Cochrane Library: Interventions for preventing the progression of autosomal dominant polycystic kidney disease

Introduction

Introduction

Autosomal Dominant Polycystic kidney disease (ADPKD) is the most common inherited kidney disorder leading to end-stage kidney disease requiring dialysis treatment or transplantation. This disease is mainly characterized by uncontrolled growth of cysts with renal parenchyma injury, compression, and fibrosis. Increases in cyst numbers and size over time cause clinical complications such as infections, bleeding, flank pain, hypertension and, ultimately, a progressive loss in renal function. Recently, major advancements have been made in the biological understanding of the cellular pathways involved in cyst growth. Yet, therapeutic management of patients with ADPKD remains confined to symptom management and disease complications such as hypertension, urinary infections and flank pain. The main aim of this Cochrane review was to summarize the benefits and harms of therapeutic interventions directed at preventing progression of ADPKD. The Cochrane review included 30 studies among about 2000 patients. Despite numerous potential treatments targeting disease pathogenesis, evidence from clinical trials is currently sparse or limited. At present there is no evidence that pharmacological interventions prevent end-stage kidney disease or mortality.

0 Evidence summary

Authors

davide

Davide Bolignano

Davide is a nephrologist working as clinical researcher and epidemiologist at the Institute of Clinical Physiology of the Italian National Research Council (CNR) in Reggio Calabria, Italy. His fields of interest and research are the epidemiology, physiology, and pathophysiology of kidney diseases.

palmer

Suetonia Palmer

Suetonia is a nephrologist based at the University of Otago, Christchurch in New Zealand, and who trained in New Zealand and the USA. She is an Editor and Podcast Editor for Cochrane Kidney and Transplant.

 

Copyright© 2016 Cochrane Kidney and Transplant. Published by John Wiley & Sons, Ltd.

Cochrane Library: Hemodiafiltration for end-stage kidney disease (updated evidence summary)

Introduction

Introduction

End-stage kidney disease causes accumulation of metabolites and excess fluid. Renal replacement therapy including hemodialysis is used to remove unwanted solutes and fluid retention but is incompletely effective at restoring full health. Dialysis patients experience a heavy burden of symptoms including fatigue, itch, depression, sleep disturbance, and appetite loss. In addition, 10-20% of dialysis patients die each year.

Hemodialysis eliminates solutes by diffusion across the dialysis membrane. Diffusion in the movement of solutes down a concentration gradient from high to low concentration. However, diffusion fails to remove metabolites of larger molecular weight (such as beta-2-macroglobulin) due to their slow diffusion capacity. High levels of ‘middle molecules’ are associated with poorer patient outcomes including infection and mortality.

Hemodiafiltration is a hybrid dialysis technology that uses diffusion and convection to remove solutes and water. In convection, positive pressure pushes water across the dialysis membrane. Solutes cross the membrane with the water movement in a phenomenon known as ‘solvent drag’. Hemodiafiltration is more effective than hemodialysis at removing larger circulating molecules and is associated with improved survival in non-randomized studies.

This updated Cochrane review directly compared convective dialysis technologies (hemofiltration and hemodiafiltration) with hemodialysis for treatment of end-stage kidney disease to explore the effects of hemodiafiltration on patient outcomes.

Authors

nistor

Ionut Nistor

Ionut is a nephrologist based at the "Gr. T. Popa" University of Medicine and Pharmacy, Iasi, Romania. He has worked as an Honorary Research Fellow at Cochrane Kidney and Transplant and joined European Renal Best Practice (ERBP) in August 2011 as an ERBP fellow in the Methods Team.

palmer

Suetonia Palmer

Suetonia is a nephrologist based at the University of Otago, Christchurch in New Zealand, and who trained in New Zealand and the USA. She is an Editor for Cochrane Kidney and Transplant.

 

Copyright© 2016 Cochrane Kidney and Transplant. Published by John Wiley & Sons, Ltd.

Cochrane Library: Erythropoiesis-stimulating agents for anemia

Introduction

Introduction

Anemia affects nearly all adults with advanced kidney disease and is linked to fatigue, breathlessness, impaired quality of life and physical function, and shorter survival. ESA treatment aims to improve anemia-related symptoms and minimize treatment-related cardiovascular events. Several ESA classes are available for anemia treatment (epoetin alfa, epoetin beta, darbepoetin alfa, methoxy polyethylene glycol-epoetin beta as well as biosimilar ESAs) but whether these drugs have differing benefits and harms is uncertain. This Cochrane review directly compares available ESAs for treatment of anemia among adults with chronic kidney disease.

Authors

palmer

Suetonia Palmer

Suetonia is a nephrologist based at the University of Otago, Christchurch in New Zealand, and who trained in New Zealand and the USA. She is an Editor for Cochrane Kidney and Transplant.

stipolli

Giovanni Strippoli

Giovanni is a nephrologist based at the University of Bari in Italy, who also trained at the Sydney School of Public Health, Australia. He is an Editor for Cochrane Kidney and Transplant and the journal Nephrology, Dialysis and Transplantation.

 

Copyright© 2015 Cochrane Kidney and Transplant. Published by John Wiley & Sons, Ltd.

 

Saturday, 06 September 2014 13:23

Cochrane Library: Treatment for Lupus Nephritis

Cochrane Library: Treatment for Lupus Nephritis

Introduction

Introduction

Lupus nephritis is an inflammatory condition affecting the kidneys which is caused by systemic lupus erythematosus (SLE), an autoimmune disease that is more common among women. About half of all people with SLE develop lupus nephritis, and of these about 1/10 experience chronic kidney disease or kidney failure. Treatment aims to delay disease progression and achieve remission by stabilising and improving kidney function and minimising side effects. For about the past 30 years, standard treatment for lupus nephritis has focused on a combination of cyclophosphamide (an alkylating agent) and corticosteroids. This Cochrane review assesses the benefits and harms of different immunosuppressive treatments in biopsy-proven proliferative lupus nephritis.

Authors

Henderson

Lorna Henderson

Lorna Henderson is a Nephrologist based in Edinburgh, and who trained in Scotland and Australia. During a fellowship year at Westmead Hospital in New South Wales, Lorna spent some time training with the Cochrane Renal Group, and working on the review update of treatment for Lupus Nephritis. She has an interest in transplantation and evidence based practice.

agnela webster

Angela Webster

Angela is a Nephrologist and Transplant Physician, having trained in England, Scotland and Australia. She also works at the University of Sydney as a Clinical Epidemiologist and is the Deputy Coordinating Editor of the Cochrane Renal Group

 

Copyright© 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

 

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