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Allon Friedman, MD

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Nephrology

Associate Professor of Medicine

Academic Office

University Hospital, Suite 6100
550 University Blvd
Indianapolis IN 46202-5250 Map

Contact Information

Email:

Research Interests

Nutrition in kidney disease, omega-3 fatty acids, obesity’s impact on kidney health, sudden cardiac death.

Clinical Interests

General nephrology, dialysis, fluid and electrolyte derangements, glomerulonephritides.

Education and Training

Residency Tufts University
Medicine (M.D.) Mcgill University
Political Science, General Columbia University

Board Certifications

Clinical Nutrition
Internal Medicine 1997
Nephrology 2000

Publications (31)¹

Is Routine Multivitamin Supplementation Necessary in US Chronic Adult Hemodialysis Patients? A Systematic Review.
Journal: Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation
Authors: Tucker BM; Safadi S; Friedman AN;
Publication Date: 2014 Oct 29

Abstract

Because of concern that United States (US) chronic hemodialysis patients are at high risk for the development of vitamin deficiencies, the great majority of such patients are routinely supplemented with a multivitamin. This policy is supported by major US dialysis providers and nonprofit organizations. Yet routine multivitamin supplementation expands hemodialysis patients' already large pill burden, probably accounts for many millions of dollars in annual costs, and in light of previous reports may even carry with it the possibility of increased risk of adverse outcomes. An analysis of the benefits of routine multivitamin supplementation in US patients is therefore in order. We performed a systematic review of the medical literature between 1970 and 2014 using the Ovid MEDLINE database to address this question. We conclude that there is insufficient evidence to support routine multivitamin use and recommend that the decision to supplement be made on an individual basis.
View details for PubMedID 25446839
Influence of dietary protein on glomerular filtration before and after bariatric surgery: a cohort study.
Journal: American journal of kidney diseases : the official journal of the National Kidney Foundation
Authors: Friedman AN; Quinney SK; Inman M; Mattar SG; Shihabi Z; Moe S;
Publication Date: 2013 Dec 31

Abstract

Obesity-associated elevations in glomerular filtration rate (GFR) are common and may play a role in the development of kidney disease, so identifying the underlying mechanism is important. We therefore studied whether reductions in dietary protein intake, which is known to modulate GFR, explain why GFR decreases after bariatric surgery-induced weight loss.
View details for PubMedID 24387796
Predicting the glomerular filtration rate in bariatric surgery patients.
Journal: American journal of nephrology
Authors: Friedman AN; Moe S; Fadel WF; Inman M; Mattar SG; Shihabi Z; Quinney SK;
Publication Date: 2013 Dec 19

Abstract

Identifying the best method to estimate the glomerular filtration rate (GFR) in bariatric surgery patients has important implications for the clinical care of obese patients and research into the impact of obesity and weight reduction on kidney health. We therefore performed such an analysis in patients before and after surgical weight loss.
View details for PubMedID 24356416
Short-term changes after a weight reduction intervention in advanced diabetic nephropathy.
Journal: Clinical journal of the American Society of Nephrology : CJASN
Authors: Friedman AN; Chambers M; Kamendulis LM; Temmerman J;
Publication Date: 2013 Aug 8

Abstract

Obesity precedes and is strongly linked to the development of type 2 diabetic nephropathy in most patients, yet little is known about the effects of weight reduction on this disease. This study aimed to establish proof of concept for the hypothesis that weight reduction ameliorates diabetic nephropathy.
View details for PubMedID 23929927
Fatty acids and other risk factors for sudden cardiac death in patients starting hemodialysis.
Journal: American journal of nephrology
Authors: Friedman AN; Yu Z; Denski C; Tamez H; Wenger J; Thadhani R; Li Y; Watkins B;
Publication Date: 2013 Jun 25

