scholarly journals P1698MULTI- NATIONAL SURVEY AMONG NEPHROLOGISTS AND TRANSPLANT SURGEONS ABOUT THE SUITABILITY AND ACCEPTANCE OF MARGINAL LIVE KIDNEY DONORS WITH MILD HYPERTENSION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Ziad Arabi ◽  
El Waleed El Hassan ◽  
Abdulrahman Altheaby ◽  
Abdullah Hamad ◽  
Kaysi Saleh
Keyword(s):  
Blood Pressure ◽  
Gestational Hypertension ◽  
Blood Pressure Monitoring ◽  
White Coat Hypertension ◽  
Kidney Donation ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Kidney Donors ◽  
Increased Risk ◽  
Alternative Donor

Abstract Background and Aims There is variability among transplant centers in the acceptance of living donor candidates with well-controlled hypertension. Increased gestational hypertension and preeclampsia are more common in donors than in the general population especially if the donor is hypertensive at baseline. The purpose of this survey is to form a consensus about the evaluation of marginal live kidney donors (women and men) with hypertension. Method This is a cross-sectional survey of nephrologists and transplant surgeons about Suitability and Acceptance of The Marginal live Kidney Donors. The survey was sent to nephrologists in different countries and it was also distributed through AST & ERA-EDTA. Results A total of 122 practitioners from 22 countries responded to the survey. Of those, (N=96, 80.2%) were nephrologists and (n=23 19.83%) were transplant surgeons. The majority (45%) of the respondents were from USA. Most of the respondents (N=85, 69.7%) would allow a multiparous female (MPW) with mild and controlled hypertension (on a single blood pressure medication) who is not planning to have more children to donate. The rest would either advise against donation unless there is no alternative donor (n=23, 18.85%), or decline it altogether (n=14, 11.5%). In contrast, more respondents would reject a primiparous donor woman (PPW) with the same clinical scenario who considers having children (n=51, 42.2%, P=0.00001 ), or accept it only if there is no alternative donor (n=46, 38.0%, P=0.0009). Furthermore, most would not allow donation of a 20 years old male ( M) with an apparent white coat hypertension if his 24-hour ambulatory blood pressure monitoring shows non-dipping nocturnal pattern (n=67, 54.9%), or only accept it if there is no alternative donor (n=36, 29.5%). When comparing the rejection rate among the three donors: 11% for MPW, 41% for PPW and 54% for M. (P = 0.0001 for MPW vs PPW; P=0.00001 for MPW vs M; P=0.04 for PPW vs M). Conclusion Most of the nephrologists and transplant surgeons will clear mulptiparous women with mild and controlled hypertension for kidney donation as long as there no further plans for pregnancy. However, the majority of respondents will not clear a hypertensive primiparous due to the increased risk of gestational hypertension and preeclampsia after kidney donation. Most would be also reluctant to accept very young male donors if they show indicators of higher risk of developing hypertension in future.

scholarly journals Comparison of ambulatory blood pressure monitoring and self-blood pressure monitoring for diagnosing white coat hypertension amongst pregnant women

2019 ◽  
Vol 9 (1) ◽  
pp. 274
Author(s):  
Sandeep Sood ◽  
Sirisha Anne ◽  
Kuldeep Kumar Ashta ◽  
Ravi Kumar
Keyword(s):  
Blood Pressure ◽  
Pregnant Women ◽  
Ambulatory Blood Pressure Monitoring ◽  
Ambulatory Blood Pressure ◽  
Gestational Hypertension ◽  
Blood Pressure Monitoring ◽  
Antenatal Clinic ◽  
White Coat ◽  
White Coat Hypertension ◽  
Pressure Monitoring

Background: White coat hypertension (WCH) is a common and well recognized phenomenon. It is also very prevalent amongst pregnant women and is often diagnosed as chronic/ gestational hypertension leading to unnecessary medications during pregnancy. ABPM is the gold standard for diagnosis of WCH. SBPM is an easy effective and reliable method to measure blood pressure but its efficacy needs to be tested and compared with ABPM in cases of WCH. It is important to compare the two methods in assessing WCH so SBPM can be utilized in cases of WCH, if found useful and efficacious.Methods: All pregnant women who presented to the ANC were screened for hypertension. Those who were diagnosed to be hypertensive in antenatal clinic and these patients were then admitted for ambulatory blood pressure monitoring (ABPM) for 24 hours and SBPM on 6 hourly bases for 5 days.Results: The ABPM and SBPB readings were noted, tabulated and compared. It was found that the prevalence of ‘WCH’ in this study using ABPM and SBPM were 47.368% (27/54) and 45.614% (26/54) respectively.Conclusions: The results in diagnosing WCH using ABPM and SBPM were comparable.

