Hypertension and nephrology

[Prevalence of bone abnormalities and soft tissue calcification and their determining factors in dialyzed patients]

KISS Zoltán, AMBRUS Csaba, SZABÓ András, SZEGEDI János, BALLA József, TÖRÖK Marietta, LADÁNYI Erzsébet, CSIKY Botond, ÁRKOSSY Ottó, TÚRI Sándor, KULCSÁR Imre, KISS István

SEPTEMBER 21, 2012

Hypertension and nephrology - 2012;16(03-04)

[Disturbances of bone and mineral metabolism are frequent complications of chronic kidney disease. In the last decades, increasing evidence of both pathophysiological and epidemiological nature support the relationship between bone disease and soft tissue calcification. In this current research, we analysed characteristics, determining factors and relationship of these two complications in a nationwide, cross-sectional cohort of dialysed patients. We collected demographical data (age, gender, body weight, height, diabetes, type of dialysis), laboratory results (serum parathormone, calcium, phosphat, albumin levels) and the presence of diabetes mellitus, bone abnormalities and soft-tissue calcification in patients on maintenance dialysis in 2010. The prevalence of bone abnormalities and soft tissue calcification followed similar pattern: both prevalences were high when parathormone <150 pg/ml (42.9% and 51.5%, respectively) or >500 pg/ml (44.2% and 55.5%) and they were significantly lower when parathormone was between 150-500 pg/ml (30.7% and 47.4%). In a multivariate logistic regression model, independent predictors of bone abnormalities were low (<150 pg/ml) and high (>500 pg/ml) parathormone levels (p<0.001), orhemodialysis (vs peritoneal dialysis) (p<0.001), age (p<0.001) and diabetes (p<0.001). In a similar statistical model, predictors of soft tissue calcification were also low (<65 pg/ml) (p<0.01) and high (>500 pg/ml) parathormone levels (p<0.001), hemodialysis (p<0.001), age (p<0.001), diabetes (p<0.001) and serum calcium level greater than 2.4 mmol/l (p<0.05). In summary, there was a U-shaped relationship between increasing serum parathormone levels and prevalence of bone abnormalities and soft tissue calcification in ESRD patients on maintenance dialysis. Further research and long term follow up are needed in order to reveal more detailed relationship among the two diseases and their determining factors.]

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Hypertension and nephrology

[Is there a role of triple combination in the therapy of hypertension? - Antihypertensive efficiency of perindopril-amlodipine-indapamide]

PÁLL Dénes, SZÁNTÓ Ildikó, PARAGH György, KATONA Éva

[Blood pressure reduction to target level decreases cardiovascular morbidity and mortality. However, in the vast majority of cases, this can be achieved only with a (multiple) combination regimen. The primary objective of the PAINT (Perindopril- Amlodipine plus Indapamide Combination for Controlled Hypertension Non-intervention Trial) study was to evaluate the efficacy of combination therapy with perindopril, amlodipine, and indapamide in patients who had not reached target blood pressure with their pre-existing therapy. Secondary objectives included the monitoring of metabolic parameters and the number of antihypertensive tablets taken by the subjects. In this subgroup-analysis we involved 126 patients (74 females and 52 males, mean age 59.8±12.5 years) who had a valid 24-hour ambulatory blood pressure monitoring both at baseline and at the end of the 4-months follow-up. At the beginning of the study none of the subjects reached blood pressure target despite taking on average 2.4±1.4 antihypertensive drugs. During the study, the subjects received the combination of amlodipine, perindopril, and indapamide instead of their pre-existing antihypertensive regimen. 24-hour mean systolic blood pressure decreased from 139.2±13.4 mmHg to 126.5±12.9 mmHg (p<0.01), as well as mean diastolic blood pressure from 77.3±11.3 mmHg to 71.1±8.7 mmHg (p<0.01). Heart rate remained unchanged. Blood pressure reduction was statistically significant both during the day and the night. We found significant blood pressure reduction in all hours (10.1-15.4/5.1-7.8 mmHg; p<0.001). Hyperbaric impact decreased from 366.9±251.1 mmHg × hour to 166.2±185.4 mmHg × hour (p<0.01) for systolic blood pressure, and from 112±130.6 mmHg × hour to 41.6±65.6 mmHg × hour (p<0.01) for diastolic blood pressure. We also could observe favourable changes in metabolic parameters, not only in lipids, but also in blood sugar level. The mean number of tablets taken by the subjects increased from 2.4 to 2.9, but this led to a significantly improved control of blood pressure. Triple combinations of state-of-the-art antihypertensive agents - such as of perindopril, amlodipine and indapamide - ensure effective blood pressure control in sufficiently compliant patients.]

