Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 102
Filtrar
1.
Artigo em Inglês | MEDLINE | ID: mdl-35030246

RESUMO

BACKGROUND: COVID-19-related short-term mortality is high in dialysis patients, but longer-term outcomes are largely unknown. We therefore assessed patient recovery in a large cohort of dialysis patients three months after their COVID-19 diagnosis. METHODS: We analyzed data on dialysis patients diagnosed with COVID-19 from February 1st, 2020-March 31st, 2021 from the European Renal Association COVID-19 Database (ERACODA). The outcomes studied were patient survival, residency, and functional- and mental health status (estimated by their treating physician) three months after COVID-19 diagnosis. Complete follow-up data was available for 854 surviving patients. Patient characteristics associated with recovery were analyzed using logistic regression. RESULTS: In 2449 hemodialysis patients (mean ± SD age: 67.5 ± 14.4 years, 62% male) survival probabilities at three months after COVID-19 diagnosis were 90% for non-hospitalized patients (N = 1087), 73% for patients admitted to the hospital but not to an ICU (N = 1165) and 40% for those admitted to an ICU (N = 197). Patient survival hardly decreased between 28 days and three months after COVID-19 diagnosis. At three months, 87% functioned at their pre-existent functional and 94% at their pre-existent mental level. Only few of the surviving patients were still admitted to the hospital (between 0.8 and 6.3%) or a nursing home (approximately 5%). Higher age and frailty score at presentation and ICU admission were associated with worse functional outcome. CONCLUSIONS: Mortality between 28 days and 3 months after COVID-19 diagnosis was low, and the majority of patients who survived COVID-19 recovered to their pre-existent functional and mental health level at three months after diagnosis.

2.
Hellenic J Cardiol ; 64: 1-6, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34856379

RESUMO

OBJECTIVE: Left ventricular hypertrophy (LVH) and dysfunction are highly prevalent in hemodialysis patients and are independently associated with adverse outcomes. This study examines the long-term effects of dry-weight reduction with a standardized lung ultrasound (LUS)-guided strategy on echocardiographic indexes of left ventricular (LV) mass and function in hemodialysis patients. METHODS: Seventy-one clinically euvolemic hemodialysis patients with hypertension were randomized to dry-weight reduction guided by pre-hemodialysis LUS (n = 35) or standard-of-care treatment (n = 36) and were followed-up for 12 months. Two-dimensional and tissue-Doppler echocardiographies (TDI) were performed at the baseline and 12-month evaluations. RESULTS: During follow-up, dry-weight reduction took place in more patients in the active arm than in the control arm of the trial (71.4% vs 22.2%; p < 0.001). Left atrial (LA) surface (-1.37 ± 4.50 vs 1.28 ± 5.00 cm2; P = 0.006) and LA volume index (-3.22 ± 11.82 vs 4.76 ± 12.83 ml/m2; P = 0.009) decreased in the active and increased in the control group. LV end-diastolic volume (-0.94 ± 11.45 vs 6.58 ± 13.92 ml/m2; P = 0.015) decreased only in the active group. The LV mass index was unchanged in the active (134.21 ± 44.75 vs 133.57 ± 45.51; P = 0.844) and marginally increased in the control group (134.21 ± 40.96 vs 143.77 ± 50.04 g/m2; P = 0.089). The LV E/e' wave ratio was unchanged in the active (12.45 ± 4.69 vs 12.56 ± 4.89; P = 0.521) and increased in the usual-care group (10.91 ± 4.97 vs12.36 ± 6.43; P = 0.003). LV systolic function did not differ between the two study arms across the trial. CONCLUSION: Over 12 months, LUS-guided dry-weight reduction is associated with reverse LV and LA remodeling, myocardial hypertrophy regression, and improved LV diastolic filling properties.


