Hypertension and nephrology

[Paradigmal changes in renal replacement therapy. Dialysis and drug therapy of quality in chronic renal patients - Optimal and adequate opportunities of dialysis therapy]

KISS István, SZEGEDI János, FODOR Erzsébet, BARABÁS Noémi, REMPORT Ádám, AMBRUS Csaba, KULCSÁR Imre

MARCH 22, 2013

Hypertension and nephrology - 2013;17(01)

[Researches over the past thirty years, many results have been related to acute and chronic renal failure pathophysiology, clinical characteristics and therapy. Can be more than just the uremic toxins and their characteristics of the regulation of salt and water balance, renal anemia treatment, uremic metabolic disorders, calcium phosphate and lipid metabolism dysfunction. Improve the quality of treatment and reduce mortality and options can be influenced by factors come to, therefore, execution and technique of dialysis therapy. We know the primary concern of the treatment period for reducing mortality. This is best for intermittent treatments increased (4.5-6 hours) treatment will help. Narrow scope is optional for the treatment several times a week treatment, the daily 8-hour long nightly therapy. The mortality of the patient significantly influenced by age, gender, co-morbidities, fluid balance and the CaxPO4. The technical side is the key factor influencing the dialysis fluid purity and membrane properties. The use of high-flux membranes is clearly improving the quality of treatment, the additional benefit of hemodiafiltration therapy, the mortality for those still controversial. For optimal dialysis adequacy, complexity may result in reducing mortality and improving the quality of life in chronic dialysis patients.]

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Hypertension and nephrology

[Obstructive sleep apnea, hypertension and cardiovascular risk]

ALFÖLDI Sándor

[Obstructive sleep apnea (OSA) is a surprisingly frequent disease worsening the quality of life of the patients, associated with serious complications, however, largely underdiagnosed and undertreated. OSA, hypertension and other symptoms of the metabolic syndrome are closely and independently correlated. OSA has been substantially emphasized as a new (emerging) cardiometabolic risk factor, not only a risk marker. The severe form of OSA (apnea-hypnea index>20/hour) has been accepted as a component of high cardiovascular risk on the Hungarian Cardiovascular Consensus Conference in 2008. Greater attention both to the identification and to the treatment of blood pressure increase associated with OSA as well as to the detection of OSA in patients with the diagnosis of hypertension has been suggested by the new European OSA and Hypertension Position Papers, because hypertension associated with OSA is frequently resistant and the proper management of OSA and hypertension could decrease the cardiovascular risk in patients followed up either in sleep or in hypertension centres.]

Hypertension and nephrology

[Causes of and therapeutic opportunities in resistant hypertension]

SIMONYI Gábor, GENCSI Kristína

[Hypertension is an independent cardiovascular risk factor and one of the most frequent diseases in Hungary. In the treatment of hypertensive patients usually more than two drugs are needed for the appropriate blood pressure control. Resistant hypertension (RH) is defined when blood pressure remains above target value despite full doses of antihypertensive medications, which consist of at least three different classes of drugs including a diuretic administered in maximal doses. The frequency of RH can reach 20-30% among hypertensive patients. RH increases the cardiovascular risk because of the lack of target blood pressure. RH is multifactorial and it is important to exclude pseudo-resistant hypertension (e.g. poor compliance, white coat effect). In the background of RH we can find lifestyle factors (e.g. obesity, excessive salt intake, alcoholism, etc.) and a variety of drugs (e.g. non-steroids, corticosteroids, sympathomimetics). In the pathogenesis of RH the increased activity of the sympathetic nervous system has an important role. In the treatment of RH we should manage lifestyle factors and it is important to assess the drugs and diseases (e.g. sleep apnea, chronic kidney disease, diabetes mellitus) which may cause increased blood pressure. It is no exact recommendations for the treatment of RH. Therapy often consists of 4-5 various drugs in combination. An important role has the device therapy of RH in recent years (e.g. stimulation of the carotid baroreceptors and renal denervation) as well.]

