scholarly journals Assessment of the 24-hour profle of blood pressure and arterial stiffness in patients with end-stage renal disease

2019 ◽  
Vol 25 (1) ◽  
pp. 66-73
Author(s):  
I. E. Minyukhina ◽  
E. A. Praskurnichiy
Keyword(s):  
Blood Pressure ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Age Groups ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage ◽  
Design And Methods ◽  
Daily Changes

Objective. The purpose of our study was to research specifc features the daily changes of the vascular stiffness (VS) in patients with end-stage renal disease (ESRD) and to assess the feasibility of using the 24-hour vascular index Pulse Time Index of Norm (PTIN) (the percentage of the 24-hour period during which the pulse wave velocity (PWVao) does not exceed 10 m/second) in the management of arterial hypertension (HTN) in patients after renal transplantation (RT).Design and methods. We examined 158 people, divided into 4 comparable age groups: those receiving program hemodialysis (PGD), patients after RT, patients with essential HTN and healthy volunteers. All of them underwent 24-hour blood pressure (BP) monitoring with a daily evaluation of VS indices and central BP. At follow-up, 27 patients from the PG group underwent all assessments also 1 week and 6 months after transplantation.Results. Patients with ESRD compared with patients with essential HTN had elevated PWVao, night central BP and decrease PTIN. PTIN changes were the most signifcant. In 27 patients a week after the RT a decrease in the PTIN was found in most cases. After 6 months the mean PTIN in the whole group increased again. Our study demonstrates HTN persistence after kidney transplantation can be predicted. Two PTIN states could be predicted by the cutoff PTIN value that was determined in the study: a state of improvement and a state of decline/unchanged state. PTIN cutoff value at 45 % was characterized by 69 % sensitivity, 76 % specifcity and AUC of 0,65. Therefore, baseline PTIN ≥ 45 % (before RT) is associated with its further growth, and a favourable course of HTN.Conclusions. Patients receiving replacement therapy, compared to patients with essential HTN, showed a marked increase in the daily VS and the night central BP. The daily PTIN is the most accurate predictor of the changes in the VS index, the PTIN values before the RT at the PG stage allow predicting the course of HTN after the RT

scholarly journals P1159MILD BLOOD PRESSURE VARIABILITY IS ASSOCIATED WITH BETTER SURVIVAL IN PATIENTS WITH END STAGE RENAL DISEASE AND PERITONEAL DIALYSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Hanri Afghahi ◽  
Salmir Nasic ◽  
Khaled Alhomsi ◽  
Henrik Hadimeri ◽  
Helena Rydell ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Renal Disease ◽  
Mortality Risk ◽  
End Stage Renal Disease ◽  
Laboratory Findings ◽  
Risk Of Mortality ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims Recently, variability in blood pressure (BP) has been recognized as a risk factor for mortality and cardiovascular events in the general population. However, most studies included patients with normal or near normal kidney function. Aim To study the association between BP variability and the risk of all-cause mortality in patients with end stage renal disease (ESRD) and peritoneal dialysis (PD) treatment. Method From 2008 until the end of 2017, 2329 patients with ESRD and at least three months of PD (mean age: 63.8 years, men: 67.5%) were followed for 16 months in median (interquartile range: 11-28 months). Data were extracted from the Swedish Renal Register (SNR). The coefficient variation (CV = the ratio of the standard deviation (SD) to the mean value) was defined as BP variability in terms of systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) [SBP(SD)/SBP(mean), DBP(SD)/ DBP(mean), and MAP(SD)/MAP(mean), respectively]. The relationships between BP variability and mortality were examined by time-dependent Cox models to estimate hazard ratios (HR) and 95% confidence intervals (CI) in univariate and multivariate analyses, with adjustment for demographics, laboratory findings and comorbidity. Results During the follow-up period, 1054 (45%) deaths occurred. The mean level of BP variability was CV=0.10± 0.1. The highest rate of mortality was observed in the patients with the highest variability in SBP (CV>0.25; 64% of those patients died). In the multivariate model, for each of the BP variables, we compared the risk of mortality in the lowest variability group (CV≤ 0.05) with that in the CV=0.10-0.15 group (reference): SBP: (HR 1.74, 95% CI 1.44- 2.09; p<0.001); DBP: (HR 1.91, 95% CI 1.59- 2.23; p<0.001); and MAP: (HR 1.73, 95% CI 1.44- 2.06; p<0.001). Thus, for all BP variables, the lowest variability was associated with increased mortality risk. We then compared the highest variability group (CV>0.25) with the CV=0.10-0.15 group (reference): SBP: (HR 1.60, 95% CI 1.14- 2.25; p<0.001); DPB: (HR 1.74, 95% CI 1.44- 2.09; p<0.001); and MAP: (HR 1.98, 95% CI 1.21- 3.27; p<0.001). Thus, for all BP variables, the highest variability was related to increased mortality risk. Conclusion In this study, the association between BP variability and the risk of mortality was U-shaped in patients with ESRD and PD. Thus, both very low and high levels of BP variability were related to higher risk of mortality. Mild BP variability was associated with the lowest risk of mortality, which could suggest that, non-intensive and long duration of ultrafiltration (UF) with PD was probably beneficial in terms of survival

