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149 results on '"Sarafidis, Pantelis A"'

2. From Cardiorenal Syndrome to Chronic Cardiovascular and Kidney Disorder

Author

Zoccali, Carmine, Mallamaci, Francesca, Halimi, Jean-Michel, Rossignol, Patrick, Sarafidis, Pantelis, De Caterina, Raffaele, Giugliano, Robert, and Zannad, Faiez

Abstract

The association between cardiac and kidney dysfunction has received attention over the past two decades. A putatively unique syndrome, the cardiorenal syndrome, distinguishing five subtypes on the basis of the chronology of cardiac and kidney events, has been widely adopted. This review discusses the methodologic and practical problems inherent to the current classification of cardiorenal syndrome. The term “disorder” is more appropriate than the term “syndrome” to describe concomitant cardiovascular and kidney dysfunction and/or damage. Indeed, the term disorder designates a disruption induced by disease states to the normal function of organs or organ systems. We apply Occam's razor to the chronology-based construct to arrive at a simple definition on the basis of the coexistence of cardiovascular disease and CKD, the chronic cardiovascular–kidney disorder (CCKD). This conceptual framework builds upon the fact that cardiovascular and CKD share common risk factors and pathophysiologic mechanisms. Biological changes set in motion by kidney dysfunction accelerate cardiovascular disease progression and vice versa. Depending on various combinations of risk factors and precipitating conditions, patients with CCKD may present initially with cardiovascular disease or with hallmarks of CKD. Treatment targeting cardiovascular or kidney dysfunction may improve the outcomes of both. The portfolio of interventions targeting the kidney–cardiovascular continuum is in an expanding phase. In the medium term, applying the new omics sciences may unravel new therapeutic targets and further improve the therapy of CCKD. Trials based on cardiovascular and kidney composite end points are an attractive and growing area. Targeting pathways common to cardiovascular and kidney diseases will help prevent the adverse health effects of CCKD.

Published
2024
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4. The association of sex differences in ambulatory blood pressure with cardiovascular events and mortality in dialysis patients

Author

Iatridi, Fotini, Theodorakopoulou, Marieta P., Georgiou, Areti, Karagiannidis, Artemios G., Haddad, Nasra, Devrikis, Nikolaos, Mayer, Christopher C., Kamperidis, Vasileios, Anastasiou, Vasileios, Karpetas, Antonios, and Sarafidis, Pantelis

Abstract

Male patients with pre-dialysis chronic kidney disease (CKD) have worse ambulatory blood pressure (BP) control than females; this is associated with higher mortality. Male hemodialysis patients have higher ambulatory BP levels than females. This analysis aimed to investigate the association of sex differences in ambulatory BP with cardiovascular events and mortality in hemodialysis individuals. 129 male and 91 female hemodialysis patients with valid 48-h BP monitoring were followed for 53.4 ± 31.1 months. The primary endpoint was cardiovascular mortality; the secondary endpoint was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, resuscitation after cardiac arrest, heart failure-hospitalization, coronary or peripheral revascularization. Cumulative freedom from the primary endpoint was lower for women (logrank-p= 0.032), while cumulative-freedom from the secondary endpoint did not differ significantly between-groups (logrank-p= 0.644). The crude risk for cardiovascular mortality was significantly higher in women (HR = 1.613, 95% CI [1.037, 2.509]). The crude risk for the combined endpoint was not different between the two groups (HR = 0.918, 95% CI [0.638, 1.320]). After adjusting for major risk factors (age, diabetes, dialysis vintage, coronary disease and hemoglobin) no significant differences in the risk for both the primary and the secondary endpoint were observed between women and men (primary: HR = 1.295 (95% CI [0.808, 2.078]), secondary: HR = 0.763 (95% CI [0.521, 1.118])). After additional adjustment for 44-h systolic BP the above relationships did not alter (primary: HR = 1.329 (95% CI [0.826, 2.137]), secondary: HR = 0.808 (95% CI [0.551, 1.184])). In conclusion, female hemodialysis patients have higher crude but similar adjusted cardiovascular mortality rates compared to male counterparts. In contrast to pre-dialysis CKD, the neutral relationship between gender and adverse cardiovascular outcomes in hemodialysis is not further affected by ambulatory BP.

Published
2024
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5. Dialysate sodium and short-term blood pressure variability in patients with intradialytic hypertension: a randomized crossover study

Author

Iatridi, Fotini, Ekart, Robert, Xagas, Efstathios, Karkamani, Eleni, Karpetas, Antonios, Theodorakopoulou, Marieta P., Devrikis, Nikolaos, Revela, Ioanna, Papagianni, Aikaterini, and Sarafidis, Pantelis

Abstract

Increased blood pressure (BP) variability (BPV) is associated with high cardiovascular risk in hemodialysis. Patients with intradialytic hypertension (IDH) also exhibit an increased cardiovascular risk compared to hemodialysis patients without this condition. The impact of non-pharmacological BP-lowering interventions on BPV in this population remains unknown. This analysis evaluated the effect of low (137mEq/L) compared to standard (140mEq/L) dialysate sodium concentration on short-term BPV in patients with IDH. In a randomized cross-over manner, 29 IDH patients underwent 4 hemodialysis sessions with low (137mEq/L) followed by 4 sessions with standard (140mEq/L) dialysate sodium or vice versa. 48 h ambulatory BP measurement was performed from the start of the 4th session on each dialysate sodium. BPV indices during the 48 h, 24 h, day-time and night-time periods were calculated. Mean 48 h BP was 5.3/2.6 mmHg lower with low compared to standard dialysate sodium concentration, (p= 0.005/p= 0.007 respectively). All 48 h systolic BPV indices examined showed non-significant differences between low and standard dialysate sodium (SBP-SD: 16.99 ± 5.39 vs. 16.98 ± 4.33 mmHg, p= 0.982; SBP-wSD: 15.93 ± 5.02 vs. 16.12 ± 4.16 mmHg, p= 0.769; SBP-ARV: 11.99 ± 3.67 vs. 11.45 ± 3.35 mmHg, p= 0.392; SBP-CV: 12.36 ± 3.65 vs. 11.92 ± 3.18%, p= 0.302, with low vs. standard dialysate sodium, respectively). Diastolic BPV indices were numerically, but not statistically, lower with low dialysate sodium. Overall, significant differences were observed in some comparisons with a trend for lower BPV during day-time 2 and higher BVP during night-time 2 with low dialysate sodium. In conclusion, low dialysate sodium concentration does not affect BPV levels in patients with IDH. Future research should explore alternative interventions to reduce BP and BPV in this high-risk population.

Published
2024
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6. Inflammation is an amplifier of lung congestion by high lv filling pressure in hemodialysis patients: a longitudinal study

Author

Torino, Claudia, Gargani, Luna, Sicari, Rosa, Letachowicz, Krzysztof, Ekart, Robert, Fliser, Danilo, Covic, Adrian, Siamopoulos, Kostas, Stavroulopoulos, Aristeidis, Massy, Ziad A., Fiaccadori, Enrico, Regolisti, Giuseppe, Bachelet, Thomas, Slotki, Itzchak, Martinez-Castelao, Alberto, Coudert-Krier, Marie-Jeanne, Rossignol, Patrick, Hannedouche, Thierry, Wiecek, Andrzej, Sarafidis, Pantelis, Battaglia, Yuri, Prohić, Nejra, Klinger, Marian, Hojs, Radovan, Seiler-Mußler, Sarah, Lizzi, Fabio, Siriopol, Dimitrie, Balafa, Olga, Shavit, Linda, Loutradis, Charalampos, Seidowsky, Alexandre, Tripepi, Rocco, Mallamaci, Francesca, Tripepi, Giovanni, Picano, Eugenio, London, Gérard Michel, and Zoccali, Carmine

Abstract

Introduction: Since inflammation alters vascular permeability, including vascular permeability in the lung, we hypothesized that it can be an amplifier of lung congestion in a category of patients at high risk for pulmonary oedema like end stage kidney disease (ESKD) patients. Objective and methods: We investigated the effect modification by systemic inflammation (serum CRP) on the relationship between a surrogate of the filling pressure of the LV [left atrial volume indexed to the body surface area (LAVI)] and lung water in a series of 220 ESKD patients. Lung water was quantified by the number of ultrasound B lines (US-B) on lung US. Six-hundred and three recordings were performed during a 2-year follow up. Longitudinal data analysis was made by the Mixed Linear Model. Results: At baseline, 88 had absent, 101 had mild to moderate lung congestion and 31 severe congestion. The number of US B lines associated with LAVI (r= 0.23, P< 0.001) and serum CRP was a robust modifier of this relationship (P< 0.001). Similarly, in fully adjusted longitudinal analyses US-B lines associated with simultaneous estimates of LAVI (P= 0.002) and again CRP was a strong modifier of this relationship in adjusted analyses (P≤ 0.01). Overall, at comparable LAVI levels, lung congestion was more pronounced in inflamed than in non-inflamed patients. Conclusion: In ESKD systemic inflammation is a modifier of the relationship between LAVI, an integrate measure of LV filling pressure, and lung water. For any given pressure, lung water is increased with higher CRP levels, likely reflecting a higher permeability of the alveolar-capillary barrier.

Published
2024
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7. Hyperkalemia in chronic kidney disease: a focus on potassium lowering pharmacotherapy

Author

Sampani, Erasmia, Theodorakopoulou, Marieta, Iatridi, Fotini, and Sarafidis, Pantelis

Abstract

ABSTRACTIntroductionHyperkalemia is one of the most common electrolyte disorders in chronic kidney disease (CKD) and is associated with serious adverse outcomes. Hyperkalemia risk is even greater when CKD patients also have additional predisposing conditions such as diabetes or heart failure. Renin-angiotensin-aldosterone-system blockers are first-line treatments for cardio- and nephroprotection, but their use is often limited due to K+elevation, resulting in high rates of discontinuation.Areas coveredThis article provides an overview of factors interfering with K+homeostasis and discusses recent data on newer therapeutic agents used for the treatment of hyperkalemia. A detailed literature search was performed in two major databases (PubMed/MEDLINE and Scopus) up to April 2023.Expert opinionMajor clinical trials have tested new and promising kidney protective therapies such as sodium/glucose-cotransporter-2 inhibitors and mineralocorticoid-receptor-antagonists, with promising results. Until recently, the only treatment option for hyperkalemia was the cation-exchanging resin sodium-polystyrene-sulfonate. However, despite its common use, the efficacy and safety data of this drug in the long-term management of hyperkalemia are scarce. During the last decade, two novel orally administered K+-exchanging compounds (patiromer and sodium-zirconium-cyclosilicate) have been approved for the treatment of adults with hyperkalemia, as they both effectively reduce elevated serum K+and maintain chronically K+balance within the normal range with an excellent tolerability and no serious adverse events.

Published
2023
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8. Endovascular Versus Medical Management of Atherosclerotic Renovascular Disease: Update and Emerging Concepts.

