The role of bioimpedance analysis in overweight and obese patients with acute heart failure: a pilot study.

AIMS: Residual congestion at the time of hospital discharge is an important readmission risk factor, and its detection with physical examination and usual diagnostic techniques have strong limitations in overweight and obese patients. New tools like bioelectrical impedance analysis (BIA) could help to determine when euvolaemia is reached. The aim of this study was to investigate the usefulness of BIA in management of heart failure (HF) in overweight and obese patients. METHODS AND RESULTS: Our study is a single-centre, single-blind, randomized controlled trial that included 48 overweight and obese patients admitted for acute HF. The study population was randomized into two arms: BIA-guided group and standard care. Serum electrolytes, kidney function, and natriuretic peptides were followed up during their hospital stay and at 90 days after discharge. The primary endpoint was development of severe acute kidney injury (AKI) defined as an increase in serum creatinine by >0.5 mg/dL during hospitalization, and the main secondary endpoint was the reduction of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels during hospitalization and within 90 days after discharge. The BIA-guided group showed a remarkable lower incidence of severe AKI, although no significant differences were found (41.4% vs. 16.7%; P = 0.057). The proportion of patients who achieved levels of NT-proBNP < 1000 pg/mL at 90 days was significantly higher in the BIA-guided group than in the standard group (58.8% vs. 25%; P = 0.049). No differences were observed in the incidence of adverse outcomes at 90 days. CONCLUSIONS: Among overweight and obese patients with HF, BIA reduces NT-proBNP levels at 90 days compared with standard care. In addition, there is a trend towards lower incidence of AKI in the BIA-guided group. Although more studies are required, BIA could be a useful tool in decompensated HF management in overweight and obese patients.

Design and optimization strategies for the development of new drugs that treat chronic kidney disease.

Introduction: Chronic kidney disease (CKD) is characterized by increased risks of progression to end-stage kidney disease requiring dialysis and cardiovascular mortality, predicted to be among the five top causes of death by 2040. Only the design and optimization of novel strategies to develop new drugs to treat CKD will contain this trend. Current therapy for CKD includes nonspecific therapy targeting proteinuria and/or hypertension and cause-specific therapies for diabetic kidney disease, autosomal dominant polycystic kidney disease, glomerulonephritides, Fabry nephropathy, hemolytic uremic syndrome and others.Areas covered: Herein, the authors review the literature on new drugs under development for CKD as well as novel design and development strategies.Expert opinion: New therapies for CKD have become a healthcare priority. Emerging therapies undergoing clinical trials are testing expanded renin-angiotensin system blockade with double angiotensin receptor/endothelin receptor blockers, SGLT2 inhibition, and targeting inflammation, the immune response, fibrosis and the Nrf2 transcription factor. Emerging therapeutic targets include cell senescence, complement activation, Klotho expression preservation and microbiota. Novel approaches include novel model systems that can be personalized (e.g. organoids), unbiased systems biology-based identification of new therapeutic targets, drug databases that speed up drug identification and repurposing, nanomedicines that improve drug delivery and RNA targeting to expand the number of targetable proteins.

MYH9-related disease: it does exist, may be more frequent than you think and requires specific therapy.

In this issue of ckj, Tabibzadeh et al. report one of the largest series of patients with MYH9 mutations and kidney disease. The cardinal manifestation of MYH9-related disease is thrombocytopenia with giant platelets. The population frequency of pathogenic MYH9 mutations may be at least 1 in 20 000. The literature abounds in misdiagnosed cases treated for idiopathic thrombocytopenic purpura with immune suppressants and even splenectomy. Additional manifestations include neurosensorial deafness and proteinuric and hematuric progressive kidney disease (at some point, it was called Alport syndrome with macrothrombocytopenia), leucocyte inclusions, cataracts and liver enzyme abnormalities, resulting in different names for different manifestation combinations (MATINS, May-Hegglin anomaly, Fechtner, Epstein and Sebastian syndromes, and deafness AD 17). The penetrance and severity of kidney disease are very variable, which may obscure the autosomal dominant inheritance. A correct diagnosis will both preclude unnecessary and potentially dangerous therapeutic interventions and allow genetic counselling and adequate treatment. Morphological erythrocyte, granulocyte and platelet abnormalities may allow the future development of high-throughput screening techniques adapted to clinical peripheral blood flow cytometers.

