Hip fractures in end-stage renal disease patients: incidence, risk factors, and prevention.

Hip fractures are an important problem for end-stage renal disease (ESRD) patients treated with dialysis. The incidence of hip fractures in the dialysis population is approximately four times that of the general population. Even more concerning is the associated 1 year mortality, which is twice that of other dialysis patients.

Reliability of a noninvasive device to measure systemic hemodynamics in hemodialysis patients.

Objective: To evaluate the reliability of a noninvasive hemodynamic monitor in hemodialysis patients.

Methods: We enrolled 15 male patients (mean age 63+/-12 years) on stable chronic hemodialysis. Blood pressure and hemodynamic readings were obtained with the Dynapulse 500 Guardian device (Pulsemetric Inc.

The role of aldosterone blockers in the management of chronic heart failure.

The neurohormonal model of congestive heart failure (CHF) has replaced the previously accepted hemodynamic model. A shift in this paradigm has allowed alterations in therapy of CHF such that agents that target the neurohormonal axis and specifically the renin-angiotensin-aldosterone system, with drugs such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and beta-blockers, are utilized. Employment of these drugs markedly improves survival in patients with CHF.

Drug-induced nephropathy: an update.

Medications cause renal disease by promoting various types of injury in the kidney. Several drugs reduce renal perfusion and cause prerenal azotemia. Vascular disease can develop following exposure to various medications through direct and indirect effects.

Adverse cardiorenal effects of aldosterone: is aldosterone antagonism beneficial?

Aldosterone has recently been recognized as an important factor in the development and progression of cardiorenal disease. Animal and human data suggest that aldosterone contributes importantly to several disease states. These include congestive heart failure, coronary heart disease and progression of kidney disease.

Effect of intravenous iron on haemodialysis catheter microbial colonization and blood-borne infection.

Background: Intravenous (i.v.) iron is employed to treat absolute and relative iron deficiency in end-stage renal disease patients.

Calcific uremic arteriolopathy in a transplanted kidney.

Calcific uremic arteriolopathy is a severe and life-threatening condition that develops in patients with kidney disease. Most commonly, it presents with skin rash and painful subcutaneous nodules. However, other organs may be involved.

The cardiovascular implications of hypokalemia.

The role of potassium in the progression of cardiovascular disease is complex and controversial. Animal and human data suggest that increases in dietary potassium, decreases in urinary potassium loss, or increases in serum potassium levels through other mechanisms have benefits in several disease states. These include the treatment of hypertension, stroke prevention, arrhythmia prevention, and treatment of congestive heart failure.

Percutaneous balloon cryoplasty: a new therapy for rapidly recurrent anastomotic venous stenoses of hemodialysis grafts?

Vascular access dysfunction is a major source of morbidity for end-stage renal disease patients on hemodialysis. The arteriovenous graft is a common access type for many of these patients. Frequent stenosis formation and thrombosis complicate this form of access.

Drug-induced renal failure: a focus on tubulointerstitial disease.

Therapeutic agents induce acute renal failure (ARF) by promoting various types of injury to the kidney. Acute interstitial nephritis (AIN) develops from medications that incite an allergic reaction, leading to interstitial inflammation and tubular damage. Acute tubular necrosis (ATN) is a dose-dependent process that develops from direct toxicity on tubular epithelia, typically in the absence of inflammation.

Acute interstitial nephritis associated with atazanavir, a new protease inhibitor.

Atazanavir is a new human immunodeficiency virus 1 protease inhibitor that has a favorable side-effect profile and is available in once-daily dosing. We report the case of a young man with human immunodeficiency virus infection who developed acute renal failure after therapy with this drug. Renal biopsy showed acute interstitial nephritis.

A review of chronic lead intoxication: an unrecognized cause of chronic kidney disease.

Chronic lead nephropathy occurs as a result of years of lead exposure. This disease has been prevalent throughout human history. It is important that primary care providers and internists recognize this disorder because it can contribute to progressive loss of kidney function.

