Continuous arterio-venous haemodiafiltration: hydraulic and diffusive permeability index of an AN-69 capillary haemofilter

The dependence of uraemic solute clearance on the hydraulic and diffusive permeability index of an AN-69 capillary haemofilter is investigated during the treatment of patients with continuous arterio-venous haemodiafiltration (CAVHD). A mathematical model is presented to calculate solute clearance and the hydraulic and diffusive permeability index parameters from clinical data and to predict the blood flow rate entering the extra-corporeal circuit from the manufacturer's specifications and blood viscosity. By measuring the flow rates, the patient's mean arterio-venous pressure difference and uraemic solute clearance under different clinical and operational conditions, mathematical model equations are evaluated. During the average survival time of an AN-69 capillary haemofilter of about five days, it is found that both the hydraulic permeability index and the diffusive permeability index decline over treatment time, independent of the haemofilter resistance to blood flow. The measured haemofilter resistance to blood flow is three times higher than the haemofilter resistance predicted from the manufacturer's specifications and blood viscosity. Predicting the blood flow rate entering the extra-corporeal circuit from the arterial haematocrit, plasma protein concentration and temperature and the manufacturer's specifications is not reliable.     

Renal blood flow after bilateral ureteral ligation in the rat

Renal blood flow (RBF) in rat was measured by using a noncannulating electromagnetic flowmeter. In the sham control rats, anesthetized with Inactin, RBF averaged 7 ml/min/g KW when arterial blood pressure was above 110 mm Hg. Auroregulation of RBF was observed when the arterial blood pressure was in the range of 110–150 mm Hg. Glomerular filtration rate (GFR), measured by polyfructosan clearance, averaged 1.08 ml/min/g KW. In experimental rats with 24 h of bilateral ureteral ligation (BUL), RBF averaged 38% of control value. During 1/2–3 h following release of the left ureteral occlusion, RBF increased to 60% of control value. The autoregulatory ability of the damaged kidney was reduced during BUL and did not improve after releasing occlusion. During the post-obstructive period arterial blood pressure remained stable. Thus, a high total renal vascular resistance was responsible for the depressed RBF. GFR in these rats averaged only 9% of control value. The reduction in RBF alone does not explain the drastic reduction in GFR in this model of renal failure.     

Cardiovascular effects of preparation CIBA 34,276-Ba and imipramine

The cardiovascular effects of compound CIBA 34,276-Ba and imipramine were compared.In the conscious dog, intravenous infusion or oral administration of compond CIBA 34,276-Ba had only a slight effect on blood pressure and heart rate, whereas the intravenous administration of imipramine gave rise to clearcut tachycardia and did not influence blood pressure.In dogs anaesthetized with chloralose, compound CIBA 34,276-Ba reduced blood pressure and heart rate slightly, diminished cardiac output when given in high doses and increased total peripheral resistance. Imipramine administered in the same doses had no effect on blood pressure, increased heart rate and led to qualitatively similar but quantitatively more pronounced changes in cardiac output and peripheral resistance than compound CIBA 34,276-Ba.In cats anaesthetized with allobarbitone, compound CIBA 34,276-Ba and imipramine in doses up to 3 mg/kg i.v. had only a slight effect on blood pressure, contractile force and heart rate. A negative inotropic effect was evident after intravenous administration of 3 mg/kg imipramine.In the isolated guinea-pig atrium imipramine increased cardiac contractile force in a concentration of 1 mcg/ml, while both compounds displayed a cardiodepressant effect with 10 mcg/ml.In conscious renal hypertensive rats, both compounds had no effect on blood pressure, but reduced blood pressure in the same animals anaesthetized with ether.     

"Stolen" blood flow: effect of an open arterial filter purge line in a simulated neonatal CPB model