Author

Pappaccogli, Marco, Robberechts, Tom, Lengelé, Jean-Philippe, Van der Niepen, Patricia, Sarafidis, Pantelis, Rabbia, Franco, and Persu, Alexandre

Abstract

Atherosclerotic renovascular disease is the most frequent cause of renovascular hypertension and its prevalence increases with age and in specific subset of patients, such as those with end-stage chronic kidney disease, heart failure, and coronary artery disease. Besides hypertension, atherosclerotic renovascular disease is responsible for several clinical manifestations, including life-threatening conditions, such as recurrent flash pulmonary edema, rapidly progressive chronic kidney disease, or acute kidney injury. Atherosclerotic renovascular disease is usually part of a more diffuse atherosclerotic process and requires a combination therapy including antihypertensive, antiplatelet and lipid-lowering agents, as well as optimization of antidiabetic treatment, if needed. Besides medical therapy, percutaneous renal angioplasty was supposed to be the most effective therapy for atherosclerotic renovascular disease, by leading to blood flow restoration. However, despite an apparently solid rationale, several randomized clinical trials failed to confirm the favorable effects of percutaneous renal angioplasty on blood pressure control, kidney function, cardiovascular and renal outcomes, previously reported in observational, retrospective and single-center cohorts, switching off the enthusiasm for this procedure. Several studies' limitations may partly account for this failure, including heterogeneity of diagnostic techniques, overestimation of the degree of renal artery stenosis, inappropriate timing of revascularization, multiple protocol revisions, frequent crossovers, and most importantly exclusion of patients at higher likelihood to respond to angioplasty. The purpose of this review is to summarize studies' potential weaknesses and provide guidance to the clinician for identification of patients who may benefit most from revascularization. [ABSTRACT FROM AUTHOR]

Published
2023
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10. Effect of patient gender on short-term blood pressure variability in hemodialysis patients

Author

Theodorakopoulou, Marieta P., Alexandrou, Maria-Eleni, Karagiannidis, Artemios G., Geladari, Virginia, Polychronidou, Georgia, Papagianni, Aikaterini, and Sarafidis, Pantelis

Abstract

Increased blood pressure variability (BPV) is strongly associated with cardiovascular events in end-stage kidney disease patients. Male hemodialysis patients present higher cardiovascular risk compared with females. The aim of this study is to investigate sex differences in short-term BPV in hemodialysis patients. 129 male and 91 female hemodialysis patients that underwent 48-h ABPM were included in this analysis. Standard deviation (SD), weighted SD (wSD), coefficient of variation (CV), and average real variability (ARV) of SBP and DBP were calculated with validated formulas. Age, dialysis vintage and history of major comorbidities did not differ between men and women. 48-h SBP/DBP (137.2 ± 17.4/81.9 ± 12.1 mmHg vs 132.2 ± 19.2/75.9 ± 11.7 mmHg, p= 0.045/<0.001) was significantly higher in men than women. During the 48-h period, all systolic BPV indices were similar between men and women (48-h SBP-ARV: 12.0 ± 2.9 vs 12.1 ± 3.2 mmHg, p= 0.683); 48-h DBP-SD, DBP-wSD and DBP-ARV (9.1 ± 1.6 vs 8.4 ± 1.8 mmHg, p= 0.005) were higher in men. In conclusion, short-term diastolic BPV indices are higher in male than female hemodialysis patients. Increased BPV may impact on the higher incidence of cardiovascular events observed in male hemodialysis patients.

Published
2023
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11. Outcomes with Finerenone in Participants with Stage 4 CKD and Type 2 Diabetes

