Day 2 :
- Diabetes and Endocrine Complications|CardioMetabolic Syndromes|Diagnosis and Prevention: Diabetes & Heart Diseases|Diabetes & Heart Monitoring Management
Location: Radisson Hotel Narita
Gerald C Hsu
eclaireMD Foundation, USA
Chacon Lozsan F
Caracas University Hospital, Venezuela
Title: Hemodynamic management of high blood pressure
Chacón-Lozsán F, polyglot, graduated as Medical Doctor in UCLA (Venezuela) 2014, Graduated in Critical Care Medicine -"Universidad Central de Venezuela”, University Central Hospital-Caracas, and Master degree Student in Higher Education at the International Iberoamerican University. Scientific activity since 2007 with Rafael Bonfante-Cabarcas MD PhD on Neurochemical and Molecular Pharmacology Laboratory in behavior,cardiac molecular electrophysiopathology and Chaga’s Disease with training in statistics, critical reading and redaction of scientific production, molecular electrophysiology, biochemistry and bioterious management. Student fellow in Cardiology (2010-2012) with Bartolomé Finizola MD PhD FACC in the Cardiovascular Association ASCARDIO; in medical and surgical emergencies (2010-2012) with Dr. Ruy Dario Medina in the University Central Hospital Antonio Maria Pineda.
Background: Hypertension is an important risk factor for cardiovascular events, stroke and kidney disease, optimal hypertension control still a controversial subject in medical literature, several studies proposed the hypertension control calculating hemodynamic parameters.
Materials and Methods: In the present study we recruited 84 patients’ males (34%) and females (49%) between 32 and 95 years of age with non-controlled hypertension taken 2 or more medications and measured heart rate (HR), systolic (SBP), diastolic (DBP) andmean (MAP) blood pressure, pulse pressure (PP), cardiac index (CI) using Liljestrand & Zander modified formula to calculate stroke volume (CI = [HR*(PP/MAP)]/Body surface area), central venous pressure (CVP) using inferior vena cava diameter (IVCD), systemicvascular resistance index (SVRi = MAP/CI*80) and divided in six hemodynamic groups Hyperdynamics (Hd) were those with CI > 3,5L/min/m2, High Resistance (Hr) group when SVRi > 2500 dynas, Fluid overload (FO) when CVP > 8 cm H2O or IVCD > 2 cm and mixed types, Hd + Hr, Hd + FO and Hr + FO, a basal values was measured after 1 week washout with captopril, after washout treatment was selected according hemodynamic groups with a 6 months follow up.
Results: We found a statistical significant reduction of all parameters at the first month after treatment and hypertension control according European of Society Cardiology guidelines in 100% of patients at 3rd month of treatment with hemodynamic normalization, only Hd + FO at 6th month, with no symptomatic hypotension.
Conclusion: Hemodynamic guided treatment to control high blood pressure had good results in this study; however, bigger trials are needed to prove his efficacy.
Alexandria University, Egypt
Title: Level of Human Kidney Injury Molecule-1 (Kim-1) as an early marker for Diabetic Nephropathy in Egyptian Type 2 diabetic patients
Professor EL-Attar HA has completed MBBch in 11/1979 from Faculty of Medicine, University of Alexandria, MS in Chemical Pathology in 4/1987 and MD in Chemical Pathology in 4/2001 from Medical Research Institute. Assistant Professor in Chemical Pathology in 28/8/2006 and Professor in Chemical Pathology since30/8/2011 in Medical Research Institute. Alexandria University, Egypt.
Background: Human Kidney Injury Molecule-1 (KIM-1) is produced in the affected segments of the proximal renal tubule whenever there is a pathophysiological state resulting in dedifferentiation of the epithelium. The kidney injury molecule-1 is a type 1 transmembrane glycoprotein (339 aa). KIM-1 ectodomain is cleaved and shed in a metalloproteinase-dependent fashion. The soluble KIM-1 protein that appears in the urine of humans is about 90 KDa. All forms of chronic kidney disease, including diabetes, are associated with tubulo-interstitial injury. Aim: The current study was performed try to assess use of urinary KIM-1/Creatinine ratio as a sensitive diagnostic tool for renal injury in the urine of patients with type 2 diabetic Egyptian patients. Methods: Eighty subjects were subjected to clinical examination included and subdivided as 20 apparently healthy control volunteers (group I) and 60 diabetic patients which were divided into 3 subgroups (Group II, Group III and Group IV) of 20 patients each: according to ACR: (ACR<30 mg/g, 30 – 299 mg/g and ≥ 300 mg/g respectively). All were subjected to laboratory investigations which included: Morning mid-stream urine sample for: 1) Complete urine analysis. 2) Quantitative measurement of urinary albumin. 3) Urinary creatinine. 4) Calculation of urinary albumin to creatinine ratio. 5) Measurement of KIM-1 (ELISA) 6) Calculation of KIM-1 to creatinine ratio. Calculation of estimated glomerular filtration rate (eGFR). Estimation of: fasting and post prandial glucose, urea and creatinine serum levels and blood level of glyclated hemoglobin (HbA1c). Results: Urinary KIM-1 levels were increased with the progression of nephropathy. Urinary KIM-1 levels were independent risk factor of (eGFR) and albuminuria in diabetic patients. Urinary KIM-1/Cr ratio was more sensitive than KIM-1. There was no correlation between urinary KIM-1/Cr ratio and GFR in all studied groups. Conclusion: Urinary KIM-1/Cr ratio is a sensitive, noninvasive diagnostic tool for kidney affection in Type 2 diabetic Egyptian patients that seem to predict renal injury in early period independent of albuminuria. Due to lack of correlation, both KIM-1/Cr and Alb/Cr ratios are required to be calculated for Type 2 diabetic patients. Recommendations: The use of KIM-1/Cr ratio as a diagnostic tool for kidney affection by measuring it in urine of Type 2 diabetic patients at risk of chronic kidney disease.
