An observational study of the effects of telmisartan on insulin resistance in hypertensive patients with chronic kidney disease undergoing hemodialysis

2019 ◽  
Author(s):  
budi suprapti ◽  
Bayu Dharma ◽  
Mahadri Drik ◽  
Zamrottul Izzah ◽  
Wenny Nilamsari ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Antihypertensive Drugs ◽  
Model Assessment ◽  
Hypertensive Patients ◽  
Fasting Plasma ◽  
Homeostatic Model Assessment ◽  
Observational Cohort ◽  
The Mean

Abstract Background In the clinical setting, the activity of telmisartan in decreasing insulin resistance has been proven superior to other antihypertensive drugs in hypertensive patients. However, there has been no published study in determining the effect of telmisartan on insulin resistance in hypertensive chronic kidney disease patients undergoing hemodialysis.Objective To analyze the effect of telmisartan on insulin resistance in hypertensive patients undergoing hemodialysis.Method It was a prospective observational cohort study in 16 chronic kidney disease patients undergoing regular hemodialysis and using telmisartan who met the inclusion criteria.Results Sixteen patients received telmisartan, 12 were male patients and four were female. The mean age was 45 ± 8 years and the mean body mass index was 22.85 ± 1.99. Hypertensive chronic kidney disease was the highest etiology (56%) for hemodialysis. Mean percentage of fasting plasma insulin and homeostatic model assessment of insulin resistance concentratons decreased significantly by 22.6% (P<0.05) and 22.9% (P<0.05) respectively after 3-month administration. On the other hand, the mean percentage of fasting plasma glucose concentrations declined by 2.9% (P=0.187, Zcount<1.96) after 3-month of treatment.Conclusion Administration of telmisartan for three months decreases insulin resistance significantly in hypertensive patients undergoing hemodialysis.

scholarly journals Utilization patterns of antihypertensive drugs in the management of hypertension among patients with chronic kidney disease at a tertiary hospital

2021 ◽  
Vol 10 (5) ◽  
pp. 466
Author(s):  
Abdulrahman Al-Mirza ◽  
Hamad R. Al-Subhi ◽  
Aly M. Abdelrahman
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Antihypertensive Drugs ◽  
Study Cohort ◽  
Channel Blockers ◽  
Antihypertensive Medications ◽  
Hypertensive Patients ◽  
Significant Difference ◽  
Utilization Patterns ◽  
Β Blockers

Background: Objective of the current investigation was to identify the utilization patterns of antihypertensive drugs among hypertensive patients with chronic kidney disease at Sultan Qaboos university hospital.Methods: This is a retrospective study of the utilization patterns of antihypertensive drugs that were prescribed to 181 hypertensive patients with CKD. Patients’ data and drugs’ data were collected from the hospital track care system and analysed.Results: The results show that diuretics were prescribed for 63.53% of the patients followed by β-blockers (61.3%). Drugs were prescribed orally to 90% of the patients. Furosemide was prescribed to 55.8% of patients followed by amlodipine (55.2%). The majority of the patients were on multiple antihypertensive medications (84%). There was no significant difference between drug utilization in patients with albuminuria and those without albuminuria. Among patients with CKD stages two and three, β-blockers were the most common antihypertensive drugs being utilized. Among patients with stage 4 and stage 5, calcium channel blockers and diuretics were the most common antihypertensive drugs being utilized. The prescription of angiotensin II receptor blockers and direct vasodilators showed a significant difference among different stages of CKD.Conclusions: This study showed that diuretics were the most commonly prescribed antihypertensive drugs among the study cohort. The majority of the patients were on multiple antihypertensive medications.

scholarly journals Insulin Resistance in Patients with Essential Hypertension Using Homeostatic Model Assessment

