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Article ; Online: What to measure at dialysis initiation for reliable prediction of cardiovascular outcomes: just look at CRP and pulse pressure.

Segall, Liviu / Covic, Adrian

Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis

2010 Volume 30, Issue 3, Page(s) 280–283

MeSH term(s)	Biomarkers/blood ; Blood Pressure ; C-Reactive Protein/analysis ; Cardiovascular Diseases/blood ; Cardiovascular Diseases/complications ; Humans ; Kidney Failure, Chronic/blood ; Kidney Failure, Chronic/complications ; Peritoneal Dialysis/adverse effects ; Predictive Value of Tests ; Risk Factors
Chemical Substances	Biomarkers ; C-Reactive Protein (9007-41-4)
Language	English
Publishing date	2010-04-26
Publishing country	United States
Document type	Comment ; Journal Article
ZDB-ID	645010-6
ISSN	1718-4304 ; 0896-8608
ISSN (online)	1718-4304
ISSN	0896-8608
DOI	10.3747/pdi.2010.00019
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Article ; Online: Heart failure in patients with chronic kidney disease: a systematic integrative review.

Segall, Liviu / Nistor, Ionut / Covic, Adrian

BioMed research international

2014 Volume 2014, Page(s) 937398

Abstract: Introduction: Heart failure (HF) is highly prevalent in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) and is strongly associated with mortality in these patients. However, the treatment of HF in this population is largely ...

Abstract	Introduction: Heart failure (HF) is highly prevalent in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) and is strongly associated with mortality in these patients. However, the treatment of HF in this population is largely unclear. Study design: We conducted a systematic integrative review of the literature to assess the current evidence of HF treatment in CKD patients, searching electronic databases in April 2014. Synthesis used narrative methods. Setting and population: We focused on adults with a primary diagnosis of CKD and HF. Selection criteria for studies: We included studies of any design, quantitative or qualitative. Interventions: HF treatment was defined as any formal means taken to improve the symptoms of HF and/or the heart structure and function abnormalities. Outcomes: Measures of all kinds were considered of interest. Results: Of 1,439 results returned by database searches, 79 articles met inclusion criteria. A further 23 relevant articles were identified by hand searching. Conclusions: Control of fluid overload, the use of beta-blockers and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and optimization of dialysis appear to be the most important methods to treat HF in CKD and ESRD patients. Aldosterone antagonists and digitalis glycosides may additionally be considered; however, their use is associated with significant risks. The role of anemia correction, control of CKD-mineral and bone disorder, and cardiac resynchronization therapy are also discussed.
MeSH term(s)	Angiotensin Receptor Antagonists/adverse effects ; Angiotensin Receptor Antagonists/therapeutic use ; Angiotensin-Converting Enzyme Inhibitors/adverse effects ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Glomerular Filtration Rate ; Heart Failure/complications ; Heart Failure/mortality ; Heart Failure/pathology ; Humans ; Kidney Failure, Chronic/complications ; Kidney Failure, Chronic/mortality ; Kidney Failure, Chronic/pathology ; Renal Insufficiency, Chronic/complications ; Renal Insufficiency, Chronic/mortality ; Renal Insufficiency, Chronic/pathology ; Risk Factors
Chemical Substances	Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors
Language	English
Publishing date	2014-05-15
Publishing country	United States
Document type	Journal Article ; Review ; Systematic Review
ZDB-ID	2698540-8
ISSN	2314-6141 ; 2314-6133
ISSN (online)	2314-6141
ISSN	2314-6133
DOI	10.1155/2014/937398
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Article ; Online: Diagnosis of tuberculosis in dialysis patients: current strategy.

Segall, Liviu / Covic, Adrian

Clinical journal of the American Society of Nephrology : CJASN

2010 Volume 5, Issue 6, Page(s) 1114–1122

Abstract: Patients with ESRD undergoing chronic dialysis are much more prone to develop tuberculosis (TB) than the general population. In these patients, the diagnosis of TB disease is often difficult because of prevailing extrapulmonary involvement and ... ...

