bluuebunny/crossref_metadata_2025 huggingface dataset:
THE CHRONOLOGY OF ONSET OF TARGET ORGAN DAMAGE IN HYPERTENSIVE PATIENTS
Authors: Ouail Djamel Eddine , Tebbani Meriem , Bouali Fayçal
Published: June 2022

Objective:

The duration of hypertension is a risk factor dependent on damage to target organs

Target organ damage appears at different periods of evolution of the hypertensive pathology.

The objective of our work is to study the age of onset of the various attacks

Design and method:

Prospective study of a cohort of uncomplicated hypertensive patients seen in consultation. The duration of evolution of hypertension is noted in all patients and age categories have been identified as follows Recent discovery hypertension < 1 year, between 1 and 5 years, between 5 and 10 years, between 10 and 20 years and > 20 years.

Organ damage is defined according to the recommendations of the ESH 2018.

Results:

300 patients included in our study. These are 60% women with an average age of 59 years.

Cardiac and ophthalmic attacks are early, they occur during the first 5 years of evolution of hypertension. Vascular damage is early and progressive over the first 20 years of evolution. Kidney damage is late. They occur after 10 years of evolution and are mainly represented by the urinary excretion of albumin A2 and A3. The glomerular filtration rate is long preserved in our series.

Conclusions:

The relationship between the duration of hypertension and damage to target organs is variable, certain pathologies such as left ventricular hypertrophy and carotid stenosing plaques are rather found in hypertensives of less than 5 years of evolution. On the other hand, renal pathologies and the overall profile are more observed in patients between 10 and 20 years of evolution of hypertension.
RENAL SYMPATHETIC DENERVATION AS TREATMENT FOR REFRACTORY HYPERTENSION: CASE REPORT
Authors: Paffer Matheus Toscano , Paffer Pedro Toscano , Procópio Arthur , Ribeiro Fernando , Montenegro Gabriela , Montenegro Patrícia
Published: June 2022

Objective:

Among hypertensive patients, a portion is considered refractory hypertension, where the pressure remains uncontrolled with the use of five or more antihypertensive drugs. For such patients with refractory hypertension, a new hemodynamic procedure has been gaining ground in recent years, being performed in selected cases, the renal sympathetic denervation. We present the case of Mr. GAS, 55 years old.

Design and method:

GAS, male, 55 years old, BMI of 33.95, hypertensive for a long, was refractory to drug treatment, using 7 antihypertensive drugs. At the admission, laboratory tests, he presented potassium of 4, sodium of 141, blood urea nitrogen of 31 and creatinine of 1.4. The admission BP was 130x80 mmHg. On September 25, 2021, the procedure was performed through percutaneous access in the right femoral artery, up to the renal arteries, with the Simplicity catheter. Thirty-one ablations were performed in the right kidney and 28 ablations in the left kidney. Soon after the procedure, the patient had a blood pressure of 116x69mmHg and at discharge it was 120x80mmHg. The patient was discharged with 3 antihypertensive drugs and maintains follow-up with maintenance of the discharge prescription so far.

Results:

Hypertension refractory to drug treatment showed the need for an alternative treatment leading to the development of radiofrequency renal denervation. The procedure consists of applying radiofrequency in the lumen of the renal arteries, leading to thermal rupture of the postganglionic sympathetic nerves that innervate the kidneys. Its goal is to reduce the renal efferent activity, with an increase in blood flow in the kidneys, decreasing the activation of the renin-angiotensin-aldosterone system and water retention.

Conclusions:

In the present report, the patient on admission was not out of control, but also had a high antihypertensive load, in order to maintain pressure control. Renal sympathetic denervation can provide a better quality of life to the patient, since in some cases, it can reduce the amount of medication and also the chance of future problems, such as target organ damage, heart attack and stroke. Proving to be a good option, in selected cases in patients with refractory hypertension.
ASSOCIATION BETWEEN THE REFLECTION MAGNITUDE AND BLOOD-PRESSURE IN A MULTI-ETHNIC COHORT: THE HELIUS STUDY
Authors: Bouwmeester Thomas , Van De Velde Lennart , Galenkamp Henrike , Postema Pieter G. , Westerhof Berend E. , van den Born Bert-Jan H. , Collard Didier
Published: June 2022

Objective:

The reflection magnitude (RM), the ratio of the amplitudes of the backward and forward central arterial pressure waves, has been shown to be predictive for future cardiovascular events, but the association between blood pressure (BP) and RM remains unknown. We aimed to assess the association between RM, BP and hypertension in a large multi-ethnic population-based cohort study.

Design and method:

We assessed RM in 10 195 individuals of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan origin aged between 18–70 years (54.2% female) participating in the HEalthy Life in an Urban Setting (HELIUS) study. To determine RM, central arterial pressure and flow were reconstructed from non-invasive finger BP measurements using a generalized transfer function and Windkessel model, whereafter wave separation was performed (Fig 1, panel A & B). Hypertension was defined based on office-BP and use of BP lowering medication. Associations between RM and systolic- and diastolic BP, hypertension, and hypertension mediated end-organ damage were assessed using regression models with correction for age, height, ethnicity and an interaction term for sex.

Results:

Mean RM was 62.5% (SD 8.0) in men and 63.8% (SD 8.1) in women. For every 10 mmHg increase in systolic BP, RM increased linearly by 1.35 (95% CI 1.23–1.46) from 120 mmHg onwards, while for every 10 mmHg increase in diastolic BP above 80 mmHg RM increased by 1.99 (95% CI 1.61 – 2.38) (Fig 1, panel C & D). RM was 2.40 (95% CI 2.04–2.76) higher in hypertensive men and 3.82 (95% CI 3.46–4.19) higher in hypertensive women compared to normotensive men and women. RM was 1.64 (95% CI 1.09–2.20) and 0.94 (95% CI 0.37–1.52) higher in hypertensive men and women with ECG-based left ventricular hypertrophy or increased albuminuria compared to hypertensive men and women without hypertensive organ damage. Following correction for height ethnic and sex differences in RM were attenuated, however the relation with BP did not change.

