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Zoccali C, Mark PB, Sarafidis P, Agarwal R, Adamczak M, Bueno de Oliveira R, Massy ZA, Kotanko P, Ferro CJ, Wanner C, Burnier M, Vanholder R, Mallamaci F, Wiecek A. Diagnosis of cardiovascular disease in patients with chronic kidney disease. Nat Rev Nephrol 2023; 19:733-746. [PMID: 37612381 DOI: 10.1038/s41581-023-00747-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/25/2023]
Abstract
Patients with chronic kidney disease (CKD) are at high risk of cardiovascular disease (CVD) and cardiovascular death. Identifying and monitoring cardiovascular complications and hypertension is important for managing patients with CKD or kidney failure and transplant recipients. Biomarkers of myocardial ischaemia, such as troponins and electrocardiography (ECG), have limited utility for diagnosing cardiac ischaemia in patients with advanced CKD. Dobutamine stress echocardiography, myocardial perfusion scintigraphy and dipyridamole stress testing can be used to detect coronary disease in these patients. Left ventricular hypertrophy and left ventricular dysfunction can be detected and monitored using various techniques with differing complexity and cost, including ECG, echocardiography, nuclear magnetic resonance, CT and myocardial scintigraphy. Atrial fibrillation and other major arrhythmias are common in all stages of CKD, and ambulatory heart rhythm monitoring enables precise time profiling of these disorders. Screening for cerebrovascular disease is only indicated in asymptomatic patients with autosomal dominant polycystic kidney disease. Standardized blood pressure is recommended for hypertension diagnosis and treatment monitoring and can be complemented by ambulatory blood pressure monitoring. Judicious use of these diagnostic techniques may assist clinicians in detecting the whole range of cardiovascular alterations in patients with CKD and enable timely treatment of CVD in this high-risk population.
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Affiliation(s)
- Carmine Zoccali
- Renal Research Institute, New York, NY, USA.
- Institute of Biology and Molecular Genetics (BIOGEM), Ariano Irpino, Italy.
- Associazione Ipertensione Nefrologia e Trapianto Renale (IPNET) c/o Nefrologia, Grande Ospedale Metropolitano, Reggio Calabria, Italy.
| | - Patrick B Mark
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Rajiv Agarwal
- Indiana University School of Medicine, Indianapolis, IN, USA
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Marcin Adamczak
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice, Katowice, Poland
| | - Rodrigo Bueno de Oliveira
- Department of Internal Medicine (Nephrology), School of Medical Sciences, University of Campinas (Unicamp), Campinas, Brazil
| | - Ziad A Massy
- Ambroise Paré University Hospital, APHP, Boulogne Billancourt/Paris, Billancourt, France
- INSERM U-1018, Centre de recherche en épidémiologie et santé des populations (CESP), Equipe 5, Paris-Saclay University (PSU), Paris, France
- University of Paris Ouest-Versailles-Saint-Quentin-en-Yvelines (UVSQ), FCRIN INI-CRCT, Villejuif, France
| | - Peter Kotanko
- Renal Research Institute, LLC Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Charles J Ferro
- Department of Renal Medicine, University Hospitals Birmingham, Birmingham, UK
| | - Christoph Wanner
- Division of Nephrology, University Hospital of Würzburg, Würzburg, Germany
| | - Michel Burnier
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Raymond Vanholder
- Nephrology Section, Department of Internal Medicine and Paediatrics, University Hospital, Ghent, Belgium
| | - Francesca Mallamaci
- Nephrology and Transplantation Unit, Grande Ospedale Metropolitano Reggio Cal and CNR-IFC, Reggio Calabria, Italy
| | - Andrzej Wiecek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
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Singh S, Aggarwal V, Pandey UK, Sreenidhi HC. Study of left ventricular systolic dysfunction, left ventricular diastolic dysfunction and pulmonary hypertension in CKD 3b-5ND patients-A single centre cross-sectional study. Nefrologia 2023; 43:596-605. [PMID: 36564233 DOI: 10.1016/j.nefroe.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 06/03/2022] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION Cardiovascular diseases are associated with increased morbidity and mortality among CKD (chronic kidney disease) population. Recent studies have found increasing prevalence of PH (pulmonary hypertension) in CKD population. Present study was done to determine prevalence and predictors of LV (left ventricular) systolic dysfunction, LVDD (left ventricular diastolic dysfunction) and PH in CKD 3b-5ND (non-dialysis) patients. METHODS A cross sectional observational study was done from Jan/2020 to April/2021. CKD 3b-5ND patients aged ≥15 yrs were included. Transthoracic 2D (2 dimensional) echocardiography was done in all patients. PH was defined as if PASP (pulmonary artery systolic pressure) value above 35mm Hg, LV systolic dysfunction was defined as LVEF (left ventricular ejection fraction)≤50% and LVDD as E/e' ratio >14 respectively. Multivariate logistic regression model was done to determine the predictors. RESULTS A total of 378 patients were included in the study with 103 in stage 3b, 175 in stage 4 and 100 patients in stage 5ND. Prevalence of PH was 12.2%, LV systolic dysfunction was 15.6% and LVDD was 43.65%. Predictors of PH were duration of CKD, haemoglobin, serum 25-OH vitamin D, serum iPTH (intact parathyroid hormone) and serum albumin. Predictors of LVDD were duration of CKD and presence of arterial hypertension. Predictors of LV systolic dysfunction were eGFR (estimated glomerular filtration rate), duration of CKD, serum albumin and urine protein. CONCLUSION In our study of 378 CKD 3b-5ND patients prevalence of PH was 12.2%, LV systolic dysfunction was 15.6% and LVDD was 43.65%.
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Affiliation(s)
- Shivendra Singh
- Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Vikas Aggarwal
- Department of Cardiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Umesh Kumar Pandey
- Department of Cardiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - H C Sreenidhi
- Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
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Kitamura H, Tanaka S, Hiyamuta H, Shimamoto S, Tsuruya K, Nakano T, Kitazono T. Cardiovascular Risk Factor Burden and Treatment Control in Patients with Chronic Kidney Disease: A Cross-Sectional Study. J Atheroscler Thromb 2023; 30:1210-1288. [PMID: 36596531 PMCID: PMC10499443 DOI: 10.5551/jat.63891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/31/2022] [Indexed: 12/29/2022] Open
Abstract
AIM Cardiovascular disease is a life-threatening chronic kidney disease (CKD) complication. Although cardiovascular risk factor management is significant in patients with CKD, there are few reports that detail the frequency of complications and the treatment of cardiovascular risk factors at different stages of CKD in clinical practice. METHODS There were a total of 3,407 patients with non-dialysis-dependent CKD who participated in the Fukuoka Kidney disease Registry Study, and they were cross-sectionally analyzed. The patients were classified into five groups based on their estimated glomerular filtration rate and urinary albumin to creatinine ratio according to Kidney Disease: Improving Global Outcomes 2012 guidelines, which recommend low, moderate, high, very high, and extremely high risk groups. The primary outcomes were the cardiovascular risk factor burden and the treatment status of cardiovascular risk factors. Using a logistic regression model, the association between the CKD groups and the treatment status of each risk factor was examined. RESULTS The proportion of patients with hypertension, diabetes mellitus, and dyslipidemia significantly increased as CKD progressed, whereas the proportion of patients who achieved cardiovascular risk factor treatment targets significantly decreased. In the multivariable analysis, the odds ratios (ORs) of uncontrolled treatment targets were significantly higher for hypertension (OR 3.68) in the extremely high risk group than in the low risk group. CONCLUSIONS Patients with non-dialysis-dependent CKD demonstrate an increased cardiovascular risk factor burden with greater severity of CKD. Extremely high risk CKD is associated with difficulty in managing hypertension.
