Autonomic cardiovascular alterations as therapeutic targets in chronic kidney disease

Abstract Purpose The present paper will review the impact of different therapeutic interventions on the autonomic dysfunction characterizing chronic renal failure. Methods We reviewed the results of the studies carried out in the last few years examining the effects of standard pharmacologic treatment, hemodialysis, kidney transplantation, renal nerve ablation and carotid baroreceptor stimulation on parasympathetic and sympathetic control of the cardiovascular system in patients with renal failure. Results Drugs acting on the renin–angiotensin system as well as central sympatholytic agents have been documented to improve autonomic cardiovascular control. This has also been shown for hemodialysis, although with more heterogeneous results related to the type of dialytic procedure adopted. Kidney transplantation, in contrast, particularly when performed together with the surgical removal of the native diseased kidneys, has been shown to cause profound sympathoinhibitory effects. Finally, a small amount of promising data are available on the potential favorable autonomic effects (particularly the sympathetic ones) of renal nerve ablation and carotid baroreceptor stimulation in chronic kidney disease. Conclusions Further studies are needed to clarify several aspects of the autonomic responses to therapeutic interventions in chronic renal disease. These include (1) the potential to normalize sympathetic activity in uremic patients by the various therapeutic approaches and (2) the definition of the degree of sympathetic deactivation to be achieved during treatment.

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Inflammation in chronic kidney disease: sources, consequences and anti-inflammatory therapy.

Clinical Medicine (Russian Journal) ◽

10.18821/0023-2149-2018-96-4-314-320 ◽

2018 ◽

Vol 96 (4) ◽

pp. 314-320

Author(s):

K. A. Aitbaev ◽

Ilkhom T. Murkamilov ◽

V. V. Fomin ◽

J. A. Murkamilova ◽

Z. R. Rayimzhanov ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Renal Failure ◽

Kidney Disease ◽

Filtration Rate ◽

Microbiological Quality ◽

Therapeutic Interventions ◽

Low Grade ◽

Low Grade Inflammation ◽

Additional Role

The role of various factors contributing to the development of systemic persistent low-grade inflammation in chronic kidney disease (CKD) is considered. It is reported that inflammation in patients with CKD is directly correlated with the glomerular filtration rate (GFR) and culminates in the terminal stage of renal failure, where extracorporeal factors such as dialysate contaminants, dialysate microbiological quality and the biocompatibility of factors in the dialysis chain play an additional role. The effectiveness of therapeutic interventions aimed at correcting inflammation in patients with CKD is discussed. Further investigations are needed to evaluate the effects of these interventions on hard outcomes, as well as to better understand the role of inflammation in selected CKD populations, particularly in children.

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Renal Nerve Ablation for Hypertensive Patients with Chronic Kidney Disease

Current Vascular Pharmacology ◽

10.2174/15701611113119990143 ◽

2014 ◽

Vol 12 (1) ◽

pp. 47-54 ◽

Cited By ~ 8

Author(s):

Papademetriou V. ◽

Doumas M. ◽

Anyfanti P. ◽

Faselis C. ◽

Kokkinos P. ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Renal Nerve ◽

Hypertensive Patients ◽

Renal Nerve Ablation

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KUALITAS HIDUP PASIEN GAGAL GINJAL KRONIS DENGAN TERAPI HEMODIALISA

Jurnal Ilmiah Perawat Manado (Juiperdo) ◽

10.47718/jpd.v8i01.1183 ◽

2021 ◽

Vol 8 (02) ◽

pp. 21-32

Author(s):

Ns Nolla Lisa Lolowang ◽

Welmin M.E Lumi ◽

Amelia A. Rattoe

Keyword(s):

