Hypertension and nephrology

[Sleep disorders and quality of life in patients after kidney transplantation]

TURÁNYI Csilla Zita1, ZALAI Dóra2, MOLNÁR Miklós Zsolt3,4, NOVÁK Márta1,2, MUCSI István1,3,5

MAY 20, 2012

Hypertension and nephrology - 2012;16(02)

[Kidney transplantation provides the best outcomes, concerning morbidity, mortality and health related quality of life for patients with end stage renal disease. Health related quality of life is increasingly recognized as an important outcome measure in patients with different chronic medical conditions, including chronic kidney disease. Sleep disorders, such as insomnia, sleep apnea syndrome and restless legs syndrome are common in patients with chronic kidney disease. The prevalence of insomnia and restless legs syndrome is similar in kidney transplanted patients to the prevalence observed in the general population. On the other hand, the prevalence of sleep apnea is considerably higher, about 30%. The association between sleep disorders and impaired health related quality of life has been relatively well documented in dialysis patients but only scarce information has been published about the kidney transplanted population. In this paper we summarize published data about sleep disorders and also about their association with health related quality of life in the kidney transplanted population.]

AFFILIATIONS

  1. Semmelweis Egyetem, Magatartástudományi Intézet, Pszichonefrológia és Alvásmedicina Munkacsoport, Budapest
  2. Department of Psychiatry, University Health Network, University of Toronto, Toronto, Canada
  3. Semmelweis Egyetem, Általános Orvostudományi Kar, Kórélettani Intézet, Budapest
  4. Harold Simmons Center for Chronic Disease Research & Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
  5. Division of Nephrology, McGill University Health Network, Montreal, Quebec, Canada

COMMENTS

0 comments

Further articles in this publication

Hypertension and nephrology

[May patients with chronic kidney disease do sports?]

APOR Péter, RÁDI Attila, BABAI László

[Physical activity and sports in healthy people do not result in renal impairment. In end-stage renal disease - together with dialysis - moderate physical activity supports the maintenance of the controlled status. In chronic kidney disease moderate exercise improves filtration, the lipid profile, diminishes proteinuria and oxidative damage, maintains the muscular performance and metabolically active muscle mass. Metabolism of diabetics are significantly improved with exercise, it provides renal protection. Excess consumption of proteins, non-steroidal antiinflammatory drugs or creatine can be a problem in competitive sports. The high muscle mass implies higher creatinine level.]

Hypertension and nephrology

[Gender differencies in coronary reactivity in angiotensin II hypertension rat model]

MÁTRAI Máté, NÁDASY György L, HETHÉSSY Judit, SZEKERES Mária, MONOS Emil, SZÉKÁCS Béla, VÁRBÍRÓ Szabolcs

[It is known that hypertension shows several gender specific elements both in pathogenesis and in therapy. Understanding this phenomenon may bring us closer to individualized therapy. That was the reason why we examined process of hypertensive adaptation on the level of small intramural coronary arteries. 10-10 male and female Sprague-Dawley rats were used in this study. Animals received osmotic pumps in anaesthesia, which emitted 100 ng/bwkg/min angiotensin II acetate for four weeks. After four weeks treatment, animals were sacrified and heart weights were measured. We isolated intramural, small branches of the left anterior descendant coronary artery, placed them into vessel chamber and tested biomechanical properties and pharmacological reactivity. Heart weight and wall thickness were higher in females comparing to males. However, basal vascular tone and thromboxane-mediated vasoconstriction were elevated in males. Bradykinin relaxation was bigger in females. In female animals inward eutrophic remodeling was found, while in males increased wall stress and elastic moduli dominated the adaptation process. In conclusion, initial steps of angiotensin II mediated hypertension induced markedly gender dependent alterations.]

Hypertension and nephrology

[Recommendation on the Investigation of Calculated GFR and the Testing of Albuminuria and Proteinuria for Laboratory Experts]

V. OLÁH Anna, KAPPELMAYER János, NAGY Judit, MÁTYUS János

Hypertension and nephrology

[Position Paper Concerning the Use of Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers (Inhibition of the Renin-Angiotensin System) in Chronic Renal Disease]

MÁTYUS János, KISS István

Hypertension and nephrology

[Sándor Gerő, the researcher clinician (1904-1992)]

GÁCS János

[Sándor Gerő presents two theories concerning the origin of atherosclerosis. The first one is called “primary lipid infiltration concept” which means the penetration of high concentration plasma lipids into the arterial wall without its damage. The other theory for the origin of atherosclerosis is primary damage of the vascular wall (namely of fibers, mucopolysaccharid etc.) which is followed by lipid infiltration. In the literature it is named “primary vascular concept” of atherosclerosis. The author investigates the two possibilities with experimental and clinical methods and concludes that primary vascular damage is more probable to be the origin of atherosclerosis.]