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Affiliation(s)
- Hiromasa Kitamura
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shigeru Tanaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroto Hiyamuta
- Department of Internal Medicine, Faculty of Medicine, Division of Nephrology and Rheumatology, Fukuoka University, Fukuoka, Japan
| | - Sho Shimamoto
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Olanrewaju TO, Osafo C, Raji YR, Mamven M, Ajayi S, Ilori TO, Arogundade FA, Ulasi II, Gbadegesin R, Parekh RS, Tayo B, Adeyemo AA, Adedoyin OT, Chijioke AA, Bewaji C, Grobbee DE, Blankestijn PJ, Klipstein-Grobusch K, Salako BL, Adu D, Ojo AO. Cardiovascular Risk Factor Burden and Association With CKD in Ghana and Nigeria. Kidney Int Rep 2023; 8:658-666. [PMID: 36938080 PMCID: PMC10014339 DOI: 10.1016/j.ekir.2022.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Cardiovascular disease is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD); however, the burden of cardiovascular risk factors in patients with CKD in Africa is not well characterized. We determined the prevalence of selected cardiovascular risk factors, and association with CKD in the Human Heredity for Health in Africa Kidney Disease Research Network study. Methods We recruited patients with and without CKD in Ghana and Nigeria. CKD was defined as estimated glomerular filtration rate of <60 ml/min per 1.73 m2 and/or albuminuria as albumin-to-creatinine ratio <3.0 mg/mmol (<30 mg/g) for ≥3 months. We assessed self-reported (physician-diagnosis and/or use of medication) hypertension, diabetes, and elevated cholesterol; and self-reported smoking as cardiovascular risk factors. Association between the risk factors and CKD was determined by multivariate logistic regression. Results We enrolled 8396 participants (cases with CKD, 3956), with 56% females. The mean age (45.5 ± 15.1 years) did not differ between patients and control group. The prevalence of hypertension (59%), diabetes (20%), and elevated cholesterol (9.9%), was higher in CKD patients than in the control participants (P < 0.001). Prevalence of risk factors was higher in Ghana than in Nigeria. Hypertension (adjusted odds ratio [aOR] = 1.69 [1.43-2.01, P < 0.001]), elevated cholesterol (aOR = 2.0 [1.39-2.86, P < 0.001]), age >50 years, and body mass index (BMI) <18.5 kg/m2 were independently associated with CKD. The association of diabetes and smoking with CKD was modified by other risk factors. Conclusion Cardiovascular risk factors are prevalent in middle-aged adult patients with CKD in Ghana and Nigeria, with higher proportions in Ghana than in Nigeria. Hypertension, elevated cholesterol, and underweight were independently associated with CKD.
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Affiliation(s)
- Timothy O. Olanrewaju
- Division of Nephrology, Department of Medicine, University of Ilorin, Ilorin, Nigeria
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Charlotte Osafo
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Ghana
| | - Yemi R. Raji
- Department of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Manmak Mamven
- Department of Medicine, University of Abuja, Abuja, Nigeria
| | - Samuel Ajayi
- Department of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Titilayo O. Ilori
- Section of Nephrology, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Ifeoma I. Ulasi
- Department of Medicine, College of Health Sciences, University of Nigeria, Enugu, Nigeria
| | - Rasheed Gbadegesin
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Rulan S. Parekh
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Bamidele Tayo
- Department of Public Health Sciences, Loyola University Parkinson School of Health Sciences and Public Health, Maywood, Illinois, USA
| | - Adebowale A. Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Adindu A. Chijioke
- Division of Nephrology, Department of Medicine, University of Ilorin, Ilorin, Nigeria
| | - Clement Bewaji
- Department of Biochemistry, University of Ilorin, Ilorin, Nigeria
| | - Diederick E. Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Peter J. Blankestijn
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Dwomoa Adu
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Ghana
| | - Akinlolu O. Ojo
- University of Kansas School of Medicine, Kansas City, Kansas, USA
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Study of left ventricular systolic dysfunction, left ventricular diastolic dysfunction and pulmonary hypertension in CKD 3b-5ND patients—A single centre cross-sectional study. Nefrologia 2022. [DOI: 10.1016/j.nefro.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Yang C, Long J, Shi Y, Zhou Z, Wang J, Zhao MH, Wang H, Zhang L, Coresh J. Healthcare resource utilisation for chronic kidney disease and other major non-communicable chronic diseases in China: a cross-sectional study. BMJ Open 2022; 12:e051888. [PMID: 35027417 PMCID: PMC8762138 DOI: 10.1136/bmjopen-2021-051888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 12/14/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To evaluate the healthcare resource utilisation for chronic kidney disease (CKD) and other major non-communicable chronic diseases (NCDs) in China. DESIGN A cross-sectional study. SETTING A national inpatient database of tertiary hospitals in China. PARTICIPANTS The study included a total of 19.5 million hospitalisations of adult patients from July 2013 to June 2014. Information on CKD and other major NCDs, including coronary heart disease (CHD), stroke, hypertension, diabetes, chronic obstructive pulmonary disease (COPD) and cancer, was extracted from the unified discharge summary form. OUTCOME MEASURES Cost, length of hospital stay and in-hospital mortality. RESULTS The percentages of hospitalisations with CKD, CHD, stroke, hypertension, diabetes, COPD and cancer were 4.5%, 9.2%, 8.2%, 18.8%, 7.9%, 2.3% and 19.4%, respectively. For each major NCD, the presence of CKD was independently associated with longer hospital stay, with increased percentages ranging from 7.69% (95% CI 7.11% to 8.28%) for stroke to 21.60% (95% CI 21.09% to 22.10%) for CHD. Hospital mortality for other NCDs was also higher in the presence of CKD, with fully adjusted relative risk ranging from 1.91 (95% CI 1.82 to 1.99) for stroke to 2.65 (95% CI 2.55 to 2.75) for cancer. Compared with other NCDs, CKD was associated with the longest hospital stay (22.1% increase) and resulted in the second highest in-hospital mortality, only lower than that of cancer (relative risk, 2.23 vs 2.87, respectively). CONCLUSIONS The presence of diagnosed CKD alongside each major NCD was associated with an additional burden on the healthcare system. Healthcare resource utilisation and prognosis of CKD were comparable with those of other major NCDs, which highlights the importance of CKD as a major public health burden.
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Affiliation(s)
- Chao Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, People's Republic of China
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
- Advanced Institute of Information Technology, Peking University, Hangzhou, People's Republic of China
| | - Jianyan Long
- Clinical Trial Unit, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Ying Shi
- China Standard Medical Information Research Center, Shenzhen, People's Republic of China
| | - Zhiye Zhou
- China Standard Medical Information Research Center, Shenzhen, People's Republic of China
| | - Jinwei Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, People's Republic of China
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Ming-Hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, People's Republic of China
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
- Peking-Tsinghua Center for Life Sciences, Beijing, People's Republic of China
| | - Haibo Wang
- Clinical Trial Unit, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
- National Institute of Health Data Science at Peking University, Beijing, People's Republic of China
| | - Luxia Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, People's Republic of China
- Advanced Institute of Information Technology, Peking University, Hangzhou, People's Republic of China
- National Institute of Health Data Science at Peking University, Beijing, People's Republic of China
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Liu T, Liu W. Angiotensinogen and Risk of Stroke Events in Patients with Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes 2022; 15:419-425. [PMID: 35177918 PMCID: PMC8846557 DOI: 10.2147/dmso.s335746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/21/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Activation of the renin-angiotensin system (RAS) in diabetic patients is a vital pathophysiological mechanism of cardiovascular complications. AIM We aimed to assess whether serum and urinary angiotensinogen levels could predict the risk of stroke events in patients with type 2 diabetes. METHODS An analysis of the relationships between serum and urinary angiotensinogen levels at baseline and the risk of stroke events was performed in a study consisting of 467 patients with type 2 diabetes with a follow-up of 5 years. Multivariate Cox regression models were built by controlling for a large range of related risk factors. RESULTS Kaplan-Meier analysis showed that patients with low estimated glomerular filtration rate (eGFR) <57 mL/min/1.73 m2 had a significantly higher risk of stroke events than those with high eGFRs (≥57 mL/min/1.73 m2, P=0.040). Our results suggested that urinary angiotensinogen levels (HR=2.74, 95% CI 1.50-5.88, P=<0.001), but not serum angiotensinogen levels (HR=1.42, 95% CI 0.95-2.65, P=0.071), were independent predictors of the risk of stroke events in patients with type 2 diabetes after adjusting for confounding factors. Similarly, sensitivity analysis also suggested that higher urinary angiotensinogen levels still contributed to an increased risk of stroke events (HR=2.71, 95% CI 1.48-5.82, P<0.001) but not serum angiotensinogen levels (HR=1.37, 95% CI 0.89-2.21, P=0.104). Importantly, we found that significant associations only existed in patients with eGFRs<60 mL/min/1.73 m2 (HR=2.78, 95% CI 1.59-6.30, P<0.001) but not in patients with eGFRs≥60 mL/min/1.73 m2 (HR=1.39, 95% CI 0.95-3.53, P=0.054). CONCLUSION The study suggested that elevated urinary angiotensinogen levels were correlated with a higher risk of stroke events in patients with type 2 diabetes mellitus.
