- Email: [email protected]
Patient characteristics with intradialytic hypertension despite the drop of their dry weight
09 - Kidney Results Initial nephropathy was of vascular origin in 25% of patients; 30% had diabetic origin and 10% resulted from glomerular nephropathies. Fifty-five % of patients were hypertensive; HT was more prevalent in men with diabetes; the patients had echocardiographic abnormalities. While HT in patients treated with erythropoietin was 30%, 41% of the hypertensives had a hydro-sodic retention and 90% of the anuric patients were hypertensive. The HT was predominantly systolic in 70% of hypertensive patients. The blood pressure increased linearly with respect to the duration of the hemodialysis period. Conclusion Hypertension is common in chronic hemodialysis patients. The expansion of extracellular volume likely plays a major role in HT; underlining the need to fix dry weight for each patient and the individualisation of dialysis characteristics. Cardiac repercussions are frequent in hemodialysis patients, hence the interest of echocardiographic examination, which must be systematic and periodic for each patient undergoing extra-renal purification. Disclosure of interest The author has not supplied his declaration of competing interest. https://doi.org/10.1016/j.acvdsp.2019.05.085
Patterns of hypertension in renal transplant patients evaluated with 24 h ambulatory blood pressure monitoring Miriana Dinic ∗ , Nicolas Maillard , Guillaume Claisse , Ingrid Masson , Eric Alamartine , Christophe Mariat CHU Nord, service néphrologie, dialyse et transplantation rénale, centre HTA, 42055 Saint Etienne Cedex 2, France ∗ Corresponding author. E-mail address: [email protected] (M. Dinic) Rational Prevalence of the different patterns of hypertension in renal transplant recipients (RTR) using 24 h ambulatory blood pressure monitoring (ABPM) along with their determining factor are lacking. The aim of our study was to describe the epidemiology of hypertension in RTR, based on ambulatory blood pressure monitoring (ABPM). Methods In this cross-sectional study, prevalent RTR were proposed systematic blood pressure work-up consisting of ABPM, office blood pressure (3 consecutive blood pressure measurements performed by a nurse after 5 minutes of quiet rest) and detection of orthostatic hypotension. Optimal target was defined as BP < 130/80 mmHg for office BP. ABPM goals was defined using the ESH guidelines but we also defined another targets using only the 24 h average ABPM as seen in the literature. Results Two hundred and fifty-eight RTR underwent ABPM. Mean ABPM was 132/76 mmHg not different from the mean office BP (132/73 mmHg). Prevalence of patients with resistant hypertension and uncontrolled BP when we considered day-time and night-time values were respectively 23% and 48% versus 20% and 41% when we take into consideration only the 24 h average ABPM. Twenty % of RTR had orthostatic hypotension. When we identified the patterns of BP, 31% of patients had masked hypertension with circadian ABPM versus 20% with only 24 h average ABPM. All the patients identified as having uncontrolled BP or masked hypertension with circadian ABPM and not with 24 h average ABPM presented only nocturnal hypertension. Conclusion Our results show a suboptimal control of BP in a cohort of RTR with 20% of patients with resistant hypertension and more than 50% of patients with uncontrolled BP. ABPM is a valuable tool to detect nocturnal hypertension. Prevalence of hypertension is underestimated in RTR because of the lack of established definition of blood pressure using ABPM in this population. ABPM goals need to be better defined to assess correctly hypertension and improve the management of BP in RTR.
e367 Disclosure of interest peting of interest.