Conclusions:

Hypertension is associated with a higher RM in men and women of different ethnic origins, and may, in part, explain disparities in hypertension associated cardiovascular risk.
VALIDATION AND FEASIBILITY OF AN AUTOMATED SYSTEM FOR THE ASSESSMENT OF VASCULAR STRUCTURE AND MECHANICAL PROPERTIES IN THE DIGITAL ARTERIES THROUGH ULTRA-HIGH FREQUENCY ULTRASOUND
Authors: Poli Federica , Fortier Catherine , Khettab Hakim , Faita Francesco , Vitali Saverio , Aringhieri Giacomo , Ghiadoni Lorenzo , Taddei Stefano , Amar Laurence , Lorthioir Aurelien , Boutouyrie Pierre , Bruno Rosa Maria
Published: June 2022

Objective:

The validation of a semi-automatic software to quantify vascular structure and mechanical properties of digital arteries acquired using ultra high frequency ultrasound (UHFUS).

Design and method:

UHFUS 5-second longitudinal scans of digital arteries of 15 patients with vascular diseases and 15 healthy controls were obtained by VevoMD (70 MHz probe, FUJIFILM, VisualSonics, Toronto, Canada) and analyzed using Carotid Studio (Quipu Srl, Pisa, Italy), using as reference technique a manual measurement in a Matlab interface (MathWorks, R2019b). Agreement between the two techniques for diameter, distension and intima-media thickness (IMT) was evaluated using Bland-Altman analyses; inter- and intra-operator reproducibility was carried out using coefficients of variation (CV).

Results:

No trend or significant bias were observed between Carotid Studio and Matlab manual analysis for diameter, distension, and IMT. All limits of agreement were acceptable. Intra-observer CV of diastolic diameter and IMT were 4.1 %, and 4.2 % respectively. Inter-observer CV for diastolic diameter, and IMT were 7.3 % and 5.4% respectively. Intra- and inter- observer CV for distension were higher (25.7 % and 26.7 % respectively).

Conclusions:

Carotid Studio software is a valid and reproducible tool for the assessment of vascular structure and mechanical properties in UHFUS scans of digital arteries.
GLOBAL LOGITUDINAL STRAIN IN HYPERTENSIVE DISORDERS DURING PREGNANCY AS A PREDICTOR FOR EARLY DETECTION OF SUBCLINICAL LEFT VENTRICULAR DYSFUNCTION
Authors: Farhan Hasan Ali , Ybeer Hanaa Falah
Published: June 2022

Objective:

To identify the role of left ventricular (LV) global longitudinal strain (GLS) in the early diagnosis of LV dysfunction among pregnant women with hypertensive disorders.

Design and method:

Cross-sectional study was conducted at one of the heart centers in Iraq from November 2020 – July 2021, included pregnant women with hypertensive disorder. Echocardiographic data was collected using GE (Vivid E9) diagnostic ultrasound equipment with (M5ScD) MHz transducer. Pregnant women were classified into three groups according to the hypertensive disorders: chronic hypertension (HTN), gestational HTN, and preeclampsia (PE).

Results:

A 60 pregnant women were enrolled in the study, mean age (32.7 ± 5.8) years, 25% with chronic HTN, 33% with gestational HTN, and 42% with PE. The mean of systolic and diastolic blood pressure were (130.1 ± 10.8) mmHg and (79 ± 7.9) mmHg; respectively, 90% were on medication, and 18% were diabetic. See Table 1.

Conclusions:

Echocardiography is a valuable tool in diagnosis of LV hypertrophy and diastolic dysfunction in all types of hypertensive disorders during pregnancy. Subclinical cardiac dysfunction in pregnancy related hypertension and preeclampsia can be early detected by impaired GLS.
ASTRAGALOSIDE IV INHIBITS H2O2-INDUCED APOPTOSIS IN H9C2 CELLS BY ATTENUATING OXIDATIVE STRESS AND MITOCHONDRIAL DAMAGE
Authors: Qi Miaomiao , Wang Qiongying , Sun Runmin , Tian Li , Yu Jing
Published: June 2022

Objective:

To investigate the effects and mechanisms of As-IV on H2O2-induced apoptosis in H9c2 cells.

Design and method:

H9c2 cells were divided into three groups, including normal control group (cultured without intervention), H2O2 group (cultured with 200umol/L H2O2 for 2 hours), As-IV group (cultured with 100umol/L As-IV for 1 hour), As-IV with H2O2 group (pretreated with 100umol/L As-IV for 1 hour, then incubated with H2O2 for 2 hours). FITC/PI and DCFH-DA are stained to examine levels of apoptosis and ROS receptively. Levels of SOD and MDA were measured. Stained with JC-1 probe to observe the change of mitochondrial membrane potential (MMP). Western-blot was detected to analyze the expression of Drp-1.

Results:

1. The apoptosis rate of H2O2 group ((13.22 ± 3.17 vs 40.55 ± 13.74)%, P < 0.05) was significantly higher than that of control group, which was lower in As-IV with H2O2 group((23.43 ± 4.3 vs 40.55 ± 13.74) %, P < 0.05). 2. The ROS levels were higher in H2O2 group than control group((73.53 ± 5.33 vs 39.02 ± 7.90) %, P < 0.05), which were significant reduced in As-IV with H2O2 group((57.6 ± 4.63 vs 73.53 ± 5.33) %, P < 0.05) Meanwhile, the activity of MDA was increased and the activity of SOD was decreased in H2O2 group compared with that in control group((10.97 ± 0.56 vs 4.85 ± 0.55) nmol/mL, P < 0.05), ((1192.23 ± 341.59 vs 2710.95 ± 274.32)U/L, P < 0.05). Compared with H2O2 group, As-IV with H2O2 group significantly decrease the activity of MDA and increase the activity of SOD ((6.58 ± 0.79 vs 10.97 ± 0.56) nmol/mL, P < 0.05), ((1984.66 ± 188.81 vs 1192.23 ± 341.59) U/L, P < 0.05). 3.MMP was lower and the expression of Drp1 was higher in H2O2 group than that in control group ((0.31 ± 0.01 vs 1.52 ± 0.25) %, P < 0.05), ((0.86 ± 0.003 vs 0.45 ± 0.004) %, P < 0.05). Compared with H2O2 group, MMP was significantly increased and the expression of Drp1 was downregulated ((0.65 ± 0.38 vs 0.31 ± 0.01) %, P < 0.05), ((0.72 ± 0.005 vs 0.86 ± 0.003) %, P < 0.05).

