Journal of Nephrology & Therapeutics

Objective: Hypotension is quite common in any dialysis unit and despite significant improvements of hemodialysis techniques in the recent years; the frequency of recurrent intradialytic hypotension episodes has remained nearly unchanged. Our study is aimed to define the pathogenesis of intradialytic hypotension and attempts to describe effective measures for the hypotension prone hemodialysis patients on an individual basis. Design: This is a prospective study of 100 hemodialysis patients observed over 12 months at the Lilavati Hospital and Research Centre, Mumbai, India. Subjects with more than two episodes/month of hypotension on dialysis were diagnosed as having IDH. Results: Intradialytic hypotension was found in 18% of subjects. Incorrectly assessed ideal body weight was found to be the commonest cause of intradialytic hypotension. Volume assessment and adjusting the ideal body weight was found to be central to the problem of preventing intradialytic hypotension. Conclusion: This study shows that intradialytic hypotension is a common phenomenon, even in a tertiary care centre. Preventive strategies should be developed in each unit to decrease the future risk for intradialytic hypotension in specific patients.

Introduction: High blood pressure (HBP) that is a leading cause of end-stage renal disease (ESRD) in black African populations and is frequently associated to autosomal polycystic kidney disease (ADPKD). This study aimed to describe prevalence and severity of HBP in black Africans with ADPKD and to identify associated risk factors. Patients and methods: We performed a retrospective study of 65 ADPKD patients regularly followed in outpatient nephrology clinic between 1995 and 2009. ADPKD was diagnosed according to recent unified criteria (2009). Statistical analyses were done with SPSS 16.0. Results: We included 65 patients (36 males and 29 females) with a mean age of 47 ± 5 years. Hypertension was found in 73.8 % of patients and it preceded diagnosis of ADPKD in 23 patients (median delay of 28 months). Mean systolic/diastolic blood pressure was 168 ± 30 /96 ± 16 mm Hg respectively. All hypertensive patients presented retinopathy and left ventricular hypertrophy. Two patients presented stroke. Fifty one percent of patients were treated with angiotensin converting enzyme inhibitors alone and 29% received combinations of anti-hypertensive drugs. One third of them had their blood pressure normalized. Patients with HBP at diagnosis showed a similar proportion of ESRD in comparison with normotensive patients (p=0.12). At univariate analysis, HBP was correlated with age, gender, BMI, GFR and proteinuria. Multiple regression analysis identified age (OR=1.95, p=0.05) and glomerular filtration rate (OR=2.33, p=0.001) as independently associated to HBP. Conclusion: Hypertension with organ damage is frequent in Senegalese patients with ADPKD. Age and glomerular filtration rate at diagnosis were the main risk factors of HBP identified in our patients.

Numerous trials have shown that chronic kidney disease increases the risk of cardiovascular disease. Dyslipidemias have been shown to accelerate progression of kidney disease. Statins have assumed a pivotal role in management of hyperlipidemia. However their effect on renal function is still not fully understood. Some clinical trials have shown some renoprotective effect of statins but there is still need for more data to clarify effects of statins on renal function.