INFLUENCE OF NEUROPATHIC PAIN ON QUALITY OF LIFE IN DIABETIC PATIENTS

Dijabetička polineuropatija (DPN) najčešća je komplikacija dijabetesa, a može biti prisutna s i bez neuropatke boli uz poznatu pojavu depresivnih simptoma u dijabetičara. Kvaliteta života ključan je parametar na osnovi koje je moguće dati objektivnu procjenu stanja bolesnika, ali i predvidjeti daljnji tijek bolesti kao i uspjeh liječenja. Cilj ovog istraživanja je ispitati da li bolna dijabetička polineuropatija i prisutna depresija značajno utječu na smanjenje kvalitete života bolesnika sa šećernom bolešću. Ispitanici i metode Istraživanje je provedeno u KB Merkur- Sveučilišnoj klinici „Vuk Vrhovac“. U istraživanje je uključeno 240 bolesnika – od kojih 80 bolesnika ima bolnu dijabetičku neuropatiju, 80 bolesnika dijabetičku neuropatiju bez boli, a 80 ispitanika su bolesnici koji su liječeni u KB Merkur zbog križobolje, ali bez dijabetesa. Kvaliteta života ispitanika ispitivana je SF – 36 (Short Form Health Survey) upitnikom. Za procjenu simptoma i znakova neuropatske boli u ispitanika korištene su dvije ljestvice VAS (visual analogue scale) i LANSS (Leeds Assessment of Neuropathic Symptoms and Signs) ljestvica, a za probir depresivnosti upotrijebljen je BDI -II (Beck Depression Inventory) upitnik. Rezultati Vidljivo je da postoji izrazita negativna linearna korelacija jačine boli i kvalitete života u svim promatranim slučajevima. Korelacija je bila statistički značajna za sve dimenzije SF-36 i za sva tri načina evaluacije boli, kao i za prisutnost depresivnih simptoma. Zaključak U skupini dijabetičara s bolnom DPN statistički je značajno jače prisutna bol kao i depresivni poremećaji, što omogućuje donošenje zaključka da su upravo bol i depresivni poremećaji uzrokom konstantno niže kvalitete života u ovih bolesnika.Neuropahtic pain is defined by IASP as pain that occurs as a direct result of lesions or disease affecting somatosensory system. Diabetic Peripheral Neuropathy (DPN) is the most common complication of diabetes and may be found with and without neurophatic pain. It increases with duration of diabetes. There is also occurrence of depressive symptoms with persons with diabetes. Quality of life is a key parameter on which to base an objective assessment of the patient’s condition but also to predict the future course of the disease and the success of treatment. Objective The aim of this study was to examine whether Diabetic Peripheral Neuropathy and present depression significantly impact reduction in quality of life in diabetic patients. Subjects and Methods The study was conducted in Clinical Hospital Merkur- University Clinic "Vuk Vrhovac" Reference centre for health care of persons with diabetes of Croatian Ministry of Health and WHO collaborating institution. The study included 240 patients, 80 of which had been diagnosed with painful diabetic neuropathy (group B), 80 patients with diabetic neuropathy without pain (group D). The remaining 80 patients (control group K) were the patients who were treated in Clinical Hospital Merkur because of back pain and the diagnosis of DPN was excluded. In addition to a complete neurological examination included in the General Questionnaire on the Subject, demographic data was also collected. The EMNG tests of arms and legs were conducted, Doppler Ultrasound of leg artery, CDFI of carotid arteries and, when necessary, X-ray, CT or MRI test of lumbosacral spine. The quality of life of the subjects was questioned using the SF - 36 (Short Form Health Survey). For the assessment of symptoms and signs of neuropathic pain in patients two VAS (visual analogue scale) scales were used for current pain and pain during the past month and LANSS (Leeds Assessment of Neuropathic Symptoms and Signs) scale. Breakthrough of depression was tested by BDI-II (Beck Depression Inventory) survey. Results The average age of the subjects was 60.8 years (59.4 +/- 62.2 y). The study included 128 women and 112 men. Most of the subjects diagnosed with diabetes (group B and D) suffered from type II diabetes (87.4%). The average duration of