Action Points

Gout is independently associated with both chronic kidney disease (CKD) and kidney stones, and patients with gout should be screened for CKD to offset CKD-related risks, a meta-analysis indicates.

In a systematic review and meta-analysis of epidemiological studies, the pooled prevalence estimate of CKD stage ?3 was 24% (95% CI 19%-28%), and self-reported kidney stones was 14% (95% CI 12%-17%) among individuals with gout compared with those without gout.

Furthermore, after adjustment for confounding variables, people with gout were more than twice as likely to have CKD ?3 at an odds ratio (OR) of 2.41 (95% CI 1.86-3.11).

Data from three studies were pooled to provide a prevalence estimate of CKD?4 of 2% (95% CI 0%-4%) in the setting of gout versus non-gout.

Patients with gout were also over 1.5 times more likely at an OR of 1.77 to ever have had kidney stones as those who do not have gout.

After adjusting for age, sex, diabetes, and hypertension, gout was also an independent risk factor for incident end-stage renal disease (ESRD) at a hazard ratio (HR) of 1.57 based on one study.

"To our knowledge, this is the first meta-analysis of associations between gout and CKD/nephrolithiasis," Matthew Roughley, MD, Keele University, Keele, Staffordshire, and colleagues report in Arthritis Research and Therapy.

"The main clinical implications of our findings are that patients with gout should be screened for CKD and that clinicians should be made aware of the associations between gout and CKD/nephrolithiasis."

Seventeen studies were included in the meta-analysis: seven in CKD; eight on kidney stones, and two studies which included both CKD and kidney stones.

Six studies provided suitable data to allow the investigators to ascertain the pooled prevalence of CKD stage ?3 in individuals with gout.

Four studies provided suitable data to calculate a pooled age and gender-adjusted OR of 1.87 (95% CI 1.25-2.80) between those with gout and the risk of nephrolithiasis.

As investigators note, previous epidemiological studies have shown that CKD is an independent risk factor for gout.

Yet renal damage can result from comorbid hypertension and diabetes, hyperuricemia-mediated endothelial dysfunction, and renovascular disease along with the use of NSAIDs, suggesting there are plausible mechanisms by which gout might predispose to CKD, they add.

"Inflammation in gout is increasingly recognized to persist in the intercritical period between acute attacks," the authors write, "raising the possibility that inflammatory mechanisms contribute to vascular risk, as has been proposed for other inflammatory arthropathies."

As with any systematic review, findings are dependent upon the size and the quality of the published literature, and only a small number of studies had examined the potential association between CKD or kidney stones and gout.

The small number of published studies thus raises the possibility of publication bias.

The majority of the studies included in the meta-analysis were also not designed with the primary aim of assessing the association between gout and CKD and kidney stones, the authors add.

Several studies also did not include control groups without gout and only reported the prevalence of CKD and kidney stones in gout but not the strength of association between the two.

There were also few prospective studies on the risk of CKD and kidney stones in gout so investigators could not draw firm conclusions about temporal aspects of these potential associations.

"Unless sought for, CDK usually progresses subclinically until reaching more advanced stages," investigators concluded.

"In view of this ... a presentation with gout in primary care should be viewed as a 'red flag' for CKD and should prompt screening for and treatment of both CKD and its associated risk factors such as hypertension and diabetes mellitus, which are also risk factors for gout."

Current national and international guidelines regarding CKD and nephrolithiasis do not recognize gout as a risk factor for these conditions.

As a consequence, only one in five people presenting to primary care with acute gout are screened for CKD within a month of presentation.

The authors declared they did not receive any support from any company for the work submitted, nor did they have any relationships with companies that might have an interest in the submitted work.

• Reviewed by F. Perry Wilson, MD, MSCE Assistant Professor, Section of Nephrology, Yale School of Medicine

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London, UK (PRWEB) April 06, 2015

Market Publishers Ltd is happy to inform that in-demand research reports worked out by GlobalData have been recently uploaded to its catalogue.

Global Planned Refining Industry Outlook to 2019 - Capacity and Capital Expenditure Forecasts with Details of All Planned Refineries. The research publication elaborated by the company provides a comprehensive overview of the global planned crude oil refining market. The report contains detailed information on refinery capital expenditures at global and regional levels (by year and by key countries). Furthermore, the study suggests future outlook for the global planned refining market along with a set of forecasts up to 2019. Besides, operator information for all planned refineries globally is included. The report investigates recent developments and analyzes the latest tenders and contracts in the market.

