Abstract:
BACKGROUND:Persons with chronic kidney disease (CKD) represent a population prone to cardiovascular disease (CVD) but vulnerable to adverse medication effects. We assessed the impact of intensive antihypertensive therapy on the cerebrovascular and other CVD outcomes in high-risk patients with type 2 diabetes and baseline CKD. METHODS:Using current guideline criteria, 1,726 (36.9%) of 4,678 participants in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) blood pressure (BP) arm had mild to moderate CKD (CKD1-3B) at baseline. Participants of this study were randomized to intensive (systolic <120 mm Hg) or standard (systolic <140 mm Hg) BP goals. Fatal and non-fatal stroke were pre-specified secondary outcomes of the ACCORD study. RESULTS:Total cerebrovascular events were significantly higher in participants with baseline CKD (0.66%/year) compared with participants free of CKD (0.28%/year). A significantly higher rate of events was observed in CKD participants. Intensive antihypertensive therapy in participants without CKD at baseline resulted in a 55% significant reduction of any stroke (hazard ratio 0.447; 95% CI 0.227-0.880) and a 50% reduction of non-fatal stroke (hazard ratio 0.498; 95% CI 0.250-0.993). In participants with CKD at baseline, the occurrence of any stroke was reduced by 38% (hazard ratio 0.623; 95% CI 0.361-1.074) and non-fatal stroke by 36% (hazard ratio 0.642; 95% CI 0.361-1.142). Test for interaction was NS between the 2 groups. Changes in other CVD outcomes did not reach statistical significance. CONCLUSIONS:These findings suggest that intensive antihypertensive therapy offers significant cerebrovascular protection in diabetic participants without CKD at baseline, but significant benefit to patients with CKD cannot be excluded.
journal_name
Am J Nephroljournal_title
American journal of nephrologyauthors
Papademetriou V,Zaheer M,Doumas M,Lovato L,Applegate WB,Tsioufis C,Mottle A,Punthakee Z,Cushman WC,ACCORD Study Group.doi
10.1159/000446122subject
Has Abstractpub_date
2016-01-01 00:00:00pages
271-80issue
4eissn
0250-8095issn
1421-9670pii
000446122journal_volume
43pub_type
杂志文章,多中心研究,随机对照试验abstract:BACKGROUND:Conditionally immortalized podocytes are valuable research tools but are difficult to efficiently transfect and do not provide graded transgene expression. METHODS:Conditionally immortalized mouse podocyte cell lines were established employing a tetracycline-inducible system. Glomerular cells, isolated from...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000151770
更新日期:2009-01-01 00:00:00
abstract::Renal function and life expectancy can be improved by aggressive antihypertensive therapy in severe hypertension. However, most reports of severe hypertension and renal failure concern primary hypertensive states. 3 cases of primary renal disease, 1 glomerular, 1 obstructive and 1 of chronic pyelonephritis, are descri...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000166576
更新日期:1982-01-01 00:00:00
abstract::Acute hyperammonemia is an emergent cause of central nervous system dysfunction for which renal replacement therapy is advocated. We report the successful use of continuous venovenous hemodiafiltration in this metabolic emergency, and report the calculated ammonia clearances for both continuous venovenous hemofiltrati...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000013400
更新日期:1998-01-01 00:00:00
abstract::The objective was to evaluate the effect of high-flux hemodialysis on quality of life, intra- and interdialytic symptoms and neuropsychological function. The study was double-blind single cross-over with random allocation to order of treatment. The patients were stable adult hospital hemodialysis patients. Both the co...
journal_title:American journal of nephrology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1159/000168491
更新日期:1992-01-01 00:00:00
abstract:BACKGROUND:Dietary acid load (DAL) contributes to the risk of CKD and CKD progression. We sought to determine the relation of DAL to racial/ethnic differences in the risk of end-stage renal disease (ESRD) among persons with CKD. METHODS:Among 1,123 non-Hispanic black (NHB) and non-Hispanic white (NHW) National Health ...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000487715
更新日期:2018-01-01 00:00:00
abstract:BACKGROUND/AIMS:A recent study suggests that inflammation and malnutrition are strongly associated with cardiovascular disease in dialysis patients. Endothelial lipase (EL) is a newly cloned physiological regulator of high-density lipoprotein cholesterol (HDL), which is associated with the progression of atherosclerosi...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000144025
更新日期:2008-01-01 00:00:00
abstract::Heavy proteinuria in patients with essential hypertension raises the question of underlying primary renal disease. While malignant hypertension may be associated with proteinuria in the nephrotic range, it is generally held that protein excretion in benign nephrosclerosis is almost invariably less than 0.5-1.0 g/24 h....
