Relationship among Left Ventricular Hypertrophy, Cardiovascular Events, and Preferred Blood Pressure Measurement Timing in Hemodialysis Patients

This study aimed to identify the ideal timing and setting for measuring blood pressure (BP) and determine whether the left ventricular mass index (LVMI) is an independent risk factor associated with increased cardiovascular events in hemodialysis (HD) patients. BP and LVMI were measured at baseline and at 6 and 12 months after HD initiation. BP was monitored and recorded at nine different time points, including before and after HD over a one-week period (HDBP). The mean BP measurement was calculated as the weekly averaged BP (WABP). LVMI was significantly correlated with home BP, in-office BP, HDBP, and WABP. Receiver operating characteristic analysis indicated that the cutoff LVMI value for cardiovascular events was 156 g/m2. LVMI and diabetes mellitus were significant influencing factors for cardiovascular events (hazards ratio (95% confidence interval): diabetes mellitus, 2.84 (1.17,7.45); LVMI > 156 g/m2, 2.86 (1.22,6.99)). Pre-HDBP, post-HDBP, and WABP were independently associated with higher LVMI in the follow-up periods. Hemoglobin and human atrial natriuretic peptide (hANP) levels were associated with LVMI beyond 12 months after HD initiation. Treatment of hypertension, overhydration based on hANP, and anemia may reduce the progression of LVMI and help identify HD patients at high risk for cardiovascular events.

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The relationship between diastolic blood pressure and the risk of cardiovascular events in patients with atrial fibrillation: the Fushimi AF registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.1168 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Ikeda ◽

M Iguchi ◽

H Ogawa ◽

Y Aono ◽

K Doi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Blood Pressure ◽

Diastolic Blood Pressure ◽

Cardiovascular Events ◽

Left Ventricular ◽

Cox Proportional Hazards ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

The Impact

Abstract Background Hypertension is one of the major risk factors of cardiovascular events in patients with atrial fibrillation (AF). However, relationship between diastolic blood pressure (DBP) and cardiovascular events in AF patients remains unclear. Methods The Fushimi AF Registry is a community-based prospective survey of AF patients in Japan. Follow-up data were available in 4,466 patients, and 4,429 patients with available data of DBP were examined. We divided the patients into three groups; G1 (DBP<70 mmHg, n=1,946), G2 (70≤DBP<80, n=1,321) and G3 (80≤DBP, n=1,162), and compared the clinical background and outcomes between groups. Results The proportion of female was grater in G1 group, and the patients in G1 group were older and had higher prevalence of heart failure (HF), diabetes mellitus (DM), chronic kidney disease (CKD). Prescription of beta blockers was higher in G1 group, but that of renin-angiotensin system-inhibitors and calcium channel blocker was comparable. During the median follow-up of 1,589 days, in Kaplan-Meier analysis, the incidence rates of cardiovascular events (composite of cardiac death, ischemic stroke and systemic embolism, major bleeding and HF hospitalization during follow up) were higher in G1 group and G3 group than G2 group (Figure 1). When we divided the patients based on the systolic blood pressure (SBP) at baseline (≥130 mmHg or <130 mmHg), the incidence of rates of cardiovascular events were comparable among groups. Multivariate Cox proportional hazards regression analysis including female gender, age (≥75 years), higher SBP (≥130 mmHg), DM, pre-existing HF, CKD, low left ventricular ejection fraction (<40%) and DBP (G1, G2, G3) revealed that DBP was an independent determinant of cardiovascular events (G1 group vs. G2 group; hazard ratio (HR): 1.40, 95% confidence intervals (CI): 1.19–1.64, G3 group vs. G2 group; HR: 1.23, 95% CI: 1.01–1.49). When we examined the impact of DBP according to 10 mmHg increment, patients with very low DBP (<60 mmHg) (HR: 1.50,95% CI:1.24–1.80) and very high DBP (≥90 mmHg) (HR: 1.51,95% CI:1.15–1.98) had higher incidence of cardiovascular events than patients with DBP of 70–79 mmHg (Figure 2). However, when we examined the impact of SBP according to 20 mmHg increment, SBP at baseline was not associated with the incidence of cardiovascular events (Figure 3). Conclusion In Japanese patients with AF, DBP exhibited J curve association with higher incidence of cardiovascular events. Funding Acknowledgement Type of funding source: None

