scholarly journals Decreased Serum Levels of Klotho Protein in Chronic Kidney Disease Patients: Clinical Imortance

2016 ◽  
Vol 71 (4) ◽  
pp. 288-296 ◽  
Author(s):  
L. Y. Milovanova ◽  
N. A. Mukhin ◽  
L. V. Kozlovskaya ◽  
Y. S. Milovanov ◽  
G. G. Kiyakbaev ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Abdominal Aorta ◽  
Blood Pressure Level ◽  
Serum Levels ◽  
Left Ventricular ◽  
Pressure Level ◽  
Target Blood Pressure ◽  
Klotho Protein

Objective: to determine the role of serum Klotho (s-Klotho) protein levels changes in patients with different stages of chronic kidney disease (CKD).Methods: The study involved 130 patients with CKD stages 1–5D (mean age ― 41±6.7 years). Serum levels of parathyroid hormone (PTH), calcium, phosphorus and s-Klotho protein (ELISA method) at baseline and after 1 year of follow-up were examined in all the patients so as the blood pressure (BP), including central (aortic), pulse wave velocity ― with the help of «Sphygmоcor» (Australia), echocardiography, radiography of the abdominal aorta in a lateral projection were also performed.Results: when comparing the s-Klotho levels in patients with different CKD stages, it was found that the level change associated with the reduction of glomerular filtration rate (GFR) ahead of phosphorus and PTH increase in serum, stared at 3A CKD, whereas hyperphosphatemia and PTH increase started at 4–5 CKD stages. According to ROC analysis, decreasing of s-Klotho levels below 387 pg/ml was indicated a calcification risk of abdominal aorta increased with an 80% sensitivity and 75% specificity. In addition, a strong negative relationship of low s-Klotho levels and heart remodeling was found. When comparing the patients with hypertension who were receiving antihypertensive monotherapy, the highest serum levels of Klotho protein were observed in those of them whose target blood pressure level was achieved primarily through Angiotensin II Receptors Blockers (ARB), compared to those who was administered another drug group (p0.01) or has not reached the target blood pressure level (p=0,008).Conclusion: The change of serum Klotho levels (decrease) in CKD progression is associated with the degree (increase) of cardiovascular calcification and remodeling (the development of left ventricular hypertrophy, and cardiomyopathy) and it can be seen as an early independent marker of the cardiovascular system lesions in CKD. Our preliminary data of the effect of blood pressure correction on s-Klotho levels may indicate the possibility of drug maintaining serum Klotho levels and it requires further research.

A clinical case of refractory arterial hypertension

2021 ◽  
pp. 56-63
Author(s):  
Dmitriy Sergeevich Kovalev
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Arterial Hypertension ◽  
Antihypertensive Therapy ◽  
Clinical Case ◽  
Blood Pressure Level ◽  
Pressure Level ◽  
Entire Population ◽  
Treatment Refractory

Arterial hypertension is considered treatment refractory (resistant), if the treatment, involving a change (improvement) in lifestyle and a rational combined antihypertensive therapy, consisting of three drugs, including a diuretic, in the maximum tolerated doses does not lead to the achievement of the target blood pressure level. Pseudo-refractory and true refractory arterial hypertension are distinguished. According to modern data, true refractory arterial hypertension occurs in no more than 5 % of cases among the entire population of patients with arterial hypertension, however, in certain groups of patients, for instance, with chronic kidney disease, its prevalence can reach 30–50 %. The article presents a clinical case of diagnosis and treatment of refractory arterial hypertension.

scholarly journals Experience of treating hypertension in an outpatient setting: a clinical case

2014 ◽  
Vol 11 (1) ◽  
pp. 78-81
Author(s):  
A N Agafonov ◽  
N Yu Khozyainova ◽  
O V Petruschenkova
Keyword(s):  
Blood Pressure ◽  
Ventricular Hypertrophy ◽  
Fixed Combination ◽  
Blood Pressure Level ◽  
Outpatient Setting ◽  
Left Ventricular ◽  
Pressure Level ◽  
Target Blood Pressure ◽  
Outpatient Basis ◽  
Observation Period

Presents a case of treating hypertension stage II, 2 nd degree, risk 3 (high) in a patient of 54 years on an outpatient basis. For antihypertensive therapy was chosen fixed combination of quinapril 20 mg + hydrochlorothiazide 12.5 mg (Akkuzid) 1 times a day. Assigned therapy has several solutions to achieve the urgent tasks: to reach target blood pressure (BP) during the entire two weeks, to maintain the target blood pressure level throughout the observation period (24 weeks) to achieve regression of left ventricular hypertrophy. Effectiveness of prescribed therapy served as the main reason for high patient complains of treatment.

