The Relationship of Epicardial Adipose Tissue and Cardiovascular Disease in Chronic Kidney Disease and Hemodialysis Patients

Cardiovascular diseases remain the most common cause of morbidity and mortality in chronic kidney disease patients undergoing hemodialysis. Epicardial adipose tissue (EAT), visceral fat depot of the heart, was found to be associated with coronary artery disease in cardiac and non-cardiac patients. Additionally, EAT has been proposed as a novel cardiovascular risk in the general population and in end-stage renal disease patients. It has also been shown that EAT, more than other subcutaneous adipose tissue deposits, acts as a highly active organ producing several bioactive adipokines, and proinflammatory and proatherogenic cytokines. Therefore, increased visceral adiposity is associated with proinflammatory activity, impaired insulin sensitivity, increased risk of atherosclerosis, and high morbidity and mortality in hemodialysis patients. In the present review, we aimed to demonstrate the role of EAT in the pathophysiological mechanisms of increased cardiovascular morbidity and mortality in hemodialysis patients

Ambulatory blood pressure monitoring: from old concepts to novel insights

Ambulatory blood pressure monitoring (ABPM) is an out-of-office technique for the assessment of 24-h blood pressure measurements. ABPM is indicated to diagnose many conditions, including white-coat hypertension, resistant hypertension, episodic hypertension, nocturnal hypertension, autonomic dysfunction, hypotension secondary to excessive usage of antihypertensive medication, and masked hypertension. ABPM gives a better prediction of clinical outcomes in patients with hypertension and cardiovascular diseases when compared to office blood pressure measurements. Recently, several new indices have been introduced with the aim of predicting various clinical end-points in several patient populations. In this review, we aimed to determine the clinical utility of 24-h ABPM and its potential implications for the management of hypertension in patients with a high risk of cardiovascular mortality and morbidity, as well as various novel indices that can predict clinical end-points in different patient populations

Atherosclerosis And Inflammatory Status In Chronic Kidney Disease Patients After Renal Transplantation: Where Are We Now?

Cardiovascular diseases are the most common cause of mortality and morbidity in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD), receiving haemodialysis, peritoneal dialysis, and renal transplantation (Rtx). Estimated glomerular filtration rate (eGFR) places Rtx patients in one of the stages of CKD. Therefore, Rtx patients might be considered a subset of CKD patients. Besides the traditional risk factors of hypertension, diabetes, and dyslipidaemia, advanced-age novel risk factors such as endothelial dysfunction, vascular calcification, and increased chronic low-grade inflammation are highly prevalent and seem to play a more important role for vascular disease in CKD and Rtx patients compared to the general population. The role of Rtx in terms of atherogenesis and chronic ongoing low-grade inflammation is still unclear. To date, in the literature, the data are scant regarding the relationship between atherosclerosis, chronic inflammation, and cardiovascular events in Rtx patients with well-functioning kidneys. This review will discuss classical and recent epidemiological, pathophysiological, and clinical aspects of atherosclerosis and inflammation in Rtx patients

Uncontrolled hypertension secondary to leukemic cell infiltration of kidneys in a hemodialysis patient

Kultigin Turkmen1, Lutfullah Altintepe2, Ibrahim Guney2, Ismet Aydogdu3, Osman Koc4, Mehmet Ali Erkut5, Halil Zeki Tonbul11Department of Nephrology, Meram School of Medicine, Selcuk University, 2Meram Training and Research Hospital, Selcuk University, 3Department of Hematology, Meram School of Medicine, Selcuk University, 4Department of Radiology, Meram School of Medicine, Selcuk University, 5Department of Hematology, Meram Training and Research Hospital, Selcuk UniversityAbstract: Leukemic infiltration of the kidney is usually silent, and the admission of the patients with renal dysfunction or acute kidney injury is uncommon. We present a 34-year old hemodialysis patient with new onset of uncontrolled hypertension, erythropoietin-resistant anemia, thrombocytopenia, and Bell’s palsy. On admission, his blood pressure (BP) was 210/110 mmHg and he had petechiae and purpura at upper and lower extremities. Renal ultrasonography (USG) showed bilaterally enlarged kidneys without hydronephrosis, unlike his previous USG, which determined bilaterally atrophic kidneys. Acute lymphoblastic leukemia, hypertensive crisis due to bilateral leukemic cell infiltration of kidneys, tumor lysis syndrome, and leukemic involvement of the facial nerve were diagnosed. Despite intense antihypertensive management, his BP was not controlled. After prednisolone, daunorubicine, and vincristine therapy, the size of kidneys diminished and his BP dropped under normal range. In conclusion, pathological findings such as uncontrolled hypertension, flank pain, skin rashes, and abnormal blood count should be considered carefully, even in patients with end-stage renal disease receiving renal replacement therapy.Keywords: leukemic cell infiltration, uncontrolled hypertension, hemodialysi