Conclusions:

As-IV exerts protective effects on H2O2-induced apoptosis by attenuating oxidative stress and mitochondrial damage.
PATIENT PREFERENCE FOR RENAL DENERVATION THERAPY IN HYPERTENSION: A CROSS-SECTIONAL SURVEY IN CHENGDU, CHINA
Authors: Zhipeng Zhang , Xiaoping Chen
Published: June 2022

Objective:

Recent new-generation randomized controlled trials have shown good efficiency and safety of catheter-based renal denervation (RDN) in patients on and off antihypertensive medications. We aimed to investigate patients’ preferences for RDN therapy in hypertension in Chengdu, China.

Design and method:

A questionnaire-based cross-sectional study was conducted from August 2020 to December 2020. Information on demographics, duration of hypertension, medication or not, medication regimen, duration on medication, maximal and minimal blood pressure levels, self-reported comorbidities, their willingness to choose RDN as blood pressure control strategy, determinants of the choice and their expectations for RDN were collected and analyzed.

Results:

A total of 485 patients were interviewed and 402 questionnaires were considered eligible for analysis. Mean age of the participants was 61 years, 53.9% of them were males. 32.6% patients indicated a willingness to choose RDN as blood pressure control strategy, the proportion was 34.7% in patients already on medication and 23.3% in patients not on medication. Patients willing to choose RDN treatment tended to be younger males, more obese, have higher levels of office blood pressure, take more antihypertensive pills and have larger proportions of cardiovascular comorbidities. Patients’ perspectives on RDN did not depend on their education levels. Physicians’ recommendations accounted for the reasons to choose RDN in vast majority of patients, followed by that patients could take less pills after RDN. 47.3% patients would choose RDN treatment if the procedure could decrease their blood pressure by over 20mmHg and no patient would choose the device treatment if their blood pressure decreased by less than 5 mmHg. 56.5% patients expected that they could take one less pill after RDN. Appropriately 70% patients expected RDN could persistently decrease blood pressure for at least 15 years.

Conclusions:

Among hypertensive patients in Chengdu, appropriately one-third were willing to choose RDN as blood pressure control strategy. These patients tended to be younger males, take more antihypertensive drugs and have concomitant metabolic disorders. Patients’ perspectives on RDN did not depend on their education levels and their expectations for RDN were high.
LEPTIN AS A PREDICTOR OF CARDIOPROTECTIVE EFFICIENCY OF RENAL DENERVATION IN PATIENTS WITH RESISTANT HYPERTENSION AND TYPE 2 DIABETES MELLITUS
Authors: Manukyan Musheg , Falkovskaya Alla , Mordovin Victor , Zyubanova Irina , Tsoy Ekaterina , Pekarskiy Stanislav , Ryabova Tamara , Khunkhinova Simzhit , Vtorushina Anastasia , Gusakova Anna , Suslova Tatiana
Published: June 2022

Objective:

To evaluate serum leptin level before renal denervation (RDN) and to assess whether this baseline metabolic marker predicts cardioprotective efficacy in patients with resistant hypertension (RHTN) and type 2 diabetes mellitus (T2DM).

Design and method:

The study included 25 patients with RHTN and T2DM (mean age 60.9 ± 7.1 years, 16 women, mean 24-hour (24-h) blood pressure (BP) (systolic/diastolic) 158.8 ± 16.5/81.1 ± 13.1 mm Hg, mean HbA1c 7.4 ± 1.5%). All patients were enrolled in the prospective interventional study with RDN (NCT02667912 and NCT01499810 at ClinicalTrials.gov). Office BP and ABPM, tissue Doppler echocardiography with assessment of diastolic function, serum leptin level were performed at baseline and 6-months after RDN. Twenty patients completed a 6-month follow-up.

Results:

RDN led to a significant reduction in systolic and diastolic 24-h BP (-13.4/-7.6 mm Hg, p = 0.001/0.002).

The baseline leptin level correlated with the mean E/e ‘ratio at baseline (R = 0.52, p = 0.015) and its dynamics after 6 months (R = 0.71, p = 0.001). Depending on the degree of decrease in average E/e’ ratio, the patients were retrospectively divided into 2 groups: 1st (with improvement) (persons with a decrease in average E/e’ ratio by 1 unit or more, n = 10 (50%)) and 2nd (without improvement) (with a lesser degree of decrease in average E/e’ ratio). Initially, the pts of 1st group not differed from those of 2nd group by age, BP and HbA1c level. At the same time, pts of the 1st group had higher baseline leptin level (60.4 ± 24.05 and 35.8 ± 9.82 ng/ml, p = 0.008) than pts of the 2nd group. A ROC analysis showed that the best cut-off value of the leptin level is 47.4 ng/ml with 70% sensitivity and 85% specificity (AUC: 0.84; 95% CI:0.64–1.04; p = 0.001).

Conclusions:

Estimation of the leptin allows predicting the cardioprotective efficacy of renal denervation in patients with resistant hypertension and type 2 diabetes mellitus.
BRAIN OXYGENATION ASSESSED BY NEAR-INFRARED SPECTROSCOPY DURING A MENTAL TASK AND A MILD PHYSICAL STRESS IN HEMODIALYSIS AND PERITONEAL DIALYSIS
Authors: Faitatzidou Danai , Dipla Konstantina , Zafeiridis Andreas , Theodorakopoulou Marieta , Koutlas Aggelos , Polychronidou Georgia , Chalkidis Georgios , Dimitriadis Chrysostomos , Tsouchnikas Ioannis , Giamalis Panagiotis , Papagianni Aikaterini , Sarafidis Pantelis
Published: June 2022

Objective:

Cognitive impairment is highly prevalent in end-stage kidney disease (ESKD) individuals. Brain oxygenation is a parameter that plays major role in cognitive function. This study aimed to examine for the first time changes in brain oxygenation during a mental and a mild physical task in hemodialysis (HD) and peritoneal dialysis (PD) patients.

