiple Myeloma
Stent Placement in Patients With Atherosclerotic Renal Artery Stenosis and Impaired Renal Function
Bax L et al. Annals of Internal Medicine (June 2009)
Bottom Line: This randomized clinical trial evaluated the efficacy and safety of stent placement in patients with atherosclerotic renal artery stenosis (ARAS) and impaired renal function. The study included 140 patients and compared stent placement with medical treatment to medical treatment only. The primary outcome was a 20% or greater decrease in creatinine clearance, with a secondary focus on safety and cardiovascular morbidity and mortality. The results showed no significant difference in the primary outcome between the intervention and control groups, but serious complications occurred in the stent group. The study suggests a conservative approach to managing patients with ARAS may be more beneficial.
The Effects of Dietary Protein Restriction and Blood-Pressure Control on the Progression of Chronic Renal Disease
Klahr S et al. NEJM (March 1994)
Bottom Line: This randomized controlled trial aimed to investigate the effects of a low-protein diet and controlling blood pressure on the progression of renal disease in patients with chronic renal diseases. A total of 840 patients were included in the study and were divided into intervention and comparator groups. The intervention group received a low-protein diet and had their blood pressure controlled, while the comparator group followed a usual-protein diet and had their blood pressure controlled. The primary outcome was the decline in glomerular filtration rate at three years, and the results showed that the intervention group had a more rapid decline in the first four months, but no significant difference overall compared to the comparator group. Safety outcomes showed no delay in the time to end-stage renal disease or death. The study concluded that a low-protein diet and controlling blood pressure may delay the progression of renal disease in patients with moderate renal insufficiency.
Plasma Exchange When Myeloma Presents as Acute Renal Failure
Clark WF et al. Annals of Internal Medicine (December 2005)
Bottom Line: This study was a small, randomized, open, controlled trial conducted in 14 Canadian medical centers from 1998 to 2004. The study aimed to assess the effect of 5 to 7 plasma exchanges on a composite outcome in patients with acute renal failure at the onset of multiple myeloma. The study included 104 patients between 18 and 81 years of age and compared conventional therapy plus plasma exchange to conventional therapy alone. The primary outcome was a composite measure of death, dialysis dependence, or low glomerular filtration rate at 6 months. The results showed no significant difference between the intervention and control groups in the primary outcome. The study was limited by its small sample size and use of a composite outcome. The conclusion was that there is no conclusive evidence that plasma exchange reduces the primary outcome in these patients.
Nephro Trial Files Issue #NPH-2025-05
Want to view past issues? Visit our archive:
