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Canaud B, Blankestijn PJ, Grooteman MPC, Davenport A. Why and how high volume hemodiafiltration may reduce cardiovascular mortality in stage 5 chronic kidney disease dialysis patients? A comprehensive literature review on mechanisms involved. Semin Dial 2021; 35:117-128. [PMID: 34842306 DOI: 10.1111/sdi.13039] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 12/19/2022]
Abstract
Online hemodiafiltration (HDF) is an established renal replacement modality for patients with end stage chronic kidney disease that is now gaining rapid clinical acceptance worldwide. Currently, there is a growing body of evidence indicating that treatment with HDF is associated with better outcomes and reduced cardiovascular mortality for dialysis patients. In this comprehensive review, we provide an update on the potential mechanisms which may improve survival in HDF treated patients. The strongest evidence is for better hemodynamic stability and reduced endothelial dysfunction associated with HDF treatments. Clinically, this is marked by a reduced incidence of intradialytic hypotensive episodes, with a better hemodynamic response to ultrafiltration, mediated by an increase in total peripheral vascular resistance and extra-vascular fluid recruitment, most likely driven by the negative thermal balance associated with online HDF therapy. In addition, endothelial function appears to be improved due to a combination of a reduction of the inflammatory and oxidative stress complex syndrome and exposure to circulating cardiovascular uremic toxins. Reports of reversed cardiovascular remodeling effects with HDF may be confounded by volume and blood pressure management, which are strongly linked to center clinical practices. Currently, treatment with HDF appears to improve the survival of dialysis patients predominantly due to a reduction in their cardiovascular burden, and this reduction is linked to the sessional convection volume exchanged.
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Affiliation(s)
- Bernard Canaud
- Department of Nephrology, Montpellier University, Montpellier, France.,Global Medical Office, FMC, Deutschland, Bad Homburg, Germany
| | - Peter J Blankestijn
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Muriel P C Grooteman
- Department of Nephrology and Amsterdam Cardiovascular Sciences (ACS), Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Andrew Davenport
- UCL Department of Nephrology, Royal Free Hospital. University College London, London, UK
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Szabó Z, Hornyák L, Miskei M, Székvölgyi L. Two Targets, One Hit: new Anticancer Therapeutics to Prevent Tumorigenesis Without Cardiotoxicity. Front Pharmacol 2021; 11:569955. [PMID: 33643029 PMCID: PMC7902874 DOI: 10.3389/fphar.2020.569955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 12/08/2020] [Indexed: 11/24/2022] Open
Abstract
A serious adverse effect of cancer therapies is cardiovascular toxicity, which significantly limits the widespread use of antineoplastic agents. The promising new field of cardio-oncology offers the identification of potent anti-cancer therapeutics that effectively inhibit cancer cell proliferation without causing cardiotoxicity. Future introduction of recently identified cardio-safe compounds into clinical practice (including ERK dimerization inhibitors or BAX allosteric inhibitors) is expected to help oncologists avoid unwanted cardiological complications associated with therapeutic interventions.
