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Marano M, Senigalliesi L, Cocola R, Fontana M, Parente E, Russo V. Advanced Interatrial Block across the Spectrum of Renal Function. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1001. [PMID: 38929618 PMCID: PMC11205515 DOI: 10.3390/medicina60061001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/13/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
Background and Objective: Interatrial block (IAB) is defined as a conduction delay between the right and left atria. No data are available about the prevalence of both partial IAB and advanced IAB among the different stages of chronic kidney disease. The aim of this study was to describe the prevalence and type of advanced IAB across the spectrum of renal function, including patients on dialysis and the clinical characteristics associated with advanced IAB. Materials and Methods: Retrospective, single-center study of 151 patients consecutively admitted to the Nephrology and Ophthalmology Unit for 3 months. The study population was divided into three groups according to stages of chronic kidney disease. We evaluated the prevalence and pattern of IAB among the groups and the clinical characteristics associated with advanced IAB. Results: The prevalence of partial IAB was significantly lower in end-stage kidney disease (ESKD) group compared to control group (36.7% vs. 59.6%; p = 0.02); in contrast the prevalence of advanced IAB was significantly higher in both chronic kidney disease (CKD) (17.8% vs. 5.3%, p = 0.04) and ESKD group (24.5% vs. 5.3%, p = 0.005) compared to control group. The atypical pattern of advanced IAB was more frequent in both the ESKD and CKD group than in the control group (100% and 75% vs. 33.3%; p = 0.02). Overall, among patients that showed advanced IAB, 17 (73.9%) showed an atypical pattern by morphology and 2 (8.7%) showed an atypical pattern by duration of advanced IAB. The ESKD group was younger than the control group (65.7 ± 12.3 years vs. 71.3 ± 9.9 years; p = 0.01) and showed a higher prevalence of beta blockers (42.9% vs. 19.3%; p = 0.009), as in the CKD group (37.8% vs. 19.3%; p= 0.04). Conclusions: The progressive worsening of renal function was associated with an increasing prevalence of advanced IAB. Advanced IAB may be a sign of uremic cardiomyopathy and may suggest further evaluation with long-term follow-up to investigate its prognostic significance in chronic kidney disease.
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Affiliation(s)
- Marco Marano
- Unit of Nephrology and Dialysis, Maria Rosaria Clinic, Via Colle San Bartolomeo, 80045 Pompei, Italy; (M.M.); (L.S.); (R.C.); (M.F.)
| | - Luigi Senigalliesi
- Unit of Nephrology and Dialysis, Maria Rosaria Clinic, Via Colle San Bartolomeo, 80045 Pompei, Italy; (M.M.); (L.S.); (R.C.); (M.F.)
| | - Rossella Cocola
- Unit of Nephrology and Dialysis, Maria Rosaria Clinic, Via Colle San Bartolomeo, 80045 Pompei, Italy; (M.M.); (L.S.); (R.C.); (M.F.)
| | - Mariarosaria Fontana
- Unit of Nephrology and Dialysis, Maria Rosaria Clinic, Via Colle San Bartolomeo, 80045 Pompei, Italy; (M.M.); (L.S.); (R.C.); (M.F.)
| | - Erika Parente
- Cardiology Unit, Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Via Leonardo Bianchi, 80126 Naples, Italy;
| | - Vincenzo Russo
- Cardiology Unit, Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Via Leonardo Bianchi, 80126 Naples, Italy;
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Alfano G, Morisi N, Giovanella S, Frisina M, Amurri A, Tei L, Ferri M, Ligabue G, Donati G. Risk of infections related to endovascular catheters and cardiac implantable devices in hemodialysis patients. J Vasc Access 2024:11297298241240502. [PMID: 38506890 DOI: 10.1177/11297298241240502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
Patients requiring dialysis are extremely vulnerable to infectious diseases. The high burden of comorbidities and weakened immune system due to uremia and previous immunosuppressive therapy expose the patient on dialysis to more infectious events than the general population. The infectious risk is further increased by the presence of endovascular catheters and implantable cardiologic devices. The former is generally placed as urgent vascular access for dialysis and in subjects requiring hemodialysis treatments without autogenous arteriovenous fistula. The high frequency of cardiovascular events also increases the likelihood of implanting indwelling implantable cardiac devices (CIED) such as pacemakers (PMs) and defibrillators (ICDs). The simultaneous presence of CVC and CIED yields an increased risk of developing severe prosthetic device-associated bloodstream infections often progressing to septicemia. Although, antibiotic therapy is the mainstay of prosthetic device-related infections, antibiotic resistance of biofilm-residing bacteria reduces the choice of infection eradication. In these cases, the resolution of the infection process relies on the removal of the prosthetic device. Compared to CVC removal, the extraction of leads is a more complex procedure and poses an increased risk of vessel tearing. As a result, the prevention of prosthetic device-related infection is of utmost importance in hemodialysis (HD) patients and relies principally on avoiding CVC as vascular access for HD and placement of a new class of wireless implantable medical devices. When the combination of CVC and CIED is inevitable, prevention of infection, mainly due translocation of skin bacteria, should be a mandatory priority for healthcare workers.
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Affiliation(s)
- Gaetano Alfano
- Nephrology, Dialysis and Kidney Transplant Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Emilia-Romagna, Italy
| | - Niccolò Morisi
- Nephrology, Dialysis and Kidney Transplant Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Emilia-Romagna, Italy
- Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
| | - Silvia Giovanella
- Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
| | - Monica Frisina
- Nephrology, Dialysis and Kidney Transplant Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Emilia-Romagna, Italy
- Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
| | - Alessio Amurri
- Nephrology, Dialysis and Kidney Transplant Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Emilia-Romagna, Italy
- Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
| | - Lorenzo Tei
- Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
- Nephrology and Dialysis Unit, Azienda USL di Modena, Modena, Emilia-Romagna, Italy
| | - Maria Ferri
- Nephrology, Dialysis and Kidney Transplant Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Emilia-Romagna, Italy
- Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
| | - Giulia Ligabue
- Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
| | - Gabriele Donati
- Nephrology, Dialysis and Kidney Transplant Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Emilia-Romagna, Italy
- Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
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3
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Franczyk B, Rysz J, Olszewski R, Gluba-Sagr A. Do Implantable Cardioverter-Defibrillators Prevent Sudden Cardiac Death in End-Stage Renal Disease Patients on Dialysis? J Clin Med 2024; 13:1176. [PMID: 38398488 PMCID: PMC10889557 DOI: 10.3390/jcm13041176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/23/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
Chronic kidney disease patients appear to be predisposed to heart rhythm disorders, including atrial fibrillation/atrial flutter, ventricular arrhythmias, and supraventricular tachycardias, which increase the risk of sudden cardiac death. The pathophysiological factors underlying arrhythmia and sudden cardiac death in patients with end-stage renal disease are unique and include timing and frequency of dialysis and dialysate composition, vulnerable myocardium, and acute proarrhythmic factors triggering asystole. The high incidence of sudden cardiac deaths suggests that this population could benefit from implantable cardioverter-defibrillator therapy. The introduction of implantable cardioverter-defibrillators significantly decreased the rate of all-cause mortality; however, the benefits of this therapy among patients with chronic kidney disease remain controversial since the studies provide conflicting results. Electrolyte imbalances in haemodialysis patients may result in ineffective shock therapy or the appearance of non-shockable underlying arrhythmic sudden cardiac death. Moreover, the implantation of such devices is associated with a risk of infections and central venous stenosis. Therefore, in the population of patients with heart failure and severe renal impairment, periprocedural risk and life expectancy must be considered when deciding on potential device implantation. Harmonised management of rhythm disorders and renal disease can potentially minimise risks and improve patients' outcomes and prognosis.
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Affiliation(s)
- Beata Franczyk
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-419 Lodz, Poland; (B.F.); (J.R.)
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-419 Lodz, Poland; (B.F.); (J.R.)
| | - Robert Olszewski
- Department of Gerontology, Public Health and Didactics, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland;
| | - Anna Gluba-Sagr
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-419 Lodz, Poland; (B.F.); (J.R.)
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Effect of Implanted Defibrillator on Mortality in Patients With Chronic Kidney Disease. Am J Cardiol 2023; 188:36-40. [PMID: 36463780 DOI: 10.1016/j.amjcard.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/06/2022] [Accepted: 11/04/2022] [Indexed: 12/04/2022]
Abstract
The beneficial role of implantable cardioverter defibrillators (ICDs) in patients with chronic kidney disease (CKD) is controversial. This meta-analysis aimed to evaluate the effect of ICD on mortality in patients with CKD. A literature search was conducted for studies reporting the effect of ICD on all-cause mortality in patients with CKD (estimated glomerular filtration rate <60 ml/min/1.73 m2). The search was not restricted to time or publication status. The search included the following databases: Ovid MEDLINE, EMBASE, Scopus, Web of Science, Google Scholar, and EBSCO CINAHL. The primary end point was all-cause mortality. The minimum duration of follow-up required for inclusion was 1 year. The literature search identified 834 studies, of which 14 studies with 70,661 patients were included. Mean follow-up was 39 months (12 to 81 months). For all patients with CKD, ICD was associated with lower all-cause mortality (log hazard ratio [HR] -0.247, standard error [SE] 0.101, p = 0.015). Heterogeneity: degree of freedom = 13 (p <0.01), I2 = 97.057; test for overall effect: Z = -2.431 (p = 0.015). When further stratified based on dialysis, patients with CKD without the need for dialysis had significantly lower mortality (log HR -0.211, SE 0.095, p = 0.026), with a similar trend in patients who underwent dialysis (log HR -0.262, SE 0.134, p = 0.051). ICD implantation is associated with a significant mortality benefit in patients with CKD.
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5
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Ryan DK, Banerjee D, Jouhra F. Management of Heart Failure in Patients with Chronic Kidney Disease. Eur Cardiol 2022; 17:e17. [PMID: 35990402 PMCID: PMC9376857 DOI: 10.15420/ecr.2021.33] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 04/11/2022] [Indexed: 11/19/2022] Open
Abstract
Chronic kidney disease (CKD) is increasingly prevalent in patients with heart failure (HF) and HF is one of the leading causes of hospitalisation, morbidity and mortality in patients with impaired renal function. Currently, there is strong evidence to support the symptomatic and prognostic benefits of β-blockers, renin–angiotensin–aldosterone inhibitors (RAASis), angiotensin receptor-neprilysin inhibitors (ARNIs) and mineralocorticoid receptor antagonists (MRA) in patients with HF and CKD stages 1–3. However, ARNIs, RAASis and MRAs are often suboptimally prescribed for patients with CKD owing to concerns about hyperkalaemia and worsening renal function. There is growing evidence for the use of sodium–glucose co-transporter 2 inhibitors and IV iron therapy in the management of HF in patients with CKD. However, few studies have included patients with CKD stages 4–5 and patients receiving dialysis, limiting the assessment of the safety and efficacy of these therapies in advanced CKD. Interdisciplinary input from HF and renal specialists is required to provide integrated care for the growing number of patients with HF and CKD.
