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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Oral sodium phosphate solutions (Fleet Mcneil Consumer Healthcare, Guelph, Ontario, Canada) are commonly used as bowel cleansing agents in preparation for colonoscopic exams; however, serious electrolyte disorders associated with oral sodium phosphate use have been described in case reports including hyperphosphatemia, hypocalcemia, hypomagnesemia, hypernatremia, and hypokalemia. We describe a 57-year-old patient with a past history of resistant hypertension who experienced severe symptomatic hypokalemia following colonic cleansing with an oral sodium phosphate solution. Further investigations revealed a serum aldosterone of 691 pmol/L and a serum renin level of 0.02 ng/L/s with a corresponding aldosterone-to-renin ration of 34550:1. The patient was subsequently diagnosed with primary aldosteronism secondary to an adenoma of the adrenal gland. Bilateral adrenal venous sampling revealed excessive levels of aldosterone in the left adrenal vein prior to definitive surgery. This case indicates that an oral sodium phosphate bowel preparation, though safe for most patients, can be complicated by a previously not diagnosed endocrine disease like the primary aldosteronism (Conn's syndrome) reported here. This is the first report of a Conn's syndrome diagnosed after bowel cleansing with a sodium phosphate solution.
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PMID:A case of Conn's syndrome revealed after oral sodium phosphate (Fleet) preparation for colonoscopy. 2040 38

Niacin has profound and unique effects on lipid metabolism. In addition to increasing high-density lipoprotein cholesterol, it is also known to decrease total cholesterol, low-density lipoprotein cholesterol, and triglyceride. Interestingly, the plasma concentration of lipoprotein(a) [Lp(a)], which has been suggested to play a role as an independent risk factor for coronary heart disease, is also decreased by niacin. Therefore, it is not surprising that in the literature it was given unique description as broad-spectrum lipid drug. Its impact is referred to as desirable normalization of a range of cardiovascular risk factors. However, its clinical use is limited due to harmless but unpleasant unique side effect of cutaneous flushing. Interestingly, recent experimental and clinical studies suggest the potential benefit of niacin as a treatment of dyslipidemia and high plasma phosphate associated with chronic kidney disease (CKD). Both dyslipidemia and high serum phosphate levels are shown to be associated with higher cardiovascular mortality. Furthermore, niacin administration improves renal tissue lipid metabolism, renal function and structure, hypertension, proteinuria, and histological tubulointerstitial injury. Further studies are required before the use of niacin for the treatment of both dyslipidemia and hyperphosphatemia with CKD advocated.
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PMID:Niacin as potential treatment for dyslipidemia and hyperphosphatemia associated with chronic renal failure: the need for clinical trials. 2048 51

Left ventricular hypertrophy (LVH) is a cardiovascular complication highly prevalent in patients with chronic kidney disease (CKD) and end-stage renal disease. LVH in CKD patients has generally a negative prognostic value, because it represents an independent risk factor for the development of arrhythmias, sudden death, heart failure and ischemic heart disease. LVH in CKD patients is secondary to both pressure and volume overload. Pressure overload is secondary to preexisting hypertension, but also to a loss of elasticity of the vessels and to vascular calcifications, leading to augmented pulse pressure. Anemia and the retention of sodium and water secondary to decreased renal function are responsible for volume overload, determining a hyperdynamic state. In particular, the correction of anemia with erythropoietin in CKD patients is advantageous, since it determines LVH reduction. Other risk factors for LVH in CKD patients are documented: some are specific to CKD, as mineral metabolism disorders (hypocalcemia, hyperphosphatemia, low serum vitamin D levels and secondary hyperparathyroidism), others are non-traditional, such as increased asymmetric dimethylarginine, oxidative stress, hyperhomocysteinemia and endothelial dysfunction that, in turn, accelerates the process of atherogenesis, triggers the inflammation and pro-thrombotic state of the glomerular and the vascular endothelium and aggravates the process of both CKD and LVH.
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PMID:Hypertension, left ventricular hypertrophy and chronic kidney disease. 2111 11