Quality Of Life ◽

Chronic Kidney Disease ◽

Renal Failure ◽

Chronic Renal Failure ◽

Kidney Disease ◽

Poor Quality ◽

Therapeutic Interventions ◽

Building Relationships ◽

Education Support

ABSTRAK Gagal ginjal kronis merupakan penyakit yang berkepanjangan, sangat berbahaya, asimptomatik sejak tahap awalnya. Perlu untuk mengetahui dan mengevaluasi kualitas hidup pasien gagal ginjal kronis yang menjalani terapi hemodialisa sehingga dapat memberikan masukan kepada perawat dalam menetapkan intervensi terapeutik dalam membangun hubungan, memberikan dukungan secara komprehensif kepada pasien dan keluarga. Tujuan penelitian ini adalah memberikan gambaran kualitas hidup pasien gagal ginjal kronis dengan terapi hemodialisa. Desain penelitian adalah deskriptif, dengan metode sampel adalah total sampling, 45 responden. Data dianalisis secara univariat untuk mengetahui frekuensi dan persentase. Hasil penelitian menunjukkan kualitas hidup pasien gagal ginjal kronis dengan terapi hemodialisa bervariasi antara baik dan buruk. 17 orang (37.8%) memiliki kualitas hidup buruk pada domain kesehatan, 6 orang (13.3%) memiliki kualitas hidup buruk pada domain psikologis, 14 orang (31.1%) memiliki kualitas hidup buruk pada domain hubungan sosial dan 6 orang (13.3) memiliki kualitas hidup yang buruk pada domain lingkungan. Peran perawat dalam memberikan edukasi, dukungan dan motivasi sangat diperlukan untuk meningkatkan kualitas hidup pasien gagal ginjal kronis yang menjalani terapi hemodialisa. Kata-kata kunci: kualitas hidup, hemodialisa, gagal ginjal kronis. ABSTRACT Chronic renal failure is a prolonged, very dangerous, asymptomatic disease from its early stages. It is necessary to know and explain the quality of life of patients with chronic kidney disease who undergo hemodialysis therapy so that they can give advice to nurses in determining therapeutic interventions in building relationships, providing comprehensive support to patients and their families. The aim of this study was to offer an overview of the quality of life of patients with chronic renal failure with hemodialysis therapy. The research design is descriptive with the sampling method is total sampling, 45 respondents. Data were analyzed to find the frequency and percentage. The results showed that the quality of life of patients with chronic renal failure with hemodialysis therapy varied between good and bad. 17 people (37.8%) had a poor quality of life in the health domain, 6 people (13.3%) had a poor quality of life in the psychological domain, 14 people (31.1%) had a poor quality of life in the social relationship domain and 6 people (13.3) had quality bad life in the environmental domain. The role of nurses in providing education, support, and motivation is needed to improve the quality of life for chronic renal failure patients undergoing hemodialysis therapy. Keywords: quality of life, hemodialysis, chronic kidney disease.

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NAFLD Among Patients With Chronic Kidney Disease and the Effect of Kidney Transplantation

Case Medical Research ◽

10.31525/ct1-nct03866421 ◽

2019 ◽

Author(s):

Keyword(s):

Chronic Kidney Disease ◽

Kidney Transplantation ◽

Kidney Disease

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Faculty Opinions recommendation of The risk of acute renal failure in patients with chronic kidney disease.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1120002.576126 ◽

2008 ◽

Author(s):

David Ellison

Keyword(s):

Chronic Kidney Disease ◽

Renal Failure ◽

Acute Renal Failure ◽

Kidney Disease

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Avaliação da Resiliência em Pacientes com Insuficiência Renal Crônica Submetidos à Hemodiálise / Assessment of Resilience in Patients With Chronic Kidney Disease Undergoing Hemodialysis

REVISTA CIÊNCIAS EM SAÚDE ◽

10.21876/rcsfmit.v6i1.461 ◽

1970 ◽

Vol 6 (1) ◽

pp. 5-13

Author(s):

Renata Izabel dos Santos ◽

Otávia Regina Souza Costa

Keyword(s):

Chronic Kidney Disease ◽

Renal Failure ◽

Health Status ◽

Chronic Renal Failure ◽

Kidney Disease ◽

Renal Insufficiency ◽

Social Economic ◽

Descriptive Study ◽

Psychological Resilience ◽

Resilience Scale

RESUMOObjetivo: Avaliar o nível de resiliência dos portadores de insuficiência renal crônica em tratamento de hemodiálise. Materiais e Métodos: Estudo prospectivo, quantitativo e de abordagem descritiva. A amostra foi constituída por 61 pacientes em tratamento dialítico. Para obtenção dos resultados, foi utilizada a escala de resiliência, desenvolvida por Wagnild e Young (1993) e adaptada por Pesce et al., (2005). Foi aplicado, também, um questionário para caracterização pessoal, familiar, social, econômica e de saúde do grupo. Resultados: Foi constatado que 61% dos pacientes apresentaram tendência à resiliência. O gênero masculino obteve maior pontuação, sugerindo maior tendência à resiliência, bem como os pacientes que são praticantes de uma religião. Conclusão: Os resultados assinalam que os pacientes em tratamento dialítico no hospital apresentam capacidade à resiliência, o que sugere melhor adaptação ao tratamento.Palavras-chave: Avaliação, Resiliência psicológica, Insuficiência renal crônica.ABSTRACTObjective: To evaluate de the level of resilience in patients with chronic renal failure undergoing dialysis. Materials and Methods: Prospective, quantitative and descriptive study. The sample consisted of 61 patients on dialysis. To obtain the results we used Resilience Scale developed by Wagnild and Young (1993) and adapted by Pesce et al., (2005). A questionnaire to characterize personal, familiar, social, economic and health status was applied. Results: It was found that 61% of patients showed trend to resilience. Males had higher scores, suggesting more likelihood to resilience, as well as patients who were practitioners of a religion. Conclusion: The results indicate that the majority of patients on dialysis have capability of resilience, which suggests better adaptation to treatment.Keywords: Evaluation, Psychological resilience, Chronic renal insufficiency.

