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Contributors: A Bansal (U of Pennsylvania) | P Dedhia

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

I ssue 6

Volume 2

Year 2015

URL http://goo.gl/QDSB5B

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

THE ANSWERS ISSUE

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

Q: I remember a USA athlete

winning the bronze in 110m in
Beijing, but with GFR< 20ml/min.
He must have been on EPO, right?
In these cases is EPO allowed?
A: I believe you are referring to
Aries Merritt at the 2015 World
championships in China. Indeed he
will be receiving a kidney
transplant firm his relative after the
completion of the Games.
In our practice we use ESAs to
maintain hemoglobin levels
between 10-11 g/dL in those
receiving renal replacement and
9-10 g/dL in those who are
pre-ESRD. We reached these target
values based on the TREAT trial
results and extrapolating those
results to pre-ESRD patients.

So in the case of Mr Merritt, we

would have given him enough
ESA to keep his hemoglobin
between 9-10: well below what
most male athletes would be at.
Aries Merritt at the
2012 London Olympic
Games posing with
his gold medal in the
110 m hurdles

1. Platelet dysfunction
2. Anemia ? causing loss of normal
laminar flow
Take a look at the schematic below
from NEJM 2014:847

Q: What causes the bleeding

diathesis in ESRD patients? Is it
platelet dysfunction or VWF
deficiency?
This was a board question
yesterday (August 2015).
Thanks. I hope I passed!!

A: There are two reasons: Two

Q: Hello! A resident asked how

hemodialysis affects CRP and ESR
levels. They have patient w/
osteomyelitis & wanted to check
levels but the patient received dialysis
before the lab draw.

A: We received a lot of different

answers for this question
A1: Why are they checking CRP and
ESR levels in a patient with
osteomyelitis?. These levels are
non-specific and it is important to
remember the CKD/ESRD is a
chronic inflammatory state; so levels
are highly variable.
Not sure how reliable it would be to
check these levels in ESRD patients
because levels are variable as this
study showed:
ncbi.nlm.nih.gov/pubmed/15504945
A2: The model shows the hazard ratio
of death for three predictor variable
(age, male gender, and BMI) in a
24-month follow-up study. As noted,
hazard ratios for age and BMI are
statistically significant (because their
95% confidence intervals do not cross
1.00). A hazard ratio of more than 1
signifies increased risk and a ratio of
less than 1 implies reduced risk. In the
model shown, for every 1-year
increase in age, there is 3.2% increase
in the risk of death. Similarly, for each
1-unit (kg/m2) increase in BMI, there
is 6.3% reduction in risk of death.

As you can see, survival analyses

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