51
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Huang ST, Yu TM, Ke TY, Wu MJ, Chuang YW, Li CY, Chiu CW, Lin CL, Liang WM, Chou TC, Kao CH. Syncope and Collapse Are Associated with an Increased Risk of Cardiovascular Disease and Mortality in Patients Undergoing Dialysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2082. [PMID: 30248947 PMCID: PMC6210976 DOI: 10.3390/ijerph15102082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 11/16/2022]
Abstract
Objective: This study explored the impact of syncope and collapse (SC) on cardiovascular events and mortality in patients undergoing dialysis. Methods: Patients undergoing dialysis with SC (n = 3876) were selected as the study cohort and those without SC who were propensity score-matched at a 1:1 ratio were included as controls. Major adverse cardiovascular events (MACEs), including acute coronary syndrome (ACS), arrhythmia or cardiac arrest, stroke, and overall mortality, were evaluated and compared in both cohorts. Results: The mean follow-up periods until the occurrence of ACS, arrhythmia or cardiac arrest, stroke, and overall mortality in the SC cohort were 3.51 ± 2.90, 3.43 ± 2.93, 3.74 ± 2.97, and 3.76 ± 2.98 years, respectively. Compared with the patients without SC, those with SC had higher incidence rates of ACS (30.1 vs. 24.7 events/1000 people/year), arrhythmia or cardiac arrest (6.75 vs. 3.51 events/1000 people/year), and stroke (51.6 vs. 35.7 events/1000 people/year), with higher overall mortality (127.7 vs. 77.9 deaths/1000 people/year). The SC cohort also had higher risks for ACS, arrhythmia or cardiac arrest, stroke, and overall mortality (adjusted hazard ratios: 1.28 (95% confidence interval (CI) = 1.11⁻1.46), 2.05 (95% CI = 1.50⁻2.82), 1.48 (95% CI = 1.33⁻1.66), and 1.79 (95% CI = 1.67⁻1.92), respectively) than did the non-SC cohort. Conclusion: SC was significantly associated with cardiovascular events and overall mortality in the patients on dialysis. SC may serve as a prodrome for cardiovascular comorbidities, thereby assisting clinicians in identifying high-risk patients.
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Affiliation(s)
- Shih-Ting Huang
- Division of Nephrology, Taichung Veterans General Hospital, Taichung 407, Taiwan.
- Graduate Institute of Public Health, China Medical University, Taichung 404, Taiwan.
| | - Tung-Min Yu
- Division of Nephrology, Taichung Veterans General Hospital, Taichung 407, Taiwan.
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung 404, Taiwan.
| | - Tai-Yuan Ke
- Division of Nephrology, Ministry of Health and Welfare Chiayi Hospital, Chiayi 600, Taiwan.
| | - Ming-Ju Wu
- Division of Nephrology, Taichung Veterans General Hospital, Taichung 407, Taiwan.
| | - Ya-Wen Chuang
- Division of Nephrology, Taichung Veterans General Hospital, Taichung 407, Taiwan.
- Graduate Institute of Public Health, China Medical University, Taichung 404, Taiwan.
| | - Chi-Yuan Li
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung 404, Taiwan.
- Department of Anesthesiology, China Medical University Hospital, Taichung 404, Taiwan.
| | - Chih-Wei Chiu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung 404, Taiwan.
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung 404, Taiwan.
- College of Medicine, China Medical University, Taichung 404, Taiwan.
| | - Wen-Miin Liang
- Graduate Institute of Biostatistics, China Medical University, Taichung 404, Taiwan.
| | - Tzu-Chieh Chou
- Department of Public Health, China Medical University, Taichung 404, Taiwan.
- Department of Health Risk Management, College of Public Health, China Medical University, Taichung 404, Taiwan.
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung 404, Taiwan.
- Department of Nuclear Medicine and PET Center, China Medical University, Taichung 404, Taiwan.
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung 404, Taiwan.
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Lee HF, See LC, Chan YH, Yeh YH, Wu LS, Liu JR, Tu HT, Wang CL, Kuo CT, Chang SH. End-stage renal disease patients using angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may reduce the risk of mortality: a Taiwanese Nationwide cohort study. Intern Med J 2018; 48:1123-1132. [DOI: 10.1111/imj.13971] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 05/06/2018] [Accepted: 05/17/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Hsin-Fu Lee
- Department of Cardiology, Chang Gung Memorial Hospital; Chang Gung University; Linkou Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Lai-Chu See
- Department of Public Health, College of Medicine; Chang Gung University; Taoyuan Taiwan
- Biostatistics Core Laboratory, Molecular Medicine Research Center; Chang Gung University; Taoyuan Taiwan
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine; Chang Gung Memorial Hospital; Linkou Taiwan
| | - Yi-Hsin Chan
- Department of Cardiology, Chang Gung Memorial Hospital; Chang Gung University; Linkou Taiwan
| | - Yung-Hsin Yeh
- Department of Cardiology, Chang Gung Memorial Hospital; Chang Gung University; Linkou Taiwan
| | - Lung-Sheng Wu
- Department of Cardiology, Chang Gung Memorial Hospital; Chang Gung University; Linkou Taiwan
| | - Jia-Rou Liu
- Department of Public Health, College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Hui-Tzu Tu
- Department of Public Health, College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Chun-Li Wang
- Department of Cardiology, Chang Gung Memorial Hospital; Chang Gung University; Linkou Taiwan
| | - Chi-Tai Kuo
- Department of Cardiology, Chang Gung Memorial Hospital; Chang Gung University; Linkou Taiwan
| | - Shang-Hung Chang
- Department of Cardiology, Chang Gung Memorial Hospital; Chang Gung University; Linkou Taiwan
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53
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Bazyluk A, Malyszko J, Zbroch E. Cardiovascular risk in chronic kidney disease: what is new in the pathogenesis and treatment? Postgrad Med 2018; 130:461-469. [PMID: 29846140 DOI: 10.1080/00325481.2018.1481714] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The prevalence of chronic kidney disease (CKD) has increased markedly over past decades due to the aging of the worldwide population. Despite the progress in the prevention and treatment, the cardiovascular (CV) morbidity and mortality remain high among patients with CKD. Although CKD is a progressive and irreversible condition, it is possible to slow decreasing kidney function, as well as the development and progression of associated with kidney disease comorbidities. Diabetes mellitus has become major cause of CKD worldwide. It is estimated that the prevalence of diabetes will increase from 425 million worldwide in 2017 to 629 million by 2045, substantially the percentage of diabetic nephropathy among CKD patients is set to rise markedly. The results of multicenter trials concerning novel antidiabetic drugs suggest that efficacy in reducing CV risk is independent of the improvement in glycemic control. This review discusses underlying causes of high CV risk and strategies reducing individual burden among CKD patients.
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Affiliation(s)
- Angelika Bazyluk
- a 2-nd Department of Nephrology and Hypertension with Dialysis Centre , Medical University of Białystok , Bialystok , Poland
| | - Jolanta Malyszko
- a 2-nd Department of Nephrology and Hypertension with Dialysis Centre , Medical University of Białystok , Bialystok , Poland.,b JM- Department of Nephrology, Dialysis and Internal Medicine , Warsaw Medical University , Warsaw , Poland
| | - Edyta Zbroch
- a 2-nd Department of Nephrology and Hypertension with Dialysis Centre , Medical University of Białystok , Bialystok , Poland
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Lin YH, Sung KT, Tsai CT, Wu PC, Lai YH, Lo CI, Yu FC, Wu HP, Lan WR, Kuo JY, Hou CJY, Yen CH, Peng MC, Hung TC, Hung CL, Lai E, Yeh HI. The relationship of renal function to segmental vascular stiffness, ankle-brachial index, and peripheral artery disease. J Clin Hypertens (Greenwich) 2018; 20:1027-1035. [PMID: 29749701 DOI: 10.1111/jch.13297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/21/2018] [Accepted: 04/02/2018] [Indexed: 12/21/2022]
Abstract
The authors consecutively assessed various arterial pulse-wave velocity (PWV) indices and ankle-brachial index (ABI) by an automatic device (VP2000, OMRON Health Care Co. Ltd., Kyota, Japan) in outpatients with ≥ 1 cardiovascular risk. PAD was defined as ABI ≤ 0.9. Among 2309 outpatients (mean age 62.4 years), worse renal function was associated with higher brachial-ankle PWV, heart-carotid PWV, heart-femoral PWV (hf-PWV), and lower ABI (all P < .001). Multivariate regression models showed independent associations between lower eGFR, lower ABI (Coef: 0.42 & 0.41 for right and left), higher hf-PWV (Coef: -11.4 [95% CI: -15.4, -7.3]) and greater PAD risk (adjusted OR: 0.83 [95% CI: 0.76, 0.91], all P < .05). eGFR set at 77 mL/min/1.73m2 was observed to be useful clinical cutoff (c-statistics: 0.67) for identifying PAD (P for ΔAUROC: .009; likelihood X2 : 93.82 to 137.43, P < .001) when superimposed on clinical risks. This study suggested early renal insufficiency is tightly linked to region-specific vascular stiffness and PAD.