disease was 18 years. Subjects with type I diabetes were significantly younger (49.5 years of age) than patients with type II diabetes (64.2 years of age). In subjects with type I diabetes the average duration of disease was longer (23.6 years) than in subjects with type II diabetes (17.2 years). Persons with diabetes without painful DPN suffered more often from type I diabetes compared to the subjects with painful DPN. As regards to the therapy they were taking, the majority of subjects (50.6%) were on insulin therapy, around one quarter of the subjects were either on a combination of peroral and insulin therapy (22.2%) or on a peroral therapy alone (27.2%). There were statistically significant differences of subjects by type of polyneuropathy according to the age, i.e. more severe forms were noticed in the older subjects. In 90.4% of subjects pain occurred couple of years before. In the past month, most of the subjects (47.1%) had pain every day, followed by those who had pain several times a week (33.8%) or several times a month. According to the parameter of the current intensity of pain, the highest figures were found in group B - 5.9 points VAS, and the lowest - 3.1 points VAS in Group D. The test of degree of pain during the previous month recorded similar results; the highest amount of 7.1 points VAS found in group B, and the lowest of 3.9 points VAS found in group D. By gender, women experienced pain significantly stronger than men. This applies both to current pain (4.8 versus 3.8 points), and pain during the previous month (6.5 versus 4.7 points). Current pain was significantly and linearly related to age, but not as regards to the pain during the past month. LANNS scale showed that the subjects of the study had an average of 12.2 points. According to Beck scale (revision II), the subjects got an average of 13.4 points. In both observed scales women showed on average statistically much higher figures of pain and depression than men. The stronger the pain that the subjects felt the stronger level of depression was found. It is interesting to note that the strongest correlation was found between the degree of pain during the past month according to the VAS scale. It can be concluded that the degree of pain determined in this manner is the best predictor of the level of depression in patients. The largest share of the subjects controlled defecation and urination (84.5%), while only a very small proportion of subjects controlled it partially or had not at all been able to control it. In women, the defecation and urination control was significantly weaker than in men. The same was found for sleep, whereas the women showed worse results. Accordingly, in group D, it was found that the highest number of subjects (85%) described their sleep as good, quite the opposite of group B with only 18.75% of subjects describing their sleep as good. The average number of medication, analgesics, was the highest in Group B (2.1), followed by the group K (1.7), while the lowest average number of persons taking medication was found in the subjects from the group D (1,2). By observing the results in all eight dimensions of the SF-36 scale, it is evident that the subjects from the general population had higher average results in all dimensions. On the basis of such comparison it is possible to conclude that the subjects of this study had on average lower quality of life than would be expected by observing the figures recorded in the general population. In all dimensions except for GH (general health perceptions), the lowest average figures were found in group B, and the highest in group D and the subjects from the Group K showed middle result figures compared to these two groups. It is also interesting to note that in four dimensions (VT, SF, RE and MH), the subjects of Group D showed higher average figures when compared to those found in the general population. The correlation of all 8 dimensions of the SF-36 scale with all three variables used to assess the degree of pain during the study with the results of the BDI scale was confirmed. It is