Arterial hypertension in patients with diabetic nephropathy

Šećerna bolest najčešći je uzrok kroničnog bubrežnog zatajenja u svijetu. Dijabetička nefropatija je bolest koju karakteriziraju perzistentna proteinurija, pad glomerularne filtracije (GF), povišenje krvnog tlaka i progresija u završnoj fazi zatajenja bubrega. Hipertenzija je česta kod bolesnika s kroničnom bolesti bubrega (KBB) i šećerne bolesti. U ovoj populaciji hipertenzija povećava rizik za nastanak bolesti bubrega i napredovanja i kardiovaskularnog (KV) morbiditeta i mortaliteta. Dijabetička nefropatija (DN) je najčešći uzrok KBB u onih s dijabetesom. Mehanizam hipertenzije dijabetičke nefropatije je složen, nedovoljno razjašnjen, a uključuje višak zadržavanja natrija, simpatički živčani sustav (SNS) i aktivaciju renin-angiotenzin-aldosteron (RAAS) sistema, disfunkciju endotelnih stanica. Ti mehanizmi su odgovorni za nastanak i pogoršanje hipertenzije u ovoj populaciji i doprinijeli su povećanom riziku za nepovoljni KV ishod. Trenutno upravljanje hipertenzije kod dijabetičke nefropatije treba uključivati terapije koje blokiraju proizvodnju angiotenzina ili akciju i ciljeva liječenja krvnog tlaka s tim lijekova trebaju biti usmjereni na krvni tlak < 130/80 mmHg. Važno postizanje tog cilja će biti potrebno korištenje obje nefarmakološke intervencije u kombinaciji s više antihipertenzivnih lijekova. Nedavne studije istražuju korištenje kombiniranih terapija koje koriste više od jednog RAAS lijeka, te formalne preporuke čekaju svoje rezultate.Diabetes mellitus is the most common cause of chronic renal failure in the world. Diabetic nephropathy is a disease characterized by persistent proteinuria, decreased glomerular filtration rate (GF), blood pressure and progression to the final stage of kidney failure. Hypertension is common in patients with chronic kidney disease (CKD) and diabetes. In this population, hypertension increases the risk of kidney disease and progression of cardiovascular (CV) morbidity and mortality. Diabetic nephropathy (DN) is the most common cause of CKD in patients with diabetes. The mechanism of hypertension, diabetic nephropathy is complex and insufficiently understood, and includes the excess sodium retention, sympathetic nervous system (SNS) and the activation of Irene - angiotensin - aldosterone system (RAAS) system, dysfunction of the endothelium - muscle cells. These mechanisms are responsible for the development and aggravation of hypertension in this population and have contributed to the increased risk of adverse CV outcome. Current management of hypertension in diabetic nephropathy should include therapies that block the production or action of angiotensin and blood pressure treatment goals with these drugs should be focused on blood pressure < 130/80 mmHg. Important to the achievement of this goal will be necessary to use both non - pharmacological intervention in combination with more antihypertensive drugs. Recent studies investigating the use of combination therapy using more than one drug RAAS, and formal recommendations await their results