Abstract	Patients with ESRD undergoing chronic dialysis are much more prone to develop tuberculosis (TB) than the general population. In these patients, the diagnosis of TB disease is often difficult because of prevailing extrapulmonary involvement and nonspecific symptoms. The prevalence of latent TB infection (LTBI) in ESRD patients is elevated, and those who become infected are at high risk of developing active disease. Therefore, screening for LTBI in this population is recommended, aiming to prevent progression to active TB and secondary contamination of others. The tuberculin skin test (TST), the classic diagnostic tool for LTBI, has several major drawbacks, including poor sensitivity (because of a high prevalence of anergy in dialysis patients) and specificity [with false-positive tests in those vaccinated with bacille Calmette-Guérin (BCG)]. In the past 10 years or so, new immunological tests using IFN-gamma release assays (IGRAs) have become available and have shown superior sensitivity and specificity for the diagnosis of TB compared with the TST in several studies, some very recent ones including ESRD patients. Therefore, current strategy in dialysis patients should use these tests instead of TST for LTBI screening and as an aid for the diagnosis of active TB.
MeSH term(s)	Enzyme-Linked Immunosorbent Assay ; Humans ; Interferon-gamma/metabolism ; Kidney Failure, Chronic/complications ; Kidney Failure, Chronic/therapy ; Latent Tuberculosis/diagnosis ; Latent Tuberculosis/microbiology ; Mass Screening/methods ; Mycobacterium tuberculosis/immunology ; Predictive Value of Tests ; Renal Dialysis/adverse effects ; Sensitivity and Specificity ; T-Lymphocytes/immunology ; T-Lymphocytes/microbiology ; Tuberculin Test
Chemical Substances	Interferon-gamma (82115-62-6)
Language	English
Publishing date	2010-06
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2226665-3
ISSN	1555-905X ; 1555-9041
ISSN (online)	1555-905X
ISSN	1555-9041
DOI	10.2215/CJN.09231209
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Article ; Online: Heart Failure in Patients with Chronic Kidney Disease

Liviu Segall / Ionut Nistor / Adrian Covic

BioMed Research International, Vol

A Systematic Integrative Review

2014 Volume 2014

Abstract: Introduction. Heart failure (HF) is highly prevalent in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) and is strongly associated with mortality in these patients. However, the treatment of HF in this population is largely ... ...

Abstract	Introduction. Heart failure (HF) is highly prevalent in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) and is strongly associated with mortality in these patients. However, the treatment of HF in this population is largely unclear. Study Design. We conducted a systematic integrative review of the literature to assess the current evidence of HF treatment in CKD patients, searching electronic databases in April 2014. Synthesis used narrative methods. Setting and Population. We focused on adults with a primary diagnosis of CKD and HF. Selection Criteria for Studies. We included studies of any design, quantitative or qualitative. Interventions. HF treatment was defined as any formal means taken to improve the symptoms of HF and/or the heart structure and function abnormalities. Outcomes. Measures of all kinds were considered of interest. Results. Of 1,439 results returned by database searches, 79 articles met inclusion criteria. A further 23 relevant articles were identified by hand searching. Conclusions. Control of fluid overload, the use of beta-blockers and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and optimization of dialysis appear to be the most important methods to treat HF in CKD and ESRD patients. Aldosterone antagonists and digitalis glycosides may additionally be considered; however, their use is associated with significant risks. The role of anemia correction, control of CKD-mineral and bone disorder, and cardiac resynchronization therapy are also discussed.
Keywords	Medicine ; R
Subject code	610
Language	English
Publishing date	2014-01-01T00:00:00Z
Publisher	Hindawi Limited
Document type	Article ; Online
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Article: Cardiovascular disease in haemodialysis and peritoneal dialysis: arguments pro haemodialysis.

Segall, Liviu / Covic, Adrian

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

2007 Volume 22, Issue 1, Page(s) 59–63

MeSH term(s)	Cardiovascular Diseases/complications ; Cardiovascular Diseases/therapy ; Heart Failure/therapy ; Humans ; Inflammation ; Kidney Failure, Chronic/therapy ; Peritoneal Dialysis/methods ; Prevalence ; Renal Dialysis/methods ; Risk ; Risk Factors ; Treatment Outcome ; Uremia/metabolism
Language	English
Publishing date	2007-01
Publishing country	England
Document type	Comment ; Journal Article
ZDB-ID	90594-x
ISSN	1460-2385 ; 0931-0509
ISSN (online)	1460-2385
ISSN	0931-0509
DOI	10.1093/ndt/gfl643
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Zs.A 2198: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Dialysis modality choice in elderly patients with end-stage renal disease: a narrative review of the available evidence.

Segall, Liviu / Nistor, Ionut / Van Biesen, Wim / Brown, Edwina A / Heaf, James G / Lindley, Elizabeth / Farrington, Ken / Covic, Adrian

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

2017 Volume 32, Issue 1, Page(s) 41–49

Abstract: The number of elderly patients on maintenance dialysis has rapidly increased in the past few decades, particularly in developed countries, imposing a growing burden on dialysis centres. Hence, many nephrologists and healthcare authorities feel that ... ...

