1
|
Gregg LP, Hedayati SS. Management of Traditional Cardiovascular Risk Factors in CKD: What Are the Data? Am J Kidney Dis 2018; 72:728-744. [PMID: 29478869 PMCID: PMC6107444 DOI: 10.1053/j.ajkd.2017.12.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 12/06/2017] [Indexed: 12/22/2022]
Abstract
Patients with non-dialysis-dependent chronic kidney disease (NDD-CKD) are 10 times more likely to die of cardiovascular (CV) diseases than the general population, and dialysis-dependent patients are at even higher risk. Although traditional CV risk factors are highly prevalent in individuals with CKD, these patients were often excluded from studies targeting modification of these risks. Although treatment of hypertension is beneficial in CKD, the best target blood pressure has not been established. Trial data showed that renin-angiotensin-aldosterone blockade may prevent CV events in patients with CKD. The risks of aspirin may equal the benefits in NDD-CKD samples, and there are no trials testing aspirin in dialysis-dependent patients. Lipid-lowering therapy improves CV outcomes in NDD-CKD, but not in dialysis-dependent patients. Strict glycemic control prevents CV events in nonalbuminuric individuals, but showed no benefit in those with baseline albuminuria with albumin excretion > 300mg/g, and there are no data in dialysis-dependent patients. Data for lifestyle modifications, such as weight loss, physical activity, and smoking cessation, are mostly observational and extrapolated from non-CKD samples. This comprehensive review summarizes the best existing evidence and current clinical guidelines for modification of traditional risk factors for the prevention of CV events in patients with CKD and identifies knowledge gaps.
Collapse
Affiliation(s)
- L Parker Gregg
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX; Division of Nephrology, Medical Service, Veterans Affairs North Texas Health Care System, Dallas, TX.
| | - S Susan Hedayati
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| |
Collapse
|
2
|
Zhang S, Wolf K, Breitner S, Kronenberg F, Stafoggia M, Peters A, Schneider A. Long-term effects of air pollution on ankle-brachial index. ENVIRONMENT INTERNATIONAL 2018; 118:17-25. [PMID: 29787898 DOI: 10.1016/j.envint.2018.05.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/10/2018] [Accepted: 05/12/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Ankle-brachial index (ABI) has been linked to the risk of cardiovascular events. However, the association between long-term exposure to air pollution and abnormal ABI has not been fully investigated. METHODS This cross-sectional study involved 4544 participants from the KORA Study (2004-2008) in the region of Augsburg, Germany. Participants' residential annual mean concentrations of particulate matter (PM) and nitrogen dioxide (NO2) were predicted with land-use regression models, and the traffic information was collected from geographic information systems. We applied multinomial logistic regression models to assess the effects of air pollution on the prevalence of low and high ABI, and quantile regression models to explore the non-monotonic relationship between air pollution and ABI. We also examined effect modification by individual characteristics. RESULTS Long-term exposure to PM with an aerodynamic diameter ≤ 10 μm (PM10) and ≤ 2.5 μm (PM2.5) was significantly associated with a higher prevalence of low ABI, with the respective odds ratios (ORs) of 1.82 (95%CI: 1.11-2.97) and 1.59 (95%CI: 1.01-2.51) for a 5th to 95th percentile increment in pollutants. Positive associations with the prevalence of high ABI were observed for PM (e.g., PM10: OR = 1.63, 95%CI: 1.07-2.50) and NO2 (OR = 1.84, 95%CI: 1.15-2.94). Quantile regression analyses revealed similar non-monotonic results. The effects of air pollution on having abnormal ABI were stronger in physically inactive, hypertensive, or non-diabetic participants. CONCLUSIONS Long-term exposure to PM and NO2 was associated with a higher prevalence of both low and high ABI, indicating the adverse effects of air pollution on atherosclerosis and arterial stiffness in the lower extremities.
Collapse
Affiliation(s)
- Siqi Zhang
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany.
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany.
| | - Susanne Breitner
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany.
| | - Florian Kronenberg
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria.
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Regional Health Service, Local Health Unit ASL RM1, Rome, Italy.
