RESUMEN
BACKGROUND: It is unclear whether short-term blood pressure variability (BPV) is associated with target organ damage in patients with non-dialysis chronic kidney disease (CKD). METHODS: A cross-sectional, single-center study was conducted among 3442 non-dialysis CKD patients hospitalized in the department of Nephrology of the Fifth Affiliated Hospital of Sun Yat-sen University from November 2017 to July 2022 and collected the demographic, laboratory, clinic blood pressure, ambulatory blood pressure data, and short-term BPV assessed by the weighted standard deviation (wSD) derived from ambulatory blood pressure monitoring (ABPM). Multivariate logistic analyses were used to evaluate the independent effects between short-term BPV and subclinical target organ damage, including left ventricular hypertrophy (LVH), abnormal carotid intima-media thickness (CIMT), low estimated glomerular filtration rate (eGFR), and albuminuria. RESULTS: The average age of the participants was 47.53 ± 14.06 years and 56% of participants were male. The baseline eGFR was 69 mL/min/1.73 m2. Based on the tertile distribution of wSD according to equal numbers, patients were divided into three categories with T1(< 9.66 mmHg), T2(9.66-12.23 mmHg), and T3(> 12.23 mmHg) of SBPV; T1(< 8.17 mmHg), T2(8.17-9.93 mmHg), and T3(> 9.93 mmHg) of DBPV. The participants with the higher wSD group had a higher prevalence of target organ damage than their counterparts (P-trend < 0.05). An increasing trend in short-term variability was present with advancing CKD stages (P-trend < 0.001). Multivariate logistic analyses results showed that the odds ratio (OR) of SBP wSD was (1.07 [1.03,1.11], P < 0.001) for LVH, (1.04 [1.01,1.07, P = 0.029) for abnormal CIMT, (1.05 [1.02,1.08], P = 0.002) for low eGFR, and (1.06 [1.02,1.09], P = 0.002) for albuminuria; The OR of DBP wSD was (1.07 [1.02,1.12], P = 0.005) for LVH, (1.05 [1.01,1.09], P = 0.028) for abnormal CIMT, (1.05 [1.01,1.09], P = 0.022) for low eGFR, and (1.05 [1.01,1.10], P = 0.025) for albuminuria when adjusted for confounding factors and mean BP. CONCLUSIONS: In conclusion, short-term BPV is associated with target organ damage, and irresponsible of average blood pressure levels, in Chinese non-dialysis CKD participants.
Asunto(s)
Hipertensión , Insuficiencia Renal Crónica , Humanos , Masculino , Adulto , Persona de Mediana Edad , Femenino , Presión Sanguínea , Hipertensión/complicaciones , Monitoreo Ambulatorio de la Presión Arterial , Albuminuria/epidemiología , Albuminuria/complicaciones , Estudios Transversales , Grosor Intima-Media Carotídeo , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/epidemiología , Hipertrofia Ventricular Izquierda/complicacionesRESUMEN
BACKGROUND: Hospitalized patients on maintenance hemodialysis often develop pleural effusion (PE). The prognosis of these patients is likely to be affected by the PE. This study examined the characteristics of PE, identified risk factors for its development, and explored its negative effects. METHODS: In this retrospective study, we analyzed medical records of 1,077 patients who underwent maintenance hemodialysis between October 2014 and January 2022. According to the chest computed tomography (CT) imaging results, patients were categorized into two groups: PE and non-PE. A definitive diagnosis of PE was made after a nephrologist, a pulmonary physician, and a radiologist reviewed the case. RESULTS: Of the 1,077 patients, 343 (31.85%) were diagnosed with PE. These patients had a mean age of 55.28±15.21 years old and 61.47% of them were men. There were 77.84% patients with PE resulting from heart failure, and 82.02% of these patients had bilateral effusions. The occurrence of PE was associated with cardiovascular disease, clinic-systolic blood pressure (SBP), chest tightness, leg edema, and pro-brain natriuretic peptide (pro-BNP). PE patients had a poorer survival rate than patients without PE (unadjusted hazard ratio [HR]: 4.17; 95% CI: 3.12-5.57). The survival rates of patients with small PE did not differ from those with moderate to large PE. Similarly, no difference was found in survival between the bilateral PE and unilateral PE groups, as well as between the heart failure and non-heart failure groups. CONCLUSIONS: Hospitalized patients undergoing maintenance hemodialysis have a high incidence of PE. PE (even a small amount) is an risk factor for increased mortality. These poor prognostic features should be noted by physicians and managed accordingly.
RESUMEN
The Internet of Health Things (IoHT), which is an extension of the Internet of Things (IoT) in healthcare, has provided a new type of telemedicine approach. In IoHT, wearable sensors are used to collect patient health data, and information is transmitted remotely to doctors who can develop accurate treatment plans and provide timely telemedicine services to patients. However, patient health data are transmitted over a public channel, which means that the privacy and medical data of patients are at significant risk of leakage and can be confronted by serious security problems. We proposed a lightweight authentication protocol known as LAP-IoHT for IoHT environments to overcome the various threats that are currently faced by IoHT. We verified the security of LAP-IoHT using a Real-or-Random model and demonstrated its significant performance advantage by conducting a comparative analysis with other similar protocols for a better adaptation to the IoHT environment.