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Affiliation(s)
- Yueh-Hung Lin
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Kuo-Tzu Sung
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Cheng-Ting Tsai
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Pei-Chen Wu
- Division of Nephrology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yau-Huei Lai
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan
| | - Chi-In Lo
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Fa-Chang Yu
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Hsu-Ping Wu
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan
| | - Wei-Ran Lan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Jen-Yuan Kuo
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei City, Taiwan
| | - Charles Jia-Yin Hou
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei City, Taiwan
| | - Chi-Hsuan Yen
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei City, Taiwan
| | - Ming-Cheng Peng
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ta-Chuan Hung
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei City, Taiwan
| | - Chung-Lieh Hung
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Edward Lai
- Ira A. Fulton School of Engineering, Arizona State University, Tempe, AZ, USA
| | - Hung-I Yeh
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
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Garadah TS, Thani KB, Sulibech L, Jaradat AA, Al Alawi ME, Amin H. Risk Stratification and in Hospital Morality in Patients Presenting with Acute Coronary Syndrome (ACS) in Bahrain. Open Cardiovasc Med J 2018. [PMID: 29541260 PMCID: PMC5838636 DOI: 10.2174/1874192401812010007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Risk factors and short-term mortality in patients presented with Acute Coronary Syndrome (ACS) in Bahrain has not been evaluated before. Aim: In this prospective observational study, we aim to determine the clinical risk profiles of patients with ACS in Bahrain and describe the incidence, pattern of presentation and predictors of in-hospital clinical outcomes after admission. Methods: Patients with ACS were prospectively enrolled over a 12 month period. The rate of incidence of risk factors in patients was compared with 635 non-cardiac patient admissions that matched for age and gender. Multiple logistic regression analysis was used to predict poor outcomes in patients with ACS. The variables were ages >65 years, body mass index (BMI) >28 kg/m2, GRACE (Global Registry of Acute Coronary Events) score >170, history of diabetes mellitus (DM), systolic hypertension >180 mmHg, level of creatinine >160 μmol/l and Heart Rate (HR) on admission >90 bpm, serum troponin rise and ST segment elevation on the ECG. Results: Patients with ACS (n=635) were enrolled consecutively. Mean age was 61.3 ± 13.2 years, with 417 (65.6%) male. Mean age for patients with ST-segment elevation myocardial infarction (STEMI, n=156) compared with non-STEMI (NSTEMI, n=158) and unstable angina (UA, n=321) was 56.5± 12.8 vs 62.5±14.0 years respectively. In-hospital mortality was 5.1%, 3.1% and 2.5% for patients with STEMI, NSTEMI, and UA, respectively. In STEMI patients, thrombolytic therapy was performed in 88 (56.5%) patients and 68 (43.5%) had primary coronary angioplasty (PCI). The predictive value of different clinical variables for in-hospital mortality and cardiac events in the study were: 2.8 for GRACE score >170, 3.1 for DM, 2.2 for SBP >180 mmHg, 1.4 for age >65 years, 1.8 for BMI >28, 1.7 for creatinine >160 μmol/L, 2.1 for HR >90 bpm, 2.2 for positive serum troponin and 2.3 for ST elevation. Conclusion: Patients with STEMI compared with NSTEMI and UA were of younger age. There was higher in-hospital mortality in STEMI compared with NSTEMI and UA patients. The most significant predictors of death or cardiac events on admission in ACS were DM, GRACE Score >170, systolic hypertension >180 mmHg, positive serum troponin and HR >90 bpm.
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Affiliation(s)
- Taysir S Garadah
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
| | - Khalid Bin Thani
- Salmaniya Medical Complex, Ministry of Health, Manama, Kingdom of Bahrain
| | - Leena Sulibech
- Bahrain Defense Force Hospital, Al Riffa, Kingdom of Bahrain
| | - Ahmed A Jaradat
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
| | - Mohamed E Al Alawi
- Salmaniya Medical Complex, Ministry of Health, Manama, Kingdom of Bahrain
| | - Haytham Amin
- Bahrain Defense Force Hospital, Al Riffa, Kingdom of Bahrain
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Ramphul R, Fernandez M, Firoozi S, Kaski JC, Sharma R, Banerjee D. Assessing cardiovascular risk in chronic kidney disease patients prior to kidney transplantation: clinical usefulness of a standardised cardiovascular assessment protocol. BMC Nephrol 2018; 19:2. [PMID: 29310598 PMCID: PMC5759801 DOI: 10.1186/s12882-017-0795-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 12/12/2017] [Indexed: 12/01/2022] Open
Abstract
Background Despite pre-kidney-transplant cardiovascular (CV) assessment being routine care to minimise perioperative risk, the utility of such assessment is not well established. The study reviewed the evaluation and outcome of a standardised CV assessment protocol. Methods Data were analysed for 231 patients (age 53.4 ± 12.9 years, diabetes 34.6%) referred for kidney transplantation between 1/2/2012-31/12/2014. One hundred forty-three patients were high-risk (age > 60 years, diabetes, CV disease, heart failure, peripheral vascular disease) and offered dobutamine stress echocardiography (DSE); 88 patients were low-risk and offered ECG and echocardiography with/without exercise treadmill test. Results At the end of follow-up (579 ± 289 days), 35 patients underwent kidney transplantation and 50 were active on the waitlist. There were 24 events (CV or death), none were perioperative. One hundred fifteen patients had DSE with proportionally more events in DSE-positive compared to DSE-negative patients (6/34 vs. 7/81, p = 0.164). In 42 patients who underwent coronary angiography due to a positive DSE or ischaemic heart disease symptoms, 13 (31%) had events, 6 were suspended, 11 removed from waitlist, 3 wait-listed, 1 transplanted and 17 still undergoing assessment. Patients with significant coronary artery disease requiring intervention had poorer event-free survival compared to those without intervention (56% vs. 83% at 2 years, p = 0.044). However, the association became non-significant after correction for CV risk factors (HR = 3.17, 95% CI 0.51–19.59, p = 0.215). Conclusions The stratified CV risk assessment protocol using DSE in all high-risk patients was effective in identifying patients with coronary artery disease. The coronary angiograms identified the event-prone patients effectively but coronary interventions were not associated with improved survival.
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Affiliation(s)
- Robin Ramphul
- Renal and Transplantation Unit, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - Maria Fernandez
- Renal and Transplantation Unit, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - Sam Firoozi
- Cardiology Clinical Academic Group, Molecular and Cell Sciences Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Juan C Kaski
- Cardiology Clinical Academic Group, Molecular and Cell Sciences Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Rajan Sharma
- Cardiology Clinical Academic Group, Molecular and Cell Sciences Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Debasish Banerjee
- Renal and Transplantation Unit, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK.
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Long-term patient and kidney survival after coronary artery bypass grafting, percutaneous coronary intervention, or medical therapy for patients with chronic kidney disease. Coron Artery Dis 2018; 29:8-16. [DOI: 10.1097/mca.0000000000000557] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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58
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Sato T, Aoki J, Kozuma K, Maruyama Y, Nasu K, Otsuka M, Ando K, Hibi K, Uehara Y, Tanabe K, Ikari Y. Impact of Serum Phosphorus Levels on Outcomes After Implantation of Drug-Eluting Stents in Patients on Hemodialysis. Circ J 2017; 82:388-395. [PMID: 29057771 DOI: 10.1253/circj.cj-17-0649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Elevated serum phosphorus level is an important risk factor for cardiovascular death in general patients on hemodialysis (HD). However, the effect of serum phosphorus levels on outcomes after drug-eluting stent (DES) implantation in HD patients is unknown.Methods and Results:This was a post-hoc study of the OUCH study series, a series of prospective multicenter registries of HD patients who underwent DES implantation comprising 359 patients from 31 centers in Japan. Patients were categorized into 3 groups according to their preprocedural serum phosphorus levels. The 1-year clinical outcomes of the 336 patients treated for de novo lesions were evaluated. Compared with patients with high (>5.5 mg/dL; n=65) or normal (3.5-5.5 mg/dL; n=219) serum phosphorus levels, those with low serum phosphorus levels (<3.5 mg/dL; n=52) had significantly fewer target lesion revascularization events (13.9% vs. 16.9% vs. 1.9%; P=0.0090) and major adverse cardiac and cerebrovascular events (29.2% vs. 31.1% vs. 13.5%; P=0.032). Multivariate logistic regression analysis revealed that low serum phosphorus level was an independent negative predictor for major adverse cardiac and cerebrovascular events (adjusted odds ratio, 0.31; 95% confidence interval, 0.12-0.70; P=0.0036). CONCLUSIONS Lowering of serum phosphorus levels beyond the current recommended range may be considered in HD patients who undergo DES implantation.
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Affiliation(s)
| | - Jiro Aoki
- Division of Cardiology, Mitsui Memorial Hospital
| | - Ken Kozuma
- Division of Cardiology, Department of Internal Medicine, Teikyo University School of Medicine
| | | | - Kenya Nasu
- Division of Cardiology, Toyohashi Heart Center
| | - Masaya Otsuka
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | - Kiyoshi Hibi
- Department of Cardiology, Yokohama City University Medical Center
| | | | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital
| | - Yuji Ikari
- Division of Cardiology, Tokai University School of Medicine
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Halawa A, Rowe S, Roberts F, Nathan C, Hassan A, Kumar A, Suvakov B, Edwards B, Gray C. A Better Journey for Patients, a Better Deal for the NHS: The Successful Implementation of an Enhanced Recovery Program After Renal Transplant Surgery. EXP CLIN TRANSPLANT 2017; 16:127-132. [PMID: 28836932 DOI: 10.6002/ect.2016.0304] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Our aim was to apply the principles of enhanced recovery in renal transplant recipients and to assess the changes in the quality of patient care and patient satisfaction. MATERIALS AND METHODS Our study included 286 consecutive renal transplant patients. Of these, 135 patients went through the enhanced recovery program and 151 patients had traditional recovery. Patient education and discharge planning were commenced on admission. For enhanced recovery, prolonged preoperative fasting was avoided by carbohydrate loading. Goal-directed fluid management was aided by transesophageal Doppler to avoid central line insertion. Intrathecal diamorphine and ultrasonography-guided transversus abdominis plane blocks were used to achieve adequate analgesia. Patients started oral intake a few hours postoperatively. The urinary catheter was removed 2 to 4 days after transplant. RESULTS The postoperative patient-controlled analgesia requirement for morphine was significantly reduced in the enhanced recovery versus traditional recovery group (median of 9.5 vs 47 mg; P < 0.001). The length of stay was significantly reduced for living-donor (median 5 vs 7 days; P < .001) and for deceased-donor transplant recipients (median 5 vs 8.5 days; P < 0.001) with enhanced recovery versus recipients who had traditional recovery. Implementing enhanced recovery saves £2160 per living-donor transplant and £3078 per deceased-donor transplant. In the enhanced recovery group, readmission within 10 days after transplant was 5%. CONCLUSIONS Our service evaluation demonstrated that enhanced recovery benefits both types of renal transplant (living and deceased grafts) procedures, with excellent patient satisfaction and reduction of hospital length of stay.
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Affiliation(s)
- Ahmed Halawa
- From the Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
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Ohtake T, Kobayashi S. Impact of vascular calcification on cardiovascular mortality in hemodialysis patients: clinical significance, mechanisms and possible strategies for treatment. RENAL REPLACEMENT THERAPY 2017. [DOI: 10.1186/s41100-017-0094-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Kobayashi S. Cardiovascular Events in Hemodialysis Patients: Challenging against Vascular Calcification. Ann Vasc Dis 2017; 10:1-7. [PMID: 29034013 PMCID: PMC5579802 DOI: 10.3400/avd.ra.17-00006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 01/20/2017] [Indexed: 12/21/2022] Open
Abstract
Particularly in patients with hemodialysis, cardiovascular mortality rate is extremely high. Polyvascular diseases develop at an early stage of chronic kidney disease (CKD). Pathophysiology includes insulin resistance and/or imbalance between nitric oxide (NO) and endothelin bioavailability as well as oxidative stress. The understanding in pathophysiology of vascular calcification and strategic treatment is a critical issue to achieve favorable outcome for the patients with CKD. In this article, we aim to review the cardiovascular disease for the patients with CKD with a particular emphasis on the clinical aspects of polyvascular disease. Finally, we address to detect microcirculatory impairment and eradicate vascular calcification as early as possible prior to renal replacement therapy. (This is a translation of Jpn J Vasc Surg 2016; 25: 359-365.).
