1
|
Wu CK, Yar N, Chen YY. Continuous aspirin treatment improves cardiovascular events and all-cause mortality in hemodialysis patients with peripheral artery disease. Ren Fail 2024; 46:2380754. [PMID: 39039846 PMCID: PMC11268230 DOI: 10.1080/0886022x.2024.2380754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 07/11/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Hemodialysis (HD) patients with peripheral arterial disease (PAD) are at heightened risk of adverse vascular events, and aspirin positively affects those outcomes. We aimed to investigate the association between different patterns of aspirin use and clinical vascular events in chronic HD patients with PAD. METHODS This retrospective nationwide cohort study enrolled 758 chronic HD patients who had been diagnosed with PAD between January 1, 2008, and December 31, 2012, and followed up until the end of 2020. Patients were divided into three groups according to medication possession ratio (MPR) and continued use of aspirin (i.e., low MPR, high MPR but discontinuous prescription, and high MPR and continuous prescription). Percutaneous transluminal angioplasty (PTA), surgical bypass, lower leg amputation, cardiovascular events, cerebrovascular events, and all-cause mortality were evaluated. RESULTS High MPR and continuous aspirin use had the lowest incidence of all-cause mortality and cardiovascular events compared with the two other groups, and it was significantly associated with low risk of PTA, surgical bypass, cardiovascular events, and all-cause mortality (aHR: 0.58 [0.41-0.83], 0.49 [0.25-0.95], 0.57 [0.40-0.81], and 0.70 [0.55-0.88], respectively). Kaplan-Meier analysis revealed that event-free rates of PTA, cardiovascular events, and all-cause mortality of patients with high MPR and continuous aspirin treatment were the highest among the three groups (p < 0.05). CONCLUSION Among HD patients with PAD, high MPR and continuous aspirin use significantly reduced the risk of PTA, surgical bypass, cardiovascular events, and all-cause mortality and improved the event-free rates of PTA, cardiovascular events, and all-cause mortality during long-term follow-up.
Collapse
Affiliation(s)
- Chung-Kuan Wu
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Noi Yar
- College of Management, School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Yun-Yi Chen
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Research, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, Taipei, Taiwan
| |
Collapse
|
2
|
Bonet-Monné S, Urgell CV, Sáez MJP, Puertolás OC, Baena-Díez JM, Pascual J, Lago CO, Ruiz JR, Gonzalez BS, Pedrós RM. NSAIDs, analgesics, antiplatelet drugs, and decline in renal function: a retrospective case-control study with SIDIAP database. BMC Pharmacol Toxicol 2024; 25:58. [PMID: 39198874 PMCID: PMC11351315 DOI: 10.1186/s40360-024-00771-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 07/23/2024] [Indexed: 09/01/2024] Open
Abstract
INTRODUCTION We aim to explore the association between NSAIDs consumption, Symptomatic Slow Action Drugs for Osteoarthritis (SYSADOA), analgesics, and antiplatelet drugs, and decline in renal function by estimated Glomerular Filtration Rate (eGFR). METHODS We performed a case-control study using the SIDIAP database in Catalonia. We considered defined cases, patients with an eGFR value ≤ 45 ml/min/1.73 m2 in the period 2010-2015 with a previous eGFR value ≥ 60, and no eGFR ≥ 60 after this period. Controls had an eGFR ≥ 60 with no previous eGFR < 60. Five controls were selected for each case, matched by sex, age, index date, Diabetes Mellitus and Hypertension. We estimated Odds Ratios (OR, 95% Confidence Intervals) of decline in renal function for drugs group adjusting with logistic regression models, by consumption measured in DDD. There were n = 18,905 cases and n = 94,456 controls. The mean age was 77 years, 59% were women. The multivariate adjusted model showed a low risk for eGFR decline for NSAIDs (0.92;0.88-0.97), SYSADOA (0.87;0.83-0.91) and acetaminophen (0.84;0.79-0.89), and an high risk for metamizole (1.07;1.03-1.12), and antiplatelet drugs (1.07;1.03-1.11). The low risk in NSAIDs was limited to propionic acid derivatives (0.92;0.88-0.96), whereas an high risk was observed for high doses in both acetic acid derivatives (1.09;1.03-1.15) and Coxibs (1.19;1.08-1.30). Medium and high use of major opioids shows a high risk (1.15;1.03-1.29). Triflusal showed high risk at medium (1.23;1.02-1.48) and high use (1.68;1.40-2.01). CONCLUSION We observed a decline in renal function associated with metamizole and antiplatelet agent, especially triflusal, and with high use of acetic acid derivates, Coxibs, and major opioids. Further studies are necessary to confirm these results.
