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Renal Impairment
Diabetes mellitus is the leading cause of kidney failure and reportedly accounted for 44 of new cases in 2002, according to estimates from the Centers for Disease Control and Prevention (CDC). See below for related articles on the association between renal impairment and diabetes.
Management and Treatment of Renal Impairment in Elderly Patients with Diabetes
Management and Treatment of Renal Impairment in Elderly Patients with Diabetes Management and Treatment of Renal Impairment in Elderly Patients with Diabetes Catherine S. Vinen, MRCP, and Hugh S. Cairns, MD, FRCP Click here to download full article in PDF From the Renal Unit, King? 30 Renal function in patients with diabetes can also deteriorate rapidly due to urinary tract infection or obstruction, both of which must be excluded or treated in the patient with diabetes. Prescribing Drugs in ...
Featured Content from Clinical Geriatrics
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Thrombosis Management: Long-Term Care Perspective
Thrombosis Management: Long-Term Care Perspective Thrombosis Management: Long-Term Care Perspective Laurie G. Jacobs, MD, Edith Nutescu, PharmD, and David A. Smith, MD, FAAFP, CMD Download Article PDF Thrombosis Management: Long-Term Care Perspective Laurie G. Jacobs, MD, Edith Nutescu, PharmD, and David A. Smith, MD, FAAFP, CMD The Annual Meeting of the American Medical Directors Association was held March 6-9, 2003, in Orlando, Florida. The reduction in relative risk is 58% in patients ...
Featured Content from Annals of Long-Term Care
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Thrombosis Management: Long-Term Care Perspective
Thrombosis Management: Long-Term Care Perspective Thrombosis Management: Long-Term Care Perspective Laurie G. Jacobs, MD, Edith Nutescu, PharmD, and David A. Smith, MD, FAAFP, CMD Thrombosis Management: Long-Term Care Perspective Laurie G. Jacobs, MD, Edith Nutescu, PharmD, and David A. Smith, MD, FAAFP, CMD The Annual Meeting of the American Medical Directors Association was held March 6-9, 2003, in Orlando, Florida. The reduction in relative risk is 58% in patients treated with LMWH and 56...
Featured Content from Annals of Long-Term Care
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Nephrogenic Systemic Fibrosis: A Devastating Complication of Gadolinium in Patients with Severe Renal Impairment
1Mark A. Perazella, MD and 2Roger A. Rodby, MD "> Nephrogenic Systemic Fibrosis: A Devastating Complication of Gadolinium in Patients with Severe Renal Impairment Clinical Review: Nephrogenic Systemic Fibrosis: A Devastating Complication of Gadolinium in Patients with Severe Renal Impairment - 1Mark A. Perazella, MD and 2Roger A. Rodby, MD Physicians are constantly introduced to new diagnostic and therapeutic modalities developed to enhance patient care. 8 Gadolinium exposure in these ...
Featured Content from Vascular Disease Management
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Effects of Global Renal Artery Stenting on Chronic Renal Failure
Background. The efficacy of renal artery stenting (RAS) in preserving renal function (RF) is controversial. This prospective study examines the effects of RAS in patients with global renal stenosis and chronic renal insufficiency. Methods. Successful RAS was performed in 30 patients with renal impairment (creatinine > 1.5 mg/dL) and global atherosclerotic obstruction (bilateral artery stenosis or unilateral stenosis in the presence of a solitary or single functional kidney). To assess a significant change of RF, we compared the slopes of the regression lines derived from the reciprocal of creatinine versus time, and plotted before and after stent deployment. We also evaluated changes in renal length and interlobar resistive index (RI). Results. Before stenting, all patients showed a negative slope, indicating progression of renal failure. During a median follow-up of 24 months, the slope mean became positive (pre -0.0249 ± 0.0527 versus post 0.0050 ± 0.0194 dL · mg-1 · month-1, p < 0.009). Ten patients (33.3%) showed a significant positive slope, indicating improvement of RF; in 13 patients (43.3%) slopes were not significantly different from zero and were associated with a stable RF. Seven patients (23.3%) presented negative slopes and showed a persistent decrease of RF. A low baseline creatinine was associated with positive outcome (p = 0.05), while patients with negative slopes showed a decrease in kidney size (p < 0.02). Pre-stent RI was not related to the outcome. Conclusions. In the majority of patients with chronic renal failure and global obstructive renovascular disease, RAS appears to be associated with improvement or stabilization of impaired RF.