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Affiliation(s)
- Shuzo Kobayashi
- Hemodialysis Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
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62
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Matsubara Y, Kimachi M, Fukuma S, Onishi Y, Fukuhara S. Development of a new risk model for predicting cardiovascular events among hemodialysis patients: Population-based hemodialysis patients from the Japan Dialysis Outcome and Practice Patterns Study (J-DOPPS). PLoS One 2017; 12:e0173468. [PMID: 28273175 PMCID: PMC5342257 DOI: 10.1371/journal.pone.0173468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 02/22/2017] [Indexed: 01/30/2023] Open
Abstract
Background Cardiovascular (CV) events are the primary cause of death and becoming bedridden among hemodialysis (HD) patients. The Framingham risk score (FRS) is useful for predicting incidence of CV events in the general population, but is considerd to be unsuitable for the prediction of the incidence of CV events in HD patients, given their characteristics due to atypical relationships between conventional risk factors and outcomes. We therefore aimed to develop a new prognostic prediction model for prevention and early detection of CV events among hemodialysis patients. Methods We enrolled 3,601 maintenance HD patients based on their data from the Japan Dialysis Outcomes and Practice Patterns Study (J-DOPPS), phases 3 and 4. We longitudinaly assessed the association between several potential candidate predictors and composite CV events in the year after study initiation. Potential candidate predictors included the component factors of FRS and other HD-specific risk factors. We used multivariable logistic regression with backward stepwise selection to develop our new prediction model and generated a calibration plot. Additinially, we performed bootstrapping to assess the internal validity. Results We observed 328 composite CV events during 1-year follow-up. The final prediction model contained six variables: age, diabetes status, history of CV events, dialysis time per session, and serum phosphorus and albumin levels. The new model showed significantly better discrimination than the FRS, in both men (c-statistics: 0.76 for new model, 0.64 for FRS) and women (c-statistics: 0.77 for new model, 0.60 for FRS). Additionally, we confirmed the consistency between the observed results and predicted results using the calibration plot. Further, we found similar discrimination and calibration to the derivation model in the bootstrapping cohort. Conclusions We developed a new risk model consisting of only six predictors. Our new model predicted CV events more accurately than the FRS.
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Affiliation(s)
- Yukiko Matsubara
- Department of Artificial Organs, Akane-Foundation Omachi Tsuchiya Clinic, and Hiroshima Medical University, Hiroshima, Japan
| | - Miho Kimachi
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan
| | - Shingo Fukuma
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan
- Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
| | - Yoshihiro Onishi
- Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan
| | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
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de Bie MK, Buiten MS, Rotmans JI, Hogenbirk M, Schalij MJ, Rabelink TJ, Jukema JW. Abdominal aortic calcification on a plain X-ray and the relation with significant coronary artery disease in asymptomatic chronic dialysis patients. BMC Nephrol 2017; 18:82. [PMID: 28253835 PMCID: PMC5335756 DOI: 10.1186/s12882-017-0480-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 02/09/2017] [Indexed: 01/30/2023] Open
Abstract
Background Coronary artery disease (CAD) is common in asymptomatic chronic dialysis patients and plays an important role in their poor survival. Early identification of these high-risk patients could improve treatment and reduce mortality. Abdominal aortic calcification (AAC) has previously been associated with CAD in autopsy studies. Since the AAC can be quantified easily using a lateral lumbar X-ray we hypothesized that the extent of AAC as assessed on a lateral lumbar X-ray might be predictive of the presence of significant CAD in dialysis patients. Methods All patients currently enrolled in the ICD2 trial without a history of CABG or a PCI with stent implantation were included in this study. All patients underwent CT-angiography (CTA) and a lateral X-ray of the abdomen. AAC on X-ray was quantified using a previously validated scoring system whereupon the association between AAC and the presence of significant CAD was assessed. Results A total of 90 patients were included in this study (71% male, 67 ± 7 years old). Forty-six patients were found to have significant CAD. AAC-score was significantly higher in patients with CAD (10.1 ± 4.9 vs 6.3 ± 4.6 (p < 0.05). Multivariate regression analysis revealed that AAC score is an independent predictor for the presence of CAD with a 1,2 fold higher risk per point increase (p < 0.01). The AAC score has a sensitivity of 85% and a specificity of 57% for the presence of significant CAD. Conclusion This study shows that abdominal aortic calcification as assessed on a lateral lumbar X-ray is predictive for the presence of significant coronary artery disease in asymptomatic dialysis patients. This simple, non-invasive and cheap screening method could contribute to early identification of patients eligible for further screening of CAD. Trial registration NTR948, registered 10-4-2007 ; ISRCTN20479861, registered 2-5-2007
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Affiliation(s)
- M K de Bie
- Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - M S Buiten
- Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - J I Rotmans
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - M Hogenbirk
- Department of Nephrology, Rijnstate Ziekenhuis, Arnhem, The Netherlands
| | - M J Schalij
- Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - T J Rabelink
- Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - J W Jukema
- Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
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Relationship between history of coronary heart disease at dialysis initiation and onset of events associated with heart disease: a propensity-matched analysis of a prospective cohort study. BMC Nephrol 2017; 18:79. [PMID: 28245790 PMCID: PMC5331727 DOI: 10.1186/s12882-017-0495-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 02/23/2017] [Indexed: 01/26/2023] Open
Abstract
Background Chronic kidney disease (CKD) is an independent risk factor for cardiovascular disease (CVD) events, and a number of reports have shown a relationship between CKD and CVD in pre-dialysis or maintenance dialysis patients. However, few studies have reported serial observations during dialysis initiation and maintenance. Therefore, we examined whether the incidence of heart disease events differed between CKD patients with and without a history of coronary heart disease (CHD) at dialysis initiation. Methods The subjects were patients in the 17 centers participating in the Aichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis (AICOPP) from October 2011 to September 2013. We excluded nine patients whose outcomes were unknown, as determined by a survey conducted at the end of March 2015. Thus, we enrolled 1,515 subjects into the study. We classified patients into 2 groups according to the history of CHD (i.e., a CHD group and a non-CHD group). Propensity scores (PS) represented the probability of being assigned to a group with or without a history of CHD. Onset of heart disease events and associated mortality and all-cause mortality were compared in PS-matched patients by using the log-rank test for Kaplan-Meier curves. Factors contributing to heart disease events were examined using stepwise multivariate Cox proportional hazards analysis. Results There were 254 patients in each group after PS-matching. During observation, heart disease events occurred in 85 patients (33.5%) in the CHD group and 48 (18.9%) patients in the non-CHD group. The incidence was significantly higher in the CHD group (p < 0.0001). The CHD group was associated with higher incidence of heart disease events (vs. the non-CHD group, hazard ratio = 1.750, 95% confidence interval = 1.160–2.639). In addition, comorbidities such as diabetes mellitus, low body mass index, and low serum high-density lipoprotein cholesterol were associated with higher incidence of events. Conclusion History of CHD at dialysis initiation was associated with a higher incidence of heart disease events and mortality and all-cause mortality. Trial registration UMIN 000007096. Registered 18 January 2012. Electronic supplementary material The online version of this article (doi:10.1186/s12882-017-0495-8) contains supplementary material, which is available to authorized users.
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Makar MS, Pun PH. Sudden Cardiac Death Among Hemodialysis Patients. Am J Kidney Dis 2017; 69:684-695. [PMID: 28223004 DOI: 10.1053/j.ajkd.2016.12.006] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 12/12/2016] [Indexed: 02/07/2023]
Abstract
Hemodialysis patients carry a large burden of cardiovascular disease; most onerous is the high risk for sudden cardiac death. Defining sudden cardiac death among hemodialysis patients and understanding its pathogenesis are challenging, but inferences from the existing literature reveal differences between sudden cardiac death among hemodialysis patients and the general population. Vascular calcifications and left ventricular hypertrophy may play a role in the pathophysiology of sudden cardiac death, whereas traditional cardiovascular risk factors seem to have a more muted effect. Arrhythmic triggers also differ in this group as compared to the general population, with some arising uniquely from the hemodialysis procedure. Combined, these factors may alter the types of terminal arrhythmias that lead to sudden cardiac death among hemodialysis patients, having important implications for prevention strategies. This review highlights current knowledge on the epidemiology, pathophysiology, and risk factors for sudden cardiac death among hemodialysis patients. We then examine strategies for prevention, including the use of specific cardiac medications and device-based therapies such as implantable defibrillators. We also discuss dialysis-specific prevention strategies, including minimizing exposure to low potassium and calcium dialysate concentrations, extending dialysis treatment times or adding sessions to avoid rapid ultrafiltration, and lowering dialysate temperature.
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Affiliation(s)
- Melissa S Makar
- Duke Clinical Research Institute, Durham, NC; Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC.
| | - Patrick H Pun
- Duke Clinical Research Institute, Durham, NC; Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC
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66
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Dhondup T, Qian Q. Electrolyte and Acid-Base Disorders in Chronic Kidney Disease and End-Stage Kidney Failure. Blood Purif 2017; 43:179-188. [PMID: 28114143 DOI: 10.1159/000452725] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The kidneys play a pivotal role in the regulation of electrolyte and acid-base balance. With progressive loss of kidney function, derangements in electrolytes and acid-base inevitably occur and contribute to poor patient outcomes. As chronic kidney disease (CKD) has become a worldwide epidemic, medical providers are increasingly confronted with such problems. Adequate diagnosis and treatment will minimize complications and can potentially be lifesaving. In this review, we discuss the current understanding of the disease process, clinical presentation, diagnosis and treatment strategies, integrating up-to-date knowledge in the field. Although electrolyte and acid-base derangements are significant causes of morbidity and mortality in CKD and end-stage renal disease patients, they can be effectively managed through a timely institution of combined preventive measures and pharmacological therapy. Exciting advances and several upcoming outcome trials will provide further information to guide treatment and improve patient outcomes.
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Affiliation(s)
- Tsering Dhondup
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, College of Medicine, Rochester, MN, USA
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Abstract
Cardiovascular disease is a major concern for patients with end-stage renal disease (ESRD), especially those on hemodialysis. ESRD patients with coronary artery disease often do not have symptoms or present with atypical symptoms. Coronary lesions in ESRD patients are characterized by increased media thickness, infiltration and activation of macrophages, and marked calcification. Several studies showed worsened clinical outcomes after coronary revascularization, which were dependent on the severity of renal dysfunction. ESRD patients on hemodialysis have the most severe renal dysfunction; thus, the clinical outcomes are worse in these patients than in those with other types of renal dysfunction. Medications for primary or secondary cardiovascular prevention are also insufficient in ESRD patients. Efficacy of drug-eluting stents is inferior in ESRD patients, compared to the excellent outcomes observed in patients with normal renal function. Unsatisfactory outcomes with trials targeting cardiovascular disease in patients with ESRD emphasize a large potential to improve outcomes. Thus, optimal strategies for diagnosis, prevention, and management of cardiovascular disease should be modified in ESRD patients.
