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Biomedical subjects

Ali A Haydar

Publications and source records attributed to Ali A Haydar.

At least 19 recordsLinked to original sources
PubMed2004

Coronary artery calcification is related to coronary atherosclerosis in chronic renal disease patients: a study comparing EBCT-generated coronary artery calcium scores and coronary angiography.

BACKGROUND: Coronary artery calcification (CAC) measured by electron beam computed tomography (EBCT) correlates with plaque burden, vessel stenosis and is predictive of future cardiac events in the general population. Extensive CAC has been described recently in dialysis cohorts. For the first time we studied the relationship between CAC and coronary angiographic findings in patients with chronic renal failure, on dialysis and after renal transplantation. METHODS: We studied 46 patients who all had an EBCT-derived Agatston coronary calcium score and a diagnostic coronary angiogram within a 12-month period. The mean age was 55.7+/-13.2 (SD) years (range 29-80). The mean duration of dialysis was 54.4 months (range 1-372). RESULTS: The mean CAC was 2370+/-352.8. The mean CAC in patients with an abnormal coronary angiogram (n = 35) was 2869.6+/-417.9, while that in patients with a normal coronary angiogram (n = 11) was 559.4+/-255.1 (P = 0.001 for the inter-mean comparison). Total CAC correlated with the number of diseased vessels (P = 0.0001) and with severity of atherosclerosis in all the vessels (P = 0.0001). The individual coronary artery calcification score correlated well with the severity of atherosclerotic coronary disease (P<0.0001 for all) in the left anterior descending, right coronary and circumflex arteries. Running a multivariate regression analysis for atherosclerosis burden, we found that the only predictor was CAC (r = 0.34, P = 0.0001). CONCLUSION: CAC is common and more severe in patients with chronic kidney disease. Although in chronic kidney disease patients CAC can occur in the absence of occlusive coronary atherosclerosis, our data suggest that, as in the general population, CAC in chronic kidney disease patients is associated with obstructive atherosclerosis and may therefore be associated with a worse outcome.

Adult↗
PubMed2004

Insights from ambulatory blood pressure monitoring: diagnosis of hypertension and diurnal blood pressure in renal transplant recipients.

BACKGROUND: Accurate diagnosis of hypertension is essential in chronic kidney disease patients, as it is linked to increased left ventricular mass, stroke, cardiovascular mortality and morbidity, and progression to end-stage renal disease. Elevated blood pressure (BP) detected by ambulatory BP monitoring (ABPM) has been shown to be predictive of worse outcome in chronic kidney disease patients. Another predictor of worse outcome is diurnal BP variation, measured also by ABPM. In this study, the authors examined the relationship (concordance or discordance) between blood pressure measured by ABPM compared with daytime office BP, and also explored the predictors of diurnal variation in renal transplant recipients. METHODS: All the patients who underwent renal transplantation and follow-up at the authors' institution from January 1998 to January 2003 were involved in this study (n=177) in addition to another randomly selected 64 patients that underwent transplantation before 1998. All patients had their ABPM performed according to previously described protocols at least 2 weeks after discharge from the hospital, dialysis-independent and with a functioning renal allograft. RESULTS: The authors found a positive correlation between systolic BP (SBP) diurnal variation and age (r =0.263, P <0.0001), glomerular filtration rate (GFR) (r =-0.229, P <0.0001), cyclosporine trough (r =0.171, P =0.047), and ABPM-to-transplant interval (r =-0.133, P =0.039). After fitting a regression model, the authors found that only GFR (P <0.0001) and age (P =0.001) were independent predictors of SBP diurnal variation (r =0.357). Concordance rate between casual BP and ABPM was 80%, and by using casual BP, only 15% of hypertensive renal transplant patients would be erroneously diagnosed as normotensive. CONCLUSIONS: The authors found that SBP diurnal variation is predicted independently by age and GFR, although it does correlate with cyclosporine trough and ABPM-to-transplant interval. In addition, the authors showed that ABPM is a more sensitive method for diagnosing hypertension than is sole reliance on office BP in renal transplant recipients.