evident that there is a strong negative linear correlation between intensity of pain and quality of life in all observed cases. The correlation was statistically significant for all dimensions of the SF-36, and for all three methods of pain evaluation, and the presence of depression symptoms. Conclusion The primary hypothesis - pain and depressive symptoms significantly impact the quality of life in patients with painful diabetic polyneuropathy was confirmed. The positive and statistically significant correlation between the two parameters, depression and pain, with all eight of the observed dimensions of quality of life of SF 36 survey lead to the conclusion that pain and depression caused a constantly lower quality of life in these patients

INFLUENCE OF NEUROPATHIC PAIN ON QUALITY OF LIFE IN DIABETIC PATIENTS

Dijabetička polineuropatija (DPN) najčešća je komplikacija dijabetesa, a može biti prisutna s i bez neuropatke boli uz poznatu pojavu depresivnih simptoma u dijabetičara. Kvaliteta života ključan je parametar na osnovi koje je moguće dati objektivnu procjenu stanja bolesnika, ali i predvidjeti daljnji tijek bolesti kao i uspjeh liječenja. Cilj ovog istraživanja je ispitati da li bolna dijabetička polineuropatija i prisutna depresija značajno utječu na smanjenje kvalitete života bolesnika sa šećernom bolešću. Ispitanici i metode Istraživanje je provedeno u KB Merkur- Sveučilišnoj klinici „Vuk Vrhovac“. U istraživanje je uključeno 240 bolesnika – od kojih 80 bolesnika ima bolnu dijabetičku neuropatiju, 80 bolesnika dijabetičku neuropatiju bez boli, a 80 ispitanika su bolesnici koji su liječeni u KB Merkur zbog križobolje, ali bez dijabetesa. Kvaliteta života ispitanika ispitivana je SF – 36 (Short Form Health Survey) upitnikom. Za procjenu simptoma i znakova neuropatske boli u ispitanika korištene su dvije ljestvice VAS (visual analogue scale) i LANSS (Leeds Assessment of Neuropathic Symptoms and Signs) ljestvica, a za probir depresivnosti upotrijebljen je BDI -II (Beck Depression Inventory) upitnik. Rezultati Vidljivo je da postoji izrazita negativna linearna korelacija jačine boli i kvalitete života u svim promatranim slučajevima. Korelacija je bila statistički značajna za sve dimenzije SF-36 i za sva tri načina evaluacije boli, kao i za prisutnost depresivnih simptoma. Zaključak U skupini dijabetičara s bolnom DPN statistički je značajno jače prisutna bol kao i depresivni poremećaji, što omogućuje donošenje zaključka da su upravo bol i depresivni poremećaji uzrokom konstantno niže kvalitete života u ovih bolesnika.Neuropahtic pain is defined by IASP as pain that occurs as a direct result of lesions or disease affecting somatosensory system. Diabetic Peripheral Neuropathy (DPN) is the most common complication of diabetes and may be found with and without neurophatic pain. It increases with duration of diabetes. There is also occurrence of depressive symptoms with persons with diabetes. Quality of life is a key parameter on which to base an objective assessment of the patient’s condition but also to predict the future course of the disease and the success of treatment. Objective The aim of this study was to examine whether Diabetic Peripheral Neuropathy and present depression significantly impact reduction in quality of life in diabetic patients. Subjects and Methods The study was conducted in Clinical Hospital Merkur- University Clinic "Vuk Vrhovac" Reference centre for health care of persons with diabetes of Croatian Ministry of Health and WHO collaborating institution. The study included 240 patients, 80 of which had been diagnosed with painful diabetic neuropathy (group B), 80 patients with diabetic neuropathy without pain (group D). The remaining 80 patients (control group K) were the patients who were treated in Clinical Hospital Merkur because of back pain and the diagnosis of DPN was excluded. In addition to a complete neurological examination included in the General Questionnaire on the Subject, demographic data was also collected. The EMNG tests of arms and legs were conducted, Doppler Ultrasound of leg artery, CDFI