The purpose of this study was to evaluate the effect of different flow rates and pressures on the degree of shunting of blood flow by the arterial filter purge line in a simulated neonatal cardiopulmonary bypass circuit. The circuit was primed with heparinized bovine blood (hematocrit 24%) and postfilter pressure was varied from 60-180 mm Hg (20 mm Hg increments) using a Hoffman clamp. Trials were conducted at flow rates ranging from 200-600 ml/min (100 ml/min increments). During trials conducted at a postfilter pressure of 60 mm Hg, 42.6% of blood flow was shunted through the purge line at a flow rate of 200 ml/min, whereas only 12.8% of flow was diverted at a flow rate 600 ml/min. During trials conducted at a postfilter pressure of 180 mm Hg, 82.8% of blood flow at 200 ml/min and 25.9% of blood flow at 600 ml/min was diverted through the open arterial purge line. The results of this study confirm that a significant amount of flow is diverted away from the patient when the arterial purge line is open. Shunting of blood flow through the arterial purge line could result in less effective tissue perfusion, particularly at low flow rates and high postfilter pressures. To minimize hypoperfusion injury, a flow probe (distal to the arterial filter) may be used to monitor real-time arterial flow in the setting of an open arterial filter purge line.     

Constant glomerular filtration rate in diabetic nephropathy. Correlation to blood pressure and blood glucose control

Twenty-one patients with diabetes of type I and diabetic nephropathy with reduced glomerular filtration rate (GFR) were followed prospectively with regard to GFR, proteinuria, blood pressure and glucosylated haemoglobin (HbA1). All patients were on antihypertensive treatment. The mean rate of decline in GFR was only 0.38 ml/month = 4.6 ml/year. In one third of the patients, GFR remained constant at a reduced level for at least 24 months. Mean plasma clearance of 51Cr-EDTA in this group was 48.3 +/- 14.6 ml/min/1.73 m2 body surface at entry and 48.0 +/- 13.6 at the time of evaluation. The patients with constant GFR had significantly less proteinuria and lower systolic as well as mean arterial pressure during the study than patients with falling GFR. They also had significantly lower mean HbA1 and fewer very high HbA1 values than patients who deteriorated. The data thus indicate that a combination of good metabolic control and effective blood pressure control may strongly delay the progression of renal insufficiency in diabetic nephropathy. They also show that low degree of proteinuria is a marker of good prognosis.     

Pharmacokinetics and pharmacodynamics of intravenous digoxin and digitoxin

Summary Healthy volunteers received single 1.0-mg doses of intravenous digoxin (n=10) or digitoxin (n=12). Glycoside pharmacokinetics were determined from multiple plasma samples drawn over the 48 hours (for digoxin) or 14 days (for digitoxin) after the dose. Electrocardiogram, echocardiogram, and blood pressure were recorded at multiple time points 24 h after the dose. To control for nonspecific cardiovascular changes, pharmacodynamic measurements were repeated on a second occasion for 8 hours after an intravenous injection of saline. Mean (±S.E.) kinetic variables for digoxin were: volume of distribution (Vd), 8.3 (±0.6) l/kg; elimination half-life (t1/2), 49 (±5) h; clearance 2.1 (±0.2) ml/min/kg. Changes in blood pressure, ventricular rate, and corrected QT-interval attributable to digoxin were small. However, echocardiographically-determined mean rate of circumferential fibre shortening (mVcf) and ejection fraction (EF) increased significantly following digoxin when compared to saline infusion. Changes were maximal at 4–6 h after dosage, and were highly correlated with plasma digoxin concentration. mVcf and EF returned to baseline by 24 h post-dosage. Mean kinetic variables for digitoxin were: Vd, 0.63 (±0.03) l/kg; t1/2, 7.3 (±0.4) days; clearance, 0.043 (±0.003) ml/min/kg. Like digoxin, digitoxin infusion produced minimal change in blood pressure, ventricular rate, or QT-interval. However, mVcf and EF increased significantly when compared to saline control. Changes were maximal at 4–8 h after infusion, and were correlated with plasma digitoxin concentration; at 24 h post-dosage, mVcf and EF were still increased over baseline. Thus, digoxin and digitoxin significantly increase myocardial contractility in healthy humans, but without important change in heart rate and blood pressure. Changes in contractility are of slow onset, probably due to slow distribution of glycoside to sites of pharmacologic activity.Supported in part by Grant Oc 10/4 from Deutsche Forschungsgemeinschaft, Bonn-Bad Godesberg, FRG; and by Grant MH-12279 from the United States Public Health Service     

胶体预扩容与晶体限制性补液对急诊剖宫产产妇血流动力学的影响

目的:探讨胶体预扩容与晶体限制性补液对急诊剖宫产产妇血流动力学的影响.方法:选取2018年9月至2019年9月我院急诊行剖宫产的125例产妇,按照随机数字表法分为两组,其中对照组62例产妇麻醉前30 min内快速静脉滴注6％羟乙基淀粉(130/0.42)0.5 L,随后静脉滴注乳酸林格溶液5 ml?(kg·h)-1,观...     

