Nephrology

Behavioral therapy with pelvic floor muscle exercises, strategies to prevent stress and urge leakage, fluid management, and self-monitoring using bladder diaries decreases episodes of postprostatectomy incontinence by half, according to a Jan. 12 report in JAMA.

In what researchers described as the first randomized, controlled trial of behavioral therapy involving men with incontinence persisting more than 1 year after radical prostatectomy, the intervention also improved symptoms of frequency, urgency, and nocturia; lessened the impact of incontinence on daily activities; and improved incontinence-specific quality of life, compared with a control condition, said Dr. Patricia S. Goode of the Department of Veterans Affairs Birmingham-Atlanta Geriatric Research, Education, and Clinical Center, and her associates.

Adding biofeedback training and pelvic floor electrical stimulation did not improve on the results compared with the behavioral intervention alone, they noted.

In the multicenter trial, 70 patients were randomly assigned to receive the behavioral intervention alone, 70 to receive the behavioral intervention plus biofeedback and pelvic floor electrical stimulation, and 68 were assigned to a control group. A total of 176 subjects completed the 8-week intervention and were followed-up at 6 months and 1 year.

The behavioral therapy entailed four office visits at 2-week intervals with a physician or nurse practitioner. Patients were instructed in using anal palpation and in pelvic floor muscle exercises that they were to practice in three daily sessions at home. They were given a handout to guide management of fluid intake, with attention to distributing fluid consumption throughout the day.

Patients with stress incontinence were taught to contract the pelvic floor muscles just before and after activities that caused leakage, such as coughing or lifting. Patients with urge incontinence were taught to stay still rather than rushing to a toilet when urinary urgency occurred and to contract the pelvic floor muscles repeatedly until the urgency abated, when they could then walk to a bathroom at a normal pace.

All the intervention patients kept daily bladder diaries and exercise logs through the 8-week therapy, which they discussed with caregivers at office visits.

Patients in the "behavior plus" group received this intervention plus in-office biofeedback to help them isolate the pelvic floor muscles. They also were instructed in daily home use of electrical stimulation of the pelvic floor muscles using an anal probe for 15-minute sessions.

Patients in the control group kept daily bladder diaries and discussed urinary incontinence at office visits every 2 weeks, to control for the effects of self-monitoring, clinic visits, and attention from clinic staff.

The primary outcome measure was the reduction in the number of incontinence episodes cited in the patient diaries at 8 weeks. Patients who received behavioral therapy alone showed a mean reduction of 55%, from 28 episodes to 13 per week. Those in the "behavior plus" group showed a similar 51% reduction, from 26 to 12 episodes per week.

This reflects a significantly greater decrease than the 24% reduction, from 25 to 20 episodes per week, reported in the control group, Dr. Goode and her colleagues said (JAMA 2011;305:151-9).

About 16% of the men who received behavioral therapy and 17% of those who received behavioral therapy plus biofeedback and electrical stimulation achieved complete urinary continence, compared with less than 6% of the control group.

Similarly, men in both active-treatment groups showed significant improvement on measures of quality of life and impact of incontinence on daily activities, while those in the control group did not. Men in both active-treatment groups also reported decreases in urinary frequency, urgency, and nocturia, while those in the control group did not.

Ninety percent of men in both active-treatment groups described their urinary leakage as "better" or "much better," compared with only 10% of the control group. Similarly, 47% of the men in both treatment groups said they were completely satisfied with their improvements. Episodes of urinary leakage were "extremely disturbing" to only 4% of the men who received active treatment, compared with 18% of the control group.

The men in both active treatment groups also were more likely to report that they needed fewer pads or diapers than before therapy (42%-55%), compared with only 5% of the control group.

The improvements in both active treatment groups largely persisted throughout the 1-year follow-up period.

Since biofeedback and electrical stimulation of the pelvic floor yielded no additive benefit, they don’t appear to be useful for postprostatectomy urinary incontinence. Dropping these techniques from the regimen will make behavioral therapy more practical and less costly, the investigators noted.

"Many of the participants in our trial reported that they had tried pelvic floor muscle exercises after their surgery, but had stopped when they failed to improve sufficiently." In contrast, more than 80% of the men in the active treatment groups continued to adhere to the exercise and bladder control strategies for months after this behavioral intervention, most likely because they perceived greater improvement.

The study findings clearly show that behavioral therapy should be offered to all men with persistent postprostatectomy urinary incontinence "because it can yield significant durable improvement in incontinence and quality of life, even years after radical prostatectomy," Dr. Goode and her associates noted.

They added that two good resources for locating qualified behavioral therapy in such patients are the National Association for Continence and the Wound, Ostomy, and Continence Nurses Society.

This study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases and the Department of Veterans Affairs Birmingham-Atlanta Geriatric Research, Education, and Clinical Center. Dr. Goode reported receiving a research grant from Pfizer. Her associates reported ties to Astellas, GlaxoSmithKline, Vantia, Boehringer-Ingelheim, Ferring, Johnson & Johnson, Allergan, Indevus, and Novartis.

Behavioral therapy with pelvic floor muscle exercises, strategies to prevent stress and urge leakage, fluid management, and self-monitoring using bladder diaries decreases episodes of postprostatectomy incontinence by half, according to a Jan. 12 report in JAMA.

In what researchers described as the first randomized, controlled trial of behavioral therapy involving men with incontinence persisting more than 1 year after radical prostatectomy, the intervention also improved symptoms of frequency, urgency, and nocturia; lessened the impact of incontinence on daily activities; and improved incontinence-specific quality of life, compared with a control condition, said Dr. Patricia S. Goode of the Department of Veterans Affairs Birmingham-Atlanta Geriatric Research, Education, and Clinical Center, and her associates.

Adding biofeedback training and pelvic floor electrical stimulation did not improve on the results compared with the behavioral intervention alone, they noted.

In the multicenter trial, 70 patients were randomly assigned to receive the behavioral intervention alone, 70 to receive the behavioral intervention plus biofeedback and pelvic floor electrical stimulation, and 68 were assigned to a control group. A total of 176 subjects completed the 8-week intervention and were followed-up at 6 months and 1 year.

The behavioral therapy entailed four office visits at 2-week intervals with a physician or nurse practitioner. Patients were instructed in using anal palpation and in pelvic floor muscle exercises that they were to practice in three daily sessions at home. They were given a handout to guide management of fluid intake, with attention to distributing fluid consumption throughout the day.

Patients with stress incontinence were taught to contract the pelvic floor muscles just before and after activities that caused leakage, such as coughing or lifting. Patients with urge incontinence were taught to stay still rather than rushing to a toilet when urinary urgency occurred and to contract the pelvic floor muscles repeatedly until the urgency abated, when they could then walk to a bathroom at a normal pace.

All the intervention patients kept daily bladder diaries and exercise logs through the 8-week therapy, which they discussed with caregivers at office visits.

Patients in the "behavior plus" group received this intervention plus in-office biofeedback to help them isolate the pelvic floor muscles. They also were instructed in daily home use of electrical stimulation of the pelvic floor muscles using an anal probe for 15-minute sessions.

Patients in the control group kept daily bladder diaries and discussed urinary incontinence at office visits every 2 weeks, to control for the effects of self-monitoring, clinic visits, and attention from clinic staff.

The primary outcome measure was the reduction in the number of incontinence episodes cited in the patient diaries at 8 weeks. Patients who received behavioral therapy alone showed a mean reduction of 55%, from 28 episodes to 13 per week. Those in the "behavior plus" group showed a similar 51% reduction, from 26 to 12 episodes per week.

This reflects a significantly greater decrease than the 24% reduction, from 25 to 20 episodes per week, reported in the control group, Dr. Goode and her colleagues said (JAMA 2011;305:151-9).

About 16% of the men who received behavioral therapy and 17% of those who received behavioral therapy plus biofeedback and electrical stimulation achieved complete urinary continence, compared with less than 6% of the control group.

Similarly, men in both active-treatment groups showed significant improvement on measures of quality of life and impact of incontinence on daily activities, while those in the control group did not. Men in both active-treatment groups also reported decreases in urinary frequency, urgency, and nocturia, while those in the control group did not.

Ninety percent of men in both active-treatment groups described their urinary leakage as "better" or "much better," compared with only 10% of the control group. Similarly, 47% of the men in both treatment groups said they were completely satisfied with their improvements. Episodes of urinary leakage were "extremely disturbing" to only 4% of the men who received active treatment, compared with 18% of the control group.

The men in both active treatment groups also were more likely to report that they needed fewer pads or diapers than before therapy (42%-55%), compared with only 5% of the control group.

The improvements in both active treatment groups largely persisted throughout the 1-year follow-up period.

Since biofeedback and electrical stimulation of the pelvic floor yielded no additive benefit, they don’t appear to be useful for postprostatectomy urinary incontinence. Dropping these techniques from the regimen will make behavioral therapy more practical and less costly, the investigators noted.

"Many of the participants in our trial reported that they had tried pelvic floor muscle exercises after their surgery, but had stopped when they failed to improve sufficiently." In contrast, more than 80% of the men in the active treatment groups continued to adhere to the exercise and bladder control strategies for months after this behavioral intervention, most likely because they perceived greater improvement.

The study findings clearly show that behavioral therapy should be offered to all men with persistent postprostatectomy urinary incontinence "because it can yield significant durable improvement in incontinence and quality of life, even years after radical prostatectomy," Dr. Goode and her associates noted.

