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Hiyamuta H, Yamada S, Nakano T, Taniguchi M, Masutani K, Tsuruya K, Kitazono T. Impact of Electrocardiographic Parameters on Sudden Death in Patients Receiving Maintenance Hemodialysis: Ten-Year Outcomes of the Q-Cohort Study. J Atheroscler Thromb 2024; 31:214-231. [PMID: 37730375 PMCID: PMC10918032 DOI: 10.5551/jat.64255] [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: 03/22/2023] [Accepted: 07/13/2023] [Indexed: 09/22/2023] Open
Abstract
AIM Sudden death is one of the most common causes of death among hemodialysis patients. Electrocardiography (ECG) is a noninvasive and inexpensive test that is regularly performed in hemodialysis clinics. However, the association between abnormal ECG findings and the risk of sudden death in hemodialysis patients is yet to be fully elucidated. Thus, the aim of this study was to determine the ECG parameters linked to sudden death in patients undergoing hemodialysis. METHODS The Q-Cohort Study is a multicenter, longitudinal, observational study of hemodialysis patients. In this study, 1,153 Japanese hemodialysis patients aged ≥ 18 years with ECG data recorded within 1 year of study enrollment were followed up for 10 years. Cox proportional hazards models were used to estimate the multivariate-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for the association between ECG parameters and sudden death. RESULTS During the median follow-up period of 9.0 years, 517 patients died, 76 of whom exhibited sudden death. After adjusting for confounding factors, higher heart rate, QT prolongation, and left ventricular hypertrophy as per the Sokolow-Lyon voltage criteria were found to be independently associated with an increased risk of sudden death. The adjusted HRs [95% CIs] for each abnormal ECG parameter were 2.02 [1.05-3.89], 2.10 [1.30-1.77], and 1.91 [1.18-3.09], respectively. CONCLUSIONS Higher heart rate, QT prolongation, and left ventricular hypertrophy on ECG have been determined to be associated with an increased risk of sudden death. Therefore, regular ECG recording could enable medical practitioners to identify hemodialysis patients who require intervention to prevent lethal arrhythmia.
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Affiliation(s)
- Hiroto Hiyamuta
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shunsuke Yamada
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Kosuke Masutani
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | | | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Echefu G, Stowe I, Burka S, Basu-Ray I, Kumbala D. Pathophysiological concepts and screening of cardiovascular disease in dialysis patients. FRONTIERS IN NEPHROLOGY 2023; 3:1198560. [PMID: 37840653 PMCID: PMC10570458 DOI: 10.3389/fneph.2023.1198560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/10/2023] [Indexed: 10/17/2023]
Abstract
Dialysis patients experience 10-20 times higher cardiovascular mortality than the general population. The high burden of both conventional and nontraditional risk factors attributable to loss of renal function can explain higher rates of cardiovascular disease (CVD) morbidity and death among dialysis patients. As renal function declines, uremic toxins accumulate in the blood and disrupt cell function, causing cardiovascular damage. Hemodialysis patients have many cardiovascular complications, including sudden cardiac death. Peritoneal dialysis puts dialysis patients with end-stage renal disease at increased risk of CVD complications and emergency hospitalization. The current standard of care in this population is based on observational data, which has a high potential for bias due to the paucity of dedicated randomized clinical trials. Furthermore, guidelines lack specific guidelines for these patients, often inferring them from non-dialysis patient trials. A crucial step in the prevention and treatment of CVD would be to gain better knowledge of the influence of these predisposing risk factors. This review highlights the current evidence regarding the influence of advanced chronic disease on the cardiovascular system in patients undergoing renal dialysis.
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Affiliation(s)
- Gift Echefu
- Division of Cardiovascular Medicine, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Ifeoluwa Stowe
- Department of Internal Medicine, Baton Rouge General Medical Center, Baton Rouge, LA, United States
| | - Semenawit Burka
- Department of Internal Medicine, University of Texas Rio Grande Valley, McAllen, TX, United States
| | - Indranill Basu-Ray
- Department of Cardiology, Memphis Veterans Affairs (VA) Medical Center, Memphis, TN, United States
| | - Damodar Kumbala
- Nephrology Division, Renal Associates of Baton Rouge, Baton Rouge, LA, United States
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Maqbool S, Shafiq S, Ali S, Rehman MEU, Malik J, Lee KY. Left Ventricular Hypertrophy (LVH) and Left Ventricular Geometric Patterns in Patients with Chronic Kidney Disease (CKD) Stage 2-5 With Preserved Ejection Fraction (EF): A Systematic Review to Explore CKD Stage-wise LVH Patterns. Curr Probl Cardiol 2023; 48:101590. [PMID: 36632930 DOI: 10.1016/j.cpcardiol.2023.101590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
Left ventricular hypertrophy (LVH) is the most common structural abnormality associated with CKD patients accounting for 70% of the patients suffering LVH with ESRD. This art of the state review is first of its nature which aimed to analyze the studies involving LVH in CKD patients, and stage-wise association of CKD with various geometrical patterns of LVH. The literature search was done through various databases like PubMed, EMBASE, CINAHIL, Web of Science, and Cochrane Library. After careful quality assessment a total of 7 studies, and 2121 patients were included in our study. The mean age of the patients was 61.5±12.4 years. Similarly, the mean value of eGFR was 39.81±13.71 ml/min. The incidence of LVH was 47.05%, and on stage-wise analysis, the higher CKD stage was associated with eccentric LVH as compared to lower stages. The ejection fraction (EF) values were showing preserved EF in all included studies. ESRD was showing more preponderance towards eccentric LVH as compared to other stages of CKD.
