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1.
Hypertension ; 74(4): 998-1004, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31401878

RESUMO

The International Society of Peritoneal Dialysis recommends that adequate blood pressure (BP) assessment among patients on peritoneal dialysis should at least include measurements performed once-weekly at home and at each visit at clinic. However, the quality of evidence to support this guidance is suboptimal. Using ambulatory daytime BP as reference standard, we explored the diagnostic performance of clinic and home BP recordings in a cohort of 81 stable patients receiving peritoneal dialysis. BP was recorded using 3 different methodologies: (1) triplicate automated clinic BP recordings after a 5-minute seated rest with the validated monitor HEM 705 CP (Omron Healthcare); (2) 1-week averaged home BP recorded with a validated automated monitor on awaking and at bedtime; and (3) ambulatory BP monitoring with the Mobil-O-Graph device (IEM, Germany). The area under the curve of receiver operating characteristic curves in detection of ambulatory daytime systolic BP (SBP) ≥135 mm Hg was similar for clinic [area under the curve, 0.859; 95% CI, 0.776-0.941] and home SBP (area under the curve, 0.895; 95% CI, 0.815-0.976). In Bland-Altman analysis, clinic SBP overestimated daytime ambulatory SBP by 5.02 mm Hg with 95% limits of agreement ranging from -17.92 to 27.96 mm Hg. Similarly, home SBP overestimated daytime ambulatory SBP by 4.23 mm Hg, again with wide 95% limits of agreement (-16.05 to 24.51 mm Hg). These results show that 1-week averaged home SBP is of at least similar accuracy with standardized clinic SBP in diagnosing hypertension confirmed by ambulatory BP monitoring among patients on peritoneal dialysis.


Assuntos
Monitorização Ambulatorial da Pressão Arterial/métodos , Pressão Sanguínea/fisiologia , Hipertensão/diagnóstico , Falência Renal Crônica/fisiopatologia , Diálise Peritoneal , Adulto , Idoso , Feminino , Humanos , Hipertensão/fisiopatologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade
3.
Case Rep Nephrol ; 2019: 3614980, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30775040

RESUMO

Immune-checkpoint-inhibitors (ICPIs) represent a novel class of immunotherapy against several malignancies. These agents are associated with several "immune-mediated" adverse effects, but the reported renal toxicity of ICPIs is less well defined. We present the case of a 60-year-old man with a history of non-small cell lung cancer, who developed acute kidney injury (AKI) approximately 3.5 months after initiation of immunotherapy with nivolumab. Urinalysis revealed sterile pyuria, without microscopic hematuria or proteinuria. Immunological examination was negative. A renal biopsy showed severe interstitial inflammatory infiltration of T-cells, monocytes, and eosinophils without interstitial granulomas and normal appearance of glomeruli, indicating acute interstitial nephritis (AIN) as the cause of AKI. After a short-term course of corticosteroids and permanent nivolumab discontinuation, partial recovery of renal function was noted. AIN is a rare adverse effect of ICPIs that mandates the close monitoring of renal function in patients under immunotherapy with these agents.

5.
Adv Perit Dial ; 34(2018): 24-31, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30480533

RESUMO

The aim of the present study was to compare the aortic systolic blood pressure (aSBP), heart-rate-adjusted augmentation index (AIx75), and pulse wave velocity (PWV) obtained using the Mobil-O-Graph (IEM, Stolberg, Germany) and SphygmoCor (AtCor, Sydney, Australia) devices in patients receiving peritoneal dialysis (PD).After a 10-minute rest in the supine position, the Mobil-O-Graph and SphygmoCor devices were applied in randomized order in 27 consecutive PD patients. The agreement between the measurements produced by the Mobil-O-Graph and SphygmoCor devices was explored using Bland-Altman analysis.The Mobil-O-Graph-derived aSBP, AIx75, and PWV did not differ from the same measurements obtained with SphygmoCor (aSBP: 120.5 ± 18.2 mmHg vs. 124.4 ± 19.0 mmHg, p = 0.438; AIx75: 27.0% ± 12.4% vs. 24.5% ± 10.6%, p = 0.428; PWV: 9.5 ± 2.1 m/s vs. 10.1 ± 3.1 m/s, p = 0.397). The slight difference in the estimation of aSBP is possibly explained by the difference in brachial SBP used for the calibration of the devices (131.0 ± 20.6 mmHg vs. 134.5 ± 19.7 mmHg, p = 0.525). Mobil-O-Graph-derived measurements correlated strongly with paired measurements obtained with the SphygmoCor device. Bland-Altman plots showed no evidence of asymmetry and a wide range of agreement between the two devices.Our study shows acceptable agreement between Mobil-O-Graph and SphygmoCor in the estimation of arterial stiffness indices in PD patients. Accordingly, the Mobil-O-Graph device accurately performs aortic ambulatory blood pressure monitoring in this population.


