<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20090101_19_3475"
                     title="ASN: HCV Changes Dialysis Treatment Needs (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/ASN/tb/16712?impressionId=1265806917435"
                     
      &lt;p&gt;SAN DIEGO  --  Patients on dialysis need less epoetin to treat their anemia if they are infected with hepatitis C (HCV), a researcher reported here.&lt;/p&gt;
&lt;p&gt;HCV-positive patients also needed a lower dose of IV iron than their noninfected counterparts, even though they had similar hemoglobin levels, according to David Goodkin, MD, of the Arbor Research Collaborative for Health in Ann Arbor, Mich.&lt;/p&gt;
&lt;p&gt;This is a &quot;surprising, unusual finding,&quot; Goodkin said at the American Society of Nephrology meeting, because most inflammatory diseases, which interfere with the signal the bone marrow sends to make more red blood cells, would result in the need for a higher dose of epoetin.&lt;/p&gt;
&lt;p&gt;&quot;We speculate that it may be that this viral infection is actually stimulating the liver to make this hormone erythropoietin,&quot; Goodkin said, although he admitted that he doesn&apos;t know why the virus would activate the erythropoietin-producing cells.&lt;/p&gt;
&lt;p&gt;He said the finding would probably not affect clinical practice because patients on dialysis have their epoetin doses adjusted regularly anyway.&lt;/p&gt;
&lt;p&gt;&quot;The doctors are still going to follow the hemoglobin level and adjust the EPO dose,&quot; Goodkin said. &quot;This is just a clue that if it&apos;s hepatitis C-positive, they&apos;ll need less EPO, on average, than people who are hepatitis C-negative.&quot;&lt;/p&gt;
&lt;p&gt;Goodkin said he decided to investigate after he saw the results of a small case-control study from 2008, involving 66 patients, showing that those on dialysis who were infected with HCV needed significantly lower doses of erythropoietin (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01). There was also a trend toward lower IV iron requirements (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.07).&lt;/p&gt;
&lt;p&gt;To explore the issue on a larger scale, he turned to the prospective Dialysis Outcomes and Practice Patterns Study (DOPPS).&lt;/p&gt;
&lt;p&gt;The current analysis included 36,245 patients in 12 countries who were on hemodialysis, 7.8% of whom were positive for HCV.&lt;/p&gt;
&lt;p&gt;After adjusting for age, sex, race, years of hemodialysis, country, and 14 comorbidities, he and his colleagues found that the weekly epoetin dose was significantly lower in the HCV-positive patients (7,737 versus 8,210 Units, &lt;em&gt;P&lt;/em&gt;=0.02).&lt;/p&gt;
&lt;p&gt;IV iron dose was also significantly lower in the infected patients (89.2 versus 96.4 mg/month, &lt;em&gt;P&lt;/em&gt;=0.02).&lt;/p&gt;
&lt;p&gt;Hemoglobin concentration was not significantly different in the two groups (&lt;em&gt;P&lt;/em&gt;=0.46).&lt;/p&gt;
&lt;p&gt;The odds ratios for not receiving epoetin or IV iron therapy among HCV-positive patients were 1.15 (&lt;em&gt;P&lt;/em&gt;=0.002) and 1.19 (&lt;em&gt;P&lt;/em&gt;=0.0002), respectively.&lt;/p&gt;
&lt;p&gt;Hepatitis B infection, on the other hand, offered no advantage.&lt;/p&gt;
&lt;p&gt;In addition to the unexpected effect of HCV infection on the epoetin dose, another surprising finding was that only seven infected patients in the study received antiviral treatment, including interferon.&lt;/p&gt;
&lt;p&gt;Goodkin speculated that clinicians might have been sparing the patients the adverse effects of antiviral therapy because most HCV-positive patients do not develop cirrhosis and liver failure, and patients on dialysis, many of whom are older, have a limited lifespan.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;DOPPS is funded by Amgen, Kyowa Hakko Kirin, and Genzyme.&lt;/p&gt;&lt;p&gt;Goodkin reported relationships with Affymax, AMAG Pharmaceuticals, Amgen, FibroGen, Keryx, Seattle Life Sciences, Xenon Pharmaceuticals, and Urodynamix Technologies.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_3494"
