ABSTRACT
Hypertension (HT) is recognized as one of the major risk factors for vascular damage. Although current guidelines recommend an aggressive drug treatment with blood pressure control goals ever lower, the prevalence of uncontrolled hypertension is still apparently high. It is often forgotten that BP is a very labile hemodynamic parameter, which requires a correct methodology measurement that meets only rarely, leading to a misdiagnosis and wrong hypertensive monitoring. Even being an arbitrary limit the definition of HT has been set at 140/90 mmHg, based on casual BP taken in the office. This register itself can provide useful information beyond systolic and diastolic values, and with a certain hemodynamic meaning (pulse pressure and mean blood pressure). For a proper diagnosis of hypertensive patients is essential to enhance measure BP in any area with an strict methodology, and to incorporate into clinical practice new techniques such as 24 hours MAPA and AMPA at home, which still require definition of specific reference objectives. The application of these techniques has led to the emergence of several subgroups of hypertensive patients, such as white-coat hypertension and masked hypertension, which have their peculiarities in relation to the therapeutic management and prognosis. These techniques, together with the publication of new clinical trials using criteria of evidence, have led to the review of the Guidelines for the management of hypertension by modifying the limits of BP for some special clinical situations, and changing the paradigm of the lowest BP is the best, by that of: as early and more associated vascular risk factors were controlled it's better.
Subject(s)
Hypertension/diagnosis , Algorithms , Blood Pressure Determination , Humans , Hypertension/drug therapyABSTRACT
La Enfermedad Renal Crónica (ERC) representa, al igual que otras enfermedades crónicas, un importante problema de salud pública, tanto por su elevada incidencia y prevalencia, como por su importante morbi-mortalidad y coste socioeconómico. La Enfermedad Renal Crónica Avanzada (ERCA) incluye los estadios 4 y 5 de la clasificación de la ERC. Se define por tanto como la enfermedad renal crónica que cursa con descenso grave del filtrado glomerular (FG < 30ml/min) Los objetivos terapéuticos están dirigidos a disminuir y tratar las complicaciones asociadas a la insuficiencia renal, y preparar de forma adecuada y con suficiente antelación el tratamiento sustitutivo de la función renal. La prevalencia de la ERCA es del 0,2-0,6% de la población adulta. Esta prevalencia aumenta con la edad, siendo en (..) (AU)
Chronic kidney disease (CKD), like other chronic diseases, is a serious public health problem because of both its high incidence and prevalence and its significant morbidity and mortality and socioeconomic cost. Advanced chronic kidney disease (ACKD)includes stages 4 and 5 of the CKD classification. It is defined as chronic kidney disease in which there is a severe reduction inglomerular filtration rate (GFR < 30 ml/min). The treatment goals are to reduce and treat the complications associated with chronickidney failure and to prepare the patient adequately and sufficiently in advance for kidney replacement therapy. The prevalence of ACKD is 0.2-0.6% of the adult population. This prevalence increases with age and in Spain is 1.6% in persons (..) (AU)
Subject(s)
Humans , Renal Insufficiency, Chronic/epidemiology , Severity of Illness Index , Early Diagnosis , Hypertension/epidemiology , Diabetes Mellitus/epidemiology , Risk Factors , Clinical ProtocolsABSTRACT
Un asistencia óptima en la fase de ERC avanzada (ERCA),antes del inicio de la diálisis, debe contemplar: detección precoz de la enfermedad renal progresiva, intervenciones para retardar su progresión prevenir las complicaciones urémicas atenuar las condiciones comórbidas asociadas adecuar la preparación para el TRS e iniciarlo en el momento adecuado de forma programada. La alternativa de futuro son los equipos multidisciplinarios(EMD) de manejo de la ERC avanzada y deberá de disponer de recursos humanos y materiales especificos (AU)
Optimal care of patients with advanced CKD (ACKD) before the initiation of dialysis should include: Early detection of progressive kidney disease Interventions to delay its progression Prevention of uremic complications Reduction of associated comorbid conditions Appropriate preparation and scheduled initiation of KRT. Multidisciplinary teams (MDT) are the future alternative for management of advanced CKD and they should have specific human and material resources (AU)
Subject(s)
Humans , Hospital Units/organization & administration , Renal Insufficiency, Chronic/epidemiology , Hemodialysis Units, Hospital/organization & administration , Patient Care Team/organization & administration , Health Services AccessibilityABSTRACT