Design and method:

63 ESKD patients (>18 years old) were enrolled in this cross-sectional study. Patients were allocated in two groups according to dialysis modality (n = 29 HD and n = 34 PD). All participants underwent a mental (countdown from 100 to 0 by 7, performed twice) and a mild physical task (a 3-min intermittent handgrip exercise at 35% of maximal handgrip strength). Changes in brain oxygenation [oxy- (O2Hb), deoxy- (HHb) and total- (tHb) hemoglobin] during the two tasks were continuously recorded via near-infrared spectroscopy (NIRS, Artinis).

Results:

Age, sex, and dialysis vintage did not differ between the two groups. The average response in brain oxygenation during the mental task (O2Hb change from rest: 1.51 ± 1.68 vs 1.60 ± 1.82 micromol/l, in HD and PD, respectively, p = 0.841), as well as the duration needed for task completion (191.53 ± 124.27 vs 200.19 ± 118.84 s, p = 0.781) were similar between groups. Furthermore, the average response in brain oxygenation during the handgrip exercise also did not differ between the groups (O2Hb change 1.20 ± 1.03 vs 1.49 ± 0.95 micromol/l, respectively, p = 0.262). In the total cohort, the average response in brain oxygenation during handgrip exercise was inversely correlated with dialysis vintage (p < 0.05).

Conclusions:

Dialysis modality does not appear to have an impact on brain oxygenation, as HD and PD patients presented similar responses during a mental and a mild physical task. Dialysis vintage may negatively affect brain oxygenation in ESKD individuals.
ASSOCIATION OF LEFT VENTRICULAR MASS INDEX WITH ALL-CAUSE MORTALITY IN CHRONIC KIDNEY DISEASE PATIENTS
Authors: Manousopoulos Konstantinos , Spiliopoulou Sotiria , Tsoutsoura Nefeli , Lykka Aikaterini , Dimitriou Athina , Manios Efstathios
Published: June 2022

Objective:

Although the association of left ventricular mass (LVM) with outcome is well established in dialysis patients, the importance of this association in pre-dialysis chronic kidney disease (CKD) populations is not well documented. Aim of the study was to examine the association of LVM index with all-cause mortality in CKD patients.

Design and method:

Our study population consisted of 126 patients with CKD stages 3–4, referred for evaluation at the Hypertension Unit of our department. The patients underwent office blood pressure measurements and echocardiographic measurements. LVM was estimated using Devereux’s formula according to the Penn Convention Protocol. LVM index was defined as LVM divided by the body surface area. Cox regression analysis was used to evaluate the association between LVM index and all-cause mortality.

Results:

After a median follow-up of 3 years, 11 cardiovascular and 16 non-cardiovascular deaths occurred. The study population consisted of 95 men (75%). Mean age was 70 years, mean office BP was 143/76 mmHg. The multivariate Cox regression analyses revealed that LVM index was independently associated with all-cause mortality (HR: 1.011, 95%CI 1.000–1.023, p = 0.049) after adjustment for age, sex, history of diabetes mellitus and hyperlipidemia, smoking, antihypertensive treatment and mean office blood pressure values.

Conclusions:

Left ventricular mass index is an independent predictor of all-cause mortality in hypertensive patients with CKD.
HIGH FRUCTOSE DIET INCREASES RENAL CHREBP-BETA EXPRESSION AND LEADS TO INTRA-RENAL FAT ACCUMULATION IN A METABOLIC-LIKE SYNDROME RAT MODEL
Authors: Leibowitz Avshalom , Bier Ariel , Shpira Eli , Khashab Rawan , Sharabi Yehonatan , Grossman Ehud
Published: June 2022

Objective:

A high fructose diet induces metabolic syndrome (MeS) which includes ectopic lipid accumulation, such as fatty liver. MeS is also associated with chronic kidney disease (CKD). A novel isoform of ChREBP, ChREBPb, was recently reported to regulate liver fructose metabolism that leads to fatty liver development.

The aim of this study was to evaluate fructose metabolism in the kidney and whether this metabolism leads to intra-renal fat accumulation.

Design and method:

In-vivo: Sprague Dawley rats were fed either normal chow (Ctrl) or a high fructose diet (HFrD) for eight weeks. Blood pressure, fasting blood glucose and triglycerides were measured. The kidneys were harvested for ChREBPb and de novo lipogenesis (DNL) gene expression, triglyceride content and histopathology staining.

In-vitro: HK2 (human kidney) cells were treated with fructose for 48 h and gene expression for ChREBPb and DNL were determined.

Results:

The HFrD rats exhibited higher blood pressure (152 vs. 138 mmHg), glucose (146 vs. 127 mg/dl) and triglyceride (280 vs. 143 mg/dl) levels. Kidneys weight normalized to body weight of the HFrD rats were significant higher than the Ctrl (7.32 vs. 5.87). The difference can be explained by the higher triglyceride content in the HFrD kidneys (16.4 vs. 12.4 mg). Oil red staining revealed higher lipid droplet formation in the HFrD kidneys, which was also supported by higher adipophilin mRNA expression. The expression level of ChREBPb and its downstream genes, scd and fasn, were elevated in the HFrD kidney.

Treating HK2 cells with 40 mM fructose increased ChREBPb expression levels. Its downstream genes, fasn and acc, also showed an increasing trend. In three out of five experiments, adipophilin was increased as well.