Assuntos
Diálise Peritoneal , Rigidez Vascular , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , Humanos , Oscilometria , Análise de Onda de Pulso
7.
BMC Nephrol ; 19(1): 293, 2018 10 25.
Artigo em Inglês | MEDLINE | ID: mdl-30359230

RESUMO

BACKGROUND: Icodextrin is a starch-derived, water soluble glucose polymer, which is used as an alternative to glucose in order to enhance dialytic fluid removal in peritoneal dialysis patients. Although the safety and efficacy of icodextrin is well-established, its use in everyday clinical practice has been associated with the appearance of skin rashes and other related skin reactions. CASE PRESENTATION: Herein, we report the rare case of a 91-year-old woman with a history of severe congestive heart failure, who initiated continuous ambulatory peritoneal dialysis with icodextrin-based dialysate solutions and 15 days after the initial exposure to icodextrin developed a generalized maculopapular and exfoliative skin rash extending over the back, torso and extremities. Discontinuation of icodextrin and oral therapy with low-dose methyl-prednisolone with quick dose tapering improved the skin lesions within the following days. CONCLUSIONS: This case report highlights that skin hypersensitivity is a rare icodextrin-related adverse event that should be suspected in patients manifesting skin reactions typically within a few days or weeks after the initial exposure.


Assuntos
Soluções para Diálise/efeitos adversos , Exantema/induzido quimicamente , Síndrome de Exfoliação/induzido quimicamente , Icodextrina/efeitos adversos , Diálise Peritoneal Ambulatorial Contínua/tendências , Idoso de 80 Anos ou mais , Exantema/diagnóstico , Síndrome de Exfoliação/diagnóstico , Evolução Fatal , Feminino , Humanos
8.
Hypertens Res ; 41(5): 309-319, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29531291

RESUMO

Arterial stiffness is an important risk factor for cardiovascular morbidity and mortality in patients with end-stage renal disease (ESRD). Arterial stiffness aggravates cardiovascular risk via multiple pathways, such as augmentation of aortic systolic pressure, subendocardial hypoperfusion, and excess pulsatile energy transmission from macro- to microcirculation. Pathogenesis of the arteriosclerotic process in ESRD is complex and not yet fully understood. Several factors unique to ESRD, such as mineral metabolism disturbances, vascular calcifications, formation of advanced glycation end-products, and acute and chronic volume overload, are proposed to play a particular role in the progression of arteriosclerosis in ESRD. As these and other mechanistic pathways of arterial stiffening in ESRD are elucidated, there is hope that this knowledge will be translated into novel therapeutic interventions targeting arterial stiffness. In the meantime, blood pressure (BP) lowering via strict volume control and appropriate use of antihypertensive drugs is a fundamental step in reversing accelerated arterial stiffening and modifying the cardiovascular risk profile of ESRD patients. In this article, we review the pathogenesis, clinical epidemiology, and therapies targeting arterial stiffness in ESRD, discussing recent advances and high-priority goals of future research in these important areas.


Assuntos
Falência Renal Crônica/epidemiologia , Falência Renal Crônica/patologia , Rigidez Vascular , Anti-Hipertensivos/uso terapêutico , Arteriosclerose/fisiopatologia , Progressão da Doença , Produtos Finais de Glicação Avançada , Humanos , Falência Renal Crônica/terapia
9.
J Am Soc Hypertens ; 12(4): 242-247, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29459219