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Twenty-four-hour and office blood pressure measurement in a comprehensive assessment of the effectiveness of 12-week therapy with a triple fixed-dose combination of amlodipine/indapamide/perindopril in hypertensive patients in actual clinical practice

Russian Journal of Cardiology ◽

10.15829/1560-4071-2021-4498 ◽

2021 ◽

Vol 26 (5) ◽

pp. 4498

Author(s):

V. M. Gorbunov ◽

Yu. A. Karpov ◽

E. V. Platonova ◽

Ya. N. Koshelyaevskaya

Keyword(s):

Blood Pressure ◽

Clinical Practice ◽

Antihypertensive Therapy ◽

Blood Pressure Measurement ◽

Fixed Dose Combination ◽

Fixed Dose ◽

Actual Clinical Practice ◽

Dose Combination ◽

The Mean

Aim. To study the efficacy and safety of the triple fixed-dose combination (FDC) of amlodipine/indapamide/perindopril on blood pressure (BP) profile in patients with grade I-II hypertension (HTN) in actual clinical practice.Material and methods. Data from 54 patients with paired 24-hour ambulatory BP monitoring (ABPM) data were included in the TRICOLOR subanalysis (ClinicalTrials. gov study ID — NCT03722524). The mean 24-hour, daytime, and nighttime BP were calculated at baseline and after 12-week follow-up. We determined the proportion of patients with nocturnal HTN (≥120/70 mm Hg) and nocturnal hypotension (<100/60 and <90/50 mm Hg) initially and after 12 weeks of triple FDC therapy. Patients with nocturnal BP decrease included dippers (D; 10-20%), reduced dippers (RD; 0-10%) and extreme dippers (ED; >20%), as well as those without nocturnal BP decrease (>0%, non-dipper (ND)). The smoothness index (SI) was analyzed as the ratio of the mean hourly SBP fall to its mean standard deviation in paired ABPM. To assess the BP phenotypes, two methods were used with reference values of <130/80 and <140/90 mm Hg for ABPM and office BP, respectively. Controlled hypertension (CHT), uncontrolled hypertension (UHT), white coat hypertension (WHT) and masked ineffectiveness of antihypertensive therapy were distinguished.Results. Among 1247 participants of the TRICOLOR study, 54 patients with valid paired ABPM were selected (men, 46%; mean age, 57,7 [12,1] years; mean office BP, 150,4 [16,6]/93,3 [10,7] mm Hg; HTN duration, 8,3 [7,5] years). Initially, the mean 24-hour, daytime and nighttime BP was 141,1 [15,4]/85,9 [9,9], 144,2 [15,5]/88,8 [10,5] and 132,6 [18,0]/78,1 [9,9] mm Hg, respectively. After 12-week follow-up, the mean 24-hour, daytime and nighttime BP was 123,1 [10,5]/75,6 [8,5], 125,7 [10,9]/77,9 [8,7] and 115,4 [10,2]/68,6 [8,8] mm Hg, respectively (p<0,001). After 12-week follow-up, the proportion of patients with nocturnal hypertension decreased from 64,8% to 25,0% (2,6 times) (p<0,001). The proportion of NDs and EDs decreased from 16,7% and 7,4% to 5,8% and 0%, respectively (p=0,048); the proportion of patients with RD and D patterns increased from 42,6% and 33,3 to 57,7% and 36,5%, respectively (p=0,048). With triple FDC therapy, the SI during the day was higher than 0,73 in half of the cases. According to the two methods, the proportion of patients with UHT decreased from 81,6% to 4,4%, WHT from 12,2% to 0%. The prevalence of CHT increased from 4,1% to 57,8%, while masked ineffectiveness of antihypertensive therapy — from 2,0% to 37,8%.Conclusion. Twelve-week FDC therapy of amlodipine/indapamide/perindopril led to a significant fall in the mean 24-hour, daytime and nighttime BP values. Comprehensive analysis of two techniques (24-hour and office BP measurement) identified patients requiring further triple FGC titration.