of carotid arteries and, when necessary, X-ray, CT or MRI test of lumbosacral spine. The quality of life of the subjects was questioned using the SF - 36 (Short Form Health Survey). For the assessment of symptoms and signs of neuropathic pain in patients two VAS (visual analogue scale) scales were used for current pain and pain during the past month and LANSS (Leeds Assessment of Neuropathic Symptoms and Signs) scale. Breakthrough of depression was tested by BDI-II (Beck Depression Inventory) survey. Results The average age of the subjects was 60.8 years (59.4 +/- 62.2 y). The study included 128 women and 112 men. Most of the subjects diagnosed with diabetes (group B and D) suffered from type II diabetes (87.4%). The average duration of disease was 18 years. Subjects with type I diabetes were significantly younger (49.5 years of age) than patients with type II diabetes (64.2 years of age). In subjects with type I diabetes the average duration of disease was longer (23.6 years) than in subjects with type II diabetes (17.2 years). Persons with diabetes without painful DPN suffered more often from type I diabetes compared to the subjects with painful DPN. As regards to the therapy they were taking, the majority of subjects (50.6%) were on insulin therapy, around one quarter of the subjects were either on a combination of peroral and insulin therapy (22.2%) or on a peroral therapy alone (27.2%). There were statistically significant differences of subjects by type of polyneuropathy according to the age, i.e. more severe forms were noticed in the older subjects. In 90.4% of subjects pain occurred couple of years before. In the past month, most of the subjects (47.1%) had pain every day, followed by those who had pain several times a week (33.8%) or several times a month. According to the parameter of the current intensity of pain, the highest figures were found in group B - 5.9 points VAS, and the lowest - 3.1 points VAS in Group D. The test of degree of pain during the previous month recorded similar results; the highest amount of 7.1 points VAS found in group B, and the lowest of 3.9 points VAS found in group D. By gender, women experienced pain significantly stronger than men. This applies both to current pain (4.8 versus 3.8 points), and pain during the previous month (6.5 versus 4.7 points). Current pain was significantly and linearly related to age, but not as regards to the pain during the past month. LANNS scale showed that the subjects of the study had an average of 12.2 points. According to Beck scale (revision II), the subjects got an average of 13.4 points. In both observed scales women showed on average statistically much higher figures of pain and depression than men. The stronger the pain that the subjects felt the stronger level of depression was found. It is interesting to note that the strongest correlation was found between the degree of pain during the past month according to the VAS scale. It can be concluded that the degree of pain determined in this manner is the best predictor of the level of depression in patients. The largest share of the subjects controlled defecation and urination (84.5%), while only a very small proportion of subjects controlled it partially or had not at all been able to control it. In women, the defecation and urination control was significantly weaker than in men. The same was found for sleep, whereas the women showed worse results. Accordingly, in group D, it was found that the highest number of subjects (85%) described their sleep as good, quite the opposite of group B with only 18.75% of subjects describing their sleep as good. The average number of medication, analgesics, was the highest in Group B (2.1), followed by the group K (1.7), while the lowest average number of persons taking medication was found in the subjects from the group D (1,2). By observing the results in all eight dimensions of the SF-36 scale, it is evident that the subjects from the general population had higher average results in all dimensions. On the basis of such comparison it is possible to conclude that the