Author

Sarafidis, Pantelis, Agarwal, Rajiv, Pitt, Bertram, Wanner, Christoph, Filippatos, Gerasimos, Boletis, John, Tuttle, Katherine R., Ruilope, Luis M., Rossing, Peter, Toto, Robert, Anker, Stefan D., Liu, Zhi-Hong, Joseph, Amer, Ahlers, Christiane, Brinker, Meike, Lawatscheck, Robert, Bakris, George, Aizenberg, Diego, Bartolacci, Inés, Besada, Diego, Bittar, Julio, Chahin, Mariano, Elbert, Alicia, Gelersztein, Elizabeth, Liberman, Alberto, Maffei, Laura, Manghi, Federico Pérez, Sanabria, Hugo, Vallejos, Augusto, Viñes, Gloria, Wassermann, Alfredo, Abhayaratna, Walter, Acharya, Shamasunder, Ekinci, Elif, Lee, Darren, MacIsaac, Richard, Mah, Peak Mann, Nelson, Craig, Packham, David, Pape, Alexia, Roger, Simon, Stephenson, Hugo, Suranyi, Michael, Wittert, Gary, Vale, Elizabeth, Colman, Peter, Colquhoun, David, Ellis, Chris, Joshua, Kim, Pedagogos, Eugenia, Regal, Paul, Topliss, Duncan, Vandeleur, James, Verjans, Johan, Wittert, Gary, Wynne, Katie-Jane, Clodi, Martin, Ebenbichler, Christoph, Fliesser-Görzer, Evelyn, Hanusch, Ursula, Krebs, Michael, Lhotta, Karl, Ludvik, Bernhard, Mayer, Gert, Neudorfer, Peter, Paulweber, Bernhard, Prager, Rudolf, Preiß, Wolfgang, Prischl, Friedrich, Schernthaner, Gerit-Holger, Sourij, Harald, Wiesholzer, Martin, Drexel, Heinz, Oberbauer, Rainer, Schönherr, Hans-Robert, Doubel, Peter, Engelen, Wendy, Gillard, Pieter, Hougardy, Jean-Michel, Krzesinski, Jean-Marie, Maes, Bart, Speeckaert, Marijn, Stas, Koen, van Gaal, Luc, Vanbelleghem, Hilde, Duyck, Francis, Scheen, André, Antunes, Daniela, Botelho, Roberto, Brito, Claudia, Canani, Luis, Canziani, Maria Eugenia, Cerqueira, Maria, de Paula, Rogerio, Eliaschewitz, Freddy, Figueiredo, Carlos Eduardo, Forti, Adriana, Hissa, Miguel, Leite, Emerson Lima Maurilo, Noronha, Irene, Paolino, Bruno, Paschoalin, Nathalia, Paschoalin, Raphael, Filho, Roberto Pecoits, Pereira, Marcio, Portes, Evandro, Precoma, Dalton, Rea, Rosangela, Riella, Miguel, Salles, Joao Eduardo, Vasconcellos, Eduardo, Vencio, Sergio, Bacci, Marcelo, Maia, Lilia, Villacorta, Aline, Apostolova, Emiliya, Boshnyashka, Radostina, Farah, Ghassan, Georgiev, Dimitar, Gushterova, Valentina, Klyuchkova, Neli, Lucheva, Mariya, Manova, Petya, Minkova, Dotska, Nonchev, Boyan, Pichmanova, Mariyana, Prakova, Zhulieta, Rangelov, Rangel, Rashkov, Rosen, Stanchev, Pavel, Stoyanovska-Elencheva, Bilyana, Tagarev, Zhivko, Temelkova-Kurktschieva, Theodora, Vasileva, Svetla, Yoncheva-Mihaylova, Mariana, Marinchev, Angel, Miteva, Mariya, Barre, Paul, Carlson, Brian, Conway, James, Cournoyer, Serge, Dumas, Richard, Fikry, Sameh, Goluch, Richard, Hamet, Pavel, Hart, Randolph, Henein, Sam, Liutkus, Joanne, Madore, Francois, Martinho, Valdemar, Mazza, Giuseppe, McFarlane, Philip, Keefe, Dennis O′, Peterson, Sean, Schwartz, Daniel, Shu, Daniel, Steele, Andrew, Tellier, Guy, Tennankore, Karthik, Tobe, Sheldon, Tsoukas, George, Tytus, Richard, Vitou, Louise, Walsh, Michael, Weisnagel, Stanley, Wilderman, Igor, Yale, Jean-Francois, El Boreky, Fadia, Kelly, Alan, Leiter, Lawrence, Teitelbaum, Ivor, Cobos, Jorge, Godoy, Juan, González, Fernando, Lobos, Sergio, Palma, Juan Carlos, Prieto Dominguez, Juan Carlos, Reyes, Eliana, Romero, Carmen, Saavedra, Victor, Vega, Mario, Medina, Marcelo, Varleta, Paola, Bu, Ruifang, Cai, Hanqing, Chen, Nan, Chen, Qinkai, Chen, Dejun, Cheng, Jinluo, Dong, Youping, Dong, Junwu, Guan, Tianjun, Hao, Chuanming, Huang, Wen, Jiang, Fangfang, Lei, Minxiang, Li, Ling, Li, Zhonghe, Li, Xuemei, Li, Jingmei, Li, Yan, Liang, Xinling, Liang, Bo, Liu, Fang, Liu, Yinghong, Liu, Yuantao, Liu, Zhihong, Long, Gang, Lu, Guoyuan, Lu, Weiping, Lu, Yibing, Luo, Ping, Ma, Jianhua, Mo, Zhaohui, Niu, Jianying, Peng, Ai, Shen, Jiansong, Shen, Feixia, Shi, Bingyin, Su, Qing, Sun, Zhuxing, Tang, Shuifu, Tong, Nanwei, Wang, Hao, Wang, Xinjun, Wang, Guixia, Wang, Jianqin, Wang, Yangang, Wang, Li, Wei, Jiali, Wu, Tianfeng, Wu, Chaoqing, Xing, Changying, Xiong, Fei, Xu, Xudong, Xu, Ning, Yan, Tiekun, Yang, Jinkui, Yin, Aiping, Zeng, Longyi, Zhang, Hao, Zhang, Yanlin, Zhang, Ying, Zhao, Wenjing, Zhao, Zhiquan, Zheng, Hongguang, Zhong, Ling, Zhu, Dalong, Zhuang, Yongze, Du, Yuming, Fang, Yi, Guo, Weiying, Jiang, Sheng, Kuang, Jian, Li, Dongmei, Li, Hongmei, Li, Yinan, Li, Yuxiu, Liu, Jian, Liu, Yu, Miao, Heng, Peng, Wen, Wang, Lihua, Xu, Mingtong, Zhong, Liyong, Zhu, Jun, Arango, Clara, Barrera, Sandra, López, Nelly Beltrán, Benitez, Diego, Blanco, Guillermo, Cadena, Andrés, Coronel, Julian, Cure, Carlos, Durán, Carlos, González, Alexander, Guzmán, Gustavo, Hernández, Eric, Ibarra, Jaime, Jaramillo, Carlos, Jaramillo, Nicolás, Kattah, William, Molina, Dora, Sánchez, Gregorio, Terront, Mónica, Trujillo, Freddy, Urina, Miguel, Vargas, Ruben, Villegas, Iván, Yupanqui, Hernán, Arcos, Edgar, Aroca, Gustavo, Barreto, Germán, Bermudez, Andres, Botero, Rodrigo, Cárdenas, Tatiana, Figueroa, Wilmer, Jaramillo, Mónica, Liévano, Manuel, López, Mónica, Molina, Dora, Rosero, Ricardo, Trillos, Pedro, Alferi, Dino, Brada, Michal, Brezina, Jiri, Bucek, Petr, Edelsberger, Tomas, Gulakova, Drahomira, Zapletalova, Jitka Hasalova, Hola, Olga, Hornova, Lucie, Houdova, Jana, Hrmova, Helena, Karasek, David, Kopecka, Sarka, Kovar, Richard, Krcova, Eva, Kuchar, Jiri, Kutejova, Vlasta, Lubanda, Hana, Matyasek, Ivo, Mokrejsova, Magdalena, Okenka, Libor, Prazny, Martin, Pumprla, Jiri, Tomanek, Pavel, Andersen, Ulla, Andries, Alin, Bech, Jesper, Faber, Jens, Gislason, Gunnar, Hangaard, Jørgen, Pacyk, Grzegorz Jaroslaw, Juhl, Claus, Krarup, Thure, Lindhardt, Morten, Madsbad, Sten, Nielsen, Joan, Pedersen-Bjergaard, Ulrik, Poulsen, Per, Rasmussen, Ole, Rossing, Peter, Schousboe, Karoline, Gram, Jeppe, Lauridsen, Thomas, Pedersen, Erling, Thorsteinsson, Birger, Flöjt, Päivi, Honkasalo, Mikko, Honkasalo, Mikko, Humaloja, Kari, Kananen, Kristiina, Kantola, Ilkka, Koistinen, Arvo, Korsoff, Pirkko, Lahtela, Jorma, Nieminen, Sakari, Nieminen, Tuomo, Sadeharju, Karita, Strand, Jorma, Sulosaari, Sakari, Cariou, Bertrand, Chantrel, François, Clavel, Sylvaine, Combe, Christian, Fauvel, Jean-Pierre, Gallouj, Karim, Gouet, Didier, Guerci, Bruno, Guerrot, Dominique, Hourmant, Maryvonne, Klein, Alexandre, Mariat, Christophe, Marre, Michel, Mesbah, Rafik, Le Meur, Yannick, Monier, Arnaud, Moranne, Olivier, Roussel, Ronan, Serusclat, Pierre, Vendrely, Benoit, Verges, Bruno, Zaoui, Philippe, Axthelm, Christoph, Bergmann, Andreas, Birkenfeld, Andreas L., Braun, Hermann, Busch, Klaus, Contzen, Christel, Degenhardt, Stefan, Derwahl, Karl, Giebel, Thomas, Hagenow, Andreas, Haller, Hermann, Hasslacher, Christoph, Horacek, Thomas, Jungmair, Wolfgang, Kloos, Christof, Koch, Thorsten, Krüger, Thilo, Mühlfeld, Anja, Müller, Joachim, Pfützner, Andreas, Pistrosch, Frank, Rinke, Andrea, Rose, Ludger, Rump, Lars, Schettler, Volker, Schiefke, Ingolf, Schlichthaar, Heike, Schröppel, Bernd, Schöll, Norbert, Schubert, Kristin, Schürholz, Thomas, Sigal, Helena, Stemler, Lutz, Strack, Georg, Täschner, Heidrun, Toursarkissian, Nicole, Tschöpe, Diethelm, Ulmer, Achim, van der Giet, Markus, Wanner, Christoph, Winkelmann, Bernhard R., Boletis, Ioannis, Dimitriadis, George, Hatziagelaki, Erifili, Iatrou, Christos, Ioannidis, Ioannis, Kounadi, Theodora, Makriniotou, Ioanna, Papadopoulou, Dorothea, Papagianni, Aikaterini, Passadakis, Ploumis, Piaditis, George, Stefanidis, Ioannis, Ip, Tai Pang, Lee, Paul, Andrea Luk, On Yan, Ma, Ronald, Chow, Wing Sun, Wang, Angela, Yeung, Vincent, Bajcsi, Dora, Danos, Peter, Harcsa, Eleonora, Kalina, Akos, Kazup, Szilvia, Keltai, Katalin, Kirschner, Robert, Kiss, Julianna, Kovacs, Laszlo, Lamboy, Beata, Literati-Nagy, Botond, Mileder, Margit, Nagy, Laszlo, Noori, Ebrahim, Nyirati, Gabor, Petro, Gizella, Schneider, Karoly, Simon, Judit, Szocs, Albert, Vasas, Szilard, Wudi, Krisztina, Zilahi, Zsolt, Zsom, Marianna, Eustace, Joe, Holian, John, Reddan, Donal, Meara, Yvonne O′, Abramof Ness, Rosane, Adawi, Faiad, Armaly, Zaher, Atar, Shaul, Bashkin, Amir, Ben Chetrit, Sydney, Yanay, Noa Berar, Chernin, Gil, Darawsha, Mahmud, Efrati, Shai, Elias, Mazen, Farber, Evgeny, Glandt, Mariela, Grossman, Ehud, Halabi, Majdi, Harman-Boehm, Ilana, Khazim, Khaled, Liberty, Idit, Minuchin, Oscar, Mosenzon, Ofri, Nakhoul, Farid, Nimer, Assy, Schwartz, Doron, Wainstein, Julio, Yagil, Yoram, Zukermann, Robert, Avogaro, Angelo, Battaglia, Giovanni Giorgio, Bevilacqua, Maurizio Tiziano, Bonora, Enzo, Bossi, Carlo Antonio, Calabrò, Paolo, Cavalot, Franco Luigi, Cimino, Roberto, Cozzolino, Mario Gennaro, David, Salvatore, Emdin, Michele, Fiaccadori, Enrico, Fiorina, Paolo, Giorda, Carlo Bruno, Gregorini, Maria Cristina, La Manna, Gaetano, Maggi, Davide Carlo, Manti, Roberta, Meregalli, Giancarla, Pani, Antonello, Parvanova, Aneliy Ilieva, Perico, Norberto, Piatti, PierMarco, Pisani, Antonio, Pontiroli, Antonio Ettore, Ponzani, Paola, Santorelli, Gennaro, Santoro, Domenico, Scanziani, Renzo, Teatini, Ugo, Tonolo, Giancarlo, Trevisan, Roberto, Veronelli, Anna Maria, Viviani, Giorgio Luciano, Araki, Hideo, Bando, Yukihiro, Ebisui, Osamu, Fujita, Naruhiro, Fukasawa, Hirotaka, Furuya, Ryuichi, Hamamoto, Yoshiyuki, Hamasaki, Akihiro, Hasegawa, Kotaro, Hatazaki, Masahiro, Hayashi, Terumasa, Higashi, Takayuki, Hirohata, Yoshihide, Horinouchi, Shuji, Hoshi, Ayumu, Imoto, Hirofumi, Inagaki, Akemi, Inagaki, Masayuki, Inaguma, Daijo, Inoue, Toshihiko, Ishii, Masao, Ishiko, Tamayo, Isono, Motohide, Jinnouchi, Hideaki, Kanai, Hidetoshi, Kanda, Daisuke, Kanehara, Hideo, Kashima, Masayuki, Kataoka, Yuko, Katayama, Shigehiro, Kato, Kiyoe, Katsuki, Takeshi, Kawamitsu, Katsunori, Kawasaki, Satsuki, Kikuchi, Fumi, Kikuchi, Hidetoshi, Kishimoto, Rui, Kobayashi, Kunihisa, Koide, Junko, Komi, Rieko, Kubota, Miyuki, Kuriya, Genpei, Kurose, Takeshi, Kusano, Yoshiro, Hajime, Maeda, Matsubayashi, Sunao, Matsumoto, Kazunari, Matsumura, Naoya, Matsuo, Yasuto, Matsuoka, Naoki, Miyaoka, Hiroaki, Miyata, Satoshi, Morita, Takeshi, Murakami, Isao, Murao, Satoshi, Nakamura, Udai, Nakayama, Mikihiro, Nakazawa, Jun, Nohara, Sakae, Nomiyama, Takashi, Noritake, Masayuki, Oda, Yoshiaki, Ogiwara, Takayuki, Ohashi, Hiroshi, Okamoto, Hideki, Okino, Shinichi, Osonoi, Takeshi, Sasaki, Nobuhiro, Sayo, Yoshitaka, Sekigami, Taiji, Shibasaki, Taro, Shibata, Hirotaka, Shimoyama, Tatsushi, Shinoda, Junji, Sobajima, Hiroshi, Sugitatsu, Kazuya, Sugiura, Toshiyuki, Sugiyama, Toru, Suzuki, Daisuke, Suzuki, Hiroyuki, Suzuki, Masaaki, Takeda, Asami, Tanaka, Asami, Tanaka, Seiichi, Tsunematsu, Izumi, Ueda, Yasuo, Uekihara, Soichi, Ujihara, Makoto, Yajima, Ken, Yamada, Daishiro, Yamada, Masayo, Yamagata, Kazuo, Yamakawa, Ken, Yamakawa, Fumiko, Yamasaki, Yoshimitsu, Yambe, Yuko, Yanagida, Taihei, Yanai, Hidekatsu, Yanase, Toshihiko, Yasuda, Tetsuyuki, Kriauciuniene, Dovile, Lasiene, Jurate, Navickas, Antanas, Radzeviciene, Lina, Urbanaviciene, Egle, Urbonas, Gediminas, Velaviciene, Audrone, Abd Ghani, Rohana, Aziz, Nor Azizah, Lee, Li Yuan, Loh, Chek Loong, Ali, Norhaliza Mohd, Noor, Nurain Mohd, Fatnoon Nik Ahmad, Nik Nur, Ratnasingam, Jeyakantha, Halimi Bin Wan Hasan, Wan Hasnul, Izani Wan Mohamed, Wan Mohd, Khir, Rizmy Najme, Mohamad, Masni, Alexander Tan, Tong Boon, Avila Pardo, Sandro, Adrian, Miriam Bastidas, Wong, Alfredo Chew, Escobedo de la Peña, Jorge, Salmón, Guillermo Fanghänel, Gálvez, Guillermo González, Ochoa, Ramiro Gutiérrez, Santana, Saúl Irizar, Rovalo, Magdalena Madero, Machado, Gustavo Méndez, Ruiz, Luis Nevarez, Ibarra, Denisse Ramos, López, Gabriel Ramos, Reyna, Leobardo Sauque, Ortiz, Gustavo Solache, Ortiz, Rafael Valdez, Mesa, Juan Villagordoa, Salazar, Melchor Alpizar, Hernández, Pedro