Conclusions:

In this study, we demonstrated that fructose consumption leads to intra-renal lipid accumulation and to the formation of a fatty kidney. This suggests a potential mechanism that can partially explain CKD development in fructose induced MeS.
EFFECTS OF APOCYNIN TREATMENT AND HBO PRECONDITIONING ON IMMUNOHISTOCHEMICAL 4-HNE, HIF1 ALPHA, HIF2 ALPHA AND NGAL TISSUE EXPRESSION IN POSTISCEMIC ACUTE KIDNEY INJURY IN SHR RATS
Authors: Kovacevic Sanjin , Ivanov Milan , Zivotic Maja , Brkic Predrag , Miloradovic Zoran , Jeremic Rada , Mihailovic-Stanojevic Nevena , Vajic Una Jovana , Karanovic Danijela , Jovovic Djurdjica , Ostojic Jelena Nesovic
Published: June 2022

Objective:

Oxidative stress has been considered as a central aggravating factor in the development of postischemic acute kidney injury (AKI). 4-hydroxynonenal (4-HNE) is a product of lipid peroxidation and may serve as non-invasive biomarker of oxidative stress while neutrophil gelatinase-associated lipocalin (NGAL) is a biomarker of AKI. Hypoxia-inducible factors (HIFs) are the “master’’ transcription factors responsible for gene expression in hypoxia, which play an important role in kidney injury and repair by regulating HIF target genes, including microRNAs.

Design and method:

The study was conducted on male SHR rats, randomly divided into following groups: sham-operated group (SHAM) AKI control group, AKI group with apocynin treatment (AKI+APO), group with HBO preconditioning before AKI induction (AKI+HBO) and group with HBO preconditioning before and apocynin treatment after AKI induction (AKI+APO+HBO). HBO preconditioning was performed by exposing to pure oxygen (2.026 bar) twice a day for two consecutive days for 60 minutes, and 24 h before AKI induction. Apocynin, NADPH oxidase inhibitor was injected 5 minutes before reperfusion.

Results:

AKI induction significantly decreased creatinine (CCr), urea (CU) and phosphate (CPhos) clearances when compared to SHAM group. Remarkable increase in CCr, CU, CPhos levels were observed in all treated groups (AKI+APO, AKI+HBO, AKI+APO+HBO) in comparison to AKI group. Sham – operated rats did not express 4-HNE and NGAL in any parenchymal structure. AKI induced abundant and strong glomerular expression of 4-HNE along with expression in interstitial compartment. All treatments (AKI+APO, AKI+HBO, AKI+APO+HBO) significantly decreased 4-HNE expression both in glomeruli and interstitium. Also, AKI stimulated widespread NGAL expression in renal epithelial tubular cells with fine granular appearance on the apical surface of the cells, affecting entire circumference of tubular cross-sectioning, which was decreased in all treated groups. In SHAM group, the expression of HIF1 alpha and HIF2 alpha was focal with weak intensity in glomeruli and interstitium. In AKI group, the expression was diffuse and strong, with remarkable improvement in all treated groups.

Conclusions:

Considering our results, we can conclude that apocynin treatment, as well as HBO preconditioning may have protective effects in postischemic acute kidney injury induced in spontaneously hypertensive rats.
TRAJECTORIES OF BLOOD PRESSURE, TREATMENT PATTERNS AND HYPERTENSION CONTROL IN PATIENTS WITH LUPUS NEPHRITIS – DATA FROM A RETROSPECTIVE COHORT STUDY
Authors: Knezevic Tamara , Padjen Ivan , Laganovic Mario , Ivkovic Vanja , Biloglav Zrinka , Jezic Ivana , Prlic Margareta Fistrek , Cerovec Mislav , Rukavina Kresimir , Zivko Marijana , Bulimbasic Stela , Coric Marijana , Mayer Miroslav , Jelakovic Bojan , Anic Branimir
Published: June 2022

Objective:

Prevalence of hypertension seems to be higher in patients with systemic lupus erythematosus (SLE) than in the general population, but there is scarce data on the epidemiology of hypertension in lupus nephritis (LN). Furthermore, to the best of our knowledge, there are no studies examining the trajectories of blood pressure (BP), treatment patterns and control of hypertension in LN.

Design and method:

We have conducted a retrospective cohort study to evaluate the prevalence, treatment and control of hypertension in patients with biopsy-proven LN. We have collected data on demographics, clinical and laboratory parameters, histopathology and office BP measurement at the time of biopsy and after long-term follow-up. BP measurement and definition of hypertension were according to 2018 ESC/ESH guidelines.

Results:

A total of 36 patients with biopsy-proven LN were followed up for 4.5 ± 2.9 years (81% women, mean age at biopsy 38 ± 14). Mean duration of SLE prior to biopsy was 4.3 years (min-max 0 to 27 years). Both systolic and diastolic BP decreased from the time of biopsy to last follow-up (137/85 mmHg vs. 125/79 mmHg, p < 0.001 for systolic BP and p = 0.075 for diastolic BP). Prevalence of hypertension at the time of biopsy was 58% and increased to 72% at the time of last follow-up (p = 0.22). Mean number of drugs per patient did not change (2.0 vs. 1.8, p > 0.05). Only 48% and 58% of patients with hypertension had achieved BP control (p = 0.67) and a total of 1 and 2 patients had resistant hypertension at the time of biopsy and at last follow-up, respectively. When examining treatment, 67% and 77% patients with hypertension had an ACEI/ARB, while 48% and 38% had calcium channel blocker, 43% and 35% had diuretics and 24% and 31% had beta blockers at the time of biopsy and follow-up, respectively.

Conclusions:

LN is associated with high cardiovascular risk and mortality as well as a high prevalence and inadequate control of hypertension. Achieving BP control is crucial and should be an important therapeutic goal in these patients.
DETECTING CHRONIC KIDNEY DISEASE BY LEVERAGING SCREENING INITIATIVES FOR OTHER NON-COMMUNICABLE DISEASES
Authors: George Cindy , Hill Jillian , Nqebelele Nolubabalo U. , Peer Nasheeta , Kengne Andre P.
Published: June 2022

Objective:

Early diagnosis of chronic kidney disease (CKD) slows disease progression and reduces mortality; yet screening for CKD is sparse in clinical practice. Contrary, screening for CKD risk factors like hypertension and type 2 diabetes mellitus (T2DM) are included in clinical practice guidelines in most countries. Therefore, an opportunity exists to implement CKD screening as a by-product of these existing screening programmes. To evaluate the viability of CKD screening, we used the South African Diabetes Prevention Programme (SA-DPP) to assess the yield of CKD cases.