Collapse
Affiliation(s)
- Sara Bonet-Monné
- Servei d'Atenció Primària Baix Llobregat Centre, Institut Català de la Salut, Cornellà de Llobregat, Spain
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Cristina Vedia Urgell
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Servei d'Atenció Primària Barcelonès Nord i Maresme, Institut Català de la Salut, Badalona, Spain
| | | | - Oriol Cunillera Puertolás
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Unitat de Suport a la Recerca (USR), Atenció Primària Metropolitana Sud, Institut Català de la Salut - IDIAPJGol, L'Hospitalet del Llobregat, Barcelona, Spain
| | - José Miguel Baena-Díez
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Servei Atenció Primària Esquerra, CAP La Marina, Institut Català de la Salut, Barcelona, Spain
| | - Julio Pascual
- Servicio de Nefrologia y del programa de Trasplante Renal, Hospital 12 de Octubre, Madrid, Spain
| | - Cristina Orive Lago
- Atenció Primària Metropolitana Sud, CAP El Castell, Institut Català de la Salut, Castelldefels, Spain
| | - Jordi Rodriguez Ruiz
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Betlem Salvador Gonzalez
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Unitat de Suport a la Recerca (USR), Atenció Primària Metropolitana Sud, Institut Català de la Salut - IDIAPJGol, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Rosa Morros Pedrós
- Unitat d'estudi del Medicament, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
| |
Collapse
|
3
|
Saeed Z, Sirolli V, Bonomini M, Gallina S, Renda G. Hallmarks for Thrombotic and Hemorrhagic Risks in Chronic Kidney Disease Patients. Int J Mol Sci 2024; 25:8705. [PMID: 39201390 PMCID: PMC11354877 DOI: 10.3390/ijms25168705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/31/2024] [Accepted: 08/06/2024] [Indexed: 09/02/2024] Open
Abstract
Chronic kidney disease (CKD) is a global health issue causing a significant health burden. CKD patients develop thrombotic and hemorrhagic complications, and cardiovascular diseases are associated with increased hospitalization and mortality in this population. The hemostatic alterations are multifactorial in these patients; therefore, the results of different studies are varying and controversial. Endothelial and platelet dysfunction, coagulation abnormalities, comorbidities, and hemoincompatibility of the dialysis membranes are major contributors of hypo- and hypercoagulability in CKD patients. Due to the tendency of CKD patients to exhibit a prothrombotic state and bleeding risk, they require personalized clinical assessment to understand the impact of antithrombotic therapy. The evidence of efficacy and safety of antiplatelet and anticoagulant treatments is limited for end-stage renal disease patients due to their exclusion from major randomized clinical trials. Moreover, designing hemocompatible dialyzer membranes could be a suitable approach to reduce platelet activation, coagulopathy, and thrombus formation. This review discusses the molecular mechanisms underlying thrombotic and hemorrhagic risk in patients with CKD, leading to cardiovascular complications in these patients, as well as the evidence and guidance for promising approaches to optimal therapeutic management.
Collapse
Affiliation(s)
- Zeeba Saeed
- Center for Advanced Studies and Technology, G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Vittorio Sirolli
- Nephrology and Dialysis Unit, Department of Medicine, G. d’Annunzio University of Chieti-Pescara, SS. Annunziata Hospital, Via dei Vestini, 66100 Chieti, Italy; (V.S.); (M.B.)
| | - Mario Bonomini
- Nephrology and Dialysis Unit, Department of Medicine, G. d’Annunzio University of Chieti-Pescara, SS. Annunziata Hospital, Via dei Vestini, 66100 Chieti, Italy; (V.S.); (M.B.)
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Giulia Renda
- Center for Advanced Studies and Technology, G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy;
- Department of Neuroscience, Imaging and Clinical Sciences, G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy;
| |
Collapse
|
4
|
Shende P, Reddy A, Vikhe VB, Patil RS, Faruqi AA, Khandol D. A Study of Abnormal Echocardiogram Findings in Patients With Chronic Kidney Disease With Reference to Cardiac Biomarkers. Cureus 2024; 16:e65398. [PMID: 39184755 PMCID: PMC11344873 DOI: 10.7759/cureus.65398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Accepted: 07/25/2024] [Indexed: 08/27/2024] Open
Abstract
Background Chronic kidney disease (CKD) is prevalent, especially in populations with multiple risk factors, such as undiagnosed and untreated hypertension and diabetes mellitus. Cardiovascular diseases (CVDs) leading to poor quality of life or even death have been noted as an increasing trend among CKD patients. This study aims to use cardiac biomarkers to evaluate their association with abnormal echocardiogram findings in CKD patients, which may allow for the improvement of quality of life with early treatment. Methods and materials This observational, cross-sectional study was conducted on 103 diagnosed CKD patients at the Department of Medicine, Dr. D.Y. Patil Medical College, Hospital, and Research Centre in Pimpri, Pune, from January 2023 to January 2024. Ethical approval was acquired, and written consent was obtained from participants. The study utilised cardiac biomarkers such as N-terminal pro-B type natriuretic peptide (NT-proBNP), troponin I (Trop I), and a radiological tool, transthoracic echocardiography (TTE). All patients with diagnosed stages 3, 4, and 5 CKD between the ages of 18-80 years were included, and the exclusion criteria consisted of patients who had already undergone cardiac interventional procedures or known cases of CVDs. Results In our study, out of 103 participants, the majority were aged between 51 and 60 years (35, 34%). The study had a majority of male participants (76, 73.8%). Major risk factors were considered, noting hypertension in 63 (61.2%) and diabetes mellitus in 81 (78.6%). Participants were divided into stages of CKD. Cardiac biomarkers such as NT-proBNP and Trop I levels were assessed in all participants in the different stages of CKD showing elevated levels of NT-proBNP across all stages. Transthoracic echocardiogram (TTE) screening tests were also evaluated for all patients, showing diastolic dysfunction (DD) as the most common finding in stage 3 (5, 41.67%), stage 4 (25, 62.5%), and stage 5 (35, 68.83%), followed by left ventricular hypertrophy (LVH) as a common finding in stage 3 (4, 33.3%), stage 4 (20, 50%), and stage 5 (30, 58.2%) CKD. Furthermore, the association between raised cardiac biomarkers and abnormal echocardiogram findings across the stages of CKD was evaluated, resulting in a statistically significant association with p-values < 0.05. Conclusion This research sheds light on the association between cardiac biomarkers and abnormal echocardiogram findings in CKD patients and helps us determine if there is any added benefit or predictive value in screening these individuals at different stages of the disease to allow early intervention and improvement in treatment and quality of life.