García, González, José, Soto, José Lazcano, Mendoza, Arturo Saldaña, Santana, Sergio Irizar, Vilchis, Elvira González, Bakker, R.C., Barendregt, J.N.M., Boonstra, A.H., Bos, Willem, Brouwer, C.B., Buren, M. van, Gansevoort, Ron, Kooy, Adriaan, Krekels, Marielle, Leendert, Ruud J.M. van, Lieverse, Louis A.G., Luik, P.T., Penne, E. Lars, Gregoor, Peter Smak, Vogt, Liffert, Born, Bert-Jan van den, Baker, John, Crawford, Veronica, Cutfield, Rick, Dunn, Peter, Krebs, Jeremy, Nirmalaraj, Kingsley, Scott, Russell, Smuts, Nine, Titchener, Janet, Eriksen, Erik, Finnes, Trine, Høivik, Hans, Karlsson, Thomas, Munk, Peter Scott, Radtke, Maria, Risberg, Knut, Rocke, Jan, Solnør, Leidulv, Stenehjem, Aud-Eldrid, Tafjord, Anne-Beathe, Asprusten, Emil, Hagemeier, Robert, Høye, Kjetil, Selsås, Hilde, Thorup, Frode, Wium, Cecilie, Pamugas, Glenda, Panelo, Araceli, Perez, Ronald, Tanque, Maribel, Tirador, Louie, Villa, Michael, Bautista, Albert, Catindig, Elizabeth, Manalo, Carlo, Mirasol, Roberto, Butrymowicz, Patrycja, Ciechanowski, Kazimierz, Cieslik, Grazyna, Franek, Edward, Gumprecht, Janusz, Hoffmann, Michal, Krzykowska, Jolanta, Kurnatowska, Ilona, Landa, Katarzyna, Madrzejewski, Adam, Madziarska, Katarzyna, Mazur, Stanislaw, Napora, Piotr, Nowicki, Michal, Ocicka-Kozakiewicz, Anna, Rewerska, Barbara, Rusicka, Teresa, Ruxer, Jan, Skokowska, Ewa, Stankiewicz, Andrzej, Stompor, Tomasz, Tiuryn-Petrulewicz, Agnieszka, Wasilewska, Katarzyna, Wierusz-Wysocka, Bogna, Wnetrzak-Michalska, Renata, Jedynasty, Krystyna, Anand, Izabela Sein, Almeida, Edgar, Ballesteros, Rosa, Barreto, Carlos, Beirao, Idalina, Birne, Rita, Esteves, Cesar, Guia, Jose, Heitor, Susana, Marques, Olinda, Melo, Pedro, Nolasco, Fernando, Pereira, Amalia, Roque, Cristina, Rosario, Francisco, Silva, Gil, Silva, Ana, Teixeira e Costa, Fernando, Lobos, Ana Vila, Alves, Ana Rita, Brandao, Ilidio, Carvalho, Rui, Coelho, Joao, Lourenco, Ana, Matos, Pedro, Rosario, Vanisa, Neves, Joao Sergio, Cortes-Maisonet, Gregorio, Roman-Miranda, Amaury, Brito-Peguero, Yudit, Colon-Vega, Gildred, Albota, Adrian, Bala, Cornelia, Barbonta, Hortensia, Caceaune, Elena, Catrinoui, Doina, Constantin, Ciprian, Dumitrescu, Adriana, Mindrescu, Nicoleta, Mistode, Cristina, Negrisanu, Gabriela, Onaca, Adriana, Paveliu, Silvia, Pintilei, Ella, Pop, Lavinia, Popa, Amorin, Popescu, Alexandrina, Radulian, Gabriela, Szilagyi, Iosif, Turcu, Liana, Vacaru, Georgeta, Vlad, Adrian, Filimon, Adriana, Veresiu, Ioan, Antsiferov, Mikhail, Arkhipov, Mikhail, Babkin, Andrey, Barbarash, Olga, Baranov, Vitaliy, Chernyavskaya, Elena, Demko, Arkadiy, Dreval, Alexander, Edin, Anton, Ermakova, Polina, Fadeev, Valentin, Galyavich, Albert, Gaysina, Leyla, Gordeev, Ivan, Ipatko, Irina, Kalashnikova, Marina, Khalimov, Yuriy, Klimontov, Vadim, Kobalava, Zhanna, Kosmacheva, Elena, Koziolova, Natalya, Sergey Levashov, Lyudmila Kvitkova, Libis, Roman, Marasaev, Vyacheslav, Malykh, Natalia, Martynenko, Vladimir, Malyutina, Sofya, Merai, Imad, Mkrtumyan, Ashot, Nechaeva, Galina, Petunina, Nina, Palyutin, Shamil, Pimenov, Leonid, Rechkova, Elena, Rodionova, Tatyana, Rymar, Oksana, Sardinov, Ruslan, Semenova, Olga, Sherenkov, Alexander, Solovev, Oleg, Smolyarchuk, Elena, Strongin, Leonid, Ukhanova, Olga, Verlan, Nadezhda, Vorokhobina, Natalya, Yakhontov, Davyd, Yakushin, Sergey, Zakharova, Elena, Zalevskaya, Alsu, Zanozina, Olga, Zhdanova, Elena, Zhukova, Larisa, Zykova, Tatyana, Argunova, Yulia, Nikolaev, Konstantin, Villevalde, Svetlana, Fang Sum, Chee, Suhail, Sufi Muhummad, San Tan, Ru, Vathsala, Anantharaman, Wong, Edmund, Bee, Yong Mong, Babikova, Jana, Buganova, Ingrid, Dzupina, Andrej, Ochodnicka, Zuzana, Sosovec, Dalibor, Spodniakova, Denisa, Minarik, Peter, Ahmed, Fayzal, Amod, Aslam, Bhana, Sindeep, Distiller, Larry, Jansen van Rensburg, Dirkie, Joshi, Mukesh, Joshi, Shaifali, Lakha, Deepak, Mitha, Essack, Podgorski, Gracjan, Ranjith, Naresh, Rayner, Brian, Rheeder, Paul, Sarvan, Mohamed, Seeber, Mary, Siebert, Heidi, Tayob, Mohammed, Trokis, Julien, Urbach, Dorothea, van Zyl, Louis, Jansen van Rensburg, Dirkie, Choi, Bum-Soon, Choi, Moon Gi, Chung, ChoonHee, Hwang, YouCheol, Kim, ChongHwa, Kim, InJoo, Kim, JaeHyeon, Kim, SinGon, Kim, SungGyun, Kim, Tae Hee, Lee, WooJe, Lee, ByungWan, Lee, Kang Wook, Oh, Kook-Hwan, Oh, Ji Eun, Oh, Yun Kyu, Oh, Dong-Jin, Park, Junbeom, Shin, Seok Joon, Sung, Su-Ah, Yu, Jae Myung, Chung, HyeSoo, Huh, Ji Hye, Kang, JunGoo, Kim, ChulSik, Kim, HyeSoon, Kim, NamHoon, Lim, Soo, Cho, Young Min, Park, Cheol Young, Agraz, Irene, Ampudia, Francisco Javier, Bouarich, Hanane, Calero, Francesca, Castro, Cristina, Guldris, Secundino Cigarrán, Garrit, Josep Cruzado, de Álvaro, Fernando, Galcerán, Josep, Albarrán, Olga González, Jaras, Julio Hernández, Ibernón, Meritxell, Deben, Francisco Martínez, Ma, Esteban, Dolores Martínez, Pascual Izuel, José María, Martins, Judith, Mediavilla, Juan, Michán, Alfredo, Santos, Julio Pascual, Poch, Esteban, Rusillo, Manuel Polaina, Juan, Carlos Sánchez, Olmo, Rafael Santamaría, Segura de la Morena, José Julián, Soto, Alfonso, Troya, Maribel, Castro, Fernando Cereto, Fernández, Pablo Gómez, Sánchez, Laura Fuentes, Moya, Mercedes González, Marrero, Domingo Hernández, Maroto, Gonzalo Piedrola, Redón, Josep, Seron, Daniel, Bruchfeld, Annette, Curiac, Dan, Eliasson, Ken, Frank, Malin, Guron, Gregor, Hellberg, Olof, Hellgren, Margareta, Larnefeldt, Hans, Lindholm, Carl-Johan, Löndahl, Magnus, Rein-Hedin, Erik, Soveri, Inga, Spaak, Jonas, Tengmark, Bengt-Olov, Lif-Tiberg, Cornelia, Månflod, Johan, Nguyen, Han, Ackermann, Daniel, Bilz, Stefan, Burnier, Michel, Forster, Christian, Kalbermatter, Stefan, Kistler, Andreas, Pechère-Bertschi, Antoinette, Schultes, Bernd, Laimer, Markus, Rudofsky, Gottfried, Strey, Christopher, Wuerzner, Gregoire, Chang, Chiz-Tzung, Hung, Cheng-Chieh, Jiang, Ju-Ying, Lee, Chien-Te, Lin, Shuei-Liong, Tarng, Der-Cherng, Tu, Shih-Te, Wu, Mai-Szu, Wu, Ming-Ju, Chuang, Lee-Ming, Deerochanawong, Chaicharn, Kitiyakara, Chagriya, Ophascharoensuk, Vuddhidej, Pongchaiyakul, Chatlert, Satirapoj, Bancha, Kosachunhanan, Natapong, Sritara, Piyamitr, Eren, Necmi, Gul, Ibrahim, Gulel, Okan, Kocyigit, Ismail, Kumbasar, Abdulbaki, Sahin, Idris, Sari, Ramazan, Sayin, Burak, Tavli, Talat, Ustundag, Sedat, Yenicerioglu, Yavuz, Badak, Ozer, Cayli, Murat, Oguz, Aytekin, Ozdogan, Oner, Sari, Ibrahim, Temizhan, Ahmet, Tigen, Mustafa, Turk, Ugur, Yilmaz, Huseyin, Yilmaz, Mehmet, Bondarets, Iryna, Botsyurko, Volodymyr, Chernikova, Viktoriia, Donets, Oleksandra, Fushtey, Ivan, Grachova, Mariia, Isayeva, Anna, Kogut, Dmytro, Komisarenko, Julia, Kravchun, Nonna, Malyar, Kateryna, Mankovsky, Borys, Martynyuk, Liliya, Maslyanko, Vitaliy, Myshanych, Halyna, Pererva, Larysa, Pertseva, Nataliia, Serhiyenko, Oleksandr, Smirnov, Ivan, Sokolova, Liubov, Stryzhak, Vasyl, Vlasenko, Maryna, Isayeva, Ganna, Larin, Oleksandr, AbouSaleh, Ahmad, Barratt, Jonathan, Dang, Cuong, Kahal, Hassan, Kirk, Adam, Kilvert, Anne, Kon, Sui Phi, McCafferty, Kieran, Patel, Dipesh, Rice, Sam, Vijayaraman, Arutchelvam, Wong, Yuk-ki, Gibson, Martin, Wahba, Mona, Zaidi, Reza, Bilous, Rudy, Johnson, Andrew, Kalathil, Dhanya, Kilvert, Anne, Kyriakidou, Christina, Mathew, Amit, Mukhtar, Rasha, Munsoor, Imrozia, Poterajlo, Anton, Swift, Pauline, Acosta, Idalia, Adams, Atoya, Adler, Sharon, Ajani, Dilawar, Ali, Slamat, Alicic, Radica, Al-Karadsheh, Amer, Alla, Sreedhara, Allison, D., Andrawis, Nabil, Arif, Ahmed, Awad, Ahmed, Azizad, Masoud, Bahrami, Michael, Bansal, Shweta, Barag, Steven, Barakzoy, Ahmad, Barney, Mark, Barzilay, Joshua, Bashir, Khalid, Bautista, Jose, Beddhu, Srinivasan, Belo, Diogo, Benjamin, Sabrina, Berenji, Ramin, Bhargava, Anuj, Birriel, Jose, Brietzke, Stephen, Brosius, Frank, Brusco, Osvaldo, Burgner, Anna, Busch, Robert, Canadas, Rafael, Caramori, Maria, Cardona, Jose, Case, Christopher, Cruz, Humberto, Dandillaya, Ramprasad, Dawoud, Dalia, Din, Zia, Dixon, Bradley, Doshi, Ankur, Drakakis, James, El Shahawy, Mahfouz, El-Meanawy, Ashraf, El-Shahawy, Mohammed, Evans, John, Fadda, George, Farooq, Umar, Fernando, Roland, Fink, Raymond, First, Brian, Fitz-Patrick, David, Flack, John, Fluck, Patrick, Fogelfeld, Leon, Fonseca, Vivian, Frias, Juan, Galphin, Claude, Garcia-Mayol, Luis, Goldstein, Gary, Gonzalez, Edgar, Gonzalez-Abreu, Francisco, Gore, Ashwini, Grant, David, Habwe, Violet, Hamilton, Maxine, Hammoud, Jamal, Handelsman, Stuart, Hartman, Israel, Heigerick, Glenn, Henry, Andrew, Hernandez, German, Hernandez-Cassis, Carlos, Herrera, Carlos, Hertel, Joachim, Huang, Wenyu, Iglesias, Rogelio, Iranmanesh, Ali, Jackson, Timothy, Jain, Mahendra, Jamerson, Kenneth, Johnson, Karen, Judd, Eric, Kaplan, Joshua, Kayali, Zeid, Khan, Bobby, Khan, Muhammad, Kharait, Sourabh, Kirkman, M. Sue, Kopyt, Nelson, Kotzker, Wayne, Kovesdy, Csaba, Kreit, Camil, Krishna, Arvind, Kronfli, Saeed, Lee, Keung, LeJeune, Derek, Lemus, Brenda, Leon-Forero, Carlos, Linfert, Douglas, Lora, Henry, Lurie, Alexander, Maddukuri, Geetha, Magno, Alexander, Maletz, Louis, Mandayam, Sreedhar, Markell, Mariana, Mayfield, Ronald, Mbogua, Caroline, McMullen, Dierdre, Meisner, Carl, Minton, Stephen, Mocherla, Bharat, Mohandas, Rajesh, Montero, Manuel, Moustafa, Moustafa, Nadkarni, Salil, Nakhle, Samer, Navarro, Jesus, Neyra, Nilda, Nica, Romanita, Nicol, Philip, Norwood, Paul, Numrungroad, Visal, Donovan, Richard O′, Odugbesan, A., Paoli-Bruno, Jorge, Parikh, Samir, Patel, Rakesh, Peixoto, Aldo, Pergola, Pablo, Perlman, Alan, Pettis, Karlton, Pisoni, Roberto, Ponduchi, Mirela, Posada, Jorge, Prabhakar, Sharma, Radhakrishnan, Jai, Rahman, Mahboob, Raina, Rupesh, Rastogi, Anjay, Reisin, Efrain, Rendell, Marc, Robertson, David, Rocco, Michael, Romeu, Hugo, Rosas, Sylvia, Rosenfeld, Jack, Ross, Dennis, Rothman, Jeffrey, Rudolph, Lance, Ruhullah, Yusuf, Ruoff, Gary, Ryu, Jeffrey, Sahani, Mandeep, Sam, Ramin, Samuels, Garfield, Sanchez, William, Santos, Vladimir, Satko, Scott, Saxena, Sanjeev, Scott, David, Seco, Gilberto, Seek, Melvin, Serota, Harvey, Shafi, Tariq, Shahid, Nauman, Shanik, Michael, Sharma, Santosh, Sinha, Arjun, Smelser, James, Smith, Mark, Soe, Kyaw, Solomon, Richard, Soroka, Eugene, Soufer, Joseph, Spinowitz, Bruce, Spry, Leslie, Suarez, Rosa, Subramanian, Bala, Szerlip, Harold, Tamirisa, Aparna, Thomson, Stephen, Tran, Tuan-Huy, Treger, Richard, Trullenque, Gretel, Turk, Thomas, Umpierrez, Guillermo, Urbach, Daniel, Valdes, Martin, Valika, Shujauddin, Vega, Damaris, Weissman, Peter, Whaley-Connell, Adam, Winston, Jonathan, Wise, Jonathan, Wynne, Alan, Zeig, Steven, Abdel-Rahman, Emaad, Abreu, Edel, Awad, Alaa, Bahri, Nader, Bertsch, John, Bleich, David, Bornfreund, Jonathan, Brar, Harjeet, Brian, Susan, Brinson, Cynthia, Bruschetta, Humberto, Carpio, Jose, Cohen, Steven, Cosby, John, Dhanireddy, Soni, Diaz, Jorge, Dunn, Fredrick, Eppanapally, Sabitha, Fayad, Joseph, Goel, Archana, Govindaraju, Kanakadurga, Halpern, Stephen, Jones, Audrey, Kaye, William, Knight, Herbert, Koch, Stanley, Kohli, Nandini, Lastra, Guido, Lerman, Sam, Loredo, Jorge, Lovre, Dragana, Mandviwala, Mustafa, Martin, Earl, Meyer, Jill, Murray, John, Oliver, David, Oparil, Suzanne, Penabad, Jesus, Pereira, Isabel, Popeil, Larry, Quesada, Gonzalo, Ramanathan, Kodangudi, Ramos-Gonez, Luis, Rastegar, Mandana, Rastogi, Padmashri, Rondon, Juan, Roy-Chaudhury, Prabir, Smith, David, Williamson, Don, Womack, Catherine, Yamout, Hala, Yuryev, Michael, Chu, Phuong, Van Hoang, Lam, Khanh, Tran, Phi Nga, Nguyen Thi, Son, Pham Nguyen, Tran, Lan Phuong, Le, Thuy Khuong, Nguyen, Boi Ngoc, Nguyen, Thao, Nui, Nguyen Minh, Nam, Tran Quang, and Tran, Kim Chi