Hypertension and nephrology

[The success of fixed combined amlodipine/atorvastatin (Amlator®) therapy in patients with hypertension and dyslipidemia]

KÉKES Ede

[In total 2606 patients with hypertension and dyslipidemia got combined antihypertensive and antilipid-treatment. The main component of therapy was amlodipine/ atorvastatin fixed combination in different dose variations. The goal of the study was to access optimal target blood pressure and lipid profile. The baseline average blood pressure value was 155.9/90.18 mmHg and it decreased to 132.77/80.04 mmHg during the six months therapy. The lipid profile also changed successfully: the average value of total cholesterol decreased from 5.97 mmol/l to 4.68 mmol/l, LDL cholesteron from 3.45 mmol/l to 2.49 mmol/l and serum triglyceride from 2.1 mmol/l to 1.69 mmol/l. We reached the target values in respect of LDL cholesterol (<2.5 mmol/l) and of triglyceride (<1.7 mmol/l) prescribed in guidelines for subjects with high cardiovascular risk. According to the global cardiovascular risk estimation (European Heart Score) the risk ratio in percent was significantly decreased in each age group, in both genders and in smoking or nonsmoking subjects.]

Hypertension and nephrology

[Population based study of hypertension in Hungary - 2012 Comprehensive Health Protection Screening Program of Hungary 201-2020]

BARNA István, DAIKI Tenno, DANKOVICS Gergely, KÉKES Ede, KISS István

[Background: The year 2011 saw the continuation of Hungary’s greatest and to date most comprehensive health screening programme started in 2010. The aim of the screening programme established according to the directives of the European Union with the cooperation of more than forty professional organisations is the preservation of the health of the population, the prevention of illnesses and the improvement of the general health status. The programme contributes to the prevention of coronary diseases by passing on knowledge concerning healthy nutrition and guidelines to help the establishment of a health-conscious lifestyle. Partecipants and methods: In the Comprehensive Health Tests Programme of Hungary, the examinations, among them coronary examinations covering the fields of cardiology and hypertension, take place in a specially furnished lorry. The results of the examinations of the people who have presented themselves for the tests (n=19,814) have been evaluated. In the Comprehensive Health Tests Programme of Hungary a total of 10,444 (52.7%) women and 9,370 (47.3%) men were tested at 332 locations. Although the tests were free for all adults, predominantly persons between the ages of 26 and 55 presented themselves. The average age of women was 42 years and that of the men was 40 years. Results: Upon data processing with the help of a query, 28% of the participants reported suffering from hypertension disease. Measurement of the blood pressure was carried out in each case with validated equipment and by qualified medical staff. Based on the data, it can be observed that while among men hypertension tends to occur in larger numbers at a younger age, the tendency is reversed at ages above 45 years, where hypertension is more frequent among women. Among women, the state of normotonia was most frequent up to the age of 45 and stage 1 hypertension became most frequent from the age of 46 onwards. It must be noted, however, that stage 3 hypertension was already present in 1.7% of women of 26 years of age, and the frequency of this category increased to 6% from the age of 46 onwards. The average systolic blood pressure measured among men exceeded the upper limit of the normal range for all age groups. The average systolic blood pressure measured among women was in the normal range up to the age of 55 years and only moved to the pathological range from the age of 56 onwards. The diastolic blood pressure levels were in the normal range for both sexes (with the exception of the age group 46-55 of the men, where it exceeded the upper limit of the normal range by a minimal extent). Among the men, stage 1 hypertension was the most frequent status for all age groups; blood pressures above 140/90 were measured for 39% of the subjects from the age of 18 onwards. The distribution of this did not vary significantly with the increase of age. It must be mentioned here too, that stage 3 hypertension became more frequent with age, and that it was observed in more than 11% of the patients above 56 years of age. The correlation between abdominal circumference, total cholesterol, blood sugar level and the measured blood pressure values was unambiguously ascertainable. In case of simultaneous presence of diabetes and hypertension (women, n=344 and men, n=303), blood pressures above 140/90Hgmm were 2-3 times more frequent for both sexes than without the presence of diabetes. Discussion: Thanks to the vast information obtained through the programme, a comprehensive picture has been drawn up about Hungary’s present health status not only on a regional or cross sectional level, but as it was described in the programme, too. ]

Hypertension and nephrology

[The beginning and difficulties of peritoneal dialysis at the end of the last century - Part I. International experiences]

