Comprehensive lifestyle change can impact health favorably in many domains, from prevention and treatment of various diseases to improved functional status and quality of life. Although habitual behaviors clearly influence chronic kidney disease (CKD), lifestyle change often is not stressed in the clinical setting. The purpose of this review is to provide a critical appraisal of the scientific basis for effects of lifestyle on CKD and practical strategies that promote healthy behaviors. This review begins with a clinical case presentation to provide context for the scientific discussion. Dietary composition of macronutrients, particularly protein intake, is highlighted. Clinical evidence is presented for avoiding protein excess, a contemporary problem in the typical overeating environment of the developed world.
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New England Journal of Medicaine Volume 361:1339-1348, October 1, 2009
Mark B. Landon, M.D., Catherine Y. Spong, M.D., Elizabeth Thom, Ph.D., Marshall W. Carpenter, M.D., Susan M. Ramin, M.D., Brian Casey, M.D., Ronald J. Wapner, M.D., Michael W. Varner, M.D., Dwight J. Rouse, M.D., John M. Thorp, Jr., M.D., Anthony Sciscione, D.O., Patrick Catalano, M.D., Margaret Harper, M.D., George Saade, M.D., Kristine Y. Lain, M.D., Yoram Sorokin, M.D., Alan M. Peaceman, M.D., Jorge E. Tolosa, M.D., M.S.C.E., Garland B. Anderson, M.D.,
ABSTRACT
Background It is uncertain whether treatment of mild gestational diabetes mellitus improves pregnancy outcomes.
Methods Women who were in the 24th to 31st week of gestation and who met the criteria for mild gestational diabetes mellitus (i.e., an abnormal result on an oral glucose-tolerance test but a fasting glucose level below 95 mg per deciliter [5.3 mmol per liter]) were randomly assigned to usual prenatal care (control group) or dietary intervention, self-monitoring of blood glucose, and insulin therapy, if necessary (treatment group). The primary outcome was a composite of stillbirth or perinatal death and neonatal complications, including hyperbilirubinemia, hypoglycemia, hyperinsulinemia, and birth trauma.
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Dr. Michael Ring, recently presented a poster session on behalf of his co-authors: Ken Daratha, Robert Short, Denise Dominik, Lynn Shuler and Katherine Tuttle, for the 2008 American College of Cardiology (ACC) Conference in Chicago, Il. His topic was "Two Year Safety and Revascularization Outcomes Following Coronary Artery Intervention with Bare Metal Stents Versus Strategies of Selective or Predominant Drug Eluting Stents in a Community Setting".
The poster presentation represented the work of their current study completed at Providence Medical Research Center and Sacred Heart Medical Center. The study compared the outcome of individuals who had received a bare metal stent with those who had received drug eluting stents. Patients were tracked for a minimum of 2 years following the placement of the stent, using a regional hospital electronic record.
The current standard-of-care is inadequate to stem the rising tide of kidney failure, cardiovascular disease, and death attributable to diabetic kidney disease (DKD). Improved treatment approaches for DKD are, therefore, urgently needed. In this Practice Point commentary, I discuss a randomized, placebo-controlled clinical trial performed by Parving et al., which evaluated the effects of a renin inhibitor, aliskiren, on albuminuria in patients with type 2 diabetes mellitus and macroalbuminuria. The investigators administered aliskiren combined with losartan, an angiotensin-receptor blocker that represents current standard-of-care treatment for DKD. The primary outcome measure of the study-a 20% reduction in the mean urinary albumin-to-creatinine ratio in aliskiren-treated participants as compared with the placebo group-was achieved after 6 months' treatment. Although aliskiren holds promise, large, long-term studies are necessary to confirm its safety and to demonstrate its beneficial effect on clinical end points before renin inhibition is embraced as the next step forward in the treatment of DKD.
Rodney D. Raabe, MD is the Principal Investigator for a new research trial being conducted at Providence Medical Research Center. This is a trial primarily sponsored by the National Heart, Lung and Blood Institute investigating the treatment of Deep Vein Thrombosis. The name of this trial is:Acute Venous Thrombosis: Thrombosis Removal With Adjunctive Catheter-Directed Thrombolysis (ATTRACT)
Deep vein thrombosis, or DVT, is a blood clot that forms in a vein deep in the body, usually in the leg. Blood clots occur when blood thickens and clumps together. Most deep vein blood clots occur in the lower leg or thigh. They also can occur in other parts of the body.
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For more information about this study use the "study keyword" search box and enter the word ATTRACT.
Current Hypertens Reports 9:393-402, 2007.
Radica Alicic and Katherine R. Tuttle
Background
Evidence from individual trials comparing Mediterranean to low-fat diets to modify cardiovascular risk factors remains preliminary.
Maldanado AQ, Davies NM, Crow SA, Little C, Ojogho ON, Weeks DL. Effects of plasmaphoresis on mycophenolic acid concentrations. Transplantation 91:e3-e4, 2011.
Dr. M. Shane McNevin is the Principal Investigator for several research trials at Providence Sacred Heart Medical Center and Children's Hospital (SHMC). Dr. McNevin is a leading physician at the Providence Continence Center, as well as the program director for the gastrointestinal section of Providence Cancer Center. Board certified in general surgery, along with colon and rectal surgery, he is an expert in the diagnosis, medical management and surgical treatment of colorectal and anal tumors, inflammatory bowel disease and pelvic floor disorders. Dr. McNevin is also highly respected by his peers across the nation. In the last year alone, he has been invited to share his expertise at four major professional conferences.
