Search

Background.An abnormally high mortality from atherosclerotic cardiovascular (CV) accidents has long been reported in patients on maintenance haemodialysis (HD). However, incidence of atherosclerotic CV accidents had not been so far assessed in predialysis patients. In order to evaluate the respective influence of uraemia and the dialysis procedure, we compared incidence of atherosclerotic accidents before and after initiation of HD in a large population of patients. [ABSTRACT FROM PUBLISHER]

Objective: To analyze the long term evolution of patients undergoing percutaneous balloon mitral valvoplasty comparing the Inoue and Balt single balloon methods, and to identify predictors of death and major events (death, repeat balloon mitral valvoplasty or mitral valve surgery)., Methods: The follow-up for the single and Inoue balloon groups were 54 +/- 31 (1 to 126) months and 34 +/- 26 (2 to 105) months, respectively (p < 0.0001). The Balt single balloon was used in 254 (84.1%) patients and the Inoue balloon in 48 (15.9%)., Results: The following data were found for the Inoue and single balloon groups, respectively: age, 36.9 +/- 10.4 (19 to 63) years and 38.0 +/- 12.6 (13 to 83) years (p = 0.5769); echocardiographic score, 7.5 +/- 1.3 points and 7.2 +/- 1.5 points (p = 0.1307); female gender, 72.9% and 87.4% (p = 0.0097); atrial fibrillation, 10.4% and 16.1% (p = 0.4275); mortality during follow-up, 2.1% and 4.3% (0.6984); and major events, 8.3% and 17.7% (p = 0.1642). Univariate and Kaplan-Meier curve analyses revealed no differences between the Inoue and Balt single balloon techniques in relation to survival and major event free survival. In the multivariate analysis, age > 50 years and an echocardiographic score > 8 were independent predictors of death; and an echocardiographic score > 8 and post operative mitral valve area < 1.50 cm(2) were predictors for major events., Conclusion: No differences were found in the long term evolution of patients undergoing the Inoue versus the single balloon technique. Predictors of death and/or major events were: age > 50 years, echocardiographic score > 8 and mitral valve area < 1.50 cm(2) after the procedure.

Objective: To evaluate 501 procedures of mitral balloon valvuloplasty and the differences among the group already submitted the prior surgical or balloon valvuloplasty, with 59 procedures and the group without previous intervention, with 442 procedures., Methods: It was used the single balloon in 403, Inoue balloon in 89 and a double balloon in six, with no difference between the 2 groups (p=0.6610)., Results: The prior surgical or balloon valvuloplasty group was older, with higher echo score and higher atrial fibrillation rate and of its 59 patients, 48 had been submitted only to mitral surgical commissurotomy, 8 only to mitral balloon valvuloplasty and 3 to surgical commissurotomy and after submitted to balloon valvuloplasty because of restenosis. In prior surgical or balloon valvuloplasty and mitral balloon valvuloplasty without previous intervention groups pre valvuloplasty there were respectively: echo mitral valve area 0.99+/-0.21 and 0.94+/-0.21 cm2 (p=0.0802) and mitral valve area (Gorlin) 0.94+/-0.18 and 0.91+/-0.21 cm2 (p=0.2518) and post mitral valvuloplasty 1.95+/-0.44 and 2.05+/-0.42 cm2 (p=0.1059)., Conclusions: The hemodynamic and angiographic outcome of the prior surgical or balloon valvuloplasty group were similar to the group without previous intervention. The evolution was satisfactory in the prior valvuloplasty subgroup with long-term follow-up.

Objective: To identify the factors that predict death and combined events, (death, new mitral balloon valvotomy, or mitral valve surgery) in long-term follow-up of patients undergoing percutaneous mitral balloon valvotomy., Methods: Follow-up was 49.0+/-31.0 (1 to 122) months. Techniques used were the single-balloon (84.4%), Inoue-balloon (13.8%), and double-balloon techniques (1.7%)., Results: Included in the study were 289 patients 38.0+/-12.6 years of age (range, 13 to 83). Before the procedure, 244 patients had echocardiographic score < or = 8, and 45 patients had score > 8. Females comprised 85%, and 84% patients were in sinus rhythm. During follow-up, survival of the total group was 95.5%, that of the group with < or = 8 was 98.0%, finally that of the group with scores > 8 was 82.2% (P < 0.0001), whereas combined event-free survival was 83.4%, 86.1%, and 68.9%, respectively (P < 0.0001). In the multivariate analysis, the factors that predicted long-term death were a preprocedure echocardiographic score > 8 and the presence of severe valvular mitral regurgitation during the procedure. The events that predicted combined events were a previous history of mitral valvular commissurotomy and atrial fibrillation and the presence of severe mitral valvular regurgitation during the procedure, and postprocedure mitral valvular area < 1.5 m2 (failure)., Conclusion: Percutaneous mitral balloon valvotomy is an effective procedure, and over 2/3 of the patients were event-free at the end of follow-up. Survival in the group was high, even higher in the group with lower echocardiographic scores.

