276 Association of Systolic Blood Pressure and Residual Kidney Function Decline Among Hemodialysis Patients

2021 ◽  
Vol 77 (4) ◽  
pp. 653-654
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Kidney Function ◽  
Hemodialysis Patients ◽  
Residual Kidney Function ◽  
Kidney Function Decline

scholarly journals Individualized Hemodialysis Treatment: A Perspective on Residual Kidney Function and Precision Medicine in Nephrology

2018 ◽  
Vol 9 (2) ◽  
pp. 69-82 ◽  
Author(s):  
Inkyong Hur ◽  
Yong Kyu Lee ◽  
Kamyar Kalantar-Zadeh ◽  
Yoshitsugu Obi
Keyword(s):  
Blood Pressure ◽  
Precision Medicine ◽  
Kidney Function ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Clinical Aspects ◽  
Patient Centeredness ◽  
Mineral And Bone Disorder ◽  
Term Survival ◽  
Residual Kidney Function

Background: Residual kidney function (RKF) is often expected to inevitably and rapidly decline among hemodialysis patients and, hence, has been inadvertently ignored in clinical practice. The importance of RKF has been revisited in some recent studies. Given that patients with end-stage renal disease now tend to initiate maintenance hemodialysis therapy with higher RKF levels, there seem to be important opportunities for incremental hemo­dialysis by individualizing the dose and frequency according to their RKF levels. This approach is realigned with precision medicine and patient-centeredness. Summary: In this article, we first review the available methods to estimate RKF among hemodialysis patients. We then discuss the importance of maintaining and monitoring RKF levels based on a variety of clinical aspects, including volume overload, blood pressure control, mineral and bone metabolism, nutrition, and patient survival. We also review several potential measures to protect RKF: the use of high-flux and biocompatible membranes, the use of ultrapure dialysate, the incorporation of hemodiafiltration, incremental hemodialysis, and a low-protein diet, as well as general care such as avoiding nephrotoxic events, maintaining appropriate blood pressure, and better control of mineral and bone disorder parameters. Key Message: Individualized hemodialysis regimens may maintain RKF, lead to a better quality of life without compromising long-term survival, and ensure precision medicine and patient-centeredness in nephrology practice.

scholarly journals Residual Kidney Function Decline and Mortality in Incident Hemodialysis Patients

2016 ◽  
Vol 27 (12) ◽  
pp. 3758-3768 ◽  
Author(s):  
Yoshitsugu Obi ◽  
Connie M. Rhee ◽  
Anna T. Mathew ◽  
Gaurang Shah ◽  
Elani Streja ◽  
...  
Keyword(s):  
Kidney Function ◽  
Hemodialysis Patients ◽  
Residual Kidney Function ◽  
Kidney Function Decline

scholarly journals Systolic Blood Pressure Can Be Lowered by Strict Volume Control in Hemodialysis Patients

2013 ◽  
Vol 15 (8) ◽  
pp. 607-607
Author(s):  
Hakan Sarlak ◽  
Muharrem Akhan ◽  
Mustafa Dınc ◽  
Mustafa Cakar ◽  
Omer Kurt ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Hemodialysis Patients ◽  
Volume Control

Free vitamin D is independently associated with systolic blood pressure in diabetic patients with impaired kidney function

2021 ◽  
Author(s):  
Shufei Zeng ◽  
Daniela Bachert ◽  
Mira Pavkovic ◽  
Peter Sandner ◽  
Carl-Friedrich Hocher ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Vitamin D ◽  
Systolic Blood Pressure ◽  
Kidney Function ◽  
Diabetic Patients ◽  
Free Vitamin D

Volume management as a key dimension of a high-quality PD prescription

2020 ◽  
Vol 40 (3) ◽  
pp. 282-292 ◽  
Author(s):  
Angela Yee-Moon Wang ◽  
Jie Dong ◽  
Xiao Xu ◽  
Simon Davies
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Kidney Function ◽  
Clinical Care ◽  
Small Sample ◽  
Volume Status ◽  
Volume Control ◽  
High Quality ◽  
Volume Management ◽  
Residual Kidney Function