University of Ottawa Heart Institute, Canada
Title: Participation in Prediabetes Education Post Discharge from a Cardiac Institution
Improving glycemic control through lifestyle change in people with prediabetes can help prevent or delay the onset of type 2 diabetes. “Impaired fasting glucose and impaired glucose tolerance are associated with modest increases in the risk for cardiovascular disease” 1. Study done by Diabetes Prevention Program Research Group reveals the importance of early education regarding lifestyle change s will reduce risk of or delay the diagnosis of diabetes 2.
As part of a medical directive to manage dysglycemia at the University of Ottawa Heart Institute (UOHI), all in- patients are screened utilizing HbA1C. Those identified with prediabetes are provided with education material on prediabetes and HbA1c and referred to a community education program closest to client’s preferred location. These patients are also followed post discharge by interactive voice response. An automated voice activated system that cues and coaches people to eat regular meals, promotes physical activity and reminds them of the importance of attending education on prediabetes. The hospital has been referring people to several community programs over the last two years.
To find out whether or not people with prediabetes who are referred from a cardiac hospital, attend a community diabetes education program.
Retrospective attendance analysis of 91 people who have been referred from one cardiac hospital, UOHI, to one community program , Community Diabetes Education Program of Ottawa (CDEPO), for diabetes education. A community program with the largest number of educational sites across the city was chosen. A period of 13 months was analyzed between January 2015-January 2016.
A total of 91 referrals were received for prediabetes; 30% attended a diabetes education group and 9% attended an individual session with a diabetes educator(s) (Fig.1). The results show a low attendance rate of these individuals to a community program. Further investigation is required to improve attendance rate.
Alexandria University, Egypt
Title: Renalase and Dopamine study in chronic renal failure patients
The human kidney releases a monoamine oxidase, Renalase, which was discovered in 2005, to the blood stream to regulate the blood pressure .Renalase decreases systemic pressure by metabolizing the circulating catecholamines.
Hypertension is highly prevalent in patients with diabetic nephropathy which is one of the leading causes (about 80%) of chronic kidney disease and end-stage –kidney disease.
When considered in isolation, hypertension and diabetes are associated with increased risk of the development of cardiovascular and renal complications. It is recognized that sympathetic nervous activation and stimulation of the rennin –angiotensin-aldosterone are involved.
The dopaminergic and rennin-angiotensin systems interact to regulate the blood pressure.
The vasodilator, Dopamine, counteracts angiotensin receptors in the paracrine regulation of renal sodium transport.
Levels of Renalase that metabolize catecholamines are decreased in chronic kidney disease and the plasma concentration of Renalase is markadely reduced in patients with ESRD.
Chronic kidney disease is often characterized by the presence of sympathetic hyperactivity , which contribute to the development of other forms of organ damage independent of its effect on blood pressure .It is associated with heart failure , arrhythmias and atherogenesis .
Decrease Renalase level plays an important role in cardiovascular pathology
Chronic kidney disease lead to an 18-fold increase in cardiovascular complications not fully explained by traditional risk factors .
Preventing the progression of renal failure and reducing cardiovascular risk of uraemic patients are major challenges for nephrologists. Interference with sympathetic overactivity may provide a new therapeutic avenue to follow in clinical medicine.
Aim: to assess the relationship between Dopamine and Renalase in Egyptian Type 2 diabetic patients in the presence and absence of diabetic nephropathy.
Subjects and Methods: 80subjects were divided as: Group1:10 control healthy volunteers, Group2:60 Type 2 diabetic patients and Group 3:Type 2 diabetic patients on maintenance hemodialysis .
Detailed history taken, thorough physical examination,12 lead ECG. Laboratory investigations of fasting serum glucose, urea, creatinine, uric acid, sodium, potassium, lipid profile, urinary albumin to creatinine ratio, Dpamine and Renalase .
1. Significant increase in blood pressure, both systolic and diastolic in diabetic patients and diabetic patients on maintenance hemodialysis as compared to controls.
2. No significant change in Dopamine level in between the studied groups.
3. No significant change in Renalase in Type 2 diabetic patients ,but significant increase in Renalase level in diabetic patients on maintenance hemodialysis as compared to controls (p=0.000)also to diabetic patients (p=0.004).
4. There was significant correlation between Renalase and Dopamine(r=0.261, p=0.022) , and Renalase and diastolic blood pressure (r=0.243,p=0.041) in diabetic patients.
Conclusion: Renalase is an attractive replacement therapeutic modality in hypertensive Type2 diabetic patients in order to prolong the interval between early chronic and end-stage renal failure.