Objective: To evaluate prior mitral surgical commissurotomy and echocardiographic score influence on the outcomes and complications of percutaneous mitral balloon valvuloplasty., Methods: We performed 459 complete mitral valvuloplasty procedures. Four hundred thirteen were primary valvuloplasty and 46 were in patients who had undergone prior surgical commissurotomy. The prior commissurotomy group was older, had higher echo scores, and a tendency toward a higher percentage of atrial fibrillation., Results: When the groups were compared with each other, no differences were found in pre- and postprocedure mean pulmonary artery pressure, mean mitral gradient, mitral valve area, and mitral regurgitation. Because we found no significant differences, we subdivided the entire group based on echo scores, those with echo scores < or =8 and those with echo scores >8 the mitral valve area being higher in the < or =8 echo score group 2.06+/-0.42 versus 1.90+/-0.40 cm2 (p=0.0090) in the >8 echo score group., Conclusion: Dividing the groups based on echo score revealed that the higher echo score group had smaller mitral valve areas postvalvuloplasty.

Objectives: To evaluate incidence and prevalence of patients with end-stage renal disease (ESRD) treated with maintenance dialysis in the Ile de France district in 1998., Methodology: Prospective epidemiologic inquiry with the cooperation of the 91 nephrology departments and dialysis facilities of the Ile de France district (total population: 10,695,300 inhabitants in March 1999), from January 1st to December 31st, 1998. Evaluation of the demographic and clinical characteristics of the 1155 patients accepted on maintenance dialysis in 1998, and recording of the total number of dialyzed patients at the beginning and at the end of the same year., Results: The total number of ESRD patients was 1155, including 29 (2.5%) children aged < or = 17 years and 86 (7.4%) returns to dialysis following kidney graft failure. Incidence of ESRD in first-dialyzed patients was 100/million/year and overall incidence, including returns from transplantation, was 108/million/year. Mean age of the 1040 adult first-dialysis patients was 59 +/- 16.8 years, with a proportion of those aged > or = 75 years of 21.6%. Patients with vascular renal disease were 22.5% and those with diabetic nephropathy 20.6%. As a whole, 36.5% of patients were referred to the nephrologist < 6 months of starting dialysis. Prevalence of patients on supportive dialysis increased from 417 to 433 per million inhabitants (a 3.8% increase) from the beginning to the end of 1998, with the proportion of patients treated with self-care dialysis or peritoneal dialysis rising by 10%. From January 1995 to January 1999, prevalence of dialysis-treated ESRD patients rose by nearly 4% per year as a mean., Conclusion: Incidence of ESRD patients requiring maintenance dialysis in the Ile de France district reached 100/million in 1998, an increment of 4% per year over the past 4 years. The increase in incidence results from the increasing number of older patients, parallel to the ageing of general population, these patients having a high comorbidity mainly due to diabetes and atherosclerosis. Prevalence of dialysis-treated patients was 433/million population at the end of 1998. It rose at a similar rate as did incidence, although with a growing proportion of out-center dialysis.

A prospective epidemiological study was conducted from January 1 to December 31, 1998 in the Ile-de-France district to determine the incidence and the prevalence of end-stage renal disease (ESRD) and the characteristics of the patients. All nephrology and dialysis units of the Ile-de-France district participated in the study. The total number of ESRD patients requiring maintenance dialysis was 1155 (including 86 kidney graft failures and 29 children) for a total population of 10.7 millions inhabitants, or 108/10(6)/year. The incidence of new ESRD patients was 100/10(6)/year. The mean age of first-dialyzed, adult patients was 59.8 +/- 16.8 years, with 21.6% aged > or = 75 years. Vascular renal diseases accounted for 22.5% and diabetic nephropathy for 20.6%. As a whole, 36.5% of patients were referred to the nephrologist less than 6 months before starting dialysis. In the latter, the median duration of hospitalization was 28 days, compared to only 3 days in patients cared for by the nephrologist for at least 6 months. Prevalence of patients on maintenance dialysis in the Ile-de-France district grew from 417 to 433/10(6) from the beginning until the end of year 1998, an increment of 3.8%, with an increase in the number of patients treated out-center by self-care hemodialysis or peritoneal dialysis.

