Rajiv Agarwal

..The reproducibility of BP measurements followed the order home > ambulatory >> predialysis > postdialysis. These data provide support for the use of home BP monitoring for the management of hypertension in hemodialysis patients...

..The effect of BP monitoring itself on the level of physical activity and sleep remains unknown. If BP monitoring affects these parameters, then monitoring itself may influence the circadian BP pattern...

..Home BP monitoring is similar to standardized recording of BP in hemodialysis patients. A systolic BP threshold of 150 mmHg at home averaged over 1 week serves as a useful predictor of hypertension diagnosed by ambulatory BP monitoring...

..Several large trials are currently under way to examine the safety and efficacy of statins in renally compromised patients at high risk for cardiovascular disease...

..Whether VDRAs will accomplish this goal among proteinuric patients with chronic kidney disease needs to be tested in randomized controlled trials...

..In patients with CKD, BPs obtained at home are a stronger predictor of ESRD or death compared to BPs obtained in the clinic. Systolic home BP is an independent predictor for ESRD...

..01 to 1.52) after adjusting for average systolic BP and chronic kidney disease. BP differences between arms are reproducible and carry prognostic information. Patients should have evaluation of BP in both arms at the screening visit...

..While active vitamin D and its analogs have been shown to have renal protective effects in animals, these hormones have not been shown to reduce proteinuria in CKD patients...

..Smoking is a common mechanism for generating oxidative stress and inflammation. Whether smokers have increased REE and if so, whether it is accounted for by the pro-oxidant and inflammatory state is not known...

..These results have implications for other applications utilizing fluorescence detectors...

....

....

..It has long been recognized that kidney function affects and is affected by hypertension. This article discusses the pathophysiology and management of hypertension in patients with CKD...

..We hypothesized that PPAR-gamma-based antidiabetic therapy would result in greater reduction in proteinuria compared to sulfonylurea-based therapy...

....

..To assess the role of out-of-clinic BP recordings in predicting cardiovascular events in patients with chronic kidney disease (CKD), a prospective cohort study was conducted in 217 veterans with CKD...

..The goal of this study was to describe the variability in these measurements and to calculate minimum sample size estimates over varying time frames for clinical trials...

..The purpose of this review is to examine the physiology of circadian BP variation and propose a tripartite model that explains the regulation of circadian BP...

..The reduction of dry weight is a simple, efficacious, and well-tolerated maneuver to improve BP control in hypertensive hemodialysis patients. Long-term control of BP will depend on continued assessment and maintenance of dry weight...

..The purpose of this study was to evaluate whether the duration of plasma sampling influences precision and estimation of GFR...

..Nontraditional risk factors such as albuminuria can then be tested to evaluate the predictive value of these markers over and above traditional risk factors for patient-level decision making...

..The use of intradialytic BP measurements to diagnose hypertension is unknown...

..The purpose of our study was to evaluate the competing risk of ESRD versus mortality and to evaluate the risk factors associated with these two outcomes...

..Assessment of volume state is difficult in hemodialysis patients. Whether continuous blood volume monitoring can improve the assessment of volume state is unclear...

..Volume control is a key component of treatment of hemodialysis patients. The role of pedal edema as a marker of volume is unknown. The objective of this study was to determine factors that are associated with edema...

..We tested the hypothesis that the variability in hemoglobin (Hgb) response (epo sensitivity) is determined by key nutritional, inflammation, and oxidative stress markers...

..Whether it is the greater number of measurements made outside the dialysis unit that correlates with prognosis or whether BPs outside dialysis units are ecologically more valid is unknown...

..Leaner patients have an accelerated mortality rate in the first 2 years; this is not completely explained by BP, LVMI, or other cardiovascular or dialysis-specific risk factors...

..Whether nocturia itself or the resulting nondipping associated with nocturia is of prognostic importance for cardiorenal events in patients with chronic kidney disease should be tested in future studies...

..The purpose of this review is to discuss the recent advances in out-of-office BP recordings in the management of patients with CKD including those on hemodialysis...

....

....

..Measurement of total intact albumin may better quantify acute renal injury...

..Home BP monitoring should be used as a cost-effective means to diagnose occult hypertension in chronic hemodialysis patients...

..Beta blockers, dihydropyridine calcium blockers, and agents that block the renin-angiotensin system appear to be effective in lowering BP in these patients...