2018 ◽  
Vol 3 (3) ◽  
pp. 104
Author(s):  
Mohammad Hossein Rasoulzadegan ◽  
Hamid Reza Soltani ◽  
Masoud Rahmanian ◽  
Nakisa Amid
Keyword(s):  
Insulin Resistance ◽  
Blood Pressure ◽  
Plasma Insulin ◽  
Density Lipoprotein ◽  
Uncontrolled Hypertension ◽  
Model Assessment ◽  
Fasting Plasma ◽  
Homeostatic Model Assessment ◽  
Fasting Plasma Insulin ◽  
Homeostatic Model

Introduction: Insulin resistance has a strong relationship with the incidence of type II diabetes. It also has a direct relationship with other risk factors of diabetes, which together are known as metabolic syndrome. The aim of this study was to investigate the relationship between insulin resistance and hypertension.Materials and Methods: In this historical cohort study, 90 patients were divided into three different groups: those without hypertension, those with controlled hypertension, and those with uncontrolled hypertension. Systolic and diastolic blood pressure, body mass index, and laboratory test results such as cholesterol, triglycerides, low- density lipoprotein, high-density lipoprotein, fasting plasma glucose, and fasting plasma insulin were compared among the three groups. Data were analyzed with t-tests and the analysis of variance test, which were performed using statistical package for the social sciences version 20 software.Results: Age and sex were the same among the three groups; however, BMI, systolic blood pressure, and diastolic blood pressure in the uncontrolled-hypertension group were higher than in the controlled-hypertension and without-hypertension groups (P<0.05). Lipid profile (P<0.05), creatinine (P=0.77), and uric acid (P=0.233) were not significantly different among the groups, although fasting plasma insulin (P=0.012) and homeostatic model assessment of insulin resistance (P=0.038) were significantly higher in the uncontrolled-hypertension group than in the other groups.Conclusion: Homeostasis model assessment of insulin resistance in patients with uncontrolled hypertension was higher than in patients with controlled hypertension and those without hypertension. Therefore, homeostatic model assessment of insulin resistance can be used as a predictive clinical test for the early diagnosis of diabetes in patients with uncontrolled hypertension.

Abstract 554: Vitamin D in Chronic Kidney Disease is Not Associated with Insulin Resistance

Hypertension ◽  
2014 ◽  
Vol 64 (suppl_1) ◽  
Author(s):  
MARIA INES BARRETO SILVA ◽  
VANESSA VICENTE ◽  
CARLA LEMOS ◽  
MARCIA R KLEIN ◽  
RACHEL BREGMAN
Keyword(s):  
Insulin Resistance ◽  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Kidney Disease ◽  
Serum Levels ◽  
Model Assessment ◽  
Body Adiposity ◽  
Group 2 ◽  
Total Body ◽  
Group 1

INTRODUCTION: Vitamin D deficiency is reported to be associated with Insulin Resistance (IR) in general population. Although the impaired homeostasis of vitamin D and IR are common conditions in chronic kidney disease (CKD), the underlying mechanisms of IR remain unclear and it is not known if vitamin D status is associated with IR in nondialyzed CKD patients. OBJECTIVE: To investigate if serum levels of 25 hidroxivitamin D [25(OH)D] are associated with IR in nondialyzed CKD patients. Methods: Cross-sectional study conducted in nondialyzed CKD outpatients under regular treatment, clinically stable, age≥18 years, estimated glomerular filtration rate (CKD-EPI) (eGFR)≤ 60 ml/min., not using vitamin D, corticosteroids and immunosuppressive drugs and without malignant diseases. Body adiposity: body mass index (BMI); total body adiposity by dual-energy X-ray absorptiometry-DXA; waist-to-height ratio (WheiR). Vitamin D was determined by analysing 25(OH)D by Passing-Bablok method; insulin by radioimmunoassay; Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). Results: Patients included in this study were 158 (men:55%/n=87) nondialyzed CKD patients presenting age=66±13years; eGFR=29±13ml/min.; BMI=26±5kg/m2 (54%/n=86 overweight/obese: BMI>25). Total body adiposity-DXA=34±9% and central body adiposity-WheiR=0.6±0.08. Patients were grouped according to HOMA-IR as: Group 1 (HOMA-IR<2.7; n=110) and Group 2 (HOMA-IR ≥2.7; n=48). VitD levels (ng/ml) were not different (p≥0.05) between Group 1 (27±9) and Group 2 (28±9). Participants were also stratified as: VitD-deficient (<20ng/ml; 25%/n=40) and VitD-no-deficient (≥20 ng/ml; 75%/n=118). VitD-deficient patients compared to VitD-no-deficient presented, respectively, similar values (p≥0.05) of HOMA-IR (median; interquartil interval: 1.7; 1-3 vs. 1.6; 1-3.4), insulin (7; 5-12 vs. 6; 5-13 μU/mL); glucose (105±28 vs. 109±62 mg/dl), glycosylated hemoglobin (GHb=6±1 vs. 6±2 %). No correlation (adjusted for confounders) was observed between VitD with HOMA-IR (r=0.01,p=0.87), insulin (r=0.02,p=0.8), glucose (r=-0.05,p=0.5) and GHb (r=-0.1,p=0.6). Conclusion: The present study suggests that serum levels of 25(OH)D are not associated with IR in nondialyzed CKD patients.

