KIDNEY FAILURE

Diuretics during hospitalization may increase the risk of death.

* THE QUESTION Do diuretic drugs affect the risk of death in critically ill patients with kidney failure?

* PAST STUDIES have shown that physicians routinely prescribe diuretics -- drugs that help remove excess water in the body by increasing urine -- to people with acute renal failure (ARF) even though there are no studies to support this practice. The authors say that ARF patients often have a more pressing problem than inadequate urine -- a problem that calls for dialysis treatment, which takes over kidney function by filtering the blood through a machine.

* THIS STUDY compared complications in 552 ARF patients in the intensive care unit at four academic hospitals, 326 of whom received diuretics on a particular day and 226 who did not. The researchers found that those using diuretics had a 77 percent higher risk of death or not recovering kidney function than those who did not use diuretics. An unspecified number of patients received dialysis during their hospitalization.

* WHO MAY BE AFFECTED BY THESE FINDINGS? Critically ill patients with kidney failure.

* CAVEATS This was not a randomized trial. In addition, the results may not apply to other settings, where the availability of dialysis may vary. Finally, people with very early ARF may benefit from diuretics.

* BOTTOM LINE Hospitalized ARF patients may wish to consult a kidney specialist about starting dialysis instead of using diuretics.

* FIND THIS STUDY Nov. 27 issue of the Journal of the American Medical Association; abstract online at http://jama.ama-assn.org/.

PAIN CONTROL

Ionized bracelets are no better than placebos for pain relief.

* THE QUESTION Do ionized bracelets relieve muscle and joint pain?

* PAST STUDIES have shown that such established treatments for chronic pain as medication and physiotherapy are ineffective for many patients. As a result, some people seek alternatives, even though the value of many of these treatments has not been proven.

* THIS STUDY randomly assigned 610 people with muscle and joint pain to wear either an ionized copper/zinc bracelet -- priced at about $50 and claiming an ability to "relieve pain the natural way" -- or a placebo bracelet for a month. About three-quarters of the participants in both groups reported significant improvement, both at the site of the greatest pain and at all painful sites, such as neck, wrists, back and knees.

* WHO MAY BE AFFECTED BY THESE FINDINGS? People with muscle and joint pain.

* CAVEATS Most participants in the study said they believed that bracelets could help reduce pain.

* BOTTOM LINE People with muscle and joint pain should be aware that ionized bracelets provide no better pain relief than placebo.

* FIND THIS STUDY November issue of the Mayo Clinic Proceedings or www.mayo.edu/proceedings/2002/nov/7711a2.pdf.

HEART DISEASE

Follow-up care by a cardiologist improves chances of survival.

* THE QUESTION Does the type of physician who provides care after a heart attack affect a patient's odds of survival?

* PAST STUDIES have shown that heart attack survivors treated by cardiologists during their hospital stay survive longer than those who receive hospital care from other physicians.

* THIS STUDY extends those findings to outpatient care. The researchers compared the odds of two years of survival in 35,520 heart attack survivors aged 65 or older, some of whom received outpatient care from cardiologists and some from internists or family doctors. The cardiologists' patients had a lower death rate (14.6 percent) than those seen by other doctors (18.3 percent).

* WHO MAY BE AFFECTED BY THESE FINDINGS? Heart attack survivors aged 65 or older.

* CAVEATS The participants were not randomly assigned to one group or the other. In addition, the results may not apply to younger patients.

* BOTTOM LINE Elderly heart attack survivors may wish to arrange follow-up care with a cardiologist. They should also make sure that they receive appropriate medication, such as beta blockers or cholesterol-lowering drugs, that are known to prevent further complications. (The researchers found that many patients did not receive these drugs, regardless of whether they saw a cardiologist or a primary physician.

* FIND THIS STUDY Nov. 21 issue of the New England Journal of Medicine; abstract online at www.nejm.org.

-- Haleh V. Samiei