..The microplate method is a reliable alternative to a reference HPLC method and can be performed for a fraction of the cost, time, and reagents...

..MDA degrades at room temperature at a rate of 10% per hour. It is therefore, suggested that the total assay time be limited to 1 h beginning with sample preparation...

..In part, this is because it can detect white-coat hypertension and masked hypertension. Whether the same is true for hemodialysis patients is not known...

..Hypervolemia is an important and modifiable cause of hypertension. Hypertension improves with probing dry weight, but its effect on echocardiographic measures of volume is unknown...

..Most guidelines recommend that seated clinic blood pressure (BP) be targeted to less than 130/80 mmHg in patients with chronic kidney disease (CKD). The evidence underlying these recommendations is the subject of this review...

....

..In conclusion, supervised lisinopril therapy is effective in controlling hypertension in chronic HD patients. This may be related to blockade of angiotensin II generation by kidneys despite the loss of excretory function...

..We sought to determine the clinical performance of predialysis and postdialysis systolic and diastolic blood pressure values (BPs) in diagnosing hypertension or assessing its control...

..Although probing dry-weight improves blood pressure control, its effect on echocardiographic left ventricular mass index (LVMI) is unknown...

..The purpose of this study was to evaluate the levels and patterns of total and differential leukocyte counts and their prognostic importance in a cohort of people with and without chronic kidney disease (CKD)...

..d.) will result in additional Ang II antagonism in patients with proteinuric chronic renal failure with hypertension...

..The epidemiology of hypertension among hemodialysis (HD) patients is difficult to describe accurately because of difficulties in the assessment of blood pressure (BP)...

..There is a substantial variability in venous pressures in the same patient that reduces with increasing Qbs. Venous pressure monitoring at greater Qbs provides a more sensitive method for predicting access failure...

..Atenolol, a water soluble beta-blocker has a prolonged half-life in renal failure and may serve as a useful antihypertensive agent in these patients...

..These results suggest that patients with 3+ or greater proteinuria should not only trigger appropriate evaluation of proteinuria, but also have mean arterial pressures targeted to less than 92 mm Hg...

..Hypertension control with home BP monitoring can be enhanced further when accompanied by plans to monitor and treat elevated BP such as through telemonitoring...

..Drugs that may lead to rapid transferrin saturation may lead to greater efficacy but also increased toxicity if transferring-mediated uptake of iron is the basis of this toxicity...

..Its use to assess excess volume-related morbidity among chronic hemodialysis patients should be tested in randomized, controlled trials...

..The relationship of oxidative stress and renal injury in patients with CKD is unknown. Whether renal injury can occur at a time point when transferrin is incompletely saturated is also unclear...

..Skinfold thickness measurements may be a better test to classify obesity among those with CKD. Given the low negative predictive value of BMI for obesity, our study may provide an explanation of the "obesity paradox."..

..This and other methods for more accurate measurement of GFR in patients with acute renal failure may provide the foundation for clinical studies that assess the severity and management of acute renal failure...

..Hypertension is common in chronic hemodialysis patients, yet there are limited data on the epidemiology of hypertension in these patients in the United States...

..This study examined differences in proteinuria between two intravenous iron preparations after multiple doses...

..However, among those with chronic kidney disease (CKD), the determinants of electrocardiographic (EKG) LVH and its prognostic value are not clear...

..The current data suggest that the overall risk-benefit ratio favors use of IV iron when compared with untreated or partially treated iron-deficiency anemia...

..The significant association of the change in urinary MCP-1 with a reduction in oxidative stress supports the role of the redox state in the kidney with renal fibrosis and progressive kidney damage...

..There was excellent thermal and pH stability of iothalamate. No interference was found with para-amino hippuric acid (PAH) or N-acetyl PAH, which can be simultaneously assayed, if desired...

..This study sought to determine the optimal time to perform home BP monitoring in hemodialysis patients to improve the strength of prediction of 44-hour interdialytic ambulatory BP...

..Intravenous (i.v) iron is widely used to treat anaemia in patients with chronic kidney disease (CKD). Although beneficial and usually well tolerated, concerns have been raised about its ability to cause oxidative stress and renal injury...

..We conclude that RPV slope monitoring is a valid method to assess dry weight among hypertensive hemodialysis patients...

