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Hubbard D, Colantonio LD, Rosenson RS, Brown TM, Jackson EA, Huang L, Orroth KK, Reading S, Woodward M, Bittner V, Gutierrez OM, Safford MM, Farkouh ME, Muntner P. Risk for recurrent cardiovascular disease events among patients with diabetes and chronic kidney disease. Cardiovasc Diabetol 2021; 20:58. [PMID: 33648518 PMCID: PMC7923492 DOI: 10.1186/s12933-021-01247-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/15/2021] [Indexed: 02/08/2023] Open
Abstract
Background Adults who have experienced multiple cardiovascular disease (CVD) events have a very high risk for additional events. Diabetes and chronic kidney disease (CKD) are each associated with an increased risk for recurrent CVD events following a myocardial infarction (MI). Methods We compared the risk for recurrent CVD events among US adults with health insurance who were hospitalized for an MI between 2014 and 2017 and had (1) CVD prior to their MI but were free from diabetes or CKD (prior CVD), and those without CVD prior to their MI who had (2) diabetes only, (3) CKD only and (4) both diabetes and CKD. We followed patients from hospital discharge through December 31, 2018 for recurrent CVD events including coronary, stroke, and peripheral artery events. Results Among 162,730 patients, 55.2% had prior CVD, and 28.3%, 8.3%, and 8.2% had diabetes only, CKD only, and both diabetes and CKD, respectively. The rate for recurrent CVD events per 1000 person-years was 135 among patients with prior CVD and 110, 124 and 171 among those with diabetes only, CKD only and both diabetes and CKD, respectively. Compared to patients with prior CVD, the multivariable-adjusted hazard ratio for recurrent CVD events was 0.92 (95%CI 0.90–0.95), 0.89 (95%CI: 0.85–0.93), and 1.18 (95%CI: 1.14–1.22) among those with diabetes only, CKD only, and both diabetes and CKD, respectively. Conclusion Following MI, adults with both diabetes and CKD had a higher risk for recurrent CVD events compared to those with prior CVD without diabetes or CKD. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-021-01247-0.
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Affiliation(s)
- Demetria Hubbard
- Department of Epidemiology, University of Alabama At Birmingham, 1665 University Blvd, RPHB 140J, Birmingham, AL, 35233-0013, USA
| | - Lisandro D Colantonio
- Department of Epidemiology, University of Alabama At Birmingham, 1665 University Blvd, RPHB 140J, Birmingham, AL, 35233-0013, USA
| | - Robert S Rosenson
- Mount Sinai Heart, Icahn School of Medicine At Mount Sinai, New York, NY, USA
| | - Todd M Brown
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Elizabeth A Jackson
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Lei Huang
- Department of Epidemiology, University of Alabama At Birmingham, 1665 University Blvd, RPHB 140J, Birmingham, AL, 35233-0013, USA
| | - Kate K Orroth
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | - Stephanie Reading
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | - Mark Woodward
- The George Institute for Global Health, Imperial College, London, UK.,Department of Epidemiology and Biostatistics, School of Public Health, The George Institute for Global Health, University of New South Wales, Kensington, Australia.,Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Vera Bittner
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Orlando M Gutierrez
- Department of Epidemiology, University of Alabama At Birmingham, 1665 University Blvd, RPHB 140J, Birmingham, AL, 35233-0013, USA
| | - Monika M Safford
- Weill Cornell Medical College, Cornell University, Ithaca, NY, USA
| | - Michael E Farkouh
- Peter Munk Cardiac Centre, University of Toronto and Heart and Stroke Richard Lewar Centre of Excellence, Toronto, ON, Canada
| | - Paul Muntner
- Department of Epidemiology, University of Alabama At Birmingham, 1665 University Blvd, RPHB 140J, Birmingham, AL, 35233-0013, USA.