Published
2023
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12. Blood Pressure and Cardiorenal Outcomes With Finerenone in Chronic Kidney Disease in Type 2 Diabetes.

Author

Ruilope, Luis M., Agarwal, Rajiv, Anker, Stefan D., Filippatos, Gerasimos, Pitt, Bertram, Rossing, Peter, Sarafidis, Pantelis, Schmieder, Roland E., Joseph, Amer, Rethemeier, Nicole, Nowack, Christina, Bakris, George L., Mentenich, Nicole, and FIDELIO-DKD Investigators

Abstract

Background: Chronic kidney disease is frequently associated with hypertension and poorly controlled blood pressure can lead to chronic kidney disease progression. Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, significantly improves cardiorenal outcomes in patients with chronic kidney disease and type 2 diabetes. This analysis explored the relationship between office systolic blood pressure (SBP) and cardiorenal outcomes with finerenone in FIDELIO-DKD trial (Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease).Methods: Patients with type 2 diabetes, urine albumin-to-creatinine ratio 30 to 5000 mg/g, and estimated glomerular filtration rate of 25 to <75 mL/min per 1.73 m2 receiving optimized renin-angiotensin system blockade, were randomized to finerenone or placebo. For this analysis, patients (N=5669) were grouped by baseline office SBP quartiles.Results: Finerenone reduced office SBP across the baseline office SBP quartiles, including patients with baseline office SBP of >148 mm Hg. Overall, patients with lower baseline office SBP quartile and greater declines from baseline in SBP were associated with better cardiorenal outcomes. The risk of primary kidney and key secondary cardiovascular composite outcomes was consistently reduced with finerenone versus placebo irrespective of baseline office SBP quartiles (P for interaction 0.87 and 0.78, respectively). A time-varying analysis revealed that 13.8% and 12.6% of the treatment effect with finerenone was attributed to the change in office SBP for the primary kidney composite outcome and the key secondary cardiovascular outcome, respectively.Conclusions: In FIDELIO-DKD, cardiorenal outcomes improved with finerenone irrespective of baseline office SBP. Reductions in office SBP accounted for a small proportion of the treatment effect on cardiorenal outcomes.Registration: URL: https://www.Clinicaltrials: gov; Unique identifier: NCT02540993. [ABSTRACT FROM AUTHOR]

Published
2022
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13. Blood pressure variability: methodological aspects, clinical relevance and practical indications for management - a European Society of Hypertension position paper∗

Author

Parati, Gianfranco, Bilo, Grzegorz, Kollias, Anastasios, Pengo, Martino, Ochoa, Juan Eugenio, Castiglioni, Paolo, Stergiou, George S., Mancia, Giuseppe, Asayama, Kei, Asmar, Roland, Avolio, Alberto, Caiani, Enrico G., De La Sierra, Alejandro, Dolan, Eamon, Grillo, Andrea, Guzik, Przemysław, Hoshide, Satoshi, Head, Geoffrey A., Imai, Yutaka, Juhanoja, Eeva, Kahan, Thomas, Kario, Kazuomi, Kotsis, Vasilios, Kreutz, Reinhold, Kyriakoulis, Konstantinos G., Li, Yan, Manios, Efstathios, Mihailidou, Anastasia S., Modesti, Pietro Amedeo, Omboni, Stefano, Palatini, Paolo, Persu, Alexandre, Protogerou, Athanasios D., Saladini, Francesca, Salvi, Paolo, Sarafidis, Pantelis, Torlasco, Camilla, Veglio, Franco, Vlachopoulos, Charalambos, and Zhang, Yuqing

Published
2023
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15. Finerenone and effects on mortality in chronic kidney disease and type 2 diabetes: a FIDELITY analysis

Author

Filippatos, Gerasimos, Anker, Stefan D, August, Phyllis, Coats, Andrew J S, Januzzi, James L, Mankovsky, Boris, Rossing, Peter, Ruilope, Luis M, Pitt, Bertram, Sarafidis, Pantelis, Teerlink, John R, Kapelios, Chris J, Gebel, Martin, Brinker, Meike, Joseph, Amer, Lage, Andrea, Bakris, George, and Agarwal, Rajiv

Abstract

Graphical AbstractFinerenone demonstrated significant on-treatment reduction in the incidence of all-cause and cardiovascular mortality in patients with chronic kidney disease and type 2 diabetes. Sudden cardiac death was also lowered when the intention-to-treat population was assessed. These effects with finerenone were consistent across Kidney Disease: Improving Global Outcomes risk groups, irrespective of baseline urine albumin-to-creatinine ratio, but were more pronounced in patients with higher baseline estimated glomerular filtration rate.