Assuntos
Hipertensão , Disfunção Ventricular Esquerda , Ecocardiografia/métodos , Humanos , Hipertrofia Ventricular Esquerda/complicações , Hipertrofia Ventricular Esquerda/etiologia , Pulmão/diagnóstico por imagem , Diálise Renal/efeitos adversos , Ultrassonografia de Intervenção , Perda de Peso
3.
Blood Purif ; 51(1): 15-22, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-33784665

RESUMO

BACKGROUND: Monitoring of arteriovenous (AV) fistula to detect hemodynamically important stenosis is crucial for the prevention of AV fistula thrombosis. The aim of our study was to analyze the importance of dialysis dose (Kt/V) during online postdilution hemodiafiltration (HDF) for early detection of AV fistula stenosis. METHODS: Hemodialysis patients with AV fistula were included in this study. We compared a group of 44 patients who have undergone fistulography and subsequently percutaneous transluminal angioplasty (PTA) of significant AV fistula stenosis (active group) with a group of 44 age- and sex-matched patients without PTA (control group). Observational time in both groups was the same. RESULTS: All patients had postdilution online HDF using a F5008 dialysis machine, which can measure online single-pool Kt/V. All data were analyzed during the performance of 2056 HDF procedures. In the active group, we found statistically significantly lower values of Kt/V, all 8 weeks before PTA. In the active group, there was a significant improvement in Kt/V in the first (p < 0.001) and second week (p = 0.049) after PTA. Three and 8 weeks after PTA, we did not find any statistically significant difference in Kt/V between both groups (p = 0.114; p = 0.058). Patients in the active group had statistically significantly lower substitution volumes and blood pump flow rates during HDF over the whole observation period before and after PTA. In contrast, there were no differences in venous pressure in the dialysis circuit between both groups throughout the observation period. CONCLUSION: In hemodialysis patients with AV fistula, treated with online HDF, routine measurements of Kt/V during each HDF are a beneficial, quick, and straightforward method for early detection of hemodynamically significant AV fistula stenosis.


Assuntos
Fístula Arteriovenosa/diagnóstico , Diálise Renal , Idoso , Angioplastia , Constrição Patológica/diagnóstico , Diagnóstico Precoce , Feminino , Hemodiafiltração/efeitos adversos , Hemodiafiltração/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Renal/efeitos adversos , Diálise Renal/métodos
4.
Clin Nephrol ; 96(1): 43-48, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34643490

RESUMO

BACKGROUND: Cystatin C (cysC) is freely filtered in the glomeruli, and its serum concentration is independent of muscle mass, diet, gender, or age. In patients with chronic kidney disease (CKD), cysC is associated with advanced atherosclerosis and increased arterial stiffness. The purpose of this study was to define possible associations between arterial stiffness parameters and cysC in patients without CKD. MATERIALS AND METHODS: The study included 111 non-CKD patients. Basic demographic and laboratory data were recorded. Arterial stiffness was measured by applanation tonometry (sphygmocor, Australia). RESULTS: Mean age of the patients was 64.3 ± 9.4 years, 65.8% were men. Most common co-morbidities were arterial hypertension (AH) (n = 86, 77.5%), hyperlipidemia (n = 64, 57.7%), and diabetes mellitus (DM) (n = 22; 19.8%). Mean creatinine was 77.7 ± 13.8 µmol/L (range 49 - 108), estimated GFR 81.3 ± 9.4 mL/min/1.73m2 (range 62 - 90), and cysC 0.94 ± 0.18 mg/L (range 0.67 - 1.63). Mean carotid-femoral pulse wave velocity (cfPWV) was 10.1 ± 2.4 m/s (range 6.2 - 16.8), subendocardial viability ratio (SEVR) 165.7 ± 36.1% (range 92 - 299), ejection duration (ED) 33.8 ± 4.4 ms (range 22 - 46), and pulse pressure (PP) 46.6 ± 14.8 mmHg (range 17 - 94). A statistically significant association was found between cysC and cfPWV (r = 0.472, p < 0.001), SEVR (r = -0.316, p < 0.001), ED (r = 0.217, p = 0.025), and pulse pressure (PP) (r = 0.241, p = 0.012). Multiple regression analysis between arterial stiffness parameters and cysC, age, male gender, AH, DM, hyperlipidemia, and eGFR confirmed a statistically significant and independent association between cysC and cfPWV (ß = 0.220, p = 0.038), between cysC and SEVR (ß = -0.278, p = 0.017), and between cysC and ED (ß = 0.241, p = 0.045). CONCLUSION: Elevated cysC is associated with increased cfPWV, increased ED, and decreased SEVR.