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Affiliation(s)
- Tao Liu
- Department of Neurology, Tianjin Nankai Hospital, Tianjin, 300100, People’s Republic of China
- Correspondence: Tao Liu Department of Neurology, Tianjin Nankai Hospital, NO. 6, Changjiang Road, Nankai District, Tianjin, 300100, People’s Republic of China Email
| | - Weihong Liu
- Department of Traditional Chinese Medicine, Tianjin Fourth Central Hospital, Tianjin, 300140, People’s Republic of China
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Role of Pocket Ultrasound in Assessing Intravascular Volume to Guide Management in Heart Failure Patients with Renal Impairment. Cardiol Ther 2021; 10:491-500. [PMID: 34173941 PMCID: PMC8555013 DOI: 10.1007/s40119-021-00229-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/11/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Inpatient management of patients with heart failure (HF) and renal impairment is challenging. We sought to evaluate the role of pocket ultrasound (US)-guided management of this patient population. Methods We prospectively included patients with acute HF exacerbation and renal impairment admitted to the HF service in our University hospital from January 2017 to August 2018. We compared the outcomes of patients who received US-guided management with those who received standard of care management. The main study outcome was the change in estimated glomerular filtration rate (eGFR). Multivariable logistic analysis was used to adjust for basic demographics and risk factors. Results A total of 211 patients with renal impairment presenting with acute HF exacerbation (mean age 66.8 ± 14.6 years, 41% females, 62% white) were enrolled in the study, of whom 69 (32.7%) received US-guided management and 151 (68%) received standard of care management. The change in the eGFR was significantly lower in US-guided group than in the group receiving standard of care (1.1 ± 4.3% vs. − 11.15 ± 2.9%; p = 0.04). No significant difference was observed between the patient groups in the length of stay (6.45 ± 0.38 vs. 6.44 ± 0.56; days; p = 0.98) and in the 30-day HF readmission rate (hazard ratio 1.27, 95% confidence interval 0.28–5.6; p = 0.75). Conclusion Ultrasound-guided management of patients admitted with acute HF exacerbation and renal impairment may be beneficial in preserving kidney function. US provides a simple easily accessible tool to guide the management of patients with HF.
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Wang F, Liu A, Brophy JM, Cohen S, Abrahamowicz M, Paradis G, Marelli A. Determinants of Survival in Older Adults With Congenital Heart Disease Newly Hospitalized for Heart Failure. Circ Heart Fail 2020; 13:e006490. [PMID: 32673500 DOI: 10.1161/circheartfailure.119.006490] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Nearly 90% of patients with adult congenital heart disease (ACHD) die after the age of 40 years, and heart failure (HF) is the most common cause of death. We aimed to characterize the association between an incident HF hospitalization (HFH) and mortality and to identify the predictors of 1-year postdischarge mortality after incident and repeated HFHs, respectively. METHODS Patients with ACHD aged ≥40 years between 2000 and 2010 were identified from the Québec CHD database. We conducted a propensity score-matched study to explore the association between an incident HFH and mortality. We performed Bayesian model averaging to identify the predictors of 1-year postdischarge mortality with a posterior probability ≥50% considered to be evidence of a significant association. RESULTS The mortality hazard ratio was high at 6.01 (95% CI, 4.02-10.72) within 1-year postdischarge, decreasing significantly but entering an elevated equilibrium until year 4 with a continued 3-fold increase in death. Kidney dysfunction (hazard ratio, 2.28 [95% credible interval, 1.59-3.28], posterior probability, 100.0%) and a history of ≥2 HFHs in the past 12 months (hazard ratio, 1.77 [95% credible interval, 1.18-2.66], posterior probability: 82.2%) were the most robust predictors of 1-year mortality after incident and repeated HFHs, respectively. CONCLUSIONS In patients with ACHD aged ≥40 years, incident HFH was associated with high mortality risk at 1 year, declining but remaining elevated for 4 years. Kidney dysfunction was a potent predictor of 1-year mortality risk after incident HFHs. Repeated HFHs further increased mortality risk. These observations should inform early risk-tailored health services interventions for monitoring and prevention of HF and its associated complications in older patients with ACHD.
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Affiliation(s)
- Fei Wang
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada (F.W., J.M.B., M.A., G.P.).,McGill Adult Unit for Congenital Heart Disease Excellence, Montreal, QC, Canada (F.W., A.L., A.M.)
| | - Aihua Liu
- McGill Adult Unit for Congenital Heart Disease Excellence, Montreal, QC, Canada (F.W., A.L., A.M.)
| | - James M Brophy
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada (F.W., J.M.B., M.A., G.P.).,Division of Cardiology, McGill University Health Centre, Montreal, QC, Canada (J.M.B.)
| | - Sarah Cohen
- Hospital Marie Lannelongue, Congenital Heart Diseases Department, Complex Congenital Heart Diseases M3C Network, Paris-Sud University, Paris-Saclay University, Plessis-Robinson, France (S.C.)
| | - Michal Abrahamowicz
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada (F.W., J.M.B., M.A., G.P.)
| | - Gilles Paradis
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada (F.W., J.M.B., M.A., G.P.)
| | - Ariane Marelli
- McGill Adult Unit for Congenital Heart Disease Excellence, Montreal, QC, Canada (F.W., A.L., A.M.)
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Laine M, Lemesle G, Burtey S, Cayla G, Range G, Quaino G, Canault M, Pankert M, Paganelli F, Puymirat E, Bonello L. TicagRelor Or Clopidogrel in severe or terminal chronic kidney patients Undergoing PERcutaneous coronary intervention for acute coronary syndrome: The TROUPER trial. Am Heart J 2020; 225:19-26. [PMID: 32473355 DOI: 10.1016/j.ahj.2020.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 04/20/2020] [Indexed: 12/17/2022]
Abstract
Chronic kidney disease (CKD) is associated with an increased risk of acute coronary syndrome (ACS) and cardiovascular death. CKD patients suffering from ACS are exposed to an increased risk of thrombotic recurrences and a higher bleeding rate than patients with normal renal function. However, CKD patients are excluded or underrepresented in clinical trials. Therefore, determining the optimal antiplatelet strategy in this population is of utmost importance. We designed the TicagRelor Or Clopidogrel in severe or terminal chronic kidney patients Undergoing PERcutaneous coronary intervention for acute coronary syndrome (TROUPER) trial: a prospective, controlled, multicenter, randomized trial to investigate the optimal P2Y12 antagonist in CKD patients with ACS. Patients with stage ≥3b CKD are eligible if the diagnosis of ACS is made and invasive strategy scheduled. Patients are randomized 1:1 between a control group with a 600-mg loading dose of clopidogrel followed by a 75-mg/d maintenance dose for 1 year and an experimental group with a 180-mg loading dose of ticagrelor followed by a 90-mg twice daily maintenance dose for the same duration. The primary end point is defined by the rate of major adverse cardiovascular events, including death, myocardial infarction, urgent revascularization, and stroke at 1 year. Safety will be evaluated by the bleeding rate (Bleeding Academic Research Consortium). To demonstrate the superiority of ticagrelor on major adverse cardiovascular events, we calculated that 508 patients are required. The aim of the TROUPER trial is to compare the efficacy of ticagrelor and clopidogrel in stage >3b CKD patients presenting with ACS and scheduled for an invasive strategy. RCT# NCT03357874.
