Abstract Objectives Acute kidney injury (AKI) is frequent event in patients with acute heart failure (AHF) and is associated with poor short and longterm outcome. Aim of the study was to decribe diagnostic yield of selected novel biomarkers in prediction of AKI in patients addmitted for AHF. Methods We performed a prospective cohort study of 72 consecutive patients (46/26 M/F) aged 69±10,3 years admitted for AHF. Renal damage was defined according to KDIGO guidelines. Patients were divided into two groups: AKI- (without renal injury, n=52) and AKI+ (with renal injury, n=20). Urine samples for AKI biomarkers measurements (NGAL, TIMP2, IGFBP7) were collected at admission. The ROC and linear logistic regression of new biomarkers and selected clinical variables was performed for evaluation of the AKI prediction. Results Patients with AKI + were older (median age: 75 vs. 64 years, p=0,01), had lower BMI (median: 28 vs. 29,5 kg/m2, p=0,04), were with higher proportion of patients with HF with reduced ejection fraction (55% vs 23,1%, p=0,01) and higher level of serum NTproBNP. Urinary NGAL at admission was significantly higher in the AKI+ compared to AKI – group (152 vs. 19,5 ng/ml, p <.0001); also median of u-TIMP-2 and u-IGFBP-7 in the AKI+ patients were significantly higher: 194,1 versus 42,5 ng/ml (p<0.0001) and 379 versus 92,4 pg/ml (p<0.0001) resp. Age, u-NGAL, u-TIMP2, u-IGFBP7, s-hemoglobin, NTproBNP and LVEF were associated with the development of AKI. Urine concentration IGFBP-7 performs the best for the prediction AKI (AUC 0,94). Conclusion Urine concentrations of NGAL, TIMP2, IGFBP7 at the time of admission for AHF predict developement of AKI. Age, NTproBNP, LVEF and s-hemoglobin are also associated with AKI in AHF patients. Acknowledgement/Funding Project was supported by Slovak Society of Cardiology research grant 2015-2018.
Poor blood pressure control in chronically haemodialysed patients leads to increased cardiovascular morbidity and mortality. Information on valid values of blood pressure during haemodialysis and out of office is very important in order to set up adequate treatment.To measure blood pressure during the haemodialysis and the subsequent 24-hour period using an ambulatory blood pressure monitoring (ABPM) in patients with normal blood pressure (BP) and patients with high normal BP and hypertension. Relationship between time-dependent blood pressure changes, ultrafiltration (UF) and interdialytic weight gain (IDWG) was analysed.Fifty chronically haemodialysed (> 3 months) patients (males/females 33/18) aged 57.5 (53-63; median, interquartile interval) years were studied. Systolic and diastolic pressures (SP, DP) were measured during haemodialysis every hour (H0-H4) and over following 24 hours using Spacelab 90217 monitor. Pulse pressure (PP) values were calculated as a difference between SP and DP. The patients were stratified into two groups based on the cut-off-point calculated as the mean of two mean arterial pressure (MAP) values obtained at the beginning and after the first hour of HD: Group A (n = 25), MAP < 100 mm Hg; Group B (n = 25), MAP 100 mm Hg. Interdialytic weight gain was measured before HD (IDWG1) and after the ABPM (IDWG2); also ultrafiltration (UF) was obtained. The post-dialysis 24-h ABPM period was divided into eight 3-hour intervals (M1-8).During HD no significant change in SP, DP or PP was found in both group, but there was a significant difference (p = 0.01) between both groups in SP, DP and PP. Values of BP at the end of dialysis were in group A: SP 125 (120-130) mm Hg, DP 75 (60-80) mm Hg and PP 50 (40-60) mm Hg in group B: SP 150 (140-160) mm Hg, DP 80 (80-90) mm Hg a PP 60 (60-70) mm Hg. We did not find any influence of IDWG1 or IDWG2 on SP or DP in both groups. Relationship between UF 3 000 (2 500-4 300) ml and SP (Δ sTK -5 mm Hg) was confirmed only in group A (p = 0.04). In group A, we found a decrease in SP during the third and sixth 3-hour interval (p = 0.01; p = 0.02) including sleeping period, all compared to the end of HD (H4). In group B, such a decrease in SP was found only in the second sleep interval (p = 0.01) and in the sixth 3-hour interval (p = 0.03), all compared to the end of HD (H4). As to DP at the end of dialysis (H4) in group A, it differed only in the third 3-hour interval (p = 0.02), but not during the sleeping period. In group B, the decrease of DP compared to the end HD (H4) was recorded during the two sleep intervals (p = 0.01), and also in the sixth and seventh 3-hour intervals (p = 0.01; p = 0.03). In group A, PP was compared to the end of HD (PPH4) significantly decreased in the first 3-hour interval (p = 0.02) and in seventh and eight 3-hour interval (p = 0.03; p = 0.04). In group B, PP did not significant change from the end of HD. Difference in SP between both groups was maintained over the entire course of ABPM (p = 0.01). However, DP values in both groups were different in the first and third 3-hour intervals (p = 0.01) but in following intervals DP in group B decreased to the level of that in group A. There was no significant difference in the proportion of non-dippers and reverse dippers in both groups.Systolic, diastolic, mean arterial and pulse pressure pressures were not significantly changed during the haemodialysis in both groups. Relationship between ultrafiltration and systolic pressure was confirmed only in group A. No influence of interdialytic weight gain on blood pressure during 24 hours was seen in either group. Systolic pressure decreased in both groups during the nighttime compared to post-HD values, but diastolic pressure decreased only in group B. PP did not decrease during the night in any group. There was no significant difference in the proportion of non-dippers and reverse dippers in both groups.