KARÁTSON András

[The theoretical background of peritoneal dialysis dates back to the 18th and 19th century. It was in 1923 when the first experimental and clinical experiences were summarised by Ganter from Munich. Of the Hungarian researchers Stephen Rosenak’s name can be mentioned, who was working in this field in Bonn in 1926 and later in London and New York. Obstacles to the spread of this treatment method was the lack of appropriate abdominal catheters, biocompatible solutions and equipment. The intermittent technique of the method was time consuming and, due to the conditions of that time, peritonitis frequently developed. The spread of the method was facilitated by the catheter constructed by Tenchkoff towards the end of the 1960s, the automatization of the treatment and later continuous ambulatory peritoneal dialysis (CAPD) described by Popovich and Moncrief. Further development of the method became possible by the use of the two-litre plastic bags instead of the bottled solution and later a twin-bag system employing the “flush before fill” technique. The occurrence of peritonitis developing during the treatment gradually decreased, in which Stephen I. Vas of Hungarian origin, working in Toronto as a professor of microbiology played an important role by constantly improving and modifying the principles of the therapy. Besides the infection in the abdominal cavity the bioincompatibility of the dialysis fluid presented another problem, which was solved by the use of essential amino acids, icodextrin instead of glucose and bicarbonate instead of lactate. By the turn of the century it became clear that the survival rate of peritoneal dialysis is very similar to that of hemodialysis in the second and third years following the treatment, while in relation to the quality of life it proved to be better. This observation has been proved in numerous clinical studies in the past decade and has been refined with regard to patients’ age, their primary and accompanying diseases. It is my intention to give account of the Hungarian experiences with peritoneal dialysis in the second part.]

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[COVID-19 and Parkinson’s disease]

TÓTH Adrián, TAKÁTS Annamária

[Parkinson’s disease is the elderly people’s condition which increases the risk of infections in the upper airways in its ad­vanced stages. Specific diseases (as hypertension, diabetes mellitus), older age and the male sex are significantly worsening the course of COVID-19. It would be challenging to examine parallel these diseases, since they are raising two important ques­tions. First, if Parkinson’s disease be a risk factor of COVID-19 morbidity and mortality. Se­condly, how the COVID-19 pandemic can influence the Parkinson’s disease patients. The authors are seeking answers to these questions based on the published results in the topic concerned.]

Lege Artis Medicinae

[Lipid lowering therapy during COVID-19 pandemic]

MÁRK László

[The COVID-19 pandemic posed significant challenges to all healthcare systems of the world as created a new situations above the large number of people infected, solutions of which were lacking any previous patterns. Former experiences were specifically needed among physicians who practised usually with therapies supported by evidence based clinical experiences thus they were working along the principles of Evidence-Based Medicine. The new observations and recommendations for treating infected patients increased gradually, however they were not always well-founded by the general urgency. In this situation, physicians faced often problems of the patient’s former medications since they had to focus on the therapy of the prevalent life-threatening condition. In such cases, therapy as lipid lowering, which is inherently inimically and lightly taken, may be omitted even more often. Basic drugs of lipid lowering are statins. They are used to reduce cholesterol levels and the risk of cardiovascular events, but they have also been described as having beneficial effect on the new viral infection. In this effect, the statins beyond the well-known anti-inflammatory impact and increasing the expression of angiotensin-converting enzyme-2 further mechanisms can take part as well. These may include among others the promoted breakdown of lipid rafts, which directly inhibits the entry of coronavirus into the cell through the S protein by decreasing the level of cholesterol required for this proceeding. In a group of more than 1200 statin treated and SARS-COV-2 infected patients the overall mortality rate by the 28th day was 48% lower than among the non-statin-users. According to a meta-analysis of nearly nine thousand COVID-19-infected statin users, they had 30% lower mortality rate or serious complications. Up to date observational studies suggest that statin therapy and the administration of other lipid lowering drugs should be continued or initiated according to the guidelines also during the COVID-19 infection.]

