The edition · Nephrology
Tacrolimus did not differ significantly from mycophenolate in lupus nephritis, and family history of kidney disease is rarely recorded
An Asian multicentre trial found no significant difference in sustained renal response between tacrolimus and mycophenolate over 96 weeks, with a different safety profile. In 1.1 million US primary care records, a family history of CKD was noted in only 5.4% yet was linked to three times the odds of kidney failure.
The edition in brief
In a 96-week Asian multicentre randomised trial of 130 patients with class III/IV lupus nephritis (with or without class V), tacrolimus plus glucocorticoid and mycophenolate plus glucocorticoid gave similar sustained renal response (58.5% vs 69.2%, not significant); tacrolimus caused more acute kidney injury and tremor, while mycophenolate had more treatment-related serious adverse events, serious infections and all three deaths. Across 1,130,961 adults in three US health systems, family history of CKD was recorded in 5.4%, against 39.1% for diabetes, and was associated with CKD (OR 1.39) and kidney failure (OR 3.15). A meta-analysis of 19 trials (1,636 peritoneal dialysis patients) found roxadustat regimens gave haemoglobin about 7.3 g/L higher than ESA regimens, but certainty was low and comparators varied. A meta-analysis of seven studies (742 patients with CKD) found no overall change in eGFR after ureteroscopy or retrograde intrarenal surgery, with very low certainty. The lupus trial is the only randomised evidence today, and it was small for a between-group comparison.
Family history of kidney disease was recorded in one in twenty records but linked to three times the odds of kidney failure
Ask about and record family history of kidney disease, and test relatives of patients with kidney failure.
Roxadustat raised haemoglobin slightly more than ESAs in peritoneal dialysis, on low-certainty evidence
Roxadustat is a reasonable oral alternative to ESAs in peritoneal dialysis, but this evidence does not show it is better.
Ureteroscopy did not worsen kidney function overall in patients with CKD
Ureteroscopy did not reduce kidney function overall in CKD, so indicated stone treatment should not be withheld on that concern alone.
Give patients with CKD written sick-day rules
Give every patient with CKD written sick-day rules naming the drugs to pause during dehydrating illness.
Tacrolimus did not differ significantly from mycophenolate in lupus nephritis, and serious infections were fewer
Consider tacrolimus with glucocorticoid as an alternative to mycophenolate in lupus nephritis when mycophenolate is unsuitable, while mycophenolate remains standard.
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