This meta-analysis found vasopressin receptor antagonists are effective at raising serum sodium levels in patients with euvolemic and hypervolemic hyponatremia. Normalization of serum sodium occurred significantly earlier with these agents than without, and were more effective in euvolemic than hypervolemic patients. There was also no increase risk of adverse events or hypernatremia, and no reported demyelination syndromes. Although these agents seem to be still finding their role in clinical medicine, they do appear to be safe and moderately effective based on this meta-analysis (abstract)

In this population-based case-control study of elderly patients on an ACE or ARB, the risk of hyperkalemia-associated hospitalization was 7 times higher for patients with a recent prescription for trimethoprim-sulfamethoxazole, compared to amoxicillin (with no increased risk with other comparator antibiotics), even after matching for age, sex, renal insufficiency, and diabetes. For elderly patients on an ACE or ARB, the risk of hyperkalemia should be considered before being prescribed trimethoprim-sulfamethoxazole (abstract)

In this large trial of patients with end stage kidney disease, patients were randomized to initiation of dialysis at a GFR of 10-14 or GFR of 5-7. Mean time to dialysis initiation was 1.8 months versus 7.4 months, but there was no difference between the groups (after a median of 3.6 years) in death or adverse events (including complications of dialysis). Dialysis initiation can be delayed until the development of symptoms (abstract)

In this observational cohort of 50 critically ill patients with 2009 pandemic H1N1 influenza infection, the incidence of kidney injury and dialysis was 67% and 11%, and mortality was 16%. Renal failure is common in patients with pandemic influenza (abstract).

In this retrospective cohort of 338 patients undergoing emergency PCI for ACS, 28% developed CIN, which was significantly more common in women, those with an LAD lesion, a contrast volume >200cc, or an end-diastolic pulmonary artery pressure > 15mmHg. Mortality in the CIN group was significantly higher than the non-CIN group (10% vs 3%). CIN is common and associated with high mortality post-emergency PCI. Better peri-procedural management is required to reduce the associated morbidity and mortality (abstract)

In this trial of 4038 diabetic patients with chronic kidney disease (not on dialysis) and anemia, patients were randomized to darbepoetin or placebo for a Hb goal of 13 g/dL (with rescue darbepoetin if Hb fell to 9 g/dL in the placebo group). There was no difference between the groups in the primary endpoints (death / cardiovascular event, or death / end stage renal disease), but the darbepoetin group had a higher rate of stroke (hazard ratio 1.92, CI 1.38-2.68). Risks of darbepoetin outweigh the benefits in this patient population (abstract)

In this large cohort of 94,917 patients who received gadolinium-based contrast over an 8 year period, the risk of developing NSF was 1% among hemodialysis patients and 0.8% among renal transplant patients (abstract). Although retrospective, the large cohort study helps to quantify the risk of NSF among patients with significant renal insufficiency.

In this cohort of 3702 nursing home patients who initiated dialysis, 58% had died by 1 year, and only 13% had maintained their pre-dialysis level of function. Although this study did not have a control group, it is still valuable in it’s assessment of the grim prognosis of nursing home patients at the time of initiation of dialysis (abstract)

In this case-control study of dialysis and non-dialysis patients with UGI bleeding, all had endoscopic control of their bleeding, and received 3 days of IV PPI (40mg IV BID), then oral PPI (20mg qday) for 2 months. The rate of re-bleeding at 7 days was about the same in the 2 groups, but between 7-30 days, the dialysis group had significantly higher rates of re-bleeding (10% vs 0%). Higher PPI doses in dialysis patients at discharge may be necessary to reduce the intermediate risk of re-bleeding (abstract).

In this trial of 92 patients with creatinine >1.7 mg/dl undergoing cardiac catheterization, they were randomized to saline hydration, or euvolemic forced diuresis (with saline, mannitol, and furosemide). The forced diuresis group had a significantly higher rate of CIN (50% vs 28%). The same study did a meta-analysis (including 2 other studies with a total of 251 patients) and found the relative risk of harm of forced diuresis (compared to saline hydration) was 2.15 (CI 1.37 to 3.37). Forced diuresis to prevent CIN is harmful (abstract).