Kostas Siamopoulos - Academia.edu (original) (raw)
Papers by Kostas Siamopoulos
International Urology and Nephrology, Sep 19, 2010
Nephrology Dialysis Transplantation, 2013
Introduction and Aims: Patients with Chronic Kidney Disease (CKD) and/or Diabetes are at a high r... more Introduction and Aims: Patients with Chronic Kidney Disease (CKD) and/or Diabetes are at a high risk for cardiovascular (CV) disease. Improved outcomes require a better understanding of specific risk factors that distinctly modulate the incidence of atheromatous disease. Herein. we compared the distinct and combined impact of CKD and of diabetes (DM) on the development of atheromatous disease, and prevalent risk factors per condition. Methods: Cross sectional study in 2088 asymptomatic patients categorized as: 1) General Population (2 CV risk factors, no DM, estimated glomerular filtration rate (eGFR)>60 ml/min); 2) CKD,no DM; 3) DM, eGFR>60 ml/min, proteinuria<300 mg/dl; 4) Established diabetic nephropathy (DN). Carotid ultrasound of left and right carotid arteries evaluated intima-media thickness (IMT) in the common, bulb, internal and external carotid. Carotid plaque (CP) was defined as IMT>1.5mm. Multivariate Logistic Regression analysis examined the variables independently associated with the presence of CP, including glycosylated haemoglobin (HbA1c) in diabetics. Results: Table 1 shows the percent of patients with CP among the 4 populations of patients categorized by age.Table 2 shows the results of the multivariate analyses. There is a distinct association between classical risk factors and CP among the 4 subpopulation of patients. In DN, age and Triglycerydes are the only classical risk factors independently associated with CP. Also, exclusively in DN, HbA1 is independently associated with the presence of CP. Conclusions: Our findings confirm the high prevalence of atheromatous disease in asymptomatic high CV risk patients with a distinct association of risks factors among patient populations. Importantly, in diabetic nephropathy, HbA1C emerges as a main risk factor independently associated with the presence of carotid plaques.
Nephrology Dialysis Transplantation
Nephrology Dialysis Transplantation, 2014
Kidney International, 2021
Lung congestion, estimated by lung ultrasound is a risk factor for all-cause and cardiovascular m... more Lung congestion, estimated by lung ultrasound is a risk factor for all-cause and cardiovascular mortality in patients on chronic hemodialysis and may be useful to guide ultrafiltration and drug therapy in this population. In an international, multi-center randomized controlled trial (NCT02310061) we investigated whether a lung ultrasound-guided treatment strategy improved a composite end point (all-cause death, non-fatal myocardial infarction, decompensated heart failure) vs usual care in patients receiving chronic hemodialysis with high cardiovascular risk. Patient Reported Outcomes (Depression and the Standard Form 36 Quality of Life Questionnaire, SF36) were assessed as secondary outcomes. A total of 367 patients were enrolled; 183 in the active arm and 180 in the control arm. In the active arm, the pre-dialysis lung scan was used to titrate ultrafiltration during dialysis and drug treatment. Three hundred and seven patients completed the study; 152 in the active arm and 155 in the control arm. During a mean follow-up of 1.49 years, lung congestion was significantly more frequently relieved in the active (78%) than in the control (56%) arm and the intervention was safe. The primary composite end point did not significantly differ between the two study arms (Hazard Ratio 0.88; 95% Confidence Interval: 0.63-1.24). The risk for all cause and cardiovascular hospitalization and the changes of left ventricular mass and function did not differ among the two groups. A post hoc analysis for recurrent episodes of decompensated heart failure (0.37; 0.15-0.93) and cardiovascular events (0.63; 0.41-0.97) showed a risk reduction for these outcomes in the active arm. There were no differences in patient reported outcomes between groups. Thus, in patients on chronic hemodialysis with high cardiovascular risk a treatment strategy guided by lung-ultrasound effectively relieved lung congestion but was not more effective than usual care in improving the primary or secondary end points of the trial.
