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Cardiopulmonary exercise testing (CPET) was limited to peak oxygen consumption analysis (VO2peak), and now the ventilation/carbon dioxide production (VE/VCO2) slope is recognized as having independent prognostic value. Unlike VO2peak, the VE/VCO2 slope does not require maximal effort, making it more feasible. There is no consensus on how to measure the VE/VCO2 slope; therefore, we assessed whether different methods affect its value. This is a retrospective study assessing sociodemographic data, left ventricular ejection fraction, CPET parameters, and indications of patients referred for CPET. The VE/VCO2 slope was measured to the first ventilatory threshold (VT1-slope), secondary threshold (VT2-slope), and included all test data (full-slope). Of the 697 CPETs analyzed, 308 reached VT2. All VE/VCO2 slopes increased with age, regardless of test indications. In patients not reaching VT2, the VT1-slope was 32 vs. 36 (p < 0.001) for the full-slope; in those surpassing VT2, the VT1-slope was 29 vs. 33 (p < 0.001) for the VT2-slope and 37 (all p < 0.001) for the full-slope. The mean difference between the submaximal and full-slopes was ±4 units, sufficient to reclassify patients from low to high risk for heart failure or pulmonary hypertension. We conclude that the method used for determining the VE/VCO2 slope greatly influences the result, the significant variations limiting its prognostic value. The calculation method must be standardized to improve its prognostic value.

Background Beta-blockers are increasingly prescribed while the effects of beta-adrenergic receptor blockade on cardio-pulmonary exercise test (CPET)-derived parameters remain under-studied. Methods Twenty-one young healthy adults repeated three CPET at the same time with an interval of 7 days between each test. The tests were performed 3 h after a random, double-blind, cross-over single-dose intake of placebo, 2.5 mg or 5.0 mg bisoprolol, a cardio-selective beta1-adrenoreceptor antagonist. Gas exchange, heart rate (HR) and blood pressure (BP) were measured at rest and during cyclo-ergometric incremental CPET. Results Maximal workload and VO2max were unaffected by the treatment, with maximal respiratory exchange ratio > 1.15 in all tests. A beta-blocker dose-dependent effect reduced resting and maximal BP and HR and the chronotropic response to exercise, evaluated by the HR/VO2 slope (placebo: 2.9 ± 0.4 beat/ml/kg; 2.5 mg bisoprolol: 2.4 ± 0.5 beat/ml/kg; 5.0 mg bisoprolol: 2.3 ± 0.4 beat/ml/kg, p 2 slope and the ventilatory equivalent for CO2 at the ventilatory threshold were not affected by beta1-receptor blockade. Post-exercise chronotropic recovery measured after 1 min was enhanced under beta1-blocker (placebo: 26 ± 7 bpm; 2.5 mg bisoprolol: 32 ± 6 bpm; 5.0 mg bisoprolol: 33 ± 6 bpm, p Conclusion The present results suggest that a single dose of bisoprolol does not affect metabolism, respiratory response and exercise capacity. However, beta-adrenergic blockade dose dependently reduces exercise hemodynamic response by lowering BP and the chronotropic response.

