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https://www.readbyqxmd.com/read/27895136/recognition-and-management-of-resistant-hypertension
#1
REVIEW
Branko Braam, Sandra J Taler, Mahboob Rahman, Jennifer A Fillaus, Barbara A Greco, John P Forman, Efrain Reisin, Debbie L Cohen, Mohammad G Saklayen, S Susan Hedayati
Despite improvements in hypertension awareness and treatment, 30%-60% of hypertensive patients do not achieve BP targets and subsequently remain at risk for target organ damage. This therapeutic gap is particularly important to nephrologists, who frequently encounter treatment-resistant hypertension in patients with CKD. Data are limited on how best to treat patients with CKD and resistant hypertension, because patients with CKD have historically been excluded from hypertension treatment trials. First, we propose a consistent definition of resistant hypertension as BP levels confirmed by both in-office and out-of-office measurements that exceed appropriate targets while the patient is receiving treatment with at least three antihypertensive medications, including a diuretic, at dosages optimized to provide maximum benefit in the absence of intolerable side effects...
November 28, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/27856633/effects-of-vitamin-d-receptor-activation-and-dietary-sodium-restriction-on-residual-albuminuria-in-ckd-the-virtue-ckd-trial
#2
Charlotte A Keyzer, G Fenna van Breda, Marc G Vervloet, Maarten A de Jong, Gozewijn D Laverman, Marc H Hemmelder, Wilbert M T Janssen, Hiddo J Lambers Heerspink, Arjan J Kwakernaak, Stephan J L Bakker, Gerjan Navis, Martin H de Borst
Reduction of residual albuminuria during single-agent renin-angiotensin-aldosterone blockade is accompanied by improved cardiorenal outcomes in CKD. We studied the individual and combined effects of the vitamin D receptor activator paricalcitol (PARI) and dietary sodium restriction on residual albuminuria in CKD. In a multicenter, randomized, placebo (PLAC)-controlled, crossover trial, 45 patients with nondiabetic CKD stages 1-3 and albuminuria >300 mg/24 h despite ramipril at 10 mg/d and BP<140/90 mmHg were treated for four 8-week periods with PARI (2 μg/d) or PLAC, each combined with a low-sodium (LS) or regular sodium (RS) diet...
November 17, 2016: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/27825313/using-pharmacists-to-improve-risk-stratification-and-management-of-stage-3a-chronic-kidney-disease-a-feasibility-study
#3
Alex R Chang, Michael Evans, Christina Yule, Larissa Bohn, Amanda Young, Meredith Lewis, Elisabeth Graboski, Bethany Gerdy, William Ehmann, Jonathan Brady, Leah Lawrence, Natacha Antunes, Jamie Green, Susan Snyder, H Lester Kirchner, Morgan Grams, Robert Perkins
BACKGROUND: Measurement of albuminuria to stratify risk in chronic kidney disease (CKD) is not done universally in the primary care setting despite recommendation in KDIGO (Kidney Disease Improving Global Outcomes) guidelines. Pharmacist medication therapy management (MTM) may be helpful in improving CKD risk stratification and management. METHODS: We conducted a pragmatic, cluster-randomized trial using seven primary care clinic sites in the Geisinger Health System to evaluate the feasibility of pharmacist MTM in patients with estimated glomerular filtration rate (eGFR) 45-59 ml/min/1...
November 8, 2016: BMC Nephrology
https://www.readbyqxmd.com/read/27810277/-community-pharmacists-interventions-to-prevent-and-screen-chronic-kidney-disease-patients
#4
Stéphanie Belaiche, Edwige Mercier, Damien Cuny, Nicolas Kambia, Patrick Wierre, Élisabeth Bertoux, Daniel Mascaut, Raymond Azar, Pierre Bataille, Franck Bourdon, Évelyne Mac Namara, Nathalie Maisonneuve, Bernard Painchart, Laurence Vrigneau, Christian Noël, Bertrand Décaudin, François Glowacki
Chronic kidney disease (CKD) is a major concern of public health. The pharmacist is known as a health practitioner involved in prevention and therapeutic education. Our study aimed at defining the impact of community pharmacists' interventions for preventing and screening CKD. In our observational prospective study of 5 months conducted in 109 community pharmacy, we included 2 groups of patients: A (therapeutic optimization): CKD patients and B (CKD screening): population at risk. In group A, we included 354 patients, mainly women (51...