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Patti G, Ricottini E, Nenna A, Cavallari I, Antonucci E, Calabrò P, Cirillo P, Gresele P, Palareti G, Pengo V, Pignatelli P, Bisignani A, Marcucci R. Impact of Chronic Renal Failure on Ischemic and Bleeding Events at 1 Year in Patients With Acute Coronary Syndrome (from the Multicenter START ANTIPLATELET Registry). Am J Cardiol 2018; 122:936-943. [PMID: 30057232 DOI: 10.1016/j.amjcard.2018.05.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/24/2018] [Accepted: 05/24/2018] [Indexed: 11/16/2022]
Abstract
Chronic renal failure (CRF) impairs prognosis in patients with acute coronary syndromes (ACS); the differential impact of CRF on ischemic and bleeding events in the setting of ACS is unclear. We explored the predictive role of CRF, identified by different equations for the glomerular filtration rate estimation, on the occurrence of the composite end point, including both ischemic cardiovascular and major bleeding (major adverse cardiovascular and bleeding events [MACBE]) at 1 year, and its components. We accessed each patients data from 718 participants in the prospective, multicenter, and START ANTIPLATELET registry, performed on patients with ACS. The ability to predict the risk of MACBE was modest and similar for Cockcroft-Gault, MDRD, and CKD-EPI equations (area under the curves: 0.55, 95% confidence interval [CI] 0.47 to 0.63; 0.53, 95% CI 0.45 to 0.61; 0.54, 95% CI 0.46 to 0.62; respectively, overall p = 0.63). The incidence of MACBE in patients with CRF was 12.6 versus 7.4 per 100 patients/year in those with preserved renal function (adjusted odds ratio [OR] 1.80, 1.02 to 3.20, p = 0.045); the absolute excess in events rate due to CRF was higher for ischemic events (3.5%) than for major bleeding (2.6%). The increased occurrence of MACBE was even greater in patients with CRF and concomitant anemia (OR 2.16) and in patients with severe CRF (OR 2.78). In conclusion, our study indicates that, in patients with ACS, CRF impairs the clinical outcome at 1 year, especially when severe and when is concomitant with anemia. CRF is associated with greater absolute increase of ischemic events than major bleeding.
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Affiliation(s)
- Giuseppe Patti
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy.
| | - Elisabetta Ricottini
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Antonio Nenna
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Ilaria Cavallari
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | | | - Paolo Calabrò
- Division of Cardiology, Monaldi Hospital and "Luigi Vanvitelli" University of Campania, Naples, Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, School of Medicine, "Federico II" University, Naples, Italy
| | - Paolo Gresele
- Department of Medicine, Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | | | - Vittorio Pengo
- Department of Cardiothoracic and Vascular Sciences, University Hospital of Padua, Padua, Italy
| | - Pasquale Pignatelli
- Department of Internal Medicine and Medical Specialties, La Sapienza University of Rome, Rome, Italy
| | | | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, Center for Atherothrombotic Diseases, University of Florence, Florence, Italy
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Guo LZ, Kim MH, Kim TH, Park JS, Jin E, Shim CH, Choi SY, Serebruany VL. Comparison of Three Tests to Distinguish Platelet Reactivity in Patients with Renal Impairment during Dual Antiplatelet Therapy. Nephron Clin Pract 2016; 132:191-7. [DOI: 10.1159/000444027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 01/13/2016] [Indexed: 11/19/2022] Open
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Guo LZ, Kim MH, Shim CH, Choi SY, Serebruany VL. Impact of renal impairment on platelet reactivity and clinical outcomes during chronic dual antiplatelet therapy following coronary stenting. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2015; 2:145-51. [DOI: 10.1093/ehjcvp/pvv052] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 12/07/2015] [Indexed: 01/09/2023]