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Renal Function as a Predictor of Reamputation After Initial Transmetatarsal Amputation in the Perioperative Period

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00017 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0001

Author(s):

Junho Ahn ◽

Katherine Raspovic ◽

Dane Wukich ◽

George Liu

Keyword(s):

Chronic Kidney Disease ◽

Renal Failure ◽

Renal Function ◽

Kidney Disease ◽

Lower Extremity ◽

Perioperative Period ◽

Improvement Program ◽

Acs Nsqip ◽

Cell Counts ◽

Insulin Dependent

Category: Midfoot/Forefoot Introduction/Purpose: With increasing rates of patients being newly diagnosed with diabetes mellitus, foot complications are becoming more common, which often lead to amputation. Compared to major lower extremity amputations, transmetatarsal amputations (TMA) are associated with lower cost, better function, and more aesthetically satisfactory results for patients. Renal failure has been shown to be a significant predictor of morbidity and mortality in lower extremity amputations at various levels. However, previous reports examining the effect of renal function on reamputation rates after TMA have been mixed. As a result, the purpose of this study was to evaluate renal dysfunction as a risk factor for reamputation after initial TMA during the 30-day perioperative period in a large population database. Methods: Patients under 90 years of age who underwent a TMA between 2012 and 2015 were retrospectively identified in the prospectively collected American College of Surgeons-National Surgical Quality Improvement Program® (ACS-NSQIP®) database using the Current Procedure Terminology (CPT) code 28805. Failure of the initial TMA was defined as reamputation in the 30-day perioperative period through corresponding CPT codes. From these criteria, a total of 1,775 patients were identified. More than 150 unique patient factors were included in the study, but glycated hemoglobin (HbA1C) was not reported by the ACS-NSQIP® database. Diabetes status was categorized into four groups: “Insulin” dependent, “Non-Insulin” dependent, or “None.” Filtration rate was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, and patients were categorized into stages of chronic kidney disease (CKD). Results: Over the 30-day perioperative period, the rate of reamputation after TMA was 6.5%. No statistical differences in age, gender, race, body-mass index, or level of pre-operative functional status were found between groups. Reamputation rates after TMA was significantly correlated with higher white blood cell counts (p<.00001), greater serum creatinine (p=.021), higher blood urea nitrogen (p=.021), type of glycemic control (p=.002), stage of CKD (p=.003), dialysis (p=.001), and pre-operative blood transfusion (p=.042). Stage IV-V CKD was associated with 75% increased odds of reamputation (OR=1.75, 95% CI=1.12-2.73), and higher stage of CKD was associated with greater reamputation rates (p=.003) where stage II CKD had the lowest reamputation rate (3.6%) and stage V with the highest reamputation rate (10.9%). A similar trend was seen with 30-day mortality (p<.00001). Conclusion: In the current study, CKD was significantly correlated with reamputation rates after TMA as well as 30-day mortality. In contrast to a previous report, dialysis was also associated with TMA failure and need for reamputation. Our findings corroborate previous findings correlating dialysis-dependent renal failure and mortality. Whether patients in certain stages of CKD would achieve better outcomes with higher-level amputation rather than a TMA should be investigated in future studies.

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New Potential Biomarkers for Chronic Kidney Disease Management—A Review of the Literature

International Journal of Molecular Sciences ◽

10.3390/ijms22010043 ◽

2020 ◽

Vol 22 (1) ◽

pp. 43

Author(s):

Irina Lousa ◽

Flávio Reis ◽

Idalina Beirão ◽

Rui Alves ◽

Luís Belo ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Clinical Practice ◽

Kidney Disease ◽

Renal Damage ◽

Recent Literature ◽

Therapeutic Interventions ◽

Review Of The Literature ◽

Medical Need ◽

Early Use ◽

Reasonable Approach

The prevalence of chronic kidney disease (CKD) is increasing worldwide, and the mortality rate continues to be unacceptably high. The biomarkers currently used in clinical practice are considered relevant when there is already significant renal impairment compromising the early use of potentially successful therapeutic interventions. More sensitive and specific biomarkers to detect CKD earlier on and improve patients’ prognoses are an important unmet medical need. The aim of this review is to summarize the recent literature on new promising early CKD biomarkers of renal function, tubular lesions, endothelial dysfunction and inflammation, and on the auspicious findings from metabolomic studies in this field. Most of the studied biomarkers require further validation in large studies and in a broad range of populations in order to be implemented into routine CKD management. A panel of biomarkers, including earlier biomarkers of renal damage, seems to be a reasonable approach to be applied in clinical practice to allow earlier diagnosis and better disease characterization based on the underlying etiologic process.

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