                     title="ASN: Regular Soda Not to Blame for Hyperuricemia (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/ASN/tb/16737?impressionId=1265806917435"
                     
      &lt;p&gt;SAN DIEGO  --  Drinking regular soda is not associated with the development of hyperuricemia or chronic kidney disease, a large, epidemiological study showed.&lt;/p&gt;
&lt;p&gt;Although drinking more than one soda a day was associated with an increased risk of prevalent hyperuricemia, the link disappeared in a longitudinal analysis, Andrew Bomback, MD, MPH, of Columbia University, reported at the American Society of Nephrology meeting here.&lt;/p&gt;
&lt;p&gt;Bomback said the longitudinal look, which allows the investigators to better adjust for confounders, likely explains why the findings differ from previous epidemiological studies that identified a relationship between guzzling regular soda and kidney disease.&lt;/p&gt;
&lt;p&gt;&quot;Sugared soda consumption, in my opinion, is just a marker for some lifestyle factors, whether it&apos;s a lifestyle that involves going to McDonald&apos;s, sitting on the couch, playing video games, not eating enough fruits and vegetables, smoking, or drinking,&quot; he said.&lt;/p&gt;
&lt;p&gt;&quot;It&apos;s part of a conglomerate of risk factors that we need to avoid, but a lot of the onus on sugared soda, I think, is a little bit too simplistic.&quot;&lt;/p&gt;
&lt;p&gt;Consumption of high fructose corn syrup has increased dramatically over the past three decades, according to Bomback and his colleagues, with regular soda accounting for 70% of the total intake.&lt;/p&gt;
&lt;p&gt;Bomback said that animal studies have found that fructose intake is associated with uric acid levels and subsequent kidney damage, but that this link hasn&apos;t been established in humans.&lt;/p&gt;
&lt;p&gt;To explore the issue, he and his colleagues examined data from 15,745 participants in the Atherosclerosis Risk in Communities (ARIC) study. Participants were selected from four field sites  --  Jackson, Miss., Forsythe County, N.C., Washington County, Md., and suburban Minneapolis.&lt;/p&gt;
&lt;p&gt;Each participant completed a baseline dietary questionnaire and was followed for nine years.&lt;/p&gt;
&lt;p&gt;Most of the participants (12,981) reported drinking less than one regular soda a day. Another 1,902 drank one soda a day, and 862 drank more than one soda a day.&lt;/p&gt;
&lt;p&gt;Mean uric acid level went up as consumption increased  --  from 6.0 to 6.2 to 6.3 mg/dL.&lt;/p&gt;
&lt;p&gt;Hyperuricemia was defined as a uric acid level greater than 5.7 mg/dL in women and 7.0 mg/dL in men.&lt;/p&gt;
&lt;p&gt;After adjustment for age, sex, animal protein intake, sodium intake, caloric intake, caffeine intake, education, diabetes, hypertension, body mass index, renal function, tobacco and alcohol use, ARIC field center, and race, drinking more than one soda a day was associated with prevalent hyperuricemia (OR 1.31, 95% CI 1.12 to 1.53), compared with drinking less than one a day.&lt;/p&gt;
&lt;p&gt;The association between soda consumption and prevalent chronic kidney disease approached statistical significance (OR 1.46, 95% CI 0.96 to 2.22).&lt;/p&gt;
&lt;p&gt;A longitudinal analysis, however, found no significant association between soda consumption and the development of hyperuricemia (OR 1.17, 95% CI 0.95 to 1.43) or chronic kidney disease (OR 0.82, 95% CI 0.59 to 1.16).&lt;/p&gt;
&lt;p&gt;Another analysis in which exposure to diet soda was examined came to a similar conclusion, supporting the idea that soda consumption is a marker for general lifestyle, Bomback said.&lt;/p&gt;