October 31, 2016: Néphrologie & Thérapeutique
https://www.readbyqxmd.com/read/27754015/br-04-1management-of-treatment-resistant-hypertension
#5
David John Webb
Treatment-resistant hypertension (TRH) is defined as the failure to achieve an office BP target of <140/90 mmHg (<130/80 mmHg in patients with chronic kidney disease (CKD) or diabetes) in patients with hypertension (HT), despite adherence to at least 3 antihypertensive medications at optimal tolerated doses, ideally including a diuretic (Calhoun et al., Circulation 2008). TRH identifies patients with hard-to-treat HT, who might benefit from specialist investigation and treatment. Although some studies put the prevalence of TRH as >10%, these levels may be inflated by white-coat hypertension and poor adherence...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27754003/js-ish-isn-2-role-of-the-kidney-in-resistant-hypertension-why-so-resistant-to-bp-control-in-ckd-patients
#6
George Bakris
Resistant hypertension is defined as a blood pressure above 140/90 mmHg despite adherence to a combination of at least three optimally dosed antihypertensive medications, one of which is a diuretic. Chronic kidney disease (CKD) is one of the more common patient comorbidities associated with resistant hypertension. Recommended low-salt diet and triple antihypertensive drug regimens that include a diuretic, should be complemented by the sequential addition of other antihypertensive drugs. CKD is associated with premature vascular ageing, characterized by accelerated arteriosclerosis or atherosclerosis and endothelial dysfunction...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27721548/prescribing-patterns-of-medicines-in-chronic-kidney-disease-patients-on-maintenance-hemodialysis
#7
Sourav Chakraborty, Saugata Ghosh, Avishek Banerjea, Radha Raman De, Avijit Hazra, Swapan Kumar Mandal
OBJECTIVES: To study medicine prescribing pattern for chronic kidney disease (CKD) patients on maintenance hemodialysis. MATERIALS AND METHODS: This prospective observational study was conducted in hemodialysis unit of a teaching hospital with adult CKD patients on maintenance hemodialysis. Patients' clinical profile, drug-use pattern, and medication-related problem data were captured in a structured case report form and the data were analyzed descriptively. Adherence level was assessed by Morisky Medication-Taking Adherence Scale 4-item...
September 2016: Indian Journal of Pharmacology
https://www.readbyqxmd.com/read/27707612/prevalence-of-treatment-resistant-hypertension-and-important-associated-factors-results-from-the-swedish-primary-care-cardiovascular-database
#8
Lina Holmqvist, Kristina Bengtsson Boström, Thomas Kahan, Linus Schiöler, Jan Hasselström, Per Hjerpe, Björn Wettermark, Karin Manhem
We aimed to describe the prevalence, treatment, and associated comorbidity of treatment-resistant hypertension (TRH). This registry-based cohort study from The Swedish Primary Care Cardiovascular Database assessed 53,090 hypertensive patients attending primary care. Patients adherent to antihypertensive treatment measured by pharmacy fills and with proportion of days covered ≥80% were included. The prevalence of TRH was 17% when considering all current TRH definitions. Adherence to mineralocorticoid receptor antagonists differed between TRH- and non-TRH patients (8 vs...
September 6, 2016: Journal of the American Society of Hypertension: JASH
https://www.readbyqxmd.com/read/27671037/assessing-outcomes-of-enhanced-chronic-disease-care-through-patient-education-and-a-value-based-formulary-study-access-study-protocol-for-a-2%C3%A3-2-factorial-randomized-trial
#9
David J T Campbell, Marcello Tonelli, Brenda Hemmelgarn, Chad Mitchell, Ross Tsuyuki, Noah Ivers, Tavis Campbell, Raj Pannu, Eric Verkerke, Scott Klarenbach, Kathryn King-Shier, Peter Faris, Derek Exner, Vikas Chaubey, Braden Manns
BACKGROUND: Chronic diseases result in significant morbidity and costs. Although medications and lifestyle changes are effective for improving outcomes in chronic diseases, many patients do not receive these treatments, in part because of financial barriers, patient and provider-level knowledge gaps, and low patient motivation. The Assessing outcomes of enhanced chronic disease care through patient education and a value-based formulary study (ACCESS) will determine the impact of two interventions: (1) a value-based formulary which eliminates copayment for high-value preventive medications; and (2) a comprehensive self-management support program aimed at promoting health behavior change and medication adherence, combined with relay of information on medication use to healthcare providers, on cardiovascular events and/or mortality in low-income seniors with elevated cardiovascular risk...