Outcomes of Simultaneous Peritoneal Dialysis and Arteriovenous Fistula Placement in End-Stage Renal Disease Patients

2017 ◽  
Vol 37 (6) ◽  
pp. 658-661 ◽  
Author(s):  
Nosratollah Nezakatgoo ◽  
Albert Ndzengue ◽  
Manhunath Ramaiah ◽  
Elvira O. Gosmanova
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
Arteriovenous Fistula ◽  
End Stage Renal Disease ◽  
Catheter Insertion ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Peritoneal dialysis (PD) interruption requiring hemodialysis (HD) is not uncommon and its frequently abrupt nature prevents timely creation of permanent HD access and avoidance of central venous catheters (CVC). We retrospectively studied a cohort of 24 end-stage renal disease (ESRD) patients (mean age 50.7 years, 83.3% African-Americans, 58.3% females, time on dialysis interquartile range [IQR] 0 - 65 days) who had simultaneous PD catheter insertion and backup arteriovenous fistula (AVF) creation between January 1, 2012, and December 31, 2013. The primary outcome of interest was the percent of patients receiving HD through the backup AVF at the time of PD interruption. A median (IQR) for PD catheter use after its insertion was 10.5 (2 - 20) days. After the mean follow-up of 19.6 months, 12 patients remained on PD, 2 patients received a kidney transplant, and 1 patient died. The overall AVF patency was 66.7%. A total of 9 (37.5%) patients had PD interruption requiring permanent (8 patients) or temporary (1 patient) HD after the mean (standard deviation [SD]) follow-up of 12.3 (8.2) months. Arteriovenous fistula was used as the initial access in 4 patients, and in 3 patients the original AVF was used after additional surgical revision. Forty-four percent of patients with a backup AVF fistula avoided CVC at the time of PD interruption requiring HD. The simultaneous AVF creation at the time of PD catheter insertion reduced but did not fully eliminate CVC at the time of PD interruption. Larger studies are needed to evaluate the utility of a backup AVF in PD patients.

scholarly journals Kidney and Urinary Tract Involvement in Epidermolysis Bullosa: Is Routine Follow-Up Necessary?

2021 ◽  
pp. 2021051
Author(s):  
Neslihan Cicek ◽  
Nurdan Yildiz ◽  
Ruslan Asadov ◽  
Ayse Deniz Yucelten ◽  
Halil Tugtepe ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Renal Disease ◽  
Epidermolysis Bullosa ◽  
End Stage Renal Disease ◽  
Creatinine Ratio ◽  
Tract Involvement ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage

Background: Several renal and urinary tract complications have been reported in patients with epidermolysis bullosa. Objective: This study investigated kidney and urinary tract involvement in patients with epidermolysis bullosa. Patients and Methods: Patients with epidermolysis bullosa in treatment at the Dermatology Unit were included in the study. Glomerular and tubular functions were investigated. Results: The study included 16 patients (4 females, 12 males) of mean 11.1 years (SD = 8.1 years). Estimated GFR was normal in all patients except one with end-stage renal disease. Excluding this patient, the urinary albumin/creatinine ratio and the fractional excretion of sodium were normal. The mean beta-2 microglobulin/creatinine ratio was 278.8 µg/g, and it was abnormally high in 2 patients. The mean tubular phosphorus reabsorption was 92.6%; it was abnormally low in 1 patient. Severe kidney or urinary tract involvement was present in 2 patients with recessive dystrophic EB-generalized severe (RDEB-GS): one patient had obstructive bullous lesions in the urethra; the other had end-stage renal disease secondary to focal segmental glomerulosclerosis and was on peritoneal dialysis for 3 years.   Conclusions:  Assessment for renal and urinary tract involvement should become a routine part of the evaluation of patients with any type of EB, but especially of patients with RDEB-GS. Patients with mild tubular dysfunction need long-term follow-up to detect early deterioration of renal function.