Collapse
Affiliation(s)
- Prakash Shende
- General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Avani Reddy
- General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Vikram B Vikhe
- General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Rahul S Patil
- General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Ahsan A Faruqi
- General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Devansh Khandol
- General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| |
Collapse
|
5
|
Losin I, Hagai KC, Pereg D. The Treatment of Coronary Artery Disease in Patients with Chronic Kidney Disease: Gaps, Challenges, and Solutions. KIDNEY DISEASES (BASEL, SWITZERLAND) 2024; 10:12-22. [PMID: 38322630 PMCID: PMC10843189 DOI: 10.1159/000533970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 08/23/2023] [Indexed: 02/08/2024]
Abstract
Background Chronic kidney disease (CKD) is associated with a high burden of coronary artery disease (CAD), which remains the leading cause of death in CKD patients. Despite the high cardiovascular risk, ACS patients with renal dysfunction are less commonly treated with guideline-based medical therapy and are less frequently referred for coronary revascularization. Summary The management of CAD is more challenging in patients with CKD than in the general population due to concerns regarding side effects and renal toxicity, as well as uncertainty regarding clinical benefit of guideline-based medical therapy and interventions. Patients with advanced CKD and especially those receiving dialysis have not traditionally been represented in randomized trials evaluating either medical or revascularization therapies. Thus, only scant data from small prospective studies or retrospective analyses are available. Recently published studies suggest that there are significant opportunities to substantially improve both cardiovascular and renal outcomes of patients with CAD and CKD, including new medications and interventions. Thus, the objective of this review is to summarize the current evidence regarding the management of CAD in CKD patients, in particular with respect to improvement of both cardiovascular and renal outcomes. Key Messages Adequate medical therapy and coronary interventions using evidence-based strategies can improve both cardiac and renal outcomes in patients with CAD and CKD.
Collapse
Affiliation(s)
- Ilya Losin
- Cardiology Department, Meir Medical Center, Kfar Saba, Israel
| | - Keren-Cohen Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - David Pereg
- Cardiology Department, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
6
|
Guo Y, Ge P, Li Z, Xiao J, Xie L. Ticagrelor or Clopidogrel as Antiplatelet Agents in Patients with Chronic Kidney Disease and Cardiovascular Disease: A Meta-analysis. Am J Cardiovasc Drugs 2023; 23:533-546. [PMID: 37530990 DOI: 10.1007/s40256-023-00600-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/03/2023]
Abstract
INTRODUCTION The worldwide prevalence of chronic kidney disease (CKD) has significantly increased in the past decades. Scientific reports have shown CKD to be an enhancing risk factor for the development of cardiovascular disease (CVD), which is the leading cause of premature death in patients with CKD. Clinical practice guidelines are ambiguous in view of the use of antiplatelet drugs in patients with CKD because patients with moderate-to-severe CKD were often excluded from clinical trials evaluating the efficacy and safety of anticoagulants and antiplatelet agents. In this analysis, we aimed to systematically assess the adverse cardiovascular and bleeding outcomes that were observed with ticagrelor versus clopidogrel use in patients with CKD and cardiovascular disease. METHODS Electronic databases including Web of Science, Google Scholar, http://www. CLINICALTRIALS gov , Cochrane database, EMBASE, and MEDLINE were carefully searched for English-based articles comparing ticagrelor with clopidogrel in patients with CKD. Adverse cardiovascular outcomes and bleeding events were the endpoints in this study. The latest version of the RevMan software (version 5.4) was used to analyze the data. Risk ratios (RR) with 95% confidence intervals (CI) were used to represent the data post analysis. RESULTS A total of 15,664 participants were included in this analysis, whereby 2456 CKD participants were assigned to ticagrelor and 13,208 CKD participants were assigned to clopidogrel. Our current analysis showed that major adverse cardiac events (MACEs) (RR: 0.85, 95% CI: 0.71-1.03; P = 0.09), all-cause mortality (RR: 0.82, 95% CI: 0.57- 1.18; P = 0.29), cardiovascular death (RR: 0.83, 95% CI: 0.56-1.23; P = 0.35), myocardial infarction (RR: 0.87, 95% CI: 0.70-1.07; P = 0.19), ischemic stroke (RR: 0.80, 95% CI: 0.58-1.11; P = 0.18), and hemorrhagic stroke (RR: 1.06, 95% CI: 0.38-2.99; P = 0.91) were not significantly different in CKD patients who were treated with ticagrelor versus clopidogrel. Thrombolysis in myocardial infarction (TIMI)-defined minor (RR: 0.89, 95% CI: 0.52-1.53; P = 0.68) and TIMI major bleeding (RR: 1.10, 95% CI: 0.69-1.76; P = 0.67) were also not significantly different. However, bleeding defined according to the academic research consortium (BARC) bleeding type 1 or 2 (RR: 1.95, 95% CI: 1.13-3.37; P = 0.02) and BARC bleeding type 3 or 5 (RR: 1.70, 95% CI: 1.17-2.48; P = 0.006) were significantly higher with ticagrelor. CONCLUSIONS When compared with clopidogrel, even though ticagrelor was not associated with higher risk of adverse cardiovascular outcomes in these patients with CKD, it was associated with significantly higher BARC bleeding. Therefore, the safety outcomes of ticagrelor still require further evaluation in patients with CKD. Nevertheless, this hypothesis should only be confirmed with more powerful results that could usually only be achieved using large-scale randomized trials.