Dr. Mc Nevin has been selected as an investigator for new treatments for fecal incontinence (FI). These research trials examine the effectiveness and safety of new treatment methods and are being run in only a handful of locations in the United States. Dr. Mc Nevin was chosen as an investigator by the companies sponsoring these trials because he is a leader in the field of colon and rectal surgery. In addition to his work on these ground breaking trials, Dr. McNevin also conducts his own original research through his office at Surgical Specialists of Spokane.
SHMC is currently participating in a research trial for the treatment of FI. This study, sponsored by Torax Medical, Inc., is investigating the safety and effectiveness of a revolutionary new device to treat FI. This is a study being done in only four locations across the United States. Current treatment options for FI are limited. These include standard treatment with sphincteroplasty (surgical repair of the rectal sphincter), bulking agents (adding fiber to the diet), or Radio Frequency delivery to the anal canal which can cause tissue shrinkage and tightening of muscle tissue.
This current study will evaluate a novel device called the Magnetic Anal Sphincter (MAS).The MAS is an implantable device made up of a series of magnetic beads. The beads are attached with little wires to create a "necklace" shape. The device is implanted around the muscles that control continence. The attractive force of the magnetic beads provides additional strength to these muscles.
Saha SA and Tuttle KR. Influence of glycemic control on the development of diabetic cardiovascular and kidney disease. Cardiol Clin 28:497-516,2010.
Diabetes mellitus leads to the development of a host of micro- and macrovascular complications, which collectively lead to substantial morbidity and mortality. Among the microvascular complications of diabetes, diabetic kidney disease is the most common. Macrovascular complications from diabetes lead to a 2- to 4-fold increase in the incidence of cardiovascular disease and up to twice the mortality from cardiovascular causes as compared with nondiabetic individuals. This article discusses the various drug classes used to treat diabetes mellitus, and reviews the current clinical evidence linking glycemic control using these drug classes on diabetic kidney and cardiovascular disease.
Clinical Journal of The American Society of Nephrology 2:631-636, 2007.
Katherine R. Tuttle*, Janet B. McGill, Douglas J. Haney, Toni E. Lin, Pamela W. Anderson; for the PKC-DRS, PKC-DMES, and PKC-DRS 2 Study Groups
In the state of Washington, the Fraternal Order of Eagles have donated thousands of dollars to the Max Baer Heart Fund, which in turn has provided grants to the local heart health programs at area hospitals and health centers. Over the past decade, they have generously supported medical research, first at The Heart Institute of Spokane, then at PMRC. The Eagles have made donations tor research every year beginning in 1998 and continuing today. Funds provided have helped to further research in the fields of heart disease, diabetes, and diabetic kidney disease. Through these generous donations, we have been able to purchase equipment and perform specialized analyses for a number of studies.
PMRC is grateful to the donations from the Spokane Aerie #2, Valley Eagle's Aerie # 3433 and Deer Park Aerie #3564. The Mission of the Eagles, to provide hope and lessen ills, is being well served as we reach beyond what is known in science and medicine.
Longitudinal Relationships among Coronary Artery Calcification, Serum Phosphorus, and Kidney Function
Clinical Journal of the American Society of Nephrology Published ahead of Print November 5, 2009
Katherine R. Tuttle and Robert A. Short
Background and objectives: Coronary artery calcification (CAC) is common in advanced chronic kidney disease (CKD), yet its onset and time course are uncertain. The study objective was to assess longitudinal relationships among CAC, kidney function, and traditional and putative cardiovascular disease (CVD) risk factors.
December 2010 - Volume 53 - Issue 12 - pp 1604-1610
Lehur, Paul-Antoine M.D., Ph.D.; McNevin, Shane M.D.; Buntzen, Steen M.D., Ph.D.; Mellgren, Anders F. M.D., Ph.D.; Laurberg, Soeren M.D., Ph.D.; Madoff, Robert D. M.D.
Podium Abstract Presentation for the American Society of Colon and Rectal Surgeons 2010.
S.Buntzen,P.Lehur, S. McNevin, A. Mellgren, S. Laurberg, R. Madoff.
Purpose: Restoration of adequate sphincter function in case of end-stage fecal incontinence (FI) is still a challenge. We report our initial clinical results following implantation of a novel magnetic anal sphincter (MAS).
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Diabetic kidney disease (DKD) is the leading cause of end-stage renal disease (ESRD), and one of the most prevalent microvascular complications of both type 1 and type 2 diabetes. Additionally, risk of death is increased at all stages of DKD. As early as the microalbuminuric stage, the death rate approaches 20% per year. Therefore, management strategies should address reducing risk of mortality as well as progression to ESRD.
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There are 26 million American adults with Chronic Kidney Disease (CKD). Often there are no symptoms with early kidney disease so most people aren't even aware that they have CKD. Millions of others are not aware that they are at risk. High risk groups include those with diabetes, hypertension and family history of kidney disease.
African Americans, Hispanics, Pacific Islanders, Native Americans and Seniors are also at increased risk. The key to preventing the progression of kidney disease is early detection.
The National Kidney Foundation's Kidney Early Evaluation Program (KEEP®) offers free screening for those with certain risk factors including anyone 18 years and older with high blood pressure, diabetes or a family history of kidney disease. KEEP is designed to raise awareness about kidney disease among high risk individuals and provide free testing and educational information so that kidney disease and its complications can be prevented or delayed.
There are three simple tests that can be done to detect CKD. These tests are: blood pressure check, a urine test for urine albumin (protein in the urine) and a blood test for serum creatinine (a blood protein byproduct).
To help raise awareness, and appreciation for all the vital functions the kidneys perform, the National Kidney Foundation is encouraging Americans to learn more and take steps now to preserve kidney health. March 12 is World Kidney Day, the perfect time to get to know your kidneys and find out if you're at risk.
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