If a patient's serum creatinine level is elevated and chronic renal insufficiency is suspected, it is important to determine whether the problem is acute or chronic; to determine the cause; to identify secondary causes (including multiple myeloma, renal vascular disease, diabetes mellitus, reflux nephropathy, stone disease with infection, and hypertension); to institute measures to slow the disease; and to control hypertension, hyperphosphatemia, and acidosis.
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PMID:Chronic Renal Failure: Determining the cause. 2122 96

The risk of death in patients with advanced chronic kidney disease (CKD) is markedly higher than in the population without CKD, even in patients suffering from advanced cardiovascular disease. Among several clinical features of CKD, the following are considered the most important areas of therapeutic intervention: hypertension, lipid abnormalities, mineral and bone disorders of CKD (previously known as renal osteodystrophy), renal anemia, and uremic toxicity. However, numerous treatment strategies, which are applied based on the understanding of underlying pathologies, did not result in significantly improved prognosis. These strategies include lowering of blood pressure, use of statins, control of hyperphosphatemia and hyperparathyroidism, erythropoesis-stimulating agents, use of better and more biocompatible dialysis membranes, and higher dialysis dose. In this critical review, we discuss the most important, large clinical trials, in which the above therapies failed to show desirable results and to reduce mortality in patients with advanced CKD.
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PMID:Can we prolong life of patients with advanced chronic kidney disease: what is the clinical evidence? 2143 Jun 10

Kidney patients often suffer numerous comorbidities (e.g., hyperphosphatemia, renal osteodystrophy, and bodyweight gain induced by fluid overload or hypertension), which often impart discomfort and a significantly reduced quality of life. The literatures points to the efficacy of behavior modification therapy in changing inappropriate self-health care behavior in order to improve comorbidity symptoms. This article introduces behavior modification theory and its application as well as clinical strategies related to kidney patient care. The authors hope this article will promote knowledge of behavior modification theory among healthcare professionals and facilitate to the application of this theory in clinical practice to improve nursing care.
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PMID:[Behavior modification therapy: application in renal nursing]. 2145 87

Nocturnal home hemodialysis (HD) was conceived in the 1960s, but fell out of favor in the 1970s, only to be resurrected in a modified form in the 1990s. This modality is now used by patients on 4 continents, but still accounts for only a very small number of patients who receive chronic HD therapy. Nocturnal home HD provides a weekly Kt/V urea in the range of 4.5-6, and provides superior clearance of a number of middle molecules as well as some protein-bound and charged molecules. The first randomized trials of nocturnal home HD compared to conventional 3 times per week HD were performed in the first decade of the 21st century. In the Alberta trial, 52 patients were randomized to either nocturnal home HD conducted 5-6 times per week or conventional HD conducted 3 times per week; the patients were followed for 6 months. In this trial, subjects who received nocturnal home HD had a decrease in left ventricular mass, and improvement in the management of hypertension and hyperphosphatemia, but no significant benefit in either quality of life or anemia management. There was a decrease in systolic blood pressure, despite a decrease in the number of antihypertensive medications prescribed. There was also a decrease in serum phosphorus levels as well as a marked reduction or elimination of phosphate binders in more than two thirds of the nocturnal subjects. In the Frequent Hemodialysis Network study of Nocturnal Hemodialysis, 87 patients were randomized to either nocturnal home HD (6 times per week) or conventional (3 times per week) dialysis, and were followed for 12 months. Results from this trial will be published in 2011. It is likely that the results from these 2 trials will influence the update to the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative HD guidelines that will be published in 2012.
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PMID:Nocturnal home hemodialysis: which of your patients should choose this modality? 2162 85

