We describe our preliminary experience with percutaneous renal denervation in end-stage renal disease patients with resistant hypertension and challenging anatomy, in terms of the feasibility, safety, and efficacy of this procedure. Four patients with end-stage renal disease patients with resistant hypertension (mean hemodialysis time, 2.3 years) who had been taking at least four antihypertensive medications underwent percutaneous renal denervation. Renal artery eligibility included the absence of prior renal artery interventions, vessel stenosis <70%, or extended calcifications (more than 30% of the vessel circumference). No cut off values of vessel diameter were used. All patients were successfully treated with no intra-or postprocedural complications, and all showed 24-hour ambulatory blood pressure reduction at the 12-month follow-up. Percutaneous renal denervation is a feasible approach for end-stage renal disease patients with resistant hypertension with encouraging short-term preliminary results in terms of procedural efficacy and safety.
Background: Heart rate variability (HRV), pulse pressure amplification, and obesity represent risk factors for cardiovascular events. The aims of the present study are (1) to explore the impact of HRV on pulse pressure amplification and (2) to investigate whether the association between HRV and pulse pressure amplification differs in obese and lean subjects. Methods: A total of 342 patients (age 61 ± 11 years) were enrolled. HRV was analyzed concerning both the frequency and time domain as well as concerning the HRV triangular index. Pulse pressure amplification was estimated as the ratio between brachial and carotid pulse pressure, the latter measured with SphygmoCor. Results: Time domain HRV indices were directly correlated with pulse pressure amplification (the lower the HRV indices, the lower the pulse pressure amplification). This association was stronger in obese than in lean subjects after controlling for age and sex. Conclusion: Larger controlled studies are needed to provide a more detailed insight into the relation between HRV and pulse pressure amplification and to determine which pathways are differentially activated in lean and obese subjects.
Central venous catheter (CVC) infections represent one of the most common complications in hemodialysis patients. Understanding the risk factors that induce CVC infection and identifying the microorganisms that cause them, is essential for developing preventive strategies. Therefore, it is important to develop prophylaxis and surveillance protocols, but also to determine adequate diagnostic criteria that include the use of new laboratory tools, useful in identifying a wider range of pathogenic microorganisms. We reported a clinical case of CVC related infection caused by the gram negative Methylobacterium radiotolerans in a hemodialysis patient. Matrix-assisted laser desorption/ionizationtime of flight is a type of mass spectrometry (MALDI-TOF MS) which utilizes microbial protein mass distribution analysis, generating a signal that is decoded and represented as a peak on a Cartesian reference system. MALDI-TOF MS was fundamental in the identification of the pathogen, which remained previously unidentified using routine laboratory techniques. The use of MALDI-TOF MS has therefore allowed the pathogen's tempestive identification, accurate diagnosis and targeted antibiotic treatment, positively impacting on infection resolution, prognosis and patient survival.
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