Refining Industry Outlook in South America, Central America and Caribbean to 2019 - Capacity and Capital Expenditure Forecasts with Details of All Operating and Planned Refineries. This in-demand research study offers a complete description of the crude oil refining industry in South America, Central America and Caribbean. The report includes data on refinery name, country and refinery operator name; provides information on crude distillation unit, CDU capacity and other major unit capacities for all active and planned refineries in South America, Central America and Caribbean. Growth segments and opportunities within the market are thoroughly scrutinized, including historical performance during 2009-2014 and forecasts up to 2019.

Refining Industry Outlook in Middle East and Africa to 2019 - Capacity and Capital Expenditure Forecasts with Details of All Operating and Planned Refineries. The study delves into the crude oil refining market in the Middle East and Africa. The report gives forecasts for the Middle East and Africa crude oil refining markets up to 2019. Moreover, the research report examines the key factors driving and restraining the market growth in Middle East and Africa. Additionally, the report offers data on refining, FCC, hydrocracking and coking capacities on the basis of refinery and country. This research publication also includes an in-depth analysis of the major trends, an overview of the leading project participants by value and by sector.

End-Stage Kidney Disease (end-stage renal disease or ESRD) Global Clinical Trials Review, H1, 2015. The research report includes data on the clinical trial scenario of the end-stage kidney disease. The study covers disease clinical trials by their phase, trial status and prominence of the sponsors. Moreover, the publication was elaborated on the basis of data and information sourced from proprietary databases, including primary and secondary research. Furthermore, the study suggests data on the number of clinical trials conducted globally and on top five national contributors. The list of suspended, withdrawn and terminated trials is provided in the report as well.

More comprehensive reports by the publisher can be found at GlobalData page.

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In May 2014, a 56-year-old man arrived in the emergency department at the veterans' hospital in Little Rock, Arkansas. He reported intense but vague symptoms: weakness, fatigue, and body aches. The emergency-room team drew some of his blood and found it bursting with a waste chemical called creatinine—more than four times the normal level. That meant he was experiencing severe kidney failure. Doctors started urgent dialysis, cycling the blood out of the man's body, through a machine that cleaned it in lieu of functional kidneys.

The University of Arkansas physicians who managed the case were perplexed, they report in the current issue of The New England Journal of Medicine. What causes an otherwise healthy person to develop such dramatic renal failure? Another clue initially confused the picture: Urine tests found oxalate crystals at more than twice the upper limit of normal. When they show up in those quantities, doctors are taught to ask if the person has been drinking antifreeze, because ethylene glycol can cause oxalate crystals to accumulate. This man denied drinking antifreeze—as people who drink antifreeze tend to do. But the doctors didn't need to pursue that line because, they report, "on further questioning, the patient admitted to drinking 16 eight-ounce glasses of iced tea daily." And then it made sense.

The man had been brewing the tea at home, and luckily, despite the Southern tradition, it was unsweetened. Black tea constitutes upwards of 80 percent of the tea consumed in the United States, and it is high in oxalate, a chemical that is a metabolic byproduct in many plants. If a person is eating a lot of those plants, regardless of said person's relationship to antifreeze, oxalate can build up in the kidneys and lead to renal failure. In this case, the doctors did a biopsy of the man's kidneys and found oxalate throughout the renal tissue.

"That's what we think was the cause of his kidney failure," nephrologist Umbar Ghaffar said in a local television interview. She and her colleagues extrapolate in the New England Journal, "Oxalate nephropathy may be an underrecognized cause of renal failure," implying that people might be more vigilant in monitoring their oxalate intake. Or, at least, avoiding extremes. Other kidney specialists agree.

“I wouldn't tell people to stop drinking tea,” nephrologist Randy Luciano of the Yale School of Medicine told the Associated Press, attributing the man's renal failure to the fact that his intake constituted "a lot of tea."

"Two to three glasses [of tea] would be considered safe if you are not eating other oxalates," the UCLA nephrologist Ramya Malchira told Medline Plus. "However, if someone were also eating high quantities of high-oxalate foods such as spinach, even two or three glasses could be too much."