The authors declare that they have no com-
https://doi.org/10.1016/j.acvdsp.2019.05.086
Metabolic syndrome and cardiovascular risk in patients on chronic hemodialysis of University Hospital of Annaba Manel Djeddi Laboratoire de Biochimie, CHU Ibn Rochd, Annaba, Algeria E-mail address: [email protected] Introduction While cardiovascular diseases are the leading cause of death in chronic hemodialysis patients the prevalence of the metabolic syndrome in these patients is currently poorly explored. The metabolic syndrome is composed of various abnormalities, which considered separately can be considered as innocuous. However, if they are found together in the same patient, they represent a major cardiovascular risk. Objective The objective of the study was to evaluate the prevalence of the metabolic syndrome in chronic hemodialysis patients in the nephrology service of Annaba University Hospital. Methods A prospective study was conducted on 60 patients with end-stage renal failure treated by hemodialysis recruited from the nephrology and hemodialysis unit of Annaba University Hospital in Algeria. The mean patients’ age was 41.55 ± 14.1 years old with a slight male predominance, the sex ratio M/F was 1.14. The data were collected by using a questionnaire including the patient size, weight, waist circumference and blood pressure. The biochemical parameters included: blood glucose, total cholesterol, HDL-C, LDL-C and triglycerides. Results The metabolic syndrome was present in 47% of the study population. Arterial hypertension was the most common abnormality with a prevalence of 70% followed by the decrease in HDL-C and abdominal obesity in 65% and 52% of the study population, respectively. Hypertriglyceridemia was present in 40%, and hyperglycemia in 35% of the patients. The cardiovascular risk was predominantly multifactorial: 58% of patients had at least 2 risk factors associated with their hypertension. Conclusion The frequency and severity of cardiovascular and coronary complications, particularly in chronic uremia, necessitates a correction of risk factors, some of which are inherent in chronic renal failure. The evaluation of the metabolic syndrome is a mean of screening so as to prevent its complications, in particular the cardiovascular ones, the main cause of death in these patients. Disclosure of interest The author declares that she has no conflict of interest. https://doi.org/10.1016/j.acvdsp.2019.05.087
Patient characteristics with intradialytic hypertension despite the drop of their dry weight Lila Ghouti-terki ∗ , Guillaume Seret , Frederic Lavainne , Pierre-Yves Durand , Toma Ilinca , Stéphanie Coupel , Angelo Testa ECHO-Association: Néphrologie-Hémodialyse, 44400 Nantes, France ∗ Corresponding author. E-mail address: [email protected] (L. Ghouti-terki) Introduction Intradialytic hypertension (IHT), defined by an increase of 10 mmHg [1], is a frequent but poorly understood complication of hemodialysis treatment [2,3], associated with an over-risk of mortality [4]. In spite of the association with clinical signs of extracellular volume expansion, in clinical practice the attempt of a dry weight was not always associated with a normal-
e368 ization of blood pressure. The aim of our study was to investigate the clinical and biological characteristics of patients with persistent intradialytic hypertension after the drop of their dry weight (DW). Materials and methods From January 2013 to June 2013, 50 patients with IHT were identified based on the definition. According to the effect of dry weight reduction after 6 months, 2 groups of patients were described with and without effect on IHT. Demographics, clinical and biological data were analyzed. We estimated vascular status using a score. We also investigated differences in 5-year mortality and comorbidity. Results The two groups were respectively constituted by 23 and 27 patients without significant differences for gender (OR [0.23; 2.94] P = 0.78) or age (P = 0.13). The patient’s vascular status was not more high in the group 1 than in the group 2 (1.5 vs. 1.9; P = 0.26). The reduction in dry weight was the same in two groups (− 2,44 vs. − 2.57; P = 0.94), and no differences were found in the level of parathyroid hormone(169 vs. 387; P = 0.9). The number of hypertension treatments was lower