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000166931
更新日期:1985-01-01 00:00:00
abstract:UNLABELLED:Although it is anticipated that most patients with renal insufficiency will progress towards end-stage renal disease (ESRD) there have been few population-based studies to validate this assumption. We examined serial creatinines from 3,874 anonymous patients at an urban VA medical center who had a baseline c...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000046280
更新日期:2001-09-01 00:00:00
abstract:BACKGROUND:There has been an increasing incidence of hemodialysis (HD) due to old age and comorbid condition such as diabetes. In general, socioeconomic status (SES) is known as one of the most important risk factors for patient mortality and morbidity. Whether low SES is associated with poorer outcome in HD patients i...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000512855
更新日期:2021-01-13 00:00:00
abstract::A patient with unilateral gross hematuria was found to have mesangial proliferation and IgM deposition on renal biopsy, consistent with the entity of primary renal hematuria. This case refutes previous assumptions that renal biopsy is normal in patients with unilateral hematuria. Glomerular lesions may be more common ...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000167127
更新日期:1986-01-01 00:00:00
abstract::Forty-eight chronic hemodialysis patients were divided comparably into two groups (24 patients in each). Two micrograms of 1 alpha(OH)D3 was administered to one group for 3 months and its placebo to the other group. In the 1 alpha(OH)D3-treated group, serum total calcium increased from 7.82 +/- 0.11 (mean +/- SEM) to ...
journal_title:American journal of nephrology
pub_type: 临床试验,杂志文章
doi:10.1159/000167658
更新日期:1988-01-01 00:00:00
abstract:BACKGROUND:A poor nutritional state is associated with an increased risk of cardiovascular events in end-stage renal disease. It is unclear whether malnutrition itself can induce cardiovascular disease (CVD). We examined the impact of nutritional status on patients' arterial stiffness in peritoneal dialysis (PD) patien...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000206697
更新日期:2009-01-01 00:00:00
abstract:BACKGROUND:Obesity is an independent risk factor for morbidity and mortality in cardiovascular diseases not only in the general population, but also in hemodialysis (HD) patients. We previously reported that an increased visceral fat area (VFA) determined using computed tomography (CT) scans was associated with atheros...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000358335
更新日期:2014-01-01 00:00:00
abstract:BACKGROUND:Health-related quality of life (HRQOL) reflects a patient's perceived disease burden, treatment effectiveness, and health status. Given the time burden and physiologic effects of hemodialysis, patients who spend dialysis time (9-15 h/week) physically or intellectually engaged may have better HRQOL. We charac...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000492623
更新日期:2018-01-01 00:00:00
abstract::A 50-year-old woman presented with thrombocytopenia, microangiopathic hemolytic anemia, and nephrotic syndrome. Although a high level of circulating immune complexes, mild hypocomplementemia, and the antinuclear antibody also were present, the criteria for collagen disease were not fulfilled. Renal biopsy demonstrated...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000013326
更新日期:1998-01-01 00:00:00
abstract::Collapsing glomerulopathy is a pattern of renal injury that is seen in association with human immunodeficiency virus (HIV) infection. Patients with this HIV-associated nephropathy (HIVAN) present nephrotic syndrome and rapid deterioration of the renal function. There is no proven effective therapy for HIVAN, and the m...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000065229
更新日期:2002-07-01 00:00:00
abstract:BACKGROUND/AIMS:Intradialytic hypotension is the most common complication of modern day haemodialysis (HD). Convective modalities, including haemodiafiltration (HDF) are reported to result in greater cardiovascular stability compared to standard HD, which has been suggested to be due to improved solute transport betwee...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000349925
更新日期:2013-01-01 00:00:00
abstract:BACKGROUND:Estimating total body water (TBW) is crucial in determining dry weight and dialytic dose for hemodialysis patients. Several anthropometric equations have been used to predict TBW, but a more accurate method is needed. We developed an artificial neural network (ANN) to predict TBW in hemodialysis patients. M...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000088279
更新日期:2005-09-01 00:00:00
abstract:BACKGROUND/AIMS:The shortage in organ supply has required the use of expanded criteria donors (ECD) for kidney transplantation. Current pre-transplant evaluations of ECD organs are based on histological, clinical or mixed criteria. This monocentric study investigates the predictivity of Karpinski's histological score o...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000346257