scholarly journals P1686MULTI-NATIONAL SURVEY AMONG NEPHROLOGISTS AND TRANSPLANT SURGEONS ABOUT THE SUITABILITY AND ACCEPTANCE OF MARGINAL LIVE KIDNEY DONORS WITH MICROSCOPIC HEMATURIA

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Ziad Arabi ◽  
Kaysi Saleh ◽  
Abdullah Hamad ◽  
Mohammad Bukhari
Keyword(s):  
Kidney Biopsy ◽  
Microscopic Hematuria ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Kidney Donors ◽  
Living Kidney Donors ◽  
Mild Degree ◽  
Alternative Donor ◽  
Isolated Microscopic Hematuria ◽  
American Society

Abstract Background and Aims Potential kidney donors with isolated hematuria are often excluded from donating although there is a wide controversy about the definition and threshold of investigations or exclusion form donation. Many centers use the cut off of > 3 RBC in men and > 5 RBC in women. Some centers consider positive dipstick on urinalysis as the definition of microscopic hematuria. Kidney biopsy in these donors can be borderline and inconclusive. We conducted a short survey about the suitability of these marginal living kidney donors with microscopic hematuria. Method This is a cross-sectional survey of nephrologists and transplant surgeons (TS) about suitability and acceptance of marginal live kidney donors with isolated microscopic hematuria. The question was about a 35-yr. old man non-smoker with isolated microscopic hematuria (4 RBC on repeated UA and trace hematuria on dipstick) and negative imaging. The survey was mainly distributed through American Society of Transplantation, American Society of Transplant Surgeons and European Renal Association-European Dialysis and Transplant Association. In-training nephrologists or transplant surgeons were excluded. Results A total of (n= 122 from 22 countries, 80% nephrologists and 20% TS) responded to the survey. Most respondents were experienced in donor evaluation (72% of physicians have over 6 years’ experience and 68.5% of them perform donors’ evaluation on weekly or monthly bases). Interestingly, at this low level of microscopic hematuria (4 RBC on repeated UA and trace hematuria on dipstick) only very limited number of respondents (7.5%) would allow donation without further work up. Instead, most respondents (n= 75, 63%) would ask for kidney biopsy prior to taking further steps. Many physicians (n=35, 29%) choose to ask for an alternative donor to avoid the hassle of kidney biopsy which may not change the management. There was no difference in acceptance rate for donors between TS and nephrologists (7.2% versus 8.3% respectively, p=NS), requesting kidney biopsy (63.9% vs. 62.5%) or in declining these donors (28.8% versus 29.1%, p=NS). Conclusion Young kidney donors with persistent isolated microscopic hematuria (even at mild degree) require further evaluation with kidney biopsy before donation. However up to one third of the nephrologist and transplant surgeon will ask for an alternative donor to avoid the hassle of kidney biopsy which can be borderline or inconclusive.

scholarly journals Is there a need to redo many of the diagnoses of hypertension?

2012 ◽  
Vol 130 (3) ◽  
pp. 173-178
Author(s):  
José Marcos Thalenberg ◽  
Bráulio Luna Filho ◽  
Maria Teresa Nogueira Bombig ◽  
Yoná Afonso Francisco ◽  
Rui Manuel dos Santos Póvoa
Keyword(s):  
Blood Pressure ◽  
Drug Withdrawal ◽  
Blood Pressure Monitoring ◽  
Target Organ Damage ◽  
Diagnostic Procedures ◽  
White Coat ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Cross Sectional ◽  
Clinical Measurements