Effect of physical fitness on vanillylmandelic acid excretion during immersion

Summary The effects of 4–6 h head-out immersion on excretion of vanillylmandelic acid (VMA), blood pressure and plasma volume were estimated in 8 endurance-trained (TR) and 8 untrained (UT) subjects. In the trained only a slight increase of VMA excretion occurred (4 h value: +2.7±10.9 ng/ml GFR), but there was a highly significant increase in the UT (+29.0±17.2 ng/ml GFR). VMA values during control experiments in supine position tended to decrease in both groups.Systolic and diastolic blood pressure fell by 20 mm Hg after beginning of immersion; in the UT plasma volume was reduced while it remained constant in TR.The results indicate that orthostatic intolerance (o.i.) after immersion is not effected by decreased sympathetic innervation of vessels; in contrast it seems to be partly compensated for by an elevated sympathetic activity at least in the UT. As a main cause for the post-immersion o.i. one might suggest a decrease in renin activity.Supported by the Minister für Wissenschaft und Forschung des Landes Nordrhein-Westfalen, Grant No. 06/0604/685 11     

Isolation of large numbers of highly purified lymphocytes and monocytes with a modified centrifugal elutriation technique

A modified centrifugal elutriation technique is described for the isolation of large numbers of lymphocytes and monocytes. Elutriation was carried out by lowering the rotor speed at a constant flow rate which was generated by hydrostatic pressure. The flow rate could be kept constant if the separation procedure was performed at high pressure and high systemic resistance.

Up to 2.3 × 10⁹ mononuclear cells derived from 2000 ml blood were separated in one single experiment in approximately 1 h. The lymphocytes and monocytes were isolated at purities of 98 ± 1% and 94 ± 1% respectively. The purity of the lymphocytes was increased to 99.8 ± 0.1% by a second elutriation run. Additional advantages of the elutriation procedures are that the choice of medium is free, and that relatively large numbers of cells may be separated with high recoveries.     

Renal autoregulation of blood flow and filtration rate in the rabbit

Electromagnetic flow techniques and inulin clearance were used to determine the autoregulatory capabilities of the rabbit kidney in vivo. Renal blood flow was measured in 13 animals over a renal perfusion pressure range of 40-110 mmHg. Normal renal blood flow averaged 3.2 +/- 0.3 ml.min-1.g kidney-1 and was efficiently autoregulated above a renal artery pressure of 75 mmHg. For every 10 mmHg renal pressure change above 75 mmHg renal blood flow changed only 0.96%. Renal perfusion pressure was reduced from 102 +/- 3 to 74 +/- 2 mmHg in six animals. Over this pressure range glomerular filtration rate was not significantly decreased and averaged 4.2 +/- 0.5 ml/min at high pressure compared to 4.0 +/- 0.5 ml/min at low perfusion pressure. Results show that the rabbit kidney autoregulates renal blood flow and glomerular filtration rate efficiently above 75 mmHg. This range of autoregulation compares well with the autoregulatory range of the dog. The results also show that in the autoregulatory range the rabbit and the rat appear to autoregulate with equal efficiency but that the rabbit kidney begins to autoregulate at a low perfusion pressure than the average of approximately 100 mmHg usually found in the rat.     

Administration of tibolone decreases 24 h heart rate but not blood pressure of post-menopausal women