Abstract	The number of elderly patients on maintenance dialysis has rapidly increased in the past few decades, particularly in developed countries, imposing a growing burden on dialysis centres. Hence, many nephrologists and healthcare authorities feel that greater emphasis should be placed on the promotion of home dialysis therapies such as peritoneal dialysis (PD) and home haemodialysis (HD). There is currently no general consensus as to the best dialysis modality for elderly patients with end-stage renal disease. In-centre HD is predominant in most countries, although it is widely recognized that PD has several advantages over HD, including the lack of need for vascular access, continuous slow ultrafiltration, less interference with patients' lifestyle and lower costs. Comparisons of outcomes between elderly patients on PD and HD rely on observational studies, as randomized controlled trials are lacking. The results of these studies are variable. However, most of them suggest that survival rates are largely similar between the two modalities, except for elderly patients with diabetes and/or beyond 1-3 years from dialysis initiation, in which cases HD appears to be superior. An equally important aspect to consider when choosing dialysis modality, particularly in this age group, is the quality of life, and in this regard most studies found no significant differences between PD and HD. In these circumstances, we believe that dialysis modality selection should be guided by patient's preference, based on comprehensive and unbiased information. A multidisciplinary team should review elderly patients starting on dialysis, aiming to identify possible barriers to PD and home HD, including physical, visual, cognitive, psychological and social problems, and to overcome such barriers by adequate care, education, psychological counselling and dialysis assistance.
MeSH term(s)	Aged ; Choice Behavior ; Humans ; Kidney Failure, Chronic/psychology ; Kidney Failure, Chronic/therapy ; Quality of Life ; Renal Dialysis/psychology ; Renal Dialysis/utilization
Language	English
Publishing date	2017--01
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	90594-x
ISSN	1460-2385 ; 0931-0509
ISSN (online)	1460-2385
ISSN	0931-0509
DOI	10.1093/ndt/gfv411
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Zs.A 2198: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: The prevalence of chronic kidney disease in the general population in Romania: a study on 60,000 persons.

Cepoi, Vasile / Onofriescu, Mihai / Segall, Liviu / Covic, Adrian

International urology and nephrology

2011 Volume 44, Issue 1, Page(s) 213–220

Abstract: Introduction: Chronic kidney disease (CKD) is a major public health problem worldwide, due to its epidemic proportions and to its association with high cardiovascular risk. Therefore, screening for CKD is an increasingly important concept, aiming for ... ...

