Top PDF Cardiovascular Disease and Chronic Inflammation in End Stage Kidney Disease

Cardiovascular Disease and Chronic Inflammation in End Stage Kidney Disease

Cardiovascular Disease and Chronic Inflammation in End Stage Kidney Disease

Background: Chronic Kidney Disease (CKD) is one of the most severe diseases worldwide. In patients affected by CKD, a progressive destruction of the nephrons is observed not only in structural but also in functional level. Atherosclerosis is a progressive disease of large and medium-sized arteries. It is characterized by the deposition of lipids and fibrous elements and is a common complication of the uremic syndrome because of the coexistence of a wide range of risk factors. High blood pressure, anaemia, insulin resistance, inflammation, high oxidative stress are some of the most common factors that cause cardiovascular disease and atherogenesis in patients suffering from End Stage Kidney Disease (ESRD). At the same time, the inflammatory process constitutes a common element in the apparition and development of CKD. A wide range of possible causes can justify the development of inflammation under uremic conditions. Such causes are oxidative stress, oxidation, coexistent pathological conditions as well as factors that are due to renal clearance techniques.
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The Importance of Magnesium in Chronic Kidney Disease: New Aspects Magnesium and Chronic Kidney Disease

The Importance of Magnesium in Chronic Kidney Disease: New Aspects Magnesium and Chronic Kidney Disease

Magnesium is one of the 11 most abundant elements in the human body and it is required for the action of over 300 enzymes. It is the most common intracellular, bivalent cation. It is located in quite important structures from DNA/RNA to ATP. It interacts with negatively charged ions to provide an allosteric effect and therefore plays the role of a bridge in connecting different molecules. It is mostly found in dark green vegetables, the chlorophyl complex and unprocessed cereals. The current environmental pollution and the increased consumption of refined products cause serious problems with Mg uptake. Despite considerable advances over the last decades, cardiovascular diseases exact a very high toll as the leading cause of death in Western societies. This is mainly the result of the increasing prevalence of atherosclerosis, related to the aging of the population, the increase in diabetes and obesity, unhealthy diets, sedentary lifestyle, and particularly hyperlipidemia and hypertension. Chronic kidney diseases are quite common in the population at present and are associated with serious mortality and morbidity. Our aim in this review was to investigate the effect of Mg on endothelial dysfunction, atherosclerosis and CKD.
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End-Stage Renal Disease in Familial Amyloidosis ATTR Val30Met: A

End-Stage Renal Disease in Familial Amyloidosis ATTR Val30Met: A

Patient 1. Patient 1 was a 44-year-old woman when first evaluated in 1994 and is of Portuguese ancestry. She had sinus bradycardia, hypertension, and nephrotic syndrome. Sensory neuropathy of the lower limbs and constipation began 1 and 2 years later, respectively. Renal biopsy specimen revealed extensive TTR amyloidosis. She had a strong family history of FAP (proved TTR Val30Met) and renal failure. Two years after presentation, a cardiac pace- maker was needed. Recurrent UTI and urinary inconti- nence were present since 1996; postvoid residual urine was estimated at 100 mL. The renal impairment progressed to ESRD and the patient commenced hemodialysis in Decem- ber 1997. She became progressively fatigued, with alternat- ing diarrhea-constipation and nocturnal fecal incontinence. Weight loss was estimated at 2 kg. Before transplantation she was score I for motor neuropathy, and, by this time, she showed palsy of dorsiflexion of the toes. Combined liver- kidney transplantation was performed in January 2000.
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Peripheral neuropathy in patients in haemodialysis treatment

Peripheral neuropathy in patients in haemodialysis treatment

Aetiology of end-stage kidney disease was the primary outcome variable. Collected data were analysed in terms of absolute and relative frequencies of each variable studied by descriptive statistics. Data are presented as the mean ± standard deviation (SD). We analysed the correlation between the variables of the study through Fisher’s Exact Test. We also used the association measures Φ (Phi) and odds ratio (OR). To measure the factors effects we used partial Eta square (η 2 ). Parametric tests were used (t test or ANOVA) after verifying the
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Framingham risk score with cardiovascular events in chronic kidney disease.