RESISTANT ARTERIAL HYPERTENSION IN PATIENTS WITH CHRONIC KIDNEY DISEASE: PREVALENCE, PROGNOSTIC SIGNIFICANCE, REASONS AND APPROACHES TO ANTIHYPERTENSIVE THERAPY

2019 ◽  
Vol 23 (1) ◽  
pp. 37-44 ◽  
Author(s):  
O. B. Kuzmin ◽  
V. V. Zhezha ◽  
L. N. Landar ◽  
O. A. Salova
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Drug Therapy ◽  
Kidney Disease ◽  
Arterial Hypertension ◽  
Antihypertensive Therapy ◽  
Resistant Hypertension ◽  
Antihypertensive Drugs ◽  
Refractory Hypertension ◽  
Hypertensive Patients

Arterial hypertension (AH) resistant to drug therapy is the phenotype of uncontrolled AH, in which patients receiving at least 3 antihypertensive drugs, including a diuretic, maintain blood pressure above the target level. Initially, the term refractory hypertension was also used to refer to resistant hypertension. Recently, however, refractory hypertension has been isolated into a separate phenotype of difficult to treat hypertension, which is defined as insufficient control of target blood pressure, despite the use of at least 5 different mechanisms of antihypertensive drugs, including long-acting diuretic and antagonist of mineralcorticoid receptors. Resistant hypertension is detected in 10–15 % of all hypertensive patients receiving drug therapy, and is often found in patients with chronic kidney disease. Hypertension can be a cause and/or consequence of kidney damage and is typical of most patients with chronic kidney disease. The lack of control of target blood pressure in a significant proportion of hypertensive patients with CKD who receive at least 3 antihypertensive drugs of different mechanisms of action indicates a lack of effectiveness of antihypertensive therapy, which not only accelerates the loss of renal function, but also significantly worsens the prognosis, contributing to such people risk of cardiovascular and renal complications. The review presents data on the prevalence, prognostic value of resistant hypertension in patients with chronic kidney disease, features of its formation and approaches to increasing the effectiveness of antihypertensive therapy in this patient population.

scholarly journals THE IMPACT OF ANTIHYPERTENSIVE DRUG THERAPY IN PATIENTS WITH CHRONIC KIDNEY DISEASE: A PROSPECTIVE OBSERVATIONAL COHORT STUDY

2019 ◽  
pp. 10-15
Author(s):  
ALMAS SAFINA KAUSER ◽  
HABEEB UNNISA ◽  
AFIFA NAMREEN ◽  
AYESHA SABA ◽  
JAVED AKHTAR ANSARI
Keyword(s):  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Drug Therapy ◽  
Kidney Disease ◽  
Antihypertensive Drugs ◽  
Observational Cohort Study ◽  
Antihypertensive Drug Therapy ◽  
Prospective Observational Cohort Study ◽  
Observational Cohort ◽  
The Impact