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Affiliation(s)
- Shahzaib Maqbool
- Department of Cardiology, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Saba Shafiq
- Department of Medicine, Holy Family Hospital, Rawalpindi, Pakistan
| | - Sarmad Ali
- Department of Cardiology, Rawalpindi Medical University, Rawalpindi, Pakistan
| | | | - Jahanzeb Malik
- Department of electrophysiology, Cardiovascular analytics group, Canterbury, UK
| | - Ka Yiu Lee
- Department of Health Sciences, Mid Sweden University, Ostersund, Jamtland, Sweden.
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4
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Yap YS, Chi WC, Lin CH, Liu YC, Wu YW, Yang HY. Combined cardiomegaly and aortic arch calcification predict mortality in hemodialysis patients. Ther Apher Dial 2023; 27:31-38. [PMID: 35735215 DOI: 10.1111/1744-9987.13902] [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: 12/13/2021] [Revised: 03/22/2022] [Accepted: 06/20/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION This study aimed to investigate the relationship between cardiomegaly and aortic arch calcification (AAC) and overall/cardiovascular mortality in hemodialysis patients. METHODS We conducted a retrospective cohort study and enrolled patients who underwent initial hemodialysis. Cardiomegaly and AAC were determined by chest radiography and classified into four groups according to cross-classification of cardiothoracic ratio (CTR) of 0.5 and lower/higher grade AAC (LGAAC/HGAAC). The relationship between these groups and mortality was then analyzed by Cox proportional hazards model. RESULTS In multivariate Cox regression analysis, those in CTR ≤ 0.5 and HGAAC [hazard ratio (95% confidence interval): 2.07 (1.14-3.77)], CTR > 0.5 & LGAAC [3.60 (2.07-6.25)] and CTR > 0.5 & HGAAC [3.42 (2.03-5.77)] were significantly associated with overall mortality; while those in CTR > 0.5 & LGAAC [2.81 (1.28-6.19)] and CTR > 0.5 & HGAAC [2.32 (1.09-4.95)] were significantly related to cardiovascular mortality. CONCLUSION Combined cardiomegaly and AAC predicted overall and cardiovascular mortality in hemodialysis patients.
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Affiliation(s)
- Yit-Sheung Yap
- Division of Nephrology, Department of Internal Medicine, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Wen-Che Chi
- Division of Nephrology, Department of Internal Medicine, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Cheng-Hao Lin
- Division of Nephrology, Department of Internal Medicine, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Yi-Chun Liu
- Division of Nephrology, Department of Internal Medicine, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Yi-Wen Wu
- Chronic Kidney Disease Education Center, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Hui-Yueh Yang
- Hemodialysis Center, Yuan's General Hospital, Kaohsiung, Taiwan
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5
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Zheng Z, Soomro QH, Charytan DM. Deep Learning Using Electrocardiograms in Patients on Maintenance Dialysis. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:61-68. [PMID: 36723284 DOI: 10.1053/j.akdh.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Cardiovascular morbidity and mortality occur with an extraordinarily high incidence in the hemodialysis-dependent end-stage kidney disease population. There is a clear need to improve identification of those individuals at the highest risk of cardiovascular complications in order to better target them for preventative therapies. Twelve-lead electrocardiograms are ubiquitous and use inexpensive technology that can be administered with minimal inconvenience to patients and at a minimal burden to care providers. The embedded waveforms encode significant information on the cardiovascular structure and function that might be unlocked and used to identify at-risk individuals with the use of artificial intelligence techniques like deep learning. In this review, we discuss the experience with deep learning-based analysis of electrocardiograms to identify cardiovascular abnormalities or risk and the potential to extend this to the setting of dialysis-dependent end-stage kidney disease.
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Affiliation(s)
- Zhong Zheng
- Nephology Division, Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Qandeel H Soomro
- Nephology Division, Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - David M Charytan
- Nephology Division, Department of Medicine, New York University Grossman School of Medicine, New York, NY.
