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Background: Low peak kilovoltage (kVp) computed tomography (CT) may be used to reduce contrast medium doses in patients at risk of contrast medium-induced acute kidney injury if image noise can be controlled by increasing X-ray tube loading (mAs). Purpose: To evaluate objective and subjective image quality in 80-kVp CT with reduced contrast medium dose and compensated mAs for unchanged image noise in patients with estimated glomerular filtration rate <45 mL/min compared with the standard 120-kVp protocol. Material and Methods: 80-kVp CT with 300 mg I/kg in 40 patients (body mass index 18–32 kg/m2, glomerular filtration rate <45 mL/min) and 120-kVp CT with 500 mg I/kg in 40 patients (body mass index = 17–30 kg/m2, glomerular filtration rate ≥45 mL/min) was compared on mean hepatic attenuation, image noise, contrast medium enhancement, signal-to-noise ratio, contrast-to-noise ratio, effective radiation dose, and subjective image quality. Results: There were no significant differences regarding median hepatic post-contrast attenuation, image noise, contrast medium enhancement, signal-to-noise ratio, contrast-to-noise ratio, or effective dose between the 80-kVp and 120-kVp cohorts: 114/110 HU; 14/14 HU; 57/53 HU; 8.0/7.4; 3.8/3.5; and 5.3/5.9 mSv, respectively. However, subjective image visual grading showed statistically significantly inferior scores for 80 kVp for six of eight items. After exclusion of seven inferior examinations not caused by the chosen kVp technique, only three items showed inferior scores for 80 kVp. Only 5% of gradings regarding overall image quality were <3 of 5 points. Conclusion: Despite lower subjective image quality, objective data indicate that 80-kVp CT with reduced contrast medium doses and compensated mAs may have the potential to provide satisfactory diagnostic quality in patients with body mass index <30 kg/m2, which could benefit patients at risk of contrast medium-induced acute kidney injury. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: What is the prognostic significance of achieving a systolic blood pressure of <140mmHg? Setting: Diabetic renal policlinic, university hospital of Lund, Sweden. Subjects: 118 type 2 diabetic patients with micro-macroalbuminuria were followed for four years (range 1–8years). Method and main outcome measures: The prognostic significance of office, day- and nighttime measurements of blood pressure (BP) for development of cardiovascular complications was studied. Results: Forty-two percent (n=49) developed one or more of the following cardiovascular endpoints: 23% (n=27) death, 9% (n=10) stroke, 9% (n=11) myocardial infarction, 9% (n=11) heart failure, 31% (n=36) uremia and 17% (n=20) need for dialysis. Reaching the goal for day- and nighttime systolic BP (SBP) at baseline of <140mmHg was associated with lower risk for developing uremia. Reaching the goal for nighttime SBP was associated with a decreased risk for developing myocardial infarction and need for dialysis treatment. None of these associations was found for office SBP. Patients not achieving the goal for nighttime systolic blood pressure of <140mmHg had a 12.9 times higher risk of developing myocardial infarction and 3.9 times increased risk of uremia and 2.7 times increased risk for death than patients achieving the goal. Conclusion: Nighttime blood pressure had better prognostic significance for developing cardiovascular and renal complications than office and daytime blood pressure. [Copyright &y& Elsevier]

Objective. Early detection of oral infections plays an important role for dental referral during progression of renal disease and during dialysis treatment in uraemic patients. This study investigated how oral health is related to uraemia in a group of uraemic patients in Stockholm, Sweden. Material and methods. This cross-sectional study assessed oral diseases in chronic kidney disease (CKD) patients in different stages (n=93) compared with healthy age- and gender-matched controls. Differences in multiple oral outcomes, assessed by a dentist, were investigated in multivariate analyses, adjusted for tobacco habits, diabetes mellitus and uraemia status (predialysis, peritonealdialysis or haemodialysis). Results. Compared with healthy controls, uraemic patients had significantly worse dental status regarding the decayed, missing, filled teeth (DMFT) index (3.3, p=0.003), periodontal loss of attachment (0.9, p=0.00002) and periapical lesions (0.6, p=0.002). For haemodialysis patients DMFT (6.5, p=0.01), periodontal loss of attachment (2.2, p=0.007) and periapical lesions (1.0, p=0.01) were worse compared with controls. The differences between uraemic patients and controls remained after adjustment for age, gender, tobacco habits and diabetes (p<0.05 for all outcomes). Conclusions. Objective measurements showed that uraemic patients have more dental problems than healthy controls and the patients seem to develop their problems before they have progressed to dialysis. Therefore greater attention to dental problems may be warranted during the progression of uraemia to prevent deterioration of oral health. [ABSTRACT FROM AUTHOR]

Objective: The Swedish Registry for Active Treatment of Uraemia (SRAU) was founded in 1991 with the objective of documenting demographic data on patients treated for end-stage renal disease (ESRD). The aim of this study was to describe the prevalence, incidence, comorbidity risk factors and survival of patients with ESRD who underwent dialysis treatment and/ or kidney transplantation in Sweden between 1991 and 2002. Material and Methods: All dialysis and transplant units (n = 65) presently report to the SRAU and almost all patients are reported and followed until death. Results: The prevalence of patients on dialysis and transplantation, being &ap;750 per million population (PMP). has increased by 75% in 12 years. The recent annual rise is &ap;3% (200 patients). The incidence has been stable since 1997 at &ap;125 patients PMP. In 2002, there were 1113 new patients, the majority of whom were aged >65 years. Their original kidney disease was most often diabetic nephropathy (23.7%), with nephrosclerosis (19.0%) being the second most common disease. The total number of renal transplantations performed has decreased to some extent. The overall 5-year patient survival rate was 23.1% in patients on dialysis and 85.5% after kidney transplantation. The major cause of death was cardiovascular disease (48%) and an increasing frequency of malignancy after transplantation (26%) was noted. Conclusion: The prevalence of ESRD has nearly doubled since 1990 and the number of new patients being referred for dialysis has increased. These patients are becoming older, with a large proportion having non-renal complicating diseases. Survival after transplantation was excellent. The shortage of cadaveric donors in Sweden in recent years and increasing mortality from malignant disease after transplantation are issues of great concern. [ABSTRACT FROM AUTHOR]