RESUMO

In the era of newly introduced hypertension guidelines recommending lower blood pressure (BP) targets for drug-treated hypertensives, the necessity for optimized management of hypertension becomes even more urgent. The concept of home BP-guided antihypertensive therapy is for long suggested as a simple and feasible approach to improve BP control rates and optimize the management of hypertension. Home BP-guided antihypertensive therapy is particularly applicable to hypertensives with chronic kidney disease (CKD) for several reasons including the following: (1) difficult-to-control BP and high BP variability in the CKD setting; (2) poor accuracy of office BP in determining hypertension control status and detecting "white-coat" and "masked" hypertension; (3) poor value of routine office BP recordings in predicting the longitudinal progression of target-organ damage; and (4) superiority of home BP over office BP recordings in prognosticating the risk of incident end-stage renal disease or death. The concept of home BP-guided antihypertensive therapy is even more relevant for those on hemodialysis, given the high intradialytic and interdialytic BP variability and poor value of conventional peridialytic BP recordings in estimating the actual BP load recorded outside of dialysis with the use of home or ambulatory BP monitoring. Randomized trials comparing home BP-guided antihypertensive therapy versus usual care are warranted to prove the feasibility and effectiveness of this therapeutic approach and convince clinicians for using home BP monitoring as the standard of care when managing hypertension, particularly in people with CKD or end-stage renal disease.

11.
Int Urol Nephrol ; 49(12): 2217-2221, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29027620

RESUMO

PURPOSE: Sodium polystyrene sulfonate (SPS) is a cation-exchanging resin that has been widely used for several decades as first-line therapy of mild chronic hyperkalemia in patients with chronic kidney disease (CKD). However, evidence to prove the long-term tolerability and efficacy of SPS for the treatment of this condition is still missing. METHODS: In this retrospective, observational study, we enrolled 26 outpatients with stages 3-4 CKD who received oral therapy with low-dose SPS for mild chronic hyperkalemia in the Outpatient Nephrology clinic of our Department during 2010-2016. We obtained medical records on side effects potentially attributable to SPS use, and we analyzed the changes in serum electrolytes before and after the initiation of SPS therapy. RESULTS: Serum potassium levels fell from 5.9 ± 0.4 to 4.8 ± 0.5 mmol/l (P < 0.001) over a median follow-up of 15.4 months (range 3-27 months). SPS use was associated with a slight, but significant elevation in serum sodium levels (139.5 ± 2.9 vs 141.2 ± 2.4, P = 0.006), whereas serum calcium and phosphate remained unchanged before and after the initiation of SPS. We recorded ten episodes of recurrent serum potassium elevation ≥ 5.5 mmol/l, none of which required hospitalization or acute dialysis. No episode of colonic necrosis or any other serious drug-related adverse event was observed. SPS therapy was well-tolerated, since only 1 out of 26 patients discontinued SPS at 3 months due to gastrointestinal intolerance. CONCLUSION: This study suggests that low-dose SPS is well-tolerated and can effectively normalize elevated serum potassium over several weeks in CKD outpatients with mild chronic hyperkalemia.


Assuntos
Resinas de Troca de Cátion/uso terapêutico , Hiperpotassemia/tratamento farmacológico , Poliestirenos/uso terapêutico , Insuficiência Renal Crônica/complicações , Idoso , Idoso de 80 Anos ou mais , Cálcio/sangue , Resinas de Troca de Cátion/efeitos adversos , Feminino , Seguimentos , Humanos , Hiperpotassemia/sangue , Hiperpotassemia/etiologia , Masculino , Pessoa de Meia-Idade , Poliestirenos/efeitos adversos , Potássio/sangue , Recidiva , Estudos Retrospectivos , Sódio/sangue , Fatores de Tempo
12.
Iran J Kidney Dis ; 11(3): 192-200, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28575879

RESUMO

INTRODUCTION: Hypertension has been identified as one of the commonest modifiable determinants for chronic kidney disease progression. A variety of antihypertensive drugs are available and their effect on kidney function has been investigated by a large number of randomized controlled trials. Observational studies, although scarcely been used, outpatient can reflect everyday practice, where drug exposures vary over time, and may provide an alternative for detecting longitudinal changes in kidney function. MATERIALS AND METHODS: We applied mixed model repeated measures analysis to investigate the effect of antihypertensive drug categories and their combinations on kidney function change over time in a cohort of 779 patients with essential hypertension, using the data from a Greek hypertension outpatient clinic. Antihypertensive drugs were grouped in 5 categories. Their effect was evaluated and their combinations with and without renin-angiotensin-system inhibitors (RASI) to each other. In addition, the combination of RASI with calcium channel blockers (CCBs) was studied. RESULTS: Diuretics, RASI, CCBs, and beta-blockers had a significant renoprotective and blood pressure lowering effect. Combinations with RASI had a smaller beneficial effect on kidney function compared to CCBs (0.75 mL/min/1.73 m2 per year of drug use versus 0.97 mL/min/1.73 m2). There was no additional effect when combining RASI with CCBs. However, the lowering effect on systolic blood pressure was greater (-0.83 mm Hg per year of drug use, P < .001). CONCLUSIONS: RASI were found to have a smaller, although significant, renoprotective effect. There was no additional effect on kidney function when combining RASI with CCBs.