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Feasibility of a New Cuffless Device for Ambulatory Blood Pressure Measurement in Patients With Hypertension: Mixed Methods Study (Preprint)

10.2196/preprints.11164 ◽

2018 ◽

Author(s):

Paula AM Ogink ◽

Jelske M de Jong ◽

Mats Koeneman ◽

Mariska Weenk ◽

Lucien JLPG Engelen ◽

...

Keyword(s):

Blood Pressure ◽

Qualitative Interviews ◽

Blood Pressure Measurement ◽

Home Blood Pressure ◽

Strongly Correlated ◽

User Friendliness ◽

Validated Questionnaire ◽

System Usability Scale ◽

The Mean

BACKGROUND Frequent home blood pressure (BP) measurements result in a better estimation of the true BP. However, traditional cuff-based BP measurements are troublesome for patients. OBJECTIVE This study aimed to evaluate the feasibility of a cuffless device for ambulatory systolic blood pressure (SBP) measurement. METHODS This was a mixed method feasibility study in patients with hypertension. Performance of ambulatory SBPs with the device was analyzed quantitatively by intrauser reproducibility and comparability to a classic home BP monitor. Correct use by the patients was checked with video, and user-friendliness was assessed using a validated questionnaire, the System Usability Scale (SUS). Patient experiences were assessed using qualitative interviews. RESULTS A total of 1020 SBP measurements were performed using the Checkme monitor in 11 patients with hypertension. Duplicate SBPs showed a high intrauser correlation (R=0.86, P<.001). SBPs measured by the Checkme monitor did not correlate well with those of the different home monitors (R=0.47, P=.007). However, the mean SBPs measured by the Checkme and home monitors over the 3-week follow-up were strongly correlated (R=0.75, P=.008). In addition, 36.4% (n=4) of the participants performed the Checkme measurements without any mistakes. The mean SUS score was 86.4 (SD 8.3). The most important facilitator was the ease of using the Checkme monitor. Most important barriers included the absence of diastolic BP and the incidental difficulties in obtaining an SBP result. CONCLUSIONS Given the good intrauser reproducibility, user-friendliness, and patient experience, all of which facilitate patients to perform frequent measurements, cuffless BP monitoring may change the way patients measure their BP at home in the context of ambulant hypertension management.

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EFFECT OF CANDESARTAN ON PARAMETERS OFDAILYBLOOD PRESSURE IN PATIENTS WITH CHRONIC KIDNEYDISEASE ON HEMODIALYSIS

Ukrainian Journal of Nephrology and Dialysis ◽

10.31450/ukrjnd.3(43).2014.05 ◽

2017 ◽

pp. 27-34

Author(s):

V. A. Vizir ◽

О. G. Ovska ◽

A. S. Sadomov

Keyword(s):

Blood Pressure ◽

Cardiovascular Events ◽

Blood Pressure Measurement ◽

Ambulatory Monitoring ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Normal Blood Pressure ◽

Treatment Of Hypertension ◽

Before And After ◽

Positive Effect

Introduce.Advances of normal blood pressure in patients on program hemodialysis presented a serious problem related disciplines. For verification hypertension used routine blood pressure measurement and ambulatory monitoring to control the pressure in interdialytic time, which is an important predictor of cardiovascular events among these patients. The aim of research was to investigate features ofparameters the ambulatory monitoring of blood pressure in the dynamics after treatment of candesartan in patients receiving renal replacement therapy. Materials and methods: 53patients ongoing chronic hemodialysis were makethe ambulatory monitoring of blood pressure before and after 12–weeks treatment of candesartan (4–32 mg). Results. It was established that the prevalence of hypertension in a population of patients on hemodialysis influenced by candesartan treatment decreased from 53.6 % to 32.1 %. Patients on hemodialysis in 75 % of cases have incresedpulse pressure (> 60 mm Hg), the percentage of which after therapy decreased to 51.8. Prevailing type of daily blood pressure as the treatment and after treatment is «non–dipper». Established that candesartan showed a positive effect in relation to a statistically significant reduction in the average time indices and blood pressure Conclusion: results of the study allowtorecommend candesartan for treatment of hypertension in hemodialysis patients.

