Association of obesity with 3-month mortality in kidney failure patients with COVID-19.

Background: In the general population with coronavirus disease 2019 (COVID-19), obesity is associated with an increased risk of mortality. Given the typically observed obesity paradox among patients on kidney function replacement therapy (KFRT), especially dialysis patients, we examined the association of obesity with mortality among dialysis patients or living with a kidney transplant with COVID-19. Methods: Data from the European Renal Association COVID-19 Database (ERACODA) were used. KFRT patients diagnosed with COVID-19 between 1 February 2020 and 31 January 2021 were included. The association of Quetelet's body mass index (BMI) (kg/m2), divided into: <18.5 (lean), 18.5-24.9 (normal weight), 25-29.9 (overweight), 30-34.9 (obese I) and ≥35 (obese II/III), with 3-month mortality was investigated using Cox proportional-hazards regression analyses. Results: In 3160 patients on KFRT (mean age: 65 years, male: 61%), 99 patients were lean, 1151 normal weight (reference), 1160 overweight, 525 obese I and 225 obese II/III. During follow-up of 3 months, 28, 20, 21, 23 and 27% of patients died in these categories, respectively. In the fully adjusted model, the hazard ratios (HRs) for 3-month mortality were 1.65 [95% confidence interval (CI): 1.10, 2.47], 1 (ref.), 1.07 (95% CI: 0.89, 1.28), 1.17 (95% CI: 0.93, 1.46) and 1.71 (95% CI: 1.27, 2.30), respectively. Results were similar among dialysis patients (N = 2343) and among those living with a kidney transplant (N = 817) (Pinteraction = 0.99), but differed by sex (Pinteraction = 0.019). In males, the HRs for the association of aforementioned BMI categories with 3-month mortality were 2.07 (95% CI: 1.22, 3.52), 1 (ref.), 0.97 (95% CI: 0.78. 1.21), 0.99 (95% CI: 0.74, 1.33) and 1.22 (95% CI: 0.78, 1.91), respectively, and in females corresponding HRs were 1.34 (95% CI: 0.70, 2.57), 1 (ref.), 1.31 (95% CI: 0.94, 1.85), 1.54 (95% CI: 1.05, 2.26) and 2.49 (95% CI: 1.62, 3.84), respectively. Conclusion: In KFRT patients with COVID-19, on dialysis or a kidney transplant, obesity is associated with an increased risk of mortality at 3 months. This is in contrast to the obesity paradox generally observed in dialysis patients. Additional studies are required to corroborate the sex difference in the association of obesity with mortality.

Vitamin d in the patients with chronic kidney disease: when, to whom and in which form.

Alteration in vitamin D metabolism has a central role in the pathogenesis of secondary hyperparathyroidism (SHPT) and is also associated with increased cardiovascular morbidity and mortality in patients with chronic kidney disease (CKD). For more than sixty years, vitamin D, nutritional vitamin D (ergocalciferol, cholecalciferol or calcifediol) and nonselective vitamin D receptor (VDR) activators (calcitriol, alfacalcidol) have been used in the prevention and treatment of SHPT. In the last twenty years, selective VDR activators (paricalcitol, maxacalcitol) have been used to target SHPT. However, there are many open questions regarding use of nutritional vitamin D or VDR activators. The K/DOQI and KDIGO guidelines recommended testing for vitamin D insufficiency and deficiency in patients with CKD, but there is no consensus on the definition of vitamin D insufficiency in CKD. There are a many open questions, for example, regarding the optimal nutritional vitamin D type and the dose and co-administration of nutritional vitamin and VDR activators. Therapy with VDRAs is required in the majority of patients with CKD, particularly in dialysis patients. However, when to start with VDRAs is not so apparent. Is PTH level the only indication of when to start therapy? Although VDRAs are very effective in lowering PTH levels and bone metabolism the effect of patients mortality is not so straightforward. Despite many unanswered questions, there is a large body of experimental and clinical data to support vitamin D use in patients with CKD. To obtain answers to the open questions, we need more randomized controlled trials.

Ambulatory blood pressure monitoring in diabetic hypertensive patients, single center report--preliminary results.

ABPM (ambulatory blood pressure monitoring) has been considered to be a useful tool for the diagnosis and management of arterial hypertension and is a better predictor of future cardiovascular events as compared with conventional office-based BP measurements. Despite its potential values, ABPM is not yet widely used in many clinical offices mainly because of lack of knowledge and unavailability. Aims of this preliminary study are to determine the control of hypertension and circadian BP characteristics in patients referred to our Centre whom we enrolled in the "HRKMAT" Study-Croatian Registry of ABPM. Although patients included in HRKMAT Study had other risk factors for cardiovascular diseases, in this paper we analyzed differences between hypertensive diabetics (N = 20) and nondiabetics (N = 57). 24-hours ABPM was performed with an automated oscillometric device Mobil-O-Graph NG Vers.20 and office BP using mercury sphygmomanometer. Average office BP was 139/90 mmHg, and average 24h ABPM was 130/82 mmHg. Majority of hypertensive patients used antihypertensive drugs (79.2%). Diabetic patients had higher systolic BP but lower diastolic BP. There were no statistically significant differences in dipping status, but earlier BP surge was noticed in reverse diabetic dippers than in reverse non-diabetic dippers. Though no significant, there was higher prevalence of WCH ("white coat hypertension") in diabetics, and we found MH (masked hypertension) in only two patients. These are preliminary results on ABPM from our centre and of HRKMAT registry. Further and more valuable data and results are awaited from the main HRKMAT database.

[Chronic kidney disease--mineral and bone disorder: why and how to control phosphate]. / Kronicna bubrezna bolest--poremecaj metabolizma minerala i kosti: zasto i kako kontrolirati fosfor.

Chronic kidney disease (CKD) is a global public health problem. Metabolic bone disease and mineral metabolism disturbance are common disturbance of CKD. A critical role of phospohorus in metabolic bone disease, i.e. secondary hyperparatyhroidism is well known. There is growing evidence that hyperphosphatemia isa strong predictor of mortality in CKD, i.e. is a novel risk factor for vascular calcification, left ventricular hypertrophy and kidney disease progression. Prevention and treatment of phosphate disturbace in CKD is still great challenge and new phosphate binders ofer new and advanced possibilites.