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Affiliation(s)
- David K Ryan
- Clinical Pharmacology and Therapeutics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Debasish Banerjee
- Renal and Transplantation Unit, St George’s University Hospitals NHS Foundation Trust, and Transactional and Clinical Research Institute, London, UK; Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George’s University of London, London, UK
| | - Fadi Jouhra
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George’s University of London, London, UK; Cardiology Department, St George’s University Hospitals NHS Foundation Trust, London, UK
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6
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Spatola L, Rivera RF, Migliore F, Bilato C, Mugnai G. Cardiovascular implantable electronic devices in hemodialysis patients: an updated review. J Cardiovasc Med (Hagerstown) 2021; 22:867-873. [PMID: 34009181 DOI: 10.2459/jcm.0000000000001214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cardiovascular diseases are the leading life-threatening complications in hemodialysis patients. In this scenario, both tachy-arrhythmias and brady-arrhythmias are involved with related hemodialysis and nonhemodialysis-dependent mechanisms; moreover, those arrhythmias usually occur in different time intervals before sudden cardiac death (SCD). Furthermore, current evidence shows that the presence of advanced chronic kidney disease (CKD) reduces the benefits of implantable cardioverter--defibrillators (ICDs), which increases the risk of both arrhythmic and nonarrhythmic death, especially in patients with advanced stages of heart failure. Notably, patients with advanced CKD show a more severe degree of heart failure compared with mild CKD patients. However, the benefits of the ICD implantation in the primary prevention of hemodialysis patients is still controversial, and by now, no significant benefits have emerged compared with nonhemodialysis-dependent CKD patients. In secondary prevention, hemodialysis patients with ICD implantation have higher mortality rates compared with nonhemodialysis-dependent CKD patients with ICD. On the other hand, most articles include hemodialysis patients with reduced left ventricular ejection fraction, neglecting those with preserved systolic function. This review focuses on the epidemiology of SCD in the setting of hemodialysis and the current evidence on ICD implantation in patients on hemodialysis therapy analyzing novel strategies, which might reduce the risk of ICD placing.
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Affiliation(s)
- Leonardo Spatola
- Division of Nephrology, Dialysis and Renal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Rodolfo F Rivera
- Division of Nephrology and Dialysis, ASST Monza, Desio and San Gerardo Hospital
| | - Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Padova
| | - Claudio Bilato
- Division of Cardiology, West Vicenza General Hospitals, Arzignano (Vicenza), Italy
| | - Giacomo Mugnai
- Division of Cardiology, West Vicenza General Hospitals, Arzignano (Vicenza), Italy
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7
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Genovesi S, Boriani G, Covic A, Vernooij RWM, Combe C, Burlacu A, Davenport A, Kanbay M, Kirmizis D, Schneditz D, van der Sande F, Basile C. Sudden cardiac death in dialysis patients: different causes and management strategies. Nephrol Dial Transplant 2021; 36:396-405. [PMID: 31538192 DOI: 10.1093/ndt/gfz182] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 08/01/2019] [Indexed: 01/12/2023] Open
Abstract
Sudden cardiac death (SCD) represents a major cause of death in end-stage kidney disease (ESKD). The precise estimate of its incidence is difficult to establish because studies on the incidence of SCD in ESKD are often combined with those related to sudden cardiac arrest (SCA) occurring during a haemodialysis (HD) session. The aim of the European Dialysis Working Group of ERA-EDTA was to critically review the current literature examining the causes of extradialysis SCD and intradialysis SCA in ESKD patients and potential management strategies to reduce the incidence of such events. Extradialysis SCD and intradialysis SCA represent different clinical situations and should be kept distinct. Regarding the problem, numerically less relevant, of patients affected by intradialysis SCA, some modifiable risk factors have been identified, such as a low concentration of potassium and calcium in the dialysate, and some advantages linked to the presence of automated external defibrillators in dialysis units have been documented. The problem of extra-dialysis SCD is more complex. A reduced left ventricular ejection fraction associated with SCD is present only in a minority of cases occurring in HD patients. This is the proof that SCD occurring in ESKD has different characteristics compared with SCD occurring in patients with ischaemic heart disease and/or heart failure and not affected by ESKD. Recent evidence suggests that the fatal arrhythmia in this population may be due more frequently to bradyarrhythmias than to tachyarrhythmias. This fact may partly explain why several studies could not demonstrate an advantage of implantable cardioverter defibrillators in preventing SCD in ESKD patients. Electrolyte imbalances, frequently present in HD patients, could explain part of the arrhythmic phenomena, as suggested by the relationship between SCD and timing of the HD session. However, the high incidence of SCD in patients on peritoneal dialysis suggests that other risk factors due to cardiac comorbidities and uraemia per se may contribute to sudden mortality in ESKD patients.
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Affiliation(s)
- Simonetta Genovesi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Nephrology Unit, San Gerardo Hospital, Monza, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena University Hospital, Modena, Italy
| | - Adrian Covic
- Nephrology Clinic, Dialysis and Renal Transplant Center - 'C.I. Parhon' University Hospital, Iasi, Romania.,'Grigore T. Popa' University of Medicine, Iasi, Romania
| | - Robin W M Vernooij
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.,Unité INSERM 1026, Université de Bordeaux, Bordeaux, France
| | - Alexandru Burlacu
- 'Grigore T. Popa' University of Medicine, Iasi, Romania.,Department of Interventional Cardiology - Cardiovascular Diseases Institute, Iasi, Romania
| | - Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital, Division of Medicine, University College London, London, UK
| | - Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | | | - Daniel Schneditz
- Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Frank van der Sande
- Division of Nephrology, Department of Internal Medicine, University Hospital Maastricht, Maastricht, The Netherlands
| | - Carlo Basile
- Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti, Italy.,Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy
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Cardiac Implantable Electronic Devices in Hemodialysis and Chronic Kidney Disease Patients-An Experience-Based Narrative Review. J Clin Med 2021; 10:jcm10081745. [PMID: 33920553 PMCID: PMC8073061 DOI: 10.3390/jcm10081745] [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: 02/28/2021] [Revised: 04/03/2021] [Accepted: 04/13/2021] [Indexed: 11/17/2022] Open
Abstract
Cardiovascular implantable electronic devices (CIEDs) are a standard therapy utilized for different cardiac conditions. They are implanted in a growing number of patients, including those with chronic kidney disease (CKD) and end-stage kidney disease (ESKD). Cardiovascular diseases, including heart failure and malignant arrhythmia, remain the leading cause of mortality among CKD patients, especially in ESKD. CIED implantation procedures are considered minor surgery, typically with transvenous leads inserted via upper central veins, followed by an impulse generator introduced subcutaneously. A decision regarding optimal hemodialysis (HD) modality and the choice of permanent vascular access (VA) could be particularly challenging in CIED recipients. The potential consequences of arteriovenous access on the CIED side are related to (1) venous hypertension from lead-related central vein stenosis and (2) the risk of systemic infection. Therefore, when creating permanent vascular access, the clinical scenario may be complicated by the CIED presence on one side and the lack of suitable vessels for arteriovenous fistula on the contralateral arm. These factors suggest the need for an individualized approach according to different clinical situations: (1) CIED in a CKD patient; (2) CIED in a patient on hemodialysis CIED; and (3) VA in a patient with CIED. This complex clinical conundrum creates the necessity for close cooperation between cardiologists and nephrologists.
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Liu Y, Sun JY, Zhu YS, Li ZM, Li KL, Wang RX. Association between CRT(D)/ICD and renal insufficiency: A systematic review and meta-analysis. Semin Dial 2020; 34:17-30. [PMID: 33296540 DOI: 10.1111/sdi.12937] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 08/27/2020] [Accepted: 10/21/2020] [Indexed: 12/27/2022]
Abstract
Cardiac resynchronization therapy with or without a defibrillator (CRT(D)) and implantable cardioverter defibrillator (ICD) may reduce the risk of arrhythmia or heart failure-specific mortality and improves the prognosis of patients with chronic kidney disease (CKD) or dialysis. The aim of this study was to perform a meta-analysis investigating the relationship between CRT(D)/ICD and renal insufficiency. Cochrane Library, Web of Science, Embase, and Pubmed were systematically searched from inception to 29 October 2019. We included studies that report all-cause mortality of patients with renal insufficiency who received CRT(D)/ICD therapy. Twenty-six studies (n = 119,263) were included, exploring the relationship between CRT(D)/ICD and renal insufficiency from two aspects: (1) Compared with ICD-only, CRT(D) was associated with lower risk of all-cause mortality in CKD patients (odds ratios (OR) = 0.67; 95% confidence interval (CI), 0.60 to 0.75). For non-primary prevention (secondary prevention or both), the analysis revealed a lower risk of all-cause mortality in the ICD group than in the no-ICD group (OR = 0.47; 95% CI, 0.40 to 0.55). (2) CKD increased all-cause mortality in comparison with control group (OR = 2.12; 95% CI, 1.85 to 2.44), and so did dialysis (OR = 2.53; 95% CI, 2.34 to 2.73). Furthermore, compared with CKD3 (eGFR: 30-59 ml/min/1.73 m2 ), CKD4/5 (eGFR <30 ml/min/1.73 m2 ) was observed to have a significantly higher risk of all-cause mortality (OR = 2.70; 95% CI, 1.93 to 3.80). This review shows a clear association between CRT(D)/ICD and renal insufficiency in the aspect of all-cause mortality, and may provide a reference for the clinical application of CRT(D)/ICD.
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Affiliation(s)
- Ying Liu
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Jin-Yu Sun
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China.,Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yu-Shan Zhu
- Department of Nephrology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Zi-Meng Li
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ku-Lin Li
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Ru-Xing Wang
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
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10
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Yang CH, Chen JJ, Yeh JK, Kuo G, Lee CC, Hsieh IC, Hsieh MJ, Tian YC, Chang CH. The incidence and survival after in-hospital cardiopulmonary cerebral resuscitation in end-stage kidney disease patients: A nationwide population-based study. PLoS One 2020; 15:e0238029. [PMID: 32857782 PMCID: PMC7454972 DOI: 10.1371/journal.pone.0238029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 08/07/2020] [Indexed: 01/10/2023] Open
Abstract
Background This study analyzed the survival and protective predictors of in-hospital cardiopulmonary cerebral resuscitation (CPCR) to potentially help physicians create effective treatment plans for End-stage kidney disease (ESKD) patients. Methods We extracted the data of 7,116 ESKD patients who received their first in-hospital CPCR after initial dialysis between 2004 and 2012 from the National Health Insurance Research Database. The primary outcome was the survival rate during the first in-hospital CPCR. The secondary outcome was the median post-discharge survival. Results From 2004 through 2012, the incidence of in-hospital CPCR decreases from 3.97 to 3.67 events per 1,000 admission days (P for linear trend <0.001). The survival rate for the first in-hospital CPCR did not change significantly across the 9 years (P for trend = 0.244), whereas the median survival of post-discharge survival increased significantly from 3.0 months in 2004 to 6.8 months in 2011 (P for linear trend <0.001). In addition, multivariable analysis identified older age as a risk factor and prior intracardiac defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) implantation as a protective factor for in-hospital death during the first in-hospital CPCR. Conclusion The incidence of in-hospital CPCR and the duration post-discharge among ESKD patients improved despite there being no significant difference in the survival rate of ESKD patients after CPCP. Either ICD or CRT-D implantation may be advisable for ESKD patients with a high risk of sudden cardiac death.