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Affiliation(s)
- Marc Laine
- Aix-Marseille Univ, Intensive cardiac care unit, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France; Aix Marseille Univ, INSERM, INRA, C2VN, Marseille, France.
| | - Gilles Lemesle
- Institut Cœur et Poumon, CHRU de Lille, Faculté de Médecine de l'Université de Lille, Unité INSERM UMR 1011, Lille, France
| | - Stéphane Burtey
- Aix Marseille Univ, INSERM, INRA, C2VN, Marseille, France; Service de Néphrologie, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | | | - Grégoire Range
- Département de Cardiologie, CHU Chartres, Chartres, France
| | - Gonzalo Quaino
- Service de Cardiologie, Centre Hospitalier Toulon, Toulon, France
| | | | - Mathieu Pankert
- Service de Cardiologie, Centre Hospitalier d'Avignon, Avignon, France
| | - Franck Paganelli
- Aix-Marseille Univ, Intensive cardiac care unit, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Etienne Puymirat
- Département de Cardiologie, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Université Paris Descartes, INSERM U-970, Paris, France
| | - Laurent Bonello
- Aix-Marseille Univ, Intensive cardiac care unit, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France; Aix Marseille Univ, INSERM, INRA, C2VN, Marseille, France
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11
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Litvin CB, Nietert PJ, Jenkins RG, Wessell AM, Nemeth LS, Ornstein SM. Translating CKD Research into Primary Care Practice: a Group-Randomized Study. J Gen Intern Med 2020; 35:1435-1443. [PMID: 31823314 PMCID: PMC7210359 DOI: 10.1007/s11606-019-05353-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 09/11/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is common in the primary care setting. Early interventions may prevent progression of renal disease and reduce risk for cardiovascular complications, yet quality gaps have been documented. Successful approaches to improve identification and management of CKD in primary care are needed. OBJECTIVE To assess whether implementation of a primary care improvement model results in improved identification and management of CKD DESIGN: 18-month group-randomized study PARTICIPANTS: 21 primary care practices in 13 US states caring for 107,094 patients INTERVENTIONS: To promote implementation of CKD improvement strategies, intervention practices received clinical quality measure (CQM) reports at least quarterly, hosted an on-site visit and 2 webinars, and sent clinician/staff representatives to a "best practice" meeting. Control practices received CQM reports at least quarterly. MAIN MEASURES Changes in practice adherence to a set of 11 CKD CQMs KEY RESULTS: We observed significantly greater improvements among intervention practices for annual screening for albuminuria in patients with diabetes or hypertension (absolute change 22% in the intervention group vs. - 2.6% in the control group, p < 0.0001) and annual monitoring for albuminuria in patients with CKD (absolute change 21% in the intervention group vs. - 2.0% in the control group, p < 0.0001). Avoidance of NSAIDs in patients with CKD declined in both intervention and control groups, with a significantly greater decline in the control practices (absolute change - 5.0% in the intervention group vs. - 10% in the control group, p < 0.0001). There were no other significant changes found for the other CQMs. Variable implementation of CKD improvement strategies was noted across the intervention practices. CONCLUSIONS Implementation of a primary care improvement model designed to improve CKD identification and management resulted in significantly improved care on 3 out of 11 CQMs. Incomplete adoption of improvement strategies may have limited further improvement. Improving CKD identification and management likely requires a longer and more intensive intervention.
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Affiliation(s)
- Cara B Litvin
- Division of General Internal Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Ruth G Jenkins
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Andrea M Wessell
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Lynne S Nemeth
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Steven M Ornstein
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC, USA
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12
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Vascular access animal models used in research. Ann Anat 2019; 225:65-75. [DOI: 10.1016/j.aanat.2019.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 06/13/2019] [Accepted: 06/13/2019] [Indexed: 12/22/2022]
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13
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Hu F, Warren J, Exeter DJ. Geography and patient history in long-term lipid lowering medication adherence for primary prevention of cardiovascular disease. Spat Spatiotemporal Epidemiol 2019; 29:13-29. [DOI: 10.1016/j.sste.2018.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 10/03/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
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14
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Chartier MJ, Tangri N, Komenda P, Walld R, Koseva I, Burchill C, McGowan KL, Dart A. Prevalence, socio-demographic characteristics, and comorbid health conditions in pre-dialysis chronic kidney disease: results from the Manitoba chronic kidney disease cohort. BMC Nephrol 2018; 19:255. [PMID: 30305038 PMCID: PMC6180583 DOI: 10.1186/s12882-018-1058-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 09/25/2018] [Indexed: 11/24/2022] Open
Abstract
Background Chronic Kidney Disease (CKD) is common and its prevalence has increased steadily over several decades. Monitoring of rates and severity of CKD across populations is critical for policy development and resource planning. Administrative health data alone has insufficient sensitivity for this purpose, therefore utilizing population level laboratory data and novel methodology is required for population-based surveillance. The aims of this study include a) develop the Manitoba CKD Cohort, b) estimate CKD prevalence, c) identify individuals at high risk of progression to kidney failure and d) determine rates of comorbid health conditions. Methods Administrative health and laboratory data from April 1996 to March 2012 were linked from the data repository at the Manitoba Centre for Health Policy. Prevalence was estimated using three methods: a) all CKD cases in administrative and laboratory databases; b) all CKD cases captured only through the laboratory data; c) and the capture-recapture method. Patients were stratified by risk by estimated Glomerular Filtration Rate (eGFR) and albuminuria based on Kidney Disease Improving Global Outcomes (KDIGO) criteria. For comorbid health conditions, the counts were modelled using a Generalized Linear Model (GLM). Results The Manitoba CKD Cohort consisted of 55,876 people with CKD. Of these, 18,342 were identified using administrative health data, 27,393 with laboratory data, and 10,141 people were identified in both databases. The CKD prevalence was 5.6% using the standard definition, 10.6% using only people captured by the laboratory data and 10.6% using the capture-recapture method. Of the identified cases, 46% were at high risk of progression to end-stage kidney disease (ESKD), 41% were at low risk and 13% were not classified, due to unavailable laboratory data. High risk cases had a higher burden of comorbid conditions. Conclusion This study reports a novel methodology for population based CKD surveillance utilizing a combination of administrative health and laboratory data. High rates of CKD at risk of progression to ESKD have been identified with this approach. Given the high rates of comorbidity and associated healthcare costs, these data can be used to develop a targeted and comprehensive public health surveillance strategy that encompass a range of interrelated chronic diseases. Electronic supplementary material The online version of this article (10.1186/s12882-018-1058-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mariette J Chartier
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Navdeep Tangri
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Department of Medicine and Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Paul Komenda
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Department of Medicine and Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Randy Walld
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ina Koseva
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Charles Burchill
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Kari-Lynne McGowan
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Allison Dart
- Department of Pediatrics and Child Health, Section of Nephrology, University of Manitoba, Winnipeg, Canada
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15
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Al‐Naher A, Wright D, Devonald MAJ, Pirmohamed M. Renal function monitoring in heart failure - what is the optimal frequency? A narrative review. Br J Clin Pharmacol 2018; 84:5-17. [PMID: 28901643 PMCID: PMC5736847 DOI: 10.1111/bcp.13434] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 08/31/2017] [Accepted: 09/05/2017] [Indexed: 12/29/2022] Open
Abstract
The second most common cause of hospitalization due to adverse drug reactions in the UK is renal dysfunction due to diuretics, particularly in patients with heart failure, where diuretic therapy is a mainstay of treatment regimens. Therefore, the optimal frequency for monitoring renal function in these patients is an important consideration for preventing renal failure and hospitalization. This review looks at the current evidence for optimal monitoring practices of renal function in patients with heart failure according to national and international guidelines on the management of heart failure (AHA/NICE/ESC/SIGN). Current guidance of renal function monitoring is in large part based on expert opinion, with a lack of clinical studies that have specifically evaluated the optimal frequency of renal function monitoring in patients with heart failure. Furthermore, there is variability between guidelines, and recommendations are typically nonspecific. Safer prescribing of diuretics in combination with other antiheart failure treatments requires better evidence for frequency of renal function monitoring. We suggest developing more personalized monitoring rather than from the current medication-based guidance. Such flexible clinical guidelines could be implemented using intelligent clinical decision support systems. Personalized renal function monitoring would be more effective in preventing renal decline, rather than reacting to it.
