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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Lipid abnormalities are common in diabetes mellitus and in essential hypertension, but their contributions to diabetic and hypertensive nephropathy are unclear. Relevant data from several clinical trials are summarized here, as is a longitudinal study of diabetes mellitus showing that cholesterol correlates with both angiotensin II and blood pressure. The significant association of blood pressure and the renin-angiotensin system with declining renal function provides a mechanism whereby cholesterol may possibly impact adversely upon kidney function in diabetes.
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PMID:Relation of lipid abnormalities to progression of renal damage in essential hypertension, insulin-dependent and non insulin-dependent diabetes mellitus. 823

The US Renal Data System Annual Report reveals that 57% of new cases and of end-stage renal disease are attributed to hypertensive nephropathy and diabetic nephropathy. Analyses of the data on serum creatinine from the Multiple Risk Factor Intervention Trial confirms that one in 20 of the hypertensive men exhibits a rate of decline in renal function that equals or exceeds 3% per year, the rate of loss being greater in older men, black men, and men with higher baseline blood pressure. Effective blood pressure treatment with maintenance of diastolic blood pressure below 95 mm Hg protected renal function in non-blacks but not in blacks, despite comparable blood pressure reduction in blacks. A longitudinal study of a diabetic cohort (n = 131) revealed that hypertension, plasma angiotensin II, and aldosterone are independent predictors of accelerated loss of renal function in diabetic nephropathy, possibly aggravated by diuretic usage as part of the antihypertensive regimen in diabetic nephropathy. No significant loss of renal function could be documented in those individuals whose blood pressure was adequately controlled (systolic blood pressure, < 140 mm Hg). These findings provide emphasis for the importance of adequate blood pressure control in both essential hypertension and hypertension associated with diabetes mellitus. They also provide support for the proposal that careful blood pressure control offers promise for reducing the incidence of end-stage renal disease in both hypertensive nephropathy and diabetic nephropathy.
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PMID:Hypertension-related renal injury: a major contributor to end-stage renal disease. 832 80

Renal replacement therapy of the next decade in Europe will be strongly influenced by certain epidemiological developments, which can be observed in some parts of the world since several years. The overall incidence rates of new patients will rise up to 300 pmp per year, the prevalence rates of patients on treatment will exceed 1000 pmp in some European countries as well as in Japan and in the USA. This is due to a more than proportional increase in the acceptance rates for people older than 65, mostly patients with type II diabetes and hypertensive nephropathy. In Europe, the proportion of patients with NIDDM and diabetic nephropathy shows marked regional differences, which may be more or less important for the development of the whole patient population. Since diabetes as well as hypertensive disease are conditions with high risks for non-renal complications, one cannot expect important improvements in patient survival in spite of technical developments in dialysis therapy.
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PMID:Future evolution of the ESRD patient population--a perspective for the year 2000. 904 43

Tight blood pressure control among diabetic and nondiabetic patients with hypertension is perhaps the single most effective intervention used to delay progression to end-stage renal disease (ESRD). The renoprotective actions of angiotensin-converting enzyme (ACE) inhibitors in patients with diabetic and hypertensive nephropathy is well established. Drugs of this class fairly uniformly reduce glomerulosclerosis, delay the deterioration in renal function, and improve proteinuria, a predictive surrogate marker for renal injury. Calcium- channel blockers (CCBs) in the phenylalkylamine (verapamil) and benzothiazepine (diltiazem) classes also improve proteinuria and delay the progression of renal disease in diabetic and nondiabetic hypertensive nephropathy beyond that attributable to blood pressure control. The short-acting dihydropyridine CCBs worsen proteinuria and accelerate renal injury in both animal models and humans with hypertension or diabetes. A very limited number of studies in animals or humans with hypertension or diabetes have demonstrated at least an additive renoprotective effect when the combination of ACE inhibitors and nondihydropyridine CCBs has been compared with each agent administered as monotherapy. Because patients with impaired renal function and either hypertension or diabetes appear to benefit from aggressive blood pressure reduction, many of these patients will require two or more drugs to achieve the currently recommended blood pressure goals. Combinations of ACE inhibitor and CCB are attractive because they may provide better blood pressure control, appear to be better tolerated with fewer side effects than either drug alone, and may exert a greater renoprotective effect in patients at risk for renal failure than either an ACE inhibitor or a CCB.
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PMID:The case for combining angiotensin-converting enzyme inhibitors and calcium-channel blockers. 1098 Nov 4