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Affiliation(s)
- Chia-Hung Yang
- Department of Cardiology, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital and Chang Gung University
| | - Jia-Jin Chen
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jih-Kai Yeh
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - George Kuo
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Cheng-Chia Lee
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - I-Chang Hsieh
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Ming-Jer Hsieh
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Ya-Chung Tian
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Chih-Hsiang Chang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- * E-mail:
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Jha AK, Lata S. Kidney transplantation and cardiomyopathy: Concepts and controversies in clinical decision-making. Clin Transplant 2020; 34:e13795. [PMID: 31991012 DOI: 10.1111/ctr.13795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/21/2019] [Accepted: 01/24/2020] [Indexed: 11/30/2022]
Abstract
Increasing comorbidities and an aging population have led to a tremendous increase in the burden of both kidney and cardiac dysfunction. Concomitant cardiomyopathy exposes the patients with kidney disease to further physiological, hemodynamic, and pathologic alterations. Kidney transplantation imposes lesser anesthetic and surgical complexities compared to another solid organ transplant. The surgical decision-making remains an unsettled issue in these conditions. The surgical choices, techniques, and sequences in kidney transplant and cardiac surgery depend on the pathophysiological perturbations and perioperative outcomes. The absence of randomized controlled trials eludes us from suggesting definite management protocol in patients with end-stage kidney disease with cardiomyopathy. Nevertheless, in this review, we extracted data from published literature to understand the pathophysiologic interactions between end-stage renal diseases with cardiomyopathy and also proposed the management algorithm in this challenging scenario. The proposed management algorithm would ensure consensus across all stakeholders involved in decision-making. Our simplistic evidence-based approach would augur future randomized trials and would further ensure refinement in our management approach after the emergence of more definitive evidence.
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Affiliation(s)
- Ajay Kumar Jha
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Suman Lata
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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12
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Kiuchi MG, Ho JK, Nolde JM, Gavidia LML, Carnagarin R, Matthews VB, Schlaich MP. Sympathetic Activation in Hypertensive Chronic Kidney Disease - A Stimulus for Cardiac Arrhythmias and Sudden Cardiac Death? Front Physiol 2020; 10:1546. [PMID: 32009970 PMCID: PMC6974800 DOI: 10.3389/fphys.2019.01546] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 12/09/2019] [Indexed: 12/11/2022] Open
Abstract
Studies have revealed a robust and independent correlation between chronic kidney disease (CKD) and cardiovascular (CV) events, including death, heart failure, and myocardial infarction. Recent clinical trials extend this range of adverse CV events, including malignant ventricular arrhythmias and sudden cardiac death (SCD). Moreover, other studies point out that cardiac structural and electrophysiological changes are a common occurrence in this population. These processes are likely contributors to the heightened hazard of arrhythmias in CKD population and may be useful indicators to detect patients who are at a higher SCD risk. Sympathetic overactivity is associated with increased CV risk, specifically in the population with CKD, and it is a central feature of the hypertensive state, occurring early in its clinical course. Sympathetic hyperactivity is already evident at the earliest clinical stage of CKD and is directly related to the progression of renal failure, being most pronounced in those with end-stage renal disease. Sympathetic efferent and afferent neural activity in kidney failure is a crucial facilitator for the perpetuation and evolvement of the disease. Here, we will revisit the role of the feedback loop of the sympathetic neural cycle in the context of CKD and how it may aggravate several of the risk factors responsible for causing SCD. Targeting the overactive sympathetic nervous system therapeutically, either pharmacologically or with newly available device-based approaches, may prove to be a pivotal intervention to curb the substantial burden of cardiac arrhythmias and SCD in the high-risk population of patients with CKD.
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Affiliation(s)
- Márcio Galindo Kiuchi
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Jan K Ho
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Janis Marc Nolde
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Leslie Marisol Lugo Gavidia
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Revathy Carnagarin
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Vance B Matthews
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, WA, Australia.,Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, WA, Australia.,Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
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13
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Tanaka A, Inaguma D, Shinjo H, Takeda A. Incidence rate of atrial fibrillation after dialysis initiation and its relationship with cardiovascular events. Acta Cardiol 2019; 74:527-535. [PMID: 30794057 DOI: 10.1080/00015385.2018.1530085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Aim: This study aimed to investigate the incidence of atrial fibrillation (AF) and its prognosis in the patients after dialysis initiation.Methods: A total of 1524 patients with chronic kidney disease who were initiated on dialysis were included. Dialysis was initiated between October 2011 and September 2013. Electrocardiogram was obtained at dialysis initiation, in March 2015, and September 2016. The mortality and cardiovascular disease (CVD) event rates of 1520 patients (1028 men and 492 women; mean age, 67.5 ± 13.1 years) who were followed up were compared, and they were divided into 2 groups: the AF group (with AF at least once) and N group (without AF).Results: The prevalence of AF was 6.2, 7.9, and 6.5% at dialysis initiation, in March 2015, and September 2016, respectively, and the incidence of new AF onset was 4.8% in March 2015 and 2.3% in September 2016. In total, 45 (28.0%) and 347 (25.5%) patients died in the AF and N groups, (p = .508), respectively. The incidence rates of CVD event were 91 (56.5%) and 413 (30.4%) in the AF and N groups (p < .001), respectively. In the multivariate analysis, mortality was not significant, but the incidence of CVD event was significantly higher in the AF group. Albumin level was associated with new-onset AF.Conclusions: After dialysis initiation, a high incidence of new-onset AF was observed. The lower albumin value at the time of dialysis initiation is more likely to be associated with AF development. Attention should be paid to the CVD events in the AF group.
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Affiliation(s)
- Akihito Tanaka
- Kidney Disease Center, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Daijo Inaguma
- Kidney Disease Center, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
- Aichi Cohort Study of Prognosis in Patients Newly Initiated Into Dialysis (AICOPP), Aichi, Nagoya, Japan
| | - Hibiki Shinjo
- Kidney Disease Center, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Asami Takeda
- Kidney Disease Center, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
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14
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Samanta R, Chan C, Chauhan VS. Arrhythmias and Sudden Cardiac Death in End Stage Renal Disease: Epidemiology, Risk Factors, and Management. Can J Cardiol 2019; 35:1228-1240. [DOI: 10.1016/j.cjca.2019.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/23/2019] [Accepted: 05/07/2019] [Indexed: 11/17/2022] Open
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15
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Mehdi B, Kaveh H, Ali VF. Implantable Cardioverter-Defibrillators in Patients with ESRD: Complications, Management, and Literature Review. Curr Cardiol Rev 2019; 15:161-166. [PMID: 30657044 PMCID: PMC6719391 DOI: 10.2174/1573403x15666190118123754] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/26/2018] [Accepted: 01/10/2019] [Indexed: 01/25/2023] Open
Abstract
Background: Cardiovascular diseases are the leading cause of death among dialysis pa-tients, accounting for about 40% of all their mortalities. Sudden cardiac death (SCD) is culpable for 37.5% of all deaths among patients with end-stage renal disease (ESRD). Implantable cardioverter-defibrillators (ICDs) should be considered in dialysis patients for the primary or secondary preven-tion of SCD. Recent studies on the implementation of ICD/cardiac resynchronization therapy do not exclude patients with ESRD; however, individualized decisions should be made in this group of pa-tients. A thorough evaluation of the benefits of ICD implementation in patients with ESRD requires several large-scale mortality studies to compare and follow up patients with ESRD with and without ICDs. In the present study, we sought to determine and clarify the complications associated with ICD implementation and management thereof in patients suffering from ESRD. Methods: To assess the complications allied to the implementation of ICDs and their management in patients with ESRD, we reviewed available related articles in the literature. Results and Conclusions: ICD implementation in dialysis patients has several complications, which has limited its usage. Based on our literature review, the complications of ICD implementation can be categorized as follows: (1) Related to implantation procedures, hematoma, and pneumothorax; (2) Re-lated to the device/lead such as lead fracture and lead dislodgment; (3) Infection; and (4) Central vein thrombosis. Hence, the management of the complications of ICDs in this specific group of patients is of vital importance.
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Affiliation(s)
- Bayati Mehdi
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hosseini Kaveh
- Cardiology Resident, MS in Public Health, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Vasheghani-Farahani Ali
- Cardiac Primary Prevention, Research Center (CPPRC), Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Electrophysiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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16
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Abstract
The challenge presented by sudden cardiac death in dialysis patients is to better define risk factors and delineate multiple etiologies. Only then can therapy be tailored to the highest risk patients and the incidence of sudden cardiac death be reduced. This article details the many possible etiologies and presents a brief overview of more recent research that may in the future prove of great benefit in improving the mortality of our patients with end-stage renal disease.
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17
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Pun PH, Al-Khatib SM. Implantable Defibrillators for Primary Prevention of Sudden Death in Patients on Dialysis. Am J Kidney Dis 2019; 74:857-860. [PMID: 31257051 DOI: 10.1053/j.ajkd.2019.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 05/11/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Patrick H Pun
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
| | - Sana M Al-Khatib
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
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18
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Jukema JW, Timal RJ, Rotmans JI, Hensen LCR, Buiten MS, de Bie MK, Putter H, Zwinderman AH, van Erven L, Krol-van Straaten MJ, Hommes N, Gabreëls B, van Dorp W, van Dam B, Herzog CA, Schalij MJ, Rabelink TJ. Prophylactic Use of Implantable Cardioverter-Defibrillators in the Prevention of Sudden Cardiac Death in Dialysis Patients. Circulation 2019; 139:2628-2638. [DOI: 10.1161/circulationaha.119.039818] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- J. Wouter Jukema
- Department of Cardiology (J.W.J., R.J.T., L.C.R.H., M.S.B., M.K.d.B., L.v.E., M.J.S.), Leiden University Medical Center, The Netherlands
| | - Rohit J. Timal
- Department of Cardiology (J.W.J., R.J.T., L.C.R.H., M.S.B., M.K.d.B., L.v.E., M.J.S.), Leiden University Medical Center, The Netherlands
| | - Joris I. Rotmans
- Department of Internal Medicine (J.I.R., T.J.R.), Leiden University Medical Center, The Netherlands
| | - Liselotte C. R. Hensen
- Department of Cardiology (J.W.J., R.J.T., L.C.R.H., M.S.B., M.K.d.B., L.v.E., M.J.S.), Leiden University Medical Center, The Netherlands
| | - Maurits S. Buiten
- Department of Cardiology (J.W.J., R.J.T., L.C.R.H., M.S.B., M.K.d.B., L.v.E., M.J.S.), Leiden University Medical Center, The Netherlands
| | - Mihaly K. de Bie
- Department of Cardiology (J.W.J., R.J.T., L.C.R.H., M.S.B., M.K.d.B., L.v.E., M.J.S.), Leiden University Medical Center, The Netherlands
| | - Hein Putter
- Department of Biomedical Data Sciences (H.P.), Leiden University Medical Center, The Netherlands
| | - Aeilko H. Zwinderman
- Department of Medical Statistics, Academic Medical Center, Amsterdam, The Netherlands (A.H.Z.)