All articles in the issue

Related contents

Clinical Neuroscience

[Examining the psychometric properties of a new quality of life questionnaire in migraineurs]

MANHALTER Nóra, PALÁSTI Ágnes, BOZSIK György, ÁFRA Judit, ERTSEY Csaba

[Background - The deleterious effect of primary headaches on the sufferers’ quality of life (QOL) has been abundantly documented using both generic and headache-specific instruments. The currently used questionnaires focus on a limited number of factors and therefore may not be sensitive enough to detect the effect of headache type and headache characteristics on QOL, despite the obvious clinical differences. We have devised a comprehensive questionnaire that may be more sensitive to the burden of headache. Objective - To assess the psychometric properties of the new questionnaire on a group of migraineurs. Patients and method - We studied 117 migraineurs who completed the validated Hungarian version of the SF-36 generic QOL measure and our new, 25-item questionnaire. Reliability was assessed by internal consistency, measured by Cronbach’s a of all items. Content validity was exam- ined by calculating the correlation of the items with subscales of the SF-36 measure. The correlation of the patients’ migraine characteristics with the questionnaire’s items was used to assess criterion validity. Results - The questionnaire was quick and easy to administer. The questionnaire demonstrated good reliability, with Cronbach’s alpha being 0.893. Content validity was adequate; most “physical” items of the new questionnaire showed significant correlations with the bodily pain and role physical SF-36 subscales and most “psychical” and “social” items were correlated with mental health and social functioning SF-36 subscales. Criterion validity was adequate, with headache severity being correlated with most of the items. Discussion - In this study the new headache-specific quality of life instrument showed adequate psychometric properties.]

Clinical Neuroscience

[Earlier and more efficiently: the role of deep brain stimulation for parkinson’s disease preserving the working capabilities]

DELI Gabriella, BALÁS István, KOMOLY Sámuel, DÓCZI Tamás, JANSZKY József, ASCHERMANN Zsuzsanna, NAGY Ferenc, BOSNYÁK Edit, KOVÁCS Norbert

[Background – The recently published “EarlyStim” study demonstrated that deep brain stimulation (DBS) for the treatment of Parkinson’s disease (PD) with early fluctuations is superior to the optimal pharmacological treatment in improving the quality of life and motor symptoms, and preserving sociocultural position. Our retrospective investigation aimed to evaluate if DBS therapy was able to preserve the working capabilities of our patients. Methods – We reviewed the data of 39 young (<60 years-old) PD patients who underwent subthalamic DBS implantation at University of Pécs and had at least two years follow-up. Patients were categorized into two groups based on their working capabilities: Patients with active job (“Job+” group, n=15) and retired patients (without active job, “Job-” group, n=24). Severity of motor symptoms (UPDRS part 3), quality of life (EQ-5D) and presence of active job were evaluated one and two years after the operation. Results – As far as the severity of motor symptoms were concerned, similar (approximately 50%) improvement was achieved in both groups. However, the postoperative quality of life was significantly better in the Job+ group. Majority (12/15, 80%) of Job+ group members were able to preserve their job two years after the operation. However, only a minimal portion (1/24, 4.2%) of the Job- group members was able to return to the world of active employees (p<0.01, McNemar test). Conclusion – Although our retrospective study has several limitations, our results fit well with the conclusions of “EarlyStim” study. Both of them suggest that with optimal timing of DBS implantation we may preserve the working capabilities of our patients.]

Ca&Bone

[The role of alfacalcidol in the prevention of osteopenia following renal transplantation]

BERCZI Csaba, ASZTALOS László, KINCSES Zsolt, BALOGH Ádám, LŐCSEY Lajos, BALÁZS György, LUKÁCS Géza