Published
2023
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18. A prespecified exploratory analysis from FIDELITY examined finerenone use and kidney outcomes in patients with chronic kidney disease and type 2 diabetes

Author

Bakris, George L., Ruilope, Luis M., Anker, Stefan D., Filippatos, Gerasimos, Pitt, Bertram, Rossing, Peter, Fried, Linda, Roy-Chaudhury, Prabir, Sarafidis, Pantelis, Ahlers, Christiane, Brinker, Meike, Joseph, Amer, Lawatscheck, Robert, and Agarwal, Rajiv

Abstract

In FIDELITY, a prespecified pooled analysis of the FIDELIO-DKD and FIGARO-DKD studies, finerenone was found to improve cardiorenal outcomes in patients with type 2 diabetes, a urine albumin-to-creatinine ratio of 30–5000 mg/g, an estimated glomerular filtration rate (eGFR) of 25 ml/min per 1.73 m2or more and also receiving optimized renin-angiotensin system blockade treatment. This present analysis focused on the efficacy and safety of finerenone on kidney outcomes. Among 13,026 patients with a median follow-up of three years, finerenone significantly reduced the hazard of a kidney composite outcome (time to kidney failure, sustained 57% or more decrease in eGFR from baseline, or kidney death) by 23% versus placebo (hazard ratio, 0.77; 95% confidence interval, 0.67–0.88), with a three-year absolute between-group difference of 1.7% (95% confidence interval, 0.7–2.6). Hazard ratios were directionally consistent for a prespecified baseline eGFR and urine albumin-to-creatinine ratio categories (Pinteraction= 0.62 and Pinteraction= 0.67, respectively), although there was a high degree of uncertainty in the 30–300 mg/g subgroup. Finerenone significantly reduced the hazard of end-stage kidney disease (ESKD) by 20% versus placebo (0.80; 0.64–0.99). Adverse events were similar between treatment arms, although hyperkalemia leading to treatment discontinuation occurred significantly more frequently with finerenone versus placebo (2.4% vs 0.8% and 0.6% vs 0.3% in patients with eGFR less than 60 vs. greater than or equal to 60 ml/min per 1.73 m2, respectively). Thus, finerenone improved kidney outcomes, reduced the hazard of ESKD, and is well tolerated in patients with chronic kidney disease and type 2 diabetes.

Published
2023
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22. Mineralocorticoid receptor antagonists for cardioprotection in chronic kidney disease: a step into the future

Author

Alexandrou, Maria-Eleni, Theodorakopoulou, Marieta P., Kanbay, Mehmet, and Sarafidis, Pantelis A.

Abstract

Chronic kidney disease (CKD) and cardiovascular disease (CVD) share major risk factors and mechanistic pathways for progression. Furthermore, either decreased glomerular filtration rate or increased albuminuria are major risk factors for cardiovascular events. Evidence from previous renal outcome trials in patients with proteinuric CKD showed that angiotensin-converting-enzyme inhibitors (ACEIs) and angiotensin-II receptor blockers (ARBs) effectively slow CKD progression, establishing these agents as fundamental CKD pharmacologic treatments. However, in all these trials and subsequent meta-analyses, ACEIs and ARBs did not significantly reduce cardiovascular events or mortality, indicating a high residual risk for CVD progression in individuals with CKD. In contrast to the above, several outcome trials with old and novel mineralocorticoid receptor-antagonists (MRAs) clearly suggest that these agents, apart from nephroprotection, offer important cardioprotection in this population. This article is an overview of previous and recent evidence on the effects of MRAs on cardiovascular outcomes in patients with CKD attempting to highlight a pathway able to improve both cardiovascular and renal prognosis in this population.

Published
2022
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23. Early morning hemodynamic changes and left ventricular hypertrophy and mortality in hemodialysis patients

Author

Mallamaci, Francesca, Tripepi, Rocco, Torino, Claudia, Tripepi, Giovanni, Sarafidis, Pantelis, and Zoccali, Carmine

Abstract

Introduction: An exaggeration of the early morning increase in BP, a phenomenon accompanied by a parallel rise in heart rate (HR), is a marker of high cardiovascular risk. The early morning changes in these parameters have not been investigated in the hemodialysis population. Methods: In a pilot, single center study including a series of 58 patients we measured the pre-awakening BP and HR surges and the nocturnal dipping of the same parameters as well as other established indicators of autonomic function (weighted 24 h systolic BP and HR variability) and tested their relationship with the left ventricular mass index (LVMI) and with the risk of death over a median follow up of 40 months. Results: The pre-awakening HR surge (r = − 0.46, P = 0.001) but not the corresponding BP surge (r = − 0.1, P = 0.98) was associated with LVMI and the risk of death [HR (1 unit): 0.89, 95% CI 0.83–0.96, P = 0.001]. The link between the pre-awakening HR surge with these outcome measures was robust and largely independent of established risk factors in the hemodialysis population, including the nocturnal dipping of BP. Weighted 24 h systolic BP and HR variability did not correlate with LVMI (all P > 0.11) nor with the risk of death (P > 0.11) and were also independent of the nocturnal dipping of systolic BP and HR. Conclusion: This pilot study suggests that the low early morning changes in HR, likely reflecting enhanced sympathetic activity, entail a high risk for left ventricular hypertrophy (LVH) and mortality in the hemodialysis population.

Published
2022
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30. IMPACT OF COVID-19 ON THE PREVALENCE, AWARENESS AND CONTROL OF HYPERTENSION IN GREECE: MAY MEASUREMENT MONTH SURVEY 2019 VS 2022

Author

Menti, Ariadni, Kollias, Anastasios, Gkaliagkousi, Eugenia, Goumenos, Dimitrios, Grassos, Charalampos, Kalaitzidis, Rigas G., Kallistratos, Manolis, Katsi, Vasiliki, Konstantinidis, Dimitrios, Kotsis, Vasileios, Krokidis, Xenophon, Kyriakoulis, Konstantinos, Lanaras, Leonidas, Makaris, Emmanouil, Makris, Thomas, Manios, Efstathios, Maragkoudakis, Spyridon, Manolis, Athanasios, Marketou, Maria, Milionis, Charalampos, Nikitas, George, Papachristou, Evangelos, Papadakis, John, Papadopoulos, Dimitrios, Protogerou, Athanasios, Pikilidou, Maria, Sarafidis, Pantelis, Saraki, Vasilios, Tsoufis, Konstantinos, Zebekakis, Pantelis, Doumas, Michael, and Stergiou, George

Published
2024
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33. Association of peridialytic, intradialytic, scheduled interdialytic and ambulatory BP recordings with cardiovascular events in hemodialysis patients

Author

Iatridi, Fotini, Theodorakopoulou, Marieta P., Karpetas, Antonios, Bikos, Athanasios, Karagiannidis, Artemios G., Alexandrou, Maria-Eleni, Tsouchnikas, Ioannis, Mayer, Christopher C., Haidich, Anna-Bettina, Papagianni, Aikaterini, Parati, Gianfranco, and Sarafidis, Pantelis A.

Abstract

Background: Ambulatory-BP-monitoring (ABPM) is recommended for hypertension diagnosis and management in hemodialysis patients due to its strong association with outcomes. Intradialytic and scheduled interdialytic BP recordings show agreement with ambulatory BP. This study assesses in parallel the association of pre-dialysis, intradialytic, scheduled interdialytic and ambulatory BP recordings with cardiovascular events. Methods: We prospectively followed 242 hemodialysis patients with valid 48-h ABPMs for a median of 45.7 months to examine the association of pre-dialysis, intradialytic, intradialytic plus pre/post-dialysis readings, scheduled interdialytic BP, and 44-h ambulatory BP with outcomes. The primary end-point was a composite one, composed of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, resuscitation after cardiac arrest, hospitalization for heart failure, coronary revascularization procedure or peripheral revascularization procedure. Results: Cumulative freedom from the primary end-point was significantly lower with increasing 44-h SBP (group 1, &lt; 120 mmHg, 64.2%; group 2, ≥ 120 to &lt; 130 mmHg 60.4%, group 3, ≥ 130 to &lt; 140 mmHg 45.3%; group 4, ≥ 140 mmHg 45.5%; logrank-p = 0.016). Similar were the results for intradialytic (logrank-p = 0.039), intradialytic plus pre/post-dialysis (logrank-p = 0.044), and scheduled interdialytic SBP (logrank-p = 0.030), but not for pre-dialysis SBP (logrank-p = 0.570). Considering group 1 as the reference group, the hazard ratios of the primary end-point showed a gradual increase with higher BP levels with all BP metrics, except pre-dialysis SBP. This pattern was confirmed in adjusted analyses. An inverse association of DBP levels with outcomes was shown with all BP metrics, which was no longer evident in adjusted analyses. Conclusions: Averaged intradialytic and scheduled home BP measurements (but not pre-dialysis readings) display similar prognostic associations with 44-h ambulatory BP in hemodialysis patients and represent valid metrics for hypertension management in these individuals.

Published
2022
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34. Opportunistic screening for hypertension: what does it say about the true epidemiology?

Author

Menti, Ariadni, Kalpourtzi, Natasa, Gavana, Magda, Vantarakis, Apostolos, Voulgari, Paraskevi V., Hadjichristodoulou, Christos, Gkaliagkousi, Eugenia, Doumas, Michael, Kalaitzidis, Rigas G., Kallistratos, Manolis S., Karakosta, Argiro, Katsi, Vasiliki, Krokidis, Xenophon, Manios, Efstathios, Marketou, Maria, Ntineri, Angeliki, Papadakis, John A., Papadopoulos, Dimitrios, Sarafidis, Pantelis, Trypsianis, Grigoris, Chatzopoulos, Michail, Chlouverakis, Grigoris, Alamanos, Yannis, Zebekakis, Pantelis, Touloumi, Giota, and Stergiou, George S.

Abstract

This study aimed to assess the reliability of opportunistic screening programs in estimating the prevalence, treatment, and control rate of hypertension in the general population. Two recent epidemiological surveys obtained data on hypertension in the adult general population in Greece. The EMENO (2013–2016) applied a multi-stage stratified random sampling method to collect nationwide data. The MMM (2019) collected data through opportunistic (voluntary) screening in five large cities. Hypertension was defined as blood pressure (BP) ≥ 140/90 mmHg (single occasion; average of 2nd–3rd measurement; electronic devices) and/or use of antihypertensive drugs. Data from a total of 10,426 adults were analyzed (EMENO 4,699; MMM 5,727). Mean age (SD) was 49.2 (18.6)/52.7 (16.6) years (EMENO/MMM, p< 0.001), men 48.6/46.5% (p< 0.05) and body mass index 28.2 (5.7)/27.1 (5.0) kg/m2(p< 0.001). The prevalence of hypertension in ΕΜΕΝΟ/MMM was 39.6/41.6% (p< 0.05) and was higher in men (42.7/50.9%, p< 0.001) than in women (36.5/33.6%, p< 0.05). Among hypertensive subjects, unaware were 31.8/21.3% (EMENO/MMM, p< 0.001), aware untreated 2.7/5.6% (p< 0.001), treated uncontrolled 35.1/24.8% (p< 0.001), and treated controlled 30.5/48.3% (p< 0.001). In conclusion, the prevalence of hypertension was similar with random sampling (EMENO) and opportunistic screening (MMM). However, opportunistic screening underestimated the prevalence of undiagnosed hypertension and overestimated the rate of hypertension treatment and control. Thus, random sampling national epidemiological studies are necessary for assessing the epidemiology of hypertension. Screening programs are useful for increasing awareness of hypertension in the general population, yet the generalization of such findings should be interpreted with caution.

