Antihypertensive drug treatment and the risk for intra-hemodialysis hypotension.

BACKGROUND: Antihypertensive medications are often prescribed to manage hypertension in hemodialysis (HD) patients, and intradialytic hypotension (IDH) is a common complication in these patients. We investigated the risk of IDH in incident HD patients who initiated treatment with antihypertensive drugs in monotherapy. METHODS: The study was conducted as an emulation of a randomized clinical trial in 4072 incident HD patients who started anti-hypertensive drug treatment between January 2016 to December 2019. The primary outcome was the occurrence of IDH during HD sessions. The Gener alised Estimating Equation (GEE) analysis was adjusted by inverse probability treatment weighting (IPTW). RESULTS: Calcium channel blocker (CCB) use was associated with an IDH incidence rate of 7.4 events per person-year (95% CI: 6.2-8.6). Compared to CCB use, use of beta and alpha-beta blockers was strongly associated with a higher likelihood of IDH (OR [95% CI] 2.27 [1.50-3.43]). Use of angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (OR [95% CI] 1.71 [1.14-2.57]) and diuretics (OR [95% CI] 1.52 [1.07-2.16]) were also associated with higher likelihood of IDH compared to CCB use. CONCLUSION: The study suggests that using beta and alpha-beta blockers, ACE inhibitors or angiotensin II receptor blockers, and diuretics may increase the risk of IDH in HD patients compared to CCB use.

Biomarkers in clinical epidemiology studies.

This paper discusses the use of biomarkers in clinical practice and biomedical research. Biomarkers are measurable characteristics that can be used to indicate the presence or absence of a disease or to track the progression of a disease. They can also be used to predict how a patient will respond to a particular treatment. Biomarkers have enriched clinical practice and disease prognosis by providing measurable characteristics that indicate biological processes. They offer valuable insights into disease susceptibility, progression, and treatment response, aiding drug development and personalized medicine. However, developing and implementing biomarkers come with challenges that must be addressed. Rigorous testing, standardization of assays, and consideration of ethical factors are crucial in ensuring the reliability and validity of biomarkers. Reliability is vital in biomarker research. It ensures accurate measurements by preventing biases and facilitating robust correlations with outcomes. Conversely, validation examines which and how many biomarkers correspond to theoretical constructs and external criteria, establishing their predictive value. Multiple biomarkers are sometimes necessary to represent the complex relationship between exposure and disease outcomes accurately. Susceptibility factors are pivotal in disease states' complex interaction among genetic and environmental factors. Gaining a comprehensive understanding of these factors is essential for effectively interpreting biomarker data and maximizing their clinical usefulness. Using well-validated biomarkers can improve diagnoses, more effective treatment evaluations, and enhanced disease prediction. This, in turn, will contribute to better patient outcomes and drive progress in medicine.