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According to the 2007 National Health Interview survey, fish oil is the most popular dietary supplement used by adult Americans (
Clinicians are trained to review prescription drugs with patients during their clinic visits and hospital admissions. However, less emphasis is placed on appropriate review and documentation of foods and nutrients that are known or suspected to interact with medications. This scenario places kidney disease patients at significant risk, given the 10 to 12 different medications that are typically prescribed (
Phosphorus levels are elevated in patients with chronic kidney disease due to decreased urinary excretion. Higher levels of blood phosphorus are associated with increased mortality in patients on dialysis, patients with kidney disease not yet on dialysis, and in the general population. In animal studies, adding phosphorus to the diet causes calcification of arteries and progression of kidney disease.
In the petri dish in the lab, adding phosphorus to artery vascular smooth muscle cells results in a change of the cell to become a bone-like cell and to calcify. This and other data support the hypothesis that phosphorus is a
Although cardiologists and nephrologists have debated for years about the relative contributions of the vasculature and the kidney to the pathogenesis of hypertension, new data have emerged that may recast essential hypertension as an autoimmune disease. These studies do not discount the importance of vascular tone and regulation of intravascular volume in the determination of blood pressure. Rather, these novel experiments illustrate that immune cells and inflammatory mediators can influence blood pressure precisely by impacting vascular function and renal sodium handling. Moreover, these recent findings have stimulated renewed interest in earlier, pioneering studies that first hinted at a role for
Body sodium content is most intimately coupled with extracellular water content. The idea is that body fluids inside and outside the cells readily equilibrate, resulting in constant electrolyte concentrations in extra- and intracellular fluids. This concept of constancy of internal environment composition is perhaps one of the hallmarks of medical physiology established by Claude Bernard in the 19th century (
Renal denervation is an emerging and promising new therapy for resistant hypertension. Although 54 percent of all hypertension is “uncontrolled” (
In evaluating a patient with resistant hypertension, it’s important to consider reversible
Most people with chronic kidney disease (CKD) have high blood pressure. Treatment of hypertension in patients with CKD is considered critical to prevent CKD progression and related cardiovascular events. However, questions remain about the appropriate BP goal. Most evidence indicates there is no benefit of treating to a goal any lower than 140/90 mm Hg, but there is some suggestion that such a goal may be appropriate for patients with albuminuria. Given recent evidence that a lower goal in patients with diabetes (without CKD) actually increases risk, and the subsequent change in American Diabetes Association guidelines from 130/80 mm Hg
Hypertension is a common condition that is a significant risk factor for development of other cardiovascular diseases. The prevalence of hypertension is higher in men than women until after menopause, when the prevalence reverses and is higher in women. In addition, more women die of cardiovascular disease each year than do men.
There is mounting evidence that blood pressure in women is less well controlled than in age-matched men, despite the facts that women see their physicians more frequently and are often more compliant with their medications than men. This statistic makes one consider that either physicians are not as
In 1995, Ratner, Kavoussi, and colleagues at Johns Hopkins University revolutionized live kidney donor transplantation through the development of the laparoscopic donor nephrectomy (
Transplantation from a living kidney donor provides the best outcomes in recipients with end stage renal disease. However, our knowledge regarding the effects of kidney donation on long-term mental and physical health of the living donor remains incomplete. Published data are largely derived from single-center retrospective studies in young, healthy, and mostly white populations (
We also suffer from a paucity of information on the psychological and socioeconomic consequences of donation, including the long-term health-related quality of life, financial consequences of
