Hypertension and nephrology

[Dietary treatment of dialysis patients]


APRIL 20, 2018

Hypertension and nephrology - 2018;22(02)

[Adequate nutritional indices and intake are the corner stone of long term success of renal replecement therapies (hemo- and peritoneal dialysis, transplantation) characterized by favourable survial rates and a good quality of life. There has been no major change in basic principles of nutritional prescription (protein, energy, fluid intake, restriction of sodium, potassium and phosphorous), increasing emphasis has been placed on the reduction of calcium load and ”native” vitamin-D therapy in these patients. Less avareness has been put however in the past ten years (according to recent metaanalyses) on the role and replacement of the full scale of vitamins, in spite of their occasionally altered metabolism and replacement-requirements in ESRD patients. Usually there is a need for their replacement, but some of them are represented in abundant, sometimes toxic amounts in commercially available multivitamin preparates. With in the scope of general aspects of nutrition in ESRD patients, the article gives a detalied overview of their multivitamin recommendations and alternatives of a specified substition.]



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Hypertension and nephrology

[Remembering Professor István Czuriga MD]


Hypertension and nephrology

[Cholesterol-lowering is not the Holy Grail, but neither is the work of the devil]


[Cholesterol-lowering statins are the most tested medications in respect of the effects and side-effects. Based on these, we can safely claim that most of the negative opinions about cholesterol-lowering are not realistic. It is not a panacea, but it is proven that around a 30% of cardio- and cerebrovascular risk reducation can be achieved by their regular taking, while the incidence of side effects and risks are at least one order of magnitude lower in each patient groups. For cholesterol, there is no “normal” lab threshold or low level, only “target values”, since the mean value in the general population is high in regard of atherosclerosis (the values measured at birth and among natural people can be considered normal). Let us appreciate the cholesterol- lowering medications because we do not have a large armamentarium!]

Hypertension and nephrology

[Summary of guidelines for American, European and International Companies in diabetes mellitus type 2 associated with hypertonia]

KÉKES Ede, DOLGOS Szilveszter

[The importance of hypertension in type 2 diabetes mellitus, the method of continuous blood pressure control and patient’s careas well as the forms of non-drug and drug therapy have been disclosed by presenting therapeutical recommendations from American, European scientific societies and international organizations. It has been established that the principles of care and treatment of hypertonia have basically remained unchanged in diabetes all over the world, despite the recent widespread debate over the interpretation of normal blood pressure and the consideration of the benefits of intensive or standard treatment.]

Hypertension and nephrology

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Hypertension and nephrology

[Role of β-blockers, especially carvedilol in the treatment of hypertension]

PÁLL Dénes, MARODA László, ZRÍNYI Miklós

[Changes in hypertension guidelines in the past years have affected the clinical thinking about β-blockers. Authors reviewed the development of β-blockers emphasizing the differences across various active pharmaceutical agents. Different hemodynamic and metabolic effects are being discussed in details for the third ge - neration vasodilatator carvedilol. Carvedilol has no effect on cardiac output but decreases peripheral vascular resistance which results in lower blood pressure values. However, carvedilol, opposite to unfavorable effects of traditional β-blockers, has a neutral impact on both carbohydrate and lipid metabolisms. Its more advanced cardiac effects include decreased left ventricular hypertrophy and increased coronary flow reserve. Vasodilatator type β-blockers (carvedilol, nebivolol) are indicated in the combi - nation treatment of hypertension, especially when the patient has heart failure, coronary disease or suffered from a previous heart attack.]

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Hypertension and nephrology

[Association of body composition and mortality in patients on maintenance dialysis]


[Overweight [body mass index (BMI) = 25-30 kg/m2] and obesity (BMI ≥30 kg/m2) have become mass phenomena with a pronounced upward trend in prevalence in most countries throughout the world and are associated with increased cardiovascular risk and poor survival. In patients with end stage renal disease (ESRD) undergoing maintenance hemodialysis an “obesity paradox” has been consistently reported, i.e., a higher BMI is incrementally associated with better survival. Whereas this “reverse epidemiology” of obesity is relatively consistent in maintenance hemodialysis patients, studies in peritoneal dialysis patients have yielded mixed results. However, BMI is unable to differentiate between adiposity and muscle mass and may not be an acceptable metric to assess the body composition of ESRD patients. Assessing lean body mass, in particular skeletal muscle, and fat mass separately are needed in ESRD patients using gold standard techniques such as imaging techniques. Alternatively, inexpensive and routinely measured surrogate markers such as serum creatinine, waist and hip circumference or mid-arm muscle circumference can be used. We have reviewed and summarized salient recent data pertaining to body composition and clinical outcomes about the association of survival and body composition in peritoneal and hemodialysis patients.]