They added that two good resources for locating qualified behavioral therapy in such patients are the National Association for Continence and the Wound, Ostomy, and Continence Nurses Society.

This study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases and the Department of Veterans Affairs Birmingham-Atlanta Geriatric Research, Education, and Clinical Center. Dr. Goode reported receiving a research grant from Pfizer. Her associates reported ties to Astellas, GlaxoSmithKline, Vantia, Boehringer-Ingelheim, Ferring, Johnson & Johnson, Allergan, Indevus, and Novartis.

Behavioral therapy with pelvic floor muscle exercises, strategies to prevent stress and urge leakage, fluid management, and self-monitoring using bladder diaries decreases episodes of postprostatectomy incontinence by half, according to a Jan. 12 report in JAMA.

In what researchers described as the first randomized, controlled trial of behavioral therapy involving men with incontinence persisting more than 1 year after radical prostatectomy, the intervention also improved symptoms of frequency, urgency, and nocturia; lessened the impact of incontinence on daily activities; and improved incontinence-specific quality of life, compared with a control condition, said Dr. Patricia S. Goode of the Department of Veterans Affairs Birmingham-Atlanta Geriatric Research, Education, and Clinical Center, and her associates.

Adding biofeedback training and pelvic floor electrical stimulation did not improve on the results compared with the behavioral intervention alone, they noted.

In the multicenter trial, 70 patients were randomly assigned to receive the behavioral intervention alone, 70 to receive the behavioral intervention plus biofeedback and pelvic floor electrical stimulation, and 68 were assigned to a control group. A total of 176 subjects completed the 8-week intervention and were followed-up at 6 months and 1 year.

The behavioral therapy entailed four office visits at 2-week intervals with a physician or nurse practitioner. Patients were instructed in using anal palpation and in pelvic floor muscle exercises that they were to practice in three daily sessions at home. They were given a handout to guide management of fluid intake, with attention to distributing fluid consumption throughout the day.

Patients with stress incontinence were taught to contract the pelvic floor muscles just before and after activities that caused leakage, such as coughing or lifting. Patients with urge incontinence were taught to stay still rather than rushing to a toilet when urinary urgency occurred and to contract the pelvic floor muscles repeatedly until the urgency abated, when they could then walk to a bathroom at a normal pace.

All the intervention patients kept daily bladder diaries and exercise logs through the 8-week therapy, which they discussed with caregivers at office visits.

Patients in the "behavior plus" group received this intervention plus in-office biofeedback to help them isolate the pelvic floor muscles. They also were instructed in daily home use of electrical stimulation of the pelvic floor muscles using an anal probe for 15-minute sessions.

Patients in the control group kept daily bladder diaries and discussed urinary incontinence at office visits every 2 weeks, to control for the effects of self-monitoring, clinic visits, and attention from clinic staff.

The primary outcome measure was the reduction in the number of incontinence episodes cited in the patient diaries at 8 weeks. Patients who received behavioral therapy alone showed a mean reduction of 55%, from 28 episodes to 13 per week. Those in the "behavior plus" group showed a similar 51% reduction, from 26 to 12 episodes per week.

This reflects a significantly greater decrease than the 24% reduction, from 25 to 20 episodes per week, reported in the control group, Dr. Goode and her colleagues said (JAMA 2011;305:151-9).

About 16% of the men who received behavioral therapy and 17% of those who received behavioral therapy plus biofeedback and electrical stimulation achieved complete urinary continence, compared with less than 6% of the control group.

Similarly, men in both active-treatment groups showed significant improvement on measures of quality of life and impact of incontinence on daily activities, while those in the control group did not. Men in both active-treatment groups also reported decreases in urinary frequency, urgency, and nocturia, while those in the control group did not.

Ninety percent of men in both active-treatment groups described their urinary leakage as "better" or "much better," compared with only 10% of the control group. Similarly, 47% of the men in both treatment groups said they were completely satisfied with their improvements. Episodes of urinary leakage were "extremely disturbing" to only 4% of the men who received active treatment, compared with 18% of the control group.

The men in both active treatment groups also were more likely to report that they needed fewer pads or diapers than before therapy (42%-55%), compared with only 5% of the control group.

The improvements in both active treatment groups largely persisted throughout the 1-year follow-up period.

Since biofeedback and electrical stimulation of the pelvic floor yielded no additive benefit, they don’t appear to be useful for postprostatectomy urinary incontinence. Dropping these techniques from the regimen will make behavioral therapy more practical and less costly, the investigators noted.

"Many of the participants in our trial reported that they had tried pelvic floor muscle exercises after their surgery, but had stopped when they failed to improve sufficiently." In contrast, more than 80% of the men in the active treatment groups continued to adhere to the exercise and bladder control strategies for months after this behavioral intervention, most likely because they perceived greater improvement.

The study findings clearly show that behavioral therapy should be offered to all men with persistent postprostatectomy urinary incontinence "because it can yield significant durable improvement in incontinence and quality of life, even years after radical prostatectomy," Dr. Goode and her associates noted.

They added that two good resources for locating qualified behavioral therapy in such patients are the National Association for Continence and the Wound, Ostomy, and Continence Nurses Society.

This study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases and the Department of Veterans Affairs Birmingham-Atlanta Geriatric Research, Education, and Clinical Center. Dr. Goode reported receiving a research grant from Pfizer. Her associates reported ties to Astellas, GlaxoSmithKline, Vantia, Boehringer-Ingelheim, Ferring, Johnson & Johnson, Allergan, Indevus, and Novartis.

DENVER – When patients with stage 3 chronic kidney disease develop anemia, they have a worse clinical course, according to results of a multicenter study in Spain.

"Anemia is a very complicated cardiovascular risk factor. It appears early in many (chronic kidney disease) patients, especially in the diabetic population," Dr. Alberto M. Castelao said in an interview during a poster session at the annual meeting of the American Society of Nephrology.

He and his associates evaluated data from 431 patients aged 18-78 years who were enrolled in the Study of Non-Anaemic Stage 3 CKD Patients Who Develop Renal Anaemia (NADIR-3), an epidemiologic, prospective, 3-year trial conducted at 27 centers in Spain. At baseline, the patients had a mean estimated glomerular filtration rate of 30-59 mL/min per 1.73m2 without anemia. They were followed every 6 months until they started renal replacement therapy or died.

If anemia occurred, the researchers conducted a diagnostic study to rule out causes not related to chronic kidney disease. In women, anemia was defined as a hemoglobin of less than 11.5 g/dL. In men, anemia was defined as a hemoglobin of less than 13.5 g/dL in those aged younger than 70 years and a level of less than 12.0 g/dL in men aged 70 and older.

Dr. Castelao, a nephrologist who practices in Bellvitge, Spain, reported that the mean age of the 431 patients was 63 years and 70% were male. Nearly one-third (30%) developed anemia – 85% from a renal cause – over the time period. The probability of developing anemia was 10% at 1 year, 20% at 2 years, and 26% at 3 years. The mean time to onset of anemia was 35 months.

Compared to patients without anemia, those who developed anemia had lower baseline estimated glomerular filtration rate (35.9 mL/min per 1.73m2 vs. 40.0 mL/min per 1.73m2, respectively), greater baseline proteinuria (0.94 g/day vs. 0.62 g/day), lower albumin (4.1 g/dL vs. 4.3 g/dL), greater reduction of estimated glomerular filtration rate (6.8 mL/min per 1.73m2 vs. 1.6 mL/min per 1.73m2 at 3 years), earlier progression to stage 4 CKD (18 months vs. 28 months), and greater rate of major cardiovascular events (16.1% vs. 6.9%), hospitalization (33.7% vs. 19.4%), and mortality (10.3% vs. 6.6%). All differences between the two groups were statistically significant.

"If we can stop anemia early, perhaps we can stabilize the renal function," Dr. Castelao said.

The study was sponsored by the Spanish Group for the Study of Diabetic Nephropathy. It received financial support from Amgen. Dr. Castelao said that he had no relevant financial disclosures.

DENVER – When patients with stage 3 chronic kidney disease develop anemia, they have a worse clinical course, according to results of a multicenter study in Spain.

"Anemia is a very complicated cardiovascular risk factor. It appears early in many (chronic kidney disease) patients, especially in the diabetic population," Dr. Alberto M. Castelao said in an interview during a poster session at the annual meeting of the American Society of Nephrology.

He and his associates evaluated data from 431 patients aged 18-78 years who were enrolled in the Study of Non-Anaemic Stage 3 CKD Patients Who Develop Renal Anaemia (NADIR-3), an epidemiologic, prospective, 3-year trial conducted at 27 centers in Spain. At baseline, the patients had a mean estimated glomerular filtration rate of 30-59 mL/min per 1.73m2 without anemia. They were followed every 6 months until they started renal replacement therapy or died.

If anemia occurred, the researchers conducted a diagnostic study to rule out causes not related to chronic kidney disease. In women, anemia was defined as a hemoglobin of less than 11.5 g/dL. In men, anemia was defined as a hemoglobin of less than 13.5 g/dL in those aged younger than 70 years and a level of less than 12.0 g/dL in men aged 70 and older.

Dr. Castelao, a nephrologist who practices in Bellvitge, Spain, reported that the mean age of the 431 patients was 63 years and 70% were male. Nearly one-third (30%) developed anemia – 85% from a renal cause – over the time period. The probability of developing anemia was 10% at 1 year, 20% at 2 years, and 26% at 3 years. The mean time to onset of anemia was 35 months.