Background: Appropriate volume control is one of the key goals in a peritoneal dialysis (PD) prescription. As such it is an important component of the International Society of Peritoneal Dialysis (ISPD) guideline for “High-quality PD prescription” necessitating a review of the literature on volume management. The workgroup recognized the importance of including within its scope measures of volume status and blood pressure in prescribing high-quality PD therapy. Methods: A Medline and PubMed search for publications addressing volume status and its management in PD since the publication of the 2015 ISPD Adult Cardiovascular and Metabolic Guidelines, from October 2014 through to July 2019, was conducted. Results: There were no randomized controlled trials on blood pressure intervention and six randomized trials of bioimpedance-guided volume management. Generally, all studies were of small sample size, short duration, and used surrogate markers as primary outcomes. As a consequence, only “practice points” were drawn. High-quality goal-directed PD prescription should aim to achieve and maintain clinical euvolemia taking residual kidney function and its preservation into account, so that both fluid removal from peritoneal ultrafiltration and urine output are considered and residual kidney function is not compromised. Blood pressure should be included as a key objective parameter in assessing the quality of PD prescription but there is currently no evidence for a specific target in PD. Clinical examination remains the keystone of routine clinical care. Conclusions: High-quality goal-directed PD prescription should include volume management as one of the key dimensions.

P1445ESPECIALLY HYPOKALEMIA IS A RISK FACTOR FOR ALL-CAUSE MORTALITY IN INCIDENT HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Esther De Rooij ◽  
Friedo W Dekker ◽  
Saskia Le Cessie ◽  
Johan W De Fijter ◽  
Ellen K Hoogeveen
Keyword(s):  
Risk Factor ◽  
Kidney Function ◽  
Serum Potassium ◽  
Potassium Level ◽  
Proportional Hazards Model ◽  
Serum Potassium Level ◽  
Hemodialysis Patients ◽  
Cox Proportional Hazards Model ◽  
Residual Kidney Function ◽  
All Cause Mortality

Abstract Background and Aims Both hypo- and hyperkalemia can potentially induce fatal cardiac arrhythmias in the general population. However, little is known about the effect of potassium as a modifiable risk factor in hemodialysis (HD) patients. Therefore, we investigated the relation between serum potassium level and all-cause mortality in incident HD patients and whether there is an optimum serum potassium level to pursue. Method All incident HD patients (>18 y) from the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD), a prospective multi-center cohort study, were included. These patients were followed from the start of their first dialysis treatment until death, transplantation or a maximum of 2 years. Serum potassium levels were obtained at fixed 6-month time intervals and divided into six categories: ≤ 4.0, > 4.0 - ≤ 4.5, > 4.5 - ≤ 5.0, > 5.0 - ≤ 5.5 (reference), > 5.5 - ≤ 6.0 and > 6.0 mmol/L. Using a Cox proportional-hazards model with serum potassium category as a time-dependent variable, hazard ratios (HR) for all-cause mortality were calculated, adjusted for baseline age, sex, current smoking, diabetes and residual kidney function. Results In total, 1278 HD patients were included. At baseline, mean (±SD) age was 64 (±14) years, 60% were men, 23% were current smokers, 21% had diabetes and the median (interquartile range) residual kidney function was 3.0 (1.5-4.8) ml/min/1.73m2. Mean (±SD) serum potassium level was 4.8 (±0.8) mmol/L. The prevalence of the six potassium categories was: 10%, 19%, 26%, 22%, 15% and 8%, respectively. A total of 298 (23%) deaths was observed during 2 years of follow-up. After multivariable adjustment the HR (95% CI) for any death according to the six potassium categories were: 2.5 (1.5-4.3), 1.9 (1.2-3.0), 1.6 (1.0-2.5), 1 (reference), 1.3 (0.8-2.2) and 1.7 (1.0-3.0). Conclusion We found a U-shaped relation between serum potassium and all-cause mortality in incident hemodialysis patients. Especially, low serum potassium was a 2.5-fold stronger risk factor for all-cause mortality compared to normal serum potassium. Our results indicate an optimum serum potassium level between 5.0 - 5.5 mmol/L, emphasizing that potassium lowering therapy should be used with caution in hemodialysis patients.