Abstract

Little is known about risk factors for sudden cardiac death in hemodialysis patients during the high-risk first year of dialysis. We therefore undertook to identify such risk factors in a nationally representative cohort and were able to include baseline levels of blood fatty acids, some of which influence arrhythmogenicity and sudden cardiac death risk.
View details for PubMedID 23816975
The coming fiscal crisis: nephrology in the line of fire.
Journal: Clinical journal of the American Society of Nephrology : CJASN
Authors: Andersen MJ; Friedman AN;
Publication Date: 2013 May 23

Abstract

Nephrologists in the United States face a very uncertain economic future. The astronomical federal debt and unfunded liability burden of Medicare combined with the aging population will place unprecedented strain on the health care sector. To address these fundamental problems, it is conceivable that the federal government will ultimately institute rationing and other budget-cutting measures to rein in costs of ESRD care, which is generously funded relative to other chronic illnesses. Therefore, nephrologists should expect implementation of cost-cutting measures, such age-based rationing, mandated delayed dialysis and home therapies, compensated organ donation, and a shift in research priorities from the dialysis to the predialysis patient population. Nephrologists also need to recognize that these changes, which are geared toward the population level, may make it more difficult to advocate effectively for the needs of individual patients.
View details for PubMedID 23704301
Obesity in patients undergoing dialysis and kidney transplantation.
Journal: Advances in chronic kidney disease
Authors: Friedman AN;
Publication Date: 2013 Mar

Abstract

Obesity poses a major challenge for nephrologists and patients alike, and its prevalence among patients with kidney disease is increasing at least as fast as in the general population. Although the body mass index (BMI) is the most commonly used measurement of excess adiposity, it has important limitations that can be ameliorated by incorporating other markers of body composition. The influence of obesity on outcomes in patients undergoing dialysis and kidney transplantation is of great interest. Although the preponderance of epidemiologic data suggests that, at least in patients undergoing dialysis, obesity has a neutral or protective effect on mortality, although this has not been confirmed in interventional studies needed to establish causality. The effect of obesity on other important outcomes such as quality of life has yet to be determined, and much less information on obesity and outcomes is available in the kidney transplantation population. Similarly, research on the optimal strategies and effects of weight loss in dialysis and kidney transplantation patients is at a nascent stage.
View details for PubMedID 23439371
Inverse relationship between long-chain n-3 fatty acids and risk of sudden cardiac death in patients starting hemodialysis.
Journal: Kidney international
Authors: Friedman AN; Yu Z; Tabbey R; Denski C; Tamez H; Wenger J; Thadhani R; Li Y; Watkins BA;
Publication Date: 2013 Feb 6

Abstract

Experimental and clinical evidence suggests that long-chain n-3 fatty acids may protect against sudden cardiac death, the leading cause of mortality in hemodialysis patients. Here we investigated whether long-chain n-3 fatty acids have a protective relationship with sudden cardiac death in 100 patients who died of sudden cardiac death during the first year of starting hemodialysis and 300 patients who survived. Individuals were selected from a nationally representative cohort of over 1000 US hemodialysis units in 2004-2005. The odds of sudden cardiac death were calculated by quartile of long-chain n-3 fatty acid levels over the first year. There was a significant inverse relationship between long-chain n-3 fatty acids and the risk of sudden cardiac death even after adjusting for relevant comorbid conditions, biochemical values, and dietary fats. The odds of sudden cardiac death at 1 year for the second, third, and fourth quartile groups of long-chain n-3 fatty acids were 0.37, 0.22, and 0.20, respectively, compared with the lowest quartile. This significant inverse relationship was maintained even during the highest-risk first few months on hemodialysis. Thus, long-chain n-3 fatty acids are strongly and independently associated with a lower risk of sudden cardiac death in hemodialysis patients throughout the first year of hemodialysis.
View details for PubMedID 23389417
Low blood levels of long-chain n-3 polyunsaturated fatty acids in US hemodialysis patients: clinical implications.
Journal: American journal of nephrology
Authors: Friedman AN; Yu Z; Tabbey R; Denski C; Tamez H; Wenger J; Thadhani R; Li Y; Watkins BA;
Publication Date: 2012 Nov 2