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Serebruany VL, Tomek A, Pokov AN, Kim MH. Clopidogrel, prasugrel, ticagrelor or vorapaxar in patients with renal impairment: do we have a winner? Expert Rev Cardiovasc Ther 2015; 13:1333-44. [PMID: 26513059 DOI: 10.1586/14779072.2015.1101343] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The optimal utilization of antiplatelet therapy in patients with renal impairment (RI) following acute coronary syndromes (ACS) represents an urgent, unmet and yet unsolved need with regards to the choice of agents, duration of treatment and potential dose/regimen adjustment. The lack of any large randomized trials designed and powered specifically in such high-risk patients, absence of the uniformed efficacy and safety data reporting policy to the FDA and endless overoptimistic publications based on post hoc analyses of primary trials sometimes exaggerating benefits and hiding risks, clouds reality. In addition, triaging RI patients is problematic due to ongoing kidney deterioration and the fact that such patients are prone to both vascular occlusions and bleeding. The authors summarize available FDA-confirmed evidence from the latest trials with approved antiplatelet agents, namely clopidogrel (CAPRIE, CURE, CREDO, CLARITY, CHARISMA); prasugrel (TRITON, TRILOGY); ticagrelor (PLATO, and PEGASUS); and vorapaxar (TRACER and TRA2P) in RI patient cohorts on top of aspirin as part of dual antiplatelet therapy (DAPT). We deliberately avoided any results unless they were verified by the FDA, with the exception of the recent PEGASUS, since Agency reviews are not yet available. Despite differences among the trials and DAPT choices, RI patients universally experience much higher (HR = 1.3-3.1) rates of primary endpoint events, and bleeding risks (HR = 1.7-3.6). However, only ticagrelor increases creatinine and uric acid levels above that of clopidogrel; has the worst incidence of serious adverse events, more adverse events, and inferior outcomes in patients with severe (eGFR <30 ml/min), especially in the lowest (eGFR <15 ml/min) RI subsets. Clopidogrel, prasugrel and vorapaxar appear safer. Moreover, less aggressive half dose (5 mg/daily) prasugrel and strict DAPT, are well justified in RI, but not predominantly triple strategies with vorapaxar as tested in TRA2P and especially in TRACER. In conclusion, data from clinical trials, their sub-studies and affiliated FDA reviews indicate that RI cause more vascular occlusions and bleeding in ACS patients treated with DAPT. Among the novel antiplatelet agents, prasugrel and vorapaxar, but probably not ticagrelor, offer advantage in RI patients.
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Affiliation(s)
- Victor L Serebruany
- a Osler Medical Center , Towson , MD , USA.,b Department of Neurology , Johns Hopkins , Towson , MD , USA
| | - Ales Tomek
- c Department of Neurology , University of Prague , Prague , Czech Republic
| | | | - Moo Hyun Kim
- d Department of Cardiology , Dong-A University , Busan , Korea
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Evidence-based care in a population with chronic kidney disease and acute coronary syndrome. Findings from the Australian Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events (CONCORDANCE). Am Heart J 2015; 170:566-72.e1. [PMID: 26385041 DOI: 10.1016/j.ahj.2015.06.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/20/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acute coronary syndrome (ACS) guidelines recommend that patients with chronic kidney disease (CKD) be offered the same therapies as other high-risk ACS patients with normal renal function. Our objective was to describe the gaps in evidence-based care offered to patients with ACS and concomitant CKD. METHODS Patients presenting to 41 Australian hospitals with suspected ACS were stratified by presence of CKD (glomerular filtration rate <60 mL/min). Receipt of evidence-based care including, coronary angiography (CA), evidence-based discharge medications (EBMs), and cardiac rehabilitation (CR) referral, were compared between patients with and without CKD. Hospital and clinical factors that predicted receipt of care were determined using multilevel multivariable stepwise logistic regression models. RESULTS Of the 4,778 patients admitted with suspected ACS, 1,227 had CKD. On univariate analyses, patients with CKD were less likely to undergo CA (59.1% vs 85.0%, P < .0001) or receive EBM (69.4% vs 78.7%, P < .0001), or were offered CR (49.5% vs 68.0%, P < .0001). After adjusting for patient characteristics and clustering by hospital, CKD remained an independent predictor of not undergoing CA only (odds ratio 0.48, 95% CI 0.37-0.61). Within the CKD cohort, presenting to a hospital with a catheterization laboratory was the strongest predictor of undergoing CA (odds ratio 3.07, 95% CI 1.91-4.93). CONCLUSION The presence of CKD independently predicts failure to undergo CA but not failure to receive EBM or CR, which is predicted by comorbidities. Among the CKD population, performance of CA is largely determined by admission to a catheterization capable hospital. Targeting these patients through standardization of care across institutions offers opportunities to improve outcomes in this high-risk population.
