<strong>Background:</strong><span style="font-family:Verdana;"> Chronic kidney disease (CKD) patients have considerably high atherosclerotic changes which predict cardiovascular events</...<strong>Background:</strong><span style="font-family:Verdana;"> Chronic kidney disease (CKD) patients have considerably high atherosclerotic changes which predict cardiovascular events</span><span style="font-family:Verdana;">;</span><span style="font-family:Verdana;">hence</span><span style="font-family:Verdana;">,</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> this study evaluated the prevalence of carotid atherosclerotic plaques in pre-dialysis CKD patients at a tertiary institution in south-east, Nigeria. </span><b><span style="font-family:Verdana;">Materials</span></b><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">and</span></b><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Method: </span></b><span style="font-family:Verdana;">107 pre-dialysis CKD patients were consecutively recruited for the study. 81 subjects who were screened and had no kidney disease served as control. The control group was sex and age matched with the CKD patients. A pre-tested questionnaire was administered to all participants and physical examination was done. Presence of atheromatous plaques was assessed using doppler ultrasound at 3 sites—distal common carotid artery (CCA), the internal carotid artery (ICA) and the carotid bulb by a single skilled radiologist specialized in doppler ultrasound. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Atheromatous plaques were significantly increased in CKD patients. 14.2% of CKD patients had atheromatous plaques versus 2.5% in the control group (p value < 0.05). Commonest site of occurrence was at the common carotid artery (CCA-7.5% versus ICA-4.7% versus bulb 1.8%). </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> Atheromatous plaques are prevalent in CKD patients. It is recommended that carotid doppler ultrasound should be done in CKD patients to identify patients for possible intervention.</span></span>展开更多
This single-center prospective cohort study establishes ultrafiltration rate variability(quantified by coefficient of variation,UFRCV)as an independent predictor of all-cause and cardiovascular mortality in maintenanc...This single-center prospective cohort study establishes ultrafiltration rate variability(quantified by coefficient of variation,UFRCV)as an independent predictor of all-cause and cardiovascular mortality in maintenance hemodialysis patients.While absolute ultrafiltration rate thresholds represent established risk factors,dynamic fluid removal fluctuations remain prognostically uncharacterized.We longitudinally monitored ultrafiltration rate patterns during a 90-day observation period in 202 hemodialysis patients(median follow-up:38.7 months).Stratification by median UFRCV(0.187)revealed significantly reduced survival among patients with elevated variability.This association demonstrated particular clinical significance in elderly individuals(>60 years),those with recurrent intradialytic hypotension,and subjects exhibiting elevated predialysis systolic blood pressure variability.Notably,UFRCV exhibited stronger mortality prediction in patients with lower mean ultrafiltration volumes(<2469 mL),indicating that current static ultrafiltration rate targets inadequately reflect dynamic hemodynamic vulnerability.These findings underscore the imperative to integrate ultrafiltration rate variability metrics into personalized volume management frameworks—a parameter currently absent from dialysis adequacy guidelines.Collectively,UFRCV assessment emerges as a critical indicator of subclinical hemodynamic compromise,providing pivotal insights for refining hemodynamic risk stratification in maintenance hemodialysis populations.展开更多
文摘<strong>Background:</strong><span style="font-family:Verdana;"> Chronic kidney disease (CKD) patients have considerably high atherosclerotic changes which predict cardiovascular events</span><span style="font-family:Verdana;">;</span><span style="font-family:Verdana;">hence</span><span style="font-family:Verdana;">,</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> this study evaluated the prevalence of carotid atherosclerotic plaques in pre-dialysis CKD patients at a tertiary institution in south-east, Nigeria. </span><b><span style="font-family:Verdana;">Materials</span></b><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">and</span></b><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Method: </span></b><span style="font-family:Verdana;">107 pre-dialysis CKD patients were consecutively recruited for the study. 81 subjects who were screened and had no kidney disease served as control. The control group was sex and age matched with the CKD patients. A pre-tested questionnaire was administered to all participants and physical examination was done. Presence of atheromatous plaques was assessed using doppler ultrasound at 3 sites—distal common carotid artery (CCA), the internal carotid artery (ICA) and the carotid bulb by a single skilled radiologist specialized in doppler ultrasound. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Atheromatous plaques were significantly increased in CKD patients. 14.2% of CKD patients had atheromatous plaques versus 2.5% in the control group (p value < 0.05). Commonest site of occurrence was at the common carotid artery (CCA-7.5% versus ICA-4.7% versus bulb 1.8%). </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> Atheromatous plaques are prevalent in CKD patients. It is recommended that carotid doppler ultrasound should be done in CKD patients to identify patients for possible intervention.</span></span>
基金supported by Shanghai Key laboratory of Kidney and Blood Purification(Nos.14DZ226022 and 20DZ2271600)Shanghai Federation of Nephrology Project supported by Shanghai ShenKang Hospital Development Center,No.SHDC2202230+2 种基金Shanghai Clinical Research Center for Kidney Disease,No.22MC1940100Shanghai Municipal Key Clinical Specialty(No.shslczdzk02501)National Natural Science Foundation of China(Nos.82270772 and 81903969).
文摘This single-center prospective cohort study establishes ultrafiltration rate variability(quantified by coefficient of variation,UFRCV)as an independent predictor of all-cause and cardiovascular mortality in maintenance hemodialysis patients.While absolute ultrafiltration rate thresholds represent established risk factors,dynamic fluid removal fluctuations remain prognostically uncharacterized.We longitudinally monitored ultrafiltration rate patterns during a 90-day observation period in 202 hemodialysis patients(median follow-up:38.7 months).Stratification by median UFRCV(0.187)revealed significantly reduced survival among patients with elevated variability.This association demonstrated particular clinical significance in elderly individuals(>60 years),those with recurrent intradialytic hypotension,and subjects exhibiting elevated predialysis systolic blood pressure variability.Notably,UFRCV exhibited stronger mortality prediction in patients with lower mean ultrafiltration volumes(<2469 mL),indicating that current static ultrafiltration rate targets inadequately reflect dynamic hemodynamic vulnerability.These findings underscore the imperative to integrate ultrafiltration rate variability metrics into personalized volume management frameworks—a parameter currently absent from dialysis adequacy guidelines.Collectively,UFRCV assessment emerges as a critical indicator of subclinical hemodynamic compromise,providing pivotal insights for refining hemodynamic risk stratification in maintenance hemodialysis populations.
