Chronic kidney disease prevalence and ambulatory blood pressure profile in healthy HIV positive subjects pre and post anti-retroviral therapy

Introduction: Few studies have been done in South Africa to establish the extent of chronic kidney disease (CKD) in stable outpatients infected with the human immunodeficiency virus (HIV). Both HIV and the anteretroviral therapy (ART) used to treat HIV have been associated with abnormal metabolic profile, increased cardiovascular risk and renal disease1,2,3. Hypertension has been found to be common in HIV infected individuals, in European and American cohorts, with a prevalence ranging from 13- 34%2. Nocturnal blood pressure (BP) is superior to daytime or office BP as a predictor of cardiovascular disease4. However, the relationship between circadian BP patterns, measured via ambulatory blood pressure (ABP) monitoring, and HIV has never been documented in the South African HIV infected population. Individuals with an abnormal diurnal rhythm and a blunted nocturnal decline in systolic BP (SBP), i.e. ≤ 10%, are referred to as 'non- dippers' and have the highest risk of cardiovascular complications4. HIV itself has been associated with a non- dipping status and may play a role in the HIV related increase in cardiovascular risk5

Diffuse infiltrative lymphocytosis syndrome presenting as renal failure in South African HIV-positive individuals: a single-centre case series

Diffuse infiltrative lymphocytosis syndrome (DILS) in human immunodeficiency virus (HIV) infection presented most commonly with parotidomegaly and sicca symptoms in the pre-antiretroviral era. However, numerous clinical manifestations are possible due to the multi-organ nature of the CD8+ lymphocytic infiltration. Renal involvement is infrequently described, but common characteristics of a renal syndrome associated with DILS have been identified. This case series describes four South African HIV-positive patients with DILS, in whom renal failure was the sole clinical manifestation. As DILS responds well to antiretroviral and corticosteroid therapy, this series highlights the importance of considering this syndrome as a cause of renal failure in an HIV-positive patient

The Effects of Angiotensin Converting Enzyme Inhibitors (ACE-I) on Human N-Acetyl-Seryl-Aspartyl-Lysyl-Proline (Ac-SDKP) Levels: A Systematic Review and Meta-Analysis

BACKGROUND: Tuberculous pericardial effusion is a pro-fibrotic condition that is complicated by constrictive pericarditis in 4% to 8% of cases. N-acetyl-seryl-aspartyl-lysyl-proline (Ac-SDKP) is a ubiquitous tetrapeptide with anti-fibrotic properties that is low in tuberculous pericardial effusion, thus providing a potential mechanism for the heightened fibrotic state. Angiotensin-converting enzyme inhibitors (ACE-I), which increase Ac-SDKP levels with anti-fibrotic effects in animal models, are candidate drugs for preventing constrictive pericarditis if they can be shown to have similar effects on Ac-SDKP and fibrosis in human tissues. Objective To systematically review the effects of ACE-Is on Ac-SDKP levels in human tissues. METHODS: We searched five electronic databases (1996 to 2014) and conference abstracts with no language restrictions. Two reviewers independently selected studies, extracted data and assessed methodological quality. The protocol was registered in PROSPERO. RESULTS: Four studies with a total of 206 participants met the inclusion criteria. Three studies (106 participants) assessed the change in plasma levels of Ac-SDKP following ACE-I administration in healthy humans. The administration of an ACE-I was associated with an increase in Ac-SDKP levels (mean difference (MD) 5.07 pmol/ml (95% confidence intervals (CI) 0.64 pmol/ml to 9.51 pmol/ml)). Two studies with 100 participants further assessed the change in Ac-SDKP level in humans with renal failure using ACE-I. The administration of an ACE-I was associated with a significant increase in Ac-SDKP levels (MD 8.94 pmol/ml; 95% CI 2.55 to 15.33; I 2 = 44%). CONCLUSION: ACE-I increased Ac-SDKP levels in human plasma. These findings provide the rationale for testing the impact of ACE-I on Ac-SDKP levels and fibrosis in tuberculous pericarditis

A Current State of the Art and Science of Exercise in Dialysis: A Narrative Review

Purpose of the review: The purpose of the review is to discuss current proven benefits and problems of integrating exercise in the care of people receiving dialysis by reviewing literature from the last few years and identifying important questions that still need to be asked and answered. Methods: A focused review and appraisal of the literature were done. Original peer-reviewed articles, review articles, opinion pieces and guidelines were identified from PubMed and Google Scholar databases. Only sources in English were accessed. Search terms “exercise” and “dialysis” were used to find active recruiting randomized trials in various clinical trial registry platforms. Key findings: Numerous studies have demonstrated the benefits of exercise training in individuals receiving dialysis, limited by factors such as short duration of follow-up and inconsistent adverse event reporting and outcomes selected. Notable gaps in exercise research in dialysis include ways to maintain programs and patient motivation, studies in peritoneal dialysis and home hemodialysis patients, and how best to define and measure outcomes of interest. Implications: This review summarizes the current state of exercise in people receiving dialysis and serves as a call to action to conduct large, randomized controlled trials to improve the quality of evidence needed to implement and sustain innovative, exercise interventions, and programs for this population

Change in Ac-SDKP levels in healthy participants.

<p>ACE-I, Angiotensin Converting Enzyme Inhibitors; IV, inverse variance.</p

Change in Ac-SDKP levels in participants with renal failure.

<p>ACE-I, Angiotensin Converting Enzyme Inhibitors; IV, inverse variance.</p

Flow diagram of search results.

<p>Flow diagram of search results.</p