Framingham risk score with cardiovascular events in chronic kidney disease.

Relation of FRS Category to Cardiovascular Events The mean follow-up period was 26.5612.3 months (range 6– 50 months). Seventy cardiovascular events (15.9%) were recorded during the follow-up period, including cardiovascular death (n = 17), hospitalization for unstable angina and nonfatal myocardial infarction (n = 16), sustained ventricular arrhythmia (n = 6), hospitalization for congestive heart failure (n = 16), and transient ischemia attack and stroke (n = 15). Table 2 shows the hazard ratios (HR) of the FRS category for cardiovascular events with and without adjustment for clinical, biochemical and echocardiographic parameters. Patients with ‘‘high’’ risk were significantly associated with cardiovascular events (HR 2.090, 95% confidence interval [CI] 1.144 to 3.818, P = 0.017 v.s. ‘‘low’’ risk), whereas patients with ‘‘intermediate’’ risk (v.s. ‘‘low’’ risk), did not achieve significance (P = 0.135). In addition, the univariate regression analysis showed that the presence of DM, coronary artery disease, low albumin, low hemoglobin, low eGFR, high uric acid, proteinuria, left atrial diameter .4.7 cm, left ventricular hypertrophy, and left ventricular ejection fraction ,50% were all significantly associated with an increase in cardiovascular events. The relation of ‘‘high’’ risk patients to cardiovascular events still remained significant after further adjustment for diabetes mellitus, coronary artery disease, albumin, hemoglobin, eGFR, uric acid, proteinuria, left atrial diameter .4.7 cm, left ventricular hypertrophy and left ventricular ejection fraction ,50% (HR 1.924, 95% CI 1.008 to 3.673, P = 0.047 v.s. ‘‘low’’ risk).
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Rev. paul. pediatr.  vol.34 número2

Rev. paul. pediatr. vol.34 número2

Chronic Kidney Disease data are from North American Pediatric Renal Trials and Collaborative Studies, the Italian Registry and the Belgian Registry.. Childhood onset end-stage renal dise[r]

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Intermittent hemodialysis in dogs with chronic kidney disease stage III

Intermittent hemodialysis in dogs with chronic kidney disease stage III

The prescription of intermittent hemodialysis in this study did not change the survival rate of dogs with chronic kidney disease in stage III. However, IHD did improve overall blood chemistry by reducing the levels of serum urea, creatinine, and phosphorus more effectively than intravenous fluid therapy alone. Although, dialysis treatment was more invasive and contained greater risks than treatment with intravenous fluid therapy, the incidence of complications from IHD was low in this study, indicating that it is a safe technique to prescribe for dogs with CKD in stage III. However, it did not increase patient survival. Therefore, this study does not support the early prescription of IHD for dogs with chronic kidney disease stage III.
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Introduction: Chronic kidney disease

Introduction: Chronic kidney disease

Introduction: Chronic kidney disease (CKD) is an independent risk factor for several unfavorable outcomes including cardiovascular disease (CVD), particular- ly in the elderly, who represent the most rapidly growing segment of the end-stage kidney disease (ESKD) population. Portu- gal has the highest European unadjusted incidence and prevalence rates of ESKD. In 2012, we started to follow a cohort of elderly CKD patients, we describe their baseline characteristics, risk profile, and cardiovascular disease burden. Methods: All CKD patients aged 65 years and older referred to our department during 2012 were enrolled. Baseline data included: demographic, CKD stage, medication, comorbid conditions. Estimated glomeru- lar filtration rate (eGFR) was calculated by the CKD-EPI formula. Results: A to- tal of 416 patients, 50% referred by pri- mary care physicians, aged 77 ± 7 years, 52% male, with a median eGFR of 32 mL/min/1.73m 2 participated in the study.
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Chronic Kidney Disease and Endothelium