Hypertension and nephrology

[Dialyzed patients with Covid-19 infection in Hungary in 2020]

KULCSÁR Imre

[We have observed the number and mortality of dialyzed patients with Covid-19 infection in 2020 in Hungary. We have summarized all of 54 dialysis facility where adult patients were treated. During the year, 1242 cases of infection were confirmed in patients undergoing dialysis. 16% (753/4704) of incident dialysis patients were infected. The number of dialysis patients with all Covid-19 infections was 1995. 31.1% of infected patients have died. The mortality was higher in large hemodialysis centers (patient transport, isolation difficulties, increased risk of contamination). Covid-19 positive patients treated with peritoneal dialysis (PD) had significantly lower mortality than those treated with hemodialysis (HD). Chronic kidney disease (CKD) is the most common risk factor for serious Covid-19 infections worldwide, which is why these patients require increased attention (especially for dialysis and transplant recipients). In 2020, there was no vaccine available in our country]

Clinical Neuroscience

The evaluation of the relationship between risk factors and prognosis in intracerebral hemorrhage patients

SONGUL Senadim, MURAT Cabalar, VILDAN Yayla, ANIL Bulut

Objective - Patients were assessed in terms of risk factors, hematoma size and localization, the effects of spontaneous intracerebral hemorrhage (ICH) on mortality and morbidity, and post-stroke depression. Materials and methods - The present study evaluated the demographic data, risk factors, and neurological examinations of 216 ICH patients. The diagnosis, volume, localization, and ventricular extension of the hematomas were determined using computed tomography scans. The mortality rate through the first 30 days was evaluated using ICH score and ICH grading scale. The Modified Rankin Scale (mRS) was used to determine the dependency status and functional recovery of each patient, and the Hamilton Depression Rating Scale was administered to assess the psychosocial status of each patient. Results - The mean age of the patients was 65.3±14.5 years. The most common locations of the ICH lesions were as follows: lobar (28.3%), thalamus (26.4%), basal ganglia (24.0%), cerebellum (13.9%), and brainstem (7.4%). The average hematoma volume was 15.8±23.8 cm3; a ventricular extension of the hemorrhage developed in 34.4% of the patients, a midline shift in 28.7%, and perihematomal edema, as the most frequently occurring complication, in 27.8%. Over the 6-month follow-up period, 57.9% of patients showed a poor prognosis (mRS: ≥3), while 42.1% showed a good prognosis (mRS: <3). The mortality rate over the first 30 days was significantly higher in patients with a low Glasgow Coma Scale (GCS) score at admission, a large hematoma volume, and ventricular extension of the hemorrhage (p=0.0001). In the poor prognosis group, the presence of moderate depression (39.13%) was significantly higher than in the good prognosis group (p=0.0001). Conclusion - Determination and evaluation of the factors that could influence the prognosis and mortality of patients with ICH is crucial for the achievement of more effective patient management and improved quality of life.

Clinical Neuroscience

[MORTALITY OF HOSPITALIZED STROKE PATIENTS IN HUNGARY; 2003-2005]

GULÁCSI László, MÁJER István, KÁRPÁTI Krisztián, BRODSZKY Valentin, BONCZ Imre, NAGY Attila, BERECZKI Dániel

[The aim of our research was to assess the incidence and the 12- and 24-month mortality of hospitalized stroke in Hungary. We analyzed the rate of mortality after stroke and compared it to the standard mortality rate of the population. To assess the incidence we extracted the data of “new” stroke patients (ICD- 10 diagnoses: I60-64) hospitalized in May 2003 from the database of the National Health Insurance Fund Administration. We regarded those as “new” patients who had not been treated with these primary or secondary diagnoses in the previous 24 months. Data were collected by sex and age (age groups: 25-44, 45-64, 65 and over). We analyzed the patients' survival on the basis of their April 2004 and April 2005 data. The incidence of the “new” hospitalized stroke patients was higher in men than in women; the incidence in the age group of 65 and over was 2112/100.000 in males and 1582/100.000 in females, the corresponding values in the 45-64 age group were 623 vs. 366 per 100.000, respectively. In 2003 more than 42 thousand “new” stroke patients were hospitalized in Hungary of whom over 10 thousand died in the first year, followed by a further 2 thousand in the second year. Women’s survival is more favourable than men's: in the first year it is 71.47% vs. 69.24% (65+ group), and 88.18% vs. 83.16% (45-64 group); in the second year the corresponding values are 66.95% vs. 61.62% (65+), and 85.45% vs. 80.90% (45-64), respectively. The risk of death in the first year after stroke, compared to the standard population, is 5.17- fold in women and 4.70-fold in men in the total sample, and 10-15-fold in the 45-64 group. There are large differences by gender, particularly in men of the working age groups (25-44, 45-64), whose mortality is twice as high as that of women of the same age.]