Collapse
Affiliation(s)
- Yinxue Guo
- Department of Nephrology, Guizhou University of Traditional Chinese Medicine, Guiyang, 550001, Guizhou, People's Republic of China.
| | - Pingyu Ge
- Department of Urology, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, 550001, Guizhou, People's Republic of China
| | - Ziju Li
- Department of Nephrology, Guizhou University of Traditional Chinese Medicine, Guiyang, 550001, Guizhou, People's Republic of China
| | - Jingxia Xiao
- Department of Nephrology, Guizhou University of Traditional Chinese Medicine, Guiyang, 550001, Guizhou, People's Republic of China
| | - Lirui Xie
- Department of Nephrology, Guizhou University of Traditional Chinese Medicine, Guiyang, 550001, Guizhou, People's Republic of China
| |
Collapse
|
7
|
Room for improvement: diagnosing and managing acute coronary syndromes in persons with reduced eGFR. Kidney Int 2022; 102:20-22. [PMID: 35738829 DOI: 10.1016/j.kint.2022.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 04/14/2022] [Accepted: 04/27/2022] [Indexed: 11/27/2022]
Abstract
Cardiovascular events are the leading cause of death in chronic kidney disease. A recent analysis from the High-Sensitivity Troponin in the Evaluation of Patients With Suspected Acute Coronary Syndrome trial focused on results in those with reduced estimated glomerular filtration rate. This commentary discusses aspects of acute coronary syndrome diagnosis in this group and the differential approach to acute coronary syndrome management that was observed between those with normal and reduced kidney function.
Collapse
|
8
|
Natale P, Palmer SC, Saglimbene VM, Ruospo M, Razavian M, Craig JC, Jardine MJ, Webster AC, Strippoli GF. Antiplatelet agents for chronic kidney disease. Cochrane Database Syst Rev 2022; 2:CD008834. [PMID: 35224730 PMCID: PMC8883339 DOI: 10.1002/14651858.cd008834.pub4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Antiplatelet agents are widely used to prevent cardiovascular events. The risks and benefits of antiplatelet agents may be different in people with chronic kidney disease (CKD) for whom occlusive atherosclerotic events are less prevalent, and bleeding hazards might be increased. This is an update of a review first published in 2013. OBJECTIVES To evaluate the benefits and harms of antiplatelet agents in people with any form of CKD, including those with CKD not receiving renal replacement therapy, patients receiving any form of dialysis, and kidney transplant recipients. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies up to 13 July 2021 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA We selected randomised controlled trials of any antiplatelet agents versus placebo or no treatment, or direct head-to-head antiplatelet agent studies in people with CKD. Studies were included if they enrolled participants with CKD, or included people in broader at-risk populations in which data for subgroups with CKD could be disaggregated. DATA COLLECTION AND ANALYSIS Four authors independently extracted data from primary study reports and any available supplementary information for study population, interventions, outcomes, and risks of bias. Risk ratios (RR) and 95% confidence intervals (CI) were calculated from numbers of events and numbers of participants at risk which were extracted from each included study. The reported RRs were extracted where crude event rates were not provided. Data were pooled using the random-effects model. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS We included 113 studies, enrolling 51,959 participants; 90 studies (40,597 CKD participants) compared an antiplatelet agent with placebo or no treatment, and 29 studies (11,805 CKD participants) directly compared one antiplatelet agent with another. Fifty-six new studies were added to this 2021 update. Seven studies originally excluded from the 2013 review were included, although they had a follow-up lower than two months. Random sequence generation and allocation concealment were at low risk of bias in 16 and 22 studies, respectively. Sixty-four studies reported low-risk methods for blinding of participants and investigators; outcome assessment was blinded in 41 studies. Forty-one studies were at low risk of attrition bias, 50 studies were at low risk of selective reporting bias, and 57 studies were at low risk of other potential sources of bias. Compared to placebo or no treatment, antiplatelet agents probably reduces myocardial infarction (18 studies, 15,289 participants: RR 0.88, 95% CI 0.79 to 0.99, I² = 0%; moderate certainty). Antiplatelet