Treatment of Hypertension in Italian Nephrology Out-patient Clinics: The THIN Study

Russo, Domenico; Andreucci, Michele; Blasio, Antonella De; Frattolillo, Paolo; Andreucci, Vittorio E.

doi:10.1016/j.semnephrol.2005.05.015

Cited by 5 publications

(4 citation statements)

References 17 publications

(19 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…6-month follow up of Nephrology care, less than 15% of patients had blood pressure at target (<130/80 mmHg) and more than 80% patients showed an excessive salt intake not counterbalanced by an adequate treatment with loop diuretics, usually prescribed successfully by clinicians (Andreucci et al, 1999). However, the frequency of patients who had a better controlled hypertension significantly increased (up to 75% of patients) after 12 months of Nephrology care, which is generally considered a sufficient time interval for Nephrologists to intervene on the main co-morbidities (Russo et al, 2005;De Nicola et al, 2015a). Similarly, prevalence of hypercholesterolemia reached 50-60% depending on the stage of CKD (De Nicola et al, 2006).…”

Section: The Tertiary Nephrology Care Settingmentioning

confidence: 99%

Unraveling Cardiovascular Risk in Renal Patients: A New Take on Old Tale

Provenzano

Coppolino

Nicola

et al. 2019

Front. Cell Dev. Biol.

Self Cite

View full text Add to dashboard Cite

Chronic kidney disease (CKD), defined by an estimated glomerular filtration rate <60 ml/min/1.73 m 2 and/or an increase in urine protein excretion (i.e., albuminuria), is an important public health problem. Prevalence and incidence of CKD have risen by 87 and 89%, worldwide, over the last three decades. The onset of either albuminuria and eGFR reduction has found to predict higher cardiovascular (CV) risk, being this association strong, independent from traditional CV risk factors and reproducible across different setting of patients. Indeed, this relationship is present not only in high risk cohorts of CKD patients under regular nephrology care and in those with hypertension or type 2 diabetes, but also in general, otherwise healthy population. As underlying mechanisms of damage, it has hypothesized and partially proved that eGFR reduction and albuminuria can directly promote endothelial dysfunction, accelerate atherosclerosis and the deleterious effects of hypertension. Moreover, the predictive accuracy of risk prediction models was consistently improved when eGFR and albuminuria have been added to the traditional CV risk factors (i.e., Framingham risk score). These important findings led to consider CKD as an equivalent CV risk. Although it is hard to accept this definition in absence of additional reports from scientific Literature, a great effort has been done to reduce the CV risk in CKD patients. A large number of clinical trials have tested the effect of drugs on CV risk reduction. The targets used in these trials were different, including blood pressure, lipids, albuminuria, inflammation, and glucose. All these trials have determined an overall better control of CV risk, performed by clinicians. However, a non-negligible residual risk is still present and has been attributed to: (1) missed response to study treatment in a consistent portion of patients, (2) role of many CV risk factors in CKD patients not yet completely investigated. These combined observations provide a strong argument that kidney measures should be regularly included in individual prediction models for improving CV risk stratification. Further studies are needed to identify high risk patients and novel therapeutic targets to improve CV protection in CKD patients.

show abstract

Section: The Tertiary Nephrology Care Settingmentioning

confidence: 99%

Unraveling Cardiovascular Risk in Renal Patients: A New Take on Old Tale

Provenzano

Coppolino

Nicola

et al. 2019

Front. Cell Dev. Biol.

Self Cite

View full text Add to dashboard Cite

show abstract

“…Optimizing risk stratification of chronic kidney disease (CKD) patients referred to tertiary nephrology care is a central issue of current Nephrology research because identification of high-risk patients allows nephrologists to better focus on patients who require closer monitoring and treatment to improve outcome as well as timely planning of renal substitutive therapy [1][2][3][4][5][6]. In the past few years there has been a growing attention to markers of subclinical renal damage, because they provide an accurate prediction of global cardio-renal outcome.…”

