Disease. Chronic kidney disease is associated with a high risk of mortality and cardiovascular events. While cardiovascular patients without renal impairment undoubtedly benefit from lipid-lowering drugs, it is less clear whether these drugs are equally effective in patients with kidney disease. This overview compiles evidence of the effectiveness of lipid-lowering measures for cardiovascular and renal protection in patients with chronic kidney disease with regard to the degree of renal impairment.

Reduction of Cardiovascular and Renal Risks by Means of Lipid-Lowering Medication in Patients with Chronic Kidney Disease. Chronic kidney disease is associated with a high risk of mortality and cardiovascular events. While cardiovascular patients without renal impairment undoubtedly benefi t from lipid-lowering drugs, it is less clear whether these drugs are equally effective in patients with kidney disease. This overview compiles evidence of the effectiveness of lipid-lowering measures for cardiovascular and renal protection in patients with chronic kidney disease with regard to the degree of renal impairment. J Hypertonie 2014; 18 (1): 9–17.

Background: Both elevated non-HDL cholesterol (C) and elevated blood pressure (BP) are major risk factors for the development and targets for the prevention of atherothrombotic disease. Possible interactions between these two parameters have not been studied in detail. This investigation aims at looking at values of blood serum cholesterol, blood pressure and possible correlations therein in men and women, with a special focus on the impact of age. Methods: A total of 7496 outpatients with arterial hypertension in Austria were recruited. Four age groups were analyzed (<= 49 years, 50-59 years, 60-69 years and >= 70 years). Results: Overall, men and women had similar systolic and diastolic blood pressure (158 +/- 91 vs 159 +/- 19 mmHg and 91 +/- 10 vs 91 +/- 11 mmHg, respectively; p < 0.01) and similar non-HDL C values (165 +/- 45 mg/dl; 164 +/- 43 mg/dl, resp.; p < 0.001). Both, systolic (SBP) and diastolic (DBP) blood pressure correlated highly significantly with non-HDL (p < 0.001) in men (mean r = 0.15 for SBP and r = 0.18 for DBP, both p < 0.001). Women showed a weaker correlation with a mean r = 0.10 for SBP and r = 0.09 for DBP (both p < 0.001). With respect to the four age groups, non-HDL C was similar in men between 172 +/- 47 and 173 +/- 44 mg/dl up to the age of 60 years and declined to 157 +/- 43 mg/dl in the group above 70 years of age. In women we detected a rise of non-HDL C by 10 mg/dl around menopause (mean 158 +/- 42 mg/dl < 50 years of age, mean 168 +/- 42 mg/dl with 50-59 years, afterwards declining to 163 +/- 43 mg/dl; p < 0.01). SBP was similar in men and women over all age groups (between 157 +/- 19 and 159 +/- 19 mmHg), whereas DBP declined with increasing age (95 +/- 10 to 88 +/- 11 mmHg in men; 94 +/- 11 to 88 +/- 11 mmHg, resp.). Correlations between SBP, DBP and non-HDL cholesterol were greater for men. Women showed an increase around menopause. Conclusion: Our results demonstrate a correlation of non-HDL C and blood pressure in hypertensive men of all age groups. In women, menopause has a significant influence not only on lipid levels, but also on correlations to blood pressure.

Considering the extremely low restenosis rates of drug-eluting stents, intervention of long coronary lesions is an increasing challenge for cardiologists. In contrast to the technique of spot-stenting, the complete coverage of long lesions with overlapping drug-eluting stents has become the method of first choice. On the other hand, stenting of long lesions is associated with a higher procedural risk as well as higher restenosis rates. Stent delivery and optimal side-branch management pose a challenge to the operator. Finally, late stent thrombosis remains an unresolved problem.In a retrospective analysis from 1/2004 to 4/2006 of 33 consecutive symptomatic patients with native coronary lesions of 41 to 81 mm in length (medium 52.1 mm), we are able to show that stenting of long lesions with multiple overlapping sirolimus-eluting stents (SES/Cypher stents) is technically feasible and is associated with excellent clinical short-and long-term outcomes. With the exception of one patient who showed an acute side-branch occlusion during the procedure, we could achieve very good acute angiographic results in all patients. In clinical follow-up, only one patient developed a diffuse in-stent restenosis within the target vessel after seven months. In three further patients, we found a side-branch restenosis. There were no major acute coronary events in follow-up and no need for any urgent revascularisation.

