Background and objectivesShared decision making in patients with glomerular disease remains challenging because outcomes important to patients remain largely unknown. We aimed to identify and prioritize outcomes important to patients and caregivers and to describe reasons for their choices.Design, setting, participants, & measurementsWe purposively sampled adult patients with glomerular disease and their caregivers from Australia, Hong Kong, the United Kingdom, and the United States. Participants identified, discussed, and ranked outcomes in focus groups using the nominal group technique; a relative importance score (between zero and one) was calculated. Qualitative data were analyzed thematically.ResultsAcross 16 focus groups, 134 participants (range, 19–85 years old; 51% women), including 101 patients and 33 caregivers, identified 58 outcomes. The ten highest-ranked outcomes were kidney function (importance score of 0.42), mortality (0.29), need for dialysis or transplant (0.22), life participation (0.18), fatigue (0.17), anxiety (0.13), family impact (0.12), infection and immunity (0.12), ability to work (0.11), and BP (0.11). Three themes explained the reasons for these rankings: constraining day-to-day experience, impaired agency and control over health, and threats to future health and family.ConclusionsPatients with glomerular disease and their caregivers highly prioritize kidney health and survival, but they also prioritize life participation, fatigue, anxiety, and family impact.

These findings suggest that the severity of proximal renal artery lesions is often unrelated to the severity of renal dysfunction in patients with ARVD. Associated renal parenchymal damage is the more probable arbiter of renal dysfunction, and this should be considered when revascularization procedures are contemplated.

BackgroundCatheter-related bloodstream infections (CRBSI) are associated with increased morbidity and mortality in hemodialysis patients (HD). Cathasept (Tetra-sodium EDTA) solution has antimicrobial and anticoagulant activities. Study DesignMulti-center, prospective, randomized, and controlled study. Setting & Participants117 maintenance HD patients with confirmed uncolonised tunneled hemodialysis catheters (t-HDC) were recruited from four hemodialysis centers. InterventionPatients were randomly assigned to remain on heparin 5000 units/ml locks (Heparin Group -HG) or to receive Cathasept 4% locks (Cathasept Group -CG) thrice weekly according to the catheter lumen volume and were followed up until their catheter was removed or for a maximum of 8 months. OutcomesPrimary outcome was the incidence rate of clinically significant microbial colonization of t-HDC defined as through-catheter quantitative blood culture (TCQBC) yielding ≥1000 CFU/ml of bacteria or yeast. Secondary outcomes included CRBSI rate, catheter patency, and biomarkers of inflammation and anemia. MeasurementsWeekly TCQBC. hs-CRP was measured fortnightly, and FBC and Ferritin monthly. ResultsCatheter colonization rate was 0.14/1000 catheter-days in the CG and 1.08/1000 catheter-days in the HG [Incidence rate ratio (IRR) 0.13; 95% CI, 0.003-0.94; p=0.02]. CRBSI rate was 0.28/1000 catheter-days in the CG and 0.68/1000 catheter 4 days in the HG [IRR 0.40; 95% CI, p=0.3]. The proportion of dialysis sessions with achieved prescribed blood flow rate was significantly lower in the CG (66.8% vs 75.3%; p<0.001), with more patients required thrombolytic locks or infusion to maintain catheter patency (22 vs 9; p=0.01). On average, hs-CRP was 11.6 (SE ±5.3) mg/l lower for patients in the HG (p=0.03). Anemia markers were comparable in both groups. LimitationsThe study was underpowered to assess the effect on CRBSI, was terminated early due to slow recruitment, and was not double-blinded. ConclusionCathasept significantly reduced t-HDC colonization but the reduction in CRBSI was not statistically significant, and it was associated with more thrombotic complications.Its safety profile was comparable to heparin lock solution.

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Proteinuria is well described in atherosclerotic renovascular disease (ARVD), but the prevalence is unknown, and the pathogenesis may vary between patients. Substantial proteinuria (> 2 g/day) however, would be regarded by many as atypical of ARVD. We studied 94 patients (52 male) with ARVD, median age 67 years (range 49-87). Digital subtraction angiography was performed on all patients. Protein was assayed in 24-h urine samples and GFR derived using the Cockroft-Gault formula. Forty-nine patients (52%) had proteinuria < 0.5 g/24 h. Proteinuria increased with worsening renal function. Biopsies from seven non-diabetic patients with substantial proteinuria showed: minimal changes (1); glomerular sclerosis with marked ischaemic changes (3); focal glomerulosclerosis (2); and athero-emboli (1). Proteinuria, rather than being indicative of other pathology, is often a marker of severity of parenchymal disorder in atherosclerotic nephropathy, which itself is the major determinant of renal dysfunction in patients with ARVD.