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Affiliation(s)
- Ahmed Al‐Naher
- The Wolfson Centre for Personalised MedicineThe University of LiverpoolLiverpoolUK
| | - David Wright
- Institute of Cardiovascular Medicine and ScienceLiverpool Heart and Chest HospitalLiverpoolUK
| | | | - Munir Pirmohamed
- The Wolfson Centre for Personalised MedicineThe University of LiverpoolLiverpoolUK
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16
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Ketabchi F, Bajoovand S, Adlband M, Naseh M, Nekooeian AA, Mashghoolozekr E. Right ventricular pressure elevated in one-kidney, one clip Goldblatt hypertensive rats. Clin Exp Hypertens 2017; 39:344-349. [PMID: 28513232 DOI: 10.1080/10641963.2016.1259329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Both renal and respiratory diseases are common with high mortality rate around the world. This study was the first to compare effects of two kidneys, one clip (2K1C) and one-kidney, one clip (1K1C) Goldblatt hypertension on right ventricular pressure during normal condition and mechanical ventilation with hypoxia gas. Male Sprague-Dawley rats were subjected to control, 2K1C, or 1K1C groups. Twenty-eight days after the first surgery, animals were anesthetized, and femoral artery and vein, and right ventricle cannulated. Systemic arterial pressure and right ventricular systolic pressures (RVSP) were recorded during ventilation the animals with normoxic or hypoxic gas. RVSP in the 1K1C group was significantly more than the control and 2K1C groups during baseline conditions and ventilation the animals with hypoxic gas. Administration of antioxidant Trolox increased RVSP in the 1K1C and control groups compared with their baselines. Furthermore, there was no alteration in RVSP during hypoxia in the presence of Trolox. This study indicated that RVSP only increased after 28 days induction of 1K1C but not 2K1C model. In addition, it seems that the response to hypoxic gas and antioxidants in 1K1C is more than 2K1C. These data also suggest that effects of 1K1C may partially be related to reactive oxygen species (ROS) pathways.
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Affiliation(s)
- Farzaneh Ketabchi
- a Department of Physiology, School of Medicine , Shiraz University of Medical Sciences , Shiraz , Iran
| | - Shirin Bajoovand
- b Department of Food and Drug, Reference Laboratory, School of Pharmacy , Shiraz University of Medical Sciences , Shiraz , Iran
| | - Mojtaba Adlband
- a Department of Physiology, School of Medicine , Shiraz University of Medical Sciences , Shiraz , Iran
| | - Maryam Naseh
- a Department of Physiology, School of Medicine , Shiraz University of Medical Sciences , Shiraz , Iran
| | - Ali A Nekooeian
- c Department of Phamacology, School of Medicine , Shiraz University of Medical Sciences , Shiraz , Iran
| | - Elaheh Mashghoolozekr
- c Department of Phamacology, School of Medicine , Shiraz University of Medical Sciences , Shiraz , Iran
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17
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Abstract
Research on adjustment to chronic disease is critical in today's world, in which people are living longer lives, but lives are increasingly likely to be characterized by one or more chronic illnesses. Chronic illnesses may deteriorate, enter remission, or fluctuate, but their defining characteristic is that they persist. In this review, we first examine the effects of chronic disease on one's sense of self. Then we review categories of factors that influence how one adjusts to chronic illness, with particular emphasis on the impact of these factors on functional status and psychosocial adjustment. We begin with contextual factors, including demographic variables such as sex and race, as well as illness dimensions such as stigma and illness identity. We then examine a set of dispositional factors that influence chronic illness adjustment, organizing these into resilience and vulnerability factors. Resilience factors include cognitive adaptation indicators, personality variables, and benefit-finding. Vulnerability factors include a pessimistic attributional style, negative gender-related traits, and rumination. We then turn to social environmental variables, including both supportive and unsupportive interactions. Finally, we review chronic illness adjustment within the context of dyadic coping. We conclude by examining potential interactions among these classes of variables and outlining a set of directions for future research.
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Affiliation(s)
- Vicki S Helgeson
- Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213;
| | - Melissa Zajdel
- Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213;
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18
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Parrinello CM, Matsushita K, Woodward M, Wagenknecht LE, Coresh J, Selvin E. Risk prediction of major complications in individuals with diabetes: the Atherosclerosis Risk in Communities Study. Diabetes Obes Metab 2016; 18:899-906. [PMID: 27161077 PMCID: PMC4993670 DOI: 10.1111/dom.12686] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/29/2016] [Accepted: 05/03/2016] [Indexed: 12/11/2022]
Abstract
AIMS To develop a prediction equation for 10-year risk of a combined endpoint (incident coronary heart disease, stroke, heart failure, chronic kidney disease, lower extremity hospitalizations) in people with diabetes, using demographic and clinical information, and a panel of traditional and non-traditional biomarkers. METHODS We included in the study 654 participants in the Atherosclerosis Risk in Communities (ARIC) study, a prospective cohort study, with diagnosed diabetes (visit 2; 1990-1992). Models included self-reported variables (Model 1), clinical measurements (Model 2), and glycated haemoglobin (Model 3). Model 4 tested the addition of 12 blood-based biomarkers. We compared models using prediction and discrimination statistics. RESULTS Successive stages of model development improved risk prediction. The C-statistics (95% confidence intervals) of models 1, 2, and 3 were 0.667 (0.64, 0.70), 0.683 (0.65, 0.71), and 0.694 (0.66, 0.72), respectively (p < 0.05 for differences). The addition of three traditional and non-traditional biomarkers [β-2 microglobulin, creatinine-based estimated glomerular filtration rate (eGFR), and cystatin C-based eGFR] to Model 3 significantly improved discrimination (C-statistic = 0.716; p = 0.003) and accuracy of 10-year risk prediction for major complications in people with diabetes (midpoint percentiles of lowest and highest deciles of predicted risk changed from 18-68% to 12-87%). CONCLUSIONS These biomarkers, particularly those of kidney filtration, may help distinguish between people at low versus high risk of long-term major complications.
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Affiliation(s)
- Christina M. Parrinello
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kunihiro Matsushita
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mark Woodward
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- The George Institute for Global Health, University of Oxford, Oxford, UK
- The George Institute for Global Health, University of Sydney, New South Wales, Australia
| | - Lynne E. Wagenknecht
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Josef Coresh
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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19
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Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jiménez MC, Judd SE, Kissela BM, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Magid DJ, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Rosamond W, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Woo D, Yeh RW, Turner MB. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation 2015; 133:e38-360. [PMID: 26673558 DOI: 10.1161/cir.0000000000000350] [Citation(s) in RCA: 3736] [Impact Index Per Article: 415.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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20
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Inker LA, Tighiouart H, Aspelund T, Gudnason V, Harris T, Indridason OS, Palsson R, Shastri S, Levey AS, Sarnak MJ. Lifetime Risk of Stage 3-5 CKD in a Community-Based Sample in Iceland. Clin J Am Soc Nephrol 2015; 10:1575-84. [PMID: 26286924 DOI: 10.2215/cjn.00180115] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 06/09/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVES Lifetime risk estimates of CKD can be used effectively in public education campaigns. This study sought to estimate lifetime risk of incident CKD stage 3 and higher in Iceland for people without CKD by the age of 45 years. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This was a prospective cohort study with longitudinal creatinine measurements of residents in Reykjavik, Iceland, from 1967 to 2005. CKD was ascertained by two consecutive eGFR measurements <60 ml/min per 1.73 m(2), development of treated kidney failure, one eGFR<60 ml/min per 1.73 m(2) if the participant died before the next evaluation, or one eGFR<45 ml/min per 1.73 m(2) if it was the last eGFR. RESULTS Mean follow-up was 25 (SD 10) years. Of the study participants, 727 (19%) developed the outcome and 942 (24%) died first. By age 85 years, the lifetime risks for 45-year-old women and men without prevalent CKD were 35.8% (95% confidence interval [95% CI], 32.7 to 38.9) and 21.3% (95% CI, 18.7 to 23.8), respectively. Risk was higher in individuals with a lower eGFR, hypertension, and a higher body mass index. Lifetime risk for higher stages of CKD 3b and 4 were less common than stage 3a; by age 85 years, the lifetime risks for CKD stages 3a, 3b, and 4 in women were 38.5% (95% CI, 25.8 to 51.1), 19.4% (95% CI, 8.9 to 29.9), and 3.6% (95% CI, 2.2 to 5.0), respectively. CONCLUSIONS The lifetime risk of developing CKD stage 3 or higher is substantial, emphasizing the importance of strategies to prevent development of CKD throughout the course of life. Estimates are lower than reported using single estimates of GFR, emphasizing the importance of confirming estimates of reduced GFR in studies of CKD.