September 26, 2016: Implementation Science: IS
https://www.readbyqxmd.com/read/27648739/medication-taking-behaviors-in-ckd-with-multiple-chronic-conditions-a-meta-ethnographic-synthesis-of-qualitative-studies
#10
Rebecca J Bartlett Ellis, Janet L Welch
AIMS AND OBJECTIVES: This meta-ethnographic study identified behaviors associated with taking medications and medication adherence reported in qualitative studies of adults with chronic kidney disease (CKD) and co-existing multiple chronic conditions (MCCs). BACKGROUND: To inform medication adherence interventions, information is needed to clarify the nature of the relationships between behaviors that support medication-taking and medication adherence in MCCs. STUDY DESIGN: Meta-ethnographic review and synthesis...
September 20, 2016: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/27642926/br-04-1management-of-treatment-resistant-hypertension
#11
David John Webb
Treatment-resistant hypertension (TRH) is defined as the failure to achieve an office BP target of <140/90 mmHg (<130/80 mmHg in patients with chronic kidney disease (CKD) or diabetes) in patients with hypertension (HT), despite adherence to at least 3 antihypertensive medications at optimal tolerated doses, ideally including a diuretic (Calhoun et al., Circulation 2008). TRH identifies patients with hard-to-treat HT, who might benefit from specialist investigation and treatment. Although some studies put the prevalence of TRH as >10%, these levels may be inflated by white-coat hypertension and poor adherence...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27642914/js-ish-isn-2-role-of-the-kidney-in-resistant-hypertension-why-so-resistant-to-bp-control-in-ckd-patients
#12
George Bakris
Resistant hypertension is defined as a blood pressure above 140/90 mmHg despite adherence to a combination of at least three optimally dosed antihypertensive medications, one of which is a diuretic. Chronic kidney disease (CKD) is one of the more common patient comorbidities associated with resistant hypertension. Recommended low-salt diet and triple antihypertensive drug regimens that include a diuretic, should be complemented by the sequential addition of other antihypertensive drugs. CKD is associated with premature vascular ageing, characterized by accelerated arteriosclerosis or atherosclerosis and endothelial dysfunction...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27595514/a-coordinated-transition-model-for-patients-with-cystinosis-from-pediatrics-to-adult-care
#13
Gema Ariceta, Juan Antonio Camacho, Matilde Fernández-Obispo, Aurora Fernández-Polo, Josep Gámez, Judit García-Villoria, Enrique Lara, Pere Leyes, Nieves Martín-Begué, Manel Perelló, Guillem Pintos-Morell, Roser Torra, J Vicens Torregrosa, Sandra Torres-Sierra, Anna Vila-Santandreu, Ana Güell
INTRODUCTION: Improved outcome and longer life-expectancy in patients with cystinosis, and disease complexity itself, justify planning a guided-transition of affected patients from Pediatrics to adult medicine. The aims of the process are to guarantee the continuum of care and patient empowerment, moving from guardian-care to self-care. METHODS: review of articles, expert opinion and anonymous surveys of patients, relatives and patient advocacy groups. RESULTS: elaboration a new document to support and coordinate the transition of patients with cystinosis providing specific proposals in a variety of medical fields, and adherence promotion...
November 2016: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
https://www.readbyqxmd.com/read/27578113/patterns-and-predictors-of-medication-adherence-to-lipid-lowering-therapy-in-children-aged-8-to-20-years
#14
Nina R Joyce, Gregory A Wellenius, Charles B Eaton, Amal N Trivedi, Justin P Zachariah
BACKGROUND: The American Academy of Pediatrics recommends lipid-lowering therapy (LLT) for children at high risk of cardiovascular disease. However, the use of LLT in children is rare, and rates of nonadherence are unknown. OBJECTIVE: To identify patterns of use and predictors of nonadherence to LLT in children aged 8 to 20 years and the subgroup with dyslipidemia. METHODS: Commercially insured patients with a new dispensing for an LLT were included...
July 2016: Journal of Clinical Lipidology
https://www.readbyqxmd.com/read/27524806/primary-care-and-chronic-disease-the-intersection-of-comfort-and-specialty-involvement-a-cross-sectional-study
#15
Andrew Schreiner, Kit Simpson
BACKGROUND: Primary care referrals to specialty physicians play an integral role in patient care and health care costs. Multiple factors play into the primary care physician's decision to refer, including comfort managing particular conditions. As the burden of chronic disease climbs, the relationship between patients, primary care physicians and specialists in accurately diagnosing, managing and treating chronic conditions needs clarity. The objective of this study is to assess the relationship between specialty physician involvement and the care of three chronic conditions: diabetes mellitus (DM), chronic kidney disease (CKD) and systemic lupus erythematosus (SLE)...