| | - Lieselot van Erven
- Department of Cardiology (J.W.J., R.J.T., L.C.R.H., M.S.B., M.K.d.B., L.v.E., M.J.S.), Leiden University Medical Center, The Netherlands
| | | | - Nienke Hommes
- Department of Internal Medicine, Haaglanden Medisch Centrum, The Hague, The Netherlands (N.H.)
| | - Bas Gabreëls
- Department of Internal Medicine, Alrijne Ziekenhuis, Leiderdorp, The Netherlands (B.G.)
| | - Wim van Dorp
- Department of Internal Medicine, Spaarne Gasthuis, Haarlem, The Netherlands (W.v.D.)
| | - Bastiaan van Dam
- Department of Internal Medicine, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands (B.v.D.)
| | - Charles A. Herzog
- Department of Internal Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis (C.A.H.)
| | - Martin J. Schalij
- Department of Cardiology (J.W.J., R.J.T., L.C.R.H., M.S.B., M.K.d.B., L.v.E., M.J.S.), Leiden University Medical Center, The Netherlands
| | - Ton J. Rabelink
- Department of Internal Medicine (J.I.R., T.J.R.), Leiden University Medical Center, The Netherlands
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19
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Sgroi MD, McFarland G, Itoga NK, Sorial E, Garcia-Toca M. Arteriovenous Fistula and Graft Construction in Patients with Implantable Cardiac Devices: Does Side Matter? Ann Vasc Surg 2018; 54:66-71. [PMID: 30339901 DOI: 10.1016/j.avsg.2018.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 10/02/2018] [Accepted: 10/09/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Limited reports have documented the effect cardiac implantable electronic devices (CIEDs) have on arteriovenous (AV) access patency. Current recommendations suggest placing the access on the contralateral side of the CIEDs, as there is concern for increased central venous stenosis and access failure. The goal of this study is to review our single-center AV access patency rates for dialysis patients with an ipsilateral or contralateral side CIED. METHODS A retrospective review was performed from 2008 to 2016 at a single institution identifying all patients who have received a CIED and the diagnosis of end-stage renal disease (ESRD). Medical records were queried to identify each patient's dialysis access and whether it was ipsilateral or contralateral to the CIED. Primary outcomes of study were primary and secondary patency rates. RESULTS A total of 44 patients were identified to have ESRD and CIED. Of these patients, 28 patients with fistulas or grafts (13 ipsilateral and 15 contralateral) had follow-up with regards to their AV access. There were 3 primary failures in both groups. For patients who had the CIED placed after already starting the dialysis, patency was based on when the cardiac device was implanted. Primary patency for ipsilateral and contralateral access was 20.2 and 22.2 months, respectively. With secondary interventions, ipsilateral and contralateral mean patency was 39 and 48.8 months, respectively. Six-month and 1-year primary patency for arteriovenous fistula or arteriovenous graft on patients with ipsilateral access was 69.2% and 53.8%, respectively. Ipsilateral 1-year cumulative patency was 39 months. CONCLUSIONS CIED may lead to stenosis or occlusion to one's AV access; however, primary assisted and secondary patency rates are still acceptable at 6 months and 1 year compared to Kidney Disease Outcomes Quality Initiative guidelines. Despite a CIED, a surgeon's algorithm should not lead to the abandonment of an ipsilateral access if the central venous system is patent.
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Affiliation(s)
- Michael D Sgroi
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA.
| | - Graeme McFarland
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA
| | - Nathan K Itoga
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA
| | - Ehab Sorial
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA
| | - Manuel Garcia-Toca
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA
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20
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Alqahtani F, Almustafa A, Shah K, Akram Y, Abbasi D, Rattan R, Subrayappa N, Alkhouli M, Munir MB. Sudden cardiac arrest in end-stage renal disease patients on dialysis: A nationwide study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1467-1475. [PMID: 30225901 DOI: 10.1111/pace.13498] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/06/2018] [Accepted: 09/09/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Fahad Alqahtani
- Department of Cardiology; West Virginia University Heart and Vascular Institute; Morgantown WV USA
| | - Ahmed Almustafa
- Department of Cardiology; West Virginia University Heart and Vascular Institute; Morgantown WV USA
| | - Kuldeep Shah
- Department of Cardiology; West Virginia University Heart and Vascular Institute; Morgantown WV USA
| | - Yasir Akram
- Department of Cardiology; West Virginia University Heart and Vascular Institute; Morgantown WV USA
| | - Danish Abbasi
- Department of Cardiology; West Virginia University Heart and Vascular Institute; Morgantown WV USA
| | - Rohit Rattan
- Department of Cardiology; Heart and Vascular Institute, University of Pittsburgh Medical Center; Pittsburgh PA USA
| | - Navin Subrayappa
- Department of Cardiology; West Virginia University Heart and Vascular Institute; Morgantown WV USA
| | - Mohamad Alkhouli
- Department of Cardiology; West Virginia University Heart and Vascular Institute; Morgantown WV USA
| | - Muhammad Bilal Munir
- Department of Cardiology; West Virginia University Heart and Vascular Institute; Morgantown WV USA
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21
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Huang ST, Yu TM, Ke TY, Wu MJ, Chuang YW, Li CY, Chiu CW, Lin CL, Liang WM, Chou TC, Kao CH. Syncope and Collapse Are Associated with an Increased Risk of Cardiovascular Disease and Mortality in Patients Undergoing Dialysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2082. [PMID: 30248947 PMCID: PMC6210976 DOI: 10.3390/ijerph15102082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 11/16/2022]
Abstract
Objective: This study explored the impact of syncope and collapse (SC) on cardiovascular events and mortality in patients undergoing dialysis. Methods: Patients undergoing dialysis with SC (n = 3876) were selected as the study cohort and those without SC who were propensity score-matched at a 1:1 ratio were included as controls. Major adverse cardiovascular events (MACEs), including acute coronary syndrome (ACS), arrhythmia or cardiac arrest, stroke, and overall mortality, were evaluated and compared in both cohorts. Results: The mean follow-up periods until the occurrence of ACS, arrhythmia or cardiac arrest, stroke, and overall mortality in the SC cohort were 3.51 ± 2.90, 3.43 ± 2.93, 3.74 ± 2.97, and 3.76 ± 2.98 years, respectively. Compared with the patients without SC, those with SC had higher incidence rates of ACS (30.1 vs. 24.7 events/1000 people/year), arrhythmia or cardiac arrest (6.75 vs. 3.51 events/1000 people/year), and stroke (51.6 vs. 35.7 events/1000 people/year), with higher overall mortality (127.7 vs. 77.9 deaths/1000 people/year). The SC cohort also had higher risks for ACS, arrhythmia or cardiac arrest, stroke, and overall mortality (adjusted hazard ratios: 1.28 (95% confidence interval (CI) = 1.11⁻1.46), 2.05 (95% CI = 1.50⁻2.82), 1.48 (95% CI = 1.33⁻1.66), and 1.79 (95% CI = 1.67⁻1.92), respectively) than did the non-SC cohort. Conclusion: SC was significantly associated with cardiovascular events and overall mortality in the patients on dialysis. SC may serve as a prodrome for cardiovascular comorbidities, thereby assisting clinicians in identifying high-risk patients.
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Affiliation(s)
- Shih-Ting Huang
- Division of Nephrology, Taichung Veterans General Hospital, Taichung 407, Taiwan.
- Graduate Institute of Public Health, China Medical University, Taichung 404, Taiwan.
| | - Tung-Min Yu
- Division of Nephrology, Taichung Veterans General Hospital, Taichung 407, Taiwan.
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung 404, Taiwan.
| | - Tai-Yuan Ke
- Division of Nephrology, Ministry of Health and Welfare Chiayi Hospital, Chiayi 600, Taiwan.
| | - Ming-Ju Wu
- Division of Nephrology, Taichung Veterans General Hospital, Taichung 407, Taiwan.
| | - Ya-Wen Chuang
- Division of Nephrology, Taichung Veterans General Hospital, Taichung 407, Taiwan.
- Graduate Institute of Public Health, China Medical University, Taichung 404, Taiwan.
| | - Chi-Yuan Li
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung 404, Taiwan.
- Department of Anesthesiology, China Medical University Hospital, Taichung 404, Taiwan.
| | - Chih-Wei Chiu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung 404, Taiwan.
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung 404, Taiwan.
- College of Medicine, China Medical University, Taichung 404, Taiwan.
| | - Wen-Miin Liang
- Graduate Institute of Biostatistics, China Medical University, Taichung 404, Taiwan.
| | - Tzu-Chieh Chou
- Department of Public Health, China Medical University, Taichung 404, Taiwan.
- Department of Health Risk Management, College of Public Health, China Medical University, Taichung 404, Taiwan.
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung 404, Taiwan.
- Department of Nuclear Medicine and PET Center, China Medical University, Taichung 404, Taiwan.
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung 404, Taiwan.
