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CKD, DIABETES, HYPERTENSION, HYPERKALEMIA

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https://www.readbyqxmd.com/read/27754188/sp-05-1-should-the-target-for-blood-pressure-reduction-be-lower-in-adults-with-hypertension-and-a-history-of-cardiovascular-disease
#1
Paul Whelton
BACKGROUND: Choice of the optimal target for blood pressure (BP) reduction during treatment of patients with hypertension, including those with underlying co-morbid conditions, is an important challenge in clinical practice. The Systolic Blood Pressure Intervention Trial (SPRINT) was designed to provide guidance in selection of a Systolic BP target during treatment of hypertension. METHODS: Adults ≥50 years old with hypertension and at least one additional risk factor for cardiovascular disease (CVD), but excluding persons with diabetes mellitus, prior stroke, or advanced chronic kidney disease (CKD) were randomly assigned to intensive therapy (intensive), targeting a systolic BP (SBP) <120 mmHg, or standard therapy (standard), targeting a SBP <140 mmHg...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27643145/sp-05-1-should-the-target-for-blood-pressure-reduction-be-lower-in-adults-with-hypertension-and-a-history-of-cardiovascular-disease
#2
Paul Whelton
BACKGROUND: Choice of the optimal target for blood pressure (BP) reduction during treatment of patients with hypertension, including those with underlying co-morbid conditions, is an important challenge in clinical practice. The Systolic Blood Pressure Intervention Trial (SPRINT) was designed to provide guidance in selection of a Systolic BP target during treatment of hypertension. METHODS: Adults ≥50 years old with hypertension and at least one additional risk factor for cardiovascular disease (CVD), but excluding persons with diabetes mellitus, prior stroke, or advanced chronic kidney disease (CKD) were randomly assigned to intensive therapy (intensive), targeting a systolic BP (SBP) <120 mmHg, or standard therapy (standard), targeting a SBP <140 mmHg...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27548687/patiromer-the-first-potassium-binder-approved-in-over-50-years
#3
Betty N Vu, Alyssa Mae De Castro, David Shottland, William H Frishman, Angela Cheng-Lai
For over 50 years, there have been limited options for the management of hyperkalemia, especially among patients with chronic kidney disease (CKD), diabetic nephropathy, hypertension, and heart failure, who were receiving concomitant renin-angiotensin-aldosterone system (RAAS) inhibitor therapy. Hyperkalemia is a potential, life-threatening electrolyte abnormality that frequently challenges clinicians from maximizing the mortality benefit and organ-protective properties of RAAS inhibitors especially in CKD and heart failure populations...
November 2016: Cardiology in Review
https://www.readbyqxmd.com/read/27502849/long-term-changes-of-renal-function-in-relation-to-ace-inhibitor-angiotensin-receptor-blocker-dosing-in-patients-with-heart-failure-and-chronic-kidney-disease
#4
Hanna Fröhlich, Christoph Nelges, Tobias Täger, Vedat Schwenger, Rita Cebola, Johannes Schnorbach, Kevin M Goode, Syed Kazmi, Hugo A Katus, John G F Cleland, Andrew L Clark, Lutz Frankenstein
BACKGROUND: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have become cornerstones of therapy for chronic heart failure (CHF). Guidelines advise high target doses for ACEIs/ARBs, but fear of worsening renal function may limit dose titration in patients with concomitant chronic kidney disease (CKD). METHODS: In this retrospective observational study, we identified 722 consecutive patients with systolic CHF, stable CKD stage III/IV (estimated glomerular filtration rate [eGFR] 15-60 mL min(-1) 1...
August 2016: American Heart Journal
https://www.readbyqxmd.com/read/27180623/recent-advances-in-pharmacological-treatments-of-hyperkalemia-focus-on-patiromer
#5
Murray Epstein, Bertram Pitt
INTRODUCTION: Hyperkalemia is a common electrolyte disorder, especially among patients with chronic kidney disease (CKD), diabetes mellitus, or heart failure, and is associated with a significantly increased risk for all-cause mortality. Hyperkalemia remains a vexing and challenging problem for clinicians, particularly in the management of patients with chronic kidney disease and congestive heart failure. Several observational and retrospective studies have reported a large gap between recommendations in guidelines and real-world practice in the implementation of RAASi therapies...