Compared to patients without anemia, those who developed anemia had lower baseline estimated glomerular filtration rate (35.9 mL/min per 1.73m2 vs. 40.0 mL/min per 1.73m2, respectively), greater baseline proteinuria (0.94 g/day vs. 0.62 g/day), lower albumin (4.1 g/dL vs. 4.3 g/dL), greater reduction of estimated glomerular filtration rate (6.8 mL/min per 1.73m2 vs. 1.6 mL/min per 1.73m2 at 3 years), earlier progression to stage 4 CKD (18 months vs. 28 months), and greater rate of major cardiovascular events (16.1% vs. 6.9%), hospitalization (33.7% vs. 19.4%), and mortality (10.3% vs. 6.6%). All differences between the two groups were statistically significant.

"If we can stop anemia early, perhaps we can stabilize the renal function," Dr. Castelao said.

The study was sponsored by the Spanish Group for the Study of Diabetic Nephropathy. It received financial support from Amgen. Dr. Castelao said that he had no relevant financial disclosures.

DENVER – When patients with stage 3 chronic kidney disease develop anemia, they have a worse clinical course, according to results of a multicenter study in Spain.

"Anemia is a very complicated cardiovascular risk factor. It appears early in many (chronic kidney disease) patients, especially in the diabetic population," Dr. Alberto M. Castelao said in an interview during a poster session at the annual meeting of the American Society of Nephrology.

He and his associates evaluated data from 431 patients aged 18-78 years who were enrolled in the Study of Non-Anaemic Stage 3 CKD Patients Who Develop Renal Anaemia (NADIR-3), an epidemiologic, prospective, 3-year trial conducted at 27 centers in Spain. At baseline, the patients had a mean estimated glomerular filtration rate of 30-59 mL/min per 1.73m2 without anemia. They were followed every 6 months until they started renal replacement therapy or died.

If anemia occurred, the researchers conducted a diagnostic study to rule out causes not related to chronic kidney disease. In women, anemia was defined as a hemoglobin of less than 11.5 g/dL. In men, anemia was defined as a hemoglobin of less than 13.5 g/dL in those aged younger than 70 years and a level of less than 12.0 g/dL in men aged 70 and older.

Dr. Castelao, a nephrologist who practices in Bellvitge, Spain, reported that the mean age of the 431 patients was 63 years and 70% were male. Nearly one-third (30%) developed anemia – 85% from a renal cause – over the time period. The probability of developing anemia was 10% at 1 year, 20% at 2 years, and 26% at 3 years. The mean time to onset of anemia was 35 months.

Compared to patients without anemia, those who developed anemia had lower baseline estimated glomerular filtration rate (35.9 mL/min per 1.73m2 vs. 40.0 mL/min per 1.73m2, respectively), greater baseline proteinuria (0.94 g/day vs. 0.62 g/day), lower albumin (4.1 g/dL vs. 4.3 g/dL), greater reduction of estimated glomerular filtration rate (6.8 mL/min per 1.73m2 vs. 1.6 mL/min per 1.73m2 at 3 years), earlier progression to stage 4 CKD (18 months vs. 28 months), and greater rate of major cardiovascular events (16.1% vs. 6.9%), hospitalization (33.7% vs. 19.4%), and mortality (10.3% vs. 6.6%). All differences between the two groups were statistically significant.

"If we can stop anemia early, perhaps we can stabilize the renal function," Dr. Castelao said.

The study was sponsored by the Spanish Group for the Study of Diabetic Nephropathy. It received financial support from Amgen. Dr. Castelao said that he had no relevant financial disclosures.

DENVER – When patients with stage 3 chronic kidney disease develop anemia, they have a worse clinical course, according to results of a multicenter study in Spain.

"Anemia is a very complicated cardiovascular risk factor. It appears early in many (chronic kidney disease) patients, especially in the diabetic population," Dr. Alberto M. Castelao said in an interview during a poster session at the annual meeting of the American Society of Nephrology.

He and his associates evaluated data from 431 patients aged 18-78 years who were enrolled in the Study of Non-Anaemic Stage 3 CKD Patients Who Develop Renal Anaemia (NADIR-3), an epidemiologic, prospective, 3-year trial conducted at 27 centers in Spain. At baseline, the patients had a mean estimated glomerular filtration rate of 30-59 mL/min per 1.73m2 without anemia. They were followed every 6 months until they started renal replacement therapy or died.

If anemia occurred, the researchers conducted a diagnostic study to rule out causes not related to chronic kidney disease. In women, anemia was defined as a hemoglobin of less than 11.5 g/dL. In men, anemia was defined as a hemoglobin of less than 13.5 g/dL in those aged younger than 70 years and a level of less than 12.0 g/dL in men aged 70 and older.

Dr. Castelao, a nephrologist who practices in Bellvitge, Spain, reported that the mean age of the 431 patients was 63 years and 70% were male. Nearly one-third (30%) developed anemia – 85% from a renal cause – over the time period. The probability of developing anemia was 10% at 1 year, 20% at 2 years, and 26% at 3 years. The mean time to onset of anemia was 35 months.

Compared to patients without anemia, those who developed anemia had lower baseline estimated glomerular filtration rate (35.9 mL/min per 1.73m2 vs. 40.0 mL/min per 1.73m2, respectively), greater baseline proteinuria (0.94 g/day vs. 0.62 g/day), lower albumin (4.1 g/dL vs. 4.3 g/dL), greater reduction of estimated glomerular filtration rate (6.8 mL/min per 1.73m2 vs. 1.6 mL/min per 1.73m2 at 3 years), earlier progression to stage 4 CKD (18 months vs. 28 months), and greater rate of major cardiovascular events (16.1% vs. 6.9%), hospitalization (33.7% vs. 19.4%), and mortality (10.3% vs. 6.6%). All differences between the two groups were statistically significant.

"If we can stop anemia early, perhaps we can stabilize the renal function," Dr. Castelao said.

The study was sponsored by the Spanish Group for the Study of Diabetic Nephropathy. It received financial support from Amgen. Dr. Castelao said that he had no relevant financial disclosures.

DENVER – When patients with stage 3 chronic kidney disease develop anemia, they have a worse clinical course, according to results of a multicenter study in Spain.

"Anemia is a very complicated cardiovascular risk factor. It appears early in many (chronic kidney disease) patients, especially in the diabetic population," Dr. Alberto M. Castelao said in an interview during a poster session at the annual meeting of the American Society of Nephrology.

He and his associates evaluated data from 431 patients aged 18-78 years who were enrolled in the Study of Non-Anaemic Stage 3 CKD Patients Who Develop Renal Anaemia (NADIR-3), an epidemiologic, prospective, 3-year trial conducted at 27 centers in Spain. At baseline, the patients had a mean estimated glomerular filtration rate of 30-59 mL/min per 1.73m2 without anemia. They were followed every 6 months until they started renal replacement therapy or died.

If anemia occurred, the researchers conducted a diagnostic study to rule out causes not related to chronic kidney disease. In women, anemia was defined as a hemoglobin of less than 11.5 g/dL. In men, anemia was defined as a hemoglobin of less than 13.5 g/dL in those aged younger than 70 years and a level of less than 12.0 g/dL in men aged 70 and older.

Dr. Castelao, a nephrologist who practices in Bellvitge, Spain, reported that the mean age of the 431 patients was 63 years and 70% were male. Nearly one-third (30%) developed anemia – 85% from a renal cause – over the time period. The probability of developing anemia was 10% at 1 year, 20% at 2 years, and 26% at 3 years. The mean time to onset of anemia was 35 months.

Compared to patients without anemia, those who developed anemia had lower baseline estimated glomerular filtration rate (35.9 mL/min per 1.73m2 vs. 40.0 mL/min per 1.73m2, respectively), greater baseline proteinuria (0.94 g/day vs. 0.62 g/day), lower albumin (4.1 g/dL vs. 4.3 g/dL), greater reduction of estimated glomerular filtration rate (6.8 mL/min per 1.73m2 vs. 1.6 mL/min per 1.73m2 at 3 years), earlier progression to stage 4 CKD (18 months vs. 28 months), and greater rate of major cardiovascular events (16.1% vs. 6.9%), hospitalization (33.7% vs. 19.4%), and mortality (10.3% vs. 6.6%). All differences between the two groups were statistically significant.

"If we can stop anemia early, perhaps we can stabilize the renal function," Dr. Castelao said.

The study was sponsored by the Spanish Group for the Study of Diabetic Nephropathy. It received financial support from Amgen. Dr. Castelao said that he had no relevant financial disclosures.

DENVER – When patients with stage 3 chronic kidney disease develop anemia, they have a worse clinical course, according to results of a multicenter study in Spain.

"Anemia is a very complicated cardiovascular risk factor. It appears early in many (chronic kidney disease) patients, especially in the diabetic population," Dr. Alberto M. Castelao said in an interview during a poster session at the annual meeting of the American Society of Nephrology.

He and his associates evaluated data from 431 patients aged 18-78 years who were enrolled in the Study of Non-Anaemic Stage 3 CKD Patients Who Develop Renal Anaemia (NADIR-3), an epidemiologic, prospective, 3-year trial conducted at 27 centers in Spain. At baseline, the patients had a mean estimated glomerular filtration rate of 30-59 mL/min per 1.73m2 without anemia. They were followed every 6 months until they started renal replacement therapy or died.

