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Arterial Stiffness, Pulse Wave Analyses: What Can’t Blood Pressure Tell you in Chronic Kidney Disease
No full textAbstract: Increased arterial stiffness is emerging as a useful marker of cardiovascular damage. A growing body of
evidence suggests that the stiffening of the conduit arteries is linearly associated with poor survival in the general
population and high-risk population such as Chronic Kidney Disease (CKD) patients. Indeed, the loss of the elastic
properties of conduit arteries induces an increase in the central pulse pressure and cardiac workload leading to left
ventricular hypertrophy and reduced coronary and capillary perfusion. Notably, all these changes are independent of mean
blood pressure and other established cardiovascular risk factors.
Though, evidence is still inconclusive, some preliminary data suggest that arterial stiffness and central blood pressure
evaluation can be of use for risk stratification and treatment individualization. We herein summarize the current evidence
supporting the usefulness of arterial stiffness assessment for CKD patients’ management
Mortality in Kidney Disease Patients Treated with Phosphate Binders: A Randomized Study
No full textSummary
Background and Objectives Dietary phosphorous overload and excessive calcium intake from calcium-containing
phosphate binders promote coronary artery calcification (CAC) that may contribute to high mortality of dialysis
patients. CAC has been found in patients in early stages of nondialysis-dependent CKD. In this population, no study
has evaluated the potential role of phosphorus binders onmortality. This study aimed to evaluate all-causemortality
as the primary end point in nondialysis-dependent CKD patients randomized to different phosphate binders;
secondary end pointswere dialysis inception and the composite end point of all-causemortality and dialysis inception.
Design, Setting, Participants, & Measurements This is a randomized, multicenter, nonblinded pilot study.
Consecutive outpatients (n=212; stage 3–4 CKD) were randomized to either sevelamer (n=107) or calcium carbonate
(n=105). Phosphorus concentrationwasmaintained between 2.7 and 4.6 mg/dl for patientswith stage 3–4
CKD and between 3.5 and 5.5 mg/dl for patients with stage 5 CKD. The CAC score was assessed by computed
tomography at study entry and after 6, 12, 18, and 24 months. All-cause mortality, dialysis inception, and the
composite end point were recorded for up to 36 months.
Results In patients randomized to sevelamer, all-cause mortality and the composite end point were lower; a
nonsignificant trend was noted for dialysis inception.
Conclusions Sevelamer provided benefits in all-cause mortality and in the composite end point of death or
dialysis inception but not advantages in dialysis inception. Larger studies are needed to confirm these results
Muscle stimulation in elderly patients with CKD and sarcopenia
Full text linkAim of our study was to assess the potential effects of high-tone external muscle stimulation (HTEMS) on improvement of endothelial dysfunction (ED) and kidney damage in elderly patients with chronic kidney disease (CKD), sarcopenia and/or serious physical disability with a high Multidisciplinary Prognostic Index (MPI).
METHODS:
We enrolled 12 consecutive CKD patients with MPI > 0,66 from January 1st, 2008 to December 31st, 2014. Six patients underwent a 2-hours HTEMS during the first day (group A) and the other six patients (group B) underwent a sham experiment with HTEMS without power supply. After 24 hours, patients of group A were shifted to group B and viceversa. Nitrite/nitrate (NOx), endotheline-1 (ET-1) and urine creatinine concentration were measured in all patients.
RESULTS:
During HTEMS urine amount increased by 22% (p=0.049), so did urine creatinine that increased by 40%, (p=0.034) and creatinine clearance that increased by 26% (p=0.041). There was no statistical difference in urine nitrogen (that raised by 11%, p=0.526), urine sodium (that reduced by 42%, p=0.121) and urine potassium levels (p=0,491). At the same time, NOx changed from 44.15.1 to 38.45.3 M/L after 1 hour, to 36.44.8 M/L after 2 hours, to 41.15.7 M/L after 3 hours and to 46,95.0 M/L after 4 hours (p=0.008) during HTEMS, while it did not vary during the sham section of the experiment, respectively 43.66.1 M/L , 436.4 M/L, 42.85.5 M/L, 434.7 M/L, and 42.85.8 M/L (p=0.992).
CONCLUSION:
Our study showed that HTEMS may improve microcirculation and, through this mechanism, may reduce kidney damage in elderly patients with CKD and severe muscle atrophy
CARDIOVASCULAR EVENTS AND INCEPTION OF DIALYSIS IN DIABETIC AND NON-DIABETIC CKD PATIENTS WITH CORONARY ARTERY CALCIFICATION. FOLLOW-UP STUDY
No full textCoronary artery calcification (CC) is frequent in patients with CKD and even more in those
with concomitant type 2 diabetes. Presence and progression of CC are both strong predictive
factors of cardiovascular events (CVE) in on-dialysis patients. In contrast, the effects of CC
on the rate of CVE has been seldom evaluated as predictors in pre-dialysis (NDD-CKD)
diabetic patients. Main aim of the present study is the evaluation of the rate of CVE and
inception to dialysis in NDD-CKD patients with CC.