Predictors for the Healing of Transmetatarsal Amputations: Retrospective Study of 91 Amputations

Vascular ◽  
2007 ◽  
Vol 15 (3) ◽  
pp. 126-133 ◽  
Author(s):  
Peter Blume ◽  
Christine Salonga ◽  
Juan Garbalosa ◽  
Daphne Pierre-Paul ◽  
Jonathon Key ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Final Examination ◽  
The Mean ◽  
Group 2 ◽  
Stage Renal Disease ◽  
End Stage ◽  
Group 1

This retrospective study reviewed 80 consecutive patients (mean age 62 years; range 21–91 years) who underwent 91 transmetatarsal amputations (TMAs) between 1995 and 2003. The mean follow-up was 12 ± 1.36 months. Sixty-two TMAs healed initially (group 1), whereas 29 TMAs did not heal by 3 months (group 2). At the final examination, in groups 1 and 2, 63 of 91 (69%) limbs were healed. Of the 28 limbs that did not heal, 25 of 28 (89%) required further proximal amputation. Initial healing correlated significantly with the ability to ambulate ( p < .0001) and overall limb salvage ( p < .0001). In group 1, 20 of 27 (74%) limbs that were revascularized healed ( p = .0336). Nonhealing amputations were associated with end-stage renal disease (13 of 19; 68%) ( p = .0209) and leukocytosis (13 of 19; 68%) ( p = .0052).

MO282EARLY RENAL RECOVERY AFTER A FIRST FLARE OF PAUCI IMMUNE GLOMERULONEPHRITIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Jeremy Zaworski ◽  
Cyrille Vandenbussche ◽  
Pierre Bataille ◽  
Eric Hachulla ◽  
Francois Glowacki ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Interstitial Fibrosis ◽  
Univariate Analysis ◽  
Renal Recovery ◽  
Neurological Involvement ◽  
Factors Associated ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims Renal involvement is a severe manifestation of ANCA-associated vasculitis. Patients often progress to end-stage renal disease. The potential for renal recovery after a first flare has seldom been studied. Our objectives were to describe the evolution of the estimated glomerular filtration rate (eGFR) and identify factors associated with the change in eGFR between diagnosis and follow-up at 3 months (ΔeGFRM0–M3) in a cohort of patients with a first flare of pauci-immune glomerulonephritis. Methods This was a retrospective study over the period 2003–2018 of incident patients in the Nord-Pas-de-Calais (France). Patients were recruited if they had a first histologically-proven flare of pauci immune glomerulonephritis with at least 1 year of follow up. Kidney function was estimated with MDRD-equation and analysed at diagnosis, 3rd, 6th and 12th months. The primary outcome was ΔeGFRM0–M3. Factors evaluated were histological (Berden classification, interstitial fibrosis, percentage of crescents), clinical (extra-renal manifestations, sex, age) or biological (severity of acute kidney injury, dialysis, ANCA subtype). Results One hundred and seventy-seven patients were included. The eGFR at 3 months was significantly higher than at diagnosis (mean ± standard deviation, 40 ± 24 vs 28 ± 26 ml/min/1.73 m2, p &lt; 0.001), with a ΔeGFRM0–M3 of 12 ± 19 ml/min/1.73 m2. The eGFR at 12 months was higher than at 3 months (44 ± 13 vs 40 ± 24 ml/min/1.73m2, p = 0.003). The factors significantly associated with ΔeGFRM0–M3 in univariate analysis were: sclerotic class according to Berden classification, percentage of interstitial fibrosis, percentage of cellular crescents, acute tubular necrosis, neurological involvement. The factors associated with ΔeGFRM0–M3 in multivariate analysis were the percentage of cellular crescents and neurological involvement. The mean increase in eGFR was 2.90 ± 0.06 ml/min/1.73m2 for every 10-point gain in the percentage of cellular crescents. ΔeGFRM0–M3 was not associated with the risks of end-stage renal disease or death in long-term follow-up. Conclusions Early renal recovery after a first flare of pauci-immune glomerulonephritis occurred mainly in the first three months of treatment. The percentage of cellular crescents was the main independent predictor of early renal recovery.