Objective: Hypertension (HTN) is both a cause and an effect of chronic kidney disease (CKD). To adequately control blood pressure (BP) in CKD, choosing antihypertensive strategies with the highest nephro-protective effect is crucial for preventing or reversing end-stage renal disease (ESRD) progression and reducing cardiovascular disease (CVD) risk. The present study was therefore designed to evaluate the impact of clinical use of antihypertensive drug therapy in patients with CKD and ESRD. Methods: It is a prospective observational cohort study. The patients were divided into two cohorts i.e.; non-dialysis dependent (NDD) and dialysis-dependent (DD) CKD. This study was conducted for six months in the Nephrology department, Osmania General Hospital, Hyderabad, India. The data collected and entered into Microsoft Excel (2007) and mean, SD and range were calculated using SPSS version 25. Results: Antihypertensive drugs were prescribed alone or in combination based on the co-morbidities associated with CKD and HTN. Loop diuretics (Furosemide and Torsemide) and calcium channel blocker (Amlodipine, Nifedipine and Cilnidipine) were most commonly prescribed antihypertensive drugs. Triple therapy (44.11%) was prescribed mostly in both the cohorts (NDD = 16.66%+DD = 27.45%) of which calcium channel blockers+loop diuretic+sympatholytic accounts for 19.16% (NDD = 5.88%+DD = 13.73%).  Conclusion: The practice of prescribing antihypertensive drugs for the management of HTN and to achieve BP targets in CKD and ESRD remains uncertain. The development of new and revised guidelines is needed to reduce inappropriate variations in practice and promote better delivery of evidence-based treatment.

scholarly journals Is There Any Relation Between Insulin Resistance and Menstrual Irregularity in Obese Women?

2020 ◽  
Author(s):  
Fariba Almassinokiani ◽  
Peyman Akbari ◽  
Fahimeh Soheilipour
Keyword(s):  
Insulin Resistance ◽  
Insulin Level ◽  
Educational Status ◽  
Model Assessment ◽  
Obese Women ◽  
Menstrual Irregularity ◽  
Significant Relation ◽  
Homeostatic Model Assessment ◽  
The Mean ◽  
Menstrual Pattern

Abstract Objectives: Menstrual irregularity is a common issue in obese women that can cause anovulation and infertility. Insulin resistance is also common in obese women. We aimed to find the relation between menstrual pattern and insulin resistance in obese women.Results: The samples were 233 obese women 18-36 years old coming to obesity clinic for treatment of obesity. We checked Homeostatic Model Assessment for Insulin Resistance (HOMA – IR) and lipid profile in the clients and also we filled a form including the age, educational status, marital status, menstrual pattern and severity of hirsutism. Sample size was 233. The mean age of women was 25.6±8 years. The mean Body mass index (BMI) was 44.6±4.8 kg/m2. 84.55% of women had insulin resistance. There was significant relation between menstrual pattern and fasting insulin level (p=0.05). There was no significant relation between presence of Insulin resistance and menstrual pattern (p=0.28). There was significant relation between age and menstrual pattern (p=0.007). Based on the results, there was no significant relation between HOMA- IR and menstrual pattern (p=0.28). Perhaps type of obesity (android) may have relation with menstrual pattern and also we need to a standard IR definition to explain the relation between different findings.