The International Journal of Artificial Organs, 2005
We analyzed the changes in serum potassium concentration ([K]) and acid-base parameters in 43 epi... more We analyzed the changes in serum potassium concentration ([K]) and acid-base parameters in 43 episodes of dialysis-associated hyperglycemia (serum glucose level > 33.3 mmol/L), 22 of which were characterized as diabetic ketoacidosis (DKA) and the remaining 21 as nonketotic hyperglycemia (NKH). All episodes were treated with insulin therapy only. Age, gender, initial and final serum values of glucose, sodium, chloride, tonicity and osmolality did not differ between DKA and NKH. At presentation, serum values of [K] (DKA 6.2 ± 1.3 mmol/L; NKH 5.2 ± 1.5 mmol/L) and anion gap [AG] (DKA 27.2 ± 6.4 mEq/L; NKH 15.4 ± 3.5 mEq/L) were higher in DKA, whereas serum total carbon dioxide content [TCO2] (DKA 12.0 ± 4.6 mmol/L; NKH 22.5 ± 3.1 mmol/L), arterial blood pH (DKA 7.15 ± 0.09; NKH 7.43 ± 0.07) and arterial blood PaCO2 (DKA 26.2 ± 12.3 mm Hg; NKH 34.5 ± 6.7 mm Hg) were higher in NKH. At the end of insulin treatment, serum values of [K] (DKA 4.0 ± 0.7 mmol/L, NKH 4.0 ± 0.5 mmol/L), [AG] ...
BMC nephrology, Jan 17, 2017
Preclinical studies demonstrate renal proximal tubular injury after administration of some intrav... more Preclinical studies demonstrate renal proximal tubular injury after administration of some intravenous iron preparations but clinical data on renal effects of intravenous iron are sparse. FIND-CKD was a 56-week, randomized, open-label, multicenter study in which patients with non-dialysis dependent chronic kidney disease (ND-CKD), anemia and iron deficiency without erythropoiesis-stimulating agent therapy received intravenous ferric carboxymaltose (FCM), targeting either higher (400-600 μg/L) or lower (100-200 μg/L) ferritin values, or oral iron. Mean (SD) eGFR at baseline was 34.9 (11.3), 32.8 (10.8) and 34.2 (12.3) mL/min/1.73 m(2) in the high ferritin FCM (n = 97), low ferritin FCM (n = 89) and oral iron (n = 167) groups, respectively. Corresponding values at month 12 were 35.6 (13.8), 32.1 (12.7) and 33.4 (14.5) mL/min/1.73 m(2). The pre-specified endpoint of mean (SE) change in eGFR from baseline to month 12 was +0.7 (0.9) mL/min/1.73 m(2) with high ferritin FCM (p = 0.15 versu...
Seminars in Dialysis, 2008
The mechanisms of fluid and solute abnormalities that should be considered in any patient with se... more The mechanisms of fluid and solute abnormalities that should be considered in any patient with severe hyperglycemia include changes in the total amount of extracellular solute, osmotic diuresis, intake of water driven by thirst, and influences from associated conditions. The absence of osmotic diuresis distinguishes dialysis-associated hyperglycemia (DH) from hyperglycemia with preserved renal function (HPRF). Mainly because of this absence, comparable degrees of hyperglycemia tend to produce less hypertonicity and less severe intracellular volume contraction in DH than in HPRF, while extracellular volume is expanded in DH but contracted in HPRF. Ketoacidosis can develop in both DH and HPRF. Among DH patients, hyperkalemia appears to be more frequent when ketoacidosis is present than when nonketotic hyperglycemia is present.
