Silent cerebral white matter lesions and their relationship with vascular risk factors in middle-aged predialysis patients with CKD.

BACKGROUND: Silent cerebral white matter lesions are observed on magnetic resonance imaging (MRI) scans in elderly people, and they are related to vascular risk factors, particularly hypertension. No data on the prevalence and risk factors of white matter lesions in patients with chronic kidney disease (CKD) are available. The aim is to analyze the prevalence of white matter lesions and their determinants in this population. METHODS: We studied 52 patients without diabetes with CKD (stage 3 or 4) aged 30 to 60 years (average, 49 years) and a group of 32 normotensive control subjects. MRI studies were performed and subcortical and periventricular white matter lesions were evaluated by using semiquantitative measures. Patients were classified into 2 groups depending on the presence or absence of white matter lesions. Echocardiographic studies and measures of markers of systemic inflammation (C-reactive protein and interleukin 6) also were performed. RESULTS: White matter lesions were more prevalent in patients with CKD than controls (33% versus 6%; P = 0.008). Patients with CKD who had white matter lesions were older; had a greater history of cardiovascular disease and vascular nephropathy as a primary cause of renal disease and greater levels of systolic blood pressure, pulse pressure, left ventricular mass index, and C-reactive protein; and were administered more antihypertensive drugs than patients with CKD without white matter lesions. Stage and duration of CKD were not related to the presence of white matter lesions. After adjusting for several factors, only vascular nephropathy (odds ratio, 15.6; 95% confidence interval, 1.27 to 191.54; P = 0.03) independently predicted an increased risk for white matter lesions. CONCLUSION: One third of middle-aged patients with CKD have silent cerebral white matter lesions. Vascular nephropathy seems to be the most important factor related to the presence of these lesions, suggesting that white matter lesions reflect ischemic brain damage caused by generalized vascular damage.

[Prevalence of HIV-1-infection in dialysis units in Spain and potential candidates for renal transplantation: results of a Spanish survey]. / Prevalencia de la infección por el VIH en centros de diálisis en España y potenciales candidatos para trasplante renal: resultados de una encuesta española.

INTRODUCTION: Patients with HIV infection and end-stage renal disease (ESRD) have improved their survival in the last few years. HIV infection is not considered a contradiction for renal transplantation, but little experience exists in renal transplantation in HIV infected individuals. There is no information about the prevalence of HIV infection in Spanish patients under renal replacement therapies (RRT). METHODS: A survey was performed in Spanish dialysis units during 2004. The objective was to study the prevalence and characteristics of HIV infection in patients under RRT in Spain. We also aimed to know how many of them met the Spanish criteria to be included on the renal transplantation waiting list. RESULTS: HIV prevalence was 1.15% (95%CI 0.85-1.45) of 4,962 patients who were under RRT, mostly under hemodialysis and, less commonly, peritoneal dialysis. The most frequent risk factor for HIV infection was parenteral drug use (58%). The most common causes of ESRD were glomerulonephritis (44%). The median time under RRT was 46 months. Coinfections with hepatitis C (60%) and B (7%) were found. Thirty-four percent of patients had a history of aids-defining events. Eighty-six percent were under HAART. The median CD4 cell count was 333 cells/.l and the viral load was undetectable in 68%. Of 40 patients with a completed clinical questionnaire, 9 (22.5%) met the Spanish criteria for renal transplantation. CONCLUSION: HIV prevalence in patients under RRT in Spain is 1.15% (0.85%-1.45%) and 22.5% percent of these patients met the Spanish criteria to be included on a renal transplantation waiting list.

Exercise blood pressure, cardiac structure, and diastolic function in young normotensive patients with polycystic kidney disease: a prehypertensive state.

BACKGROUND: Increased left ventricular mass (LVM) and left ventricular hypertrophy have been found in early stages of autosomal dominant polycystic kidney disease (ADPKD). The mechanisms that lead to an increase in LVM in this population are unknown. The aim of this study is to evaluate blood pressure (BP) response to exercise and very early alterations in cardiac structure and diastolic function in young normotensive patients with ADPKD. METHODS: Color Doppler echocardiography and exercise treadmill testing according to the Bruce protocol were performed in 18 young normotensive patients with ADPKD and 18 healthy subjects. RESULTS: LVM index was greater and isovolumic relaxation time (IVRT) was longer in patients with ADPKD than controls (93.3 +/- 21.4 versus 77.5 +/- 18.6 g/m2; P = 0.02; 100 +/- 20.2 versus 80 +/- 9.7 milliseconds; P = 0.001, respectively). Exercise capacity in metabolic equivalents was similar in both groups. Systolic BP response during exercise and recovery were similar in both groups. Diastolic BP decreased during exercise, but the magnitude of decrease was lower in patients with ADPKD than controls (P = 0.01). During recovery, patients with ADPKD showed a greater sustained diastolic BP than controls (P = 0.02). Patients with ADPKD with an exaggerated systolic BP response had a greater LVM index than those with a normal response (112.1 +/- 10.4 versus 84 +/- 19.2 g/m2; P = 0.001). Multivariate regression analysis showed that exercise systolic BP and diastolic BP were independent predictors of LVM index and IVRT, respectively. CONCLUSION: Young normotensive patients with ADPKD showed increased LVM index and prolonged IVRT, which are related to exercise BP response. Exaggerated diastolic BP response during exercise suggests an impaired capacity for exercise-induced vasodilatation and may indicate a greater risk for the development of future hypertension.