Assuntos
Insuficiência Renal Crônica , Rigidez Vascular , Idoso , Cistatina C , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Onda de Pulso , Insuficiência Renal Crônica/diagnóstico
5.
Clin Nephrol ; 96(1): 68-73, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34643494

RESUMO

BACKGROUND: Optimal fluid management is a physician's everyday challenge in patients on maintenance hemodialysis (HD). Bioimpedance spectroscopy (BIS) is a non-invasive method to estimate body composition, including estimates of fluid overload (FO). Our study aimed to analyze the association between FO and the mortality rate in HD patients. MATERIALS AND METHODS: We performed a retrospective single-center cohort study in 92 HD patients. The body composition was measured before HD using the portable whole-body BIS device Body Composition Monitor (BCM). We have analyzed the mortality rates of HD patients in two FO groups, a standard definition FO group (> 1.1 L), and a severe FO group (> 2.5 L) and compared them to mortality rates of patients without FO or without severe FO, respectively. RESULTS: The mean age of patients was 64.3 ± 13.0 years, mean dialysis vintage 64 months, 60.9% were men. 68 (73.9%) patients had FO of > 1.1 L and 30 (32.6%) had FO of > 2.5 L. During the follow-up period of 1,020 ± 417 days, 29 (31.5%) patients died. Kaplan-Meier survival analysis showed that patients with FO > 2.5 L had worse survival (p = 0.039). In a Cox regression model, which included FO > 2.5 L, age, dialysis vintage, hemoglobin, C-reactive protein, and albumin, only FO > 2.5 L and advanced age turned out to be predictors of death (p = 0.044 and p = 0.001, respectively). CONCLUSION: HD patients with FO > 2.5 L before HD have poorer survival than patients with normohydration or lower overhydration.


Assuntos
Falência Renal Crônica , Desequilíbrio Hidroeletrolítico , Idoso , Composição Corporal , Estudos de Coortes , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Diálise Renal , Estudos Retrospectivos
6.
Clin Nephrol ; 96(1): 80-84, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34643496

RESUMO

AIMS: Pulmonary congestion is a direct result of either general overhydration or cardiac dysfunction. Lung ultrasonography (LUS) with lung B-lines (LUS comets) can be used to assess extravascular lung water in patients with end-stage renal disease on hemodialysis or peritoneal dialysis (PD). Subendocardial viability ratio (SEVR) is a pulse wave analysis parameter that is a non-invasive measure of coronary perfusion and is related to cardiac work and oxygen consumption. Our aim was to investigate the association between LUS comets and SEVR in PD patients. MATERIALS AND METHODS: We performed an observational study in 25 PD patients in a single dialysis center. Extravascular lung water was quantified by the number of LUS comets, using a portable ultrasound (US) device. LUS comets were recorded in each intercostal space and defined as hyperechoic US bundles at a narrow base extending from the transducer to the edge of the screen. The sum of LUS comets yields a score reflecting the extent of water accumulation in the lungs. SEVR was determined non-invasively by radial applanation tonometry. RESULTS: Mean age of patients was 54.7 ± 10.7 years, mean PD vintage 27 ± 33 (1 - 167) months, 60% were men. The mean number of LUS comets was 13 ± 19 (0 - 71), and the mean SEVR was 153 ± 40%. We found a statistically significant negative correlation between the number of LUS comets and SEVR (r = -0.467; p = 0.019). Multiple regression analysis with LUS comets as dependent variable, and SEVR and age as independent variables showed a statistically significant relationship between SEVR and the number of LUS comets (ß = -0.467, p = 0.021). CONCLUSION: Higher number of LUS comets is associated with lower SEVR in PD patients.


Assuntos
Diálise Peritoneal , Análise de Onda de Pulso , Adulto , Idoso , Feminino , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/efeitos adversos , Diálise Renal , Ultrassonografia
7.
Clin Nephrol ; 96(1): 85-88, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34643497