Abstract	Introduction: Chronic kidney disease (CKD) is a major public health problem worldwide, due to its epidemic proportions and to its association with high cardiovascular risk. Therefore, screening for CKD is an increasingly important concept, aiming for early detection and prevention of progression and complications of this disease. Materials and methods: We studied the prevalence of CKD in the adult population of Iaşi, the largest county in Romania, based on the results of a national general health screening program from 2007 to 2008. The patients were tested for CKD with serum creatinine and urinary dipstick. We used two different methods to estimate the glomerular filtration rate (eGFR): the simplified Modification of Diet in Renal Disease (MDRD) and the CKD Epidemiology Collaboration (CKD-EPI) equations. Based on the Kidney Disease Improving Global Outcomes (KDIGO) criteria, we defined CKD as the presence of either eGFR < 60 ml/min/1.73 m(2) and/or dipstick proteinuria. The classification of CKD by stage was also done according to the KDIGO criteria. Results: The study population included 60,969 people. The global prevalence of CKD was found to be 6.69% by the MDRD formula and 7.32% when using the CKD-EPI equation. The prevalence of CKD was much higher in women than in men: 9.09% versus 3.7%, by MDRD, and 9.32% versus 4.85%, by CKD-EPI. By age groups, the prevalence of CKD was 0.95% and 0.64% in persons aged 18-44 years old, 4.27% and 3.57% (45-64 years old), 13.36% and 15.34% (65-79 years old), and 23.59% and 34.56% (>80 years old), according to MDRD and CKD-EPI, respectively. By stages, the prevalence of CKD stage 3a (eGFR 59 to 45 ml/min/1.73 m(2)) was 5.72% by MDRD and 5.96% according to CKD-EPI, whereas the prevalence of stages 3b, 4, and 5 taken together (eGFR < 45 ml/min/1.73 m(2)) was 0.96% (MDRD) and 1.35% (CKD-EPI). Patients with CKD were significantly older (71.0 years versus 53.7 years) and had lower levels of serum Hb, total cholesterol, and glutamic pyruvic transaminase, and significantly higher serum creatinine and blood glucose, in comparison with the individuals without CKD. Impaired fasting glucose (106 mg/dl) was found in the CKD population, but not in non-CKD individuals. Conclusions: Our study is one of the largest ever reported on the prevalence of CKD worldwide, the first one in Romania, and one of the very few of its kind in Europe (particularly in Eastern Europe). The study showed that the prevalence of CKD in our country is around 7%, which is lower than in other countries; however, this could be underestimated due to population selection bias. The prevalence is similar with the MDRD and the CKD-EPI equations; it increases with age and is much higher in women than in men. Impaired fasting glucose was detected in CKD patients, a finding that should probably raise the awareness of the high cardiovascular risk associated with CKD.
MeSH term(s)	Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Alanine Transaminase/blood ; Analysis of Variance ; Blood Glucose/metabolism ; Cholesterol/blood ; Creatinine/blood ; Female ; Glomerular Filtration Rate ; Hemoglobins/metabolism ; Humans ; Male ; Middle Aged ; Prevalence ; Proteinuria/etiology ; Renal Insufficiency, Chronic/classification ; Renal Insufficiency, Chronic/epidemiology ; Renal Insufficiency, Chronic/physiopathology ; Romania/epidemiology ; Young Adult
Chemical Substances	Blood Glucose ; Hemoglobins ; Cholesterol (97C5T2UQ7J) ; Creatinine (AYI8EX34EU) ; Alanine Transaminase (EC 2.6.1.2)
Language	English
Publishing date	2011-03-02
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	204048-7
ISSN	1573-2584 ; 0301-1623 ; 0042-1162
ISSN (online)	1573-2584
ISSN	0301-1623 ; 0042-1162
DOI	10.1007/s11255-011-9923-z
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Article ; Online: Protein-energy wasting, as well as overweight and obesity, is a long-term risk factor for mortality in chronic hemodialysis patients.

Segall, Liviu / Moscalu, Mihaela / Hogaş, Simona / Mititiuc, Irina / Nistor, Ionuţ / Veisa, Gabriel / Covic, Adrian

International urology and nephrology

2014 Volume 46, Issue 3, Page(s) 615–621

Abstract: Introduction: In patients with end-stage renal disease on chronic hemodialysis (HD), protein-energy wasting (PEW) is very common and is associated with increased morbidity and mortality. Evaluation of nutritional status should be performed regularly in ... ...

Abstract	Introduction: In patients with end-stage renal disease on chronic hemodialysis (HD), protein-energy wasting (PEW) is very common and is associated with increased morbidity and mortality. Evaluation of nutritional status should be performed regularly in all such patients, using multiple methods. In this study, we analyzed the influence of several nutritional markers on long-term (5 years) survival of HD patients in one center. This is the first study on the long-term influence of nutritional status on mortality in dialysis patients ever conducted in Romania. Materials and methods: We included all prevalent HD patients in our center. Those with ongoing acute illnesses and with inflammation (C-reactive protein ≥ 6.0 mg/l) were excluded. In the remaining subjects (N = 149, 82 males, mean age 55 years old), we performed the following measurements of nutritional status: estimation of dietary protein intake by normalized protein equivalent of nitrogen appearance (nPNA), subjective global assessment (SGA), body mass index (BMI), tricipital skinfold thickness, mid-arm circumference, assessment of body composition by bioelectrical impedance analysis (BIA), and pre-dialysis serum creatinine, albumin, and total cholesterol. We used receiver operating characteristic curves to determine the cutoff points for most of the variables, and we applied the Kaplan-Meier estimator and the Cox's proportional hazards model (stepwise method) to analyze the influence of these variables on survival. Results: In univariate analysis, general factors including age ≥ 65 years, male gender, dialysis vintage ≥ 2 years, and the presence of diabetes and heart failure were all significant predictors of mortality. Among nutritional parameters, BMI ≥ 25 kg/m(2), SGA-B (mild PEW), nPNA < 1.15 g/kg per day, and the BIA-derived phase angle (PhA) <5.58° were also significantly associated with reduced survival. All of these factors maintained statistical significance in multivariate analysis, except for male gender and heart failure. Conclusion: We showed that low values of SGA, nPNA, and PhA independently predict mortality in HD patients. In conjunction with an earlier study, we demonstrated that the relative risk of death associated with these markers is highest during the first year of monitoring and it decreases in the following 4 years, although it still remains significantly increased. On the other hand, overweight and obesity were also associated with lower survival after 5 years, whereas this association was not apparent after 1 year.
MeSH term(s)	Aged ; Female ; Humans ; Kidney Failure, Chronic/complications ; Kidney Failure, Chronic/mortality ; Kidney Failure, Chronic/therapy ; Male ; Middle Aged ; Nutritional Status ; Obesity/complications ; Obesity/mortality ; Overweight/complications ; Overweight/mortality ; Protein-Energy Malnutrition/complications ; Protein-Energy Malnutrition/mortality ; Renal Dialysis/mortality ; Risk Factors ; Survival Analysis ; Time Factors
Language	English
Publishing date	2014-01-29
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	204048-7
ISSN	1573-2584 ; 0301-1623 ; 0042-1162
ISSN (online)	1573-2584
ISSN	0301-1623 ; 0042-1162
DOI	10.1007/s11255-014-0650-0
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Article: Direct renin inhibitors: the dawn of a new era, or just a variation on a theme?