in the group 2 (1.7 vs. 2,5; P = 0.05). The two group showed a similar 5year mortality (70 and 78% respectively, P = 0.75). Conclusion Despite overhydratation correction, we could not explain intradialytic hypertension by vascular status alone. After improvement of IHT, mortality rate remains high. Disclosure of interest The author declares that she has no competing interest. References [1] Eftimovska-Otovic N, et al. Clinical Characteristics of Patients with Intradialytic Hypertension. Pril(Makedon Akad Nauk Umet Odd Med Nauki) 2015;36(2):187—93. [2] Van Buren P. The prevalence of persistent intradialytic hypertension in a hemodialysis population with extended follow-up. Int J Artif Org 2012. [3] Gunal AI. Paradoxical rise in blood pressure during ultrafiltration is caused by increased cardiac output. J Nephrol 2002. [4] Inrig Jk. Association of blood pressure increases during hemodialysis with 2-year mortality in incident hemodialysis patients: a secondary analysis of the Dialysis Morbidity and Mortality Wave 2 Study. AJKD 2009. https://doi.org/10.1016/j.acvdsp.2019.05.088
Renal outcome of living kidney donors at Tlemcen University Hospital L. Kara-Hadj Safi ∗ , I. Hamidaoui , M. Benmansour Nephrology Department, University Hospital Tlemcen, Tlemcen, Algeria ∗ Corresponding author. E-mail address: kara [email protected] (L. Kara-Hadj Safi) Introduction Renal transplantation from living donors is the most beneficial for recipients in terms of survival and quality of life. However, this option raises many questions, including the risks for the donor. Objective The objective of the study was to investigate the occurrence of complications such as kidney failure or high blood pressure in the short and long term after kidney donation. Method Descriptive cross-sectional study of 100 living donors who have donated a kidney to their relatives at least one year ago, between 2007 and 2017. The evaluation criteria were the complications of nephrectomy in the short and long term: occurrence of renal failure, high blood pressure or proteinuria. Results The donors’ mean age was 39.8 years old, 2/3 of donors were women. Donors were parents (34.7%), collateral (50.6%) or spouses (10.7%). Only 3 donors had a laparoscopy. Perioperative and subsequent mortality was null. Five donors have pregnancies after donation without any fetus or maternal complications. The main complaints expressed concerned pain and scarring after-
09 - Kidney effects. Donor-recipient relationships improved in 86% of cases and remained unchanged in the remaining (14%). After a mean delay post-transplant of 5 years, no donor developed a renal failure, or a proteinuria. Mean GFR was 88,5 ml/min/1,73m2 , and no donor had lower GFR than 60 ml/min/1.73 m2 . However, 6 years after surgery, 5.6% of patients developed high blood pressure. Discussion The results of our study did not reveal any risk associated with donation in comparison with the general population. However, recent studies have reported a higher risk of chronic renal failure in kidney donors compared to control subjects. Biases were identified in the selection of control groups for these latter studies. Indeed, our study did not include a control group, however, after a medium delay of 5 years, we did not observe donors’ renal complication, probably because our population is predominantly made of young subjects. However, our present work strongly pleads for a rigorous evaluation of potential donors. Conclusion Transplantation from living donors allows better results in terms of graft survival without exposing the donor to inconsiderate risks, provided that the donors are properly selected. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.05.089
Therapeutic education of the renal transplant patient L. Kara-Hadj Safi 1,∗ , M. Kasmi 2 , M. Benmansour 1 Nephrology Department, University Hospital Tlemcen, Tlemcen, Algeria 2 Pharmacy Department, University Abou Bekr Belkaid, Tlemcen, Algeria ∗ Corresponding author. E-mail address: kara [email protected] (L. Kara-Hadj Safi)
1
