Association Between Residual Kidney Function and Visit-to-Visit Blood Pressure Variability in Peritoneal Dialysis Patients.

Visit-to-visit blood pressure (BP) variability has recently been recognized as an important risk factor for decline of residual kidney function (RKF) in patients with chronic kidney disease. However little is known about the impact of visit-to-visit BP variability on RKF in peritoneal dialysis (PD) patients. We retrospectively studied the association between RKF and visit-to-visit BP variability in 42 patients who started on PD between February 2006 and March 2012. Residual kidney function was defined as the mean of the urea and creatinine clearances in the patients. Visit-to-visit BP variability was defined as the average real variability of BP measurements taken during 12 consecutive visits after the start of PD. A significant association between the slope of RKF after the start of PD and the visit-to-visit variability of systolic BP was evident (r = -0.353, p = 0.022). On multiple regression analysis, the association was significant (p = 0.024) after adjustments for possible confounders (proteinuria, estimated glomerular filtration rate, and mean systolic BP). Decline in RKF was significantly associated with visit-to-visit BP variability in PD patients. The results suggest that RKF can be better maintained by reducing visit-to-visit BP variability.

[Characteristics and dosage of antihypertensive medication].

Several classes of antihypertensive drugs are currently available. Among them, diuretics, Ca antagonists, ACE inhibitors, ARBs and beta blockers are currently established as a first line drug because of its effectiveness for blood pressure lowering as well as prevention of cardiovascular diseases with a long-term use. Each class of antihypertensive drugs has a unique pharmacological property leading to the advantages and disadvantages in the various clinical settings. Furthermore, individual drug in the same class shows a unique pharmaokinetic and pharmacodynamic profiles. Hence, selection of antihypertensive drugs should be individualized, taking into account various factors including age and comorbid conditions. The characteristics of specific antihypertensive drugs, the setting in which they are most useful and the contraindications to use will be reviewed here. From the viewpoint of the strict blood pressure control throughout 24 hour, practical considerations related to dosing and frequency will also be discussed.

Nephrotic syndrome and acute kidney injury induced by malathion toxicity.

We treated a case of acute kidney injury and nephrotic syndrome after malathion inhalation. A 69-year-old Japanese man presented with oedema 15 days after inhalation of malathion, a widely used pesticide. Serum albumin was 2.4 g/dL, urinary protein 8.6 g/gCr and serum creatinine 2.5 mg/dL. Kidney biopsy revealed tubular cell damage, epithelial cell damage in glomeruli and diffuse foot process effacement in electron microscopy. Acute kidney injury progressed to treatment with dialysis. Renal function recovered after corticosteroid administration from the 43rd day after admission. Malathion inhalation should be ruled out as a differential diagnosis in individuals who develop acute kidney injury and nephrotic syndrome, especially in rural-dwelling patients.

Visit-to-visit variability of blood pressure and renal function decline in patients with diabetic chronic kidney disease.

The authors previously reported that the visit-to-visit variability of blood pressure is correlated with renal function decline in nondiabetic chronic kidney disease. Little is known about the association between visit-to-visit variability and renal function decline in patients with diabetic chronic kidney disease. The authors retrospectively studied 69 patients with diabetic chronic kidney disease stage 3a, 3b, or 4. The standard deviation and coefficient of variation of blood pressure in 12 consecutive visits were defined as visit-to-visit variability of blood pressure. The median observation period was 32 months. In univariate correlation, the standard deviation and coefficient of variation of blood pressure were not significantly associated with the slope of estimated glomerular filtration rate. There was no significant association between the visit-to-visit variability of blood pressure and renal function decline in patients with diabetic chronic kidney disease, in contrast with our previous study of nondiabetic patients with chronic kidney disease.

Three patients with familial Mediterranean fever: a possible underdiagnosed entity in Japan.

Familial Mediterranean fever (FMF) is an autosomal recessive disorder characterized by periodic fever and serosal inflammation. FMF is mostly reported in the Mediterranean region and is considered to be rare in Japan with estimated 292 cases. We treated three unrelated FMF patients in one year in a city with 144,000 residents. Two of the three patients were over 70 years old. FMF may therefore be underdiagnosed in Japan.

Impact of visit-to-visit variability of blood pressure on deterioration of renal function in patients with non-diabetic chronic kidney disease.

An association between visit-to-visit variability (VVV) of blood pressure (BP) and renal damage was recently reported in a cross-sectional study. We aimed to clarify the longitudinal effect of VVV of BP on deterioration of renal function in patients with non-diabetic chronic kidney disease (CKD). We retrospectively studied 56 patients with non-diabetic CKD (stage 3 or 4) who visited our nephrology clinic between September 1994 and May 2011. VVV of BP was defined as the standard deviation and coefficient of variation (CV) of office BP measured at 12 consecutive visits. Main outcomes were the annual decline in the estimated glomerular filtration rate (eGFR) and the composite renal end point defined as a doubling of serum creatinine or the need for dialysis. The median observation period was 83 months. Standard deviation and CV of office systolic BP (SBP) were significantly associated with the slope of the eGFR after adjustments for confounders. The adjusted risk for composite renal end points more than doubled for each increment of 1-standard deviation of the standard deviation of office SBP (hazard ratio (HR) 2.20, P=0.001), and for each increment of 1-standard deviation of the CV of office SBP (HR 2.12, P=0.002). The present study demonstrated that the visit-to-visit variability of BP is an independent determinant of deterioration of renal function in patients with non-diabetic CKD.