Design and method:

The SA-DPP was conducted across 16 resource-poor communities in Cape Town, South Africa, between 2017 and 2019. Participants, aged 25–65 years, were recruited by random and self-selected sampling techniques. The African diabetes risk score (ADRS), which is a screening tool comprising non-laboratory-based variables including age, waist circumference and the presence of hypertension, was used to identify adults at high risk for T2DM. Those at high-risk were invited for confirmatory oral glucose tolerance test (OGTT). Kidney function was estimated using the serum creatinine-based CKD Epidemiology Collaboration equation. CKD was defined as an estimated glomerular filtration rate (eGFR) of < 90 ml/min/1.73 m2 and/or albumin-to-creatinine ratio > 3 mg/mmol.

Results:

Of the 2039 individuals screened in the community, 690 participants deemed at high-risk of T2DM presented at the research clinic for an OGTT. Of these individuals, 9.6% (n = 66) had diabetes and 18.1% (n = 125) had CKD, with 2.2% (n = 15) presenting with both CKD and T2DM. Most CKD cases were in the early stages of the disease, with 73.6% (n = 92), 17.6% (n = 22) and 7.2% (n = 9) presenting with stage 1–3, respectively. Of those with CKD stages 1–3, 72.8%, 68.2% and 44.5% had microalbuminuria, respectively with 27.2%, 31.8% and 11.1% presenting with macroalbuminuria. Most participants with early-stage CKD were overweight/obese (95.1%) and 47.0% had hypertension.

Conclusions:

By including markers of kidney function into the scope of markers collected in an existing disease screening programme, we were able to detect a great proportion of CKD cases. Therefore, by utilizing an opportunistic approach, people with early-stage CKD can be identified and appropriately treated.
QUALITY OF LIFE AND PHYSICAL ACTIVITY OF ELDERLY PATIENTS WITH CARDIOVASCULAR DISEASES AND CHRONIC KIDNEY DISEASE
Authors: Efremova Elena , Shutov Alexander
Published: June 2022

Objective:

Chronic kidney disease (CKD) is an unfavorable prognostic factor in patients with cardiovascular diseases (CVD). Physical activity is associated with a better prognosis and improvement of the functional status of patients. The aim of this study was to investigate quality of life and physical activity of elderly patients with CVD and CKD.

Design and method:

214 elderly patients with stable cardiovascular diseases (106 males, mean age 69.5 ± 7.6 years) were studied. Arterial hypertension had 201 (93.9%)patients, coronary artery disease - 198 (92.5%), 150 (70%) - chronic heart failure, 57 (26.6%) - diabetes mellitus. Arterial hypertension was diagnosed according to the ESC guidelines (2018). Components of physical activity were assessed through questionnaires, interviews and International Questionnaire on Physical Activity (IPAQ). The quality of life of patients was estimated using EQ-5D-5L (Russian, 2009 EuroQol Group) and Visual analog scale. Frailty syndrome and personality profile (PHQ-9) were appreciated.

Results:

CKD with glomerular filtration rate (GFR) less than 60 ml/min/1.73 m2(CKD-EPI, 2011) was diagnosed in 144 (67.3%) patients. The frequency of physical activity in elderly patients with CVD did not differ depending on the presence of CKD (p > 0.05). Despite the rather high awareness of the benefits of physical activity (75%), adherence to the recommendations in elderly patients with CVD and CKD was significantly lower (63.2%) (X2 = 4.7; p = 0.03). Hypodynamia was observed in 54 (37.5%) elderly patients with CKD. The main type of physical activity for elderly patients with CKD was walking. Patients with CKD and frailty syndrome had lower indicators of physical activity (IPAQ) compared with patients without frailty syndrome: 14.5 (7.5;24) and 19 (12;26) points, resp., p = 0.03. Patients with CKD and hypodynamia had a higher level of depressive reactions (PHQ-9) (11 (8;15) and 9 (6;11) scores, resp., p = 0.03.), lower visual analogue scale scores (60 (45; 70) and 55 (50; 70) scores, p = 0.002) and the integral indicator of QoL (0.37 (0.27; 0.53) and 0.56 (0.53) .33; 0.68), p = 0.01)compared with patients without hypodynamia.

Conclusions:

Hypodynamia was observed in 37.5% elderly patients with CVD and CKD and leads to depressive reactions and a decrease in the quality of life.
ADHERENCE TO DIETARY RECOMMENDATIONS BY ELDERLY PATIENTS WITH CARDIOVASCULAR COMORBIDITY AND CHRONIC KIDNEY DISEASE
Authors: Efremova Elena , Shutov Alexander
Published: June 2022

Objective:

Chronic kidney disease (CKD) worsens the quality of life and prognosis of patients with cardiovascular comorbidity. Adherence to therapy, including lifestyle modification, determines the effectiveness of a treatment. For patients with CKD, a healthy diet includes restriction of salt, animal protein, sufficient consumption of vegetables and fruits. The aim of this study was to investigate adherence to dietary recommendations by elderly patients with cardiovascular comorbidity and CKD.

Design and method:

214 elderly patients with stable cardiovascular diseases (106 males, mean age 69.5 ± 7.6 years) were studied. CKD was diagnosed and classified according to the KDIGO guidelines (2012). Adherence to dietary recommendations was assessed through questionnaires and interviews.