RESUMO

BACKGROUND: Lung ultrasound (LUS) is a non-invasive technique for estimating extravascular lung water in patients with end-stage renal disease and heart diseases. In this study, we examined an association between the severity of lung congestion as detected by LUS B-lines (LUS comets), anemia, and serum biomarker N-terminal pro-brain natriuretic peptide (NT-proBNP) in peritoneal dialysis (PD) patients. MATERIALS AND METHODS: 19 patients, who were treated with PD in our dialysis center were enrolled. On the day of their routine check-up, we performed a lung auscultation, LUS on 28 typical locations and determined blood levels of hemoglobin and NT-proBNP. RESULTS: The average age of patients was 54 (range 30 - 71) years, the average duration of PD treatment was 53 (range 10 - 194) months, 63% (12) of the patients were male. Nine (47.4%) patients had peripheral edema, and only 1 (5.3%) patient had inspiratory crackles. Using LUS, we found mean 17 (range 1 - 87) lung comets. Mean hemoglobin level was 108.6 g/L (SD ± 10.4), mean NT-proBNP level 1,151 pmol/L (SD ± 1,077). We found a statistically significant correlation between the number of lung comets and hemoglobin level (r = -0.655; p = 0.002) and NT-proBNP (r = 0.759; p < 0.0001). Multiple regression analysis with the number of lung comets as dependent variable and hemoglobin and NT-proBNP levels as independent variables confirmed a statistically significant association between the number of lung comets and NT-proBNP (ß = 0.572; p = 0.009). CONCLUSION: In PD patients, the number of LUS comets is associated with hemoglobin and NT-proBNP.


Assuntos
Peptídeo Natriurético Encefálico , Diálise Peritoneal , Adulto , Idoso , Biomarcadores , Feminino , Hemoglobinas , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Fragmentos de Peptídeos , Diálise Peritoneal/efeitos adversos
9.
Kidney Int ; 100(6): 1325-1333, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34418415

RESUMO

Lung congestion is a risk factor for all-cause and cardiovascular mortality in patients on chronic hemodialysis, and its estimation by ultrasound may be useful to guide ultrafiltration and drug therapy in this population. In an international, multi-center randomized controlled trial (NCT02310061) we investigated whether a lung ultrasound-guided treatment strategy improved a composite end point (all-cause death, non-fatal myocardial infarction, decompensated heart failure) vs usual care in patients receiving chronic hemodialysis with high cardiovascular risk. Patient-Reported Outcomes (Depression and the Standard Form 36 Quality of Life Questionnaire, SF36) were assessed as secondary outcomes. A total of 367 patients were enrolled: 183 in the active arm and 180 in the control arm. In the active arm, the pre-dialysis lung scan was used to titrate ultrafiltration during dialysis and drug treatment. Three hundred and seven patients completed the study: 152 in the active arm and 155 in the control arm. During a mean follow-up of 1.49 years, lung congestion was significantly more frequently relieved in the active (78%) than in the control (56%) arm and the intervention was safe. The primary composite end point did not significantly differ between the two study arms (Hazard Ratio 0.88; 95% Confidence Interval: 0.63-1.24). The risk for all-cause and cardiovascular hospitalization and the changes of left ventricular mass and function did not differ among the two groups. A post hoc analysis for recurrent episodes of decompensated heart failure (0.37; 0.15-0.93) and cardiovascular events (0.63; 0.41-0.97) showed a risk reduction for these outcomes in the active arm. There were no differences in patient-reported outcomes between groups. Thus, in patients on chronic hemodialysis with high cardiovascular risk, a treatment strategy guided by lung ultrasound effectively relieved lung congestion but was not more effective than usual care in improving the primary or secondary end points of the trial.


Assuntos
Doenças Cardiovasculares , Falência Renal Crônica , Doenças Cardiovasculares/diagnóstico por imagem , Fatores de Risco de Doenças Cardíacas , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Pulmão/diagnóstico por imagem , Qualidade de Vida , Diálise Renal/efeitos adversos , Fatores de Risco , Ultrassonografia de Intervenção
10.
World J Diabetes ; 12(7): 975-996, 2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-34326949

RESUMO

The prevalence and burden of diabetes mellitus and chronic kidney disease on global health and socioeconomic development is already heavy and still rising. Diabetes mellitus by itself is linked to adverse cardiovascular events, and the presence of concomitant chronic kidney disease further amplifies cardiovascular risk. The culmination of traditional (male gender, smoking, advanced age, obesity, arterial hypertension and dyslipidemia) and non-traditional risk factors (anemia, inflammation, proteinuria, volume overload, mineral metabolism abnormalities, oxidative stress, etc.) contributes to advanced atherosclerosis and increased cardiovascular risk. To decrease the morbidity and mortality of these patients due to cardiovascular causes, timely and efficient cardiovascular risk assessment is of huge importance. Cardiovascular risk assessment can be based on laboratory parameters, imaging techniques, arterial stiffness parameters, ankle-brachial index and 24 h blood pressure measurements. Newer methods include epigenetic markers, soluble adhesion molecules, cytokines and markers of oxidative stress. In this review, the authors present several non-invasive methods of cardiovascular risk assessment in patients with diabetes mellitus and chronic kidney disease.