July 2016: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/26781039/knowledge-of-physicians-on-chronic-kidney-disease-and-their-attitudes-towards-referral-in-two-cities-of-cameroon-a-cross-sectional-study
#6
Simeon-Pierre Choukem, Pennghan K Nchifor, Marie-Patrice Halle, Daniel N Nebongo, Yannick Mboue-Djieka, François F Kaze, Gotlieb L Monekosso
BACKGROUND: Chronic kidney disease (CKD) is frequently unrecognized by non-nephrology physicians. There is an ongoing governmental program to create hemodialysis centers in the ten regions of Cameroon, where a previous study reported high levels of late referral to nephrologists. We aimed to assess the knowledge of physicians on CKD and their attitudes regarding referral. METHODS: A questionnaire based on the Kidney Disease Outcome Quality Initiative Guidelines of 2002 was self-administered to general practitioners and non-nephrology specialists working in two Cameroon cities that have hemodialysis centers (Douala and Bamenda)...
January 18, 2016: BMC Research Notes
https://www.readbyqxmd.com/read/26456884/patiromer-a-clinical-review
#7
REVIEW
Ann G Montaperto, Mona A Gandhi, Lauren Z Gashlin, Melanie R Symoniak
IMPORTANCE: Patiromer FOS (for oral suspension), formerly known as RLY5016, is pending FDA approval for the treatment of hyperkalemia. Once approved, patiromer, as well as a second agent known as sodium zirconium cyclosilicate (ZS-9), will be among the new therapeutic options available to treat hyperkalemia in over 50 years. OBJECTIVE: The primary objective of this review is to analyze the efficacy and safety of patiromer to treat hyperkalemia and compare its pharmacokinetics to currently available sodium polystyrene sulfonate (SPS) therapy...
2016: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/26049384/dual-renin-angiotensin-system-blockade-and-outcome-benefits-in-hypertension-a-narrative-review
#8
REVIEW
Johannes F E Mann, Michael Böhm
PURPOSE OF REVIEW: Inhibition of the renin-angiotensin system (RASi) lowers blood pressure, reduces cardiovascular outcomes and blunts the progressive course of heart failure and of chronic kidney disease. This narrative article summarizes why the hypothesis came up that more complete RASi with two different agents should be more beneficial compared with one agent and how this hypothesis was deflated in randomized clinical trials (RCTs). RECENT FINDINGS: The hypothesis was based on experimental findings and surrogate endpoints in patients, namely lowering of blood pressure and reduction of proteinuria...
July 2015: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/25762415/the-necessity-and-effectiveness-of-mineralocorticoid-receptor-antagonist-in-the-treatment-of-diabetic-nephropathy
#9
REVIEW
Atsuhisa Sato
Diabetes mellitus is a major cause of chronic kidney disease (CKD), and diabetic nephropathy is the most common primary disease necessitating dialysis treatment in the world including Japan. Major guidelines for treatment of hypertension in Japan, the United States and Europe recommend the use of angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers, which suppress the renin-angiotensin system (RAS), as the antihypertensive drugs of first choice in patients with coexisting diabetes. However, even with the administration of RAS inhibitors, failure to achieve adequate anti-albuminuric, renoprotective effects and a reduction in cardiovascular events has also been reported...
June 2015: Hypertension Research: Official Journal of the Japanese Society of Hypertension
https://www.readbyqxmd.com/read/25572273/predictors-of-hyperkalemia-risk-after-hypertension-control-with-aldosterone-blockade-according-to-the-presence-or-absence-of-chronic-kidney-disease
#10
Sangeon Gwoo, Ye Na Kim, Ho Sik Shin, Yeon Soon Jung, Hark Rim
BACKGROUND/AIMS: Aldosterone antagonists have been proven to be efficient in the management of hypertension and the reduction of proteinuria; however, they are not widely used because of the risk of hyperkalemia. We assessed the predictors of hyperkalemia risk following hypertension control using aldosterone blockade in the presence or absence of chronic kidney disease (CKD). METHODS: A total of 6,575 patients with hypertension treated between January 1, 2000, and November 30, 2012, were evaluated for the safety of an aldosterone-blocking agent (spironolactone) added to preexisting blood pressure-lowering regimens...
