Browse Ideas with tag 'hypertension':

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  CKD »

  Direct renin inhibitors vs. ACEI/ARB for CKD

  Theoretical grounds suggest that direct renin inhibitors (Aliskiren) may be superior at slowing CKD progression compared to ACE-inhibitors or ARB, and is supported by some animal studies. Renoprotective effect in humans has been demonstrated, but whether this represents "superiority" remains an unanswered question. Larger trials, including head-to-head comparisons are needed to determine whether direct renin inhibition ...more »

  Theoretical grounds suggest that direct renin inhibitors (Aliskiren) may be superior at slowing CKD progression compared to ACE-inhibitors or ARB, and is supported by some animal studies. Renoprotective effect in humans has been demonstrated, but whether this represents "superiority" remains an unanswered question.

  Larger trials, including head-to-head comparisons are needed to determine whether direct renin inhibition provides superior protection against CKD progression, or might replace or supplant ACE/ARB as the standard of care.

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  Submitted by Bruce Carter 2 years ago

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  HYPERTENSION »

  CKD, hypertension, and autonomic neuropathy

  CKD, elevated nighttime BP, and autonomic neuropathy are all associated with increased morbidity and mortality (both cardiovascular and renal). The bivariate relationships between each of these "risk factors" has been well documented. The interaction between the three variables is not as well studied. A better understanding of this interaction could lead to novel therapies that significantly reduce cardiovascular and ...more »

  CKD, elevated nighttime BP, and autonomic neuropathy are all associated with increased morbidity and mortality (both cardiovascular and renal). The bivariate relationships between each of these "risk factors" has been well documented. The interaction between the three variables is not as well studied. A better understanding of this interaction could lead to novel therapies that significantly reduce cardiovascular and renal morbidity and mortality.

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  Submitted by Paul Drawz 2 years ago

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  CKD »

  Diastolic heart failure

  Diastolic heart failure comprises up to 50% of heart failure presentations. The majority of these patients have abnormal renal function. Despite the incidence increasing there are no therapies and an unclear understanding of the mechanisms involved. What is the role of increasing renal blood flow in diastolic HF? Is there more to this than "volume" or is this congestive "renal" failure?

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  Submitted by Flora Sam 2 years ago

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  AKI »

  miRNAs and Renal Disease

  It is becoming clear that miRNAs regulate all aspects of renal disease, and they are 'druggable' targets: the first antagomir human trial is underway in heart. We need to understand which miRNAs are specific to kidney, in what to kidney cell type they are expressed and how they regulate renal disease. This effort should be systematic - with data made available publicly to avoid duplicative effort and funding.

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  Submitted by Ben Humphreys 2 years ago

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  CKD »

  What is the optimum dietary sodium intake in CKD?

  A lower Na diet has been suggested for CKD patients, and may help reduce proteinuria, but impact on progression has not been proven, and in heart failure, the role of a low sodium diet is being questioned (see Rothberg et al, J Gen Intern Med 25(10):1136–7, 2010). Proposed would be a randomized study in proteinuric diabetic CKD patients with target dietary Na of 1.5 vs. 3.0 g/day, with endpoints being 50% reduction in ...more »

  A lower Na diet has been suggested for CKD patients, and may help reduce proteinuria, but impact on progression has not been proven, and in heart failure, the role of a low sodium diet is being questioned (see Rothberg et al, J Gen Intern Med 25(10):1136–7, 2010).

  Proposed would be a randomized study in proteinuric diabetic CKD patients with target dietary Na of 1.5 vs. 3.0 g/day, with endpoints being 50% reduction in estimated cystatin GFR or dialysis/transplantation.