Assessment of Coronary Artery Disease in Hemodialysis Patients with Delayed Systolic Blood Pressure Response after Exercise Testing

2005 ◽  
Vol 23 (6) ◽  
pp. 466-472 ◽  
Author(s):  
Masayoshi Fukui ◽  
Yasukiyo Mori ◽  
Kazuya Takehana ◽  
Hiroya Masaki ◽  
Masayuki Motohiro ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Systolic Blood Pressure ◽  
Exercise Testing ◽  
Blood Pressure Response ◽  
Hemodialysis Patients ◽  
Pressure Response ◽  
Artery Disease

Predialysis Systolic Blood Pressure Evolution in Incident Hemodialysis Patients: Effects of the Dry Weight Method and Prognostic Value

2012 ◽  
Vol 33 (4) ◽  
pp. 275-283 ◽  
Author(s):  
Charles Chazot ◽  
Cyril Vo-Van ◽  
Patrik Deleaval ◽  
Christie Lorriaux ◽  
Jean Marc Hurot ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Prognostic Value ◽  
Dry Weight ◽  
Hemodialysis Patients ◽  
Weight Method ◽  
Pressure Evolution

scholarly journals Plasma osteoprotegerin levels are associated with glycaemic status, systolic blood pressure, kidney function and cardiovascular morbidity in type 1 diabetic patients

2006 ◽  
Vol 154 (1) ◽  
pp. 75-81 ◽  
Author(s):  
Lars Melholt Rasmussen ◽  
Lise Tarnow ◽  
Troels Krarup Hansen ◽  
Hans-Henrik Parving ◽  
Allan Flyvbjerg
Keyword(s):  
Blood Pressure ◽  
Type 1 Diabetes ◽  
Systolic Blood Pressure ◽  
Kidney Function ◽  
Vascular Complications ◽  
Diabetic Patients ◽  
Diabetic Vascular Complications ◽  
Patients With Diabetes ◽  
Type 1 Diabetic Patients

Objective: The bone-related peptide osteoprotegerin (OPG) has recently been found in increased amounts in the vasculature in diabetes. It is produced by vascular smooth muscle and endothelial cells, and may be implicated in the development of vascular calcifications. OPG is present in the circulation, where increased amounts have been observed in patients with diabetes. In this study, we examined whether plasma OPG is associated with the glycaemic and vascular status of patients with type 1 diabetes. Methods: Two gender-, age- and duration-comparable groups of type 1 diabetic patients either with (n = 199) or without (n = 192) signs of diabetic nephropathy were studied. Plasma OPG was determined by an ELISA. Results: The plasma OPG concentration was significantly higher in patients with nephropathy than those without (3.11 (2.49–3.99) vs 2.57 (2.19–3.21) (median (interquartiles), ng/ml), P < 0.001). Plasma OPG correlated with haemoglobin A1c (HbA1c), systolic blood pressure and age in both groups and, in addition, with kidney function in the nephropathic group. These correlations remained significant in multivariate models. In addition, we found that plasma OPG concentrations were increased among patients with cardiovascular diseases (CVD), both in the normoalbuminuric and the nephropathic groups. The differences between nephropathic and normoalbuminuric, as well as subgroups with and without CVD, could largely be ascribed to changes in HbA1c, age, systolic blood pressure and creatinine. Conclusion: OPG is associated with glycaemic control and CVD in patients with type 1 diabetes, compatible with the hypothesis that OPG is associated with the development of diabetic vascular complications.

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