OBJECTIVE: Elevation of blood pressure and heart rate increase the risk of cardiovascular disease. Administration of estrogens does not affect heart rate but may decrease 24 h blood pressure. In this study, we tested the effect of the estro-progestogenic compound tibolone. METHODS: Thirty healthy, post-menopausal women were randomized to receive placebo (n = 15) or tibolone, at the commonly prescribed dose of 2.5 mg per day (n = 15). Before and after 6 months of treatment, in each woman blood pressure and heart rate were monitored every 30 min for 41 h by an ambulatory device. Valuable readings were those collected from 8:00 a.m. of the second day to 8:00 a.m. of third day. Analyses were performed of 24 h, day-time (7:00 a.m.-11:00 p.m.) and night-time (11:00 p.m.-7:00 a.m.) values. Day to night difference was also calculated. Results: Placebo did not modify 24h, day-time, and night-time blood pressure or heart rate values. Day-night differences were also not affected by placebo. Similarly to placebo, tibolone administration did not modify any of the blood pressure parameters taken into consideration. By contrast, a significant decline of 24 h heart rate (73.2 +/- 2.3 beats/min versus 69.3 +/- 1.7 beats/min; P < 0.0008) was observed. The effect was significant both at day (76.6 +/- 2.4 beats/min versus 72.1 +/- 1.9 beats/min; P < 0.0001) and night (65.8 +/ 2.6 beats/min versus 62.4 +/- 1.9 beats/min; P < 0.05). Day-night blood pressure and heart rate differences were not affected by tibolone. CONCLUSIONS: In post-menopausal women, administration of tibolone does not influence 24 h blood pressure but reduces heart rate.     

Niravoline, a selective kappa-opioid receptor agonist effectively reduces elevated intracranial pressure

To ascertain the effects of niravoline (RU 51599, a selective kappa-opioid receptor agonist) on elevated intracranial pressure with mass lesion, the authors experimentally induced intracranial hypertension in cats by progressive inflation of an extradural balloon with physiological saline at the constant rate of 0.5 ml/h for 2.5 h. After 2.5 h, inflation was discontinued, but the balloon remained inflated for an additional 3 h. Immediately after cessation of balloon inflation and while the balloon remained expanded, the control group (n = 8) received ringer's lactate solution only. In the treatment group (n = 8), each cat was treated with an intravenous administration of niravoline at a dose of 1.0 mg/kg immediately after the cessation of balloon inflation and every hour for 3 h in post-inflation period (three injections total). Changes in intracranial pressure (ICP), mean arterial blood pressure (MAP), cerebral perfusion pressure (CPP), electroencephalogram (EEG), pupil size, blood gasses and pH, plasma osmolality and electrolytes, and brain water content were studied in both groups. Compared with the untreated group, niravoline treatment produced significant decreases in ICP and significant increases in CPP at 1, 2, and 3 h post-inflation in the presence of an extradural mass lesion. Brain water content was significantly reduced both in the compressed and contralateral hemispheres following niravoline treatment. No significant changes were observed in plasma osmolality and systemic arterial blood pressure following niravoline administration. The results from this present study provide further evidence that niravoline is effective in reducing elevated intracranial pressure, brain water content, and maintaining an adequate cerebral perfusion pressure even in the presence of an extradural mass lesion. Niravoline may offer a new therapeutic modality in head-injury patients with an acute intracranial, expanding mass lesion by providing a safer extended time-period until the mass can be surgically evacuated.     

The effect of hysterectomy or levonorgestrel-releasing intrauterine system on cardiovascular disease risk factors in menorrhagia patients: a 10-year follow-up of a randomised trial

Objective

To compare, whether women with menorrhagia, treated with either hysterectomy or LNG-IUS, differ in their cardiovascular risk profile during 10-year follow-up.

Study design

A total of 236 women were randomized to treatment by hysterectomy (n = 117) or LNG-IUS (n = 119). Their cardiovascular risk factors were analyzed at baseline, at 5 years, and at 10 years. As 55 originally randomized to the LNG-IUS group had hysterectomy during the follow-up, all analyzes were performed by actual treatment modality.

Main outcome measures

Waist circumference, body-mass index (BMI), blood pressure, and the levels of blood lipids, serum high-sensitivity CRP (hsCRP) and tumor necrosis factor alpha (TNF-α) were measured, and the use of medication for hypertension, diabetes, hypercholesterolemia, and ischemic heart disease was analyzed.

Results

After 5 years, an increase in the use of diabetes medication during the follow-up was only detected in the hysterectomy group (from 1.7% to 6.7%, P = 0.008 vs from 5.1% to 8.4%, P = 0.08), as well as they had significantly higher serum levels of TNF-α (108.59 pg/ml vs 49.02 pg/ml, P = 0.001) and hsCRP (1.55 μg/ml vs 0.78 μg/ml, P = 0.038) at 5- and 10-years. There was no difference between the groups in the use of cardiovascular medication, neither was there difference in blood pressure, waist circumference, BMI, or concentrations of blood lipids.