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22
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Outcomes of ICDs and CRTs in patients with chronic kidney disease: a meta-analysis of 21,000 patients. J Interv Card Electrophysiol 2018; 53:123-129. [DOI: 10.1007/s10840-018-0424-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 07/19/2018] [Indexed: 01/10/2023]
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23
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Turakhia MP, Blankestijn PJ, Carrero JJ, Clase CM, Deo R, Herzog CA, Kasner SE, Passman RS, Pecoits-Filho R, Reinecke H, Shroff GR, Zareba W, Cheung M, Wheeler DC, Winkelmayer WC, Wanner C. Chronic kidney disease and arrhythmias: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Eur Heart J 2018; 39:2314-2325. [PMID: 29522134 PMCID: PMC6012907 DOI: 10.1093/eurheartj/ehy060] [Citation(s) in RCA: 166] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/18/2017] [Accepted: 01/27/2018] [Indexed: 12/15/2022] Open
MESH Headings
- Arrhythmias, Cardiac/epidemiology
- Arrhythmias, Cardiac/therapy
- Atrial Fibrillation/complications
- Atrial Fibrillation/drug therapy
- Atrial Fibrillation/epidemiology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- Humans
- Hyperkalemia/epidemiology
- Hyperkalemia/metabolism
- Hypokalemia/epidemiology
- Hypokalemia/metabolism
- Inflammation
- Kidney Failure, Chronic/epidemiology
- Kidney Failure, Chronic/metabolism
- Kidney Failure, Chronic/therapy
- Oxidative Stress
- Potassium/metabolism
- Renal Dialysis
- Renal Insufficiency, Chronic/epidemiology
- Renal Insufficiency, Chronic/metabolism
- Renal Insufficiency, Chronic/therapy
- Risk Factors
- Stroke/etiology
- Stroke/prevention & control
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Affiliation(s)
- Mintu P Turakhia
- Stanford University School of Medicine, Veterans Affairs Palo Alto Health Care System, Miranda Ave, Palo Alto, CA, USA
| | - Peter J Blankestijn
- Department of Nephrology, room F03.220, University Medical Center, Utrecht, The Netherlands
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Stockholm, Sweden
| | - Catherine M Clase
- Department of Medicine and Department of Health Research Methods, Evidence, and Impact, McMaster University, St. Joseph’s Healthcare, Marian Wing, 3rd Floor, M333, 50 Charlton Ave. E, Hamilton, Ontario, Canada
| | - Rajat Deo
- Section of Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, 9 Founders Cardiology, Philadelphia, PA, USA
| | - Charles A Herzog
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, Minnesota and Chronic Disease Research Group, Minneapolis Medical Research Foundation, 914 S. 8th Street, S4.100, Minneapolis, MN, USA
| | - Scott E Kasner
- Department of Neurology, 3W Gates Bldg. Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, USA
| | - Rod S Passman
- Northwestern University Feinberg School of Medicine and the Bluhm Cardiovascular Institute, 201 E. Huron St. Chicago, IL, USA
| | - Roberto Pecoits-Filho
- School of Medicine, Pontificia Universidade Catolica do Paraná, Rua Imaculada Conceição Curitiba PR, Brazil
| | - Holger Reinecke
- Department für Kardiologie und Angiologie Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, Muenster, Germany
| | - Gautam R Shroff
- Division of Cardiology, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN, USA
| | - Wojciech Zareba
- Heart Research Follow-up Program, Cardiology Division, University of Rochester Medical Center, Saunders Research Building, 265 Crittenden Blvd. CU, Rochester, NY, USA
| | | | - David C Wheeler
- Centre for Nephrology, University College London, Rowland Hill Street, London, UK
| | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, ABBR R705, MS: 395, Houston, TX, USA
| | - Christoph Wanner
- Division of Nephrology, Department of Medicine, University Hospital of Würzburg, Oberduerrbacherstr. 6 Würzburg, Germany
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24
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Boyle NG, Do DH. Hemodialysis Patients. JACC Clin Electrophysiol 2018; 4:409-411. [DOI: 10.1016/j.jacep.2017.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 09/14/2017] [Indexed: 10/18/2022]
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25
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Munir MB, Alqahtani F, Aljohani S, Bhirud A, Modi S, Alkhouli M. Trends and predictors of implantable cardioverter defibrillator implantation after sudden cardiac arrest: Insight from the national inpatient sample. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:229-237. [PMID: 29318626 DOI: 10.1111/pace.13274] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 12/12/2017] [Accepted: 12/22/2017] [Indexed: 11/29/2022]
Affiliation(s)
| | - Fahad Alqahtani
- West Virginia University Heart & Vascular Institute; Morgantown WV USA
| | - Sami Aljohani
- West Virginia University Heart & Vascular Institute; Morgantown WV USA
| | - Ashwin Bhirud
- West Virginia University Heart & Vascular Institute; Morgantown WV USA
| | - Sujal Modi
- West Virginia University Heart & Vascular Institute; Morgantown WV USA
| | - Mohamad Alkhouli
- West Virginia University Heart & Vascular Institute; Morgantown WV USA
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Abstract
Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). The rate of death in incident dialysis patients remains high. This has led to interest in the study of the evolution of CVD during the critical transition period from CKD to ESRD. Understanding the natural history and risk factors of clinical and subclinical CVD during this transition may help guide the timing of appropriate CVD therapies to improve outcomes in patients with kidney disease. This review provides an overview of the epidemiology of subclinical and clinical CVD during the transition from CKD to ESRD and discusses clinical trials of CVD therapies to mitigate risk of CVD in CKD and ESRD patients.
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Affiliation(s)
- Nisha Bansal
- Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, WA.
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27
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Vachharajani TJ, Salman L, Costanzo EJ, Mehandru SK, Patel M, Calderon DM, Mathew RO, Sidhu MS, Asif A. Subcutaneous defibrillators for dialysis patients. Hemodial Int 2017. [DOI: 10.1111/hdi.12577] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
| | - Loay Salman
- Department of Medicine; Albany Medical College; Albany New York
| | - Eric J. Costanzo
- Department of Medicine; Jersey Shore University Medical Center, Seton Hall-Hackensack-Meridian School of Medicine; Neptune New Jersey USA
| | - Sushil K. Mehandru
- Department of Medicine; Jersey Shore University Medical Center, Seton Hall-Hackensack-Meridian School of Medicine; Neptune New Jersey USA
| | - Mayurkumar Patel
- Department of Medicine; Jersey Shore University Medical Center, Seton Hall-Hackensack-Meridian School of Medicine; Neptune New Jersey USA
| | - Dawn M. Calderon
- Department of Medicine; Jersey Shore University Medical Center, Seton Hall-Hackensack-Meridian School of Medicine; Neptune New Jersey USA
| | | | | | - Arif Asif
- Department of Medicine; Jersey Shore University Medical Center, Seton Hall-Hackensack-Meridian School of Medicine; Neptune New Jersey USA
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28
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Fu L, Zhou Q, Zhu W, Lin H, Ding Y, Shen Y, Hu J, Hong K. Do Implantable Cardioverter Defibrillators Reduce Mortality in Patients With Chronic Kidney Disease at All Stages? Int Heart J 2017; 58:371-377. [PMID: 28539571 DOI: 10.1536/ihj.16-357] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
The benefits of implantable cardioverter defibrillator (ICD) implantation in chronic kidney disease (CKD) patients with high sudden cardiac death (SCD) risk are uncertain. To clarify the effects of receiving an ICD in CKD patients, we conducted this meta-analysis to identify the effects of ICDs on patients with CKD, including those on dialysis. We searched the Cochrane library, EMBASE, PubMed, and clinical trials for studies published before July 2016. Eleven studies including 20,196 CKD patients were considered for inclusion. The pooled analysis suggested that patients with an estimated glomerular filtration rate (eGFR) < 60 mL/minute/1.73 m2 would benefit from receiving treatments with ICDs compared with patients without an ICD device (aHR = 0.74; 95% confidence interval [CI], 0.63 to 0.86). [corrected]. This is the first report of a subgroup analysis on the survival rate of ICD implantation in CKD patients according to an eGFR group. The subgroup analysis indicated a similar protective association of ICDs in stage 3 (aHR = 0.71; 95% CI, 0.61 to 0.82) and 5 (aHR = 0.71; 95% CI, 0.54 to 0.92) CKD patients [corrected] compared with the control group. However, there was no significant improvement in all-cause mortality in stage 4 CKD patients (aHR = 1.02; 95%CI, 0.75 to 1.37) [corrected]. This is the first meta-analysis reporting that ICD implantation reduces all-cause mortality in stage 3 and 5 [corrected] CKD patients. However, the data do not indicate there is any benefit to ICD implantation in stage 4 [corrected] CKD patients.
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MESH Headings
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- Global Health
- Humans
- Incidence
- Registries
- Renal Insufficiency, Chronic/complications
- Renal Insufficiency, Chronic/diagnosis
- Renal Insufficiency, Chronic/mortality
- Risk Assessment
- Risk Factors
- Survival Rate/trends
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Affiliation(s)
- Linghua Fu
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University
| | - Qiongqiong Zhou
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University
| | - Wengen Zhu
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University
| | - Huang Lin
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University
| | - Ying Ding
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University
| | - Yang Shen
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University
| | - Jinzhu Hu
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University
| | - Kui Hong
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University
- Jiangxi Key Laboratory of Molecular Medicine
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29
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Borne RT, Katz D, Betz J, Peterson PN, Masoudi FA. Implantable Cardioverter-Defibrillators for Secondary Prevention of Sudden Cardiac Death: A Review. J Am Heart Assoc 2017; 6:JAHA.117.005515. [PMID: 28258050 PMCID: PMC5524042 DOI: 10.1161/jaha.117.005515] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Ryan T Borne
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - David Katz
- Division of Cardiology, Medical Center of the Rockies, University of Colorado Health, Loveland, CO
| | - Jarrod Betz
- Division of Cardiology, The Ohio State University Medical Center, Columbus, OH
| | - Pamela N Peterson
- Division of Cardiology, Denver Health and Hospital Authority, Denver, CO
| | - Frederick A Masoudi
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
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30
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Saad TF, Weiner HL. Venous Hemodialysis Catheters and Cardiac Implantable Electronic Devices: Avoiding a High-Risk Combination. Semin Dial 2017; 30:187-192. [PMID: 28229483 DOI: 10.1111/sdi.12581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
End-stage renal disease is frequently accompanied by cardiac comorbidity that warrants treatment with a cardiovascular implantable electronic device (permanent pacemaker or implantable cardioverter-defibrillator). In the United States, chronic hemodialysis (HD) population, cardiac implantable devices are present in up to 10.5% of patients; a venous HD catheter is utilized for blood access in 18% of prevalent patients. The concomitant presence of a venous HD catheter and cardiovascular implantable device creates a high-risk circumstance, with potential for causing symptomatic central venous stenosis, and for developing complicated endovascular infection. This dangerous combination may be avoided for many patients by utilizing nondialysis methods for management of advanced chronic kidney disease, initiating dialysis without venous catheter access, or managing cardiac rhythm disorders without use of transvenous cardiac implantable electronic devices. In those situations where the combination of a venous HD catheter and cardiac implantable device is unavoidable, there are strategies to minimize duration of venous catheter access, and to reduce risks for infectious complications. It is essential for nephrologists and cardiologists to understand the indications, alternatives, and risks involved with venous HD access and cardiac implantable devices. Coordinated management of renal disease and cardiac rhythm disorders has potential to minimize risks, improve outcomes, and substantially reduce the cost of care.
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Affiliation(s)
- Theodore F Saad
- Section of Renal and Hypertensive Diseases, Christiana Care Health System, Newark, Delaware
| | - Henry L Weiner
- Section of Cardiology, Christiana Care Health System, Newark, Delaware
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31
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Makar MS, Pun PH. Sudden Cardiac Death Among Hemodialysis Patients. Am J Kidney Dis 2017; 69:684-695. [PMID: 28223004 DOI: 10.1053/j.ajkd.2016.12.006] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 12/12/2016] [Indexed: 02/07/2023]
Abstract
Hemodialysis patients carry a large burden of cardiovascular disease; most onerous is the high risk for sudden cardiac death. Defining sudden cardiac death among hemodialysis patients and understanding its pathogenesis are challenging, but inferences from the existing literature reveal differences between sudden cardiac death among hemodialysis patients and the general population. Vascular calcifications and left ventricular hypertrophy may play a role in the pathophysiology of sudden cardiac death, whereas traditional cardiovascular risk factors seem to have a more muted effect. Arrhythmic triggers also differ in this group as compared to the general population, with some arising uniquely from the hemodialysis procedure. Combined, these factors may alter the types of terminal arrhythmias that lead to sudden cardiac death among hemodialysis patients, having important implications for prevention strategies. This review highlights current knowledge on the epidemiology, pathophysiology, and risk factors for sudden cardiac death among hemodialysis patients. We then examine strategies for prevention, including the use of specific cardiac medications and device-based therapies such as implantable defibrillators. We also discuss dialysis-specific prevention strategies, including minimizing exposure to low potassium and calcium dialysate concentrations, extending dialysis treatment times or adding sessions to avoid rapid ultrafiltration, and lowering dialysate temperature.
