Blood pressure targets for hemodialysis patients: Aspirational or practical?

Abstract Whereas there is strong relationship between high blood pressure and increased overall and cardiovascular mortality for the general population, observational studies in hemodialysis patients have reported a “U” shaped relationship between pre‐hemodialysis blood pressure recordings and patient survival. Previous attempts to introduce pre and post‐hemodialysis blood pressure targets were associated with an increased frequency of intra‐dialytic hypotension, itself an independent risk factor for mortality. Conversely, meta‐analyses of trials of antihypertensive medications in hemodialysis patients, reported survival benefit for those prescribed medication. More recently, further meta‐analyses have suggested a reduced risk for cardiovascular mortality benefit with a systolic blood pressures (SBPs) of less than 140 mmHg, the absolute benefit, in terms of risk reduction was greatest in those with the highest vascular disease burden. Even though data from current observational studies and studies of antihypertensive medications would suggest that patient survival would be greater with pre‐dialysis SBP should be less than 160 mmHg, there is no current data to propose specific blood pressure targets. Defining blood pressure targets can only be answered by adequately powered prospective randomized controlled trials comparing different targets. As the benefits of lowering blood pressure appear to be greatest for those with most vascular disease, then bloo...
Source: Hemodialysis International - Category: Hematology Authors: Tags: REVIEW ARTICLE Source Type: research

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CONCLUSIONS: The incidence of pregnancy-related AKI remains high in the maternal ICU setting. Septic shock, hypovolemic shock, and higher APACHE II and SOFA scores were independently associated dialysis therapy (hemodialysis in all cases). KDIGO stages 2 and 3 were less frequent than KDIGO stage 1 in patients with gestational hypertension. Norepinephrine and hemodialysis therapy were independently associated with maternal mortality in patients with pregnancy-related AKI. KDIGO stage 3 was associated with higher maternal mortality. PMID: 32072506 [PubMed - as supplied by publisher]
Source: Journal of Nephrology - Category: Urology & Nephrology Authors: Tags: J Nephrol Source Type: research
Conclusion: In patients with ESRD undergoing HD, PH was a common finding being associated with increased PVR, a longer duration of HD and chronic glomerulonephritis as etiology for ESRD. The majority of patients with PH had altered left ventricular systolic function, predisposing them to an increased risk to develop heart failure.
Source: Nigerian Journal of Clinical Practice - Category: Rural Health Authors: Source Type: research
Conclusion: The most commonly affected domains were usual activities (79%), pain (76.20%) and anxiety/depression (71.91%). Factors such as age (>65 yrs.), BMI (Underweight and Obese), educational background (Illiterate), Unemployment, domiciliary status (Rural), number of medications (>11) had significant association with EQ–5D index and VAS scores (p–0.000). It was found that QoL was impaired in stage 5D compared to other stages (p–0.000).
Source: Clinical Epidemiology and Global Health - Category: Epidemiology Source Type: research
AbstractSpontaneous native kidney rupture (SNKR) is a rare occurrence, commonly associated with underlying renal tumors or acquired renal cystic disease in both the kidney transplant (KT) and non-KT populations. Herein, we present a 65-year-old African American man who experienced a non-malignant SNKR 6  days after a deceased donor KT and underwent emergent native nephrectomy. The patient’s hospital course was complicated by thrombocytopenia and refractory hypertension. He experienced delayed graft function and was maintained on hemodialysis until post-operative day 30. This case demonstrates an unusual presenta...
Source: CEN Case Reports - Category: Urology & Nephrology Source Type: research
ConclusionThe atypical hemolytic uremic syndrome is a rare disease entity requiring a high index of suspicion to diagnose. It is a diagnosis of exclusion. Early diagnosis with prompt treatment will render a better outcome. The atypical hemolytic uremic syndrome needs to be considered in all patients with thrombotic microangiopathy.
Source: Journal of Medical Case Reports - Category: General Medicine Source Type: research
Authors: Toroghi HM, Lo KB, Ziccardi MR, Horn B, Kanjanahattakij N, Malik E, Penalver J, Rangaswami J, Gupta S, Amanullah A Abstract Worsening renal function in patients with heart failure with preserved ejection fraction is associated with poor outcomes. Pulmonary arterial capacitance is a novel right heart catheterization derived hemodynamic metric representing pulmonary arterial tree distensibility and right ventricle afterload. Given the strong association between heart failure, pulmonary hypertension, and kidney function, the goal of this study is to investigate the correlation between Pulmonary arterial capac...
Source: Reviews in Cardiovascular Medicine - Category: Cardiology Tags: Rev Cardiovasc Med Source Type: research
We report our care of a 48-year-old woman suffering from right heart failure and massive fluid overload due to severe pulmonary hypertension secondary to a combination of left-heart disease and status after recurrent pulmonary embolisms. Alterations in Doppler-derived intrarenal venous flow patterns and a novel renal venous stasis index were used to evaluate improvement in renal venous congestion during recompensation. Due to refractory congestion despite optimal medical treatment and continuous veno-venous hemodialysis, a peritoneal dialysis catheter was placed to relieve the massive ascites. The paracentesis of ascites l...
Source: Reviews in Cardiovascular Medicine - Category: Cardiology Tags: Rev Cardiovasc Med Source Type: research
Conclusion: The use of individualized dialysate sodium level is safe and results in lower IDWG, pre-HD systolic BP, and intradialytic hypertension in patients on HD.
Source: Indian Journal of Nephrology - Category: Urology & Nephrology Authors: Source Type: research
ConclusionIn addition to classical and predictable abnormalities related to the the uremic condition such as myocardial hypertrophy, we found a high prevalence of dilatation of the ascending aorta. Some associated factors are highlighted.
Source: Archives of Cardiovascular Diseases Supplements - Category: Cardiology Source Type: research
Rationale: Pituitary apoplexy (PA) and posterior reversible encephalopathy syndrome (PRES) are rare neurologic diseases that show acute neuro-ophthalmologic symptoms such as headache, decreased visual acuity, and altered consciousness. These diseases are rarely found in patients with end-stage renal disease (ESRD) on hemodialysis, and simultaneous occurrence of these 2 diseases has not been reported. Patient concerns: The patient was a 75-year-old man with a history of hypertension, diabetes mellitus, and non-functioning pituitary macroadenoma. He had been receiving hemodialysis for ESRD for 3 months before his presen...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
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