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Affiliation(s)
- Zoltán Szabó
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Lilla Hornyák
- MTA-DE Momentum Genome Architecture and Recombination Research Group, Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Debrecen, Doctoral School of Molecular Cell and Immune Biology, Debrecen, Hungary
| | - Márton Miskei
- MTA-DE Momentum Genome Architecture and Recombination Research Group, Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Debrecen, Doctoral School of Molecular Cell and Immune Biology, Debrecen, Hungary
| | - Lóránt Székvölgyi
- MTA-DE Momentum Genome Architecture and Recombination Research Group, Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Debrecen, Doctoral School of Molecular Cell and Immune Biology, Debrecen, Hungary.,Faculty of Pharmacy, University of Debrecen, Debrecen, Hungary
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3
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Szabó Z, Ujvárosy D, Ötvös T, Sebestyén V, Nánási PP. Handling of Ventricular Fibrillation in the Emergency Setting. Front Pharmacol 2020; 10:1640. [PMID: 32140103 PMCID: PMC7043313 DOI: 10.3389/fphar.2019.01640] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 12/16/2019] [Indexed: 12/11/2022] Open
Abstract
Ventricular fibrillation (VF) and sudden cardiac death (SCD) are predominantly caused by channelopathies and cardiomyopathies in youngsters and coronary heart disease in the elderly. Temporary factors, e.g., electrolyte imbalance, drug interactions, and substance abuses may play an additive role in arrhythmogenesis. Ectopic automaticity, triggered activity, and reentry mechanisms are known as important electrophysiological substrates for VF determining the antiarrhythmic therapies at the same time. Emergency need for electrical cardioversion is supported by the fact that every minute without defibrillation decreases survival rates by approximately 7%–10%. Thus, early defibrillation is an essential part of antiarrhythmic emergency management. Drug therapy has its relevance rather in the prevention of sudden cardiac death, where early recognition and treatment of the underlying disease has significant importance. Cardioprotective and antiarrhythmic effects of beta blockers in patients predisposed to sudden cardiac death were highlighted in numerous studies, hence nowadays these drugs are considered to be the cornerstones of the prevention and treatment of life-threatening ventricular arrhythmias. Nevertheless, other medical therapies have not been proven to be useful in the prevention of VF. Although amiodarone has shown positive results occasionally, this was not demonstrated to be consistent. Furthermore, the potential proarrhythmic effects of drugs may also limit their applicability. Based on these unfavorable observations we highlight the importance of arrhythmia prevention, where echocardiography, electrocardiography and laboratory testing play a significant role even in the emergency setting. In the following we provide a summary on the latest developments on cardiopulmonary resuscitation, and the evaluation and preventive treatment possibilities of patients with increased susceptibility to VF and SCD.
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Affiliation(s)
- Zoltán Szabó
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Dóra Ujvárosy
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Doctoral School of Health Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Tamás Ötvös
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Doctoral School of Health Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Veronika Sebestyén
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Doctoral School of Health Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Péter P Nánási
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Department of Dental Physiology, Faculty of Dentistry, University of Debrecen, Debrecen, Hungary
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Delanaye P, Krzesinski F, Dubois BE, Delcour A, Robinet S, Piette C, Krzesinski JM, Lancellotti P. A simple modification of dialysate potassium: its impact on plasma potassium concentrations and the electrocardiogram. Clin Kidney J 2019; 14:390-397. [PMID: 33564443 PMCID: PMC7857800 DOI: 10.1093/ckj/sfz157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/02/2019] [Indexed: 11/14/2022] Open
Abstract
Background Sudden death is frequent in haemodialysis (HD) patients. Both hyperkalaemia and change of plasma potassium (K) concentrations induced by HD could explain this. The impact of increasing dialysate K by 1 mEq/L on plasma K concentrations and electrocardiogram (ECG) results before and after HD sessions was studied. Methods Patients with pre-dialysis K >5.5 mEq/L were excluded. ECG and K measurements were obtained before and after the first session of the week for 2 weeks. Then, K in the dialysate was increased (from 1 or 3 to 2 or 4 mEq/L, respectively). Blood and ECG measurements were repeated after 2 weeks of this change. Results Twenty-seven prevalent HD patients were included. As expected, a significant decrease in K concentrations was observed after the dialysis session, but this decrease was significantly lower after the switch to an increased dialysate K. The pre-dialysis K concentrations were not different after changing, but post-dialysis K concentrations were higher after switching (P < 0.0001), with a lower incidence of post-dialysis hypokalaemia. Regarding ECG, before switching, the QT interval (QT) dispersion increased during the session, whereas no difference was observed after switching. One week after switching, post-dialysis QT dispersion [38 (34-42) ms] was lower than post-dialysis QT dispersion 2 weeks and 1 week before switching [42 (38-57) ms, P = 0.0004; and 40 (35-50) ms, P = 0.0002]. Conclusions A simple increase of 1 mEq/L of K in the dialysate is associated with a lower risk of hypokalaemia and a lower QT dispersion after the dialysis session. Further study is needed to determine if such a strategy is associated with a lower risk of sudden death.