CONTEXT AND OBJECTIVE: Most hypertensive subjects undergoing treatment were diagnosed solely through measurements made in the consultation office. The objective of this study was to redo the diagnosis of treated patients after new clinical measurements and ambulatory blood pressure monitoring (ABPM). DESIGN AND SETTING: Cross-sectional study conducted in an outpatient specialty clinic. METHODS: Patients with mild-to-moderate hypertension or undergoing anti-hypertensive treatment, without target organ damage or diabetes, were included. After drug withdrawal lasting 2-3 weeks, new blood pressure (BP) measurements were made during two separate visits. ABPM was performed blindly, in relation to clinical measurements. The BP thresholds used for diagnosing hypertension, white-coat hypertension, normotension and masked hypertension were: 140 (systolic) and 90 (diastolic) mmHg for office measurements and 135 (systolic) and 85 (diastolic) mmHg for mean awake ABPM (MAA). RESULTS: Evaluations were done on 101 subjects (70% women); mean age 51 ± 10 years. The clinical BP was 155 ± 18/97 ± 10 mmHg (first visit) and 150 ± 16/94 ± 11 mmHg (second visit); MAA was 137 ± 13/ 86 ± 10 mmHg. Sixty-four patients (63%) were confirmed as hypertensive, 28 (28%) as white-coat hypertensive, nine (9%) as normotensive and none as masked hypertensive. After ABPM, 37% of the presumed hypertensive patients did not fit into this category. CONCLUSION: This study showed that hypertension was overdiagnosed among hypertensive subjects undergoing treatment. New diagnostic procedures should be performed after drug withdrawal, with the aid of BP monitoring.

scholarly journals May Measurement Month 2019: an analysis of blood pressure screening results from Korea

2021 ◽  
Vol 23 (Supplement_B) ◽  
pp. B89-B91
Author(s):  
Hae-Young Lee ◽  
Gyu Chul Oh ◽  
Il Suk Sohn ◽  
Sungha Park ◽  
Jinho Shin ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Treatment Rate ◽  
Cross Sectional Survey ◽  
Antihypertensive Medications ◽  
Cross Sectional ◽  
Screening Programs ◽  
Increased Risk ◽  
Temporary Solution ◽  
Artery Disease ◽  
Global Initiative

Abstract Hypertension is the biggest contributing risk factor to cerebrovascular disease and is associated with increased risk of coronary artery disease. The May Measurement Month (MMM) campaign is a global initiative aimed at raising awareness of hypertension and acting as a temporary solution to the lack of screening programs worldwide. An opportunistic cross-sectional survey of participants aged ≥18 was carried out during May 2019 in Korea. Over 10 000 participants were recruited in the MMM campaign in Korea, with a slogan of ‘A simple measure to save lives—#checkyourpressure’. A total of 9975 participants with valid clinical and blood pressure (BP) data were used for analysis. All participants were Korean in ethnicity, mean age was 57.2 (SD ± 21.2) years, 57.7% were females, and the mean body mass index was 23.4 kg/m2 (SD ± 3.3). In total, 37.7% of the participants reported a previous diagnosis of hypertension, and 91.3% of those diagnosed were on antihypertensive medications. For other comorbidities, 11.6% reported having diabetes mellitus, 2.0% had previous stroke, and 1.0% had previous myocardial infarction. Mean BP was 130.0/81.0 mmHg in the overall population. After multiple imputation, 47.6% of participants were classified as hypertensive (systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg or on treatment for raised BP). Among all hypertensive participants, the awareness rate, the treatment rate, and the control rate (systolic BP <140 mmHg and diastolic BP <90 mmHg) were 76.2%, 74.0%, and 50.5%, respectively. Of those on antihypertensive medication, the control rate was 68.2%. While awareness and treatment rates were relatively high in the MMM19 campaign, the BP control rate of the total hypertensive population was still only ∼50%, which demands more emphasis on strict BP control.

scholarly journals Extent of Hypertension and Renal Injury in Children Surviving Acute Lymphoblastic Leukemia

2021 ◽  
Author(s):  
Reeti Kumar ◽  
John Mahan ◽  
Joseph Stanek ◽  
Suzanne Reed
Keyword(s):  
Blood Pressure ◽  
Acute Lymphoblastic Leukemia ◽  
Blood Pressure Monitoring ◽  
Lymphoblastic Leukemia ◽  
Survival Rates ◽  
High Survival ◽  
Cross Sectional ◽  
Nocturnal Dipping ◽  
Increased Risk ◽  
High Prevalence