If anemia occurred, the researchers conducted a diagnostic study to rule out causes not related to chronic kidney disease. In women, anemia was defined as a hemoglobin of less than 11.5 g/dL. In men, anemia was defined as a hemoglobin of less than 13.5 g/dL in those aged younger than 70 years and a level of less than 12.0 g/dL in men aged 70 and older.

Dr. Castelao, a nephrologist who practices in Bellvitge, Spain, reported that the mean age of the 431 patients was 63 years and 70% were male. Nearly one-third (30%) developed anemia – 85% from a renal cause – over the time period. The probability of developing anemia was 10% at 1 year, 20% at 2 years, and 26% at 3 years. The mean time to onset of anemia was 35 months.

Compared to patients without anemia, those who developed anemia had lower baseline estimated glomerular filtration rate (35.9 mL/min per 1.73m2 vs. 40.0 mL/min per 1.73m2, respectively), greater baseline proteinuria (0.94 g/day vs. 0.62 g/day), lower albumin (4.1 g/dL vs. 4.3 g/dL), greater reduction of estimated glomerular filtration rate (6.8 mL/min per 1.73m2 vs. 1.6 mL/min per 1.73m2 at 3 years), earlier progression to stage 4 CKD (18 months vs. 28 months), and greater rate of major cardiovascular events (16.1% vs. 6.9%), hospitalization (33.7% vs. 19.4%), and mortality (10.3% vs. 6.6%). All differences between the two groups were statistically significant.

"If we can stop anemia early, perhaps we can stabilize the renal function," Dr. Castelao said.

The study was sponsored by the Spanish Group for the Study of Diabetic Nephropathy. It received financial support from Amgen. Dr. Castelao said that he had no relevant financial disclosures.

LONDON – Extremely low birth weight infants need extended follow-up for renal problems, according to a 7-year follow-up of Polish children born between 2002 and 2003.

The regional cohort study results show that, at a mean age of 6.7 years, kidney function was not only significantly reduced in extremely-low-birth-weight (ELBW) infants vs. normal-weight control subjects, but that several ELBW children had hypertension.

Furthermore, renal volume was significantly lower in the ELBW children, with 13 (18%) of 72 children having smaller-than-expected kidneys for their age (P = .04).

"Survival rates [among ELBW infants] are now pretty good, so we have an increasing number of school-aged children," the study’s lead author Dr. Przemko Kwinta said in an interview at the Excellence in Paediatrics annual meeting.

"Traditionally we think about the mental development, the motor development, but there’s a lot of risk factors during early life that can also influence the kidney," Dr. Kwinta, head of the department of pediatrics at Jagiellonian University in Krakow, Poland, said. "We think that there are a lot of babies with borderline [renal] function, so maybe it is necessary to introduce some type of prophylaxis."

ELBW during the study was defined as a weight of less than 1,000 g at birth. Of 95 children born in the Malopolska district of Poland between 2002 and 2003, 72 infants had a mean birth weight of 841 g, and 23 had a mean birth weight of 3,559 g.

The mean gestational age of the ELBW and normal-weight infants was 27.3 weeks and 39.9 weeks, respectively, and the mean age at follow-up was 6.7 and 6.9 years.

Mean estimated glomerular filtration (eGFR) rates were significantly lower (94.8 vs. 103.9 mL/min per 1.73 m2; P less than .01) in the ELBW vs. the normal-weight groups, but the mean serum cystatin C level was higher (0.64 vs. 0.57 mg/L; P less than .01) in the ELBW group. However, in all children, both eGFR and cystatin C were within normal ranges.

Hypertension was observed in three (4.1%) of ELBW infants but in none of the normal-weight children (P = .1). Three ELBW children also had microalbuminuria, which was not seen in any child in the control group.

The mean volume of both the left and right kidneys was reduced in the ELBW children vs. the control group, and small kidneys (defined as less than 70% of the predicted size) was detected in 13 ELBW children, but none of the control children (P = .04).

Based on their clinical experience Dr. Kwinta and associates believe that ELBW infants require very close renal follow-up.

"We have to check the renal function, not only after birth or at 1 year, but also after 3, 6, and 7 years because the prevalence of renal problems is quite high," Dr. Kwinta observed. This may help us to recognize the early stages of renal disease so that problems in later life can be prevented.

Further follow-up of the cohort is planned at ages 10 and 11 years.

The Polish Ministry of Science supported the study. Dr. Kwinta said he had no relevant financial disclosures.

LONDON – Extremely low birth weight infants need extended follow-up for renal problems, according to a 7-year follow-up of Polish children born between 2002 and 2003.

The regional cohort study results show that, at a mean age of 6.7 years, kidney function was not only significantly reduced in extremely-low-birth-weight (ELBW) infants vs. normal-weight control subjects, but that several ELBW children had hypertension.

Furthermore, renal volume was significantly lower in the ELBW children, with 13 (18%) of 72 children having smaller-than-expected kidneys for their age (P = .04).

"Survival rates [among ELBW infants] are now pretty good, so we have an increasing number of school-aged children," the study’s lead author Dr. Przemko Kwinta said in an interview at the Excellence in Paediatrics annual meeting.

"Traditionally we think about the mental development, the motor development, but there’s a lot of risk factors during early life that can also influence the kidney," Dr. Kwinta, head of the department of pediatrics at Jagiellonian University in Krakow, Poland, said. "We think that there are a lot of babies with borderline [renal] function, so maybe it is necessary to introduce some type of prophylaxis."

ELBW during the study was defined as a weight of less than 1,000 g at birth. Of 95 children born in the Malopolska district of Poland between 2002 and 2003, 72 infants had a mean birth weight of 841 g, and 23 had a mean birth weight of 3,559 g.

The mean gestational age of the ELBW and normal-weight infants was 27.3 weeks and 39.9 weeks, respectively, and the mean age at follow-up was 6.7 and 6.9 years.

Mean estimated glomerular filtration (eGFR) rates were significantly lower (94.8 vs. 103.9 mL/min per 1.73 m2; P less than .01) in the ELBW vs. the normal-weight groups, but the mean serum cystatin C level was higher (0.64 vs. 0.57 mg/L; P less than .01) in the ELBW group. However, in all children, both eGFR and cystatin C were within normal ranges.

Hypertension was observed in three (4.1%) of ELBW infants but in none of the normal-weight children (P = .1). Three ELBW children also had microalbuminuria, which was not seen in any child in the control group.

The mean volume of both the left and right kidneys was reduced in the ELBW children vs. the control group, and small kidneys (defined as less than 70% of the predicted size) was detected in 13 ELBW children, but none of the control children (P = .04).

Based on their clinical experience Dr. Kwinta and associates believe that ELBW infants require very close renal follow-up.

"We have to check the renal function, not only after birth or at 1 year, but also after 3, 6, and 7 years because the prevalence of renal problems is quite high," Dr. Kwinta observed. This may help us to recognize the early stages of renal disease so that problems in later life can be prevented.

Further follow-up of the cohort is planned at ages 10 and 11 years.

The Polish Ministry of Science supported the study. Dr. Kwinta said he had no relevant financial disclosures.

LONDON – Extremely low birth weight infants need extended follow-up for renal problems, according to a 7-year follow-up of Polish children born between 2002 and 2003.

The regional cohort study results show that, at a mean age of 6.7 years, kidney function was not only significantly reduced in extremely-low-birth-weight (ELBW) infants vs. normal-weight control subjects, but that several ELBW children had hypertension.

Furthermore, renal volume was significantly lower in the ELBW children, with 13 (18%) of 72 children having smaller-than-expected kidneys for their age (P = .04).

"Survival rates [among ELBW infants] are now pretty good, so we have an increasing number of school-aged children," the study’s lead author Dr. Przemko Kwinta said in an interview at the Excellence in Paediatrics annual meeting.

"Traditionally we think about the mental development, the motor development, but there’s a lot of risk factors during early life that can also influence the kidney," Dr. Kwinta, head of the department of pediatrics at Jagiellonian University in Krakow, Poland, said. "We think that there are a lot of babies with borderline [renal] function, so maybe it is necessary to introduce some type of prophylaxis."

ELBW during the study was defined as a weight of less than 1,000 g at birth. Of 95 children born in the Malopolska district of Poland between 2002 and 2003, 72 infants had a mean birth weight of 841 g, and 23 had a mean birth weight of 3,559 g.

The mean gestational age of the ELBW and normal-weight infants was 27.3 weeks and 39.9 weeks, respectively, and the mean age at follow-up was 6.7 and 6.9 years.

Mean estimated glomerular filtration (eGFR) rates were significantly lower (94.8 vs. 103.9 mL/min per 1.73 m2; P less than .01) in the ELBW vs. the normal-weight groups, but the mean serum cystatin C level was higher (0.64 vs. 0.57 mg/L; P less than .01) in the ELBW group. However, in all children, both eGFR and cystatin C were within normal ranges.

Hypertension was observed in three (4.1%) of ELBW infants but in none of the normal-weight children (P = .1). Three ELBW children also had microalbuminuria, which was not seen in any child in the control group.

The mean volume of both the left and right kidneys was reduced in the ELBW children vs. the control group, and small kidneys (defined as less than 70% of the predicted size) was detected in 13 ELBW children, but none of the control children (P = .04).

Based on their clinical experience Dr. Kwinta and associates believe that ELBW infants require very close renal follow-up.

"We have to check the renal function, not only after birth or at 1 year, but also after 3, 6, and 7 years because the prevalence of renal problems is quite high," Dr. Kwinta observed. This may help us to recognize the early stages of renal disease so that problems in later life can be prevented.