In 22 patients (age 19 to 73 years) the authors examined the glomerular filtration by assessing the renal clearance of 51Cr-EDTA in addition to the plasmatic method with several blood samples, methods with a smaller number of blood samples and external assessment of the radioactivity, or else by estimation of the creatinine clearance by biochemical methods. They used as the reference method assessment of the renal plasma clearance of 51Cr-EDTA by means of a one-compartment model from the radioactivity of blood samples collected during the 60th, 120th and 180th minute. It was revealed that for the normal value of glomerular filtration (GF = 1.8 ml/s) and for its reduced value (GF = 0.5 ml/s), as compared with the reference method RP, the highest external and internal accuracy, i.e. the best agreement with the reference method and the closest interval estimates, are obtained by the single sample method RE (blood sample during the 120th minute), supplemented by three external assessments of radioactivity during the 50th-70th, 110th-130th and 170th-190th minute. The regression relationship of these methods is expressed by the following equations: RE = -8.9 + 1.06 . RP; RP = 8.47 + 0.94 . RE. The biochemical methods were, as compared with the radionuclide ones, less accurate. Their accuracy declined in the order from the calculated creatinine clearance according to Cockcroft and Gault via the inverse value of the serum creatinine concentration towards the 24-hour creatinine clearance.
A series of 72 type I diabetics was grouped according to the mean value of 24-h albuminuria (AU) determined from three 24-h urine collections: group A (n = 49, normoalbuminuria, AU less than or equal to 26 mg/24 h), group B (n = 16, microalbuminuria, AU less than or equal to 26 mg/24 h), group C (n = 7, clinically significant proteinuria, AU greater than 260 mg/24 h). Glycosylated hemoglobin (GHb) was examined five times in three-month intervals. Systolic and diastolic blood pressure (BPs and BPD) were determined from four values taken in the course of one year. Glomerular filtration (GF) was established a single examination of 24-h creatinine clearance. Fluorescent angiography was used to examine the fundus of the eye. The function of the cardiovascular autonomic nervous system was assessed on the basis of three tests: variation of heart rate during deep respiration, response of heart rate to upright position, Valsalva's maneuver. Group C had the longest duration of diabetes, the highest GHb, the lowest GF, and the highest BPS and BPD values. The number of diabetics with different findings on the fundus of the eye (normal finding/simple retinopathy/preproliferative and proliferative retinopathy) was as follows: group A--15/31/3, group B--9/6/1, group C--0/3/4. Group C exhibited the most pronounced derangement of the cardiovascular autonomic nervous system, whose extent depended on the length of diabetes duration and on the quality of metabolic compensation. Between the groups A and B no significant differences were found in any of the parameters studied.(ABSTRACT TRUNCATED AT 250 WORDS)
ABSTRACT. Diabetic nephropathy may be effectively prevented and treated by controlling glycemia and administering angiotensin-converting enzyme (ACE) inhibitors. However, strict metabolic control can be difficult, and ACE inhibitors may be poorly tolerated and only partially effective, particularly in diabetes mellitus type 2 (DM2), warranting the search for ancillary treatment. Sulodexide is a glycosaminoglycan, a new class of drug that has demonstrated nephroprotective activity in experimental investigations. The Di.N.A.S. study was a randomized, double-blind, placebo-controlled, multicenter, dose-range finding trial to evaluate the extent and duration of the hypoalbuminuric effect of oral sulodexide in diabetic patients. A total of 223 microalbuminuric and macroalbuminuric DM1 and DM2 patients with serum creatinine ≤150 μmol/L and stable BP and metabolic control were recruited. They were randomly allocated to one of four groups: 50 mg/d, 100 mg/d, or 200 mg/d sulodexide daily or placebo for 4 mo (T0 to T4), with 4 mo of follow-up after drug suspension (T4 to T8). Treatment with 200 mg/d sulodexide for 4 mo significantly reduced log albumin excretion rate (logAER) from 5.25 ± 0.18 at T0 to 3.98 ± 0.11 at T4 (P < 0.05), which was maintained till T8 (4.11 ± 0.13; P < 0.05 versus T0). Moreover, the sulodexide-induced percent reductions in AER at T4 were significantly different from the placebo value at T4 and approximately linear to dose increments (30% [confidence limits, 4 to 49%], P = 0.03; 49% [30 to 63%], P = 0.0001; and 74% [64 to 81%], P = 0.0001 in the sulodexide 50, 100, and 200 mg/d groups, respectively. At T8, the sulodexide 200 mg/d group maintained a 62% (45 to 73%) AER significant reduction versus placebo (P = 0.0001). Subanalysis by type of diabetes (DM1 versus DM2, microalbuminuric versus macroalbuminuric, or on concomitant ACE inhibitors versus not on ACE inhibitors) demonstrated similar findings. These effects were obtained without any significant variation in metabolic control and BP or serum creatinine. Very few adverse events were reported; none were serious. In conclusion, a 4-mo course of high doses of sulodexide significantly and dose-dependently improves albuminuria in DM1 and DM2 patients and micro- or macroalbuminuric patients with or without concomitant ACE inhibition. The effect on albuminuria is long-lasting and seemingly additive to the ACE inhibitory effect.
Epidemiological studies show increasing prevalence of diabetic nephropathy. Diabetic patients with chronic kidney disease are the biggest group from among patients on renal replacement therapy. Renal Pathology Society developed pathological classification of diabetic nephropathy. The cardinal biochemical diagnostic parameters are albuminuria and estimated glomerular filtration rate. European Renal Best Practice work group developed Clinical Practice Guideline on management of patients with diabetes and chronic kidney disease stage 3b or higher.epidemiology of diabetic nephropathy - diagnostics of diabetic nephropathy - therapy of chronic kidney disease in diabetic patients.
Les modeles d'evaluation d'actifs traditionnels ne parviennent pas a expliquer la coupe transversale des rendements des actions. La finance d'entreprise contribue a l'identification des mecanismes sous-jacents de ces regularites non-expliquees. Cette these etudie de nouveaux determinants des rendements avec une vision fondamentale de l'entreprise. Le premier chapitre etudie la pertinence economique de quatre elements non-operationnels des profits comptables. Nous etudions dans le second chapitre l'effet des contraintes financieres et de la concurrence sur le risque fondamental de l'entreprise. Nous montrons que l'interaction entre ces deux facteurs amplifie le risque fondamental, mais qu'elle n'est pas refletee dans les valorisations. Le troisieme chapitre analyse le lien entre l'intensite salariale, le levier operationnel et les rendements esperes des actions. Nous trouvons un effet positif de l'intensite salariale sur les rendements esperes des petites et moyennes capitalisations
AIM To analyze factors after successful direct-current cardioversion in patients with atrial fibrillation and to explore late recurrences of the arrhythmia. METHODS Forty-three patients with atrial fibrillation without associated valvular heart disease, who underwent non-emergent cardioversion within the years 2002-2006, were included. We retrospectively analyzed clinical data from the medical records. Late reccurence of the arrhythmia was defined as arrhythmia in patients discharged with sinus rhythm. RESULTS Median follow-up of the patients was 33 (17, 48) months. We found 20 late recurrences of atrial fibrillation in the total group of 43 patients after successful direct-current cardioversion (46.5%). In a 6-month period after direct-current cardioversion the recurrence of arrhythmia was found in two patients, in a one-year period in 6 patients and in a period longer than one year in 12 patients. Median time to recurrence was 15 (6, 33) months. Females relapsed more frequently than males (p < 0.02), what could be explained by higher age, incidence of hypertension and thyreopathy in females. Patients with a history of thyropathy had more frequent occurrence of arrhythmia, despite normal values of TSH, as compared to patients without a history of thyropathy (p < 0.04). Patients with recurrence of the atrial fibrillation had higher systolic pressure (130 vs 120 mm Hg, p < 0.05) and pulse arterial pressure (50 vs 40 mm Hg, p < 0.01) after cardioversion. No significant difference between the two groups in age, left atrium diameter, left ventricle ejection fraction and cardiovascular, or non-cardiovascular risk factors was found. CONCLUSION Despite successful direct-current cardioversion, the risk of late recurrence of the atrial fibrillation in a following period is at least 46.5%. Females, patients with a history of thyropathy and those with higher systolic and pulse arterial pressures are at higher risk of late recurrences.