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Daralammouri Y, Qaddumi J, Ayoub K, Abu-Hantash D, Al-Sadi MA, Ayaseh RM, Azamtta M, Sawalmeh O, Hamdan Z. Pathological right ventricular changes in synthesized electrocardiogram in end-stage renal disease patients and their association with mortality and cardiac hospitalization: a cohort study. BMC Nephrol 2022; 23:79. [PMID: 35209873 PMCID: PMC8867672 DOI: 10.1186/s12882-022-02707-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/11/2022] [Indexed: 11/20/2022] Open
Abstract
Background Right ventricular (RV) function is an important prognostic predictor for end-stage renal disease (ESRD) patients. Non-invasive evaluation of RV function by simple electrocardiogram (ECG) is not yet evident. The purpose of this article was to investigate the presence and association of pathological right ventricular changes in synthesized ECG with cardiac hospitalization and mortality. Methods A prospective cohort study of 137 ESRD patients (mean age: 56 years) were recruited from the hemodialysis unit in An-Najah National University Hospital, Nablus, Palestine. Synthesized ECG was done right before the hemodialysis (HD) session. The pathological right ventricular changes were recorded for each patient. The relationship between pathological RV changes and mortality, cardiac and non-cardiac hospitalization was assessed through a 6-months follow-up period. Results Right ventricular Q wave was found in 2.2% of patients, while right ventricular ST elevation was found in 0.7% of patients, and right ventricular negative T wave was found in 0.7% of patients. During the 6-month period of follow-up, 36 (26.3%) patients were hospitalized, nine patients (6.6%) due to cardiac causes. A total of 8 (5.83%) patients died, out of those 4 patients (2.91%) due to cardiac causes. Using Fisher’s exact test, there was a significant association between pathological abnormalities in synthesized ECG and hospitalization among hemodialysis patients, (p = 0.047). Pathological changes in synthesized ECG were less prevalent in non-cardiac hospitalizations than in cardiac hospitalizations. Conclusions The presence of pathological RV synthesized ECG changes can predict cardiac hospitalization in ESRD patients. Synthesized ECG is a good available tool that can be easily performed in ESRD patients. To determine whether Synthesized ECG can be used as a screening tool for pathological RV changes in a dialysis patients, more research with a larger number of patients and a longer follow-up period is required.
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Affiliation(s)
- Yunis Daralammouri
- Department of Cardiology, An-Najah National University Hospital, Nablus, Palestine. .,Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
| | - Jamal Qaddumi
- Public Health Department, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Khubaib Ayoub
- Department of Internal Medicine, An-Najah National University Hospital, Nablus, Palestine
| | - Doaa Abu-Hantash
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Mai Arafat Al-Sadi
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Rofayda M Ayaseh
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Murad Azamtta
- Department of Cardiology, An-Najah National University Hospital, Nablus, Palestine
| | - Osama Sawalmeh
- Department of Internal Medicine, An-Najah National University Hospital, Nablus, Palestine
| | - Zakaria Hamdan
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.,Department of Internal Medicine, An-Najah National University Hospital, Nablus, Palestine.,Nephrology Unit, An-Najah National University Hospital, Nablus, Palestine
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7
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Bahie A, El-Said G, Abd El Wahab AM. Relation between carotid intimal medial thickness and left ventricular mass and left ventricular mass indices in maintenance hemodialysis patients. Ther Apher Dial 2021; 26:387-397. [PMID: 34459119 DOI: 10.1111/1744-9987.13728] [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: 04/19/2021] [Revised: 07/17/2021] [Accepted: 07/30/2021] [Indexed: 12/12/2022]
Abstract
Left ventricular hypertrophy (LVH) is a risk factor of cardiovascular morbidity in dialysis patients. The association between LV mass and carotid intimal medial thickness (CIMT) could be due to increased hemodynamic load in dialysis patients. The relationship between CIMT and LVM indices in hemodialysis (HD) patients was investigated. This is a cross-sectional study including 65 HD patients, divided into two groups: Group 1 with CIMT ≤ 1 mm (N = 29), Group 2 with CIMT > 1 mm (N = 36). Echocardiographic evaluation of the LVM, CIMT measurement using B-mode ultrasonography, patients' basic clinical and biochemical data were recorded. Patients with CIMT > 1 mm (Group 2) showed significantly higher LVM, LVM/BSA (body surface area), and LVM/Ht2.7 (height). Regarding linear regression, CIMT was found to be an independent predictor for LVM, LVM/BSA, and LVM/Ht2.7 . LVM, LVMI, and LVM/Ht2.7 are significantly elevated in HD patients with CIMT > 1 mm group. CIMT was found to be the independent predictor for LVH in maintenance HD patients.
