Lipids, blood pressure, kidney – what was new in 2011?

The year 2011 was very interesting regarding new studies, trials and guidelines in the field of lipidology, hypertensiology and nephrology. Suffice it to mention the new European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines on the management of dyslipidaemias, American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) guidelines on hypertension in the elderly, and many important trials presented among others during the American Society of Nephrology (ASN) Annual Congress in Philadelphia and the AHA Annual Congress in Orlando. The paper is an attempt to summarize the most important events and reports in the mentioned areas in the passing year

Powikłania sercowo-naczyniowe oraz nowotwory nerek własnych u pacjenta po zabiegu transplantacji nerki - opis przypadku

Głównymi powikłaniami po zabiegu transplantacji nerki są powikłania sercowo-naczyniowe, infekcje oraz choroby nowotworowe. W artykule przedstawiono opis przypadku pacjenta, u którego po zabiegu transplantacji nerki usunięto w odstępie 1,5 roku nerki własne z powodu nowotworu. Po 5 latach po transplantacji stwierdzono złożoną wadę aortalną wymagającą pilnego zabiegu kardiochirurgicznego. Wszczepiono sztuczną zastawkę aortalną i jeden tętniczy pomost aortalno-wieńcowy. Przebieg pooperacyjny był powikłany niewydolnością krążeniowo-oddechową i ostrym uszkodzeniem nerek wymagającym hemodiafiltracji, następnie stężenie kreatyniny ustabilizowało się na poziomie niższym niż przed zabiegiem. Prowadzenie biorcy przeszczepu z powikłaniami sercowo-naczyniowymi powinno się opierać na interdyscyplinarnym zespole kardiologów, kardiochirurgów i nefrologów/ transplantologów. Forum Nefrologiczne 2010, tom 3, nr 4, 284-29

Factors affecting change in renal function after contrast-enhanced computed tomography in cancer patients

Objectives. Contrast-enhanced computed tomography (CECT) is the most common form of assessing the effectiveness of cancer patient treatment. However, an injection of an iodine-based contrast agent can cause acute kidney damage (AKI). To determine the frequency and factors affecting post-contrast kidney function deterioration during oncological treatment.  Material and methods. Kidney function in cancer patients with solid tumors undergoing a total of 206 CECTs was retrospectively analyzed.  Results. Two hundred and six CECT procedures in 79 patients (age 68.4 ± 10.6 years) were included in the study. The median eGFR before CECT according to the MDRD was 81 mL/min/1.73m2 (IQR 26). The median time between CECT and kidney function examination was 8 (IQR 8) days. In the whole group, the median eGFR change defined as the difference between eGFR after and before CECT was 0.0 (9.0) mL/min/1.73m2 and was not significant. eGFR decreased in 100/206 (48.5%) CECT procedures with the median difference = –5.0 (6.0) mL/min/1.73m2. However, clinically significant deterioration of renal function (an increase in SCr of > 0.3 mg/dL) was found only in two cases (0.9%). The change in eGFR associated with CECT correlated significantly (p < 0.05) with initial creatinine (r = 0.117) and urea (r = 0.158), but not with age and comorbidities. After dividing the analyzed population according to the median GFR, it turned out that in the group of patients with eGFR < 81 mL/min/1.73m2, the median difference in GFR level was 1 (IQR 10), and in the group with a higher eGFR level the median was –1 (IQR 8.5), which was statistically significant (p = 0.03). The multivariate logistic regression analysis in subsequent reduced models confirmed that SCr, uric acid level, and the use of antimetabolites were the factors independently reducing the risk of deterioration of renal function after CECT.  Conclusions. CECT can be responsible for kidney function deterioration; however, it has no impact on oncological treatment

Heart failure with preserved ejection fraction in patient with chronic kidney disease