subjects of this study had on average lower quality of life than would be expected by observing the figures recorded in the general population. In all dimensions except for GH (general health perceptions), the lowest average figures were found in group B, and the highest in group D and the subjects from the Group K showed middle result figures compared to these two groups. It is also interesting to note that in four dimensions (VT, SF, RE and MH), the subjects of Group D showed higher average figures when compared to those found in the general population. The correlation of all 8 dimensions of the SF-36 scale with all three variables used to assess the degree of pain during the study with the results of the BDI scale was confirmed. It is evident that there is a strong negative linear correlation between intensity of pain and quality of life in all observed cases. The correlation was statistically significant for all dimensions of the SF-36, and for all three methods of pain evaluation, and the presence of depression symptoms. Conclusion The primary hypothesis - pain and depressive symptoms significantly impact the quality of life in patients with painful diabetic polyneuropathy was confirmed. The positive and statistically significant correlation between the two parameters, depression and pain, with all eight of the observed dimensions of quality of life of SF 36 survey lead to the conclusion that pain and depression caused a constantly lower quality of life in these patients

Common pathogenetic factors in metabolic syndrome and dementia

Metabolic syndrome (MetS) is characterized by a defined cluster of clinical conditions which include hypertension, impaired glucose tolerance, visceral adiposity and dyslipidemia. Dementia is group of symptoms which have in common deterioration in cognitive function, more than expected from the age of individual, and Alzheimer’s disease (AD) is the most common formo f dementia. Prevalence of both MetS and dementia, including AD, is growing at explosive rate worldwide, both conditions are multifactorial and there is a growing evidence of increased risk of dementia in patients with MetS. In this review, we described the potential underlying role of main components of MetS in the mechanism of pathogenetic changes in dementia. The main pathophysiological factors that contribute to dementia are non-ischemic neurodegeneration and/or neuronal death with accompanying neuroinflamma- tion, and vascular injury. Specific components of MetS may cause or exaggerate all these changes in individual patient, leading to worsening or accelerating cognitive decline. Better understanding and recognition of the role and mechanism of MetS components as potential underlying factors in demen- tia, is expected to have a beneficial role in prevention and treatment of dementia, as many of MetS components may be influenced on with appropriate change of habits and therapy

DENERVACIJA BUBREŽNIH ARTERIJA I REZISTENTNA HIPERTENZIJA

Renal sympathetic denervation (RDN) with radiofrequency (RF) is being used to treat resistant hypertension in seven non-responder patients (62±6 years for age, 5F/2M) despite treatment with >4 different antihypertensive drugs in optimal doses. Prior to diagnosing a patient as having resistant hypertension, we document adherence and exclude white-coat hypertension, inaccurate measurement of blood pressure and secondary causes. Office blood pressure (BP) measurements at 1, 3, 6, 12 and 18 months follow-up visits were compared to baseline. We used STATISTICA 10, 2011 software (Stat Soft Inc., Tulsa, OK, USA). Values are mean SD and considered statistically significant if P <0.001. At baseline, values were 184±21 and 106±26 mmHg for systolic (SBP) and diastolic (DBP), 6.7±1 for number of antihypertensive drug classes. One, 3, 6, 12 and 18 months after RDN, office SBP values were significantly lower (144±13 mmHg, 140±17, 141±15, 139±12 and 135±11 mmHg; P <0.001), with no significant reduction in DBP values at 1, 3, 6, 12 and 18 months after RDN (81±6, 82±9, 79±9, 78±6, and 76±7 mmHg). The number of