Clinical Impact of Blood Pressure Variability in Kidney Transplant Patients: A Systematic Review and Meta-Analysis.

The association between blood pressure (BP) dipping profiles and kidney function among chronic kidney disease (CKD) patients has been well established within the literature, but studies conducted on kidney transplant (KT) patients remain limited. Individual KT studies have small sample sizes and conflicting results. Meta-analysis overcomes these limitations by pooling data to increase statistical power and provide robust clinical guidance.

From pathophysiology to novel approaches for obesity-associated hypertension.

Obesity is a rapidly growing epidemic affecting >15% of the global adult population and has considerable clinical consequences and comorbidities, including hypertension, diabetes mellitus, cardiovascular and cerebrovascular diseases and chronic kidney disease. There is a strong association between obesity or body mass index and high blood pressure (BP) in epidemiological studies while the underlying pathophysiological events linking those conditions are not fully elucidated. Hypothetical mechanisms include a sedentary lifestyle and excess intake of processed foods that contribute to obesity, overactivation of the renin-angiotensin-aldosterone and sympathetic nervous systems, inflammation, altered adipokine homeostasis and the fatty kidney hypothesis involving adipose tissue accumulation in the renal sinus and perirenal space.

European guidelines for hypertension in 2024: a comparison of key recommendations for clinical practice.

Hypertension is the most prevalent modifiable risk factor for cardiovascular disease and for cardiovascular and all-cause mortality globally. Suboptimal control of elevated blood pressure places a substantial burden on health-care systems worldwide. Several factors contribute to this suboptimal control, such as limited awareness of hypertension, lack of appropriate diagnosis and poor control of blood pressure among those with a diagnosis.

Effects of Proteinuria on Cerebral and Muscle Oxygenation and Microvascular Reactivity in Patients With Pre-Dialysis Chronic Kidney Disease: A Post-Hoc Analysis.

Introduction Vascular dysfunction is a hallmark of chronic kidney disease (CKD), with previous studies showing progressively deteriorating microvascular reactivity in skeletal muscles with advancing CKD stages. Additionally, cognitive impairment is quite common in CKD patients, as significant determinants of brain activation, i.e.

Understanding endothelial dysfunction in kidney transplantation: assessment techniques, existing evidence, and research needs.

Introduction: Kidney transplant recipients (KTRs) have substantially lower risk for cardiovascular events compared to dialysis, but it remains significantly higher than in the general population due to the synergistic action of traditional and nontraditional factors. Among them, endothelial dysfunction is suggested to be involved pathogenetically in cardiovascular and renal disease progression, with its improvement being another potential benefit of transplantation.

Areas Covered: VOP was the first technique to be used, followed by several functional methods, most commonly FMD.

Nocturnal blood pressure: pathophysiology, measurement and clinical implications. Position paper of the European Society of Hypertension.

Interest in the pathophysiology, measurement, and clinical implications of nocturnal blood pressure (BP) has significantly increased due to its strong association with cardiovascular risk, and its importance was recognized by the 2023 European Society of Hypertension (ESH) guidelines. Nocturnal BP regulation is complex and multifactorial, involving sleep-wake cycle, circadian rhythms, autonomic nervous system, renin-angiotensin-aldosterone system, and renal mechanisms. 24-h ambulatory blood pressure monitoring is currently the reference method for nocturnal BP assessment.

Vascular endothelial dysfunction in pediatric rheumatic diseases: a systematic review and meta-analysis.

Objectives: Endothelial dysfunction is associated with increased cardiovascular risk in individuals with autoimmune diseases. This systematic review and meta-analysis included studies assessing endothelial function with functional methods in children with rheumatic diseases versus controls.

Methods: Literature search involved PubMed and Scopus databases (from inception to February 2024) and manual reference screening.

Baroreflex Sensitivity and Hemodynamic Parameters at Rest and in Response to Physical and Mental Stress: A Comparative Study of Patients Undergoing Different Dialysis Modalities.

Introduction Cardiac arrhythmias are the leading mortal cause of end-stage kidney disease (ESKD), and autonomic dysfunction plays a predominant role. This is the first study to compare baroreflex sensitivity (BRS) and hemodynamic responses at rest and after mental and physical stimulation maneuvers between hemodialysis (HD) and peritoneal dialysis (PD) patients. Methods A total of 68 ESKD patients (34 HD and 34 PD, matched for age, sex, and dialysis vintage) were included.

Impact of Intradialytic Weight Gain on Left Ventricular Function and Characteristics in Hemodialysis Patients.

Background: Pulmonary circulation is particularly overloaded in hemodialysis patients with high interdialytic weight gain (IDWG), as evidenced by deterioration in right ventricular function indices. This study aimed to evaluate the impact of the degree of fluid accumulation on left ventricular (LV) systolic and diastolic function and sizing characteristics.

Methods: This is a post hoc analysis of a cross-over study in 41 hemodialysis patients.

Aldosterone synthase inhibition in chronic kidney disease.