Blood Pressure Monitoring, Ambulatory↗
PubMed2004

Sirolimus-induced pneumonitis: three cases and a review of the literature.

Interstitial pneumonitis is a rare disease that is seen in the context of some infections (e.g. PCP and CMV pneumonia), as side-effects of drugs (e.g. beta-blockers, amiodarone) and rarely in the context of renal transplantation. It manifests itself usually as a pneumonic illness; with symptoms of dyspnea, cough, fatigue and sometimes fever. Characteristic radiological changes are bilateral lower zone haziness. Interstitial pneumonitis is now emerging in solid organ transplant patients secondary to sirolimus). We describe three cases of sirolimus-induced pneumonitis in two patients who started sirolimus to permit cyclosporin withdrawal and in one patient initially started on sirolimus. The presentations in these cases ranged from insidious to fulminant; there was a rapid response to sirolimus withdrawal. This is an important syndrome, with an unknown frequency.

Aged↗
PubMed2004

Systolic blood pressure diurnal variation is not a predictor of renal target organ damage in kidney transplant recipients.

Elevated blood pressure and diurnal blood pressure variation detected by ambulatory blood pressure monitoring has been shown to be predictive of worse outcome in end-stage renal disease patients in small studies. What has been lacking is a large study to determine whether these ambulatory blood pressure monitoring (ABPM)-derived variables are predictors of worse outcome in renal transplant recipients. All the patients that underwent renal transplantation and follow up at this institution from January 1998 till October 2002 were involved in this study (n=177). All patients were followed up for at least 48 weeks. Last creatinine correlated positively with duration of dialysis (p=0.035, r=0.158), kidney-donor age (p<0.0001, r=0.377), early kidney function (p<0.0001, r=0.610, r=0.683), 24-h systolic blood pressure (SBP) load (p=0.002, r=0.228), and ABPM-derived pulse pressure (p<0.0001, r=0.269). However neither office blood pressure nor SBP diurnal variation were predictors of kidney outcome. Regression analysis showed that early kidney function was the only independent predictor of transplant outcome (p<0.0001). Systolic blood pressure diurnal variation, though an important predictor of target organ damage in chronic kidney disease patients, was not a predictor of renal transplant function in renal transplant recipients. Only early kidney function was an independent predictor of later serum creatinine.

Adult↗
PubMed2004

Waldenström's macroglobulinaemia presenting as isolated epistaxis: a common complaint but a rare cause.

A patient with isolated severe epistaxis and non-specific history or examination findings was shown to have anaemia, raised erythrocyte sedimentation rate (ESR), renal impairment and raised total protein with hypercoagulable blood. Waldenstrom's macroglobulinaemia was diagnosed after serum electrophoresis and bone marrow studies. Urgent plasma exchange and chemotherapy were undertaken to good effect. This case was a diagnostic dilemma, as the presentation of this common complaint did not initially suggest the rare underlying cause.

Aged↗
PubMed2004

Coronary artery calcification and aortic pulse wave velocity in chronic kidney disease patients.

BACKGROUND: Patients with end-stage renal disease (ESRD) are at increased risk of cardiovascular mortality and morbidity. Many complications arise in ESRD patients as a result of the twin arterial pathologies of atherosclerosis and arteriosclerosis. Part of this latter process is calcification of the arterial media, which is thought significantly to increase vascular stiffness. The aim of our study was to explore the relationship between measures of arterial stiffness-pulse wave velocity (PWV)-and the extent of calcification in the coronary arteries (CAC). METHODS: Over a period of 2 years 82 patients from our renal unit were invited to participate in our study. Sixty-two patients agreed to undergo electron beam computerized tomography (EBCT), and in 55 (38 males and 17 females), PWV measurements were made. EBCT and PWV measurements were done according to previously described protocols. RESULTS: The mean age of the 55 patients was 56.4 years. The mean duration of dialysis was 65.4 months, and the mean CAC score was 2551. The mean PWV was 9.13 m/s. PWV strongly correlated with total CAC even after correction for age, dialysis duration, and time averaged C-reactive protein (CRP) (P= 0.0001). CAC scores were significantly different when compared according to PWV tertiles (P= 0.0001). CONCLUSION: We have demonstrated that PWV is strongly related to the degree of EBCT-derived coronary artery calcium score in chronic kidney disease patients.

