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Extended-release dipyridamole plus low-dose aspirin (ERDP/ASA) prolongs primary unassisted graft patency of newly created hemodialysis arteriovenous grafts, but the individual contributions of each component are unknown. Here, we analyzed whether use of aspirin at baseline associated with primary unassisted graft patency among participants in a randomized trial that compared ERDP/ASA and placebo in newly created grafts. We used Cox proportional hazards regression, adjusting for prespecified baseline comorbidities and covariates. Of all participants, 43% reported use of aspirin at baseline; of these, 82% remained on nonstudy aspirin (i.e., excluding ERDP/ASA) at 1 year. After 1 year of follow-up, the incidence of primary unassisted patency among participants using aspirin at baseline was 30% (95% CI: 24 to 35%) and among those not using aspirin was 23% (95% CI: 18 to 27%). Use of aspirin at baseline associated with a dose-dependent prolongation of primary unassisted graft patency that approached statistical significance (adjusted HR, 0.83; 95% CI: 0.68 to 1.01; P=0.06). Use of aspirin at baseline did not associate with prolongation of cumulative graft patency or participant survival. In conclusion, use of aspirin associates with a trend toward longer primary unassisted patency of newly placed hemodialysis grafts similar to that observed for ERDP/ASA., (Copyright © 2011 by the American Society of Nephrology)

Background and Objectives: Niacinamide inhibits intestinal sodium/phosphorus transporters and reduces serum phosphorus in open-label studies. A prospective, randomized, double-blind, placebo-controlled crossover trial was performed for assessment of the safety and efficacy of niacinamide., Design, Setting, Participants, & Measurements: Hemodialysis patients with phosphorus levels > or =5.0 mg/dl were randomly assigned to 8 wk of niacinamide or placebo, titrated from 500 to 1500 mg/d. After a 2-wk washout period, patients switched to 8 wk of the alternative therapy. Vitamin D analogs and calcimimetics were held constant; phosphorus binders were not changed unless safety criteria were met., Results: Thirty-three patients successfully completed the trial. Serum phosphorus fell significantly from 6.26 to 5.47 mg/dl with niacinamide but not with placebo (5.85 to 5.98 mg/dl). A concurrent fall in calcium-phosphorus product was seen with niacinamide, whereas serum calcium, intact parathyroid hormone, uric acid, platelet, triglyceride, LDL, and total cholesterol levels remained stable in both arms. Serum HDL levels rose with niacinamide (50 to 61 mg/dl but not with placebo. Adverse effects were similar between both groups. Among patients who were > or =80% compliant, results were similar, although the decrease in serum phosphorus with niacinamide was more pronounced (6.45 to 5.28 mg/dl) and the increase in HDL approached significance (49 to 58 mg/dl)., Conclusions: In hemodialysis patients, niacinamide effectively reduces serum phosphorus when co-administered with binders and results in a potentially advantageous increase in HDL cholesterol. Further study in larger randomized trials and other chronic kidney disease populations is indicated.

The article presents a study seeking to determine whether the drug clopidogrel reduces early failure of hemodialysis fistulas among patients treated with hemodialysis. The design, setting, and participants of the double-blind, placebo controlled trial involving 877 patients with end-stage renal disease or advanced chronic kidney disease are detailed. The main outcomes measured were fistula thrombosis and failure of the fistula to become suitable for dialysis. Researchers conclude that clopidogrel was capable of reducing the frequency of early thrombosis of arteriovenous fistulas, but it failed to increase the proportion of fistulas that became suitable for dialysis.

Klotho plays an important role in the pathogenesis of cardiovascular disease in chronic kidney disease (CKD). Klotho is highly expressed in the kidney and parathyroid glands, but its presence in the vasculature is debated. Renal Klotho is decreased in CKD, but the effect of uremia on Klotho in other tissues is not defined. The effect of vitamin D receptor activator therapy in CKD on the expression of Klotho in various tissues is also in debate. In uremic rats (surgical 5/6th nephrectomy model), we compared 3 months of treatment with and without paricalcitol on Klotho immunostaining in the kidney, parathyroid glands, and aorta. With uremia, Klotho was unchanged in the parathyroid, significantly decreased in the kidney (66%) and the intimal-medial area of the aorta (69%), and significantly increased in the adventitial area of the aorta (67%) compared with controls. Paricalcitol prevented the decrease of Klotho in the kidney, increased expression in the parathyroid (31%), had no effect in the aortic media, but blunted the increase of Klotho in the aortic adventitia. We propose that fibroblasts are responsible for the expression of Klotho in the adventitia. In hyperplastic human parathyroid tissue from uremic patients, Klotho was higher in oxyphil compared with chief cells. Thus, under our conditions of moderate CKD and mild-to-moderate hyperphosphatemia in rats, the differential expression of Klotho and its regulation by paricalcitol in uremia is tissue-dependent. [ABSTRACT FROM AUTHOR]

Vascular calcium deposition in end-stage renal disease occurs commonly, but its relation to cardiovascular risk factors and fetuin-A levels in African Americans is not known. Compliant African American patients who were undergoing hemodialysis (HD; n = 17) agreed to undergo 64-slice multidetector computed tomography for the assessment of coronary artery calcium score (CACS). The relation between traditional cardiovascular risk factors (i.e., age; gender; dialysis vintage; history of diabetes; means of the previous 3 years of weekly predialysis blood pressure values and hemoglobin levels; means of monthly values of calcium, phosphorus, alkaline phosphatase, uric acid; and albumin; and means of quarterly measurements of parathyroid hormone and lipids) and fetuin-A levels and CACS was explored using univariate analyses. Serum phosphorus levels over the previous 3 years were well controlled. The CACS range was 0 to 3,877 Agatston units (mean 996, median 196). Among the tested variables, only fetuin-A was significantly and inversely associated with CACS (standardized β = −0.64, 95% confidence interval −18.09 to −3.62, p = 0.006). There was no association between age and fetuin-A level (standardized β = −0.02, 95% confidence interval −0.10 to 0.23). In conclusion, African-American patients who were undergoing long-term hemodialysis and with good phosphorus control exhibited a strong inverse correlation between fetuin-A level and CACS that was independent of age. [Copyright &y& Elsevier]