&lt;p&gt;Public health policies would do better to focus on general lifestyle factors and not soda consumption alone, he said.&lt;/p&gt;
&lt;p&gt;He said if people exercise more, eat less salt, consume fewer calories, and substitute some vegetable protein for animal protein, they likely will not be drinking a lot of regular soda. Their uric acid levels will probably be low and their kidney function will not be damaged.&lt;/p&gt;
&lt;p&gt;&quot;Those who want to crucify sugared soda need to calm down a bit and look at the other lifestyle factors that are associated with it,&quot; he said. &quot;To date, there is no causative evidence in humans that sugared soda is associated with either hyperuricemia or chronic kidney disease.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The ARIC study is carried out as a collaborative study supported by contracts from the National Heart, Lung, and Blood Institute, the National Human Genome Research Institute, and the NIH.&lt;/p&gt;&lt;p&gt;Bomback reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_3513"
                     title="ASN: ESA Use Rose Substantially in Dialysis Units Worldwide (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/ASN/tb/16759?impressionId=1265806917435"
                     
      SAN DIEGO  --  From the mid-1990s to early 2007, the use of erythropoiesis-stimulating agents (ESAs) for anemia increased dramatically around the world, which resulted in a rise in hemoglobin levels, researchers found.&lt;br&gt;
&lt;br&gt;The trends appeared to be independent of policies regarding the way the drugs were reimbursed, Philip McFarlane, MD, of the University of Toronto, reported at the American Society of Nephrology meeting here.&lt;br&gt;
&lt;br&gt;&quot;There must be other drivers ... that are contributing to this in an important way,&quot; he said, although he didn&apos;t know what those were.&lt;br&gt;
&lt;br&gt;The study stopped collecting data in early 2007, just months after the results of two major trials  --  CHOIR and CREATE  --  showed that aggressively raising hemoglobin worsened cardiovascular outcomes in patients with anemia.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;Subsequently, the FDA added boxed warnings to the ESAs and the Kidney Diseases Outcomes Quality Initiative revised their recommended target hemoglobin value to between 11 and 12 g/dL.&lt;/p&gt;
&lt;p&gt;McFarlane said the effects of these actions would not have been captured in the current analysis.&lt;/p&gt;
&lt;p&gt;Nor would the effects of the recently reported TREAT trial, which found that, in patients with type 2 diabetes, chronic kidney disease, and anemia, treating to a high target hemoglobin had no impact on cardiovascular outcomes or death, but did result in a higher stroke rate. (See: &lt;a href=&quot;http://www.medpagetoday.com/MeetingCoverage/ASN/16724&quot; mce_href=&quot;http://www.medpagetoday.com/MeetingCoverage/ASN/16724&quot; target=&quot;_blank&quot;&gt;ASN: No Clinical Benefit for ESA in Anemic Patients with Diabetes, CKD&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;&quot;It may be that physician perception of what the target hemoglobin should be will start to drift back downwards again,&quot; he said.&lt;/p&gt;
&lt;p&gt;It had been known that the use of ESAs was increasing for U.S. patients on hemodialysis, prompting concerns that reimbursement policies were providing a financial incentive for clinicians to use these drugs. ESAs were reimbursed at mean cost plus 6%, McFarlane said.&lt;/p&gt;
&lt;p&gt;But he and his colleagues thought other factors were contributing to the rise, and they wanted to look at trends across countries to evaluate the contribution of reimbursement policies.&lt;/p&gt;
&lt;p&gt;So they examined data from the Dialysis Outcomes and Practice Patterns Study (DOPPS), which included information from 12 countries  --  Australia, Belgium, Canada, France, Germany, Italy, Japan, New Zealand, Spain, Sweden, the U.K., and the U.S.&lt;/p&gt;
