Kidney function measures predict risk
REGARDLESS of age, two measures of poor kidney function — low estimated glomerular filtration rate (eGFR) and high albuminuria — are associated with risk of death and end-stage renal disease (ESRD), according to a large collaborative study published in JAMA. The study included more than two million people worldwide, including Australians, with average follow up of 5.8 years. The researchers found that mortality (112 325 deaths) and ESRD (8411 events) risks were higher at lower eGFR and higher albuminuria in every age category. An accompanying editorial said identifying the presence of chronic kidney disease (CKD) and its associated risks was an important first step in improving the lives of patients with CKD. “In this respect, [this study] makes it clear that CKD is a challenge for all ages”, it said.

Oily fish lowers stroke risk
PEOPLE who eat two to four servings of oily fish a week have a moderate but significant 6% lower risk of cerebrovascular disease compared with those eating one or fewer servings, according to a meta-analysis of 38 studies published in the BMJ. The researchers found that the risk reduction rose to 12% for those eating five or more servings a week. However, levels of omega 3 fats in the blood and consumption of fish oil supplements were not significantly associated with reduced risk. The review involved nearly 800 000 people in 15 countries with 34 817 cerebrovascular events recorded. Fish and long chain omega 3 fatty acid consumption was assessed using dietary questionnaires, identifying markers of omega 3 fats in the blood and recording use of fish oil supplements. An accompanying editorial said although it was “reasonable” to advise patients that eating one or two portions of fish a week could reduce the risk of coronary heart disease and stroke, any benefit from supplements was likely to be small. However, patients with additional risk factors such as diabetes might benefit from supplements, the editorial said.

Renal risks for obese kids
OVERWEIGHT and obesity at age 17 years are strongly and positively associated with the incidence of future treated end-stage renal disease (ESRD), although the absolute risk remains low, according to a study of nearly 1.2 million 17-year-olds published in the Archives of Internal Medicine. The study found a substantial association between elevated body mass index (BMI) and non-diabetic ESRD. The research, based on the medical data of 17-yearolds examined for fitness for military service in Israel over a 30-year period, found 874 participants developed treated ESRD, with overweight and obese adolescents having an increased future risk of 6.08 and 13.40 cases per 100 000 person-years, respectively. An accompanying commentary said the strong association between obesity at age 17 years and ESRD many years later underscored the fact that overweight adolescents generally become overweight adults. “Unfortunately, no magic pill can substitute for healthier dietary and exercise habits”, it said.

Drug combo promising for metastases
A COMBINATION of two cancer drugs, lapatinib plus capecitabine, has had similar response rates to whole brain radiotherapy for women with advanced HER2-positive breast cancer whose disease has spread to the brain, according a small Phase II trial published in The Lancet Oncology. Brain tumours shrank by at least 50% in 29 of 44 women with advanced HER2-positive breast cancer using the drug combination. Nine patients experienced at least 80% reduction in tumour size with manageable side effects using the drug combination in the, open-label trial. An accompanying editorial said the findings might already be sufficient to begin treating some women with the drug combination, sparing them from the debilitating neurological side effects of radiotherapy.

Vigilance on antidepressant use
PHYSICIANS and health professionals who care for women with infertility need to be vigilant in questioning patients about antidepressant use, according to the authors of a literature review on the impact of selective serotonin reuptake inhibitor (SSRI) on fertility, pregnancy and neonatal health published in Human Reproduction. The authors said infertile patients with a history of depression and/or who are taking SSRI antidepressants should consider alternatives to antidepressants if considering fertility treatment. The literature review found that SSRI antidepressant use during pregnancy was associated with increased risks of miscarriage, birth defects, preterm birth, newborn behavioural syndrome, persistent pulmonary hypertension of the newborn and possible longer term neurobehavioral effects, with no evidence of improved pregnancy outcomes. “All infertile patients who have a history of depression and/or are currently taking antidepressant medication, and the providers who care for them, need to have a complete understanding of what the literature shows in this area and the importance of investigating alternatives other than medication”, the authors said.

Huntington disappointment
THE antihistamine latrepirdine, which has been trialled for a number of neurodegenerative disorders, is not effective in improving cognition or global function in individuals with mild to moderate Huntington disease (HD), according to the results of a randomised, double-blind, placebo-controlled trial published in Archives of Neurology. The study of 403 patients from research centres in Australia, Europe and North America, found that treatment with latrepirdine for 6 months was safe and well tolerated but did not improve cognition or global function relative to placebo. The study was the largest trial of any drug aimed at improving cognition in HD. The researchers said although the results were disappointing, the trial laid the foundation for the assessment of future treatments aimed at reducing the growing burden of cognitive impairment from HD and related neurodegenerative disorders.

Posted 5 November 2012

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