Introduction The success of kidney transplantation depends on the long-term immune-suppressive treatment; therapeutic education programs for transplant recipients are being implemented world-wide to help patients acquiring the needed skill to manage their treatment and lifestyle in the best possible way. Objectives (1)To assess knowledge and observance of transplant patients receiving immunosuppressive treatments, and (2) to develop information, monitoring tools and matrices of therapeutic education program (ETP) adapted to our patients. Patients and methods Our cross-sectional study was conducted in 100 kidney transplant patients followed in our department; age: 34 ± 10.8 years old; sex ratio: 1.76. Observance was assessed by the Girerd’s questionnaire and knowledge of their medical status by a questionnaire consisting of 12 items. Results Eight % of patients did not respect their medical appointment dates. Twenty-five % had a good knowledge of their immunosuppressive treatment. The risk of not taking the immunesuppressant were well-known (more than 80% of correct answers), other notions concerning the mechanisms of action and the possible side effects were much less understood. The knowledge of the risks of treatment, lifestyle and diet was incomplete. The item evaluating what to do if the patient forgets to take a medication received the lowest percentage (5%) of correct answer. This level was significantly correlated with the educational level (P = 0.02). Forty four percent of our patients were considered as good observers and 51% had minor observance problems. Irregularity in the time of intake appeared to be the main factor in patients’ poor compliance. No relation was evidenced between the level of knowledge of the patients and their level of observance. Discussion and Conclusion Our study revealed that our patients’ knowledge was fragmented and insufficient, likely limiting the observance and increasing the risk of kidney rejection. In order to improve this situation, we adapted the ETP methods to our patients’ pathology and established 4 educational tools: an information
Patterns of hypertension in renal transplant patients evaluated with 24 h ambulatory blood pressure monitoring Miriana Dinic ∗ , Nicolas Maillard , Guillaume Claisse , Ingrid Masson , Eric Alamartine , Christophe Mariat CHU Nord, service néphrologie, dialyse et transplantation rénale, centre HTA, 42055 Saint Etienne Cedex 2, France ∗ Corresponding author. E-mail address: [email protected] (M. Dinic) Rational Prevalence of the different patterns of hypertension in renal transplant recipients (RTR) using 24 h ambulatory blood pressure monitoring (ABPM) along with their determining factor are lacking. The aim of our study was to describe the epidemiology of hypertension in RTR, based on ambulatory blood pressure monitoring (ABPM). Methods In this cross-sectional study, prevalent RTR were proposed systematic blood pressure work-up consisting of ABPM, office blood pressure (3 consecutive blood pressure measurements performed by a nurse after 5 minutes of quiet rest) and detection of orthostatic hypotension. Optimal target was defined as BP < 130/80 mmHg for office BP. ABPM goals was defined using the ESH guidelines but we also defined another targets using only the 24 h average ABPM as seen in the literature. Results Two hundred and fifty-eight RTR underwent ABPM. Mean ABPM was 132/76 mmHg not different from the mean office BP (132/73 mmHg). Prevalence of patients with resistant hypertension and uncontrolled BP when we considered day-time and night-time values were respectively 23% and 48% versus 20% and 41% when we take into consideration only the 24 h average ABPM. Twenty % of RTR had orthostatic hypotension. When we identified the patterns of BP, 31% of patients had masked hypertension with circadian ABPM versus 20% with only 24 h average ABPM. All the patients identified as having uncontrolled BP or masked hypertension with circadian ABPM and not with 24 h average ABPM presented only nocturnal hypertension. Conclusion Our results show a suboptimal control of BP in a cohort of RTR with 20% of patients with resistant hypertension and more than 50% of patients with uncontrolled BP. ABPM is a valuable tool to detect nocturnal hypertension. Prevalence of hypertension is underestimated in RTR because of the lack of established definition of blood pressure using ABPM in this population. ABPM goals need to be better defined to assess correctly hypertension and improve the management of BP in RTR.
e367 Disclosure of interest peting of interest.