Chronic Kidney Disease and Endothelium

but total antioxidant capacity has been observed to be exceeded only in end-stage renal disease (ESRD), suggesting that production of reactive oxygen species starts overcoming its clearance at the beginning of the decline in renal function. Reactive oxygen species react with and deactivate NO. Reduced bioavailability of NO as a resultant of ED enhances the development and maintenance of hypertension by augmenting systemic vascular resistance by increasing adrenergic tone, volume expansion and vascular smooth muscle cell proliferation, matrix accumulation, and vascular remodelling, which are inhibited by NO and promoted by free radicals. 19 OS increases
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J. Bras. Nefrol.  vol.36 número2

J. Bras. Nefrol. vol.36 número2

Up to now, there is no single method that provides complete and unambiguous assessment of the nutritional status in chronic kidney disease (CKD). Therefore, it has been recommended the use of many nutritional markers. The subjective global assessment (SGA) contains questions regarding the clinical history and physical examination. Subsequently, other versions of the SGA were developed. The malnutrition inflammation score (MIS) was also developed from the original version of the SGA and consists of 70% of the items common to SGA in addition to objective questions. Since many modifications were proposed in the original form of SGA, the use of these questionnaires in CKD patients has increased substantially in clinical practice. Therefore, this paper aims to review the applicability of the SGA and MIS when applied to assess the nutritional status of CKD patients.
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Stage effect of chronic kidney disease in erectile function

Stage effect of chronic kidney disease in erectile function

The work has other characteristics that may have affected the results. This is an observa- tional study. Therefore, association among studied variables can be found, but causal relationships cannot be proved among them. Non-random sam- ples were used in this work, thus the samples may have been subject to bias. Evaluation of some variables cited as influential in erectile function (prolactin, testosterone, and zinc levels, etc.) was not performed in the present research (32, 33). These unevaluated variables might not have been equally distributed between patient Groups com- pared (stage III versus IV/V) in the study. Thus, ED prevalence in the groups could have been altered.
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Dia Mundial do Rim 2011 albuminúria e creatinina: testes simples, baratos e essenciais no curso da DRC

Dia Mundial do Rim 2011 albuminúria e creatinina: testes simples, baratos e essenciais no curso da DRC

But the determinations of eGFR and albuminuria, beside of being key in the diagnosis and staging of CKD, are also important in predicting outcomes. (Chart 2). The benefits of assessing kidney function based on eGFR are not limited to predicting which patients, over the course of the disease, will need RRT, but also include the identification of those at increased risk for accelerated loss of kidney function associated with morbidity and mortality. The lower the GFR, the more likely the need for dialysis or renal transplanta- tion. Epidemiological studies have evidenced that the risk of a stage 1 or 2 CKD patient requiring renal replacement therapy (RRT) is lower than that of a stage 3 or 4 CKD patient, because the time required to exhaust the renal functional reserve of the former is longer. These observations, however, are not absolute, because the rate of progression of the kidney disease depends on several determinants, such as patient’s age, CKD etiol- ogy, presence of risk factors associated with progression, and comorbidities, particularly those of cardiovascular origins. Naturally, the higher the amount of data about eGFR available and longer the study, more reliable the calculation of eGFR fall will be. 10,14,15
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J. Bras. Nefrol.  vol.39 número3

J. Bras. Nefrol. vol.39 número3

Introduction: Cardiovascular disease (CVD) is especially prevalent in patients with chronic kidney disease (CKD). Objective: To evaluate the role of CKD and metabolic syndrome (MS), which is a cluster of risk factors for CVD, as predictors of CVD. Methods: Observational, cross-sectional study with a random sample aged 45 or more years extracted from the population assisted by the primary care program in Niterói city in the state of Rio de Janeiro, Brazil. CKD was diagnosed by the K/DOQI guidelines and MS, by the harmonized criteria. CVD was said to be present if the participant had one or more of the following findings: echocardiographic abnormalities, and history of myocardial infarction, stroke or heart failure. A logistic regression model was developed to analyze risk factors for CVD using CKD as the variable of primary interest. Results: Fifty hundred and eighty-one participants (38.2% male) with a mean age of 59.4 ± 10.2 years were analyzed. The prevalence rate of CKD was 27.9%. In participants without CKD, MS was associated with a slight but statistically significant increase in the risk for CVD (OR = 1.52, p = 0.037); in those with CKD but without MS the risk for CVD was also statistically significant and at a greater magnitude (OR = 2.42, p = 0.003); when both were present the risk for CVD was substantially higher (OR = 5.13, p < 0.001). Conclusion: In this study involving a population assisted by a primary care program, CKD was confirmed as an independent risk factor for CVD. The presence of MS concurrent with CKD substantially amplified the risk for CVD.
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Cardiovascular risk and mortality in end-stage renal disease patients undergoing dialysis: sleep study, pulmonary function, respiratory mechanics, upper airway collapsibility, autonomic nervous activity, depression, anxiety, stress and quality of life: a