Further follow-up of the cohort is planned at ages 10 and 11 years.

The Polish Ministry of Science supported the study. Dr. Kwinta said he had no relevant financial disclosures.

LONDON – Extremely low birth weight infants need extended follow-up for renal problems, according to a 7-year follow-up of Polish children born between 2002 and 2003.

The regional cohort study results show that, at a mean age of 6.7 years, kidney function was not only significantly reduced in extremely-low-birth-weight (ELBW) infants vs. normal-weight control subjects, but that several ELBW children had hypertension.

Furthermore, renal volume was significantly lower in the ELBW children, with 13 (18%) of 72 children having smaller-than-expected kidneys for their age (P = .04).

"Survival rates [among ELBW infants] are now pretty good, so we have an increasing number of school-aged children," the study’s lead author Dr. Przemko Kwinta said in an interview at the Excellence in Paediatrics annual meeting.

"Traditionally we think about the mental development, the motor development, but there’s a lot of risk factors during early life that can also influence the kidney," Dr. Kwinta, head of the department of pediatrics at Jagiellonian University in Krakow, Poland, said. "We think that there are a lot of babies with borderline [renal] function, so maybe it is necessary to introduce some type of prophylaxis."

ELBW during the study was defined as a weight of less than 1,000 g at birth. Of 95 children born in the Malopolska district of Poland between 2002 and 2003, 72 infants had a mean birth weight of 841 g, and 23 had a mean birth weight of 3,559 g.

The mean gestational age of the ELBW and normal-weight infants was 27.3 weeks and 39.9 weeks, respectively, and the mean age at follow-up was 6.7 and 6.9 years.

Mean estimated glomerular filtration (eGFR) rates were significantly lower (94.8 vs. 103.9 mL/min per 1.73 m2; P less than .01) in the ELBW vs. the normal-weight groups, but the mean serum cystatin C level was higher (0.64 vs. 0.57 mg/L; P less than .01) in the ELBW group. However, in all children, both eGFR and cystatin C were within normal ranges.

Hypertension was observed in three (4.1%) of ELBW infants but in none of the normal-weight children (P = .1). Three ELBW children also had microalbuminuria, which was not seen in any child in the control group.

The mean volume of both the left and right kidneys was reduced in the ELBW children vs. the control group, and small kidneys (defined as less than 70% of the predicted size) was detected in 13 ELBW children, but none of the control children (P = .04).

Based on their clinical experience Dr. Kwinta and associates believe that ELBW infants require very close renal follow-up.

"We have to check the renal function, not only after birth or at 1 year, but also after 3, 6, and 7 years because the prevalence of renal problems is quite high," Dr. Kwinta observed. This may help us to recognize the early stages of renal disease so that problems in later life can be prevented.

Further follow-up of the cohort is planned at ages 10 and 11 years.

The Polish Ministry of Science supported the study. Dr. Kwinta said he had no relevant financial disclosures.

LONDON – Extremely low birth weight infants need extended follow-up for renal problems, according to a 7-year follow-up of Polish children born between 2002 and 2003.

The regional cohort study results show that, at a mean age of 6.7 years, kidney function was not only significantly reduced in extremely-low-birth-weight (ELBW) infants vs. normal-weight control subjects, but that several ELBW children had hypertension.

Furthermore, renal volume was significantly lower in the ELBW children, with 13 (18%) of 72 children having smaller-than-expected kidneys for their age (P = .04).

"Survival rates [among ELBW infants] are now pretty good, so we have an increasing number of school-aged children," the study’s lead author Dr. Przemko Kwinta said in an interview at the Excellence in Paediatrics annual meeting.

"Traditionally we think about the mental development, the motor development, but there’s a lot of risk factors during early life that can also influence the kidney," Dr. Kwinta, head of the department of pediatrics at Jagiellonian University in Krakow, Poland, said. "We think that there are a lot of babies with borderline [renal] function, so maybe it is necessary to introduce some type of prophylaxis."

ELBW during the study was defined as a weight of less than 1,000 g at birth. Of 95 children born in the Malopolska district of Poland between 2002 and 2003, 72 infants had a mean birth weight of 841 g, and 23 had a mean birth weight of 3,559 g.

The mean gestational age of the ELBW and normal-weight infants was 27.3 weeks and 39.9 weeks, respectively, and the mean age at follow-up was 6.7 and 6.9 years.

Mean estimated glomerular filtration (eGFR) rates were significantly lower (94.8 vs. 103.9 mL/min per 1.73 m2; P less than .01) in the ELBW vs. the normal-weight groups, but the mean serum cystatin C level was higher (0.64 vs. 0.57 mg/L; P less than .01) in the ELBW group. However, in all children, both eGFR and cystatin C were within normal ranges.

Hypertension was observed in three (4.1%) of ELBW infants but in none of the normal-weight children (P = .1). Three ELBW children also had microalbuminuria, which was not seen in any child in the control group.

The mean volume of both the left and right kidneys was reduced in the ELBW children vs. the control group, and small kidneys (defined as less than 70% of the predicted size) was detected in 13 ELBW children, but none of the control children (P = .04).

Based on their clinical experience Dr. Kwinta and associates believe that ELBW infants require very close renal follow-up.

"We have to check the renal function, not only after birth or at 1 year, but also after 3, 6, and 7 years because the prevalence of renal problems is quite high," Dr. Kwinta observed. This may help us to recognize the early stages of renal disease so that problems in later life can be prevented.

Further follow-up of the cohort is planned at ages 10 and 11 years.

The Polish Ministry of Science supported the study. Dr. Kwinta said he had no relevant financial disclosures.

LONDON – Extremely low birth weight infants need extended follow-up for renal problems, according to a 7-year follow-up of Polish children born between 2002 and 2003.

The regional cohort study results show that, at a mean age of 6.7 years, kidney function was not only significantly reduced in extremely-low-birth-weight (ELBW) infants vs. normal-weight control subjects, but that several ELBW children had hypertension.

Furthermore, renal volume was significantly lower in the ELBW children, with 13 (18%) of 72 children having smaller-than-expected kidneys for their age (P = .04).

"Survival rates [among ELBW infants] are now pretty good, so we have an increasing number of school-aged children," the study’s lead author Dr. Przemko Kwinta said in an interview at the Excellence in Paediatrics annual meeting.

"Traditionally we think about the mental development, the motor development, but there’s a lot of risk factors during early life that can also influence the kidney," Dr. Kwinta, head of the department of pediatrics at Jagiellonian University in Krakow, Poland, said. "We think that there are a lot of babies with borderline [renal] function, so maybe it is necessary to introduce some type of prophylaxis."

ELBW during the study was defined as a weight of less than 1,000 g at birth. Of 95 children born in the Malopolska district of Poland between 2002 and 2003, 72 infants had a mean birth weight of 841 g, and 23 had a mean birth weight of 3,559 g.

The mean gestational age of the ELBW and normal-weight infants was 27.3 weeks and 39.9 weeks, respectively, and the mean age at follow-up was 6.7 and 6.9 years.

Mean estimated glomerular filtration (eGFR) rates were significantly lower (94.8 vs. 103.9 mL/min per 1.73 m2; P less than .01) in the ELBW vs. the normal-weight groups, but the mean serum cystatin C level was higher (0.64 vs. 0.57 mg/L; P less than .01) in the ELBW group. However, in all children, both eGFR and cystatin C were within normal ranges.

Hypertension was observed in three (4.1%) of ELBW infants but in none of the normal-weight children (P = .1). Three ELBW children also had microalbuminuria, which was not seen in any child in the control group.

The mean volume of both the left and right kidneys was reduced in the ELBW children vs. the control group, and small kidneys (defined as less than 70% of the predicted size) was detected in 13 ELBW children, but none of the control children (P = .04).

Based on their clinical experience Dr. Kwinta and associates believe that ELBW infants require very close renal follow-up.

"We have to check the renal function, not only after birth or at 1 year, but also after 3, 6, and 7 years because the prevalence of renal problems is quite high," Dr. Kwinta observed. This may help us to recognize the early stages of renal disease so that problems in later life can be prevented.

Further follow-up of the cohort is planned at ages 10 and 11 years.

The Polish Ministry of Science supported the study. Dr. Kwinta said he had no relevant financial disclosures.

DENVER – Interleukin18 appears to reliably predict the need for renal replacement therapy in patients who develop acute kidney injury after cardiac surgery, according to results from a multicenter study.

While a number of biomarkers have been identified that may prove useful in determining which patients with acute kidney injury will require renal replacement therapy – especially proteins associated with inflammation, signaling, and tubular injury – these markers have not been compared and validated in a large group of patients with the condition.

Only about 10% of patients with acute kidney injury will go on to require dialysis, explained Dr. John M. Arthur of the division of nephrology at the Medical University of South Carolina, Charleston. "What we’re trying to do is figure out a test that clinicians could do in their hospitals that would help them determine which patients are likely to go on to require dialysis," he said at the annual meeting of the American Society of Nephrology. "That’s something that we don’t have right now. We’re still not there yet, but this is bringing us closer."

He presented results from a study of urine samples from 117 patients who developed at least stage 1 acute kidney injury after undergoing cardiac surgery at the Medical University of South Carolina; Duke University, Durham, N.C.; George Washington University, Washington; and the University of Tennessee, Memphis. The patients were assessed for an increase in serum creatinine of 50% or 0.3 mg/dL. The primary outcome measure was the requirement for renal replacement therapy.