Background: Childhood acute lymphoblastic leukemia (ALL) fortunately has high survival rates, and understanding longer-term implications of therapy is critical. In this study, we aimed to investigate kidney health outcomes by assessing the prevalence of renal dysfunction and hypertension (HTN) in children with ALL at one to five years after ALL diagnosis. Methods: This was a single center, cross-sectional study of children with ALL who were 1-5 years post diagnosis. GFR measurements were calculated, and urine samples were collected to assess for protein/creatinine and albumin/creatinine. Blood pressure (BP) was determined by standard oscillometric technique, and children >6 years of age were eligible for ambulatory blood pressure monitoring (ABPM). Results: Forty-five patients enrolled in the study, 21 completed ABPMs. Fifteen patients (33%, 95% CI: 20-49%) developed AKI at least once. Thirteen (29%, 95% CI: 16-44%) had hyperfiltration, and 11 (24%) had abnormal proteinuria and/or albuminuria. Prevalence of HTN based on clinic measurements was 42%. In the 21 ABPM patients, 14 had abnormal results (67%, 95% CI: 43-85%) with the majority (11/21) demonstrating abnormal nocturnal dipping pattern. . Conclusions: Among children with ALL, there is a high prevalence of past AKI. The presence of hyperfiltration, proteinuria and/or albuminuria at 1-5 years after ALL diagnosis suggest real risk of developing CKD over time. There is a high prevalence of HTN on casual BP readings and even higher prevalence of abnormal ABPM in this group. The high prevalence of impaired nocturnal dipping by ABPM indicates an increased risk for future cardiovascular or cerebral ischemic events.

scholarly journals Utility of 24-hour ambulatory blood pressure monitoring in potential living kidney donors

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Nabeel Aslam ◽  
Sobia H. Memon ◽  
Hani Wadei ◽  
Elizabeth R. Lesser ◽  
Shehzad K. Niazi
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Kidney Donation ◽  
Prior History ◽  
Newly Diagnosed ◽  
Pressure Monitoring ◽  
Kidney Donors ◽  
History Of ◽  
Group 2 ◽  
New Diagnosis

Abstract Introduction Hypertension (HTN) is a risk factor for cardiovascular disease; therefore, it is imperative to risk stratify potential kidney donors during evaluation. Clinic blood pressure (CBP) measurement is inaccurate in assessing presence or absence of HTN. There is paucity of data about utility of 24-h ambulatory blood pressure monitoring (ABPM) during kidney donor evaluation. Methods 24-h ABPM is performed on all kidney donors at Mayo Clinic Florida. We conducted retrospective review of 264 consecutive potential kidney donors from 1/1/2012 to 12/31/2017. Demographic, comorbid conditions, laboratory results and 24-h ABPM data were collected. Subjects were divided into two groups: Group1: Subjects with no prior history of HTN and new diagnosis of HTN using 24-h ABPM; Group 2: Subjects with no prior history of hypertension and normal BP on 24-h ABPM. Results Baseline demographic included mean age 46.40 years, 39% males, 78.4% Caucasians, and mean BMI was 26.94. Twenty one subjects (8.0%) had prior diagnosis of HTN. Among 243 subjects without prior HTN, 62 (25.5%) were newly diagnosed with HTN using 24-h ABPM. CBP was high only in 27 out of 62 (43.6%) of newly diagnosed HTN subjects. Thirty-five subjects (14.4%) had masked HTN and 14 subjects (5.8%) had white-coat HTN. Newly diagnosed hypertensive subjects were more likely to be males as compared to Group 2 (53.2% vs 34.3% P = 0.008). There was a trend of more non-Caucasians subjects (30.6% vs 19.9% P = 0.08) and more active smokers (17.7% vs 11.6%, P = 0.054) in Group1 as compared to Group 2. Only 17 (27.4%) out of 62 newly diagnosed hypertensive subjects were deemed suitable for kidney donation as compared to 105 (58.0%) out of 181 normotensive subjects (P < 0.001). Conclusion In our cohort, use of ABPM resulted in new diagnosis of HTN in 1 out of 4 potential kidney donors. Newly diagnosed HTN was more common in men, those with non-Caucasian race, and in active smokers. There was a significantly reduced acceptance rate for kidney donation among newly diagnosed HTN subjects. Further studies are needed to determine the value of 24-h ABPM among these high risk groups.

scholarly journals Sustained high blood pressure and 24-h ambulatory blood pressure monitoring in Tanzanian adolescents

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mussa K. Nsanya ◽  
Philip Ayieko ◽  
Ramadhan Hashim ◽  
Ezekiel Mgema ◽  
Daniel Fitzgerald ◽  
...  
Keyword(s):  
Blood Pressure ◽  
High Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Cross Sectional Study ◽  
Screening Strategy ◽  
Cross Sectional ◽  
School Settings ◽  
Education And Health ◽  
Screening Algorithm ◽  
Estimate Prevalence

