Efficacy of losartan for improving insulin resistance and vascular remodeling in hemodialysis patients

Abstract Insulin resistance and vascular remodeling are prevalent and predict cardiovascular mortality in hemodialysis patients. Angiotensin II (Ang II) may be involved in both pathogenesis. In the present study, we investigated the effects of the Ang II receptor blocker losartan on insulin resistance, arterial stiffness, and carotid artery structure in hemodialysis patients. Seventy‐two hemodialysis patients were randomly assigned to receive either losartan 50 mg qd (n = 36) or β‐blocker bisoprolol 5 mg qd (n = 36). At the start and at month 12, ambulatory blood pressure (BP) monitoring, aortic pulse wave velocity (PWV) measurements, and carotid artery ultrasound were performed, and homeostasis model assessment index of insulin resistance (HOMA‐IR) was determined. During the study period, bioimpedance method was used to evaluate volume status every 3 months. Home‐monitored BPs were measured at least monthly. Ambulatory BP decreased significantly and similarly by either losartan or bisoprolol. Decreases in PWVs in losartan group at the end of month 12 were significantly greater than changes in PWV in bisoprolol group (0.9 ± 0.3 vs. 0.4 ± 0.5 m/s, P = 0.021). Common carotid artery intima‐media cross‐sectional area decreased significantly only in patients treated with losartan (20.3 ± 4.9 vs. 19.1 ± 5.1 mm2, P...
Source: Hemodialysis International - Category: Hematology Authors: Tags: Original Article Source Type: research

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Battaglia Y, Prohić N, Klinger M, Hojs R, Seiler-Mußler S, Lizzi F, Siriopol D, Balafa O, Shavit L, Loutradis C, Seidowsky A, Tripepi R, Mallamaci F, Tripepi G, Picano E, London GM, Zoccali C Abstract INTRODUCTION: Since inflammation alters vascular permeability, including vascular permeability in the lung, we hypothesized that it can be an amplifier of lung congestion in a category of patients at high risk for pulmonary oedema like end stage kidney disease (ESKD) patients. OBJECTIVE AND METHODS: We investigated the effect modification by systemic inflammation (serum CRP) on the relationship between a...
Source: Journal of Nephrology - Category: Urology & Nephrology Authors: Tags: J Nephrol Source Type: research
Macaulay Amechi Chukwukadibia Onuigbo, Nneoma Agbasi, Bibek Sarki, Sana Khan, Kramer WahlbergIndian Journal of Nephrology 2020 30(1):29-31 Internal jugular vein (IJV) cannulation was originally described by English et al. in 1969 as the safest approach. Carotid artery puncture had an incidence rate of 4–6% before ultrasound guidance. We encountered an unexpected sequence of events following the ultrasound-guided placement of a temporary HD catheter in the left IJV. The postprocedure chest radiograph was misinterpreted as an arterial misplacement, the blood return was correspondingly bright red, and simultaneous ...
Source: Indian Journal of Nephrology - Category: Urology & Nephrology Authors: Source Type: research
Authors: Colucci M, Torreggiani M, Bernardi I, Stangalino S, Catucci D, Esposito V, Sileno G, Esposito C Abstract BACKGROUND: Smart Flow is an innovative tool available on the Carestream Touch Prime Ultrasound machines, which provides automated blood flow measurement and shows the vectors that form the blood flow in the vessel. We compared the use of Smart Flow with traditional Duplex Doppler Ultrasound to evaluate blood flow of arteriovenous fistulas in prevalent hemodialysis patients. METHODS: A total of 31 chronic patients on hemodialysis were enrolled. Blood flow was measured on the brachial artery with Sma...
Source: The Journal of Vascular Access - Category: Surgery Tags: J Vasc Access Source Type: research
CONCLUSION: Arteriovenous fistulae show haemodynamic and remodelling changes up to three months post-operatively. Previous ipsilateral VAs may initiate vessel preconditioning, and accelerate the observed haemodynamic changes after AVF creation. However, this preconditioning does not result in a beneficial or detrimental effect on VA function. PMID: 31911136 [PubMed - as supplied by publisher]
Source: PubMed: Eur J Vasc Endovasc ... - Category: Surgery Authors: Tags: Eur J Vasc Endovasc Surg Source Type: research
CONCLUSION: The baseline diameter of the cephalic vein was the only predictor of arteriovenous fistula maturation based on the pre-operative ultrasound measurements in Chinese hemodialysis patients. PMID: 31884877 [PubMed - as supplied by publisher]
Source: The Journal of Vascular Access - Category: Surgery Tags: J Vasc Access Source Type: research
This study aims to determine whether post-operative duplex ultrasound surveillance can improve fistula patency at 12 months and improve the proportion of 'pre-haemodialysis' patients commencing haemodialysis via a usable fistula. METHODS: All arteriovenous fistulae formed between 1st January 2015 and 31st August 2017 in a single, tertiary vascular centre were included. Primary and secondary patency at 12 months, along with the proportion of pre-haemodialysis patients commencing haemodialysis via a usable arteriovenous fistula, were compared between the fistulae undergoing duplex ultrasound surveillance an...
Source: The Journal of Vascular Access - Category: Surgery Tags: J Vasc Access Source Type: research
CONCLUSION: The results of this study suggest that the possibility of successful early cannulation with a percutaneous arteriovenous fistula can be considered as an additional factor in making this access a reasonable alternative for a surgically created arteriovenous fistula in appropriate patients. PMID: 31854231 [PubMed - as supplied by publisher]
Source: The Journal of Vascular Access - Category: Surgery Tags: J Vasc Access Source Type: research
The creation of an arteriovenous fistula (AVF) is the preferred mode of access for hemodialysis in patients with End-Stage Renal Disease (ESRD). High output cardiac failure is a known but rare complication of AVF resulting from high flow volume. This case report describes the use of intraoperative ultrasound as a guide for banding of an AVF to decrease flow volume in a patient with high cardiac output failure. The access was preserved and a gradual decline of cardiac function before and recovery after banding is demonstrated over an 18-year period.
Source: Annals of Vascular Surgery - Category: Surgery Authors: Tags: Case Report Source Type: research
Condition:   Arteriovenous Fistula Intervention:   Device: doppler ultrasound Sponsor:   Assiut University Not yet recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
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