Abstract

Cardioprotective and other clinical benefits of long-chain n-3 polyunsaturated fatty acids (PUFA) are inversely related to dietary intake and hence blood content. We therefore investigated, in the first study of its kind, the blood content and distribution of these fatty acids in a large representative population of US hemodialysis patients.
View details for PubMedID 23128302
Comparative effects of low-carbohydrate high-protein versus low-fat diets on the kidney.
Journal: Clinical journal of the American Society of Nephrology : CJASN
Authors: Friedman AN; Ogden LG; Foster GD; Klein S; Stein R; Miller B; Hill JO; Brill C; Bailer B; Rosenbaum DR; Wyatt HR;
Publication Date: 2012 May 31

Abstract

Concerns exist about deleterious renal effects of low-carbohydrate high-protein weight loss diets. This issue was addressed in a secondary analysis of a parallel randomized, controlled long-term trial.
View details for PubMedID 22653255
Making measures count.
Journal: Clinical journal of the American Society of Nephrology : CJASN
Authors: Friedman AN; Fadem SZ;
Publication Date: 2011 May 19

Abstract

An abundance of available laboratory information has led in part to the establishment of quantitative performance goals that use serum albumin, hemoglobin, Kt/V, and bone mineral indices to track quality of medical care and even physician reimbursement. As we look to the future, the next generation of measures should should more specifically reflect efforts to improve more fundamental outcomes, such as mortality, hospitalization, and quality of life. In this essay we address the important question of how clinicians can translate rich sources of quantitative data into a service that makes a difference in our patients' lives; a way to distinguish exemplary from ordinary care; a means to support continuous improvement in our care patterns individually and as part of larger, integrated health care systems all while avoiding prematurely advocating flawed quality measures. We also offer a pathway for how future quality measures can be developed. Our ultimate goal is to individualize quantitative assessments and by doing so encourage more meaningful, patient-oriented care that will lead to improved outcomes, greater physician job satisfaction, and wiser allocation of scarce resources.
View details for PubMedID 21597026
Independent influence of dietary protein on markers of kidney function and disease in obesity.
Journal: Kidney international
Authors: Friedman AN; Yu Z; Juliar BE; Nguyen JT; Strother M; Quinney SK; Li L; Inman M; Gomez G; Shihabi Z; Moe S;
Publication Date: 2010 Jul 21

Abstract

Obesity is associated with glomerular hyperfiltration and increased urinary protein excretion, as well as structural and functional changes that lead to kidney disease and failure. Dietary protein mimics obesity's effects on the glomerular filtration rate (GFR) and proteinuria and, in certain circumstances, may have the potential to adversely affect kidney function. Here we tested the hypothesis that dietary protein independently explains elevations in the GFR and proteinuria found in obese persons with a normal serum creatinine. Seventeen patients were randomized in a double-blind, crossover fashion for 1-week periods to high (140 g/day) and low (50 g/day) protein diets with a 1-week washout interval separating these periods. High protein consumption was associated with a very modest but significant increase in the GFR of 5 ± 6 ml/min. Hence, while dietary protein does modulate kidney parameters, it is unlikely to fully account for the elevations in GFR and proteinuria found in obesity.
View details for PubMedID 20664561
Measuring the glomerular filtration rate in obese individuals without overt kidney disease.
Journal: Nephron. Clinical practice
Authors: Friedman AN; Strother M; Quinney SK; Hall S; Perkins SM; Brizendine EJ; Inman M; Gomez G; Shihabi Z; Moe S; Li L;
Publication Date: 2010 Jul 2

Abstract

Identifying methods to accurately measure the glomerular filtration rate (GFR) in obese individuals without kidney overt kidney disease is necessary to understanding the pathophysiology and natural history of obesity-related kidney disease.
View details for PubMedID 20606483
Omega-3 fatty acid supplementation in advanced kidney disease.
Journal: Seminars in dialysis
Authors: Friedman AN;
Publication Date: 2010 Jul