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Affiliation(s)
- Ahmed Bahie
- Department of Internal Medicine, Mansoura Nephrology and Dialysis Unit (MNDU), Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Ghada El-Said
- Department of Internal Medicine, Mansoura Nephrology and Dialysis Unit (MNDU), Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Ahmed M Abd El Wahab
- Department of Internal Medicine, Mansoura Nephrology and Dialysis Unit (MNDU), Mansoura Faculty of Medicine, Mansoura, Egypt
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8
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Yamaguchi S, Hamano T, Oka T, Doi Y, Kajimoto S, Yasuda S, Shimada K, Matsumoto A, Sakaguchi Y, Inoue K, Matsui I, Suzuki A, Isaka Y. Electrocardiogram findings at the initiation of hemodialysis and types of subsequent cardiovascular events. Hypertens Res 2021; 44:571-580. [PMID: 33398130 DOI: 10.1038/s41440-020-00592-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 10/21/2020] [Accepted: 10/28/2020] [Indexed: 11/09/2022]
Abstract
The prognostic value of electrocardiograms (ECGs) has been reported in predialysis patients but not in incident hemodialysis patients with overhydration and electrolyte disturbances, both of which potentially affect ECG results. We performed a retrospective multicenter cohort study involving incident hemodialysis patients and examined whether ECG parameters immediately before hemodialysis initiation can predict subsequent cardiovascular disease (CVD) using Cox proportional hazards models. We explored potential effect modifications by several electrolytes on the predictive power of ECG abnormalities. Among the 618 enrolled patients, 16%, 10%, 46%, and 22% showed a PR interval ≥ 200 ms, QRS interval ≥120 ms, QTc interval ≥ 450/460 ms (male/female), and left ventricular hypertrophy (LVH) by voltage criteria, respectively. Over a median 3-year follow-up, 19% and 16% of the patients developed atherosclerotic and nonatherosclerotic CVD, respectively. The Cox regression model results revealed that the sum of the number of abnormalities in PR, QRS, and QT intervals was a significant risk factor for nonatherosclerotic CVD (hazard ratios (HRs) [95% confidence interval (CI)]: 1.58 [1.24-2.01] per number of abnormalities). The predictive value of LVH for atherosclerotic CVD was attenuated over time. At up to 36 months, although the proportional hazards assumption was met, LVH was significantly associated with atherosclerotic CVD (HR [95% CI]: 1.89 [1.15-3.11]). The adjusted HR was particularly high (HR [95% CI]: 4.02 [1.68-9.60]) among patients who were in the lowest tertile of serum magnesium levels (P for interaction = 0.04). PR, QRS, and QT prolongation additively predicted nonatherosclerotic CVD, while LVH predicted atherosclerotic CVD in the short term.
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Affiliation(s)
- Satoshi Yamaguchi
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Internal Medicine, Japan Community Health care Organization Osaka Hospital, Osaka, Japan
| | - Takayuki Hamano
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan. .,Department of Nephrology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
| | - Tatsufumi Oka
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yohei Doi
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Sachio Kajimoto
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Seiichi Yasuda
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Karin Shimada
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ayumi Matsumoto
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yusuke Sakaguchi
- Department of Inter-Organ Communication Research in Kidney Disease, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazunori Inoue
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Isao Matsui
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akira Suzuki
- Department of Internal Medicine, Japan Community Health care Organization Osaka Hospital, Osaka, Japan
| | - Yoshitaka Isaka
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
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9
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Malik J, Lomonte C, Rotmans J, Chytilova E, Roca-Tey R, Kusztal M, Grus T, Gallieni M. Hemodialysis vascular access affects heart function and outcomes: Tips for choosing the right access for the individual patient. J Vasc Access 2020; 22:32-41. [PMID: 33143540 PMCID: PMC8606800 DOI: 10.1177/1129729820969314] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Chronic kidney disease is associated with increased cardiovascular morbidity and mortality. A well-functioning vascular access is associated with improved survival and among the available types of vascular access the arterio-venous (AV) fistula is the one associated with the best outcomes. However, AV access may affect heart function and, in some patients, could worsen the clinical status. This review article focuses on the specific cardiovascular hemodynamics of dialysis patients and how it is affected by the AV access; the effects of an excessive increase in AV access flow, leading to high-output heart failure; congestive heart failure in CKD patients and the contraindications to AV access; pulmonary hypertension. In severe heart failure, peritoneal dialysis (PD) might be the better choice for cardiac health, but if contraindicated suggestions for vascular access selection are provided based on the individual clinical presentation. Management of the AV access after kidney transplantation is also addressed, considering the cardiovascular benefit of AV access ligation compared to the advantage of having a functioning AVF as backup in case of allograft failure. In PD patients, who need to switch to hemodialysis, vascular access should be created timely. The influence of AV access in patients undergoing cardiac surgery for valvular or ischemic heart disease is also addressed. Cardiovascular implantable electronic devices are increasingly implanted in dialysis patients, but when doing so, the type and location of vascular access should be considered.