scholarly journals Effects of Variability in Blood Pressure, Glucose, and Cholesterol Concentrations, and Body Mass Index on End-Stage Renal Disease in the General Population of Korea

2019 ◽  
Vol 8 (5) ◽  
pp. 755 ◽  
Author(s):  
Mee Kyoung Kim ◽  
Kyungdo Han ◽  
Hun-Sung Kim ◽  
Yong-Moon Park ◽  
Hyuk-Sang Kwon ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Body Mass Index ◽  
General Population ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
High Variability ◽  
Metabolic Parameters ◽  
Metabolic Parameter ◽  
Stage Renal Disease ◽  
End Stage

Aim: Metabolic parameters, such as blood pressure, glucose, lipid levels, and body weight, can interact with each other, and this clustering of metabolic risk factors is related to the progression to end-stage renal disease (ESRD). The effect of variability in metabolic parameters on the risk of ESRD has not been studied previously. Methods: Using nationally representative data from the Korean National Health Insurance System, 8,199,135 participants who had undergone three or more health examinations between 2005 and 2012 were included in this analysis. Intraindividual variability in systolic blood pressure (SBP), fasting blood glucose (FBG), total cholesterol (TC), and body mass index (BMI) was assessed by examining the coefficient of variation, variability independent of the mean, and average real variability. High variability was defined as the highest quartile of variability and low variability was defined as the lower three quartiles of variability. Results: Over a median (5–95%) of 7.1 (6.5–7.5) years of follow-up after the variability assessment period, 13,600 (1.7/1000 person-years) participants developed ESRD. For each metabolic parameter, an incrementally higher risk of ESRD was observed for higher variability quartiles compared with the lowest quartile. The risk of ESRD was 46% higher in the highest quartile of SBP variability, 47% higher in the highest quartile of FBG variability, 56% higher in the highest quartile of BMI variability, and 108% higher in the highest quartile of TC variability. Compared with the group with low variability for all four parameters, the group with high variability for all four parameters had a significantly higher risk for incident ESRD (hazard ratio (HR) 4.12; 95% CI 3.72–4.57). Conclusions: Variability in each metabolic parameter was an independent predictor of the development of ESRD among the general population. There was a composite effect of the variability in additional metabolic parameters on the risk of ESRD.

scholarly journals Correlation between Calcium Phosphorus Product and Mean Arterial Pressure among Hemodialysis Patients with End Stage Renal Disease

2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Muhammad Nadeem ◽  
Mansoor Abbas Qaisar ◽  
Ali Hassan Al Hakami ◽  
Fateh Sher Chattah ◽  
Muhammad Muzammil ◽  
...  
Keyword(s):  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Hemodialysis Patients ◽  
Age Group ◽  
Calcium Phosphorus ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage

Background: The mean arterial pressure serves as an expression of blood pressure in patients on chronic hemodialysis. Serum calcium phosphorus product is considered as a risk factor of vascular calcification that is associated with hypertension in the patients of end stage renal disease. The literature regarding this relationship is inconsistent therefore this study is designed to determine the correlation between calcium phosphorus product and mean arterial pressure among hemodialysis patients with end stage renal disease. Methods: A total of 110 patients of end stage renal disease on hemodialysis for at least one year, 20 to 60 years of age were included. Patients with primary or tertiary hyperparathyroidism, peripheral vascular disease, malignancy, hypertension secondary to any cause other than kidney disease were excluded. Mean arterial pressure was calculated according to the standard protocol in lying position. Blood samples for estimation of serum calcium and phosphorous were taken and was sent immediately to the laboratory for serum analysis. Results: Mean age was 44.17 ± 10.94 years. Mean calcium phosphorous product was 46.71 ± 7.36 mg/dl and mean arterial pressure was 103.61 ± 12.77 mmHg. The values of Pearson correlation co-efficient (r) were 0.863 for age group 20 to 40 years and 0.589 for age group 41 to 60 years. This strong positive correlation means that high calcium phosphorous product goes with high mean arterial pressure (and vice versa) for both the age groups. Conclusion: A strong positive relationship exists between the mean arterial pressure and calcium phosphorous product and is independent of patients’ age.

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