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Affiliation(s)
- Jiro Aoki
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yuji Ikari
- Department of Cardiovascular Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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68
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Skin perfusion pressure predicts mortality in hemodialysis patients: long term follow-up. RENAL REPLACEMENT THERAPY 2016. [DOI: 10.1186/s41100-016-0078-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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69
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David C, Bover J, Voiculet C, Peride I, Petcu LC, Niculae A, Covic A, Checherita IA. Coronary risk score for mineral bone disease in chronic non-diabetic hemodialysis patients: results from a prospective pilot study. Int Urol Nephrol 2016; 49:689-700. [DOI: 10.1007/s11255-016-1481-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 12/07/2016] [Indexed: 12/27/2022]
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70
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Coronary artery disease screening and prognosis in incident dialysis patients. RENAL REPLACEMENT THERAPY 2016. [DOI: 10.1186/s41100-016-0033-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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71
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Iwasaki M, Yamazaki K, Ikeda N, Tanaka Y, Hayashi T, Kubo S, Matsukane A, Hase H, Joki N. Point of care assessment of cardiac troponin T level in CKD patients with chest symptom. Ren Fail 2016; 39:166-172. [PMID: 27846783 PMCID: PMC6014468 DOI: 10.1080/0886022x.2016.1256311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
We challenged to identify the cutoff value of cTnT in chronic kidney disease (CKD) patients by point of care assessment way. A single center, prospective cross-sectional study was planned and performed. 201 consecutive patients who were visited emergency room for chest symptoms were enrolled in this study. All patients were performed routine practice for differential diagnosis of chest symptom by cardiologist. Simultaneously, semiquantitative measurement of cTnT was performed using same blood sampling on the blind condition to cardiologists for this study. Study patients were divided into four groups according to the estimated glomerular filtration rate (eGFR), CKD1-2, CKD3, CKD4-5, and CKD5D. Usefulness of semiquantitative measurement for diagnosing ACEs was investigated in each group. 77 (38%) of total patient was diagnosed as acute coronary events (ACEs). About 50% of patients were showing cTnT level less than 0.03 ng/mL. The cTnT level over 0.1 ng/mL was found in 30% of total subjects. Mean quantitative value of cTnT was 0.29 ± 0.57 ng/mL in total subjects. Estimated cutoff value in CKD3 patients was 0.088 ng/mL with a sensitivity of 59.3% and specificity of 80.0%. Interestingly, the cutoff values of CKD1-2, CKD4-5, and CKD5D were 0.047, 0.18, and 0.27 respectively, which are half, two times, and three times of CKD3 cutoff value 0.088. The specificities of four cutoff values in each CKD group were showing over 80%, which is higher than sensitivity, respectively. In CKD patients, semiquantitative, point of care assessment of cTnT could be a useful tool for screening for ACEs.
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Affiliation(s)
- Masaki Iwasaki
- a Division of Nephrology , Toho University Ohashi Medical Center , Tokyo , Japan
| | - Kenji Yamazaki
- b Divisions of Cardiovascular Medicine , Odawara Cardiovascular Hospital , Kanagawa , Japan
| | - Nobutaka Ikeda
- c Divisions of Cardiovascular Medicine , Toho University Ohashi Medical Center , Tokyo , Japan
| | - Yuri Tanaka
- a Division of Nephrology , Toho University Ohashi Medical Center , Tokyo , Japan
| | - Toshihide Hayashi
- a Division of Nephrology , Toho University Ohashi Medical Center , Tokyo , Japan
| | - Shun Kubo
- a Division of Nephrology , Toho University Ohashi Medical Center , Tokyo , Japan
| | - Ai Matsukane
- a Division of Nephrology , Toho University Ohashi Medical Center , Tokyo , Japan
| | - Hiroki Hase
- a Division of Nephrology , Toho University Ohashi Medical Center , Tokyo , Japan
| | - Nobuhiko Joki
- a Division of Nephrology , Toho University Ohashi Medical Center , Tokyo , Japan
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Choong Hou K, Sin Yoong Kong K, Kee Yi Shern T, Tan Wei Chieh J. Impact of Chronic Kidney Insufficiency on Cardiovascular Outcomes in Patients that Undergo Coronary Revascularization: A Historical Review. ACTA ACUST UNITED AC 2016; 24:8. [PMID: 27917389 PMCID: PMC5110577 DOI: 10.7603/s40602-016-0008-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Chronic kidney disease (CKD) is associated with poorer short and long-term cardiovascular morbidity and mortality. Even after the commencement of haemodialysis in end stage renal failure patients, mortality exceeds 20% in the first year1. More than 50% of these deaths are contributed by cardiovascular diseases (CVD), of which 20% are caused by acute myocardial infarction2. Consequent to these findings, the degree and impact of coronary revascularization on CKD patients represents a clinical challenge, especially in the setting of advanced stages of CKD.
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Affiliation(s)
- Koh Choong Hou
- Department of Cardiovascular Medicine, National Heart Centre Singapore, 5 Hospital Drive, Singapore, Singapore 169609
| | - Kenny Sin Yoong Kong
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, 5 Hospital Drive, Singapore, Singapore 169609
| | - Terence Kee Yi Shern
- Department of Renal Medicine, Singapore General Hospital, Outram Road, Singapore, Singapore 169608
| | - Jack Tan Wei Chieh
- Department of Cardiovascular Medicine, National Heart Centre Singapore, 5 Hospital Drive, Singapore, Singapore 169609
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73
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Hayashi T, Joki N, Tanaka Y, Hase H. Anaemia and early phase cardiovascular events on haemodialysis. Nephrology (Carlton) 2016; 20 Suppl 4:1-6. [PMID: 26456311 DOI: 10.1111/nep.12642] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2015] [Indexed: 01/30/2023]
Abstract
Although the mechanism of the cardio-renal anaemia syndrome (CRAS) has been elucidated in considerable detail over the past decade, cardiovascular disease (CVD) remains a leading cause of death among patients with end-stage kidney disease (ESKD) undergoing haemodialysis, and these patients' cardiovascular mortality is greater than that of the general population. Recent studies have reported that the CVD risk increases with advancing chronic kidney disease (CKD) stage. Furthermore, the incidence of cardiovascular events is highest during the first week after dialysis initiation, with increased risk in incident haemodialysis patients. This accumulated evidence demonstrates that how patients are managed during the pre-dialysis phase may have important implications on long-term outcomes in ESKD. Anaemia, a non-traditional risk factor for CVD, advances exponentially along with declining kidney function due to insufficient erythropoietin production. Anaemia causes functional abnormalities of the heart, as represented by cardiac hypertrophy, which results from increased cardiac workload induced by an increased preload. Left ventricular hypertrophy (LVH), a traditional risk factor for CVD, is especially associated with advanced CKD stage and could be a major risk factor for cardiovascular complications such as ischaemic heart disease, heart failure, and sudden cardiac death. In ESKD, anaemia develops more severely and requires a higher amount of erythropoiesis-stimulating agent (ESA) therapy before dialysis initiation. This suggests that improvement in anaemia management during the pre-dialysis phase may have a beneficial effect on cardiac hypertrophy and contribute to reducing the CVD risk after initiating haemodialysis.
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Affiliation(s)
- Toshihide Hayashi
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Nobuhiko Joki
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yuri Tanaka
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Hiroki Hase
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
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Nishimura M, Watanabe K, Kitamura Y, Nagashima T, Tokoro T, Takatani T, Sato N, Yamazaki S, Hashimoto T, Kobayashi H, Ono T. Possible Inhibitory Effect of Erythropoiesis-Stimulating Agents at the Predialysis Stage on Early-Phase Coronary Events after Hemodialysis Initiation. Cardiorenal Med 2016; 7:21-30. [PMID: 27994599 PMCID: PMC5159719 DOI: 10.1159/000448009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 06/17/2016] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND We examined whether the use of erythropoiesis-stimulating agents (ESAs) to correct anemia at the predialysis stage could inhibit early-phase coronary events after hemodialysis initiation. METHODS We enrolled 242 patients with chronic kidney disease who had received continued medical treatments and initiated maintenance hemodialysis from 1 September 2000 to 31 December 2014 at Toujinkai Hospital. Patients with a previous history of blood transfusion or any cardiovascular events or interventions were excluded. The coronary events were followed for 1 year after initiation of hemodialysis. RESULTS Coronary events occurred in 51 of 242 patients: 10 patients had acute coronary syndrome [9 with percutaneous coronary intervention (PCI), 1 without intervention], and 41 had elective coronary revascularization (38 PCI and 3 coronary artery bypass graft). ESA was administered in 118 of 242 patients (48.8%). In stepwise logistic analysis, coronary events were positively associated with nonuse of ESA at the predialysis stage (odds ratio 2.66, p = 0.005) and diabetes mellitus (odds ratio 5.33, p < 0.001). When dividing the patients into 4 subgroups by blood hemoglobin (Hb) level (8.5 g/dl) and the use/nonuse of ESA, coronary event-free survival rates were higher (p = 0.005) in those with Hb ≥8.5 g/dl, ESA+ (86.6%, n = 82) and tended to be higher (p = 0.055) in those with Hb <8.5 g/dl, ESA+ (86.1%, n = 36) than in patients with Hb <8.5 g/dl, ESA- (68.6%, n = 86) in a Kaplan-Meier analysis. CONCLUSIONS The use of ESA to correct anemia at the predialysis stage may inhibit early-phase coronary events after hemodialysis initiation.