agents has uncertain effects on fatal or nonfatal stroke (12 studies, 10.382 participants: RR 1.01, 95% CI 0.64 to 1.59, I² = 37%; very low certainty) and may have little or no effect on death from any cause (35 studies, 18,241 participants: RR 0.94, 95 % CI 0.84 to 1.06, I² = 14%; low certainty). Antiplatelet therapy probably increases major bleeding in people with CKD and those treated with haemodialysis (HD) (29 studies, 16,194 participants: RR 1.35, 95% CI 1.10 to 1.65, I² = 12%; moderate certainty). In addition, antiplatelet therapy may increase minor bleeding in people with CKD and those treated with HD (21 studies, 13,218 participants: RR 1.55, 95% CI 1.27 to 1.90, I² = 58%; low certainty). Antiplatelet treatment may reduce early dialysis vascular access thrombosis (8 studies, 1525 participants) RR 0.52, 95% CI 0.38 to 0.70; low certainty). Antiplatelet agents may reduce doubling of serum creatinine in CKD (3 studies, 217 participants: RR 0.39, 95% CI 0.17 to 0.86, I² = 8%; low certainty). The treatment effects of antiplatelet agents on stroke, cardiovascular death, kidney failure, kidney transplant graft loss, transplant rejection, creatinine clearance, proteinuria, dialysis access failure, loss of primary unassisted patency, failure to attain suitability for dialysis, need of intervention and cardiovascular hospitalisation were uncertain. Limited data were available for direct head-to-head comparisons of antiplatelet drugs, including prasugrel, ticagrelor, different doses of clopidogrel, abciximab, defibrotide, sarpogrelate and beraprost. AUTHORS' CONCLUSIONS Antiplatelet agents probably reduced myocardial infarction and increased major bleeding, but do not appear to reduce all-cause and cardiovascular death among people with CKD and those treated with dialysis. The treatment effects of antiplatelet agents compared with each other are uncertain.
Collapse
Affiliation(s)
- Patrizia Natale
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Valeria M Saglimbene
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Marinella Ruospo
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Mona Razavian
- Renal and Metabolic Division, The George Institute for Global Health, Newtown, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | | | - Angela C Webster
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Transplant and Renal Research, Westmead Millennium Institute, The University of Sydney at Westmead, Westmead, Australia
| | - Giovanni Fm Strippoli
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| |
Collapse
|
9
|
Wang L, Li S, Mo Y, Hu M, Zhang J, Zeng M, Li H, Zhao H. Gender-Disparities in the in-Hospital Clinical Outcome Among Patients with Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention. Int J Gen Med 2022; 15:593-602. [PMID: 35058710 PMCID: PMC8765440 DOI: 10.2147/ijgm.s343129] [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: 10/07/2021] [Accepted: 12/21/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The current study was to evaluate the gender-disparities in the in-hospital thrombotic and bleeding events among patients with chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI). PATIENTS AND METHODS Patients with CKD undergoing PCI were retrospectively enrolled. Baseline characteristics, and thrombotic and bleeding events occurred during hospitalization were collected and compared by gender. RESULTS Compared to males (n = 558), females (n = 402) were older and more likely to have diabetes mellitus (37.1% vs 29.7%). Females had a lower estimated glomerular filtration rate (eGFR; 51.2 ± 7.9 vs 54.6 ± 5.1 mL/min/1.73m2) and were more likely to undergo urgent PCI (66.7% vs 60.2%) and use glycoprotein IIb/IIIa inhibitor (15.4% vs 7.5%) at peri-PCI period. Compared to males, females had a higher rate of in-hospital mortality which was due to thrombotic events (9.0% vs 3.4%). Females also had a higher rate of moderate-to-severe hemorrhage (8.0% vs 3.2%). After multivariable adjustment, diabetes mellitus (odds ratio [OR] 1.15 and 95% confidence interval [CI] 1.07-1.29) and acute coronary syndrome (ACS) presentation (OR 1.53 and 95% CI 1.34-1.93) were associated with gender-disparities in composite thrombotic events. Ageing (OR 1.10 and 95% CI 1.02-1.33), diabetes mellitus (OR 1.21 and 95% CI 1.07-1.40) and glycoprotein IIb/IIIa inhibitor use (OR 1.13 and 95% CI 1.02-1.28) were associated with composite bleeding events. CONCLUSION Females with CKD undergoing PCI had a higher risk of experiencing in-hospital thrombotic and bleeding events than males.