Contains fulltext : 286841.pdf (Publisher’s version ) (Closed access) BACKGROUND: Resistant hypertension is associated with increased cardiovascular risk. The endothelin pathway has been implicated in the pathogenesis of hypertension, but it is currently not targeted therapeutically, thereby leaving this relevant pathophysiological pathway unopposed with currently available drugs. The aim of the study was to assess the blood pressure lowering efficacy of the dual endothelin antagonist aprocitentan in patients with resistant hypertension. METHODS: PRECISION was a multicentre, blinded, randomised, parallel-group, phase 3 study, which was done in hospitals or research centres in Europe, North America, Asia, and Australia. Patients were eligible for randomisation if their sitting systolic blood pressure was 140 mm Hg or higher despite taking standardised background therapy consisting of three antihypertensive drugs, including a diuretic. The study consisted of three sequential parts: part 1 was the 4-week double-blind, randomised, and placebo-controlled part, in which patients received aprocitentan 12·5 mg, aprocitentan 25 mg, or placebo in a 1:1:1 ratio; part 2 was a 32-week single (patient)-blind part, in which all patients received aprocitentan 25 mg; and part 3 was a 12-week double-blind, randomised, and placebo-controlled withdrawal part, in which patients were re-randomised to aprocitentan 25 mg or placebo in a 1:1 ratio. The primary and key secondary endpoints were changes in unattended office systolic blood pressure from baseline to week 4 and from withdrawal baseline to week 40, respectively. Secondary endpoints included 24-h ambulatory blood pressure changes. The study is registered on ClinicalTrials.gov, NCT03541174. FINDINGS: The PRECISION study was done from June 18, 2018, to April 25, 2022. 1965 individuals were screened and 730 were randomly assigned. Of these 730 patients, 704 (96%) completed part 1 of the study; of these, 613 (87%) completed part 2 and, of these, 577 (94%) completed part 3 of the study. The least square mean (SE) change in office systolic blood pressure at 4 weeks was -15·3 (SE 0·9) mm Hg for aprocitentan 12·5 mg, -15·2 (0·9) mm Hg for aprocitentan 25 mg, and -11·5 (0·9) mm Hg for placebo, for a difference versus placebo of -3·8 (1·3) mm Hg (97·5% CI -6·8 to -0·8, p=0·0042) and -3·7 (1·3) mm Hg (-6·7 to -0·8; p=0·0046), respectively. The respective difference for 24 h ambulatory systolic blood pressure was -4·2 mm Hg (95% CI -6·2 to -2·1) and -5·9 mm Hg (-7·9 to -3·8). After 4 weeks of withdrawal, office systolic blood pressure significantly increased with placebo versus aprocitentan (5·8 mm Hg, 95% CI 3·7 to 7·9, p

Background: Beta-blockers are increasingly prescribed while the effects of beta-adrenergic receptor blockade on cardio-pulmonary exercise test (CPET) derived parameters remain under-studied. Methods: 21 young healthy adults repeated 3 CPET at an interval of 7 days at the same time of the day. The tests were performed 3 hours after a random, double blind, cross-over single dose intake of placebo, 2.5 mg bisoprolol or 5 mg bisoprolol. Gaz exchange, heart rate and blood pressure were measured at rest and during cyclo-ergometric CPET.Results: Maximal workload and VO2max were unaffected by the treatment, with maximal respiratory exchange ratio > 1.15 in all tests. A beta-blocker dose-dependent effect reduced resting and maximal blood pressure and heart rate and the chronotropic response to exercise, evaluated by the heart rate/VO2 slope (placebo: 2,9 ± 0,4 beat/ml/kg; 2,5 mg bisoprolol: 2,4 ± 0,5 beat/ml/kg; 5 mg bisoprolol: 2,3 ± 0,4 beat/ml/kg, p2 slope and the ventilatory equivalent for CO2 at the ventilatory threshold were not affected by beta1-receptor blockade. Post-exercise chronotropic recovery measured after 1 min was enhanced under beta1-blocker (placebo: 26 ± 7 bpm; 2,5 mg bisoprolol: 32 ± 6 bpm; 5 mg bisoprolol: 33 ± 6 bpm, pConclusion: The present results suggest that a single dose of bisoprolol does not affect metabolism, respiratory response and exercise capacity. However, beta-adrenergic blockade dose-dependently reduced exercise hemodynamic response by lowering the pressure and chronotropic responses.

info:eu-repo/semantics/published

To investigate if modern seismocardiography (SCG) and ballistocardiography (BCG) are useful in the detection of hemodynamic changes occurring during simulated obstructive apneic events., info:eu-repo/semantics/published