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Affiliation(s)
| | - Hocine Tighiouart
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts; Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts
| | - Thor Aspelund
- Icelandic Heart Association, Kopavogur, Iceland; Centre for Public Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland; Centre for Public Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Olafur S Indridason
- Division of Nephrology, Landspitali - National University Hospital of Iceland, Reykjavik, Iceland; and
| | - Runolfur Palsson
- Centre for Public Health Sciences, University of Iceland, Reykjavik, Iceland; Division of Nephrology, Landspitali - National University Hospital of Iceland, Reykjavik, Iceland; and
| | - Shani Shastri
- Division of Nephrology, University of Texas Southwestern, Dallas, Texas
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21
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Thomas B, Wulf S, Bikbov B, Perico N, Cortinovis M, Courville de Vaccaro K, Flaxman A, Peterson H, Delossantos A, Haring D, Mehrotra R, Himmelfarb J, Remuzzi G, Murray C, Naghavi M. Maintenance Dialysis throughout the World in Years 1990 and 2010. J Am Soc Nephrol 2015. [PMID: 26209712 DOI: 10.1681/asn.2014101017] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Rapidly rising global rates of chronic diseases portend a consequent rise in ESRD. Despite this, kidney disease is not included in the list of noncommunicable diseases (NCDs) targeted by the United Nations for 25% reduction by year 2025. In an effort to accurately report the trajectory and pattern of global growth of maintenance dialysis, we present the change in prevalence and incidence from 1990 to 2010. Data were extracted from the Global Burden of Disease 2010 epidemiologic database. The results are on the basis of an analysis of data from worldwide national and regional renal disease registries and detailed systematic literature review for years 1980-2010. Incidence and prevalence estimates of provision of maintenance dialysis from this database were updated using a negative binomial Bayesian meta-regression tool for 187 countries. Results indicate substantial growth in utilization of maintenance dialysis in almost all world regions. Changes in population structure, changes in aging, and the worldwide increase in diabetes mellitus and hypertension explain a significant portion, but not all, of the increase because increased dialysis provision also accounts for a portion of the rise. These findings argue for the importance of inclusion of kidney disease among NCD targets for reducing premature death throughout the world.
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Affiliation(s)
- Bernadette Thomas
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, Washington; Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington;
| | - Sarah Wulf
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Boris Bikbov
- Nephrology, A. I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation; Department of Nephrology Issues of Transplanted Kidney, Academician V. I. Shumakov Federal Research Center of Transplantology and Artificial Organs, Moscow, Russian Federation; Moscow City Nephrology Center, Moscow City Hospital 52, Moscow, Russian Federation
| | - Norberto Perico
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCC), Mario Negri Institute for Pharmacological Research, Bergamo, Italy
| | - Monica Cortinovis
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCC), Mario Negri Institute for Pharmacological Research, Bergamo, Italy
| | | | - Abraham Flaxman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Hannah Peterson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Allyne Delossantos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Diana Haring
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Rajnish Mehrotra
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, Washington
| | - Jonathan Himmelfarb
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, Washington
| | - Giuseppe Remuzzi
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCC), Mario Negri Institute for Pharmacological Research, Bergamo, Italy; Unit of Nephrology, Dialysis and Transplantation, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Christopher Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
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Carreira MAMDQ, Nogueira AB, Pena FM, Kiuchi MG, Rodrigues RC, Rodrigues RDR, Matos JPSD, Lugon JR. Heart Rate Variability Correlates to Functional Aerobic Impairment in Hemodialysis Patients. Arq Bras Cardiol 2015; 104:493-500. [PMID: 26131705 PMCID: PMC4484682 DOI: 10.5935/abc.20150039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 01/19/2015] [Indexed: 11/20/2022] Open
Abstract
Background Autonomic dysfunction (AD) is highly prevalent in hemodialysis (HD) patients and
has been implicated in their increased risk of cardiovascular mortality. Objective To correlate heart rate variability (HRV) during exercise treadmill test (ETT)
with the values obtained when measuring functional aerobic impairment (FAI) in HD
patients and controls. Methods Cross-sectional study involving HD patients and a control group. Clinical
examination, blood sampling, transthoracic echocardiogram, 24-hour Holter, and ETT
were performed. A symptom-limited ramp treadmill protocol with active recovery was
employed. Heart rate variability was evaluated in time domain at exercise and
recovery periods. Results Forty-one HD patients and 41 controls concluded the study. HD patients had higher
FAI and lower HRV than controls (p<0.001 for both). A correlation was found
between exercise HRV (SDNN) and FAI in both groups. This association was
independent of age, sex, smoking, body mass index, diabetes, and clonidine or
beta-blocker use, but not of hemoglobin levels. Conclusion No association was found between FAI and HRV on 24-hour Holter or at the recovery
period of ETT. Of note, exercise HRV was inversely correlated with FAI in HD
patients and controls.
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Affiliation(s)
| | - André Barros Nogueira
- Department of Cardiology, Universidade Federal Fluminense, Rio de Janeiro, RJ, Brazil
| | - Felipe Montes Pena
- Department of Cardiology, Universidade Federal Fluminense, Rio de Janeiro, RJ, Brazil
| | - Marcio Galindo Kiuchi
- Department of Cardiology, Universidade Federal Fluminense, Rio de Janeiro, RJ, Brazil
| | | | | | | | - Jocemir Ronaldo Lugon
- Department of Nephrology, Universidade Federal Fluminense, Rio de Janeiro, RJ, Brazil
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Carreira MAMQ, Nogueira AB, Pena FM, Kiuchi MG, Rodrigues RC, Rodrigues RR, Matos JPS, Lugon JR. Detection of autonomic dysfunction in hemodialysis patients using the exercise treadmill test: the role of the chronotropic index, heart rate recovery, and R-R variability. PLoS One 2015; 10:e0128123. [PMID: 26042678 PMCID: PMC4456158 DOI: 10.1371/journal.pone.0128123] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 04/22/2015] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To evaluate the ability of different parameters of exercise treadmill test to detect autonomic dysfunction in hemodialysis patients. METHODS Cross-sectional study involving hemodialysis patients and a control group. Clinical examination, blood sampling, echocardiogram, 24-hour Holter, and exercise treadmill test were performed. A ramp treadmill protocol symptom-limited with active recovery was employed. RESULTS Forty-one hemodialysis patients and 41 controls concluded the study. There was significant difference between hemodialysis patients and controls in autonomic function parameters in 24h-Holter and exercise treadmill test. Probability of having autonomic dysfunction in hemodialysis patients compared to controls was 29.7 at the exercise treadmill test and 13.0 in the 24-hour Holter. Chronotropic index, heart rate recovery at the 1st min, and SDNN at exercise were used to develop an autonomic dysfunction score to grade autonomic dysfunction, in which, 83% of hemodialysis patients reached a scoring ≥2 in contrast to 20% of controls. Hemodialysis was independently associated with either altered chronotropic index or autonomic dysfunction scoring ≥2 in every tested model (OR=50.1, P=0.003; and OR=270.9, P=0.002, respectively, model 5). CONCLUSION The exercise treadmill test was feasible and useful to diagnose of the autonomic dysfunction in hemodialysis patients. Chronotropic index and autonomic dysfunction scoring ≥2 were the most effective parameters to differentiate between hemodialysis patients and controls suggesting that these variables portrays the best ability to detect autonomic dysfunction in this setting.