更新日期:2013-01-01 00:00:00
abstract:BACKGROUND/AIM:While the familial nature of chronic kidney disease (CKD) has been recognized, it has primarily been defined from studies of first-degree relatives of selected sets of cases. The goal of this study is an evaluation of the familial clustering of end-stage renal disease (ESRD) and CKD mortality using a pop...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000092280
更新日期:2006-01-01 00:00:00
abstract:BACKGROUND:It has been demonstrated that phosphate uptake through the type III sodium-dependent phosphate co-transporter, Pit-1, induced apoptosis of aortic vascular smooth muscle cells and endothelial cells in vitro. However, the apoptotic effects of high phosphate (HP) level in human peritoneal mesothelial cells (HPM...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000329081
更新日期:2011-01-01 00:00:00
abstract::A patient with advanced chronic renal failure secondary to polycystic kidney disease suffered an episode of volume contraction during which his urinary sodium concentration fell to less than 5 mEq daily. Urine sodium excretion remained at this level when later in his course he became clinically volume expanded. The pa...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000166535
更新日期:1981-01-01 00:00:00
abstract::To verify if exogenous prostaglandin E2 (PGE2) is able to release antidiuretic hormone (ADH) and if endogenous angiotensin II plays a role in this eventual PGE2-induced stimulation of vasopressin, increasing doses of PGE2 were infused in 6 normal volunteers before (PGE2 study) and after the administration of 100 mg of...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000167982
更新日期:1989-01-01 00:00:00
abstract:BACKGROUND:Predicting the mortality risk of patients un-dergoing hemodialysis (HD) is challenging. Cell-free DNA (cfDNA) is released into circulation from dying cells, and its elevation is predictive of unfavorable outcome. In a pilot study, we found post-HD cfDNA level to be a predictor of all-cause mortality. Thus, t...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000510771
更新日期:2020-01-01 00:00:00
abstract:BACKGROUND:Chronic kidney disease (CKD) is increasingly common and disproportionately affects older adults. The contribution of kidney disease to the functional impairment noted in the elderly CKD population is unclear. METHODS:This is a cross-sectional analysis of a hypertensive cohort of people aged ≥75 years from t...
journal_title:American journal of nephrology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1159/000455388
更新日期:2017-01-01 00:00:00
abstract:BACKGROUND:There is a higher risk of gastrointestinal (GI) bleeding in patients treated with dabigatran versus warfarin. We analyzed the impact of renal function on the relative risk of bleeding in patients converted to dabigatran. METHODS:Patients aged ≥65 years who received anticoagulation with warfarin for a minimu...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000446848
更新日期:2016-01-01 00:00:00
abstract:BACKGROUND:Tacrolimus is mainly metabolized by cytochrome P450 3A5 (CYP3A5), which is expressed in the liver. However, CYP3A5 is also expressed in the kidney tissue and may contribute to local tacrolimus clearance in the kidney allograft. We aimed to evaluate the association between the allograft CYP3A5 genotype and tr...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000487857
更新日期:2018-01-01 00:00:00
abstract:BACKGROUND:Almost 20 million people in the US have chronic kidney disease (CKD). Cardiovascular disease and arterial wall abnormalities are common in this population. Because angiotensin II may have adverse effects on the arterial wall, we hypothesized that an angiotensin receptor blocker (ARB) would improve arterial c...
journal_title:American journal of nephrology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1159/000087211
更新日期:2005-07-01 00:00:00
abstract:BACKGROUND:Transplant glomerulopathy (TG) represents a major cause of long-term allograft failure and is the leading cause of overall post-transplant proteinuria. The extent to which histopathologic features predicts prognostication is uncertain. METHODS:A single-center retrospective cohort with biopsy-proven TG was i...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000500043
更新日期:2019-01-01 00:00:00
abstract:OBJECTIVE:Anthropometric parameters may play a role in modulating the risk of kidney dysfunction. The aim of this study was to evaluate whether anthropometric indices and the metabolic syndrome are associated with alterations of the renal resistive index (RI) in normoalbuminuric type 2 diabetic (T2DM) patients. METHOD...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000109239
更新日期:2008-01-01 00:00:00