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Hipertensão Essencial/tratamento farmacológico , Taxa de Filtração Glomerular/efeitos dos fármacos , Rim/efeitos dos fármacos , Sistema Renina-Angiotensina/efeitos dos fármacos , Idoso , Anti-Hipertensivos/efeitos adversos , Anti-Hipertensivos/classificação , Bases de Dados Factuais , Quimioterapia Combinada , Hipertensão Essencial/diagnóstico , Hipertensão Essencial/fisiopatologia , Feminino , Grécia , Humanos , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
15.
Int Urol Nephrol ; 48(4): 601-8, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26769025

RESUMO

BACKGROUND: In hemodialysis patients, the intradialytic rise in blood pressure (BP) is associated with increased mortality risk. However, the mechanisms of this adverse effect are not yet elucidated. This study examined whether intradialytic rise in BP is associated with increased arterial stiffness and wave reflections, which are powerful cardiovascular risk predictors in hemodialysis. METHODS: The pattern of intradialytic hemodynamic response was evaluated in 70 prevalent hemodialysis patients, by measuring seated brachial BP before and after the mid-week dialysis session. All patients had pre- and post-dialysis determination of aortic pulse wave velocity (PWV) and heart rate-adjusted augmentation index [AIx(75)], as measures of arterial stiffness and wave reflections, with the Sphygmocor device. RESULTS: Intradialytic rise in brachial systolic BP (SBP) was evident in 17 patients, whereas intradialytic change in SBP (ΔSBP) of -10 to 0 mmHg was observed in 23 and ΔSBP greater than -10 mmHg in 30 patients. Participants with intradialytic SBP rise had significantly higher pre-dialysis aortic PWV (10.4 ± 1.6 vs 8.3 ± 1.9 vs 9.4 ± 2.4 m/s, P < 0.01) and AIx(75) (28.1 ± 7.3 vs 21.7 ± 8.6 vs 25.8 ± 8.2%, P < 0.05) than those experiencing intradialytic ΔSBP of -10 to 0 and greater than -10 mmHg, respectively. Patients with rise in SBP during dialysis exhibited also lower intradialytic reduction in AIx(75) (-1.5 ± 4.9 vs -5.4 ± 5.9 vs -6.7 ± 5.3%, P < 0.001). CONCLUSIONS: This study shows that aortic stiffness and wave reflections are higher and not affected by dialysis procedure in patients with intradialytic SBP rise, suggesting that accelerated arteriosclerosis may be one possible explanation for the heightened cardiovascular risk associated with intradialytic hypertension.


Assuntos
Aorta Torácica/fisiopatologia , Velocidade do Fluxo Sanguíneo/fisiologia , Pressão Sanguínea/fisiologia , Doenças Cardiovasculares/fisiopatologia , Falência Renal Crônica/terapia , Diálise Renal , Rigidez Vascular/fisiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Feminino , Seguimentos , Grécia/epidemiologia , Humanos , Incidência , Falência Renal Crônica/complicações , Falência Renal Crônica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Análise de Onda de Pulso
17.
Semin Nephrol ; 34(5): 483-91, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25416656

RESUMO

Until a few years ago, information regarding the epidemiology of resistant hypertension was obtained from indirect sources, such as cross-sectional studies on hypertension control in large cohorts from tertiary hypertension centers and outcome trials in hypertension. During the past 3 years, however, large population-based studies have provided direct epidemiologic data on resistant hypertension and estimated its prevalence at 8% to 12% of adult patients with hypertension. Chronic kidney disease (CKD), in particular, has been long considered a frequent underlying cause of resistant hypertension, however, recently, direct epidemiologic data for this entity in patients with CKD were brought to light again, suggesting an even higher prevalence of resistant hypertension (approximately 20%-35%) among such individuals. Furthermore, recent prospective cohort studies have suggested incident resistant hypertension to be associated with increased cardiovascular and renal risk in both the general hypertensive population and patients with CKD. This article discusses currently available data on epidemiology of resistant hypertension, providing a comparative overview of its prevalence, incidence, and prognosis in these two populations.