Collapse
Affiliation(s)
- Li Wang
- Department of Nephrology, People’s Hospital of Longhua District, Shenzhen, Guangdong, People’s Republic of China
| | - Sha Li
- Department of Nephrology, People’s Hospital of Longhua District, Shenzhen, Guangdong, People’s Republic of China
| | - Yihao Mo
- Department of Nephrology, People’s Hospital of Longhua District, Shenzhen, Guangdong, People’s Republic of China
| | - Mingliang Hu
- Department of Nephrology, People’s Hospital of Longhua District, Shenzhen, Guangdong, People’s Republic of China
| | - Junwei Zhang
- Department of Nephrology, People’s Hospital of Longhua District, Shenzhen, Guangdong, People’s Republic of China
| | - Min Zeng
- Department of Nephrology, People’s Hospital of Longhua District, Shenzhen, Guangdong, People’s Republic of China
| | - Huafeng Li
- Department of Nephrology, People’s Hospital of Longhua District, Shenzhen, Guangdong, People’s Republic of China
| | - Honglei Zhao
- Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Science, Shenzhen, Guangdong, People’s Republic of China
| |
Collapse
|
10
|
Lenci Marques G, Assano Stangler NH, Ferro H, Calisto J, Brehm J, Felicio Morais G, Hartmann C, Guedes M. Kidney Disease as Risk of In-Hospital Mortality in Patients With Acute Coronary Syndrome. Cureus 2021; 13:e19557. [PMID: 34917437 PMCID: PMC8669781 DOI: 10.7759/cureus.19557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2021] [Indexed: 11/30/2022] Open
Abstract
Background An acute coronary syndrome (ACS) event can be linked to several risk factors, including kidney disease. Currently, it is unknown if kidney disease is associated with the in-hospital mortality of patients admitted with ACS, regardless of the main confounders. In this study, we aimed to determine if kidney disease predicts in-hospital mortality among ACS patients. Methodology This is a retrospective cohort study that included patients who were admitted to the cardiology center with ACS. The patients were analyzed for their clinical characteristics, previous diseases, risk factors, and blood samples for laboratory analysis. Continuous variables were analyzed using Student’s t-test, and categorical variables using the chi-square test. A p-value of <0.05 was considered statistically significant. Results Of the 340 patients who were included in the study, 59 had ST-elevation myocardial infarction. The mean age of the patients was 62.17 years, 59.41% were male, 67.9% were Caucasian, 26% had diabetes, and 20% had a history of coronary artery disease. Age, systolic blood pressure, and a history of myocardial infarction and chronic kidney disease were linked with a higher mortality rate. In the multivariate analysis, only kidney disease was shown to be an independent marker of mortality. Conclusions Among individuals admitted with ACS, kidney disease at hospital admission is associated with increased chances of in-hospital mortality, regardless of other major and minor cardiovascular comorbidities and inflammation at baseline.
Collapse
Affiliation(s)
- Gustavo Lenci Marques
- Internal Medicine Department, Federal University of Paraná, Curitiba, BRA.,Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, BRA
| | - Noessa Hiromi Assano Stangler
- Internal Medicine/Cardiology, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, BRA.,Internal Medicine/Cardiology, Marcelino Champagnat Hospital, Curitiba, BRA
| | - Heloísa Ferro
- Internal Medicine, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, BRA
| | - Julia Calisto
- Internal Medicine, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, BRA
| | - Josiane Brehm
- Internal Medicine, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, BRA
| | - Gabriel Felicio Morais
- Internal Medicine, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, BRA
| | - Camila Hartmann
- Cardiology, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, BRA.,Cardiology, Marcelino Champagnat Hospital, Curitiba, BRA
| | - Murilo Guedes
- Internal Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, BRA
| |
Collapse
|
11
|
Jabbar A, Qureshi R, Dhrolia M, Nasir K, Ahmad A. Variety of Cardiac Events in Hospitalized Chronic Kidney Disease Patients. Cureus 2021; 13:e18801. [PMID: 34804663 PMCID: PMC8592791 DOI: 10.7759/cureus.18801] [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] [Accepted: 10/15/2021] [Indexed: 11/05/2022] Open
Abstract
Objective This study assessed the variety and frequency of various cardiovascular events in different stages of chronic kidney disease (CKD) patients who were hospitalized due to different causes. Methods This prospective cross-sectional observational analysis was conducted at the Department of Nephrology in The Kidney Centre Post Graduate Training Institute Karachi on all adult CKD (of all stages with or without dialysis) patients, who developed cardiovascular events during their hospital admission either in ward or ICU due to any cause between August 2020 and February 2021. Total of 765 patients got admitted in the given time period and among them, 290 patients developed various cardiovascular events. Baseline data, co-morbidities, clinical features, drug history and management were determined. Results There were a total of 290 patients in our study in which 154 (53.1%) were male and 136(46.9%) were female. Mean age was 57 ± 15.5. Our majority of patients were end-stage renal disease and on maintenance hemodialysis (n=119, 41%) while the most prevalent co-morbid condition was hypertension (n=227, 78.3%) followed by diabetes mellitus (n=204, 70.4%). The most frequent cardiovascular events in CKD patients was the atrial fibrillation 101(34.8%) while 37(12.8%) patients suffered ST-elevation myocardial infarction and supraventricular tachycardia. Patients who had high potassium levels (>5.2) most frequently suffered from atrial fibrillation (n=16, 28.1%) as compared to other cardiovascular events. Conclusion Patients with CKD are at increased risk of having several cardiovascular events. Numerous risk factors involved in the pathogenesis. Among the diverse causes, fluctuations in serum levels of various electrolytes are important causes as certain electrolytes disbalance can trigger various life-threatening cardiac arrhythmias.