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Affiliation(s)
- Melissa S Makar
- Duke Clinical Research Institute, Durham, NC; Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC.
| | - Patrick H Pun
- Duke Clinical Research Institute, Durham, NC; Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC
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32
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Shah AD, Peddareddy LP, Addish MA, Kelly K, Patel AU, Casey M, Goyal A, Leon AR, El-Chami MF, Merchant FM. Procedural outcomes and long-term survival following trans-venous defibrillator lead extraction in patients with end-stage renal disease. Europace 2017; 19:1994-2000. [DOI: 10.1093/europace/euw367] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 10/13/2016] [Indexed: 11/12/2022] Open
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33
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Deo R, Khodneva YA, Shlipak MG, Soliman EZ, Judd SE, McClellan WM, Brown TM, Rhodes JD, Gutiérrez OM, Shah SJ, Albert CM, Safford MM. Albuminuria, kidney function, and sudden cardiac death: Findings from The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Heart Rhythm 2017; 14:65-71. [PMID: 27523775 PMCID: PMC5256547 DOI: 10.1016/j.hrthm.2016.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Moderate-to-severe kidney disease increases risk for sudden cardiac death (SCD). Limited studies have evaluated how mild degrees of kidney dysfunction impact SCD risk. OBJECTIVE The purpose of this study was to evaluate the association of albuminuria, which is one of the earliest biomarkers of kidney injury, and SCD. METHODS The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study is a prospective, population-based cohort of U.S. adults. Associations between albuminuria, which is categorized using urinary albumin-to-creatinine ratio (ACR), estimated glomerular filtration rate (eGFR), and SCD were assessed independently and in combination. RESULTS After median follow-up of 6.1 years, we identified 335 SCD events. Compared to participants with ACR <15 mg/g, those with higher levels had an elevated adjusted risk of SCD (ACR 15-30 mg/g, hazard ratio [HR] 1.53, 95% confidence interval [CI] 1.11-2.11; ACR >30 mg/g, HR 1.56, 95% CI 1.17-2.11). In contrast, compared to the group with eGFR >90 mL/min/1.73 m2, the adjusted risk of SCD was significantly elevated only among those with eGFR <45 mL/min/1.73 m2 (HR 1.66, 95% CI 1.06-2.58). The subgroup with eGFR <45 mL/min/1.73 m2 (n = 1003) comprised 3.7% of REGARDS, whereas ACR 15-30 mg/g (n = 3089 [11.3%]) and ACR >30 mg/g (n = 4040 [14.8%] were far more common. In the analysis that combined ACR and eGFR categories, albuminuria consistently identified individuals with eGFR ≥60 mLmin/1.73 m2 who were at significantly increased SCD risk. CONCLUSION Low levels of kidney injury as measured by ACR predict an increase in SCD risk.
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Affiliation(s)
- Rajat Deo
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Yulia A Khodneva
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael G Shlipak
- Department of Epidemiology, Biostatistics, and Medicine, University of California San Francisco and Department of General Internal Medicine, San Francisco VA Medical Center, San Francisco, California
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, and Department of Internal Medicine, Cardiology Section, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Suzanne E Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - William M McClellan
- Departments of Medicine and Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Todd M Brown
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - J David Rhodes
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Orlando M Gutiérrez
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sanjiv J Shah
- Division of Cardiovascular Medicine, Northwestern University, Chicago, Illinois
| | - Christine M Albert
- Center for Arrhythmia Prevention, Division of Preventive Medicine, and Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Monika M Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
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34
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Wang AYM, Brimble KS, Brunier G, Holt SG, Jha V, Johnson DW, Kang SW, Kooman JP, Lambie M, McIntyre C, Mehrotra R, Pecoits-Filho R. ISPD Cardiovascular and Metabolic Guidelines in Adult Peritoneal Dialysis Patients Part II - Management of Various Cardiovascular Complications. Perit Dial Int 2016; 35:388-96. [PMID: 26228783 DOI: 10.3747/pdi.2014.00278] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Cardiovascular mortality has remained high in patients on peritoneal dialysis (PD) due to the high prevalence of various cardiovascular complications including coronary artery disease, left ventricular hypertrophy and dysfunction, heart failure, arrhythmia (especially atrial fibrillation), cerebrovascular disease, and peripheral arterial disease. In addition, nearly a quarter of PD patients develop sudden cardiac death as the terminal life event. Thus, it is essential to identify effective treatment that may lower cardiovascular mortality and improve survival of PD patients. The International Society for Peritoneal Dialysis (ISPD) commissioned a global workgroup in 2012 to formulate a series of recommendation statements regarding lifestyle modification, assessment and management of various cardiovascular risk factors, and management of the various cardiovascular complications to be published in 2 guideline documents. This publication forms the second part of the guideline documents and includes recommendation statements on the management of various cardiovascular complications in adult chronic PD patients. The documents are intended to serve as a global clinical practice guideline for clinicians who look after PD patients. We also define areas where evidence is clearly deficient and make suggestions for future research in each specific area.
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Affiliation(s)
| | - K Scott Brimble
- St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada
| | - Gillian Brunier
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Stephen G Holt
- Division of Nephrology, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Vivekanand Jha
- George Institute for Global Health India, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - David W Johnson
- University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
| | - Shin-Wook Kang
- Department of Internal Medicine, College of Medicine, Severance Biomedical Science Institute, Yonsei University, Korea
| | - Jeroen P Kooman
- Division of Nephrology, University Hospital Maastricht, Maastricht, The Netherlands
| | - Mark Lambie
- Health Services Research Unit, Institute for Science and Technology in Medicine, Keele University, Keele, Staffordshire, United Kingdom
| | - Chris McIntyre
- School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, United Kingdom
| | - Rajnish Mehrotra
- Harborview Medical Center, Division of Nephrology/Department of Medicine, University of Washington, Washington, DC, United States
| | - Roberto Pecoits-Filho
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
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35
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Di Lullo L, Rivera R, Barbera V, Bellasi A, Cozzolino M, Russo D, De Pascalis A, Banerjee D, Floccari F, Ronco C. Sudden cardiac death and chronic kidney disease: From pathophysiology to treatment strategies. Int J Cardiol 2016; 217:16-27. [PMID: 27174593 DOI: 10.1016/j.ijcard.2016.04.170] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 04/27/2016] [Accepted: 04/30/2016] [Indexed: 02/07/2023]
Abstract
Chronic kidney disease (CKD) patients demonstrate higher rates of cardiovascular mortality and morbidity; and increased incidence of sudden cardiac death (SCD) with declining kidney failure. Coronary artery disease (CAD) associated risk factors are the major determinants of SCD in the general population. However, current evidence suggests that in CKD patients, traditional cardiovascular risk factors may play a lesser role. Complex relationships between CKD-specific risk factors, structural heart disease, and ventricular arrhythmias (VA) contribute to the high risk of SCD. In dialysis patients, the occurrence of VA and SCD could be exacerbated by electrolyte shifts, divalent ion abnormalities, sympathetic overactivity, inflammation and iron toxicity. As outcomes in CKD patients after cardiac arrest are poor, primary and secondary prevention of SCD and cardiac arrest could reduce cardiovascular mortality in patients with CKD.
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Affiliation(s)
- L Di Lullo
- Department of Nephrology and Dialysis, L. Parodi - Delfino Hospital, Colleferro, Rome, Italy.
| | - R Rivera
- Division of Nephrology, S. Gerardo Hospital, Monza, Italy
| | - V Barbera
- Department of Nephrology and Dialysis, L. Parodi - Delfino Hospital, Colleferro, Rome, Italy
| | - A Bellasi
- Department of Nephrology and Dialysis, S. Anna Hospital, Como, Italy
| | - M Cozzolino
- Department of Health Sciences, Renal Division, San Paolo Hospital, University of Milan, Italy
| | - D Russo
- Division of Nephrology, University of Naples "Federico II", Naples, Italy
| | - A De Pascalis
- Department of Nephrology and Dialysis, Vito Fazzi Hospital, Lecce, Italy
| | - D Banerjee
- Consultant Nephrologist and Reader, Clinical Sub Dean, Renal and Transplantation Unit, St George's University, London, UK
| | - F Floccari
- Department of Nephrology and Dialysis, S. Paolo Hospital, Civitavecchia, Italy
| | - C Ronco
- International Renal Research Institute, S. Bortolo Hospital, Vicenza, Italy
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36
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Chronic kidney disease and risk factors responsible for sudden cardiac death: a whiff of hope? Kidney Res Clin Pract 2015; 35:3-9. [PMID: 27069851 PMCID: PMC4811986 DOI: 10.1016/j.krcp.2015.11.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/11/2015] [Accepted: 11/18/2015] [Indexed: 02/07/2023] Open
Abstract
Several studies have shown a strong independent association between chronic kidney disease (CKD) and cardiovascular events, including death, heart failure, and myocardial infarction. Recent clinical trials extend this range of adverse cardiovascular events, also including ventricular arrhythmias and sudden cardiac death. Furthermore, other studies suggest structural remodeling of the heart and electrophysiological alterations in this population. These processes may explain the increased risk of arrhythmia in kidney disease and help to identify patients who are at increased risk of sudden cardiac death. Sympathetic hyperactivity is well known to increase cardiovascular risk in CKD patients and is a hallmark of essential hypertensive state that occurs early in the clinical course of the disease. In CKD, the sympathetic hyperactivity seems to be expressed at the earliest clinical stage of the disease, showing a direct relationship with the severity of the condition of renal failure, being more pronounced in the terminal stage of CKD. The sympathetic efferent and afferent neural activity in kidney failure is a key mediator for the maintenance and progression of the disease. The aim of this review was to show that the feedback loop of this cycle, due to adrenergic hyperactivity, also aggravates many of the risk factors responsible for causing sudden cardiac death and may be a potential target modifiable by percutaneous renal sympathetic denervation. If it is feasible and effective in end-stage renal disease, little is known.
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37
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Luque Y, Bataille A, Taldir G, Rondeau É, Ridel C. [Cardiac arrest in dialysis patients: Risk factors, preventive measures and management in 2015]. Nephrol Ther 2015; 12:6-17. [PMID: 26547563 DOI: 10.1016/j.nephro.2015.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/29/2015] [Accepted: 06/30/2015] [Indexed: 02/06/2023]
Abstract
Patients undergoing hemodialysis have a 10 to 20 times higher risk of sudden cardiac arrest (SCA) than the general population. Sudden cardiac death is a rare event (approximately 1 event per 10,000 sessions) but has a very high mortality rate. Epidemiological data comes almost exclusively from North American studies; there is a great lack of European data on the subject. Ventricular arrhythmia is the main mechanism of sudden cardiac deaths in dialysis patients. These patients develop increased sensitivity mainly due to a high prevalence of severe ischemic heart disease and left ventricular hypertrophy and to a frequent trigger event: electrolytic and plasma volume shifts during dialysis sessions. Unfortunately, accurate predictive markers of SCA do not exist, however some primary prevention trials using beta-blockers or angiotensin II receptor blockers are encouraging, while the use of implantable cardioverter defibrillators in the population of chronic dialysis patients remains controversial. Identification of patients at risk, minimizing trigger events such as electrolytic shifts and improving team skills in the diagnosis and initial resuscitation with the latest recommendations from 2010 seem necessary to reduce incidence and improve survival in this high risk population. Organization of European studies would also allow a more accurate view of this reality in our dialysis units.