Hypertension and nephrology

[Hypertensive and cardiovascular risks of nonsteroidal antiinflammatory drugs]

FARSANG Csaba, BEDROS J. Róbert, ALFÖLDI Sándor

[Nonsteroidal antiinflammatory drugs (NSAIDs) are among the most frequently used medicines. During the last ten years several original publications, reviews and meta-analyses were published on the cardiovascular safety of NSAIDs and the results underlined their potentially harmful cardiovascular side effects. It can also be emphasized that there are substantial differences between different compounds, and the CV risk does not depend on the ratio of COX-1/COX-2 selectivity. Cardiovascular risk can be increased by all NSAIDs and paracetamol with the possible exception of naproxen and probably aceclofenac.]

Hypertension and nephrology

[The apparatus which controls our kidney too. - Part 1]

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Hypertension and nephrology

[Etiology and diagnosis of renal failure after pediatric cardiac surgery]

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[Acute kidney injury is a common and severe clinical problem in children after cardiac surgery, defined by abrupt decline in renal function, with manifestations ranging from minimal elevation of serum creatinine to anuric renal failure. The condition can have a negative influence on the long-term outcome of the illness. The problem is more likely in pediatric cardiac surgery, where the low birth-weight neonates and premature infants can be even more affected. On the other hand chronic renal disease can occur as a severe consequence of acute renal failure. The standard methods to diagnose the acute renal failure in patients are henceforward good applicable, but besides these based on the latest articles of scientific journals there are a lot of new alternatives, which could help us to establish the diagnosis of renal failure more quickly and correctly. These renal specific biomarkers and proteins could predict renal failure sensitively and specifically. Although the applicability of these methods is limited yet, there are a lot of cardiac centres for children, where they are used as routine tests.]

Hypertension and nephrology

[Estimation of serum uric acid in the Hungarian population]

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

[The clinical significance of serum uric acid markedly increased in the last years, especially in the civilized countries, but the abnormal serum uric acid level shows a significantly strong increasing tendency worldwide. The high level of uric acid is an integral part of metabolic syndrome. Today we recognized the important role of xanthine oxidase in the clinical practice for developing of oxidative stress in some tissues and organs. In 2011 during the Hungarian Health Care Screening Program we analyzed the prevalence of metabolic factors in 18 886 subjects. In the present publication we have dealt with uric acid and calculated the occurrence of abnormal values in percentage of the observed population. We found abnormal values in 12.3% of women (over 350 µmol/l) and 16.5% of men (over 400 µmol/l). The average values were higher in hypertensive subjects against normotensive ones in both gender. There was a close correlation among the metabolic components and the elevated uric acid level. The screening had given a possibility for detecting hidden gout and some other diseases, where the elevated uric acid level is specific of the clinical entity.]

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Hypertension and nephrology

[Case report of supine hypertension and extreme reverse dipping phenomenon decades after kidney transplantation]

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Hypertension and nephrology

[Beyond the blood sugar reduction. SGLT-2 inhibitors in kidney protection]

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[Results of cardiovascular safety studies with SGLT-2 inhibitors have shown that in addition to their hypoglycaemic and beneficial cardiovascular effects, they are renoprotective. A number of mechanisms underlying the renoprotective effects of SGLT-2 inhibitors have been shown to reduce albuminuria and deterioration of renal function. Their nephroprotective effects extend over a very wide range of eGFR and albuminuria categories. In the DAPA-CKD study, dapagliflozin was shown to exert its nephroprotective effect regardless of the presence of diabetes and a baseline eGFR, while also having a beneficial effect on cardiovascular endpoints and mortality. Following the confirmation of favourable renal results for SGLT-2 inhibitors, it is no coincidence that they have been included in national and international recommendations for the treatment of chronic kidney disease.]

Hypertension and nephrology

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

SIMONYI Gábor

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