scholarly journals The Copenhagen chronic kidney disease echo study (COInCYDE)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Landler ◽  
S Bro ◽  
B Feldt-Rasmussen ◽  
D Hansen ◽  
A.L Kamper ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Cardiac Function ◽  
Left Ventricular ◽  
Funding Source ◽  
Ckd Stage ◽  
Significant Difference ◽  
Stage 1

Abstract Background The cardiovascular mortality of patients with chronic kidney disease (CKD) is 2–10 times higher than in the average population. Purpose To estimate the prevalence of abnormal cardiac function or structure across the stages CKD 1 to 5nonD. Method Prospective cohort study. Patients with CKD stage 1 to 5 not on dialysis, aged 30 to 75 (n=875) and age-/sex-matched controls (n=173) were enrolled consecutively. All participants underwent a health questionnaire, ECG, morphometric and blood pressure measurements. Blood and urine were analyzed. Echocardiography was performed. Left ventricle (LV) hypertrophy, dilatation, diastolic and systolic dysfunction were defined according to current ESC guidelines. Results 63% of participants were men. Mean age was 58 years (SD 12.6 years). Mean eGFR was 46.7 mL/min/1,73 m (SD 25.8) for patients and 82.3 mL/min/1,73 m (SD 13.4) for controls. The prevalence of elevated blood pressure at physical exam was 89% in patients vs. 53% in controls. Patients were more often smokers and obese. Left ventricular mass index (LVMI) was slightly, albeit insignificantly elevated at CKD stages 1 & 2 vs. in kontrols: 3.1 g/m2, CI: −0.4 to 6.75, p-value 0.08. There was no significant difference in LV-dilatation between patients and controls. Decreasing diastolic and systolic function was observed at CKD stage 3a and later: LVEF decreased 0.95% (CI: −1.5 to −0.2), GLS increased 0.5 (CI: 0.3 to 0.8), and OR for diastolic dysfunction increased 3.2 (CI 1.4 to 7.3) pr. increment CKD stage group. Conclusion In accordance to previous studies, we observe in the CPHCKD cohort study signs of early increase of LVMI in patients with CKD stage 1 & 2. Significant decline in systolic and diastolic cardiac function is apparent already at stage 3 CKD. Figure 1. Estimated GFR vs. GLS & histogram of GLS Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): The Capital Region of Denmark

scholarly journals Association between Protein-Bound Uremic Toxins and Asymptomatic Cardiac Dysfunction in Patients with Chronic Kidney Disease

Toxins ◽  
2018 ◽  
Vol 10 (12) ◽  
pp. 520 ◽  
Author(s):  
Shanmugakumar Chinnappa ◽  
Yu-Kang Tu ◽  
Yi Chun Yeh ◽  
Griet Glorieux ◽  
Raymond Vanholder ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cardiac Dysfunction ◽  
Serum Levels ◽  
Significant Negative Correlation ◽  
Cross Sectional Study ◽  
Left Ventricular ◽  
Uremic Toxins ◽  
Cross Sectional ◽  
The Individual

Although the relationship between protein-bound uremic toxins (PBUTs) and cardiac structure and cardiac mortality in chronic kidney disease (CKD) has been studied in the past, the association between cardiac dysfunction and PBUTs has not yet been studied. We therefore evaluated the association between impaired peak cardiac performance and the serum free and total concentrations of potentially cardiotoxic PBUTs. In a cross-sectional study of 56 male CKD patients (stages 2–5 (pre-dialysis)) who were asymptomatic with no known cardiac diseases or diabetes we measured peak cardiac power (CPOmax), aerobic exercise capacity (VO2max), and echocardiographic parameters of cardiac morphology and evaluated their association with PBUTs. The serum total and free concentrations of indoxyl sulfate (IXS), p-cresyl sulfate (PCS), p-cresyl glucuronide, indole acetic acid, and hippuric acid showed significant negative correlation with CPOmax and VO2max. IXS and PCS were independently associated with CPOmax and VO2max even after controlling for eGFR. No correlation between left ventricular mass index (LVMI) and PBUTs was seen. The present study for the first time has demonstrated the association between subclinical cardiac dysfunction in CKD and serum levels of a panel of PBUTs. Further studies are required to evaluate the mechanism of cardiotoxicity of the individual uremic toxins.

scholarly journals Association of Blood Pressure Level With Left Ventricular Mass in Adolescents