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Tisminetzky M, McManus DD, Dor A, Miozzo R, Yarzebski J, Gore JM, Goldberg RJ. Decade-long trends (1999-2009) in the characteristics, management, and hospital outcomes of patients hospitalized with acute myocardial infarction with prior diabetes and chronic kidney disease. Int J Nephrol Renovasc Dis 2015; 8:41-51. [PMID: 25999755 PMCID: PMC4427079 DOI: 10.2147/ijnrd.s78749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Despite the increasing magnitude and impact, there are limited data available on the clinical management and in-hospital outcomes of patients who have diabetes mellitus (DM) and chronic kidney disease (CKD) at the time of hospitalization for acute myocardial infarction (AMI). The objectives of our population-based observational study in residents of central Massachusetts were to describe decade-long trends (1999–2009) in the characteristics, in-hospital management, and hospital outcomes of AMI patients with and without these comorbidities. Methods We reviewed the medical records of 6,018 persons who were hospitalized for AMI on a biennial basis between 1999 and 2009 at all eleven medical centers in central Massachusetts. Our sample consisted of the following four groups: DM with CKD (n=587), CKD without DM (n=524), DM without CKD (n=1,442), and non-DM/non-CKD (n=3,465). Results Diabetic patients with CKD were more likely to have a higher prevalence of previously diagnosed comorbidities, to have developed heart failure acutely, and to have a longer hospital stay compared with non-DM/non-CKD patients. Between 1999 and 2009, there were marked increases in the prescribing of beta-blockers, statins, and aspirin for patients with CKD and DM as compared to those without these comorbidities. In-hospital death rates remained unchanged in patients with DM and CKD, while they declined markedly in patients with CKD without DM (20.2% dying in 1999; 11.3% dying in 2009). Conclusion Despite increases in the prescribing of effective cardiac medications, AMI patients with DM and CKD continue to experience high in-hospital death rates.
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Affiliation(s)
- Mayra Tisminetzky
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Ma, USA
| | - David D McManus
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Ma, USA ; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Ma, USA
| | - Alon Dor
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Ma, USA
| | - Ruben Miozzo
- Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA ; Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jorge Yarzebski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Ma, USA
| | - Joel M Gore
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Ma, USA
| | - Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Ma, USA ; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Ma, USA
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Mas E, Barden A, Burke V, Beilin LJ, Watts GF, Huang RC, Puddey IB, Irish AB, Mori TA. A randomized controlled trial of the effects of n-3 fatty acids on resolvins in chronic kidney disease. Clin Nutr 2015; 35:331-336. [PMID: 25908532 DOI: 10.1016/j.clnu.2015.04.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 03/27/2015] [Accepted: 04/07/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVE The high incidence of cardiovascular disease (CVD) in chronic kidney disease (CKD) is related partially to chronic inflammation. n-3 Fatty acids have been shown to have anti-inflammatory effects and to reduce the risk of CVD. Specialized Proresolving Lipid Mediators (SPMs) derived from the n-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) actively promote the resolution of inflammation. This study evaluates the effects of n-3 fatty acid supplementation on plasma SPMs in patients with CKD. METHODS In a double-blind, placebo-controlled intervention of factorial design, 85 patients were randomized to either n-3 fatty acids (4 g), Coenzyme Q10 (CoQ) (200 mg), both supplements, or control (4 g olive oil), daily for 8 weeks. The SPMs 18-HEPE, 17-HDHA, RvD1, 17R-RvD1, and RvD2, were measured in plasma by liquid chromatography-tandem mass spectrometry before and after intervention. RESULTS Seventy four patients completed the 8 weeks intervention. n-3 Fatty acids but not CoQ significantly increased (P < 0.0001) plasma levels of 18-HEPE and 17-HDHA, the upstream precursors to the E- and D-series resolvins, respectively. RvD1 was significantly increased (P = 0.036) after n-3 fatty acids, but no change was seen in other SPMs. In regression analysis the increase in 18-HEPE and 17-HDHA after n-3 fatty acids was significantly predicted by the change in platelet EPA and DHA, respectively. CONCLUSION SPMs are increased after 8 weeks n-3 fatty acid supplementation in patients with CKD. This may have important implications for limiting ongoing low grade inflammation in CKD.