Background: Propylene glycol and glycerol are e-cigarette constituents that facilitate liquid vaporization and nicotine transport. As these small hydrophilic molecules quickly cross the lung epithelium, we hypothesized that short-term cessation of vaping in regular users would completely clear aerosol deposit from the lungs and reverse vaping-induced cardio-respiratory toxicity. Aims: To assess the acute effects of vaping and their reversibility on biological/clinical cardio-respiratory parameters (serum/urine pneumoproteins, hemodynamic parameters, lung-function test and diffusing capacities, transcutaneous gas tensions (primary outcome) and skin microcirculatory blood flow). Methods: Regular e-cigarette users were enrolled in this randomized, investigator-blinded, three-period crossover-study. The periods consisted of nicotine-vaping (nicotine-session), nicotine-free vaping (nicotine-free-session), and complete cessation of vaping (stop-session), all maintained for five days before the session began. Multiparametric metabolomic analyses were used to verify subjects' protocol compliance. Biological/clinical cardio-respiratory parameters were assessed at the beginning of each session (baseline) and after acute vaping exposure. Results: Compared to the nicotine- and nicotine-free-sessions, a specific metabolomic signature characterized the stop-session. Baseline serum club-cell protein-16 was higher during the stop-session than the other sessions ( p, info:eu-repo/semantics/published

A healthy 66-year-old female presented to the emergency department with acute chest pain, T-wave inversion in the anterior leads, and elevated troponin-I. Coronary angiography showed a stenosis in the midportion of the left anterior descending coronary artery (LAD), which did not wrap the left ventricle (LV) apex. LV angiography demonstrated a large LV apical akinetic systolic ballooning with a 45% ejection fraction. Fractional flow reserve (FFR) of LAD lesion was 0.71. Percutaneous intervention was performed. At six months, transthoracic echocardiography was normal. Fifteen months later, the patient presented with chest pain and a small rise in troponin-I. Coronary angiogram was unchanged. Repeat FFR in distal LAD was 0.86 and left ventriculography was normal. Diagnostic criteria for Takotsubo cardiomyopathy (TTC) require the absence of obstructive coronary artery disease. In the present case, TTC was highly suspected on the basis of typical LV apex ballooning. However, significant ischemia in the same territory was demonstrated by positive FFR, which could not be falsely positive in this context. Current TTC diagnostic criteria increase specificity for diagnosing TTC. This case reminds us that it is at the price of reduced sensitivity, since there is no reason to believe that coronary lesions may protect from TTC.

Propylene glycol and glycerol are electronic cigarettes vehicles allowing liquid vaporization and nicotine transport. The respective effects of these different constituents on the cardiovascular system are unknown. We assessed the differential effects of vehicles (propylene glycol and glycerol) and nicotine on microcirculatory function, arterial stiffness, hemodynamic parameters and oxidative stress. Twenty-five tobacco smokers were exposed to vaping with and without nicotine, and sham vaping, in a randomized, single blind, 3-period crossover design study. Neither sham-vaping nor vaping in the absence of nicotine resulted in modifications of cardiovascular parameters or oxidative stress. In contrast, vaping with nicotine: 1) impaired acetylcholine mediated vasodilation (mean ± standard error mean) (area under curve, perfusion unit (PU), 3385 ± 27PU to 2271 ± 27PU, p < 0.0001); 2) increased indices of arterial stiffness, namely augmentation index corrected for heart rhythm (-3.5 ± 1.5% to 1.9 ± 2.3%; p = 0.013) and pulse wave velocity (4.9 ± 0.1 m.s-1 to 5.3 ± 0.1 m.s-1; p < 0.0001); 3) increased systolic and diastolic blood pressures as well as heart rate (all p < 0.0001) and finally; 4) raised plasma myeloperoxidase (median [interquartile range]) (13.6 ng.ml-1 [10-17.7] to 18.9 ng.ml-1 [12.2-54.4], p = 0.005). Our findings demonstrated that high temperature e-cigarette vehicle vaporization does not alter micro- and macro-vascular function, and oxidative stress, and that these effects are solely attributable to nicotine., SCOPUS: ar.j, info:eu-repo/semantics/published