Abstract

Long-chain polyunsaturated omega-3 fatty acids (n-3 PUFA), which are obtained primarily from dietary sources such as coldwater fish, have diverse and potent mediating effects on the immune, inflammatory, and metabolic pathways, signal transduction, and cell membrane physiology. N-3 PUFA are increasingly being studied for their clinical benefits in a variety of medical conditions, some of which are relevant to individuals with advanced chronic kidney disease (CKD). These include, among others, renoprotection in IgA nephropathy, cardioprotective effects via a variety of mechanisms including blood pressure and triglyceride reduction, maintenance of dialysis access patency, sparing of inflammation-associated muscle loss, and even mortality. However, further confirmatory work needs to be performed before establishing formal intake recommendations and dosing goals for advanced CKD patients. In the meantime, the current American Heart Association n-3 PUFA intake guidelines can be applied to CKD patients, especially given n-3 PUFA's potential benefits and negligible risk profile. Over time, it will be incumbent upon the nephrology community to more clearly define the utility and optimal dosing of n-3 PUFA in CKD patients with advanced disease via randomized clinical trials.
View details for PubMedID 20701719
Applications of nanopipettes in the analytical sciences.
Journal: The Analyst
Authors: Morris CA; Friedman AK; Baker LA;
Publication Date: 2010 Jun 19

Abstract

In this review, we describe measurements and applications of interest to the analytical community that makes use of simple nanopipettes. Fabricated by applying heat during the separation of a glass capillary, nanopipettes provide a route for nanoscale studies of ion transport and for development of chemical and biochemical sensors. When mounted on a translation stage, nanopipettes also enable unique modes of imaging and material deposition. These facets of nanopipette research, as well as some of the unique properties of nanopipettes, will be discussed.
View details for PubMedID 20563341
Optimizing acne therapy with unique vehicles.
Journal: Journal of drugs in dermatology : JDD
Authors: Kircik L; Friedman A;
Publication Date: 2010 May

Abstract

The science of cutaneous drug delivery is focused on overcoming the major force of resistance to drug penetration and permeation-the stratum corneum. Acne vulgaris is a multifactorial disease of the pilosebaceous unit, resulting from abnormalities in sebum production, follicular epithelial desquamation, bacterial proliferation and inflammation. Topical treatment of even mild-moderate acne requires combination topical therapy, yet often systemic therapy is needed to ultimately confer an acceptable clinical endpoint. New delivery systems have emerged in response to the limited routes of entry and therefore efficacy of topical regimens. The unique physical and optical properties of micro/nano encapsulation of known therapeutics such as benzoyl peroxide and tretinoin allow for both improved efficacy while minimizing issues of compliance and adverse events. Vehicles that offer both inherent biological reactivity and permeation enhancement have also been shown improvement over the current armament of topical drug delivery. This current and exciting path of topical drug development will likely be continued with investigative vigor.
View details for PubMedID 20518361
Feasibility study of erythrocyte long-chain omega-3 polyunsaturated fatty acid content and mortality risk in hemodialysis patients.
Journal: Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation
Authors: Friedman AN; Saha C; Watkins BA;
Publication Date: 2008 Nov

Abstract

Long-chain omega-3 polyunsaturated fatty acids (n-3 PUFA) are increasingly believed to be cardioprotective. We tested the hypothesis that erythrocyte n-3 PUFA levels, as measured by the omega-3 index (O3I), are inversely related to mortality in hemodialysis patients.
View details for PubMedID 18940654
Value of urinary albumin-to-creatinine ratio as a predictor of type 2 diabetes in pre-diabetic individuals.
Journal: Diabetes care
Authors: Friedman AN; Marrero D; Ma Y; Ackermann R; Narayan KM; Barrett-Connor E; Watson K; Knowler WC; Horton ES; Diabetes Prevention Program Research Group;
Publication Date: 2008 Sep 16

