Atherosclerotic renovascular hypertension is a form of secondary hypertension due to renal artery stenosis. After the introduction of medical therapy such as with statins and angiotensin blocking agents, it has been considered a very slowly progressive disease. In the 1990s, surgical methods were compared to radiological intervention and showed no additional benefits. Recent clinical data also demonstrate that in cases of relatively stable atherosclerotic renovascular disease, medical therapy is as effective as other interventions with regard to patient outcomes. In this paper the recent clinical outcomes are reviewed.
Angiotensins ; Atherosclerosis ; Humans ; Hypertension ; Hypertension, Renovascular ; Renal Artery Obstruction

No abstract available.
Humans ; Renal Dialysis

Mineral metabolism abnormalities, such as low 1,25-dihydroxyvitamin D (1,25(OH)2D) and elevated parathyroid hormone (PTH), are common at even higher glomerular filtration rate than previously described. Levels of 25-hydroxyvitamin D (25(OH)D) show an inverse correlation with those of intact PTH and phosphorus. Studies of the general population found much higher all-cause and cardiovascular (CV) mortality for patients with lower levels of vitamin D; this finding suggests that low 25(OH)D level is a risk factor and predictive of CV events in patients without chronic kidney disease (CKD). 25(OH)D/1,25(OH)2D becomes deficient with progression of CKD. Additionally, studies of dialysis patients have found an association of vitamin D deficiency with increased mortality. Restoration of the physiology of vitamin D receptor activation should be essential therapy for CKD patients.
Dialysis ; Glomerular Filtration Rate ; Humans ; Kidney ; Kidney Diseases ; Parathyroid Hormone ; Phosphorus ; Receptors, Calcitriol ; Renal Insufficiency, Chronic ; Risk Factors ; Vitamin D ; Vitamin D Deficiency ; Vitamins

Hypokalemia occurs frequently in patients undergoing peritoneal dialysis (PD). However, the therapeutic strategy may differ from that of non-PD-related hypokalemia. We investigated clinical features and related factors of de novo hypokalemia in incident PD patients. We retrospectively enrolled 82 normokalemic patients starting PD at Gachon University Gil Hospital, Korea. The patients were divided into hypokalemia (K+<3.5 mEq/L) and normokalemia (3.5 mEq/L< or =K+<5.5 mEq/L) groups based on the plasma potassium levels at month 13, and then clinical parameters including peritoneal function and adequacy tests and biochemical parameters were compared. Eight patients who showed hyperkalemia (K+> or =5.5 mEq/L) at month 13 were excluded from our analyses. The incidence of hypokalemia in PD patients was 7.3% in a year. The de novo hypokalemia (n=6) and normokalemia (n=68) groups had no significant differences in baseline characteristics. The serum albumin levels and normalized protein equivalent of nitrogen appearance (nPNA) at month 1 were not significantly different between the two groups. At month 13, on the other hand, serum albumin levels and nPNA were significantly lower in the hypokalemia group (P=0.014; P=0.006, respectively). Kt/Vurea, residual renal function, dialysate-peritoneal creatinine ratio, and glucose load were not significantly different between the two groups. Hypokalemia occurring after initiation of PD may largely be associated with poor nutritional status.
Creatinine ; Glucose ; Hand ; Humans ; Hyperkalemia ; Hypokalemia ; Incidence ; Korea ; Nitrogen ; Nutritional Status ; Peritoneal Dialysis ; Plasma ; Potassium ; Retrospective Studies ; Serum Albumin

Adipsia is a rare disorder that occurs due to damage to the osmoreceptor and not feeling thirst despite hyperosmolality. Adipsic hypernatremia can occur when there is damage to the anterior communicating artery that supplies blood to osmoreceptors, and the level of arginine vasopressin secretion varies widely. A 37-year-old woman, suffering from severe headache, was consulted to the nephrology department for hypernatremia and polyuria after clipping of a ruptured aneurysm in the anterior communicating artery. Despite her hypernatremic hyperosmolar state, she denied thirst and did not drink spontaneously. She was diagnosed adipsic hypernatremia by evaluating the osmoregulatory and baroregulatory function tests.Because adipsic hypernatremia is caused by not enough drinking water even for hyperosmolality due to the lack of thirst stimulus, the strategies of treatment are that setting the target body weight when serum osmolality is normal and have the patient drink water until patient reach the target body weight. Adipsic hypernatremia should be considered to be a rare complication of subarachnoid hemorrhage associated with an anterior communicating artery aneurysm.