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Affiliation(s)
- Yosu Luque
- Service des urgences néphrologiques et de transplantation rénale, hôpital Tenon, 4, rue de la Chine, 75571 Paris cedex 20, France; Inserm UMR S 1155, bâtiment recherche, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France.
| | - Aurélien Bataille
- Département d'anesthésie-réanimation, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France; Inserm UMR S 1155, bâtiment recherche, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Guillaume Taldir
- Service de cardiologie, centre hospitalier de Saint-Brieuc, 22027 Saint-Brieuc cedex 1, France
| | - Éric Rondeau
- Service des urgences néphrologiques et de transplantation rénale, hôpital Tenon, 4, rue de la Chine, 75571 Paris cedex 20, France; Inserm UMR S 1155, bâtiment recherche, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Sorbonne universités, UPMC université Paris 06, 4, place Jussieu, 75005 Paris, France
| | - Christophe Ridel
- Service dialyse et aphérèse Aura Paris Plaisance, 185A, rue Raymond-Losserand, 75014 Paris, France
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38
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Boriani G, Savelieva I, Dan GA, Deharo JC, Ferro C, Israel CW, Lane DA, La Manna G, Morton J, Mitjans AM, Vos MA, Turakhia MP, Lip GY. Chronic kidney disease in patients with cardiac rhythm disturbances or implantable electrical devices: clinical significance and implications for decision making-a position paper of the European Heart Rhythm Association endorsed by the Heart Rhythm Society and the Asia Pacific Heart Rhythm Society. Europace 2015; 17:1169-96. [PMID: 26108808 PMCID: PMC6281310 DOI: 10.1093/europace/euv202] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Giuseppe Boriani
- Corresponding author. Giuseppe Boriani, Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S.Orsola-Malpighi University Hospital, Via Massarenti 9, 40138 Bologna, Italy. Tel: +39 051 349858; fax: +39 051 344859. E-mail address:
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Franczyk-Skóra B, Gluba-Brzózka A, Wranicz JK, Banach M, Olszewski R, Rysz J. Sudden cardiac death in CKD patients. Int Urol Nephrol 2015; 47:971-82. [PMID: 25962605 DOI: 10.1007/s11255-015-0994-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 04/20/2015] [Indexed: 02/02/2023]
Abstract
The risk of sudden cardiac death (SCD) is high in chronic kidney disease patients, and it increases with the progression of kidney function deterioration. The most common causes of SDC are the following: ventricular tachycardia, ventricular tachyarrhythmia, tachycardia torsade de pointes, sustained ventricular fibrillation and bradyarrhythmia. Dialysis influences cardiovascular system and results in hemodynamic disturbances as well as electrolyte shifts altering myocardial electrophysiology. Studies suggest that this procedure exerts both detrimental (poor volume control can exacerbate hypertension and left ventricle hypertrophy) and beneficial effects (associated with fluid removal and subsequent decrease in left ventricle stretch). Dialysis-related vulnerability to serious arrhythmias is the result of sudden shifts in fluid status and electrolytes, particularly potassium, which alter the physiological milieu. Also Ca(2+) ions, in which concentration alters during dialysis, are of key importance in the contraction of vascular smooth muscle cells and cardiac myocytes, thus exerting significant effects on hemodynamics. Due to the fact that SCD occurs with similar frequency in peritoneal dialysis and in hemodialysis patients, it seems that end-stage renal disease factors are more important than the specific ones associated with dialysis type. The results of randomized trials suggested that hemodialysis patients may not derive the same benefit of cardiovascular disease therapy including beta-blockers, calcium channel blockers and angiotensin-converting enzyme inhibitors as the general population with normal kidney function. Noninvasive tests used to stratify SCD risk in HD patients have poor positive value, and thus, combining tests including HRV, baroreceptor sensitivity and effectiveness index as well as its function indices and heart rate turbulence should be implemented. There are only few large randomized placebo-controlled trials assessing the influence of cardioprotective medications or implantable cardioverter defibrillator (ICD) implantation in dialysis patients on life quality and survival, and their results are sometimes contradictory. The decision concerning treatment and/or ICD implantation in this group of patients should be made on the basis of careful assessment of individual risk factors. Moreover, due to the high hazard of cardiovascular mortality including SCD in dialysis patients, physicians should concentrate on the early selection of high-risk patients, monitoring them and introduction of preventive measures.
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Affiliation(s)
- Beata Franczyk-Skóra
- Department of Nephrology, Hypertension and Family Medicine, WAM University Hospital, Żeromskiego 113, 90-549, Lodz, Poland
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Genovesi S, Porcu L, Luise MC, Riva H, Nava E, Stella A, Pozzi C, Ondei P, Minoretti C, Gallieni M, Pontoriero G, Conte F, Torri V, Vincenti A. Mortality, sudden death and indication for cardioverter defibrillator implantation in a dialysis population. Int J Cardiol 2015; 186:170-7. [DOI: 10.1016/j.ijcard.2015.03.178] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 02/09/2015] [Accepted: 03/16/2015] [Indexed: 12/18/2022]
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Wheeler DC, London GM, Parfrey PS, Block GA, Correa-Rotter R, Dehmel B, Drüeke TB, Floege J, Kubo Y, Mahaffey KW, Goodman WG, Moe SM, Trotman ML, Abdalla S, Chertow GM, Herzog CA. Effects of cinacalcet on atherosclerotic and nonatherosclerotic cardiovascular events in patients receiving hemodialysis: the EValuation Of Cinacalcet HCl Therapy to Lower CardioVascular Events (EVOLVE) trial. J Am Heart Assoc 2014; 3:e001363. [PMID: 25404192 PMCID: PMC4338730 DOI: 10.1161/jaha.114.001363] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Premature cardiovascular disease limits the duration and quality of life on long‐term hemodialysis. The objective of this study was to define the frequency of fatal and nonfatal cardiovascular events attributable to atherosclerotic and nonatherosclerotic mechanisms, risk factors for these events, and the effects of cinacalcet, using adjudicated data collected during the EValuation of Cinacalcet HCl Therapy to Lower CardioVascular Events (EVOLVE) Trial. Methods and Results EVOLVE was a randomized, double‐blind, placebo‐controlled clinical trial that randomized 3883 hemodialysis patients with moderate to severe secondary hyperparathyroidism to cinacalcet or matched placebo for up to 64 months. For this post hoc analysis, the outcome measure was fatal and nonfatal cardiovascular events reflecting atherosclerotic and nonatherosclerotic cardiovascular diseases. During the trial, 1518 patients experienced an adjudicated cardiovascular event, including 958 attributable to nonatherosclerotic disease. Of 1421 deaths during the trial, 768 (54%) were due to cardiovascular disease. Sudden death was the most frequent fatal cardiovascular event, accounting for 24.5% of overall mortality. Combining fatal and nonfatal cardiovascular events, randomization to cinacalcet reduced the rates of sudden death and heart failure. Patients randomized to cinacalcet experienced fewer nonatherosclerotic cardiovascular events (adjusted relative hazard 0.84, 95% CI 0.74 to 0.96), while the effect of cinacalcet on atherosclerotic events did not reach statistical significance. Conclusions Accepting the limitations of post hoc analysis, any benefits of cinacalcet on cardiovascular disease in the context of hemodialysis may result from attenuation of nonatherosclerotic processes. Clinical Trials Registration Unique identifier: NCT00345839. URL: ClinicalTrials.gov.
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Affiliation(s)
| | | | | | | | - Ricardo Correa-Rotter
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico (R.C.R.)
| | - Bastian Dehmel
- Amgen, Inc, Thousand Oaks, CA (B.D., Y.K., W.G.G., M.L.T.)
| | - Tilman B Drüeke
- Inserm Unit 1088, UFR Médecine/Pharmacie, Université de Picardie, Amiens, France (T.B.D.)
| | - Jürgen Floege
- Universitätsklinikum der RWTH Aachen, Aachen, Germany (F.)
| | - Yumi Kubo
- Amgen, Inc, Thousand Oaks, CA (B.D., Y.K., W.G.G., M.L.T.)
| | - Kenneth W Mahaffey
- Stanford University School of Medicine, Palo Alto, CA (K.W.M., S.A., G.M.C.)
| | | | - Sharon M Moe
- Indiana University School of Medicine, Roudebush Veterans Administration Medical Center, Indianapolis, IN (S.M.M.)
| | | | - Safa Abdalla
- Stanford University School of Medicine, Palo Alto, CA (K.W.M., S.A., G.M.C.)
| | - Glenn M Chertow
- Stanford University School of Medicine, Palo Alto, CA (K.W.M., S.A., G.M.C.)
| | - Charles A Herzog
- Hennepin County Medical Center, University of Minnesota, Minneapolis, MN (C.A.H.)
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Pun PH. The interplay between CKD, sudden cardiac death, and ventricular arrhythmias. Adv Chronic Kidney Dis 2014; 21:480-8. [PMID: 25443573 DOI: 10.1053/j.ackd.2014.06.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 06/04/2014] [Accepted: 06/27/2014] [Indexed: 12/23/2022]
Abstract
CKD patients face an increased risk of cardiovascular disease mortality, and the risk of sudden cardiac death (SCD) increases as kidney function declines. Risk factors for SCD are poorly understood and understudied among CKD patients. In the general population, coronary heart disease-associated risk factors are the most important determinants of SCD risk, but among CKD patients, there is evidence that these factors play a much smaller role. Complex relationships between CKD-specific risk factors, structural heart disease, and arrhythmic triggers contribute to the high risk of SCD and ventricular arrhythmias and modulate the effectiveness of available therapies. This review examines recent data on the epidemiology, pathophysiology, and mechanisms of SCD among CKD patients and examines current evidence regarding the use of pharmacologic and device-based therapies for management of SCD risk.
