Comparative Analysis of Arterial Stiffness and Body Composition in Early and Late Periods After Kidney Transplantation

Quality of life improvement in breast cancer survivors affected by upper limb lymphedema through a novel multiperspective physical activity methodology: a monocentric pilot study

PURPOSE

Chronic lymphedema causes psychophysical sequelae jeopardizing quality of life (QoL) of breast cancer (BC) survivors, and lack of effective therapies represents a major challenge for healthcare professionals. Structured adapted physical activity (APA) may represent an effective strategy to attenuate cancer treatment-related impairments and improve QoL. Here, we describe the effects of a specific APA intervention based on a novel multiperspective methodology in counteracting lymphedema-related morphofunctional alterations and improving QoL of BC survivors.

METHODS

BC survivors with chronic moderate/severe lymphedema attending the Cancer Rehabilitation Center in Florence were assessed before and after 8-week APA. The protocol consisted of both APA specialist-supervised and self-leaded sessions using a tailor-designed proprioceptive board. Body mass index, bioimpedance parameters, indirect upper limb volume measurement, and ultrasonography were performed. Wrist flexion/extension and hand strength functional tests were also executed. QoL, depression/anxiety and pain intensity were evaluated by ULL27, HADS, distress thermometer and NRS questionnaires, respectively.

RESULTS

Although bioimpedance, ultrasound and volumetric measures remained mostly unchanged, wrist mobility, pain perception, depression, and QoL were all significantly ameliorated after APA.

CONCLUSIONS

Our findings suggest that a multidisciplinary treatment approach involving APA professionals should be employed in the management of BC-related lymphedema to improve patient psychophysical outcomes and QoL.

Hypertension in kidney transplantation: a consensus statement of the 'hypertension and the kidney' working group of the European Society of Hypertension

Hypertension is common in kidney transplantation recipients and may be difficult to treat. Factors present before kidney transplantation, related to the transplantation procedure itself and factors developing after transplantation may contribute to blood pressure (BP) elevation in kidney transplant recipients. The present consensus is based on the results of three recent systematic reviews, the latest guidelines and the current literature. The current transplant guidelines, which recommend only office BP assessments for risk stratification in kidney transplant patients should be reconsidered, given the presence of white-coat hypertension and masked hypertension in this population and the better prediction of adverse outcomes by 24-h ambulatory BP monitoring as indicated in recent systematic reviews. Hypertension is associated with adverse kidney and cardiovascular outcomes and decreased survival in kidney transplant recipients. Current evidence suggests calcium channel blockers could be the preferred first-step antihypertensive agents in kidney transplant patients, as they improve graft function and reduce graft loss, whereas no clear benefit is documented for renin-angiotensin system inhibitor use over conventional treatment in the current literature. Randomized control trials demonstrating the clinical benefits of BP lowering on kidney and major cardiovascular events and recording patient-related outcomes are still needed. These trials should define optimal BP targets for kidney transplant recipients. In the absence of kidney transplant-specific evidence, BP targets in kidney transplant recipients should be similar to those in the wider chronic kidney disease population.

Obesity, Fat Tissue Parameters, and Arterial Stiffness in Renal Transplant Recipients

OBJECTIVE

Arterial stiffness and altered body composition (increased body fat mass [BFM] and decreased lean body mass) are acknowledged risk factors for adverse outcomes after kidney transplantation related to cardiovascular diseases. The aim of the study was the assessment of the relationship between arterial stiffness and fat tissue parameters in renal transplants recipients (RTrs).

METHODS

A group of 344 RTrs with stable disease and a mean age of 52.7 years (62.5% men) who underwent transplantation between 1994 and 2018 were randomly enrolled in the study. The following parameters of arterial stiffness were measured: brachial-ankle and carotid-femoral pulse waves velocities (baPWVs left and right, cfPWVs). The obesity and fat tissue (body mass index [BMI], waist-to-hip ratio [WHR], BFM, fat free mass [FFM], percent body fat [PBF], trunk segmental fat analysis [TSFA], and visceral fat area [VFA]) parameters were assessed with InBody 170.

RESULTS

The median time of dialysis and after kidney transplantation was 58.5 and 78 months, respectively. Obesity according BMI, WHR, and VFA was diagnosed in 49.7%, 45.0%, and 44.5% of patients, respectively. The median value of BFM, FFM, VFA, and TSFA and the mean value of PBF were 19.3 kg, 55 kg, 93.2 cm², 24.9 kg, and 27.3%, respectively. We found significant positive correlations among WHR, VFA, baPWV right, baPWV left, and cfPWV.

CONCLUSIONS

Obesity and visceral fat tissue influence on arterial stiffness. The analysis of magnitude of obesity and body fat tissue parameters can be used as an additional cardiovascular risk factor in RTrs.

Arterial Stiffness in Patients With Renal Transplantation; Associations With Co-morbid Conditions, Evolution, and Prognostic Importance for Cardiovascular and Renal Outcomes

Patients with chronic kidney disease (CKD), particularly those with end-stage renal disease (ESRD), are at increased risk of cardiovascular events and mortality. The spectrum of arterial remodeling in CKD and ESRD includes atheromatosis of middle-sized conduit arteries and, most importantly, the process of arteriosclerosis, characterized by increased arterial stiffness of aorta and the large arteries. Longitudinal studies showed that arterial stiffness and abnormal wave reflections are independent cardiovascular risk factors in several populations, including patients with CKD and ESRD. Kidney transplantation is the treatment of choice for patients with ESRD, associated with improved survival and better quality of life in relation to hemodialysis or peritoneal dialysis. However, cardiovascular mortality in transplanted patients remains much higher than that in general population, a finding that is at least partly attributed to adverse lesions in the vascular tree of these patients, generated during the progression of CKD, which do not fully reverse after renal transplantation. This article attempts to provide an overview of the field of arterial stiffness in renal transplantation, discussing in detail available studies on the degree and the associations of arterial stiffness with other co-morbidities in renal transplant recipients, the prognostic significance of arterial stiffness for cardiovascular events, renal events and mortality in these individuals, as well as studies examining the changes in arterial stiffness following renal transplantation.