Obesity and insulin resistance in resistant hypertension: implications for the kidney.

There is recognition that the obesity epidemic contributes substantially to the increasing incidence of CKD and resistant hypertension (HTN). The mechanisms by which obesity promotes resistance are an area of active interest and intense investigation. It is thought that increases in visceral adiposity lead to a proinflammatory, pro-oxidative milieu that promote resistance to the metabolic actions of insulin. This resistance to insulin at the level of skeletal muscle tissue impairs glucose disposal/utilization through actions on the endothelium that include vascular rarefaction, reductions in vascular relaxation, and vascular remodeling. Insulin resistance derived from increased adipose tissue and obesity has system-wide implications for other tissue beds such as the kidney that affects blood pressure regulation. The additional autocrine and paracrine activities of adipose tissue contribute to inappropriate activation of the renin-angiotensin-aldosterone system and the sympathetic nervous system that promote kidney microvascular remodeling, stiffness, and sodium (Na(+)) retention that in turn promote HTN and in the CKD patient, resistance. In this review, we will summarize the important mechanisms that link obesity to CKD as they relate to resistant HTN.

Lipid abnormalities in kidney disease and management strategies.

Patients with kidney diseases continue to experience significant cardiovascular disease (CVD) morbidity and mortality. Although there are many important risk factors playing a role in the pathogenesis of CVD in chronic kidney disease (CKD) patients, dyslipidemia (elevated triglycerides, elevated oxidized low-density lipoprotein and low/dysfunctional low high-density) represents one of the modifiable risk factors. Renal failure patients have unique lipid abnormalities which not only have complex role in pathogenesis of CVD but also cause relative resistance to usual interventions. Most of the randomized trials have been in hemodialysis population and data from CKD non-dialysis, peritoneal dialysis and renal transplant populations is extremely limited. Compared to general population, evidence of mortality benefit of lipid lowering medications in CKD population is scarce. Future research should be directed towards establishing long term benefits and side effects of lipid lowering medications, through randomized trials, in CKD population.

Having a personal healthcare provider and receipt of adequate cervical and breast cancer screening.

INTRODUCTION: The purpose of this study was to assess the relationship between having a personal health care provider and adequate cervical and breast cancer screening behavior. METHODS: Cross-sectional data were obtained from the 2004 Behavior Risk Factor Surveillance System. For cervical cancer, female respondents 18 years of age and older who did not have hysterectomy were included (n = 130,359); for breast cancer, female respondents 40 years of age or older were included (n = 129,929). Multiple logistic regression analyses were performed to determine the association between having a personal health care provider, specific demographics, and health insurance status with adequate cervical and breast cancer screening behavior. RESULTS: Approximately 9% and 14% of the study population for the breast cancer and cervical cancer analyses, respectively, did not have a personal health care provider. Having at least one personal health care provider was significantly associated with adequate cervical cancer screening behavior (odds ratio, 2.37; 95% CI, 2.08-2.70) and breast cancer screening behavior (odds ratio, 2.86; 95% CI, 2.54-3.24) in multivariate analyses. Both multivariate analyses were adjusted for age, race/ethnicity, education, income, and health insurance. CONCLUSION: Having at least one personal health care provider was associated with adequate cervical and breast cancer screening behavior. Efforts to increase primary care access are a necessary part of the plan to increase preventive health services utilization.