Purpose Of Review: Chronic kidney disease (CKD) is associated with elevated cardiovascular risk and progression to kidney failure, despite advances in therapy with renin-angiotensin system inhibitors and sodium-glucose-co-transporter-2 inhibitors. Overactivation of the aldosterone pathway contributes to residual cardiorenal risk. Nonsteroidal mineralocorticoid receptor antagonists (MRAs) have shown efficacy in reducing cardiorenal outcomes in patients with albuminuric diabetic kidney disease, providing a rationale to explore broader aldosterone pathway inhibition in CKD.

Endothelin receptor antagonists for diabetic kidney disease: back to the future?

Introduction: Diabetic kidney disease (DKD) is a leading cause of chronic kidney disease worldwide. Endothelin-1 (ET-1) is a potent vasoconstrictor secreted by vascular endothelial cells, actively involved in the pathophysiology of numerous cardiovascular diseases. Based on the differential downstream effects of ET-1 binding to its two distinct types of receptors (ET/ET) within the kidney, selective ET receptor blockade has been long proposed as a promising treatment modality for DKD.

Efficacy and safety of finerenone in patients with an acute change in estimated glomerular filtration rate in the prespecified FIDELITY pool analysis.

Introduction: The efficacy and safety of finerenone (a nonsteroidal mineralocorticoid receptor antagonist) versus placebo were assessed according to different changes in estimated glomerular filtration rate (eGFR) using data from FIDELITY, a pooled individual-level analysis of two clinical trials.

Methods: Patients had chronic kidney disease (eGFR of 25 ml/min/1.73 m or greater) and type 2 diabetes with optimized renin-angiotensin system blockade.

Sex Differences in Ambulatory Central Blood Pressure and Arterial Stiffness in Hemodialysis Patients.

Introduction: Sex differences have a significant role on epidemiology of cardiovascular complications in chronic kidney disease. Among hemodialysis patients, central blood pressure (BP) levels and increased arterial stiffness parameters are independent predictors of cardiovascular and all-cause- mortality.

Aim: To examine the potential differences in ambulatory central BP and arterial stiffness parameters between male and female hemodialysis patients.

A salty symphony: unraveling the tale of uromodulin and sodium sensitivity.

Uromodulin is a kidney-specific glycoprotein which is uniquely synthesized by the epithelial cells lining the thick ascending limb and early distal convoluted tubule. Among multiple roles in complex physiological and pathological processes, uromodulin mediates renal sodium handling through modulating tubular sodium transporters that reabsorb sodium and therefore is putatively linked to hypertension through generating sodium sensitivity of blood pressure. This review aims to present an updated overview of the role of uromodulin in sodium renal handling and summarize the existing evidence originating from preclinical, genetic, and clinical studies that support a relationship between uromodulin and sodium-sensitive hypertension.

Structural and Functional Capillary Integrity, Arterial Stiffness and Central Hemodynamics in CKD Patients With and Without Nocturnal Hypertension.

Background: Nocturnal hypertension is associated with an increased risk for renal and cardiovascular events in patients with chronic kidney disease (CKD). Endothelial dysfunction and microvascular damage are highly prevalent in CKD and related to CKD progression and adverse cardiovascular outcomes. The aim of this analysis was to compare for the first time microcirculatory function parameters and central hemodynamics in CKD patients with and without nocturnal hypertension.

Blood pressure variability in CKD patients with and without nocturnal hypertension.

Nocturnal hypertension is highly prevalent in patients with chronic kidney disease (CKD) and represents a strong predictor of cardiovascular events. Increased blood pressure variability (BPV) is also independently associated with cardiovascular events in these patients. Differences in short-term BPV indices between CKD patients with and without nocturnal hypertension have not been previously studied.

The Effect of Low Dialysate Sodium Concentration on Ambulatory Aortic Blood Pressure and Arterial Stiffness in Patients With Intradialytic Hypertension: A Randomized Crossover Study.

Introduction: Intradialytic hypertension (IDH) is associated with increased cardiovascular risk. Arterial stiffness is a strong predictor of adverse outcomes in dialysis patients and may contribute to the development of the phenomenon, as patients with IDH exhibit higher ambulatory aortic blood pressure (BP) and arterial stiffness parameters than patients without IDH.  Methods: This analysis examined the effect of low (137mEq/L) compared to standard (140mEq/L) dialysate sodium concentration on 48-hour aortic BP and arterial stiffness parameters in IDH patients.

Physical Activity in Patients With Chronic Kidney Disease: The Effects of Caregivers and Residential Factors.

Introduction Physical inactivity is common in chronic kidney disease (CKD) patients; several patient- and disease-related factors are linked to a sedentary lifestyle, but social and environmental influences remain unexplored. This study evaluates the level of physical activity in patients with CKD and investigates the associations with caregivers' physical activity levels, characteristics of the residential environment, and objective measures of exercise capacity. Methods Eighty CKD patients (20 per CKD stage 2-4) were included; patients and their carers filled out the International Physical Activity Questionnaire (IPAQ), questionnaires about residential environment and past exercise habits.

Endothelial dysfunction in adults with congenital heart disease: A systematic review and meta-analysis.

Background: Adults with congenital heart disease (ACHD) can face a lifelong risk of premature cardiovascular events. Endothelial dysfunction and arterial stiffness may be some of the key mechanisms involved. Early identification of endothelial damage in ACHD could be crucial to mitigate the adverse events.