Peritoneal Dialysis International, 2014
International Urology and Nephrology, 2010
The main difference between dialysisassociated hyperglycemia (DH) and diabetic ketoacidosis (DKA)... more The main difference between dialysisassociated hyperglycemia (DH) and diabetic ketoacidosis (DKA) or nonketotic hyperglycemia (NKH) occurring in patients with preserved renal function is the absence of osmotic diuresis in DH, which eliminates the need for large fluid and solute (including potassium) replacement. We analyzed published reports of serum potassium (K ?) abnormalities and their treatment in DH. Hyperkalemia was often present at presentation of DH with higher frequency and severity than in hyperglycemic syndromes in patients with preserved renal function. The frequency and severity of hyperkalemia were higher in DH episodes with DKA than those with NKH in both hemodialysis and peritoneal dialysis. For DKA, the frequency and severity of hyperkalemia were similar in hemodialysis and peritoneal dialysis. For NKH, hyperkalemia was more severe and frequent in hemodialysis than in peritoneal dialysis. Insulin infusion corrected the hyperkalemia of DH in most cases. Additional measures for the management of hyperkalemia or modest potassium infusions for hypokalemia were needed in a few DH episodes. The predictors of the decrease in serum K ? during treatment of DH with insulin included the starting serum K ? level, the decreases in serum values of glucose concentration and tonicity, and the increase in serum total carbon dioxide level. DH represents a risk factor for hyperkalemia. Insulin infusion is the only treatment for hyperkalemia usually required.
Nephrology Dialysis Transplantation, 2013
Background. This study aimed to investigate the association of both body mass index (BMI) and wai... more Background. This study aimed to investigate the association of both body mass index (BMI) and waist circumference (WC) with left ventricular mass (LVM) in hypertensive predialysis chronic kidney disease (CKD) patients. Methods. From 2004 to 2005, 206 consecutive incident adult patients from the outpatient CKD clinics of two hospitals in Greece were included. Inclusion criteria were the presence of CKD and hypertension. BMI (kg/m 2), WC (cm) and LVM (g) were assessed annually for 3 years. Results. The mean age was 68.1 years, mean BMI 29.1 kg/m 2 and mean WC was 103.7 cm. The median LVM was 245.7 g (n = 179). In the cross-sectional data, linear regression models showed that WC {β = 1.2 [95% confidence interval (CI) 0.15; 2.3]}, and not BMI [β = 2.1 (95% CI: −0.70; 4.8)], was significantly associated with LVM. After adjustment for age, sex, primary renal disease, smoking and history of cardiovascular disease, both BMI [β = 4.7 (95% CI: 2.0; 7.4] and WC [β = 1.2 (95% CI: 0.14; 2.3)] were significantly associated with LVM. These associations were pronounced in CKD stage 1-3, but not in CKD stage 4-5. In the longitudinal analysis, linear mixed models adjusting for confounders showed that both an increase in BMI [β = 2.9 (95% CI: 0.74; 5.1)] and an increase in WC [β = 1.1 (95% CI: 0.28; 1.8)] were significantly associated with an increase in LVM. Conclusions. In hypertensive predialysis CKD patients, both BMI and WC were associated with LVM in CKD stage 1-3, but not in CKD stage 4-5. In the longitudinal analysis, both an increase in BMI and WC were associated with an increase in LVM. Future studies should focus on mechanisms responsible for the associations between anthropometric variables and LVM. I N T RO D U C T I O N Cardiovascular events, mortality and the progression to endstage renal disease (ESRD) are major complications of chronic kidney disease (CKD) [1-3]. Previous studies have shown that a patient with CKD is at higher risk of developing a cardiovascular event than reaching ESRD [4-6]. Left ventricular hypertrophy (LVH), a common comorbidity in CKD patients and hypertensive patients [7-10], is a strong risk factor for cardiovascular events and mortality [11-14]. Therefore, identification of modifiable risk factors for increased LV mass (LVM)
Clinical Nephrology, 1970
We report on a case of lifethreatening abdominal aorta hemorrhage following percutaneous renal bi... more We report on a case of lifethreatening abdominal aorta hemorrhage following percutaneous renal biopsy. A 42year-old woman with chronic kidney disease stage 2 and microscopic hematuria underwent a percutaneous renal biopsy to evaluate renal insufficiency. One hour following the biopsy procedure, she complained of an abdominal pain and developed signs of oligemic shock. In despite of 4 blood units transfusion, the patient continued to be in shock. She was transmitted urgently to the operating room without any other examinations (such as abdominal computer tomography) and underwent an emergency laparotomy. A transverse tear in the abdominal aorta was identified as the bleeding site, and after occlusion, the hemorrhage was stopped. The patient gradually recovered and she was discharged in good clinical condition after a few days.
