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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EPerioperative treatment of patients undergoing noncardiac surgery with aspirin did not reduce the risk of acute kidney injury compared with placebo, nor did the use of clonidine compared with placebo. This article presents data from the Perioperative Ischemic Evaluation-2 Trial substudy [POISE-2].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ERenal Failure\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENephrology Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ENephrology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERenal Failure\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENephrology Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EPerioperative treatment of patients undergoing noncardiac surgery with aspirin did not reduce the risk of acute kidney injury (AKI) compared with placebo, nor did the use of clonidine compared with placebo. Amit X. Garg, MD, PhD, Western University, London, Ontario, Canada, presented data from the Perioperative Ischemic Evaluation-2 Trial substudy [POISE-2; Garg AX et al. \u003Cem\u003EJAMA\u003C\/em\u003E. 2014].\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EIt is estimated that about 10% of the 200 million noncardiac surgeries performed each year are complicated by AKI, and 0.5% of patients experience severe AKI that requires dialysis treatment [Garg AX et al. \u003Cem\u003EBMJ Open\u003C\/em\u003E. 2014]. The underlying mechanism that is thought to be responsible for perioperative AKI is decreased kidney perfusion and ischemia. Aspirin decreases platelet aggregation and can increase the glomerular filtration rate. Clonidine is a centrally acting \u03b12-adrenergic agonist that has analgesic, anxiolytic, and anti-inflammatory effects. The purpose of the POISE-2 substudy was to evaluate the effect of aspirin vs placebo, or clonidine vs placebo, on AKI after surgery.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EIn the POISE-2 trial, 6905 patients were randomly assigned in a 2-by-2 factorial design to receive perioperative aspirin vs placebo and clonidine vs placebo. The mean age was 69 years, and all patients underwent noncardiac surgery.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EIn the substudy, treatment with aspirin or clonidine was not significantly associated with AKI, death, or need for acute dialysis compared with placebo (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/15293\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/15293\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15293\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EEffects of Aspirin and Clonidine on Perioperative AKI\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-22\u0022\u003EThe rate of AKI or death was about 13% in all arms of the substudy. Prof Garg concluded that neither aspirin nor clonidine was effective in preventing perioperative AKI.\u003C\/p\u003E\n         \u003Cp id=\u0022p-23\u0022\u003EProf Garg also discussed one aspect of living kidney donation: concern regarding the effect of kidney donation on future pregnancies. In 2004, the international consensus was that kidney donation did not affect the outcomes of future pregnancies [Monaco AP, Morris PJ. \u003Cem\u003ETransplantation\u003C\/em\u003E. 2004]. However, after the consensus was published, 2 studies demonstrated that there were higher risks of gestational hypertension and preeclampsia after kidney donation in women who had a pregnancy prior to and after donation [Ibrahim HN et al. \u003Cem\u003EAm J Transplant\u003C\/em\u003E. 2009; Reisaeter AV et al. \u003Cem\u003EAm J Transplant\u003C\/em\u003E. 2009]. However, the methods and results of the 2 studies have been debated and are not widely disseminated by transplant programs [Nevis IF et al. \u003Cem\u003EAm J Transplant\u003C\/em\u003E. 2009].\u003C\/p\u003E\n         \u003Cp id=\u0022p-24\u0022\u003EGarg and colleagues [\u003Cem\u003EN Engl J Med.\u003C\/em\u003E 2014] conducted a retrospective cohort study in which kidney donors with pregnancies were matched to nondonor controls with pregnancy. Donors had a significantly higher rate of gestational hypertension or preeclampsia compared with nondonor controls (11% vs 5%; 95% CI, 1.2 to 5; \u003Cem\u003EP\u003C\/em\u003E = .01). However, there was no association between kidney donation and caesarian section, postpartum hemorrhage, preterm birth, or low birth weight. Most women had an uncomplicated pregnancy after kidney donation.\u003C\/p\u003E\n         \u003Cp id=\u0022p-25\u0022\u003ETherefore, Prof Garg concluded that living kidney donation remains an important treatment option for patients with kidney failure and their families. This new information on the pregnancy outcomes of living kidney donors can feature in clinical practice guidelines, can be shared in the informed consent process for potential donors and their recipients when a woman has reproductive potential, and can be used to guide the care of pregnant donors.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/49\/15.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlu61\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzlu61\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}