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Self-Management of Diabetes Mellitus with Remote Monitoring

International Journal of E-Health and Medical Communications ◽

10.4018/ijehmc.2017010104 ◽

2017 ◽

Vol 8 (1) ◽

pp. 52-61 ◽

Cited By ~ 4

Author(s):

Hayat Mushcab ◽

William George Kernohan ◽

Jonathan Wallace ◽

Roy Harper ◽

Suzanne Martin

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Remote Monitoring ◽

Medical Records ◽

Social Care ◽

Self Management ◽

Remote Monitoring System ◽

Before And After ◽

Patients With Diabetes ◽

The Mean

Purpose: The efficacy of one remote monitoring system was reviewed in order to explore if optimal self-management of diabetes was achieved. Methods: Medical records of 214 patients with diabetes were reviewed from seven diabetes clinics within a single Health & Social Care trust using a remote monitoring solution to help patients self-manage their condition. Data on HbA1c, blood glucose, blood pressure and body mass index were obtained from the patient's medical record, before and after using the remote monitoring solution. Results: The average age of users was 61 years: 60% of the sample were male. The average time living with diabetes was 14 years; the mean duration with remote telemonitoring was 147 days. A greater reduction in HbA1c was seen with female users compared to males 2.37% and 0.87%, respectively. Conclusion: Remote telemonitoring provided the opportunity to collect comprehensive data, allowing patients to be maintained at home, while showing significant improvement in their HbA1c and better overall management of their diabetes

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Outcome of Elderly Population Undergoing Primary PCI in a Tertiary Hospital in Bangladesh

Ibrahim Cardiac Medical Journal ◽

10.3329/icmj.v10i1-2.53999 ◽

2021 ◽

Vol 10 (1-2) ◽

pp. 18-26

Author(s):

Sahela Nasrin ◽

Shitil Ibna Islam ◽

F Aaysha Cader ◽

M Maksumul Haq

Keyword(s):

Myocardial Infarction ◽

Cardiovascular Events ◽

Left Ventricular ◽

Advanced Age ◽

Left Ventricular Ejection ◽

Primary Pci ◽

Female Ratio ◽

Vessel Disease ◽

The Mean

Objective: To evaluate in-hospital and 1-year outcomes of primary percutaneous coronary intervention (PPCI) in elderly patients with ST-elevation myocardial infarction (STEMI). Methods: All patients aged ≥ 65 years presenting with STEMI and undergoing PPCI at Ibrahim Cardiac Hospital & Research Institute, Bangladesh from January 2015 to August 2017 were consecutively included in the study based on predefined eligibility criteria. Data pertaining to angiographic characteristics, procedural variables, in-hospital and 1-year outcome variables were recorded and analyzed with the help of descriptive statistics and Chi-square Test. Results: The mean age of the patients was 69.2 ± 5.2 (range: 65-85) years with male to female ratio being 4:1. The patients were predominantly diabetic (78%) followed by hypertensive (74%) and dyslipidaemic (70%) smoker (54%). Half of the patients presented with anterior myocardial infarction (MI), 30% had inferior MI, 12% with right ventricular (RV) extension and 8% with inferolateral extension. About one-quarter (24%) had arrhythmia with complete heart block (CHB). The culprit arteries were LAD (50%), followed by RCA (42%) and LCx (8%). Nearly half (46%) had single vessel disease, 34% double and 20% triple vessel disease. Majority (80%) received a single stent and 20% required two stents with mean diameter and length of the stents were 2.9 ± 0.4 mm and 27.3 ± 7.9 mm respectively. Intracoronary eptifibatide was used in 20% cases. In terms of left ventricular ejection fraction (LVEF), 58% and 28% had mild and moderate LV systolic dysfunction respectively. The mean duration of hospital stay was 4.0 ± 1.9 days. About 18% required repeat hospitalization. Overall, 7(14%) patients died (4 during their stay in the hospital due to cardiac cause and 3 during follow up due to non-cardiac causes). At 1 year follow up, in-stent restenosis was seen in 1 case followed by target vessel revascularization (TVR). The Association between age and outcome revealed that advanced age (age ≥ 75 years) was an important predictor of in-hospital and one-year outcome with Relative Risk (RR) of having unfavorable outcome was > 5-fold (95% CI: 1.6-19.5) in patients of advanced age than that in patients of age < 75 years (p = 0.008). Conclusion: Primary PCI is a feasible treatment option for elderly Bangladeshi patients presenting with STEMI with fewer in-hospital and 1-year follow up deaths. Adverse cardiovascular events are even less. Advanced age (age ≥75 years) is an important determinant of adverse cardiovascular events including mortality, probably because of more medical co-morbidities associated with advanced age. Ibrahim Card Med J 2020; 10 (1&2): 18-26