SUMMARY Henoch-Schonlein purpura is a generalized vasculitis presenting with purpura, glomerulone... more SUMMARY Henoch-Schonlein purpura is a generalized vasculitis presenting with purpura, glomerulonephritis, cryoglobulinemia, arthralgias and acute abdominal pain. It occurs mainly in childhood and serum IgA is increased in half of the patients. A 54-year-old male patient was admitted to the Department of Nephrology because of lower extremities purpura, mild abdominal pain and acute renal failure (creatinine clearance at 60 ml/min). Physical examination showed both lower extremities purpura and mild epigastric tenderness. Abdominal imaging did not show anything remarkable. Further laboratory investigation showed serum urea 75 mg/dl, serum creatinine 1.9 mg/dl, amylase 600 UI/ ml (normal values up to 90 UI/ml) and albumin 3.2 gr/dl. Serum isoamylase analysis was compatible with that of pancreatic origin. Urine amylase was 138 UI/ml, while the examination of the urinary sediment showed microscopic hematuria and proteinuria. In the 24-hour urine collection albuminuria reached nephrotic s...
The effectiveness of erythropoiesis-stimulating agents (ESAs) to correct renal anemia has been on... more The effectiveness of erythropoiesis-stimulating agents (ESAs) to correct renal anemia has been one of the great advancements in the last 2 decades of renal replacement therapy (RRT) (1). Quality of life of patients on RRT has improved substantially with the advent of ESAs (2, 3), and a major reduction in the need of blood transfusions is an undeniable, concrete benefit of ESA therapy. However, even after intense research on ESAs and their use to achieve an optimal hemoglobin (Hb) target capable of improving patient outcome, some key points are yet to be clarified (4), as was recently underlined by some recent trials (5, 6) and a meta-analysis (7). The need for optimal ESA use is amplified by the fact that these agents are quite expensive. In the United States, e.g., expenditures for ESAs have doubled from 0.9billionto0.9 billion to 0.9billionto1.9 billion over the last 5 years, whereas the overall level of expenditure for care has remained stable. As health care budgets are not endlessly expandable, grea...
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, Jan 27, 2017
The evidence base regarding the safety of intravenous (IV) iron therapy in patients with chronic ... more The evidence base regarding the safety of intravenous (IV) iron therapy in patients with chronic kidney disease (CKD) is incomplete and largely based on small studies of relatively short duration. FIND-CKD (ClinicalTrials.gov number NCT00994318) was a 1-year, open-label, multicenter, prospective study of patients with nondialysis-dependent CKD, anemia and iron deficiency randomized (1:1:2) to IV ferric carboxymaltose (FCM), targeting higher (400-600 µg/L) or lower (100-200 µg/L) ferritin, or oral iron. A post hoc analysis of adverse event rates per 100 patient-years was performed to assess the safety of FCM versus oral iron over an extended period. The safety population included 616 patients. The incidence of one or more adverse events was 91.0, 100.0 and 105.0 per 100 patient-years in the high ferritin FCM, low ferritin FCM and oral iron groups, respectively. The incidence of adverse events with a suspected relation to study drug was 15.9, 17.8 and 36.7 per 100 patient-years in the...
Clinical Nephrology, 2009
Fabry disease is a progressive metabolic disorder with a clinical course characterized by differe... more Fabry disease is a progressive metabolic disorder with a clinical course characterized by different phases and a variety of disease manifestations. The first symptoms generally appear in childhood or early adolescence and are followed by late lifethreatening complications involving vascular, renal, cardiac, and cerebral systems. We report the clinical and biochemical characteristics of 16 male patients from 10 unrelated families who represent almost the entire cohort of known Fabry patients in Greece. Despite the presence of early symptoms in almost every patient (mean age at onset of symptoms 15.6 years), the diagnosis was delayed for a mean of about 18 years (mean age of diagnosis 36 years). Patients are currently monitored and the majority (15 out 16 patients) treated with Enzyme Replacement Therapy.