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Affiliation(s)
- Pierre Delanaye
- Department of Nephrology, Dialysis, Transplantation, University of Liège (ULg CHU), CHU Sart Tilman, Liège, Belgium.,GIGA Cardiovascular Sciences, University of Liège (ULg CHU), CHU Sart Tilman, Liège, Belgium
| | - François Krzesinski
- Department of Cardiology, University of Liège (ULg CHU), CHU Sart Tilman, Liège, Belgium
| | - Bernard E Dubois
- Department of Nephrology, Dialysis, Transplantation, University of Liège (ULg CHU), CHU Sart Tilman, Liège, Belgium
| | - Alexandre Delcour
- Department of Cardiology, University of Liège (ULg CHU), CHU Sart Tilman, Liège, Belgium
| | - Sébastien Robinet
- Department of Cardiology, University of Liège (ULg CHU), CHU Sart Tilman, Liège, Belgium
| | - Caroline Piette
- Department of Cardiology, University of Liège (ULg CHU), CHU Sart Tilman, Liège, Belgium
| | - Jean-Marie Krzesinski
- Department of Nephrology, Dialysis, Transplantation, University of Liège (ULg CHU), CHU Sart Tilman, Liège, Belgium.,GIGA Cardiovascular Sciences, University of Liège (ULg CHU), CHU Sart Tilman, Liège, Belgium
| | - Patrizio Lancellotti
- GIGA Cardiovascular Sciences, University of Liège (ULg CHU), CHU Sart Tilman, Liège, Belgium.,Department of Cardiology, University of Liège (ULg CHU), CHU Sart Tilman, Liège, Belgium
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Sivri S, Çelik M. Evaluation of index of cardiac-electrophysiological balance before and after hemodialysis in patients with end-stage renal disease. J Electrocardiol 2019; 54:72-75. [PMID: 30928820 DOI: 10.1016/j.jelectrocard.2019.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/13/2019] [Accepted: 03/20/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Ventricular arrhythmias and sudden cardiac deaths are the most common cause of mortality in patients with end-stage renal disease (ESRD). Index of cardiac-electrophysiological balance (iCEB) (QT/QRS) may predict malignant ventricular arrhythmias. In this study, we investigated whether iCEB value is increased in ESRD patients and whether it changes before and after hemodialysis. METHODS The study included 52 ESRD patients and 53 control subjects matched for age and comorbidities. Biochemical, electrocardiographic and echocardiographic values of all participants were recorded. QRS, QT, Tp-e were measured manually. QTC was calculated using Bazett's formula. Then, Tp-e/QT, Tp-e/QTc, QT/QRS, and QTc/QRS ratios were calculated. The changes in ECG parameters of the ESRD patients before and after HD were compared using paired t-test. RESULTS Mean age and male sex ratio was comparable in both groups (p = 0.448 and p = 0.777, respectively). Comorbidity incidences, and biochemical parameters except eGFR (p < 0.001), albumin (p < 0.001), HDL cholesterol (p = 0.03) and platelet counts (p < 0.001) were comparable in both groups. Compared to the control group, QT, QTc, Tp-e, Tp-e/QT, Tp-e/QTc, QT/QRS, and QTc/QRS ratios were higher in the ESRD group (p < 0.05 for each). While QT and QTc intervals did not change after HD in ESRD patients, Tp-e, Tp-e/QT, Tp-e/QTc, QT/QRS, and QTc/QRS parameters increased significantly. CONCLUSION In addition to ventricular repolarization dispersion indices in ESRD patients, iCEB elevation and increasing values after HD session indicate the increased risk of TdP-mediated ventricular arrhythmia after HD. Larger studies are needed to confirm our results.
