Browsing by Subject "End stage renal disease"

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    Hypertension Treatment for Patients with Advanced Chronic Kidney Disease
    (Springer, 2014-10) Sinha, Arjun D.; Agarwal, Rajiv; Department of Medicine, IU School of Medicine
    Chronic kidney disease is common and frequently complicated with hypertension. As a major modifiable risk factor for cardiovascular disease in this high risk population, treatment of hypertension in chronic kidney disease is of paramount importance. We review the epidemiology and pathogenesis of hypertension in chronic kidney disease and then update the latest study results for treatment including salt restriction, invasive endovascular procedures, and pharmacologic therapy. Recent trials draw into question the efficacy of renal artery stenting or renal denervation for hypertension in chronic kidney disease, as well as renin-angiotensin-aldosterone system blockade as first line therapy of hypertension in end stage renal disease. Positive trial results reemphasize salt restriction and challenge the prevailing prejudice against the use of thiazide-like diuretics in advanced chronic kidney disease. Lastly, clinical practice guidelines are trending away from recommending tight blood pressure control in chronic kidney disease.
  • Thumbnail Image
    Item
    Past, Present, and Future of Phosphate Management
    (Elsevier, 2022-02-01) Doshi, Simit M.; Wish, Jay B.; Medicine, School of Medicine
    Cardiovascular (CV) disease (CVD) accounts for >50% of deaths with known causes in patients on dialysis. Elevated serum phosphorus levels are an important nontraditional risk factor for bone mineral disease and CVD in patients with chronic kidney disease (CKD). Given that phosphorus concentrations drive other disorders associated with increased CV risk (e.g., endothelial dysfunction, vascular calcification, fibroblast growth factor-23, parathyroid hormone), phosphate is a logical target to improve CV health. Phosphate binders are the only pharmacologic treatment approved for hyperphosphatemia. Although their safety has improved since inception, the mechanism of action leads to characteristics that make ingestion difficult and unpleasant; large pill size, objectionable taste, and multiple pills required for each meal and snack make phosphate binders a burden. Side effects, especially those affecting the gastrointestinal (GI) system, are common with binders, often leading to treatment discontinuation. The presence of "hidden" phosphates in processed foods and certain medications makes phosphate management even more challenging. Owing to these significant issues, most patients on dialysis are not consistently achieving and maintaining target phosphorus concentrations of <5.5 mg/dl, let alone more normal levels of <4.5 mg/dl, indicating novel approaches to improve phosphate management and CV health are needed. Several new nonbinder therapies that target intestinal phosphate absorption pathways have been developed. These include EOS789, which acts on the transcellular pathway, and tenapanor, which targets the dominant paracellular pathway. As observational evidence has established a strong association between phosphorus concentration and clinical outcomes, such as mortality, phosphate is an important target for improving the health of patients with CKD and end-stage kidney disease (ESKD).
  • Thumbnail Image
    Item
    Pilot Study of the Effects of High-Protein Meals During Hemodialysis on Intradialytic Hypotension in Patients Undergoing Maintenance Hemodialysis
    (Elsevier, 2019-03) Choi, Mun Sun; Kistler, Brandon; Wiese, Gretchen N.; Stremke, Elizabeth R.; Wright, Amy J.; Moorthi, Ranjani N.; Moe, Sharon M.; Hill Gallant, Kathleen M.; Medicine, School of Medicine
    Objective Hemodialysis (HD) patients have high protein and energy requirements, and protein-energy wasting is common and associated with poor outcomes. Eating during dialysis may improve nutritional status by counteracting the catabolic effects of hemodialysis treatment; but, eating during HD may be discouraged due to concerns of postprandial hypotension. However, little data is available to support this practice. In this study, we hypothesized that high protein meals during HD does not lead to symptomatic intradialytic hypotension events. Design A 9-week, non-randomized, parallel-arm study. Setting A single in-center HD clinic. Subjects 18 HD patients from two shifts completed the study. Patients were 62±16 years-old in age with dialysis vintage 3.4±2.6 years. Intervention The intervention group (n=9) received meals of ~30g protein and ~1/3 daily recommended intakes of sodium, potassium, phosphorus, and fluid for hemodialysis patients during dialysis for 25 consecutive HD sessions. The control group (n=9) completed all aspects of the study including a visit by study personnel but were not given meals. The 25 consecutive sessions prior to the start of the intervention/control phase were used as a baseline comparison for each patient. Main Outcome Measure Symptomatic hypotension event frequency. Results In the intervention arm, there were 19 symptomatic hypotension events in 5 patients pre-study and 18 events in 6 patients during the study. In the control arm, there were 16 events in 7 patients pre-study and 13 events in 7 patients during the study. Change in the frequency of symptomatic hypotension events from pre-study to during study was not different between groups (P=0.71). There was no effect of meals on nutritional status, but patients reported positive attitudes towards receiving meals during dialysis. Conclusion High-protein meals during HD did not increase symptomatic hypotension events. Larger, longer-term studies are needed to confirm these results and evaluate whether high-protein meals on dialysis benefit nutritional status and clinical outcomes.