(Press-News.org) Blood pressure lowering drugs do not improve life expectancy among adults with diabetes and kidney disease, a new study of the global evidence published today in The Lancet reveals.
However, the study, which brings together 157 studies involving more than 43,000 adults with diabetes, shows that angiotensin-converting-enzyme (ACE) inhibitors and angiotensin-receptor blocker (ARB) treatments, alone or in combination, are the most effective drug regimen for preventing end-stage kidney disease -- an important finding given that diabetes is now the leading cause of people starting dialysis.
This finding is important because until now it has not been known whether any available treatment can protect kidney function in the long term, and combination therapy of an ACEi and an ARB has been thought to cause harm.
While treatments in the new study have been shown to help patients, it also shows that any benefits of treatment need to be balanced against potential side-effects. In fact, the study provides a unique opportunity for busy clinicians, who simply cannot read all the literature, to review existing evidence which has been analysed using the highly innovative technology of network meta-analysis. This measures specifically both the benefits and harms of all available treatments and provides a ranking of the most effective interventions.
"In absolute terms, our findings suggest that giving 1000 adults with diabetes and kidney disease a combination of an ACE inhibitor and an ARB for 1 year might prevent 14 patients developing end-stage kidney disease and induce regression of albuminuria in 208, at the cost of 55 patients having acute kidney injury and 135 developing hyperkalemia," says contributing author, Professor Jonathan Craig, a renal physician and professor of clinical epidemiology at the University of Sydney.
In the clinic, this means a careful conversation between doctors and patients, which can be informed by this study.
Senior author, Professor Giovanni Strippoli of the University of Bari, an Adjunct Associate Professor of Epidemiology at the University of Sydney and Chairman of the Diaverum Academy, added: "Although our analysis suggests a somewhat greater efficacy of combination regimens for kidney function outcomes, treatment decisions are ultimately made after consideration of efficacy and safety.
"The study brings together overwhelming numbers of research studies into one place so they can help doctors and patients make confident treatment decisions," says author Associate Professor Suetonia Palmer, a practicing kidney specialist at the University of Otago Christchurch in New Zealand.
"This has been a global team working to convert all the available studies around the world into a single study that can be used by consumers, doctors, and policy makers," she added.
"The findings of our analysis show that differing efficacy of ACEi and ARB alone or in combination has not been proven for mortality and end-stage kidney disease or adverse treatment effects and this is a major challenge for future research," concludes Strippoli.
INFORMATION:
A study by researchers from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King's College London has shown that mood instability occurs in a wide range of mental disorders and is not exclusive to affective conditions such as depression, bipolar disorder and anxiety disorder.
The research, published today in BMJ Open, also found that mood instability was associated with poorer clinical outcomes.
Taken together, these findings suggest that clinicians should screen for mood instability across all common mental health disorders. Targeted interventions ...
BUFFALO, N.Y. - Smokers are four times more likely than non-smokers to become frequent visitors of emergency rooms.
That is one of the findings uncovered by a preliminary study led by Jessica Castner, a University at Buffalo emergency room utilization researcher.
The research - which sought to shed light on whether patients are replacing visits to their primary care physicians with trips to hospital ERs- also found that Americans with chronic diseases use both services equally and that, overall, medical care visits have soared in recent years.
"There are a few super-users ...
Imagine someone hands you a smoothie and asks you to identify everything that went into it.
You might be able to discern a hint of strawberry or the tang of yogurt. But overall it tastes like a blend of indiscernible ingredients.
Now imagine that the smoothie is made of 20,000 ground-up cells from, say, the brain.
You could run tests to determine what molecules are in the sample, which is what scientists do now. That would certainly give you useful information, but it wouldn't tell you which cells those molecules originally came from. It would provide only an average ...
Many people who live in sub-Saharan Africa develop a natural immunity to malaria, through repeated exposure to Plasmodium parasites. Even so, the disease kills close to half a million children per year, according to the World Health Organization.
What factors can interfere with the development of immunity?
Infectious disease researchers at Emory are calling attention to a trouble-maker whose effects may be underappreciated: Epstein-Barr virus (EBV). Their experiments with mice show that co-infection with a virus closely related to EBV can make a survivable malaria parasite ...
Normal skin contains an unexpectedly high number of cancer-associated mutations, according to a study published in Science. The findings illuminate the first steps cells take towards becoming a cancer and demonstrate the value of analysing normal tissue to learn more about the origins of the disease.
The study revealed that each cell in normal facial skin carries many thousands of mutations, mainly caused by exposure to sunlight. In fact, around 25 per cent of skin cells in samples from people without cancer were found to carry at least one cancer-associated mutation. ...
Tropical rainforests have long been considered the Earth's lungs, sequestering large amounts of carbon dioxide from the atmosphere and thereby slowing down the increasing greenhouse effect and associated human-made climate change. Scientists in a global research project now show that the vast extensions of semi-arid landscapes occupying the transition zone between rainforest and desert dominate the ongoing increase in carbon sequestration by ecosystems globally, as well as large fluctuations between wet and dry years. This is a major rearrangement of planetary functions. ...
(SACRAMENTO, Calif.) -- Researchers at UC Davis have conducted a comprehensive study to determine whether pediatric telemedicine consultations with rural emergency departments save money compared to telephone consults. The answer is a resounding yes. While telemedicine systems are expensive to install and maintain, they more than pay their way, saving an average $4,662 per use. The study was published in the journal Medical Decision Making.
"Our previous work showed that telemedicine was good for kids, families and providers, but we didn't really address the cost issue," ...
Lawrence Livermore researchers have determined that a tunnel bomb explosion by Syrian rebels was less than 60 tons as claimed by sources.
Using seismic stations in Turkey, Livermore scientists Michael Pasyanos and Sean Ford created a method to determine source characteristics of near earth surface explosions. They found the above-ground tunnel bomb blast under the Wadi al-Deif Army Base near Aleppo last spring was likely not as large as originally estimated and was closer to 40 tons.
Seismology has long been used to determine the source characteristics of underground ...
This news release is available in French. Montreal, May 21, 2015 - A new study published by the team of Naguib Mechawar, Ph.D., a researcher at the Douglas Institute (CIUSSS de l'Ouest-de-l'île-de-Montréal) and Associate Professor in the Department of Psychiatry at McGill University, suggests that the integration of new neurons in the adult brain is a phenomenon more generally compromised in the brains of depressed patients.
This new work confirms that neurogenesis in the human olfactory bulb is a marginal phenomenon in adults. These findings shed light ...
Alexandria, VA - In the years following the 1986 Chernobyl nuclear disaster, forest fires billowed plumes of contaminated smoke, carrying radioactive particles throughout Europe on the wind. Now, researchers fear that a shift to a hotter, drier climate in Eastern Europe could increase the frequency of these fires.
Researchers from the University of South Carolina in Columbia used satellite imagery of fires in the 2000s and field measurements of radioisotope levels to model changes in the distribution of radiation over the region. The researchers found that fires likely ...