T50 is a novel serum-based marker that assesses the propensity for calcification in serum. A shorter T50 indicates a greater propensity to calcify and has been associated with cardiovascular disease and mortality among patients with chronic kidney disease. The factors associated with T50 and the correlation between T50 and bone mineral density (BMD) are unknown in hemodialysis (HD) patients. Methods: This cross-sectional study included 184 patients undergoing HD. Individuals were grouped into tertiles of T50 to compare the demographic and disease indicators of the tertiles. Linear regression was used to evaluate the association between T50 and hip and spinal BMD in a multivariate model. Results: Mineral and inflammatory parameters, including serum phosphate (r = –0.156, p = 0.04), albumin (r = 0.289, p < 0.001), and high-sensitivity C-reactive protein (r = –0.224, p = 0.003) levels, were associated with T50. We found a weak association between T50 and BMD in the total hip area in the unadjusted model (β = 0.030, p = 0.04) but did not find a statistically significant association with the total hip (β = 0.017, p = 0.12), femoral neck (β = –0.001, p = 0.96), or spinal BMD (β = 0.019, p = 0.33) in multivariable-adjusted models. Conclusion: T50 was moderately associated with mineral and inflammatory parameters but did not conclusively establish an association with BMD in HD patients. Broad-scale future studies should determine whether T50 can provide insights into BMD beyond traditional risk factors in this population.

The timing for dialysis initiationis still debated. The aim of this study was to compare mortality rates, using a propensity-score approach, in dialysis patients with early or late starts. From January 2000 to June 2009, incident adult patients (n = 836) starting dialysis for end-stage renal disease (ESRD) were enrolled. The patients were assigned to either an early- or late-start group depending on the initiation time of the dialysis. After propensity-score-basedmatching, 450 patients remained. At the initiation of dialysis, the mean estimated glomerular filtration rate (eGFR) was 11.1 mL/min/1.73 m2 in the early-start group compared with 6.1 mL/min/1.73 m2 in the late-start group. There were no significant differences in survival between the patients in the early- and late-start groups (Log rank tests P = 0.172). A higher overall mortality risk was observed in the early-start group than in the late-start group for the patients aged > or = 70 yr (hazard ratio [HR]: 3.29; P = 0.048) and/or who had albumin levels > or = 3.5 g/dL (HR: 2.53; P = 0.046). The survival of the ESRD patients was comparable between the patients in the early and late-start groups. The time to initiate dialysis should be determined based on clinical findings as well as the eGFR.
Adult ; Age Factors ; Aged ; Female ; Glomerular Filtration Rate ; Humans ; Kaplan-Meier Estimate ; Kidney Failure, Chronic/diagnosis/*mortality ; Male ; Middle Aged ; Propensity Score ; Proportional Hazards Models ; *Renal Dialysis ; Risk Factors ; Serum Albumin/analysis ; Time Factors