2014: Nephron. Clinical Practice
https://www.readbyqxmd.com/read/25425465/new-drugs-for-the-treatment-of-hyperkalemia-in-patients-treated-with-renin-angiotensin-aldosterone-system-inhibitors-hype-or-hope
#11
REVIEW
Juan Tamargo, Ricardo Caballero, Eva Delpón
Hyperkalemia (serum potassium >5.5 mmol/L) may result from increased potassium intake, impaired distribution between the intracellular and extracellular spaces, and/or reduced renal excretion. Renin-angiotensin-aldosterone system inhibitors (RAASIs) represent an important therapeutic strategy in patients with hypertension, heart failure, chronic kidney disease, and diabetes, but hyperkalemia is a key limitation to fully titrate RAASIs in these patients who are most likely to benefit from treatment. Thus, we need new drugs to control hyperkalemia in these patients while maintaining the use of RAASIs...
November 2014: Discovery Medicine
https://www.readbyqxmd.com/read/25399731/angiotensin-blockade-in-late-autosomal-dominant-polycystic-kidney-disease
#12
RANDOMIZED CONTROLLED TRIAL
Vicente E Torres, Kaleab Z Abebe, Arlene B Chapman, Robert W Schrier, William E Braun, Theodore I Steinman, Franz T Winklhofer, Godela Brosnahan, Peter G Czarnecki, Marie C Hogan, Dana C Miskulin, Frederic F Rahbari-Oskoui, Jared J Grantham, Peter C Harris, Michael F Flessner, Charity G Moore, Ronald D Perrone
BACKGROUND: Hypertension develops early in patients with autosomal dominant polycystic kidney disease (ADPKD) and is associated with disease progression. The renin-angiotensin-aldosterone system (RAAS) is implicated in the pathogenesis of hypertension in patients with ADPKD. Dual blockade of the RAAS may circumvent compensatory mechanisms that limit the efficacy of monotherapy with an angiotensin-converting-enzyme (ACE) inhibitor or angiotensin II-receptor blocker (ARB). METHODS: In this double-blind, placebo-controlled trial, we randomly assigned 486 patients, 18 to 64 years of age, with ADPKD (estimated glomerular filtration rate [GFR], 25 to 60 ml per minute per 1...
December 11, 2014: New England Journal of Medicine
https://www.readbyqxmd.com/read/25097954/preventing-chronic-kidney-disease-complications
#13
(no author information available yet)
No abstract text is available yet for this article.
June 2014: Johns Hopkins Medical Letter Health After 50
https://www.readbyqxmd.com/read/25014549/complete-inhibition-of-the-renin-angiotensin-aldosterone-system-where-do-we-stand
#14
REVIEW
Shan Shan Chen, Stephen L Seliger, Linda F Fried
PURPOSE OF REVIEW: This review presents the role of combination therapy of renin-angiotensin-aldosterone system blockade on cardiovascular and kidney disease. RECENT FINDINGS: Three large randomized controlled trials comparing combination therapy of renin-angiotensin-aldosterone system blockade to monotherapy in individuals with increased cardiovascular risk, chronic kidney disease, or diabetic nephropathy have been reported. These trials - ONTARGET, ALTITUDE, and VA NEPHRON-D - demonstrated an excess risk of adverse effects [especially acute kidney injury (AKI) and hyperkalemia] with combination therapy, without significant benefit in reducing cardiovascular and renal morbidity...
September 2014: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/24904657/hyperkalemia-among-hospitalized-patients-and-association-between-duration-of-hyperkalemia-and-outcomes
#15
Jagadish Khanagavi, Tanush Gupta, Wilbert S Aronow, Tushar Shah, Jalaj Garg, Chul Ahn, Sachin Sule, Stephen Peterson
INTRODUCTION: The aim of the study was to investigate predictors of mortality in patients hospitalized with hyperkalemia. MATERIAL AND METHODS: Data among hospitalized patients with hyperkalemia (serum potassium ≥ 5.1 mEq/l) were collected. Patients with end-stage renal disease on dialysis were excluded. RESULTS: Of 15,608 hospitalizations, 451 (2.9%) episodes of hyperkalemia occurred in 408 patients. In patients with hyperkalemia, chronic kidney disease, hypertension, diabetes, coronary artery disease and heart failure were common comorbidities...