..Antihypertensive drugs, though associated with higher average BP, are associated with blunted rate of change in BP over time...

..The goal of this meta-analysis was to estimate the prevalence and determinants of white-coat and masked hypertension in the adult CKD population...

..Although the long-term dangers of intravenous iron are unproved, these data call for examination of effects of intravenous iron on the potential for long-term harm in patients with chronic kidney disease...

..Several ongoing studies are evaluating the effect of statins on cardiovascular end points in patients with CKD and may provide data needed to support adjunctive use of these agents in this high-risk population...

..The objective of this study is to determine factors associated with NT-pro-BNP and cTnT and determine whether these levels are associated with mortality...

..Treatment of concomitant iron deficiency with SFGC was well tolerated in patients with CKD and appears to optimize management of anemia...

..An average HBP of approximately 140/80 mm Hg appears to be the best correlate of hypertension defined by means of ABPM...

..If nephrologists are to take their appropriate place as leaders of the care delivery team, nephrology fellowships must be restructured with appropriate emphasis placed on the comprehensive care of ESRD and CKD patients...

..We conducted this longitudinal study to better understand the relationship between kidney size and function...

..Therefore, the management of hypertension among these patients should focus on blood pressure recordings outside the dialysis unit...

..The causes of this blunted circadian variation remain incompletely understood...

..Emerging evidence suggests that consideration of excretory function together with proteinuria may provide a more holistic assessment of the extent of derangement in renal function...

....

..Reduced circadian variation in blood pressure (BP) has been associated with cardiovascular morbidity, mortality and accelerated progression of kidney disease, but its independent prognostic value remains unknown...

..Achieving and maintaining dry-weight appears to be an effective but forgotten strategy in controlling and maintaining normotension among hypertensive patients on hemodialysis...

..The value of measurement of glycosylated hemoglobin (HgbA(1C)) in determining the degree of glycemic control in patients with chronic kidney disease (CKD) is unclear...

..This purpose of this report is to describe the development of an instrument to measure the presence and severity of a wide range of symptoms commonly attributable to CKD...

..Intradialytic blood pressure (BP) profiles have been associated with all-cause mortality, but its pathophysiology remains unknown. We tested the hypothesis that intradialytic changes in BP reflect excess volume...

..Out-of-office BP monitoring is recommended for the management of hypertension in all stages of CKD...

..This surrogate end point needs to be confirmed in trials designed to demonstrate cardiovascular protection...

..Pulse pressure is related to proteinuria independent of the awake-sleep state. Reducing mean arterial pressure during the day and pulse pressure during the day or night may be effective antiproteinuric strategies...

....

....

..1 to -36.3 mmHg) and diastolic BP (19.3 to -23.9 mmHg). Dialysis unit BP measurements are imprecise estimates of ABP. Better methods are needed for the assessment of BP in hemodialysis patients for clinical decision making...

..This review compares blood pressure measurements obtained in the clinic with those obtained outside the clinic to predict cardiovascular and renal injury and outcomes...

..We speculate that dual blockade with losartan and an ACE inhibitor may provide additional renoprotection by decreasing renal production of TGF-beta1...

..Evidence for effect modification was tested for several plausible demographic, clinical and laboratory factors...

..Routine and standardized measurements of BP were similarly weak correlates of LVH. Systolic BP outside the dialysis unit was a stronger correlate of LVH compared with dialysis unit BP...

....

..Home BP agree well with ambulatory BP, but the prognostic significance of home BP recordings is unknown in hemodialysis patients. This study ascertained the role of home BP in predicting all-cause and cardiovascular mortality...

..Whether control of hypertension translates into better outcomes is not known, but collective evidence suggests that hypertension should be controlled in hemodialysis patients...

..Long-term randomized, controlled trials are required to confirm these benefits of vitamin D analogs...

..A competing Cox regression model was used to describe the risk of myocardial infarction (MI) in the two groups (CKD and diabetes) over a decade of follow-up...

....

..Novelty and Health Relatedness of the Project: This proposal will provide translational data on the role of intravenous iron to progression of kidney disease in patients with CKD. ..

..Evaluation of such strategies will improve BP control in hemodialysis patients and, in the long-term, provide cardiovascular protection. ..

..We hypothesize that that volume control can improve BP and antihypertensive therapy can regress left ventricular hypertrophy in long-term hemodialysis patients. ..