Of the 117 patients, 11 required renal replacement therapy and 106 did not. Both groups were similar in gender (71% male among those who did not require renal replacement vs. 73% among those who did); age (a mean of 64 vs. 68 years, respectively); race (23% vs. 9% African American), proportion on bypass (85% vs. 73%); bypass time (2.47 hours vs. 2.36 hours), preoperative serum creatinine (1.2 vs. 1.3 mg/dL), and time of urine collection after surgery (1.4 days vs. 1.8 days).

Compared with their counterparts who did not undergo renal replacement therapy, those who did had significantly higher levels of serum creatinine at the time of collection (1.9 vs. 2.7 mg/dL) as well as mortality (3.80% vs. 72.70%).

Using a receiver operator characteristics area under the curve analysis, which is an indicator for the predictive quality of the marker, the researchers found that several markers significantly predicted the need for renal replacement therapy, including IL-18, vascular cell adhesion molecule (VCAM), N-acetyl-beta-D-glucosaminidase (NAG), IL-6, and liver-type fatty acid binding protein (L-FABP).

IL-18 was the strongest marker to predict the association, with an area under the curve of 0.86 and a positive predictive value of 60%, which Dr. Arthur said is good enough to help select patients for clinical trials in acute kidney injury.

He noted that a study of at least 1,000 patients is needed to confirm the findings.

Dr. Arthur said that he had no relevant financial conflicts to disclose. The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases and by a VA Merit award.

DENVER – Interleukin18 appears to reliably predict the need for renal replacement therapy in patients who develop acute kidney injury after cardiac surgery, according to results from a multicenter study.

While a number of biomarkers have been identified that may prove useful in determining which patients with acute kidney injury will require renal replacement therapy – especially proteins associated with inflammation, signaling, and tubular injury – these markers have not been compared and validated in a large group of patients with the condition.

Only about 10% of patients with acute kidney injury will go on to require dialysis, explained Dr. John M. Arthur of the division of nephrology at the Medical University of South Carolina, Charleston. "What we’re trying to do is figure out a test that clinicians could do in their hospitals that would help them determine which patients are likely to go on to require dialysis," he said at the annual meeting of the American Society of Nephrology. "That’s something that we don’t have right now. We’re still not there yet, but this is bringing us closer."

He presented results from a study of urine samples from 117 patients who developed at least stage 1 acute kidney injury after undergoing cardiac surgery at the Medical University of South Carolina; Duke University, Durham, N.C.; George Washington University, Washington; and the University of Tennessee, Memphis. The patients were assessed for an increase in serum creatinine of 50% or 0.3 mg/dL. The primary outcome measure was the requirement for renal replacement therapy.

Of the 117 patients, 11 required renal replacement therapy and 106 did not. Both groups were similar in gender (71% male among those who did not require renal replacement vs. 73% among those who did); age (a mean of 64 vs. 68 years, respectively); race (23% vs. 9% African American), proportion on bypass (85% vs. 73%); bypass time (2.47 hours vs. 2.36 hours), preoperative serum creatinine (1.2 vs. 1.3 mg/dL), and time of urine collection after surgery (1.4 days vs. 1.8 days).

Compared with their counterparts who did not undergo renal replacement therapy, those who did had significantly higher levels of serum creatinine at the time of collection (1.9 vs. 2.7 mg/dL) as well as mortality (3.80% vs. 72.70%).

Using a receiver operator characteristics area under the curve analysis, which is an indicator for the predictive quality of the marker, the researchers found that several markers significantly predicted the need for renal replacement therapy, including IL-18, vascular cell adhesion molecule (VCAM), N-acetyl-beta-D-glucosaminidase (NAG), IL-6, and liver-type fatty acid binding protein (L-FABP).

IL-18 was the strongest marker to predict the association, with an area under the curve of 0.86 and a positive predictive value of 60%, which Dr. Arthur said is good enough to help select patients for clinical trials in acute kidney injury.

He noted that a study of at least 1,000 patients is needed to confirm the findings.

Dr. Arthur said that he had no relevant financial conflicts to disclose. The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases and by a VA Merit award.

DENVER – Interleukin18 appears to reliably predict the need for renal replacement therapy in patients who develop acute kidney injury after cardiac surgery, according to results from a multicenter study.

While a number of biomarkers have been identified that may prove useful in determining which patients with acute kidney injury will require renal replacement therapy – especially proteins associated with inflammation, signaling, and tubular injury – these markers have not been compared and validated in a large group of patients with the condition.

Only about 10% of patients with acute kidney injury will go on to require dialysis, explained Dr. John M. Arthur of the division of nephrology at the Medical University of South Carolina, Charleston. "What we’re trying to do is figure out a test that clinicians could do in their hospitals that would help them determine which patients are likely to go on to require dialysis," he said at the annual meeting of the American Society of Nephrology. "That’s something that we don’t have right now. We’re still not there yet, but this is bringing us closer."

He presented results from a study of urine samples from 117 patients who developed at least stage 1 acute kidney injury after undergoing cardiac surgery at the Medical University of South Carolina; Duke University, Durham, N.C.; George Washington University, Washington; and the University of Tennessee, Memphis. The patients were assessed for an increase in serum creatinine of 50% or 0.3 mg/dL. The primary outcome measure was the requirement for renal replacement therapy.

Of the 117 patients, 11 required renal replacement therapy and 106 did not. Both groups were similar in gender (71% male among those who did not require renal replacement vs. 73% among those who did); age (a mean of 64 vs. 68 years, respectively); race (23% vs. 9% African American), proportion on bypass (85% vs. 73%); bypass time (2.47 hours vs. 2.36 hours), preoperative serum creatinine (1.2 vs. 1.3 mg/dL), and time of urine collection after surgery (1.4 days vs. 1.8 days).

Compared with their counterparts who did not undergo renal replacement therapy, those who did had significantly higher levels of serum creatinine at the time of collection (1.9 vs. 2.7 mg/dL) as well as mortality (3.80% vs. 72.70%).

Using a receiver operator characteristics area under the curve analysis, which is an indicator for the predictive quality of the marker, the researchers found that several markers significantly predicted the need for renal replacement therapy, including IL-18, vascular cell adhesion molecule (VCAM), N-acetyl-beta-D-glucosaminidase (NAG), IL-6, and liver-type fatty acid binding protein (L-FABP).

IL-18 was the strongest marker to predict the association, with an area under the curve of 0.86 and a positive predictive value of 60%, which Dr. Arthur said is good enough to help select patients for clinical trials in acute kidney injury.

He noted that a study of at least 1,000 patients is needed to confirm the findings.

Dr. Arthur said that he had no relevant financial conflicts to disclose. The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases and by a VA Merit award.

DENVER – Interleukin18 appears to reliably predict the need for renal replacement therapy in patients who develop acute kidney injury after cardiac surgery, according to results from a multicenter study.

While a number of biomarkers have been identified that may prove useful in determining which patients with acute kidney injury will require renal replacement therapy – especially proteins associated with inflammation, signaling, and tubular injury – these markers have not been compared and validated in a large group of patients with the condition.

Only about 10% of patients with acute kidney injury will go on to require dialysis, explained Dr. John M. Arthur of the division of nephrology at the Medical University of South Carolina, Charleston. "What we’re trying to do is figure out a test that clinicians could do in their hospitals that would help them determine which patients are likely to go on to require dialysis," he said at the annual meeting of the American Society of Nephrology. "That’s something that we don’t have right now. We’re still not there yet, but this is bringing us closer."

He presented results from a study of urine samples from 117 patients who developed at least stage 1 acute kidney injury after undergoing cardiac surgery at the Medical University of South Carolina; Duke University, Durham, N.C.; George Washington University, Washington; and the University of Tennessee, Memphis. The patients were assessed for an increase in serum creatinine of 50% or 0.3 mg/dL. The primary outcome measure was the requirement for renal replacement therapy.

Of the 117 patients, 11 required renal replacement therapy and 106 did not. Both groups were similar in gender (71% male among those who did not require renal replacement vs. 73% among those who did); age (a mean of 64 vs. 68 years, respectively); race (23% vs. 9% African American), proportion on bypass (85% vs. 73%); bypass time (2.47 hours vs. 2.36 hours), preoperative serum creatinine (1.2 vs. 1.3 mg/dL), and time of urine collection after surgery (1.4 days vs. 1.8 days).

Compared with their counterparts who did not undergo renal replacement therapy, those who did had significantly higher levels of serum creatinine at the time of collection (1.9 vs. 2.7 mg/dL) as well as mortality (3.80% vs. 72.70%).

Using a receiver operator characteristics area under the curve analysis, which is an indicator for the predictive quality of the marker, the researchers found that several markers significantly predicted the need for renal replacement therapy, including IL-18, vascular cell adhesion molecule (VCAM), N-acetyl-beta-D-glucosaminidase (NAG), IL-6, and liver-type fatty acid binding protein (L-FABP).

IL-18 was the strongest marker to predict the association, with an area under the curve of 0.86 and a positive predictive value of 60%, which Dr. Arthur said is good enough to help select patients for clinical trials in acute kidney injury.

He noted that a study of at least 1,000 patients is needed to confirm the findings.

Dr. Arthur said that he had no relevant financial conflicts to disclose. The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases and by a VA Merit award.

DENVER – Interleukin18 appears to reliably predict the need for renal replacement therapy in patients who develop acute kidney injury after cardiac surgery, according to results from a multicenter study.