&lt;p&gt;More than 7,500 patients on hemodialysis, hemofiltration, or hemodiafiltration from more than 300 dialysis units were evaluated.&lt;/p&gt;
&lt;p&gt;From 1996 through 2007, ESA dose increased significantly in all countries but Belgium. At the end of the study, the highest average dose was used in the U.S. (21,420 U/patient/week) and the lowest was in Japan (5,270 U/patient/week).&lt;/p&gt;
&lt;p&gt;This increase in the amount of ESA used was accompanied by an expected rise in hemoglobin levels in all countries but Sweden.&lt;/p&gt;
&lt;p&gt;In every country but Japan, more than 40% of patients had hemoglobin levels that exceeded 12 g/dL by the end of the study. In five countries  --  Australia, Belgium, New Zealand, Spain, and the U.S.  --  more than half of all patients exceeded that value.&lt;/p&gt;
&lt;p&gt;McFarlane and his colleagues reviewed publicly available policy statements and incentives in funding of ESAs in each country and surveyed governmental affairs sections of ESA manufacturers and some of the DOPPS investigators to evaluate the effect of reimbursement policy on the observed trends.&lt;/p&gt;
&lt;p&gt;They did not find a correlation between reimbursement and the rise in the use of ESAs or hemoglobin levels.&lt;/p&gt;
&lt;p&gt;Although McFarlane couldn&apos;t explain what contributed to the increases, he said clinicians likely became more convinced that a higher hemoglobin level was better over time, an attitude that likely would have changed after the CREATE and CHOIR results were announced in late 2006.&lt;/p&gt;
&lt;p&gt;However, further DOPPS data will be needed to evaluate that, McFarlane said.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;DOPPS receives funding from Amgen and Kirin.&lt;/p&gt;&lt;p&gt;McFarlane reported receiving research/grant support from and serving as a consultant for Amgen Canada, Ortho Biotech of Canada, and Roche Canada, as well as serving as a scientific adviser for and receiving honoraria from Amgen Canada and Ortho Biotech of Canada.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_3523"
                     title="ASN: Comorbidities Determine Effects of Raising Hemoglobin (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/ASN/tb/16767?impressionId=1265806917435"
                     
      &lt;p&gt;SAN DIEGO  --  The presence of comorbidities appears to be an important factor in evaluating the cardiovascular risk associated with aggressively raising hemoglobin levels in anemic patients with chronic kidney disease, a secondary analysis of the CHOIR trial showed.&lt;/p&gt;
&lt;p&gt;The primary CHOIR results found that treating anemic patients who were not on dialysis with epoetin-alfa (Epogen, Procrit) to achieve a target hemoglobin of 13.5 g/dL worsened cardiovascular outcomes compared with a target of 11.3 g/dL.&lt;/p&gt;
&lt;p&gt;The finding contributed to the FDA&apos;s decision to add a boxed warning to the labels of epoetin-alfa and other erythropoiesis-stimulating agents (ESAs) against the aggressive raising of hemoglobin levels with these drugs. (See: &lt;a href=&quot;http://www.medpagetoday.com/ProductAlert/Prescriptions/5231&quot; mce_href=&quot;http://www.medpagetoday.com/ProductAlert/Prescriptions/5231&quot; target=&quot;_blank&quot;&gt;Black Box Warning Ordered for Aranesp, Epogen, and Procrit&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;A secondary analysis of the results, however, showed that the risk was not increased in the subgroups of patients with heart failure or diabetes, according to Lynda Szczech, MD, of Duke University Medical Center.&lt;/p&gt;
&lt;p&gt;Instead, patients who were free from these comorbidities were the ones with significant risk from the higher hemoglobin target, she said at the American Society of Nephrology meeting here.&lt;/p&gt;