Background Uric acid (UA) is a plasmatic antioxidant that has possible effects on blood pressure. The effects of UA on endothelial function are unclear. We hypothesize that endothelial function is not impaired unless significant UA depletion is achieved through selective xanthine oxidase inhibition with febuxostat and recombinant uricase (rasburicase). Methods and Results Microvascular hyperemia, induced by iontophoresis of acetylcholine and sodium nitroprusside, and heating-induced local hyperemia after iontophoresis of saline and a specific nitric oxide synthase inhibitor were assessed by laser Doppler imaging. Blood pressure and renin-angiotensin system markers were measured, and arterial stiffness was assessed. CRP (C-reactive protein), allantoin, chlorotyrosine/tyrosine ratio, homocitrulline/lysine ratio, myeloperoxidase activity, malondialdehyde, and interleukin-8 were used to characterize inflammation and oxidative stress. Seventeen young healthy men were enrolled in a randomized, double-blind, placebo-controlled, 3-way crossover study. The 3 compared conditions were placebo, febuxostat alone, and febuxostat together with rasburicase. The allantoin (μmol/L)/UA (μmol/L) ratio differed between sessions (P, info:eu-repo/semantics/published

Supplement to the main nanuscript:Short halt in vaping modifies cardio-respiratory parameters and urine metabolome: a randomized trial

Objective: To assess if micro-accelerometers and gyroscopes may provide useful information for the detection of breathing disturbances in further studies. Approach: Forty-three healthy volunteers performed a 10 s end-expiratory breath-hold, while ballistocardiograph (BCG) and seismocardiograph (SCG) determined changes in kinetic energy and its integral over time (iK, J • s). BCG measures overall body accelerations in response to blood mass ejection into the main vasculature at each cardiac cycle, while SCG records local chest wall vibrations generated beat-by-beat by myocardial activity. This minimally intrusive technology assesses linear accelerations and angular velocities in 12 degrees of freedom to calculate iK during the whole cardiac cycle. iK produced during systole and diastole were also computed. Main results: The iK during normal breathing was 87.1 [63.3; 132.8] µJ • s for the SCG and 4.5 [3.3; 6.2] µJ • s for the BCG. Both increased to 107.1 [69.0; 162.0] µJ • s and 6.1 [4.4; 9.0] µJ • s, respectively, during breath-holding (p = 0.003 and p < 0.0001, respectively). The iK of the SCG further increased during spontaneous respiration following apnea (from 107.1 [69.0; 162.0] µJ • s to 160.0 [96.3; 207.3] µJ • s, p < 0.0001). The ratio between the iK of diastole and systole increased from 0.35 [0.24; 0.45] during apnea to 0.49 [0.31; 0.80] (p < 0.0001) during the restoration of respiration. Significance: A brief voluntary apnea generates large and distinct increases in SCG and BCG waveforms. iK monitoring during sleep may prove useful for the detection of respiratory disturbances. ClinicalTrials.gov number: NCT03760159, SCOPUS: ar.j, info:eu-repo/semantics/published