Published
2022
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36. Cardiovascular Protection With Sodium-Glucose Cotransporter-2 Inhibitors and Mineralocorticoid Receptor Antagonists in Chronic Kidney Disease: A Milestone Achieved.

Author

Sarafidis, Pantelis, Papadopoulos, Christodoulos E., Kamperidis, Vasilios, Giannakoulas, George, and Doumas, Michael

Abstract

Chronic kidney disease (CKD) and cardiovascular disease are intimately linked. They share major risk factors, including age, hypertension, and diabetes, and common pathogenetic mechanisms. Furthermore, reduced renal function and kidney injury documented with albuminuria are independent risk factors for cardiovascular events and mortality. In major renal outcome trials and subsequent meta-analyses in patients with CKD, ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin II receptor blockers) were shown to effectively retard CKD progression but not to significantly reduce cardiovascular events or mortality. Thus, a high residual risk for cardiovascular disease progression under standard-of-care treatment is still present for patients with CKD. In contrast to the above, several outcome trials with SGLT-2 (sodium-glucose cotransporter-2) inhibitors and MRAs (mineralocorticoid receptor antagonists) clearly suggest that these agents, apart from nephroprotection, offer important cardioprotection in this population. This article discusses existing evidence on the effects of SGLT-2 inhibitors and MRAs on cardiovascular outcomes in patients with CKD that open new roads in cardiovascular protection of this heavily burdened population. [ABSTRACT FROM AUTHOR]

Published
2021
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37. Joint ESH excellence centers' national meeting on renal sympathetic denervation: A Greek experts’ survey

Author

Doumas, Michael, Andreadis, Emmanouil, Andronoglou, Markos, Davlouros, Periklis, Dimitriadis, Kyriakos, Gkaliagkousi, Eugene, Grassos, Harris, Hatzitolios, Apostolos, Iliakis, Panagiotis, Kalaitzidis, Rigas, Kallistratos, Emmanouil, Kasiakogias, Alexandros, Konstantinidis, Dimitrios, Kotsis, Vasilios, Makris, Thomas, Manolis, Athanasios, Moulias, Athanasios, Marketou, Maria, Papadakis, Ioannis, Papadopoulos, Dimitrios, Poulimenos, Leonidas, Sanidas, Elias, Sarafidis, Pantelis, Savopoulos, Christos, Stergiou, George, Tatakis, Fotis, Thomopoulos, Konstantinos, Triantafyllidi, Helen, Triantafyllou, Areti, Vlachakos, Dimitrios, Zebekakis, Pantelis, Ziakas, Antonios, Papademetriou, Vasilios, and Tsioufis, Costas

Abstract

The efficacy of renal sympathetic denervation (RDN) has been affirmed by a number of recent clinical studies, despite controversies in this field over the last five years. Therefore, it is of paramount importance that hypertension experts debate the merits of RDN by revealing and expressing their personal beliefs and perspectives regarding this procedure.

Published
2021
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38. Hypertension in kidney transplantation: a consensus statement of the ‘hypertension and the kidney’ working group of the European Society of Hypertension

Author

Halimi, Jean-Michel, Ortiz, Alberto, Sarafidis, Pantelis A., Mallamaci, Francesca, Wuerzner, Grégoire, Pisano, Anna, London, Gérard, Persu, Alexandre, Rossignol, Patrick, Sautenet, Bénédicte, Ferro, Charles, Boletis, John, Kanaan, Nada, Vogt, Liffert, Bolignano, Davide, Burnier, Michel, and Zoccali, Carmine

Published
2021
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39. Ambulatory blood pressure changes with lung ultrasound-guided dry-weight reduction in hypertensive hemodialysis patients: 12-month results of a randomized controlled trial

Author

Loutradis, Charalampos, Sarafidis, Pantelis A., Ekart, Robert, Tsouchnikas, Ioannis, Papadopoulos, Christodoulos, Kamperidis, Vasileios, Alexandrou, Maria Eleni, Ferro, Charles J., Papagianni, Aikaterini, London, Gerard, Mallamaci, Francesca, and Zoccali, Carmine

Abstract

Supplemental Digital Content is available in the text

Published
2021
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40. Renin-angiotensin system blockade in patients with chronic kidney disease: benefits, problems in everyday clinical use, and open questions for advanced renal dysfunction

Author

Loutradis, Charalampos, Price, Anna, Ferro, Charles J., and Sarafidis, Pantelis

Abstract

Management of hypertension and albuminuria are considered among the primary goals of treatment to slow the progression of chronic kidney disease (CKD). Renin-angiotensin system (RAS) blockers, i.e., angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) are the main drugs to achieve these goals. Seminal studies have showed that RAS blockers present significant renoprotective effects in CKD patients with very high albuminuria. In post hoc analyses of such trials, these renoprotective effects appeared more robust in patients with more advanced CKD. However, randomized trials specifically addressing whether RAS blockers should be initiated or maintained in patients with advanced CKD are scarce and do not include subjects with normoalbuminuria, thus, many clinicians are unconvinced for the beneficial effects of RAS blockade in these patients. Further, the fear of hyperkalemia or acute renal decline is another factor due to which RAS blockers are usually underprescribed and are easily discontinued in patients with more advanced CKD; i.e., those in Stages 4 and 5. This review summarizes evidence from the literature regarding the use of RAS blockers in patients with advanced CKD.

Published
2021
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41. Opportunistic screening for hypertension in the general population in Greece: International Society of Hypertension May Measurement Month 2019

Author

Stergiou, George S, Menti, Ariadni, Doumas, Michael, Gkaliagkousi, Eugenia, Grassos, Charalampos, Kalaitzidis, Rigas G, Kallistratos, Manolis S, Katsi, Vasiliki, Krokidis, Xenophon, Makris, Thomas, Manios, Efstathios, Manolis, Athanasios, Marketou, Maria, Papadakis, John A, Papadopoulos, Dimitrios, Protogerou, Athanasios, Chatzopoulos, Michail, Sarafidis, Pantelis, Tsioufis, Costas, and Zebekakis, Pantelis

Abstract

Hypertension remains a major public health issue with inadequate control worldwide. The May Measurement Month (MMM) initiative by the International Society of Hypertension was implemented in Greece in 2019 aiming to raise hypertension awareness and control. Adult volunteers (≥18 years) were recruited through opportunistic screening in five urban areas. Information on medical history and triplicate sitting blood pressure (BP) measurements were obtained using validated automated upper-arm devices. Hypertension was defined as systolic BP ≥140 mmHg and/or diastolic ≥90 mmHg, and/or self-reported use of drugs for hypertension. A total of 5727 were analysed [mean age 52.7 (SD 16.6) years, men 46.5%, 88.3% had BP measurement in the last 18 months]. The prevalence of hypertension was (41.6%) and was higher in men and in older individuals. Among individuals with hypertension, 78.7% were diagnosed, 73.1% treated, and 48.3% controlled. Awareness, treatment, and control of hypertension were higher in women and in older individuals. Hypertensives had a higher body mass index (BMI) and were more likely to have diabetes, myocardial infarction and stroke, and less likely to smoke than normotensives (all P< 0.001). Among treated hypertensives, 65.1% were on monotherapy, and with increasing number of antihypertensive drugs the BP levels were higher and hypertension control rates lower. The prevalence of hypertension in Greece is high, with considerable potential for improving awareness, treatment, and control. Screening programmes, such as MMM, need to be widely implemented at the population level, together with training programmes for healthcare professionals aiming to optimise management and control.

Published
2021
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42. Heart Failure and Atrial Fibrillation Modify the Associations of Nocturnal Blood Pressure Dipping Pattern With Mortality in Hemodialysis Patients.

Author

Mayer, Christopher C., Schmaderer, Christoph, Loutradis, Charalampos, Matschkal, Julia, Theodorakopoulou, Marrieta, Lorenz, Georg, Karpetas, Antonios, Angermann, Susanne, Bikos, Athanasios, Braunisch, Matthias C., Raptis, Vasilios, Baumann, Marcus, Papagianni, Aikaterini, Heemann, Uwe, Wassertheurer, Siegfried, and Sarafidis, Pantelis A.

Abstract

Heart failure (HF), hypertension, and abnormal nocturnal blood pressure dipping are highly prevalent in hemodialysis patients. Atrial fibrillation (AF) and HF might be important mediators for the association of abnormal dipping patterns with worse prognosis. Thus, the aim of this study is to investigate the association of dipping with mortality in hemodialysis patients and to assess the influence of AF and HF. In total, 525 hemodialysis patients underwent 24-hour ambulatory blood pressure monitoring. All-cause and cardiovascular mortality served as end points. Patients were categorized according to their systolic dipping pattern (dipper, nondipper, and reverse dipper). Cox regression analysis was performed to determine the association between dipping pattern and study end points with dipping as reference. Subgroup analysis was performed for patients with and without AF or HF. In total, 185 patients with AF or HF and 340 patients without AF or HF were included. During a median follow-up of 37.8 months, 177 patients died; 81 from cardiovascular causes. Nondipping and reverse dipping were significantly associated with all-cause mortality in the whole cohort (nondipper: hazard ratio, 1.95 [1.22-3.14]; P=0.006; reverse dipper: hazard ratio, 2.31 [1.42-3.76]; P<0.001) and in patients without AF or HF (nondipper: hazard ratio, 2.78 [1.16-6.66]; P=0.02; reverse dipper: hazard ratio, 4.48 [1.87-10.71]; P<0.001) but not in patients with AF or HF. For cardiovascular mortality, associations were again significant in patients without AF or HF and in the whole cohort. The observed associations remained significant after adjustment for possible confounders. This study provides well-powered evidence for the association between abnormal dipping patterns and mortality in hemodialysis patients and suggests that HF or AF modifies this association. [ABSTRACT FROM AUTHOR]

Published
2020
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43. Hypoxia and Endothelial Dysfunction in Autosomal-Dominant Polycystic Kidney Disease.