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Affiliation(s)
- Maria Angela M. Q. Carreira
- Department of Medicine, Cardiology Division, Medical School, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - André B. Nogueira
- Department of Medicine, Cardiology Division, Medical School, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Felipe M. Pena
- Department of Medicine, Cardiology Division, Medical School, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Marcio G. Kiuchi
- Department of Medicine, Nephrology Division, Medical School, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Ronaldo C. Rodrigues
- Department of Medicine, Cardiology Division, Medical School, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Rodrigo R. Rodrigues
- Department of Medicine, Cardiology Division, Medical School, Universidade Federal Fluminense, Rio de Janeiro, Brazil
- Department of Medicine, Nephrology Division, Medical School, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Jorge P. S. Matos
- Department of Medicine, Nephrology Division, Medical School, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Jocemir R. Lugon
- Department of Medicine, Nephrology Division, Medical School, Universidade Federal Fluminense, Rio de Janeiro, Brazil
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Unni S, White K, Goodman M, Ye X, Mavros P, Bash LD, Brixner D. Hypertension control and antihypertensive therapy in patients with chronic kidney disease. Am J Hypertens 2015; 28:814-22. [PMID: 25421796 DOI: 10.1093/ajh/hpu215] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 10/08/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Hypertension is a major risk factor in the progression of chronic kidney disease (CKD). Although hypertension is more prevalent and treated more often among CKD patients, it is less likely to be controlled. Current guidelines recommend the use of multiple antihypertensive agents to achieve optimal blood pressure (BP) control. However, BP control attained by number and type of antihypertensive therapy according to CKD stage has not been examined thoroughly. STUDY DESIGN Cross-sectional analysis of an electronic medical record (EMR) database. SETTING AND PARTICIPANTS A total of 115,608 patients with CKD (Stages 1-4) and diagnosed or treated hypertension in General Electric Centricity EMR from 1996 to 2012. OUTCOME BP control, based on JNC 7 guidelines, was defined as less than 130/80 mm Hg. MEASUREMENTS BP and antihypertensive therapy use was obtained from the EMR. The Cockcroft-Gault equation was used to calculate estimated glomerular filtration rate and classify CKD stage. RESULTS Overall prevalence of BP control was 24.3%. BP control varied by CKD stage and number of antihypertensive therapy. In multivariable analysis, younger age was less likely to be associated with BP control, regardless of CKD stage. Multiple antihypertensive therapy use and BP control was strongest among CKD Stage 2 (odds ratio (OR): 1.41; 95% confidence interval (CI): 1.05, 1.90). Diuretic use was less likely to be associated with BP control among CKD Stage 1 (OR: 0.71; 95% CI: 0.59, 0.87) and 2 (OR: 0.78; 95% CI: 0.72, 0.85). LIMITATIONS Information on antihypertensive prescription fill data and adherence to medication regimens was unavailable. CONCLUSIONS This study highlighted the need to pay closer attention to achieving BP treatment goals for younger individuals with CKD. More research is needed to assess the extent to which specific combinations of antihypertensive drugs leads to adequate BP control.
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Affiliation(s)
- Sudhir Unni
- Pharmacotherapy Outcomes Research Center, Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA;
| | - Kellee White
- Arnold School of Public Health, Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA
| | - Michael Goodman
- Pharmacotherapy Outcomes Research Center, Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
| | - Xiangyang Ye
- Pharmacotherapy Outcomes Research Center, Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
| | | | - Lori D Bash
- Merck & Co., Inc., Whitehouse Station, New Jersey, USA
| | - Diana Brixner
- Pharmacotherapy Outcomes Research Center, Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
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25
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Calabresi L, Simonelli S, Conca P, Busnach G, Cabibbe M, Gesualdo L, Gigante M, Penco S, Veglia F, Franceschini G. Acquired lecithin:cholesterol acyltransferase deficiency as a major factor in lowering plasma HDL levels in chronic kidney disease. J Intern Med 2015; 277:552-61. [PMID: 25039266 DOI: 10.1111/joim.12290] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES It has been suggested that a low plasma high-density lipoprotein cholesterol (HDL-C) level contributes to the high cardiovascular disease risk of patients with chronic kidney disease (CKD), especially those undergoing haemodialysis (HD). The present study was conducted to gain further understanding of the mechanism(s) responsible for the low HDL-C levels in patients with CKD and to separate the impact of HD from that of the underlying CKD. METHODS Plasma lipids and lipoproteins, HDL subclasses and various cholesterol esterification parameters were measured in a total of 248 patients with CKD, 198 of whom were undergoing HD treatment and 40 healthy subjects. RESULTS Chronic kidney disease was found to be associated with highly significant reductions in plasma HDL-C, unesterified cholesterol, apolipoprotein (apo)A-I, apoA-II and LpA-I:A-II levels in both CKD cohorts (with and without HD treatment). The cholesterol esterification process was markedly impaired, as indicated by reductions in plasma lecithin:cholesterol acyltransferase (LCAT) concentration and activity and cholesterol esterification rate, and by an increase in the plasma preβ-HDL content. HD treatment was associated with a further lowering of HDL levels and impaired plasma cholesterol esterification. The plasma HDL-C level was highly significantly correlated with LCAT concentration (R = 0.438, P < 0.001), LCAT activity (R = 0.243, P < 0.001) and cholesterol esterification rate (R = 0.149, P = 0.031). Highly significant correlations were also found between plasma LCAT concentration and levels of apoA-I (R = 0.432, P < 0.001), apoA-II (R = 0.275, P < 0.001), LpA-I (R = 0.326, P < 0.001) and LpA-I:A-II (R = 0.346, P < 0.001). CONCLUSION Acquired LCAT deficiency is a major cause of low plasma HDL levels in patients with CKD, thus LCAT is an attractive target for therapeutic intervention to reverse dyslipidaemia, and possibly lower the cardiovascular disease risk in these patients.
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Affiliation(s)
- L Calabresi
- Center E. Grossi Paoletti, Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
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Susin N, de Melo Boff R, Ludwig MWB, Feoli AMP, da Silva AG, Macagnan FE, da Silva Oliveira M. Predictors of adherence in a prevention program for patients with metabolic syndrome. J Health Psychol 2015; 21:2156-67. [PMID: 25805660 DOI: 10.1177/1359105315572451] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The study objectives were (1) comparison of baseline characteristics between individuals with metabolic syndrome, adhering/not adhering to a primary prevention program modificação do estilo de vida e risco cardiovascular; and (2) determination of risk factors for program adherence. The sample included 127 participants with mean age (±standard deviation) of 49.58 (±7.77) years, participating in the modificação do estilo de vida e risco cardiovascular between 2010 and 2012. Results show that program adherence predictors were age (odds ratio: 1.134, 95% confidence interval: 1.106-1.833); practicing physical exercise (odds ratio: 1.322, 95% confidence interval: 1.115-7.589); self-efficacy for regular eating habits (odds ratio: 2.044, 95% confidence interval: 1.184-3.377); low binge eating scores (odds ratio: 1.922, 95% confidence interval: 1.118-3.974); and low isolation and depression scores (odds ratio: 0.721, 95% confidence interval: 0.322-0.917).
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Affiliation(s)
- Nathália Susin
- Pontífícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil
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27
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Wu-Wong JR, Chen YW, Wessale JL. Vitamin D receptor agonist VS-105 improves cardiac function in the presence of enalapril in 5/6 nephrectomized rats. Am J Physiol Renal Physiol 2014; 308:F309-19. [PMID: 25503724 DOI: 10.1152/ajprenal.00129.2014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Vitamin D receptor (VDR) agonists (VDRAs) are commonly used to manage hyperparathyroidism secondary to chronic kidney disease (CKD). Patients with CKD experience extremely high risks of cardiovascular morbidity and mortality. Clinical observations show that VDRA therapy may be associated with cardio-renal protective and survival benefits in patients with CKD. The 5/6 nephrectomized (NX) Sprague-Dawley rat with established uremia exhibits elevated serum parathyroid hormone (PTH), hypertension, and abnormal cardiac function. Treatment of 5/6 NX rats with VS-105, a novel VDRA (0.05 and 0.5 μg/kg po by gavage), once daily for 8 wk in the presence or absence of enalapril (30 mg/kg po via drinking water) effectively suppressed serum PTH without raising serum calcium. VS-105 alone reduced systolic blood pressure (from 174 ± 6 to 145 ± 9 mmHg, P < 0.05) as effectively as enalapril (from 174 ± 6 to 144 ± 7 mmHg, P < 0.05). VS-105 improved cardiac functional parameters such as E/A ratio, ejection fraction, and fractional shortening with or without enalapril. Enalapril or VS-105 alone significantly reduced left ventricular hypertrophy (LVH); VS-105 plus enalapril did not further reduce LVH. VS-105 significantly reduced both cardiac and renal fibrosis. The lack of hypercalcemic toxicity of VS-105 is due to its lack of effects on stimulating intestinal calcium transport and inducing the expression of intestinal calcium transporter genes such as Calb3 and TRPV6. These studies demonstrate that VS-105 is a novel VDRA that may provide cardiovascular benefits via VDR activation. Clinical studies are required to confirm the cardiovascular benefits of VS-105 in CKD.