antihypertensive drug classes before and 6, 12, 18 months after RDN were evaluated. Six months after RDN the number of antihypertensive drug classes required was 6.5±1, after 12 and 18 months was 5.5±1 and 4.5±1. During RDA no complications occurred (the pain during the procedure was well tolerated) and the renal function remained stabile. Renal sympathetic denervation is being a concomitant treatment of drug-resistant hypertension (rHT). The sustained reduction of SBP was observed after the RDN. Patients have benefit the most from procedure after 6-12 months. Further meta-analysis will evaluate the importance of new devices for less pain treatment of RDN.Denervacija bubrežnih arterija (DBA) radiofrekvencijom jedna je od obećavajućih novih metoda liječenja rezistentne hipertenzije refraktorne (RH) na optimalno liječenje kombiniranom antihipertenzivnom terapijom koja uključuje 3 i više lijekova iz različitih antihipertenzivnih skupina od kojih jedan mora biti diuretik. Nakon isključenja sekundarnih uzroka, neadekvatnog mjerenja tlaka te nesuradljivosti prikazujemo učinak DBA u 7 bolesnika (62±6 years for age, 5F/2M) tijekom razdoblja od 18 mjeseci praćenja. Za statističku analizu korišten je program STATISTICA 10, 2011 softwer (Stat Soft Inc., Tulsa, OK, USA), uz razinu značajnosti P <0,001. Bolesnici su praćeni na redovitim ambulantnim kontrolama 1, 3, 6, 12 i 18 mjeseci nakon DBA uz mjerenje krvnog tlaka i praćenje laboratorijskih parametara. Od početnih izmjerenih vrijednosti tlaka u ambulanti 184±21 za sistolički i 106±26 mm Hg za dijastolički tlak, uz prosječni broj antihipertenzivnih lijekova od 6,7±1 nakon DBA 1, 3, 6, 12 i 18 mjeseci prati se značajno smanjenje sistoličkih vrijednosti tlaka (144±13, 140±17, 141±15, 139±12, 135±11 mm Hg; P <0,001), bez značajnog smanjenja dijastoličkih vrijednosti (81±6, 82±9, 79±9, 78±6, 76±7 mmHg). Nakon 6 mjeseci prosječan broj antihipertenzivnih lijekova ostao je nepromijenjen (važno da se objektivizira učinak DBA) i iznosio je 6.5±1, dok je nakon 12 i 18 mjeseci došlo do smanjenja broja antihipertenzivnih lijekova (5.5±1 i 4.5±1). Tijekom DBA bolest je bila podnošljiva, nije zabilježeno neposrednih ni kasnijih komplikacija DBA, bubrežna funkcija je bila stabilna tijekom praćenja. Dokazana je dugoročna sigurnost DBA i učinkovitost na smanjenje sistoličkog krvnog tlaka u bolesnika s refraktornom RH

DENERVACIJA BUBREŽNIH ARTERIJA I REZISTENTNA HIPERTENZIJA

Renal sympathetic denervation (RDN) with radiofrequency (RF) is being used to treat resistant hypertension in seven non-responder patients (62±6 years for age, 5F/2M) despite treatment with >4 different antihypertensive drugs in optimal doses. Prior to diagnosing a patient as having resistant hypertension, we document adherence and exclude white-coat hypertension, inaccurate measurement of blood pressure and secondary causes. Office blood pressure (BP) measurements at 1, 3, 6, 12 and 18 months follow-up visits were compared to baseline. We used STATISTICA 10, 2011 software (Stat Soft Inc., Tulsa, OK, USA). Values are mean SD and considered statistically significant if P <0.001. At baseline, values were 184±21 and 106±26 mmHg for systolic (SBP) and diastolic (DBP), 6.7±1 for number of antihypertensive drug classes. One, 3, 6, 12 and 18 months after RDN, office SBP values were significantly lower (144±13 mmHg, 140±17, 141±15, 139±12 and 135±11 mmHg; P <0.001), with no significant reduction in DBP values at 1, 3, 6, 12 and 18 months after RDN (81±6, 82±9, 79±9, 78±6, and 76±7 mmHg). The number of antihypertensive drug classes before and 6, 12, 18 months after RDN were evaluated. Six months after RDN the number of antihypertensive drug classes required was 6.5±1, after 12 and 18 months was 5.5±1 and 4.5±1. During RDA no complications occurred (the pain during the procedure was well tolerated) and the renal function remained stabile. Renal sympathetic denervation is being a concomitant treatment of drug-resistant hypertension (rHT). The sustained reduction of SBP was observed after the RDN. Patients have benefit the most from procedure after 