While a number of biomarkers have been identified that may prove useful in determining which patients with acute kidney injury will require renal replacement therapy – especially proteins associated with inflammation, signaling, and tubular injury – these markers have not been compared and validated in a large group of patients with the condition.

Only about 10% of patients with acute kidney injury will go on to require dialysis, explained Dr. John M. Arthur of the division of nephrology at the Medical University of South Carolina, Charleston. "What we’re trying to do is figure out a test that clinicians could do in their hospitals that would help them determine which patients are likely to go on to require dialysis," he said at the annual meeting of the American Society of Nephrology. "That’s something that we don’t have right now. We’re still not there yet, but this is bringing us closer."

He presented results from a study of urine samples from 117 patients who developed at least stage 1 acute kidney injury after undergoing cardiac surgery at the Medical University of South Carolina; Duke University, Durham, N.C.; George Washington University, Washington; and the University of Tennessee, Memphis. The patients were assessed for an increase in serum creatinine of 50% or 0.3 mg/dL. The primary outcome measure was the requirement for renal replacement therapy.

Of the 117 patients, 11 required renal replacement therapy and 106 did not. Both groups were similar in gender (71% male among those who did not require renal replacement vs. 73% among those who did); age (a mean of 64 vs. 68 years, respectively); race (23% vs. 9% African American), proportion on bypass (85% vs. 73%); bypass time (2.47 hours vs. 2.36 hours), preoperative serum creatinine (1.2 vs. 1.3 mg/dL), and time of urine collection after surgery (1.4 days vs. 1.8 days).

Compared with their counterparts who did not undergo renal replacement therapy, those who did had significantly higher levels of serum creatinine at the time of collection (1.9 vs. 2.7 mg/dL) as well as mortality (3.80% vs. 72.70%).

Using a receiver operator characteristics area under the curve analysis, which is an indicator for the predictive quality of the marker, the researchers found that several markers significantly predicted the need for renal replacement therapy, including IL-18, vascular cell adhesion molecule (VCAM), N-acetyl-beta-D-glucosaminidase (NAG), IL-6, and liver-type fatty acid binding protein (L-FABP).

IL-18 was the strongest marker to predict the association, with an area under the curve of 0.86 and a positive predictive value of 60%, which Dr. Arthur said is good enough to help select patients for clinical trials in acute kidney injury.

He noted that a study of at least 1,000 patients is needed to confirm the findings.

Dr. Arthur said that he had no relevant financial conflicts to disclose. The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases and by a VA Merit award.

DENVER – Interleukin18 appears to reliably predict the need for renal replacement therapy in patients who develop acute kidney injury after cardiac surgery, according to results from a multicenter study.

While a number of biomarkers have been identified that may prove useful in determining which patients with acute kidney injury will require renal replacement therapy – especially proteins associated with inflammation, signaling, and tubular injury – these markers have not been compared and validated in a large group of patients with the condition.

Only about 10% of patients with acute kidney injury will go on to require dialysis, explained Dr. John M. Arthur of the division of nephrology at the Medical University of South Carolina, Charleston. "What we’re trying to do is figure out a test that clinicians could do in their hospitals that would help them determine which patients are likely to go on to require dialysis," he said at the annual meeting of the American Society of Nephrology. "That’s something that we don’t have right now. We’re still not there yet, but this is bringing us closer."

He presented results from a study of urine samples from 117 patients who developed at least stage 1 acute kidney injury after undergoing cardiac surgery at the Medical University of South Carolina; Duke University, Durham, N.C.; George Washington University, Washington; and the University of Tennessee, Memphis. The patients were assessed for an increase in serum creatinine of 50% or 0.3 mg/dL. The primary outcome measure was the requirement for renal replacement therapy.

Of the 117 patients, 11 required renal replacement therapy and 106 did not. Both groups were similar in gender (71% male among those who did not require renal replacement vs. 73% among those who did); age (a mean of 64 vs. 68 years, respectively); race (23% vs. 9% African American), proportion on bypass (85% vs. 73%); bypass time (2.47 hours vs. 2.36 hours), preoperative serum creatinine (1.2 vs. 1.3 mg/dL), and time of urine collection after surgery (1.4 days vs. 1.8 days).

Compared with their counterparts who did not undergo renal replacement therapy, those who did had significantly higher levels of serum creatinine at the time of collection (1.9 vs. 2.7 mg/dL) as well as mortality (3.80% vs. 72.70%).

Using a receiver operator characteristics area under the curve analysis, which is an indicator for the predictive quality of the marker, the researchers found that several markers significantly predicted the need for renal replacement therapy, including IL-18, vascular cell adhesion molecule (VCAM), N-acetyl-beta-D-glucosaminidase (NAG), IL-6, and liver-type fatty acid binding protein (L-FABP).

IL-18 was the strongest marker to predict the association, with an area under the curve of 0.86 and a positive predictive value of 60%, which Dr. Arthur said is good enough to help select patients for clinical trials in acute kidney injury.

He noted that a study of at least 1,000 patients is needed to confirm the findings.

Dr. Arthur said that he had no relevant financial conflicts to disclose. The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases and by a VA Merit award.

DENVER – Patients with end-stage renal disease who were admitted to the hospital on a weekend were 17% more likely to die in the hospital than were those who were admitted on a weekday, results from a large retrospective analysis showed.

Poor outcomes related to weekend hospital admission for many acute medical conditions have been described in the medical literature, "but not in patients with end-stage renal disease who are on dialysis," Dr. Ankit Sakhuja said in an interview during a poster session at the annual meeting of the American Society of Nephrology. "This population of dialysis patients is very fragile, because they get admitted much more frequently than the general population who are not on dialysis and they have much poorer outcomes than the general population. It becomes important to see how they do in different settings."

Using the Nationwide Inpatient Sample, Dr. Sakhuja, a third-year internal medicine resident at the Medical College of Wisconsin, Milwaukee, and his associates analyzed data from 836,550 patients with ESRD, aged 18 years and older, who were admitted in 2007. The primary outcomes of interest were all-cause in-hospital mortality and time to hemodialysis.

Of the total, 164,800 (20%) were admitted on a weekend. Dr. Sakhuja reported that roughly 8% of patients admitted on a weekend died in the hospital, compared with 7% of those who were admitted on a weekday, a difference that was statistically significant.

After adjusting for age, gender, race, other medical conditions, and hospital characteristics, the researchers found that patients admitted on a weekend were 17% more likely to die in the hospital compared with their counterparts who were admitted on a weekday. The also found that patients admitted on a weekend experienced delays in the start of dialysis treatment by 0.29 days compared with those who were admitted on weekdays.

"As this is a retrospective study we cannot describe a causal relationship," Dr. Sakhuja commented. "However, unavailability of dialysis facilities over weekends, especially on Sundays, and different staffing patterns over weekends in hospitals could be playing a role. The patients don’t tend to get less sick on the weekends. In fact, the seriousness of disease in patients admitted on weekends is higher."

Dr. Sakhuja said that the findings underscore "the deficiencies in our current model of work in the hospitals where there is limited availability of both number of physicians and other accessory hospital staff and services." He and his colleagues propose shift work and better incentives for hospital staff on the weekends to prevent this phenomenon.

He said that a prospective study is needed to confirm the findings and to determine other factors that affect this weekend effect in patients with ESRD.

Dr. Sakhuja reported having no relevant financial disclosures.

DENVER – Patients with end-stage renal disease who were admitted to the hospital on a weekend were 17% more likely to die in the hospital than were those who were admitted on a weekday, results from a large retrospective analysis showed.

Poor outcomes related to weekend hospital admission for many acute medical conditions have been described in the medical literature, "but not in patients with end-stage renal disease who are on dialysis," Dr. Ankit Sakhuja said in an interview during a poster session at the annual meeting of the American Society of Nephrology. "This population of dialysis patients is very fragile, because they get admitted much more frequently than the general population who are not on dialysis and they have much poorer outcomes than the general population. It becomes important to see how they do in different settings."

Using the Nationwide Inpatient Sample, Dr. Sakhuja, a third-year internal medicine resident at the Medical College of Wisconsin, Milwaukee, and his associates analyzed data from 836,550 patients with ESRD, aged 18 years and older, who were admitted in 2007. The primary outcomes of interest were all-cause in-hospital mortality and time to hemodialysis.

Of the total, 164,800 (20%) were admitted on a weekend. Dr. Sakhuja reported that roughly 8% of patients admitted on a weekend died in the hospital, compared with 7% of those who were admitted on a weekday, a difference that was statistically significant.

After adjusting for age, gender, race, other medical conditions, and hospital characteristics, the researchers found that patients admitted on a weekend were 17% more likely to die in the hospital compared with their counterparts who were admitted on a weekday. The also found that patients admitted on a weekend experienced delays in the start of dialysis treatment by 0.29 days compared with those who were admitted on weekdays.

"As this is a retrospective study we cannot describe a causal relationship," Dr. Sakhuja commented. "However, unavailability of dialysis facilities over weekends, especially on Sundays, and different staffing patterns over weekends in hospitals could be playing a role. The patients don’t tend to get less sick on the weekends. In fact, the seriousness of disease in patients admitted on weekends is higher."

Dr. Sakhuja said that the findings underscore "the deficiencies in our current model of work in the hospitals where there is limited availability of both number of physicians and other accessory hospital staff and services." He and his colleagues propose shift work and better incentives for hospital staff on the weekends to prevent this phenomenon.

He said that a prospective study is needed to confirm the findings and to determine other factors that affect this weekend effect in patients with ESRD.

Dr. Sakhuja reported having no relevant financial disclosures.