In May 2004, an Austrian scientific board started a hypertension project, LIIFE-IN-LIFE, to gain epidemiological data on hypertension in Austria and, based on the LIFE study results, to document antihypertensive regimen in daily practice. In 20,615 hypertensive patients, epidemiologic and clinical data of the typical Austrian hypertensive patient were evaluated and extensive risk management was initiated.The average hypertensive patient turned out to be overweight, was on average 66 years old, showed in more than 50 % at least one underlying cardiovascular disease and suffered from diabetes in 24 %; the mean LDL cholesterol level was 134 mg/dl. Mean systolic blood pressure was 158.3 +/- 18.9 mmHg and diastolic blood pressure 90.8 +/- 10.8 mmHg. According to the Framingham apoplexy score, the risk of apoplexy was estimated as 28.9 % in the studied population within 10 years. Less than one fifth (18.7 %) showed blood pressure values at goal according to the European criteria (ESC, EHC) despite antihypertensive combination therapy. Changing to an optimized, losartan-based therapy 7 of 10 (68.9 %) hypertensive patients reached the blood pressure goal and remained stable for one year.This largest-ever Austrian project in hypertensive patients proves the extensive cardiovascular risk profile in the project patients with, in general, inadequate antihypertensive therapy. LIIFE-IN-LIFE will show long-term data on more than 20,000 hypertensives in a follow-up period of up to 5 years (until 2008) and will evaluate intensified antihypertensive regimen with respect to endpoint data. First data over 12 months in 9000 patients document that 7 out of 10 hypertensive patients put on a losartan-based therapy reach and maintain their blood pressure target values.

The Austrian Hypertensive Patient in Daily Clinical Practice: A First Analysis of 20,615 Hypertensive Patients Included in the LIIFE-INLIFE-Project with Therapeutic Results of 12 Months in 9000 Patients. In May 2004, an Austrian scientific board started a hypertension project, LIIFE-IN-LIFE, to gain epidemiological data on hypertension in Austria and, based on the LIFE study results, to document antihypertensive regimen in daily practice. In 20,615 hypertensive patients, epidemiologic and clinical data of the typical Austrian hypertensive patient were evaluated and extensive risk management was initiated.

Soft, cuffed, implantable central venous catheters such as the Quinton Permcath (Quinton Instrument Co, Seattle, WA) are increasingly used as permanent access in patients with end-stage renal disease. Their major limitations, besides infection, are thrombosis and inadequate blood flow. To prevent those complications, heparin is conventionally used for priming the Quinton Permcath between dialysis sessions. In this study, we compared recombinant tissue plasminogen activator (rTPA) with heparin for priming the Quinton Permcath in a prospective, randomized, crossover design. Twelve patients were randomly assigned to receive 2,000 IU of heparin or 2 mg of rTPA injected into each catheter lumen at the end of each dialysis session over a period of 4 months, followed by a switch to the other substance. Blood flow rate (flow), venous pressure (VP), and arterial pressure (AP) were monitored at each dialysis session hourly. Flow was significantly greater (P = 0.0001) with rTPA (mean ± SD, 237.7 ± 18.1 and 231.6 ± 12.4 mL/min for the first and second 2 months, respectively) compared with heparin (208.5 ± 10.1 and 206.9 ± 14.2 mL/min for the first and second 2 months, respectively). VP was significantly less (P = 0.0001) with rTPA (135.4 ± 8.2 and 140 ± 15.2 mm Hg for the first and second 2 months, respectively) compared with heparin (160.5 ± 16.1 and 159.2 ± 20.7 mm Hg for the first and second 2 months, respectively). AP was significantly greater (P = 0.0002) with rTPA (–113.5 ± 11.8 and –115.9 ± 12.7 mm Hg for the first and second 2 months, respectively) compared with heparin (–136.5 ± 23.3 and –134.7 ± 25.8 mm Hg for the first and second 2 months, respectively). In addition, fewer complications (flow problems, clotting, and need for fibrinolysis) occurred in the rTPA period. These results show that rTPA is superior to heparin for priming the Quinton Permcath between hemodialysis sessions and can be used as a valuable alternative to conventional heparin in selected patients.

INTRODUCTION:Gastrointestinal disorders occur frequently in dialysis patients. Few data are available on the prevalence of symptoms originating from the gastrointestinal tract in this group of patients. Our aim was to obtain data on the prevalence of chronic gastrointestinal symptoms in patients undergoing hemodialysis.METHODS:All 109 patients of our dialysis unit were given a questionnaire to complete which was previously validated and designed to measure the occurrence of gastrointestinal, and some general symptoms during the preceding year. 105 subjects responded (96% response rate).RESULTS:79% of dialysis patients had at least one of the following chronic gastrointestinal symptoms: Esophageal symptoms were reported in 21% abdominal pain in 28% and dyspeptic symptoms in 48%. The irritable bowel syndrome was diagnosed in 12 patients (11%), 40% had chronic constipation and 24% had chronic diarrhoea. Colonic pain was described in 20% of patients. Frequent general symptoms (such as weakness, headaches, insomnia and fatigue) were described in up to 51%, and patients were severely bothered by symptoms in up to 33% of cases.CONCLUSION:Although patients on hemodialysis generally report a good quality of life, the prevalence of gastrointestinal symptoms and of general symptoms is high and many dialysis patients consider these symptoms to cause major impairment of daily life.