&lt;p&gt;This finding is likely explained by the mechanism by which diabetics and patients with heart failure experience morbidity and mortality which is not affected by anemia treatment, she said.&lt;/p&gt;
&lt;p&gt;&quot;So there&apos;s something about competing risk in patients with kidney disease that we as a renal community really need to understand.&quot;&lt;/p&gt;
&lt;p&gt;She said the findings were consistent, with the newly reported results of the placebo-controlled TREAT trial, which found no effect from using an ESA  --  darbepoetin alfa (Aranesp)  --  on the occurrence of composite cardiovascular events in patients with type 2 diabetes, chronic kidney disease, and anemia. (See: &lt;a href=&quot;http://www.medpagetoday.com/MeetingCoverage/ASN/16724&quot; mce_href=&quot;http://www.medpagetoday.com/MeetingCoverage/ASN/16724&quot; target=&quot;_blank&quot;&gt;ASN: No Clinical Benefit for ESA in Anemic Patients with Diabetes, CKD&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;A trial in patients with heart failure  --  RED HF  --  is ongoing, she said.&lt;/p&gt;
&lt;p&gt;She said she decided to perform this secondary analysis of CHOIR when it became apparent that there would not be a significant positive or negative effect on the primary outcome in the TREAT trial because it went to completion.&lt;/p&gt;
&lt;p&gt;&quot;I wanted to see how the two trials would fit together in terms of results,&quot; she said.&lt;/p&gt;
&lt;p&gt;This post hoc analysis found that a diagnosis of heart failure significantly interacted with hemoglobin target (&lt;em&gt;P&lt;/em&gt;=0.028), but a diagnosis of diabetes did not (&lt;em&gt;P&lt;/em&gt;=0.559).&lt;/p&gt;
&lt;p&gt;Among patients who had either heart failure (HR 0.99, 95% CI 0.68 to 1.43) or diabetes (HR 1.21, 95% CI 0.88 to 1.67), there was no significant increased risk of cardiovascular events from the higher hemoglobin target through three years of follow-up.&lt;/p&gt;
&lt;p&gt;The elevated risk from the higher target was confined to patients who did not have heart failure (HR 1.86, 95% CI 1.21 to 2.85) or diabetes (HR 1.70, 95% CI 1.03 to 2.81).&lt;/p&gt;
&lt;p&gt;&quot;These results suggest the increased risks associated with higher hemoglobin targets are not clinically apparent among subgroups with greater mortality risk,&quot; according to Szczech and her colleagues.&lt;/p&gt;
&lt;p&gt;Szczech said the clinical message from the analysis was that &quot;we might need to focus on more functional outcomes in our patients with comorbidities.&quot;&lt;/p&gt;
&lt;p&gt;If outcomes such as cardiovascular events and death are not improved or worsened with ESA treatment, she said, then the focus can be on improving quality of life.&lt;/p&gt;
&lt;p&gt;The study was limited, the authors said, by the post hoc design and the limited statistical power of performing subgroup analyses.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Szczech reported receiving grant/research support from Pfizer and Genzyme, serving as a consultant for OBI, NABI, Gilead, , Kureha, Affymax, Acologix, Roche, Pharmasset, Merck, and AstraZeneca, and receiving honoraria from NABI, Gilead, Fresenius Medical Care North America, GlaxoSmithKline, Genzyme, Abbott, Amgen, OBI, and AMAG.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_3524"
                     title="ASN: No CVD Benefit for Folic Acid in Kidney Transplant (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/ASN/tb/16774?impressionId=1265806917435"
                     
      &lt;p&gt;SAN DIEGO  --  Lowering homocysteine levels with folic acid supplementation yielded no cardiovascular benefit for stable renal transplant recipients, a randomized trial showed.&lt;/p&gt;
&lt;p&gt;Patients who received a multivitamin containing a high dose of folic acid and other B vitamins had a similar rate of cardiovascular events as those who received a multivitamin without folic acid (&lt;em&gt;P&lt;/em&gt;=0.70), according to Andrew Bostom, MD, of Rhode Island Hospital in Providence.&lt;/p&gt;
