A Nephrology On-Demand publication. Visit us on Twitter @nephOnDemand or on the web @ goo.gl/mfziXG to learn more.

The Nephrology On-Demand Plus App keeps you connected w/ all the latest teaching resources. Download the newest version @ goo.gl/tfSAQT (iOS) or goo.gl/R1S4nE (Android).

Contributors: A Bansal (U of Pennsylvania) | P Dedhia (U of Cincinnati) | A Elebiary (Lahey Clinic) | X Vela (U of El Salvador) | D Thomson (ECU) | P Jawa (ECU) | S Sridharan (Lister Hospital, UK) | F Iannuzsella (IRCCS, Italy) | D Mitema (Johns Hopkins U) | Malvinder Parmar (Northern Ontario, Canada) | Wisit Cheungpasitporn (Mayo)

#KidneyKONNECTION

Issue 6 Volume 2 Year 2015

URL http://goo.gl/QDSB5B

Editor: Tejas Desai | Chief: Tushar Vachharajani | Free subscription by @ https: / / goo.gl/ PTVJuo

THE ANSWERS ISSUE

So in the case of Mr Merritt, we would have given him enough ESA to keep his hemoglobin between 9-10: well below what most male athletes would be at.

Q: What causes the bleeding diathesis in ESRD patients? Is it platelet dysfunction or VWF deficiency?

This was a board question yesterday (August 2015).

Thanks. I hope I passed!!

A: There are two reasons: Two

1. Platelet dysfunction

2. Anemia ? causing loss of normal laminar flow

Take a look at the schematic below from NEJM 2014:847

Q: Hello! A resident asked how hemodialysis affects CRP and ESR levels. They have patient w/ osteomyelitis & wanted to check levels but the patient received dialysis before the lab draw.

Q: I remember a USA athlete winning the bronze in 110m in Beijing, but with GFR< 20ml/min. He must have been on EPO, right? In these cases is EPO allowed?

A: I believe you are referring to Aries Merritt at the 2015 World championships in China. Indeed he will be receiving a kidney transplant firm his relative after the completion of the Games.

In our practice we use ESAs to maintain hemoglobin levels between 10-11 g/dL in those receiving renal replacement and 9-10 g/dL in those who are pre-ESRD. We reached these target values based on the TREAT trial results and extrapolating those results to pre-ESRD patients.

It's that time of the year again. As we conclude another successful year it's time to review some of our most popular questions asked on the Nephrology On-Demand Forums. These questions, just like the answers, are from medical students, residents, fellows, and patients. You can read these and other questions, as well as ask your own, by visiting https://muut.com/nephrologyondemand

Aries Merritt at the 2012 London Olympic Games posing with his gold medal in the 110 m hurdles

A: We received a lot of different answers for this question

A1: Why are they checking CRP and ESR levels in a patient with osteomyelitis?. These levels are non-specific and it is important to remember the CKD/ESRD is a chronic inflammatory state; so levels are highly variable.

Not sure how reliable it would be to check these levels in ESRD patients because levels are variable as this study showed: ncbi.nlm.nih.gov/pubmed/15504945

A2: The model shows the hazard ratio of death for three predictor variable (age, male gender, and BMI) in a 24-month follow-up study. As noted, hazard ratios for age and BMI are statistically significant (because their 95% confidence intervals do not cross 1.00). A hazard ratio of more than 1 signifies increased risk and a ratio of less than 1 implies reduced risk. In the model shown, for every 1-year increase in age, there is 3.2% increase in the risk of death. Similarly, for each 1-unit (kg/m2) increase in BMI, there is 6.3% reduction in risk of death.

As you can see, survival analyses are an essential part of biomedical statistics. You?ve probably come across them in the medical literature; hopefully you have a better handle on how to interpret the results. It is important to familiarize oneself with the basic concepts of this analysis to interpret and critically analyze the published literature.