Wrist Circumference: An Independent Predictor of Both Insulin Resistance and Chronic Kidney Disease in an Elderly Population

2013 ◽  
Vol 20 (3) ◽  
pp. 323-329 ◽  
Author(s):  
Adina Mitrea ◽  
Andreea Soare ◽  
Simona Georgiana Popa ◽  
Mirela Nicoleta Tudor ◽  
Maria Mota ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Elderly Population ◽  
Independent Predictor ◽  
Surrogate Marker ◽  
The Elderly ◽  
Control Group ◽  
Model Assessment ◽  
Wrist Circumference

Abstract Background and aim: It was recently reported that wrist circumference is associated with insulin resistance (IR) both in children and adults. We aimed to evaluate whether wrist circumference is a useful anthropometrical parameter for the evaluation of IR in an elderly population. Material and method: We performed a study on 40 subjects, 20 with type 2 diabetes (T2D) and 20 control subjects. IR was evaluated using the homeostasis model assessment of insulin resistance (HOMA-IR). We measured the following anthropometrical parameters: weight, height, waist circumference (WC), hip circumference, wrist circumference, waist to hip ratio (WHR), waist to height ratio (WHtR), body mass index (BMI) and body adiposity index (BAI). Results: We found statistically significant differences between the subjects with T2D and the control group for all the analyzed parameters. Statistically significant correlations between all the anthropometrical parameters and HOMA-IR were observed. However, only WC was an independent predictor of IR. Wrist circumference was the only parameter negatively correlated with the estimated glomerular filtration rate (eGFR). Furthermore, this measurement was an independent predictor of chronic kidney disease (CKD) in the studied subjects. Conclusion: Wrist circumference can be used in the general practice as a surrogate marker of IR in the elderly, being both easily determined and a cost-free method

Prevalence and Correlates of Chronic Kidney Disease in Patients with hypertension in Rural Malawi

2019 ◽  
Author(s):  
Chiyembekezo Kachimanga ◽  
Lawrence Nazimera ◽  
Enoch Ndarama ◽  
Richard Kamwezi ◽  
Limbani Thengo ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Regression Analysis ◽  
Kidney Disease ◽  
Renal Insufficiency ◽  
Medical Records ◽  
Filtration Rate ◽  
Hypertensive Patients ◽  
Ckd Stage ◽  
The Mean ◽  
Very High

Abstract Background The prevalence of chronic kidney disease (CKD) in patients with hypertension is very high in Africa. We investigated the prevalence and correlates of CKD in patients with hypertension attending longitudinal care in rural Malawi, where currently no data on prevalence of CKD in patients with hypertension exists. Methods We retrospectively reviewed medical records of all hypertensive patients who were screened for CKD between January 2018 and April 2019. Screening was done using serum creatinine and CKD epidemiology formula was used to estimate the glomerular filtration rate (eGFR). We used Kidney Disease: Improving Global Outcomes definitions of renal insufficiency and CKD. Logistic regression analysis was used to identify correlates of CKD. Results During the study duration, 1197 patients with hypertension were screened for CKD. The mean creatinine and eGFR was 0.90 mg/dl (Confidence Interval (CI) 0.85-0.94 mg/dl) and 84.1 ml/min/1.73m2 (CI 82.7-85.4 ml/min/1.73m2) respectively. About half of the patients had a normal eGFR (48.3%, n=578) and 36.3% (n=435) had mildly decreased eGFR. The prevalence of renal insufficiency was 15.4% (CI 13.4-17.5, 184/1197) and the prevalence of CKD was 7.1% (CI 5.7-8.7%). By eGFR category in the CKD patients, 41.2% (n=35), 31.8% (n=27), 24.7% (n=21) and 2.3% (n=2) had CKD stage 3a, 3b, 4 and 5 respectively. CKD was strongly associated with age and diabetes. Conclusions We found moderately high renal insufficiency and CKD in this cohort. We propose investing in screening for CKD in patients with hypertension in other clinics in Malawi.

scholarly journals Impact of Long-Term Dexamethasone Therapy on the Metabolic Profile of Patients With 21-Hydroxylase Deficiency