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Affiliation(s)
- Jan Malik
- Third Department of Internal Medicine, General University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Carlo Lomonte
- Miulli General Hospital, Division of Nephrology, Acquaviva delle Fonti, Italy
| | - Joris Rotmans
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Eva Chytilova
- Third Department of Internal Medicine, General University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ramon Roca-Tey
- Department of Nephrology, Hospital de Mollet, Fundació Sanitària Mollet, Barcelona, Spain
| | - Mariusz Kusztal
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Tomas Grus
- Second Department of Surgery, General University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Maurizio Gallieni
- Nephrology and Dialysis Unit – ASST Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences ‘L. Sacco’, University of Milano, Milano, Italy
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10
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Huang P, Guo X, Jin Y, Huang Q. A novel DSN-based fluorescence assay for MicroRNA-133a detection and its application for LVH diagnosis in maintenance hemodialysis patients. J Clin Lab Anal 2020; 34:e23438. [PMID: 32677047 PMCID: PMC7595923 DOI: 10.1002/jcla.23438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/29/2020] [Accepted: 05/13/2020] [Indexed: 01/11/2023] Open
Abstract
Left ventricular hypertrophy (LVH) is the most powerful predictor of cardiovascular mortality in maintenance hemodialysis (MHD) patients. Circulating microRNA-133a (miR-133a) was reported to be a potential biomarker for LVH in MHD patients. The aim of this experiment is to establish a novel DSN (duplex-specific-nuclease)-based fluorescence assay for the ultrasensitive detection of miR-133a and investigate its application for LVH diagnosis in MHD patients. The results indicate DSN enzyme combined with ultrathin metallic MoS2 nanosheets presents high sensitivity, specificity, and low fluorescence background for miR-133a detection. Then, circulating miR-133a levels in plasma from 40 MHD patients and 20 healthy controls are analyzed by such assay. The levels of miR-133a are down-regulated in MHD patients with LVH compared to MHD patients without LVH and healthy controls, and the ROC (receiver operating characteristic) curve shows strong separation between MHD with LVH patients and MHD without LVH patients. Furthermore, the liner regression analysis shows negative correlation of miR-133a level and interventricular septum thickness (IVS) as well as left ventricular mass index (LVMI), the indicators of LVH. Therefore, our findings reveal DSN-based fluorescence assay for miR-133a is suitable for LVH diagnosis in MHD patients.
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Affiliation(s)
- Pei Huang
- Department of Oncology, Wuxi No. 2 People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Xuedan Guo
- Department of Oncology, Wuxi No. 2 People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Yan Jin
- Department of Gastroenterology, Wuxi No. 2 People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Qing Huang
- Department of Emergency, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
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11
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Additional prognostic value of electrocardiographic left ventricular hypertrophy in traditional cardiovascular risk assessments in chronic kidney disease. J Hypertens 2020; 38:1149-1157. [PMID: 32371805 DOI: 10.1097/hjh.0000000000002394] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) is a common predictor of the cardiovascular prognosis in chronic kidney disease (CKD). However, whether or not electrocardiography-derived LVH (ECG-LVH) has prognostic value in patients with various degrees of CKD and improves the cardiovascular risk stratification based on traditional risk factors remains unclear. METHODS A total of 7206 participants at least 40 years of age who were free from cardiovascular events in a general population were followed for the incidence of cardiovascular events. CKD was confirmed by either the presence of a reduced estimated glomerular filtration rate (eGFR) (<60 ml/min per 1.73 m) or albuminuria, defined as a urinary albumin-to-creatinine ratio (UACR) of at least 30 mg/g Cr. RESULTS A total of 1886 (26.2%) had CKD, of which 1471 (78.0%) had a preserved eGFR (CKD stage 1-2). After an average 11.3 years of follow-up, the adjusted hazard ratio for the incidence of cardiovascular events significantly increased for ECG-LVH according to the Sokolow--Lyon voltage, Cornell voltage, or Cornell voltage product among participants with CKD (hazard ratio 1.47, P = 0.002), in contrast to those without CKD (hazard ratio 1.15, P = 0.210). The inclusion of any ECG-LVH parameters improved the accuracy of reclassification in any risk prediction model based on the eGFR, UACR, or Framingham 10-year risk score in the CKD participants (net reclassification improvement = 0.13-0.32, all P values <0.040). CONCLUSION In patients with CKD stage 1-5, ECG-LVH is useful for predicting the risk of future cardiovascular events and adds prognostic information to traditional cardiovascular risk assessments.
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12
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Zanib A, Anwar S, Saleem K, Wasif Khan HM, Zafar S. Frequency of Left Ventricular Hypertrophy Among Patients on Maintenance Hemodialysis by Voltage Criteria and Its Relationship with Biophysical-Chemical Parameters. Cureus 2020; 12:e7426. [PMID: 32337146 PMCID: PMC7182164 DOI: 10.7759/cureus.7426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 03/26/2020] [Indexed: 11/24/2022] Open
Abstract
Background Among the dialysis population, left ventricular hypertrophy (LVH) is becoming a major cause of cardiovascular death, mainly due to myocardial infarction, heart failure, and arrhythmias. Electrocardiography (ECG) is a cheap and easily available test to detect the presence of left ventricular hypertrophy. The basic purpose of this study was to assess the frequency of left ventricular hypertrophy among the maintenance hemodialysis patients by applying different voltage criteria for the diagnosis of LVH and its relationship with various biophysical and biochemical parameters. Methods A total of 68 patients of end-stage renal disease (ESRD) were included in the study who were on maintenance hemodialysis at the dialysis center of Sughra Shafi Hospital. Baseline characteristics were recorded from the patients' data. Blood samples were drawn and electrocardiographs were taken, both before and after hemodialysis. Results Results showed variability in the detection of left ventricular hypertrophy in the pre- and post-dialysis period, as it was positive for 45%, 21%, and 17% in the pre-dialysis period versus 40%, 32%, and 25% in the post-dialysis period, when the Framingham, Sokolow-Lyon, and Cornell criteria were applied, respectively. The study showed a significant relationship between left ventricular hypertrophy with a high body mass index (BMI), hypertension, and pre- and post-dialysis hypomagnesemia (P <0.05). A significant association was also seen with low serum albumin levels over the past year. Conclusion According to this study, almost half of the dialysis patients were having left ventricle hypertrophy when Framingham criteria were applied. Good control of factors that are significantly associated with the occurrence of left ventricular hypertrophy can reduce morbidity and mortality among dialysis patients secondary to cardiovascular events. In this study, these factors included hypertension, hypomagnesemia, hypoalbuminemia, and high BMI.