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Affiliation(s)
- Emilie Mas
- School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Australia.
| | - Anne Barden
- School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Australia
| | - Valerie Burke
- School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Australia
| | - Lawrence J Beilin
- School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Australia
| | - Gerald F Watts
- School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Australia
| | - Rae-Chi Huang
- School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Australia; Telethon Kid's Institute, Australia
| | - Ian B Puddey
- School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Australia
| | - Ashley B Irish
- Department of Nephrology and Transplantation, Royal Perth Hospital, Perth, WA 6000, Australia
| | - Trevor A Mori
- School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Australia
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Morici N, De Servi S, Toso A, Murena E, Piscione F, Bolognese L, Petronio AS, Antonicelli R, Cavallini C, Angeli F, Savonitto S. Renal dysfunction, coronary revascularization and mortality among elderly patients with non ST elevation acute coronary syndrome. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2014; 4:453-60. [DOI: 10.1177/2048872614557221] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 10/07/2014] [Indexed: 11/15/2022]
Affiliation(s)
- Nuccia Morici
- Azienda Ospedaliera Ospedale Niguarda Cà Granda, Italy
| | | | - Anna Toso
- Ospedale Misericordia e Dolce, Italy
| | | | | | | | | | | | | | - Fabio Angeli
- Azienda Ospedaliera Ospedale Santa Maria della Misericordia, Italy
| | - Stefano Savonitto
- Azienda Ospedaliera della Provincia di Lecco, Ospedale A. Manzoni, Italy
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Greco A, Paroni G, Seripa D, Addante F, Dagostino MP, Aucella F. Frailty, disability and physical exercise in the aging process and in chronic kidney disease. Kidney Blood Press Res 2014; 39:164-8. [PMID: 25117919 DOI: 10.1159/000355792] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2014] [Indexed: 11/19/2022] Open
Abstract
Frailty in the elderly is a state of vulnerability to poor resolution of homoeostasis after a stressor event and is a consequence of cumulative decline in many physiological systems during a lifetime. This cumulative decline depletes homoeostatic reserves until minor stressor events trigger disproportionate changes in health status. It is usually associated to adverse health outcomes and to one-year mortality risk. Physical exercise has found to be effective in preventing frailty and disability in this population. Chronic kidney disease (CKD) is also a clinical condition where protein energy-wasting, sarcopenia and dynapenia ,very common symptoms in the frail elderly, may occur. Moreover elderly and CKD patients are both affected by an impaired physical performance that may be reversed by physical exercise with an improvement of the survival rate. These similarities suggest that frailty may be a common pathway of aging and CKD that may induce disability and that can be prevented by a multidimensional approach in which physical exercise plays an important role.
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Affiliation(s)
- Antonio Greco
- Geriatric Unit and Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy
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Barbieri L, Verdoia M, Schaffer A, Niccoli G, Perrone-Filardi P, Bellomo G, Marino P, Suryapranata H, Luca GD. Elevated Homocysteine and the Risk of Contrast-Induced Nephropathy. Angiology 2014; 66:333-8. [DOI: 10.1177/0003319714533401] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Contrast-induced nephropathy (CIN) is a common complication in patients with impaired kidney function undergoing coronary angiography/angioplasty. We evaluated whether elevated homocysteine (known to be associated with free radical generation and oxidative stress) increases the risk of CIN. Patients (n = 876) with creatinine clearance <60 mL/min undergoing coronary angiography or percutaneous coronary intervention (PCI) were divided into tertiles of homocysteine levels. Contrast-induced nephropathy was defined as ≥0.5 mg/dL or ≥25% creatinine increase 24 to 48 hours post-PCI. A significant relationship was observed between homocysteine levels and the risk of CIN ( P = .033), confirmed after correction for baseline confounding factors, adjusted odds ratio, OR (95% confidence interval, [CI]) = 1.68 (1.09-2.59), P = .019. This association was also significant applying the new definition of contrast-induced acute kidney injury (11.9% in group 1, 10.4% in group 2, and 22.8% in group 3; P < .001), adjusted OR (95% CI) = 1.96 (1.3-2.95), P = .001. Future studies are needed to confirm our findings and to define the role of homocysteine in CIN.
