Arterial Stiffness in Chronic Kidney Disease: The Usefulness of a Marker of Vascular Damage

Increased arterial stiffness is a marker of vasculopathy in chronic kidney disease (CKD) patients, suggesting a significant cardiovascular damage. Detection of arterial stiffness provides physicians with useful prognostic information independent of traditional cardiovascular (CV) risk factors. In addition, this knowledge may help guide appropriate therapeutic choices and monitor the effectiveness of antihypertensive therapies. We review the relationship between arterial stiffness and CKD, as well as the prognostic implications of increased arterial stiffness and the potential therapeutic strategies to ameliorate arterial compliance and outcome in CKD

Analisi di processo applicata agli accessi vascolari per emodialisi

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Calcificazioni coronariche in una popolazione di donne in post-menopausa affette da sindrome metabolica

Background. The aim of this study was to evaluate the burden of coronary calcifications in a subgroup of post-menopausal women with metabolic syndrome (MS) in agreement with the National Cholesterol Educational Program-Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP-ATP III) definition. Methods. We studied 81 women (43 control subjects and 38 women with MS) in agreement with the NCEP-ATP III definition undergoing multislice computed tomography for evaluation of coronary calcifications. The patients were similar for Framingham risk score. Results. The severity and extent of coronary artery calcifications were higher in individuals with MS (10.8 \uc2\ub1 15.8 vs 3.02 \uc2\ub1 5.6; p = 0.006). In all patients total cholesterol, low-density lipoproteins and triglycerides were correlated with calcium score (p <0.05) while high-density lipoproteins were inversely correlated with coronary calcifications. In women with MS total cholesterol and low-density iipoprotein cholesterol were correlated with calcium score. Conclusions. Women with MS have a higher burden of subclinical coronary atherosclerosis. The correlation between MS and calcium score concerned more the presence rather than the severity of coronary calcifications. Moreover, no correlation was observed among single components of MS in agreement with the NCEP-ATP III definition. \uc2\ua9 2007 AIM Publishing Srl

Evaluation of dialysis access care by means of process quality indicators

Improvement of dialysis access management depends on technical skill but also on effective choice, construction, monitoring and revision of the access. Surgical procedure is only one step of a complex course, beginning with the referral of patients to nephrologists. Using two process quality indicators, we describe the evolution of access management at our centre, where access surgery and access-related activities are performed by nephrologist. The first process indicator is based on the prevalence of temporary access at first dialysis (TA1st) in end stage renal disease ESRD patients, the second one measures the prevalence of permanent central venous catheters (%CVC) in dialysis population. TA1st increased to 27.1% in 1999, more than twofold compared to the previous year. There was also an increase in %CVC from 20.6 to 26.3%. Native access remained the most utilised, well above 70% of dialysis patients. Our process monitoring suggests a rapid worsening of late referral, as indicated by the increasing use of temporary catheters at the beginning of chronic dialysis. Increasing surgical activity and diagnostic procedures were only partly effective in containing the rise in CVC. Venous sparing, early referral, Continuous Quality Improvement and a multiprofessional access-team co-ordinated by a nephrologist could be the key-elements in facing the never-ending-story of dialysis vascular access

Arterial Stiffness, Pulse Wave Analyses: What Can’t Blood Pressure Tell you in Chronic Kidney Disease

Abstract: Increased arterial stiffness is emerging as a useful marker of cardiovascular damage. A growing body of evidence suggests that the stiffening of the conduit arteries is linearly associated with poor survival in the general population and high-risk population such as Chronic Kidney Disease (CKD) patients. Indeed, the loss of the elastic properties of conduit arteries induces an increase in the central pulse pressure and cardiac workload leading to left ventricular hypertrophy and reduced coronary and capillary perfusion. Notably, all these changes are independent of mean blood pressure and other established cardiovascular risk factors. Though, evidence is still inconclusive, some preliminary data suggest that arterial stiffness and central blood pressure evaluation can be of use for risk stratification and treatment individualization. We herein summarize the current evidence supporting the usefulness of arterial stiffness assessment for CKD patients’ management

Renal diffusion tensor imaging: Is it possible to define the tubular pathway? A case report

The authors report a case of unilateral xanthogranulomatous pyelonephritis, associated with chronic lithiasis studied by standard clinical magnetic resonance imaging protocol and diffusion tensor imaging (DTI). Maps of apparent diffusion coefficient (ADC) and fractional anisotropy (FA) and tractography were reconstructed on both healthy and pathologic kidney. ADC and FA values are in agreement with the literature. Tractography reconstruction of tubular renal architecture was confirmed by histology. This result suggests the potential ability of DTI to detect structural alterations in the architecture of the kidney, as noninvasive tool, preceding the onset of clinical-laboratory alterations. \ua9 2011 Elsevier Inc

Diffusion tensor imaging and tractography of the kidneys: Assessment of chronic parenchymal diseases

Objective: To assess renal dysfunction in chronic kidney diseases using diffusion tensor imaging (DTI). Methods: Forty-seven patients with impaired renal function (study group) and 17 patients without renal diseases (control group) were examined using DTI sequences. Cortical and medullary regions of interest (ROIs) were located to obtain the corresponding values of the apparent diffusion coefficient (ADC) and the fractional anisotropy (FA). The mean values of the ADC and FA, for each ROI site, were obtained in each group and were compared. Furthermore, the correlations between the diffusion parameters and the estimated glomerular filtration rate (eGFR) were determined. Results: In both the normal and affected kidneys, we obtained the cortico-medullary difference of the ADC and the FA values. The FA value in the medulla was significantly lower (P = 0.0149) in patients with renal function impairment as compared to patients with normal renal function. A direct correlation between DTI parameters and the eGFR was not found. Tractography visualised disruption of the regular arrangement of the tracts in patient with renal function alteration. Conclusion: DTI could be a useful tool in the evaluation of chronic kidney disease and, in particular, the medullary FA value seems to be the main parameter for assessing renal damage. Key Points: \u2022 Magnetic resonance diffusion tensor imaging (MRDTI) provides new information about renal problems. \u2022 DTI allows non-invasive repeatable evaluation of the renal parenchyma, without contrast media. \u2022 DTI could become useful in the management of chronic parenchymal disease. \u2022 DTI seems more appropriate for renal evaluation than diffusion-weighted imaging. \ua9 2013 European Society of Radiology