The Effect of Visit-to-Visit Blood Pressure Variability on Renal Function in Geriatric Chronic Kidney Disease.

OBJECTIVE: The visit-to-visit variability (VVV) of blood pressure (BP) has been recognized as a risk factor for cardiovascular events and chronic kidney disease (CKD). The objective of this study is to valuate the association between the VVV of BP and changes in estimated glomerular filtration rate (eGFR) in elderly CKD patients at different stages of renal function. MATERIALS AND METHODS: For 60 months, we analyzed the medical records of 105 patients with and without diabetes and hypertension. Systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) were examined. A multivariable linear regression model was used to analyze the correlation between eGFR and the VVV of BP. RESULTS: No differences were demonstrated between the groups in the clinical characteristics. Mean SBP and DBP were not significant between the groups, and we observed no decrease in renal function. A significant negative correlation between PP and eGFR was observed in the total CKD population with a P of .010 (95% CI: -0.20, -0.03) and a correlation coefficient of -0.11. CONCLUSION: Our study shows no statistical significances in terms of the VVVs of BP in any of the geriatric groups, with no significant decreases in renal function. However, we observed a significant negative correlation between PP and eGFR. We demonstrated that if a VVV of BP does not occur, there is no decrease in eGFR.

Analysis of clinical characteristics of dialysis patients at the University Hospital.

OBJECTIVES: The incidence and prevalence of Chronic Kidney Disease (CKD) patients treated with dialysis has continued to increase worldwide. These patients are at the highest risk of developing cardiovascular complications which contribute to their demise. The objective of this study was to describe the clinical and demographic characteristics of the patients on maintenance hemodialysis at the University Hospital, in San Juan Puerto Rico. METHODS: We reviewed a total of 55 active patients. Data was collected to identify the demographic and clinical characteristics. Co-morbid conditions such as diabetes mellitus, hypertension, and coronary artery disease (CAD) were noted as well as age, dialysis vintage and social and educational profiles. RESULTS: Patients were divided into two groups according to age (group 1 were less than 60 years and group 2 were more than 60 years). Average age was 42 years in group 1 with 17 females and 24 males and 78 years in group 2 with 6 females and 8 males. Diabetes mellitus was present in 17 (41%) of group 1 and 5 patients (35%) of group 2. Likewise hypertension was present in 26 (63%) of group 1 patients and 11(78%) of group 2 patients. CAD was present in 15 (36%) of group 1 patients and 7 (50%) of group 2 patients. There was an association between low annual income in both groups but not in the level of education. CONCLUSION: A relatively young population was identified in our descriptive analysis of hemodialysis patients at the University Hospital. The expected high incidence of diabetes mellitus observed in the general population of hemodialysis patients in our country was not present. Hypertension and CAD were major risk factors in these patients. In view of these findings we recommend better control of blood pressure, prevention and early detection of CAD in CKD patients before initiating dialysis.