Usefulness of kidney function evaluation in the interpretation of cardiovascular risk in the group of patients with arterial hypertension

Wstęp Przewlekła choroba nerek jest niezależnym czynnikiem ryzyka chorób układu sercowo-naczyniowego (CVD). Również nadciśnienie tętnicze jest czynnikiem ryzyka CVD i występuje u 70-85% pacjentów z przewlekłą chorobą nerek. W obecnych wytycznych Kidney Disease Outcomes Quality Initiative zaleca się, by funkcję nerek oceniać poprzez oszacowanie przesączania kłębuszkowego (GFR) zamiast stężenia kreatyniny w surowicy. Pozwala to na zidentyfikowanie pacjentów z przewlekłą chorobą nerek oraz ocenę stopnia niewydolności nerek. Materiał i metody Oceniano częstość występowania upośledzonej funkcji nerek na podstawie GFR u 58 hospitalizowanych osób (20 kobiet oraz 38 mężczyzn) chorujących na nadciśnienie tętnicze. Pacjentów podzielono na dwie grupy: A - 28 osób bez towarzyszącej choroby niedokrwiennej serca (9 kobiet i 19 mężczyzn) oraz B - 30 osób ze stwierdzoną chorobą niedokrwienną serca (11 kobiet i 19 mężczyzn). Wyniki Zgodnie ze wzorem Modification of Diet in Renal Disease stwierdzono: 1. stopień przewlekłej choroby nerek w grupie pacjentów z nadciśnieniem tętniczym bez towarzyszącej choroby niedokrwiennej serca (A) u 25% osób, natomiast w grupie pacjentów chorujących na nadciśnienie tętnicze i chorobę niedokrwienną serca (B) u 6,67% chorych; 2. stopień przewlekłej choroby nerek w grupie pacjentów z nadciśnieniem tętniczym bez towarzyszącej choroby niedokrwiennej serca (A) u 39,29% osób, natomiast w grupie pacjentów z nadciśnieniem tętniczym i chorobą niedokrwienną serca (B) u 50% chorych; 3. stopień przewlekłej choroby nerek w grupie pacjentów z nadciśnieniem tętniczym bez towarzyszącej choroby niedokrwiennej serca (A) u 14,29% osób, natomiast w grupie pacjentów z nadciśnieniem tętniczym i chorobą niedokrwienną serca (B) u 23,33% osób. Wnioski Pacjenci z nadciśnieniem tętniczym i chorobą niedokrwienną serca cechowali się wyższym od setkiem bardziej zaawansowanej niewydolności nerek. Zależność GFR oraz wieku od rozkurczowego ciśnienia tętniczego u chorych z nadciśnieniem i bez choroby niedokrwiennej serca wskazuje na wartość rokowniczą stopnia wydolności nerek w interpretacji ryzyka sercowo-naczyniowego.Background Hypertension is one of the cardiovascular disease (CVD) risk factors and is present in approximately 70-85% of patients with chronic renal failure. The current Kidney Disease Outcomes Quality Initiative guidelines advocate creatinine-based equations for estimating glomerular filtration rate (GFR) to identify patients with potential chronic kidney disease (CKD) and to classify them into different stages on the basis of these values. Material and methods Assessment of prevalence of CKD using estimating GFR according to Modification of Diet in Renal Disease (MDRD) formula in 58 hospitalized hypertensive patients (20 women and 38 men). They were divided in two groups: A - 28 patients without coronary artery disease (9 women and 19 men) and B - 30 patients with coronary artery disease (11 women and 19 men). Results According to MDRD formula: stage 1 CKD in the group of hypertensive patients without coronary artery disease (A) was found in 25%, whereas in the group of hypertensive patients with coronary artery disease (B) it was found in 6.67%. Stage 2 CKD in the group of hypertensive patients without coronary artery disease (A) was found in 39.29%, whereas in the group of hypertensive patients with coronary artery disease (B) it was found in 50%. Stage 3 CKD in the group of hypertensive patients without coronary artery disease (A) was found in 14.29%, whereas in the group of hypertensive patients with coronary artery disease (B) it was found in 23.33%. Conclusions There is a need to estimate GFR according to MDRD formula, because there isn’t a linear dependence between GFR and creatinine concentration. We have to remember that GFR which gives evidence of chronic kidney disease is considered to be a significant cardiovascular risk factor

Congenital Heart Disease Increases Mortality in Neonates With Necrotizing Enterocolitis