Journal of Nursing Theory and Practice

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[The arterio-venous fistula is also called the dialysis patient’s lifeline. The name lifeline stands for the essential connection between the body and the dialysis machine. Keeping it in good condition is very important, because fistulas play a keyrole in the successful dialysis treatment. Fistula care is indispensable both from the nurse and patient side. The dialysis team is responsible for the fistula puncture and care. We introduced the bevel down puncture technique in November of 2011 for better arterio-venous shunt care. Our dialysis nurses were trained on the correct position of the fistula needle. We emphasised the benefits and long-term effects. We use this technique for all patients, except for the first fistula puncture. The bevel down puncture technique reduces the patient’s fear of fistula puncture as it causes less pain. After removal of the needle, the bleeding time decreased from the approximate 6-7 minutes to less than 5 minutes and bleeding volume is also decreased. It also reduces the size of the scab and the aneurysm formation. In our dialysis unit we have had good experiences with the bevel down puncturing technique, as it kept our patients’ fistulas in good condition, this may prolong vascular accesses lifetime.]

Hypertension and nephrology

[Stroke is a common, severe, but preventable cardiovascular disease in chronic kidney disease]

NAGY Judit, KOVÁCS Tibor, KÉSŐI István, TÓTH Péter, SÁGI Balázs, SZAPÁRY László, VAS Tibor, KOMOLY Sámuel, KOLLER Ákos, WITTMANN István, BERECZKI Dániel, KISS István

[In chronic kidney disease (CKD) patients the high risk for cardiovascular events represents the major cause for morbidity and mortality. Stroke is the third most common manifestation of cardiovascular diseases and cause of death. The risk of cerebrovascular diseases persists in CKD patient in predialysis increases by 1.5-3 times whereas in patients on dialysis is increases by 4-10 times. The combination of classical cardiovascular risk factors and the pathomechanisms present in CKD and activated by dialysis treatment may explain the increased risk. The outcome of stroke is more severe in CKD, than in other populations. There are only a few data regarding early identification, primary and secondary prevention. and proper treatment of stroke in CKD patients with and without dialysis. In this review we summarize the diagnostic and treatment strategies that are based on the existing state of knowledge. However, additional studies are needed to address the poor prognosis through early identification of risk developing potential preventions and treatments of stroke in CKD.]

Lege Artis Medicinae

[New opportunities for the estimation of health loss in Hungary]


[BACKGROUND - The Global Burden of Disease Study has been publishing its reports since the early 1990’s. The last one from 2010 covers 291 diseases, and 67 risk factors for 187 countries. AIMS - Presenting examples of the Hungarian health burden status the authors advocate the use this unique data source. METHODS - The authors downloaded the 1990 and 2010 data for Hungary from the Global Burden of Disease Study website. To quantify the economic burden they calculated the change in GDP related to the absence from work as a consequence of risks and diseases. RESULTS - In the publication the authors presented some of the versatile utilization methods of the GBD data and the data visualization tools available on GDB’s website. In 2010 the DALY for Hungary was 3,714,900 years which is the 84% of the country’s DALY in 1990. The most Years Lived by Disability was caused by musculoskeletal disorders (YLD: 28.4%), while cardiovascular and circulatory diseases caused the most Years of Life Lost (YLL: 40.3%). In 2010 the dietary risk was the leading risk factors in Hungary accountable for 840 thousand of life years lost which economic cost was over 950 milliard Hungarian forints. CONCLUSIONS - The use of the result provided by the Global Burden of Disease Study can significantly contribute for planning and evaluating interventions to promote healthy lifestyle, to advance supporting living conditions, and to distribute health care capacity efficiently.]

Hypertension and nephrology

[Covid-19 and the kidney]

PATÓ Éva, DEÁK György

[Covid-19 pandemy has emerged from Wuhan, China in December 2019. The infection affects not only the lung but other organs such as the kidney, as well. The relation between Covid-19 infection and the kidney is bidirectional. On one hand, Covid-19 infection may cause kidney damage in 50-75% of the cases resulting in proteinuria, haematuria and acute kidney injury (AKI). The etiology of AKI is multifactorial. Main pathogenic mechanisms are direct proximal tubular cell damage, sepsis-related haemodinamic derangement, citokine storm and hypercoagulability. The virus enters proximal tubular cells and podocytes via the ACE2 receptor followed by multiplication in the lysomes and consequential cell lesion. Histopathology shows acute tubular necrosis and acute tubulointerstitial nephritis. AKI is a strong predictor of mortality in critically ill patients. On the other hand, the risk of Covid-19 infection and mortality is substantially increased in patients with chronic kidney disease – especially in those with a kidney transplant or on dialysis – due to their immunocompromised status. Among haemodialysis patients, infection may spread very easily due to the possibility of getting contacted in the ambulance car or at the dialysis unit. The mortality rate of patients on renal replacement therapy with Covid-19 infection is 20-35%. In order to avoid mass infection it is obligatory to employ preventive measures and implement restricions along with (cohors) isolation of infected patients. In Hungary, every dialysis or kidney transplant patient with Covid-19 infection should be admitted to dedicated Covid-19 wards.]