When heated by an electronic cigarette, propylene glycol and glycerol produce a nicotine-carrying-aerosol. This hygroscopic/hyperosmolar aerosol can deposit deep within the lung. Whether these deposits trigger local inflammation and disturb pulmonary gas exchanges is not known. The aim of this study was to assess the acute effects of high-wattage electronic cigarette vaping with or without nicotine on lung inflammation biomarkers, transcutaneous gas tensions, and pulmonary function tests in young and healthy tobacco smokers. Acute effects of vaping without nicotine on arterial blood gas tensions were also assessed in heavy smokers suspected of coronary artery disease. Using a single-blind within-subjects study design, 25 young tobacco smokers underwent three experimental sessions in random order: sham-vaping and vaping with and without nicotine at 60 W. Twenty heavy smokers were also exposed to sham-vaping (n = 10) or vaping without nicotine (n = 10) in an open-label, randomized parallel study. In the young tobacco smokers, compared with sham-vaping: 1) serum club cell protein-16 increased after vaping without nicotine (mean ± SE, -0.5 ± 0.2 vs. +1.1 ± 0.3 µg/l, P = 0.013) and vaping with nicotine (+1.2 ± 0.3 µg/l, P = 0.009); 2) transcutaneous oxygen tension decreased for 60 min after vaping without nicotine (nadir, -0.3 ± 1 vs. -15.3 ± 2.3 mmHg, P < 0.001) and for 80-min after vaping with nicotine (nadir, -19.6 ± 2.8 mmHg, P < 0.001). Compared with sham vaping, vaping without nicotine decreased arterial oxygen tension for 5 min in heavy-smoking patients (+5.4 ± 3.3 vs. -5.4 ± 1.9 mmHg, P = 0.012). Acute vaping of propylene glycol/glycerol aerosol at high wattage with or without nicotine induces airway epithelial injury and sustained decrement in transcutaneous oxygen tension in young tobacco smokers. Intense vaping conditions also transiently impair arterial oxygen tension in heavy smokers., SCOPUS: ar.j, info:eu-repo/semantics/published

(1) Background: Previous research (Van Gucht, Adriaens, and Baeyens, 2017) showed that almost all (99%) of the 203 surveyed customers of a Dutch online vape shop had a history of smoking before they had started using an e-cigarette. Almost all were daily vapers who used on average 20 mL e-liquid per week, with an average nicotine concentration of 10 mg/mL. In the current study, we wanted to investigate certain evolutions with regard to technical aspects of vaping behaviour, such as wattage, the volume of e-liquid used and nicotine concentration. In recent years, much more powerful devices have become widely available, e-liquids with very low nicotine concentrations have become the rule rather than the exception in the market supply, and the legislation has been adjusted, including a restriction on maximum nicotine concentrations to 20 mg/mL. (2) Methods: Customers (n = 150) from the same Dutch online vape shop were contacted (to allow a historical comparison), as well as 274 visitors from the Facebook group “Belgian Vape Bond” to compare between groups from two different geographies and/or vaping cultures. (3) Results: Most results were in line with earlier findings: Almost all surveyed vapers were (ex-)smokers, had started (80%) vaping to quit smoking and reported similar positive effects of having switched from smoking to vaping (e.g. improved health). A striking observation, however, was that whereas customers of the Dutch online vape shop used e-liquids with a similar nicotine concentration as that observed previously, the Belgian vapers used e-liquids with a significantly lower nicotine concentration but consumed much more of it. The resulting intake of the total quantity of nicotine did not differ between groups. (4) Conclusions: Among vapers, different vaping typologies may exist, depending on subcultural and/or geographic parameters. As a consequence of choosing low nicotine concentrations and consuming more e-liquid, the Belgian vapers may have a greater potential to expose themselves to larger quantities of harmful or potentially harmful constituents (HPHCs) released during vaping., SCOPUS: ar.j, info:eu-repo/semantics/published

Nucleotides play a role in inflammation processes: cAMP and cGMP in the endothelial barrier function, ADP in platelet aggregation, ATP and UTP in vasodilatation and/or vasoconstriction of blood vessels, UDP in macrophages activation. The aim of this study is to develop and validate a LC/MS-MS method able to quantify simultaneously nine nucleotides (AMP, cAMP, ADP, ATP, GMP, cGMP, UMP, UDP and UTP) in biological matrixes (cells and plasma). The method we developed, has lower LOQ's than others and has the main advantage to quantify all nucleotides within one single injection in less than 10 min. The measured nucleotides concentrations obtained with this method are similar to those obtained with assay kits commercially available. Analysis of plasma and red blood cells from healthy donors permits to estimate the physiological concentration of those nucleotides in human plasma and red blood cells, such information being poorly available in the literature. Furthermore, the protocol presented in this paper allowed us to observe that AMP, ADP, ATP concentrations are modified in human red blood cells and plasma after a venous stasis of 4 min compared to physiological blood circulation. Therefore, this specific method enables future studies on nucleotides implications in chronic inflammatory diseases but also in other pathologies where nucleotides are implicated in., SCOPUS: ar.j, info:eu-repo/semantics/published