METHODS:
Outpatients with stage 2 to 4 CKD were screened for presence of CC with CT scan. Inclusion
criteria were: age > 18 years, CKD stage 2-4. Exclusion criteria were: symptoms of heart
failure and/or coronary artery disease, previous history of myocardial infarction, coronary
bypass surgery, angioplasty, stroke, arrhythmia. Routine blood chemistry was assessed at
enrollment and every six months. Recorded events were: sudden death, fatal and not fatal
myocardial infarction, other-cause mortality, and inception of dialysis. The scheduled followup
for evaluation of events was 48-month long. Coronary Calcium Score (CAC-Score) was
assessed by computed tomography at study entry, and on 48th month.
RESULTS:
Recruited patients (n.275) were divided in 4 groups according to presence of CC and diabetes.
Patients without CC and without diabetes were n.126; those with CC but without diabetes
were n.88; those with CC and diabetes were n.48; those without CC but with diabetes were
n.13. Presence of CC was significantly (p<0.001) higher in diabetics (79% Vs 41%) as well as
baseline CAC-score (489±571 Vs 335±666 SD; median: 250 Vs 132; Agatston Unit). At the
end of follow-up progression was 76% higher in diabetics compared to non-diabetics.
Descending artery was more frequently involved both in diabetics and not diabetics (80-91%);
circumflex coronary artery was mostly involved (71% Vs 31%) in diabetics. Composite endpoint
(CVE and inception of dialysis) was encountered in 42%, and in 69% of calcified NDDCKD
patients without and with diabetes, respectively. In the whole population, patients with
CC more frequently experienced CV events. Inception to dialysis was more frequent in non
calcified patients because fatal CVE were less frequent than those occurring in calcified
patients.
CONCLUSIONS:
Calcified NDD-CKD diabetic patients are more prone to composite end-point of CVE and
inception to dialysis. Initiation of dialysis is more frequent in non calcified NDD-CKD
patients. Because of the higher risk for cardiovascular events, NDD-CKD diabetic patients
might benefit from risk stratification with CAC-score screening. This non invasive procedure
may help physicians in choosing the better medical therapy for diabetics
Saturday, Ma
Lanthanum carbonate is not associated with QT interval modification in hemodialysis patients
No full textGoing Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Phosphate binders in moderate chronic kidney disease: where do we stand?
No full textPhosphate levels are strikingly associated with poor outcomes in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. Numerous epidemiological studies have repeatedly documented a worrisome link between serum phosphorus and adverse outcome in CKD stages 3 and 4. Notably, some but not all series suggest that the risk is significantly increased even for serum levels within the reference range of normality for serum phosphorus. The use of phosphate binders as a tool for controlling hyperphosphatemia has also been associated in observational studies with a better survival both in CKD and ESRD. However, no randomized clinical trial (RCT) has ever tested the impact of phosphate-lowering interventions (i.e., phosphate binder or nutritional intervention) on hard outcomes. Furthermore, a recent RCT seems to caution against the indiscriminate use of phosphate binders in CKD patients not receiving maintenance dialysis. Considering the clinical sequelae associated with phosphate overload in CKD, phosphate-lowering therapy is perceived as crucial and safe to prevent chronic kidney disease-mineral bone disorder (CKD-MBD). However, when to start in the course of CKD, how to monitor and whether to choose a calcium-based or a calcium-free phosphate binder are still subject to debate. Further research is deemed necessary to elucidate whether early treatment with phosphate binders is safe and may attenuate the CKD-MBD progression through phosphate load reduction
Coronary Artery Calcification Progression Is Associated with Arterial Stiffness and Cardiac Repolarization Deterioration in Hemodialysis Patients
No full textBackground/Aims: Evidence suggests that vascular calcification
(VC) portends poor cardiovascular (CV) prognosis in
patients undergoing maintenance dialysis (CKD-5). Nonetheless,
how VC might predispose to CV mortality still remains
to be clarified. Herein, we report on the association
between coronary artery calcification (CAC) progression and
changes in cardiac repolarization as well as arterial stiffness.
Methods: 132 patients new to dialysis were identified. Demographic
and clinical characteristics were collected at
study entry and during the 12-month follow-up. CAC, 12-
lead ECG and pulse wave velocity (PWV) were assessed at
baseline and study completion. Uni- and multivariable analyses
were applied to detect factors associated with worsening
of cardiac repolarization (QTd) and arterial stiffness
(PWV). Results: Uni- and multivariable analyses revealed
that CAC progression was associated with a significant increase
in both QTd and PWV. Every 20-unit increase in the
CAC score corresponded to a significant 23% (95% CI 1.12–
1.27; p ! 0.001) and 32% (95% CI 1.09–1.37; p ! 0.01) increase
in the risk of experiencing a 1-m/s increase in PWV and 1 ms in QTd, respectively. Conclusion: VC is a marker of vasculopathy
and appears to be associated with cardiac repolarization
and arterial stiffness abnormalities in CKD-5 patients
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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