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany.
| | | |
Collapse
|
3
|
Krishnasamy R, Tan SJ, Hawley CM, Johnson DW, Stanton T, Lee K, Mudge DW, Campbell S, Elder GJ, Toussaint ND, Isbel NM. Progression of arterial stiffness is associated with changes in bone mineral markers in advanced CKD. BMC Nephrol 2017; 18:281. [PMID: 28870151 PMCID: PMC5584006 DOI: 10.1186/s12882-017-0705-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 08/22/2017] [Indexed: 12/17/2022] Open
Abstract
Background Arterial stiffness is an independent predictor of all-cause and cardiovascular mortality in patients with chronic kidney disease (CKD). There are limited prospective data however on progression of arterial stiffness in CKD, including evaluating associations with bone mineral markers such as fibroblast growth factor 23 (FGF23) and soluble α-klotho (sKl). Methods In this prospective, single-center, observational study, arterial stiffness [measured by pulse wave velocity (PWV)] and hormones influencing mineral homeostasis, including serum FGF23 and sKl, were compared between non-dialysis CKD stages 4/5 and healthy controls at baseline and 12 months (12 m). Abdominal aortic calcification (AAC) was quantitated using lateral lumbar radiography at baseline. Results Forty patients with CKD [mean estimated glomerular filtration rate (eGFR) 19.5 ± 6.7 mL/min/1.73m2] and 42 controls (mean eGFR 88.6 ± 12.9 mL/min/1.73m2) completed follow-up. There were no differences in age, gender and body mass index between groups. A significant increase in FGF23 [240.6 (141.9–1129.8) to 396.8 (160.3–997.7) pg/mL, p = 0.001] was observed in the CKD group but serum phosphate, corrected calcium, parathyroid hormone and sKl did not change significantly over 12 m. At baseline, CKD subjects had higher AAC prevalence [83.8% versus (vs.) 43.6%, p = 0.002] and higher aortic PWV [9.7(7.6–11.7) vs. 8.1 (7.2–9.7) m/s, p = 0.047] compared to controls. At 12 m, aortic PWV increased by 1.3 m/s (95% confidence interval, 0.56 to 2.08, p < 0.001) in the CKD cohort, with 30% of subjects showing progression from normal aortic elasticity to stiffening (PWV > 10 m/s). Serum FGF23 was associated with AAC, abnormal PWV and progression of PWV at 12 m. Conclusions Arterial stiffness and serum FGF23, both of which are associated with increased cardiovascular risk, increased over one year in individuals with CKD. Additionally, a significant association was found between serum FGF23 and arterial calcification and stiffness. Larger clinical studies and further experimental work are warranted to delineate the temporal relationship as well as the pathological mechanisms linking FGF23 and vascular disease. Electronic supplementary material The online version of this article (10.1186/s12882-017-0705-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Rathika Krishnasamy
- Department of Nephrology, Sunshine Coast University Hospital, PO Box 5340, Sunshine Coast, Birtinya, MC QLD, 4560, Australia. .,Faculty of Medicine, The University of Queensland, Brisbane, Australia.
| | - Sven-Jean Tan
- Department of Nephrology, The Royal Melbourne Hospital (RMH), Melbourne, VIC, Australia.,Department of Medicine (RMH), The University of Melbourne, Parkville, VIC, Australia
| | - Carmel M Hawley
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - David W Johnson
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Tony Stanton
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Cardiology, Sunshine Coast University Hospital, Birtinya, Australia
| | - Kevin Lee
- Department of Radiology, Princess Alexandra Hospital, Brisbane, Australia
| | - David W Mudge
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Scott Campbell
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Grahame J Elder
- Department of Renal Medicine, Westmead Hospital, Sydney, Australia.,Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia
| | - Nigel D Toussaint
- Department of Nephrology, The Royal Melbourne Hospital (RMH), Melbourne, VIC, Australia.,Department of Medicine (RMH), The University of Melbourne, Parkville, VIC, Australia
| | - Nicole M Isbel
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| |
Collapse
|
4
|
Cuevas X, García F, Martín-Malo A, Fort J, Lladós F, Lozano J, Pérez-García R. Risk Factors Associated with Cardiovascular Morbidity and Mortality in Spanish Incident Hemodialysis Patients: Two-Year Results from the ANSWER Study. Blood Purif 2012; 33:21-9. [DOI: 10.1159/000332395] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 08/29/2011] [Indexed: 12/12/2022]
|
5
|
Knoll F, Sturm G, Lamina C, Zitt E, Lins F, Freistatter O, Kronenberg F, Lhotta K, Neyer U. Coumarins and survival in incident dialysis patients. Nephrol Dial Transplant 2011; 27:332-7. [DOI: 10.1093/ndt/gfr341] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
6
|
Liebman SE, Lamontagne SP, Huang LS, Messing S, Bushinsky DA. Smoking in dialysis patients: a systematic review and meta-analysis of mortality and cardiovascular morbidity. Am J Kidney Dis 2011; 58:257-65. [PMID: 21664017 DOI: 10.1053/j.ajkd.2011.03.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 03/23/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Cigarette smoking is associated with increased cardiovascular morbidity and mortality in the general population, but the effect of smoking on these outcomes in the dialysis population is less well studied. STUDY DESIGN Systematic review and meta-analysis of cohort studies. SETTING & POPULATION Adults treated with long-term hemodialysis or peritoneal dialysis. SELECTION CRITERIA FOR INCLUDED STUDIES: Cohort studies of unselected dialysis patients reporting the association between smoking status and cardiovascular morbidity and/or mortality. PREDICTOR Smoking status (determined using patient report). OUTCOMES (1) All-cause or cardiovascular mortality; (2) incident cardiovascular events. RESULTS We identified 34 studies that fulfilled all inclusion criteria. Of these, 26 studies provided data for smoking and mortality and 10 (n = 6,538) were included in a meta-analysis. The pooled HR for all-cause mortality in smokers compared with nonsmokers was 1.65 (95% CI, 1.26-2.14; P < 0.001). 11 studies provided data for smoking and incident cardiovascular events; 5 (pooled n = 845) were included in a meta-analysis. The pooled HR for composite cardiovascular events in smokers compared with nonsmokers was 1.01 (95% CI, 0.98-1.05; P = 0.4). LIMITATIONS Data for these meta-analyses were heterogeneous. Few individual studies assessed smoking as the primary variable of interest. CONCLUSIONS Active smoking is associated with a significant increase in all-cause mortality in dialysis patients, although there was no corresponding increased risk of cardiovascular events.