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Affiliation(s)
- Serkan Sivri
- Department of Cardiology, Ahi Evran University Training and Research Hospital, Kırşehir, Turkey.
| | - Mustafa Çelik
- Department of Cardiology, Ahi Evran University Training and Research Hospital, Kırşehir, Turkey
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Páll A, Czifra Á, Sebestyén V, Becs G, Kun C, Balla J, Paragh G, Lőrincz I, Páll D, Padra TJ, Agarwal A, Zarjou A, Szabó Z. Hemodiafiltration and hemodialysis differently affect P wave duration and dispersion on the surface electrocardiogram. Int Urol Nephrol 2015; 48:271-7. [PMID: 26560477 DOI: 10.1007/s11255-015-1144-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 10/19/2015] [Indexed: 11/27/2022]
Abstract
AIM The incidence of atrial fibrillation is increased during hemodialysis (HD); however, the effects of hemodiafiltration (HDF) on atrial arrhythmias have not been evaluated. The prolongation of the P wave and P dispersion (Pd) can predict atrial arrhythmias. METHODS Data from 30 patients receiving HDF over a period of 3 months were collected; the same group of patients was then evaluated during treatment with conventional HD for at least another 3 months. Electrolyte values were obtained, and surface electrocardiograms (ECG), echocardiography, and Holter ECGs were performed. RESULTS The duration of the P wave and Pd increased significantly during HD. The left atrial diameter decreased significantly only during HDF. During HDF, the left atrial cross diameter measured at the beginning of the session was positively correlated with the incidence of supraventricular premature beats (p = 0.011, r = 0.4556). The decrease in left atrial diameter during HDF was negatively correlated with the incidence of supraventricular premature beats (p = 0.016, r = -0.43). During HDF, the changes in sodium and Pd were significantly positively correlated (p < 0.05, r = 0.478). During HD, the changes in ionized calcium levels and Pd were positively correlated (p < 0.05, r = 0.377). CONCLUSION Our results suggest that HDF has a more beneficial effect on P wave duration and Pd than HD. The alterations in the ECG markers may be the result of the simultaneous occurrence of certain electrolyte imbalances and renal replacement methods.
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Affiliation(s)
- Alida Páll
- Division of Emergency Medicine, Faculty of Medicine, Clinical Center, Institute of Medicine, University of Debrecen, Nagyerdei krt. 98, P.O. Box 19, 4032, Debrecen, Hungary
| | - Árpád Czifra
- Division of Emergency Medicine, Faculty of Medicine, Clinical Center, Institute of Medicine, University of Debrecen, Nagyerdei krt. 98, P.O. Box 19, 4032, Debrecen, Hungary
| | - Veronika Sebestyén
- Division of Emergency Medicine, Faculty of Medicine, Clinical Center, Institute of Medicine, University of Debrecen, Nagyerdei krt. 98, P.O. Box 19, 4032, Debrecen, Hungary
| | - Gergely Becs
- Division of Nephrology, Faculty of Medicine, Clinical Center, Institute of Medicine, University of Debrecen, Debrecen, Hungary
| | - Csaba Kun
- Faculty of Medicine, Clinical Center, Institute of Cardiology, University of Debrecen, Debrecen, Hungary
| | - József Balla
- Division of Nephrology, Faculty of Medicine, Clinical Center, Institute of Medicine, University of Debrecen, Debrecen, Hungary
| | - György Paragh
- Division of Emergency Medicine, Faculty of Medicine, Clinical Center, Institute of Medicine, University of Debrecen, Nagyerdei krt. 98, P.O. Box 19, 4032, Debrecen, Hungary
| | - István Lőrincz
- Division of Emergency Medicine, Faculty of Medicine, Clinical Center, Institute of Medicine, University of Debrecen, Nagyerdei krt. 98, P.O. Box 19, 4032, Debrecen, Hungary
| | - Dénes Páll
- Division of Nephrology, Faculty of Medicine, Clinical Center, Institute of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tamás János Padra
- Division of Nephrology, Faculty of Medicine, Clinical Center, Institute of Medicine, University of Debrecen, Debrecen, Hungary
| | - Anupam Agarwal
- Department of Medicine, Nephrology Research and Training Center and Center for Free Radical Biology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Abolfazl Zarjou
- Department of Medicine, Nephrology Research and Training Center and Center for Free Radical Biology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Zoltán Szabó
- Division of Emergency Medicine, Faculty of Medicine, Clinical Center, Institute of Medicine, University of Debrecen, Nagyerdei krt. 98, P.O. Box 19, 4032, Debrecen, Hungary.
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