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Affiliation(s)
- Alvina Zanib
- Internal Medicine, Fatima Jinnah Medical University, Lahore, PAK
| | - Shahid Anwar
- Nephrology, Fatima Jinnah Medical University, Lahore, PAK
| | - Khurram Saleem
- Internal Medicine, University College of Medicine, University of Lahore, Lahore, PAK
| | | | - Sana Zafar
- Internal Medicine, University College of Medicine, University of Lahore, Lahore, PAK
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13
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Skampardoni S, Poulikakos D, Malik M, Green D, Kalra PA. The potential of electrocardiography for cardiac risk prediction in chronic and end-stage kidney disease. Nephrol Dial Transplant 2020; 34:1089-1098. [PMID: 30085289 DOI: 10.1093/ndt/gfy255] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Indexed: 11/14/2022] Open
Abstract
Cardiovascular mortality is very high in chronic and end-stage kidney disease (ESKD). However, risk stratification data are lacking. Sudden cardiac deaths are among the most common cardiovascular causes of death in these populations. As a result, many studies have assessed the prognostic potential of various electrocardiographic parameters in the renal population. Recent data from studies of implantable loop recordings in haemodialysis patients from five different countries have shed light on a pre-eminent bradyarrhythmic risk of mortality. Importantly, heart block addressed by permanent pacing system was detected in a proportion of patients during the prolonged recording periods. Standard electrocardiogram is inexpensive, non-invasive and easily accessible. Hence, risk prediction models using this simple investigation tool could easily translate into clinical practice. We believe that electrocardiographic assessment is currently under-valued in renal populations. For this review, we identified studies from the preceding 10 years that assessed the use of conventional and novel electrocardiographic biomarkers as risk predictors in chronic and ESKD. The review indicates that conventional electrocardiographic markers are not reliable for risk stratification in the renal populations. Novel parameters have shown promising results in smaller studies, but further validation in larger populations is required.
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Affiliation(s)
- Sofia Skampardoni
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Renal Department, Salford Royal NHS Trust, Salford, UK
| | - Dimitrios Poulikakos
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Renal Department, Salford Royal NHS Trust, Salford, UK
| | - Marek Malik
- National Heart and Lung Institute, Imperial College, London, UK
| | - Darren Green
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Renal Department, Salford Royal NHS Trust, Salford, UK
| | - Philip A Kalra
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Renal Department, Salford Royal NHS Trust, Salford, UK
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14
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Buerschaper L, Floege J, Mühlfeld A, Schlieper G. Evaluation of Electrocardiographic Parameters Predicting Cardiovascular Events in Patients with End-Stage Renal Disease before and after Transplantation. Kidney Blood Press Res 2019; 44:615-627. [PMID: 31242495 DOI: 10.1159/000500917] [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] [Received: 03/02/2019] [Accepted: 05/12/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Cardiovascular (CV) mortality represents the leading cause of death in patients with end-stage renal disease (ESRD). Efficient screening is required to detect CV disease at an early stage, but the best diagnostic work-up is uncertain. The aim of this study was to identify electrocardiographic parameters in dialysis patients associated with an increased frequency of CV events. METHODS A 12-lead electrocardiogram was performed in 139 patients who were on the renal transplant waiting list and who subsequently received a kidney transplant. CV events were analyzed from the day of listing for kidney transplantation until 1 year after renal transplantation. RESULTS Multivariate Cox regression analysis showed that an elevated T:R ratio in anterior and inferior leads was independently associated with CV events (T:R ratio of anterior leads hazard ratio [HR] 1.32 [95% CI 1.09-1.59; p = 0.004] and inferior leads HR 2.15 [95% CI 1.23-3.77; p = 0.008]). In particular, a T:R ratio in inferior leads exceeding 0.6 was associated with CV events in a Kaplan-Meier analysis. CONCLUSIONS Taken together, we found an increased T:R ratio in ESRD patients to be a predictive marker for CV events.