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Foster MC, Rawlings AM, Marrett E, Neff D, Grams ME, Kasiske BL, Willis K, Inker LA, Coresh J, Selvin E. Potential effects of reclassifying CKD as a coronary heart disease risk equivalent in the US population. Am J Kidney Dis 2014; 63:753-60. [PMID: 24369751 PMCID: PMC3988260 DOI: 10.1053/j.ajkd.2013.11.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 11/01/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Persons with chronic kidney disease (CKD) are at high risk for cardiovascular disease events, but are not classified as such in current US cholesterol treatment guidelines. We examined potential effects of modified guidelines in which CKD was considered a "coronary heart disease (CHD) risk equivalent" for risk stratification. STUDY DESIGN Nationally representative cross-sectional study. SETTING & PARTICIPANTS 4,823 adults 20 years or older from the 2007-2010 National Health and Nutrition Examination Survey. PREDICTORS Cardiovascular risk stratification based on current US cholesterol treatment guidelines and 2 simulated scenarios in which CKD stages 3-5 or CKD stages 1-5 were considered a CHD risk equivalent. OUTCOMES & MEASUREMENTS Proportion of persons with low-density lipoprotein (LDL) cholesterol at levels above treatment targets and above the threshold for lipid-lowering therapy initiation, based on current guidelines and the 2 simulated scenarios. RESULTS Under current guidelines, 55.1 million adults in 2010 did not achieve the target LDL cholesterol goal. Of these, 25.2 million had sufficiently elevated levels to meet recommendations for initiating lipid-lowering therapy; 12.1 million were receiving this therapy but remained above goal. When CKD stages 3-5 were considered a CHD risk equivalent, 59.2 million persons were above target LDL cholesterol goals, with 28.5 million and 13.3 million meriting therapy initiation and intensification, respectively. When CKD stages 1-5 were considered a CHD risk equivalent, 65.2 million adults were above goal, with 33.9 million and 14.4 million meriting therapy initiation and intensification, respectively. LIMITATIONS CKD and LDL cholesterol defined using a single laboratory value. CONCLUSIONS Many adults in the United States currently do not meet recommended goals for LDL cholesterol levels. Modifying the current cholesterol guidelines to include CKD as a CHD risk equivalent would lead to a substantial increase in both the number of persons with levels above LDL cholesterol treatment targets and those recommended to initiate lipid-lowering therapy.
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Affiliation(s)
- Meredith C Foster
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health and Medical Institutions, Baltimore, MD
| | - Andreea M Rawlings
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health and Medical Institutions, Baltimore, MD
| | | | - David Neff
- Merck, Sharp & Dohme Corp, Whitehouse Station, NJ
| | - Morgan E Grams
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health and Medical Institutions, Baltimore, MD; Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Bertram L Kasiske
- Department of Medicine, Hennepin County Medical Center, Minneapolis, MN
| | | | - Lesley A Inker
- William B. Schwartz Division of Nephrology, Tufts Medical Center, Boston, MA
| | - Josef Coresh
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health and Medical Institutions, Baltimore, MD; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine, Johns Hopkins Hospital, Baltimore, MD
| | - Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health and Medical Institutions, Baltimore, MD; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
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Do patients with chronic kidney disease get optimal cardiovascular risk reduction? Curr Opin Nephrol Hypertens 2014; 23:267-74. [DOI: 10.1097/01.mnh.0000444913.78536.b1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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30
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Wang J, Xiong X, Liu W. Chinese patent medicine tongxinluo capsule for hypertension: a systematic review of randomised controlled trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2014; 2014:187979. [PMID: 24693319 PMCID: PMC3947843 DOI: 10.1155/2014/187979] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 12/31/2013] [Indexed: 12/14/2022]
Abstract
This study was intended to evaluate the efficacy and safety of Tongxinluo capsule for hypertension. Search Strategy. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, The PubMed, EMBASE, Chinese Bio-Medical Literature Database (CBM), Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database, and Wan-fang Data started from the first of database to October 28, 2013. No language restriction was applied. We included randomized clinical trials testing Tongxinluo capsule against western medicine, Tongxinluo capsule versus placebo, and Tongxinluo capsule combined with western medicine versus western medicine. Study selection, data extraction, quality assessment, and data analyses were conducted according to the Cochrane standards. Results. 25 trials with 1958 participants were included. The methodological quality of the included trials was evaluated as generally low. The blood pressure (BP) lowering effect of Tongxinluo capsule plus western medicine was significantly higher than that of western medicine (systolic blood pressure (SBP): -3.87, -5.32 to -2.41, P < 0.00001; and diastolic blood pressure (DBP): -2.72, -4.19 to -1.24, P = 0.0003). The BP also decreased significantly from baseline with Tongxinluo capsule than placebo (SBP: -9.40, -10.90 to -7.90, P < 0.00001; and DBP: -11.80, -12.40 to -11.20, P < 0.00001) or western medicine (SBP: -3.90, -4.93 to -2.87, P < 0.00001; and DBP: -3.70, -3.83 to -3.57, P < 0.00001). 12 trials reported adverse events without details. Conclusions. There is some but weak evidence about the effectiveness of TXL in treating patients with hypertension.
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Affiliation(s)
- Jie Wang
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beixiange No. 5, Xicheng District, Beijing 100053, China
| | - Xingjiang Xiong
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beixiange No. 5, Xicheng District, Beijing 100053, China
| | - Wei Liu
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beixiange No. 5, Xicheng District, Beijing 100053, China
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Rhee JW, Wiviott SD, Scirica BM, Gibson CM, Murphy SA, Bonaca MP, Morrow DA, Mega JL. Clinical features, use of evidence-based therapies, and cardiovascular outcomes among patients with chronic kidney disease following non-ST-elevation acute coronary syndrome. Clin Cardiol 2014; 37:350-6. [PMID: 24481910 DOI: 10.1002/clc.22253] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 12/31/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with an increased risk of cardiovascular events following acute coronary syndrome (ACS). The underlying pathobiology and optimal treatments for this population continue to be evaluated. HYPOTHESIS Patients with CKD will receive fewer evidence-based therapies and experience high rates of adverse cardiovascular events in both the short- and long term. METHODS The MERLIN-TIMI 36 (Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST-Elevation Acute Coronary Syndromes-Thrombolysis in Myocardial Infarction 36) trial randomized non-ST-elevation ACS patients to ranolazine or placebo, with no exclusion for renal dysfunction (except dialysis). We conducted a prespecified analysis among 6543 patients based on the degree of CKD. RESULTS Patients with worse renal function were older with more comorbidities (P < 0.0001 for each). They were less likely to receive evidence-based cardiovascular medicines (P < 0.04 for each). Rates of an early invasive management strategy varied based on renal function; however, among patients with the highest TIMI risk scores, the rates of an early invasive management strategy were similar regardless of glomerular filtration rate (GFR) (Pinteraction = 0.005). Lower GFR was associated with increased rates of cardiovascular disease or myocardial infarction in the short and long term, even after adjustment (GFR <30 vs ≥90 mL/min/1.73 m(2) ; hazard ratio [HR]: 3.24 [95% confidence interval {CI}: 1.26-8.38] through 7 days and HR: 2.12 [95% CI: 1.33-3.39] through 1 year). The effect of ranolazine vs placebo on clinical outcomes was similar among those with and without CKD (Pinteraction = not significant). CONCLUSIONS Following ACS, patients with renal dysfunction had more cardiovascular risk factors but were less likely to receive evidence-based medical therapies. A strong graded, independent relationship between the degree of CKD and poor clinical outcomes was observed over time. Continued efforts to optimize ACS treatment strategies in patients with CKD are warranted.
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Affiliation(s)
- June-Wha Rhee
- Department of Medicine, Stanford University Medical Center, Stanford, California
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Moreira J, Jaramillo E, Anselmi M, Sempertegui R, Ortiz P, Mena MB, Tognoni G. Appraisal of Five Clinical Guidelines for the Management of Hypertension in Andean Countries and Europe. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/wjcd.2014.45028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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