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Affiliation(s)
- Lucia Barbieri
- Division of Cardiology, Azienda Ospedaliera-Universitaria “Maggiore della Carità,” Eastern Piedmont University, Novara, Italy
| | - Monica Verdoia
- Division of Cardiology, Azienda Ospedaliera-Universitaria “Maggiore della Carità,” Eastern Piedmont University, Novara, Italy
| | - Alon Schaffer
- Division of Cardiology, Azienda Ospedaliera-Universitaria “Maggiore della Carità,” Eastern Piedmont University, Novara, Italy
| | - Giampaolo Niccoli
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Pasquale Perrone-Filardi
- Department of Medicine, Cardiovascular and Immunological Sciences, University of Naples Federico II, Naples, Italy
| | - Giorgio Bellomo
- Clinical Chemistry, Azienda Ospedaliera-Universitaria “Maggiore della Carità,” Eastern Piedmont University, Novara, Italy
| | - Paolo Marino
- Division of Cardiology, Azienda Ospedaliera-Universitaria “Maggiore della Carità,” Eastern Piedmont University, Novara, Italy
| | | | - Giuseppe De Luca
- Division of Cardiology, Azienda Ospedaliera-Universitaria “Maggiore della Carità,” Eastern Piedmont University, Novara, Italy
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Seidel UK, Gronewold J, Volsek M, Todica O, Kribben A, Bruck H, Hermann DM. Physical, cognitive and emotional factors contributing to quality of life, functional health and participation in community dwelling in chronic kidney disease. PLoS One 2014; 9:e91176. [PMID: 24614180 PMCID: PMC3948783 DOI: 10.1371/journal.pone.0091176] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 02/10/2014] [Indexed: 11/28/2022] Open
Abstract
Background Quality of life (QoL) impairment is a well-known consequence of chronic kidney disease (CKD). The factors influencing QoL and late life functional health are poorly examined. Methods Using questionnaires combined with neuropsychological examinations, we prospectively evaluated physical, cognitive, and emotional factors influencing QoL, functional health and participation in community dwelling in 119 patients with CKD stages 3–5 including hemodialysis (61.5±15.7years; 63% men) and 54 control patients of the same age without CKD but with similar cardiovascular risk profile. Results Compared with control patients, CKD patients showed impairment of the physical component of QoL and overall function, assessed by the SF-36 and LLFDI, whereas disability, assessed by LLFDI, was selectively impaired in CKD patients on hemodialysis. Multivariable linear regressions (forced entry) confirmed earlier findings that CKD stage (β = −0.24; p = 0.012) and depression (β = −0.30; p = 0.009) predicted the QoL physical component. Hitherto unknown, CKD stage (β = −0.23; p = 0.007), cognition (β = 0.20; p = 0.018), and depression (β = −0.51; <0.001) predicted disability assessed by the LLFDI, while age (β = −0.20; p = 0.023), male gender (B = 5.01; p = 0.004), CKD stage (β = −0.23; p = 0.005), stroke history (B = −9.00; p = 0.034), and depression (β = −0.41; p<0.001) predicted overall function. Interestingly, functional health deficits, cognitive disturbances, depression, and anxiety were evident almost only in CKD patients with coronary heart disease (found in 34.2% of CKD patients). The physical component of QoL and functional health decreased with age and depressive symptoms, and increased with cognitive abilities. Conclusions In CKD, QoL, functional health, and participation in community dwelling are influenced by physical, cognitive, and emotional factors, most prominently in coronary heart disease patients.
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Affiliation(s)
- Ulla K. Seidel
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Janine Gronewold
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Michaela Volsek
- Department of Nephrology, University Hospital Essen, Essen, Germany
| | - Olga Todica
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, Essen, Germany
| | - Heike Bruck
- Department of Nephrology, University Hospital Essen, Essen, Germany
| | - Dirk M. Hermann
- Department of Neurology, University Hospital Essen, Essen, Germany
- * E-mail:
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Cardiovascular Risk in Diabetes Mellitus: Cause and Effect. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2014. [DOI: 10.1007/s40138-013-0034-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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