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Affiliation(s)
- Laura Buerschaper
- Department of Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Aachen, Germany,
| | - Jürgen Floege
- Department of Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Aachen, Germany
| | - Anja Mühlfeld
- Department of Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Aachen, Germany
| | - Georg Schlieper
- Department of Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Aachen, Germany.,Zentrum für Nieren-, Hochdruck- und Stoffwechselerkrankungen, Hannover, Germany
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15
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Paajanen H, Helanterä I, Kaartinen K, Nikus K, Eskola M, Groop PH, Koskinen P. Electrocardiographic changes before and after successful kidney transplantation and associations with cardiovascular and mortality outcomes. Clin Transplant 2018; 32:e13242. [PMID: 29573467 DOI: 10.1111/ctr.13242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Electrocardiographic (ECG) changes before and after kidney transplantation are not well-defined. Our aim was to describe the evolution of ECG in patients on dialysis before and after successful kidney transplantation and to explore the association between ECG findings and major cardiovascular (CV) events and mortality after kidney transplantation. PATIENTS AND METHODS Electrocardiographics were collected retrospectively 3 times: at entry to the transplantation waiting list, at transplantation, and 1 year after the transplantation from 212 kidney transplantation recipients. Altogether 19 ECG variables were analyzed. RESULTS Left ventricular hypertrophy was present in 10.2% by the Cornell voltage-duration product criteria and 10.7% by the Sokolow-Lyon voltage criteria before kidney transplantation. The presence of ST depression (OR 3.12, 95% CI 1.12 -8.7 and P = .03) at entry to the waiting list and Q wave at the time of transplantation (OR 3.28, 95% CI 1.06-10.10 and P = .04) were both independently associated with major CV events after the transplantation. In addition, the presence of Q wave at entry to the waiting list was a risk factor of premature death after the transplantation (OR 2.92, 95% CI 1.06-8.05 and P = .04). DISCUSSION Careful analysis of the ECG before transplantation can be used to estimate cardiovascular events and mortality risk after kidney transplantation.
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Affiliation(s)
- Hanna Paajanen
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum, Helsinki, Finland.,Diabetes and Obesity Research Program, Research Program's Unit, University of Helsinki, Helsinki, Finland
| | - Ilkka Helanterä
- Abdominal Center Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kati Kaartinen
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kjell Nikus
- Heart Center, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Markku Eskola
- Heart Center, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Per-Henrik Groop
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum, Helsinki, Finland.,Diabetes and Obesity Research Program, Research Program's Unit, University of Helsinki, Helsinki, Finland.,Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Petri Koskinen
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
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16
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The Pros and Cons of Preserving a Functioning Arteriovenous Fistula after Kidney Transplantation. J Vasc Access 2016; 17 Suppl 1:S16-22. [DOI: 10.5301/jva.5000525] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2015] [Indexed: 12/21/2022] Open
Abstract
The autologous arteriovenous fistula (AVF) for hemodialysis burdens the cardiovascular system with increased cardiac output and pulmonary artery pressure, increasing cardiovascular risk. This article reviews literature on the benefits and drawbacks of a functioning AVF after kidney transplantation and discusses the cardiovascular effects of AVF closure. Several cohort studies demonstrate a significant cardiac burden of an AVF and improvement of cardiac dimensions after AVF ligation. However, no randomized trials have been conducted on routine AVF closure after successful kidney transplantation. Therefore, clinical trials are warranted to evaluate whether the cardiovascular benefits of routine AVF closure outweigh the potential harm for patients after successful kidney transplantation.
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17
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Han JH, Han JS, Kim EJ, Doh FM, Koo HM, Kim CH, Lee MJ, Oh HJ, Park JT, Han SH, Ryu DR, Yoo TH, Kang SW. Diastolic dysfunction is an independent predictor of cardiovascular events in incident dialysis patients with preserved systolic function. PLoS One 2015; 10:e0118694. [PMID: 25739020 PMCID: PMC4349827 DOI: 10.1371/journal.pone.0118694] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 01/23/2015] [Indexed: 01/20/2023] Open
Abstract
Background Diastolic heart failure (HF), the prevalence of which is gradually increasing, is associated with cardiovascular (CV) morbidity and mortality in the general population and, more specifically, in patients with end-stage renal disease (ESRD). However, the impact of diastolic dysfunction on CV outcomes has not been studied in incident dialysis patients with preserved systolic function. Methods This prospective observational cohort study investigates the clinical consequence of diastolic dysfunction and the predictive power of diastolic echocardiographic parameters for CV events in 194 incident ESRD patients with normal or near normal systolic function, who started dialysis between July 2008 and August 2012. Results During a mean follow-up duration of 27.2 months, 57 patients (29.4%) experienced CV events. Compared to the CV event-free group, patients with CV events had a significantly higher left ventricular (LV) mass index, ratio of early mitral flow velocity (E) to early mitral annulus velocity (E’) (E/E’), LA volume index (LAVI), deceleration time, and right ventricular systolic pressure, and a significantly lower LV ejection fraction and E’. In multivariate Cox proportional hazard analysis, E/E’>15 and LAVI>32 mL/m2 significantly predicted CV events (E/E’>15: hazard ratio [HR] = 5.40, 95% confidence interval [CI] = 2.73–10.70, P< .001; LAVI>32 mL/m2: HR = 5.56, 95% CI = 2.28–13.59, P< .001]. Kaplan-Meier analysis revealed that patients with both E/E’>15 and LAVI>32mL/m2 had the worst CV outcomes. Conclusion An increase in E/E’ or LAVI is a significant risk factor for CV events in incident dialysis patients with preserved LV systolic function.