Section: Introductionmentioning

confidence: 99%

Renal resistive index in chronic kidney disease patients: Possible determinants and risk profile

et al. 2020

Self Cite

View full text Add to dashboard Cite

BackgroundHigh ultrasound renal resistive index (RI) predicts poor cardiorenal outcomes in chronic kidney disease (CKD) and has recently emerged as a marker of nephroprotective drugs response. Thus, having a risk profile of CKD patients with abnormal RI may be relevant for the clinicians. MethodsConsecutive patients referred to our non-dialysis CKD clinic from 01/01/2016 to 01/12/2016, were evaluated by clinical and ultrasound analysis. Inclusion criteria were age >18 years and presence of CKD defined as estimated glomerular filtration rate (eGFR)<60 mL/min/ 1.73m 2 and/or proteinuria>0.150g/24h. Renal artery stenosis, solitary kidney, acute kidney injury were the main exclusion criteria. RI value was the mean of three measures in segmental arteries in each kidney. Univariate analysis was performed to evaluate associations between continuous RI and clinical variables. Multivariate linear regression analysis, based on stepwise method with an elimination criterion of p<0.10, was used to assess the independent correlates of RI as continuous variable. ResultsWe studied 73 patients (69.9% men). Mean RI was 0.67±0.09. Frequencies of diabetes and cardiovascular disease (CVD) were 19.2% and 20.6% and median eGFR 54.1 [30.0-84.6] mL/min/1.73m 2 . From low (<0.65) to intermediate (0.65-0.70) to high (>0.70) RI categories, eGFR and haemoglobin levels were decreased while diabetes, cardiovascular disease (CVD), phosphate and smokers were higher. At univariate analysis, RI was significantly associated with age, presence of diabetes, CVD, serum phosphorus, eGFR, Urea and haemoglobin. Multi-adjusted stepwise regression analysis showed that lower eGFR levels PLOS ONE

show abstract

“…A further important finding from previous studies is that, in CKD patients, CV disease is poorly controlled Russo et al, 2005). The TArget Blood Pressure LEvels (TABLE-CKD), a multicenter observational study, showed that in a cohort of CKD patients with CKD stage 3-5, followed for at least 6 months, less than 15% of patients were within the target blood pressure ( < 130/80 mmHg).…”

Section: Is Ckd a Risk Equivalent For Cardiovascular Events ?mentioning

confidence: 99%

Epidemiology of cardiovascular risk in chronic kidney disease patients: the real silent killer

Provenzano

Coppolino

Faga

et al. 2019

Rev. Cardiovasc. Med.

View full text Add to dashboard Cite

This is an open access article under the CC BY-NC 4.0 license (https://creativecommons.org/licenses/by-nc/4.0/). Chronic kidney disease is a growing public health problem, as its prevalence and incidence have almost doubled over the last three decades. Chronic kidney disease is defined as the presence of an estimated glomerular filtration rate < 60 ml/min/1.73 m 2 and/or proteinuria ≥ 0.150 g/24 h. It has been demonstrated that both proteinuria and reduction in estimated glomerular filtration rate can predict the development of fatal and nonfatal cardiovascular events, regardless of traditional cardiovascular risk factors, namely blood pressure, smoking habit, cholesterol, age, gender. This relationship is found in the general population, high-risk cohorts and in patients referred to Nephrologists (tertiary care). The accuracy by which proteinuria or estimated glomerular filtration rate can predict these events, exceeds that obtained by the combination of all the other traditional risk factors. These important findings have led to chronic kidney disease being considered as a cardiovascular risk equivalent. Although this needs further investigation, a great effort has been made to reduce the cardiovascular risk in chronic kidney disease patients. Indeed, many clinical trials have been carried-out testing the effect of antihypertensive, proteinuria-lowering, lipid-lowering and hypoglycemic agents on cardiovascular risk protection. All these trials reduced, but did not eliminate, the overall cardiovascular risk. Future studies should be undertaken to identify high cardiovascular risk patients and novel therapeutic targets for cardiovascular protection in chronic kidney disease patients.

show abstract

Treatment of Hypertension in Italian Nephrology Out-patient Clinics: The THIN Study

Cited by 5 publications

References 17 publications

Unraveling Cardiovascular Risk in Renal Patients: A New Take on Old Tale

Unraveling Cardiovascular Risk in Renal Patients: A New Take on Old Tale

Renal resistive index in chronic kidney disease patients: Possible determinants and risk profile

Epidemiology of cardiovascular risk in chronic kidney disease patients: the real silent killer

Contact Info

Product

Resources

About