Conclusions

Hysterectomy seems to be associated with increased levels of serum inflammatory markers and increased diabetes medication, which in turn, may predispose individual to future cardiovascular events.     

Continuous venovenous renal replacement therapy using a conventional infusion pump

To evaluate continuous venovenous hemofiltration and hemodiafiltration with a conventional infusion pump in a pediatric sized animal model. Fourteen Maryland pigs weighing 8 to 13 kg were used. A conventional infusion pump (IVAC 571), with a flow of 900 ml/h and a pediatric hemofilter of 0.22 m2 were used. Ringer's solution was used for both the dialysate and the replacement fluid. Each experiment included 1 hour of hemofiltration and 1 hour of hemodiafiltration. Heart rate, arterial blood pressure, pH, Na, K, Cl, and hematocrit were measured every 30 minutes. Mean ultrafiltrate flow was 249.7 +/- 100.3 ml/hr, 240.5 +/- 109.5 ml/hr with hemofiltration and 271 +/- 101.1 ml/hr with hemodiafiltration, the differences not being significant. No significant changes were seen in heart rate, blood pressure, hematocrit, electrolytes, or pH. Pressure in the circuit rose from 107.7 +/- 70.3 mm Hg at the beginning of the experiment to 234.2 +/- 118.1 mm Hg after 2 hours (p < 0.05). The technique was well tolerated by all the pigs. Continuous venovenous hemofiltration and hemodiafiltration with a conventional infusion pump is a possible alternative to conventional methods of extrarenal replacement therapy in neonates and infants.     

Factors affecting the maturation of glomerular filtration rate and renal plasma flow in the new-born dog

1. The maturation of glomerular filtration rate was studied by comparison of thirty-six new-born mongrel dogs aged 1-35 days with six adult dogs.2. Under mannitol diuresis, glomerular filtration rate (GFR) rose from 0.16 ml. min(-1).g kidney(-1) at 1 day of age to 0.34 ml. min(-1).g kidney(-1) at 1 month of age. Adult GFR averaged 0.68 ml. min(-1).g(-1). There was good correlation of GFR with arterial blood pressure (r = 0.76, P < 0.001). Part of the statistical correlation of GFR with blood pressure was found to be independent of the relationship between blood pressure and age.3. Acute increases or decreases in blood pressure resulted in parallel changes in GFR in the puppies. There was no change of GFR with change of blood pressure in adult dogs. Carotid artery clamping, independent of blood pressure changes, produced increased renal vascular resistance and decreased GFR in the pups.4. Renal plasma flow (RPF) increased from 0.70 ml. min(-1).g(-1) at 1 day of age to 1.80 ml. min(-1).g(-1) at 1 month and showed good correlation with blood pressure (r = 0.67, P < 0.001). Filtration fraction (GFR/RPF) and renal vascular resistance did not vary with age in the pup and were the same as those for the adult.5. These results support the hypothesis that maturation of GFR and RPF are closely related to maturation of arterial blood pressure in the mongrel dog. The factors other than blood pressure which also affect renal maturation in the dog still need to be more clearly defined.     

Elevation of arterial blood pressure in the squirrel monkey at 10 degrees C.

Systemic arterial blood pressure, heart rate, and total body oxygen consumption were measured in seven unanesthetized squirrel monkeys exposed to ambient temperatures of 28 degrees C and 10 degrees C. At 28 degrees C, subjects sat quietly, the average mean arterial blood pressure was 116 +/- 16 (mean +/- SD, n - 7) mmHg, heart rate was 274 +/- 31 beats/min, and oxygen consumption was 14 +/- 1.4 ml/kg-min. At 10 degrees C, the animals shivered vigorously, the average mean arterial blood pressure was 139 +/- 16 mmHg, heart rate was 328 +/- 18 beats/min, and oxygen consumption was 31.6 +/- 3.9 ml/kg-min. Thus, the oxygen consumption more than doubled, the blood pressure rose by approximately 21%, and the heart rate by approximately 20%. Elevations in heart rate as well as systemic mean arterial blood pressure during exposure to low ambient temperature were probably mediated by sympathetic-adrenal discharges as well as by activity of skeletal muscles.     

Changes in cortical impedance and EEG activity induced by profound hypotension.