The authors declare that they have no com-
https://doi.org/10.1016/j.acvdsp.2019.05.086
Metabolic syndrome and cardiovascular risk in patients on chronic hemodialysis of University Hospital of Annaba Manel Djeddi Laboratoire de Biochimie, CHU Ibn Rochd, Annaba, Algeria E-mail address: [email protected] Introduction While cardiovascular diseases are the leading cause of death in chronic hemodialysis patients the prevalence of the metabolic syndrome in these patients is currently poorly explored. The metabolic syndrome is composed of various abnormalities, which considered separately can be considered as innocuous. However, if they are found together in the same patient, they represent a major cardiovascular risk. Objective The objective of the study was to evaluate the prevalence of the metabolic syndrome in chronic hemodialysis patients in the nephrology service of Annaba University Hospital. Methods A prospective study was conducted on 60 patients with end-stage renal failure treated by hemodialysis recruited from the nephrology and hemodialysis unit of Annaba University Hospital in Algeria. The mean patients’ age was 41.55 ± 14.1 years old with a slight male predominance, the sex ratio M/F was 1.14. The data were collected by using a questionnaire including the patient size, weight, waist circumference and blood pressure. The biochemical parameters included: blood glucose, total cholesterol, HDL-C, LDL-C and triglycerides. Results The metabolic syndrome was present in 47% of the study population. Arterial hypertension was the most common abnormality with a prevalence of 70% followed by the decrease in HDL-C and abdominal obesity in 65% and 52% of the study population, respectively. Hypertriglyceridemia was present in 40%, and hyperglycemia in 35% of the patients. The cardiovascular risk was predominantly multifactorial: 58% of patients had at least 2 risk factors associated with their hypertension. Conclusion The frequency and severity of cardiovascular and coronary complications, particularly in chronic uremia, necessitates a correction of risk factors, some of which are inherent in chronic renal failure. The evaluation of the metabolic syndrome is a mean of screening so as to prevent its complications, in particular the cardiovascular ones, the main cause of death in these patients. Disclosure of interest The author declares that she has no conflict of interest. https://doi.org/10.1016/j.acvdsp.2019.05.087
Patient characteristics with intradialytic hypertension despite the drop of their dry weight Lila Ghouti-terki ∗ , Guillaume Seret , Frederic Lavainne , Pierre-Yves Durand , Toma Ilinca , Stéphanie Coupel , Angelo Testa ECHO-Association: Néphrologie-Hémodialyse, 44400 Nantes, France ∗ Corresponding author. E-mail address: [email protected] (L. Ghouti-terki) Introduction Intradialytic hypertension (IHT), defined by an increase of 10 mmHg [1], is a frequent but poorly understood complication of hemodialysis treatment [2,3], associated with an over-risk of mortality [4]. In spite of the association with clinical signs of extracellular volume expansion, in clinical practice the attempt of a dry weight was not always associated with a normal-
e368 ization of blood pressure. The aim of our study was to investigate the clinical and biological characteristics of patients with persistent intradialytic hypertension after the drop of their dry weight (DW). Materials and methods From January 2013 to June 2013, 50 patients with IHT were identified based on the definition. According to the effect of dry weight reduction after 6 months, 2 groups of patients were described with and without effect on IHT. Demographics, clinical and biological data were analyzed. We estimated vascular status using a score. We also investigated differences in 5-year mortality and comorbidity. Results The two groups were respectively constituted by 23 and 27 patients without significant differences for gender (OR [0.23; 2.94] P = 0.78) or age (P = 0.13). The patient’s vascular status was not more high in the group 1 than in the group 2 (1.5 vs. 1.9; P = 0.26). The reduction in dry weight was the same in two groups (− 2,44 vs. − 2.57; P = 0.94), and no differences were found in the level of parathyroid hormone(169 vs. 387; P = 0.9). The number of hypertension treatments was lower in the group 2 (1.7 vs. 2,5; P = 0.05). The two group showed a similar 5year mortality (70 and 78% respectively, P = 0.75). Conclusion Despite overhydratation correction, we could not explain intradialytic hypertension by vascular status alone. After improvement of IHT, mortality rate remains high. Disclosure of interest The author declares that she has no competing interest. References [1] Eftimovska-Otovic N, et al. Clinical Characteristics of Patients with Intradialytic Hypertension. Pril(Makedon Akad Nauk Umet Odd Med Nauki) 2015;36(2):187—93. [2] Van Buren P. The prevalence of persistent intradialytic hypertension in a hemodialysis population with extended follow-up. Int J Artif Org 2012. [3] Gunal AI. Paradoxical rise in blood pressure during ultrafiltration is caused by increased cardiac output. J Nephrol 2002. [4] Inrig Jk. Association of blood pressure increases during hemodialysis with 2-year mortality in incident hemodialysis patients: a secondary analysis of the Dialysis Morbidity and Mortality Wave 2 Study. AJKD 2009. https://doi.org/10.1016/j.acvdsp.2019.05.088