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Affiliation(s)
| | | | - Yuki Kitamura
- Department of Urology, Toujinkai Hospital, Kyoto, Japan
| | | | - Toshiko Tokoro
- Department of Nephrology, Toujinkai Hospital, Kyoto, Japan
| | - Toru Takatani
- Department of Nephrology, Toujinkai Hospital, Kyoto, Japan
| | - Nodoka Sato
- Department of Urology, Toujinkai Hospital, Kyoto, Japan
| | | | | | | | - Toshihiko Ono
- Department of Urology, Toujinkai Hospital, Kyoto, Japan
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75
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Kobayashi S. Cardiovascular events in chronic kidney disease (CKD)—an importance of vascular calcification and microcirculatory impairment. RENAL REPLACEMENT THERAPY 2016. [DOI: 10.1186/s41100-016-0062-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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76
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Bangalore S. Diagnostic, Therapeutic, and Clinical Trial Conundrum of Patients With Chronic Kidney Disease. JACC Cardiovasc Interv 2016; 9:2110-2112. [DOI: 10.1016/j.jcin.2016.08.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 08/16/2016] [Accepted: 08/22/2016] [Indexed: 11/26/2022]
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James MT, Wilton SB, Clement FM, Ghali WA, Knudtson ML, Tan Z, Tonelli M, Hemmelgarn BR, Norris CM. Kidney Function Does Not Modify the Favorable Quality of Life Changes Associated With Revascularization for Coronary Artery Disease: Cohort Study. J Am Heart Assoc 2016; 5:JAHA.116.003642. [PMID: 27436303 PMCID: PMC5015401 DOI: 10.1161/jaha.116.003642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Although patients with kidney disease have potential to benefit from revascularization, they are also at higher risk of complications, which may affect quality of life. Methods and Results We studied a cohort of 8198 adults who underwent coronary angiography in Alberta, between 2004 and 2008, and completed health‐related quality‐of‐life (HR‐QOL) surveys. Changes in HR‐QOL measures were most favorable among patients who received coronary artery bypass graft (CABG), but did not significantly differ by kidney function within groups of patients who received CABG, percutaneous coronary intervention (PCI), or medical therapy (P value for interaction between estimated glomerular filtration rate [eGFR] and revascularization status >0.10 for all outcomes). Among those who received CABG, the adjusted mean EuroQol 5 dimensions (EQ‐5D) utility score for those with eGFR >90 mL/min per 1.73 m2 increased by 0.11 (95% CI, 0.09–0.14) and for those with eGFR <30 mL/min per 1.73m2 by 0.13 (95% CI, 0.05–0.21). The adjusted mean EQ‐5D utility score also increased similarly at all levels of eGFR for those who received PCI and for those who received medical management. Mean changes in Seattle Angina Questionnaire (SAQ) scores were also similar across all levels of eGFR within each treatment group for the quality of life, angina frequency, angina stability, physical limitations, and treatment satisfaction domains of the SAQ. Among those who received CABG, the adjusted mean SAQ quality of life score for those with eGFR >90 mL/min per 1.73m2 increased by 22.1 (95% CI, 18.5–25.7) and for those with eGFR <30 mL/min per 1.73m2 by 14.0 (95% CI, 2.31–25.63). Conclusions Changes in HR‐QOL do not vary by kidney function among patients selected for CABG, PCI, or medical management of coronary disease.
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Affiliation(s)
- Matthew T James
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada Department of Community Health Sciences, University of Calgary, Alberta, Canada
| | - Stephen B Wilton
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada Department of Community Health Sciences, University of Calgary, Alberta, Canada
| | - Fiona M Clement
- Department of Community Health Sciences, University of Calgary, Alberta, Canada
| | - William A Ghali
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada Department of Community Health Sciences, University of Calgary, Alberta, Canada
| | - Merril L Knudtson
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Zhi Tan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada Department of Community Health Sciences, University of Calgary, Alberta, Canada
| | - Brenda R Hemmelgarn
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada Department of Community Health Sciences, University of Calgary, Alberta, Canada
| | - Colleen M Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Lien CT, Tsai CC, Chen CA, Kuo C, Tsai MY. Serum ferritin is an independent factor in coronary artery stenosis among hemodialysis patients. Int J Hematol 2016; 104:440-5. [DOI: 10.1007/s12185-016-2045-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/15/2016] [Accepted: 06/16/2016] [Indexed: 10/21/2022]
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Hayashi T, Kimura T, Yasuda K, Sasaki K, Obi Y, Rakugi H, Isaka Y. Cardiac troponin T elevation at dialysis initiation is associated with all-cause and cardiovascular mortality on dialysis in patients without diabetic nephropathy. Clin Exp Nephrol 2016; 21:333-341. [PMID: 27178276 DOI: 10.1007/s10157-016-1278-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 05/02/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND It is not known whether asymptomatic cardiac troponin T (cTnT) elevation is associated with all-cause or cardiovascular mortality in non-diabetic and advanced chronic kidney disease (CKD) patients. METHODS We measured cTnT in 248 consecutive patients at 1-2 weeks before dialysis initiation between March 2005 and August 2010 and followed them prospectively. A Cox proportional hazard model was used to investigate the relationship between cTnT and all-cause and cardiovascular mortality on dialysis. RESULTS The median age of the patients was 67 years (male 59.3 %), and the prevalence of diabetic nephropathy (DN) was 38.3 %. Asymptomatic cTnT elevation (>0.01 ng/mL) was observed in 196 (79 %) and 111 (73 %) patients among the overall patients and among patients without DN, respectively. A total of 51 patients died during a median follow-up period of 31.6 months. The cTnT level was associated with all-cause [hazard ratio (HR) 1.453; 95 % confidence interval (CI) 1.093-1.931; P = 0.010] and cardiovascular mortality [HR 1.973; 95 % CI 1.127-3.454; P = 0.017] on dialysis after extensive adjustment in the overall patient population. Patients without DN showed similar associations as those for the overall patient population (all-cause mortality: HR 1.566; 95 % CI 1.048-2.339; P = 0.029 and cardiovascular mortality: HR 2.657; 95 % CI 1.115-6.328; P = 0.027). CONCLUSION Asymptomatic cTnT elevation might be strongly associated with all-cause and cardiovascular mortality in patients without DN, as well as in the overall advanced CKD patients. We suggest that cardiovascular risk in patients with pre-dialysis CKD should be stratified according to cTnT levels.
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Affiliation(s)
- Terumasa Hayashi
- Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandaihigashi Sumiyoshi-ku, Osaka, 558-8558, Japan. .,Department of Nephrology, Rinku General Medical Center, Izumisano, Japan.
| | - Tomonori Kimura
- Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Keiko Yasuda
- Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Koichi Sasaki
- Department of Nephrology, Japan Community Health Care Organization Osaka Hospital, Osaka, Japan
| | - Yoshitsugu Obi
- Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiromi Rakugi
- Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshitaka Isaka
- Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
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Lee HF, Wu LS, Chan YH, Lee CH, Liu JR, Tu HT, Wen MS, Kuo CT, Chen WJ, Yeh YH, See LC, Chang SH. Dialysis Patients with Implanted Drug-Eluting Stents Have Lower Major Cardiac Events and Mortality than Those with Implanted Bare-Metal Stents: A Taiwanese Nationwide Cohort Study. PLoS One 2016; 11:e0146343. [PMID: 26731408 PMCID: PMC4711720 DOI: 10.1371/journal.pone.0146343] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 11/15/2015] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To investigate the efficacy and long-term clinical benefits of DES for dialysis patients. BACKGROUND It is unclear whether percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation is associated with lower rates of major adverse cardiovascular events (MACE) or mortality compared to bare-metal stents (BMS). METHODS From a nationwide cohort selected from Taiwan's National Health Insurance Research Database, we enrolled 2,835 dialysis patients who were hospitalized for PCI treatment with stent implantation from Dec 1, 2006. Follow-up was from the date of index hospitalization for PCI until the first MACE, date of death, or December 31, 2011, whichever came first. RESULTS A total of 738 patients (26.0%) had DES implanted, and 2,097 (74%) had BMS implanted. The medium time to the first MACE was 0.53 years (interquartile range: 0.89 years; range: 0-4.62 years). At 1-year follow-up, patients treated with BMS had significantly, non-fatal myocardial infarction (MI), all-cause mortality, and composite MACE compared to those treated with DES. The overall repeat revascularization with coronary artery bypass graft (CABG), non-fatal MI, all-cause mortality, and composite MACE were significantly lower in patients treated with DES than those treated with BMS. Multivariate cox regression analysis showed that older age, history of diabetes, history of heart failure, history of stroke, and DES vs. BMS were independent significant predictors of MACE. CONCLUSIONS DES implantation conferred survival benefits in dialysis patients compared with BMS implantation.
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Affiliation(s)
- Hsin-Fu Lee
- Chang Gung University and Department of Cardiology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Lung-Sheng Wu
- Chang Gung University and Department of Cardiology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Yi-Hsin Chan
- Chang Gung University and Department of Cardiology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Cheng-Hung Lee
- Chang Gung University and Department of Cardiology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Jia-Rou Liu
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hui-Tzu Tu
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Shien Wen
- Chang Gung University and Department of Cardiology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Chi-Tai Kuo
- Chang Gung University and Department of Cardiology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Wei-Jan Chen
- Chang Gung University and Department of Cardiology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Yung-Hsin Yeh
- Chang Gung University and Department of Cardiology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Lai-Chu See
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan
- * E-mail: (LCS); (SHC)
| | - Shang-Hung Chang
- Chang Gung University and Department of Cardiology, Chang Gung Memorial Hospital, Taipei, Taiwan
- * E-mail: (LCS); (SHC)
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Tanaka Y, Joki N, Hase H. Ischemic Heart Disease in Patients with End-Stage Kidney Disease. Blood Purif 2015; 40:332-6. [PMID: 26657740 DOI: 10.1159/000441582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND It was recently reported that the severity of coronary and carotid atherosclerosis in patients with end-stage kidney disease (ESKD) has improved over the last two decades. However, the frequency of coronary artery events observed at the initiation of dialysis remains high. SUMMARY Recently, 5 different clinical types of acute myocardial infarction (MI) were introduced in the third universal definition of MI. Type 2 MI, known as secondary MI, is a more heterogeneous entity, where a condition other than coronary artery narrowing contributes to an acute imbalance in oxygen supply and demand. In patients with chronic kidney disease, it has been demonstrated that type 2 MI is more common than type 1 MI, which is associated with coronary occlusive disease. It is suspected that patients with ESKD also often have type 2 MI. Factors associated with incremental increases in oxygen demand may cause myocardial ischemia in ESKD. KEY MESSAGES Significant epicardial coronary narrowing might not be a necessary precursor of myocardial ischemia in ESKD. To prevent ischemic heart disease and improve prognosis in patients with ESKD, we need to pay attention not only to coronary stenotic lesions, but also to the factors associated with the induction of an imbalance in myocardial oxygen supply and demand.
