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NIB1109.qxd 10/27/09 1:27 PM Page 2 10 Renal & Urology News NOVEMBER 2009 www.renalandurologynews.com Please visit us at www.renalandurologynews.com News in Brief Severe LUTS, Big CAC in Stage 3 Warfarin May Raise Stroke Waists Linked CKD Patients Risk in ESRD Patients study of 602 Korean men with A lower urinary tract symptoms (LUTS) secondary to benign prosta- C oronary artery calcification (CAC) is common among patients with W arfarin use in patients with both end-stage renal disease (ESRD) and atrial fibrillation are at increased risk for stroke, data suggest. It is not asso- tic hyperplasia found that those with stage 3 CKD, data show. Bryan R. ciated with increased all-cause mortality or hospitalization. a waist circumference greater than Kestenbaum, MD, of the University of Researchers followed 1,671 new ESRD patients with preexisting atrial fibril- 90 cm (central obesity) had a 36% Washington in Seattle, and colleagues lation for an average of 1.6 years from the time they started dialysis. Compared increased risk of severe LUTS com- studied 562 adult patients with CKD with nonuse, warfarin use was associated with a nearly twofold increased risk pared with men who had smaller (estimated glomerular filtration rate for a new stroke, investigators reported in the Journal of the American Society waists. In addition, in men with cen- [eGFR] of less than 60 mL/min/ of Nephrology (2009;20:2223-2233). Clopidogrel or aspirin use was not associ- tral obesity, prostate volume corre- 1.73 m2) and without clinical car- ated with the risk of a new stroke. lated positively with urgency and diovascular disease. The patients were The investigators concluded that “physicians should be cognizant of the pos- nocturia. Findings appear in the participants in the Multi-Ethnic Study sible risks associated with warfarin use for atrial fibrillation in patients with Asian Journal of Andrology (2009; of Atherosclerosis. Of the 562 subjects, ESRD, with careful evaluation of the risks and benefits of intervention at the published online ahead of print). n 98% had stage 3 CKD at baseline individual patient level.” n (median eGFR of 55.4). The study measured CAC at baseline and again Megestrol May approximately 1.6 or 3.2 years later. At baseline, 370 subjects (66%) had Emergency Departments Found Improve Weight CAC and 192 (34%) did not, accord- To Underuse MET for Stones ing to a report in Kidney International pilot study showed that mega- (2009;76:991-998). The prevalence edical expulsive therapy (MET) for urinary stones in American emer- A strol may help improve weight and the ability to exercise in dialy- was 24% lower in African Americans than in Caucasians after adjusting for M gency departments (ED) is underused despite evidence of its safety and efficacy, investigators have concluded. sis patients, according to a report in numerous potential confounders. CAC John M. Hollingsworth, MD, and colleagues at the University of Michigan in the Journal of Renal Nutrition (2009; developed in 39 (20%) who did not Ann Arbor analyzed 2000-2006 data from the National Hospital Ambulatory published online ahead of print). have it at baseline, for an estimated Medical Care Survey. They determined MET use by the prescription for a cal- Investigators randomized nine el- incidence of 8.5% per year. The inci-
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