Arterial hypertension in patients with diabetic nephropathy

Šećerna bolest najčešći je uzrok kroničnog bubrežnog zatajenja u svijetu. Dijabetička nefropatija je bolest koju karakteriziraju perzistentna proteinurija, pad glomerularne filtracije (GF), povišenje krvnog tlaka i progresija u završnoj fazi zatajenja bubrega. Hipertenzija je česta kod bolesnika s kroničnom bolesti bubrega (KBB) i šećerne bolesti. U ovoj populaciji hipertenzija povećava rizik za nastanak bolesti bubrega i napredovanja i kardiovaskularnog (KV) morbiditeta i mortaliteta. Dijabetička nefropatija (DN) je najčešći uzrok KBB u onih s dijabetesom. Mehanizam hipertenzije dijabetičke nefropatije je složen, nedovoljno razjašnjen, a uključuje višak zadržavanja natrija, simpatički živčani sustav (SNS) i aktivaciju renin-angiotenzin-aldosteron (RAAS) sistema, disfunkciju endotelnih stanica. Ti mehanizmi su odgovorni za nastanak i pogoršanje hipertenzije u ovoj populaciji i doprinijeli su povećanom riziku za nepovoljni KV ishod. Trenutno upravljanje hipertenzije kod dijabetičke nefropatije treba uključivati terapije koje blokiraju proizvodnju angiotenzina ili akciju i ciljeva liječenja krvnog tlaka s tim lijekova trebaju biti usmjereni na krvni tlak < 130/80 mmHg. Važno postizanje tog cilja će biti potrebno korištenje obje nefarmakološke intervencije u kombinaciji s više antihipertenzivnih lijekova. Nedavne studije istražuju korištenje kombiniranih terapija koje koriste više od jednog RAAS lijeka, te formalne preporuke čekaju svoje rezultate.Diabetes mellitus is the most common cause of chronic renal failure in the world. Diabetic nephropathy is a disease characterized by persistent proteinuria, decreased glomerular filtration rate (GF), blood pressure and progression to the final stage of kidney failure. Hypertension is common in patients with chronic kidney disease (CKD) and diabetes. In this population, hypertension increases the risk of kidney disease and progression of cardiovascular (CV) morbidity and mortality. Diabetic nephropathy (DN) is the most common cause of CKD in patients with diabetes. The mechanism of hypertension, diabetic nephropathy is complex and insufficiently understood, and includes the excess sodium retention, sympathetic nervous system (SNS) and the activation of Irene - angiotensin - aldosterone system (RAAS) system, dysfunction of the endothelium - muscle cells. These mechanisms are responsible for the development and aggravation of hypertension in this population and have contributed to the increased risk of adverse CV outcome. Current management of hypertension in diabetic nephropathy should include therapies that block the production or action of angiotensin and blood pressure treatment goals with these drugs should be focused on blood pressure < 130/80 mmHg. Important to the achievement of this goal will be necessary to use both non - pharmacological intervention in combination with more antihypertensive drugs. Recent studies investigating the use of combination therapy using more than one drug RAAS, and formal recommendations await their results

Epidemiological characteristics, baseline clinical features, and outcomes of critically ill patients treated in a coronavirus disease 2019 tertiary center in continental Croatia

Aim To describe epidemiological characteristics and base - line clinical features, laboratory findings at intensive care unit (ICU) admission, and survival rates of critically ill coro - navirus disease 2019 (COVID-19) patients treated at a ter - tiary institution specialized for COVID-19 patients. Methods This retrospective study recruited 692 patients (67.1% men). Baseline demographic data, major comorbid - ities, anthropometric measurements, clinical features, and laboratory findings at admission were compared between survivors and non-survivors. Results The median age was 72 (64-78) years. The median body mass index was 29.1 kg/m 2 . The most relevant comor - bidities were diabetes mellitus (32.6%), arterial hyperten - sion (71.2%), congestive heart failure (19.1%), chronic kid - ney disease (12.6%), and hematological disorders (10.3%). The median number of comorbidities was 3 and median Charlson Comorbidity Index (CCI) was 5. A total of 61.8% patients received high-flow nasal oxygen therapy (HFNO) and 80.5% received mechanical ventilation (MV). Median duration of HFNO was 3, and that of MV was 7 days. ICU mortality rate was 72.7%. Survivors had significantly lower age, number of comorbidities, CCI, sequential organ failure assessment score, serum ferritin, C-reactive protein, D-dim - er, and procalcitonin, interleukin-6, lactate, white blood cell, and neutrophil counts. They also had higher lymphocyte counts, Pa O 2 /FiO 2 ratio, and glomerular filtration rate at ad - mission. Length of ICU stay was 9 days. The median surviv - al was 11 days for mechanically ventilated patients, and 24 days for patients who were not mechanically ventilated. Conclusion The parameters that differentiate survivors from non-survivors are in agreement with published data. Further multivariate analyses are warranted to identify in - dividual mortality risk factor

Bacterial superinfections in critically ill COVID-19 patients – experiences from University Hospital Dubrava tertiary COVID-19 center