In December of 1999 and 2000 we visited all hemodialysis centers of Lithuania and collected data about all hemodialysis patients, using special questionnaires. The aim of the study was to evaluate the relationship between lethality of hemodialysis patients, erythropoietin dosage for renal anemia treatment and hemodialysis quality. The patients with higher Kt/V, higher levels of iron and albumin, normal levels of phosphorus and parathyroid hormone (PTH) requested lower doses of erythropoietin (analysis of the patients who were on hemodialysis in 2000 more than 6 months). So, we can conclude that adequate hemodialysis procedure and good management of hemodialysis patient are leading to the decrease request of erythropoietin doses for anemia treatment. We compared two groups of patients in order to examine relationship between hemodialysis quality and lethality of hemodialysis patients. We selected incident patients registered in December of 1999 and we divided these patients in December of 2000 in two groups: a) 175 patients, who continued hemodialysis treatment and b) 41 patients, who died in 2000. The results revealed, that dead patients were elder, their duration of weekly hemodialysis was shorter, Hb concentration lower, they had worse nutritional status (blood albumin level was lower). Lethality was associated with underlying diseases such as diabetes, hypertensive nephropathy and renal amyloidosis.
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PMID:[Relationship between lethality of hemodialysis patients, erythropoietin dosage for renal anemia treatment and hemodialysis quality]. 1276 33

Renal transplantation in India costs about US$5000 ($1=Rupees 48.25), azathioprine costs $200 a year and cyclosporine costs $2000. Against this the average per capita income is $279 (Rs. 12989) per year; 36% of the population earn less than $105, and only 2.2% earn more than $1000. The country cannot afford to treat end-stage renal disease. Thirty percent of chronic renal failure is due to diabetic nephropathy, and 10% each to hypertensive nephropathy and chronic pyelonephritis. Social and preventive health workers of the Kidney Help Trust administered a questionnaire at the homes of a study population of 25,000, examined the urine of every individual for albumin and reducing substances, and checked the blood pressure of every person aged over 5; 90% of the population cooperated. Six percent were hypertensive and four percent had diabetes. Eight percent of them subsequently took regular treatment. Using only reserpine, hydrallazine and hydrochlorothiazide for hypertension, and glibenclamide and metformin for diabetes (as these are the cheapest agents available), we were able to control the blood pressure to 140/90 or less in 96% of cases, and to reduce HbAIC by 10% or more of the original reading in 77%. An HbA1C of 7% was achieved in 50% of the diabetic subjects. The total cost amounts to 27 US cents for one year per capita of the study population. The Indian Government now spends $7.67 per capita on health each year, but expects patients to attend its Primary Health Centers. The patients do not attend because in doing so they lose a day's wages. We believe that domiciliary treatment is the solution for these diseases, and expect to see a fall in the incidence of chronic renal failure if this is instituted in the future.
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PMID:Prevention of chronic renal failure at the community level. 1286 81

Hypertension is more prevalent and severe in African descendent populations living outside Africa than in any other population. Given this greater burden of hypertension in blacks, it is increasingly necessary to refine strategies to prevent the disorder as well as improve its treatment and control. This review assesses results from clinical trials on lifestyle and pharmacologic interventions to identify which approaches most effectively prevent adverse hypertension-related outcomes in African descendent populations. The Dietary Approaches to Stop Hypertension (DASH) study provided evidence that a carefully controlled diet rich in fruits, vegetables, low-fat dairy foods, and reduced in saturated fat, total fat, and cholesterol (i.e., the DASH diet) reduces blood pressure in blacks and is well accepted. The combination of the DASH diet with reduction in dietary sodium below 100 mmol/d may provide a reduction in blood pressure beyond that reached by the DASH diet alone. Physical exercise and interventions to reduce psychological stress may also reduce blood pressure in blacks. Strong evidence from numerous studies is a compelling argument for continuing to recommend diuretics and beta blockers as first-line antihypertensive therapy for persons of all races. Some new studies also favor angiotensin-converting enzyme inhibitors as first-line antihypertensive drugs. The African American Study of Kidney Disease and Hypertension provided evidence that an angiotensin-converting enzyme inhibitor-based treatment program is more beneficial than calcium channel blockers and beta blockers in reducing the progression of renal failure in blacks with hypertensive nephropathy. Studies in patients with diabetes have also shown evidence that both angiotensin-converting enzyme inhibitors and angiotensin receptor antagonists are more effective than other classes of antihypertensives in reducing adverse renal events. Studies to evaluate the effects of the new antihypertensives in improving outcomes in blacks living outside the United States are needed.
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PMID:Meeting the challenge to improve the treatment of hypertension in blacks. 1468 94