Chronic kidney disease (CKD), like other chronic diseases, is a serious public health problem because of both its high incidence and prevalence and its significant morbidity and mortality and socioeconomic cost. Advanced chronic kidney disease (ACKD) includes stages 4 and 5 of the CKD classification. It is defined as chronic kidney disease in which there is a severe reduction in glomerular filtration rate (GFR < 30 ml/min). The treatment goals are to reduce and treat the complications associated with chronic kidney failure and to prepare the patient adequately and sufficiently in advance for kidney replacement therapy. The prevalence of ACKD is 0.2-0.6% of the adult population. This prevalence increases with age and in Spain is 1.6% in persons older than 64 years. - CKD is easily detected in clinical practice with simple tests (GFR estimated by equations based on serum creatinine, albuminuria and urine sediment) (Strength of Recommendation B). - It is recommended to detect the presence of CKD in all persons older than 60 years or with hypertension, diabetes or cardiovascular disease (Strength of Recommendation B). - Early detection and appropriate referral to the nephrology of patients with ACKD improves long-term morbidity and reduces costs for both the patient and the health care system (Strength of Recommendation B). Adequate communication and coordination between the primary care and nephrology is essential for this early detection: - Referral to nephrology should be made based on the stage of CKD, age of the patient, rate of progression of kidney failure, degree of albuminuria and presence or appearance of early warning signs.All patients with CKD stages 4-5 should be referred to nephrology (Strength of Recommendation C). - A protocol should be established in each health area for joint follow-up between primary care and nephrology (Strength of Recommendation C). - The creation of multidisciplinary ACKD units including a nephrologist, nephrology nurse, dietitian and social worker allows an integrated approach to the different aspects of management of patients with ACKD and is cost-effective (Strength of Recommendation B).
Subject(s)
Kidney Diseases/diagnosis , Kidney Diseases/therapy , Chronic Disease , Disease Progression , Early Diagnosis , Humans , Kidney Diseases/epidemiology , Nephrology , Primary Health Care , Referral and Consultation , Renal DialysisABSTRACT
Optimal care of patients with advanced CKD (ACKD) before the initiation of dialysis should include: Early detection of progressive kidney disease Interventions to delay its progression Prevention of uremic complications Reduction of associated comorbid conditions Appropriate preparation and scheduled initiation of KRT. Multidisciplinary teams (MDT) are the future alternative for management of advanced CKD and they should have specific human and material resources.
Subject(s)
Hospital Units/organization & administration , Kidney Diseases/therapy , Chronic Disease , Disease Progression , HumansABSTRACT
No disponible
Subject(s)
Adult , Aged , Female , Male , Middle Aged , Humans , Diabetic Nephropathies/diagnosis , Diabetic Nephropathies/prevention & control , Diabetic Nephropathies/epidemiology , Diabetes Mellitus/diagnosis , Diabetes Mellitus/classification , Diabetes Mellitus/etiology , Blood Pressure Monitoring, Ambulatory/methods , Spain/epidemiology , Proteinuria/diagnosis , Renal Insufficiency/diagnosis , Diabetes Mellitus, Type 1/diagnosis , Diabetes Mellitus, Type 2/diagnosisABSTRACT
OBJECTIVES: The incidence of arterial hypertension post-renal transplantation has been reported to be 48.6%. The present study investigated the usefulness of echo Doppler in detecting renal artery stenosis and the effects of arterial pressure control and hypotensive agents on the vascular resistance of the renal graft. METHODS: A total of 234 echo Doppler studies were done in 110 patients. The pulsatility index (PI), resistance index (RI), acceleration and mean velocity (MV), maximum systolic (SVMX) and minimum diastolic (DVMN) velocities of the external iliac, renal, segmental, interlobar and arcuate arteries were determined. RESULTS: In the stenotic segment, an elevation of SVMX was observed, followed by turbulent flow in the post-stenotic segment in 73% of the cases with arterial stenosis. The hypertensive patients had a higher external iliac artery RI than the normotensives. The beta-blockers reduced the RI in large vessels (external iliac), the vasodilators in medium-sized extraparenchymal vessels (segmental) and the calcium antagonists changed the PI in the smaller caliber intraparenchymal vessels (interlobar and arcuate). CONCLUSIONS: Evaluation by echo Doppler is the first diagnostic approach in patients suspected as having arterial stenosis of the renal graft. It permits evaluating blood flow changes from hypertension and hypotensive agents.