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Affiliation(s)
- Yuri Tanaka
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
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82
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Sawai A, Yasuda Y, Suzuki S, Ishii H, Goto M, Kato S, Hayashi M, Maruyama S, Murohara T, Oiso Y, Matsuo S. Impact of non-invasive cardiovascular screening programs as a predictor of cardiovascular events among asymptomatic chronic kidney disease patients. Clin Exp Nephrol 2015; 20:416-24. [DOI: 10.1007/s10157-015-1169-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 09/08/2015] [Indexed: 10/23/2022]
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Szabó RP, Varga I, Balla J, Zsom L, Nemes B. Cardiovascular Screening and Management Among Kidney Transplant Candidates in Hungary. Transplant Proc 2015; 47:2192-5. [PMID: 26361677 DOI: 10.1016/j.transproceed.2015.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Cardiovascular disease is a major cause of morbidity and mortality in end-stage renal disease patients on dialysis and the most common cause of death in the immediate post-transplantation period. The aim of our study was to describe a novel approach of cardiovascular screening and management of dialysis patients evaluated for the transplant waiting list. METHODS Twenty-eight patients with end-stage renal disease put on the waiting list between July 2013 and July 2014 were subjected to a prespecified cardiovascular screening protocol utilizing noninvasive and/or invasive tests. Patients were subsequently divided into 3 strata in terms of their estimated cardiovascular risk. Each of these groups were then prescribed interventions aiming to improve their cardiovascular condition. RESULTS According to our prespecified protocol of cardiovascular screening studies, 15 (54%) patients were identified as low, 5 (18%) as intermediate, and 8 (28%) as high risk. Four (14%) patients were current smokers. In the low-risk group, we initiated a patient education program involving counseling on regular exercise such as swimming or cycling to improve their functional capacity. In the high-risk group revascularization was done in 5 cases (63%), including 3 percutaneous transluminal coronary angioplasties (PTCA) with stents for single-vessel disease, and coronary artery bypass graft surgeries (CABG) for triple-vessel disease in 2 cases. In the medium-risk group medical management was opted for, including introduction of beta-blockers, inhibitors, statins, and ezetimibe, as well as efforts to optimize anemia management, indices of bone-mineral disease, and fluid status. CONCLUSION In our regional transplant program, we introduced a comprehensive multidisciplinary approach to treat potential transplant candidates according to cardiovascular risk stratification based on a prespecified screening protocol. Further studies are needed to correlate this novel strategy with post-transplantation outcomes.
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Affiliation(s)
- R P Szabó
- FMC Debrecen, Extracorporal Organsupport Centre, University of Debrecen, Debrecen, Hungary; Institute of Surgery, Division of Transplantation, University of Debrecen, Debrecen, Hungary.
| | - I Varga
- Institute of Cardiology, University of Debrecen, Debrecen, Hungary
| | - J Balla
- FMC Debrecen, Extracorporal Organsupport Centre, University of Debrecen, Debrecen, Hungary; 1st Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - L Zsom
- Institute of Surgery, Division of Transplantation, University of Debrecen, Debrecen, Hungary
| | - B Nemes
- Institute of Surgery, Division of Transplantation, University of Debrecen, Debrecen, Hungary
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Agrawal H, Aggarwal K, Littrell R, Velagapudi P, Turagam MK, Mittal M, Alpert MA. Pharmacological and non pharmacological strategies in the management of coronary artery disease and chronic kidney disease. Curr Cardiol Rev 2015; 11:261-9. [PMID: 25981315 PMCID: PMC4558358 DOI: 10.2174/1573403x1103150514155757] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 12/18/2014] [Accepted: 01/08/2015] [Indexed: 02/06/2023] Open
Abstract
Patients with advanced chronic kidney disease (CKD), including those treated with dialysis, are at high risk for the development of cardiovascular disease (CVD). CVD accounts for 45-50% of deaths among dialysis patients. Therapy of acute and chronic coronary heart disease (CHD) that is effective in the general population is frequently less effective in patients with advanced CKD. Drug therapy in such patients may require dose modification in some cases. Oral anti-platelet drugs are less effective in those with advanced CKD than in persons with normal or near normal renal function. The intravenous antiplatelet drugs eptifibatide and tirofiban both require dose reductions in patients with advanced CKD. Enoxaparin requires dose reduction in early stage CKD and is contraindicated in hemodialysis patients. Unfractionated heparin and warfarin maybe used without dose adjustment in CKD patients. Atenolol, acetbutolol and nadolol may require dose adjustments in CKD. Metoprolol and carvedilol do not. Calcium channel blockers and nitrates do not require dose adjustment, whereas ranolazine does. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers may safely be used in CKD patients with close observation for hyperkalemia. The safety of spironolactone in such patients is questionable. Statins are less effective in reducing cardiovascular complication in CKD patients and their initiation is not recommended in dialysis patients. Coronary artery bypass grafting is associated with higher short-term mortality, but better long-term morbidity and mortality than percutaneous coronary interventions in patients with advanced CKD with non-ST segment ACS and chronic CHD.
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Affiliation(s)
| | | | | | | | - Mohit K Turagam
- Rm CE-306, University of Missouri Health Sciences Center, 5 Hospital Drive, Columbia, MO, USA 65212.
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Buronova N, Kamishima K, Yamaguchi J, Jujo K, Watanabe E, Inagaki Y, Kishi S, Wada A, Hatakeyama S, Watanabe M, Nakao M, Okayama D, Arashi H, Yamada N, Takagi A, Ogawa H, Hagiwara N. Effect of Hemodialysis on 7-Year Clinical Outcomes After Sirolimus-Eluting Stent Implantation. Circ J 2015; 79:2169-76. [PMID: 26310781 DOI: 10.1253/circj.cj-15-0113] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hemodialysis (HD) patients are reported to show poor clinical outcomes after percutaneous coronary intervention (PCI) with sirolimus-eluting stent (SES) compared with non-HD patients and their long-term prognosis remains unclear. METHODS AND RESULTS We prospectively enrolled 489 consecutive patients undergoing PCI with SES and performed a retrospective analysis focusing on HD patients. Median follow-up was 7.0 years (interquartile range, 4.2-7.9) and the follow-up rate was 100%. At the 7-year follow-up, the cumulative incidences of all-cause death, target lesion revascularization (TLR) and major adverse cardiac events (MACE) were significantly higher in HD patients than in non-HD patients (HD vs. non-HD=34.7% vs. 9.6%, 42.6% vs. 10.2% and 75.3% vs. 24.4%, respectively; log-rank P<0.001). Cox-proportional hazard analysis revealed that independent predictors of all-cause death were HD (hazard ratio [HR] 2.88, 95% confidence interval [CI]: 1.39-6.00), insulin-treated diabetes mellitus (HR 2.19, 95% CI: 1.17-4.11), heart failure (HR 2.58, 95% CI: 1.25-5.32) and older age (HR 1.06/1-age, 95% CI: 1.02-1.10). Moreover, HD was an independent predictor of TLR (HR 3.63, 95% CI: 1.85-7.11) and MACE (HR 3.54, 95% CI: 2.19-5.73). CONCLUSIONS In the present study, Japanese HD patients undergoing PCI with SES showed poorer long-term clinical outcomes than non-HD patients. HD was a strong predictor of long-term adverse events after SES implantation.
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Affiliation(s)
- Nozima Buronova
- Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University
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Parnham S, Gleadle JM, Bangalore S, Grover S, Perry R, Woodman RJ, De Pasquale CG, Selvanayagam JB. Impaired Myocardial Oxygenation Response to Stress in Patients With Chronic Kidney Disease. J Am Heart Assoc 2015; 4:e002249. [PMID: 26260054 PMCID: PMC4599475 DOI: 10.1161/jaha.115.002249] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Coronary artery disease and left ventricular hypertrophy are prevalent in the chronic kidney disease (CKD) and renal transplant (RT) population. Advances in cardiovascular magnetic resonance (CMR) with blood oxygen level-dependent (BOLD) technique provides capability to assess myocardial oxygenation as a measure of ischemia. We hypothesized that the myocardial oxygenation response to stress would be impaired in CKD and RT patients. METHODS AND RESULTS Fifty-three subjects (23 subjects with CKD, 10 RT recipients, 10 hypertensive (HT) controls, and 10 normal controls without known coronary artery disease) underwent CMR scanning. All groups had cine and BOLD CMR at 3 T. The RT and HT groups also had late gadolinium CMR to assess infarction/replacement fibrosis. The CKD group underwent 2-dimensional echocardiography strain to assess fibrosis. Myocardial oxygenation was measured at rest and under stress with adenosine (140 μg/kg per minute) using BOLD signal intensity. A total of 2898 myocardial segments (1200 segments in CKD patients, 552 segments in RT, 480 segments in HT, and 666 segments in normal controls) were compared using linear mixed modeling. Diabetes mellitus (P=0.47) and hypertension (P=0.57) were similar between CKD, RT, and HT groups. The mean BOLD signal intensity change was significantly lower in the CKD and RT groups compared to HT controls and normal controls (-0.89±10.63% in CKD versus 5.66±7.87% in RT versus 15.54±9.58% in HT controls versus 16.19±11.11% in normal controls, P<0.0001). BOLD signal intensity change was associated with estimated glomerular filtration rate (β=0.16, 95% CI=0.10 to 0.22, P<0.0001). Left ventricular mass index and left ventricular septal wall diameter were similar between the CKD predialysis, RT, and HT groups. None of the CKD patients had impaired global longitudinal strain and none of the RT group had late gadolinium hyperenhancement. CONCLUSIONS Myocardial oxygenation response to stress is impaired in CKD patients and RT recipients without known coronary artery disease, and unlikely to be solely accounted for by the presence of diabetes mellitus, left ventricular hypertrophy, or myocardial scarring. The impaired myocardial oxygenation in CKD patients may be associated with declining renal function. Noncontrast BOLD CMR is a promising tool for detecting myocardial ischemia in the CKD population.
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Affiliation(s)
- Susie Parnham
- Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, South Australia, Australia (S.P., S.G., R.P., C.G.D.P., J.B.S.) School of Medicine, Flinders University, Bedford Park, South Australia, Australia (S.P., J.M.G., R.P., C.G.D.P., J.B.S.) South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia (S.P., S.G., J.B.S.)
| | - Jonathan M Gleadle
- Department of Renal Medicine, Flinders Medical Centre, Bedford Park, South Australia, Australia (J.M.G.) School of Medicine, Flinders University, Bedford Park, South Australia, Australia (S.P., J.M.G., R.P., C.G.D.P., J.B.S.)
| | - Sripal Bangalore
- Cardiac Catheterization Laboratory, Cardiovascular Outcomes Group, New York University School of Medicine, New York, NY (S.B.)
| | - Suchi Grover
- Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, South Australia, Australia (S.P., S.G., R.P., C.G.D.P., J.B.S.) South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia (S.P., S.G., J.B.S.)
| | - Rebecca Perry
- Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, South Australia, Australia (S.P., S.G., R.P., C.G.D.P., J.B.S.) School of Medicine, Flinders University, Bedford Park, South Australia, Australia (S.P., J.M.G., R.P., C.G.D.P., J.B.S.)
| | - Richard J Woodman
- Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Bedford Park, South Australia, Australia (R.J.W.)
| | - Carmine G De Pasquale
- Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, South Australia, Australia (S.P., S.G., R.P., C.G.D.P., J.B.S.) School of Medicine, Flinders University, Bedford Park, South Australia, Australia (S.P., J.M.G., R.P., C.G.D.P., J.B.S.)
| | - Joseph B Selvanayagam
- Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, South Australia, Australia (S.P., S.G., R.P., C.G.D.P., J.B.S.) School of Medicine, Flinders University, Bedford Park, South Australia, Australia (S.P., J.M.G., R.P., C.G.D.P., J.B.S.) South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia (S.P., S.G., J.B.S.)