Abstract

The albumin-to-creatinine ratio (ACR) reflects urinary albumin excretion and is increasingly being accepted as an important clinical outcome predictor. Because of the great public health need for a simple and inexpensive test to identify individuals at high risk for developing type 2 diabetes, it has been suggested that the ACR might serve this purpose. We therefore determined whether the ACR could predict incident diabetes in a well-characterized cohort of pre-diabetic Americans.
View details for PubMedID 18796622
Challenges of treating a 466-kilogram man with acute kidney injury.
Journal: American journal of kidney diseases : the official journal of the National Kidney Foundation
Authors: Friedman AN; Decker B; Seele L; Hellman RN;
Publication Date: 2008 May 21

Abstract

Caring for super obese patients (body mass index > 50 kg/m(2)) presents a number of complex and unique clinical challenges, particularly when acute kidney injury is present. We describe our experience treating the heaviest individual with acute kidney injury requiring renal replacement therapy reported to date. A 24-year-old black man was admitted to our hospital with fever, vomiting, progressive weakness, shortness of breath, and hemoptysis. Admission weight was 1,024 lbs (466 kg), height was 6 ft 4 in (1.9 m), and body mass index was 125 kg/m(2). During hospitalization, the patient experienced oligoanuric acute kidney injury and required initiation of continuous and subsequently intermittent renal replacement therapy. This clinical scenario identifies the many challenges involved in caring for super obese patients with acute kidney injury and may be a harbinger of what awaits the nephrology community in the obesity pandemic era.
View details for PubMedID 18495309
Acute rise of omega-3 polyunsaturated fatty acids during hemodialysis treatment.
Journal: Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation
Authors: Friedman AN; Siddiqui R; Watkins BA;
Publication Date: 2008 May

Abstract

Hemodialysis patients have an extremely high rate of cardiac arrhythmia-induced sudden cardiac death, although the risk during the hemodialysis procedure is relatively low. A higher blood content of long-chain omega-3 polyunsaturated fatty acids (PUFAs) is believed to reduce the risk of sudden cardiac death. We performed this study to measure the effect of a single-standard hemodialysis treatment on plasma and erythrocyte omega-3 PUFA levels in chronic hemodialysis patients.
View details for PubMedID 18410887
Analysis of self-associating proteins by singular value decomposition of solution scattering data.
Journal: Biophysical journal
Authors: Williamson TE; Craig BA; Kondrashkina E; Bailey-Kellogg C; Friedman AM;
Publication Date: 2008 Jan 22

Abstract

We describe a method by which a single experiment can reveal both association model (pathway and constants) and low-resolution structures of a self-associating system. Small-angle scattering data are collected from solutions at a range of concentrations. These scattering data curves are mass-weighted linear combinations of the scattering from each oligomer. Singular value decomposition of the data yields a set of basis vectors from which the scattering curve for each oligomer is reconstructed using coefficients that depend on the association model. A search identifies the association pathway and constants that provide the best agreement between reconstructed and observed data. Using simulated data with realistic noise, our method finds the correct pathway and association constants. Depending on the simulation parameters, reconstructed curves for each oligomer differ from the ideal by 0.05-0.99% in median absolute relative deviation. The reconstructed scattering curves are fundamental to further analysis, including interatomic distance distribution calculation and low-resolution ab initio shape reconstruction of each oligomer in solution. This method can be applied to x-ray or neutron scattering data from small angles to moderate (or higher) resolution. Data can be taken under physiological conditions, or particular conditions (e.g., temperature) can be varied to extract fundamental association parameters (DeltaH(ass), DeltaS(ass)).
View details for PubMedID 18212017
Robotic hierarchical mixing for the production of combinatorial libraries of proteins and small molecules.
Journal: Journal of combinatorial chemistry
Authors: Avramova LV; Desai J; Weaver S; Friedman AM; Bailey-Kellogg C;
Publication Date: 2007 Dec 12