Assuntos
Resistência a Medicamentos , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Vasoespasmo Coronário/epidemiologia , Humanos , Incidência , Prevalência , Prognóstico
18.
Am J Nephrol ; 40(3): 242-50, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25322847

RESUMO

BACKGROUND/AIMS: Elevated wave reflections and arterial stiffness, as well as ambulatory blood pressure (BP) are independent predictors of cardiovascular risk in end-stage-renal-disease. This study is the first to evaluate in hemodialysis patients the validity of a new ambulatory oscillometric device (Mobil-O-Graph, IEM, Germany), which estimates aortic BP, augmentation index (AIx) and pulse wave velocity (PWV). METHODS: Aortic SBP (aSBP), heart rate-adjusted AIx (AIx(75)) and PWV measured with Mobil-O-Graph were compared with the values from the most widely used tonometric device (Sphygmocor, ArtCor, Australia) in 73 hemodialysis patients. Measurements were made in a randomized order after 10 min of rest in the supine position at least 30 min before a dialysis session. Brachial BP (mercury sphygmomanometer) was used for the calibration of Sphygmocor's waveform. RESULTS: Sphygmocor-derived aSBP and AIx(75) did not differ from the relevant Mobil-O-Graph measurements (aSBP: 136.3 ± 19.6 vs. 133.5 ± 19.3 mm Hg, p = 0.068; AIx(75): 28.4 ± 9.3 vs. 30.0 ± 11.8%, p = 0.229). The small difference in aSBP is perhaps explained by a relevant difference in brachial SBP used for calibration (146.9 ± 20.4 vs. 145.2 ± 19.9 mm Hg, p = 0.341). Sphygmocor PWV was higher than Mobil-O-Graph PWV (10.3 ± 3.4 vs. 9.5 ± 2.1 m/s, p < 0.01). All 3 parameters estimated by Mobil-O-Graph showed highly significant (p < 0.001) correlations with the relevant measurements of Sphygmocor (aSBP, r = 0.770; AIx(75), r = 0.400; PWV, r = 0.739). The Bland-Altman Plots for aSBP and AIx(75) showed acceptable agreement between the two devices and no evidence of systemic bias for PWV. CONCLUSION: As in other populations, acceptable agreement between Mobil-O-Graph and Sphygmocor was evident for aSBP and AIx(75) in hemodialysis patients; PWV was slightly underestimated by Mobil-O-Graph.


Assuntos
Monitorização Ambulatorial da Pressão Arterial/métodos , Artéria Braquial/patologia , Falência Renal Crônica/terapia , Diálise Renal/métodos , Sístole , Idoso , Aorta/patologia , Velocidade do Fluxo Sanguíneo , Pressão Sanguínea , Calibragem , Doenças Cardiovasculares/fisiopatologia , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Oscilometria , Análise de Onda de Pulso , Insuficiência Renal , Fatores de Risco , Decúbito Dorsal , Rigidez Vascular
20.
Blood Purif ; 37(1): 18-26, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24481249

RESUMO

BACKGROUND/AIMS: The hypothesis that dialytic modality affects arterial stiffness was never investigated. This study includes comparative evaluation of hemodiafiltration versus hemodialysis on arterial function during first and second weekly dialysis sessions. METHODS: 24 patients receiving hemodiafiltration and another 24 age- and sex-matched controls receiving hemodialysis were included. Patients were evaluated before and after first and second weekly dialysis sessions. Applanation tonometry of peripheral arteries was applied to determine aortic and brachial pulse wave velocity and heart rate-adjusted augmentation index (AIx(75)). RESULTS: Hemodiafiltration and hemodialysis reduced AIx(75), but not aortic and brachial pulse wave velocity. Intradialytic reductions in AIx(75) did not differ between hemodiafiltration and hemodialysis in first and mid-week dialysis. In multivariate linear regression, predictors of intradialytic reduction in AIx(75) were changes in body weight and central aortic systolic blood pressure, but not dialytic modality. CONCLUSION: This study showed that hemodiafiltration has similar effects with hemodialysis on wave reflections and stiffness.


Assuntos
Pressão Arterial , Artérias/fisiologia , Hemodiafiltração , Diálise Renal , Rigidez Vascular , Aorta/fisiologia , Velocidade do Fluxo Sanguíneo , Feminino , Humanos , Masculino , Fluxo Pulsátil , Resistência Vascular
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