Cardiovascular risk and mortality in end-stage renal disease patients undergoing dialysis: sleep study, pulmonary function, respiratory mechanics, upper airway collapsibility, autonomic nervous activity, depression, anxiety, stress and quality of life: a

Lung function tests will be performed during the day, with the patient seated in a comfortable position. For such, the KoKo PFT Spirometer System version 4.11 (nSpire Health, Inc, Louisville, CO, USA) will be used in accordance with the guidelines for the execution of lung function tests established by the Brazilian Society of Pneumology [30] and European Respiratory Society [31]. The subjects will perform the test in a comfortable pos- ition, with the body erect and upper limbs unsupported. All the examinations will be performed by a competent technician trained in obtaining the necessary cooper- ation from the subjects and appropriately operating the equipment to ensure accurate, reproducible results. The spirometer will be calibrated before each exam using a 3-L syringe [30].
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STUDY OF CARDIOVASCULAR INVOLVEMENT IN ESRD PATIENTS IN A TERTIARY CARE CENTER

STUDY OF CARDIOVASCULAR INVOLVEMENT IN ESRD PATIENTS IN A TERTIARY CARE CENTER

Two hundred patients of chronic kidney disease who were admitted in the medical wards and dialysis unit of Maharajahs Institute of Medical Sciences, Vizianagaram, during Jan 2013 to June 2014. Patients with chronic kidney disease with stage 3, stage 4 and stage 5 exclusion criteria, 2 chronic Alcoholics, Acute renal failure patients.

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Association of periodontitis and chronic kidney disease in dogs

Association of periodontitis and chronic kidney disease in dogs

of pregnancy, daily water intake and nutrition). Thus, longitudinal studies are needed to determine to what extent periodontal disease is a true risk factor for chronic renal failure and to what extent treatment of periodontal disease affects the kidney function over time [24, 25]. Despite these limitations in our study, there is some evidence that warrant considering severe periodontitis as risk factor of chronic renal failure. Thus, in view of the causative association between periodontal infection, generalized inflammation and important systemic diseases like chronic renal failure, we hypothesize that targeted prophylaxis and careful treatment of oral diseases can be preventive in progression of renal failure.
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J. Bras. Nefrol.  vol.38 número1

J. Bras. Nefrol. vol.38 número1

Chagas’ disease carries high morbidity and mortality due to acute parasitemia or cardiac, digestive, cutaneous or neurolo- gic chronic lesions. Latin American coun- tries have the majority of infected or at risk people. Transplanted patients using immunosuppressive agents may develop severe and even fatal forms of the disease. The available treatment causes frequent severe side-effects. A 59 years-old woman with end stage renal disease and positive serology for Chagas` disease, but without any clinical manifestation of this patho- logy, underwent kidney transplantation from a cadaveric donor and displayed three months later a thigh panniculitis from which a biopsy unveiled amastigo- te forms of Trypanosoma cruzi. The skin lesions disappeared following treatment with benzonidazole, but the drug was discontinued due to severe pancytopenia. Along with this, infection with E. faeca- lis and cytomegalovirus were treated with vancomicin and ganciclovir. The patient kept very well afterwards, with no new skin lesions and with good graft func- tion. One year and three months after the transplant, she had an emergency surgery for an aortic dissecting aneurysm. Irre- versible shock and death occurred in the immediate post-surgical period. It was not possible to establish or to rule out a rela- tionship between the trypanosomiasis and the aortic lesions. Chagas` disease must be remembered in differential diagnosis of several clinical situations in transplant patients, mainly in endemic areas. The treatment can yeld good clinical respon- se, but serious side-effects from the drugs may ensue. More effective and better tole- rated options are in need for treatment or prophylaxis.
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The interplay between mineral metabolism, vascular calcification and inflammation in Chronic Kidney Disease (CKD): challenging old concepts with new facts