Abstract

We present a method to automatically plan a robotic process to mix individual combinations of reactants in individual reaction vessels (vials or wells in a multiwell plate), mixing any number of reactants in any desired stoichiometry, and ordering the mixing steps according to an arbitrarily complex treelike assembly protocol. This process enables the combinatorial generation of complete or partial product libraries in individual reaction vessels from intermediates formed in the presence of different sets of reactants. It can produce either libraries of chimeric genes constructed by ligation of fragments from different parent genes or libraries of chemical compounds constructed by convergent synthesis. Given concentrations of the input reactants and desired amounts or volumes of the products, our algorithm, RoboMix, computes the required reactant volumes and the resulting product concentrations, along with volumes and concentrations for all intermediate combinations. It outputs a sequence of robotic liquid transfer steps that ensures that each combination is correctly mixed even when individualized stoichiometries are employed and with any fractional yield for a product. It can also account for waste in robotic liquid handling and residual volume needed to ensure accurate aspiration. We demonstrate the effectiveness of the method in a test mixing dyes with different UV-vis absorption spectra, verifying the desired combinations spectroscopically.
View details for PubMedID 18072752
A pilot study in hemodialysis of an electrophysiological tool to measure sudden cardiac death risk.
Journal: Clinical nephrology
Authors: Friedman AN; Groh WJ; Das M;
Publication Date: 2007 Sep

Abstract

The hemodialysis procedure may play a role in the elevated risk of sudden cardiac death seen in hemodialysis patients.
View details for PubMedID 17915618
Oral fish oil supplementation raises blood omega-3 levels and lowers C-reactive protein in haemodialysis patients--a pilot study.
Journal: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
Authors: Saifullah A; Watkins BA; Saha C; Li Y; Moe SM; Friedman AN;
Publication Date: 2007 Jul 10

Abstract

We previously reported that haemodialysis patients have suboptimal blood levels of the cardioprotective omega-3 polyunsaturated fatty acids (n-3 PUFA) eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids. In the present pilot study, we tested the hypothesis that supplementing haemodialysis patients for 12 weeks with the American Heart Association (AHA)-recommended fish oil dose would be well tolerated and efficacious in boosting blood n-3 PUFA levels and improving cardiovascular risk biomarkers.
View details for PubMedID 17623719
Site-directed combinatorial construction of chimaeric genes: general method for optimizing assembly of gene fragments.
Journal: Proteins
Authors: Saftalov L; Smith PA; Friedman AM; Bailey-Kellogg C;
Publication Date: 2006 Aug 15

Abstract

Site-directed construction of chimaeric genes by in vitro recombination "mixes-and-matches" precise building blocks from multiple parent proteins, generating libraries of hybrids to be tested for structure-function relationships and/or screened for favorable properties and novel enzymatic activities. A direct annealing and ligation method can construct chimaeric genes without requiring sequence identity between parents, except for the short (approximately 3 nt) sequences of the fragment overhangs used for specific ligation. Careful planning of the assembly process is necessary, though, in order to ensure effective construction of desired fragment assemblies and to avoid undesired assemblies (e.g., repetition of fragments, fragments out of order). We develop algorithms for specific planned ligation of short overhangs (SPLISO) that efficiently explore possible assembly plans, varying the fragment overhangs and the order of ligation steps in the assembly pathway. While there is a combinatorial explosion in the number of possible assembly plans as the number of breakpoints and parent genes increases, we employ a dynamic programming approach to find globally optimal ones in low-order polynomial time (in practice, taking only seconds for basic assembly plans). We demonstrate the effectiveness of our algorithms in planning the assembly of hybrid libraries, under a variety of experimental options and restrictions, including flexibility in the position and amino acid sequence of breakpoints. Our method promises to enable more effective application of site-directed recombination to protein investigation and engineering.
View details for PubMedID 16783818
Fish consumption and omega-3 fatty acid status and determinants in long-term hemodialysis.
Journal: American journal of kidney diseases : the official journal of the National Kidney Foundation
Authors: Friedman AN; Moe SM; Perkins SM; Li Y; Watkins BA;
Publication Date: 2006 Jun