Collapse
Affiliation(s)
- Asfia Jabbar
- Nephrology, The Kidney Centre Postgraduate Training Institute, Karachi, PAK
| | - Ruqaya Qureshi
- Nephrology, The Kidney Centre Postgraduate Training Institute, Karachi, PAK
| | - Murtaza Dhrolia
- Nephrology, The Kidney Centre Postgraduate Training Institute, Karachi, PAK
| | - Kiran Nasir
- Nephrology, The Kidney Centre Postgraduate Training Institute, Karachi, PAK
| | - Aasim Ahmad
- Nephrology, The Kidney Center Post Graduate Training Institute, Karachi, PAK
| |
Collapse
|
12
|
Hazardous Effect of Low-Dose Aspirin in Patients with Predialysis Advanced Chronic Kidney Disease Assessed by Machine Learning Method Feature Selection. Healthcare (Basel) 2021; 9:healthcare9111484. [PMID: 34828530 PMCID: PMC8625790 DOI: 10.3390/healthcare9111484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/18/2021] [Accepted: 10/28/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Low-dose aspirin (100 mg) is widely used in preventing cardiovascular disease in chronic kidney disease (CKD) because its benefits outweighs the harm, however, its effect on clinical outcomes in patients with predialysis advanced CKD is still unclear. This study aimed to assess the effect of aspirin use on clinical outcomes in such group. Methods: Patients were selected from a nationwide diabetes database from January 2009 to June 2017, and divided into two groups, a case group with aspirin use (n = 3021) and a control group without aspirin use (n = 9063), by propensity score matching with a 1:3 ratio. The Cox regression model was used to estimate the hazard ratio (HR). Moreover, machine learning method feature selection was used to assess the importance of parameters in the clinical outcomes. Results: In a mean follow-up of 1.54 years, aspirin use was associated with higher risk for entering dialysis (HR, 1.15 [95%CI, 1.10-1.21]) and death before entering dialysis (1.46 [1.25-1.71]), which were also supported by feature selection. The renal effect of aspirin use was consistent across patient subgroups. Nonusers and aspirin users did not show a significant difference, except for gastrointestinal bleeding (1.05 [0.96-1.15]), intracranial hemorrhage events (1.23 [0.98-1.55]), or ischemic stroke (1.15 [0.98-1.55]). Conclusions: Patients with predialysis advanced CKD and anemia who received aspirin exhibited higher risk of entering dialysis and death before entering dialysis by 15% and 46%, respectively.
Collapse
|
13
|
Li J, Liu FH, Guo J, Yu YF, Li CQ. Retrospective analysis of renal prognosis in elderly coronary artery disease patients complicated with renal insufficiency. Aging (Albany NY) 2021; 13:22856-22866. [PMID: 34606471 PMCID: PMC8544318 DOI: 10.18632/aging.203579] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 09/10/2021] [Indexed: 11/25/2022]
Abstract
Objective and Methods: The aim of this study was to retrospectively analyze the renal prognosis of elderly coronary artery disease (CAD) patients complicated with renal insufficiency. Results: A total of 307 patients were included. The mean follow-up period was 25±11months. The average age was 79±7 years. In the worsening renal function group, there were higher occurrence rate of heart failure and severe coronary artery stenosis, lower rate of percutaneous coronary intervention, lower medication rate of renin-angiotensin blocker, lower plasma albumin, magnesium and hemoglobulin level. There was no significant difference in the rate of worsening renal function or gastrointestinal bleeding between patients who took anti-platelet agents/statins and those without. Patients with reduced left ventricular ejective fraction had higher rate of worsening renal function, yet lower medication rate of renin-angiotensin blockers, lower plasma albumin and hemoglobulin level. Anemia, malnutrition and worsening cardiac function were risk factors of renal function deterioration and mortality. Conclusions: In the elderly coronary artery disease patients who had renal insufficiency, antiplatelet agents and statin have non-adverse effects on renal function; lower medication rate of renin-angiotensin blocker were found in patients with either worsening renal function or heart failure. Anemia, malnutrition and worsening cardiac function are risk factors of renal function deterioration and mortality.
Collapse
Affiliation(s)
- Jun Li
- Department of Nephrology, Affiliated Hospital of Jiangnan University, Wuxi 214062, Jiangsu, China
| | - Fa-Hu Liu
- Research Center, Wuxi Institute of Technology, Wuxi 214121, Jiangsu, China
| | - Jing Guo
- Department of Cardiology, Affiliated Hospital of Jiangnan University, Wuxi 214062, Jiangsu, China
| | - Ya-Fen Yu
- Department of Nephrology, Affiliated Hospital of Jiangnan University, Wuxi 214062, Jiangsu, China
| | - Chun-Qing Li
- Department of Nephrology, Affiliated Hospital of Jiangnan University, Wuxi 214062, Jiangsu, China
| |
Collapse
|
14
|
Chavda V, Chaurasia B, Deora H, Umana GE. Chronic Kidney disease and stroke: A Bi-directional risk cascade and therapeutic update. BRAIN DISORDERS 2021. [DOI: 10.1016/j.dscb.2021.100017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
|
15
|
Lee HF, Cheng YW, Peng JR, Hsu CY, Yang CH, Chan YH, Chu PH. Impact of chronic kidney disease on long-term outcomes for coronary in-stent restenosis after drug-coated balloon angioplasty. J Cardiol 2021; 78:564-570. [PMID: 34454808 DOI: 10.1016/j.jjcc.2021.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/07/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) and coronary instent restenosis (ISR) treated with drug-coated balloon (DCB) angioplasty have been excluded from randomized controlled trials. We aimed to investigate the clinical impact of CKD stratified by severity, on clinical outcomes for patients with ISR treated with DCB angioplasty. METHODS This cohort study enrolled 1,376 patients treated with DCB angioplasty; 639 CKD patients defined as having an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 and 737 patients with preserved renal function were identified. Risks of target vessel failure (TVF), all-cause mortality, and any repeated revascularization were analyzed. RESULTS The CKD group had a significantly higher risk of TVF [adjusted hazard ratio (HR): 1.337; 95% confidence interval (CI): 1.125-1.590; p = 0.0010], all-cause mortality (adjusted HR: 2.553; 95% CI: 1.494-4.361; p = 0.0006), and any repeated revascularization (adjusted HR: 1.447; 95% CI: 1.087-1.927; p = 0.0114) compared with the non-CKD group. After multivariable adjustment, patients with severe CKD (eGFR = 15-29 mL/min/1.73 m2) and end-stage renal disease (ESRD) (eGFR <15 mL/min/1.73 m2) had a significantly higher risk of adverse events comparable to that in patients with preserved renal function. CONCLUSIONS In this cohort study, patients with CKD and ISR undergoing DCB angioplasty had a significantly higher risk of adverse events compared with patients with preserved renal function, whereas subgroups with mild to moderate CKD did not display this difference. Different revascularization strategies may be considered for patients with severe CKD or ESRD with ISR.