The interplay between mineral metabolism, vascular calcification and inflammation in Chronic Kidney Disease (CKD): challenging old concepts with new facts

measurement of CPP in blood has been proposed as a prognostic marker in CKD as predictive of mortality [135]. CPPs can be detected since early stages of CKD when baseline serum phosphate is still within the normal range, and increasing with worsening renal function [129, 135, 136]. Moreover, correlations between circulating CPP levels and coronary artery calcification scores, aortic pulse wave velocity, aortic stiffness and serum markers for inflammation have been described [129, 135-137]. In patients with end-stage renal disease, the reduction of PTH also results in a reduction in serum CPP [129]. Possible explanations for the relation between CPP levels and VC have been suggested. These are focused either on the decreased levels of free circulating fetuin-A due to increased CPP levels, that otherwise would prevent VC at the vascular wall, or on the toxicity of CPPs. In fact, several lines of evidence point for a pathogenic role of CPP-II containing a more crystalline and insoluble hydro- xyapatite-like mineral phase, where circulating mineralization inhibitors play a crucial role to block mineral nucleation, growth and maturation. Synthetic CPP-II, and not CPP-I, have been shown to induce VSMCs calcification, and serum derived CPPs have a higher protective effect compared to synthetic CPPs in macrophage activation [138-140]. Recently, CPP particles from healthy individuals were shown to resemble CPP-I, while those from CKD patients had CPP-II-like features with increased mineral maturation and decreased levels of fetuin-A and GRP [108]. These CKD-derived CPP-II particles are uptake by VSMCs and promote calcification by inducing osteochon- drogenic differentiation and inflammation processes. Importantly, incubation of CKD-CPPs with γ-carbo- xylated GRP rescued the calcification, osteogenic differentiation and inflammatory status induced in VSMCs [108].
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Cardiovascular risk and lifestyle in patients with chronic kidney disease

Cardiovascular risk and lifestyle in patients with chronic kidney disease

Objective: to correlate cardiovascular risk factors of patients with kidney disease with elevated blood pressure levels. Methods: this is a cross-sectional study with 150 patients on hemodialysis. Two forms were used, one referring to socioeconomic factors and the other to lifestyle. Results: the sample consisted predominantly of male patients, aged over 52 years old, married and not working. Blood pressure levels were the most affected of the cardiovascular risk factors, where 78.0% had systolic blood pressure above ideal values. A statistically significant association was found between blood pressure and age (p=0.024) and between blood pressure and ability to deal with stress (p=0.015). Conclusion: through this study, it was verified that the statistical significance between the variables indicates that high systolic blood pressure, age and ability to deal with stress favor cardiovascular risk factors in patients with chronic kidney disease.
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Aplicabilidade da avaliação global subjetiva e malnutrition inflammation score na avaliação do estado nutricional na doença renal crônica.

Aplicabilidade da avaliação global subjetiva e malnutrition inflammation score na avaliação do estado nutricional na doença renal crônica.

Up to now, there is no single method that provides complete and unambiguous assessment of the nutritional status in chronic kidney disease (CKD). Therefore, it has been recommended the use of many nutritional markers. The subjective global assessment (SGA) contains questions regarding the clinical history and physical examination. Subsequently, other versions of the SGA were developed. The malnutrition inflammation score (MIS) was also developed from the original version of the SGA and consists of 70% of the items common to SGA in addition to objective questions. Since many modifications were proposed in the original form of SGA, the use of these questionnaires in CKD patients has increased substantially in clinical practice. Therefore, this paper aims to review the applicability of the SGA and MIS when applied to assess the nutritional status of CKD patients.
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