Abstract

Blood levels of the anti-inflammatory and cardioprotective omega-3 eicosapentaenoic (EPA) and docosahexaenoic (DHA) fatty acids are determined primarily by dietary consumption. There is reason to believe that hemodialysis patients are at risk for inadequate omega-3 intake and, consequently, low blood levels.
View details for PubMedID 16731302
Adiposity in dialysis: good or bad?
Journal: Seminars in dialysis
Authors: Friedman AN;
Publication Date: 2006 Mar

Abstract

There exists in the general population a complex and mostly positive relationship between adiposity and mortality risk. Because the dialysis population has a high prevalence of excess adiposity, in addition to a strikingly elevated mortality rate, the effects of obesity are of potential clinical importance. In contrast to the general population, the preponderance of data in dialysis, particularly hemodialysis patients, suggest that adiposity has a neutral or even protective association with mortality. Although methodological concerns exist with regards to confounding and survival bias, among others, the major limitation of this body of literature is its inability to establish causality. Thus, although obese dialysis patients, with certain exceptions, appear to live longer, there is no evidence to suggest that intentional weight loss adversely affects patient outcomes. In light of these limitations and the substantial body of literature implicating obesity as a pathophysiological state, it is currently premature to advocate for excess adiposity as being beneficial or intentional weight loss as dangerous. Decisions regarding optimal weight should be made by clinicians on an individual basis and with close supervision and follow-up. Efforts should be made to preserve lean mass during weight loss regimens by encouraging exercise and recommending sufficient protein consumption. Future research efforts in this area should focus on interventional trials designed to manipulate weight and measure outcomes, identifying potentially beneficial secretory products of adipose tissue, and documenting obesity's effects on quality of life and resource utilization in the dialysis setting.
View details for PubMedID 16551291
Topical alprostadil (PGE1) for the treatment of female sexual arousal disorder: in-clinic evaluation of safety and efficacy.
Journal: Journal of psychosomatic obstetrics and gynaecology
Authors: Heiman JR; Gittelman M; Costabile R; Guay A; Friedman A; Heard-Davison A; Peterson C; Dietrich J; Stephens D;
Publication Date: 2006 Mar

Abstract

This multi-center, randomized, placebo-controlled, crossover design study evaluated the effects of a topical alprostadil solution for the treatment of female sexual arousal disorder (FSAD). A total of 79 naturally or surgically post menopausal women with FSAD were treated with either 100 or 400 micrograms of alprostadil solution and placebo, delivered on separate clinic visits in random order. Study drug was applied to the external genitalia and was followed by 30 minutes of visual sexual stimulation. Study evaluations included investigator assessments of genital vasocongestion and patient assessments of physical and emotional sexual arousal, and sexual satisfaction. Genital vasocongestion in response to PGE1 was significantly greater than placebo (p < 0.0001) at each dose level and at all post dosing time points. Patient assessments of physical and emotional arousal and sexual satisfaction were significantly greater than placebo with the 400 mcg dose, but not with the 100 mcg dose of alprostadil. Topical alprostadil was well tolerated with no reports of significant systemic side effects. The most common adverse event was mild, transient genital burning typically < 1 minute duration. Other side effects were mild-moderate, resolving within two hours of application. These data suggest topical alprostadil should be further researched as a potentially appropriate on-demand therapeutic choice for women experiencing FSAD.
View details for PubMedID 16752874
Review of the effects of omega-3 supplementation in dialysis patients.
Journal: Clinical journal of the American Society of Nephrology : CJASN
Authors: Friedman A; Moe S;
Publication Date: 2005 Nov 30