Teicoplanin is a new glycopeptide antibiotic with potent activity against Gram-positive bacteria. It has been considered to be non-dialyzable due to its high molecular weight (1875-1891 d) and high protein binding (89%). Therefore, a reduced dose was recommended for patients on hemodialysis therapy, with the loading dose being followed by a considerably lower maintenance dose and/or extension of the interval between doses. The present study was performed to evaluate the pharmacokinetics of teicoplanin during hemodialysis therapy using high flux membranes. The pharmacokinetic parameters of teicoplanin were studied in 15 patients with chronic renal failure on hemodialysis. A high flux polysulfone membrane (ultrafiltration coefficient of 40 ml/h/mmHg) was used. Teicoplanin was administered at a dosage of 10 mg.kg-1 body weight in 100 ml isotonic saline solution during the first 10 minutes of hemodialysis therapy. Pharmacokinetic analysis was performed using a three compartment analysis. After a single dose of teicoplanin plasma peak levels were 26.4 +/- 12.0 micrograms/mL (mean +/- SD) after 30 minutes. Teicoplanin concentrations rapidly declined to a nadir of 6.1 +/- 2.5 micrograms/mL at the end of the 3.5-hour session dialysis. Extracorporeal clearance was 39.7 +/- 24.5 mL/min. Removal of 19.3 +/- 7.7% of the drug was estimated if infused during hemodialysis. T 1/2 alpha were 0.37 +/- 0.25 hrs, t 1/2 beta 20.1 +/- 7.1 hrs, and t 1/2 gamma 549.7 +/- 210.5 hrs. We conclude that teicoplanin levels are reduced to a subtherapeutic range during one single high-flux dialysis session if the drug is administered during hemodialysis. Thus, in contrast to previous suggestions relevant amounts of teicoplanin are removed during hemodialysis and thus teicoplanin cannot be viewed as non-dialyzable drug. We recommend obligatory drug monitoring to achieve therapeutic plasma concentrations.

In the present study the effect of unfractionated heparin (UFH) (Liquemin, 750-1000 IU/h), low molecular weight heparin (LMWH) (Fragmin, 3000-7250 IU bolus), and prostacyclin (Flolan, 5 ng/kg body weight/min) on the activation of blood coagulation and fibrinolysis, induced by polysulfone membrane dialyzers during hemodialysis, was compared. Plasma levels of thrombin-antithrombin III complex (TAT), fibrin split product D-dimer, and plasmin-plasmin inhibitor-complex (PPI) were measured in the arterial and venous line of the dialyzer at the beginning and at 10, 60, 120, and 180 minutes of hemodialysis. Five patients on chronic hemodialysis treatment were investigated in a cross over study. Clinically all three anticoagulation regimen were sufficient for hemodialysis treatment. Using UFH or LMWH TAT, PPI, and D-dimer levels were similar in the venous and the arterial line of the dialyzer. However, during prostacyclin treatment the levels of these activation markers were significantly higher in the venous line. Based on these data the dialyzer membrane can be considered as a site of activation of blood coagulation and of fibrinolysis during anticoagulation with prostacyclin in hemodialysis.

A 60-year-old man had end-stage renal disease because of biopsy-proven systemic sclerosis. He had been on chronic haemodialysis (HD) since July 1994. The dialysis regimen was 3 x 4 h/week. Blood access for HD was a long-term Permcath-catheter in the right subclavian vein. The patient had bicarbonate dialysis using a cuprophane dialyser. For anticoagulation highmolecular-weight heparin was given in a dose of 4000 units each dialysis.

Thirty-seven kidney graft recipients with chronically declining transplant function accompanied by renal anemia were treated with recombinant human erythropoietin for 3 months. In all these patients anemia improved and mean hemoglobin levels increased from 7.67 +/- 1.26 g/dl to 9.83 +/- 1.94 g/dl (p < 0.01). Mean creatinine increased from 4.23 +/- 1.82 to 4.62 +/- 2.42 (p < 0.05) but the progression of transplant failure was not influenced when compared with pretreatment values obtained at least 6 months before study entry. Mean blood pressure levels were not altered but 12 patients required additional antihypertensive medication.