Author

Theodorakopoulou, Marieta, Raptis, Vasileios, Loutradis, Charalampos, and Sarafidis, Pantelis

Subjects
POLYCYSTIC kidney disease, VASCULAR endothelial cells, GENETIC disorders, HYPOXEMIA, PATHOLOGY, RENAL tubular transport disorders, ENDOTHELIUM diseases
Abstract

Autosomal-dominant polycystic kidney disease (ADPKD) is the most prevalent inherited kidney disease, characterized by growth of bilateral renal cysts, hypertension, and multiple extrarenal complications that eventually can lead to renal failure. It is caused by mutations in PKD1 or PKD2 genes encoding the proteins polycystin-1 and polycystin-2, respectively. Over the past few years, studies investigating the role of primary cilia and polycystins, present not only on the surface of renal tubular cells but also on vascular endothelial cells, have advanced our understanding of the pathogenesis of ADPKD and have shown that mechanisms other than cyst formation also contribute to renal functional decline in this disease. Among them, increased oxidative stress, endothelial dysfunction, and hypoxia may play central roles because they occur early in the disease process and precede the onset of hypertension and renal functional decline. Endothelial dysfunction is linked to higher asymmetric dimethylarginine levels and reduced nitric oxide bioavailability, which would cause regional vasoconstriction and impaired renal blood flow. The resulting hypoxia would increase the levels of hypoxia-inducible-transcription factor 1α and other angiogenetic factors, which, in turn, may drive cyst growth. In this review, we summarize the existing evidence for roles of endothelial dysfunction, oxidative stress, and hypoxia in the pathogenesis of ADPKD. [ABSTRACT FROM AUTHOR]

Published
2019
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44. Reply

Author

Sarafidis, Pantelis A., Ortiz, Alberto, Ferro, Charles J., Halimi, Jean-Michel, Kreutz, Reinhold, Mallamaci, Francesca, Mancia, Giuseppe, and Wanner, Christoph

Published
2022
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45. Role of hypertension in kidney transplant recipients

Author

Loutradis, Charalampos, Sarafidis, Pantelis, Marinaki, Smaragdi, Berry, Miriam, Borrows, Richard, Sharif, Adnan, and Ferro, Charles J.

Abstract

Cardiovascular events are one of the leading causes of mortality in kidney transplant recipients. Hypertension is the most common comorbidity accompanying chronic kidney disease, with prevalence remaining as high as 90% even after kidney transplantation. It is often poorly controlled. Abnormal blood pressure profiles, such as masked or white-coat hypertension, are also extremely common in these patients. The pathophysiology of blood pressure elevation in kidney transplant recipients is complex and includes transplantation-specific risk factors, which are added to the traditional or chronic kidney disease-related factors. Despite these observations, hypertension management has been an under-researched area in kidney transplantation. Thus, relevant evidence derives either from studies in the general population or from small trials in kidney transplant recipients. Based on the relevant guidelines in the general population, lifestyle modifications should probably be applied as the first step of hypertension management in kidney transplant recipients. The optimal pharmacological management of hypertension in kidney transplant recipients is also not clear. Dihydropyridine calcium channel blockers are commonly used as first line agents because of their lack of adverse effects on the kidney, while other antihypertensive drug classes are under-utilised due to fear of the possible haemodynamic consequences on renal function. This review summarizes the existing data on the pathophysiology, diagnosis, prognostic significance and management of hypertension in kidney transplantation.

Published
2021
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46. SGLT-2 inhibitors and nephroprotection: current evidence and future perspectives

Author

Piperidou, Alexia, Loutradis, Charalampos, and Sarafidis, Pantelis

Abstract

Chronic kidney disease (CKD) is a major public health issue and an independent risk factor for cardiovascular and all-cause mortality. Diabetic kidney disease develops in 30–50% of diabetic patients and it is the leading cause of end-stage renal disease in the Western world. Strict blood pressure control and renin-angiotensin system (RAS) blocker use are the cornerstones of CKD treatment; however, their application in everyday clinical practice is not always ideal and in many patients CKD progression still occurs. Accumulated evidence in the past few years clearly suggests that sodium-glucose co-transporter-2 (SGLT-2) inhibitors present potent nephroprotective properties. In clinical trials in patients with type 2 diabetes mellitus, these agents were shown to reduce albuminuria and proteinuria by 30–50% and the incidence of composite hard renal outcomes by 40–50%. Furthermore, their mechanism of action appears rather solid, as they interfere with the major mechanism of proteinuric CKD progression, i.e., glomerular hypertension and hyperfiltration. The present review summarizes the current evidence from human trials on the effects of SGLT-2 inhibitors on nephroprotection and discusses their position in everyday clinical practice.

Published
2021
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47. The Beneficial Hemodynamic Actions of SGLT-2 Inhibitors beyond the Management of Hyperglycemia

Author

Loutradis, Charalampos, Papadopoulou, Eirini, Angeloudi, Elena, Karagiannis, Asterios, and Sarafidis, Pantelis

Abstract

Type 2 diabetes mellitus (DM) is a public health burden and its co-existence with hypertension is long established in the context of the metabolic syndrome. Both DM and hypertension are major risk factors, for end-stage renal disease, cardiovascular events and mortality. Strict blood pressure (BP) control in diabetics has been associated with a cardiovascular and renal risk decrease. Inhibitors of the sodium-glucose co-transporter 2 (SGLT-2) in the proximal tubule is a relatively novel class of agents for the treatment of type 2 DM. Inhibition of SGLT-2 co-transporter combines proximal tubule diuretic and osmotic diuretic action leading to glucose reabsorption reduction and mild natriuretic and diuretic effects. On this basis, several studies showed that treatment with SGLT-2 inhibitors can effectively decrease hyperglycemia but also increase BP control and reduce renal outcomes and cardiovascular mortality. Based on such evidence, the recent guidelines for the management of type 2 DM now suggest that SGLT-2 inhibitors should be preferred among oral agents in combination with metformin, in patients at increased cardiovascular risk, chronic kidney disease or heart failure. This review summarizes the existing data from studies evaluating the effect of SGLT-2 inhibitors on BP, and its potential value for cardio- and nephroprotection.

Published
2020
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48. Pharmacotherapy of hypertension in patients with pre-dialysis chronic kidney disease

Author

Loutradis, Charalampos and Sarafidis, Pantelis

Abstract

ABSTRACTIntroductionHypertension is the most common co-morbidity in patients with chronic kidney disease (CKD), with prevalence gradually increasing across CKD Stages to the extent that about 90% of end-stage renal disease (ESRD) patients are hypertensives. Several factors contribute to blood pressure (BP) elevation and guide the therapeutic interventions that should be employed in these patients.Areas coveredThis review summarizes the existing data for the management of hypertension, regarding optimal BP targets and the use of major antihypertensive classes in patients with CKD.Expert opinionManagement of hypertension in CKD requires both lowering BP levels and reducing proteinuria to minimize the risk of both CKD progression and cardiovascular disease. In this respect, aggressive control of office BP to levels <130/80 mmHg has long been proposed for patients with proteinuric nephropathies. Following evidence from recent studies that confirmed significant reductions in renal and cardiovascular outcomes with strict BP control, most, but not all, of international guidelines, suggest such BP goals for all hypertensive patients, including those with CKD. Use of renin-angiotensin system (RAS) blockers is the treatment of choice for patients with proteinuric nephropathies, while, in most patients with CKD, combination treatment with two, three, or more antihypertensive agents is often required to control BP.

Published
2020
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49. Euglycaemic diabetic ketoacidosis as a complication of SGLT-2 inhibitors: epidemiology, pathophysiology, and treatment

Author

Sampani, Erasmia, Sarafidis, Pantelis, and Papagianni, Aikaterini

Abstract

ABSTRACTIntroductionSodium-glucose co-transporters 2 (SGLT-2) inhibitors are a relatively novel class of oral medications for the treatment of Type 2 Diabetes Mellitus, which lower plasma glucose by inhibiting glucose reabsorption in the proximal renal tubule. Apart from their hypoglycemic action, recent data suggest these agents have additional major cardioprotective and nephroprotective properties.Areas coveredThis review summarizes the existing data on epidemiology, pathophysiology, and treatment of euglycaemic ketoacidosis (euDKA) as a complication of SGLT-2 inhibitor use.Expert opinionAlthough SGLT-2 inhibitors have a relatively good adverse event profile, they have been associated with the serious and potentially life-threatening metabolic complication of euDKA. Data from major outcome trials suggest that the rate of DKA is quite low. However, the rate of DKA could be generally underestimated in clinical trials due to the atypical presentation of ketoacidosis, and even more so in real-life conditions. Management of this serious metabolic complication requires a proper understanding of its pathophysiology as well as increased awareness and early recognition of the potential risk factors involved. Following this, the institution of an array of simple supportive measures, could safely restore normal acid–base balance in most patients.

Published
2020
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50. Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Author

Flythe, Jennifer E., Chang, Tara I., Gallagher, Martin P., Lindley, Elizabeth, Madero, Magdalena, Sarafidis, Pantelis A., Unruh, Mark L., Wang, Angela Yee-Moon, Weiner, Daniel E., Cheung, Michael, Jadoul, Michel, Winkelmayer, Wolfgang C., Polkinghorne, Kevan R., Adragão, Teresa, Anumudu, Samaya J., Chan, Christopher T., Cheung, Alfred K., Costanzo, Maria Rosa, Dasgupta, Indranil, Davenport, Andrew, Davies, Simon J., Dekker, Marijke J.E., Dember, Laura M., Gallego, Daniel, Gómez, Rafael, Hawley, Carmel M., Hecking, Manfred, Iseki, Kunitoshi, Jha, Vivekanand, Kooman, Jeroen P., Kovesdy, Csaba P., Lacson, Eduardo, Liew, Adrian, Lok, Charmaine E., McIntyre, Christopher W., Mehrotra, Rajnish, Miskulin, Dana C., Movilli, Ezio, Paglialonga, Fabio, Pecoits-Filho, Roberto, Perl, Jeff, Pollock, Carol A., Riella, Miguel C., Rossignol, Patrick, Shroff, Rukshana, Solá, Laura, Søndergaard, Henning, Tang, Sydney C.W., Tong, Allison, Tsukamoto, Yusuke, Watnick, Suzanne, Weir, Matthew R., Wetmore, James B., Wilkie, Caroline, and Wilkie, Martin

Abstract

Blood pressure (BP) and volume control are critical components of dialysis care and have substantial impacts on patient symptoms, quality of life, and cardiovascular complications. Yet, developing consensus best practices for BP and volume control have been challenging, given the absence of objective measures of extracellular volume status and the lack of high-quality evidence for many therapeutic interventions. In February of 2019, Kidney Disease: Improving Global Outcomes (KDIGO) held a Controversies Conference titled Blood Pressure and Volume Management in Dialysisto assess the current state of knowledge related to BP and volume management and identify opportunities to improve clinical and patient-reported outcomes among individuals receiving maintenance dialysis. Four major topics were addressed: BP measurement, BP targets, and pharmacologic management of suboptimal BP; dialysis prescriptions as they relate to BP and volume; extracellular volume assessment and management with a focus on technology-based solutions; and volume-related patient symptoms and experiences. The overarching theme resulting from presentations and discussions was that managing BP and volume in dialysis involves weighing multiple clinical factors and risk considerations as well as patient lifestyle and preferences, all within a narrow therapeutic window for avoiding acute or chronic volume-related complications. Striking this challenging balance requires individualizing the dialysis prescription by incorporating comorbid health conditions, treatment hemodynamic patterns, clinical judgment, and patient preferences into decision-making, all within local resource constraints.

Published
2020
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