International Urology and Nephrology, Sep 19, 2010
Nephrology Dialysis Transplantation, 2013
Introduction and Aims: Patients with Chronic Kidney Disease (CKD) and/or Diabetes are at a high r... more Introduction and Aims: Patients with Chronic Kidney Disease (CKD) and/or Diabetes are at a high risk for cardiovascular (CV) disease. Improved outcomes require a better understanding of specific risk factors that distinctly modulate the incidence of atheromatous disease. Herein. we compared the distinct and combined impact of CKD and of diabetes (DM) on the development of atheromatous disease, and prevalent risk factors per condition. Methods: Cross sectional study in 2088 asymptomatic patients categorized as: 1) General Population (2 CV risk factors, no DM, estimated glomerular filtration rate (eGFR)>60 ml/min); 2) CKD,no DM; 3) DM, eGFR>60 ml/min, proteinuria<300 mg/dl; 4) Established diabetic nephropathy (DN). Carotid ultrasound of left and right carotid arteries evaluated intima-media thickness (IMT) in the common, bulb, internal and external carotid. Carotid plaque (CP) was defined as IMT>1.5mm. Multivariate Logistic Regression analysis examined the variables independently associated with the presence of CP, including glycosylated haemoglobin (HbA1c) in diabetics. Results: Table 1 shows the percent of patients with CP among the 4 populations of patients categorized by age.Table 2 shows the results of the multivariate analyses. There is a distinct association between classical risk factors and CP among the 4 subpopulation of patients. In DN, age and Triglycerydes are the only classical risk factors independently associated with CP. Also, exclusively in DN, HbA1 is independently associated with the presence of CP. Conclusions: Our findings confirm the high prevalence of atheromatous disease in asymptomatic high CV risk patients with a distinct association of risks factors among patient populations. Importantly, in diabetic nephropathy, HbA1C emerges as a main risk factor independently associated with the presence of carotid plaques.
Nephrology Dialysis Transplantation
Nephrology Dialysis Transplantation, 2014
Kidney International, 2021
Lung congestion, estimated by lung ultrasound is a risk factor for all-cause and cardiovascular m... more Lung congestion, estimated by lung ultrasound is a risk factor for all-cause and cardiovascular mortality in patients on chronic hemodialysis and may be useful to guide ultrafiltration and drug therapy in this population. In an international, multi-center randomized controlled trial (NCT02310061) we investigated whether a lung ultrasound-guided treatment strategy improved a composite end point (all-cause death, non-fatal myocardial infarction, decompensated heart failure) vs usual care in patients receiving chronic hemodialysis with high cardiovascular risk. Patient Reported Outcomes (Depression and the Standard Form 36 Quality of Life Questionnaire, SF36) were assessed as secondary outcomes. A total of 367 patients were enrolled; 183 in the active arm and 180 in the control arm. In the active arm, the pre-dialysis lung scan was used to titrate ultrafiltration during dialysis and drug treatment. Three hundred and seven patients completed the study; 152 in the active arm and 155 in the control arm. During a mean follow-up of 1.49 years, lung congestion was significantly more frequently relieved in the active (78%) than in the control (56%) arm and the intervention was safe. The primary composite end point did not significantly differ between the two study arms (Hazard Ratio 0.88; 95% Confidence Interval: 0.63-1.24). The risk for all cause and cardiovascular hospitalization and the changes of left ventricular mass and function did not differ among the two groups. A post hoc analysis for recurrent episodes of decompensated heart failure (0.37; 0.15-0.93) and cardiovascular events (0.63; 0.41-0.97) showed a risk reduction for these outcomes in the active arm. There were no differences in patient reported outcomes between groups. Thus, in patients on chronic hemodialysis with high cardiovascular risk a treatment strategy guided by lung-ultrasound effectively relieved lung congestion but was not more effective than usual care in improving the primary or secondary end points of the trial.