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Affiliation(s)
- Jae Hyun Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Suk Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Jin Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Fa Mee Doh
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyang Mo Koo
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Chan Ho Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Jung Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Jung Oh
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Tak Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Ryeol Ryu
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Severance Biomedical Science Institute, Brain Korea 21 PLUS project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
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18
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Oh HJ, Lee MJ, Lee HS, Park JT, Han SH, Yoo TH, Kim YL, Kim YS, Yang CW, Kim NH, Kang SW. NT-proBNP: is it a more significant risk factor for mortality than troponin T in incident hemodialysis patients? Medicine (Baltimore) 2014; 93:e241. [PMID: 25501091 PMCID: PMC4602775 DOI: 10.1097/md.0000000000000241] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Numerous studies have demonstrated that cardiac biomarkers are significant predictors of cardiovascular (CV) and all-cause mortality in ESRD patients, but most of the studies were retrospective or included small numbers of patients, only prevalent dialysis patients, or measured 1 or 2 biomarkers. This study was to analyze the association between 3 cardiac biomarkers and mortality in incident HD patients. A prospective cohort of 864 incident HD patients was followed for 30 months. Based on the median values of baseline NT-proBNP, cTnT, and hsCRP, the patients were divided into "high" and "low" groups, and CV and all-cause mortality were compared between each group. Additionally, time-dependent ROC curves were constructed, and the NRI and IDI of the models with various biomarkers were calculated. The CV survival rates were significantly lower in the "high" NT-proBNP and cTnT groups compared to the corresponding "low" groups, while there was no significant difference in CV survival rate between the 2 hsCRP groups. However, all-cause mortality rates were significantly higher in all 3 "high" groups compared to each lower group. In multivariate analyses, only Ln NT-proBNP was found to be an independent predictor of mortality. Moreover, NT-proBNP was a more prognostic marker for mortality compared to cTnT. In conclusion, NT-proBNP is the biomarker that results in the most added prognostic value on top of traditional risk factors for CV and all-cause mortality in incident HD patients.
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Affiliation(s)
- Hyung Jung Oh
- From the Department of Internal Medicine, College of Medicine, Brain Korea 21 for Medical Science, Severance Biomedical Science Institute, Yonsei University, Seoul, Korea (HJO, MJL, JTP, SHH, T-HY, S-WK); Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea (Y-LK); Department of Internal Medicine, Seoul National University of Medicine, Seoul, Korea (YSK); Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, Seoul, Korea (CWY); Department of Medicine, Chonnam National University Medical School, Gwangju, Korea (N-HK); and Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea (HSL)
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19
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Abstract
PURPOSE OF REVIEW Left ventricular hypertrophy (LVH) is common in end-stage renal disease (ESRD) and has been advocated as a therapeutic target. We review the considerations for targeting LVH as a modifiable risk factor in ESRD. RECENT FINDINGS Pathologic myocardial changes underlying LVH provide an ideal substrate for the spread of arrhythmia and may be key contributors to the occurrence of sudden death in ESRD. LVH is present in 68-89% of incident hemodialysis patients and is frequently progressive, although regression is observed in a minority of patients. Higher degrees of baseline LVH, as well as greater increases in left ventricular mass index over time, are associated with decreased survival, but whether these associations are causal remains uncertain. Several interventions, including angiotensin blockade and frequent dialysis, can reduce the left ventricular mass index, but whether this is associated with improved survival has not been definitively demonstrated. SUMMARY LVH is a highly prevalent and reversible risk factor, which holds promise as a novel therapeutic target in ESRD. Interventional trials are needed to provide additional evidence that LVH regression improves survival before prevention and reversal of LVH can be definitively adopted as a therapeutic paradigm in ESRD.
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MESH Headings
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Disease Progression
- Humans
- Hypertrophy, Left Ventricular/diagnosis
- Hypertrophy, Left Ventricular/etiology
- Hypertrophy, Left Ventricular/mortality
- Hypertrophy, Left Ventricular/therapy
- Kidney Failure, Chronic/complications
- Kidney Failure, Chronic/diagnosis
- Kidney Failure, Chronic/mortality
- Kidney Failure, Chronic/therapy
- Prevalence
- Prognosis
- Risk Assessment
- Risk Factors
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Affiliation(s)
- David Charytan
- Renal Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Cordeiro AC, Moraes AA, Cerutti V, França F, Quiroga B, Amodeo C, Picotti JC, Dutra LV, Rodrigues GD, Amparo FC, Lindholm B, Carrero JJ. Clinical determinants and prognostic significance of the electrocardiographic strain pattern in chronic kidney disease patients. ACTA ACUST UNITED AC 2014; 8:312-20. [DOI: 10.1016/j.jash.2014.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 02/21/2014] [Accepted: 02/23/2014] [Indexed: 12/12/2022]
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21
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Reliability of electrocardiographic surrogates of left ventricular mass in patients with chronic kidney disease. J Hypertens 2014; 32:439-45. [DOI: 10.1097/hjh.0000000000000026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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22
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Park JT, Oh HJ, Kang SW. Cardiovascular disease in end-stage renal disease. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2013. [DOI: 10.5124/jkma.2013.56.7.576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jung Tak Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Jung Oh
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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