I like this case as a reminder of the misguidedness of consumptive extremes, even of something so healthy as tea. People have developed kidney failure from oxalate-rich foods including rhubarb, peanuts, star fruit, and wheat bran. The complication is extremely rare, and can in no way be taken to mean that these foods are categorically unsafe. A rare point of unanimity among nutritionists is that fruits and vegetables are the foundation of healthy diets, even though blueberries, blackberries, and raspberries are high in oxalate and could theoretically cause kidney failure at exorbitant doses.

This is a time of binges and cleanses, all-or-nothing good-or-bad dichotomies in nutrients and food. No saturated fat, or all the saturated fat I want? Eliminate gluten because some people have celiac disease? Avoid a preservative because it can be toxic at extremely high doses? Just because a little bit of something is good doesn't mean a lot is good; just because a lot is bad doesn't mean a little is bad. Vitamin C breaks down to form oxalate in the body, and it has been found to cause oxalate nephropathy at high doses. Of course, without vitamin C, you get scurvy and bleed from your eyes. Hopefully the idea that tea and spinach could kill us, too, is only liberating.

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The Report Acute Renal Failure (ARF) (Acute Kidney Injury) Global Clinical Trials Review, H1, 2015 provides information on pricing, market analysis, shares, forecast, and company profiles for key industry participants. - MarketResearchReports.biz

This press release was orginally distributed by ReleaseWire

Albany, NY -- (ReleaseWire) -- 04/06/2015 -- GlobalData's clinical trial report, Acute Renal Failure (ARF) (Acute Kidney Injury) Global Clinical Trials Review, H1, 2015" provides data on the Acute Renal Failure (ARF) (Acute Kidney Injury) clinical trial scenario. This report provides elemental information and data relating to the clinical trials on Acute Renal Failure (ARF) (Acute Kidney Injury). It includes an overview of the trial numbers and their recruitment status as per the site of trial conduction across the globe. The databook offers a preliminary coverage of disease clinical trials by their phase, trial status, prominence of the sponsors and also provides briefing pertaining to the number of trials for the key drugs for treating Acute Renal Failure (ARF) (Acute Kidney Injury). This report is built using data and information sourced from proprietary databases, primary and secondary research and in-house analysis by GlobalData's team of industry experts.

Note: Certain sections in the report may be removed or altered based on the availability and relevance of data for the indicated disease.

View Full Report
http://www.marketresearchreports.biz/analysis/258270

Scope

- Data on the number of clinical trials conducted in North America, South and Central America, Europe, Middle-East and Africa and Asia-pacific and top five national contributions in each

- Clinical trial (complete and in progress) data by phase, trial status, subjects recruited and sponsor type

- Listings of discontinued trials (suspended, withdrawn and terminated)

Download Sample Copy of this Report
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Reasons to buy

- Understand the dynamics of a particular indication in a condensed manner

- Abridged view of the performance of the trials in terms of their status, recruitment, location, sponsor type and many more

- Obtain discontinued trial listing for trials across the globe

- Espy the commercial landscape of the major Universities / Institutes / Hospitals or Companies

Table of Contents

Table of Contents 2
List of Tables 4
List of Figures 6
Introduction 7
Acute Renal Failure (ARF) (Acute Kidney Injury) 7
Report Guidance 7
Clinical Trials by Region 8
Clinical Trials and Average Enrollment by Country 9
Top Five Countries Contributing to Clinical Trials in Asia-Pacific 11
Top Five Countries Contributing to Clinical Trials in Europe 12
Top Countries Contributing to Clinical Trials in North America 13
Top Countries Contributing to Clinical Trials in Middle East and Africa 14
Top Countries Contributing to Clinical Trials in Central and South America 15
Clinical Trials by G7 Countries: Proportion of Acute Renal Failure (ARF) (Acute Kidney Injury) to Genito Urinary System And Sex Hormones Clinical Trials 16
Clinical Trials by Phase in G7 Countries 17
Clinical Trials in G7 Countries by Trial Status 18
Clinical Trials by E7 Countries: Proportion of Acute Renal Failure (ARF) (Acute Kidney Injury) to Genito Urinary System And Sex Hormones Clinical Trials 19
Clinical Trials by Phase in E7 Countries 20
Clinical Trials in E7 Countries by Trial Status 21
Clinical Trials by Phase 22
In Progress Trials by Phase 23
Clinical Trials by Trial Status 24
Clinical Trials by End Point Status 25

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