The International Journal of Artificial Organs, 2005
We analyzed the changes in serum potassium concentration ([K]) and acid-base parameters in 43 epi... more We analyzed the changes in serum potassium concentration ([K]) and acid-base parameters in 43 episodes of dialysis-associated hyperglycemia (serum glucose level > 33.3 mmol/L), 22 of which were characterized as diabetic ketoacidosis (DKA) and the remaining 21 as nonketotic hyperglycemia (NKH). All episodes were treated with insulin therapy only. Age, gender, initial and final serum values of glucose, sodium, chloride, tonicity and osmolality did not differ between DKA and NKH. At presentation, serum values of [K] (DKA 6.2 ± 1.3 mmol/L; NKH 5.2 ± 1.5 mmol/L) and anion gap [AG] (DKA 27.2 ± 6.4 mEq/L; NKH 15.4 ± 3.5 mEq/L) were higher in DKA, whereas serum total carbon dioxide content [TCO2] (DKA 12.0 ± 4.6 mmol/L; NKH 22.5 ± 3.1 mmol/L), arterial blood pH (DKA 7.15 ± 0.09; NKH 7.43 ± 0.07) and arterial blood PaCO2 (DKA 26.2 ± 12.3 mm Hg; NKH 34.5 ± 6.7 mm Hg) were higher in NKH. At the end of insulin treatment, serum values of [K] (DKA 4.0 ± 0.7 mmol/L, NKH 4.0 ± 0.5 mmol/L), [AG] ...
BMC nephrology, Jan 17, 2017
Preclinical studies demonstrate renal proximal tubular injury after administration of some intrav... more Preclinical studies demonstrate renal proximal tubular injury after administration of some intravenous iron preparations but clinical data on renal effects of intravenous iron are sparse. FIND-CKD was a 56-week, randomized, open-label, multicenter study in which patients with non-dialysis dependent chronic kidney disease (ND-CKD), anemia and iron deficiency without erythropoiesis-stimulating agent therapy received intravenous ferric carboxymaltose (FCM), targeting either higher (400-600 μg/L) or lower (100-200 μg/L) ferritin values, or oral iron. Mean (SD) eGFR at baseline was 34.9 (11.3), 32.8 (10.8) and 34.2 (12.3) mL/min/1.73 m(2) in the high ferritin FCM (n = 97), low ferritin FCM (n = 89) and oral iron (n = 167) groups, respectively. Corresponding values at month 12 were 35.6 (13.8), 32.1 (12.7) and 33.4 (14.5) mL/min/1.73 m(2). The pre-specified endpoint of mean (SE) change in eGFR from baseline to month 12 was +0.7 (0.9) mL/min/1.73 m(2) with high ferritin FCM (p = 0.15 versu...
Seminars in Dialysis, 2008
The mechanisms of fluid and solute abnormalities that should be considered in any patient with se... more The mechanisms of fluid and solute abnormalities that should be considered in any patient with severe hyperglycemia include changes in the total amount of extracellular solute, osmotic diuresis, intake of water driven by thirst, and influences from associated conditions. The absence of osmotic diuresis distinguishes dialysis-associated hyperglycemia (DH) from hyperglycemia with preserved renal function (HPRF). Mainly because of this absence, comparable degrees of hyperglycemia tend to produce less hypertonicity and less severe intracellular volume contraction in DH than in HPRF, while extracellular volume is expanded in DH but contracted in HPRF. Ketoacidosis can develop in both DH and HPRF. Among DH patients, hyperkalemia appears to be more frequent when ketoacidosis is present than when nonketotic hyperglycemia is present.