Fourteen late juvenile monkeys were subjected to a single 30-min episodes of markedhypotension using an infusion of trimethaphan. Afterward, blood pressure was rapidly restored to and maintained at preinsult levels with an intravenous drip of phenylephrine (.02 mg/ml). The respiratory gas tensions and pH of the arterial blood weremaintained within normal limits at all times. During the 30-min episodes, the cortical electrical impedence increased by a mean of 27% while the EEG frequencies and amplitudes decreased by 47 and 30%, respectively. The impedance and EEG activity generally altered at the same time but inversely to one another, although, on restoration of blood pressure, the impedance recovered within minutes while the EEG activity returned to normal only after 1 h. The impedance values and EEG activity of those animals that eventually died began to diverge significantly from the values of theanimals that were to survive at about 2.5 h after restoration of blood pressure.     

Vasopressor choice for hypotension in elective Cesarean section: ephedrine or phenylephrine?

Introduction

Hypotensive episodes are a common complication of spinal anesthesia during Cesarean section. The purpose of this study was to compare the effectiveness and the side effects of vasopressors, ephedrine and phenylephrine, administered for hypotension during elective Cesarean section under spinal anesthesia.

Material and methods

The study consisted of 100 selected ASA I/II females scheduled for elective Cesarean section under spinal anesthesia. Each patient was randomly assigned to one of the two double-blind study groups. Group E received 1 ml ephedrine (5 mg/ml) with normal saline if hypotension was present (n=50). Group P received 1 ml phenylephrine (100 µg/ml) with normal saline if hypotension developed (n=50). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) were compared within and between groups to basal levels at time increments of 0, 2, 4, 6, 8, 10, 15, 20, 25, 30, 45, and 60 min from start of surgery. Incidence of side effects and neonatal outcomes were studied between groups.

Results

All patients required vasopressor therapy for hypotension. Administration of phenylephrine was associated with significant drop in HR. Changes in SBP, DBP, and MAP were similar in both groups for most observed times. The incidences of nausea/vomiting and tachycardia were significantly higher in the ephedrine group.

Conclusions

Phenylephrine and ephedrine are acceptable choices to combat maternal hypotension related to spinal anesthesia in elective Cesarean section. Complications of intra-operative nausea and vomiting, tachycardia and bradycardia should be considered when choosing a vasopressor, suggesting phenylephrine may be more appropriate when considering maternal well-being.     

Design analysis of parallel plate and hollow fibres haemofilters

A theoretical model of mass transfer by ultrafiltration (u.f.) at large transmembranes pressures in parallel plate and hollow fibres haemofilters is presented. The analysis assumes that the maximum u.f. flow Q_FM is limited by protein concentration polarisation and that the concentration boundary layer is thin. It takes into account the decrease of local blood flow along the membrane and therefore remains valid when the u.f. flow rate is a large fraction of the incoming blood flow Q_bi. It is found that the ratio Q_FM/Q_bi increases nonlinearly with S/(Q_bid_h) where S is the membrane area and d_h the hydraulic diameter of the blood film. A parallel-plate haemofilter will have 20% more ultrafiltration than one of hollow fibre of the same membrane area and blood volume. However, if the two units have the same u.f. flow rate, the hollow fibre one will have the smaller blood volume. For a fibre type haemofilter at a given blood flow, Q_FM is a function of the total fibre length and is independent of fibre diameter. By using a blood film thickness in the vicinity of 150 μ, adequate clearances (0·4Q_bi) can be obtained with membranes areas of 0·6 to 0·7 m², significantly less than with present haemodialysers.     

Metabolic and blood pressure monitoring in diabetic renal failure

In a prospective study of eight patients with type I diabetic renal failure, metabolic and blood pressure monitoring was evaluated during progression to end-stage renal disease (ESRD). The mean observation time was 37 months. The mean glomerular filtration rate (GFR) fell significantly (from 33 to 16 ml/min) implying a mean deterioration rate of 0.57 ml/min/month. This rate showed significant correlation with mean arterial blood pressure at out-patient observations, but not with blood glucose monitored as 24-hour profile or with glycosylated hemoglobin. Patients with growth hormone values within the upper limit of the normal range showed faster decline of GFR than patients with low values. The study demonstrated that advanced diabetic renal failure may progress slowly to ESRD. The blood pressure pattern, but not blood glucose values, influenced significantly the deterioration rate of glomerular function.