To the Editor:More than 5% of adults in the United States are current electroniccigarette (e-cigarette) users (1). The liquid vehicles that arevaporized in e-cigarettes are propylene glycol and glycerol. Regulare-cigarette users buy last-generation devices delivering a highenergy level to low coil resistance (subohm vaping). High-energysettings are used to increase heat and vapor production, to enhancethe throat and nicotine hits, while nicotine concentration in thee-liquid is reduced (2, 3). E-cigarettes with high output wattageincrease the quantity of e-liquid consumed per puff and producevolatile carbonyls by thermal degradation (3). Daily exposures tolarge amounts of high-temperature propylene glycol/glycerolaerosol may present a hazard to health. The preliminary resultspresented here are a part of a larger in-depth, placebo-controlled,randomized, crossover, and single-blinded study on thecardiorespiratory effects of e-cigarettes. We present here the mainhypothesis tested, namely, that acute vaporization of a propyleneglycol and glycerol mix (50:50), under intense use conditions, alterslung and skin microvascular functions via an oxidative stresspathway (ClinicalTrials.gov identifier: NCT03036644) [...]

Objective:Tobacco smoking enhances cardiovascular (CV) risk in hypertensive patients. Whether smoking cessation by means of electronic-cigarette (e-cigarette) is advisable in such patients is unsettled. Propylene glycol (PG) and glycerol (GLY) are e-cigarette vehicles allowing liquid vaporization an

An asymptomatic 31-year-old woman underwent transthoracic echocardiography (TTE) in the setting of a routine cardiological check-up in another hospital. A 4 × 7.9 cm cavity appended to the right at...

Background Whereas high wattage electronic cigarettes (e-cigarettes) vaping (V) is increasingly popular, its health effects are largely unknown. We tested the hypothesis that pure propylene glycol/glycerol e-liquid vehicles V decreases arterial oxygen partial pressure in heavy tobacco smokers suspected of coronary artery disease. Methods After their coronary angiogram, twenty tobacco smokers participated in an open-label randomized parallel study; serial intra-arterial blood samples were performed before and after 1-gram propylene glycol/glycerol e-cigarette V at 60 Watts (N = 10) or sham-vaping (SV) (N = 10). Peripheral pulse oximetry, transcutaneous gas tension and microcirculatory blood flow were also assessed throughout the experimental sessions. Results Eighty % of the patients were hypertensive and 60% had a left ventricular ejection fraction – Δ-arterial oxygen partial pressure (SV: + 5.4 ± 3.3 mmHg vs. V: − 5.4 ± 1.9 mmHg; P = 0.012) (difference between groups; 10.8 [95%CI, 8.4–13.2]mmHg); – Δ-arterial oxygen saturation (SV: + 0.9 ± 0.6% vs. V: − 0.8 ± 0.3%; P = 0.023); – Δ-oxyhemoglobin fraction (SV: + 1 ± 0.5% vs. V: − 0.6 ± 0.3%; P = 0.028); – Δ-peripheral oxygen saturation (SV: + 1.3 ± 0.4% vs. V: − 1.3 ± 0.5%; P – Δ-transcutaneous oxygen partial pressure (SV: + 6 ± 3.4 mmHg vs. V: − 1.2 ± 2.1 mmHg; P = 0.041). The decrease in Δ-peripheral oxygen saturation (SV: + 0.7 ± 0.6% vs. V: − 0.7 ± 0.5%; P = 0.036) persisted up to 20 minutes after V compared to SV. Conclusions Acute high wattage e-cigarette V in smokers with heart disease induces arterial hypoxemia with subsequent tissue hypoxia. The latter could be related to ventilation/perfusion mismatches.