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Changes in Lipids and Lipoproteins after Selective LDL Apheresis (7-Year Experience)

Cholesterol ◽

10.1155/2012/976578 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 5

Author(s):

Genovefa Kolovou ◽

Georgios Hatzigeorgiou ◽

Constantinos Mihas ◽

Nikos Gontoras ◽

Panagiotis Litras ◽

...

Keyword(s):

Cardiovascular Events ◽

Ldl Cholesterol ◽

Plasma Lipids ◽

Ldl Apheresis ◽

Before And After ◽

Premature Cad ◽

The Mean ◽

Lipids And Lipoproteins ◽

Direct Adsorption

Background. The aim of the study was to investigate the changes in plasma lipids and lipoproteins and the cardiovascular events after selective LDL apheresis. Methods and Results. Two pediatric patients with familial hypercholesterolemia aged 11 and 13 years and 19 dyslipidemic adults aged 41 ± 14 years underwent direct adsorption of lipoproteins (DALI) sessions. The mean follow-up period was 47 ± 23 months. The total cholesterol (TC) values before and after treatment were 8.2 ± 2.2 and 3.1 ± 1.6 mmol/l (318 ± 86 and 122 ± 62 mg/dL), respectively. The interval mean of TC was 6.9 ± 1.9 mmol/l (268 ± 75 mg/dL). The LDL cholesterol concentrations before and after treatment were 6.6 ± 2.1 and 1.7 ± 1.1 mmol/l, (256 ± 82 mg/dL and 65 ± 41 mg/dL), respectively. The percentage of acute LDL cholesterol reduction was 75 ± 11%. Cardiovascular events were observed in seven patients. The average annual event rate was 5.51%. Conclusion. LDL apheresis is a very important therapeutic tool in managing patients at high risk for premature CAD or with aggressive CAD, despite adequate medical treatment.

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SAT-563 The Unsuppressed Plasma Renin Activity May Not Enough for Management of Non-Surgically Treated Primary Aldosteronism

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1393 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Takamasa Ichijo ◽

Moe Hayasaka ◽

Takayuki Suzuki ◽

Ayako Suzuki ◽

Manabu Saito ◽

...

Keyword(s):

Blood Pressure ◽

Plasma Renin Activity ◽

Primary Aldosteronism ◽

Cardiovascular Events ◽

Plasma Renin ◽

Renin Activity ◽

Plasma Aldosterone Concentration ◽

Significant Difference ◽

The Mean

Abstract It is well known the primary aldosteronism (PA) is most common endocrinological hypertension and accounted for 10% among all hypertension population, and it develops cardiovascular disease more frequently than blood pressure matched essential hypertension. Those patients with bilateral hyperaldosteronism, called idiopathic hyperaldosteronism (IHA), or unwilling for surgical treatment are treated by mineralcorticoid receptor antagonists (MRAs). Although it had been unclear how titrate MRAs to prevent atherosclerotic cardiovascular events, a managemental target for those patients was recently reported as plasma renin activity (PRA) ≥ 1.0 ng/ml/hr to prevent cardiovascular events (Hundemer GL, et. al. Lancet Diabetes Endocrinol. 2018 Jan;6(1):51-59). Thus, we investigated 77 cases of adrenal venous sampling performed patients with PA and followed up for 3 years in our hospital since 2007, including 24 males and 53 females, and their mean age was 56.3 ± 12.5 years old. All patients underwent AVS and showed bilateral hyperaldosteronism and treated with MRAs and followed up more than 3 years. We collected blood pressure, serum sodium and potassium concentration, estimated glomerular filtration ratio (eGFR), PRA, plasma aldosterone concentration (PAC), atherosclerotic parameter, such as mean intima media thickness (IMT), brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index (ABI). We evaluated the relationship of those patients’ PRA and aldosterone to renin ratio (ARR) with eGFR, IMT, baPWV, and ABI. The change of mean IMT after 3 year-follow up were 0.03 ± 0.11 mm vs. 0.06 ± 0.09 mm for well controlled (PRA ≥ 1.0 ng/ml/hr) and poorly controlled (PRA < 1.0 ng/ml/hr), respectively, and no significant difference between them. In the other hand, the change of mean IMT after 3 year-follow up showed 0.03 ± 0.10 mm vs. 0.08 ± 0.10 mm for well controlled (PRA ≥ 1.0 ng/ml/hr and ARR <20) and poorly controlled (PRA < 1.0 ng/ml/hr or ARR ≥ 20), respectively, and the mean IMT increase was significantly lower in this group. The mean IMT increase showed significantly lower only with PRA ≥ 1.0 ng/ml/hr and ARR <20 rather than PRA ≥ 1.0 ng/ml/hr alone. In our results, both PRA ≥ 1.0 ng/ml/hr and ARR<20 are important to prevent or improve atherosclerosis, rather than only PRA ≥ 1.0 ng/ml/hr and should be titrated MRAs to achieve this target. In conclusion, our result revealed the titration of MRAs is important to prevent atherosclerotic cardiovascular event and not only PRA ≥ 1.0 ng/ml/hr, but both PRA and ARR <20 should be achieved.