Cilj istraživanja: Utvrditi incidenciju najčešćih bakterijskih superinfekcija, distribuciju uzročnika ovisno o sijelu infekcije, demografske podatke, relevantne laboratorijske i kliničke parametre te ishode liječenja kritično oboljelih bolesnika liječenih u tercijarnom regionalnom centru specijaliziranom za liječenje COVID-19 bolesnika PRIC KB Dubrava. Ispitanici i metode: Provedeno je retrospektivno opservacijsko ispitivanje te su podaci skupljeni pregledom povijesti bolesti u bolničkom informacijskom sustavu (BIS, In2, Zagreb) pacijenata liječenih u jedinicama intenzivne medicine PRIC-IC KB Dubrava tijekom razdoblja od 01. ožujka 2020. do 01. veljače 2021. Skupljeni podaci analizirani su u statističkom programskom paketu jamovi. Rezultati: Od ukupno 692 pacijenta, 383 je razvilo bakterijsku ili gljivičnu superinfekciju. Njih 305 je razvilo pneumoniju, 133 bakterijemiju a 120 urinarnu infekciju. 66,3% pacijenata bilo je muškog spola, te su češće primani sa bolničkih odjela i JIM-ova drugih bolnica. Od 305 pacijenata sa pneumonijom 295 je bilo mehanički ventilirano te je razvilo VAP. Kod pacijenata koji nisu razvili bakterijemiju primjećen je porat omjera neutrofili leukociti, te limfopenija i pad vrijednosti CRP-a. Urinarna infekcija češća je kod žena. U sve tri skupine, pacijenti su imali produljen period boravka u JIM-u i u bolnici. Zaključci: Incidencija bakterijskih superinfekcija u kritično oboljelih COVID-19 pacijenata vrlo je visoka i iznosi 55,3%. Najčešće bakterijske superinfekcije su VAP, bakterijemija i urinarna infekcija. Najčešći uzročni patogeni su MDR bakterije. Pacijenti sa sekundarnom infekcijom imaju dulji period boravka u JIM. Povećanje omjera neutrofili / limfociti i progresija limfopenije povezane su sa nepovoljnim kliničkim ishodima.Goal: To determine incidence of bacterial superinfections, causative pathogens demographic data, relevant laboratory parameters and outcomes in critically ill COVID-19 patients treated in primary respiratory intensivist center (PRIC) UH Dubrava. Patients and methods: In this retrospective observational study, clinical and laboratory data of 692 critically ill patients treated in PRIC UH Dubrava between March 1st 2020. and February 1st 2021. was collected using the hospital information system software (BIS) and statistical analysis was performed using the jamovi statistical package. Results: Out of 692 patients admitted to the ICU, 383 acquired bacterial or fungal superinfections. 305 acquired pneumonia, 133 bloodstream infections and 120 urinary infections. 66.3% of patients were males, and bacterial superinfections were more common in patients admitted from hospital wards or external ICUs. Out of 305 patients with pneumonia, 295 were receiving mechanical ventilation and satisfied the criteria for ventilator associated pneumonia. Patients with bloodstream infections maintained elevated neutrophil lymphocyte ratio, lymphopenia and elevated CRP levels on day 7 compared to those without BSI. Urinary infections were more common in females, and did not have an effect on outcomes. All patients that developed superinfections had prolonged ICU and hospital stay. Conclusion: Incidence of bacterial superinfections in critically ill COVID-19 patients is 55.3%. Most common infections are ventilator associated pneumonia, bloodstream infections and urinary infections. Most common pathogens are multi-drug resistant pathogens. Patients with bacterial superinfections have longer ICU and hospital stay, and in these patients, persistent elevation of NLR ratio and worsening of lymphopenia are characteristic for patients with worse outcomes

Arterial hypertension in patients with diabetic nephropathy

Šećerna bolest najčešći je uzrok kroničnog bubrežnog zatajenja u svijetu. Dijabetička nefropatija je bolest koju karakteriziraju perzistentna proteinurija, pad glomerularne filtracije (GF), povišenje krvnog tlaka i progresija u završnoj fazi zatajenja bubrega. Hipertenzija je česta kod bolesnika s kroničnom bolesti bubrega (KBB) i šećerne bolesti. U ovoj populaciji hipertenzija povećava rizik za nastanak bolesti bubrega i napredovanja i kardiovaskularnog (KV) morbiditeta i mortaliteta. Dijabetička nefropatija (DN) je najčešći uzrok KBB u onih s dijabetesom. Mehanizam hipertenzije dijabetičke nefropatije je složen, nedovoljno razjašnjen, a uključuje višak zadržavanja natrija, simpatički živčani sustav (SNS) i aktivaciju renin-angiotenzin-aldosteron (RAAS) sistema, disfunkciju endotelnih stanica. Ti mehanizmi su odgovorni za nastanak i pogoršanje hipertenzije u ovoj populaciji i doprinijeli su povećanom riziku za nepovoljni KV ishod. Trenutno upravljanje hipertenzije kod dijabetičke nefropatije treba uključivati terapije koje blokiraju proizvodnju angiotenzina ili akciju i ciljeva liječenja krvnog tlaka s tim lijekova trebaju biti usmjereni na krvni tlak < 130/80 mmHg. Važno postizanje tog cilja će biti potrebno korištenje obje nefarmakološke intervencije u kombinaciji s više antihipertenzivnih lijekova. Nedavne studije istražuju korištenje kombiniranih terapija koje koriste više od jednog RAAS lijeka, te formalne preporuke čekaju svoje rezultate.Diabetes mellitus is the most common cause of chronic renal failure in the world. Diabetic nephropathy is a disease characterized by persistent proteinuria, decreased glomerular filtration rate (GF), blood pressure and progression to the final stage of kidney failure. Hypertension is common in patients with chronic kidney disease (CKD) and diabetes. In this population, hypertension increases the risk of kidney disease and progression of cardiovascular (CV) morbidity and mortality. Diabetic nephropathy (DN) is the most common cause of CKD in patients with diabetes. The mechanism of hypertension, diabetic nephropathy is complex and insufficiently understood, and includes the excess sodium retention, sympathetic nervous system (SNS) and the activation of Irene - angiotensin - aldosterone system (RAAS) system, dysfunction of the endothelium - muscle cells. These mechanisms are responsible for the development and aggravation of hypertension in this population and have contributed to the increased risk of adverse CV outcome. Current management of hypertension in diabetic nephropathy should include therapies that block the production or action of angiotensin and blood pressure treatment goals with these drugs should be focused on blood pressure < 130/80 mmHg. Important to the achievement of this goal will be necessary to use both non - pharmacological intervention in combination with more antihypertensive drugs. Recent studies investigating the use of combination therapy using more than one drug RAAS, and formal recommendations await their results