2019 ◽  
Vol 3 (8) ◽  
pp. 1574-1582 ◽  
Author(s):  
Carlos E Seraphim ◽  
Juliana S Frassei ◽  
Bruna S Pessoa ◽  
Renata C Scalco ◽  
Mirela C Miranda ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Metabolic Syndrome ◽  
The Body ◽  
Model Assessment ◽  
Hydroxylase Deficiency ◽  
Homeostatic Model Assessment ◽  
The Mean ◽  
Homeostatic Model ◽  
21 Hydroxylase Deficiency

Abstract Context No consensus has been reached regarding the glucocorticoid (GC) to use for congenital adrenal hyperplasia (CAH) during adulthood. Dexamethasone (DEX), because of its longer half-life, could improve compliance; however, no data are available regarding the long-term effects of DEX therapy. Objective To analyze the metabolic effect of DEX therapy for adults with CAH. Design Retrospective analysis of a CAH cohort receiving DEX therapy. Setting Medical School Hospital, São Paulo University, Brazil. Participants Sixty patients with well-controlled classic CAH (41 women; 30 with salt-wasting) receiving DEX after achievement of final height. Interventions None. Main Outcome Measures Clinical, laboratory, and metabolic data were compared immediately before DEX and at the last evaluation. Results The mean age at the last evaluation was 31.9 ± 9.6 years, and the duration of DEX therapy was 11.5 ± 4.9 years. The mean DEX dose was 0.18 ± 0.07 mg/m2/d. The body mass index SD score (1.6 ± 1.6 vs 1.5 ± 1.5 mg/m2; P = 0.65) and obesity prevalence (27% vs 27%) did not differ between evaluations. However, the waist/height ratio (WtHR) had increased from 0.54 ± 0.08 to 0.56 ± 0.1 (P = 0.001). An increase in the homeostatic model assessment for insulin resistance index (2.5 ± 1.3 vs 2.8 ± 1.7; P = 0.03) was observed and positively correlated with the WtHR (r = 0.54). The prevalence of metabolic syndrome (7% vs 10%; P = 0.7) and hypertension (15% vs 13.3%; P = 0.8) did not differ significantly between the two evaluations. Conclusions Long-term and low-dose DEX therapy did not lead to increases in obesity or metabolic syndrome, although it was associated with an increased WtHR and greater homeostatic model assessment for insulin resistance observed with chronic use of GCs. DEX appears to be an acceptable option to treat adult CAH.

Correlation of Serum Sclerostin Levels with Carotid Intima Media Thickness in Chronic Kidney Disease Hemodialysis

2020 ◽  
Vol 6 (1) ◽  
pp. 18-26
Author(s):  
Adhi Permana ◽  
Ian Effendi ◽  
Taufik Indrajaya
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Vascular Calcification ◽  
Ultrasound Examination ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Media Thickness ◽  
The Mean ◽  
Sclerostin Level ◽  
Hemodialysis Duration

Chronic kidney disease is associated with a high mortality rate, especially cardiovascular disease associated with mineral and bone disorders. Sclerostin is an inhibitor of Wnt signaling which has the effect of increasing the occurrence of vascular calcification in patients with chronic kidney disease. There are several studies that show different results. Carotid intima media thickness ultrasound examination is a tool to identify atherosclerosis which is part of vascular calcification. The aim of this study is to look at the correlation of sclerostin with carotid intima media thickness (CIMT) in patients with chronic kidney disease undergoing hemodialysis. In this cross section, the concentration of sclerostin was measured by examination of enzymed linked immunosorbent assay. CIMT measurement by ultrasound mode B examination. There were 40 patients in this study. The mean sclerostin level was 256.68 ± 127.76 pg / ml. Sclerostin levels are declared high if above 162 pg / ml there are 30 people. CIMT thickening was present in 11 patients. There was no significant correlation of serum sclerostin with CIMT in patients with chronic kidney disease undergoing hemodialysis (r-0.32 p0,847). In multivariate linear regression, hemodialysis duration is an independent factor that is significantly significant with CIMT. There was no significant correlation of serum sclerostin with CIMT in patients with chronic kidney disease undergoing hemodialysis.

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