Collapse
Affiliation(s)
- Scott E Liebman
- Division of Nephrology, University of Rochester Medical Center, NY, USA.
| | | | | | | | | |
Collapse
|
7
|
Gouya G, Sturm G, Lamina C, Zitt E, Freistätter O, Struck J, Wolzt M, Knoll F, Lins F, Lhotta K, Neyer U, Kronenberg F. The association of mid-regional pro-adrenomedullin and mid-regional pro-atrial natriuretic peptide with mortality in an incident dialysis cohort. PLoS One 2011; 6:e17803. [PMID: 21408188 PMCID: PMC3049793 DOI: 10.1371/journal.pone.0017803] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 02/11/2011] [Indexed: 12/02/2022] Open
Abstract
High levels of the plasma peptides mid-regional pro-adrenomedullin (MR-proADM) and mid-regional pro-atrial natriuretic peptide (MR-proANP) are associated with clinical outcomes in the general population. Data in patients with chronic kidney disease are sparse. We therefore investigated the association of MR-proANP and MR-proADM levels with all-cause and cardiovascular (CV) mortality, CV events and peripheral arterial disease in 201 incident dialysis patients of the INVOR-Study prospectively followed for a period of up to more than 7 years. The overall mortality rate was 43%, thereof 43% due to CV events. Both baseline MR-proANP and MR-proADM were associated with higher risk of all-cause (HR = 1.44, p = 0.001 and HR = 1.32, p = 0.002, respectively) and CV mortality (HR = 1.75, p<0.001 and HR = 1.41, p = 0.007, respectively) after adjustment for age, sex, previous CV events, diabetes mellitus and time-dependent type of renal replacement therapy. We then stratified patients in high risk (both peptides in the upper tertile), intermediate risk (only one of the two peptides in the upper tertile) and low risk (none in the upper tertile). Although demographic, clinical and laboratory variables were similar among the intermediate and high risk group, to be with both parameters in the upper tertile was associated with a 3-fold higher risk for all-cause (HR = 2.87, p<0.001) and CV mortality (HR = 3.58, p = 0.001). In summary, among incident dialysis patients MR-proANP and MR-proADM were shown to be associated with all-cause and CV mortality, with the highest risk when both parameters were in the upper tertiles.
Collapse
Affiliation(s)
- Ghazaleh Gouya
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
| | - Gisela Sturm
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Innsbruck Medical University, Innsbruck, Austria
| | - Claudia Lamina
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Innsbruck Medical University, Innsbruck, Austria
| | - Emanuel Zitt
- Department of Nephrology and Dialysis, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Otto Freistätter
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | - Joachim Struck
- Research Department, B.R.A.H.M.S GmbH (Part of ThermoFisher Scientific), Hennigsdorf/Berlin, Germany
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
| | - Florian Knoll
- Department of Nephrology and Dialysis, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Friederike Lins
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | - Karl Lhotta
- Department of Nephrology and Dialysis, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | - Ulrich Neyer
- Department of Nephrology and Dialysis, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | - Florian Kronenberg
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Innsbruck Medical University, Innsbruck, Austria
- * E-mail:
| |
Collapse
|
8
|
Kono K, Fujii H, Miyoshi N, Kawamori H, Shite J, Hirata KI, Fukagawa M. Coronary Plaque Morphology Using Virtual Histology-Intravascular Ultrasound Analysis in Hemodialysis Patients. Ther Apher Dial 2010; 15:44-50. [DOI: 10.1111/j.1744-9987.2010.00855.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
9
|
Current World Literature. Curr Opin Nephrol Hypertens 2007; 16:388-93. [PMID: 17565283 DOI: 10.1097/mnh.0b013e3282472fd5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|