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87
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Malleshappa P, Shah BV. Prevalence of Chronic Kidney Disease and the Incidence of Acute Kidney Injury in Patients with Coronary Artery Disease in Mumbai, India. Heart Views 2015; 16:47-52. [PMID: 26240732 PMCID: PMC4485201 DOI: 10.4103/1995-705x.159219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background and Objective: To determine the prevalence of chronic kidney disease (CKD) and incidence of acute kidney injury (AKI) in patients with coronary artery disease (CAD) demonstrated on coronary angiography. Materials and Methods: Totally, 125 patients admitted to Lilavati Hospital and Research Centre, Mumbai, with CAD were included in the study. Results: Left anterior descending artery was the major vessel involved (40%), followed by a circumflex artery (21.6%). 49 out of 125 (39.2%) were found to have underlying CKD. 69% (34) of these CKD patients developed AKI. 21 out of 34 patients who developed AKI required hemodialysis. Only 47.1% (16 out of 34) of CKD patients had complete recovery, 29% had partial recovery, and 23% had no recovery of their renal function from AKI. Statistically significant number of patients in CKD group had no recovery from AKI as compared to non-CKD group (23.5% vs. 0%). Conclusion: Our study concludes that there is a very high prevalence of CKD (39.2%) in patients with CAD and AKI is a very important complication (38.4%) in these patients. Considering such a high prevalence of CKD, nephrology referral must be considered in patients with abnormal urinalysis, spot urinary protein to creatinine ratio and in patients whose creatinine clearance is <60 ml/min.
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Affiliation(s)
- Pavan Malleshappa
- Department of Medicine, Division of Nephrology, Adichunchanagiri Institute of Medical Sciences, B. G. Nagara, Mandya, Karnataka, India
| | - Bharat V Shah
- Department of Nephrology, Global Hospital, Mumbai, Maharashtra, India
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Matsukane A, Hayashi T, Tanaka Y, Iwasaki M, Kubo S, Asakawa T, Takahashi Y, Imamura Y, Hirahata K, Joki N, Hase H. Usefulness of an Upright T-Wave in Lead aVR for Predicting the Short-Term Prognosis of Incident Hemodialysis Patients: A Potential Tool for Screening High-Risk Hemodialysis Patients. Cardiorenal Med 2015; 5:267-77. [PMID: 26648943 DOI: 10.1159/000433562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 05/13/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND/AIMS An upright T-wave in lead aVR (aVRT) has recently been reported to be associated with cardiovascular death and mortality among the general population and patients with prior cardiovascular disease (CVD). However, evidence for the predictive ability of aVRT in patients with chronic kidney disease is lacking. Therefore, a hospital-based, prospective, cohort study was conducted to evaluate the predictive ability of an upright aVRT for the short-term prognosis in incident hemodialysis patients. METHODS Among 208 patients who started maintenance hemodialysis, 79 with preexisting CVD (CVD cohort) and 129 with no history of CVD (non-CVD cohort), were studied. An upright and non-upright aVRT were defined as a wave with a positive deflection in amplitude of ≥0 mV and a negative deflection in amplitude of <0 mV, respectively. The endpoint was all-cause death. RESULTS Overall, the prevalence of an upright aVRT was 22.6% at baseline. During the mean follow-up period of 2.1 ± 1.0 years, 33 deaths occurred. Cumulative survival rates at 3 years after starting dialysis in patients with an upright and non-upright aVRT were 50.0 and 80.7%, respectively, in the CVD cohort and 92.0 and 91.3%, respectively, in the non-CVD cohort. In the CVD cohort, multivariate Cox regression analysis showed that an upright aVRT was an independent predictor of death after adjusting for confounding variables. CONCLUSION Among Japanese hemodialysis patients at high risk for CVD, an upright aVRT seems to be useful for predicting death.
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Affiliation(s)
- Ai Matsukane
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Toshihide Hayashi
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yuri Tanaka
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Masaki Iwasaki
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Shun Kubo
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Takasuke Asakawa
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yasunori Takahashi
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | | | | | - Nobuhiko Joki
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Hiroki Hase
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
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Manganese-Induced Parkinsonism and Parkinson's Disease: Shared and Distinguishable Features. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:7519-40. [PMID: 26154659 PMCID: PMC4515672 DOI: 10.3390/ijerph120707519] [Citation(s) in RCA: 219] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 12/12/2014] [Accepted: 01/06/2015] [Indexed: 11/30/2022]
Abstract
Manganese (Mn) is an essential trace element necessary for physiological processes that support development, growth and neuronal function. Secondary to elevated exposure or decreased excretion, Mn accumulates in the basal ganglia region of the brain and may cause a parkinsonian-like syndrome, referred to as manganism. The present review discusses the advances made in understanding the essentiality and neurotoxicity of Mn. We review occupational Mn-induced parkinsonism and the dynamic modes of Mn transport in biological systems, as well as the detection and pharmacokinetic modeling of Mn trafficking. In addition, we review some of the shared similarities, pathologic and clinical distinctions between Mn-induced parkinsonism and Parkinson’s disease. Where possible, we review the influence of Mn toxicity on dopamine, gamma aminobutyric acid (GABA), and glutamate neurotransmitter levels and function. We conclude with a survey of the preventive and treatment strategies for manganism and idiopathic Parkinson’s disease (PD).
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Hakeem A, Bhatti S, Chang SM. Screening and risk stratification of coronary artery disease in end-stage renal disease. JACC Cardiovasc Imaging 2015; 7:715-28. [PMID: 25034921 DOI: 10.1016/j.jcmg.2013.12.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 12/12/2013] [Accepted: 12/19/2013] [Indexed: 01/30/2023]
Abstract
End-stage renal disease (ESRD) is a growing global health problem with major health and economic implications. Cardiovascular complication is the major cause of morbidity and mortality in this population. Clustering of traditional atherosclerotic risk factors, such as diabetes, systemic inflammation, and altered mineral metabolism, contributes to enhanced systemic atherosclerosis in patients with ESRD. Prevalence of obstructive coronary artery disease (CAD) on coronary angiography exceeds 50% in this population. Despite having extensive CAD and vascular disease, patients with ESRD often do not present with classic symptoms because of impaired exercise capacity and diabetes. Furthermore, clinical trial data are exceedingly lacking in this population, resulting in considerable clinical equipoise regarding the optimal approach to the identification and subsequent management of CAD in these patients. Traditional clinical screening tools, including conventional risk prediction models, are significantly limited in their predictive accuracy for cardiovascular events in patients with ESRD. Noninvasive cardiac stress imaging modalities, such as nuclear perfusion and echocardiography, have been shown to improve the traditional clinical model in identifying the presence of CAD. Furthermore, they add incremental prognostic information to angiographic data. Novel imaging techniques and biomarker assays hold significant promise in further improving the ability to identify and risk-stratify for CAD. This review focuses on the current understanding of the clinical risk profile of asymptomatic patients with ESRD with an emphasis on the strengths and limitations of various noninvasive cardiovascular imaging modalities, including the role of novel methods in refining risk prediction. In addition, issues and challenges pertaining to the optimal timing of initial risk assessment ("screening") and possible repeat screening ("surveillance") are addressed. We also summarize the current data on the approach to the patient with ESRD being evaluated for transplantation in the context of recent guidelines and position statements by various professional societies.
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Affiliation(s)
- Abdul Hakeem
- University of Arkansas for Medical Sciences, Little Rock, Arkansas; Central Arkansas VA Medical Center, Little Rock, Arkansas
| | - Sabha Bhatti
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Su Min Chang
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas.
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91
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Affiliation(s)
- Wajeh Y. Qunibi
- Division of Nephrology; Department of Medicine; University of Texas Health Sciences Center at San Antonio; San Antonio Texas
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92
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Nakao T, Inaba M, Abe M, Kaizu K, Shima K, Babazono T, Tomo T, Hirakata H, Akizawa T. Best Practice for Diabetic Patients on Hemodialysis 2012. Ther Apher Dial 2015; 19 Suppl 1:40-66. [DOI: 10.1111/1744-9987.12299] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | | | - Masanori Abe
- Japanese Society for Dialysis Therapy; Tokyo Japan
| | - Kazo Kaizu
- Japanese Society for Dialysis Therapy; Tokyo Japan
| | - Kenji Shima
- Japanese Society for Dialysis Therapy; Tokyo Japan
| | | | - Tadashi Tomo
- Japanese Society for Dialysis Therapy; Tokyo Japan
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93
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Hung AM, Hakim RM. Dialysate and serum potassium in hemodialysis. Am J Kidney Dis 2015; 66:125-32. [PMID: 25828570 DOI: 10.1053/j.ajkd.2015.02.322] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 02/04/2015] [Indexed: 11/11/2022]
Abstract
Most patients with end-stage renal disease depend on intermittent hemodialysis to maintain levels of serum potassium and other electrolytes within a normal range. However, one of the challenges has been the safety of using a low-potassium dialysate to achieve that goal, given the concern about the effects that rapid and/or large changes in serum potassium concentrations may have on cardiac electrophysiology and arrhythmia. Additionally, in this patient population, there is a high prevalence of structural cardiac changes and ischemic heart disease, making them even more susceptible to acute arrhythmogenic triggers. This concern is highlighted by the knowledge that about two-thirds of all cardiac deaths in dialysis are due to sudden cardiac death and that sudden cardiac death accounts for 25% of the overall death for end-stage renal disease. Developing new approaches and practice standards for potassium removal during dialysis, as well as understanding other modifiable triggers of sudden cardiac death, such as other electrolyte components of the dialysate (magnesium and calcium), rapid ultrafiltration rates, and safety of a number of medications (ie, drugs that prolong the QT interval or use of digoxin), are critical in order to decrease the unacceptably high cardiac mortality experienced by hemodialysis-dependent patients.
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Affiliation(s)
- Adriana M Hung
- Veterans Administration Tennessee Valley Healthcare System, Nashville, TN; Vanderbilt University Medical Center, Nashville, TN.