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  Submitted by John Daugirdas 2 years ago

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  ESRD/DIALYSIS »

  Effect of low sodium and low phosphate diet on outcomes in ESRD

  Data by Ozkahya et al (NDT 1988) suggested that sodium restriction and volume control could markedly reduce left ventricular mass index (LVMI). Ayus et al. (JASN 2005) found that LVMI reduction with daily dialysis correlated with better control of serum phosphate (P). Guida et al found that serum P could be reduced in 3/week patients using a low P, whey-substituted diet. The ability to maintain a low sodium (e.g., ...more »

  Data by Ozkahya et al (NDT 1988) suggested that sodium restriction and volume control could markedly reduce left ventricular mass index (LVMI). Ayus et al. (JASN 2005) found that LVMI reduction with daily dialysis correlated with better control of serum phosphate (P). Guida et al found that serum P could be reduced in 3/week patients using a low P, whey-substituted diet. The ability to maintain a low sodium (e.g., ~1.0 g/day) or low P (~0.6 g/day) diet in ESRD patients, or the effect of such diets on either surrogate outcomes (e.g. LVMI) or hard outcomes (survival, hospitalizations) has not been examined in a randomized trial. Proposed is a study, with patients randomized to either low Na / normal Na, and low P / normal P diets using a 2 x 2 factorial design in 3/week hemodialysis patients; a pilot study to look at feasibility with a main surrogate outcome of LVMI (200 patients), and a hard outcomes study (2000 patients) to look at mortality and hospitalizations.

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  Submitted by John Daugirdas 2 years ago

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  HYPERTENSION »

  Pediatric Hypertension and risk for cardiovascular disease

  The development of hypertension in the pediatric age group serves as a model for the investigation of the natural history, risk factors, and prevention of cardiovascular disease. There is a need for GWAS studies in populations at risk, i.e., African Americans, Latino Americans, and obese children and those with sustained high blood pressure. Utilize existing databases, CKiD and compare to normal populations during growth ...more »

  The development of hypertension in the pediatric age group serves as a model for the investigation of the natural history, risk factors, and prevention of cardiovascular disease. There is a need for GWAS studies in populations at risk, i.e., African Americans, Latino Americans, and obese children and those with sustained high blood pressure.

  Utilize existing databases, CKiD and compare to normal populations during growth and development.

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  Submitted by Frederick Kaskel 2 years ago

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  CKD »

  Survival and Cardiovascular Paradoxes in Chronic Kidney Disease

  Most of the 20 million Americans with chronic kidney disease (CKD) die before commencing dialysis. One of every five dialysis patients dies each year in the United States. Although cardiovascular disease is the most common cause of death in CKD, conventional cardiovascular risk factors such as hypercholesterolemia, hypertension and obesity are paradoxically associated with better survival at least consistently in hemodialysis ...more »

  Most of the 20 million Americans with chronic kidney disease (CKD) die before commencing dialysis. One of every five dialysis patients dies each year in the United States. Although cardiovascular disease is the most common cause of death in CKD, conventional cardiovascular risk factors such as hypercholesterolemia, hypertension and obesity are paradoxically associated with better survival at least consistently in hemodialysis patients. Emerging data indicate the existence of this ‘reverse epidemiology’ even in earlier stages of CKD. These survival paradoxes might evolve progressively over the natural course of CKD as a result of time differential of the competing risk factors and the overwhelming contribution of malnutrition, inflammation and wasting. Reversal of the reverse epidemiology upon successful kidney transplantation underscores the role of nutritional status and kidney function in engendering these paradoxes. These observations, if indicative of biologically plausible and causal associations, may lead to emergence of new paradigms and potential management strategies to improve survival in CKD patients. Such movement away from use of targets derived from general populations (e.g. Framingham) would represent a major paradigm shift in clinical medicine and public health.

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  1 comment for Idea: Survival and Cardiovascular Paradoxes in Chronic Kidney Disease

  Submitted by Kamyar Kalantar-Zadeh 2 years ago

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  HYPERTENSION »

  Labile hypertension

  Substantial fluctuations in blood pressure within an individual are not uncommon. Yet the definition, implications on clinical outcomes, pathogenesis and management are unclear. This would be an important and challenging area for translational and clinical research and later basic research.

  1 comment for Idea: Labile hypertension

  Submitted by Alfred Cheung 2 years ago

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