Collapse
Affiliation(s)
- Hsin-Fu Lee
- Division of Cardiology, Department of Internal Medicine, New Taipei City Municipal Tucheng Hospital, New Taipei City, Taiwan; The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Wen Cheng
- The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jian-Rong Peng
- Division of Cardiology, Department of Internal Medicine, New Taipei City Municipal Tucheng Hospital, New Taipei City, Taiwan; The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chiu-Yi Hsu
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Chia-Hung Yang
- Division of Cardiology, Department of Internal Medicine, New Taipei City Municipal Tucheng Hospital, New Taipei City, Taiwan; The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Hsin Chan
- The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Microscopy Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
| | - Pao-Hsien Chu
- The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| |
Collapse
|
16
|
Toprak O, Bozyel EA, Alp B, Kirik A. Discontinuation of Hemodialysis After 8 Years in Favor of Toprak's Kidney Care in a Patient with End-Stage Kidney Disease. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e930857. [PMID: 33895768 PMCID: PMC8083794 DOI: 10.12659/ajcr.930857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Patient: Male, 77-year-old Final Diagnosis: End-stage renal failure Symptoms: No symptoms Medication:— Clinical Procedure: — Specialty: Nephrology
Collapse
Affiliation(s)
- Omer Toprak
- Department of Medicine, Division of Nephrology, Balikesir University School of Medicine, Balikesir, Turkey
| | - Emel A Bozyel
- Department of Medicine, Division of Internal Medicine, Balikesir University School of Medicine, Balikesir, Turkey
| | - Burak Alp
- Department of Medicine, Division of Internal Medicine, Balikesir University School of Medicine, Balikesir, Turkey
| | - Ali Kirik
- Department of Medicine, Division of Internal Medicine, Balikesir University School of Medicine, Balikesir, Turkey
| |
Collapse
|
17
|
De Lima JJG, Gowdak LHW, David-Neto E, Bortolotto LA. Diabetes, Cardiovascular Disease, and Cardiovascular Risk in Patients with Chronic Kidney Disease. High Blood Press Cardiovasc Prev 2021; 28:159-165. [PMID: 33548022 DOI: 10.1007/s40292-021-00434-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/22/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION It is unclear whether the increased risk associated with diabetes in patients on dialysis is due to diabetes or a consequence of associated cardiovascular disease (CVD). AIM The purpose of this work was to answer the question: do diabetes and CVD have a similar impact on the incidence of cardiovascular events in patients undergoing maintenance hemodialysis? METHODS A prespecified protocol was used to prospectively evaluate and follow up 310 diabetic patients on hemodialysis without clinical evidence of CVD and 395 nondiabetic patients with CVD. Endpoint was the incidence of composite CV events and coronary events. RESULTS The incidence of composite CV events (log-rank = 0.540) and coronary events (log-rank = 0.400) did not differ between groups. Because of the potential influence of occult CVD in patients with diabetes, we repeated the analysis excluding subjects with altered ejection fraction, a myocardial perfusion scan defect, and coronary artery disease in the group of patients with diabetes. Again we found no difference between groups (log-rank = 0.657). CONCLUSION In patients on hemodialysis, diabetes and CVD carry similar risks for CV events. These results are congruent with the diabetes mellitus-CVD equivalence risk concept reported in the general population.
Collapse
Affiliation(s)
- Jose J G De Lima
- Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, Rua Enas Carvalho Aguiar 44, São Paulo, SP, 05403-000, Brazil.
| | - Luis Henrique W Gowdak
- Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, Rua Enas Carvalho Aguiar 44, São Paulo, SP, 05403-000, Brazil
| | - Elias David-Neto
- Renal Transplant Unit, Urology, Hospital das Clínicas, University of São Paulo Medical School, Rua Eneas Carvalho Aguiar 23, São Paulo, SP, 05403-000, Brazil
| | - Luiz A Bortolotto
- Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, Rua Enas Carvalho Aguiar 44, São Paulo, SP, 05403-000, Brazil
| |
Collapse
|