Subendocardial viability ratio predicts cardiovascular mortality in chronic kidney disease patients.

BACKGROUND: The subendocardial viability ratio (SEVR), calculated by pulse wave analysis, is an index of myocardial oxygen supply and demand. Here we analyze the relation between SEVR and cardiovascular mortality in the chronic kidney disease (CKD) population of a post hoc analysis of a multicenter, prospective, randomized, nonblinded study. METHODS: We studied 212 consecutive asymptomatic outpatients receiving care at 12 nephrology clinics in south Italy. Inclusion criteria were age >18 years, 6 months of follow-up before the enrollment and stage 3-4 CKD. RESULTS: During follow-up, 34 subjects died, 29 of them for cardiovascular causes. SEVR correlated inversely with vascular calcifications (r = -0.37) and myocardial mass (r = -0.45); SEVR changed from 1.33 ± 0.24 to 1.36 ± 0.16 (p = NS; baseline and final values, respectively) in living patients, and from 1.16 ± 0.31 to 0.68 ± 0.26 in deceased patients (p < 0.001). Kaplan-Meier curves show that that a greater reduction of SEVR values during the study (third tertile) significantly predicts cardiovascular mortality (p < 0.0001). CONCLUSIONS: This post hoc analysis shows that a reduction of SEVR values impacts cardiovascular mortality in CKD patients.

[Epidemiology of cardiovascular disease in CKD-MBD]. / Epidemiologia della patologia cardiovascolare nella CKD-MBD.

Evidence has been accumulating in recent years that chronic kidney disease (CKD) is a common disease associated with a high risk of morbidity and mortality. Cardiovascular complications are the leading cause of death in patients with CKD, and the risk of cardiovascular mortality is 10-30-fold higher in dialysis patients than in age-, gender- and race-matched controls. On the basis of this evidence it has been suggested that the cardiovascular risk profile of CKD patients is different from that of the general population, resulting from a complex and peculiar interaction of risk factors. In fact, traditional risk factors such as hypertension, aging, smoking, diabetes, and lipid disorders do not fully explain the high frequency of cardiovascular disease in CKD, so other factors must be involved in the high mortality rate in uremic patients. In this article we will provide an overview of the epidemiology of the cardiovascular risk factors in CKD. Among the non-traditional risk factors we have focused particularly on those related to mineral metabolism, which contribute the high rates of cardiovascular events observed in CKD.

[The usefulness of Cochrane systematic reviews in nephrology]. / Le principali revisioni sistematiche Cochrane all'attenzione della Societa' Italiana di Nefrologia: a cosa servono?

Systematic reviews (SRs) of the literature are clinical research studies carried out according to rigorous methodological criteria. They are aimed at searching, critically appraising and summarizing all studies with similar characteristics that address the same research question. The Cochrane Collaboration is the main institution that coordinates the production of SRs. The Cochrane Renal Group is one of the 50 research groups of the Cochrane Collaboration and is in charge of SRs in nephrology. This group compiled the Renal Health Library, an annually updated collection of SRs (Cochrane and not) and randomized controlled trials in nephrology, dialysis and renal transplantation. We searched the Renal Health Library to identify SRs useful to answer clinical questions in patients with renal disease and/or following kidney transplant. The SRs identified were summarized and the results were expressed as relative risk, weighted mean difference, standardized mean difference, and 95% confidence intervals. Since the number of randomized controlled trials is quite large and SRs are a reliable summary of the scientific evidence, their distribution is of paramount importance. Here we show several clinical cases where related SRs in the Renal Health Library provide useful guidance for treatment.

[Methimazole versus methimazole and diphosphonates in hyperthyroid and osteoporotic patients]. / Metimazolo versus metimazolo e bifosfonatiin pazienti ipertiroidei con osteoporosi.

AIM: It is well-know that hyperthyroidism is one of the key causes of secondary osteoporosis. High values of thyroid hormones increase the bone mineral turnover speed by promoting osteoclastic and osteoblastic activities. The aim of our study is to evaluate the increase of bone mineral density (BMD) in osteoporotic and hyperthyroid patients treated with only antithyroid drugs versus patients treated with antithyroid drugs and diphosphonates. METHODS: Twenty-six elderly male patients, 65-75 years, were selected. In all these patients, thyroid function (FT3, FT4, TSH, Tg, AbTg, AbTPO) was evaluated at baseline and after 6 and 12 months from the start of medical treatment; the following were evaluated: BMD, calcium serum, phosphorus serum, alkaline phosphatase, PTH and 24 hours urinary calcium, phosphorus and hydroxyprolin. Thirteen patients (group 1) were treated with antithyroid drugs (methimazole 5-20 mg/die/os) and diphosphonates (alendronate 10 mg/die/os). The control group of 13 patients (group 2) was treated with antithyroid drugs only. RESULTS: After 6 months of treatment, the patients of group 1 showed a mean increase of 2.5% in lumbar spine BMD compared with a mean increase of 0.3% in group 2 (p<0.01). After 12 months, group 1 showed a mean increase of 6.2% in lumbar spine BMD, compared with a mean increase of 2% in group (p<0.001). CONCLUSIONS: The combination of antithyroid and diphosphonates drugs appears to be more efficacious than antithyroid therapy alone for the treatment of osteoporosis in male hyperthyroid patients.