Featured Content from Vascular Disease Management
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Management of Chronic Heart Failure in the Elderly Patient
Management of Chronic Heart Failure in the Elderly Patient Management of Chronic Heart Failure in the Elderly Patient Danny Liew, BMedSc, MBBS, and Henry Krum, MBBS, FRACP, PhD From the Clinical Pharmacology Unit, Department of Epidemiology and Preventive Medicine, Monash Medical School, Alfred Hospital, Prahran, Victoria, Australia. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure: U.S. Carvedilol Heart Failure Study Group. Effect of the ...
Featured Content from Clinical Geriatrics
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Current Clinical Applications of Bivalirudin: An Overview
Bivalirudin is a specific and reversible direct thrombin inhibitor with predictable anticoagulation. It is cleared by both proteolytic cleavage and renal mechanisms. Bivalirudin with provisional glycoprotein (GP) IIb/IIIa inhibition is indicated in elective contemporary percutaneous coronary interventions (PCI). It has been shown to be non-inferior to unfractionated heparin and planned GP IIb/IIIa inhibitors during PCI for the ischemic and hemorrhagic combined endpoints of death, myocardial infarction, unplanned urgent revascularization and major bleeding, including subgroups of patients with renal impairment and diabetes. In addition, bivalirudin has consistently been shown to have significantly less in-hospital major bleeding than heparin alone or heparin-GP IIb/IIIa inhibitor combination, and appears to be safe and effective in patients with heparin-induced thrombocytopenia and undergoing PCI. The role of bivalirudin in high-risk acute coronary syndrome patients is currently being tested in the Acute Catheterization and Urgent Intervention Triage StrategY (ACUITY) trial. Finally, data from peripheral percutaneous interventions also support the hypothesis that bivalirudin is safe and effective, but direct randomized comparison with unfractionated heparin is lacking.
Featured Content from Vascular Disease Management
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Atherosclerotic Vascular Disease and Diabetes in the Older Adult Part II: Rationale and Strategies for Multi-Interventional Treatment
Part II of this article summarizes treatment guidelines designed to reduce risk and prevent progression of ASVD, and suggests recommendations for their applicability in the older adult population with diabetes. Insulin-Dependent Diabetes Mellitus (STOP-NIDDM) trial, acarbose was shown to reduce the risk for MI, major CVD, and hypertension.30 Insulin When hyperglycemia is inadequately controlled on oral agents, insulin therapy is indicated regardless of age. SUMMARY Given that diabetes-...
Featured Content from Clinical Geriatrics
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Renal Considerations in the Older Hypertensive Patient
Renal Considerations in the Older Hypertensive Patient Renal Considerations in the Older Hypertensive Patient James V. Felicetta, M.D. Renal function declines very predictably with advancing age in both men and women. Rosansky et al also reached the conclusion that hypertensive patients without clinically evident renal dysfunction will nonetheless experience a greater reduction in renal function over time than will subjects with normal blood pressure. Blood pressure control, proteinuria, ...
Featured Content from Clinical Geriatrics
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Efficacy of New Drug Therapies for Diabetes in the Elderly
Oral Agents for the Treatment of Type 2 Diabetes The Table lists the categories of drugs available to treat type 2 diabetes. Glimepiride has a marked insulin secretory effect, both in vitro and in vivo, increasing plasma insulin levels by as much as 50% in patients with type 2 diabetes. Effect of repaglinide addition to metformin monotherapy on glycemic control in patients with type 2 diabetes.
Featured Content from Annals of Long-Term Care
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