Trending Clinical Topic: Kidneys

Ryan Syrek

Disclosures

May 27, 2022

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A new study investigating a dangerous "triple whammy" in patients taking blood pressure (BP) medications, research into complications from cancer regimens, and recent findings about treatment and prevention concerns resulted in kidneys becoming this week's top trending clinical topic. The combination of three drugs — a diuretic; a renin-angiotensin system inhibitor, such as an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker; and a nonsteroidal anti-inflammatory drug (NSAID) — increases the risk for kidney injury. New research has identified the mechanism responsible (see Infographic).

Not all patients who take the "triple whammy" combination develop kidney problems. To better understand the mechanism responsible for injury, researchers used computational models to gauge interactions. Their simulations suggested that low water intake, the myogenic response, and drug sensitivity may predispose certain patients to develop triple whammy–induced acute kidney injury. Without these additional risk factors, the risk was not elevated when an ACE inhibitor and NSAID were combined. In contrast, when an ACE inhibitor, diuretic, and NSAID are combined, critical BP and estimated glomerular filtration rate (eGFR) regulatory mechanisms are simultaneously interrupted.

The "triple whammy" isn't the only drug combination that creates kidney concerns. A preprint study that has not yet been peer-reviewed examined which colorectal cancer regimens are most likely to result in acute kidney injury. The most likely culprit was FOLFIRI + bevacizumab. Prognostic factors included older age, low body mass index, and proteinuria at baseline. Across the four included regimens, patients' median eGFR fell from 90.9 mL/min/1.73 m2 at baseline to 80.1 mL/min/1.73 m2 at 12 months. Median 12-month eGFR among the 97 patients receiving FOLFIRI + bevacizumab fell the most, to 74.9 mL/min/1.73 m2. Incidence of acute kidney disease was lowest among patients treated with FOLFOX + cetuximab (2.1%) and highest among those who received FOLFIRI + bevacizumab (19.2%).

In more encouraging kidney news, a recent study found that risks are low for donors. According to what is believed to be the largest study to date to examine the risks associated with living kidney donation via hand-assisted laparoscopic nephrectomy, the overall rate of complications was lower than that reported in some larger databases. Among 3002 living kidney donor nephrectomies, the overall complication rate was 12.4% (n = 371). Most were an infection or hernia related to the incision. The incidence of major complications was 2.5% (n = 74). Of these, 15 were intraoperative, 12 were postoperative to discharge, and 47 occurred after discharge to day 120 (all were reoperations, of which 46 were related to incisional issues).

Not all kidney treatment-related news is as positive. A qualitative study recently found that Black veterans who have chronic kidney disease (CKD) report emotional and physical stress caused by racism in the medical setting. Researchers interviewed 36 Black veterans with CKD who were receiving care at the Corporal Michael J. Crescenz Veterans Affairs Medical Center. The mean age of participants was 66 years, and men comprised 97% of the study group. The qualitative data showed that Black veterans experienced physiologic symptoms (eg, headaches) and psychological symptoms of hurt and anger. They also felt a need to be hypervigilant during medical visits, which may be indicative of posttraumatic stress disorder.

Outside of medical facilities, certain interventions may be beneficial in slowing kidney function decline. According to an analysis of randomized clinical trials, a structured moderate-intensity physical activity and strength/flexibility program in older adults (mean age, about 79 years) benefited kidneys. The program resulted in a statistically significantly lower decline in eGFR rate per cystatin C (eGFRCysC) compared with health education alone (mean difference, 0.96 mL/min/1.73 m2) and lower odds of rapid eGFRCysC decline (odds ratio, 0.79). Patients in the intervention arm underwent a structured, 2-year, partially supervised, moderate-intensity physical activity and exercise (strength and flexibility). Those in the health-education control arm attended weekly workshops.

From insights into a "triple whammy" to key findings related to treatments and interventions, various kidney-related news resulted in this week's top trending clinical topic.

Learn more about acute kidney injury.

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