[AIM - The aim of this prospective study was the long-term evaluation of the effect of calcium and alfacalcidol treatment on calcium metabolism in patients with renal transplantation. METHODS - Patients were divided in two groups. Patients in Group 1 (n=159) received calcium substitution, while patients in Group 2 (n=81) were treated with alfacalcidol. Serum Ca, P, Mg, alkaline phosphatase (AP) and PTH levels were determined before and after transplantation regularly for three years. Femur neck and lumbar vertebral bone mineral densities (BMD) were measured at the same time after transplantation. RESULTS - After transplantation the mean serum calcium level significantly increased, while the mean serum phosphate level significantly decreased in both groups. After the operation the PTH levels decreased in both groups and it was found to be more pronounced in the alfacalcidol group.The majority of patients had osteopenia in the follow-up period. Between the third month and the third year after transplantation, BMD increased by 9.4% in Group1, and decreased by 4% in Group 2 at the lumbar spine. At 3 years the mean BMD value at the femoral neck was increased by 6.5% in Group 1, and by 6.7% in Group 2, compared to the 3-month values.The change in BMD was only significant at the lumbar spine, in Group 1 (p=0.019). During the follow-up period osteonecrosis was diagnosed in 6 patients in Group 1 and in 9 cases in Group 2. CONCLUSION - Alfacalcidol treatment decreased secondary hyperparathyroidism more rapidly and effectively, which was also indicated by the more pronounced decrease of serum PTH levels. During the 3 years follow-up period, BMD increased in both groups except for the lumbar spine in Group 2, however, the majority of the patients still had osteopenia.The study could not demonstrate a superiority of alfacalcidol over calcium supplementation in the prevention of posttransplantational osteopenia.]

Lege Artis Medicinae

[End of the line? Addenda to the health and social care career of psychiatric patients living in Hungary’s asylums]

KAPÓCS Gábor, BACSÁK Dániel

[The authors are focusing on a special type of long term psychiatric care taking place in Hungary outside of the conventional mental health care system, by introducing some institutional aspects of the not well known world of so called social homes for psychiatric patients (asylums). After reviewing several caracteristics of institutional development of psychiatric care in Hun­gary based on selected Hungarian and in­ternational historical sources, the main struc­tural data of present Hungarian institutional capacities of psychiatric health and social care services are shown. Finally, the authors based on own personal experiences describe several functional ascpects of the largest existing asylum in EU, a so­cial home for long term care of psychiatric pa­tients. By the beginning of the 20th century, Hungarian psychiatric institutions were operating on an infrastructure of three large mental hospitals standing alone and several psychiatric wards incorporated into hospitals. Nevertheless, at the very first session of the Psychiatrists’ Conference held in 1900 many professionals gave warning: mental institutions were overcrowded and the quality of care provided in psychiatric hospital wards, many of which located in the countryside of Hungary, in most cases was far from what would have been professionally acceptable. The solution was seen in the building of new independent mental hospitals and the introduction of a family nursing institution already established in Western Europe; only the latter measure was implemented in the first half of the 20th century but with great success. However, as a result of the socio-political-economic-ideological turn following the Second World War, the institution of family nursing was dismantled while different types of psychiatric care facilities were developed, such as institutionalised hospital and outpatient care. In the meantime, a new type of institution emerged in the 1950s: the social home for psychiatric pa­tients, which provided care for approximately the same number of chronic psychiatric patients nationwide as the number of functioning hospital beds for acute psychiatric patients. This have not changed significantly since, while so­cial homes for psychiatric patients are perhaps less visible to the professional and lay public nowadays, altough their operational conditions are deteriorating of late years. Data show, that for historical reasons the current sys­tem of inpatient psychiatric care is proportionately arranged between health care and social care institutions; each covering one third. Further research is needed to fully explore and understand the current challenges that the system of psychiatric care social- and health care institu­tions are facing. An in-depth analysis would significantly contribute to the comprehensive improvement of the quality of services and the quality of lives of patients, their relatives and the health- and social care professionals who support them. ]

Hypertension and nephrology

[The significance of depressive disorders in patients with chronic kidney diseases]

ZALAI Dóra Márta, SZEIFERT Lilla, NOVÁK Márta

[In this article a practice-oriented narrative review of the depressive disorders in chronic kidney disease is provided. Depressive disorders affect approximately one fourth of the chronic kidney disease population. These mental disorders interfere with physical, cognitive and social functioning and are associated with poor prognosis of patients with chronic kidney disease. Bio-psycho-social factors, including immuno-inflammatory processes, disturbance in glucose- insulin homeostasis, sleep disorders, chronic pain, sexual difficulties, changes in social roles, losses in multiple areas of life and low social support increase the risk for the development of depression. Routine, regular screening of depression in the chronic kidney disease population seems to be warranted. Only limited published evidence is available on the therapeutic possibilities of depression in chronic kidney disease. Preliminary evidence indicates that short, structured psychotherapy may be effective for acute treatment and prevention of psychological distress. Some antidepressants can be applied without the need for dose adjustments. On the other hand, some of the psychotropic medications require dose reduction or should be avoided.]