11.
Drugs ; 81(13): 1467-1489, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34313978

RESUMO

Despite recent therapeutic advances, chronic kidney disease (CKD) is one of the fastest growing global causes of death. This illustrates limitations of current therapeutic approaches and, potentially, unidentified knowledge gaps. For decades, renin-angiotensin-aldosterone system (RAAS) blockers have been the mainstay of therapy for CKD. However, they favor the development of hyperkalemia, which is already common in CKD patients due to the CKD-associated decrease in urinary potassium (K+) excretion and metabolic acidosis. Hyperkalemia may itself be life-threatening as it may trigger potentially lethal arrhythmia, and additionally may limit the prescription of RAAS blockers and lead to low-K+ diets associated to low dietary fiber intake. Indeed, hyperkalemia is associated with adverse kidney, cardiovascular, and survival outcomes. Recently, novel kidney protective therapies, ranging from sodium/glucose cotransporter 2 (SGLT2) inhibitors to new mineralocorticoid receptor antagonists have shown efficacy in clinical trials. Herein, we review K+ pathophysiology and the clinical impact and management of hyperkalemia considering these developments and the availability of the novel K+ binders patiromer and sodium zirconium cyclosilicate, recent results from clinical trials targeting metabolic acidosis (sodium bicarbonate, veverimer), and an increasing understanding of the role of the gut microbiota in health and disease.


Assuntos
Hiperpotassemia/epidemiologia , Hiperpotassemia/fisiopatologia , Insuficiência Renal Crônica/epidemiologia , Humanos , Hiperpotassemia/prevenção & controle , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Gravidade do Paciente , Polímeros/uso terapêutico , Sistema Renina-Angiotensina/fisiologia , Silicatos/uso terapêutico , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico
12.
Pharmaceuticals (Basel) ; 14(6)2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34208285

RESUMO

Diabetes mellitus is a global health issue and main cause of chronic kidney disease. Both diseases are also linked through high cardiovascular morbidity and mortality. Diabetic kidney disease (DKD) is present in up to 40% of diabetic patients; therefore, prevention and treatment of DKD are of utmost importance. Much research has been dedicated to the optimization of DKD treatment. In the last few years, mineralocorticoid receptor antagonists (MRA) have experienced a renaissance in this field with the development of non-steroidal MRA. Steroidal MRA have known cardiorenal benefits, but their use is limited by side effects, especially hyperkalemia. Non-steroidal MRA still block the damaging effects of mineralocorticoid receptor overactivation (extracellular fluid volume expansion, inflammation, fibrosis), but with fewer side effects (hormonal, hyperkalemia) than steroidal MRA. This review article summarizes the current knowledge and newer research conducted on MRA in DKD.

13.
Genes (Basel) ; 12(6)2021 05 28.
Artigo em Inglês | MEDLINE | ID: mdl-34071541

RESUMO

The ten most statistically significant estimated glomerular filtration rate (eGFRcrea)-associated loci from genome-wide association studies (GWAs) are tested for associations with chronic kidney disease (CKD) in 208 patients, including dialysis-independent CKD and dialysis-dependent end-stage renal disease (kidney failure). The allele A of intergenic SNP rs2453533 (near GATM) is more frequent in dialysis-independent CKD patients (n = 135, adjusted p = 0.020) but not dialysis-dependent kidney failure patients (n = 73) compared to healthy controls (n = 309). The allele C of intronic SNP rs4293393 (UMOD) is more frequent in healthy controls (adjusted p = 0.042) than in CKD patients. The Allele T of intronic SNP rs9895661 (BCAS3) is associated with decreased eGFRcys (adjusted p = 0.001) and eGFRcrea (adjusted p = 0.017). Our results provide further evidence of a genetic difference between dialysis-dialysis-independent CKD and dialysis-dependent kidney failure, and add the GATM gene locus to the list of loci associated only with dialysis-independent CKD. GATM risk allele carriers in the dialysis-independent group may have a genetic susceptibility to higher creatinine production rather than increased serum creatinine due to kidney malfunction, and therefore, do not progress to dialysis-dependent kidney failure. When using eGFRcrea for CKD diagnosis, physicians might benefit from information about creatinine-increasing loci.