August 15, 2016: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/27490366/health-and-nutrition-literacy-and-adherence-to-treatment-in-children-adolescents-and-young-adults-with-chronic-kidney-disease-and-hypertension-north-carolina-2015
#16
Nikita Patel, Maria Ferris, Eniko Rak
INTRODUCTION: Adherence to treatment and dietary restrictions is important for health outcomes of patients with chronic/end-stage kidney disease and hypertension. The relationship of adherence with nutritional and health literacy in children, adolescents, and young adults is not well understood. The current study examined the relationship of health literacy, nutrition knowledge, nutrition knowledge-behavior concordance, and medication adherence in a sample of children and young people with chronic/end-stage kidney disease and hypertension...
2016: Preventing Chronic Disease
https://www.readbyqxmd.com/read/27441093/the-association-between-individual-counselling-and-health-behaviour-change-the-see-kidney-disease-seekd-targeted-screening-programme-for-chronic-kidney-disease
#17
Lauren Galbraith, Brenda Hemmelgarn, Braden Manns, Susan Samuel, Joanne Kappel, Nadine Valk, Paul Ronksley
BACKGROUND: Health behaviour change is an important component of management for patients with chronic kidney disease (CKD); however, the optimal method to promote health behaviour change for self-management of CKD is unknown. The See Kidney Disease (SeeKD) targeted screening programme screened Canadians at risk for CKD and promoted health behaviour change through individual counselling and goal setting. OBJECTIVES: The objectives of this study are to determine the effectiveness of individual counselling sessions for eliciting behaviour change and to describe participant characteristics associated with behaviour change...
2016: Canadian Journal of Kidney Health and Disease
https://www.readbyqxmd.com/read/27438073/association-between-medication-adherence-and-clinical-outcomes-in-patients-with-chronic-kidney-disease-a-prospective-cohort-study
#18
Mayuree Tangkiatkumjai, Dawn-Marie Walker, Kearkiat Praditpornsilpa, Helen Boardman
BACKGROUND: There is limited evidence of medication adherence related to progression of chronic kidney disease (CKD) worldwide. The aim of this study was to determine associations between medication adherence and the progression of CKD in outpatients with CKD. METHODS: This cohort study recruited 339 Thai patients with stages 3-5 CKD. Patients with a glomerular disease or receiving renal replacement therapy before recruitment were excluded. 295 were followed up regarding their serum creatinine, blood pressure, glycated hemoglobin, and low-density lipoprotein cholesterol over 12 months...
July 20, 2016: Clinical and Experimental Nephrology
https://www.readbyqxmd.com/read/27399144/impact-of-pay-for-performance-on-mortality-in-diabetes-patients-in-taiwan-a-population-based-study
#19
Yu-Ching Chen, Charles Tzu-Chi Lee, Boniface J Lin, Yong-Yuan Chang, Hon-Yi Shi
BACKGROUND: The impact of pay-for-performance (P4P) programs on long-term mortality for chronic illnesses, especially diabetes mellitus, has been rarely reported. Several studies described the favorable impact of P4P for diabetes mellitus on medical utilizations or intermediate outcomes. Therefore, this study aimed to investigate the impact of a P4P program on mortality in patients with type 2 diabetes. METHODS: The P4P group in this population-based cohort study was 2090 individuals with a primary diagnosis of type 2 diabetes who had been newly enrolled in the P4P program of Taiwan between January 1, 2004 and December 31, 2004...
July 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27340288/variation-in-patients-awareness-of-ckd-according-to-how-they-are-asked
#20
Delphine S Tuot, Yunnuo Zhu, Alexandra Velasquez, Juan Espinoza, C Damaris Mendez, Tanushree Banerjee, Chi-Yuan Hsu, Neil R Powe
BACKGROUND AND OBJECTIVES: Awareness of CKD is necessary for patient engagement and adherence to medical regimens. Having an accurate tool to assess awareness is important. Use of the National Health and Nutrition Examination Survey (NHANES) CKD awareness question "Have you ever been told by a doctor or other health professional that you had weak or failing kidneys (excluding kidney stones, bladder infections, or incontinence)?" produces surprisingly low measures of CKD awareness. We sought to compare the sensitivity and specificity of different questions ascertaining awareness of CKD and other health conditions...
September 7, 2016: Clinical Journal of the American Society of Nephrology: CJASN
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