Renal outcome of living kidney donors at Tlemcen University Hospital L. Kara-Hadj Safi ∗ , I. Hamidaoui , M. Benmansour Nephrology Department, University Hospital Tlemcen, Tlemcen, Algeria ∗ Corresponding author. E-mail address: kara [email protected] (L. Kara-Hadj Safi) Introduction Renal transplantation from living donors is the most beneficial for recipients in terms of survival and quality of life. However, this option raises many questions, including the risks for the donor. Objective The objective of the study was to investigate the occurrence of complications such as kidney failure or high blood pressure in the short and long term after kidney donation. Method Descriptive cross-sectional study of 100 living donors who have donated a kidney to their relatives at least one year ago, between 2007 and 2017. The evaluation criteria were the complications of nephrectomy in the short and long term: occurrence of renal failure, high blood pressure or proteinuria. Results The donors’ mean age was 39.8 years old, 2/3 of donors were women. Donors were parents (34.7%), collateral (50.6%) or spouses (10.7%). Only 3 donors had a laparoscopy. Perioperative and subsequent mortality was null. Five donors have pregnancies after donation without any fetus or maternal complications. The main complaints expressed concerned pain and scarring after-
09 - Kidney effects. Donor-recipient relationships improved in 86% of cases and remained unchanged in the remaining (14%). After a mean delay post-transplant of 5 years, no donor developed a renal failure, or a proteinuria. Mean GFR was 88,5 ml/min/1,73m2 , and no donor had lower GFR than 60 ml/min/1.73 m2 . However, 6 years after surgery, 5.6% of patients developed high blood pressure. Discussion The results of our study did not reveal any risk associated with donation in comparison with the general population. However, recent studies have reported a higher risk of chronic renal failure in kidney donors compared to control subjects. Biases were identified in the selection of control groups for these latter studies. Indeed, our study did not include a control group, however, after a medium delay of 5 years, we did not observe donors’ renal complication, probably because our population is predominantly made of young subjects. However, our present work strongly pleads for a rigorous evaluation of potential donors. Conclusion Transplantation from living donors allows better results in terms of graft survival without exposing the donor to inconsiderate risks, provided that the donors are properly selected. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.05.089
Therapeutic education of the renal transplant patient L. Kara-Hadj Safi 1,∗ , M. Kasmi 2 , M. Benmansour 1 Nephrology Department, University Hospital Tlemcen, Tlemcen, Algeria 2 Pharmacy Department, University Abou Bekr Belkaid, Tlemcen, Algeria ∗ Corresponding author. E-mail address: kara [email protected] (L. Kara-Hadj Safi)
1
Introduction The success of kidney transplantation depends on the long-term immune-suppressive treatment; therapeutic education programs for transplant recipients are being implemented world-wide to help patients acquiring the needed skill to manage their treatment and lifestyle in the best possible way. Objectives (1)To assess knowledge and observance of transplant patients receiving immunosuppressive treatments, and (2) to develop information, monitoring tools and matrices of therapeutic education program (ETP) adapted to our patients. Patients and methods Our cross-sectional study was conducted in 100 kidney transplant patients followed in our department; age: 34 ± 10.8 years old; sex ratio: 1.76. Observance was assessed by the Girerd’s questionnaire and knowledge of their medical status by a questionnaire consisting of 12 items. Results Eight % of patients did not respect their medical appointment dates. Twenty-five % had a good knowledge of their immunosuppressive treatment. The risk of not taking the immunesuppressant were well-known (more than 80% of correct answers), other notions concerning the mechanisms of action and the possible side effects were much less understood. The knowledge of the risks of treatment, lifestyle and diet was incomplete. The item evaluating what to do if the patient forgets to take a medication received the lowest percentage (5%) of correct answer. This level was significantly correlated with the educational level (P = 0.02). Forty four percent of our patients were considered as good observers and 51% had minor observance problems. Irregularity in the time of intake appeared to be the main factor in patients’ poor compliance. No relation was evidenced between the level of knowledge of the patients and their level of observance. Discussion and Conclusion Our study revealed that our patients’ knowledge was fragmented and insufficient, likely limiting the observance and increasing the risk of kidney rejection. In order to improve this situation, we adapted the ETP methods to our patients’ pathology and established 4 educational tools: an information