Results:

CKD with glomerular filtration rate (GFR) less than 60 ml/min/1.73 m2was diagnosed in 144 (67.3%) patients. Most of the patients had arterial hypertension - 201 (93.9%). Most elderly patients with CKD were informed about the benefits of salt restriction (84.7%) and daily eating vegetables and fruits (92.4%). There were no differences in adherence to dietary recommendations by elderly patients depending on the presence of CKD (p > 0.05). 106 (73.6%) elderly patients with CKD always and most of the time limit salt intake (mostly do not consume salty foods). Only half of elderly patients with CKD eat vegetables and fruits daily (81; 56.3%) and include fish in the menu every day or at least twice a week (75; 52%). Only 35 (24%) patients with CKD consume up to 4–6 servings per day of vegetables and fruits daily. More than half (76; 52.8%) of elderly and senile patients with CKD do not restrict protein in the diet. More than half of elderly patients (65.4%), have scales at home for self-monitoring of weight, regardless of the presence of CKD. However, half of elderly patients (50,5%) never control their weight.

Conclusions:

There were no differences in adherence to dietary recommendations by elderly patients with cardiovascular comorbidity depending on CKD. Despite the rather high awareness of dietary modification, adherence to dietary recommendations in elderly patients with cardiovascular comorbidity and CKD was significantly lower. Most elderly patients with CKD did not restrict protein.
PREVALENCE OF CHRONIC KIDNEY DISEASE – PRELIMINARY RESULTS EH-UH 2 STUDY (CROATIAN SCIENTIFIC FOUNDATION)
Authors: Domislovic Marija , Gellineo Lana , Jelakovic Ana , Fucek Mirjana , Begic Zvonimir , Frkanec Stjepan , Katic Luka , Radunovic Danilo , Prelevic Vladimir , Stevanovic Ranko , Dika Zivka , Karanovic Sandra , Domislovic Viktor , Bukal Nikolina , Premuzic Vedran , Jelakovic Bojan
Published: June 2022

Objective:

According to the results of epidemiological studies, the worldwide prevalence of chronic kidney disease (CKD) is 9.1% with an observed trend of increasing over the last thirty years. High prevalence is a consequence of worldwide epidemics of arterial hypertension, diabetes, obesity but also aging of the population. The data on the prevalence of CKD in Croatia are scarce. Our aim was to determine the prevalence of CKD in Croatia and to determine the stages of CKD according to the KDIGO guidelines.

Design and method:

Data on 781 subjects (Croatian general adult population) which were enrolled in a nationwide survey (EH-UH 2) from 2018–2020 (mean age 59 yr., 34.7% male) were analysed. CKD EPI equation was used to estimate glomerular filtration rate (eGFR) in total group. CKD was defined according to the guidelines as a value of eGFR < 60 mL/min/1.73 m2. Subjects were distributed depending on the eGFR value in stages of CKD.

Results:

Prevalence of CKD in Croatia is 10.1%, with higher prevalence among women (10.4% vs. 9.6%, p = 0.820). Prevalence of CKD according to the CKD stages is 9.3% for G3a and G3b, 0.6% for G4 and 0.1% for G5. When looking at age characteristics, there is a sharp increase in the prevalence of CKD in the eighth decade (Figure 1). The prevalence of diabetes is 14%, obesity 39%, and arterial hypertension 63% in the whole group.

Conclusions:

These preliminary results of EH-UH 2 study show that the prevalence of CKD is high in Croatia, with women being affected more than men. Our data are consistent with global prevalence data of CKD.
RENAL EXTRACTION EFFICIENCY FOR PAH IS COMPARABLE IN ESSENTIAL HYPERTENSION AND RENAL FIBROMUSCULAR DYSPLASIA
Authors: de Leeuw Peter W. , Houben Alphons Jhm , Kroon Abraham A.
Published: June 2022

Objective:

Previously, we demonstrated that intrarenal blood flow in most patients with renal fibromuscular dysplasia (FMD) does not differ from that of patients with essential hypertension and patent renal arteries. In the present study, we assessed whether the renal extraction of para-aminohippurate (PAH) as a marker of tubular function was affected by the presence of FMD.

Design and method:

We studied 136 hypertensive patients who were scheduled for diagnostic renal angiography with arterial and renal venous blood sampling. In all of them, a continuous infusion of PAH was started two hours before the procedure to obtain steady state plasma levels at the time of sampling. Blood was collected simultaneously from the arterial and venous catheter prior to the administration of contrast material. Mean renal blood flow (MRBF) was measured simultaneously using the 133Xenon washout technique.

Results:

Altogether, 21 patients were diagnosed with renal FMD, 45 with atherosclerotic renal artery stenosis (ARAS) and 70 with essential hypertension (EH). Extraction ratio of PAH (ER-PAH) in the patients with renal FMD averaged 72 + 4% which did not differ significantly from that in patients with EH (74 + 3%). MBRF did not differ between these two groups either. Per contra, in patients with ARAS both MRBF and ER-PAH were significantly lower as compared to the other groups. ER-PAH in FMD patients was not modified by age, sex, height of blood pressure or MBRF.

Conclusions:

The ER of PAH in patients with renal FMD does not differ from that in EH. Thus, both flow and tubular function are well preserved in FMD when is EH is taken as control. This suggests that the pathophysiological mechanism which contribute to hypertension in FMD are different from those which are active in ARAS.
EARLY MARKERS OF THE KIDNEYS DAMAGE IN PATIENTS WITH RESISTANT HYPERTENSION
Authors: Bezrodna Larysa , Mishchenko Larysa , Serbenjuk Kateryna , Matova Olena , Bezrodnyi Volodymyr , Gulkevych Oxana , Kupchinska Olena , Ovdiienko Tetiana , Logvynenko Alla , Radchenko Volodymyr , Boghenko Galyna , Mospan Maryna
Published: June 2022

Objective:

To define early specific markers for assessing the degree of kidney damage in patients with resistant hypertension (RH).

Design and method:

We examined 235 patients with RH confirmed by the office and ambulatory BP monitoring despite the use of 3 antihypertensive medications with diuretic. Chronic kidney disease (CKD) was diagnosed using estimated glomerular filtration rate (eGFR) according to the CKD-EPI equation. Microalbuminuria (MAU) was defined as levels of albumin ranging from 30 to 300 mg in a 24-h urine collection. In all pts plasma levels of citrulline, creatinine, matrix metalloproteinase-12 (MM-12), C-reactive protein (CRP), fibrinogen, uric acid were measured.