AbstractEstimates for prevalence of high blood pressure (BP) among adolescents in Africa vary widely and few studies, if any, have documented the results of the recommended stepwise BP screening. In this cross-sectional study in Tanzania, we aimed to estimate prevalence of sustained high BP in 3 public secondary schools using the American Academy of Pediatrics BP screening strategy. On Day 1, one screening automated office BP (AOBP) measurement (Step 1) was followed by two more AOBP measurements (Step 2). Repeat AOBP measurements were obtained after about one month on adolescents with high AOBP measurements on Day 1 (Step 3). Participants with sustained high BP underwent 24-h ambulatory BP monitoring (step 4). Of all 500 enrolled participants, the prevalence of high blood pressure at each step in the process was 36.6% (183), 25.6% (128), 10.2% (51), and 2.6%(13) respectively for Steps 1–4. All except 6 students completed all 4 steps of the BP screening algorithm as indicated. We conclude that diagnosis of hypertension in African adolescents should use multiple AOBP measurements over multiple days followed by 24-h ABPM. Screening for high BP in school settings appears to be feasible and could provide a platform for cardiovascular disease education and health promotion.

scholarly journals Risks of Major Mental Disorders and Irritable Bowel Syndrome among the Offspring of Parents with Irritable Bowel Syndrome: A Nationwide Study

2021 ◽  
Vol 18 (9) ◽  
pp. 4679
Author(s):  
Ta-Chuan Yeh ◽  
Ya-Mei Bai ◽  
Shih-Jen Tsai ◽  
Tzeng-Ji Chen ◽  
Chih-Sung Liang ◽  
...  
Keyword(s):  
Irritable Bowel Syndrome ◽  
Mental Disorders ◽  
Autism Spectrum ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Early Implementation ◽  
Increased Risk ◽  
Nationally Representative ◽  
Irritable Bowel

Irritable bowel syndrome (IBS) is a functional bowel disorder that is highly comorbid with mental disorders. However, few studies have examined the risk of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), bipolar disorder, major depressive disorder (MDD), and schizophrenia in the offspring of parents with IBS. We used nationally representative cross-sectional survey data to analyze cross-generational transmission patterns of both IBS and major mental disorders. Odds ratio (OR) was calculated by using logistic regression models with adjustment for potential confounding factors. Offspring of parents with IBS were more likely to develop IBS themselves (OR = 2.41, 95% confidence interval (CI), 2.09–2.78), ADHD (OR = 1.33, 95% CI, 1.08–1.62), and MDD (OR = 1.32, 95% CI, 1.04–1.68) than the controls. Data stratification by parental sex revealed that paternal IBS increased risk of ADHD (OR = 1.34, 95% CI, 1.01–1.77) in the offspring, while maternal IBS increased the risk of MDD (OR = 1.51, 95% CI, 1.11–2.06). This is the first study to reveal parental IBS is associated with IBS, ADHD, and MDD among offspring, suggesting the necessity for early implementation of prevention strategies for at-risk children.

ASSOCIATION BETWEEN CELL PHONE USAGE AND MUSCULOSKELETAL DISORDERS IN SCHOOL GOING CHILDREN

2021 ◽  
Author(s):  
Sujata Mandhwani ◽  
Sadaf Zia ◽  
Emad Salman Shaikh ◽  
Dante Duarte ◽  
Erum Tanveer
Keyword(s):  
Musculoskeletal Disorders ◽  
Cell Phone ◽  
Smart Phone ◽  
Sampling Technique ◽  
The Body ◽  
Camera Phone ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Increased Risk ◽  
Margin Of Error

The adverse effects of excessive mobile phone (MP) use on children include deprivation from sleep, increased risk of lack of concentration, depression, anxiety and obesity. No such study has been conducted in children from Pakistan. Objectives: To assess the association of MP usage and musculoskeletal disorders in school going children. Methods: This was a cross sectional survey. Data were collected from different private schools of Karachi, Pakistan. Convenient non probability sampling technique was used. A sample size of 385 students was taken keeping a confidence interval of 95% with 5% margin of error. Results: A total of 385 subjects participated. It was also noticed that 75.6% (291) students have smart phone and 5.2% (20) have conventional phone and remaining 19.2% (74) have camera phone. It was noticed that the participants 306 (79.5%) said they slept for 1–2[Formula: see text]h daily and 30 (7.8%) had sleep for 3–4[Formula: see text]h daily. One hundred and four 104 (27%) had noticed pain in neck. Conclusion: The use of MP for any activity was associated with sleep deprivation and pain in wrist/hands followed by neck and upper back pain. The usage of MP should be limited to avoid the stress on musculoskeletal parts of the body.

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