Assuntos
Amidinotransferases/genética , Polimorfismo de Nucleotídeo Único , Insuficiência Renal Crônica/genética , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Proteínas de Neoplasias/genética , Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/patologia , Insuficiência Renal Crônica/terapia , Uromodulina/genética
14.
J Hypertens ; 39(7): 1444-1452, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34074973

RESUMO

OBJECTIVES: Hypertension is highly prevalent and independently associated with adverse outcomes in patients undergoing hemodialysis. Volume overload is the main mechanism of increased blood pressure (BP) in these individuals. This study examines the long-term effects of dry-weight reduction with a standardized lung-ultrasound (US)-guided strategy on ambulatory BP in hypertensive hemodialysis patients. METHODS: This is the report of the 12-month follow-up of a randomized controlled trial in 71 clinically euvolemic, hemodialysis patients with hypertension. Patients were randomized to dry-weight reduction guided by prehemodialysis lung ultrasound and to standard care. A 48-h ambulatory BP monitoring (ABPM) was performed in all study participants at baseline and after 12 months. RESULTS: During follow-up, a greater proportion of patients in the active group underwent dry-weight reduction compared with the control group (71.4% vs. 22.2%; P < 0.001). The number of lung US-B lines (a metric of lung water) reduced in the active (-4.83 ±â€Š13.73) and increased in the control arm (+5.53 ±â€Š16.01; P = 0.005) paralleling dry-weight changes (-1.68 ±â€Š2.38 vs. 0.54 ±â€Š2.32 kg; P < 0.001). At 12 months, 48-h systolic BP (136.19 ±â€Š14.78 vs. 130.31 ±â€Š13.57 mmHg; P = 0.034) and diastolic BP (80.72 ±â€Š9.83 vs. 76.82 ±â€Š8.97 mmHg; P = 0.008) were lower compared to baseline in the active but similar in the control group. Changes in 48-h systolic BP (-7.78 ±â€Š13.29 vs. -0.10 ±â€Š14.75 mmHg; P = 0.021) were significantly greater in the active compared to the control group. The proportion of patients experiencing ≥1 episode of intradialytic hypotension was nominally lower in the active group (71.4% vs. 88.9%, P = 0.065). CONCLUSIONS: Lung-US-guided dry-weight reduction can effectively and safely decrease ambulatory BP levels in the long-term.


Assuntos
Monitorização Ambulatorial da Pressão Arterial , Hipertensão , Pressão Sanguínea , Humanos , Pulmão/diagnóstico por imagem , Diálise Renal , Ultrassonografia de Intervenção , Perda de Peso
15.
Clin Kidney J ; 14(4): 1067-1076, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34188903

RESUMO

Anaemia is a common complication of chronic kidney disease (CKD). In this setting, iron deficiency is frequent because of the combination of increased iron needs to sustain erythropoiesis with increased iron losses. Over the years, evidence has accumulated on the involvement of iron in influencing pulmonary vascular resistance, endothelial function, atherosclerosis progression and infection risk. For decades, iron therapy has been the mainstay of therapy for renal anaemia together with erythropoiesis-stimulating agents (ESAs). Despite its long-standing use, grey areas still surround the use of iron therapy in CKD. In particular, the right balance between either iron repletion with adequate therapy and the avoidance of iron overload and its possible negative effects is still a matter of debate. This is particularly true in patients having functional iron deficiency. The recent Proactive IV Iron Therapy in Haemodialysis Patients trial supports the use of intravenous (IV) iron therapy until a ferritin upper limit of 700 ng/mL is reached in haemodialysis patients on ESA therapy, with short dialysis vintage and minimal signs of inflammation. IV iron therapy has also been proven to be effective in the setting of heart failure (HF), where it improves exercise capacity and quality of life and possibly reduces the risk of HF hospitalizations and cardiovascular deaths. In this review we discuss the risks of functional iron deficiency and the possible benefits and risks of iron therapy for the cardiovascular system in the light of old and new evidence.