Częstość występowania przewlekłej choroby nerek  oraz niewydolności serca wzrasta istotnie szczególnie  u pacjentów w podeszłym wieku i stanowi  bardzo istotny problem kliniczny i społeczny. Każda  osoba z przewlekłą chorobą nerek powinna być  traktowana jako chory z wysokim ryzykiem sercowo-  naczyniowym, a u pacjentów z niewydolnością  serca i przewlekłą chorobą nerek należy się liczyć  ze znacznie gorszym rokowaniem. U pacjentów ze  współistniejącą niewydolnością serca oraz przewlekłą  chorobą nerek zarówno diagnostyka, jak i leczenie  jest znacznie utrudnione i wymaga szczególnej  uwagi, wielodyscyplinarnego podejścia oraz ścisłej  współpracy nefrologa z kardiologiem, co w wielu  przypadkach pozwala na uzyskanie wieloletniego  stabilnego przebiegu klinicznego. W pracy przedstawiono  opis przypadku pacjenta z rozkurczową  niewydolnością serca oraz towarzyszącą przewlekłą  chorobą nerek, omówiono postępowanie diagnostyczne  i terapeutyczne.Patients with chronic kidney disease and heart  failure have already become the clinical and social  issue of great importance. Moreover, the improvement  of health care and aging of the society  contribute to the escalation of the scope of the  issue. Every patient with chronic kidney disease  should be considered at increased cardiovascular  risk. Additionally, in patients with heart failure and  chronic kidney disease worse prognosis should be  taken into account. The treatment of such patients  includes the elimination of reversible causes of the  diseases and the prevention of their progression  with optimal risk factors control. In patients with  heart failure and coexisting chronic kidney disease  diagnostic work-up and treatment are difficult and  require much attention, multi-professional approach  with constant cooperation of nephrologist  and cardiologist, which in many cases results in  stable clinical course of the diseases over the  years. We present a case of heart failure with preserved  ejection fraction. We also presented diagnostic  and therapeutic strategy in this patient

Inhibitors of sodium-glucose transport protein 2: A new multidirectional therapeutic option for heart failure patients

Several mechanisms have been suggested to explain positive cardiovascular effects observed in studies with sodium-glucose co-transporter 2 (SGLT2) inhibitors. The reduction in glucose reabsorption in proximal tubuli induced by SGLT2 inhibitors increases urinary glucose and sodium excretion resulting in increased osmotic diuresis and consequently in decreased plasma volume, followed by reduced preload. In addition, the hemodynamic effects of SGLT2 inhibition were observed in both hyper and euglycemic patients. Due to the complex and multidirectional effects induced by SGLT2 inhibitors, this originally antidiabetic group of drugs has been successfully used to treat patients with heart failure as well as for subjects with chronic kidney disease. Moreover, their therapeutic potential seems to be even broader than the indications studied to date

May Measurement Month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension

Aims Raised blood pressure (BP) is the biggest contributor to mortality and disease burden worldwide and fewer than half of those with hypertension are aware of it. May Measurement Month (MMM) is a global campaign set up in 2017, to raise awareness of high BP and as a pragmatic solution to a lack of formal screening worldwide. The 2018 campaign was expanded, aiming to include more participants and countries. Methods and results Eighty-nine countries participated in MMM 2018. Volunteers (≥18 years) were recruited through opportunistic sampling at a variety of screening sites. Each participant had three BP measurements and completed a questionnaire on demographic, lifestyle, and environmental factors. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or taking antihypertensive medication. In total, 74.9% of screenees provided three BP readings. Multiple imputation using chained equations was used to impute missing readings. 1 504 963 individuals (mean age 45.3 years; 52.4% female) were screened. After multiple imputation, 502 079 (33.4%) individuals had hypertension, of whom 59.5% were aware of their diagnosis and 55.3% were taking antihypertensive medication. Of those on medication, 60.0% were controlled and of all hypertensives, 33.2% were controlled. We detected 224 285 individuals with untreated hypertension and 111 214 individuals with inadequately treated (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) hypertension. Conclusion May Measurement Month expanded significantly compared with 2017, including more participants in more countries. The campaign identified over 335 000 adults with untreated or inadequately treated hypertension. In the absence of systematic screening programmes, MMM was effective at raising awareness at least among these individuals at risk

Oncometabolites—A Link between Cancer Cells and Tumor Microenvironment

The tumor microenvironment is the space between healthy tissues and cancer cells, created by the extracellular matrix, blood vessels, infiltrating cells such as immune cells, and cancer-associated fibroblasts. These components constantly interact and influence each other, enabling cancer cells to survive and develop in the host organism. Accumulated intermediate metabolites favoring dysregulation and compensatory responses in the cell, called oncometabolites, provide a method of communication between cells and might also play a role in cancer growth. Here, we describe the changes in metabolic pathways that lead to accumulation of intermediate metabolites: lactate, glutamate, fumarate, and succinate in the tumor and their impact on the tumor microenvironment. These oncometabolites are not only waste products, but also link all types of cells involved in tumor survival and progression. Oncometabolites play a particularly important role in neoangiogenesis and in the infiltration of immune cells in cancer. Oncometabolites are also associated with a disrupted DNA damage response and make the tumor microenvironment more favorable for cell migration. The knowledge summarized in this article will allow for a better understanding of associations between therapeutic targets and oncometabolites, as well as the direct effects of these particles on the formation of the tumor microenvironment. In the future, targeting oncometabolites could improve treatment standards or represent a novel method for fighting cancer