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SGLT2 Inhibition in Patients With Type 2 Diabetes Mellitus Post-Nephrectomy: A Single-Center Case Series

Canadian Journal of Kidney Health and Disease ◽

10.1177/20543581211065528 ◽

2021 ◽

Vol 8 ◽

pp. 205435812110655

Author(s):

Marko Škrtić ◽

David Z. I. Cherney ◽

Vikas S. Sridhar ◽

Christopher T. M. Chan ◽

Abhijat Kitchlu

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Type 2 Diabetes ◽

Sglt2 Inhibitor ◽

Case Series ◽

Pressure Measurements ◽

Sglt2 Inhibition ◽

The Mean

Background: Nephrectomy is the mainstay of treatment for many kidney cancers, but has been correlated with increased incidence of acute kidney injury (AKI) and chronic kidney disease (CKD). Recently, sodium-glucose cotransporter-2 (SGLT2) inhibition has been shown to decrease the incidence of end-stage kidney disease and death in people with type 2 diabetes mellitus (T2D). However, at present, there has been no description of the use of SGLT2 inhibition in patients with T2D and solitary kidney despite the high risk of CKD progression. Objective: To characterize the use of SGLT2 inhibition and kidney function in a series of patients with T2D with prior nephrectomy for renal cell carcinoma (RCC). Design: Retrospective case series. Setting: University hospital outpatient onco-nephrology clinic. Patients: Patients post-nephrectomy for RCC with T2D who were prescribed an SGLT2 inhibitor. Measurements: Serum creatinine, albumin to creatinine ratio (ACR), HgA1c, and blood pressure measurements. Methods: Patients post-nephrectomy with incident use of SGLT2 inhibitor were identified from an existing registry of patients followed in the Onco-Nephrology Clinic at our institution from May 2019 to March 2021. Demographics, medication use, time since nephrectomy, cancer diagnosis, serum creatinine, ACR measurements, and blood pressure measurements were extracted from electronic medical records. Results: Five patients were identified who had initiated SGLT2 inhibition post-nephrectomy. All patients were male, had T2D, and a prior history of hypertension. Renal cell carcinoma was the clinical indication for nephrectomy in all patients. None of patients were prescribed diuretics, and all were receiving renin-angiotensin system (RAS) inhibition therapies. The time from nephrectomy to SGLT2 inhibitor initiation ranged from 5 to 74 months. Baseline mean estimated glomerular filtration rate (eGFR) values were 49 mL/min/1.73 m2 (95% confidence interval [CI]: 31.5-66.5), and mean ACRs were 8.7 mg/mmol (95% CI: 0.6-16.9). After 6 months of SGLT2 inhibition, the mean eGFR and ACR values were 58 mL/min/1.73 m2 (95% CI: 29.7-86.2) and 23.8 mg/mmol (95% CI: 0-60), respectively. After 16 to 18 months of follow-up (4 patients), the mean eGFR was 56 mL/min/1.73 m2 (95% CI: 37.3-74.7), and mean ACR was 10.5 (95% CI: 0-30.5), similar to baseline values before SGTL2i therapy initiation. At baseline, mean systolic blood pressure was 128 mm Hg (95% CI: 118.3-140.9) and remained similar after 12 months of treatment (mean 131 mm Hg [95% CI: 112.3-149.7]). There were no adverse events related to AKI, electrolyte disturbances, ketoacidosis, or genitourinary infections during the 18-month follow-up period. Limitations: Small sample size, lack of a comparison group, and the variable timing of clinical data collection, including eGFR levels following initiation of SGLT2 inhibition. Conclusions: SGLT2 inhibition is becoming a standard component of nephrology care to reduce kidney function decline, cardiovascular risk, and mortality. To our knowledge, our report is the first to provide longitudinal data on SGLT2 inhibitor usage in patients with T2D and solitary kidneys post-nephrectomy. Larger prospective studies are needed to determine the efficacy and safety of SGLT2 inhibition strategies for kidney protection in patients post-nephrectomy.