Background: Studies on the influence of congenital heart disease (CHD) on neonates with necrotizing enterocolitis (NEC) have produced varied results. We therefore examined the influence of CHD on NEC outcomes.Methods: We carried out a retrospective single-center study including infants with confirmed NEC, treated between 2004 and 2017. We excluded patients with isolated patent ductus arteriosus or pulmonary hypertension (n = 45) and compared outcomes of patients with hemodynamically relevant CHD (n = 38) and those without CHD (n = 91).Results: Patients with CHD were more mature than those without CHD [gestational age, median, 95% confidence interval (CI95), 37.1, 34.5–37.2w, vs. 32.6, 31.9–33.3w; P < 0.01]. The presence of CHD did not influence the frequencies of severe disease (overall 21% Bell stage III), nor surgical interventions (overall 30%), the occurrence of intestinal complications (overall 13%), nor the duration of hospitalization (overall 38 days in survivors). The overall mortality as well as NEC-related mortality was increased with the presence of CHD, being 50% (19 out of 38) and 13% (5 out of 38), respectively, when compared to patients without CHD, being 8% (7 out of 91) and 3% (3 out of 91). The presence of CHD and of advanced NEC stage III were independent predictors of NEC-associated fatalities with multivariable odds ratios (CI95) of 7.0, 1.3–39.5 for CHD, and of 3.4, 1.6–7.5 for stage III disease.Conclusions: While some outcome parameters in neonates with NEC remained unaffected by the presence of CHD, the mortality risk for patients with CHD was seven times higher than without CHD

Risk factors for mortality in preterm infants with necrotizing enterocolitis: a retrospective multicenter analysis

It is difficult to predict the risk of mortality in necrotizing enterocolitis (NEC). This study aimed at identifying risk factors for severe NEC (Bell stage III) and mortality in preterm children with NEC. In this multicenter retrospective study, we analyzed multiple data from 157 premature children with confirmed NEC in the period from January 2007 to October 2018. We performed univariate, multivariate, stepwise logistic regression, and receiver operator characteristics (ROC) analyses. We were able to demonstrate that low Apgar scores (notably at 1' and 5'), low hemoglobin concentration (Hgb), and high lactate level at disease onset and during disease correlated with NEC severity and mortality (P < 0.05, respectively). Severe NEC was related to congenital heart disease (CHD - OR 2.6, CI95% 1.2-5.8, P 0.015) and patent ductus arteriosus (PDA - OR 3.3, CI95% 1.6-6.9, P 0.0012), whereas death was related to the presence of PDA (OR 5.5, CI95% 2.3-14, P < 0.001).Conclusion: Low Apgar scores, low Hgb, high lactate levels, and the presence of CHD or PDA correlated with severe NEC or mortality in children with NEC. What is Known: • It remains difficult to predict which infant that suffers from necrotizing enterocolitis at risk of death. • Several clinical and laboratory parameters tools to predict fatal outcome in NEC. What is New: • The following laboratory parameters were associated with the risk of death from NEC: Hemoglobin concentration, base excess and lactate level. • The following clinical variables were associated with the risk of death from NEC: Apgar scores, as well as the presence of congenital heart disease and patent ductus arteriosus

Gastrointestinal sequelae after surgery for necrotising enterocolitis: a systematic review and meta-analysis.

OBJECTIVES To document what types of gastrointestinal sequelae were described after surgery for necrotising enterocolitis (NEC) and to analyse their frequency. DESIGN Systematic review and meta-analysis. DATA SOURCES Medline, EMBASE and the Cochrane library (CENTRAL) from 1990 to October 2016. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included studies, which provided original data on the occurrence of gastrointestinal sequelae in patients surviving surgery for NEC. Meta-analysis and metaregression to assess heterogeneity were performed for studies including 10 or more patients with gastrointestinal strictures, recurrence of NEC, intestinal failure (IF) and adhesion ileus. RESULTS Altogether 58 studies, including 4260 patients, met the inclusion criteria. Strictures were reported to occur in 24% (95% CI 17% to 31%) of surviving patients, recurrence of NEC in 8% (95% CI 3% to 15%), IF in 13% (95% CI 7% to 19%) and adhesion ileus in 6% (95% CI 4% to 9%). Strictures were more common following enterostomy (30%; 95% CI 23% to 37%) than after primary anastomosis (8%; 95% CI 0% to 23%) and occurred more often after enterostomy without bowel resection than with bowel resection. We found considerable heterogeneity in the weighted average frequency of all sequelae (I range: 38%-90%). Intestinal outcomes were poorly defined, there were important differences in study populations and designs, and the reported findings bear a substantial risk of bias. CONCLUSIONS Gastrointestinal sequelae in neonates surviving surgery for NEC are frequent. Long-term follow-up assessing defined gastrointestinal outcomes is warranted