Epidemiological characteristics, baseline clinical features, and outcomes of critically ill patients treated in a coronavirus disease 2019 tertiary center in continental Croatia

Aim: To describe epidemiological characteristics and baseline clinical features, laboratory findings at intensive care unit (ICU) admission, and survival rates of critically ill coronavirus disease 2019 (COVID-19) patients treated at a tertiary institution specialized for COVID-19 patients. ----- Methods: This retrospective study recruited 692 patients (67.1% men). Baseline demographic data, major comorbidities, anthropometric measurements, clinical features, and laboratory findings at admission were compared between survivors and non-survivors. ----- Results: The median age was 72 (64-78) years. The median body mass index was 29.1 kg/m2. The most relevant comorbidities were diabetes mellitus (32.6%), arterial hypertension (71.2%), congestive heart failure (19.1%), chronic kidney disease (12.6%), and hematological disorders (10.3%). The median number of comorbidities was 3 and median Charlson Comorbidity Index (CCI) was 5. A total of 61.8% patients received high-flow nasal oxygen therapy (HFNO) and 80.5% received mechanical ventilation (MV). Median duration of HFNO was 3, and that of MV was 7 days. ICU mortality rate was 72.7%. Survivors had significantly lower age, number of comorbidities, CCI, sequential organ failure assessment score, serum ferritin, C-reactive protein, D-dimer, and procalcitonin, interleukin-6, lactate, white blood cell, and neutrophil counts. They also had higher lymphocyte counts, PaO2/FiO2 ratio, and glomerular filtration rate at admission. Length of ICU stay was 9 days. The median survival was 11 days for mechanically ventilated patients, and 24 days for patients who were not mechanically ventilated. ----- Conclusion: The parameters that differentiate survivors from non-survivors are in agreement with published data. Further multivariate analyses are warranted to identify individual mortality risk factors

Distribution of Pathogens and Predictive Values of Biomarkers of Inflammatory Response at ICU Admission on Outcomes of Critically Ill COVID-19 Patients with Bacterial Superinfections—Observations from National COVID-19 Hospital in Croatia

Background: Superinfections contribute to mortality and length of stay in critically ill COVID-19 patients. The aim of this study was to determine the incidence and pathogen distribution of bacterial and fungal superinfections of the lower respiratory tract (LRTI), urinary tract (UTI) and bloodstream (BSI) and to determine the predictive value of biomarkers of inflammatory response on their ICU survival rates. Methods: A retrospective observational study that included critically ill COVID-19 patients treated during an 11-month period in a Croatian national COVID-19 hospital was performed. Clinical and diagnostic data were analyzed according to the origin of superinfection, and multivariate regression analysis was performed to determine the predictive values of biomarkers of inflammation on their survival rates. Results: 55.3% critically ill COVID-19 patients developed bacterial or fungal superinfections, and LRTI were most common, followed by BSI and UTI. Multidrug-resistant pathogens were the most common causes of LRTI and BSI, while Enterococcus faecalis was the most common pathogen causing UTI. Serum ferritin and neutrophil count were associated with decreased chances of survival in patients with LRTI, and patients with multidrug-resistant isolates had significantly higher mortality rates, coupled with longer ICU stays. Conclusion: The incidence of superinfections in critically ill COVID-19 patients was 55.3%, and multidrug-resistant pathogens were dominant. Elevated ferritin levels and neutrophilia at ICU admission were associated with increased ICU mortality in patients with positive LRTI