Climaterio: oleadas de calor y otrossíntomas en indígenas Zenúes colombianas / Climacteric hot flashes and other symptoms in Colombian Zenúes indigenous / Climatério: ondas de calor e outros sintomas em indígenas colombianas Zenúes

Introducción: las oleadas de calor (OC) son un importante indicio con prevalencia diferente según etnias, del estado menopáusico. El objetivo de nuestra investigación fue evaluar la frecuencia y severidad de OC, y estimar en mujeres sintomáticas el riesgo de otros síntomas menopáusicos concomitantes. Método: estudio transversal como parte del proyecto CAVIMEC (Calidad de Vida en la Menopausia y Etnias Colombianas), realizado con la escala ‘MenopauseRating Scale’ en indígenas colombianas Zenúes, resguardo de San Andrés deSotavento, (Córdoba, Colombia), con edades entre 40 y 59 años. El análisis de los resultados se realizó en Epi-Info. 3.5.1 (Centers for Disease Control and Prevention, Atlanta, EEUU; 2008).Resultados: 596 (86.0%) de las 693 involucradas presentaron OC y solo el 1% mostró manifestación severa. Las mujeres sintomáticas tenían 51.2±5.7 años; escolaridad 4.6±4.6 años; 88.4% con pareja 98,2% con hijos, y 14.9% usaban terapia hormonal. 4.5% premenopáusicas, 12.6% perimenopáusicas y 62.9%posmenopáusicas. La prevalencia de OC moderada + severa, se incrementó con los cambios en el estado menopáusico. Fueron factores de riesgo la baja escolaridad y una edad mayor a 45 años. Sequedad vaginal, problemas vesicales y sexuales tuvieron elevado OR para presentarse concomitantemente en un modelo ajustado. Conclusión: fue elevada la presencia de OC en Zenúes, pero baja la presencia de síntomas severos. Los síntomas urogenitales tuvieron importante presencia concomitante.

Introduction: hot flashes (HF) are an important clue with different prevalence by ethnicity, menopausal status. The aim of our research was to evaluate the frequency and severity of HF, and estimate the risk of symptomatic women other menopausal symptoms attendant.Method: cross-sectional study as part of the CAVIMEC (Quality of Life Menopause and Colombian Ethnic groups), performed with the scale 'Menopause Rating Scale' in Colombian Zenues indigenous shelter of San Andrés de Sotavento, (Cordoba, Colombia), aged between 40 and 59 years. The analysis of the results was performed using Epi-info. 3.5.1 (Centers for Disease Control and Prevention, Atlanta, USA, 2008).Results: 596 (86.0%) of the 693 involved had HF and only 1% had severe manifestation. Symptomatic women were 51.2 ± 5.7 years, education 4.6 ± 4.6 years, 88.4% with 98.2% couples with Children, and 14.9% used hormone therapy. 4.5% premenopausal, 12.6% perimenopausal and postmenopausal 62.9%.HF prevalence moderate + severe increased with changes in the menopausal state. Risk factors were low education and age older than 45 years. Vaginal dryness, bladder and sexual problems were presented concomitantly elevated HFor an adjusted model.Conclusion: the presence of HF was elevated in Zenues but low presence of severe symptoms. Urogenital symptoms had concomitant significant presence.