Segall, Liviu / Covic, Adrian / Goldsmith, David J A

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

2007 Volume 22, Issue 9, Page(s) 2435–2439

MeSH term(s)	Drug Therapy, Combination ; Humans ; Kidney Failure, Chronic/therapy ; Renin/antagonists & inhibitors ; Renin-Angiotensin System ; Risk Factors
Chemical Substances	Renin (EC 3.4.23.15)
Language	English
Publishing date	2007-09
Publishing country	England
Document type	Editorial
ZDB-ID	90594-x
ISSN	1460-2385 ; 0931-0509
ISSN (online)	1460-2385
ISSN	0931-0509
DOI	10.1093/ndt/gfm363
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Zs.A 2198: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article: Antihypertensive treatment and stroke prevention in patients with and without chronic kidney disease: a review of controlled trials.

Segall, Liviu / Oprisiu, Roxana / Fournier, Albert / Covic, Adrian

Journal of nephrology

2008 Volume 21, Issue 3, Page(s) 374–383

Abstract: Background: Stroke is the leading cause of serious long-term disability and the third leading cause of death in the Western world. In patients with chronic kidney disease (CKD), stroke and vascular dementia are significantly more prevalent than in the ... ...

Abstract	Background: Stroke is the leading cause of serious long-term disability and the third leading cause of death in the Western world. In patients with chronic kidney disease (CKD), stroke and vascular dementia are significantly more prevalent than in the general population. However, the optimal stroke prevention strategy in these patients is unclear, because controlled studies are scarce. Methods: In this paper, the results of the major antihypertensive trials and meta-analyses for stroke prevention in the general high cardiovascular (CV) risk population and in the CKD population are reviewed. Results: The risk of stroke is much more blood pressure (BP)-dependent than the risk of other CV events, and, consistently, risk reduction is also strongly dependent on BP reduction. The magnitude of BP lowering is crucial in both populations. In renal patients, diuretics alone or in combination with angiotensin-converting enzyme (ACE) inhibitors, compared with placebo, are powerful BP-lowering and stroke-protective agents. Calcium channel blockers and ACE inhibitors also seem to be superior to placebo, but with more modest BP-decreasing effects and statistically nonsignificant reductions in stroke risk. In active versus active drug studies, independently of the BP-lowering effect, there are no significant advantages of any class over the others, although the results point to a slight superiority of diuretics and calcium channel blockers. Antihypertensive regimens in CKD patients should always include a diuretic, because, in the pathogenesis of CKD-associated hypertension, volume overload plays a crucial role. Diuretics are also inexpensive and well tolerated. Conclusions: We suggest that further studies of CV outcomes in CKD patients should compare various combinations of diuretics plus other drugs, such as calcium channel blockers, ACE inhibitors and angiotensin II receptor blockers.
MeSH term(s)	Antihypertensive Agents/therapeutic use ; Chronic Disease ; Humans ; Kidney Diseases/complications ; Randomized Controlled Trials as Topic ; Risk Factors ; Stroke/prevention & control
Chemical Substances	Antihypertensive Agents
Language	English
Publishing date	2008-05
Publishing country	Italy
Document type	Journal Article ; Review
ZDB-ID	1093991-x
ISSN	1724-6059 ; 1121-8428 ; 1120-3625
ISSN (online)	1724-6059
ISSN	1121-8428 ; 1120-3625
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