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Chen TH, Wo HT, Chang PC, Wang CC, Wen MS, Chou CC. A meta-analysis of mortality in end-stage renal disease patients receiving implantable cardioverter defibrillators (ICDs). PLoS One 2014; 9:e99418. [PMID: 25036181 PMCID: PMC4103758 DOI: 10.1371/journal.pone.0099418] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 05/14/2014] [Indexed: 11/25/2022] Open
Abstract
Data on the effectiveness of implantable implantable cardioverter defibrillators (ICDs) with respect to reducing mortality in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) are lacking. The purpose of this meta-analysis was to compare the mortality of patients with ESRD who have received and not received an ICD. A search was conducted on January 31, 2013 of Medline, Cochrane, EMBASE, and Google Scholar. Studies were selected for inclusion based on the following criteria. 1) Randomized controlled trial. 2) ESRD patients with heart failure. 3) Device therapy (ICD, CRT-defibrillator [CRT-D]) used to treat heart failure. 4) Primary outcome is survival analysis. 5) Retrospective study if survival analysis was performed. The primary outcome was overall survival (OS), and the secondary outcome was 2-year survival. Odds ratios (ORs) with 95% confidence intervals (CI) were calculated, and a χ2-based test of homogeneity was performed. Three studies were included in the analysis. The combined OR for OS was 2.245 (95% CI 1.871 to 2.685, P<0.001), indicating that patients with an ICD had a significantly higher OS than those without an ICD. The combined OR for 2-year survival was 2.312 (95% CI 1.921 to 2.784, P<0.001), indicating that patients with an ICD had a significantly higher 2-year survival rate than those without an ICD. The use of ICD in patients with ESRD is associated with an increase in the OS and the 2-year survival rate.
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Affiliation(s)
- Tien-Hsing Chen
- Department of Cardiology, Chang-Gung Memorial Hospital, Linko, Taiwan
- Department of Cardiology, Chang-Gung Memorial Hospital, Xiamen, China, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hung-Ta Wo
- Department of Cardiology, Chang-Gung Memorial Hospital, Linko, Taiwan
| | - Po-Cheng Chang
- Department of Cardiology, Chang-Gung Memorial Hospital, Linko, Taiwan
| | - Chun-Chieh Wang
- Department of Cardiology, Chang-Gung Memorial Hospital, Linko, Taiwan
| | - Ming-Shien Wen
- Department of Cardiology, Chang-Gung Memorial Hospital, Linko, Taiwan
| | - Chung-Chuan Chou
- Department of Cardiology, Chang-Gung Memorial Hospital, Linko, Taiwan
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Rear R, Meier P, Bell RM. Implications of Kidney Disease in the Cardiac Patient. Interv Cardiol Clin 2014; 3:317-331. [PMID: 28582216 DOI: 10.1016/j.iccl.2014.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Traditional cardiovascular risk factors, particularly hypertension and diabetes, are common in the disease processes of both renal and cardiac pathology. Unfortunately the coexistence of renal impairment is not an innocent bystander in cardiovascular disease; it disorder not only increases the prevalence and severity of cardiovascular disease, but also negatively affects prognostic outcomes and the safety and efficacy of cardiac interventions. This article discusses the role and impact of kidney disease in the cardiac patient in 3 key common cardiovascular processes: coronary artery disease, arrhythmia, and heart failure.
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Affiliation(s)
- Roger Rear
- General and Interventional Cardiology Department, The Heart Hospital, University College Hospitals NHS Trust, 16-18 Westmoreland Street, London, W1G 8PH, UK; Clinical Research Department, The Hatter Cardiovascular Institute, University College London, 37 Chenies Mews, London, WC1E 6HX, UK
| | - Pascal Meier
- General and Interventional Cardiology Department, The Heart Hospital, University College Hospitals NHS Trust, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Robert M Bell
- General and Interventional Cardiology Department, The Heart Hospital, University College Hospitals NHS Trust, 16-18 Westmoreland Street, London, W1G 8PH, UK; Clinical Research Department, The Hatter Cardiovascular Institute, University College London, 37 Chenies Mews, London, WC1E 6HX, UK.
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Saad TF, Ahmed W, Davis K, Jurkovitz C. Cardiovascular implantable electronic devices in hemodialysis patients: prevalence and implications for arteriovenous hemodialysis access interventions. Semin Dial 2014; 28:94-100. [PMID: 24863543 DOI: 10.1111/sdi.12249] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Cardiovascular implantable electronic devices (CIEDs) are frequently utilized in hemodialysis patients. CIED leads are typically implanted via the subclavian vein resulting in stenosis and venous hypertension. We studied 1235 chronic hemodialysis patients under the care of our nephrology practice. For each, we determined the presence of a CIED, indication for implantable cardioverter-defibrillator (ICD), and type of hemodialysis access. Records were reviewed to identify all interventions performed on the access circuit and the central veins specifically. A CIED was present in 129 patients (10.5%), including ICDs in 75 (6.1%) and pacemakers in 54 (4.4%). The access circuit intervention rate was 1.48/access year (AY) and was similar when a CIED was ipsilateral (1.53/AY) or contralateral (1.44/AY) to arteriovenous access (p = 0.477). The rate of central venous interventions was greater in the ipsilateral (0.59/AY) versus contralateral group (0.28/AY), (p < 0.001). Fifty-four of 59 patients with ipsilateral access and CIED required <2 interventions per AY, but six failed angioplasty and required access ligation. None had superior vena cava stenosis requiring intervention. We conclude that there is a high prevalence of CIEDs in our HD patients. Ipsilateral CIED and arteriovenous access results in higher central venous intervention rates compared with contralateral cases; overall access circuit intervention rates are similar.
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Affiliation(s)
- Theodore F Saad
- Nephrology Associates, PA, Vascular Access Center, Newark, DE; Section of Renal & Hypertensive Diseases, Department of Medicine, Christiana Care Health System, Newark, DE
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Hickson LJ, Gooden JY, Le KY, Baddour LM, Friedman PA, Hayes DL, Wilson WR, Steckelberg JM, Sohail MR. Clinical presentation and outcomes of cardiovascular implantable electronic device infections in hemodialysis patients. Am J Kidney Dis 2014; 64:104-10. [PMID: 24388672 DOI: 10.1053/j.ajkd.2013.11.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 11/18/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Infection is a serious complication of cardiovascular implantable electronic device (CIED) implantation. Kidney failure is as an independent risk factor for CIED infection and associated mortality. The presence of multiple comorbid conditions may contribute to varied clinical presentations and poor outcomes in hemodialysis (HD)-dependent patients with cardiac device infection. STUDY DESIGN Case series. SETTING & PARTICIPANTS CIED infections in HD patients (n=17) and non-HD patients (n=398) at Mayo Clinic in Rochester, MN, between 1991 and 2008. OUTCOMES Surgical management and death. MEASUREMENTS Clinical presentations, microbial organisms. RESULTS Of 415 patients admitted with CIED infection, 17 (4%) were receiving maintenance HD therapy. Among those on HD therapy, mean age was 72±15 (SD) years, 59% were women, and 53% had a central venous catheter for dialysis access. All 17 patients receiving HD therapy presented with CIED-associated bloodstream infection and 41% of these had infected vegetations on CIED leads or cardiac valves. A majority (82%) were managed with complete device removal and almost half (43%) received a replacement device when bloodstream infection cleared. Device infection was associated with significant short-term mortality in HD patients and 90-day survival was only 76% in this group of patients. LIMITATIONS Smaller sample size, majority white cohort, observational study. CONCLUSIONS CIED infection in patients receiving HD usually is associated with bloodstream infection and frequently is complicated with device-related endocarditis. Despite complete device removal in the majority of HD patients with infection, mortality remains high.
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Affiliation(s)
| | | | | | - Larry M Baddour
- Infectious Diseases, Mayo Clinic, Rochester, MN; Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | | | | | | | - M Rizwan Sohail
- Infectious Diseases, Mayo Clinic, Rochester, MN; Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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Farshid A, Pathak R, Shadbolt B, Arnolda L, Talaulikar G. Diastolic function is a strong predictor of mortality in patients with chronic kidney disease. BMC Nephrol 2013; 14:280. [PMID: 24359445 PMCID: PMC3878021 DOI: 10.1186/1471-2369-14-280] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 12/17/2013] [Indexed: 11/12/2022] Open
Abstract
Background Cardiovascular disease is a major cause of death in patients with stage 4–5 Chronic Kidney disease (CKD, eGFR < 30). There are only limited data on the risk factors predicting these complications in CKD patients. Our aim was to determine the role of clinical and echocardiographic parameters in predicting mortality and cardiovascular complications in CKD patients. Methods We conducted a prospective observational cohort study of 153 CKD patients between 2007 and 2009. All patients underwent echocardiography at baseline and were followed for a mean of 2.6 years using regular clinic visits and review of files and hospital presentations to record the incidence of cardiovascular events and death. Results Of 153 patients enrolled, 57 (37%) were on dialysis and 45 (78%) of these patients were on haemodialysis. An enlarged LV was present in 32% of patients and in 22% the LVEF was below 55%. LV mass index was increased in 75% of patients. Some degree of diastolic dysfunction was present in 85% of patients and 35% had grade 2 or higher diastolic dysfunction. During follow up 41 patients (27%) died, 15 (39%) from cardiovascular causes. Mortality was 24.0% in the non-dialysis patients versus 31.6% in patients on dialysis (p=ns). On multivariate analysis age >75 years, previous history of MI, diastolic dysfunction and detectable serum troponin T were significant independent predictor of mortality (P < 0.01). Conclusion Patients with stage 4–5 CKD had a mortality rate of 27% over a mean follow up of 2.6 years. Age >75 years, history of MI, diastolic dysfunction and troponin T were independent predictors of mortality.
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Affiliation(s)
- Ahmad Farshid
- Cardiology Unit, The Canberra Hospital, PO Box 11, Woden, ACT 2605, Australia.
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Wan C, Herzog CA, Zareba W, Szymkiewicz SJ. Sudden cardiac arrest in hemodialysis patients with wearable cardioverter defibrillator. Ann Noninvasive Electrocardiol 2013; 19:247-57. [PMID: 24252154 PMCID: PMC4034590 DOI: 10.1111/anec.12119] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background The survival outcome following a sudden cardiac arrest (SCA) in hemodialysis (HD) patients is poor regardless of whether an event takes place in or out of a dialysis center. The characteristics of SCA and post‐SCA survival with HD patients using a wearable cardioverter defibrillator (WCD) are unknown. Methods All HD patients who were prescribed a WCD between 2004 and 2011 and experienced at least one SCA event were included in this study. Demographics, clinical background, characteristics of SCA events were identified from the manufacturer's database. An SCA event was defined as all sustained ventricular tachycardia/fibrillation (VT/VF) or asystole occurring within 24 hours of the index arrhythmia episode. The social security death index was used to determine mortality after WCD use. Results A total of 75 HD patients (mean age = 62.9 ± 11.7 years, female = 37.3%) experienced 84 SCA events (119 arrhythmia episodes) while wearing the WCD. Sixty six (78.6%) SCA events were due to VT/VF and 18 (21.4%) were due to asystole. Most SCA episodes occurred between 09:00 and 10:00 (RR = 2.82, 95% CI [1.05, 7.62], P < 0.0001), followed by the 13:00–14:00 time interval (RR = 2.22, 95% CI [0.79, 6.21], P = 0.006). Acute 24‐hour survival was 70.7% for all SCA events; 30‐day and 1‐year survival were 50.7% and 31.4%, respectively. Women had a better post‐SCA survival than men (HR = 2.41, 95% CI [1.09, 5.36], P = 0.03). Conclusions The use of WCD in HD patients was associated with improved post‐SCA survival when compared to historical data.
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