Prevention of sudden cardiac death in patients with chronic kidney disease

Abstract Cardiovascular deaths account for about 40% of all deaths of patients with chronic kidney disease (CKD), particularly those on dialysis, while sudden cardiac death (SCD) might be responsible for as many as 60% of SCD in patients undergoing dialysis. Studies have demonstrated a number of factors occurring in hemodialysis (HD) that could lead to cardiac arrhythmias. Patients with CKD undergoing HD are at high risk of ventricular arrhythmia and SCD since changes associated with renal failure and hemodialysis-related disorders overlap. Antiarrhythmic therapy is much more difficult in patients with CKD, but the general principles are similar to those in patients with normal renal function - at first, the cause of arrhythmias should be found and eliminated. Also the choice of therapy is narrowed due to the altered pharmacokinetics of many drugs resulting from renal failure, neurotoxicity of certain drugs and their complex interactions. Cardiac pacing in elderly patients is a common method of treatment. Assessment of patients’ prognosis is important when deciding whether to implant complex devices. There are reports concerning greater risk of surgical complications, which depends also on the extent of the surgical site. The decision concerning implantation of a pacing system in patients with CKD should be made on the basis of individual assessment of the patient.</p

Występowanie czynników ryzyka sercowo-naczyniowego zależnych od stylu życia u studentów kierunków medycznych

Introduction: Knowledge about the importance of a healthy lifestyle in the prevention of cardiovascular diseases should be an integral part of the medical education of future physicians and other healthcare professionals. The aim of the study was to assess the presence of selected cardiovascular risk factors in comparison to cardioprotective factors in the group of students of the Medical University of Warsaw. Material and methods: The study was conducted using a lifestyle questionnaire based on the questionnaire developed at the Loma Linda University with the participation of the American College of Lifestyle Medicine. It covered 280 students of medicine and physiotherapy. Results: Although 81% of the respondents have a normal BMI, 77% of the surveyed population does not eat the recommended 5 portions of vegetables and fruits a day. 44% of physiotherapy students and 32% of medical students do not attain the recommended minimum of 30 minutes a day of moderate or vigorous physical activity. 76 out of 212, i.e. almost 36% of students, declare using nicotine in the last year. Conclusions: Medical students are not free from lifestyle-related cardiovascular risk factors. The percentage of people using nicotine is high and further studies are needed to assess what factors contribute to the lack of adherence to healthy lifestyle recommendations among this group of respondents.Wstęp: Wiedza na temat zdrowego stylu życia w prewencji chorób sercowo-naczyniowych powinna być istotnym elementem zdobywania wykształcenia na kierunkach medycznych. Celem pracy było określenie występowania wybranych czynników ryzyka sercowo-naczyniowego zależnych od stylu życia oraz czynników kardioprotekcyjnych w grupie studentów studentów Warszawskiego Uniwersytetu Medycznego. Materiał i metody: Badanie przeprowadzono za pomocą ankiety, będącej polskim odpowiednikiem kwestionariusza opracowanego na uniwersytecie Loma Linda z udziałem American College of Lifestyle Medicine. Objęło ono 280 studentów kierunku lekarskiego i fizjoterapii. Wyniki: W badanej populacji 77% osób nie spożywa 5 porcji warzyw i owoców dziennie. 80,67% respondentów ma prawidłowe BMI (przy średniej wynoszącej 21,24 dla kobiet i 23,49 dla mężczyzn). Spośród przebadanych 51% studentów kierunku lekarskiego i ponad 60% studentów fizjoterapii to osoby aktywne fizycznie min. 3 razy w tygodniu. 76 spośród 212, a więc prawie 36% studentów, deklaruje używanie nikotyny w ostatnim roku. Wnioski: Pomimo wysokiej świadomości zagrożeń, studenci kierunków medycznych nie są wolni od czynników ryzyka sercowo-naczyniowego. Odsetek osób używających nikotynę jest wysoki i konieczne są dalsze badania, które ocenią jakie czynniki wpływają na brak przestrzegania zaleceń zdrowego stylu życia wśród tej grupy badanych