May 12, 2014: Archives of Medical Science: AMS
https://www.readbyqxmd.com/read/24731738/potentially-preventable-hospitalization-as-a-complication-of-ckd-a-cohort-study
#16
Natasha Wiebe, Scott W Klarenbach, G Michael Allan, Braden J Manns, Rick Pelletier, Matthew T James, Aminu Bello, Brenda R Hemmelgarn, Marcello Tonelli
BACKGROUND: Ambulatory care-sensitive conditions have been described as those that (if appropriately managed in an outpatient setting) generally do not require subsequent hospitalization. Our goal was to identify clinical populations of people who are at the highest risk of ambulatory care-sensitive conditions related to chronic kidney disease (CKD). STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: 2,003,054 adults (including 238,747 adults with CKD) residing in Alberta, Canada, with at least one serum creatinine measurement between 2002 and 2009...
August 2014: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/24573394/lipid-blood-pressure-and-kidney-update-2013
#17
REVIEW
Maciej Banach, Corina Serban, Wilbert S Aronow, Jacek Rysz, Simona Dragan, Edgar V Lerma, Mugurel Apetrii, Adrian Covic
The year 2013 proved to be very exciting as far as landmark trials and new guidelines in the field of lipid disorders, blood pressure and kidney diseases. Among these are the International Atherosclerosis Society Global Recommendations for the Management of Dyslipidemia, European Society of Cardiology (ESC)/European Society of Hypertension Guidelines for the Management of Arterial Hypertension, American Diabetes Association Clinical Practice Recommendations, the Kidney Disease: Improving Global Outcomes Clinical Practice Guidelines for Managing Dyslipidemias in Chronic Kidney Disease (CKD) Patients, the American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults, the Joint National Committee Expert Panel (JNC 8) Evidence-Based Guideline for the Management of High Blood Pressure in Adults, the American Society of Hypertension/International Society of Hypertension Clinical Practice Guidelines for the Management of Hypertension in the Community, the American College of Physicians Clinical Practice Guideline on Screening, Monitoring, and Treatment of Stage 1-3 CKD and many important trials presented among others during the ESC Annual Congress in Amsterdam and the American Society of Nephrology Annual Meeting--Kidney Week in Atlanta, GA...
May 2014: International Urology and Nephrology
https://www.readbyqxmd.com/read/23031150/role-of-single-pill-combination-therapy-in-optimizing-blood-pressure-control-in-high-risk-hypertension-patients-and-management-of-treatment-related-adverse-events
#18
REVIEW
Abdul Ali Abdellatif
Renin-angiotensin-aldosterone system (RAAS) inhibitors in combination with other antihypertensive drugs (eg, calcium channel blockers [CCBs] and/or diuretics) are a preferred treatment option for managing uncontrolled hypertension in high-risk patients with chronic kidney disease (CKD), diabetes, or heart failure because RAAS inhibitors provide cardiorenal benefits in addition to lowering blood pressure (BP). However, when prescribing antihypertensive therapies to high-risk patients, physicians must be aware of the risks of treatment-related adverse events of hyperkalemia and peripheral edema associated with RAAS inhibitors and CCBs, respectively...
October 2012: Journal of Clinical Hypertension
https://www.readbyqxmd.com/read/22342847/predictors-of-hyperkalemia-and-death-in-patients-with-cardiac-and-renal-disease
#19
COMPARATIVE STUDY
Nishank Jain, Suman Kotla, Bertis B Little, Rick A Weideman, Emmanouil S Brilakis, Robert F Reilly, Subhash Banerjee
Predictors of hyperkalemia in patients with cardiovascular disease (CVD; defined as patients with hypertension and heart failure) and associated chronic kidney disease (CKD) are not well established. The aim of this study was to ascertain risk factors of hyperkalemia (defined as serum potassium concentration >5.0 mEq/L) and associated all-cause mortality in patients with CVD treated with antihypertensive drugs that impair potassium homeostasis. In a retrospective analysis using a logistic regression model, risk factors for hyperkalemia and all-cause mortality were analyzed in 15,803 patients with CVD treated with antihypertensive drugs...
May 15, 2012: American Journal of Cardiology
https://www.readbyqxmd.com/read/22269185/mineralocorticoid-receptor-blockade-in-chronic-kidney-disease
#20
REVIEW
Andrew S Bomback, Philip J Klemmer
Mineralocorticoid receptor blockers (MRBs) have proven highly successful in the treatment of congestive heart failure and resistant hypertension. In contrast, their use in chronic kidney disease (CKD) has lagged due to the concern of hyperkalemia and, possibly, because of the incorrect assumption that traditional therapy with angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers consistently reduce aldosterone activity in all patients. Low-dose MRB therapy may offer additional antihypertensive and unique anti-inflammatory benefits in select CKD populations...
2012: Blood Purification
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