Today, hemodialysis (HD) represents a rescue therapy for an increasing number of patients worldwide. Thanks to continuous improvements, it is now better tolerated; thus, allowing patients relief from uremic symptoms and increasing survival. However, many questions regarding the best way of ameliorating the outcomes of chronic kidney disease patients requiring dialysis are still open. Recently, 2 randomized controlled clinical trials tried to give some answers to the current debates around dialysis. The first one--the IDEAL trial--evaluated the effects of beginning early or late dialysis on patient mortality and morbidity, and it did not find any significant difference between the 2 groups, suggesting that starting dialysis on the basis of an estimate of GFR alone is not suitable. The second one--the FHN daily trial--compared in-center conventional (3 times per week) with in-center frequent (6 times per week) HD. It found that daily dialysis is associated with improvements in left ventricular mass, physical health composite scores and some secondary outcomes (hypertension and hyperphosphatemia) - although it also discovered there had been more frequent interventions related to vascular access. Despite the fact that both studies presented some unavoidable limitations, they gave important information which is useful in everyday clinical practice. According to evidence-based medicine, such well-designed and well-conducted randomized controlled trials are the best way to improve our knowledge.
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PMID:Lessons from recent trials on hemodialysis. 2162 87

Abnormalities of bone mineral parameters (calcium, phosphate, vitamin D, and parathyroid hormone) are nearly always present in patients with chronic kidney disease (CKD). These typically consist of hypocalcemia, hyperphosphatemia, abnormalities of vitamin D metabolism, and secondary hyperparathyroidism, and are now defined as CKD mineral bone disorders (CKD-MBD). Currently, emerging evidence indicates that deficiencies in vitamin D receptor (VDR) activation play crucial roles in adversely affecting the cardiovascular health of CKD patients. VDRs are not restricted to skeletal tissue, but are instead widely expressed throughout the body at several sites, such as in cardiac tissue, vascular smooth muscle cells, endothelial cells, renal tissue, and cells of the immune system. Restoring the physiology and modulation of VDR activator levels results in correlative regulatory effects on mineral homeostasis, hypertension, cardiovascular disease, and vascular calcification, as well as a number of other endpoints in cardiac and renal pathology. Among the compounds available for treatment of CKD-MBD, paricalcitol is a selective VDR activator. The term 'selective' refers to paricalcitol being more selective in affecting VDR pathways in the parathyroid gland compared with bone and intestine. As such, paricalcitol's selectivity allows for a wider therapeutic window with effects beyond parathyroid hormone control and mineral management, and may explain, in part, the increased survival advantage with paricalcitol treatment.
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PMID:Restoring the physiology of vitamin D receptor activation and the concept of selectivity. 2162 4

Prior small studies have shown multiple benefits of frequent nocturnal hemodialysis compared to conventional three times per week treatments. To study this further, we randomized 87 patients to three times per week conventional hemodialysis or to nocturnal hemodialysis six times per week, all with single-use high-flux dialyzers. The 45 patients in the frequent nocturnal arm had a 1.82-fold higher mean weekly stdKt/V(urea), a 1.74-fold higher average number of treatments per week, and a 2.45-fold higher average weekly treatment time than the 42 patients in the conventional arm. We did not find a significant effect of nocturnal hemodialysis for either of the two coprimary outcomes (death or left ventricular mass (measured by MRI) with a hazard ratio of 0.68, or of death or RAND Physical Health Composite with a hazard ratio of 0.91). Possible explanations for the left ventricular mass result include limited sample size and patient characteristics. Secondary outcomes included cognitive performance, self-reported depression, laboratory markers of nutrition, mineral metabolism and anemia, blood pressure and rates of hospitalization, and vascular access interventions. Patients in the nocturnal arm had improved control of hyperphosphatemia and hypertension, but no significant benefit among the other main secondary outcomes. There was a trend for increased vascular access events in the nocturnal arm. Thus, we were unable to demonstrate a definitive benefit of more frequent nocturnal hemodialysis for either coprimary outcome.
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PMID:The effects of frequent nocturnal home hemodialysis: the Frequent Hemodialysis Network Nocturnal Trial. 2269 82


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