Results:

Patients were assigned to 3 groups: without CKD (Gr.I pts), CKD stage 1 (GFR more than 90 ml/ min/ 1.73 m2) (Gr.II pts), and CKD stages 2–3 (GFR 30–90 ml / min/1.73 m2) (Gr.III pts). Plasma citrulline content was significantly higher in Gr.II pts and Gr.III pts than that in Gr.I pts: 92.2 ± 4.3 and 116.50 ± 5.06 mol/l vs 71.0 ± 6.2 mol/l (p < 0.05 in both cases). The difference between Gr.II and Gr.III pts was also significant (p < 0.05). Patients with kidney damage had a significantly (p < 0.05) higher level of markers of systemic inflammation (CRP, fibrinogen, MM-12) compared with the group of patients without CKD. There was no significant difference in creatinine or uric acid content between pts without CKD (Gr.I) and CKD stage 1 pts. (Gr.II). There was negative correlative relationship between blood levels of citrulline, CRP, MM-12, fibrinogen and eGFR (r = -0,532; P < 0.04; r = -0,384; P < 0.05; r = -0,332; P < 0.05; r = -0,331; P < 0.05 accordingly).

Conclusions:

Citrulline level could be used to estimate the early degree of renal damage in RH pts that in conjunction with identifying inflammatory markers may be useful in developing effective strategies for the prevention or early detection and treatment of impaired renal function. Relationship between citrulline, CRP, MM-12, fibrinogen and eGFR may indicates on underlying tubulointerstitial dysfunction and chronic inflammation in mechanism of kidney damage of hypertensive nephropathy in patients with RH.
HYPERTENSION AS A RISK FACTOR FOR MORTALITY AND THE DEVELOPMENT OF CHRONIC KIDNEY DISEASE AFTER AN EPISODE OF ACUTE KIDNEY INJURY WITH FULL RECOVERY
Authors: Mahmoud Nouha Ben , Hamouda Mouna , Maatoug Jihen , Salem Meriem Ben , Salah Manel Ben , Letaief Ahmed , Aloui Sabra , Skhiri Habib
Published: June 2022

Objective:

Acute kidney injury (AKI) is a real public health problem due to its severity and its consequences in the short, medium and long term. Hypertension is a very common disease in our country. So our objective was to evaluate if hypertension was a real major risk factor of mortality among patients fully recovered from AKI.

Design and method:

We undergone a retrospective study which was carried out in the nephrology department of Fattouma Bourguiba hospital in Monastir.

We included patients who had an AKI with full recovery who had been hospitalized between January 2002 and December 2015. Our study aimed to assess the impact of hypertension on mortality and the development of chronic kidney disease (CKD) after an episode of AKI.

Results:

Our population was made up of 107 men and 107 women, median age was 61 years and 42.1% had multiple comorbidities. Pre renal AKI represented the predominant mechanism which was retained in our study with a rate of 52.3% and dehydration as the main aetiology in 105 patients.

In the short term, 25 patients had progressed to CKD. The mean overall survival in our study was 159 months with a high risk of mortality in elderly (patients aged > 65 years), who had multiple comorbidites, hypertensive (p = 0.007), diabetics, with vascular disease, Charlson Cmorbidity index > 5, who presented with hyperkaleamia > 5.5 and pre renal mechanism of the AKI episode.

Hypertensive patients had 3 times the risk of cardiovascular death and 4 times risk of developping CKD comparing to patients with normal blood pressure.

Conclusions:

Hypertension is a real public health problem impacting the short, medium and long term prognosis of patients who have had an episode of AKI with full recovery. Prevention and diagnosis of hypertension remain a global issue and our study demonstarted that hypertension is also a risk factor of mortality and development of CKD.
CAN WE USE NEUROTROPHINS FOR CAROTID PLAQUE VULNERABILITY ASSESSMENT – IVUS VH CASE SERIES
Authors: Yaneva-Sirakova Teodora , Traykov Latchezar , Zlatancheva Galina , Karamfiloff Kiril , Hristova Julieta , Vassilev Dobrin
Published: June 2022

Objective:

Defining carotid atherosclerotic plaque vulnerability is problematic. The combination between imaging and biomarkers may be of practical significance for future assessment of extracranial stenoses. Brain derived neurotrophic factor (BDNF) and neuronal growth factor (NGF) are neurotrophins. There are some studies, which suggest association between endothelial dysfunction and circulating BDNF, impaired neurotrophins’ endothelial secretion in atherosclerosis and correlation between BDNF concentration and Agatson’s score, as well as coronary plaque vulnerability. Neurotrophins also play important role in cerebral functioning. Their role in carotid atherosclerosis is not known.

Design and method:

We share the results of 13 patients with angiographically significant carotid stenoses. The plaque morphology was assessed with IVUS VH and we evaluated their serum BDNF and NGF concertation. All the patients were without coronary artery disease or fully revascularized, as well as without significant or symptomatic peripheral artery disease. We had the results for BDNF and NGF from a reference group without any atherosclerotic disease. SPSS (IBM) was used for the statistical analysis, p < 0.05, CI 95%.

Results:

The patients with significant carotid stenoses had lower mean BDNF values than the reference group. There was correlation between luminal diameter and BDNF (p = 0.049; r = -0.605), total Ca2+ area (mm2) and BDNF (r = 0.681, p = 0.021), Proximal Ca2+area and BDNF (p = 0.007, r = 0.784), Necrotic core % in the proximal plaque area and NGF (r = 0.891, p = 0.001)

Conclusions:

BDNF concentration was negatively correlated with the maximal values for minimal luminal diameter and positively with total Ca2+ plaque area, t.i. with plaque stability. We found positive correlation with necrotic core % and NGF values. This case series is small, and a much larger sample is needed to define precisely any association. Nevertheless, this is a beginning of the study for the potential role of neurotrophins in carotid plaque morphology, either by their local endothelial secretion or by modification of their central secretion from the altered cerebral hemodynamics. They may be both markers and factors for carotid plaque vulnerability.

The work was partially funded by a Research GRANT 2020 number 133 from Medical University Sofia, Bulgaria.