&lt;p&gt;There were also similar numbers of all-cause death (&lt;em&gt;P&lt;/em&gt;=0.50) and end-stage renal disease (&lt;em&gt;P&lt;/em&gt;=0.35) in the two groups, he reported at the American Society of Nephrology meeting here.&lt;/p&gt;
&lt;p&gt;Commenting on the study, society president Thomas Coffman, MD, of Duke University Medical Center, said, &quot;Unfortunately, the study suggests that modulation of homocysteine doesn&apos;t affect cardiovascular risk, and it&apos;s consistent with other studies that are out there in other populations.&quot;&lt;/p&gt;
&lt;p&gt;Previous studies had shown that higher homocysteine levels were associated with cardiovascular outcomes in various patient populations, including chronic stable renal transplant recipients.&lt;/p&gt;
&lt;p&gt;Bostom and his colleagues hypothesized that lowering homocysteine with a high-dose combination of folic acid, vitamin B6, and vitamin B12, as well as other vitamins, would reduce the risk of cardiovascular events, including death, myocardial infarction, resuscitated sudden death, stroke, and invasive procedures for coronary, peripheral, or renovascular disease.&lt;/p&gt;
&lt;p&gt;They tested their hypothesis in the Folic Acid for Vascular Outcome Reduction in Transplantation (FAVORIT) trial, which was conducted at 30 sites in the U.S. (27), Canada (two), and Brazil (one).&lt;/p&gt;
&lt;p&gt;The high-dose group received a multivitamin containing 5 mg of folic acid, 50 mg of pyridoxine HCl, and 1 mg of vitamin B12, and the low-dose group received a multivitamin lacking folic acid and containing estimated average requirements of pyridoxine and vitamin B12.&lt;/p&gt;
&lt;p&gt;The researchers randomized 2,056 patients to the high-dose group and 2,054 to the low-dose group.&lt;/p&gt;
&lt;p&gt;The mean age of the patients was 52, and all had a functioning renal graft for at least six months, a total homocysteine level of at least 11 &amp;#181;mol/L for women and 12 &amp;#181;mol/L for men, and creatinine clearance of at least 30 mL/min for men and 25 mL/min for women.&lt;/p&gt;
&lt;p&gt;Baseline homocysteine levels were 16.4 &amp;#181;mol/L in the high-dose group and 16.1 &amp;#181;mol/L in the low-dose group.&lt;/p&gt;
&lt;p&gt;During the study, homocysteine levels dropped by 4.6 &amp;#181;mol/L in the high-dose group and 0.2 &amp;#181;mol/L in the low-dose group, about what the researchers expected, Bostom said.&lt;/p&gt;
&lt;p&gt;However, the larger drop in homocysteine levels in the high-dose group was not associated with a significantly lower number of cardiovascular events  --  there were 236 in the high-dose group and 252 in the low-dose group (&lt;em&gt;P&lt;/em&gt;=0.70).&lt;/p&gt;
&lt;p&gt;There was also no significant difference in the number of all-cause deaths (202 versus 195, &lt;em&gt;P&lt;/em&gt;=0.50) or cases of end-stage renal disease (149 versus 139, &lt;em&gt;P&lt;/em&gt;=0.35).&lt;/p&gt;
&lt;p&gt;There was no evidence of benefit from the high dose in any of the subgroups the researchers analyzed.&lt;/p&gt;
&lt;p&gt;&quot;These data expand and confirm earlier clinical trial evidence accumulated from patient populations with and without chronic kidney disease,&quot; Bostom said.&lt;/p&gt;
&lt;p&gt;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases and the Office of Dietary Supplements.&lt;/p&gt;&lt;p&gt;Bostom reported no financial disclosures.&lt;/p&gt;&lt;p&gt;Coffman reported being a member-at-large for the Leadership Council of the AHA-Council for High Blood Pressure, serving on the board of directors for the Program Committee, Consortium for Southeastern Hypertension Control, and on the scientific advisory board for Daiichi Sankyo.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>