Purpose: To assess short-term results and complications of percutaneous mitral balloon valvuloplasty (PMBV) performed with Inoue balloon (IB) and single low profile balloon (SB)., Methods: We performed 390 PMBV procedures, 29 with IB and 337 with SB. There were no differences in age, sex, echocardiographic score distribution and echocardiographic mitral valve area (MVA)., Results: We performed 29 complete procedures with IB and 330 of 337 in SB group. Comparing IB and pre and pos-PMBV data we obtained: mean pulmonary artery pressure (MPAP) 36 +/- 15 and 39 +/- 14 mmHg, p = 0.2033, mean mitral gradient 17 +/- 6 and 20 +/- 77 mmHg, p = 0.0396 and MVA 0.9 +/- 0.2 and 0.9 +/- 0.2 cm2, p = 0.8043 and pos-PMBV:MPAP 25 +/- 8 and 28 +/- 10 mmHg, p = 0.2881, gradient 5 +/- 3 and 5 +/- 4 mmHg, p = 0.2778 and MVA 2.2 +/- 0.2 and 2.0 +/- 0.4 cm2, p = 0.0362. Mitral valve (MV) was competent in 26 patients in IB and in 280 in SB group and we had +/4 mitral regurgitation in 3 patients in IB and in 57 in SB group (p = 0.3591) pre-PMBV respectively and pos-PMBV there was also no difference in MV competence (p = 0.7439)., Conclusion: Both techniques were effective. Hemodynamic data were also similar although MVA was greater in IB group after PMBV.

Hyperhomocysteinemia has been shown to constitute an independent risk factor for premature occlusive arterial disease. Moderate hyperhomocysteinemia is present in chronic uremic patients, who often develop premature atherosclerosis, but no direct evidence of an association between the occurrence of atherosclerotic cardiovascular accidents (CVAs) and hyperhomocysteinemia has yet been reported in such patients. We serially determined total plasma homocysteine (Hcy) levels in a cohort of 93 consecutive chronic renal failure, undialyzed patients (57 males, 36 females) with creatinine clearance (Ccr) < 50 ml/min.1.73 m2 and age > or = 50 years at start of follow-up, together with serial assessment of Ccr and blood lipid parameters. From January 1989 to December 1995, 24 patients (group 1) experienced myocardial infarction (18 cases, 13 males) or cerebral infarction (6 cases, 3 males) while the remaining 69 (group 2) remained free of CVAs. Patients in groups 1 and 2 did not differ with respect to age (66 +/- 1.8 vs. 65 +/- 1.1 years, mean +/- Se) or serum creatinine (227 +/- 24 vs. 251 +/- 36 mumol/l) at onset of a CVA (group 1) or at the end of follow-up (group 2). The mean Hcy level was significantly higher in group 1 (20.7 +/- 1.6 vs. 12.8 +/- 0.5 mumol/l, p < 0.0001), as was the proportion of patients with Hcy in excess of 14 mumol/l, the upper limit in healthy controls (83 vs. 30%, p < 0.0001). Logistic regression analysis identified Hcy as an independent risk factor for CVA, with an odds ratio of 11.4 (95% confidence interval 3.5-37.7), which remained significant after adjustment on other variables. We conclude that an elevated Hcy level is associated with a risk of occlusive arterial accidents in patients with chronic renal failure and that hyperhomocysteinemia contributes to the accelerated atherosclerosis complicating chronic uremia.

Reflux nephropathy is one of the most prevalent renal diseases and a leading cause of chronic renal failure in women-of childbearing age. To evaluate the issue and possible complications of pregnancy in women with reflux nephropathy, we retrospectively analyzed fetal and maternal outcome in 158 women who had 375 pregnancies between 1965 and 1994. The overall fetal death rate was 10.2% and tended to decrease in the 1985 to 1994 decade as compared to the preceding period (8.4% vs. 12.6%). The relative risk of fetal death was 4.8 times greater hypertension was present at conception than in normotensive patients. Fetal death rate was also higher in patients with impaired renal function that in those with serum creatinine < 0.11 mmol/liter at conception (36.7% vs. 7.7%, P < 0.0001). Urinary tract infection accounted for frequent morbidity but seldom resulted in fetal mortality. Maternal renal disease was unaffected by pregnancy, excepted for 4 of the 21 patients with pre-existing renal failure who exhibited an irreversibly accelerated course after pregnancy. We conclude that pregnancy is essentially successful and uneventful in patients diagnosed with reflux nephropathy who have normal blood pressure and preserved renal function, whereas the fetal prognosis is more compromised and there is a risk of accelerated progression of maternal renal disease when serum creatinine concentration is in excess of 0.22 mmol/ liter. This suggests that women with reflux nephropathy should preferably conceive before having reached that stage of renal failure.