Can strict volume control be the key for treatment and prevention of posterior reversible encephalopathy syndrome in hemodialysis patients?

WOS: 000313751100014PubMed ID: 22360471Posterior reversible encephalopathy syndrome (PRES) is a rare but if diagnosed late an irreversible disease. The majority of the patients present with severe hypertension, and effective blood pressure control is the mainstay of therapy. In this case report, we present three cases with PRES, treated successfully with strict volume control policy and propose that strict volume control policy may be a key element for the treatment of PRES

Controversies and problems of volume control and hypertension in haemodialysis

WOS: 000379736100033PubMed ID: 27226131Extracellular volume overload and hypertension are important contributors to the high risk of cardiovascular mortality in patients undergoing haemodialysis. Hypertension is present in more than 90% of patients at the initiation of haemodialysis and persists in more than two-thirds, despite use of several antihypertensive medications. High blood pressure is a risk factor for the development of left ventricular hypertrophy, heart failure, and mortality, although there are controversies with some study findings showing poor survival with low-but not high-blood pressure. The most frequent cause of hypertension in patients undergoing haemodialysis is volume overload, which is associated with poor cardiovascular outcomes itself independent of blood pressure. Although antihypertensive medications might not be successful to control blood pressure, extracellular volume reduction by persistent ultrafiltration and dietary salt restriction can produce favourable results with good blood pressure control. More frequent or longer haemodialysis can facilitate volume and blood pressure control. However, successful volume and blood pressure control is also possible in patients undergoing conventional haemodialysis

Interplay of volume, blood pressure, organ ischemia, residual renal function, and diet: certainties and uncertainties with dialytic management

WOS: 000409301100009PubMed ID: 28581677Extracellular fluid volume overload and its inevitable consequence, hypertension, increases cardiovascular mortality in the long term by leading to left ventricular hypertrophy, heart failure, and ischemic heart disease in dialysis patients. Unlike antihypertensive medications, a strict volume control strategy provides optimal blood pressure control without need for antihypertensive drugs. However, utilization of this strategy has remained limited because of several factors, including the absence of a gold standard method to assess volume status, difficulties in reducing extracellular fluid volume, and safety concerns associated with reduction of extracellular volume. These include intradialytic hypotension; ischemia of heart, brain, and gut; loss of residual renal function; and vascular access thrombosis. Comprehensibly, physicians are hesitant to follow strict volume control policy because of these safety concerns. Current data, however, suggest that a high ultrafiltration rate rather than the reduction in excess volume is related to these complications. Restriction of dietary salt intake, increased frequency, and/or duration of hemodialysis sessions or addition of temporary extra sessions during the process of gradually reducing postdialysis body weight in conventional hemodialysis and discontinuation of antihypertensive medications may prevent these complications. We believe that even if an unwanted effect occurs while gradually reaching euvolemia, this is likely to be counterbalanced by favorable cardiovascular outcomes such as regression of left ventricular hypertrophy, prevention of heart failure, and, ultimately, cardiovascular mortality as a result of the eventual achievement of normal extracellular fluid volume and blood pressure over the long term

The Impact of Strict Volume Control Strategy on Patient Survival and Technique Failure in Peritoneal Dialysis Patients

WOS: 000291539400005PubMed ID: 21293119Strict volume control strategy provides better cardiac functions and control of hypertension in dialysis patients. We investigated the effect of this strategy on mortality and technique failure in peritoneal dialysis patients over a 10-year period. 243 patients were enrolled. Strict volume control by dietary salt restriction and ultrafiltration was applied. Mean systolic and diastolic blood pressures decreased from 138.4 +/- 29.9 and 86.3 +/- 16.8 to 114.9 +/- 32.3 and 74.7 +/- 18.3 mm Hg, respectively. Overall and cardiovascular mortality rates were 48.4 and 29.6 per 1,000 patient-years, respectively. In multivariate analysis, age, diabetes and baseline serum albumin level were independent predictors of overall mortality, and age, diabetes and baseline serum calcium of cardiovascular mortality. Residual diuresis and peritoneal equilibration test values were not related to mortality. Strict volume control leads to lower mortality than comparable series in the literature. Technique survival is better during the first 3 years, but not after 5 years. Copyright (C) 2011 S. Karger AG, Base

Association of insulin resistance with arterial stiffness in nondiabetic peritoneal dialysis patients

WOS: 000299080500034PubMed ID: 21643643Insulin resistance is a risk factor for cardiovascular morbidity and mortality in the general and end-stage renal disease populations. In this study, we investigated the association between insulin resistance and arterial stiffness in nondiabetic peritoneal dialysis (PD) patients. Fifty-three patients were enrolled. Patients were divided into 2 groups as homeostasis model assessment of insulin resistance (HOMA-IR) a parts per thousand currency sign2.97 (low) and > 2.97 (high). Carotid-femoral pulse wave velocity (c-f PWV) analysis and intima-media thickness of the carotid artery were measured. Mean age was 46 +/- A 12 years and HOMA-IR was 2.97 +/- A 1.77 (0.77-8.88). Mean c-f PWV was 7.6 +/- A 1.7 m/s. HOMA-IR was positively correlated with age, body mass index, and c-f PWV and negatively with serum HDL cholesterol and parathormone. In linear regression analysis, age and mean arterial pressure were predictors for c-f PWV. When patients were divided into 2 groups according to median age as a parts per thousand currency sign49 and > 50, mean arterial pressure, male gender, and age were predictors for c-f PWV in patients aged a parts per thousand currency sign49, whereas HOMA-IR was the only predictor for c-f PWV in patients aged > 50 years. Insulin resistance is an independent risk factor for arterial stiffness in PD patients older than 50 years. IR is not associated with carotid intima-media thickness.ISPDThe authors would like to thank Dr. Evert Dorhout Mees for his critical review of the manuscript. This study was presented as a free communication in 13th Congress of International Society of Peritoneal Dialysis, 2010, Mexico City and received the ISPD travel grant award

THE RELATIONSHIP BETWEEN RENAL OSTEODYSTROPHY AND FIBROBLAST GROWTH FACTOR-23 IN HEMODIALYSIS PATIENTS

50th European-Renal-Association - European-Dialysis-and-Transplant-Association Congress -- MAY 18-21, 2013 -- Istanbul, TURKEYWOS: 000319498200063European Renal Assoc (ERA), European Dialysis & Transplant Assoc (EDTA