Peritoneal Dialysis International, 2014
International Urology and Nephrology, 2010
The main difference between dialysisassociated hyperglycemia (DH) and diabetic ketoacidosis (DKA)... more The main difference between dialysisassociated hyperglycemia (DH) and diabetic ketoacidosis (DKA) or nonketotic hyperglycemia (NKH) occurring in patients with preserved renal function is the absence of osmotic diuresis in DH, which eliminates the need for large fluid and solute (including potassium) replacement. We analyzed published reports of serum potassium (K ?) abnormalities and their treatment in DH. Hyperkalemia was often present at presentation of DH with higher frequency and severity than in hyperglycemic syndromes in patients with preserved renal function. The frequency and severity of hyperkalemia were higher in DH episodes with DKA than those with NKH in both hemodialysis and peritoneal dialysis. For DKA, the frequency and severity of hyperkalemia were similar in hemodialysis and peritoneal dialysis. For NKH, hyperkalemia was more severe and frequent in hemodialysis than in peritoneal dialysis. Insulin infusion corrected the hyperkalemia of DH in most cases. Additional measures for the management of hyperkalemia or modest potassium infusions for hypokalemia were needed in a few DH episodes. The predictors of the decrease in serum K ? during treatment of DH with insulin included the starting serum K ? level, the decreases in serum values of glucose concentration and tonicity, and the increase in serum total carbon dioxide level. DH represents a risk factor for hyperkalemia. Insulin infusion is the only treatment for hyperkalemia usually required.
Nephrology Dialysis Transplantation, 2013
Background. This study aimed to investigate the association of both body mass index (BMI) and wai... more Background. This study aimed to investigate the association of both body mass index (BMI) and waist circumference (WC) with left ventricular mass (LVM) in hypertensive predialysis chronic kidney disease (CKD) patients. Methods. From 2004 to 2005, 206 consecutive incident adult patients from the outpatient CKD clinics of two hospitals in Greece were included. Inclusion criteria were the presence of CKD and hypertension. BMI (kg/m 2), WC (cm) and LVM (g) were assessed annually for 3 years. Results. The mean age was 68.1 years, mean BMI 29.1 kg/m 2 and mean WC was 103.7 cm. The median LVM was 245.7 g (n = 179). In the cross-sectional data, linear regression models showed that WC {β = 1.2 [95% confidence interval (CI) 0.15; 2.3]}, and not BMI [β = 2.1 (95% CI: −0.70; 4.8)], was significantly associated with LVM. After adjustment for age, sex, primary renal disease, smoking and history of cardiovascular disease, both BMI [β = 4.7 (95% CI: 2.0; 7.4] and WC [β = 1.2 (95% CI: 0.14; 2.3)] were significantly associated with LVM. These associations were pronounced in CKD stage 1-3, but not in CKD stage 4-5. In the longitudinal analysis, linear mixed models adjusting for confounders showed that both an increase in BMI [β = 2.9 (95% CI: 0.74; 5.1)] and an increase in WC [β = 1.1 (95% CI: 0.28; 1.8)] were significantly associated with an increase in LVM. Conclusions. In hypertensive predialysis CKD patients, both BMI and WC were associated with LVM in CKD stage 1-3, but not in CKD stage 4-5. In the longitudinal analysis, both an increase in BMI and WC were associated with an increase in LVM. Future studies should focus on mechanisms responsible for the associations between anthropometric variables and LVM. I N T RO D U C T I O N Cardiovascular events, mortality and the progression to endstage renal disease (ESRD) are major complications of chronic kidney disease (CKD) [1-3]. Previous studies have shown that a patient with CKD is at higher risk of developing a cardiovascular event than reaching ESRD [4-6]. Left ventricular hypertrophy (LVH), a common comorbidity in CKD patients and hypertensive patients [7-10], is a strong risk factor for cardiovascular events and mortality [11-14]. Therefore, identification of modifiable risk factors for increased LV mass (LVM)
Clinical Nephrology, 1970
We report on a case of lifethreatening abdominal aorta hemorrhage following percutaneous renal bi... more We report on a case of lifethreatening abdominal aorta hemorrhage following percutaneous renal biopsy. A 42year-old woman with chronic kidney disease stage 2 and microscopic hematuria underwent a percutaneous renal biopsy to evaluate renal insufficiency. One hour following the biopsy procedure, she complained of an abdominal pain and developed signs of oligemic shock. In despite of 4 blood units transfusion, the patient continued to be in shock. She was transmitted urgently to the operating room without any other examinations (such as abdominal computer tomography) and underwent an emergency laparotomy. A transverse tear in the abdominal aorta was identified as the bleeding site, and after occlusion, the hemorrhage was stopped. The patient gradually recovered and she was discharged in good clinical condition after a few days.