DENVER – Patients with end-stage renal disease who were admitted to the hospital on a weekend were 17% more likely to die in the hospital than were those who were admitted on a weekday, results from a large retrospective analysis showed.

Poor outcomes related to weekend hospital admission for many acute medical conditions have been described in the medical literature, "but not in patients with end-stage renal disease who are on dialysis," Dr. Ankit Sakhuja said in an interview during a poster session at the annual meeting of the American Society of Nephrology. "This population of dialysis patients is very fragile, because they get admitted much more frequently than the general population who are not on dialysis and they have much poorer outcomes than the general population. It becomes important to see how they do in different settings."

Using the Nationwide Inpatient Sample, Dr. Sakhuja, a third-year internal medicine resident at the Medical College of Wisconsin, Milwaukee, and his associates analyzed data from 836,550 patients with ESRD, aged 18 years and older, who were admitted in 2007. The primary outcomes of interest were all-cause in-hospital mortality and time to hemodialysis.

Of the total, 164,800 (20%) were admitted on a weekend. Dr. Sakhuja reported that roughly 8% of patients admitted on a weekend died in the hospital, compared with 7% of those who were admitted on a weekday, a difference that was statistically significant.

After adjusting for age, gender, race, other medical conditions, and hospital characteristics, the researchers found that patients admitted on a weekend were 17% more likely to die in the hospital compared with their counterparts who were admitted on a weekday. The also found that patients admitted on a weekend experienced delays in the start of dialysis treatment by 0.29 days compared with those who were admitted on weekdays.

"As this is a retrospective study we cannot describe a causal relationship," Dr. Sakhuja commented. "However, unavailability of dialysis facilities over weekends, especially on Sundays, and different staffing patterns over weekends in hospitals could be playing a role. The patients don’t tend to get less sick on the weekends. In fact, the seriousness of disease in patients admitted on weekends is higher."

Dr. Sakhuja said that the findings underscore "the deficiencies in our current model of work in the hospitals where there is limited availability of both number of physicians and other accessory hospital staff and services." He and his colleagues propose shift work and better incentives for hospital staff on the weekends to prevent this phenomenon.

He said that a prospective study is needed to confirm the findings and to determine other factors that affect this weekend effect in patients with ESRD.

Dr. Sakhuja reported having no relevant financial disclosures.

DENVER – Patients with end-stage renal disease who were admitted to the hospital on a weekend were 17% more likely to die in the hospital than were those who were admitted on a weekday, results from a large retrospective analysis showed.

Poor outcomes related to weekend hospital admission for many acute medical conditions have been described in the medical literature, "but not in patients with end-stage renal disease who are on dialysis," Dr. Ankit Sakhuja said in an interview during a poster session at the annual meeting of the American Society of Nephrology. "This population of dialysis patients is very fragile, because they get admitted much more frequently than the general population who are not on dialysis and they have much poorer outcomes than the general population. It becomes important to see how they do in different settings."

Using the Nationwide Inpatient Sample, Dr. Sakhuja, a third-year internal medicine resident at the Medical College of Wisconsin, Milwaukee, and his associates analyzed data from 836,550 patients with ESRD, aged 18 years and older, who were admitted in 2007. The primary outcomes of interest were all-cause in-hospital mortality and time to hemodialysis.

Of the total, 164,800 (20%) were admitted on a weekend. Dr. Sakhuja reported that roughly 8% of patients admitted on a weekend died in the hospital, compared with 7% of those who were admitted on a weekday, a difference that was statistically significant.

After adjusting for age, gender, race, other medical conditions, and hospital characteristics, the researchers found that patients admitted on a weekend were 17% more likely to die in the hospital compared with their counterparts who were admitted on a weekday. The also found that patients admitted on a weekend experienced delays in the start of dialysis treatment by 0.29 days compared with those who were admitted on weekdays.

"As this is a retrospective study we cannot describe a causal relationship," Dr. Sakhuja commented. "However, unavailability of dialysis facilities over weekends, especially on Sundays, and different staffing patterns over weekends in hospitals could be playing a role. The patients don’t tend to get less sick on the weekends. In fact, the seriousness of disease in patients admitted on weekends is higher."

Dr. Sakhuja said that the findings underscore "the deficiencies in our current model of work in the hospitals where there is limited availability of both number of physicians and other accessory hospital staff and services." He and his colleagues propose shift work and better incentives for hospital staff on the weekends to prevent this phenomenon.

He said that a prospective study is needed to confirm the findings and to determine other factors that affect this weekend effect in patients with ESRD.

Dr. Sakhuja reported having no relevant financial disclosures.

DENVER – Patients with end-stage renal disease who were admitted to the hospital on a weekend were 17% more likely to die in the hospital than were those who were admitted on a weekday, results from a large retrospective analysis showed.

Poor outcomes related to weekend hospital admission for many acute medical conditions have been described in the medical literature, "but not in patients with end-stage renal disease who are on dialysis," Dr. Ankit Sakhuja said in an interview during a poster session at the annual meeting of the American Society of Nephrology. "This population of dialysis patients is very fragile, because they get admitted much more frequently than the general population who are not on dialysis and they have much poorer outcomes than the general population. It becomes important to see how they do in different settings."

Using the Nationwide Inpatient Sample, Dr. Sakhuja, a third-year internal medicine resident at the Medical College of Wisconsin, Milwaukee, and his associates analyzed data from 836,550 patients with ESRD, aged 18 years and older, who were admitted in 2007. The primary outcomes of interest were all-cause in-hospital mortality and time to hemodialysis.

Of the total, 164,800 (20%) were admitted on a weekend. Dr. Sakhuja reported that roughly 8% of patients admitted on a weekend died in the hospital, compared with 7% of those who were admitted on a weekday, a difference that was statistically significant.

After adjusting for age, gender, race, other medical conditions, and hospital characteristics, the researchers found that patients admitted on a weekend were 17% more likely to die in the hospital compared with their counterparts who were admitted on a weekday. The also found that patients admitted on a weekend experienced delays in the start of dialysis treatment by 0.29 days compared with those who were admitted on weekdays.

"As this is a retrospective study we cannot describe a causal relationship," Dr. Sakhuja commented. "However, unavailability of dialysis facilities over weekends, especially on Sundays, and different staffing patterns over weekends in hospitals could be playing a role. The patients don’t tend to get less sick on the weekends. In fact, the seriousness of disease in patients admitted on weekends is higher."

Dr. Sakhuja said that the findings underscore "the deficiencies in our current model of work in the hospitals where there is limited availability of both number of physicians and other accessory hospital staff and services." He and his colleagues propose shift work and better incentives for hospital staff on the weekends to prevent this phenomenon.

He said that a prospective study is needed to confirm the findings and to determine other factors that affect this weekend effect in patients with ESRD.

Dr. Sakhuja reported having no relevant financial disclosures.

DENVER – Patients with end-stage renal disease who were admitted to the hospital on a weekend were 17% more likely to die in the hospital than were those who were admitted on a weekday, results from a large retrospective analysis showed.

Poor outcomes related to weekend hospital admission for many acute medical conditions have been described in the medical literature, "but not in patients with end-stage renal disease who are on dialysis," Dr. Ankit Sakhuja said in an interview during a poster session at the annual meeting of the American Society of Nephrology. "This population of dialysis patients is very fragile, because they get admitted much more frequently than the general population who are not on dialysis and they have much poorer outcomes than the general population. It becomes important to see how they do in different settings."

Using the Nationwide Inpatient Sample, Dr. Sakhuja, a third-year internal medicine resident at the Medical College of Wisconsin, Milwaukee, and his associates analyzed data from 836,550 patients with ESRD, aged 18 years and older, who were admitted in 2007. The primary outcomes of interest were all-cause in-hospital mortality and time to hemodialysis.

Of the total, 164,800 (20%) were admitted on a weekend. Dr. Sakhuja reported that roughly 8% of patients admitted on a weekend died in the hospital, compared with 7% of those who were admitted on a weekday, a difference that was statistically significant.

After adjusting for age, gender, race, other medical conditions, and hospital characteristics, the researchers found that patients admitted on a weekend were 17% more likely to die in the hospital compared with their counterparts who were admitted on a weekday. The also found that patients admitted on a weekend experienced delays in the start of dialysis treatment by 0.29 days compared with those who were admitted on weekdays.

"As this is a retrospective study we cannot describe a causal relationship," Dr. Sakhuja commented. "However, unavailability of dialysis facilities over weekends, especially on Sundays, and different staffing patterns over weekends in hospitals could be playing a role. The patients don’t tend to get less sick on the weekends. In fact, the seriousness of disease in patients admitted on weekends is higher."

Dr. Sakhuja said that the findings underscore "the deficiencies in our current model of work in the hospitals where there is limited availability of both number of physicians and other accessory hospital staff and services." He and his colleagues propose shift work and better incentives for hospital staff on the weekends to prevent this phenomenon.

He said that a prospective study is needed to confirm the findings and to determine other factors that affect this weekend effect in patients with ESRD.

Dr. Sakhuja reported having no relevant financial disclosures.

In this video, Dr. Rebecca Rogers, president of the American Urogynecologic Society, discusses the four main research challenges faced by urogynecology.

In this video, Dr. Rebecca Rogers, president of the American Urogynecologic Society, discusses the four main research challenges faced by urogynecology.

In this video, Dr. Rebecca Rogers, president of the American Urogynecologic Society, discusses the four main research challenges faced by urogynecology.