6-12 months. Further meta-analysis will evaluate the importance of new devices for less pain treatment of RDN.Denervacija bubrežnih arterija (DBA) radiofrekvencijom jedna je od obećavajućih novih metoda liječenja rezistentne hipertenzije refraktorne (RH) na optimalno liječenje kombiniranom antihipertenzivnom terapijom koja uključuje 3 i više lijekova iz različitih antihipertenzivnih skupina od kojih jedan mora biti diuretik. Nakon isključenja sekundarnih uzroka, neadekvatnog mjerenja tlaka te nesuradljivosti prikazujemo učinak DBA u 7 bolesnika (62±6 years for age, 5F/2M) tijekom razdoblja od 18 mjeseci praćenja. Za statističku analizu korišten je program STATISTICA 10, 2011 softwer (Stat Soft Inc., Tulsa, OK, USA), uz razinu značajnosti P <0,001. Bolesnici su praćeni na redovitim ambulantnim kontrolama 1, 3, 6, 12 i 18 mjeseci nakon DBA uz mjerenje krvnog tlaka i praćenje laboratorijskih parametara. Od početnih izmjerenih vrijednosti tlaka u ambulanti 184±21 za sistolički i 106±26 mm Hg za dijastolički tlak, uz prosječni broj antihipertenzivnih lijekova od 6,7±1 nakon DBA 1, 3, 6, 12 i 18 mjeseci prati se značajno smanjenje sistoličkih vrijednosti tlaka (144±13, 140±17, 141±15, 139±12, 135±11 mm Hg; P <0,001), bez značajnog smanjenja dijastoličkih vrijednosti (81±6, 82±9, 79±9, 78±6, 76±7 mmHg). Nakon 6 mjeseci prosječan broj antihipertenzivnih lijekova ostao je nepromijenjen (važno da se objektivizira učinak DBA) i iznosio je 6.5±1, dok je nakon 12 i 18 mjeseci došlo do smanjenja broja antihipertenzivnih lijekova (5.5±1 i 4.5±1). Tijekom DBA bolest je bila podnošljiva, nije zabilježeno neposrednih ni kasnijih komplikacija DBA, bubrežna funkcija je bila stabilna tijekom praćenja. Dokazana je dugoročna sigurnost DBA i učinkovitost na smanjenje sistoličkog krvnog tlaka u bolesnika s refraktornom RH

Poboljšanje krvnog tlaka, cirkadijalnog ritma i proteinurije u bolesnika s kroničnom bubrežnom bolešću nakon postupka denervacije bubrežnih arterija

Renal sympathetic denervation (RSD) could be an effective antihypertensive treatment of resistant hypertension that triggers additional positive effects on glucose metabolism and insulin sensitivity in type 2 diabetes mellitus. We report the effects of RSD in a patient with chronic kidney disease, type 2 diabetes mellitus and resistant hypertension, manifesting as blood pressure reduction with dipping pattern restoration, followed by nephrotic proteinuria alleviation. The non-dipping blood pressure pattern and proteinuria increase the risk of cardiovascular complications and accelerate kidney disease progression. Thus, further research documenting the frequency and investigating the mechanisms of these effects reported after RSD in chronic kidney disease patients with type 2 diabetes mellitus and resistant hypertension is necessary for the benefit of this high-risk patient population.Denervacija bubrežnih arterija (DBA) je jedna od obećavajućih novih metoda liječenja rezistentne hipertenzije refraktorne na optimalno liječenje kombiniranom antihipertenzivnom terapijom koja uključuje 3 i više lijekova iz različitih antihipertenzivnih skupina, od kojih jedan mora biti diuretik. Uz učinak na sniženje tlaka, radiofrekventnom ablacijom periarterijskih simpatičkih niti denervacijom uočeni su dodatni pleotropni pozitivni učinci poput regulacije glikemije i inzulinske rezistencije u osoba sa šećernom bolešću tipa 2. U radu je prikazan učinak DBA u bolesnika s kroničnom bubrežnom bolešću (KBB), šećernom bolešću tipa 2 i refraktornom hipertenzijom: djelomično sniženje krvnog tlaka polučilo je dodatni učinak na snižavanje krvnog tlaka tijekom noći uz smanjenje nefrotičke proteinurije, bez pogoršanja KBB. Izostanak očekivanog sniženja krvnog tlaka tijekom noći i nefrotska proteinurija povećavaju kardiovaskularni rizik bolesnika i progresiju KBB. Daljnja prospektivna istraživanja mehanizama nastanka povoljnih učinaka DBA u bolesnika sa šećernom bolešću tipa 2, KBB i rezistentnom hipertenzijom su neophodna kako bi se dokazali dodatni učinci blokade simpatičkog sustava DBA u ove visoko rizične populacije