Hypertension and nephrology - 2013;17(05-06)

Hypertension and nephrology

DECEMBER 10, 2013

Hypertension and nephrology

DECEMBER 10, 2013

[Relationship of Adipokins with Diurnal Changes in Blood Pressure ]

KOVÁCS Imre, TARJÁN Jenő, HEGEDŰS Zoltán, VÉGH Tibor, HORVÁTH Judit, KERN András, KOVÁCS Nóra, KOLLER Ákos

Hypertension and nephrology

DECEMBER 10, 2013

[Early histopathological changes in new onset diabetes mellitus after renal transplantation]

IBRAHIM Munir Yasmin, BORDA Bernadett, LENGYEL Csaba, VÁRKONYI Tamás, KEMÉNY Éva, SZABÓ Viktor, KUBIK András, LÁZÁR György

[Introduction: New-onset diabetes after transplantation (NODAT) is one of the most common complications following kidney transplantation. The diagnosis of NODAT is often late or missed, therefore it impairs the implanted renal allograft. Patients and methods: Patients were randomized to receive cyclosporine A- or tacrolimusbased immunosuppression. One year after the transplantation, fasting and oral glucose tolerance tests were performed, and the patients were assigned to one of the following three groups based on the results: normal, impaired fasting glucose/impaired glucose tolerance (IFG/IGT), NODAT. Age, laboratory results, renal function, morphological abnormalities, and changes in the Banff score were evaluated. Results: NODAT developed in 14% of patients receiving cyclosporine A-based immunosuppression and in 26% of patients taking tacrolimus (p=0.0002). Albumin levels were similar, but uric acid level (p=0.002) and the age of the recipient (p=0.003) were significantly different between the diabetic and the normal group. The evaluation of renal function showed no significant differences in case of serum creatinine level, eGFR, and urea level. Evaluation of tissue samples revealed that acute cellular rejection (ACR) and interstitial fibrosis/ tubular atrophy (IF/TA) were significantly different in the NODAT group. Changes in the Banff score provided significant difference regarding tubulitis (“t”) and interstitial inflammation (“i”) (p=0.05). Discussion: The pathological effect of new-onset diabetes after kidney transplantation can be detected in the morphology of the renal allograft earlier, before any signs of functional impairment.]

Hypertension and nephrology

DECEMBER 10, 2013

[Monitoring of effectiveness of ramipril-amlodipine fixed combination, a non-interventional trial (Ramona study). Subgroup analysis of patients with chronic kidney disease]

SIMONYI Gábor

[Hypertension and chronic kidney disease are independent cardiovascular risk factors. The 5th Cardiovascular Consensus Conference has recommended chronic kidney disease in high-risk category. In chronic kidney disease hypertension is observed in most cases. In patients with chronic kidney disease blood pressure targets are as 140/90 mmHg blood pressure below must be achieved without overt proteinuria. In chronic kidney disease combined antihypertensive therapy treatment should be initiated according the Hungarian Society of Hypertension recommendations. Aims: Monitoring the effectiveness and safety of the fix combination of ramipril/amlodipine Egiramlon® therapy in chronic kidney disease suffering from mild or moderate hypertension despite antihypertensive treatment. Patients and methods: Open, prospective, phase IV clinical observational study, which involved known chronic kidney disease (age over 18 years) with mild or moderate hypertension. Ramipril/amlodipine fixed combination (5/5, 5/10, 10/5 or, 10/10 mg) were administered or titrated in three visits, during the 4 months of trial period. The doses of the fixed combination drugs were determined individually during the visits by the 923 physicians involved in the study. The target blood pressure value was <140/90 mmHg according the new guidelines of ESH/ESC. Results: 70.1% of total patient (9169) was fulfilled the protocol during the four month of trial (6423 patients). In this population 194 patients suffered from chronic kidney disease. The age of patients was 68.52±1.84 (mean±SD) years, 85 (43.8) women and 109 (56.2%) men. 74.74% of total patients with chronic kidney disease has reached target blood pressure at the end of 4th month (primary endpoint). The blood pressure has decreased significantly (all p<0.0001) from 158.04/90.46±9.97/8.30 mmHg (1. visit) to 138.77/82.12±10.68/7.21 mmHg 2. visit and to 130.40/78.59±7.56/5.75 at the and of trial (3. visit), it means -27.64/- 11.87 mmHg decrease from the beginning of the 4th Month (3. visit). eGFR level increased significantly from 46.3±16.49 ml/min/1,73m2 to 49.0±19.58 ml/min/1,73m2. Patients suffered from chronic kidney disease have tolerated well the various doses of fixed combination of ramipril/amlodipine, and adverse events have no occurred correlation of treatment.]