Addition of sertraline to other therapies to reduce dialysis-associated hypotension.

Sertraline has shown promise in the treatment of dialysis-associated hypotension (DAH) in a limited number of end-stage renal disease patients. We undertook a study to evaluate the effect of adding sertraline to other therapies for patients with documented DAH. We also measured the effect of sertraline on intradialytic haemodynamics.

The renin-angiotensin-aldosterone system and the kidney: effects on kidney disease.

The renin-angiotensin-aldosterone system regulates renal vasomotor activity, maintains optimal salt and water homeostasis, and controls tissue growth in the kidney. However, pathologic consequences can result from overactivity of this cascade, involving it in the pathophysiology of kidney disease. An activated renin-angiotensin-aldosterone system promotes both systemic and glomerular capillary hypertension, which can induce hemodynamic injury to the vascular endothelium and glomerulus.

Intradialytic administration of amphotericin B: clinical observations on efficacy and safety.

Background: Amphotericin B is used commonly to treat fungal infections. Unfortunately, little information exists regarding the use of intravenous amphotericin B in patients with end-stage renal disease (ESRD).

Methods: We retrospectively reviewed the clinical course of patients receiving amphotericin B during hemodialysis (HD).

Intravenous iron and the risk of infection in end-stage renal disease patients.

Oral iron is typically insufficient for the iron deficiency of hemodialysis patients. Intravenous (IV) iron is well tolerated by most patients and non-dextran-containing iron preparations are associated with few allergic reactions. However, there is the potential for an increased risk of infection with IV iron that appears to increase bacterial growth as well as inhibit the host's innate immune response to bacterial infection.

Can dual blockade of the renin-angiotensin system reduce progression of kidney disease beyond monotherapy?

It is well-accepted that therapies directed at the renin-angiotensin system (RAS) reduce the progression of chronic kidney disease. Angiotensin-converting enzyme (ACE) inhibitors and the angiotensin receptor blockers (ARBs) are currently available to interrupt this cascade. Their positive actions result from better blood pressure control, a reduction in glomerular capillary pressure and a decrease in proteinuria.

Vascular access surveillance: evaluation of combining dynamic venous pressure and vascular access blood flow measurements.

Background/aims: Vascular access thrombosis is one of the most morbid problems encountered by hemodialysis patients. Surveillance protocols utilizing venous pressure (Vp) and vascular access blood flow (VABF) measurements have been employed to preserve vascular access. We undertook a study to evaluate combined dynamic Vp and VABF measurements in the identification of vascular access impairment.

COX-2 selective inhibitors: analysis of the renal effects.

COX-2 selective inhibitors provide analgesia and blunt inflammation while also sparing the gastrointestinal tract from classic NSAID toxicity. Therapeutic effects are thought to result from inhibition of the inflammatory COX-2 isoform. Organ sparing is considered the result of preservation of homeostatic COX-1 enzyme function.

Efficacy and safety of midodrine in the treatment of dialysis-associated hypotension.

Dialysis-associated hypotension is a morbid problem in haemodialysis patients. Employment of midodrine at the start of dialysis has reduced the severity and frequency of hypotensive episodes in these patients. Through selective alpha(1)-adrenergic receptor-binding, desglymidodrine, the active metabolite of midodrine, raises blood pressure by enhancing venous and arterial tone.

The renin-angiotensin-aldosterone system: cardiorenal effects and implications for renal and cardiovascular disease states.

The renin-angiotensin-aldosterone system (RAAS) plays an integral role in maintaining vascular tone, optimal salt and water homeostasis, and cardiac function in humans. However, it has been recognized in recent years that pathologic consequences may also result from overactivity of the RAAS. Clinical disease states such as renal artery stenosis, hypertension, diabetic and nondiabetic nephropathies, left ventricular hypertrophy, coronary atherosclerosis, myocardial infarction, and congestive heart failure (CHF) are examples.