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Evaluation of the French National Program on Home Return of Patients with Chronic Heart Failure (PRADO-IC): Pilot Study of 91 Patients During Its Deployment in the Bas Rhin Area

Journal of Clinical Medicine ◽

10.3390/jcm9041222 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1222

Author(s):

Mylène Radreau ◽

Noel Lorenzo-Villalba ◽

Samy Talha ◽

Jean-Jacques Von Hunolstein ◽

Michel Hanssen ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Controlled Study ◽

National Program ◽

Number Of Patients ◽

Before And After ◽

The Mean

Objective: The main objective of this study was to evaluate the impact of the French national program on home return of chronic heart failure patients (PRADO-IC) in terms of re-hospitalizations for heart failure (HF) during its deployment in the Bas-Rhin (France). Patients and methods: This was a pilot, descriptive, quantitative, retrospective, and bi-centric study (University Hospitals of Strasbourg and Haguenau Hospital Center, France). It included all patients included in the PRADO-IC program from these centers between January 1, 2015 and December 31, 2015. The primary endpoint of our study was the evaluation of the number of 1-year, 6-month, and 30-day re-admissions to the hospital in relation to an acute HF episode, before and after the inclusion of patients in the PRADO-IC program. The secondary endpoints were the number of overall re-hospitalizations (all-cause); the number of days of hospitalization for HF; the time to first re-hospitalization and the average length of hospital stay, before and after inclusion in PRADO-IC; and the overall and cardiovascular mortality rates. Results: 91 patients out of 271 (33,6%) with a mean age of 79.2 years (67–94) were included. They all had chronic HF, essentially class II-III NYHA (90.1%), mostly of ischemic origin (41.9%), with altered left ventricular ejection fraction in 71.4% of cases. A reduction in the mean number of hospitalizations for HF per patient at 30 days, 6 months and 1 year was observed, respectively, from 0.18 ± 0.42 per patient before inclusion to 0.15 ± 0.36 after inclusion (p = 0.56); 0.98 ± 1.04 hospitalizations to 0.53 ± 0.81 at 6 months (p < 0.01); and 1.64 ± 1.14 hospitalizations 1.04 ± 1.05 at 1 year (p < 0.001). Patients were hospitalized less overall after inclusion in the PRADO-IC program. The number of days of hospitalization for HF was reduced after inclusion of patients from 18.02 ± 7.78 days before inclusion to 14.28 ± 11.57 days for the 6 month follow-up (p = 0.006), and from 22.07 ± 10.33 days before inclusion to 16.39 ± 15.94 days for the 1 year follow-up (p < 0.001). In contrast, inclusion in PRADO-IC statistically increased the mean time to first re-hospitalization for HF from mean 99.36 ± 72.39 days before inclusion to 148.11 ± 112.77 days after inclusion (p < 0.001). Conclusion: This study seems to demonstrate that the PRADO-IC program could improve the management of chronic HF patients in ambulatory care, particularly regarding HF re-hospitalization. However, due to the limitations of the methodology used and the small number of patients, it is advisable to consolidate its initial results with a randomized controlled study on a larger number of patients. In our opinion, its results need to be communicated because, to our knowledge, no equivalent study exists.

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