Hypertension and nephrology

DECEMBER 10, 2013

[Change in prescribing RAS inhibitors with respect of data of National Health Insurance Fund (NHIF)]

BARNA István, GYURCSÁNYI András

[The authors examined and analyzed monthly data of accounted prescription sales that were supported by the National Health Insurance Fund. They wished to determine how the use of angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARB) had changed. They separately evaluated how much this data was in accordance with the several, recently published articles about clinical trial results that compared inhibitors of the renin-angiotensin system (RAS inhibitors). It seemed worthwhile to examine the use of RAS inhibitors in Hungary and more specifically where RAS inhibitors stand among subsidized drugs based on the National Health Insurance Fund (OEP) database. The processed data was obtained from the National Health Insurance database, in the Decembers of 2007-2012 years and was based on prescription sales in pharmacies that were accounted for by the National Health Insurance Fund. During the data analysis we examined the number of prescriptions accounted for by looking at ATC codes and molecules, and examined the number of products (brands) available by ATC with Social Insurance Support in the given period. We examined the monthly turnover of ACE inhibitors and ARB products and the kedveamount of Social Insurance Support on these prescriptions in the given period. Next, we analyzed how much the average cost of prescriptions was by ATC codes and what kind of molecules have been available in Hungary with Social Insurance Support according to ATC codes.]

Hypertension and nephrology

DECEMBER 10, 2013

Hypertension and nephrology

DECEMBER 10, 2013

[Managing medical quality and patient safety in an international dialysis network]

TÖRÖK Marietta, OROSZ Attila, CHARLOTTA Wollheim, JÖRGEN Hegbrant

[A dialysis provider’s core activities include providing dialysis care with excellent quality, ensuring a low variability across the clinic network and ensuring strong focus on patient safety. In this article, we summarize the pertinent components of the quality assurance and safety program of the Diaverum Renal Services Group. Concerning medical performance, the key components of a successful quality program are setting treatment targets; implementing evidence- based guidelines and clinical protocols and revising targets, guidelines and clinical protocols based on sound scientific data. Consistently, regularly, prospectively and accurately collecting data from all clinics in the network; processing collected data to provide feedback to clinics in a timely manner. The key activities for ensuring patient safety include a standardized approach to education, i.e. a uniform education program including control of theoretical knowledge and clinical competencies; implementation of clinical policies and procedures in the organization in order to reduce variability and potential defects in clinic practice. We point out the importance of auditing clinical practice on a regular basis. By applying a standardized and systematic continuous quality improvement approach throughout the entire organization, it has been possible for Diaverum to progressively improve medical performance and ensure patient safety]

Hypertension and nephrology

DECEMBER 10, 2013

[Current diagnosis and treatment of membranous nephropathy]

STUDINGER Péter, CSEPREKÁL Orsolya, FINTHA Attila, KARDOS Magdolna, TISLÉR András

[Primary membranous nephropathy is a common glomerular disorder characterized by subepithelial immune deposits. The pathomechanism underlying these lesions has only recently been elucidated: M-type phospholipase A2receptor (PLA2R) protein emerged as being the leading autoantigen. Antibodies to PLA2R, typically of IgG4 subclass are expressed in 70-80% of patients with primary membranous nephropathy. The level of autoantibody to PLA2R was shown to correlate with disease severity and to change parallel with disease activity in response to therapy. While mild forms of the disease are prone to spontaneous remission and carry excellent prognosis, severe forms often progress into end-stage renal disease without treatment and necessitate immunosuppression. The latest guidelines recommend the application of corticosteroids with alkylating agents or calcineurin inhibitors as first-line therapy. Promising new therapies that are currently being explored for this disease include rituximab, mycophenolate mofetil, and adrenocorticotropic hormone.]