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94
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Parikh RH, Seliger SL, deFilippi CR. Use and interpretation of high sensitivity cardiac troponins in patients with chronic kidney disease with and without acute myocardial infarction. Clin Biochem 2015; 48:247-53. [DOI: 10.1016/j.clinbiochem.2015.01.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 01/09/2015] [Accepted: 01/12/2015] [Indexed: 01/10/2023]
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95
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Choi HY, Park HC, Ha SK. How do We Manage Coronary Artery Disease in Patients with CKD and ESRD? Electrolyte Blood Press 2014; 12:41-54. [PMID: 25606043 PMCID: PMC4297703 DOI: 10.5049/ebp.2014.12.2.41] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 12/05/2014] [Indexed: 12/11/2022] Open
Abstract
Chronic kidney disease (CKD) has been shown to be an independent risk factor for cardiovascular events. In addition, patients with pre-dialysis CKD appear to be more likely to die of heart disease than of kidney disease. CKD accelerates coronary artery atherosclerosis by several mechanisms, notably hypertension and dyslipidemia, both of which are known risk factors for coronary artery disease. In addition, CKD alters calcium and phosphorus homeostasis, resulting in hypercalcemia and vascular calcification, including the coronary arteries. Mortality of patients on long-term dialysis therapy is high, with age-adjusted mortality rates of about 25% annually. Because the majority of deaths are caused by cardiovascular disease, routine cardiac catheterization of new dialysis patients was proposed as a means of improving the identification and treatment of high-risk patients. However, clinicians may be uncomfortable exposing asymptomatic patients to such invasive procedures like cardiac catheterization, thus noninvasive cardiac risk stratification was investigated widely as a more palatable alternative to routine diagnostic catheterization. The effective management of coronary artery disease is of paramount importance in uremic patients. The applicability of diagnostic, preventive, and treatment modalities developed in nonuremic populations to patients with kidney failure cannot necessarily be extrapolated from clinical studies in non-kidney failure populations. Noninvasive diagnostic testing in uremic patients is less accurate than in nonuremic populations. Initial data suggest that dobutamine echocardiography may be the preferred diagnostic method. PCI with stenting is a less favorable alternative to CABG, however, it has a faster recovery time, reduced invasiveness, and no overall mortality difference in nondiabetic and non-CKD patients compared with CABG. CABG is associated with reduced repeat revascularizations, greater relief of angina, and increased long term survival. However, CABG is associated with a higher incidence of post-operative risks. The treatment chosen for each patient should be an individualized decision based upon numerous risk factors. CKD is associated with higher rates of CAD, with 44% of all-cause mortality attributable to cardiac disease and about 20% from acute MI. Optimal treatment including aggressive lifestyle modifications and concomitant medical therapy should be implemented in all patients to maximize benefits from either PCI or CABG. Future prospective randomized controlled trials with newer second or third generation DES and bioabsorbable DES are necessary to determine if PCI may be non-inferior to CABG in the future.
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Affiliation(s)
- Hoon Young Choi
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeong Cheon Park
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Kyu Ha
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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96
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Parnham SFC, Gleadle JM, De Pasquale CG, Selvanayagam JB. Myocardial Ischemia Assessment in Chronic Kidney Disease: Challenges and Pitfalls. Front Cardiovasc Med 2014; 1:13. [PMID: 26664863 PMCID: PMC4668858 DOI: 10.3389/fcvm.2014.00013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 12/07/2014] [Indexed: 01/15/2023] Open
Abstract
Coronary artery disease is the leading cause of mortality and morbidity in the chronic kidney disease (CKD) population and often presents with atypical symptoms. Current diagnostic investigations of myocardial ischemia in CKD lack sensitivity and specificity or may have adverse effects. We present a case vignette and explore the challenges of diagnostic myocardial stress investigation in patients with CKD.
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Affiliation(s)
- Susie F C Parnham
- Department of Cardiovascular Medicine, Flinders Medical Centre , Bedford Park, SA , Australia ; School of Medicine, Flinders University , Bedford Park, SA , Australia
| | - Jonathan M Gleadle
- School of Medicine, Flinders University , Bedford Park, SA , Australia ; Department of Renal Medicine, School of Medicine, Flinders University , Bedford Park, SA , Australia
| | - Carmine G De Pasquale
- Department of Cardiovascular Medicine, Flinders Medical Centre , Bedford Park, SA , Australia ; School of Medicine, Flinders University , Bedford Park, SA , Australia
| | - Joseph B Selvanayagam
- Department of Cardiovascular Medicine, Flinders Medical Centre , Bedford Park, SA , Australia ; School of Medicine, Flinders University , Bedford Park, SA , Australia
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97
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Pun PH. The interplay between CKD, sudden cardiac death, and ventricular arrhythmias. Adv Chronic Kidney Dis 2014; 21:480-8. [PMID: 25443573 DOI: 10.1053/j.ackd.2014.06.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 06/04/2014] [Accepted: 06/27/2014] [Indexed: 12/23/2022]
Abstract
CKD patients face an increased risk of cardiovascular disease mortality, and the risk of sudden cardiac death (SCD) increases as kidney function declines. Risk factors for SCD are poorly understood and understudied among CKD patients. In the general population, coronary heart disease-associated risk factors are the most important determinants of SCD risk, but among CKD patients, there is evidence that these factors play a much smaller role. Complex relationships between CKD-specific risk factors, structural heart disease, and arrhythmic triggers contribute to the high risk of SCD and ventricular arrhythmias and modulate the effectiveness of available therapies. This review examines recent data on the epidemiology, pathophysiology, and mechanisms of SCD among CKD patients and examines current evidence regarding the use of pharmacologic and device-based therapies for management of SCD risk.
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98
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Hwang HS, Park MW, Yoon HE, Chang YK, Yang CW, Kim SY, Cho JS, Kim CJ, Park GM, Park CS, Choi YS, Koh YS, Lee JM, Shin DI, Seo SM, Jeon DS, Moon KW, Yoo KD, Kim HY, Kim DB, Park HJ, Kim PJ, Chang K, Chung WS, Seung KB, Jeong MH, Her SH, Ahn Y. Clinical significance of chronic kidney disease and atrial fibrillation on morbidity and mortality in patients with acute myocardial infarction. Am J Nephrol 2014; 40:345-52. [PMID: 25358406 DOI: 10.1159/000368422] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 09/12/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Atrial fibrillation (AF) often coexists with acute myocardial infarction (AMI), and chronic kidney disease (CKD) is a major risk for AMI. However, the combined impact of CKD and AF on the mortality and morbidity in AMI population has not been determined. METHODS Between January 2004 and December 2009, a total of 4,738 AMI patients were enrolled prospectively. Patients were divided into four groups according to the combined status of CKD and AF. The primary endpoint was a combination of 5-year major adverse cardiac and cerebrovascular events (MACCE). RESULTS The prevalence of AF was significantly higher in CKD patients than in non-CKD patients (6.76 vs. 3.31%, p < 0.001). The highest cumulative event rate of MACCE and death was observed in patients with both CKD and AF (68.5 and 64.0%), respectively. In multivariable analyses, compared with patients with neither AF nor CKD, hazard ratios (HR) for composite of MACCE were 1.66 (95% CI, 1.14-2.41), 1.24 (95% CI, 1.06-1.46), and 2.10 (95% CI, 1.42-3.13) for patients with AF only, those with CKD only, and those with both CKD and AF, respectively (p for interaction = 0.935). Patients with both CKD and AF had a greatest risk for all-cause mortality (HR 2.54; 95% CI, 1.60-4.53), and the significant synergistic interaction was observed between CKD and AF (p for interaction = 0.015). CONCLUSION The combined effect of AF and CKD on the risk of MACCE after an AMI is stronger than any separate condition, and it confers a synergistic effect on the all-cause mortality risk.
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Affiliation(s)
- Hyeon Seok Hwang
- Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
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99
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Hart A, Weir MR, Kasiske BL. Cardiovascular risk assessment in kidney transplantation. Kidney Int 2014; 87:527-34. [PMID: 25296093 DOI: 10.1038/ki.2014.335] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 04/14/2014] [Accepted: 05/01/2014] [Indexed: 12/28/2022]
Abstract
Cardiovascular disease (CVD) remains the most common cause of death after kidney transplantation worldwide, with the highest event rate in the early postoperative period. In an attempt to address this issue, screening for CVD prior to transplant is common, but the clinical utility of screening asymptomatic transplant candidates remains unclear. A large degree of variation exists among both transplant center practice patterns and clinical practice guidelines regarding who should be screened, and opinions are based on mixed observational data with great potential for bias. In this review, we discuss the potential risks, benefits, and evidence for screening for CVD in kidney transplant candidates, and also the next steps to better evaluate and treat asymptomatic kidney transplant candidates.
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Affiliation(s)
- Allyson Hart
- 1] Division of Nephrology, Hennepin County Medical Center, Minneapolis, Minnesota, USA [2] University of Minnesota Medical School, Duluth, Minnesota, USA
| | - Matthew R Weir
- Department of Medicine, Division of Nephrology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Bertram L Kasiske
- 1] Division of Nephrology, Hennepin County Medical Center, Minneapolis, Minnesota, USA [2] University of Minnesota Medical School, Duluth, Minnesota, USA
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100
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Massy ZA, Maizel J. [Pleiotropic effects of sevelamer: a model of intestinal tract chelating agent]. Nephrol Ther 2014; 10:441-50. [PMID: 25070605 DOI: 10.1016/j.nephro.2014.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 03/29/2014] [Accepted: 04/15/2014] [Indexed: 12/25/2022]
Abstract
The number of patients with chronic kidney disease (CKD) with its associated complications has increased dramatically worldwide in recent years. Therefore, many experimental and clinical studies have examined over the last decade the mechanisms involved, in order to explain the sharp increase in cardiovascular mortality. Hyperphosphatemia is a major problem in these patients especially at advanced stages of CKD, and it is associated with cardiovascular and mineral complications in these patients. Sevelamer is a phosphate binder that allows a better control of hyperphosphatemia, like other phosphate binder agents, but it has additional pleiotropic effects such as correcting certain abnormalities of lipid metabolism and clearance of several uremic toxins. These effects of sevelamer, restricted to the intestinal lumen, underline the importance of intestinal pathway in CKD and open the way to new therapeutic strategies for the management of the CKD and its complications.
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Affiliation(s)
- Ziad A Massy
- Inserm U-1088, UFR de médecine et de pharmacie, université de Picardie-Jules-Verne, 1, rue des Louvels, 80037 Amiens cedex, France; Service de néphrologie, université Paris Île-de-France ouest (UVSQ), hôpital Ambroise-Paré, 9, avenue Charles-de-Gaulle, 92104 Boulogne-Billancourt cedex, France.
| | - Julien Maizel
- Inserm U-1088, UFR de médecine et de pharmacie, université de Picardie-Jules-Verne, 1, rue des Louvels, 80037 Amiens cedex, France; Unité de réanimation médicale, service de néphrologie, CHU d'Amiens, place Victor-Pauchet, 80054 Amiens cedex, France
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