Abstract

Chronic dialysis patients experience a host of conditions that limit quality and length of life, and recent therapeutic strategies have had only modest success in ameliorating many of these problems. By mediating cell membrane function and structure and the synthesis of lipid mediators such as eicosanoids, omega-3 fatty acids may offer dialysis patients a host of therapeutic benefits. Omega-3 fatty acids are derived primarily from dietary sources, and cold-water fish is the main source of eicosapentanoic and docosahexanoic acids, the two major bioactive omega-3 fatty acids. Studies of omega-3 supplementation in dialysis patients describe salutary effects on triglyceride levels, dialysis access patency, and perhaps uremic pruritus and oxidative stress. In contrast, the putative hematologic, antihypertensive, anti-inflammatory, and antiarrhythmic effects are not as well documented. Adverse effects generally have been limited to gastrointestinal complaints. Unfortunately, the preponderance of published studies are characterized by suboptimal study design, small sample sizes, supraphysiologic omega-3 doses that may be difficult to consume for extended periods, little long-term follow-up, and a lack of confirmation of compliance. Not surprising, the 2005 National Kidney Foundation Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines for Cardiovascular Disease in Dialysis Patients recommend further research in this field. In summary, although preliminary data suggest that omega-3 fatty acids may have clinical benefits, formal recommendations encouraging omega-3 supplementation of dialysis patients are premature until long-term and adverse effects are better defined.
View details for PubMedID 17699207
Total plasma homocysteine and arteriosclerotic outcomes in type 2 diabetes with nephropathy.
Journal: Journal of the American Society of Nephrology : JASN
Authors: Friedman AN; Hunsicker LG; Selhub J; Bostom AG; Collaborative Study Group;
Publication Date: 2005 Sep 14

Abstract

Total serum homocysteine (tHcy) has been shown to predict de novo and recurrent cardiovascular events in many studies. However, results in diabetic populations with minimal nephropathy are mixed. The independent relationship between tHcy and arteriosclerotic outcomes and congestive heart failure (CHF) events in a population with high cardiovascular risk and diabetic nephropathy was examined. A total of 1575 individuals were enrolled in the international Irbesartan Diabetic Nephropathy Trial (IDNT) and followed for 2.6 yr. All participants had baseline diabetic nephropathy, overt proteinuria, and hypertension and were recruited between 1996 and 1999. A total of 492 total arteriosclerotic outcomes (primary outcome) and 317 CHF events (secondary outcome) were tallied. Established cardiovascular risk factors were highly prevalent, as were high tHcy levels (quintiles [microM]: first 4.5 to 11; second >11 to 13; third >13 to 15; fourth >15 to 19; fifth >19). No association between tHcy and arteriosclerotic outcomes was observed in a univariate model or after adjustment for study randomization and established cardiovascular risk factors. The strongest outcome predictor was the presence of baseline cardiovascular disease, followed by an inverse relationship to diastolic BP. The significant univariate association between tHcy and CHF events disappeared when serum creatinine alone was added to the model. These findings question the utility of tHcy in predicting de novo or recurrent cardiovascular events in individuals with diabetic nephropathy. Further studies are needed to confirm whether these negative results apply to other populations with heavy cardiovascular risk burdens. Previous positive findings can potentially be explained through tHcy's role as a sensitive surrogate marker for kidney disease, itself a recognized cardiovascular risk factor.
View details for PubMedID 16162814
C-reactive protein as a predictor of total arteriosclerotic outcomes in type 2 diabetic nephropathy.
Journal: Kidney international
Authors: Friedman AN; Hunsicker LG; Selhub J; Bostom AG; Collaborative Study Group;
Publication Date: 2005 Aug

Abstract

The inflammatory marker C-reactive protein (CRP) has been found in most, but not all, prospective studies to be associated with future cardiovascular outcomes. However, CRP has not been tested in the high-cardiovascular risk population of type 2 diabetic nephropathy.
View details for PubMedID 16014055