Section of Adult Medicine, Philippine General Hospital

Correction. Tomorrow is team meeting day for the section conference.The presentation of the appraisal of the meta-analysis on troponin in CKD will be on august 4.

Let us read and appraise this article and listen to the journal report tomorrow during the Section conference.
Role of troponin in CKD and suspected ACS: meta-analysis
http://annals.org/article.aspx?articleid=1895305

Role of Troponin in Patients With Chronic Kidney Disease and Suspected Acute Coronary Syndrome:... From Johns Hopkins University Bloomberg School of Public Health and Johns Hopkins University School of Medicine, Baltimore, Maryland.

What is the troponin level that would diagnose myocardial infarction among patients with chronic kidney disease?

The overall incidence of lactic acidosis in metformin users varies across studies from approximately 3 per 100 000 person-years to 10 per 100 000 person-years and is generally indistinguishable from the background rate in the overall population with diabetes. Data suggesting an increased risk of lactic acidosis in metformin-treated patients with chronic kidney disease are limited, and no randomized controlled trials have been conducted to test the safety of metformin in patients with significantly impaired kidney function.

In the section conference yesterday, team C presented an article on the incidence of lactic acidosis with metformin use among patients with CKD. Although it was initially appraised as an article on harm, further analysis showed that it was an article on prognosis. See the result slide below and the link to the article which was published in diabetes care.http://care.diabetesjournals.org/content/37/8/2291.abstract

However, there is a systematic review on risk of acidosis with Metformin in patients with impaired kidney function published in JAMA 2014

What is the risk of lactic acidosis with Metformin use among individuals with impaired kidney function?
See the article via this link from a systematic review in JAMA published 2014
http://jama.jamanetwork.com/article.aspx?articleid=2084896

Metformin in Type 2 Diabetes and Kidney Disease This systematic review reports that available evidence supports cautious expansion of metformin use in patients with mild to moderate chronic kidney disease.

DOES BEETROOT JUICE REDUCE SYSTOLIC AND DIASTOLIC BLOOD PRESSURES AMONG HYPERTENSIVE PATIENTS?

ARTICLE LINK: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4288952/

Reviewer's Conclusion: The results of this 4-week trial have indeed showed a robust BP lowering effect of dietary nitrates (in the form of beetroot juice) among drug-naïve and treated hypertensive adult patients. Since the degree of BP reduction is a very good surrogate outcome for cardiovascular events, the levels of BP reduction by dietary nitrates demonstrated in this study make beetroot juice a very appealing and noteworthy treatment that needs further investigation and evaluation. Until such a long-term trial that would illustrate dietary nitrates’ efficacy on hard CVD outcomes and safety profile is conducted, beetroot juice’s value as an antihypertensive will remain as an attractive strategy to pursue but not an intervention that we can currently recommend.

(See complete appraisal: https://docs.google.com/file/d/0B4cFN4CbfH-tZWNWRDFuYlJla1k/)

Beetroot juice reduces systolic and diastolic blood pressures among hypertensive patients.pdf