We report here the case of a patient with perindopril intoxication inducing severe bradycardia together with a profound hypotension. Initiation of a naloxone infusion completely resolved those symptoms. As a consequence, we could recommend as a first step the use of naloxone in order to prevent the use of more invasive therapeutic tools.

In 1985, we observed the case of a coronary arteriovenous fistula (CAVF) between left circumflex artery and coronary sinus diagnosed for the first time by nuclear magnetic resonance ( Figure 1 A ). This healthy 21 year-old male had presented to our hospital for evaluation of a systolo-diastolic murmur. Transthoracic echocardiography had revealed dilation of both left circumflex artery (15 mm in maximum diameter) and coronary sinus. On colour Doppler examination, a continuous turbulent flow was seen in …

A 70-year-old man was admitted for heart failure and fast atrial fibrillation (average ventricular rate 140 bpm) and was referred for transoesophageal echocardiography before cardioversion. Left ventricular ejection fraction was 45%. Two-dimensional colour (83°, Panel A , Supplementary data online, Video S1 ) and colour-M-mode ( Panel B ) transoesophageal echocardiography demonstrated intermittent and …

Introduction. Propylene glycol (PG) and glycerol (GLY) are the carriers vaporized in electronic cigarette (e-cigarette). Patients with coronary artery disease (CAD) frequently use e-cigarettes as a step to quit tobacco smoking. We demonstrated that e-cigarette vaping induces sustained tissue hypoxia

Objective:The new generation of electronic cigarettes (e-cigarettes) deliver high energy to heat the carriers allowing vaporization process, mainly composed of propylene glycol (PG) and glycerol (GLY). At high temperature, PG and GLY undergo combustion instead of vaporization, and produce volatile c

In contrast to angiotensin receptor blockers (ARBs), mainly excreted by the liver, the dosage of angiotensin-converting enzyme (ACE) inhibitors, cleared by the kidney, must be adapted to account for renal clearance in patients with chronic kidney disease (CKD) to avoid acute kidney injury (AKI). Community-acquired AKI and the use of ACE inhibitors or ARBs in the emergency department were retrospectively assessed in 324 patients with baseline stage 3 or higher CKD. After stepwise regression analysis, the use of ACE inhibitors (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.1-3.1; P=.02) and the presence of dehydration (OR, 30.8; 95% CI, 3.9-239.1) were associated with AKI. A total of 45% of patients using ACE inhibitors experienced overdosing, which causes most of the excess risk of AKI. These results suggest that dosage adjustment of ACE inhibitors to renal function or substitution of ACE inhibitors with ARBs could reduce the incidence of AKI. Moreover, ACE inhibitors and ARBs should be stopped in cases of dehydration.

Background. Although numerous risk factors for delayed graft function (DGF) have been identified, the role of ischemia-reperfusion injury and acute rejection episodes (ARE) occurring during the DGF period is ill-defined and DGF impact on patient and graft outcome remains controversial. Methods. From 1983 to 2014, 1784 kidney-only transplantations from deceased donors were studied. Classical risk factors for DGF along with two novel ones, recipient's perioperative saline loading and residual diuresis, were analyzed by logistic regression and receiver operating characteristic (ROC) curves. Results. Along with other risk factors, absence of perioperative saline loading increases acute rejection incidence (OR = 1.9 [1.2-2.9]). Moreover, we observed two novel risk factors for DGF: patient's residual diuresis ≤500 mL/d (OR = 2.3 [1.6-3.5]) and absence of perioperative saline loading (OR = 3.3 [2.0-5.4]). Area under the curve of the ROC curve (0.77 [0.74-0.81]) shows an excellent discriminant power of our model, irrespective of rejection. DGF does not influence patient survival (P = 0.54). However, graft survival is decreased only when rejection was associated with DGF (P < 0.001). Conclusions. Perioperative saline loading efficiently prevents ischemia-reperfusion injury, which is the predominant factor inducing DGF. DGF per se has no influence on patient and graft outcome. Its incidence is currently close to 5% in our centre., info:eu-repo/semantics/published