16.
Artigo em Inglês | MEDLINE | ID: mdl-33944938

RESUMO

Diabetic kidney disease develops in about 40% of patients with diabetes and is the commonest cause of chronic kidney disease worldwide. Patients with chronic kidney disease, especially those with diabetes mellitus, are at high risk of both developing kidney failure and cardiovascular death. The use of renin-angiotensin system blockers to reduce the incidence of kidney failure in patients with diabetic kidney disease dates back to studies that are now 20 or more years old. During the last few years sodium-glucose co-transporter-2 inhibitors have shown beneficial renal effects in randomized trials. However, even in response to combined treatment with renin-angiotensin system blockers and sodium-glucose co-transporter-2 inhibitors, the renal residual risk remains high with kidney failure only deferred, but not avoided. The risk of cardiovascular death also remains high even with optimal current treatment. Steroidal mineralocorticoid receptor antagonists reduce albuminuria and surrogate markers of cardiovascular disease in patients already on optimal therapy. However, their use has been curtailed by the significant risk of hyperkalaemia. In The FInerenone in reducing kiDnEy faiLure and dIsease prOgression in Diabetic Kidney Disease (FIDELIO-DKD) study comparing the actions of the non-steroidal mineralocorticoid receptor antagonist finerenone with placebo, finerenone reduced the progression of diabetic kidney disease and the incidence of cardiovascular events with a relatively safe adverse event profile. This document presents in detail the available evidence on the cardioprotective and nephroprotective effects of mineralocorticoid receptor antagonists, analyses the potential mechanisms involved and discusses their potential future place in the treatment of patients with diabetic chronic kidney disease.

17.
Am J Nephrol ; 52(5): 404-411, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33975308

RESUMO

INTRODUCTION: Chronic kidney disease (CKD) is a risk factor for cardiovascular and all-cause mortality. Recognition of high-risk patients is important and could lead to a different approach and better treatment. The CHA2DS2-VASc score was originally used to predict cerebral infarction in patients with atrial fibrillation (AF), but it is also a useful predictor of outcome in other cardiovascular conditions, independent of AF. Therefore, the aim of our research was to assess the role of CHA2DS2-VASc score in predicting cardiovascular and all-cause mortality in CKD patients. METHODS: Stable nondialysis CKD patients were included. At the time of inclusion, medical history data and standard blood results were collected and CHA2DS2-VASc score was calculated. Patients were followed till the same end date, until kidney transplantation or until their death. RESULTS: Eighty-seven CKD patients were included (60.3 ± 12.8 years, 66% male). Mean follow-up time was 1,696.5 ± 564.6 days. During the follow-up, 21 patients died and 11 because of cardiovascular reasons. Univariate Cox regression analysis showed that CHA2DS2-VASc score is a significant predictor of cardiovascular and all-cause mortality. In multivariate Cox regression analysis, in which CHA2DS2-VASc score, serum creatinine, urinary albumin/creatinine, hemoglobin, high-sensitivity C-reactive protein, and intact parathyroid hormone were included, CHA2DS2-VASc score was an independent predictor of cardiovascular (HR: 2.04, CI: 1.20-3.45, p = 0.008) and all-cause mortality (HR: 2.06, CI: 1.43-2.97, p = 0.001). The same was true after adding total cholesterol, triglycerides, and smoking status to both the analyses. CONCLUSION: The CHA2DS2-VASc score is a simple, practical, and quick way to identify the risk for cardiovascular and all-cause mortality in CKD patients.


Assuntos
Doenças Cardiovasculares/mortalidade , Insuficiência Renal Crônica/complicações , Idoso , Doenças Cardiovasculares/etiologia , Causas de Morte , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Insuficiência Renal Crônica/mortalidade , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco
18.
Biomedicines ; 9(2)2021 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-33670423

RESUMO

Chronic kidney disease (CKD) is one of the major health problems of the modern age. It represents an important public health challenge with an ever-lasting rising prevalence, which reached almost 700 million by the year 2017. Therefore, it is very important to identify patients at risk for CKD development and discover risk factors that cause the progression of the disease. Several studies have tackled this conundrum in recent years, novel markers have been identified, and new insights into the pathogenesis of CKD have been gained. This review summarizes the evidence on markers of inflammation and their role in the development and progression of CKD. It will focus primarily on cytokines, chemokines, and cell adhesion molecules. Nevertheless, further large, multicenter studies are needed to establish the role of these markers and confirm possible treatment options in everyday clinical practice.