The prevalence and incidence of End-Stage Renal Disease (ESRD) have progressively increased in the last 20 years. Hypertension and diabetes are the two most important causes of ESRD, and antihypertensive treatment plays a crucial role in preventing Chronic Renal Failure (CRF) and ESRD. The glomerulus and mesangial extracellular matrix are the principal sources giving rise to hypertensive nephropathy, which is finally characterized by progressive glomerulosclerosis. Several mechanisms are involved in hypertensive nephropathy, including increases in intraglomerular pressure and extracellular matrix production and reactive oxygen species (ROS)-related damage. The various activities of antihypertensive drugs on the kidney are particularly important in understanding their nephroprotective role and in developing new nephroprotective pathways in the future. This paper reviews the main pathophysiological aspects of renal damage in hypertension, the effects of various types of calcium channel blockers (CCBs) on renal function, and their role in nephroprotection.
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PMID:Calcium channel blockers and nephroprotection. 1664 Jan 71

Using a retrospective cohort study, we evaluated survival and mortality risk factors in our dialysis population at the Renal Unit, RTS Cauca--Nephrologic San Jose, Popaydn, Cauca, Colombia. In the study, we included patients with chronic renal failure who started dialysis therapy during the period 1994-1999, and who remained on dialysis for a minimum of 5 years. Endpoints (living, died, lost to follow-up) were evaluated at the end of the study (July 2004), and a Kaplan-Meier survival analysis was performed. Mortality risk was analyzed using the multivariate Cox proportional hazard model. The study included 236 patients (129 on peritoneal dialysis and 107 on hemodialysis), whose mean age (+/- standard deviation) was 54.5 +/- 15.6 years. Of the group, 51% were women, 68.7% were urban dwellers, and 31.3% were rural dwellers. Major causes of end-stage renal disease included chronic glomerulonephritis (43.2%), diabetic nephropathy (35.7%), and hypertensive nephropathy (6.0%). The racial origins of the study population were half-caste (80.7%), Afro-Colombian (8.8%), indigenous (7.6%), and white (2.6%). Median (+ standard error) survival on hemodialysis was 66 +/- 10 months. Median survival on peritoneal dialysis was 57 +/- 7 months. Among patients with diabetes, median survival on hemodialysis was 40 +/- 13 months, and on peritoneal dialysis, it was 38 +/- 4 months. Major causes of mortality included sudden death (40%), infection (25%), and cardiovascular causes (22.5%). Significant mortality risk factors for hemodialysis patients were congestive heart failure (p = 0.01) and albumin <3 g/dL (p = 0.01). For peritoneal dialysis patients, the significant risk factors were diabetes mellitus (p = 0.01) and albumin < 2.5 g/dL (p = 0.02). Patient survival in our setting is similar to that reported in other series. The strongest predictive factors for mortality were diabetes mellitus, congestive heart failure, anemia, and hypoalbuminemia.
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PMID:Survival on chronic dialysis: 10 years' experience of a single Colombian center. 1668 11

Oxidative stress is at play in the progression of chronic renal failure (CRF) and in the genesis of atherosclerosis. The aim of the present study was to evaluate the factors that might influence the oxidative-antioxidative balance in patients on hemodialysis. The study group consisted of 71 hemodialysis patients due to CRF. Sixteen healthy subjects constituted a control group. The levels of 8-hydroxy-2'-deoxyguanosine (8-OHdG), C-reactive protein (CRP), and the blood lipid profile were measured in both groups. The results showed significantly higher mean levels of both 8-OHdG and CRP in the hemodialysis patients compared with that in the control subjects. The highest level of 8-OHdG was found in the subgroups of the patients with CRF primarily caused by diabetes (16.4 ng/ml) and with hypertensive nephropathy (15.8 ng/ml). More than a 2.5-fold higher level of 8-OHdG in the hemodialysis patients compared with the control subjects points to the presence of intensive oxidative stress in the patients.
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PMID:What influences the level of oxidative stress as measured by 8-hydroxy-2'-deoxyguanosine in patients on hemodialysis? 1707 47


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