SUMMARY Henoch-Schonlein purpura is a generalized vasculitis presenting with purpura, glomerulone... more SUMMARY Henoch-Schonlein purpura is a generalized vasculitis presenting with purpura, glomerulonephritis, cryoglobulinemia, arthralgias and acute abdominal pain. It occurs mainly in childhood and serum IgA is increased in half of the patients. A 54-year-old male patient was admitted to the Department of Nephrology because of lower extremities purpura, mild abdominal pain and acute renal failure (creatinine clearance at 60 ml/min). Physical examination showed both lower extremities purpura and mild epigastric tenderness. Abdominal imaging did not show anything remarkable. Further laboratory investigation showed serum urea 75 mg/dl, serum creatinine 1.9 mg/dl, amylase 600 UI/ ml (normal values up to 90 UI/ml) and albumin 3.2 gr/dl. Serum isoamylase analysis was compatible with that of pancreatic origin. Urine amylase was 138 UI/ml, while the examination of the urinary sediment showed microscopic hematuria and proteinuria. In the 24-hour urine collection albuminuria reached nephrotic s...
The effectiveness of erythropoiesis-stimulating agents (ESAs) to correct renal anemia has been on... more The effectiveness of erythropoiesis-stimulating agents (ESAs) to correct renal anemia has been one of the great advancements in the last 2 decades of renal replacement therapy (RRT) (1). Quality of life of patients on RRT has improved substantially with the advent of ESAs (2, 3), and a major reduction in the need of blood transfusions is an undeniable, concrete benefit of ESA therapy. However, even after intense research on ESAs and their use to achieve an optimal hemoglobin (Hb) target capable of improving patient outcome, some key points are yet to be clarified (4), as was recently underlined by some recent trials (5, 6) and a meta-analysis (7). The need for optimal ESA use is amplified by the fact that these agents are quite expensive. In the United States, e.g., expenditures for ESAs have doubled from 0.9billionto0.9 billion to 0.9billionto1.9 billion over the last 5 years, whereas the overall level of expenditure for care has remained stable. As health care budgets are not endlessly expandable, grea...
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, Jan 27, 2017
The evidence base regarding the safety of intravenous (IV) iron therapy in patients with chronic ... more The evidence base regarding the safety of intravenous (IV) iron therapy in patients with chronic kidney disease (CKD) is incomplete and largely based on small studies of relatively short duration. FIND-CKD (ClinicalTrials.gov number NCT00994318) was a 1-year, open-label, multicenter, prospective study of patients with nondialysis-dependent CKD, anemia and iron deficiency randomized (1:1:2) to IV ferric carboxymaltose (FCM), targeting higher (400-600 µg/L) or lower (100-200 µg/L) ferritin, or oral iron. A post hoc analysis of adverse event rates per 100 patient-years was performed to assess the safety of FCM versus oral iron over an extended period. The safety population included 616 patients. The incidence of one or more adverse events was 91.0, 100.0 and 105.0 per 100 patient-years in the high ferritin FCM, low ferritin FCM and oral iron groups, respectively. The incidence of adverse events with a suspected relation to study drug was 15.9, 17.8 and 36.7 per 100 patient-years in the...
Clinical Nephrology, 2009
Fabry disease is a progressive metabolic disorder with a clinical course characterized by differe... more Fabry disease is a progressive metabolic disorder with a clinical course characterized by different phases and a variety of disease manifestations. The first symptoms generally appear in childhood or early adolescence and are followed by late lifethreatening complications involving vascular, renal, cardiac, and cerebral systems. We report the clinical and biochemical characteristics of 16 male patients from 10 unrelated families who represent almost the entire cohort of known Fabry patients in Greece. Despite the presence of early symptoms in almost every patient (mean age at onset of symptoms 15.6 years), the diagnosis was delayed for a mean of about 18 years (mean age of diagnosis 36 years). Patients are currently monitored and the majority (15 out 16 patients) treated with Enzyme Replacement Therapy.