19.
BMC Cardiovasc Disord ; 21(1): 33, 2021 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-33441117

RESUMO

INTRODUCTION: Functional changes in peripheral arterial disease (PAD) could play a role in higher cardiovascular risk in these patients. METHODS: 123 patients who underwent elective coronary angiography were included. Ankle-brachial index (ABI) was measured and arterial stiffness parameters were derived with applanation tonometry. RESULTS: 6 patients (4.9%) had a previously known PAD (Rutherford grade I). Mean ABI was 1.04 ± 0.12, mean subendocardial viability ratio (SEVR) 166.6 ± 32.7% and mean carotid-femoral pulse wave velocity (cfPWV) 10.3 ± 2.4 m/s. Most of the patients (n = 81, 65.9%) had coronary artery disease (CAD). There was no difference in ABI among different degrees of CAD. Patients with zero- and three-vessel CAD had significantly lower values of SEVR, compared to patients with one- and two-vessel CAD (159.5 ± 32.9%/158.1 ± 31.5% vs 181.0 ± 35.2%/166.8 ± 27.8%; p = 0.048). No significant difference was observed in cfPWV values. Spearman's correlation test showed an important correlation between ABI and SEVR (r = 0.196; p = 0.037) and between ABI and cfPWV (r = - 0.320; p ≤ 0.001). Multiple regression analysis confirmed an association between cfPWV and ABI (ß = - 0.210; p = 0.003), cfPWV and mean arterial pressure (ß = 0.064; p < 0.001), cfPWV and age (ß = 0.113; p < 0.001) and between cfPWV and body mass index (BMI (ß = - 0.195; p = 0.028), but not with arterial hypertension, dyslipidemia, diabetes mellitus or smoking status. SEVR was not statistically significantly associated with ABI using the same multiple regression model. CONCLUSION: Reduced ABI was associated with increased cfPWV, but not with advanced CAD or decreased SEVR.


Assuntos
Índice Tornozelo-Braço , Velocidade da Onda de Pulso Carótido-Femoral , Isquemia Miocárdica/diagnóstico , Doença Arterial Periférica/diagnóstico , Rigidez Vascular , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Coronária , Estudos Transversais , Feminino , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Isquemia Miocárdica/complicações , Isquemia Miocárdica/fisiopatologia , Doença Arterial Periférica/complicações , Doença Arterial Periférica/fisiopatologia , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco
20.
Front Med (Lausanne) ; 7: 579677, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33195328

RESUMO

Background: High-density lipoprotein (HDL) plays an essential role in the immune system and shows effective antioxidative properties. We investigated correlations of lipid parameters with the sequential organ failure assessment (SOFA) score and the prognostic association with mortality in sepsis patients admitted to intensive care unit (ICU). Methods: We prospectively recruited consecutive adult patients with sepsis and septic shock, according to sepsis-3 criteria as well as non-sepsis ICU controls. Results: Fifty-three patients with sepsis (49% with septic shock) and 25 ICU controls without sepsis were enrolled. Dyslipidemia (HDL-C < 40 mg/l) was more common in sepsis compared to non-sepsis patients (85 vs. 52%, p = 0.002). Septic patients compared to controls had reduced HDL-C (14 vs. 39 mg/l, p < 0.0001), lower arylesterase activity of the antioxidative paraoxonase of HDL (AEA) (67 vs. 111 mM/min/ml serum, p < 0.0001), and a non-significant trend toward reduced cholesterol efflux capacity (9 vs. 10%, p = 0.091). We observed a strong association between higher AEA and lower risk of 28-day [per 10 mM/min/ml serum increase in AEA: odds ratio (OR) = 0.76; 95% CI, 0.61-0.94; p = 0.01) and ICU mortality (per 10 mM/min/ml serum increase in AEA: OR = 0.71, 95% CI, 0.56-0.90, p = 0.004) in the sepsis cohort in univariable logistic regression analysis. AEA was confirmed as an independent predictor of 28-day and ICU mortality in multivariable analyses. AEA discriminated well-regarding 28-day/ICU mortality in area under the receiver operating characteristic curve (AUROC) analyses. In survival analysis, 28-day mortality estimates were 40 and 69% with AEA ≥/< the 25th percentile of AEA's distribution, respectively (log-rank p = 0.0035). Conclusions: Both compositional and functional HDL parameters are profoundly altered during sepsis. In particular, the functionality parameter AEA shows promising prognostic potential in sepsis patients.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...