Adult↗
PubMed2004

Measuring blood pressure in stable renal transplant recipients: what you measure depends on what you use.

BACKGROUND: Blood pressure levels have a major impact on cardiovascular and renal transplant outcomes after renal transplantation. But there are significant challenges to accurately measure blood pressure levels in stable healthy renal transplant outpatients. We aimed to test whether there are differences in BP measurements taken using either automated oscillometric machines or a random zero sphygmomanometer. METHODS: Blood pressure was recorded twice in a random order with each of three BP measuring devices (DINAMAP BP8800; OMRON HEM 713 and a Random-Zero Hawskley sphygmomanometer). Results were analysed to determine observer bias, cardiovascular artefacts, and intra- and inter-machine BP variation. RESULTS AND CONCLUSIONS: There was no significant observer bias or cardiovascular artefacts. Intra-machine variability was small. BP measurement using DINAMAP and OMRON could lead to a difference of up to 30 mm Hg higher or 15 mm Hg lower than Hawskley random zero BP readings. Though widely used for 'convenience', oscillometric measures of BP in the renal transplant clinic are not optimal.

Adult↗
PubMed2003

Recent insights from studies using ambulatory blood pressure monitoring in patients with renal disease.

PURPOSE OF REVIEW: To identify and evaluate recent (2000-2003) published studies employing ambulatory blood pressure monitoring in patients with chronic renal failure, on dialysis, and after renal transplantation. RECENT FINDINGS: We discuss several studies that have employed ambulatory blood pressure monitoring to refine the analysis of the link between blood pressure levels, and diurnal alterations, and end-organ damage or patient survival. There is now some evidence that an abnormal diurnal blood pressure profile, although intrinsically not a very reproducible label, has predictive value for patient survival, and that the non-dipping phenomenon is linked to a high incidence of cardiovascular disease and autonomic dysfunction. SUMMARY: Ambulatory blood pressure monitoring remains an important adjunct to the comprehensive cardiovascular evaluation of patients with chronic, end-stage renal failure or after renal transplantation.

Blood Pressure Monitoring, Ambulatory↗
PubMedDate not supplied

Ambulatory blood pressure monitoring in hemodialysis patients: a critique and literature review.

Ambulatory blood pressure (ABP) monitoring has been in use for nearly four decades. In that time, the advantages of using a more reproducible and accurate method to assess the true contribution of blood pressure to the cardiovascular risk profile of patients have steadily become more clearly established, balanced by the additional expense and expertise involved. In nephrology, and in particular in dialysis patients, there are significant difficulties in accurately registering truly representative blood pressure values and understanding the relationship between blood pressure, end-organ damage, and patient mortality. This arises because of the way in which hemodialysis acutely changes blood pressure values as well as the widespread abnormality of diurnal blood pressure rhythm seen in dialysis patients. Use of ABP monitoring can go some way to overcoming these obstacles. In this review we critically examine the use of ABP monitoring in the understanding of blood pressure control in dialysis patients.

Blood Pressure↗
PubMedDate not supplied

The role of inflammation in acute coronary syndromes: review of the literature.

Extensive evidence supports a pathogenic role for both local and systemic inflammation in acute coronary syndrome (ACS). The determination of inflammatory markers levels in combination with the new imaging modalities can be used to identify patients at high risk of future cardiovascular events. Interestingly, this inflammatory component is a novel therapeutic target in ACS.

Angina, Unstable↗