Hypertension ◽  
2019 ◽  
Vol 74 (3) ◽  
pp. 590-596 ◽  
Author(s):  
Elaine M. Urbina ◽  
Brenda Mendizábal ◽  
Richard C. Becker ◽  
Steve R. Daniels ◽  
Bonita E. Falkner ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Left Ventricular Mass ◽  
Blood Pressure Level ◽  
Left Ventricular ◽  
Pressure Level ◽  
Ventricular Mass

scholarly journals Achievement of target blood pressure in patients with arterial hypertension on the background of antihypertensive therapy in real clinical practice

2018 ◽  
pp. 100-109 ◽  
Author(s):  
S. V. Nedogoda ◽  
A. V. Sabanov
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Antihypertensive Therapy ◽  
Blood Pressure Level ◽  
Pressure Level ◽  
Target Blood Pressure ◽  
Angiotensin Receptors ◽  
Target Value ◽  
Target Values ◽  
Comorbid Diseases

Aim. To evaluate the features of pharmacotherapy in achieving different levels of target blood pressure (BP) in patients with arterial hypertension (AH) with the absence or presence of comorbid diseases in real outpatient practice.Material and methods. At the open multicenter observational study, outpatient physicians filled original patient questionnaires, which reflected the demographic data of patients, the presence of comorbid diseases and conditions prescribed antihypertensive drugs and achieved during treatment with their use levels of systolic (SBP) and diastolic (DBP) blood pressure (BP), body mass index (BMI), creatinine and blood glucose levels, as well as information about smoking. The obtained data were stratified into groups depending by the level of blood pressure achieved in patients during the therapy, as well as depending on the existing comorbid diseases. Estimated rate of prescription of antihypertensive agents, the number of components of therapy, the number assigned to tableted dosage forms (tablets). We also evaluated the frequency assignments of fixed combinations (FC). Results. The study included data from 2073 patients. They were divided into six groups according to the level of BP achieved. The groups were comparable by demographic and anthropometric characteristics, as well as in gender representation. In patients of the first group on the background of therapy were achieved the lowest values of blood pressure — 120­129/<80 mm Hg. art. They were less likely than other groups to detect comorbid diseases, less frequently prescribed thiazide/thiazide­like diuretics (TD), and FC were prescribed in 33,8%. In patients of the second group the blood pressure level was 130­139/<80 mm Hg. art., the duration of hypertension was the smallest, they were most often prescribed angiotensin II receptor blockers (ARBS) and so on, and the share of FC was the maximum among the compared groups — 42,3%. In the third group, the blood pressure level was 120­139/80­89 mm Hg. St. These patients are most often prescribed angiotensin converting enzyme inhibitors (ACEi), but rarely angiotensin receptors blockers (ARB), frequency assignments of FC — 37,8%. The level of blood pressure in patients of the fourth group who did not achieved the target value of SBP (≥140 mm Hg), in the fifth group — the target value of DBP (>90 mm Hg), and in the sixth group — the target values of SBP (≥140/>90 mm Hg. art.). Their share in the total sample was 19,9%, 4,1%, and 41,2%, respectively. Patients from these groups were more likely to have comorbid diseases, they were more often prescribed four or more components of therapy. BP level <130/<80 mm Hg in patients with type 2 diabetes mellitus (DM 2) was achieved in 4,2%, in patients with coronary heart disease (CHD) in 8,3%. In these groups, a high frequency of beta­blockers (BB) was noted. Patients with chronic kidney disease (CKD) had blood pressure levels of 130139/<80 mm Hg was 7,9%. Among patients with stroke/transient ischemic attack (TIA) blood pressure 120­129/<80 mm Hg was achieved in 2%. In the general sample of patients, one component of antihypertensive therapy was prescribed in 5,8%, two — in 48,3%, three — in 34,7%, four or more — in 11,2%.Conclusion. Target blood pressure <140/90 mm Hg was achieved at 34,8%, and the level of blood pressure <130/80 mm Hg — only at 11,5% of patients. In these patients, comorbid diseases were less often observed, from hypotensive drugs, ACEI, BB or TD were most often used, the predominant appointment of twocomponent antihypertensive therapy was noted, which was most often presented in the form of two tablets. In patients with comorbid diseases revealed a very low proportion of achieving the target level of blood pressure: with DM 2 — 4,2%, with CKD — 7,9%, with IHD — 8,3%, with stroke/TIA — 2%. Among the patients of the whole sample, two­ and three­component antihypertensive therapy was most often prescribed (48,3% and 34,7%, respectively). A greater number of antihypertensive components were prescribed to patients with several comorbid diseases, and, consequently, with a more severe course of hypertension. 

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