Introdução: as ondas de calor (OC) são um indicio importante, que variam segundo etnias, do estado menopáusico. O objetivo de nossa pesquisa foi avaliar a frequência e severidade das OC, e estimar em mulheres sintomáticas o risco de outros sintomas menopáusicos concomitantes.Método: estudo transversal como parte do projeto CAVIMEC (Qualidade de Vida na Menopausa e Etnias Colombianas), realizado con a escala Menopause Rating Scale' em indígenas colombianas Zenúes, resguardo de San Andrés de Sotavento, (Córdoba, Colômbia), com idades entre 40 e 59 anos. A análise dos resultados foi feita em Epi-Info. 3.5.1 (Centers for Disease Control and Prevention, Atlanta, EEUU; 2008).Resultados: 596 (86.0%) das 693 envolvidas apresentaram OC e só 1% apresentou manifestação severa. As mulheres sintomáticas tinham 51.2±5.7 anos; escolaridade 4.6±4.6 anos; 88.4% com companheiro, 98,2% com filhos, e 14.9% usavam terapia hormonal. 4.5% premenopáusicas, 12.6% perimenopáusicas e 62.9% posmenopáusicas.A prevalencia de OC moderada mais severa, se incrementou com as mudanças no estado menopaúsico. Foram fatores de risco a baixa escolaridade e uma idade superior a 45 anos. Secura vaginal, problemas vesicais e sexuais liberam elevado OR presentes concomitantemente em um modelo ajustado.Conclusão: foi elevada a presença de OC en Zenúes, mas baixos os síntomas severos. Os síntomas urogenitais tiveram importante presença concomitante.

Prevalencia de insomnio y deterioro de la calidad de vida en posmenopáusicas que presentan oleadas de calor residentes en el Caribe Colombiano / Prevalence of insomnia and quality of life for post-menopausal women suffering hot flushes living in the Colombian Caribbean region

Objetivo: comparar la prevalencia subjetiva de insomnio y del deterioro severo de la calidad de vida en un grupo de mujeres posmenopáusicas que presentan oleadas de calor, con la obtenida en otro grupo con ausencia de las mismas. Materiales y métodos: estudio transversal en 589 mujeres posmenopáusicas, 40-59 años de edad, que hacen parte del estudio Calidad de vida en la menopausia y etnias colombianas (Cavimec). Se compararon mujeres que referían oleadas de calor con otras que no tenían dicha sintomatología. Para evaluar la calidad de vida se utilizó la Menopause Rating Scale, y para el insomnio la Athens Insomnia Scale. Resultados: el 49,2% (290/589) de las mujeres manifestaron experimentar oleadas de calor y la prevalencia de insomnio para todo el grupo fue del 34,8% (IC 95%: 31,0-38,8%). En el grupo de mujeres menopáusicas con oleadas de calor la prevalencia de insomnio fue del 45,5% (IC 95%: 37,9-51,4%) mientras en el grupos sin oleadas de calor fue del 24,4% (IC 95%: 19,7-29,7%). Las oleadas de calor aumentan 2,07 veces el riesgo de insomnio. La prevalencia de deterioro severo de la calidad de vida fue del 17,2% (IC 95%: 13,1-22,1%) en las mujeres con oleadas de calor y del 1,7% (IC 95%: 0,5-3,9%) en las mujeres sin oleadas de calor. Conclusiones: fue más prevalente el insomnio y el deterioro severo de la calidad de vida en mujeres con oleadas de calor, que entre aquellas libres de dicha manifestación.

Objective: Comparing the prevalence of subjective insomnia and severe deterioration in the quality of life in a group of postmenopausal women suffering from hot flushes to that obtained in another group not suffering from hot flushes. Materials and methods: This was a cross-sectional study of 589 40-59-year-old postmenopausal women forming part of a quality of life study covering menopause and Colombian ethnic groups (Cavimec). Women suffering hot flushes were compared to others who were not suffering such symtomatology. The menopause rating scale was used for evaluating the quality of life and the Athens insomnia scale for insomnia. Results: 49.2% (290/589) of the women stated that they had suffered from hot flushes and the prevalence of insomnia for the whole group was 34.8% (31.0-38.8 95%CI). The prevalence of insomnia was 45.5% (37.9-51.4 95%CI) in the group of menopausal women suffering hot flushes whilst prevalence in groups in which hot flushes had not occurred was 24.4% (19.7-29.7 95%CI). Hot flushes increased the risk of insomnia 2.07 times. The prevalence of severe deterioration in the quality of life was 17.2% (13.1-22.1 95%CI) in women suffering hot flushes and 1.7% (0.5-3.9 95%CI) in women without them. Conclusions: Insomnia and severe deterioration in the quality of life was more prevalent in women suffering hot flushes than in women free from such manifestation.