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UPDATE 2017 CONFERENCES 41. Nephrologisches Seminar 4. Heywood JT, Fonarow GC, Costanzo MR et al.; ADHERE Scientific Advisory Committee and Investigators. High prevalence of renal dysfunction and its impact on outcome in 118,465 patients hospitalized with acute decompensated heart failure: a report from the ADHERE database. J Card Fail 2007; 13(6): 422–30. 5. Damman K, Tang WH, Felker GM et al. Current evidence on treatment of patients with chronic systolic heart failure and renal insufficiency: practical considerations from published data. J Am Coll Cardiol 2014; 63(9): 853–71. 6. Ponikowski P, Voors AA, Anker SD et al.; Authors/Task Force Members. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37(27): 2129–200. 7. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002; 39 (2 Suppl 1): S1–266. 8. Schwenger V, Remppis BA, Westenfeld R et al. [Dialysis and ultrafiltration therapy in patients with cardiorenal syndrome: recommendations of the working group “heart-kidney” of the German Cardiac Society and the German Society of Nephrology]. Dtsch Med Wochenschr 2014; 139(7): e1–8. 9. Elahi M, Asopa S, Pflueger A et al. Acute kidney injury following cardiac surgery: impact of early versus late haemofiltration on morbidity and mortality. Eur J Cardiothorac Surg 2009; 35(5): 854–63. 10. Payen D, de Pont AC, Sakr Y et al. Sepsis Occurrence in Acutely Ill Patients (SOAP) Investigators. A positive fluid balance is associated with a worse outcome in patients with acute renal failure. Crit Care 2008; 12(3): R74. 11. Udani SM, Murray PT. The use of renal replacement therapy in acute decompensated heart failure. Semin Dial 2009; 22(2): 173–9. 12. Costanzo MR, Guglin ME, Saltzberg MT et al.; UNLOAD Trial Investigators. Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. J Am Coll Cardiol 2007; 49(6): 675–83. 13. Bart BA, Goldsmith SR, Lee KL et al.; Heart Failure Clinical Research Network. Ultrafiltration in decompensated heart failure with cardiorenal syndrome. N Engl J Med 2012; 367(24): 2296–304. 14. Costanzo MR, Negoianu D, Jaski BE et al. Aquapheresis versus intravenous diuretics and hospitalizations for heart failure. JACC Heart Fail 2016; 4(2): 95–105. 15. Nakayama M. Nonuremic indication for peritoneal dialysis for refractory heart failure in cardiorenal syndrome type II: review and perspective. Perit Dial Int 2013; 33(1): 8–14. 16. Sánchez JE, Ortega T, Rodríguez C et al. Efficacy of peritoneal ultrafiltration in the treatment of refractory congestive heart failure. Nephrol Dial Transplant 2010; 25(2): 605–10. 17. Núñez J, González M, Miñana G et al. Continuous ambulatory peritoneal dialysis and clinical outcomes in patients with refractory congestive heart failure. Rev Esp Cardiol (Engl Ed) 2012; 65(11): 986–95. 18. Fröhlich H, Katus HA, Täger T et al. Peritoneal ultrafiltration in end-stage chronic heart failure. Clin Kidney J 2015; 8(2): 219–25. 12
NEWS New insights from the COSMOS study High phosphate concentrations are associated with an increased incidence of cardiovascular complications and mortality in the general population and especially in patients with chronic kidney disease (CKD). As the kidney has a key role in phosphate regulation, phosphate homeostasis is disturbed in patients with kidney disease. Many dialysis patients develop hyperphosphataemia, which is associated with poor clinical outcomes as epidemiological data consistently indicate. 12 % mortality reduction, if serum phosphate levels are brought into the target range of 3.6 to 5.2 mg/dL The COSMOS study (Current management of secondary hyperparathyroidism: A multicentre observational study), a 3-year, open cohort, prospective observational study conducted in 6,797 HD patients randomly selected from 227 centres of 20 European countries studied in this analyses the association between reductions in serum phosphate during 6 periods of 6 months and the relative risk of mortality likewise the influence of two days (midweek) and three days (post-weekend) interdialytic period on serum phosphate levels and survival. Associated to better survival The study shows the reduction of serum phosphate (–1.1 mg/dL) from mean serum phosphate values of 6.5 mg/dL towards the COSMOS serum phosphate safest target ranges (3.6 to 5.2 mg/d, in which the lowest mortality risk was observed), was associated with 12 % reduction in the relative risk of mortality. In addition, it shows that the timing of blood withdrawal influences not only serum phosphate levels – significant higher post-weekend (p>0.001) –, but also the association between serum phosphate levels (including their safest ranges) and the lowest risk of mortality, a matter of great importance as the upper levels of the serum phosphate safest ranges are currently used to guide the management of hyperphosphataemia, mainly modifying the phosphate binding agents’ prescription. Prof Jorge Cannata-Andía, (Chairman), and Dr Jose Luis Fernández (Project Manager) of COSMOS said; “For the first time, using a COSMOS analyses which mimics as much as possible what happens in randomized clinical trials, it was found that the reduction of serum phosphorus in dialysis patients may render the expected benefits, as it is associated to better survival.” In addition, the analyses showed that the time of blood withdrawal (related to the extent of the intradialytic period) matters as influences not only serum phosphate but also its association with survival. This aspect should be considered in future guidelines for its important clinical implications. Source: Scientific Press Conference, 54 th ERA-EDTA Congress, June 4, 2017, Madrid CONFERENCES 13