PURPOSE: Hyponatremia occurs infrequently in patients undergoing peritoneal dialysis (PD). Nevertheless, one must understand its pathophysiology, since the therapeutic strategy differs from that of non- PD-related hyponatremia. This study examined the clinical features of hyponatremia in PD and evaluated the factors that may contribute to its development. METHODS: We retrospectively enrolled 51 normonatremic PD patients at Gachon University Gil Hospital, South Korea. Using the plasma sodium levels at month 13, the patients were divided into hyponatremia (Na+ <135 mEq/L) and normonatremia (Na+ > or = 135 mEq/L) groups. Then, the clinical variables of these patients were examined, including peritoneal function and adequacy tests, and biochemical parameters. RESULTS: The de novo hyponatremia (n=8) and normonatremia (n=43) groups had no significant differences in baseline characteristics. At month 1, the serum albumin was lower in the hyponatremia group (p=0.022). In the peritoneal equilibration test analysis, the dialysate-to-plasma ratio for creatinine (D/ P(Cr)) measured after 13 months differed significantly between the two groups (p=0.007), while the maximum dip in sodium did not differ. No significant differences were observed in the normalized protein equivalent of nitrogen appearance, Kt/V, or residual renal function. CONCLUSION: Our data suggest that the development of hyponatremia is associated with a lower initial serum albumin level and increased D/P(Cr) in patients undergoing PD. Therefore, the serum sodium levels should be monitored more carefully in these patients.
Creatinine ; Humans ; Hyponatremia ; Nitrogen ; Peritoneal Dialysis ; Plasma ; Republic of Korea ; Retrospective Studies ; Serum Albumin ; Sodium

The long-term clinical benefits of vascular access blood flow (VABF) measurements in hemodialysis (HD) patients have been controversial. We evaluated whether early VABF may predict long-term vascular access (VA) patency in incident HD patients. We enrolled 57 patients, of whom 27 were starting HD with arteriovenous fistulas (AVFs) and 30 with arteriovenous grafts (AVGs). The patients' VABF was measured monthly with the ultrasound dilution technique over the course of the first six months after the VA operation. During the 20.4-month observational period, a total of 40 VA events in 23 patients were documented. The new VA events included 13 cases of stenosis and 10 thrombotic events. The lowest quartile of average early VABF was related to the new VA events. After adjusting for covariates such as gender, age, hypertension, diabetes, VA type, hemoglobin levels, body mass index, parathyroid hormone, and calcium-phosphorus product levels, the hazard ratio of VABF (defined as <853 mL/min in AVF or <830 mL/min in AVG) to incident VA was 3.077 (95% confidence interval, 1.127-8.395; P=0.028). There were no significant relationships between early VABF parameters and VA thrombosis. It is concluded that early VABF may predict long-term VA patency, particularly VA stenosis.
Blood Vessel Prosthesis/*statistics & numerical data ; Female ; Graft Occlusion, Vascular/*diagnosis/*epidemiology ; *Graft Survival ; Humans ; Indicator Dilution Techniques/statistics & numerical data ; Kidney Function Tests/*statistics & numerical data ; Korea/epidemiology ; Male ; Middle Aged ; Prevalence ; Prognosis ; Renal Dialysis/*statistics & numerical data ; Reproducibility of Results ; Risk Assessment ; Risk Factors ; Sensitivity and Specificity ; Treatment Outcome ; *Vascular Patency

BACKGROUND: Although adequate removal of small solutes are essential for effective hemodialysis, many patients are suffering from inadequate delivery of hemodialysis, especially with the conventional fixed regimen of dialysis for 4 hours three times per week. We tried to evaluate actual delivered dose of hemodialysis in patients receiving 4 hours of low-flux hemodialysis, and to analyze factors affecting inadequate delivery of hemodialysis. METHODS: 97 stable maintenance hemodialysis patients who were undergoing 4 hours of hemodialysis thrice weekly were included for analysis. Prescribed dose of dialysis was calculated by Kt/V where K was in vitro urea clearance of dialyzer membrane and V was estimated according to the Watson's formula. Delivered dose of dialysis was calculated according to the Daugirdas equation. To find factors that may impair adequate delivery of hemodialysis, various clinical and technical parameters were analyzed. RESULTS: Prescribed dose of hemodialysis was 1.37+/-0.21, while delivered dose was 1.23+/-0.27, and thus, there was a significant difference (p <0.03). In 45% of the patients, delivered dose was less than 1.2. They were heavier and prescribed dose was low. delta Kt/V (Prescribed dose-Delivered dose) was significantly greater in patients who did not use heparin therapy compared to patients who used heparin. Other parameters such as hypotension, missed treatment, sex, type of vascular access and degree of recirculation were not associated with impaired delivery of hemodialysis.
Dialysis* ; Heparin ; Humans ; Hypotension ; Membranes ; Renal Dialysis* ; Urea